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HomeMy WebLinkAboutMiscellaneous - 143 CARTER FIELD ROAD 4/30/2018 �, i i i k ��� _� t Deems, Maura From: Kate Foster <kate@ecfplumber.com> Sent: Friday, August 22, 2014 3:29 PM To: Deems, Maura Subject: FW: Gas Permit Cancellation Maura, We would like to cancel gas permit [9435] for pool heater at 14rt 3 Carter Field Road, North Andover MA] eu v IR9� ( - - Thank oupods v . Kate Foster Eric C. Foster Plumbing&Heating 145 Stedman Street Chelmsford, MA 01824 Phone: 978-256-5976 Fax: 978-452-4711 www.ecfplumber.com 1 Date... .. ................................. OF TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION E �18sAC•�g�4 i This certifies that ..E-12, '.....0 �S� - ......................................................... has permission for gas installation . ......................... in the buildinsof..... .R S„'!` .: ` ^►.......................................- ...................... T at.....�` ?�...........f +rz-C - �. t ..." Com.... North Andover, Mass. Fee. '....... Lic. No.rJ..i3.11............ "J,, :''..................................................... GASINSPECTOR Check#3)6 7- 4 3 5 ...435 -CN- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING fWORK oq CITY 1� , CAI?X _ MA DATE (n PERMIT# y JOBSITE ADDRESS OWNER'S NAME (,l � OWNER ADDRESS TEC: FAX PPE OT OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES D NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER --- FIREPLACE � C FRYOLATOR a �....... w..w FURNACE w..._ GENERATOR [ GRILLE INFRARED HEATER �- LABORATORY COCKS �, MAKEUP AIR UNIT i OVEN a POOL HEATER ROOM 1 SPACE HEATER R .. ROOF TOP UNIT i � TEST - mm UNIT HEATER .��. UNVENTED ROOM HEATER 1 i WATER HEATER OTHER , 3 INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S 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 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 complia with al PedinB—nLarovlsion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` PLUMBER-GASFITTER NAME Eric C.FosterLICENSE#9311 SIGNATURE MP El MGF El JP JGF LPGI CORPORATION ,- # PARTNERSHIP # LLC # 3092C COMPANY NAME:Eric C.Foster &Heating LLC �ADDRESS 145 Stedman Street CITY Chelmsford STATEi MA ZIP 01824 TEL 978- C FAX 978-452-4711 CELL EMAIL �u The Commonwealth of Massachusettst� Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Eric C.Foster Plumbing&Heating LLC Address: 145 Stedman Street City/State/Zip:Chelmsford, MA 01824 Phone#: 978-256-5976 Are you an employer?Check the appropriate box: Type of project(required): I.El 4.I am a employer with I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'� 9. ❑Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑✓ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entitles have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Guard Insurance Group Policy#or Self-ins. Lic.#: ERWC321586 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci under the airs d enaldes ofperjury that the information provided above is true and correct Si ature: Date: t:' Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 0-MMOU .. LTH,OF^ 0Hi1S S. DIM[0191= - . r' SHEET .t TAL ORKER j'.SSIAS THE Fot.bW1 Nt <L I£ENSE AS„ 4AS7 ER t11VRE- TR#.CTE t7" R#C -FOSTER .84 DEfl{T R13 W:1rSfif(3RD 01$86 1359 :14473 b a: OMMONWEALTH OF Miai&USE7TS • Ma"Te BQARD QF. . , PLUMBERS. AttD t ASF I TTERS ISSUES TWE. FOLLOWINIC 'L'11rENSE L I CE.XStt? -`A A JOURNEYMAN PLUMBE•� f¢ FOSTER rn ,o Pfl 80X 199. l 7 WSTFORD ISA 01886 0007 174�i 05%01J1b:: 204282 Lei, !EOMMONUVEALTH.OF M:.SACHI)S S ; s • • - • • BOAR OF PLUMBERS"At GASP 1TT;ERS ISSUES ?Hf <Ft?LLOW IMG L>'ICENS.E '. kCt:t SEb; 'AS ARASTER PLUMBER, ' ER t;G f OSTER JA Pfl;BitX 1g9j 1�tE3 F ORD IMA 01&8G-0007` ' 2.04283 :gi>tCOMMONWEALT f.OF MASSA CHl3SE.TC-S •lun, •1"1012W• • MIMM B1:JA�©-flF P LUMOt. S. :W G'AS F a TT E S ISSUES THE ..FaLLt3k41C°EN.SE SIT* 4S.:V:PLUMS I NG''L`ORP EER::II; t FOSTER E#+`1C C - FOSTER PLUMBING �'.,HEATIw Pt? Bflx 99 W>r'STFbRD t ,01886 30 ol 20'4280 1 LM Town of North Andover Your permit has been sent back to you for the following reasons: 1) Check amount incorrect 2) No copy of current Ii e 3) Insurance Binde not on fi or expired / 4) No Workers' Compensa ion Insurance Affadavit Form Please call with any questions 978-688-9545. Workers'Compensation Form and Schedule of Fees can be found on the Town of North Andover Website under Building Department. I i Date...... .#................ OF NopTM�ti TOWN OF NORTH ANDOVER O � T PERMIT FOR GAS INSTALLATION '��''°��;.ems•"t<°j HU This certifies that .49s' '.j. /.�............. ................................. has permission for gas installation ....f mll...hee�tw..M............................. inthe buildings of.................................................................................................................... at... Ij................................. .North Ando er, Mass. Fee 3MPO... Lic. No. ...q�...�......... ...... ...;............. �////// ........................ (r,AWINSPECTOR/ Check# F4 9503 i ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER MA DATEAUGUST 29 2014 PERMIT# 056AT JOBSITE ADDRESS 1143 CARTERFIELD OWNER'S NAME FRANK MACMILLAN GOWNER ADDRESS FRANK MACMILLAN TE 978-687-4121 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL _ RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT:El PLANS SUBMITTED: YES[] NO APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER - FIREPLACE FRYOLATOR FURNACE GENERATOR _ GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOLHEATER 1 _ ROOM/SPACE HEATER _ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _ OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required b Y Chapter 142 of the q P Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT _ CHECK ONE ONLY: OWNER ® AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in is ce with a rti t ov ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JOHN MARSHALL LICENSE# 778 SIGNATURE MP® MGF® JP® JGF® LPGI CORPORATION®# PARTN SHIP®# LLC # COMPANY NAME: EASTERN PROPANE GAS =ADDRESS 131 WATER ST. CITY DANVERS STATE MA ZIP 01923 TEL 1-800-322-6628 FAX CELLI EMAIL The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 ,veJp www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Print Le ibl Applicant Information Eastern Propane Gas, Inc Name(Business/organization/Individual): — Address: 131 Water St .978-750-6500 •Danvers, MA 01923 Phone#. City/State/Zip. Are you an employer? Check the appropriate box: Type of project(required): 1.Q I am a employer with 45 4• ❑ I am a general contr7nd5 ❑New construction have hired the sub-cemployees (full and/or part-time).* �, Remodelinlisted on the attache ❑ g 2.❑ I am a sole proprietor or partner- These sub-contractors have g. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. E] Building addition comp. insurance.$ o workers' comp. insurance 10.❑ Electrical repairs or additions � and its required.] 5. ❑ We are a corporation a [] officers have exercised their 11.❑ Plumbing repairs or additions 3. I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL myself. Roof repairs c. 152, §1(4),and we have no Gas Fitting&Fuel Supply t 9 insurance required.] employees. [No workers' 13.0 Other comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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. Insurance Company Name:Safehold Special Risk, Inc � Policy#or Self-ins. Lia #: EWGCD000080614 Expiration Date:03 1 15/2015 Job Site Address: 14 3 Cc,✓i e,.-�,,p I d (,5+ City/State/Zip:(lo,.A IgL6,daue, ✓ .; Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 0666 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I dol:ereby certify under the pains and penalties of perjury that a information provided above is true and correct. Si ature: Date: Phone#: - 6500 FFL nly. Do not write in this.area,to be completed by city or town official. n: Permit/License # hority(circle one): nt 3.Ci !Town Clerk 4.Electrical Inspector S.Plumbing Inspector health 2.Building Departure tYson: Phone#: NH477156 A DATE(MNYY) CERTIFICATE OF LIABILITY INSURANCE 3/13/20142014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Donna Desharnais NAME: Commercial Lines-800-990-7465(CA DOI#OG13561) PHONE603-559 1361 FAX 855-529-7684 A1C No Ext: A/C No): Safehold Special Risk,Inc. E-MAIL — i h donna.desarnas safehold.com ADDRESS: donna,desharnais@safehold.com Commerce Way,Suite 230 INSURER(S)AFFORDING COVERAGE i NAIC# Portsmouth,NH 03801 INSURERA: HDI-Gerling America Insurance Company 41343 INSURED INSURER B Eastern Propane Gas, Inc. INSURER C P.O.BOX 1800 INSURER D: INSURER E: Rochester,NH 03866 INSURER F COVERAGES CERTIFICATE NUMBER: 7441964 REVISION NUMBER: See below 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 ADDL SUBR: i POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A I X COMMERCIAL GENERAL LIABILITY I EGGCD000080614 3/15/2014 3/15/2015 EACH OCCURRENCE S 2000000 X DAMAGE TO RENTED CLAIMS-MADE OCCUR I I i I PREMISES IEa occurence) l$ 250000 i � ; MED EXP(Any one Peron) i S 5,000 I I PERSONAL&ADV INJURY I, 5 2C00000 i GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE $ 2000000 i� i —�I POLICY jEr„07 j LOC j PRODUCTS-COMP/OP AGG S 2000000 OTHER: S A I AUTOMOBILE LIABILITY EAGCDO00092214 3/15/2014 3/15/2015llaal:IIE SINGLE NT"ert s 2.000,000 X I BODILY INJURY Per person) S ANY AUTO I ( P ) 1I ALL OWNED I SCHECULED I I BODILY INJURY(Per accident)I S AUTOS AUTOS I NON-OWNED I PROPERTY DAMAGE � r` HIRED AUTOS iJ!AUTOS i fPeraccid=nt ' S �{ f S I UMBRELLA LIAR I I `.--1 OCCUR EACH OCCURRENCE I$ EXCESS LAB I CLAIMS-MADE! ` I AGGREGATE I S ' + I I I I DED I RETENTION S I 1 S A WORKERS COMPENSATION PER OTH- EWGCD000080614 03/15/2014 i 03/15/2015' X STATUTE ; E.R AND EMPLOYERS'LIABILITY j ANY PROPRIETORiPARTNER/EXECUTIVE Y/N I NT 1,000,000 OFFICER/MEMBER EXCLUDED? N I N/A' ''. E.L.EACH ACCIDENT S (Mandatory in NH) �I o 1,000,000 E.L.DISEASE-EA EM. S If yes,describe under r DESCRIPTION OF OPERATIONS belo•.vI E.L.DISEASE-POLICY LIMIT S 1,000,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of coverage CERTIFICATE HOLDER CANCELLATION Any city/town in Massachusetts SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MA AUTHORIZED REPRESENTATIVE � J I The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) iThls-e F( to rnlams ce fimle 7. 1310 7/1X20111 4 r ' Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS : BOARD OF;. PLUMBERS AND GASFITTERS ' ISSUES';THE FOLLOWING LICENSE LI CN ED 'AS ANLP GAS INSTALLER • e 2 JOHN F MARSHALL _ . t 47 HOBART'STREET �� J� DANVERS. MA 01923-1943' 778 &/01/16 8548 ............ OF NOH7iy,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING sS,CHU This certifies that ... ..... ... .............................. has permission to perform ........ ........... ....................................... wiring in the building of.... .. . ................. ml al .. ............................................................... . .. .......... .... at .............. ...eA4......P.J.-, North Andover,Mass. .. .. ...... ...... . . Fee......... .......n...........Lic.Non� ... ..M.Ds . ......... ..................... ... . . EL TRICAL INSPECTOR -Check# l�Ommon�vYRUiL o�///ivaaciu�le�1 Official Use Only ' c� Permit No. J _- — ..UePartmenf o��ira�arvica9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR Pr EJRMIT TQ PERFORM ELECTRICAL WORK All work to be performed in accrorddnce with the Massachusetts Electrical Code( EC) 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION)' Date: Cityor Town of: Gy411 &4LAt-lL 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) I'!� 0 A r TGY Owner or Tenant OIC /-4 k7 , FrA Q ,� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building 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: 17 Completion of the following!able 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 a No.of Luminaires Swimmin Pool Above ❑ In- Elo.o Emergency Lighting g 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.o Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons K o.oSelf-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Co nicnnenctioape El other Con No.of Dryers Heating Appliances KW Security Systems: rY 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 a ecommuntcahons Winn No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. s INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑✓ BOND ❑ OTHER ❑ (Specify:) certify,under the pains and penalties of perjury,that the informati n on this application is true and complete. FIRM NAME: Village Electric Inc LIC.NO.:9163A Licensee: Anthony P. DelPapa Signature LIC.NO.:21861E (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:978-256-4845 Address: PO Box 4044 Chelmsford, MA 01824 Alt.Tel.No.: *Per M.G.L.e. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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 E-]owner's a ent. ❑ Owner/Agent Signature Telephone No. PERMIT FEE.$-j a 4 ' c$ x cr kblIx f \ \q u. ee a t �... e tei, �. Y � w E, CTR, x/ i v'H BOX 4044 15 SOUTH CKLMSFD, MA 01:82,4 -0-61 . t. .: 9163 A 07/31 /167 " *f4m E V COMIMONWEA.LTH, OF MASSA,CH. °g e h m , Md • k r ARD F �e= LEC NAS a ' 3 + OW I UE �: ;. U gN n AS A REG JOURNEYMAN ELECTRICIAN T DELPAPA s , x , i BOX .14044 �. 4 0 6 4 4 . �• �'• LA 0 A few 6 13 2 7/3 11 i A6 K s .a� m I DATE (MMIDDIYYYY) ACORO° CERTIFICATE OF LIABILITY INSURANCE 06/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: (978)562-5652 Fax: 978-562-7120 NAME' Welsh&Parker Insurance Agency,Inc. WELSH&PARKER INSURANCE AGENCY,INC. PHONE FAX Ac No Exl: 978 562-5652 aC Ne; 131 COOLIDGE STREET,SUITE 100 978-562-7120 E-MAIL HUDSON MA 01749 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA Peerless Insurance Company INSURED VILLAGE ELECTRIC INC INSURERD PO BOX 4044 INSURER C 4 KIDDER ROAD,UNIT#1 INSURER D: CHELMSFORD MA 01824 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 60070 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSIJRANCE 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 ADD'L SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DD MMIDD A GENERAL LIABILITY CCP8795902 08/01/13 08/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50,000 PREMISES(Ea omurence) $ CLAIMS-MADE 51 OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 f N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- El POLICY7 JE LOC $ A (Ea aAUTOMOBILE LIABILITY BA8795702 08/01/13 08/01/14 COMBccident)ident)INED NGLE LIMIT $ 1,000'000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED NSCHEDLILED AUTOS BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGEX HIREDAUTOS $ AUTOS (per accident) $ A UMBRELLA LIAR X OCCUR CU8796702 08/01/13 08/01/14 EACH OCCURRENCE $ 2,000,000 EXCESS LIARCLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ A WORKERS COMPENSATION WC8796202 08/01/13 08/01/14 X TORYTLITH MITS OER $ AND EMPLOYERS' LIABILITY ANY PROP YI RIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? FN] NIA E.L.DISEASE-EA EMPLOYEE $ 5500,000 (Mandatory in NH) If DESCRIPTION OF E.L.DISEASE-POLICY LIMIT $ 500,000 ' DESCRIPTION OF OPERATIONS below I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) r CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: Wiring Inspector Mildred G. Medina ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Date... © ...y ..>..3..... � pORTM °ft"'°.•_�"° TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �,SSACMUS� This certifies that ................ (1M bot ......................................................................... has permission to perform ...1��,e w /4v w . ....................... .................................. wirinz in the building of T�1� Ler .4 at............................................................................,North Andover,Mass. C l� - Fee.........7 3 RS� ...............................� y ELECTRICAL INSPECTOR j Check # !bi V b I 4782 TBE COMMONME4UHOFMASSACHUSE77S Office Use Use only — DEPAR7A1ENT0FPUB11CS4FETY Permit No. !-Z 6 BOARD OFFNEPREVUMONREGUTATIONS527CAR 12M Occupancy&Fees Checked, �.. APPLICATTONFOR PERMIT TO PERFORMELECTRICAL WORK j ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datl Town of North Andover To the�Inspectcttor of Wire: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) �� may` 6 6 C�-, Owner or Tenant j (�� Owner's Address til c c.L- Is this permit in conjunction with a building permit: YesNo r--J (Check Appropriate Box) Purpose of Building 126S( t /--n r-t Utility Authorization No. Existing Service 'Amps� Volts Overhead Underground No.of Meters New Service L-.)(;, Amps /4.,V 2(4,-Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (,Jl a-F k o JSE No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained •� Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER' y kMrMWCovaage.RuwaittothelegzmlaZofMassadxmMGaxaalLaws IhaveactnartLiabi}nyhnluarloePblicyinch>dmgCornplebe Coveageoritswbgmroalepvalat .YES NO IbavesulnriwdvandploofofsamtotheOffim YES � ) IfyoubavecheckedYES plea9eh ic&thetAkofeovrageby drcidTdr `J INSURANCE BOND MIER a (P1v<meSpetafy) Fxlm-atialDate EsWna1ed ValueofEkcftiCal Wolk$ WotktoStart �`� »�� hmpectionDateRequested Rough Final Sigped undaTie Rtalhes of petjuT.. ERMNAME LzL-U'�t ttiJ. UcawNo. Al Kt l b Signa><a►e qLLiCUMNo 1�—'- Z7 nn Busk e Tel.No. 3-67-- L) Z-O AttTelNo. 9� 37s o�bZ_ OWNERIs INSURXNCEWAIVER,IamaWaietlratthel-mmedoesnothavetheimtnanxcovaageoritsaksmitalequivalatasregLmudbyMa%adnrgzCvlawLam - andthatmysignattueonthispamitaWhcawnwaiNesthistequitar t (Please check one) Owner Agent Telephone No. PERMIT FEE Sig nature o . caner or Agent Z The Commonwealth of Massachusetts Z y Department of Industrial Accidents z m%9, Office of investigations —693 Boston, Mass. 02111 5�1b Workers'Compensation Insurance Affi Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name- - - Address Ci Phone#: Insurance.Co. Policv# Company name: Address City Phone#: Insurance Co. Policv# 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'imprisomnent.as_weU_as-civil.Renaltiesin-thelmn-dA-STOP WDRK ORDJER md-a.fine_of($1D0_W)_atlayagainst_me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 7 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct ° Signature Date C Print name Pbone.# Official use only do not write in this area to be completed by city or town officiar City or Town Permit/Licensin-g. Building Dept Check if immediate response is required L] Licensing Board p Selectman's Office Contact person: Phone#: o Health Department Other r r Fire Protection by Computer Design TRI-STATE SPRINKLER CORP. P.O. BOX 968 DERRY NH 03038 603-647-0600 Job Name 143 CARTER FIELD ROAD Building SINGLE FAMILY RESIDENCE Location NORTH ANDOVER, MA System 1 Contract Data File TOMZ.WXF Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 TRI-STATE SPRINKLER CORP. Page 2 143 CARTER FIELD ROAD Date 9/1/03 HYDRAULIC DESIGN INFORMATION SHEET Name - 143 CARTER FIELD ROAD Date - 9/1/03 Location - NORTH ANDOVER. MA Building - SINGLE FAMILY RESIDENCE System No. - 1 Contractor - TARA LEIGH DEVELOPMENT Contract No. - Calculated By - CHRIS Drawing No. - FP lofl Construction: (X) Combustible ( ) Non-Combustible Ceiling Height OCCUPANCY - RESIDENTIAL S Type of Calculation: ( )NFPA 13 Residential ( )NFPA 13R (XX)NFPA 13D Y Number of Sprinklers Flowing: ( )1 (X)2 ( )4 ( ) S ( )Other T ( )Specific Ruling Made by Date E M Listed Flow at Start Point - 18 Gpm System Type Listed Pres. at Start Point - 18.4 Psi = (X} Wet ( ) Dry D MAXIMUM LISTED SPACING 20 x 20 ( ) Deluge ( ) PreAction E Domestic Flow Added - 0 Gpm Sprinkler or Nozzle S Additional Flow Added - 0 Gpm Make CENTRAL Model LFII FLUSH I Elevation at Highest Outlet - 18 Feet Size 1/2" K-Factor 4.2 G Note: Temperature Rating 162 N Calculation Gpm Required 36.3 Psi Required 83.133 At Test Summary C-Factor Used: Overhead 150 Underground 150 W Water Flow Test: Pump Data: Tank or Reservoir: A Date of Test - 8/29/03 Rated Cap. Cap. T Time of Test - 10:45AM @ Psi Elev E Static (Psi) - 92 Elev. R Residual (Psi) - 70 Other Well Flow (Gpm) - 1350 Proof Flow Gpm S Elevation - 0 P Location: CARTER FIELD ROAD P L Source of Information: RESIDENTIAL SPRINKLER G0; Y I Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 TRI-STATE SPRINKLER CORP. Page 3 143 CARTER FIELD ROAD Date 9/1/03 City Water Supply: Pump Data: C1-Static Pressure: 92 PSI C2-Residual Pressure: 70 PSI C2-Residual Flow: 1350 GPM 150 D1-Elevation: 7.796 PSI D2-System Flow:36.3 GPM 140 D2-System Pressure: 83.133 PSI Hose ( Adj City ) :0 GPM 130 Hose ( Demand ) :0 GPM P 120 Safety Margin: 8.839 PSI R 110 E 100 1 S 90 2 S 80 C2 U 70 R 60 E 50 40 30 20 10 200 400 600 800 1000 1200 1400 1600 1800 FLOW ( N 1.85 ) Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 TRI-STATE SPRINKLER CORP. Page 4 14'3 CARTER FIELD ROAD Date 9/1/03 Fitting Legend Abbrev. Name A Generic Alarm Va B Generic Butterfly Valve C Roll Groove Coupling D Dry Pipe Valve E 90' Standard Elbow F 45' Elbow G Gate Valve H 45' Grvd-Vic Elbow I 90' Grvd-Vic Elbow J 90' Grvd-Vic Tee K Detector Check Valve L Long Turn Elbow M Medium Turn Elbow N PVC Standard Elbow 0 PVC Tee Branch P PVC 45' Elbow Q Flow Control Valve R PVC Coupling/Run Tee S Swing Check Valve T 90' Flow thru Tee U 45' Firelock Elbow,, - V 90' Firelock Elbow W Wafer Check Valve X 90' Firelock Tee Y Mechanical Tee Z Flow Switch i Computer Programs by H dratec Inc. Route 111 Windham N.H. USA 03087 i TRI-STATE SPRINKLER CORP. Page 5 143 CARTER FIELD ROAD Date 9/1/03 Unadjusted Fittings Table 1/2 3/4 1 1 1/4 1 1/2 2 2 1/2 3 3 1/2 4 A 7.7 21.5 17.0 B 7 10 12 C 1 1 1 1 1 1 1 1 1 1 D 9.5 17 28 E 2 2 2 3 4 5 6 7 8 10 F 1 1 1 1 2 2. 