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HomeMy WebLinkAboutMiscellaneous - 120 WEYLAND CIRCLE 4/30/2018I I 9172 �SACMUS� Date. )J:41.1.... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING pp � This certifies that .. J?CA�?.. has permission to perform..9?,? (4.ti??P✓� ...#'! r�. S........ . plumbing in the buildings of ...SGlAr . Zc ......... at. ............. North Andover, Mass. Fee ..%I.SIU . Lic. No../o W . ............................. . PLUMBING INSPECTOR Check # 24 54 ave a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ you have checked Yes, please indicate the type of coverage by checking the appropriate box below. 'lability insurance policy ® Other type of indemnity ❑ Bond ✓NER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ssachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only nature of Owner or Owner's A ent Owner ❑ Agent ❑ iereby 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 nowledge and that all plumbing work and installations pertorrned under the permit Issued for this application will be in compliance with all artinent provision of the Massachusetts State Plumbing Co�� a�� r.►,a� t�qy of the General Laws. rown ROVED (OFFICE USE ONLY). Type of License: ❑ Plumber Signature of Lice#710lumber [Master Journeyman License Number: I 1 1 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: MA. Date: ZQ-(1 Permit# 'Building Location:Z (� -) O '� � �->� 1 C I�., Owners Name: I fyt ra 5chWq►'`i-Z Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ institutional ❑ Residential 0 New: ❑ Alteration: ❑ Renovation: ❑ Replacement: © Plans Submitted: Yes ❑ NoQ FIXTURES DEDICATED W z z0 U SYSTEMS .W >z 4Abeu 4A 45O 4A M �► d O D: W m x W� z Fa- OC a � z in Q Y 0 a to z Q a Q H Y N Q ( l7 W N z zQ © y W z OC a W :4N N .W a a' Q Y O Z W Q a a 3= z ae a .O ~ ac z W 4A 3 �n r Q x u d W W x _� ol! O W 3 3 W a, a V a m f. x a IA m c d h C 0 F- 0 O t� x u ]C z ' a > g O 99 O O H H z z Q 3 Q Q x+ 3 0 a ' W Q ~ 3 . 3 a U SUB BSMT. 'ASEMENT FLOOR I oZ FLOOR FLOOR FLOOR FLOOR FLOOR FLOOR FLOOR stalling Company Name:,, /h /a Check One Only Certificate # of MA rl untn R�oter 13a Corporation 2 5 4 Idress:_175 Maula_gT` City/Town: Stoughton State: MA ❑ Partnership isinessTel:-781-997 7044Fax: 7R1 7 _-j41 _RR1 ❑ Firm/Company Ime of Licensed Plumber: Daniel Huntress I' Sl1ReN1r`F rnvrn...r. ave a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ you have checked Yes, please indicate the type of coverage by checking the appropriate box below. 'lability insurance policy ® Other type of indemnity ❑ Bond ✓NER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ssachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only nature of Owner or Owner's A ent Owner ❑ Agent ❑ iereby 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 nowledge and that all plumbing work and installations pertorrned under the permit Issued for this application will be in compliance with all artinent provision of the Massachusetts State Plumbing Co�� a�� r.►,a� t�qy of the General Laws. rown ROVED (OFFICE USE ONLY). Type of License: ❑ Plumber Signature of Lice#710lumber [Master Journeyman License Number: I 1 1 r z O F U ;a W z O x a _z a w O a w W w LL A W z 0 z m 2 .a F" d O U C7 a se w d z � � O w O F U � x F z � Q z w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): K) ()(Ljay (-)�: /' ntq C( . b <X_j� �`�' - � �L Address: 115 1'l'1 A ,C)co O -) A- Phone #: Are you an employer? Check the appropriate box: 1. ❑ `I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time). * have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. [1 We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy informations t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:�� fl Policy # or Self -ins. Lic. #: LA,i C Expiration Date.H - Job Site Address: Q0 C, lof YJ �l C � City/State/Zip: Attach a copy of the workers' colnpensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: ICS -1 c --.I Phone #: v I g t_ 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 #: 0 „ , t ``�R V CERTIFICATE OF LIABILITY INSURANCE