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HomeMy WebLinkAboutMiscellaneous - 247 FARNUM STREET 4/30/2018 (3)N T— Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 CLCAT@CL-NA.COM Facsimile (214) 488-6766 ***********************AUTO**3-DIGIT 018 752 T3 P1 95000058942 Building Commissioner or Inspector of Buildings 120 MAIN STREET N ANDOVER, MA 01845 Cunnin fiham (Lindsey Form of Notice of Casualty Loss to Building Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 36. No insurer shall pay any claims'(1) covering the loss, damage; or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the'said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 2027512 Policy Number: 2027512 15 N Company Name: MERRIMACK MUTUAL FIRE INS co Cause of Loss: ICE DAM Lo Date of Loss: 2/17/2015 0 Insured: DANIEL & JOY HEYSTEK & DUNCAN Property Location: 247A FARNUM ST Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 36. No insurer shall pay any claims'(1) covering the loss, damage; or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the'said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. 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. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Date ...�.�.�..... �5....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that........... '�!��tT/1 u ................/.............................................................. has permission to perform ?.2� 1�G....... "&P�/..... -�V�� ............................ wiring in the building of........ i ......................................................................................... at ..�...Q- ! ...........................................h ...... , North Andover, Mass. Fee .... ��........... Lic. No Check # Zto ( % sS3�............ ............... ELECTRICAL INSPE-TOR _x �e— Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 13 % qs Occupancy and Fee Checked [Rev.1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts ElectricaAInspct4 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL .INFORMATION) Date: % City or Town of: NORTH ANDOVER To theof Wires: By this application the undersigned gives notice of�u's or her intention to perform the electrical work described below. Location (Street & Number)_ A 4 - Owner or Tenant u MCA. Owner's Address Telephone No. Is this permit in conjunction with a bQding erne Yes ❑ No (Check Appropriate Box) Purpose of Building JM� M { 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 r-11-- Location LLocation and Nature of Proposed Electrical Work: it Y1 .0 �n �/ LPc _- �A 2 Sh d -p S , Y Comnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. El o. o mergency 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 Heat Pump Totals: Number ......................................................... Tons KW .Detection/Alertin No. of Self -Contained Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Sectioty yesteilc : or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector q j wyres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspect ons 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 s e thh ermit issuing office. CHECK ONE: INSURANCE I BOND El OTHER El (Specify:) X certify, under the pn'ndpenalftes fperju , tlzie information on this application is true and corrtpleteFIRM NAME:�v ih G LIC. NO.: ,/ 3 Licensee: G, ieli,,±n ,j (/�' Signature LTC. NO.: (If applicable, ente; "exempt" in the license number line) Bus. Tel. No.: Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed O on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: �^ Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com 04 The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions `12.❑ Roof repairs 13. ❑ Other *.Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam 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. Lie. #:• Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -... fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ' Investigations of the DIA for insurance coverage verification. r I do hereby certto under the pains and penalties ofperjury that the information provided above is true and correct. Siff -nature: Date: Phone #: 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 #: 'q Information 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 j oint 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 w Accidents for 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 you 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 rw year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of ladustrial Accidents OfAce gfIn�estigatlons 600 Washington Street Boston, MA. 02111 Tel # 617-727-4900 ext 406 or. 1-877MASSAFE Revised 5-26-05 Fax ## 617"727-7749 www.mass,govaa VF tow. suoltOJO,Pgd IN BUOIV 401490 0841 `Plod Date .....3..-5 — TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ -:Jv&q ......... ............................ 9— has permission to perform A&zl ............... 48 . wiring in the building of ........................... -bakv.nV ...................................................... q 4 F ,,at .... -1 ..... ...............7... ..... ... �f ...... /-�N d ............... ., o rth Andover, Mass. Op .Fee.$7;�7 LIC. No. .............. �(;&� 1-7 Check# -7 G`6mmon wealth of Massachusetts official use Only Department of Fire Services Permit No. 13 ? LI y Occupancy and Fee Checked �M s BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts ElectricaWInspect 7 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATIOA9 Date: City or Town of: NORTH ANDOVER To the Wires: By this application the undersigned gives notic_ of hy's or her intention to perform the electrical work described below. Location (Street & Number) 2 Y-7 J—j ,4t)b'1 Owner or Tenant d Owner's Address Is this permit in conjunction with a building per it? Yes ❑ Purpose of Building g� T Telephone No. No [Y (Check Appropriate Box) Utility Authorization No. - Existing Service Amps / Vo is Overhead ❑ New Service Amps Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters Completion ofthe_following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑N—O.—OlTmergency.Lighting rnd. grnd. 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 p 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 Heating Appliances KW SecNoto Devi es or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs - Ballasts No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors Total HP WirinNo. Telecommunications No. of Devices or Equivalent OTHER: I V) I YU � Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of El trical Work: 3 (When required by municipal policy.) Work to Start: � Inspect ons to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO RAGE: 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: INSURA=NCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pys nd penalties of pe ury, that!Ae that!inf oration on this application is true and complete. t. FIRM N �/U G yj 33 LIC. NO.: Licensee: Signature LTC. NO.: (If applicable, en"e empt" -n he lijcnsenumber lin Bus. Tel. No.: OAAddress: 1 � / Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work quires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance`coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent 1p7p�MIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G,L. c. 143, § 3L, the 'a permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed �{ on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an �1 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ ! Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed IN Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of lVlassachusetts - Department of industrial Aceid&ts Office of fnvestigations 600 Washington. Street Boston, MA 02111 www.massgov/iiia Workers' Compensation Insurance Affidavit: Builders/Cont°actors/Blectriciansfpliaimbers AnnNeant information - Please Priv Lealibz Name (Businesslorganizationlfndividual): Address: City/State/Zip: Phone #; Are you an, employer? Check the appropriate box: Type of project (required): 1. Q I am a employer with . 4. ❑ I am a general contractor and I 6. E] Now construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner have lured the sub -contractors listed on the attached sheet. t 7. ❑ Remodeling ship and'haveno.employees These sub -contractors have 8. ❑ Demolition working for me is any capacity. workers' comp. insurance. g, (l Building addition [No workers' comp. insurance 5. ❑ We are a corporal ion and its 10.❑ Electrical repairs or additions required.] ?u [( I am a homeowner doing all work officers have exercisedtheir right of exemption per MGL 11. El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), andwehaveno 12.❑ Roofrepairs iusuranceregaired.] ; employees. [No workers' 13.❑ Other comp. insurance required.] x,!Any applicant that checks box must also fill outthe section below showingtheir vTorkers' compensatton.poltcy inronnanon. 'Homeowners who submit this affidavit indicatingthey tie doing allworlc and then hire outside contractors must submit anew affidavit indicating such. tContractors that chekthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am are employer that isproviding workers' compensation iusurance formy employees Below is the policy and job site information. Insurance Company Name: Policy # or Self ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy olthe workers' compensationn-polley cleclaration page (showing the policy number and expiration date). TAR= to secure coverage.as reg' dunder Section 25A ofMGL o.152 can lead to the imposition. of criminal penalties of a A je 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 ofup to $250.00 a day against the violator. Be advised that a copy of this statementmay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do 71ereby cert& under flee pains and penartles o fperjury treat the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town of Mal City or Town: PermMicense # 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 #: A %� Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eraployee is defined as "...every person ti the service of another under any contract ofhire,- express or impH4 oral or written.,, An em ployeils defined as "an individual, partnership, association, corporation ox 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 trdstee 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 doomed 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 prod -aced -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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have b een 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 n6cessary, supply sub-contractor(s) name(s), address(es) andphonenumber(s) along with their certificates) of Insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to carry workers' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed 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 you are required to obtain. a *orkers' 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/Rcense number which will be used as a reference number, lu addition, an applicant thatmust submit multiple permit/license applications in. any given year, need only submit one aflxdavit 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 b een 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. Anew 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 (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would litre to thank you in advance for your cooperation and should you. have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho Cmugoaw. ealth ofW-pagafihuse s - Deparbent QfkdusWaX Aceldwita Office offAveftatim 60 iagta Sire$ BoStQna MA 02111 Tei, # f17-7.2-7-4900 QA 406 ox. 1-877":MM8AFE Revised 5-26-05 Fax # 617-727-7749 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordanee-with theprovisions of M.G.L. c.143, §, 3L, the permit application form to provide notice of installation of wiring shall be uniforin throughoutthe Commonwealth, and applications shall be filed " bn the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. CU o. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the " notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall_be limited as to the time of ongoing constmction activity, and may be deemed bythelnspector of_W-ices abandoned-and.invalid.if he— or she has detennined that the authorized work has not commenced or has not progressed during the preceding 12 month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 23 8 of the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008.and extendingthrough August 15, 2012. 0>40e 8—Permit/Date Closed: ��3._ %c��� *** N.ote:Aeal2ply for new permio 'Oe�, ermit Extension Act—Permit/Date Closed: j:. -' Date .......):....2....." d .... . �7 �i ""-' �o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that OM 57 Ow rU� has permission to perform .......... . ��(� �-� l./ AU C'¢� ........... ............................. wiring in the building of 'V loa/� A� Y,!.!qp. ................... ............................................. at .......52y �qe� 9& S. � ............ . North Andover, Mass. ..................... ................. Fee .. .`.S""""^ Lic. No.. NOMF ZEA. tk ...�� .... ................... ..... ............... ELECTRICAL INSPECTOR J �� Check # V VBZ9 I a—\ ` ThEC0M110IVWE4LTH0F1qiMCJ1 %.SE17,S Office Use only DEPARR1E7VT OFPUBLICS4My BOARD OFFNEPREI1VM0NREG(II.IT10AS'527Ct�1R1Z.�00 Permit No. L Q Z-41 Occupancy & Fees Checked APPLICATIONFOR 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 Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perform the electrical work described below. Location (Street d Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Pwlrpose of Building Existing Service Amps / Volts Ne Service Amps / Volts Number of Feeders and Ampacity --� Location and Nature of Proposed Electrical Work _ -r Yes No r7 (Check Appropriate Box) rid 4tv r. o f- IDlly_ Yt30rr-% it `�rr� 0&r4e Utility Authorization No. _ Overhead M Underground No. of Meters Overhead L__J Underground Q No. of Lighting Outlets Total No. of Hot Tubs KVA KVA No. of Transformers No. of Lighting Fktures p 4 Swimming Pool Above Below Generators 11 No. of Receptacle lets No. of Oil Burners. and round r No. of Emergency Lighting Ban Na., o Switch Outlets No. of Gas Burners v � No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Disposals No. of Heat' Tons Total Total No. of Detection and No. of Dishwashers Pum s Space Area Heating Tans KW KW Initiating Devices No. of Sounding Devices No. of Self Contained No. of Dryers n Heating Devices KW Detection/Sounding Devices LocalMunicipal �Conncctions No. of Water Heaters Key No. of o. of Signs :13ailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER No. of Meters Iha%,eaartartLiabtlityh>str&toePblityurludrt>gt„QTTift Comageoritssuhstaleqtmrrlent YES o NO ` Ilta,,embTitedvaMploofofsmxiothe0&,-- YES NO r7 IfjculmedodWYE$pleaseir*dtetAxcfwmawbydnl,,,Cthe 4pcpri*b M BONDED OR-IER r7 (PkmSpeciy) EViatimDle F dValuedMmfticalWcrk$ t7O0 Waklosbd hq)a-:timDA-Ralucs1ed Rao Falai SigrWunckrTr ofpjtay. FIRMNAME Lio�>SeNa sigttufe r ioa>.seNo BudimTdNTa Ak.Te1Nn OWNER'S INSLIRAIVCESVAIVFR;Iarrtawarethatthe[ ecioesaathatetheit>sla�Ioeoaaa�ol �a�1e ftas mqxed by Mxsetrs Canal Iaws �d&atrnysigttalimCrIttlispnutwpkdm this legt*Mrl I (Please • Ck ) O171 Agent Telephone No, O PERMIT FEE $ Total KVA KVA :ry Units No. of Zones — Other Iha%,eaartartLiabtlityh>str&toePblityurludrt>gt„QTTift Comageoritssuhstaleqtmrrlent YES o NO ` Ilta,,embTitedvaMploofofsmxiothe0&,-- YES NO r7 IfjculmedodWYE$pleaseir*dtetAxcfwmawbydnl,,,Cthe 4pcpri*b M BONDED OR-IER r7 (PkmSpeciy) EViatimDle F dValuedMmfticalWcrk$ t7O0 Waklosbd hq)a-:timDA-Ralucs1ed Rao Falai SigrWunckrTr ofpjtay. FIRMNAME Lio�>SeNa sigttufe r ioa>.seNo BudimTdNTa Ak.Te1Nn OWNER'S INSLIRAIVCESVAIVFR;Iarrtawarethatthe[ ecioesaathatetheit>sla�Ioeoaaa�ol �a�1e ftas mqxed by Mxsetrs Canal Iaws �d&atrnysigttalimCrIttlispnutwpkdm this legt*Mrl I (Please • Ck ) O171 Agent Telephone No, O PERMIT FEE $ ' 1 kpLQ po�/ �? - ( 7- e9,4 - 06 y 06 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .........0. -:........ ... !T4 !........................................ has permission to perform ..C...- '.. t�-?�'. Q.t ` ...... -�5212 "t--L--- `� ........ ................................................. wiring in the building of............ Dul:o`, C'... ^- -................................................................... at .T 1 !2.N/^�q....l�� /� �.:......................... North Andover, Mass. Fee... ....,....... Lic. No. "t. .. P.. � .." ► O .................. . EL CAL INSPECTO Check # '/oZ U 12.215 I Commonwealth of Massachusetts Official Use 0 Department of Fire Services Permit No. 17i% BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 01/07] 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 ININK OR TYPE ALL INFORMATION) Date: 3/10/14 City or Town of. North Andover to the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 247A Farnum Road Owner or Tenant Joy Duncan Telephone No. 978-701-2039 Owner's Address 247A Farnum Road Is this :permit in conjunction with a building permit? Yes a No (Check Appropriate Box) Purpose of Building Residence w/ commercial space Utility Authorization No. 16(0' M ()I) Existing Service 200 Amps 120/240 Volts Overhead X Undgrd No. of Meters 1 New Service Amps Volts Overhead Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Repaired service riser torn off home by ice sliding off the roof, this caused the meter socket hub to break 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 Above In- Swimming Pool rnd. Grnd. o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I 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 PumpNumber Totals: Tons ... ... .. KW " '""' No. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water K`,1, Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 11NaUKA1NCE 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:) General Liability 1/25/2015 (Expiration Date) ' Estimated Value of Electrical Work: $ (When required by municipal policy.) (-1� Work to Start: 3/10/14 inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the info077o th' applicat' n is true and complete. FIRM NAME: Peter S. Manzelli LIC. NO.: A4790 Licensee: Peter S. Manzelli Signatur J10LIC. NO.: �(1 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 978-761-3500 Address: 32 Winchester Street Medford MA 02155 Alt. Tel. No.: LL 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. $ J-/-6� &-7 razz u 11 01 Ll Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name:PETER S. MANZELLI MEDFORD, MA ..This Licensee has additional Licenses, click here to view them.** Licensing Board: ELECTRICIANS License Type: MASTER ELECTRICIAN TYPE CLASS: A License Number: 4790 Status: CURRENT Expiration Date: 7/31/2016 Issue Date: Exam Date: School: This web site displays disciplinary, actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, March 11, 2014 at 9:44:21 AM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More Site Policies Contact Us http://license.reg. state.ma.us/publiclpubLicenseQ.asp?board_code=EL&type_class=_A&li... 3/11/2014 4� • ACORDT� CERTIFICATE OF LIABILITY INSURANCE DATE 03/10/IDDIYYYY) 03/10/2014 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Emond & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 857 Turnpike Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 133 North Andover, MA 01845 INSURED Peter S. Manzelli 32 Winchester Street Medford, MA 02155 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Farm Family Casualty Insurance INSURER B: INSURER C: INSURER D: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDN'kl POLICY EXPIRATIONffm DATE (MMIDDNY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ✓ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence $ 50,000 F✓ 5,000 LAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $ A 2009X0658 01/25/2014 01/25/2015 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000.000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY $ 100'000 A ALL OWNED AUTOS X SCHEDULED AUTOS 2001 C5668 -2A 06/19/2013 06/19/2014 (Per person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ 300,000 PROPERTY DAMAGE (Per accident) $ 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATUS OTH- EMPLOYERS' LIABILITY 2001 W7249 01/14/2014 01/14/2015 E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ 100,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Operations by named insured. CERTIFICATE HOLDER Town of North Andover, MA ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE z , l t © ACORD CORPORATION 1988 t 0 0 0 0 0 m doq� rD f7) wi (J h v ,,nrti^^ �v Q Q o 0 0 0 0 0 0 0� 07!21. pM LPRRY OGDEN` 9'R $52 2953 LAWRENCE EAST H. DEN, p&, 198 E�pn'9.y7�R MAI STMT Ggq1�7�jy%j�.���6._1�(ipq�alyyxgg'O�'Vg4°N, MA 019M ��A3$243l,3 fm 979 —392-2850 0119781- -3921 SGPbC°rtiber 26,20M Mr, Kandeth murp a.y to 9790688-no7' 169130xib)jt 8ftw North Aubver. , Ma, 01$41 E: 247 A Famum St., North ,, ovgr DW Mr. mur A6 You roquttd 1 vtslt d the a*va sit* W rM ew ft LVL Bctm uwd 1n the fi»t floor over the pmge suppareing the .t1*snily rotes flow above. This be= demist of 4 ►nmbm 1314' s 13 " with a "n of 23.3 ft, and supe 13fm or the hest floor ' vii, '1'h1s be= is weeptable and mem the requirements of ��assechras�s Stet SWIdtg code. 8tureaid you require any additional info ra&tjoia, please do hc..t i*eitaj. to call. Youn truly, juapisa.ld 11jals'OH d lalue4 woo • lou&iXajouze.z9 :11mg 109Z -8t,9 (.18L) AU -4 tL 1 ZO dW `u0l�uMIJV 0090-8t,9 (18L) :auoud anuand uosID►Q 94 Location a No. Date TOWN OF NORTH ANDOVER 18'19 5 y` Building Inspector 000 Certificate of Occupancy $ • CHU Building/Frame Permit Fee $ -� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # 18'19 5 y` Building Inspector ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING TliiB :f+�ll' BUILDING PERMIT NUMBER: DATE ISSUED: 5 SIGNATURE: Building Commissi er/In for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 24 A -Sr 1.2 Assessors Map and Parcel Number: 10?4 Map Number Parcel Number 1.3 Zoning Information: ZoningDistrict Proposed Use 1.4 Property Dimensions: 11, syt Lotot Area Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private 0 Zone Outside Flood Zone r'l Municipal ❑ On Site Disposal System SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT -mo 2.1 Owner of Record bAQC-35 SEK t _ 6s7-r��; f MNANDW69— Name (Print) Address for Service P' ..✓� 14 C141 (o?)