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HomeMy WebLinkAboutMiscellaneous - 163 OLYMPIC LANE 4/30/2018 163 OLYMPIC LANE 210/106.13-0132-0000.0 �--- - -- -' - - --� I I � I 1 I I �Y Date.... .... �.`...... ....... r10RTl� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING fs�_ w oma. w CHU9��4 I 1 .This certifies that ...................................�....................{..�................................................................. has permission to perform ....... .g .. . 1 wiring in the building of...... .'."YNJ C) .......................................................................................... at ......:...: .. ....... .kY !��.Q— North Andover Mass. E-, Fee " .... ........:..............Lic.No. ELECTRICAL INSPECTOR t 1 'a Check# t i t 2 6 4` r P -77fi till., , " Commonwealth of Massachusetts Offici 1 Use Only Department of Fire Services Permit Number Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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: 12/8/2015 City or Town of: North Andover To the inspector of Wires By this application the undersigned gives notice of their intention to perform the electrical work described below. Location(Street&number) 163 Olympic Ln Owner or Tenant Thomas Secondo Telephone No. 617.694.7463 Owners 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 ❑ 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: Install 38 solar panels on existing roof. System size of 9.69 kW Completion ofthe.following table may be waived by the Ins ector of Wires No.of Recessed Luminaires No.of Ceil.-susp.(paddle)fans No of Total Transformers KVA No.of Luminaires Outlets No of Hot Tubs I Generators KVA # No. of Luminaires Swimming Pool Above❑ Below❑ No.of Emergency Lighting Battery units No.of Receptacle Outlets No. of Oil Burners Fire Number of zones Alarms No.of Switches No. of Gas Burners No.of Detection and Initiating devices No.of Ranges No. of Air Total No.of Alerting Devices Cond. tons No.of Waste Disposers Heat pump Number Tons KW No.of Self Contained Detection/Alertin 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.of Water KW No.of No.of Data Wiring: Heaters signs 1 Ballasts No.of devices or Equivalent Telecommunications Wiring: No.Hydro massage Bathtubs No.of Motors Total HP No.of devices or Equivalent Other: ISOLARINSTALL 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): 07/23/2016 Estimated Value of Electrical Work (When required by municipal policy) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC rule 10.And upon completion. I certify,under the pains and penalties of perjury,that the information on this application Is true Tete. Firm United Solar Associates,LLC l Name: / No.: Licensee: Dan McGrath Signature: ( c.No.: 20616A (If applicable,enter"exempt"in the license number line) City of Leominster contractor No. el..No.: 855-786-1776 Address: 452 Pleasant Street, Second Floor,Malden,MA 02148 Alt. Tel..No.: * Security System Contractor License required for this work:If applicable,enter license number here Llc.No.: Owner's Insurance waiver:I am aware that the licensee does not have the liability coverage I am the(check one)Owner❑ Owner's Agent❑ normally required by law.By my signature below I hereby waive this requirement Owner/Agent Telephone Signature Number Permit Fee: $ 4 i 1 I I 1 f I I i ��, 1 � '�� �o I �N� 1 2 3 4 5 ELECTRICAL KEY: INVERTER 1 SPECIFICATIONS INVERTER 2 SPECIFICATIONS MODULE ELECTRICAL SPEC FICATIONS SOLAREDGE SE5000A-US SOLAREDGE SE380OA-US (38)Trina Solar TSM-255 PD05.05 11 BREAKER RATED WATTS(EACH): 5000 RATED WATTS(EACH): 3800 SHORT CIRCUIT CURRENT(IsC): 8.88 -/� SWITCH AC OPERATING VOLTAGE(V): 240 AC OPERATING VOLTAGE(V): 240 OPEN CIRCUIT VOLTAGE(Voc): 38.1 Q SCREW TERMINAL AC OPERATING CURRENT(A): 21 AC OPERATING CURRENT(A): 16 OPERATING CURRENT(IMP): 8.37 C9 FUSE NUMBER OF MPPT CHANNELS 0 NUMBER OF MPPT CHANNELS 0 OPERATING VOLTAGE(VMP): 30.5 • SPLICE INVERTER EFFICIENCY: 0.98 INVERTER EFFICIENCY: 0.98 MAX SERIES FUSE RATING: 15 ff EARTH GROUND INTEGRATED DC DISCONNECT INTEGRATED DC DISCONNECT STC RATING: 255 rn