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HomeMy WebLinkAboutMiscellaneous - 129 WEBSTER WOODS 4/30/20187 ! 9c; Date ..5. ". 7 _`. R .......... ,e,e o TOWN OF NORTH ANDOVER j PERMIT FOR GAS INSTALLATION 41�, This certifies that yA--� S has permission for gas installation ... .......... in the buildings of ... �`.......5 e .. ................... . at ...�. `.. <. (--%Z �7 �. 1. U-0', .. , North An4o , Mass. FeO S .•u?. Lic. No..?: 3.5 �► - Check # H :3 q 6 .... .......-......... GAS INSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: OY'Tr' MA. Date: / �� &- ( Permit# Building Location: GJe6 s tl.%�iraru Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New:z Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No [ INSURANCE COVERAGE: v I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ErNo ❑ If you have checked Yes, please md' a the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner El Agent By checking this box ❑; I hereby certify that all of the.details and information I have submitted (or entered) regarding this application are true and -- -55r "WvvW !JV Oil U t IOL all Niumumy work ana Installations perrormeu 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. By Title License: City/Town Ljjourneyman APPROVED (OFFICE USE ONLY) ❑ LP Installer Signature of Licensed Plumber/Gas Fitter License Number:.��Sr.SJ`� Wco W Z 1"'� co v (� X N Qco X co Lfi '^ v/ LLI Vd O •i r Lu z �O C7 -1 Z Z M co Lu p W 2 0 w fi Q H W w co V w W m Z 0 ~ = U a. 0 Lu = LL z W of W J F H O z -t O C H FW- W~ o Lu W © S� cxe U 5, 0 D u- N cal _ O CL H >> O BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 6T'—FLOOR Installing Company Name: ��)1Z N:'*� Ch ck One Only Certificate # Address: 3 1 "C J 3--- City/Town:/111A 4�-% State: Corporation Business Tel: %' `j7 �' fr34L' Zt c, 3 Fax: � �' �� �- y- /Soo El Partnership .3C, ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: � �_ — , INSURANCE COVERAGE: v I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ErNo ❑ If you have checked Yes, please md' a the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner El Agent By checking this box ❑; I hereby certify that all of the.details and information I have submitted (or entered) regarding this application are true and -- -55r "WvvW !JV Oil U t IOL all Niumumy work ana Installations perrormeu 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. By Title License: City/Town Ljjourneyman APPROVED (OFFICE USE ONLY) ❑ LP Installer Signature of Licensed Plumber/Gas Fitter License Number:.��Sr.SJ`� Location 4///;'/ /C,)z xle4�rl? 140`- L/F No. 076 Date 40RT#1 TOWN ,0F NORTH ANDOVER ' 0. 9 Certificate of Occupancy $ *Ar '°' cMus ;<� Building/Frame Permit Fee $ s�/� Foundation Permit Fee $ L0e Other Permit Fee TOTAL Check # (% 6 5,Z 3 13656 C wilding 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: a 8 00 t SIGNATURE: aofV44A� BuilSng Commissioner/Inspector of Buildings Date Q O SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: mot 17 - Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: l� Zl-f Ei�a...:,,� 41 Zoning District Pr odds Use Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3v� 83` 36.# 35 3' 36e /8' 1.7 Water Supply M.G.L.C.Ab. 1.5. Flood Zone Information: 1.8 sewerage Disposal System: Public V Private "' ❑. Zone Outside Flood Zone Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIi1P/AUTHORIZED AGENT' 2.1 Owner of Record Name (Printf Address for Service ,�487- s Sao Signature Telephone 2.2 Owner of Record: Name Print Address for Service: S nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Sup Not Applicable ❑ �/� /erviisor: Licensed Construction Supervisor: License Number Address a-:,>0 o Expiration Date Signature Telephone 5 <I -e � S"S7 - 5 7 �O 3.2 Registered Home Improvement Contractor. Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.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 ...... 