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Miscellaneous - 19 BEAVER BROOK ROAD 4/30/2018
XaEAVER BROOK ROAD .f�_ 210/106.6-0240-0000.0 L i -` _� r The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02I11 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers App icant Information \ PleasePrintLegibly Name(Business/Organization/lndividual): �j C O� �To b e— G,nsj� J Address: � I City/State/Zip: CMrb,,gALvv , Ulf?_54 Phone#: T7 Y- S-Z- - Zfy Are you an employer?Check the appropriate box: Type of project(required): 'L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling [ ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. [wilding addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. o workers'comp. c. 152,§1(4),and we have no Y [N p 12.❑Roof repairs insurance required.] employees.No workers' comp.insurance required.] Un Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new,affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 1Se�l �( �� City/State/Zip:_h) Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify der the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Z- hZ • ,: Phone#: L —2S� Official use only. Do not write in this area,to be completed by city orstown official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: ].'hone#: 08/29/2007 14:23 FAX 978 373 6611 J AND S DEQ%LOPMENT 0001 \ ��Stewart's Septic Service 0 Andover Septic Q Stratham Hill;Septic ❑ Roto-Ram (978)372.7471 (978)475-2593 (603)772.5548 (978)452.9022 ti 20 South Mill Street, Bradford, MA 01835 Of icg,, RAY FROM TWS RILL Customer Nam�e:� / Q g of Service Service tion // O N/C Ve"91.Maim. 0 Emergency Phone: �;;, a Day O Night Contact: optic Tank Pumping and Cleaning Billing Address: "bone the Right Way" f /zip, Special Instructions t nUcnUpfeted Incompleted Reason: Per: — _ AM/PM Services Rendered r7 /D Y JPD U Pumping Observations Drain Cleaning [� 8 nk ❑ Good Condition Cl Main Line Drywell ❑ Lnechfi®Id Runback O Toilet Bowl ❑ Leech Pit/Overflow 0 Riding High ❑ Kitchen Sink Cl D-Box liquid level) Q Bathtub/Shower J Pump Chamber Fu to Cover ID Vanity 0 Grease Trap essive Solids ❑ Floor Drain 0 Catch Basin Top/ ottom ❑ Vent O Portable Toilet O e o Powdered Soap O Sewer Jet U Other ❑ Heavy Grease ❑ Other Qty= G Roots Footage- S17.0-- O Suggest Electric ❑ Under 1000 gallons ❑ 1000 gallo60igafn, allons Rootering ❑ 2000 gallons 0 3000 gallons ❑ O Van Called ❑ 5000 gallons ) Other a Other Misc. ❑ Digging Charge _ ❑ Backhoe O Inspection ❑ Location It./1n, ❑ Consultlon hre, 0 Certification-- P/F Q Service Call ❑ Estimate Reason-- U eason:❑ Labor O Portable Toilet Rental 0 Pump Repair G Waiting Time ❑ Baffle 0 Repair w Digging Charge is Per Driver ❑ Chemical Treatment Discretion ❑ Other I Description of work t r3ffa f ` L Recommendations--� Terms of Payment Parts Vacuum Pumping Drain Cleaning NIET 15 DAYS A !V e Yr. Month Yr. Month Tax Terms&Conditions ❑ C Discount Cash hook Q Credit _ _ Tot 1. Not responslNe for damage beyond curb line. 3. 1.5%per month will be charged to accounts past due. /0 J,-) 2- All complaints shell be reported w1thh148 hOUrs. 4. The UUrchaser agrees to pay all cost of collection. C:ustomcr Signature _ Serviceman LA (-4e 'Propozat V_ t' BERUBE CONSTRUCTION 771 Salem Street Fully Licensed & Insured Phone: 978-521-2544 Groveland, MA 01834 Remodeling • Additions • Custom Homes PROPOSAL SUBMITTED TO PHONE# ��' DATE _ t i n r tTc FAX# t (( STR ET JOB NAME CITY,STATE AND ZIP CODE JOB LOCATION ESTIMA ORt I DATE OF PLANS JOB PHONE UL-t 1 1 7 We hereby submit specifications and estimates . . . . . . . . . . . . . . . . . . . . . . . .l � t�1G�i �.t("1 C'b. Cl:'�e�:l.�f�.G. .1': t<�C�. cd.G:r.Cil. . ,? i.� t�tC . . e c kt CIj CL.(-t �. ll�: �C �'��:�.1.J� ( t C 1�. .. .c .�c:��. . C YU P, . '. 1 c rr L tC� .r >�t✓��t.. +�t� ti .�: �. ��L. .(;:Rcj. .0iP. :L°l.c_ . . GI 'c.k `dr.(.t1k�Cti. Ct� 1�.� . .�1'� �bAj.�� �.yt".�1Q � 7 Cf1 rte` u� ``�`.is ..t 1pir. {dl�/ ��C.t1. l�t�.yG��4.t,Cj'. . ��.. V eSt. �(�.✓?.f 3.�-r. . )✓!1.� �.`. .S,i C. .t.t.4�.�1.t,�.E._�t,d. .Wei t tl i .��1.A.�%'i��..ii�.J 4L.t�...l. .l�'.�L.J S� �ni�'/..�4-r�.d. �..1.rn. . . . . h C d. .SWrf,W5. Cl-P � .� C<'ff— .L. C-Ai.� .R `� �t�CS. . .�C�(C.�. �'��a:�. . t: _t�C� .S�., ",7 .v..f�. t� f 5. .v�a.►.t:�. .i 1C t< >. ra .v� c' ti.c' ...mac.cy-'bi Ct. > cCckr.lct'. .VQ. . is C. .�`1 t:ti:�lr, i.is lel± s l . .lJ •. .i.e1 L_1L4..e-6. t,l 0 i .,C , CCk .r ��! . ��C' ti I . .CC,\Rt_��a?; '�. . �;C � C� , �a�;. �� .b.e.. a w� � . �u.5.�� '.'. .. .Y�-? r�( .St �L: ic -� . p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�zf. . .(. .S. . . . . L.`C).G.0.1. . �- T VC VrOpO.