CHASSISGROUND INVERTER I INPUT SPECIFICATIONS INVERTER2 INPUT SPECIFICATIONS PTC RATING: 232 ——— GEC NOMINAL CURRENT PER STRING(Inom): 8.8 NOMINAL CURRENT PER STRING(Inom): 11.7 DESIGN CONDITIONS EGC NOMINAL VOLTAGE(Vnom): 350 NOMINAL VOLTAGE(Vnom): 350 HIGHEST 2%DB DESIGN TEMP(°C): 32 MAX SYSTEM VOLTAGE(Vmax): Soo MAX SYSTEM VOLTAGE(Vmax): 500 MIN.MEAN EXTREME ANNUAL DB(°C): -18 A MAX CURRENT PER STRING(Imax): 15 MAX CURRENT PER STRING(Imax): is A MAX INPUT CIRCUIT CURRENT(Imax): 30 MAX INPUT CIRCUIT CURRENT(Imax): 15 (3)#8 THWN-2 (3)#8 THWN-2 (3)#8 THWN-2 (3)#6 THWN-2 (6)#10 PV-Wire (6)#10 THWN-2 (3)#10 THWN-2 (1)#B GEC (1)#B GEC (1)#8 GEC (1)#B GEC (1)#10 EGC (1)#10 EGC (1)#8 GEC 3/4"EMT 3/4'EMT 3/4"EMT 3/4"EMT FREE AIR 3/4"EMT 3/4"EMT (N)MIN.60A AC Combiner METER SUB PANEL AC DISCONNECT, SUPPLY SIDE CONNECTION WITH (N)SE5000A-US 60AMP, AC DISCONNECT, 250VAPOLARATED LLSTE AR INVERTER W/INTEGRATED NON-FUSIBLE,C-H 60AMP,FUSIBLE APPROVED RATED UL LISTED AND DC DISCONNECTS APPROVED CONNECTOR DG222URB C-H DG222NR6 1 STRING OF + 30A 2P LOCUS SOA USE pV 200A MA IN BREAKER 11 MODULES -AC OUR OPT.CURRENT=8.01A DC v OUTPUT LOAD LINE LOAD LINE 1 STRING OF j(E)LOADS i t MODULES I (E)200A GO MSP INVERTER OPT.CURRENT=8.01A (E)LOADS 240V 2P 3W t� (3)#10 THWN-2 L_______ B (1)iF8 GEC B 3/4"EMT wl J— (N)SE380OA-US INVERTER W1 INTEGRATED DC DISCONNECTS GEC 1 STRING OF + - VERSIBLY SPLICED TO AC 20A 2P EXISTING GEC EOR BONDED DIRECTLY 16 MODULES �� TO EXISTING GROUNDING ELECTRODE , OPT.CURRENT=11.66A DC OUTPUT ——————— _______ .a (IF APPLICABLE) MIN.NEMA3R UL LISTED JUNCTION INVERTER BOX WITH 90'C TERMINAL RATINGS LOCATED ON ROOF C C Inom=(16 x 255W)/350V=11.7A CONDUIT ELEVATION:1/2 TO 3-1/2"=22°C 38 MODULES TOTAL OPERATING VOLTAGE=350VDC(REGULATED) HIGH AMBIENT TEMPERATURE:32°C 38 x 232(PTC WATTS)x 0.98=8640 CEC WATTS CUSTOMER INFORMATION: EXTREME LOW:-18°C THOMASC SECONDO ROOFTOP AMBIENT TEMP(Tcorr):54°C=0.76 SE5000A-US MAX OUTPUT CURRENT=21A + IBREAKER SIZE=21 A x 1.25=26.25A=>30A 163 OLYMPIC LANE CONDUIT FILL(Cfill):0.8 SE3800A-US MAX OUTPUT CURRENT=16A NORTH ANDOVER,MA 01845 CONTINUOUS USE=Imax`1.25=15A BREAKER SIZE=16A x 1.25=20A=>20A (617)694-7463/#2242998 CONDITIONS OF USE=Imax/Tcorr/Cfill =15A/0.76/0.8=24.67A CONDUCTOR SIZE FOR 24.67A DESIGNED BY: REV#: DATE: INSTALLATION SHALL USE MIN.#10 AWG PV.-:3.]0 TUSHAR.K 1 0 1214/15 SUNGEYTYINC.W FRANIOJN ST SOTE 310 C-0.CF BO60] y EWCOMB Dete.—Lo®Wn:Secm00-YH19985V1 SMH Siza:t 1.11 THESE DRAWINGS,SPECIFICATIONS AND DESIGNS ARE THE PROPERTY OF SUNGEMW INC.NO PMT SHALL BE COPIED OR VBEO FOR OR WITH ANY OTHER WORK OTHER THAN THE SPECIFIC PROJECT FOR WHICH THEY HAVE BEEN DEVELOPED WITHOUT OUR WRITTEN CONSENT The Commonwealth of Massachusetts Department of Industrial Accidents d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Legibly Name (Business/Organization/Individual):United Solar Associates, LLC Address:452 Pleasant Street, Second Floor City/State/Zip:Malden, MA 02148 Phone#:855-786-1776 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 5 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a h 9. ❑Demolition omeowner doing all work ❑ g myself. No workers'comp. required.]t [ p q ed.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.e I will 10 ❑Building addition 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 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[D Other Solar Install 152,§1(4),and we have no employees.[No workers'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. 2 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 h 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:TRAVELERS Policy#or Self-ins.Lic.