Loading...
HomeMy WebLinkAboutMiscellaneous - 150 JOHNSON STREET 4/30/2018 (\. of 4 �• r 1 l �: Date . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . .!. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform `&A . . ACJ?.��. wiring in the building of �J- at . �. 'UJ.� 'J. � . . . . . !J. . . . . . . ,No Andover, Mass Fee .a2�V-. Lic. No. ZPO . N� . . . . . ELECTRICAL INSPECT Check# 2-4 5r 11379 i ^ f Commonwealth of Massachusetts ficial Use Only I Official � Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1-24-13 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 150 Johnson St Owner or Tenant Martin McGrath Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No❑ (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. Existing Service Amps / Volts Overhea Undg No.of Meters New Service Amps / Volts Overhea Undg No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installing a 9.25 KW Photovoltaic system Completion of theollowin 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 rnd.Above ❑ n-rnd. E] No.o Emergency Lighting BatteEl Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.o etection an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.o Water o.o o.o Heaters Kms' Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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: INSURANCEa 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 inform on this application is true and complet . FIRM NAME: SunBug Solar LIC.NO.: 1070-A Licensee: g Patrick McDonough Signature LIC.NO.: $1-�@�-#$31 (If applicable n er " pt"i t lic se,nu er t Bus.Tel.No- Address:41�� Hlg�i' ancewte1�Somerville Ma 02144 Att.Tel.No.: 181-856-9062 INSURANCE WAIVER: I am aware that the Licensee does not have the liabilit trance c ge normally required by law. By my signature below,I hereby waive this requirement. I am the(check on owner wner's agent. Owner/Agent Signature n Telee)hone No. PERMIT FEE:$ //20.3 MP3 cv�. .-ems �. A le—-e'x'l--o j i a_ COMMONWEALTH OF MASSACHUSETTS ' REGISTERED MASTED ELECTRICIAN ISSUES THE ABOVE LICENSE TOi ;1 SUN B.UG SOLAR LLC - PATR;ICK .F - MCDONOUGH , I % LINTAVE MA .02180 3 STONEHAM5Z�f � W —2107 1 10710 A 07/31/13 7301;14 - I Panel Characteristics: 250 Watts DC at STC VOC=37.8V a M t5A ISC=8.28A 0 Vmax=31.1V t/) N Imax=8.05A � 0)0 , AC Combiner 15A Inverter Characteristics a 1sA 240VAC Branch Circuits =3 ! 15A Inverter Output Current= .9A =o 15A Branch 1 Current=9.9A a(1) Branch 2 Current= 11.7A Branch 3 Current= 11.7A 9.25W solar array composed of 37 Solarworld SW-250 250 watt panels Total Current=33.3A 37 Enphase M215 Microlnverters Module frames grounded to main panel ground or ground rod. c a Y V y > _ r C C c -5Q To utility grid z I Utility NET o Meter CD m c U — � m Solar 0 Production 3 Meter Supply Side Tap o Notes: 200A Service Panel a 1)All equipment to be listed or Lockable 3R 20°A w 240V AC labeled for its application PP 2-pole 200A Panel 2)installation to be compliant with 50A Fused Nov 19,2012 National Electric Code AC Disconnect 3)Equipment labels to comply Not to scale with NEC 690 Back-fed 4)Point of connection to existing power 40A Breaker E_1 distribution system shall be coordinated aoA s with local utility company f L ENPHASE MICROINVERTER M215 enphase E R ; Y The Enphase Energy Microinverter System improves energy harvest, increases reliability, and dramatically simplifies design, installation and management of solar power systems. The Enphase System includes the microinverter, the Envoy Communications Gateway, and Enlighten, Enphase's monitoring and analysis software. - Maximum energy production PRODUCTIVE - Resilient to dust, debris and shading - Performance monitoring per module - System availability greater than 99.8% RELIABLE - No single point of system failure SMART - Quick & simple design, installation and management - 24/7 monitoring and analysis S A F E - Low voltage DC - Reduced fire risk ��® c us a J. MICROINVERTER TECHNICAL DATA Input Data (DQ M215-60-21-L-522/523 M215-60-2LL-S22-NA/523-NA(Ontario) Recommended maximum input power(STC) 260W Maximum input DC voltage 45V Peak power tracking range 22V—36V Operating range 16V—36V Min./Max.start voltage 26.4V/45V Max.DC short circuit current 15A Max.input current 10.5A Output Data (AQ @208 Vac @240 Vac Maximum output power 215W 215W Nominal output current 1.0 A* 0.9 A* Nominal voltage/range 208V/183V-229V 240W21 1V-264V Extended voltage/range 208WI79V-232V 240W206V-269V Nominal frequency/range 60.0/59.3-60.5 60.0/59.3-60.5 Extended frequency/range 60.0/59.2-60.6 60.0/59.2-60.6 Power factor >0.95 >0.95 Maximum units per 20A branch circuit 25(three phase) 17(single phase) Maximum output fault current 1.05 Arms,over 3 cycles;25.2 Apeak,1.74ms duration *Arms at nominal voltage Efficiency CEC weighted efficiency 96.0% Peak inverter efficiency 96.3% Static MPPT efficiency(weighted,reference EN 50530) 99.8% Dynamic MPPT efficiency(fast irradiation changes,reference EN 50530) 99.9% Night time power consumption 46mW Mechanical Data Ambient temperature range -40°C to+65°C Operating temperature range(internal) -40°C to+85°C Dimensions(WxHxD) 17.3 cm x 16.4 cm x 2.5 cm(6.8"x 6.45"x 1.0")* Weight 1.6 kg(3.5 lbs) Cooling Natural convection—no fans Enclosure environmental rating Outdoor—NEMA 6 *without mounting bracket Features Compatibility Pairs with most 60-cell PV modules Communication Power line Warranty 25-year limited warranty Compliance UL1741/IEEE1547,FCC Part 15 Class B CAN/CSA-C22.2 NO.0-M91,0.4-04,and 107.1-01 Enphase Energy, Inc. 05/17/2011 f 201 19� Street,Petaluma,CA 94952 8,77 797 4743 www.enphase.com ®Printed on 100 percent recycled paper, 1 Sunmodule- SW-02-SOOIUS01-2012 US SW 250 mono / Version 2..0 and 2.5 Frame PERFORMANCE UNDER STANDARD TEST CONDITIONS(STC)` PERFORMANCE AT 800 W/m2,NOCT,AM 1.5 SW 250 SW 250 Maximum power p- 250 Wp Maximum power Pm 183.3 WP Open circuit voltage Von 37.8 V Open circuit voltage V. 34.6 V Maximum power point voltage Vmpp 31.1 V Maximum power point voltage VmPP 