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HomeMy WebLinkAboutMiscellaneous - 105 LEANNE DRIVE 4/30/2018Claim # Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner 0. Board of Health or Inspector of Buildings Board of Selectmen Town Hall Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: Mamta Lohia Property address: 105 Leanne Dr. North Andover, MA 01845 Policy #: 3008489 Loss of: 2016/02/09 File or Claim No. AD 1962 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. _Gen. _Laws, _Chapter _143, Section 6 to be applicable. If any notice under Mass_ Gen _Laws,_Ch _139—Sec.-3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by first class mail. 02-10-16 Signature a d date DelleChiaie, Pamela From: Sent: To: Subject: THANKS PAM! Dana S. Cohen, Esq. Cohen Law Offices, P.C. 873 Turnpike Street North Andover, MA 01845 978-975-6000 978-975-6008 (fax) 978-604-0967 (cell) F Cohenlawpc@aol.com Monday, May 23, 2011 11:48 AM DelleChiaie, Pamela Re: I.R. - 105 Leanne Drive To ensure compliance with the requirements imposed on us by IRS Circular 230, we inform you that any tax advice contained in this communication (including any attachments) is not intended to and cannot be used for the purpose of. (►) avoiding tax -related penalties under the Internal Revenue Code, or (ii) promoting, marketing or recommending to another party any tax -related matter(s) addressed herein. This transmission is intended solely for the recipient to whom it is addressed and the information contained in this message is legally privileged and confidential information. If the reader of this message is not the designated recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this message in error, please notify our office by telephone at (978) 975-6000 and destroy all copies of this message and any file attachments. Thank you. In a message dated 5/23/2011 11:42:05 A.M. Eastern Daylight Time, pdellech(cD-townofnorthandover.com writes: http://csc-ma. us/PROPAPP/display. do?linkld=1702149&town=NandoverPubAcc Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://Www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. North Andover Board of Assessors Public Access t NO DTM 7 i i� ,sswcHuse'� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 —41property Record Card n.._..,.i m .w�nin�� r nn�c noon n �v.�nt t !"',,,,,,,,,,,,;r.. • N..,-th A„a..<.o, Location: 105 LEANNE DRIVE Owner Name: BINGHAM INVESTMENT TRUST BINGHAM, W.SCOTT &KERRY A. Owner Address: 105 LEANNE DRIVE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 8 - 8 Land Area: 0.95 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3081 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 652,300 679,300 Building Value: 423,300 450,300 Land Value: 229,000 229,000 Market and Value: 229,000 Chapter Land Value: http://csc-ma.us/PROPA PP/display.do?linkId=1702149&town=NandoverPubAcc 5/23/2011, —I m m E E O U -1 .I 0 o F- CL O N c O L}L �'O W i ~ o U L-0-0 � 0O 0 W e C? 10 GO 0 Q W W� z J W z ep U M J r t F- C r N z a v p W 2 of L] m W U � O N O U M CL W > 'o z o Q N J O> Q U i tL CD Z C,- Q proaQGO a <6 O ai ai a) -a U .c a= .. co aoH>0 �o o a�a�m0 �ommm (nmmmC� 0 e0 •' N 00 O 0 O H M O Y is m Q J m O � Q C UULL-1 > N Z N m o 0 O O D F- F- F- CL 00 Q z QLL —I m m E E O U -1 .I 0 o z o0 Q tC � 0O 0 W e C? HY < z c Q LL, Z W� M C J W �0 �C ep U W 0. 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Y U) co W wLij 2LL 2LiliU IL V) 0 24 D Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ....... ................... .............................. S -e has permission to perform ............................. Z� ........................................ wiring in the building of ..... at /e� ...... ... ............ ................. I N irth Andover; Mass. Fee 7 .......... Lic. No x��-P--7 ....... ........ ECTRICAL IN CT Check Commonwealth of Massachusetts Official Use Only Department of mire Services Permit No. �. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM All work to be perfonned in accordance with the Massachusetts ElectricallCELECTRICAL 527 CMR 12 00 WORK (PLEASE PMT flVAW OR TYPEALL INFORMATIO / City or Town of: NORTH ANDOVER � Date: By this application the undersign—ed To the Inspector of Wires: gives notice of his or her intention to perfoimn the electrical work described below. Location (Street ��7�w �U � Owner or Tenant Owner's Address Telephone No. Is this permit in conjunc ' with a building permit? Yes Purpose of Building s No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps _ / _Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps ._._ � _Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: 1 letion of the followin table may be waived by the Ins ector of Wires. No. of Recessed Luminaires j � No. of Ceil: Sus No. of p. (Paddle) Fans Total No. of Luminaire Outlets Transformers KVA No. of Hot Tubs Generator;: KVA No. of Luminaires Swimming Pool Above❑ In- o. o mergency tg g -- No. of Receptacle Outlets d• nd. Batt e Units ��J No. of Oil Burners FL>aF ALARMS No. - ALARMS -of Zones No, of Switches No. of Gas Burners No. of Detection and No. of Ranges Initiatin Devices . No. of Air Cond. Total No. of Waste Disposers HeaTons No. of Alerting Devices t Pump Number Tons KW _ No. of I! ed Totals: _._......__.__. __....__._..... No. of DishwashersDetection/Alertin Devices Space/Area Heating KW Local ❑ Municipal No. of Dryers Heating Appfiances fiances ' Connection El Other KW Security Systems: No. of Water Heaters KW o.. of No. of � No. of Devices or Equivalent � Data Wirin Si s Ballasts. No. of Devices or _Equivalent i No. Hydromassage Bathtubs No. of Motors Telecommunications Wiring: f , Total HP OTHER. No, of Devices or E uivalent Estimated Value of,E] trical Work: Attach additional detail if desired, or as required by the Inspector of Wires. Work to Start: ( (When required by municipal policy.) L �t Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER EI certify, p ❑.