Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 2245 TURNPIKE STREET 4/30/2018 (2)
��' `c� `, 1 1� 1 Commonwealth of Massachusetts RECEIVED N W City/Town of NO. ANDOVER DEC 10 2007 System Pumping Record Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ iettan Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 2245 TURNPIKE ST. Address NO.ANDOVER City/Town 2. System Owner: BRENDA SAWYER Name Address (if different from location) Citylrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 11/8/07 Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: 6. System Pumped By: Benjamin Shute Name J's Septic & Drain Company 7. Location where contents were disposed: GLSD _ /% MA 01845 State Zip Code State Telephone Number — 2. Quantity Pumped Septic Tank Zip Code 2000 Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 11/8107 Date t5form4.doc- 06103 System Pumping Record - Page t of 1 _ Co►nulosswoa6tla o� Iilaasaa�a:aetla Official Use Only %p � l o ire aru13• S Permit No. a ar n ico9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 11.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5 1 121 1 (o City or Town of: X101' rh t'`W [t 0V 2t' 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 by-41—OY1 d 0 s GAA A C Telephone No. 9-18' -'92-5s- Owner's $?mssOwner's Address V _+C1 I Cl Is this permit in conjunction with a building permit? Ves FZ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Install Solar Electric -Photovoltaic (PV) system panels rated f (o .14 1 kW t- STC Grid Tied. In conjunction with a Building Permit Completion of thefolloswing table way be waived by the Inspector of ryires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transforauers [CVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. ❑ d. a. o Emergency tug BatteEy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS Na. of Zones No, of Switches No. of Cas Burners No. or Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Pumpumber 'Pons K o. of 1 ontoined Detection/Alertiu Devices No. of Dishwashers 7Spac"c/AreafleatingICR' Local ❑Con icipalln ❑Other 11`0. of Dryers iances �,y ecurity yst;Noof Deviceor uivalent No. o ater K�V I o. or— Heaters Signs Ballasts No, of Devices or Equivalent No. Ilydromassage Bathtubs No, of Motors Total HP Telecommunicationsiring: No. of Devices or E uivalent OTHER: �l,ttach additional detail ifdesii ed, or as t equired by the Inspector of IYtres. Estimated Value of Electrical Work:(When required by municipal policy.) Work to Start: ASAP Inspections to be requested in accordance with MBC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical wort: 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 Q BOND ❑ OTHER ❑ (Specify:) 1 cedif �, under the paters and penalties ofperjutg), that the fitforniadon on thins application ds true and complete. FIRM NAME: SOLARCITY CORPORATION LIC, NO.:1136MR Licensee: MATTHEW T. MARKHAM Signature LIC. NO.:1136MR (If applicable, enter "exempt" in the license number line) Bus. Tel, No.:774.25&8180 Address: 24 ST MARTIN DRIVE (BUILDING 2. UNIT 11) MARLBOROUGH, MA 05752 Alt. Tel. No.: 774-268.8505 *per M.G.L. c. 147, s. 57-61, security work requires Department ol'Public Safety "S" License: Lic, No. OWNER'S INSURANCE WAIVER: l 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) Q owner El owner's a it. Own nt PERMIT FEE: $ Signature hire Telephone No. Office of Consunier A1fait. itld Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02) 116 Flow Improvement Contractor Ruistration SOLAR CITY CORPORATION MATT MARKHAM 3055 C.ErARVIEW WAY SAN MATEwO, CA 94402 '0144 As [i 4'. rak#t'W f1tRt/[P y,. . 4" ('t 0"Fw».aavr.. t/%/, V , It,I .r./Y 40 *,&# Office oft'oasumerAll'alrs.'u businessticgulation ' HOME IMPROVEMENT CONTRACTOR Rogistrmtl0n: 168572 Typo: � A Erpiration: 1`,I:20 7 Supplentent Caid SOLAR GIt t.(ti=f"ORA i'ON MATT MAIM IIFSM 24 ST MARTIN S'IRLLi 13LD 2UNI iV,AhLBOROUGII, ARA 01752 tinderseeretan Registration: 168572 Type: Supplement Card [expiration: 3/812017 UpdalcAddress and return card.,'141ark reason for change. Address Renewal Employment fast Curd I .icense or rcgistration vidid for individul use only helure the expiration date. if found return to: Office of Consumer Affairs and Business Her Illation 111 Park Plaza - Suite 5170 Boston, MA 02116 t Not valid without signature r iD r s ► • BOARD'Effi ffa.." Of ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A�,_ g RFC I STE1RE 0 MASTER ELECTRICIAN S0i.ARC11'* CORPORATION AA"'NEW T MARRHAM 24 SAINT MARTIN DR BLDG 2 UN IT 11 ARLROROUCt3 MA 01752-3060 The Commonwealth ofMassachusetts .Department o. f'IndustrialAccidenfs Dree of In vestigatfons I Congress Street, Suite 100 Boston, IIIA# 021.14-2017 tvww mass.gov/alio Workers' Compensation Insurance Affidavit: Builders/ContmetordElectricians/Plumbers A licant Informatian Please Print Le ibl NEU=(13usincst/Qrganization/ludividuaf . SolarCity Corp. Address: 3055 Clearview Way Phone #: 000- / vo-c,+oy Are you an employer? Check the appropriate box: , 1.1r l' am a employer with 15,000 4- E] I ant a general wntractar and I employees (full and/or partfirne).* havc hired the sub -contractors 2. ❑ 1 am it sole proprietor or partner.- listed on the attached suet. ship and have no employees working for mein any capacity. lNo workers' comp. insurance required.) 3. ❑ I artt a hameowner doing all work xnyselL [No workers' comp. insurance requireal t Thest: sub -contractors have emplvyecs and have workers' comp; insttranct? 5. (] We are a corporation and its officers have exercised their riy",jitof excarl.4don per MGL c. 152, § 1(4), and we have no employees. [No workers' comp, insurance required.] Type of project (required): b. d New construction 7. ❑ Remodeling S. ❑ Demolition 9. 0 Building addition 10.0 Electrical repairs or additions I Q] Plumbing repairs or additions 12.