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Home My WebLink AboutMiscellaneous - 265 WEBSTER WOODS 4/30/20184 Date....�.�.. .Y......... -: �o. TOWN OF NORTH ANDOVER PERMIT FOR WIRING R This certifies that ......eo .. L:... �..!,�x.1..!!..........�C.c.'�"............... has permission to perform ............ F -b -AL .......................... wiring in the building of ........... .. ►..t ... ...6-i.L.............. at ..... . ��.5 .... W .. .d.. a, 4 ................. . North Andover, Mass. -Fee...'Vr.......... Lic. Noe&..............................................11. ....t.... ELECTRICAL INSPECTOR Check # ' f 67 10 Commonwealth of Massachusetts ' 11�i�i:ii t ,c t ll> Permit ^.u. 6710 Department of Fire Services r' Occupancy and Fee Checked _ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9 0;j Ic;lvt blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK \II '.)ark to Ile I,crfornled in ;RXORIMICe \\itil the \I,11,Sachtretts I]WI-ic,ll Co& ( \IF.C). 5117 (AIR 12.00 1 1'LE: (.ti•F_ PRL% T 1.N INK OR TYPEILL I FOR.1 L I TION) Date:(0 12'4 (p Cite or Town of: Q— Aluda0,,-2. TO the IiavlVc101 Oj fVil-(Is. By this ;lpplication the undersigned gives notice of his ur her intention to perform the electrical work described below. Location (Street & Number) CIS 6A'fJ1— Owner or Tenant �t,N i �� SZ br L,v Telephone No. Ovvner's Address (� f. �r h<�. o , . ,n�.•� .,)S L , 1 Is this permit in conjunction with a building permit? Purpose of Building Existing Service Z c>o Amps IZO/ Z'gC)Volts New Service Amps / Vol Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: is Yes [V No ❑ (Check Appropriate Box) Utility Authorization No, ll Overhead ❑ Undgrd [0� No, of Meters t Overhead ❑ Undgrd ❑ No. of :Meters No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans r No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool above ❑ In- ❑ o. of Emergency Lighting send, rl,d, ;Battery Units No. of Receptacle Outlets No. of Oil Burners it FIRE ALARMS [No.ofZones No. of Switches No. of Gas Burners jNo. of Detection and Initiating Devices No. of RangesNo. of Air Cond. Total No, of Alerting Devices Tons g No. of Waste Disposers Heat Pump Numher Tons KW ',No. of Self -Contained Totals: 1 Detection/, kierting Devices No. of Dishwashers S ace/Area Heating KW Municipal P' g r Local ❑ Other ConnectionEj Heating AppliancesKW Security Systems:* No. of Dryers No. of Devices or Equivalent No. of Water No. of No. of Reuters KW Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total tip Ielecommunications Wiring: No. of Devices or E uivalent OTHER: Il,et�hr::,.Gnr:,rn,':h'rru! /..lrsuetl..,r„srr�ulrr11.:1 rhe!!.../.t�n,r: ;t,_ F,,timated Value of Electrical Work: (bb hen required by municipal policy.) \bark to Start: In:,pections to be requested in accordance with \IEC Rule 10, and upon completion. INSL.RANCE COVERAGE: (- mess waived by the u)vncr. no permit fur the performance of electrical work nw) I'.�AIC unls , fhc liCelU t Provides proofuf liability ineur;ulcc incltldim( "'-'onlplctcd operation” cover» -ie or its 1.I.Ilnfantial :cluiv;llL'Ilt. 11h 1:I1tllr:I'.Ilcd (e'rtitic; tha!':IICh Cc kc e i;, Ill II!1'Ce. ;Intl has c'.hlhltcd 1lrout tlt'lanle to the pct"11111 I .',tllll^ otticc. I IL�t: K OSE: IL'';t R.\�:l'i� 13t f�.l) ❑ ! i l tll•:R ❑ I `ipccily:t iader !/1 1tl1/!J' .rll(i fJt','hlil!!'.1' )I pe! j!„'I', !wt he !Tl f (1I''tlrf�'911 JPl . % %(,I fl/lCt1111fP► J t!'tr�' ;1 '(� !'U '1(l.�_`/P'. t.!C.: ').:--A 15930 ��yyy ��` ,�u.s. T.J. No..LR.2�5-_ .(•i bddreSs: 2( El�DbeyA1 5� I•tuelcl/�jr)x1I_C�� Alt. Tel. CiI�775Lz_3!p(oSl :Sceurity Sy,tcm Contractor IA w;c rcquirsd fix this lurk. if applic.lblc. enter dlc Uccle number here: 0W.NER'S INSURANCE bb,\IVER: I and ;tiv;u'c that the Lir:cn:-ec c/r::.' eta hul"r.• the liability inSLlr;ulce squired by ia)v. Cay my :;ierrlture below. I hcrLhy waive this: requirslrn.nt. I ;un the (,-heck on,,) ❑ r.)vvnvr ❑ uw,lcr':, u,unt. Owner/Accent ) I / g PTRI i f tr '•)F' 1 iril:llUl C a _�11111 t, tlil :: ). T, i TOWN OF NORTH ANDOVER I -or PERMIT FOR GAS INSTALLAT This certifies that ... ....dry!n -�O- +.PA .... ..... has permission for gas installation in the buildings of ................ at � 4, 10S. k,4 P ik North Andover, Mass. Fee —24).7--Lic. No.//.-?/. ... IS INPSWCR�TO Check # '; 1; 516 rN MASSACHUSETTS UNHDRM APPLICATON FOR PERNffr TO DO GAS FnTNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations _ L 4.