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HomeMy WebLinkAboutMiscellaneous - 184 CARTER FIELD ROAD 4/30/2018®r'r
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
1600 Osgood Street
North Andover, MA 01845
RE: Insured:
Property Address
Policy Number:
Date/Cause of Loss
File or Claim Number:
John & Jill MacMillan
184 Carter Field Road
HP3080708
3/23/2015, Water/Ice Dams
31766-W
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS,
CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and
include a reference to the captioned insured, location, policy number, date of loss and claim or
file number.
Wade Anderson
On this date, I caused copies of this Notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
5' ature and Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053
Location -la ca T '� y (114,
No. �f Date
NORTh
TOWN OF NORTH ANDOVER
• O�
9
'
Certificate of Occupancy
$
1
ancNusa
Building/Frame Permit Fee
$
Foundation Permit Fee
$
O O
Other Permit Fee
$
TOTAL
$
%Sw S —
Check # /311
17630
V Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
su �., �7. ��. �� •i�15;�' bir,Qtii�Cii� Use �1�t
r� � waw ��,x„„r� �.«
BUILDING PERMIT NUMBER:
(
DATE ISSUED:
� �a
SIGNATURE:
llit�
Building Commissi fier rispector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
1-t-
9 -CIS O
l
/L n� r l ' p O
J
fZonnngg�Inf(ormation: lel jf
,
Map Nu�mber
Parcel Number
IVZoning
1.4 Property Dimensions:
R ► SSD
Zzg�
/oDl
Zoning District Proposed Use
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
- ' Rear Yard
Required rovide
Required Provided
Required Provided
2. 2
t54)
J 2 )
7- 2-Top
1.7 Water Supply M.G.L.C.40.
Zone
1.5. Flood Zone Information:
Outside Flood Zone
1.8 Sewerage Disposal System:
Public Private ❑
Municipal
it On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of RecordULU
la
Name (Print)
Addressfor Service
/�/�f
[V .7 V
Signature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
4P.
1`
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
:77;4XM-d,S 7a4bilv
,
Licensed Construction Supervisor:
License Number
1 Ca
Expiration Date
nature
Telephone
3.2 Registered Home Improvement Contractor
Not Applicable
Conk, -,Name
Registration Number
9
Address
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.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 ...... J< No ....... ❑
SECTION 5 Description of Proposed Work check an a licabie
New Construction X I Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ ( Demolition ❑ I Other ❑ Specify
Brief Description of Proposed Work:
S i:- k Fr -311A
I SECTION 6 - RSTTMATRD CONSTRurTTON COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
t3FFICIAI LtSErONZY
1. Building
Z lJ
(a) Building Permit Fee
Multiplier
2 Electrical
U�
(b) Estimated Total Cost of
Construction
Jr old G� S
3 Plumbing
Building Permit fee (a) X (b)
f
4 Mechanical HVAC
'z rJ If1%
5 Fire Protection
p
6 Total 1+2+3+4+5
f eniq
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES OR BUILDING PERMIT
I, S 1/� as Owner/Authorized Agent of subject property
Hereby authorize to act on
My be �in a natters relativ o rk authorized by this building permit application.
Si re of Owner Date /
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, / ,/a/1J� � IiJ�JYw (it.. as Owner/Authorized Agent of subject `
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief t
of
NO. OF STORIES —
BASEMENT OR SLAB &11/o
SIZE OF FLOOR TIMBERS 1
SPAN 1 %—
DIMENSIONS OF SILLS Z
DM ENSIONS OF POSTS
DIMENSIONS OF GIRDERS 24)6
HEIGHT OF FOUNDATION Q
SIZE OF FOOTING
MATERIAL OF CHIMNEY jG j
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Date
SIZE
1Z 2 ND7) 3
AUY
THICKNESS 16
X >
n
FORM : U - LOT RELEASE FORM
INSTRUCTIONS. This form is used. to verify that ail necessary approval/ permits from
Boards and Departments having jurisdiction have been obtained_ This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
own ------- moos ■.■r........■■.fwas
//was own - Nun ..........l......■■..■.. ..f■..f.■
APPLICANT /' s� AU�1071 LL( PHONE cl' 6$ 7 2633
ASSESSORS MAP NUMBER 4 Z- LOT NUMBER Z V'- /Sf
SUBDIVISION Ce r;. ,r- p LOT NUMBER /
STREET C4 foil f, -Q, lV P'.0a-.4) STREET NUMBER
�... �'... ...■.'...'.-.!.'....!!..-...:..1......fl.f.....f...l...............ff......�f..f
OFFICLA, E. USE ONLY
.RECO ........ ATIONS OF TOWN AGENTS ........ ..................1..... ■ - -
t.l... .. !lf.l.. ■.... ■. ■. ..!-■......l... �..!!■!!!.!!!!!!!■l....f..f- fff.f....
