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Home My WebLink AboutMiscellaneous - 15 BUCKLIN ROAD 4/30/2018 15 BUCKLIN ROAD f 210/025.0-0116-0000.0 - _-~- - - - - - NORTH Town of t ,F. 6Andover O h ver, Mass, �,pCOC MIC NlWKK �1� ADRATED �`PP,`�5 S U BOARD OF HEALTH Food/Kitchen - PERMIT. T LD Septic System THIS CERTIFIES THAT A.5�9......Rftad.*^4 . .....SO!�!!�......<< C BUILDING INSPECTOR ........ ... ............ ... has permission to erect .......................... buildings on ......... O.S�C.Ia.n %............................. Foundation p' I. 10#1 .4. C&...* ov �. Rough y to be occupied as ..... ....... .... ....................... .... ........... ............ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and ® � Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR Rough .................. Service ...... BUILDING INSPECTOR nal ® GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. k cfj Location No. Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ li CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL Check 16236 Building Inspector I TOWN OF NORTH ANDOVER 1 DUIODINIG DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH AO�yNE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: X ic SIGNATURE: BuildingCommissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 15 BOO< LAN Aod-D a Map Number Parcel Number o (^N 1.3 Zoning Information: 1.4 Property Dimensions: Rf-=s>lflE7,�T,q L. . N A- 'm A Zoning DistrictProposed Use Lot Area(sf) Fronta 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record MboUD Pk(soanR 15 @UcXLUly Name(Print) Address for Service �75- Zff- 095 wdK 6(7-235- 34-73 Signature Telephone g P W 2.2 Owner of Record: ROYA Rp-H GOZ A2 15 B UCKOU k4b Name Print Address for Service: z M Signature Telephone SECTION 3-C NSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ MCOU1>12f 60MJI� �S 04-22o 4-Licensed Construction Supervisor: License Number Address r 7- 2-4,- o3 q7ff--69$— Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable Company Name 1w Registration Number rA Address r a® Expiration Date Si nature Telephone I I I SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) ,R 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 g licable New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 70 AM A Aotit OMJf MMR00114 1/1J 845a4t�; Cc/IfPL9TF2 V PkC 11100 O IVMC-g 4f, dry" SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � OILFC � I Completed by pennit applicantSPIN " I. Building (a) Building Permit Fee 1 0/,Sao, co Multiplier 2 Electrical (b) Estimated Total Cost of 200, oo Construction 3 Plumbing 3, 3 ao , 60 Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 1 15, Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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. J Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Si ature of Owner/A ent Date Ee. il�Fes NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DM ENSIONS OF POSTS MENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL,OF CHEVINEY 66j13 IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE e5 Nwth Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A._ The debris will be disposed of in: (Location of Facility) Z� A� Signature of Permit pplicant 3- 1 - 63 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector Nvn � iy ovm Of - Andover OIC P dover, Mass., 3- 8 a C OC MICN w C � AORATED PPf:1 C� S 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....1 .............Rah...4.. w4A................................................... Foundation has permission to erect...F.4 q* ............ buildings on ......I.. ...... .V K l� ..... I.................... Rough to be occupied as.....a.A.I*.Ir.00. . .... *% ...14f.t..100. .... . . W A Z&S Q M*%j-4- 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-Larelating to the In sp ction, Alteration and Construction of Buildings in the Town of North Andover. 4A 5-711 40000 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough .......... .. .... ...... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. 4 _ , . 1 t r , 1 �l j, J r od --------- __ J Location No: d5�" Date t") NORTh TOWN OF NORTH ANDOVER . ; Certificate of Occupan yr.�,$ + f• xL �y`-� a • 7 ; . Building/Frame Permit F6�e�;$`� y ` 1 .7`, " cMus t� Foundation Permit Fee Other Permit Fee - sU $ a� � Sewer Connectike Water Connection Fee $y 9S TOTAL $ Building Inspector TQ 7925 Div. Public Works APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 a�0. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ONE I SUB DIV. LOT NO. �— /LOCATION �� (Jtko� ` �I'q` URPOSEOFBUILDING P��/� / AWNER'S NAME E` J3 P - NO. OF STORIES hSIZE OWNER'S ADDRESS ue BASEMENT OR SLAB -- ARCHITECT'S NAME v SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS TrJISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X JS BUILDING ADDITION „r?\ MATER;AL OF CHIMNEY IS BUILDING ALTERATION �A IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION i LAND COST �f,� SEE BOTH SIDES t( EST. BLDG. COST PAGE t FILL OUT SECTIONS 1 - 3 2 C>�v� EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 PC,a�l Jr.®WS ��`�� i v ��` EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �° BUILDING INGPECTOR SIG OF WNER OR AUTHORIZED AGENT FEE OWNER TEL.N PERMIT GRANTED CONTR.TEL.M ?A V') 19 cis CONTR.LIC.# H.I.C.a BUILDING RECORD. i 1 OCCUPANCY 12 SINGLE FAMILY _ S OkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _I 3 1 2 I3 9Q-, CONCRETE BL K. PINE o/ BRICK OR STONE HARDw D PIERS — PIASTER DRY VJALL r<' UNFIN. 3 BASEMENT AREA FULL FIN. B M"T' AREA _ V, 1/1 1/1 FIN. ATTIC AREA _ MO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B 1 22 f 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING -HARDW D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I-A POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) _ GAMBQELMANSARD TOILET RM. 12 FIX.) _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 1 3 6 FRAMING II i 1 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM r �` STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ CT ELERIC 1st 13rd I NO HEATING I -rrown ool hAnd over E'�� } M N/�NS l ort dower, Mass., t3�A 1 19 CiV 1< 0 C OC1110111: BUILD r�r TAr BOARD OF HEALTH Food/Kitchen IER. M IT TO Septic System BUILDING INSPECTOR THIS.CERTIFIES THAT � ........ ........ .................................................................................... Foundation has permission to yes#-...A4Z .................... buildings on ..... ....... Rough tobe occupied as TitIL .....`Il. .MKw ......A M...A ... ...................................................................................... 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EllnTRU F 1\411 �1T`HS ELECTRICAL INSPECTOR UNLESS CONp_ a ,Ya1 `' Rough Service .. ..... ... ...... . ... . ... ....... .......... BUILDING I CTOR i Final 1 Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT 3 ' A/ Date. .. . . .. . . . HORTq TOWN OF NORTH ANDOVER 1 o .• PERMIT FOR PLUMBING II ,SSACMUS� ,! This certifies that PAZ:;�. . . .GIe�'��. . . . . . . . . . . . . . . . 5 l, i k has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . !. E� -. . . . . . . . . . . . . . . at . f-?-' :. . . . . . , forth Andover, Mass. Fee . . . . .Lic. No.. . . . . . . . . Check # c PLU I GINSPECTOR 5569 \y{] MASSACHUSETTS UNIF.ORIVI,APPLICATION FOR PERMITTO DO PLUMBING `i Date r Building Location/�" 8 00<0M A o Owm ners Nae M -SCX)fl �U7rYrjd Permit# Amount i Type of Occupancy New Renovation Replacement'' Plans Submitted Yes No FIXTURES 3 R . L W .a-1 C^ R' x A 1. {7"r Lz+ a a xrA a rA w w aZ ra F x x Q x4 �- o_4 m Q a w x Q stsssv>T , �Ivmvr . •-. Is il" �� 3�Il1 FIDCR ; 3M R" 4M FLOCK . 