1A No ....... ❑ SECTION 5 Description of Proposed Work check all a licable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 7a?ZYd!ie �S Xao? �aLy rdDlYJ `iX /02 `rllrc.f G`i,h- eZo Adood cylPa/" e% F< 2 / j�rjo ler-tee 31 ✓ (D lam+ � �i`�'c�� L SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 0 (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) + ®GC. P40PAI� o • N ' 3 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) 3050 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, moi/as Owner/AA Loriz:edA ; ubject property P�'` Hereby authorize to act on My behalf. in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, A 014 as O /Authorized A en 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 Name ie4 v�da Si ature of weer/AVnt Date NO. OF STORIES SIZE BASEMENT OR SLAB p�C-ems SIZE OF FLOOR TIMBERS 1 sr 2 09- 1 v 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 3 a z HEIGHT OF FOUNDATION < <r THICKNESS O 4 SIZE OF FOOTING X r� MATERIAL OF CHIMNEY cocoa IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 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 compiianc-- with any applicable or requirements. ******APPLICANT FILLS GUT THIS SECTION" "" S/�� 6Y7 -5_X0 APPLICANT �a0 ,/ ?'e� GGG PHONE 6E 7 -5-300 LOCATION: Assessor's Map Number 109# PARCEL SUBDIVISION C� rvre-S-l' LOT (S) STREET 06651-er GUo&o�5 L e ST. NUMBER 42 USE ONLY******* 11F W /lo 0 RECOMMENDATIONS OF TOWN AGENTS: �6/ CONSERVATION ADMINISTRATOR DATE APPROVED 2 0 DATE REJECTED COMMENTS S � 0 � Q G:_ �c JC ,, �✓/'j� � � �J /`I COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT W ,00 FIRE DEPARTMENT RECEIVED SY EUILDING INSPECTOR qDATE Revised 9197 jm t FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and*dated Dec, 14 19 3_9_ and/or by the Covenant dated mu 9 19 59 and recorded in District Deeds, Book 4280 Page 1.14 or registered in L4 No. Land Registry District as Document and noted an Certificate of Title No. in Registration Book Page ; has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown an Plan entitled " C4ML)621 a rP-S $ Plqiv Section (s) , 'Sheets 1- 7 Plan dated , 19 q— recorded by the ESSpx N ortk D r Stri ct'Registry of Deeds, Plan Book , or registered in said Land Registry District, Plan Book , Plan -*/ a7 8 +f , and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) C.orS Lars ! -rJurw / 3 ; LOTS I`` , L hereby certify that lot number (s) Lon Zs 7-)4 3 i 8A UonM'4r bt+ve C AI -A w sc Wo+oo► Oo-+NM• zuLt,f Street (s) conform to layout as shown on Definitive Plan entitled Section Sheet (s) zY,ZS 3 on do MAS�9cyGs . AL6ERT T. C> TRUDEL R gistered Land Surveyor Q No. 36869 CC a0 �fCfST 'VAt LAN" SJ 1 of 2 -:,�Ojsft,-t a 10 �W SPT HORtH 3 ' ' 0 Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT ISSv � PERMIT NO.: PROJECT: '° s��'e'UC`�- �' / I"kTTfBbJ DATE:_Z UNIT NO.: REMARKS: FLOOR: WING: BUILDING NO.:�`% 1,,:,-f— tv, b,54pe G(ivo t)S LA -,V e_ Excavation - depth and soil conditions Framing - Other: Date: Date: ��+3 ^ Date: _ Inspector ,Q/l /� �i� Inspector �AdAl C6- Inspector Footings and foundations and drains - Insulation - Other: Date: Date: ' 6 Date: Inspector �� ��� Inspector IA/r'"— Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: `�`�� Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: 8 �S Date: ` / Date: Inspector Inspector Inspector Fire Dept - oil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: ` / S '`'�� Date: C of O # Inspector Inspector Form 8995 Action Press, 685-7000 ` t� Location No. :/l/ Date 2�� �o f TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1388.— Foundation 388. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 13 616 Check #O�% i Building Inspector m CrE"RT/FIED A 4 T AAA S.E CUMMINGS & ASSOCIA TES P.O. BOX 1337 PLAISTOW, All. 03865 TELEPHONE (603)-382-5065 FAX f603I-382-5216 SCALE 1" = 60' I HF - RE -By CERTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THAT THE EXIS TING FOUNDA T/OAi DRA WN ON THIS PL AN IS L OCA TED AS SHOWN AND THA T IT DOES COMP,' Y TO THE MINIMUM BUILDING S'ETBAC'KS TO PROPER FY L INES. DA TE: MARCH 13, 2000 MINIMUM �S)ETBACKS: FRONT - 3G' FiEET SIDE - 30 f f_. 7 REAR - 30 EFF. T 0 d sa iia massy s r LA i wwrtS T S 0 T :3(l1 00--tp' T -NOW CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 09b-00 THIS CERTIFIES THAT THE BUILDING LOCATED ON d -/ �"%0?9 Ae-i MAY BE OCCUPIED AS I Date g—/S-® 0 IN ACCORDANCE V WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 9 QQ®j-n s- a ►(a t3h*�s -a 6jAlj U#.;IcQe(_ o� "° or" CERTIFICATE ISSUED TO CAP4�"ellh- . a ADDRESS C�731 SvaN 's 0 ►7f ++�s ✓,�� 3"C! s 74 Building spector aim O ;d C aq c Crri Q a . m m n m CA C) •O CLC N r V 1 co o m •� 0-C 0a CO) AI = �a T m � rF �■ y Q � _� �Cm� mm CD Co O O CA 10 C7 0 CD 0 Z CCD O cop) . 