DATE APPROVED
CO SERVATION ADNIiNiS OR
DATE REJECTED
f rLisj"k
COTS
LD INSPECTOA- HEALTH
o►:� •• i
DATE APPROVED
DATE REJECTED
DATE APPROVE©
�21
DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORDS — SEWER I WATER CONNECTIONS p p
DRIVEWAY PERMIT C G(/
'12�� /� u S de r n S �Q,144DATE APPROVED
FIRE FDEPARv1iVfENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR
10
z w
00
�2
J >of
W
W
w U)
C) z
0 Z
AD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111 .
Workers' Compensation Insurance Affidavit
Name j Please Print
Name: 6
Location:
Citv I v A Phone # 47 -)F -4V1,(3
I am a homeowner pdrfonning all work myself.
I am a sole proprietor and have no one working in any capacity
WLi
I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City Phone #
Insurance Co. P011cv #
Company name:
Address
City: Phone #
Failure to secure coverage as required under Section 25A 00
52 can lead to the imposition of criminal penalties of.a fine up to $1,5.00
and/or one years' imprisonment_as.welLas.civii.penaltiesin Dfa..STOP WORK.ORDER..and a.fine.af.(.$100.ODJa day against me. I
understand that a copy of this statement may be forward tot office of Investigations of the DIA for coverage verification.
I do hereby certify u r the pains d penalties ofpei at the informat' provided above is true and correct.
Signature Date
Print nagmPhone # J2V
S
official use only do not write in this area to be completed by city or town official'
City or Town Permit/Ucensing
❑
Building Dept
❑Check if immediate response is required ❑
Licensing Board
❑
Selectman's Office
Contact person: Phone #.• ❑
Health Department
❑
Other
Town of North Andover
Building Department
27 Charles Street
North Andover, MA. 01845
D. Robert Nicetta
Building Commissioner
(978) 688-9545
(978) 688-9542. Fax
HOMEOWNER LICENSE EXEMPTION
Please print.
DATE
JOB LOCATION
Number Street Address Map / lot
"HOMEOWNER
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
City Town
State
The current exemption for "homedwners" was extended to include owner -occupied dwellings
of two units or less and to allow such homeowners to engage an individual for hire who does
not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one or two family dwelling, attached or detached structures ac-
cessory to such use and/or farm structures. A person who constructs more than onehome in a
two-year period shall not be considered a homeowner.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other
Applicable codes, by-laws, rules and regulations,
The undersigned "homeowner" certifies that he/she understands the Town of No. Andover
Building Department minimum inspection procedures and requirements and that he/she will
comply with said procedures and requirements.
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING OFFICIAL
Zip Code
GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT
TOWN OF NORTH ANDOVERBUILDING DEPARTMENT
This form shall be used to assist the Building Department in their determination of exemption under section
8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the
necessary information as requested below.
/4:::� r,;r 6411, Z1_
ermit Applic t Property address -Map / Parcel
Applicant's Phone Number Single Family Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this form is completed
does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not
absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building
permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only
officially accepted when the building permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building,
permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark.
This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as
of the effective date of this bylaw, provided that no additional residential unit is created.
The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw.
This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions
of 8.7.6 are met and or represents dwelling units' for senior residents, where occupancy of the units is restricted to senior citizens
through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean
persons over the age of 55.
This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in
density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the
surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall
be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other
similar mechanism approved bythe planning board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent
parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and
Development Scheduling provisions for thepurpose of constructing one single family dwelling unit on the parcel.
This application represents a lot which is ready for a building permit ( all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule does not
accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as
the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this
EXEMPTION.
PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A
DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS.
BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED
BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE.
FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE
CHECKING OFF OF A ABOVE EXEMPTION ICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR
NOT IS GROUNDS F REFUSAL BY THE LDING DEPARTMENT TO ISSUE A BUILD PERK .
ICANTS SIGNATURE DATE
S FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.3 Release lb
Data filename: C:\Program Files\Check\MECcheck\Lot 12 Carter Fields.cck
TITLE: Carter Field Lot 15
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 09/09/04
DATE OF PLANS: May 4, 2004
PROJECT INFORMATION:
Carter Fields
COMPANY INFORMATION:
Tara Leigh Development LLC
COMPLIANCE: Passes
Maximum UA = 590
Your Home = 576
2.4% Better Than Code
Ceiling 1: Flat Ceiling or Scissor Truss
Wall 1: Wood Frame, 16" o.c.
