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HomeMy WebLinkAboutMiscellaneous - 261 WEBSTER WOODS 4/30/2018Date ..... I.01;k .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ............................ ............. ................................................... )has permission for gas installation ......% ..tl:'Ltt.v. �:.................................... in the building of/ ........./.......''...// ......... '*'*****" *"**"*****'*'* ... **"**"*'*'****"*** ... -i ...................................... at.Cx-.1 .. (04:�t. J*',.'�.It.*W�T ............ , No Ajfdover, Mass. Fee.et')!..��. Lic. No.qR .............. .. ...... ... 4 ........ ....... ... ......................... ill r I- A INSPECTOR Check # 10329 )-L MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY �,,2/�/j/J- �, �•r ,2 _� MA DATE Q'PERMIT # JOBSITE ADDRESS OWNER'S NAME GOWNER ADDRESS_J1 TEL _, FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: E] RENOVATION: [l REPLACEMENT: Uj--- PLANS SUBMITTED: YES E] NO Q APPLIANCES"I FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BOILER __.. :mj E:. ., I _� L.. _ .1 - BOOSTER --�-_ i_ _. -� -. _ _ CONVERSION BURNER _ _._J I _ _(^-J --- - --- - - ---- COOK STOVE DIRECT VENT HEATER.- DRYER �- .. _ .._ .... FIREPLACE FRYOLATOR- FURNACE ,Z,.ir, ve _ IL_--- GENERATOR i GRILLE INFRARED HEATER LABORATORY COCKS -_---1 MAKEUP AIR UNIT (� _ _ ~ _ [ -- -- a EN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _.� - L_- - ( OTHER �77 --------------- - -- INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES <0- I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej BOND EjJ 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 Q AGENT SIGNATURE OF OWNER OR AGENT 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 kno edge' and that all plumbing work and installations performed under the permit issued for this application wi (be in com fiance ith provision of 7aent Massachusetts State Plumbing Code. and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME LICENSE# 6XGNATUAE MP MGF EjI JP D JGF LPGI 0 CORPORATION E]# PARTNERSHIP 0I# _ LLC E]# COMPANY NAME:moo° y f C__ ADDRESS e-_ CITYr_.j STATE 2 ZIP ]TEL FAX CELL -EMAIL -� L H O z z 0 H U W w a z O �El W >- �- W [Oi a z U w F- W rA Cl) w OLU �+ w z a o a a U J H a IL Q �r � w z w F- LL H O z 0 H U a V' C7 The Commonwealth of Massachusetts Department of IndustrialAceidents 1 Congress Street, Suite 100 Boston, M02114-201 i _ A. www.mass.gov/die Workers' Compensation insurance Affidavit: Builders/Contractors/E+lectricians/I'lnxnbers. • TO BE FILED WITH THE PERMITTING AUTHORITY. Naame, (Business/O iganizationllndividual): Address: / /� gag Phone #: Are you an employer? Check the appropriate box: 1, am a employer with employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees Working for me in any capacity. [No workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. C]I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. ❑We are a corporation and its, officers have exercised their right of exemption per MGL c. M Rim and we have ni employees: [No workers' comp. insurance required.] Type of project (required): 7. 0 New'construction 8. E Remodeling 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additions 12. E j, plumbing repairs or additions 11E] Roof repairs 14.[] Other�� �S *Any applicant that checks box a, must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached additional sheet showing the name of the sub contractors and state whether or not (hose entities have employees. If the sub -contractors have employees, they must provide thein workers' comp. policy number. mpensation insurance for my employees. Below is the policy and job site X am an employer that is providing workers' co information. Insurance Company Name: / l �J S Policy # or Self -ins. Lic. Expiration Date, City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). .00 e by a ffib up to Failure to secure coverage as required under iil enalties?inthe form of a25A is a aSSTOP WORK ORDER al violation Iand a fine of up to $200.00 a andlor one-year imprisonment, as well p be forwarded to the Office of Investigations of the DTA for insurance day against the violator. A copy of this statement may coverage verification. X do Hereby t� un er the p ' s d penalties ofrperju the information providelabove tr arrectSi afore: �Date: Phone #: official use only. Do not write in this area, to be completed by city or town offacia% PermWLicense City or Town: # issuing Authority (circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4., Electrical Inspector 5. Plumbing Inspector 6. Other Phone #: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their eriiployees. 