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HomeMy WebLinkAboutMiscellaneous - 217 GRAY STREET 4/30/2018 (2)TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # r 17330 Building Inspe qt Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # r 17330 Building Inspe qt 4 .TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP "XOVATL OR DEMOLISH A ONE OR TWO FAMILY DWELLING 3 .eek .[•f i a'.ni } ,.!' "..,. J+ `..^.+ r.. - � :fiaG;l7y 4 moi. �. �"Z'4'.' �, ,�� .:.ri a BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: Building Co sioller or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Z ( 'i Ger-X-� 1.2 Assessors Map and Parcel Number. r707 rl / i /2-- Map Number Parcel t0mber tj ' � ho—of M .1.3 Zoninglnformation: Zarin District ProposedUse 1.4 PropertyDnnmsims: let Area F ft 1.6 BUn DING SETBACKS ft Front Yard Side Yard hear Yard RA*fired Provide tedProvided R=iMd Pmvided 1.7 Water SopptylvLGLG.10. 3D 13. Flood Zoe lofo mrtion: 1.8' SrawW Dispout S}steak PaMM 0 Piiwte ❑ Zone oatsi& Had Z= ❑ Mwkw ❑ on aim nkposai Syxam ❑ SECTION 2 - PROPERTY OW nPMUPIAU'I'BORMED AGENT 2.1 Ompwff c !>a (s" - Nti I Cr 2/-1 (c,(,y 'S r Address for Service: � r Zo 3 qsppatur.7-Telephone of R rd 2.2 Ownerl.E.l " 1 • _ Y �-�/ f'il. L3 ou'ptini Address for Service: v 6. 6f ?---52o Si store Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Licensed Construction Supervisor: Address Signature Telephone Not Applicable J� License Number farpiratioa Date 3.2 Registered Home Improvement Coraractor Not Applicable 0 Company Name Registtat on Number Address Expiration Date signature Telephone Wo M Z 0 0 m go MF 0 r v M r r z 0 0 a r i I SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25e(6) Workers Comnensation insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Desert bon of ProposedWork: %v i C21) o ij er Item Estimated Cost (Dollar) to be Com leted by permit applicant L OFFICIAL?ASE DJrTLY r 1. Building 3� J (/ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (.) x (b) J� 4 _ Mechanical AC 5 fine Protection 6 Total 1+2+3+4+5 Check Number SECTION 78 OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION 7, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Date FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used.to verify that all -necessary approval /permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and` or landowner from compliance With any applicable requirements. .l.■!f ■!!l■ii.. ii -i !•al,,f(lital,lif.l if alf Ll aii li!!flf lafi.............-�... fiiliiiiliii �D APPLICANT ?ao Y l I i t' l/PHONE ASSESSORS MAP NUMBER %O `r LOT NUMBER' SUBDIVISION LOT NUMBER STREET Z' 6k s'� t' S ' Z r rRI ET NUMBER .■■s�saasslsas..afaaMnswas MEN asss .■.sisaNsasNsasaN�asasss.a.s.slsass.assasaMas■ OFFICIAL USE QNLY usaN-rii.Na.rsai:lsisNaaiasi■aaaa.asaass.a�:■saNs-■flfs-.sa.as..sas.as.asaaaaalasaa.■ RECORNDATIONS OF TOWN AGENTS ■.fn.f. anon s-...sO..-al.......s.s..f..�.l.s-Nafasssasas!■ ■Naass.aassa■ i DATE APPROVED a�7 CONSERVATION ZMTRAT L / / 6 / DATE REJECTED COMMENTS S��dS 40 te- „LDA �� �l�,kq Las2`fld i1��2d�Lw o c((`eCi TOWN PLANNER COMIv1IINT'S DATE APPROVED DATE REJECTED DATE APPROVED FOOD 4' EC -HEALTH DATE REJECTED DATE APPROVED ECTOR TTi DATE REJECTED COMMENTS % f a �T_ ��— r s�o4� l a_ PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTTvIEIVT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE n l: r 1 1 �Tlr. 6 -l -FV -d71 -ON .4T ......... 