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Home My WebLink AboutMiscellaneous - 29 NADINE LANE 4/30/2018IT 0 Date... ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING s h . ......... .................... ! ...... 7(- - YC� ..... . I . .. Jcl� This certifie t at . ., .1 41 ('P ...... ... �.�; . ............. has permission to perform /,)A -J5 7 ..... I ...................... wiring in the building of ..... ............................................................. Af at ........ ........ ..................................... orth Andover, Mass. Pee ...... Lic. No. ��i ....... . ..... . ............. . E- AECTR,,,CALr)N . SPECTOR ........ . ......... Check # JA -�, ;L, 12 3 9 3 IS15)- VA oy-\ I PelMit No"' .j � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Nfassachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRflVT X AW OR TYPE ALL INFORMA TIOA9 Mte: —I C-� - I 'A - (q - City or Town of.- �\ . aVVkJJdA I To the Inspector of Wires: By this application the unders4�e�d gives notice of his or her tatention to perform. the electrical work described below. Location (Street & Niqm4er) �M Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes LJ No LJ - (check Appropriate Box) Purpose ofBailding C--,,kna Ip_ -�-QM I It I lft()M,.e UtffityAnthorkmtionNo. J, f Existing Service Amps ta0/840Volts Overhead Undgrd No. of Meters New Service Amps voks overheadE] undgrd El No. of meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical WeAL- Ins= Ck A-1 on nc ra* Mg I rza-pj MkNoan '0- aiar fmsAqTy) Ack Comvle�on of the follawin-a table mav be warved bv the Inweetar af W�F-P-v No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tabs Generators KVA No. of Luminaires Swimming Pool Above grad. El In - grad. No. of Emergency "PtIng unit No. ofReceptacle Outlets No. of Off Burners FIRE ALARM INo. of Zones NO. Of Switches No. of Gas Burners Detection in Ikitiating Devices No. of Ranges Total No.of Air Cond. Tons No. of Alerting Devices DispMNIS Beat 1**umv I ons I KW �e�r No. of Self -Contained .1 otals: I I I yetemontAleogg Devices No. of Dishwashers SpacelArea Heating KW Local El cNo`,n,1=-o, 0 Other No. of Dryers Heating Appliances KW I S'cN"oofS== or Equivalent No. of Wi—ter Heaters KW NO. Of N& of S, Ballasts Data Wid mg: No. of Devices or vivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wirmig.- I No. of Devices or Eavivalent OTHEM Attach addWonal detail if desired, or as Ynzdred by dw Impector Of Wilres. Estimated Value of Electrical WO& 2)CA (When mM-ed by mumLVal policy.) Work to Start.- I - � S - tq - bspecdons to be requested in accordance with NEC 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 equivdent The undersigned certifies the such coverage is in force, and has mdhited proof of same to the permit L%ming office. CEECK ONE: wsuRANcE 11 BOND 11 OTHER El (specify-.) I ceiWfy, under thepains andpenaftes ofpediuy, that the informadon on Ws appAcadon is "" cowkie FIRM NAME: V k V nt IS�Ckr A.P\(,D LIC-NO-;_M�J 00" Licensee: f()J\J1r) ZaMo�-R.1�0(Si ata�%& LIC. NO.: I N 14 1 A- V ll MW=—_ Iq jzenwt in the heenle mmber Bm.TeLNo..-, -)2,1-26e,,.-kX0r0 , f applicablT. ;;�.7!r Z* ) rn "A C &) Address: ) g I yn no Ar 5z� UD�z — Alt Tel. No.Apt-4-10Iq -5104�1 *Per KG.L. c. 147, s. 57-61, security work requires Department of Public Safety "r License: Lic. No. OWNEWS INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally reauked-bylaw. Bv mv simature below. I herebv waive this reauirement I am the (check one) M owner M nwnee-, siom7t Telephone No. E 10 10 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 1K_' Boston, IVA 02114-2017 wwwmass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Pfease Print Leziblv Name (Business/Organization/individual): Vivint Solar Developer, LLC Address: 3301 North Thanksgiving Way, Suite 500 Citv/State/Zip: Lehi, UT 84043 Phone #: 801-377-9111 Are you an employer? Check the appropriate box: El I am a employer with 110 4. E] I am a general contractor and 1 Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. New construction I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub -contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp. insurance.1 required.] 