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HomeMy WebLinkAboutMiscellaneous - 192 CARTER FIELD ROAD 4/30/2018 lei �Q l 1 Date.....V.`.. .....:.D X f NORTH� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 ,44 t i r �,SSACMUS� �v2 r" This certifies that ��;.1..� �./C has permission to perform .L�.CU.: .. wiring in the building of...V....... .'l/.................................... 2�eG��— ........................................,North Andover,Mass. t `� � ' ` Lic.No.... 3 '! Fee..... ...... �'�r......�-,r.-............. ........�J.. ... .... ' T f Check # TR ELECICAL INSPECTO�� 2.,3 ©e36 8009 (,onv„vnuiraiLh o�//'Jaisaciru�al�i Official Use Only �] Perr,^.it No. 50eqC7 _l..J�Parfmszf`r0}ire��-visa ---- Occupancy and Fee Checked BOARQ,OF FIRE PREVENTION REGULATIONS (Rcv. 1/07] Leave blank) APPLICAT.t,ON FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE FR2' rrIN.'✓K OR TYPE ALL INFORMATION Date: o`j o2 U Uhf Cit, or Towyn of: r �N To the Inspector of Wires: By this applicadon the undersigned gives notice of his or her intention to.perform the electrical work described below. Location (Street&Number) Owner or Te:ant % ��tQa7 /�}1 rl /l��V� S_ ,LLJI Telephone Owner's Address 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 Sew,Acc -_ Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters _ Number of reede:-s ziad Ampacity Location and Nature of Proposed Electrical Work: a e-Clur t 7� Completion o the followinz table m�z be waived by the Inspector of'.'fires. j No. of Recessed'Lu:;rinaires No.of CeiL-Susp.(Paddle)Fans o.o ota --j '14 i Transformers KVA 11 No.of i-urnin-.irc OvAlets No.of Hot TubsKVA Generators No. of Lumin7ir�•s Swimming Pool Above ❑ n- t o.o Emergency :g ting _---- Qrnd. ornd. ❑ Battery Units - ) No.of Receptar.ie Outlets No.of Oil Burners FIRE ALARMS No.of Zones::: " No.of Switches No.of Gas Burners �ivo.of Detection an 1 Initiating Devices. No.of Ran es No.of Air Cond.i; Tons ,No.of Alerting Devices` No.of Waste Disposers eat Pump I Number 11 ous� __ o. o Je -Contained Totals: - (Detection/Alertin4 Devices No.of Dishwashers Space/Area Heating KWLoral Municipal ❑ Other _ onnec _ - No.of Dryers Heating Appliances KW ec : o. o titer KW o.o. o_o o.oT evices or E uivalent %i_f Heaters Ballasts Data Wiring: Suns No.of Devices or Eui valent No. Hydromassage Bathtubs No.of Motors Total HP r e ecornmuntcattons. iring: _ q No.of Devices or E uivalent OTHER__ /a 79. Attach additional derail if desired or as required by t.5e/rrpeclor of Wiles. Estimated Value of Electrical Work: (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 cquivalenL 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:) !certif ur,der the penins and penalties ofperjury,that the information on this application it true and complete. FIRM NAME:_ P�,b-T S2C-l_irlT Zc_rV(CPS LIC. NO.: / S33 e Licensee: t.471,-,417 y/02- Si nature I P O ^ =� r7. / C.N O.: (If applicable, enter'"c empt"in the lie erase number line.) Bus-.Tel.No:: 3 Address: [? L l IJT-n `Ij�_ ��(S �f� 0.� 9 — AIL Tel.No.s S� "Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. S L L, -,_ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by iaw. By r,.y signature below, l hereby waive this requirement. I am the(check one)❑ owner ❑ owner's a-enA. Owner/Agent Signature `_—_� Telephone No. PERMIT.FE: _ . � .- -. � . .--: • . . - _ �` �� -Pam' ���: -=_ ,: . . Department of Public S< One Ashburton Place, Rm 1' ' Boston, Isla 021.08-1618 License: CERTIFICATE OF CLEARANCE Number: SS CC 002577 Expires: 12/23!2009 F� WILLIAM M TAYLOR 1R 18 CLINTON DR HOLLIS, NH 03049 Tr.no: 89 Keep top fol DPS-CAI C, 5W-07/07-PC8490 I .'.zx ✓�c ��nr�rrnoirrrMrr�/� r���•�(.rrJJrrr�uJe«J � , DEPARTMENT OF PUBLIC SAFETY CERTIFICATE OF CLEARANCE ._ :..:.:::.. ::.:.........:.....:........ .. ....,. ugExpires: umber SS CC 00257712/2 9 3/200 Tr. no: 893.0 I S-License: ADT SECURITY SERVICES I WILLIAM M TAYLOR JR ' 18 CLINTON DR HOLLIS. NH 03049 = CommSsslon..r e='7 DIG SAFE CALLLL CERI'1 ER: (Q . _ -. .. .... ,�• � is COMMONWEALTH OF MASSACHUSETTS. REGISTERED STEM TECHNICIAN _ ISSUES THIS LICENSE TO L :AM TAYLOR JR WYLM 2 27 STONEHENGE RD r. a AP53-2 .. .... .. _ � 437 _ Y 6 NH _ 03 I L70NOONDERRY 0731/10 29.1168 10099 U ., - Date.......... .........1..... AORTPI 3rp��,r���^•���OpL TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUSE� This certifies that ..... ....... .......... .... ......................... ..�'...U....'.°s... ' -Pw � viYl P has permission to perform ........................ . .............................................. wiring in the building of....... ....... L ��/'mac . �� ..................................... . .... .... . D l F ... rth AndoY.erx ... .. . . //yy}} // . .. ..... Fee....2 ... Lic.No.!! I.3 .................- ... ...�...�f..................... t� /-I LECTRICAL INSPECTOR Check # �`� `/ 5457 TRE COMMONWFALTHOFMASSACHUSL+TIS Office Use only D0MRTAI&WOFPUBL CSONY7 c1 Permit No. BiOARDOFFMPREVEN ONRBGUlAT7OM5rOMl2.0 <, Occupancy&Fees Checked �APPLICA77ONFOR PERNHT ,/,PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 �. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date O Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the lectric' work described below. Location(Street&Number) Ce4 - Owner or Tenant —l�� c e—e Est_p M6, — Gc w Owner's Address Z 1 LA %�'� A, Isthis permit in conjunction with a building permit: Yes N a (Check Appropriate Box) Purpose of Building 4&-Se��ti, � Utility Authorization No. 3 Existing Service AmpsVolts Overhead Underground No.of Meters New Service ZOO Amps o/Z Y,(Volts Overhead Underground No.of Meters Number of Feeders and Ampacity 0 Location and Nature of Proposed Electrical Work Wk K.r'' U2,)S No.oC Lighting Outlets No.of Hot Tubs No.of Transformers Total V KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners 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 11ishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of 1p"ers Heating Devices KW Local Municipal Other 4 ID Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydra Massage Tubs No.of Motors Total HP OTHER' hmaarreCo�er�Pasoan[e�lheregtriterr�eds >setlsGataalL3ws M- Iha�eaa�aYliabtTlyhnuatoelblicyincludelgCornpke,� txflsWbstari quivaimt YES NO Ihavesubnitiedvddpoafofsam oDdrOktiee YES ff}vulmveched�dl'ES,pleaseindra�thetypeoferneageth' NSURANCE ' ` J `BOND O IEREvimfim(Ple�ve Spacc y) 1.1..1 f)W FsWMMd VakueofF"K3l Wok$ W0&0 A3t3 0 Ralgtl �^'�w ---- F1W FIRMNAME '"t L ����C-4-C� � c S Lmff eNo. Lcatsae C(, sigu,te LimwNo t 2. b 5- -� Btnel�sTd No. (�, iS Y Z 3 6� Adim. P� � 1 P�"Is Ty cJ. �� "i�31�. ,yl-1 Z�3 fC��Alt Td No. 11-2 OWTI RSMURANCEWAMY,l awatedUtheL=Wdmnothatelherma.,.,r,g,c,rilsRkg@rialNMldbtastegxWbyMasxhmoI C=WdIIaws anddomysignamcn ihispemitapplicatign w4yes ft m4miemn fI (Please check one) Owner Agent Telephone No. PERMIT FEE$ ��0 , signature or Owner or Agent TBE COMMONWE4UHOFAIASSACHUSE77S Office Use only DEPARTA10 'OFPE1RW ,.SAFETY Permit No. V / ✓� BOARDOFFWPREVMMNR AT70NS527(�IIlel�� Occupancy&Fees Checked 0 APPLICA77ONFOR PERMIT `PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date rJ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform thealectricorkdescribed below. Location(Street 8tNumber) � Z ( C,c_� G�r / - � �'1 }. '�. Owner or Tenant ,n. Lac <-1 L �-a M E,tib •^ ''� Owner's Address Z`'�`s �..�.� � iL_r, .._, �- r1,�'-,) �:%; ;„,,,•�-�.. i Is this permit in conjunction with a building permit: Yes[:3--No (Check Appropriate Box) Purpose of Building L)E A-IT) Utility Authorization No. 3 Existing Service Amps� Volts Overhead Underground No.of Meters e Zo 0 Amps o/2`t(Nolts Overhead Underground No.of Meters Feeders and Ampacity d Nature of Proposed Electrical Work WL rl F CJS ting Outlets No.of Hot Tubs No.of Transformers Total KVA ting Fixtures Swimming Pool Above Below Generators KVA round M ground ri eptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units itch Outlets No.of Gas Burners ges No.of Air Cond. Total FIRE ALARMS No.of Zonefa s Tons sposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices shwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices E1s Heating Devices KW Local Municipal