HomeMy WebLinkAboutMiscellaneous - 29 STONEWEDGE CIRCLE 4/30/2018C
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TOWN OF NORTH ANDOVER
I
Vow PERMIT. FOR WIRING
This certifies that ..............
has permission to perform ........ �ZY .......
A . ................
wi!ring in the building of ...... M./fU. 5.��06 .....................................
at ....... ;-5 ... ...... ......... .. North Andover, Mass.
Fee .... ��. Lic. No.
ELECTRICAL INSPLACTO
Check #
9395
lie
(fonimlomupallk ol MJJaC/,11Je1b
2etaarl(A-grd 01J�re Se.,Cej
BOARD OF FIRE PREVENTION REGULATIONS
OFFIcial Use 0111N
Pemill No. ?!5�p -S
Occupancy and Fee Checked
Rev. 1/07) blank)
APP,LICAT.ION FOR PER MIT TO PERFORM ELECTRICAL WORK,
-1 C R Q. 0,0
All work to be performed In accordance -Ith diz i\,`[3ssachus,-c1s Elcurical Code (\-(EQ. 5-7
(PLEASE PRJ,qT1.-VJVK OR TYPE .4LL A�� 6R.AL4T1ON)' Date: "5—
QJ ty -o r Town o f: 1�9,6—fy Ail)O'l-C 4— io'the Inspec(ol- of [Vt'res.
By this application the undersi2ned gives.notice oflils or her Intention to perform (he electrical work, described below.
Location (Street &. Number) S73.,Ir Ld&�:h C4. 1141�
Owner or Tenant 0,6�A 'p-, V_ -e /��_c g- �— Telephone No.
Owner's Address
Is this permit in -conjunction wit.h a building permit"
Purpose of Building
Exiscin2 Ser-yice Amps Volts
New Service Am'ps -Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Yes El No El (Check Appropriate Bo -o
Uti!i[v Authorization No.
Overhe3d Undard No. of I'Oe(ers
Overhead Unclard No. of Meters
Completion of the followinq table moy 62 ivoo;ed bY the Insoector oi- H`ires,
N o. of Recessed Luminaires
No. of Ceit.-Susp.-(Paddle) Pans
IN 0. of Total
Trinsformers KVA
6'. of Luminaire Outlets
No. of Hot Tubs
Generators K VA
.No. of Luminaires
Swimming Pool Above o In- El
r'nd. Yrn
s! L d.
No. ol Emergency Ligh(1(12
Batten - Uniu
N 0. of Receptacle Outlets
-.No. of Oil Burners
FIRE AL.-�i�AIS
I INO. of Zones
IN 0. o f S w i cc h es
No. of Gas Burners
No. of Detect I on 3nd
lnici3tin2 Devices
9.,of Ranges
No. of Air Cond. Total
Tons
No. ofAler-ting Devices
N o, of Waste Disposers
eat Pump
o t.
T als:
LI rri..b..e.!.J.T�,!�s
..............
..........
... .....
[K..W ...........
IN o. of Self-Concained
Detection/Aleriina- Devices
No. o[Dish)y2shers
Space/Area-Heating KW
I'Ylunicip�l D Other
Local Connection
N o.'o f D ry e rs
Heating Appliances
0 KW
Securiry Systems:
No. of bevices or Equivalent
No. of Water
Heaters KNV
No. of No. of
Siens Ballasts
Data Wirin-:
No. of D'evices or Equiv2lent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunicat: I ons �Yiring:
No. of Devices Or EqUiVllent
77 F%l
ch additional de toil if desired, or as required by the Inspect or of I l'ires.
eri required by municipal policy.)
Es-tiniated Value of Electr cal W0'rk:At4rj.2' V" C
�Vork to Start:Aoio lnspection's"T�req`uested In accorclanctwith l,[EC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for (he performance ofelectrical work may Issue unless
the licens-ce provides proof of liabillry insurance including "completed operation" coverage or its substantial equivalent. The
undersiened certifies that such coverage is In force, and has exhibited proof of same to (lie penrik issuing office.
