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Miscellaneous - 20 NUTMEG LANE 4/30/2018
r IL Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ......... ...................................... has permission to perform ...... ...................................................................... wiring in the building of ...... ?..,ft .... ..... "---I ............................................... at ................. North Andover, Mass. Fee./A...... . ..... Lic. No�. ...... Lc.... -4.1 ............................. ELECTRIC AL L"R Check # 7511,3 Commonwealth of Massachusetts Official Use Only Department of Fire Services Occupancy and Fee Checked Permit No. '���.'`7~ IRS TBOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME9), 527 C R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 71c) Z City or Town of: NORTH ANDOVER To the Inspe for of fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant <17- ,n/ Telephone No. Owner's Address 54Ll 6:� Is this permit in conjunction with a building permit? Yes A> r No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceC2�� Amps Ipto /L o Volts Overhead ❑ UndgrdAFiNo. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1 DMm�f/'Z 4 .All cL.-J 139Tt' Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires aa CJS No..of Ceil.-Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of LuminairesSwimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency ig in Battery Units No. of Receptacle Outlets c�G (� No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of DetFc-t-ion and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number Tons K No. o Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWStieWt'ri hl Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances g pp KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecom in u n icaffons Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: '1 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEI� BOND ❑ OTHER ❑ (Specify:) / certify, under th ams an penalties of p77�1 that the in ormation on this application is true and complete. FIRM NAME: f�Yn/i,J ��Tt� I C t LIC. NO.: Licensee: /,�j,J �,q�'IY,�J Signature LIC. NO.: 01 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: d Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Own nt PERMIT FEE. $ �95 Signaturetura Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street : Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nnlicnnt Tnfnrmatian Please Print Les!ibl' Name (Business/Organization/Individual): Address: 2 Lis✓� a'� City/State/Zip: Phone #: 7i Are ou an employer? Check the appropriate box: 1. Kam a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 4ezly Insurance Company Name:1, Policy # or Self -ins. Lic. #: Expiration Date: b� Lc;w k E Job Site Address:_j A A J //' �� �� City/State/Zip: /" Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under a pains andpenalties ofperjury that the information provided above is true and correct. Sivnature:_ Date: 'Z 7 d Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Date .... .-.�X TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .........41�• -:-. has permission to perform ....... .. plumbing in the buildings of at ........ ......... North Andover, Mass. Fee?K. .LNo.............. PLUMBING INSPECTOR Check # 7421 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location Permit #/v� Amount 4 Tvoe of Occuoancv New Renovation �/ Replacement 0 Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Installing Company Name,/ ,46',11 ,' ,,i) Z "�� S 1 11 Corp. Address 36 �i''`'e S +' MCrIl.i; l f C' N. /-/ G/ 351 4 E�Partner.'-,Business Telephone O 3 `- 9a .—� 1'rgd o. Name of Licensed Plumber. Insurance Coverage: Indicate a type ce coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1:1 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 ignature 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 erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the_Wsae Vii, e and Chapter 142 of the General Laws. T e of Plumbing License Title �- 71-' Z City/Town License N111110— Master Journeyman APPROVED (OFFICE USE ONLY Location 01 13 No. Date 10 -/91 -0c -A, TOWN OF NORTH ANDOVER Certificate of Occupancy $ CM�s <� Building/Frame Permit Fee $ Z Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1310 Check #/ &) `� 5 6 3 Building Inspector SNS r.e� —,q_ °z PLAN OF LAND [/evL,r f��DINNO, AND 0 VER, HAYFS• ENGINEERING, /NC. CML ENG/NEERS & LAND SURVEYORS MASS. JUNE 18, 2002 603 SALSA/ S7REET 01'rELO, A41SS 01880 TEL. (781) 246-2801 / CER17fY TNAT THIS f0t1Na477ON /S LO04W ON 1HE GROUND AS SNOWN, AND 7m /T Ci VFDRA/S 117 THE SETBACK REQUIREMENTS OF 7HE IAN/NG BY-LAWS OF THE TOWN AF• NOYPIN ANDOVER. / FuRTHER CLRRAfY 7mr TH/S PROPE7PTY Dors NOT U£ WHIN A FLOOD MZ4RD AWA (ZONE A OR V) AS SiWWN ON FLOOD 1MWRRNX RATE MAP COMMUN1 Y PANEL NUMBER 250098 0006 C- Ef7FC7/VE L47F �uNE o Zbo Z PROFESSION LOT 14 PA 4 \,«....