4 5M R" 6M HDM 7M FLOCK j SIH MM (Print or type) PARIS /' Check one: Certificate !} Installing Company Name FOR � Corp. ` ` 1 �Q Address N U l ff elk /QC Partner. ,q M E Business Telephone a y 512. CGt/ Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond ❑ Insurance Waiver: I,the undersigned, ve be made aware that the licensee of this application does not have any one of the above - threeinsurarice ignature„ Owner Agent f� , 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' allations under Permit Issued for this application will be in compliance with all pertinent provisions of the M ach S g Code and Chapter 142 of the General Laws. Iks By: & -,RgRaTure or Licenscuum er Title Type of Plumbing License Y City/Town tr License i um r Master Journeyman �rAPPROVED(OFFICEuse ONLY iF Date..... I CAORTH A TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSAcwUS This certifies that ........R.t- ...........................t.`......................."..................... has permission to perform ...... -S.?! 1��!�Y./..... ,.,�6trA / ................................ winn,!in the building of..... I . Z.. ........ at... 1.. ........& .. ..e / ........ ................ orth Andov F.-Mass Fee..—�.I)..,.��ic.— . N -�:ol .U................. ......... ............ . ................. CAL INSPECTOR Check # 4460 THECOMMONWEUTHOFMASSACHUSETTS Office Use only DEPARTA117ff0FPUBL1CS4FETY Permit No. (�/f BOARDOFFREPREVE MONREGUTAHONS527CM12.00 Occupancy&Fees Checked APPUCARONFOR PERMIT TO PERFORMEUCIIMC U WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 /J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 15 3UCKL 1(`1 RoE}p Owner or Tenant IV A5 0 U b AaHrozPA Owner's Address S14M& Is this permit in conjunction with a building permit: Yes© No (Check Appropriate Box) Purpose of Building 19 D7> A {?ATHAIZQM (ZEc RD-A Utility Authorization No. Existing Service J00 AmpsioZ�Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /3I4SF_/;1 En/T �r No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 0 ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners 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 Othe 1 Connections No.of Water Heaters KW No.of No.of • Signs Bailasis No.Hydro ylvlassage Tubs No.of Motors Total HP OTHER' IlmnanceCoverdg—Rusrlarttothetagtmea)cMofMwmdlECMG 2WUws Iba,&acamentLiabkyh>stua=Pnlicymchx)ingComplee CoverWoritssubmale4uvalat YES 1:3NO Er Iba,&MhmmedvaalidROtOfsametotheOffue YES r7p Fyouhawdxd®dYES,plea9eirrl *dietypeofcovaageby cheddrigthebox j INSURANCE BOND O IER (Please Spa*) EviatimDaie Eshi VahieofHochicalWotk$ w�ktosl�t `� - �S"-�3 � e? F><,al Sigrled ulxl`r�ie F of peijtuy. FIRMNAME z-31L-4- S,,/67T LimmNo. F 3 8 QQ L'o ee /c_L v./F_ i T Signahne W ( 4��n�—�° Lia=No BuskmTel NO. Adnc� _ f Sfl�/6u Rnl S'T_ L.o t.c)ELL /rl tel_ AitTelNo. 9,'e eo I ONVIIWSINSURANCEWANER Iamawmethat&Lio wdoesnothavetheinstlrmxeocvaageorZRksUitialegtwdmtasmgtmedbyMasmtn>mGeneralLaws and thatmysigriAmonthispeurvtappfiabmwaivesthisregtmer xi t (Please check one) Owner Agent Telephone No. _q 7 8—99'9'—6569 PERMIT FEE —�� Igna ure or Owne gen I RE. The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations �~ Boston, Mass. 02111 c�°�M Sy•y�� Workers'Compensation Insurance Affidavit 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: M Address City: Phone#-. Insurance.Co. Policv# Company name: Address City: Phone#- Insurance Co. Policv# ca 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$1,500.0 and/or one years'inprisorunent-as_mm[Las-ciA.penaftiesinmeli rm-dABTOP VY9RK_ORDFRand_a fkw-d-($111t).OD)-a dayagainstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y . I do hereby certify under the pains and penalties of perjury that the information provided aboveis true and correct. Signature Date Print name Phlne.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing. D Building Dept E]Check if immediate respoaise is required .D Licensing Board E] Selectman's Office Contact person: Phone#. I] Health Department Other li lild Date...... X....... ........ NORTH °ft"`°;• "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING WWI CHUS / This certifies that ........... .../�. /..........S .........S ................. ...... .. has pern►7ssion to perform ................................................ .............................. �J � c��{�� wiring ini;he building of.......... 'G� `............ ... .......................�......................... at........ ...... .. .f�. .......(!!...........................No Andover dss. Fee....l -5.......... Lic.No..C.1 .� --7................... .. .. .......... ELECTRICAL INBPECfOR Check # 4533 t Official Use Only Commonwealth of Massachusetts ' 3Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), VCM 12.00 (PLEASE PRINT IN INK OR TYPE AL INF RMATION) Date: City or Town of: To the Inspe for o Wires: By this application the undersigned gives A tice of his or her in io to perform the electrical work described below. Location(Street&Number) , Owner or Tenant 9L;WTelephone No. 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.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system t t Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above In- o. mergency Lighting rnd. [Drnd. EJBattoe Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o No.of Switches No.of Gas Burners o. Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kit Security Systems: No.of Devices or Equivalent No.o Water KW No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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:) dQ (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 th pain andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: Secwrity LIC.NO.: l r �� Licensee: John S. Bassett Signature LIC.NO.: 1533C (Ifapplicable, enter"exempt"in the license number line.) Bus.Tel.No..• 603 594 SW8 Address: U Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licl9hsee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Location I5' l L-fr/CLtaJ r _flz *C4 �o. Date N°RT" TOWN OF NORTH ANDOVER ' ; p Certificate of Occupancy $ t * Building/Frame Permit Fee $ -Q 'ssCtt Foundation Permit Fee $ �f►l3. Other Permit Fee $ Sewer Connection Fee Water Connection Fee TOTAL t g. ,Q, Building Inspector 04X8.0[ 862.00 PAID '" 71-57 Div. Public Works kocation / ,.^ /'_� No. Date o2/G>/ T, NoRTN TOWN OF NORTH ANDOVER i3?0 � �ih`p Certificate of gccupancy $ Building/Frame.Permit Fee $ fj,b•�ras+��(� ss�cMusE Foundation Permit Fee �M76er-Permit Fee $ �• ` Sewer-Connection Fee Water Connection Fee $ r. TOTAL I. $ �� O• d C�L G1 Building Inspector 76 29 / b Div. Public Works Location X Rge Ili ti._ i !ol No. /9 d 9' Date N°"T.1ti TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ CM�S t� Foundation Permit Fee $ Other Permit Fp,-,P' $ 633 Sewer Connect b' Fee $ 0 3Z(, Water Connection Fee $ 1000 TOTAL - $ o2ag/? � ildi g Inspector +1t 6917! ` (��C, ` Div ub �Works PER'11'1`O. ' <d' PAGE 1 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.