28.5 V Short circuit current I,c 8.28 A Short circuit current 1,, 6.68 A Maximum power point current Impp 8.05 A Maximum power point current IMP 6.44 A 'STC:1000W/m�,25°C,AM 1.5 Minor reduction in efficiency under partial load conditions at 25`C:at 200W/m�,95% (+/-3%)of the STC efficiency(1000 W/m�)is achieved. THERMAL CHARACTERISTICS COMPONENT MATERIALS NOCT 46'C Cells per module 60 TC Is, 0.004%/K Cell type Mono crystalline TC va, -030%/K Cell dimensions 6.14 in x 6.14 in(156 mm x 156 mm) TC Pmap -0.45%/K Front tempered glass(EN 12150) Operating temperature -40*C to 8S*C Frame Clear anodized aluminum Weight 46.7 lbs(21.2 kg) 1-V cvrves low Solar~d Sunmo"Mus SW ISO nw4 art 25%Call 2tmperetwe 90 SYSTEM INTEGRATION PARAMETERS so 70 7 so loWWW Maximum system voltage SC II 1000 V so _eoo wfm, Max.system voltage USA NEC 600 V a0 -woww Maximum reverse current 16A 30 -Amww Number of bypass diodes 3 -moW1W 20 UL Maximum Test Load" 45 psf(2.1 kN/mz) 10 IEC Maximum Snow Test Load** 113 psf(5.4kN/m2) 00 0 to 20 30 40 "Pleaseapplytheappropriate factors ofsafetyaccordingtothe test standard and local Module sohiaa M building code requirements when designing a PV system. ADDITIONAL DATA =L-x4 37.44(951) Power tolerance) -0 Wp/+S Wp 11= J-Box IP65 Connector MC4 11.33(288) Module efficiency 14.91% Fire rating(UL 790) Class C 41.30(1050) 0.6 15.31. 0.6 15.3 Version 2.5 frame 65.94(1675) bottom mounting m holes n ry .5(12.65 1.34 34 0.6 15.3 VERSION 2.0 FRAME VERSION 2.5 FRAME 6_ x4 Compatible with"fop-Down" Compatiblewithboth"Top-Down' 4.20(107)* mounting methods and"Bottom"mounting methods ♦Grounding Locations: lGrounding Locations: 1.22(31) 39.41(1001) 4 corners ofthe frame -4 corners ofthe frame -4 locations along the length of the module in the extended flange+ r `TOP QUALITY Sunmodule'T'/"" SW 250 mono / Version 2.0 and 2.5 Frame World-class quality 1 Fully-automated production lines and seamless monitoring of the process 3� '+ Qualified,IEC 61215 and material ensure the quality that the company sets as its benchmark for Safety tested, y IEC 61 its sites worldwide. ?UVpn01Nen6 D E ,a � ParPeriodicc In Inspedlon '°0000a% SolarWorld Plus-Sorting Plus-Sorting guarantees highest system efficiency. SolarWorld only delivers naliff modules that have greaterthan or equal tothe nameplate rated power. Intertelc 25 years_linea r performance guarantee and extension of product warranty to 10 years SolarWorld guarantees a maximum performance degression of 0.7% p.a. in C US LISTED t°SE the course of 25 years,a significant added value compared to the two-phase P atovatNOModai.iPanN Made in USA warranties common in the industry. In addition, SolarWorld is offering a product warranty,which has been extended to 10 years.' `in accordance with the applicable SolarWorld Limited Warranty at purchase. www.solarworld.com/warranty SOLARWORLD 1)Surwnodules dedicated for the United States and Canada are tested to UL 1703 Standard and listed by a third party laboratory.The laboratory may vary byproduct and region.Check with your SolarWorld representative to confirm which laboratory has a listing for the product. .2)Measuring tolerance traceable toTUV Rheinland:+/-2%(TUV Power Controlled), 3)All units provided are imperial.SI units provided in parentheses. SolarWorld AG reserves the right to make specification changeswithout notice. SOURCE COMBINER RATINGS rJL- (0&&WAt OCPD=OVERCURRENT PROTECTION UNUSED SERIES STRINGS MAX OCPD RATING= A UTILITY SERVICE�21 / DEVICE(IF NO OCPD-LEAVE ITEM BLANK) LEAVE BLANK BELOW OCPD AMP RATING=_ A ,'+�p OCPD VOLT RATING= o� V INVERTER RATINGS y s MAX DC VOLT RATING=' �V Modules in Series MAX POWER @ 40°C SW i NOMINAL AC VOLTAGE= 'Zy V MAX AC CURRENT= ft A 1 1 , A MAX OCPD RATING= J J Modules in Series ; INVERTER � PV OUTPUT METER ' DC DISCONNECT AC DISCONNECT (IF REQUIRED) AC M DC Modules in Series ; -•------ ----•--- -- -- ........ ---- ---- --- GROUNDING i � q � � ELECTRODE MAIN SERVICE PANEL ' _ ✓ DC DISCONNECT RATINGS AC DISCONNECT RATINGS SERVICE PANEL RATINGS DISCO AMP RATING= A DISCO AMP RATING=JPO A BUS AMP RATING= 21)Z) A Modules in Series DISCO`JOLT RATING= V DISCO VOLT RATING= V SERVICE VOLTAGE= 2 V OCPD AMP RATING= A OCPD AMP RATING= yb A MAIN AMP RATING= 2C C) A OCPD VOLT RATING- V OCPD VOLT RATING= 2�� V INVERTER OCPD �\ AMP RATING= y A _�Q _ ��� I�C �-✓l�.�iL�-{,� NOTES: 1�AC✓.D.FA4 A CtYr`) 690.53 PHOTOVOLTAIC POWER 1)IF UTILITY REQUIRES VISIBLE-BREAK SWITCH, DOES THE AC DISCONNECT PV MODULE RATINGS Cad STC PV ARRAY INFORMATION SOURCE SIGN ON DC DISCO O SATISFY THE UTILITY REQUIREMENTS OR IS AN ADDITIONAL SWITCH NECESSARY? 2)IF INCENTIVE PROGRAM REQUIRES PV OUTPUT METER,ADD METERBASE THAT MODULE MANUFACTURE WOf #OF MODULES IN SERIES �2'� RATED CURRENT= A MEETS REQUIREMENTS. MODULE MODEL# SW a� #OF PARALLEL CIRCUITS 3 RATED VOLTAGE:= V LOWEST EXPECTED TEMP�Z J °C MAX SYS VOLTAGE= V OPEN-CIRCUIT VOLTAGE=Slit V HIGHEST EXPECTED TEMP °C MAX CIRC CURRENT= A OPERATING VOLTAGE= 31, 1 V SOUR WIRE TYPE(OUTSIDE CONDUIT-CIRCLE ONE) MAX SYSTEM VOLTAGE_ V USE- V WIR T WIRE TYPE(INSIDE CONDUIT-CIRCLE ONE) OPERATING CURRENT= -05V THWN-2 HHW-2:RHW-2: USE-2 SHORT-CIRCUIT CURRENT= $►2`d A SOURCE CIRCUIT WIRE SIZE(SEE NOTE BELOW) 1 MAXIMUM POWER= 2S7t> W NOTES: 1.)ASHRAE FUNDEMENTALS OUTDOOR DESIGN TEMPERATURES DO NOT Voc TEMP COEFF=^.3 MV -/-C EXCEED 47°C IN THE UNITED STATES(PHOENIX,AZ; PALM SPRINGS, CA). 2)FOR LESS THAN 9 CURRENT-CARRYING CONDUCTORS IN ROOF-MOUNTED Generic Photovoltaic System Electrical Diagram (IF SUPPLIED) SUNLIT CONDUIT AND USING THE OUTDOOR DESIGN TEMPERATURE OF 47°C, for PV Systems of 10 kW or less a) 12 AWG CONDUCTORS ARE GENERALLY ACCEPTABLE FOR MODULES WITH Isc OF 6.4 AMPS OR LESS WHEN PROTECTED BY A 10-AMP FUSE. SIZE FSCM NO DWG NO REV b) 10 AWG CONDUCTORS ARE GENERALLY ACCEPTABLE FOR MODULES WITH Drawn By: A E1.1 0 Isc OF 9.6 AMPS OR LESS WHEN PROTECTED BY A 15-AMP FUSE. Checked By: SCALE NTS Date: SHEET N° Z 2 17 Date... ..�.�- ...