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Miscellaneous - 299 WEBSTER WOODS 4/30/2018 (2)
Date ...... .... a ........................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Jf % This certifies that ............. / 1 ,i has permission to perform ........lam ....................................................................................... wiring in the building of.......� n '�— (,...................................................................................................... at .4�...WC'5.f.....! ...........�.... n......... , �North�ndover, Mass.. l4 //j/AbELECTRICAL INSPECTOR Check # Nob G �i�/ r/ 12995-f .:v Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT 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 his or her intention to perform the electrical work described below. Location (Street & Number) Aav \ + "( �(=�c �.i Z:,\Ae.- G e6<Jer wccA Owner or Tenantpa. IT A-u�'4 '2, Telephone No. Owner's Address 7,q1J " 1, 5-�cr 1,,1rr,A S Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building C,1,5-je Utility Authorization No. Existing Service 7j&t2 Amps �- y / )XU Volts Overhead ❑ Undgrd No. of Meters l New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters 14 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires (1 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- ❑ rnd. grnd. 790-.-07 mergency Lighting Baq Units No. of Receptacle Outlets 50 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches Xu No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I Number.. � .......................................... Tons . K. ... ....... W No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW pSouo Local ElMunicipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 5OU (When required by municipal policy.) Work to Start: I !A- t( Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: V CL I ke-.t f-- - r � �1- Zv\C o LIC. NO.: �Ao l I�D A Licensee: 4 r : a.,. W r ,"Aw Signature __ LIC. NO.: (Ifapplicable, enter "exempt" in the hgen number line) A Bus. Tel. No.• cl18'- i)1 -WO Address: �\ )�v4e � Cc, �t r w� 1��i k. til 935 Alt. Tel. No.: QZ& 376- 1162 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ l �, lI U lu r, I— 'I,-� ACO LY CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 12/28/2016 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 Phone: 978-6884474 Fax: 9783273558 CONTACT DEGNAN INSURANCE AGENCY NAME: DEGNAN INSURANCE AGENCY PHONE AX Arc No Ed : 978-688-4474 ac No), 978-327-6668 86 SALEM STREET E-MAIL cde nanfde naninsurance.com ADDRESS: g v g LAWRENCE MA 01843 INSURER(S) AFFORDING COVERAGE MAIC # EACH OCCURRENCE $ 1,000,000 INSURER : MOUNT VERNON FIRE INSURANCE COMPANY 26622 COMMERCIAL GENERAL LIABILITY INSURED VALLEY ELECTRIC INC. INSURER B INSURER 21 HYATT AVENUE HAVERHILL MA 01836 DAMAGE TO RENTED 100,000 PREMISES (Ea oocurence) $ INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 25830 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 L TYPE OF INSURANCE ADD'L INSR SUBR wvD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A GENERAL LIABILITY CL 2661642A 11/14/16 11/14/16 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PREMISES (Ea oocurence) $ CLAIMS -MADE I-1 OCCUR MED. EXP (Any one person) $ 6,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO - $ POLICY El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS UTOS HIRED AUTOS NON -OWNED UTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LI CLAIMS -MADE DED IRETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A TO STATU- OTH TORY LIMITS ER $ E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ Ryes, under DESCRIPTIIPTI ONNOF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN N. Andover, MA 01846 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 40L l Attention: Carla M. De nan ACORD 26 (2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCPR6° CERTIFICATE OF LIABILITY INSURANCE DATE (MNIIDDIYYYY) 12/28/2016 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(Fes) 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 Phone: 978-688-4474 Fax: 978-327-6558 DEGNAN INSURANCE AGENCY 86 SALEM STREET LAWRENCE MA 01843 CONTACT DEGNAN INSURANCE AGENCY NAME: PHONE FAX ac n Exl: 978-688-4474 ac No: 978-327-6668 E-MAIL naninsurance.comd cde nan e ADDRESS: g � g INSURER(S) AFFORDING COVERAGE NAIC # INSURER : NORFOLK AND DEDHAM INSURED VALLEY ELECTRIC INC. INSURER B INSURER 21 HYATTAVENUE HAVERHILL MA 01836 INSURER D: INSURERE INSURER F COVERAGES CERTIFICATE NUMBER- 9SA99 RFVISIAN NtIMRFR- 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 ADD'L INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDO POLICY EXP MM/DD LIMITS Carla M. GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-1 OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) $ MED. EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO - $ POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS UTOS HIRED AUTOS NON -OWNED UTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (per accident) $ UMBRELLA -9 OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WE132614A 11/13/16 11/13/16 RYTLIM TS ER $ E.L. EACH ACCIDENT $ 600,000 ANY PROPRIETORIPARTNERIEXECUTNE Y/N OFFICERIMEMBER EXCLUDED? f� J (Mandatory in NH) NIA E.L. DISEASE -EA EMPLOYEE $ C00 ,QQO If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 600,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN N. Andover, MA 01846 ACCORDANCE WITH THE POLICY PROVISIONS. Attention: AUTHORIZED REPRESENTATIVE 6wa `) 40( Carla M. De nan ACORD 26 (2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Date..IZ ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that`�o . ............................................................. has permission to perform Qt wiring in the buildingof .... .........e.,P, ..................................................................................... at..2M .... ....... �, North Andover, Mass. .......... . .... dee..5S . . .......... Lic. No. ........I ..... ...................... ........... ........... .... ELECTRICAL INSPECTOR Check # 1247 • A 'A' Commonwealth of Massachusetts official use oily - Departnment of Fire Services Penna No. (? 1 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev_ 9/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance whit the Massachusetts Electrical Code (MEC) 527 CMR 12-00- 0"LWE PRINT.aV i x OR TYPEAU BWOJU"HOM Date; a -1 l.i l y City of Town of: �;A�I.yE? , To the lis c-t�or of Tines: By this application the undersigned gives notice ofhis or iter intention to perform the electrical.work described below. Location (Street & Number) q Owner or Tenant x- Telephone No..77,2 3176 9d3$' Owner's Address Is this permit in conjunction with a bailtjiag permit"! Purpose Yes n No (Check Appropriate Box) of Building_ D, ,s,,-�, ., c , ztaa_r Tarr Existing S U ta'lii3+AuthorizafionNa i � J Volts Overhead ❑ Undgrd ❑ No. of Meters New Service=- ps J Volts OverheadEl- Undgrd ❑ No. of Meters Number of Feeders and Arnpacity Location and Nature of Proposed Electrical Work: W+R�£ 4ter 7U 11 4k av'r-Doo.2 IL , ConwietimqfMc fallowin table be valved by the ka7ector of W.