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Miscellaneous - 25 HERRICK ROAD 4/30/2018
P_ " ,A* Date ... 4-/-3-en 3 ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ..................................................................................... has permission to perforrri-7:'-'J�0!�..;!%e - ....... ................................. wiring in the building of .... ........... .................... ................................. at North Andover, Mass. .............. Fee..k ............. ........ ............ T ic. �LECTR;ICAZIN�S;P�EC�R Check # x/11' 5— ,10 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. ��dG Or Occupancy and Fee Checked , [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6/10/08 WORK City or Town of. North Andover, AM To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 25 Herrick Road Owner or Tenant Chivon Marzluft Telephone No. 978-794-4852 Owner's Address 25 Herrick Road. North Andover. MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Residence Utility Authorization No. 4775805 Existing Service 100 New Service Amps 120/240 Volts Amps / Volts Overhead ® Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters 1 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Panel Change, replace 2 wall sconces, install dimmer switch f'n.,..,7.,t;-., nftt.n fn71,ywina tnhln may he waived by the insoector of Mires. No. of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans INO. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 2 A oven_ Swimming Pool d. E] rnd. ❑ No. of Emergeicy Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection an No. of Switches 1 No. of Gas Burners _ Initiating DevicesTotal No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers HentTotals - -um er _,_ons _. _• �� ����• e o elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW al Local El Connection ❑ Other No. of Dryers Heating Appliances KW eCNritv in o. of bei ces or Equivalent o. o atero. Heaters KW o o. o Signs Ballasts Data Wiling: No. of Devices or Euivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications inngg. No. of Devices or E uivalent OTHER: •r r__._— ...1 L...L� Attach adamonat aeiatt y cxsiret4 Or us rcyutt cu uy ME <rwp—W J .... Estimated Value of Electrical Work: $1450 (When required by municipal policy.) Work to Start: 6/13/08 Inspections to be requested in accordance with MEC Rule 10, and upon completion. n unit for the performance of electrical work may issue unless COVERAGE: Unless waived b the owner, o pe pe INSURANCE CO S the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete" FIRM NAME: Folsetter Electric, Inc. LIC. NO.: 20421A Licensee: Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-658-9975 Address: 30 Parker Avenue. Tewksbury. MA 01876 Alt. TeL No.: 978-387-9709 *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent I PERMIT FEE: $ 65.00 Signature Telephone No. r The Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigadons y 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers . A licant Information Please Print Legibly Name (Business!organization./Individual): f""O 4g'FGT�IC Address: , J/JiF 1.-oe'Q. 1,0it .:e A/ 17`71,a. Phone k Are you an employer? Check the appropriate box: 1 jaI am a employer with & `l• ❑ 1 am a general Oontractor and I employees (full and/or part-time)-* have hired the sub -contractors listed on the attached sheet. 2. ❑ I am a sole proprietor of partner- These sub -contractors lave ship and have no employees employees and have workers' working for me in any capacity. [No wormers' comp. insurance comp insurance 5 ❑ . we are a corporation and its 3. ❑ aim ahowner doing all wort - officers have exercised their � of exemption per MGL nn self [No workers' comp. insurance required.] t c. 152. §1(4), and we have no employees. [No workers' comp. insurance required.] Tr pe of project (required): 6. 0 New construction .7. 0 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10,®'Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs . 13.0 Other *Any applicant that checks box #1 must also rul our me secaon oc,vw sww.ue ...�� =oma=� -� ••, _ --- r- -+ - - -- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below h the policy and job site information. ' / Insurance Company Name: �T 4T� ZiUS11�94 y a ICE Policy # or Self -ins. Lic. #: Expiration Date: l.L �G4T70 City/State/Zip: Job Site Address:U'Gf� 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. Ido hereby certify under theins and pambles of perjury that the information provided Afeve-k'hwe and correct Date_- �. A-79 , /.<'%?- 9975 Official use only. Do not write in this area, to be completed by city or toren gffidal Citi' or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Badding 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 housfWavit►g ndt or than•three.:apAVTts-and:who� esides 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 becapse,of sub , mploTqt be-lo."j to, � employer." MGL chapter`I52"'§ISC(61 also stares•tii t "6yery state or 1 Eal.liEtnsing a e�cy shVI wAt h�olr� he� is'suance or renewal of a license or permit to operate a business or to con stract buildingstin t�►e 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 i&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 be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete -aid printed giyfly. The Depahmk ha `ofovided a space at the bottom of the affidavitfbr yawto fill out in the event the Office of Invesggatioas has.t�qQ pontpct*Xojregarding the applicant. Please be sure to'fill in the permit/license number which will be '6erd a§,a referd'nce-nutnbef In addition, an applicant that must submit multiple permit/license applications in any given year, nee4 onj)+;sgbmit one affidavit -indicating current policy information (if necessary) and under "Job Site Address" the applicant &-old ovtite'"all location§ 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: The Commonwealth of MassachuliWf Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mnass.gov/dia °\ f .