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Miscellaneous - 190 WEBSTER WOODS 4/30/2018
!3 � � a O �, C.n y0 R n m r b �. b• S _-` Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 jAoRTN L, Q Yy , COCwI[w[ APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 190 1d) "- 6v n -r) �s G r LOT NUMBER ,4 SUBDIVISION � o /�� DATE REQUEST FILED Z/C) DATE READY FOR INSPECTION�J $� / FIVE (5) 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 TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STWC NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATION ` "� " DATE PLANNING DATE 16') D.P.W. — WATER TEI> ° _� DATE d D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED P R TO INSPECTION REQUEST DATE. IGNATURE /DPW A HORIZAT o, HOniM ,y w Town of __A U fir. NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.:PROJECT:-�'�I 3JIlU�x"" �Q+4' DATE: UNIT NO.: FLOOR: WING: BUILDING NO.: / / 0 9' REMARKS: 10 RoO M t,2' 6� j8x--fh Excavation - depth and soil conditions Framing - Other: Date: '3_5 Date: r` Date: Inspector Inspector eW M G Inspector Footings and foundations and drains - Insulation - Other: Date: 3-8-01�I -IS--aai Date: '� ` Date: � C Inspector .,0,174 Inspector "W/�G�I Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: �%'a�_�� Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: 01-13-69,1 Date: 7 /j'-0/ Date: Inspector Inspector Inspector "ire Dept - Jil burner, tank, stove, smoke detectors Final inspection Certifi of Use and Occupancy V 85 Date: Date: C of O# Inspector Inspector Inspe or Form 1995 Action Pre", 685-7000 CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number -� Date L 3- f `i THIS CERTIFIES THAT ,,, THE BUILDING LOCATED ON /�©J"2� �° � C,0��s �- MAY BE OCCUPIED AS L�1✓�y/e�h� �`� ���'�/ IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. &)Pot, r7.5/ c2,,, 8A h5, , ,54// utir/e� °1 "' oT .1 CERTIFICATE ISSUED TO ADDRESS '°3 4CHUs�` Building Inspector U) 7) m m 0 m y CD� Z CD O CL CL �. D� CD O p CL C� CSD O .... d O CD W -o CD O O CO) O CO) = CD O r� CD y CD CA O co O CCD OR C c 2:w = O -• Ce O Q fA a0a y O3O O O n m�a� m Z N �* H• O� d ,df w H 'TI Er m.?d = y CD -40 m y p OO ,44. O N > >� C O� G O �► m O O y.� 00 a o m c ?y7 CL O CL NtG O ? E�� C m C o m O c O. -1CD QC VJ a O1 Q .yi O< H H Q i �ebuca, CD Q� �$ C2 : lb O CD .+ O O C CA CD to 0CD A !4 hCL .� Cos o C CD= =: .IM rX rA I d O ao O .IM rX rA I d O N° 3186 Date..../....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that - haspermission to perform......................................../_......................................... wiring in the building of��.Y'..`.�..��-c................:`.:'.: ................................ '/9" -�= :...... , North Andover, Mass. ?fit ....................................... ......... Fee.:,-).rQ............. Lic. No�> % ..:.. _ 1 ... .......................... i ELECTRICAL INSPECTOR Check # �� 73 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ]HE (1UM 11U1yWr- L1HupMA&"CJ1U3b11Jutnce use only DEPARTMNVT OFPUBLICSAFM Permit No. &/ f Z7 BOARDOFFIREPRE[/EMONREGUT4TIOAN5270MR12.0 occupancy &Fees Checked APPLICATTONFOR PERMIT TO PEWORMELE=CAL 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) Dati `"&o- IQ ���rr��irrrr. Town of North Andover The undersigned applies for a permit to perform the electrical Location (Street & Number) /90 Aj,"eze Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building ] Y, 5, / Existing Service Amps / Volts New Service 00 Amps I a Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes described below. .11 No To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No Overhead Underground r7 No. of Meters Overhead Underground ©' No. of Meters I No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA N�. of Lighting Fixtures Swimming Pool Above c Below Generators KVA and ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units %. 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 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 LocalMunicipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTI4j--R Ir i TceCaaage PtvymtbtheteWmTv tsdMamdiEftGai%WLm Iha%eaastertLikklsu=xePb1iyarh>da9CarFi* Cot orilssi ecf"att YES Iha%esubmilledvalr<lptoofofs&netoftOffM YES No INSURANCE [D/Skim E] OHi R ® ft=Spac Est m&dValueolF]adnd Wak $ WakbSm¢t � — l3 -677 h pectimD*RacA> *d RaterJ 17'61..