HomeMy WebLinkAboutMiscellaneous - 28 STONEWEDGE CIRCLE 4/30/2018 (2)a
Date ...... $ .........
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TOWN OF NORTH ANDOVER
PERM I T FOR WIRING
cm
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41-. Th""'eirtifies that
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ifiing of .........................................
........................ .. ........ ........ ............................... . North Andover, Mass.
No. ...............
....... . ............. Lic
ELEcTRicAL INSPECT67
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked
Lev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfonned in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLE_4SEPNNTrNNK OR MEALLMFONIIATION) Date:
City or Town of. NORTH ANDOVER To the In�pector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below,
Location (Street & Number) �.g QT641p,,
Owner or Tenant q:!ZJJ1ZA1A&1 Telephone No.
or=� Aq -In Era, 1, �VO
Owner's Address A CnTawi 1� Mt AA00?4- AR
Is this permit in conjunction with a building permit? Yes No (Check Appropriate 13ox)
Purpose of Building EA55y,@Z kJgkUV
Al "Y) 'Utility Authorization No.
Existing Service 1;�-90 Amps volts OverheadEl Undgrd No. of Meters
New Servic Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion ofthe followinz table mav be waived bv the Inspector of Wires.
No. of Recessed Luminaires
Zt
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above M In- E]
No. of mergency Lighting
grnd. L -J grnd.
BatterV Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I N*o. of Zones
No. ofSwitclies
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: �
Number
............ * *1--
I Tons
**
I KW
[* *
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Munlc'pPl El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
0. of No. of
Data Wiring:
Heaters
Signs Ballasts
. No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or EU uivalent
OTHER:
Attach additional detail ifdesired, or as required by the Inspector of 07res.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with YIEC 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 operation7' 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.
cBEcK ONE: iNsu_R_A_NcE F] BOND [I OTHEREI (Specify:)
Icerfify, underthepainsandpenalties ofperjury, thatfiteinformation on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: Signature LIC. NO.:
(Yapplicable, enter "exempt" in the license number line) Bus. Tel. No. -
Address: Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
requixed by law. By my signature below, I hereby waive this requirement. I am the (che one) D owner El owner's agent.
Owner/Agent 3ZO,
Signature —Telephone No. PERMITFEE: $
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension. of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
El The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
1�o'te: Reapply f6r new permit 0
0 Rule 8 — Permit/Date Closed:
0 Permit txtension Act — Permit/Date- Posed:
Trench Inspection
Pass
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signatu re:
Date:
PARTIAL ROUGH INSPECTION:
Pass
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass n?
Failed IN
Re- Inspection Required D_
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSP06TION:
Pass M 1Z
Failed
Re- Inspection Required D
Inspectors Comments:
4 01
od
Inspectors Signature: aj&&
Date:
DEBWEINHOLD ... TOWN OF MERRIMAC, MA.
Commonwealth of Massachusetts
Department ofindustrialAccidents
I Congress Street, Suite 100
Boston, HA 02114-2017
www.mass-gov1dia lWb
- Buffders/ContractorsM�ectridansip ers.
rkers� Compensation insurance Affidavito
wo TO BE FILED WITH THE PERMTTING AUTjE(ORITY'
Name (Busi d6rga4ii��dual):
Mes
Address:-
City/State/Zip: Phone
chec� ifie appropriate box:
Are you an emP!0Ye
10 1 am a empl6yer with __L__,.�roPl'y"' (f"ll and/or part-tiroe).*
2.Fj I am a sole proprietor Or Partnership and have no employees working for me in
any capacity. [No workprs,comp. insurance required.]
[No worke
3.Fj I am a homeowner doing all work myself rs, omp. insurance required.] t
<1 I am a horneomer and will be hiring contractors to conduct all work on my property. I will
.Sure that all contract6p either 1�avc workers' compensation insurance or are sole
- , I fi 111�-�11�
proprietors with no 160'g. ce�s.
5.F] I am a general contracfor�gh.4 I have hired the sub -contractors listed on the attached sheet
These sub-contract�li��av� �joyee� and have workers' comp. insurance.$
6rs have exercised their right of 'exemption per MGL c.