�C hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: �A ;L ✓ Payment to be made as follows' dollars($ All work to be completed in a workmanlike manner according to standard practices.Any alter- r} ation or deviation from above specifications involving extra costs will be executed only upon Respectfully written orders,and will become an extra charge over and above the estimate.This estimate is submitted by for completing the job as described above.It is based on our evaluation and does not include material price increases or additional labor and materials which may be required should unfore- Note:This proposal may be seen problems or adverse weather conditions arise after the work has started,or delays beyond withdrawn by us if not accepted within C days. our control.Our workers are fully covered by Workmen's Compensation Insurance. /t Acceptance of propogat—The above prices, specifications Signature and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature Date of Acceptance: cf� p Office of Cons mer airs u'sinessegu a4tro HOME IMPROVEMENT CONTRACTOR Registration: .119555 Expiration: 7126/2013 DBA TYPe B E CONSTRUCTION SCOTT BERUBE ; 771 SALEM ST GROVELAND,MA 01834 Undersecretan^ Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cual,tructiu(I Sul)cr%i4,n• License: CS-065246 SCOTT A BE 1 \%, % I IN A A:� E 771 SALEM ST GROVELVND MA 01834 •F' ,r tAl� Commissioner Expiration Commissioner 12/16/2013 DA A CERTIFICATE OF LIABILITY INSURANCE 5/7/20/m7/20'°"n""' 12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT E: Insurance Solutions Corporation PHONE 603.382.4600 x12 FAX 0:603.382.2034 60 Westville Rd E4WUL ADDRESS, Plaistow, NH 03865PRODUCER RIDO- Cynthia St. Amand INSURERS AFFORDING COVERAGE NAICti INSURED INSURER A:PeerleS$ INSURER B: Scott Berube, dba Berube Construction INSURERC: 771 Salem Street INSURER D: INSURER E: Groveland MA 01834 INSURER F: COVERAGES CERTIFICATE NUMBER:e ires 5-22-12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ INSRR TYPE OF INSURANCE A L POLICY EFF POLICY EXP M POLICY NUMBER MND MMADD LIMITS GENERAL LIABILITY CCP9571262 5/22/2011 5/22/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO PREM SES EaENTED egwmmNo $ 50,000 A CLWS-MADE rx-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X I POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea ) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per acckWA) $ PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIASOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $_ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION I WC STATU- 07N- AND EMPLOYERS'LIABILrY Y I N ER T ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? F-1NIAE.L.EACH ACCIDENT $ (Mandatory In NH) EL DISEASE-EA EMPLOYEd S R yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,ff more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. attn: Building Dept 120 Main Street AUTH07 RE RESENTATIVE N Andover, MA 01845 ACORD 25(2009109) ©1988-20 9 A7ORb CORPORATION. All rights reserved. INS025(20osos) The ACORD name and logo are registe d marks of ACORD NORTH TONM Of 0 11oL` dower 1Vlass. �'" �t 2_1 LAKE ' ' . COCKIC ME WICK V S RATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... l�l gel��[rl ^tIA l/� has permission to erect........................................ buildings on ...C��. . ...... ....... Rough to be occupied as............���o�f fG� ,�G o1� ( .....� -�.[ ?. Cl..r��'1� ..F..... (l.Va.' Chimney provided that the person accepting this permit shall in every respect conform the terms t application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and'Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough ,.... ff ...• ". ............................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE.DEPARTMENT ; Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. BEA VER BROOK RD. L=60.0 —, ` 90.0 N� JI w EXISTING DWELLING 19 BEAVER BROOK RD. I N N EXISTING HOUSE 43.10, 81 5g. ROPOSED 14'x 21'-4" ADDITION V 4 EXISTING 1 HOUSE LOT 22B 0 PROPOSED ADDITION PLAN -jH0 F&SS9 PREPARED FOR MICHAEL �s WILLIAM HAST/NGS f J. N o SERGI y v A No.33191 y~ 19 BEAVER BROOK RD.,NO.ANDOVER,MA. �sss%O 40 0 40 80 FT DATE: 4/10112 SCALE.-I"=40' CSTPROFESSIONAL ENGINEERS&LAND SURVEYORS CHRIS TIANSEN & SERGI INC. 160 SUMMER STREET, HAVERHILL,MASSACHUSETTS 01830 WWW.CSI-ENGR.COM TEL.978-373-0310 FAX.978-372-3960 DWG.NO.94036.001.101 'Berua Construction Fully Licensed&Insured 771 Salem Street Phone:978-994-3452 Groveland, Ma 01834 www.Berubeconstruction.com Proposal Submitted to: Bill Hasting Phone#: 978-476-3560 Job Address: 19 Beaverbrook Rd No.Andover Ma. We hereby submit specifications and estimates for: 14x21 Addition for 3rd garage bay and three season room above. Job consist of removal of all landscape trees/shrubs/and plants.Removal of deck stairway and one section of concrete slab.Excavation for foundation will be done and all materials are to be stock pile on site until