1(7 -OR OvcSTG NE - EX15TIN6 CZGIWZON 47 ......... Rl�LIIR 4c D651�N .4S f3U/LT INV PIPE OUT OF AVU.5LC 11VII P/ ,P,47 /A/70 74 -NA' 11VV PIR4c- OUT OF 74 -NA' INV RIPE INTO D 45OX /1VV PIP,7 OUT 0".C' 49 BOX INV END OF P/RL47 CIEX4TION ,4VF)e,46Lc STONE D60714T Aeo84c &L"4Z 04, t Cj 2>!�� r� ............... ..................... .45 L%;;p L AOR C-4 L E .- / "= -, ") I D,4 rte. V L N -,5 PI -AN 15 No7-.4 &.4ee4ly7-Y A107 -E-111 ' 7 0,A- TlkC A1WVE1e111l- ..q 'VC'ACzrjc411vA1 OF TSE LOCATION OF 7WF EXIS71Mi� aefli.' L&R Designs. LLC PAGE 1 8'x 8' GABLE END STORAGE SHED ITEM QUANT MATERIALS Materials MATERIAL DESCRIPTION COST EACH COST TOTAL 1 4 4" x 4" Pressure Treated, 8'-0" Long customers projects. If you would like to participate, 2 3 2" x 4" Pressure Treated, 8'-0" Long 3 2 3/4" Thick CDX Plywood, 4'x 8' Sheet (for floor) 4 42 • 2" x 4" Stud Grade (or better) Doug -Fir, 8'-0" Long 356 Holcomb Rd- d 5 1 2" x 6" Stud Grade (or better) Doug -Fir, T-0" Long 6 4 2" x 4" Soffit Vents (22-1/2" long), or Full Aluminum Vent 7 6 2x4 Hurricane Ties - Roof Beam to Wall (Simpson Model Hl or equal) based on our plans. 8 2 2x6 Face Mount Beam Hanger (Simpson Model LUS26 or equal) HAMMER 9 6 2x4 Face Mount Beam Hanger (Simpson Model LUS24 or equal) 10 9 Tx 8' Sheet of Siding (T-111, CDX, Wafer, etc.) conditions, contact your local building official. 11 3 7/16" Thick (or greater) Wafer Board, 4' x 8' Sheet (for roof) CAULKING GUN 12 8 1 " x 4" Cedar Trim Board (or equal), 8'-0" Long 13 10 V x 4" Cedar Trim Board (or equal), 10'-0" Long permit, but may not be a complete package as 14 1 36" Wide by 6'-8" Tall Entry Door with Frame 15 1 Door Hardware (Lockable Opener and Dead bolt if desired) 16 0-2 2'-0" x 2'-0" Window (Actual size 23.5" X 23.5") (Optional) Copvripht (c) 2001 L&R Designs, LLC 17 96 ft Asphalt Shingles (I Square) 18 96 ft 2 15# Tar Pape r 19 1,000 8d 2-1/2" Common Nails, Galvanized (for framing and sheeting) 20 —250 1 " Long Roofing Nails, Galvanized (for roofing) 21 20 10d 3" Finishing Nails, Galvanized (for door installation) 22 —150 6d 2" Common Nails, Galvanized (for trim work) 23 2 Package of cedar shims for door installation 24 - Exterior Paint as Desired 25 1 Exterior silicone based caulking, Paintable • (42) 2x4-8' WITH o WINDOWS LIST NOTE: (52) 2x4-8' �" WINDOW (52) 2x48' Wf['ll2 WINDOWS List assumes a purohacedpre-hung door is to be installed if you TOTAL COST �{ � D T � T �v 7� MATERIALS OF 1Vl ATE1�1L�L S MA This Mate will be making your own door (either 36" or additional materials will be needed. Homemade 36" door: (1) 4'x8' sheet of 1/2" COX plywood (5) 1 "x3" Cedar Trim Board (or equal) 8' long (3) Hinges, (1) Door Latch as desired Homemade 30" doors: (2) 4'x'8' sheet of 1 /2" CDX plywood (10) 1 "x3" Cedar Trim Board (or equal) 8' long (6) Hinges, (1) Door Latch, (1) Slave Latch, as desired. We are working on a customer "do-it-yourself' photo album web page which will feature photographs of our customers projects. If you would like to participate, take a picture of your project and either mail the photograph to is or scan it and e-mail it to us at: mail to: L & R Designs, LLC 356 Holcomb Rd- d Kelso, WA 98626 Kelso, e-mail to: doityourself@choosefreedom.com L & R Designs, LLC is not responsible or liable for the safety of any person building or using the items based on our plans. TOOLS REQUIRED: There are no stated, assumed, or implied HAMMER O guarantees of the structural integrity of this shed. CIRCULAR SAW If there is concern about abnormal environmental LEVEL conditions, contact your local building official. CAULKING GUN A building permit may be required for construction of this shed. These plans should help acquire a permit, but may not be a complete package as required by your building official. These plans are copyright protected. F' T Gt J # 1 No unauthorized reproduction of these plans is allowed 1 1 1 Copvripht (c) 2001 L&R Designs, LLC FINISHED SHED COMPARE TO COST TO PURCHASE! ! 