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Home My WebLink AboutMiscellaneous - 126 OLD FARM ROAD 4/30/2018 (4) BUILDING FILE I / i Date. . ?/ rj., -,`r' p ,a°RTM 3� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SS C" This certifies that . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . has permission for gas installations.,:in the buildings of . ! � ^-^' . . . . . . . . . . . . . . at . . . . . . ..�. . ~�-f��'�`�- `�'' North Andover, Mass. Fee:�c']I . .. . Lic. No.. . . . . . . . . . .. . . . .. Check# /0_7 6624 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) r, - NORTH ANDOVER ,Mass. Date 11/18 2008 Permit ff �. 126 OLD FARM RD DEIDRE DUNN i Building Location Owner's Name � Owner Tcl# 978 771 7731 -978 681 5420 Type of Occupancy RESIDENTIAL New W1 Renovation❑ Replacement Plan Submitted: Yet No❑ FIXTURES w � a F U z W W a O U Cn x x z a H ¢ z z o H m W a o ° x O w E. W w w X630.50 Z W F w W W o U x z a x a x o a 3 is o° a > m ° w o SUB-BSMT BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR I P 8T"FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate y 131 Water Street Address Corporation Danvers, MA 01923 1Partnership Business Telephone# 800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter ED LAMPHIER I INSURANCE COVERAGE: I have a cures liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. ye ✓ I No ❑ If you have c ecked�,please indicate the type coverage by checking the appropriate box. s A liability insurance policy❑✓ Other type of indemnity ❑ Bond El 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: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application a d accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this ap cation will a in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the S. n� By Type of License: umber gnat ensed kurriber or Gas Fitter Title as fitter •-Master License Number 1220 City/Town •-Journeyman APPROVED(OFFICE USE ONLY) I Dateg�� .gy'LTpy TOWN OF NORTH ANDOVER PERMIT FOR WIRING v ! `�!'' This certifies that . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U has permission to perform w C-0— wiring S!_wiring in the building of . . . 'Pi. . . . . . . . . . . . . . . . . . . . . . . . at ... . . . . � . . ' . . .Vn. . . . N rth Andover, Mass. 'j i Fee .�.�)•—"' . Lic. No� l. . . . . MD . — ELECTRICAL . M ELECTRICAL INSPECTOR 4 1 Check# IWA 11049 Nolan Richardson Permit&Inspections Coordinator T (888)765-2489x2358 M (774)226-0769 F (508)460-0318 nrichardson@solarcity.com "MOM 1 OW, •:,u en • \ Commonweald o`*466acluosib Official Use Only Aparimeni of-7irw Swvkoe Permit No._ 6 to f-f Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/073 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:+ � as City or.T own of: tA. Ky%c]n!je_t: 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) IQ(o C`�1e1. Farm jZQQA Owner or Tenant 0 Telephone No.&I V► -Sgaio Owner's Address _ Sakft, As abn.:e Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building So`ou-CPV) �. .S Utility Authorization No. Existing Services tap/,2y© Volts Overhead �L?ieL Amps ❑ Undgrd No.of Meters 1 New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Fceders and Antpacity. Location and Nature of Proposed Electrical Work: R80�p tYV)Uy%+_Fr-Q P%af_0o-�fCz_r PVA S Jai N.m f`4ter12_ I.(o4 K 0C S t C -Ti4uk. Ti4u Completion of the ollou,bt table m be waived b the Ins jector o Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Cans °•° Total r Transformers KVA . No,of Luminaire Outlets No.of Hot Tubs Generators KVA No,of Luminaires Swimming Pool Above-❑ n- ❑ o.o Units Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detectloiiand Initlatine Devices No.of Ranges T No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers ent urnp ,nm cr .on$ o.o e - onta ne Totals: """" """""""""""" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local n] Municipal ❑ Other Connection i No.of Dryers heating Appliances KW . ccuri oystemw f Devices or Equivalent No.o Water o.a o,° KW Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.liydromassage Bathtubs No.of Motors Total HP a ecomintrn ca ons r ng: No.of Devices or E uivalent OTIIER: (, Attach additional detail if desit ed,or ars required by the Inspector of lVires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stnit:� �.e._- inspections to be requested in accordance with MEC Rule 10,and upon completion. 5 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. C'11EiCKONE: INSURANCE C[ 130ND ❑ 01'1IER C] (Specify:) i certify,under the pains and penalties 'of perjnty,that lite information on tlis application is true and complete. FIRM NAME: ; �„�tor, LIC.NO.:.7O 11 A Licensee: A Uth a. ISignr►turc e� LIC.NO.:a 1 e.7 TK 1 (1f applicable,enter"exempt"in the license monber line.)^ Bus-Tel.No.:. -714-2-5fOS Addressa {. el;n 6r. • f,�(a��t� . ,�tA otos, Alt.Tel. *Per M.G.L.c. 147,s.57-GI,security Ark requires Department o ublic Safety"S"License: Lic.No. _ OWNER'S INSURANCE WAIVER: J am aware that the Licensee does not have the liability insurance coverage normallyy required by law. 13y my signature below, I hereby waive this requirement. I am the(check one [�owner Owner's n cat. 1 Owner/Agent Signature _.--- 'Telephone No. ._ PE"NAHT FEE: ___..___.._.. 1 �;, r r The C:ontntonti►ealtit o Massachusetts Print Form 't1a Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nome(Business/Organization/Individual):SolarCity Corporationp . Address:3055 Clearview Way City/Stale:/1 ip:San Mateo, CA 94402 Phone 4:650 963-5100 Are you an employer?Check the appropriate box: Type otrproject(required): I.0 1 am a employer with 1500 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time). * have hired the sub-contractors E]New construction 2.❑ 1 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.1 required.] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing al work. officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL p 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no Solar Installation employees. [No workers' 13.❑J Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information I 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 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 employes Below Is the policy and Job site Information. Insurance Company Name:Zurich American Insurance Company Policy#or Self-ins. Lic. #:WC96734670Expiration Date:9/01/2012 T Job Site Address: �vZ(7 Q •r,n (LQgoQ City1State/%ip:,A)L.and �a eCt_NA-Q(2_1/S' 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 herehr verli i?render lite a u.wm d X41ahles nl& urp that the intbrmation provided above Is true and correct. 5i+na uPa'• e`l: �- _...�.. Urtte.�=•Sf a� ao[01 Phone#.802 299-5885 0J)7cial use ou&. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. hoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ABBREVIATIONS ELECTRICAL NOTES INDEX LEGEND LICENSE A AMPERE 1. WHERE ALL TERMINALS OF THE DISCONNECTING PV1 COVER SHEET E UTILITY METER (6) ALTERNATING CURRENT MEANS MAY BE ENERGIZED IN THE OPEN PV2 SITE PLAN BL ( ) POSITION, A SIGN WILL BE PROVIDED WARNING PV3 STRUCTURAL VIEWS BLDG BUILDING PV4 STRUCTURAL VIEWS & UPLIFT CALCS. My INVERTER W/ INTEGRATED DC DISCO & CONC CONCRETE OF THE HAZARDS PER ART. 690.17. WARNING LABELS. (3),(4),(5),(6) 2. EACH UNGROUNDED CONDUCTOR OF THE PV5 THREE LINE C COMBINER BOX PV6 ELECTRICAL CALCULATIONS D DISTRIBUTION PANEL IRE BRANCH CIRCUIT WILL BE IDENTIFIED PV7 CUTSHEETS © BY PHASE AND SYSTEM PER ART. 210.5. DC DISCONNECT (4),(5) DC DIRECT CURRENT BY PHPV8 CUTSHEETS ECC EQUIPMENT GROUNDING CONDUCTOR 3. A NATIONALLY-RECOGNIZED TESTING (E) EXISTING LABORATORY SHALL LIST ALL EQUIPMENT IN PV9 CUTSHEETS © AC DISCONNECT (3),(4),(5),(6) JURISDICTION NOTES EMT ELECTRICAL METALLIC TUBING COMPLIANCE WITH ART. 110.3. G SOLAR GUARD METER 4. CIRCUITS OVER GROUND SHALL Q JUNCTION BOX — ALL WORK SHALL GALV GALVANIZED COMPLY WITH ART.RT. 255 0.97, 250.92(6) GEC GROUNDING ELECTRODE CONDUCTOR 5. DC CONDUCTORS EITHER DO NOT ENTER COMPLY WITH T H E GNC GROUND BUILDING OR ARE RUN IN METALLIC RACEWAYS GENERAL NOTES DC COMBINER BOX (7),(9) MASSACHUSETTS STATE HDG HOT DIPPED GALVANIZED OR ENCLOSURES TO THE FIRST ACCESSIBLE DC BUILDING CODE. I CURRENT DISCONNECTING MEANS PER ART. 690.31(E). 1. THIS SYSTEM IS GRID-INTERTIED VIA A Q DISTRIBUTION PANEL (1),(2) - ALL ELECTRICAL WORK Imp CURRENT AT MAX POWER 6. ALL WIRES SHALL BE PROVIDED WITH STRAIN UL-LISTED POWER-CONDITIONING INVERTER. INVS INVERTERS RELIEF AT ALL ENTRY INTO BOXES AS SHALL COMPLY WITH T H E REQUIRED BY UL LISTING. 2. THIS SYSTEM HAS BATTERIES, NO UPS. Lc Isc SHORT CIRCUIT CURRENT 3. PHOTOVOLTAIC SOURCE AND INPUT CIRCUITS AND LOAD CENTER (3),(4),(5),(6) 2011 NEC, kVA KILOVOLT AMPERE 7. MODULE FRAMES SHALL BE GROUNDED AT THE INVERTER INPUT CIRCUIT ARE UNGROUNDED. kW KILOWATT UL-LISTED LOCATION PROVIDED BY THE 4. SOLAR MOUNTING FRAMES ARE TO BE GROUNDED O DEDICATED PV SYSTEM METER LBW LOAD BEARING WALL MANUFACTURER USING UL LISTED GROUNDING 5. ALL ELECTRICAL WORK SHALL COMPLY WITH THE MIN MUM HARDWARE. CONDUIT RUN ON EXTERIOR MINI N MINI 8. ALL EXPOSED METAL PARTS (MODULE FRAMES, 2011 NATIONAL ELECTRIC CODE. --- CONDUIT RUN ON INTERIOR NEW6. WORK TO BE DONE TO THE 8TH EDITION OF MA NEC NATIONAL ELECTRIC CODE RAIL, BOXES, ETC.) SHALL BE GROUNDED USING GATE NIC NOT IN CONTRACT UL LISTED LAY-IN LUGS LISTED FOR THE STATE BUILDING CODE. --- INTERIOR EQUIPMENT 7. UL 1703 - SOLAR MODULES NTS NOT TO SCALE PURPOSE. POSTS SHALL BE MADE 8. UL 1741 - INVERTERS OC ON CENTER ELECTRICALLY CONTINUOUS WITH ATTACHED �A��H Of 414ssgc P PANEL BOARD RAIL. PL PROPERTY LINES 9. MODULE FRAMES, RAIL, AND POSTS SHALL BE �� ELAINE A. tiN PV PHOTOVOLTAIC BONDED WITH EQUIPMENT GROUND CONDUCTORS 0 HUANG PVC POLYVINYL CHLORIDE AND GROUNDED AT THE MAIN ELECTRIC PANEL. CIVIL "' S SUBPANEL 10. THE DC GROUNDING ELECTRODE CONDUCTORVICINITY MAP ° �Fc 49029° 0- SCH SCHEDULE SHALL BE SIZED ACCORDING TO ART. SS STAINLESS STEEL 250.166(B) & 690.47. ss/ONALFNG SSD SEE STRUCTURAL DRAWINGS STC STANDARD TESTING CONDITIONS HickiD H14SyyH SOLAR WATER HEATER TYP TYPICAL . ` UON UNLESS OTHERWISE NOTED A ' UPS UNINTERRUPTIBLE POWER SUPPLY V Ith VOLT U.- w�`ence �.� Vmp VOLTAGE AT MAX POWER Municipal Aii`port €old� sn +� Voc VOLTAGE AT OPEN CIRCUIT _ W WATT 3R NEMA 3R, RAINTIGHT 3fth'Farm Rte Mazwenko Farm orm+fr9'Yatio1 Area REV BY DATE COMMENTS T8rP41 ?, REV• s •�,�, , 511 Z I Tat PI CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER: JB-01 810 9 00 PREMISE OWNER: AHJ North Andover DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER BENEFIT LL ANYONE EXCEPT IN WHOLE INC., MARKET: MODULES: , s��a �t o NOR SHALL IT BE DISCLOSED IN WHOLE OR IN REST 3s YINGLI YL240P-29b 126 OLD FARM ROAD 8.64 KW PV Array y PART TO OTHERS OUTSIDE THE RECIPIENT'S PROJECT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 ANIZATION, EXCEPT IN CONNECTION MATH 3055 Clearview Way _j4E SAI 17_AND USE OF THE RESPECTIVE Yeti- 1 lag- Uphill 9786815420 PAGE NAME: SHEET: REV: DATE: "^''.LENT, WITHOUT THE WRITTEN San Mateo,CA 94902 y PAYMENT TYPE: INVERTER: T:(650)638-1028 I F:(650)638-1029 �cITYINC. PPA (2) POWER-ONE # AURORA PVI-3.6-OUTD S-US COVER SHEET PV 1 7/23/2012 (888)-SOL-CITY(765-2489) I www.solarcity.com - Roof Mounted SEE PV3 DETAILS A-C MPl PITCH: 32 ARRAY PITCH:32 $ E AZIMUTH: 189 ARRAY AZIMUTH: 189 AC M it PV4 MATERIAL: Comp Shingle Roof STORY: 2 - Roof Mounted SEEPV3,4DETAILS C-E ID�,, Mpg PITCH: 35 ARRAY PITCH:35 AZIMUTH:99 ARRAY AZIMUTH: 99 � MATERIAL: Comp Shingle Roof STORY: 2 �Inv (LC Of Mass --- Inv,': cS ELAINE A. o HUANG + CIVIL_ D LEGEND o No.49029 PV4 SS�ONAL ENc' (E) UTILITY METER (6) INVERTER W/ INTEGRATED DC DISCO & s I°� WARNING LABELS. (3),(4),(5),(6) M P2 DC I DC DISCONNECT (4),(5) AC DISCONNECT (3),(4),(5),(6) Q JUNCTION BOX Front Of House Q DC COMBINER BOX (7),(9) Q DISTRIBUTION PANEL (1),(2) Lc LOAD CENTER (3),(4),(5),(6) ODEDICATED PV SYSTEM METER CONDUIT RUN ON EXTERIOR --- CONDUIT RUN ON INTERIOR MPI GATE --- INTERIOR EQUIPMENT B - E PV3 DRIVEWAY A SITE PLAN o PV3 N Scale: 3/32" = 1' E W 01, 10' 21' 5 J B-01810 9 0 0 PREMISE OWNER AHA North Andover DESCRIPTION: DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER: CONTAINED SHALL NOT BE USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER Sola� t a BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES: NOR SHALL IT BE DISCLOSED IN WHOLE OR IN REST 36 YINGLI YL240P-29b 126 OLD FARM ROAD 8.64 KW PV Array PART TO OTHERS OUTSIDE THE RECIPIENTS PROJECT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH 3055 Clearview Way THE SALE AND USE OF THE RESPECTIVE Yeti- 1 lag- Uphill 9786815420 PAGE NAME: SHEET: REV: DATE: SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN San Mateo,CA 94402 PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: T:(650)638-1028 I F:(650)638-1029 PPA (2) POWER-ONE # AURORA PVI-3.6-OUTJDS-US SITE PLAN PV 2 7/23/2012 (888)-SOL-CITY(76S-24I www.solardty.com (E) 2x10 RAFTER ® 16" 0.C. (E) 2x10 RIDGE BOARD .yP Xg 4' BETWEEN ol FOOTINGS C (STAGGERED) 2x8 pq nn =rT 1' 11'-8" (E) LBW RAFTER: 2x10 1'-4" TYP (E) 2x10 RAFTERS SUPPORT: 2x10, 2x8 ® 16" SPACING SIDE VIEW OF MP1 MAX SPAN: 11'-8" B FRONT VIEW OF MOUNTING PLANE AScale: 1/2" = 1'-0" SOLAR PANEL INSTALLA11ON ORDER ATTACHED WITH MODULE LOCATE RAFTER, MARK HOLE CLAMPS, J"-16 BOLTS, (1) LOCATION, AND DRILL PILOT AND J" NUT HOLE. SOLARCITY SOLAR RAIL = _ _ _ (4) (2) PSEAL EILOT HOLWITHSEALANT. YETIOLY A�� M4Ss'9 & BOLT (3) (3) INSERT ECOFASTEN FLASHING. �� (E) COMP. SHINGLE (1) ELAlt��: A. c!