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Miscellaneous - 270 WINTER STREET 4/30/2018
N. I Date.., ................................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING 19 .. .... This certifies that ..... .............. ..... ....... ............... 4..� .... .................................. has permission to perform 2L ....... J.. ........... wiring in the building of ....................................... ................................................ at .......... North Andover, Mass. Fee ..................... . Lic. No. Z&�� ............... ........... OELEcrRICAL INSPEc, Check # 4lu- 9022 Commonwealth of Massachusetts Official Use Only Department of Fire Services . Permit No. `moo a BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee CheckedV [Rev. 1/07] tIP.A VP }1�9n�ri APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION Date: q' 2/ "o 9 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) a70 4V.., Al 7 t � r Owner or Tenant C e Telephone No J Owner's Address— 95::7 . Is this permit in conjunction with a building permit? Yes Purpose of Building !7L✓e�t NG � No ❑ (Check Appropriate Boz) Utility Authorization No. Emstmg Service Ld U Amps / 7 -ye) Volts Overhead El New Service a{ Amps f �' / -,tvv Volts Overhend IQ Number of Feeders and Ampacity Location and Nature of Proposed Electrical No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets E f Switches f Ranges f Waste Disposers No. of Dishwashers No. of Dryers No. of Water KW Heaters No. Hydromassage Bathtubs OTHER: No. of Ceil: Susp. (Paddle) Fans INo. of Hot Tubs Swimming P001 Above ❑ d No. of Oil Burners No. of Gas Burners No. of Air Cond. Ta Totals Space/Area Heating KW Heating Appliances KW No. of No. of Signs Ballasts Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters .ng table may be waived by the Inspector of Wires. LEI t ranstormersKVA Generators KVA ALARMS INo. of Zones �No. of Alerting Devices 1 No. of Self -1 _nntAmPfi 1I Letectlon/Alertin Devices Local ❑ Municipal ('nnnarfinn ❑ Other No. of Devices or Equivalent Data Wiring: No. of Devices nr F.nniva1an+ No. of Motors Total HP IT elecommunications No. of Devices or Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the ains andPenalties of perjury, that the information on this application is true and complete. M FIRM NAE: i� LIC. NO.: // �'%��/ Licensee: G ,� Signature LIC. (If applicable, enter "exempt " in the licens number line.) Address: /fid *561,k- A9p� ��j©S/ �_ p/��� Bus. Tel. No.. 1 7 *Per M.G.L c. 147, s. 57-6f, security work requires Department of Public Safety "S" License: Alt L cl. No � 6 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Alassachusettr Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anylicant Information Please Print Legibly Name (Business/OTmization/individual) -71114-11c- Address: 1-2U Zok S/yZ,F City/State/Zip:_ a95,5Wco y /IYW= 6/�Wl Phone #:_ ,/ -4— / 7-7P 7 Are you an employer? Check the appropriate box: 1. I am a employer with4. ❑ I am a genera[ contractor and I Type of project (required): __,3 employees (full and/or part-time),* 2. ❑ I am a.sole proprietor or partner- have hired the sub -contractors listed on the attached sheet 6• ❑ New construction 7• ❑ Remodeling ship and. have no employees These sub -contractors have S. ❑ Demolition working for me .in any capacity [No workers' comp, insurance workers' comp. insurance, S. ❑ We are a corporation and its 9, ❑ Building addition required_] 3. ❑ I am a homeowner doing officers have exercised their 10.❑ Electrical repairs or additions all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No -workers' comp. c. 1.52, § 1(4), and we have no 12.[] Roof repairs insurance required.] t .employees. [No workers' 13'0 Other „comp. insurance required..] t-rr••�••• •��� w.c Ks uoz If r most also Till 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 contractor; must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the frame of the sub -contractors and their workers' comp,policy information. I ant an employer that is providing:workers' compensation insurapiceformw employees: Below is the information policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif,"nder the pains and penalties of perjury that the information provided above is true and correct ZIZ/.� / t Official use only. Do not write in this area, to be completed by city or town official _� 11 City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other `y , [[-C.0.n. tact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." l An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of theforegoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trmstee 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 locai licensing agency shall withhold the issuance or renewal of a license or permit to operate a bnsioess or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence..oir 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 -contractors) name(s), address(es), acid phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the numberlisted 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 acid 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 %,ill 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 dr 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 Investigkations 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 Waslzi.ngton Street Boston, IIIA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-774 Revised 5-26-05 wvvw.mass.gov/dia Date.... e 1107" 01 — TOWN OF NORTH ANDOVER -lel`m PERMIT FOR WIRING TA & _ a- �7 '_ ��n ... ............. . This certifies that .... has permission to perform ....... ........... wiring in the building of .... ..... '7 0 -0 ................................. at ...... ..' ............ L ..... L4t.& ............ ), North Andover, Mass. .. ...... . Fee ... ! ................. Lic. No. .......... . ....... c dLaECrR11ALNS Check # 8974 FA Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. _ —] BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: F-2 V -- City --City or Town of: NORTH ANDOVER To .the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) %O L t>i n/ 9' �- Owner or Tenant _0 7c�Y �0 L &-;p_ q s.Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes . No ❑ (Check Appropriate Box) Purpose of Building_ -ow n/(y Utility Authorization No. Existing Service 10 U Amps t2,u/ -""Volts Overhead Undgrd ❑ No. of Meters I New Service Amps _____L_Volts Overhead . ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires g INo. of CeiL.-Susp. (Paddle) Fa No. of Luminaire Outlets No. of Total No. of Hot Tubs No. of Luminaires Swimming Pool Above ED; d. ceptacle Outlets of Emergency tg g Batte Units No. of oil Burners itches No. of Zones / No. of Gas Burners nges 400f No. of Air Cond. Tota ste Disposers i Heat Pump Number ons n o. of Self -Contained Totals: hwashers / Space/Area Heating KW No. of Dryers -W Heating Appliances I{ No. of Water Heaters' No. of No. of Data Wiring: Si s Ballast No. Hydromassage Bathtubs IP No. of Motors Total E the following table may be waived h„ the Tncnant . „r ur. as No. of Total Transformers KVA Generators KVA In -o. 'rad. ❑ of Emergency tg g Batte Units FIRE ALARMS No. of Zones / o. of Detection and Initiathi Devices sNo. of Alerting Devices _'. " o. of Self -Contained Deteetion/Alertin a, Devices Local ❑ Municipal ❑ Other Connection -W Security Systems: No. of Devices or Equivalent Data Wiring: s No. of Devices or Equivalent IP Telecommunications Wiring: No. of Devices or Eauivalent Attach additional detail if desired, or as requi Estimated Value of Electrical Work: (When required by municipal policy.) red by the Inspector of Wires. Work to Start Com, !� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAG :Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same 14 to the permit issuing office. CHECK ONE: INSURANCE] BOND ❑ OTHER ❑ (Specify:) l�"tf+ I certify, under the ains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: � �`i l� /✓�/i Lr~ % l3Uoi LIC. NO.: Licensee. Signature (If applicable, em t " i th license number line.) LIC. NO. • Address: 774 OY I 01*(al Bus. Tel. No.• ? *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl. 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) ❑ owner ED owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ r�l i 7 E:1�ra a� The Commonwealth of Massachusetts Department o- f Industrial Accidents Office of Investigations 600 NMashington Street Boston, MA 02111 www mass gov/dia . Workers' Compensation Imilrance Affidavit: Builders/Contractors/Electricians/Plumbers ADIICant Tnfarrrra"nn Name (Business/prgmization/Individual): `��-�� ffZL%G7,Ve(' CO/✓��'Z ��, , Address: 140 D '96-f-, Z/ R' City/State/Zip: C WA © . Phone #: . �?7� 9Z-7 Are you an employer? Check.the appropriate box: 1. I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2•❑ I am a -sole proprietor or have hired the sub -contractors listed partner- on the attached sheet x ship and have no employees These sub -contractors have working for me .in any capacity. [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.) 3. ❑ I am a homeowner doing.all officers have exercised their work right of exemption per MGL myself [Nonworkers' comp. C. 1.52, § 1(4), and we have no insurance required.].t employees. [No workers' comp. insurance required..] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [] Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ .Other t Homeowners who submit this affidavit indi ;Contractors that check this box mcating they us dol g all work anMow d thenro hiie outside ntractom musts bmiitt satioT, policy asnew affidavit indicating such. ust attacher► an additional sheet showing the name Of the sub -contractors and their workers' omD. Dolim infi,, Aa n 1 am an employer that is providtng:workers' compensation information, irarurancefor my employees; Below is the policy and job site Insurance Company Name: 1-01icy # or Self -ins. Lie. Expiration Date: Job Site Address: City/state/Zip. Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration dat:e� Failure to secure coverage as required under Section 25A of MGL c. 152 cars 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 certify under the pains and penalties ofperjury that the information provided above is true and colied IFM�10 ��970`3P Official ase only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5 6. Other . Plumbing Inspector Contact Person: Phone #• i fv Information and Instructions Massachusetts.General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined. as "...every person in the service of another under any contract of hire, express or implied, oral, or written." An employer is defined as "an individual:, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the owner -of a dwelling house having not 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 local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance'eoverage 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 toyour situation and, if necessary, supply sub-contractor(s) name(s), address(es). acid phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the mercers or partners, are not required to cavy workers' compensation insurance. if -an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not.the Department