- IAJeA/ jei- &660 Owner's Name New Renovation Replacement ❑ Date % —/,1— d � �- Permit # J� T Aunt $ Zp .7 Plans Submitted ❑ va'Y aao(e —/ (Print or type) (,pp Name 4,2 p/ Address Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company 11 Corp. Partner. U Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes. 4s No 0 If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity 1:1 Bond 13 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 13 Agent 13 nereoy certtry tnat an or me octans ana mrormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusaktAate Gas Code „and Cjtaptpy142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber /(-7/ q 0 Gas Fitter License um er Master Journeyman � w oW �O a z z O O z F Gw w � x a w w A > F x U' z> F z F w z F F W 0 p > W °o I.W. U .a F QS z a� o w$ w o x W 3 a 0 a W> c a F o SUB -BASEMEN T B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR va'Y aao(e —/ (Print or type) (,pp Name 4,2 p/ Address Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company 11 Corp. Partner. U Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes. 4s No 0 If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy M Other type of indemnity 1:1 Bond 13 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 13 Agent 13 nereoy certtry tnat an or me octans ana mrormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassachusaktAate Gas Code „and Cjtaptpy142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber /(-7/ q 0 Gas Fitter License um er Master Journeyman TOWN OF NORTWANDOVER PERMIT FOR PLUMBING This certifies that ... �2B.. 1i.v-n 6 4 .. A Arv-4..... . has permission to perform . pg4h. <<.!�.G... *. ,t,'.. . //� ff plumbing in the buildings of .K... �?.�t,h.......... . at .. .. .qhs ? 9 !? 444P...... North Andover, Mass. Fee.�U,9. Lic. Noll. -.?i.. ........................ . PLUMBING INSPECTOR Check !i00�' 027 ,Aa MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS &44-�arBuilding Location p� 000 L 1 New 1:1 Renovation Owners Name of Replacement 1 Date 7 Permit # o 1 / Amount Plans Submitted Yes ❑ No ❑ (Print or type) Check one: I '"L - Certificate Installing Company Name / M f .:t I1 C . ❑Corp. Add ess d 1:1 Partner. t tt'e Q Business a ep one _ V laFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ma�fnhusetotatePj imb�nglCode,�ind C[tapter 142 of the General Laws. City/Town APPROVED (OFFICE USE ONLY 1/ Type of Plumbing License tcense NuTnuer Master � Journeyman i' .M -------------- I -MM --. MMM MM MM MM M ' �0 mmmmmm MMM HMM�� ' ....................--..-■ i t' .......M...��.......-.--� !' ..........M.......-...-..■ 5MMMM=MMMMMMMMMMMMMM�� (Print or type) Check one: I '"L - Certificate Installing Company Name / M f .:t I1 C . ❑Corp. Add ess d 1:1 Partner. t tt'e Q Business a ep one _ V laFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Ma�fnhusetotatePj imb�nglCode,�ind C[tapter 142 of the General Laws. City/Town APPROVED (OFFICE USE ONLY 1/ Type of Plumbing License tcense NuTnuer Master � Journeyman Location 121)oiro ,-r-, - tae bs49 X%ad 1�N. No. 3 Date 2 b- 0 a /0,I,',-,, f OTq TOWN OF NORTH ANDOVER _ ,. R Check # H91,31 16029 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL �A.- Building Inspector kA as ill i ri m_ c� c i O. t @ L FI7 � S.E; CUMMINGS J ASSOCIATES P.O. 80X 1337 PLATS; `OW; AM. 08865 ' MIEPNl?W (8881 8 5 85 FAX 4101)482-5218 3q 4 } I I %F.I m 1F.3Qd S. F (4o us. +1 a 5 # 238.5• �� k X547. 4k tV'N A• `¢t — TAX MAP 109—A L 0 T 1T—A CAMPBELL FOREST NORTH ANDOVER, MA. Pfl" PAREO FOR. BAY CJ�StO+r,1 HUIslT j P 0. SOX 1008 MDOLEIGN, MA. 01949 OA 7'E.- NOVEMnER 14, 2002 SCALE 1" = 80' / ll£R£SY CERT/FY TO TOWV OF NORTH ANDOVER, MA BUILDING DEPARTMENT THA T THE EXIS7i'ivG FOUNDA TION DRAWN 01i THIS PLAN IS L OCA TED AS SHOWN ANO THA T l T DOES COmpi Y TO THE I VIMUM BUILDING SETSACAS TO P OPER TY LINES. MINIMUM SETBACKS. FRONT -- JO FEET SIDE — JO r c ET REAR — 3O FEET Of Mas �c ALBERTT. Gam, TRUDEL No. 36P69 �1 Date.. �� ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. ............ '` .7�?.... ........... . has permission for gas installation . ............ . in the buildings of ......................... at �z7p�47 . /AZ -.e. c .. , North Andover, Mass. Fee./6 ..... Lic. No.! ? Ir .� ... ..... .......... AS INS Check # 4271 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING .. (Print or Type) 00, 41, 4i' Mass. Date G •�,4�—/Permit # d ` Building Location Z S �.r/�%Z�"ti &J.�wner's Name Type of Occupancy �r'1 G New D' Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ Installing Company;F21 ESC MBUrFIRW NV& Check one: Certificate Address ❑ Corporation ❑ Partnership Business Telephone 0.3 %� d�33a ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter < <' INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy, Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are tro and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicatio will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genes. By tGasfitter License: mber nature o Licen um er or s atter Title ster License Number City/Town urneyman APPAO'vE ONO E ma IN 4TK FLOOR M0 7Tk FLOOR -0 MEMO Installing Company;F21 ESC MBUrFIRW NV& Check one: Certificate Address ❑ Corporation ❑ Partnership Business Telephone 0.3 %� d�33a ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter < <' INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy, Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are tro and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicatio will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genes. By tGasfitter License: mber nature o Licen um er or s atter Title ster License Number City/Town urneyman APPAO'vE NORTq f 9 ,SSACMUS� This certifies that Date../, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform .. _, . y ................... . •plumbing in the buildings of .. ............... at . G-�f�- .......... , North Andover, Mass. Fee?