� HJA1VG 4 (4) PLACE THE LEVELING FOOT. CAVIL ECOFASTEN FLASHING (2) (5) INSTALL LAG WITH SEALING Na. 49029© (E) ROOF DECKING WASHER. " DIA LAG BOLT (5) (2—j" EMBED, MIN) SS/�� (E) RAFTER C STANDOFF J B-01810 9 0 0 PREMISE OWNER: AHd North Andover DESCRIPTION: DESIGN: CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER: CONTAINED SHALL NOT THOMER USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE �� ' o NORBENEFIT OF SHALL ITYONE EXCEPT BE DISC OSED N WHOLE ORREST 36 YINGLI YL240P-29b 8.64 KW PV Array CIN MARKET: MODULES 126 OLD FARM ROAD orf PART TO OTHERS OUTSIDE THE RECIPIENT'S PRUCT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 il ORGANIZATION, EXCEPT IN CONNECTION WITH 3055 Clearview Way THE SALE AND USE OF THE RESPECTIVE Yeti— 1 lag— Uphill 1 9786815420 PAGE NAME: SHEET: REV. DATE: SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN San Mateo,CA 94402 PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: T:(650)636-1oz8 I F:(650)638-1029 PPA (2) POWER—ONE # AURORA PVI-3.6—OUTD S—US STRUCTURAL VIEWS PV 3 7/23/2012 (888)-SOL-CITY(765-2489) 1 www•solarcity.com (E) 2x8 RAFTER UPLIFT CALCULATIONS Va�P\--N"aF 44s ® 18" O.C. sq (E) 2x10 INPUT VARIABLES CALCULATIONS AND VALUES RIDGE BOARD ELAINE A. cn Required Variables Design wind pressures based upon: o HUANG CIVIL -4 1x8 Mean Roof Height: 25 ASCE 7-05 Chapter 6 Wind Loading -o No.49029 Exposure Category: C Equation 6.5.13.3: Component and Cladding Elements Basic wind speed(or city in the future): 100 Wind pressure P=qh*Cn*G ss/ONAL ENG Importance factor(1 for residential): 1 6.5.10: Velocity pressure qh=0.00256*Kz*Kzt*Kd*V^2*1 Roof shape: pitched From Table 6-3: Roof Angle(degrees): 35 Kz=0.94 Roof zone: 3 From Figure 6-4: Contiguous sq. feet of array: 70 Kzt= 1.00 Least width of the building: 35 Obstructed wind flow? TRUE From Table 6-4: Kd =0.85 13'-7" (E) 2x8 CEILING Local Topographical Features 1 – JOIST ® 16" O.C. (choose "standard"or refer to pictures right, and below) From figure 6-1: V=100 (E) LBW - Type of hill: none RAFTER: 2x8 Hill height(h)(ft): From table 6-1: SIDE VIEW OF MP2 SUPPORT: 2x8, 1x8 Slope of hill(degrees): I = 1 DMAX SPAN: 13'-7" Horizontal distance from hilltop to house(x): From Velocity Pressure Equation Height from bottom of hill to mean roof height(z): qh=20.45 Design Wind Pressure From Figure 6-19B P(lbs. per sq.ft.)=qh*Cn*G Cn(uplift)=-1.20 Pd(downforce pressure)= F 8.69 Cn(down)=0.50 Pu(uplift pressure)= rn.86 From 6.5.8.1 G=0.85 4'-6" BETWEEN Max Tributary Area Feet Inches FOOTINGS Individual Rows in Portrait X(E-W distance between standoffs)= 4 6 (STAGGERED) Yingli YL240 P-29b Y(N-S distance between standoffs)= 2 8 Amax(sq.ft.)=0.5*L*X Staggered Penetrations= Yes nn I L(length of panel in ft. perpendicular to rail) 5.41 Module Rail Max. Span/Cantilever(in)= 44 15 X= 4.50 Y= 2.67 Max Uplift Force on a Single Standoff L= N/A Pmax(lbs.)=Amax*Pu Amax= 12.18 254 1'-6" TYP (E) 2x8 RAFTERS Dead Load Calculations Factor of safety=FI*D*NI/Pmax DL(lbs/sq.ft.)=(Mm+Mh)/(L*W) 5/16 x 4 in. = Lag size and length ® 18 SPACING 984 =Capacity(lbs)of 1 lag (NDS) L(length of modules) 5.41 1 = NI(number of lags per standoff) E FRONT VIEW OF MOUNTING PLANE W(width of modules) 3,25 3.87 =Factor of safety Scale: 1/2" = 1'-0" Mm (weight of modules)43.65 Point Load Calculations Mh(weight of hardware per module)= 8.99 PL(lbs)=Amax*DL DL—= 2.99 36 J B-01810 9 0 0 PREMISE OWNER: AHJ: North Andover DESCRIPTION: DESIGN: CONFIDENTIAL — THE INFORMATION HEREIN JOB NUMBER: CONTAINED SHALL NOTUSED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER ��11 � o BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES � NOR SHALL IT BE DISCLOSED IN WHOLE OR IN REST 36 YINGLI YL240P-29b 1.26 OLD FARM ROAD 8.64 KW PV Array PART OTHERS OUTSIDE THE RECIPIENT'S PROJECT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH 3055 Clearview way THE SALE AND USE OF THE RESPECTIVE Yeti— 1 lag— Uphill 9786815420 PAGE NAME: SHEEL REV: DATE: SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN San Mateo,CA 94402 PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: 7/23/2012 T:(650)638-1028 I F:(650)638-1Oz9 PPA (2) POWER—ONE # AURORA PVI-3.6—OUTD S—US STRUCTURAL VIEWS & UPLIFT CALCS. PV . 4 (888)-SOL-CITY(765-2489) 1 www.solarcity.com GROUND SPECS MAIN PANEL SPECS GENERAL NOTES INVERTER SPECS MODULE SPECS LICENSE BOND (N) #8 GEC TO (N) GROUND ROD E 200A MAIN SERVICE PANEL Inv 1: DC Ungrounded INV 1 —(1)POWER-ONE URORA PVI-3.6-OUTD-S-US — YINGII 8 YL24OP-2 b AT PANEL WITH IRREVERSIBLE CRIMP SE 200 2P MAIN CIRCUIT BREAKER Inv 2: DC Ungrounded Inverter (-291i�; 360OW, 277\/240 208\, 9 %h6% PV Module (-2011; 240W, 215.9W PTC, H4, 50MM, Black Frame l / g Voc: 37.5 Panel Number:ITE G3030MB1200 INV 2 —(1)P Innve�rter0(E2Ql; 336 OW, 277V/240ov/208v 9�y96% Vpmax:29.5 Meter Number:12 807 378 Underground Service Entrance �) *MODULE CURRENT RATINGS ARE SHOWN AS Isc AND Imp IN INV 3 THE DC STRINGS IDENTIFIER OF THE SINGLE LINE DIAGRAM. MAIN SERVICE PANEL (E) WIRING SOLARGUARD BRYANT Inverter 1 CUTLER—HAMMER METER1 Load Center 0OA/2P Disconnect 7 5 POWER—ONE DC+ AURORA PVI-3.6—OUTD—S—US — pC_———— 1 String(s)of 9 on MP 1_ (E) LOADS A B 1 C 20A/2P EGC znav ---------------------------------- --- � L, - �. L2 GFP/GFCI DC+ N DC- 1 f:DC+4 40A/2P -___ GND __- _ _EGC/ __ DC+ --I < r-—----------- GEC pC_ pC - 1String(s)Of9OnMP1 A I Iir I B I I w 1 Ing GND __ EGC __ EGC 1 I I Inverter 2. N 3 EGC/GEC I LAURORA POWER—ONE DC+ ---- z CD _ ____ PVI-3.6—OUTD—S—US DC- 1 String(s)Of 9 On MP 1 20A/2P EGC GEC 1 1 z4ov r——--———————————————————————————————— ————————————————————� --- - r--T L2 1 I I GFP/GFCI DC+ TO 120/240V I N DC- I 4 SINGLE PHASE 1 L_ ___ EGC/ __ DC+ DC+ UTILITY SERVICE 1 I GEC pC_ pC_ 1 String(s)Of 9 On MP 1 1 I EGC -- -----------—-----------—----------- - EGCL1. ----------------- 1 1 I I PO1 (1)SIEMENS 021 aocT PV BACKFEED BREAKER A (I CUTLER-HAMMER 8 DG222URB /fj D� Breaker, 15A 1P-40A//2P-15A 1P, 2 Spaces, Quad Disconnect 60A, 24OVac Non-Fusible, NEMA 3R /-� —(1)CUTLER-HAM R BQC 252115/ —(1)CUTLER-{1ANMER DG100N8 Breaker 15AI P-25A�P-15A/1P, 2 Spaces, Quadplex Ground/Neutral 1t; 60-100A, General Duty(DG) —(2)G fiad; 555}8' x 8, Copper B (I)BRYANT 8 BR612LI25RP Load Center 125A, 120 24OV, NEMA 3R —(2)Bre�akerH 2OA 2P, 2 Spaces C (1)AWG 810, THWN-2, Black (5FT)WIRES FOR SOLARGUARD METER —(1)AWG 810, THWN-2, Red (5FT) —(1)AWG 810, THWN-2, Green (5FT) —(1)SOLARCITY#SG METER (1)AWG 810, THWN-2, Black Monitoring-Equipment; 208/240 2-wire O (1)AWG 810, THWN-2, Red —(2)Multi-Cable Connector, 3 Port O (2)AWG 810, PV WIRE, Black Voc =337.5 VDC Isc =8.65 ADC (1)AWG 810, THWN-2, White NEUTRAL Vmp =240 VAC Imp=15 AAC #4-814 AWG, Some side, Insulated 1 PF(1)AWG #10, Solid Bare Copper EGC Vmp =265.5 VDC Imp=8,14 ADC -(1)AWG.88,.THWN-2,.Green. .EGC/GEC. .-(1)Conduit Kit; 3/4' EMT (1)Conduit Kit:.3/4' EMT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 (1)AWG 810, THWN-2, Black (2)AWG 810, PV HARE, Black Voc =337.5 VDC Isc =8.65 ADC O fT(I)AWG 810, Solid Bare Copper EGC Vmp =265.5 VDC Imp=8,14 ADC O � (1)AWG 810, THWN-2, Red `� (I)AWG 810, THWN-2, White NEUTRAL Vmp =240 VAC Imp=15 AAC (1)Conduit Kit; 3/4" EMT —(1)AWG 18, THWN-2, Green EGC GEC — 1 Conduit Kit 3 4 EMT (2)AWG 810, PV WIRE, Black Voc =337.5 VDC Isc 8.65 ADC . . . . . . . T". . . .. ./. .( .). . /Y . . . . . . . . . . . (1)AWG �, THWN-2, Black 3 � (1)AWG 810, Slid Bare Copper EGC Vmp =265.5 VDC Imp=8.14 ADC O (1)AWG #8, THWN-2, Red "� (1)AWG 810, THWN-2, White NEUTRAL Vmp =240 VAC Imp=30 AAC (1)Conduit.0,.P WIRE, Block _ _ .. . . . . . . . . . . . . . . . (2 AWG X10, PV MIRE, Bladc voc =337.5 VDC Isc =8.65 ADC #8,.THWN-2,.Green. .EGC/GEC. .-(1)Conduit.Kit;.3/4� EMT ®PE(1)AWG 810, Solid Bare Copper EGC Vmp =265.5 VDC Imp=8.14 ADC J B-01810 9 0 0 PREMISE OWNER: AHl North Andover DESCRIPnoN: DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER: - CONTAINED SHALL NOT BE USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER �� BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES *opt Sol.arCity. NOR SHALL IT BE DISCLOSED IN WHOLE OR IN 126 OLD FARM ROAD 8.64 KW PV Arra PART TO OTHERS OUTSIDE THE RECIPIENTS REST 36 YINGLI YL240P-29b Y ORGANIZATION, EXCEPT IN CONNECTION WITH PROJECT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 THE SALE AND USE OF THE RESPECTIVE Yeti- 1 lag- Uphill 97868154.20 3055e ,CA 94402 Way SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET: REV DALE San Mateo,CA PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: 7/23/20121 x:(650)638-1028 I F:(650)638-1029 PPA (2) POWER—ONE # AURORA PVI-3.6—OUTD S—US THREE LINE PV 5 (888)-SOL-CITY(765-2489) 1 www.solardty.com 1. Conductor Sizing per Art 690.8(8)(1) ELECTRICAL CALCULATIONS a. Conductor must have 30 deg. C ampacity >= 125% of continuous current per Art 215.2(A)(1). Module: 18 Yingli Yt_240P-29b 215.91 Inv Pwr W PTC StrLen Voltage Drop Calculations Version 5_8.23 b. Conductor must have (after corrections for conditions Of use) >= Inverter 1: 1 Power-One PVI-3.6-S 96.66 3,600 _73 9 Vdrop= (imp) * (2*Length)*(Resistance) / (Vmp) continuous current per Table 310.15(6)(16). Module: 18 Yingli YL240P-29b 215.9 Imp(A) Max. Length(ft) Wire Inverter 2: 1 Power-One PVI-3.6-S J6.0% 3,6001 9 String: 8.14 50 C AWG 10 1 at Max Ave Hi: 83 deg F c. Evaluate conductor temperature at terminations per 110.14(c). Module: - Vdrop= (8.14 A * 100 ft *0.00124 Ohms) / 241 V= 0.42% P PInverter 3: r: Branch: F 8.14 50 C AWG 10 1 at Max Ave Hi: 83 deg F Ampacity of wire derated for conditions of termination must be >= Module: Vdrop= (8.14 A * 100 ft *0.00124 Ohms) / 241 V= 0.42% continuous current*1.25. All string terminations are rated at 90' C. Inverter 4: Total voltage drop in DC conductors=E8E ------------------------------------------ F Inverter: 1 15.00 25 C AWG 10 at 240V 2. OCP Sizing per Art 690.8(6)(1) Total: modules Total Inv Pwr ,_ 462 PTC Vdrop= (15.00 A * 50 ft *0.00120 Ohms) / 240 V 0.38% a. Round Up to next size per Art 240.4(B) Photovoltaic Module Electrical Specifications: Total STC�_8,640 Combined 30.00 25 D AWG 08 at 240V __________ Voc= 37.5 V deg F deg C Vdrop= (30.00 A 50 ft *0.00078 Ohms) / 240 V 0.49% 3. Conductor Sizing Art 690.8(6)(1) Vmp= 29.5 V Record Low Temp: -25Total voltage drop in AC conductors= 0.86% ger-P Isc= 8.65 A Max Average Hi Temp: 83 28.333 Total voltage drop in AC and DC conductors=F1._7_01/_61 a. Conductor must have 30 deg. C ampacity >= 125% of continuous Imp= 8.14 A current per Art 215.2(A)(1). Twc= -0.13875 V/deg C Power-One Strings: n Ivi ual PP Tisc= -5.1 mA/deg C b. Conductor must have (after corrections for conditions of use) >= String Type A and 2 Combined Strings Type A Voc Correction Method: Manuf Twc data Branch Circuit Type A 1-way wire length: 50 ft Power-One PVI-3.6-S 1,strings per branch 1 1 strings per branch 2 continuous Current per Table 310.15(8)(16). 