�� Final Sig,adt>nda�iePofpauc ,, � '--- f FIRMNAME / �3 7 $ Lioa (/ /�/ r %� / ✓� f=r�,,� Sigj� � r:..�..i a Limmilb Btsine s Tel.Na p 7 9 6 95-3,? � OWNER'S MJRANCEWAIVERl �eirstranet a Qssu6c i>balec�rivalat�rt�cpmedbyMa�sad SC�raalLaws aodthatmysigr�teern$aspenrritappfird�otrvvai�thisregtmattat. (Please check one) OwnerQ Agent L..� �'" l Telephone No. PERMIT FEE $ 3 V� t1° 4C70 NORTH O A 49 ,SSACNUS� Date.:. .... ... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..:.:. :.... .. .. �......... ... ..... . has permission to perform .. ...................... -,-y� plumbing in the buildings of .....:�=�-�-:7... ;:�.�-)--�� ........ . al. ?-�-�? ?!`u-...j�U' .... , North Andover, Mass. Fee... %�..�. Lic. No%.`.S. .. 1. r -,vim,,. ............ . PLUMBING INSPECTOR Check # (( 2 �' WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR4PERMIT TO DO PLUMBING (Type or print) ` NORTH ANDOVER, MASSACHUSET'TTS% 16'3 Building Location�� //o U"es %e -06D7K Typeof New Er" Renovation ❑ Replacement El r. FIXTURES Date d / E Permit # f Amount D �•y °"— Plans Submitted Yes ❑ No (Tint or type) .'41G Check one: Installing Company Name Certificate3 ft ❑Corp: Address Ty �f4 S'� �C _ �`��G� . ❑ Partner. Business Telephone 603 S9*so 02-31 ❑ Fimi/Co. Name of Licensed Plumber. 4" b (J-1-1 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 �Signature Owner ❑ Agent R thereby 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 Plumbing Code and Chapter 142 of the General Laws. , � �i 71� _ Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License fCE3sz-- icease Number Master Joumeyman ❑ Date........... ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .... 14 /Y- . . . . . . . . . ... . . . . . has permission for gas installation .......... .................. in the buildings of ................................. at ............. North Andover, Mass. -&ee. Lic. No. "�. 1. .1� �.. �� ............ GAS IN Check # la 3675 f, 'MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING X _.7 F or print) Date v n e___ 2tJ W W NORTH ANDOVER, MASSACHUSETTS Building Locations C 0 S r C,) � S ' " Permit # `3 � ? i b� ��p{ n - Amount $ (- �+ 1F'� Owner's Name I'�I ��/, New Renovation ❑ Replacement ❑ Plans Submitted ❑( �-- (Print or type)j / 1 j k one: Certificate Installing Company Name W( A Corp. Address -� ❑ Partner. 191-Y111/14TI ALLQSO Business Telephone '603 S:: S ria z i ❑ Firm/Co. i Name of Licensed Plumber or Gas Fitter -D P�) I, t) Al2 IS Ulm No ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I nereoy certify tnat all of the details and intormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St_e Gas Cgde and Chapter 142 of the General Laws. lArrKV V LV (OFFICE USE ONLY) I Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 0 6 �� ❑ G Fitter Li e se Number aster ❑ Journeyman • j • (Print or type)j / 1 j k one: Certificate Installing Company Name W( A Corp. Address -� ❑ Partner. 191-Y111/14TI ALLQSO Business Telephone '603 S:: S ria z i ❑ Firm/Co. i Name of Licensed Plumber or Gas Fitter -D P�) I, t) Al2 IS Ulm No ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I nereoy certify tnat all of the details and intormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St_e Gas Cgde and Chapter 142 of the General Laws. lArrKV V LV (OFFICE USE ONLY) I Signature of Licensed Plumber Or Gas Fitter ❑ Plumber 0 6 �� ❑ G Fitter Li e se Number aster ❑ Journeyman / •�� P / ,?( G�e6Sk/I Location xo No. is S Date 'd7' 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $� I' Check # )YO O V 1471--13 j J Building Inspector APR -16-01 MOAN 12 :47 S. E. Cumm i n-is Assac i a,*, es p. 02 CERT1RE,D PLO PLAH S.E. 4'lJMWe$ A ASSOCIA TES Pta wx wr P!`Al row AUC mQd' 6's Uz- / 9°0 �vOOns *00, 'X;'7* - SCALE 1' - 60' two 3'rt LOT 29A 43,614 SF 5 I HEREBY CERTIFY TO TOWN OF NORTH ANDO WR, MA BUILDING DEPARTMENT mA T THE EXISTING FOUNDA TION DRAWN ON THIS PLAN IS LOCATED AS SHOWN AND INAT IT DOES COWL Y TO THE INlMUM QUILD/NG SETBACKS TO xERrY LINES DATE• APRIL 13, 2001 TAX MAP 109--A / LOT 29A CAMPBELL FOREST NORTH ANDOVER, MA. MINIMUM SETBACKS.