-.& 3 No. ofRecessed Luminaires . No. ofC6JL-Susp. (Paddle) Fans No, of Total Transformers KQA No. ofLuminaire Outlets - No. ofHotTubs Generators" KVA No. of Luminaires Swimmi n Pool- Above' Lr- o. o mergeacy g g d- d. Ant—ke Units No. of Receptacle Outlets No. of On Burners' FIRE ALARM 114o. of Zones FNo. f Switches No: of Gas Burners No. ofDn and Total bitia . Devices f Ranges No. of Air Cond. Tons Na of Alerting Devices f Waste Disposers Rest umber fiber Tons 0. of nt>,ined Detection/Alertina Devices Dishwashers �- Space/Ares Heating KW Municipal Local ❑ Connection 0 Other Dryers Heating Appliances KW ecur- Systems: WaterNo. No. of No o of vrces or uivaleat - of Heaters BallastsData Wu-ing: Na of Devices or Equivalent \ ^ No. Hydromassage Bathtubs No. of Motors Total HP Telecomm ;"';DIMS Wirn'w. y' OTHER No. of Devices or - lent flttarh additional detail ifdesire4 or as red Me Estimated Value of Electrical Worth re9:<J by InapectorofiYurs � _ _� • OU - (Whea required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rude 10, and INSURANCE CO GE: Unless waived b the completion_ y 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 c�ov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE U BOND ❑ OTBER ❑ (Specify-) o 2� � e•� _ I certify, under the pains andpenaities ofperjury, thatthe1fifornmaon on application it true and complete: FIRM NAME: 3wr;F n LIC. NO.. F Licensee: Sw.y.�_ Signa LIG NO» (ljappliccrble, enter. "exempt" in the license nimrber line.) Address: A. Le Bus. T&No_: j-rg -.rr7 S93Tr rtis� o i4 t4 Alt TeL No.• 'Security System Contractor License required for this work;, if applicable, 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 lam the chkone) owner ❑ owners agent Signatureg ` Telephone No. .� The Commonwealth of Massachusetts f epartnent o l�f Industrial Accidents Office of Investigations ' - 600 Washington Street Boston, NIA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 16 L t a c 2;�j 5T SAmc-S -3 FBF- . City/State/Zip:D L rz TU rJ MA-- 019 tt Phone k 775 `777 S 9 72�' u an employer? Check the appropriate box: AWT.= Type of project (required): 1. a employer with 1-1 4. E] I am a general contractor and 1 6. E] New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. F1 Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. 0 Building addition [No workers' comp. insurance required.] 5.E] We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11.0 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 1311 Other employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t 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 atm an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: rm l5,7 Policy # or Self -ins. Lic. #: a 9 1 R 1 3 a Expiration Date: 31-s Job Site Address: g WE s r Z LUQQ Q S City/State/Zip: M A 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 ' sonment,'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 vi or. Be advised that a copy of this statement may be forwarded to the Office of ;Investigations of the DIA forksupfficA coverage verification. Ido hereby certify tinder We p6inskindpenalties of perjury that the information provided above is true and correct: Phone #: Official use only. Do not write in this area; to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person:. Phone #: . ' � � � . . ' ` ^ ' � � � . ` x , , �. .- , ' - ~ - ` COMMONWEALTH OF mA§§AdH U -SETTS - Department of Pubhc Safevv o%fassachusetts w, Board of Buildirig Reguiations and Standard's L I Coe n se-, CS -093882 JAMES 3 CARBONS 16 LIBERTY:ST MUDDLETON MA 019490: T::xr , iratiop 1212412013 OSHA Lf,s. Department of Labor a Occupational Safety �ind Healthadminismtion James Carbone has 5 uccessfuuy completed a 1 "Our occupational Safety and Heel*it, Training Course in Construction Safety & Heafth Jean C. Mano, 1i 617-969-7177 12/7/07 (Trainer) (Date) e Date .. . .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... 8114) has permission for gas installation ......................0 ............................ w ....................... in �� the buildings of Z�i ....... W.9 ...... e, wb-u at ...... *i. r6�� . .......................................................... I North Andover, Mass. Fee4? ............ Lic. No. /.3'� ......... . . .................................................... - GAS INSPECTOR Check# 55/3 9332 OVEN POOL HEATER F,t00M / SPACE HEATER ROOF TOP UNIT I UNIT HEATER 1' UNVENTED ROOM HEATER WATER HEATER OTHER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYMA DATE 3 PERMIT# JOBSITE ADDRESS OWNER'S NAME �. P GOWNER ADDRESS a. -etj S ate-' TE ') q j� FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL CLEARLY NEW: ,_. RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES F NO E APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ MP Rj"`MGF 0 JP ® JGF Q LPGI © CORPORATION # PARTNERSHIP [D# LLC []#� BOOSTER CITY _ I' ,t F -w- P STATE [el"ITZIP 94S TEL - 9361 - Z�%7 CONVERSION BURNER COOK STOVE�P DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR -- GRILLE o,�+-sa J� T 1 - - -—- _ �--I : -- INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER F,t00M / SPACE HEATER ROOF TOP UNIT I UNIT HEATER 1' UNVENTED ROOM HEATER WATER HEATER OTHER I -- - - - —� ' INSURANCE COVERAGE ul have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES NO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY n. OTHER TYPE INDEMNITY © BOND F OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 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 plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME��!LG� LICENSE# r3 _� SIGNATURE _ MP Rj"`MGF 0 JP ® JGF Q LPGI © CORPORATION # PARTNERSHIP [D# LLC []#� COMPANY NAME: Afs� t PI C4 ra � � ADDRESS CITY _ I' ,t F -w- P STATE [el"ITZIP 94S TEL - 9361 - Z�%7 FAX CELL—EMAIL _ W 0 H U W. a w o� a z O N� W � � W FO{ a Uw �* w Ln CO w a O LLI > o w w CO a o a a U ��y J Fi a a a � w H LL N z° 0 H U a U C�7 z I The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations quo 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): 1 t ec r ► (�y c-, S Address: S i City/State/Zip:'✓lr �� k-r��-- Phone #: Are you an employer? Chuck the appropriate box: 1. ERam a employer with --**'4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. F1 Plumbing repairs or additions 1211 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i -Homeowners who submit this affidavit indicating they are doing all work and then.hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. I /",) 1 Insurance Company Policy # or Self -ins. Lic. #: 6� S �% �-� S 3 7 Expiration Date: L,9 / , _ Job Site Address: 21 % zfr -pity/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. X do hereby cert& under the pains and penalties of perjury that the information provided above is true aV correct Phone #• %% O o>-3 61 - 2 r ; Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Information and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, • express or implied, oral or written." An employer - is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth. ofMassadhvsetts Department of Industrial Accidents Office of havestigatIoU 600 Wasbington Street Boston, ASA, 02111 Tel, # 617-727-4900 ext 406 or 1-877 MASS.AFB Revised 5-26-05 Fax # 617-727-7749 wwvv=ss,govM is Date ........................... .... p• ao .a 'N �pTOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that 1 ✓ /� ` T ................................................. ................. has permission to perform ............ 