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HomeMy WebLinkAboutMiscellaneous - 143 WEBSTER WOODS 4/30/2018Date. ! ........ ,see O TOWN OF NORTH ANDOVER a PERMIT FOR 'GAS INSTALLATION This certifies that ... tr a� .!Z�S•?�!7��?....... ..........:. . has permission for gas installation in the buildings of .. Allez�. / �...................... . at .. �r'�-�..fr . �� �!� North ndov -r, Mass. Zs s� i Vis' .! . Fee. Lic. No.. S . GAS INSPECTOR Check # 9965 8023 4 -k G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYMA DATE 7(J��� _. PERMIT # C i JOBSITE ADDRESS [;;����i�_ WNER'S NAME OWNER ADDRESS TELE:--7— . a� OCCUPANCY TYPE COMMERCIAL EDUCATIONAL F RESIDENTIAL NEW: I RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES El Mr- APPLIANCES -1 FLOORS BSM I 1 1 2 1 3 1 4 1 5 1 6 1 7 1 S 1 9 1 10 1 11 1 12 1 13 1 14 WATER HEATER- - OTHER j - - ._w.._ i �I N INSURANCE COVERAGE I have a current liabilinjinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES. 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 Generat 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 rate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co i a Pertinent provigion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i PLUMBER-GASFITTER NAME jj/C (} ILICENSE1 7�: qq SIGNATURE MPF+'MGF ( I JP .GF j LPGI CORPORATIONS, PARTNERSHIP LLC COMPANY NAME I-G,ri's�tfC� iADDRESS CITY STATE ]ZIP �� TEL, FAX 14,W CELL jEMAIL[ U�/�Z-. -AAe7 Uri W O z z 0 U Fa a z a 0 E a d❑ Z } o � w � W 0 CL u LU 0 LU LU O w O o � v J a a y LL1 g W H � Fa � z � \ z t -i Eb U � a z Cx7 O A QSk Tire counnonlyealth ofmMacklmem D001,114711 o, lid o,`Xatres6rgRGttrs 690 WOUNValf Stred Boston, MW 02111 mp.lumgorldhi 19flifft-rd, ODH1tMCf1DrWWtft*,bAWulubm a RAmm it I i i for, mut [on. MOM if.. At"eYou an emPlOPr? Check the aPproprkfe box: I'D Iata. H.etnp1qYLTvxi1h 4. 1 am a general-4effiltmoorml I Type of Praimt (revar—eq. -7-- ctupkyem (fall andFor pad-timor I dro Intim fired contmckrs 6. mcollstmetim 2. El I am a sole; proprietor or bat tier listed, On lite afthed Acet. I 7. Rcmo&ft ship, and hm, � no cuiployces 71=0 iub-contractors, haemo & Dentaffflan Vverking rorm famy capacity. [No lwrkvw comPAUSUMCC work-ew COMP. 11mmm. 5. We are a coiporaflou and its 9. El RuildheaddMon mtrcd Ofr[Cershav;ech�m, (ilheir 311 IAnn, afloured mmdofii&afl%mk grit Ofeweimption Per MGL PlumbIng r or additions "UNIC [NO, WorkeW comp :0. 152, §1(4)a and %ve have no 0213 Roorrepah iaisuraue0 raphe&I t clup1qcesfHo work-ew 13 ©alter comm inum rei iretfl .0 L Mmyj4plk4d that ch.& boxEl uiu4ddo r1wou I ffr stOC6(On&,1O%vS11O1A11.* theirmk-W Cor"Cusaii .. on Nkyluratimlim amdaing till %vork mid then a kunveffiftakwofingtSuck �dbrtty la ii dA UE%t,,oi mi;t -.n&-fW.j mt Adigaz-Att.EemeiWm,P. prr..T wki M661L tom, fcirnrrttli�rF Policy a or Sdf-hm. M. Job Sib , PiW&,aicM,*pz AttavkA cOf File WOrkeW ecaureasation policy declaration page (showing tbt Mae tosecure covmge as required, tinder SictWi 25A ofMGL c. 152 can lead to (he FuTuskidij oferimiftial perW=�,a of fmcapteS,1,5.M,Og�an. d,foron--year imps 'sonnicoLt,asvvelI as civil pematfies in the f0mil of'a SPOP-111ORK ORDM and a filue Of uptasnOLOG aLday against the violator. Be advised that acopy. of [tits statement in' Y bC fOM-dided, to ft - Officoof tuveslipftis; of the DIA for, fitsurance covemge verification. Idolremb r car froft eadpeflafts otpedury Iftaf life fir curled t tri=iirLr al fs fte affdicurr"t 0 fflmhrf, use OH4-. Do. flat W&C N WS area, to be CmUfftted hir do� or town af)ldff I City, or` av�m: . PeratfuLl feense ff Issuing Anthurity(circle one): I. D , p. rd of Health 7- Building,v Reirartment 3. Cityfiroa Cterk 4. Eleetrica, I I Inspector 5.P1t=btughtspvdoe &Offier— Colituct Pet -so, Information and Ins udions M chMe#fs General Laws chapter 152 require at eniploym to, provide worker' compensation for their employee& a to l statute, an en+plo�ee is �Pefinexl frs ",..e yea y person in file sereice of arao#her t ederarny contract of-Wre, =P= or implied; oral or written-°° Milvier is defined as "an individual, p a"'t"o shiip, association, corporation or other 1 6 entity, or any fivo or Yme of foregoing engaged its a joint enterprls-,and itncluffig the legal represetttatitres, of a deceased entpl%ger, or the river or ktWee of'an Individual„ partnerships associatian or other legal entity,; employing employees` Ifowever the OwIler offa dwelling house having, not more thigh throe apatfinents and Silo resides th, oreirp, ortheaccupant of the dWellft house of another who employs persons to do mairafetttance� wastrttetion or repair work on such div�eIIiug house or on. the grounds or building appifrtenattt thereto shalt not because of such emplay�nrent hewed to be an emplayer." M -W chapter 157 §25C(6) also states that "every state or local lk-e sing agency shall wfUlhoM the issuance or newat of fn license or permit to operate a lafuiness or to construct buildings in the cornmenwealth for any applicatnf when has_ not produced irceeptable evidence ofeomplv1th fire insurance coverage required" Additionally, MGI: chapter I52; 4,25C(T) states "Neither the comanoniveaitlt