�• N-3 ISOLATED N-2 WETLAND '1 +6 iN-1 R_77.08 j� 7 e8 1 r \ o �5o\ r \� h J ��oao ry.0,=%V �k• LOT 12 i N ZONE R-3 v, MIN/MUM SETBACKS.• s m FRONT = 30' SIDE = 20' REAR = 30' MIN. LOT AREA = 25, 000 s. F. MIN. FRONTAGE = 125' %YY� N „_,. _,.�A I � 4� F•�0.37 L� C A =86'3155' EDGE OF WETLAND r 8-20.00 I RESOURCE AREA L =30.21 L1' �D �K LOT 13 6y�� 29,369 S.F. �F / 11, V' .ra'• O � •2 0 t!1 A =00.18'06" R=775.00 L=4.08 Of NORTH � A �'fsACHus CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number �11 5- / Date i - 3 --6� D03 THIS CERTIFIES THAT THE BUILDING LOCATED ON o� J c3 #tea D ���/� e q a N MAY BE OCCUPIED AS B PfOCMI a Va &4-Th4 0? 6fd11, r�4.ched cS/,u y le- Yeslalelvcle, IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO �`�� % - � M 'v- - ^ Building Inspector I E.' Ns O z LLJ am v V v o �Oo z vCL cc iC7 •ate � A C m O C A ,= O off cc 4DID c O Z �, •o MO `• L co cm y C Ulm co C w vc� Oacs � C� ^w' WV •+ C O c CL. CD cm h O C �C = m `m .Z. C N COO ev t m W G err Cw .� N dt y C Z oc Ecj 'oc y O cW.3 m c m c_ g ti acc C43 CA C) !- t 0 dim CO O CD L O Z a O CO) c s 4..4 Qr 2 41 0 uiw w w zIlk �� w a o w cY w° a: U w raN a E w cn U) Ns O z LLJ am v V v o �Oo z vCL cc iC7 •ate � A C m O C A ,= O off cc 4DID c O Z �, •o MO `• L co cm y C Ulm co C w vc� Oacs � C� ^w' WV •+ C O c CL. CD cm h O C �C = m `m .Z. C N COO ev t m W G err Cw .� N dt y C Z oc Ecj 'oc y O cW.3 m c m c_ g ti acc C43 CA C) !- t 0 dim CO O CD L O Z a O CO) c s 4..4 Qr 2 41 0 uiw w w Location [.e"a -S/a �Z°Gz'1 dU Nu VI -/r -y NaDate ��d c�� 2 TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee R A L $ ^ TOTAL $ Check # OZ L 15 5 6 Buiiding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING f 1171. BUILDING PERMIT NUMBER: DATE ISSUED: C/ ` SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ,40 PC" C, 1.2 Assessors Map and Parcel Number: 038 ©oaf Map Number Parcel Number 1.3 Zoning Information: Demolition Zoning District Proposed Use 1.4 Property Dimensions: P9,36 g a20f.'<8 Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReIqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record " North Andover Land Corp. 60 Beechwood Drive, North Andover, MA Name (Print) Address for Service: 978-683-3163 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Benjamin C. Osgood Licensed Construction Supervisor: 69 Old Villagwe Lane, North Andover, MA Addpps 978-683-3163 Sign re Telephone Not Applicable ❑ CS 075302 License Number 12/04/2002 Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ou M Z O O Z M 90 O Mn r v M r r Z Q SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 S 25c(61 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building [IRepair(s) ❑ Alterations(s)� ❑ Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: Demolition of old three bed room house. to be replaced with a new home. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building®� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC)-�- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 6-1 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 thorize 3 7� /4. 10 f �6-acs) to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, d as Owner/Authorized Agent of subject property Hereby clare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and b tef Benjamin C. Osgood Print fne _�g /27 _ Signatidof owner/A ent Date NO. OF STORIES two IZE 30 x 30 BASEMENT OR SLAB Basement SIZE OF FLOOR TIMBERS 1 2 3 -72ND SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE J J_ d M U J C`7 0 i Z N Q a ¢ coo a� wit CCLUF- OF LL coo o C? NO co o coo .� rn Qo Z v O(o -m >o ao F- r Z wQ Lu Lw F - Z v7 Q Z_ Lu F Cn LU LL LL w0 C1F- X d Zw Lu Z F- F - Z U O�<- JZ J Q d U cd QCr ¢O O= a. rj- ww cr I.- u- < .-LLa , e• •�rw •.wwr v.....r vrr �... o.r.�. v• r.. �...v.