DATEnYYY1 0410441201112011 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(ies) 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 lieu of such endorsement(s). PRODUCER MARSH USA INC. 525 VINE STREET, SUITE 1600 CINCINNATI, OH 45202 Attn: cincinna6.cenrequest@marsh.com, Fax 212-948-0785 CONTACT NAME: JNE PN _No xt : � No): E-MAIL PRODUCER CUSTOMER INSURERS AFFORDING COVERAGE NAIC d 400408-RRSC-GAUW-11-12 00015 INSURED INSURER A: Zurich American Insurance Company 16535 ROTO -ROOTER SERVICES COMPANY 175 MAPLE STREET INSURER 8 National Union Fire Ins Co Pittsburgh PA 19445 INSURER C : NIA NIA STOUGHTON, MA 02780 INSURER D: PERSONAL & ADV INJURY S 2,000,000 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER_ CLF -402664501-08 RFVISION N11MRFR- 3 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. ILPOLICY TR TYPE OF INSURANCE ADDL SUER wa POLICY NUMBER EFF MnMIDDDYY POLICY EXP MWDDNYYY LIMITS A GENERAL LIABILITY GLO9379365-07 04/0112011 0410112012 EACH OCCURRENCE S 2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE AI OCCUR TO DAMAGE RENTED S PREMI„cc �S Ea occurrence � MED EXP (Any one person) S 5,000 PERSONAL & ADV INJURY S 2,000,000 GENERAL AGGREGATE S 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 5,000,000 X POLICY PRO- LOC $ A AUTOMOBILE X LIABILITY ANY AUTO BAP9379363-07 (AOS) 04/0112011 04101 "2012_ COMBINED SINGLE LIMIT s 3,000,000 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS - BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS B X UMBRELLA LIAR X OCCUR 25030232 04101/2011 04(01/2012 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE Is 5.000,000 DEDUCTIBLE $ X RETENTION S 25,000 I S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINER ANY PROPRIETORMARTNEPoEXECUTIVE OFFICERIMEMBER EXCLUDED? N I A WC9379366-07 (AOS) 0410112011 0410112012 OC sTATu• 0TH - X I 1W E.L. EACH ACCIDENT $ 1,000,000 � E.L. DISEASE - EA EMPLOYE S 1,,60-6 (Mandatory in NH) If DEes. SCRIPTION describe under OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ 1,000,000 %.c n I Iriw% i r- n V L.Ur H CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. John F. Schultz �-G rr— v 19UU-2UU9 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD This certifies that 5kpf'F.cj"'JU .�...... , has permission to perform .21 . .. , , , , , , , . wiring in the building of ........................ at . �.7_.... �? 1 -cls, ` i R , North Andover,ass. Fee Lic. Noq... ..,(,'Il r LECTRICAL INSPECT6R Check # 11237 00. Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Z. 2-, :% Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: WILIle— City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his. or intentio top form the electrical work described below. Location (Street & Number) � P W'�14AW (il-P Owner or Tenant Ka c I (, �>(,)A ►2._I _ z _ _ Telephone No. Owner's Address -- Is this permit in conjunction with a buildiaermit? Yes No F1 (Check Appropriate Box) Purpose of Building S f BVI �F-t � Overhead ❑ Existing Service Amps New Service Amps Volts Utility Authorization No. Volts Overhead ❑ Undgrd ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: l n is RAse,P" - 17 No. of Meters No. of Meters Comnletion of the following table 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 g No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets 12 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches � Q No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons KW .......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Dr y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Wirin Telecommunications No. of Devices or Eg u valent 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 s e t the i)ermit i ui office. q CHECK ONE: INSURANCE IV 1 BOND ❑ OTHER ❑ (Specify:) � �/,D y (v � / L 0/o I certify, under the painted penalties 4ic; perjury, that the information on this application is true and complete. FIRM NAME:. `,_ f U 6,4 �jt ((- 6) TMG _ LIC. NO.: ��� Licensee: �)- -P i h,p vx �—Jub,�1 Signature /(/%iJ �? - LIC. NO.: (If applicable, enter "e mpt" i the lir�gnse number lit) Bus. Tel. No.:_ 7 Address: G/C 1� ' OCG 0 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work r uires Department of Public Safety "S" License: Lic. No. 687 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 [PERMIT FEE. $ Signature Telephone No. • V � • MEM�l.Qy�-;.cH�.'