5.0 We are a corporation and its 10. [] Electrical repairs or additions D I am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12. [] Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.7E Other Solar Installation comp. insurance required.] *Any applicant that checks box# 1 must also fill out the section below showing their workers' compensation policy information. � Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site information. Insurance Company Name: Zurich American Insurance Company Policy # or Self -ins. Lic. #: WC 509601300 Expiration Date: 11/1/2015 Job Site Address: C—po YA QW11 6az City/State/Zip-0-nnnIQi &-u 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 certify under the pains andpenalfies ofperjury that the information provided above is true and correct Sianature: Date: Phone #: 801-2296459 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permifticense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Cgerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: a -1 F VIVINT SOLAR UEVELOPER LLC PHILIP F ZA14PITELLA JR (EL) 4931 N 300 W PROVO UT 84604 FoK Then Detuh AftV M PW.fo 6L0C-M I C I AMS ISSUES 7ME FOLLOWING 64TEME RM. 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Proeect Information Project Name: Rajeev Dhawan Project Address: 29 Nadine Ln, North Andover MA A System Description: The array consists of a 5.865 kW DC roof -mounted Photovoltaic power system operating in parallel with the utihty grid. There are (23) 255 -watt modules and (23) 215 -watt micro -inverters, mounted on the back of each PV module. The array includes (2) PV circuit(s). The array is mounted to the roof using the engineered racking solution from Ecobbrium Solar. B. Site Design Temperature: (From Lawrence MUNI weather station) Average low temperature: -24.3 "C (-1 1.74 'F) Average high temperature: 37.6 OC (99.68 'F) C. Minimum Design Loads: Ground Snow Load: 50 psf (State Board BR&S) Design Wind Speed: 100 mph (State Board BR&S) 2. Structural Review of PV Array Mounting System: A. System Description: 1. Roof type: EcoX Comp. Shingle 2. Method and type of weatherproofing roof penetrations: Flashing B. Mounting System Information: 1. Mounting system is an engineered product designed to mount PV modules 2. For manufactured mounting systems, following information applies: a. Mounting System Manufacturer: Ecolibriurn Solar b. Product Name: Ecorail c. Total Weight of PV Modules and mounting hardware: 1081 lbs d. Total number of attachment points: 57 e. Weight per attachment point: 18.96 lbs f Maximum spacing between attachment points: * See attached engineering calcs g. Total surface area of PV array: 405.03 square feet h. Array pounds per square foot: 2.66 lbs/square foot i. Distributed weight of PV array on roof sections: -Roof section 1: (16) modules, (39) attachments 19.28 pounds -Roof section 2: (7) modules, (18) attachments 18.27 pounds per square foot s o I a r 3. Electrical Components: A. Module (UL 1703 Listed) Qty Trina TSM 255-PA05.18 23 modules Module Specs Pmax - non-iinal maximum power at STC - 255 watts Vmp, - rated voltage at maximum power - 30.5 volts Voc - rated open -circuit voltage - 37.7 volts Imp - rated current at maximum power - 8.36 amps Isc - rate short circuit current - 8.92 amps B. Inverter (UL 1741 listed) Qty Enphase M215 -60 -2U -S22 23 inverters Inverter Speca 1. Input Data (DC in) Recommended input power (DC) 260 watts Max. input DC Voltage 45 volts Peak power tracking voltage 22V - 36V Min. /Max. start voltage 22V/45V Max. DC short circuit current 15 amps Max. input current 10.5 amps 2. Output Data (AC Out) Max. output power 215 watts Nominal output current 0.9 amps Nominal voltage 240 volts Max. units per PV circuit 17 micro -inverters Max. OCPD rating 20 amp circuit breaker C. System Configuration Number of PV circuits 2 PV circuit 1 - 12 modules /inverters (15) amp breaker PV circuit 2 - 11 modules /inverters (15) amp breaker 2011 NEC Article 705.60(B) D. Electrical Cakulations 1. PV Circuit current PV circuit nominal current 10.8 amps Continuous current adjustment factor 125% PV circuit continuous current rating 13.5 amps 2. Overcurrent protection device rating PV circuit continuous current rating 13.5 amps Next standard size fuse/breaker to protect conductors 15 amp breaker 3. Conductor conditions of use adjustment (conductor ampacity derate) a. Temperature adder Average high temperature 37.6 OC (99.68 -F) Conduit is installed 1 " above the roof surface Add 22 'C to ambient Adjusted maximum ambient temperature 59.6 OC (139.28-F) b. PV Circuit current adjustment for new ambient temperature Derate factor for 59.6 'C (139.280F) 71% Adjusted PV circuit continuous current 19 amps c. PV Circuit current adjustment for conduit 0 Number of current -carrying conductors 6 conductors Conduit fill derate factor 80% Final Adjusted PV circuit continuous current 15.2 amps Total derated arnpacity for PV circuit 15.2 amps Conductors (tag2 on 1 -line) must be rated for a minimum of 15.2 amps 2011 NEC Article 705.60(B) Use 15 amp AC rated fuse or breaker 2011 NEC Article 705.60(B) 2011 NEC Article 705.60(B) 2011 NEC Article 705.60(B) THWN-2 (90 'C) #14AWG conductor is rated for 25 1 amps (Use #14AWG or larger) 2011 NEC Article 705.60(B) 4. Voltage drop (keep below 3% total) Zw-r—ts.. 1. Voltage drop across longest PV circuit micro -inverters (from modules to j -box) 2. Voltage drop across AC conductors (from j -box to point of interconnection) 1. Mirco-inverter voltage drop: 0.58% The largest number of micro -inverters in a row in the entire array is 11 inCircuit 2. According to manufacturer's specifications this equals a voltage drop of 0.58 %. 2. AC conductor voltage drop: =IxRxD (—* 240 x 100 to convert to percent) = (Nominal current of largest circuit) x (Resistance of #14AWG copper) x (Total wire run) = (Circuit 1 nominal current is 10.8 amps) x (0.00319Q) x (200� — (240 volts) x (100) 2.87% Total system voltage drop: 3.45% vMnl. s o I a r EcolibriumSolar Customer Info Name: Email: Phone: Project Info Identifier: 17884 Street Address Line 1: 29 Nadine Ln Street Address Line 2: City: North Andover State: MA Zip: 01845 Country: United States System Info Module Manufacturer: Trina Solar Module Model: TSM -255 PA05.18 Module Quantity: 23 Array Size (DC wafts): 5.865 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: Enphase Energy Inverter Model: M215 Project Design Variables Module Weight: 44.8 lbs Module Length: 65.5 in Module Width: 39.625 in Basic Wind Speed: 100.0 mph Ground Snow Load: 50.0 psf Seismic: 0.0 Exposure Category: B Importance Factor: 11 Exposure on Roof: Partially Exposed Topographic Factor: 1.0 Wind Directionality Factor: 0.85 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load - Upward: 820 Ibf Lag Bolt Design Load - Lateral: 288 Ibf EcoX Design Load - Downward: 493 Ibf EcoX Design Load - Upward: 568 Ibf Eco,X Design Load - Downslope: 353 IV EcoX Design Load - Lateral: 233 Ibf Module Design Moment — Upward: 3655 in -lb Module Design Moment — Downward: 3655 in -lb Effective Wind Area: 20 ft2 Min Nominal Framing Depth: 2.5 in Min Top Chord Specific Gravity: 0.42 Plane Calculations (ASCE 7-05): 2 Roof Shape: Gable Roof Type: Composition Shingle Average Roof Height: 25.0 ft Least Horizontal Dimension: 27.0 ft Roof Slope: 33.0 deg Truss Spacing: 16.0 in Snow Load Calculations Edge and Corner Dimension: 3.0 ft Stagger Attachments: Yes Include Snow Guards: No EcofibriumSolar Description Interior Edge Corner Unit Flat Roof Snow Load 42.0 42.0 42.0 psf Slope Factor 0.68 0.68 0.68 psf Roof Snow Load ISAR � 28.6 --�28.6 1.0 28.6 -I psf vViilu Pressure Caicuiations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -17.1 -20.1 -20.1 psf Net Design Wind Pressure Downforce 16.0 16.0 16.0 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 psf Design Wind Pressure Uplift -17.1 -20.1 -20.1 psf Design Wind Pressure Downforce 16.0 16.0 16.0 psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.5 2.5 2.5 psf Snow Load 28.6 28.6 28.6 psf Downslope: Load Combination 3 14.4 14.4 14.4 psf Down: Load Combination 3 22.2 22.2 22.2 psf Down: Load Combination 5 18.1 18.1 18.1 psf Down: Load Combination 6a 29.2 29.2 29.2 psf Up: Load Combination 7 -15.8 -18.8 -18.8 psf Down Max 29.2 29.2 1 29.2 psf Spacing Results (Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 60.4 60.4 60.4 in Max Spacing Between Attachments With RafterfTruss Spacing of 16.0 in 48.0 48.0 1 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 20.1 20.1 20.1 1 i Spacing Results (Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 37.2 37.2 37.2 in Max Spacing Between Attachments With RafterrTruss Spacing of 16.0 in 32.0 32.0 32.0 in Max Cantilever from Attachment to Perimeter of PV Array 12.4 12.4 12.4 Layout Skirt Coupling 0 Clamp * Bonding Jumper EcolibriumSolar Warning: PV Modules may need to be shifted with respect to roof trusses to comply with maximum allowable overhang. Plane Calculations (ASCE 7-05): 1 Roof Shape: Gable Roof Type: Composition Shingle Average Roof Height: 35.0 ft Least Horizontal Dimension: 27.0 ft Roof Slope: 34.0 deg Truss Spacing: 16.0 in Snow Load Calculations Edge and Corner Dimension: 3.0 ft Stagger Attachments: Yes Include Snow Guards: No EcolibriumSolar Description Interior Edge Corner Unit Flat Roof Snow Load 42.0 42.0 42.0 psf Slope Factor 0.66 0.66 0.66 psf Roof Snow Load %A#: A ft 27.7 r27.7 27.7 psf WTInu r-ressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -17.1 -20.1 -20.1 psf Net Design Wind Pressure Downforce 16.0 16.0 16.0 psf Adjustment Factor for Height and Exposure Category 1.05 1.05 1.05 psf Design Wind Pressure Uplift -18.0 -21.1 -21.1 psf Design Wind Pressure Downforce 16.8 16.8 16.8 -Jpsf psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.5 2.5 2.5 psf Snow Load 27.7 27.7 27.7 psf Downslope: Load Combination 3 14.2 14.2 14.2 psf Down: Load Combination 3 21.1 21.1 21.1 psf Down: Load Combination 5 18.9 18.9 18.9 psf Down: Load Combination 6a 28.9 28.9 28.9 psf Up: Load Combination 7 -16.7 -19.9 -19.9 psf Down Max 28.9 28.9 28.9 psf Spacing Results (Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 60.6 60.6 60.6 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in [Max Cantilever from Attachment to Perimeter of PV Array 20.2 20.2 20.2 1 "n Spacing Results (Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 37.4 37.4 37.4 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 32.0 32.0 32.0 in Max Cantilever from Attachment to Perimeter of PV Array 12.5 12.5 12.5 1 "n EcolibriumSolar Layout Skirt Coupling 0 Clamp Warning: PV Modules may need to be shifted with respect to roof trusses to comply with * Bonding Jumper maximum allowable overhang. EcolibriumSolar Distributed Weight (All Planes) In Conformance with Solar ABC's Expedited Permit Process for PV System (EPP) Weight of Modules: 1030 lbs Weight of Mounting System: 114 lbs Total System Weight: 1144 lbs Total Array Area: 415 ft2 Distributed Weight: 2.76 psf Number of Attachments: 57 Weight per Attachment Point: 20 lbs Bill Of Materials Part Name Quantity ECO -001101 EcoX Clamp Assembly 57 ECO -001102 EcoX Coupling Assembly 29 ECO -001-105B EcoX Landscape Skirt Kit 4 ECO -001-105A EcoX Portrait Skirt Kit 3 ECO -001103 EcoX Composition Attachment Kit 57 ECO -00 1 —116 EcoX Flat -Tile Flashing 0 ECO -001117 EcoX S -Tile Flashing 0 ECO -001118 EcoX W -Tile Flashing 0 ECO -001363 EcoX Lower Support - Tile 0 ECO -001109 EcoX Electrical Assembly 2 ECO -001106 EcoX Bonding Jumper Assembly 6 ECO -001104 EcoX Inverter Bracket Assembly 23 ECO -001338 EcoX Connector Bracket 23 Locatio Hkblut LAMC; No Date ro TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Tuilding Inspector Div. Public Works 00 Locatibn L -e No. Date koRTI, TOWN OF NORTH ANDOVER 0 ;L 45�� Certificate of Occupancy $ 4 Building/Frame Permit Fee $ ss C U Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 06/29/95 14:58 150.00 PAID 8667 Div. Public Works Location No. Date V40 TOWN OF NORTH ANDOVERS. 