��. PLUMBING IAI�PECTOH Check # �- 5487 { MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print a Type) Mass. Date Z' Permit # Building Location Owner's Name New ❑ Renovation ❑ Type of Occupancy %? � Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name 27 ESCUMBUIT ROAD Address Check one: O Corporation ❑ Partnership Certificate Business Telephone e G3 6y.3 YJ3 2 ❑ Flrm/Co. 41 Name of LJcensed Plumber ,t I INSURANCE COVERAGE: I I have a current I rty Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ if you have checked yo. please Indicate the type coverage by checking the appropriate box. A liaburty insurance pollcy z Other type of Indemnfty ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the ilcenseo does____ not havt the Insurance coverage requlrcd by Chapter 142 of the Mass. General Laws, and that my signature on this permft appliheck ocation nwaives this requirement. Owner ❑ Agent ❑ S gnature of Ownor or owner s nm I horeby certify that all of the details and information I have wbmillad (or entered) in above application are Uue and accurate to the best of my knowledge and that all plumbing work and installations performed under the per t issued for this applicaUon will W in compliance with all Pertinent provisions of the ►dassachusetts Stale Plumbing Code VAdthaptet 1 2 1 e Gonial Laws. By— gnatu o cen um r Title Type of t3cense: µasler� Journeyman ❑ City/Town /�� 6 L Ucense Number v, IN MEN NEI mum IN am 0 MMMMI1MMM1 El F3, ON MENOMONEE on NOME IN IMMMMMmMM vii Installing Company Name 27 ESCUMBUIT ROAD Address Check one: O Corporation ❑ Partnership Certificate Business Telephone e G3 6y.3 YJ3 2 ❑ Flrm/Co. 41 Name of LJcensed Plumber ,t I INSURANCE COVERAGE: I I have a current I rty Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ if you have checked yo. please Indicate the type coverage by checking the appropriate box. A liaburty insurance pollcy z Other type of Indemnfty ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the ilcenseo does____ not havt the Insurance coverage requlrcd by Chapter 142 of the Mass. General Laws, and that my signature on this permft appliheck ocation nwaives this requirement. Owner ❑ Agent ❑ S gnature of Ownor or owner s nm I horeby certify that all of the details and information I have wbmillad (or entered) in above application are Uue and accurate to the best of my knowledge and that all plumbing work and installations performed under the per t issued for this applicaUon will W in compliance with all Pertinent provisions of the ►dassachusetts Stale Plumbing Code VAdthaptet 1 2 1 e Gonial Laws. By— gnatu o cen um r Title Type of t3cense: µasler� Journeyman ❑ City/Town /�� 6 L Ucense Number �� S. t � i. - � �... ..... �.. Mme... __ �"�' _ __�_._._._ -��.' �" __ r�� __. .0 /- 1� !�' - 013 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING =this certifies that ...... ........ 20 has permission to perfo.... '—/ ........................... : ............................................ ........ wiring in the building of ..... ............................................................................. at North Andover, Mass. Fee ....... Lic. ... ............................................ ..... ELECTRICAL INSPECTOR Check # 43 i%j 7 THE C0AW0NWE4L7H DF MASSACHUSETTS DEPARTA1EW 0FPUXJCS4FL7Y BOARD OFFVEPREVEMONREGUTA770NS5270212.00 Office Use only y�� r Permit No. ' Occupancy & Fees Checked 13 f. APPLICATTONFOR 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 a �% Town of North Andover To the Inspecto of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) ,e-6'5 a )C. Ds'l egf, lk) (Y'A- h 0 Owner or Tenant 1 J cu t Se. STja R l k P. Owner's Address Is this permit in conjunction with a building permit: Yes �No (Check Appropriate Box) . Purpose of Building c I (; Utility Authorization No. 12 75,q3 Existing Service Amps / Volts Overhead M Underground No. of Meters t I V =r� New Service -Z-Ck:�) _ Amps I z a / Z k OVolts Overhead r7 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IJ e, tx -� Cox.) STrz is c Tr n k ) CO I to W l d 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 Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges I No. of Air Cond. Total FIRE ALARMS No. of Zones ,.......� Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices'�"�"' No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal Other I Q Connections. No. Vater Heaters KW No: of No. of Signs Bailasis No. Hydro Massage Tubs 1 No. of Motors Total HP' OTHER- hlsinatloq,Comagt~ RusUMIIDdieia4MMY ltsoflVf sC*rfalLavus Iba,&aqmtLnbkykn==Pbky=ixkgcmrl*2#6mCome orgsabg3tdeguvalent YFB NO O Ihavasub Ti&dvaldproofofsametotheOffice, YES r -'T ff}ouhamdreclodYES,plemirr&atedletypeofm by L ---J � IC�S[IRAlVCE BOI`ID- OrII-1FR �9ea9eSpeafy) Esti i*dvalueofEbchicalWolir $ WolktaSrart htspectionD&Ret d Rough Is" Signed undff Pp�T ofpaW FMMNAME ( T LicenseNo R 3 Ucffwe d i>C. �T� 1 Signature 15 6 BtMr%Te1N0- Address I 6 -Db I .1 C � � ON ��T I` A % dd 1G 10-1 2- AIL Tel. 1, LU E) 7:56 3 6d,J� DWNIIZ'SINSURANCEWANE;;IamawarethattheLicemdoesnothavetheir>surm=oovwageoritsatl MWegwvalalasrequiredbyMassachusettsGaraalLaws urd thatmysig i&neon itvspamitapphcaftm waives this mquimfnt Please check one Owner O Agent Telephone No. PERMIT FEE $ rgna ure ot Uwn—e-r-5r-A`ge77 Location 6Uekler ""40j 1'41` No. 395;1 Date a'I' L °3 Check # T S a TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL 16158 LIRA I C --- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 3 DATE ISSUED: SIGNATURE: ca -"- Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Q ("5- bi.aj5 4 1.2 Assessors Map and Parcel Number: 16-)61'3 g�, Map Number Parcel Number No FA04d 191;:� ` 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 00/715e SZG�i C J Gc�C�t7 �r �O lr%f/1�' Name (Print) Address for Service A 6 / Signature Telephone 2.2 Owner of Record: Name Print Address fo Service: Signature Tel hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: /-)� /), % M� Addr l �j // l Sig-na-Ture Telephone Not Applicable ❑ X CS - 070(2Z License Number 51 aC, Expiration Date 3.2 Registered Home `Improvement Contractor Company Na Z / / 4 Address Not Applicable ❑ Registratio Number Expiration Date Signature Tele hone OU M X Z O 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 ...... o ....... ❑ SECTION 5 Desch tion of Proposed Work check all cable New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description ofProposed Work: I i � / 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant QIC(A)%,'TSE=Q1,y 1. Building (a) Building Permit Fee Multiplier 2 Electrical /OO d (b) Estimated Total Cost of Construction 3 Plumbing /00 Q Building Permit fee (a) X (b) �- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 w Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Om -se S�" le . as Owner/Authorized Agent of subject property Hereby authorize 03(no� / / i? e C to act on May behalf, in all matters relative to work authorized by its building permit application. l� 3 !� Y' C6 O Signature of Owner Date SECTION 7b OWNEI�P%JAUTHORIZED AGENT DECLARATION I, T C ��"� Q, C C, as Owner/Authorized Agent of subject property Hereby declare that the statements oyd information on the foregoing application are true and accurate, to the best of my knowledge and belief `3T n-tMvron. (o C[01 Print e /C' �a _3 Si ature of Owner/A ent Date z, .. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I[EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a Cf) M DO Cf) 0 CO) .O CD 0 Z CD O ar d n� .o 0 CD o v CL Q CD O CO) 'v CD O CA 'v d d O CA 0 y C) CD 0 .rt CD CD Cif CD CO) 0 CCD 0 CD C C 7� 0 w D nOCO � y OS®0 m C) C2 nm.�C C-) m z O y� =-c N .0-► = -1.0 CL O T . =r CDCD C. CA C H --1 o i m o m a > >r O � CC* � o �« 0 n0 eye �o� ►� C N A CL -+w co =?: 0 co Cn o In Cl)= cc n�y m CCD aCA O y Q OL =r: :`Q C/) EL H C :�►y f0• VCA y ? :� �.i. `03 CCD A all F CD 0 O ..« o h_ CD cn Z CA y CDr s cn aH m o�a _ C dr y; o O 0 0=3 0 9 0 c r a z r 7� RL x C) x a td r z 0=3 0 9 0 c TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUTED: ` �ct�nr��sla.a �. C'oti�ll�nt:.JCn` SIGNATURE: t1AiUSOle Y, L� ' Ri iltling Com missioner/Inmector of Buildings Date SECTION 1= SITE INFORMATION 1.1 Property Address: I ft7 1.2 Assessors Map and Parcel Number: _ Map Number Parcel Number 1.3 Zoning Information: ` 1.,4r� Property Dimensions: C 1 ZoningDistrict Pro os JJ Lot Area sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rered Provided 3c� 7S6 3 aSn 70 4 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Water Simply .G.L.C.40. 54) Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 Public Private p SECTION 2 - PROPERTY OWNERSHW/AUTH(ORIZED AGENT 2.1 Owner of Record -hEo L R 0 L) Na rint) Address for Service y { Signature Telephone 2.2 Owner of Reco d: Name Print Ad ess for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: (* :s C-)76 v n� License Numbet C e.Uort.�t� Address � (J`c- �� Expiration Date C� i Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Na Registration mber Address j / Expiration Date Si nature Telephone T M z O Z M 90 ic G) SECTION 4 - WORKERS COMPENSATION (M -C.1. r t5-) R 'm,f4l Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. with this application. Failure to provide this affidavit will result Si ned affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Constructio Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: (Gf;r�ia1 f f �� %� �i ;.? Vc 3�gr' 677 6r1Z'e ' ; CO C kmlmce C, RctU�S l✓c t 1) SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be— ei077!—! CIL g": USE ONLY a>�,Com ' 4�I Completed leted b ermit a licant . Building00 2 Electrical st of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r h k E�i 1 S as Owner/Authorized Agent of subject property Hereby authorize rh �� E �� to act on My ba in all matters rel t authorize by this building pennit application. &3 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, g i -e r, 4 M �Y�v► It. aster/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 andbelief Print �1 1C' Si ature of Owner/Agent _ Date NO. OF STORIES SIZE . BASEMENT OR SLAB : SIZE OF FLOOR TMERS 1 2N') �� 3 SPAN t DIMENSIONS OF SILLS DIN ENSIONS OF POSTS ;-i "t r DIlNIENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING !`✓) ,l X r MATERIAL OF CHI v NEY IS BUU-DING ON SOLD OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 4 v V) O z xxP4a E� x O Fw V IX1 w° � cid 0 a C7 �1 M o b c° .G ° (j 0 U W � .+r � O W a �+r U Ed z 'L _ co W w cn 4! U) WN a� 0 CD z O D CIO y .CD L CLc O V cc ran L cov CL CO) C O H = ev � 0 O O d d Q� Q C r=•+ C ev cqo OO zQ Q. CO) C r-7 c� 0 m C C ci .oma C O OL) O O Now C C O � m Ec 1 • L � �5 cCb o dftlb. v� v .�? E M0-641 a C •�� N �� N O N C O C N O O N A O E.a� ebmu m D y m 11p `G0 v®5 cm Cs. N � co V .y OA >z o CMC Q r C A i m C Ams=.+ p o0 N !- o ®'O, s� o COD O t m s 2 J=MD C .� s.. .. cc 0 oc E cm o 0.2 ® p ®� C COD CL 4D.0 o 'fl w m ` 'y � cx WN a� 0 CD z O D CIO y .CD L CLc O V cc ran L cov CL CO) C O H = ev � 0 O O d d Q� Q C r=•+ C ev cqo OO zQ Q. CO) C r-7 t ✓ 1W VO�II'i/IyL0021.I/P,Q'GUL. O�i,�I�U.[O�p�2t10('.Uo- � BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR: Number: CS= 07061% Birthdate: ,05/26/1967 Expires: 05!26/2003 Tr. no 2640' Restricted: 00 BRENT L MCKENELLEY:_ r- .I '10 CAMPBELL RD MIDDLETON, 'MA 01949` Administrator " The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: �" � kf (.UsctJ[ , ICA/1ne City tl o[kk 1Tn(JI0Jt-C Ihex Phone # 0 I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity Eg""I am an employer providing workers' compensation for my employees working on this job. Company name BASA Lu S`li?tn an -a Address z; (3-eUOA5ki✓e- City X n,\A e' 4 jn t h r.. d L a. LI C' Phone* oI 6,61o' Insurance. Co. 6efi2tca a f i�Sc vc�nCL Policy # -L-1�1 R �°I U 6 D ComRgny name: i Address City Phone #: Insurance Co. _ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_wetLas_civil.penaltiesln.iheinrmd-a_STOP WORK.ORDER.md..a.fine._cf_(.$1D.0-00)-asiay againsime. 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 pains fqd penalties of pedwy that the information provided above is true and correct. Print Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina Building Dept Check if immediate response is required 0 Licensing Board E] Selectman's Office Contact person: Phone #.• Ej Health Department 0 Other f� I O � U O I MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I Permit # MAScheck Software Version 2.01 Release 3 I I Checked by/Date TITLE: PLAN NO.34221 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 9-13-2002 DATE OF PLANS: 9-13-02 PROJECT INFORMATION: COLONIAL HOUSE COMPANY INFORMATION: BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 COMPLIANCE: Passes Maximum UA = 1187 Your Home = 1172 I I I I I I Area or Cavity Cont. Glazi,rig/Door Perimeter R -Value R -Value U-V<�lue UA ------------------------------------------------------------------ ------------ CEILINGS 2512 33.0 33.0 40 WALLS: Wood Frame, 16" O.C. 3226 19.0 19.0 110 BSMT: Conc. 8.0' ht/7.0' bg/8.0' insul 1552 19.0 19.0 R. 37 GLAZING: Windows or Doors 2879 0.330 950 DOORS 105 0.330 35 HVAC EQUIPMENT: Furnace, 98.5 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 selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date 1 � !/ TITLE: PLAN NO.34221 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 9-13-2002 I Bldg.I Dept. I t . XS Use I I CEILINGS: [ ] I 1. R-33 + R-33 Comments/Location I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-19 + R-19 Comments/Location BASEMENT WALLS: [ ] I 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 cavity +.R-0 continuous Comments/Location I WINDOWS AND GLASS DOORS: ( ] I 1. U -value: 0.33 For windows without labeled U -values, describe features: i # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location I I DOORS: [ ] I 1. U -value: 0.33 Comments/Location I I HVAC EQUIPMENT: ( ] i 1. Furnace, 98.5 AFUE or higher Make and Model Number I ' AIR LEAKAGE: [ ] I 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 I shall meet one of the following requirements: I 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 I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be ., provided. Insulation R-values'glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed 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 I air and water systems. 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 HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I HVAC PIPING INSULATION: ( ] I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: 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 CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1:' I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 I 100-130 I 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only) ------------------------- I Location �� I I o� �.S �i�b%�� (NOc�� /,. No. 3 9 �;L Date 1-31-0 �Z- NORTH TOWN OF NORTH ANDOVER � OL Certificate of Occupancy $ S 0 -u'ding/Frame Permit Fee $ ACW Foundation Permit Fee $ % Other Permit Fee $ TOTAL $� Check # /c/is-0 15294 l,lr lc(�� Building Inspector I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT PPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING TIEfIS�titl8.lf'AC>� lA QIiY BUILDING PERMIT NUMBER. )c� DATE ISSUED: SIGNATURE: uurituu �ommISSIoner/In Ctor of Bt SECTION I- SITE INFORMATION e1.1 Property Address. / O T / % �/.