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HomeMy WebLinkAboutMiscellaneous - 19 WOODLEA ROAD 4/30/2018Date......... ...... .. .. . ......... TOWN OF NORTH ANDOVER RMIT FOR WIRING This certifies that .....t.:. o�.Tb..A) ........... :t��AA� ................................ ....... ...... has permission to perform ...... ............. L4 ... .... krIv ............................... wiring in the building of ......... .... ... ................................................ .. ........... . North Andover, Mass. ............................. ........ . . at ............ ...... Fee ...... Lic. No. ....... .. . .. . . . ............................................................. aa�LEC�TRICAL INSPECTOR Check # 670� 13016-/ e (:ommoietveaUh o� ///alsace Official Use Only .1JePartinen� o�.:tir¢ �etwite! Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) . Date: 1/1V2016 City or Town. of: North Andover To the. Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 19 Woodlea Circle Owner or Tenant Amir Satam Telephone No. 508=423=0911 Owner's Address same Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps /. Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of an 11.445 kw (35 panels) rooftop solar array .F Completion ofthe following, table may he waived by the Insnector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above E] In- ❑ rnd. grnd. NO. o Emergency rg mg Battery Units No. of Receptacle Outlets No. of OiI Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o• o elect on an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat umpdiff Totals: er Tons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Connection ❑ :Other No. of Dryers Heating Appliances KW ec url tySystems:* No. of Devices or Equivalent. No. of Water.No. o. of o. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommunignons rang No. of Devices or Equivalent OTHER: Attach. additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $31,743 (When required by municipal. policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ .OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Boston Solar LIC. NO.: 12689A Licensee: William T. FOEIit?tta Signature LIC. NO.: (Ifapplicoble, enter "exem t"in the license number line.) Bus. Tel. No., 78146M702 Address: 55 Sixthoad Woburn MA 01$01 Alt: Tel. No.: *Per M.G.L. c. 147; s. 57-61, security work requires Department of Public Safety "S" Licenser Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) E] owner ❑ owner's agent. Own tura nt PERMIT FEE. $- Signature Telephone No,. - Mailing address: Boston Solar, 55 Sixth Road, Wobun MA 01801, Attn: permits Email address: permits@bostonsolar.us CONTROL# .1..1284188 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass,gov/dpl for Instructions to ensure the. proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le My Name (Business/Organization/Individual): The Boston Solar Company Address: 55 Sixth Road City/State/Zip: Wobum MA 01801 Are you an employer? Check the appropriate box: Phone #: 617-858-1645 1. E✓ I am a employer with .20 employees (full and/or part-time) * 2.[:] 1 am a sole proprietor or partnership and have no employees working for me in, any capacity. [No workers' comp. insurance required.] 3.F1 1 am a homeowner doing all work myself. (No workers' comp. insurance required.] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 501 am a general contractor and t have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.[ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 Q Building addition 1 Lo Electrical repairs or additions 12. Q Plumbing repairs or additions 13.[]Roof repairs 14. QOther solar 'Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this aff davit 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 [tame of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HDI -Gerling America Insurance Company Policy # or Self ins. Lic. #: EWGCC000153815 Expiration Date: 1/14/2017 Job Site Address: 19 Woodlea Circle City/State/Zip: North Andover MA 01845 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure. to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy_ of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the Phone #: 617-858-1645 of perjury that the information provided above is true and correct: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License #, Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City./Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: f4­44F- 4n44f1C 17G&LTsl ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1,0812016 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(les) 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 People's United Ins. Agency CT One Goodwin Square Hartford, CT 06103 860 524-7600 NAME:.. Peggy J. Meratl PHONE 860 524-7624 844 702-8075 AIC No Ext): AIC No : E-MAIL. a merati ADDRESS: p ggy �peoples.com . INSURER(S) AFFORDING COVERAGE NAIC # :. INSURERA: HDI -Gerling America Insurance C 47343 INSURED The Boston Solar Company, LLC 55 Sixth Road, Suite 1 Woburn, MA 01801 INSURERB: Merchants. Mutual Insurance Co 23329 INSURERC: Philadelphia Indemnity Insuranc 18058 INSURER D INSURER E : INSURERF: CAVFRAnPR GFRTIFICATF NIIMRFR• - REVISION MUMMER: - . - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSRL UBI WVD POLICY NUMBER MM/DDY EFF MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR !. C//�/1i d,J AW EGGCC000153814 D1101/2016 0110112017 EACH OCCURRENCE $1,000,000 DqMq ET r� PREMI�ES EaENCTUED nce $100,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F J CT .LOC - OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ (, C AUTOMOBILE LIABILITYPHPK1438834 X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS PHPK1438838 1101/2016 0110112016 01/01/201 01/0112017 Ee acc id.n SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP0001367 0116112016 01/0112017 EACH OCCURRENCE $5,000,000 AGGREGATE $5,00 0 000 DED X I RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N 1 A EWGCC000153815 111412016 0111412017 X PER 0TH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street_ ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED RE)�PREEgSEENTAAIIVp,TE' !. C//�/1i d,J AW ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S657624/M655319 . 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INSURANCE February 19, 2016 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 19 Woodlea Rd, North Andover, Ma 01845 Policy Number: H3S21855947340 Underwriting Company: LM General Insurance Company Claim Number: 033096298-0001 Date of Loss: 2/15/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, � 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Office Use Only Permit Occupancy &Fee Checked Dr�«r o6 r�a6lle Sa�Cry BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number L0� o�/ # �9 > J OO a �2A— C 1 Owner or Lei Date I - 9-n J To the Inspector of Wires: Ownerres Owner's Adds ` Q l J'� �r�c%2 S Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) _ y Purpose of Building S/ Al Q / ¢. t" Y.