The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 116 PRESCOTT STREET 4/30/2018 (2) 116 PRESCOTT STREET 210/082.0-0008-0000.0 \l z�I� Date.......3.. ........................................ f o °� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION *�1+•O+�ieo�'�t'�g 83.�CRU9� This certifies that ................................ has.,:permission for gas installation ....�/�!4 -1. -:............... .?. :1....... in the buildinsKea-e.of.... . ... �-G�' at......�A.�....... A..... �........, North Andover, Mass. Fee....00...... Lic. No.�.........'........... �j.. - GASINSPECTOR Check# 0 Sly � d' I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I $CITY- fJoRzla+vDo - _ - _- ` SMA DATE y �SPE-..- Imo :. �.R. JOBSITE ADDRESS / 4 Corr I OWNER'S NAME ��` L l co -• �►; I _ OWNER ADDRESS L TE DFAX TYPE OR I PAZ, OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL C1,EA,I2LY NEW:© RENOVATION:[ REPLACEMENT:,®'` PLANS SUBMITTED: YESEI NO[R- APPLIANCES 1 FLOORS-► BSM 1 2 3~ ; 4 . 5. 6 7 8 1 9 10 '11 1 12 13 1 14 BOILER I BOOSTER 1 _ CONVERSION BURNER I COOK STOVE a DIRECT VENT HEATER M DRYER i FIREPLACE I FRYOLATOR I FURNACE I GENERATOR (~— GRILLE I INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT I OVEN I POOL HEATER I I ROOM/SPACE HEATER I ROOF TOP UNIT' I TESD 1 UN11�NEATER _ 1 UNVENTED ROOM HEATER WAT6 HEATER M OTHER �I I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES WO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND F 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 ® AGENT I hereby cerlify that all of the,details and information I have submitted or entered regarding this application are true and accurate to the best m knovO e and that all plumbing work and Installations performed under the permit issuedfior this application will be in compliance with.a rtinen Massachusetts State Plumbing Code and Chapter 142 of the General Laws`- PLUMBER-GASFITTERNAME LICENSE# i56k SIG MP[3'MGF® JP® JGF 0 LPGI® CORPORATION PARTNERSHIP®# LLC COMPANY NAME: ee_ Bra SEzv t e, ADDRESS — CITY as—� - STATE'�ZIP 2 ( Z 2 TEL 7- dd — d. FAX CELL s. Qa6-14Q4 EMAIL �' �' ; � � ,� ., .. �� /� v �� l�r v (, , . .. � t + •;COMMONW�gLTH OF • • . . • MASSACHUSETTS- PLUMBERS 5D •p ISSUESASFITTERS -- THE FOLLOWING: L:ICENSE LICENSED AS A MASTER PLUMBER.,. DAVIp W �_ GARFIELD i,v( x 7 � 21 WILLOW Sj- BROCKTON 15645 MA 02301-145'1' :. 05/01/1,6., . 226442 '.'. COMMONWEALTH OF MASSACHUSETTS: BOARD OF, PLUMBERS.`.ANO GASF.ITTERS ! ISSUES THE FOLLOWING' :Ll CENSE I REGISTERED AS A .P.LUMB I e CUR c� DAVID W GARF I ELD FLB�ROC�I(TbN EENEY BROTHERS SERVICE, ...\L� �11�' JI;: Z WILLOW -5T .�' ar �� MA 02301 3619 05/01/16 221413 i FEENBRO.01 SMORAN _...........---------— I DA7E(Mh11DDM'YY} CE�tTIEIC�iTE OF LIA�ILITY INSURANCE TF THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,I EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ' IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In(leu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX (877}816-2156 434 Rte 134 ac No Ex:: Arc No South Dennis,MA 02880 ADDRESS: INSURER(S)AFFORDING COVERAGE MAIC S INSURERA:Old Republic General Insurance Corp. 24139 INSURED (INSURER B Feeney Brothers Services LLC I[NSURERC• 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (LTR TYPE OF INSURANCE POLICY NUMBER PA LDOADDLSUBRYEFF IPs�p EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 ClA11I5-h1ADE a OCCUR A2CGO7501601 0210112015 0210112018 PREMISES Ea occurrence S 300,00 MED ERCP(Any one person) S 10,00 PERSONAL&ADV INJURY S 1,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,0 POLICY MJE�T LOC PRODUCTS-COMPIOPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea aacidertt ANY AUTO BODILY INJURY(Per person) $ ALLOV,NED SCHEDULED BODILY I NJURY(Per accident) $ AUTOS AUTOS NON O1%NE0 PROPERTY DAMAGE HIRED AUTOS AUTOS Peraaide t $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESSLIAB CWh1S•1,tADE AGGREGATE $ DEO RETENTION$ S VlORKERSCOMPENSATION X PER O H- ANDEMPLOYERS`LIABILITY STATIJT£ ER YEN A ANY PROPRIETORMARTNERIEXECUTIVE A2CW07601501 02/0112015 02/01/2016 E,L.EACH ACCIDENT $ 1,000,00 OFFICERtI&MBEREXCLUDEO? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,00 Ues,describe under SCRIPTIONOFOPERATIONS beaN E.LDlSEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North 1800 Osgood And ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE REPPRESENTATIVE 7 :(b ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo-,are registered marks of ACORD E.:. Date.....—�. `�� .11.��................... OF r►ORT#v TOWN OF NORTH ANDOVER o m h � INSTALLATION . . . . PERMIT FOR GAS S r `4wCHU5 ' Tz - This-pertifies that ...................:..."............... .......................................................................... has permission for gas.installation .... ?` .e L.......` .... .`i!?. ........... inthe buildin"sof.......... .Q ......................................................................... t` at.....\.1... ........... .. P. � ° ........--�..:................. North Andover, Mass. �� Fee....................... L>c. No. �................��....... GG GASINSPECTOR Check# '32 O 09 G r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK n�; � CITY -:r�oaz•N�=I�N� �, `.� • N :.SMA DATE� PERMIf77 JOBSITEADDRESS i I o-' fesco rr 5-C i OWNER'S NAME GOWNER ADDRESS 1 TEL __ .FAXI � TYPE OR I PRINT OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL Q RESIDENTIAL CT'EAR.LY NEW:Q RENOVATION:Q REPLACEMENT:( '' PLANS SUBMITTED: YES Q NO APPLIANCES Z FLOORS ^BSM r 1 2 3~ 14 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER _I CONVERSION BURNER COOK STOVE _ DIRECT VENT HEATER DRYER i FIREPLACE i FRYOLATOR a _ FURNACE I GENERATOR Iz GRILLE INFRARED HEATER LABORATORY COCKS t *MAKEUPAIR UNIT OVEN POOL HEATER I ROOM/SPACE HEATER RO F TOP UNIT i TEST UNIT HEATER UNVENTED ROOM HEATER i WATER HEATER i OTHER OJT i I . _ f INSURANCE,COVERAGE. have a current liabilify nsurance policy .or its substantial equivalent which meets the requirements of MGL.Ch.142 YES W0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND Q .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© AGENT hereby certify that all of the details and Information I have,submitted or entered regarding this applicationare.true and accurate to the b 'of nowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance II Pertfi rov of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# ,516NATU E MP[3,MGF® JP Q JGF© LPGI® CORPORATION[.,V' PARTNERSHIP®# LLC COMPANY NAME: ee_ tiro Sez v e ADDRESS - - I CITY ;�a�-� STATE' A ZIP Z ( Z 2 ITELI 61-7-a = �0 FAX CELL s°�rfa1;-14QQ]EMAIL 'SeeMe I _ I COMMON WE'4Lr►� OF MASSACHUS ' • • • • , ETTS . PLUMBERS. ISSUES THE FOLILOWSFITTERS LICENSED AS A NG LICENSE MASTER PLUMBER . DAVID W GARFIELD 21 WILLOW ST .� gr c� 1 w BROCKTON `. W 15645 -145 MA 02301 0$ /01/16 226442 ' v COMMONWEALTH OF MASSACHUSETTS BOARD OF. PLUMBERS AND GpSFITTERS ISSUES THE FOLLOWING LICENSE �W REGISTERED AS A PLUMBI ��OIIR < Z DAVID W GARF I ELD 1 EENEY BROTHERS SERVICE, \I 21 WILLOW ST V ��,� 'uwl gROCKTON MA 023011. 3619 o5/o1/i6 221413 F FEENBRO.01 SMORAN DATE(MMIDDIYYYY)-- ----... ... (�� CE�2TIEICATE OF LIABILITY INSURANCE 1130/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,J EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS},AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the,policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer•rights to the certificate holder In Ileu of such endorsement(s). PRODUCER iCONTACT NAME: Rogers&Gray Insuranco Agency,Inc. PHONE Fax 434 Rte 134 ac o Extl: wC No:(877)816-2156 South Dennis,MA 02660 ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A:Old Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC INSURERC: 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATHSTANDING 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (LTR TYPE OF INSURANCE D S B POLICY NUMBER hAMIDDYJYYYY POLICY E P LIMIT'S A X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE S 1,000,00 CLAIMS-MADE a OCCUR A2CG07601601 02/01/2015 02/01/2016 PREMISES aoccurrews $ 300,00 MED FXP(Any ono person) S 10,00 PERSONAL&ADVINJURY S 1,000,00 GEN'L AGGREGATE LI M IT APPLIES PER: GENERALAGGREGATE $ 2,000,00 POUCY N JEC M LOC PRODUCTS-COM P1OPAGG 5 2,000,00 OTHER: $ AUTOMOBILE LIABILITY - COMBINEDSINGLELIMIT $ • Ea accident ANYAUTO BODILY INJURY(Perperson) $ ALLOAAUTOS AUTOS SCHEDUAUTOS LED BODILY I NJURY(Per accident) $ UTED PROPERTY DAMAGE AUTOS AOSacide $ S ' UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESSLIAB HCLAR.IS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER A ANY 0 FICERI PROPRI �ECUTIVE �Nla 2CW07501501 02/0112015 02/01/2016 E.L.EACH ACCIDENT S 1,000,00 (MandatorylnNH) E.LDISEASE-EAEMPLOYEE $ 1,000,00 Ifyyes descn'beunder DESGRIP710NOFOPERATIONS bekrn E.LDISEASE-POLICY LIMIT 5 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 07 i A AA ;t A2 ©1988-2014 ACORD CORPORATION. All rights reserved. 4. ACORD 26(2014101) The ACORD name dnd Iogo.Are registered marks of ACORD.-. i Date.../......�......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING S`4ACHU5� This certifies that ................ ........ ........................................;................................ ....... has permission to perform ... ............................................................................................. rwiring in the building of....................................................... ..................................................... at ........l.�..)`'........... `P..S. ............<- j .......Lic.No. -h Andover,Massa Fee...... �: ,."' �� !....!.�...... !:,,.,,,.1., +, ELECTRICAL INSPECTOR Check_# 2— BP � Commonwealth of Massachusetts umciai use uniy Department of Fire Services permit No. I Z j Occupancy and Fee C ecked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date November 5,2014 City or Town oh 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) 116 PrescottSt. Owner or Tenant Robert Barnes Telephone No 978-283-2299 Owner's Address 116 PrescottSt. Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Residential 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 Installation of 20W Gas Generator Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires • No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- 0.0Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners. FIRE-ALARMS lvo.of Zones No.of Detection and No.of Switches No.of Gas Burners._ InitiatingDevices No.of Ranges No:'of Air Cond. Total No.of Alerting Devices . Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: 'i ................... 