3 3 3 4 G 1 1 1 1 2 H 1 1.5 2 2 3 3 3.5 3.5 I 2 3 4 3.5 6 5.0 8 7 J 4.5 6 8 8.5 10.8 13 17 16 K 14 14 L 1 1 2 2 2 3 4 5 5 6 M 2 2 3 3 4 5 6 6 8 N 7 7 7 8 9 11 12 13 O 3 3 5 6 8 10 12 15 P 1 1 1 2 2 2 3 4 Q 18 29 35 R 1 1 1 1 1 1 2 2 S 4 5 5 7 9 11 14 16 19 22 T 3 4 5 6 8 10 12 15 17 20 U 1.8 2.2 2.6 3.4 V 3.5 4.3 5 6.8 W 10.3 X 8.5 10.8 13 16 Y 2.0 4.0 5.0 6.0 8.0 10.5 12.5 15.5 22 2 2 2 2 3 4 5 6 7 8 10 5 6 8 10 12 14 16 18 20 24 A 17 27 29 B 9 10 12 19 21 C 1 1 1 1 1 1 1 1 1 1 D 47 E 12 14 18 22 27 35 40 45 50 61 F 5 7 9 11 13 17 19 21 24 28 G 2 3 4 5 6 7 8 10 11 13 H 4.5 5 6.5 8.5 10 18 20 23 25 30 I 8.5 10 13 17 20 23 25 33 36 40 J 21 25 33 41 50 65 78 88 98 120 K 36 55 45 L 8 9 13 16 18 24 27 30 34 40 M 10 12 16 19 22 N 0 P Q 33 R S 27 32 45 55 65 76 8^. 98 109 130 T 25 30 35 50 60 71 81 91 101 121 U 4.2 5.0 5.0 V 8.5 10 13 W 13.1 31.8 35.8 27.4 X 21 25 33 Y Z 12 14 18 22 27 35 40 45 50 61 Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 TRI-STATE SPRINKLER CORP. Page 6 143 CARTER FIELD ROAD Date 9/1/03 Hyd. Qa Dia. Fitting Pipe Pt Pt Ref. "C" or Ftng's Pe Pv ******* Notes ****** Point Qt Pf/UL Eqv. Ln. Total Pf Pn 1 18.02 1.109 10.000 18.400 K Factor = 4.2 to 150 2 18.02 0.0542 10.000 0.542 Vel = 5.985 2 18.28 1.109 2E 3.962 32.500 18.941 K Factor = 4 .2 to 150 2T 9.906 27.735 3 36.30 0.1979 60.235 11.919 Vel = 12.057 3 1.109 lE 3.962 9.000 30.857 to 150 3.962 3.898 4 36.30 0.1979 12.962 2.565 Vel = 12.057 4 1.109 lE 3.962 12.000 37.319 to 150 2T 9.906 23.773 5 36.30 0.1979 35.773 7.078 Vel = 12.057 5 1.109 2E 3.962 14.000 44.396 to 150 1T 9.906 17.829 3.898 6 36.30 0.1979 31.829 6.298 Vel = 12.057 6 1.049 3E 2.000 21.000 54..590 to 120 2T 5.000 16.000 TASR 36.30 0.3920 37.000 14.505 Vel = 13.476 TASR 1.049 lE 2.000 6.000 69.091 to 120 2.000 2.599 BASR 36.30 0.3920 8.000 3.136 Vel = 13.476 BASR 1.049 2.000 74.825 to 120 5.866 Fixed loss = 5 BKFL 36.30 0.3920 2.000 0.784 Vel = 13.476 BKFL 1.245 1G 40.000 81.475 to 150 1T 5.492 5.491 -3.465 TEST 36.30 0.1126 45.491 5.124 Vel = 9.567 36.30 83.134 K Factor = 3.98 Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 f'[,ICO Flow ControlTyco Fire Products Technical Services:Tel:(800)381-9312/Fax:(800)791-5500 Series LFII Residential Flush Pendent sprinkler 4.2 K-factor General standards of any other authorities hav- ing jurisdiction. Failure to do so may Description Impair the integrity of these devices. The owner Is responsible for maintain- The Series LFII (TY2284) Residential Ing their fire protection system and de- Flush Pendent Sprinklers are decora- vices in proper operating condition. s tive, fast response, fusible solder The installing contractor or sprinkler sprinklers designed for use in residen- manufacturer should be contacted tial occupancies such as homes, relative to any questions. s apartments, dormitories, and hotels. r' When aesthetics is the major consid- s'pr►nkler/Mode1 �. eration, the Series LFII (TY2284) should be the first choice. Identificationg,. The Series LFII are to be used in wet pipe residential sprinkler systems for Number one-and two-family dwellings and mo- bile homes per NFPA 13D; wet pipe SINTY2284 residential sprinkler systems for resi- dential occupancies up to and includ- ing four stories in height per NFPA Operation 13R;or, wet pipe sprinkler systems for Data P the residential portions of any occu- The sprinkler assembly contains a Approvals: pancy per NFPA 13. P y small fusible solder element.When ex- The Series LFII (TY2284) has a 4.2 UL and C-UL Listed. posed to sufficient heat from a fire,the (60,5) K-factor that provides the re- Maximum Working Pressure: solder melts and enables the internal quired residential flow rates at reduced components of the sprinkler to fall pressures,enabling smaller pipe sizes 175 psi(12,1 bar) P 9 P P away. At this point the sprinkler acti- and water supply requirements. Discharge Coefficient: vates with the deflector dropping into The flush design of the Series LFII K=4.2 GPM/psis/2(60,5 LPM/barl/2) its operated position (Reference Fig- (TY2284) features a separable es- Temperature Rating: ure 1C),permitting water to flow. cutcheon providing 3/8 inch (9,5 mm) 1620F/72°C vertical adjustment. This adjustment Vertical Adjustment: reduces the accuracy to which the pipe 3/8 inch(9,5 mm) drops to the sprinklers must be cut to help assure a perfect fit installation. Finishes: Sprinkler and Escutcheon: The Series LFII (TY2284) has been White or Chrome designed with heat sensitivity and water distribution characteristics Physical Characteristics: proven to help in the control of residen- Body . . . . . Bronze tial fires and to improve the chance for Deflector. . . Copper occupants to escape or be evacuated. Button . . . . . . . . . . . . Brass Orifice Seal . . . . . . . . . Copper WARNINGS Heat Collectors . . . . . . . Copper The Series!FN(TY2284)Residential Flush Pendent Sprinklers described herein must be installed and main- tained in compliance with this docu- ment, as well as with the applicable standards of the National Fire Protec- tion Association, in addition to the Page 1 of 4 JUNE, 2002 TFP420 " Page 2 of 4 TFP420 Minimum Flow N and Minimum Flow(e)and Installation Maximum Maximum Residual Pressure Residual Pressure Coverage Spacing For Horizontal Ceiling For Sloped Ceiling The Series LFII (TY2284) must be in- Area(a) Ft. (Max.2 inch Rise (Max.8 Inch Rise stalled in accordance with the follow- Ft,x Ft. (m) for 12 Inch Run) for 12 Inch Run) ing instructions: (m x m) NOTES The Protective Cap is to remain on the 162°F/72°C 162°F/72°C sprinkler during installation until the ceiling installation is complete. The 12 x 12 12 13 GPM(49,2 LPM) 22 GPM(83,3 LPM) Protective Cap must be removed to (3,7 x 3,7) (3,7) 9.6 psi(0,66 bar) 27.4 psi(1,89 bar) place the sprinkler in service. 14 x 14 14 13 GPM(49,2 LPM) 22 GPM(83,3 LPM) A leak tight 1/2 inch NPT sprinkler joint (4,3 x 4,3) (4,3) 9.6 psi(0,66 bar) 27.4 psi(1,89 bar) should be obtained with a torque of 7 16 x 16 16 14 GPM(53,0 LPM) 22 GPM(83,3 LPM) to 14 ft.lbs. (9,5 to 19,0 Nm). A maxi- (4,9 x 4,9) (4,9) 11.1 psi(0,77 bar) 27.4 psi(1,89 bar) mum of 21 ft.lbs. (28,5 Nm)of torque 118x 18 18 18 GPM(68,1 LPM) 22 GPM(83,3 LPM) is to be used to install sprinklers. (5,5 x 5,5) (5.5) 18.4 psi(1,27 bar) 27.4 psi(1,89 bar) Higher levels of torque may distort the 20 x 20 20 22 GPM(83,3 LPM) 24 GPM(90,8 LPM) sprinkler inlet with consequent leak- (6,1 x 6,1) (6,1) 27.4 psi(1,89 bar) 32.7 psi(2,25 bar) age or impairment of the sprinkler. Do not attempt to compensate for in- (a) For coverage area dimensions less than or between those indicated,ft is sufficient adjustment in an Escutcheon necessary to use the minimum required flow for the next highest coverage area Plate by under-or over-tightening the for which hydraulic design criteria are stated. Sprinkler. Readjust the position of the (b) Requirement is based on minimum flow in GPM(LPM)from each sprinkler.The Sprinkler fitting to Suit. associated residual pressures are calculated using the nominal K-factor.Refer to Step 1.The Sprinkler must be installed Hydraulic Design Criteria Section for details. only in the pendent position and with TABLE the Sprinkler waterway centerline per- NFPA 13D AND NEPA 13R HYDRAULIC DESIGN CRITERIA pendicularto the mounting surface. FOR THE SERIES LFI►(TY2284) Step 2. Install the sprinkler fitting so RESIDENTIAL FLUSH PENDENT SPRINKLER that the distance from the face of the fitting to the mounting surface will be nominally 29/32 inches (23,0 mm) as Demanding n manding sprinklers.The minimum re- shown in Figure 1A. quired discharge from each of the four Step 3. With pipe thread sealant ap- sprinklers is to be the greater of the plied to the pipe threads,hand tighten Criteria following: the Sprinkler into the sprinkler fitting. The Series LFII (TY2284) Residential • The flow rates given in Table A for Step 4. Wrench tighten the Sprinkler Flush Pendent Sprinklers are UL NFPA 13D and 13R as a function of using only the Sprinkler Socket or Listed and C-UL Listed for installation temperature rating and the maxi- Wrench & Socket Combination (Ref. in accordance with the following crite- mum allowable coverage area. Figure 4). The wrench recess of the ria. • A minimum discharge of 0.1 gpm/sq. Socket is to be applied to the sprinkler ft.over the"design area"comprised wrenching area(Ref.Figure 1 A). NOTE of the four most hydraulically de- When conditions exist that are outside manding sprinklers for the actual Step n Use the„ceiling level tolerance i limit" n the scope of the provided criteria,refer coverage areas being protected by dicator on the Protective Cap to check for proper installation height. to the Residential Sprinkler Design the four sprinklers. Guide TFP490 for the manufacturer's Relocate the sprinkler fitting as neces- recommendations that maybe accept- Obstruction To Water Distribution, sary.If desired the Protective Cap may able the local Authority Having Jurus- Locations of sprinklers are to be in also be used to locate the center of the diction. accordance with the obstruction rules clearance hole by gently pushing the of NFPA 13 for residential sprinklers. ceiling material against the center System Type.Only wet pipe systems point of the Cap. may be utilized. Operational Sensitivity. The sprin- klers are to be installed in the flush Step 6.Afterthe ceiling has been com- Hydraulic Design. The minimum re- position per Figure 1 with the provided plated with the 2 inch(50 mm)diame- quired sprinkler flow rate for systems escutcheon. ter clearance hole, use the Protective designed to NFPA 13D or NFPA 13R Cap Removal Tool (Ref. Figure 5) to are given in Table A as a function of Sprinkler Spacing. The minimum remove the Protective Cap and then temperature rating and the maximum spacing between sprinklers is 8 feet push on the Escutcheon until its flange allowable coverage areas.The s rin- (2,4 m). The maximum spacing be 9 p just comes in contact with the ceiling. kler flow rate is the minimum required tween sprinklers cannot exceed the Do not continue to push the Escutch- discharge from each of the total length of the coverage area(Ref.Table eon such that it lifts a ceiling panel out numberof"design sprinklers"asspeci- A)being hydraulically calculated(e.g., of its normal position. If the Escutch- fied in NFPA 13D or NFPA 13R. maximum 12 feet for a 12 ft.x 12 ft. eon cannot be engaged with the Sprin- coverage area,or 20 feet for a 20 ft.x kler, or the the Escutcheon cannot be For systems designed in NFPA t the 20 ft.coverage area). engaged sufficient) to contact the number of design sprinklers is to beY the the four most hydraulically de- ceiling, relocate the sprinkler fitting as necessary. Location �0� '�3 CSA iz 4ep F,elC:r pel r No. C/1 Date q as_03 NORT1y TOWN OF NORTH ANDOVER O � R 9 s ; ; Certificate of Occupancy $ CM Building/Frame/Frame Permit Fee $ swusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3�� a Check # 0 'i673 � Building Inspector NOTES: 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM A PLAN ENTITLED SPECIAL PERMIT AND DEFINITIVE SUBDIVISION PLAN, CARTER FIELDS SUBDIVISION; SCALE: 1" = 40'; DATED: AUGUST 9, 2002 (rev. 1/1703); PREPARED BY THIS OFFICE. DELINEATED WETLAN 2) THE INTENT OF THIS PLAN IS TO SHOW THE AS— LOT 7 PER PLAN REF. #1 BUILT LOCATION OF THE FOUNDATION ONLY. N71.24'17"E 218.00' • N N , z w U) O ((A --- - o - - Oo CD - - -- - - - - -- - - -- - -- - -- - - - Ln +� -I: JIB, I HEREBY CERTIFY THAT THE FOUNDATION SHOWN HEREON C4 31.08' . 