(,�t.Q �l.-r tis 4� Utility AuthorizationNo. gvz96 Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service �l�t') Amps f2 l Voits Overhead ❑ Undgmd No. of Meters / Number of Feeders and Ampacity l Location and Nature of Proposed Electrical OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General taws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalentS NO = _ have s ed valid proof of same to the Office YES= NO = If you have checked YES please indicate the typ NO by checking the appropriate box 25RANeE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electri brkE Work to Start 4r -3g _ 7� Inspection Data Rasquested Rough /.f//;y Final Signed under the nalttes of perjury: �-y FIRM NAME _�� Y Cu R, z-1 R..C�J7 <A� int t v Q / 4_ LIC. NO. NO. n Bus. Tel No. 79' --6n GS 'l Address S �/C� oAlt Tel. No. OWNER'S INSURANCE WAIVER: am aware that the�enses does not have the insurance coverage or its substantial equivalent as required by Massachusetts I General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $__� (Signature of Owner or Agent) Total No. of Light8ng Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ ' No. of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Oioosal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Soace/Area Heating KW Oetection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers - Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General taws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalentS NO = _ have s ed valid proof of same to the Office YES= NO = If you have checked YES please indicate the typ NO by checking the appropriate box 25RANeE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electri brkE Work to Start 4r -3g _ 7� Inspection Data Rasquested Rough /.f//;y Final Signed under the nalttes of perjury: �-y FIRM NAME _�� Y Cu R, z-1 R..C�J7 <A� int t v Q / 4_ LIC. NO. NO. n Bus. Tel No. 79' --6n GS 'l Address S �/C� oAlt Tel. No. OWNER'S INSURANCE WAIVER: am aware that the�enses does not have the insurance coverage or its substantial equivalent as required by Massachusetts I General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $__� (Signature of Owner or Agent) N2 1 550 TOWN OF NORTH ANDOVER PERMIT FOR WIRING A ti This certifies that i—�. has permission to perform %1.. -/0.....:...................................................... wiring in the building of :................:. at f %7-r7- .........[�.... .:....... �- ....: �.:� .............................. ,North Andover, Mas Fee-) .. Lic. No �� �n%r�............................................................. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ►SSACHUSETTS UNIFORM APPLICATIOII.FOR.PERMIT--TO:DO�PLUMBING' (Type or Print) > ,; NORTH ANDOVER ,Mass. Date:;;; Building Location Permits - Owners Name l New J]D" Renovation n ' Replacement ❑ Plans Submitted ❑ , Ft TURE • z m . N (Print or Type) Installing Company Name WILMINGTON PL11MAINn R I EATI Q 1 UTOPIA RD. Address BILLERICA, MA 01821 b08-988-0003 MA. MASTER PLUMBER #116W JAMES CAW4 Business Telephone Name of Licensed Plumber: Check one: Certificate 0 Corp. v Partner. ED Firm/Co. Insurance Coverage: Indicate the 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 coverages. Signature of owner/agent of property Owner E] Agene.D I hereby ccrtify Usat all of We details and infornulion I Isa•e wbmi(tcd lot enlcrcd) in aNsve