• FROW T - 30 FEET SIDE - 30 fWr REAR - 30 f££T Town of North Andover of NaRTH t.fL10 ,6 M Building Department 3� hti ; �, �_', o 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 O COC MIC Mt wK M ACHU APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS . I �?d oyawls � L LOT NUMBERSUBDIVISION�� DATE REQUEST FILED DATE READY FOR INSPECTION VAM FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TME FRAME. A RE -INSPECTION FE - F NTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STR DOES T MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION DATE PLANNING DATE ell 2 Z,�) 4 D.P. W. - WATER METE DATE (� D MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOP TOME INSPECTION REQUEST DATE. Location 04 0 q No. g Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 50 Building/Frame Permit Fee $ Foundation Permit Fee $ /00 Other Permit Fee TOTAL $ Check #-t? c5 3 % Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �� DATE ISSUED: SIGNATURE: Building Commissioner ct r of uildin Date SECTION 1- SITE INFORMATION 1.1 Property Address: f UT r a g 1.2 Assessors Map and Parcel Number: Map Number Parcel Number jet W U U "o 5 ), N , 1.3 Zoning Information: R12- a2 S/rJ,3`F f�,� t!� Zoning District ProposedTJse 1.4 Property Dimensions: i G /Y �_ l Sa + Lot Ar sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided 3(D/ 3 ' 3 ' 3-3 1 3(�` /oo' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal X On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reword_ C�y�-��i�/ l`"[i%t��T� � � �:- ��i' c�'c�T"�iT �1`. .S.v<'�P �2i� /t/�, /�8?c�r1. ✓� Name (PrinK Address for Service �� ii 6 $�-sem®� Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 License Construction Supervisor: Licensed Contruction Supervisor: air Address _ S '. 30o Signature Telephone ev 657— �;— 7(v.tD Not Applicable ❑ 0 G 3 License Number 511010 Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone a i m N 1C.J z M r M r r z G) I t SECTION 4 - WORKERS COMPENSATION (MG.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 bui ingpermit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Descri tion of Proposed Work check all a Ucable New Construction # I Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: a 5,0-ry n /0-W, a e alter rvLM10, Iv Booms ►�.� s .3 s4a,1I Vri ety { SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item SIZE 3dW- Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY SIZE OF FLOOR TIIvMERS 1 ` 1. Building $ O U (a) Building Permit Fee Multiplier DIMENSIONS OF POSTS 2 Electrical r(b) Estimated Total Cost of� Construction '° THICKNESS C '' ll 3 Plumbing _ d Building Permit fee (a) x (b) S dZ; of 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ©7l Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 7b OWNE'R//AAUTHORIZED AGENT DECLARATION I,as (w/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the. best of my knowledge and belief Print of Owner/. Date NO. OF STORIES SIZE 3dW- BASEMENT OR SLAB dc2r SIZE OF FLOOR TIIvMERS 1 ` ND p: s 2 91 Stv ;St 3 SPAN G " DM ENSIONS OF SILLS a X- (b DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS ' : e 2 HEIGHT OF FOUNDATION '° THICKNESS C '' SIZE OF FOOTING 11ole X MATERIAL OF CHIMNEY _ d IS BUILDING ON SOLID OR FILLED LAND S dZ; of IS BUILDING CONNECTED TO NATURAL GAS LINE v� 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 APPLICANT C f� �OJ i''S� CGe PHONE 6Y,_ -7-6_3c,0 LOCATION: Assessor's Nlap Number JOG PARCEL/77 SUBDIVISION 0- .6,a, eG/ /-OO 5 LOT (S) _ STREET LVC13 S / C Z LU O Q p}_ N, ST. NUMBER USE REC MMENDAT ONS OF TOWN AGENTS: CON ERVATION ADMIN TRATOR DATE APPROVED'71 DATE REJECTED i � COMMENTS0 /\,,�1,z �- C TOWN P COMMENTS ER FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm e Z DATE j- /6-0e;, ,5-16 '57D FROM :-MCKENZIE ENGINEERING GROUP,INC PHONE NO. : 6179412662 Jan. 04 2001 11:31AM P3 000 SMt I-15 ,� 4 ~7 r 37, f MM—i 10 `\ 1ss -� AE I Lri� . MM J MM�� � f ( MM--7 mm MMJ4 l 2 LL—i0 —1 TLAND •-- s�r� / . L-s LL_ LL-6 ��.�° / Y--,7�- SOT 29, CBA08,091 SF 7><V vo LOT 28Br S 6�. ` 4 `` -� \ -� r -•'"45,261 SF �- ,�9 0417319 r l / LOT 28C \ . �, E neen 014 10C. J,%,960 SF �c�3/ - CBA-$4,411 SF 'd' ca T ) 94 j;M2 The .Commonwealth of Massachusetts Department of Industrial Accidents Office or Investigations `l Boston, Mass. 02111 !workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone I am a homeowner performing alt work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. 