�6�,�� 0165-- jy ebsf�r t� s L Date 1.2 Assessors Map and Parcel Number: 60 1068 Map Number Parcel Number 1.3 Zoning Information: •��-- � � 1.4 Property Dimensions: Zonis Proposed District� c >`"i aCy )J, 0 Y; 66Z>/ �Ise �— �Lot Area s 1.6 BUILDING SETBACKS ft Frontage ft Front Yard Side Yard Required ProvideRear Yard � � � 7 R fired Provided Re ttired 30 Provided t� ` "Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:2 3 V Public Private 0 Zone1.8 Sewerage Disposal System: Outside Flood Zone ❑ Municipal On SECTION 2 - PROPERTY OWNERSnw/AUTHORIZED AGENT Site Disposal system ❑ 2.1 Owner of Record r�sT= Lmenntj Signature � 6 Telephone 2.2 Owner of Record: Name Print SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: rcass: Licensed Constrpction Supervisor: Address for Service: Address for Service: /LtD--cam j35 5thc�t� Address �� 7 -- 6�3oo Signature Telephone 3.2 Registered Home Improvement Contractor Company Name Not Applicable ❑ License Number /0 L Expiration Date Not Applicable ❑ Registration Number Address Si nature Tele hone Expiration Date 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 a licable New Construction 0 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ { Other ❑ Specify Brief Description of Proposed Work: 3 C �a-,-awe tl��er /& X� i ,Lco rco•�,. /6 x5v� r®o�_ (a) Building Permit Fee Multiplier SPAN / 2 Electrical DRv ENSIONS OF SILLS .2 - (b) Estimated Total Cost of Construction - // x /'Z Fri r► Pyr f a., C /.;7-x rid W00.1 aC&C'k;' 2�&qla SF.CTTON 6 - 10.STTMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pen -nit applicant OFFICIAL USE ONLY .... _.... .... 1. Building 6 Q U (a) Building Permit Fee Multiplier SPAN / 2 Electrical DRv ENSIONS OF SILLS .2 - (b) Estimated Total Cost of Construction - C� c!l, /Do� 3 Plumbing DIMENSIONS OF GIRDERS Building Permit fee (a) x (b) HEIGHT OF FOUNDATION 4 Mechanical HVAC SIZE OF FOOTING 5 Fire Potection MATERIAL OF CHIMNEY 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 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. Signatuie df Owner Date SECTION 7b OWNE'R//AAUTHORIZED AGENT DECLARATION as Cir/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 J l� Print Na k N Signature of Owner/Age Date NO. OF STORIES SIZE 11;2 X S ` BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS lsr " i 2 / s- 3 SPAN / DRv ENSIONS OF SILLS .2 - DIMENSIONS OF POSTS 4, DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS /v ' SIZE OF FOOTING /0 MATERIAL OF CHIMNEY d IS BUILDING ON SOLID OR FILLED LAND 2 , IS BUILDING CONNECTED TO NATURAL GAS LINE v e s FORM U - LOT RELEASE FORM ,ems( 4 gym P,-- I- I—Z-- VL INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS si*t-e# 6-6-7- 676 U APPLICANTS PHONE (,,,Y7 -6__7o0 LOCATION: Assessor's Map Number fab PARCEL SUBDIVISION 009 / LOT (S) _ / STREET ST. NUMBER **********************OFF 1 C 1A L U S += O N LY**************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED _ DATE REJECTED_ Io, DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEW Y PERMIT c FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm DATE " L - Growth Management Bylaw Exemption Statement Town of North Andover Building Department T'nis form shall be used to assist the Building Department in their determination of exemptions under section 8,7.6 of the Town o0orth Andover Growth Management Bylaw. The building applicznt shall provide all of the necessar/ information as requested 'below. Name of Applicant on cuilding Permit (below) Address of Property fcr Permit (below) j �l�'1u4AE% IIic �l ��G �L1 �� y a 1�`��ki%S L%7 Map and Parcel : � Purpose of Application (check below) Phone Number of Ap licant Single Family Two Family 1 the undersigned applicant for the above property attest that the attached building pe.^it for which this form is completed does comply with the E<EMP-n0N section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me Cr anv party to this permit from the requirements of obtaining other permits required prior to the issuance of the 1uiiding Permit. Further I understand that my interpretation of the E<ENIPTiON status is subiect to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above mat and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lots) werelwas created prior to May 6, 1996 are exempt from the provisions of 'his Secicn 9.7 of the Zoning Ty—law. This application is for dwelling units for low andlor moderate income families or individuals, where all of the conditions of 8.7.6.c, are met and/or represents Owelling units for senior residents, where eccupanc/ 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. �I This application is a part of a development prciec, which voluntarily agreed to a minimum 40% 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 acres and permanently designated as open spaco and/or farmland. The land to be preserved shall be protected from deve!epment