-* 212-13 tgnature Telephone 2.2 Owner of Record: 3 Nam P 'nt Address for Service: Si atu a Telephone SEC110S 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: icensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor i 0tNr�trt5 wr�{ Zxc Z�5 Cr1 L,rL a .Lt Rr Not Applicable X Company Name zuk {Aon Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check aR a Rcable New Construction ❑ 1 Existing Building & I Repair(s) 0 Alterations(s) ❑ 1 Addition Accessory Bldg. ❑ I Demolition 0 I Other 0 Specify Brief Description of Propos d Work: lw'1t4q 1A,Ar(%VV Lq A r A -'L- 6 V (p w i -PS M e -A o-�n� C, 2 r?,Q f- In ►ry 1) l� '& -AL,'A caa bay R?, i, nark eF +L P t4i'nc. (oyrr qy_" ` G2rZ`,_Gy, r E -pa ACI it ^-(D r ;rXe�Oc�A, SPeACQ_ O�Wen nf_w +�rrc� ?l�2 L'. b ye ©� cnrmer �.UJvldotal 0, rKk CF.rT10N 6 - F.CTTMATF.n VnNQT121TrTTn1V rncTc Item Estimated Cost (Dollar) to be Com leted bpermit applicant OFFICIAL USE ONLY _ 1. Building �j ccc� (a) Building Permit Fee Multiplier 2 Electrical S u v (b) Estimated Total Cost of Construction Y3i v O cV '— 3 Plumbing © Building Permit fee (a) x tbl 4 Mechanical HVAC 5 Fire Protection - u 6 Total 1+2+3+4+5 C12.2 ci a Check Number "ra,i"""' iu vni"Z",nvinvicl�11v1� 1V �1G l V1YlYLEllll Wt1N1V OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as O-,vner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by this building permit application. to act on Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, /�J %� I_ - L- �'i% �S I �. k, , 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 me of Owner/Aeent Date _X) NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T1IyIBERS IST 2 No 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIIZDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATUIZA.L GAS LINE 0 O If r, FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. **""**APPLICANT FILLS OUT THIS SECTION APPLICANT_DA t--) }! r `f S T E ,kJ� `/ b,)dV C 4, •U ! .� L. PHON !�j�' 6 � - LOCATION: Assessor's Map Number /c)? A PARCEL a'? 9' SUBDIVISION ,� LOT (S) = STREET ST. NUMBER TOWN OFFICIAL USE ONL DATE APPROVED DATE RE-JECTEn TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS M DATE APPROVED DATE REJECTED TH DATE APPROVED y DATE REJECTED ' COMMENTS__, % PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jm 247A Farnum Street North Andover, MA 01845 Owners: Dan Heystek and Joy Duncan Application for Permit Notes: This is phase two of a house addition project. Phase one included the construction of a shed dormer on the third floor. Permit issued (#269) included septic design by New England Engineering Services approved by the Health Department on 11/2004. This addition does not create any additional rooms as its purpose is to expand the garage from a two car to a three car, enlarge the room above the garage by 336 sq feet and raise the roof to allow for the construction of a stairway to reach the prior addition. The expansion of the garage is to the front of the house where there are no setback or conservation issues anticipated. TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. G�fti z c Sj -� 4/5 G©b Type of Work: �I ` _ P Est. Cost Address of Work `ly4 r- r - S f- ,No 2TI-1 it—VOO-) � •Z � �" �•�' Owner Name:10 A >y 4 F S Tc_ o Y N C14 �kj Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner -occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date ��Oer Name D. Robert Nicetta . Building Commissioner (978) 688-9545 (978) 688-9542. Fax Please print. r DATE 11 JOB LOCATION Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Number Street Address / C) ,HOMEOWNER /� E2. 3O`l �U✓lCA9V Name Home Phone lot Work Phone PRESENT MAILING ADDRESS A r" A tZ-K) J v --i S I No��`c r� AN)oj (�, 61 Y -S City Town State Zip Code The current exemption for "homedwners" 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 SIGNA APPROVAL OF BUILDING OFFIC North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: CeA^ ,�IJi� (Dc C (Location of Facility) Signatur of P rmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector to 2 � Lim- o z a a � a TOR cn cn • c c: O N v a Z Q A+r i+ V : 4D m : s:EIAp mc_ E 40 m m � z O O � �co _ m V mo o •' acs � m �+ 42 ac +_.. jO cn '80 c '.,i� ♦ y .cz •:mor m wvio CD ♦: v 1.2 O � co co CEL o c H m y m c = 0 0 3 0 mo0 m LU o . w 'o = •� v L. o� cros,C y a s = A a a= s C t- z sawm zoo f T COO Ma) c O as cc CIO O O d y O O V) D ul N W W ce W U) Lim- ui z • c c: O N v a Z Q A+r i+ V : 4D m : s:EIAp mc_ E 40 m m � z O O � �co _ m V mo o •' acs � m �+ 42 ac +_.. jO cn '80 c '.,i� ♦ y .cz •:mor m wvio CD ♦: v 1.2 O � co co CEL o c H m y m c = 0 0 3 0 mo0 m LU o . w 'o = •� v L. o� cros,C y a s = A a a= s C t- z sawm zoo f T COO Ma) c O as cc CIO O O d y O O V) D ul N W W ce W U) d p� e, h F0 Z-07-;9 .78,r4i1�. �V r4 0997AC. . •Qo' 0 a � 23.oa G 72 S/ I' 1 AJ /yorE.• �..,vo oT/On/ Loco r/av F j,,7 14.1 -'I i" nING DEPARTMENTI 'r mexcaY cE,crifY rb rye rirzx /asawar4vo YU T.yE G,4,OV r 7W.47 r.VE .Ol✓.-."aA C IS Lac-. rT-O O,v rW.0 ZOT. S S.Win✓ ANO T/.cIT?OAFS CodFGup! mIrIv r.NE ���' O/,iaA�vaoriQ 2GLVivs ,-E.Skl4 rA:WT ,"Ca.4.40/.0 LOT L/.✓ES. " _• Feg, er o r L-eL-, ✓B /r Ivor Z4044MP /.S/ r d' f*&nreAG , 4 pop ,wzw ep .4.rC o. OF M� t D SL'YJ98 Ll�'r8G CY ca--,WAII pewr.WAY EAsc",r,7- R4 or RL Apt/ /N O•PA�✓�t/ f4.P F.evv� .PE.o L r� �vs T -jam. ; . • .. _. �,,.�� ' HOT FD,E' Bovvo.� �'r'c*•e.;�i<i/Rrr'`ov- Bo�.vO.4.e�Y it/FoR�sf- �E��P/�fIAG� E".�/G•u�EE.P�.�/6 SE.PY/lEs ,4r�o.t/ rot'E.y f�,f, E.Y/JT/.(/G ,cez-o,�os. G6 �A•c'.E� .S•T.rEET '• A.i/OOYE.� /f7.4S.�v�,•v//SETTS O/8/O - - ----- -- ------- ..... 9t,810 VV4 M3AOGNV' 'N OVMUID838 8Z S83N!DIS34 IVIIN30IS38: SUMOSSY ONnua.'r,S "L-I_l f 1 _t;= Cc-- 1.42 a 12 who jE9 05 Q Oil 46 14pmtMO. gig 3. ajdo ri jjj 5111 IM8 1 oil Li 1! JI ii i i I r 5H. 9401§82? logo H M8.6, I a 2 8 z aflis'. liffil--11 ?I- JEJ111,11,J1, j®® 1! Is R� -, Ru 8. 20 P I s 4 dud .6 gd I a u 1B u 31 2 5 'ON E)NIMVUCI DEMME=—& ILO)L aor II ii tT to II II i II 0 wig 3 w Ix z;; < O 6 z u z 0 z wz II OAR o 0<0 a -41 968.1:0 VIN 283AO(INV 'N Ovod AITM38 88 SUMOIS34 IVIIN34IS38 531MOSSd ONnus 'f ,o i > Z N LL Q z 2 frogwz 3 >aw . g gs ~Oz w OON UUO fin' IFN F 2Jw 2 DJC p UQD p 0 10 i 7 .. �f a f. IT �j 3E �,311�1 7 43, sW s�Pal q� lL �c�3Z1 }I IIO iL ��—:Val! I aji I Sig _ 94 I I - x t-31 a - 3R e u'Alli 111 0 ] Al $ _ l � 5 � I 0 jigs �o �f LIL I w �Wuls J9 'ON ora mviia uiv > O!Lj w SZ.. d z -Z 10 <ww irt , 0 LU z U. f iJ� Iib 'r d ��� ���-� 24 iOWL i k� vy ion rO 4 w �Wuls J9 'ON ora mviia uiv > O!Lj w SZ.. z -Z 10 <ww irt , 0 LU z i k� vy rO Location,A/7/� FANZ14-57- No. Date A /��- r�lllw f .. NORT1TOWN OF NORTH ANDOVER ,. • O S o ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ Wo Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17750 Building Inspector a ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ISiAOHiiCl� SSC777. ' BUILDING PERMIT NUMBER: � DATE ISSUED: /0// D SIGNATURE: L&k-t� Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use - - Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required I Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ,lame rint) r Address for Service (o8`� 2-12o 'No(4 4- KA x'01645, ignature Telephone 2.2 Owner of Record: S CTI N ONSTRUCTION SERVICES )1-0-4 Address for Service: 12T14 N pc7V�i�r `�V OIS 3.1 Licensed ConstructionSupervisor: k Licensed Construction Supervisor: ' O ` Bes `'y1 MA l (0 1 V5 Address Signatur Telephone Not Applicable ❑ c',S 042t "L License Number Expiration Date 3.2 Registered Home Improvement Contractor ,,, �j cow2-kn�l aroN %tGe Not Applicable 0 y 9 C0 I / "' t Com, ny Name �r. ,,. ri YSfiC MI& , ,�,Q Cf Registration Number \qo 27 69 • Expiration Date Signature — Telephone ou M X z O b ^ V SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... A, No ....... 0 SECTION 5 Description of Proposed Work check all applica=ble New Construction ❑ 1 Existing Building ❑ 1 Repair(s) 0 Altcrations(s) 0 Addition Accessory Bldg. ❑ I Demolition 0 I Other 0 Specify Brief Description of Proposed Work: L 13--6 � 36 -4 tZF'1�t2 1 I SECTION 6 - RIMMATRD CONSTRITCTTON COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFRCIAL USE ONLY 1. Building os �0 1 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction q 3 Plumbing Building Permit fee (a) X tbl 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .�.Ty, I, y_ �� �" p� 1( , as Owner/Authorized Agent of subject property Hereby authorize_ �, v 7 �d `^' `x-� to act on Mydae�>If, in, III matersrelative w work authorized by this building permit application. 