of Industrial Accidents. Should you have any .questions regarding the law or if you are required to obtain a workers' ; compensation policy, please call the Department at the numberfisted below. Self-insured companies should enter their b. self-insurance-Iicense 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 vvilI be used as a reference number. In addition, an applicant that must submit multiple pennit/lic rm 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 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. G' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Luvestigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised s -26 -QS Fax # 617-727-774.9 www.mass.gov/dia Dati. 41 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .;7 ...................... has permission to perform plumbing in the buildings of .............. at C.�6.7, North Andover, Mass. Fee ,x�—. Lic. No .......... . ......... .............. — _PLPlu Ums NG INSPECTOR Check 8185 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS 1 / j c Building Location %(, �,f fH, -�ep Owners Name S C� Date 199, p� Permit # i Typ e of Occupancy Amount New Renovation Replacement Plans Submitted Yes No ❑ (Print or type) Installing Company Name Address Check one: Certificate Corp. Partner. El—Arm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee 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 Massachu S to Plumbing de and Chapter 142 of the General Laws. By: lona nr n 1qWh r/ Title Type of Plumbing License 3 City/Town icense um er Master Journeyman APPROVED (OFFICE USE ONLY F1 .r OMMMOM MM mmmmmm MMMMMMMM MMM El (Print or type) Installing Company Name Address Check one: Certificate Corp. Partner. El—Arm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee 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 Massachu S to Plumbing de and Chapter 142 of the General Laws. By: lona nr n 1qWh r/ Title Type of Plumbing License 3 City/Town icense um er Master Journeyman APPROVED (OFFICE USE ONLY F1 k� 11ML :L ref The Common wealth of Alassachusettv Department of Industrial Accidents Office of Investigations 600 TEashinglon Street Boston, MAI 02111 www -n ass gov/dia . Workers' Compensation Iusurance Affidavit: Builders!Contractors/Eiectrici$as/plambers Aicant Info vftaiion Name (Business/organization/individual): Address: A City/State/Zip: 7VP2j 6 ly � Q Phone 77 -,- Type. Are you an employer? Check -the appropriate bo= 1. ❑ I am a empio with 4. ❑ I am 8 general contractor and I 2. ❑employ and/or -time).* I am .a.sole proprietor or have hicred the sub -contractors listed partner- ship and have no employees on the attached sheet These sub -contractors have working for me in any capacity, [No workers' comp, insurance workers' comp. insurance. S. ❑ We are a corporation and its required.] 3.E3 I am a homeowner doing officers have exercised heir all work myself., [No -workers' comp, right of exemption per MGL ew 152, § 1(4), and -we have no insurance required.].t em to ees P Y [No workers' comp. insurance uired- Type of Project (required): 6• ❑ New construction . T• ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10•❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions I2.❑ Roof repairs ] homeowners 13.❑.Other •Airy applicant tfiat checks boz' 1 must also fill out the sectiow n below showing their warkem' compensation policy mfnrmatron. I r who submit this of avit indicating they am daing an work and than hce outside cvn ;Contractors that check this boa must attaehtd an additional sheet showing. the name of the sub -coo :factors must'submit a new affidavit indickk succi. tractim and their workers' car rt. pain• intoUM60a. 1 arc on employer thin isProvr M,-:workerw' co ensadon information. mP insurance for fi""Ploys Below is the Policf' and yok site . Insurance Company Name: ' e ge, Policy # or Self -ins. Lie. #: . Expiration Date: Job Site Address: Attach a copy of the woCity/state/Zip: rkers' compensation policy declaration page (showing the policy number and expiration date), . Failure to secure coverage as g 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/onone-year imprisonment; as well Ets 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 investigations of the DIA for insurance covemp verification. Office of I do hereby cerci under the pains and ena/ties ofPej*7 that the in ormadon w f P ab2/;7f: Si lure: Q Date: Phone #: % % �`� Og% i Official ase only, do not write in this area, to be cn let mp tea' by ctty or town officio( City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2- Building Department 3. City/'iown Clerk 4. Electri 6. Other cal Inspector 5. Piutrbing inspector Contact Person: Phone #: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp 3oyers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An en ployer is defined as "an. individual, partnership, assodiation, corporation or other legal entity, or any two or more of thelbmgoing engagedin a joint enterprise, and mcludirig the legal representatives of a deceased employer, or the receiver ortrustee of an individual, partnership, associatioin or other iegal entity, employing employees: 'However the owner -of a dwelling house having not more thah 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 er local fieensing agency shall withhold the issuance or renewal of license or permit to operate a business or Yte construct baiidings in thecommonwealth for any applicant who has not produced acceptable evideoce.of compliance with the insurance coverage required:" Additionally, MOL chapter 152, §25C(7) states "Neither glue commonwealth nor any of its political subdivisions shall