(Specify:) . under the ns a:'fp d pet(alties of perju that the information on this application is true and complete FIRM NAME: s-u�s f 12C t y`C U.L Licensee: 1- LIC. NO.: Signature I` (If applicable, en�er " t " in the lice umber line.) LIC. NO.: 33 Z . Address: Bus. Tel. No.: ?� 34 *Per M.G.L c 147, s 57-61, se nu ty work requires es D 7 Department of Public Safety "S" License: �� Tel. No.: OWNER'S INSURANCE WAIVER; I am aware that the Licensee does not have the liabili Lic. No. required by law. By my signature below, I hereby waive this requirement. I am the (check one) E-1owner ance coverage o❑ o owner's agent. Owner/Agent Signature Telephone No. ELECTRICAL PERM(T NO. INSPECTION REPORT: ELECTRICAL,INSPECTOR -DOUG SMALL r v v v.u. -LL\ V.0 . 1.11V.LV. ID x aneu — Inspectors' comments: I (Inspectors' Signature - no t2.FINAL 7NSPE N, — [ Failed —ors' comments: (Inspectors' Signature - no i 3. UNDER GROUND INSPECTION: Passed — [ ] Failed Inspectors' comments: L k LU0 jJMLUIS- oiguature - no li 4- INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: Passed — [ ] Failed — [ Inspectors' comments: (Iuspectors' Signature - no ini 5. INSPECTION - OTHER: Passed — [ 1 Failed — [ ] Inspectors' comments: - no initials) fs) > Date ( Date ispection required (550.001.. r 7 NAME: Date Date Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A REINSPECTION OF $50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinvestigations ..600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Iiuffders/Contractors/Electricians/Plumbers Applicant Information Please Print L�.e ibl� Dame (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box., LEI ❑ I am a employer with -Part-time).* 4. ❑ I am a general contractor and I employees (full and/or 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. I ship and have no employees These subcontractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required..] t employees. [N`To -,iiorkers' comp. insurance required.] ;Any a-YpirCant :hit checks box'#, 1 must also En L` St the seCtton below sno!? nb :herr rC i `Fs' Cmm� . -ins tg Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ other omeow ners who subnut this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation information. insurance for my employees Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: 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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sip -nature: Date.: 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 6. Other Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector Contact Person: Phone #: Date .. ..: ........ J .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING �1 i This certifies that . C. -,'�-1c �'?.......3 . -- -G 1-- .....,.. J .� Co has permission to perform.., ................................................. wiring in the building of ......x.! f, ...................................... at ...k.........t--:,!`A-r :..:::,:.r.-_�..........:.:!. ........ ,North Andover, Mass. 7. Lic. No.�� � �� .......... Fee .................... ELECTRIC INSPECTOR Check # i i N Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date. l �e� City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) WS S LP-" r1R— Owner or Tenant vl C, V\jr— ins Owner's Address Is this permit in conjunction with a building permit? Yes [�' No ❑ Telephone No. 112-4 (� L(31 (Check Appropriate Box) Purpose of Building i�f S��-� Utility Authorization No. Existing Service New Service Amps / Volts Amps / Volts Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Locatt'on and Nature of Proposed Electrical Work: 6 y � VeM�tre�►� 4 r6 vel N00W,—jV �, Completion of the ollowin table may be waived b the In ector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans s Total of Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above rnd. *h nd. ` r o. o cy ig ng Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection andInitiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number I Tons KW No. of Self -Contained Detection/Alerting Devices of Dishwashers Space/Area Heating KW Municipal ❑OtherNo. Local ❑ Connection No. of Dryers �'Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Kms, Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: 111 `{DOi—,6 \ V -ktt ke-� 1-0 A- l -cv ((- La S) Attach additional detail if desired, or as required by tate Inspector of -Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: (j \0 1 (3 C( Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Er BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and enaldes of perjury, that the information on this application is true and complete. FIRM NAME: Q wty' ��� S F je.Jy L- L.L .(._ LIC. NO.: (SI -1 Licensee: . �CA ,N�ytilaX' Signature LIC. NO.: (If applicable, enter "exem te number lLILXYA-ine) Bus. Tel. No.. ifol� N -Address: �� Zx14 `t39� Alt. Tel. No.. *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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ � D2 4:�,j &k -C_ 9- 2 9-OS r 0 .r CA r.f Y j ,4r J f iM1 .ii �lr'" f T, r The Common wealth of Massachuset& Department of Industria! Accidents Office of Investigations 600 Washing ton Street Boston, MA 02111 www nrassgov/dia Workers' Compensation Inshr-annp AMA -44 - Are you A. 44- Areyou an employer? Check the appropriate box: ' 1.1.E I am a employer with O 4. ❑ 1 am a general contractor and I . Tyles of project (required): employees (full and/or part-time).