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Miscellaneous - 180 WEBSTER WOODS 4/30/2018
ro O e� t In a Date.. �Ah'Z!....... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION -4- 1 This certifies that ....l! .d -� .. LU..... . has permission for as installation .4 P S / in the buildings of,.... �l�r ........................ at ..®O. ...�? . Nph do er,/Masj Fee.`S�.4"P. Lic. No./?.... td.... GAS INSPECTOR Check # TYPE OR " PRINT CLEARLy FIXUT BATHTUB CROS CSCROS O DNN DNN MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM CITY PLUMBING WORK v� MA. DATE JOBSITE ADDRESS r OWNER ADDRESS: 0 � OWNER'S NAME OCCUPANCYTYPE. COMMERCIAL I] EDUCATI NEW: ❑ RENOVATION: El ORS—► Bsmt WASTE SYS 'u'u"I CU UFAY WATER DEDICATED WAS 4USj DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER Uh FLOOR DRAIN SINK DRAIN URINAL WASHING MACHINE CONNE WATER HEATER ALL TYPES WATER PIPI1 r REPLACEMENT: X 4 ONAL ❑ PERMIT # TEL: FAX: RESIDENTIAL Al PLANS SUBMITTED: YES ❑ NOW 1011 12 1314 I have a current Iiabil' insurance policy ar its substantial equivalent which meets the requirements of MG 11 If you have checked YES please indicate the L. Ch. 142 YES Q NO ❑ type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑i OTHER TYPE INDEMNITY W BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does---- n0-ve the insurance coverage ❑ Massachusetts General Laws, and that my signature on this permit application waives this requirement g required by Chapter 142 of the SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT ❑ =,CerfifY that a1! of the details and information f havesubmitted (or entered) regarding this application are true and accue and that all plumbing work and installations performed under the permit issued for this a I' 'n will be in w pliance all Pertinent Provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. pp rate to the best of my PLUMBER NAME:George Koval LICENSE # (12405 COMPANY NAME: Koval Plumbing. Heating & AC Inc. SIGNATURE ADDRESS: i Dupras Rd CITY: i Tyng�sboro ' STATE: A ZIP: 01879 TEL:9782517200 FAX: 9782517206 CELL 9788665321 EMAIL• + george@kovalplumbing.com MASTER F111 JOURNEYMAN W CORPORATION ■ # "2548 1 ❑ PARTNERSHIP ❑ # (� LLC ❑ # I—� I 9328 Date. Z/z h?n-. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS�~. ~ ������ This certifies that 4. .. .......... ..�; has permission to perform ..�'�2h?..J` ............... . plumbing in the `buildings of ..�4� � I ................... at // ,North Andoer, Mass. Fee. 7 .%GYJ . Lic. No 32./c� .�*/ .iISPECTO'R ....... PLUMBIN Check # T 2 03 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORT( Fws. z CITY n 0� MA DATE PERMIT # JOBSITEADDRESS 1 /90 *J t' W1064 I OWNER`S NAME] JIj P OWNERADDRESS I /SO W Si �G� ' � S ] TEL] IFAX] I TYPE -OFR OCCUPANCYTYPE COMMERCIAL{ { EDUCATIONAL j I RESIDENTIAL]. PRINT CLEARLY ,{ NEWS { I RENOVATION: I I REPLACEMENT: ( { PUNS S WITTED: YES { N0.{ { FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 II 9 10- 1t 12 13 14 BATHTUB _I -- CROSS CONNECTION :DEVICE ; DEDICATED SPI=CIALWASTE-SYSTEM DEDICATED GAS/OIUSAND SYSTEM i ..i DEDICATED GREASE SYSTEM I - { - • ._. DEDICATED GRAY WATER SYSTEM i .:..:_ _ .._.._.:-,. _� .._...._.'__.... 1 ......_. ,......... 1 . .:..:..,. DEDICATED WATER RECYCLE SYSTEM I DISHWASHER - DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) i KITCHEN SINK LAVATORY — - ROOF DRAIN ' �.. _._ I .----' - ---- SHOWER STALL • 1 _:, _. _.. I . _ .:_ !• ...... , _ .� . � _. i :... ,. �_ } SER=EIMOPSINK -... �_ TOILET . �. I . : _ —_._. _._.__ .. • ._.:. . URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES. WATER PIPING I .OTHERSell INSURANCE COVERAGE: have a ctirrentliabilit hsilratice policy.or its substantial equivalent which meets the reggirentents of MGL> It. 142. YES ! C<'N-O IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE 13OX BELOW LIABILITY INSURANCE POLICY ( 4,-- OTHER TYPE OF INDEMNITY I j BOND I, I OWNER'S INSURANCE:INAIVER:I am aware that the licensee sloes not have the insurance coverage required by Chaptee 142 of the Massachusetts General Laws, and thatti)y signature oil this permit application waives this requicetitent. - CHECK-ONEONLY:. OWNER ( { AGENT. ( { SIGNATURE OF OWNER Olt AGENT t hereby certify that all of [tie details and information I have subniiited of entered regarding:fhis application are true and accutate to the best of my knoeiledge and that all plumbing work and installations performed under the permit issued for this application W11 be in m dance vAlh all Pertinent prpviston of tha &1assachuselts State Plumbing Code and Chap er 142 of the General Laws. PLUMBER'S NAME ] �Q q` \@ ILICENSE ft SIGNATURE MPI I ,IPI"{' CORPORATIONI.III'i 1PARTNERSHIP11 111'j,LLCI !#I I J COMPANY NAME( C L �(t!d�� •� ADDRESS ] 3q 'Fp �reL•� CITY ST TE ZIP 1. b 3 -a"4 TEL FAX ] CELL 'EMAIL I z O ul W 04 ❑ o O I MWOW MOW � A��ti�'li�xert�of1'ttrTitsfe�irrl Elccll�irts ��,�%ic�'o,�`Xri►'�sfigir�iotrs 4bmisfitrlgfonm-eel 11OStoui'MA. 02111 Tokko0o. ' A►i;�:otettieenti�To�:et•7CflccTrf[tenlil+t•oprintcGoi: � ,��ri�;bfl»•bjccE�chilttietij: I:©iltnaaemplo�crt�iti> - �i. Ialit (Igeneralcoittrdctormit 1 �; bNeEC6iistriicti4n biu yecsftT[nnctfori+atttiitic) [taee[ttrctil)Icsnlscoriiinclors �. ; 2. - autasoicltroprietoroipat�ncr listettolitiien[(aFite(i��itei.I d cntotielin g alt(l[lavonocillpfo}gees Tttesesttb•conlmeldtsl'lavo {tI�orari.cing.fornotittnycpgly. cvoikr,'con}piltsilralloo, iI. []'0yhe7li(tttoitniglioti(t liatti uoL.9 0li?p*3Isittattco acbiporallg11and its ��fiittij o!`ticershadcc,�ercise(Tltictr td;Q�rleclrirnllzpttlr.braddi(i0ns .dI;not.rilibuitotvlicrctun>SntltgoiR rJ�itto£c�eauptioneioits 1tt3self[t`ta�tbrRer eotnti. .I_S2,sJ[�1), 44t" lgivefto - }2:QngoPrepai►s [lisuranccregaireci jlT +E1iij�foi�ccs. [i�Iowor.. ke j '( OtTicr Cgthp. EItSllrtlnCG1't(}I1tCC1T.i f j1Q} C llt ltl_`iC$;iiS (h%ta vtritf.}so illCC. LRt! ZJOV I VI IQ scuto 14litoo;MY, Nofcelin CagrredAt�p}I lRftirari�ertrllls;t�c�rllirrf7rlicvt+ldirrbr a�nrlers'cciiirj,.cjrtsrrf�ntr ii�ni'nrrtfiarr. Peloj o tv thepvlt y outtloli stfe lnsttrauce:Contl�an5��iuirfz .. t'olioyfFortel.tilts uo./l; sjiifnti}iltll�t ;job$ttei1�ISt3trlZiii- 1L(tttcttitcolli=of(iietcoittel's'coilt�iezisiil;oiiZibliit�Ytectnrn(io+rpageisitRis•ittT;(TiolioTie;golitbot.nlid :kxtt iTiaiEitgCc). Itiifilrcioscour •tdt°cittg nsreRtutecttnti[etSectioliSSRdMd c.152`01jetcl(oliictniposllioiiprcrintilinipuafdcsQ£a flits; lip [o'S1,SQQ.