0 Certificate of Occupancy $ N1. Building/Frame Permit Fee $ 14 Foundation Permit Fee $ Uj 'Other Permit Fee $ :z Sewer Connection Fee $ /00,::P 473� Water Connection Fee $ TOTAL $ —&!)—, —Yb ildi Inspector T.- Div. 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H+...+ � }•�y �,�'e .. w.,� �:'• � . w7 a� �� REECO 0 AG=S: Dat"a Amcroved C::=en zs --=en1:s Food insp ector�.He sei571EYc Cz=e.",cs - 4t>A �s j!�!, Lk-) e -k - Data Approved Cate Rejected Daze Approved Date Rejected Date Approved Date Rejected Works - sewer water c::nnections -TJ-Ld - drivewav e z 54,.co k -,e Gle-78 c.; 7.-i=e Denart-ment 14sra ze Received by Building Inspec-=r Date 'M 2 21995 -7 -7, L40T RELEASE F01M -,---j.F0RK U INSTRUCTIONS: This f& jLs 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 local or state law, regulations or r ****************Applicant fills out.this section** q APPLICANT: LOCATION: Assessor's Mam Number Parcel OR Subdivision ffq _-2) I A) E Lot(s) St.. Number Street REECO 0 AG=S: Dat"a Amcroved C::=en zs --=en1:s Food insp ector�.He sei571EYc Cz=e.",cs - 4t>A �s j!�!, Lk-) e -k - Data Approved Cate Rejected Daze Approved Date Rejected Date Approved Date Rejected Works - sewer water c::nnections -TJ-Ld - drivewav e z 54,.co k -,e Gle-78 c.; 7.-i=e Denart-ment 14sra ze Received by Building Inspec-=r Date 'M 2 21995 The Commonwealth ofMassachuseas Depattment �f IndustrialAccidents 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit 6u i i �Ir g - WE phone# I am a homeowner performing all work myself I am a sole proprietor and have no one working in any capacity I am an ernployer providing workers' compensation for my employees working on this job. n I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cedift un ,der Me pa ,os and penalties ofpedury that the inforntation provided above is true and correct. oo Print name C-1-1 ( , _C ___Yhone # official use only do not write in this area to be completed by city or town official city or town: permit(liccuse #.. 01Y �Uil -ng Department oLicensing Board 0 check if immediate response is required oSelectmen's Office (:IHealth Department. contact person: phone#; rlOther (revised 3/95 PJA) ,- C), " - " Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", 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 dwellin-'house having not more than three apartments and who resides therein, or the occupant of the dwellino, 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 section 25 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 coverage required. Additionally, 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. t. . . . . . . . . . Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as a a 'davits mav be submitted to the Department of 1. 1 11 ffi Industrial Accidents for confirmation of insurance coverne. Also be sure�to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. 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 Investizations 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to us a call. .;�' 21-52-11 . 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M lk 0 a 0 a 0 0 (n " �r= (Da M 04 > 0 M C*4 >. 0 CL - . .6.- 0 .0 0 .90 .6 C71 e = (D .6 C71 C! :3 L- V- -CQ-- -81 310: < 0 ci x C) > :z 0 C)L x C-4 x < *04 < 4) C-4 a 12 -9-- 0 ,� !i C) -I-- I*,-- 0-�* o CD -c> 04 (n (n.9 (n (n 4 4 4 4 14 1 .c O,rcD o fe) 04 4 4 4 4 4 4, 4 a) > "S2 Z,t,6,2 a) 0 0 m m .32 4 0 W =3 a C:) a 0 x CN4 It P 4 4 0 co -0 x a C14 cn Q V) Lo 0 r (D 4 = > 0.92 X 0 t3 0 4) 0 LLJ 4) m 75 < 0 co 12 . 0 am -0 0 it 00 J.- 0 0 14- = N; .9 0) 0 x x 0) LL- K) C14 W— It -d - L) C14 W > L) 4 4 a ,q I 86 CLIENT. FOUNDATION LOCATION PLAN SCOTT CONSTR. THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. (d LOCATION: LOT 18 - NADINE LN.