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INSTALL FRAMED LEFT AND RIGHT WALL PANELS (UN -SHEETED) AS SHOWN IN FIGURES #6 AND #7. STAND WALLS UP SUCH THAT BOTH ENDS ARE FLUSH WITH FLOOR PANEL AND OUTSIDE IS ALSO FLUSH WITH FLOOR PANEL. NAIL THROUGH BOTTOM PLATES INTO FLOOR PANEL WITH 8d COMMON NAILS, 6" ON CENTER, STAGGERED. USE LEVEL TO ENSURE WALLS ARE PLUMB. USE A SPARE 2x4 NAILED TO A STUD AND NAILED TO THE SHED FLOOR TO BRACE WALL UNTIL FRONT AND BACK WALLS ARE INSTALLED. Oq qyo. ♦�'q J5 04 � ti0�4�, �.ti� R �O VV &' O� FIGURE LEFT WALL INSTALLATION NOTE: IF YOU WILL BE INSTALLING A DOUBLE HOME MADE DOOR, SEE FINAL PAGE FOR ALTERNATE FIGURE #8A FOR FRONT WALL PANEL FABRICATION WITH LARGER DOOR OPENING. T-5" 3'-81/2" —�r 3'-8112" TOPPLATE Z � n O e BOTTOM PLATE 2'-1 318"--�.r�� 3'-21/4" 1 a a I 2'-13/8" FIGURE #8 PAGE 3 y�o Geo SAO. S��S'�yPS.SgP y 0oyo�0 0 41 PKC 'igyP�Pyy ti� O��PG� FRAME FRONT AND BACK WALL PANELS AS SHOWN IN FIGURES #8 AND #9 BELOW. FRAME WALLS ON FLAT SURFACE (PREFERABLY PAVEMENT OR CONCRETE). NAIL THROUGH TOP AND BOTTOM PLATES INTO END OF STUDS, TWO NAILS (8d) PER EACH END OF EACH STUD. ALL FULL WALL STUDS FOR THIS SHED WILL BE T-6 1/2" TO ENSURE FULL 4x8 SHEETS OF PLYWOOD CAN BE USED FOR SIDING. BOTTOM PLATE FIGURE #9 FRONT WALL INSTALLATION BACK WALL INSTALLATION T-5" 3'-81/2" 81/2' TOP PLATE O t� �-L-Jl 2x4 STUDS BOTTOM PLATE FIGURE #9 FRONT WALL INSTALLATION BACK WALL INSTALLATION INSTALL FRAMED FRONT AND BACK WALL PANELS (UN -SHEETED) AS SHOWN IN FIGURES # 10 AND # 11. STAND WALLS UP SUCH THAT OUTSIDE IS FLUSH WITH FLOOR PANEL. NAIL THROUGH BOTTOM PLATE INTO FLOOR PANEL WITH 8d COMMON NAILS, 6" ON CENTER, STAGGERED. USE LEVEL TO ENSURE WALLS ARE PLUMB. NAIL THROUGH OUTSIDE STUDS ON FRONT AND BACK WALL PANELS INTO OUTSIDE STUDS OF LEFT AND RIGHT WALL PANELS @ 6" ON CENTER. TEMPORARY BRACES FOR LEFT AND RIGHT WALL PANELS CAN NOW BE REMOVED. USE THE ASSEMBLED TRUSS IN FIGURE #12 AS A GUIDE FOR CUTTING SIDING SHOWN BELOW. THE DIMENSIONS SHOWN BELOW 4, SHOULD BE VERIFIED. PLYWOOD SIDING OR EQUAL IV � NOTE: IF GROOVED THIS DIMENSION IS SET, ALL SIDING (T-111 or equal) OTHERS CAN BE ADJUSTED BASED IS USED, THIS PIECE ON ASSEMBLED TRUSSES MUST BE INSTALLED IN (2) PIECES SUCH THAT THE GROOVES WILL FIGURE # 12b MATCH WALLS TRUSS SHEETING CUT DETAIL PAGE 4 FRAME TWO END TRUSSES AS SHOWN IN FIGURE #12. CUT TOP CORD ACCORDING TO FIGURE #12a. BOTTOM CORD OF TRUSS TO BE 8'-0" LONG AND SITTING ON EDGE AS SHOWN IN SECTION VIEW. MIDDLE VERTICAL MEMBER TO BE 19-7/16" LONG. ASSEMBLE TRUSS ON FLAT SURFACE, TOE -NAILING JOINTS FOR TEMPORARY SUPPORT. CUT SIDING (THIS WILL BE THE FINAL EXTERIOR SIDING ABOVE THE DOOR AND ON BACK OF THE SHED) AS SHOWN IN FIGURE #12b, TWO TRUSSES REQUIRED. TURN TRUSSES OVER AND INSTALL SIDING ON FLAT SURFACE OF TRUSSES. NAIL WITH 6d COMMON NAILS AT 12" ON CENTER. TOP CORD OF TRUSS SEE FIGURE #12a BELOW FOR DIMENSIONS INSIDESH JSIDING TRUSS/SI-IED FIGURE #12_ OUTSIDE