enter into any contract for the perfomismce of public, work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the cortbacting authority." Applicants Please fill out the workers' compensation• affidavit compie✓tely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addrms(es), ar,d phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited ' Liability Partnerships (LLP) with no employees other than the mcnibers or partners, are not require&to carry workers' ocvrnpmsation insurance. If an LLC or UP does have . employees, a policy is required. Be advised that this affidavit may be submitted to the Departraent of industrial Accidents for confirmation of insurance coverage.. Ain lye 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, notthe 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 nuuzriber listed below. Set{ +sts►ired c�+atipani �tia�ld en+Prti,,•;r self-insurance license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Departminit has provided a space at the bottom of the affidavit for yob 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 %-ilI be used as a.refererice number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicatirig 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 be= officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is an file for futwe permits or licenses. A new affidavit must be filled out each year. When a home owner or citizen is obtaining a license or permit not related to any business or commercial vWtWe (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 hike 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 Departi nnenf of Industial Accidents Office of LnvestiiDations " 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax 4 617-727-7749 www.mass.govldia Date..—.. ...... ��-�........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ...... r✓..... - .p -E' f .....: ..- has permission to perform.....-- ........................ :. wiring in the building of ... r%?..-t....-.'.�.;�......................................... k a at .... .,Zv..... /��' % ...........,� ................ .North Andover, Mass. d�S Fee../�.... �........ Lic. No...f,S...7i.;0, . ........... .. . r LECCRICALINSP INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Only - The Commonwealth of Massachusetts . Permit No.s� Is Occupancy & Fee Checked = Department of Public Safety 3/90 (leave blank) \"? BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 RULE 8 Effective 1/1/78 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRT IINTI;��1N-�INK/�OR TYPE ALL INFORMATION) Date //3/00 City or Town of /`�'rp `-'► Ff k (%y , To the Inspector of Wires: The undersigned applies for a permit toerform the electrical work described below. Location (Street & Number) X70 In ST,64� Owner or Tenant S CA 11- 1- , M A C �t !3 n ZI Owner's Address S4 -m$— is this permit in conjunction with y building permit: Yes ❑ No [� (Check Appropriate Box) Purpose of Building t �`�✓� C -- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd. ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd. ❑ No. of Meters Number of Feeders and Ampacity rM Location and Nature of Proposed Electrical Work tN 12-t-ai +15 �Cw tai# -+U No. of Lighting Outlets No. of Hot Tubs 1 No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above ❑ rnd. grnd. In- ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges Total No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained Detection/ Sounding Devices Local ❑ Municipal ❑ Connection Other No. of Disposals, No. of Heat Pumps Total Total Tons KW No. of Dishwashers Space/ Area Heating KW No. of Dryers Heating Devices KW No. of 'iter Heaters KW No. of No. of Low Voltage Signs Ballasts Wiring No. Hylr� csage Tubs No. of Motors Total HP Other: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO ❑ I have submitted valid proof of same to this office. YES ® NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE Q BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work $ Lim 00 Work to Start 131A 30l R 9 Inspection Date Requested: Rough Final Signed'und'er the'p aIties of:perjur FIRM; NAME. ii�n iZ. LIC. NO. I1 15 ' 1 Licensee t✓'n # .�Z nature LIC. NO. L- 371; 32 :Address ,3.7}. • S - " Bus. Tel. No. �7a' "(P f % — t7 7 0 Alt. Tel. No. 1� g�� `�7 - 7��� OWNER`S 'INSU.RANCE WAIVEkA-am •aware that the Licensee 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. (Signature of Owner or Agent) FORM 18922 (FPR11-RULE 8) A.M. SULKIN CO.. BOSTON. MA PERMIT FEE $ Location c%),2�) No G7r4119 Date HQRTN TOWN OF NORTH ANDOVER f ' toot 1 Certificate Occupancy $ + ; , of s+c►+us `� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ $ TOTAL Check # ,�) -3-5 l� /� Building Inspector d Q v� U �Q Z F W J G F- W J_ J d Q v� F � Z F W J N F- W C C a O u C i O U � O W z f �• N V •= z C cn N H W.�. i. � � C C) x � � z 7- z u U c N v G r L _ i Z W U o J)41 z SL� _z a0 W C J o E' O ❑ O 4. O O Z O U Z O U Z O U U.N Z Z Z W Q O O O U U U U Z N0 O H N W N W y a C 4 j y q C c 5 Z CJ N C 3 H ^U ~ z 0 In � o p ✓� Ih � c U 0 Ov '^ � � � W U '• v N F F c N v ? O r qy W W C < Z c W Z GG O O 2 Z G .0 W N h�a z < F N W F. O U U U C O Li U Z U z U T W O C _ G _ G c or U - . o. r . Q z F � Z F W J N F- W C C a O u C i O U � O W f �• . Q z F OZ N ( � O u C i O � W Z N V •= z W.