5f Ll e _l)gy Cil', Address :2,31 5o16i-cv7 S/ SSI�ft- 02/ - .City' /k a, 4/Sys Phone T7 O7Jr) 6$7- 5.300 Insurance Co. e- 4 , -aft.. , Policy COmDany name, Address Phone 1-: Insurance Co. Poiicv Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to 31,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine cf ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pain and penal s of perjury that the information provided above is true and correct. Signature /� Date 12 / �A 4i9 557-5760 Print name �/ten /7, Phone % Official use only do not write in this area to be completed by city or town official' City or Town Permifticensi— Building Dept Fl Check if immediate response is required p licensing Board Selectman's Office Contact person: Phone: Health Department Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL C 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Si6tfure oYrermit Applicant 2 /0 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Growth Management Bylaw Exemption Statement Town of North'Andover Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of,Ncrth Andover Growth Management Bylaw. The building applicant shall provide all of the necessar/ information as requested 'below. Name of Applicant on Building Permit (below) Address of Property fcr Perl (below) f 1 /GG / 4?8 LUe As 7-e-,?-, wo, 6 Is �,Aj INI20 and Parcel ;/06 2 Purpose of Application (check below) Phone Number of Applicant: • 14Single Family Two Family i the undersigned applicant for the above property attest that the attached building permit far which this form is completed does comply with the E<EMP-nGN section,8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or ary party to this permit from the requirements of obtaining other permits required prior to the issuance of the Suilding Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only offically_ 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 existents as of the effective date of this by-law, provided that no additional residential unit is created, The lots) were/was created prior to May 6, 1966 are exempt from the provisions of this Seaton 8.7 of the Zoning Ty—law. This application is for dwelling units for low and/or moderate income families or iindividuals, where all of the conaitians of 8.7,6.care met and/or represents Dwelling units for senior residents, where eccupancl of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. 'I This application is a part of a development project which voluntarily agreed to a minimum ,'O% 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 aces and permanently designated as open spate 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 Oeveloper 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 Oevelopment Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per (Development until such Ume as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this E<E'dPTiON. 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 he accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as c: d above. Further I understand that the submittal of misleading and or inaccurate information, or the ecking off of an above item which does not comply, whether done to my knowledge or not, is grounds r refusal by the Building Department to issue a Building Permit. �ture ar wrier r n o gent who signed the Attached Budding Permit Oate form must be -ched to the Building Permit upon application far such permit 1517 APPLICATION FOR SEWER SERVICE CONNECTION 1zeco North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main inG��C�j subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. —Z Owner %�✓�t,%; Contractor 24-2 -S l ?% �Dr l� / �� ,c� Street Address PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to+i* f� 14/ ?h' to make a connection with the sewer main at /, f/�Go �1 1�� C _� riw Street subject to the rules and regulations of the Division of Public Works.. v Inspected by Date Division of Public Works By See back for rules and regulations Address Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to+i* f� 14/ ?h' to make a connection with the sewer main at /, f/�Go �1 1�� C _� riw Street subject to the rules and regulations of the Division of Public Works.. v Inspected by Date Division of Public Works By See back for rules and regulations 9? APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. ,ll Application by the undersigned is hereby made to connect with the town water main in IN G �%( W4�(! c7 .