TRUSS FRAMING - (2) REQUIRED - -- 4'-11 9/16" --� 3/4" 2x4 1 1/2" 4" FIGURE #12a 23` TOP CORD CUT DETAIL ROOF RAFTER INSTALLATION STEP #10 INSTALL SHEETING ON ALL STUD WALLS AS SHOWN IN FIGURE # 15. ALL SHEETS SHOULD BE FULL 4x8 SHEETS. MEASURE LOCATION OF DOOR AND WINDOWS (IF PRESENT) AND CUT OUT BEFORE PLACING SHEETS ON WALLS. NAIL WITH 8d NAILS @ 6" O.C. AROUND PERIMETER OF ALL SHEETS AND 12" O.C. ON INTERIOR OF ALL SHEETS WHERE SHEETS ARE OVER STUDS. MEASURE GAP BETWEEN RAFTERS AND CUT SOFFIT CAPS OR SOFFIT VENTS TO FIT AS SHOWN IN FIGURE # 15. SOFFIT CAPS TO BE MADE FROM REGULAR 2x4's. SOFFIT VENTS CAN BE PURCHASED FROM LUMBER YARD OR MADE WITH SCREEN MATERIAL. FULL 4x8 SHEET OF PLYWOOD F START WITH FULL 4x8 SHE PLYWOOD, MEASURE CUT WINDOWS AND DOORS IF I ROOF SHEATHING INSTALLATION rl11iurcr ffID SIDING INSTALLATION E FROM RIDGE TO EDGE 4x8 SHEET, CUT AND INSTALL FULL 4x8 SHEET OF PLYWOOD (OR EQUAL) d,L SHEETING ON ROOF AS SHOWN IN ZE #16. START WITH A FULL SHEET OF LYWOOD (OR EQUAL) ON THE HANG SIDE OF THE ROOF. INSTALL ON SIDES OF SHED AND NAIL WITH 8d '@ 9" ON CENTER INTO RAFTERS. NOW ,URE DISTANCE REMAINING TO THE OF THE SHED AND CUT A 4x8 SHEET PLYWOOD (OR EQUAL) TO THIS NSION, LEAVING THE 8' DIMENSION UT. REPEAT THIS STEP FOR THE OTHER OF THE SHED AND NAIL. M STEP #12 INSTALL TRIM AROUND ROOF AS SHOWN IN FIGURE #17. START WITH THE SIDE WALL FACIA TRIM. MEASURE THE DISTANCE FROM THE OUTSIDE OF SHEATHING ON THE FRONT OF THE SHED TO THE OUTSIDE OF THE SHEATHING ON THE BACK OF THE SHED AND CUT A Ix4 TRIM BOARD TO THIS DIMENSION. INSTALL AND NAIL WITH (2) 6d NAILS INTO THE END OF EACH ROOF RAFTER. NOW MEASURE DISTANCE FROM THE PEAK OF THE RIDGE ALONG THE TOP OF THE ROOF LINE TO THE OUTSIDE OF THE FACIA TRIM BOARD NST INSTALLED ON THE SIDE. SUBSTITUTE THIS LENGTH FOR DIMENSION "A" IN FIGURE # 17a BELOW AND CUT GABLE FACIA BOARD PER FIGURE #I 7a BELOW AND THE MEASUREMENT TAKEN. INSTALL GABLE FACIA BOARD, NAIL WITH 6d COMMON NAILS @ 12" O.C., STAGGERED. REPEAT THIS FOR ALL (4) GABLE FACIA BOARDS. DIMENSION "A" 4-10 3/4" r -1n^ 1x4 1 1/2^ FIGURE #17a- 23- 17a23° PITCH TRIM DETAIL STEP #3 INSTALL SHIMS ON TOP OF DOOR FRAME. ENSURE DOOR CLOSES SMOOTHLY AND TOP OF DOOR FRAME IS LEVEL, THEN NAIL (WIFFI LARGE FINISH NAILS) SHIMS SHIMS THROUGH SHIMS. PAGE 7 SHIMS STEP #2 INSTALL SHIMS AT SAME ELEVATIONS AS HINGES OF DOOR FRAME. ENSURE DOOR CLOSES SMOOTHLY AND HANDLE SIDE IS LEVEL, THEN NAIL (WITH LARGE FINISH NAILS) THROUGH SHIMS. SHIMS FOLLOW MANUFACTURERS INSTRUCTION FOR INSTALLATION OF DOOR HANDLE 14ARDWARE NOTE: SI�f9 IF YOU CHOOSE TO MAKE YOUR OWN DOOR, SEE THE FINAL PAGE FOR INSTRUCTIONS. ALSO, IF YOU CHOOSE TO UTILIZE THE DOUBLE DOOR OPTION, YOU MUST MODIFY THE TRIM DIMENSIONS SHOWN ON THE FOLLOWING PAGE FOR THE WIDER DOOR FIGURE #18 DOOR INSTALLATION riuuK-n ffi i ROOF TRIM INSTALLATION SHIMS HINGE STEP #1 INSTALL SHIMS BEHIND HINGES OF DOOR FRAME. ENSURE HINGE SIDE OF DOOR IS LEVEL, THEN NAIL (WITH LARGE FINISH NAILS) THROUGH SHIMS. SHIMS HINGE SHIMS HINGE STEP #13 INSTALL DOOR IN FRONT WALL PER STEPS SHOWN IN FIGURE #18. STEP #14 INSTALL TRIM AROUND DOOR, WINDOWS (IF INSTALLED), AND CORNERS OF SHED AS SHOWN IN FIGURE #19. FOR DOOR VERTICAL TRIM BOARD, MEASURE DISTANCE FROM THE BOTTOM OF THE SIDING TO THE BOTTOM OF THE DOOR FRAME AND SUBSTITUTE THIS LENGTH FOR DIMENSION "A" IN FIGURE #20. FOR THE TOP TRIM BOARD ON THE DOOR AND THE TRIM BOARDS AROUND THE WINDOWS, MEASURE THE INSIDE DIMENSION