5fc�-/z. `Tf� /..... ��Y la, wiring in the building of ...... 6........" ......... at ........1 �... w�ES %....i!�%.... , North Andover, Mass. Fee ....IZ "' Lic. No :�A-16 ELECTRICAL INSPECTOR Check #_ Y 8962 111 +nt/T•..O/ttLl�a��n OI S�¢C/�l7AW , r !. _ � � Qr O Lft lrVK2i olr7 9 SOARD.OF FIRE PREVENTREGULATIONS OiT.icial Use Only Pcrmit No. •3� Occupancy and Fee Checked ;Rcv.1/07'(Ica-c blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All -ocic to be performcd in accordant- with the ttMasszcatisc.^s Elcc riccl Codc (NIEC), 527 CMR, 12.00 (PLEASE PRINT N LVK OR �%G/ZZ�-- By � TIOt1� . City or Town of: this opolieation the undersi Locntion (Street & Number) Owner orTrnznt Date: 1-8.4-07 76 the Inspector of Wires: Otic ner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Existing Servicc Amps / volts New Service — _ Amps / volts Number o`i'Feeders and Ami acity Location an Nature of Proposed EIectricai Work:. Utility Authorization No. Ove. -head ❑ Undgrd Overhead ❑ Undard No. oCt'1:.eters No. of Meters 40 /'le LJ7�'QTtC7r a. 0f Completian o the fallowing table iray 0e waivcd 5 the lnsAector o%Wires. No_ cf Recessed Luinirairc: i`'�. of Ceil: Susp. (Paddlr_) Fans No. of odes Transfor`+ ers KVA: Generat;� . KVA No. of HotTubs No. of Luminaire Outlets No- of Luminaires A ave n- Swimming Pool rad_ ❑ Qrnd. ❑ t o_ o: meroency .g..•ang Batter Units No. or Oil Burners FIRE ALARMS No. of Zones No_'of Receptacle Outlets —o. No. of Gas Burners of etectron and— �: '-iatinQ Devices No. of Alerting De -,'IC( --S O No. of Switc'-Nes � No. of Air Cond. • orb ' No. of Ranges .'ons _ o. o e - ontame eat ump um�r "Ions No. of Waste Disposers Totals: F Detection/AIerting Devices Space/Area Heating KW IY unicipal Loral ❑ Connection ❑Other No. of Dishwashers Heating Appliances KW Security sterns:* No_ of Devices or E uivalent No. of Dryers KterW ue 0-0 o_ of Ballasts Data Wiring: hio. of DeYrces C— E ui -- - ters Sins No. Hydromassage Bathtubs No. of Motors Total HP e ecommunicatsons rrrng: No. of Dericcs'or Equivalent OTHER: Estimated Value of Electrical Work: -Z-ogy , !?o (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unlcz waived by the ovmcr, no permit fat the performance of eiec.tri l work may issue unless the licence provides proof of liability insurance including "completed operation" coverage or its substantial equiva]ent _ The undersigned certifies that such covcrage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE. INSURANCE PQ BOND ❑ OTSER ❑ (Specify:) I certify, under the pains andpenalties afperjury, that the irtfornration on this application is true and.eomplete c FIRM NAME: -ur1-�" Sc,r�NO.: C�es LIG " Signature'] LIC NO-Xw I,iccnscc: K _ Bus Td_ No.: 9 (/fappl cable, enter t eTc pt"res L llr r� � e) 115 ufI ��`�� Alt Tei. No.: Address:Nd. Per M.G_L. e_ I �7, s. 57� I, seeuriry work --quires Deparunent of Public Safety " S" License: Lik s -DWNE.R'S Ii (SUFLANCE WAIVER I am avrre'thal. the Licensed does not have lh liability insurance covcra,e normally reouircd by taw. By my signaturc'below, I hereby waive ti;is requircrnenL I am the (check one) EJ owner LJ owncr't Qent. O,•iar_r/Arent TelephonE. e No L m q7 O 7z ri rri rn m �71 cn no =z0 7 M m z C: cn o x 3 --j CDm C, m S"\ rn II 0 Q -V C7, rl cn -Z: > C: (n 0 --i c g W n > mZ M _<;z cn —4 7— m 0 M --i z 00 0 M. 92 C') 0 0 > < C-) -j 110 r— Un M rn 0 0 C) > M -n W m rj 0 -4L. m cr. C/) n n n 0 > cJ M Ln 0 n n m r - x m > co > F! 2: M (D o rr. > CD Cf) 0 LT 0CG CD C: 0 CO (D 3 CO CD (n lV ll< co O CD CD v q7 N 7z ri rri m �71 no M 0 cn mr- --j CDm II 0 C7, rl -Z: C: cn M M _<;z cn in r M. 92 0 > < rn W z rj -4L. J. N cr. C/) n n n 0 > cJ M Ln 0 n n m r - x m > co > F! 2: M (D o rr. > CD Cf) 0 LT 0CG CD C: 0 CO (D 3 CO CD (n lV ll< co O CD CD v Location , Ci =% t'eb S 4 2 tOoodS No. 17 Date l�- ,J--c70 0.3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 0 r Other Permit Fee �'� � � $ o? a TOTAL $ d a o Check # 16398 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING I1i1S: or: -(W IJSC`�9I BUILDING PERMIT NUMBER: 1 DATE ISSUED: SIGNATURE. Building Cornmissionerfigntor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Num bcs: 2qq web5-[e-(W&9 Cage /V (0,0 016,y MA„' W erqaW. Q 10.F Mi{ Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions. M YJO �W Zoning Disinct Proposed Use Lt Areas Frontage (ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard 1.7 Water S 1.3. /ood Zone Information: 1.8 Sewer�gc�Disposal System: _ Vi.G.L.C.�tO. S4) ®/ Public Private 0 Zone Outside Flood Zone Municipal On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of" Record Name ( 'Print) ' Address for Service to Signature 2.2 Owner of Record: Name Print Sicmature SECTION 3 - CONSTRUCTION SERVICES Telephone 3.1 Licensed Cons wction Su rvisor: Licensed Construction Supervisor: 1 Address I n iigna ems; i1n, _ Telephone i.2 Register ff Home improvement Contractor ,vdW.9 Cr Cb. f0 C/- �.'ompany Name RT f �.. 311 ture // T Address for Service: Not Applicable ❑ 05 License Number 3-I4-04 Expiration Date Not Applicable ❑ Registration Number Expiration Date M SECTION 4 - WORKERS COMPENSATION (n G.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 ....... ❑ SECTION 5 Descrintimx of Pronosed Work (check all annticabte 1 New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition 0 Other Specify Brief Description of Proposed Work: • PP�PC� 1� C�I,ST I�C�1� �- �D r�C-Q�i�G�C�(� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beM Completed by pen -nit applicant �4FFCsi�lYI7SE 011 Y 1. Building 4 on �yKyP�- A(11�,(j (a) Building Permit Fee Multi Tier 2 Electrical vul/ (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) v 4 Mechanical HVAC 5 Fire Protection -- 6 Total (1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Hereby authorize My behalf, ' , i rs Signature of OW11er � �-i P2 1a a Owner Authorized Agent of subject property tt C Al �l V-MI � to act on e to work authorized by this building application. g p 49A 21 03 Date I SECTION 71) OWNER/AUTHORIZED AGENT DECLARATION I I, mQyl< Otl \ as Owner/A thorized Agent o 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 Dat NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS . ISF 2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. .............n.'.'..............(W6.