Window 1: Vinyl Frame, Double Pane with Low -E
Door 1: Solid
Floor 1: All -Wood Joist/Truss, Over Unconditioned Space
Furnace 1: Forced Hot Air, 90 AFUE
Air Conditioner 1: Electric Central Air, 11 SEER
Furnace 2: Forced Hot Air, 80 AFUE
Permit Number
Checked By/Date
Gross
Glazing
Area or
Cavity
Cont.
or Door
Perimeter R -Value
R -Value
U -Factor
UA
1996
0.0
30.0
62
3492
0.0
19.0
245
504
0.340
171
35
0.340
12
1996
0.0
19.0
86
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 Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to
comply with the mandatory requirements listed in the MECcheck Inspection Checklist.
The heating load for this building, and the cooling load if appropriate, has been determined using the applicable
Standard Design Conditions found in the Code.
be no greater than 125% of the design load as s
Builder/Designer
VAC equipment selected to heat or cool the building shall
in Sections 780CMR 1310 an��4 . .
Date !! Q
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.3 Release lb
DATE: 09/09/04
TITLE: Carter Field Lot 15
Bldg.
Dept.
Use
I
I
[ J I
[ J
[ J
[ J
[J
[l
[ l
Ceilings:
1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 continuous insulation
Comments:
Above -Grade Walls:
1. Wall 1: Wood Frame, 16" o.c., R-19.0 continuous insulation
Comments:
Windows:
1. Window 1: Vinyl Frame, Double Pane with Low -E, U -factor: 0.340
For windows without labeled U -factors, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [
Comments:
Doors:
1. Door 1: Solid, U -factor: 0.340
Comments:
] No
Floors:
1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R-19.0 continuous insulation
Comments:
Heating and Cooling Equipment:
1. Furnace 1: Forced Hot Air, 90 AFUE or higher
Make and Model Number
2. Air Conditioner 1: Electric Central Air, 11 SEER or higher
Make and Model Number
3. Furnace 2: Forced Hot Air, 80 AFUE or higher
Make and Model Number
Air Leakage:
Joints, penetrations, and all other such openings in the building envelope that are sources of air
leakage must be sealed.
When installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944
L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled.
Vapor Retarder:
[ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors.
Materials Identification:
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 -factors, and heating and cooling 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:
[ ] I 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.
[ ] I The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
[ ] I 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.
I
Heating and Cooling Equipment Sizing:
[ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as
specified in Sections 780CMR 1310 and AA
I
Circulating Hot Water Systems:
[ ] I Insulate circulating hot water pipes to the levels in Table 1.
I
Swimming Pools:
[ ] I 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.
I
Heating and Cooling Piping Insulation:
[ ] I .HVAC piping conveying fluids above 120 °F or chilled fluids below 55 °F must be insulated to the
I levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Range (F) 2 Runouts V and Less 1.25 to 2 2.5 to 4
Heating Systems
Insulation Thickness in Inches by Pipe Sizes
Heated Water
Non -Circulating Runouts
Circulating
Mains and Runouts
Temperature ( F)
Up to V
Up to 1.25"
1.5" to 2.0"
Over 2"
170-180
0.5
1.0
1.5
2.0
140-160
0.5
0.5
1.0
1.5
100-130
0.5
0.5
0.5
1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Range (F) 2 Runouts V and Less 1.25 to 2 2.5 to 4
Heating Systems
Low Pressure/Temperature
201-250
1.0
1.5
1.5
2.0
Low Temperature
120-200
0.5
1.0
1.0
1.5
Steam Condensate (for feed water)
Any
1.0
1.0
1.5
2.0
Cooling Systems
Chilled Water, Refrigerant,
40-55
0.5
0.5
0.75
1.0
and Brine
Below 40
1.0
1.0
1.5
1.5
NOTES TO FIELD (Building Department Use Only)
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+ No. ! Date 1Z t q b
Check # 0/ V
186L9
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL
' Building Inspector
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s
Date. 3 - �-)~ ^ C)r- .................
3 TOWN OF NORTH ANDOVER
i PERMIT FOR GAS INSTALLATION
'i Off.. _�•
This certifies that ... �V c : . j .... 1� (S ...............
has permission for gas installation ...),V:<. �... Vf ' . ''`.........
in the buildings of :I . !--...............................
at ./ A7 J ........ North Andover, Mass.