nor any, of its political subdivisions shall enter into any contract for the performance afpttbllic tzrarkttntil acceptable evidence of compliam with the insurance requireunents of, this chapter have been presented to the contracting authority!' Applicants Please f>t out the workers' compensation affidavit cor"plefely, by checking; the boxes that apply toyoursituat on and, if necessary, supply, sub-contractor(s)narne(s), address(es)'andphonenurnber(s) along with their certMcate(s) of irauce. Lirnifed Liability Companies, (LLC) or Limited Liability; Patlherships (LM with, no employees other than the members e r partaeers� are not. required to carry workers' compensation ittsatrauce. If ata LLC or LLP does have employees, apolicy is required. Be advised that this affidat-it may be submitted to the Department of Industrial Ace dents for confirmation of insurance coverage. Also be stare to sigh and date fire affidavit. the affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should yon have any questions regarding.tho late or if yore are required to obtain a workers' compensation policy, please call the Depart in at the numbef listed below. Self-insured compaiaies should enter flreir self -ice license number on the appropriate line. C tyor Town Officials Flee be: stare that the affidavit is complete and printed legiEily. The Department has provided a sPace at fire bottom, of the. affidavit.for you to fill out itu the event the Office of investigations has to contactyou regarding the applicant. Please be sure to fill in the perniitdficense number which gilt be used as a reference number. In addition an applicant Mat irrust submit multiple. permit/license applications in. any given year, need only submit one affirdavit indicating current Policy infarirnafion (if necessary) and under "Jobs Site AddresP the app ie nt should u rite "fall locations in . (city or towta r A copy of the affidavit that Iras. been Officially stamped or,narked by the city or fowit maybe provided', to the applicant as proof that a valid affidavit lion file for future permits or licenses. Anew, affidavit must be filled out each gear_ Where a home owner or cifimn is obtaining a license or permit not related to, any business or comnnercial venture (i -e. a doglicense, or permit to bunt leaves etc ), said person is NOT required to com plete this affidavit. The Office oflnvestigations would like to thaak you hi advance for youar cooperation and shoutd ym have arty questions, plemdo not hesitate to give us a calf. The dent's address, telephone and fax number The C:ommonma th ofMasmchusetts Department ofInd0sleia Accidents Office of f tivesf ga,i' pans 600 Washington Street[ Boston, IMA. 021.11 Tel. # 617-727-4900 ext 4406 or I-877-MASSAFE Reviso,d,5-26-05 Fa! # 617-727-7749 A,%v maSs.gov1dia Date ........ -3 -, ....— ., / ,) ..................... Of NORTH 0 TOWN OF NORTH ANDOVER 0 PERM -IT FOR WIRING This certifies that ................. has permission to perform ..... .. ........... ....................................... wiring in the building of. at .. ......... North Andover, Mass. ... ... . ...... ... Fee ................. Lic. Nol-;17 ........ .... ........... ... . ELECTRICAL INSPECTOV Check# I Commonwealth of Massachusetts official Use only Department of Fire Services Permit No. .14 633 BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELEC rRiCAt WORK All work to be perforated in accordance with the Massachusetts Electrical Code (MEC}, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEALI, INFORM�T1011� Date: �' 3 a — City or Town of- 121-17, e - 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) /% 3f�, Owner or Tenant 41, 6 , , � i" f � � Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 2-ilding Permit # 11 Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Gtl %y� "7'r C No. of Meters No. of Meters . Comnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans o. o ot, Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures l;h g Swimming Pool A ove ❑ r ❑ g rad. rad. o, o Units Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Devices No. of Ranges TotaInitiatin No. of Air Cond. Tons No, of Alerting Devices No. of Waste Disposers p Heat -Pump Totals: um ,er ons _..... o. ofSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local Elumctp ❑ Other Connection No. of Dryers i'Y Heating Appliances KW Security : No. of Devicor E uivalent No. of Water ICS Heaters o. of No. of Signs Ballasts ; Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a eNo of Devices or Eqns uivalent uivrinalent OTHER: 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 covers force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) 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. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. Current Insurance certificate must be on file in our /office and affidavit must also be filled out with each application. FIRM NAME: x /-,�� "- < /fi le- / I rt / LIC. NO.: Licenseeli :, �' Signature /�/ LIC. N0• ; (If applicable, eat "exempt - in the license niunber line.) Bus. Tklf.: HJT ` Z Address. Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licenfee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ELECTRICAL PERMIT NO. INSPECTION REPORT.- ELECTRICAL-INSPECTOR EPORT:ELECTRICAL-INSPECTOR - DOUG SMALL, 1. ROUGH INSPECTION: Passed - [ l Failed — l Reins tion required Inspectors' comments: (Inspectors' Signature - no initials} Date 2. FINAL INPECTTON: Passed - ( Failed - [ j Inspecio mments: Re-inspectian required ($50.60) - 'co ,: i} a (Ins tors' Signature - no initials) f. UNDER GROUND INSPECTION:assed - [) Failed ; [ j .Re -inspection required ($50.00) - j jnspectors' comments: �C (Inspectors' Siena re - no initials) = - Date 4. INSPECTION — SERVICE; - - --. DATE CALLED NATIONAL GRID: - NAMEs Passed - i 1 Inspectors' comments: Re -inspection required {$50.00} _ C - - r - . (Inspectors' Signature -.no initials} Date 5. INSPECTION - OTHER: Passed (j Failed •- [ j Reinspection r _ Inspectors' comments: squired {550.00} - [ ]' (Inspectors' Signature - no initials) ., 5 DOOR TAGS ARE' TO BE FILLED OUT AND LEFT ON SITE -IF TIRE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF. $5"0 IS.TO RF Alt- EEI3. i C� HOFty ,� i 0 Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT r PERMIT NO.: 3� PROJECT: UNIT NO.: REMARKS: FLOOR: �SSu � 7-//-00 `J i�s / C- .. 1 1d0.DATE: / /l D i' WING: BUILDING NO.: /Z -3 Excavation - depth and soil conditions Framing - Other: Date: f "�©� Date: /7-9- Date: Inspector( Inspector Inspector Footings and foundations and drains - Insulation - Other: Date: - e, -co Date: / 2— r 3 '" oo Date: Inspector AM ��`'' Inspector ,/" Com`"-- Inspector Electrical - rough - Plumbing and/or gas - rough - Other: L Date: C96 ` t'r Date: -z - 1 S '-0 Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Af`3� ` G l Date: ` ' Date: Inspector �;��///( Inspector 7 `4nef Inspector Fire Dept - oil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: `� `� `c'� Date: y` Date: C of O # .3 5 Inspector Inspector In ector Form #995 Action Press, 685-7000 _ ,-. .�...a.-,-r+� z+,....-...;-,�„ ._ ., �.-,--'�. -: s .. - z. � r � - , :•�» A ' � � -:mss,,.. „ t,,y�.. _ _ i / " ,;p -y f'� 1 .� C CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 31— o.t. H-6 ami THIS CERTIFIES THAT ,, / ,,� THE BUILDING LOCATED ON�dg 7 � bees MAYBE OCCUPIED AS �' whil��`��' IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONIS AS MAY APPLY. -5 S te!/ tv.t.Jr'in Q MORTq , CERTIFICATE ISSUED TO O •.o , ye p ADDRESS e2 , / ,56UN ' ST ,Sur (f O� 1t �ACMU � Building Inspector 4`, 0I J i] I FO O FM4 f UJ z 0 C H O :vV com oQ o � O • � � r V O nit. o a� c � O �CD c CL= _Zip ICEdZ_ aL m c 0 c C O Q 'fl a am O cc) y Ir Z O W 2-8 Q! •+ c CLO _c m H m c �c CD O.*"31 O N LL - ,(AA a=OC Z oc �E W= ;;C H o v m omc g CIO -F, O� O� 2 � 0 ,= O z sa..m RX 0 /•u�' �I O LIM ts a� O CDts • oc i- 0 Z o G. O y o c cm O■� ca 0 'O O LA O O 'E m m 0 CD CLCD CD O Ca i A d C O .ca 'O d O D C Z ts a± V y C c COD cm 0 U) U) W W ccw U) O v d H A�:z � L �z � d W®�a w ,� o a w° cin .0 q w° ' ° U w V ww ° cn c z Q o H rz° rA cn cn FO O FM4 f UJ z 0 C H O :vV com oQ o � O • � � r V O nit. o a� c � O �CD c CL= _Zip ICEdZ_ aL m c 0 c C O Q 'fl a am O cc) y Ir Z O W 2-8 Q! •+ c CLO _c m H m c �c CD O.*"31 O N LL - ,(AA a=OC Z oc �E W= ;;C H o v m omc g CIO -F, O� O� 2 � 0 ,= O z sa..m RX 0 /•u�' �I O LIM ts a� O CDts • oc i- 0 Z o G. O y o c cm O■� ca 0 'O O LA O O 'E m m 0 CD CLCD CD O Ca i A d C O .ca 'O d O D C Z ts a± V y C c COD cm 0 U) U) W W ccw U) 'W 0 3 y W Cd 6 z c o : m C o C N dC r O v P. C r O O O r Win:cm� a� E O y C=OM p y H C C O O :.r y O to 0 CM O y m O Z Z O Cf C� C C N Q 0 0 v Z o O Cpf x m�CLC O •O m�o N M r y 'CL m Z m LU .. c M .y 'St �° c Z �E w :� � .y O L3 a oma g cap a m� O� A ��v''� Q �- 0 COL 1 1M cm I 0 ca 'ff m m CL co i cmQ ca Cc .� co U H c C C .s CO) t 'A 0 U) ccW LU ItW LLJ U) rokAG w x v LE cn ci w° U w" W V) yp 7 C L14 Z 4 co cn cn 6 z c o : m C o C N dC r O v P. C r O O O r Win:cm� a� E O y C=OM p y H C C O O :.r y O to 0 CM O y m O Z Z O Cf C� C C N Q 0 0 v Z o O Cpf x m�CLC O •O m�o N M r y 'CL m Z m LU .. c M .y 'St �° c Z �E w :� � .y O L3 a oma g cap a m� O� A ��v''� Q �- 0 COL 1 1M cm I 0 ca 'ff m m CL co i cmQ ca Cc .� co U H c C C .s CO) t 'A 0 U) ccW LU ItW LLJ U) Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS l q 3 W e e ,91-er M e-DWs Zsj . LOT NUMBER SUBDIVISION 0 awe L:.,�1 ries f DATE REQUEST FILEDc31-7$"/O / DATE READY FOR INSPECTION '1610 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STR.IJUGI-bpES NOT MEET ALL APPLICABLE CODES. SIGNATURE ************************************************************************ ROUTING CONSERVATION PLANNING D.P.W. — WATER DATE v A, DATE VV 1� 5,11a ATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIG THE INSPECTIO REQUEST DATE. SI NATURE / DPW AUTHORIZATION "14-4k I f 1. APQ-0-14-01 12:24 PM PIS TUMHWOODS AAA 894 r,971 p 1 0 x 13 -1 -ling ONarth4-% I ,A U 1.i4 'SIP A i Andover, A :Si Nif. 1vat'Lluire.