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Miscellaneous - 127 Campion Road
�a� COL„, ,v,� . Date.Al /16.......... OF 4 RTH TOWN OF NORTH ANDOVER 10 PERMIT FOR WIRING S`rACHU This certifies that ............................. .............N.6�.............. . ....... ................ ....... /AU P_ ,-.) "-,,� � has permission to perform ........................t.................................................................................. wiring in the building of....... S /b'f '9,5 4,5 ..................... le 7 at ..............................................r......................................... North Andover,Mass. Fee G�-/J, �! Lic.No.a66,v .. ... .. ............ .............................. ................. INSPEC�r Check# (f6 i 3 ') C' Q 61p:ll- -7111 6�_ z _ _ - - Commonwealth of Massachusettts of Sial Use Only Department of Fire Services Permit No. 116c) Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM .ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( ),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of NORTH ANDOVER To the Ins ctor 6f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical ileph scribed be1q Location(Street&Number) Q M ti Rd Owner or Tenant a2G a yyt �a�,� Tee Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Checopriate B Purpose of Building '�, ,Q, Utility Authorization NExisting Service Amps / Volts Overhead 0 Undgrd❑ f MNew Service 9� Amps 190/ Volts Overhead❑ Undgrd f Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the followin table mav be waived bv the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total `A Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 47 No.of Switches No.of Gas Burners No.If Detection iing Devices No.of Ranges No.of Air Cond. TotaTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal El El Other Connection15 No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterNo.KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. �f INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER El (Specify:) I certify,under the pains and pen Nfles ofperjmy,that the information 211his appli .on is ue and coriplete. FIRM NAME: 44LVp/ LIC.NO.•_ Licensee: Signat LIC.NO.:J (If applicable,enter`exempt"in the license number line.) Bus.Tel.No.• ^8 Address: P0 -a 01 Alt.Tel.No.: 9 6? *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ ELECTMCAL 3CNSPECTOR-. ' 1.ROUW)WI. CTION; Passed=j ] trailed--j ] Re-inspection requirec't($50.00)•-j j .Inspectors'ca e�afs: speefors'�i ature o fnftials) —�� /' . Date Z.I+'IN�]N'SPECTIOI�1'; . Passed-j ) Failed-j ] Re4nspectionrequired($50.00)-•j I Inspectors'comments: (Ins&ctors'Signature-no inifials) Date 3,UNDER GROUND 7N9'9MON: Passed-[ ] Failed-j ) Re-inspection required($50.00)-•j ] inspectors'comments: (Inspectors'Signatare-no initials) Date P t.'. INSPECTION—SMWCCE': DATE CALLER WANTIONAL GPi i ; NAM:. Passed-j ) Valle d-j ] Re-inspection required($50.00)••j ] Inspectbrs'coin (Inspectors'ftK4"afko initials) Date J 5.IN"STECTION-•OTHER: Passed-j ) I+siled--j 'Re-inspection required($50.00)-j l Inspectors'comments: o - G o c.K�r 4a•M G�s�N rcL�c (Iuspe fors'i�ignature xto initials) Date I)0 O TAGS AX TO BE FILLED OUT AND LEFT ON SITE xF`TJH AREA.TO BE INSPECTED 19 NOT 1 ACCESSIBLE.AND ARE INSPECTION OF$50.00 XS TO DE CHARGED. - i ' ,rte r The Commonwealth of Massachusetts F Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 .�� www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/El ectricians/plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Please Print Le ibl A licant Information /� Name(Business/Organization/Individual): )qR I/1 iL Z Ay olp Address: /2) O _ �P�- Phone#: 9 — City/State/Zip: Are you an employer?Check the appropriate box: Type of projecLoradditions employees fiill and/or part-time).