❑ Roof repairs 13DIher Solar/PV *Any applicant that checks box t t mast atso fdt out the section below showing thck wo*as' comperiantion poitcy information. I Homeowners wbo submit this affidavit indicating they an doing all work and tion hirroutside cantraeMrs must submit a new affidavit ladiealingsueh. tContractors that cheek this box must attached an additional sheet showing the name of the sub-coraractars and state whether or not those entities have cmptoytes. If the subxoninctttrs have ernployecs, they must provide their workers' comp policy number. I arrr an employer shat is proridtng rvrttkers' Competrsatlon Insurance for my employees. Beloto is tike pokey and job site informatlon. InsumnceCompany Name; Zurich American Insurance Company Policy -9 or Self -ins. l.,ic. #: WC0182015-00 Expiration Daae; 9/1/2016 Job Site Address 2Q=LA 5 _T V J�_a D 1' Ke S tT-F,� i- City/State/zip: bJQVU0 Q\IU Att®ch a copy of the workers' compensation policy declaration page (showing the policy number and expiration datej. Failure to secure coverage as rctluired under Section 25A of MUL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 ah&or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to $250.00•a day against the violator. Be advised that a copy of this statement inay'be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby eerlt* under the paltts and perealtiess ofperjury that Ilse informatlen provct ided above Is true and corre. Official use OWY. DO nor write in dila Ma, to be completed by elty ©r town 0, tout. City or Town- Permit/L. leevise q Issuing Authority (circle one): 1. Board of Health 2. Buildiag Department 3. CitylTown Clerk 4, Electrical Ipspector S. Plumbing Inspector G, Other Contact Person: Phone #o A� " CERTIFICATE OF LIABILITY INSURANCE ° °°r"""' r CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY ,;; -_ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT .BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement{s). PRODUCER CONTACT MARSH RISK& INSURANCE SERVICES PHONE r FAX . ... ... .... ... . ... _....-..._.. 345 CALIFORNIA STREET, SUITE 1300 Not ..........._ ................._ ..._ CALIFORNIA LICENSE NO. 0437153 EMAIL :........... SAN FRANCISCO, GA 94104 _APPR€f....... .. ...................._....T Attn Shannon 5ant1$15-7438334 --..... _. ...........INSURERS] AFFOR01#G COVERAGE .. ... . .. .........._.._j _ . MAIC 0 998W1STND-GAWUE-15-16 INSURER A;Zurich American instriance,Company 116535 _. _..._ INSURED INSURER B: NIA ILIA SolarCity Corporation t .. ......... .... 3055 Clearvlew Way _. INS.URER q: N1A NIA .. .. ..... ....._. ........................ _ .._ ............_. +._ ._. San Mateo, CA 94402 wsurERAD American Zurich insurance Company 140142 GEN'L AGGREGATE LIMIT APPLIES PER I INSURER E: 6,000.006 04SURER F: � COVERAGES CERTIFICATE NUMBER: SWO2713MOB REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PMOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I#SR - DOL.SUBR - POLICY EFFr'QLICY EXP of Marsh Risk & Insurance Services LTR TYPE OF INSURANCE POLICY NUMBER M : tM1MMOr Y11 LIMITS A X COMMERCIAL GENERAL LIABILITY 1131.0018201"0 OW01J2015 0914112016 i EACH OCCURRENCE Sl 3,000,000 r l I T..._...... DAAQPGET6NEA I�E ---- i CLAIMS -MADE I. X . I OCCUR; ; PREIyAI.S.E$ (Ea oecurrencgZ . _ .t $_ _ _- . ....... _ . 3,000,000 X SIR: $250,000 I MED EXP (Any one person) $ 5,000 . _.. _ ..__....._......_....._ .... _.................. .... S PERSONAL &AUV INJURY .... .V . ......... _.............. 3,000,U06 ....---- ...._ GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 6,000.006 X l 1 PRO- r .... , 1 i POLICY i JECT t.... LOC PRODUCTS • COraProP BGG : $ ..._ - _._...._ ............... . 6060,000 i ` OTHER 5... A ; AUTOMOBILE LIABILITY 8AP0182017-00 :09M1/2015 0910112018 MBINED SINGLE LIMIT r . 1.iE@ acctdenl), X ' ANY AUTO BODILY INJURY (Per person) ". S X ALL OWNED X SCHEDULED AUTOSAUTOS BODILY INJURY (Per accident); $ i.. NOMOMED X . HIREQAUTOS F.......... PROPERTY DAMAGE ._ .. f.x AUTOS t{Perecq•Idant), ..... _... _....+$.. ....._ _.. _ COMPICOLL DED: $ 85,000 UMBRELLA LIAB OCCUR TEACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE ' OED REMIONS I S D 'WORKERS COMPENSATION 'WCfl182014 00 (AOS) :0910`2015 ;0910112016 i X ': PER ; OTH• ; :ANO EMPLOYERS' LIABILITY A Y 1 N , .00 WC0182015MA PRL1aitETORlPARTNERiEXECUTIVE { )..,....i STATUTE. ;......i €R ..... i.... ... 09/01/2015 09101/2016 - ' 1.000,000 .ANY OFFICERIMEMBEREXCLUDSO7 N NIA) E.L EACH ACCIDENT S I_....._._......._....................i- ........ .......... (Mandatory In NH) WC DEDUCTIBLE $500,060E.L DISEASE - EA EMPLOYEE' S _._...__....... ..... ._ ...... ._ . 1,000,000 N yes, descnDe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT I S 1,000,000 I I i DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD. 101, Additional Remarks Schedule, may be attached If more space Is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SolarCity Corporation. 3055 Clearview Way SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL B9 DELIVERED IN San Mateo, CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOROM REPRESENTATIVE of Marsh Risk & Insurance Services ChadesMarmolojo ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD O N O 2 4-- 0 0 C O L LL J x W � J J Q W W J J O m O Q Q <lf W Of O m E M ry L W in V M Try � v 0 w o w d A E O a ry O + 0 M O m v ,5-009 bo V) 9 Q J U O C) CD O m J LLJ Q J Cr � W w W 2 (n v rn D CQ 9 S v� W Z Z_ Z m Q C7 Z � pC Q V)WLLJ D t�0 Q Z �, / v w Q F- N 3-.C cn J m LLJ Z 3: cn r O W Z w ,W v F- LiW Z Q U U O `� Cn V O O Z uj W \"J W W Z Z LLJd O Z Z U => =) CY LLJ Z J � > �Z H w o N o N Z [n z U o Q m \� J W< O D � O U 5 5 Z O Cl W _O w I..L > Z�j U U U N Q O O W QZZF-Q F- O O Q LLJ H Z W O O Q 0 O J O Cn L) L) C'2 w v ��F—/�4 V/ o=®a®o•JOal1Oit It L.�--j m E M ry L W in V M Try � v 0 w o w d A E O a ry O + 0 M O m v ,5-009 bo V) W U Z W _m N W � Q W Q Q � C/) a- D Y Z WCE N m CO 00 �— O W W Q H N Elf EC W W W >- Y > 3:: O N � Q Q w w E, �E�NO �mNZ O o a_ CDO 0 0 U) U � ON m O a cn c Q No Z g N _0jpp��a z Z U =god W -F=_ 6�=jWtwF Q m N? OHO FCLM UwZ 4W V q m2�.�.� O W N �dmF-O _ 2 z w 0 O U W W J 1-1•¢ym�w�a_N =�r w c z o0 F U w 0 0 F a y w z z w Q O N J r O . z m = Q W n z ZZ Z4-' MCDO C U U m M d O N a 9 4-1 _ ^y Icoo •` ■ o � M 0 o 'v v rn D CQ 9 S v� coo.o O O � t�0 ~ m �, / v W U Z W _m N W � Q W Q Q � C/) a- D Y Z WCE N m CO 00 �— O W W Q H N Elf EC W W W >- Y > 3:: O N � Q Q w w E, �E�NO �mNZ O o a_ CDO 0 0 U) U � ON m O a cn c Q No Z g N _0jpp��a z Z U =god W -F=_ 6�=jWtwF Q m N? OHO FCLM UwZ 4W V q m2�.�.� O W N �dmF-O _ 2 z w 0 O U W W J 1-1•¢ym�w�a_N =�r w c z o0 F U w 0 0 F a y w z z w Q O N J r O . z m = Q W n z ZZ Z4-' MCDO C U U m M d O N a o � U f0 G O � v N1 O p g0 (O G y v LnL 0 N <f 0 C C3 W 0 U > W U Z W (1) LLJ LLJ LQ > ' J F- Y U o Z a L1J C N z F- m co Cn G��$E LL 2 U LO � F— o w J ~ w Q =O =F- F=- F- p Y� 3:: -1 U �' p(n O � Q JN = Wp W< ON L-2 W W W >-Y> ow C) aL'i Q ma caN ��O O ck p J Z .j Li m C' � Z Q Z C:)< H Z ¢_ O F- Q oFL w C-) Q U w w J J w� J Q�Q O N LLJ Z w0 V) Z w Q w -j C) J m F- VU LLJ U))O Cl- zN tQ- �al:�NO QOo Z wmNZ N U) w w w ~Ow ^ N F7 d Ln CO O U Z T 7 Ln W N I- w 2= wU U n z �� a II as O L.L.