- fill, in r"'I"Al ihn rellittIA,irs" farm Will --t l%A L.., 41-- —11-- -- A19101d1l I OR'. M -Ft Mal Location �7 Lv'e� �" W,,( 4 No. Date C;7 -A TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ J9� ,-- Foundation Permit Fee $ Other Permit Fee $ (1 TOTAL $ Check # / 3 � —3 145 I -A /A ca, v Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Use Q� BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: -�^�-- Building Commissioner/In for ofRididings Date SECTION 1- SITE INFORMATION 1.1 Property Address: u7 = l� r-OTP� r S' 6)/?, 1.2 Assessors Map and Parcel Number: / P& /9- Map Number Parcel Number 111-3 1-ue r6 ''ter 6)o p js Cam 1.3 Zoning Information: Zonin District Proposed Use 1.4 Property Dimensions: Lot Ar—'ea so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard. Rear Yard Required Provide Required Provided Required Provided �'`' ` 0 � D � 6 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public V, Private ❑ Zone Outside Flood Zone 0 _ 1.8 Sewerage Disposal System: Municipal On Site Disposal System 0 SECT ON 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 31 S 5 s 41,-te Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 'Ila�G�? � 1.S.Cf' r/, Licensed Construction rvisor. ress Addell G 87- S.3Qa Signature V Telephone Not Applicable ❑ CS License Numbei Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ESA 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 .......0 No ....... ❑ SECTION 5 Description of Proposed Work(check all a Ucable New Construction Existing Building ❑ Repair(s) ❑Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed bX permit applicant OFFICIAL USE ONLY 1. Building 1�3t� 000 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) t 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, �i6i//�i �� ash/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 IV Print Name % Signature of Owner/Agen-1 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS FIE IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIA- OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE + 4 FORM U - LOT RELEASE FORM INST RUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/Gr landowner from compliance with any applicable or requirements. *"APPLICANT FILLS OUT THIS APPLICANT. 2�� �o,re54 CGC PHONE LOCATION: Assessor's Map Number PARCEL0 SUBDIVISION=ozwaAell / 0�f5 t LOT (S) �5 STREET (�j fPr ,)00,Cs L,,f'74 ST. NUMBER�� I,Ci P * ** k* *.,.,****************** O F F iC IA L USE ONLY**�ttttt *t * ** t *** RECOMMENDATIONS OF TONIN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS 6 DRIVEWAY PERMIT /tw FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 im DATE ti m m C m m m Omi .0 O O v CD C. crV � d CD O .. .. d O CQ CD CA 10 CD 0 ivJ d C7 CD CD CD a� H CD �i CD 0 CD O -• ceN d C., �. 0 ,� y Sm O O n cc cm M Z y ?� ca y. .� = NO O y '77 ?arta O .�E MR Fr cp rt CD H p ti O . .••1 ^o' i o 0a o%S SO o = 00''�� m n o y. n � oo . b c ?' S C4)Cn _ Z so o g . ff^^ � m H ,..dcn � c a Vat. ®C, N c-� z G W d C cn ►Q ti c m ll 11�, v, CD GO ry�q m Md m CD l l `� 3 W m 0 0CD��'-� n Z % �sw c ED OW CAo ogr r : � CD .- -100 �, _ CAr-: CA y C z 0 )Nq 0 9 (n 0. r, d C/) o oj ., z p'_ 0 a� ^n Cn 0 fix° M r n x 0 � x .d `"X °� n p aim �- O 0 a a Gi c O �. O W v N2 2758 Date^ TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies ....................................................... .................... has permission to perform, ......� ..- *O !T - ..... wiring in the building of ................................ ............. . North Andover, Mass. Fee.`- -- ... Lic. No .............. .... ................................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer The Commonwealth of Massachusettsr..,�,tt No, �`" °t' e 1� • Department of Public Safety ��0 °'"`'' ° �" Chi " �- �(tuve bl.pk) BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.00 APPLICATION FOR PERMIT.TO PERFORM ELECTRICAL WORK All w.+ork to be performed In accordance with the Mattachutetts Electrical Code, 527 CFS(t 1,2`�:000 (PLEASE PRna IN INK OR E. ALL I 0:M:1&TIOII) Date -1Z- <)(0... Q city or Town O �6r To the Inspector of hires: The undersigned applies for permit to perform the electrical work described below. Location (Street & Number7 ) I �3 ("ani e4e r Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No, Kew Service Amps / Volts Overhead ❑ of Mctcra�� Undgrd No. of I.Ieters Number of Feeders and Ampacity-� Location and tlature of Proposed Electrical Work No. of Lighting Outlets No. of llot Tubs No, of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- grnd, ❑ ❑ KVA Generators grnd, 1�Vp No, of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting No. of Switch Outlets No. of Cas Burners Batt'rY Units FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond, Total No. of Detection and •o, of Disposals tons No. of 11eat Total Total Initiating Devices ----- pumps Tons KW No. of Sounding Devices No. of Dishwashers Space/Area heating KW No. of Self Contained 1 No. of Dryers Detection/Sounding Devices Heating Devices, KWLocal Municipal 1:1Connection ❑ Other No. of Water Heaters KW ltO� °f °• ° S1 Low Voltage ns 11allasts Wiring -Oyl.l �� No. Hydro Massage Tubs No. of Motors Total IlP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or iNO ❑ ts substantial equivalent. YES �j NO I have submitted valid proof of same to this office. YES If you have chew ed YES, please indicate the type of coverage by checking the appropriate box. INSURANCE � BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S xpirat on ate Work to Star tf_&c7 W Inspection Date Requested: Rough Final Signed under, the penalties of perjury: FIRM NAME i/ %; A e " LIC. PI,-,, Licenseeh e J;-,* , Signature LIC. N0. y- 1 g7J Address _ Bus. 1•cl. No. vQ� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not leave tle•insurance coverage or is su stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S ti Signature of Owner or Agent 3350 Date./ 1i.:..