CHECKONE: INSUP-ANCE 2 BOND [] OTFEEF� f—I (Specify:) Self Insured
I certifj,, under thepoins andpenolties ofperjur)-, that the i rmation on diis application is fr(ie and complete.
FIRMNAME: ADT Security Services NO.:
Lictirisee': Ma rk - A Brop , hy Sianntu.,e L I C. NO.: C - 4 5
11f op*plico'ble, enter in the license i'mniber line.) S. Tel. No.: 603 -59�- S928
It, Tel. No.:
Addrpss:. ' 8 Clinton Drilve Hollis N H
L
Per M.'G.L. c. 147,'s. 57-6 1, security work requires Department of Public Sa fery "S" License: L 1 c. NI o. 009S3
O�VNER'S INSURANCE WAIVER: I am aware that the Licensee does not have (he liabilily insurance coverage, normally
required by lav/. By my signature b�low, I hereby waive this requirement. I am the (check one) E] owner El 0&4ner's a0ent.
1P
ONvaer/Agent
Signature Telephone No. FPZ�vT FEE:
C;?
Location /
No. 59 Date
Check #
16093
TOWN OF NORTH-AN-UCIVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
A
A
Other Permit Fee $
TOTAL $
,5690-
56120 -
All# r
Building Inspector
Location I d, -
No. "5"3 6�lr Date 20C,
TOWN OF NORTH ANDOVER
0
Certificate
of Occupancy $
"us
Building/Frame Permit Fee $
x6
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
15838
Buildi.ng Inspectorc/
1. 1 Property Address:
101rl) 'Sto 11 C-Uj e-&, e-
0 (-,:A e
1.2 Assessors Map and Parcel
/06� 41�1
Map Number
Number:
3
Parcel Number
A"�) C-)
Name Address for Service
1.3 Zoning Information:
es,
Zoning District Propqsed Use
1.4 Property Dimensions:
I -At Area (sf)
3 2-0
Frontage (ft)
1.6 BUI]LDJNG SETR� ��Sf %�z-
Name Print Address for Service:
Profft . Yara
Side Yard
SECTION 3 - CONSTRUCTION SERVICES
Rear Yard
Required 1",Pr0*'VAd6"-'
Required Provided
Required
Provided
Lu
Address
1.7 Water Supply M.G.L�1'4�--
5
Public &I private N[3� Zone
'n, '.., j
1.5. Flood Zone Information:
Outside Flood Zone 0
.1.8
Municipal
SeWerage Disposal System:
4—On Site Disposal System 0
SECTION 2 -= OWNERSHIMAUTHORIZED AGENT
2.1 Owner of Record
M
A"�) C-)
Name Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
,D -/9-V/ Y�n U C,
Licensed Construc6o—n Supervisor:
Not Applicable 0
0 �60 K5 -
License Number
Lu
Address
'Ie-L'j 1:�,Zvp U (-7/ (Y-1 c;,— ct �7— Z:3;,;5
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable -0
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
00
M
z
0
0
z
M
90
0
Mn
ic
M
z
Q
't 0, -k A
SECTION 4 - WORXERS COMPENSATION (MG.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 ....... 0 No ....... 0
SECTION 5 Description o Proposed Work (check
applicable)
New Construction %fr
Existi�Yuildin 0
9
Repair(s)
0
Alteration4-s)_ 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
To C, o ns o c. ot 2, R x
3-2
w IT ca r rp q r q � c— u n '16
-SECTION 6 - ESTIMATED CONSTRUCTION
COSTS
Item
I . Building
Estimated Cost (Dollar) to be
Completed by permit applicant
2K-0, 00c)
. . . . . . . . . . . . . . . . . . . . . .
(a) Building Permit Fee
MultiE�er
'5'
2 Electrical
121nc) C)
(b) Estimated Total Cost of
Construction
-3 Plumbing
Z'6' 00 C)
Building Permit fee (a) x (b)
Mechanical (HVAC)
-4
-5 Fire Protection
-6 Total (1+2+3+4+5)
1 q 0a o
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COVWLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorizedkient of subject property
Hereby authorize /)/,4CK 0 r7 0 L) 19- to act Oil
My behalf, in all matters relative to work authorized by this building permit application.
