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HomeMy WebLinkAboutMiscellaneous - 29 WINTERGREEN DRIVE 4/30/2018 (4)Commonwealth of Massachusetts Sheet Metal Permit Date: 9 Estimated Job Cost: Plans Submitted: YES V'NO Business License # Business Information: Name: J r e, S. 0 Street: M u r 49 s City/Town:. o S Telephone: �0 03 013 yrl — Permit #�'� Permit Fee: $ —N4— plans Reviewed: YES NO Applicant License # 9-3 � Property Owner / Job Location Information: Name: Street: City/Town: - Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family U-� Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. V-11�- over 35,000 cu. ft. Sheet metal work to be completed: New Work: ✓ Renovation: HVAC Metal Roofmg Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy 0-- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ igna a of Owner or Owner's Agent By checking this box0,1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date Progress Inspections Comments Final Inspection Inspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at www.mass.gov/dpi Type of License: By ❑ Master Title ❑ Master -Restricted City/Town ❑Journeyperson Permit # ❑Journeyperson-Restricted Fee $ ❑_ Inspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at www.mass.gov/dpi r Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease /kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper c1dYances, fire rated enclosures and pressure testing required: S0; 1.reS`.�a'i'�ltb install ti :n1 iE F, required 'bh equip 1, ment and dAh, , ai.. _ — Duct penetrations in fi e'ratc ivall-3 acid floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct rums installed 6'•-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) s Sheet Metal Residential Guidelines,/ Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joameyperson-to- apprentice ratios Equipment sized per heating/ cooling load calculations Duct work sized per manual "D" calculations Bath/ shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) 371 Date.?/. ��.� ... AORTF, TOWN OF NORTH ANDOVER pF ao ,e 6 °� pL PERMIT FOR MECHANICAL INSTALLATION A'— This certifies that ....��� . c "`�� D ' �........... . has permission for mechanical installation .....jr ............ in the buildings of I. �.... i.I.z�! a--' • • • at.. -w-1- ►-j. pedwt„-.. North Andover, Mass. Fee.. Vy .. Lic.No.�1.... .............:.... . GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1p Jeff Dawson P.O. Box 295 Hampstead, NH 03841 (603) 234 0452 WORK AGREEMENT Customer: Mike Ditroia 29 Wintergreen Dr Norah Andover Ma 01845 Estimated Start Date: July 25, 2015 Job Name: Ditroia Location: 29 Wintergreen Dr North Andover Ma 01845 We hereby submit specificatkms for: Installation of two 13 seer, 2 ton Carrier (mod number 24ABB324AON31 F84CNP024L00) split air conditioning systems, one in the basement and one in the attic. Systems include all ductwork, wide media arc finers, digital programmable thermostats, secondary drain pan in attic, condensate removal pump in basement, and all necessary high and low voltage electrical. We Agree to hereby famish material and labor - complete in accordance with the above specifications, for the sum of: Payments to be made as follows: 50% with signed work agreement. 50% upon completion of job. Warranty : Parts - 5 years, Compressors -10 years, tabor - 2 years All material is guaranteed to be as specified. Ali work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra casts will be executed only upon written orders, and will become an extra charge over and above this work agreement. All agreements contingent upon strikes, accidents or delays beyond our control. Acceptance of Work Agreement The above prices, specifications and conditions are satisfactory and are hereby accepted. Jeff Dawson is hereby authorized to do the work as specified. Payment will be made as outlined above. ( $12,000.00 ). Authorized Signature Date Customer Signature Date? Please mail the deposit of $ _ and one original signed work agreement to: Jeff Dawson @ P.O. Box 295 Hampstead, NH 03841 Deposit and work agreement must be received no later than in order to keep current scheduling. Please keep second original of this