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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) ul= L, m o 'a m O r-« z aa, °, -� 0 ? 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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 a Z Q' w U Zw z Ln ¢ of w w� m Q z o;s z� 9: wad Q <n HJ =z f 111 a+ zr, [� FN ".E4 WJE O InQ O Z J N W �+Qo �=m Z =gw>- oz zo 0 0 1 �� o� o 3:ELMcnQ Q}m �'i oo< U-< s: mo 0 �pQ ox ZW o � s ¢ �"4=a m �B >� 3 a $ 0Za II w —o WN O N� 6 Y 0 p w A U_ O xz��to O !n UI w ~_W Q w 0 W WaZa►�1=z �y O¢ ►3.� m¢ '�IIII 1111 p w U g J �4.OU^ FZ-Q N¢ .�J...+..,. �'To�'os��, �A7 � UII� 9 �¢mfn� OO LLQO _��>6c r [H]�� < Z '7 Z o N o llu MIL 1 8 ¢mLn . ¢ ZXW� ZQ LL > Ln L w �f o wo o�m a¢4z �� 'b U o z g v w W q I 1 II° g a m Ul o Q F >" F c� Ln W`t U < W m w Z p N z J m !r ~OlYYl0J W y W m W W j W w m U) E WIIIII a F~O fnN Nm W�Q w in 1�w 1� $ m J U a Z rn a V) U)w o Of 0 O O 2 F O E+ ,00'9lZ M„LI,bZ.ILS �+ m 14, c6 4 r ----------(-d.11 39-n xTwin5 9NOiFe 1 N FF��11 It -M I I L E- C M CD F e -i I I w U a eo �O I z E -I I cn z t, I w f------ 24.96' I I in o �i ---------------- I M U 0 0 --------� Z ,i,z I oo. M O O Lli a E- 0 E- a m F E - 0 a .yiowo! IdSoa: >0/20l0! sMv wosou\oesm i\art\:»aro,aVe J A=101*3015411 R=60.00i L=1'06.311 L 22, 25 - 3 1 S3r. 0 1 AC, 0 A-SY07' R==40.00' L=37.09' A=5Y07', R-40.00' L:;t31.oqf 40.00' 1 31-12'— C i N I R 43, 13 t L 0 T 2 BARKER, JR. A -92'22'-f8 PROP. F R=60.00, iT=09'l 11 Ds t4 L=96.7,33' RI=40. f L==6-9:7" C'q LOT 14 22 21 .9 SF. <; X51 AC, u vii I LOT 15 122,807 SF, 0.52 AC. r. 112.34' N18'35$ 43" w L 0 T 2 BARKER, JR. 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: m m X m Ch m mm 2 y CIO Cl) d C .0 10 0 CD Z y a �. G. _ y O CD CL cr =r �C m CD CD CD C CD y. C2. C7 y o caCD C2 CO) O .0 CD z CD C CD c>:�o m z O —• y O Q N m cn =m0 m c� mciaC.) m m ..� O m ca y N �� � o i m 5 c m = O N O 2-4 p• C .O. m O p N .C- (1 Co p m . r o ..._.M r(nn CD CD CD (J) �0CD r"• O06 y d d Ca CD ` �1 Crsm e-� m CD col V/ =m O p� -i O ~o-.tCD 'moo o 1`r i Cn n cn d Oq r•, .. =m; C'n b: 2CD o 'r � Iw 7d i M. At z GO r S. � �� p7 O a O a • � o o has permission to perform . 0.4& wiring in the building; of f/ 0-ja� at JAW1.....�..Q��/ Fee../,./,.. Lic. . 0 'deck # X�3 7/4 5761 Date ....... /_ F NORTH ANDOVER AIT FOR WIRING .., ............................. a .................... .......... /a.zen/o/ .............. North Andover, Mass. ��i.�.� ELECTRICAL INSPECTOR TOWN C PER HUS C u This certifies that P'. a .... �Ab ................ _� 1,F I has permission to perform . 0.4& wiring in the building; of f/ 0-ja� at JAW1.....�..Q��/ Fee../,./,.. Lic. . 0 'deck # X�3 7/4 5761 Date ....... /_ F NORTH ANDOVER AIT FOR WIRING .., ............................. a .................... .......... /a.zen/o/ .............. North Andover, Mass. ��i.�.� 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 - YM NO lha`e&kwi&dvardpRdcfsaneat rOfloe YM1:1 CT IrycuhmedmdzdMpkmm&*dzeypecfwwwVby dttxiarlgute wpm 6aoc D61 RANCE BOND rl U1f11R (Pfeasesptrdy) WodcbStat ' �� ®S kgwdmDweRea X9kd Ra*I C varEofE alWak$ FkW RRMNAME tic t _ _ /,-I A- 5 L;oertsae E"`lc �l- �iact�r�p vA r� Signatize ._JCS-- �. To Bush=TelNa 3 6Le z- 3 6 is Lf AdAmwi s 6�� �45� ��.6 ti air AkTd.NoL q7� 3�s-oFs6Z_ OWNER'SiNSURANMWANFR;Iam dudrLwwdomnotharelheinuaneeom*crilsa*G i[MeqLivalmltastac iWbyN ugmG. I "Lam atd that my signatiae on this peurit appficaeon waves tlis regtioenri�t Please check one) Owner Agent a Telephone No. PERMIT FEE S signature Owner M s ,. . ��> sc�'� .tpe `y i O o •^c° CPQ' ,t �4 O E-� i -R: Q .