�� y�/� 3 s f MAP KJO. LOT NO. - 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE .ZONE SUB DIV. LOT NO. �— LOCATION AMA . PURPOSE OF BUILDING � OWNER'S NAME H, J ` (fa NO. OF STORIES `n_ SIZE / OWNER'S ADDRESS6 �, BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST n x�O 2ND !FX/O 3RD BUILDER'S NAME -7'�' �� a / SPAN / / ! . DISTANCE TO NEAREST BUILDING �® DIMENSIONS OF SILLS /1 x DISTANCE FROM STREET o POSTS L ie - DISTANCE FROM LOT LINES -SIDES REAR !fes` GIRDERS AREA OF LOT FRONTAGE J / HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW yp�� SIZE OF FOOTING ,/� fi" X IS BUILDING ADDITION VV /i / �j MATERIAL OF CHIMNEY IS BUILDING ALTERATION V IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANYAIA IS BUILDING CONNECTED TO TOWN SEWER • IS BUILDING CONNECTED TO NATURAL GAS LINE As INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES DI DuGs PERM'FEE blL If 0 EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 LESS FM EEE / Le , 00 EST. BLDG. COST PER SQ. FT z/ / PAGE 2 FILL OUT SECTIONS 1 - 12 OUE FRAME PERMff 44a' O EST. BLDG.:COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS - PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED BOARD OF HEALTH SIGNATURE OF OWNER ORA ORI AGENT r FEE ` PLANNING BOARD PERMIT GRAD - 4J ` 19 fC� BOARD OF SELECTMEN OWNER TEL.# '3 cm 8��.-� CGNTR.LIC.# d BUILDING INSPECTOR b Q a .� i �E4 !—r--)ING.� r RrRIT1 7/f 7 z^ I. / t.� I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY sroRlEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT..AND DISTANCE FROM - FAMILY OFFICES APARTMENTS LOT LINES AND EXACT DIMENSIONS OF BUILDINGS: ,WITH PORCHES. GA- C. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION ¢I 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ -GN F NN. — — 3 BASEMENT. AREA FULL FIN. B M T AREA _ '/, FIN. ATTIC AREA _ NO B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 " DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDWD _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY\ STUCCO ON FRAME _ I I I ; BRICK ON MASONRY "ATTIC STRS. & FLOOR '11 :13t BRICK ON FRAME I I 3Ii +L.Cl1 2:,"J'.J� CONC. OR CINDER BILK. lg K. �.,.,.j13 STONE ON MASONRY WIRING TIM R34 NAM 3LIC, STONE ON-FRAME tY#T1[3 i=i�4/ 3LIC, SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.1 FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK f SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR J 1 TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd e _ ELECTRIC 1st 13rd I NO HEATING f FORM U - LOT REIEASE FORK INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: /Le Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) C Street _ SGA /rte St. Number -� Use Only************************ RECO AT S OF TOWN AGENTS: ' Date Approved Z Conservation Administrator Date Rejected Comments Date Approved t Town Planner Date Rejected Comments Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connections _y¢ - driveway permit -fes Fire Department Received by Building Inspector i t- WDate I f ("L M--DING DEPARTIVIE Y' ' � - - ., � � I' I i 7Ni id,e Teaet# ar,p. 1183 VENDOR ID: TOWNHALL CHECK NO. : 1183 DATE: 04/19/94 PAYEE: TOWN OF NORTH ANDOVER MEMO: INVOICE INVOICE INVOICE PREVIOUS DISCOUNT AMOUNT OF NUMBER --DATE--- ---AMOUNT--- PAY/CREDIT TAKEN ----PAYMENT-- f --------- ------------ ------------ l LOT 9 04/19/94 862 .00 862 . 00 CHECK TOTAL : *******$862 . 00 F APR 1 919 Lar#9 L'u+f'_Dk":E:3 DEFRAI a•Sdst-fq 6943 =0./369 AC. 8o S� c' rOv vo�o -10AI La4A F,2an A.c/ 's A"COY CeA-71, - To'T.yE riTZE i.VSr/,eO.e.4,vo RL O T Rz 4& TIJ THE B4N&TNgT T•yEOwECu.HS /S ZCe..oTEG VV Me Gar fs S.fGIlrN ANO TiGG4T?OAFS Galv..O elle .. ZIV !Y/TN T//E7"-f—V• OF.pro IOVW- e. ZON/N6 dE,00ZAT•!7.1S �6vI.?D/.Ks JET�IG'.t'S FEO•!1 ST•�ECTS f GDT G/•vE.S."' /V6. i'7NGi0 t/E,2 �%SS� LOG4TEo/,S/ HErFE�AG Fz& oO ,Z.4 O APEAOT O.P.9f�iV fO.P %SAI,d#VA!O/V AFM. r � Si`/t/N/Ty/aifNGG 'R �Fpo [y- : JNt 2soa98 e ��c sivE �E��ry �oe.� �%•.„;/,,. `'"' �`i`.�te,�. G'CTEQ (0 293 .. F :rt•$;.Ha " ;d��/ P,L.S DATE . Ae • BoavoeY G�ETEf4'� r�'+�it/. BD!/NOA.PY/i(/FORA'1- �IE�P.P/iy1.4Gt'E.f/G�.t/EE.P/.1/6 SE.Pf�/�'ES AT/O•f/ TA.rE.S/ 15cO,s7 EX/STivG .PEG'o.POS. 66 Pq.P,E� .ST.rEET A.t/ODYE.� �1ASS,�Gf�//SETTS o/8/O ' 11 O R TFC Town of � `ojAndover L No. 020 ..,, -Ngo dover, Mass., r3_ ♦ 19�y COC HICHEWICK DRATED � ' I [G, A BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..,�..,�. .f'......T..Y/' .D........... Foundation has permission to erect-l!OR40f" buildings on .J..478k� C.J(W.�a.*.T. .P.,T..".9......... Rough to be occupied as..4 �. .4...L /,C.��'1 L., .,DWFJ-LlfAC M1/...e CV*X...,C .AC9744C, 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 InspectioRERINMR FftQ&Aj"tM& Buildings in the Town of North Andover. REGULATED BY PARA. 114.8,5, aC. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough DATE._.!1 /',/' FUPAID �' d Final PERMIT EXPIRES IN 6 MONTHSD p ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough PERMIT FOR FRAMUBUILDING ...................e--'4L6LE;i ....... Service DATE: y ` FEE PAID' BNG INSP CTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. E Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT CERTIFICATE O F USE & OCCUPANCY Town of N or-th Andover Building Permit Number L%' % Date THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. N°"Tp CERTIFICATE ISSUED TO Of '1,�, : ' O ADDRESS "ss., US Building Inspector .�ORI'hi 6 F ,.� � v r� 0VM 0r over � 0%L Tom- t _ I ----, n dover, Mass.,A�� ♦ 6 19�� o i �A coc H,C ME w'C D f'A T E D ?YL ClG♦-J I '9S ! BOARD OF HEALTH am Food/Kitchen I y Septic System 4 PERMIT T D Fi 4 t ;.� WILDING INSPECTOR THIS N y°THIS CERTIFIES THAT......./ ...t0.#!KP....lPD.......... Foundation U t p 0 f Rough C lv • y`J J'�S/ 1 = has ermission to erect.N'�...b.... !E.. buildings on ./.. .., u..CJ�C, ....... .L ., .� ::: to be occupied as.. /.W%.404; 0' JFL'.Y.4PW I AA.O0f**#. e...a&Ci..-2 9a�� Chimney provided that the person accepting this permit shall in eve respect conform to the terms of the application on file in P P P 9 P every P PP Final ' p &C this office, and to the provisions of the Codes and By-Laws relating to the InspectioRENAIIftR F*Jg fttMLy Buildings in the Town of North Andover. REGULATED By PARA 114.85. 6.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. R6ug O(\ 1 1 DATES FE PERMIT EXPIRES IN 6 MONTHS PAID �_ d lOfi s a'i '�'� , C) O ELECT111CAL INSPEC OR f UNI-.ESS CONSTRUCTION STARTS PERMIT FOR FRAMUBUILDINGft Rough 100V Service BUILDING INSP CTOR / DATE: y FEE PAID' Final O� Occupancy Permit Required to Occiipy BuildingG SRS PECTOR Display in a Conspicuous Place on the Premises — Do Not Remove u No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTME T Burner d � C! L �;• PLANNING 06 FfNAL CONSERVATIO �� Street No. `�1! t/I eel A, Smoke Det. AL 1� SEWER/WATER � _5" - INAL DRIVEWAY ENTRY PERMIT 1 S �/Rv5 "CA�N�7 poRrN 1 T - BUILDING PERMIT r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION b Permit NO: 0/'� Date Received / 7- 1,6 " °9 � •M�. ° �4SSACHUS� Date Issued: 10 , /"7 / IMPORTANT:Applicant must complete all items on this page LOCATION �� ' 8UCu Q.c,r-1 P- "t :PROPERTY OWNER Pnrrt MAP NO: 4 , PARCEL: 16 ZONING DISTRICT .; Historic Dis#riot yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building DK-One family D Addition Fi Two or more family 0 Industrial y X Alteration No. of units: 0 Commercial y Ll Repair, replacement ❑Assessory Bldg El Others: ❑ Demolition F--j Other a Septic 0 Well " 0 Floodplain '-:b We#lands ❑" Watershed District E3 Waier/Sewer r A44 ��. � IAC 5�J:5��5l►zt GIM Identification Please Type or Print Clearly) OWNER: Name: Phone:& &s 79 - 06-1) Address: i,JAI CONTRACTOR Name: PeS� cwu1"Svtarw Phone: g 1" . N Address: , Supervisor's Construction License: Exp. Date Home Improvement License: - , .Exp: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $J 1 (0® FEE: $ Check No.: Receipt No.: a NOTE: Persons contracting with unregistered contractors do not have access tothe guarantyfund Signature of Agent/Owner �w c(.tvi : `Signature of contracto h 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑' TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF -U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street IRE DEPARTMENT Temp.Dumpster,on site yes = no =, .Located'at 124 Main Street Fire Department-signature/date COMMENTS _tY Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 0 Notified for pickup - Date Doe.Building Permit Revised 2012 J BUILDING PERMIT .01 "qti —6 TOWN OF NORTH ANDOVER *6 C 0 APPLICATION FOR PLAN EXAMINATION '-- L.2 Permit No#: Date Received 4 AT o Date Issued: U IMPORTANT:Applicant must complete all items on this page • N E111 1L A % I.U' hs _4 N RERTrS ®��,N E-R 27, A 0 yes M" �JPU`R, IV[ N INQ'B I-ST I-S!hHIkFi1,' Z 5t- h0plIgAll r Fe 0�. 