Other Connections ater Heaters KW No.of No.of Signs Bailasis ro Massage Tubs No.of Motors Total HP C A>rsuatbthetegtuernafsofMassad><>sensGalaldL3ws o LiabkLaua mPo yaai>"Waluiva n YES [D---NO I1meaftnodvdidpoofafsame1Ddr011=YES ffyauhaveche kDdYFS,pk=iftVAxtfanwWby MRANM Jy BOM ED a nIER 0 s y) Estur*dVakrdE1=cdWedc$ wod(OD's tt 3 o hlswionD*Regllesidd Rou0 FuW Sgredundir afpaW- FIRMNAME "'t L -�-� `J c S LmwNa /-1 fb Licensee /"�e GKA E(, til Sigraw v Li..M Z b n BasiwTelNa 6661-Y2 36& �J A`4iraa 2j 3 `�OY �jA1t7e.Na T7 $ � 1 ..v� � OWI�RSINSURAN:EWAIVFR;I awaedUdIeLio WdotsmthMdrirs=aloemmageorisatsmridepvabtasmgwidby Ca>nWLaws anddamyslgamon ispwritappGcadonwavesftlewimnat CI (Please check one) Owner 0 Agent7r� Telephone No. PERMIT FEE$X-�;7 ' igna ure of Owner or gen o° . s "gtid u a �9'"q,..> "•-tom SSACHU- - CERTIFICATE OF UsE & OCCUPANCY TOWN OF NORTH ANIDOVE Building Permit Number Date d-aJ -0S ,THIS CERTIFIES THAT .THE BUILDING LOCATED ON �D 7 / Y /�f o2 L'i4 X12 Fig iot' /2nP MAY BE OCCUPIED AS EA-vVl r j y ::/2cz, -, % IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO 7 A?ag �i �� U E' C� Building Inspector NORTH TOINM of No. �/ =_ _ =o� dower, Mass., ifiz3�� O COC LA MIC ME WICK S RATE D V BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System THIS CERTIFIES THAT 7'.je.la............ BUILDING INSPECTOR ........ .� WationAW has permission 4o erect..... .......... ........ .... b id . .../ . . .4 . .. .....IC.....................�....E.........�............. Rough � .9, moII .. .......... .. himneyto be occu ied as..I$ R .......... f a6jo provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final �� R— 3,4 r��s this office, and to the provisions of the Codes and BX;# s relating to the In spe ion, Alteration and Construction of Buildings in the Town of North Andover. �� �D PLUMBING INSPECTOR S VIOLATION of the Zoning or Building Regulations Voids this Permit. h��—l�--.-7� PERMIT EXPIRES IN 6 MONTHS ?�a---~� LECTRIC INS E oe UNLESS CONSTRUCIVY SbkRTb 0 B DING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove �F� 727 No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner , VV" Street No. SEE REVERSE SIDE Smoke Det. lr' Location NO �'t ` 1 ARAM pTf et No. Date NORTH TOWN OF NORTH ANDOVER � • 09 s i � Certificate of Occupancy $ t e•b.�:'� • a 1'7Js„'O Eta' Building/Frame Permit Fee $ �CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Step S'0 Check # 17510 {�----- U Building Inspector CARVER FIELD ROAD 0=09°59'1 1 " NOTES: R=40.00' L=6.97' 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS A=92`22,18„ TAKEN FROM A PLAN ENTITLED SPECIAL PERMIT AND LOT 13 R=60.00' k DEFINITIVE SUBDIVISION PLAN, CARTER FIELDS L=96.73' SUBDIVISION; SCALE: 1 " = 40'; DATED: AUGUST 9, 2002 (rev. 1/17/03); PREPARED BY THIS OFFICE. 2) THE INTENT OF THIS NIS TO O BUILT LOCATION THE EFOUNDATIONONLY.W THEC'y AS— BUILT I9� ce -def F I '<?V N�31 22.71' C\ OUNDA ON ^ I HEREBY CERTIFY THAT -THE FOUNDATION SHOWN HEREON \\ 0 IS THE RESULT OF A FIELD SURVEY MADE ON \ ^�, 21._13' JULY 7, 2004. \\ ro \\ LOT 14 N7 \\ LOT 15 ��� CHRISTDPtER ym �� FRANCHER 07, Ca No. 36116 CO \\ ^ LICENSED LAND SURVEYOR DATE CERTIFIED FOUNDATION PLAN E OPEN SPACE �� \ ID \ CARTER FIELDS SUBDIVISION — LOT 14 7�' \ CARTER FIELD ROAD NORTH ANDOVER, MASSACHUSETTS PREPARED FOR n TARA LEIGH DEVELOPMENT, LLC 185 HICKORY HILL ROAD NORTH ANDOVER, MASSACHUSETTS GRAPHIC SCALE — — — — 103 Stiles Road, Suite One a 0 1530 60 Salem. New�603) 893P0720 0shire 3079 o MHF Design Consultants, Inc. ENGINEERS•PLANNERS•SURVEYORS U SCALE: 1" = 30' DATE: JULY 13, 2004 DRAWING Y (IN FEET) NAME NO. DESCRIPTION BY DATE DRAWN BY: CHECKED BY: PROJECT NO. t 1 inch = 30 ft. REVISIONS JAC CMF 110900 1109ABF.DWG t Location Jj CAHC9 F(,--IcP Pd No. Date 7 NORTH TOWN OF NORTH ANDOVER 4 i � Certificate of Occupancy $ ��J'�•NUE<� Building/Frame Permit Fee $ 00 ^GS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r 0. Check # �I r 17422 A� � building Inspector ry TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .>: ,...;.. ,. a.. -�IL�'�C>13dR�t►r�0lf�iclR1�8�`�nI 7; F - '" s �, �� �� �" BUILDING PERMIT NUMBER. DATE ISSUED. SIGNATURE: �L Buildin ommissioner/I for of Bu Idinks Date Z SECTION I-SITE INFORMATION O 1.1 Property tAddres;�Wz 1.2 Assessors Map and Parcel Number: t4r y r., 4l a ZZ Map Number Parcel Number N, _�S 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I Lot Area f) Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided 3 Zo � v 1.7 Water Supply M.G.L.C.40. 54) 1.3. Flood Zone Information: , .8 S Overage Disposal System: Public Pmfate ❑ Zone Outside Flood Zone jK Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record r�3� Name(Print) Address for Service Telephone 2.2 Owner of Record: i Name Print Address for Service: O MI Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licens "Construction S/u.�perviso/rf� _'n,, Not Applicable ❑ s 1/, !tel� t'�/ Licensed Construction Supervisor: O / r-r A/ ( /) � License Number M (- �/. /7' AddressA f D 79—,47/"Z43� E1:pirattonEfate S Sig re Telephone r r 3.2 Registered Home Improvement Contractor Not Applicable ❑ y Comparyy Name m Registration Number r Address r Expiration Date ^ Signature Telephone YI SECTION 4-WORKERS-COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes....... No.......❑ I' SECTION 5 Descri tion of Proposed Work check allgppUcable New ConstructionA., Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ t. Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: V- 1300 ` &(R*"\ 4-- Arca SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated CostDollar ( )to be OFFICIAL;USE ONLY Completed by permit a licant 1. Building (a) Building Permit Fee Z Z 4 ►-M ` Multiplier 32 Electrical 4M27. (b) Estimated Total Cost of _ � 1 Construction 3 3 Plumbin /2 Building Permit fee(a)s (b) � 4 Mechanical(HVAC) 2. G py, ' U/a Q S- 5 Fire Protection L/ ,,00 6 Total 1+2+3+4+5) Z6Z D . I Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR'CONTRACTOR APPLIES OR BUILDING PERMIT 1, S as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf:in all afters relative tow uthorized by this building permit applicati 1 IAel Si ire of Owner ((00 6 Dat SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I' Z41 as Owner/Authorized Agent of subject property Here6v declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 2.) z Print Name 6 / doh Si e of Owner/A ent Date NO. OF STORIES SIZE Z x 3Z 13ASEMENT OR SLAB ,Id SIZE OF FLOOR TIMBERS 1 2 p 2' (� 3 SPAN DIMENSIONS OF SILLS a Zx Q DIMENSIONS OF POSTS ,S DIMENSIONS OF GIRDERS p I h-IG[IT OF FOUNDATION THICKNESS /p SIZE OF FOOTING ZG�' X MATERIAL,OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND S f IS BUILDING CONNECTED TO NATURAL GAS LINE j� FORM - U - LOT RELEASE FORM INSTRUCTIONS_ This form is used.to verify that all necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and`or landowner from compliance with any applicable requirements. w.■wwaww-■awwswws-■wrws�w�tsw■wwwwwsww•asswssssswwEwsw•swswwrw.sswswewsswwssswas APPLICANT 7a'ra Le b A.Pp✓ed LLC PHONE ASSESSORS MAP NUMBER—J,^ - &Z LOT NUMBER 7 4- 13S SUBDIVISION �l c '�(�C LOT NUMBER In U STREET Ca r�� Fi'�(�r teoca STREET NUMBER /2 ....*w w:....w...w...w w....w.. OFFICIAL USCONLY w................ w w w w.. ....s............ws.sw-wss■w■s......�wswswss-s.....w...w..........................s..,....man noun RECO ONS OF TOWN AGENTS �wwwwws ■ .ssaswU....s..A4 Le,� .... ....sww....... 7006 swwss■ DATE APPROVED CON ERVATION ADMINISTRAT DATE REJECTED COMMENTS NAA TOWN DATE APPROVED P DATE REJECTED COMMENTS S DATE APPROVED FOOD INSPECTO -HEALTH DATE REJECTED DATE APPROVED �d t;e S E OR- DATE REJECTED COMMENTS PUBLIC WORDS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT `2 9 DTE APPROVED 0/7- /y- d y FIRE PART 6 r S fia7j DATE REJECTED CONDA ENTS RECEIVED BY BUILDING INSPECTOR -- DATE I K Ag 4j, \ ag,fi�.t3.