* 7. ONew con 1.KI am a employer with 2.❑I am a sole proprietor or partnership and have no employees working forme in 8. []Remodel any capacity.[No workers'comp.insurance required.] 9, ❑Demoliti 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electricadditions proprietors with no employees. 12. Plumbingdditions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 14.Q Other 6.Q We are a corporation and its officers.have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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 employees. Below is the policy and job site information. C' Insurance Company Name: P tisr Policy#or Self-ins.Lic.#: Expiration Date: 8 �� Job Site Address: " /, �i City/State/Zip: 2 Attach a copy of the workers' compens 'ion policy declaration page(showing the policy number and expirati n date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up too$$25250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. c v hereby verification. r the pa' sand Ities of perjury that the information provided above is true and correct. erti Date: Si nature: if Phone#: rFof,flcially. Do not write in this area,to be completed by city or town officiate• Permit/Licenserity(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 legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to 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 e 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i> , COMMONWEALTH OF MASSACHUSETTS. ; :: UPC;. I C'I A N S ISSUES THE FOLLOWING L1G;ENS� 2EG I STERE'D MASTER. ELECTR IC IW rt •" � BRIAN LAVO I E 4 THAYC tETHuEN MA 01844-26 11648 0 /31/16 39231 i COMMONWEALTH OF MA$SAGHUSM. BQARD EL1 CTkICIAt i ISSUES T.NE FOLLOWIhi LICENSE . I AS A "REO . OURNEYMAN ..ELECTR'I C W " r R!AN' E LAVO I E s } . TiIIAYER ST W !E F-fl; Eir1 MA 01844-2617 07/31/&..l _ > 39232 a ...................... OF 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING s3ACHU Thiscertifies that ............................................................................................................................ has permission to perform .................................... wiring in the building of.......... ....... ........&AAILA.5..................................... at ...... ....... .....1?.CD........................... North Andover,Mass. Fee... ............Lic. Nc,.A'�.45C RICAL INSPECTdR Check# 7 IC r., Commonwealth of Massachusetts Official Use Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank 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: '/. 2 VIL City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /6r�Rd�i Owner or Tenant O-A�-Zx,, Telephone No. Owner's Address Z,:r Is this permit in conjunction with a building permit? Yes ff No ❑ (Check Appropriate Box) Purpose of Building ll�S.�G',�CP Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA r No.of Luminaires Swimming Pool Above [IIn- 1-1 o.o Emergency Lighting rnd. rnd. 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Nber Tons KW No.of Self-Contained Totals: ............... ..... .......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: t;6 O (When required by municipal policy.) k G Work to Start: -2 t/`� Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such Coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE El BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 7-x-a w;, LIC.NO.: Licensee: TT o "qT d4--" M-ZJ Signature LIC.NO.: `;arc (If applicable,enter "exempt"in the license number line.) Bus.Tel.No..