�f! ..... NORTp o0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING o : t � • ; ,TMus�� This certifies that --; � f � ..... - has permission to perform ............................... . R wiring in the building of.. ................................................................................. �.. �........ ,North Andover,Mass. t Feer.'`... ........ Lic.No.`^�..'�. ���.„,�.-, �,�• i .. ...� —�-ELECTR[CALINSPECTOR WHITE: ApplicaX/21/9%A Y: BuildingNOO PAIPINK:Treasurer Office Use Only Permit No, 'ga 1 I Occupancy 8 Fee Checked Dr.»urs Pa6[ie S4ry BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM E ECTRICAL WORK All work to be performed in accordance with the Massachusetts,EI cal Code 527 CMR 12:00 (Please Print in ink or type all information) Date I" _ To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the elect icai work described below. Location(Street&Number Owner or Tenant Owners Address Is this permit in conjunction with a building permit Yes (A-' No ❑ (Check Appropriate Box) Purpose of Building W e,,, /f a / Utility Authorization No. Exiting Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters NAber of Feeders and Ampacity Location and Nature of Proposed Electrical Work -5*;?Gy r r ,, 01 r Al I Total No.of Light8nq Outlets No.of Hot fuse No.of Transformers KVA Above CO In ❑ No.of Lighting Fixtures Swimminq Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting 41o.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and 7No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Dloosal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Soace/Area Heeling KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection Na of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER ��C ✓rr��., ��a/1�'1 r INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Competed Operations Coverage or its substantial equivalent YES VNO = have submitted lid proof of same to the Office YES Y NO = If you hive checked YES please indicate the type of coverage by checking the appropriate box INSURANCEBOND = OTHER = (Please Specify) G� (Expiration Date) Estimated Value of Electrical Work$ -7 0©r 0 Work to Start Inspection Date Resquested Rough Final Signed under the Pena e$of perjury: L FIRM NAME 5-V I V A/-' fin/% -r A L A !Z p'J LIC.NO. e`V.5 Licenses /2©hLer-1 40. 5V 1I/ v H'�'SISnature lea 4� v� 6 uc.N0.2 2 y Bus.Tel No. �7�/ r/�`6 V7/ Address -2-7 ^;`/ Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Ma achusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check onel Telephone No. PERMIT FEE 5�- (Signature of Owner or Agent) � 1 N2 2z 0 Date... ... ... / ,aORT1{ °!< °;•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �1 •O+�r�o��`�� ,SSACMUS� This certifies that-, ............ ....................... has permission to perform ..... ......Y.....1................................................ wiring in the building of...... ^- ............................................... at...... S!Jam. lti-.:...:`-- ........ .....,,'6rth Andover s. 'Fee ......�! Lic.No j.-O.`�.&................ ... ...... LECTRICALINSPECTOR 01/12/9914:49 255.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer TWOOM11•ONWE+ 0HOFAUMMISL+7T5' Office Use only DEPARMENTOFPUBLIC Permit No. BOARD OFF7REPREVEN770N TIONS527CMR 12. ' Occupancy&Fees Checked APPUCATIONFOR PERW TO PERFORM=CMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH TETE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat �i 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) (S0 SCVH�J :�QJ�2 i t Owner or Tenant Hity Ry 1,e{ Owner's Address Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building /-FA in t L, t J �f p��� Utility Authorization o. Existing Service Amps / Volts Overhead M Underground M No.of Meters New Service 91016 — Amps 2®/ ( Volts Overhead M Underground ® No.of Meters / Pumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work ` No.of Lighting Outlets / No.of Hot Tubs No.of Transformers Total J KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ED ground No.of Receptacle Outlets 60 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets ,i No.of Gas Burners 1;-L No.of Ranges �— No.of Air Cond. tL 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 Municipala Other '—� 51 Connections No.of Water Heaters KW No.of No.of � Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER htsur=COKrg Risttarttothem m Tie&ofM%MdaEcZGataalLaws 4- Iha%eaamatLiabr7d'yhtstra=Pbbcymdu&gCartp& CrmaWcrisskAmialegivakrt YES a NO I ha%esubmEtedvalidpoofofsa M1DtheOff=-YES M NO Ifjauha%wiledcadYES,pltwsemdc*thetMxof bydakitgthe appropriAebox INSURANCE M BONDF-1 OnER o ftwe ) E*afim Date Est¢tEkd Va9kcf Iamial wads$ Wolk aD Srart 116 ._��.�.. D* //�I �... Emal Sigrt mcg Mie PFi�ofptzjuy: f FIRM NAME .5T JrL4r4) '� Lioa>seNa Busilm Tel.No, a Ar c_7�'I .�ZCff��f r/11f�J6!r� / AItTCL Na q� 8`r/`� OWNERS INSURANCE WAIVER,tanawarethactheli=wdM theg�strane orRssub�irmalegrnwietttastecgm Iby dase7[s(3a>eralLaws and fat my sigt�dtseoa this prem€appGrrirn this racg,ast�. (Please check one) Owner Agent Telephone No. PERMIT FEE$ CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number '� 3 �O Date 8 THIS CERTIFIES THAT o --� THE BUILDING LOCATED ON `c� a � ,� s a MAY BE OCCUPIED AS J '�W I`,-1 T fiffJY e>�, S-/a) �N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. f 'to Rr" 1 CERTIFICATE ISSUED TO ADDRESS 1-SD ^l a N .5-0 43 S �'s,CNU'f Building Inspector loops Town. o \; 4Andover i No. 0 LAKE 0 dover, Mass., _199V -i COCHICHEWICK BOARD OF HEALTH /Kitchen PERMIT T D Foo c/Kthen tem BUILDING INSPECTOR THIS CERTIFIES THAT........S.Vrk ......4..... S ...C)...... ...........h..................................... Foundation, has permission to erect............. ..................... b 'Idin s on ...... ..........=ro.......A.)..