-� sfteet. subject to the rules and regulations of the Division of Public Works. The premises are known as No, or subdivision lot no. j� Owner T Address Contractor Address y c Applicant's Signa re �;- PERMIT TO CONNECT WITH WATER The Board of Public Works hereby grants permission to JN e----',5� L l / � r to make a connection with the water main at �!1 ��' er jidF / Street subject to the rules and regulations of the Division of Public Works. Inspected by Date cam'' Board of Public Works By See back for rules and regulations TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William I-Imurciak, Director Timothy J. 6Yillett Telephone (978) 685-0950 .Staff Engineer Fax (978) 688-9573 Additional conditions for lot 29, Campbell Forest May 12, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lot 29 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for this lot so that the construction of the home can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into the residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. 2. No water service shall be installed into the residence until all offsite sewer facilities are approved by this office. Any violation of t ve conditions will void both water and sewer connection permits. No refunds will be granted. , r s. 6 1e'lv Mesiti Devlop n Printed Name Date 47 -% Division o u is Works Printed Narf Date CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffm Mesiti Dev Group J V111tam H=Miak Director Fax : 978-5578160 Jul 17 2000 13:54 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Mr. Kenneth. Gmndst4 President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Telephone (978) X85-0950 Fax (978) 68&9573 July 14, 2000 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. Grandstaff- The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the foIIowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and facilities in the event ___.._:------- ............ .._... _ that Mesid Development or its agents fad to adequately perform maintenance - of the pumping station Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesio development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very ours, T . J. Wiliim Hmurc E. Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant of nditional use. ei up K eth Gr d idem Date: (WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 'EO , DRIVEWAY PERMIT Telephone (978) 685-6950 Fax (978) 688-9573 DATE 17 LOCATION /?D BUILDER phone OWNERzz C phone 7- S THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. �;.�� ✓rte-����.� a��� -BOARD OF BUILDING REGULATIONS f License: CONSTRUCTION SUPERVISOR . Number: CS 069234 Birthdate: 05/09/1954 ti Expires: 05/09/2002 Tr, no: 23903 Restricted To: 00 ALAN G RUSSELL 400 MAIN ST _ GROVELAND, MA 01834 Administrator I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 2-16-2001 DATE OF PLANS: January 24 , 2001 TITLE: Lot 29 Lincoln PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 594 Your Home = 591 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1752 30.0 0.0 62 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1752 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the a able Standard Design Conditions found in the Code. The HVAC equipmen selec d to heat or cool the building shall be no greater than 1 % o the des* n load as specified in Sections 780CMR 1310 4.4. Builder/ Designer Date d� C?> 0 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 29 Lincoln DATE: 2-16-2001 Bldg.l Dept.1 Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] 1 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ l I Materials and equipment must be identified so that compliance can �I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. i I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or 1 joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be i omitted where gaps are less than 1/8 inch. Duct tape is not ( permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ ) I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I I ) I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) 1 NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 FROM f1CKENZIE ENGINEERING GROUP,INC PHONE NO. : 6179412662 Jan. 04 2001 11:31AM P3 \ ~� SMO -15 c7 - \ / 143 lb j C Ll237. j \ ! 0 MM -1 M_g i l- WETLAND s MM 8 Q ' -- 2 MM -S /. MM -7 MM m f f � f % � l MM—&mm I MMJ4 LL -10 ND � s�rl ` —9 LL-- _ �" �• t -5 Iva - <11 �` § -, ,44 / �ciT 294, l r / f ( a j CBA08,091 SF 1 LOT 28B— , -45,261 $B,45,261 SF LOT 28CEiineenxW iar.