� ov/ C 1t -D RoAn ID 4.0 t . S75'34'23'*W 247.74' 1 t Os P0901t1D foUUDA-TwN/S1Te PLN a to L oT i Lt CAT E&F`IEt.ID Ro A-D 2. LAO T AR A L0 Gta b 6v At,o PkkP- Nj LSC 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 exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw.The applicant shall provide all of the necessary information as requested below. CQ Permit AprAcant I Property address Map/Parcel -178-6T 7-L6 3 .r Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for.on the above lot,in the building permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for building permit for the enlargement,restoration or reconstruction of a dwelling in. existence as of the effective date of this bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6,1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved 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 and 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 a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN JSUBNUTTAL ED ABOVE. FURTHER I UNDERSTAND THAT THSLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPNOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FO REFUSAL BYARTMINT TO ISSUE A BING ERMIT. / V APP TS SIGNATURE DATE Tflf�TORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION i W The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: J L city k. -A4 e A4 Phone # —0 2-26Yr I am a homeowner pdrforming 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 City: Phone#: Insurance Co. Policy# Company name: Address City Phone#: Insurance Co. Policy# 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$1,500.00 and/or one years'imprisonment assvell.as_civil..penaltiesin the form ofa_STO WORK_ORDER..and_a.fine-of-(.$1D0.00)a day against-me. I understand that a copy of this statement may be forwarded to the Office nv tigations of the DIA for coverage verification. !do hereby certify under the pains an lenalties of perjury that the i rmati provided above is true and correct. Signature Date Print name ) Phone#4I Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required p Licensing Board Selectman's Office Contact person: Phone#: E, Health Department Other Town of North Andover Planning Board � p�" This form represents the schedule for allowing the following lots to be considered as eligible for l�ti permits under the Town of North Andover Management by-law Section 8.7 of the Zoning by-law. ? to 8.7 this Development Schedule must be filed in the Registry of Deeds and be referenced on the deed of each of the lots below and be filed with the Planning Board prior to the issuance of any buildi5a( >"gyp' permit for construction. , Nam�andAddress of A licant for Lots: Name of Develo ment: At� D@U&LO(?mk '1 LLC C RRT t R Fl£t,L�S 185 H\(�Ui� H 1 LL ROhD (oFF SRAbFGftb$TAFf7'l NORTrI t,,JbootIMA O i8`y Map and Parcel of Original: M h P G 2 L61 z l Date of Application for Lot(s) Division: AUGUS-T 9 2002 Lots Covered by this Schedule l —k-4 -J The Planning Board by their signature below,or a signature of a duly authorized repres.native, do hereby establish for the above named development the following Development Schedule for the purpose of Section 8.7 of the Growth management By-Law. The applicant,their assignees,successors and or subsequent property owners shall conform to the following schedule that limits the eligibility of the following lots for building permits. This form must be filed in the Registry of Deeds by the property owner orrepresentative and be referenced on each deed for each of the following lots. Such deed reference for the deed of each lot shall at minimum reference the book and page in which this Development Schedule is filed and contain the language;'`This lot is subject to a Development Schedule pursuant to the Town of North Andover Zoning �.. By-Law all owners, representatives, and future purchasers should avail themselves of said restriction by reviewing the approved Development Schedule as filed in Book insert here and Page insert here. The fact that a lot is eligible for a building permit is subject to the limitation of the number of building permits per- year eryear pursuant to section 8.72d of the Zoning By-Law." the Planning Board hereby schedule the lot(s) for the above development as follows: Year Eligible dumber of Lots Building Office Use Building Office Use Elib,ible Date Lot Elic_ibility Notes i COmr)letely