9 Yingli YL240P-29b Inverter Min Vdc Input: 9 Vdc 9 modules per series string 9 modules per series string Voc= 337.5 V Min Vmp at Max Temp: 241 Vdc Voc= 7. V 331.6 V c. Evaluate conductor temperature at terminations per Art 110.14(C). Vmp= 265,5 V Max Voc at Min Temp: 408 Vdc Vmp= 265.5 V 265.5 V Ampacity of wire derated for conditions of termination must be >= Isc= 8.65 A Inverter Max Vdc Input: 6" Vdc Isc= 8.65 A 8.65 A continuous current*1.25. All branch terminations are rated at 75' C Imp= 8.14 A Max String Sizej I3 Imp= 8.14 A 8.14 A min. (cont= 10.81 A Art 690.8(A)(1) 1-way wire length: 50 ft (cont= 10.81 A 10.81 A Art 690.8(90) ------------------------------------------ 1.a Conductor-IC AWG 10 1 PV Wire 2.a Conductor 1:C AWG 10 PV Wire 4. OCP Sizing Conductor 2:C AWG 10 PV Wire a. Round up to next size per Art 240.4(B) conductor 1: Conductor 2: Icont*1.25=(Amps) 13.52 Icont*1.25=(Amps) 13.52 13.52 ------------------------------------------ 30 deg Campacity= 401 30 deg Campacity= 40 40 5. Conductor Sizing per Art 690.8(6)(1) 1.b Icont= (Amps) 10.81 2.b Icont= (Amps) 10.81 10.81 a. Conductor must have 30 deg. C ampacity >= 125% of continuous Start ampacity4 Start ampacity 40 40 current per Art 215.2(A)(1). Temperature derate(%=F) 0.7 Temp. derate(%=F) 0.76 0.7 Conduit fill derate(%_#) 1 Cndt. fill derate(%=#) 0.8 0:8 b. Conductor must have (after Corrections for Conditions of use) >= Derated ampacity 30.40 Derated ampacity 24.32 24.32 continuous current per Table 310.15(8)(16). Term 1 Term 2 1.c Icont*1.25=(Amps) 13.5. Temp table 75degC 75degC Ampacity 401 2.c Icont*1.25=(Amps) 13.52 13.52 c. Evaluate conductor temperature at terminations per Art 110.14(C). Ampacity 35 Ampacity of wire derated for conditions of termination must be >= 1.d (cont*1.25=(Amps) 13.5 2.d EGC C AWG 10 C AWG 10 Art. 250.122 continuous current*1.25. All inverter output terminations are rated at OCP size= 15 OCP size= 15 1 75' C. ------------------------------------------- Inverter Type A Output Combined Inverter Outpu PVI t 6. OCP 2zjD_g Power-One -3.6-S �� 1-way wire length: 25 ft Service Voltage= 240 Volts a. Round up to next size per Art 240.4(6) Icont= 16. A Art 690.8(A)(1) Total Inverter Power- 7, 0 Watts 1-way wire length: 25 ft 3.a Icont*1.25= (Amps) 18.75A Art 690.8(B)(1) Icont=#of inverters*max inverter current Art 690.8(A)(1) OCP size= 20 A Art. 240.6(A) (cont=(Amps) 30.0 7. Conductor Sizing per Art 690.8(6)(1) 3.b Conductor IC AWG 10 THWN-2 at 90 deg C:Table 310.15(B)(16) 4.a Icont*1.25= (Amps) 37.50 A Art 690.8(B)(1) a. Conductor must have 30 deg. C ampacity >= 125% of continuous Icont*1.25=(Amps) 18.75 OCP size= 1 40 A Art. 240.6(A) Current per Art 215.2(A)(1). 30 deg C ampacity 0 r 4.b Conductor 10 AWG 08 THWN-2 at 90 deg C:Table 310.15(B)(16) 3.c Icont= (Amps) 15.00 (cont*1.25=(Amps) 37.8.01 b. Conductor must have (after corrections for conditions of use) >= Start ampacity 40 30 deg C ampacity= 55 Temperature derate(%=F) 1 4.c Icont= (Amps) 30.00 continuous current per Table 310.15(8)(16). Conduit fill derate(%_#) 1 Start ampacity 55 Derated ampacity Temp. derate(%=F) 1 c. Evaluate conductor temperature at terminations per Art 110.14(C). 3.d Icont*1.25=(Amps) 18.75 Cndt.fill aerate(%=#) 1 Ampacity of wire derated for conditions of termination must be >= Ampacity 3 Derated ampacity s continuous current*1.25. All inverter output terminations are rated at 3.e EGC/GEC = D AWG 08 Art.690.47(C)(3), 250.166(B) 4.d Icont*1.25=(Amps) 37.50 75' C min. Ampacity 50 JB-01 810 9 0 0 PREMISE OWNER.- AHJ North Andover DESCRIPTION: DESIGN: CONFIDENTIAL- THE INFORMATION HEREIN JOB NUMBER: '%. . CONTAINED SHALL NOT BEE USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER SOWFCit3f. BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES: NOR SHALL IT BE DISCLOSED IN WHOLE OR IN REST 36YINGLI YL240P-29b 126 OLD FARM ROAD 8.64 KW PV Array it PART TO OTHERS OUTSIDE THE RECIPIENTS PRO�CT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH ay THE SALE AND USE OF THE RESPECTIVE Yeti- 1 lag- Uphill 9786815420 an Mateo,CA 94 0 SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET: REV: DATE: San Mateo,CA 94402 PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: T:(65o)638-1028 I F:(650)638-1029 PPA (2) POWER-ONE # AURORA PVI-3.6-OUTD S-US ELECTRICAL CALCULATIONS PV 6 7/23/2012 (888)-SOL-CITY(765-2489) 1 www.solarcity.com YGE240 YL240P-29b ®YL235P-296 YIN lG I S�LAR r YGE240SERIES YL230P-296 ti � +` SERIES YL225P-296OFFrCIAN50R ELECTRICAL PERFORMANCE I.F-LoCuP l� GENERAL CHARACTERISTICS Module name YGE 240 YGE 235 YGE 230 i YGE 225 Dimensions(L/W/H) 64.96 in(1650 mm)/38.98 in(990 mm)/ Module type YL24oP-29b YL235P-29b YL230P-29b YL225P-23b 1.97 in(50 mm) Power output Pm,. W 240 _ _ 235 230 225 Weight 43.0 lbs 09.5 kg) --�- COMPANY Power output tolerances' Ap- % +/-3 Yingli Green Ener (NYSE:YGE)is one of the world's largest fully Module efficiency rlm % 14.7 14.a 14.1 13.8 vertically integrated PV manufacturers.With over 2 GW of modules Voltage Vmap V 29.5 29.5 29.5 29s _ PACKAGING SPECIFICATIONS _ - Current at Pmax Impp A 8.14 7.97 7.80 7.63 Number of modules per pallet 20 installed globally,we are a leading solar energy company built upon - - 9 Y, 9 9Y P Y P � .y. .._ ._. � --Open-circuit voltage V« V i- 37.5 37.0 37.0 36.5 Number of (lets rove"product reliability and sustainable performance.Founded --- ----" ---- - - �- .�----- � - --- - pa per 53'Container 36 P P Y P Short-circuit current IK A 8.65 8.54 8.40 8_28 Packaging box dimensions(L/W/H) 67 in(1700 mm)/45 in(1150 mm)/ in 1998,Yingli Green Ener serves customers through our U.S. - -----'- - _.. -- - - si s 9 9Y g 'STC:1000W/m�irradiance,25°C module[emperoture.AM 1.59 spectrum according to EN 60904-3 subsidiary,Yingli Americas,co-headquartered in New York and Promium power output tolerance options are available upon request 47 in(1190 mm) Box weigh San Francisco.We are the first renewable energy company and the t 941 lbs _. _. _._(427 kg) .... ._ .. Electrical parameters at Nominal Operating Cell Temperature(NOCT) first Chinese company to sponsor the FIFA World Cup'". Power output P w 174.3 170.7 167.0 163.4 Units:inch(mm) PERFORMANCE Voltage at Pm _ v-- - 26`6 _ -26_6 26.6 _''r- -' -'--" 38.98(990) Current at Pm,. )map A 6.56 6.42 6.29 6.15 _. .__ _.... ._. __:,.__.-Y _ - 37.24(946) 1.97(50) -Industry leading in-house manufacturing of polysilicon,ingots, open-circuit voltage v« V 34.2 33.8 33.8 33.3 wafers,cells and modules ensures tight control of our material Short-circuit current 6 ( A 7.01-� 6.92 6.81 6.71 and production quality. Noce:open-ci,cuitoperating cell temperature at600W/m2irroaian 20°Camaentten,perature.Im/swindspeed -High performance,multicrystalline solar cells deliver a module series $ efficiency of up to 14.7%,reducing installation costs and maximizing THERMAL CHARACTERISTICS the kWh output per unit area. Nominal operating cell temperature NOCr[ °C I _ _ _46+/-2 p Temperature coefficient of Pm,° v ( %/°C -0.45 Power tolerance of+/-3/o minimizes PV system mismatch losses. _ _ - -+ - 1-- Grounding holes° Temperature coefficient of V« B 9(J°C -0.37 2-00.236(6) QUALITY & RELIABILITY Temperature coefficient of 1. l %ro 0.06 0 f -Robust,corrosion resistant aluminum frame independently tested to withstand wind and snow loads of up to 50 psf and 113 psf, OPERATING CONDITIONS Mount holes respectively,ensuringa stable mechanical life. 4-o.2sbxoa,s Max.system voltage 60OVa (6.5x8) Manufacturing facility certified to IS09001 Quality Management Max.series fuse rating -' 15A Drainage Proles System Standards. Operating temperature range -40 to 194°F(-00 to 90°C) 8-°0'157(4) < A A -Module packaging optimized to rotect productduring -----. _.-_------ ---- -- ---__._-- Max.static load,front(e.g.,snow and wind) 113 psf(5400 Pa) transportation and minimize on-site waste. ---�-- - ----- _ Max.static load,back(e.g.,wind)f 50 psf(2400 Pa) - -____ G.47(12) WARRANTIES Hailstone impact - -- -tin(25 mm)at 51 mph(23 m/s) Extensive 5-year limited product warranty and a 25-year limited power ; warranty. CONSTRUCTION MATERIALS ; SILVER FRAME BLACK FRAME o Front cover(material/type/thickness) Low-iron glass/tempered/3.2 mm CTION A-A -Limited power warranty*=90%of the minimum rated power output _.. _ ..... ... ... .... .. .. . ... ...._. .... ._...._.__ .. ._.. _._....._ ..-__ SE I ` o Cell(quantity/material/type/dimensions/ama) 60/polysilicon/multicrystalline/ t� / for 10 years,80%of the minimum rated power output for 25 years- 156 mm x 156 mm/243.3 cm' i ` 'In compliance with our warranty terms and conditions. Encapsulant(material) Ethylene vinyl acetate(EVA) t ' � 1.26(32) � Frame(material/color) Aluminum alloy/anodized silver or black QUALIFICATIONS & CERTIFICATES _ - -- Junction box(protection degree) IP65 L Warning:Read the Installation and User Manual in its entirety ' UL 1703 and ULC 1703,UL Fire Safety Class C,CEC,FSEC,ISO 9001:2008, Cable(typeAength/gauge/outside diameter) ~PV Wire/47.24 in(1200 mm)/12 AWG/0.244 in(6.2 mm) ` before handling,installing,and operating Yngli modules. ISO 14001:2004,BS OSHAS 18001:2007,SA8000 _ _.. . . - Plug connector Amphenol/H4/IP68 (manufacturer/type/protection degree) _ Our Partners 6114TEU OS /t '' •The specifications in this datasheet are not guaranteed and are subject to change without prior notice. aV�mOLISTlE runrxncl i'ayY Yingli Green Energy Americas,Inc. info@yingliamericas.com Tel:+1 (888)686-8820 YING_ SOLAR YINGLISOLAR.COM I NYSE:YGE M a YINGLISOLAR.COM Yin li Americas g W Yngli Green Energy Holding Co.Ltd. I VGE2405eries_EN_201107_v01 ; JB-01 810 9 0 0 PREMIA OWNER AHF North Andover DESCRIPTION: DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER: . CONTAINED SHALL NOT E USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER ��'� ' o BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES: l NOR SHALL IT BE DISCLOSED IN WHOLE OR IN REST 36YINGLI YL240P-29b 126 OLD FARM ROAD 8.64 KW PV Array PART TO OTHERS OUTSIDE THE RECIPIENT'S PROJECT MANAGER: ORGANIZATION, EXCEPT IN CONNECTION NTH MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 THE SALE AND USE OF THE RESPECTIVE Yeti- 1 lag- Uphill 9786815420 SHEET: REV: DATE: 3055 Mateo,CA,CA Way PAGE NAME: SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN San Maat94402 PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: CU TSHEETS 7/23/2012 T:(650)638-1028 1 F:(650)638-1029 PPA (2) POWER-ONE # AURORA PVI-3.6-OUTD S-US PV 7 (888)-SOL-CITY(765-2489) I www.solarcity.com J AURORA AURORA aower'oae Photovoltaic Inverters coffer-Me Photovoltaic Inverters `Changing the Shape of Power \ 1 Changing the Shope of Power (I o INPUT PARAMETERS DC Side Nominal DC Power 3120 W 3750 W 4380 W General Specifications Total Max DC Power 3500 W 4150 W 4820 W •7 0 eratin MPPT Input Voltage Range 90 V to 580 V 360Vnominal Outdoor Models 200 V to 530 V Co3 V'[ 277 V 200 V to 530 V @ V rid 277 V Full Power MPPT Range 160 V to 530 V 200 V to 530 V 3 V rid 240 V 200 V to 530 V @ V rid 240 V �� 220 V to 530 V V rid 208 V 220 V to 530 V�?VQ Max ut Volta a 600rid 208 V PVI-3.0-Ot1TO-US/ PVI-3.0-OUTD-S-US �+ � � Activation Voltage 200 V nominal ad'ustable from 120 V to 350 V PVI-3.6-OUTD-US/ PVI-3.6-OUTD-S-US Number of Independent MPPT Channels 2 of Max DC Power On Each MPPT Channel 2000 W 3000 W 3000 W PVI-4.2-OUTD-US / PVI-4.2-OUTD-S-US �, Max.DC Current Per MPPT Channel 10A 12.5A short circuit 16A 20A short circuit 16A 20A short circuit Thermal Protected DC Side Varistor 4 DC Switch Integrated in the-S versions(rating 60OW25A G. 4(2 positive;2 negative) DC Connections Screw Terminal Block Wire sizes:Solid,from,AWG20 to AWG 6-Stranded,from AWG20 to AWG 9 Cable Gland:M25-Cable diameter:3/8"to 11/16" OUTPUT PARAMETERS AC Side Nominal AC Power 3000 W 3600 W 4200 W Max AC Power 3300 W 4000 W 4600 W High-Efficiency, 3 kW to 4.2 kW Inverters Installer friendly AC Grid Connection split phase 240V - single phase 208V/277V Aurora®grid-tie transformerless inverters offer a unique combination of •Reverse-polarity protection minimizes potential damage caused b Nominal AC Voltage Default 04) Optional 208V or 264)77V(setting 8 wired P tY P P 9 Y AC Volta a Range 277 V 244-304 240 V 211-264 208 V 183-228 ultra-high efficiencies, installer-friendly designs, long service life, and miswiring during installation. Nominal AC Frequency 60 Hz competitive initial acquisition costs; significantly increasing return on •Front-panel mounted LCD display provides real-time updates for all Continous AC Output Current 12A - 14.5A - 14.5A I 16A - 16A 17.2 i 20A - 20A 20A investment in solar-power installations. critical operating parameters. Maximum Output OC Protection 15A - 20A - 20A I 15A - 20A 25A 25A 25A 25A •RS 485 and USB communications interfaces. AC Side Varistor 2 live-netrual/live-PE •Integrated DC switch available in compliance with NEC Standard, Screw Terminal Block Industry-Leading features and Performance AC Connection Wire sizes: from,AWG20 to AWG 6-Stranded,from AWG20 to AWG 8 •High efficiencies deliver more energy–up to 96.8%(96%GEC). Article 690"Solar Photovoltaic System"(USA). Cable Gland:M25-Cable diameter:3/8"to 11/16" •Two inputs with independent MPPTS, optimize power from multiple •Anti islanding