--I li Z W LL Z w } < 22� 17 O } m O LO Q w V) m O M ZNco rIj o N _W i r c "' LU u^CN Lo ^w It 00 7 m (n Ln X O T Q Ocn In a' w o z O cn Q CD Of 5 219 9 J a~ E ��� U V) .z z Z � N Z W-O}-.5•. V) F- U U W C' WZ�a3 = 0 Y F- C' C7 Y W N zo��caFWw UJ J Q Ur V)_ = W Z J w 11 GW���,�,V_ Q Z mD:f r Ln Cn D Q W N m Z m �OrC FUWZ EmUO CL J [r J L.L w w Z O X d- 10 WZgs CO D Z w J Q U O U Q QC' �` aa D J uj �aom W N LW N ^ \ �N O [i Li N W �\ W w J W = W p l C/i �i N w Z C �O Lf7 C-)�{ H :za n CK Z=z SW�i� U U Wm Z d Wd E u O .V N � cavo+ mMLI: F* N Op O�O 1p C d - Ln z O � ` Q 0 J t\ Q Z o 0 W 0 J 0 _ U > 0- U J � Q o ` U ` Y C-) U t—L Q H J a_ LLI a LLJ U z � < o a Lf) C/) N o Q w N< w U m Lf) Q U p Y � ZF-- LLJ� ej Li J N z m CC) a p a 'zi- F- 0 L.I J L LJ Q V) 0 Q Z CD Q w C) O w of N O �mNZ a O 17 O o CD O 0 - U) rq0 ~ W U J ~ O m O v S W o ¢ Z co EM F- m FE C9 Q E .Z z Z � � W U W � FW zwz�N,lr a VIN- W ZCpU ... X U = W y2 VV;� mU0 W_=�F`�S~ vo ZWOQOF �O O aWJ -R ao Q u m z Fina I �1I� I I V Q O O F- u .UV 00 DinT QQ .QQ a o .` � i i U Q J � 1f') ■� j M 1 I Lull', z m 0u -)0 (o N Q^ II II 11 11NNa 'V^ E Ua^ 1 ,N,•I I I I C' W 4 •g ¢ v a m� a: rxi ,1 0 0 U U : U U O O .0 0 §F f;. J W J (.) •--I I rl I d 1 d I Z O O 0> . Do> N a_ C'4 O W I 1CL � Q I s{ I� n aD I I C) W O LOM 'nM ■f (w] S�e�`cU I I U J XLLJ II II II II ., i ✓+ 0 IY O OL >> c-, ~ 1 I W C9 W Z :>> /I 00 w1 O�c�I p O 0 I N Z 0 m (J ' U O O y d Z W Y U• .Y o w o w O ; m m CO N I I cg oo I� ao n ~ O ~.O N \ I I U x d'2 Cj (3 co �W.to �W. w Co O E IL CL N N�p Y L�.. W I I Y d h-- ` p 0 O O Jrh ih •�. iipe •�. L C �G F ZI I I I 3 y M L(7 W CL En U R M v } W N tT3 r Z l o 3Oft 3Oft o Y W v Q U f C) �� t0 U O p I I i-. W Z w O d3 r7 W I 1 I I NN Z I I Q Q :Q Q MI X I I E m c6 m c6 p O "7V I I � N ai I I II Iln II Iln L.1 U) 0 Q I I U U �U U W 00 tL I I. C14 :00 I,*: c6 0 x .- t` P-: CO F4 CO QLO ZZ I I 3 ' L) h ¢ Z II II II II te> > E W Q IV 1 I N N Q LLS L--- a CD a v I _o O m a � 2 3 y .m Z O VI - ..� O O :0 Cj Q 0 0 0 0 wI w N [' U .'o m co IOW Tc m MO zo Z `' W z \ O z ~ O Ld 'o 0 9 d rOn .d rn a W N b' _ U -i > 1.�� - Z m 9b` O .CCVT� 4► m c6 °' o v ~ $ E {VCM {C,,��I CD If U 'n > <n I U N I I J 55ft 55ft ? w Q= 0 Z WIC Q M Cr O:O: wLO I H O LO U W z m^ J� in Sa 00 I W NN I W Q LO OO I N I :EO w' cn NLA W W'W ot„ I max. TWO -w Z Z M ((¢ ^ 1 ¢ N Cj: Q N M I Z q D 6 W. X W Z Z z z w. W M CN mZ 04 a> °� c� c�c,- m W c 7 U I "'pO: CD C¢ W N N N N. O I W W� WO m 2 2-- z z z CTN c.o - � W •- away O 2 S wc O O O W U T O a Q O C7 = C W O y�j0 W C ���� Z ^ N l o N (D c cLU - P2o U 1 .- I uD 2 I U 1 � �. i Oft 1 tmu I �n O 0 o U e W m CL V) L> Q Q O O ca N ULu d L (OSI w y W N IQ r. 00 J J m Lo C m M W m m 2 1 ppJqpp F- w. M- W fJ- LU z O M 0 00 U U I I S N .. r�i. O U O d' N r2 u '= H�� v---� r - - - - - ---.- - - - - -- I SCS ¢ oY' � •y-� .~-J O O Q c O I I I I �--------- ,o N z 0 (n a; c. `i 0,. 0 o Q z •- O N z'z p I C.O.• oar c ¢ m z Iwl 21 v E > I; g� m d zC — � IL 2 W N I Y 0 11 ---, w 0 [, arm O¢ a Z M c Fw .O wm J ¢ Z. a G O �U s`z� � C1 N O� Z ;= J imCLV) zJ z U �_ W O U CA Ln m � N W U o K ~ `� Z¢ m z W��waoF U O W O SU O W2 N d C U Z Ww N N N O. m. ZS O U F w LU NQ F- p��'�a ga �-' Zd ZI ZI ZI �_ o�p�Ztwi� V) Ckf OO- QdZ Q a_Ud 00 cy �xry:,.• 333 �ZF 'LF t%i: F=O OX wp~(�.,N wUw Z z W �+ MN d' U Q wwamXOo�F- -c°m0� yU aprZ� CD W Q :> 00� oN5 u"' - �w U 5� <a< -. wowN ��Ow� co0 Z C -4X NN �¢� Q ^ dtn I¢>-m� jdfOn O_ W W \Q— m y �N.. j N . JNZr 4100 W O oz¢ Nz� II rn¢ 5ft I cZoaoNN mp0 (n 0 O V/ /'1 OOwowa,om UC-) dO�Nd =' § N . U ■ � MI yp N 1N ^ Ni O p OO�p e: 1 /,I,, N ~ ' N C LO O L � O v U > z CL US c Y � W U Z W p W p � Q m � Q LLJQ Q Q m > c, n- Z Q Q C:) Y m W W � N H M C0 (n o a 00 �O L LJ L LJ Q LLJ p O = O W W a 0 af O NpQ '0 Q 00 un Z Z U Iw- Cn V M p~� O Q O O J> �� pp w�� (/) (n � > p �ofNO � 0 U U_ ►- w U �mNz L L Q p Q p Z Cn z p n 0 Q O J V I acri a O IV) I cc J ISI D� iQi �W (n I Z Z oz ei L5 J z IU Q p IQ I F- I V IV) -I � I - I 10 1 Z ao I> I O Z 0 I I l 17 LO F— F_- O o 9 Q^, L_ J L-_-_-- J I O I ii O CD J W I I G [)" C,4 4-1 I I N I CO m II N I I V U-) W i O i LV U 2 � c �� °' Q m I- O o m y N O 13� (D Na g N� F- LU z N H �Z-1 _ _— o � � S' A a Oaj J L LU _0O a zWc) Z N _ �O �5O a � p�N~ZU o W OWN �d OrZS I <>-Mw W R h = h W Z�Z � 0 F O J O F a W O W Z= O NZ< U N ZZZd' d'OW �d' OOWO CL =nOW N V O � tI U .H A ao a � M O 3 3 o z: O U 2. VI � OOJ N N N Q N O M M Q O L _ w p S J FSo m U °� ._ 0) N C m N c C O o U X C U ma 4)C) O— i -C L C o U L z ■ _ C O U cn OAs O Mk O Cl) -0 C U� o::U Q O U •N � a) c o:=Q° C 0 .. ^j ,. QUU�OU?S-3SCOL A r�®4�� z W z 0 o � p UJ Z U> �6Z) W � = o Z -0 rn ~ O J�OCO W Q' ix �.-.UUmWU L 0 d Z � e � � r O r , r e 'o e Lq O a) U W z o W o �* 0 0° o o m is is coo a (.0 m m U- U- -0 a) CO C J_�a U 0JaN � 0� OU Q CO Q O Q ^U U - U a U U - U UU UO Lu O L„ L (D LIJ Q O L JQQZ Jn'QZ J�QZ Ja QZ JaQZ 3 y y' e I t r e t u Q ®' • ` I e m � s --.. �,. a ®. a ,�. e ®. � e � ® ■ vat .� r' e ' ® G �" e r � • .d � � it '' 8 � � kr ge. a ti :., •.w.#x.:. f� � t� .tl �,��V � �: t, 4 T,t. ' rr 7 J M N N o 0 0 0 �j o 0 Lj c 0 _ m CO M O -aOZ-0 MIn OZ� M OZci O OOo m LO 0OoW W ci z z J m v (D O� O U� 0(0 O CD tiF0(0JW L) Qi i� U/ 1 �� U f 1 m W ~ M U O W N D O W N D O W N D O W N D O W O U O W O U O W o�w J —CL Z J —Q Z J ...Q z J �Q z J —Q Z J Q Q Z J Q Q Z z z ( p = WOE ic � W • eg� " � w H� �> 01 � r @ ® e �e � t*. . �° ZZ N to W &. r (� O �7 ZF �- e e a to CD L �ki Z xW U = Z w N O V). Q ® N V O Ln cc O N M ® N V Ln E z O I1 o g ° p N N � N � O o E (}\ LL ° w a _ } Z N far N a y d d w -O V C .d L N E O O > J =F n > T" m E z O s � >, a c m m m O N N 3 ` N O. d2 0 O y p • J 7 U V � any d L 00 Za m 3 ACL . zi mizi L-[2 a Z V 0 Q a 3 a 0 ygoc m c $m m m fA Nva d U o .o D S a 3t5 C .2 ,2 o a UJ d N o do mia N o t+" mm? NNU C t w Y Nom o ..2:6 3 J N Zia Zuoi 'y o d IL a�D J O « m _ '22 C m = m J a o c c _ y a U U a o w m a � m a `mmm n V w :,. W r7 aay N N OJ dam-' Q c v ` p 0 � 6 m O r yLX o 3 m ` m N a CL J y C m w0.2 N � $mo Tm ° u m Q m m j N la a y Q. d � m m « O c 'p rn 0 m E m a t > o o U U U O m # m a -.2 c U O'y m N a n 0. H o N am O I1 o g ° p N N � N � fV m y E p 3 _ J D d o j E N N far N a y k� -O V C .d L N E O O > =F n > T" m D N O m mmn Z m 7 fn 'E m C Q m U 'a _O 'fN m m n � N •° C $ a0 d m y N m °-R' C- m m m N c M - c C c L M N ?i > N c u m C13 3_ O N O 26 6 N C a O O NQJ =-tea C O Q c 3mo U N Q C N� N .0 O N £ 3 m ` m FT c y > J Q m O N d O Q y c m A o 0 m w N 0 O m ^ J N c 0 N 0 7 m Q O N 3-0= J° a N - - c O N d° -o m .N 0 y C CO EQa J an N yu m N T ° m� d Q 0 CL C) f0 o m zy� Ea3Uy mcimnM, ° Nm� « U 0. m O a p L�w W w -O a L)O "O O N 00 N 0cn a0 0.CL p N c ?