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 enferprise, and including the legal representatives of a deceased employer, or the receiver'orr trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or theoccupant 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,whd has' not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(1) 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 sixb contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If anLLC 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 In.dustrialAccidents. 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Location .2(, ( to-,, / S )�g MOO A l J)" - No. 983 Date c.2 4011Th TOWN OF NORTH ANDOVER .. • 0. _ Certificate of Occupancy $ •, cN • Building/Frame Permit Fee $ _//17 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ %% o Check # 1531.,6 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Sectiog':for Ufiic�at Use 0aI BUILDING PERMIT NUMBER: 3 DATE ISSUED: Q 02—� _ SIGNATURE: Building Commissioner/Inspectoi of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map Map Number and Parcel Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ILi 6-A Uj 0 1 Ire Name (Printy Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: iF Aj to e,6 3.1C Eetj Licensed Constrsction Supervisor: 21 9f w; � �IJE ly• �Nb�0c1Eti Address 6 Z� S e Telephone Not Applicable 0 S'g z, 4S, License Number Expiration Date 3.2 Registered Home Improvement Contractor 1� Fr N Ce" w,S lg!, u C- a t Not Applicable 0 3 g 3 Company Name Z, E W 1 4,j iF Al. 4.uA 6y�, Registration Number li 2-12 l 2- z Q O O Address n �S - Si Telephone Expiration Date ou M X Z O W v rn I Y 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 affi in the denial of the issuance of the build rmit. Signed affidavit Attached Yes ....... ref No ....... SECTION 5 Description of Pro osed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: r _ i� N r S h IQ Pei� O X S�C� 7 ►4� - /r► �i SECTION 6 - ESTIMATED C Item 1. Building 2 Electrical 3 Plumbing 4 Mechanical (HVAC 5 Fire Protection 6 Total (1+2+3+4+5 will result C( Item UUP IN Estimated Cost (Dollar) to be OFFICIAL USE ONLY Com leted by penrut applicant ' (a) Building Permit Fee Multiplier (b) Estimated Total Cost of 3F'— Construction Building Permit fee (a) X (b) /7 L Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner/Authorized Agent of subject property Hereby authorize �N Ett+ c x/ EE'N aJ�2 Gto act on My bel nilniall matt r 11- ork authorized by this building pennit application. _ . 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 /A ,ent NO. OF STORMS BASEMENT OR SLAB SIZE OF FLOOR TUABERS 1 SPAN DMENSIONS OF SILLS DIMENSIONS OF POSTS DM-,'NSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHMINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE, Date SI/_E THICKNESS X 3F'— xx _ ✓iie �amzmaruaeall% a�,�faaurT 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 L•i.�.� �i ! N ANDOVER, MA 01845 Administrator HOME IMPROVEMENT CONTRACTOR Registration: 108383 Expiration: 8/18/02 Type: 08A KEEN CONSTRUCTION CO. Kenneth Keen 2 ADMINISTRATOR 1 Hewitt Ave No. Andover MA 01845 The Commonwealth of Massachusetts Department of Industrial Accidents office011000921ions 600 Washington Street Boston, Mass. 02111 ddress• "urnnrr en �rra Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and' r one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER And a fine of S100.00 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 certify under the 'perjury that the information provided above is true and correct. SignatureDate — —31 `O L QC n' / Print name N /� fL x F w Phone # 7 7 a- G T l 1 ZO official use only do not write in this area to be completed by city