�o.r... r.r vr....vr o WASTE MANAGEMENT DIVISION Health and Human Services Building 6 Hazen Drive, Concord, NH 03301.6509 ; 603-271-2921 - FOR STATE USE ONLY `----------------------- Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved OMB No. 2050-0039 EPA Form 8700-22 (Rev. 9-88) Previous Editions are Obsolete COPY 8: GENERATOR COPY UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 1 Information in the shaded areas WASTE MANIFEST 6 1 6 � Do�u�e� N� of Federal law is not required required but may ere byed b State taw. 0 3 3 3. Generator's Name and Mailing Address A. State Manifest Document Number NH H 0o484i.s varh�var1=4 -r#. sae 'Chop 'U fu 60- Bef--m eW Drive Suarth Andorar, VA 0194,: 4. Generator's Phone 3-3116 5. Transporter 1 Company Name 6. US EPA ID Number c. State ransporter's I & S Tmak C. u` ';PC,. P4 A •9 .8 .1 •7, J .6 .7 .6 .f! D. Transporter's Phone 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID . . . . . . . F. Transporter's Phone 9. Designated Facility Name and Site Address 10, US EPA ID Number G. State Facility's ID (Not Required) H. Facility'sPhone 141 kiyzr load lit ted WI X -V •9 1 •0 •5 •2- .1 .8-4.3 3-01-24 11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total 14. Unit No. Type Quantity WtNol Waste No. E a. ubustA e .1,1q ut, 240.5. Cur," EPA N EGt'$.>.#�99s mace_ T b. EPA O R ----- STATE C. EPA STATE - d. EPA STATE J. Additional Description for Materials Listed Above K. Handling Codes for Wastes Listed Above a.Interim Final Interim Final C. a. C. b. d. ----------------- ------------------------------------------- ------- b. d. 15. Special Handling Instructions and Additional Information 0576 -QX am, RC M11. U FMC."* 21-4 RMS. 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transfiort by highway according to applicable international and national government regulations. y If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. Printed/Typed Name Signature Month Day Year T R 17. Transporter 1 Acknowledgement of Receipt of Materials z A PrirltV') yped Namer)/. Signature3 j f , Month Day Year o R 18. Trdnsporter 2 Acknowledgement of Receipt of Materials Printed/Typed Name Signature Month Day Year E R 19. Discrepancy Indication Space F A c i L 1 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 9-88) Previous Editions are Obsolete COPY 8: GENERATOR COPY 41adkk*111'*o IV 04,10 May 14, 2002 d•` Mr. Ben Osgood Lot # 13 - Nutmeg Lane North Andover, MA 01842 RE: Lot # 13 - Nutmeg Lane INTEGRATED PEST MANAGEMENT SERVICES MAIN OFFICE: 1320 MIDDLESEX STREET, LOWELL, MA 01851-1297 TEL: (978) 452-9621 FAX: (978) 459-3184 Dear Mr. Osgood: This letter is to certify that BAIN Pest Control Service did perform Rodent Control Prior to Demolition on Tuesday, May 14, 2002 at the above referenced address. Sincerely, %V_I�Je Michael Bishop Service Coordinator MB/kmp .Y BRANCH.Ff.CES: BOSTON AREA, WOBURN 9331678 - FRAMINGHAM 875-0636 • LAWRENCE 683-2320 • FITCHBURG 365-2663 • LYNN S99-0226 • GLOUCESTER 261-5679. NEWBURYPORT 462-0266 -� NEWTON 527.9250 . DOVER, NH 742.4300 - NASHUA, NH 689.9191 • MANCHESTER, NH 623-2260 - PORTSMOUTH, NH 6363797 - ROCHESTER, NH 332-7400 ESTABLISHED 1926 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Print Name: North Andover Land Cor Location: 629 Salem Street also known as Lot 1 Abbott Villaee, and 20 Nutmeg Lane cmc__- North Andover, Ma Phones 978-683-3163 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 rimy employees working on this job. Oamlaany name: North Andover Land Corp. Address 60 Beechwood Drive City: North Andover, MA Phone* 978-683-3163 Insurance Co Maryland Commercial Insurance GrouD Policv# SCP 34275777 Comlaanv name: Address City. Phone # Far1u19 to secure coverage as required under Section 25A or MGL 152 can lead to the iIT"ition d C* Mnal penalties. d a fine up to $1,-&;00.00 and/or one years' imprisonment as well as civil penalties in the form of a STOW WORK ORDER and a fine of ($100.00) 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 herby certify under thq pains and Signature of perjury that the information provided above is hue and correct Print name Phone # Official use only do not write in this area to be completed by city or town official'Building Dept []Check if immediate response is required Building Dept p Licensing Board Contact person: Phone # p Selectman's office 0 Health Department 0 Outer RM WORKMAN'S COMPENSATION �/e�om„wouueail�C �y"'..ii%aar,�ivaelta BOARS 6F BUILDINGR GULATiONS License: CONSTRUCTION SUPERVISOR_ Numbet:*CS 075302 Birthdate: 12/04/1941 'Ezpire3: 1210/2002 R stricted To: 00 BENJAMIN C OSGOOD Tr. no: 75302 69 OLD VILLAGE LANE. NO ANDOVER, MA 01845 Administrator r Town of North Andoveroti NORTH q Building Department 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 O 9g0R'reo rva`,�5 Building Demolition Affidavit �SSACHI!