«o a0 �� ff c° OJ N y .7o a'O N CN N Q ) m C O N E -O o n d CL m° J m U) 0 'C o_ao ��y0. mr a c p . �o�n O N t a r H 4' rn �° 0 1b N Em E o a m s � >, a c m m m O N N 3 ` N O. d2 0 O y p • J 7 U V � any d L 00 Za m 3 ACL . zi mizi L-[2 a Z V 0 Q a 3 a 0 ygoc m c $m m m fA Nva d U o .o D S a 3t5 C .2 ,2 o a UJ d N o do mia N o t+" mm? NNU C t w Y Nom o ..2:6 3 J N Zia Zuoi 'y o d IL a�D J O « m _ '22 C m = m J a o c c _ y a U U a o w m a � m a `mmm n V w :,. W r7 aay N N OJ dam-' Q c v ` p 0 � 6 m O r yLX o 3 m ` m N a CL J y C m w0.2 N � $mo Tm ° u m Q m m j N la a y Q. d � m m « O c 'p rn 0 m E m a t > o o U U U O m # m a -.2 c U O'y m N a n 0. H o N am O o g ° p N N � N � fV m y E p 3 _ J D d o j E N N o E N a y w nu3 -O V C .d L N E O O > =F n > T" m D N O m mmn Z m 7 fn 'E m C Q m U 'a _O 'fN m m n � N •° C $ a0 d m y N m °-R' C- m m m N c M - c C c L M N ?i > N c u m C13 3_ O N O 26 6 N C a O O NQJ =-tea C O Q c 3mo U N Q C N� N .0 O N £ 3 m ` m FT c y > J Q m O N d O Q y c m A o 0 m w N 0 O m ^ J N c 0 N 0 7 m Q O N 3-0= J° a N - - c O N d° -o m .N 0 y C CO EQa J an N yu m N T ° m� d Q 0 CL C) f0 o m zy� Ea3Uy mcimnM, ° Nm� « U 0. m O a p L�w W w -O a L)O "O O N 00 N 0cn a0 0.CL p N c ?«o a0 �� ff c° OJ N y .7o a'O N CN N Q ) m C O N E -O o n d CL m° J m U) 0 'C o_ao ��y0. mr a c p . �o�n O N t a r H 4' rn �° 0 1b N Em E o a m mm -SE @ '� $ ° a E m E E a E c N of c0 > m C y�to y E mmm C E O m=��"tn� c 3r in U)2 OE0On> += y> ° 7 O c R Qa � Q N m CnmaCaa'c)aM 0 N 0 '- m m c m= NN N W N Q .d= N N 'Et o w a. Vi ;Na m o N ao d a E. c E a G 20N d m a U « O mIS� m H J c rn n f\� Q E m a t > o O 0 o aci o m °31 . 1FQ (6 E v n - O N o o. a n C ? CL y 7 a N F am d N d N M O N O 3 m: m LU u U V N M N M E V i E e U f + n ell 9> w 0 'n p CI O O N �. Z Q Z Q I;J w ¢o /M1 m O i ^ t t1 O q) _ E 1 E oc O • ., N 66 N C y, /��,p LU 0 O F"" �. r E 0/) a' 12 L U n7 i- ,..w t r -.. 6 O c O u G l t, it O t : O Z '� O. U *' r �. lMs7+� �3 s_e Q C K Q ° a`o O f o` a ' E 3, > CU I .�° h ^ y" r E G - � F p ®. Q a7 > O 0 Q p °. 3 0 3> U_ ov Q N- _ _ o > LU O -' °' > E E V c a5 a o v 00 o o a 2 N 0 O to - w a a i 0 O a 180 150 990 > Q > u Q if U> a - < O 3 m: m LU u U V o °' °''.. ; ..> U 0 U E E E E E E V i E e U f O QI of US9l 00 O i I 0 m LU u U V of US9l 00 m u m 1 Lffon I Ob N s o U 1 M h4 p O p :a.> 0 `c `c z N O 07 d 0 O O Ut U U C, Q) a N Et O > r z� 5 8 8 8 8 8 0..8....8 V SIOZ qo VY N3 WSl ............ W NU � Ido B 14 J10 -11 c 0fzc O a m LU u U V O ,.LLA , • n ell 9> 0 CI O O N �. Z Q Z Q I;J n °{ �v J - [z is /M1 Q t t1 O q) _ E 1 E a • ., L U N C y, /��,p LU 0 O F"" �. 0/) a' 12 L U n7 i- ,..w t r -.. 6 O c O u G l t, it O t : O Z '� O. U *' r �. lMs7+� 0 Thi v C K Q li7 O f o` a ' c C ol O CU I .�° h ^ C O r E U � x - � F p ®. v O O 0 E C7 -a c c �' •t as s a o E. LU L 4..0 _ • • a U u • u J r c V O ~O d u �. . p `: E O a c ¢ o OE o E s ' o ,m E p nn o °Qn f V �, •O °''n 3 and a� ice. Q � c ° C t a ° 0 U `a E. Z 0 X N O. a) 41 m ° v o u - m u m 1 Lffon I Ob N s o U 1 M h4 p O p :a.> 0 `c `c z N O 07 d 0 O O Ut U U C, Q) a N Et O > r z� 5 8 8 8 8 8 0..8....8 V SIOZ qo VY N3 WSl ............ W NU � Ido B 14 J10 -11 c 0fzc m LU u U V O ,.LLA , • n ell 9> 0 CI O O �. Z Q Z Q I;J n °{ �v J - [z is /M1 Q t t1 O q) _ E 1 E • ., D9 t G. L y .'i J � J 0 y, /��,p LU 4 Z ♦ Q F"" �. 0/) a' 12 L U n7 i- ,..w t r -.. 6 O c O u G l t, it O t : O Z '� O. U *' r �. lMs7+� Thi v `J li7 C, >„ 5 O E (�' S�- O< O G O -� N O O f o` a ' c C ol O CU I .�° i7 :-., 'J. C O. Z7._ CJ i7 `- p ` "} c r LU CL �.. X F LJ C1 .L J.. j O C g- S C L 7 C) 5 O - ®. Q an ,suj C7 -a c c �' •t as s LU 6a1. 4..0 _ • • a U u • u J r O u iemod paaluo,on<j UA m LU u 3 0) V aLU� ,.LLA , • n ell 9> O �. Z Z Q I;J n °{ �v J - [z is /M1 t t1 O q) _ E 1 E • ., ui t G. L y .'i J � J 0 y, /��,p t1— y 4 Z ♦ Q F"" �. 0/) a' 12 L U n7 i- ,..w t r -.. 6 O c O u G l t, it O t : O Z '� O. U *' r �. lMs7+� Thi v `J li7 C, >„ 5 O E (�' S�- O< O G O -� N O O f o` M • �. I .�° i7 :-., 'J. C O. Z7._ CJ i7 `- p ` "} c r LU "�# �.. X F LJ C1 .L J.. j O C g- S C L 7 C) 5 O - ®. C7 -a c c �' •t as s E m r N cn c 0 r r co .Q m R E co m a� D w m m 0 70 U t v W F - K Q r-'-` / R , .§ J j ƒ 2 \ M % / § = \ \ 0 CL E / \ � 2 2 < § - \ 2\ 7 § Q) \ \ ° \ j ° / { \ \ q / / } \ & : - $ \ / LL Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address Policy Number: Date/Cause of Loss File or Claim Number: Michael & Brenda Sawyer 2245 Turnpike Street HP2673885 2/28/2015, Water/Ice Dams 31695-W Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Wade Anderson On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 P Date.... -.Zk d.7.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that R...... 7; t ............ has permission to perform .......... .. .............................................. wiring in the building of. M ........ ITAW.YFR ........................................... Sl at ... ��)Y ...... ,,North Andover, Mass. Fee..................... Lic. No.............. ........... ........ ........ e . . .. ......... U CMCAL INSPECTOR Check# 75'18 'J It v Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2-s-4--, Occupancy -s— Occupancy and Fee Checked [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), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: % 4/ .— y City or Town of: NORTH ANDOVER To the Inspector oaf Wires. By this application the undersigned gives notice of his or her intention to perform 11W electrical work described below. Location (Street & Number) Owner or Tenant 'Oix ! x Owner's Address Is this permit in conjunction with a buildi permit? Yes [�r No ❑ (Check Appropriate Box) Purpose of Building �/� po S' f G -e Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ %®? CP' ® ., No. of Meters No. of Meters ®cs� Completion nfthe fnllmvino tnhlo —, ho .. -;,-4 1.. rl.o t--.,... „r rei:.,,... No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs nerators KVA No. of Luminaires Swimming Pool Above ❑In- rnd. grnd. lNo. 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 g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area .Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of Si ns Ballasts Security Systems:* No. of Devices or Equivalent Data Wirin No. of Devices or Equivalent 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 the aims andPen%a so erjury, that theeiinformati n on this application is true and complete`. FIRM NAME: G veX 9, G- ✓' I LIC. NO.: Licensee: %e. - Y �C Signature LIC. NO/ (If applicable, enter "ezen:pt' int license number lin .) Address: Bus. Tel. No.: �'=A EN Alt. Tel. No. *Per M.G.L c. 147, s. 57-61, security work requires Department o 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. Owner/Agent Signature Telephone No. PERMIT FEE: $ c The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Dle...... n_a_� •..+��. a a aaaa Lc lUl Name (Business/Organization/Individual): Address: City/State/Zip: Phone.#: Are you an em to er? Ch k h p y ec t e appropriate box: L ❑ I am a employer with 4. 13 I am a general contractor and I Type of project (required):, employees (full and/or part-time).* 2. ❑ I am a sole have hired the sub -contractors listed 6. ❑ New construction proprietor or partner- ship and have no employees on the attached sheet. These sub -contractors have 7. 0 Remodeling working for me in any capacity. employees and have workers' g' ❑Demolition [No workers' comp. insurance comp. insurance.$ 9• ❑ Building addition 3. ❑required.) I am a homeowner doing all work 5. [] We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions myself. [No workers' comp. right of exemption per MGL 11.❑plumbing repairs or additions insurance required.] t c. 152, § 1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.0 Other comp. insurance re Hired *Any applicant that checks box #1 must also fill out the section below showing their workers compensationl t Homeowners who submit this affidavit indicating they are doing all work and then hire outside otractors mus bmo a neve affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub_contractors and state whether or not those entities have em ' comP• Policy employees. If the sub -contractors have employees, they must provide their workers number. I am an employer that isproviding workers' compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 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 Investieations of the DIA for insurance coveraee verifi,-st;-- Ido hereby certify under the pains and pens/ties of perjury that the information provided above is true and correct ua[e: Phone #: Official use only. Do not write in th area, to be completed y city or town off[cia[ 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 #: V6 0 z LAJ am 5.00 o _ O y yv •ate ac W O fie: 8:Z C _ O �: �• O \c cD a t t" y C glom 402 �. CD mi c0 zy y � 3 +• .m a 4=0 C y O O y YC o o, � a CD c �Z o o► :momm C20 oa C p C CL LD y op c = O •CL +_•+ p Z W 0 � �+ � t .■.. c •- •wasCML Z W •E i = t�� C.3 O C c g z ca ID sa.sm 0 z O U C4 O as x `� Z h x O D C ' Ccm C OA •LAm CO O U w eov o o- CL M CMa o ca LAJ am 5.00 o _ O y yv •ate ac W O fie: 8:Z C _ O �: �• O \c cD a t t" y C glom 402 �. CD mi c0 zy y � 3 +• .m a 4=0 C y O O y YC o o, � a CD c �Z o o► :momm C20 oa C p C CL LD y op c = O •CL +_•+ p Z W 0 � �+ � t .■.. c •- •wasCML Z W •E i = t�� C.3 O C c g z ca ID sa.sm 0 z O U 0 U) W W -19 W U) O as ■ L Z h O D C ' Ccm C OA •LAm CO O ow. eov o o- CL M CMa ca cs. o env fs co ZCL •Qr C di V y C O O C ■ C c y D 0 U) W W -19 W U) Location c9S2qS /v M)! t�e S No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ 6-0 Building/Frame Permit Fee $ Foundation Permit Fee $ /QO Other Permit Fee TOTAL Check # 4341 Building Inspector lTOWN OF NORTH ANDOVER r 2, I BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR (DEMOLISH A ONE OR TWO FAMILY DWELLING pw BUILDING PERMIT NUMBER: ` DATE ISSUED. //—/ lj /� AL SIGNATURE: Building Commissioner1finspector of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: S�f�y�T irn.a& .-(56D' /0.SC j P _ _ &OU � 1 � n )Informaation: Map Number Parcel Number 1.3 Zoning 1.4 Property Dimensions: / ' J CJ Zoning District Proposed Use Lot ea s Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re aired Provided n 7;� 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: ZODe 1.8 Sewerage Disposal System: Public ❑ Private Outside Flood Zone Me" Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Z Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Const- •on Supervisor: SLicense /YI Number / % Ad(iess �"5 1)6,5 ml " �� Expiration Date Signatur elephone 3.2 Registered Home Impr ement Contractor Not Applicable 1( 5_7W Ae1,E Y SSV Z4/ ,05�.oJMV Company Name Registration Number Address r Expiration Date �- Si nature - _Tele hone -� I a f 5'ECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result ,yy in the denial of the issuance of the buil ng permit. Signed affidavit Attached Yes ......1 No ....... ❑ SECTION 5 Descri tin of Proposed Work check all a Gcable New Construction Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: I SFCTInN 6 - F.STTMATFD CnNSTRTTCTTnN CnCTC I Item Estimated Cost (Dollar) to beMY Completed by permit applicant CIAL USE ONLY I. Building(a) 50 nQDMulti Building Permit Fee Tier S . 6,` 2 Electrical DIMENSIONS OF SILLS _ (b) Estimated Total Cost of Construction DIMENSIONS OF POSTS.3 V421 Z,4& 3 Plumbin 00 Building Permit fee (a) x (b) HEIGHT OF FOUNDATION THICKNESS v'o 4 Mechanical (HVAC) SIZE OF FOOTING -1 A X 5 Fire Protection MATERIAL OF CHRvvINEY y p 6 Total (1+2+3+4+5) IS BUILDING ON SOLID OR FILLED LAND S( , Check Number SECI'lUN 7a UWINEK AU I'HURILA11UN TO KE CUMYLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date 1, I "Lf -ry 1 o", 7'E I I Ly }' (-- ,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 Name of lC1-S-OCA Date NO. OF STORIES SIZE BASEMENT OR SLAB ,r� != -,9 SIZE OF FLOOR TEVIBERS U /� `, < 3 SPAN DIMENSIONS OF SILLS _ DIMENSIONS OF POSTS.3 V421 Z,4& DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS v'o SIZE OF FOOTING -1 A X MATERIAL OF CHRvvINEY y p IS BUILDING ON SOLID OR FILLED LAND S( , IS BUILDING CONNECTED TO NATURAL GAS LINE i•r �f- �.'� a cCD 0 a: m Jo c ® v- C. Ea`'ca CD cm 5 = m O fir. a ICA Zj: ui CD o C - m ea LLJ U) 00 CD GO C2 > =tmN ui C. W rm ui ®' e` Eca Co COM cc Cc CD CD v - CD d C L = s c cc ca CL cl, C_ ® N m C •C CI °'j p fd r0, N m yO„ g m L s uicoo N aL 5 LL. ca :3*' •N O_ y •m O m C H co a o A A h •.. F� L ZZ =sL+CE a 41 Cc: o w v cn o w o o4 x a U w w o� o u�4 :13w. pq ' . E �f- �.'