1 m IS THE RESULT OF A FIELD SURVEY MADE ON AUGUST 27, 2003. LOT 6 CONCRETE `. I rA44 f Aoq FOUNDATION ' 1$ CHRISTOPHER nv°� 0' NO FRANCHER ;d ' i DISTURBA�VZdNIE No. 36116 25.05 c s — — — — — — — ———— — — —= — — —— —— ——— — — — 00 O O --- O� / r OD LICENSED LAND SURVEYOR DATE S71'24'1 7"W 218.00' CERTIFIED FOUNDATION PLAN LOT 5 CARTER FIELDS SUBDIVISION f- LOT 6 CARTER FIELD ROAD` NORTH ANDOVER, MASSACHUSETTS PREPARED FOR TARA LEIGH DEVELOPMENT, LLC 185 HICKORY HILL ROAD NORTH ANDOVER, MASSACHUSETTS GRAPHIC SCALE — — 1000 -- 103 Slee Road, SuMe One C ��■ Salem, New Hampshire 03079 0 15 30 60 C i (603) 893-0720 ENGINEERS•PLANNERS•SURVEYORS � MHF Design Consultants, Inc. SCALE: 1" = 30' DATE: AUGUST 28, 2003 DRAWING (IN FEET) NO. DESCRIPTION BY DATE DRAWN BY: CHECKED BY. PROJECT NO. NAME 1 inch = 30 ft. REVISIONS JAC CMF 110900 1109ABF.DWG Date. . ... . . /� �4 HONrN 1ti TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION �9SgACMUSEtS This certifies that . . . .. . . . . �'.'� . . . . . . . . . . . . . has permission for gas installation . . .'A. '.�. . ./X� .:'. . . . . . . . . . in the buildings of . . . c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at J.`f. .? . . .0 1'/' r�`. ` �. .`{. . . . . . , North Andover, Mass. Fee. l . . . Lic. No../'. .. ... . . . . . ... . . . . GASINSPECTOR Check# � ' L 4496 I I � i MASSACHUSETTS UNIORM APPUCATON FOR PERMIT TO DO GAS G (Type or print) Date 3 lo:) NORTH ANDOVER,MASSACHUSETTS Building Locations " � �.c.d`!tr �ti �.CX Permit# Amount$ �, Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ a o c ° a z c W 94 F w C C w E 0 w x Wz F p x > GU W F �-+ Z � � F � rn O z O ,� U O 04 [7TH. UB-BASEMENT ASEMENT ST. FLOOR ND. FLOOR j RD. FLOOR TH . FLOOR 1 TH. FLOOR TH . FLOOR FLOOR H. FLOOR (Print ` h one: Certificate Installing Company Nameor VINI C \an��ti. rr�'?�n Corp. Address &P�er. Business Telephone C.irj-� L - ttj(�b // ❑ Firn✓Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked M,please' Icate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waiv this requirement. h one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have sub entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and instal ormed under Permit Issued for this application will be in iI compliance with all pertinent provisions of the Massachu S to Code and Chapter 142 ofthe General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ® Plumber 0141 City/Town ❑ Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date. G �. i t NORTH O 1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �. .0"th L � ,SSACMus� This certifies that . . t !�.'?. . . . .`. . . . . .(. . . . r� has permission to perform . . . .X r u- . . - (" -,._. . . . . . . . . . . . . . . plumbing in the buildings of . .Z . . . . . . . . . . . . . . . . . . . . . . at �. . North Andover, Mass. Fee. Lic. No.f .1. 3. . . . . . . . . . . . ... . . .�..:.�.,.�--. PL WING INSPECTOR` Check # L- 5 7 84 -5784 i MASSACHUSETTS UNIFORM APPLICATION'FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 1 Building Location ( k. CcxrNtt` �\-434wnersName \©M Tri co Permit# 17 Amount \� Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES d H O CrZ unW C W W w a ra a z a o a F d x x a A w 1%RF8NK lkSEMENr BE MOM � 4 M HA" 3Mfl" 4M MOOR 5M fl" sHDM 7MH,oCIR 8M Hf= (Print or type) Check one: Certificate Installing Company Name nuc a ts. M Corp. Address N^& art^f Fq/pf�artner. Busmess Te ep one G-h " ` ' Finn/Co. Name of Licensed Plumber: �•� f1 Insurance Coverage: Indicate th pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have s mi d(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and i 'on erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass s S e Plumbing Code and Chapter 142 of the General Laws. By: Signawre or Lianseaum er Type of Plumbing License Title �3L\g 3 City/Town icense lNumoer Master E3---Journeyman ❑ APPROVED(OFFICE USE ONLY i f f 0 CERTIFICATE OF USE & OCCUPANCY "r®►WN OF NORTH ANDOVER Building Permit Number Date is - a3 HIS CERTIFIES THAT THE BUILDING LOCATED ON v 143 MAY BE OCCUPIED AS �S r i'O�r ^� l7 `-`' „ 4~ g 77 o o Boz /a a 5 �r l ,4,4Ac-k,,c� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Ria- Building Inspector NORTFj ® of Oger.Y•a.^, 1;j.•..4•, :'�`�'�:,, N0'0 . D AK dover, Mass., 9 t9 2COCMICMEWICK S RATED V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....� ..... ....., ,.0,. R ....... ......�at�y Foundation � �--- has permission to erect.........I............................ buildings on .....��.�.6...010 C� r �.� Rough /0'( ................... to be occupied as...&.Qdq w4 42 •* (!! . ,...s ...., .!� ..'......... ......... chi=ne - provided that the person accepting th(spermksha111neveyrespectconformto the terms of the application on file in Final., j 4 ,3 this office, and to the provisions of the Codes and By-Laws relating to the Ins action, Alteration and Construction of Buildings in the Town of North Andover. & aL 1 42 q3 9po ego, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. F• "1.'L� R PERMIT EXPIRES IN 6 MONTHS C ON T S Ro LEC ICAL INSPEC R UNLESS CONSTRU .... .................. ervic .. ............................... BUILDING INSPECTOR / ,l< Occupancy Permit Required to Occupy Building GAs EC R Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPAR NT Until Inspected and Approved by the Building Inspector, Burner Street No. SEE REVERSE SIDE Smoke Det. ��'� Town of North Andover %AORTH , tUFO f6�'Y Building Department , RQ 27 Charles Street p �' North�Andover, Massachusetts 01845 _ (978) 688r-9545 Fax(978) 688-9542 O�p CDG N1[H;wSGH ty1• O Pit a 'asgTlD ofCHUS APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS 1�3 LOT NUMBER (D SUBDIVISION (-A$7tR F1 &-tPS DATE REQUEST FILED 1212 2/03 DATE READY FOR INSPECTION '2�2-5/0:3 TEN (10)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. —WATER METER D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED P OR TO THE INSPECTION QUEST DATE. 5I NATURE/DPW A HORIZATIO II Date h� . . .. Hoar„ r` ' r O?01..... .. TO OF NORTH ANDOVER 1- i� P • - PERMIT FOR GAS INSTALLATION • h SACMUSE4t r This certifies that . . . . .� �.-.�..-2�.,�- -..!. ...f:�. ..?:►�.(�r�,.�.Q has permission for gas installation in the buildings of =.,rF'. . . 7, . 1. � ! �. . . . . . . . at , North Andover, Mass. Fee . Lic. 1403. 9�, . . /�: -. ` . . . . . / f G C&R S INSPE � Check# ?tea C/ 5597 C_34�:) Q �) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �y ANDOVER Mass. Date 6/08 .2006 Permit# Building Location 143 CARTER FIELD RD LOT 6 Owner's Name FRANK MACMILLAN Owner Tel# 978-687-4121 Type of Occupancy RESIDENTIAL New F] Renovation Replacement Plan Submitted: Yet No[:] FIXTURES a � W 0 w F Z J E� FFOW .tC ¢ z z 00 F m W d wx W OF a o: j W F Z W~ Z x 2 � O > O W cVW� x4 H �axl o 3 aa u °x Q ° o V. SUB-BSMT BASEMENT 1ST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6TH FLOOR 7TH FLOOR 8TR FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street Corporation Danvers, MA 01923 Partnership Business Telephone# 800-322-6628 (� Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I havehayvv `Mecked a u liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. No ❑ If you Les,please indicate the type coverage by checking the appropriate box. 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 Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit is su for this app tion will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge ale By Type of License: 1 �"/ •-Plumber Sign to of Licensed Plumber or G, Fitter Title •-Gas fitter • -Master License Number City/Town •-Journeyman APPROVED(OFFICE USE ONLY) 6131 / `x Date... .. .. .. b �aORTM TOWN OF NORTH ANDOVER j p PERMIT FOR WIRING °+ �,SS�tCNUs� _ This certifies that r .................... �A has permission to perform ........... � II wiring in the buildin of.............. �.. l..l d.. N................................... y at...... `! �'. �`.. �,North Andover,Mass. Fee... ' .... Lic.No.............. ......................... q I! .. .............Y,................. ELECTRICAL INSPECT•R Check # AUG-26-2095 98 :36 PM ENVIRmENTAL.PUULS 97 5666'9 P, 02 /� i Offlcial Use Only C,ornnWKwa4��o��etsAaeAa4o1/d i ..�.. . �y, e� it No. d lapatrt'+rarnl p .}lea riiicea =paney and Fee Chocked } V. 11/99) (ieaYe ylaek? ` BOARD Or- FIRE PREVENTION AEGULAXIONB APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work tobe performed to accordarce with the Matsachusetts 131eauical Cade(MEQ,317 CMR 12.04 011 (PLEASE PRINT IN INK OR' P 'ALL INFORII�,A�r41V) City or Town of; To the Inspector of Fires; By+his application tba undersigned gives notice of his or her intention to perform the electrical'work described below. Location(Street Number) T+1e,'phone Na. j' l r " f4 Owner's Address QU - — 1a this permit in conjunction with a-Mtilldiing psrmiO Yes ❑ No (QteckAppropriatz Sox) Purpose of Buildiag - T- ��— -- Utility Aud"Xization No_- Ewsting Service — Amps �. ---- Volta Overhead 0 tlndgtd Nc.of Misters Sims Services ,� Amps _. / Vetts Overhesci Undgr4(� No.I Metes - -- -- Number of Feeders and Ampaoity Location and Nature of Progceed Electrical Work: Co. tion of the foRowmg to a may. r*wNW4 Me sive O, 0.o No.of Recessed ltuurea Na of GSL-9tup•:(Pt90 Fsaa. . . A No.of UgUing Outlets No.of Hot 1ltbs' Generators ICVA No. mergency ig ting No.of usbting f�f=SB Svrira ittg Pool' 0 Bette Units No.of Reoeptecle outlets No.of M l�tirpt'<rs PIItB p•I ARMS Na of Zones No,of swite"s No,of Craa`$t�es's. o tm No.of Ranges No,of Air.Cond., To No.of Alerting Devices HeatF�unpA _ 4t y -1? on/A Devices No,of Waste Disposers : . ttriroipal No,of Dishwashers Spaca/Area0cada KW Locel❑ coon Other ecu ty, a+t�t,at No:of Dryers.