work agreement for your records. If you should have any questions regarding this agreement, please call me @ (603) 234 0452 We Thank You for Your Businessl -k- f i- Project Name: 29 WD System: 2 1329 Wintergreen Dr, North Andover, MA 01845, USA BETA CoolC91C nual J Summer Outdoor F: [ice] Summer Indoor F: Design Grains: Daily Range: _ ................. ._. -- ---- ------- _. _.. " - -- -- -------- - - Winter Outdoor f: a Winter Indoor F: Coohn9RH: a Elevation (ft}: j Loads Windows Cooling AED Excursion � 0.8% 7.6% Name Area Sensible Latent Duct Doors Windows & Glass Doors 160 1,449 0 11.1% 3.1% Skylights 0 0 0 Above Grade Doors 28 582 0 Walls Internal 13° Above Grade Wails 1,232 2,459 0 Floors 140 231 0 22.5% floors / Ceiling 1,240 3,038 0 1.2? Ventilation 0 0 0 Ceiling Infiltration 0 1,893 2,790 16% Internal 0 3,275 .1,000 Duct 0 1,952 149 Infiltration Blower Heat 0 0 0 24.7% ` AED Excursion 0 157 0 1,600 1,200 t 800 400 n ❑ HTM Total 2,800 15,037 3,940 � Calculations Heating Loads P' Duct Name Area Heat Loss 9.8% ^N Floors Windows 20.4? Windows & Glass Doors 160 Skylights 0 8,500 0 2.2% estimates on building use, weather data, and inputted values Doors 28 1,366 selections should meet both the latent and sensible gain as Above Grade Walls 1,232 6,224 �✓ ' J Doors Below Grade Walls 0 0 - --�'= 3.3% Ceiling 1,240 3,706 Above Grade Ventilation 0 0 Infiltration Walls infiltration 0 16,932 a 40.5%=4 T Internal 0 0 Floors 140 929 `r Ceiling Duct 0 4,105 8.0;, Humidification 0 0 �✓ Hot Water Piping 0 0 . . Total 2,800 41,762 AED Graph A rove d RCCA M 8 1,600 1,200 t 800 400 n ❑ HTM pp � Calculations Average P' ❑ Average 1.3 Calculations are based on the ACCA Manual J 8th Edition and are approved by ACOA. All computed calculations are estimates on building use, weather data, and inputted values such a R -Values, window types, duct loss, etc. Equipment selections should meet both the latent and sensible gain as well as building heat loss. See Cool Calc Manual S Report for 8 9 10 11 12 13 14 15 16 17 18 19 equipment sizing verification. Hours Prepared by: Cool Calc Version 1.0.0 Beta -.www.coolcalc.com i' Project Name: 29 WD BETA 6 System: 1 1329 Wintergreen Dr, North Andover, MA 01845, USA Cool C91C nual J Summer Outdoor F: ftp, Summer Indoor F: Design Grains: * ---------- ---------------------------- Daily Range: ----------------- --------- C) Average ------------------------- Winter Outdoor F: ------------ ----- -------------------------------- Winter Indoor f: Cooling RH: Elevation (Ft): Calculations are based on the ACCA Manual j 8th Edition and ----------- are approved by ACCA. All computed calculations are Name Area Heat Loss selections should meet both the latent and sensible gain as W inclows & Glass Doors AED Excursion 8,279 I Cooling Loads Skylights 0 0 Windows Name Area Sensible Latent Duct 3 3. 1 IN Above Grade Walls 1,200 19.4% Windows & Glass Doors 156 4,409 0 3.7% 25.8% Ceiling Doors Skylights 0 0 Ventilation 0 0 L Infiltration 2.61% Doors 40 582 .0 0 0 0 1.3%74V 5,57 Floors Above Grade Above Grade Walls 1,200 2,394 0 0 1,259 Walls Walls Floors 1,240 316 0 Hot Water Piping -0 0 Total 2,776 ii 25,013 10.5% Ceiling 140 266 0 Internal Floors Ventilation 0 0 0 514% 1,4% Infiltration 0 712 1,049 Ceiling Internal 0 10,250 1.901 Duct 0 681 151 Infiltration Blower Heat 0 0 0 7.7% AED Excursion .0 64 0 AED Graph 7,000 5,500 4,000 2,500 1 nnn Total 2,776 19,675 3,102 Calculations C) Average Heating Loads ❑ Average Duct Calculations are based on the ACCA Manual j 8th Edition and are approved by ACCA. All computed calculations are Name Area Heat Loss selections should meet both the latent and sensible gain as W inclows & Glass Doors 156 8,279 Floors ' Skylights 0 0 Windows Doors 40 1,366 3 3. 