� a cCD 0 a: m Jo c ® v- C. Ea`'ca CD cm 5 = m O fir. a ICA Zj: ui CD o C - m ea LLJ U) 00 CD GO C2 > =tmN ui C. W rm ui ®' e` Eca Co COM cc Cc CD CD v - CD d C L = s c cc ca CL cl, C_ ® N m C •C CI °'j p fd r0, N m yO„ g m L s uicoo N aL 5 LL. ca :3*' •N O_ y •m O m C H co a o A A h •.. F� L ZZ =sL+CE a �14RTiq CERTIFICATE OF USE & OCCUPANCY Building Permit Number 6�' / K Date . THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS 5f �'� �-A f �/� IN ACCORDANCE WITH THE PROVISIONS OF 11M MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO o26-1 14�-S- "amu r^ v 10i Kc &,)F- c Building Inspector Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 µORT;l O APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS -_ r L� 5 TU rV\ Dj V0 J LOT NUMBER /0!3' A!,V ISO SUBDIVISION DATE REQUEST FILED DATE ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING 77 CONSERVATION PLANNING DATE�5� U DATE -i -/ z1 -Uy D.P.W. -WATER METER VI I DATE V� D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURE / DPW AUTHORIZATION I IV i, �2 a� c .o O cc r C R W .Nmmm• O O E In d y' ca $ , `. cm 0 y y O C •• O E D v c a� cmCIE. y cr- :_= O cm C O ; 'O (IJ 0 W ®' C3— cm cm Q CL C_ H O C •C = O d +' a N 'r CD V� W EL C rte= r r C r •N O � � W dt O C O r O •y O E m CJ CD o c S V� = O� Co' R 0 m 8=*Zm a 'w 41 uv z CD a F 1.5 o v i a - a w bo o cn G U w `G o a: m cn cn. ..y CD .� ; i, �2 a� c .o O cc r C R W .Nmmm• O O E In - ,o m. z 7. ca $ , `. cm 0 y y O C •• O E D v c a� cmCIE. y cr- :_= O cm C O ; 'O (IJ 0 W ®' C3— cm cm Q CL C_ H O C •C = O d +' a N 'r CD V� W EL C rte= r r C r •N O � � W dt O C O r O •y O E m CJ CD o c S V� = O� Co' R 0 m 8=*Zm a .o a co , 0 CD ?A " 0 'w z CD a F co i a - i ..y CD .� CD 0 CD _0 w ca :Dftca W m C2 CL w W c C U) �..• cc 40, CD co c ai cc CA 's � aw FORM - U - LOT RELEASE FORM i 0--r D-�--ac> 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 complia i I any applicable requirements. APPLICANT ASSESSORS MAP NUMBER O LOT NUMBER �) i SUBDIVISIONLOT NUMBER STREET T(4, r—r)ke STREET NUMBER ZZ�S OFFICIAL USE ONLY �......................................................................... RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADftMSTRATOR DATE REJECTED COMMENTS e DATE APPROVED 3 /0 (� TOWN P K DATE REJECTED CO \ a DATE APPROVED FOOD INSPEC -HEAL p'', i DATE REJECTED DATE APPROVED _ v S-SRIkTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER ! WATER CONNECTIONS T-TL0 /O - /,5 _ DO D �fWAY PERMIT R LiO r —6 CDATE APPROVED FIRE DEPARTMENT a DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR BUILDING DEPARTMENT' DEBRIS DISPOSAL FOP -1V1 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility 7 Signature of P Applicant Date NOTE: Demolition . permit t iiom the Town of North Andover must be obtained for this project through the Office of the Building Inspector > _ C The Commonwealth of Massa&use!ts Department of Industrial..9 lidents OF, of Investieations Boston, Mass. 02 111 Workers' Compensarion Insurance .45davit Flame !'2V"t Cc M Please Print Flame: (� -q�— Location: r,it�l 1A 7 4VA ml l' J Phone T � (0or4-� 'Z-70 I am a homeowner perrcmiine all work myself. r j I am a sole proprietor and have no one ,,vcrkina in any capa&/ C I am an emIr- lo:rcvidinc workers' compensation for my employees wcrkine on this job. P Insurance Co. Policv T I Insurance Co. Pclic✓ T Failure to sec::re coverage as recuirec under Sec:icn 25.a or iUIGi_ 152 can lead to the imposition cr criminal penalties of a tine up to st, 5Co.CO ander one years' imorscnrent as •.veil as c:vii Penalties in the form df a STCP `/I/CRK ORCER and a rine cr (s1 CO. CC) a day against me. I understand that a copy of this <_taement may ce fcrNarded to the Office of Invesrgaticns of :he GIA fcr coverage verification. / do hereby cerrdy uncar the pains and Sicnatu Print n pe7ury that the information provided accve is `rue and correct. "S X00 Phcne ;r 6'$S--: 2 Offic:al use only Cc not write in this area to ce completed by c::y or town c^ ciaf C'ty or Town Permit/licensire Euildirg Dept ❑Check .f immediate resperse is required ❑ L'cen$ing EGard Se!ectman's Offlc4 Contac; person: phone ; C Health Department Other 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. ba, �,e I T -U rn IQI' kk--4s� ho 150 Permit Applicant `� Property address Map / Parcel 6 �(g! 735c� 1 . 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 effective date ofthis 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 tat buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN 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 GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION D. Robert Nicetta Building Commissioner (978) 688-9545 `(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATI "HOMEOWNER PRESENT MAILING ADORES City Town Address J� C Map / lot Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL I t - Town of North Andover - t NORT11 01 ••""< ` Building Department 27 Charles Street s North Andover, MA. 01845 1 A, D. Robert Nicetta Building Commissioner (978) 688-9545 `(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATI "HOMEOWNER PRESENT MAILING ADORES City Town Address J� C Map / lot Work Phone Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL I X MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Middleton STATE: Massachusetts HDD: 6063 CONSTRUCTION TYPE: 1or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 10-10-2000 DATE OF PLANS: TITLE COMPLIANCE: PASSES Required UA = 73 Your Home = 71 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 280 38.0 0.0 8 WALLS: Wood Frame, 16" O.C. 392 21.0 0.0 22 GLAZING: Windows or Doors 12 0.300 4 GLAZING: Windows or Doors 12 0.300 4 GLAZING: Windows or Doors 12 0.300 4 GLAZING: Windows or Doors 18 0.300 5 GLAZING: Windows or Doors 6 0.290 2 GLAZING: Windows or Doors 24 0.300 7 GLAZING: Skylights 6 0.410 2 GLAZING: Skylights 6 0.410 2 FLOORS: Over Outside Air 224 19.0 11 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 125% of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer_4��6:,2,2 �'_ Dat MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 10-10-2000 Bldg. Dept. Use CEILINGS: [ ] 1. R-38 Comments/Locati WALLS: [ ] 1. Wood Frame, 16" O.C., R-21 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U -value: 0.30 For windows without labeled # Panes U -values, describe features: Frame Type Comments/Location Thermal Break? [ ] Yes [ ) No ] 2. U -value: 0.30 For windows without labeled # Panes U -values, describe features: Frame Type Comments/Location Thermal Break? [ ] Yes [ ] No ] 3. U -value: 0.30 For windows without labeled # Panes U -values, describe features: Frame Type Comments/Location Thermal Break? [ ] Yes [ ] No ] 4. U -value: 0.30 For windows without labeled # Panes U -values, describe features: Frame Type Comments/Location Thermal Break? [ ) Yes [ ] No ] 5. U -value: 0.29 For windows without labeled # Panes U -values, describe features: Frame Type Comments/Location Thermal Break? [ ] Yes [ ] No ] 6. U -value: 0.30 For windows without labeled # Panes U -values, describe features: Frame Type Comments/Location Thermal Break? [ ] Yes [ ] No SKYLIGHTS: 1. U -value: 0.41 For skylights without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. U -value: 0.41 For skylights without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: 1. Over Outside Air, R-19 Comments/Location AIR LEAKAGE: [ ] 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 0.511 clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ l 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 and glazing U -values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ l 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 providea means for balancing air and water systems. TEMPERATURE CONTROLS: [ l 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: [ l 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)------------------------- Building Value Calculation - for Pro a at..... Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 28 14 392.00�� 25e 480.x0 $ Living Room 14 13 182.00 $ 11,830.00 Dining Room 14 13 182.00 �� $ 11,830.00 Family Room 26 18 468.00 $ 30,420.00 Study $ - Laundry 10 9 90.00 X65 $ 5,850.00 Garage 26 24 624.00 $ 21,840.00 Entry 16 12 192.00 - $ 12,480.00 Basement Finished - - Deck Screened Porch Breakfast Nook Bedroom 1 18 13 234.00 $ 15,210.00 Bedroom 2 16 12 192.00�� =� $ 12,480.00 Bedroom 3 14 13 182.00 11,830.00 Bedroom 4 15 13 195.006' $ 12,675.00 Bedroom 5 - 6 V $ - Bathroom 1 13 10 130.00 �:�.. '"; $ 8,450.00 Bathroom 2 10 8 80.00 $ 5,200.00 Bathroom 3 Bathroom 4 Bathroom 5 $ 185,575.00 I o am H x� Z oa z AtCon Z V m ® Si CL w o Z L L ° vj O .0 a LLQ U_ 0 C: E w 0 �'ai Oct ° U d C u y U U y c c `• a t C C5 ° O C t, m �•N � .0 .� T3 ai 40.`: 7 C C '� Ie ® r o 3 �M:Hc c o ai � rg ® o0 0 o *lip Eu o � vs ap in ,� ac Q ` dao u =tui ~ " ) o c � LU —1 > f�. o = n- moo Q_ ua`i aj �- 0 � a o o c U w c ai H a c o P c v , LU 0 x U a) N o f m m W0. «+ an y CU V) LL o. tQ � +_+ U1 t Sop- o O �D Z o C O L.. CU go o � �. > m I ;14 A G 4- 1 C4 ° u a a a v w 04 0 w a a�, C � w GG O � W a � u W C1 C R R vi co w x ° H a z 94 w z A x w v cmc Cl) cn so 4- 1 o� _2 o � 0 C � o 8.0 C1 C R R ��. 0O G 2: rte.. m E Q 3 m E E m 5 cm m� C,* 14 W M m Co� N �N 01 m ex N d% c ev o V!E 0 11 CLC N m m Ic �c oa COD N O m � �;oa C � w Q m m e o ~ r N Oma~ a7 COD cc •fNA Z 4 d t m'N LU •O Z O a C.3 p m C o :o CODCL _ m cc o Cl O N GD O O z O w y .CD CLL O C O CD Q m H 0 CL CA H C O _cc �. C/! L O V co 0. COO) C c 0 ,c o� m m 0 co Lft O L d CL cmQ C c cc m Z0 Q d CO) C 0 w fr w U) ;1 i. 3 1 9 o Date ............. ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... r� l c1n....... ...... P` ..�!1.................................. has permission to perform wiring in the building of ........ ...�........ !�P. ��-�.......................................... at ... ..................... . d' h Andover, MassI57 F Lic. No.%n/�la........lr!z G . . ....... j r c- RICAL INSPECTOR Check #� � � _ ` WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THECIOMMONWEALTHOFMAlSS�4Gf�lIS M Office Use only DEPARTMENTOFPUBLICS4FM Permit No. BOARD OFmEPREYEN770NREGMTI0NS527CMR 120 U19- Occupancy & Fees Checked 4 PPUCATTONFOR 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 �.1L Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address S /r rf C Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building l/ecv.sl le i—I'M /z,v- I-, 4 e Utility Authorization No on? Existing Service Amps /� Volts Overhead Underground No. of Meters New Service . 4 Ampsf Z� O Volts Overhead Underground No. of Meters Number of Feeders and Ampacity L4.-ation and Nature of Proposed Electrical Work 1Ufl� /�t/G OF 7e N/si yYe�f�/hi6l hDmP 7`J CrID2 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and ound 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 a Other No. of Dryers Heating Devices KW w Connections No. of Water Heaters KW No. of No. of signs Bailasis `so. Hydro Massage Tubs No. of Motors Total HP OTHER • IrstrmtceCo� Ptttstmtbthetegtmetta��Ga>la'alLaws [Zf Iha%eamnatLdikh> xr&=Pbbtyarhxlff gCmV Co ortsgkgmM Ww t YES NO Iha%es► mWWdvasdpodcfsanetotheOlf= YES I�ba%edvckod�Spimenbc*tct)WcfwmaWbyd=kirgibe 4TwprimeINSURANCE ff BOND o GER (P<easeSp *) ��P //�o A �17l flZ Fvnirarir" rlkdp E*n*dVa dE6ctncal WO>ic $ hWedmD&Ragxstod I wia C!911 FmA A/ Z e 4Z FIRMNAME D P/y T, _. lioalseNa�,�7� Limm f 001' i 7 d'7` tfifk S; Zwnz d4y� 1ixmNo Btsff=Td.Na Baa ��Iy ������' �%/�. D/�'yy AkTeI.Na = oWN©t'SIIqgURAN WAIVER;Iammmethat*cLjmwdmnut te wr= wmrW " WAythlecg A ttasmgmedby Mmmdwsws G=rJLaws mrdditmy mlbspmniWpbcMrnvm-�mthism*M-Meat (Please check one) Owner a Agent M 7 f ��/ 4--'+ Telephone No. PERMIT FEE S 3/ � (/ O, wORTh Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: 616 PROJECT: StCOMI 3 B4h, a 3idci U�1 INGMMAX �ssu� DATE: ' (� UNIT NO.: FLOOR: WING: BUILDING NO.: a T� REMARKS: e4 Cr -)'s4 185 q� Excavation - depth. and soil conditions Framing - Other: Date: ® /_C `_ Date: Date: Inspector Inspector A MfL, Inspector Footings and foundations and drains - Insulation - Other: Date: 1w)— G Date: Date: Inspector 0 ly Inspector Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept - oil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: —Cof 0# Inspector Inspector Inspector Form 9995 Action Press, 585-7000 N2 2908 0 Date .. '-4) - "� 4,-, - . ;:76,0 / .............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................... / ...........................::2.......,................................. has permission to perform ..... .............................................. wiring in the building,of ............................................. at? ........... North Andover, Mass. Feed.o .... Lic. ................................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer f 1ClC4-UJWY1V1VrrFV1G1nVl'L110 , "1 DEPARTMEIVT0FPUBLIC&4FE7Y Permit No. �9O / BOARD 0FFIREPREVEW0NRE0004TI0NS527CW 12.09 (J-0 Occupancy & Fees Checked /f UV PPLICATIONFOR 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 x' I Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address o?