�eo_, /0C. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... _...n ........................................ .......1. e C.... ..... has permission to perform........`P to J �- ��, t, �J wiring to the building of.... .......................d- at ......../.J........................ ... ......�.....�. Cy .V �.��...� ..(............ North Andover . Fee ... L . O � Lic. No.:Z�� ... .. ., •••YY••. ......... . _ ... Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 11iL: WLYLLYLVLYYiGfJIL117 fir 1Kga"(,HV3EJ LN Uthuse on1� DEPARMENTOFPUBLICS MY Permit No. BOARD OFFIRE PREMMONREGNAT10M4 5270212:00 Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, $27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / — 6 — 0 / Town of North Andover The undersigned applies for a permit to p Location (Street & Number) Owner or Tenant Owner's Address -m the electrical work described below. To the Is this permit in conjunction with a building permit: Yes No - (Check Appropriate Box) Purpose of Building ! &&)e0(g- Utility Authorization No. %® Existing Service _ Amps / Volts Overhead r7 Underground No. of Meters New Service Amps/piafQVolts Overhead M Underground �i No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 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 I 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 Total Total Pum s Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Locala 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 lns rd=CvRrdr_ PI13M1Dlfietegt»arVnlSdNbsmd7iB&GaoWLam MM Iha%eaametLiabdtyhEL=roePbtityarh>*Can#AdeOpw4iomCmeag crksabqmtfiale4ivilat YES NO lhawst.minedvatidpto�ofsatte8�theO�oaYES [aNO ® If}cuha%edledWYES,pleas mk*thetypeCfaMrdFbyd=iangthe WSURANCE BOND r7 OTFEER O ft=Spe fy) Eamon Date _U 1 Esfin� lvaluedElechiral Wait $ Wakmstazt `7' lo...._.._. /... y Final FIRMNAME� OrV-G Ivy f��c e . U=WN6. 7 C . Lioe>9ee- . GCI /',, n � Btsit�essTeLNa �Q3 g%�%6%d� A �® �dx ���� �1��-L '✓l , /y�� ��r��l`J AkTeLNa-�11�% VS--- ��.. OWNER'S INRJRAI KEWAIVER;IamawatethsttheL=Ne ttteit>suartaecr a substar>tiale:grivale astagt>IIac}byM GertaalLaws andti�atmyaeonths p�app6ratiatwai�es this t�manatt (Please check one) Owner M Agent Telephone No. PERMIT FEE (/ UV Location no 1wel e 10043 )114).e - No. S 3 Date NORTH TOWN OF NORTH ANDOVER Certificate Occupancy $ of E<� �CMUS „,' Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ l /Lj TOTAL $ Check # 15475 Building Inspector „a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING TI3Is Sei#lda :#or U#i' tlseil�I ,�7-777 , BUILDING PERMIT NUMBER: DATE ISSUED: `0? SIGNATURE: oj�ff ` Building Commissionerfi for of Buildings Date SECTION i- SITE INFORMATION 1.1 ^^Prop/errty,Address: rrte�, 17U {�✓ ����UL Vt/�` v 1.2 Assessors Map and Parcel Number: D {� r Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private 0 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ NEC11ON 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Ho P ^ /TC�%s_ 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 ❑ Licensed Construction Supervisor:7,1 License Number Address (� / Expiration Date- ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �E It1 t�0 6yt$ �!2 A1C (-1 O a1 Company Name Al230q 3 Z / Eu/ ! rl WL -16- 6- . N l©!%fy(, � . Registration Number AddressA41- Expiration Date nature Telephone rrnmrnw A rvnDYTi?c lYlMU1VN4ZATTnN !M G T._ r 152 s 25cm61 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 buildingpermit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check all a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) W1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: l N 1geM0 )- 17, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beOFF'ICXAL;USE�Ony Completed by permit applicant § 1. Building Z (a) Building Permit Fee Multiplier 5 0 2 Electrical (b) Estimated Total Cost of Construction a a % 3 3 Plumbing Building Permit fee (a) X (b) aa ` V 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Checkhlumber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. of Owner Date —Signature SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 9 e I) L� G 9 /�. AZ as c 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 a e a Si ature of /A ent Date NO. OF STORIES; SIZE BASEMENT OR SLAB ND SIZE OF FLOOR TBERS I 2 IM3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ✓1. T000)7/I)LOlLC!