HomeMy WebLinkAboutMiscellaneous - 27 HEPATICA DRIVE 4/30/2018'NA14
gd4ff Faftov
45 Hepatica Drive
North Andover, MA01 845
5 Stairs Plus
Confinned
Uniform Energy Rating System Energy Efficient
1 Star 1 1 Star Plus 1 2 Stars lars Plus 3 Stars 3 Stars Plus [4 Stars 4 Stars Plus
:[t 1-10-101 100-91 90-W 85-71 1 70 or Les
HERS Index: 60
General Information
ConditionedArea: 2475 sq. ft HouseType: Single-family detached
Conditioned Volume: 20576 cubic ft. Foundation: Unconditioned basement
Bedrooms: 3
Mechanical Systems Features
Heating: Fuel -fired air distribution, Propane, 95.8 AFUE.
Cooling: Air conditioner, Electric, 14.0 SEER.
Water Heating: Conventional, Propane, 0.67 EF, 50.0 Gal.
Duct Leakage to Outside: 144.00 CFM25.
Ventilation System: Exhaust Only: 55 dm, 6.0 watts.
Programmable Thermostat: Heating: Yes Cooling: Yes
Building Shell Features
Ceiling Flat: R-46 Slab: None
Sealed Attic: NA Exposed Floor. R-30, R-27
Vaulted Ceiling: NA WindowType: U:0.30, SHGC:0.29
Above Grade Walls: R-24, R-21 Infiltration Rate: Htg: 1352 CIg: 1352 CFM50
Fou - ndatio - n Walls: R-0.0- Method: -Blower door test
Lights and Appliance Features
Percent Interior Lighting: 100.00 Range/Oven Fuel: Propane
Percent Garage Lighting: 100.00 Clothes Dryer Fuel: Electric
Refrigerator (kWh/yr): 562.00 Clothes Dryer EF: 3.01
Dishwasher Energy Factor: 0.00 Ceiling Fan (cfm/Watt): 0.00
The Home Energy Rating Standard Disclosure for this home is available from the rating provider.
REM/Rate - Residential Energy Analysis and Rating Software vi 4.3
This information does not constitute any warranty af energy cost or savings.
0 1985-2013 Architectural Energy Corporation, Boulder, Colorado.
/'� g�
6121
"7;7
Registry ID: 314690690
RatingNumber: ABA4922-2-1
Certified Energy Rater: MichaelA.Browne
Rating Date: 9-6-13
Rating Ordered For: Key Lime, Inc- Ben Osgood
Estimated Annual Energy Cost
Confirmed
Use MMBtu Cost Percent
Heating 64.3 $2124 53%
Cooling 2.8 $143 4%
HotWater 18.3 $600 15%
Lights/Appliances 22.8 $1126 28%
Photovoltaics -0.0 $_0 -0%
Service Charges $0 0%
Total 108.1 $3993 100%
This home meets or exceeds the minimum
criteria for all of the following:
2009 International Energy Conservation Code
2009 IECC Air Sealing Mandatory Req. lnfil.< 7ACH50*
2009 IECC Duct Leakage Mandatory Req.*
MA Base Code HERS Rating Performance Req.*
MA Stretch Code HERS Rating Performance Req.*
Compliance with criteria for this program is
determined by the rater.
Advanced Building Analysis, LLC
2 Woodlawn St
Amesbury, MA 01913
www.advancedbuildinganalysis.com
Vj
,gy Rater
2009 IECC Certificate
45 Hepatica Drive, North Andover, MA01 845
Building Envelope Insulation
Ceiling Flat:
R-46
Vaulted Ceiling:
NA
Above Grade Walls:
R-24, R-21
Foundation Walls:
R-0.0
Exposed Floor:
R-30, R-27
Slab:
None
Infiltration:
Htg: 1352 Clg: 1352 CFM50
Duct:
R-6.0
Duct Leakage to Outside:
144.00 CFM @ 25 Pascals
Window Data
U -Factor SHGC
Window:
0.300 0.290
Mechanical Equipment
HEAT: Fuel -fired air distribution, Propane, 95.8AFUE.