�Oauciloi=aiie��t'itrun�rismune+t[;as%+ili[is citiipeilat1MIllOld fo'111ofnSTOi'AVORiCOji[)�[Ztftfti1if�1b tfujzfoS2S0.OQnda}+t�g�ntstlhcviol'�tfor. l3Gnd,~isciTthafitcaiiybF(lits:s[atEntetttuay�Gefont%aritetltc�tlt�Officeoi` loves[igitious:oftheDl/t-fot•insumiieeco><eraget�et�iGcation. - - --- - l4k(re etv t ntTir`tcswacr t. po um tir frt lrrfids area, fo 'Uir Cify61-ioAA<_ .... L'etiiiirlLiegiiseff �citite oi►e); t, lttal'doi'1-1cal(It 2.ITni[tlingl�cli;11;linettl3.GifYl�'otviiCteit(+).UJScIt•isnTuspec(oi=�:I')ntuGfnglnsjiE�tot: 6. Q(Itct� COO,," and h91aition, S Pdquall1to-AlWatilf art TeOeAfo ror F17t) 6fMI (T�VotMg hoiis6oF6IibtI*tsonsdalWortheoccupalitof-IrIm. tor Sh Pal r wom 01 uc .0111ploymentbe-&e.aleirto ekui njpjciyprpt? MOP &,Dtor 152',PSO(). also 'Slato VOOS6 Pir Permitto Gftr.ften bi'&IIICST . 0 . r S el i ce u r ally tim-acc-,to ve ragorequirea?, 'pinsurance t . ateGpygt}j S tlpply s' i ib - c on 4meto r(s) i A 111 e'Cs), t d &e.s s (cqa I i4plol 10 11111 1bp J.( dong with of In.90mlicen M)liifedtbbiIiVCO'nPafI' ii"I Ilips (M) IVIIII 110 cm�!Oye les )orMmtfcdU'aVj&yf�j-- ' 1116ibe.rso*yparfilersi-,ire.itotreqjiirecTtoq,itfivbrk-ejecoillpoilsat', ins,, -� or 10 'LLPdomjuljo lice. n. ftployeeoqs apolicyisrequilred. to the-Depaitmentot . lubstelfil Acotdoiifs:forcOltrinilati(iiiofitistit-aitco.icdverage. bare-fut-Ileff(O tile city or town (Ilat (TIO.I.Pplicatioll for slgilfll�d(Ifitet]16',Ifficlillit 'Thofiffidavic-should file petunt or liceng.cilis being requested, not flie-Departnical; of bollip-60 . kaffollIj ORGY, Plea . i so call 'flic Is 'tire I -C q t t i red to. -obfn b i a Vvorkc rs' Qty or TwIl Oincials mthe-eweiftbaofac brfji' )VINSfAcisilrd to all in th6pe-mi-if/I ve0liations, ling to lit Non Ufflecewky) Paid videet ,job Rix Addrese'theL vpplfcajjt*shottI*d lvri(e 'fa 14►01)2'A c9pyof (Ile. a If focalioligin Wallyselamped of marked by the ClOr tONI'll blaybe-proy cled to 111e bliplicanta'sproffthafavafid ifft ieraii pf ficuses. Wn Wiere-altomeo"g.acetlse filedolifeadh 00� a cloglicellsooffeen nito, burn kaves Ctr,-) Said Pel-Soll-is NornqupErniit -ired to cojiiplerpflas p.-ffid34it. lit ap, do. not flesirate ta-gWip fk-og' 1D61jad"Ielit Oft 101IsieiRAPOI'depts Office Of-fIIvaT'(gfqfO)Iil 600AVash ifigtoll Skeet Bostoll, AIAL.011*11 TO. 0 617-72 Q 0 D �emso Rag Y1 67,74-7749 WilIvAless'gov/dIa 0, Date .. Z! ZB*hz....... . TOWN OF NORTH ANDOVER PERMIT FOR CAS INSTALLATION This certifies thatQ�jo .. ................... has permission for gas installat' n j : fe.lq ................. `/ rT in the buildings of ..U�. . at . ,����'...1.?North Andover/Mass. Fee !-�ry Lic. Nol.14141/65'... % �.:... GAS INSPECTOR Check # XZ -03 8072 0 FIXTI IRF.R MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Toww V /1 fl MA. Date: c) :;L Permit# Building Location: "6A Owners Name: 4 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTI IRF.R INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent El Signature of Owner or Owner's Aaent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the nest or my Knowleage and that an plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent proy4sion of the Massachusetts State Plumbing Code anal Chapter 142 of the General Laws. Type of License: By (Il Q Plumber Title Zll/Z ❑ Gas Fitter F1 Master Si re of Licensed Plumber/Gas Fitter City/Town ❑! -5C Journeyman License Number: APPROVED (OFFICE USE 6NLY) LP Installer Z m 0LLJ F- C7 W J L) to 1--W z 0 W W 5" z�z 0 N w CO m w Q W tW- o o ix F- lu x fy > v W [� o o W CO a 0 LLI t— = LL > V W W z i7 J F- F- O z -1 O u_ F` W W W W z A 0 D o N o: Q o -1 Q it W a. W m � W O 0 a z O a F- >>> > z Q X u. 0 0 x z FW- O SUB BSMT. BASEMENT 1bT FLOOR 2 NuFLoOR 3 FLOOR 4 1H FLOOR 9'r—FLOOR , 6 FLOOR 7 1HFLOOR 81HFLOOR Check One Only Certificate # Installing Company Name: tit 11 Address;5"A i�0 City/Town: State: [Corporation ❑ Partnership Business Tel: ^ ��c �Cj Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: Q INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent El Signature of Owner or Owner's Aaent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the nest or my Knowleage and that an plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent proy4sion of the Massachusetts State Plumbing Code anal Chapter 142 of the General Laws. Type of License: By (Il Q Plumber Title Zll/Z ❑ Gas Fitter F1 Master Si re of Licensed Plumber/Gas Fitter City/Town ❑! -5C Journeyman License Number: APPROVED (OFFICE USE 6NLY) LP Installer 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 % PIease Print Leg><bly Name (Business/Organiza6on/Individnal): h `-�` L ek �•� Address: City/State/Zip:_ K. Phone #:_ 4(J -^ Are you an employer? Check the appropriate box: 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 2.Tam a sole proprietor or partner- listed on the attached sheet # ship and have no employees These sub_contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ .I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Any applicant that checks box i;1 must also fi.l out the section b4m., �x�•: ,. +s Type of project (required): 6. ❑ New construction 7. [] Remodeling 8..❑ Demolition 9. ElBuilding addition 10. El Electrical repairs or additions 11. ElPlumbing repairs or additions 12-ElRoofrepairs 13.[] Other 9 T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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: Policy # or Self -ins. Lic. Expiration Date:, Job 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. Ido hereby cerci unde the pains and penalties of perjury that the information provided a0ve is ue and correct %�. 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): L Board of Health 2. Building 6. Other Department 3. City/Town Clerk Contact Person: 4. Electrical Inspector 5. PIumbing, Inspector Phone #. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer.., or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house _of another who employs persons to do -maintenance, construction_ or -repair work on such dwelling-houseor on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,* §25C(6) also states that "every state or local licensing *agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sulrcontractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with.no employees other than the members or partners,. are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be.advised that this affidavit maybe submitted to the Department of Industrial � Accidents for confirmation of insurance coverage. Also be sure to sign and date -the affidavit. The affidavit should . e returned to the city or toren that, the app lica[�.ian for he pet i F license vbeingrequested, e 1 to t n f �t o_ 1< � .s i � aaes.�d, not the D_parrt^:yn:. of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be -used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations wouldlike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 Tel. # 617-72749000 ext 406 or 1-8.77 IMASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass-gov/dia Date... ........- --� 3..... - 1Z ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ..................................................... . ...... . ........................ has permission to perform ....... 9,VY&—X4 e7.,7— ....................................................................... wiring in the building of............. :k��4.6 , at ......1... 2 .... kA1.5 ..... ........ ..... .. North Andover, ass. Fee..�� Lic. No..! 3 263 4 .............. ........................ ELECTRICAL IS . Check # 16 L10 10675 �L\ - Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (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: r-6,32yf9 t2 y Z,7 -,-Z017, 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) ---Lao SQ W69STTC—R f v 0 o -s 6PAJ9 Owner or Tenant JTO 14a wo Hi i 04-U _ C' 14uz L?> WZ'- Telephone No. Owner's Address 160 CU61S t✓2 (.woos (—Al16 Is this permit in conjunction with a building permit? Yes D< No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (,y 1 r j a./ G 01C S#17614C,5-07' rmmnlafinn nffha fnnnwino }nhlo mm, ho v.nh.oll h,. A. T -- i— of M 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 Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency LigRing Battery Units No. of Receptacle Outlets /6 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. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons ""' "' KW ' "" No. of Self -Contained 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. of Water, Heaters No. of No. of Si ns Ballasts Data 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: (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 ofperju_ry, that the information on this application is true and coriplete. FIRM NAME: G E0 tZc e .1, 1 -rcAen it 6i C /C LIC. NO.: A 13263 Licensee: 66OQ66Sl,- 14-S.CA/cD J�T-- Signature�, LIC.NO.: 629932 (Ifapplicable, enter exempt" in the license numberline. Bus. Tel. No.; 6,09- 23S' 0588 _ _ _ .. _ .�._ ,.... Address: 13 f.MESavcocin /J,2iv€ 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 a eat. Owner/Agent PERMIT FEE. $ Signature Telephone No. _ ELECMC.A.L PERM N0. EEECTMAL INSPECTOP_ Passed _ Failed --I ] ?fie -inspection zequzxecY($50.00) ~ I j inspectors' comme�afs: Q54p ecto s' Signatare no i ials) Date F �'rN1 ALINNSPXCiTON, ssed—I .Failed -j ] Re4uspectionrequired ($50.00)-•[ ] Inspectors' comments: (Cbsl ectors' Signature -.no iuitials) Jute 3. UMER GROUM WSPECTZON: passed — [ ] F+ iled — j ] ?fie -inspection required ($50.00) -• I ] Inspectors' comments: (fhspectors} Signature •- no initials) Date DOOR; TA-GIS.ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA-.. TO BE WSPECTED Iw NOT ACCESSIBLE AND .A BE INSPECTION OFA _$50. 0 IS TO DE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kip 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/Organization/Individual): 66096 W tz o Address: i 3 40 LM6S 60000) QJet vr✓ City/State/Zip: S oo mj )J k 03873 Phone #: 6o3 2 3 5 _o3 $ 8 Are you an employer? Check the appropriate box: 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 2. I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ 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 aie 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. Iam an employer that is providing workers' compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 1 Job Site Address:. Expiration Date: 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 hereby certify under tJie�palnAand penalties of perjury that the information provided above is true and correct. Phone #• ` 6c)3 - 23.E -036 r) Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Z -LZ - 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or'permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 wwwmass.govldia 3 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ; .......... ADT . .............................. ............ ;- 3-4� has permission to perform . ........................ . .......................................... wiring in the building of ... ......, e .................................... , -,.. -d .. I at ..'IL ----North Andover, Mass. Fee I.V6 ............... Lic. No�'O,' ELECTRICAL N" S* PE ' iR' Check # (e 4 A t4 4 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked 15 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC . 527 CNIR 1 00 (PLEASE PRINT IN INK ORT PE ALL INRIV F ;4 TION) Date: � Citv or Town of: / To the Inspector of Wires: By this application the undersigne l ives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or TenantTelephone Nq r Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service _ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: lit /".//, 4,li4 AJ „ , t I,� Completion of the fiollowing table may be waived by the Inspector of GVires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Tranformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above [i In- ❑ rnd. grnd. 170—.-01 mergency Lighting 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 ana . Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices i No. of Waste Disposers P Heat Pum Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers g S ace/Area Heating p t, KW Municipal Local ❑ Connection El Other No. of Dryers Heating Appliances b PP KW Security Systems:* j5 No. of Devices or Equivalent ( No. of WaterKW tVo. of No. of Data Wiring: Heaters 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. Estimated Value of ElectricalWork: �� (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:) /certify, under the pains and penalties of perjury, that the information on this upplication is trite and complete. FIRM NAME: ADT Security Services, Inc. LIC. NO.: 1533 C Licensee: % ��tire' /- D, ,e' Signature ' LIC. NO.: 3S- ffG 4 -:- (If (If applicable. enter "exempt" in the license number line.) Bus. Tel. No.: 603-594-5900 Address: 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-5930 *Security System Contractor License required for this work; if applicable, enter the license number here: 0 0 2 V11 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 a;ent. Owner/Agent PERMIT FEE: S 44C 5 .101 Signature Telephone No. i t� � _ Location�oOj��� No. _ Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ �r''�,,..o ✓''`mss 1, { t sS CMUStS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /6-31 Check # 1 v Y'i 4 _Ax (!� 15222 Building Inspector CERTIF/"D Pl0'?` PLAN S.E. CUMMINGS & ASSOC/A TES P.a BOX 133T PLA/STOW, N.H. 03885 TELEPHONE (8031382-5085 AAX (6031382 5, 16 A?; U D to 15g'3 r2 -A 1� �ttl 6F 4f ti ALBERT T. TRUDEL y No.36869 Q 11 TAX MAP 210 BLOCK 106-B LOT 28B CAMPBELL FOREST NORTH ANDOVER, MA. PREPARED FOR. MESITI DEVELOPMENT 100 ANDOVER BYPASS, SUITE 300 NORTH ANDOVER, MA. 01845 DA TE.- DECEMBER 17, 2001 SCALE I" = 50' ,o r rn m m / HFP.FBY r'FRTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THAT THE EXISTING FOUNDATION DRA WN ON THIS PLAN IS L DCA TED AS SHOWN AND THA T IT DOES COyPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. LOT 28B 45,261 SF CBA=32,731 SF r-l;,o 88_10\11 1 MINIMUM SETBACKS: FRONT -- 30 FE£T SIDE - 30 FEET REAR - 30 FEET 1997-754 Combell Forest\CPP LOT 28B.dwg 3979 Date ..... 7 ...00/.g - TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........../ .:.... •..... %.�?' �J.........1• /.. �........... .... ....... has permission to perform ........w .......................... *firing in the building of �v C � `...` at .......�.�....Luf .` 5.. .G.� ..... 4&orth Andove , S. r. &e,L i LEMMUICAL INSP CCOR Check # --73 J�3 (..onvnonmaa o` ///adda�ttc4a�! For Office Use 0 _ (Rev. 11/99) o cc�/� cc'77 Permit Number. 1JsParEntu� o�..tiro �iwica.! ; Occupancy & Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of:To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work descdi eed—below. - Location: (Street & Number) �G� ��� �� v �� �S ✓ G/ ���� Owner or Tenont: 9,1115 15,1�s Owner's ^11 Is this permit in conjunction with a Building Permit? Yes ❑ No ❑ (Check Appropriate Box) _ Purpose of Building: q aJ"//,/w- �z. Utility Authorization #: e�J / Z� Existing Service: Amps ! Volts Overhead ❑ Underground.0 i # of Meters 4New Service: 74Il7 Amps Volts Overhead ❑ Underground. of Meters:_ Number of Feeders and Ampacity: t _ Location and Nature of Proposed Electrical Work: No. of Recessed Fixtures Z v No. of Ceil.-Susp. (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets l/ No. of Hot Tubs / Generators KVA No. of Lighting Fixtures Z Swimming Pool: Aboveground o In Ground o # of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners Fire Alarms # of Zones # of Detection & Initiating Devices # of Sounding Devices: No. of Switches �J No. of Gas Burners # of Self Contained Detection!Sounding Devices No. Ranges No. of Air Conditioners TOTAL TONS: of Z Local o Municipal Connectionfl Othe r No. o' Waste Dispo��is, V? Usat Fume Tolaic . Secu i, Sys e'^s i ,Number: ?ONS: KN': _ No. of Devices or Equivalent 1 Data Wring, No. of Devices or Equivalent: No. of Dishwashers / Space /Area Heating:_KW No. of Dryers Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent No. of Water Heaters KW No. of Signs: # of Ballasts: OTHER; of Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Unless waived by the owner, no penult 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, anis has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 9----BCIW D OTHER 0 • Please specify: Estimated Value of Electrical Work 5 (When required by municipal policy) Work, to Start: '7 3 G , L Inspections to be requested in accordance with MEC Rule 10, and upon completion I certify, under the pains and penalties of perjury, that the Information on this application is true and complete. Firm Nat Licensee Address LIC. # 154'� f -T 3 LIC.# h -9s 3 3 Alt. Tel. OWNER'S INSURANCE WAIVER I am aware Ina! the Licensee does not have the habil:iy insurance coverage normally reoured by lav,,. by my signature beioK. I here -,y waive this requirement. I am the (check one) Owner C OR Agent c 7 f..___...__ -1-...-.-.1w---• TnlnnAnne&' ------ . /.f NORTq O 9 ,SSACHUS(ct 4' This certifies that Date.. �.!`7 �T.'r1 Z TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING dc n......... . .................. has permission to perform ..... IM .... � .. N ... .............. . plumbing in the buildings of ...C. s si �, H at ...�. .. � �........ ....t-'....... C, North Andover, Mass. Fee.No..? .`.�.3.y.� ....... � �......... . DPLUMBING INSPECTOR Check # !�1 5313 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 00 ate �� Z Building Location /y " /� LS _ Permit # � Owner Amount �� S� / � ��, /,/�' 111 —�-�= :x New 1 Renovation Replacement ❑ Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Installing Company Name z2arQV E H ❑ Corp. Address �v El Partner. " 21dv o' ti. Business Te ep one 97V � C17- 3 y Firm/Co. T Name of Licensed Plumber: 4e5l i ;7C' c " r, E' Insurance Coverage: Indicate the t of insurance coverage by checking the appropriate box: Liability insurance policyIL3 Other type of indemnity ElBond11 Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner F1 Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P g Codes / Cha;W)142 of the General Laws. . By:Signature o icense um er � Type of Plumbing License Title c> 3 / City/Town kens um er Master ❑ Journeyman 1 EY APPROVED (OFFICE USE ONLY LLLJJJ Mesiti Development Corp. July 18, 2002 James Diozzi, Plumbing Inspector