HomeMy WebLinkAboutMiscellaneous - 161 WEYLAND CIRCLE 4/30/2018This certifies that .......
Date.................. 3...'................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Vj..V/r(/�.........�OLiR
...........-.....
haspermission to perform......................................................................................................
wiring in the building of.. �............... i .......... v. 5.......................................................
at ...................L .. ....... ................ > rth Andover, Mass.
Few (�J�Lic. No. / 3 / q � 4 ///..s..C�
M ... ... .. 'L'ECT ".. ...:... ......
.I ............... ......... ................. ............... ..... .
% ELECTRICAL INSPECTOR
72,%1/ 7
Check #
Commonwea& o f Nama.Lelb
U
1Jepaftment o 3ire Service.4
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. `Y
Occupancy and Fee Checked
[Rel'. 1/071 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALLFORMATION) Date: 9 _1 ' i — l
City or Town oh w .QpJa y- 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)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑
Purpose of Building, .Q, f Cl(Yl I� LA }AC)M-e-
Existing Service a�TTAm�ps fa0 /84() Volts Overhead
New Service Amps
No ❑
Telephone No. W7. -10- LIW7q
(Check Appropriate Bog)
Utility Authorization No.
F
Volts Overhead ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Undgrd ❑
Undgrd ❑
No. of Meters
No. of Meters
Completion of thefollowing table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil-Susp. (Paddle) Fans
o. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above -
Swimming Pool d. ❑ rud. E]Batte
o. o mergency Lighting
Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection an
Initiating Devices
No. of Ranges
No. of Air Cond. Tonsl
No. of Alerting Devices
Heat Pum umber Tons
o. of Self -Contained
•
otals: I I
Uetection/Alertmg Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑Municipal EJ Other
Connection
No. ofD Dryers
17'
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
o. of ater KWo.
Heaters
of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
TelecommunicationsofDeier Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if -desired, or as required by the Inspector of Wires.
Tstimated 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.
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:)
I certify, under the pains and penalties of perjury, that the information on this application is
FIRM NAME: V k V 0 ` t SrAck ' f7P \(,o loci )r ,"l/_ /
Licensee: Zam \Ck
(If applicabl , enter " empt" in the liter a number line.)
Address: q _ _GnQ U �' ' Z o r i-1
*Per M G L c 147 s.57-61 security work requires Department of Public Safety "S" License:
rid complete.
LIC. NO,: 1?5` L4 I P
_ LIC. NO.: ISI N I A -
Bus. Tel. No.: lis►5'J
Alt. Tel. No.:SQL 4 -1qq .5goa
. Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
I am the (check one) F-1 owner I] owner's
Signature Telephone No.
Department of Industrial Accidents
Dice of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
M v'yI www mass.gov1dta
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Vivint Solar LLC.
Address: 29 Draper st
tate/Zip-Woburn, MA. 01801
Phone #: 781-305-3065
Are you an employer? Check the appropriate box:
.. ❑ I am a employer with 10 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partner-
ship and have no employees
working forme in any capacity.
[No workers' comp. insurance
required.]
3. ❑ lam a homeowner doing all work
myself. [No workers' comp.
insurance required.]
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.1
5. We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. E] Remodeling
8. ❑ Demolition
9. Building addition
10. ❑ Electrical repairs or additions
I I. F-1 Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
+Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their, workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: MJ Insurance, Inc
Policy # or Self -ins. Lic. #: 029342338
Expiration Date: 11/1/14
Job Site Address: VG� 1� �11� �,�� City/State/Zip: IV - andnv�,,Y '
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do herT,6n,
u er the pains and penalties of perjury that the information provided above is true and correct.