10 )1/' I Siggnature of Owner l Date C SECTION 7b OWNER/A ' ZED AGENT DECLARATION 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 of Owner/Agent Date NO. OF STORIES Z5 SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I S7 2 Nri 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DMNSI014S OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY��-- IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: t*�[Q- Location: � 1-\ 4EWUV - City �-Rk NAr"4Ve I .f � 41-D Phone # 0 I am a homeowner performing all work myself. c I am a sole proprietor and have no one working in any capacity E6— 1 am an employer providing workers' compensation for my employees working on this job. Company name:yoe o WN -q-, w L�aN COO ` Insurance Co.1Q �M S-'/ T'E- NS I - CO Policv it WC, ID 14 11--� - Company name: Address City: Phone #• Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as _well_as.civil.penaftiesinlhelam ,of a..ST.OP WORK_ORDER.and..a.fine of (.$100.00)-aday.against_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify und,§�rthe pains and penalties of perjury that the information provided above is true and correct. 10/1410 Print name v `M F Phone #( 3cj Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept []Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A- ❑ Health Department ❑ Other GrlF ..� 7770F; ABIL! i `( INSURANCE `".r- "cogc4 'EP3 GO WELSH & PARKER INSURANCE AGENCY, ItJC. iH15 CJ:RT FtCATE 19 ISSUED AS A MATTER OF tNFORNATION ,.433 MA'N STREET ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUDSON MBA 01749 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PHONE: 978-562.5652 ALTER THE COVERAGE AFFORDED BY .THE POLICIES 6ELOW. ` FAX: 9?8 662.7120 i VRED INSURERS AFFORDINv COVERAGE � MAIC KNEEL1t iN EELAND CONSTRUC'ION CORPORATION NSURER A; Cantr21 Murttal IMSYrence Cpmparry_ 407 R MYSTIC AVENUE SUITE 340 INSURER 8: _ INEDFORD MA 02155 (INSURER C; WSURER D. ��— WSURER E: CnvleoAete _ 'HE POLICIES 0.' INELRAWE LISTED BELOLv HA'vL SEEN SS'JEO T-) THE INSUAFD NAMED AeMVE POR THE POUCYPER!CO INOICATED, NCT'lJITHs'rnnDLVCi AN" REOLUREMENT, 'ERM OR CONDITION OF ANY : ONTRACT OR OTHER DOCUMENT WIT,y RESPECT MAL ?EPTAW. TME INSURANCE AFFORDED 0Y THE POLICIES OcSCFAOF,O HEREW IS FL'BJECT TO W."IICI•i THIS CERTIFICATE raAY 8E ISSUE^u OR TO ALL THE TERMS. EJLCW810V3 /w0 CONDITION$ CF SUCH POLICIES. r GREGArE LMT( SHCY/N NAY s4Xre BEEN REDUCED $y BAUD CLAMS rri'f TYPE OF INSuRAhoeI ., rOLI..YNUMEER P�kY[}PECTIVR . IOLIi'Y�P�/1TON UABIUTYrt i CLP 799806E I AUG 104 X: COMMERCIAL GENERAL t-- LIMITS AUG I OS EIACH OCCURRENCE 61,OOC,OOo LIARIUTY I�MAO: �-C KNTa CLAIMS NYIOE ! X I OCCUR I s 100,000 A ii I MED. EXP (Any Onr. Pawn! = 10,000 lY---'' PERSONAL A:. ADV INJURY S ilg 1,000 QQO 3..rrL AGGREGATE LIrnIT gePues cER GENERALAC,CREGATF ( ! PRODLCTS 2,000,000 COMPIOP AG_ GSI}_— 0 0 2,000,00 AUTCQCBR.E t iAMUTY I ANYAJ'O COMBINE[' SINGLE LIMIT � (En epxJenrl S ALL Qk"JED AUTOS JJ BODILY INa.RY SCAFOLLED AVTC; I (Peroaten) HIREDAuras I NON-OV1AEpAUT05 I_ BODILY INURY ; � fPerxrirfEnt; IS '-- PROPERn DAMAGE IS GARAGE, I :ADILITY r AFP' ALITO I AUTO ONLY - EA ACCMENT 1$ i (OTHER THAN fAA_ IUM@F,REILAL:A6tLITY I j AUTO ONLY: Y.^ iF.XOESJ{ OCCUR CLAWS MACE I tEACHO:CURFENCE .i _I rr� DFIJLICT161.E I AGGREGATE r S .� ' RETEWION -- : WCRKER9 COMPENSATION AND EMPLOYERS LIAMUTY ,NCATRT7- I IOt�ER I _ T711Y L,4K� ANS PROPRrFIr"(P AR T.W, RrEXEC:TME I E.L. EACH ACCIDENT ^r OFFICEVAOM1Ia e.CunEd, If qw d"'? be.,,$w I E L. DISEASE-EI4 EMPLOYE: 6 %OMAL FROVIVORA !"N. E.L. r)15EAS2!•P0;ICY U.V T I GTHER. ESCRIPTWN OF OPERA TIO NS/LOCATIONWHiCLES1EXCLUSIONS ADDED ENDORSEMENT( SPECIAL PROVISIONS CERTIFICATE HOLDER I AJOIT1pNgL INSIJRFD: IYZURER LETT=• ^.ANCEL TION S110,;1D ANS OF TMC .-.EaVE DE9_RIOEC F'0,!C!E6 FE CANCF-LE7 pEFJAF. THE EX21RATTON t1ATE THERE CF Twr,[M NV r,OMPANY WILL ENDEAY-)R *0 MPoI,,, DAYS WRITTEN NCTiCE '0 THE CER-IFI',ATE 401.r -FR NAMEC Tr, THE .EFT SVT 7AU,URE -0 DO u0 S4, -LL IMPOSE NO CHLIGATION OR L ARIL ri op AW (IND U•ON T,;E I?J"!R. IT'S ACE FITS OA REPRESENTAT(VES AUTHOP.!LEOREPM.u;G rATNE Attention: 761.393-0601 ACORO 25 (2001/08) Certrf tate a 21570 Ni,pIP. M. McMeekin 9.4e""Nonweala Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration KNEELAND CONSTRUCTION CORP. CARL DUMAS 407 R MYSTIC AVE #3413 MEDFORD, MA 02155 •• ✓ire �ana�naeruealll `7 ` ilau��..aelta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 113869 Expiration: 7/19/2005 Type: Private Corporation KNEELAND CONSTRUCTION CORP. CARL DUMAS 407 R MYSTIC AVE #34B MEDFORD, MA 02155�1 Administrator Registration: 113869 Type: Private Corporation Expiration: 7/1912005 Update Address and return card. Mark reason for change. Address [] Renewal Ll Employment Lost Card License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rut 1301 Boston, Ma. 02108 Not valid without signature TI. L�a�nmra�euiea�!% o`'.-wos/ruaella BOARD OF BUILDING REGULATIONS, License: CONSTRUCTION SUPERVISOR Number. CS 042144 Birthdate: 06/29/1956 Expires: 06/29/2005 Tr. no: 11274 Restricted: Oa_ CARL O DUMAS 10 BROOKHEAD AVE BEVERLY, MA 01915 Administrator ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTIOti and ADDITIONS 780 CMR Appendix J Applicant Name: W mN t - Applicant Address: 1, (' C,T �11'b sq-P-3,1`'1�F�12�D Applicant Phone: l -39 3 9 S I Cl Compliance Path (check one): Site Address: 0"4 '�' .A fi v H G✓T- City/Town: Aaz _ Use Group: Date of Application: A (© Applicant Signature: ❑ Prescriptive Package (Limited to 1- or 2 -family wood frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2.1b): Heating Degree Days (HDD.) from Table J5.2.1a: (For items d. through i., fill in all values that apply from Table J5.2. lb:) a. Gross Wall Area sq.ft f. Wall R -value R- b. Glazing Area' sq.ft. c. Glazing % (100 x b + a) d. Glazing U -value U_ e. Ceiling R -value R - g. Floor R -value R- h. Basement wall R - i. Slab Perimeter R - j. Heating AFUE ❑ Component Performance: "Manual Trade -Off" (Limited to wood or metal framed buildings only) Climate Zone (from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade -Off Worksheet from Appendix J, [and HVAC Trade -Off Worksheet, if applicable] ❑ MA.Scheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate (HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall + Ceiling Area � sq.ft. b. Glazing Area' sq.ft. c. Glazing % (100 x b + a)% ❑ ADDITION with Glazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: t 2 3 M�`-MUM U -value MINIMUM R -Values Fenestration' C61in ' Wall I Floor Basement Wall Slab Perimeter. Depth 039' R-37 R-13 I R-19 R-10 R-10 4 ft Glazing Area may be either Rough Opening or Unit dimensions. Based on NFRC listing. Applies either to every unit, or to area -weighted average of all units. R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R -value over the entire ceiling area (i.e.- not compressed over exterior walls, and including any access openings.) ❑ "StiNROOM" addition (greater than 40% glazing -to -wall and ceiling gross area) Attach "Consumer Information Form" from 780 CMIR Appendix B. Official's Name: Application approved Denied Official's Signature: _ Date of Approval/Denial: Reason(s) for Denial: (provide additional details as needed on back side) t North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in:�`� i3 ( (-[No1 /VT, 1n1.