-%..... NORTH TOWN OF NORTH ANDOVER Oy 11to ,t 6 p PERMIT FOR GAS INSTALLATION /: This certifies that ... .:...:. " :� .... �..`..................... . has permission for gas installation .............., `............ . in the buildings ofd .. ! ::.f:. r f. ?: : ..................... at ��... �... ..1 . 37 :...::......... : North Andover, Mass. Fee. Lic. No...%...' .......... : f...... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer acro. � i i t r ��Type or print) NORTH ANDOVER, I Building Location�o�� MASSACHUSETTS ni IFORM APPLICATON FOR PERMIT TO DO GAS-)♦r=G CHUSETTS Owner's Name New ❑ Renovation ❑ Replacement ❑ Permit # Amount S Plans Submitted ❑ 7J- 19 OG - Print or type) ame (j a ddress 3usiness Telephone Check one: Certificate Installing Company °�l? ❑ Corp. ❑ Partner. %Lt! Firm/Co. Name of Licensed Plumber or Gas Fitter z INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. YesElNo ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy j� Other4vpe of indemnity ❑ Bond ❑ Owners Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws.. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ AQent ❑ N hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of Massachusetts Sta�jGas Code and Chapter 112 of tie General Laws. By: Title City/Town APPROVED wFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber ❑ Gas Fitter License Number 'Master Journeyman e ''-- o N2 2624 Date ...l.........5........'f.............. TOWN OF NORTH ANDOVER 211 0 PERMIT FOR WIRING 4L Thiscertifies that .................... .............................................................. has permission to perform ................. ............................................................ wiring in the building of .... ...................................... ......... ......North Andover, Mass. 7" Fee.. ........ Lic. Nc(-': ...... 1-1A .... ...................................... ELECTRICAL INSPECTOR Check 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date /A-.1:1. • . ` I, - N2 462 �H0NTM 1 o do TOWN OF NORTH ANDOVER 00 PERMIT FOR PLUMBING This certifies that .. ��.. �,.%� • •f/ G r` °` •'/ • • • has permission to perform ..../1/. .�` . �,`.�'•`�............ • • • plumbing in the buildings of ...1-;Af r-7 .r5:! '. ............. • • • at .�� .C. ..>. tti �•r /r.`'• •``•`I North Andover, Mass. Fee Li c. No.. ....... i\ . .......... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS U ad G� 11 'r_ ` �` ate Building Locatio 4 Owners Name i Permit #' D L Amount 3— — New 0 Renovation 1:1 Replacement 0 Yes 1:1 No 11 (Print or type) / / Check one: Installing Company Name �i % 0 Y /�� 2��7` t° /"� Corp. Partner. 0 Firm/Co. Name of.Licensed Plumber- Insurance lumberInsurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Q, Other type of indemnity ❑ Bond Certificate 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 submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State PI b' g Code C 142 of a General Laws. By: ignattire ot L1c—e&n`si0IumUe—r ' Type of Plumbing License Title City/Town rMse fqum5er Master Joumeyman ❑ APPROVED (OFFICE USE ONLY �-F� DeJanteuecrt °� �u�lta Saaefiy BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 umclal use Only Permit No. Occupancy & Fee Check4,57 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date A— Y -'G1 � To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the Location (Street & Number / 7 Owner or Owner's Is this permit in conjunction with a building permit Yes 67,-' Purpose of Building Pe? tib N®R No ❑ (Check Appropriate Box) Existing Service,, //Amps Voits Overhead ❑ New Service Q10 6 Amps la bld)ld Voits Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot fuse Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ No. of Receptacles Outlets. No. of Oil Burners No. of Switch Outlets No of Gas Burners Initiating Devices No. of Ranges No of Air Cond Total Tons Heat Total No. of Di osal No. Pumps . Tons KW ❑ Municipal ❑ Other Local Connection No. of Dishwashers ✓ Space/Area Heating No. of Dryers Heating Devices No. of No. of No. of Water Heaters KW ec,,.,- Tuds (/ 1 No. of Authorization No. © 0 & ,tea ) Undgrnd ❑ Undgmd o---- No. ad No. of Generators KVA No. of Emergency Lighting No. of Meters No. of Meters INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have.a current Liability Insurance Policy includi mpleted Operations Coverage or its substantial equivalent NO = have submitted valid proof of same to the Offs NO = If y u have the ed YES please indicate the_type of coverage by checking the appropriate box. RANC = BOND = OTHER = (Ple .Specify) /�w� f � _ p C �Esttiimated Value of Electrical Work$ (Expiration Date) Work to Start 4,0 — Y Inspection Date Resquested Rough C•"�� Final Signed underthe Penalties of p rjury: FIRM NAMES r� �s LIC. NO. a3 > LIC. NO. Bus. Tel No. / Address %/ �/� %" iei' i !