protection. Line Power Factor ° t AC Current Distrortion <2%at rated ower with sine wave voltage arrays oriented in different directions. Max Efficiency 96.8% •Compact size and high power density:460OW max of output power in CEC Efficiency 96% a box size of just 3311/16"x 1213/16"x 81/4". Feed in Power Threshold 20 W Nighttime Consumption <2 W s e Isolation NO transformerless topology) Unmatched Applications flexibility u -' ► I ENVIRONMENTAL PARAMETERS •Full-rated power available up to 50°C ambient temperature. PVI-3.0-OUTD US 3000 W Coolin Natural cooling •Two input sections,with parallel option,with independent high-speed Ambient Temp.Range foCl -25°C to+60°Goutput ymerderatin for Tamb>55°C -25°Cto+60°Cderating for Tamb>45°C MPPTs, optimize energy harvesting from multiple arrays oriented in PVI-3.0-OUTD-S-US 3000 W Operating Altitude 6,000 ft P 9Y 9 P Acoustical Noise <50 dBA Q 1 m different directions- PVI-3.6-OUTD-US 3600 W Environmental NEMA Rating NEMA 4X •Wide MPPT operating range:90 to 580 VDC. PVI-3.6-OUTD-S-US 3600 W Relative Humidit 0-100%condensin MECHANICAL PVI-4.2-OUTD-US 4200 W -S version: 3311/16"x1213/16"x81/4" Field-Proven Reliability Dimensions(HxWxD)[inches] PVI-4.2-OUTD-S-US 4200 W basic version: 211/2"x 1213/16"x 81/4" •IP65(NEMA 4)rated enclosure withstands the harshest environmental r Weight lbs 37.5 lbs - 46.25 lbs conditions- . - ' +x OTHER •Front-mounted heat sink resists contamination,enhancing cooling and AURORA®Communicator software simplifies monitoring via PC. Display YES(Alphanumeric 2 lines increasing reliability and long-term efficiency. AURORA®EasyControl datalo er is available for remote } RS485(spring terminal block-wire cross section:AWG28-16) •Grid-connected operation according to international standards, et Communication 7 USB connection(for Service only) P 9 control via Internet or modem. "Aurora Easy Control"system for remote control(Optional) UL1741/IEEE1547&CSA-C22.2 N.107.1-01. _____— __._ __. _ --._---_._-_--._.w – •10-year warranty,optionally extendable to 15 and 20 years. Standards and Codes Aurora°inverters comply with standards set for grid-tied operation,safety,and electromagnetic compatibility including:UL1741/IEEE1547&CSA-C22.2 N.107.1-01, Renewable Energy Division VDE0126,CEI 11-20,DK5940,CEI64-8,IEC 61683,IEC 61727,EN50081,EN50082,EN61000,CE certification,EI Real Decreto RD1663/2000 de Espana. CONFIDENTIAL— THE INFORMATION HEREIN JOB NUMBER J B-01810 9 00 PREMISE OWNER AHJ North Andover DESCRIPTION: DESIGN: CONTAINED SHALL NOT BE USED FOR THE DUNN, DEIRDRE DUNN RESIDENCE THOMER BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES: rI f SolarCity NOR SHALL IT BE DISCLOSED IN MOLE OR IN RESI 36YINGLI YL240P-29b 126 OLD FARM ROAD 8.64 KW PV Array PART TO OTHERS OUTSIDE THE RECIPIENT'S PROJECT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE Yeti- 1 lag- Uphill 9786815420 3055 Mateo, CA Way SOLARCITY EQUIPMENT, WITHOUT THE WRITTEN PAGE NAME: SHEET: REV DATE: San Mateo,CA 94402 PAYMENT TYPE: INVERTER: T:(650)638-1028 I F:(650)638-1029 PERMISSION OF SOLARCITY INC. PPA (2) POWER-ONE # AURORA PVI-3.6-OUTD S-US CUTSHEETS PV 8 7/23/2012 (888)-SOL-CITY(765-2489) 1 www.solardty.com r 7 ei •. r The SolarCity Yeti with Eco-Fasten Green Fasten flashing optimizes strength, performance and aesthetics while structurally attaching solar panels to composition shingle roofs. This engineered connection uses 0.378THRU ALL Eco-Fasten's patented, IAPMO-certified "green fasten"technology to achieve a watertight seal. 6000 coRIOR TO series aluminum offers superb structural and fatigue strength,which in conjunction with anodization offers excellent corrosion resistance even in coastal environments. it%Of A/,fS {- ��.q► ryG 1.92 +f , • 1APMO-ES-certified for waterproofing—Tested to ICC ac286 JOSEPH H. �, �•_-- • Tested in accordance with U L 441—Waterproofing for rooftop penetrations calNIN • Anodized for long term corrosion resistance and best aesthetics CIVIL • No shingle cutting required No. 45117 2s3 0 4` • Fast and error-proof installation reduces overall impact on roof A�O,(�FQIST�.Q`L � ' • Compatible with SolarCity Canopy Rail 5/aNALE11�` s.7s • Rail is attached using Stainless Steel Fasteners Digitally signed by Joseph H.Cain,P.E. Date:2012.07.17 18:07:57-07'00' .3801.010 Components Installation Instructions A. 5/16"Lag Screw 1. Drill pilot hole in rafter B. Stainless Steel+ EPDM Sealing Washer 2. Seal pilot hole with roofing sealant 1.94 C. Yeti(L-foot) 3. Insert Eco-Fasten flashing under upper layer of D. Eco-Fasten GreenFasten Flashing shingle 3.00 4. Place SolarCity Yeti 5. Install lag with sealing washer f . A �l Of 44$��yG _ �1�' � �� J0 N H B CAI C � CIVIL No.49117 RFaISTEQ�� ssiaN�r<.E�G� 8 Digitally signed by Joseph H.Cain,P.E. D Date:2012.07.17 18:09:27-07'00' STAMPED AND SIGNED �tDd�9 � y STAMPED AND SIGNED ;�°S®ea�ity FOR STRUCTURAL ONLY FOR STRUCTURAL ONLY J B—01810 9 0 0 PREMISE OWNER aH r North Andover DESCRIPTION: DESIGN: CONFIDENTIAL THE INFORMATION HEREIN JOB NUMBER CONTAINED SHALL NOT BE USED FOR THE DUNN DEIRDRE DUNN RESIDENCE THOMER BENEFIT OF ANYONE EXCEPT SOLARCITY INC., MARKET: MODULES: NOR SHALL IT BE DISCLOSED IN MOLE OR IN REST 3s YINGLI YL24oP-29b 126 OLD FARM ROAD 8.64 KW PV Array 001 S0�'� j�'.ty PART TO OTHERS OUTSIDE THE RECIPIENT'S PROJECT MANAGER: MOUNTING SYSTEM: NORTH ANDOVER, MA 01845 ORGANIZATION, EXCEPT IN CONNECTION WITH THE SALE AND USE OF THE RESPECTIVE Yeti— 1 to — Uphill 9786815420 3055 Clearview Way SOLARCITY EQUIPMENT, VATHOUT THE WRITTEN PAGE NAME: SHEET: REV: DATE: San Mateo,CA 94402 PERMISSION OF SOLARCITY INC. PAYMENT TYPE: INVERTER: T:(650)638-1028 1 F:(650)638-1029 PPA (2) POWER—ONE # AURORA PVI-3.6—OUTD S—US CUTSHEETS PV 9 7/23/2012 (888)-SOL-CITY(765-2489) 1 wwwmiardty.com Date. HORTIy TOWN OF NORTH ANDOVER a PERMIT FOR GAS INSTALLATION . 9 y,SSACHUSESt k This certifies that fl.lQ,6 1 . . . . . . . . . . . . . has permission for gas installation in the buildings of . . -n�u! !J . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . o ver S. FeeW�. . Lic. No:�!Z' . . . . . . . . . . Check# 4�v 8246 MASSA CHUS;=TTS UNIFORM APPLICATION FOR k PERMIT TO PERFORM GAS FITTIIJG WORK CITY: e tA Ll n o le-e C MA. DATE: ff PERMIT t JOBSITE ADDRESS: I C 6 it � -rG�r vr. y�� OWNER'S NAME: OWNER ADDRESS: �� Ola{ 40 r vr%. TEL: 60 r-4�1-5!j2a I OI. OCCU/RENOVATION: YPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL I'Rlh''I" CLEA1d,)' NEW: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ IJO❑ APPSTOVE FLOOR- Bsml 1 2 3 4 5 6 1 7 F3 9 10 11 12 13 14 BO BO COR CO DIRECT VENT H EATER DRYER FIREPLACE FP,YOLATOR FURNACE GENERATOR GRILLE INFRARED HEATi ER LABORATORY COCK MAKEUP AIR U41T OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT- TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current C lability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [ NO ❑ 'f you have checked YES,please indicate the type of coverage by checking the appropriate box, below. LIABILITY INSURANCE POLICY �/ OTHER TYPE INDEMNITY ❑ BOND ❑ )WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Aassachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ED AGENT ❑ SIGNATURE OF OWNER OR AGENT rereby certify Ilia 1 all of the details and information I have submitted(or entered)regarding this application are true a d accurate t- the e I of y nowledge and ih at all plumbing wort;and insiallalions performed under the permil issued for this application I'b 'n omplic e" lh a erti e -ovision of the M�ssachusells, taie Rlumbing Code and -hapter 142 of the General Laws. , I r 'LUMBERIGASFITTER t AJ�Ei- C� r.'f✓ J - �� LICENSE 11 l C Flo '---z SIGNATURE ;OMPANA' AME: ��.� j /C% /��CJ� ADDRESS C' ! tn r- ITl . �. �� l t STATE: � /� ZIP: C1� I � t�' FA>,; EL:6� 1` ,/;� �' C�; l CELL: EMAIL: tSTER[]�JOJRNEYMANI❑ LP INSTALLER[D CORPORATION [J'#1 .�` C� '� PARTNERSHIP❑ LLC❑#J -� � | ' | Yes �o | ---- T�l��I!�]! �� -_- �E E: s PERMIT ___ m/ ' ----------�� ( ' ' ------------- ----' - - ----- -'-------------- --�� ' -- ------ - - ' -- --- - -' --------- | | - '�----- ---------- ---- �� i i ! \ ----'-------- -' - ---- � `---------'------------'-- ! ` 1x The Commonwealth of Massachusetts ,.a ff Department of Industrial Accidents Office of Investigations V) 600 Washington Street Boston, Mass. 02111 wtvw.nlass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/hidividual): T 1 ! Q S M V1 V t Address: -� Ct��r� �VtG'd1 L) r? City/State/Zip• (��e �5�� `�� b �' S�J Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[i• I am an employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors ?_ G Remodeling 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' q. ❑ Building addition [No workers'comp. insurance comp.insurance.$ required] 5.0 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 perm MGL insurance required]t c. 152, § 1(4),and we have no 12. ❑ Roof repairs employees. [no workers' 13. ❑Other comp. insurance required.] iI *Any applicant that checks box#1 must also rill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must suhmit a new affidavit indicating such. $Contactors that check this box must attach 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.policv number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. p ( L Insurance Company Name:�V e lA5 L ��S t x'15 u reCdlc G L-�U/LAllJ1 t� Policy#or Self-ins.Lie. Ogg Expiration Date: d-U I a-- 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify un er the p 'ns a td penalties of perjury that the information provided above is true and correct. Signature: Date: Pint Name 1cC ha e-1 36er-r 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 Heath 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact person: Phone#: i 9057 Date. .' °'•H�°T +o TOWN OF NORTH ANDOVER 3r oc PERMIT FOR PLUMBING40 n �,SSACMUS� �. This certifies that ': �' f.�. 5 . .1�" . . . . . . . . . . . . . . . . . . . . has permission to perform . . .� { t�". . !�Zu (�`u,c,� •T:. . . . . . plumbing in the buildings of . . .?e-.Vc.r. V .. . . . . . . . . . . . . at . . .(0-L6. . (),I:CQ• . ;�-i . . . . . . . .. North Andover, Mass. Fee.j.�.59.Lic. No..x.3.2 �. . . . . . .� PLOMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) !' Y8 —M /grde VOMass. Date //_ Permit # I Building Location &6/ 611 FGrl—In /n� Owner's %yv Type of Occupancy Residential New U Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ FIXTURES L n w n o z r- O C7 W b r v, = LU rd I w Y J N > V a o) 0 s �4 74 34 Q) 'A Z � a � _ ~ N = o _ Z Ln a N N 31 x of N �±' V) i N U w 0 Y -< n U_ - a - 3 � rti b 49 � `� m W r a r '� o a Z n cn Z M ( W O F W Q N o a J N 2 J ? LL r L) r o = a N r z o Op w xZ LL W r O V N N N I a r a a x a a a Q J J a cc cc m a c a 4J 1 4-) �4 3 x J m cn o o J3: = r N U. 0 D 3 Z 3 cc m rd N (d b SUB-BSMT. I BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR i 5TH FLOOR 6TH FLOOR r 7TH FLOOR I y� 8TH FLOOR I-T Installing Company Name Heritage Htg. &Plg. CO. Inc. Check one: Certificate Address 35 Pleasant Street EX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 -438-7776 l Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 91 No ❑ If you have checked ye, please indicate the type coverage by checking the appropriate box. A liability insurance policy 3 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: Owner ❑ Agent❑ Signature of Owner or Owner's 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of th?General Laws. By 64 /J L Title SigYMuie of Licensed Plumber- Type lum erType of License. Master[g Journeyman❑ City/Town 8322 APPROVED(OFFICE USE ONLY) License Number ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 1.2.00§Rule 8: In accordance-with theprovisions of M.G.L.c.143,§.3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed ba the prescribed form.Atter a permit application has been accepted by an Inspector of Wires appointed pursuant to M.GI o.166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall_belimited as to the time of ongoing construction activity,and may be.deemed_bytheJnsp.ector-of_W.ires abandoned_and_invalidafhe—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on thq permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promot6job.growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certaiurpe>mits-and licenses concemingthe use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence'during the qualifying period beginning on August 15,2008.and extending'through August 15,2012. Permit(Date Closed: ***Note:Rea ly for new permit' � rmit Extension Act—Permit/Date Closed: � / �/ij�. Date...6 .. dv, .. ....................... k t koRTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING US This certifies that .............................?1 / .L................................. has permission to perform .............to ."Poe- wiring in the building of......... ......................... c94,0 at..........7,.........................................4................... .North Andover,Mass. 1 1z, 6 Fee..................... Lic.No..o.