'v ,,. CL r c CO d �. y m m n� m -moo o o v CD m CD '' ^^ VJ Q.. Q _ m `C d CD CD o p m CD W ca C CD y fl. v y O I CD y O CD Z O CD O Q w10 Ob • 1 p n• El C O d= _,%�foO oQ N • / ;d C aq c Crri z a . m m n m CA C) •O CLC N r V 1 co o m •� 0-C 0a CO) AI = �a T m r _ CD N o y o _� �Cm� mm CD Co O O -21C Z�.MA. O N• C7 m gO o.�.. .? c CD m dCD . I CaCA O1 N CL d Acr 10 C* CD s :1 N CD yQ 0 d N s D :�• %3. � K W od01) .- _ '� : ` ,a ^O D i iG O M m = m 'no I. , oCD:: _ C-) n M ce lY CD v • Cn Cn w Z ~ K7 ;d C aq c Crri C r 111 "1 P 91 C C ::r w • M a✓ HV cn Op 'r1 CL cn 7_C o cn VV 91 �. r V 1 co o AI H r nA 1 o Omi 0 9 • Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978)688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS % o� % 60e h S7Le-r (,,70 p2/s La",e LOT NUMBER h% SUBDIVISION Cr/� rtlrf's it - DATE DATE REQUEST FILED S� !y(60 DATE READY FOR INSPECTION sh's 1p6 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTIO OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUICTURF DUES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATION PLANNING D.P.W. — WATER METER 'FICIAL USE ONLY L DATE 4141/y� DATE ellqk 0 DATE��f/� D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR T INSPECTION REQUE T DATE. SIGNATURE / DPW AUTHORIZATION Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Jura Hmurciak Telephone (978).685-0050 Director Fax (978) 688-9573 July 14, 2000 1V1r. Kenneth Grands� President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear W. Grandstaf The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the Mowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and facilities in the event that Mesiti Development or its agents fail to adequately perform maintenance _ : of the pumping station. Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 r 6. Mesiti development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnky, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered .by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T . ours, r :� J. W,. ism Hmurc' .E. Director of Public Works . _ The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant of nditiornaI use. e up K eth �Cmwd M&dent Date: C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated , 19 and/or Covenant dated 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book, f Page , acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said pian as follows: EXECUTED as a sealed instrument this S day of 19 cm Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS -Es Sex , ss be�2t.� bZ1, 19 9 � Then personally appeared ����,,�� ��� one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary blic *IVI .1 5, ).006 My Commissi n Expires 2 of 2 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. Willett Telephone (978) 685-0950 Staff -Engineer Fax (978) 688-9573 Additional conditions for lots 7,8, and 13, Campbell Forest January 26, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 7, 8, and 13 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these three homes can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. , 2. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation ofthe—above conditions will void both water and sewer connection permits. No refunds will be granted. C,7 -112,.r,--// Fringed Name "rff tYL I !'1tD Division of X69i, Works Printed N CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin � LL/6U Date Date NO 938 APPLICATION FOR WATER SERVICE CONNECTION - . North Andover, Mass. 1� Application by the undersigned is hereby made to connect with the town water main in U���ei subject to the rules.and regulations of the Division of Public Works. ,-/ The premises are known as No. r w ►`���� "�� 4 l -6 t7 Street or subdivision lot no. 7 �p87 53� / -41 �el Owner Address Contractor EWIN !4VA 1, - 71 -: � 1s c.00 PERMIT TO CONNECT WITH WATER MAIN MMU The Board of Public Works hereby grants permission to /' , "r�'� r �! ( ✓�� %�� to make a connection with the water main at �"� ( �60G ^ 'lr't e Street subject to the rules and regulations of the Division of Public Works. Inspected by Date c� Board of Public Works By See back for rules and regulations 7/4 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass.��--- Application by the undersigned is hereby made to connect with the town sewer main in �`S l C��e��s L7 Stfeet,. subject to the rules and regulations of the Division of Publics Works. The premises are known as No. /Z < C�� %� ��o/ � ! Q kf e— Street or subdivision lot no. 693?-S3oo /' P,-"/ Cir // OU' Owner Address Contractor Z= Address cc� Z - Applicant's Si ure PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at LoeLS w�C subject to the rules and regulations of the Division of Public Works.. Inspected by Date Street Division of Public Works By See back for rules and regulations Ajd . (* (, / ,5 to 0 TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF. PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Date: Z (LOCATION: (BUILDER: phone: E�✓ � OWNER:e�,,� �phone: Telephone (508) 685-0950 Fax (508) 688-9573 10- ,�:g7- 534o e North Andover Superintendent of Highway Utilities & Operations MUST be notified of the ide and set -back from street established in any driveway entry onto any street or way maintained by TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: n I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I 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: 1-11-2000 DATE OF PLANS: December 1999 TITLE: Lot 7 "The Harvard" PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC. / Mesiti Dev. Corp. 231 Sutton Strret Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 511 Your Home = 502 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 2090 30.0 0.0 74 WALLS: Wood Frame, 16" O.C. 1915 11.0 0.0 171 GLAZING: Windows or Doors 442 0.350 155 DOORS 56 0.490 27 FLOORS: Over Unconditioned Space 1590 19.0 0.0 76 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 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 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 7 "The Harvard" DATE: 1-11-2000 Bldg.I Dept.1 Use I I I [ ] I I I I [ ] I I I I [ ] I I I I I I [ ] I I I I [ ] I I I I [ ] I I I I [ ] I I I I I I I I I I I I I I [ ] I I I I [ ] I CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-11 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.49 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 92.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] 1 All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or 1 joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not ( permitted. The HVAC system must provide a means for balancing ( air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ) I Rated output capacity of the heating/cooling system is I not greater than 1250 of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ l I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from 1 non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 1 refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 0 • I 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only) ------------------------- I BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: 17?4 Asn �H Location of Facility Si6ffr= 4-Ferrnit Applicant Ji Dare NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I Growth Management Bylaw Exemption Statement Town of North Andover Euilding Department This forth shall be used to assist the Building Department in their determination of exemcdons under section 8.7.6 of the Town of.North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant on cuilding Permit (below) Address of Property fOr PelTMit (below) GC %21' �Ooo-& < 0�, e Map and Parcel : Purpose of Applic.3ticn (c.'ieck below) Phone Number of Applicant: • _I Single Famiiy Two Family _ /0 1 5%7a I the undersigned applicant for the above property attest that the attached building permit for which this form is =mpleted does comply with the E{EMP-nCN section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this farm does not absolve me or anv party to this permit from the requirements of obtaining other permits required prior to the issuance cf the 5"uiicing Permit. Further I understand that my interpretation of the E{EMPTiON status is subject tc review 5y the Building Department and is only ofFcally accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reccnstruc :en of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. Al The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of 'his Section 3.