Utilized v 2 ac3 FY 2oori i I Signa f Pl g,,Board member or Authorized Representative Date SignatuTe of Property Own or Authorize esentative Date/4 7 ' I Y� �: ✓xe - � BOARD pF " 'License: CONSTRUCTION REGULATIONS NSTRUCTION SUPERVISOR Number-CS. 055417 Birthdate 04105/4960 Ezptres�iO4/05/2QQ6 Tr.no: 21033 Resthicted DQs THOMAS D ZAHORUPK6 121 CARTERFIELD R'D N ANDOVER, MA 01845 Acting c . mis oner i Permit Number MECcheck Compliance Report Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename: C:\Program Files\Check\MECcheck\Lot 14 Carter Fields.cck TITLE:Lot 14,#192 Carter Field Road CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE:06/30/04 DATE OF PLANS: 5/25/04 PROJECT INFORMATION: CArter Fields COMPANY INFORMATION: Tara Leigh Development LLC COMPLIANCE:Passes Maximum UA=496 Your Home=448 9.7%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1588 0.0 30.0 49 Wall 1: Wood Frame, 16"o.c. 2584 0.0 19.0 174 Window 1: Vinyl Frame,Double Pane with Low-E 446 0.340 152 Door 1: Solid 42 0.340 14 Floor 1: All-Wood Joist/Truss,Over Unconditioned Space 1372 0.0 19.0 59 Furnace 1:Forced Hot Air,90 AFUE Air Conditioner 1:Electric Central Air, 11 SEER COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications,and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the desi ad as specifi Sections 780CU R 1310 anj J A. Builder/Designer Date !/ l<<! i I MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lb DATE: 06/30/04 TITLE:Lot 14,#192 Carter Field Road Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 continuous insulation Comments: I Above-Grade Walls: [ ] I 1. Wall 1: Wood Frame, 16"o.c.,R-19.0 continuous insulation Comments: I Windows: [ ] I 1. Window 1: Vinyl Frame,Double Pane with Low-E,U-factor:0.340 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: I Doors: [ ] I 1. Door 1: Solid,U-factor: 0.340 Comments: I Floors: [ ] I 1. Floor 1: All-Wood Joist/Truss,Over Unconditioned Space,R-19.0 continuous insulation Comments: I Heating and Cooling Equipment: [ ] I 1. Furnace 1:Forced Hot Air,90 AFUE or higher Make and Model Number [ ] I 2. Air Conditioner 1:Electric Central Air, 11 SEER or higher Make and Model Number I Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air I leakage must be sealed. [ ] I When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfin(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R-values,glazing U-factors,and heating and cooling equipment efficiency must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Ducts shall be insulated per Table J4.4.7.1. I Duct Construction: [ ] I All accessible joints, seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ l I HVAC piping conveying fluids above 120°F or chilled fluids below 55°F must be insulated to the levels in Table 2. Y Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness.in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range(F) 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) Town of North Andover NORTH q Building Department O 400 Osgood Street 3� g�: _ '' ° OL North Andover Ma 01845 ►0 - 1K (978) 688-9545 Fax (978) 688-9542 ��SSACHVS APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS 19 ✓ LOT NUMBER / SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION TEN 10 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST4BE COMPLETE TTHIN THIS TIME FRAME. A RE-INSPECTION FEE OF ENTY- ( 5.)DOLLARS WILL BE CHARGED IF THE STRUCTURE S NOT MEE L APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. —WATER METER, DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURE/DPW AUTHORIZATION I I RTH own o 4Andover No. o dover, Mass., ` /3m /Ga dog) C' T �-- LAKE T COC HICHEMCK V ORATED P'V 5 �sSACHUS�� P T FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ....7 .ra.........X A.........Pr................ .. ..`........................................ has permission to excavate and our f undation at ��� �V eA/�f4*r ' a/d Rc� . .................................... . ...................... .... .......................... p Roo p �.� aA7I.I.A.A4,11 a •for the purpose of.. ......_...:........ .... ............ .,.....................:................... .................... The person accepting this permit must return to the office of the Building Inspector a certified D10t Dian show of building thereon before Foundatio-n-will be inspected. ` a/42 o a 'STL VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. WUPERWIT FEE .. .... .........LASS FD FEE*'* ...... .EE REVERSE SIDE ............ DUE-FRA E PERMIT$ BUILDING INSPECTOR NORTH Town of Andover O -.acv,,.w-., l :•4••. �'7.�t No. A dover, Mass., COCHICHEWICK A. S�S44 RATED V ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT........ ............4.10! . ... �j 7> v• em BUILDING INSPECTOR I ****"**'*...... CA ��ie maJ anon V60 has permission to erect.................................. ..... b ddm s on ... Q............ .......... ... ....... .............................. Rough to be occupied as.. .. `� 1,1 � ���'' Chimney p .� ........................ ......................................................... 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 In tion, Alteration and Construction of Buildings in the Town of North Andover. s �D s PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR -UNLESS CONSTRUCTI S T � Rough ...... .................. .... ...... . . Service ipor JAW. B LDING 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. r f J 111 N � LHI EE - M TF FA 1. 1-1-F-A 1-1 -i I ft ]] o LF i f I 1- .0 Lam1�► lffn zi L IA LI1JI_-1 17� STRIP-ET ELEVXTl J LOT 14, #192 CARTER FIELD ROAD NORTH ANDOVER, MA 01845 SCALE: 1/4" = 1'0" DATE: 5/25/04 TARA LEIGH DEVELOPMENT LLC NORTH ANDOVER, MA 01845 '7-0 -d • D � K�TCN�tJ -• 0 6`0 N ARcw 0 v 61�R�6P LIVING I, � .il1N�NG � cNczA6+, 3 N II F 0YER I i I I ply ' G x OIt O N � t,ovER£D PoRchl 2'Y p'`B 1- 1 R ST :�L.00 K P L.N�11 LOT 149 #192 CARTER FIELD ROAD NORTH ANDOVER, MA 01845 SCALE: 1/8" = 110" DATE: 5/25/04 TA.RA.LEIGH DEVELOPMENT LLC NORTH ANDOVER, MA 01845 AL B z ilEtppaA'S 0 O l3fbRpou��{ [ D i � �-X pA►�S�0�.1 . t � �AszeR ii ops is -10 i i f S ECo"D- T-Lo o tZ PLAN LOT 149 #192 CARTER FIELD ROAD NORTH ANDOVER, MA 01845 SCALE: 1/8" = 1'0" DATE: 5/25/04 TARA LEIGH DEVELOPMENT LLC NORTH ANDOVER, MA 01845 42-o n 0 � 3 910 L 7-o -0 7-0 '7-a 7-0 7-O r , .a q-6 I-ci '6 0 (b 2. 4,b tti-o b 1�-0 1 -v f=a�1J.l� to PLS! H LOT 14, 14192 CARTER FIELD ROAD NORTH ANDOVER, MA 01845 SCALE: 1/8" = 1'0" DATE: 5/25/04 TARA LEIGH DEVELOPMENT LLC NORTH ANDOVER, MA 01845 0 4 x CV q " r v • r i N Aj y. 16-0 r1 RST T-uooR 'f?'kxkt coND T-Loa R Tv"A)� LOT 14, #192 CARTER FIELD ROAD ' NORTH ANDOVER, MA 01845 SCALE: 1/8" = 1'0" DATE: 5/25/04 TARA LEIGH DEVELOPMENT LLC NORTH ANDOVER, MA 01845 a\,�stZFJ to / —^Z.x(o Cot_LAk 3/o`r �lTvrtlle.s6 C-^LV btttP. .\, 3 DP - — C—a\LIWG ZUIST 1=t.1 CRY DOOK -�f BiiuGA T-s R O.CDB Va x 83 ?xB/ ; �t�f�3aG lx3 �P Ix3 s:�� t G �x7ER oma )DOCperil-y 'K.0. 38t�2 x I S� y2"awtBoarD, ���;s;�R � coM-c.v�r q`x 8` OK C���6� PaoR �I I �q i1 -3 34X4 X CSS\/L Is I 3/1i'r AbVAu�C4 TvC7 �; _ t IN ce��t�cti v�s6+KE 2 x�O/�� 34 CzS.-3 t at Y, X (Sly I T�Vr{I�auty S-T 3 `t x 5 f �/{ D r Q r tl F X tsm oc /, 3�ts�-3 tot 2-2 C.,S3 22 /4 G 22-345?22 I/' S la. �1 f 2 t ��� 17� i .}� i� Ot{� (oJ'/1{ x l — c O Co f7 2 2 1tz 13t -e ' t — zx o/ i'U J( R t`1 VG ��e�Rlti2aa2S ?-� U Lic — �SS iia; I l C-0 cY. (o.;to Y[ �2�2xo Pt 51LL �'�)Z�la �Fa� !; 8 ��;t _� i 7,tOrXtpd LL 9 30aoPsL 113 J '-ILZ zt2?h3R}G v1ALL d 071 3/�tt SZ�uE a- PERF I)K +I: G sn Q? Y P.tv. LF1Q ;Cx?O PS L �(J� ftG (_mss S� �:S •i�l __..-... _... _. _. o z�'�.rlo^ ?�. LOTS 1 — 17 CANTER F[ELD ROAD �`� F ;;'o.�' �c" P C. �a.G :>OT IG' " NORTH ANDOVER, MA 01845 TCY? I_P�o C SCALE- varies DATE- 3/23/04 TARA LEIGH DEVELOPMENT LLC S��Tt o \Q (-T y p) ;ou\,,�- ->�:�Fav NORTH ANDOVER, MA 01845 Date.. (5/0 .U.C`.. HORTM o? �` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9SSACMUSEtS This certifies that . UA ti?('`OGf !� l . . . . . . . . . . . . . . has permission for gas installation /66 . . . . . . . . . . in the buildings of . !� RR l:� t � . . .Ike a . .L': `�.�". . at . . . . 1.`��. . 0A �r li ek0 . North Andover, Mass. Fee. . . Lic. No o?