�?f !4..................... .. ELECTRICAL INSPECTOR Check # 4/ 3 67 '14 Commonwealth of Massachusetts IIIILiA I No. Department of Fire Services Permit 71V Occtipanc% Fcc Chcckcd [ BOARD OF FIRE PREVENTION REGULATIONS Rev. 9 i)�] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORM to he 1-crtcinicd \011 the 527(AIR I 1.1M PLE.(.tiE PRL%r i,N L\K OR�� 1,I TIOX,, Date: —19)9 Ch or Town of: To 117C hi,spec-lor of [Virc Ily Illis ilpjflicatioii the undersi,ncd notice his or licl. 111tclitio t( C11*01-111 die'Jectrical -Nork de'Al'ihed 1100k�. Location (street& Number)-/0- 7G411-111n Owner or Tenant 401-. - e 0z 1-2a^1 Telephone Owner's Address -5/4/;1 Is this permit in conjunction with a building permit? Yes E]-" No (Check Appropriate Box) Purpose of Building 11A eg C.r Ltility Authorization No. Existing Service Amps I Volts Overhead 0 UndgrdE] No. of Meters New Service Amps Volts Overhead El Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W.,AA il"l,whh'm(a .,e 11 No.of Recessed Luminaires No.of Ceil.-Su-sp.(Paddle)Fans No.of - Total Transformers KNA No.of Luminaire Outlets No. of"OtTubs Gen rators KVA No.or Liominaires Swimming Pool In- o. I Emergency Lighting ,,rod. FAQ'o Battery Units No.of Receptacle Outlets No. of Oil Burners 'FIRE ALARMS No. of Zones No.of Switches No. of Gas Burners No.of Detection and InitiatinDevices No.of Ranges No.of,Air Cond. Total g Tons No.of:Alerting Devices No.of Waste Disposers Heat Pump Number IFoM I K No. Self-ContainsY)tals: - ,Detection/Alerting Devices No.of Dishwashers Space/Area "eating KWIVI t , , I LocalEl ""W 0 Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of bev ices or Equivalent No.No.of Water Nof N o.of Heaters KW Data Wiring:Signs Ballasts No.of Devices or Equivalent �No. Hydromassage 13athtubs No.of Motors Total HP I elecommunications Wiring: OTHER: No.of Dcv ices or EquiN alent i F.,.tiinat%:d VAuc of Electrical W !rk: I A hell required by HILIniLipal P( iCv,) \k oi k to�t;ij-t: In:pectioni to be rk:qL[C1,tecI in W�:0111;111LC with \IE(. Rule it), and upon C0111PIctioll. VINS(-RANC E 0A ERACE: I. nlc s waived by the owner. 1141 Permit ter the perl'ormancc :fjeL:tj-iLal work may P-LIC 11111, :114: liccn-iec pri:'.ides proof o."l-,lii;Hlik i1l-A11-;11lC,: lncltldille or its I i t I co r;I ,e I. ;Il I t,1 1 1) t L..d r ro c t t a111e It Ille P I i t I 11111'1 1--1 c L-J FR 1- o� X� -X—W.04f P 41 ... ..... A ldrcss e . Or F ? T.- rj. 1;:apl,11Cdh1C 1, ter Lill. IiLOLL Q1111170'111LIV (-,11tra(�W1, 1A(1'-,W NIFR's INsl-RA.V F AAIVER.- I that(ho i'lb:lit, IL]Llired by law. 13v ni% (,.h,:A ...... Owner,'Atyent 00,91 6 r � t M Location / Old ~An �` �-► _ No. c O Date ~ORTN TOWN OF NORTH ANDOVER ', 9 • ; . Certificate of Occupancy $ s 6, Building/Frame Permit Fee $ es s^cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # p),vo IS 5 7 ' Building Inspector r• TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING _. /� �_> 78#'►111 ' - sN BUILDING PERMIT NUMBER. DATE ISSUED. � SIGNATURE: C C Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O/�Q �a�,r�, 35- Com. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 30 -35 3 0 - 3G 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public V Private ❑ Zone Outside Flood Zone R' Municipal ;W0 On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 O/w�ner of Record Name(Print) Address for Service: v �� _ l7ff 6*! -S a Signature Telephone (`) 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ c S � � Licensed Construction Supervisor: � �a a License Number 4V%—¢/11-1 r /C4"- .4ndo,G„ /11 ,• mn mn Address * 5/1`Y1�(x F,90 Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Gams- �0Jy-,n Company Name /0 6 Registration Number Address P q �/ 2`A a- 1 / 75- A0 3 Expiration Date ^ Signature Telephone Y♦ r . 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 au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 444 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 60.40,06 — Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 7/0 Check Number SECTION 7a OWNER AUTHORIZA ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 0e f/ as Owner/Authorized Agent of subject property Hereby autho e LtJ¢��ra�-. f✓vy�ti /fir+-S'. C-RIl GoAd Co.440 to act on My beha '/� ive 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 Print N'rre _ Si atrue of � f Owner/A ent `(J Date . . NO. OF STORIES SIZE ' BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS Isr2 ND 3 RD SPAN DIMENSIONS OF SILLS -� DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CI VIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FOAM U - LOT RELEASE FORM IQ�cQ��crN� INSTRUCTIONS: This form is used to verify that all necessary approvals/permits a _ 1ls/pe ermits 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_ 1 e ` D 106-1 .ICJ AI,/ PHONE_ LOCATION: Assessor's Map Number 3 PARCEL — SUBDIVISION . LOT(S) - STREET �u-�M Iia , ST. NUMBER �a *****************************************OFFICIAL USE ONLY * RECOMMENDATIONS OF TOWN AGENTS: C NSERVATION ADM RATOR DATE APPROVED p d,� DATE REJECTED COMMENTS uo +tahks off ocapv4A wre cJfin I60 i - roX. au 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 Of MORTN 1 M' RECEIVED JOYCE BRADSHAW 11S44c TOWN CLERK NORTH ANDOVER NORTH ANDOVER OFFICE OF THE ZONING BOARD OF APPEALS 1000 JAN 20 P 1: 36 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01815 FAX(978)683-9542 Any appeals shall be filed NOTICE OF DECISION 1 within(20)days after the Year 2000 date of filing ofthis notice Property at: 126 Old Farm Road in the ottice ofthe Town Clerk. NAME: Peter& Deidre Dumr DATE: 1/12/2000 ADDRESS: 126 Old Farm Road PETITION: 045-99 North Andover. )VW 01845OOn HEARING: 1/11/2000 The Board of Appeals held a regular gWar meeting on Tuesday evening, January 11. 2000. at 7:30 PM upon the application of Peter&Deidre Dunn- 126 Old Farm Road, North Andover, requesting a variance from the requirements of Section 7, Paragraph 7.3 of Table 2. for a rear setback to construct a proposed addition of garage.bedroom, bath,and study, within the R-2 Zoning District. The following members were present: Walter F. Soule. Robert Ford John Pallone, Ellen McIntyre. Scott O Karpinski. eco Upon a motion made by Robert Ford and seconded by John Pallone. the Board voted to GRANT a dimensional variance from the requirements of Section 7, Paragraph 7.3 for relief of 5'for a rear setback in order to construct a garage,bedroom, bath,and study. The Board finds that the petitioner has satisfied the a provision of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. e In accordance with the Plan of Land by: Carmen A. Testa, Registered Land Surveyor,#18467. Northern Associates. Inc., 3.42 North Main Street. Andover, MA-and in accordance with elevation drawings of. A1. A2. A3, A4, A5,drawn by G.J. Bruno Associates. Architectural Designers, 28 Berkeley Road. North Andover. MA 01 845. Voting in favor: Walter F. Soule. Robert Ford, John Pallone, Ellen McIntyre, Scott Karpinski. 10.4 Variances and Appeals: FEB ;, � +�� rt t•--t4" The Zoning Board of Appeals shall have power upon appeal to grant variances from the terms of this Zoning Bylaw where the Board {� finds that owning to circumstances relating to soil conditions,shape,or topography ofthe land or structure and especially atyeding -� such land or structures but not affecting generally the zoning district in general,a literal enforcement ofthe provisions of this Bylaw will involve substantial hardship.financial or otherwise,to the petitioner or applicant.and that desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of this Bylaw. Furthermore,if the rights authorized by the variance are not exercised within one(1)year ofthe date ofthe grant-they shall lapse.and may be re-established only atter notice,and a new hearing. Furthermore,if a Special Permit granted under the provisions contained fig herein shall be deemed to have lapsed after a two(2)year period from the date on which the SI sial Permit was granted unless P-► substantial use or construction has commenced,they shall lapse and may be re-established only after notice.and a new hearing By order of the Zoning Board of Appeals. CJ Walter F. Soule, Acting Chairman cn m1/deci si ons2000/2 BOARD OFAPPEALS 688-9541 BL1LD NGS 688-9545 CONSERVATION 688.9530 HEALTH 688-9540 PLANN-MG 688-9535 f 4� • NORTH REGISTRY OF D=S c �Cr t-AWRENC-E. MASS. A TRUE COPY: ATTEaT: i Registry of Deeds Northern District of Essex County Lawrence, MA 01840 02/11/00 DUNN JC # 5 Rec: Type PLAN 10.00 Copies 1.00 # u Rec: Type CERT 10.00 Copies 0.75 Total ^1 N 7 Payment Cash 25.00 THANK YOU! Thomas J. Burke Register of Deeds NORTHERN ASSOCIATES INC . 401 SOUTH BROADWAY LAWRENCE MA 01843 TEL:978-837-3335 FAX.-978-837-3336 (AS- BUILT) L9 Lf 0 L>1 LOT 8AA L12 L8 L1. 328.84" 28.84' L7 L1 L2. 116.86' L3. 85.71' L4. 99.63' L5. 50.34' L2 L6. 350.00' p► L7. 228.30 L8. 459.88' L9. 186.51 L10.471.27'- IS L11.2 77.86' Old Farm Road L12. 78.08' (not to scale) LOT C LOT 8AA LOT 16C64 2 a 18.00' 161.75' 35'f \ — — DECK DRIVEWAY EASEMENT\ / \ to EXISTING Qo / ADDITION \ M / LANDING q6 1 .06 25'.t 2� w 7 \ fhs., 114 � W / 0 rn o � I o h co LOT 7B w $ F C.COVIELLO I s#136 w � ^ 1 I LOT 9AA A I 'ccoo N/F W.ADAMS I I I � I R=125.00' i I 7.=.50.34' �OL FARM ROAD I ZONING DISTRICT R2 CERTIFIED TO:FIRST UNION MORTGAGE CORP.& TITLE CO. PREPARED FOR: PREPARED BY: PETER & DEIDRE DUNN �` Of OA NORTHERN ASSOCIATES INC. 126 OLD FARM ROAD ° CARS 401 SOUTH BROADWAY NORTH ANDOVER MA �TA LAWRENCE MA 01843 .1 0_ sa6 DATE:OCT.10,2000 SCALE:1"= 40 ONAt LANG! li'�/t^llln r` n I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # MAScheck Software Version 2.01 Release 3 I I I 1 Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-15-2002 DATE OF PLANS: 5/14/02 PROJECT INFORMATION: Peter and Deidre Dunn 126 Old Farm Rd No. Andover Ma COMPANY INFORMATION: EMH Construction Corp 9 Bartlet St Suite 102 Andover Ma COMPLIANCE: Passes Maximum UA = 77 Your Home = 65 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 300 30.0 30.0 5 WALLS: Wood Frame, 16" O.C. 370 13.0 13.0 18 GLAZING: Windows or Doors 102 0.350 36 FLOORS: Over Unconditioned Space 240 19.0 19.0 6 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1311L-,�0 and J4.4..� Builder/Designer„/ ®"�� ®i Date fG.1' ?/rrC�e 00=wmeadth of Massachusetts N LEpaTl77Z of 1nduA7ZafAx d✓= ON - Office of Imvest =i= 600 Was&ngton S't'reet Boston, atX 02111 Workers'Compensation hmi ance Affidavit APPLICANT INFORMATION Please PRINT Legibly Name: Location: City Telephone#: 0 I am a homeowner performing all work myself. 0 I am sole proprietor and have no one working in my capacity .ki am an employer providing workers'compensation for my employees working on this job Company Name: L5 Address: City: 14r,2&1164- Jwc%t Telephone#-. Cf17 Insurance Company: ism&vS Policy#: P 1-- 013 3 7 q W50 70 f O I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following. i, workers' compensation policies: Company Name: Address: City: Telephone M Insurance Company: Policy M Company Name: Address: City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepainsand penalties of perjury that the information above is true and correct Signature: Date: /0"�® Print Name: C-Q®1//'Cll Art �t<=��+��_ Phone# 7FSy 7 f �a�0 Official Use ONLY-Do not write in this area o Building Department M Licensing Board Permit/License#: City or?own: o Selectmen's Office o Health Department ❑ Check if Immediate response is required 0 Other INFORMATION &YNST.l ucnONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law" an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the-dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also-states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented io.the contracting authority. Applicants Please BE in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the. Department of Industrial Accidents for.confumation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should.be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"-or if you are required to obtain a workers' .compensation policy,please call'the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you-regarding the applicant. .Please.be sure to fill in the permit/hcrose number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like.to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street . Boston, MA 02111 Fax# (617) 727-7749 Telephone# (617) 727-4900 ext. 406,409, or 375 NORTfy �.E TONM a ,...: Andover o \/ h � Mass., �- o z- L AC f( dower, 2 COCHIC 1 RATED S u G H 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �Q��/' �' ,�t!