`=h >;eat(ixgAtiai+i:bs. gW, hld:of es.or, siivaicrtt o.of site o: N of, Data ata Si a heaters xW No.of R vices or uivalesu No. Hydromassage Bathtubs No.of Motors 'Ibtel HP No.ofDevii=or 134givalent t 0THM-' AttQc*dddlHoiial detailssiret or o4 ngwie t e fnsp,60W res, INSIMANCE COVERAGE-Unless waived'by the owner,bb parmlt for the:performance of electrical work may issue unless the licensee provides proof of liability insuirant:e including"completed operation"coverage or its substantial equivalent.The undersigned cwt fres that such coverage is in force,and has ex7Nc80ND d proof of saint to the Permit issuing office. � /� CHECK ONE: 1NSU tA. zr M OTHER j] (Specify: ) , '•GLo. (Kipirstion Data) e'stirnated Value of 121wrical Work: �L (When required by rnuaicipal policy) Work to Start: Inspectio'ns to be Mquested in accordaoce with MEC Rule 10,and upon completion. 1 carft Wnder the Pabrs and penalties Operjury, that the Wormation on this applicadoft fa inw aAd complMe FIRM NAME: LIC.NO.:.,,,.e_ • Licensees 5igagture L'IC NO,: AIZ& ilfapplfen&la,enter" rtmpr" •rhe ficdRse nu .r i+.i+,S But.71ti.NO. mom Address; Alt.Tel.tier OWNF.It' INSURANCE WAIVER-1 4m aware that the Li ,see does rant have the liability ittsumnce ct vc ge hornisily required by law.By my signature below.1 qteby wai.ve Ws requirement.f nen the(check one) 0 owner i� owner's agent OwnerlAgent (/` K� Q 1�-4-nw� p Signature Telephone No. _, UVIT FEE: $ Date., ./G .. . ?... .. .. ,AORT#q �r TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .�:,��.4 d? �.-. �. . . f�� .r�. . . . . . . . . . . . . . has permission for gas installation . .�`:.0 �.. .l . . . .Y. . . . . . . . . . in the buildings of . . .7. c:.+.f.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . ./:. . . . . . . . . . . . . . . ...North Andover, Mass. Fee.A,.�. ... . . Lic. No..I. . .. . . . . . . . . . . ` . . . .�. . . . ._:. . . . . . . GAS INSPECTOR Check# / ) 4557 MASSACHUSETTS UNIFORMAPPUCATON FORPII2IVIIT TO DO GAS HTI NG (Type or print) -4-t Li�5 Date � p' NORTH ANDOVER,MASSACHUSETTS Building Locations kc ir [� Permit# Tr 7 Amount$ Owner's Name \off ztr New Renovation Replacement Plans Submitted x w O W o-r W z F G z wza5 oz U o a E-4F oz a o a Ha U > o SUB -BASEMEN T B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . F L O O R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type Check one: Certificate Installing Company Name Corp. Address Partner. nxs Business Telephone CT r< a Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance polic r it's substantial equivalent. Yes 13No13 If you have checked y '_es,please in to the type coverage by checking the appropriate box. Liability insurance policy rn Other type of indemnity 0 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives hi requirement. Ch k o Signature of Owner or Owner's Agent ner El Agent i hereby certify that all of the details and information I have submIG'/oed((e tered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett a and Chapter 142 of the General Laws. By: Signat e o Licensed Plumber Or Gas Fitter Title Plumber 1,4140 City/Town Ga ' er icense umber aster APPROVED(OMCE USE ONLY) Journeyman I i h0 . .�M1 F; Town of NORTH ANDOVER O BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECTJY3 CA-A�� l`Z�P�� �� �55U C�/7 Q 3 I�&PIEWMI DATE: © J UNIT NO.: I FLOOR: WING: BUILDING NO.: r V 3 67 REMARKS: Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Cire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of 0# Inspector Inspector Inspector Form N995 Action Press,685-7000 F Location No. �� Date NORTq TOWN OF NORTH ANDOVER 0 t6 .4iffilillik9 Certificate of Occupancy $ �'�b'•'°''c�' 9 cMuBuilding/Frame/Frame Permit Fee $ I' ss� sa Foundation Permit Fee $ I Other Permit Fee $ c � TOTAL $ Check # 6 C1 � 66 , 5 1 ' Building Inspe6or ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT. . APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLI'yS�HH A ONE OR TWO FAMILY DWELLING Or 41OR" "'N 1 -V•-r b i. qty ' t. BUILDING PERMIT NUMBER. ✓ DATE ISSUED: _ O D 3 M ic /C _ SIGNATURE: Laaaaal Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Lor (0 1q3 �c 'e� Flod W �2 2+138 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: K 1 s,F(Z 21 ,800 loo" Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required ProvidedReqwred Provided z,0 ZS' 20 zo +7,7- Z40 -4- i,Sd p 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public W Private ❑ Zone Outside Flood Zone X Municipal On Site Disposal System ❑ SE(-jTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record 1 , Name(Print) Address for Service:gg Si re Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES go 3.1 Licensed Construction Supervisor: Not Applicable 0 censed Construction Supervisor: Aj License Number Address �( Ll�s/� Expiration Date f ic Si re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable p N A Company Name rn Registration Number r Address r Expiration Date ^z Signature Telephone Y SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes......X No.......0 SECTION 5 Description of Proposed Work check all licable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: S r, - q 13k 2 r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated CostDollar ( )to be OFFICIAL USE ONLY Completed by permit applicant 1. Building U (a) Building Permit Fee lalb 4 �o tc 2 l' Multiplier + 65 d P 2 Electrical (b) Estimated Total Cost of �'�• Construction 0� (] 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC 7-6 / 5 Fire Protection 3 pzo „ 6 Total 1+2+3+4+5 1,77..666 Check Ntumber SECTION 7a.OWNER AUTHORIZATION O BE COMPLETED WHEN d OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT j. I' as Ow71er/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION l' 2 ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Ti Si at Owner/A ent Date ISISM NO. OF STORIES Z SIZE s 6,r3 BASEMENT OR SLAB r SIZE OF FLOOR TIMBERS 1 Z( 2: IY 3RD SPAN M X 1 S DIMENSIONS OF SILLS DIMENSIONS OF POSTS 3 (,Z, io IL A JZY DI-MENSIONS OF GIRDERS Zjelo f[EIGHT OF FOUNDATION ']_1 CII THICKNESS /) SIZE OF FOOTING � X O*' MATERIAL,OF CHIMNEY C IS BUILDING ON SOLID OR FILLED LAND Z IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fron Boards and Departments having jurisdiction have been obtained. This does not relievE the applicant and/or landowner from compliance with any applicable or requirements_ *APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE LOCATION: Assessor's Map Number G Z PARCEL Z 4-1-7 8 Pit (�SUBDIVISION C4�'`�e T �/Q S LOT(S) �D STREET_ �Qc"1rf �12I� Rec,4 ST. NUMBER. y OFFICIAL USE REC MMENDA ONS OFT WN AGENTS: C NSERVATION ADMINIS OR DATE APPROVED d DATE REJECTED COMMENTS �} T P NNER DATE APPROVED DATE REJECTED COMMENTS �l J/1 ? S S l/S UL FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PER T �1 FIRE DEPARTMENT 03 RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm 1 Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS /DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) -9)MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) f 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBU LDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption tinder section 8.7.6 of the Town of North Andover GroiNih IN lanagement Bylaw. The applicant shall pro,6de all of the necessary information as requested below. Permit Ap scant Propem:address Map/Parcel 41-7v-,43-2:Z6 . IV/ Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6. 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town.or other similar 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 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for thepurpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM L'with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DET,11-M]NATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE F,,TMPTIONS. 13Y SIGNING BELOW I ATTEST TO THE ACCURACY OF THE fNFORMATION PROVIDED.AmND THAT TILE ATTACHED BUILDING PERMIT 1S ALLOWED"-" MPTION AS CITED ABOVE,. FURTHER I UNDERSTAND THAT TI S MITTAL OFMISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXT, N WHICH DOES NOT COMPLY,WHETHER DONT-TO MY KNOWLEDGE OR NOT IS GROUND FOR REFUSAL, Y BUILDING DEPARTMENT TO ISSUT-A)�L)b G Pk RMIIT. d ANTS SIGNATURE DA"IT S DORM TO 13E ATIACIIED TO THE BUILDING PERMIT APPLICATION The Commonwealth of Massachusetts s u j 1- -. .4 . d Department of Industrial Accidents Office of Investigations 4 Boston, Mass. 02111 �,M 5�•"'W Workers'Compensation Insurance Affidavit Name Please Print Name: dH'rliS Location: A/3 Cli;(44 (Zlej , City N , Aw e Phone # `F7,Y 16 I am a homeowner performing all work myself. ® I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone# Insurance.Co. Policy# Company P Y name: � Address Cih': Phone#: Insurance Co. Polia# Failure to secure coverage as regwred.under Section 25A or MGL 152 can lead to the imposition of crilyinal penatbes of,afihe up to$1,500.00 and/or one years'imprisonment.as_t+tdLas_cxvll.penattiesjnlheSorm-a-a STOP WORK_ORDFR_and_afine_af_($iDOM)-aAw againstme I understand that a copy of this statement may be f to the office of Investigations of the DIA for coverage verification. I do hereby certify under the pains d penalties per] that the information provided above is true and correct.r Signature Date l J 4 Print name ) 410 Pie#q�•-�� Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensi � Building Dept E]Check if immediate response is reguered Licensing Board Ej Selectman's Office Contact person: Phone#: ❑ Health Department Ei Other I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number TSA is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) S!iggnat re of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover Planning Board9 z This form represents the schedule for allowing the following lots to be considered as eligible for permits under the Town of North Andover Management by-law Section 3.7 of the Zoning �ti 11 L n ;� t by-law. LP�r _U .