1 IN Above Grade Walls 1,200 6,059 Infiltration Below Grade Walls 0 0 25.8% Ceiling 140 325 Ventilation 0 0 L Infiltration 0 6,455 Ceiling Doors Internal 0 0 1.3%74V 5,57 Floors 1,240 .1,270 Above Grade Duct 0 1,259 Walls Humidification 0 0 24.2% Hot Water Piping -0 0 Total 2,776 ii 25,013 AED Graph 7,000 5,500 4,000 2,500 1 nnn 8 9 10 11 12 13 14 15 16 17 18 19 equipment sizing verification, Hours Prepared by; Cool Calc. Version 1.0.0 Beta- www.coolcalc.com Approved ACCA MJ8 0 HTM Calculations C) Average ❑ Average 1.3 Calculations are based on the ACCA Manual j 8th Edition and are approved by ACCA. All computed calculations are estimates on building use, weather data, and inputted values such a R -Values, window types, duct loss, etc. Equipment selections should meet both the latent and sensible gain as well as building heat loss. See Coal Calc Manual S Report for 8 9 10 11 12 13 14 15 16 17 18 19 equipment sizing verification, Hours Prepared by; Cool Calc. Version 1.0.0 Beta- www.coolcalc.com 1> .9 AlIz Load -Calc ----- Design Indoor Cooling Temp.: 75 OF Design Outdoor Cooling Temp.:' 87 ° F Temp. Difference Cooling :12°F Indoor Humidity: 50,_11 Grains difference: 31 Mike Ditroia 29 Wintergreen Dr Area: Lawrence, MA Front Door Orientation Whole House Load Calculator 7/28/15, 2:58 PM Design Indoor Heating Temp.: 70 ° F Design Outdoor Heating Temp. 0 OF Temp. Difference Heating :70° F :Cool: lrF Heat:70°F Outside Wall: North Sq. ft. -types 1 and 2 1:304 2:.304 - shading Windows x Sq. ft: types 1 and 2 1:.140 2 140 _._ .. IL shading Glass Doors x Sq. R - typal 1 and 1:40 2: Doors 20- Outside Wall: South Outside Outside Wall: NE & NW Outside Wall: SE & SW -_ 1:120 2 120 1: 2 1: 2 w - Windows Windows x Wmdows —.-_ 1: 2 1. 2 1: 2:,- , rs Glass Doors Glass Doors Glass Doors x Glass Doors — - 1 2 1 —^ 2 L 2 Doors Doors - 20 --- Sky Lights c S FW: 11 NE -NW SE -SW: _ 1824 sq. R Floor - (linear ft. if slab) 1:1220 2 1220_ B$Sement Walls -above grade .1824 below grade Ceiling 1:1220 , 2:: 1220 Basement loot —1220 width 27 to 21 feet below grade:. 4 ft�V� Number of: Appliances ,4 Fireplaces' i ._ Fresh air recommended: 62c&n — CFM Number of People 4 Conditioned - Sq. R: 2440IL Cubic. Ft.: 19520 Construction: average Duct system: attic ® R-8 ® very tigh asement floor Calculate Load Total Btu's Cooling 47990 Sensible Load F45966F7 Latent Load Total Btu's Heating 2024 _IF185188 Btu breakdown Structure types Outside Walls 1: Siding or Stucco R19 insulation Outside Walls 2: Siding or Stucco R19 insulation Windows 1: double pane - drapes Windows 2: double pane - drapes Glass Doors 1: double pane slider - drapes Glass Doors 2: Floors is closed or vented crawl R-19 insulation Floor 2: Ceiling 1: Ceiling 2: Ceiling under attic space R-25 Doors: Metal Skylights: Basement Walls: block brick or concrete - no insulation Basement Floor: no insulation underneath Win ht.: 5'0" Overhang: 1.5' Top to overhang: 2' http://www.loadcalc.net/load.php# Page 1 of 1 Sensible Latent Heating fw—alls 1297 5217 dows I920 11172 eilings I2318 245 oors 36 2520 oors 705 3288 appliances eople 800 20 800 lass doors 560 1596 skylights 000 asement walls 5390 129340 asement floor �� 1879 lltration 687 1097 556 esh air 00� uctload 117375 otals 5966 2024 185188 Structure types Outside Walls 1: Siding or Stucco R19 insulation Outside Walls 2: Siding or Stucco R19 insulation Windows 1: double pane - drapes Windows 2: double pane - drapes Glass Doors 1: double pane slider - drapes Glass Doors 2: Floors is closed or vented crawl R-19 insulation Floor 2: Ceiling 1: Ceiling 2: Ceiling under attic space R-25 Doors: Metal Skylights: Basement Walls: block brick or concrete - no insulation Basement Floor: no insulation underneath Win ht.: 5'0" Overhang: 1.5' Top to overhang: 2' http://www.loadcalc.net/load.php# Page 1 of 1 ..0 RZ MAY/21/2015/THU 11:53 AM FAX No, P 002/002 ACORN® �. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F5/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Deb Basiliere NAME: Kingston Insurance Agency (PA IHExt : (603) 642-4800 FAX No): (603) 692-3733 152 A Main Street ADDRESS: deb@kingstonins.com INSURER($) AFFORDING COVERAGE NAIC & INSURERA MERCHANTS MUTUAL INS CO 23329 Kingston NH 03848 INSURED INSURERS: INSURERC: JEFFREY DAWSON INSURER D : PO BOX 295 INSURER E : INSURERF: HAMPSTEAD NH 03841-0295 COVERAGES CERTIFICATE NUMBER:CL1552103803 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X�OCCUR DAMAGERENTED ESEaoccurnce $ 500,000 PREMSO MED EXP (Any one person) $ 15, 000 BOPI068627 10/9/2019 10/9/2015 PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER* GENERAL AGGREGATE $ 2,000,000 X POLICY a �� F� LOC PRODUCTS - COMP/OP AGG $ 2,000, 000 EPL $ 100,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE I I ER ANY PRO PR I ETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Air Conditioning and Heating Work (978)688-9542 TOWN OF NORTH ANDOVER 120 MAIN ST N ANDOVER, NA 01845 ACORD 25 (2014/01) INS025 (201401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Basiliere/DEB-�i."'