Fee. .%Uq.—. Lic. No. .I e.5 . ... 7) ���-
GAS INSPECTOR
Check # /l ) - J'
5064
(Type or print)
NORTH AND,
Building
New
UNN ORMAPPUCATONFOR PERNUr TO DO GAS FMING
MASSACHUSETTS
21
Owner's Name
Date 3AIL-5
❑ Replacement 0 Plans Submitted ❑
Permit # _ Su 6 Y
Amount $ /G eJ
(Print or type).v S /1Certificate Installing Company
Name hec o
Address El Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check o e:
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.
Liability insurance policy 0 . Other type of indemnity D Bond 0
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 13 Agent 0
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 Gaskode anQ;hayt7 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber -21,o � 0
Gas Fitter Ic��ense' NumSer
Master
Journeyman
•
�BASEM ENT
,3RD. FLOOR
(Print or type).v S /1Certificate Installing Company
Name hec o
Address El Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check o e:
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.
Liability insurance policy 0 . Other type of indemnity D Bond 0
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 13 Agent 0
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 Gaskode anQ;hayt7 142 of the General Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber -21,o � 0
Gas Fitter Ic��ense' NumSer
Master
Journeyman
HORTPI
FO 9
SSACNUS�
Date.., }^ .. ! °-) —--
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that tlxt rl .. L� ...................
has permission to perform .... 17"...
plumbing in the buildings of ... If- `.' 4. ....................
at .. ,./.IJ..Y. ....... , North Andover, Mass.
Fee . 6. 7.9. 7 . Lic. No.. ... — ..e..... .
PLUMBING INSPECTOR
Check #
6365
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN
or print)
'H ANDOVER, MASSACHUSETTS
Owners Name
of Occunancv
Date0 S�
Permit # 6
Amount
12 New Renovation Replacement Plans Submitted Yes No ❑
FIXTURES
(Print or type) f% tCheck one: Certificate
Installing Company Name L / thr.Corp.
Address `fit -s / E] Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber: IrI4
Insurance Coverage: Indicate the e of insurance coverage by checking the appropriate box:
Liability insurance policyLA Other type of indemnity p Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑ Agent E
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 Massachylissetts S ate PI bing Co a Chapter 142 of the General Laws.
IM 1 `elwr IL
By: Signe of icense um er
Type of Plumbing License
Title
City/Town LICeNSe TIMM Master Journeyman
APPROVED (OFFICE USE ONLY LLLJJJ
Location Mg—
No. Date --!
r
y
NORTH
TOWN OF NORTH ANDOVER
i • OL
ebb+,y S1.��`• f
Certificate of Occupancy $
•,SSACMUSEt�
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # `43
18227
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
50
BUILDING PERMIT NUMBER: DATE ISSUED: �—
[� l Gf va 1
C
SIGNATURE:
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel
Cd L
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
Recpired Provide
Required
Provided
Required
Provided
1.7 Water Supply M.G.L.C.40. 54)
Public 11Private 0 Zone
1.5. Flood Zone Information:
Outside Flood Zone ❑
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System 0
SECTION 2- PROPERTY OWNERSHIP/AUTHORIUDAGENT r -I StonC District: Yes No
2.1 Owner of Record
K, ke. m o -&k& 8Y co,,- �Cu Rill
Name (Print) 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:` Not Applicable ❑
1Jnk Gn A- fi�v.cl�
Licensed Construction Supervisor: _ (
3 ( cwr-y h S �� u`�1 �l,( — License Number
Address
7 J ` `'�{ j c�
Expiration Date
Sigiratt re Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Si nature Telephone
Ma
M
M
Cr`
Q
O
z
M
Ey
SECTION 4 - WORKERS COMPENSATION (M.G.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 .......❑ No ....... ❑
SECTION 5 Description of Proposed Work Lcheck all applicable)
New Construction ❑
Existing Building Vr
Repair(s)
❑
Alterations(s)
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
E'N
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
3
Item Estimated Cost (Dollar) to be
Completed by permit applicant
bFFICIAY. USE"+3NLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
7 �2
3 Plumbing
Building Permit fee (a) X (b)
/
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner ` Date
SECTION 77b OWNER/AUTHOR��IZjj��ED AGENT DECLARATION
1, '`� � L C.A As Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the.foregoing application are true and accurate, to the best of my knowledge
and belief
Print e
Si ure o Owner/A en
Date6-
.. _..
22li-
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1ST2
ND 3 RD
SPAN
DIlVIENSIONS OF SILLS
DIMENSIONS OF .POSTS
DINIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CH ANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Atfrdavit
Please Print
Location: Z 1e -Le." S/,r ' g64 - -
City / fiPhone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
F-1 I am an employer providing workers' compensation for my employees working on this job.