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate into me families or individuals, where all of the pnditions of 8.7.6.aare met and/or represents Dwelling units for senior residents, where cc _—jpanc/ of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior'shall mean persons over the age of 55. �l This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduuctipn in density, (buildable lots), below the density, (buildable lots), permitted under :aping and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable aces and permanently designated as open spats and/or farmland. The land to be preserved shall be protected from deve!ccment by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Panned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits.(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Sctredule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Sc'tedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination" that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the atta&ed building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inac=rate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, i ds for refusal by the Building Department to issue a Building Permit. ignature of OwneMr Attrr6rizm Agent who signed the Attached Budding Permit Oate This form must be attached to the Building Permit upon application for such permit. DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number; Expires; Birthdate: CS 0WSf 0510912000 05/09/1954 Rest=ricted 6i 00 ALAN G-OUSSELL 400 MAIN ST GROVELAND, MA 01834 The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, !Class. 02111 Worl(ers' Compensation Insurance Affidavit 1 Name Please Print I Name: Location: City Phone n F7 1 am a homeowner performing all work myself. F7I 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. rmmnanv Hama C "�nnr !J l �/ /—/���5� L �/�5/ / U Py' c�) Address 2,31 Su ft 0,7 ,City- Or �-1-4/V-" v,-/- /eta , 0 / 8 y3 Phone � 7� � $ % - :5'30 o Insurance Co Ur7/ led 19d ci Yip .YrIS 610Policy Comoanv name: Address City- Phone Insurance Co. Pollcv Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' 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 ccpy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pain and peva ' s of perjury that the information provided above is true and correct. Signature Date Print name ��a4 /2 SSS' /% Phone b 57-5 76 c7 Official use only do not write in this area to be completed by city or town cincial' City or Town Permitfl icensing Building Dept ❑Check if immediate response is required Contact perscn: ❑ licensing Board ❑ Selectman's Office Phone #: ❑ Health Department 171 Other -N j { 0009 -13 12 { 3 .�926 R g o rte. Q /f u, y - - " I J✓ . . . . . . . . . . .To 7, / '3e+ 932 w• �,� \ BA 40,72R#.) 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Flood Zone Information: 1 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Tohfy (Zpap - Seib was Ujoo� C ,) Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed COnstructlon Supervisor: Address 4��7 / -S- -2,0 1 Sign Telephone 3.2 Registered Home Improvement Contractor Company Name Address for Service: Not Applicable ❑ SS zqS License Number -5-2y Expiration Date Applicable 0 /o s3F3 Registration Number 'i "I 9 -a -z, Expiration Date M M X z O v M �J Q O z M 90 O -n r v G M r r z 0 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 in the denial of the issuance of the buildingrmit. Signed atlidavit Attached Yes ....... & No ....... ❑ SECTION 5 Descri tion of Pro osed Work check all a licahle ❑ Alterations(s) Addition ❑ New Construction ❑ Existing Building ❑ Repair(s) Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I h.J12S clo SECTION 6 - ESTIMATED CONSTRUCTION COSTS OFFICIIAL USE ONLY Item Estimated Cost (Dollar) to be - _t:... r (a) Building Permit Fee 1. Building 1 Z A4 � Multi Tier 2 Electrical (b) Estimated Total Cost of Construction Building Permit fee (a) x (b) 3 Plumbin 4 Mechanical (HVAC) 5 Fire