• Address: � 612re?9 Alt.Tel.No.: Y;Y 07 -�3 *Per M.G.L c. 1471/s.57-61,security work requires apartment of Public Safety"S"License: Lic.No. S- e619�9&1 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner '❑owner's agent. Owner/Agent �. Signature Telephone No. PERMIT FEE: $ y+J, ao • / V, h t s 9/- a2 � �� ��� >'OMMONW60 OF MAWAOEM SE TS Y ' BOARD OF ELE.GTR I Cl ANS: - < : °ISSUES .THE FOLLOWING LFCENSE AS A -REGISTERED SYSTEM TECHNICIAN ` T HO(fiA5 C MADD EN. 11 COPPER -BEECH tAETHUEN M'A 01844-1700 OMMOEALTH OF MASSACH['7SETFS` `_. NW E-L;ECTR I Cl ANS2� ' A R°Ei;t STEERED SYSTEM CONTRACTOR��''``''� = 02 T13aMAS C MADDEN: >'y <WS Kc 11 COOPER°'BEECH N METHUE M`A 01844-1 50143 t commonwealth_ of `Massachusetts Department o;Public Safety _ t'itll'14'1':mit ilt -\ i.lit'tit' P. t '_icense: SS-001796 Thomas C Madden 11 Copper Beech Ln Methuen MA 01844 xpiration: commissioner 06/2712016 _ - - __ X ` Date.17-i n.�o....:..... 0 , 23 TOWN OF NORTH ANDOVER oar�,1 `` �.• oop PERMIT FOR PLUMBING ``r gBACMuBE This certifies that:.:.. .... "!� ' ,� 2 r1 �p�5' .................................................................................... ..... has permission to perform...,�. ........ 4- ............................................................................. plumbing in the buildings of..I�1...... at.........L0...... ......................................... North Andover,Mass. Fee g.�1� ��l .....Lic. No. ... M. ........................................................... PLUMBING INSPECTOR Check# �� O MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY or as ( MA DATE _ ( PERMIT# Z l JOBSITE ADDRESS lag C �_ Q_��1 OWNER'S NAME Lw � a ^ POWNER ADDRESS un TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL �(] EDUCATIONAL RESIDENTIAI.;Eg,,_ PRINT CLEARLY NEWZ2_ RENOVATION:® REPLACEMENT:Q PLANS SUBMITTED: YES© NO�] FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM k -t ._ Ew,_ DEDICATED GREASE SYSTEM _J DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN �I .._._J ( .__._._k f ! k 1 I f _...._1 I _.._...._k FOOD DISPOSER i ._._. _.1 JIF-.___I I ._ _J FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _I .1-11 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET k __ v I .. _ k —__k — _k �� .�I 4 URINAL WASHING MACHINE CONNECTION I I _..-_j WATP,R HEATER ALL TYPES ► I __ { I j _ I _� _ 4 r WA?F&PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIC OTHER TYPE OF INDEMNITY Q BOND DI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER El AGENT 10 SIGNATURE OF OWNER OR AGENT Z17 I I hereby certify that all of the details and information I have submitted or entered regarding this application are tru a a urate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com is e a e ment provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I PLUMBER'S NAME __ S ,�*yrti LICENSE# 76 ( SIGNATURE MPR— JP Q CORPORATION 0#PARTNERSHIP U# LLC�i#�( COMPANY NAME e �n e ADDRESS 0, aA CITY 'saves__._ _1STATE U1 ZIP B3Xh f— it TEL FAX CELL���EMAIL ROUGH PLUMBING INSPECTION NOTES BEI; -R OFFICE USE ONLY FINAL INSPECTION NOTES Yes No �l�v THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ D ! Q_`� FEE: $ PERMIT it PLAN REVIEW NOTES ffr �I 12 )-1 Date.................................................. 1- T#4 °3a '• °°�, TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Hus�� Otis certifies that .......c. ",""!.. W` { !.P .......................... ........................................ has permission for gas 'nstallation .........P. inthe buildinfs of.........;.. !'`. ......................................................................... at...... ... .......... ..! !S. .................................., North Andover,Mass. Fee..AUv...�.... Lic. No. .� Z.�`�.... `.....1 ��.............................................. � GAS INSPECTOR Check# 97 49 - X02-1 cnr.. 1z 111`- 1 C -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I CITY �� _ .