or town official city or town: permit/license # nBuilding Department — —"" C] pLict:nsingBoard check if immediate response is required C]Selectmen's Office []Health Department contact person phone #; n0ther KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Wolfe, Ed & Mary 261 Webster Woods Rd. N. Andover, MA 01845 (978) 688-8848 Contract # 1594: Appendix A Date:01/27/02 Remodel basement: • Frame partition walls to create @ 550 sq. ft. finished basement • Create %2 bath near roughed in pipes • Frame kneewall jog near back door to create TV stand • Frame kneewall under windows to close in radon & soil pipes • Frame small unfinished closet for electrical panel • Insulate exterior walls • Supply & install two vacuum outlets( in family room and garage) • Relocate vacuum canister to garage • Supply & install blueboard & plaster walls to smooth finish • Supply & install three 6 -panel hollow core textured doors • Supply & install 2'x 2' revealed edge suspended ceiling in finished area • Supply & install 3 1/2" Jalco casing on doors & windows to match existing • Supply & install 5 1/4" "speedbase" throughout finished area • Paint all walls & trim( 2 coat finish, 2 neutral colors) • Supply & install ceramic tile in entry(from garage door to work shop including play area), bathroom & small area near back door ( @285 sq. ft.) ($640.00 material allowance) • Supply & install carpet in remaining finished area including stairs($1200.00 installed allowance) Electric: • Supply & install outlets to code • Supply & install 5 fluorescent troffer lights in ceiling(double switched) • Supply & install all switching for lights • Supply & install one cable outlet and one telephone outlet • Supply & install electric baseboard heat to code ( on programmable thermostat if possible) Plumbing: • Supply & install rough plumbing for i/2 bath • Supply & install standard toilet, vanity, sink & faucet in %z bath 4 m m J) Cl) 0 m _) y d C � CA C'7 n Z y Co O 'v CL c i� ? o CZ y o C-) c v CD CDCL O Q d CD CD O CD DO C CD V� C1 y I �= CD S- CA O Z CD O CD O CCD O cn 0 p7 c =; ►� b Orb, N �O O O 0 x t'' hi '� H n d M CD Cn Z r - ?. d N N l J O 11�yy�J � m Cn p O IE =r ' R O > ^ CD > 0 0 �z 0 ON O N� n :� ' m W n � p =ryCL =1 CD CD ;i*: Z� mo®06 m Oq CA :W G d y dCL n N r.� CD : to .► �t 3E m N N 7d . T S CA t') m T m CAO) S cn 0 cn 0 p7 c =; ►� b Q C•NCD N �O O O 0 x t'' hi 0 x H n d M CD m Z r - ?. d N N O .di m =r CL.+ a CD m N O an d p O IE =r ' R O > ^ CD > C to p O N� n :� ' m W n � p =ryCL =1 CD CD ;i*: Z� mo®06 m Co :W N d y dCL N r.� CD : to .► �t 3E m N N �N T m� y pjCD, 'v ' g2� O po CD � S di ea n 3 T N V � CD =W it •o a"o h_ :� S CA t') m T m CAO) S cn 0 cn 0 p7 c =; ►� b 7* o x /1 r �' 0 x t'' hi 0 x "d C) Cn m n 0 x 0 a 0 0 C1� cn CD g o z 0=3 0 0 c 71 -�q t'06 No 455f' HORT" f 9 .. j Date.............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS A 1� ( I /-/- This certifies that ...._�-L�.� ............ has permission to perform ...� ... ........................ . plumbing in the buildings of atca'. :/....:-��..... North Andover, Mass. Fee 2/3.... Lic. N P.17 ... /. , '. _ ...... :....... . G/ PLUMB IN XECTOR Check WHITE: Applicant CANARY: Building Dept. PINK: Treasurer W MASSACHUSETTS UNIFORM APPLICATION FO (Type or print) NORTH ANDOVER, MASSACHUSETTS Building r Owners Name of TO DO PLUMBING Date _L Z, t C& y Q Permit # Amount New � Renovation ❑ Replacement Plans Submitted Yes No (Print or type) Installing Company Name Address Check one: Corp. Partner. , Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate te type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Certificate 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 work and installationnerformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S P mbing C d r 4 f the General Laws. By: Tignature-01 LIcensed Flumoer Type of P umbing License Title 7 ' City/Town 4inse Numner Master Journeyman ❑ APPROVED (OFFICE USE ONLY • (Print or type) Installing Company Name Address Check one: Corp. Partner. , Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate te type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Certificate 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 work and installationnerformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S P mbing C d r 4 f the General Laws. By: Tignature-01 LIcensed Flumoer Type of P umbing License Title 7 ' City/Town 4inse Numner Master Journeyman ❑ APPROVED (OFFICE USE ONLY 3547 r r--, j Date ......... ... �. `'.......... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 1. This certifies that. - ... -' .. .. .......... . i has permission for gas installatio .. !.. ............ in the buildings of ..'c....: ........ . at .` .. �� . f .1. �'.f�:". North Andover, Mass. Fee. .G ... Lic. No..°.1.. ..... ! -�. ... . GAS INSPEC.O l WHITE: Applicant CANARY: Building Dept. PINK: Treasurer jT MASSACHUSETTS UNIFORM APPLICATON FOR or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name 4 P DO GAS MING Date 19 U' New Renovation ❑ Replacement ❑ Plans Submitted ❑ Permit # (� 31�yI Amount S 2JI-91 (Print or type I Address � Business Telephone Name of Licensed Plumber or Gas Fitter ���� Check one: ❑ Corp. Certificate Installing Company ❑ Parmer. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalpnt. Yes ❑ No❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy12�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 ( 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 pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts SO Gas Code andgapter 1_2 ofPe General Laws. By: Title City/Town APPROVED (OFFICI USE IMLY) Signature of Licensed Plumber Or G -L- Fitter ❑ Plumber Df 77� ❑ Gas Fitter License Numoer Master ❑ oumeyman � t !' (Print or type I Address � Business Telephone Name of Licensed Plumber or Gas Fitter ���� Check one: ❑ Corp. Certificate Installing Company ❑ Parmer. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalpnt. Yes ❑ No❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy12�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 ( 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 pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts SO Gas Code andgapter 1_2 ofPe General Laws. By: Title City/Town APPROVED (OFFICI USE IMLY) Signature of Licensed Plumber Or G -L- Fitter ❑ Plumber Df 77� ❑ Gas Fitter License Numoer Master ❑ oumeyman CERTIFICATE OF USE & OCCUPANCY Towyn of North Andover Building Permit Number � DateJ/ ERTIFIES THAT THE BUILDING LOCATED ON MAYBE OCCUPIED AS ��� �� /��/ �Gv�l�it7 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. q foo s� 02 13,V 1 S� 7 5�1/ v,�V,0� CERTIFICATE ISSUED TO ADDRESS a0130J 1 d Sue Q zj� 0'�&Ldz sACHUS � Building Inspector C/) m m C/) C CO) CD 0 z CD O ar � m 1 o p n� Q CD O .. ... CO) 10 CD O CA _m O _ 0 CO) CD O CD CD a CD CA 0 st CCD 0 CD CD y O cr vs cA a C 0 Ci C4 CD c Z - ?-o co) 0 O1 ,0.r m O T M ? CLCL 0 m/-+ w®my CO) - - - CD -0 O Cl) tozic O O 0yO� moo•® Co CL '�► L!J C my CD CD b c am cp.0d y L3 H & d :�cr v , C n ►� N �1 O y ca ca m d Vl 0 ic if%. n 1-� O �0 y l -� Z as w CCIDJ CA dC=D _a. Arm-: CD rso KL' CL Z I - s N " Nr N 0 c CD C dw6 w G G arc r� p'- Q nG� -� � r r C7 � 0-4 y " CD : \v O z C17 i" •� z I - s N " Nr N 0 c CD C dw6 A I •:'�y '1 Town of North Andover oI NORTH EO Building Department ? y�` ^6`6 0 27 Charles Street ti North Andover, Massachusetts 01845 V _ (978) 688-9545 Fax (978) 688-9542IL 4 V �9SSACtiJus APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS c2 6` Lr/e,,4 Ln LOT NUMBER SUBDIVISION—el DATE REQUEST FILED DATE READY FOR INSPECTION 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 TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUC DOE NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATI DATE PLANNING DATE D.P. W. -WATER METER Oe -f:T(/) DATE X100 D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. �Xl¢ v -Z7-off SIGNA / AUTHORIZATION Mesiti Dev Group Fax : 978-5578160 Jul 17 2000 1354 P. 01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak �°"'" ,, Telephone (08) .685-0050 13irector ,•��• ; Fax (978) 688-9573 f July 14, 2000 Mr. Kenneth Grandstaff, President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. Grandstaff- i The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the foIlowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. 