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Miscellaneous - 21 DELUCIA WAY 4/30/2018
Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 IAORTH d O ,tLlO .�6�� s.6 OO O L 2 M "moi_ [Y[M[1HM�tM _ 'I• APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER SUBDIVISION DATE REQUEST FILED G - .3 D DATE READY FOR INSPECTION -7-13 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARSWILL BE CHARGED IF THE STRUCTU1jE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED 11 PRIOR TO THE INSPECTION YEQUEST DATE. SIGNATURE / DPW -AUTHORIZATION N�pTh 014 CNUSE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 36-0 Date 7 7 c� D a 3 THAT THE BUILDING LOCATED ON .0 c 71�CERTIIFIES # o? / c A y MAY BE OCCUPIED AS S 1 <<T ��- T—A h, i Af -Z)w d, OO Fw-5z a I/C2 2J Is C�? 6 a// 4#4chL- IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO V �e p rJ ea DA I e,�-� c Building Inspector o b 0 z e cc co ci �0 `. C7 E u C� m °C o �� � V ® co y c U)CO CM COD� Cco ;� c CO) CL -) m �_� U w CD CD coL6 0CL ti 1110 co w cn c 41 co iLU .— o C V m r CL cr cc Q 9� CD U �0 Lcn .: Cc :.Cc c ® co Cs2 •� .�,0 CL C 4' �•�z m v C ma cm �NayC � C y y 4Dm« 3 N C COD LL. tOS ® LO R® vi !-v an 06= = � •� 0.0 � '® ® c CO) a' 01 -0 �- , lz U ./ 00 �J q 0 U W € (16� W �+ Ca ;+ z q U -• , w 1�-- ��." a o v O v p O i .rC G W O G V rz° cn cn cc co ci �0 `. C7 E u C� m °C o �� � V ® co y c U)CO CM COD� Cco ;� c CO) CL -) m �_� U w CD CD coL6 0CL ti 1110 co w cn c 41 co iLU .— o C V m r CL cr cc Q 9� CD U �0 Lcn .: Cc :.Cc c ® co Cs2 •� .�,0 CL C 4' �•�z m v C ma cm �NayC � C y y 4Dm« 3 N C COD LL. tOS ® LO R® vi !-v an 06= = � •� 0.0 � '® ® c CO) a' 01 -0 �- , Date..:-.'. .... .)........ ....... TOWN OF NORTH ANDOVER s p PERMIT FOR WIRING This certifies that .........:.........j�...4 -..:.' :...... ..................... has permission to perform .......... -"C :..... ..�........//..�........................................ wiring in the building of �`..� __.,, t� at....'�....::/ we��� ..........,............................................... .North Andover, Mass. .4 Fee ::........... Lic. No. ......L/" ............... '`�...................... ...... ..... ELECTRICAL INSPECTOR Check # '`// �r��U THE C0MM0NWF,4L1H0FMASS4CHUSE77S Office Use only DEPARTAffiW0FPUBLfCS4= permit No. BOARDOFFIREPREVEVHONREGUTAHONS527C R12VO Y Occupancy & Fees Checked APPLICAHONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date S (� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 1 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building ,�i t-\.4 `e Existing Service AMPS Volts New Service 00 Amp / ff Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work I Yes ® No L --OL ,v-, , l v Overhead Overhead (Check Appropriate Box) Underground Underground Utility Authorization No. No. of Meters No. of Meters —r— No. of Lighting Outlets No. of Hot Tubs No_ of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round and No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No_ of Detection and _ No_ of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW • No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No_ of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER ! V P w I LO�JSe kMrMMCOWrago A�uarYbd�elegtm>�rtaltsafNlacsad>useltsC,apralLaws Ihaveaarnaltl�ab>ldylrmlrmoePblicyirrllcjngCample>eCo�era�oriLsst>llegtrivalaY YES NO IbawaimiledvardptoofofsametotheOliiM YESt' / ( �Fyruha,edrdwdYFS,plt�eic>dCalethetypeofcort by t� gdr C) box NSURANCE BOND 011-mt r --J (P1 mSM*) 30 �3 Eq*afimDaM 3 EstirrWd VakrofEkhial Wbrk $ Wodclosta t ^ 0 h>Spec'MD&RoWested Rough -4 eS Feral SignedundertTiePt'nal iCsof FIRMNAMEr�f 1 e! °CA LiarSeNo �V 6 11 Licernae { "� S ti Signature LitseNo 6 �! BusQtessTel Na !OO Addte At Tei No. OWNER'S INSURANCE WANF12; I am awate drat the l -mm does na have the rostra it coven W or its st>bsa>tial egnvalai as teWted by Masmdmetts Gataat Laws aril drat my@gnahreon dmpetmitapphcation wanes fttegumeniff t (Please check one) Owner F-1 Agent Telephone No. PERMIT FEE $ igna ure ot Owner or Agent Date... ! ....1.... G .... . or TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ... has permission for gas installation .... ! " J..... 7 :.::..:... . in the buildings of ... 6 i. !% ........................ . at IA.,,:' ! . , orth Andover, Mass. Fee../..?0... Lic. No..././....:.. �-... ! ....... -.... GAS!INSPECTOR Check # I tl ��J1JU MASSACHUSETTS UNIFORM APPUCATON FOR PERAHr TO DO GAS Ff rnNG (Type or print) ate 7 -" S- NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New 1..Jll— Renovation ❑ Replacement ❑ Permit #... y 3> ? Amount $ (� 0 s��•!/�. S h'I1S ( x Plans Submitted ❑ (Print or ) j Crh c one: Certificate Installing Company Name ®yz. yJ 1A,� d r l�� i'Z-U� � Corp �WCcj CxJ r 6 02 Name of Licensed Plumber or Gas Fitter of16V,1-Y1,5L 1C14 110 8 < K..v ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No[:] Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policyttr 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 ofthe 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 perform under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Mass setts State Gas qWC and Chapter 142,aofthe Gene)ral Laws. ICity/Town OVER (OFFICE USE ONLY) � Si ature of Licensed Plumber Or Gas Fitter Plumber // -s-ff ❑ Gas Fitter License Number 0--lCaster ❑ Journeyman I • • 1 _ ������������������s��■ (Print or ) j Crh c one: Certificate Installing Company Name ®yz. yJ 1A,� d r l�� i'Z-U� � Corp �WCcj CxJ r 6 02 Name of Licensed Plumber or Gas Fitter of16V,1-Y1,5L 1C14 110 8 < K..v ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No[:] Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policyttr 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 ofthe 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 perform under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Mass setts State Gas qWC and Chapter 142,aofthe Gene)ral Laws. ICity/Town OVER (OFFICE USE ONLY) � Si ature of Licensed Plumber Or Gas Fitter Plumber // -s-ff ❑ Gas Fitter License Number 0--lCaster ❑ Journeyman Date. .,1 .. A- -. r-..'. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 * , I - :. - -.1. -'3 This certifies that ................ I )................ has permission to perform .... &.! .,A ... ............ plumbing in the buildings of ................. at. North Andover, Mass. (71 Fee.3-?V.-7. Lic. No..//.). ......... PLUMBING INSPECTOR Check Check# 3/t/ 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS L/ /_ Date s� a Building Location 2 �2 "!11 4A- Owners Name SFS,✓e, JyJd' `� Permit / Amount Type of Occupancy J"�F es �Jel'-r/'4f ` New Renovation Replacement E] Plans Submitted Yes No ,A Y FIXTURES .f / •f ' � •N � dw •ii it •�! �� •• •• �.�/1 .f •% ��� •. (Print, or type) �� � � Installing Company Name___ Address 1d f" -je- 6 �'� 1""� Name of Licensed Plumber: Z(/ d Insurance Coverage: Indicate the Liability insurance policy M1 -t� Check one: Certificate L U 9 -i i4� r-1 Corp. FS7 insurance coverage by cnecKr Other type of indemnity _ p Partner. . —� Firm/Co. ire �v blv the appropriate box: Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are fire 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 M setts State Plumb' Code�td Chapt 42 of General Laws. By: a o i sea riumoer ype of Plumbing License Title ✓ 1!g -P7 City/Town rcense NumSer Master Journeyman 0 - APPROVED (OFFICE USE ONLY L-ocation �d�`5 a :D -e Ju ` l,) tuAy No. J �S 3 Date I - IS -03 Check # All b I- 161 u7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ /0 D Other Permit Fee $ _ TOTAL $ Building Inspector TOWN OF NORTH ANDOVER 1MW TTY T%VILTA" 111n71 ♦ 11T1 ArInILTrIn DU1LiJ1114" 1Ji`41-11L1lllrll`J114 1 APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7777 $A001001, BUILDING PERMIT NUMBER: r� DATE ISSUED: SIGNATURE: �G L Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 4„ l U 1, Lu 1.3 Zoning Information: -��os ZoningDistrict Fr ed Use 1.4 Property Dimensions: Lot 7 7 may. 5� Area ronta e 00 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided 17 1.7 Water Suyply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public @/ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal AK On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHMIAUTHORIZED AGENT 2.1 Owner of Record f / Name (P t) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: 7 / � 4 /� s � �� G� 496 Addre ign re Telephone Not Applicable 0 L / I �(� o� License um�I ber Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone T rn X Z O FORM U - LOT RELEASE FORM I al 3°!n Z 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__ LOCATION: Assessor's Map Number 1-- SUBDIVISION U -PIU C1 A' i c� STREET PHONE F6- YlY/ PARCEL J Z-1 LOT (S) ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOI�YENDATIONS OF TOWN AGENTS: CONSERVATION ADMIN TOR DATE APPROVED DATE REJECTED COMMENTS Hau.Se foUJO Ia11 e„ corm" skmh b�, �i4tkW o�nc� �CirA PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTION G'Cd/D� C2 -I6 DRIVEWAY FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm i DATE 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 c 11, S 150 A. The debris will be disposed of in: (Location of Facility) ignature of l3ermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Name The Commonwealth of Massachusetts = Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print am home&v ner 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. ls' Company name: Address City Phone#: Insurance. Co. < Policy # Company name: WNSu i2li ia c.,P— AQ9 k1( A 4 Address 522 CIn1c-1 P-Fn.c Rel City: No c-Av-GI M R bliS`45 Phone#: (Cn$ (0-&5• ^1(vcl d Insurance Co. 6-1.IM ML& 4-t..a t Policy # (too ac)6 601 2-000 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_wteD-as_chdi.penaltiesin1helmn-fA-STOP WORKORDER and_a fine_cf ($1.0DM)-aAay.against.me- 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensinq Building Dept ❑Check if immediate response is required licensing Board p Selectman's Office Contact person: Phone #. I] Health Department Ei Other GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUII.DING 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 requesstted below. 15 �e P \�wd Permit Applicant Property address Map / Parcel 97K 4rFY/11/ 41--l- 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 ofthe 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 ofthe following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this 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 echanism approved bythe 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 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 OUNDS OR REFjJSAL BY T B DEPARTMENT TO ISSUE A BUILDING PERMIT. 4/111 PLI S SI NATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 12-21-2002 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: 12/12/02 TITLE: SINGLE FAMILY RESIDENCE PROJECT INFORMATION: DELUCIA WAY NORTH ANDOVER, MA COMPANY INFORMATION: STEVE SMOLAK CONSTRUCTION COMPLIANCE: PASSES Required UA = 539 Your Home = 432 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS CEILINGS WALLS: Wood Frame, 16" O.C. WALLS: Wood Frame, 16" O.C. WALLS: Wood Frame, 16" O.C. GLAZING: Windows or Doors DOORS FLOORS: Over Unconditioned Space FLOORS: Over Outside Air HVAC EFFICIENCY: Furnace, 94.0 AFUE 1036 30.0 0.0 556 30.0 0.0 1030 13.0 3.0 794 13.0 3.0 514 13.0 3.0 308 63 1036 19.0 556 30.0 am, 37 20 73 57 37 117 24 49 18 COMPLIANCE STATEMENT: The proposed building design represented in these documents 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 1250 of thedesignad as specified in sections 780CMR 1310 and /J4.4. 4 / i Builder/Designer�f� f � �'/i>_,U L Date./%. ; O� r MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 SINGLE FAMILY RESIDENCE DATE: 12-21-2002 Bldg.( Dept.( Use I CEILINGS: [ ] ( 1. R-30 Comments/Location [ ] I 2. R-30 ( Comments/Location ( WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 + R-3 ( Comments/Location [ ] I 2. Wood Frame, 16" O.C., R-13 + R-3 Comments/Location [ ] I 3. Wood Frame, 16" O.C., R-13 + R-3 ( Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.38 ( For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No ( Comments/Location ( DOORS: [ ] ( 1. U -value: 0.38 ( Comments/Location ( FLOORS: [ ] ( 1. Over Unconditioned Space, R-19 ( Comments/Location [ ] ( 2. Over Outside Air, R-30 ( Comments/Location I I HVAC EQUIPMENT EFFICIENCY: [ ] ( 1. Furnace, 94.0 AFUE or higher i Make and Model Number I THERMOSTATS: [ ] I Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ) I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations ( or installed inside an appropriate air -tight assembly with a 0.5" ( clearance from combustible materials and 3" clearance from insulation. 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. Manufacturer manuals for all installed heating i and cooling equipment and service water heating equipment must be I DUCT INSULATION: Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. 