� r��/ (I MA DATE PERMIT# JOBSITE ADDRESS R� OWNER'S NAME G ,- OWNER ADDRESS /07TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EjEDUCATIONAL RESIDENTIAAL PRINT CLEARLY NEW:a RENOVATION:E] REPLACEMENT:El PLANS SUBMITTED: YES F1, NO Q APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER =.1�.._. __. _ !t - ( 1_ . _ 1 BOOSTER - �--- - — CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE -- 1 :_J GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ( (G- MAKEUP AIR UNIT OVEN __ J __ POOL HEATER ROOM/SPACE HEATER f ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER Y WATER HEATER OTHE�_ - - -I INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YE$49kNO [� I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND F OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 11-17 hereby certify that all of the details and information I have submitted or entered regarding this application are true nd cc ate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com an wit ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 PLUM BER-GASFITTER NAMELICENSE# ( I SIGNATURE MP IGF Ej JP D JGF 0 LPGI© CORPORATION Ej#L:=PARTNERSHIP©#=LLC E1# COMPANY NAME: - -,rich_-- (tsu i,n ADDRESS CITY . - J1 STATE L '11-4••ZIP — TEL ,{ FAX �CELL EMAIL b ROUGH GAS INSPECTI T NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES �-� //9�w Yes No d �l THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts - Department of 1ndustriglAccMiks Office ofluvestigadons 600 Washington.Street Boston,MA.02111 www.rnass govIdia Workers' Compensation bsurance Affidavit:Lui tiers/Contractors/.EleclriciansTliiinbers Appueant Wormation Please Print Legibly NaMe(Businessl0rganhationffadMdual): Address: City/State/Zip: �� S �{ �v Phone#:� �7 Are you an employer?Check the appropriate box: Type of project(required): 1.[l aam.a employer with�i �• x am a general confractox and I 6. ❑Now construction employees(fall and/ox part time)* have hired the sub-contractors 2.[] I am a soleP ro xietor or annex listed on the attached sheet 7. El Remodeling p p ship and'have no.employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance. g. Building addition. [No workers'comp.insurance 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions required.] officers have exercised.their 3.[J 1 am a homeowner doing all work right of exemption per MGL 11.[]Plumbing,repairs or additions myself[No workers'comp. c.152,§1(4),andwehaveno 12.QRoofrepaixs insurancerequired.]i employees.[No workers' 1311 Other comp.insurance required.] XAny applicautthat cheeks box#I must also filloutthe section below showing their Workers'compensationpolicy information. 'Homeowners who submit this affidavit indicating they kdoing all work and then hire outside contractors must subunit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am an employer that is providing workers'compensation insurance forrny employees Below is thepoliey and job site information. Insurance Company Name: //�fvri9�I� w 17tJs Policy#or Self ins.Lic.#: Expiration Date: Job Site Address:169 7 City/State/Zip: (/• r Attach a copy o#the workers'compensationpolicy declaration page(showing the policy number and expiration date). Fail-are to secure coverage as re0edunder Section 25A ofMGL o.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 maybe forwarded to the Office of Investigations of the DIA.for insurance coverage verification. -Ido Hereby cert&under the pains and penalties ofperjury that the informationprovided above is true and correct. - Siiature• Date: Phone#• Official use mtly. 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 ofhiro,- express or implied,oral or written." An employei 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 emplo7er,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 ofthe 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 employes." 