�,.,�............................................. APPLICANT ANWRC�SatE1 C- PHONE UKO 27Q--TQ4b ASSESSORS MAP NUMBER /0& 6 LOT NUMBER 6./d SUBDIVISION I Qrn I d I f:b 1 , LOT NUMBER 20-P STREET 2Q4 We�� �ocd 5 [me STREET NUMBER *g't q OFFICIAL USE ONLY REC NDATIONS OF TOWN AGENTS DATE APPROVED JCONSERVATIONADUINISTr _ / / DATE REJECTED �- �sSJ iTre- — TOWN PLANNER CONRVM'NTS FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED J� �lryrjzr�to�ruuea`l�i c �l�la�sac�iuse�'s Board of Building Regulations Nv. � One Ashburton Prace Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number. CS 027999 Expires: 03/142004 RODNEY P ANDREINS 1647 LOWELL RO CONCORD, i%tA 0174_ ✓lie Transincnurarl� •6 • r�,.::r�r,•i.:l�% SCARD CF BUILDING RE=ULOMNS License: C--NSTRUC.,CN SLPE `:1SCR Number. CS vT'?9? Birthdate: M1111,141924 Expires: 03/t4r rN'd Restricted: CO RCONEY P ANOREAS 1647 LOWEL. RO �,�._... ^�i:7r=' CONCORO. mA o,.-,4-, .�ctnlrlsttatcr Birthdate: 0311411934 Restricted To: 00 Tr. 10: 067 <eeo :oo `or receipt and ::^arce or address notification. 7. tvlEv- -,cn. cr_e r.�l�rcve men: �ont -Lcmr Rei '=—G:I =CONE .� ,.r/r 00«�wwrwusl.�i .K. i(�LY�Jwrrtfl Ooaro of Budding Reguuuons amSlaaoarns i F HOME IMPROVEAE.4r =HTRACTOR r Requvation: t:,',i... Exa,ratlon: J7J1Jr.^0: Type. Pnvato C.:tCoratwn ANORENS GUNIM CO.. INC. PCONEY ANORE'NS REPW3LC PO rl elt I ZRICA, MA 0186". Adaaaswnwr Cita"ut . t:Puate Addrrss sad rtmr" c2ro- Man` reson for ct:: Audress _ Rme+rai _ E nu,ovtnent Limnse lir rr;tsmoon wild for indindni use -mw twore enc espsnuoo date. If found remm co: Board ot• Ilulidint; Retntianons sad Stanoarns One :�snburton Place Rm 1301 Roston -N112. 02108 ,���_4val without slosturr acoRo�CERTIFICATE OF LIABILITY INSURANC ID JM • �TDR89P5 °" '' °^�' 03%04/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IN RI LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 276 W.Main St., P.O. Box 1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northboro MA 01532 - Phone : 5 0 8- 3 9 3 -7 7 4 4 INSURERS AFFORDING COVERAGE INSURED INSURER A: American Casualty Co/Reading INSURER e: - Transportation Insurance Co. X COMMERCIAL GENERAL LIABILITY INSURER C: Valley Forge Insurance Co. Andrews Gunite Co., Inc. 6 Republic Road North Billerica MA 01862 INSURER D: INSURER E: - COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN RI LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 2048661231 03/01/02 03/01/03 FIRE DAMAGE (Any one fire) $ 50000 CLAIMS MADE [ 7X OCCUR MED EXP (Any one person) $5000 PERSONAL BADV INJURY $1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1000000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 C ANY AUTO 1081829964 03/01/02 03/01/03 (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY $ FX NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE _1$2000000 B OCCUR CLAIMS MADE 2048660466 03/01/02 03/01/03 AGGREGATE $ 2000000 $ DEDUCTIBLE $ X RETENTION $10000 WORKERS COMPENSATION AND TORY LIMITS B EMPLOYERS' LIABILITY 2048661276 03/01/02 03/01/03 E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYE $ 1000000 E.L. DISEASE -POLICY LIMIT 1 $ 1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SAMPLEC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SAMPLE CERTIFICATE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRES VES. ACORD 25-S (7/97) ' % - — ` " /-(OACORD CORZRATTON! 1988 a A Coad R ], s, _____...�A.......... �... PRODUCER ■■■{■{ a N� DATE (MM/DD/YY) �.. ....' _.. 11/0Ml 1/02 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Anawan Insurance Agency, 4 Anawan Avenue Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Roxbury, MA 02132 COMPANIES AFFORDING COVERAGE COMPANY A Norfolk & Dedham INSURED COMPANY ROBERT M AQUINO DBA B COMPANY AQUINO ELECTRIC 763 WEBSTER ST C NEEDHAM, MA 02492-314 COMPANY D .. �Zw RAG RAG RAG _• .. J... � _ .. 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OPAGG $ 1,000,000 A COMMERCIAL GENERAL LIABILITY R801559 11/04/02 11/04/03 CLAIMS MADE ❑ OCCUR PERSONAL &ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: m. EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER EL EACH ACCIDENT $ 100,000 A THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE WEND0595 8/13/02 8/13/03 EL DISEASE - POLICY LIMIT $ '5500,000 EL DISEASE - EA EMPLOYEE $ 100,000 OFFICERS ARE: EXCL OTHER A CONTRACTOR EQU P008066 11/04/02 11/04/03 4,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS WORK USUAL TO AN ELECTRICIAN CERTIFICATE HOLDER _--.......,—...,.........wm..t... .. .. �.,..._.., m,,„i.. vr` ._....,.,..,..».w .,....... ..«... �V F... .. OANGELLATIdOw, J.,, _, K.........:c"c.. ,.i.._ ......... ..,...... �,'o�_.._.. �..�„` .....�.w' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF NORTH ANDOVER EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BUILDING DEPT 120 MAIN ST NORTH ANDOVER, MA 01845 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BLILEFJJ�� BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR?LIABIIATY --- - 't- --I y OF ANY KIND UPON�THE'COMPANY, ITS �AG-ENTS1OR%REPRIIENT541 S. AUTHORIZED REPRES TATIVE . W' ✓•- ` 61i r A(4RD"25=5 {1%95}NOWORi"GiRRATIIN'T'�'i�i iW7W ... :`n• 7 X R D O b 6 z I y CO !1 w" s q IL nz 4 O �i z �� O ; �o m=v � C2 _m z y O W r CL -v v)=cm ccr- :o L Q ac= m ' a �"z `o o a .. i a 0C o G _ m :ago N �+ • L W Com_ ~ • r .vi ar c Z d. _ = m •y p A L L) a cm s dr' E = m col 0 Cc t tdop L F. 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I tJ u ) n z O v w J Z Q J h W o' 0 _-j tL N V7 PH Location �o-FabcC #-t;?Ci' No. 3 Date ��r' Z NORTH TOWN OF NORTH ANDOVER 0L Certificate of Occupancy $ C J C U s'•'�° � Eta Building/Frame Permit Fee $ sAMs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #(O 15261 IW(6-- / Building Inspector TO" OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: / _ % _ 00 0 a C SIGNATURE: Building Commissioner/In ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 0 1.2 Assessors Map and Parcel Number: 106 t� �� LtJ c>bsfer Woc�.s L` n . Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: " �� R,a �� tL(— 22�� C.� -39 Zoning District Pr osed se Lot Area so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 3(D 0 3 -7 f 3 ` 3O6' 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 2a,:?..5.r So IA6 Sop Name (Prin Address for Service: 6 &7-���© Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ > c 7% - Ce/ Licensed Constriction Supervisor: 06 0 G y v2 3 License Number ioo i3 .,s- Sle . Address # % �• `- 300 Expiration Date Signa, Telephone Is, 17 7 - 3.2 Registered Home Improvement Contractor Not Applicable ❑ - Company Name Registration Number Address Expiration Date Signature Telephone z W SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... V No ....... 