6.Fj We are a corpora,Ojoii and its. offic
8 1(4) and'WehaV6 no. epPjqlye'�e [No workers' comp. insurance requiredj
Type of pro*t ii6
7. Ne 'd6nstr66fl0R
8. Remodeling
9. El Demolition
10 [] Building addition
ME] Electrical reRairs or additions
12. s
j-rm%ng repair 'oi additions
11 El Ro6f repairs
14. Other-----.
compensation policy ifformatiOn.'
*Any applicant thatch " b , ok �Ii miist So flu out the section. below showing their workers' affidavit indicating such
oing; all work and then hire outside contractors must submit a now
'i Romeowners who slj�njj�'",e&avlt indicating they are d ors and state whether or not those pntit�es� have
ached �n additional sheet showing the name of the sub -contract
tContractors that check this box mus att. comp. policy number.
-1 . . st proyide their workers
employees. If the sub-captr
�acqrs have employees, they mu
ensation insurancefor MY enVIbYees- Pelow is thepolicy andyob site
f am an employer t1lat is providing -workers' e0np
in rmation.
insurance Company
policy # or Self-ir[S� UG. #;
Expiration Date,
----------
City/State/Zip:
fob Site Address olicy declaration page (showing the Policy number and expiration date).
Attach a copy of the workers, compepsation P sh
'coverage as required iinderMGL c. 152, §25A is a criminal violation puni able by a fnib up to $1.,500.00
Failure to secure penalties in the form of a STOP WORK ORDER and a fine of up to $.250'.00 a
and/or one-year imprisonment, as well as civil
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
is irue ariv, cul 1
thepains andpenalties ofperjury that the information providea aDove
Date:
Sigriati 0:
ofyicial use only. Do not write in this area, to be completed by c1tY or town official.
City or Town:
Permit/License #.
issuing Authority (circle One): . i wn : s c
1. Board of Health ?,. Building pepartment 3. City/To Clerk 4. Electrical In pe tor 5. Plumbing Inspector
6. other
Phone4:
Contact Person:
Information and Instructions
Massachusetts General Laws chapter 152 requires' all 6mlloyefs to provide workers' compensation for theiK pnipiby�"e§.
Pursuant to this statute, an employee is defined as "...every person in the service of another undek'� any contract O'iA
express or finplied, oral or written."
An employer is'deffied as "an in:dividuat, partnership, association, corporation or other legal entity, or an
y two or more
of the foregoing engaged in ajoint enf6rprise, and including the legal representatives of a deceased employer, or the
receiver Or, trustd'd of an individual, partnership, association or other legal enifty, employing empl.bypO. - Hollyeve.r the
owner of a dwelling house having not more than three apartments and who resides therein, or the . occu'pf'A�j . 6f66
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelli-11v house
or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer."
M.01, C * hapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any
applicantiwh6: has not produced -acceptable evidence of compliance with the insurance coverage req` uired."
Additionally, MdL ch?[Ptqr 152, §25C(l) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic -work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Pleasb fill out th6.Workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
nece�s�ry, supply sub� contractor(s) name(s), address(es) and phone number(s) along with their certificate'
1. (S) of
insurance. Limited -Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employeesoilier than the
members or partners, are not required to carry workers' compensation insurance. If anLLC o*rLLP d6e's have
employees, a policy is required. )�e 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.afidAvit should
be returned to the city,or town that the application for thepermit or license is being requested, not.the Department of
JmdustriallAccidents. Should you have an y* questions regarding the law or if you are re
quired to obtain a w`&kers'
compensatioil policy, please call the Department at the'number listed below. Self-insuredicompanies sl�oiiidenter their
self-insuranc'e 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 ofInvestigations 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 �pplicant
thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy inf(jimation (if necessary) and under "fob Site Address" the applicant should write 5'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 now affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or pemiit 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 Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-AIASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
Date
,j0RTh
of 6"4, TOWN OF NORTH ANDOVER
0-
0
40 PERMIT FOR PLUMBING
CHUS
This certifies that . ................ .................
has permission to perform ....................................
plumbing in the buildings of . A.A? 4?:� ...... 3kd r .............
at. .......................... ISlo h Andover, Mass.