Town of North Andover North Andover, Ma. 01845 Dear Jim: 100 Andover Bypass Suite 300 North Andover, Ma. 01845 Yrs I' -? I— C Recently, Mesiti Development Corp. sold 2 lots in our Campbell Forest Subdivision off Campbell Road, lots 28B & C. The new owner, Bob Messina of Messina Construction brought to our attention that permits for plumbing & gas were pulled on October 29, 2001 for lot 28B (180 Webster Woods Lane). Upon receiving copies of the permits & payment receipts, it appears our plumber Gerry Keefe of Keefe Plumbing & Heating was the person who pulled these permits. As the site manager in charge of this subdivision, I can assure you that Gerry Keefe was not authorized to pull these permits. Therefore, I ask that you transfer the permits to Daniel Doore Plumbing & Heating, 9 Clayton Avenue, Methuen, Ma. 01844, License # 24393. If there are any questions concerning this matter or if I can be of assistance in any way, please feel free to call me. The site phone number is 978-557-5760 or my cell number is 978-423-1522. Thank you for your consideration on this matter. Alan v. t,\ussen Site Manager Mesiti Development Corp. MESSINA DEVELOPMENT COMPANY, INC. 44 GREAT POND DRIVE BOXFORD, MASSACHUSETTS 01921 978-887-3102 July 17, 2002 Town of North Andover Michael McGuire — Building Inspector Dear Mike: Please transfer the existing plumbing and gas permit for 180 Webster Woods Lane, North Andover, to Daniel Doore Plumbing & Heating, 9 Clayton Avenue, Methuen, MA, 01844, License # 24393. If you should have any questions regarding this matter, I can be reached at the phone number listed above. Thank you, Bob Messina � Y 1� N O OLn r -p �D O Rt G �2 n. � sH r O 0 0 R- W 03 0 0 N Q7 Q O Ep wi W TlKD O{ Z E� Dn cn I k ° o _ -! 6 f -q A Ul 0 A M SSACHU TTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Date Permit # i Amount Type of Occupancy �� New \ Renovation ® Replacement Plans Submitted Yes No ❑ Date.. NORTH TOWN OF NORTH ANDOVER Op PERMIT FOR PLUMBING ArI ° SACHU � This certifies that • • • i; �.._ = r' has permission to perform-: • • ; .............. plumbing in the buildings of . • .. •, North Andover, Mass. at!...' .. 1 ti ... . ! Fee - tic. No... PLUMBING INSPECTOR Check # ---— i Check one: Certificate ❑ Corp. ® Partner. ❑ Firm/Co. box: Bond ❑ ication does not have any one of the above t ❑ e application are true and accurate to the Issued for this application will be in app�er 142 of the General Laws. Journeyman ❑ an ' i r • 19,11.11.tilk t -.-- .... .-.-. M. MMM No t `� ....U.MM® ®®®®®®�m®mm®®�® mmm 0=000..NN.... OMMMMMUMMMM MM MM t•., FF- ............... t „ �����■�����_������������MM MMMOMOMM N MMM Date.. NORTH TOWN OF NORTH ANDOVER Op PERMIT FOR PLUMBING ArI ° SACHU � This certifies that • • • i; �.._ = r' has permission to perform-: • • ; .............. plumbing in the buildings of . • .. •, North Andover, Mass. at!...' .. 1 ti ... . ! Fee - tic. No... PLUMBING INSPECTOR Check # ---— i Check one: Certificate ❑ Corp. ® Partner. ❑ Firm/Co. box: Bond ❑ ication does not have any one of the above t ❑ e application are true and accurate to the Issued for this application will be in app�er 142 of the General Laws. Journeyman ❑ MASSACHUSETTS Uy1FORM APPLICATON FOR PERMIT TO DO GAS Fr=c I, pe or print) Date f� _/I 19 NORTH ANDOVER, MASSACHUSETTS Buildinz Locations ( '� %�` ��' 1 ��'' '�''"rte/ Permit 9 Amount S Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ Date....' ::............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....................... .. .............. . has permission for gas installation .....; .................... . in th buildings of ...... ... .......................... . at .. ............... . North Andover, Mass. Fee. ..... Lic. No........... ........: ............ GAS INSPECTOR Check # By: Title City/Town i L-kPPP,0VED I()Fric:; use !Er,LVE Teck one: Certificate Installing Company ❑ Corp. ❑ Parmer. FirmiCo. one: No Q Bond ❑ -age required by Chapter 1 121 of the ent- A--ent ❑ application are true and accurate to the Issued For this application will be in 1-1'_ of the General Laws. Sienature of Licensed Plumbe O� Gas Fltter ❑I Plum ,`, , Plumber/`11' `' F7 Gas Fitter LIc--rise Numoer LaiN . das[e ❑ Joumeyman n .n -.. Cn SUa -aa SEM ENT— a7k1EM FN'r / I s r. F L O O K ?:v D. FLOOR J K D. F L U O R rill. FLOG It �TE1 FI- ooR 6T 11 F LOU R Date....' ::............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....................... .. .............. . has permission for gas installation .....; .................... . in th buildings of ...... ... .......................... . at .. ............... . North Andover, Mass. Fee. ..... Lic. No........... ........: ............ GAS INSPECTOR Check # By: Title City/Town i L-kPPP,0VED I()Fric:; use !Er,LVE Teck one: Certificate Installing Company ❑ Corp. ❑ Parmer. FirmiCo. one: No Q Bond ❑ -age required by Chapter 1 121 of the ent- A--ent ❑ application are true and accurate to the Issued For this application will be in 1-1'_ of the General Laws. Sienature of Licensed Plumbe O� Gas Fltter ❑I Plum ,`, , Plumber/`11' `' F7 Gas Fitter LIc--rise Numoer LaiN . das[e ❑ Joumeyman ©/f7� 0• ��RAN .e •',40 O f Town of ;,1sA�NUSrA' NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT tz'�PROJECT:Q'S i.dQ-AjC-`e ISsU�g'`p7t/' 0/PERMIT NO.: IM�DATE: UNIT NO.: FLOOR: REMARKS: fr.� (Caj '74 WING: BUILDING NO.: / 8 O 'Lot a8ra w Ir b 5A r \&(op'p S LA --v -�C- F6 F, 4 ► o Riov S40 0 NCfv-r Excavation - depth and soil conditions Framing - Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains - Insulation - Other: Date: _ Date: Date: Inspector Inspector Inspector Electrical - rough - Plumbing and /or gas - rough - Other: Date: Date: Date: Inspector _ Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept - oil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# Inspector Inspector Inspector Form 8995 Action Press, 685-7000 Z�r Date ..� : TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ; .Q Q h., has permission for gas installation ........... in the buildings of ... ........................ at ../ .f.'o....Lc�.e_. .�. �.c.��.. �,,� (—cam /, North Andover, Mass. Fee.