Protection Check Number 6 Total (1+2+3+4+5) --7 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT result as Owner/Authorized Agent of subject property to act on Hereby authorize My behalf. in all matters relative to work authorized by this building permit application. Date Si nature of Owner 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 Owner/ NO. OF STORIES BASEMEN"f OR SLAB 1 SIZE OF FLOOR TIMBERS SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS Illa(ill'1'OF FOUNDATION SI . OF FOOTING MATERIAL OF CHRANEY 1S m ni DING ON SOLID OR FILLED LAND Is 13UIl.DING CONNI:C"I ED TO NAT5RAL GAS LNE Date SVE 11IICKNESS X If % KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978)691-5201 Toohey, Bob & Kara 129 Webster Woods N. Andover, MA 01845 (978) 687-0497 7�f Contract #4540., Appendix A Date. 11/06/00 Remodel Basement: • Frame, insulate, & sheetrock walls creating @ 480 sq. ft of finished room • Tape & seam walls • Remove door & frame at bottom of stairs & create %z wall from bottom of stairs to ceiling • Supply & install 4'0" x 6'6" 6 -panel textured masonite double door unit into electrical utility room • Create 2' x 6' closet between storage area & finished room • Supply & install 4'0" x 6'6" 6 -panel textured masonite double door unit for closet • Supply & install 2'6" x 6'6" 6 -panel textured masonite door into storage area • Install customer supplied 15 light door at top of stairs • Supply & install upgraded handrail on one side of stairs • Create Y2 wall from corner of storage area to first lally column • Supply & install trim on doors to match existing • Supply & install 5 % " "speedbase" around finished walls • Supply & install ceramic file from garage to stairs, including existing closet($260.00 material allowance) • Supply & install carpet in remainder of finished area ($1225.00. installed allowance) • Paint walls and trim (2 coat finish, 2 neutral colors) • Supply and install 2' x 2' revealed edge suspended ceiling (Dune series) Electrical: ($2585.00 allowance)" ' • Add sub panel to facilitate new circuits • Supply & install baseboard electric heat to code e o S f0 sn • Supply &install 12 recessed lighting fixtures, switched on dimmers • Supply & install switching and outlets to code • Supply & install one cable outlet and one telephone outle 9/( Total price:"17. ll /`2.11'1 �avLl�c`'7'tir�sa��c� F`�v #jrr),Z �Fyr�� Price does not include necessary permit fees or any necessary plumbing work. All extras to be paid in full when ordered Payment schedule: $1000.00 due upon signing of contract "j2C j Z $4000.00 due the fust day of work - (7k Lt K t 9 3 3 4 0 0 a •o !95000 00 due after rough framing and rough electrical is complete ($2415.00 if we don't do electrical work) $2000.00 due after the sheetrock is hung $1611.00 due after completion of work except carpet $1225.00 due at completion of contracted work Customer // ' Q ! 00 Date Z / 7 - o -) Date W.,MWOM Z / 7 - o -) Date ✓he iooammolzaAeaffh of �i7Caa�a�,liude!!a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 . Birthdate: 03/24/1943 Expires: 03/24/2002 Tr. no: 18312 Restricted To: 00 KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 Administrator Tie C�anvrna�wiea/.Gi �✓1�a��u� MUM HOME IMPROVEMENT CONTRACTOR Registration: 108383 Expiration: 8/18/02 Type: 08A KEEN CONSTRUCTION CO. Kenneth Keen 2 ADMINISTRATOR 1 Hewitt Ave No. Andover MA 01845 The Commonwealth of Massachusetts Department of Industrial Accidents Office 81/0sesti90811s =1 LIc 600 Washington Street Boston, Mass 02111 �~ Workers' Compensation Insurance Affidavit A licant to orf'° ma ori: e? 11 .l / leasR et1 ,. x name: ILEC"l� �orJST2ac-tiDa> r' l �C NN � 4 l eni 77-L / / tet- A,16-- f1 /� location:./'� ertu i 1— L/E :"b�Ndauln &4. phone# 972-671-S At�itclrAdclitional s1es'saryt�_ 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, 0.00 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. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the fiins a ndpen allies of perjury that the information provided above is true and correct. Print name K EdiA! E to 1 • if iF-611_.._... Phone # 2'%-' " 6 9) 'SZ,O 1 official use only do not write in this area to be completed by city or town official city or town: permit/license # nBuilding Department pLiceosingBdard ' — check if immediate response is required pSelectmen's Office [3Health Department contact person: phone #; nOther (revised Il95 PIA) I CO m m C m m 0 i v, y C. CA Cl) Z C4 CL o F, r � � o CL = y V O CD o p CL � o cc r♦ CTC =r % d CD CCD O CCD mm P. C CD CA y o CO CD S v CA O CD Z o CD 0 CD C C E -% O O �•N O Q h n co < o m y O . m 00 m C7 m C9 d0 M cm Z N ?-a N• 0)CD N CL m =r m n=rof O y m -4OaN p N Oh: m Z 7 7.00IF m: m0. 1 = •-► 0 o Z� n: ri C OCD NO: C N " CL ao • r = �m Z ^ VJm m N ACD C. d l T y N o. C V :O Cn CD ar ►Q N p, m N • r^ ca N V/ � 1 i•�� O d fmq r•r 3 m 0 C 0 n � �o cn d CD top � s CD d �C=L m ro: _ c c o Ej •n o °�'� x a w oCa o w r -w :v n 77 'TJ GQ � c o a C7 0 C) rt o C y 7Ctv O n 7d r z 0 O C N2 4899 This certifies that te....... �. N OFNORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ... `.. , r!f :::<•^^-" --�`' plumbing in the buildings of 7_�.-.- .................. at : �� ...... �� ?�� ?- .6'J�North Andover, Mass. P s � Feei.b....... Lic. No .......... ..... '`: ?; .............. PLUMBING:INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N2 4399 �e S cmus This certifies that Date . .. .. ... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ........................... -� I—A - has permission to perform .... A ..............kz ---T.................. plumbing in the buildings of /k�/*`//`./�?. .................. at ./—. . " . . �/ . . L'�' S / t-. - -. . . ... ................ . . �. North Andover, Mass. Fee. 3 613.. Lie. No. 1G ... ....... ....... )PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer -MASSACHUSETTS UNIFORM APPLICATION FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location L { qt New Z Renovation ❑ Replacement ❑ X13 �r 1't,M1 In 0 1 - ' i TI: i Date `# Permit # Amount L%3 Plans Submitted Yes ❑ No ❑ (Print or type) Check one: Certificate Installing Company Name Cl–� tf ( < t a _ ❑ Corp. Address c t $ 1 c �„ k s b u f/ ElPartner. Business Telephone ( 7 `F — 1 o i 3 Firm/Co. q Name ofLicensed Plumber. G t –i !G -- Insurance -Coverage: InsuranceCoverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all ofthe details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Cod a] ChapterLaws. own R,OVM (OFFICE USE ONLY Type of Plumbing License n4e7NUMDer Master Journeyman ❑ 3 4 u 8 Date.. l�:. t..`.� ..`..`..... NORTH TOWN OF NORTH ANDOVER pyto ,e1tip� p PERMIT FOR GAS INSTALLATION This certifies that .. !k.,.'./..:r.......................... . has permission for gas installation in the buildings of' . j.......... . at .... f 4 �.... .'. S C./� � .. Itc-, ;°North Andover, Mass. Fee ...Lic. No.. ....... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATON FOR PERIVITT TO DO GAS or print) wvrcIH ANDOVER, MASSACHUSETTS Building Locations `-O+ -7 T1 lkq Owner's Name Date 19 % New Renovation F-1ReplacementF-1PI san SubmittedLPJ ❑ Permit 9 i Amount S (Print or type) Check one: Certificate Installing Company Name G t r i 1C �. e rl Corp. C Address � t--�wr<- rpt cS � \ -t �.�, \ s � u t' y Partner. /Yt a. , , i b-? 6 Business Telephone g -z g cr —( p 1 3 ® Firm/Co. Name of Licensed Plumber or Gas Fitter 61 — e r lit INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stdclas Code arA Qapter;42 of the General Laws. By: Tide C ityiTuwn APPROVED (oFr•ici- USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 4-7 ❑ Gas Fitter :ce,: e Numoe: Nlaster ❑ loumeyman R D FLO OR IMM (Print or type) Check one: Certificate Installing Company Name G t r i 1C �. e rl Corp. C Address � t--�wr<- rpt cS � \ -t �.�, \ s � u t' y Partner. /Yt a. , , i b-? 6 Business Telephone g -z g cr —( p 1 3 ® Firm/Co. Name of Licensed Plumber or Gas Fitter 61 — e r lit INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stdclas Code arA Qapter;42 of the General Laws. By: Tide C ityiTuwn APPROVED (oFr•ici- USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 4-7 ❑ Gas Fitter :ce,: e Numoe: Nlaster ❑ loumeyman N° 2291 Date.......// /—" // ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....G.%1..!. ........ 4-7 ..��'<...........��" �............. has permission to perform ...... / V `e w / / wiring in the building of ... ..`. f .. u a .at 1 ! ..7.... c�` . (n/. P'!