$dP Rough ....... ............. .... /y to be occupied as......3.I.A. ................................... . ..... ..... S .... ..... . ...... ... .... ..... Chimney.... provided that the person ac g this permit shall in every respect conform to the terms of the application on file in Fina l C 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 SR A'o 5;9� VIOLATION of the Zoning or Building Regulations Voids this Permit. noy'�"' 4A— C�;-C> 9C ;2 PERMIT EXPIRES IN 6 MONTHS )ELLf6TRIC INS AI _ O_ S kRTT UNLESS CONSTRUC-11 S]011, .......... .. ... ........ ... .. .............. . ..... . UILDIN INSPECTOR �fn Occupancy Permit Required to Occupy Building GASIT�SPECTO ,/-?/ (RR��g­hX/ " , e--� Display in a Conspicuous Place on the Premises — Do Not Remove &_ - s s No LathinA or Dry Wall To Be Done FIKE DEPARTMENT Until Inspected and pproved by the Building Inspector. Burner D251, Street No. -a Smoke Det. ql's- 06/23/99 . WED 15:57 FAX 978 688 9573 NORTH ANDOVER DPW 001 E "ORT h 0' 93 !�' O tjao 46'q,yo tetwiiVwntw '• �O �ss�ICHU APPLICATION FOR CERTIFICATE OF:O(%CIIPANC Y/IN PEGTION ADDRESS/LOCATION OF PROPERTY DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY; - FIVE 5 DAYS,-NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING CONSERVATION / PLANNING OK* �Iz3/ cl S DPW-WATER METER NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL. OF THE OCCUPANCY/INSPECTION REQUEST DPW Sig ature Re QC(om rav,,w Sim Location No. - Date TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ +� Foundation Permit Fee $ s�CHus Other Permit Fee $ Sewer Connection Fee $ - Water Connection Fee $ TOTAL Building Inspector Div. Public Works I'll-RM ITNO . �/,q 4'L+ IZMI'I' "1'O 13UIL1)********NUR"1'11 ANDOVER, MA AI 11'NO. (/7 LDT.NO. e� 1. RE('(1RI)m oWN1 RSIIIP ��/ 1)ATE LIOOK PAGE z(INI_ l Slllf 1,1,. VO N(l. !YH A, ,/ J 18VA0, + OS90 a d /D -/ 9 Lit.6,? 232 10( ,k IIIIN s PI IRI'()SE(Y:III III III NG OWNER'S NAhILNo -OF SIOFIll:S SIZF. O 2 O Q P7- OWNER'S)WNER'S ADDI(FSS At,73 BASEMENT(Ni SI All r AR(III I ECCS N kNIE ,r, SIIL OF tl OOR I IMHURS O I O 2 ND 3 III III UGR�S N.MIE L SPAN ' DIS'IANCFTONEAREST BUII DING (So i DIMENSI(NJS(*SIL]S DISI'ANCEIRCN.ISTREEI " oo DIMENSIONS Ol:I'tDIS DIS I'ANCE FROM LOT LINES-SIDES 2S'" REAR / ' DIMENSIONS OF GIRDERS 0 AREA OF LOT 4 FR(NJIAGE O �� IIEIGIITl1FF(RINDAII(NJ ' V THICKNESS o ISBI111_DINGNEW Gs SIZEOFI(X)IINC, X 2 IS BUILDING ADDI TION MATERIA].OF Cl IIMNEY O f} CLt'A,e NcZ.:-- f') T-A L- IS BI111.TNNG ALTERATION NO IS BUILDING ON SOI.IDOR FII LED LAND Wit 1.BUII.DING CONFORM TO REQ IIREMEN I S OF CODE e5, IS BI IILDING CONNECT ED lO TOWN WATER BOARD OF APPEALS ACTION, IF ANY ISBUII.DING CONNECIE'D10TOWN SI:WIR410 IS BUII.DING CONNECT ED TO NA FURAL GAS LINE �S INSI II("PIONS 3. PROPE1111' INFORMATION LAND COST 6 000 ESI. el lx;. COST' tdd Ooo PAGE 1 FILLOIIFSECTIONS 1-3 EST. BIT)(;. COSI I'L-RSo. FT. O EST. BI D(;. COS I I1:R R(X" ELECTRIC AIEFERS MUST BE ON(xTTSIDE OF BI II DIN(; SE19IC PER1,11 T NO. IN A ATIACI 1¢I)GARAGES MUST C(NJFMIITOSTATEFIRE REGIII.ATI(NdS A. APPROVED BY: PIANS h1UST BE FILED AND APPROVED BY.N II LDING INSPECTOR BUILDING INSP F CTO11 DA It:III ED Q t91 OWNERS 11:1 COKIRAFI.M V b�� ,�,yL / e 1,13 SIGNAf11RP.( � WNFRIN(AIfIINx21LliI)AGENT � � PIRLIIT GRAN IED 19 • ] C FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****''*****APPLICANT FILLS OUT THIS S ECT ION****r*—**************** APPLICANT C o cl el/ 7 c 8.to-s flyc . PHONE k5 LOCATION: Assessors Map Number PARCEL�� SUBDIVISION Q/L d CIE-1-1-TCA Lava:- LOT (S) ? B'a STREET J 0 ha S o lw ST ST. NUMBER ***' ************************OFFICIAL USE ONLY*******.**"****,�'' RECOMMENDATIONS OF TOWN AGENTS: /CONSERVATION ADMINI$TRAT DATE APPROVED DATE REJECTED COMMENTS A� TOWN PLANNER DATE gPPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS /PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE r i r Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall 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. The building applicant shall provide all of the necessary information as requested below. Name of Applicant an Building Permit(below) Address of Property for Permit(below) Co c. • y s TiT'l/ acs tic _ /�_O Map and Parcel : Purpose of Application (check below) Phone Number of A licant: I _KSingle Family _Two Family ZR�- sr{ 9 I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the 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 issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit iq issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. fihis is an application for a building permit for the enlargement,restoration,or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. eyVThe lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning aw. ,This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section"senior'shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density, (buildable lots), below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. adjThis application represents a tract of land existing and not held by a Developer in common ownership with an acent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. yi iatuw o �wor�AuthonziedAgg ntwno signed theAttached Budding Permit Date This form must be attached to the Building Permit upon application for such permit t IL • 1 N° 1353 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 19 7p Application by the undersigned is hereby made to connect with the town sewer main in Street subject to the rules and regulations of the Division of Public Works. The premises are known as No. ��� �(?� GLt Street or subdivision lot no. Owner Address Contractor Address rpph�canvsi ature PERMIT TO CONNECT WITH SEWERAMIN The Division of Public Works hereby grants permission to r ' Ll to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of ub is Works By Inspected by Date See back for rules and regulations t RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the (town). 671 , ✓'Ze 7/Jd777//7�"09Zf.!/pq� d�. i.QQq,C�6FJP.� DEPARTMENT OF PUBLIC SAF CONSTRU`UiN,SUPERVISOR LIC F Number: .,Expires: irthdate; ` CS 026143 8`S 2 / 4/2000 5J24/1940 Restrie'tedT1: gg ENRYI BfNO, IAN. 636 CHICKERING RD N ANDOVER, MA 0184y The Commonwealth of Massachusetts Department of Industrial Accidents -- Office v/InyesUgaUons - _ 600 Washington Street Boston, :Plass. 