�1. >.,.... Lic. No. . �.? ?.. �, h_l.: - If -,A ..... G�1�S INSPECTOR Check # %/ �? t / U 4090 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS Ff-rrI iG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations —.1' XU - 40,� C,* rl ey, W O a Owner's Name New ❑ Renovation ❑ Replacement ❑ Date 7 --1 1` O Permit # Q D �'" Amount $ Plans Submitted ❑ (Print!2ND. FLOOR or Name a !>✓fp /I Address 47 1� 61 7- 7110 k - Name of Licensed Plumber or Gas Fitter ` C�one: Certificate Installing Company Corp. ❑ Partner. a'Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indi to the type coverage by checking the appropriate box. Liability insurance policy ' 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 13Agent 13 i nereny cermy mat an of the detaus and mtormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G e and Chapter 132%pf the General Laws. I (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber -Z—'-t 31 3 ❑ Gas Fitter License Numoer ❑ Master r Journeyman -0 rA Date..��>: TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SSACNUSe � �� This certifies that ........... . �:- . f . . , . has permission to performer -y. plumbing in the braildings ���................... . f �°��'�`', North Andover, Mass. Fee.'-- ��4.. I.ic. No.h).�,7� ... .. L MSING IN PECTOR Check # 5010 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS I/ Date Building Location G!/4�Owners NameA*t4,Permit # - Amount Type of Occupancy /� New Renovation rl Replacement Plans Submitted Yes ❑ No ❑ FFAT'11RES • ,' .J • / • .J _ I .I . - I • / • • • mmmm MMMMM� M M M M M W W 0 M M M M W W W 0 0 M M M M M W W M (Print or type)y� Installing Company Name �� �i^ y 641e Check one: ❑ Corp. rl Partner ® Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S e Plumbing Codt IanOChap,r 142 of the General Laws. BY igna ure-ot Licenseu Pium5er Type of Plumbing License Title &-7 7 r City/Towni�se INUMDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY Date.. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....... .................. n-� .............. has permission for gas installation,. ............... in "the buildings of .......................................... at... . North Andover, Mass. -/ ... . .... ... Fee. Lic. No ........... ........... GASINSPECTOR Check# -' — * (/ 3k OU ` 5 ✓IASSACHUSETTS UNIFORM APPLICATON FOR PERMIT T TO DO GAS F=G or print) Date �Q CI 19 tv�rcfH ANDOVER, MAtcc f-1JUSE-r1rz Building Locations ( I D �/�� t'1//%T/7�' Permit 9 Owner's Name New a Renovation ❑ Replacement ❑ Amount S Plans Submitted ❑ 1 (Print; or type) Namic r 0 Check one: Certificate Installing, Company ❑ Corp. Address �'r,�/��—� ❑ Partner. Business Telephone ❑ Firm/Co. dame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liabilit�insurance policy 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 ❑ I hereby certify that all of the details and intormation I have submitted (or entered) in above appitcanon are true ana accurate to me best of my knowledge and that all plumbing work and installations pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions or the Massachusetts State Gas Code aV Chapte/142- of the General Laws. By: Title ClryiTown APPROVED i0 vnc:=I !)NI -Y) Signature oFLictrised Plumb Or Gas Firtcr ❑ Plumber Lr? 7 ❑ Gas Fitter tcense wumoer ,711n, Master ❑ Journeyman .r. ism 1 (Print; or type) Namic r 0 Check one: Certificate Installing, Company ❑ Corp. Address �'r,�/��—� ❑ Partner. Business Telephone ❑ Firm/Co. dame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. Liabilit�insurance policy 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 ❑ I hereby certify that all of the details and intormation I have submitted (or entered) in above appitcanon are true ana accurate to me best of my knowledge and that all plumbing work and installations pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions or the Massachusetts State Gas Code aV Chapte/142- of the General Laws. By: Title ClryiTown APPROVED i0 vnc:=I !)NI -Y) Signature oFLictrised Plumb Or Gas Firtcr ❑ Plumber Lr? 7 ❑ Gas Fitter tcense wumoer ,711n, Master ❑ Journeyman Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 t%0R,r n iSaEo r �: 0 0 T 4 - CACOL "ItCA_ ^' APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS' 1A)(1005 LOT NUMBER SUBDIVISION (2 A M F S&:L.L DATE REQUEST FILED -3 DATE READY FOR INSPECTION 03 0 TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. —WATER MET4W DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED TO THE INSPECTIO%�EQUEST DATE. A\/ � TION Location JW-aRB#/$o 4y-e6,4e e Wbob—s L/l1 No. ! Date a6 -a/ TOWN OF NORTH ANDOVER Certificate of Occupancy $ /-0 Building/Frame Permit Fee $ Foundation Permit Fee $ l Other Permit Fee TOTAL Check # 16 62S"- 15 ! 15 0 3 9 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER DATE ISSUED: SIGNATURE: Building ComnLisdonei/Imator of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ,gyp % 46 eama6e j/ res t 5✓b�l� �, 5'/0--K 1.2 Assessors Map and Parcel Number: 146 Map Number Parcel Number O� Iv(f /3 S 7-e/?— W © O b S L 1.3 Zoning Information: R12— Zoning District ProposedfJse 1.4 Property Dimensions: A Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided. Required Provided 3(D 3 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: Public V Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �c�?iya/.��OC/i// �/7'�Sl" C. G � �3�' c5'c�7��7t �7`. S��.f,� �' � /iJ'• /� ✓P Name (Prin4 Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ✓ S'��iitil � Lic nse Construction uper/viso - ����q �:QfUf Address S. Telephone Not Applicable ❑ p i� �Z��G License Number Expiration Date 3, 2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone MU M z �514 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 building permit. Signed affidavit Attached Yes .... X No ....... 