backfill is completed.Foundation consist of 10x20 footings with 10x48 walls all poured concrete.Garage floor will be 5 inches thick with steel matting. Framing consist of preasure treated 2x6 sill plates/2x6 wall studs/structural Ivl door and window headers/structural ridge pole to support cathedral ceiling.All floor joist and rafters are 2x10 kd wall sheathing is 1/2 inch cdx fir plywoodand 5/8 inch cdx fir plywood on roof. Sub flooring is 3/4 inch advantech glued and nailed.All exterior trim will be pvc and match house trim.Roofing will be a 30 year shingle and match the house as close as possible. Ice & water sheild will be done on entire roof and around skylights.There will be a ridge vent and soffit vents.There will be all anderson windows and doors installed as spec on new plans They have the grids between the glass and are pre-finish interior.The skylights are velux with electric operating openers and shades between the glass.After all the windows and doors have been installed we wrap the nail fins with vicor window wrap to ensure proper sealing.Tyvex house wrap will be used on entire addition and all seams wiil be tape. Exterior siding will be 1/2x6 red cedar clapboard pre primed and nailed with stainless siding nails.Insulation will be R-19 in the walls and R-30 in the ceilings and floors.Blue board and plaster will done in the garage and the 3 season room.ln the garage there will be one window and the garage door that will match the other two as close as possible. Interior trim will match house trim on the windows/doors and base boards.lnterior and exterio paint consist of one coat of primer and two coats of finishon walls ceilings and trim. We Propose hereby to furnish materials and labor--complete in accordance with above specifications,for the sum of: $ 96.146.00 Respectfully Submitted by: Scott Berub�e� Acceptance Signature: ' )��✓C�-C-�{i���W�zT�' Date of Acceptance: NOTE: This proposal may be withdrawn by us if not accepted within 30 DAYS. • \`�. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . has permission to perform . . �1,�, f.►�, j .. �,�,.' ,Pc��j �-� , , , , wiring in the building of . . . . . . / S�""jsu�. .. . . . . . . . . . . . . . . . at . Ij, . . , North Andover, Mass. Fee .1,77.�k--"-Lic. No. =ECT j-ECTRICAL INOR/ / Check# t/ 10945 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. d 9 V \ ' Occupancy and Fee Checked b BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank N ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeMEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -7191 2 City or Town of: NORTH ANDOVER To theInsp rec o0 of Wires: r By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) q 6 Owner or Tenant I-)f c, o-� Telephone No. 976-4176-3j60 Owner's Address Ict Q a vv.( __0 l c 12 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building &C4-0-se- o-4 S Q n P 0 t`C)-,\ Utility Authorization No. Existing Service 90 0 Amps oZ 4 0 Volts Overhead ❑ Undgrd 9 No.of Meters t New Service Amps / Volts Overhead [:1Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t� Completion of the ollowing table may be waived by the Inspector o Wires. 1 No.of Recessed Luminaires (p No.of Ceil:Susp.(Paddle)Fans ' No.of Total Transformers KVA No.of Luminaire Outlets -2- No.of Hot Tubs Generators KVA Above In- o.o Emergency ig tmg No. of Luminaires Z, Swimming Pool rnd. ❑ rnd. E] Batte Units No.of Receptacle Outlets (Q No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons 1.KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters sig.'s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: '2, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains mad penalties of ry erju ,)hat the information on this application is true and complete. !FIRM NAME: ( dCn cl ( C (1 C� (0 T V-�c LIC.NO.: 0 (o Licensee: Signature ,.P _LX4 LIC.NO.: /0 99V A (If applicable, en er "exem t in the license number line.) Bus.Tel.No.•�33 /3 5-44 Address: r"1 i o,n0 `P1�;41P, Sc,-Jct�1 S � ��91� �� Alt.Tel.No.: IN 72�(�� *Per M.G.L c. 147,s. 57-61,security work requires DepartnIent of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. 1 am the(check one) ❑ owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE: $ j A `_ V�•/'�/ {r � } ��y � G�� ���. vv G J /� �`-r a l/ � —.z� �� D � .� 4 ♦ r . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information II l n Please Print Legibly Name(Business/Organization/Individual): L n G a y\ f C 1r C Cyt C Address: City/State/Zip: Sg,\j %`y S f1c, OM(c Phone #: 78 ) Z 3 3 l 357L/ Are_you an employer?Check the appropriate box: Type of project(required): [YJ 1. am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. E] Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#]must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. .Insurance Company Name: 5 Q. 2�S ��� Q �- o'So e,4 l h S v1 P Q Policy#or Self-ins.Lic.