('7v GAS INSPECTO Check# 4819 f I 1VIASSACHUSE 11S UNIFORM APPUCATON FOR= ERIVIlT TO DO GAS FfrnNG (Type or print) Date O NORTH ANDOVER,MASSACHUSETTS / Building Locations ° (� Permit# Amount$ Owner's Name � �CiJ �✓ld New❑ Renovation Replacement Plans Submitted U vl ° U c o c a P z z cd H ° o a w x C WW cq cx O C� A 0 a U 90 44 A a H 1SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3R D . F L O O R 4TH . FLOOR STH . F L O O R 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) hec ne: Certificate Installing Company Name G CCorp. Address 6, Partner. usmess Teleptione/ 6 Firm/Co. ' Name of Licensed Plumber or Gas Fitter 4 INSURANCE COVERAGE Check on : . I have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked yes,please i cate the type coverage by checking the appropriate box. D 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: Signature of Owner or Owner's Agent Owner 0 Agent 1 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 Massachusett e G Co an hap r 42 of the General Laws. vz Signature of Licensed Plumber Or Gas Fitter By. Plumber ,, (& • ZQ Title City/Town Gas Fitter License Number 11-Master APPROVED(OFFICE USE ONLY) Journeyman Date. ���. 0. . . .. . Of N�pTM 1H o= TOWN OF NORTH ANDOVER ti P PERMIT FOR GAS INSTALLATION s �• �9SSACMUSEt -' This certifies that . . . . . . . . . . . . . . . has permission for gas installation . . N. ' `�VV tw a' . . . . . in the buildings of TWP-A . �f 'Q. . . . . . . . . . . . . . . . . . at . ��? `.�~ .{� . 01 . R �`. . .. . .. North Andover, Mass. Fee. 4 . . . Lic. No. AM . . . . . GAS INSPECTOR Check# 4905 MASSACHUSETTS UNIFORM APPIXATON FOR PERMIT TO DO GAS FITTING (Type or print) Date 10/23/04 NORTH ANDOVER,MASSACHUSETTS Building Locations 192 Carter Field Rd Lo/14 , Permit# of Amount S Ow er'sName Tara Leight Dev. New Renovation ❑ Rep l cern t ❑ Plans Submitted un er ro nd $25.00 w w a a ° as li e o p U c o c 1 be s to ;Q G U d Z � C � E" � v� C � O � g O H WW � O x w 3 q c7 UO a A a F O 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) Chec one: Certificate Installing Company Name Eastern Pro-pane GasCorp. Address 131 Water St. , Danvers MA 01923 ❑ Partner. ❑ Business Telephone 1 800 322 6628 Finn/ o. Name of Licensed Plumber or Gas Fitter Brian Kimball INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes ff No❑ Kyou have checked yes,please' dicate the type coverage by checking the appropriate box Liability insurance policy please 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: Signature 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 S to Gas Code and Chapt 4 f era]Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber i9i410 City/Town r7 Gas Fitter License Number ❑ Master APPROVED(OFFICE USE ONLY) ❑ Journeyman ' i HORT1y ?�.<� °„•'�ooL TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that .,�!-!.u^!�CYQO 1� . . . . has permission to perform . . ./v R . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of I—V:RA. .�`P at. t� / , No\th ndo(er, Mass. Fee.? . . .Lic. No.a.&949 . ... . . . .`. . . .. . . . PLUMBING I SPECTOR Check # o� g� 6154 MASSACHUSETTS UNIFOR , 'APPLICATION FOR PERMIT TO DO PLUMBP (Type or print) NORTH ANDOVER,MASSACHUSETTS Date l4 e�. Building Locati n Ow'ne s Name �yYl -v/.��!> Permit - Amount ri Pl Type of'Occu anc / e� 1 01-1 New Renovation Replacement Plans Submitted Yes No 0 FIXTURES SLRI RVIE R4SWEW IST RDD f X zrn HDM 5 3MH>M 4M HDM sM Rfm 6M FL CIR MKDOR gm HDM 14-H-7f (Print or type) Che one : Certificate Installing Company Name (ACorp Adlress 1�3 � Partner. j14 elm'VS� usmess Te ep one „( �, 3jf� (� 0 Firm/Co. a Name of Licensed Plumber: Insurance Coverage: Indicate VItype of insurance coverage by checking the appropriate box: Liability insurance policy13 Other type of indemnity 0 Bond 0 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 D 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 Massac=stPlu =d a ter 142 of the General Laws. By: Signature of Licenseaum er Type of Plumbing License Title �� � City/Town Ouense NumDer Master Journeyman APPROVED(OFFICE USE ONLY El