Si aturDate: N
Phone #:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
VIVINT SOUR DEVELOPER LLC
PHILIP F ZA14PITELLA JR (EL)
4931 N 300 W
PROVO UT 84604
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DETAILS
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UTILITY ACCOUNT NUMBER: 91027-92011
DRAWN BY: EF AR 3218794
Last Modified: 8!21/2014
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M � '{ MA LICENSE: MAHIC 170848 Q North Andover, MA 01845
DIAGRAM DRAWN BY: EF I AR 3218794 Last Modified: 8/21/2014 UTILITY ACCOUNT NUMBER: 91027-92011
Vivint Solar - PV Solar Rooftop System Permit Submittal
1. Proiect Information
Project Name: Greg Titus
Project Address: 161 Weyland Cir, North Andover MA
A. System Description:
The array consists of a 7 kW DC roof -mounted Photovoltaic power system operating in parallel with the utility grid. There are (28) 250 -
watt modules and (28) 215 -watt micro -inverters, mounted on the back of each PV module. The array includes (2) PV circuit(s). The array
is mounted to the roof using the engineered racking solution from Ecolibrium Solar.
B. Site Design Temperature: (From Lawrence MUNI weather station)
Average low temperature: -24.3 °C (-11.74 °F)
Average high temperature: 37.6 °C (99.68 °F)
C. Minimum Design Loads:
Ground Snow Load: 50 psf (State Board BR&S)
Design Wind Speed: 100 mph (State Board BR&S)
2. Structural Review of PV Array Mounting System:
A. System Description:
1. Roof type: Comp. Shingle
2. Method and type of weatherproofing roof penetrations: Flashing
B. Mounting System Information:
1. Mounting system is an engineered product designed to mount PV modules
2. For manufactured mounting systems, following information applies:
a. Mounting System Manufacturer:
b. Product Name:
c. Total Weight of PV Modules and mounting hardware:
d. Total number of attachment points:
e. Weight per attachment point:
f. Maximum spacing between attachment points:
g. Total surface area of PV array:
h. Array pounds per square foot:
i. Distributed weight of PV array on roof sections:
-Roof section 1:
(11) modules, (15) attachments
-Roof section 2:
(7) modules, (15) attachments
-Roof section 3:
(10) modules, (20) attachments
Ecolibrium Solar
Ecorail
1204 lbs
50
24.08 lbs
* See attached engineering calcs
493.08 square feet
2.44 lbs/square foot
31.53 pounds
20.06 pounds per square foot
21.5 pounds per square foot
k i
3. Electrical Components:
A. Module (UL 1703 Listed) Qty
Trina TSM 250-PA05.18 28 modules
Module Specs
Pmax - nominal maximum power at STC - 250 watts
Vmp - rated voltage at maximum power - 30.3 volts
Voc - rated open -circuit voltage - 37.6 volts
Imp - rated current at maximum power - 8.27 amps
Isc - rate short circuit current - 8.85 amps
B. Inverter (UL 1741 listed)
Qty
Enphase M215-60-2LL-S22
28 inverters
Inverter Specs
1. Input Data (DC in)
Recommended input power (DC)
- 260 watts
Max. input DC Voltage
- 45 volts
Peak power tracking voltage
- 22V - 36V
Min./Max. start voltage
- 22V/45V
Max. DC short circuit current
- 15 amps
Max. input current
- 10.5 amps
2. Output Data (AC Out)
Max. output power
- 215 watts
Nominal output current
- 0.9 anips
Nominal voltage
- 240 volts
Max. units per PV circuit
- 17 micro -inverters
Max. OCPD rating
- 20 amp circuit breaker
C. System Configuration
Number of PV circuits 2
PV circuit 1 - 17 modules/inverters (20) amp breaker
PV circuit 2 - 11 modules/inverters (15) amp breaker
2011 NEC Article 705.60(6)
I
D. Electrical Calculations
1. PV Circuit current
PV circuit nominal current 15.3 amps
Continuous current adjustment factor 125% 2011 NEC Article 705.60(B)
PV circuit continuous current rating 19.125 amps
2. Overcurrent protection device rating
PV circuit continuous current rating 19.125 amps
Next standard size fuse/breaker to protect conductors 20 amp breaker
Use 20 amp AC rated fuse or breaker
3. Conductor conditions of use adjustment (conductor ampacity derate)
a. Temperature adder
Average high temperature 37.6 °C (99.68 °F)
Conduit is installed 1" above the roof surface Add 22 °C to ambient
Adjusted maximum ambient temperature 59.6 °C (139.28°F)
b. PV Circuit current adjustment for new ambient temperature
Derate factor for 59.6 °C (139.28°F) 71%
Adjusted PV circuit continuous current 26.9 amps
c. PV Circuit current adjustment for conduit fill
Number of current -carrying conductors 6 conductors
Conduit fill derate factor 80%
Final Adjusted PV circuit continuous current 33.6 amps
Total derated ampacity for PV circuit
33.6 amps
Conductors (tag2 on 1 -line) must be rated for a minimum of 33.6 amps
THWN-2 (90 °C) #10AWG conductor is rated for 40 amps (Use #lOAWG or larger)
4. Voltage drop (keep below 3% total)
2 arts:
1. Voltage drop across longest PV circuit micro -inverters (from modules to j -box)
2. Voltage drop across AC conductors (from j -box to point of interconnection)
1. Mirco-inverter voltage drop:
The largest number of micro -inverters in a row in the entire array is 9 inCircuit 2. According to
manufacturer's specifications this equals a voltage drop of 0.24 %.
