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Miscellaneous - 247 WEBSTER WOODS 4/30/2018
v Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ........................... ... .. ... This certifies that ..... ....... . . ................................. V has permission for ga!stallation..O—M .. . .............................. in the buildings '.of. 'i .......................... L-� ................................................... at ............ 0 . ......... L./�'* ........ ....... North Andover, Mass. 6; Fee ... 17 ..... Y Lic. No. , 04 ...... GAS INSPECTOR Check # 10179 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FI 1 TING WORK F 5 01 CITY: A/I M.A. DATE: P RMIT# JOSSITE ADDRESS: �71 //, :& V&S� OWNER'S NAME: NINNERADDRESS: Same as above TEL: TYPE OR �titi'T OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL Ia i CLEARLY NEW: L] RENOVATION: ❑ REPLACEMENT: � PLANS SUBMITTED: YES ❑NO APPLIANCE%' FLOOR- Bsmt 1 j 2 3 --j-4 I 5 6 I 7 1 8 9 10 1 11 12 13 1 14 BOILER BOOSTER j { CONVERSION BURNER J ( ( ( 1 I COOK STOVE I ( ► ( ( ( { { 1 { DIRECT VENT HEATER { { { 1 DRYER FIREPLACE I FRYOLATOR ( I ( 1 { GENERATOR { { ( ( { { { GRILLE a INFRARED HEATER I LABORATORY COCK I MAKEUP AIR UNIT OVEN POOL HEATER it ROOM / SPACE HEATER ROOFTOP UNIT 1 { 1 TEST UNIT HEATER UNVEN TED ROOM HEATER WATER HEATER f i i { ) 114SURANCE COVERAGE I have a current Egig i insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES 00 F] If yu4 have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the j Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNAT URE OF OANNER OR AGENT CHECK ONE ONLY: OWNER AGENT ❑ hereby certify that all of the details and information I have submii<ed (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application wi be in compliance vii' Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASATTERNAME: GEORGE A. POUDRIER LICENSE# 15764 SiGNATUP.E COMPANY NAME: GAPS PLUMBING & HEATING ADDRESS: 15 EAGLE DRIVE CITY: DUDLEY STATE: MA ZIP: 01571 i=AX. 508-461-9349 TEL: 508-461-9382 MASTER _/ I JOURNEYMAN CELL.508-789-3486EI,nAIL: GAPSPLUMBI NG@CHARTER. NET INSTALLERI I CORPORATION I The Commonwealth of Massachusetts Department of Industrial Accidents iLV Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 1}numass.gov/dia P E_ P,-, M I T4-- Compensation Insurance AMdaVtV Builders/Contractors/Electricians/Plumbers f F X11 %� `moi Name (13usiness�Organization`Individual): `' l !`) J Address: Are you an employer? Check the ttppr LCI ❑ i am a employer with employees (full and/or pan -time).' '_. I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [ivo workers' comp. insurance required.] 3. ❑ 1 am a homeowner doine all work myself. (No workers' comp. insurance required.)' Phone -r": 1 G `'' nate box: 4. (] 1 am a general contractor and I have hired the sub-conuactors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance 5. [] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. (No workers' comp. insurance reouired.l Type of project (required): b. ❑ New construction 7. Remodeling 8. [] Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions I I.N Plumbi ig repairs or additions 12.0 Roof repairs 13.0 Other Anv applicant diet checks box 01 must also fill out the section below showing their workers' compensation policy information_ ' Homeowners who submit this affidavit indicating thcr are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors hay a emplovees, they must provide their workers' comp, policy number. I ant an employer that is providing workers' compensation insurance for my empiovees. Below is the polkv and job site information. Insurance Company Name: Policy Job Site Attach a copy of the workers' compensation policy declaration page (showing the policy number and expirationtdate). 01K3 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andtor one-year imprisonment, as well as civil penalties in the form of'a STOP WORK ORDER and a tine of up to S250.00 a day against the violator. Be ad-ised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerdfi, under the pains and penq des of perjury that the information provided above is true and correct Phone - 4-7 , )C Offlclal use only. Do not write in this area, to be complreled by city or town official. Citv or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CityTrown Clerk 3. Electrical Inspector S. Plumbing Inspector G. Other Contact Person: Phone #: ACCORD CERTIFICATE OF LIABILITY INSURANCE 3/4/2015 rn THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. , IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME cT Rristi Gravel Anastasi Insurance Agency, Inc. PHONE (508)248-1440 FAXNo: (508)248-1447 4 Brookfield Rd E-MAIL ADDRESS:kgravel@anastasiinsurance.com INSURERS AFFORDING COVERAGE NAIC # P.O. BOX 1261 INSURER A -Western World Insurance Charlton City MA 01508 INSURED INISURERB-Safety Ins Company 9454 INSURERC: GAPS Plumbing & Heating, Inc. INSURERD: 3 Black Point Road INSURER E : AUTOMOBILE X INSURERF: Webster MA 01570 COVERAGES CERTIFICATE NUMBER:14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE im POLICY NUMBER POLICY EFF MM/D POLICY EXP D LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ex—I OCCUR NPP8184900 /19/2015 /19/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT PREMISES Ea occurrence $ 100,000 MED EXP (Arry one person) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS-COMP/OP AGG S 1,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS Ix HIRED AUTOS AUT SWMED 6227518 /15/2015 /15/2016 CEO a�Bl�[d nt)SINGLE LIMIT 1 000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PReo,aoc d IDAMAGE $ Uninsured motorist BI split limit $ 20,00 UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y I NLIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A STATU- OTH- I ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Best Yet Installations Inc 369 Main St Suite 2 Spencer, MA 01562 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. Prrrd1%Wd9d with pdfFactory Prd1riW%T6Tff v -MJ. —qa i 115SUES THE r O1 LOW A JGURNp GEORGE A PO�DR I BLACiof- T )ATE NOMSER I M MUMMITERM OMM�ONWE�H` 0 MASS-A40AUSETT.S.. ,11 HE F w ;LUES ; TI I — I -"!( .q E L 0 '1, 17 AS' A I"CASTE'k i G EQR, G -f A '206of) �-Al ttitQ K R hlT :AD �n w- H, 570 5 6' i 14 22544 o SHEEtlME"CAL WORKERSr ISSUES THE F OL LOW R lffe-`ItE4SE A" EYPERSON,-, -LEORVE A ROUDRIER ' 15 EAG:-v�""�; rA'A 01571 70Z.5i` 12/2.8/1 3$0b45 0 Date.. //. &?.�-Z......... INOIX TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... m.1�!ti?6�h ....... / . has permission for gas installation ..,'4e!� in the buildings of .&/,ejj��e.rC� ................. at ..� 7.4*44r !:. ,��'A... AO�. , North,,Andover, Mass. Fee.:.j., �. Lic. No..A�?:?.. �Gh�y�o0 fr1 r','' .. . GAS INSPECTOR Check # t10J6 � i�� .G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY L .rpt N_C�aV ,r a MA DATE; 12�_ =PERMIT# -- JOBSITE ADDRESS ',Z�� Q��r Wa S„grQ, ;OWNER'S NAME AN OWNER ADDRESS _ �-w ` r — TEL�� � 6�6`� 'T 7 70 FAX. OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL RESIDENTIAL NEW: RENOVATION:: REPLACEMENT: +k? BURNER VENT HEATER FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER PLANS SUBMITTED: YES 'aX NO INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES IWi NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY! X OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: - OWNER _ _' AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance withrtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �, 1e PLUMBER GASFITTER NAME; r_�,a �,rt C k-.a�:�cr, M 'LICENSE #`q� Z� v``► SIGNATURE MP ;. MGF _ JP JGF� LPGI ~ CORPORATION K t# Y'Zq- PARTNERSHIP # _.. _ LLC # - -- --t -- -- -------- COMPANY ----COMPANY NAME:- k.My rs� b 1 h .. e ADDRESS CITY STATE �Z ' ZIPOFAX ` _ _ �� __' CELL __ EMAIL Aj w z � . a w Z El w El rZw H H a w z CA CA a 5 � a � w W W z a d � Q J CL 0. Q xw ►- w roll H z H rA z x 9258 , Date. .