� Check # ✓ .s 7590 Building Inspector Location No. Date y NORTh O:i••o ��0 TOWN OF NORTH ANDOVER ,• F R 9 } ie •; , Certificate of Occupancy $ ACMUS EI Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f .� Check # ✓ .s 7590 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT !E!Al& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUIl.DING PERMIT NUMBER: j C� DATE ISSUED: 1c;1_61or SIGNATURE: Building Commissioner/12ELWoT of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel 'tap Number Number: Parcel Number 1j (0f\)D 0JC71V - 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Required Provided ReclWred Provided 1.7 water Supply h SGLRAO. 34) 1.5. Flood Zone Iafmmahon: Public ❑ Private 0 - Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 2.1 Owner of Record Name (Print) Address foc Service Signature Telephone � 2.2 Owner of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor. �-- 2 Licensed Construction Supervisor: D 0 Address Telephone t2 Registered Home Improvement Contractor Cbmpany Name (�-?8 (. e Not Applicable ❑ License Number a Expiration ate Not Applicable ❑ Registration Number Expiration Date C 2 R ai CA "T s r a M r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 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 it. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Descri tion of Proposed Work check a0 a bk New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: L` N n t camry C %?1 0 0-1 l�%� 124 CXR otr b . -Ad SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building c. 03 I-0-tr.. (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) -2 m 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, I ` 1 t c [h� T`Z\') as Owner/Authorized Agent of subject property Hereby authorize 9 k ( G 0 4j�/ (—'�-t�l,� GO'� `� ���. to act on My =ters authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si attire of Owner/Agent ent Date iW NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDaERS 1ST2 ND 3 RD SPAN DM ENSIONS OF SILLS DIN ENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 M } BOARW'OF.SWLDING REGUL.. License: -6NSTRUCTION SUPERVISGR Number: CS 050710 Birthdate: 04/22/1956 Expires: 04/22/2005 Tr. no: 9641 .ij r Restricted:' 00 RICHARD A FLUET ' 11 102 BRIDLE PATH LN .� I METHUEN, MA 01844 Administrator j Board or Building Regulxtioris and Standards HOME IMPROVEMENT CONTRACTOR Registotio ; 106620 x�1 CAi P - 7124/2006 S I , Pnvate Corporation RICHARD FLUET'd T NG:INC. Richard Fluet -' 102 Bridle Path Lane, , .��' �' � C L---•.� Methuen, MA 01844 - Administrator R ,ou,O ,C�ESre�GT/Uc%.5 a C = /c/a C -,u '.r .S "COY -Cl 7We riTGE /Nsr/,eo.P,ONo RL or Ti/E B4,V& r10,17 T//E OwEGG/•a6 /1 LOC.4T6G OAA �' �aT.lS .SifCA✓N ANO THAT/T OG1ES CD.dFG+P.f/ /N �/y'// Y�E7'ow</ • OfN.�� ✓E� ZON/.vG .C�d�/LAT.bt/S f�"dvlf0/Nle JET�/C.t'S F•POM STPEC'TS � LOT U•vES. '' �{ � /� / , / r �7 /�) /� / V D, �'-/ /V �Qv G /` / i i /'/ t FarT,s�Er LE.rT/FY TiY.4T T/f/S OA✓ELL/N6 /.s NOT ,rIl / O.PAfl�it/ FO.P :Ot /N r1ld,FEOE.PAG 040 HAZA�O APEA. WdWAI ON �fM•f' O �Y P,.t vct. zsoo9e s Al �D BD710 PIAN,�op .SES - tio7 FDP U,t/O,PS/ Y AT/O�/ TA.c'E.y F,Po.H.Pe"Co,PpS. G6 �'A.P,E� .ST.PEET ' �„ � o s 9 A.NDOYE',P, �J,4S,SAC.f/l/SETT.S O/8/O q-� ?I 5 09- w A IWA, I cry 09- w A IWA, I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Ll Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector CA66—N.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 - Workers' Compensation Insurance Affidavit Name Please Print a Name: lI C�✓}W&t `(— C, � i Location: t Ti'`4/2e Ct ( I `� Citv ly, V rPyxlcg Phone # 7 3 3 76 I 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. Company name: Address % o a— 17,T% �2 )'f�'/ 1,��✓ City. �` C� >'� �"lQ . Phone # °i' 7 �J =�0/ 0 Insurance Co. Policv # W C— w% �i (2 Companv 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 $1,500.0 and/or one years' imprisonment_as.weU_as_civil.penalties.m]he fmnofa..ST.OP WORK..ORDER..and_a.fine.of.(.3100.OD)-ariay against xne. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u ins and penalf sop =tthemat/on provided above is true and correctSi nature �Date vC Lo ,n Print nam4 e P-7 Phone Official use only do not write in this area to be completed by city or townofficial' City or Town Permit/Licensin4 ❑ Building Dept ❑Check d immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #.• ❑ Health Department ❑ Other Town of North Andover Building Department 27 Charles Street "Y North Andover, MA. 01845 1SSAra�SEi� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name PRESENT MAILING ADDRESS. City Town Home Phone State Work Phone . • The current exemption for "home6wners" was extended to include owner -occupied dwellings of two units or less and to alk)w such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Zip Code RICHARD FLUET CONTRACTING INC. 1.02 Bridle Path Ln. METHUEN,- MASSACHUSETTS 01844 (978) 685-7010 TO Gail Batsim 25 Herrick Rd. N. Andover, Ma. 01845 Page No. 1 PROPOSAL of 1 Pages. 