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 Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of-same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) • I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: Roy Spittle Associates,Inc. LIC.NO.: A13208 Licensee: Thomas Spittle Signature LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 978-283-2299 Address: 5 Heritage Way,Gloucester MA 01930 Alt.Tel.No.: *Security System Contractor License required for this woik;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the-liability.insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: SS IIMtt MYv I i } ACORQ CERTIFICATE OF LIABILITY INSURANCEliATE(M I D� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ,JOHN RAPO Beneficial Insurance Group PHONE -262-1200 o:877 -560-6880 E 33 Arch Street - Suite 3150 A-NAIL : Boston, MA 02110 INSURER(S)AFFORDING COVERAGE NAICI INSURER A: Travelers Insurance Group INSURED ROY SPITTLE ASSOCIATES, INC. INSURERB: AIM Mutual Insurance 5 HERITAGE WAY INSURERC: GLOUCESTER, MA 01930 INSURE-RD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: splitllemaster REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE IWV NSR D POLICY NUMBER MIDD F MIDD LIMITS GENERAL LIABILITY T-CO-OF292573-TIA-14 09/11/2014 09/11/2015 EACH OCCURRENCE $ 1,000,00 UAMACit 10 RLN I ED X COMMERCIAL GENERAL LIABILITY I PREMISES(Ea occurrence) $ 300,00C CLAIMS-MADE FiI OCCUR MED EXP(Any one person) $ 5,00( C FORM CG0001 PERSONA.&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( G 1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X JE LOC $ f AUTOMOBILE LIABILITY BA-OF292573-14=CNS 09111/2014 09/11/2015 UUMBINLIJ (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A X ALL AUTOS X AUTOS ED BODILY INJURY(Per accident) $ X NON-OWNED PRO 'YDAMAGE HIRED AUTOS X AUTOS (Per accident) $ X UMBRELLA LIAB OCCUR 4TSM-CUPOF292573-TIL14 09/11/2014 09/11/2015 EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATIONTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE 80080065752014 09111/2014 09111/2015 E.L.EACHACCIDENT $ 500,00 B OFFICER/MEMBER EXCLUDED? N� N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood Street THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE JOHN RAPO O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth o Massachusetts f Department of IndustrialAccidents Office of Investigations ' d 1 Congress Street,Suite 100 Boston,MA 02114-2017 s� 'e www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Roy Spittle Associates, Inc. Address:5 Heritage Way City/State/Zip:Gloucester, MA 01930 Phone#:978-283-2299 Are you an employer?Check the appropriate box: Type of project(required): 1. ■❑ I am a employer with 25 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑■ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:A.I.M. Mutual Insurance Company Policy#or Self-ins. Lic.#:WMZ-800-8006575-2014A Expiration Date:9/11/2015 Job Site Address: 116 Prescott St. City/State/Zip:N.Andover, MA 01845 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 u pains and penalties of perjury that the information provided above is true and correct 11/5/14 Signature: z2-�44—L, Date: Phone It: 9782832299 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: GENERATOR APPLICATION DATE: 1\ - -" " ' LV LOCATION I 1 b p re.S c-o A, OWNERS NAME: �� b�✓� GENERATOR kw o C NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS' CONTRACTOR: o 1'4--I.Q- As C�.c- S PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY 'R QcL.✓ o Imo vw- A-v +�,A- LOCATION OF GENERATOR a ,,,�a c.� -�ro w• C�S� 101 *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL ' .-� :'::*'�:COMMONWEALT:H OF MASi46H BOARD OF C'(80WICIANS .C.�.: CSSUES THE .FOLLOWING L)::dh�St AS:Al;: RE rar.4-t MASTER.,ELECTRI CI.AN:.� RDY. I TTL E ASSOCIATES I N C' �V*';' .:THOMAS 4..._5P E 5 HERITAGE WAY 'Z GLOUCESTE R MA 01930-2211: 27888 13200.:_A':�:::.:� 07:/31:/ i North Andover MIMAP November 6, 2014 I Interstates —I —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Roads Meters Data Sources:The data for this map was produced by Merrimack Valley Planning Commission(MVPC)using data provided by the Town of 1!.�E�asements North Andover.Additional data provided by the Executive Office of OMVPC Boundary Environmental Affairs/MassGIS.The information depicted on this map is for planning purposes only.It may not be adequate for legal boundary (camels definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 1"=60 ft - - Date... ................................................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU 0 J'D Thiscertifies that ................... ...................................................... ............e_ , " has permission for gas installation .....1..� ".1eX el+rL— t"'h the buildings-of ....... .. .. .................................................................................... ................................................... .........V� ........... North Andover, Mass. Fee .... Lic. No. .......... '0.1�..................................................... GASINSPECTOR Check# y 9714 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY j MA DATE to / PERMIT# i JOBSITE ADDRESS (` OWNER'S NAME GOWNER ADDRESS sGtm-e— � TE FAX PST OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALa CLEARLY NEW:141/ RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES[j N0UI-- APPLIANCES 7 FLOORS— BSM 1 2 3 ( 4 5 1 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER - ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER L OTHER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ZNO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNER'S I SURANCE WAIVER:I am away that the licensee does not have the insurance coverage required by Chapter 142 of the Massa se Ge I aws and that sign on this permit application waives this requirement. CHECK ONE ONLY: OWNER [) AGENT IGNATURE OF 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-GASFITTER NAME i i LICENSE# ® SIGNATOR MP® MGF® JP® JGF® LPGI® CORPORATION I,# PARTNERSHIP®# LLC®# COMPANY NAME: ADDR,ESS101 CITYSTATE®ZIP TEL FAXIM I CELL EMAIL I i r Q The Commonwealth of Massachusetts Department of+Industrial Accidents Office of Investigations 1 CongressiStreet, Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Hoiden Oil, Inc. Address:91 Lynnfield Street City/State/Zip:Peabody, MA 01960 Phone#:978-531-2984 Are-you an employer?Check the appropriate box: Type of project(required): LM I am a employer with 45 4. [] I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.C1 am a sole proprietor or partner- listed on.the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity. employees and have workers' 9. C]Building addition [No workers' comp.insurance comp.insurance.$ 5. We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g p myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no as fitting employees. [Nb workers' UK Otherg g comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:HDI Gerling America Insurance Co. Policy#or Self-ins. Lic.#:EWGCD000014513 Expiration Date: 12/31/2014 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 herebyce der the �Wpof perjury that the information provided above is true and correct Sianature. Date:01-06-2014 Phone#: 9785312984 Ojflcial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f S � r OMMONWEAH OF MAS /11iUSETT.S: < ;;....: • ..:;•.B...QARfJ QF . PLUMBER z tkt l t"AS:E-ETT. ;ER` ISSUES.:.THE FOLLOW I',,:•.>; <+:.:> L "AS AN L.P.......:GAS LLI 01960-31`j9 228680 A Date.......1. .. .�..�..'7....................... I °�NOi1TN,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,�CMUgg ThisL' . certifies that .....'....................... ...... ......:.I. ... has permission for gas 'nstallation .......k.�t e: ............................... in the buildings of. '�'"P S at.:.........1 v.6 K sa- 5 �, North Andover, Mass. .................................................................... Fee ...... Lic. No.?-�..?? T)......... 1 ................................................................. GAS INSPECTOR Check# { G 2`J—1 9516 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS-FITTING WORK CITY MA DATE PERMIT# v — JOBSITE ADDRESS h1 S4 c OWNER'S NAME I Rabe GOWNER ADDRESS So�YY✓L TE 4'��.1 as ��p�FAx�� TYPE OR OCCUPANCYTYPE COMMERCIALE] EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT:LT PLANS SUBMITTED: YES[] NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 . 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE_ . . INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ' ROOM l SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER.. Q INSURANCE COVERAGE I.have a current liab insyrance.policy or its substantial equivalent which meets the requirements.of MGL.Ch.142 YES.. NO Q IIF YOU.CHECIOED YES,PLEASE INDICATE THEME OF COVERAGE BY CHECIONG THE APPROPRUATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Q BOND ❑ OWNER'S INSURANCE WAIVER:lam aware that the licensee does not have the insurance overage required by Chapter 143 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT Q SIGNATURE OF OWNER OR AGENT I here by certify that a8 of the detat'Is and information 1 have submitted or entered regarding this application are true and aomnats to the best of my krwwledga and mat aN plumbing work and insta0ations performed under the permit issued for this application will be in oanplian P of the. Massachusetts State Phunbing Code.and C hapter.142 of the General.Laws. PLUMBER-GASFITTER NAME I Mi fgffeLICENSE# IU MP Q MGF Q JP JQ JGF LPGI Cl CORPORATION[]#F7-77 PARTNERSHIP Q#=LLC Q# COMPANY NAM _t A ADDRESS CITY ( STATEZOMP T11 a- 60 rte. FAX __3 C81 504 MAIL �1 �� -� --�� '� �� .�- E Feb 201310:20a p.1 M Cammenweadth ofMassachuseM Prlrrtfbrr I Congreis SboaSufte 100 ` Besmft,M4 02114-2017 it9i r wrvwarnamZOVIiM Workers' Compensation lisaAranee f idav[ : derdCo rslEeel3fiieaa wMUjnbers An�tL��ufm 3tio Please PrAat Mom Name(Ber�neOr�niaaFion�lscc&vislual}: � i�` --- �-- Ad : .S/ e c;ity/st z PtL(Me#: Are you au ejnpb . Check tfie appropriate bay 1Pg of project(required): I.0 I am a emPk*W wi& 4. l am 44ge d eont;wwr at+d I layees(tin and/or part time}.* haveb, the sub-caatracto a 6, [�New eansnudicm 2. I am a sole L mA or partner listed on the atm sheet. 7. ❑R� ship acid. no employees These have & ❑Demolition woe4ing for me in any caPacity cmp. kr}es and hav-0 wax'sers, 1. t 9, rI Brulxt*addition TNo wodkers`comp.insurmme c rap.;utsczsasrcc. �.] 5. ❑we art a moa and its MD Eluuical ropsica or addi 3.❑ I am a homeowner doing all work ofce�s have exercised titer 11.50bsnft repairs or addidox MYUM ov0dM, dot of==p1ioager lam, ❑ Roof insane required.j t c. 152;§1(4),and we bave no 1211 - emp*ees.[Ivo workers' camp.,m=rauce reqube3.] =stay e�eice�cs btu f3 asscs�so su as ase n ;st��worms'��r�a as rHOMMWMMwho SIaru smrxaeiloi ansaoflcand niceascrsi eea ais a nearat ii': gas�c tsucearcat ckeds�ss&t r*Mzd-sameofd-�a amxagarorrac�m teak o if ea 1 of t wo:icas'�VaImy==bcr ,Ira==aff employer tkae isprov dag x+erkers'campanwi6s&wwwofbP my exWfayees Br.Fow is Aga a jib&ice ' bafioa. . Izurance Company Nom=• Poficy#or Self-ins.Lie.#: Expiration D I Job Site Ad&=:I U Pf�CM S. CitylStawzip:mo�y-�„ v�-� A O'�` ' 5 Attach a copy of the wo tm"moa Ply dearadom pap(dowing tb*peaky numcber a A ezpbabian date) Failure to w=e covemSe as mr-dred under Section 25A of MGL c.152 can lead to fire imgosaiam of c ra inal peaahies of s fine ug to S 1,500-00 sandier one-year imprh*nment as weU.as civil penalties in the farm ofa.STOP WORK ORDER and a 6 of up to S250"a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Fnvwt*dm of&e DLA for iasuuasrce covereV v=ificat= r a CYOZ= d MW 0XIV. Do not WTW area,to lie cur VIe&d lag rky or t ae offilew Ciiy or Taw PerrmMSm" d Issuing Au4hm*(circle me): L Board ofBesM I BuUftg DeparemoU 3. Nown CLrk 4.MMrjW bVector 5r ft=biag Uweeftr 6.Other Coma lis: rho=#; 02/04/20:: TUB 8:50 �A2 781 272 2S62 �_-_ " 3.. _ 'JiII iL`$i:T2.IICe ..