by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Tewn, 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 parol 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 dwelling unit an the parcal. This application represents a mat 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 Oevelopment Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Oevelopment until such time as the Oevelopment Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to ccuracy of the information provided and that the attached building permit is allowed an EXEMPTION- cited ave. Further I understand that the submittal of misleading and or inaccurate information,7r the checki g off of an above item which does not comply, whether done to my knowledge Wat, is gyaunds for re' al by the Building Department to issue a Building Permit. I / iture of Owner ad A on d A e no signed the Attac, ed Budding Permit Oate farm must be a ched to the Building Permit upon application far such permit. P The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # ❑ 1 am a homeowner performing all work myself. F7I am a sole proprietor and have no one working in any capacity (�j I am an employer providing workers' compensations for my employe/es working /mon/®this jjob. , L� r-mmnaflV I'1aTP' Address /00'j?c�a�D City: /V O� 4-aley fz: A7 Phone # �% � G �5 7 s 3c�c� Insurance Co. 5 f r �YI.S�� r --I-"C e- 6 el . Policv # tV G' O / S (� Comoanv name: Address Citi: 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' imprisonment as well as ' nalties in the form of a STOP WORK ORDER and a fine cf ($100.00) a day against me. I understand that a copy of this statement ay be fo rded to the Office of Investigations of the DIA for coverage verification. I do hereby certify and the ins and ! nalti s of pe ry that the information provided above is true and ccrrect. Signature e Date Z 7 Print name Phone # 5-3--7. 7 7( O Official use only do not write in this area to be completed by city or tcwn cfr"icial City or Town Permit/Licensina 0 Building Dept ❑Check if immediate response is required C] licensing Board C] Selectman's Office Contact perscn.• Phone 9: Health Department Other 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: U,2, g-f-,er //0 /*/1, Location of Facility Sijua e kPeiniit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and dated Der-, 19 �9__ and/or by the Covenant dated Mow aq , 19 J9,_ and recorded in District Deeds, Book 48g0 Page lag or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book , Page has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Pian entitled el or2S affl_ "iy fSybil► itSJj PIAN Section (s) , Sheets 1 - 7 Plan dated DecernhPr�, 19 '71 _ recorded by the E�X NortR District registry of Deeds, Plan Book or registered in said Land Registry District, Plan Book Plan / a7 8 tt , and said lots are hereby released from the restriction as to sale and building specified thereon. L-4 Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) LorS ZC,zSf Z-1 L 0 TS 17 W a-- / 3 ; Lo-rS IS �iGv Z 3 I hereby certify that lot number (s) Go T -,r. Zg 7W -,j 31_� 84 on C.aOo�►C,�,,,,�L10wNp. ZNUV!' Streets) do conform to layout as shown on Definitive Plan entitled tSection Sheet (s) " of MAssq � cti G ALBERT T. TRUOEL Z R gistered Land Surveyor No. 36869 0 �FGIST,�`�° e,�a �AC LANA SJ 1 of 2 C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated , 19 and/or Covenant dated 19 from the Of the (-4+-'t T i y/ own of _ County, Massachusetts District Deeds, Book_ or registered in Land Registry District and noted on Certific t a a Registration Book, Page satisfaction of the terms thereof and hereby right, title and interest in the lots designate as follows: Page s e of T1tle No. recorded with Document No. in acknowledges releases its d on said pian EXECUTED as a sealed instrument this day of 19 ESSeX ss Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS Dei.e ,-A LC'L- , 19 9 5 Then personally appeared ��1��,�� ; d one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary Pkiblic My Commissi n Expires 2 of 2 1105 APPLICATION FOR WATER SERVICE CONNECTION 2� North Andover, Mass. 11"' Application by the undersigned is hereby made to connect with the town water main in i ` Stfeet; subject to the rules and regulations of the Division of Publliicc Works. The premises are known as No. Z- 6 �` ��'►/ Street � 7,�e53iOQ or sub 'vision lot %no. l Owner Address Contractor Address cant's Signatu PERMIT TO CONNECT WITH WATER M N f The Board of Public Works hereby grants permission to /�"/3��7i �% ,� ey _ e to make a connection with the water main at VVC-< subject to the rules and regulations of the Division of Public Works. Inspected by Date Street �—�- Board o`Public Works Byf V See back for rules and regulations 1 729 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 1 EJB Application by the undersigned is hereby made to connect with the town sewer main in e,", - I subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street or subdivision lot no. 1 - XZe4rVti'.,.. >eV �af n ^ r1G,/ &Izr Owner Address13, Contractor Address icant's Signatu PERMIT TO