Xk
...........
PLUMBIN INSPECTOR
Check #
5555
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date 3-jf-;2LV-S
Building Location SjoNe- We OwnersName AVj0V1'fL Permit#
E pe
Amount
Type of Occupancy
New Renovation Replacement Plans Submitted Yes No
FIXTURES
Cn z En
0
U En
zo
U >
Lei CA
0
SLIMM
BA99ANr
MRaR
—MRUR
4M FUM
5M RDCR
61H FLOCR
7]HHDM
91H FLOCR
(Print,or type) Check one: Certificate
Installing Company Name &C-orp.
Address 00 Partner.
.glel-ON S� X4
Business Telephone, TIT 77M Firm/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: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
4L�= ,, "'L -L
=ipature Owner ED— Agent E]
A 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
q compliance with all pertinent provisions of the Massach tate Plum *g CAe7nd Chapter 142 of the General Laws.
A 4;;� e,
=J �—,*Lk
By: Yl-g-n-aT&U-0T LICenSea riumDer
Type of Plumbing License
Title
City/Town Master r-ZP--4ourneyman
17cense Murnour
APPROVED (OFFICE USE ONLY
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION -
A to f C_ a
*This
-certifies that ... T.,. .................................
has permission for gas installation s .........
in the buildings of Ii �4� ................ .
- ��. 8 % 0 A- p_ U.,
at JA 9� .. .... .... ...... C9_T�.("'Rorth Andover, Mass.
GAS INSPEC. ........
Fee../71'�'.. Lic. No. ... /OR
Check# 21 a,-(
4322
MASSACHUSETrS UNDDRM APPUCAIDN FOR PERNffr TO DO GAS FfrnNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations -�o *OAJe'
Alyjave�L- Owner's Name
New [I- Renovation [D Replacement [:]
Plans Submitted
Date ---3 - I I Poo-%
Permit #
Amount $
(Print or type
,1,
C.h_e_ck one: Certificate installing Company
I Corp.
Address V�j I Y4*f - nPartner.
Business Telephone 9�rA - 375-- 7979 ElFirm/Co.
Name officensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [R-- Noo
Ifyou have checked M, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 19— Other tylx of indemnity [:] Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. ral Laws, and] that my fignature on this permit application waives this requirement.
4t�tANA11-6,- - Check one:
Sign of Owner or Owner's Agent Owner [a Agent 0
i her�)y certify that all of the details and information I have submitted (or entered) in above application are true and accuia weto th�e
beitpfiny knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
comAance with all pertinent provisions ofthe Massachusetts StatePoKode and ChapterJ42 of the Peneral Laws.
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
a—number 4 U-1 q .
0 Gas Fitter License Num5er
M—Master
E3Journeyman
4TH. FL*4�R
(Print or type
,1,
C.h_e_ck one: Certificate installing Company
I Corp.
Address V�j I Y4*f - nPartner.
Business Telephone 9�rA - 375-- 7979 ElFirm/Co.
Name officensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [R-- Noo
Ifyou have checked M, please indicate the type coverage by checking the appropriate box.
Liability insurance policy 19— Other tylx of indemnity [:] Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. ral Laws, and] that my fignature on this permit application waives this requirement.
4t�tANA11-6,- - Check one:
Sign of Owner or Owner's Agent Owner [a Agent 0
i her�)y certify that all of the details and information I have submitted (or entered) in above application are true and accuia weto th�e
beitpfiny knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
comAance with all pertinent provisions ofthe Massachusetts StatePoKode and ChapterJ42 of the Peneral Laws.
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
a—number 4 U-1 q .