COOL: Air conditioner, Electric, 14.0 SEER.
DHW: Conventional, Propane, 0.67 EF, 50.0 Gal.
Builder or Design Professional
Signature
REAVRate - Residential Energy Analysis and Rating Software 04.3
RESNET HOME ENERGY RATING
Standard Disclosure
For home located at: 45 Hepatica Drive
City And ver State: MA
1. 7The Raoter or the Ra�teesemployer is —receiving a fee �forproviding the rating on this home.
2. 0 In addition to the rating, the Rater or Rater's employer has also provided the following consulting services for this
home:
ElA. Mechanical system design
B. Moisture control or indoor air quality consulting
C. Performance testing and/or commissioning other than required for the rating itself
D. Training for sales or construction personnel
11 E. Other (specify below)
3. [_] The Rater or Rater's employer is:
L1A. The seller of this home or their agent
B. The mortgagor for some portion of the financed payments on this home
C. An employee, contractor or consultant of the electric and/or natural gas utility serving this home
4. [_] The Rater or Rater's employer is a supplier or installer of products, which may include:
HVAC systems
Thermal insulation systems
Air sealing of envelope or duct systems
Windows or window shading systems
Energy efficient appliances
Construction (builder, developer, construction
contractor, etc.)
Other (specify below):
Installed in this home by:
Rater Employer
Rater Employer
Rater Employer
F] Rater
1-1 Employer
Rater
Employer
Rater
Employer
Rater
Employer
OR Is in the business of:
Rater Employer
Rater Employer
Rater Employer
F1 Rater Employer
Rater Employer
Rater Employer
1-1 Rater 17 Employer
I attest that the above information is true and correct to the best of my knowledge. As a Rater or Rating Provider I abide by
the rating quality control provisions of the Mortgage Industry National Home Energy Rating Standard as set forth by the
Residential Energy Services Network (RESNET). The national rating quality control provisions of the rating standard are
contained in Chapter One 4.C.8 of the standard and are posted at http:/Aivww.natresnetorg/�ccred/Standards.pdf. This
home may have been verified under the provisions of Chapter Six, Section 603,'Technical Requirements for Sampling" of
the Standard.
Michael A. Browne
Rater's Printed Name
r's Sign
3992602
Certification #
July 21, 2014
Date
RESNET Form 0300-2
'10052
Date. ...... // ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .... P.'r ....... .... A .....
... . ......... / �� . ... ...............
has permission to perform ... ........ ....... / e's -f—
. ............................
wiring in the building of ..... :!!n ...... .6 ..........................
......... A*orth Andover, Mass.
. ..........
Fee ... �-; ........ Lic. NoAlqtv .................
ALEc r Rti�c A�L N S� P i �C �TO R
Check #1?,3--t-7-
r
_&\,
MEL=
BOARD OF FIRE PREVENTIOU REGULATIONS
Official Use Only
PermitNo._
Occupancy and Fee Checked
[Rev- 11071
(leave.blank)
APPLICATION FOR PERMfT.T0 PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PRflVT N NK OR TYPEALL NFORMATION) Date:
City or Town of: /V /z_ To the Impector of Wires:
By ibis application the undersigned gives notice of his orber intention to perform the electrical work described below.