02111 Workers' Compensation Insurance Affidavit location. z 6 6) ❑ 1 am a homeowner perfo ing all work myself. Col am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees wq.rking on this job. comnary ratne: address:' city: insurance cu. phone tt kl ❑ I am a-sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: citv' phone q insurance co oolicv# address:. city:. phone# insarance ca. Failure to secure coverage as required under Section 25A of vICL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP 1VORK ORDER and a fine of 5100.00 a day against me. I understand(bat a copy of this statement may be forwarded to the Office ul lnvestigatiuns of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct SignaturesDate ,/ p ,� Print name— �/ C fes_ ( ►\P ( I\ 1��� Phone Ccheck do not write in this area to be completed by city or town official permiUlicense p -Building Department ❑Licensing Board CO] diate response is required C3Selcctmen's OfEce Health Departmcat phone is: -Other (r-W 1/95 PIA) • ( it 10/27/98 08:51 $508 664 0872 MOYNIHAN LUMBER 005%(108 1' MASchcck COt-TLIANCE RZPORT ! Mast achusettLi Energy Code I Permit # ! MAScheck Sort-ware version 2.01 ! ! I I I CheckSd by/Date I CITY: North Arnciover STATE: Massachusetts EDD: 6322 CONSTRUCTIQN TYPE: 1 or 2 Family, Detached _ hEATING SYSTEM TYPE: Other (Plop-Electric Resistance) ftp J C), Ns O.Al �F DATE: 10-26-1998 / DATE OF PLANS: 10/24/98 / TITLE: L�sndikian 13 PRO ECT INFORI.9TION-- 4002 ION:40x32 colonial w/;i 6x26 fr North Andover COMPLIANCE: PASSES Required UA - 551 Your Home = 538 Area or Cavity Glazing/Dour Perir.etr,r R-Valus R-Vc 1uF• U-Valuo UA CEILINGS 1'751 30.0 0.0 62 CEILINGS 10 0.0 0.0 6 WALLS: Wood Fra n9, 16" U.C. 2431 11.0 0.0 2i7 GLA21NG: Windows or Doors 391 0.330 129 GLAZ NG: Windows or Doors 41 0.560 23 GLAZING: Windows or Doors 41 0.320 13 DOORS 22 0.190 4 COORS 16 0,270 4 FLOORS: Over Uncoaditicried Space 1691 19.0 0.,0 80 HVAC EQUIPMrNT: Boiler, Gar Steam, 24.0 AFIJE COWLIANCE STATEMENT: The proposed building design described dere is consistent with the building ,plans, specifications, and other calculations submitted with the permit application. The proposed building has berr: designed tc moet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has beer. determined using the applicable Standard Design Conditions found in the Code. The RVAC ecf.:ipment selected to heat or cool she building shall be no grester than 1252 of tho design load n3 specified in Sections 780CN,R 1.x10 and Builder/Designer ]Onto ' 10/27;'98 03:52 $503 6134 0372r MOY( IHAIv LUMBER zQo6,-Qo3 { check INSr'ECTZON CI�CKLIST Massachusetts l:nc.rgy Code HASCheck Software Version 2.01 Bendikian DATE: 10-26-1995 Bldg. l Dept. I Use I I I CEILINGS: ( ) i 1. R-30 I Comments/Location I' l 1 2. R-0 0mtrentc�/Location T LS: Wood Fr•Wftf, IC" O.C., R-11 1 Comme�ntslLocaticn I T+VINT-Q/dS ANL GLASS DOORS: V-value: 0.33 I For windows without labeled U-valuers, describe features: ( 9 Panes Frame Type Theiznsl Jz-ea.k7 ( 13 Yes ( ( No I COrM.ents/,Location U-value: 0.56 - I ro,r wincic•ws without labeled ti va.,7,Ue5, describe fea.t�-os: I fJ Panes Frump Type_ Thormal Brea,k7 r ) Yes ( ) No i Conments/Location ( J f 3. if-value: 0.32 I For windows witbout labeled U-vslucks, describe features: E # Panes Framc+ Type T Cpl.,,,rma,l Bre;k? I Comments/hc•cat-.cn No I DQORS: ( J I I. U-value: 0.19 I Cn�1Fnt;;/L9C8t10Il ( J I 2. U-va„ue: 0.27 i Commer:ts/Lvcatioa i FLOOR; Over Uncondit9.oned Space, R-19 I comments/Location I HVAC EQUIPMENT: Boiler, Gas Stjaam, 94.0 AFUE or higher Make and Model Nur,Lbcr I AIR LEAKAGE: ( J 1 Joints, pF'netrations, and all other such openings in the building I envelop,, that are sources of air lenk,:jg0 must be ,sealed. When irista.11ed ir, the buildinq envelope, recessed lighl:ing fixtures I shall r.,00t anc� of the 'following roquirements: 1. T'fpe _TC rated, manufactured with nc 1_enotr&ti011s between the inside of the recessed fixture and ceiling cavity and sealed or I yaskrtod to prevent air leakage into the unconditioned space. 10/27,'98 08:52 $504 664 0872 itf0i'NIHA\ LUMBER �007:008 1 COOLING SYMV.S: I Chilled water or 40-55 0.5 0.5 0.75 '1.0 i refrigerant below 40 1.0 1.0 1.5 1.5 I I CIRMLAT'.ING HOT :,LkTZR SYSTEMS; ! Iasulatc circulating hot water pipes to the following ravels ( .n.): I 1 .' PIPE SIZES (in.) NON-CIRCULATING I CIRCULATT.NG INNS 6 RIJNOUTS e H—EATED h?kT'irR ;E14P (FJ ; RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+^ 1 170-180 0.5 1 7.0 1.5 2.0 1 140-160 0.5 1 0.5 110 1.5 1 100-130 0.5 1 0.$ 0.5 1.0 I -NOTES TO FIELD (8111ila.Lag rjepartrtent Use Only)-------------------------- l . � e 10,,27,,68 08: 52 $504 661 0472 MOYNIHAN LUMBER 008!'00$ Type IC rated, in accoxdancs with Standard ASTM E 253, with no I more than 2,0 cfm (0.944 L/s) air novemont from the the ! conditioned space to the ceiling Cavity. Thi; lighting fixture I shall have barn tcstvd at 75 PA or 1.57 lbs/ft? pressure ! difference and shall be labeled. 1 VAPOR. RETARDER: ( I Recfokled on the warm-in-winter side of all non-vented framed I ceiling.:, wal.i.s, and floors. ! I MATERIALS IDENTIFICATION: ( I Materials and equipment must be zdentiflod so that compliance can I bo dotem.i.ned. Manufacturer manuals for all installed heating ! and cooling ecrsipment and aerviCo water heating ec�uipmervc must be provided. Insulation R-values, glazing U-values, and heating I aquipsaeat afficiency must be clearly marked on t)-,.e buiid.ing plane or specifications. I I DUCT INSULATION: J I L`uc: 10/2'/1995 12:� 47 975-644-9450 F'H h�1Ei_s HAd I CSL It,-JC PAGE %t - S M21019 R 21019 RiaHT-J SHORT FORM Filc n e: PROJECTI.RSP? Job#: For: BENDIRIAN Htg Cig PLAN 442 Outside db 0 87 N,ANDOVER. 1b-6 MA Inside db 70- R 75 1— OT 3 $,(� Design TD 7 0 12 Joh/ysah 3F, Daily Range - M By: R.A. M$CRANIC-AL INC. Inside11unlid. 