} to 3.7 this Development Schedule must be filed in the Registry of Deeds and be referenced on the deed of each of the lots below and be filed with the Planning Board prior to the issuance of any buildjr�� git" '` 7i/1; ; permit for construction. Name and Address of Applicant for Lots: Name of Development: ARA LeIG4 DVU&LOI?mtN'1 LLC. chR-TeP, FIP_ 19S tj\C-'Uig' Hi LL flohID (oaF SRAbFbRa'STKV T� Y NORTh i��}DOVtIR M A O I8Yy ;'' Map and Parcel of Original: M h P 6 2 Loi Z ! Date of Application for Lot(s) Division: flV G UST 9 2o0,2 Lots Covered by this Schedule =J The Planning Board by their signature below, or a signature of a duly authorized representative, do hereby establish for the above named development the following Development Schedule for the purpose of Section 8.7 of the Growth management By-Law. The applicant,their assignees,successors and or subsequent property owners shall conform to the following schedule that limits the eligibility of the following lots for building permits. This form must be filed in the Registry of Deeds by the property owner or representative 'a and be referenced on each deed for each of the following lots. Such deed reference for the deed of each lot shall at minimum reference the book and page in which this Development Schedule is filed and contain the language;7-his lot is subject to a Development Schedule pursuant to the Town of North Andover Zoning . By-Law all owners, representatives, and future purchasers should avail themselves of said restriction by reviewing the approved Development Schedule as filed in Book insert here and Noe insert here. The fact that a lot is eligible for a building permit is subject to the limitation of the number of building permits per year pursuant to section 8.7.2d of the Zoning By-Law." The Planning Board hereby schedule the lot(s)for the above developmer_t as follows: Yea.Eligible t Number of Lots Building Office Use Buildin?Office Use Elib;ible Date Lot Elig-ibiliNotes t Completely Utilized i Y 2 003 FY 2ooy � � S I t I SigrYa f Pl • g,Board member or Authorized Representative Al Date Sigrratureof Property Own or Authorize esentative Date 7/ A�I 01 w � lie toa7x7rcaruuea�i o�✓UGaaaacsiude✓�6 . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number GS, 055417 Birthdate 04/05/:19.60 Eiepr&k: 040562004 Tr.no: 21586 Reitricted:i W; THOMAS D ZAHO.RUIK0�- 185 HICKORY HILL RD . � N ANDOVER, MA 01845 Administrator f Proposed Lot Plan Carter Field Road Lot (o Scale '/4 = 1" 6 f 21,800�SF� 0.50 AC. �I I FROR'TAGE 100' 15 Z2' PROP. I \ 1�2 , I5ra 16�{ yRrii wAIL' N '44 KPPO.6K V, 9 At>wQr CAR�sR F18.►b RoA7� Tel: 978-687-2635 Fax: 978-689-2310 THOMAS D. ZAHORUIKO Tmi,\ LEIG-1 DEVELOPMENT LLC MEETINGHOUSE COMMONS LLC 185 Hickory Hill Road, North Andover, M.\ 01845 E-mail tzeke@comcast.nel r s , f Permit Number MECcheck Compliance Report Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename:Untitled TITLE:Lot 6 Carter Field Road CITY:North Andover STATE:Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE: 08/07/03 DATE OF PLANS: 8/5/03 PROJECT INFORMATION: Carter Fields COMPANY INFORMATION: Tara Leigh Development LLC COMPLIANCE:Passes Maximum UA=596 Your Home=534 10.4%Better Than Cade Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 2080 0.0 38.0 52 Wall 1: Wood Frame, 16"o.c. 3400 0.0 19.0 236 Door 1: Solid 84 0.280 24 Door 2: Glass 63 0.330 21 Window 1:Vinyl Frame,Double Pane with Low-E 405 0.330 134 Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 1552 0.0 19.0 67 Furnace 1:Forced Hot Air,85 AFUE Air Conditioner 1:Electric Central Air, 10 SEER COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. T)ioffAC equipment selected to heat or cool the building shall be no greater than 125%of the desi load as in Sections 780CMR 1310 and AA Builder/Designer Date / MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lb DATE: 08/07/03 TITLE:Lot 6 Carter Field Road Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 continuous insulation Comments: I Above-Grade Walls: [ ] I 1. Wall l:Wood Frame, 16"o.c.,R-19.0 continuous insulation Comments: I Windows: [ ] I 1. Window 1: Vinyl Frame,Double Pane with Low-E,U-factor:0.330 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ ]No I Comments: Doors: [ ] I 1. Door 1: Solid,U-factor:0.280 Comments: [ ] I 2. Door 2: Glass,U-factor:0.330 #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: i Floors: [ ) I 1. Floor 1: All-Wood Joist/Truss,Over Unconditioned Space,R-19.0 continuous insulation T Comments: Heating and Cooling Equipment: [ ] I 1. Furnace 1:Forced Hot Air,85 AFUE or higher Make and Model Number [ ] I 2. Air Conditioner 1:Electric Central Air, 10 SEER or higher Make and Model Number Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I 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 cfin(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. 1 Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] ( Insulation R values,glazing U-factors,and heating equipment efficiency must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Ducts shall be insulated per Table J4.4.7.1. I Duct Construction: [ ] I All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as I specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ l I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120°F or chilled fluids below 55 OF must be insulated to the levels in Table 2. b Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 111 Uy to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Ding System Types Range(F) 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) � ORTIy { Town o 3� � : � Andover 0 No. T C' LAKE - O ndover, Mass., - o�00 COCHICHEWICK A0RATEO PPf`�.(5 SSAC HUSITH M FOR r EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ... `Ta �a .... � .......... . .........-..7..L ,,,,,_„�....................... .w .. .......................................... has permission to excavate and pour foundation at ..h.. ��3 a, f'e^ �`«/ �� .......................................�. .............................. for the purpose of..... . The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. G oZ IQ 4-/3 8 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLM i ERMiiT ME LESS FDAI v f s ...... .... ............................�1� ......... ...................... ..... ........... DUE FRWE PMMIT$ Y 3 J/ BUILDING INSPECTOR NpRTIy TONM OfE over O r.'..v -' ti 4VIM No. 95" i g - dower Mass. ° f f 9-9 03 COCHIC IC IC ADRATE D qS BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System -'j� BUILDING INSPECTOR THIS CERTIFIES THAT......�.J`}le ........ � .�1....... �v,e�o/�l�l t'c' ` ice- .. ............ ..................................................... Foundation cJ . has permission to erect................/.................... buildings on..44 .6.... /..- ..... !4ie 9 ;,/-e/a/ Rough to be occupied as...5....!p.m .c�.c?.&)%,.a.(57Al) ./.� G��Q� //V /e°. ;R.s I c e4C SL ` Chimney provided that the person accepting this permit shall in every respect conform to the terms oche application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. &&Z Q ?f' f 3cm --- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. �' Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .... ....................... ' ........................... ............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. L f r 1 .................. LL I ]I. I I T1 t 1_oT lD C AMR FtELJ RaAD 1/4" �._0 8 �5 X03 �00N0�3S I I i f, I I I � I o I .9 p io01 s I'a I ,4C lix- V � . - i IW •W � Ip 71M O f I O _ ri I X015-Z 'v�tsv w N I I IN i I� 9 I � --- o,z i I I' • 1 kO 8kb NO exp, i o – — I m I � i 9NNV,6 I I I W i N 7/15 o �s vi � . i IN 0 I D ,yc rou�aa b�ib ol '^ �b 2h 21 n i N �W Nano ; N3rV111\ I A h ` cgN Z 5 £ E.1 2�it 81 4' 1NL2f>l3N p w I_ i•yS�� ; � i s s I I 0-5 O-Z a-F o-F o Z o-L o-L I L 19 r a I I { r I f i ( I c 1=C)U N.l)AT o nl 5�-o 0 o O N I � N o 10-0 - _`'t"off .—i._._ _. =�-- —7-° I I i it I N j N 01 l i i ' I i i i I ! � i a 12 p I f � � ► I j r ji I r 0 6` n P ( si -t)E' r b i _ ~J x - � Z � lid _.. s It TIC t i --- � i , (a OP ai i '> �'D u 2 2 RtDoL uvsitfD R\9c� 10 / 2x(o GotL�R 't` o Co qq\,L Aq, 2 ►5 lb F�L,T R..O . �t���UL� 3fo'� t3lTV'tllEvE _ 1x3 IPP `C\LlV.A l0t&T J"CRY DGL�R W�' ID�l.1C�11"t'S axs/ o K39 T* PP i - ,x3 STIP#^13G tx1ER\0?,L R ON>-�' i � `/2"BwF6oARD,Ft�sYfR �� `o"'-c.\►�'r q`x S` Oil GAR�IC� AooR yl ixy eP � 2I N �I !\mAknecA Tr6r 7 x Go N c£awRctAP�ISNAKE Z x\0112 TyvcK IEauty 2x1o/i2 auocKtt3R)Uhf • (2)2 x\O HiDR 1 4` 40 ,V z; FP MAE bPt7A1L DECK+RA\l. 4 pF0. *,Ec5. cz O i' i 4 xW � By-T POST actteD 2Xsho PT 2�c 1O/\2. e>_.OcK/eeicoe poi% � ti8"cOveR G'A(o2x6PT 51 ILL ; Ly)2x10 13EA� r*�N 110114 J ct�AN St\ckF\L.L, 9 3oaaPsg Sj C L P Ut F1LTtaR a RBgt►G WALL. 1 CST (D # 14 3 3/4ii STova� L— 1 c a +' �re�000 KFvwry �t P.C.StQ13 3000YS1 C�RT£.R FlEL17 RO�� oLtli o' P q �y� oNF N o RTS l�N1JoVeR 1 M A e� a �ea"q a 3000f SI 8d u1 y P•C.SLAt3 �1)00ewoo FooTING CP �GGob 2,U K\O ON.\Y �� SIo3 SC�L� VAR��S CT Y p 5ccT\o v► INIR N LE1 CA t U-XLoP,MkNJ7 L1.0 HUG-26-2005 08 :36 FM E1AY1 mEMTAL. FOOLS 9732566620 P. 02 offices,Use,only � C onta►onweara o� llfetaeaetra4otle I Permit r.,�.pra.lrsrnl v)� lreiriricYe ' i R ecupanc)find Pea f`herised ! (jtby. l 1 J99)t:ta4e W^nk? � BOARD OF FIRE PREVENTION AEGIULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfWmVd in ceorda:ce with the N;aasaGhusetti Electrical Code(MEQ,517 CMR 12.00 (PLEASE PRINT WX OR P ALL 1NFORMATION)it 1401 'Aft 0 Two the inspector of Wires: City or Town of: VVI notice of his or ha'in to perform the electrical work described beicw. By this application the undersigned gives no Location(Street dt Number) _ 4% Alf=Owner or tenant 'fVepbone Ivo. Dwnees Address . Is this permit In conjunction with a bW'dtng permit? yes ❑ No 0 (Check Appropriait Bos) Purpose of Buildia$_ 1y -r - -- Utility Au.0WdZation Na, r�� Sxisdnt Service Amps volts overhead ZI 1Jndgrd❑ No.r Mbtnrs Siv sem -- Amps / _Volts overh"d ElLndgrd f' Na''o Me= Number of Feeders and Ampaoiry Location and Nan=of Proposed Viiectrical Work: . Comp edvn ref tka o otvtRg to a n+rt7 t Owe Iii r n acro►v a o.0 No.of Recessed 1E�ittur� Na a!f CeiL-9uep:.Memo)Fus Nu..of Hot`tube Qeneratora tCVA Na.of ilghting Outlets Abov t o. ttseW1kCy ig ting t No.of Lighting Fixnuos awit»aRing Pool :©' Batte Utsits 1110,of Oil atirpe:ta• PIIiB� Neo..of Zoasca No.of lteice�ptacla t')tttleta .—.--.., wd No,of 3vV%toltes No,0f 00 Somm. No. tlit a on No,of Ranges No.of Air Const.. Ton No.o!Aiets. 