/E2G[IL � /�iaaaac/Luaet�a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ,. t Number: CS 058245 Birthdate: 03/24/1943 Expires: 03/24/2004 Tr. no: 20021 Restricted: 00 KENNETH B KEEN 21 HEWITT AVE�y N ANDOVER, . MA 01845 Administrator. � r i NONE INPROVENENT CONTRACTOR i Registration 108383 ExPiration� 8/18102 ' �yPg: 08A KEEN CONSIRUCiION CO. i Kenneth Keen G� �o wl Aye Andoyei ADMINISTRATOR Np, IIA 01845 name: LEGw DONS f rt t C-t;0rt ` /LEP V - locations 'Z/ /7 e-tu 11- /9[JE city A 9NQ 6 Uln A&. phone# 272 671'5ZO) C3 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. company name: address: citle phone #. _. Insurance co. ..-T+r.. _.....r•.T+,e.ns+e..... .... .. .. .. }n ��. -'PRN '^�"9C'fri9YiG 9�� po icy .. >,......s ,. ..................... ... - .._, _ :.k 1_.,�,� .'"'i.►aJtd.`«�..na+�.r ,. � 'i.��rwias�w '___ .=�:���+`5r .. C3 I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers'.compensation polices: Failure to secure coverage :is required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 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 under the Ains and penalties of perjury that cite information provided above is true and correct SignatureDate 2 Z Print name kEA)A1 E to t3 • t= B"K'J" .. -1_. •phone # official use only do not write in this area to be completed by city or town official city or town: permit/license # nBuilding Department pLii:eosingBdard " O check if immediate response is required C]Selectmen's Once pHealth Department contact person: phone #; nOther (remed ;mc rtA) The Commonwealth of Massachusetts ' = -_=, Department of Industrial Accidents !� ►� office 0//nYesl%gati0ns 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit name: LEGw DONS f rt t C-t;0rt ` /LEP V - locations 'Z/ /7 e-tu 11- /9[JE city A 9NQ 6 Uln A&. phone# 272 671'5ZO) C3 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. company name: address: citle phone #. _. Insurance co. ..-T+r.. _.....r•.T+,e.ns+e..... .... .. .. .. }n ��. -'PRN '^�"9C'fri9YiG 9�� po icy .. >,......s ,. ..................... ... - .._, _ :.k 1_.,�,� .'"'i.►aJtd.`«�..na+�.r ,. � 'i.��rwias�w '___ .=�:���+`5r .. C3 I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers'.compensation polices: Failure to secure coverage :is required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 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 under the Ains and penalties of perjury that cite information provided above is true and correct SignatureDate 2 Z Print name kEA)A1 E to t3 • t= B"K'J" .. -1_. •phone # official use only do not write in this area to be completed by city or town official city or town: permit/license # nBuilding Department pLii:eosingBdard " O check if immediate response is required C]Selectmen's Once pHealth Department contact person: phone #; nOther (remed ;mc rtA) KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Linton, David & Hope 190 Webster Woods Ln. N. Andover, MA 01845 (978) 681-9136 Contract #1521: Appendix A Date:04/19/02 Remodel basement: • Frame partition walls in basement to create @ 600 sq. ft. of finished area • Create unfinished closets near water meters & HVAC • Create finished closets near electrical panel & under stairs • Create % bath near HVAC room • Insulate exterior walls • Hang blueboard & skimcoat plaster • Supply & install four 6 -panel hollow core textured doors & one double door unit • Supply & install trim on doors & baseboard to match existing • Supply & install 2'x 2' revealed edge suspended ceiling throughout finished area • Paint walls & trim (2 coat finish, 2 neutral colors) • Supply & install 2 vinyl hopper windows to replace existing • Supply & install 1 central vacuum outlet • Supply & install ceramic tile in entry( to stairs) & in bath($140.00 material allowance) • Supply & install carpet in remainder of finished area including stairs ($1500.00 installed allowance) Plumbing: • Supply & install plumbing and fixtures for '/z bath including pump toilet, 24" vanity & faux marble one piece vanity top • Move 1 water meter • Cap off existing future bath pipes in floor Electrical: • Supply & install 12 recessed ceiling light fixtures • Supply & install outlets & switching to code ( with ceiling lights on dimmers) • Move cable junction box to electrical panel area • Supply & install 1 cat -5 phone outlet & 1 cable outlet using existing cable Total Price: $22,350.00 (twenty two thousand three hundred fifty dollars) Price does not include cost of permits, heat, shower or plaster ceilinF. All extras to be paid in full when ordered. ' C _ , .. .t.' $ -. - , 3 .. _ ... .. _ . _. , ;- �� �� � �I � C/) M m C/) 0 CH CD CD O CL r � r•�F CD =z 0.