S ignature of O,�Amer Date
7b OWNER/AUTHORIZED AGENT DECLARATION
-SECTION
as Owner/Authorized Agent of subject
r i r oVeWy
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
D19611 6 / /5Z
(VP ' Name
_ _e I �
Signature of Owner/A 1. ent
-NO. OF STORIES 2—
� -2- /Y
Dat e
Siz
-BASEMENT OR SLAB '4'
-SIZE OF FLOOR TIMBERS is, 2-)( 1 C.)
N5
2 Z_X I c-) T Z-4 10
SPAN Z�(
_DMENSIONS OF SILLS 2-X G
-DIMENSIONS OF POSTS _17z- _j 4\ k:�
_DIIAENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS �70
-SIZE OF FOOTING 30 x �J 0
x
-MATERIAL OF CHIIVINEY
,IS BUILDING ON SOLID OR FILLED LAND
IS BTJTLDING CONNECTED TO NATURAL GAS LINE
r1-9- () 3,
FORM U LOT RELEASE FORM NEV'A OOVAQ-.
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***********************
0
APPLICANT 0 R\j N,>, 00,1 a J C1, --I PHONE'JO
LOCATION: Assessor's Map Number PARCEL 7�
-3Y ;6- /0 6
SUBDIVISION. CCA, vA LOT (S)
STREET S�0 A C, W C:b.s ST. NUMBER
************************************OFFICIAL USE
I RECOMWD,4TIO IF TOWN AGENTS:
CON§Eff,VATION AdM&ISTOATOR DATE APPROVED
DATE REJECTED
COMME
COMMEN
FOOD INSPECTOR -H
SEPTIC IN
Comm
ri
- - -W"� I "�
,TE PPRO D
'T
REJE D
DATEAPPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PE
FIRE DEPARTMENT
RECEIVED BY BUILDING INSP
Revised 9\97 jm
-- r ... ,
SO
A,
6013UILDINq REGULATIONS
t3bARD
'LldelnM,�ONSTRUCTION SUPERVISOR
076045
Birthditi: 641 711057
iExoires;:'04117120M Ti. no- 16045
Restncted,To: Ao��
IbAVIQ-G. DOINOVA_,�'
TWkSiBURY, IMA 01876 Administrabot
LIBERTY Liberty Mutual Group
MUTUALio
P.O. Box 8094
Wausau, WI 54402-8094
June 12, 2001 Telephone: (800) 653-7893
FAX: (715) 843-2650
JEDM REALTY TRUST
35 DONOVAN RD
TEWKSBURY, MA 01876
RE: Your Workers Compensation policy
Policy number: WC1-31S-328272-011
Effective date: May 19,2001
Dear Policyholder:
Liberty Mutual is pleased to have been selected to service your Workers Compensation policy. We are
completing our review of your applicafion and expect to send your policy, along with an explanatory
service package, within the next 30 days. However, to assist you in the interim, we are providing you
with your newly assigned policy number, (referenced above).
If you need to report a claim, please fax to (781) 642-7499.
For all other claims related issues, please call (800) 762-5026.
Prompt reporting of accidents is critical. It enables us to get involved in treatment early, to manage
medical costs and set the stage for a successful return to work.
Please direct all other questions you may have to your producer.
Producer of Record: JOHN F BYETTE INSURANCE AGENCY
Producer Phone No. (978) 851-6678
You applied for coverage for the state(s) of - If you open operations in any other state, please contact your
producer. Depending on the state, we may or may nbt be able to provide coverage for you.
We look forward to servicing your business.
sincelely,
Andrea Brown
Involuntary Market Operations
cc: JOHN F BYETTE INSURANCE AGENCY
IM00260995 WCI-31S-328272-011 Pa
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software -Version 2.01 Release 3
TITLE: Roberts Farms Estates
CITY: Tewksbury
STATE: Massachusetts
HDD: 6339
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 1-25-2002
DATE OF PLANS: December 26, 2001
PROJECT INFORMATION:
Roberts Farms Estates
Jeom Realty Trust
Tewksbury, Ma.