0 Gas Fitter License Num5er
M—Master
E3Journeyman
Location 14 "J'q �-S70A),eu)pdf,
No. —3 Date
Check it
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $ 1,00
Other P ermit Fee $
TOTAL $ j
16103 Building Inspector
W_
TOWN OF NORTH
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERM[IT NUMBER: DATE ISSUED-
1,�2 —
SIGNATURE:
Building Commissioner/IR�Rector of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
4_r -9-111, r_ 14�e Y_
1.2 Assessors Map and Parcel Number:
lob 13
Map Number Parcel Number
1.3 Zoning Information:
Zoning Diii�d_ Proposed Use
1.4 Propefty Dimensions:
Lot Area (so Fronta&e (ft)
1.6 BUILDING SETBACKS )
Front Yard I,' . ' Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public De Private, ' D Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal OnSiteDisPosal System 0
SECTION 2 - PROPERTY OVVNERSHW/AUTHORIZED AGENT
2.1 Ownerof Record
L"L
Name (Print) Address for Service:
s r iin-a—ture Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3'eCONSTRUCTION SERVICES
3.1 Licensed Construcfion Supervisor:
Se, 1ze_
Licensed Construcly' on Supervisor�'
A__ C
ess
19�-gnature Telephone
Not Applicable 0
0S75
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
..Not Applicable X,
Company Name
Registration Number
Address
Expiration Date
Signature Telephone'
ou
M
X
z
0
Mn
M
z
G)
SECTION 4 - WORKERS COMPENSATION (XG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ...... V;8�, No ....... 0
SECTION5 Descriptiono Propoiid Work (chevck applicable
-7 FA
New Construction�,B Existing Building 0 Repair(s) 0 Alterations(s) ddition 0
3
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
X"It ell— Q-0 (9
C,
SECTION 6 - RSTTMATRD
- r 11 1 V.
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
XV -1
]SE 0 !Lv
I Building
�3� 0 0
(a) Building Permit Fee
Multiplier
P.,
2 Electrical
-(b) Estimated Total Cost of
Construction
-3 PlumNgg
Building Pen -nit fee (a) x (b)
-4 Mechanical (HVAC)
to,
5 Fire Protection
-6 Total (1+2+3+4+5)
L) ) 0—>
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
I
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMT
as Ovmer/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, se�_ '37- &' �� as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
f4
P
A,) -U
Slature of Owner/Agent Date
'� . 1— -1 RMER NO
NO_qJ_S_T_0RIES SIZE
=7 BASERIJ��T N OR SLAB
9mr—or FLOOR TIMBERS I s1r oap'_'N 2 ND 3 RD 0—c", fj3
SPAN k 6 ,
-DIMENSIONS OF SELLS 0--< 6 VV��_
-DINENSIONS OF POSTS
-DIMENSIONS OF GIRDERS
HE IGHT OF FOUNDATION THICKNESS
-SIZE OF FOOTING - X
MATERIAL OF CHIMNEY
IS BUILDIN ON SOLID OR FILLED LAND 4A
IS BUHDING CONNECTED TO NATURAL GAS LINE
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OCT -16-03 09:00 AM EUGENE T. SULLIVAN INC. 508 657 8563 P.01.
EUGENE SULLIVAN, INC.
Consulling Enghieers-
October 17. 2003
Andover Builders
AttentJon:
PLANNIM;
DIN0.0))HIM' RE,
Puma PR(X'I'S�
D1:.,Si(iN
CON.SiRIX-01,S
We understand the tile in the master bath, has not been completed at this time and that the materials to
complete the work are on back order, We also understand the Installation will be completed as soon as
the materials are available.
If you have any further questions regarding this matter, please contact me.
Sean Szekely
28 Stonewedge Circle , ,
North Andover, MA 01845
Sincerely,
Gene Sullivan
31 S1 WAIDAN ROAD WII,MINGTON. MAO 1887.
Ti?i,, 978-057-6469 FAx. 978-6.57-8563:
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—Location
No. 33 C;z Date 0
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
CHU
Building/Frame Permit F ee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
b002 -
&000 —
16124 A�, ( Cv, —
Building Inspector
JAN -27-03 MON 1,2;22 S.E.Cummingr. Associa't-es P.01
CER rIFIED x o r A A N
SA CUMMINeS & A S$001A rES
P.O. BOX 037 P"I=W, N.1i 00865
rEI.E.&HOW ilmOX-882-5085 FAX. 6000)-382-5210
'L=71 fk
Rt� w C
,R=250.00
L=36.79'
�cj
00
LOT 5
LOT AAEA=90.131 SF
CBA=32,823 SF
E T
0 L r\
0.