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 pumping 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 equipment. and facilities in the event __ _._..._... ..... _.. __ _ that Mesiti Development or its agents fad to adequately perform maintenance of the pumping station. a' T Mesiti UeU broup I ax:y 8-bt)M160 Jul 17 2000 1354 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, ciauns, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. VeryTT ours, J. William Hmurc' E. Director of Public Works acknowledge i The undersigned thereceipt of and agrees to the terms and conditions of -the above grant ofSonditional use. N° 2565 Date.....7....�...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....1........!.. .�.. s..........�%...��....................................... has permission to perform ...... .......... + v ........... .................... wiring in the building of .......Oi1. P J .......... e.........LoT ...... ,........ J�.. ! & Gs{ � u! u� North Ando%�t, Mass. F/3./�•..... Lic. No. ��. ............... ^�/�........................ ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer y� Official Use Only/ eG2t;S� Permit No.__23 fP s aee�t Sam Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date 9 — / — C? C) To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described be ow. Location (Street &Number Owner or Tenant i :0 ?' Owners Address 3, )I l T (/y/P j(e Is this permit in conjunction with a building permit Yes t3 No ❑ (Check Appropriate Box) 7 Purpose of Building > h, le t Utility Authorization No. 0 0 (0 Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service 42 00 Ampslo -) Voits oqLY0 Overhead ❑ Undgmd B ---'No. of Meters Num`�er of Feeders and Ampacity Locat!.pn and Nature of Proposed Electrical Work / )v No. of Lighting Outlets No. of Hot fuse Total No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Receptacles Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps . Tons KW No. of Sounding Devices Nod of Self Contained No. of Dishwashers f Space/Area Heating KW Detection/Sounding Devices No. of pryers Heating Devices KW ❑ Municipal ❑ Other Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) 1-2 Estimated Value of Electrical Work$ (Expiration Date) % Work to Start 9—(--Oc7 Inspection Date Resque-sttedd Rough OZ C14-41111 Final j Signed under tho.1249alties of penury: FIRM NAME �, G �- e LIC. NO. !f Lkensee !? Signature ` 1 ! LIC. NO. ffll 114, Bus. Tel No. Address IFO Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE (Signature of Owner or Agent) Location./,i//, 70 v 1) No. oC ` Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ IS -l" Building/Frame Permit Fee $ Foundation Permit Fee $ y Other Permit Fee TOTAL $ is D 106'1� - Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T1 s S tiio %►r. (1►ti"lc* Bse BUILDING PERMIT NUMBER: ' DATE ISSUED: , J) SIGNATURE:e ' '010000 Building Commissioner/I ctor of Buildings Date SECTION 1- SITE INFORMATION %f 1.1 Property Address: )-d f /6 `_ a g.,XgZ2'e � � r --s , - J EFIl it , --m 1.2 Assessors Map and Parcel Number: 1069 1 9'/ Map Number Parcel Number �1 A)& 7 - &Joods i r . _k SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... V No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: e v nwej�-, Ke eters W dee-ye. ate re e%aer,,ee SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction q ®' ®�[ 3 Plumbing Building Permit fee (a) X (b) / 53 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 p p Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Ovaier Date SECTION 77b OWNER//AAUTHORIZED AGENT DECLARATION I, as Chez/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 Na DO Signature of 0e/A e Date NO. OF STORIES SIZE.S�o BASEMENT OR SLAB AcG SIZE OF FLOOR T ABERS 1 , 2 7/; 3RD SPAN (p DM ENSIONS OF SILLS DINIENSIONS OF POSTS `l DIMENSIONS OF GIRDERS MAW`s HEIGHT OF FOUNDATION Aja- THICKNESS SIZE OF FOOTING IdecX 707F MATERIAL OF CHEVINEY WD 0 of IS BUILDING ON SOLID OR FILLED LAND 5 ,`d IS BUILDING CONNECTED TO NATURAL GAS LINE Yes a_ 396 6-5 2S y b5-. 6 C/ l a a 3 38 &S- 5 9 � / a 6s 1 S 4� a o2NJ 39 (0 a 5 q a s ( 0 CR )l L o (ter a s 3/ �8911 a 8 17 O �� 01 0 ® d �o f / (� Ciao o 5 �� vA) e� 5)L v j-'- lk 8 a - Al Ne� ��dt�%Z I-/��I�M oZ 13 A* L� Gt 0 9)s 24 -f The .Commonwealth of Massachusetts Department of Industrial Accidents Offica of Investigations Boston, plass. 