2 vlac Z_ TYPE OF IMPROVEMENT_—PROPOSED USE Residential Non- Residential 0 New Building 0 One family El Addition 11 Two or more family 0 Industrial El Alteration No. of units: [I Commercial 0 Repair, replacement 0 Assessory Bldg El Others: El Demolition 0 Other M&S@p"Midjr W El plain 01Y, etl0ds W.TW.atef_s h-6dt 01 strict, o&d iT1YL Water/Sewer N DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly' OWNER: Name: Phone: Address: _ -0 W" -S �F`ZT rinqu im INT Rt f x -k 4 - Ak��Wri raq or lo 11., X� NiUF 2 7 & T� F�, - - 6 fil qeNkii§ k..wt, 77 A ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. rotal Project Cost: $ FEE: $ Check No.: Receipt No.,: NOTE: Persons contracting with unregistered contractors do not have�aecess to the guaranty fund tr'e--bfA' e' r _-ha_ 6_ —------ na uT.,b .cohtrqttbt Location r` (D' Get s Date 0 _�Xa t N0. Q +� TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ L Other Permit Fee $ G; $ 1" TOTAL Check# t dLd ' _•, �-' Budding Inspector : t S Y ' �t r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TypB OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swim"ning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street iHIREIDEPARTMENTa Teflip 3 : Dumpster on site es ` , y� w .. :. d �r"� , �� r P yk zi x z ,i >l'a n o y; i�,i�X53 x�r1�`�a� rF y Locatetl 24MainStreet, �, � N �k .r+�,.At1iv ��i� .�[La"�4 Fire uepartrnen#signature/date �� ,z � � ,x #s i r '`' ° c _ '. i '`ck`� A,- � f �,TI '.r'-.,, a " Aa `r-� r" ��.y_.��"' � K'�` ��Y°',` D�� .<�`45tI� �S.F.':si�.��S, �`^ Yt�s��a¢4��✓F f�r1�LE ` r�''�'�iYlM�L. r� tiaTtiY4��W=Z•1 .. .m P,.r�,a+.K�.�.,._'4�a.^-.i„.g�' FS=�a�ic..Jr.►t:�_+,:. � "$r a,. 4 "3� i �- p * ,f +,,y�,�T,r,,.g y.'�+.'� ri r. *� .axe, .xt,._ ♦ �c'i' ��.. Sxre"�.�.+.Y �4f,.1;' �A �Wp.tr's�h ..'t:TJ� i"'jai- »7w.s:."$ 3i �. F limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop.requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-sl000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Perinit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract -- ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit 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 the building application Doc:Building Permit Revised 2014 i Town of �. 6 Andover No. -fit- h ver, Mass, 'I cochecMew�cw 1• Pull? �y S u BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT cgr...... S.I. �L !.►. .� offa,0M.t......<<! C BUILDING INSPECTOR ................. ...... ....... has permission to erect .......................... buildings on ......'. ...1 .r it^............................. Foundation Rough to be occupied as ...../1...... . 4 .4.3.......................C&...�...67 ..... ............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR Rough Service ...... ....'................�. ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. ACE SOLAR 3crr» ti-oni eNperience. Owner's Authorization Form For Permit Applications i The sole purpose of this form is to provide ACE Residential Solar, LLC, dba ACE Solar, with the necessary permission from Owner to file Permit Application(s) for such Project work as agreed upon between the Owner and the Owner's Authorized Company (ACE Residential Solar, LLC). Owner's Name: 34,0 4 i 1 J Solar Project Address: 96vejllm Please Sign below to grant permission for ACE Residential Solar, LLC to apply with your local AH1 for the necessary permits to install your Solar Installation. Ow:nees''. 1gnature: Y"",A44 Owner's Authorized Company:ACE Residential Solar,LLC Company Address: 342 North Main St. Andover,MA 01814 Applicable Licenses: MA HIC#182429 MA PE License:52468 NH PE License:12863 ECTOR . E n G 1 n E E R S Project Number:U 1977-0044-161 October 10,2016 ACE Solar 342 North Main Street Andover,MA 01810 ATTENTION: Eric McLean REFERENCE: Dhar Residence: 15 Bucklin Road,North Andover,MA 01845 Solar Panel Installation Dear Mr.McLean: Per your request, we have reviewed the layout and photos relating to the installation of solar panels at the above- referenced site.The following materials and components are proposed in the installation of the solar panels. Roof Structure:2x10 Rafters @ 16 in O.C. Roof Material:Composite/Asphalt Shingles Based upon our review,it is our conclusion that the installation of solar panels on this existing roof will not adversely affect the structure of this house. The design of solar panel supporting members and connections is by the manufacturer and/or installer. The adopted building code in this jurisdiction is the Massachusetts State Building Code, 8th Edition (2009 IBC)and ASCE 7-05. Appropriate design parameters which must be used in the design of the supporting members and connections are listed below: Ground snow load:50 psf per Massachusetts amendments to the IBC(verify with local building department) Design wind speed for risk category II structures: 100 mph(3-sec gust). Wind exposure:Category C Our conclusion regarding the adequacy of the existing roof is based on the fact that the additional weight related to the solar panels is less than 3.5 pounds per square foot.In the area of the solar panels,no 20 psf live loads will be present. Regarding snow loads,it is our conclusion that since the panels are slippery,effective snow loads will be reduced in the areas of the panels. Solar panels will be flush-mounted, parallel to and no more than 6" above the roof surface. Regarding wind loads, we conclude that any additional forces will be negligible due to the low profile of the flush- mounted panel system.It is our conclusion that any additional seismic loadings related to the addition of these solar panels is negligible. During design and installation,particular attention must be paid to the maximum allowable spacing of attachments and the location of solar panels relative to roof edges. The use of solar panel support span tables provided by the manufacturer is allowed only where the building type, site conditions, and solar panel configuration match the description of the span tables.Attachments to existing roof joist or rafters must be staggered so as not to over load any existing structural member. Waterproofing around the roof penetration is the responsibility of others. All work performed must be in accordance with accepted industry-wide methods and applicable safety standards. Vector Structural Engineering assumes no responsibility for improper installation of the solar panels. Please note a representative of Vector Structural Engineering has not physically observed the roof framing. Our conclusions are based upon the assumption that all structural roof components and other supporting elements are in good condition,free of damage and deterioration,and are sized and spaced such that they can resist standard roof loads. Very truly yours, VECTOR STRUCTURAL ENGINEERING,LLC 'tN OF ROGER T. _A IVI .4T Roger T.Alworth,S.E. Q� j Principal RTA/ssb 1011012016 9138 S. State St., Suite 101 I Sandy, UT 84070 I T(801)990-17751 F (801) 990-1776/www.vectorse.com I The Commonwealth of Massachusetts Department oflndusWalAccidents 1 Congress Sheet,Suite 100 ) Boston„MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbera. TO BE FILED WITH THE PERMITTING AUTHORITY. Anulleaut Informs{tion Please Print LeribIx Name (Business/Organiaation/ludividual): Addrek."