Location (Street & Number) 0 oe eil 7'21 e�_ x-,
Owner or Tenant kc C/ Telepbi!Ao. -3 _ P-- ell, -3 0
Owner's Address 41
Is this permit in conjunction with a buffda(g permit? Yes -S-�-�o (Check -Appropriate Box)
"ose of Building Utility AiftOAMUOD No: AZ 17 %3� 3 7-t
Existing Service-. A�ps I V�ts. Overhead E) Undgrd E] No. of Meters
New Soft ��d Amps X -Y41 Vohs Overhead [] Undgrdg----No. of Meters
Number of Feeders and Ampacity . . . - - - .1
Location and Nat�re of Proposed Electrical Work: �1_1 I-
Comoletim of the following table waived hv the T?Lqnpcw nfWires
No. of Recessed Luminaires
No. of CRL -S u-sp. (Paddle) Fans
INO. of Total
Transformers KVA
No. of I 8-tre Outlets
No. of Hot Tubs
Generators KVA.
No. of Luminaires
Swim -11 e C1 In-
--ming pout wnd; em(L
of Emergency Ughting
Battery Ulf
W
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARM
of Zones
No. of Switches -
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
I Number
I Tons'
. ... . ............
JKW
F_
No. of Self -Contained
Dot"" Devices
No. of Dishwashers
Space/Area Heating KW
Local n C�tunldjal. [] O&er
to
No, of Dryers
Heating Appliances KW
See S
N $ =or Equivalent
uni
No. of Wa—ter KW
Heaters
0 -No-.-07-
Ballasts
Data Wirl
No. of [Dugevices or Equivalent
No� HydromassageBathtubs
No� of Motan Total,.RP
-'TeTe-communications wirmg..
No. of -Devices or Equival
-tent
OTHER.
Attack ad*tional detail ifdesireck or as reqtdred by the InVector of Wires -
Estimated Value of Electrical Work: (When required by municipal policy,)
WorktoStart: Inspections to be requested in accordance with NEC Rule 10, and upon'60tripletion.
INSURANCE COVERAGE: Unless waived by ft owner, no permit for the pefforniance of electrical work may issue unless
the licensee provides proof -ofriability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCES BOND [3 OTHER (3 (Specify:)
Icerfift, under thepains andpenaMes �f, r' that the information on this application is true and conViele,
FIRMNAME: .0, X_ - S)vq// LIC.NO.: _07ff
Licensei� / .5;izfll Signature LIC. NO.: 1A?1'7A6
Wapph'bable, ewer -exempt" u-4 the fi-censenumberfino"i- Bus.Tel.No., 9W--19?V--;9W
Address: — 9 /,JgVQ�/If Adg:�' XA-�,4 Ad��, 1V,4 gIRI-5 Alt Tel. No.:
*Per M.G.L. c. 147, s. 57-61Ysecurity work requires Department of Public Safety "S" License: Lic. No.
OWNEWS INSURANCE WAIVER: I am aware that the Licensee does noi have the liability insurance coverage nornially
required by law. By my signature below, I hereby waive this requirement. I am the (check one) [3owner [1 owner's agent
Owner/Agent - . I - -i ' "r'
Signature Telephone No. PERMIT FEE.- $
ELECTRICAL PERAUT NO. INSPECTION REPORT:
ELECTRICAL INSPECTOR - DOUG SMALL
1. ROUGH INSPECTION:
Passed —bd Failed — Re -inspection required ($50.00)
Inspectors' comments:
(Inspectors' Signature - no initials) Date
E2. FINAL MPECTION:.
Passed Failed — Re -inspection required ($50.00) -1
Inspectors' comments:
AA.jfJ
I VL- k
Onspettors' SignaUre - no in1dafs) Date
3. UNDER GROUND INSPECTION:
Passed — [ I Failed — Re -inspection required ($50.00) - f
Inspectors' comments:
(Inspectors' Signature - no initials) Date
4. INSPECTION — SERVICE:
DATE "AL ED NATIONAL GRID: NAME:
Passed — t�L Failed — Re -inspection required (S50.00) -
Inspectors' comments:
�2, b — �j
(Inspectors' Signature - no initials) Date
5. INSPECTION - OTHER:
Passed — I I Failed — I Re -inspection required ($50.0%—j
Inspectors' comments:
(Inspectors' Signature - no initials) Date
DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT
ACCESSIEBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... -'e ...... .........................................
has permission to perform ... ........ ...............................
wiring in the building of ...... z.-��.' ............................
at')r7 ... //�'
......... .......... North Andover, Mass.