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 ofpublic 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-contractors)name(s),address(es)andphonenumber(s)along with their certif'zcate(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 cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised thatthis affidavit maybe 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 retumed to the city or town that the application for thepermit 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 thatthe affidavit is complete andprinted 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/license number which will be used as a reference number. In addition,an applicant thatrnust submitmultiple permit/license applications in any given year;need only submit one afCdavit indicating current Policy information(ifnecessary)and under"Job Site Address"the applicant shouldwrite all locations in (city or town)"A- opy of the affidavit that has been officially stamped or marked by the city or town may b e 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 crliermit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your coop oration and should you have any questions, please do not hesitate to give us a call. The Departm.ent's address,telephone and fax number: The Caxnmonwealt LofA4p achuse�� - J-Qep.afteRt ofJadu Wal.A,cc%dents Me of YAVedtzgationa 6.00 Wa ftgt m Sjxeet Boston,.MA 02111 TOL#617721-7,4900 OA 406 Qx 1-877� A-SS.AFF, Revised 5-26-05 Fax#617"727'7749 -WWw.Ma,%gQVM'a t OF MASS (4.c ACHi3$�TTS e • • • • • BOARD t!1^ PLUM6R5 AND GASFIT ;ER ' ISSUES.:THE F0LLOWENG NSE C ' 1:OEN&ED AS A MASTERS U BER EQRY J ST PIERRE I ,, Z' I' 19 EAST`"P'I NEST ��fs� 1a'f W J PLAISTOW NH 03865-2621 '3` 05L01A1f�: 231164 e s Date... ...................... OF r►ORTp�,� TOWN OF NORTH ANDOVER F p i PERMIT FOR GAS INSTALLATION A CHUS� This certifies that . ...... '............................................................. . .................................. has permission for ga installation G�°`�"'' �' '?'"� .... ....... ................ in the buildings f.. �^..'�.'c. ....... (. ..:...`-&,S........................................ at.... a...1......... `'�:........ ... ..'000'�? ........, North Andover, Mass. ................. ..... s� Fee..3 ....... Lic. No. wa.... ... ..................................................................... GASINSPECTOR Check# /���� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I North Andover MA DATE 4-16-2015 PERMIT# JOBSITE ADDRESS 107 Cam ion Road OWNER'S NAME CenturyBUildefpL itogs Saragas GOWNER ADDRESS I P.O.Box 907,Methuen,MA 01844 1 TE 978-815-7073 IFAXI TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONALE] RESIDENTIAL " PRINT CLEARLY , \ NEW:® RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES E] NO® C APPLIANCES 7 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE j DIRECT VENT HEATER DRYER FIREPLACE ML—j FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I Installation of 3/4"IPS -polyethylene tubin ropane vapor r,A line from-tauk-to-house.-apimox 1 2M press.tested for inspection INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ® *� 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND ® \ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. - CHECK ONE ONLY: OWNER ® AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing worts and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Steven E.Castle Sr. I LICENSE# 1023 SIGNATURE MP® MGF® JP® JGF® LPGI CORPORATION®# PARTNERSHIP®# LLC D# COMPANY NAME: Proulx Oil and Propane ADDRESS 1 Simons Lane CITY Newmarket STATE NH ZIP 03857 TEL 603-659-7011 FAX 603-659-6557 CELL 603-285-1996 EMAILscastle@proulxoilandpropane.com Ld I("I I • � - F�-tf t / 1 i.: r• + . , � L, � �' ` r V'� �����`�, � � � 1 � Cr�� s.� � ��� 4 S GOMMONWEALT`H OF MASSACHUSETTS D p p pG IM BOARD OF PLUMBERS: AND GASFITTERS ISSUES THE FOLLOWING LICENSE . E LICENSED AS AN LP GAS INSTALLER ' ---S TEVEN E CASTLE SR } 23 CRYSTAL DRIVELou v HAMPTON FALLS NH 03844 2136 1023 05/01./:i6 222366 ACE'S OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `.� 4/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DataRisk LLC CONTACT Risk Strategies Company -NAME,.---- APHONE FAX 1 New Hampshire Avenue, Suite 340 WC IL° 603 778 8985 ac No: 603 778 8987 Portsmouth, NH 03801 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: HDI Gerling America Insurance Co. INSURED INSURER B: Axis Surplus Insurance Co. Proulx Oil & Propane Service, LLC P.O. Box 419 INsuRERc: NH Motor Transport 1 Simons Lane INSURER D: Newmarket NH 03857 INSURER E: 1INSURERF: COVERAGES CERTIFICATE NUMBER: 24265477 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UB POLICY EFF POLICY EXP LTR POLICY NUMBER MWDD MM/DD LIMITS A COMMERCIAL GENERAL LIABILITY EGGCD000007414 10/28/2014 10/28/2015 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ❑✓ DAMA TO RENTED OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY CT LOC PRODUCTS-COMP/OP AGG $ 1E 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY EAGCD000007414 10/28/2014 10/28/2015 cO(EaaeaNd D nt)SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ A AUTOS EXAXD000007414 10/28/2014 10/28/2015 Peracadent Excess Auto Excess Auto $ 1,000,000 B / UMBRELLA LIAB OCCUR EXAGD000007414 10/28/2014 10/28/2015 EACH OCCURRENCE $ 3,000,000 A / EXCESS LIAB CLAIMS-MADE AGGREGATE $ NHA069640 10/28/2014 10/28/2015 DED RETENTION$ EXCeSS $ 6,000,000 i `1 C WORKERS AND EMPLOYERS'LIABIILITY YIN ON P000706NHMTA2015 111/2015 1/1/2016 ,/ STATUTE PERER" +J ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 e� OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION Town Of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 107 Cam Ion Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North AndOVer MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael S.Daigle .��J ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 24265477 Penny Zust 4/15/2015 4:49:31 PM (EDT) Page 1 of 1 The Commonwealth of Massachusetts Department oflndustrialAccidents X Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERIV.QTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individiid): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer withemployees(full and/or part-time).* 7. New construction 2.F]I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9.100❑Demolition Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no.employees. ` ' 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] , *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. 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 workeis'comp.policy number. I din an employee that is pNoviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpeijuiy that the information provided above is true and correct. Signature: Date: Phone#: N Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commorrWealth 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=contractors)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' compensatioli 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)-and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia IQ Off!\ \ \ \ \ <<� \ \\\ \\\ \ \\ X Zwu4� NICHOLAS T. & ANDREA P. PAPAPETROS AKED HAY BALE EROSION \ \ J / \ NTROL BARRIER (typ.)\ \ �7>O lopV3 \ \\ \\ � y B(1)L(7) \ LOT AREA 2 v \\ 43,647 S.F. \'oQ ���' \ ' \ ;'4Q \ 100' BUFFER \ \ 4f; Q ZONE / AIL c(2) \ ( ) \ PROPOSED SHALLOW DIVERSION SWALE \ Q J(3) :.: :: H(7) N/F CAMPION ESTATES 011, \ • .• ,... \ \ \ \ \ �q6 N F NICHOLAS T. & ANDREA P. ••1 //\\ \ \ \ \ \ \ PAPAPETROS \ STAKED HAY BALE EROSION \ \ J / \ \\ \ B(1) \\\CONTROL BARRIER (typ.)