8 Devices Neat Pump t _ a_ '�jz.Vo Devices ! of Sdf No,of Waste DiBpaaere }No.of Dishwashers splea/Aeea'Noatiag ICSV Lxal .L I- - btu ty stm>a:, . . . !No,of Dryers..:. Hoath gA�rtt"C".. T-W.. Nb:of ea.or uivalcttt o.of ter o: Daft WU" No:of 1 liea�e ra KW Ballaw No.of&,toes or ftui.valwx N Has ydromsage 3atbtabs No.of VIAD rs Total HP � No.ofDevio-s r pvvalent � 1 OTIiER: X—R.1-7 ddaltooAal5tallAsir a oro,reglcirvd'F�f e lnspaator 0j W;,V;. INSCRANCE COVERAGE*Unless wuivee by the owner,no OrMit for tho:performun;e of electrical work may issue unless rho licensee provides proof of liability insuttance ineludiag'completed operation"Coverage or its substantial equivalent.7be undersigned oertifiu that sura coverage is in force,and has exhibit d proof of same too the permit issuing office. CHECK OANE: iNSUR.ANCE BOND 0 OTHER D (Specify:) ( pirativn Oats) .Stsrnated value of 1?lectriosi Work' (When required-by rnu>;ieipei policy.) Work to Start: Laspectiene to be requealed im accordance with MEC Ruse 10,and upon completion. 1 cerrfy:antler the pains and penabies cf perjury, that rhe irtlormarlon on this application la true anal complete v F'RM NAME: LiC.No., !_!Censee ._.C' (�, Li�L� signature ._ LIC;NO.: 2' lit+PPlienble,toter.° ramp+' -rhe llceRio Ru BUL Inel.No. 01 r .address: 41t.'Tef.hie:: •- } OWNER' INSURANCE WAJVER:.t,11`1 awflre that the Li see does nor have the liability insurnrce ccwemge normally required bylaw,By my f signature below.t Ireby waive this requirement.tarn the(check one) !� owner C:, owner's agent 1 Owner/Agent ` i .� �--.•__.__r�__. r�� SignatureGi� `((1_� FRti11T FEE: $ J `� C C�l t I Location t �. t. No. �°�� Dated TOWN OF NORTH ANDOVER Certificate of Occupancy $ �'�s''^•E<� Building/Frame Permit Fee $ AC NUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Check # Al 18586 ' Building In64ctor 5 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T V Sccfide:for(?ft'x�ial Use 0aI rn BUILDING.PERMIT NUMBER. DATE ISSUED: S X j c � _ i SIGNATURE: ...� Building Commissioner/IEEQEtor of Buildings Date Z SECTION I-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 143 CAIZ.15AF0540 Rib r/ 19 1/ e,,?, Map Number Parcel Numb V 1.3 Zoning Information: 1.4 Property Dimensions: (tel t�/,goo / Zonis Distnct Proposed Use Lot Areas Fronts a(fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply Ivf.G.L.C.40.5 54) 1.5. Flood Zone Info mution: 1.8 Sewerage Disposal System: D Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Addr s for Service: t Signature Telephone � 12.2 Owner of Record: —� O Na rint_-Az; Address for Service: AUG �a O� .fir Y� f�U V rn` SiKaifurc Telephone M SECTION 3-CONSTRUCTION SERVICES PT. 7� 3.1 Licensed Construction Su isor. Not Applicable ❑ u C41V d Licensed Construction Supervisor: 0 ' ��S p / Le lcns� a Ner Number O 62 9CA S�c�� 's SCJ .s b��� Address I!� 9,7 Expiration ate� Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v i5,:NV)1aAA0a&ML- AV.-As Company Name 1137-093 M Registration Number —� AAddres7 ?Expiration Date /'1e Telephone Li� 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...-...0 No.......0 SECTION 5 DescriroAion of Proposed Work check atl applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be &s�� i3e U (3NLY; Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC ry 5 Fire Protection 6 Total (1+2+3+4+5) f Check Number SECTION 7a OWNER AUTHORIZ.4TI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �, , .�-y� ,�jc , as Owner/Authorized Agent of subject property Hereby autho ' e to act on My beha i rs r ativelto work authorized by this building permit application. kT�fs S 9ti nat ier Date SECTION 7b OW-N-ER/AUTHORIZED AGENT DECLARATION 1, 4!51'4, 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 P ur of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR.SLAB S17_E OF FLOOR TDABERS 1 ST 2 ND 3RD SPAN DIMENSIONS OF SILLS DINIENSIONS OF POSTS DIMENSIONS OF GIRDERS 1-EEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH]NINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �� v ,�:� 5 �� �,r�.f ,� �� �� `fy y =� � Z�� � FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. gown APPLICANT%=0;+(41m 1 T��- / L.S :&C PHONE ?7�'bd�6"OL17D ASSESSORS MAP NUMBER b . D LOT NUMBER .i& 0/411 SUBDIVISION LOT NUMBER 6P STREET STREET NUMBER I3 OFFICIAL USE ONLY RE OMMEND NS OF TOWN ENTS .... .. .. ■ woos...... ............................ ......mons.■. DATE APPROVED C N-A'n6N MINIS TOR DATE REJECTED CO 15 k ( C2' ` DATE APPROVED TOWN PLANNER DATE REJECTED CONMIENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE RECEIVED ,61.1r, 2 6 2005 BUILDING DEPT. i License: CONST�iUCTIOt3.SUP�FiViS{SR Number: C5 083208 Birthdate: ..0211411956 Expire:0211412008 Tr.no: 83208;.. Restricted: 00: DEAN CONSERVA 29 CRESCENT STS TEWKSBURY, MA 01876 Administrator i I ✓fie 1°am�zaiacuea�C o�✓�,Cuaac� ,ll6 Board of Building Regulations and Standards 'HOME IMPROVEMENT CONTRACTOR Registrstio`,n: 107083 00 7!29/2006 TgpW Private Corporation ENVIRONMENTAL POOLBINE Andrew Everle!gh t E A84 Rivemeck Chelmsford;.MA 01824 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 r: Boston,M2.02108 r. a Not valid without signature 0 v I I I c e ' CERTIFICATE OF LIABILITY INSURANCE PQC-N 4500675-2191 FAX C5 3671-2135 TWISCERTIFICATEIISISSUED ASAmATT>ft4FWFIORMATION I ''veb,.aar Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CESRTIFICATE HOLDIR.THIS CCRTIRCATE DOES NOT AMEND,EXTDID OR s I 0;6,'A Webster Insgrance VEMOR AFFORDED BY TN POLICIES BELOW, P O.I30'k 80? ' SWANSEA, MA 02777 INSURERS AFFORDING COVERAGE MAIC 9 Olimnta Pool S INSURERA: AACH BKORKE ap A—Ny j 184 R Fiverneck Road �NSUI¢RS: ENC IMURA14CE COMFPAK '"Selms`4rd, MA 013Z4-2921 !IusLla�Rc: _ ' IN6U.aeR 0 - sNsu�l?E ._.. =,R8AGrzS ''I iE?ciIJC1E$OF fN9URAlrE U3TED 911-OW MAVE OFFN IY3UEC TO THE INSURPO NAMED ABOVE FOR THE POLICY PERI00INOICAT=D.NQTNlI HSTAN6IN 4NLREOU!REMEVT,TOM OR CONbITION OF ANY COirtRAC,OR OTHER DOCUMENT WITH RESPECT To Y,�HICI~rKs cEAnFICATE MAY BE ISSUED OR anv PE?TAM,THE INSURANCE AFFORDED BY THE POUCIPS 058CRIBED HEREIN 18 SUB.I-eCT T f'4LL THE TERMS.EXCLUSIONS ANO CONDITIDW OR SUCH AGGREGATE*-1M!T$SHOWN MAY HAVE SEEN RED3)CEO BY PAID CLAIMS, rn!e OF INWRAHCE POLMY MUMBIRR i cFSIExALua9lLrrr �� 2AGL5q.0tr79dO. 5/I+4/2005 43/14!2006 EACI�occura�Nee s_ 1,040,000 X CDRIASE4CLIL SEVERAL LIAB4RY f _ 140.40 CwrnS NAGE l X I OCWR I j MED EKP(Any a!a*.*wq $ I %P40NAL A AQV PCIUltY b 11000,0 A !-- ! ftKiRALAGQREGATE s 2,000 OO a aEN'L AGGREGATE LIUFT APPLIES PEI'i Pf�QUCT'S•CX3NPA�P NSG t 1.000 Q I �np>.LC+' �eR�T Loc AUTCW81LE UAUJN PENDING OS1141 S 1S Z006 CONON19 VINWA LIMIT S I oyAv"0 fEaaxlda+0 AI,LQWUEUAUTOS ' i BOO''/IN,fWt'J f SCl1�7G+LL:C a.JTQ•".• I(Pet Cerem! 1.000,0110! B i !X MIRE:(AUT05 BOON![VURY f 1 IIr31aarhALlrQs { xaa+dant) I:000:0 I — SOP�DAMABE S 1 000 000 4 AUTOOULY.E/.ACrDW S ! �C/�AG`L LLA6ELITT � i F f If CMIRTyA1I EAAG:. S I AUTO ONLY: ,. S ErG SIWtT9RELLA.LtA1HILITI EAGN OCCURfSNc s L j i �CCLuR �i:lYMS M.40e I � ABGFtEG14TE S i !U TElt'UN S f s A OTM, '9YORYzR$COVPENSATICN AMC' ! eu-wrFasuAerxy ZAWC19014700 05/14/200S OS/14/2006 F.LwmAccow S 11000, i A!JY P4C?Fc1 fpk NEft.`!R'GU77JE I OF.ir=ti'NEMHFR D�IiU.�'D'r e)—P.+E'ASE-EA EAFLUIU S 11000. !CYes 428f:ia2�'i:1�f I 1 I SPECiF�L°ACV:Jolt$eebr E,4 DISlJsBC-IOLICYLIMIT i 2,000. OT10p. i ! I Gf;$:aJj*T1UN DF fiPEAA'!3Ma i LuCATXU9/'YEHIC4E.9 J EXCLIIS!CMS A000 QY ENDCIR6rNt(SMIG.AL PROVffiICMS I i I _ I CRT IFI AT•N,'i DFyR� KMATION SMOULO ANI'Or THP ARM CRAMMED POL;IEB BE CANCEIAM&EPO F_TWE EmrunvN DATE TMr;RlOF,TMe I$Uscs u4BURER VOLLEA(XAVOR TO"L 2.0 GAYS MUrm ROME TO?H:OEM 1F7CATIt hoLlm kAME070THILe?. I EMrIROP1A9E:hYAL POOLS INC BUT FAILURE?0 MAIL SW W NOTICE SHALL jOKU NO OWJMAT-a 0R LLUUTY i J.S R RIVMECK ROAD OF ANY x:NO UPON"f ASLIRFK:TS AGMM OR WREBEMTATrVM IF-L%5F0RV, MFA 01424 auTMJRI oREARESEti'TAr*1JE aCORL 25(.`!01lO8;u OACORD CORPORATION 1910 The Commonwealth. ofMassachusetts Department oflndustrial Accidents _ Office 01117vestigali0178 600 Washington Street, 7`h Floor Boston,Mass. 02111 �1:InWa:�4i1o;`.U�rkxey•r:k-s';'^•d-C:'Jos^;maY::,•.r. �3nr=dns':4sa,.t_ion:,rInsurance nsurance a`Afti6f-V'iT�ndaa�.vrsit:,B.,•.u��e�il�odi�narrr�?/#:PLti.cl�lr�u5,i-a.',m? biiCn'-My.e l•'ec_J:,�t?il'ic.{ar_:..l.;.`r.C.�aNx-�ontro-rr^acvl.tors s ��; �:4:.. . • name: address: city state: zip: phone# n work site location(full address): AlLY %jr D- � ❑ I am a homeownerperforming.all wor]cmyself. Project Type: [;?'New Cons&uction❑Remodel ❑ 1 am a sole proprietor and have no one working in any can acityv $uildinAddition :.:,`a. ,d. ren rr, ''E'•+aii:" 's,:r: :g .. .•:_.._.:;f.::'(?..,.(4.J..a,.4ti°2Y.sS.n.. ...:._'::i'..;:!Y•,.�..�Y..i:.4'-'1'J:'.Y:d:.:,E[�.':IY::t:..:.:_::5':J: I am an employer providing workers'compensation for my employees working on this job. N . cornpany name: . etrlrs/l�- �C�� T address: cih" (� &S _ f C �f phone#: insuranc*.co. . yy olio' # uC:J .. ❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: compaity�.name: • address: city: ( phone:# insurance co. oli ;# company name:- address': ame:address: city: Phone M. insurance.co � y, ` ' '> y • -oic ' # -1 §1 ,may' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one 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 AIA for coverage verification. 1 do hereby cern to th pai realties ofp /rr that the information provided above is true and correct. �. Signature . Date Print name&A N er.U) � Phone# q75?_e;56 p Voil 00 �f43333izc:vtsst�t�5ti _ �'�^' +�xvt£C > av�a fel wnii sI' iitir b •=i official use only do not write in this area to be completed by city or town official city or town: permit/license# Building Department Licensing Board ❑check if immediate response is required ❑Selectmen's Office �I3ealth Department �., contact person: phone#; ❑Other 1� (revised Sept 2003) "�dt3?';�tr-;�'ue 'Ya,°�1 �ari. ;fe,�53c`?;::�'?d'�Fixa �z.'�x�:{tem+,�".�•t-��.;��,'r �'e�?s3���fr:.�•.�''+psi'�.��'3�iY�r-��.•����1�' x'� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied,oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of .the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. .,u, ysv., y,�,,:�,,pE;(!;Ty�v,-.�'ri�i'�uu��,�'S'�.T�•1�r -7'�tiz ST'y �: . 'Y�'rw �� y�y Y� �� t@" '.lt r r f�s�. ° 4 �,.bt�I i�• f r 7r C�'�,w't.� ��'r.�y°3'����.VFk�s� �Pirr*YJ r w��'{4 Nf;}��-n,,�t{,w,�YyJ �S�u.t�Y� `k��i�''�r r 'k "� � Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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 sbould be retumed 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. 'V'r Ys y H P IN u. y E. '�'. �^ rr5'f rf + I.lnk uvd rasS ' �'i ..ao-aavai City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. .._ ....... ...... .......:,:,-:.-.•�:... .'..e ..., .{ .zx;.::J:. .i- .;(... :"�:, ;iE,' .41'.. .-.L... .E.--.z3� .:yn .'6.;'.r 41, ra [� ...:i.-` ;;'.;%yt'. ''1' d,, rt.r •mac`n;tz. v ?Iu,s.>1 1 +�,f ..1:i�Y 'IC .e SSi�t3'. 'i5'ut ,3:ba i°'`.:?.:;1;Hr�:' :_s-. s:�-Sav A. „ tt. a,.._r_. .C• a_.rfi:J.S.i<nl.. :.�1>:n;�"n .ar. 1.. 