__^v L'D +`j• 2002/002 CLARK-2 OP 10:JZ CERTIFICATE OF LIABILITY INSURANCE I aaTE(rauoD:rml 02J0312014 • THIS CERTIFICATE !S ISSUED AS A MATTER OF INFORMATION ONLY ANG CONFERS NO RIGHTS UPON THE CERTIFICATE HOLLER.THIS • CERTIFICATE DOES NOT AFFIMMATTVELY OR NEGATIVELY AMEND, EX-LEND OR ALTER rRE COVERAGE AFrORDEI� 3Y THE POLlC�S � i 13cti.'1. 1-HIS CERTIFICATE OF INSURANCE DOE NOT CONST?TUT'e A CON RACT BEEN THE ISSUING INSURER(S), AUTHOFtfZEO ` ! REPRESEWATIrVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ! IMPORTANT: !f the ce:tificate holder is ar:Ai3DtT10NAL INSURED,the POBCy;es)must to endorse3 if SUSROGATiON iS r"1AIVED subject to i the terms anc c*rditions of the poiicy,certain policies may require an endorsement- A statement on this certificate does not confer rights i cert rcate holder in lieu of such endorsement(s). ghts to the i PRODUCER C 3 `., Philbin insurance Group IpPhHii'LBIN bin insurance Agency Inc (��' p INSURANCE GROUP {�"� �,:617389-9400 !F� 629 Broadway � N AY.No: 617-3$5-634'$ ;. ` ALL r 02'14S Everett.M� ,A:rJ:icss: • {Philbin i.is sra Ce GrO:p i IISURERM)AFFORDir.�a COVERAGE: NRSC` I RaURER A,A�eila Inde=fty 1,s Company ! kxsUREO Clark Plumbing ! ?Iichae!Clark iNSUMERa: i 513,4averhill Street 2ohley,ISA 01M (rsuasR D INSURER E, ccvERAcr-s CERTIFICATE NUMBER: REVISION NUMBER: TiiiS IS TO—,_P1:—FY ;IAT THEE I'0}LICIES OF iNSL ANG LISTED. SILO lj`s,AVE SEEN ISSLfE.D TG THE WVJRED NA 1VEED A30k'E FOR THE POLICY ps IOC l U01C:+iED. .:C?d1lTHSThNDING Ai�,Y f2EQltiR&1Rc7VT,?-tR}T OR CJyBtsiOU 0-AN COWRAC, OR OTHER DOCUMENT WiTh RESPECT 70 WHICH'H}S I CcRTEFlCr.T'c MAY SE ISSUE:OR MAY PERTAIN, THE WSUR:iNCE AFFORDED BY THE P�JLiCI=S DESCRIBED HEREN IS SUBJECT TO ALL THE TER.'�S$ I EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIaffi SKOWN MAY HAIJF BEEN REDUCEDdY PAi-v CI.kUs. �iNSRI � ,., i.- -sus LTR i : E OF SURArty=_ i 'ICY NUMRSR 'mEFF i e)LoYLIMITS —i aG. !GENERAL tuslLV.. i ! i EACH OCCURRENCE iI 5 I ! i CG.iM1'tRCA'.GENERAL l.lr31LIT`.' I I c �,4IM1rS.fi (^I `• I PREMISES=a�Irrenco S i _i ADE OCCUR I NI-1-0 OW(AnyoneDersor) is — ( i PERSONAL SAOV MIURY 1$ i—= E GS4ERALAGGR'EGATE 5 i I C;Yt AG^:y.GATE LEE�'T APPLIES PER: % F— ;---1 Pr RCOUCTS-M-AP/OPAGG j;S i POLICY' P2O- F-1'LOC AJTOMOS;:=LIA61L?i! e0r2SINGLE LLWT is A 1 ANY AL7c 1020006084 : i9 122Ci3;09112,W14 3OOELYINJUrcY?a;person) is 25Q { ALLC,4t: ;;X;'SCii=OutFv I s AUfCS: AtJT I I i i i I oODiLY MURY Oer a=ideat) $ WGION X I HSREC?.0 T OS i X !AU CS i PRO?ERTY DAMAGE t ,,nACCYD I S MICH C..M.5R LLA Li A& I t OCCUR ! :EACH OCCURRENCE I$ ^i EXCESS LAB AGGREGATE DEC. : :RE,tYTb?�I Arte at-PLO-En-LEAF Y y r N i oT>,. TORY LEr� s I SR i j \Y PROP?!_;v?•PAR T�3/ OU:Je i' t Et.EACH ACClOE,Y?V yes. S {MandatGy.�?•Irl; .—�' c'L SE iZS�A .EA EMPLOYE 5 DESCRIPTIONdFOPERTIONS tickle (_-—_ L JIStAS=-POLICY LW S DESCRIPTION OF OP_R..10NS 1 LOCA.MKS I VEHICLES(A:ach ACORD 16:,AddlSonal R—narks Schadule,I:=ore space Is roquired) . L. • I { k (CERTIFICATE HOLDER CANCELLATION . ( i � SHOULD ANY O:-THE ABOVE DESCRIBED POUMES BE CANCEILEg BEFORE IN.E.Electrical Services THE EXPIRATION DATE THEREOF, NOTICE MLL BE DELIVERED tN E ACCORDANCE JW,T H TFIE POLICY PROVISIONS. 40;North Main Street l I &--9;n9harn,INA 02019 ALmtcRl��aes4:AnsrE r: {Fhilbin insurance Group i ©1888-2010 ACORD CORPORATION, All rights reserved. ACORD 25(201 GA05) The ACORD name and logo are registered marks of ACORD 11; & `-- CERTIFICATE OF LIABILITY INSURANCE �;slssv�c ------------ _NO - i �cR-*tCAi= O_S N07AFF Fhi;,?y�y O Coil i`} tiC:O4FERS NO iG :o UPON ,-CERTfF(CA. _ _" _ ?<=v=?�< itn't_e,.r C^L^4^� j} � c OF iMSC>RA,ai.^..Z �; x:.F=O're=D 3'�::i-C�i�ES j1F v4�tt J 3ErRc5�^I:;aT:is O.'�ri'i�?DUCE -- - _ =n C^vft�%.C'B�hZE:'i:rc iSSsi'+lE ec,;t°-+�- ir3E^_tit:r .Cia— j ^a ar!s= p e :srs aid ca ac� Gf :<5.sF ts:,' pc;t�(�s` �5�i— - -cut _ -se F Oti;S` . •�h� 'ala FviGf:t=_22^:p�dEs r-:z'r ra„usz z�� C- n<IIviii :r.•:vcD,sc:3j� •;t c :^is >=z a MEs-rct cc-,er -its (4 to 4 F+.^,DZ55 0-AL 029, {° i^ b��eei�.:s.-� � �:�:.: Vic:^i2�i'�:;:�n.:c;�- ��•�z�a~ wee.- .. =c,•-a•, =.•'s- �` -- '="sem.moo: vs r x _R2 — 3�\iS..v -J^__tS�:?� tiF Y:r.�fi30i� =sE .-,..,;.�- _FOR;mac� �" itAv Cci- =N N c;• __ :'J.4'S.ti�?J C��rs';J,�q CFSY';�JL'C'.ES.._fe< 1 _"=Q2"j 3Y _ _K$r,_ ?.3 ri-Rai, ~ .— 'i5:•;,.,C= iXf:....�.? -E.. _.cY2:•^.�:c�a; is 'WS201Q8; !�l v$iSviS vilv9r0i0'LSC,v:`6.�:��a.x.?•r li SG-.0,0 G 4 R.SL%+-GREG:3: {$ ;Xi I mo+ _CC owc-S- vG Is fi,i�. • f_-; •rte`"^^� � i ,` • I Y^- i3 f i ,1: c -��CakLYR•' �I 1 I=L��n¢-Ln cZ.P C.= �� CF C*__•tA-lc_NS ::C..:aCwsat.Z- ,bbb��ii��;r - ccc,.-—.c-,o-r. .<:-.4:n_Co—s Sao-. I t i i C:RT,RCA=HO 0ER 4 �'M--'C.?RA Cii DxTL?kxMk=F,ESOS w:7.IL' 6�7EuF E*i 4 4J."r�1,"..'�s ;,�`„2£t 1 E +iCC.^,s!"i.F.iCc 7aT:•i s'IE P^..UCY PROVi ON& i t � Kelley, -AAI,, CIC Kathenme �.CGR 2^ 2�t�GQ; [-E iiv�v -.2 I'D iS88-,Z=9ACa. GORF:c�TiC?v.A1:s;gi s te52sv^� c iagc=� sus err cs ;:.LORD I • i �i! i May 31 14 04:07p p.1 wla Thi.Home,duo ng AD j¢::COMMONYVEL'[H OF M �PuMor{aHfo�ns LUMBEgS' GASzI� � ISSUES;;.:THE fF WIY �4` '. i L 1-0 , 0lLO W� C I`CENS vsVS A:J..0 UIMAN PLUl1B .Y L J CLARK; LARTS;; : 513 HAVE<i2{'CL ST I . =<> s OJEi� j 0 a 8 �� f Date . �. . . . . . . .r[ITt176y' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . a .Y.L 0Y17 . . All o�Aj . . . . . . . . . . . . . . . has permission to perform . . f-4. . . . . . . . . . . . . . plumbing in the buildings of./,. ��r/ ! ' . . . . . . . . . . . . . . . . . . . . . . at . . . . . .�.�. . Ef.�.j C A .`l .. . . . . . . . . . . .North Andover, Mass. Fee . 10�'. . Lic. No. .(J.S . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK INKCm'NORTH ANDOVER ; MA DATE �/—��3 PERMIT# dOBS1TEADDRESS 116 fifes Ga 7l' S? OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL* .._ EDUCATIONAL RESIDENTIAL X PRINT CLEARLY NEW-,;.- *:- RENOVATION .. REPLACEMENT: PLANS SUBMITTED: YES FIXTURES 1 FLOOR— SSM 1 2 3 41 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN I SHOWER STALL i SERVICE l MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPMG I I—ER _ I I INSURANCE COVERAGE: 1 have a current Ilablib nsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 1c NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW g LIABILITY INSURANCE POUCY ( OTHER TYPE OF INDI fNNITY 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 appiliation waives this requirement. CHECK ote my-. OWHER : ;_ ALGIN SIGNATURE OF OWNER OR AGENT I 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 udp be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I PLUMBER'S NAME5 THOMAS HALLORAN LICENSE#24833 SIGNATURE S MP , = JP CORPORATION # PARTNERSHIP----.. LLC _~ # COMPANY NAME HALLORAN PLUMBING ADDRESS 826 DALE ST. CRY NORTH ANDOVER STATEMA ZIP 01 -978-685.9504 FAX CELL EMAIL t91 mo-A 1t t COMMONWEALTH OF MASSACHUSETTS :.. I; - r P: BERFi S A AS .S -.. ► ..-.LICENSED AS A JOURNEYMAN-PLUMBER:::`� :' i ISSUES THE ABOVE LICENSE TO: 1`THOMAS M HALLORAN <'826 .DALE ST I.:>NORTH. ANDOVER MA 01845-14`22. 4 24833 05/01/14 142701 LICENSE NO. EXPIRATION DATE SERIAL NO. I Date . t . . . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . . I .�.I. "�.l !!� . . . . . . . . . . . . . . has permission for gas installation .tI4xI� . �.�.e .. . . . . . . . in the buildings of. . . ...-BG,rr .je.c.. . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . .I.`.Y . . .e(.e '1 0-z%# . .�T . . . . . . . . , North Andover, Mass. Fee x2C): lam. Lic. No.c--' 14�. . . .R"i . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# 8653 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE Y-/-13 PERMIT# G JOBSITE ADDRESS //( l0/r'eSC0 ZI S7- OWNER'SNAME L.% 144 13-'9�N4 S OWNER ADDRESS S 9M,e TEL FAX TYPE OR ,-..-.n OCCUPANCY TYPE COMMERCIALS EDUCATIONAL?'y' RESIDENTIAL PRINT . . CLEARLY - NEW:`_ RENOVATION:IL,- REPLACEMENT:X, PLANS SUBMITTED: YES'___, N0)< APPLIANCES 1 FLOORS- 88M 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER 1 WATER HEATER 1 OTHER r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1) I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ,, OTHER TYPE INDEMNITY _ BOND �y__` 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 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-GASFITTER NAME THOMAS HALLORAN LICENSE#a?f 5, SIGNATURE MP __ MGF JP JGF i GI CORPORATION_# PARTNERSHIP_ # LLC # �. , COMPANY NAME:HALLORAN PLU ING ADDRESS 826 DALE ST. CITY NORTH ANDOVER STATE MA ZIP 01845 TEL FAX 978.208-0840 CELL EMAIL r s .;: �� - _- ; _ _. . :. �� h//� �_ U7� - �-°� 4� �_ z. �o, ..� OMMONWEALTH OF MASSACHUSETTS !::..-.:.7 P,L`UMSERS AND GASF LICENSED AS JOURNEYMAN'-PLUMBER_-j-.,_. ' ISSUES THE ABOVE LICENSE TO: ..: ! .. THOMAS M HALLORAN Em -!Cn :-826 DALE S7 i.::NORTH ANDOVER MA 018 4 5 1.42 2. , 24833o5/01/14 _ :,142701:. ^- MASSACHUSETTS UNIFORM,APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date L/ .2 S _ Building Location �I p�2fSCc 57-Owners Name ZI/W- s1 e4lOS Permit 4 :Z /7 Amount Type of Occupancy New Renovation Replacement 1_ Plans Submitted Yes ❑ No FIXTURES C rA a o o w z U � � w � a F. > U W 04 04 = A C�7 A = SLRESNE s RASEVEN)(' BE FTOCIt r 11DHJOCR ':M1HjOCIR 41H H-OCR 5IH HBM 6HI HDM 71H HIM 8IH RIM (Print or type) Check one: Certificate Installing Company Name_)1.+(L 0 Iz q ry G L��►'�� I6J� Corp. Address P© • 136'k 7.Z Partner. e 43 e,!f1 eN!-c /4 .4 4!dr V Z Business Telephone S- 5 O / Finn/Co. Name of Licensed Plumber: �7OM &lr#GyRAt Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Lzzr 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 Massachusetts State Cde d Chapter 142 of the General Laws.an By: ignaure of Ocensea Plumber Title i�p$e of Plumbing License City/Town (cense NumDer Master ❑ Journeyman APPROVED(OFFICE USE ONLY r � , Date. �. . � . .. No°':�+ TOWN OF NORTH ANDOVER i PERMIT FOF(PE MBING �f ,SSACHUSE� This certifies that .I?`.�`! has permission to perform . . plumbing in the buildings of . . .`. . s at lL `'/t � <` (`7 . . . . .� . . . . . . . . . . . . . . . . . . . . . . , North Andover, Mass. Fee. Z G. . .Lic. No..))YJ .? . . . . . . . Lj — . . . . . . . p PLUMBING INSPECTOR INSPECTOR Check # 7 7 ` 7 - HORTM . 4,.6 6 6 TOWN OF NORTH ANDOVER ° - PERMIT FOR GAS INSTALLATION SACH �4 c This certifies that . . Il . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .�, . .�' �.s . . . . . . . . . North Andover, Mass. Fee. .1'' . Lic. No..9. GAS INSPECTOR Check# �l � :6408 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIlT M DO GAS F rnNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 1/(o co wt ST Permit# K� 'L Owner's Name Amount$ 6 .� New D Renovation Replacement ® Plans Submitted ❑ w c� o w ,n z u w x rA z F a O °' > w Q x a x w a � N q x z d w Q z H F w O > w F ., r w E, x o x 3 0 U z > o a H o SU B-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) ' Check one: Certificate Installin Coman Name PA LLO1� A A/ PLUM�1ej� g P Y P0 0 Corp. Address 1 0 p�X E??