-cz-�`-'-e��'� L� f © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Date ... — / -7--06 .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.......... (Z ....... k IJAIL- L t5 � x -r-7— .................................................................. has permission to perform .................. HprT ............................. wiring in the building of ...........•......... ................................. at ..... 4e-ls-�.. &C'y .. . . e".O-f .................... North Andover, Mass. .... .......... Fee ..Y:5.'—. Lic. No..J.3��9)P? ............ Atz� ................ ELECTRICAL INSPECTOR Check # 7056 I�D'\ Commonwealth of Massachusetts Uthcial Use Unly Department of Fire Services Permit No. %Y> EL Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 122..00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of hjs or her intention to perform the electrical work described below. Location (Street & Number)�i! n! .P Owner or Tenant t~ 4� �. Z e� Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No Rr (Check Appropriate Box) Purpose of Building I���Q�4� E' Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ;4 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires 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 ❑ In- ao. rnd. grnd. ovLmergFficy Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Number Tons I K No. o Self -Contained Totals I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipa E] Other Connection No. of Dryers HeatingAppliances pp KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. or— Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring. No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) / certify, under the �pus a d penalties of p rjury, that the information on this application is true and complete. FIRM NAME: /\ LIC. NO.: -"X Licensee:e�one- (—Signature LIC. NO.: (If applicable enter "exempt" 'n the hce e num line.) Bus. Tel. No.: r Address: Z22 -e �� �W e tl-"V D%Alt. Tel. No.:?' *Security System Contractor License required for this work;4applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. Ok 6,tm ,A, Location ! �''y� n 12G t? -p- e � V / � No. Date d� NORTH TOWN OF NORTH ANDOVER .. 9 a ; ; ._..:..:. Certificate of Occupancy $ fid_ d '�s'••°'''<� s�cwusE Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17038 /,""Building'Inspector TOWN OF NORTI1hANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MPA I RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING' mss. S'�^ •e`�" .�„�"'7.wb'+:4f,�3""_ F'.a4 :,e�al��-.. �.,, ay3�Si, aa�i< � �" 1 S '� '&t��?w� BUILDING PERMIT NUMBER: DACE ISSUED: SIGNATURE: Bul&ng Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1..11 Property Address: 1.2 Assessors Map and Parcel Number: %Uyi3 000 Map Number Parcel Number Jcl - 4_� 1.3 Zoning Information: Zarin Ni ;ic—t Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RequiredProvided R red Provided 1.7 Water Supply M G L.C.40. 54) 1.5. Flood Zone lnfomration: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes NO 2.1 Owner of Record +k446v? 51161' 0� I C L)) Name (Print) / Address for Service ,/M � K a— q Sikilature Telephone 2.2 Owner of Record: Name Print Address for Service: r Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: A7 Signature Telephone Not Applicable ' License Number _ Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name .y Registration Number -i Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L• C 15T & 25cO) 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check all a livable New Construction ❑ Existing Building ❑ Repair(s) 11Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: cct &-k7pl& V1 1XV, WY110GO _:�> Zplwfy��2 d1du 0, Move J, �, 7doo-r � ,l�-c% 01 ��G�s SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Completed by permit applicant OFJF`ICIAL (a) Building Permit Fee Multiplier tISI+;�� 2 Electrical 0 (b) Estimated Total Cost of Construction '522 3 3 Plumbing — Building Permit fee (a) x (b) �3 (� 4 Mechanical HVAC 5 Fire Protection 6 Total. 