application sic (rue a044 41mlate to We best of any knowledge and that all plumbing work and installations Iierfnrmcd under rcemit iasucd for this amlicalion wiU be in compliance with all pulineat pto•.at visions of the Massachusetts State rlumbiag Code and Cluptes 142 of (lie General Laws. �--� By Title. City/Town: APPROVED `OFFICE USE ONLY) Si -a ure Licensed Plumber pe of Plumbing License J 1 .41s6 License Number EfMaster ❑ i Journeyman 6207 O = ~ a Q h N ly m =¢ W N O Z 411 % Q 1- cc W U¢ Y Z O O IL Z Z Z a. } m W 93 m Ol I¢- Q W t trl Q C _ � O X V Z ¢ O Q M. 0 Q y¢j m } G Q W Z of a Q Q of J Z ¢ p o. tL Q J 4. W Z _• 3: O z 2. J Y a O f' Q x X Z Q W IL tu X cc W i :.: ; F Q V ►- Y < M a O x i �' d �' 7 Q N a f- o Z Q O J p as Q cc W W, F Q O o U Q Z t- 3 Y -a In to n a Q 3¢ m O SUB—SSMT. BASEMENT 1ST FLOOR /' l 2ND FLOOR Z �/ 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Installing Company Name WILMINGTON PL11MAINn R I EATI Q 1 UTOPIA RD. Address BILLERICA, MA 01821 b08-988-0003 MA. MASTER PLUMBER #116W JAMES CAW4 Business Telephone Name of Licensed Plumber: Check one: Certificate 0 Corp. v Partner. ED Firm/Co. Insurance Coverage: Indicate the 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 coverages. Signature of owner/agent of property Owner E] Agene.D I hereby ccrtify Usat all of We details and infornulion I Isa•e wbmi(tcd lot enlcrcd) in aNsve application sic (rue a044 41mlate to We best of any knowledge and that all plumbing work and installations Iierfnrmcd under rcemit iasucd for this amlicalion wiU be in compliance with all pulineat pto•.at visions of the Massachusetts State rlumbiag Code and Cluptes 142 of (lie General Laws. �--� By Title. City/Town: APPROVED `OFFICE USE ONLY) Si -a ure Licensed Plumber pe of Plumbing License J 1 .41s6 License Number EfMaster ❑ i Journeyman NR 3679 Date. &C TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING --7 ,SSAcmusE� This certifies .......... has permission to perform .... plumbing in. the, buildings of . 6Q.� I./(, k. .......... at. .l P ........................ ,North Andover, Mass. Fee .,2-; -,7. Lic. No.. . ................... PLUMBING INSPECTOR WHITE: Applicant CANARY:,Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING or print) Date I"I 19 1 Q 9 INUKI.H ANDOVER, MASSACHUSETTS Building Locations 0) V11ODD LLlAr (2-10 Permit # �,� i 3 Amount $ Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type)Check one: Certificate Installing Company r UMd3lA'Q it OiEAitfI 1:1 Corp. CILL Name 0 A MA 01821 �rtner. Address a C3Ato 11:" PLUMBER Oea Business Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. YesEl No❑ If you have checked des, please m ate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Cand Ch pterfthe Gyral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of I ❑ Plumber," Master s lir ❑ Journeyman sed'Plumber Or � Fitter d tcense Number m W v z a F FFd a w z � z p w F W w d W d wE W > W W W v� W iz. d x 4L' W EC-" W F 0.. U zW F z a F z a F EW W �% O > W E.., WVG .7 W d `" Z a d d O C W C- O w F r� w O x w 3 A t7 a U cG > o a F C SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)Check one: Certificate Installing Company r UMd3lA'Q it OiEAitfI 1:1 Corp. CILL Name 0 A MA 01821 �rtner. Address a C3Ato 11:" PLUMBER Oea Business Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. YesEl No❑ If you have checked des, please m ate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Cand Ch pterfthe Gyral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of I ❑ Plumber," Master s lir ❑ Journeyman sed'Plumber Or � Fitter d tcense Number 2843 Date...../... ..J.