-- Partner. Business Telepnone &B S: y;p�J Firm/Co. Name of Licensed Plumber'or Gas Fitter Tae, INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes 13 NoO If you have checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy 13 Other type of indemnity D Bond 13 Owner's Insurance Waiver: l,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 13 Agent 0 hereby certify that all of the details and information 1 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber -?, y5 33 City/Town•. Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ® Journeyman Date.A r....... .. it 40RTPI 0 ",to '6.6 ,"to ,"to 6 6 TOWN OF NORTH ANDOVER 4 -4*,WWW- - PERMIT FOR GAS INSTALLATION CHUS ES This certifies that . has permission for gas installation . . . . s .411 . . . . . . . . in the buildings of . . .! C. .... . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . North Andover, Mass. . . . . . . . . . . . . . . . .I Fee. . Lic. No. . . ! GA INSPECTOR Check# 4227 MASSACHUSETTS UNIFORM APPLICATON FOR PERMI r TO DO GRAS FITTING (Type or print) /ate NORTH ANDOVER,MASSACHUSETTS `�— Building Locations j /9 V ��S 017 / Permit# Amount$ Owner's Name New 1 Renovation Replacement Plans Submitted GW � G7 � Z � d CC � � G7 � C EW. �" d - � o � a � � � a° � a °w H o ISUB-BASEM ENT AASEM ENT 1ST. FLOOR l 2ND. FLOOR 1 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH'. FLOOR STH. FLOOR 1111111 1H (Print or type) CW one: CertificateateInstalling Company Name, ( orp. Address (I r)D l Partner. Business Telephone ��f, �i -�y 3 F—] Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 NoO If you have checked M please in"e e 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: Signature of Owner or Owner's Agent Owner 0 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 and Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code h er 4 General Laws. By: Signature of icensed Plumber Or Gas Fitter Title Plumber 4- � City/Town 0 Gas Fitter Licenge Number 0-master APPROVED(OFFICE USE ONLY) rj Journeyman Date.le?.- s• • C•-2 ".O RT TOWN OF NORTH ANDOVER . o ° PERMIT FOR PLUMBING 41 SS US ,f / This certifies that . .6�-1'4 `'��' � �.%. • • •! • . • � • • • • • • • • • • • • • has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . • . . . . at North Andover, Mass. Fee. Lie. No../G. . . . . . . ? . . . . . . . . . ;--PLUMBING INSPECTOR Check # 5-4E 7/ 5 .7 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date `j57-0Z Building Location I P6P5 L Owners Name. >;� Sc 1 5 c� Permit# s^yY Amount G.3 S .� Type of Occupancy.. rve',"I New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES Cn Cc z a a � Cn � i xUn � � 3 w 3 x � N x con W A A F Q pa SLS1fit4V>)r � BA9 VEW �` ISIC)FIflOR 1 i r 1 3M Hf= J 4M Hj" J 6M ROCK j SIS.FtOCR 1 (Print or type) Check one: / Certificate Installing Company Name C.,//A 6Vc Corp. ��Ca Address P•o 0'>e 170-1 Partner. 4m uc.�l C.C. ma j atg3 1 Business Telephone 47q j?y_r7[9 3 1Firm/Co. Name of Licensed Plumber: _ Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ uuu 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 rfo d unde Pe it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta lu ing Co an Chapter 142 the General Laws. i By: igna ure Of ice ea iriumDer Type of PI bing License Title D 3 City/Town icense u er r Master Journeyman ❑ APPROVED(OFFICE USE ONLY ojectiv�1H ue>ssuea. `Unsafe Structures of the Mass. State official immediately upon being informed by anything attached thereto or connected �pect same and he shall forthwith in writing appears to him to be dangerous.j." f receipt of this notice to remedylthisdangerous Health Department 688-9540 Zoning Board of Appeals 688-9541 f , r � l Town of North Andover Building Departrnt?nt 27 Charles Stree# *�a North Andover, MA. 0184,E D. Robert Nicetta Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE —� JOB LOCATION �p � . Number Street Address Map/lot "HOMEOWNER S,o�I Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Tp Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage fan individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is irrtended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who CO' rtstnxds more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL I r i S i North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: C t 11el (Location of Facility) ignature of Permit Applicant l-o � Date NOTE: Demolition permit from the Tow'G of North Andover must be obtained for this project through the Office of the Buil;ing Inspector 1804 � s APPLICATION FOR SEWER SERVICE CONNECTION 'Z North Andover, Mass. vrn— Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works; ,(c The premises are known as No. let ! PScne Street or subdivision lot no. Owner Address Contractor Address Applicant's Sig re` , PERMIT TO CONNECT WITH SEWER MAIN r The Division of Public Works hereby grants permission to /tom/1 l�/I S I G}cz- to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.: Division of Public Works By Inspected by Date See back for rules and regulations I I 1169 ` i ! APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. U/ Application by the undersigned is hereby made to connect with the town water main in z7v Street, subject to the rules and regulations of the Division of Public Works. �, �L The premises are known as No. f 1�� 'GIGO Street or subdivision lot no. �-� Q Q e%- 42 T, 1 c//A ��'i r' (2c Owner Address Contractor 4pp I i is i a e I i � << � 2�D•s� f PERMIT TO CONNECT WITH WATER MAIN / 1 The Board of Public Works hereby grants permission to i j to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. B rd of Public Wor s By Inspected by I I Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC ,WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. Telephone(978)655-09 DIRECTOR Fax(978)6889573 FI NORTh 9 32 4� 6 0 O L H � F 49 Y 9SS4CKustit DRIVEWAY PERMIT DATE 7- 7 — e>2: LOCATION I BUILDER phone I OWNER cbf-1-5 � phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENTS OFFICE BEFORE 'FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. X r Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release lb Checked By/Date CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE:07/02/02 DATE OF PLANS:6-02-02 PROJECT INFORMATION: SCIACCA RESIDENCE COMPLIANCE:Passes Maximum UA=359 Your Home=300 16.4%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1876 30.0 0.0 66 Wall 1:Wood Frame, 16"o.c. 1592 19.0 0.0 80 Window 1:Wood Frame,Double Pane with Low-E 127 0.340 43 Door 2: Solid 24 0.510 12 Door 4:Glass 33 0.330 11 Door 3:Glass 78 0.330 26 Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 1876 30.0 0.0 62 Boiler 2:Gas-Fired Steam,80 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 Massachusetts Energy Code requirements'.in MECcheck Version 3.2 Release lb. 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 780CMR 1310 and J4.4. Builder/Designer Date 5 MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release lb DATE:07/02/02 Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] 1. Wall 1: Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: Windows: [ ] 1. Window 1:Wood Frame,Double Pane with Low-E,U-factor:0.340 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: Doors: [ ] 1. Door 2:Solid,U-factor:0.510 Comments: [ ] 2. Door 4:Glass,U-factor:0.330 #Panes Frame Type Thermal Break?[ }Yes( ]No Comments: [ ] 3. Door 3:Glass,U-factor:0.330 #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: Floors: ( ] 1. Floor 1:All-Wood Joist/Truss,Over Unconditioned Space,R-30.0 cavity insulation Comments: Heating and Cooling Equipment: [ } 1. Boiler 2:Gas-Fired Steam,80 AFUE or higher' Make and Model Number Air Leakage: [ ] Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: I. 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 AS�M E 283,with no more than 2.0 cf n(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 difference and shall be labeled. Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling 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 plans or specifications. I 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 conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. f Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: ( ] Insulate circulating hot water pipes to the levels in Table 1. 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 non-depletable sources.] Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120°F or chilled fluids below 55°F must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by PiDe Sizes Heated Water Non-Circulating Runouts lCirculating Mains and Runouts Temperature(F) Up to 1„ Up to 1.25" 4.5"to 2.0" Over 2" 170-180 0.5 1.0 !1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts I"and Less 1.25"to 2" 2.5"to 4" Heating Systems ' Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) i i i AN FORM U - LOQ' -RELE.ASE FORM �`3 '0 -1-- INSTRUCTIONS: 1 ---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. F **************************APPLICANT FILLS OUT THIS SECTION*********************** 141 PLICANT F117 &C-0 ✓GIA7CC1, PHONE 6 �-�9d LOCATION: Assessor's Map Number PARCEL SUBDIVISION QLOT(S) T STREE /?�'S Co'27— ST. NUMBER i a ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERAVVATER CONNECTIONS —Z--Z DRIVEWAY E MIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 im t �F I I i I �l r i 6 . SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Descri tion of Proposed Work(check atl applicable) New Construction COY Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition R", Accessory Bldg. ❑ Demolition 1- Other ❑ Specify Brief Description of Proposed Work: l idlex 92e-4 w&arl o2 �/b refo.vbi /i�9 UHC C e g2P� /L1 30�X Lfo7'� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFjICIAI >(fSNi;Y Completed b rniit a Iicant ° � ' � AM . 1. Building �-- /,/, (a) Building Permit Fee Uvv Multiplier 2 Electrical -A f�Q v (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical(HVAC) S-p 5 Fire Protection "/ Q b Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 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 SiNature of wn A ent Date NO. OF STORIES S fL rl o s 2 SIZE as X BASEMENT OR SLAB P,r SIZE OF FLOOR TIIVIBERS I o? 2 )( 3 �jb i SPAN j DIMENSIONS OF SILLS of .526 P wTll sexz DIMENSIONS OF POSTS 3 bac Dt1VIENSIONS OF GIRDERS a2 ) HEIGHT OF FOUNDATION g' THICKNESS SIZE OF FOOTING /0"X " mhj,o vS MATERIAL OF CHIlvINEY IS BUILDING ON SOLID OR FILLED LANTD OLtb IS BUILDING CONNECTED TO NATURAL GAS LINE TOWN OF NORTIT ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .. x' _ ` _ .F1111 11 BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: /Y / 1.4 Property Dimensions: xe7000- 3/, 3 o g -301 ZoninR Efistrict Pr osed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard RegWred Provide Required Provided Required Provided 3O /,57, -1.f ' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: / 1.8 Sewerage Disposal System: Public V Private 0 Zone Outside Flood Zone fY Municipal @— On Site Disposal System ❑ aaaal SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Ch? S - AIO�W A,�D�r'Pr�/ii4 Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number aan Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name M Registration Number r Address r Z Expiration Date ^ Signature Telephone Y/ eview Narrative owing narrative is provided to further explain the reasons for denial for the application/ for the property indicated on the reverse side�e: #1iV� ' ��{C GN Y _-1 '� �� '�'h, � q�.