484 PHONE DATE 978 683-7370 6/26/2004 JOB NAME / LOCATION PORCH ENCLOSE ENCLOSE PORCH AREA;BLOCK OFF ONE DOORWAY,INSTALL NEW 15 LITE PRIMED FRENCH DOOF UNIT,FRAME IN FOR 3 HARVEY OR ANDERSON DOUBLE HUNG WINDOWS,ADD SHEATHING,SIDINC AND TRIM,BUILD HIP ROOF ABOVE,VENTILATE CRAWLSPACE,APPLY MOISTURE BARRIER, AND POINT FOUNDATION AS NEEDED,INSULATE FLOORS AND WALLS(R-19),CEILING(R-30),ADD BASEBOARD HEAT TO EXISTING LOOP,ADD PLUGS AND SWITCHES TO CODE,INSTALL 3 RECESSED LIGHT FIXTURES,LEVEL AND RAISE FLOOR TO MATCH EXISTING HARDWOOD, INSTALL NEW WHITE OAK HARDWOOD(3 COATS OF FINISH), LEVEL CEILING,1/2" DRYWALL MUDDED AND SANDED,ALL INTERIOR AND EXTERIOR SURFACES TO BE SIMILIAR TO EXISTING,SUPPLY PERMIT "AND TRASH REMOVAL. OWNER TO DO PAINTING. Extras or changes to be completed at a rate of Ll per hour, per man. Unpaid balances subject to 1'/s% finance charge per month. WE PROPOSE. hereby to furnish material and labor —complete in accordance with the above specifications, for the sum of: Nineteen Thousand Six Hundred and 00/100 Dollars dollars ($ 19, 600.00 �. Payment to be made as follows: TO BE ARRANGED All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifica- Authorized tions Involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Note: This proposal may be Our workers are fully covered by Worker's Compensation Insurance. 3 0 days. withdrawn by us if not accepted within ACCEPTANCE OF PROPOSAL —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: E be z O.0 W t O w E ur� C/)v v cn U A C p w O u: C U C x 0 w � p a C w od O U a x p a: chi C w a d O c� C w W w A w w 7 cn ° z a` In u cn ui z 0 w w P-4 U O 2 v �4 a� 0 co Ci 18 Z C3 C* co .y co L co .�r 0 m 0 ey CL CO) .Q CO) C O C CO2 is 3� O Q 0 0. CL om Q S C CD J O Z co C. co) G • as c �o :oma O y VO V d C m C � 4 o ..�. ..CD :0 i CL y C : %L —C,0 .�c 4 E m `—° D CL40moo y cf r.. m y C C " V —m�> N"�� C • o -00"!E m ea �• a3 m ; :coo cm �: y •m �V cs O 2 O cm m m e o Q s m :mro ~ ♦O.. y yrO,~ O W CO 9S -0 t •N .., c O ci �..� dt C -+ Z L= m " o " c' COO) o. m� o� a.- mom z 0 w w P-4 U O 2 v �4 a� 0 co Ci 18 Z C3 C* co .y co L co .�r 0 m 0 ey CL CO) .Q CO) C O C CO2 is 3� O Q 0 0. CL om Q S C CD J O Z co C. co) G N2 3 Date f ?.. Z(.:..7p....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that Z-:?�.....�.-�� .--1 .................... has permission to perform ... �-. = :: ��'� -'� u-� > /y .............................................. wiring in the building of .�..`-�r-�- -.--z ��+�-�........................... ... , North Andover, Mass. Fee -g?................ Lic. No .j `/� ... � ..................... ....... .. *':.:��:................. .i �{ ELECTRICAL INSPECTOR � V WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use only 7 EOOMMONW L7HOFA14�' ' CHVS '1' ---- ..- k DEPARTMM NTOFPUBLICS9FEN Permit No. BOARD OFMEPREVENTIONREGUTA77011NV7CMR 12•00 Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date, G li 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) ¢f�7Q41 G/4-- �.d - Owner or Tenant 8 AL3�.> M Owner's Address Si IV16' Is this permit in conjunction with a building permit: Yes [Ef No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps.,20dVolts Overhead o Underground a No. of Meters New Service Amps �/Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /AlS7A1L97-ie-J G� 3 dyTGE75 TO No. of Lighting Outlets No. of Hot Tubs Ihatiea=e tLi billy huta=PohcyuchxktCmo sae swrialec}nv� Iha%esdxn2edvdtidpcoofofs=1othe011m YES No. of Transformers NO a If}ouhawdmJcediESpkmrdc*thetMxcfomWbyctxckirgthe Total EVu-dtionD* Estpt>aa�d LLtatt ,,,... L� kgxManD*RqumWd Rao WotkioS/ w7 ■" �• ... VahtedUmftical Wads $ a> Final KVA No. of Lighting Fixtures Swimming Pool Above Below I y� 0 1��44M6—AZQW 2A Ale Generators KVA OWNER'S IIsi,SURANCEWAIVMIarnmvwethattheLioaasedoesnot tie L % ground - ound ED Telephone No. No. of Receptacle Outlets J No. of Oil Burners No. of Emergency Lighting Battery Units No. of Swit& Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of RanPsNo. of Air Cond. Total Tons -No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis - No. Hydro Massage Tubs No. of Motors Total HP OTHER' InstrareCov�e Aasuantbthenaqunana��Ga�alLaws CovwdWa'itss YES M NO M Ihatiea=e tLi billy huta=PohcyuchxktCmo sae swrialec}nv� Iha%esdxn2edvdtidpcoofofs=1othe011m YES rj NO a If}ouhawdmJcediESpkmrdc*thetMxcfomWbyctxckirgthe Wpcpti*W CSE Ef BOND ® CRIlM a ftmeSpe fy) - EVu-dtionD* Estpt>aa�d LLtatt ,,,... L� kgxManD*RqumWd Rao WotkioS/ w7 ■" �• ... VahtedUmftical Wads $ a> Final FIRMNANC Lica>see t)//. 6a/zl o Signer LioaiseNo �3'�% I y� 0 1��44M6—AZQW 2A Ale Btsir;essTeLNa �,�� lc � S7 �, •, AkTeLNa OWNER'S IIsi,SURANCEWAIVMIarnmvwethattheLioaasedoesnot tie L % and �atmysigt�aecstthis petm�.applic�twai� � tecpmai>er� - (Please check one) Owner E3 Agent ED Telephone No. PERMIT FEE $ s Location No. �US Date E"? OR ig 9 H v �%-*+) =W MAL 855x TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ _.ob TOTAL $ Building Inspector Div. Public Works PERJIIT NO. Jos APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4qO. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ONE SUB DIV. LOT NO. r-) I OCATION ri 4�' 1� , J PURPOSE OF BUILDING�.rf��ZkE .71rr2 CQ(�J/N(J' OWQiV.I/� liwNER'S NAME y NO. OF STORIES ( SIZE 9WNER'S ADDRESS Cry, BASEMENT OR SLAB ARCHITECT'S NAME - SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAME jJ/��p Q / I / �1� 'A ! [ SPAN DISTANCE TO NEAREST BUILDING --- DIMENSIONS OF SILLS DISTANCE FROM STREET '" POSTS DISTANCE FROM LOT LINES - SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION Is IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 INSTRUCTIONS ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR Vi6ATE FILEDd-jk4,c SIGNATURE OF OW4A OR AUTHORIZED AA HNT FEE PERMIT GRANTED 19 /5's- 3 PROPERTY INFORMATION LAND COST ;LI'TO76i , GG EST. BLDG. COST V EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY DUILDING INGPRCTOR OWNER TEL. # CONTR. TEL. # So V 3"71/ / 31 7 CONTR. LIC. k I.C..0M e-,k-"'-A� T"' BUILDING RECORD 1 OCCUPANCY 12 SINGLE' FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL V, 1/2 FIN. B'M'T' AREA FIN. ATTIC AREA _ _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS ( 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING _ HARDW'D COM/ACN ASPH. TILE VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME _ ATTIC STIRS. 6 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ to 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. C') C) Z m D —I O Z W CO) d C � CO)CD C7 n Z to a o n� r S O CL y O v CD CD ,c o CL Q cc CD C O VA Qv y O cc COD CD HCD O CD Z o • CD O C CD FA n CI O �• co, O CS H a O S oH CL 10 0 CD O m C2C7 y C9 CL m Z ?'p to —4 CL 0 =rmaCL id y m O m y p C .-►.0 : —4 N ?mCD _ C2-0 sco O H• C9 W =r== c CACL _ • . � m O m c 0 CD a �.•f CA CA CA N CS, C f ... H CD O CDCO J VJ CA O O CD: Fu co O W p • 7 Do ►-- ... rr. = ? CD ate• c o O CD LE _r m ^D ilo =x Cn cn - W a ►-3 '^7 O � � '..T'.J w Cn ( Q oGa a- CrJ n o .r1 = O a a zr "C tz 0 y0 � '17 g- /ro aGc a' O � a o C7 C) O � c ^ O Q.. x D O rZ 0 c jj 1"F' A ('T Glf ll:�7 R it r..l y 'R a t J,. 01-1 S --3 Y) -lie JT1.119. 4 C Cl A. Rei IC H A C L GRO'DW— Yt i .. �, tY �_.�� . ' �l� i i. a •��.t M}t,;.Ly 4•ilI.4 '.i•\i, 7 1, tion application. ad to the mailing address on the ent ❑ Lost Card ❑ Other ✓�e Colm„a„�a�u :i Mid yOME iMPfi-VEMEvJ i—ONTRI.-70P IY.P - INDIVIDUAL � ,44 EXO:Hation O/0'/97 '1ICr?AL . SULLIVAN ii,HAEL „, JO L IVAN &-,TFft4*C BROADWAY ZIP ADMINISTRATOR HAVERHILL MA 011830 OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING Town of NORTH ANDOVER °0�°•` DIVISION OF PLANNING & COINMUNITY DEVELOPMENT KAREN H.P. NELSON. DIRECTOR r I 2 Main Street North Andover. Massachusetts o 1845 In accordance with the provisions of NIGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly license: solid waste disposal faciIitc as defined by MGL c ill, S 150A. The .debris will be disposed of in: o ,0e i ! i S (?.ocation of Facility) Sienature f Permit Applicant ac, gzeoe Date :TOTE: Demolition permit from the Town of :forth Andover must be obtained for this project through the Office of the Building Inspector. AIR Date./ TOWN OF `k/THANDOVER PERMIT FOR PLUMBING This certifies that .. , .. �, ... .... C1, .... ..... . has permission to perform ....? ........... L plumbing in/thee buildings of �// .'� i --:4G" ` ........... . at � � �.- ./ ........ North Andover, Mass. FeeLic. No..1 X0.,3. �..� ....... . PLIBING INSPECTOR Check # % %�-%' 7961 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location ��� T L Owners Name -714 of New Q Renovation M Replacement ' �l rr'TY7'TT17 tnn /�2t cs �e / (tl;. Date Permit Amount Plans Submitted YesNo 1i El (Yrnr or type) Installing Company Name �. / ,S ,� �l/�. - P 1 b 11_4 Check one: Certificate Corp. Address 1'k u /L- 1 _ �v� e Partner. Business I elepnone © f (� v Firm/Co. Name of Licensed Plumber./�'���. �L'G Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver. I the undersigned, have been made aware that the licensee three insurance of this application does not have any one of the above 1�4Signature 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 antalla 'ons performed under PuAt Issued for this application will be in compliance with all pertinent provisions of theM a se S plum Q o Code Chapter 1 of the General Laws. ay: - �- City/Town APPROVED coFFim usE oNLy Type of Plumbing License rcense um er Master a Journeyman ❑ 0 0 x 6 T°k ;° -� (A Q -1 07 o D m a a O n 0 � > >n CD _ m Z > 0 > 3. " 5 � �, ° O n r► CD CD 1 O r► � z\� CD C C CD CD :3O (D ° �(A 69 4A 69 69 fA 69 a z CDvbl O G'�m 6 n :e > n z C z z �� 7 m z n z >_L r c c c y- n C +7 Z Z Z r m m m m .� n r o > b z>> z -� °>- z C) m zc n ri ? z N n _ yLn � m a m m cn cn NZ M Ln = n Z o ro O a n 'TI O a z ° z ^1 m cn o m I v En z m O ... rr i > n0 �••• .7 a_ "_ n O Cj C o c ° z' mo En o ti m n N L O 0 o o � ry a CA iii Fn in iii � y "" C C C y t_n O Z 7 N rn r r r r -i ti 7Z, y- m ° n N y m O ..-W ° o n n o c m en ti m cn r a O O O Z !) ''z C -+f •^n -n z Z Z Z z y "Z'.....� .ti .y^ ,i• r- �„ r- 0... aa n tom. a n m 2 r0 z AA an - a m = 0 0 0 0 o O z r- ..... - - __ C y - C r - _R nQ5-F- `z •� �� W 'k N Cn b WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 Please print. DATE / Lo JOB LOCATION "HC)NfEO�Vv"ER" Number Name PRESENT MAILING ADDRESS HOMEOWNER LICENSE EXE"YIPTION ,?(C c C Street address Section of town �,93 -? 