#:7PJUB-5B50763-8-15 Expiration Date:7/23/2016 Job Site Address:163 Olympic Ln City/State/Zip:N.Andover, MA 01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL 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 day against the violator.A of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify un er t pai and p ie nffi�tjjury that the information provided above is true and correct. Si nature: Date: SoZlg I Phone#:855-786-1776 Official use only. Do not write in this area,to be completed by city or town official. i City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• AcV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/8/2015 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 1"n ADDITIONAL INSURED theoli p cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Asset One Insurance PHONE Ext): 714{i25 8204 (A/C,No): 714-625-8290 575 Anton Blvd.,3rd FL ADDRESS: ara@solarinsure.com i INSURER(S)AFFORDING COVERAGE NAIC# ! Costa Mesa CA 92626 INSURER A: Westchester Surplus Lines Insurance Company10172 INSURED INSURER B: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERK 25674 United Solar Associates,LLC INSURER C: American Zurich Insurance Company 16535 452 Pleasant Street,Second Floor INSURER D: INSURER E: Malden MA 02148 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBERPOLICY EFF— (MMIDD/YYYY) (MM/DD/YYW LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A i 627527966 001 11/10/2015 11/10/2016 / 0/2016 -PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000 000 POLICY FX JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE G27527966 001 11/10/2015 11/10/2016 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B (MandaoryInNH)OFFICERIMEMBER EXCLUDED? a N/A 7PJUB-5850763-8-15 7/23/2015 7/23/2016 IMandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Property ER07771654 5/26/2015 5/26/2016 $522,302.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Building Department PRESENTATIVE AUTHORIZED RE 1600 Osgood St., Building 20,Suite 2035 /J RE North Andover MA 01845 9S`/Lf! 95�d ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f OR' —111118 or +� 4A _ ELECTRICIANS t SiO33 i I ssuEs THE FOLLOWING LICENSE , AE A•REG JOURNEYMAN ELECTRICIAN I O AN I E L J MCGRATH 4 CL 114 BOYLSTON ST -� ---1"-'` ren,r�u►utast x ea zi ak.r.use KALOEN� MIA 0214$-1331 IAassachusens -Department of Public Safety Soard ofSuilding Reg uial io'13 and Standards 0.n%trucais,n a wor 14 F.,msl% WAS= _ License: CSFA 104878 _, .,1. TtwtsisdwNie ���oanlpisl�di DANIEL J MCGRA1 fHr pixsptlpnM �t t+wrlitlYri�6laorw b 114 BOYLSTON ST f r �1 trityl►�M N� MALDEN MA 01148 ,x' f� ar Expiration Keith M.PMt ww"t S/aR/w" Gaxunt>;stenrr 17011512018 Oltlnsr nrrM—o�Yt er�i n',eurw arrr rr�N , nice ofConsemer Affairs&Business ME i Regulation IMPROVEMENT E ELECTRICAL UNLIMITED OL3RNEYI�ERSON MENT CONTRACTOR ME 166524 Type: DANIEL]MCGRATH piration: 3t7l2oi-t Individual 114 BOYLSTON ST DANIEL MCGRATH MALDEN.MA 02148-7931 j DANIEL MCGRATH 114 BOYLSTON ST L e IkEd N �t•.4t_� ,___ lv Iq MALDEN,MA 02148 LC.019��33-I2 10/01/2014 09/30/2015 undersecretary " STATE OF CONNIXTICUT STATE OF MAINE DEPT OF PROtE3 AAL A FINAWK REOULA110N ELECTRICAL UNLIMITED CONTRACTOR. ELECTIMM&EXAMIW4 BOARD DANIEL) NICCRAT14 LICENSE 0M8i0020f03 . . 114 BOYLSTON ST MALDEN,IMA 0'2146-7931 DANIEL MCGRATH MASTER ELECTRICIAN Lir, -ProNQ;��cCT14E ExPIF;Eq ISSUED Au028,2013 EXPIRES Aug 31,2015 ELC.0201855-E3 09/31/2015 051/3012036 ' — J -4• V f pORT►/, 3:;�t ``°-�•�"�o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING « � � • , SSACMUS� 4 This certifies that ..... ....: .f .......... .....�/ �� (J has permission to perform wrong In the building of.j..- . .. Lr--'!g7 ..�4d . . r .................... 4 at......3....Ojy—q.I.. -... G4.�,�:................... .North Andover,Mass. . Fee ............ Lic.No..!.... ................... .....:... . .:.. 7+� .... ....... ELECTRICAL INSPE R Check # 8352 Commonwealth of Massachusetts Official Use Only a Department of Fire Services Permit No. Z. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 ]eaveblank) 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: ?-14-08 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) /1,3 dlyy/C /0if t; Owner or Tenant rTt9�'i Es-kk lj ES Telephone No. 99.-Jyd- Owner's Address Is this permit in conjunction with a building permit? Yes ", No ❑ (Check Appropriate Box) Purpose of Building $Ifw g r/t A-1/61 J , Utility Authorization No. Existing Service 00 Amps /;0 /et 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: Ao?, a eem el, {rouse �r Com letion.of thefiollowing table may be waived by the Inspector of Wires. t No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool Above ElIn- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets /Z No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of.Gas Burners No.