COMPLIANCE: Passes
Maximum UA 805
Your Home 730
I Permit #
I Checked by/Date
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater U12 %. Yel load as specified in
Sections 780CMR 1310 J 4
Builder/Designer Date
4
Area or
Cavity Cont.
Glazing/Dopr
-------------------------------------------------------------------------------
Perimeter
R -Value R -Value
U -Value,
UA
CEILINGS
2163
30.0 0.0
76
WALLS: Wood Frame, 16" O.C.
3708
13.0 0.0
304
GLAZING: Windows or Doors
610
0.380
232
DOORS
38
0.500
19
FLOORS: Over Unconditioned Space
2110
19.0 0.0
99
HVAC EQUIPMENT: Furnace, 90.0 AFUE
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed
building
design described
here is
consistent with the building plans,
specifications,
and other
calculations
submitted with the permit application.
The
proposed building
has been
designed to meet the requirements of
the Massachusetts
Energy
Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater U12 %. Yel load as specified in
Sections 780CMR 1310 J 4
Builder/Designer Date
4
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 b - e' 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.):
HEATING SYSTEMS:
Low pressure/temp
Low temperature
Steam condensate
COOLING SYSTEMS:
Chilled water or
refrigerant
PIPE SIZES
TEMP (F) 2" RUNOUTS 0-1"
201-250 1.0 1.5
120-200 0.5 1.0
any 1.0 1.0
(in.)
1.25-2" 2.5-4"
1.5 2.0
1.0 1.5
1.5 2.0
40-55 0.5 0.5 0.75 1.0
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 0-1" 1 0-1.25" 1.5-2.0" 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) -------------------------
TITLE: Roberts Farms Estates
MAScheck INSPECTION CHECKLIST
I
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 3
DATE: 1-25-2002
Bldg.
Dept.
Use I
CEILINGS:
1. R-30
Comments/Location-
WALLS:
1. Wood Frame, 16" O.C., R-13
Comments/Location
WINDOWS AND GLASS DOORS:
1. U -value: 0.38
For windows without labeled U -values, describe features:
# Panes Frame Type Thermal Break? Yes No
Comments/Location
DOORS:
1. U -value: 0.5
Comments/Location'
FLOORS:
1. Over Unconditioned Space, R-19
Comments/Location
I HVAC EQUIPMENT:
1. Furnace, 90.0 AFUE or higher
Make and Model Number
I AIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
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
more than 2.0 cfm (0.944 L/s) air movement from the the
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:.
Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
1806
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
Application by the undersigned is hereby made to connect with the town sewer main in
subject to the rules and regulations of the Division of Public Works.
The premises are known as No
or subdivision lot no.
2�1v�
Owner,
Contractor
J.
Street,
Street
J -3 -5 -
Address
Addwss
.PERMIT TO CONNECT WITH SEWER
The Division ot Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
LJ-
Street
Division of Public Works
By
, Yvt=-
See back for rules and regulations
1172
APPLICATION FOR WATER SERVICE CONNECTION
North Andover, Mass.
Application by the undersigned is hereby made to connect with the town water main in
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. Street
or subdivision lot no. V
7� IQ
a�, 0 e�,
oke, t4
Own&'— Address
Contractor
Address
+ OZ?
0 j;1je A
PERMIT TO CONNECT
The Board of Public Works hereby grants permission to
to make a connection with the water main at 4
subject to the rules and regulations of the Division of Public Works"
Inspected by
Date
TH WATER MAJ.N
Y—
Street
Board f Public Works
By
See back for rules and regulations
N
r
A
4- 661
AUTOMATIC LAWN IRRIGATION SYSTEM PERMIT
TOWN OF NORTH ANDOVER
MASSACHUSETTS
ALL INFORMATION MUST BE PROVIDED, BY A LICENSED PLUMBER,
PRINTED IN INK AND LEGIBLE. IF NOT THE PERMIT WILL BE REJECTED.