02111 Workers' Compensation Insurance Affidavit ( Name Please Print I Name: Location: City Phone F7 I am a homeowner performing all work myself. F7I 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. LALJ n-nmo- 0---7-, , %% I--,r'esf /- / C 1A CWP Address o? 3% su ff 01-7 ST'_ S e o? i .City: �/,o 14a 0/bls —Phone n O;V) 6$7- 530 Insurance Co Ur✓� �Pd �� i �ic -X/-?S, Policv # /V w f,;2 X1.3 `% 11 r1 -a0 Comoanv name: Address Cita: 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 51,500.00 and/or one years' impnsonment as well as civic 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 fcr coverage verification. I do hereby certify under the pain and pena ' s of perjury that the information provided above is true and correct. Signature Date z,6" 00 Print name Ea -7,/2 SSS /% Phone # 5 S7 -S 76 0 Official use only do not write in this area to be completed by city or town cmcial' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone ❑ Health Department ❑ Other BUILDING DEPARTNIENIT 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: /0 5,V,2 .1Y, Location of Facility Sig6rfllie o ermit Applicant 0 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Oepartrnent 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 ,f e necessar/ information as requested 'below. Name of Applicant an Building Permit (below) Address of Property for Penrit (below) Z"/d Mao and Parcel :/c8�'Purpose of Application (check below) Phone Number of Apicant: Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the E<ErMPTiON seciion'8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me cr any party to this permit from the requirements of obtaining other permits required prior to the issuance of the I_udding Permit. Further I understand that my interpretation of the E<EMPTiON status is subject to review by the Building Department and is only of6caliy accepted when the Building Permit irk 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 creared. The let(s) werelwas created prior to May 6, 1996 are exempt from the provisions of this Sec:icn 8.7 of the Zoning ylaw. This application is for dwelling units for low andlor moderate income families or individuals, where all of the =nditions of 8.7.6.oare met and/or represents Owellirtg units for senior residents, where cccupanc/ of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. .1 This application is a part of a development project which voluntarily agreed to a minimum 4011. permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable aces and permanently designated as open space and/or farmland. The land to be preserved shall be protected from deve!ooment 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 Oeveloper in common ownership with an adjacent parcel an 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 dwe!ling unit an the parcel. This application represents a Iet which is ready for building permits,(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 Oevelapment until such time as the Oevelopment Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXE?MPTiON. 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 E<E1MPTiON as cited above. Further I understand that the submittal of misleading and or inaccurate inform the checking off of an above item which does not comply, whether done to my knowledge r at is ground ` r refusal by the Building Department to issue a Building Permit. `,'1 ignature of Ownef 9Ki?4*R6d Agent who signeTThe Attached Building Permit Date This form must b attached to the Building Permit upon application for such permit _�^'=• ��re TJomzirno�r2useaGcsi a�✓�Oac�uc:tef�t DEPARTMENT OF PUBLIC SAFETY CONSTRUC1�14N,SUPERVISOR LICENSE NunDe�; Expires; Birthdate: 069234 X510912000 0510911954 Hest r icted, To. 00 ALAN GRUSSELL. 400 MAIN'ST` '~" �r GROVELARD, MA 01834 TOWN OF NORTH ANDOVER DIVISION OF :PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSE'TT'S 01845 J. William Hmurciak, Director Timothy J. Willett Staff Engineer Telephone (978) 685-0.950 Fax (978) 688-9573 Additional conditions for lots 16 and 18, Campbell Forest March 17, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 16 and 18 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. 