//ak.. TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING -�ACMU�` r This certifies that ....em LGm . "At /� % has permission to perform..ar plumbing in the buildings of . ?�G' o=e l .f. !'�/ P r -7!q.......... at .Z v 7.el. ! .. , orth/A lover, Mass. Fee . ,, 4Z '.. Lic. No.. A44:L . � �-cl' }.. —Y.— � ........ // ' PLUMBING INSPECTOR Check # 40' _ Sb TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY: off- _ MA DATE �� - - _i PERMIT # JOBSITE ADDRESS 24-)_ els eY W�o�s �qhQ., OWNER'S NAME,!�f> OWNER ADDRESS i OCCUPANCY TYPE COMMERCIAL . J EDUCATIONAL Li RESIDENTIAL ?I NEW: ;� RENOVATION:; REPLACEMENT: ; PLANS SUBMITTED: YES _ NO;X' FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 '.8 9 10 11 12 13 t4 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASlOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYS TEM DISHWASHER - - DRINKING FOUNTAIN FOOD DISPOSER — — - - _ FLOOR 1 AREA DRAIN INTERCEPTOR (INTERIOR) Y - KITCHEN SINK -- - LAVATORY -- _ _ --- -- - - ROOF DRAIN - - SHOWER STALL _ SERVICE 1 MOP SINK - TOILET URINAL - -_ WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES WATER PIPING r-- -- OTHER - -- -- --- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. '142. YES)( NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX. BELOW i LIABILITY INSURANCE POLICY X. OTHER TYPE OF INDEMNITY ! J BOND ` c OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the j Massachusetts General Laws, and that my signature on this permit application waives this 1 CHECK ONE ONLY: OWNER •- AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of tl-�e details and inform bon I have submitted or entered regarding this application arejtrue and accurate to the best of my knowledge and that all plumbing vrork and irstailabons performed under the permit issued for this application will be in compliar� ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME r2a @rick `(`fl c'OnCSn., .,_'LICENSE # ;'�NC,,Z SIGNATURE I I INP X JP CORPORATION k # Z�qq-;PARTNERSHIP;_ i� _,._.. _ _._ ; LLC.__.:#,_ - COMPANYNAME G,%trN. ADDRESSTEL!L i CITY STATE �'_ 'ZIP FAX CELL EMAIL ._._ ....... NOR7q 0 9 SSACMUS� This certifies that Date.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ............. has permission to perform...D.t!(............................ plumbing in the buildings of .. h' ................... . at ...o). L�. ... `.. r '�`.�' .44 `� ...... , North Andover, Mass. Fee.Lie. .......� �`' .......... PLUMBING INSPECTOR Check # 859-6 IV MASSACHUSETTS UNIFORM APPLICATION FOP PERMIT TO DO PLUMBING t. (Type or print) NORTH ANDOVER, MASSACHUSETTS �' p Date (V!� Building Location "l �� Gi ��J(f ' 1� . j� Permit 4 e+� Ownerko v" G�, � A Vj W1,44, Amount 10 j New ❑ Renovation E] Replacement Plans Submitted Yes ❑ No (Print or type) �,� Check one: Certificate InstallingcompanyName,� /7v� D VU psi - corp. Addreessj f OCt,f°►�% ��� Partner. "U 'ems't/I KA 0, 6 f Business Telephone " 2 Fu Name of Licensed Plumber: \ ) d Insurance Coverage: Indicate the type of insurance ge by checking the appropriate box: Liability insurance policy Other type of indemnity j, 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 to the best of my knowledge and that all plumbing w k an tallations perform under Permit Issued for this application will be in compliance with all pertinent provisions of the sa us , StatePlumb C� and Chapter 142 of the General Laws. D (OFFICE USE ONLY Type of Plumbing License t, ease umoer Master Joumeyman �.____��. - --- - ---_-.r��._- --- -- The Commonwealth of Massachusetts Department of Industrial Accidents LV Office of Investigations UT 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�bly Name (Business/Organization/Individual): Address: City/State/Zip: Ai. Vie &t vte AAk d i Phone #: �( 2 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.❑ Roofrepairs 13. [1 Other T Homee:vne s who su u it this —affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is die policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here c .ender the pains/and Si ature: C4— Phone Phone #: % F2— of perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town offlciaL City or Town: Permit/License # 1- /,0 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 #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I (full and/orpar,-time).* have hired the sub -contractors ma I am a sole proprietor or partner- listed on the attached sheet. p 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 i m=ce required.] t employees. [No workers' comp. insurance required.] 'A.ny--plicant that cheeks boo: #1 must also fill out the section : 4ov., S: ,., ;.... o ,,, 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.❑ Roofrepairs 13. [1 Other T Homee:vne s who su u it this —affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is die policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here c .ender the pains/and Si ature: C4— Phone Phone #: % F2— of perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town offlciaL City or Town: Permit/License # 1- /,0 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 #: 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 joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not momAan 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign .and date the affidavit. The affidavit should bemtwrned 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 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. T'he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investibations 600 Washington Strut Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-72.7-7749 Revised 5-26-05 VvWVi'.IIlaSS..Co dIa _f 3679 .,3. � r n -"-- Date ........... �:................... o- ,..o ,. w eve �TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that :....... r- *:......... �' '.......................... :- �t has permission to perform r ' wiring in the building of ......: at .. �... s `" �! ..... !...../� , North Andover, Mass. Fee;�� ....... Lic. No..............1 .................... �7q 9, --ELECTRICAL INSPECTOR ev Check 4 / 4a N 27HC0W0AWE4LTH0FM4S aJffJMMV office Use only DF.P.9RTMF1V1'OFPUBLICS9F•E1Y E.Pe..,it No. BOARDOFFMP�ONRL' gIL47YO1�S27aR]Z-W - WMcy & Fees Checked 7^ Dpi PLEASE PPLICATTONFOR PERMIT TO PERFORMELECTTZICAL WORK _ ALL WORK To BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 INT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) J q % LJ C Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: OV e Yes [ZrNo rl (Check Appropriate Box) Purpose of Building Utility Authorization No. ea ver Amps /Z volts Overhead Existing Service Underground No. of Meters � New Service Amps / volts Overhead Q Underground ' No. of Meters Number ofFeeders and Ampacity ---'—� Location and Nature of Proposed Electrical Work No. of Lighting Outlets Not No. ofLightio¢ Fixtures L e..,:. No. Tubs crt esu6mdidw6dptaofofsaneiDfzolbcc Yo #alebm 1ftAt�f E � BE)�� ternMC t�tlti►ta{erti YES LA. NO ND iP=j*etbe>Speaf byduJiglhe d�aPmbm 4A _.� D � ' ?Z C- P Z797zr nt�rs [er7tv�a 7 'l I` `/ 7 y�- AitTelNd qt'Sll�ESLJRANC�WANFR;IarrtawatethattheLioatsedoes___ mtt�$teirlsvtaneoae�eE�stle�a�lug��P�bYt>s�(�alLaws tmYsign�ee'<tliasPennitepplir.�lwa�tlastaC�merlt� ;e check one) Owner ® Agent Telephone No. PERMIT FEE $ No. of Gas Binners No. of Ranges No. of Air Cond. TOW FIRE ALARMS No: of zXJft No. of Disposals No. of Hest ons Total TOW No; dDetectimand Tots KW l •�� Vo. of Dishwashers Space Ares Heating KW gDwices Na ofSounding Devices Nit ofSdfCoossined lo.of Dryers Heating -Devices KW Detectiun/Soodiq Devices Low! madicipal Other �- Io. of water Nesters KW No. of No. of Connections Sips Bailasis 0.ydro MempTubs No. of Motors Total HP HE ` esu6mdidw6dptaofofsaneiDfzolbcc Yo #alebm 1ftAt�f E � BE)�� ternMC t�tlti►ta{erti YES LA. NO ND iP=j*etbe>Speaf byduJiglhe d�aPmbm 4A _.