* . 2. ❑ I have hired the sub -contactors 6. ❑ New construction . am .a sole proprietor. or partner- ship and have employees listed on the attached sheet 3 These sub contractors have 7. ❑ Remodeling a working forme .in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its .. g' ❑ Demolition' 9 ❑ Building addition 3. �]reginred ] I am a homeowner doing ofiie s have exercised their 1Q•❑ Electrical repairs oradditions all work myself. [No•workin' comp, right of exemption per MGL c...152, § I (4),'and we have no 11.❑ Plumbing repairs or additions insurance required.] t •em IoYe= [No worcers 12.0 Roof repairs "Any epplicafiw cheeks bW * l must also fill comp. insurance required..] I3• er `�-4. SYo �ktrl V out the section below iihuying their worltera' boinpensation t Homeowners who submit this afit svit inditgting'tthe sec doing all work end then h orkc` side contraction ;Contractors that chcok this box Policy P cY information, must it submit a new affidavit indicatting such. must attached an oddity asl shit showing thean inure of the su&c=Mm1 os and their workern' comp. Policy in%tmetion. 1 am an employer that.isproviang:worken' informadom Insurance comperrsadoa insurance or f MY MV10yelm Below is.the'poficy med job site Company Name:_ Policy # or Self -ins. Lic. #: Expiration Date: D l Job Site Address:_ ©� ��Otyl h� 'Dr�� c,r City/State/Zip: Iv u 1 Attach a copy of the .workers' compensation policy decla rationshowing Pal;'e ( b the policy number and expira6oa date}. Faiiure to secure coverage as required under Section 25A of MGL e. 152 can lead to {ire imposition of criminal penalties of a Of up to $25Q.00 a fine up to $1,500,00 an one-year imprieaform of as well es civil penalties in the foof a STOP WORK ORDER and a fine day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby c fy under he pains and penalties o e 'u that the in ormadan ro IP rl r3' f p vcded ,akp is and correct Si tore: yy Date I Phone 4: Ofj9Clad =e only. Do not write in this area, to be completed by city or town. afftciaL City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2 Building Department 3. City/Town Clerk 4. Elec 6. Other trics[ Inspector 5. Plumbing Inspec{ar �I Contact Person: Phone #-. Information and Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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, assndiation, corporation or other legal entity, or any twa ormore ofthe%regoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or histee•of an individual, partnership, association or other legal entity, employing employe -.s. 'Howeverthe 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, 925C(6) also states that "everystate or local liieemsing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct bniidings in the commonwealth for any applicant who has not produced acceptable evideuce.of compliance with the insurance coverage required." Additionally, MGL chapter 152, S25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work tmtH 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 compietaiy, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) grad phone number(s) along with their certificsate(s)' of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no. employees otherthan the members or partners, are not required to cavy workers' compensation insurance. if an LLC. or LLP does have empioyees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also 'be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the armit 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 Departrneant at the numberlisted below. Self-insured companies should enterth self-insurance-.licemse number on the•appropriate.line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes 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 permitAicense applications in any given year, need only submit one affidavit indicating -current policy 'information (if necessary) and under "Job Site Address" the applicant sho write "all locations in (city or town)." A copy of -fire 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 bum leaves etc.) said person. is NOT required to complete this affidavit The Office of InvestilKations would Iike to thank you in advance for your cooperation and should you have any questions, pie= do not hesitate to give us a call., The Depamnent's address, telephone and fax number. The Commonwealth of Massachusetts Departnient of Indust>:ial Accidents Offim of Iavestidations 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-115 Fax 4 617-727-774 www.mass.gov/dia Location `�.� �` fG �+�Uyc Dle No. rJ� Date�� MQ*,rN O:t.o TOWN OF NORTH ANDOVER :•,ti0 i?.., JL o� d Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ � p d Other Permit Fee $ TOTAL $ A 0 Check # Building Inspector • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DExMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: Al� SIGNATURE: Building Commissioner/125 tb{f Buildings Date ` SECTION 1 -SITE INFORMATION 1.1 Property Address: - 1.2 Assessors Map and Parcel Number: /4��L e,�'�°� , ' `c 77 g CU TS V 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 R red Provided Reqwred Provided 7Q. 371 , o. '70, .30, �c• 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 S Overage Disposal System: Public V Private ❑ Zone Outside Flood Zone kl Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 4661-k .5'"3 Name t) Address for Service : I 6. F6 Signature elephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licens onstruction Supervisor: Not Applicable ❑ V/ S % "o (C e % U Licensed onstrugion Supervisor: Number isLicense Address Expiration Date Si atu ` Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (AG.