ComDanv name:
Address
cibc Phone .
Insurance Co. Policv #
Company name:
Address
Ck. Phone #
Insurance Co. Pollcv #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a flue up to s1,500.O1)
and/or one years' imprisonment.as viteU.aa_dvil.,penalties�n tbefmn �fA.SIOP of
fine of.(31Q0.00),a1W agaias;.me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify pains and pe files of p ury that the information provided above is true and correct.
Print
lture Date </ 1
name !/J r'I t` `? K�� Phone # ?7I
Official use only do not write in this area to be completed by city or town official'
City or Town censinci
❑
[]Check if immediate response is required Building Dept
❑ Licensing Board
❑ Selectman's Office
Contact person: Phone #.• ❑ Health Department
❑ Other
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
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
6-Me-li® 00VV 1a"J, !"qA—
(Location of Facility)
Signatufe of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
Ll
✓/ie �o»>rnareu�fi o ./�/cra�
BOARD OF BUILDING, REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 065005
Birthdate: 11/15%1970
Expires: 11/15/2005 `Tr. no: 9138.0
Restricted: 00
BRIAN A LYNCH ;.
31 SEVEN STAR RD
GROVELAND, MA 01834
Administrator r}
Lynch Construction
31 Seven Star Road
Groveland, MA 01834
(978) 373-1918
Construction Supervisor #: 065505
HIC #: 131266
Agreement for Construction Services
Parties:
Client: Mike Moon Contractor: Lynch Construction
1 t j Lot 15 Carter Field Rd. 31 Seven Star Road
North Andover, MA 01845 Groveland, MA 01834
Phone: (978) 761-4767 Phone: (978) 373-1918
Location of Work: Lot 15 Carter Field Rd., North Andover, MA 01845
Description of Work to be Completed; Renovate existing basement space into living
space consisting of a media room approximately 18' x 18'. An exercise area
approximately 13' x 17' and a recreation room approximately 27' x 18' also including a
%2 bath and a wet bar
Attachments: Material specifications
Scope of work
Proposed Work Schedule: Start May 16, 2005 ; completion June 17, 2005
Payment Schedule: $12,000 at start
$12,000 at finished plaster
$12,000 at finish paint
$3,612 at completion of punch list
Lynch Construction
31 Seven Star Road
Groveland, MA 01834
(978) 373-1918
Permits:
By this agreement, Client acknowledges its authority and authorizes the Contractor to
apply for and acquire all necessary construction -related permits. Client acknowledges
that no work can begin until all necessary permits are in hand and that Contractor will use
good and reasonable efforts to acquire the necessary permits, but Contractor does not
control the timely issuance of said permits. Client agrees to endorse all applications as
required to facilitate permitting.
All work and schedules, as well as that of any subcontractors, will be subject to all
applicable permits being available on a timely basis, and will be performed by licensed
and insured professionals whenever required.
General Conditions and Definitions:
1. Any changes are to be documented in writing and signed by all parties. Any
changes will be paid for at the time of the change request, prior to the changed
work being undertaken. Contractor reserves the right to not accept specific
requests for changes if and when acceptance of those change requests adversely
affects integrity of work product or schedule.
2. Additional work will be billed at the rate of $42 per hour for licensed labor, $28
per hour for common labor unless otherwise agreed.
3. Work sites will be left in equivalent condition to those existing prior to contracted
work.
4. Contract will be considered substantially complete when all work has been
initially completed; repairs and warranty are beyond the scope of substantial
completion and final payment will not be withheld due to repairs and warranty
items.
5. Non-payment or delayed payment according the payment schedule will result in
work stoppage for the duration of any payment delays, and completion time
extended accordingly.
6. Late payment will result in a finance charge applied to the entire balance due at an
annual rate of 18%.
7. Only those work items specified in the "Scope of Work" and "Plans" are included
in this contract, and this specifically excludes any items not specified, such as
upgrades to electric service, water service, furnace/boiler, or other unspecified
systems.
Lynch Construction
31 Seven Star Road
Groveland, MA 01834
(978) 373-1918
Additional Conditions for Residential/Home Improvement Contracts:
1. All home improvement contractors and subcontractors shall be registered, and any
inquiries about a contractor or subcontractor relating to a registration should be
directed to:
Director, Home Improvement Contractor Registration
One Ashburton Place, Room 1301
Boston, MA 02108
617-727-8598
2. Client is entitled to a three-day right of cancellation under MGL c.93, ss48; MGL
c. 140D, ssl0 or MGL c. 255D ssl4 as may be applicable.