1. 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 of the ab itions will granted.. / Mesiti Devlopffe-nt Corp void both water and sewer connection permits. No refunds will be , -4 4, C a-,S-�� Printed Name Division oqPuKlic Works Printed Nariv CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin �% 6d -a Date Date 1492 APPLICATION FOR SEWER SERVICE CONNECTION �a�c�t North Andover, Mass. 17 Application by the undersigned is hereby made to connect with the town sewer main in subject to the rules and regulations of the Division of Public Works. tz, The premises are known as No. (� el P� vv� s we— or —or subdivision lot no. Jug-'[ d , ui 2 �� Owner 4 {��� c 1, >?,/- e r jp Address Contractor Address Applicant's Signaure PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to W � 2-G c to make a connection with the sewer main at �" � � � ��'� "©A , E'-- 3ireet- subject to the rules and regulations of the Division of Public Works.. Inspected by Date Division of Public Works By See back for rules and regulations 7 ee Adc d C. ewll--1 i �rGI�S N® 960 APPLICATION FOR WATER SERVICE CONNECTION ZCr�le North Andover, Mass. /Z tg--- Application by the undersigned is hereby made to connect with the town water main in G(/�Pl w�G`���G2yF'Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No or subdivision lot no. �G Owner Contractor 6%e'2G- (-tip Street e Address Address I ( Applicant's Signature PERMIT TO CONNECT WITH WATER MAIN / ��� 141Z 12��,-2 Gz The Board of Public Works hereby grants permission to 11 _ to make a connection with the water main at J/1-14 subject to the rules and regulations of the Division of Public Works. Inspected by Date of Pu�corks ByGlJ ' Z �ZZoard See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET. 01845 \LM A a�reo.^v° .45� DRIVEWAY PERMIT Date: 3- 1 7 - oo Telephone (508) 685-0950 Fax (508) 688-9573 LOCATION: Gel �o��e✓ (;�� �e �o 1� BUILDER: phone: OWNER: C�e�� o��j' Z L r— phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. 1 Remarks: Approval: icaiti Llev croup rax:y(d5 n(nou Hpr 1U 1UUU 12:1 t�.UL FROM �'CKENZIE ENGINEERING GROUP, INC PHONE N0. 6179412662 Apr. 20 2000 11:13AM P2 140-7-,4550 21,.7*5 lit m.qd , �~'� _ Off` P isle. r' LON- ux `STALUT� Tt, 16 ---ine®r x138.0 PRW- ad . 0 SF Lrr 3S 4J& \ I ELEV.1340 1 s' \ R=3 f� I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-27-2000 DATE OF PLANS: March 25, 2000 TITLE: Lot 16 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 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 equipment se,lecte o heat or cool the building shall be no greater than 5$ of the desi load as specified in Sections 780CMR 1310�p 114.4. Builder/Designer w'✓ Date z d MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 16 Boxborough DATE: 4-27-2000 CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-11 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.49 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 92.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can 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 I or specifications. I 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 I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed t using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I 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: [ l I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I - ( } I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ ] 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 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: 1 Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS 1 HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 100-130 0.5 1 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- 11i FORM U - LOT RELEASE FORM 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 complianc-a with any applicable or requirements. t ** * *************APPLICANT FILLS OUT THIS SECTION**** APPLICANT e ,cra�(iG/ F -y -r -'St cG C PHONE &97-S-300 LOCATION: Assessors Nlap Number /063 PARCEL SUBDIVISION (. g!nj '11 ��T�S7� LOT (S) l� STREET websfei' wond-cse- ST. NUMBER RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS ��5\ Q r -Q - TO COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS PUBLIC WORKS - S C FIRE DEPARTMENT USE DATE APPROVED DATE REJECTED_ C6, �,Ci1J DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED - RECEIVED BY BUILDING INSPECTOR Revised 9\97 im DATE "� +l I LCV OI UUH FaA-.9fO-JJ(01VV 17N1 LV LVVV 1L•1.) 