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 bijilding permit. Signed affidavit Attached Yes ...... X No ....... ❑ SECTION 5 Description of Pioposed Work check au a Ucable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: C4f g•��A1t e' I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE`ONLY 41 1. Building �D. d C7 (j (a) BuildingPermit Fee Multiplier l 2 Electrical J0. C! D (b) Estimated Total Cost of Construction U / �� 3 Plumbing /0 000 Building Permit fee (a) X (b) 7 � 4 Mechanical HVAC -0 0 0 5 Fire Protection DIMENSIONS OF GIRDERS 6 Total 1+2+3+4+5 p. D (j 0 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 Hereby authorize�41 5 /o f h e f e!!�,oqcryil .S to act on My bell;in all matters r ''1i�/�_owork authorized by this building permit application. �I7�v�r/1/ 11�'17 /6O Signature OvMer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ��'� S �• P �lEl / Ce 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 j Print Name of ,/,,Z 7 o D Date NO. OF STORIES SIZE BASEMENT OR SLAB e.9 S< ^+ -e v / SIZE OF FLOOR TINIBERS 1 2,k i G 2 ND 2,r i o 3 RD 7M SPAN DIMENSIONS OF SILLS •� (� DIN ENSIONS OF POSTS // S DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION %' /D " THICKNESS -'0 " SIZE OF FOOTING /0 X 30 MATERIAL OF CHDANEY C1 D O O IS BUILDING ON SOLID OR FILLED LAND S P A IS BUILDING CONNECTED TO NATURAL GAS LINE iir 5 Build inq Value Calculation -for Propertv at..... LOT# 6 1 Room Brkfstnook Dining Room Family Room study/office Living room Garage Entry 2nd floor foyer/sitting Sunroom mudroom Walkin closet Basement Finished Balcony Screened Porch laundry Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4. Lav / Bar Bathroom 1 1/2 Bath Bathroom 2 Bathroom Length Width 24 14 8 8 " 14 14 26 16 10 12 18 14 24 26 15 13 8 12 12 7.5 10 6 18 16 18 14 15 14 14 14 10 8 6.75 5.5 13 10 Sq.Ft. Cost per Sq.Ft. 336.00 65 $ 64.00 65 $ 196.00 65 $ 416.00 65 $ 120.00 65 $ 252.00 65 $ 624.00 35 $ 195.00 65 $ 96.00 65 $ - 65 $ - 65 $ 90.00 65 $ 65 $ - 65 $ - 35 $ 60.00 65 $ 288.00 65 $ 252.00 65 $ 210.00 65 $ 196.00 65 $ - 65 $ 80.00 65 $ 37.13 65 $ 130.00 65 $ - 65 $ - 65 $ Total Cost 21,840.00 4,160.00 12,740.00 27,040.00 7,800.00 16,380.00 21,840.00 12,675.00 6,240.00 5,850.00 3,900.00 18,720.00 16,380.00 13,650.00 12,740.00 5,200.00 2,413.13 8,450.00 G14 FORM - U - LOT REL" EASE FORM INSTRUCTIONS: This form is used to verify that allnecessary 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 A�y /��orn c 5 PHONE � g� - G �6 g ASSESSORS MAP NUMBER 7 LOT NUMBER SUBDIVISION �f 9. 7e S LOT 1vUMBER STREET Ll A/ /VC STREET NUMBER OFFICIAL USE ONLY COMMENDATIONS OF TOWN AGENTS ■ ■..4^•■��.■..■.■■.....WOMEN ........t...........■...s■ ■........■ . S DATE APPROVED G ( O t� CONSERVATION ADMINISTRATOR !,� DATE 1. REJECTED CONO&-NTS 0^S r -to l+.i.� COMMENTS DATE APPROVED�1 DATE REJECTED DATE APPROVED FOOD INSPECTORHEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR'- HEALTH DATE REJECTED COMMENTS DATE REJECTED CONBAEN"IS RECEIVED BY BUILDING INSPECTOR DATE GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information requested below. �iO�Y�Ci/ I ✓.v/E' / Y e �r'97//f/ !ic' / Permit Applicant Property address Map / Parcel q7a 7 k Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 %permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNIN ELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILD P IS ALLOWED AN EXE ION AS CITED ABOVE. FUR R I RSTAND THAT THE S EING] AL OF MISLEADING OR INACCURATE INFORMATION OR THE CHE G Of A OVE EXEMPTI WH OES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NO IS GR FUSAL BY DEPARTMENT TO ISSUE A BUILDING RMIY. �j 7/0 Q APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION IIIC l_/Ulll/IIVIIVVGCl/UI UI /VICIOOGFUIIUJC(LJ Department of Industrial Accidents Office of Iniiostigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Location: C;fi{ Phone �e� - �% %0 % 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. Y f mmnanv nAr17P_' Address City: v.,v9O v P Phone #: f� {l ,� 4/- 7d Insurance Co G s re"� C + s� /" �� PolicyC Company name: -- - Address City: Phone # Insurance Co Policy # 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' impns ent as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. 1 understand that a C0 " 7 i'statement may be forwarded to tt Office of Investigations of the DIA for coverage verification. I do herby certify y6der theins arr'pe falties of perjury 1h,0 �0�1formation provided above is true and correct Signature i - — vale i i Print name ( s p `< < �S Phone Official use only do not write in this area to be completed by city or town official' E Building Dept ❑Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person:_ Phone #: Health Department 0 Other FORM WORKMAN'S COMPENSATION i ? 