.�7-tc��C-•�Oi�9J�FrLxdR�d�l�®p7� -^ / t _).1,'IOPJ'_eMOJ.'4 PORIT ' _ Ste rneL�.0.�l;�WILL'it�����k.l'�".. r � .. � • ON. . . MCI AMR—[ ] �3e-�zspeetioz� xequzzed'($�O.OU) � � � �ns�ectazs' xuttte�ats: . nspectoxs°Hz a e-oto:itials} Pate �'asseti--[ � �C+'aiieti--r � • �.texns�ectio�,xer�uixe�($�0.00)w[ � ' xn9pectors' comments: /LEi,2_d IV a (D14actoms' Oignatuze •• uo bufflals) o Date u Passed --Z � �azIec�-j � �Ze�ins�ectio�xe�uize�(��0.00)M[ � ffispectozs' comments. (1e�sp ectoxs' ,�ignaiuxeotzaTs) Pate assert—[) �i`aiier�--�) rhe-7nspectionxequizet�{�50.00)�� � ' �spectoxs� eoxnme�fs: (Zuspectoxs',�ignatuze�rioinzizals} Date �sec� � � � �'azIer� -• � �. ' �e �nsp ection �er�uix'ed ($50.00) � [ � - � acts' eozi��ents: _ - ' S - �"w—sp ecto7t�'zgx�ataz e oxoiutials) — _ ,date 3 O TAGS AM TO M T'MAD OLITTAMIEFT ON ISITE Y+` "M TO 3Y, INMECTED XO NOT x w li Fo14 nen Detach AkM N NdOrdb —i �'. :CCaMBNWEALTH OF MASSACWJSETTS fl G i BOARD :- . ELECTRICIANS ROISTERED MASTER EIECiR1CiAN t. E L _ }SSUES THE pBovE ticrtSE TO: _ . TYPE STEP.ItEN H JUSA III fm. �Cn _A. 555 SALEM ST f t�kURTFI -ANDGVER. KA 01845 855786 `5 786 FOK Then Detach AjoB Aa w li Date..".. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... ...... �j ...... .... . has permission to perform ..� ` . 5. ............... . plumbing in the buildings of . - `.. z ................. at...L �?J....... .�.. "`'`.��`�'�.. ... . ,North Andover, Mass. Fee..... Lic. No../S2/�...��,!sx�!.......... . / 'PLUMB G INSPECTOR Check # '32 y � ; V 7732 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Cjk of New Renovation Replacement - Tr'MrrY TD rc r Date Jl�% Q Permit # 1-23-1 Amount �o, Vr Plans Submitted Yes❑ No ❑ (Print or type) �� �� Check one: Certificate Installing Company Name A L 7—�g �i -Corp. Address / S' u �, J 17 Partner. usmess elephoneof Firm/Co. Name of Licensed Plumber: - Ins ��"' U Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance rgnature Owner ❑ Agent L 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 installatio s ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts�aty I I 't i and Chapter 142 of the General Laws. IAPPROVED (OFFICE USE ONLY Type of'Plgrh6ing License /Cal 1 I-Icense IN UMDer Master Journeyman ❑ Date. 41 .:........... NORTH ` 0y♦ Sao ,e,q•OL TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION '• . I.(.�n. •• /. This certifies that .... C :f:-�-':L-. ..u't-�" has permission for gas installation . -:�':` .. `'..` ..... �. • • in the buildings of ......... .................... at f .. ............... North Andover, Mass. Fee:.... Lic. o.... ../... . ., .......... GAS INSPE -TOR Check # 6422 MASSACHUSETTS UNIFORM APPLUCATON FOR PERMIT TO DO GAS 7jLloe(Type or print) Date 1 NORTH ANDOVER, MASSACHUSETTS , Building Loqations Or / UC / I Permita- Amount $ c;20 o✓ Owner's Namel New11 Renovation ReplacementPlans Submitted (Print or type). C/�� /' Check one: Certificate Installing Company Name C l_I A- 14/4-P/ ( 0 Corp. � Address EL -1'70 S / �e 1-1 Partner. Business a ep one C11 Firm/Co. Name of Licensed Plumbeior Gas Fitter T, I" e -- tINSURANCE COVERAGE Check one i1have a current liability Insurance, policy or it's substantial equivalent. Yes 0"' No If you have checked Les, please indic he type coverage by checking the appropriate box. Liability insurance policy �t Other type of indemnity D 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 13 Agent 0 I herehv certifv that all of the `l f--6 —4 ;-P-. a:.._ I L .... _.. _ u_ _______ _.__ .... ................ «„� kV, c„LUICUI in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations perf un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G �r7rJJ,,�r e'aAd Chapter 142 of the General Laws. By: Title City/Town, JAPPROVED (OFFICE USE ONLY) Q--mumber Gas Fitter ©-'Master Journeyman 'sed Plumber Or Gas Fitter (cense um er � a w vI o Z, W d z F w w z u w z E- a C q > w G7 F z x W w w F W U x Z I- d z W F I, > W O > z W o z W r LQ x 'o 3 0 0 z > c O W F SU B-BASEM ENT o. H o BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type). C/�� /' Check one: Certificate Installing Company Name C l_I A- 14/4-P/ ( 0 Corp. � Address EL -1'70 S / �e 1-1 Partner. Business a ep one C11 Firm/Co. Name of Licensed Plumbeior Gas Fitter T, I" e -- tINSURANCE COVERAGE Check one i1have a current liability Insurance, policy or it's substantial equivalent. Yes 0"' No If you have checked Les, please indic he type coverage by checking the appropriate box. Liability insurance policy �t Other type of indemnity D 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 13 Agent 0 I herehv certifv that all of the `l f--6 —4 ;-P-. a:.._ I L .... _.. _ u_ _______ _.__ .... ................ «„� kV, c„LUICUI in aoove application are true and accurate to the best of my knowledge and that all plumbing work and installations perf un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G �r7rJJ,,�r e'aAd Chapter 142 of the General Laws. By: Title City/Town, JAPPROVED (OFFICE USE ONLY) Q--mumber Gas Fitter ©-'Master Journeyman 'sed Plumber Or Gas Fitter (cense um er 631 Date ..../2..: j .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........X&. '-q ......4�J--C&tI.e., ...... 8 has permission to perform ........ �v. e ........1 v'^A.' ............................ cv wiring in the building of ......... �. v. W ................ .:........................ at .... f .. ...."" Vii;' ..... , North Andover, Mass.m Feed.. ic. No. A.`....4.1. 4............................................................T ELECTRICAL INSPECTOR � WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 014t &MIUVuwettitll of tt�utttliu�ett 19cpurttucut of Public eufrt0 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only #-% Permit No. Occupancy A Fee Checked 3/90 (leave blank) 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 (Z `/( 'l4 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street F Owner or Tenant Owner's Address Is this permit in conjunction with $ building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building �'��6 `yt.v�ft/;.�f a Utility Authorization No. Gl93,0 Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service 'Z -O b Amps / �O /Volts Overhead ❑ Undgrnd FV No. of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total f Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ElOther ❑ Connection No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Com leted Operations Coverage or its substantial equivalent. YES NO ❑ 1 have submitted valid proof of same to the Office. YES F NO ❑ If you have checked YES, please indicate the typ of coverage by checking the aropriate box. INSURANCE AI BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ _ Work to Start / 7. - /j --U— Signed -moiSigned under the Penalties of perjury: FIRM NAME /-a Inspection Date Requested: Rough && 0 0 YL Final LIC. NO. Licensee % i Q tti1 w^P N C SL Signature 1-7-P� �-LIC. NO. qq r , oQ/,, Bus. Tel. No., X ti Rt �/�41r—, � Address " 2 [�! - h< O j/LL�t� � All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) x-6565 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES O27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts 01845 Director (978)688-9531 C June 25, 1999 Mr. Eric Wilner 120 Weyland Circle North Andover MA 01845 Mr. Eric Wilner: Fax(978)688-9542 Enclosed are copies of the original building permit for your property, which was not included in the permits distributed at the recent meeting concerning Foxwood Rd. and Weyland Circle. Please accept our apology for any inconvenience this,oversite may have caused you. If you have any questions please call the Building Department at 978-688-9545. Enclosure (1) DRN-jm Very truly yours, D. Robert Nicetta, Building Commissioner BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Location -a No. Da e TOWN OF NORTH -A"N"[D)GVER V Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ g 0. Other Permit Fee $ Sewer Connection Fee $ 22 Water Connection Fee $ f TOTAL _jA�,q Building Inspector Div. Public Works Location No.