`3 E-a- QU : City/State/Zip: ` b1 �. Phone#' loya3 �'� �� ; Are you an employer?Cho*tt(he_appropriatc box:, Type Of prOjeCt(required): LM I am a employer with l employees(iUll and/orpart'time)."•. 7. []New construction 1 i 2. I em a sole proprietor or partnership and have no employees'work)ng for me In❑ z 8, (]Remodeling any capacity.[No workers'comp.insurance required) 1 3.[31 am a homeowner doing all work myself:(No workers'comp.insurance required.]t 9. ❑D$mOlition 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole: 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions S.Q 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof rep airs These sub-contractors have employees and have workers'comp,insurance) 6.[]We are a corporation and its officers havq exercised their right of exemption per MOL C. 14.[ Other M.,§1(4);and we have no employees.[No workers'comp.Insurance requlred.J *Any applicant that cheeks 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 hits outside contractors must submit a new affidavit indicating such. tCoutraetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employeps...If'the sub-contractors have employees;they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation Insurance for my employees. Below fs the policy and f ob site Information. Insurance Company Name A-&MW 04 AA e V%t✓fi\ Policy#or Self-ins.Lie.#: Co �c- _t 3"t �I b Expiration Date tt,,tt ] t Job Site Address:__ �C�if IU City/State/Zip:Nbly , �1u 01`tL(JT Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirati n date). Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a 1 day against the violator.A copy of this statement may be in, to the Office of Investigations of the DIA for insurance coverage verification. s 1 do hero cei7ify er the pains and penalties ofperfury that the Information provided above is true and correct. i ' D Go I Phone#: !_ 4 6 5 Official use only. Do not write In this area,to be completed by city or town officlat { 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 t l: Contact Person: Phone M i l t T x,1101 ACERE-1 OP ID: KM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)09/09/2016 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(les)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 Michaud,Rowe&Ruscak Michaud,Rowe And Ruscak Ins. PHONE 978 688 8829 AX No):978 557 2130 P.O.Box 188 A/c No EM North Andover,MA 01845 E-MAIL ADDRESS: Michaud,Rowe&Ruscak INSURERS AFFORDING COVERAGE NAIC# INSURER A:Nautilus Insurance Co. 17370 INSURED Ace Residential Solar LLC INSURER B:Travelers Insurance Company Mark Kiley INSURER C:Safety Insurance Company 342 No Main St Andover,MA 01810 INSURER D; INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE A wVD UB POLICY NUMBER MM/LDID/YYYY CY EFF MM/DDY EXP LIMITS LTR A X 'COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS MADE XOCCUR NN636658 01119/2016 01/19/2017 DAMAGE TO RENTED PREMISES Ea ooanrence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 POLICY JE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER $ AUTOMOBILE LIABILITY O eBIINEDtSINGLE LIMIT $ 1,000,00 C ANY AUTO 2705567 01/15/2016 01/15/2017 BODILY INJURY(Per person) $ ALL OWNED. SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS i AUTOS XX NOWOWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER Y / B ANY PROPRIETORIPARTNER/EXECUTIVE Y❑N N/A _WC CERT TO FOLLOW E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED (Mandatory In NH) DIRECTLY FROM TRAVELERS E L DISEASE-EA EMPLOYEE $ It yes,descnbe under r-- DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) ACC CERTIFICATE OF LIABILITY INSURANCEF 09/21/2016 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(les)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 Krista McMahon MICHAUD,ROWE AND RUSCAK INSURANCE ASSOCIATES,INC. PHONE , (978)688-8829 A/c No): EMA ADDREIL SS: kmcmahon mrrinsuranee com P.O.BOX 188 INSURER(S)AFFORDING COVERAGE NAIC 0 NORTH ANDOVER MA 01845 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: ACE RESIDENTIAL SOLAR LLC INSURERC: INSURER D: 342 NORTH MAIN ST INSURER E: ANDOVER MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER: 86964 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY EFF MPOLIICDY EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ DAMAGETE CLAIMS-MADE FlOCCUR PREMISES EaocREN currence $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY 1:1 PRO LOC PRODUCTS-COMP/OP AGG $ JECT OTHER $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION XSTATl1TE ER ETH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? WA N/A N/A 6HUB9F43435116 01/20/2016 01/20/2017 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT I$ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts If the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-wmpensationAnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of North AndoverACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover MA 01845 l 5 F Daniel M.C, y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD V adWaeM Office of Consumer Affairs and Business Regi ilption 10 Park Plaza- Suite 5170 Boston,Massa; setts 02116 Home unprovement C I or Registrati n RegisIration: 182429 Type: 'LLC z Expiration: 6/1912017 TO 267589 ACE RESIDENTIAL SOLAR LLC ERIC McLEAN 342 NORTH MAIN ST r a kt ANDOVER, MA 01810. Update Address and return card.Mark reason for change. rA 1 tf 20M-05/11 E] Address ❑ Renewal n Employment [] Lost Card u/t6�d77t47tO0tlu8QLG/L o��QA�ELIOP.� Office of Consumer Affairs&Business Regulation License or registration valid for individui use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: (40259 'type: Office of Consumer Affairs and Business Regulation xpiration•__ LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 4CE RESIDENTIAL 19 Z. R Y =RIC MCLEAN )42 NORTH MAIN ST`` r INDOVER,MA 01810 Undersecretary Not valid without signature FORTH ANDOVEP,MA 01845.00oo Fold,Then Daboh Along All Perlors"one Fmr ' K . Oakgin . � i$Sf1ES 7Y�IE-fou , LOMNe 11 9 A Ar 9� LVA 7' CLIZA 014 y�y � RD. SDOOQiDf�. NOX . , MA q, ;mM 4vt,,a'��s,�; �� •. �� I��O12�4't8 ,.x 2518$. � k all �.. �MDENTIAL 7N6-' MID ANY DATA,OESCRIPOON.AND OTHER WORmKnON CONTAINED HEREIN ARE CONSIDERED AS PROPRIETARY MO THE EXCLUSIVE PROPERTY OF ACE SOLAR MID SHALL NOT BE PUBLISHED,REPRODUCED,COMM.DISCLOSED.OR USED.IN WHOLE OR IN PARE,FOR ANY PURPOSE WITHOUT THE EXPRESS WRIRETI PERMISSION OF A DULY AUIHOPoZED REPRESFIITATNE OF ACE SOLAR SYSTEM SIZE 6.08 KW DC ENERGY 71487 kWh 1 PRODUCTION 1 2 3 4 MODULES (QTY. 19) 320W PANELS 5 6 7 8 INVERTERS STRING 1 INVERTER 20'—s„ 9 10 11 12 g ` 13 14 15 16 00/1 I 17 18 19 ID SOLAREDGE P320 POWER OPTIMIZER SOLAREDGE SE5000A—US • 320W INPUT POWER • 6750W MAX INPUT POWER • 48V MAX INPUT VOLTAGE 500V MAX INPUT VOLTAGE . 13.75A MAX INPUT CURRENT • 15.5A MAX INPUT CURRENT 21A MAX CONTINUOUS OUTPUT 0 15A MAX OUTPUT CURRENT CURRENT . 60V MAX OUTPUT VOLTAGE BAC K ROOF • 5.000W AC POWER OUTPUT 12-25 YEAR WARRANTY • 8-25 OPTIMIZERS PER STRING • 25 YEAR WARRANTY DIMENSIONS TO BE FIELD VERIFIED- 6v -� - A4 Q , N �3 . 2 8 ---1 NOTES: r a t 1. RAFTER LOCATION IS UTI LITY M ETERASSUMED. FIELD VERIFICATION OF �. PENETRATIONS REQUIRED TO 7AND UTILITY ELECTRICAL ROOM ENSURE ARRAY IS POSITIONED ,r - f DISCONNECT ' ; WITH MAI N PAN ELBOARD , sYMMEfRICAL oN ROOF. SWITCH 5 . 