0 SECTION 5 Descri tion of Proposed Work check au applicable) New Construction g Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work S 7%-7" V aW,,77 a: G w/ �// a4 -e7 e iso S � 3 / 4 ;2-9(1-c C 3 rii SECTION 6 - ESTIMATED CONSTRUCTION COSTS e Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 600 (a) Building Permit Fee Multiplier / —p p 2 Electrical (b) Estimated Total Cost of - Construction 3 Plumbing Building Permit fee (a) X (b) , r� t " �- 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 / pd Check Number SEC IION 7a OWNER AUTHORIZATION TO HE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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 77b OWNER//AAUTHORIZED AGENT DECLARATION 1, as (r/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 N of Owner/, V& %-,7 ////0/ Date NO. OF STORIES SIZE BASEMENT OR SLAB �m SIZE OF FLOOR TIMBERS 1 r % % �g �s 3RD SPAN O DIMENSIONS OF SILLS ,r DIMENSIONS OF POSTS Al 5�e el DIMENSIONS OF GIRDERS IAZI Sie�-G HEIGHT OF FOUNDATION THICKNESS- - -d'� SIZE OF FOOTING /,? -*' X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 6,W -C e z FORM U - LOT RELEASE FORM t INSTRUCTIONS: This `orm is used to verity 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 6`6 7- 5'76 0 APPLICANT 0,,2n Aoire,5f GSC PHONE (� 7 -�3or) LOCATION: Assessor's Nlap Number �0 3 PARCEL %6� jl SUBDIVISION- f�G/�Sf LOT (S) STREET%,L�v�'��/ Lt3oz?�� �_fte ST. NUMBER - *** *****OFFICIAL USE RECOMMENDATI0NS OF TOWN AGENTS: CONSERV TI N ADMINISTRATOR APPROVED a� a DATE REJECTED COMMENTS GL writ, it,' R�"— C t-L TOWN PL DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH 11 ��C)� SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ —1. PUBLIC WORKS - SEWERJINATER CONNECTION DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECT Revised 9191 im DATE The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # - ❑ 1 am a homeowner performing all work myself. 7 1 am a sole proprietor and have no one working in any capacity I am an employer providing wor/keers' compensation for my employees working onthis job. r`mm�nr %l nnma• / "1J7 --4 %`'tfJi/%i r',, �' e G e / let e'.,S� /-r Address //00 - AWd6' oC SU e 742!r 30� City-. k04 /b'ylc�oy �z )go, � ���5 Phone #• (212 5)G 8 7 -11 s 3© L Insurance Co.. ura-"C�e 60. Policv # iU �_ O / 5"� Comoanv name: Address City: 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 51,500.00 and/or one years' imprisonment as well as qinalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement glay be fo riled to the Office of Investigations of the DIA for coverage verification. I do hereby certify and the ins and nalti s of pe ry that the information provided above is true and correct. Signature Date I gl� le Print name Phone # SS .7 O Official use only do not write in this area to be completed by city or town cmcial City or Town Permit/l icensino 0 Building Dept ❑Check if immediate response is required C] licensing Board 7 Selectman's Office Contact person: Phone 9: Cl Health Department F-1 Other r � _ Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building (Department in their determination of exemodans under section 8. 7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant an Building Permit (below) Address of Prcperrt/ for Pem;it (below) Map and Parcel IV Purpose of Application (check below) Phone Number of A� plicant: • 4 Single Family Two Family 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the ECEMPTiON section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me cr any party to this permit from the requirements of obtaining other permits required prior to the issuance of the -uiiding Permit. Further I understand that my interpretation of the E<EIPTiON status is subject to revipw by the Building Department and is only officially accepted when the Building Permit iq issued. Based an 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, campiies with ane or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruc"en of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Sec:cn 9.7 of the Zoning Ty—law. This app!fcadon is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.Gare met and/or represents Dwelling units for senior residents, where cccupanc/ of the units is restricted to senior persons through a property executed and recorded dead restriction running with the land. For purposes of this section "senior' shall mean persons over the age of 55. it This application Is a part of a development project which voluntarily agreed to a minimum 401,16 permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable aces and permanently designated as open scam and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This appiicatfon represents a tract of land existing and not held by a (Developer in common cwnership with an adjacent parol an the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwefling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. 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 Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to allowed an EXEMPTION inaccurate information,/or knowledge gr ict, is gWun signature or uwner a This form must be a curacy of the information provided and that the atta&ed building permit is s cited ove. Further i understand that the submittal of misleading and or the checks g off of an above item which does not comply, whether done to my ds for re' at by the 8uildirt,g (Department to issue a Building Permit. d A e ho signed the Attac. ed Building Permit Date to the Building Permit upon application for such permit BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: NO iC C/O, Location of Facility SighatGe oYrermit Applicant Date NOTE: Demolition permit from the Town. of North Andover must be obtained for this project through the Office of the Building Inspector R c 1 r FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and dated De-, 19 9_ and/or by the Covenant dated Mav 1q , 19 Jg, and recorded in District Deeds, Book y g g 0 Page 1a4 or registed L4 1wev re in Land Registry District as Document and noted on Certificate of Title No. in Registration BookPage has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled " C4rA bell lierP_o peftNiliVB SubciiUiSJk* P�qy Section (s) Sheets Plan datedDe ce rn h er �,eg19 gam_ recorded by the E�x North, D i s± cfi �2istry of Deeds, Plan Book or registered in said Land Registry District, Plan Book Plan -*/ 017 8 4 and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) LorS L aM ! 7pa,•+ / 3 ; LoTS I\ hereby certify that lot number (s) Lo T& ZS 7}}Qv Z. 3' 8a 11on_d'4� i�GQof i6!V-A l.] iscln,�. wcyco,i." o), Do -m* Z�cuu�r Streets) conform to layout as shown on Definitive Plan entitled fl 4!)' ' Section Sheet (s) 2v,ZS E Z-1 IS i 3 on do O F M4 sp9�G ti ALBERT I F TRUOEL Z, 4Rgistered Land Surveyor 4 No. 36869 a� 9F61 ST �R�� ss��'VAL LAH� SJ 1 of 2 C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated , 19 , and/or Covenant dated 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. Registration Book, Pin Page acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: EXECUTED as a sealed instrument this iS day of 19 /M Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS ESSeX ss bei ebe'r 21, 19 9 q Then personally appeared AL`0)-) L0-S6a; kDPa (.d , one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary blic MaidUid My Commissi n Expires 2 of 2 1104 APPLICATION FOR WATER SERVICE CONNECTION ZO North Andover, Mass. 4Y' Application by the undersigned is hereby made to connect with the town water main insubject to to the rules and regulations of the Division of Public Works. 