0 r SECTION 5 Descri tion of Proposed Work check all a livable New Construction Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: 2z 1 e1 X/6 ems' SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 7 (a) Building Permit Fee Multiplier S o -,'SD, m P 2 Electrical DIMENSIONS OF SILLS (b) Estimated Total Cost of Construction DIMENSIONS OF POSTS tc el 3 Plumbing DIMENSIONS OF GIRDERS 2 < Building Permit fee (a) x (b) HEIGHT OF FOUNDATION 4 Mechanical (HVAC) SIZE OF FOOTING 5 Fire Protection MATERIAL, OF CHIMNEY D 6 Total 1+2+3+4+5 IS BUILDING ON SOLID OR FILLED LAND Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION �. I, - ,�� as Cr/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print of Owner/, FIN N NO. OF STORIES --SIZE .3 BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS r ' �e: 2 /L':' .Jf 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS tc el DIMENSIONS OF GIRDERS 2 < HEIGHT OF FOUNDATION r THICKNESS SIZE OF FOOTING Gd -,X Lp-r MATERIAL, OF CHIMNEY D IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r _� �Re l?O?)EJ3L{J?i[{tF:flf.}#L (UL l(?.S.SU!'lilCuP.l� BOARD OF BUILDING/ REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 042318 Birthdate: 08/3111952 Expires: 08/31/2003 Tr. no: 989 Restricted: 00 ROBERTA MESSINA 44 GT POND DR BOXFORD, MA 01921 Administrator Bu Iding Value Calculation - for Property at..... LOT# Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 25 15 375.00 65 $ 24,375.00 Brkfstnook 4 10 40.00 65 $ 2,600.00 Dining Room 15 13 195.00 65 $ 12,675.00 Family Room 20 16 320.00 65 $ 20,800.00 study/office 15 13 195.00 65 $ 12,675.00 Living room 13 12 156.00 65 $ 10,140.00 Garage 31.5 25.5 803.25 35 $ 28,113.75 Entry 19 12 228.00 65 $ 14,820.00 2nd floor foyer/sitting 245.00 65 $ 15,925.00 Sunroom 16 11.5 184.00 65 $ 11,960.00 mudroom 9 6.5 58.50 65 $ 3,802.50 Walkin closet 10 8.5 85.00 65 $ 5,525.00 Basement Finished 65 $ - Balcony - 65 $ - Screened Porch - 35 $ - laundry 7 7 49.00 65 $ 3,185.00 Bedroom 1 20 16 320.00 65 $ 20,800.00 Bedroom 2 13 13 169.00 65 $ 10,985.00 Bedroom 3 16.5 13 214.50 65 $ 13,942.50 Bedroom 4 15 16 240.00 65 $ 15,600.00 Lav / Bar - 65 $ - Bathroomthasement 9 5.5 49.50 65 $ 3,217.50 1/2 Bath 9 6.5 58.50 65 $ 3,802.50 Bathroom 2 15 10 150.00 65 $ 9,750.00 Bathroom 10 8 80.00 65 $ 5,200.00 Balcony - 65 $ - .MEMBERA ., aihfdi. r 's? ..,F.0 I Q coo w 5-61 l U A) dtAC�1�Y� ����C9eOp Q(?S- Ij000 I'D � Sri 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. '`******APFLiCANT FILLS OUT THIS S,'f.e4tr S 6-7- 5_76 APPLICANT Cc?n f� %l�'S� GLC PHONE (Y,- '-5_7o0 LOCATION: Assessor's Nlap Number�PARC`L SUBDIVISION LOT LOT (S)a STREET Qj C2,SI C Z L)jc)o b S L J. ST. NUMBER �S D ***** t*******************************OFFICIAL USF RECOMMENDATIONS OF TOWN AGENTS: t19 / CONSERVATION ADMINISTRATOR COMMENTS L TOW NER COMMENTS DATE APPROVED DATE REJECTED r -,e S -.b t i �D rm q-9 •a6 DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT D©u,(cS h RECEIVED BY BUILDING INSPECTO Revised 9197 im DATE Growth Management Bylaw Exemption Statement Town of North Andover Building Department This farm shall be used to assist the Building Oepartment 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 necessar/ information as requested 'below. Name of Applicant an Building Permit (below) Address of Property fcr Pen it (below) Nlap and Parcel:'"' Purpose of Application (check below) Phone Number of Applicant • _4 Single Family Two FamiN i the undersigned applicant for the above property attest that the attached building perr;i't for which this fort is completed does comply with the E{E,MPTiON sec ion•8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any parry to this permit from the requirements of obtaining other permits required prior to the issuance of the 5uiiding Permit. Further I understand that my interpretation of the E <ENIPTiON status is subject tc review by the Building Department and is only officially accepted when the Building Permit ig issued. Based an section 8.7,6 of the North Andover Growth Bylaw the above [at and the werk as applied far on the above lot, in the building permit application and associated attachments, complies with one or more of the fallowing sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in existence as of the erfiecave date of this by-law, provided that no additional residential unit is created. Y_ The lat(s) werelwas created prior to May 5, 1996 are exempt from the provisions of this Sec.;cn 8.7 of the Zoning Ty—law. 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 Oweiling units for senior residents, where eccupancl 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 meanpersons over the age of 55. i 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 spate and/or farmland. The land to be preserved shall be protected from deve!ooment by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership wiih an adjacent parcel an 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 an 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 Oevelcpment Schedule does not accommadate issuing a building permit in that Year, one building permit will be issued per Year per Oevelopment until such time as the Oevelopment schedule accommodates issuing building permits. Applicant must supply approved farm 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 allowed an EXEMPTIas cited inaccurate information or the ch knowledge or _wt, is roAi; s for This form must be of the information provided and that the attached building permit is Further I understand that the submittal of misleading and or off of an above item which does not comply, whether done to my by the Building Oepartment to issue a Building Permit. - � ,-9 signed the Attached Budding Permit Date ed to the Building it upon application far such permit BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Sie oYFermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector �® 973 APPLICATION FOR WATER SERVICE CONNECTION 1 2doo Application by the undersigned is hereby made to connect with the town water main in �i"l //) �wl Stw subject to the rules and regulations of the Division of Public Works The premises are known as No. /9t z <3,,4 2/c Address North Andover, Mass. 19"'�— or subdivision lot no. Owner Contractor � n�„f r�j• f PERMIT TO CONN The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date Addr s r 'Applicant's Sign ur WITH WATER MN Z- Zc � ��' Stree Board of Vublic Works By 1� / (� 1�) See back for rules and regulations 1516 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. lrt2 voo Application by the undersigned is hereby made to connect with the town sewer