�. i. � � C � � z 7- u U c N v G C L _ i Z W U f,. I Q F OZ N ( � O C i O � Z V L V •= FORM U LOTI RELEASE FORM 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. *******APFLICANT FILLS OUT THIS niraNc y GNrn,�A��� _ APPLICANT CRZ)L)4e'�Z 5611,es Cd PHONE ��1V� 3�Z�v� LOCATION: Assess&s Map Number I O PARCEL SUBDIVISION LOT (S) STREET Wln1 ek- ST- ST. NUMBER USE ONLY"' RECOMMENDATIONS OF TOWN AGENTS: 'fa 'J $'yt I $' oP� F_ C_ � o R_ 3 S �4 o M —Fo kc. Ee CONSERVATION ADMINISTRATOR DATE APPROVED 11610_0 DATE REJECTED COMMENTS �)O� WC -1` JS w� 11 COMMENTS FOOD INSPECTOR -HEALTH IC INSPECTOR -H DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS S �F�G✓ %4-�� �"� ��-' ���� PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING !NSPECTOR Revised 9197 jm DATE 2pZ,LIV z63.C.g' `V Or Mqs� ROBERTT. ti KING a� La 140. o Amo �Fals-r��� SSS/ONAL N` W i l000lo I CERTIFY TO THE ANDOVER AL4/V or ANO /7'5 T/TLE //VSG/FTEFt THAT THIS PLAN DEPICTS THE RESULTS OF A CLwiRENT EXAMINATION OF TME PREMISES DESCRIBED IN RECORD BOOK /1196, PAsf 3zG OF THE A6. ESSEx Reds TRY OF DEEDS AND THAT ALL EASEMENTS, ENCROACHMENTS AND SUILD/NGS ARE LOCATED ON Thr GROUND AS SHOWN HEREON. AG s p SEE �� �'.�l 'D' 300 2L. NOTES: I. THIS PLAN WAS NOT MADE FROM AN INSTRUMENT SURVEY AND IS NOT FOR RECORDING ♦URPOSES. THE PLAN SHQWS THE CONDITIONS EXISTING AS OF THE DATE SHOWN HEREON. Cf'RT/F/GIT/ON IS FOR MORTGAGE PURPOSES ONLY. PROPERTY LINES AS SHOWN ARE APPARENT ONLY. Z.' TME PREMISES DID CONFORM WITH LOCAL ZONING ORDINANCES AT TIME OF CONSTRUCTION: 3. THE PREMISES DO NOT FA,:L VlrHIN A FLOOD HAZARD ZONE. MORTGAGE CERTIFICATION SKE TCH FOR '�E•✓a-/�irli v S YL WS- /P F•.e Pxoiitrr Ar 270 w/.v 7-E.e Sr.2EE T SGAze: 1 "= h/0 V -4r,—: 2 A4)6: 89 P.4EPLOREO . ®Y :'� G/G[JE.2E Ar/MG .4550 CA4 rES 7 WILL /.4M 'ST. , .04.f00fi/ERj A44,:Irs. s HOME IMPROVEMENT CONTRACTOR Registration 104724 Type - PRIVATE CORPORATION Expiration .07/15/00 CROCKER SALES CO., INC. Louis M. Klipper + s9°rii9h Street ADw4s"ATOR Woburn MA 01801 ;T� -Pomu�e� g�✓�iaooac6uraelta BOARD OF BUILDING REGULATIONS t License. ,CONSTRUCTION SUPERVISOR ; Number CS 004418 B�rhdate09130/1.957 Ex{s.►ss 49[30/2001 Tr. no: ?866 ---qReser fedtTo: 00 LOUIS M KLIPPER, 7 _ 6 LINDA ANN 1AWAY^ MIDDLEiON, IIAt1 61949 Administrator 9 A The Comrnonwe"alth of Massachusetts Department of Industrial -Accidents Office cf lnvestications Boston, Mass. 02111 Workers` Compensation Insurance Affidavit Flame Please Print 1 Location: 02D al )AI TP" 2� Cit! ,/1AOIftr,��Y✓Z✓�0✓Pa2 I /�� , Phone # 97.F- 275-- I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. -Comoanv name: C2JCi222 l -PS Ccs Address J cit, Phone T Insurance Co OCC t/r1'S5T),:Nr/J��l�dyn r�c��'riYr Pclicv 3y % Comoanv name: Address Cihl: Phone # Insurance Co. Polio T _ Failure to secure ccverace as recuirea under Sectian 25A or iMGL 152 can lead to the imposition cf cnmir.al penalties ar a rine up to S1,5C0.00 and/or one years' imprscrment as weal as civii penalties in the form cf a STOP wCRK ORCER and a fine cf ($100.00) a day against me. I understand that a copy of ,his statement m/a� be fcrNarced to the Office of Investigations of the CIA for coverage verification. I do hereby cerrify under Sicnature of penury that the information provided above is true and correct. Date / - S--- C)(.::> Print name�oI/IS ���l n0�� Phone ���� %33- ?Oo {j Official use aniy do not write in. this area to be completed by city cr town criciai C'ty or Tccvn P�rmitlL,cersira Buiiding Dept ❑Check ,f immediate res.ccrse is required ❑ Licensing Board r—) se!ectman's Office Conract person: Phone : ❑ health Department 71 Other �c 3 0 f7 o ti -r, .0 no ��il i I 'j NO cp3 — —1 it no cs tog 19 O O —Its Q) P e 0 1 6 1 JAN -03-2000 09:01 FROM EG BARKER LUMBER CO. TO 9335892 P.01i01 E G BARKER LUMBER CO INC E G BARKER LUMBER CO INC 3 Jan 2000 8:51 am PO BOX 193 36 PROSPECT ST, WOBURN, MA. 01801-0654 (781)933-0057 FASTSeamS Engineering Analysts 01996-2000 Georgia-Pacific Corporation Version: 3.1(95/NT) Project: Information: North Andover Mass Mark #: Beam - Floor Desc : header Usage: Beam(Floor) Repetitive: No Spacing (in.) : 0.0 Max Defl : LL = L/360 TL = L/240 Composite Action: No 3.5", 565 psi 1--1 3.5", 565 psi LOADS Project Design Loads: Floor.' Live=40 psf, Dead=10 psf,• Live+Dead Ld(T) Live Ld(l.) LDF Location' # shape QStart ®End Q$tart Wnd Span# Starts Ends Additional Info 1 t oncemra1eaposi 4anu sero 1 VV1b u 3' tY nage beam point load Uniform(plf) 8 0 0 0 710.. Self Weight 'Dimensions measured from left end when span# is 0, otherwise, from left end of the specified span. SUPPORTS(Ibs) 1 2 Max R'n 2459 2459 Max 100% 1944 1944 Min R'n 515 515 Min 100% 1944 1944 DL R'n 515 515 Min Brg(ln.) 1.50 1.50 [Based an bearing stress below] BES Str(psl) 565 585 DESIGN Value Span X Group Allow LDF Ratio V(Ibs) 2452 1 6-1- 21 6152 100% 0,40 M(ft-lbs) 8557 1 T 6" 21 12202 100% 0.70 LtRn(lbs) 2459 0 0' 0" 21 6921 100% 0.36 See Nate #5 RtRn(lbs) 2459 0 7' 0" 21 6921 100% 0.36 See Note #5 LLDefl0n.) 0.12 1 3'6" 21 0.23 0675 TLDefl(in.) 0.16 1 316. 21 0.35 tJ536 USE: GPLAM 2,9E 1.75x 9.25" 2 Plies i Grade selected by User G -P LAM tm Georgia-Pacific Corp. NOTES : 1. Designed In accordance with National Design Speciflcatlons for Wood Construction and applicable Approvals or Research Reports. 2. Provide lateral support at the bearing location nearest each end of the member. Continuous lateral support required for compression edge. 3. Loads have been Input by the user and have not been vadfled by Georgia-Pacific Engineered Lumber technical Services. 4. Design valid for dry use only. S. This reaction Is based on the combination of loads 8 duration factors that produces the highest stress ratio and may be less than maximum reaction. Therefore, when reaction values are required, use Max R'n from 'Supporo'secUOn above. 6. Bearing length based on design material; support material capacity shall be verified (by others). 