1 .VG FROM 'ICKENZIE ENGINEERING GROUP, INC PHONE N0. 6179412662 Apr. 20 2000 11:I3AM P2 57 - rlle oil Tt, STALLF 14 all. 47.4 46.0 SF Lrr EEV.�i� f' St4�.4 R 3 i m m C m m cn 0 m CA 10 CD CD O CL r— d d a� 0 0 CD Q CD O W. 0 1 . y CD 0 0 0 CD VA' CD CA CCD CD0 p � Gp u < C13 m 2 C r j O —•N O Q N rm a r a 0 S. m V2 o n� m =-O CA rm rn mrm 1 n?M = Mn Y+7 O O Oy O y QN ?m�m 2 > > m C n U2 p O .-► O p t_A. C2 CD C � a m14j; cn m y cn m OT — m CD ^ � 0 m a lJ d m3 .� ems. O7 = CL /V e °° d ^^� CL m V H �• V! N ? O ^ mCD VJ CD z c,ko m CD CD cD lima lb w ?C� a_ O c) C; eon XF y: o = O O CD Z cn a cn M c ni m o O z W y eL cp `° r). o r n � w o °a ►� z GO � r x ` o a rt-< Gy z �' cn 0 n Irl 0 a\ ;;. rDr O d o x y 0 0 c { cM o v ajo S Crm o rn N�7 m W Z m Fr O 7 rr7 r�'l UI Q fD C S ren r,9 rroo -n N C. m m f�D 0 Pn 3 c rn > r o c 3 -tea o a, n� o o m �o 0 �0cD y _ 011 0 fD M 0 ro cr O • jo oM�� 1 1In 1 Ln M a -I a CL C Ln n O O' c o C '+ 7 7 gi E 5 cr .« 5'o o LO 3 ;� , Z) fD CD O Q1 a n o E a 3 ao AAO :1 OEC r r Qy CD �r �� �CD 08 1 CDa v Con —� _ o ETA fft x � m X n 0 z 0 z z 0 1' TJ e d E cation x f Date 00 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .3e �v Check # 3 S.' 13 %~ Building Ir ector JUN -20-00 TUE 9:45 S E Cumm i nas Assoc i 0Ltkes P 02 CERrIF/ED Nor PL AN CUMMINGS & ASSOC/A TES va sar iaax p«lsrow, �►.w os,#ea raemoNE wom-'s,02•Joes FAX fBDBI 982-�?f6 :SCALE 1" = 60' WEBSTER WOODS" LANE HEREBY CERTIFY TO TOWN OF NORTH AN90I.R. MA BU/LD/NG DEPARTMENT %1`�A T1E EXIST/NG FOUNDA TYON DRAWN JN TH/S PLAN /S L OCA TED A DA JUNE 19, 2000 S SHOWN MIN/MUM SETBACKS.• FRONT -- ,30 FEET " /Vo THA T /T DOES COMPL Y TO THE *IWV BU/LD/NG SETBACKS TO SIDE -- 30 FEET :P'ROPERT'Y / /A/FC RFdR - 3n rt-rr 3553 Date. -..a..-.. () a .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that (L ....................... has permission to perform ....................-BASZ............. �a ............ wring in the building of .I.. -C. j, 'L M 0 1 . ... ... , q ................................................. .......... 2�.r. at ... ......I North Andover, Mass. ..... .. .. . . ....... .. ..... -)CICI.7 Fee ................ Lic. No I :�� F�� .......... A4,. �.Gq . .... ...... LE) P CTOR �i' Check # �•� ThFC011►M0NWE4LTH0FK4YS4( RTS= Office Uas y DEPARTMENTOFPUBLIC& FM Permit No. i BOARD OFMEPREVEM0NRWM4TI0A S5V 04R 12:AD VAPPUCATION Occupancy &Fees Checked FOR P1J?W 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) I I 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) vje65fer G./ o o As Owner or Tenant �C-d 4 -mol -4 Owner's Address SGtM1 Is this permit in conjunction with a building permit: Yes [] NNo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 20 0 Amps j / z olts Overhead ® Underground No. of Meters J New Service Ampsw / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work d r�Lts2l Tct 7F t = No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets / „� (� No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total 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 a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER ItmrmceCOMtaws IhmamffutLabtldyhsur =Pbhcyet&&gCrn#&CosaagecrtsakstatWecpavalat YES [EfNO Iha%esubmitiedmWpocfcfswnetolhe0(iioeYES rJ NO M IfjwbawdvccadYES,pfemwdic*thetypecfwmaFbycttedmgt6e INSURANCE (,:2]/ BOND OTHER ® ftese ) rit e /Yg/A/C, ` .0( 0 Z EVialim D tom'° FAim*dvahtecfE7echx9Wolk $ WodcibSUi hq)ecfiwD*RoWcsted Rough Fatal FIRMNtAME° Ptrtah>Escf �r tx L=�L° G7'f �i L 2 9 7. Li=>,see �-n6r-y a 64A 1 �2 Sigrate � LioaseNo 4- 1 Btts�ess Tel. Na Q 7$ - LJ 7 j'- /l 7 Adci.��... `=��1/e %'l7'd"/L �// A1tTel. Na OWNQt'SPZURANCEWANER;I.amawatethatthelkmdoe i etheittsxaloeoo eoritss teg tas>ecg>gedbyNfassad�tr Ga�aalLaws andiatmysagitserniiispmdWpkebmwr'As isregtmmient (Please check one) Owner M Agent ED Telephone No. PERMIT FEE $