38 If <3 •wm r � C s:• .r ,... . +� . «r.. ` W a AL y a ��. FK x . art. PV �AR RAY - -- ,�_� -� - �� .� �` � � � � �` LG NEON2 (LG320N 1 C—G4) 218° AZIMUTH) Pmax (W) Vmp (V) Imp (A) Voc (V) Isc (A) a fi a� 101 320 33.60 9.53 40.90 10.05 37° SLOPE 1.rd fl A i �,y tin ia�, �y a, as 4. d} N1, mw +. " h ACE Solar DRAWN BY APPROVED B ACE Solar Y DESCRIPTION NAP 15 BUCKUN RD — NORTH ANDOVER, MA — PV ARRAY DHAR RESIDENCE- 15 BUCKLIN RD DWG#; 342 North Main St.,1 st Floor ROOF MOUNTED SOLAR ARRAY PV-1 Andover,MA 01810 DATE COPYRIGHT 2016 ACE SOLAR Born from ex PV ARRAY LAYOUT experience�D� p Phone 800-223-1462 9/27/16 ALL RIGHTS RESERVED REV 1.0 COIkIDENTIAL C M DRAWING AM ANY DATA,DESCRIPTION.AM ODETt NFORMAnM CONTAINED HEREIN ARE CONSIDERED AS PROPFWARY AND THE OCCLUSIVE PROPERLY OF ACE SOLAR NO SMALL NOT BE PUBLISHED.REPRODUCED.COPED.D=LOSED.OR USED.IN WHOLE OR N PART.FOR ANY PURPOSE WDOUT THE O(PRESS WI M PEAILLSSION OF A DULY AVRIOROZFD REPRESWAME OF ACE SOAR ' 15 BUCKLIN RD • 5.0 KW AC • 6.08 KW DC • QTY(19) 320W PANELS • 1 X 5.0 KW STRING INVERTER SOLAREDGE LG 320W SOLAREDGE LG 320W P320 LG320N1C—G4) P320 LG320N1C—G4) OPTIMIZER OPTIMIZER DC OPTIMIZER DC OPTIMIZER #1 #11 DC OPTIMIZER DC OPTIMIZER #2 #12 Az NEW UTILITY NET METER (EXISTING UTI LfTY REVENUE METER SOCKET) SOLAREDGE RGM 5.0 KW — INVERTER INV-1 DC OPTIMIZER DC OPTIMIZER 350 VDC INPUT 240V 1 PHASE OUTPUT #3 #13 ETER IAM,Q M DC OPTIMIZER DC OPTIMIZER r� #4 #14 AC �. DC OPTIMIZERDC OPTIMIZER NEW 30A AC UTILITY #5 #15 DISCONNECT SWITCH (LOCATED ADJACENT GROUNDED DC OPTIMIZER DC OPTIMIZER TO NEW UTILITY CONDUCTORS METER) #6 #16 DC OPTIMIZER DC OPTIMIZER #7 #17 DC OPTIMIZER DC OPTIMIZER #8 #18 PV WARNING LARELS 16BULA DC OPTIMIZER DC OPTIMIZER 3 4• #9 #19 • - • ;; 2 t 4• =01=W11m 9.j DC OPTIMIZER GLS+ r • 16@Ei:.E #10 —• Leaa:_a HOUSE PANEL • • • BOARD G IABEL�G (200A. 240V) 200A r200A - LABEL:_O - TO leBEl'-kl EXISTING • .• LOADS l�Q NOTE: INSTALLING ELECTRICIAN IS RESPONSIBLE FOR COMPLETING INSTALLATION ACCORDING TO ALL APPLICABLE BUILDING AND ELECTRICAL CODES ACE Solar DRAWN BY APPROVED BY DESCRIPTION DHAR RESIDENCE- 15 BUCKLIN RD DWG#: ACE Solar NAP 15 BUCKLIN RD — NORTH ANDOVER, MA — PV ARRAY ROOF MOUNTED SOLAR ARRAY PV-2 342 North Main St.,1st Floor Born from experience Andover,MA 01810 DATE COPYRIGHT 2016 ACE SOLAR SINGLE LINE DIAGRAM h Phone 800-223-1462 9/27/18 ALL RIGHTS RESERVED REV 1.0 COMM-DENTIAL 9 'THS OPAWPID AND ANY DATA.DESORMOK AND OTHER WORI47M COMMED MOWN ARE CONSIDERED AS PROPRIETARY AND 7HE MU SNE PROPERTY OF ACE SOINt AND SHALL NOT K PMONED,REPRODUCED.COPIED.OWLOSED,OR USED,IN WHORE OR IN PARE.FOR ANY PURPOSE WRHOtrr THE I . EIO+RESS WRRTEN PCIUM N OF A DULY A MONIED RE 4MMUAYW OF ACE SOIAR. CLAMPING RANGES IRONRIDGE / MID CLAMP IRONRIDGE .25 XRS RAIL END CLAM 4. 0 � I 320W 2997 MODULE MODULE 1/4_20 X 2" SS FRAME HEX CAP BOLT MOUNTING RAIL 50 9.)0 END CLAMP CLAMP DETAIL INSTALLATION D ETAI L (NOT TO SCALE) NOT TO SCALE) 320W 2997 MODULE FLASHING FQ.50 I -I--i---I 910 t RAFTERS 1/4-20 SS 320W FLANGE NUT 1/HEX0CAP2BOLT RAIL MODULE 2997 MODULE FRAME r--� MID CLAMP 74 -- L—FOOT 4. oc=ml "4' ( FLASHING ----------------- MID CLAMP ' _ r TYPICAL MODULE INSTALLATI0N DETAIL DETAIL � ��' �_ NOT TO SCALE) s". 5 .:5 (DIMENSIONS IN INCHES) L—FOOT AND FLASHING INSTALLATION DETAIL NOT TO SCALE) ACE Solar DRAWN BY APPROVED BY DESCRIPTION DWG#: ACE Solar 342 North Main St.,1st Floor NAP 15 BUCKLJN RD — NORTH ANDOVER, MA — PV ARRAY DHAR RESIDENCE- 15 BUCKLIN RD ACE SOLAR Born from experience Andover,MA 01810 DATE COPYRIGHT 20111 ROOFRAOCKIN DAG UNTED SOLAR ARRAY PV-3 p Phone 800-223-1462 9/27/1 g ALL RIGHTS RESERVED REV 1.0 C04 f,1DENTIAL X. THIS&&ttAAWW W AND ANY DATA.DEAN.AM OTHER INFORMOUM COMARIM HEREIN ARE CONMERM AS PROPRIETARY AND THE DOMA NE PROPERTY OF ACE SOLAR AND SNNL NOT RE PUOLSHEIN REPROMXM COPED.DISCLOSED.OR USED,IN WHOLE OR IN PART,FOR ANY PURPOSE WITHOUT THE EMPRESS WRITTEN PER11ISSM OF A DULY AUTIORIM REPRESQFFATNE OF ACE SOLAR - ROOF PITCH 37' 24'-9" 111 Fill] I 1 1 11 T I I 1 1 I il FLASHING AND LAG BOLT 1 I I 1 (SEE DETAILS BELOW) wE TOR E n O I n E E R 9 20'—8" Hill] 1 1 ( I 97385. STATE STREET, SUITE 107 (80 7) 990-7 775 SANDY, UTAH 6407D (BD T) 990 1 776 FAX STRUCTURAL ONLY 10/03/2016 I 1 I 11 Fill I OF ROGER T. _.AC IVI Fi .4 I il Fi I I I Fi 1 G� EXISTING (2x10, 16" O.C.) RAFTERS IRONRIDGE XR RAILS �aNAt. WITH (2x10) RIDGE BEAM AND (1x7, 48" O.C.) COLLAR TIES it:::::�L I fit III RACKING DETAIL NUT AND BOLT FLASHING I�II� DIMENSIONS AND LOCATIONS TO BE ' FIELD VERIFIED L—FOOT 3,28^ BOLT FLASHING BILL OF MATERIALS MAX ALLOWABLE SPANS SEALANT 3.71" LAG O16 11' RAILS PORTRAIT N/A I I 1 i I ( I I BOLT PORTRAIT 0 14' RAILS CANTILEVER N/A EXISTING 2 17' RAILS LANDSCAPE 6'-11" LAG BOLT I I I I I I I I I I I RAFTER 51 FLASHING LANDSCAPE 2'-9" EXISTING RAFTER CANTILEVER LAG BOLT DETAIL FLASHING DETAIL ACE Solar ACE Solar DRAWN BY APPROVED BY DESCRIPTION DWG#: NAP KJF 15 BUCKLIN RD — NORTH ANDOVER, MA — PV ARRAY DHAR RESIDENCE- 15 BUCKLIN RD 342 North Main 81 1sR Ploo� ROOF MOUNTED SOLAR ARRAY PV-4 �n Born from experience enao�er,Mnolslo DATE COPYRIGHT tots ACE SOLAR STRUCTURAL LAYOUT Ua P Phone 800-223-1462 10/4/16 ALL RIGHTS RESERVED REV 0, CONFIDENTIAL p DRAWDIO w ANY DATA,DEsawroN.AND OTHER INFO wym OONTAINED HERWN ARE CONSIDERED AS PROPRIETARY AND THE D=SIVE PROPERTY O111ACE SOLAR AND SHALL NOT EIE PIIBUSHED.REPRODUCED.COPTED.DISCLOSED.OR USED.IN WHOLE OR IN PARE,FOR ANY PURPOSE MTfHOUr THE EXPRESS WRITTEW PERhISSION OF A DULY AUTHORMED REPRESEMAINE OF ACE SOLAR 24'-9" SYSTEM SIZE 6.08 KW DC 1ENERGY 7,487 kWh / PRODUCTION 1 2 3 4 MODULES (QN• 19) 320W PANELS 5 6 7 8 INVERTERS STR NG 1 NVERTER 9 10 11 12 20'_8" 13 14 15 16 17 18 19 � SOLAREDGE P320 POWER OPTIMIZER SOLAREDGE SF500DA—US • 320W INPUT POWER 6750W MAX INPUT POWER 0 48V MAX INPUT VOLTAGE 500V MAX INPUT VOLTAGE 15.5A MAX INPUT CURRENT 13.75A MAX INPUT CURRENT • • 21A MAX CONTINUOUS OUTPUT • 15A MAX OUTPUT CURRENT CURRENT • 60V MAX OUTPUT VOLTAGE BAC K ROOF • 5,000W AC POWER OUTPUT • 12-25 YEAR WARRANTY • 8-25 OPTIMIZERS PER STRING • 25 YEAR WARRANTY DIMENSIONS TO BE FIELD VERIFIED- 7k �� e , , u (--3 . � _*" #"` • •~ ,„. 2 8NOTES: m _ fill I 111 4 1. RAFTER LOCATION IS g. p _ , r. ASSUMED.DFI L N OF PENETRATIONS REQUIRED TOUTILITY METER ,,,: a AND UTI LITY ELECTRICAL ROOM ENSURE ARRAY IS POSITIONED SYMMETRICAL ON ROOF. ` DISCONNECT WITH MAIN PANELBOARD 5 . 38 SWITCH _ .o � R e sr - PV ARRAY51 A 4 L N 2 N O 3 1 C- 4 A . ' , 218• AZIMUTH _ - " `" " ' Pmax (WG NEO Vmp (V) Imp (A) Voc (VG1sc (A) 37 SLOPE 320 33.60 9.53 40.90 10.05 5 h nnn +....rcw..rte..-.........�..a.._m......m+...,.mw.,__ � .r--�, .+_. -.....�.....-.tee .�.. ACE Solar ACE Solar DRAWN BY APPROVED BY DESCRIPTION DWG#: 342 North Main St.,1st Floor NAP 15 BUCKUN RD — NORTH ANDOVER, MA — PV ARRAY DHAR RESIDENCE- 15 BUCKLIN RD Andover,MA 01810 DATE COPYRIGHT 2016 ACE SOLAR ROOF MOUNTED SOLAR ARRAY PV-1 � �;a Born from experience Phone 800-223-1462 9/27/1 g ALL RIGHTS RESERVED PV ARRAY LAYOUT REV 1.0 CONFIDENTIAL THIS DRAWND AND ANY DATA DESCSPITON.AHD 01HER WORMATON CONIMED HEREIN ARE MISIDERED AS PROPf6ETARY AND THE EXCLUSIVE PROPOW C>g ACE SOLAR 711D SHNL NCR BE PUBLISHED,REPRODUCED.COPED.DIS=SED.OR USED.N WHOLE OR N PART.FOR ANY PURPOSE WITHOUT 7HE EXPRE15 PERM6SON OF A DW.Y AUTHORIZED REPRESI:7 MI E OF ACE SOLAR. 