� cr CD w1,FRLEJ co Cl) Cl) CD r�V CD a vi* CD W C Ccl C ?�O of o -•�,oQw ao�a y ap m C'7 o ymam M= 2 ai O ,'r w m H T mG�� m CD O m y C y N Ohm: o = > >� O �� G toO O O O LA. {�� W .�O �_Q) 1 •Q C ay= 2 R a CO C � �L a^`.. m ? �6 C ® N . C d CD l CD ca o 0 g�ad d cr►•V N `� C ) to �. m gd VVV -g :a CO 0 0 z Woho �mCD 2 L , ;wy r. cn CD d o CDI�� d �a) R . o rZco,0 r; C� O = LA oCD 0 0cn 9 z cn n n x C wG `o O � � � G �? -p G CL b7 c a� n O a O 4 0 c 3-741Date.... . q - °`t"`° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING r Pis certifies that ....... C ......../,— ................ hhs permission to perform ......................................... ,.wiring in the building of ................... ...'?..5. t .. .............................................. at .........1..�U......... Q.I T.North ove /`�'� C. . Lic. No..1..... ELECTRICAL INSPECTOR f`r Check # _>_� =rte .r.: wtrltrtvt rrilfltlLl VCLYl({(J;Office Use only DOARTA127VT OFPUBL ICS9MY BOAMOFFMPJ?LwF;l1rI701V Permit No. 7 �OluSR70i 212* Occupancy &"Fees Checked APPUCATTONFOR PEPJffTO MFORMELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 / (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date y — 2,�T ` D Town of North Andover The undersigned applies for a permit to perform the electrical work Location (Street & Number)Ito Owner or Tenant r • -, A Owner's Address below. fJ To the Inspector of Wires: s this permit in conjunctions with. a building it: Yes No (Check Appropriate Box) 'urpose of Building f < < SLe A,.�� j Utili Authorization No. :xisting Service, �� Amps ZQ/ � tilts Overhead � —� UndergrWW No. of Meters ew Service Amps / Vohs U -- —�Q nderground E No. of Meters umber of Feeders and Ampacity Overhead----� kation andWature ofProposed Electrical Work to. of Lighting;0utltts No. of Hot Tubs 01 No. of 00 Buoers Na bmi"meGdpoeitfsatnebt ZON= YO MND r �lebasc L l - (MW, . d�l$0)tl6tiF�� 5 �4 4V Udwapiwbt �ha►cddedoedYF^� YES � NO �. L- BumTdNa `i 7 ilI�SURANCEW AILM11% ANE[2; Iana►�ratethattheLim�edioes not tdnvetbe' ��sP�wai�rsthisrt�cgmerderr.°��oe°°►a-�e°r�sas��b!'�sCsdaalL3ws neck one) Owner � Agent Telephone No. PERMIT FEE No. of Gas Bumen of Ranges No. of Air Coad. TOW FME ALARMS No. ofZooEs of Dispaards No. of Heat: Tons Toal Tot of DisBwdshers Space Ares Neat;Ag Iota kw, . . ILW bevices ""��■ Nu ofSotntdiigiDerices- No, ofSe(f�apted ofDiyer4H,;ater3 ►f Water ting.[kvicea i KR►il)ev t Muoici1W err SEW of Na oCo�tiow . Zcge Tubsof Bailasis Motors Toad HP bmi"meGdpoeitfsatnebt ZON= YO MND r �lebasc L l - (MW, . d�l$0)tl6tiF�� 5 �4 4V Udwapiwbt �ha►cddedoedYF^� YES � NO �. L- BumTdNa `i 7 ilI�SURANCEW AILM11% ANE[2; Iana►�ratethattheLim�edioes not tdnvetbe' ��sP�wai�rsthisrt�cgmerderr.°��oe°°►a-�e°r�sas��b!'�sCsdaalL3ws neck one) Owner � Agent Telephone No. PERMIT FEE Date... ".0R':'4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ��1+O,�no SSACMUSE� �_ ..... ... .. .. . . A R This certifies that ......... /1.. ....... . has permission to perform . `. ...................... . .. plumbing int a buildings of ................................. . at . � ..................... �!6-..... , North Andover, Mass. Fee2s� .... Lie. No. P?743. ...... ............... PIUA. G INSPECTOR Check # 5235 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS -� Date : �� �`�� C Building Location M �% b'/�4 l iLbo�• tOwners Name Z%� Permit # Amount Type of Occupancy New Renovation Replacement 1:1 Plans Submitted Yes No ❑ FIXTURES (Print or type) Check one: Certificate Installing Company Name i I �S� ����� ��t Corp. Address d f=A-A z min � Partner. Business Te ep one 978 -- 2-Y6 - Ysn ? 13—Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy© Other type of indemnity El ❑ 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 IOwner 11 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 undeiZermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing 4de and er-142 of the General Laws. City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License 197er ❑ icense NumDer Master Journeyman