&1,�fi"" (Location of Facility) Sign re of Permit Applicant [b l4 p� , ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 10 KNEELAND CONSTRUCTION CORP. KNEELAND CONSTUCTION CORP. 14 Oct 20041:23 pm 407R MYSTIC AVE. SUITE 346, MEDFORD, MA. -0215 (781)393-9899 FASTBeam(D Engineering Analysis 01996-2003 Georgia-Pacific Corporation Version: 4.0 Project : HAYSTEK .FBD beam b Mark #: Beam - Floor beam b Usage : Beam (Floor) Repetitive : No Spacing (in.) : 0.0 Max Defl : LL = U360 TL = U240 Composite Action : No 3.5", 565 psi 3.5", 565 psi 13'6' LVfiL/J rf VJVW uevyn LUdUs . r100r Live=4U psr, ueao=l0 psf, Live+Dead Ld(T) Live Ld(L) LDF Location' # Shape @Start @End @Start @End Span# Starts Ends Additional Into 1 Uniform(plf) 329 263 100% 0 90" 13' 6" Uniform(plf) 5 0 0 0 13' 6" Self Weight 'Dimensions measured from left end when span# is 0, otherwise from left end of the specified span SUPPORTS(lbs) 1 2 Max R'n 2257 2257 Max 100% 1777 1777 Min R'n 481 481 Min 100% 1777 1777 DL R'n 481 481 Min Brg(in.) 2.28 2.28 {Based on bearing stress below) -Brg Str(psi) 565 565 DESIGN . Value Span X Group Allow LOF Ratio V(lbs) 1878 1 0' 2" 21 3948 100% 0.48 M(ft-lbs) 7618 1 fi 9, 21 10123 100% 0.75 LtRn(lbs) 2257 0 a o" 21 3461 100% 0.65 See Note #5 RtRn(lbs) 2257 0 13' 6" 21 3461 100% 0.65 See Note #5 LLDefl(in.) 0.42 1 69' 21 0.45 U383 TLDefl(in.) 0.54 1 6 9" 21 0.68 U301 USE. GPLAM 2.0E 1.75x11.88" 1 Ply Grade selected by User G -P LAM tm Georgia-Pacific Corp. NOTES: 1. Designed in accordance with National Design Specifications for Wood Construction and applicable Approvals or Research Reports. 2. Provide lateral support at the bearing location nearest each end of the member. Continuous lateral support required for compression edge. 3. Loads have been input by the user and have not been verified by Georgia-Pacific Engineered Lumber Technical Services. 4. Design valid for dry use only. S. This reaction is based on the combination of loads 8 duration factors that produces the highest stress ratio and may be less than maximum reaction. Therefore, when reaction values are required, use Max R'n from Supports'section above. 6. Bearing length based on design material, support material capacity shall be verified (by others). 7. When required by the building code, a registered design professional or building official should verify the input loads and product application. 8. This engineered lumber product has been sized for residential use. A concentrated load check, per the building code, must be performed for commercial uses. 9. Company, product or brand names referenced are trademarks or registered trademarks of their respective owners. 10. Load Combinations: l0=D,20=D+100•/,30=D+115%,40=D+125%,50=D+133%60=D+100•/+115%,70=D+100%+125% ,80=D+100%+133%, 90=D+100%+115%+133",100=D+100•/+115%./2+133%,110=D+ Commercial Ld(100•/) 11. Group = Load Combination Number + Load Pattern number. (For simple span, Load pattem = 1 for LL, 0 for DL). KNEELAND CONSTRUCTION CORP. KNEELAND CONSTUCTION CORP. 14 Oct 20041:26 pm 407R,MYSTIC AVE. SUITE 3413, MEDFORD, MA. -0215 (781)393-9899 FASTSeam® Engineering Analysis 01996-2003 Georgia-Pacific Corporation Version: 4.0 Project : HAYSTEK .FBD beam b Mark #: Beam - Floor beam a Usage : Beam (Floor) Repetitive : No Spacing (in.) : 0.0 Max Defl : LL = U360 TL = LJ240 Composite Action : No 3.5', 565 psi 3.5', 565 psi 13'6' LUAU) r•rolecr uesign Loaas : moor. Live=40 psf, Dead-- 10 ps>; Live+Dead Ld(T) Live Ld(L) LDF Location' # Shape @Start PEnd CD -Start End Span# Starts Ends Additional Info 1 Uniform(plf) 620 496 100% 0 0'0" 13' 6" Uniform(plf) 15 0 0 0 13' 6' Self Weight `Dimensions measured from left end when span# is 0, otherwise, from left end of the specified span. SUPPORTS(lbs) Max R'n 4289 4289 Max 100% 3348 3348 Min R'n 941 941 Min 100% 3348 3348 DL R'n 941 941 Min Brg(in.) 1.50 1.50 [Based on bearing stress below] Str(psi) 565 565 DESIGN Value Span X Group Allow LDF Ratio V(lbs) 3601 1 17 5" 21 11223 100% 0.32 M(ft-lbs) 14475 1 691, 21 27420 100% 0.53 LtRn(lbs) 4289 0 0101, 21 10382 100% 0.41 See Note #5 RtRn(lbs) 4289 0 13'6" 21 10382 100% 0.41 See Note #5 LLDefl(in.) 0.31 1 6 9" 21 0.45 U522 TLDefl(in.) 0.40 1 6 9" 21 0.68 L/408 USE: GPLAM 2.0E 1.75x11.25" 3 Plies Grade selected by User G -P LAM tm Georgia-Pacific Corp. NOTES: 1. Designed in accordance with National Design Specifications for Wood Construction and applicable Approvals or Research Reports. Z Provide lateral support at the bearing location nearest each end of the member. Continuous lateral support required for compression edge. 3. Loads have been input by the user and have not been verified by Georgia-Pacific Engineered Lumber Technical Services. 4. Design valid for dry use only. 5. This reaction is based on the combination of loads & duration factors that produces the highest stress ratio and may be less than maximum reaction. Therefore, when reaction values are required, use Max R'n from Supports'section above. 6. Bearing length based on design material, support material capacity shall be verified (by others). 7. When required by the building code, a registered design professional or building official should verify the input loads and product application. 8. This engineered lumber product has been sized for residential use. A concentrated load check, per the building code, must be performed for commercial uses. 9. Verify that load is applied at top or equally from both sides. 10. Nail plies together with 16d nails @ 12" o% along top and bottom edges. Nail from alternate faces, 2" from edges. 11. Company, product or brand names referenced are trademarks or registered trademarks of their respective owners. 12. Load Combinations: 10 = D, 20 = D + 100%, 30 = D + 115%, 40 = D + 125%, 50 = D + 1331.,, 60 = D + 100•% + 115%, 70 = D + 100•/ + 125% , 80 = D + 100% + 133%, 90 = D + 100% + 115% + 133V2, 100 = D + 100% + 115%✓2 + 133%, 110 = D + Commercial Ld (10054.) 13. Group = Load Combination Number + Load Pattern number. (For simple span, Load pattem = 1 for LL, 0 for DL). KNEELAND CONSTRUCTION CORP. KNEELAND CONSTUCTION CORP. 14 Oct 2004 2:08 pm 407R'MYSTIC AVE. SUITE 34B, MEDFORD, MA. -0215 (781)393-9899 FASTSeam® Engineering Analysis 01996-2003 Georgia-Pacific Corporation Version: 4.0 Project : HAYSTEK .FBD beam b Mark #: Beam - Floor beam c Usage : Beam (Floor) Repetitive : No Spacing (in.) : 0.0 Max Defl : LL = U360 TL = U240 Composite Action : No 3.5", 565 psi L 3.5", 565 psi 13'0' LOADS Project Design Loads : Floor. Live=40 psf, Dead --10 pst. Live+Dead Ld(T) Live Ld(L) LDF Location' # Shape @Start PEnd @Start CbEnd Span# Starts Ends Additional Info 1 Uniform(plf) 471 377 100% 0 o'0" 13' o" Uniform(plf) 10 0 0 0 13' 0" Self Weigh "Dimensions measured from left end when span# is 0 otherwise from lett end of the specded span SUPPORTS(lbs) 1 2 Max R'n 3128 3128 Max 100% 2449 2449 Min R'n 679 679 Min 100% 2449 2449 DL R'n 679 679 Min Brg(in.) 1.58 1.58 [Based on bearing stress below] BBr Str psi) 565 565 DESIGN Value Span X Group Allow LDF Ratio V(lbs) 2607 1 11' 11" 21 7482 100% 0.35 M(ft-lbs) 10167 1 6'6" 21 18280 100% 0.56 LtRn(lbs) 3128 0 0' 0" 21 6921 100% 0.45 See Note #5 RtRn(lbs) 3128 0 13'G" 21 6921 100% 0.45 See Note #5 LLDefl(in.) 0.31 1 6' 6" 21 0.43 U510 TLDefl(in.) 0.39 1 6 6" 21 065 U400 USE: GPLAM 2.0E 1.75x11.25" 2 Plies Grade selected by User G -P LAM tm Georgia-Pacific Corp. NOTES: 1. Designed in accordance with National Design Specifications for Wood Construction and applicable Approvals or Research Reports. 2. Provide lateral support at the bearing location nearest each end of the member. Continuous lateral support required for compression edge. 3. Loads have been input by the user and have not been verified by Georgia-Pacific Engineered Lumber Technical Services. 4. Design valid for dry use only. 5. This reaction is based on the combination of loads & duration factors that produces the highest stress ratio and may be less than maximum reaction. Therefore, when reaction values are required, use Max R'n from Supports'section above. 6. Bearing length based on design material, support material capacity shall be verified (by others). 