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating Municipal w p b KW Local❑ Connection El Other No.of Dryers Heating Appliances KW Security Systems:* No.of Waterof No.ofNo.of Devices or Equivalent + Heaters KW No. Signs Ballasts No. ta Wiring: 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. Estimated Value of Electrical Work: -26122. (When required by municipal policy.) Work to Start: 45 AV 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 ame to the permit issuing office. CHECK ONE: INSURANCE 2rBOND ❑ OTHER ❑ (Specify:) Yrr��✓d'4,11ve4/ 71,,01 I certify, under th ep lains and penalties of perjury, that the information on this application is true and complete. FIRM NAME,:., o,4 en l- ✓• LIC.NO.: • - 64359- 6 Licensee: Q,6,er v 1c-E-' Signature LIC.NO.: X7.5$ - af applicable,enter"exempt"in the license number line.) Bus.Tel.No.:-740-M-" Address: 14 His i lls*'Ld '4ifKUe At OIVO6 Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ` �, �; I � �� �_ �3� � � � �� � 1""u� N� �,, 2 0-��� �� i '� F The Commonwealth of Massachusetts r1 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UT www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLibly Name (Business/Organization4ndividual): �C�T ✓ ��f f t�v� Address: ' A I-ItS� City/State/Zip:foa,6P5 /014 p4D�, Phone #: 75/— ?0'66 S-1' r Are you an employer? Check the appropriate Vox: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions `,4 3.❑ 1 am a homeowner doing all work right of exemption per'MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: -a Policy#or,Self-ins. Lic.#: Expiration Date: ;AJob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebyunder the pains andpenalties of perjury that the information provided above is true and correct Simafore: certir -/(, r Date: Phone#: 7YI - r"-L-5-4 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 IL Contact Person: Phone#: Datel........................... toRTN 4, 0 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING. US This certifies that ... t................ ..�'e� ......... ................... ............... ....................... has permission to peri orm . )?e ........................................................................... wiring in the building of.....-C4 .......U-6 r Ek.1 c.G.;S........................ ............ ............ .........I... ... ..... at..4.Z......Q. .............. .North Andover,Mass. FeeO ............... Lic.No......I........ .................. .. .. ....... ELTRICAL INSPE R Check # 8351 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS IF [ Occ 1 any and Fee Checked leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: ^/&—0 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) Owner or Tenant h E5J-Cz?k 1ZS Telephone No. J g Owner's Address Is this permit in conjunction with a building permit? Yes FX1 No ❑ (Check Appropriate Box) "RFl ASN 1 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: K ITLL,Ly � I � Completion olf the.following table may be waived by the Inspector of Wires. No.of Recessed Luminaires g No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ig mg rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges ' No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Head Pump p Number. RRo KW No.of elf-Contained Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating AppliancesKW Security Systems:* No.of Water KW No.of No.of Data Wevices or E uivalent Heaters Signs Ballasts No.of Devices or E uivalent ;j 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. Estimated Value of Electrical Work: 3 CCO . 