4» wk The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department.of Industrial Accidents Office of InueStigati= 600 Washington Street,7t'Floor Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 NORTH TO" Of t 4Andover OO - LA E dower, Mass., 9' "oZ I • of o o S I� COCMICHEWICK 7�ADRATED PPS` �C S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....�..raN K 4 4 au t a..........��c ,/� ,u ............ .............................. ..............,.................... Foundation has permission to erect...... y buildings on .....�... C k�•A �It�.R ICO i� Rough �.'..y.....�..... ... �►....................... to be occupied as..e 1.4p ..pM. !tsl�f.I!�...... v Iw.`�'4......... ...............j N...t'!%17 R� Chimney ..... ..... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. `al PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR` Rough *'0 ............... ... ` Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ENVIRONMENTAL POOLS , INC. MEMBER 4�b 184R Riverneck Road - Chelmsford, MA 01824 978.256.0200 / 800.696.6976 / Fax 978.256.6620 E-mail: info@environmentalpools.com NATIONAL An Aquatech Builder SPA& POOL Design Excellence: With A Persond Touch INSTITUTE The General Terms, Representations, and Conditions on reverse side are part of this Agreement. NAME (Buyer) � ,,yx� ° y���/d�� / » ° f s�i;9 r`� MAIL ADDRESS_19,3 i.,...r'aiwAc. �'""/ c Ao. CITY t h//l t�v" ' STATE -4;Q. ZIP 146571 JOB ADDRESS SJ-11.16 4!& /), yr-- CITY -- iSTATE ZIP RESIDENCE PHONE_ 17 OFFICE PHONE L' �! ) T si ° °ll Environmental Pools, Inc. (hereinafter "E.Rl.") agrees with the buyer or buyers above (hereinafter the "Buyer") to construct a swimming pool and/or spa in a good and workmanlike manner in accordance with the following terms and specifications. DIMENSIONAL SPECIFICATIONS Width Length Shape D •s-1074, Depth to GENERAL CONSTRUCTION SPECIFICATIONS MISCELLANEOUS 1. Structural engineered plans........................................................................INCL. 52. Raised Bond Beam: Tile "" Stone 2. Pool layout plans ........................................................................................INCL. 6" _„r°.^'.. 12„ 18„ _�---w 3. Layout pool for Buyer's approval ................................................................INCL. 53. Start-up chemicals: Initial start-up and follow-up instructions ....................INCL. 4. Set pool elevation for Buyer's approval ...............:::....................................INCL. 54. Water Condition-$575.00-20 tons of 1.5"stone Fc� 5. Perform normal excavation and remove soil on day of excavation only......INCL. Additional stone at$300.00 per load ..................................................BU ER 6. Access wall or fence: removed by: IV0,14r 55. Clay soil -$375.00 ..................................................................................BUYER replaced by: Akw SALES TAX & INSURANCE 7. Trees in access and working area to be cut down so that the stumps do not exceed 2'in height........................................................................BUYER 8. Remove from site _loads of:trees, shrubs, stumps, asphalt, 56. Payment of all sales tax on pool components and accessories..................INCL. concrete and other debris 57. Motor vehicle insurance, workers'compensation insurance .� and general liability insurance ....................................................................INCL. 9. Hand form and shape pool..........................................................................INCL. 10. Removal or relocation of cesspool, septic tanks, leaching fields, ADDITIONAL SPECIFICATIONS sewers, pipes and utilities(overhead/underground) ................................BUYER ') 58. &ns4C,_ E..i�r�`� � ,� t" /-)n/11. Steel reinforcing per engineered plans........................................................INCL. ` '' 12. Engineered gunite structure to meet or exceed local or state codes..........INCL. 59 1 e 5c- 13. Watercure gunite shell twice daily for seven days....................................BUYER _ 14. Install continuous bond beam around skimmer............. ............................INCL. 60. 15. One set of shallow end steps with)'bench....1P ....... "`� ..................INCL. ^" 16. Swimout or loveseat a4 &%A/ UC4• 1 17. Install 6"band of Frostproof tile.........'!°o...8r..mS:+~ .....................INCL. 62. 18. Safety grip coping or bullnosebrickcryE� 19, Cantilever form for deck _10 20. *hrs.backfillingand grading-deck deck area onl ,1 r1 .................................. 9 g- y......... I NCL. 64. €1.rZr�x tl Cv r3 -c►r�l5 { �iZ7 21. Pool interior finish............�t 4.t.rg .............................................................INCL. 65.. .22. Filling-of pool promptly:atter interior finish .:..:::....:........:::::...:.:.........:::.BUYER HYDRAULIC & FILTERING SPECIFICATIONS 66. POOL DECK PRICES o SUB-BASE MATERIAL IS NOT INCLUDED. 23. Approved deluxe filter: Typ 1r1(Ak kc_C�1�. Size 4 2'4. Pump and motor: Type_fir a TH'S 7+77� Size Decking square footage: �f Type`�..s`7 0 -yX r.) 61 -4,Fr 25. Hair and Lint Strainer..................................................................................INCL. Other: I' ' `' E �� / C Cr' c ` 26. Pressure test all pool piping........................................................................INCL. 27. Hook up all water lines from filter to pool....................................................INCL. 28. Non-corrosive PVC plumbing throughout....................................................INCL. 29. Hydrostatic valve ............................................................�...........................INCL. PAYMENT 30. Provide return inlets for filtered water to pool . ... ?-...................INCL. 31. Main drain suction line with grate....I, .M..7.`!."..' ? 7 :Y...............................INCL. The Buyer agrees to pay E.P.I.the following Contract Amount for E.P.I:s 32. Automatic recessed deluxe skimmer C. ... !< ?....................................INCL. performance of its obligations under this Agreement. 33. Leaf strainer basket in skimmer..................................................................INCL. 34. Vacuum fitting outlet in skimmer..................................................................INCL. PAYMENT SCHEDULE 35. Up to 30'of plumbing between filter and skimmer......................................INCL. �;? 36. Pre-cast pad for pool equipment ................................................................INCL. Contract Amount $ 30%Day of Excavation $ /a 37. Backwash line..............................................................................................INCL. Deposit $ C186 '-' 40%Day of Gunite $ ^f L� BALANCE $ 25%Day of Tile $9L� AUTOMATIC EQUIPMENT _ 5%Day of Interior Finish $ 17 38. Automatic pool cleaner: Type Pat n els 4 bo 39. Stub plumbing for future pool cleaner ........................................................INCL. TOTAL $ �� 40. Floor recirculation system mat- 41. t- 41. Automatic chemical feeder.. OUNC.., .A?'614 INCL. TERMS AND CONDITIONS /....... . .. ................... POOL HEATER & UTILITIES THE BUYER UNDERSTANDS THAT BY SIGNING THIS AGREEMENT,HE OR SHE ENTERS INTO A CONTRACT WITH E.P.I.AND THE BUYER CONCERNING E.P.I:S CONSTRUCTION OF A SWIMMING 42. Deluxe pool Heater: Size Make POOL,MEETING THE SPECIFICATIONS CONTAINED IN THIS AGREEMENT.ANY CHANGES IN ANY Indoor/Outdoor "^- NaUPro OFTHE TERMS OR SPECIFICATIONS OF THE AGREEMENT MUST BE MADE IN WRITING SIGNED BY " "- E.P.I.AND THE BUYER,AND NO VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE Fuel connections, heater venting,fuel storage tanks, permit..............BUYER PERMITTED. 43. Install underwater light(s), each with 10'conduit ....................INCL. AS PART OF ITS OBLIGATIONS UNDER THIS AGREEMENT E.P.I. IS PROVIDING THE BUYER 44. Electrical bonding of pool as required by city or town code `1&CI . WRITTEN GUARANTEES REGARDING THE SWIMMING POOL WHICH IT WILL CONSTRUCT PUR- 45. Electrical wiring and connection up to 75'from service panel J7l L.• SUANTTOTHIS AGREEMENT.THESE GUARANTEES ARE CONTAINED IN A SEPARATE DOCUMENT Pool over 75'at$ !Z per foot BUYER WHICH IS PROVIDED TO THE BUYER. Pool/Spa at$_1L per foot BUYER THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANYTIME BEFORE MIDNIGHT OF Heat Pump at$14!! per foot BUYER THE THIRD BUSINESS DAY AFTER THE DATE ON WHICH EITHER THE BUYER OR E.P.I.HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF CANCELLATION TO E.P.I. HYDROTHERAPY SPA THE BACK OFTHIS CONTRACT CONTAINS IMPORTANTTERMS AND CONDITIONS.THEY ARE PART OF THIS AGREEMENT.READ THEM. 46. Attached ,-.N Separate -, Raised "" Light I ACKNOWLEDGE THAT THIS AGREEMENT IS A LEGALLY BINDING CONTRACT,SUBJECT ONLYTO Blower #Hydrotherapy jets THE ABOVE CANCELLATION PROVISIONS,AND I CERTIFY THAT I HAVE READ AND AGREE TO ALL Automated System - TER4S AND CONDITIONS OF THIS AGREEMENT. ���.� : .1� t'i•� t�.yl,_. -. ENVIRONMENTAL POOLS, INC. ACCESSORIES BUYER BY:-��'" - w 47. Deluxe cleaning tools(18"nylon brush, hand leaf skimmer, f� .fd thermometer, pole,test kit, deluxe vacuum) ..............................................INCL. 48. Diving board: Size Color tic - BUYER 49. 3-tread S.S.ladder/handrail 50. Pool slide: Size Color ffe DATE ~I ✓ f G- ✓,� DATE 51. All jigs installed by decking contractor or buyer - �� NOTES: 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM A PLAN ENTITLED SPECIAL PERMIT AND DEFINITIVE SUBDIVISION PLAN, CARTER FIELDS SUBDIVISION; SCALE: 1• = 40'; DATED: AUGUST 9, 2002 (rev. 1/1703); PREPARED BY THIS OFFICE. DEUNEATED WEI`LAN 2) THE INTENT OF THIS PLAN IS TO SHOW THE AS— LOT 7 PER PLAN REF- #1 BUILT LOCATION OF THE FOUNDATION ONLY. . N71.24'1.7„E. _ . . _ _._�.. - �218.00' —. N N � 00 O OD A a � 1 HEREBY CERTIFY I THAT THE FOUNDATION SHOWN HEREON 31.08' I !Z� i a w IS THE RESULT OF A FIELD SURVEY MADE ON AUGUST 27, 2003. I p LOT 6 d CONCRETE I �tN of ae�� I FOIJNbATION I Oa� s4�� • 15p, I .CHRISTOPHER N v I NO DIS1U FRANCHER / RBANC ZdNE No. 36116 0 25.05 `"'Y .., O - - - - - - ------- --- -- -- -- - --- � �N R O b o o o g1 Z� 03 LICENSED LAND SURVEYOR DATE - s71*24'1 7"W 218.00' - CERTIFIED FOUNDATION PLAN LOT 5 CARTER FIELDS SUBDIVISION — LOT 6 CARTER FIELD ROAD NORTH ANDOVER, MASSACHUSETTS PREPARED FOR TARA LEIGH DEVELOPMENT, LLC 185 HICKORY HILL ROAD NORTH ANDOVER, MASSACHUSETTS GRAPHIC SCALE 03079 ___ +03 �« Rte. Suft One 0 15 30 60 Sobm. Now Hampshire 603 $93_0720 MHF Design Consultants. Inc. SNEERS•PLANNERS•SURVEYORS SCALE: 1” = 30' DATE: AUGUST 28, 2003 DRAWING (IN FEET) N0. DESCRIPTION BY DATE DRAWN BY: CHECKED BY: PROJECT NO. NAME 1 inch = 30 ft. REVISIONS JAC CMF 110900 1109ABF.DWG