Fee- � ........... 'ic. . ...................
'I Ei a** 'dCAL �4P�ECTORf
Check #
10677
Commonwealth of Massachusetts Official Use Only
F Pennit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PRNTINEVK OR TYPEALL NFORKMON) Date: Z - Z 3 - / -z--
City or Town of. NORTH ANDOVEA To the Inspector of Wires:
By this application the undersigned gives n ice of his or, her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building Armit? 'Yes 9-�- �o (Check Appropriate Box)
Purpose of Building f/,7z- Utility Authorization No.
ExistingService zc-4' A 1,2e,- I ��Volt I s OverheadE] UndgrdE]-----No. of Meters
New Service — Amps Volts Overhead El Undgrd n No. of Meters
Number of Feeders and Ampacit�
Location and Nature of Proposed Electrical Work:
Completion nfthe Allowin table m— be waive,47- th-
No. of Recessed Luminaires
I
No. of Ceff.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above [I In-
grnd. 2r d.
No oftmergency Lig-on—g
Bawery units
No. of Receptacle Outlets
—
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
. Totals:
IMPH� er
I Tons
I KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Aria Heating KW
Local [] Mun'C'PP' El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*.
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of NO. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications WkIng:
No. of Devic es or Equivale
OTHER: .
Attach additional detail ifelesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 7- - Z .7 -IZ-- Inspections to be requested in accordance with I�IEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operatioif ' coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEE] BOND EJ OTHER [J (Specify:)
I certify, under thepains andpenalties ofterjury, that the in ormation on this application is true and corliileie.
FIRMNAME: /11�- LIC. NO.. -
Licensee: SignaturoZ/
T&� 2' LIC. NO.:
ble, � "exempt" in the license number line) Bus. Tel. No.-,Z7J- j02-7 - Oldv�l
Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires DepartmAnt ofPublic; Safety "S" License: Lie. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $
BILE(CM(CAL PERIM go. )USPECUONRUPORT:
ELECTMCAL INSPECTOR
iNW)gCTION;
Passe� raved—[ I Re -inspection required ($5O.OD) - f
"O"G
Inspectors, commots:
@54p er-fors' Signature - J4 initials) Pate
Wed — Rt, -Inspection required ($50.00) -
I In ectors, c
uPpectoris' comments:
(Ms&ctors' Signature - 4 WHA Date
3. DMER GRODND INMECTION:
Wed— Re -Inspection required ($50.00) - f
Inspectors' comments:
(Inspectors" Signatare - no hiltials) Date
M
V4. INSPECTION— SERVICE:
R'"EC'l
DATE CALTM —0 NATIONAL C-110-1 31: NA -VA: -
- 4):� C�
Ij
s
PassecEI—E I Failed — Re-iuspectlo,n required ($50.00) -
,tors c
Insveetbrs, comments:
ornspectors, Sigardure - io Rdtials) Date
D 0 OR TAGS ARE TO 13E FILLED OUT AND LEFT ON RITE IF TBE APXA TO BE INSPECTUD IS NOT
ACCESSIBLE AND A RE-WSPECTION OF L50.0 0 IS TO BF, CMRGED.
The Commonwealth ofMassachusetts
9 Department of Industrial Accid�nits
Office of Investigations
600 Washington Street
Boston, MA 02111
IV www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib
Name (Business/Organization/Individual):
Address:
City/State/Zip:
Phone #:
Are you an employer? Check the appropriate box:
1. El I am a employer with
4. n I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2.0 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. El I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. [] New con.straction
7. EJ Remodeling
8. E] Demolition
9. F] Building addition
10. F1 Electrical repairs or additions
I L El Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurancefor my employees. Below is thepolicy andjoh site
information.