50 Grains;Nater 30 - a.6 LOMAP? PARK d tho PEPPRRELL MeSimplified MA Const.. glty Average Fireplaces 1 HFAxZNG FQIJIPMENT COOL121G EQUIPMENT Make CARRIER CORPO Make CARRIER AIR C Trade Carrier, Weat.hermaker 9 Trade 64EATHERMAT.E 38C}CC" 56MX ,(,y * 38CKC0:3630/31/32/3':3 Heat ii pry 91.. 7 AFUE Efficiency 10. 0 SERR tinput. 91, Btuh Sensible Cooling 21984 B,tut1 Heatic i Output 56000 Btuh Latent Cooling Heati Ternp Rise 91 9420 Btuh DegF Total Cooling 31444 Btuh Actual eating Fa» 1256 CFM Actual Cooling Fan Htg Ai Flow Factor 0. 025 CPU/Btuh 1256 CFM Clg Air Flow Factor 0, 0-9 3 CR4/Btutl space erMogtat. Load Sensible Heat Ryba 85 I J CLOY r HTO CLu BTUH BTUH .�- ,.,...w. CFMLIVn 196 4 14 0 1832 109 lrt I 266 ( 11612 7121 306 98 o DINEJ E t 224 4622 1.060 ' 122 i 351 XITCN 1160 ! 5075� 4133 � 1.34 � 221 DI,NI 1 796 ( 3027 ! 2602 80 ! 139 LAUN1 Y ! el 4140 f 1832 109 I 98 GAR: ENTRY 2189 1 897 58 4 54 ! 3097 F? BUNT} R.CiUM ! 415� ! Q}• � �2 -- --- - -.-- r__.. 594 9815 3601 1,18 193 FIRS ZONE n D ,1903 ...— wT_ - •--- Ventil 'on Air 47700 23492 (0 1,,.56 1256 Equip. 4, 92 Rs.m I Latent coling 21613 � I —• .�—.�� 4046 TOTAL1903 47705 25659 1.'56 1256 ,x22/1999, 12'. 47 9764,49-9450 RA t--9ECH-"&-1IC:AL DIC: PI C14 SIN PSR21019 Pt"I SHORT IZO.FM File n lie: PROJECT 1.RSR Job* For; PENDINIAN Htg (71g PLAPJ 442 Qutsi4 A 0 F87 N.ANDOVER MA k1side db 70 75 L-oT 3$s _ DesjgjTD 12 0 hIY30AI Daily Range m By: R.A. MECHANICAL -CNC. Inside Hin-jid. 16 LOMAR PARR Grains Water PEPPERELL, MA Method- S i P I i.f j�,t C3. Corlut q1ty Fireplares RZKY1NIG COOLING FQT�mjm7NT Make CA?,RIZR C,C)T<pC) Trade Carrier M&,e. CARRIER AIR C 58P,A 050-08 Trade WEATRERMATE 38CXc 38CKC018-31/32 Effici icy AFUE Efficiency 10. 0 SEZR Heati Input 46000 Btuh Heati output 37000 Btuh 3ennible Cooling 123U Btuh Heati Temp Rise Latent Cooling 5250 Btuh Actual �Rting Fan 50 DegF Total Cooling 17600 Btuh 1( 67 5 c�yM Actual Cooling Far, 675 (,IpM HtgK Flow Factor 0. 027 CF24Stuh C19 Air Flow Factor 0- 053 cFM/ptuh Space" hermostat Load sensible Heat Ratio 92 I 00M P1AME �AMA HTG _La I HTO BTUlf BTUH CFM CFM BED .1 W. I. 210 4527 2304 120 123 BED 90 1218 341 32 18 B U;D BAT.a 245 7224 3283 192 176 2ND TR 95 1581 822 42 44 B 3 0 126 1.665 665 44 46 BED 224 4864 2707 1:'q 149 175 4305 111 2228 119 R r SEC ZONE 1165 25385 12631 Ventil ion Air 0 675 675 Equip. 0. 92 R.M Latent. () atefolirig 11620 TOT AM 1165 12684 675 675 X440 R TN . a - 9Andover oNo. 4tpj - m * _ IgoZ 19�f * � dower, Mass., 0 s LAKE yy:�^ 'SA_COCH(CHEW IC K taw 9 �qq E O S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT.......avrh.. ..... .....D .. ..0 4...1................ ...................................... Foundation buildin son ..... 0 moo.h N,$O. ......�� Rough has permission to erect............ ...................... �. ........................ . . � � 1 to be occupied as...... C......F N!1.�.. . ......../�..�. �.K.f�uc. ....o?...S�.�f V� .. r Chimney provided that the person acceig 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 C PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S T 1 l e Rough a � .......... .. ... ........ ... .. ............... ... ........ . WWI .... Service UILDIN 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. Smoke Det. 121,'01 98 09:59. FAX zol N OLD CENTER LANE (� PRIVATE WAY R=60.00 L=125.02 - 0 LOT 38B (J9 588'4-6'20"W N \W117045 N STER�`� �a�a ��hQl LANA This plan is for the use of the Building Inspector of the Town of No. Andover, for the purpose of determination of zoning compliance. It is my opinion that the AS—BUILT location of the foundation complies with the requirements of the Zoning Bylaws of FOUNDATION LOCATION PLAN the Town of No. Andover, for the R3 zone. This plan is the result of a survey performed LOT 3813 ^' OLD CENTER LANE I— on 11/30/913, based upon the approved NORTH ANDOVER, MASSACHUSETTS' subdivision plan recorded in the Registry of Deeds. SCALE:1 "=50' NOV.30, 1998 This property is not within the 100 Year Flood Zone as it is shown on the FIRM community Panel No_250098 006 for the Town of No- Andover, MA. NEW ENGLAND ENGINEERING SERVICES, INC. 33 WALKER ROAD r, NORTH ANDOVER, MASSACHUSETTS (978) 686-1768 ` i Country Estate Homes, Inc. I Ll 00 00 0 0 0 0 0 0 130 X 42 COLONIAL 4 BEDROOMS - 21/2 BATHS - 16 X 26 FAMLY ROOM - 2 CAR GARAGE UNDER 1433-10710 - -- e moompmoommionow MEN 0 MEN MEN MEN MEN MEN Omni � M i MEN Omni MUM i i i•� i i _- - — � � — - - - — iME ! Ill MM • Ilq �II�II�II�InIIIIIIIIIII��I�III�I�II�II�III�IIIII�I �q (IIIIIIIIIIIIII IIIIIIIIIIIIII ; � .. .. ■■NME II� lip I► .�, ME :�.. =1 ME MCI N.: MM 1000 SIR RM ME AU�,�,�,�,�,�,�,�,�,�,�,�1,11,1,1,1,1,1,1 • 2221 I► 1, 11111111111111111111111111111•'.�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII;11111111111111111111111111111111111111111111111111 ��__ 111111111111111 111111111111111111 1tIllllllllllllllllllltll IIIIIIIIIIIIII 1 11,11,1111111111,;111,111,1 1,1,1,1 1, 1 �11111111,11111111111111111,11111111111111111111 ..................... � , 1q) Illllllllllllltllllll � II 11111111111111111111111111 i�i�i i-rrrr�-rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr•rrr _ _ --- I III 111�I�1�1�1�I�1�1�I11�I�I�I�1�1�1�1�I111111I11111111111111t1t11111111111t1111111111111111111111111111111111111�1111111 i ',fill 11111111 11111111,1111111111111111I111111l11111t111111111t111111111t111111111111111111t11t11111111'1111111 III) �It1I11111�11111111 11111111;1ililililil�lilililililllilil�lililililil�lililililililililililil�lil�l�lilil�li�Ililil�l �� 11111111111111111111111111.i.