� Date SSG NORTH TOWN OF NORTH ANDOVER O?o• tf``o /•,�OOA�� A Certificate of Occupancy $ !,--:i ; ; Building/Frame Permit Fee $ r 'SsAcmU Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL A$ 00 pAID Building Irfspector� Div. Public Works Location /ZD �� ��`� , �� r— /O ? No. �3'_.? I Date � 3;o r f N TOWN OF NORTH ANDOVER 4 .4sCHU r d Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ /0�zo Water Connection Fee $ TOTAL eY �a 11082.00 $ -2-1 w f4 �8ei1 g' s ec or PA , DNA blit Works PERMIT NO. 6-5 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. ZONE t 0 I LOT NO. 3� /'�/�i SUB DIV. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE LOCATION �Q � Gv� , � a � � rf,�� �� PURPOSE OF BUILDING OWNER'S NAME -J" x wQ .05W OWNER'S ADDRESS CC�� �. P d �TV r0 r J NO. OF STORIES BASEMENT OR SLAB , 9 SIZE �-�^' ��Je s• fly ARCHITECT'S NAME M 0 BUILDER'S NAME _/ Ile - ! ` SIZE OF FLOOR TIMBERS IST i7x�v 2ND 3RD SPAN DISTANCE TO NEAREST BUILDING 30 DIMENSIONS OF SILLS POSTS L/V ✓� DISTANCE FROM STREET n'7 DISTANCE FROM LOT LINES - SIDES REAR GIRDERS �/ AREA OF LOT ` /4ot /Itr FRONTAGE 1 HEIGHT OF FOUNDATION THICKNESS `" a�x IS BUILDING NEW y"pS SIZE OF FOOTING /� X IS BUILDING ADDITION A/ l MATERIAL OF CHIMNEY /6fdsok IS BUILDING ALTERATION /va IS BUILDING ON SOLID OR FILLED LAND Sa / (� G WILL BUILDING CONFORM TO REQUIREMENTS OF CODE J/(% ` IS BUILDING CONNECTED TO TOWN WATER / e l BOARD OF APPEALS ACTION. IF ANY °(J�E? IS BUILDING CONNECTED TO TOWN SEWER s 4f 1 IS BUILDING CONNECTED TO NATURAL GAS LINE ` -e ,5' INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED PERMIT GRANTED .. 19 C� 4 FSS F�}A ss[Rw 3 PROPERTY INFORMATION LAND COST EST. BLDG. BLDG. COST EST. BLDG. COST PER SQ. FT. BLDG. COST PER SQ. FT. ALT I V EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. J 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # G 3 7 CONTR. TEL. # �l�r 3 6 CONTR. LIC. # / 6 1? 0 H.I.C. # • R • w BUILDING RECORD ' 1 OCCUPANCY 12 SINGLE FAMILY S"OR1ES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ -LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. a fol .,e 1 CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 I 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE HARDW'D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA . O 14 1/2 1/4 FIN. ATTIC AREA N_O 8 M FIRE PLACES 7 - HEAD HEAD ROOM MODERN KITCHEN L 4 WALLS I 9 FLOORS CLAPBOARDS 8 _ 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING CONCRETE EARTH HARDW D COMMON ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRI K ON MASONRY BRICK ON FRAME . ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I— I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH )3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES X LAVATORY - WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. & COLS: X HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL I NO ELECTRIC HEATING —B'M�'T �02nd tst �f 13rd a fol .,e 1 60 W R• a ER O v i O E O• O v Z Q O H cm � C I C C_ C3 'O y O O m m CD O O CLi. CD }- 3 Q cc O d a. cm< 9v O■ O ,CD O Z CD O. V CIO C R C ■ C 0. C4 0 o x � a c � v O FA a a oo—co a °clul czz a W o o a ER O v i O E O• O v Z Q O H cm � C I C C_ C3 'O y O O m m CD O O CLi. CD }- 3 Q cc O d a. cm< 9v O■ O ,CD O Z CD O. V CIO C R C ■ C 0. C4 0 c 0 c � v O FA 0 v V •a � CL. c ev Co CD = s o �a D CE :m ca 0 0 N m ld C a = H O : fA O E m cv m m ' ^H^ • rt 0 cm c O = = 'O 10Q m C cijHZ O O ` CD C d0 •O = m N a y'. O ~ LiJ C m yr Cc� � = _ r.+ _O .y • m O C H- L r2 Z ca ^mac• t� CL m� c _ W =.-aZZm:20 a ER O v i O E O• O v Z Q O H cm � C I C C_ C3 'O y O O m m CD O O CLi. CD }- 3 Q cc O d a. cm< 9v O■ O ,CD O Z CD O. V CIO C R C ■ C 0. C4 0 N W 0 0 Z 0 Z I O 0. 