�/"1C �V� � BUILDING INSPECTOR THIS CERTIFIES THAT.... ..... ............................ ................................................................ Foundation ... ... ...... .......................... �X0y a` 0/ Fwt ......A� Rough permission to erect..... ... buildin son .. / . .... ......................... ...... ........ to be occupied as.. � r'.... i....�v�!'o.. �.. y o......0 Ae4.) ...PE C�....D A.) P ed/'`- Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in mlC Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Constructignpf _ Buildings in the Town of North Andover. 3S/i�� A/`/. _ ->-rw PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. _7 Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR ............................................ Rough ..........�......... ............... ..... 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 Street No. SS-EE REVERSE SIDE Smoke Dec. Location No. ` 1'4/ Date 42 NORTH TOWN OF NORTH ANDOVER 13� •. • 0 9 ' Certificate of Occupancy $ �i�s'••• E<� Building/Frame Permit Fee $ 311J s4CNU5 y Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # 1816 ,1 / Building Inspector, ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH AONEORTWOFAMILYDWELLD(C +� Sly m BUILDING PERNIlT NUMBER: DATE ISSUED: X, SIGNATURE: BWU=CommWover of Bail ' Date Z SECTION 1-SITE INFORMATION O 1.1 Propaty Addnm 1..2, Aeosars Map and Parod Number: /016 0/d !�r m R 620 Msp Number Pared Number f w` 1.3 Zonieglnfoemarion: 1.4 PropatyDimmeiaas: � � /2e� „� its•. /6�� /�7 3 S� �, Zanit D driat use Let Anes F 1.6 BUILDING SETBACKS f Front Yard Side Yard Rear Yard Provide Required Requimd Provided d 1 31 S 1.7w4mr SWfyUGJ—C.4tl. S1j I.S. FbWZ saleixwWm: t.E SewonvDvoWSyW= Public ftW 0 zm oaftwoFleaszea. Mmidpal ,.W 0oSBaDtrpoar Sys-WN 0 SECTION 2-PROPERTY OWNERSHWIAUTHORIZED AGENT rn 2.1 Owner of Record h Old vk, Name(Print) Address for Service: 2�,_ 0 �� G 3igoaturo Telephone 2.2 Owner of Record: Q Name Print Address for Service: Z m S' re SECTION 3-CONSTRUCTION SERMCES 3.1 Licensed Construction Supervisor: Not Applicable 0 GtJ��orrr, �� 61t/� Zo2G� Licensed CConstruetion�S,upervisor C 5 ® sd0 ✓.1�r�/��l' S /D LinseNumber /4� wn Ae a y75 &L,63 s� / Expizatioa Date s*mm Telephone r -t 3.2 Registered Home Improvement Contractor Not Applicable a CA/1 Cove /p� �9 Comcp�any Name m / �Gt r��°✓� l! ' �/©� ��^�'�' f/�� R%atratau Number r Address y 7 5 990-3 Expiration Date Si stuie T e f SECTION 4-WORKERS COMPENSATION(MO:L C IS2 § 25e(6) ' Workers Compensation Insurance atEdavit must be completed and submitted with this application, Failureto provide this atlYdavit will result in the denial of the issuanoa of the bhu7din Sived affidavit Attachod Yes.... No......D SECTION 5 Dikafodon of Pro Work c1eckk11 .0 bk New Construction ❑ Existing Building ❑ Repau(s) D7 Altetntiohts(s) ❑ 1 Addition Jr Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: AJ SECTION 6-BSTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be r Completed it Iicant 1Elm Im L. Building (a) Building Permit Fee O Q U Multiplier 2 Electrical (b) Estimated Total Cost of 6 G o v Construction 3 Plumbing U D Building Permit fee(a)x.o) 4 Mechanical JHVAQ CQ 5 Fire Protection 6 Total I+2+5+4+5 3 9 O l/V Check Number SECTION 7a OWNER AUMOMUTION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT J, as Owner/Authorized Agent of subject property Hereby authorize 1 d Aa n, to act on My beh in 0 matters Live to work authorized by this building permit application 44A�/� - ` Si lure Of Owner Date SECTION 7b OWNER/AUTHORIUD AGENT DECLARATION ,as Ownet/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 ll Pant Nam J Signature of Ow=dA t Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 NO 3 SPAN DIMENSIONS OFSILLS DZMGIONS OF POSTS DIMENSIONS OF GIRDERS 1 DEIGHPP OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLD)OR FILED LAND IS BUILDING CONNECTED TO NATURAL GAS.LINE • a :`1<re CotnrtsotrtvealtfC orf JtlstssatFtstsetts Q)ep xM=t of-[=&tridA=ide Off=Of ations 600 rWasfiftib n Street Boston, 91(A 02111 Workets'Compensation tnsuran=AmdM A-PPLICANT LNFORMATION Please PRINT Lembiv Name ;vocation: Teiephone M C I am a homeowner performing all work myself. D I am sole proprietor and have no one working in my capacity ,girl am an employer providi ng workers'com-ri sation for my employees woriang on this job Company Name: Address: City: 4n-,L/r, //1G` Telephone f g� 17�' L�/�S_ 0 J? insurance Compapy lrG a/ �l!�� Policy _ 3/7 '� -W 50 70-Y D I arm(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed b.tiow who have the following woirers' compensation policies: Company Name: Address: City: Telephone : insurance Company: Policy r Company Name: Addr css: Telephone M Policy r: Insurance Co=anv- Atrach addhion:ai sheet if necessary aiiure_to secure coverage as required under Section 25A o?MGL 15B can lead to the imposition or crimina;penalties of a fine un to S1,500.00 znd/or one years' imprisonment as well as civil penalti:s in the form of a STOP WORK ORDER and a fire of 5100.00 a day a_amst me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cer#5;under the pains and penalties of perjury that the information above is True and correct. a G" Signature: DW T: L✓�-G Phone n 7Y V 7 f f o f — � Official Use ONLY-Do not write in this area c Building Depanrner: i w. = icensin Ci y of i own: FetmitlLicense n. ^- o Boar, - Seiectmen's O fi=c n Health Department n Check if Immediate response is rewired n Other + I r 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 SECTIO APPLICANT 60//Nh, 11.0.1611 *'res CMH 60,0f,C0Y1 PHONE 97g 05 'FA0 3 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) FAA- STREET li9, AASTREET1i9,6 014 `OWP" A ST.NUMBER /a6 USE CO D OF TO GENTS: fif C SERVATION ADM N STRATOR DATE APPROVED DATE REJECTE�D�- COMMENTS K+- i (I I�l'�. L4L I "t'k I r1a�1 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 PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm I � . Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 Data filename: CAProgram Files\Check\REScheck\Dunn2.rck PROJECT TITLE:Dunn Residence CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE: Other(Non-Electric Resistance) WINDOW/WALL RATIO:0.14 DATE:03/30/05 DATE OF PLANS: 5/5/04 PROJECT DESCRIPTION: Build front entry area per plans DESIGNER/CONTRACTOR: Bruno Associates 28 berkeley St.No.Andover Ma EMH Const Corp 9 Bartlet St# 1.02 Andover Ma COMPLIANCE:Passes Maximum UA=24 Your Home UA=22 8.3%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door e ' ete R-Value R-Value U-Facto UA Ceiling 1:Flat Ceiling or Scissor Truss 42 30.0 30.0 1 Wall 1: Wood Frame, 16"o.c. 176 13.0 30.0 5 Window 1:Vinyl Frame:Double Pane 24 0.350 8 Door 1: Solid 20 0.350 7 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 42 19.0 30.0 1 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MECchecl and to comply with the mandatory requirements listed in the RES checklnspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified inSections780CMR 1310 and J4.4. Builder/Designer �� /�62,Slir%`/ Date 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: l (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 .✓1e Panvrrear a�.��aQcacicuaella Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:,_106898 EzP - .9P--`712&2006 Type..Private Corporation E.M.H.CONSTRUCTION CO William Hurley 9 Bartlett Street Suite,- Andover, uite Andover,MA 01810 Administrator ✓Ice�anr�)conu�ealll a��/ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR j .� Number: CS 052262 Birthdate: 05/14/1959 Expires:05/14/2005 Tr.no: 11053 Restricted: 00 WILLIAM A HURLEY 9 BARTLETT ST#102. — / ANDOVER, MA 01810 Ad m inistrator r woRrti.�� ` tl • RECEIVED JOYCE BRADSHAW TOWN CLERK NORTH ANDOVER NORTH ANDOVER OFFICE OF THE ZONING BOARD OF APPEALS 1000 JAN 20 P 1= 3 b 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01,945 FAX(973)633-9542 Any appeals shall be filed NOTICE OF DECISION L within(20)days after the Year 2000 date of filing ofthis notice Property at: 126 OId Farm Road ' in the office of the Town Clerk. � P NAME: Peter&Deidre Dunn DATE: 1/12/2000 ADDRESS: 126 Old Farm Road PETITION: 045-99 j� North Andover.MA 018. 5 FEARING: 1/11/2000 (/ C4 The Board of Appals held a regular meeting on Tuesday evening,January. 11.2000.at 7:30 PM upon the application of Peter&Deidre Dunn, 126 Old Farm Road North Anter.requesting a variance from the requirements of Section 7,Paragraph 73 of Table 2,for a rear setback to construct a proposed addition of n n' garage.bedroom.bath,and studr,within the R-2 Zoning Distria Xf' o .// The following members were present: Walter F. Soule,Robert Ford John Pallone,Ellen McIntyre.Scott Karpinski. 1 i!/ Upon a motion made by Robert Ford and seconded by John Palione.the Board voted to GRANT a dimensional variance from the requirements of Section 7,Paragraph 7.3 for relief of 5'for a rear setback,in order to construct a garage.bedroom,bath and study. The Board finds that the petitioner has satisfied the provision,of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. In accordance with the Plan of Land by:Carmen A Testa,Registered Land Surveyor,#I3 67,Northern oil Associates. Inc..342 Norah Main Street.Andover,MA and in accordance with elevation drawings of: Al. A2,A3,Act,A5,drawn-by G.J.Bruno Associates,Ardiitectural Designers.28 Berkeley Road.North Andover,MAO 1345. Voting in favor: Walter F. Soule. Robert Ford.John Pallone,Ellen McIntyre, Scott Karpinski. 10.4 Variances and appeals: FEL 11 10101 Fik +t The Zoning Board of Appeals shall have power upon appeal to grant variances Brom the terms of this Zoning Bylaw wherethe Board finds that owning to circumstances relating to soil conditions,shape,or topography ofthe land or structure and especially affecting such[and or structures but not affecting generally the zoning district in general,a literal enforcement ofthe provisions of this Bvlaty will involve substantial hardship,financial or Otherwise.to the petitioner or applicant,and that desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the bleat or purpose of this Bylaw. Furthermore,ifthe rights authorized by the variance are not exercised within one(1)year ofthe date ofthe grant they shall lapse,and may be re-established only atter notice,and a new hearing. Furthermore,if a Special Permit granted ander the provisions contained C herein shall be deemed to have lapsed alta a two(2)year period from the date on which the Special Permit was Wanted unless substantial use or construction has commenced they stall lapse and may be re-established only after notice,and a new hearing. By order of the Zoning Board of Appeals. Walter F. Soule,Acting Chairman co ml/decisions2000/2 BOARD OF APPEALS 688-9541 BULDI iGS 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTHERN ASSOCIATES INC . 401 SOUTH BROADWAY LAWRENCE MA 01843 TEL. 978—837—3335 FAX.-978-837-3336 (AS- BUILT L9 L10 L11 LOT 8AA L12 L8 L1. 328.84' ..� . L2. 116.86' L7 L1 L3. 85.71' L4. 99.63' L5. 50.34' L2 L6. 350.00 . �► L7. 228.30 L8. 459.88' L9. 186.51 L10.471.27' L5 L11. 77'86' Old Farm Road L12. 78.08' (not to scale) LOT C LOT 8AA LOT 164 2 0 18.00' 161.75' DRIVEWAY EASEMENT\ / co \ h EXISTING co ADDITION \ M / LANDING j' — / 73 I �A J Fhsi114 W N o rn I LOT 7B I W I koo F C.COVIELLO I : s#136 W I 1 I LOT 9AA A I ccoo N/F W.ADAMS I I I I R=125.00' I L=50.34' ' OLD FARM ROAD ZONING DISTRICT R2 CERTIFIED TO:FIRST UNION MORTGAGE CORP.& TITLE CO. PREPARED FOR: �`H Of 44 PREPARED BY,- PETER & DEIDRE DUNN � NORTHERN ASSOCIATES INC. 126 OLD FARM ROAD ° CARME 401 SOUTH BROADWAY NORTH ANDOVER MA 19 LAWRENCE MA 01843 TA 3 6 DATE:OCT.10,2000 SCALE:1"= 40 o. 84 °m i+� /dTEA NORTH T.Ovm of 4Andover 0 No.S � 4 E dover, Mass., V 7 00 S' 3 COCHICKEWICK V A04ATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT JtWr �t �r � ~ .... ........................................................... ................................................................. Foundation has permission to erect....3� .04.y..0...... buildings on .... ..b....V./Of or ISI .....ft4 D Rough to be occupied 83 07 V o p Alw t ..