3. Client is entitled to owner's rights and warranties under the provisions of 780
CMR R6 and MGL c. 142 A.
4. Unless otherwise specified or notified, there is no lien or security interest given on
the residence as a consequence of this contract.
5. Any and all necessary construction -related permits are necessary for work to
commence.
6. It is the obligation of the contractor to obtain such permits as the owner's agent.
7. Any owners who secure their own construction -related permits or deal with
unregistered contractors shall be excluded from access to the Guaranty Fund.
8. The contractor and homeowner hereby mutually agree in advance that in the event
the contractor has a dispute concerning this contract, the contractor may submit
such dispute to a private arbitration service which has been approved by the
Office of Consumer Affairs and Business Regulations and the consumer shall be
required to submit to such arbitration as provided in MGL. c. 142 A.
Owner: Date: A, S
Contractor: Date:
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5761
Date ....... /_
F NORTH ANDOVER
AIT FOR WIRING
.., ............................. a ....................
.......... /a.zen/o/
..............
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��i.�.�
ELECTRICAL INSPECTOR
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Date ....... /_
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ELECTRICAL INSPECTOR
1IM Lulmnv[v rrcd1uJn yr tats kva%,rlU�.;#A i u •••• - p,
DF.PARDIENTOMBUCSAMY Permit No.
BOARDOFFMPREMMUNREGULWOMS17 12Ba %
Occupancy &Fees Checked f
A PPLIC�ITION FOR PERMTI' TO 2-�
PERFO ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) N Dat 6 5�
Town of North Andover
The undersigned applies for a permit to perform the electrical work described
Location (Street d
Owner or Tenant
Owner's Address
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes [:J -No [D (Check Appropriate Box)
Purpose of Building Lzac
ti-�- Utility Authorization No.
Existing Service AmpsVolts Overhead Underground No. of Meters
New Service AmpsVolts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of proposed Electrical Work 6>ts ti- 1
No. of Lighting Outlets
710
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
1ground
No. of Oil Burners
0
ground
No. of Receptacle Outlets
No. of Emergency Lighting Battery Units
No. of Switch Outlets
D
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
g
No. of Disposals
No. of Heat Total Total
Pumps
. Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
� Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER -
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APPLICATIONFOR P.ERMITTO PERFO.
All. WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS
C-111(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
Town of North Andover
The undersigned applies for a permit to perform the electrical work described 14
Location (Street & Number)
Owner or Tenant
IN
Owner's Address
Permit No.
7 /Z'I1b
Occupancy & Fees Checked
ELECTRICAL WORK
tICAL CODE, 527 CMR 12:00
Da S
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes [:rNo a (Check Appropriate Box)
Purpose of Building (Z. 6 >-*z),Eti--Z,� - Utility Authorization No.
Existing Service Amps /Volts Overhead [::] Underground No. of Meters
New Service Amps---.L.V olts Overhead r'—J Underground C3 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work l=t —ice A�S
No. of Lighdng Outlets
10
No. of Hat Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
swimming Pool" Above
Below
Generators
KVA
1.
and
and
No, of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
tD
No. of Gas Homers
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Haat Total TOW
Pumps
Tons
KW
Inidadng Devices
No. of Sounding Devices
No. of Dishwasher
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Sing
Bailasls
No._, ydro Massage Tubs
No. of Motors
Total HP
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Agent Telephone
Telephone No. PERMIT FEE S
NORT: ti TOWN OF NORTH ANDD- ER
PERMIT FOR PLUM,BING
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This certifies that ......� ! .. ............
has permission to perform ......r.`. ,ti..l. '�... ............. .
,tt
plumbing in the buildings of ... .�. ...............
at ..1. j / .. r14 /s..... , . , (!x........ , North Andover, Mass.
Fee. .... Lic. No..�(>. 7)...
�+ PLUMBING INSPECTOR
Check # 91 6)('/_
7737
MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO DO PLUMBING
(Print or Type)
sum Date �^ ��� 20 *,F
Permit #
Building ./1 Owner's
v AT: Location Name
Type of Occupancy:_1/
New ❑ Renovation ❑ Replacement !�
Plans
FIXTURES Submitted: Yes ❑ No ❑
i
(Print or Type) Check One:
Installing Company Name Uptack Plumbing & Heating, Inc [2 Corp 1415
Address 32 Rochambault Street ❑ Partnership
Haverhill, MA 01832 ❑ Firm/Company —
Business Telephone 978 372-8503 Name of Licensed Plumber or Gasfitter
Leonard A. Hall
Certificate
I bemby 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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Sigmtum of Oww/ Agent
I have a current liability insurance policy to include completed operations coverage..
t�tignature of Licensed Plumber
By
Title
City/Town
APPROVED (OFFICE use ONLY)
.. .