4 6- 1 `b,,' . I-' . i s ' 1 6 7' �4 S21 04'05.. r E 47.67' O- ' LEANW .DRIVE t = 1 G c �e � 9,,� 23.96' 34185_ S.F. 0.78 Ac. -L20.80- W -5.,34'20 "E _89.54• �; / �� �,, 14.5 r `�_� S25'55'S0"E 84,15. — — =,� — '25'10 � 3�E 1— CLIT 78.18' �._ `ASEM ENT_ v2-5*55 '5o'W is 85 LOT 8 41546 S.F. 0.95 .Ac. S2,51 _ -_ 33_92' _ °v5� 'Og"E - 42-52- ` ^, N22 50'09,- ti2Y34'20"W 48 55 N/F DRAPER BK 2819 PG 1, B� Town of lNorth Andover Building Department s'� y �- ~' Y° �0 0 27 Charles Street � North Andover, Massachusetts 01845 _% _ (978) 688-9545 Fax. (978) 688-9542 Teo 6 "``�,t5 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit•# - the debris resulting front the work shali.be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sI50a: The debris will be disposed of in /at: Facility location i re 0 p ica Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 1000�oo42_ MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software -Version -2.01 Release 2 CITY: North -Andover STATE: Massachusetts HDD: 6322 - CONSTRUCTION TYPE: 1 HEATING. SYSTEM -TYPE: - DATE: 11-9-2000 TITLE: LEANNE DRIVE or � Family, Detached Other (Non -Electric Resistance) PROJECT INFORMATION: BROOKVIEW COUNTRY -HOMES INC PO BOX 531 N ANDOVER MA COMPANY INFORMATION: J&J HEATING- & AIR- COND- 17 ARLINGTON ST DRACUT MA COMPLIANCE: PASSES Required UA — 56 -3 - Your Home = 515 i i Permit # Checked by -/Date i Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value --------------------------------------------------------------------------- CEILINGS 1536 3Q-.0 Q.0 WALLS: Wood Frame, lfi" O.C. 2450 33.0 0.0 2 GLAZING: Windows. or Doors- 383 0-.400 1 GLAZING: Windows or Doors 42 0.460 DOORS 39 0.400. FLOORS: Over Unconditioned Space 153b 1.9.0 -0.0 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------. --------------------------------r---------------------------- 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 fort s u ding, and the cooling load if appropriate, has been -determined sin applicable - S ndard Design_ Conditions found. in the Code. The AC i ment selected o eat or cool the building shall be -no greaY10 th 1 5$- the de oad as specified in Sections 780CMR a .9;�J e _ l l Builder/Designe --" --J Date Massachusetts Energy Code MAScheck .Software. Version 2..01 Release 2 LEANNE DRIVE DATE: 11-9-2000 Bldg. Dept. Use C-EII,INGS.:- i _ R-30- Comments/Location 30- Comments/Location WALLS.: - 1. Wood .Frame, 1fi" O.C. , R -13- -Comments /Location WINDOWS ANIS- GLASS- DOORS.: - 1. U-value:...0.4- For window a- without -labeled.: -U- values,- describe. features: # Panes Frame Type., Thermal -Break? [-] Yes [ j No Comments/Locavion. 2. U-value:•0.46 For windows without labeled -U -values, describe features.: # Pa -nes Frame Type- Thermal Break? [ j Yes [ ] No -Comments-/Location- DOORS Eomments-/Locati on - DOORS .- 1. U -value : • 0-. 4 -Comments-/Location- FLOORS:- 1. Over Unconditioned Space -,-R-19 Commnents /Location HVAC EQUIPMENT: 1. Furnace, . 92.b0 AFUE -or higher Make- and-" Model Number 2. Air•Conditioner, 10.0 -SEER AIR LEAKAGE-* Joints,, 'penetrations-,- and all other such- openings. in- the building env -elope that are sources- of air :leakage_, must be -sealed- -When. installed -in the building envelope,- recessed lighting fixtures shall. meet one et the following. rern,;-ramentG.* 1. Type.IC rated, manufactured with no penetrations-between.the- inside- of the recessed . fixture, -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 253, 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 a$ 75 PA -or 1.57 lbs/ft2 pressure difference and shall -be labeled. VAPOR RETARDER: Required on the wa-r-m-in-winter side- of all -non-vented framed ceilings, -.walls., and floors. MATERIALS.IDENTIFICATIONt '' Materials and equipment must be identified -so that -compliance can be determined. Manufacturer manuals -for all installed heating and coaling equipment -and service water heating equipment must be provided.- Insulation R -values., glazing U -values, and heating equipment efficiency must be clearly marked on the building pians or.specifications. DUCT INSULATION: Ducts shall -be insulated per Table J4.4.7.1. DUCT CONSTRUCTION- - All accessible joints, seams,. and connections of supply and return ductwork located outside. conditionedspace, including stud bays or joist cavities/ -spaces -used -to transport air, shall be sealed using mastic, and .€ibrous backing -gape installed according -to the manufacturer's ins.tallation_instructions. Mesh -tape may be omitted where gaps are less than.11g inch. Duct.tape is -not permitted.- The HVAC system.must provide a means for balancing air and water systems. TEMPERATURE, CONTROLS -- Thermostats are required€or each separate HVAC.system. A manual or automatic means.to-partially restrict or shut off the heating andlor cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: - Rated -output -capacity of theheating/cooling system.is not greater than 125% of the design-Joad as -specified In Sections-760CMR 1310 -and J4.4. SWIMMING POOLS -:- All heated swimmingpool% must.have require a cover unless_ over 20L% of non-depletable sources. Pool pumps HVAC PIPING INSLiLATIOR'-. HVAC.piping conveying fluids above. below 55 F must be insulated to the HEATING. SYSTEMS Low pressure/temp Low temperature Steam condensat�a COOLING- SYSTEMS -:- Chilled water or refrigerant anon/off heater switch.and the.. heatingenergy is from require a time clock. 120.F or chilled fluids. following levels (in.): CIRCULATING HOT'WATER SYSTEMS: PIPE SIZES (in.) TEMP (F) 2" RUNOUTS 0-1" 1..25-2" 2.5-4 201-250 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 CIRCULATING HOT'WATER SYSTEMS: Insulate circulating hotwater pipes to the following levels (in.): ----NOTES TO FIELD (Building Department Use Only)----------------"-------- PIPE SIZES (in.). 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I®� %d W �v O � L o _ F3 > F W V O d z w m W$ v J.8 �IF o S� g� o `m� $ �� I v c m c W Z t ma W9�WVCE nw vuomEI g L .