2. AC conductor voltage drop:
= I x R x D (= 240 x 100 to convert to percent)
_ (Nominal current of largest circuit) x (Resistance of #10AWG copper) x (Total wire run)
_ (Circuit 1 nominal current is 15.3 amps) x (0.00126Q) x (160 _ (240 volts) x (100)
2011 NEC Article 705.60(13)
2011 NEC Article 705.60(B)
2011 NEC Article 705.60(B)
2011 NEC Article 705.60(B)
0.24%
1.28%
Total system voltage drop: 1.52%
V1f1 lrll i
EcolibriumSolar
Customer Info
Name:
Email:
Phone:
Project Info
Identifier: 9173
Street Address Line 1: 161 Weyland Cir
Street Address Line 2:
City: North Andover
State: MA
Zip: 01845
Country: United States
System Info
Module Manufacturer: Trina Solar
Module Model: TSM -250 PA05.18
Module Quantity: 28
Array Size (DC watts): 7000.0
Mounting System Manufacturer: Ecolibrium Solar
Mounting System Product: EcoX
Inverter Manufacturer: Enphase Energy
Inverter Model: M215
Project Design Variables
Module Weight: 41.0 lbs
Module Length: 64.95 in
Module Width: 39.05 in
Basic Wind Speed: 110.0 mph
Ground Snow Load: 50.0 psf
Seismic: 0.0
Exposure Category: B
Importance Factor: II
Exposure on Roof: Partially Exposed
Topographic Factor: 1.0
Thermal Factor for Snow Load: 1.2
Lag Bolt Design Load - Upward: 820 Ibf
Lag Bolt Design Load - Lateral: 300 Ibf
EcoX Design Load - Downward: 493 Ibf
EcoX Design Load - Upward: 568 Ibf
EcoX Design Load - Downslope: 353 Ibf
EcoX Design Load - Lateral: 233 Ibf
Module Design Moment — Upward: 3655 in -Ib
Module Design Moment — Downward: 3655 in -Ib
Effective Wind Area: 20 ft2
Min Nominal Framing Depth: 2.5 in
Min Top Chord Specific Gravity: 0.42
Plane Calculations (ASCE 7-10): 2
Roof Type: Composition Shingle
Average Roof Height: 35.0 ft
Least Horizontal Dimension: 35.0 ft
Roof Slope: 38.0 deg
Truss Spacing: 16.0 in
Edge and Corner Dimension: 3.5 ft
Snow Load Calculations
Description
Interior
Edge
Corner
Unit
Flat Roof Snow Load
42.0
42.0
42.0
psf
Slope Factor
0.59
0.59
0.59
psf
Roof Snow Load
24.8
24.8
24.8
psf
Wind Pressure Calculations
Description
Interior
Edge
Corner
Unit
Net Design Wind Pressure Uplift
-20.7
-24.3
-24.3
psf
Net Design Wind Pressure Downforce
19.4
19.4
19.4
psf
Adjustment Factor for Height and Exposure Category
1.05
1.05
1.05
psf
Design Wind Pressure Uplift
-21.7
-25.5
-25.5
psf
Design Wind Pressure Downforce
20.4
20.4
20.4
psf
ASD Load Combinations
Description
Interior
Edge
Corner
Unit
Dead Load
2.3
2.3
2.3
psf
Snow Load
24.8
24.8
24.8
psf
Downslope: Load Combination 3
13.5
13.5
13.5
psf
Down: Load Combination 3
17.2
17.2
17.2
psf
Down: Load Combination 5
14.1
14.1
14.1
psf
Down: Load Combination 6a
22.5
22.5
22.5
psf
Up: Load Combination 7
-11.9
-14.2
-14.2
psf
Down Max
22.5
22.5
22.5
psf
Spacing Results (Landscape)
Description
Interior
Edge
Corner
Unit
Max Allowable Spacing Between Attachments
69.2
69.2
69.2
in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in
64.0
64.0
64.0
in
Max Cantilever from Attachment to Perimeter of PV Array
23.1
23.1
23.1
in
Spacing Results (Portrait)
Description
Interior
Edge
Corner
Unit
Max Allowable Spacing Between Attachments
48.5
48.5
48.5
in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in
48.0
48.0
48.0
in
Max Cantilever from Attachment to Perimeter of PV Array
16.2
16.2
16.2
in
Layout
� Skirt
o Coupling
Clamp
Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
maximum allowable overhang.