\ L(7) AJ) i �p \ \ \ \ LOT AREAa \ e. \ \ PROPOSED \ RAIN GARDEN "A" \ \ \ o ry \ I \\ BOTT. 163.0 43,647 S.F. 100 BUFFER ZONE / n(3) G(z)\\'�` D(s) �, 1�l / t•: I ' I PROPOSED SHALLOW 1 I s4 i DIVERSION SWALE �` i I I i K(3 AL AIL M(4 100' BUFFER )ss I I ,111c L(4) 1 C(1) ,111 ZONE 1 ' �' I ©� ) I 7 \ PROPOSED \ / RAIN GARDEN "B" l I. AL PROP. H(3) I h ce //� / \ BOTT. 181.0 \\/ \ ' RET. \ WALL 1 :;::::.. \�Wv / / A �•• d / / � /�� � � �'•.,lsa LAWN AREA ��' .... .•,• .: :.. W ....,(..../ F-EDGE p � P �\ ' M711 // I W PROPOS LANDSCAPE LEGEND: PETE H. / y ITEM SIZE OTY k N/F / x A Al—bnlwnm 8-10' B LISA H. CANPION ESTATES 2 REED / / AA Pice.marbq B-1O' '`\ / g \X ` a� \ C Wrcus Daue41F 2-x.5• Z ✓ \ �����1hhh111"��� `\ �e}'�- • °/\(`� \ • D Nyermgea pankul.t. 18-xt• 5 v�o- NICHOLAS TNS,ANDREA P. ® E S)vingO wlmrN 4-5' 6 \ \ `I PAP \ APETROS rn • �� \ F Cou. Anwka ]-8• 1 ' `\ ` ca,ma lRRrcn ppj ...\• N') 11 / \ \ .\ `\`-0 `i, `. '•.\ 4A 0 G um gmca x4-30• 2 Rom crd.. /3 Z \ , LOT AREA SEWS.S JJEANNE C. 11 �\ ' \\\R �°°°s`°•.•\\ .C' \ 1-� E7 I srmq.r.liC.mm p n m. 43,647\ ONE —k— 4-3*S.F. /`� L' ?A�a ` ppg ' t0O'BUFFER�" I • J rYgniono 4-S• 4 \ \ \\ \ 1 \\\ Z i.:, �\ AP) © K Rn.ammam. n..x4.w• s I`T1 \\1 �` I q� �� \ �•' \ 1 $� ' / d o L ECNMacm pvrpurm /1 20 Kamb.ngu.Hdb 24-30' 4 O 100'BUFFER `=ONE` 1' _ ° J./° -Ve `WA e° lS+ya" \\\A ggf�v..agoo�i•B•`\ /.j� e(T) C PRW d� Kpsl "� . `_``_ °j K.•FmtYp W`.z r n �\ UTILITY EAM.".' I aiF. \ •,\ / Poems �o�RnP��x p.M•!]M N/T —_—— /HA.35 RUSSELL P.L<ANNE M. ' SPENCFR, - \ I ��N•�f I / J w A RE LA P•TRUST GP DUANE C.uoNroPOu LEGEND: MAP 62 LOT 88 "-- --,11 EXISTING CONTOUR LANDSCAPING PLAN • g— EMSTING SEWER 107 CAMPION ROAD rt— EXISTING SEKR IORCEUNE NORTH ANDOVER, MASS. EXISTING ORAIN PREPARED FOR: DIMITRIOS SARAGAS —w— EXISTING wAMR DATE: JUNE 9, 2014 REV: JULY 30, 2014 !YYl"Y, EDGE OF TREES SCALE: 1"=20' DOCE OF LANK NTxI PROPOSED CONTOUR OndOVer --FN— PROPOSED WATER NOTES, c9nsuItOnts P 1 MFbc PROPOSED SEWER ROAD AT FFRONTOFLOT ELE-9 3INinc. >NAVDSB 1 EDsI River e e Jamas S.Fairweather II 2.FOR RAIN GARDEN DESIGN AND PLANTING SCHEDULE, MelhNeO,Mass.01844 Reg.P.f.Engineer SEE DETAILS AND SPECIFICATIONS PREPARED BY 0 20 40 60 80 Ft. WETLANDS PRESERVAFON.INC. P:\10\10-03.1\0WG\LANDSCAPING PLAN.OWG 0 5 10 20 Meter 344 Date.. .� .� ... H0RTH TOWN OF NORTH ANDOVER " 0 `p PERMIT FOR MECHANICAL INSTALLATION. SACHUSES< This certifies that . . has permission for mechanical installation . . '1 lj. _;. . . . . . . . . . . in the buildings of jJ .Cwp!�. . .K2.p,(. ... . . . . . . . . . North Andover; Masi t GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Date : ~i Sheet Metal Permit ff '' -� p�11— ,� Permit# �)44 Estimated Job Cost: ( C'� Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 5 3 5 Applicant License#- ,5 3 LJ^ Business Information: Property Owner/Job Location Information: Name: EVENFLO��9 FEAT & A/C Name: �C--y-rUf �c�! / ap S' 27 BurnpY Laneia1 ,IVJ Street: Street: Lo -rI a�. - Am ►OPV d a Cit /Tow h® City/Town: A)C) I J Y 6C� V R a Y Telephone: Telephone: 70 3 Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft.-A— over 35,000 cu. ft. Sheet metal work to be completed: New Work:_A-_ Renovation: HVAC_IV Metal Roofmg Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: Lo fiN � 7--o S 5 s 6 ! INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Ir Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent ❑ Signature of Owner or Owner's Agent By checking this boxEl,I hereby certify that all of the details and information I have submitted(or entered)regarding.this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted City/Town 11,. ❑Journeyperson Signature of Licensee Permit# � ❑Journeyperson-Restricted License Number: L Flee$ Check at www.mass.gov/dpl Inspector Signature of Permit Approval Sheet Metal Commercial Guidelines/Life Safe Critical Systems _ tv/ Inspection Checklist Yes No N/A„ Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided �\ All workers performing sheet metal work onsite has valid Massachusetts sheet metal license �r All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation .� Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doorsp pro erly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all scams and connections welded airtight with properly located cleanouts. Proper clea;`ances, fire rated enclosures and pressure testing required. , re,-Imint3 installed Wti&xr"r�quired'ou egtiipment and du..t4.J;:v Duct penetrations in and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) 4 F Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual"D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean -properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-off) S IVIMONVI/EAtTH I OF MASSACHUSETTS S H E E T BaARD t� METAL WORKERS ISSUES THE FOLLOWING LICENSE. AS' A MASTER ,UNRESTR I CT,ED I EVEN :FLOW HVAC del j RUSSELLA .801 S1/ERT EVEN FLOW :HVA C' k y y, r 10 27 BUMPY LN '�`�` , A' MA 01844 1321 "` i-' 5345 5/28/16 214625 -; {[ K t t i V Equipment Sizing Property Organization HERS Century Builders Sustainable Energy Analytics Projected Rating 107 Campion Road 781.652-8282 10/20/2014 Anrinvar,MA-01.845 Jang Yoon A0 Rating No:SEA2402P RaterID:5240057 Weather:Andover, MA Builder 107 Campion Road Gi2nn Saba SEA2402P - 107 Campion Road Andover.big �l ieating Calculated Peak Load.(kBtulhr) 80.0 Infiltration 5.7 Envelope- 74.4 Sizing Factor(%) 100.0 li Heating Equipment Capacity(kBtu/hr) Required 80.0 Specified 200.0 Cooling Calculated Peak Load (kBtu/hr)- 36.3 Sensible 31.9 Latent 4.4 i SHF 0.9 Sizing Factor(%) 100.0 Cooling Equipment Capacity(kBtu/hr) Required Total 36.3 Specified Total 42.0 jSpecified SHF 0.8 Required Sensible 31.89 Specified Sensible 33.60 Required Latent 4.40 i Specified Latent 8.40 i i REM/Rate-Residential Energy Analysis and Rating Software v 1 14.5.1 This information does not constitute any warranty of energy cost or savings. ©1985-2014 Architectural Energy Corporation, Boulder, Colorado. 6B' 22' 2'-7318' 8'-B fl4" 2'-7318' 24' 3'-6' 2'E' 4'i 5I6'�4'451e' s• r 1B' r DECK 21'-6'x 14'V BR'E��T 13'41' GENERAL NOTES: N m TOTAL LIVING SPACE 4,364 S.F.: ID Z ZER LEARANCE FIRST FLOOR: 2,162 S.F. FAMILY GAS INSERT SECOND FLOOR: 2,202 S.F. rp 23'-8'x17'-2• ILL! Screened Porch fL��°-� rreroa calb 'I A 1:1Z'x 1V-7- I aB EXTERIOR SIDING: TH F VINYL SIDING/STONE VENEER R VAPOR BARRIER bG Lu W x N GARAGES: r� antry e'er s ^zs-e•I ; ty CLOSET KITCHEN 3 STALL SIDE ENTRANCE AT GRADE _i " i6'-i"x28'-1' 32 a BASEMENT: a }6u6d•p��D'•rn 3'-r WALK OUT IN REARDINING 0 Q DECK: `o OUTDOOR WOOD FRAMING s 7 N 2 COMPOSITE DECKING I m 3w m 1-0 VINYL RAILINGS Q I I v SONO TUBE FOOTINGS _ €E N SCREENED PORCH: ��� Ru Formal LIOng 0 — z OUTDOOR WOOD FRAMING m STUDY 3'-1'x1e'-1B• y 13'-r'x 14'-5" yBr GAS INS eARANOE COMPOSITE DECKING zr-z" GAS INSERT VINYL RAILING 15o SONO TUBE FOOTINGS f^ GARAGE I I s NO FOUNDATION UNDER 4 ��V 23'-0'x95-1" FAMILY ROOM FIREPLACE: — — ZERO CLEARANCE GAS INSERT ° W m' LIVING ROOM FIREPLACE: 2PGR H FF b 2m ZERO CLEARANCE GAS INSERT I Ljm a DATE:m April 2013 SCALE: a• e'c' S'b^ xis' r s'-s• 3'E' r fa' T LIVING AREA iF 22' 24' 2162 aq B �4'`�• SHEET: 1st Floor A-2 60' .Ilb. dll ullk. GENERAL NOTES: F f� 0 ATTIC ACCESS: BEDROOM� ® 1r-6"x1s-m• PULL DOWN STAIRS =BATH h ® J WINDOWS: k ALL BEDROOMS TO HAVE EGRESS 4 a M LAUNDRY ` Lu � tj j U .Y ClosetAS I V-6"x 13'-6" HALL A 'O 6' 0 C4 51 im ELL BEDROOM '�" ❑ ..� q O y 1J'-6^x 20'.0 Ej 6•<" Shower 'a> �'1�v 6•-2••x4•-o„ E 0 ur c BEDROOM k = V Q j 13'3".18'-6" Q L N 'C OPEN BELOW1-76O d r50 Z J MASTER BDRM N 23'-0"x 21'-6" � T,,pd COIN C VI LIVING AREA F N a 2202 sq ft 5 v f1 5 0 5. m ^IIp o UP 4' 6'3" 3•A' 4'-6" 4' 3-L,..6.- 3'3' 1'—W-10'�7' F.AT p u' 6•-s" 13'3• 24• qp IE2013 2nd Floor SCALE: SHEET: A-3