#: e O ® 0 7 11 -7 Expiration Date: Job Site Address: E 01VRC{ 17 Q 6 M City/State/Zip: , �`f� 0\J Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a4adr the painrap alties of perjury that the information provided above is true and correct Sijznature: Date: 7119 J I z-, Phone#: 7V 2 3 3 it -3 SL/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: No v u J Date..... l � a NORTH TOWN OF NORTH ANDOVER o PERMIT FOR WIRING 4 i 7 �,SSACMuSEt This certifies that .....�.".v..`.� fC!.�.�. ........r aI P G I'2. �........................ has permission to perform .... P .......:1.v.4M.`...IT............................. f ( wiring in the building of....R.01A......��/.0 �,.�.�...U..Q................................ at ........1!.. .: .'.. .Y./ (�?o ......�f(.<. ............ .North Andover,Mass. Feee,3...4d . Lic.No,111(41 q....... c .....Fl�...�... ECTRICALINSPECTOR 04/20/99 14:46 391.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TAE 09MIIIONWE4LTHOFIVTV"alII Office Use only DEPARTMEIVTOFPUBLICS4FETPPermit No. BOARD OFFIREPREVF.1 ff0NRWMT101SGS527 12.00 Occupancy&Fees Checked APPLICATION FOR PIRMIT TO PERFORM nECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHussTs ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Nu erpt—ZZ 17 ca/, r Owner or Tenant Owner's Address Is this permit in con' n with a building permit: Yes No a (Check Appropriate Box) Purpose of Building ) Utility Authorization N4= Existing Service Amps � / Volts Overhead Underground a No.of Meters New Service 7 .QQ Amps Z�olts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work k)( ,CeJ 7 777 !.t�R No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA _ ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained _ Detection/Sounding Devices No 'dryers Heating Devices KW Local � Municipal a Other t , Connections No.VIf Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP . OTHER , Ir ra=CO�krage RnsuantIDiheteq MIOntSdM%mdus&GeialLaws IhmaostatLiabildyhum=PobcyirdudfftgCaripl& ' CoAragearisskswadialegivabt YES NO a Ihmesthn1&dvAdproof6fsame1fl1heOffm YES / NO If}puha%edvdWYES,pleaseedc*theNxofwmagebyd=krgthe � b �—�—� INSURANCE BOND MHER (P9 m1pa*) ExpualionDw& Estcnakd V"dDxftnl Wait$ WakuSlalt haspedmDa1eRequeslad Rough Final M Mutda�ie /`tel FIRM ioa�se � LNa /� _ BtsQles TeI14j 2 Artrj �i,��)6t)GI ��U 1 !"�ll�/d AILTe1Na OWNER'SM RANCEWAIVER Iama�mthactheli= not theinsuaioeoae�eadwss>Dialegm�a�astac�mectbyM c�taallaws G r✓I/ aodtha niys wleanftpemiiWphcadalwr*pAsftmw*mrlat. (Please check one) Owner M Agent a Telephone No. PERMIT FEE 3 ! l/ Dat N°- 2240 . fa pORTH or°;.;�`'°;°'"�°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING t ,SSAC14US� O This certifies that,...., :...... ................... ...5........... ................... ... a has permission to perform ... -- .......,. .............................!N wiring in the building of.../ .........................Y?.t....... ................................................... . ,f at....... ::?:?.................. ...�g-zr -.r.� ..:.:-,Alorth Andover,Mass. Fee'a.� ..�... Lic.No'?. .: .,. � ::�..,:...... ... �....�- ' ...... ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer THE09A M0AffE ILTHOFAf4S ACHI75= Office use only DEPARTMEVfOFPIIBLICSAFM Permit No. �t p BOARD 0FFIREPREYEM0NREGUTATI0A SV7CMR LZ-00 - Occupancy&Fees Checked VPPLICATIONFORPERAff TO PIRFORM==CAY WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR I 0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street Sc Number)� �Lca�VG.tZ7 Owner or Tenant C, Owner's Address Is this permit in conjunction with a building permit: Yes No a (Check Appropriate Box) Purpose of Building 1',u j, Utility Authorization No. Q®-73�L Existing Service Amps / Vo Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting outlets No.of Hpt Tubs -- No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners !Vo.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER It>stttar>ceCaaage Ptast mthetagtmt3nats a GalaWLam Iha%eaama,tLiabtlityhmrd=PcbymadTConrplche� Ca rdwcrtsabsortda amvalert YES NO IhareahmrDdNeWpoofofsa=iotheOlfre YES U NO IfjwhnedudcedYES,pUseat&&thetMmcfwmaWbyd�tddrlgthe N [E' BOND MIER o ) Esti t*d Vaktec(Uectnd Wads$ Wadctt,SW lnspem ]3&13 quested Raft Fatal Sighed taxia�ie FIRMNAME • L WNTa Liar=No Business Td.Na Cc7 7&) -750 (,r 6 111)41) <�:T KAA�k-,TA- ) 14 AILTUNa L 1:2 ���J Z I GG OWt1ER'SRNEURANCEWAIVER;Iama6-,mdatdrLcmsedomnotlt themraxecmenWortsaigartraleWdkrtast 7micdbyMassadiEezCatealLaws aodtvtmysigtiataemthispmnit ppkabanwai�e ttzmWmne t. (Please check one) Owner M Agent Telephone No. PERMIT FEE$ CERTIFICATE OF. USE & OCCUPANCY I Town of North Andover Building Permit Number 5 -L(iz-►7-99� Date THIS CERTIFIES THAT THE BUILDING LOCATED ON��1..