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N O, d 0 - Z Z a I- o o J UI 4 m m Z Z Z u < U m H Z M J Q IFA _ W ', O F LL < O t �C"� O F f O \ (^( V A) W N I K 0 < N 0 J ►- 0 W Z 0 YI J u W W f Al W \\ W m IA W J Z <_ W 0: Z < E O Z < O N Z O W i Z 0 M f 0 X F W O Z < J < u z Z W a a W O W W 0 0 F < m W F O 0 < H O Z OJ I _O m J J E O a O < W W W u W w u ~ W Z W u Z W u w Z 0 O "J _Z O _Z O j 0 W = 4. k _U W 0 .WJ LL Z 7 l7 Z IL Z u < O 0 Z 3 Z 1,W = _J F C F F < W m _J 7 J m m _J m J O Ci N 0: I m L1 W F U m fi t 0 m < Z W W h N J O 3 O O < m O O O t 0 --- N N J 3 O m W 0 Z W < .( J J t 0 a' a s w t .i W W M a p e L a n ti W a � �-91-1 In C //2C G E- I ,oL 19V /N /vO. 441ao ✓EAe 11455 O,Pgi✓�t/ FD.P �VE.2 G2�EsJ /y%/�.c/AG6"mE,vT' islE.P,P/�tf.9G(' E,liGidEE,P/•t�G SE.PY/CCs 64 �q.P,f� .S'T•PEET A.t/OOrE,� �Y1.4SS,4C,%G'SETTS O/8/O � Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) DXwoda rry��ra0_ >,9da.c4Q(C _C�- Map and Parcel : Purpose of Application (check below) P� i�ol�e� ur b )fyApplicant: � Single Family _ Two Family 17 I (( the f�ooundersigned 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 North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Ala This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons 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 a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), 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 and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. 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 supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed 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 and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refus by the Building Department to issue a Building Permit. ature of Owner or Authortzed Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. FORM U - VERIFICATION 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 local or state law, regulations or requirements. ***_*************Applicant fills out this section***************** APPLICANT: a o o/ a �T Phone 46 y 7 y LOCATION: Assessor's Map Number Parcel Subdivision _;t -C X bi0 0 o/ Lot (s) �7 Street �(12V' I -C 4- St . Number 22 0 _ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: -� �25proved1 / Conservation Administrator Date Rejected Comments Town Planner i ' . Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved _ /V1Y/4 Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections %71-J 'i - driveway permit�% i O Fire Department--e�(,��' rye, p"zi R ceived by Building Inspector Date' N® 1186 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. / 19 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 The premises are known as No. (�� �r Street or subdivision lot no. 17 Owner Address Contractor Address JVZL pl cans ignature PERMIT TO CONNECT W r The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Wo . Inspected by Date SEWERMAIN , 1,5 A fY9C' C/ Street ivisi r,of Public Works W/WBy See back for rules and regulations RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing, testing,, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such -building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the (town). �0 660 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. —� lj 19 Application by the undersigned is hereby made to connect with the town water main in `41 �/ Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. Lei/ l .e - or subdivision lot no. caner Address Contractor Z me,��� F +02.� I' -- Address -V fW1 YZ Applicant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at lit/ l�G K subject to the rules and regulations of the Division of Public Work . Inspected by Date i Street Street Board of P lic Works By c (7m v See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4'/z foot rod and brass plug type cover. GEORGE PERNA, DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET. 01845 6111-1 a pa O L 0�. 1 z ,9S SACHU jslelll�` DRIVEWAY PERMIT Telephone (508) 685-0950 Fax (508) 688-9573 Date: LOCATION: BUILDER: phone: OWNER: � phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: 4 W rA Cd `V 6- v rCDCl c :W .x OCCo o o v C7 � O ^ L O Z CL Q p Amo C _cm o 3 : CO) O Ey z y Q__ O .— a' o Z mm 0 O C c n «. 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