1X4
41
! ui
hk
MINIMUM SET@ACKS:
TAX �MAP 210 BLOCK 106—B co 4
FRONT 30 FEET
LOT 5
30 FEET
WEBSTER WOODS LANE 'y' SIDE
NORTH ANDOVER, MA.' I REAR 30 FEET
PREPARED FOR: 0�5e; 1 HEREBY CERTIFY TO TOWN OF NORTH
ANDOVER BUILDERS ANDOVER, MA BUILDING DEPARTMENT
6 MULBERRY CIRCLE THAT THE EXISTING FOUNDATION
DRAWN ON THIS PLAN IS LOCATED AS
ANDOVER, MA. 01810
SHOWN AND THAT IT DOES comr'LY To
DATE: JANUARY 17. 2003 THE MINIMUM BUILDING SETBACKS TO
PROPERTY LINES.
SCALE 1" 60'
Town of. North Andover %AORTIJ..,
Building Department
27 Charles Street
North Andover, Massachusetts 0 1845 , 00
(978) 688-9545 Fax (978) 688-9542 47
APPLICATION FOR CERTMCATE OF OCCUPANCY / INSPECTION
I
ADDRESS
C, �- - ( �=
LOT NUMBER _SUBDIVISION__f��—,,
DATE REQUEST FILED
DATE READY FOR INSPECTION
T'EN (10) DAYS NOTTCE PRIOR To CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME
FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE
CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGNATURE
OFFICL&L USE ONLY
ROUTING
D. P. W. — WATER NUCE TE Z&=:_DATE
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
--PFdM TO TIMINSPECTION REQUEST DATE.
TURE / DPW AUTHORIZATION
FORM U - LOT 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.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT
LOCATION: Assessor's Map Number hw 06
SUBDIVISION
STREET
Q L7
A,
P H 0 N 9 — � V,30
PARCEL
LOT (S)
ST. NUMBER
5-
5 �1-111,e 411 1 1�r
F—RECOMM E INV Q o V -t -, t 13 A-,+- L-,,
3 A� 't-1, S
CONSERV &I
-2- 9 >( aLi =S
0
Z- 10
y 07 V =,a-19 L (!P 1,2 -
LS
N PLANNSi /I/ --V -10) A2 S-
i -.3 (,V—(5 _
COMMENTS,;,6,-- 17��6
1 16 66o — per
W
6�
- - —A —1
FOOD I SPECT'
a P
SEPTI INSPE
�
COMMENTS
PUBLIC WORK,--
FIRE DEPARTMENT
RECEIVED BY BUILI
Rievised 9\97 jM
A#JY
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Dep�,Mments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION.
�PH 0 N� E,:5�24-,O 9 V30
APPLICANQ L
LOCATION: Assessor's Map Number AK *6 PARCEL
SUBDIVISION LOT (S)
STREET
ST. NUMBER
USE
Lf!ECOMMEND TIONS OF TWN AGENTS:
,A
CONSERVAM, N ADMINI ATOR DATE APPROVED 10
S1, DATE REJECTED
COMMENTS Al,
/X,1/2/17 looV—Z�Z �Z I lqA
WN PLANNER. DATE APPROVED
DATE REJECTED '
COMMENT
FOOD 114SPECTOR-HEALTH
SEPTI XINSP4EC 0134—EALTH
COMMENTS
DATE APPROVED
DATE. REJECTED
DATE APPROVED
DATE REJECTED
F�F,�,M(T5 —Lc, ME: 44
PUBLIC WORKS - SEWER/W ATER CONNECTIONS
DRIVE P MIT
1712 FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97'jm
A#JY CoVs7P-'L;c-rioA/
TE—
I
The Commonwealth of Massachusetts
Department of Industlial Accidents
Office of Investigations
Boston, Mass. 02111
Worker-s'Compensation Insurance Affidavit
Please Print
Location:
city Phone #OF
I am a homeowner performing.all work myself.
I am a sole. proprietor and have no one working in any capacity
I am an employer providing workers! compensation for my employees working on this job.