15 BUCKLIN RD • 5.0 KW AC • 6.08 KW DC • QTY(19) 320W PANELS • 1 X 5.0 KW STRING INVERTER SOLAREDGE LG 320W SOLAREDGE LG 320W OPTIMIZER LG320N1C-G4) OPTIMIZER LG320NlC-G4) DC OPTIMIZER _jZDC OPTIMIZER #1 #11 DC OPTIMIZER DC OPTIMIZER #2 #12 NEW UTILITY NET METER (EXISTING UT1LIfY REVENUE METER SOCKET) SOLAREDGE RGM 5.0 KW - INVERTER INV-1 DC OPTIMIZER DC OPTIMIZER LL 350 VDC INPUT 240V 1 PHASE OUTPUT #3 #13 E7ER 1771 Iexl r DC OPTIMIZER DC OPTIMIZER #4 #14 AC OC OPTIMIZER DC OPTIMIZER DC #5 #15 NEW 30A AC UTILITY -- DISCONNECT SWITCH (LOCATED ADJACENT 1 GROUNDED DC OPTIMIZER DC OPTIMIZER TO NEW UTILITY / CONDUCTORS #6 #16 METER) DC OPTIMIZER DC OPTIMIZER #7 #17 DC OPTIMIZER DC OPTIMIZER #8 #18 PV WARNING LAecjce lie LABELLE DC OPTIMIZER DC OPTIMIZER 3/4- #9 #19 • jfwmt��2 14• • • '` DC OPTIMIZER waocivwx iAREL-E #10 Lag" H HOUSE PANEL • • • BOARD (200A. 240V) 2DOA 200A4. - lABE7.�G TO ` ` l Agn•N EXISTING • .• LOADS d IABEL G JIML NOTE: INSTALLING ELECTRICIAN IS -RESPONSIBLE FOR COMPLETING INSTALLATION ACCORDING TO ALL APPLICABLE BUILDING AND ELECTRICAL CODES ACE Solar DHAR RESIDENCE- 15 BUCKLIN RD ACE Solar DRAWN BY APPROVED BY DESCRIPTION DWG#: NAP 15 BUCKLIN RD - NORTH ANDOVER, MA - PV ARRAY 342 North Main St.,lst Floor ROOF MOUNTED SOLAR ARRAY PV-2 Andover,MA 01810 DATE COPYRIGHT 2016 ACE SOLAR Ig Born from experience Phone 800-223-1402 9/27/16 ALL RIGHTS RESERVED SINGLE LINE DIAGRAM REV 1.0 CONFIDENTIAL ' THIS.ORAWlD IIID ANP DATA OESCRlPIDN.AND OTHER WOR►A7M COMAOED MO M ARE CONWERID AS PROPRIETARY AND THE EIiC .PROPERTY CS ACE SOLAR AND SHALL NOT BE ROMEO.REIMI UCFD,COPED,OSMOSED.OR USED,M WHOLE OR IN PARE.FOR ANY PURPOSE W MMff THE , DWRESS WRITM PERMESM OF A OILY A IMORIM REPRESDOATNE OF AGE SOLAR. • CLAMPING RANGES IRONRIDGE / MID CLAMP IRONRIDGE 25 XRS RAIL 4. 0 END CLAMP, 320W 2997 MODULE1 7MODULE 1/4-20 X 2" SS FRAME HEX CAP BOLT MOUNTING RAIL .50 9.)0 END CLAMP CLAMP D ETAI L INSTALLATION NOT TO SCALE) D ETAI L NOT TO SCALE) 320W 2997 MODULE FLASHING 50 9. 0 RAFTERS 1/4-20 SS 320W FLANGE NUT t/HEXOCAP2BOLT RAIL 2997 MODULE MODULE FRAME MID CLAMP L—FOOT r a4" 4. �,. xx+r• ` FLASHING MID- CLAMP `Si47- TYPICAL MODULE INSTALLATI0N DETAIL NOTDETAIL � -�� TO SCALE) (DIMENSIONS IN INCHES) L—FOOT AND FLASHING INSTALLATION DETAIL NOT TO SCALE) ACE Solar ACE Solar DRAWN BY APPROVED BY DESCRIPTION DWG#: 342 North Main St.,1st Floor NAP 15 BUCtcuN RD - NORTH ANDOVER, MA — PV ARRAY DHAR RESIDENCE- 15 BUCKLIN RD n ROOF MOUNTED SOLAR ARRAY Andover,MA 01810 DATE COPYRIGHT 2016 ACE SOLAR PV-3 ��Uf] Born from experience Phone 800-223-12 s/27/ts G DIAGRAM ALL RIGHTS RESERVED RACKINRxsv I.o CONFIDENTIAL NSA HIS gRAYJ1fq.911D ANY DATA DESMI AM OMER MUM ION CDWANED MOWN ARE CONSIDERED AS PROPRETARIY AND THE 00CLL9VE PROPFRIY 6F ACE SOLAR MO SHALL NOT K PUBLISHED.REPRODUCED.COPED,DISCLOSED.OR USED.N WHOLE OR N PARI.FOR ANY PURPOSE WDHDUT THE 5Z!1ESS W!LT'IE"N POUSSION OF A DULY AUMORIZED REPRESORATNE OF ACE SOLAR, ROOF PITCH 37° 24'-9" —4 2'—8 fin I-11 Fili1 1-il F I I I I FLASHING AND LAG BOLT i I (SEE DETAILS BELOW) )YEUTUKT Q n o n E 20' 8— ( I I I 1 9138 S. STATE STREET, SUITE 101 (807) 99L7-1775 SANDY, UTAH 84070 (801)990-1776 FAX STRUCTURAL ONLY 10/03/2016 I I I I I (y I � l OF ERT. A� ' IVI .a i I i IRONRIDGE XR RAILS SjGYAI,. EXISTING (2x10, 16" O.C.) RAFTERS WITH (2x10) RIDGE BEAM AND (1x7, 48" O.C.) COLLAR TIES RACKING DETAIL NUT AND BOLT DIMENSIONS AND LOCATIONS TO BE FLASHING IIIA FIELD VERIFIED L—FOOT 3,28" FLASHING BOLT MAX ALLOWABLE SPANS SEALANT LAG O BILL O F MATERIALS RA S PORTRAIT N/A I I ( 1 I i I 1 3.71" BOLT PORTRAIT 0 14' RAILS N/A CANTILEVER 1:4 2 17' RAILSLAG BOLT LANDSCAPE 6'-11" EXISTING 51 FLASHING LANDSCAPE 2'-9" EXISTING RAFTER RAFTER I I Illi CANTILEVER FLASHING DETAIL LAG BOLT DETAIL ACE Solar DRAWN BY APPROVED BY DESCRIPTION DHAR RESIDENCE- 15 BUCKLIN RD DWG#: NAP I KJF 115 BUCKLIN RD – NORTH ANDOVER, MA – PV ARRAY ACE Solar 342 North Main St,i5t Floor DATE COPYRIGHT 2016 ACE SOLAR Born from experience ROOF MOUNTED SOLAR ARRAY PV-4 Andover,MA o1sALL LAYOUT REV �� I� Phone 10/4/16 - RIGHTS RESERVED RSV 1,0 �i��yy��iie Staple a�ap�s %/ NORT►1 BUILDING PERMIT °F�t,to ,6A1'G TOWN OF NORTH ANDOVER o? °;; - ;.I °� APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received 4 Date Issued: —!Lo 0 Ss US IMPORTANT Applicant must complete all items on this page Md �+' �'- � be .X #' �' Y�3 t •�.� au. �--moi �i - »,W i PROPERTY OWNERS {� iJ �YI'Z. " . r ; ft EMAP NOP,4RCEL ZONING DISTRICT Historic D strict # yes no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building CO n e fami j Addition Two or more family Industrial Alteration No. of units: Commercial _Re air, replacemen Assessory Bldg Others: Demolition Other Vllell a ax 5epfie s t Floodp""lam; Wetlands ' F Waterstied;District �£ ME WaterlSewer _ DESCRIPTION OF WORK TO BE PREFORM ED: VV --��- 114l enti catio lease T e or Print Clearly) • OWNER: Name: - Phone: ' Address: � +.,x >.� � � "�'S��- : '� to '��'%3. v,� � �C '��♦ .,. �� CONT�RACTOR Name _ _ � PhonTV e, C } Address � Ti tion+-F4 Supervisor's ConstrucLicense � 1 - t - Exp Date"x;�. `. W".$ : - en i b t�;,�' �'. `� s 7 F tau y � _� �.� r�✓ tax 1"�''�5 �=. ''�'�``}':�'"�,,,%;�'M,- � �s � 1�.xi-5.� v,;' Home Improvement �_...�� - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ � r �— FEE: $ Check No.: _4 Receipt No.: 2Z _ NOTE: Persons contYac ing with unregistered contractors do not have a cess to the ar4tyd Signatuce��of Agent/Owner 'u� w `��``� S�i nature of=c no tractor �� -'� Y, Location 46:1 No. Date &OWTN TOWN OF NORTH ANDOVER 9 41 y � Certificate of Occupancy $ �.13 cHusE t 9 om Buildin /Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (L� 225 IAtIding Inspector I I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY. INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submittedY es Planning Board Decision: Comments Conservation Decision: - Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: F Located 384 Osgood Street FIRE DEPARTMENT` Temp'D`umpster�on siteyes no f xR - 4 T - a locatedaf 124 Mam Street �� as ' ,. x$ , .. Fire Department sgriature/date f r E W_ COMMENTS E I S Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date . ___._._............---...... _- Doc.Building Permit Revised 2009 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be'obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of.Rdg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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 the building application Doc:Building Permit Revised 2008 IAQRTH Town of 0 M 0 No. dover, Mass., T O CL A E �. OC HIC KE WICK V AORATED KC `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT k / � �- �C� ....... .U...!... .ti . ............ ......................... ... ................................ Foundation has permission to erect........................................ buildings on ........... Rough Chimney to be occupied as.... .. Z-- � y ..................... .................................................................................................... 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough �J PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR ON TARTS 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. 08-27-2009 00:04AM FROM-THE HOME DEPOT +6038940425 T-893 P.001/003 f-470 nvmn mvtrKV v=v11LtV'1LU NTRAUX PLEASE READ THIS Branch Name: Boston Dam;E7�/� Sold,Furnished and Installed by: THD At-Horne Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)756-8823 raderal ID k 75-269$460:ME Lic#C 02439;RI Cont.Lick 16427 CT L'c#565522 MA Home improvement Contractor Reg.