7. When required by the building coda, a registered design professional or building official should verify the input loads and product application. 8. This englnearad lumber product has been sized for residential use. A concentrated load check, per the building code, must be performed for commercial uses. 9. Verify that load is applied at top or equally from both sides. 10. Nall plies together with 16d nails @ 12" o% along top and bottom edges. Nall from alternate faces, 2" from edges. 11. Company, product or brand names referenced are trademarks or registered trademarks of their respective ownars. 12. Load Comb/nations: 10=D,20=D+100%,30wD+115%,40=D+125°x6,50=0+133%,60aD+100%+115%,70=0+100%+125% , 80 " D + 100% + 133%, 90 = D + 100% + 115% + 133%./2 , 100 = D + 100% + 1154x.12 + 133% 110 = D + Commercial Ld (100%) 13., Group - Load Combination Number+ Load Pattarn number. (For simple span Load pattern = 1 for LL 0 for DL) TOTAL P.01 a J7 .S .9 .L .O .b 3 O ,J7 A 60iZ0 , d sionao8d JN I Q7 I nE IUGN I 7 T T: Z T 0002-b0-NUf * BEAM DESIGN AND ANALYSIS PROGRAM COPYRIGHT 1990 by MTI SOFTWARE, SANTA ROSA, CA. For use by Lindal Cedar Homes "r JOB N0. 01/04/2000 'Crocker Sales Chandler' Job * * BEAM GEOMETRY P P P P P P V V V V V V 0 LB/FT 19.0 FT BEAM DESCRIPTION: Fir Glulam Ridge Beam OVERALL BEAM LENGTH (FEET)...... 19.00- DISTANCE 9.00DISTANCE TO LEFT SUPPORT (FT)... 0.00 DISTANCE TO RIGHT SUPPORT (FT).. 19.00 (DISTANCE MEASURED FROM LEFT END) * * LOADINGS * * LOAD DESCRIPTION: UNIFORM LOAD ON CENTER SPAN (PLF)............ POINT LOADS: DISTANCE FROM LEFT END LOAD IN POUNDS. 3.00 1,513.00 6.00 1,513.00 9.00 1,513.00 12.00 1,513.00 15.00 1,513.00 18.00 1,513.00 * * LOAD CALCULATIONS REACTIONS: LEFT SUPPORT = 4,061 POUNDS. RIGHT SUPPORT = 5,017 POUNDS. MOMENTS AND SHEARS: DESCRIPTION LEFT SIDE OF LEFT SUPPORT RIGHT SIDE OF LEFT SUPPORT LEFT SIDE OF RIGHT SUPPORT RIGHT SIDE OF RIGHT SUPPORT CENTER SPAN MAXIMUM MOMENT IS 9.00 FEET FROM LEFT SUPPORT MOMENT('#) 0 0 0 0 22,934 • •• SHEAR (#) 0 4,061 -5,017 0 1, 035 TO -478 60ib0 ' d Sionao id JN I Qi I na ldaN I -I Z T : Z T 0002-00-NHf A' * * MATERIAL PROPERTIES * * ELASTIC MODULUS (MEGA PSI)...... 1.800 ALLOWABLE BENDING STRESS (PSI).. 2,400 ALLOWABLE HORIZ. SHEAR (PSI).... 165 ALLOWABLE OVERSTRESS (?s)........ 0%r MAXIMUM ALLOWABLE STRESS (PSI).. 2,400 MAXIMUM ALLOWABLE SHEAR (PSI)... 165 * * SECTION PROPERTIES FOR A 3.125 X 16.500 BENDING STRESS (PSI) ........ 1,941 SHEAR STRESS (PSI)........ 118 No reduction has been applied. * * DEFLECTIONS BASED ON NO. OF MATRIX POINTS USED IN TATE REAL MOMENT APPROXIMATIONS, THE ACCURACy OF THE CENTER BEAM MAXIMUM DEFLECTION POSITION IS PLUS OR MINUS 0.47 FEET. MAXIMUM DEFLECTIONS: DEFL. (INCHES) POSIT. (PT) CENTER SPAN 0.70 9.51 DEFLECTION FACTOR = CENTER SPAN / MAXIMUM DEFLECTION= 326.38 60/S0 ' d Sionao d ON I Gi I na 1dGN I -1 Z i: Z Z 0002-b0-NUf 6. alf-' , I. 0 �t L ? . 9 BEAM DESIGN AND ANALYSIS PROGRAM COPYRIGHT 1990 by MTI SOFTWARE, SANTA ROSA, CA. For use by Lindal Cedar Homes JOB NO. ° .Crocker Sales 01/04/2000 Job aChandler * * BEAM GEOMETRYP P V V 0 LB/FT 9.0 FT ' BEAM DESCRIP'T'ION: Fir Glulam Eave Header OVERALL BEAM LENGTH (FEET)...... 9.00 DISTANCE TO LEFT SUPPORT (FT)... 0.00 DISTANCE TO RIGHT SUPPORT (FT).. 9.00 (DISTANCE MEASURED FROM LEFT END) * * LOADINGS * * LOAD DESCRIPTION: UNIFORM LOAD ON CENTER SPAN (PLF)............ 0.00 POINT LOADS: DISTANCE FROM LEFT END LOAD IN POUNDS. 3.00 757.00 6.00 757.00 * * LOAD CALCULATIONS REACTIONS: LEFT SUPPORT - 757 POUNDS. RIGHT SUPPORT = 757 POUNDS. MOMENTS AND SHEARS: DESCRIPTION MOMENT('#) SHEAR(#) LEFT SIDE OF LEFT SUPPORT 0 0 RIGHT SIDE OF LEFT SUPPORT 0 757 LEFT SIDE OF RIGHT SUPPORT 0 _757 RIGHT SIDE OF RIGHT SUPPORT 0 0 CENTER SPAN MAXIMUM MOMENT IS 3.00 FEET FROM LEFT SUPPORT ! 2,271 757 TO 60/90'd sioncoad JNInIns 1UGNI1 Zti:7-T 0007--b0-NUf L 61 * * MATERIAL PROPERTIES * * ELASTIC MODULUS (MEGA PSI)...... ALLOWABLE BENDING STRESS (PSI).. ALLOWABLE HORIZ. SHEAR (PSI).... ALLOWABLE OVERSTRESS (t)........ MAXIMUM ALLOWABLE STRESS (PSI).. MAXIMUM ALLOWABLE SHEAR (PSI)... * * SECTION PROPERTIES FOR A 3.125 X 6.000 1.800 2,400 165 0 °a 2,400 165 BENDING STRESS (PSI)........ 1,453 SHEAR STRESS (PSI)........ 61 No reduction has been applied. { tiDEFLECTIONS * BASED ON NO. OF MATRIX POINTS USED IN THE REAL MOMENT APPROXIMATIONS, THE ACCURACY OF T1IE CENTER BEAM MAXIMUM DEFLECTION POSITION IS PLUS OR MINUS 0.00 FEET. MAXIMUM DEFLECTIONS: DEFL. (INCRES) POSIT. (FT) CENTER SPAN 0.33 4.50 DEFLECTION FACTOR = CENTER SPAN / MAXIMUM DEFLECTION= 322.64 60iL0 ' d Sionao ld ON I al I nE 1UGN I I E T: z ti 0002-b0-Ndr I L JOB NO. Crocker Sales Chandler Job * BEAM DESIGN AND ANALYSIS PROGRAM * COPYRIGHT 1990 by MTI SOFTWARE, SANTA ROSA, CA. For use by Lindal Cedar Homes * * BEAM GEOMETRY 165 LB/FT y," I 10.2 FT 'BEAM DESCRIPTION: Fir Glulam Rafter , OVERALL BEAM LENGTH (FEET)...... 10.2'0. DISTANCE TO LEFT SUPPORT (FT)... 0.00. DISTANCE TO RIGHT SUPPORT (FT).. 10.20 (DISTANCE MEASURED FROM LEFT END) * * LOADINGS * * LOAD DESCRIPTION: UNIFORM LOAD ON CENTER SPAN (PLF)............ 165.00 * * LOAD CALCULATIONS REACTIONS: LEFT SUPPORT - 841 POUNDS. RIGHT SUPPORT = 841 POUNDS. MOMENTS AND SHEARS: DESCRIPTION LEFT SIDE OF LEFT SUPPORT RIGHT SIDE OF LEFT SUPPORT LEFT SIDE OF RIGHT SUPPORT RIGHT SIDE OF RIGHT SUPPORT CENTER SPAN MAXIMUM MOMENT IS 5.10 FEET FROM LEFT SUPPORT * * MATERIAL PROPERTIES * * ELASTIC MODULUS (MEGA PSI)...... ALLOWABLE BENDING STRESS (PSI).. ALLOWABLE HORIZ. SHEAR (PSI).... ALLOWABLE OVERSTRESS (%)........ MAXIMUM ALLOWABLE STRESS (PSI).. MAXIMUM ALLOWABLE SHEAR (PSI)... MOMENT(4) SHEAR (#) 0 0 0 841 0 -841 0 0 2,146 0 1.800 2,400 165 001 2,400 165 01/04/2000 60/80'd SionaONd ON I Gi I na -1UGN I 1 Z: Z Z 0002-b0-Ndt 6 60'd -ld101 * * SECTION PROPERTIES FOR ,A, 3.125 X 6.000 BENDING STRESS (PSI)........ 