OF THE OPENING AND SUBSTITUTE THESE LENGTHS FOR DIMENSIONS "B" IN FIGURE #20 AND FIGURE #21. FOR THE GABLE SIDE CORNER TRIM BOARDS, MEASURE THE DISTANCE FROM THE BOTTOM OF THE SIDING ALONG THE CORNER OF THE SHED TO THE GABLE TRIM BOARD PREVIOUSLY INSTALLED. SUBSTITUTE THIS LENGTH FOR DIMENSION "C" IN FIGURE #20. FOR THE SIDE WALL CORNER TRIM BOARDS, MEASURE THE DISTANCE FROM THE BOTTOM OF THE SIDING TO THE UNDER SIDE OF THE ROOF RAFTER AND SUBSTITUTE THIS LENGTH FOR DIMENSION "D" IN FIGURE #21. INSTALL TRIM WITH 6d GALV. NAILS AT 9" O.C., STAGGERED. APPLY EXTERIOR CAULKING AROUND ALL 1 x4 TRIM BOARDS. PAGE 8 FRONT OR BACK FIGURE #20 GABLE END DETAIL STEP # 15 INSTALL 15# TAR PAPER ON ROOF SHEETING. INSTALL ASPHALT ROOFING. PAINT SHED AS DESIRED. r1kiUKL THY WALL TRIM INSTALLATION SIDES FIGURE #21 SIDE DETAIL O 1 0 i.� 24:- �I CO2 y' L s C 0 as Q COD O O V COD C O O C .T CO) E 0 co �D CD D O C. cmcc c cc � C G3 Z CD C. CO) C w c9j � w° � a°' � U w aG w r2 c� w C7 C2 cz w w � � CEW 0 z L .� o cn 0 i.� 24:- �I CO2 y' L s C 0 as Q COD O O V COD C O O C .T CO) E 0 co �D CD D O C. cmcc c cc � C G3 Z CD C. CO) C �%j.76 0� it Iv5 q- " Date............................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING -ertif E . .. C . . n . C . —1 . . A 14C 4�,M6.ac,_ This c les that .... ...... . .. ... ... .. ... . ......................................................................................... i has peVmission to perform ............. ................... 3 .............................. ............... P- rlz_ wiringin the building of .......... ........................................................................................ at North And er, Mass. ........... ... .... ... ...... 5 .......... Fee ... 9.0 ............... Lic. Noj� .......... ............................... ELECTR A� 1A CTOR Check # 1 ') .� d �fl\ Commonwealth of Massachusetts Official Use Only 17 Department of Fire Services Permit No. 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 (MEC), 27 CMR 12.00 MA (PLEASE PRINT IN INK OR TYPE ALL INFORTION) Date: PI [ I � 1-5 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention tq perform the electrical work described below. Location (Street & Number) a 1-7 .S 1 1� A `1 C - Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: �US��� � � tib C"kAk PVv.�J.P Av O C�PC+5- 20 A %0-P r S- 61A Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑o. rnd. grnd. of Emergency Lighting Battery 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 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump I Number I Tons KW No. of elf -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑ Other Connection No. of Dryers Keating Appliances KW SecuritySystems:* No. of Devices or Equivalent No. of Water KWo. of No. of Data Wiring - Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications 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: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: G to LIC. NO.:3S�2S Licensee: 9" <k^Wt Signature As`/LIC. NO.: (Ifapplicable, enter "exempt" in the license number 'ne. Bus. Tel. NO.' 1C+1 35 L� Address: �3� 2 cr tvci v` (^ Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 Signature Telephone No. PERMIT FEE. $ 0 — a The Commonwealth oflMlassachusetts z . Department oflndustrialAccidents R. v. ; d 1 Congress Street, Suite 100 ' Boston, MA. 02.114-2017 www.massgov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. An-plicant Information Please Print LegLb Name (Business/Organization/individual):� I C v4�MC�� Uh i�lO e K+ C Address:p�.o��A-'' City/State/Zip: inn i ©l aTJ)hone #: Are you an employer? Check the appropriate box: 1. ❑ I air a employer with employees (full and/or part-time).