� D � ' ?Z C- P Z797zr nt�rs [er7tv�a 7 'l I` `/ 7 y�- AitTelNd qt'Sll�ESLJRANC�WANFR;IarrtawatethattheLioatsedoes___ mtt�$teirlsvtaneoae�eE�stle�a�lug��P�bYt>s�(�alLaws tmYsign�ee'<tliasPennitepplir.�lwa�tlastaC�merlt� ;e check one) Owner ® Agent Telephone No. PERMIT FEE $ y 3612 .......... ............... • ."� TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that . ,.,..:��.,�� ... rs.:..........-............................................. has permission to perform ..... -r.:- ............................................... wiring in the building of ............. .....�* . :1.. . .................................... v at ...- .. > �J--� ���� .... North Andover Mass. Fee. ............. Lic.No./:?.`........4; ...........: .................... '-ELECTRICAL INSPECTOR Check # = [/ I/{ � --i—\ Office Use Only The Commonwealth of Massachusetts Permit Department of Public Safety 2 0 Y �s t.;cupancy� S Fee Clucked BOARD.OF.-FIRE PRENTION REGULATIONS S27 CMR 12700 3/90 �y (have blank) r APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Mauaachuseru Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INF, OR TYPE ALL INFORMATION) Date re' l2 �� n Z City or Town of At,CNA Y' To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenan O.rner's Address Is this permit in conjunction with a building permit: yes No ❑ (Ghee}: Appropriate Box) Purpose of Building ` Utility Authorization NO Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Scrvicc Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and ?rapacity, Location and Nature of Proposed Electrical Work No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total k'VA No. of Lighting Fixtures SwimmingPAbove ool grad. In- ❑ grnd, Generators KVA No. of Receptacle Outlets No. of Oil Burners {No. of Emergency Lighting ((Battery units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges 110. of Air Cond. Total tons Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local El Municipal ❑ Other No. of Disposals No, of Heat Total Total Pumps Tons Rk No. of Dishwashers Space/Area Heating yy; No. of Dryers(Heating Devices KW Connection No. of Water Heaters KW of No. o Si^ns Ballasts Signs Low Voltage Wirinz No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE / // INSURANCE ❑ BOND F-1OTHER❑ (Please Specify) ��1 I S /6 00 Expiration Date) Estimated Value of Electrical Work S 1 hthih Work to Start � \[ Inspection Date Requested: Rough_jyli G,ll Final Signed under the penalties of perjury: F111,M NAME (7WA4&J> VECS C444- COnT I v1 C_ LIC. No. 416KO Licensee-�25F—m �Signature ¢_ ~ LIC. P70. , �. , Address ""_— a l OWINEP.'S INSUP�UCE WAIVER: I an aware that the Licensee does not have the insurance coverage or its stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Location 4) '1%' No. --�SDate fi TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��s..•�„S �� Building/Frame Permit Fee $ Foundation Permit Fee $ In Other Permit Fee $ Check # 15332 TOTAL $ Qy _ Building Inspect TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: , • DATE ISSUED: SIGNATURE: r Building' Comniissionerflnspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Addr 1.2 Assessors Map and Parcel Number: A � � M Number Map Parcel lumber \ ` � , (T� i,1 j 1.3 Zoning Information: 1.4 Property Dimensions: ` + )�� Zoning DistridPr s se Lot Are s r.Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone l 1.8 Sewerage Disposal system: Public 0 Private 0 Zone Outside Flood ne 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ll Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: G Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Ss r: Not Applicable 19 _yk Licensed Construction Supervisor: C2 1 ` / License Wurn'ber V Ad ess 'Signature Telephone Expiration D to 3.2 Registere Home Improve Contractor Not Applicable Registration Numbe Company Name ddr Expiration/Date 01 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 6 building permit. Signed affidavit Attached Yes ..... '.V No ....... ❑ SECTION 5 DescHi tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify AP Brief Description of Proposed Work: 1 � W SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant FF M, M, x USE ONLy_�, 1. Building ? '' (a) Building Permit Fee Multiplier , 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) , 4 Mechanical FIVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATI TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property, Hereby authorize to act on My behalf; in all matters relative to cork au e y thisaiuifd ng permit applicatio Signature of Owner Date SECTION 7b. OWNER/AUTHORIZED AGENT DECLARATION I, 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 i Na e f \MN Si ature of Owner A ent• = Date ' NO. OF STORIES SIZE BASEMENT OR SLAB - SIZE OF FLOOR TIMBERS 1 , , 2ND ;3' SPAN i i w , f DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS . HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X { + f MATERIAL OF CHIMNEY' IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE "i t J �\ The Commonwealth of Massachusetts City of Medford State Board of Building Regulations and d�\�'�!�� / Office of the Building Commissioner Standards City Hall Room 115a Massachusetts State Building Code 780 CMR o Telephone (781) 393-2509 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1.1 Property Address: 1.3 Property Dimensions: Zoning District 1.4 Building Setbacks (ft): Front Yard Required t PropQ,jd Use Provided 1.2 Zoning Information: L" -" /U& Zoning District Height of Structure 122 Building Use Side Yards I Rear Yard Required I Provided I Required I Provided -,A0 1 ll n, I 30 13� A l 3v I 1�S 1.5 Water Supply (M.G.L. c. 40. § 54) I 1.7 Flood Zone Information I 1.7 Sewage Disposal System Public ❑ Private L] Zone: Outside Flood Zone Ll Municipal ❑ On site disposal system ❑ 2.1 Owner of Record: Not Applicable ❑ Licensed Const ction Skper,, License N7mber `r CUW r Expiratit n Date N1m int) \\ \� Address for Servi(cce,:j�y�(� Telephone n Ytn 3.2 Regist ed Home Improvemen Contractor: Not Applicable ❑ Registrati n Nu er W \r Signature dres tQ: Telephone Telephone 2.2 Authorize Agent: Na(Print) Address for Service: S e—J Telephone SECTION 3 - CONSTRUCTION'BERVTCES 3.1 Licensed Construction Supervisor- Not Applicable ❑ Licensed Const ction Skper,, License N7mber `r CUW r Expiratit n Date Addr• S \\ \� Signature Telephone 3.2 Regist ed Home Improvemen Contractor: Not Applicable ❑ Registrati n Nu er Company • eme 1 Expiration Date I dres tQ: Signature Telephone aaz .w .a.�ai1 s s .a : \ : a,w art 3 rw vi�Jf;: �-54:: f " Workers' Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuan e of the building permit. Signed Affidavit Attached Yes....... No....... ❑ New Construction ❑ Existing Building Accessory Bldg. ❑ I Demolition Brief Description of Proposed Work: Tis' iA J) Y- to 0 �� 1�( art? t ❑ Repair(s) ❑ I Alteration(s) Ll Other ® Specify, ,, ❑ I Addition ❑ Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee oa Multiplier 2. Electrical (b) Estimate Total Cost of Construction from 6 3. Plumbing 4. Mechanical (HVAC) Building Permit Fee 5. Fire Protection (a) x (b) 6. Total = (1+2+3+4+5) ,� .