`t• q �3v��r3 rr�ll I?orr� MAY BE OCCUPIED AS s•F:, a�,• w 2-�Rrr —u Dr7z IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND n, SUCH OTHER REGULATIONS AS MAY APPLY. . ti NALb t�dv-6-�L� Tim MORTN f> ,, CERTIFICATE ISSUED TO . Irl �3�vt-rc. B2�K w-, RESS 1Jm�`t� o vr'r2 • mA- . i MAP O 6�o } CHU Building Inspector PARCEL 02.40 r, C✓'y} 4�sy` J ti. NORj- g 0", _ _ _ 4 over- , G No. dover, Mass., 19 /to 0 i LANE w 9 -COCHICHEWICK y�'�• - t S BOARD OF HEALTH M IT . T'.. Food/Kitchen Septic Sys/ 90 �06).F4.14 tt /Tfi1S CERTIFIES THAT.... ........!.v.0 u 1 ......................... SLD�NG INSP CTOR 1 undation �' f/ ay lci� has permission to erect.......... .. ................. buildin son F � �. . . tv�r'.... ..?�`� °,,,� ati n p �LS77/f f to be occupied as.. 1!V �G �4w1 I�tSI eUCL o2 S1'd..�. .�r. I yV� EC c e p ... .,... ...... ................................. ...................................... ....:... y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws,relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit*. Final)?J. Z/l Zl G. �,04' PERMIT EXPIRES IN 6 O S ' kY ELECMCAL INSPECTOR UNLESS CONSTRU iWT .............. ... ....................... BUILDIN SPECTOR S Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough c 1cj No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT --� `, Bumer Ile a fV PV/u 7- 1 Af Street No. e4tL Smoke Det.Q k. �°�- Q/�'1 \;\ x - SLS mss' NORTH Q (t6t0 06r �O O 16 O cocwiw:nc •' N ��t/ 'L/ A_ 4AOgATaO �SSAGHU`�ti ce l I g o d ?,3a APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION DDRESS/LOCATION OF PROPERTY : (Je' Jr�U�j L (� DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: 8Lc , p FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME L FRAME. A RE-INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. d SIGNED ROUTING '-7 CONSERVATION E2/ PLANNING I DPW -WATER METER NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW l� Sign ure File: OC form revised 6/8/98 Q AUG2 3 1999 BUILDING DEPARTMENT {f 1� v f `i'�1 �T� �� � f{�� �... Location No. Date 12 ro N r C� MORTM , TOWN OF NORTH ANDOVER n Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s�CHus _ (•her Permit Fee I=«*;pinc- $ Sewer Connection Fee $ t�o �lq Water Connection Fee $ llSl, eO TOTAL $ Build ing,l"nspector 2 G5 1 912/21/98 11:10 1,151.00 PRAMDiv. Pu is Works PERMIT NO. ;17� APPLICATION FOR PERMIT 1 ) BUILD**** 'NORTH ANDOVER, MA hl%P NO. JO/- rO r.N(1. Qqo R )Il F OWN t.RSI l It' DATE ROOK PACE ♦ / 10 snuunn•.�L(rrN(1. Qp 11)1 ,1IIIIN L� �ldLIV �'A' S / PITH POSI:Of III III DIN(' J v OWN I:K'S NAnIE ` z"JW I;= L�V�, No .OF slcx+Il:s a S"" ,/(:)x3a GAd 1(.Xo)& i)WNER'S ADDRI:SS q .,^^ t7 n .n,.11 f� -+ BASEnIENf Oft SI All Uj,p\ .-�Hc1111EC1'SN.1hIE zb %4V C+.-`�r©�e�, G SI71:()F tl(X 7R Ilnllit:HS '7 J�� ''1 x`� z 3 BI III DER'S NAME p Z p o _1 lT ���'(( SPAN x )l A 1 ` 6A < OS o-st N c/ � DIS IANCFTONEAREST BUIIDING (/� 1 DInIENSIONSI*Sit.IS / l +) xV Q !7 J T. DIS I-ANC'E I ROM SIREE I ''f DIMENSIONS()I:POS I S ( nC DIS I ANCE FROM LOT LINES-SIDES 33t 1 REAR i DIMENSIONS OF GIRDERS i ' 8>(3\ x3 /� i U�1l w `� X 53 AH[A(lf t.ur 1,O± A(, 'e j rR(M41ACE � ' IIEIGIfrovFOONDAII(N�I � I —IQ H l THICKNESS w" ISD1111_DIN(iNEW SIZEOFL(X) INC, 3 " X-%"x la 1, x ISIMILDIM;ADDITION i MArERIAI.OFCHIMNEY I /1/)Pt`opq / -ZeAo dem pAn ^ ISBI111.DINGALTERATI(NJ A/o ISBUII.DIN(;ONSOLID ORFit LED L(A,NI) J SO'Lid (�S` IC LK Wil I.BUILDING CONFORM TO REQl11REMEN IS OF CODE IS BUILDING CONNECI Ell I O TOWN WA I ER J\J�S BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECI ED rO 1OWN SEWER Y . T t N ISBUILDINGCONNECIL'DI'ONAIIIRAI.GASI.INE fV V INS III('TIONS 3. PROPER I Y INFORNIA1 ION ja sob a LAND COST 5 00Do +. I SIJ `' 1 ESI. BI IX;.cOsf C?l7 x a Gd yj j PAGE I FII.I.OIrrSECrIONS 1-3 (� Y(T ESr. DI.Ix',. COST I'LR S(1. FT. �r -33 k ESI'. Bt DG.COSI VER HOOM i'W V U EI.ECOtIC FIEFERS MUST BE ON(xITSIDE OF BIM SEPI IC PERMI INO. I.0 T I=-e,-<- A f-IL ACIIED GARAGES MUST CONFORMTO S I'ATE FIRE REGULA rIONS =-G"<-Af-IACIIEDGARAGESMUSTC(NJFORMTOSI'ATEFIREREGULArIONS a. Al'I'ltovul) 19vyo 1r4'=516013 d PANS MUST BE FILED AND APPROVED BYAOILDING INSPECTOR r ► � 81111.111 N(:INSI'F.(`f()R . DAIErIIFD - OWNERS I I:I.H OWIRAIEIN C(NJTR.I.ICH .,SIGN-111IRF(N=OWNER t�Al R)Ijj�J )AGLFIT q(,z DEC PERMIT GHANrED 19 I'I?IZMH� N0. tj AI'1'LICAI1ON 1'VIt 1'l:ltAITTO ISUll.l)**** 'NORTH ANDOVl);lt. MA n1�P Nn. I06 2. Rt:(ORI)0T 0\YNt RS1111. DATE BOOK PACE 7IlhL Still 1)1%'. I.0[NNoo .. Aa (Ili A IItIN` eV {w A) s9}-1p,�j7 e-s i1•JJ PURR XiIclY nlln nl Nle 0��� .1C^� i)\S'NER'SNAnIG �NA\a �-v2� NO.