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 1250 of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- E a atcoG o° w a c� o z o u. o cw G w W o u; c ii a o w U w w o r2 v cm x p u" z to o u: [ w `wa4 w w v c0 z b cn o E cn CO2 y O L CL co C O CD C.) m O CM C O •C O� Co m m r • v t - p y:aDC N: c *' o �•? V : : cnv ev C3 o N o n L6 c (D '"J s N � E COCM Ma n1 y (� L = ,v N O � N C O E m mo v :aC.)� N m m Cf :act vCem Qv h Z cm r.+ C O c •O F - Q � r � m C 3o = m m w N W CO �r� t •N C *_•, = w - C:C `rga O.t m N Z O C.3m p m C_ y = d A m 'CF. p -0 � � ti •O C CO2 y O L CL co C O CD C.) m O CM C O •C O� Co m m ER ** s r !i' " Qtp 1 W3 7 W 0<L Q- O.L Lij m 3 F° r01 H g 0 O a 3 c c � c -11 al in C -0 3 O ruu Ln v t aJ u c O a� ED aj a`j a c c a, O m o �E LL a a An m .c +, o - O a u :9 C L ro ai Ln L Ut i— rD Date NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..'/ .Z::� . .. �� ............... has permission to perform .....// ....:. ................. plumbing in the buildings of ................... at ...o?/....� ��...(} .;�.. , North Andover, Mass. Feea2-r .7. Lic. No..'?!� 1.. .... % ........ j PLUMBING INSPECTOR Check # 6 2 L 82.3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:� • NY -A0 V %rr MA. Date: !ut---cobIl Permit# L Z `i 3 >` Building Location: Com. 2� ��.`u •lQ W Owners Name%A� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ® Plans Submitted: Yes ❑ No `k\�,on+tli� �`v 3-7 11 ©�-A" FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ® No ❑ If you have checked YJ please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ® Plumber Signature of LAcensed Plumber ® Master 2 D City/Town []journeyman License Number: APPROVED (OFFICE USE ONLY z z W 0 to Y Z Q t>1 N} J 0 U U = 1- N W � W Z Z H Q:z Y co in F- W N Z H t� U w Q 0 OJ O� Z X rn 2 O m cn p J Q C uj o 0U. l! I — I-- Q Z >- O p Y to z w c7 v z_ n- n. LL 13 Q Y= y 0 I"— �= W °z Q u- N j � c. Y Q= w w w W Q Q Ln� o j o Q O f' _> Y g O= Q it i Q Q Q� a m m u- = fn 1— 3 O SUB BSMT. BASEMENT 1 FLOOR 2 Nu FLOOR 3 FLOOR 4 FLOOR 5 FLOOR WH FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # Q iC V\ Installing Company Name: m� 1 �q ® Corporations t Address: c� �V1t`h S C City/Towne lG'S�Jh State.\'�)rA ❑ Partnership Business Tell -i's\ F,3q LAsk t" 11 Fax: Firm/Company _ tt Name of Licensed Plumber: 10K �JY�gtN1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ® No ❑ If you have checked YJ please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ® Plumber Signature of LAcensed Plumber ® Master 2 D City/Town []journeyman License Number: APPROVED (OFFICE USE ONLY Date. ..)` )41-1 .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......! f� L I -eJ,(2, ...............................�........................................................ has permission to perform .A .................................................................................................. wiring in the building of�t v t, . ................................................................................... at .........�........e' ... ......................................... NpTtp AndovejMva Fc� .i.) ................... Lic. No. I ... M. k ................. ELE iATINSikR Check # 5 coo 2_ ' .\ Commonwealth of Massachusetts Official Use Onl Department of Fire Services Permit No. I p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: ` 76 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant A4ei Da U Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building 1&41�b0C Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ Number of Feeders and Ampacity -922a Location and Nature of Proposed Electrical Work: j,J/�Y� - t i/emaca-Z" , iil2, �c 4,;,d 4(o --Er Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires SwimmingPool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons ................................................ KW No. of Self -Contained Detection/AlertingDevices No. of Dishwashers _ S ace/Area Heating KW p g --I Municipal ❑Other Local Connection 4No. of Dryers Heating Appliances Key Security Systems:' stemDevic: or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or E u valent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. � Estimated Value of Electrical Work: !j-� (When required by municipal policy.) Work to Start: yi //" 15 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: - / oi u ee c �riC_- LIC. NO.: Licensee: ('�///j�/� Gzii/ %1/l Signature t LIC. NO.: �3a� (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: ,2 C >je C — Al ©� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Sa ety "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. Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investiqations VV 600 Washington Street Boston, MA. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cl14,v/ 67 �j� � � ( Address: City/State/Zip: V3,y)_� A124 oPhone #: Are you an employer? Check the appropriate box: 1. ❑ I am 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, I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they aie 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 thepolicy and job site information. Insurance Company Name: 5 Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: � � 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is tr and correct (` � l ti Signature: �l/,_ W �� Date: � FIA, Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: 0 Date/40/?74 40/?7 4. %....... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INST�LATION 1, This certifies that ..... has permission for gas installation .. . . .................. in the buildings of .... J�/9V.l..5.......................... at . a?. % .. Z).C:.Z O . t .. tA Ia. `,l.. North Andover, Mass. Fee. .>-..-. Lic. No. 44 .. .... �'`�`"�' AS INSPECTOR Check # —gam 69.:j C 9 MASSACHUSETTS UNIFORM :APPLICATION FOR PERMIT TO DO GAS FITTING 1 _ CitylTown�. p1tiC� of l.'�' MA. Dater Permit# 6-5 3 J�Q,Q\ Building Locatiomle\ �Q Owners Name: .1V►Q�A �NA� Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential �] New: ❑ Alteration: ❑ Renovation: ❑ Replacement: R Plans Submitted: Yes ❑ No FIXTURES -- cn W U z Z W Q W �D Lu Q m S O� Q Lu J } Z W O 0 Fw- � z H Q z O W w D w 0 0 Q F O W tin W m O Q n. a W = x > z N w wLLJ Q WOO Q �_ z w W pZC to J Q Q m w O z 0 0 > z Q l— Q 0 a� a rr w w g 0 CL °� >>> O SUB BSMT. BASEMENT ---- -1z" FLOOR 2 NuFLOOR 3 FLOOR 41H FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR _ Check One Only Certificate # Installing Company Name .: + '' 1 n;k t fA Corporation Address �'� �?'�� City/Towns•3� State: ❑ Partnership Business Tel: �-1,C,i C01IN 1-4$"k, Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: r'Q� LT kt—� ��� �►''�'' INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy X 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 Massachusetts General Laws, and that my signature on this permit application waives thisCheck One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted for entered) regarding this application are true 11 be n and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this app licationcompliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General taws. Type of License: By Plumber I -- Gas Fitter Signature o icensed Plumber/ as Fitter Title [ Master City/Town p, �� ❑Journeyman License Number: `[I LP Installer APPROVED (OFFICE USE ONLY is 04 m 00 �s rn��' W z w � Cy) y (N F w '� • r r ti:Z (n Mr� Q Qn i lel a N "' � h=-^ �1 Q z w r�i N 4) Z �[v or w I O �LO Q N 0 LLo Q �N���Op PRS m W O S 00 _O W M CC,, v ~ U U O O z m D `� Q 00 ~ O O O `t II II o0m r W ,�, V LLJ N of 0 11 o Z Z� � �' Q Q LLJcn rn z L 04 < 2500 Lu z o IILLJ ow w aoLL �� J w a z Z U � N ~Oz Q WLd O O ��YU. O v Q w Jz 4- w 0 v, nO U Q U Z Z Uo� SE U. ° o �N - U(no a Q W w It ODA ww o� o z J a Q E-4 \04 wE-4 o~ Ao �h 04 O� O tq 169.84' 04Lu LO IN Q h V ¢ z Ld 94 04 U N / CO °^ •� �s'f� // ' 20.00' 0 ® • • �'' co / a o Q V co lm� L4 1 / X5.5 �•� ,-' o o �O y C 370HNV � � O1 �vn 30alOj ,t I / W 134.05 �Vx � �� �� W \ az Q / b \ �� ` ?s LZ > / U to (0 g a Z� N O v Location h "15 1 Uj A q No. 3S,3 Date 3- le -C)3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 30 ct© Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 CY D Check # `I B a Building Inspector lis 804 N ��� 00 rt' I� z C)o W O M r O cD a vi w o a d = N J (n 00 QiE (j)o� Q a opo o�Q W�O�PR�� O "i N o to � II � II oom � � � � w can � Z � z O I it z 0 Cr y`' Q w J cn rn UJ Q o o w i !' o: cl Cti Q Q OO o Q o m o2zo D w W m z E� F -C o C) Q r WWW?