111 /,7 The premises are known as No. 6-4 xz&� 7/ f!� %fie �--`� Street or subdivision lot no. �' �g Ownar Arldr.— D Contractor m elfr K -, AN 4 ASO • 6) D PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at (tel subject to the rules and regulations of the Division of Public Works. Inspected by Date �e Street Board of Public Works Y See back for rules and regulations 1728 28 APPLICATION FOR SEWER SERVICE CONNECTION OE4 North Andover, Mass. 't�f Application by the undersigned is hereby made to connect with the town sewer main in 4few, subject to the rules and regulations of the Division of Public Works. n The premises are known as No. or subdivisiopn lot no Owner Contractor 6 - A* -5 t Ur t ,::: � (0 � Address i--- PERMIT TO CONNECT WITH SEWER MIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at LA subject to the rules and regulations of the Division of Public Works.. Inspected by Date Street �. Division Public Works 1 By See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.VVILLIAM HMURCIAK, P.E. Telephone (978) 685-095L DIRECTOR Fax (978) 688.9573 � p10RTh �Oa�t�en "9�a � OL o � n � r9 DRIVEWAY PERMIT DATE l 7x 0- )/ LOCATION Z e�S rr 1 S BUILDER phone OWNER x^ et). hone a 7 - S 3� 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. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. x MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-28-2001 DATE OF PLANS: July 6, 2001 TITLE: Lot 20C "The Hampton" PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 100 Andover Bypass Suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 596 Your Home = 594 I I I I I Permit # I I I I I I Checked by/Date I I i Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1877 30.0 0.0 66 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1720 19.0 0.0 82 HVAC EQUIPMENT: Furnace, 92.0 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 app e Standard Design Conditions found in the Code. The HVAC equipmenV selecte to heat or cool the building shall be no greater than 1 % f the design load as specified in Sections 780CMR 1310 a 4.4 Builder/Designer Date MAScfieck INSPECTION CHECKLIST ' Massachusetts Energy Code MAScheck Software Version 2.01 Lot 20C "The Hampton" DATE: 12-28-2001 Bldg.1 Dept.I Use I I CEILINGS: [ J 1 1. R-30 I Comments/Location I I WALLS: [ J 1 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: ( ) I 1. U -value: 0.35 I For windows without labeled U -values, describe features: 1 # Panes Frame Type Thermal Break? [ } Yes [ ] No I Comments/Location I I DOORS: [ ) 1 1. U -value: 0.49 1 Comments/Location I I FLOORS: [ ) I 1. Over Unconditioned Space, R-19 I Comments/Location 1 I HVAC EQUIPMENT: [ } I 1. Furnace, 92.0 AFUE or higher I Make and Model Number i i AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: i 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or f gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ) f Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ l I 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 provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): 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+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 .. I ----NOTES TO FIELD (Building Department Use Only) ------------------------- 0 .., ✓iie �anvnzoozweallii a�✓acizuoeGi~6 . f N- ; BOARD OF BUILDING REGULATIONS .. !41 License: CONSTRUCTION SUPERVISOR Number: CS 069234 i i Birthdate: 05/09/1954 Expires: 05%09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL _ 400 MAIN STe.�i!% i GROVELAND, MA 01834 Administrator i L Cl) 71 U) U m v y C � y C') CD n z CA CL C =c C1 a• y O CC-) O v CD CDCL O cr d CD CD o CD C O y CD d O CA CG I cD S v CA O -o z CD O O CD O CCD C C1 -*,a O d 2 NO Q N a < m y 0 Hd C.) co Cl) CD W Ip Ca CL O --40 m N O —i N o ? m� m = 7 -0 C O OZ:SN' n : W M. A r CL p� CLto ir. W O = CD CD \ �( l 1 � �_ 'CADCL c'7 z^ CA 0 % m �. /n N rp q lJ) N _ ;V b CD :o O �D=r C/) O H ' w % W�,` ("boq � d s*3 r: _. as �L o .+ _ o: o=' Cn 0 Cn 0 07 ti z '? 1 110f Cyd COD Cn 7d C� n y til PC7 C r m m n T C 7' T C R o. 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C/' O a CA �C �a �o CD cn cn to °�' �n cn �? w n w � cn al a^ R o T Ar. r� r � aha w tz o r G � 0 y 1 d 9 G goo 0 c �L 15 L4) LC Y�1LV�N�`J 4124 i" 117,� Date ...... ... .. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING : ... �E . �' /21 :7 // .......... - This certifies that ........ Z� ................................. / .&!;� .......... has permission to perform ...... /1„1.:r. . . . ........................... 'wiring in the building of ............ h. at ...t0o.,.27 .. �f ... ..... 64 Andover, 14 Wass. ccy . ............ Lic. No,,i.. 7v 3 ................ ECTRICALINSp Check # _700 .�.. l..onsrnonmaa[!ft o aJ! t,.� ..CJtPart`nw� o`,�`iro �aroica! r O ice us I ' / (Rev. t Num y Permit Number. / UIV BOARD OF FIRE PREVENTION REGULATIONS oceupaney(iFee ; APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL, CODE 527� 12 M / PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of:_ _ /5; 1 -9� By By this application the undersigned gives notice of his or her intention to perform To the Inspector of the electrical work described below. Location: (Street & Number)_ `i s 2 ® 4—t— ,2 ) ,�' Owner or Tenant: Owner's Address: Is this permit in conjunction with a Building Permit? Yes a--- o o (Check Appropriate Box) Purpose of Building:e -> tility Authorization #: / 3 — Existing Service: Amps 1 Volts Overhead ❑ Underground.❑ # of Meters Service?--Amps/2 v / L G,' Volts Overhead O Nii,t Underground.— # of Meters: Ner of Feeders and Ampacity: Location and Nature of Proposed Electrical Work:_ No. of Recessed Fixtures No. Of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets I No. of Switches No. of Ranges i No. of Waste Disposals No. of Dishwashers No. of Dryers ... No. of Water Heaters of Hydro Massage Tubs Z G No. of Cell.-Suso. (Paddle) Fans 2 U No. of Hot Tubs Swimming Pool: Above ground ❑ In Ground o No. of 011 Burners No. of Gas Burners No. of Air Conditioners Z TOTAL TONS:3 Heat Pump Totals: Number: TONS: KW: Space /Area Heating:_KW Heating Appliances KW KW No. of Signs: —# of Ballasts: No. of Motors Total HP No. of Transformers Total KVA Generators KVA # of Emergency Lighting Battery Units Fire Alarms # of Zones # of Deiection & Initiating Devices _ # of Sounding Devices: # of Self Contained Deteciion/Sounding Devices Local ❑ Municioal Connection c Other ❑ Security Svstems: No. of Devices or Equivalent Data Wiring, No. of Devices or Equivalent Telecommunications Wiring: No of Devices or Equivalent: OTHER; 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: INSURANCEc�BOND ❑ OTHER ❑ Pleases specify:_ tY: Estimated Value of Electrical Work $ (When required by municipal policy) Work to Start: Iy 7 - c;' Z Inspections to be requested in accordance with MEC Rule 10, and upon completion. N I certify, under the pains and penalties of perjury, that the Information on this application is true and complete. Firm Name:—/2, / �� , „ `/ 'a, /r — Licensee: " /! `/ Signature:6he applicable, anter xe _ ' i LIC. #/� / / js LIC. # , 9-39 3 Address: Ls Bus. Tel. Alt Tel. # (il0 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, 1 hereb waive this requirement. I am the (check one) Owner ❑ OR Agent ❑ Signature of Owner/Agent: Telephone PCD\!iT CCT. t/ Date...,. ✓... d.y.. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,k This certifies that .. C`:—' �.. ......... . has permission for gas installation . °'.................. in the buildings of .................................. at.9. I' . .. .., rth Andover, Mass. Fee./Z. Lic. No4'1'? ...... GAS INSPE Check # f .7 e cf & 4163 I MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print)Date /',O — 7 �. NORTH ANll�( VES MASSA'CHUSETTS Building Locations �- `� �% 14/e/ f ' t/ 1i /� (✓ � Df S Owner's Name New U Renovation ❑ Replacement ❑ Permit # yl lo -3 ' Amount $ 'Al of 5" '? n ICA/ %0C L/I , Plans Submitted (Print or type) j�% ' Name / / 4 Address CCS&I r'or ✓1 v Business Telephone 9 9117 3 , I Name of Licensed Plumber or Gas Fitter / G In / G d ✓' CSC one: Certificate Installing Company [—]Corp. ❑ Partner. ❑Firm/Co. INSURANCE COVERAGE Check one: I h%ve a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked M please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. 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 all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 o�►g General Laws. lcityarw—n� (OFFICE USE ONLY) L, mgnature of Licensed Plumber Or Gas Fitter Plumber z—<4 3 6% 3 ❑ Gas Fitter License 1CTum r ❑ Master M11/lourneyman Doi, a 3W FINIMFOINI (Print or type) j�% ' Name / / 4 Address CCS&I r'or ✓1 v Business Telephone 9 9117 3 , I Name of Licensed Plumber or Gas Fitter / G In / G d ✓' CSC one: Certificate Installing Company [—]Corp. ❑ Partner. ❑Firm/Co. INSURANCE COVERAGE Check one: I h%ve a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked M please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. 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 all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 o�►g General Laws. lcityarw—n� (OFFICE USE ONLY) L, mgnature of Licensed Plumber Or Gas Fitter Plumber z—<4 3 6% 3 ❑ Gas Fitter License 1CTum r ❑ Master M11/lourneyman 4 7 6 Date .. / . /l .7 — TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that... r has permission to perform ....... 4...'.. .jam :............................. ,s wiring in the building of ......,t.. P. . .............................................. ...`'�!.. ! t°�....... y orth An er, S. Fee ...115. '.. Lic. No.. ZS.'y .. .............. � ELECTRICAL sPECTOR Check # Commonwealth of Massachusetts Official Use On Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MRUN, 27 CMR 12.00 (PLEASE PRINT IN INK OR TYP AL F RMATION) Date: City or Town of: To the Inspector of Wires: By this application the undersigne_gives notice of his pr herjntention,to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Telephone N Is this permit in conjunction with a building permit? Yes ❑ No ff (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Com letion of the followin table mav be waived hi, the Ins ector o wz No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans tres. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- E] rnd. grnd. No. ot Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number I Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Key Security Systems: Al No. of Devices or Equivalent No. o Water Heaters KW No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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:) /� Estimated Value of lectrical Work: -L • _ (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pat s and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Licensee: John S. Bassett Signature AV (If applicable, enter "exempt" in the license number line.) Address: OWNER'S INSURANCE WAIVER: I am aware that the Lid9hsee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. D r, Hnllic m14 LIC. NO.: 1531' LIC. NO.: 1533C Bus. Tel. No.: 603 594 9 $ Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's age t. PERMIT FEE. $ - ,,ORT#1 0 4 CHU This certifies that zo ".' �' - 2 — Date ........... - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ... .................... has permission to perform .............. .......... .... plumbing in the buildings of . - �- ---/ ........ at ........ North Andover, Mass. Lic. No�.Vj.v .. ... . 07/1 ........... -- Zx PCUMBIN.PYSPECTOR Check # 5402 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDWER, MASSACHUSETTS 241 Building Location Z y 5 wd5 er Ir 60 Owners Name Date / y 2— e i/ Permit # y o v Amount Type of Occupancy New ®' Renovation ri Replacement Plans Submitted Yes ED No ❑ ►' 1 ' % • .J • ,,. • -.----�------------------ ----.-�------------------ .' M0MMW0MMMWMMMMWWMMWWMMNM (Print or type) Check one: Certificate Installing Company Name P' C ❑ Corp. r Address ElPartner. 6 Business Te ep one ,rid, 3 Ir/ Cy r7l Firm/Co. Name of Licensed Plumber: Insujance Coverage: Indicate the type of insurance coverage by checking the appropriate box: LiAlity insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. y: (APPROVED (OFFICE USE ONLY Signature of Licenseaum er Type of Plumbing License _ d'7>''7/li 1—Y- � q icense iwinoer Master Journeyman n / if CHRItTIANSEN & SERGI, INC., ,�'ROFESSIONAL ENGINEERS AND LAND SURVEYORS 011 '"0 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 (978) 3730310 FAX: (978) 372.3960 June 20, 2002 North Andover Conservation Commission 27 Charles Street North Andover, .MA 01845 Re: Lot 20D Campbell Forest Dear Commissioners: RECEIVED JUN 2.7 292 NORTH ANDOVER CONSERVATION COMMISSION At the request of the Messina Development Corp., we have prepared a modified site plan for the above referenced lot. The plan has become necessary because the home that Messina Development Corp. intends to build differs from the one indicated on the previously approved plan for the project, The modified plan differs from the approved plan as follows: The house, although it is to be built in approximately the same location as the house indicated on the approved plan, is rotated approximately 90 degrees so that the front of the house faces the roadway. 