3 Aj a Home phone ork phone ,.4 -pi `-e-- CityiTown State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a ttivo-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building, permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE v � APPROVAL OF BUILDING OFFICLU Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF,2PtALS 684-9541 BUILDING 688-9545 CONSERVATION 683-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover NORTH OFFICE OF ,�•� ,1��0� COMMUNITY DEVELOPMENT AND SERVICES �,?05 ° : p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 Please print. DATE / Lo JOB LOCATION "HC)NfEO�Vv"ER" Number Name PRESENT MAILING ADDRESS HOMEOWNER LICENSE EXE"YIPTION ,?(C c C Street address Section of town �,93 -? 3 Aj a Home phone ork phone ,.4 -pi `-e-- CityiTown State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a ttivo-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building, permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE v � APPROVAL OF BUILDING OFFICLU Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF,2PtALS 684-9541 BUILDING 688-9545 CONSERVATION 683-9530 HEALTH 688-9540 PLANNING 688-9535 BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL,c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed. of in: Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Cl) 3) m Cl) 0 C d COO CO) -- d o CD n Z y E; 0 Z7 CL r c� 0 �. _• CO) 0 0 CD CD C d CD CD CD C CD y. CD CL t=) CO) COD CO) 0 1 CD 0 Cl) CDa 0 ac CD o Z O CD 0 ea 0 C to O to c d O N N V J � co) 0 z .v,'GO a. N = CO) -cm, no n m n H m acc, 3 m C=O y QCD m -� O m W N O i m m: m n 0 5•� :�; OZN n • CD: : CL Er " 5 %► : dc O ON n � : CD N .i W N CLcr O. d C W d N P C CD N ca 1 : CD to 0 Q O O H 3 � o m IL N :` CD -7 O W Im Cl) C=l 1 � o � CD m 0' (� p ~ rte•+ rr1 � w 7 � � CSj N G � r O� ti � Gr � G m � Off, O � (n n Q n o y !J m v 0 c Date. N° 4211 <� •��c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ',SSACMUS�S• r ! This certifies that��......I. • .. • ... • • ... . has permission to perform ...'. k �. !-. �� �'.� ° ..'............. . plumbing in the buildings of ..�.f ................. at ...;1..5 ...Iye "e x(.�:..� .�........... , North Andover, Mass. Fee.. ! . Lic. N o.. � ....... ....... ...�-�.- - ...... . l,PLUMBING INSPECTOR !r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer OG �^o MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 2 - (Print (Print or Type) W, _�vlass. Date % I—t19 ermit Building Location 4 C �Ll Own Name--h-Lk �r—Sl N !A ,•�vpe of Occupancy �c SiOci fAe_._ New Renovation IK Replacement ❑ FIXTURES Plans Submitted: Yes ❑ No F - Installing Company Name /UCl Check one: Certificate Address 254 1 h rv` ❑ Corporation A�� di Lr— U d j 3Z ❑ Partnership Business TelephonelZ� J / E]Name of Licensed Plumber re INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No D If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy,_ Other type of indemnity ❑ Bond C; 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent C I herehy certify that all of the detaib and information I have submitted (or _ ed) inattov . pl' ar n Are tru accurate to the hest of my knowledge and that all plumbing work and Installations performed under the permit issued fa this application wi in c p0a ce r a linen( vision of the Massachuse General Laws. rts State Plumbing Code and Chapter 142 of the By --___ Signanue of +cenyed Plumber "— Title Type of license: Masters lltomneyman L. City/Town _ _ License Number APPROVI'D InFFICF LIS[ ONLY) BASEMENT 2nd FLOOR 3rd FLOOR 4th FLOOR 7th FLOOR Installing Company Name /UCl Check one: Certificate Address 254 1 h rv` ❑ Corporation A�� di Lr— U d j 3Z ❑ Partnership Business TelephonelZ� J / E]Name of Licensed Plumber re INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No D If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy,_ Other type of indemnity ❑ Bond C; 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent C I herehy certify that all of the detaib and information I have submitted (or _ ed) inattov . pl' ar n Are tru accurate to the hest of my knowledge and that all plumbing work and Installations performed under the permit issued fa this application wi in c p0a ce r a linen( vision of the Massachuse General Laws. rts State Plumbing Code and Chapter 142 of the By --___ Signanue of +cenyed Plumber "— Title Type of license: Masters lltomneyman L. City/Town _ _ License Number APPROVI'D InFFICF LIS[ ONLY) Date. `.:. `. ' ........ . n MORTM , TOWN OF NORTH ANDOVER p ao tiO PERMIT FOR GAS INSTALLATION 9 This certifies that .......... has permission for gas installation ....f?......` ................ . in the buildings of ... ...................... at .... %.. {? !' �. �.. ��..l ........ North Andover, Mass. Fee.Lic. No.., .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) _AAvh Q n Ti •• •: np,_� , Mass. Datel`I 19-1/ Permitff `� v Building -Location _ZS ner'sName VV 047Type of _ Occupancy New ❑ Renovation J4, Replacement ❑ Plans Submitted Yes O No ❑ rn rn ¢ w. - z ¢ - w Cr ¢ 6:p j = a z Oir Q tt: ¢ z z O H w _ J ui 0 w O a W~ -z i� Z¢ i rr¢ w O a� x (n - 1 Z Q W J t` Z 1— W p> LL U J N Cr ¢ r o C) i LL Q¢ Q o o ILL, a o w - t 34c�g¢oai-O BASEMENT TSTFC60f� - - 2ND FLOOR 3RD FLOOR ATH -FLOOR STH FLOOR 8TH FLOOR - 7TH FLOOR 13TH FLOOR Installing Company Nam t11- Address -.- Check one: Certificate ,....