7. When required by the building code, a registered design professional or building official should verify the input loads and product application. 8. This engineered lumber product has been sized for residential use. A concentrated load check, per the building code, must be performed for commercial uses. 9. Verify that load is applied at top or equally from both sides. 10. Nail plies together with 16d nails @ 12" o% along top and bottom edges. Nail from alternate faces, 2" from edges. 11. Company, product or brand names referenced are trademarks or registered trademarks of their respective owners. 12. Load Combinations: 10 = D, 20 = D + 1001Y., 30 = D + 115%, 40 = D + 125%, 50 = D + 133%, 60 = D + 1001Y. + 115%, 70 = D + 1001% + 125% , 80 = D + 100% + 133%, 90 = D + 100•/ + 115% + 133%/2, 100 = D + 100•% + 115" + 133%, 110 = D + Commercial Ld (100%) 13. Group =Load Combination Number +Load Pattern number (For simple span Load pattem = 1 for LL, 0 for DL) 9 o Z- 78, 78, A G 72 s/ 1 /t/oTE F,,vo o r1a✓ Z"'A riav 1" nING DEPARTMENT :Z Tb rWe T/TLE AlSeXWOW 44150 Tri ZWe .04,Ve 7W47 T,VE O.✓ELG/•HC /S LAC-ATEG ON rll,C LaT.�S S,fv/r.V ANO T,iGIT?OAr..S LO.t/FGui)! ,W7W r%t - "-Al' eeaVZ. rA:W-f fd-rX46r-V FE" X reCe-r-f f GOT U.✓ES. '' S 1?1e7W,--C 7W.,f7- ,rV1.f O.✓E!1/,✓V /s NOT LOIATEO /N THE FX -ACC -44 /SCOioO ,4tAZ.0�0 APER. LS.'fewN OiV FewuN/Ty P.INGL 'R 33HOFMOf ; •. �sGb98 �8G DA rRFY yam. r z SJPa 16� - zv. .PL. S O.4TE Al EASF,h6,�,T f�L O T O.P.9i�iV fO.P i /voT FD.E' BOvvo.H .aG'TE.�.sfi:i/fgf'Y~o.�! BOvvOA.PY /.f�FO.Pitf- �E,P.P//�l•4Gt' E".vG,u/EE.Piv6 SE.Pi�/G'ES 14Wv ea -C -o GG �q.P.E� .SlrEE"T _ A.t/ODYE.� �f'1AS..S.vE,�!/SETTS O/B/O �2 FORM U - LOT RELEASE FORM I o `I O & K INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT DA`NW5(, 4'C5T�y LOCATION: Assessor's Map Number I' SUBDIVISION STREET PHONE (9:8)&84'212f- PARCEL vZ LOT (S) ST. NUMBER `OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED INSPECTOR -HEALTH/ DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT, FIRE DEPARTMENT ,V, -a 10115-16 l V7- iCa2t% RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm CO) m m m CO) CO) S _v, y CO) CO) n Z y O 06 n� O 0.= y su a� o p CDCL o cr CDcD o CD C CD CO) CL CD O CO) ■ C I 04 W— F cn cn n 0 • cn O cn toto0cr � _ z d0 d •m y 0 �! o • C� d n T Z y • _� N •� o, a o =r co et o N i� IE O ' • _ to `— d aWe '� 00 =r A ' O a= w t �m mc "."•. =�. �:� CD Joao:♦ ccD baEL� CL �� •� : "'.m y O N '. SZ . db Qim ** o 101 • y a Dna I t. -A 0 n " o CD ir C O mz � M lCD i � �,�:e -*'- IF: O C, �. Mi rij M 9 --6-a ron ~? 9d ~? -q7 iy "m cp d Mi rij M 9 --6-a D D te. . t' of, NORTH -T TOWN O� N RTH ANDOVER 10, PLUMBING PERMIT\ /RPLUMBING This certifies that has permission to perform . . plumbing in the buildings of FeA . . Lic. No.. 41% Check .1 e7p"�" 7087 ................... ........ North Andover, Mass. . ..... ....... PLUM6 ININSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location p2 q%" ,.,4 Frt rYiyt^ .A 0 Owners Name Type of Occupancy Date 7^0'` Permit #_ 7 b7 Amount New Renovation 0 Replacement ® Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Instamn Com an Name IT) . P �v �►, b t hg 4- a p'- 4L • k s M Corp. g F.1 , Address —) -OOLL Lc� tie Partner. Business Telephone — — �Fum/Co. Name of Licensed Plumber: -pt• (t Insurance Coverage: Indicate the type o insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above ;W= Signature Owner Agent E] I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus 1tate Plumbiqg Cod, d Chapter 142 of the General Laws. By: Signature oiic�ense3Plumoer Type of Plumbing License Title L?— City/Town Icense=Rumserer-- Master Journeyman ❑ . APPROVED (OFFICE USE ONLY a a .i a • i i\--.....--.-�------------- .. • nnnn■innnnnnnnnt�nnnnnnnnnn MMMONNOM �-�..�.----�-------------MONO - (Print or type) Check one: Certificate Instamn Com an Name IT) . P �v �►, b t hg 4- a p'- 4L • k s M Corp. g F.1 , Address —) -OOLL Lc� tie Partner. Business Telephone — — �Fum/Co. Name of Licensed Plumber: -pt• (t Insurance Coverage: Indicate the type o insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above ;W= Signature Owner Agent E] I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus 1tate Plumbiqg Cod, d Chapter 142 of the General Laws. By: Signature oiic�ense3Plumoer Type of Plumbing License Title L?— City/Town Icense=Rumserer-- Master Journeyman ❑ . APPROVED (OFFICE USE ONLY NORTH O 9 • i 1SSA SEl Date,A?.-� .4 '�? TOWN OF NORTH ANDOVER PERMIT FORIPLUM�BING CMV / This certifies that .. !�':. ...!.-''�` �� %�.`�. ?-✓� /� �.. fi."...� has permission to perform.....:.'.�:�.�.... _�-- ............. plumbing in the buildings of .. .. ....... .. at 7 `.� y .. �, �t- r.. ... .... ,North Andover, Mass. v Fe6-� ... LIC. No.�... .... ........... !" PLUMBIN6/ SPECTOR Check # q 91 7931 9 •V► MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location *;z rA New 131", Renovation 0 of Replacement ' ED 'PYV7'TT11-1k rc. Date Ck Permit # �i Amount Plans Submitted Yes ❑ No ❑ krrnt or type) Installing Company Name (� Check one: Certificate M Corp. Address/`C! (C (� n � C1 ❑ Partner. usmess Telephone t o. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by 7heclang the appropriate box: Liability insurance policy Other type of indemriity Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner❑ ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate t best of my knowledge and that all plumbing work and installations performed under Po the ermit Issued for this application will be in t compliance with all pertinent provisions of the Mas �Sachusej�S to PlumbACod!,And Chapter 142 of the General Laws. APPROVED (OFFICE USE ONLY _i Type of Plumbing License /3 C12,r icense u oer Master Journeyman ❑ CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 031 THIS CERTIFIES THAT Date MAY 12, 1994 THE BUILDING LOCATED ON 247 FARNUM STREET (Lot A) - Type F MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGE IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. o', T tia CERTIFICATE ISSUED TO Farnum St. Realty Trust 733 Turnpike St. ADDRESS North Andover, MA I�IAAII-w Xe -:11• Buil ing Inspector Location 0 %7 �No. l 7/ Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ - �U Foundation Permit Fee $ 1/ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector t16 2 03/09194 16;19 GT Mi Public Works Location �7 lig No. ` Date tit y. t NOR*h, TOWN OF NORTH ANDOVER Certificate Occupancy A # ; of $ Building/Frame Permit Fee - -- $ ' 4190 " Eth Foundation Permit Fee $ lli0 : s�cHus 4CM Other Permit Fee $ �.. Sewer Connection Fee $ Water Connection Fee $ TOTAL II $/.t Q. �d /0 zi1fw Building Inspector �3 7 3 02/17/'94 15:06 150.00 PAID Div. Public Works K t l 'Location 47A ,4)nyw A No. 3I Date ' ego ,,,0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s+CHU Other Permit Fee $ Sewer Connection Fee $ A/V Water Connection Fee $ 14x!7 J TOTAL $ / h a �Wlding Inspect rpt h ` 02117194 16:0 ff . V 6920 Di ` 156fic Works W c� a IL b• 1 N O Z N Z uj G u� W < m Z I N W o la W f Z IO pp N J N O f Wz z Z f Ofr O F I- (R W ww z F o Z 0 m J 0 0-i Z 0 W p U) N a l7 N f f J F � s 0 z < < Z W Z �7 W LL W N L < H it 4 U W U > z U i m W fC O O O i O 3. F f < D N < m 0 Z < f < 0 m IL O0 r p Q 4 0 W = z Z 0 1 0 f 0 LL W N w IL < f O E 0 z = O L 0 O z W W W 0 W < f < N % N L Z. 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Z < D N < m 0 Z < f < 0 m N N u r p Q W < Z U W z W = z N J 0 1 F r f 0 i I - z W < O ��flg W z I 0 I ' Q W F O c a E 0 z z z G 0 • `o C i W O Z l7 uj G D W < tt z f Z N fC la J IO Z d m F Wz z f Ofr O F I- (R W ww z F o a m IrO !- 0 Z 0 W p U) < N J m o � f Z i i 0 z < < Z W Z O W LL 0 _ l7 0 l7 p Z_ Z_ Z L < H it WW U U W U J I� J O O j Lt O W z z Z O J J J m (] ON W m m m J < m O O D < N N N ; m I - z W < O ��flg W z I 0 I ' Q W F O c a E 0 z z z G 0 • `o C i L!.I uj D i 0 tt z f Cpl V :EyH :E O Gl I I I DO DreNTN D;.0 -.