`�fX•tJ1/f�t�i*R 0 qt �.'•� ,ii�,•�, ,�� :inti '!., f�i�.�•�`r 'ti� `� � au•:�.f � �tti!r��f� 1`r.►�t.rca "tiu�h +.*�`o� � .:� � Y.rks^',.,•c�*, ;';�; �r:. s.�;;s�:. 4., A boo- Ao n r!ev.e�.�iry • Pen Groe41.b( ^ ♦N O -4 �RN v N Gv •L Cd Al eeAAI •Z710^' m Lj � �a I ' ;.� :' • �� Zoning Bylaw Denial > Town Of North Andover Building Department "nC. � "+° 27 Charles St. North Andmker, MA. 01845 .A�{3 s• HU50 Phone 978-688-9546 Fax 978.688-9542 et: Stre - /�e•3�o - cS . Ma /Lot: II oZ A I cant: gR/clot $ c♦v ct,.4 Re uest• x'yat�.aY X d L ' A Or "a?b o Z a•v t7i.��/ v.0• Please be advised"that after review of your Applicat on and Plans thaat r�ur Application is DEMI D for.th .fallo i 'ng Brylaw•reasons:,%G " :.\ Zoning ' Item .. Notes Item A Lot Area Notes F Frontage 1 Lot area Insufficient - 1 Fro t _Insufficient 2 Lot AmaaPis1mg asa .-�% 2 Frontage Complies 3 Lot Area Complies e S 3 Preexisting frontage 4 Insufficient Information 4 Ins Icient Inform tion B Use , .a ►� n is 5 Nb accatiss'd$e? oRta e zAltbwed G S G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexist ng C�OMPIFFS 4 Sp�eaiel P�hrh f'e 3 P 'existing CBA 5 Insufficient Information 4� Ms�fFicierlt ,fi6+lrhetion C Setback H Building Height 1 All setbacks comply yes 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient - `rte- 3 4 Right Side Insufficient 3 Preexisting Height 4 Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexisting setback s 1 � Covera a exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed5 3 Coverage Preexisting 1 Not in Watershed Y e S 4--insufficient Information 2 In Watershed �•� t�, r� \yw'r�" �� .. Iq ld3a JNlaline !JOIs!uolsslww mH o. UE)Wpeas Jaye30ldF N � loen68suo0pJ808 uuZ � QeaH aollod Gild :ol paaaa}aa o` 40•Ty 1y y,SJACNUs t� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number Date /1J `0 3 THI CERTIFIEST THE BUILDINGLOCATED ON //_ " _�/_�8 �n e-,-5 cof MAY BE OCCUPIED AS D� Ple , 'e `//'�!9, IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO PC24RI C Id S C% 07 CC a2 � 9� c Building Inspector Ii I w- a t' tAORTH Tovm of f tAndover 0 0dower, Mass., 1',J00 A �'A7E0 P'Pa„��+� S � � BOARD OF HEALTH PERMIT T D Food/Kitchen " Septic System �� L . BUILDING INSPECTOR THIS CERTIFIES THAT.... /� . �. r1�......... .... .. Foundation C r has permission to erect.... . . .�........................ buildings on ....1..� ...... ^'S t® � r - .... ............... . Rough to be occupied as..A N 1.....10.'........ �..h... �N .... M+ .....l N. ....V IV. ................................................... chimney provided that the person accepting this permit shall in every respect conforM to the terms of the application on file in Finall /3— -- - this_office,-and-to-the-provisions-of.-the-Codes-and_-By-Laws-relating-to-the-Inspection;Alteration-and-Constr-ucti n-of � � -- - Buildings in the Town of North Andover. /-�Ie►Me S /`� �' s S�sN'I ej#r`&t T U r t PLUMBING IN ECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ( &bat� � SA 71 a o O& Y g / 3 G 3 - .�� ,�� r Oj!w EN a ��l n 1PERTMFF llis S,� � ��'` 1 r `'. ' ";�;f ELECTRICAL INSPECTOUNLE R'' �r e....... BUILDING INSPECTOR Eial Occ t.lpL r cy Pem,i i.t eq,Z-,i1"£'d t0 Occ-,.i py tui ldmg GAS INSPECTOR Rough r 7 Display in a Conspicuous Place on the Premises — Do Not Remove , No Lathing or Dry Wall To Be Done 6 FIRE EJ'FPAffMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. j1, SEE REVERSE SIDE II Town of North Andover Building Department x�a qy��?~ � h�•6�� 27 Charles Street North Andover,Massachusetts 01845 _ (978) 688-9545 Fax(978) 688-9542, OR tOCN^CflpfvKK 1 ATeo APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS f CDJ� LOT NUMBER SUBDIVISION DATE REQUEST FILED i C:>3 DATE READY FOR INSPECTION S TEN (10)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE CHARGED IF THE STRUCES NOT MEET ALL APPLICABLE CODES. J SIGNATURE CIALUSE ONLY ROUTING D.P.W. —WATER ME DATE ��-63 D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRI R TO INSPECTION QUES ATE. SIGNATURE/DPW AUTHORIZATION PLAN OF;LAND LOCATED IN NORTH ANDOVER, MASS. SCALE)"=40' DATE:7/23/2002 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road NortHAndover, Mass. j 194.30' PLAN#3047 N.E.R.D. .4 MAP 82 PARCEL 8 y o I - o } 3 1,308 S.F. y J I � - 31' -- Gqj nvYj o O 75.00' N W 3&�- ExIsr_ GAR. O TO BE O EXIST.NSE. ) RAZED E QST. FND. #116 � to 234.75'TO COR. OF MOODY STREET 75.00' D.N.FND. 119.30' PRESCOTT STREET CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS � OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY ti AND SUCH USE IS FOR THE WITH THE ZONING ILES BYLAWS OF DETERMINATION OF ZONING No. 13972 �o NORTH ANDOVER CONFORMITY OR NON-CONFORMITY `n 9FC1StERE� ` WHEN BUILT WHEN CONSTRUCTED. �L LA1M g� "PwAnoo PLAN OF LAI D LOCATED IN NORTH ANDOVER, MASS. SCALE.1"=40' DATE.6/1712002 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. 194.30' PLAN#3047 N.E.R.D. MAP 82 PARCEL 8 . 0 0 31,308 S.F. 24' 26'+1- GAR. 6'+1GAR. 0 cV 75.00' 42' NEW 6 NEW EXIST ]AR GAR.f TO BE; -EXIST. HSE: RAZED: EXIST. O FND. GAR. w 21'+/ __ #116 i i w i 0 234.75'TO COR. OF MOODY STREE.. . 75.00' D.H. FND. 119.30' PRESCOTT STREET I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USEtN Oi THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE 1S FOR THE S WITH THE ZONING DETERMINATION OF ZONING •13972 BYLAWS OF ,� AfC1STERt� NORTH ANDOVER CONFORMITY OR NON-CONFORMITY sic ,�t AMO s WHEN BUILT WHEN CONSTRUCTED. 17 v Location l/ r r s o S No. I Date 8-.2f - U a NORTH TOWN OF NORTH ANDOVER f �,y 3? ' O F � w p 6 Certificate of Occupancy $ Building/Frame Permit Fee $ swCHus Foundation Permit Fee $ /D 0 Other Permit Fee $ TOTAL $ Check # CD> 15803 IRS��-�--- 'building Inspector - - - - 8s9 11Im139 9rlryl;ijyr,s,1..,9 .At - yy a JA,Or xnfiD -5i A - _ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT .kPOLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING JL4$CCh0».f0r OW Il!C©Hj BUILDING PERMIT NUMBER: DATE ISSUED: m X SIGNATURE: Building Commissioner/I or of BuildingsDate SECTION 1-SITE INFORMATION z 1.1 Property Add 1.2 Assessors Map and Parcel Number: O es�� S Z — '% AWLS /� /�1 j" C� ti[ap Number Parcel `lumber I 1.3 Zoning Information: 1.4 Troperty Dimensions: ' f f i Zonin-District Proposed Use Lot Area sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 3 77" � ` I.S. Flood Zone Information: 1.8 1.7 Water Supp Vt.G.L.C.10. 54) Sewerage Disposal System: Public Private ❑ ZOne Outside Flood Zone ."funicipal &i-' Ott Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name(Print) Address!for Service: Signature Telephone , 2.2 Owner of Record: Name PrintAddress for Service: z M i Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable G Licensed Construction Supervisor: i License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable C Company Name l i>I Registration Number r :address r Z Expiration Date 5¢tature Telephone f SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance atlidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denialof file issuance of the building permit. Sivned affidavit Attached Yes.......Ll No.......0 SECTION 5 Description of Proposed Work check all applicable-) New Construction L� Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition e— Accessory Bldg. F, Demolition Other ❑ SpeciN 13n.-I Description of Proposed Work: / >✓ 2i[l C�_ %7 .7y /��'i f' /s�, / TD/°!f 4/'Pi7 oD/-J e-o?Z�� f D 'vim�T/y�/1 o LJ e s SECTION 6- ESTINLATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY —Completed by permit applicant 1. Building (a) Building Permit Fee Multi lier 4:;,2 Electrical 1 v? 00 (b) Estimated Total Cost of l Construction y(�.S/ 1�60 Building.:rmit ice(a) , r5) Mechapical(HVAC) r` o 5 Fire Protection j p 6 Total (1+2+3-4+5) j1l OCheck Number SECTIOiti 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTR.-XCTOR APPLIES FOR BUILDING PERMIT a J— as Opener/Authorized Agent of subject property ! Hereby authorize to act on behalf; in all matters relative to, ork authorized by this building permit application. Sl2nalLire of ONiIler Date SECTION 7b OWNER/AUTHORIZED AGENT DECLAR4TION ICix, Scar/G' as Owner/Authorized Agent of subject Property Elen_b):declare that the staremenis and information on the foregoing application are true and accurate,to the best ofmv knowledge erd __Ilet Prin! "a ne Si.-mature of ismer/A2ent Date I NO. OF S"COI2�S SIZE l;:\5;:�;1ENT OR SLAB �S'V1. Oi I LC)OR iTb1BERS 3e.� Di�,4lNSIONS Ol�SILLS I)1±4lENSIONS OF POSTS 11)!x, ENS(O±NS OF CHU)ERS :L.i ",T'"UF FOUi`il)!\"f1ON THICKNESS t)F 1,0'01'1NU X IS :;;r 1I.!)ING ON SOL.iD OR i !LLEI) L:\ND NA-111R\I.ciAS LINE Town of North Andover a4 NORTH qti Building Department �? g�tis� 616 OCL 27 Charles Street o North Andover, Massachusetts 01845 (978)688-9545 Fax (978) 688-9542 9qRrto 'Pa• � Building Demolition Affidavit �SSACHU`�� DATE � (�� OWNERS NAME&ADDRESS / lo7JZ/C%>9 ✓� Jia PROPERTY LOCATION �/b ��SCy;�7— DESCRIPTION IdL2-X e- CONTRACTORS NAME&ADDRESS �� C��-✓lac. /2� a� f �. y DEPARTMENT SIGN-OFFS ,D.P.W./WATER GAS lye S / ELECTRIC if✓ TELEPHONE AI-Q CABLE xvJ TAXES POLICE FIRE (N V cK .0Z Com`-► e. /�►a �i EXTERMINATOR L/ DUMPSTER-ON/OFF STREE`1(0FFSgF/� M/4((&-eC DIG SAFE NUMBER c�O BLDG. INSPECTOR DATE RECD - C v FORM U - LOT RELEdSE FORM r e (4- d a- 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. ****************r/''*************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT CIA �� l.c��C PHONE � ��g" Roy LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ]OR eSr.0*—� ST. NUMBER � a ************************************OFFICIAL USE ONLY*********************************** REC MENDATIONSORTOWN AGENTS: CO f ERVATION ADMINIST TOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY E MIT FIRE DEPARTMEN RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 fin PLAN OFLAND LOCATED IN! NORTH ANDOVER, MASS. SCALE.-l'!--40' DA TE.7/23*002 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North'Andoyer, Mass. 194.30' PLAN#3047 N.E R.D. T1'MAP 82 PARCEL 80o ti 31,308 S.F. 3 o d4 GAR. 2.4'--- 75.00' NEW NEW 36' EXIST- Fxsr GAR. TO BE.' Q EXIST.HSE.- RAZEDEXIST., x FND. GAR. J 16 234.75'TO COR. OF MOODY STREEV 75.00' D.H.FND. 119.30' PRESCOTT, STREET I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR,,THE WITH THE ZONING ILES BY LAWS OF DETERMINATION OF ZONING . 13972 NORTH ANDOVER CONFORMITY OR NON-CONFORMITY ioa�LIST WHEN BUILT WHEN CONSTRUCTED. ' Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release 1 b Checked By/Date CITY:North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE:08/13/02 DATE OF PLANS: 7-02-02 PROJECT INFORMATION: SCIACCA RESIDENCE 116 PRESCOTT ST N. ANDOVER,MA COMPLIANCE:Passes Maximum UA=330 Your Home=291 11.8%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 2:Flat Ceiling or Scissor Truss 960 30.0 0.0 34 Wall 2:Wood Frame, 16"o.c. 1666 19.0 0.0 75 Window 5: Wood Frame,Double Pane with Low-E 272 0.340 92 Door 3:Glass 126 0.270 34 Door 5: Solid 21 0.100 2 Floor 2:All-Wood Joist/Truss,Over Unconditioned Space 1624 30.0 0.0 54 Boiler 3:Gas-Fired Steam,80 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permitapplication. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release lb. 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 780CMR 1310 and J4.4. Builder/Designer Date MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release 1 b DATE:08/13/02 Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 2:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments-, Above-Grade Walls: [ ] I. Wall 2: Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: Windows: j ) 1. Window 5: Wood Frame,Double Pane with Low-E,U-factor:0.340 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ J Yes[ J No Comments: Doors: [ ] 1. Door 3: Glass,U-factor:0.270 #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: j l l 2. Door 5: Solid, U-factor: 0.100 Comments: Floors: [ ] 1. Floor 2:All-Wood Joist/Truss,Over Unconditioned Space,R-30.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Boiler 3:Gas-Fired Steam,80 AFUE or higher Make and Model Number Air)Leakage: [ ) Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 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 283,with no more than 2.0 cf n(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 difference and shall be labeled. Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ ) Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling 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 plans or specifications. I Duct Insulation: [ ] I Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] I All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ) I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. ( Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the I levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. •Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) i Ot r.owrh Town of North Andover �a Building Department ►9 M # 9 27 Chartes Street x ;. North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 °(978) 688-9542 Fax HOMEOWNER UCENSE EXEMPTION Please print /, DATE / / JOB LOCATION Number Street Address Map/lot "HGM //y��/�%•v S�/°�l c33 n EOW R NE Name Home Phone A Work Phone PRESENT MAILING ADORESS //z!�' vtiS ,roDn City Town State T.lp Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (Stade Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling.attached or detached structures ac- cessory to such use and/or farm structures, A person who constnsds more than one home in a two-year period shall not be'wnsidered a homeowner. The undersigned "homeowner'assumes responsibility for compliance with the State Building Cede and other Applicable codes, by naves, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL North Andover Budding Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S na in of shall beuilding ermit Number is that the debris resulting from this work disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: H (Location of Facility) (Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1804 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. ` Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. Ce9 Street The premises are known as No. or subdivision lot no. TAddress Owner Contractor Address Applicant's Sig e PERMIT TO CONNECT WITH SEWER MAIN f The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations 1169 APPLICATION FOR WATER SERVICE CONNECTION Zee North Andover, Mass. U� 2 ,� Application by the undersigned is hereby made to connect with the town water main in Street, subject to the rules and regulations of the Division of Public Works. *41 l- Street The premises are known as No._ I or subdivision lot no. Owner Address Contractor Addr App ica is it a e V/ 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 Street Street subject to the rules and regulations of the Division of Public Works. B rdof Public Wor s By Inspected by Date See back for rules and regulations GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER13UILDING 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 as requested below. Permit Applicant Property address Map Parcel 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 ofthis 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 rmmechanism approved bythe 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 onetime 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 SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS S FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS ATURE DAT THIS FORM T E ATTACHED TO THE BUILDING PERMIT APPLICATION NORTH E own of '_�:: _ rn No. z o = A dover, Mass. O� ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ` BUILDING INSPECTOR THIS CERTIFIES THAT.... ...A.. . �.�s.�. ........ C�.�.. .C� C.A _ . . ....................................... ............... ............ Foundation.... ' 11.4 has permission to erect.... .... .�......:.... buildings on .... ...... ................. ............... .........r............. Rough to be occupied as A. vq�.� .4....P*.o.hiA� V� .�............................................. Chimney .. ..... .... ........... ... . ................provided that the person accepting this permit shall in every respect conor�to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construct, n of Buildings-in-the-Town of North Andover. /-jr^M# /y I►w00 *0 t'it♦StIN� ,=f0*44_Y.r i< PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. L ••A"# V �/� a S4 Rough M N O w W t,/J AO Final laa/ s PERMIT EXPIRES IN 6� . ELECTRICAL INSPECTOR UNLESS CONSTRU ON TARTS Rough li . ....... Service ... .... .. A. rMlaki ... ........ ...... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the.Building Inspector. Burner Street No. SEE REVERSE.SIDE Smoke Det. ORTIy Town o Andover:: SZ No. y C, = o yy ndover, Mass., T Q - LAKE T COCMICHE WICK ADRATED ACHUS IT FOR EXC-A V- -A' T-1-0-N AND FOU-N-DAT 10-N- THIS CERTIFIES THAT .......... ......r�. l�.....-- ..�.��.C.�t. .................................................................... has permission to excavate and pour foundation at ... ........A!ApAlto .......a-fft................ for the purpose of.... I IYr!V., /�. �� DIV f�h �N if .....JL° �........... �� .. ..................... ...... ............ ....... The person accepting this permit must return to the office of the B ilding Inspector a certified plot plan show of building thereon before Foundation will be ins ected. A WXY RsO1y 1% ey i%*1143 %*@k%qL441f - ` roornl ��la 13A1'�• � ��a�l A�'•►e�� VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. ...... ....... C ..............`............. BUILDING INSPECTOR Location Pr-eS c o 7J`� No. Date �- 7 Gf NG RT: TOWN OF NORTH ANDOVER Certificate of Occupancy $ �"�s'••°'�,<� Building/Frame Permit Fee $ � ACNus Foundation Permit Fee $ j Other Permit Fee $ TOTAL $ Check 15990 Building Inspector --- - — ' _nciisooi .�. mow...•.r . .. ... > !!"t,�• "`.Y �'�� r • H�$ v-)nsc-»30 to ctsoilifls0 s9:; 31! lqq 1ofit0 _ JATOT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A'ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. ic SIGNATURE: Building Commissioner/1 for of Blu din Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parce Number 1.3 Zoning Information: 1.4 Property Dimensions: �3/wog /�3p� Zoning District osed se Lot Areas Fronta e ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide R red Provided Required Provided 3v' 30' r/,S' 30' 921 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: ! 1.8 Sewerage Disposal System: D Public t3/ Private ❑ Zone Outside Flood Zone 8' Municipal B — On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record (►� /f /A4,;0100 �yAC�� /� Go'�c�i yI'/d�l/�/L Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Ct%struction Supervisor: Not Applicable ❑ Licensed Consttdtction Supervisor: O License Number Address Expiration Date ; ic Signature Telephone r 3.2 Registered Home Improvement Contractor. Not Applicable ❑ v Company Name - Registration Number r Address r ^� Signature Telephone Expiration Date Y♦ • o SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction E'er Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: AyG�YP/JZS oe 1.-2 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 4"e' OFFICIALUSE ONLY ` Completed by permit a licant � _''� � `° 1. Building e 71 oo✓ (a) Building Permit Fee / Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing �� Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 DO Check Number SECTION 7a OWNER AUTHoRVATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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. -Signature of Owner Date SECTIIONN 7b/ OWNER/AUTHORIZED AGENT DECLARATION 1, /%o 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 111VIC,f'0 fc'/.a CCA d Print We + x Si ature of /A ent Date NO.OF STORIES /— eG,e SIZE / .2 6 BASEMENT OR SLAB ti7.A RD SIZE OF FLOOR TIlvIBERS 1 o?a+lU"R 7, 2 3 SPAN ° / ' ar 'DIMENSIONS OF SILLS DIMENSIONS OF POSTS 40 3e DI-WNSIONS OF GIRDERS k/o" -HEIGHT OF FOUNDATION THICKNESS e-/.e SIZE OF FOOTING /d"o14010114e )e 4/ S ' X _MA TIERIAL OF CHRvINEY /.4 IS BUILDING ON SOLID OR FILLED LAND sv/io IS BUILDING CONNECTED TO NATURAL GAS LINE A+ Imoo CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.1"=40' ; DATE.9/12/2002 i Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. 194.30' PLAN 43047 N.E.R.D. MAP 82 PARCEL 8 ' 00 31,308 S.F. 0 0 t a, 31' o / EXIST.: 0 y l6 FND. N 75.00' lot � l I + EXIST. EXIST. FND. FND. 36' J�IR _ fi ' IXlST. p EXIST.HSL GAR. € FND. '+- #116 F' w 0 234.75'TO COR. 75.00' OF MOODY STREE ._ 119.30' D.H.FND. PRESCOTT STREET . I CERTIFY THAT, OFFSETS SHOWN ARE FOR THE USE OF THE OFFSETS o� y� s SHOWN COMPLY OF THE BUILDING INSPECTOR ONLY CAND SUCH USE IS FOR THE ILES y WITH THE ZONING 0.13972 C0 DETERMINATION OF ZONING � gfl�EVO �t NORTH ANDOVER BYLAWS OF CONFORMITY OR NON-CONFORMITY s�oa�t Lppp WHEN BUILT WHEN CONSTRUCTED. r Gj (Z 2✓O?/ ."t r� ,3to, P T. F/caqois}sj/6"a c. w� 1i' C A rJifl 7' — '7 7 � u 1 lD�' �lAMe4X 1S` de as� �' � �'^�s �x 10 be,aM a N S�Ac2J) r7� APPR�- Solid (ed9et 6 b1oayi-) I-Ar v � W� hop i N-I S/y x 54 d ,4r- 4 t7 o� X/b (e 419-A (xj w k4 it CIA J CD U S euveA4e nd Q�sfni2 kgs-e 1 v" x ILI T- l6 O.c. Wl so(ld Wow Q) lD"xqS:' foodNjs g4jjjl j S 36 Alg (MIA/) Wl PAa Y 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 PHONE l LOCATION: Assessor's Map Number PARCEL_- S SUBDIVISION -�-- LOT(S) STREET ST. NUMBER,& ************************************OFFICIAL USE ONLY*********************************** EC MMENDATIONS OF TOWN AGENTS: i CONSERVATION ADMINIST ATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised.9\97 jm f ^ North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number //16 is that the debris resulting from this work shall be disposed of in a properly licensed solid `waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Loc ion of acility) w Signature of Permit Applicant Date NOTE: Demolition permit from the Town.of North Andover must be obtained for this project through the Office of the Building Inspector NORTH ... E Town 0 :. Andover No. T OLA E T - sq^��' dower Mass. COC HtCMFvv ADRATED C2 S 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..... 1 .�.�`.�.�............... ..��.�...�.�...� Foundation has permission to erect....�'..� .. .`. buildings on .......11.1.......... ^e.:S,�. .. ......a..