- - - UI 1 . ❑ Corporation ❑Partnership - Businase Telephone �' �� ! FFWPdC-rr. Name of Licensed Plumber or Gas Fitter fCt�ii i�f=7 / dsUd INSURANCE COVERAGE: i`_ -ct7ner V8fI5iliy insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes �L, No ❑ dyes pease indicate the type of coverage by checking the appropriate box. -a�.insurartce PottcY Oftr type of indemnity ❑ Bond ❑ OWNERS INSURANCE -WAVIER- I aar_awafe. gjet .duwtTorfiave the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature. on this permit application waives this requirement. ChaM one: re or oar's A nt Owner ❑ Agent ❑ �rMaDy CunthThat atrotif%detail& and information 1 have submitted (or entered) in above application are true and accurateTo the best of my knowledge and that all plumbing work and Installations performed under the permit issued for thia to Ill be In compliance with_ all pertinent Iftinne of the mass -C.1-8.118 Qlat" ng Code a hapten 142 of theeC� neral . rCAit1VrjW1;' of license Title ❑ Gasfitttter Signatur o Licensed umber or as Fitter 'Master PROVED F ❑-.tounreyman License Number__ %Z� Date................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACNUSEt This certifies that ......... has permission to perform . ............................................... wiring in the building pf . ............................................. .......... .... ........................................North Andover, Mass. Feex(?) .1 .......... Lic. No. K&M, ........................................................... ELEcrRicAL INSPECrOR %eck # 545/1. TIECOMMONWLALTHOFMASSACHUSETIS Office Use only DEPARrAfM 'OFKMUCSAFM Permit No. BOAMOFFMPREVEMONREGUL OMR7C W l2ib Occupancy &Fees Checked APPLICA71ONFOR PERNff TOY61ORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITHMASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 T (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andoverlork To the Inspector of Wires: The undersigned applies for a permit to perform the ele'tricall described below. i Location (Street & Number) Owner or Tenant c4/"�- Owner's Address Is this permit in conjunction with a building permit: Yes q No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpsVolts Overhead Underground No. of Meters New Service AmpsVolts Overhead Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures 3 Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets y No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW a Connections � No. of Water Heaters KW No. of No. of Sims Bailasis No. Hydro Massage Tubs No. of Motors Total HP +OTHER• �t�/�h c 714/9/'/ - C0M rdW RttsuartiDdrm*zmemofNi%mdugemGmydLaws o0 Itmeaa=IU*kkmmnoeR)kywAdwCmvWOgrdtuECovwWorgsmbgamdqxvaht YES NO Itinsi imdvaidpmafaf areodr0fimYESj� if)mWmdrdodYES,plea9ehk*theeAxcforneWby drdd%d a box [1 NSURAN(E BOND MiER a tPlea9eSp *) EViadmD& Ekm*dVakxof AxWcalWotk $ WodctoSlatkq)eWwD*ReWes1od Re* urtder�Pertalties of ptmjuly. EIRMNAME V1<h.4aQ T' 1Za0SSC-�4 Ck S/mac LLC Limine Signaaae ✓e=J Final LimmNa 9S7,wl, Lio=1% Buss n=Td Na ALTdNo. OWNER'SINSURANCEWAIVER;IamawarethattheLiowdoesrothavethemarameacreageoritsstxmrttde4walmtasmguaadbyNLSGeneralLaws anVAmysi iaaecnthispemiffbcaiatwaresd=tegtmet= (Please check one) Owner Agent a Telephone No. PERMIT FEE $ "'� signature of Owner or Agent I Cm Date..15.!. i ................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... `� I� ' ,..... 1-,. ........................'..,,,..... kl- ........ has permission to perform `...'S„u.,.�,A�. Q,S�3 ................................................ wiring in the building of............�.u.�-........................................................................ at .......:...2�.... !...... `'"° !R..!2^, cL , North Andover, Mass. ......................... —%D ,rFee...� G� `�............. Lic. No��O.... ..1 Mr ..................................................................... ELECTRICAL INSPECTOR Check # 171')k cc��__ _ 20,p<admenl o1..tire service6 BOARD OF FIRE PREVENTION REGULATIONS Permit No. Ift Occupancy and Fee Checked [Reo. 11071 eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT EV ENW 0RnTEALLLVF,0RMATI0A9 Date: City or Town of: N -a 1Q _a ka-K To the Inspector of Wares By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) �)6 N�c.Q,'(1(1. LCX— rd Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Bog) Purpose of Building C-�,knnjQ_ f OLM IL J ) f Y1,Utility Authorization No. Existing Service a Amps toAD / 84D Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 10SW ck ti cn ('j(- rc (* ty-w i x=a D9 Mk �,L�j� jnY 5i5-�4yy) ' 4Ac� PCA��\S . i 3 Completion of thefollowing table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceii.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA of Luminaires Swimming Pool d Above El Ignmd. ❑ of.No. Bane Units Emergency g No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners ._ - —o o etection an Initiating Devices No. of Ranges No. of Air Cond. - Tonsl No. of Alerting Devices Heat Pam Number I Ton JKW of Self—Contained •Dispme. 3 1,51als:eCtion/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ fie, Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters o. of No. of Signs Ballasts -� Data Wiring: ' No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: LAttach additional detail if desire44 or as required by the k pector of Wires. Estimated Value of Electrical Work: 5 C (When required by municipal policy.) Work to Start: - CEJ` I Y Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Icertify, under thepains andpenaNes ofperjury, that the information on this application rd complete: FIRM NAM: � `(i -r' � \ - r � _ LIC. NO.; M�LJj �Or Licensee: Z Olm k 'k Signatu LIC.,1�0.: 1 ajt L41 A - (If applicabl . enter " empt" in the license number line.) Bus. Tel. No.: 1Ss1 Address: 5� - I I )da - 1 )9( r-\SZW Alt. Tel. No.:Sot -4 -1 qq `A0O *Per M.G.L. c. 147,. s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally reauired by law_ By my signature below. I hereby waive this reauirement. I am the (check one) n owner ❑ owner's aeent. Telephone No. uepurimenu of itnausiraaa Hcctaenirs Oce of Investigations t a 1 Congress Street, Suite 100 vw` Boston, AIA 02114-2017 3y° www anass.gov/dia Workers' Compensation Iltns>ulrance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Vivirlt Solar LLC. Address: 29 Draper st ,,.Woburn, MA. 01801 Phone #:781-305-3065 Are you an empl®yea-? Cheep the appropriate box: . 