Insurance Company
- Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certio under the pains andpenalties ofperjury that the information provided above is true and correct.
Signature: Date:
Phone #:
Official use only. Do not write in this area, to he completed by city or town official
City or Town:
Permit[License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone M
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defiried as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer'is defiried as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or Ideal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirtnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in - (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is'on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
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APPLICATION FOR CERTIFICATE OF OCCLIPANCYnNSPECTION
Building Permilt#
ADDRESS&OCATION OF PROPERTY: 4
Map Parcel 07 Lot Number
SUBDIVISION
� � � - - //,
DATE REQUESTED FILED/READY FOR INSPECTION
CLOSING DATE ON PROPERTY:4zbZ/ 2�—
UST BE COMPLETED WITHIN ME MA
ALL WORK AND SIGN -OFFS M rHI�VWFRAME. A RE.
INSPECTION FEE. OF TWENTY DOLLARS $20.00i WILL 13F CHARr.l=n N: TW= Qlrm"ir-n ime
UDES NOT MEET ALL APPLICABLE CODES.
Pol 1-1 Ht 'issued to:
Address -y
ROUTING
CONSERVATION
PLANNING
DPW - WATER METER
SEWER/WATER CONNECTION
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCYlINSPECTION REQUEST
Signature
File: Application for OC form revised Jan 2007
13,,, S-- - - - # IL
CERTIFICATE OF USE & OCCUPANCY
Building Permit Number 491-2011 & 606-12 (Basement) Date: March 14, 2012
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 27 Hepatica Drive
MAY BE OCCUPIED AS A Single Family Home & Finished Basement IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Key Lime, Inc.
10 Hepatica Drive
North Andover, MA 01845
Building Inspector
Fee:
Receipt: 23800 CO $100.00 & 25032 Building Permit $108.00
8 o4
TOWN OF NORTH ANDOVER
PERMIT FOR RtOMBING
This certifies that ... ................ PL ..................
has permission to perform .. A).e --It .................
plumbing in the buildings of
at..
. .7. . # North Andover, Mass.
Fee Lic. No.. /C-> . ....... .......
PLUMBING INSPECTOR
Check ff 7 q( r".
9:IYTI 1109:Q
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: KO (LT% A N 4UV-(r- MA. Date: Permit#
Building Location: -:o 4ePq*lCA D(�AR- Owners Name: OW S"oCA4
Type of Occupancy: Commercia[F] EducationalE] IndustrialF] Institutional [] Residential
New: 91 Alteration: Renovation: Replacement:E] Plans Submitted: YesE] No
9:IYTI 1109:Q
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes R' No
If you have checked Yes
, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 21, Other type of indemnity 0 Bond F1
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 El . Aqent D
of Owner or Owner
certify that all of the
I have
application are true and accurate to the best of mv
#%nowieuge ana inat aij piumDing work and installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Title M"Plumber Signature of I icensed Plumber
CityfTown ErMaster
APPROVED (OFFICE USE ONLY) Eliourneyman License Number: 10347
DEDICATED
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Check One Only Certificate #
Installing Company Name:
PLUMISIKY,-
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Address: P-0, P30X
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'S'TIFPKEP�
C_ GAL.T015V-4?
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes R' No
If you have checked Yes
, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 21, Other type of indemnity 0 Bond F1
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
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Check One Only
owner El . Aqent D
of Owner or Owner
certify that all of the
I have
application are true and accurate to the best of mv
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By Type of License:
Title M"Plumber Signature of I icensed Plumber
CityfTown ErMaster
APPROVED (OFFICE USE ONLY) Eliourneyman License Number: 10347
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Fee. &�.--Lic. ........