DATE:
LOCATION:
LOT #:
BUILDER: NAME TELEPHONE
NUMBER STREET NAME . TOWN/CITY & STATE
OWNER:
NAME TELEPHONE
NUMBER S TREET NAME TOWN/CITY & STATE
PLUMBER:
.1 . NAME TELEPHONE
NUMBER STREET NAME TOWN/CITY & STATE
LICENSE NO. EXPIRATION DATE:) SERIAL NO.
IRRIGATION INSTALLER IF NOT THE PLUMBER
INSTALLtR:
COMPANY TELEPHONE
NUMBER STREET NAME TOWN/CITY & STATE
I
INDIVIDUAL NAME TELEPHONE
The plumber, must install'the connection to the municipal . water supply within the building, the water line to the outside
of the building and the backflow device. A registered irrigation installer may then install the balance of the Automatic
Lawn Irrigation system. NO irrigation heads will be allowed in. the right of way (near edge of pavement). ALL irrigation
heads MUST be at or behind-tbe property line. All heads installed in the right of way will be removed immediately upon
notification and said plumber or installer will not be allowed to perform any future work on'the municipal 'water supply,
until.the heads are removed from the right of way. Sign below that you have read this paragraph and understand it.
SIGNATURE OF PLUMBER DATE
THIS PERMIT MUST BE POSTED AT THE CONNECTION/METER LOCATION FOR THE INSPECTOR.
INSIDE CONNECTION METER (IF APPLICABLE) BACKFLOW DEVICE
RAfN-SENSYNG DEVICE COMMENTS
El
J.VVILLIAM HMURCIAK, P.E.
DIRECTOR
TOWN OF NORTH ANDOVER, MASSACHUSETTS
DIVISION OF PUBLIC WORKS
384 OSGOOD STREET, 01845
Telephone p7a) 685-()g!
Fax (978) 688-9573
-.1"
0
'r- -
DRIVEWAY PERMIT
2
DAT*E
LOCATION 2q 2 zin, =? r- >
V
BUILDER phone
OWNER phone
THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS
MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM
STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE
FINISH GRADING AND SURFACING FOR. APPROVAL OF
SUCH ENTRY.
FAILX=TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
x----------
A Pr 1, t cA �j r �5
GROWTH MANAGEMENT BYLAW EXEMPTI
1, ON STATEMENT
TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
This form shall be used to assist 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.
Permit Applicant
13 0 9 319- 2,
Property address Map / Parcel
Applicant's Phone Number ! Single Family Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this form is completed
does comply with the EXEMPTION section 9.7.6 ofthe 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 prior to 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 permit 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, comp ' lies with one or more ofthe following sections as indicated by a check mark.
This is an application for a building permit for the enlargement restoration or reconstruction of a dwelling in
existence as of the effective date of this bylaw,'provided 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 8.7 of the
ZoningBylaw.
— This application is for dwelling units for low and or moderate income families or individuals, where all of
the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is
restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For
purposes of this section "senior" shall mean persons over the age of 55.
_ This 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 ofthe tract, with the surplus land equal to at least ten buildable acres and permanently designated as open
space or fiamiland. The land to be preserved shall be protected from development by an Agricultural Preservation
Restriction,'Consa-vation Restriction, dedication to the Town, or other similar mechanism approved by the planning
board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with
an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned
Growth Rate and Development Scheduling provisions for the purpose of coristructing 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 the 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 developmeni 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 AMST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED
BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE.
FURTHER I UNDERSTAND THAT THE SUBM117AL OF MISLEADING OR INACCURATE INFORMATION OR TEE
CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHMIER DONE TO MY KNOWLEDGE OR
NO S G UNDS FO FUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERM[rr.