�. M Q� f/ • V NOFT�y TOWN OF NORTH ANDOVER 3?py4t�ao 16 4,OL PERMIT FOR GAS INSTALLATION f P ,SSACMUSEt O� If] .r This certifies that ... W t. ...................... l has permission for gas installation ... ........ r in the buildings of ....................... . at .. ..cam- �� �:. �. .� �4 ................. North Andover, Mass. .;7Fee ..), . . Lic. No.././. :° .. .......................... F GAS INSPECTOR i' is WHITE: Applicant CANARY: Building Dept. PINK: Treasurer .44 Date. ....... O' o= TOWN OF NORTH ANDOVER 1- L • PERMIT FOR GAS INSTALLATION P �9SSACHUSES This certifies that ... ........:.�...�tF'.... . has permission for ga installation /�.!............. . in the buildings of ... , ..... ................. at �.j���Y 1. ..... , North Andover, Mass. Fee5RS Lic. No ` 13 ......... . � C2AS INSPEG AOR Check # li" � .c�/ 4269 G ,f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER 11/27/02 20 Permit # Building Locationl9 Mass. Date WOODLEA RD Owner's Name ANA, LU Telephone 978-681- 452 Type of Occupancy 1 Family New :1Renovation :1ReplacementL,.---Plans Submitted: Yes] No ] Installip g Company Name Gerard Duff Check one: Certificate Address P.O Box 466 Mansfield MA 02048 ❑ Corporation .71 Partnership Businless Telephone 508-454-5959 Firm/Co. Name of Licensed Plumber or Gas Fitter Gerard Duff I have a current liability insurance policy or its substantial equivilant which meets the requirements of MGL Ch. 142. Yes Z No If you have checked ygs, please indicate the type coverage bychecking the appropriate box. A liability insurance policy ® Other type of indemnity ] Bond ] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent I hear certify that all of the details and the information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all the plumbing work and installations performed under the 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. By Type of Licence: Title] Plumber City/Town ] Gasfitter Signature of lice Plum r or Gas Fitter APPROVED (OFFICE USE ONLY) Master License Number 10349 Journeyman 25.00 ..-.a.-,:.'e - k" -M''`^,`.. 7,..r..n^v`_""r�"r-t'4-^'--+-••ti{Y"v.>'�r�ro.. iny.:y�l±;.c Locaton'+i� No'' D to �% ot,,,.o TOWN OF NORTH ANDOVER x . •,, C? .. • : `_ •• OOH��� Certificate of Occupancy $ ,Building/Frame Permit Fee $ 7 = Foundation Permit Fee $ cMustt Permit Fee .Q#er $ _ Sewer Connection Fee $ f�.en 77/ V' I�& Fee $ ' TOTAL- $ NORTH ANDOVERCOLLECT� uiiding Insp tor• - 101 FA -Q t 'd # /— Div. Pulic�Works i PE&'ltIT NO. i APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, `MASS. PAGE i MAP dd0. LOT NO. I 2 RECORD OF OWNERSHIP IDATEBOOK ;PAGE ZONE �� SUB DIV. LOT NO. pry to 03 — O L( 0 LOCATION ��Ow PURPOSE OF BUILDING �L OWNER'S NAME C' t�[ I ,^`10 a� J NO. OF STORIES of SIZE 43 G•••f OWNER'S ADDRESS aNpdVffk SEMENT.Aml , j A Ot Gzyt2 ARCHITECT'S NAME q..OL�s SIZE OF FLOOR TIMBERS IST 2ND ^1 �(�^L 3RD G.►/' /K�-c BUILDER'S NAME('' L CA -At ��,�-�2`=�G��ciW V SPAN 49 f / -� a DIMENSIONS OF SILLS �4_ --- POSTS - 2v I. DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS !/Q7 /I`/ AREA OF LOT 1 ' v FRONTAGE ' b� s , HEIGHT OF FOUNDATION �jJ / THICKNESS , U IS BUILDING NEW yes SIZE OF FOOTING X r� IS BUILDING ADDITION / O MATERIAL OF CHIMNEY IS BUILDING ALTERATION Al0 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING. CONNECTED TO TOWN WATER Y�+s BOARD OF APPEALS ACTION. IF ANY AAD 6 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE �J INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILE A O APPROVED BY BUILDING INSPECTOR j DATE F}L�tr1 ! v J �/ AGENT F 'E PERMIT GRANTED E 19 SOD► PERMIT FEF j LESS FDA FEE__.__ DUE FRAME PERMIT jZ 3 PROPERTY INFORMATION LAND COST „ EST. BLDG. COST /Clio EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY 9 BUILDING INBPECTOR OWNER TEL.# 5'7$`642- oY�� CONTR. TEL. # to 03 — O L( 0 CONTR. LIC. # c S 662-Of7 H.I.C. # L 2 FOUNDATION CONCRETE CONCRETE 8 L BRICK OR STONE PIERS 3 BASEMENT, •., AREA FULL NO B M'T HEAD ROOM 4 WALLS ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASON STUCCO ON FRAME STONE ON FRAME 5 ROOF ABLE 1 I HIP c BUILDIWO RECORD OCCUPANCY 12 JJ SroulEs _THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND,DISTANCE FROM OFFICES _ LOT LINES AND EXACT. DIMENSIONS -OF BUIL'DING5: Wi*H"PORCHES. GA- RAGESs,ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. DNSTRUCTION —II n8c INTERIOR FINISH__ R1 I2 13 -y—w7 _ PLASTER DRY WALL _ UNFIN. -�- <. �' < FIN. B'M'TAREA FIN. ATTIC AREA 4 ... FIRE PLACES' I M'OQERN KITCHEN f FLOORS Y B 1 2 3 `CONCRETE �_ 'EARTH _ COMMCN WIRING 10. PLUMBING BATH 13 FIX.I TOILET RM. (2 FIX.) j WATER CLOSET _ LAVATORY __ y;� -a', ` , ��"'�.• KITCHEN SINK . /•' �•- ' NO PLUMBING STALL SHOWER J .` MODERN FIXTURES - TILE FLOOR` .TILE DADO t A 6 FRAMING I / . 31? .,p}}:, ..,..�.M,,., � 1Tili1%tAMI 11,1 11 HEATING 4WOOD)JOIST- - PIP$LESS FURNACE FORCED HOT AIR FURN. STEAM STEELTIMBER-BMS..&-COLS. STEEL BMS?8 COLS:? �•-� WOOD RAFTERS HOTt W'T'R OR VAPOR AIR RADIANT HOI UNIT HEATERS�,.l' '7 NO. OF ROOMS B'M'T 2nd _ 1st 13rd GAS OIL ELECTRIC Ell NO HEATING 1 W W Cd w V E o w z A w pq o a a U ® c 0 rTl A Q W�2 u \ cn •p,� ,5 o ro 7 � V � U ro w p" � d ca w a°G w a°' w q w' cn .st yui `r O . - z I u 0 v v CD O E � L O Z CL. O CO) � C O O! I C C O •— y p 'C O — y O O 'g m m CL I-- CD CD 0 0 eevv o Off. Q O •-- cc v C 15 CL V y O C C CL •� C COD E Q- o ® c ts CD L C3 �d'fl d C V' p o A 4v NCO c t o ep: 8 a E Q: . u:om Com 07 o c a 4jmm E s cm V m __ .3 �. c H m o � Em O :mo c m :ma m �' L C C= m i t it C m `o o 0 0 cc S .o Q o :gy = m *-m= :m3 o H m w ~ N m COD -COD U.C CC Cl U ��� a g �CODVJ � p H 0 CL co :10 I u 0 v v CD O E � L O Z CL. O CO) � C O O! I C C O •— y p 'C O — y O O 'g m m CL I-- CD CD 0 0 eevv o Off. Q O •-- cc v C 15 CL V y O C C CL •� C COD E t FORM U - VERIFICATION 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �(� C CJI Phone 6� " 0 V2 13 LOCATION: Assessor's Map Number v47? ? Q /Of'Parcel Subdivision /1/-0 0 (��t )�d Lot (s) Street Number 77:7j NS`� T •GENTS: Conservation A ;fni trator pw-c Comments ,. ���� own Planner Comments Food Inspector -Health ,,-::�;pti& nspectdr-Health Comments'L Use Only************************ Date Approved/ Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections - driveway permit Fire Department e l-0­6ve vy Received by Building Inspector Date �J a L, i �f ;.. • ,. � )����i�•�•�,21 ��� Y -moi � �°' � I TAIT 1 i. f 1 1 1 i '1• l ;. 1 N 4 i J to i ` ry -'$ ^ ., ' �l ��r' } .`;l' '�' •, lk.:'� 6) 'Ul II �' ' b;�a� �` Y1 1 ►Osf�; rt. 'i"fix' ,� �*. ��'' � N M1; _� J_ 00 to �r+ . iii?4� ��}' - tir,.sfi tg R'i'r��'!,'�..1 ^'�^7�'/Y •, ,�,a `.yLi '{.�" (� f �!. '..• .a •__ `t �q'rT.l.tiit', r�.��:•('�+•q,,,..