GAS INSPEGTOR�
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
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Building Location:,)-'? OU41-h4i, 11JA— Owners Name: 0(f) S ArLJR44 UkLL4(bjr-
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F:IYTIIDIZQ
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 95'No 171
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy E?'- Other type of indemnity [] Bond E]
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
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Check One Only
Signature of Owner or Owner's Agent Owner 1:1 Agent E]
By checking this box 0 by certify that all of the details and information I have submitted (or entered) reaardina this aonlication are trup anfl
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compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
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Title El Gas Fitter Signaiure - f Li P r �g ed Plumber/Gas Fitter
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Installing Company Name:
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Check One Only Certificate #
R(Corpor-ation 31 NO
Address: P.O. (50)( 1101
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GAL.T 051(4
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 95'No 171
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy E?'- Other type of indemnity [] Bond E]
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
Signature of Owner or Owner's Agent Owner 1:1 Agent E]
By checking this box 0 by certify that all of the details and information I have submitted (or entered) reaardina this aonlication are trup anfl
accurate to tne best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
Bitlumber C
Title El Gas Fitter Signaiure - f Li P r �g ed Plumber/Gas Fitter
Wmaster
City/Town Diourneyman License Number: io-s'+%
APPROVED (OFFICE USE ONLY) El LP Installer I
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7494 Date
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ��Ale-i el - (-)fe . Izlr'
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at . . s�? 97. - H. lfoa6.4�44. . . . 247, North Andover, Mass.
Fee.4� . 7. Lic. No..'&.—p :� . ........................ 10�.
GAS INSPECTOR
Check 0/5(
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
K, Mass. Date 20 /0 Permit #
-<e C -
Building Location Z7 Ac joq r -L Owner's Name
Telephone Type of Occupancy
Replacement E] Plans Submitted: Yes No[]
New E] Renovation ID
Installing Company Name EnergyUSA Propane, Inc. Check one:
Address 100 Myles Standish Blvd., Suite 101 FX1 Corporation
Taunton, MA 02780 Partnership
Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891 Firm/Co.
Certificate
132 C
Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660
INSURANCE COVERAGE: EnergyUSA Propane, Inc.
has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes MX No F1
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy FX1 Other type of indemnity El Bond 1-1
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General La!%� a"tMy..,signature on this permit application waives this requiremeni
Check one:
Owner F1 Agent
nature of Owpdr or OWner's Agent
I hereby certif� that all of the details and information I have submitted (or entered) in above application are true
accurate to the best of my knowledge and that all plumbing work and installations performed under the permit
issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code
and Chapter 142 of the General Laws.
By
Title
City/Town
IAPPROVED (OFFICE USE ONLY)
Type of License:
ElPlumber
rX-1 Gasfitter
FlMaster
r—liourneyman
ri
Signature of Licensed Plumber or Gasfitter
License Number 3707
MwNsTe":
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0=0
R7.1110=ee
Installing Company Name EnergyUSA Propane, Inc. Check one:
Address 100 Myles Standish Blvd., Suite 101 FX1 Corporation
Taunton, MA 02780 Partnership
Business Telephone (800) 822-1300 X8055 Mike Smith Cell (508) 922-7891 Firm/Co.
Certificate
132 C
Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660
INSURANCE COVERAGE: EnergyUSA Propane, Inc.
has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142.
Yes MX No F1
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy FX1 Other type of indemnity El Bond 1-1
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General La!%� a"tMy..,signature on this permit application waives this requiremeni
Check one:
Owner F1 Agent
nature of Owpdr or OWner's Agent
I hereby certif� that all of the details and information I have submitted (or entered) in above application are true
accurate to the best of my knowledge and that all plumbing work and installations performed under the permit
issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code
and Chapter 142 of the General Laws.
By
Title
City/Town
IAPPROVED (OFFICE USE ONLY)
Type of License:
ElPlumber
rX-1 Gasfitter
FlMaster
r—liourneyman
ri
Signature of Licensed Plumber or Gasfitter
License Number 3707
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