00 (When required by municipal policy.) I Work to Start:& ff J / d-Z Inspections to be requested in accordance e 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 aims and penalties of perjury,that the information on this application is true and complete. FIRM NAME: S . LIC.NO.: Licensee: S, ,J Signature LIC. d �1/� �fai2(�1L0� NO,; � �8� (If applicable,enter"exempt' in the license number line.) Bus.Tel.No.: 7 We-1,9 Address: ®� t'�/� (o �� 7 Alt.Tel.No..2 O *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: S -20.(90 k v I -01 9-� gs (r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatio ndividual) n, Address: / �,•y� iy/� AI City/State/Zip: � � � 0�80 Phone Are on an employer? Check the appropriate l,�oz: Type of project(required): 1.�I am a employer with�— 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. [_] I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per'MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other Any applicant that checks box 41 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 their workers'comp.policy information. ' I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ 4 �(� ( Policy#or Self-ins. Liic.#: Expiration Date: ! Job Site Address: City/State/Zip: A)/7 /py,t^ yV N Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). N Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Date.- <".O RT:1�, TOWN OFJ NORTH ANDOVER PERMIT FPA PLUMBING ,SSACMUS� l This certifies that •. . . "t . . . . . . �'. . . . . . . . . . . . . . . . has permission to perform . .� .=. . .- .". . . . . . . . . . . . . . . . . . . . . plumbing.in the buildings of . . . . . . . . . . . . . . at . . . . . . . . . . . . . . z. . . . . , North Andover, Mass. Fee.z.— . . . .Lic. o..�� J . f -_"""'PGLUMBING INSPECTOR .Check # � 7989 ( � I ! (n , "1'J (t (r _, t m •�l rn cn p• W N to Y C_ ✓,�'=�(�1(:.) , '0 �1 –I 31 (n 1-" ;� _I -I pl (D ",a. :; IU X x C3 1 2 o O Q , I :r •'y t/) r-I r' !11 1� 1 I I( tl 11 71 ll 11 11 ')1 11 tU c� i (1 (' �i c t-1 ui .I; (: (l, ;1 L.. r- r i_ 1- r• r, r- r• In O O O O 0 0 0 O 0 0 l -1 -1 N• ti ,-1 t•t .:1 (D Ill 31 31 3) 31 70 M [A 0 Fr ); c: ,,, I ul I' -- - - -- - - WATFR CLO SITS (1 I It I 111 0 -rt 0 ri:r �1 ,[) IC f KI"fC11EN !1INKS it I.AVA7/11111: ' — \� ;, ,r, n •u 'C • 1'i :1.1 :,. '() ItAl-11-('1111:, c) y; t ;1 SIIOWEIi STAI.1-S :1 r i = 1'1 •.I••1 1)I:iIIWA:iIll-ilS (u - - - - - - - - - LAIJUDnY TIIAYS �> WAS11, MACI1. Ci1N11. r � `• IIOT WATFR TANKS IU � 111 n' �� ., f , l•1 � tY � - - — -- — — SLOP SINK'i � FLOOR 1)11 A I N S m -1 \ c;,o I)1 GAS TRAPS (u Z (U ID URINALS CJ rn ,-n O1 DRINKING F011NTA111 '� (UJ C [U — 1 rr A 111'_A DRAIN (U 11, (I, (U :1 (u n W A T F:R P 1 14 I N G It, 4G („ l0 '-,• � HOOF [)RAINS iu \ 1 01111'.11 1:1)( 11111I: :i: IU 1l 111 O it) -- .— _' _- -'_-- ---- --__---.----.---'--'---.-_ 11. I„ it F-1 NTI _ I ! — — U :j it. [ i I • BELOW FOR OFFICE USE ONLY FINAL INSPEI:TIONS SKEICIIES PIIOGIIE_SS INSPECTIONS j FEE NO. APPLICATION PO11 PCIIMIT TO DO PLUMBING f NAME & TYPE OF DUILDING 1 LOCATION OF BUILDING PLUMBEII rl'ON N O WI NT I ROP PENMIT GFIA14TED 1 DATI•: AI'l'Ro)VI•:1) II AI PROVIA) BY DATE 10 Pl,UNi1I1N(: & GAS INSPI-X"I'Olt PLUMBING 114SPECTOII i I Location No. /,eDate x TOWN OF NORTH ANDOVER � NORTH 1 O �.•o ,••4, 3? i • O F 9 41 4L Certificate of Occupancy $ ,ISACMUSEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � ^ I i 8474 �/ Building Inspcior dO rp TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING Old BUILDING PERMIT NUMBER: /a 0� DATE ISSUED: ic SIGNATURE: 'c Bui ommissioner for of BuildingsDate —1 ' SECTION I-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number. O / lb Q U Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Pr Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided v 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Infos ation: 1.8 Sewerage Disposal System Public ❑ PrMft ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT '� >� {� '� 't(lCt; `,�n NO M II, 0 2.1 Owner of Record VF�F/z`ti V nT'ER Na (Print / Address for Service 'Sign Telephone 2.2 Owner'-of Record: Name Print Address for Service: 0 z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 31 Licensed Construction Supervisor: Not Applicable ❑ t Licbnsed Construction Supervisor: 0 License Number Address Expiration Date Signature Telephone '... 