�(�( Check Number: Cash ❑ as Owner of the subject property herby authorize — .c P QMb to act on my behalf, in a atters relative to work authorized by this building permit application. Signature of Owner �Dat0 I, \1 )%%CXAk \J %%*) as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under`the pains nd F6Nes of perjury. of Owner Date CERTIFIED PL Q T PLA S' F- CU,4fM/NGS N P.a BOX 1337 PLA/STOIf� N yC�i4 TES TELEPHONE 0603)5825085 FAX f603�3 25218 5_05282_5" W 21.59' S SROo A F - 150.00' WEBSTER MOODS LAN . E � SCALE 1" / HEREBY CERIIF 11 EDGE OF f LA CGED WETLANDS h.9ERT T. TRUDEI ' ` ��, ; th. 36869 /. i , IND OW'f ; iyq 44UL0 NG DEPARTMEN TH ' UA E• FEBRUARY 15, 2000 THAT IT/E EX/SLING FOUNDALION DRAWN MIN/MUM SETBACKSFRONT _ i30 FEET ON TH/S PLAN IS LOCA IL'D AS SH01W AND TNA T /T DOES COMPL Y TO THE SIDE' - 30 FEET MIN/MUM BUILDING SETBACKS TO REAR - 30 FEET PRO!'ERTY LINES TdCommonwealth of Massachuseas Department of Industrial Accidents ' 0111CC Cf&Yes11g2110os 600 Washington Street Boston, Mass 02111 JOB city 1�i i�il�' f`��1ptY phone ❑ 1 am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. address: ❑ I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below whohave' the following workers' compensation polices: city: phone b• Insurance co. pig, # • a c asa '� > �•- 3 Failure to secure coverage as required under Section 2SA of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cera underh air an en ti' of perJuq that the information provided above is true and correcct Signature Date Print name �a,e �N�� �e� ii f)P,j Phone N q28- L6 2 .9 Q official use only do not write in this arca to be completed by city or town official . city or town: permitAiccnse N nituilding Department ard check if immediate response is required pUcenting pSeleetmenis Office ce 0I1ealth Department contact person: phone N: nOther Ircva" arra rJAI S 572. 1°O� o`er/�awazc/uraelt BOARD OF BUILDING REGULATIONS . License: CONSTRUCTION SUPERVISOR " Number -,,Q$ '• " ` r' IC,,Ci$. 032472 BirthdateV 03107/19.47 ' Pi;T03/07/2002 Tr. no: 17784. ;:. Restricted To:.00 WENDELL W HOLMES 23 DADANT DR t:.�.•.,..r �i :, WILMIt �TQN, MA 01887 Administrator • .r � �1ee TOomt�mom�uiu�/c�� a�.,2� G�u�st tz��a� lta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 110127 Expiration: 1.0/06/2002 INDIVIDUAL HOLMES POOLS WENDELL HOLMES, .: 23 DADANT DR :r•� ��, WILMINGTON, MA 01880 Administrator B M i 572. 1°O� o`er/�awazc/uraelt BOARD OF BUILDING REGULATIONS . License: CONSTRUCTION SUPERVISOR " Number -,,Q$ '• " ` r' IC,,Ci$. 032472 BirthdateV 03107/19.47 ' Pi;T03/07/2002 Tr. no: 17784. ;:. Restricted To:.00 WENDELL W HOLMES 23 DADANT DR t:.�.•.,..r �i :, WILMIt �TQN, MA 01887 Administrator • .r � �1ee TOomt�mom�uiu�/c�� a�.,2� G�u�st tz��a� lta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 110127 Expiration: 1.0/06/2002 INDIVIDUAL HOLMES POOLS WENDELL HOLMES, .: 23 DADANT DR :r•� ��, WILMINGTON, MA 01880 Administrator B M • Y W f r.i W e I qi 1= ZFL \ o..r+.or�ooO O .� .-- •- !� N f�7 OOOOCV er 000 000000000 .n c�LA �6 I�==--C14O Q o00 N000 x000 a0 oD co oO WOO 0000000-- -� C d ^ N oocr G oCC M. 00 _8 Ln G OO 8.c�)c6 o 0 Ii d N zo aoN M ap Go W cm • � ENN� m ee •r# J-1cD�dd do �2o6 • di E E as ;, a y C C 0 0 0 0 o o o ee E no ds OD L., ;r Mpp t9 'S C:? N N NN C�01 OO R w N p — ^ .= .-..- C — ;a OO OD zo O CO N CC .-. N - zo 0 i Ii M ap W N • � 0� c M 6D • M T 0 N LO zo 60 0 N ao Ob b 9 ;tIN x OW1�OO^^N OOOOO m d O oomo^^ P %A -Z Px .-. c, $o0oN4�o0 2= 0 0 0 = 0 0 hi 0 0 0 0 Ca L e W W i J y� W2 IFY da � W U O N BD LO N co ay C'') co 2 OD 00 ♦�L_r1 BD o O N O o00 h N1 a o C= 0 4 C.o 0 N CL z t O 6 C O d • J: 0 N c • W G G o E � y a_dm _ C G OAC o y•o ce y E'aCL. E=s N H H y-CO— �O O BD LO N co ay C'') co 2 OD 00 ♦�L_r1 BD FORM U.- LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT LOCATION: Assessor's Map Number �� r`o PARCEI// , v SUBDIVISION LOT (S) STREET vST. NUMBER�� USE ON LY************************,** CONSERVATION COMMENTS TOWN AGENTS: uA I t APPROVED 112 — 6 Z f DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD, INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO TE Revised 9197 jm D&lfwL? 1) ?w I FORM U.- LOT RELEASE FORM 01-181® / 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 Y`� �1��V\G.), %1)\NNOV, PHONE LOCATION: Assessor's Map Number. PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER__3� *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: —� NSERV, FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJFSIED DATE APPROVED DATE REJECTED DA' APPROVED SEPTIC INSPECTOR -HEALTH DATE AP DATE RE COMME PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm I41f� TE m m Cl) D _v, H d 'v O ca CM) CD �" � Z H 0 0 '0, CL C C CL �' CO) O � c v CD CD O CL Q d CD � o � C CD y av y •o co CD cn o� o C•N�aN = aO m NA n o NPC D Z == y �. Xm o „ =rm ? d y CDIE N .� m O ?m �mca _I O :V O O sn : �J C a ` a O 0 S ,., C X to O C=D � ;O ;\ CD �C9= 0 CID .3 mO N N .0) 1` s d N IR O N 0 < \ m 9 m co' fA ;� 0 N " � Ooc:. � m o � U I s IF cn cn cn w oil � �l ox b �o x �v n M R N OD Ro 1 Co \ a 0 A om cn cn w oil � �l ox b �o x �v n M W W omi 0 O C No 2099 Date ......... / ...... /.:9 ... Qc.) TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... f .... -a-.. ................- .... �n .................. , has permission to perform........ .. .................. wiring in the building of .......... . ............................................ .North Andover, Mass. ........... Fee. N .. . .... Lic. Noq)r).h"e ............ ........................ 6,1 "ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer T1 09Aff10AWE4LTH01i Mi S `4QRS .= Office Use only Q V DEPARTAIENTOFPUBLICS4= Permit No. BOARD 0FFIREPREFEM70NRWM4T1011{S5r0V 12:00 Occupancy & Fees Checked UVPPUCATION FOR PERMIT TO XWORM ELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Z %�P- — 00 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant To the Inspector of Wires: Owner's Address oZ -3 ! _,�U -nwn) 5u n?T F %�% &L>0 iFi3YtY-4 V1 Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building `ZE44 ,SZx`'j dg- Utility Authorization No. 066 '?W Existing Service Amps / Volts Overhead Q Underground Q No. of Meters New Service /00 Amps/,;?,O /o?V6 Volts Overhead r-7 Underground r777 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work a 6N9 "0l�ie'.i No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above-_- Below - Generators KVA ground El ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cord. Total Tons No. of Detection and. No. of Disposals No. of Heat Total - Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal ® Other No. of Dryers Heating Devices KW ® Connections No. of Water Heaters KW No. of No. of Si --Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHE ' Ins rwxco►e� Pu I ha%e a txmatt l-bbtldy I Ong 0Z • . • • :• :. .1► rte:' . r..: ; r v .• • • :•. : ; I Q — 0,0 WodcloSlat "lo�—oo .., Ic>�aiDe�Rec SigmdundaTt cfpajtay FIRMNAME Liar>sae �1>i!$ ��d/�2 Sigtatute () Exptratiart Date - Estim*dVahteotlIxfti al Wade$ FD# Fnal _ Lica�eNa _Lit eNo `7 7� M to //'�� �All / BusttmTdl. lab � W y—/n>D � ,U. &X o2175-7 �Az, All- 0 179 AkTelNa OWNER'SINSURANCEWA1VER;Ianawateft1thel.==dmn1 epvaiatasm4zWbyM%m1u3&Canal Lam aoti�atmysigrati.�eonthispt�iatwai�est`tis tt�ar�. - (Please check one) Owner ® Agent El Telephone No. PERMIT FEE $ N22243 Date...... .tI`..�.... NORTH ° OL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ........ ...... <<... h.!�-.......... has permission to perform ..... ...... ............................. wiring in the building of ...... M si......... 4 at �H7... ��,5,1 f ��..w ... V , North Andover, ass. ? Fee .3, .-I.: U.. Lic. No. 7Z.�W A... ... ..! ..... OELE RI AL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TRECOMIIO�V�fLIHOFMAS►S4CHUSETIS Office Use onl �3 3S� • DEPARTMENTOFPIIBLICSAFEIY Permit No. a` BOAW OFMEPREVEM ONREGUTAT1011 D709120 Occupancy &Fees Checked APPUCATTON FOR PERW TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASsACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 O� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat ZJ,2 Town of North Andover The undersigned applies for a permit to Location (Street & Number) Owner or Tenant Owner's Address of ?