1,373 SHEAR STRESS (PSI)........ 61 No reduction has been applied. * * DEFLECTIONS * * BASED ON NO. OF MATRIX POINTS USED IN THE REAL MOMENT APPROXIMATIONS, THE ACCURACY OF THE CENTER BEAM MAXIMUM DEFLECTION POSITION IS PLUS OR MINUS 0.00 FEET. MAXIMUM DEFLECTIONS: DEFL. (INCHES) POSIT. (FT) CENTER SPAN 0.40 5.10 4 DEFLECTION FACTOR = CENTER SPAN / MAXIMUM DEFLECTION= 307.78 l 9F 60/60 ' d sionaoNd ON I ai i na -lUaN I I E Z: Z T 0002-b0-Ndf cz Q ►-i¢ fQ O u w cn o z "a �J g �tu w w , v U x � O v R' c�: w" a O w u u w p u: chi w p -- O w w w Q w as o z cn cn Ouj c� o m c c � VT . O .� d'0 AR CA •�aR ID iEAQ m c :mo 'r m N y 0 E �vo -.13,CL i=+ �v�mm N cm m C � - m HC R t' N V � o -:��Z coc m H O p H W C r.+ -0=*" L c m-- _`" N dt O C U LU �E v L cm o m c C 0. O = A .0 CD H �O I- t r0 ` . d w m z 0 ►0 O :U U z O U M g_ E0 C) ac 01 " y LA coL C O CD 0 _Cqu CL CO2 0 0 V CO) C O O .0 cc Q. H w co �co 0 C. = cv cv J .0 O O Z co CL cn C 0 'U) LU V ) w w crw LLJ U) Location ' r2 Date 3T 4 &ORTN TOWN OF NORTH ANDOVER . A Certificate of Occupancy Building/Frame Permit Fee $ $ "•'•°'''<� s�CHusE Foundation Per It F $ Other Permit"`' $ $r U Sewer Connection Fee $ —� Water Connection Fee $ l4� TOTAL /$ /D� 16/94 Building Inspector / n 71 U9.10 19.50 biv. Public Works PERMIT 7;p. /O I APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. 1/AGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO. I i LOCATION 'Z-10 441iA '7&-r`S7-` PURPOSE OF BUILDING �O r� �U 57&c� 3 c/7 Gid GY OWNER'S NAME j�^r/ �� /0/GE NO. OF STORIES SIZE OWNER'S ADDRESS ��,��, BASEMENT OR SLAB a&Lel�/S•oois' ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST ZA.� 2ND 3RD BUILDER'S NAME 5eLl=- SPAN /O F DISTANCE TO NEAREST BUILDING -36, DIMENSIONS OF SILLS '" "' POSTS DISTANCE FROM STREET �Op ! DISTANCE FROM LOT LINES - SIDES ys r REAR �� "" "' GIRDERS AREA OF LOT 4 FRONTAGE �-3 HEIGHT OF FOUNDATION -, THICKNESS IS BUILDING NEW SIZE OF FOOTING ��� 6L/ X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND i�cs. WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER �yv, BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER /VC, - IS BUILDING CONNECTED TO NATURAL GAS LINE- /i/v INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FIL SIGNATURE OWNER OR AUTHORIZED AGENT F E E r 0 PERMIT GRANTED 19 "J� �0 ��- OWNER TEL. #69;7-3;K,517. CONTR. TEL. # CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST 09 EST. BLDG. COST j6 vs - EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN _ %/11w -'a d&Z BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE HARDW-D 3 1 2 13 _ _ CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL - FIN. B M T' AREA '/. '/r '/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS II 9 FLOORS CLAPBOARDS B _ 1 ��_ 2 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING HARDW D COM/.ACN ASPH. TILE VERT. SIDING _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I�POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP GAMBREL FLAT BATH (3BATH (3 FIX) MANSARD TOILET RM. (2 FIX.( SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD SHINGES SLATE KITCHEN SINK NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2�d ELECTRIC _ '3rd I NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. lsr� N 0 .o Lu N -60 2C2.y.7' 30' TOOL. s HC ►� CP2oPoSE� �oc�+'7oI�/> 67' I I l I I ' I I NB7# F`4 4F Mgsl ROBERT KING a� ria. 17871 o Qr .o�o'QFCIS7E��„ "ZS/ONAL ErV\ NOTES s I. THIS PLAN WAS NOT MADE FROM AN INSTRUMENT SURVEY AND IS NOT FOR RECORDING PURPOdES. THE PLAN smows THE CONDITIONS EXISTING AS OF THE DATE SHOWN HEREON. CERT/i/GIT/ON IS FOR MORTGAGE PURPOSES ONLY. PROPERTY LINES AS SHOWN ARE APPARENT ONLY. 2.., TME PREMISES DID CONFORM WITH LOCAL ZONING ORDINANCES AT TIME OF CONSTRUCTION. 3. TWE PREMISES DO NOT FALL WITHIN A FJ -WD HA ZA RO ZONE. MORTGAGE CERTIFICATION SKETCH FOR Ir•.e aeeiisTr A7 270 WluTE�2 sr.2EF7' No. 0%vDo veA , 10 ' . PREPl4ITE0 BY r. G/GUERE ArlAoC .4 550 C/A TES 17 AVAL L /4M S 7 A41, 00VR-Rl NErCSS- —L �— _ lN / N T I CERTIFY TO Tf1E ANDOVER B.4".jr ANO /75 r/ 7"1-.E /INSC/RER THAT rMIS PLAN DEPICTS THE RESULTS OF A CURRENT EXAMINATION OF THE PREMISES DESCRIBED IN RECORD 8009 IM, PARE 3z6 ar THE A4. ES.9EX REcis TR r of DEEDS AND THAT ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ow THF GROUND AS SNOWN HEREON. AG s p SEE A4,,f,.J 0' 30o L . NOTES s I. THIS PLAN WAS NOT MADE FROM AN INSTRUMENT SURVEY AND IS NOT FOR RECORDING PURPOdES. THE PLAN smows THE CONDITIONS EXISTING AS OF THE DATE SHOWN HEREON. CERT/i/GIT/ON IS FOR MORTGAGE PURPOSES ONLY. PROPERTY LINES AS SHOWN ARE APPARENT ONLY. 2.., TME PREMISES DID CONFORM WITH LOCAL ZONING ORDINANCES AT TIME OF CONSTRUCTION. 3. TWE PREMISES DO NOT FALL WITHIN A FJ -WD HA ZA RO ZONE. MORTGAGE CERTIFICATION SKETCH FOR Ir•.e aeeiisTr A7 270 WluTE�2 sr.2EF7' No. 0%vDo veA , 10 ' . PREPl4ITE0 BY r. G/GUERE ArlAoC .4 550 C/A TES 17 AVAL L /4M S 7 A41, 00VR-Rl NErCSS- •Out `SOOIIUaS Jeju9wu0.unu3 8Sd I QV 'A38 10'00 WMOJ 3JLVO AS r ory eor As 'dwoo 1TJ-1S ?���vrM 01 Z ioaroad 0 /a !1 �-rCIL� N ora w _ Z N c) LL 3JLVO AS r ory eor As 'dwoo 1TJ-1S ?���vrM 01 Z ioaroad N ON .--1 tz ►e H xP-W o A ¢ 4C/)a u \ ° ci a cn E- z z W G o w° X00 � c U c w � PW c z z Cir :3 rL R w O z U U W :1 4 > cn m w OU z ¢ C7 :3 � ro w w w W c aq o v cn v o cn UOD LM r � z tNi M U CO > c 0 0 o z m c GoC c 15 o s o ` Z o Q. c +•- O Co CO) c 0 z CO Q� G: Qc Cc Cc LULU U) G3 c z co o cc �CD :o CD ca � O EQ O i _R O d `mom CMQ `i CD ' :♦ $ c. N O m co COD c •. CD O O C.3 -- C �C m c E cc Q. CL m CLD O CO N eT m co) z J •� 2 C N c O O � N E O.4.p� m CD C = o cm o NQ m o� ��Z o C" oo o. c •p F- Q � y m C = m :moo N m COD yp N CDs'— W LL O •N 'O � Com•,,, m ea ea ..