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name V P-O'`�OX 637 Registration Number r North'k6ding,MA r Address 01864 Expiration Date" 16 Signature Telephone SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildingpermit. Signed affidavit Attached Yes.......V No.......0 SECTION 5 Descri tion of Proposed Workchccic a®a bk New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other VSpecify, Brief Description of Proposed Work: c r- - SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 1 A2G� 6 Total 1+2+3+4+5 O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNS NT OR CONTRACTORAPPLIESFOR BUILDING PERMIT y 4' ► 60�K4 Ti�` ,as Owner/Authorized Agent of subject property l I, .. byorize U\Ar L �f t� , LG-�- to act on y f,in all matters relative to work authorized by this building permit application. 3 aoo5 Si a of Owner Date SE N 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and informatr � �oping application are true and accurate,to the best of my knowledge and belief P.0• North Reading,MA 01864 ip, ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 167 2'JD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of o No. A o dover, Mass.,- 'd COCMICMEWICK 7,9 A0RATED `r BOARD OF HEALTH Food/Kitchen PER. MIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............. .................. ......... ................. ............................................................ Foundation 4j. has permission to erect........ .............................. buildings on w1.. ....... .. ......... • .......... ... Rough to be occupied a ... Chimney %00provided that the person acc ing this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisi ns 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 STARTS Rough �t�ih�!!` 1:•'::.nr•� Service .......................................4BUIL G INSPECTOR Final Occupancy Permit Required to Oca cpy 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. SEE REVERSE SIDE The Commonwealth ofMassachusetts Department oflndustrial Accidents «` Office of Investigations ky 600 Washington Street Boston,AM 02111 www rnassgovlo is Workers' Compensation Insurance Affidavit:Builders!Contractors/FIectrieianslPlumbers Applicant Information Dust RMIM19 Please Print Ley-MX Name (BusinessQrpdzatio dtadivictu : P.O.Box 637 Address: 01564 City/State/Zip: Phone i#: Are y a employer?Check thcappropriate boa: Type of project(required): i I am a employer with 4. ❑ 1 am a general csrniractor and I 6. C]New construction o * _ * have hired the sw)-ool>:uactvrs eatlpl yecs{full andlo pari time. i Remodeling 2.❑ 1 am a stile proprietor or partner- fisted on the attached sheet.t ship and have no employees 'Mese sub-contractors Dave 8. ❑Demolition working for me in any capacity. workeas'comp,instnance. 9. ❑Building addition (No workers'comp.insurance S. ❑We area corporation and its i 0.❑Electrical repairs or additions offftras leave exercised their 3-❑ I am a homeowner doing all work right of exemption per MGL I i-❑F -Mg f'epairs or additions myself[No workers'coup. c.152,§1(4),and we have no 12.Q'= — inswance required.)t avloym [Ko 13.❑ Other comp.itcx r�quirod.] *Any ap k=i that dwcb bas#I mud also fill ort the txdjon below&dowing their weuk9W owttpensatio0 pdicy information other- ; Homeownas who submit flus affidavit mdicatn they ane doing aA-*&cad then hire outride eonbadms mad adndt a cow AMdMVi1 1D&catft each. t Contractors that check this box mod Mad"an additional sheet showft the name of the MItH ttratxm and three wt)*—'coop.palmy infl—T—tioa I am an employer that is providing workers'compensation insuramefor my employees. Belton is the po&y and job she information. Insurance CompaDy Name: Policy#or 8elf+im.Lie.