011 am a employer with 10 4. E] I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working forme in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 5. F -I 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 required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they 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. 1f the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: MJ Insurance, Inc �alicy# or Selfins. Lic #-02934233 - xpiration Ta1-7-111-1/1.: Job Site Address: `7X City/State/Zip:)D - aw- &U-A— 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 hereb under the pains and penalties of perjury that the information provided above is true and correct. l Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of health 2. Building (Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector C. Other 0 VIVINT SOLAR REVELOPER LLC PHILIP f ZA14PITELLA JR 4931 N 300 W PROVO UT 84604 FoK Then Detach Moog m ft M. go m ELf CTR I C I ANS i ISSUES THE FOLLOWING L E'RSE AS : WWLID PLASTER ZIL.ECTR I C I AN V t.v ilwli' SOLAR DEVELOPER LLC PHILIP Ea'1ELLA JR 4931 It 300 w Piwo IW 84604 1_3r4i .A 07i3.IZ> r 101. ao (EL) W I m� K3 ZCD I m; U N I O CD Q Z � N =r m� U) 1 �x A n I o 0 09 I =z Om I m ;o I W T iv < c :Ecn rn vm nm rn N m ------------------ T ."0 O r > 3 c m ` Z C I Mcz 0 1Dmm N CLS 'g rZOA I_ jm°z 00 �mpz ou x m Mm0 mmZ0 T mi=x O� Apm� I 1 xX mm O0mz CID -y= yz �-j�o , mn 4C -Z21 I CL I .. 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N ;x o m 3 N c a o .`e. o N lC. o mn D c Z(y C� 3 3 o m`Do 5-ra CD I AD T c o N N mmo N»% �m s oto 3 m N UI 2. m m I O r Z T >>• 0 j 3 d o ED n 0 3 0n Z O Co�� Z m Y r - o m o a �3 63 a m j<<<< 3 D n T o 0 0 0 0 3 - °2 3 x m D 0AX 0 D°55d Q o O co C� (� v,o5 rom ? • c o a wcN���oN - $ (' z 0 v h z Z m 01 0 C 0 3 D w 3 Hm a i3 m 3 3 0 0 3 z z D D z D 0 m m V c= m D= m INSTALLER: VIVINT SOLAR o o Rule Residence INSTALLER NUMBER: 1.877.404.4129 CK 3 -LINE r M ��-�^�y} r" . -` MA LICENSE: MAHIC 170848 E 1.0 mm m `/ 1 G J Q •, 4 25 Herrick Rd ?9 DIAGRAM North Andover, 01845 DRAWN BY: CRS AR 3193549 Last Modified: 8122/2014 UTILITY ACCOUNT NUMBER: 91006-27020 I- ,A Vivint Solar - PV Solar Rooftop System Permit Submittal 1. Proiect Information Project Name: David Rule Project Address: 25 Herrick Rd, North Andover MA A. System Description: The array consists of a 3.25 kW DC roof -mounted Photovoltaic power system operating in parallel with the utility grid. There are (13) 250 -watt modules and (13) 215 -watt micro -inverters, mounted on the back of each PV module. The array includes (1) PV circuit(s). The array is mounted to the roof using the engineered racking solution from Ecolibrium Solar. B. Site Design Temperature: (From Lawrence MUNI weather station) Average low temperature: -24.3 °C (-11.74 °F) Average high temperature: 37.6 °C (99.68 °F) C. Minimum Design Loads: Ground Snow Load: 50 psf (State Board BR&S) Design Wind Speed: 100 mph (State Board BR&S) 2. Structural Review of PV Array Mounting System: A. System Description: 1. Roof type: Comp. Shingle 2. Method and type of weatherproofing roof penetrations: Flashing B. Mounting System Information: 1. Mounting 'system is an engineered product designed to mount PV modules 2. For manufactured mounting systems, following information applies: a. Mounting System Manufacturer: Ecolibrium Solar b. Product Name: c. Total Weight of PV Modules and mounting hardware: d. Total number of attachment points: e. Weight per attachment point: f Maximum spacing between attachment points: g. Total surface area of PV array: h. Array pounds per square foot: i. Distributed weight of PV array on roof sections: -Roof section 1: (13) modules, (31) attachments Ecorail 559 lbs 31 18.03 lbs * See attached engineering calcs 228.93 square feet 2.44 lbs/square foot 18.03 pounds �Cn.solar 3. Electrical Components: A. Module (UL 1703 Listed) Qty Trina TSM 250-PA05.18 13 modules Module Specs Pmax - nominal maximum power at STC - 250 watts Vmp - rated voltage at maximum power - 30.3 volts Voc - rated open -circuit voltage - 37.6 volts Imp - rated current at maximum power - 8.27 amps Isc - rate short circuit current - 8.85 amps B. Inverter (UL 1741 listed) Qty Enphase M215-60-2LL-S22 13 inverters Inverter Specs 1. Input Data (DC in) Recommended input power (DC) - 260 watts Max. input DC Voltage - 45 volts Peak power tracking voltage - 22V - 36V Min./Max. start voltage - 22V/45V Max. DC short circuit current - 15 amps Max. input current - 10.5 amps 2. Output Data (AC Out) Max. output power - 215 watts Nominal output current - 0.9 amps Nominal voltage - 240 volts Max. units per PV circuit - 17 micro -inverters Max. OCPD rating - 20 amp circuit breaker C. System Configuration Number of PV circuits 1 PV circuit 1 - 13 modules/inverters (15) amp