� 1 .Jtli the electrical work described below. - -')N7 We S72�Z W64 -b �!> To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [ No (Check Appropriate Box) Purpose of Building <- /� • �� , Utility Authorization No.Od S�- Existing Service Amps / Volts Overhead Underground r7 No. of Meters New Service Amps / Volts Overhead Underground �--- No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Nos of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above ground 0 Below ground Generators KVA N of Receptacle Outlets . No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Heat Total Total Pumps . Tons KW No. of Dishwashers Space Area Heating KW Detection/Sounding Devices Local Municipala Connections Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis o. Hydro Massage Tubs No. of Motors Total HP hslraroeCo� Rl�antmdieregtsrarrar$ofNta�adu9r�Cra�lLaw+s YES � NO Iha%eatamtLmbrt'yhtsur =Pcbcymdu&gCagile �� CocrtsddeWn Iha%eahniaedm1dpoofofthe0ffmYES [a NO If)whmcdvdWYES,pl=nbc*theWofootWbydrddg1he btaK INSURANCE =BOND r7 OTf ffR ® (Pla =SpMdfy) ExpiraoonDate lJt 2- L COL L_ E4¢r&dVahreofU0Cft%nI Wads $ WcdctoStat 3-o23-06 kgxcdwD*Requewd Rough Frral undamamddesofpaiwl FlIRMNAME — dAl 4WA� L f `� Li eNa �g2 I1? t2 Lirmrm /S l � �4� / Signage 4&A e / - 0' L;oa>SeNo 7 7� m/� - -QQ Btisit>essTd Na ljQ 3 may- 6%42 �, ; / �• l3�'x a17 5�� J�� J307 / Aftu% /03 231 OWNM'S1NS[JRANCEWAIVMlamawm dutheLio =Sk >a�tthe it>Su =wvmVo akartdegtnWfftasragtmWbyNtma&&a0sCaraalLaws / andduff ysigmbmai&panitapplimbmv4 i%esthis re�tanenL (Please check one) Owner Agent a Telephone No. PERMIT FEE DaW7: ./U_.O-e) N° 4340 "oRTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 'his certifies that .: f-!'EUr�/�`� has permission to perform ...,-�:...,1.. . plumbing in the buildings of �.{: --E... ......... . at-. %.`?r .. C����. - - �!. '` ? ..., North Andover, Mass. Fee. _�.... Lic. No/'. !. .. `.. _ .. �Md'INASPEC �PTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR P T TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location t/Yer 4Y wners Name Permit # Amount Type of Occupancy New M Renovation Replacement El Plans Submitted Yes ❑ No ❑ Ti TYTTTR F.R � (Print or type) /' Check one: Certificate 'i Installing Company Name (J /� �/�`� ❑ Corp. Address ❑ Partner. Business Telephone IV Firm/Co. Name ofLicensed Plumber Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy M 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 three insurance rgnanmre Owner Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts StateP.8mbing / 1: Chier at;d,Chier 142 of the General Laws. Title City/Town APPROVED (oma USE ONLY Type of Plumbing License rcense jNumoer Master M Journeyman ❑ 3365 Date .. ... .. � ..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.�... J ......... has permission for gas installs ion _._.. :..-!..... in the buildings of ... ................ at...North Andover, Mass. Feed .•.... Lic. No..�.��!�.. /�. r / .` ...... C GAS INSPECT6R,, WHITE: Applicant CANARY: Building Dept. PINK. Treasurer W`I'C_ MAP PARCEL MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING or print) NORTH ANDOVER, MASSACHUSETTS ate Q 19 aG Building Locations 7 &,ay–e " Permit # Amount $ Owner's Name % / e �G Newo Renovation Replacement ❑ Plans Submitted (Printortype) / _ / /-e- / /1 Corp.k . Certificate Installing Company (� 7 C ! AVress �— Partner. Business Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter 49 /C e -e -e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No[] If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S!#�t Gas Code an� Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber W7 % g Gas Fitter License Number Master �7 Journeyman z w p 0 rs v� F• w O z Z O O Fx�•. W Ww w W d d x x � w w Fd. CdO y a > W v� � Cx a Z d Wz C� d F d > �¢ m z O O O z w Er d x > a w z CC w D O C O G7 2 w O 3 A G7 U cG > A. F- O SUB -BA SEMEN B A S E M ENT IST. FLOOR P/ 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Printortype) / _ / /-e- / /1 Corp.k . Certificate Installing Company (� 7 C ! AVress �— Partner. Business Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter 49 /C e -e -e INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No[] If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S!#�t Gas Code an� Chapter 142 of the General Laws. VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber W7 % g Gas Fitter License Number Master �7 Journeyman Location�C�2V;7 f%'�-dt No. 76, Date ,.ORTN TOWN OF NORTH ANDOVER L • Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ -,5 TOTAL $ s `� Check # 1 4 " 7 6 C� ' Building Insp6r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUELDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: Building Commissioner/In ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 2.1 Owner of Record y�� / J ,r� T c��t 57— �t�it<! �3% �G lZT7T �y`� SJaTf��%r A/,-;P�le Name (Prin Address for Service 6 $ Signature Telephone ,`�=���` s� / g Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: RIX Zoning District ProposedTise Lot Area sP Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 3(D / -)4, 3 / 2' 30 -1 O � 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 ❑ Municipal * On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSIIIPIAUTHORIZED AGENT 2.1 Owner of Record y�� / J ,r� T c��t 57— �t�it<! �3% �G lZT7T �y`� SJaTf��%r A/,-;P�le Name (Prin Address for Service 6 $ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ,��g-_ kzs.seZ Licensed Construction Supervisor: _ Address ra 7 _ S :,300 Signature Telephone rf� 67577 - �', �6-0 Not Applicable ❑ �'�yG� �3% License Number Expiration Date 3; 2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M T p� 111 X ic z SECTION 4 - WORKERS COMPENSATION (XG.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 ...... V No ....... 0 i New Construction09 SECTION 4 - WORKERS COMPENSATION (XG.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 ...... V No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction09 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ©o C,1Z /a x 2 z SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFIC]" USE O...Ay 1. Building r j r1 `t lJ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction r ' `� o r 3 Plumbing Building Permit fee (a) X (b) 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 BUII.DING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER//AAUTHORIZED AGENT DECLARATION I,as (r/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 l/ Print Na 8� Signature of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TFVMERS 1 2 3 SPAN DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1TEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE s �. FORM U - LOT RELEASE F0RM INSTRUCTIONS: This form is used to verity 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}*sJ* '° * 57t 5-760 � APPLICANT Ct,o�eli �vr�s�, L� PHONE LOCATION: Assessor's Map Number /Q ! PARC`L SUBDIVISION LOT (S) % J� STREET 60e bSy,:/ L(1Cx-)-(s 1 zzl�fe Kof 444 - ST. NUMBER y � USE ONLY********************** RECOMMENDATIONS OF T0WN AGENTS: r(C J - lig-�-' ` S P-%,> ,.I CONSERVATION ADMINISTRATOR DATE APPROVED _- lis! DATE REJECT ED \ ` �% v�! COMMENTS �� J0`��%� TOWN PLANNER (✓ 134ye- &"-, COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED Tw 5� PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT �)L r,A3 FIRE DEPARTMENT �-�Lr RECEIVED BY BUILDING INSPECTO Revised 9197 im DATE e CELT/F/ED A O T Pl. AN S.E. CUMM/NGS J ASSOC/A TES P.O. BOX 1331' PLA/STOW, N.H. 03865 TELEPHONE (803)-082-5085 FAX (803)482-5218 C !TS'7 R'9S" IA/ A�vo \F EDGE OF FLAGGED WETLANDS I JV. VV W ` NAt LAI WEBSTER WOODS LANE SCALE 1 " = 60' I HEREBY CERTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THA T THE EXISTING FOUNDA TION DRA AN ON THIS PLAN IS L OCA TED AS SHOWN AND TNA T IT DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. DATE.