CONNECT WITH SE ER AIN lr The Division of Public Works hereby grants permission to �� r to make a connection with the sewer main at (Ve-, �7-, subject to the rules and regulations of the Division of Public Works.. Inspected by Date ivisioof Public Works By See back for rules and regulations J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 No L�--o ' p 41-11 DRIVEWAY PERMIT Telephone (978) 685-0950 Fax(978)68"573 k DATE 1 U 20 LOCATION 26 cj BUILDER phone c. OWNER phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE -NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY, FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. MMF1JcnecK CUMYLIANCE REPURT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-28-2001 DATE OF PLANS: July 6, 2001 TITLE: Lot 17 "The Hampton" Permit # Checked by/Date PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 100 Andover Bypass Suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 596 Your Home = 594 Area or Cavity Cont. Glazing/Door ------------------------------------------------------------------------------- Perimeter R -Value R -Value U -Value UA CEILINGS 1877 30.0 0.0 66 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1720 19.0 0.0 82 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 appli Ie--.S.tandard Design Conditions found in the Code. The HVAC equipmen selected to at or cool the building shall be no greater thanf 5% f the design /oad as specified in Sections 780CMR 1310,egh 4.4 Builder/Designer Date ! r7 D MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 17 "The Hampton" DATE: 12-28-2001 Bldg.I Dept.1 Use I I CEILINGS: [ ) 1 1. R-30 I Comments/Location I I WALLS: [ ] 1 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] 1 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] I Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I 1 FLOORS: [ ) I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] 1 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ l I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can No 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: [ J I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ J 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 I 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 I air and water systems. I I TEMPERATURE CONTROLS: [ J 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: [ J 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 [ J 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 [ J 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.) { HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" { Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I 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 [ J i CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 1 100-130 0.5 1 0.5 0.5 1.0 ---NOTES TO FIELD (Building Department Use Only)------------------------- '� = - ✓fie �anvnzovuueaflfi o�✓Giagaac�eCiaT ' . I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069234 (1 _3 i Birthdate: 05/09/1954 Expires: 05/09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL _ 400 MAIN STS GROVELAND, MA 01834 Administrator "TER, DECK `LOT 17/ 105,WS.F. y CBA 94,430 S.F. X-X,7x- X-X-X-X-X- 4c. BAR REFER TO ORIGNAL APPROVED PLAN FOR DETAILS OF WETLAND CROSSNO SETBACK LWE/WSo6' 47PIE k o 71.03 d) SZ ,goo s 2i N -33 * ol ! � I �` � , � i �i ;,' t. ! _ _ _ � �' 1 A-43? AA -31 AA -3 5 -GREEN ASH 2+-48 K ST= PLANTING 51 B .45 N07 50 2,;.j PROlk 20:b -LF, --Mw ALMtArFM— ASH'2 -JANTM I"W. M* L.F. t kep NmRr, . -AND SiME-TID-MA" CA. OA 0 r OF C'I IV \ Hpumb CRIL ILIM 9-M OA� 24C-48n1 ST= tO Fr I CINTM - t 1*0 GRAPHIC SCALE -0. EL- M `` � 0 \24-4W 10 ON�} , ' , ik CIA Building Value Calculation - for Property at..... lot 17 IN Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 24.5 15 367.50 - 65 $ 23,887.50 Brkfstnook 10 4 40.00 65 $ 2,600.00 Dining Room 15 13 195.00 65 $ 12,675.00 Family Room 16 20 320.00 65 $ 20,800.00 study/office 13 15 195.00 65 $ 12,675.00 Living room 14 13 182.00 65 $ 11,830.00 Garage 26 31.5 819.00 65 $ 53,235.00 Entry 19 13 247.00 65 $ 16,055.00 2nd floor foyer/sitting 19 13 247.00 65 $ 16,055.00 Sunroom 16 12 192.00 65 $ 12,480.00 mudroom 9 7 63.00 65 $ 4,095.00 Walkin closet 15 8.5 127.50 65 $ 8,287.50 Basement Finished - 65 $ - Balcony - 65 $ - Screened Porch - 35 $ - laundry 15 7 105.00 65 $ 6,825.00 Bedroom 1 20 16 320.00 65 $ 20,800.00 Bedroom 2 13 17 221.00 65 $ 14,365.00 Bedroom 3 17 13 221.00 65 $ 14,365.00 Bedroom 4 15.5 15 232.50 65 $ 15,112.50 Lav / Bar - 65 $ - Bathroom 15 10 150.00 65 $ 9,750.00 1/2 Bath 8 9 72.00 65 $ 4,680.00 Bathroom 2 8 15 120.00 65 $ 7,800.00 Bathroom 6 7 42.00 65 $ 2,730.00 Deck 10 $ - BalconY 65 $ .,1�' z tnm o ° ai0 5 n CL 0 z �° o ai _, ° �O d 5 rn Dm C -0 S .� ^N 0 0 a H '� `rVI , a �, = 9 3, o P, co C 0 o `" 0 m -, 0 p � � y -. po 000 0CD O M_ _, c M x -•� > > `° _a co Q r: p� 0 _s . � <' < CL D0 H CDo m T'0 ;� C C mac' c c Ln .. _ ai O v � rti n O p � C „n C 0 > > b -I 0 C —{UI• Z OWN ? ^ v ��= N CD d D D off+` 0 -,o:3aj a tD CD 0 rr E ZZ % a� 3 d. 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