-NO.ANDOVERNA. SCALE: 1"=20' DA TE.- 718195 PROFESSIONAL ENGINEERS CHRISTIANSEN &SERGI LAND SURVEYORS 160 SUMMER ST. HAVERHILL.AdA. 01850 TEL 508-573-051D @ 1995 BY CHRIS77ANSEN & SERGI INC. I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HoRIZONIAL SE78ACK REQUIREMENTS Or THE LOCAL APPLICABLE ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CER77FICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS, WETLANDS.EASEMENTS, ORDERS OF CONDITIONSETC) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE.EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRIS77ANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHISITED.CHRISRANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR— U477ON CONTAINED HEREON.. DWG.NO.:94015014 (7) CD 0 C) m CD M C/) CD ,3 CL. =m < Cl > CD mm—i M CO CD COM CO2 =r-5 z a w CL Cc',) 3: CD C* 0443 m CD B7 CA CM) 5! COD co) Cc) "0. CL �N8 C2 CD 0) CA CL gn CD a-- . CO2 CD CD rm n CD CL C7 C=D rn:� (7) CD 0 C) m CD M C/) CD ,3 CL. =m < Cl > CD mm—i M CO CD COM r) "I C/) 7� =r-5 z a w CL Cc',) 3: CD C* 0443 m CD >24 5! r- r "' LF%l 'i Rol m �4 n 0 z cn Cn rA : -M rn rm cm z CD CA CL m m LW Cl) cn = =r CA --4 ,3 CL. -1 CO) =r. C', PEA r) "I C/) 7� =r-5 C40) a w CL Cc',) 3: C* 0443 m OCD gr C -DI >24 5! r- r m m LW Cl) cn = Gq (z e < GQ 'N (A 0 CL CC 12) rl PEA r) "I C/) 7� Cc',) 3: - =Oiwo� 0 CD CL cc, CL r- r "' �N8 C2 CD 0) CA gn CD a-- . CO2 = CD rm n CD rn:� wu 6, Ow Q, 14 Po : 1 ca CD : Cli -.00000A m m LW Cl) cn = Gq (z e < GQ 'N (A 0 CL rl PEA r) "I C/) 7� co "' �N8 C*l z4 It 0 0 m cc C11; omi 0 9 0 41� CD -V MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/1 -CAR IN ACCORDANCE GARAGE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY "PLY. CERTIFICATE ISSUED TO Wi 11 ow Tree Dio-up 1 opMmu t Ropers Rd. Date ..... II..:Fl :7 mo 16 7 8 2D TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... 06..u.j1.q.S ....... ....... ........... .. .. .. ... ..... ..... . has permission to perform ........ ....................................... is wiring in the building of .... 1'.v�xY- ................................... P-1 at ...... . ...... P . ...... ................ . North Andover, MasS Fee..A.3--Ao... Lic. No. ......... R*'***'**'*"****** WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Q!ftca We 0.11r The Commonwealth of Massachusetts ?*rate 74- Dcperrmcnt of Public Safcr_v occ,_r s, r*% o�.td_ BOARD OF FIRE PRE�-EIMON REGULATIOt4S S27 CMR 1Z�CC 13/90 APPLICATION FOR PERMJT TO PERFORM ELECTRICAL WORK All %work to b -c per�rmcd In accordance with the HsuAchuseru Elcorical Code. 527 CMR 12-00 /;? - (JILZ&SE PR-UrZ IN 32fk OR- =E_A1_T__TNF0?MATJ011) Dace City or Tou-a of 01 To the Inspecto I r of Wires: _A_�_ - - — The under�signcd applies for a permit to p-erfor= the electric -21 work described belov. Loc-acion (Street & Number) O,--ncr or Tc"nr- 7 k2r_C-g 0--ncrIz Address Is this permit in conjunction %jtrh a building p-_r=it: Yez 11 No (Check Appropriate Box) Nqposc of Building ?,OA4;0� Utility Authorization NO. Exilti.ng Service 1670 Amps 7—Zc// Volts Overhead Und&Td V f- AJ No' of Meters Nevi ser -rice —Amps Volts Overhead Undgrd 11 No. of Meters 14=b --r of Feeders and A--pacit-f_ Location and Nature of Proposed Electrical Work Zl�,Tmew— No. of Li&htinr Outlets No. of Hot Tubs No. of Transfo=ers 1 -fat -11 No. of Lighting FLxtures 9 1 Abo n - Swi=ing pool gr -n nd . Generators No. of Receptacle Outlets 27 No. of 011 Burners No. of Emergency Light B2t:e-Y Units No. of Switch Outlets 5,-ftor %9 No. of Gas Bu=cr3 Li FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of SoundLng Devices No. of Self Contained Detection/So=ding Devices Loca 1 0 thinicipal El Other Connection No. of Ranges 10 t.2 I No. of Air Cond. tons No. of No. of Heat Total 0 Pumos Tarls KW No. of Dishwashers Space/Area Heating No. of Dr-yers Heating Devices MJ No. of Water Heaters —KW