• FEBRUARY 15, 2000 MINIMUM SETBACKS.• FRONT - 30 FEET SIDE - 30 FEET REAR - 30 FEET 97-754 .DIVG C/) m Cf) 0 0 FW d � d CD � O t7 Z y CL o "0. � � O CL = CO) O o v CD CD O cr d CD CD o CD C CD H• d0 y -• O CDD CA O CD CD Z� o CD a C CD 4C Ca C?� O N = O -• ca O Q dr O.� 9.0 CO) .,�� o o n O HOd0 m Z =� =r -C y `� CD did CL 0y m y r► m O 0' O ') N =m: mCD = > >-0 C :O r 1 ccO ii O H, AEL C �m r^om N m 0 CD CSD Y• ® y d d c H �C CO Z �. m = o IE c' y Q C, 2�++ n -R-2 AA Ow O ® Z Imo CD CODtm o, cn r: OR CD Clow ro f c(E3 4 ° R :n m G) �'� �' o �°-°QC7, CIOH b o r b �n6o a GJ � c 0 y o a x O a z Omq 0 0 c �J sl.ocatit No. D.'( Date a NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ orb+,�� �„� • S, CMustt Building/Frame Permit Fee $ �/� �— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ rte' Check # 3642 / Building�l ��ector m Cm fTl cn > co -M ma c m v c� m Cf) a. C2 � ci m � C EA CD O m .0�.'"► .0.� C c CCD m a .v JCl) _• O z -4 O ^' m H -I 2 10 CD `^ 0 m > co �Tl M O m v c� m Cf) a. C2 ,� ci m O Z p CD O m .0�.'"► .0.� C c CCD m a .v m aid O N _• O tt� CD. -4 O ^' m H -I 2 10 CD = O N o 0 m LO. d CD 0 CD CD P. CD CO2 �71- 0 CD 0 CD O O N i �• N C G. O m CL O m CO) w C2 C ci m O Z Nmac •' =r= �. N -1 .0�.'"► .0.� C O m ,•, m aid O N = m N -4 O ^' m p m -I 2 = O N o m m � O �.O � O N• O a � C ,L O � ? N a n O as CL•�.. O r = m m N C a m wm 0 O IM N _ N OW d :%mono O � _ N CCA t0 _ � m N ,� O N� CD, CA w co 0 ' OD co, c m :"Nub. ® OV:: �. s CD dd _ 2. • 0 0; _ co)CD_ a= o -3 M M z 0 O 0 c o CC "" O C w (DO G� C C pl o C pr ? o C G b , O CD z o to M M z 0 O 0 c LMfl 5Tfe-.;;(-557- 526v . 4,1 CELT/F/ED PL O T PLAN S.E. CUMM/NGS J ASSOCIA TES P.O. BOX 1337 PLA/STOW, N.H. 03865 TELEPHONE (803)-282-5085 FAX (803)-382-5218 uu c;'/l WEBSTER WOODS LANE SCALE 1 " = 60' I HEREB Y CERTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THAT THE EXISTING FOUNDATION DRAWN ON THIS PLAN IS LOCATED AS SHOWN AND THA T IT DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. S C,5 28 25 " W ---21.59' p�S Op F 6 r op?�2 F EDGE OF FLAGGED WETLANDS �tH OF Mafia` ��.A ALBERT T. TRUDEL i =i No. 36869 1 k, DATE FEBRUARY 15, 2000 MINIMUM SETBACKS- FRONT - 30 FEET SIDE - 30 FEET REAR - 30 FEET 97-754 .DWG cER nF/ED PL O T Pl. AN S.E. CUMMINGS S ASSOCIA rES P.O. BOX 1337 PLA/STOW, N.H. 03865 TELEPHONE (803)-S82-5065 FAX (603)-382-5216 MAMMA WEBSTER WOODS LANE SCALE 1 " = 60' I HEREB Y CERTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THA T THE EXISTING FOUN'DA TION DRA WN ON THIS PLAN IS L DCA TED AS SHOWN AND THA T IT DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. S 0,5'28'25 " W ---21. 59' OO' L EDGE OF FLAGGED WETLANDS DA TE. • FEBRUARY 15, 2000 MINIMUM SETBACKS- FRONT - 30 FEET SIDE - 30 FEET REAR - 30 FEET 97-754 .DKV Location ),of 15 #,211 V?-bsej tj,600�s /N No. e)" R to Date °G d ,►ORTh� TOWN OF NORTH ANDOVER Certificate Occupancy ' of $ s�cMus Building/Frame Permit Fee $ Foundation Permit Fee $ yO' .-- Other Permit Fee $ TOTAL $� Check # 'i 3 6,j 2 10 '6 -- Building Inspector I(I. A, �I �. O O z CJ -2 Ln ^ / _ V.. 'V, V. w�, a l V r V. z 7 � • V - vy n ca Ln l A, �I �. O O z CJ -2 Ln ^ / _ V.. 'V, V. w�, a l V r V. 7 � • A, �I �. O O z CJ -2 Ln V. 7 V. V.. 'V, V. w�, a l kA n Ln l V) A, �I gg� v O '� 7 V. rr w�, a l kA A, �I gg� v O '� 7 V. rr w�, a n Ln l V) A, o� I N ME I wl / �I gg� v O '� 7 o� I N ME I wl / �I 171 v '� 7 V. rr o� I N ME I wl / �I 171 v � 7 W �I 171 � 7 t t I-EEAA FORM U - LOT RELEASE FORM JAI 10 2000 INSTRUCTIONS: This form is used to verify that all necessary approvalf/per�miitsfrom Boards and Departments having jurisdiction have been obtained. TI -)[ii. A, ;sloe the applicant and/or landowner from compliance with any applicable or requirements. ********APPLICANT FILLS OUT THISSEC T lON**s, s7 5"76d I--,' APPLICANT C=�ob,e!/ �vt�Sr�LLc PHONE 6e 7-f3e"' LOCATION: Assessor's Map Number—_L12-60 8 PARCEL > 920 SUBDIVISION Ca-?wD 6 -ell r i'e S� LOT (S) /5� STREET(, ebsl- / GtJ&)=(S .Laqt' (o� ST. NUMBER 2y7 **OFFICIAL USE ONLY* g RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED i QQ DATE REJECTED COMMENTS �GISS-eG� 0/'-Q Qv�'"7 V L�w COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS UA I C MCJCt+ I CL DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED a����lD�?R coNG�lrO )e �� q PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE , Revised 9197 jm JAN 11-UU lUl; U5:L1 YM UAMY LLL rU h6l ?AX:1 9'!8 55'( 54'(3 TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT PAGE 1 Telephone (508) 685-0950 Fax (508) 688-9573 LOCATION: BUILDER: phone: OWNER: �n Q� (elpphone: re North Andover Superintendent of Highway Utilities & Operations MUST be notified of the ade and set -back from street established in any driveway entry onto any street or way maintained by TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT Remarks: Approval: JAN -11-K) TH 05:28 ?M CAMPBELL FOREST V FAX:l 978 557 5473 PAGE 8 1 Ng 0749 o • gmgcmu Date ... �72'. TOWN OF NORTH ANDOVER RECEIPT This certifies that ......... t4o ..t It ...... *.�elv ...... haspaid ............ 1 ...... ................ .............. for ... up4t, . . ........ Z, ..5e,v ...... 47W-6 Receivedby .................................. .... O.Af ..................... Department...................... ......i._..-----.-.. . ............. WHITE: Applicant CANARY' Deportment PINK:Trmumr JAN -11-00 TUE 05:28 FM CAMPBELL FOREST FAX:1 978 557 5473 PAGE 9 > , APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 21 19 7 Application by the undersigned is hereby made to connect with the town sewer main in '�(/��A����1[Il� Swet, subject to the rules and regulations of the Division of Public Works. n . A I The premises are known as No. IZ4 or subdivision lot no. _ — '357 76o Owner Address Contractor Address W�&- Applicants Sig ure PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants p to make a connexion with the sewer main at subject to the rules and regulations of the Division of Public Works.. street Inspected by nate �— Division of Public Works By x". See back for rules and regulations JAN 11—UU 1Uh U5:18 rM CAMr,BELL FAX:1 978 557 5473 PAGE 10 N° -936 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. + 19 Application by the undersigned is hereby made to connect with the town water main in td=�&g6- Stfeet, subject to the rules and regulations of the Division of Public Works. The premises are known as No.—iter' I�LdI Street' or subdivision lot no: 7 Silo Owner Address Contractor �J5 PERMIT TO CONNECT WITH WAVE The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. inspected by Date Street �y B rd of Public Works GJ By See back for rules and regulations t JAN -21-1111 YR1 111:05 PM Timothy J. Willett staff Engineer CAMPBELL FOREST FAX:1 973 557 5473 PAGE 2 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Telephone 1978) 685.0950 ,Pax (9711) 60-9573 Additional conditions for lots 15 and 23, Campbell Forest December 21, 1999 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 15 and 23 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these two model homes can begin at this time. The conditions are as follows. I. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street: At this time, the construction of these items has not been completed. 2. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation o ove conditions will void both water and sewer connection permits. No refunds will be granted. 