(YSI(N(ILS a' (/t Y/ i slZr c��X3� Gnt� �(,XRB ()\VNI:R'S ADDRESS w �fM. , 5e-u,� )�B ( (�T). BISEAILNr OR SI All AR(III 1 E(-I'S NAME ZJ „I V E . Gxo�e,1\ SIZL OF rI OOR I InIHERS 1 W 1 1 2 HD 3 ltrT tit III DER'S NAME \_ Jl T e,,n�l��(1 SPAN MAXI 6A S 05t A LL'/ DO 1 , DIS I ANCE 70 NEAREST BUII DING DIMENSIONS OF SILT S T�+VJ `'J< DI S I'ANCE I ROM S rREEI )'f DIMENSIONS Of:IX CS I S DIS I ANCE FROM LOT LINES-SIDES 3a1 REAR L.0'-j.• DIMENSIONS OF GIRDERS W 8X'2 Aria (,J '1 x 5 A1uA(IFLur `p t A��25 FR(N LACE IIEIGIfrOfF/x1NDAl7(1N � ( —10 l' rT T{11CF:N[SS w„ OI ,� Id IS B1111.DIN(i NEW SIZ)_'OF FIX)"TING X /IX " X ISlIt)1LDIN(iADDliI(NJ )JV0 MATERIAI.OFCIIIINE Y /h e5opq-pt / TDuo C� p Al)/ e IS BDILDIN(;ALTERATION �1JL IS BUILDING ON SOI 11)OR FII LED LAND Pc uYU, LA n) '�)` ^T1 UC. \N711.BUIIJA14GCONFORMTORE(2111REMENISOFCODE QS IS BIIILDINGC(NNNECIE11101OWNWAIER BOARD OF APPEALS ACTION,IF ANY I S BI II LDI N(i C(NJNECIED[0lOWNSIiWER 7 0 o IS BUII.DING CONNECTED TO NAI URAL CTAS LINE 'v V INS Iit('TIONS 3. PROPEIiI'YrNFOI2AIAiiotq LANDCOS1 ESI.BI IX;.COST (--)O P-,GE 1 FILI.CXrrSECT1ONS 1-3 ESr.BI IX;.COST1'ERSQ. FT. A ESf. Bl1X;. C(7611'LRRIXN.1 � QC ELECFRIC NIE DERS MUST BE ON Ott"(SIDE OF BIM DING SEPI IC PERLII r NO. / 1 A n ACI IED GARAGES MUST CONFORM'rO S rATE FIRE REGI LA I IONS / PLANS MUST BE FILED AND APPROVED BY.fi(III.DING INSPECTOR BUILDING LDING INSPECTOR v DAIEFit ED OWNERS 11:IN CONI RAE1.N C01-fl R.1.ICH SIGN:\IIIREOFOWNER(N(Atli lNXI GENT PFRKIIT GRANTED 19 LO 00A �W W LD 17460800 DEPARTMENT OF PUBLIC SAFETY ONE ASHBURTON PLACE, RM 1301 .174608 8OSTO*;-'SSA 02108-1618 CONSTRUCTION SUPERVISOR LICENSE ; Number: Expires= Birt: at_� �T CS 060301 05/01/2000 Restricted To: 1G - _ #.. m ! .10HN D TREMBLAY 1 12 DEVONSHIRE Rel '! MIDDLETON, MA 01949 c v Keep -top for receipt and change F��� of address notificationAll _ - x.. _._ g. .' - -•._ ... -- - -- .-_` --- �. .--:--, .��'c`4�i = _ .i-•r - -- - - _ gam:. _ _ 4: =•�:_ ..y�- r. waft- � 1 .._ S=.:,�_ _ - i�f•-� -_ e'C.4'•K° _ "�fit.:�.`� aEY ..R:.'.r_�:-- tom} .44 n . :- .c::.._ err.-^! �_ L--g _ -:r: _- _ _ •_,a. _ `� -`;• .y.-.�S!-__>...r. x .a-.._...s...w....._-J�-.e.•v:E.^:.:EA.—tea.s.�...�.._._._.> �.—.�>r:t's::�'d��l:+�...r.r..::fiL'?e:'1..P'd��a�E$"s.'a3-�i....,:e�e-s:aeN:�R`e �.�.. Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit(below) Address of Property for Permit(below) _ R()At-k�t F. NLAJeA`a _ 2a'� 6!ajJeZ_ W Map and Parcel : Purpose of A lication (check below) Phone Number of Applicant: • �S�ingle 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 North Andover 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 iq 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 by-law,provided that no additional residential unit is created. The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this 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.care met and/or represents Dwelling units for senic;residents,where occupancy of the units is restricted to senior persons through a properly executed an d recarded ed•est::cti;n running with the land. For purposes of this Section"senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density,(buildable lots), below the density,(buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/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 by the Planning Board that will ensure its protection. I/ 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 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the 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 supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to 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 and or inaccurate information, or the checking off of an above item which does not comply,whether done to my knowledge or not is grounds for refusal by the Building Department to issue a Building Permit. fgPtature of Owner or Authorized Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION* APPLICANT 9 D A)Al I L O ove l L® PHONE LOCATION: Assessor's Map,Numberr PARCEL SUBDIVISION EV a S r LOT (S) STREET &Qa�)&-- &-j)OK ST. NUMBER , ,,►,�. *, **************OFFICIAL USE ONLY*****************+ * ,.,t ,, ECO ENDATIONS OF TOWN AGENTS: E CONSERVATION ADMINISTRATOR DATE APPROVED (I-a.D 9 f> DATE REJECTED r s COMMENTS l ��'t� �' w764 o � , r ) 0 � L—'_L TOWN PLANNER DATE APPROVED ' DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTI INSPECTOR-HEALTH DATE APPROVED l DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIV WAY PE I FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE . I 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS ENERGY CONSERVATION FOR NEW CONSTRUCTION LOW-RISE RESIDENTIAL BUILDINGS HVAC Trade-Off Worksheet I, Calculate efficiency Increase in percent: EFFiiuti11cd-EFF=,,&,d =%increase EFF.mw 2. Adjust the%increase according to Trade-off Ratio(Table 1 below): I•o997S (%increase X Trade-off Ratio)+ 1=Adjusted Ratio S 3. Adjust Total Required UA(from.Manual Trade-Off Worksheet): lu• r Total Required UA X Adjusted Ratio=Adjusted Required UA- 4. Use Adjusted Required UA as new Total Required UA,and check if Total Proposed UA is now less than or equal to it. j Total Proposed UA .