Coml2any name:
Address (z
Cily: Phone #:
Insurance.Co.. Policy #
Company name: I
Address
Ci!y: Phone #:
Insurance Co. -PolicV #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,afine up to $1,500.00
and/or one years' impdsonment-as-wefl-as-cLv.ii.perialties in,lheform-d-a-STOP.W-ORK.DRDER-and-a fine of.l.$1-00.00) -a iday.against.me. I
understand that a copy of this statement may be forwarded to the Office at I nvestigations of the DIA for coverage verification.
do hereby certify d penalties of pedury that the information provided above is true and correct
Signature77!�:�-- DateZ_�h' �--6
Phone #
Print name S�L'�
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
[]Check if immediate response is required 0 Licensing Board
Selectman's Office
Contact person.- Phone E] Health Department
F1 Other
wle
�BOARD OF BUILDING REG.LILATIONS,
License: C0148YOU&ION -SUPERVISOR'
Nu, Gs
"T , mber: 069055
6iitWdAi4- 08/26/1968
1 A
Eicpii�ek-.08/26 . /2-004 Tr. n6: 2t17
0 ReitfGid:166
p,
,SEAN SZEKELYt,
'6 MULBERRY CIR,
M D`bVEAj , MA � 01810 _,AdMlhistr6t6r
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in,:
Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
GROWTH MAN�GEMENT BYLAW EXEMPTION STATEMENT
TOWN OF NORTH ANDOVERBUILDING DEPARTMENT
This form shall be used to assi I k the Building Department in their determination of exemption under section
8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the
necessary information as requested below.
a I JL__�
Permit Applicant Property address Map / Parcel
Applicant's Phone Number Single Fa�iil Two Family
I the undersigned applicant !for the above property attest that the attached building permit for which this form is completed
J
does comp ly with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not
absolve me or any party to this permit from the requirements of obtaining other permits required priorto the issuance of the building
permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only
officially accepted when the building p��iit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building
permit application and associated attachments . , complies with one or more of the following sections as indicated by a check mark.
This is an application for a building permit for the enlargement restoration or reconstruction of a dwelling in existence as
of the effective date ofthis bylaw, provilided that no additional residential unit is created.
The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 9.7 of the Zoning Bylaw.
Ibis application is for dwelling un I its for low and or moderate income fintilies or individuals, where all of the conditions
of 8.7.6 are metand or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens
through a properly executed and record1d deed restriction running with the land.For purposes of this section "senior" shall mean
persons over the age of 55.
Ibis application is part of a �'development project which voluntarily agreed to a minimum 40 % permanent reduction in
density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the
surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall
be protected from development by an A161cultural Preservation Restriction, Conservation Restriction. dedication to the Town, or other
similar mechanism approved by the plarining board that will ensure its protection.
'Ibis application represents a tract of land existing and not held by a Developer in common ownership with an adjacent
parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and
Development Scheduling provisions fbr�ihepurpose of.constructing one single family dwelling unit on the parcel.
This application represents
a! lot which is ready for a building permit ( all other permits from all other boards and
commissions have been received and th I
el project is in compliance with those permits), and the Development Schedule does not
accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as
the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this
EXEMPTION.
PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A
DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS.
BY SIGNING BELOW I ATTEST TO T! HE ACCURACY OF THE INFORMATION PROVIDED AND THAT THEATTACHED
BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE.
FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE
CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR
NO1J,S_GRQ =-OR REFUSAL BY' THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT.
4FOICANTS SIGNATURE DATE
TMS FORM TO BE ATTACBED tp I HE BUILDING PERMIT APPLICATION
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 3
TITLE: PLAN NO 8721
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 6-16-2002
DATE OF PLANS: 8-10-97
PROJECT INFORMATION:
COLONIAL HOUSE
INFORMATION:
BRUNO ASSOC
28 BERKELEY ROAD
N. ANDOVER, MA 01845
Permit #
Checked by/Date
COMPLIANCE! Passes
Maximum UA 689
Your Home 548
Area or Cavity Cont.