No, of No. oi------ Lsigns Bali<ts Low Voltage 1wirine No. Hydro Massage Tubs a. of Motors Tot:& CCV-ZRA(;Z: zur3—nc to the requirements of 'r�assachuscct3 General Laws I have a current L12bilit Insurance Policy' including Compler-ed Operacions Coverage or its substantial equiv&lenc. YESr I .:�Nox I have submitted valid proof of same to this office- YESO NO C] If you have check -ed i please indicAte the typ-- of coverage by checking the appropriate box. INSURA.11= EJ BOND E] OTHER C] (please Specify) r_JZj=tcd value of Work S (Expiracion uace) t:ork to Start 12- Z-'br-ql Inspection Date Pequested: Fough FRI —Final Signed under the penalties of perjury: FM4 N 17 —b -.C. NO. Lice"ce Sf Signatur LIC. NO. Bus. No. Z KX, Addre53 1Z 1-1071<70K Tr, M11TE-V S C= VA17M* I aza aware that the Licensee does noc have the insurance coverage or Its suQ- St2nCIAl e iVSICnted�s _� red by has2achusecr:t Cenerztl Laws, and Ehzt =,y signatur-e on this per=�t -)Pr applica w ivcs uirement. Owner Agent: (Please check one) PZ7-,XT- 7= Telephone 'to. �So% (41\ rA-N 01 4t Lfammantutato of Ifflaosat4mett '43epartment af Public —AnfetU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 I Office Use Only Permit No. Occupancy A Fee Checked 1 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1�:00 t a 3Z (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) I ate 9S (TAQ or Town of NnRTH ANnOVFR '71- M Wir— IV, The udersigned applies for a permit to perto�m the e Location (Street & Number) 2 2 42� Owner or Tenant �J;&Zz) 7A_�Pj.;� J -P Owner's Address Is this permit in conj,�4nction with a building permit: Purpose of Building Existing Service Amps Volts New Service Amps./A6 �2)10 Volts limber of Feeders and Ampacity <0, ocation and Nature of Proposed Electrical Work U No. of Lighting Outlets No. of Hot work %scribe below. 7 ALO )j Lill �t "P A lqlv S Yes V2-" No El (Check Appropriate Box) -Utility Authorization Overhead 1:1 Undgmd 0 No. of Meters Overhead 7 Undgmd X No. of Meters 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 C_ NO 7-- 1 have submitted valid proof of same to the Office. YES —_ NO —_ If you have checked YES, please indicate the type of Coverage by checking the approWiate box. INSURANCE ��BOND �_-- OTHER —� (Please Specify) 'r -x iration Datet Estimated Val Work to Start Signed under FIRM NAME, Licensee � Work S Ities of p Inspection Date Requested: Rough Final LIC. NO. LIC. NO. Tel. No. 41 Address *kll. lei. 1-40. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. _ PERMIT FEE S hg_42011 �,()o (Signature of Owner or Agent) 2 2t�, X-6565 Tubs I No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- gmd. gmd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets _lj No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained No. of Ranges Total No. of Air Cond. tons No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal D Other 1:1 Connection No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage 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 C_ NO 7-- 1 have submitted valid proof of same to the Office. YES —_ NO —_ If you have checked YES, please indicate the type of Coverage by checking the approWiate box. INSURANCE ��BOND �_-- OTHER —� (Please Specify) 'r -x iration Datet Estimated Val Work to Start Signed under FIRM NAME, Licensee � Work S Ities of p Inspection Date Requested: Rough Final LIC. NO. LIC. NO. Tel. No. 41 Address *kll. lei. 1-40. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. _ PERMIT FEE S hg_42011 �,()o (Signature of Owner or Agent) 2 2t�, X-6565 V 2M 1".. 41 0 ACHU Date ...... J TOWN OF NORTH ANDOVER PERMIT FOR WIRING CU This certifies that �,, t, r to ....... . .... ....................................... has permission to perform ..................... .. ........... wiring in the building of .... ...... ............... at .... .... ..... ............ . North Andover, Mass. Fee..�211.-,�A.U.. Lic. No. ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File L-