------- Total Required UA (from Manual Trade-M WoAaheet) El Work Space: J b 8� r Table I Trade-off Ratios City/To;wn HDD,,, Ratio.8 Ci /Town HDD., Ratio.3 < Amherst 6404 1.15 Hymis, 6137 1.13 Bedford 6521 1.15 Lawrence 6322 1.14 Blue Hill 6398 1.15 Middleton 6268 1.14 Boston 5641 1.11 Nantucket 5848 1.12 Brocton 6225 1.14 New Bedford 5426 1.10 Chatham 6058 1.13 Plymouth 6333 1.14 Clinton 6698 1.16 Provincetown .6044 1.13 East Wareham 6297 1.14 Rochester 6267 1.14 Ed artown 5916 1.13 Springfield.. 5754 1.12 Falmouth 5713 1.12 Stockbridge 7060 1.17 Framingham 6262 1.14 1 Taunton 6346 1.14 Haverhill 6413 1.15 Tully Lake 7552 1.19 Worcester 6979 1.17 Table 2 NAECA Minimum Equip ment Efficiencies' E ui nt Lyz Minimum Eauioment TvDe Minimum Furnace 78 AFUE Heat Pump:Heating Mode 6.8 HSPF Boiler:Exec t Gas Steam 80 AFUE Heat Pum2:Cooling Mode 10 SEER Boiler:Gas Steam 75 AFUE Air Conditioner 10 SEER 1. Note: No Trade-off available for electric Resistance Heating. 2/20/98 (Effective 3/1/98) 780 CMR-Sixth Edition 760.23 . 780 CMR- STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE Manual Trade-Off Worksheet n� Permit bCr BuilderName 3 Love Date ; Checked By Builder Address q A)Ue ,e('t" AA o1q+�,_�,/ Site Address tet VC12- A 4-0ZLe- `0 F Zone 12 tl713 ❑14 I Date Submitted By po'[/ NW 6L t`' Phone 57-9 PROPOSED REQUIRED Ceilings,Skvliehts,and Floors Over Outside Air Required Insulation x Net Area U-Value Description R-Value U-Value UA (fable 16.2.2h) x Arra = UA Ceiling 3°o .D3D 1775 ft' 53.3 0 2 1775 (rabic 16.2.2x) Floor over Outside Air ftt (fable J6.2 7a) t1: ft= Total Area ft Walls.Windows.and Doors Insulation x Net Required Description R-Value U-Value Area = UA U-Value xA= = UA Wails(Table 16.2.2b.e-d) 2-) OS7 V - /19-7 10-17— 1 3o(,c) 3 Windows .31 (NFRC or Table J 1.5.3a) Doors — (NFRC or Table 11.53b) '-54 fr _ Sliding Glass Doors — .31 12.Y- ft _ 12,q (NFRC or Table 11.5.3a) tt ft Total Area ft Floors and Foundations Insulation Insulation R- x Area or Required Description Depth Value U-Value Perimeter =UA U-Value x Area =UA Floor Over Unconditioned (fable30 .073 177$ � �8-6 • os0 1775 ?8•a S J61.20) Basement Wall (fable J61211) © o G35 ZZ6.(c Unheated Slab ft — (Table 16.2.2 ) in Heated Slab ft (Cable 16.2.2x) in. w XL 2l -OL 70Sftt JF Total Proposed VA must be less Total / 7 it 2 s— + Total than or equal to Total(orAdnusted)Required UA proposed UA 10l T OR Required UA Statement of Compliance:The proposed building design represented in �.Adjusted /15 these documents is consistent with the building plant,specifications, tv and other calculations submitted with the it application. Required UA Jo N CenjelL b0l6kt I ILI Builder/Designer Company Name Date ` 760.22 780 CMR-Sixth Edition 2/20/98 (Effective 3/1/98) 780 CMR: STATE BOARD OF BUILDING REGULATIONS.AND STANDARDS ENERGY CONSERVATION FOR NEW CONSTRUCTION LOW-RISE RESIDENTIAL BUILDINGS TABLE J6.2.2f Basement U-values Insulation Basement Wall Insulation Basement Wall R-Value U-Value R-Value U-Value R-0 0.360 R-10 0.072 R-1 0.244 R-11 0.067 R-2 0.188 R-12 0.062 R-3 0.155 R-13 0.059 R-4 0.132 R-14 0.055 R-5 0.115 R-15 0.052 R-6 0.102 R-16 0.050 R-7 0.092 R-17 0.047 R-8 0.084 R-18 0.045 R-9 0.077 R-19 0.043 11-10 1 0,041 (a) Insulation R-values represent the sum of exterior and/or interior insulation. Basement walls must be insulated from the top of the basement wall to ten R below ground level,or to the floor of the basement,whichever is less. TABLE J622g Slab F-values Slab U-Value Perimeter Insulation 24-im 48-in. R-Value Insulation Depth Insulation Depth R-0 1.04 1.04 R-1 0.91 0.89 R-2 0.86 0.83 R-3 0.83 0.79 R-4 0.82 0.76 R-5 0.80 0.74 R-6 0.79 0.73 R-7 0.79 0.71 R-8 0.78 0.70 R-9 0.77 0.69 R-10 0.77 0.68 R-11 0.68 R-12 0.67 R-13 0.66 R-14 0.66 R-15 0.65 R-16 0.65 R-17 0.65 R-18 0.64 R-19 0.64 R-10 064 TABLE J6.22h U-value Requirements by Climate Zone Single Multi- Family Family Wall Basement Unheated Heated Climate Ceiling U- Wall UlFloor U- Wall Slab Slab Zone value U-value' -value value U-value F-value F-value 12 0.026 0.13 022 0.05 0.079 0.80 0.79 13 0.026 0.12 020 0.05 0.078 0.74 0.71 14 0.026 0.11 0.18 0.05 0.077 0.73 0.70 Note 1: Buildings heated by electric resistance require a U=0.105 for a Single Family Wall U-value in all zones. . 220/98 (Effective 3/1/98) 780 CMR-Sixth Edition 760.21 • • ® CROWELL DESIGN• - A 3 L: P,04b, f NDP-T9 AMDoLIVV NAN04L, T/2AT)C OFF W,0(Zr- 5!4M-r- I A50 OA( US/Ac (o Au.DL` 2S 71L r -wASl-( w UL(DL)WS A-oD GLI{)i/q(2 Pg rrb Doo2� T3v7'4 SAL/ Nrec rz,4rmo of a 3) 0VAL 'TI2AbC -OFF WorC454C&j" 3A5k) OU wElL-mc-L2LIry GAS I2U-C> Bb, 40 LOWELL STREET, PEABODY, MA 01960-5400 (978) 532-8660, FACSIMILE (978) 532-3130 Date N 3985 TOWN OF NORTH ANDOVER ; s s PERMIT FOR PLUMBING ;,ssACNU This certifies that . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . � plumbing in the buildings of . . . .67' .. .,7. . . . . . . . . . , , ; at. A /. . . . . . . . . . .. North,Andover, Mass. y Fe4e� ,�� Lic. Nc .9� �. . . . . . . . . PLUMBING I E R 04/05/99 13:58 393.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TODO PLUMBING (Print or Type) Mass. Date_3" ato 19-1-1- permit J! Building Location Ute' bG Ownee3Name Map: Lot Zone: Type of Occupancy_�IO�Q�� f New Renovation 0 Replacement O P Plans Submitted: Yes 0 No O FIXTURES 7Fee N � N _Z Z Y V1 O Z <N J fA U < N = — WW/ Oto cc �" _ 0 0J H W N N S " ~ " < y O Z Y OC CL 4• t a < ; K W O �. cc < W � .1- N Z O < N C d ¢ O '_ O J y 2 a' J Z p O J I.. U < _ �' S d Z 3 Y 6 O F� < iG < W W Y W < ►�;,' Ow e7 N ►� Z O O N = W F O U440 -C CF: rcccico -c S Y J rC N CIO I.J 3. S H 1 N W V 1 7 O < ; ¢ m 0 SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR .6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name J.P_ Campi1211., -Inc- Check one: Certificate Address 61-63 Elm StrPAt nanvorG�_ mA Corporation 1992C Estimate Value of Work: O Partnership Business Telephone 978-777-2808 O Firm/Co. Name of Licensed Plumber or Gas Fitter Jn.C; p ('amp?no 11- INSURANCE 1INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 139 No 0 It.you have checked M, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 25 Other type of Indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have thq 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 Ownafs Apant Owner 0 Agent O 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 the permit Issued fol thi aeplicat�on will be in compliance with ^^W�H au pertinent provisions of the Massachusetts State Plumbing and Cha t of the GAnerallaws. By Tt:e Signa of Li used Plumber Cry i Town Type of License: Master 0 Journeyman O APPROVED OFFICE USE ONLY License Number #9050 BELOW FOR OFFICE USE ONLY $FINAL. INSPB'CTION:; SKETCHES FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING RECEIVED MAR 2 91999 LOCATION OF BUILDING NORTH ANDOVER CONSERVATiQN CQMN18SION PLUMBER PERMIT GRANTED - DATE i PLUMBING INSPECTOR r 4 3 `i 41 Date�,�.-.. 3/. .i.1! ... ,,ORTM TOWN OF NORTH ANDOVER �.ao a1ti0 PERMIT FOR GAS INSTALLATION SACHUSEt This certifies that . %:. . . .: :.'ry has permission for gas installation ... . . . . . . . . . . . . . . in the buildings of .� . . .a�"' . . . �� :{� . . . . . . . . . . . . . . . . . at .; . , � '-r-: `'. . `�"-':: : . . . . North Andover, Mass. Lic. No OaFoS7f 93:5 70.00 PAID' GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer i I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 0 GASFITTING (Print or Type) ... Nor dD L1eI' Mass. Data �S_ -ZS/ 1 g Permit # Building Location_ IQI n �—��.,,,{- p,� /� Owner's Namo___ PITON NDU I/n r Typo of Occupancy S w +A J/rI• New tr Renovation.p Replacement p Plans Submitted: YesO No p N � N W N N N V Z X O OIL X X $- 00 O V WW o: �- �.. H rr CC O ' C 1- W X y V •W < z0,, y d O y 4 W a j x < X x a W a .W f' WW cc H X Y .t W 0 Y O X W 0 W X C L7 +. W 7 O V :J V X Y O O SUB—SSMT. BASZMENT ( + 1ST FLOOR 2ND FLOOR SRO FLOOR 4TK FLOOR 5TH FLOOR 6TH FLOOR r 7TH FLOOR 8THFLoOR Installing Company-dame_ ff,p ('am hP 1 1 Tn n g-----� Check one: CertKlcate Address ® COrpomtlon 1992 anvP r Q MA O Partnership Business Telephone_ Name of Ucensod Plumber or Gas Fitter Jose h P amnh•P i i O Firm/Co INSURANCE COVERAGE: I have.a current liability Insurance policy or fts aubstantW o uIvalent whl j Yes I9 No I] q ch meets the requirements of MGL Ch, 142. It You have chocked,yM. please Indicate the type coverage by checking the appropriate box. A liability Insurance policy O Other typo of Indemnity 0 Bond I] OWNER'S INSURANCE WAIVER:I am aware that the licenseo does not have the Insurance coverage required by Chapter 142 of the Mass, General laws, and that my algnaturc on�this permh appllcatlon waives this requirement. Check one: Signature o net or ers ent OwnerO Agent 0 I herab cern that&11 of the knowtedge ano that all umbing work andtInsttaallitloniapY�dormednunderrthe ermltnl�ed for this ap Iicatlon will be In compliance with an pD pe appncatlon are true and accurate to the best of my pertinent provisioru 01 Ne.Massachusetts State(tss Code and Chapter 112 0l thi oral taws.' !3Y r T eof Ucensa: Title Plumber Gasntter a ure o cense um to( It or o /Town Master Ucense Number 1 9 0 5 0 Journeyman I BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE' 1L APPLICATION FOR PERMIT TO:DO GASFLTTING NAME TTPE OF BUILDING .c ;LOCAButt. TON OF OtNG t s PLUMBER OR GASFiTTEft PERMIT GRANTED DATE to OAS INSPECTOR