- 0 A "k;� s y Cca C N Olq �i v cj d� L� cV Q��r r.a a 1 W - O r+w4k z v .� �mc y 0 -R: Q .- 4% . A "k;� s y Cca C N �i v cj d� Z A O C t O - o �mc y O m� :r � R C -R: Q .- lw� :a w� a R 0 s v O L O V Z CD CL O y � C c O■� CACD Q y CD CD L •v G2 L ecv o c M oDQ GO S c cc C3 C co ts CD CD CL C. y O C C C H O y Cca O CD y Z . o m C N y � R C O : y O y V � O - O m O Of O Q �v•yZ i �> O H ;moo O A o m C o► CC m O.w O O CO LU 1 ui f= 44 CL `° z oCL ti O 'o cJ' a ���m O s z= W � aCD — = 06.*.. CC lw� :a w� a R 0 s v O L O V Z CD CL O y � C c O■� CACD Q y CD CD L •v G2 L ecv o c M oDQ GO S c cc C3 C co ts CD CD CL C. y O C C C H O 1110l.UlmylUiv "rtUAn Ur iVAt1►LTM1LaVjJV,1 iv DEP1,@7NWOMBIKSAFM 76 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 a 1'ES , t NO o %pl =ittdtcate&typeofaon=F1W BQm [:3 Gum[3 BoalksDa ©� EdVakleofF]ae" Wade S li>; DoeRegresW — c - FkW one) Owner c�LTtic�C_ Cvl okc ES LiaMNo. A-1 A 5 f 5a Stgsmai<e �� ,--�_ LioaeeNo z-? r 0 Btz*=TMNa Fac{ i - 3 6 8- S�tcE i��6S�bti. �� b3br�� AkTdNa Agent Telephone Telephone No. PERMIT FEE S NORT: ti TOWN OF NORTH ANDD- ER PERMIT FOR PLUM,BING � ♦ i ; i 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 ............................ �mnnmm�n�nu�nnn �n�nn�uu���nnn�nnu (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 w U L6 C4 L6 C4 0 0 ;W m fA iu z V Y H z iL H z z W V f ' I a L r a Cz W V D O I Z CL Gz Z. O z D, m U. o � ac a t U O WW A. m O V a d z O i 0+ cc W LLI X z (" u .. O z I in f ' I a L N a M 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• hmttanoeCo�erage. PtnstaatGothelegtluareaisofMassadu�tsGmlmalLaws IhaveaataaltLob>7rtYhmaanxPPbhcykri rtgOmplee- �ta@eoritssu�antialequivalalt yES ©-� NO IhaNesublriaoadvatidpa>dafsame6otheOffioe YES jT Ifyou}�c}�Y�pp2 ft ErIBJ tYpeofcom'agzbY INSURANCE BOND r7 OMM (P1ea9eSpac�y) t Fxpim6onDae Wodwslaft-7, hq)eWmD&Raquestod Rao E0matedVaijeofE1ac1ncalWcdc$ Final Sigladunder�ie ofpesw.. FIRMNAME e,-,_ -At Lc,4:-f_ V1 JS LloawNo. LjC�j� C `C'��- •A -L 4 Signattue LioameNo BusulessTelNo. b Z- �� 3 P�,A—sBL) yrS��t ' vtt� 1,�,�. s a• , AIL Tel. No. 16 OWNER'SINSURANCEWANFR;Iam watetudrL wdoesmthavedrunlr =oC) crits&j)s "dmtmysigr�Imcnttuspwritappkatiollwai�sthislec�ntetrlmlt v�age al e4�" ��4 dbyMassacllusarsC,mleraliaws. (Please check one) Owner M Agent Telephone No. PERMIT FEE $ signature of Owner or Agent )c j"r, %,L1irwriuiy rrrwu /!1 t r LYlti&x3eit "uL3Gl 1J DEPARTA1EW0FPUBUCSAFE7Y BOAROOFFIREPREVEMONRWU UONSS27CMRl2.00 urnce use omy 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 eaataetttLiabtlrtyLmnartoePbl'ryincktdngComple� 'f �Co�rageorits�riala}rivalait YES/NO a -esib kings eapp atidptocfafsanebtheOlhce YES � 1�" Ea Ifycubawt rdodYES,plea9 gdcalefetypeefw mWby iarlglhe bar �•�•1 LJ LANCE u ' _ i BOND LJ 0`111M L_J (Please Sp *) , FVaa6orlDale Estim*d Value dE1xhical Weds $ ostat 7 1gxcfimD&Regtlesmd Rough Final ,nvkrl�»tlno nf.,wna.r . t. t. C: -Lf fl - J d'I 'NNM'SiNSURANMWAMT,Iam'awatetgdcLio wdmmthm ddthatmysig rMreen duspmnkapplicatiotlwaivesthistegluem5lt. Please check one) Owner a Agent signature or Owner or Agent No Z . BtlsinessTelNa 0 Y Z- ��' ' Alt Tel Na .? C6 F-oritssubt�aWegivabltast giWbyeGeneralLaws Telephone No. PERMIT FEE $ S nvl Cr ©K kc) U 9 C a 100 Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 m� LOT F tAORTy q O �tLe° �r O 1n 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 r� u 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 ❑ Q Uz un er ro w x li e o Zo c a pl b rs st b U w x w $ x x z U Q Uz un er ro x li e o U z c a w pl b rs st b (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