Plane Calculations (ASCE 7-10): 1
Roof Type: Composition Shingle
Average Roof Height: 35.0 ft
Least Horizontal Dimension: 35.0 ft
Roof Slope: 40.0 deg
Truss Spacing: 16.0 in
Edge and Corner Dimension: 3.5 ft
Snow Load Calculations
Description
Interior
Edge
Corner
Unit
Flat Roof Snow Load
42.0
42.0
42.0
psf
Slope Factor
0.55
0.55
0.55
psf
Roof Snow Load
23.1
23.1
23.1
psf
Wind Pressure Calculations
Description
Interior
Edge
Corner
Unit
Net Design Wind Pressure Uplift
-20.7
-24.3
-24.3
psf
Net Design Wind Pressure Downforce
19.4
19.4
19.4
psf
Adjustment Factor for Height and Exposure Category
1.05
1.05
1.05
psf
Design Wind Pressure Uplift
-21.7
-25.5
-25.5
psf
Design Wind Pressure Downforce
20.4
20.4
20.4
psf
ASD Load Combinations
Description
Interior
Edge
Corner
Unit
Dead Load
2.3
2.3
2.3
psf
Snow Load
23.1
23.1
23.1
psf
Downslope: Load Combination 3
12.9
12.9
12.9
psf
Down: Load Combination 3
15.3
15.3
15.3
psf
Down: Load Combination 5
14.0
14.0
14.0
psf
Down: Load Combination 6a
21.1
21.1
21.1
psf
Up: Load Combination 7
-12.0
-14.2
-14.2
psf
Down Max
21.1
21.1
21.1
psf
Spacing Results (Landscape)
Description
Interior
Edge
Corner
Unit
Max Allowable Spacing Between Attachments
71.5
71.5
71.5
in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in
64.0
64.0
64.0
in
Max Cantilever from Attachment to Perimeter of PV Array
23.8
23.8
23.8
in
Spacing Results (Portrait)
Description
Interior
Edge
Corner
Unit
Max Allowable Spacing Between Attachments
51.7
51.7
51.7
in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in
48.0
48.0
48.0
in
Max Cantilever from Attachment to Perimeter of PV Array
17.2
17.2
17.2
in
Layout
� Skirt
o Coupling
0 Clamp
Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
maximum allowable overhang.