� ~~ ��`• �~ Chimney "�'........N.... 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 the Town of North Andover. 450/ 1/18 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S AR Rough ..... .... Service .. . .. .. . ..4i -i5 ............................... ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT - Street No. SEE REVERSE SIDE Smoke Det. 5' n /5 0� Date......... ..... .. ......... `NORTp TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS,q USES This certifies that P 2 J. Psi '........ has permission to perform : ' " .....:.............. ..................................................... � Z wiri in the building of at... `... .. ' �� ,North Andover,M ss /...... .......... �7 - F � t/) rJ�J �, Lic.No ........ ............... ,..moi:>:......../......... �..... ELECTRICALINSPECiOR i��Check # � � > Official Use Only Permit No. ` — te r, Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonmed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 c- ! 0 Z (Please Print in ink or type all information) Date JJ To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform/t►he electrical work described below. Location(Street&Number � O,`�/Un/5401 R u, Owner or Tenant L( TP// �/V�A Owner's Address / Z(o Ol � ZIM �� r Is this permit in conjunction with a building permit Yes I/ No ❑/��,(�C/heck Appropriate Box) Purpose of Building A TT/(7N 8/1eAli!ERT /IPPA A/ me, /�'/'�/�Utility Authorization No. Existing Service Z 0 C Amps 12 U Z o Voits Overhead ❑ Undgmd V No.of Meters New lervice Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Nun r of Feeders and Ampacity Locati hand Nature of Proposed Electrical Work r i Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures 30 Swimming Pool grnd ❑ gmd ❑ Generators KVA _ No.of Emergency Lighting No.of Receptacles Outlets C No.of Oil Burners Battery Units No.of Switchelft-ts -20 No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and P4'o.Maf Ranges No of Air Cond Tons Initiating Devices Heat Total Total Jo' if D.' sal L No. Pumps Tons KW No.of Sounding Devices _ , No./of Self Contained No.ibf Dishwashers Z Space/Area Heating KW Detec6on/Sounding 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: Jagpie OVPr1 /ao,41W, P44 &AIeL INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a current Liability Insurance Policy includin Completed Operations Coverage or its substantial equivalent NO = have submitted valid proof of same to the Of6 ES NO =Ile have checked YES please indicate the type of f�verage by checking the appropriate box INSURANCE = BOND = OTHER .= (Please pecify)I/tvQ ✓l9Ur`C1d6 (Expiration Date) Estimated Value oflectncal Work$ Work to Stan S d'L Inspection Date Resquested Rough Final Signed under Pepa ies oferju FIRM NAME n /] A O T. �-} N _Pr / L LIC.NO.�Z/62�� Lkensee Signature �� LIC.NO. S/7f�e Ne, NeBus.Tel No. ? D P 77�-rJb1 Address o� W IV& , M e%�i.V6i 11 /1/1�, a k� Alt Tel.No. k&'22 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) ,) Telephone No. PERMITfE $ O v (Signature of Owner or Agent) Date. . . ,AOIVTN TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACHUS . . . . . . . . . . . . . . . . . . . . . . This certifies that . .`t�Gq {�" has permission to perform . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . at /.-. �: . . . ... — North Andover, Mass. Z� FeemG'. ". .Lic. No..M/. . . . . . . . . . . . .P'LUMBI�NS ,14SPECTOR Check # 5292 .� 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 PLUMBING 0%d ar Typal lqo r+V) An 1 cyPv(- :Mass. 01,.4 OddhVe inn 12b 1 d- �x� rn �i(, owners Nano.!: M-A �L�r��Q �✓rh C V` ''Y`6N of Occupancy S� ��-a A NOW O Replacement ® Plans'Submead: Yes O No FIXWRES z a z z kc * a a a a O Z a = W F a .+ } u < p z a i s .4 . C z O z m tOJi 3 x � = C al d W > !� a O < a z C 4 C O 1i. C W O C < a C Z < W a e: J Y O C O ✓1 1• IL t� O 'i J C Ir C F < O = z O p a = z W H O u S d < < S q a < < O < J J < C C G < O < F- a C s o sue-BSKTT. BASEMENT IST FLOOR :L _A 2ND FLOOR SRO FLOOR 4TH FLOOR _ STN FLOOR STH FLOOR 7TH FLOOR STH FLOOR imuigttS Y i� deo Cxtx ��mbsn F- A Check ons:. Cati<late 2 F�r2S Stf-e.e ko•r h Y Address -•►ei O corporation M ( ats45 -OPS Business Telephone °I�-�_ �o�i 6 b to O hmv(:O. Name d Ueensed Plumber 'SCh 0Mgs 0'co nen of- `INSURANCE COVERAGE: I tme a liabilly in umnee policy or Its substantial equivalent which meets the requkanents of MGL Ch. 142. Yes G No O If you have checked M.please indiate the type coveage by checking the appropriate boot A IiabM hlsuance policy 5� Other type d indemnity O Bond O OWNER'S INSURANCE WAIVER:I am aware fiat the licensee does not have the hhstsauhce coverage required by Chapter 142 of the Mass. General taws.and that my siprature On this permit applimUon walves this requiranent Check one: tare of Owner or Owner's Owner O AGent❑ 1 hmeby aw*that d of ftM dolma and kO=a5m 1 haw auhrra'Md for amend)in above a119l an hue and aoMnW t0 the best of my I luhowledpe and that all poll-nbinp work and butalmions pectarmed under the pem*hmnd for this appkation wM be in oompianoe with atl pertinerrt prorisrorht of the Messadanegs Sfne Pkenbirq Gods and d�apter 142 of the General taws. Title � �I t7dyfram Type of license Mast Journeyman O license Numbs 1 C? 0 Location ` " No. l� Date J t �/ NORTITOWN OF NORTH ANDOVER 3?O�,t`'o ,•,�O F G� I a Oertificate of Occupancy $ sACNUSES� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ (,T-OTA L $ Check # Ll d I Ii 9" 58 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �'_ DATE ISSUED: ,t, SIGNATURE: Building Corrin-Lissioner/lE for of Buildings Date 17 SECTION 1-SITE INFORMATION z 1.1 Property.Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number 1.3 Zoning Irdlcrmation: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage(fl) 1.6 BUILDING SETBACKS ft Front Yard i I Side Yard Rear Yard Required Provide Required Provided Required Provided f-SI I L loo wd 1.3 Flood Zone Information: 1. Sewerage Disposal System: 1.7wattr snppryM.c.L.c.ao. sal � D Public 0 - Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal Systeqr SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Pri Address for Service SignAture Telephone 2.2 Owner of Record: Name Print Address for Service: 0 � .Z ii nature Telephone, m iECTION 3 CONSTRUCTION SERVICES 1.1 Licensed Construction Supervisor: Not Applicable 0 Ill,! '"'°��7� .icensed Construction upervisor. (D I oJ� O License Number ddres 0-7' fg �0jt 'Expiration Date gnature Telephone d-- 2 Registered Hom I provement Contractor Not Applicable ❑ )mpany Name ' (9ZQ 4 -+ r/� A - _S_I Registration Number ldres (� i V� r -`'- G 07 z �^ �R�d z� Expiration Date one ure Tele h NORTH - Town of 4Andover 0 No. -=_ _ _ - - _ - z= Ah A E dover, Mass., A. COCHICMEWICK ' �ADRATED PPS\ q`s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... .. .... ...............Djr..vr!!'!t.................................... .................... ... Foundation has permission to erect........................................ buildings on...124......aw.... ....... .... ..... ...t... Rough tobe occupied as........ ....I)Q. ...... ...... .....1�trl..s.. ................................................................................... Chimney provided that the pers accepting thisfrmit sha 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 the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 3 UNLESS CONSTRUCTION TS o h Rug Service BUILDING INSPECTOR Final Occupancy Permit Required to Owipy 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. FAMILY POOLS&PATIOS,INC. CSL#010330 sales • service • supplies HIC#118204 drA 70 South Broadway,Lawrence,MA 01843 WC#4951074 Tel: (978)688-8307 • Fax: (978)688-1949 LIAB#C1098398230 SlN�E 1978 Name-- lejlve, ✓1✓) Date 7 / d�•— Address / City tNPii� StateZip O�_ — Home phone �9 S ork phone -Cell pho ).,. 1 Add'l# Cross street/directions� V-ke Estimated start date Estimated completion date We propose to furnish and install one—7-0 k -9 �,I'Lo C.0 _swimming pool for the sum of$ 1-7& THIS PRICE INCLUDES: tom. •Manual vacuum cleaner kit •Leaf net •8 Ft Stepa •3-Step Stainless ladder •Wall brush •Handrail •Rope&Floats •Extension pole •Filter •Initial balancing chemicals •Test Kit plumbed no more thanpft from pool •8 to 12 Wk supply of maintenance chemicals •Surfaces 'miner s�) i •Pump&motor (supply depends on pool size) •Copin lz ,4 •Choice of liner THIS PRICE ALSO INCLUDES THE FOLLOWING WORK TO BE PERFORMED BY A LICENSED ELECTRICIAN: Bond and ground pool-wiring of a 220 volt filter pump-one 110 volt plug-wire and install one 220 volt indoor time clock-outside wiring to be done in PVC pipe-sixty feet of electrical run from service panel to filter (*note:runs over sixty feet will be subject to an extra charge)_Initials r IN ADDITION TO THIS PRICE,ADD�D--JjL—HOURS OF MACHINE TIME AT PER HOUR=$ 11S C/7 THIS PRICE DOES NOT INCLUDE: _Initials Any machine time in excess of that estimated above. Additional machine time to be billed at the same rate as above due with the second pool payment. . All hours of trucking will be charged at$ per hour per truck due with the second pool payment.,,; , Any dumping,costs incurred for disposal of ledge;large rocks,or soil'-re'seeding"of grass'around pool spreading.of loam-trucked in water -patio or fence around poobor any accessories except as noted below_additional fill,if riecessary,for.proper backfill or reshaping of hole- dis- posal of large rocks-fuel connections-heater venting-fuel storage tanks-perrnits.,.-repaii of damage to sprinkler systems or any buried items(ex.dry well,electrical lines,cables,etc.)in the access and pool overdig areas-plumbing to filter in excess of 25 feet-stumping and/or ,Tremoval of stumps.brush or debris.Homeowner is responsible for repairs of damage to known or unknown buried items. Water or soil conditions(ex.clay,�pje�a,tl,live sand,excessive rock,etc.)requiring a stone pack of the hole will be subject to an extra charge of$minimum to$ (P va maximum. Use of the above mentioned stone pack will be at the discretion of the job supervisor. Customers must supply access for all trucks and equipment. It is the owner's responsibility to obtain the building and electrical permits or to assume the costs of necessary pe rmi ts. Initials Notes: - fu(1It� �,L-L'.dvt 1 � ("'Vied �iUV16' OPTIONS ct y TOTALS Diving board ( 4 '�� Basic Pool Price $ 11600' Main drain Estimated Machine Time $w Solar cover ( ) Options _ STN-2)— Pool light o2 IFC" I t C-b- Heater 270-0 Subtotal $ 3 Environpool Plus, 5%Sales Tax Caretaker w/Electronic Valve, 16hd Additional floor heads(t ) 1 Z W Total $_ � Polaris Vac-Sweep — Less 10%Deposit Polaris retrofit only- Balance of Contract $ Swimout/ uddy Seat �x NTS:,1/3 EXCAVATION I/3 BACKFILL+EXTRAS V3 SYSTEM START-UP The buyer hereby agrees to pay,in full,the total amount of this transaction upon start-up'of the installed pool.Your salesman or job super- visor will meet with you two to three=weeks prior to excavation at which time all decisions including pool size,shape,liner print,and all options must be final. Changes after this date will be subject to extra charges where applicable. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Credit card pay nts not accepted on contract amount. BUYER date��//wo ACORD CERTIFICATE OF LIABILITY INSURANCE OPID P PM-41 0 3 DATE(MMI)D/YYYY) 01/05/05 ` PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB International New England HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 299 Ballardvale St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington MA 01887 Phone: 978-657-5100 Tax:978-988-0038 INSURERS AFFORDING COVERAGE NAICit INSURED INSURER Scottsdale Insurance Co an INSURER 3 A.1.r. Family Pools & Patio Inc. INSURER C: 70 S. Broadway Lawrence MA OT843 INSURER 7 INSURERCOVERAGES TFE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREC NAMED ABOVE=OR THE POLICY PERIOD INDICATED.NCTWITHSTANDING ANY REOUIREMEW,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT`N!TH RESPECT TC WHICH-HIS CERTIFICATE MA,1 BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORCED BY THE PCLIC ES DESCRIBED HEREIN IS SL13JECT-0 ALL-HE-EFR4:,EXC_1.16101,13.MID COPIDITICNS CF SUCF POLICIES AGGREGATE LIMITS SFICWN MIAY HAVE EEEN REDUCED BY PAID CLAIMS. NUK U L POLICY EFFECTIVE POLICY EXPIRATION LTR SRC TYPE OF INSURANCE POLICY NUMBERDATE(MM lDD/YY) DATE(MM/DDlYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1000000 A X COMMERCXGENERAL-LABILITY TBD 12/31/04 12/31/05 PP.EMIiSES;Eaoccunnce} x100000 CLAIMSMIADE �OCCUR MED FYP(Any cn=parson) S excl PERSCNAL&ADL'INJURY 51000000 111 X $2500 ded GENERAL AC-13PEGATE S2000000 GEM'LAGGREGATE LIMIT APP_IESPER: PRODUCTS-COMP/OP A3? 