�.i. 1. hUhl,l,l.l,ld,hl.ldd 1,1,1,1 � 11111 IIIIIIIIIIIIII III��I�I • � I I�� i () IIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIII ::::: ..... IMI I► � (IIl 11111 • VIII �� rlrrlr Irllrrlrllrrrl Ill IIf III I�I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ' V1 (�' �1IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII �I1 • X 42 COLONIAL I(o X 26 FAMILY/GARAGE UNDER, r • • 21/2 5ATHS " 22'0 5'10'/4 14T/4 2,6„ 3,0„ 5'0" 3'0" 2,6 4'6" 10'2'44 l'3�/4" 3'0 2 10'44" 1,1114 1101 3'4• 3'5" b'O" SLIDING �j 2'10" X 4'9' 5V5' X 4'9' CD 2'10 X 4'9' 2'10' X 4'9' KI N ° ;° LAY STUDY BREAKFAST �G�� _ o 'o IF 2'4" O iti I i O ILL,, r CA T- ' �� " 212„ 2'6" 3'414° u, 19 8 x �0 3'6" 2'b" �S��211 Ln DESK O �` FAMILY 3oO 0 `t 2'b' 6�0" � p p't N �4 cq x U lY E o - O i o r l.n co v .a 4 2'10" X 4V 2'10" X 4'9" FOYER LIVIN O -a cn A O F 2'10" X 4'9" 2'10" X 4'9' 2'10' X 4'9" 2'10" X 4'9" N 1'6 3'O" i'6 - 410 4'6" 7'0" 416" 3'6" 110� 31 6" 3'0" 8'0" 3'0 3'6" 160 14'O' 14'0" 14'O" FIS 0 10110 3-10 - • 810" 8'O" 5'0" 8'0" 4'6' 8i6" Toll 6'O" 4'64'4" O 2'O' X 4'644' 5'94'4' X 4'9' N 0 o Q an �•r m in in WALK-IN WALK-IN 7C� ° CL05ET CL05ET ATP BEDROOM 04 cn .� _Ln / LAUNIDRY � s CL.� v ♦ 2 4 2'6' L==: 2'6' _ :o I Attic — I l 3/ n " 36 53 _ 54 4'IO t♦4" �' I 5'0' I 6'0" s I I C605ET " � C C ,`� O z10 1 1 N � � N I 2 - 3'O" 2 - 'O' O I I O I I - i M BEDROOM ° 5EDROOM #2 BEDROOM #3 - - - - - - - - - - - - - - � )73C o 12110' X 4'9" 2'10' X 4'9" ` OPEN TO DELCUJ O Ln s O L2'10" V, 1 1, U X 4V 2'10" X 4'9" 2'10' X 4'9" 2'10" X 4'5r. N a 5'94'4' X 4'OV5' N 4'6" 110" 416" 316" 110" 316" 1'O" 1'O" An 1'0" 3'6" lb,ON 14'0" 14'0" 14'0" =r% ONID FLQ0 • 1,4" " 1'0" 101104-10 WO 11 12'0' 13'0 10'011 11011 51 611 510" 516' r ------------- r --------------------------------- -----=----------------------------- ---------------------------- ------------------ -1 IF C4 r -------------J ►• ------;• ►� L------------� ►• ----------------------------- -------------------------------------------------------------------------- -••; ►• • - 1 FOUNDATION ' ►• ' -------------1------1----------------- ---� 10" Concrete Wall / 8'0' Pour v ; 1 i TALC. (-) 10' Dp x 118" W Cont. Footing GARAGE FINISH IF All wood constructed walla and 1 cetlhg to have 5/8' " Y rte ; /*►I i I o rated Wallboard k*talled t 3401 .5 . 2 ] 4' Concrete Slab ' N; I �► ! O o _ I ; x 9 - 3 1/2" Dla. Lall Column& p ; Ls: I GARAGE 5ASEMENT w>tir, 26" w.xto'�Dp. I .► 2; I ; Strip Footing 6As 1 I -.410 6'O" 6'O' 610" 610" 51h�4" '¢li4" 610" 610' 610' 512" ►' O •�8► 1 + 1 1 11 1 o; I '------- ---------------- ---------------- ---------------- ---_-----------_ -------------- ----------------� --------------- ---------------- ------ I ---i ►► - 1 1 O r _– – _� -- - -----------_� - - - �—- - - --�- - - ! ' '---------------------------------------------- ---------------------- -- -----� -------- ------------------------------------- - � ►► I .� 3 - 2 x 12 Center Beam (type / t 1 / � O I p ► 1 ► er 1 BEAM POCKET1 1 I- - - r -a 6' W x 6' Dp x 9" H (I re9'd) 13402 . S .6 _ ►► ; • --t_ _ — Shim beam with steal shims or hard brick p ►► ; 4' Concrete SlabL - J p 1 ; Slope 1/e per root ; 1 11 0 1 ► , p I :1- O► ' x I 1 ►► i '� 1 I ''a'► 1 � I ; 20 minute rte door (mina 1 ' ly T.O.C. (-? " 43(min) Step down into Curage 0 ; 1 /• -------------------------------------- ----; r� - -----� O1 ►' L--------+-------------------- -------i r-----------------------------t r--------------------------------- ---J 1 L ------------------------------------- r------------------- _ - MID 1 t ! 1 N f 1 1 1 14'0' - - 3'O" - -• 8,011 - -3,Oli- 14'0' WO 11 42'0" FOUNDATION—Pat N. It'll, - 11.- Nx Continuous Baffled Ridg t 2 x 12 Ridge Board 12 9 1 x 8 Collar Ties 9 4'0" O-C. ROOFING Composite Roofing Building Paper Sheathing 2 x 10 '9161O.C. 1;7 r CEILING ascia Board 2 x 8 9 163 O-C. �:_Overhancilog soffit m R30 insulation with ventrxg a n- va�or Barrier Wallboard. 0o FLOOR o r WALL -U3/4' Sheathing Siding Air Barrier 2 X 10 9 16" D.G. Sheathing,2 x 4 9 16" O.C. p - Ril Insulation,Vapor Barriar 1/2" Wallboard FOO 3/4' Sheathing 2 X 10 9 IL" O.C. R20 insulation SiL 1 - 2X6PT, 1 - 2x6K.D. [ 3402 . 8 . 41 _ Continuous Sill Csasket 2X Fire Blocking U2' Dia, x 12" !_g. Anchor Bolts 9 8'O' O.C. (max) 3 - 1 x 12 Center Beam '- = FOUNDATION 3 U2" Dia.Lail Columns -- ' p y b Concrete Wall / 10'0' Pour WE FDAI PLAN FOR LOGATbrts} 10' Dp x 1'S' W Cont. Footing Dampproof exterior surface - 4' Concrete Slab 5 c TION THRLIHOU 1/4 1101110110 -1-10 .__•. .�_.. � _-----�.®......���.�..,�...-.-,..,..._...��-....-...e�._...�..�,._.__.............., .....- .�._...._o......-..-...�.r.�..�...__-...--.-...e... - ....___..._..-..a........�.__-.... -- ., .._.._..-.__-....'.�....-._.,. -- -- ....,...-_. .�.�_.....� .,v.�....,.. rte._...__._...-_.-- -- ....��.,.s_ . .�_.__...-..._.._......-...� .._......-__•_ _ .....- .a ..;�;*.�.. Continuous Baffled Ridg t ROOFING CONSTRUCTION 2 x 6 Collar Ties Q 16' Asphalt/Fberglass 'Roofing l5ullding Paper Sheathing 12 - 2x106I6' O.C. 9 2x8 -9163D,C. r- CEILING 2 X S 10 Yon O.C. insulation 70' Overhang SoffR O �- -WALL _ FLOOR S��g Sheathing O 2 X 10 120 O.C. 5h athis -' 2X4 -016' OC, Insulation VTor Barr;-or 1/2 Wallboard SO FOO Sheathing BILL 2X10616BOZ, 1 - 2x6 PT1 - 2x6 K.D. R20 Insulation , - Continuous 801 Gasket _ 1/2' Dia.x 12' Lg. Anchor Bolts • a 8'0' O.C.(max} • GARAGE FiNi6W • All wood constructed walls and ceiling to have 5/8' t pe Y fie rated Wallboard Installed 13401 . 9 . 2 O =m FOUNDATION - 10' Concrete Wall / 8'0' Pour 10' Dp x IV W Cont.Footing SECTION � HRU FAMILY LIMASTER , �I� = i O10110 8-10 I , c -IT I=i vaulted CedingArm see Soctfon TFxu Fandy/Mastv Beam Flush Frans INS f 10 LVL' Beam Flush Franc FIR", Ridge and valley Rafters are 2 x12 All nembers ars 2 x 8 6 16, O.C.01.N.Oj All Rafters ars 2 x 10 19 16' O.C. ATTIC M e)OIR FRAMIROOF FRAMINn van . 1'03 MAXIMUM ALLOWABLE 6PAN6 FOR JOISTS/RAFTER SPAN NOTES- JOISTS/RAFTERS L Span Tables torn Fht floor joist C 3405-2 Second floor!ueeible attic Jobt C 3405-13 16' 16' Attic(no future rooms)C 34064 • ^"' Gaya attIr-.fl c floor Joist C 3406-2 7 FIRST x,per 2 x 10/16 2 x 10/16 2x 1 2 x W* Roofs over attioe C 3406-6 Cathedral Roof Rafters C 3406-3 SECOND 2 x 3/16 2 x a/2 2 x 10/16 2 x 10/K 2 x 10/11 2. MaxIhm span for 2 x 8 cefitg jobt for AMC wnr�e goons 2 x 1D/W I2 x Cl/K cape attics b M' no 13406-2 3. ATTIC 2 x 6/13 2 x 6/12 2x aK 2x" 2 x a/16 No naw Hoorn 2 x 3/Ib ATTIC ues 2 x 6/Ib 2 x 6/16 2x6/16 2 x 6/li 1 x s/6 ROOF 2x bla 1 x a�6 2 x 3/12 7 x 10/ib 2x10/16 VVW Arno 2 x 3/16 2 x 10/16 8 10/2 CATHEDRAL 1 x 3/16 i x pn 2x10/16 2 x 10/16 2 x W* 10110 10 -10i x � r � � �� ��� / ����� iia ��' �` � f� E � Date. 70 3885 NpR,M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . . . . . . . . has permission to perform_. . plumbing in-the buildings of . .