Plane Calculations (ASCE 7-10): 3
Roof Type: Composition Shingle
Average Roof Height: 35.0 ft
Least Horizontal Dimension: 35.0 ft
Roof Slope: 42.0 deg
Truss Spacing: 16.0 in
Edge and Corner Dimension: 3.5 ft
Snow Load Calculations
Description
Interior
Edge
Corner
Unit
Flat Roof Snow Load
42.0
42.0
42.0
psf
Slope Factor
0.51
0.51
0.51
psf
Roof Snow Load
21.4
21.4
21.4
psf
Wind Pressure Calculations
Description
Interior
Edge
Corner
Unit
Net Design Wind Pressure Uplift
-20.7
-24.3
-24.3
psf
Net Design Wind Pressure Downforce
19.4
19.4
19.4
psf
Adjustment Factor for Height and Exposure Category
1.05
1.05
1.05
psf
Design Wind Pressure Uplift
-21.7
-25.5
-25.5
psf
Design Wind Pressure Downforce
20.4
20.4
20.4
psf
ASD Load Combinations
Description
Interior
Edge
Corner
Unit
Dead Load
2.3
2.3
2.3
psf
Snow Load
21.4
21.4
21.4
psf
Downslope: Load Combination 3
12.2
12.2
12.2
psf
Down: Load Combination 3
13.6
13.6
13.6
psf
Down: Load Combination 5
14.0
14.0
14.0
psf
Down: Load Combination 6a
19.8
19.8
19.8
psf
Up: Load Combination 7
-12.0
-14.3
-14.3
psf
Down Max
19.8
19.8
19.8
psf
Spacing Results (Landscape)
Description
Interior
Edge
Corner
Unit
Max Allowable Spacing Between Attachments
73.9
73.9
73.9
in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in
64.0
64.0
64.0
in
Max Cantilever from Attachment to Perimeter of PV Array
24.6
24.6
24.6
in
Spacing Results (Portrait)
Description
Interior
Edge
Corner
Unit
Max Allowable Spacing Between Attachments
54.5
54.5
54.5
in
Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in
48.0
48.0
48.0
in
Max Cantilever from Attachment to Perimeter of PV Array
18.2
18.2
18.2
in
Layout
Skirt
o Coupling
0 Clamp
Warning: PV Modules may need to be shifted with respect to roof trusses to comply with
maximum allowable overhang.
Distributed Weight (All Planes)
In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP)
Weight of Modules: 1148 lbs
Weight of Mounting System: 100 lbs
Total System Weight: 1248 lbs
Total Array Area: 493 ft2
Distributed Weight: 2.53 psf
Number of Attachments: 50
Weight per Attachment Point: 25 lbs
Bill Of Materials
Part
Name
Quantity
ESEG01 CLASA
EcoX Clamp Assembly
50
ESEG01 COASA
EcoX Coupling Assembly
26
ESEG01 SKKTA
EcoX Landscape Skirt Kit
10
ESEG01 SKKTA
EcoX Portrait Skirt Kit
4
ESEG01CPKTA
EcoX Composition Attachment Kit
50
ESEG01 ELASA
EcoX Electrical Assembly
3
!fi
Office Use Only
011%2 Tamm DnlUrato of _' tt 5#U5fnn Permit No. a�
lepartmerit of Public $af l Occupancy ,& Fee Checked 4 --
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:003190
(leave blank) 1101
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 0/1/96 —
00* or Town of NORTH ANDOVER To the Ins ecto of Wires:
The udersigned applies for a permit to perform the electrical work described bel W.
Location (Street & Number �0
Owner or Tenant
r
Owner's Address 3-5 -I—,r nl ��t S iyr—G U�✓l-�
Is this permit in conjunction with a building permit: Yes ' No ❑ (Check Appropriate Box)
Puroose of Building Sin atovla�z Utility Authorization No. 6U6 0:5;)—
Existing
S;)—Existing Service Amps _J Volts Overhead Undgrnd r—/ No. of Meters
New Service 2 Q Amps l Jy l 2 Y0 Valts Overhead r Undgrnd UG No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Z eW—) Ltieliq
No. of L:chting Cutlets I No. of Hot Tucs I No. of Transformers Total
KVA
No. of Lighting Fixtures I Swimming Pcoi Above.-- In- � I KVA
'_grno. grnd. _ Generators
No. of Emergency Lighting
No. of Receptacle Cutlets No. of Oil Burners I Battery Units
No. of Switch Outlets I No. of Gas Surners FIRE .ALARMS No. of Zones
No. of Air Cana. iotai No. of Detection and
No. of Ranges tons Initiating Devices
No. Hvcro Massage Tubs I No. of Motors Total HP
OTHER:
INSURANCE CCVERAG8: Pursuant to the recuirements of '.Massachusetts general Laws . /
I have a current Liability Insurance Policy including Combl c Coerations Coverage or its substantial ecuivaient. YES L NO = I
have suomittea valid proof of same to the Office. YES O = If you have checked YES. please indicate the type of coverage by
checking the aotprpprlate box.