� p N •O.L C Z LU `m c m c CIO co m :2 O � CDH •OCD = a:4E"m� tNi M U CO > J Q o z E GoC i 0 o s Z o Q. O O CO) z CO o G: c y �r LULU U) m m z co = ca � O i O O i _R O d CL CMQ H C -� O Cc co COD Z � CD _z C.3 R C �C cc CL CODC3 G z z z J cr w CL z CL -- LU Q W 0 W Q LU W Cn Location 70 S� No. -3 t.t,/ Date = C, " tel "ORT" TOWN OF NORTH ANDOVER .6'6 O? `•� ,- a O� „ Certificate of Occupancy $ Building/Frame Permit Fee $ ss Et Foundation Permit Fee $ Other Permit Fee $ �?- ?A*i�nnection Fee $ �© J%later Con��ction Fee $ L $ 0110ecfOr Building Inspector Div. Public Works Location No. Date .:� r - r ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ :Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ A4 Sewer Connection Fee $ 'VA Water Connection Fee $ �=OTAL $ 4_ Building Inspector Div. Public Works PER3IIT NO✓ / APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KdO. LOT NO. 2 RECORD OF OWNERSHIP IDATE- BOOK 'PAGE — ZONE SUB DIV. LOT NO. I LOCATION , , PURPOSE OF BUILDING OWNER'S NAME-L.i+JaI�YlI'i`i r!{ G' NO. OF STORIES". "_ ,i+ SIZE OWNER'S ADDRESS - .f.�, �Yt BASEMENT OR SLAB ,t /•j r ARCHITECT'S NAME - SIZE OF FLOOR TIMBERSr' IST 2ND 3RD BUILDER'S NAME SPAN %.q - 414 - DISTANCE TO NEAREST BUILDING r DIMENSIONS OF SILLSj,,, --_ DISTANCE FROM STREET amu. r POSTS r) DISTANCE FROM LOT LINES - SIDES REAR -75'� ` GIRDERS ,P AREA OF LOT d,ek FRONTAGE ✓/.j� • `••,4» HEIGHT OF FOUNDATION � THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY ' �i 4, i <'' • w- �1 ,f'ti, i d.'. "'T+� 1..•zt trod` IS BUILDING ALTERATION,MrN(�jr. / IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yle:Cs IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER - IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES �,f �r PAGE 1 FILL OUT SECTIONS 1 - 3 4 1' `.j„ i��. "r"i C, PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED��"V�%(f G f Yr SIGNA OF OWNER OR AU OR ED AGENT FEE .+ PERMIT GRANTED 61/a G ` 19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN f— WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer 'NV-ld lO1d S3OV1d3M SIHl 'a3SOdwim3dnS 013 'S30WH -V9 'S3HO2lOd H11M 'SONIC-pn8 =fo SNOISN3WIa 10VX3 CNV S3N11 101 WOUA 30NV1SIO CNV 10-1-40SNOISN3Wla 10VX3 MOHS1SnW NO11O3S SIHl zt I ADNvdn000 l CIV033b JNIaiins ONIIV31-1 ON _ I r Pic I +' L P"L DIM313 110 SWOOV d0 'ON L SV'J Sa31V3H 11Nn O.1.H 1NVIOVa ONINOI110NOD aIV aOdVA a0 a.1.M WH _ Sa311tla DOOM SlOJ '8 'SW9 1331S WV31S Nana aIV IOH MAW 3JVNanl SS313dld _ 'S10J 8 'SW9 a39W11 1S10f DOOM DNIIV3H ll II ONIWVHI 9 S OOVO 3111 aO011 3111 S3anlXIA Na300W `JNIJOOa 1108 _ a3MOHS 11V1S I . ,.:_ 13nVa0 '8 aVl ONI9Wn1d ON 31V1S _ NNIS NIHDIDI S30NIHS DOOM AaO1VnV1 S310NIHS 11VHdSV 13S01D 831VM (13HS lVll 13a9WV`J I'm Z) 'Wa 131101 OaVSNVW X1 E) H1V9 dIH 319V0 JNiownid 0 doos 9 3 a00d t-1 aO18 dns ONIUM _I 80011 a Sats D111v 3WVal NO 3NO1S AaNOSVW NO 3NO1S 'X19 a30NIJ a0 ':)NO:) 3WVa1 NO )0189 kdNOSVW NO )1)189 — E F 9Cl 3wv81 No omnis Aallosvw No omnis 3111 'HdSV ONIOIS 'lain N7VVWOD ONIOIS SOIS39SV MlldVH 11VHdSV ONIOSCIZIVO HAV3 S310NIHS DOOM 313aDN0D VIS ID SMOOId 6 S11VM b N3HD11)I Nd300W S37Vld Sall V3aV DIIIV 'NIl V3aV .1.W.9 Nil WOOa OV3H 1.W.9 ON llnl Via\$. 1N3W3SV9 £ _ 6 .. Z _ 1 _ - E N11Nn .,r 11VM Aa0 a31SVld Sa31d 3NOIS 80 )17189 ')i.19 313dDNOD Q.M(3BVH 3NId 313dDN0:) HSINII 8O113INI 8 NOUVONf10d z NO110nNISN0o Sl N3W1aVdV s3DIll0 Allwvl 111nw _ N S31a0's Aliwy1 31O1S zt I ADNvdn000 l CIV033b JNIaiins WOOD STOVE INSTALLATION CHECKLIST PERMIT # Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New Used B. Type/radiant Circulating ✓ L ^�' C. Manufacturer 6;0410f ZAAC Lab. No. v4-, /Y$Z 41vs/—!/4-737 WZ-Coz Name/Model No. Tflr" /o-F3u¢s 725X 3o Collar size '7" Dimensions/ Height 33J� Length -3 Width 23" Chimney A. New Existing ✓ B. Size (flue area) 6!� A// '' �-- 7/.5' ;-,Z- nC. C.Other appliances attached to flue (Number and flue size) No^ -E D. Prefab (Manufacturer—name and type) �14 E. Masonry/Linedy Flue liner Unlined (type & manufacturer) F. Height (refer to diagrams) cap 410iVe7 CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction 54 -is C. Minimum dimensions (refer to diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided A1011'e B. Clearances (refer to diagrams) FIREPLACE CORNER HEARTH WALL/CENTER 13 10 cap factory -built chimney root support support bracket connector pipe non-combustible wall protection connector overlap `- woodburning stove non-combustible floor protection Figure 2109.4 Figure 2109.4 STOVE INSTALLATION CLEARANC Combustible . 1/2" Asbestos Millboard (Concrete/ Masonry Spaced Out 1 " Stove Components Materitil Spaced Out 1 " 2. Foundation Wall 4 " Brick Veneer Radiant Stove 1. 36" — — - -Front Circulating Stove 1. 24" — — — —Front A. Radiant Stove 3• 36" 18" 6 l—_Side/-Back/Tgp �. Circulating Stove6 12" 6„ ' —Side/Back/Top B. Single \f a 18,. 12„ 6„ 8" Connector Pipe B. Insulated 2.. 2 " 2 ^ 2 " Connector Pipe C. Chimney Height Three (3) feet above adjacent roof and (Metal or Masonry) two (2) feet above any roof ridge within 10 feet If a damper is not included in the stove construction, D. Damper p it must be installed in the connector pipe. 12 1. Front: Fuel or ash access side. 2. Non-combustible spacers required. 3. Clearances on each side of a radiant stove with a heat shield shall be measured as if a circulating type Note: Clearances shall be measured perpendicular to stove body. Laboratory verified test clearances permitted.