67 Mesiti De eni Corp Printed Name Date ivision of P ' Works Printed Name Date CC_ Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin F � o dj IJO T 1 U 1�1000i { X66 SF°*''��• wCQ --J6, 750 SFS x� ��,00 ROP• ASSF 1� 0 t W-P41Y -, � ' 1 ARAG 1 UNDE OF 1 a SMH-1 •J 1 ( N n 45' Ed WdTS:SO 666T TE 'C)aQ Z99ETtU T9 : 'ON dNOHd ONI `dmfs ONI839NION9 31ZN3ADW : WONJ FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and -dated Dar- 14 , 19 I_ and/or by the Covenant dated Mav a9 , 19 JA and recorded in District Deeds, Book y $$ 0 Page 1,1y or registered in Land Registry District as Document No.. and noted on Certificate of Title No. in Registration Book I Page has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled C_4(AVb21 546LI-OLAA1 PIA&P Section (s), !Sheets 1- 7 " Plan dated _ -Esse ' recorded by the x N o�ti, D i strr ct egi19 �stry of Deeds, Pian Book , or registered in said Land Registry District, Plan Book Plan � / a7 8 4 , and said lots are hereby released from the restriction as to sale and building specified thereon. L* Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) LOTS 2Y,ZS F Z'1 L ors ! 7WI&I Z 3 I hereby certify that lot number (s) Lom L3 TWev 3L 84 on La A& PJPIQ Imo. &AVe (A W-4 Lacoo► (..,,,,, t�;Zljr kart ��f Street ( s) do conform to layout as shown on Definitive Plan entitled �pM-.per ,tea Section Sheet (s) if OF MAssq � Cy .� ALBERT T. TRUOEL �, R glstered Land Surveyor ,e No. 36869 0 a QEC1 ST ERE 1 of 2 C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated , 19 and/or Covenant dated , 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book, Page f acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: EXE'CCUTED as a sealed instrument this ,x 5- day of 19 Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS E�SSeX , ss DG' (;2i-^ bE'r 21, 19 q CI Then personally appeared _ JLL •)» 6a LeQ t { , one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary P40 lic My Commissi n Expires 2 of 2 ca M CIO cla L om Ag k =' \:�� co The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print I Name: Location: city Phone # ❑ I am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity F7 I am an employer providing /workers' compensation for my employees working on this job. (`mmnnnw n7ma- 0---2.:.. AQP- M'TlT 111V-/-_ v ZC1 / xte / 71--, yi��• �v/ Address /-,;477Y' Su f-; 02-� - City ,�i u" �?' e-! Gat 6 (ISYS Phone # 97�� 8 7- S ---?o C3 Insurance Co. )OF)elr, S. e- Policv# N014o2I 3 '-1f/Y-©O Com anv name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under a ains and nalties of perjury that the infonnation provided above is true and correct. SignatureDate Print nametZ—�✓`�/ v� C - Phone # � 5` 7—.S � 6 G) Official use only do not write in this area to be completed by city or town cfricial' City or Town Permit/Licensino Building Dept ❑Check d immediate response is required licensing Board Selectman's Office Contact perscn: Phone #; Health Department Other r Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessarl information as requested below. Name of Applicant an Building Permit (below) Address of Propet Ly for Perr^it (below) Map and Parcel : Joao ` Purpose of Application (check below) P.. one Number of Applicant: I Single Family —Two Family 77t- 6 %7-53450 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit iq issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lat(s) werelwas created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning 8 aw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. e__ This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lets), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building perrnits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate inform . n, or the checking off of an above item which does not comply, whether done to my knowledge or n , is g nos for refusal by the Builcli6g Department to issue a Building Permit. 116 -1 /0 d ignature of r prized Agent who signed the Attached Budding Permit Date This form must be attached to the Building Permit upon application for such permit 'fir ✓� ��"'vrn°m�uea� a���� DEPARTMENT Of PUBLIC SAFETY 1 . CONSTRUCTION,SOPERVISOR LICENSE a Nunber Expires: Birthdate ; { � �` �' 1 CS � � �B69234- g51B912088 8510911954 `; '.- RestricteE To: 88 ALAN G A.USSELL _ 488 VAIN ST'' �"''� Of*' GROVELANO, IIA 81834 a MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-22-1999 DATE OF PLANS: November 1999 TITLE: Boxborough PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 556 Your Home = 548 I I I I I Permit # I I I I I Checked by/Date I I Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1534 30.0 0.0 54 WALLS: Wood Frame, 16" O.C. 2268 11.0 0.0 202 GLAZING: Windows or Doors 484 0.350 169 DOORS 96 0.490 47 FLOORS: Over Unconditioned Space 1582 19.0 0.0 75 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equip nt se cted to heat or cool the building shall be no greater than 12 0 of th design load as specified in Sections 780CMR 1310 a J Builder/Designer Date Uv 0 s MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Boxborough DATE: 12-22-1999 Bldg.l Dept.l Use I I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ J Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans 1 or specifications. I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return 1 ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed 1 using mastic and fibrous backing tape installed according to the 1 manufacturer's installation instructions. Mesh tape may be 1 omitted where gaps are less than 1/8 inch. Duct tape is not 1 permitted. The HVAC system must provide a means for balancing 1 air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is 1 not greater than 125% of the design load as specified ( in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and I require a cover unless over 200 of the heating energy is from 1 non-depletable sources. Pool pumps require a time clock. I [ ] HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 I 140-160 0.5 1 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only) ------------------------- 9 Ul : o in m O a o O n M O Z �° o -"3O a)U'tm 3 C .0 ,O N fD ° o acv �? 3 30r 3 z .: a 3' 'd11 M :3CD o o 0- co (� N C f 'f j O ( 0 :0 � v � � ns c o Oo cc �rn��N 0 0 M E E ° E '&P a ,� ` To =� A �. Q Ln �'— : % mn3N fD !D D o ., o > 0 E" a 3 a��'O Ngnm _' T 01 0 ;u � � �-mnBoor -10s :Z o WIMILLO ID ID CL o Alk r Z �: lb m c® M -� m C m C/)c � m T o coo m a- r a- wCD U� d � C ?? oo co�d n CO) CD 0 A -, CA 5� c CA w co 0 CD CDv cn CD cn CD 0 G CD 0 C c?�O " _ O �• CA 0 Q N 97 d O m m nd � m C') 0 4 f9 0 � 2 =r.0 H Me _•1FESEEM CD = Co O y CD O m y O .. N O g CD m = _CD No� a n4 O O N' O W e� O W S. n o� n co o � _� • CD O O N ` to O m c d � H�� or w O d N " �'• a m c : �� o w -�► a :� N m tp .► m N = N . CD N O =m ft 'n� o` .46 CDo a "_i CD�� O = O c m o *41C�9 O O CD ate.: C-) cl) t1w 0 cm �0 0_. o = cn z 0 O 0 Alk 21 cn T a- r a- r a- CL W. U� C ?? oo n -e ?� rD rrl oo Cn O X n 0 Alk CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number dad DvDate 17—IV-D D THIS CERTIFIES THAT THE BUILDING LOCATED ON 10�16 #O? r MAY BE OCCUPIED AS S --L' L ` IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Ill Ro o m S;:/,5J o% -�3!h/a CERTIFICATE ISSUED TO z0t,, h dl 1 �� ADDRESS � Sc,#ON S/ S,, % `,z�Zoc: Building Inspector J'i'b � � dfiY J� z O ' CD 0 CL cf) d �. mo m >� -v m �s m cv m CD m CL V/ Q m �c d Cn Q CD 0 m ww CD Q CO)to CD CD 0 CD Dpi O CO) 0 CO) w - Cl) CD 0 CD CD y CD CA 0 0 O _V o 0 = O �• N O Q do CL am ti � ��m0 m C7 • N O O.n fl'1 z =r= y o Oy. n,r = -*a H i .a -• 0 Fn - CD �O y p y -� N =r CD w i > >-0 O :moi j r' 4. fC + p O Z �• C09. � � .T W =r CA o'b Q. �� IC O � . ji CD Oco b H O CD �1 m�: =3y s h w O p� C W % S 0 0 -c CR CD H �l do ca Cn C H C � �i%—= IE cD m :O m � D z� 0 O r► �A � m mDco CD CD= ftw CD 0 0; 0 O CD : CD Cn Cn �- i O n ';7 [,mro: •11 Or Q In r1 Oa �n ' �rp CD O r'f 1 oCA n x O � (ap-• •yy�\ �1^ l O O O 4 Tas Town of North Andovero� No RTN qti Building Department �,? y°�.