`��� DATE � � Ill z_— OWNERS NAME & ADDRESS ///0 PROPERTY LOCATION lo,,2q 9 WF &*j DESCRIPTION 2)&WO/i CONTRACTORS NAME & ADDRESS /Uae�ti I Advvt2 �o�„ 0 C,eP 0 i5:'Z4 A J/ -/V' IPI%` -a //,Oblw 000,?& BLDG. INSPECTOR DATE RECD 1(9 u�wte.� �. l 14ou t/z>/,/ 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. �"AFI'LIGANT FILLS OUT THIS SECTION********************** APPLICANTNorth Andover Land Corp. LOCATION: Assessor's Map Number 038 PHONE 978-683-3163 PARCEL_022 SUBDIVISION Abbott Village Estates LOT (S) 13 6629� STREET � / W S ii/zc c.% fPPss ao l(!v t 4lL�T. NUMBER *****************************************OFFICIAL USE ONLY********************************* ** RECOWf�NQATIOP(S OF TOWN AGENTS: CONS( KATION ALMA ISTRATOR COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED ����DATE REJECTED n=Gc.�'o r.�h,P 2y2 /Ash DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS 4Syk DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm ...I► mac., i � TE North Andover Building Department Tel: 978-688_954 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid- waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in:LA �R<<v e W,�Gt �yO/,�G sPS�o/lf� �oe� i3,`,,G ee,c,4, W1. (Location of Facility) �•y %J' r"W"""Hppllcsnt V c1 LC NOTE: Demolition permit from ti?e Town of North Andover must be obtained for this project through the Office of the Building Inspector C/) C m 0 m "-7 CO) 10 CD az CD Q cL r.7d a a� o p C CL Q CD O p p C. CD Q O RC CD CO2 CD a O L- y 1� CD CO) C 0 c COP) d CD 0 CD CD P. CO) CD CO2 O CD 0 CD ��0w_ z O —N C Q ti S 0 CD CO3 CL Ci O co H n O.O m Z ?-a co) --I O O d .di O H- 17 =r CD � d y O O m ti O N O =rm _ O O CA O O A -w� O n40 ZyC2 CCD S7' V N V / m O A �y V/! ^) V CCD CD O �+ CA . CXjaD O H �d Q :� z W - a V J N 1 O CD U2 ,.� O H 3 y Q o C411 O 1 d CD0 0ON .Z' m O * * * TO O .�► O �O O CD Cf) o ;^ 0 o ' z� O ?: O zD i CD pllsOlcn r. (n m H 3 O E •j CD m : ?� dy.r 1� :4 e a .► �+ Cl) �... p '.. C n .� -off'- fiGO CA C/) 05 cf)W z d o � a 0 10 5 0 C� x CD o c r Ctri 0 x p 0 v 0 I TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 'SACMUS` This certifies that ......:--'" j�. ................... has permission to perform ... ...r..; ;,1,.'r ................ plumbing in the buildings of ..I...E'� ............ ....... ...... ,North Andover, Mass. Fee. t'........ Lic. No../r'.?.`.�...��ll.�.�.. ....... /]PLUMBING Sl ACTOR Check # � % 93 (/ -` !/ 53444 MASSACHUSETTS UNIFORM APPLICATION FOR .PERMIT TO DO PLUMBING (Print or Type) No tJ12�Mass. Date Q " 22 2Qb. L, Permit #f Building Location 20 Ltk-�4r�`. Owner's Nalene_ Type of Occupancy New Renovation 0 Replacement ❑ Pians Submitted: Yes ❑ No ❑ FIXTURES S.P. # SEWER # sFprr t Installing Company Name ll -,&V Q •) Address �, C.1, i�ib1�` Business Telephone Check one: Certificate CL,o orporation ❑ Partnership r, /�^ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter_ V` Ccs rl nig1 INSURANCE COVERAGE: I have a current I ability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No 0 _ If you have checked Yes, please Indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond C OWNER'S INSURNACE 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. Signature of Owner or Owner's Agent Check one: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Mlassachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature of Licensed Plumber Title City/Town Type of License: ❑91Master ❑Journeyman APPROVED (OFFICE USE CNLY} e Q 3 Q d— License Number <{ j 11 z'i �z tji �l _l uij �z!z �, Oi UI ¢� i—i ! I I �� I w! tr tuj L' 0 zl ,-+ to i to w V) ¢i 1 �' �I w' z 1 Ln I H{ U� a' , LU ; { zl i 1 i 0 O z z' z a V) z i .-a a; C.L ( F- w i �, zIn j O ! I !w; ¢I w. V) txi�,¢�w!,,{Q tni z !� �, z a jOI ju- �jw _ �- I �! of of N -j V) z z o �( a LL �: -,Z �1 w ¢I > ¢! i OI _ t=n .1 tQn �, �I ¢I Hi of z' ai �! �j tn{ ¢1 d a1 O, 01 4! � iz- m to 0 0 �i x! to Chi o ¢ �I ocl m! 01 0 SUB-BSNIT BASEMENT 1ST FLOOR 2ND FLOOR 7- 3RD 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOORj— Installing Company Name ll -,&V Q •) Address �, C.1, i�ib1�` Business Telephone Check one: Certificate CL,o orporation ❑ Partnership r, /�^ ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter_ V` Ccs rl nig1 INSURANCE COVERAGE: I have a current I ability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No 0 _ If you have checked Yes, please Indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond C OWNER'S INSURNACE 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. Signature of Owner or Owner's Agent Check one: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Mlassachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature of Licensed Plumber Title City/Town Type of License: ❑91Master ❑Journeyman APPROVED (OFFICE USE CNLY} e Q 3 Q d— License Number <{ Date.. U TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... ............. ...... has permission for gas installation • .... ................. . in the buildings of... ................... . .V at .. 