* 2.t?(l am a sole proprietor or partnership and have no employees Working for me in y capacity. [No workers' comp. insurance required] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. L] I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have nQ employees. [No workers' comp. insurance required.] Type of project )Fequired): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 ❑ Building addition I L [] Electrical repairs or additions 12. [] Plumbing repairs or additions 13.0 Roof repairs 14.E] Other "Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. 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 state whether or not those entities have employees. If the sub-c6n6d6rs have employees, they must provide their workers' comp. policy number. ' I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: Job Site Expiration Date: City/State/Zip; Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration (late). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby((cer�rttify un der thepaiinnsa�njJdppenalties ofperjury that the information provided above is true and correct. Date• f L l 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 #- Informatiion and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." ` An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth, for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill- out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -'contractors) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if yoia'are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture Ge. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.rnass.gov/dia N2 2841 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... eApl .......... 5 r C S/�� ................ ........................ . ........... form ........ has permission to per ................................................... wiring in the building of ........ .................................................... at ........... X ... I ... 7 ....... ............. he .... .. ..... Y. ............... ...... . North AndoVer,,Wai F 3 ee.. ... Lic. No. ......... . ,. . ..... .......... ELEcmicAL INspEcrOR Check# -7 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Department of Fire Services BOARD 0 FIRE PREVENTION REGULATIONS O fficial Use Only d Fee Checked leaee blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .All -work to be p:rformed in accordance -lth the Massachusetts Electrical Code SCI 527 ClA 12.00 DLE4SE PR Y7 IN INK 0R TYfE ALL 1XFORM47 I0N) Date: ` I t —()I City or Toiyn of: No A-- IC , m )1� To the Inspector of Wires: By this application the unders4, ted groes notice of his or her intenuon to perform the electrical work described below. Location (Street & Number) ;� ) -1 () y-(] (1 Owner or Tenant Owner's Address Telephone No. _ q9 __(0F5_6 C b Is this permit in conjunction with a building permit? Yes ❑ No ] (Check Appropriate Bos) Purpose of Building Utility Authorization Na Existing Sen•ice Amps / Volts 'vers Service Amps ! Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Wort;: 0 Overhead ❑ Unda d ❑ Overhead ❑ Und;rd ❑ Na of Meters No. of Meters Complerion o%the rollowing table may be wvived by the IrsDector or iFires. No. of Recessed Fixtures INA of Cei-Susp. (Paddle) Fans INA of Total Transformers KVA Na of Li;hfin;Outlets No. of Hot Tubs IGcnerators KVA No. of Lighting Fixtures ° ° Above n- SR immine Pool ❑ ❑ ° ar•nd. a d. a of meraenc tRnttnQ 3 ° a Battcry Units INA of Receptacle Outlets INA of Oil Burners FIRE ALARMS INo. of Zones INo. of Snitches INo. of Gas Burners INo. of Detection and Tnitiatino Devices 'No. of Ranges Total Na of Air Cond, Tons Nn. of Alerting Devices - Iof Waste Disposers Heat Pump Number I Tons I KW I Totals: I No. of Self -Contained IDetection/Alertine Devices INo. of-Disbwashers ISpacclAreaHcaiing b'W . Local ❑ municipal ❑ Other Connection iNo. of Dryers HeatingAppliances I.'W Ibcc Na n f Dc wices orEauivalent INo. o 'Nater Heaters No. ha o Iva o Suns Ballasts Data �rtriaa: I Na of Devices or Eouivalent INo. $ydromassage Bathtubs Ih'o. of Motors Total RP Telecommunications Wirino: ( Na of Devices or Eouiv.ilent I OTHER Attach additional detoil ifdesired, or as required by the Inspector of lVires. LhST IUNCE COVERAGE: unless waived by the oximtr, no permit for tilt performance of electrical work may issue unless the Iicenste provides proof of liability insurance. including "completed operation" coverage or its substantial equivalent. The underrped cenif:ts that such coverage is in force, and has eeitibited proof of same to the permit issuing office. C=.CK ole. n.SURANCE ❑ BOND ❑ OUER ❑ (Specify,:) I f Estimated V21=of Elec 'ml Work. � I a 5 `1 G (When required by municipal policy.) (E)pi-adon Date) Work to Start 1 � � Inspections to be requested in accordance with hEC Rule 10, and upon completion. I cerfift,, under the pains and penalties of perjury, that the information on this application is true and complete FIItl11 N.01E: ADT Security Services 111 Morse Street, Nor -%4r , MA 02062 LIC. NO.: 1333C License= John S. Eassctt SignaturLIC. NO': 1S33C (If applicable, atter "r-sculpt"in the license nunther line.) / Bus. Tcl. No.- —2-7p--1 1 1 Address Alt TcL No.: 603-594-59 resi OWNER'S INSURANCE WAIVER: I am aii are that the Lixensm does not hmpe the liability insurance coverage normally ONLY required be law. B}m}' signature below. I hereby naive this requirement I am tltt (clicck one) ❑ owner ❑ owner's 22ent. Owncr/A-cnt Si;nature Telephone No. PERMIT FEF': S 35.00 c V 2407 RIM* Date ...... �--. 6 // .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... R. 0.�.!ukx ....... R. .......................................... has permission to perform ...... ....... 0,-�,- P— � (e� . .................................. wiring in the building of ........ P-C�,.��A ...... ...... (C ................................ .t .. .... �,.A] ....... North And ................................ ��Mass. Fee .... ... Lic. No.. crRICAL MpEcrOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TNEC0RIMOA E4LTH0FAL4SSIACHUSEM Office U,Se only DLPARTjWZ�NT0FPUBLICSe4F= Permit No. (67 1�� BDARDOFFMEPREVEMONREaL47YOAN527CM12-00 Occupancy &Fees Checked J- . TIONFOR ATTONFOR PERAIRT TOPERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 . (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the pector of Wires: The undersigned applies for a permit to perform the electrical work described below. C'4 PARCEL Location (Street & Number) Owner or Tenant Owner's Address ;6! at" '� Is this pen -nit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building 1P&- S , A -- m TIAL Utility Authorization No. Existing