/'P 14Bus. Tel. No.— j $ g y OWNER'S INSURANCE AIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMITTEE $ J / 0a FIRE ALARMS No. of Zone No. of Detection and Initiating Devices Total KW No. of Sounding Devices No./ of Self Contained KW Detection/Sounding Devices KW ❑ Municipal ❑ Other Local Connection Low Voltage INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have.a current Liability Insurance Policy includi mpleted Operations Coverage or its substantial equivalent NO = have submitted valid proof of same to the Offs NO = If y u have the ed YES please indicate the_type of coverage by checking the appropriate box. RANC = BOND = OTHER = (Ple .Specify) /�w� f � _ p C �Esttiimated Value of Electrical Work$ (Expiration Date) Work to Start 4,0 — Y Inspection Date Resquested Rough C•"�� Final Signed underthe Penalties of p rjury: FIRM NAMES r� �s LIC. NO. a3 > LIC. NO. Bus. Tel No. / Address %/ �/� %" iei' i !/'P 14Bus. Tel. No.— j $ g y OWNER'S INSURANCE AIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMITTEE $ J / 0a Location h0� -41Y3 AA6k WGD N No. _ Date b &OWTN TOWN OF NORTH ANDOVER f � Certificate of Occupancy $ T �SSAC"us E4 Building/Frame Permit Fee $ Q1 C1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �/ Q, r Check # QiO 1144 Building Inspector AUG -21 —00 MON 1 4: 25 S _ E _ Cumm i ns s Assoc, i goat P _ 02 S.F. Cl/MNIMS & ASSOCIA M P.a Box ia37PLA/scow, Jv.H. o�j ees rK&W0A/E (8031-0!� 821 506'S PAX ($V/�ii! 38.2-5210 c X60 WSRSr£R w0ops ` R-2� pf ` 06 9— a p CC-$ CC-3f� / T-8 W:=—, T-7' CC, -2 �,+t CC -S PKC � r-12 T -d cc -1 T-11 t-10 \ C-1 Q^` 9 2' -4L r -s f sr s�js - fetc 770V haw 1 Lot 8 r 9Z295 S.F. C -s 2.12 ACRES / f C-10 /f / C-11 l _ / INF. g /5C-12 s� / , C-13 m EDGE OF FUGGED i WVL4NDS �1 1 N 22.34'15" a 68,00, W� dry" fi3 700, ! lfic.-REBY CER77FY TO TOWN OF N©R7H ANOOVER, MA BUILDING DEPARTMENT THA T THE EX/S77NG FOUNDA TION DRAWN ON THIS PLAN 1S LOCA TED AS SHOWN AND THA T /T DOES COMPLY TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. C -z C-3 C"4 C- C -7 C AF, urs A1 -FW T. TRUIDEI c--ts SCALE I" — 60' { ' DATE: AUGUS r 18, 2000 TAX MAP 109-A / LOT 8 CAMPBELL FOREST NORTH ANDOVER, MA. MINIMUM SETBA CKS.• FRONT - 30 FEET SIDE - j0 FEET 1 REAR — 30 Ff_ ET Location L 8 ig 1V3 alPbsk-t IA)°o) 1,-,, No. S t� Date 17—IR-Do TOWN OF NORTH ANDOVER OIL go o •, Certificate of Occupancy $ (j ",•�°' E<�' Building/Frame Permit Fee $ sAcMus 1/� C7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 5 Check # 9/ E0 13 194 Building Inspector SIGNATURE: Building CommissioneLAs Int6rof Buildings Date SECTION 1- SITE INFORMATION n 1.1 Property Address: �Z o �- g'" 1.2 Assessors Map and Parcel Number: Map Number �7 Parcel Number X13 Gc)�6sf er t e.lc�U�s (014p— 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr osedTJse �— Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required ' Provide Iteqttired Provided Re red Provided 3( 43 9' 3 , 4/s- 1� a6If 1.7 Water Supply M.G.L.C:40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public JV Private ❑" Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record Name(Prin �Z, ¢� 6 Signature Telephone 2.2 Owner of Record: Name Print I -SECTION 3 - CONSTRIJC.TTON SF.RVTCFS l Address for Service : Address for Service: X3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Not Applicable ❑ �' CS 0 6/ 3 License Number Address Expiration Date Signature Telephone Is 1,) X 657 — 5' -2 0 3,.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone z M 90 0 r M r r e z G) I 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 ...... V No ....... 0 SECTION 5 Descrition of Proposed Work check A a ucable New Construction Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ I Addition ❑ Accessory Bldg. ❑ Demolition' ❑ Other ❑ Specify Brief Description of Proposed Work: I CF.CTTnN 6 - F.CTIMATRD CONSTRucTION CYSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIALUSE ONLY 1. Building ado 90 v (a) Building Permit Fee Multiplier �>D 2 Electrical (b) Estimated Total Cost of Construction V, 3 Plumbing Building Permit fee (a) x (b) aJ yo• - 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION 'PV BE CUMYLE ILD W REIN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 77b OWNER//AAUTHORIZED AGENT DECLARATION I, zoo/ I ` �S s l as Comer/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 of S_e? 3/od Date NO. OF STORIES o2 SIZE 3� BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I L t"J7� T 2 �� r� gid. f 3 SPAN 6 DIMENSIONS OF SILLS DIN ENSIONS OF POSTS OV t 2'/ DIMENSIONS OF GIRDERS t 6 y e ,e G. HEIGHT OF FOUNDATION THICKNESS 10 SIZE OF FOOTING 10 4' X 'e MATERIAL OF CHIMNEY e �qoZ IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ut'S .1 z FORM U - LOT RELEASE F0RM INSTRUCTIONS: This form is used to verity that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION""'*'`"`"`*t"` APPLICANT 62V O PHONES'30U LOCATION: Assessor's