1._. _ ...�..... , North Andover, Mass. f Feer :.. Lic. No..�<�� '1.� '-cas RNs v o,};' Check # V� y v MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print of Type) ►'� `r• ,� , Mass. Dabs �.�� 20 6 - Permit y Building Location 2_S� Owner -s Name Typi of Occupancy �'.► New Renovation ❑ Replacement ❑ dans Submitted: Yes f No ❑ Ins tailing Company Name [ :'$IS Addre%S � .(j � l'1 .- L7 a,-- ir tt Lu i r IA'l i A, v> l Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate M,Aorporatlon ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: 1 have a current ability Insurance policy or Its substantial equivalent, Which sleets the requirements of MGL Ch. 142. Yes No ❑ if you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability Insurance policy a,''r Omer type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Lags, and that my signature on this per—' mttapplication waives this requirement signature o O Wner or owners Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) in above application are true and accurate to the best of my knovNedge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. TyeA- of License: ' By poPlumber Signature of Licensed Plumber or Gas Fitter Titic c;rynowrter Gas"r License Number Z10 1 APPROVED (OFFICE USE ONLY) ❑ Journeyman LU CK d E f I i z $ i o� �; u, a w �, zf cn �' �a z ¢ �f x z cc aj U1.1►.. to b x oLU .� a I dd u� .. = x I a t9 v fr fa o. SUB-BSIMT i BASEMENT I I I, I I 1ST FLOOR 2ND FLOOR I I 3RD FL;DOR ! 4TH FLOOR I I I 5TH FLOOR i 6TH FLOOR TT -H FLOOR 8TH FLOOR Ins tailing Company Name [ :'$IS Addre%S � .(j � l'1 .- L7 a,-- ir tt Lu i r IA'l i A, v> l Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate M,Aorporatlon ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: 1 have a current ability Insurance policy or Its substantial equivalent, Which sleets the requirements of MGL Ch. 142. Yes No ❑ if you have checked yes, please Indicate the type of coverage by checking the appropriate box. A liability Insurance policy a,''r Omer type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Lags, and that my signature on this per—' mttapplication waives this requirement signature o O Wner or owners Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered) in above application are true and accurate to the best of my knovNedge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. TyeA- of License: ' By poPlumber Signature of Licensed Plumber or Gas Fitter Titic c;rynowrter Gas"r License Number Z10 1 APPROVED (OFFICE USE ONLY) ❑ Journeyman Town of North Andover i. Building Departmento0 27 Charles Street North Andover, Massachusetts 01845 * _ (978) 688-9545 Fax (978) 688-9542 ��SSACNUS���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 0 C) ���t V -.-- LOT y t DATE REQUEST FILED / 4z-gp-f DATE READY FOR INSPECTION > />�o FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED wiTH N THIS Tam .. FRAIVIE. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCVJRE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATION f DATE 112 P PLANNING`v 1121D 1ti )ATE (7 D.P.W. - WATER METER DATE I za 17 D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED THE INS CTION/Y�FQUEST DATE. TURF %DPW AUTHORIZATION 4018 Date... 0 - TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... A -C ........... ...... ........ has permission to perform ......... 4�.) ... .............................. wiring in the building of ....... ......... T�,-� ................................ at .... 7 ..5.0 ........ I ..... W ...... ,eorth Andover, , Mas -. cam, '0 . ....... "' Fee, Lic. No// .. ............PK-rOR LEAL Check # 1 �onsnsonwaa�lh o j l�adaacua[� For Office Use 0 (Rev. 11/99) BEL"cc�� cc-]� Permit Number: 6 ..LJaParEnrsrt� o�,.tira �arvicad Occupancy & Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: !' - /.3 - O Z City or Town of: C t. 1 101 c C- To the Inspector of Wires: By this application the under ' ned gives notice of his or her intention to perform the electrical work described below. Location: (Street & Number) DoT /3 7 _ v if/vTr, Owner or Tenant: �-%s 9, / - C— Owner's Address:_ _ (O d / eP4 , /,,o ./� 7 /Y- Is this permit in conjunction with a Building Permit? Yes e`No ❑ (Check Appropriate Box) Purpose of Building:" " c , tility Authorization M % Existing Service: Amps / V is Overhead ❑ Underground.❑ # of Meters New Service: 7 ao Amps Z' / L yG Volts Overhead ❑ Underground.t � # of Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: ti/ /jam•. ,(fomes Z No. of Recessed Fixtures G No. of Cell.-Susp. (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground a In Ground o # of Emergency Lighting Battery Units No. of Receptacle Outlets J o. v No. of Oil Burners Fire Alarms # of Zones # of Detection & Initiating Devices # of Sounding Devices: # of Self Contained Devices Local o MunlCipal Connection o Other c No. of Switches G No. of Gas Burners No. of Ranges No. of Air Conditioners / TOTAL TONS: 3Detection/Sounding No of Waste Disposals i Heat P! imp Tnta:c Number: I C a5: riW: _ Security Systam.s No. of Devices or Equivalent i Data Wiring, No. of Devices or Equivalent: No. of Dishwashers Space /Area Heating: KW No. of Dryers .." Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: _# of Ballasts: OTHER; # of Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or Its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE aiBOND o OTHER O Please specify: Estimated Value of Electrical Work $ (When required by municipal policy) Work to Start: J / ? — " Z_ Inspections to be requested in accordance with MEC Rule 10, and upon. completion. I certify, under the pains and penalties ofperjury, that the Information on this application is true and complete. C� Firm Name: Gam/ LIC. # / f/ Licensee: 4yy`/f /� - SiYt GSignatur G LIG. #f 3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not waive this requirement. I am the (check one) Owner o OR Agent c Signature of Owner/Age in the llcen prnbbe�r line) / 2 _ fus. ei. # % — Z l�yAlt. Tel. # I he liability insurance coverage normally required oy law. By my signature below. I hereby Telephone # PERMIT FEE: SS 3t6U Date.......6:. z......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......�? .,lJl..y.l. . ....................................................... has permission to perform ....,� :. f ^......... ........................ wiring in the building of .......j...... 2.:..r...!^..:.................................................. at ... ! ...... ......1. i ..:.................. . North Andover, Mass. Fee ....>..CJ ............... Lic. No.,............. .... i J ...................:...... ELECTRICAL INSPECTOR Check # 2 Y 11C1 '` Consrxonwaa[!h o`adaacicula[�! For Office Use Only (Rev. t Nu v cc�� cc77 Permit Number: 1J�Par�msnf o�}iaa �awicas Occupancy 8 Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: [//— / 7 — G City or Town of: Al" v "o? To the Inspector of Wires: By this application the undersigned gives notice of his of her intention to perform the electrical work described below. Location: (Street & Num ,4d-/-- /3 Owner or Tenpnt: k, /- -, , raw G - Owner's Address: (J ze'r , % , a " J Is this permit in conjunction with a Building Permit? Yes o No heck Appropriate Box) \ Purpose of Building: e,,4 Utility Authorization #: ©" — © 'Z Existing Service: Amps / Volts Overhead ❑ Underground.❑ # of Meters New Service: %l/d Amps if 0 Volts Overhead ❑ Underground.Lf'-� # of Meters:—// Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: No. of Recessed Fixtures Or No. of Cell.-Susp. (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground ❑ In Ground ❑ # of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners Fire Alarms # of Zones # of Detection & Initiating Devices # of Sounding Devices: # of Self Contained Detection/Sounding Devices ' Local ❑ Municioal Connection ❑ Other ❑ No. of Switches No. of Gas Burners No. of Ranges No. of Air Conditioners TOTAL TONS: No. of Waste Disposals Heat Pump Totals: Numaer. YGNS:KW: '" Security Systems: No. of Devices or. Equivalent No. of Dishwashers Space /Area Heating: KW Data Wiring, No. of Devices or Equivalent: No. of Dryers ... Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: # of Ballasts: OTHER; # of Hydro Massage Tubs No. of Motors Total HP 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 equiva�len . The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE I -W BOND o OTHER 0 Please specify: Estimated Value of Electrical Work (When required by municipal policy) Work to Start: /, a Z — inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. Firm Name: �ov,�l f ice- J�,tom IJ // -,,;2-,,-z LIC. # Tel. # 44,4:1-7 - �G� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) Owner ❑ OR Agent ❑ Signature of Owner/Agent: ent: Tele hone # 9 9 P PERMIT FEE: S J� �.-- Location O�/��� ✓vy��r� �'�' No. s� Date 0,;( TOWN OF NORTH ANDOVER L • Certificate of Occupancy $ 'ob.a���. +� • Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 156-7 O Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 4-:.N BUILDING PERMIT NUMBER: ' DATE ISSUED: SIGNATURE: CC Building Commissioner/IEEntor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 20 Nutmeg Lane Key—Lime, INc_ 038 0022 Name (Print) Address for Service Signature Telephone North Andover Land Corp 978-683-3163 Map Number Parcel Number North Andover, MA 01845 Benjamin C. Osgood 60 Beechwood Drive, North Andover, MA 01845 Name Print Address for Service: 1.3 Zoning Information: 1.4 Property Dimensions: Single Family Home �?�J„�(oCj istrid Proposed Use Z.j1.6 Benjamin t. Osgood Lot Areas Frontage ft BUILDING SETBACKS ft Licensed Construction Supervisor: Front Yard . Side Yard Rear Yard Required Provide Required Piqvided Required Provided 30 3o.5- O 1.7 Water Supply M.G.L.C.40. 54) 1.5. Zone Flood Zone Information: Outside Flood Zone 1.8 Sewerage Disposal System: Municipal Public I Private ❑ )l- On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Key—Lime, INc_ 6 Raarbwnnd Drive, Nnrtb Andover MA 0194 Name (Print) Address for Service Signature Telephone North Andover Land Corp 978-683-3163 2.2 Owner of Record: Benjamin C. Osgood 60 Beechwood Drive, North Andover, MA 01845 Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Benjamin t. Osgood Licensed Construction Supervisor: 075302 License Number 60 Beechwood Drive, North Andover, MA. Address 12/04/02 978-683-3163 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone f I SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Fail in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... e No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: to provide this affidavit will result Addition ❑ Construction of a single family home and 2 stall garage under, - I SECTION 6 - FSTIMATFII CONSTRITrT1nN rnCTC I Item Estimated Cost (Dollar) to be Completed by permit applicant = 3 of -;KJvoFFIIALUSE'O�TLY,, 1. Building SIZE OF FLOOR TINIBERS (a) Building Permit Fee Multi lier SPAN 2 Electrical DIMENSIONS OF SILLS (b) Estimated Total Cost of Construction / 6 3 Plumbing DRyIE NSIONS OF GIRDERS Building Permit fee (a) X (b) / L j 60 4 Mechanical HVAC SIZE OF FOOTING 5 Fire Protection MATERIAL OF CHIMNEY 6 Total 1+2+3+4+5) IS BUILDING ON SOLID OR FILLED LAND SQL, 10 Check Number Jr,l.11ViN is V W1Nr,K Av 1rivK1L.A11ViN 1 V JJt C UYWLh1E0 WHEf4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, / � �rM� hac • fi n. ` 621-00V)1 P��S . as Owner/Authorized Agent of subject property Hereby authorizeto act on M calf in all ng perm relative to work authorized by this building application. r. Sin e of Owner Date SE ON 7b OWNER/AUTRORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby are that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief f1 n'1 r �'1 i U6,1 P Date NO. OF STORIES SIZE 31/ e 3 SE R SLAB e.", SIZE OF FLOOR TINIBERS J 1sr 2 No a.Klo 3 o2JC$ SPAN DIMENSIONS OF SILLS 2boa,[C;7 !o DR%4ENSIONS OF POSTS e- DRyIE NSIONS OF GIRDERS -3X ,%. .0 — 3' X HEIGHT OF FOUNDATION ' THICKNESS /® SIZE OF FOOTING MATERIAL OF CHIMNEY p 0 Aillma-/9,4W 2)6,4 IS BUILDING ON SOLID OR FILLED LAND SQL, 10 IS BUILDING CONNECTED TO NATURAL GAS LINE VAS FORM U.- LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION *********************** APPLICANT Ka�-T imP, Tnr LOCATION: Assess6r's Map Number 038 : :. SUBDIVISION A1,bottyi Hagg. Fctates STREET 20 Nutmeg Lane PHONE 978-683-3163 PARCEL 0022 : LOT (S) 13 ST. NUMBER 20 I*****************************************OFFICIAL USE ONLY*********************************** RECO D,,ATION,(9(F TOWN AGENTS: CONSE"ATION COMME COMM FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMME TOR` DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm i a�l ATE GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. Key—Lime, INc. 20 Nutmeg Lane 038/0022 Permit Applicant Property address -Map / Parcel 978-683-3163 r yes Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building. permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as