Service `Amps / Volts Overhead Underground 1:3No. of Meters New Service Amps / Volts Overhead Underground = No. of Meters N, 1"T of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. o, Lighting Outlets No. of Hot Tubs No. of Transformers 77q-674 q Total KVA No. of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumcrs FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals t No. of Heat Total Total / -Purnps Toro KW Initiating Devices No. of Dishwashers No. of Sounding Devices Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal _ Othe No. of Dryers Heating Devices KW Conncctions No. of Water Heaters KW No. of No. of Jr Sims Bailasis Hydro Massage Tubs No. of Motors Total HP OTHER--- .4 THER •I m .• • u.:r ••:.u.• .•.v .. •. 16 ` �•:el na :• ..�. • `u nr:• al•••vr`:I •nl-•iu• a. • � • ••:..• •�.-laal;•I- ••r•r: _•• •:.v._I- I 111 ••1 :II' .•' II�`•:•1.•. •ill- �:. w�l:• LkaSigraaae Ra#r I Final _ Lioa>9eNo. �r� 3 7 Bus rssTaib 77q-674 q i, OQ _D A9yX-W �nr_ AlTel NTQ 1 OWNg2SINsURANCEWAIVER;IalnawmethadtheLnamdmnot haw themaaame cm=EF criisstlb m egtm intasmgmedbyMssadm9cttsCkuzalLzws and tlmtrrry*pafimonIl Spetrnitalplx�onWM4esdwle*ana>t. (Please check one) Owner Agent F-1 rr d 11 Telephone No. PERMIT FEE $ /, �- Signature of Uwner or Agent Location 6r-cn=:�4 No. Date FZ/ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee I $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ BullalWlnspector J�C t, 3 7 —Div. Public Works I w. -L z 0 W IL W J iL 0 0 u IL 0 J U 1-. 1-: te N _,o (n w 0 11 w (n 2 8 L 0 u w M z 0 u w I FA 0 1 J IL w L d z L u t 45 W 0 lz IL IL w U. z zx w w 01 LU z z 3: o z o d 0 C.) U z w w 0 x 0 w W z 0 0 w t w w 0: IL w IL ;a r -i >01 a -1 ii zm mo Ul Z C X c fn M ;Q, X i '>m T 3: 0 0 U) O:E mim PMX -q z > (A .0 U) o 0 to M 0 Wsz u r 6,00 Z,n Z >:E > —Z 0-1 m > z T m 00 :� x -� , - AV 0 :E CA 8 =! 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CO) c CO CM 0 C O 'a m m co M �v a 3 .a 0 0 Q o Q Q �Q tQ R O 0 Z co a CO) C NV CJ J v IE a 1-2 Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) Map and Parcel : Purposeof Application (check tionPAQne Numbpar Ap cant: ,1�_ Single Family — Two Family I the undersigned ap icant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit 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 of the effective date of this by-law, provided that no additional residential unit is created. 1 The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this 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.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permit s,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowvge or not, is grounds for refusal by the Building Department to issue a Building Permit. Signature of Owner or Au orizea Agent who signeathe Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit. I W . I . :Ido I do s�oP 2Qi�z��ENT H "ISCII J, 150� -5 ...................... 06616N 6-1EVWXON 47 .........(TOP 0,"':- 57ONE).= .............. /(-,IV o4l ....... 4. 211--7w . ......... ................... jfz&1odT1ON.5 DES/�N �1S l3U/LT �s )R/,/// T INV 'PIPE OUT OF I-IOL15tc INtl P/pec INTO TWAIlt' INV PIPE OUT OF TWNA-, INV PIPE INTO D. oo.X, INV PIPE OUT OF D. BOX /NV ENO: 014 u rn p 1,V,d TLZ2 CZ 01,4 TION ..4 vc2.46E STONE DEPTH C LC 6ao saeF.4 P.5 0 .4t : sYs�-E� //v FOR 5 CA L E D4TC: AN,567N ENCIMES& INC, /NC. • 112 cicA119,--vd 4 VF 11,4 VCelllL L AU. 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