Map Number PARCEL SUBDIVISIONl��R`� ��� LOT (S) D STREET C 10199)kPr Gc 6#pl/S Ca, ST. NUMEER__�1/3 *4k �* **OFF1C1AL USE ONLYS ***t** RECOMMENDATIONS OF TONIN AGENTS: 1 �r G, <,,z CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER DATE APPROVED /' DATE REJECTED_ dJ DATE APPRO DATE REJEC' COMMENTS FOOD INSPECTOR -HEAL SEPTI,C-fNSP'ECT,OR-HEALTH COMMENTS DATE APPROVED DATE REJECTED. DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWERIWATER CONNECTIONS 7 FIRE DEPARTMENT � P (�( `I R f.7 IN 1p IU LDiNG D �'r st i 1ENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm DATE The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # F7 1 am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity FV1-1 I am an employer providing workers' compensation for my employees working on this job. sf /- / -- / Ae5/ T.- v Pv Cd /1';' Address 1;�31 5011t61-1 Sy`' S',� f >° o, -?T .City' /ka, o /8ys Phone #: 0,-S) $ 7 Insurance Co. /Pd 190 ci rl, eo Policy # -oo Comoanv name: Address City: Phone #: Insurance Co. Policy # 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 51,500.00 and/or one years' imonsonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy cf this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pain and pena ' s of perjury that the information provided above is true and correct. Signature Date 116 v u /2 s 57- 76 Ci Print name ��� SSe// Phone n _— Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensino ❑ Building Dept ❑Check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone: ❑ Health Department ❑ Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: iY, %' Location of Facility Si ` e o ermit Applicant /vZ.3/0o ? i Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 0 Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shalt be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of.North Andover Growth Management Bylaw, i ne building applicant shall provide all of the necessar/ information as requested 'below. Name of Applicant on Building Permit (below) Address of Property for Fermit (telow) Crc,7' A4L,,L Fmrejrf &'(C /Y3 4�. e Map and Parcel Purpose of Application (check below) Phone Number of Applicant • ,moi Single Family Two Family _ &S7 5.300 I the undersigned applicant for the above property attest that the attached building permit for which this form is cmpleted does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuarca cf the uiicing Permit. Further I understand that my interpretation of the E<EMP T ION status is subjec� ta review by the Building Department and is only of Mly accepted when the Building Permit ig issued. Eased on section 8.7.6 of the North Andover Growth Bylaw the above let and the work as applied for on the above lot, in the building permit application and associated attachments, cemclies 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 recocstructien of a dwelling in existents as of the effective date of this by -taw, provided that no additional residential unit is created. The lots) wereJwas created prior to May 6, 1996 are exempt from the provisions of ;his Section 3.7 of the Zoning Bylaw. This application is for dwelling units for tow and/or moderate income families or individuals, where all of the conditions of 8.7.6.eare met and/or represents Dwelling units for senior residents, where ec unancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. �i This application is a part of a development project which voluntarily agreed to a minimum 4011G permanent recRticn in density, (buildable lots), below the density, (buildable lots), permitted under ening 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 spats and/or farmland. i ne land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the P!anned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(Le, 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 a=mmodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPT ]ON. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate infcrma ' , or a checking off of an above item which does not comply, whether done to my knowledge or not s groun for refusal by the Building Department to issue a Building Permit. .1jr11 11 ed ignature of Gwr nzed Agent wno signed the Attached Budding Permit -Oate This form must be attached to the Building Permit upon application for such permit 4 � r' _ ✓�e �o�rtrrna7uiseaLf�. o��✓��toaciuoe�i r i DEPARTMENT OF PUBLIC SAFETY i CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: CS 069234 0510912000 0510911954 Restricted ,Ta: 00 ALAN G RUSSELL w em� 400 MAIN ST i�.,.