� Rough to be occupied as... ."..I... .. .I... ..........0..0.+...so........ '�C-� s Chimney .......................................... . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in"tlie Town of-North Andover. sa PLUMBING INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Permit. Rough 9 9 g PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION SVRTS ELECTRICAL INSPECTOR Rough ....... Service ��DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. e 4092 pj Date..... . 1. NORTH A TOWN OF NORTH ANDOVER PERMIT FOR WIRING US This certifies that ................................ /......................................... has permission to perform .........A/............. ...... :wiring in the building of......... ................................................... At .... .. a... ..... ... orh A;doj . ..... ... . .................. ............ ol-U ........... lee..�M(I,-.x0 Lic.N .......... ................ ELECTRICAL INS CfOR Check # Offici se.Qn p Permit No _ °d s` Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527.CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date O To the InspMoro fres: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. 116 Location(Street&Nu ` I Owner or Tenant Owner's Addressp Is this permit in conjunction with a building permit Yes tj--� No ❑ (Check Appropriate Box) Purpose of Building 1 V. 412-w Utility Authorization No. Za V 2 .� EAsnng Servi ce__,/a=) Amps Vohs Overhead ®--- Undgmd ❑ No.of Meters Neve Servicets Overhead Undgmd ❑ No.of Meters 2(3r AmpsA��Voi Number of Feeders and Ampacity. Location and Nature of,Proposed Electrical Work �} Total No.of Lighting OutletsNo.of Hot fuse No.of Transformers KVA Above '❑ In ❑ No.of Lighting Fbdures a Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units NoAl.Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.`o_f.Ran es No of Air Cond Tons Initiating Devices Heat Total_ Total No of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers S Area Heating KW DetectionfSounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro,Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = It you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = .(Please Specify) . (Eikpiration Date) Estimated Value of Electrical Works Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME / LIC.NO. /, / LI>ensee � C-.I/1 Y �S S Signature —ff � / LIC.NO. c5_ 2-2-(Qi t� Bus.Tel No. Address Aft Tel.No. OWNER'S 1 S RANC WAIytR: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Law .And that my signature on this permit application waives this Tont lrement. Owner Agent (Please Check one) Telephone No. den4,0 0701 PERMIFI+EE $ ignatur of Owner rAgent) Location No. q Date NORTFTOWN OF NORTH ANDOVER 3? •. •• O Mr9 Certificate of Occupancy $ NuBuilding/Frame Permit Fee $ �ts Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 18 3 15867 Building Inspector Rij a c� CERTIFIED PLOT PLAN I,-Suf Z) 25-a I- LOCATED IN NORTH ANDOVER, MASS. %Y,\u S Q n,,-49 SCALE.-I"=40' DATE:9/12/2002 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. 194.30' PLAN#3047 N.TD. :-�,jMAP X82 PARC E0 o . 31,308 S.F. 0 0 31' 0 0 EXIST.' p FND. CNN 75.00' ;, 21'+ r EXIST. EXIST. FND. FND. 36' GAR. Q SEXIST.HS GAR. FND. #116 L W ' TO COR. 234. 5 , ODY STREE _ 75.00 OF NO30' 119 D.H.FND. PRESCOTT STREET I CERTIFY THATOFFSETS SHOWN ARE FOR THE USE OF THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE ILES H WITH THE ZONING DETERMINATION OF ZONING 013972' t�K +� BYLAWS OF CONFORMITY OR NON-CONFORMITY �'�'�a�L Lao g° NORTH ANDOVER WHEN BUILT WHEN CONSTRUCTED. Gf !Z 2,pO,L TOWN OF NORTH ANDOVER BUILDING DEPARTMENT i .%PPLICATION TO CONSTRUCT REPAIR RENOVATE, OR DEMOLISH At ONE OR TWO FAMILY DWELLING m T1us Seco>aa'or O�tiltaai Dae OsI BUILDING PER1�4T NUMBER: ISSUED: DATE ! SIGNATURE: (G - Building Commissioner/I d& l'Buildings Date Z SECTION 1-SITE INFOR��IATION 1.1 Property Add 1.2 Assessors.h and Parcel Number: O g� ��✓ �, X-06 �� Map Number Parcel Number i 1.3 Zoning Information: 1.4 Property Dimensions: ' i Zoning District Proposed Use .Lot Area s1) Frontage ft 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.3. Flood Zone Information: 1.8 1.7 Wit r Supply M.G.L.C.40. 3 t) Sewerage Disposal System: Public Private 0 Zone Outside Flood Zone s/ Municipal on Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT -A Owner of Record � Name Print Address t dress for Service Signature Telephone 2.2 Owner of Record: i Name PrintAddress for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable C Licensed Construction Supervisor: O License Number Mn Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable C, Q Company Name M Registration Number r Wdress 1 — ---.- Expiration Date nz rr.laturc Celr hone Y' SECTION 4 -WORKERS COtNIPEINSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance allidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial"I'the Issuance of the building permit. Signed allidavit Attached Yes.......c l No.......0 SECTION 5 Descr4 tion of Pru osed "'--"':heck-.all a "cable 1 New Construction 11�— Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition B'• Accessory Bldg. (i Demolition Other 0 Specify Brief Description of Proposed Work: P lw6w i° 2e' oati 1 g' �P:r JTi �i �J e J J •SECTION 6 - ESTUNLATED CONSTRUCTION COSTS Item Es4 timEost(Dollar)to be OFFICIAL USE ONLY Com by ermit a licantI. Building � (a) Building Permit Fee )�$ al} 2 Electrical Multiplier e (b) Estimated Total Cost of t, Construction �I (o d0 �c7 !`• � � Blllldln�Peimlt ire(a) a 15)• , arical(HVAC)j o 1),13)6) - 6 Fire Protection p 6 Total (1+2+3-4+-5) O e2 Check Numb�r.. _• SECTION 7a OWNER AUTHORIZATION TO BE CON1PLETED WHEN ONVNERS AGENT OR CONTRACTOR APPLIES FOR BUILDMG PERMIT t f• ,as Owner/Authorized Agent of subject property a Hereby authorize to act on `A behalf; in all matters relative to%vork authorized by this building permit application. Sisnauu�of Omer Date l SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION y� as Owner/Authorized Agent of subject orop,er.v l ler_b:declare that the statenlenEs and information on the foregoing application are true and accurate, to the best of my knowledge and diet' C, re" PAe,�e� St Date ! NO. OF STOR1TS SIZE 13ASl•:,%!1:'NU OR Sf.AB `f�c Oi l l.(k.)R 7�.fLERS 1' )ND DiNIENSICiNS OF Sli•LS I)INIENSIONS OF I=OS-1"> OiNIE.NSIO.NS O i�lllDGRS 1i!.(tiirrOFfOtli`il A1'10 THICKNESS *�I/F OF FOU f:N(i X IS ;t`II.I� NG ON Sof.i()OR FI1.1.E:1.)LAND I0 N:\IIIR\I.6AS UNF. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: rn SIGNATURE: Building Commissioner/I for of Buildin � Date Z SECTION 1-SITE INFORMATION O 1.1 Property Ad 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1Z i 1.4 Property Dimensions: 9/,30& 1ey,30 ' Zonin District Proposed Use Lot'Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred I Provide Required Provided ReqWred Provided �' 30' ,S-' e /' ! 1.7 Watet S�rp M.G.L.C.40. rm 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public (Private 0 Zone Outside Flood Zone ®-- Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) / Address for Service 9 --Q Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z m Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name m Registration Number r Address r Z Expiration Date /1 Signature Telephone �l/ SECTION 4-WORKERS COMPENSATION(1VLG.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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction Rl-- Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition e Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: s�—��„ 4� Ar3> �► �� o��a��rag T)� �x sr�.��o y fe db / W;r) "O'Aa&q �,,7�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAI.I'SE �. Completed by permit applicant 1. Building < D 0n (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing / a L2 Building Permit fee(a)x(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 © Check Number SECTION 7a OWNER AUTHORI7AT ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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. -Signature of Owner Date -SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, /;OA/CUP fcac"e 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 /�i4�l C1,9 ..1�1•4�� Print e Si ature of weer/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 Ir 2ND 3RD _SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 2- MASSACHUSETTS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTINO 1 (Print or Type) C NORTH ANDOVER Mass. Date Building Location /16 lze°TcoC 7 —5,7000 Permit # / ?Old' Owners Name to /V Y_ New Renovation Replacement Plans Submitted D Y�y FIXTUP=c 0 � W y sc z ac t» N v a t- a t- w w yr c d V to F- •e s N 0: i-- >- x =Ul O F. it tu W O O = O W 1— tu w G 0. rt y 4 N W Z V w z ar w '� eL 0 D x LU m 1 < a Q a w w c� w d ? tt N C? a i- W >- u? py O Z O N Z Q u > C til 6 cz Q C O O W ._ O w i- a x O t7 U. [1 c7 ,t U Q > sue—ss�aT. , BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name ��,7,� /y/1v B,1Ot//�'/I/CCorp. Address o 3 % S/y/ S ?UPPP i Partner. lot-11P41 , /7fi 0/fir/ Firm/Co. Business Telephone: ,5-0 �- y5✓S /y<< Name of Licensed Plumber or Gas Fitter �1/a/�� /�fi�17//l Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity F--j 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 coverages. Signature of owner/agent of property Owner 17 Agent D 1 hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and 1nsaUations perforated under Permit irALed for this application wW-be in compliance with all pertinent provisions of tho Massachusetts State Gas Gude and Chapter 14I of the Genual Laws. By TYPE LICENSE: Plumber Title Gas fitter- Signatur of Licensed P or Gasfitter City/Town: Master Journeyman APPROVED (OFFICE USE ONLY) License Number a s Ba State Gas Company LIM, Y P Y GAS INSTALLATION AUTHORIZATION ate 3—t?'!?K Issued to Address For Installation of: BTU Input Restrictions BSG Representative e PERMIT ISSUED _ BY INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: ❑ Heating System (BTU Input ) ❑ Range ❑ Water Heater ❑ Clothes Dryer ❑ Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO.721 LAWRENCE,MA I POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 Date. ./...%l. ...... . NpRTH TOWN OF NORTH ANDOVER .e 6 p ' n PERMIT FOR GAS INSTALLATION � a 9SSACHUSES This certifies that . 1 . . .E.. ... .. . . . . . . . . . . i... . . Z. . . . . . . . . . . . has permission for gas installation . '�. .'�. . . . . . . . . . . . . . . . . . . ... in the buildings of . . °. . :. . . .�`. . �'. . .. . . . . . . . . . . . . . . . . . �. at . . ✓.t`. F. .`. . . . . . . . . . . . . . . . North Andover, Masi; Fee.-"?. . . . . Lic. No.. .'. .`. . . . '� -. .�. .:. . . b. . . . . . . . .. I A GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File Office U-e Only SOOKEGM ThIDIOMe Commonwealth of Massachusetts penle %0. Department of Public Safety Occupancy 16 roe Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave plant) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All Work to be performed In aceordance,wijh the Mascachuseru Eleeuieal Code, $27 CMR 12:00 e� (PLEASE PRIMP ULINK OR.TtYPE Z 0 ION) � Date cs(y a owit f ry 0.