#126893 _ InstallationAddtems: o City State Zip Purchaser(s): Work Pine: Home Phonet Cell Phone: Home Address; (0'diffcrent from installation Address) City Sue Zip &mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing cmails from The Hone Depot Profect h9ormaLion: Undersigned("Customee%the owners of the property located at the above installation address,agrees to buy, and TIED At-Home Services,Inc.("The Home Depot")agues to fumish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: aniemat R.wKnco Products: Saw Sheets #. Pro ect Amount []Roofing ❑Siding ❑Windows ladon ` ❑Gutters/Covers ❑Ennry pooh ❑ J $ Roofing Siding Windows ©Insulation ❑Gutters/Covers []Entry Doom ❑ Roofing ElSiding Windows Insulation ❑Ouucrs/Covers ❑Enuy Doors❑ $ Roofing ❑Siding ❑Windows Insulation []Gurters/covers ❑Entry Doors Q $ Mlnimttm 25%Deposit of Contr a i Amount due upon auxudon of this contact. Total Contract Amount $ Maine Purchasers may not deposit more than oncahird orthc ConttuutAmormt. Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees To be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Homc Depot or it.authorized service provider determines that it cannot perform its obligations due to a strucluml problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract.Payment Summary: The Payment Summary* 16511 C] , Included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sight. Du not:sign a Completion Certificate(note: them ix one Completion Certificate for each listed Product as dellaed by Individual Spec Sheets)before work on that Product Is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the coda of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY Wrl'11HOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DFPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acccotantx and Authntiration: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the m-rrns of and has received a copy Y.this Agreement. Acce by: Y. Cus ignature Date Sales Consukin-rs Signature liate X Telephone No. 6C`r��NI� Cus mer's Signature Date Sales Consultant License No. CANCELLAI ON: CUSTOMER MAY CANCEL THIS (w;applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRr1TEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGM(NG TMS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARF.STATED ON THE Rli VP"E SIDE AND ARE PART OF THS CONTRACT 3308 C-SC White—Branch File Yellow—Custorner RAK—Sales Consultant From:PYRAMID CONTRACTING 401 349 0904 08/24/2009 09:34 #799 P.004/005 Aug, 20. 2009 3:29PM No. 7809 P. 4 CERTIFICATE OF LIABILITY INSURANCE ®�2009 PPQwCaN -404.995.3000 THIS CERrKATE 18 ISSUED AS A MATTER OF INFCIRMATIOI 1!'4en usx, IqG, ONLY ANO CONFERS NO WHTB UPON THE CERTinuTF a:ufdapot, HOLDER, THIS CERTIFICATE DOES NOT AMEND, E?'TEND cert:equratbnorah.com 71{ ALT 0415 Piedmont Ra N1, suite lino ER TH! CUVERAGc AFFORDED BY THE POLICIES ®ELUW. jatleote, (Q 30305 t` �tgx tzi21 948-0l02 INSURERS AFFORMO COVERAGE - INAICq •INaV�D fTOD At-Four CezKLy�y, Inc. nM Ghk9trad!aat IO! Co 263$7 MO Cumberland parkway 0f2UREA&Zuriok Aaaricaa Ina Ca 16535 SvitO 300 at9tlWgXhTI0NAL=XCN ixRZ rwc CO 0' PITTS 19995 1 AtIsato , CA 30339 � at01pRg0;Nav H Ira Ins Co 23092 COVEGES VASLIW a xlil"to Natl Ing C0 121917 THE POLICIES OF wSL WCC LISTED BELOW HAVE BEEN MUED TO TH8 WWRW NAME0A80 PCR TKE POLICY PERIOD OHDICATEt1_N07yMTNSTAN01t� } ANY R@DUIREMENT,TERN OR CDNOITIDN ANY ODNTRgCT OR OTI+ER DOCMAYUl�NT WITH RESPECT TO WNItrf1 T►f69 CL VICATPt VAY 0E VISM Oft POU C�E,4TA�EGATE L�IM�iT$gMp AFFORDED 11AAY yAVE BEENAM=ED BY PAI�O HMEIN 18 CLANS. SECT TOALL TFC TERMS,EXCIUSIOtrS AND COND[TIONS d�BUGhf NNMI pOLIDYN—WIM t�twTs A OiNiRALL"L tr in 3757 606-01 03/01/09 03/01/10 ELEMOCSiUaibNCE =6,000,000 f A GNMBJtCNL06 RALUA9MY LIMITS OF FOLIC!ARS Me C1AMOMMt{ Q 31.000.000 pOEta -OF SIA. $11008,000 pEA M asm em "M AAOVWJURY 9 4.000.000 j OENlMLAOATItE0A7! 5e,00a.000 I OT9n C01ptO►A� $9.000.000 ft X pam I,pO t e AtfTOM00LELJA LM S&P 2930063.06 0/01/09 03/01/20 A NVAUM re fM/01.Owmff 5i,000,000 ALLOWMAVTM "" 1 iii IeO1K�AUiOS � i I . k"WAUTOm I MONOwNEDALfT06 YRAW $ i X BELP 2aNiV w xwo rNxxaxcns OAMAOs awAGE s owwwBILny AMORLY-FAACMpr A ! ANYMJTO O EpT„rt, 1AACC I vYYYOOOONNLL A0s s A EI6aaNLwaNH1ALU1114Jry - ;pit 3707 600-01 03/02/09 03101/10 A!q!—aCCkM&495.000.000 A CMA 11Ct/t019t4ADE AOON Tr, 13,006,090 i 0®UeTteu = s C wOAKapiCOsweNsntpNaNO 3$66916 (CA) WOWS, 03/01/10 % D [L71toTeRSLtA$8j1Y 359691$JA09) TX� eNNw a0 � a 3564911 (Pt1 03101/09 03/01/10 aLNACNACCION31,000,000 03/01/09 03/01/10LL EAaM/LOTEt; $2.000 000 Q�+44aUe. QTM E.OIOEAN-pOUCY►"T 511000,000 D Work*" Nompeosatioo 3546919 city. A0. Ny, ti;. ► 03/01/09 Oi/01/10 ! Etaployare !plea., TN5Q4r691431 (TX) OS/01/0 07/01110 eurrnaee/sxat asit/3M C Packets Cw,penaaticn e00aaa3(Qs11 03101/O9 01/02/20 oeeearTtoaopopoltAt�eNSfu�rfttteN31 All tvown 01 tI MANCII 1060011XOtwpINA0000tiYr�ORttOMDIfNp64uu.pttwtipw i I CERTIFICATE HOLDER CANCCfLLAT10N 3NOI0.D ANY QP tN[AaOYE 11Gi{9i060 i+0LIG60 OiGNOCL4E09�0AdTNt iiItNRAT10N AS•N0203 SERV;CEI, Inc. MTN TIRREO/.TNA gft"d Immut M4 gMOaavfm to AWL 30 "V-Mj t l 110M 70 TW CIAhACAtE MOLMM NANO To TIN LQ".MR twaON!TO 09 6o$MALL 610 COfORKLAM pA3UMy 0 NO 00LnAT"OR UUNfUV T W ANY Mo tdON ti!YItuasa m w0Y t1V ON BITE 300 I�aE$lMATMt$. 1 gLAyIA, @A 10330 •uTMOwaaOpbaasQNrATfTE ICORD25(2007MI�crasaaas led • 11i7atao" ®ACORD CpRPORJITION 3888 Jul 09 09 09a36a Michael Bedard 1 -401 -246-2966 p,2 NI;IS ;W h1110IN- lh•IM 1.1 D IL-11 I Of PO hiit' Sill'k-It R 0,mr(I of 131h lit i 11-,! M.-jululitm 113 it 51amlaI(L .•. Collsvoctiori Ski-peTvisor Specialty License KEVIN LEGE R 1:111 COUNTY S?R'[.E7 SOMERSET,NIA 02726 .m EROir,)Oow 9/19/2012 102629 4•, J I t\` I The Commonwealth of 311assachusetts _ Departnient of Industrial Aecidents Office 00'11 vesti a.tiotrs 60.1 E ir, .,r Boson, MA 02111 www,Pf's f1,4S'.g 0 vldia Wort rs' Compensation. laFSii)<'�€T'��Aftlidihvit: l�raik'!ne4S/C�yt�a�� :°, ilicalit Information _ Please I'r�z1E Legibly Name (Business/Ofganization/Individual): � � t na Address: ( City/State/Zip: ___ �� h+r �� , �ic� � Phone.#: L)61 F219-9- AL:� yoy an employer? Check the appropriate bog: Type of project(required):. 1. /I am a employer with 4. [] I am a general contractor and I 6 E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' y p ty• 9. E]Building addition [No.workers' comp. insurance comp. insurance.$ required.,] 5. We area corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 1 L[J Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Ro rep ' s insurance required.] t _ c. 152, §1(4), and we have no employees. [No workers' 131 ther 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 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: Policy#or Self-ins. Lic. Expiration Date: ;A l Job Site,Addres9: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(sh.owing the policy num er 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 tip to$1,500.00 and/or one-year im risonment �On_ER anda fRe -- of up to$250.00 a day against the violator. Be advised that a copy of this statement may be foi warded to the Office of Investigations of the DIA for insurance coverage verification. — I do hereby certi un r e p s an penalties of perjury that the information provided above is true and correct. Si ature: Date: . t! Phone# Oficial use only. Do not write in this area, to be completed by city or town officiaL City or Town: PermitfLicense# 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#: Ali e �omz moozu ea� o� 2��a ktac�ivael�i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 126893 Expiration /3/2010 Type 'Supplement Card The- Home Depot At--Home Service RICHARD FALLONE kk 2690 CUMBERLAND:PARKWAY S A'�AN4`A,GA 30339 Administrator i