•. . . ,. . .. . . . . . . . .. .. at. . ! . . . . . . . . . ..�, s� . . . . . . . . . . .. North Andover, Mass. � 7 FecB-?.'. . . .Lic. No.. .98.j. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 12/10/98 13:29 235.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (Type or Print) - NORTH ANDOVER ,Ma• �` �/�3 °.•c. .. ::.; ' . '. � -�•�,• . ss. Date:-I t- p Building Location 4ZO T 'T � Permit # I Owners Naihe New Renovation Replacement 0 Plans Sy lamltted FIXTURFS ' z to z Qs O Z H > am t- i0 .1 U < Z W W W Y _s P. ..< h N O Q qj ZW ' O Z W� W tL = ¢ to _ Q = j ca U Z• st C3 to W T• h- h = G 4 vl C 0. a<C, C ¢ W O O W 4 at or < W 0 Q -A Z p Q J M. W Z < = O G J Q Y. X > r o N N -3 N o z o Q w z z w F. o V Z < < _ _ _ < < < < sr tc < o < f- SUB—%BSMT. • BASEMENT t IST FLOOR 1 2ND FLOOR t 3RD FLOOR ' ATM FLOOR 6TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name Cs If'p �s-,Lj5 Q Corp. Address 1 O y Partner. 1 Firm/Co. Business Telephone 7p3 _ gyy._gjgje4 Name of Licensed Plumber: ,C, _ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy r Other type of indemnity E] Bond Li Insurance Waiver: I, the undersigned, have been made aware- that the licensee of i this application does not have any one of the above three insurance coverages. � • I ' Signat 9.rfe of owner agent of property Owner Agent'% , I bcrcby oetti(y Wal all of the dctails and in(osnu�ion I ha.c subinillcd os camcd)in aMnc a , ' 1 PMiatiat sire Istte asN�iwut to Oss bpA til ttq k"wlcdgt aad that all plumbing�rosk and installations i•a(no mcd undu rcIcucd(or this a 60%will be isca ritll �li�lilK«fit I t+W4lta sal lbs Mucl► tsuscttt Sla/c Plumbioj C.odc and Cluptct 142 0(tlw C, ws- III , ► � � By Title . 'ature of 'Licensed Plumber Type of Plumbing License _ City/Toon: C I � 1 11 aDRnVFrI 7aFFtCF USE t]NLY1 License Number 6�lmlaster 1-3 Journeym&4 q"Sem u(� � �� S��-"' �.AJ tw�e.� v e.�i W. G Gt.c�a d�� `-'y fl 4� 4 s��— v ti �s� �.� �� ., 12/01.93 09:59 FAX O1 N 1 OLD CENTER LANE p PRIVATE WAY R=10.00 L=125.02 LP s. 0 9It O -' -� LOT 38B ao a �jj o> 90.00, ,L4UE9 � 54 �,193' SB8'4-F200W N 54 N� 37045 9f�lSTE4E� ��`� I Lot, This plan is for the use of the Building Inspector df the Town of No. Andover, for the purpose of determination of zoning compliance. It is my opinion that the AS—BUILT location of the foundation complies with the requirements of the Zoning Bylaws of FOUNDATION LOCATION PLAN the Town of No. Andover, for the R3 zone, This plan is the result of a survey performed LOT 38B ^' OLD CENTER LANE on 11/30/98, based upon the approved NORTH AN DOVER, MASSACHUSETTS subdivision plan recorded in the Registry of Deeds. SCALE:1 50' NOV.30, 1998 `his property is not within the 100 Year Flood Zone s it is shown on the F)RM Gomrriunity Panel —No -250098 006 for the Town of No. Andover, MA. NEIN ENGLAND ENGINEERING SERVICES, INC. 33 WALKER ROAD NORTH ANDOVER, MASSACHUSETTS D (978) 686-1768 Date. . . .... .. .. .. . .. ...... ,&ORT" or L TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION ��SSACHUSEt This certifies that . . . . �:.! . . ... . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . in the buildings of . . r' . .l. :. . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .!.1 .4 . . . . . . . . . . . . . . . .`. Z. . . . . . .. North Andover, Mass. Fee. Lic. No.. . . . . . .`. . . . . . . . . . . . . . . . . '.... . . . . . . . . 'GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FrrHNG (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Locations /�� 1b �4'Vli U�- Com _ Permit# 3 J r1'� Amount$ Owner's Name � s ` � New❑ Renovation ❑ Replacement Plans Submitted ❑ U � O wz N GW7 E� Z d ,T W 0 d >+ m O � gO � O w A Gd7 3 U a A a H O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH . FLOOR (Print or —/ one: Certificate Installing om C NameyliL�riLL �-_ / c! G"� Company Corp. Address S� �.3 r v ' ❑ Partner. Business Telephone /_1: 41 G j ❑ f i m/CO. Name of Licensed Plumber or Gas Fitters INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13— No[:] If you have checked yes—please indicate the type coverage by checking the appropriate boy- Liability oxLiability insurance policy 131� Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent [:3 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 Massa ch S Gas Code Chapter 1 of the Laws. By: ignature of Lice Plumber Or Gas Fitter Title [Er Plumber City/Town ❑ Gas FitterLicense Dumber r71-master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date. A. 4 '<"°RT: o TOWN OF NORTH ANDOVER 1 PERMIT FOR PLUMBING ,SSAtMUs� This certifies that . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .f�!�./.s: !. . . . . . . . . . . . . . . . . . . . . . at. . . s.7-Z. . . . . . . . ., North Andover, Mass. Fee. ./1 Z. . .Lic. No.. ,. .!. ?.l . . . . . . . . . . . � . .: —�--�. .. . . . . PLUMBING INSPECTOR Check # 5165 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location Owners Name Date Pemut s-//�. d Z /t s / ��— Type of OCCUDancy Amount New Renovation Replacement 13— PlansSubmitted eYes � 0 No FIXTURES Q ZURJO R 3M1,Lu= 41H FLOOR 611H ROM 71H FI" SIH FIDGR (Print or type) Installing Company Nameyl r S/ �!�'0--k Check one: Certificate Corp. Address o kp7rd ElPartner. usmess Te ephone �& n (� irm/Co. Name of Licensed Plumber- Insurance lumberInsurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner El Agent El 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 ins tallatirfo d under Permit Issue for this plication will be in compliance with all pertinent provisions of the Massachuset S Plu m de ay.d Chapter 42 of General Laws. By. igna ure o icense Title Type of Plumbing License City/Town —A�� 5 to APPROVED(OFFICE USE ONLY � icense NUMFFFMaster Journeyman D