62000000 POLICY PRO- — JECT LOC Emp Ben. 1000000 r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AU-0 (Ea acuid�n:} ALL OWNED AUTOS SCHEDULED AUTOS (Par persoon}v Ini S (Par P HIRFD P.UTOS BODIL"IN.UP'i NON-OWNED AUTOS (Per acrid=nb S PPOPERTY CAM'AGE S (Par acr_idanb GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AU-0 OR-ER T-W I EA ACC S AUTO ONLY: AGG S EXCESSfUMBRELLA LIABILITY EACH OCCLRF'ENCE S OCCUR CLAJN15 MADE AGGP.EGP.T= s' S DEDUCTIBLE S RETENT ON g S WORKERS COMPENSATION AN B D X TORY LIMITS ER EMPLOYERS'LIABILITY PNYFROPRIE'nMPaRTNERJEAECU-I'VE WC6926440 12/31/04 112/31/05 E.L.EAC.hACCIDENT q100000 OF=ICER/MEMBER EXCLLCED9 If yes,describe under E.L.DISEASE-EAE%P_VYEE.$100000 SP=CPLPFCVISIONSbelaw E.L.DISEASE-POLIC'(LIMIT S 500000 OTHER DESCRIPTION OF OPERATION!LOCATION?/VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Br•nuK_Q SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. i AUTHORIZED R RESENTATIVE ACORD 25(2001109) CORD CORPORATION 1999 ✓ate 'LrJn�inior�«a`� .�cwac�a�i�tae�`6 BOARD OP BUiLDINiGULATIONS - License. CONSTRUCtION SUPERVISOR Number`iS: 010330 Bifth' 074.9119(10 , I VOW 70�19i20d�1 Tr.no: 14273 ,g- Its j Re- ridtL ©(� WILLIAM C 70"S BROADWAYAl LAWRENCE, MA 01' CO'M61.sinner i ----------- G— ------- ----- ----------- arsv»eoovure:z a�n✓ eac! - ---- Board of Building Regulations and Standards HOME IMPROVEMENT CONT License or registration RACTOR valid for individul use only t `t•,. R., before before.the expiration date. If found return to: 9 � 1218204 lug E �t�ation_ Board of Building Regulations and Standards 21.312007 One Ashburton Place Rm 1301 { `T f?� 1. to Corporation Boston,Ma.02108 FAMILY POOLS F�ATIEb,S INZ's'r f,; WILLIAM GIANOPOULUS '`' 70 S.BROADWAY LAWRENCE,MA 01 .- Administrator CKHL. .6'X6'X150' 6 `y vI 1� 3'-6' .r 8' THIS DOCUMEITIONAL NOTES NT IS FOR IUMSIRATNE PURPOSES ONLY ANenNen Dealers It is your responsibiliy b sea that the sofey package provided by FWP is dalFerod ro pod owner and that the DMNG FWP makes 9mly Ihox repro,emotims which are,Imed in ih wv;INn wamany.Ary abler waning fobels are Propedy ,sn 2'RAD, ropte coin im,,sro m enn,d common mode by sin defier/,he ado/dm anrom nl regmdirg any makrids produ«d by FWP are otMburabb ro Me deokr/oanlmaor a�,,Ih,,, The rice er er aan end«weo 4,o install,yea pad i,an i depmdem mn�ea m d i ® BUILDING THE ® FORT WAYNE POOLS®,INC "«�" _P�fFWP TIMamsh ion ori a,needhere•ro 9gge bn STERLING 6930 GettysburgPae Lary-L left shown. NSPI TYPE II y ro males and�md Ranl.There may be'additional prmaution,and/a' iolloWlNG POOL R Fen stradian. pon,ibility i,the—rtmdo,'°. PCJLS ❑STERLING° ' ' FT WAYNE,IN 46804 USA NOTESGENERAL These die dimensions aamp M Me National Spa and Pad lnsft sled o., ou"s T v = _ = a z (219)432-8731 ,wnda ds for mss hd pads.IF d ine boa d:ar,Rde,am' ed ❑FRONTIER- 1.All_meal dimemiom areborn Itner 1.Soil ro have minimum bearing capacity of 2000 P.S.F. 3.Fxowhon,hall be 2'larger thou 000l dl amend. minim poob please h the manaFodure/s inslracnom and Bre Nofior�d Spa 8 = c www.sorNhepooLmm extrusions«i all pads. 2 Iacate lop of pad at bast 6•above surrourcFng - Fill_ids under base d parceb and I— well.. Pod MsfiMe's minimumoonw,Tris prior ro installing d'rissg boards or slides an Mva F F?O N T 1 -I? DATE TrtLE $'X 3913IT DRAWING NUMS1. 31 lend.1—tion. 4.Bach 11 w M non-expansiYe material. Ms.For information conamung NSR minimum standards,write:Notional S a F�O O L 87 JANUARY , Pool Instilure,2111 Eisenhower Avenue,Alexamdria,VA 22314•703/838-0083 1999 LAZY L 2 RADIUS STL-031 COPYRIGM 1999,FORT WAYNE POOLse,IN, 1 k 1 . . 1 44'-10 3/4' D 44'-0' 11.8'Plain Panels 08-009-5 08.009 _T C 2816' 6'X6-X30 1-5'Plain Panel 08-015-5 08-015 ` 2'RAD. 8' B' 8' 2' 2-4'Plain Panels 08-016-5 08.016 IF+ Ig, I.3'Plain Panel 08-017-5 06.017 E F —�--G IN J �—- K---I J 9 �6, 1-2'Plain Panel 08-018.5 08-018 �„rR 61 4-2'Radius Comers 08.141 08.141 4' r* g, 1-30'Rller Panel 08.131 08.131 SIZE A B C D E F G H J K L OF M d' 1-150'Rller Panel 08-132 08.132 1 2'RAD. 18-Braces 08-214 08-210 ADJUSTABLETURNBUCKLE BRACE ADJUSTABLE BRACE 20'-0' 3� N NA 1-Steel Hardware Kit 08-204 08-204 z'-0 z o 8 1-20x40 Straight Coping Set 6" 10-003 10.003 SI'ERI'II�IG• F P O O LS R S CV a'2F 1.2'Radius Coping Corner Set 10.138 10-138 Pals ANGLE ADJUSTING 1-Lary-L Coping Corner Set 10-005 10.005 TURNBUCKLE THREADED O BRACKET— ---NUTS 4r 1-Vinyl Liner RDD STEEL POOL PANEL STEEL POOL PANEL p OPTIONS DEADMAN DEADMAN 7 PLATE PLATE 2'RAD, 8' Il 8' S' 3, 2� 6'Step-Remove 2-8'panels.Insert 1-6'step,2-5'panels ONE PIECE FORMED TWO PIECE BOLTED 6'X6'X15 ' and 1-hrace. ANGLE BRACE ANGLE BRACE- 23'-6' 13`g, 8'Step-Remove 2-8'panels.Insert 1-8'step,2-4'panels CONCRETE FOOTER CONCRETE FOOTER . 16. % and]-brace. P'POOL BASE 2•POOL BASE_ \y/ FRONTIER 2'RAD• Replace 4-8'plain panels with: STAKE ,TAKE 44'-10 3/4' 1.8'skimmer panel Optional Optional 44'-0' 2-8'inlet panels 08-010.5 08-010LAYOUT 28161 6'X6'X30 1.8'light panel 08.012-5 08.012 21RAD• 8' 8' 8' 2' 8- 18'-6' 4'20_0181 t %L N 2'RAD. I -6- 4' S4' I F. h 0 2'RAD, 8' 8' S' S, 6'X6'X15 b ADDITIONAL NOTES13'-61 > y TM5 DOCUMENT 5 FOR 111M ATNF PURPOSES ONLY ANenNen Dealers It is your responsibility to see that the sofey package provided by FWP is delivered to pool owner and that the NO DMNG FWP makes only dwse rep rmmh,* whidi om,bred in in wMRen woes y Any other woming bbd,om proped, stal6d. reprmen'rfioms,sloremmn,or amlrocn mode by the d In/ tmwr to d,e an amer regarding any materials produced by FWP ore atMbuto6le ro the dealer/a roaar om 2'RAD, The dealer or con mcror who sells or inseells your wd ham independent cmtmcror 4i, ® BUILDING THE ® FORT WAYNE POOLS®,INC ran t or empbyee F FWP.Th amst uceon melhod,illusRmed hero oro su9geslMns STERLING 6930 Gettysburg Pae La Lleftshown. NSPI TYPE 11 �aapa9�nyamamal'--naieen,.Theemaybeaddihanalpamaron,amd/a M FOLLOWING POOL 9 ry _j meMad of msm rion.T�aapm,i6iliyisthe cantrodor,. PCJLS ❑STERUNCEa _ FTWAYNF,IN46804 USA GENERAL • • • These dig dimensions comply w M he National Spa and Pod Insfi M mg ted ,,,v 'e = s = i M (219)432-8731 rnini.m s ands ds Tar residential pools.If diving boards or slides ore robe used ❑FRONTIER" _ —' ` www.surfthepooLcom 1.All vertical dimensions are from liner 1.Soil to have minimum bearing capaciy of 2000 P.S.F. 3.Exeavation shall be 2'larger Ihanp�I all amend. with Mese pools please consult the manufodumes instructions and the National Spa& DATE one DRAWING NUMBER extnr9ons on all pools. 2,loeata top of pool at least 6^above surrounding Fill_ids under base of panels and tamp well. Pool Institute's minimum standards prior M installing diving boards or Bides on these F F?O N T I = R 1 32 land ele anon. A. Boddill with mon-expansive mmerid. pools.For information conceming NSR minimum standards,write:National 5p,6 F�O O LS" JANUARY 20 X 44' STL-032 Pool In,tihft,2111 Eisenhower Avenue,Alexandria,VA 22314•703/838-0083 1999 LAZY-L 2 RADIUS COPYRIGM 1999,FORT WAYNE POOL,®,INC. 1 Board of Building Regula ons and Standards One Ashburton Plce - Room 1301 Boston. Massachusetts 02108 Home Improvemeq''' tractor Registration Registration: 118204 l Type: Supplement Card z _ T µ r t Expiration: 2/13/2007 ? a� ' FAMILY POOLS & PATIOS INC GLEN WIGGIN �y-` 70 S. BROADWAY 's ._wa LAWRENCEMA 01843 Update Address and return card.Mark reason for change. DPS-CA1 is 50M-04/04-GIO1216- Address ❑ Renewal E] Employment 0 Lost Card ---- --- --- ------- ----------- ��ie:�a»vino.uuea.� o�./�aaaaclzuael7a ' Board of Building Regulations and Standards Dense or registration valid for individul use only HOME IM P1�OVEMENT CONTRACTOR before the expiration date. If found return to: t Registrat�nnX 118204 Band of Building Regulations and Standards Ekpati"3/2007 Oe Ashburton Place Rm 1301 rel-t Boston,Ma.02108 pe itpement Card r----= FAMILY POOLS&r x EE, GLEN WIGGINVA _ 70S.BROADWAY �LAWRENCE,MA 01843 '\1" Administrator Not valid without si nat r i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LejZibly Name (Business/Organization/Individual): oo Address: City/State/Zip: MAJJ Phone #: F,74 7 Are you an employer? Check the appropriate box: Type of project(required): 1. ] I am a employer with 30 4. ❑ I am a general contractor and 1 6. Fill New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. P. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[:1 Electrical repairs or additions required.] officers have exercised their 3.F1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4), and we have no 12.❑ Roof repairs o fj insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 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: 5 C 42 Policy#or Self-ins. Lic. #: (��G 6 l� Expiration Date: Job Site Address: 'y, City/State/Zip:. Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce (under the ain(sand penalties of perjury that the information provided above is true and correct Signature: "``'1!koc�,� lA.� Date: ( p-4 Phone#: — d Ojficial 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'.compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legalentity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pernmit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia 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.......0 SECTION 5 Desch tion of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ I Accessory Bldg. ❑ Demolition ❑ Other 0 Specify ' Brief Description of Proposed Work: k i h& SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be a y Completed by penrut alicant � � '` .'ate• 1. Building (a) Building Permit Fee 3� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit.fee(e)x (b) 4 Mechanical HVAC 5 Fire Protection �P 6 Total (1+2+3+4+5) Check Number SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN / [HereOWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT bya ��`7 as Owner/Authorized Agent of subject property i rize -Ak " �— ` �_ to act on y1y b , i m s relativ to work authorized by this building pennit application.` a -Signature of Owner Date SECTION 715 OWNER/AUTHORIZED AGENT DECLARATION n I„ � ,as Owner/Authorized Agent of subject prope Hereby declare that the statem and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print am r Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3KU r NENSIONS OF SILLS ENSIONS OF POSTS ENSIONS OF GIRDERS HT OF FOUNDATION THICKNESS OF FOOTING X ERIAL OF CI-UNINEY ILDING ON SOLID OR FILLED LAND ILDING CONNECTED TO NATURAL GAS LINE i FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. Nunn mommommod no A NSA Noon am Nona am Room son so mmmommm am Emu ON SENSES was MANNAR am MR a a a.......................................■■...■..............................■ APPLICANT tEa wl: 1' PHONE 93 6 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET...�.:.....Y::. :..................STREET NUMBER...a 0Z� ..... OFTICIAL USE ONLY �.......................... ........ . ........................... TIO TOWNNTS DATE APPROVED ."r,■■ MANOR ■■...■■ ANN. ■■ ■ ■ ■..........................■ ■.........■ CON IFVATIO ADMINIS TOR DATE REJECTED coMnIENTs DATE APPROVED TOWN PLANNER DATE REJECTED CONRVIE'NTS DATE APPROVED FOOD INSPECTOR-HEAL DATE REJECTED f DATE APPROVED SEPTIC INSP T`O DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Z The Commonwealth of Massachusetts t d Department of Industrial Accidents Office of Investigations Boston, Mass. 02 919 °�M Sys Workers'Compensation Insurance Affidavit Name Please Print Name: l I' t1 f" Z �c� �2` /`� dl✓1 Location: D6 w. d CAA Sr 7 -r Ci w mwzi�( Phone # F-1 q?e—Off lJd I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Com an name: 14 M IL of J, Address 0 Ci . peu, A _Phone#: 7 —�� k307 Insurance.Co. l ! S+ Policv# C Z q Z) Company name: , Address City: Phone#7 Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,afine up to$1,sw.00 and/or one years'imprisonment.as well_as_civil.penalties--infhefou -d-aBTOP WORK ORDER-and_a fine_of($i1lo.DD)-ajdW ag&.mt-me. t understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains d penalties of perjury that the information provided above is true and correct. Signature Date Print nameC�(CU'll 1 �Njj u Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing. Building Dept EJ Check if immediate response-is required Building Licensing- Board 0 Selectman's Office Contact person: Phone#: 0 Health Department Other