INSURANCE Y BONO = OTHER = (Please Scectfy)
(Expvanon Datel
Estimatea Value of E!ectricai Work S
Work to Stan
Insoect:on Cate Recuested: Rough (Al 1 C,,411 Final
Signeo under t e Pe ties of perjury* G6 C,791 LIC. NO.
FIRM NAME 199 7�
Licensee & hr� Ld-Lti I-G�� c r Signature �� r,UC'C. NO.c�
/� D w1y.�t ,y� Bus. Tel. No.. 6 d ii - 6a L 6
Address ._2 �% 7 /7 a!�:5&'L , r " ' e-��V e.0 1 r Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee cces not have the insurance coverage or its substantial ecuivaient as re-
quire* by Massachusetts General Laws. ana that my signature on tris permit aopiication waives this reauirement. Owner Agent
(Please check one)
.eieonone No. PERMIT FEE S
(Signature of Owner or Agentl x.52.55
Heat Total
+oral
No. of Disoosals
I Nc.of umcs Tons
KW
No. of Sounding Devices
No. of Seif Contained
No. of Dishwashers
/ I SoaceiArea Heating
KW
DetactionrSounding Devices
No. of Orvers
I Heating Devices
KW
Local Municipal r Other
_ Connection _.
No. of No. of
Low Voitage
No. of Water Heaters
KW i Signs Ballasts
Wiring
No. Hvcro Massage Tubs I No. of Motors Total HP
OTHER:
INSURANCE CCVERAG8: Pursuant to the recuirements of '.Massachusetts general Laws . /
I have a current Liability Insurance Policy including Combl c Coerations Coverage or its substantial ecuivaient. YES L NO = I
have suomittea valid proof of same to the Office. YES O = If you have checked YES. please indicate the type of coverage by
checking the aotprpprlate box.
INSURANCE Y BONO = OTHER = (Please Scectfy)
(Expvanon Datel
Estimatea Value of E!ectricai Work S
Work to Stan
Insoect:on Cate Recuested: Rough (Al 1 C,,411 Final
Signeo under t e Pe ties of perjury* G6 C,791 LIC. NO.
FIRM NAME 199 7�
Licensee & hr� Ld-Lti I-G�� c r Signature �� r,UC'C. NO.c�
/� D w1y.�t ,y� Bus. Tel. No.. 6 d ii - 6a L 6
Address ._2 �% 7 /7 a!�:5&'L , r " ' e-��V e.0 1 r Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee cces not have the insurance coverage or its substantial ecuivaient as re-
quire* by Massachusetts General Laws. ana that my signature on tris permit aopiication waives this reauirement. Owner Agent
(Please check one)
.eieonone No. PERMIT FEE S
(Signature of Owner or Agentl x.52.55
` 425 Date..... % ...... ..... �a .
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that.. ...f..
has permission to perform .............
wiring in the bVill.duin ..r'i.�:<11.Z... ,./.. `� •..........................
at ...� .1..
� ....... ..0 ..... , North Andover, Mass.
F .1..... No. I. .
ELECTR[CALINSPECTOR
04��97 314.50 PAID
WHITE: Applicant CANAFY: Building Dept. PINK: Treasurer
Date` .! : ......
r
i
�'"'� TOWN OF NORTH ANDOVER
' PERMIT FOR PLUMBING
49
This certifies that
has permission to perform . <� `-��'%' ='�................
plumbing in the buildings of :.................
at- '�, -".�... . , North Andover, Mass.
Fee' -P..... Lic No l�3-3 .. �, -�! �......... .
G' PLUMBIN SPECTOR
Check # -340,
6P)36
IN
PP nIUTASSACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING
(Pr nXry pe)
Mass. Date
20 Permit #
r
Building L cationwrier, m
Type of Occupancy
New 0 Renovation ❑ Replacements
Plans Submitted: Yes ❑ No ❑
B.P. #
CMAMD 4F
FIXTURES
stalling Company Name
(). '7n _
isir*ess Telephon
ime of Licensed Plumber or Gas Fitter
Check one: Certificate
0 Corporation
❑ Partnership
'tT FIrm/Co.