breaker 2011 NEC Article 705.60(B) ww cn�. soIa r D. Electrical Calculations 1. PV Circuit current PV circuit nominal current 11.7 amps Continuous current adjustment factor 125% 2011 NEC Article 705.60(B) PV circuit continuous current rating 14.625 amps 2. Overcurrent protection device rating PV circuit continuous current rating 14.625 amps Next standard size fuse/breaker to protect conductors 15 amp breaker Use 15 amp AC rated fuse or breaker 3. Conductor conditions of use adjustment (conductor ampacity derate) a. Temperature adder Average high temperature 37.6 °C (99.68 °F) Conduit is installed V above the roof surface Add 22 °C to ambient Adjusted maximum ambient temperature 59.6 °C (139.28°F) b. PV Circuit current adjustment for new ambient temperature Derate factor for 59.6 °C (139.28°F) 71% Adjusted PV circuit continuous current 20.5 amps c. PV Circuit current adjustment for conduit fill Number of current -carrying conductors 3 conductors Conduit fill derate factor 100% Final Adjusted PV circuit continuous current 20.5 amps Total derated ampacity for PV circuit 20.5 amps Conductors (tag2 on 1 -line) must be rated for a minimum of 20.5 amps THWN-2 (90 °C) #14AWG conductor is rated for 25 amps (Use #14AWG or larger) 4. Voltage drop (keep below 3% total) 2 arts: 1. Voltage drop across longest PV circuit micro -inverters (from modules to j -box) 2. Voltage drop across AC conductors (from j -box to point of interconnection) 1. Mirco-inverter voltage drop: The largest number of micro -inverters in a row in the entire array is 7 inCircuit 1. According to manufacturer's specifications this equals a voltage drop of 0.24 %. 2. AC conductor voltage drop: = I x R x D (- 240 x 100 to convert to percent) _ (Nominal current of largest circuit) x (Resistance of #14AWG copper) x (Total wire run) _ (Circuit 1 nominal current is 11.7 amps) x (0.0031952) x (120) _ (240 volts) x (100) 2011 NEC Article 705.60(B) 2011 NEC Article 705.60(B) 2011 NEC Article 705.60(B) 2011 NEC Article 705.60(B) 0.24% 1.86% Total system voltage drop: 2.1% m". solar } EcolibriumSolar Customer Info Name: Email: Phone: Project Info Identifier: 9203 Street Address Line 1: 25 Herrick Rd Street Address Line 2: City: North Andover State: MA Zip: 01845 Country: United States System Info Module Manufacturer: Trina Solar Module, Model: TSM -250 PA05.18 Module Quantity: 13 Array Size (DC watts): 3250.0 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: Enphase Energy Inverter Model: M215 Project Design Variables Module Weight: 41.0 lbs Module Length: 64.95 in Module Width: 39.05 in Basic Wind Speed: 100.0 mph Ground Snow Load: 50.0 psf Seismic: 0.0 Exposure Category: B Importance Factor: II Exposure on Roof: Partially Exposed Topographic Factor: 1.0 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load - Upward: 820 IV Lag Bolt Design Load - Lateral: 300 Ibf EcoX Design Load - Downward: 493 IV EcoX Design Load - Upward: 568 Ibf EcoX Design Load - Downslope: 353 IV EcoX Design Load - Lateral: 233 IV Module Design Moment — Upward: 3655 in -Ib Module Design Moment — Downward: 3655 in -lb Effective Wind Area: 20 ft2 Min Nominal Framing Depth: 2.5 in Min Top Chord Specific Gravity: 0.42 Plane Calculations (ASCE 7-05): 1 Roof Type: Composition Shingle Average Roof Height: 30.0 ft Least Horizontal Dimension: 30.0 ft Roof Slope: 31.0 deg Truss Spacing: 24.0 in Edge and Corner Dimension: 3.0 ft Snow Load Calculations Description Interior Edge Corner Unit Flat Roof Snow Load 42.0 42.0 42.0 psf Slope Factor 0.71 0.71 0.71 psf Roof Snow Load 29.8 29.8 29.8 psf wind Pressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -17.1 -20.1 -20.1 psf Net Design Wind Pressure Downforce 16.0 16.0 16.0 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 psf Design Wind Pressure Uplift -17.1 -20.1 -20.1 psf Design Wind Pressure Downforce 16.0 16.0 16.0 psf ASU Load Combinations Description Interior Edge Corner Unit Dead Load 2.3 2.3 2.3 psf Snow Load 29.8 29.8 29.8 psf Downslope: Load Combination 3 14.4 14.4 14.4 psf Down: Load Combination 3 23.9 23.9 23.9 psf Down: Load Combination 5 18.0 18.0 18.0 psf Down: Load Combination 6a 30.4 30.4 30.4 psf Up: Load Combination 7 -15.9 -18.9 -18.9 psf Down Max 30.4 30.4 T30.4 psf Spacing Results (Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 59.5 59.5 59.5 in Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 48.0 48.0 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 19.8 19.8 19.8 in Spacing Results (Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 35.9 35.9 35.9 in Max Spacing Between Attachments With Rafter/Truss Spacing of 24.0 in 24.0 24.0 24.0 in Max Cantilever from Attachment to Perimeter of PV Array 12.0 12.0 12.0 in .a Layout � Skirt o Coupling 0 Clamp Warning: PV Modules may need to be shifted with respect to roof trusses to comply with maximum allowable overhang. '0istributed Weight (All Planes) In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP) Weight of Modules: 533 lbs Weight of Mounting System: 62 lbs Total System Weight: 595 lbs Total Array Area: 229 ft2 Distributed Weight: 2.6 psf Number of Attachments: 31 Weight per Attachment Point: 19 lbs Bill Of Materials Part Name Quantity ESEG01CLASA EcoX Clamp Assembly 31 ESEG01COASA EcoX Coupling Assembly 17 ESEG01SKKTA EcoX Landscape Skirt Kit 1 ESEG01SKKTA EcoX Portrait Skirt Kit 5 ESEG01 CPKTA EcoX Composition Attachment Kit 31 ESEG01 ELASA EcoX Electrical Assembly 1