�a' ��5-. a,� hp�� - •V•�:,•��Mt. aA ";G���9 �•o O." �.tl. yFY Irl, , l:!r•J� 4 :. q 00 t ry t to 4� h cp o M O> CJ 0 C14 00 f If / N cp M i M ,o cq '�.9Z 8 8S v ,s j C6 �•Sp l� 0 N, 9 fn in ui a u �j al N \ ,n to Ob % 1 v N Z ,r) .gS� 0y1� �8ry jv rpm y ^ S i Q� ::g-- U,na uNg, ,hL ZL o 9p"pZ - I to U IW`' c�04 n v in rn ---- — e o l� ,� I— �,'`' 1A o rn M O o' Q -0 u --I—`-1,6L S' „ZO,S CID O1 M.,CS•4�L5` I Z6'�L lI 11 V :.,0 �)` ° {- � 4�•, i y -(:- " �_� is -� M..LC,LCI. �I"'� LO ,moo o. co- o V o J r- J8N j� It 00. Lo 00 CD fn 4 w cv 11 Ss, 7. c Lin r O "�� -I r 574,2a,15„W 46 O �{ \\ S 0 yah �-40.14' _ r ` �S� .-. rn,'y9-<�� 54 0 . - Go o�--� �r cc,bJ�Lej o - -• ai nava 01714 °' )I •mss; �",, o� rJ�•,<; I ,u a Vi 1 `- J It fn I a 0 � j ��`°1rL •:i m l LE.. LO. 1993 2:56PH MC-LEHIA CC-11ASIRUCITICT-1 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 pplicant on Building Permit (below) Address of Property for Permit (below) Map and Parcel : P r ase of Ap cation (check Ph n Number of Applicant. Single Family _ Two Family I e dersigne 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. Gy&aa lot(s) weretwas created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning "`` y����law�`�`. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.ciare met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons 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 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. 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 ci above. Further I understand that the submittal of misleading and or inaccurate information, or th ecking off of an above item which does not comply, whether done to my knowledg is groun or refusal by the Building Department to issue a Building Permits. �C ignat e� r uth zed Agent w o e Attac d Building Permit Date T orm st be a ch d to the Buil 1 ng yerrftitupon a plication for such permit. @R /O/. 0,.3 " EASE Gi P.C" rArCP WETLA,voS L aT'�Z A 0\ o r., Al 'h FavNOA rias✓ M T L R3.7' . N P�rJiiO.SEo LOiNES' 1 3. �o 'S A"COY 7V Tye T/TGE I pz or Rz /Y AP THE 104-V& IM47 TWEO/rtLL.kIC /s GOCS4TEG 0.1 TNE�or.�s.s�m-•v.gvo r.�G17'lrou�s co,✓�aegl //(/ !Y/TN T.NE >e� OF.vO. avoa���2 Zavrve .�E6vLATiCWS ' �6rll'O/.tlir JETO.IC.tCf' FEGlM JT.�EL'7'S � GOT U.vES. '' � . /�•t/l7o I/� �� �/JS.s. LOQ E � rWErFE� .44 se'POP lAfZ,I O 4,e -c,4. T 0�/�i�✓�V fOiP i �J014/N O/V i'EM•�' COMMt/N/TY P„/�/G� � a►!pW� 2Soo98 oaQ6 C Co®,�G� STo�vE �E✓E`GO�ir��.,E'T' /%'4,e eAl QP a 4;36381 lE.P.P/Al.4G(' E'.VB.uiEE.P/•l/6 SE.P'I�/�'ES '►.®v 66 f341;fw -C714 o. II.A4A,190/'E.� �1.45.£4GfU/SETT.S O/8/O R ' CERTIFICATE OF USE, OCCUPANCY Town of North Andover Building Permit Number Date THIS CERTIFIES THAT THE BUILDING LOCATED ON t �66 L)/ 1(4(o MAY BE OCCUPIED ASN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATEDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. �Mowrly CERTIFICATE ISSUED I ADDRE f. ,�i r o U MA a � �o"c\ a p ✓ z Lid Q ...........� c 5 p i o`\�`I\\\aoUO U\ ILI C1 c o a c a �t�. c o W �v w v .. o w cn U c� w cn cn U_� p �a� c o Q ...........� c 5 p i V C.3 C1 c D p W � ¢ r^ m � C/) •"` + v3 06 �E� O C/) �. ' W.-`cm $ me E �O v c.:. C—D CD m 04. H Q1 V ; m N [- 04 'C4 � _Jt Ywi C H A O :.,= m W U "' U CD y m ' '^ .00 CM c H Q C c L Co O O �aZ : o ' c o c C.3 a yts m C O Q = o CZ � 03 C N f.. COOD p N m p m ca o' m •N co C.) O CD p ero rC y CL O'pfl .0 0 y '� CD _ =4 am �> M- III 0 CD O CD L Z O ti � C co C7 C CD y 0 � M co �C m m 0 ow G.. .,-. CD i m O ca�Q C o CcCID� v J .rq .� O CR C GD (� N C 'C C CO) 0 w