APPLICANTS SIGNATURE
DATE
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Town of North Andover
Building Department
0
27 Charles Street 0
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax (978) 688-9542
HU
APPLICATION FOR CERIMCATE OF OCCUPANCY INSPECTION
ADDRESS C7 n e— (-A-) �j C e_ t
LOT NUMBER -&_i�_SUBDlVISION
DATE REQUEST FILED /0- 2 '3
DATE READY FOR INSPECTION 2,3-03
TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHN THIS TIME
-FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE
IVTHE DOE -S -NOT MEET- �&LAPPUCABEE - C-1 bnt�_._ - - � - -
SIGNATURE
OFFICIIAL USE ONLY
ROUTING
D.P.W. - WATER ME DATE
D. "N �.ST INDICATE THAT TBE WATER METER HAS BEEN INSTALLED.
,PRIOR TO) TIHE INSPECTION REOUEST DATE.
Date. . 3. -./ 0.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
..............
This certifles that 7-� ............ ly ... Pl,--,k" 4,
has permission to perform ................
i ">
plumbin� in the buildings of
/ � t:' . .............................
C"
at. A I? ................................... North Andover, Mass.
-A
Fee. . �Tuc. No.. q:0 . . —'.-
PLUMBING INSPECTOR
Check # C� C�/
HE
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSEM
Date �3
Building LocationA�/����Q�wners
N�me
Permit �57
Amount
Type of OccuEancy
New Renovation rl
Replacement
Plans Submitted Yes E] No E]
FIXTURES
0
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Ln
z
0
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SIMM
R4S94M
11DM
3M MOM
4IRFUM
51H HBM
61H FIDM
7]HHDM
91H HJ0CR
Wrint, or type)
Check one: Certificate
Installing Company Name 7—X'4W&Jff&
0&1
1:1 Corp.
Address '!!v 14� It, 1zd!;-Ae
&,P-
El Partner.
2Z1&JT-S 4P -- A
Y 6: f tf_-
Business Telephone,
Firm/Co.
Name of Licensed Plumber: 0", &,/,
Insurance Coverage: Indicate the type of insu/ance
coverage bypMeli—inj 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 inqrance
Signature 4,
Owner Agent E]
I hereby certify that all of the details and information I have submitted (or entered) in above application are tnie 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 Massachuasetts�State er 142 of the General Laws.
,glumbing Code an C apt
By: =ignawre of 17censewriumoer
Type of Plumbing License
Title /
Cityfrown Mcense numuer Master Journeyman 0 -
APPROVED (OFFICE USE ONLY
Date. . -.0-3 ...
. . ... .....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
tu
This,,certifies that V y .......
... ...........
. 4
has permission for gas installation N-!�. Av.LD.�� . . ......
,L) A -� --e "/�C, k., a, L -'/I AJ
in the buildings of ..........................................
11 'P 4 North Andover Mass
at .........
Lic. No. \.Oz
Fee ... ..... ..
GAS INSPE-4T0;R
Check#
4312
. MASSACHUSETrS UNIFORM APPUCATON FOR PERMFr TO DO GAS FrMNG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building LocationsojZ,� ;03� Permit #
Owner's Name Amount $ 757
New r—IL- Renovation Replacement Plans Submitted
L —1-3 1:1
(Print or type) Ckc* one: Certificate Installing Company
Name. . — 1:1 Corp.
Address 01 ly L4V IS alX-Ag- Ift
Name of Licensed Plumber or Gas Fitter
0 Partner.
1:1 Firm/Co
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [2]- No[j
Ifyou have checked M, please indicate the type coverage by checking the appropriate box.
Liability insurance policy P- Other type of indemnity 0 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one.
Signature of Owner or Owner's Agent 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 �V�Lll pertinent provisions of the Massachusetts State Code and Chapter 142 of the General Laws.
9as 1 .
cityrrrw�n
(OFFICE USE ONLY)
Signature ofi
19 --plumber
M Gas Fitter
[0 -'Master
m Journeyman
Plumber Or Gas Fitter
li9ZZ2
License Number
RUA ME �4 �36,
mm.
MAN'
(Print or type) Ckc* one: Certificate Installing Company
Name. . — 1:1 Corp.
Address 01 ly L4V IS alX-Ag- Ift
Name of Licensed Plumber or Gas Fitter
0 Partner.
1:1 Firm/Co
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes [2]- No[j
Ifyou have checked M, please indicate the type coverage by checking the appropriate box.