ofthe effe ive 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 tent 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 onetime exemption from the Planned Growth Rate and Development Scheduling provisions for thepurpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this E'x�F-MPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUND REF AL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. AP CANTS SIGNA DATE FORM TO BE A ACHED TO THE BUILDING PERMIT APPLICATION a MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 TITLE: PLAN NO. 1605 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 5-8-2002 DATE OF PLANS: 5-8-02 PROJECT INFORMATION: COLONIAL HOUSE COMPANY INFORMATION: BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 COMPLIANCE: Passes Maximum UA = 526 Your Home = 288 or 2 Family, Detached Other (Non -Electric Resistance) Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1705 30.0 30.0 29 WALLS: Wood Frame, 16" O.C. 2502 13.0 13.0 120 BSMT: Conc. 8.0' ht/7.0' bg/8.0' insul 1153 19.0 19.0 28 GLAZING: Windows or Doors 264 0.330 87 DOORS 72 0.330 24 HVAC EQUIPMENT: Furnace, 87.5 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 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 design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date— �l�—Q �• Is MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 5-8-2002 CEILINGS: 1. R-30 + R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 + R-13 Comments/Location BASEMENT WALLS: 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 cavity + R-0 continuous Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.33 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.33 Comments/Location HVAC EQUIPMENT: 1. Furnace, 87.5 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: 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. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: 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. HVAC EQUIPMENT SIZING: 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. SWIMMING POOLS: 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. HVAC PIPING INSULATION: PIPE SIZES (in.) HVAC piping conveying fluids above 120 F or chilled fluids HEATED WATER TEMP below 55 F must be insulated to the following levels (in.): 170-180 0.5 I 1.0 PIPE SIZES (in.) 0.5 HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): ----NOTES TO FIELD (Building Department Use Only)------------------------- PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- Key -Lime, Inc. Location: Lot 13 (20 Nutmeg Lane) Abbott Village City North Andover, MA Phone 978-683-3163 aam a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name:. Key -Lime; Inc. Address 60 Beechwood Drive City: North Andvoer, MA 01845 Phone #: 978-683-3163 Selectman's office Health Department Insurance Co. Liberty Mutual Insurance Co. Policy# WC2-31S-330435-0.11 Company name: Address City: Phone #: Insurance Co. Policv # 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 as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($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. I do herby cerfifv under the pains and penalties of oerfury that the information niovidbd above is true and correct. NN Official use only do not write in this area to be completed by city or town official' EJ Check d immediate response is required Building Dept Contact person: Phone FORM WORKMAN'S COMPENSATION le # 978-683-3163 n Building Dept p Licensing Board p Selectman's office Health Department Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: Dumpster by: Crecio Trucking Co. Billerica, MA (Location of Facility) Signature of ermit Applicant Date (VOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR, ► Number:}CS 075302 Birthdate: 12/04/1941 Expires: 12/04/2002 Tr. no: 75302 Restricted To: 00 BENJAMIN C OSGOOD _ 69 OLD VILLAGE LANE Lam' NO ANDOVER, MA 01845 Administrator ? r Cl) m m m 0 CD O CZ O O O CO CD CO) .0 CD 0 CA d 0 C. O C CO) -v m C7 CD 0 CD CD a y. CD CO) c O m 2 O -• (A O Q N CL e m C) Q col Cj G C07 m Z m H ==-a -i O_ .=i .d.► mCL y T o nim = y O c m y O -1 ri O m : m = =O O :� n Qo Z<_.C-) 1y O C! S. m � o,m n��.`o' VJ m W cn C d: m �• O N CL Q C � W N m m mcos Q N Vii. w ca m co Cf z mo(' a CDd o 0� � CD a� C,o cn: c o CD 9 - c7 °= O ar- m w rp O A m O -7 n �' ::r O C Mi J y 0 0 c Ln: L, m o :3a n m O Z � _o O, p z % _ -- CD M ai V_ ? 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