�� �6'e 0 27 Charles Street °; North Andover, Massachusetts 01845 * (978) 688-9545 Fax (978) 688-9542 O i w» ■ [O[wl[ 4 10,q A UD SSAC►+u5���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS o2 Y7 61 Selo 51c-ao- t4jOc)ds e - LOT NUMBER l S SUBDIVISION C� ,o AWZ / d e�� DATE REQUEST FILED 2z 7� d DATE READY FOR INSPECTION 7 z� /O 0 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCV61M) DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE f, -W& y�� `OFFICIAL USE ONLY ROUTING CONSERVATION / A DATE( PLANNING DATE D.P.W. —WATER METER 0/-- %yld DATE �(( 7 -lo -e?) D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO TBf INSPECTION REQUEST DATE. _;/ZC SIGNA / PW AUTHORIZATION uL i0uu iuL ui iy rm UtUWrrLLL runti�i PMA:1 91d J�/ �4IJ rMuh. 1 Mesit1 Vev broup Fax:9r*i-55(i31bV Jul 1( 11JU11 1,5:ZA V.Ul TOWN OF NOM ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Telephone (978).685-0950. F= (978) 688-9573 July 14, 2000 Mr. I th. Grandstaf� President Mesieti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pining Station. Dear Mr. Gzandstaff- The Division of Public Works has mspwted the sewer collection system and sewer pumping station, and apputtawces on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We lmby grant conditional approval for use of the system and pumping station subject to the followhW. I. Completion of items 1 through IS as listed on the Judy 10, 2000 Letter to Mr Dermis Bedrosian from Maurice Hatpin, of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of w1mowledgement of the receipt oftbis letter. 2. Satisfactory completion of an as -built plan for the Campben Road sewerage systent 3_ Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pompMg station, 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the: pumping station and related equonent•and fa Tdw in the event :- --- ...._-_-- -— ........... ..... -- -that Mesio Development or its agents fail to adequately pe&rtn makumamce of the pumping station J UL l t7 U!+ l UC U 1: 1 rin t iilnrGl LL r Unr l rnd : l y l 6 7)1 741 j Mut L an v vi Uu?I JUI If LUUU 10:J4 h'. UL •:. b. Mssiti development shall reimburse the Town upon demand for the re�']Iable .. . costs of emergency repairs to the Pumping Station 7. Mesiti Development Croup and its successors or assigns sball indemnrfy, defend, and save hmmiLm the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgumnis or liability of every n&w rad nature arising at any ti= out of or in consequme of the acts of the -Town" or its agems, employees and officials in the perfonmance of the access purposes covered by this grant of conditional use or tote faihn of the developer 2M its successors or assigns to comply with the tering and conditions of this grant. Very T . ours, 1 t� 1 Hnrurc' E. Director of Public Works Tle undersigned aclwowledge the receipt of and agrees to the terms and coadrtrong of the above grant of gonditional use. 00 M X Z O TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING °` �ThiB SCCit#OH X01' �iiiCiRl~Usc`UaY �' - BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: C�-�^-- Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: z liy, 1.2 Assessors Map and Parcel Number: G Z Map umber Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record aE tial4 A d M 1414 Name (Print) r C NzLgj it tl zv Address for gervice 00 M X Z O SECTION 4 - WUKPMMK Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result Workers Compensation in the denial of the issuance of the buildin permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check alfapplicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: I ir t v w J ofth ? fL (Z SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant 1. Building BQ0 Z 17sz (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) (� 4 Mechanical IIVAC 5 Fire Protection umber 6 Total (1+2+3+4+5)Check SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property I, Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Ov«ter Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, /J C , K,/E� r) _,as QwmFAuthorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief 96 62 -Zz _Q :P:rint a e —3 ent Date Si ature of O w mer/Agent NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DM-,'NSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE: OF FOOTING X MATERIAL OF CHEVINEY IS BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 Birthdate: 03/24/1943 Expires: 03/24/2002 Tr. no: 18312 Restricted To: 00 KENNETH B KEEN _ 21 HEWITT AVE -- NANDOVER, AAA 01845 Administrator NOME INPROVEMENT CONTRACTOR Registration: 108363 Expiration: 8/18/02 Type: 08A KEEN CONSTRUCTION CO. Kenneth Keen 2 ADMINISTRATOR 1 Newitt Aye i No. Andover gA 01845 The Commonwealth of Massachusetts Department of Industrial Accidents oficeofilrestiystfons 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit A hcant in orf m conz;...Tease. ,Iii eat 6— the following workers' compensation polices: comp my name: ' addtess: city: phone# insurance co. murnncr en —. ._ Failure to secure coverage as required under Section 25A of INICL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER 5nd a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cernfy under the iit ai ¢ penalties o perjury that the information provided above is truce and correct. Signature Date Print name g f /J ,4 j- T h k E w _. Phone # official use only do not write in this area to be completed by city or town official city or town: permit/license # nBuilding Department pLicerisingBoard' check if immediate response is required oSelectmen's Office 01-fealth Department contact person: phone #; n0ther (revised 3/95 PIA) KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Newman, Michael & Debra 247 Webster Woods N. Andover, MA 01845 (978) 689-7770 Contract # 1595; Appendix A Date: 02/27/02 Basement remodel: • Frame interior walls to create approx. 640 sq. ft. of finished area • Create kneewall on back & side wall to cover foundation & existing plumbing • Insulate all exterior walls • Hang wallboard & plaster skimcoat to smooth finish • Create soffets around existing ducts • Supply & install 6 -panel hollow core doors to match existing • Supply & install baseboard, door & window trim to match existing • Supply & install acoustic 2' x 2' suspended ceiling • Paint walls & trim (2 coat finish, 2 neutral colors) • Supply & install vinyl flooring at rear entry & bath($450.00 installed allowance) • Supply & install carpet in remaining finished area ($1100.00 installed allowance) Electric: • Supply & install four fluorescent light fixtures • Supply & install switching to code • Supply & install outlets to code • Supply & install one cable & one phone outlet (using Cat. 5 wire) • Supply & install two zones of electric baseboard heat • Supply & install exhaust fan/ light combination in bath Plumbing: • Supply & install Kohler contractor grade shower stall • Supply & install anti -scald shower valve • Supply & install 30" vanity with one piece top • Supply & install vanity sink faucet • Supply & install pump style toilet with seat • Supply & install all necessary piping to supply & drain fixtures • Cut damper in existing HVAC duct Total Price: $24,750.00 (twenty four thousand seven hundred fifty dollars) � 1 i i w�. _'�_ - � o 'i �, O I --- - � -. - .. _.. cn c.�l ! �. �-- �_ L�� _. !. �.-� � - 1 �� Cl) m U) 0 m CO) CD a Z CD 0 CLm a� � o o p Q� CD o ..: d 0 CD CA '0 CD 0 LTJ CO) d d 0 CO) n' O CO) d C) CD 0 CD CDa y' CD CO) CD 0 CD O N 2 O —• ca crEL 0 a CO2 y CL 0 .0 0 H C! d m Z C4 O� ._► .d+ O LO. 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