Glazing/Door
Perimeter R -Value R -Value
-------------------------------------------------------------------------------
U -Value
UA
CEILINGS 1945 30.0 0.0
68
WALLS: Wood Frame, 16" O.C. 3168 13.0 0.0
260
BSMT: Conc. 8.01 ht/7.01 bg/8.01 insul 1945 0.0
88
GLAZING: Windows or Doors 284
0.350
99
DOORS 93
0.350'
33
HVAC EQUIPMENT: Furnace, 87.5 AFUE
- --------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design described
here is
consistent with the building plans, specifications, and other
calculations
submitted with the permit application. The proposed building
has been
designed to meet the requirements of the Massachusetts Energy
Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the
buildin 9
shall be -no greater than 125% of the design load as specified
in
Sections 780CMR 1310 and J4.4.
TITLE: PLAN NO 8721
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software version 2.01 Release 3
DATE: 6-16-2002
Bldg..l
Dept.1
Use
CEILINGS:
1. R-30
Comments/Location
WALLS:
1. Wood Frame, 16" O.C., R-13
Comments/Location
BASEMENT WALLS:
1. Conc. 8.01 ht/7.01 bg/8.0' insul, R-19 interior cavity
Comments/Location
WINDOWS AND GLASS DOORS:
1. U -value: 0.35
For windows without labeled U -values, describe features:
# Panes Frame Type Thermal Break? Yes No
'Comments/Location
DOORS:
1. U -value: 0.35
Comments/Location
HVAC EQUIPMENT:
1 1. Furnace, 87.5 AFUE or higher
11 Make and Model Number
I AIR LEAKAGE:
[.,Joints, penetrations, and all other such openings in the building
I envelope that are sources of air leakage must be sealed. When
I installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated,, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated, in accordance with Standard ASTM E 283,,with no
(0.944 L/s) air movement from the the
more than 2.0 cfm
conditioned space to the ceiling cavity,. The lighting fixture
shall'have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled.
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
I Materials and equipment must be identified so that compliance can
I be determined. Manufacturer manuals for all installed heating
I and cooling equipment and service water heating equipment must be
provided. Insulation R -values, glazing U -values, and heating
equipment efficiency must be clearly marked on the building plans
or specifications.
DUCT INSULATION:
Ducts shall be insulated per Table J4.4.7.1.
DUCT CONSTRUCTION:
All accessible joints, seams, and connections of supply and return
ductwork located outside conditioned space, including stud bays or
joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the
manufacturer's installation instructions. Mesh tape may be
omitted where gaps are less than 1/8 inch. Duct tape is not
permitted. The HVAC system must provide a means for balancing
air and water systems.
TEMPERATURE CONTROLS:
Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in Sections 780CMR 1310 and J4.4.
SWIMMING POOLS:
All heated swimming pools must have an on/off heater switch and
require a cover unless over 20% of the heating energy is from
non-depletable sources. Pool pumps require a time clock.
HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled -fluids
below 55 F must be insulated to the following levels (in.):
NOTES TO FIELD (Building Department Use Only) -------------------------
PIPE SIZES
(in.)"
HEATING SYSTEMS:
TEMP (F)
2" RUNOUTS 0-1"
1.25-2"
2.5-4"
Low pressure/temp.
201-250
1.0 1.5
1.5
2.0
Low temperature
120-200
0.5 1.0
1.0
1.5
Steam condensate
any
1.0 1.0
1.5
2.0
COOLING SYSTEMS:
'Chilled water or
40-55
0.5 0.5
0.75
1.0
refrigerant
below 40
1.0 1.0
1.5
1.5
CIRCULATING HOT WATER
SYSTEMS:
Insulate circulating
hot water pipes to the following
levels
(in.):
PIPE SIZES (in.)
NON -CIRCULATING I CIRCULATING
MAINS &
RUNOUTS
HEATED WATER TEMP (F):
RUNOUTS
0-111 1 0-1.25"
1.5-2.011
2.0+11
170-180
0.5
1 1.0
1.5
2.0
140-160
0.5-
1 0.5
1.0
1.5
100-130
0.5
1 0.5
0.5
1.0
NOTES TO FIELD (Building Department Use Only) -------------------------
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