$ n cock mid W c yo � w O y� m�ii'°° E 82 E E to� C — im 0 W U p W 'E Q N c_ Z O o 6w m®map £ { ti a0I.S >O> E O&E C j E U m� w 9 9 O 4� L��a Si m ui N� W =•o=I[7 o.0 �a$mLLNr_ 3mwQ3w��3 N ED o _W W E m of v��LLc W'n�C�o > L L_ 7 Z O U 'W V ) ^_U F—I i u gill Z O U 'W V ) ^_U F—I Location No Date TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ ,ssACHUSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # '1 (o 0 17 15144 ,w/t (ca,— Building Inspector S70'32'41"W 35014' 207.12' fid v3 -e i jf9 vim- "o z l� 129. (s' ,. r R 0.95 Ac. LCITA t 1 36.2' 6x. Foundation I WT.F. Flev.=236.19 L i 3.0' 4A IV tie 1"OFgq 1NN to �Jn4 $TwHCPi M. _ um 9t It" r ,46* o I+�31�ra NTENDEG FOR ZONING PUR S ONLY. IT WAS PREPARED FROM EXISTING PLANS AND RECORDS w'rH THE STRUCTURES SHOWN LOCATED SY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION. l i �a S r k 1 57.2' t+ cra 4 I l l WE v4EREBY CERTIFY FHAT V& H41 EXAM&F.D' THE PREMISES AND THE DWELLING IS LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY *MEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M.A,/H.U.D: FLOOD INSURANCE RATE MAP, COMMUNITY PANEL NO.250098 0006 C DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. 0 l DERTIMED PLOT PLAN LOT 8 HERITAGE ESTATES NORTH ANDOVER, MASSACHUSETTS CAA" FOR BROOKVIEW COUNTRY HOMES, INC. P.O. Box 531 NORTH ANDOVER, MASSACHUSE'TT'S MARCHIONDA + ASSOC.,L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE ? STONEHAM. MA. 02180 (761) 438-6121 PATE: 10/31 SCALE: 1'm Oil' Date... .......... NORTH TOWN OF N�TH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . . has permission for gas,installation in the buildings of . .. �. .......................... . at ............ ............ I North Andover, Mass. Fee. ,.'4 .' Lic.:;. It ' A-7 *******,*** - GAS IN� E�gOR Check# 111t�& 64*10 s MASSACHUSETTS UNIFORMAPPUCATON FORPERMIT TODO GASFrrnNG (Type or print) Date s ` Z1✓ fi NORTH ANDOVER, MASSACHUSETTS Building Locations �� 1"AAA57 �� Permit # Amount Owner's Name ew Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or ty e) Check one: Certificate Installing Company Name Iii 13 ZL n11 1' \ s ❑ Corp. Address '5 ❑ Partner. %Y-1 & r—S' usmess a ep one 7 ,¢`/ l Finn/Co. Name of Licensed Plumber or Gas Fitter are -1 �V 1/ CJ`/ INSURANCE COVERAGE ° I have a current liability Insurance policy or it's substantial equivalent. es No ❑ If you have checked Les, ease ' dicate the type coverage by checking the appropriat x. Liability insurance polift Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and inst compliance with all pertinent provisions of the Massach (OFFICE USE ONLY) (or entered) in a e application a true and accurate to the "ed un r P it Issued application will be in ode ter 142 eneral Laws. Si a e of Licensed Pl4mber Or Gas Fitter ❑ Plumber / �? z G 1 ❑ Gas Fitter License NumDer Laster ❑ Journeyman x w w w w O U F x OE" W m F W W 0 a W d rn a4 d x a a w dF 0 v> �" O W > F wC. a z W W C7 W E.. w ..7 W z d w d z E" Q a rn d w z O O O z W O O vFi w x F de OG w > O w :C p ; A C7 U C4 > A w F O SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or ty e) Check one: Certificate Installing Company Name Iii 13 ZL n11 1' \ s ❑ Corp. Address '5 ❑ Partner. %Y-1 & r—S' usmess a ep one 7 ,¢`/ l Finn/Co. Name of Licensed Plumber or Gas Fitter are -1 �V 1/ CJ`/ INSURANCE COVERAGE ° I have a current liability Insurance policy or it's substantial equivalent. es No ❑ If you have checked Les, ease ' dicate the type coverage by checking the appropriat x. Liability insurance polift Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and inst compliance with all pertinent provisions of the Massach (OFFICE USE ONLY) (or entered) in a e application a true and accurate to the "ed un r P it Issued application will be in ode ter 142 eneral Laws. Si a e of Licensed Pl4mber Or Gas Fitter ❑ Plumber / �? z G 1 ❑ Gas Fitter License NumDer Laster ❑ Journeyman Date. Zt � ... //-P& .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform ...... .............. 7 ....................................................... wiring in the building of ...... - ...................................................... ..................... :�� ..... . N rth Andover, Mass. Fee.."/<.6 ............ Lic. No �qx�w ....... f ...................................................... Check # � (// - ELECTRICAL INSPECTOR 4- 7 6 J' THECOMMONWEALTHOFAlASSACHUSETTS Office Use only DEPART3IEVT0FPUX1CS4FEIY Permit No. L/7-!�3 BOARDOFFIREPREVEMONREGMHONS527CNIR12M 1 " e- Occupancy & Fees Checked � APPLICATIONFOR PERMIT TO PERFORMELECTERM2:00 WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) � Q � ��Q�^Ut 0, f-• J Owner or Tenant , - SCP lT1 tt�) t,_ Owner's Address �5 Is this permit in conjunction th a bu' ding permit: Yes E] No Purpose of Building�5 To the Inspector of Wire (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead Underground 1:3 No. of Meters New Service Amps / Volts Overhead Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t-4^( b No. of Lighting Outlets No. of Hot Tubs f No. of Transformers Total l KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ID pround No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets 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 t. Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Connections El No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• kMr•uloeCovrrage RUM" 10 theWWRmff11S of Mamdusetts GffXd1_aws Iba eaamaMtliabMlil lmirar=PblicyinchMdmgorilswbstm1Wequha1ai YES NO Ibaveahy imdvabdpcoofofsanetod eOf5ioe. YESLT � F)uuha ec rdodYFS pleas nka eche ofcovaageby checl�Mgthe box INSURANCE BOND r7 Wo(ktoSatt ' l�'D FIRMNAME OTEiER r-1 (P&as-Spo*) S 11 Pf y F*atioril)ate Esfiun kdValueofI!drJcalWotk $ kq)cctionDateRa gMestod -A -\ �Aej Rough Final r_ LkmseNo. AILTeL No. OWNER'SIINSURANCEWAIVER;IamawarethattheLic wdoesinothavetheinsmanoewvriageoritssubstantialequvalentasiegiiedbyNb%ad ts&lsGeneralLaws and that my signature on this p myd application v anus this mg mement. (Please check one) Owner Agent ©✓ Telephone No. PERMIT FEE signature o , wner or Agent Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit C Please Print LLC - Location: �A-_f City C - h M k Phone # I am a homeowner performing all work myself. MI am a sole proprietor and have no one working in any capacity I am an emp er providing workers' compensation for my employees working on this job. C ,cam Company name: Address_ t City 1 OA t� (� Phone .,�....,.,,.o r-.. (P,ArQj I wc" Policy# W C qqq g� 1 Compgny name: Address •-- Ci : Phone #: y Insurance Co Policy # 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' imprisonmentas welLas_civil.penattiesin.theiann-fa-STOP WORK ORDERand a fine -of .($1JDDM)arlay.againstmie� I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify under Moo ins res of perjury that the 1nfonWh0n provided above is true and correct Signature Date 1 t o 3 Print name c x Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensirm El Building Dept Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone # 0 Health Departmen, F1 Other N2 3 4 0 Date .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4— ............................ This certifies thai ................................. has permission to perform 1� ................................................................... 2 wiring in the building of .... ..................................... at,X-�}........... ............................ a .............. ........ ,North Andover, Mass. Fee. Lic. No . ............. ...... ......................... ELECrRICAL INSPEcrolt Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THECOWONWF.ALOffice Use only DEPARTAXWOFPUBMSAFM Pennit No. 2"�0 J BOARD 0FFIREPREVEM70NRWUT4TI0AN52701R12-M S��S Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 t �� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date tla, Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ®S LQa-v� V Q �l T ✓ e- Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) q Purpose of Building $ QMH Utility Authorization No.�� ` Existing Service Amps /�Volts Overhead Underground No. of Meters New Service qV'D— AmpsV-1-/ 2KO Volts Overhead Underground p®� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures r 1 ET) "( Swimming.Pool, Above Below Generators KVA ©ground ound No. of Receptacle Outlets / No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets a(9 L1 No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total C3� Tons No. of Detection and No. of Disposals 1 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 Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW t No. of No. of 1SSigns Bailasis No. Hydro Massage Tubs No. of Motors Total HP�N v f _ OTHER - - - - - Irt<xm=Cmwdge. Laws Itmea=utLiahylt' ua=Pbhyatdu&gCon# Caaagea'itssksWrtialegivdlat YES Ea NO Iha%eWxn&dmtidptodofswr1otheO ioeYES U NO If}ouha%edxdWYES,pleaseitdc&thetWof vw.W the box BOND OHiER y. 1 WotkiD&Evt Sigrte MdarSRMA FIRM NAME _ Mr 01hWxficnD*ReWcWd E4n*dvahtedE6ctW Wodc $ 'I bllt> Rotlgtl I FmW �-- Y C-1 _ Li=wNa t 1 l3 Signature Licamilb J3 2 R icirrcc TA Ain AA an Alt. TeLNo. OWNER'SMJRANCEWANFR;tanmmthattbeLioawnd Lam aodtivtmys uWcnftpami< nwaiwsdusaegm' emat (Please check one) Owner M Agent a Telephone No. PERMIT FEE $ W Date ./.1.: C'. ?-: ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...� has permission for gas installation .. tl G t '.:`........ in the buildings of ....................... at North Andover, Mass. Fee.Lic. No.A ....... .... ........ /GAS INSPECTOR Check # 3874 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO UO GASFITT!NG (Pthi► or Type) I; Date — lit ldew Dumlmg Permit # •�� - - Locatio Renovation C7 I'rplacefn^nl i' Ovine r' n L) Plans SUbMillCd: Yes ❑ No ❑ 5TIIFt00RI---1- GTIIFLOOR ._I-._.I...-I--I•_-1-....I-_I.....I_...I.--I---I.. 7TIirL001t t'TI I FLUOR... I_... L._ .L.._ I___�.. _I �L.....I _ L.- ... -I-- I. __ L_ -.-I- J_. .... I.... WR Trv,mlli.ng C.6mpanyHl A(kllcss Business Telephone lCOte " �',� 54x.:,• al. �:t � � h w �.�, }% C -kr� r•': � a r 6QYT i•:It r r •r� a �Y " {�y �3 :1 CJ ti Corp AI's — - - — ❑ Partnership --Q-� ❑ Firm/Co. ku cc H n. U li aCof F lY i J I o f a u. k H >. m Z' Z o' to � YI 1- x (� U o I- Z o� x o� z�� - } 0 m � z v o z > J 1 3 (� oac o o ,,. SUB-_BSMr. I---�._ I I I I `I --I- ---l- I.. � I - - --- BASFMENT -._�._.I--I l ! I -�---I ! I. -- _-.I. � .. L . I --�._ I -I--•I----I ! I -- -I--• I __ � I--! - - _... i i• _�,_I _I-�- ,1 1ST FLOO R .-- •---- ------L__�_. I ._I _.�.__I _ ._I .. I--_�..�_ _ I_. I _L ..I-_..�-. � .I _ISI-_L.•_.I- I-- I }• �NnfLaaR-I--�---�---�.-� �-_�_-.I..I._I I I-- �-.I....I_►-I --I---� I_ --�--I- I-�--�---- ,.,. ..'RofLaeR --�-- ..I...I- --_I- .I..I._.I_ -I- 4 rf f FLOOR 5TIIFt00RI---1- GTIIFLOOR ._I-._.I...-I--I•_-1-....I-_I.....I_...I.--I---I.. 7TIirL001t t'TI I FLUOR... I_... L._ .L.._ I___�.. _I �L.....I _ L.- ... -I-- I. __ L_ -.-I- J_. .... I.... WR Trv,mlli.ng C.6mpanyHl A(kllcss Business Telephone lCOte " �',� 54x.:,• al. �:t � � h w �.�, }% C -kr� r•': � a r 6QYT i•:It r r •r� a �Y " {�y �3 :1 CJ ti Corp AI's — - - — ❑ Partnership --Q-� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: Check one I have a current liability insurance polioy or its subsiontial equivalent. Yes p No p If you have checked yes, please indicate the tyle coveiage by checking the appropric►e flux. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware lhol file licensee does not have Ilhe instircmce. coverage requiredby Chopler 142 at the Mnss. General Laws, and thol my signolure on this peii-nil application wrlivesItis requirement. Chcck one: -- -- - -- --- - - ------------ - Owner ❑ Anent n 1 1—rhy certify that All of the details end Information I havA subntpted for enlrledl in the nhove Aptdicetirn Are Irne and Arcutnte to me best of myl', .l �.nowlydie mod thal All pltAnhinq work And Instatlaliona rrrfmmn d under the prrmit Issugrl for this AlrpticAtion will he in compliance with All petlirwnt,,, • ptovi:il.m of the hlAaaxhuarns Slate Gns Code And Chapter 142 of the General Laws. "" Type of License: — ree [j ' Plumber Check # L,]Gaslilter Signature of Licensed PI(nr1 r or Gas Filter Dale W Master (Office Use Only) ❑ Journeyrnnn License Number - MOON - APPROVED _ Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ./....... . has permission to perform ..... C. k 1. e.. . plumbing in the buildings of .................. at P North Andover, Mass. Fee,5�.7-). Lic. .... ............. P umBING INSPECTOR Check # 7 5033 t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING' - IL , ¢` (Print or Type) ,r : : F I Da to /% I City, 'rover' l?Lhrin i.t i► s a 13ttilclinq Dg � _ owner.P �,r AT: Location tJ5` P7ame ��"� TYI)e of (k*c:ttl)nnt:yes i New Renovation ❑ Replacement ❑ Plans FIXTURES ❑ 1. r Sut>mi.ttc-c(: YPti ❑ No O � psi t � f 4 ,AFI I (Print or Type)`'Y � Check Ot e: Certificate Installing Company Name �LAOA ' _ Corp. _t26C — 1 s El _---- _— a rUlcrshi P ?� s Finn/Company j i I r A :Dt. iness 'Veleplicmc( Na:re of I.iccnscd I'It.nlbcr or rlifitter i xd e:, ra tti'. I hereby certify that all of the details and information I have submiftcd (or entered) in above applicution are true and accurate to the best of niy y knowledge and that all plumbing work and installations performed under t'ennit issued for this application will he in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General laws. !rl ' I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. - , 1 have a currem liability insurance policy to include completed operations cinelage e i3 r``: HY------------ Signature of Licensed I'luntbc '1 isle -- ----- _. - _. , . ---- _ •Type, of Plum ng License City/Town _—_— Q ---- _ o C� --El Alastcx ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number •F L Fmm 1240 HonnS 61NAnnE1J.INr, 1989 I z z W Q W W to O Z F" �. W W !L J W )- V Q W z O O = W W. W z W Q cc Q = ~ _ -O z W a. Z O J ty W W t. W W m � I� V a W W W X d t4 z p, z d I. YC - O Z CC W W ?" .9 }. W p Q W Q Q = O W cc J O LA. cc 4 W = 6 Y ; 3C O cc OO 1•- a yC yJ LL u W F- rJ y I O Y d W► z O W Y Y W F O u x Q~ a d Y U) '� < Q° a J J a oc ¢ ori Q o a H SUB=BSMT. BASEMENT i L 1ST FLOOR I 1 2NDFLOOR ` 3RD FLOOR AITH FLOOR � .h .. lS'� A 6TII FLOOR,,r ' s 7TH FLOOR STH FLOOR t � f 4 ,AFI I (Print or Type)`'Y � Check Ot e: Certificate Installing Company Name �LAOA ' _ Corp. _t26C — 1 s El _---- _— a rUlcrshi P ?� s Finn/Company j i I r A :Dt. iness 'Veleplicmc( Na:re of I.iccnscd I'It.nlbcr or rlifitter i xd e:, ra tti'. I hereby certify that all of the details and information I have submiftcd (or entered) in above applicution are true and accurate to the best of niy y knowledge and that all plumbing work and installations performed under t'ennit issued for this application will he in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General laws. !rl ' I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. - , 1 have a currem liability insurance policy to include completed operations cinelage e i3 r``: HY------------ Signature of Licensed I'luntbc '1 isle -- ----- _. - _. , . ---- _ •Type, of Plum ng License City/Town _—_— Q ---- _ o C� --El Alastcx ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number •F L Fmm 1240 HonnS 61NAnnE1J.INr, 1989 I QQJER xk4 ;mEO s r� j 4 O Ze-,A ,Uc NQ 00 •� or7 �MOl .rtk t�' 0 M1 Q QQJER xk4 ;mEO s r� j 4 O Ze-,A ,Uc NQ 00 •� or7 �MOl .rtk t�' p C/) m m U) U) 0 — d CO2 Cl) 10 O CD a Z y CLO F. 0 C== CO) o C-) o p CD CD O C7 l CD CCD O CCD 00 W a C O CA -• CD CL O y O I to CD S p CO) O CD Z 0 C2 CD CD0 1-0 m E W 94w r� p�1 5� o � z a G G CL c� i r �Q -20 0to r" El C El CD � 'r' ro 4 H 0 0 c Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978)688-9542 14-5--oz- Town 4-5--vz AOR TIN O� Tteo q Mbye O O L Iftw '9� COC MCN.WNM 1' APPLICATION FOR CERTIFICATE OF OCCUPANCY I INSPECTION ADDRESS f ze4 IvIve- //e., e C LOT NUMBER v S1 DATE REQUEST FILED �7 DATE READY FOR INSPECTION ®7 ©/,1 eel/T, ZsTTe s FIVE (5) DAYS NOTTCE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND - FF' MUST BE COMP ETED WITHIN THIS TIl� FRAME. A SPEC O E OF TWENTY I ($25.) DOLLARS WILL BE CHARGED THE S U DOES NQ ALL APPLICABLE CODES. SIGNA OFFICIAL USKONLY ROUTING CONSERVATION ATE / r PLANNING DATE D.P.W. — WA R METER DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PMO—R-10 T� INSPECTION ��r ST DA zi ATURE-A.pPW AUTHORIZATION 1 GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections 1� INSPECTIONS: (Minimum), Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anrhnr_hnitc nr 0rans MOA►ti C� «•o ;a 7hO t � ♦ 1 " i CERTIFICATE OF USE & OCCUPANCY Building Permit Number o2 Date lk THIS CERTIFIES THAT II^^ THE BUILDING LOCATED ON k6� 9 4 1 C)S�'eaNto IE- --Dt2t �- MAY BE OCCUPIED AS ' � �, Q' �Ml lIt � ' ��'�'� � IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.�o CERTIFICATE ISSUED TO e P) `o r'► W *-L4-j ADDRESS c\ -HL A A; o ue , Building Inspector Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $25.00 (Be Ready). Certificate of occupancy required prior to occupyind structure. 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