main in W " S �h Street- subject to the rules and regulations of the Division of Public Works. , The premises are known as No. or subdivision lost no. �Z Owner zp"7r�i` j�21 Address Contractor �Pl 4�-L1 t9l Street PERMIT TO CONNECTAVITH SEWER MAI The Division of Public Works hereby grants permission to Cid & /j to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by �- z -Z C-7 St'Fee�j Division o Pub4 Works c ^ By Date See back for rules and regulations see.f% / �� ( A TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. Willett Telephone (978) 685-0950 Stuff Engineer Fax (978) 688-9573 Additional conditions for lot 28, Campbell Forest May 12, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lot 28 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for this lot so that the construction of the home can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into the residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. 2. No water service shall be installed into the residence until all off site sewer facilities are approved by this office. Any violation of the Londitionsill granted. esiti Devlopme void both water and sewer connection permits. No refunds will be Printed Nam 6o6 /.., Date `Division of ub 'c Works Printed Name Date CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin Mesiti Dev Group TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Fax :978-5578160 Jul 17 2000 13:54 P.01 Mr. Kenneth. Grandstaff, President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 �OMTN,, Telephone (978) 685-050 Far (978) 688-9573 t July 14, 2000 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Nft. Gmndstaff- 1 The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the fbHowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A perfonmme guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment and facilities in the event _ that Mesiti Development or its agents fad to adequately perform maintenance of the pumping station. Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable . . costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town' or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T . ours, I. Hmurc' a Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant of jonditional use. TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (508) 685-0950 Fax(508)688-9573 Date: 2t�0 LOCATION: 6JeWer Z_et BUILDER: phone: J OWNER: o��� � phone: �� 7- 5, vo The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND. OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and dated Dec,1 19 _9_9— and/or by the Covenant dated _ Mav aq 19 7,1_ and recorded in District Deeds, Book p Page c or regi ste d L* K� re in Land Registry District as Document and noted on Certificate of Title No. in Registration Book Page has been completed/partially completed,'to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled " C4rA 9 J Dorf S P Section (s) Sheets Plan dated pe19 q_!— recorded by theZ Nortk District egistry of Deeds, Plan Book registered in said Land Registry District, Plan Book or Plan X117 8 4 and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) LorS L on I 13 ; LoTS I hereby certify that lot numbers ( ) Lo rs Z5 T)+e,.., 3L'; 84 Jonrg4re beAVir C AV.w w,.My-y, . Wooz, (,�,,,�� Do..rNi. EWL'Uf Street (s ) conform to layout as shown on Definitive Plan entitled �r . Section Sheets) zv,Zs f 2-1 iS�z3 on do MAsX Gf ALBERT T. TRUOEL 4Rga4ist-ered Land Surveyor -o No. 36869 0� �FCISTCIL PJ�a NAC WO SJ 1 of 2 -��5��,� ata `�ea^•� C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated 1 19 Covenant dated and/or 19 from of the City/Town of , County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book, , Page satisfaction of acknowledges the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: EXECUTED as a sealed instrument this ,xS day of 19 �SS�X Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS ss LL:eLr, r 2 , 19 9q Then personally appeared ALLY,,)-� ��� ��� one of the above members of the Flarining Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary blic %I a t 1 ' ).006 My Comm.issi n Expires 2 of 2 ✓tom P��ll! a��� `, •BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 1, Number: CS 069234 Birthdate: 05/09/1954 Expires: 05/09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL _ 400 MAIN ST��� GROVELAND, MA 01834 Administrator - I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # f MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 8-29-2001 DATE OF PLANS: April 18,2000 TITLE: Lot 28 "The Hampton" PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 100 Andover Bypass Suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 596 Your Home = 594 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1877 30.0 0.0 66 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1720 19.0 0.0 82 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the app scab Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater thud/ o 111�11,�2n load as specified in Sections 780CMR 131 4. _ / x Builder/Designer MASchL�k INSPECTION CHECKLIST 'Massachusetts Energy Code MAScheck Software Version 2.01 Lot 28 "The Hampton" DATE: 8-29-2001 Bldg.I Dept.I Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I FLOORS: [ J I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant 2.5-4" 2.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1:25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 PIPE SIZES (in.) TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 201-250 1.0 1.5 1.5 120-200 0.5 1.0 1.0 any 1.0 1.0 1.5 2.5-4" 2.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1:25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 100-130 0.5 1 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only) ------------------- ---- a, -1 < • Lnm o aio na n O m mz O n:: ?o ? I 41F.C -0 y m N a M (Dn M. rrl > Moc 3 3 v, m CL 0 -P, cD 0 m O n fD y W O- O O 2 M Q X D d c� co 0 Q �' o :0 d t5 O nc c '+ c = 3e Q, Ln X3.3 0 o cx c E o�:w m CL mx �. o o. LCDM: :)N (U a O lo m E. n• cl O o� 0 tD D OD Cb O 0 o z� FD �o Sib• Z ����?�j z O� z 0 C CL I Qj a 0 U) m U) Cn 0 n•F aa: p o O = cm CD O CO) Cl) C c 0 C CO) S CD 0 r•M CD a N. 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