-agS. "�� l U,� /X i Is this permit in conjunction with a building permit: Yes E] No 0 Purpose of Building / C. Existing Service ( 1 Amps / Volts New Service ;� Amp /O /-%OVolts Number of Feeders and Ampacity Overhead Overhead Location and Nature of Proposed Electrical Work rt'e !O c5 E'/�G"i C6 (Check Appropriate Box) Underground Underground To the Inspector of Wires: Utility Authorization No. No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators _ KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total t 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 TruvranoeCo�aage Aasuatt{fottlelagtmarta��Ga�alLam I haw aagotLiabtldyh>Ss imixePbhcymAdi gCuiplete Opwafions CovwdWcr its stiNlartd eqiyalett YES o NO IhaNeahni advandptodofsatnetotheOflioe YES M NO IfyxhawdWWYES ple=mdc*thetW0fMWrdWbydxdingthe ,WLV box. INSURANCE (' Borm ozHR�� 0 c) Expizltiori FslimatedvaklecfE7edtic�l Wak $ ` WotkloStxt l _ °� gxciatD&Rac�d Ra# Final Sig=i under-& Rmllies ofpajtay. FIRMNAME LiariseNa LiCensee AO/J- /!!—o� sig.- LmwNio Business Tel. Na ..�.. Alt Tel. Na /?_���� OWNER'S INSURANCE WAIVER, Iant e�eit>str�toeoaeagzaAssui>�Itralecgrivala>tastt tmadby�CralaalL and dv"signalt�olthspatrda onV.QMSthisMwil3rtatt (Please check one) Owner Agent ,ED0 0 Telephone No. PERMIT FEE $ U t n c x FU2 i U mt A a�� R w ti x x a dU W^ 4 ccx R� } Yoof � U Cal Liz 0.. R 4 C7 « O co of M co cu f/1 N W it ru to ca N "v o '..� W ,9B'9TZ � -gel � 92 NI U w0 p o ul 15 � c a a U- 06 rr p N �? i u6 N 6 w U0 tCL Tjm0 v ,. r o �y so z EL �- N 'u U 1;; YVJ TZ:BO TO/4Z/10 � (j Location 'T -u r AV, Ve S� r No. f � Date Check # r 14597 TOWN OF NORTH ANDOVER h z Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ C� TOTAL $ 110 �f 'Building Inspector N24904 Date.: TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .. /' This certifies that ..��.�:�. �:�... • .�..��r. •�• • '� '•!• has permission to perform .......... plumbing in the buildings of ... T�.kt' : / ..... • . • • • • at. ..�1.>. �' •/ • • • f(7 North Andover, Mass. Fee .-;:.�`."1.�. Lic. No. .�`: �. �-. �. ......... �: t._ .... . 1 PO MBING INSPECTOR � Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMSINC (Print or ype) d V I C Mass. Date 1 19f� /— Permit # IV 4q 0 BuYding Location �� �/ r .t`,e 5 Owner's Name 1-7 Type of OccupanK t U9 New ,( Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ r• Installing Address_ FIXTURES Business Telephone If 'I Name of Ucensed Plumber � II .I 11 A I 1 rl Check one: ❑ Corporation ❑ Partnership ❑ Firm/Co. Certificate INSURANCE COVERAGE: I e have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yea No ❑ If you have cf ked y", please Indicate the type coverage by checking the appropriate box. A liability Insurance policy k Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ of Owner or Owner's 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 knowledge and that all plumbing work and insWialions performed under the per it issued for this application will be in compliance with all pertinent provisions of the hUssaehusetts State Plumbing and Ch ter t of the Qjp4ial Laws. By Sign to e of UEed-sadNumber Title Type of Ucense: toaster .Journeyman ❑ Crty/Town NL Ucense Number mom ME ON d'�E1rY�G11lrv�����■■■■t■������� ����r■111111111■�������■111 ��\111■■111■111111■■■111■■1 Business Telephone If 'I Name of Ucensed Plumber � II .I 11 A I 1 rl Check one: ❑ Corporation ❑ Partnership ❑ Firm/Co. Certificate INSURANCE COVERAGE: I e have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yea No ❑ If you have cf ked y", please Indicate the type coverage by checking the appropriate box. A liability Insurance policy k Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ of Owner or Owner's 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 knowledge and that all plumbing work and insWialions performed under the per it issued for this application will be in compliance with all pertinent provisions of the hUssaehusetts State Plumbing and Ch ter t of the Qjp4ial Laws. By Sign to e of UEed-sadNumber Title Type of Ucense: toaster .Journeyman ❑ Crty/Town NL Ucense Number m m ,w U O cr4 G r J Z 0 J 0 � O W F- 1L W O C • O Z _ Q W d O 3 Q O M. O e W z O t V rt s � d Y N z O H V W d Z J S ILI A I ILI A 3552 Date Z— � ...`v. 2.'..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 410, . ...................... ^................................................... has permission to :perform ....... a...................................................................... wiring in the building of _..:......�'..... ..:.............................................................. at 725 ?I:? ...............:.. `.............................. , North Andover, Mass. ......................... �J ELECTRICALINSPECTOR ,. .a Commonwealth of Massachusetts Official Use Only - Department of Fire Services permit No. cS`� ov BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked c^ / / [Rev. 11/991 lcmvc blank APPLICATION'FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in aceonimice with the Massachusetts Electrical Code (ME ), 527CMR 12.00. (PL£ASEPRINTININKORTY INF PM4TION) Date:VIA City or Town of: To the Insp von df Wires: By this application the undersigne giv notice o or her intention to perform the electrical work described below. Location (Street & bei)a& Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boa) Purpose of Building 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 Location and Nature of Proposed Electrical Work: 1r l2l /hr— No. of Recessed. Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- _❑ rnd. rnd. o. o Emergency tg ting 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 e No. of Waste Disposers licat Pump Totals: Number TonsKW No. of 'cif- ontained Detection/Alerting Devices No. of Dishwashers Spacc/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. o(Deviccs or Equivalent No. of Water KW Heaters o. o o. of Siens Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Nlotors Total HP Telecommunications Wiring: No. of Devices or Equivalent [OTHER: Allacn additionai detail iJ desired, or as required by the Inspector of wires. 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 ❑ (Spccif) :) (Expiration Date).._. Estimated Value of Electrical Work: (When required by municipal policy.) a Work to Start: Inspections to be requested in accordance with NEC Rule 10; and,upon completion. 1 certify, under t to pairs and penalties of perjury, that the information on this application is true and -complete. FIRINI NAME: ADT Security Services 111 Morse Street, No oao, MA! 062 LIC. NO:: 1533C Licensee: John S. Bassett Signatu�IC. NO.: 1533C (Ifapplicable, enter "exempt "in the license number line.) Bus. Tel. No.: 781-278-1131 Address: Alt. Tel. No.: 781-278-1725 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. PE -TWIT FEE: Jj; ✓