#: "% h�J� l 1:ffi(Ofiv � Expitatipn Datc: l/ Job Site Address: �v Cityistateu:^ZLcl. Attach a copy of the workers'coarp In"01 policy de dumlon page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1 52 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 mxVor one-year imptisonmen�as well as civil penalties in the form of a STOP WORK ORDER and a free of up to$250.00 a day against the violator. Bt advised that a copy of this stetrmt may be forwarded to the Ofticc of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an d penakk s of perjury that the information provided above is true and correct Si lure: Darc: j Phone 4: 79V 2'_ - ?9 Official use only. Do not write in this area,to be completed by city or town offielat City or Town: PermigUeense# Issuing Authority(circle one): 1.Board of Ae alth I.Building Department 3.Cityfrowo Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone N: t� NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris ill be disposed of in: (Location of Facility) < ,cA_ Signature of Permit Applicant Fire Department Sign off: �v Dumpster Permit Date Page No. of Pages - k Builders License # 58443 Home Construction Reg. # 109288 - o O mo (98 9) 944-1994 (998) 664-2559 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 PROPOS SUCBGMIpE�TO PHONE DATE / ! STREET/ / 1 (' ri.f 1 JOB NAME / r ?{ CITY,STATE A�D ZIP CODE JOB L,OCr4TION 1 q 5' M We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) +� Rip& Remove all shingle debris from roof&job site: Cit 1 layer ❑2 layers ❑3 layers or more Repair/or Replace any roof'decking; not to exceed 50sq.ft. sr� Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown Install ICE&WATER underlayment along horizontal eaves,valleys, sidewalls and sky-lights&chimneys (o • Install premium base sheet underlayment between roof deck and roofing shingles • Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year +/ Install-30yr-CertainTeed/GAF/Tamko-or Owens-&-Ger-ping—arGh4ect-ura+-roof-strfrfgte ❑40 year ❑50 year ❑ Lifetime See manufacturer warranty policy for more details ✓ Install new aluminum vent-pipe flange(s) •` Chimney(s) -counter-flash and re-step existing flashing ❑Cut& Install new lead flashing • Ridge-vent/exhaust vent with low profile design, hidden by shingle caps ❑Soffit-ventilation Od400f louver-vents • Seamless style aluminum gutters-custom fabricated at job site ❑downspouts n, �f ) r Other ��i at �.�r t it 0 *Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. Pe Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of: 19-00 Total price not including options. dollars($ (Z,- Payment-to L%Paymentto be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. P Signature /rl� -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within -�' , days Location fy 3 0 L v m At-c U1 No. Date I TOWN OF NORTH ANDOVER O Certificate of Occupancy $ « ; Building/Frame Permit Fee $ SIJ .00 «I^" ,. . '^°"' ' Foundation Permit Fee $ s�C14 Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ C Building Inspector 2 X1/06/95 10:14 25.O6PAID 2 <- 9 N 24 Div. Public Works 01, PERMrr NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K40. I LOT NO. 12 RECORD OF OWNERSHIP IDATE BOOK ;PAGE — ZONE SUB DIV. LOT NO. i LOCATION PURPOSE OF BUILDING OWNER'S NAM /1 ,,O NO. OF STORIES SIZE OWNER'S EMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SSE R .` SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION `' MATERIAL OF CHIMNEY IS BUILDING ALTERATION ` ,\ ry. �{/, M . fA IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ,l T+,l(�bIS 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 LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 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 LED \� e t BUILDING INSPRCTOR SIGNATIJ OF OWNER OR AUTHORIZED AGENT i " F E E OWNERTEL.# �� PERMIT GRANTED ` CONTR.TEL.# �l I to v- CONTR.LIC.# H.I.C.# � q BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES 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 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL _ JN FIN BASEMENT I ( AREA FULL FIN. B M AREA '/. 1/1 '/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD�r✓'D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. S FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE ' 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT 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 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 6 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 _ ELECTRIC 1st 13rd NO HEATING r NORTH F Town of ®Ver 0 0 -1; .