N
Lu W W
Z a D
•� O � C'i
Y =)W
►vavrcArv�e t,.yvtfiAGE:
have a current ii bllity Insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142.
Yes No. 0
f you have checked Ys, please indicate the type of coverage by checking the appropriate box.
liability Insurance policy Other type of Indemnity ❑ Bond 0
IWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter
42 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
ignature of Owner or Owner's Agent
Check one:
Owner ❑ Agent 0
reby certify that all of the details and information I have submitted for entered) In above'applicatIon are true and accurate to the best of
snowledge and that all plumbing work and Installations performed u r the permit Isausd for thi a iication will be in compliance with
ertinent provisions of the Massachusetts State Plumbing Code and h is 42 of • G oral Law .
By
Signa re of Licensed Plum Wamr
City/Town
APPROVED (OFFICE USE ONLY) Type of License:'p,Ma�ster OJourneyma:n
License Number 3
MM1I
MEN
NMI
Now
NMI
M
IN•
•
M��I
WE
..
IN
IN�����������iiii
�/IN
//1•—i'/�aasa•r
MMMMM11
stalling Company Name
(). '7n _
isir*ess Telephon
ime of Licensed Plumber or Gas Fitter
Check one: Certificate
0 Corporation
❑ Partnership
'tT FIrm/Co.
N
Lu W W
Z a D
•� O � C'i
Y =)W
►vavrcArv�e t,.yvtfiAGE:
have a current ii bllity Insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142.
Yes No. 0
f you have checked Ys, please indicate the type of coverage by checking the appropriate box.
liability Insurance policy Other type of Indemnity ❑ Bond 0
IWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter
42 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
ignature of Owner or Owner's Agent
Check one:
Owner ❑ Agent 0
reby certify that all of the details and information I have submitted for entered) In above'applicatIon are true and accurate to the best of
snowledge and that all plumbing work and Installations performed u r the permit Isausd for thi a iication will be in compliance with
ertinent provisions of the Massachusetts State Plumbing Code and h is 42 of • G oral Law .
By
Signa re of Licensed Plum Wamr
City/Town
APPROVED (OFFICE USE ONLY) Type of License:'p,Ma�ster OJourneyma:n
License Number 3
E
s
�i
It
3
rO
V#
Location I G
No. —70 Date
w
t '
B
d
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ Sy
Building/Frame Permit Fee $ Z • 9 9
Foundation Permit Fee $
.Gthw Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $(1
�I
(3- & el
U'SL Building Inspector
L S
9 5 D 8 Div. Public Works
Location—,�g/ al el'e- /6 �- 76
No. Date
Z -27 -?G
s`
i A
TOWN OF NORTH ANDOVeR
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $LO
Sewer Connection Fee $
Water Connection Fee $
TOTAL $-2 U 77 5V
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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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: _ -0 X b_hr)r) o' Ae 9,/& 6 �-a Phone
LOCATION: Assessor's Map Number Parcel
Subdivision `�'O X W 6 6 C✓ Lot(s) � 8
Street V /a 0 o! Cl k C% St. Number--l—L--
************************Official Use Only************************
RECO MMEN IONS TOI ; G
Date Approved
—2 2"?
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
P!/bF Date Approved
Food Inspector -Health Date Rejected
Add Date Approved
Septic Inspector -Health Date Rejected
Comments
Public Works - sewer/water connections 2-c-7-`6
- driveway permit
Fire Department=
Received by Building Inspector Date
• WEN H.P. `ELa`
Dirma,
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COXSE",z%:ATIOX
HEALTH
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Town of
NORTH A.�DOVER
PL Ati�iI--N- G S COLLI,, = DEVELOP-*vMNT
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number O70 Date OC o3c72 35 l9S(o
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 14,1 WA -y Lom b C , ec, c
MAY BE OCCUPIED AS [bwELL/,uG- IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
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