� tiu u Qr To the Inspector of Wires: The undersigned applies for a / permit to perform the electrical work described below. Location (Street b Hum r) l b ?Y'¢.S C,o f Owner or Tenant 6. J " b 5 g Owner's Address A? l� Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building 0_1 br% c"W±"1,6t Utility Authorization NO. To l- v K 2- Existing Service �O Amps_ jLo 12-q 0 Volts Overhead Undgrd❑ No. of Meters New Service )O o Amps 12u /'(I-L1U Volts Overhead Undgrd❑ No. of Meters N®ber of Feeders and Ampacity Location and Nature of Proposed Electrical Work -CAg'i e �y%( &I 61 No. of Lighting Outlets No. of Hot Tubs ~ No. of Transformers Total _. RVA R E: No. of Lighting Fixtures., =. Swimming,Pool Above In- �; srnd.❑grnd. ❑ Generators • KVA No. of Receptacle Outlets No.''of-Oil Burners No. of Emergency Lighting Battery Units of B. _ FIRE,ALARMS a .�Ho.��of•Zones ,.,: e ..... ,y h f'Ran es.T'�'.l"1': �•.i,u,L,,v• °:}. •ryr i ;nr., o t.Totaljy-' " .I'Y:.. No.t`of.D'eCeciion,:8ndr `ai5 - 8 r' No..of'Air Cond.; tons. r,.>a, Initiating^Devices;• No. of Disposals No. of Heats Total ToTonsKtaal No. of Sounding Devices No. of Dishwashers Space/Area Heating IBJ Npps� ofSelf Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑Municipal ❑Other Connection No. bf Water Heaters KW No, of o. o Low Voltage Signs Ballasts Wiring- No. -No. Hydro Massage Tubs No. of Rotors Total HP ' ` �' 15 � � t OTHER: INSURANCE COVERAGEt Pursuant to the requirements of Massachusetts General Lams I have a curreAcke Liabilit Insurance Policy including Completed Operations Coverage r its substantial equivalent. YNO I have submitted valid proof of same to this office. YE HO If you have chYES, please indicate the type of coverage-boy-checking the sppro ria .box. INSURANCE ® BOND ❑ OTHER❑ (Please Specify)�rL411Vl < K)jer- ins L4)2-_;M9 (Expiration-Wat-eT Estimated Value ofElectricalWtork $ =' Work to Start 2 + 1711YL`"�.[ InDate Requested: Rough Final W Signed a.Aer the,penalties of perjury: FIRM NAME 9bi f, 1 LIC.y NO.B-28-0. Licensee nfw KL-kCIYAV-"a'I k*/ siignature I kJ, LIC. N0: , ! Address 110E AX'_A 'AL _ 7l(B` Bus. 1. No. S 8-4 IN I Alt. 1. Ho. ' f S OWNER'S INSURANCE WAIVERt I am aware-that the Licensee does not have the insurance coverage or its. su - stantialquivalent as required by Massachusetts General Laws, an that my signature on this permit appl t n we vee is quir-tt-i-7 ent. Owner- Agent (Please check one) r _ ' Telephone No. -�}S�{- 1 1 I PERMIT FEE S �v (Slghs4kre of or gent Location No. Date TOWN OF NORTH AN-DOVER 0? • • Ow • ; , Certificate of Occupancy $ Building/Frame Permit Fee $ -T CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15540 Building Inspector � � r om {� �`�• - �-_� �`. is•. ...r'"� i;F `.��` r--'+. eirmitihoo w ' C , CJS iimisq `QriO JATOI A R�:u�3 ,Jt:)-J.f- F L 'Ld 1 Date.... 7A!! " 2175 NOR7F1 3?�� `��...°•�,��o` TOWN OF NORTH ANDOVER PERMIT FOR WIRING .o, 3 SS�cHusE� 4 This certifies that ..... .. . �'. ..V....�.�1. . �.'?..y....... . ......................... .'..................... J . has permission to perform ..../ '. ..c,t,.:c..l,'.........�. . .q?:.`lel .............. p wiring in the building of......kC.f7-111...... .... %� / / Yom... .................................. M at......11C.......�Iff—e-SC.0t.Sr............. .North Andover,Mass.'8 Fee.....i-�.. Lic.No...r-;'k6:?.......................................................... ELECTRICAL INSPECTOR c WO tip i WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File { TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 11§ BUILDING PERMIT NUMBER: DATE ISSUED: _ 2rc ic SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 000 Number -Parcel Number 1.3 Zoning Information: O 1.4 'Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Records^ Name(Print) Address for Service: gnature Telephone 2.2 Owner of Record: Name Print Address for Service: Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES go 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction'Supervisor: O License Number mn Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Address r s Expiration Date ^2 Signature Telephone Y, A SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial-of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) B-' Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SCC cti ? SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be {)FFICIA "USE ONLY � Completed by permit applicant z 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total. 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Heieby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION -;.eeef ,as Owner/Authorized Agent of subject pro y Hereby declare that the,statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief cl'_��4' 4S �G/ACCO Prin Sr ature of O er/A e Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 ND3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMfENSIONS 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 • ;• -. ..��;' Town of North Andover �r• � �,�Q . Building D+epartrtient `: a 27 Charles Street North Andover, MA. 01845 ; D. Robert Nicetta �rsw¢t�tis�4� Building Commissioner. (978.):60&-9545 - =(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print, DATE JOB LOCATION C2009 Number Street Address Map lot '.HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State T_rp Code The current.exemption for"homeowners"was extended to include.owner-aecupied:dwellings of two units or.less and to allow such homeowners to.engage an individuals hire.who:does. not possess a license,.provided that the.owner ads as sdperceisor. '(State Buddng Code Section 1'08.3.5.1) .DEFINITION OF HOMEWOWNER Person(s)who owns a parcel of land on which he/she resides or intendsto.reside,on which there is, or is intended to be,a one or two family dwelling,attached or detached stnrdums;ac_ cessory to such use and/or.farm str x:tures. A person who conshucts more Urn one home-in a two-year period shalt not be'considered a homeowner The undersigned*homeowner"assumes responsibility for compliance with the State.Building Code and other Applicable codes,by-laws, rules and.regulations, A. The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minima'm inspection procedures and requirements and that he/she will i comply with said ptocedures..and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 4*, a North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: S/ ZU s rl (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I %AOKTH Town of �:, 4 over O •:•`2 ` :'e`• li =-. T yOLA 'O dover, Mass., I�. COCKICKEWICK V %ds RATED 7 BOARD OF HEALTH PERMIT T D , Food/Kitchen Septic System THIS CERTIFIES THAT...... �� C�ofBUILDING INSPECTOR t S Sct> K Foundation has permission to erect... Q4"......... buildings on........ �l �it�O J Rough ... ................. ......................................................... �� y I �� I s`dol� X l{ IrV w Chimney to be occupied as.-W/40.."..4 ....................... .........................�.....................................! ........... y provided that the person accepting this permit shall In every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to Inspection, Afterati in and Construction of Buildings in the Town of North Andover. f snow, 0 /1O-0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough 6420&ftftftftw.. .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner r Street No. Smoke Det. SEE REVERSE SIDE 01* o � . Zoning Bylaw Denial Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 4SS�GNUSE� Phone,978-688-9545.Fak97$-688-9542 • 116 Street: Ma /Lot: a A licant: .9�`R/c/ae g ci d ee.4 Regjest: .Z.7l)e Z.g ..3D x'yat�.a xY d 6 ' Date: —S etbO Z A . crag .. aN v,u. Please be advised that after review of your Applicat'�o`n and Plans t at ur Application is DENT D for thg.follo ;i Hing Bylawxeasons:�E►'+�� ` Zonin Item Notes Item A Lot Area Notes F Frontage 1 Lot area Insufficient <--- 1 Fro t g Insufficient yl .,., 2 Lot A�aaPrlP.,�ci g ,�� -=� � >x 3 Lot Area Complies 2 Frontage Com lies e 5 3 Preexisting frontage 4 Insufficient Information 4 Ins Icient Inform tion F- ,, Ve B Use ,t� ,�,, ,, 5 rNo'abc"d8e? iitage `1` "Altawed 41 S G Contiguous Building Area 2 Not Allowed 3 UPist' 1 Insuffi lent Area se reexng (dot plil;S-^A U lye% 4 Speai�I F'�tT�fi i `' 3 P eexisting TC BA Insufficient Information 4.A maz]PFciettt ,f6W@tion C Setback H Building Height 2 Frontnt Insufficient 1 All setbackscomply- y z 1 Height Exceeds Maximum Insfficient G 3 Left Side Insufficient -L— Complies 4 Right Side Insufficient 3 Preexisting Height 4 5 Rear Insufficient Insufficient Information I 6 Preexisting setbacks 1 � Building Coverage Coverage exceeds maximum 7 Insufficient Information 2 Coverage Com lies D Watershed- r_ 5 3 Coverage Preexisting 1 Not in Watershed X r- S 4 Insufficient Information .2 In Watershed Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 - Not in district '�e. 2 Parkin Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parkin Remedyfor the above is checked below. Item # S ecial Permits PlanningBoard Item # Variance Site Plan Review Special Permit Access other than Fronta e S ecial Permit Setback Variance Fronta a Exce tion Lot Special Permit Parkin Variance Common Drivewa S ecial Permit Lot Area Variance -Congregate Housin S ecial Permit Her ht Variance Continuing Care Retirement Special Permit Variance for Si n IndeperElderl Housin S ecial Permit S ecial Permits Zoning Board S ecial Permit Non-Conformin Use ZBA Targe Estate Coniio S ecial Permit Planned Develo ment District Special Permit Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar Planned Residential S ecial Permit R-6 Densit S ecial Permit S ecial Permit for Sign Watershed S ecial Permit S ecial Permit reexistin nonconformin The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to .provide definitive answers-to the above reasons for DENIAL.—My inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided.atthe discretion of the Building Department.The attached document titled'Plan Review Narrative"shall beattached hereto and incorporated herein by reference. The building department will retain-all plans and documentation for the above file.You must file anew building permit application form and begin the permitting process' uilding Department Official Signature Application.Received — Application Denied Denial Sent: `7-6^'� If Faxed Phone Number/Date: r Plan(-Review Narrative The following narrative is provided to further explain the reasons for denial for the application/ permit for the property indicated on the reverse side: J A 5�✓ 4 '� /IV /�e71�iy a V O- f/•C�r I y t�N i'�►r '7�b s e G��•k l Z d.v .s, t�r 7/3 �4y a � • Pereroa.,14,If o � �a•v � �6 ) P/"CVINT/N 0 el AP CII'Lo Cd AV CYA.011P A0iV a T bIn,V Av-A N Referred To: Fire ' Police Health Conservation x Zonin Board PI de artmen #.F�Iblio`1NorJs . .tet, , Other Historica' orimmission BUILDING DEPT - 3? TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION ��SSACMUSEtt This certifies that 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` in the build75�. of . . . . .. . . �' !. . . . . . . . . . . . . . . . . . . . . . . . . k rd at ,/l.�. . . . . . . . . �� . ., North Andover, Mass. _ Fee.✓ . . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . GAS It� E OR Check# �� 4253