Type of Plumbing License
Master ❑ Journeyman
License Number
i
J:YIt�JZJ�T 43
(Print or Type) Check One:
Installing Company Name Uptack Plumbing & Heating, Inc [2 Corp 1415
Address 32 Rochambault Street ❑ Partnership
Haverhill, MA 01832 ❑ Firm/Company —
Business Telephone 978 372-8503 Name of Licensed Plumber or Gasfitter
Leonard A. Hall
Certificate
I bemby 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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Sigmtum of Oww/ Agent
I have a current liability insurance policy to include completed operations coverage..
t�tignature of Licensed Plumber
By
Title
City/Town
APPROVED (OFFICE use ONLY)
.. .
Type of Plumbing License
Master ❑ Journeyman
License Number
r
Date..
TOWN OF�NORTH ANDOVER
' P
PERMIT FOR GAS INSTALLATION
This certifies that ....�' . /) /-./�.../ /I .... ..........
has permission for gas /installation .//. l3 .............. .. .
in the buildings of ... ,1 t �.'�
at .. J �' � /. t ..... , Noah Andover, Mass.
Fee. .30.,.—Lic. No.. .. ... 1.�. ...
IZINSPECTOR
Check # ) I c7U L
6429
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Building 6 �� C444,
a 4 164A AT: Location �.
New ❑
Renovation ❑
Plans Submitted Yes ❑ No
Date �� lj 20 Cy
Permit # Z2
Owner's
Name
Type of Occupancy:
Replacement
(Print or Type) Check One: Certificate
Installing Company Name Uptack Plumbing & Heating, Inc n Corp. 1415
Address 32 Rochambault Street
❑ Partnership
Haverhill, MA 01832 ❑ Firm/Company
Business Telephone 978 372-8503 Name of Licensed Plumber or Gasfitter
Leonard A. Hall
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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent .
I have a current liability insurance policy to include completed operations coveiage.
By TYPE LICENSE: Signature of Licensed
Title Plumber Plumber or Gasfitter
City/Town ❑ Gasfitter
APPROVED (OFFICE USE ONLY) ❑ Master 8678
❑ Journeyman License Number
............................
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(Print or Type) Check One: Certificate
Installing Company Name Uptack Plumbing & Heating, Inc n Corp. 1415
Address 32 Rochambault Street
❑ Partnership
Haverhill, MA 01832 ❑ Firm/Company
Business Telephone 978 372-8503 Name of Licensed Plumber or Gasfitter
Leonard A. Hall
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 Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/ Agent .
I have a current liability insurance policy to include completed operations coveiage.
By TYPE LICENSE: Signature of Licensed
Title Plumber Plumber or Gasfitter
City/Town ❑ Gasfitter
APPROVED (OFFICE USE ONLY) ❑ Master 8678
❑ Journeyman License Number
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that. .... ......................................................
?4n..
. .............................
has permission to perform ........ ..........................................
wiring in the building of......... ;.e. ... ..................
at../Y 4,4
.............. .............. . North Andover, Mass.
Fee. Lic.
..................... .................
ELEcrRICA WgiicrOR
Check #k'
55:0
I HE c,UMMU1VWtALJH ur 1M4&"(,t1V6 11 J
DEPARTA1EW0FPUBL1CS4FL7Y
BOARD OF FIRE PREVEMON REGUL47YONS 527 CMR 12.00
Office Use only
Permit No.�
Occupancy & Fees Checked —
APPLICAU01V FOR PERMIT TO PERFORM ELECTRICAL woRK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS TRICAL CODE, 527 CMR 12:00
ELE
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) � Date , O
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical w rk described elow.
Location (Street & Number) �SS� �>�� L� t 1
Owner or Tenant � _
Owner's Address 1 -?-1 CA—L
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Z—,i f AL3
Purpose of Building K -L-5 Utility Authorization No.�Z`�
Existing Service Amps I Volts Overhead E3 Underground No. of Meters
New Service '7-00 fi__ Amps j� -I- Volts Overhead M Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work W l
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool
Above
Below
Generators
KVA
round
round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Tota! Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
t
No. of Self Contained
Detection/Sounding Devices
Local� Municipal
Other
No. of Dryers
Heating Devices KW
Connections
�
iNo. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER•
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(Please check one) Owner M Agent
Telephone No. PERMIT FEE $
signature of Owner or Agent
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Permit No.�
Occupancy & Fees Checked
APPUCAftONFOR PERMIT TO PERFORMELECTRICAL WO
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELE RICAL CODE, 527 CMR 12:00 q
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date l O S�
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical w rk described elow.