� • 5 1-0 dover, Mass., zkA&,gV eR A 19 c53 /� COCHICHEW�CK � ' ADRATED P'Pa'\' C S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System SAA. _ BUILDING INSPi?CTOR THIS CERTIFIES THAT.............. .Ubl..��...........J.A. ........... ....`�..I ...�2 �C .5................................................... Foundation has permission to erect.... .... buildings on ..... ' J......�...�.�,yra�/..�,........�.1 v............... Rough to be occupied as...........,1= . 'I. .►5. ?.......... ,, . . . ../.'1Z.. '.'.?..1...............�.../��.��. .,t .�1.C�.N7.... ...................... Chimney yy Ch' provided that the person accepting this permit shall in every respect conform to the terfns 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI N STARTS ELECTRICAL INSPECTOR Rough i...... ...... .................. Service • BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. Qe-gT: 3 5'%L+ 1 � I I f I ir------------------------------ ------------------------------ 4t - ------------------------- 4t �U I I � f I I AVP I I I I I 1 I i I I I I � I I I I PMA -UP I I I I I i I I I I I I I I N I I � I I N I I I I I I I I i I I I I I I I I I � I I I I I I I I I I I I I I f I I I I I I I I I I I I I I I I I I J I I I I i I I I I i I I i I I I I I I I I I I I I 25' i I I I I I I I I 1 f I I I I I I IL----------------------------- ----------------------------------J I i I I i I I L-------------------------------------------------------------------------� rte, t _ . . _ Office Use Qnty .� u ��ommnnui tti IIf: cs us>?i PeratitNo . ..- s e artmetn of Yukull: _ 0=pancy A Fee Checked 19J/ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 Heave blank) 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 (Myj or Town of _t NORTH ANDOVER - To the Inspector of Wires: The udersigned applies for a permit to perform `'�the electrical work described below. Location (Street & Number) Z _ (J 4j C LA . Owner or Tenant aa SOwner's Address ?Oxn� Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building S1', ��.t���[-� Utility Authorization No. Existing Service Amps _I Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 41412e- No. 1412CNo. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures i// I Swimming Pool Above r— in- KVA gma. _ grnc. '_ I Generators No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units' No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and g I tons Initiating Devices No. of Disoosals I No.of Heat Total Total Pumas Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Soace/Area Heating KW Detection/Sounding Devices r- No. of Dryers Healing Devices KW Local I Municioal OtherConnection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Camoieted Operations Coverage or its substantial equivalent. YES = NO = I have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND = OTHER = (Please Specify) Q¢l� G1�°trZ6,57 (Expiration Date) Estimated Value of lectrical Work S \ Work to Start « Inspection Date Requested: Rough 2e Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. r� Licensee (�^ �a���/�f>�' �>�� Signature LIC. NO. /Z 3 Pa` ! '�Jk �17> /7` OCac� r Bus. Tel. No. Address P��� A 619-?2 Alt. Tel No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) / x-6565 G�. � 3 7 � 5Sf5 «N. -�.:.._--+.---v.�.+ 'ro iro-•......r... -,st Y.-�.:.a�s.v.-..--'.,w_" "-'..�... :. - --- r+�r--;..•-*.—•'----Y....k '1^fi.r.^'.. T° 277Y Date../.�r•`••• /•.i•,�• NORTI{ .��4,�o� TOWN OF NORTH ANDOVER 0 p PERMIT FOR WIRING ,SSACHuS� 's This certifies that .....W.G.N K....0 A1..1 ................................... has permission to perform ....(�a.�c.S.Q..tt.t'st lf..........1n/+.i2.k. Ij.............. wiring in the building of........ . ............ ...................................................... at..... ...... ?.r;/6y'p! ....... ................ .North Andover,Mass. Fee.aJ...!;P..... Lic.No..'111.3�-:........................................................... cqy�/\ ' ELECTRICAL INSPECTOR C (( 0\6 313'/19/95 13:33 40.40 PAID k WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File