1+2+3+4+5 6C>O Check Number SECTION 7a OWNER AUTHORIZATIbN TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/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 1, ,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 Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 RD 3 SPAN DIlv1ENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlV NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax Please print. DATE I C9/-0-/ JOB LOCATION Number Town of North Andover Building Qepartment = - 27 Charles Street North Andover, MA. 01845P" 9S q` pS,A, .5��^ HOMEOWNER LICENSE EXEMPTION Street Address Map / lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, -on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or,construction of an addition to any pre-existing owner occupied building containing at least one,but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Wo Address of Work V61 (Q) ✓1 Owner Name: M I Akt/ D /Tnto­, Date of Permit Application: Z a4 I hereby certify that: Registration is not required for the foll Work excluded by law Job under $1,000 Building not owner -occupied Owner pulling own permit Other (specify) Notice is hereby given that: costL reason(s)• office Use On l /Pemit No. Date / OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name m m m m X m N m 2 y — d CO) Cl) CD n z y 06 '0!. O CL y o p CD CDCL o cr d CD CD o CD C. CD ca CD d O ca >> I co 0 oo�*Icg m -4 C y 0 Q Z d 0—CH BOB m m C y co d !7 Z =rlo H _I O .-rCL .di H m T ? 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N"prx O N �,L d1NL 3 cmc ,D m a� a� .y .E c N CC — N h o. n U N c 60 U a) -0 w 7 Q N 'a d C 4- U-0` � UCO O q .. O j.m U °�0 >a4`L•.o o)o� o �2 Q m0�jLO W c00 cd 0 0am0) 0.2V)`�ro aC(U I o�' �- O N m.°m Nv7 U m u--,N� O c N N \ - o m �'CL 3 3 i° Sao �' h NM QC� r- T- ow `O > N +' L O Ci r'i.0 N n n O I, Cl O � v 1 j U ° (0o J c (0_> 0 N(U Q) CLQ° C O L U 2� N� toco 0 a) N c m m ° 00 0 Nv C 0 0 L ,mn 3 a � ;c m m� �'0 �; o \� 7 O Y C N O U O 7 \ U (0 c ' a- C Y a) c N N O U N N U O U •C N E t7 Ni .N. C N N �1 0 •2 C N c a O E0 3 ro � U0x7 ,s mv° 3 EUw� L) to A Q m 3 c� rn L c E'0 . �- m 0)o '--------- v 00 S ;° m•o acv m u c o . = 0 °c'N �s•� n 3 a° _ -C �Y Nin c 0�_o mz0 m �U0-1 00 E aci E• comm -m ;.-U 3w 4 N t h a 1 w 1 , ib Date.0. ?...... o� y` TOWN OF NORTH ANDOVER F D f . PERMIT FOR GAS INSTALLATION o Sy { This certifies that ..P� e.t.:-- �...................... has permission for gas installation A� .......... . in the buildings of ................................ at ..... , North Andover, Mass. Fee..?.�..�. Lic. No........... ... - t..a `�-......... . GAS INSPECT6R Check # �'l� I L r MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations (,A / Gt It n f2U'�.r ra y-, ke A 4() 1 C, Owner's Name New Gr Renovation Replacement Plans Submitted UB -BASEMENT ASEM ENT ST. FLOOR ND. FLOOR RD. FLOOR TH. FLOOR TH. FLOOR TH. Z TH. FLOOR � FLOOR F e W Q d W G7FZ z M p6 I A > W 7 < w i UB -BASEMENT ASEM ENT ST. FLOOR ND. FLOOR RD. FLOOR TH. FLOOR TH. FLOOR TH. FLOOR TH. FLOOR TH. FLOOR Permit # �'S' J, Amount $ �xx � J U a F (Print or type) CW one: Certificate Installing Company Name S Address (/ Partner. Business Telephone — / 0 Firm/Co. Name of Licensed Plumber or Gas Fitter 5 L ,n �0 I„ .0 . . INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No� If you have checked des, please indicate the type coverage by checking the appropriate box. Liability insurance policy ED Other type of indemnity 13 Bond 13 O ner I urance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. ener s, and that my signature on this permit application waives this requirement. Check one: Si toe Ow er or Owner's Agent Owner Agent rl 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 apd inst latio pe rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuittts S#te Code and Chapter 142 of the General Laws. e t/Town PROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Number