Liability insurance policy P- Other type of indemnity 0 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one.
Signature of Owner or Owner's Agent 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 �V�Lll pertinent provisions of the Massachusetts State Code and Chapter 142 of the General Laws.
9as 1 .
cityrrrw�n
(OFFICE USE ONLY)
Signature ofi
19 --plumber
M Gas Fitter
[0 -'Master
m Journeyman
Plumber Or Gas Fitter
li9ZZ2
License Number
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ /� ... '- . T ........ 1-1'7-r ... //, ...............................
...... .. .... ..............
/6X -P C'�' we
has permission to perform .......... ...................................................................
A
wixi/ng in the building of ...... ��f ...... .......................
i dt Irl- A 7 x
at ... I ............... 9
............... 2� ... ...... .......... �rth Andover, M S.
Fee..ZO�'.O..o Lic. .......... . ....
.01
Check#
4 4 5 37
TDECOAMOATVVE4LIHOFAL4SS4CIIUSE77S Office Use only
DEPARTA1EW0FPUBL1CS4FM
BOARDOFMEPREVEMONREGULAHONS5rOMl2 00 Permit No.
Occupancy & Fees Checked J
APPLICATIONFORPERAlff TOPERFORMELE=CAL WORK
PP ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE JNT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: I Yes No (Check Appropriate Box)
Purpose of Building & S t Pe- -, 7T4- / Utility Authorization No.
Existing Service — Amps Volts Overhead 1-1 Underground No. of Meters
New Service 65700 — Amps/oe /,"Volts Overhead r --J Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 727 77 70 77 g�-�
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Litiliting Fixtures
Swimming Pool Above
F1
Below
Generators
KVA—
ground
2round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
1�—,
FIRE ALARMS No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dq&s
Heating Devices KW
EDConnections
No. of Watir Heaters KW
No. of No. of
I I
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER-
1mrat=CbwraW- RmarttDdiemWmiiaZdM%mdxsemGmalLaws rt"
lbawawnertb&&ylw==PblicymhdT(bW)et,-OpffabDmoDwrdWorltsgftgdegrAut . YES I t-- I NO
IhawsubndWdvafidp,00fofsametotheOfflm YES r -7p f3uuhawdudod YES, pb=fi1fi=thety1)e0fC0WrdXby
drddT die VpR3mafe bbox. A6 -;--J L --- J
INSLIRANCF, P�/--1 BOND MER qlem**) / '2 ',
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sigwdunctrTr-puiabesof pow (d -� / — .
F[RMNANE (L z7AJ
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CW�S NSURANCEWAIVERIamawated)atdrl=wdoesnothaved)emmo=oDvaageorAsabstanUogmablasmqmedbyMa%admsm Gmial Laws
and dmt my sigmtute on this pmnt apphcation wm*ves this Wq mimrit
(Please check one) Owner F7 Agent M Telephone No. PERMITFEE$
signature of Owner or Agent
The Commonwealth of Massachusetts
Department of Industfial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
I Name Please Print
Name:
Location:
cily Phone #
F-1 I am a homeowner performing all work myself
F-1 I am a sole proprietor and have no one working in any capacity
F-1 I am an employer providing workers' compensation for my employees working on this job.
Company name:
citc. Phone
Insurance. Co. Policv #
Company name:
Address
cily. Phone
Insurance Co. Policv #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a,fine up to $1,5w.
and/or one years' iffprisonfftent-as-weU-as-cMi.penattiesin-thelarm-dA-STOPMKM-ORDER-md-afine-d-($l-OD.OD)-ajdWagainstBip- 1 01
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
/ do hereby certify undgr Me pains and penalties ofperjury that the Jr*rmahon provided above is &w and correct.
Signature Date
Print name Pbone.#
Official use only do not write in this area to be completed by city or town official -
City or Town PermitAlcensing.
Buildi
ng Dept
E]Check Y immediate response is required
LicensirU Boarcr
E]
Selectman's Office
Contact person: Phone E]
Health Department
r-1
Other