�.. GROVELAND, MA 01834 a MAScheck COMPLIANCE REPORT I I I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 5-23-2000 DATE OF PLANS: May 9, 2000 TITLE: "The Hamilton" Lot 8 PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC. / Mesiti Development Corp. 231 Sutton Street Suite 2F North Andover, MA. 01845 COMPLIANCE: PASSES Required UA = 734 Your Home = 713 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 2112 30.0 0.0 74 WALLS: Wood Frame, 16" O.C. 2687 11.0 0.0 240 GLAZING: Windows or Doors 674 0.350 236 DOORS 53 0.490 26 FLOORS: Over Unconditioned Space 2881 19.0 0.0 137 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the ap icab Standard Design Conditions found in the Code. The HVAC equipmen selected to heat or cool the building shall be no greater tha 125% f t e des'gn load as specified in Sections 780CMR 131 �J4. Builder/Designer Date / MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 "The Hamilton" Lot 8 DATE: 5-23-2000 Bldg.1 Dept.1 Use I i I CEILINGS: [ ] I 1. R-30 I Comments/Location I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ) No I Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. i I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ) I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: 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. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: 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. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: 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. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp. Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant (in.) 1.25-2" 2.5-4" 1.5 2.0 1.0 1.5 1.5 2.0 0.75 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 PIPE SIZES TEMP (F) 2" RUNOUTS 0-1" 201-250 1.0 1.5 120-200 0.5 1.0 any 1.0 1.0 40-55 0.5 0.5 below 40 1.0 1.0 (in.) 1.25-2" 2.5-4" 1.5 2.0 1.0 1.5 1.5 2.0 0.75 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 100-130 0.5 1 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- b r 41: m E!d WHSE� . T i 000E 1'2 '-tdb 299Z1b62_ti9 : 'ON 3NOHd ON I `d102ig JN I d3 N I JN3 3I ZN3A3W : W0di m m 11 Zcf WHS? : S T 0002 t?Z '-tdH 99Ztib6Lt9 'ON 3NOHd ON I `dn()NJ DN 18l 9N I ON3 3I ZN3>DW : WDU TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET . NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. 6Villett Staff Engineer Telephone (978) 685-0950 Fax (978) 688-9573 Additional conditions for lots 7,8, and 13, Campbell Forest January 26, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 7, 8, and 13 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these three homes can begin at this time. The conditions are as follows. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation of a conditions will void both water and sewer connection permits. No refunds will be granted. Mesiti Printed Name ti Division of0tubtic Works Printed Naide CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin i Date Date TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Date: Telephone (508) 685-0950 Fax(508)688-9573 LOCATION: BUILDER: phone: OWNER: J`�� Phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: N° 939 APPLICATION FOR WATER SERVICE CONNECTION <r' North Andover, Mass. �Je G4 76 k9�-0D Application by the undersigned is hereby made to connect with the town water main in WG�r/ we 1Sheet subject to the rules and regulations of the Division of Public Works. /� r ,.q The premises are known as No. �a� , LClPpd �j Street or subdivision lot no. /U Owner Contractor �} `J U, / M 6 ,'� 7 5-3c3:�, ,v/mss �o,' Address }Address / �-CI Applicant's S'rgfiature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date A ZV Board of Public Works By f See back for rules and regulations F 14%5 APPLICATION FOR SEWER SERVICE CONNECTION I� North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in "`� � �� �nDQ�7 41-7 3tree, subject to the rules and regulations of the Division of Public Aorks. , The premises are known as No. or subdivision lot no. L� r' i Owner Contractor ki Street JO?- S3Gv a a /'�- ./ - A ,J.J-, PERMIT TO CONNECT WITH SEWER AA T-) The Division of Public Works hereby grants permission to /*Ye67r�-/ //1eI/ cle5 to make a connection with the sewer main at G�u'� re's `'� 00/4-� 'Vi Street subject to the rules and regulations of the Division of Public Works.. 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C :r y m H acD � C7 roc 3 x c�=-1 N 0 (D 0 y 0-0 o0 = c. ro D o• -a CD Q 0 0CIDC -1 $ 0 a3•3 =3+*o -a- C * Q :� a CD M N 0 • '` M !D ' ` 0 •` a CD , a tD 0 � CD mn ter. �co � c �o �si� CD -%i > O 0. iI i 7w Cl) M m Cf) 0 co 0 .... ao co CD CO) .p CD 0 0 y C 0 CA l' d CQ 0 CD CO)CD CD CO) N O CCD 0 CD C c?�c m S FL, dc CO O �• y O Q VJ Own m CO) Cl) yc2ae7 m Z g s co '_•1 o °: m CL G — =r m n=d O y co —a m y p O IE m m !.D a CL ffes^^ � /V�J W W y Ilz cn SCD \ C a A J J �My m 1 " C y .Z' A �• Z H n p�j � `C Cn �s N ' C.10 y� CA -5 � 1 �* O Q �C.).bi o c . o m� o inCA � CD a d• Ao 0 o � Z QM:�� a c, C O �o Rr a • C/) � 0 C/) 2 0 m cy 9 o °� �o o Cl) M w C/) pz) o C�7 -x p w �l o x r -n w n x o UQ � o z w 0 �j r = C n ro o o. . n 7- a� 0 O C No 1991 Date../ / ' ... y ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that*�.�......................................................................................... has permission to perform ........ z"�................................ wiring in the building of ............. ... C .......... *.�Zz .... ..................................... ... at .......... ................................................ — ............... North Andover, Mass. Fee.? .. . . ........ Lic. No. . . ..... �*INSPECTOR-''*'** ... * 'i�� *c' ELECTRICAL -'— WHITE: Applicant CANARY: Building Dept. PINK: Treasurer