{l�i�... /. V ..... , . Orth Andover, ass. Fee.. ee ../ Lic. No. f..J 3........... ..... ........ ......... ....... LECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer aaa'i TxECOMMONWEALTHOFMASSAChUSE77S Office Use only 1 l DEPARTAMWOFPUBLICS9FM Permit No. (' (j . a r,)o /_ l 4-7 BOARD 0FMEPREVEM0NRE M770MV7CW 120Occupancy & Fees Checked PI�CATTONFOR PERMIT TO PERFORMELECTRICAL-WORK ALL WORK TO BE PERFORMID IN ACCORDANCE WITH THE MASSACEIUSSTS ELECTRICAL CODE, S2% CMR I2:OO (PLEASE PRINT IN 11VK OR TYPE ALL INFORMATION) Datg���""�� `� Town of North Andover To the Inspector of Wires: The undersigned anolies for a hermit to perform the electrical work described below. Location (Street J Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) Purpose of Building _1f e4,,, Utility Authorization No. 0 0 a Existing Service Amps Volts Overhead Q Underground M No. of Meters New Service e,,:;200 Amp/-'20/A/o Volts Overhead Underground © No. of Meters Number of Feeders and Ampacity .O Location and Nature of Proposed Electrical Work Ni?. of Lighting Outlets No. of Hot Tubs No. of Transformers Total I KVA No. of Lighting Fixtures Swimming Pool Above 1:1ound Below 171 Generators KVA �0 and No. of Receptacle OutIeJ1 1 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets q No. of Gas Burners ALARMS No. of Zones No. of Ranges No. of Air Cond. TotalFIRE Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained / Detection/Sounding Devices Local Municipal a Other No. of Dryers Heating Devices KW Connections N(i. of Water Heaters KW No. of No. of .0 Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER • - — htstaaiwcov Pt]suatbthetegt>itanat$ofMasMdW9&CknualLaws limeaa=tLdithr&=Pb yuidmgComp * CovwdWcrilsWmwrt leViva YES © � NO a IImew&nibdvalidpttxfof§mm1o1keOfoe YES Fn No r IfycubmedriwdYES,pkm.ff icatethetAxofwvaaWbydxdazgthe bm Il�ISURANCE� BOND 01I -ER ® ftmSpacify) i ExpiratlonDt�e WoIkoStat �- 3_p 0 FIRMNAME hpodwD*RaVesWd 10, V"oflEkcttical Weds $ Rao Final LioatseNa BttsitmTel.Na kS� � C!? AILTelNa 5SA OWNERSINSURANCEWANFR;Iamawaa dgtheLioaise t4einstraneoaaagecrilss a�ialegttivataita5tt urtedlryMassadase�isGatiaratlaws atdiomys�l maiftpan*Wpfiatmwaiussdgstmtms►uit. (Please check one) OwnerAgent Q Telephone No. PERMIT FEE No 1991 Date../ ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that''�/&--6' ........................................................................................... has permission to perform ....... ............................................................ wiring in the building of ...... ........................ ... ......................................... at'tNorth Andover, Mass. Fee. ..."i ........ Lic. No. ...... . ....... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TI-IEL'QA'. Oi';KIFALTHOFAL4.S►S"f%CRUS'L+'M Office Use only DER4RVW62VT0FPUBL1CS4= PermitNo.. BOARD OFIMEPREVEMONREGM4770NS527CNR 12.00 Occupancy & Fees Checked APPLICATTONFORPERIV.IITTOPERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CIvM 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /I d Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. - PARCEL 1/ a Location (Street S Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes= No (Check Appropriate Box) �) z Purpose of Building 'rfjYJ u'/ Cgv- Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service/'6� Amps / /r„iYaVolts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of LightingFixhues Swimming Pool Above- M Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumcm FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No.. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other_ No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER - w r n: 1 eu a n6 I.qr`•.1.I a •n •1•.c • patio . O :r., a I, u•el t I :r 4 0 • Ihm%bn*dvandproof,cfsa=tDthe0ffim YES [ NO • •r.•r:• •r••u11vc n rr••":.• • •:•a .•1- i WctkALt 116•:.1,•.1 at `e w`I:• `• g X1:1 i 1 • `:1:11:. • •: FRNeWvE L.- r ..13111• ��� / ..- • • _I OATUZNSURANUEWATVEI` Iarnawxediat�rl-imise doesr 1 - 16 .1 ...• =g • ti a •6.1 ale 1 2n . :• n :• • ssa 16:Ii. :r. andfjoirrrf`ig . 1 1 • • 1 1 •:/ aFF`r 1.! .{ w this :• II : : I (Please check one) Owner gen Telephone No. PERMIT FEE $ tgnature ot owner or gent