> 0 ll I Ao OOZE nAA_-- O CCAm m1 DD NN On OAr. p� Li mIZ~; O W3 A00 n"T7c: N n�m z DO c; D ,r NmZ8 vmx °2> O �z— �Oxy3� D 2 n _ Tm T. r v N y y D nA r�T T T A n n ~mNmZ -D; = xd O .,NODDO AZ sO?m v Wz T w y mZ O O G T O D3: 3 Z Z ° A OO 0 6N0 ~ OND xN*A OZOO » cD AZ T p Z j3 O N0 NN Z Z G IV OO�3AAm O rOOmN-< ZN0 3 Zp mH �ADT CO>>nA>6 O n A CO O O m Qa D �mO 3pT Dr-; 07 < .( A z 3 N Q O T OZ< z0 I I , pG� N UI �° O Z _ A p' A m Z N Z Z 0 0 Z kp II I IN I I I I I I Af I I I I .. ' Li L SOC ffl .1J11 LK C_I 0;2:rv vA �kN 3-h Ul C z O—OCyNO O vmx °2> <> �z— mN3 2 n _ OZZTDAZmCOi'-DZDO T. r v N y y D nA r�T T T n y AtirO° Z_Z. T A = xd O .,NODDO AZ sO?m v vT w y mZ O i 0 T O D3: 3 x m'Z ZZ N p Z D N0 NN Z O OO�3AAm O rOOmN-< Zp mH �ADT O2 2y O O A CO NC IE pA TDn T Si:m Dr-; O1 A z OZ< z0 I I , pG� �° w LLL11 r 1%"•w -a® >,O 3: r Zm MMO • DO NZ Z SOC ffl �kN 3-h Ul O�0 Nod vmx i(An u,00 �z— mN3 0 Z., C N Mwo USN. r v r �p0 •Oz Z 'G) r 0 ir'N0� , DSD. �o m Z_Z. A = xd O T - v a1 D "- n Z, w mm �n m 0m DO 3 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Hoards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT:IFO,fr\ k_,Luv,\S+fj2-Q+Phone S LOCATION: Assessor's Map Number Parcel Subdivision A'' �? �� �e_-F- Lot (s) Street �v`�� St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected 7 Comments Date Approved Town Planner e-K-71pi0YACi- 1(:�)n Date Rejected �{- Comments h O )C6 � %Y -%a dr�c��nr,er>'rs leave beW, 1, -'h-e `Ploami g -%� •Seo►.-F�- w Ie miemo C��'1 �` bade Approved // T Health Agent been Y2m�% ed• Date Rejected Comments Public Works - sewer/water connections 1 drivewayppermi Fire Department° Received by Building Inspector Date J. A The Planning Staff approves the issuance of a foundation permit only at this time. A framing permit may be issued upon receipt by the Planning Department of recorded easement documents and agreements. Once these documents have been received, a memorandum will be submitted to the Building Department authorizing the issuance of the framing permit. C-) C) z m Do D O Z T z D r _) .0 C o O � — d CO2 C) 10 0 CD n Z CO) CD O CL r o. O CO) 0 CD v CD O cr CD CD O CD _a C CD Nf� CD CZ O y OO CO CD S v C„ o -a Z CD O o CD O CD oo �� g -� 1'+ 1 H o Q H = 97. d C SCD .0 V! = �m m n n a aa m Z HCD=r-O Vf, o: CD CO2 m ... � CLcL m .� CCD O C° H p --1m c �?mA) e. x a _ = W o i A 0 D �Co C -)CD � 1 00 a..-'�� oc o CD CD CD H cn CD �oc�D ca n c a -a \ J H �_ m O H • H QC, C COO y d CD „. CD H CD CDCD °+► CD N r -OO _ CD _ O CD IM O O CD 4" CD y 0 Com? ��nCA C cn CD H dCD -amdo,. Z : C a'o. boo cl CD�w�11 C rCD - � a z m ma rD r: 7 �= pq z w m C O Cil ?7 w 7J C z �, 7J m n T 7z G "r7 G z C/)r1 p CL d o W o rZI 0 to ° x • 0 C CD ►s i i CO) 10 CD C-) 0 CD O CL r COIM =� =z nC0 O v CCD �c Q. Q CD O .. .. Q O cc CD 0 CO) 10 CD 0 LTJ COF) O O O CO) M C7� 0 CO) 0.1 M) C7 O CD CD y� CD CO) 0 0 CD 0 C CD C c ?10 O = x O CO) Q y S, C. o � m .0 V3 CL 0n -i to - m n W T CD ycidC' 3 Z =r -O y -4 =-m o T „•� � r 0 T W � O CL O y O -i oN 5 m co x �cc, o i CO c �. 0 y CO's 00 � C9 FL - CL H � n �D O CD N � n'O N0 CDe CL CD O y N H H d C O `C d H dCD C < iC • •► H H H O CD CD C d CA toSh oCD . •► C9 C � o N 'O O Co �� yy c CD tv CD -°�M 03 w rMO= g ZooCD. O_ = M M E r v cn cn W 0 o rD CD M zM o w .1 0 t < to w ^ 5' o, x o o w c rt o a o .� rD �c� �4 l< (2/13 o 071 10 77 -------- — y 0 9 W � ,A ` a 0 c OF NOATy "h KAREN H.P. NELSON TOWN of Director BUILDING NORTH ANDOVER ` y CONSERVATION �8e"°�°gas DIVISION of HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT Memorandum To: Bob Nicetta, Building Inspector From: Kathleen Bradley Colwell K Date: March 8, 1994 Re: 247 Farnam Street - Common Driveway 120 Main Street, 01845 (508)682-6483 The Planning Staff has received the easement document required for the common driveway located at 247 Farnam Street. Therefore the framing permit may be released at your discretion. [-LN3VV-LHVd3(1 J "i 9 � u �•;� LoT-A /78, s4/sF 4, 4987 Ac . .P � - 3/ 6�2s -23.oG 2�.ZzLct;, EASFmEF/T /c%E I-duv�.4T/ON Loc.vT/Oc/ I�Qo�n �v l! L5 �• B. {{{ 1 • s"'' 'moi, EIA -DING DEPARTMENT �r HEREBY CE.cT/FY TO T.YE T/TGE 1A/S41XOC,,WO pz. O / Trj Tf✓E 04.V.rT.NgT T.✓EGn1e.0-1 W /S LACATEO ON rWd' LoT Af --.4V NN ANO Ti4G4T?OaES CO,�/FGLPir/ lY/TN T.</E ��N' OF.�e� A.vGO✓6Q ZONING .c�E6!/LAT.I�.✓S ,�6r/.e0/.Ks SETB�IC�t'.S' FOA! STPEC'TS f SOT G/�vES. '' S f(/.rr.YC.0 LE.�T/FY TNn/T Tif'/J ON'ELL/N6 /s' NST GOG4TE0 /AI T.YE FEACC.44 &Z OO 144ZA.00 i4.PE;4. Syawnl ov .�Eiw .w�•v�Tr P.rv« "" 43j�H0 SGV98 amyc �.�^'- r6 -.D gl //V /VOT FD.P ►' ' " .. ` .-• ~ /ilE.P.P/rjf.9l..f' E".vG/.t/EE.P�•v6 SE.P/�/lEs Bovvo.Py AET�.e�rf/.t/�¢.Y'y'ov .acavo.ver- .4T/O•(/ TA.rE.y F,eOiYl EX/ST/NC .PEGO,�pS. 6G /�q.P,E� .ST.rEET A.t/OOI�E.� �1.4SS.4G',fU/SETTS O/8/O All y� o �tJ / 6�2s -23.oG 2�.ZzLct;, EASFmEF/T /c%E I-duv�.4T/ON Loc.vT/Oc/ I�Qo�n �v l! L5 �• B. {{{ 1 • s"'' 'moi, EIA -DING DEPARTMENT �r HEREBY CE.cT/FY TO T.YE T/TGE 1A/S41XOC,,WO pz. O / Trj Tf✓E 04.V.rT.NgT T.✓EGn1e.0-1 W /S LACATEO ON rWd' LoT Af --.4V NN ANO Ti4G4T?OaES CO,�/FGLPir/ lY/TN T.</E ��N' OF.�e� A.vGO✓6Q ZONING .c�E6!/LAT.I�.✓S ,�6r/.e0/.Ks SETB�IC�t'.S' FOA! STPEC'TS f SOT G/�vES. '' S f(/.rr.YC.0 LE.�T/FY TNn/T Tif'/J ON'ELL/N6 /s' NST GOG4TE0 /AI T.YE FEACC.44 &Z OO 144ZA.00 i4.PE;4. Syawnl ov .�Eiw .w�•v�Tr P.rv« "" 43j�H0 SGV98 amyc �.�^'- r6 -.D gl //V /VOT FD.P ►' ' " .. ` .-• ~ /ilE.P.P/rjf.9l..f' E".vG/.t/EE.P�•v6 SE.P/�/lEs Bovvo.Py AET�.e�rf/.t/�¢.Y'y'ov .acavo.ver- .4T/O•(/ TA.rE.y F,eOiYl EX/ST/NC .PEGO,�pS. 6G /�q.P,E� .ST.rEET A.t/OOI�E.� �1.4SS.4G',fU/SETTS O/8/O FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT DA t-) Y s T E JO � bo AJ C 4 'v PHONE'\( LOCATION: Assessors Map Number / U � A PARCEL a SUBDIVISION _ LOT (S) A STREET/3 r�i�Nyv''I -S-1 ST. NUMBER OFFICIAL USE ONL TIONS OF TOWN AGENTS: 'CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS I TOWN PLANNER DATE APPROVED DATE REJECTED TH DATE APPROVED DATE REJECTED DATE APPROVED < DATE REJECTED A -- PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 07 Jm V77 -4 B �I LoTA" / 78, Sf/ TIC. �4.4987Ac. w .P . ` '?•00''43.x, • o 'o 29.ap � /yOrE.' /-O.�vOAT/O�/ Logo T/G4/ F,Qe.v7 �V•✓ � � � � � � ll lS j;F 1" nING DcPARTfOENT � r 116CE.0Y dleA-r/fY 7b T. d' T/TLE 1A1Se1AVW WO 727 rW6- G.o.v r rv4T T,vE n tx47Wp o v r//E LOT AS SMWiV.V ANO Ti44rlrA00" e641.,wae / lriT.✓ rvE m�•v' 40.o0-A4%,o.o'00nr4 Zav/, d ZeddZZ. --A: s ,Q�6•I�CD/MC JfT64CA-X OWaW -frMer,S ,/ eor L/•vES. S f(/,r7WMC T.VKr %.NC! AVOW 1.4-W /t oVOT LO44rE0 /40' 1A#Z• ,4W .4.PE.4. 6vfdpv" O/t/ FSM= .�It/�Y AWAIWA 'R AJ ...�,e•r OtirEwAY �AS�/h6w/7- PL O T RL /4AI /N /"C�. f✓.vOav�,[C� ///ASS O.P.4A✓A/ fO.P F.evv� .PE,e c r� �vs T BOvvo.� acr�.�.:ii<i�fgrr'v.✓. eo�.vO.,,�t� i.�,�o.P.si- ii/E.P.P/A1.9Gt' E'.vG•ctiEE,Piti6 .SE.PY/lES ,�TiO•t/ T.�.rE,y fecf, EXirrivc .cera�p,y', G6 �A.P,(� .S7".rEET •' A.t/OOI'E.� �1,•aS.SvE,�vS�'TTS O/B/D 247A Farnum Street North Andover, MA 01845 Owners: Dan Heystek and Joy Duncan Application for Permit Notes: This is phase two of a house addition project. Phase one included the construction of a shed dormer on the third floor. Permit issued (#269) included septic design by New England Engineering Services approved by the Health Department on 11/2004. This addition does not create any additional rooms as its purpose is to expand the garage from a two car to a three car, enlarge the room above the garage by 336 sq feet and raise the roof to allow for the construction of a stairway to reach the prior addition. The expansion of the garage is to the front of the house where there are no setback or conservation issues anticipated.