Location (Street & Number) `SS t
Owner or Tenant � o- I. If
Owner's Address I LA L,✓t—t- t G V\.- Y ` ✓t (-.)V, rJ V,
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
Z- Ll b L
Purpose of Building -i 1,�1 rl�' ✓�''Lr . ,.. , '-, - A.- Utility Authonzat on No..
Existing Service AmpsVolts Overhead Underground `No of Meters
New Service Amps L/Z Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work W L
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
round
ground
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
�'Vo. of Disposals
No. of Heat
Tons
Total Total
No. of Detection and
1
Pumps
. Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
_
Othe
I of Dryers
Heating Devices KW
Connections
a
. of Water Heaters KW
No. of No. of
Signs
Bailasis
Hydro Massage Tuba
No. of Motors
Total HP
tt =Coveter. PuM=1Dthetegtmatlaft >tfsGenetalLaws
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Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
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APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION
DATE REQUEST FILED '5/_3/0S
DATE READY FOR INSPECTION `s/ g/O S
TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME
FRAME. A RE -INSPECTION FEE OF TWENT4IVE ($25.) DOLLARS WILL BE
CHARGED IF THE STRUCTUR&DOES NOT ET ALL APPLICABLE CODES.
SIGNATURE.
OFFICIAI�USE ONLY
ROI TTINC;
D.P.W. — WATER METERDATE
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIOR TO THE INSPECTION REQUEST DATE.
WCC
SIGNATURE / DPW AUTHORIZATION
1
.14
Date..
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas
in the buildings of ...
at North Andover, Mass.
Feb -30s -,6Z Lic. NoAPJ9Z3.. ..........
�
'/�GAS IN I TF
Check
SC) 7 9
MASSACHUSETTS UNIFORM APPLICA'
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
184 Carter Fie
Tara Leigh Development n is Name
New 1 Renovation ❑ Replacement ❑
$30.50
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SUB -BASEMENT
BASEMENT
1ST.
2ND.
FLOOR
FLOOR
3RD.
FLOOR
4TH.
FLOOR
5TH.
FLOOR
6TH.
FLOOR
7TH.
8TH.
FLOOR
FLOOR
PERMIT TO DO GAS FITTING
Date 3/24/05
Permit #
Amount $�.
978 687 2635
Plans Submitted ❑
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(Print or type) s� Ch one: Certificate Installing
Name Easte�n Propane as r g Company
p y
u Corp.
Address 131 mater St.
❑ Partner.
?fan rarer MA (ll QP7
Business Telephone 1 Boo 7);D;) �)p ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check
I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No ❑
Ifyou have checked yes, please 'ndicate 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
14ass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
_Signature of Owner or Owner's Agent Owner ❑ Agent ❑
4 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 Gas Code anc C)"ter 142 ofth675fneral Laws.
ICity/Town
VED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fjitterr
Plumber L 1 c
Gas Fitter License Number /
❑ Master
❑ Journeyman
Date.
HORT" o TOWN OF NORTH ANDOVER
0.a° 'fib
O
C0
PERMIT FOR PLUMBING
This certifies that .... S.... P . .......................
. . I
has permission to perform ...RZ h. Ll ......................
t
plumbing in the buildings of ................................. .
at .. ....... North Andover. Mass.
Fee. Lic. No... .7 5 ....... �� Y
LU,BING INSPECTOR
Check f / IM
MASSACHUSETTS UNIFORM
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
New ' Renovation
00A
of
FIXTURES
TION FOR PERMIT TO DO PLUMBING
Date/
Permit # �'
Amount V7
Plans Submitted Yes 11 No ❑
(Print or type) /� Check one: Certificate
Installing Company Name l E] Corp.
Address v El Partner.
usmess Telephone If
S/ 11Firm/Co.
Name of Licensed Plumber:y ij� `7lhGuf
Insurance Coverage: Indicate a type of insurance coverage by checking the appropriate box:
Liability insurance policy / " Other type of indemnity Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 1:1 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 install s erfo d under Permit Issued for this application will be in
compliance with all pertinent provisions of the tts S 1 ng Code and Chapter 142 of the General Laws.
By: i re o'r MEMO F., umDer
Type of Plumbing License
Title 2
City/Town icense lNumDer Master Journeyman E]>,
APPROVED (OFFICE USE ONLY