2. The top of foundation of the house has been lowered by 2.5 feet, and the garage floor has been raised by 5 feet. The garage will be an "attached garage" rather than a "garage -under". The grading of the last 100 feet of the driveway will be changed to accommodate the raised garage elevation. The driveway turnaround outside of the garage has been switched from the right side of the driveway to the left side. 4. The proposed front porch and walkway have been added to the plan. The grading around the house has been revised to accommodate the new foundation layout. It should be noted that the limit of work and the location of the sedimentation control remain as indicated on the approved plan, and that all work relating to the proposed modifications conforms to the 25 -foot no -disturb and 50 -foot no -build requirements. Please call me if you have any question regarding this matter. LIMIT OF PROPOSED � MODIFICATIONS "AA -5 �-�'" fir- t ''1••'• % / i t11-:...... (i' : / DECK �/393,7'S7 SF 1''•. RD � �� 1 /(CB=17/,9,2SF 8}` AA -20 r >y 'fr ti r � k MA WF18 - - WF19 WF17 W85 WF16 WB22 WB7 F1 WF10 WF11 WF12 NOTE. THE INFORMATION DEPICTED ON THIS SITE PLAN, WITH THE EXCEPTION OF THE INFORMATION SHOWN INSIDE THE "LIMIT OF PROPOSED MODIFICATIONS" LINE, IS A REPRODUCTION OF THE APPROVED PLAN OF RECORD, ENTITLED "MODIFICATION TO SITE PLAN, LOT 20D" PREPARED BY ENGINEERING ALLIANCE, INC., REVISION DATE 3/23/01. ALL OF THE PROPOSED WORK RELATING TO THE DEVELOPMENT ON THE LOT WHICH LIES OUTSIDE OF THE "LIMIT OF PROPOSED MODIFICATIONS" LINE IS TO COMPLY WITH THE PREVIOUSLY APPROVED PLAN OF RECORD. AA -11 Z- AA -12 AA -1d' AA --7 _ 9 -5 AA -17 AA -21.'. LGT-2O -395,757 SF _ 1 B21 - ;�y�t iii �-,` ,�� � • A WF18 - - - - -- WF19 WF17 WB5 - X23 " WF9 WB22 WF16 r -Y WB7 13ZwFll WF10 WF12 IF2 11-40 ` Up p0� 11-39 V `•' � v 1.1 70 WB24 i J �fti AA -15 AA -13 AA -16 AA -1Q9-- -20 AA 14 ^r - WETLAND GRAPFUC SCALE Town of North Andover Office of the Conservation Department,,, >. Community Development and Services Divi, 4i6n William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Brian LaGrasse Conservation Administrator Modification to Order of Conditions File No. 242- 1�1 ✓ Project ' c + 20 D'fi 1 I� The NORTH ANDOVER CONS IERVATION COMMISSION at it's meet accept 0LA/\< ?4Jird ` AN -1--, *y,) t�- nl'✓1yLt ZG as a Modification to the Order of Conditions issued in File 242- (� ate BKd WATION COMMISSION: t 113 PG 146 NORT}{ Of's��w"1ti0 O + A x ��SSACHUSEi Telepholie (978) 688-9530 Fax(978)688-9542 on 4/18/01 agreed to and recorded in44o4k- On this 18th day of April 2001 before me personally appeared Scott Masse to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her—free act and deed. L C A [PIAN i 'Common ealt ry Public of h4a;.;ac M Com Notary Public .e...•,o,R, A receipt from the registry of Deeds must be submitted to this office showing that this Modification has been recorded and referenced to the book and page numbers where the original order 242-1�6 was recorded. ATTEST: Original -Town Clerk A True Copy -copy-File � Q. ade�E�u✓- copy-Applicant Town Clerk BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9i; 53 C V) lip NOR7q O� o ,i,4, ,SSACNus� Date . .. .... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... li .G !? .:..... ��'1. ................ has permission to perform .... .... 7 ....... . plumbing in the buildings of ............... at .... ' ......... .`, North Andover, Mass. f Fee. ..'. Lic. NoJ .. ? �... . ..... U.`......I., ........ ;PLUMBING INSPECTOR Check # 5548 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location �'G r0 e Permit # Amount Z j Type of Occupancy New Renovation ® Replacement ® Plans Submitted Yes ® No FIXTURES ftnt'or type) Installing Company Address LZI Check one: D O FiCorp. /' _ " Partner. Business Telephone 7 -F-2- 77 L Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate e e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed and it Issued for this app ' tion will be in compliance with all pertinent provisions of the Massachusetts State Plumbing C e Chapter 142 of th ne 1 Laws. By 1gna e ot Licensectum e Type of Plumbing License Title . 9Z City/Town terse um errs Master ❑ Journeyman APPROVED (OFFICE USE ONLY pOFTy Oi +pec , Rh F A t y �SSRCHUS£ CERTIFICATE OF USE & OCCUPANCY A, ..t Yom: Building Permit Number 3 `'f 0' Date 3 — / 8 o?bo 3 THIS CERTIFIES THAT THE BUILDING LOCATED THE BUILDING LOCATED ON kai d o a '�i GVf6Sker tOVC)ds L,9,ti MAY BE OCCUPIED AS _ l,2 Rao jy, 31 8A 7%, 3 5 c eVG/ &- IPW S I de-� C -w- IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO / ��'� S s l ti �•e fi-a /o /�'� iyl cel! Building Inspector Cf) m m m 0 m } CO2 10 az CD O d a O o p viol- CD.� c� CD O a: C2 CO)cm CD .0 CD 0 v y d O CO) F O CO) d CD O CD H CD CA i 0 CD 0 ® s• fA ® cr H ca 5':* ® C � �0CLn m CIO Z --- =r -C ca a. rt� °+O y T ?a o O O y C y N a m co > >CD c da Ogo n O Z - .n O O 0* C �LcCL o o 'rt a � CD m H :La oO a1 ti H rd Q C/) C IW H �i 0 O �y � '^ ^. `� ; X11 y ti � U = br CD CCD O O � � •� n z O -,, t3 �z y : : o �cD Sr: ' C/)o mcn 3 � vI �W lw `' a d r : CD , w� _ICD c 0 Cri : O O �CD Cir � Lo - cn C1� rj p ,�., 77 �7 r '�1 n or 'r1 O CD 'zf ,� x n O ro w Y z p � c :03r z z d p, b omi 0 0 c Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS Z-9'/ W e[Z+eK W od 0 5 k fi NC LOT NUMBER 2D L r SUBDMSION_ J�(SELL F S� DATE REQUEST FILED ]V/Z/ 0.3 DATE READY FOR INSPECTION 03 TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. — WATER METt DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED �Q_ <ocH�cwpw�cK lApt � _ A' APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS Z-9'/ W e[Z+eK W od 0 5 k fi NC LOT NUMBER 2D L r SUBDMSION_ J�(SELL F S� DATE REQUEST FILED ]V/Z/ 0.3 DATE READY FOR INSPECTION 03 TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. — WATER METt DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED Date .. 7:: ....... TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION 'ro This certifies that . DCS Gh has permission for gas installation .... 4 s -.l .. /.�' .......... in the buildings of ...C.�.�: ........................... at .... � 5. 7.... �- �. � f. � .'.`.. L,& C � � North Andover, Mass. Fee.. 3`'. Lic. No. 2 .� S, ? .�! ...4 : M ..... . GAS INSPECTOR' Check # C 4399 '4 MASSACHUSETTS UNDDRM APPUCATON FOR PERAW TO DO GAS FTrrING (Type or print) Date -7—-7-3 NORTH ANDOVER, MASSACHIUSETTS f Building Locations � �✓��.1� � Permit # Amount $ 10 Owner's Named�j New ❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Name D l% Y, - Address Address Name of Licensed Plumber or Gas Fitter //er 0 Check one: Certificate Installing Company Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy E!r Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe 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 all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ofthe General Laws. (Title OVED (OFFICE USE ONLY) Signature of Licensed Plumber Fitter tuber ❑ Gas Fitter icense Number/1 ® Master ® Journeyman c (Print or type) Name D l% Y, - Address Address Name of Licensed Plumber or Gas Fitter //er 0 Check one: Certificate Installing Company Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy E!r Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe 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 all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 ofthe General Laws. (Title OVED (OFFICE USE ONLY) Signature of Licensed Plumber Fitter tuber ❑ Gas Fitter icense Number/1 ® Master ® Journeyman Date.... .. .... ....... .. "ORTh Ot TOWN OF NORTH ANDOVER 0 &-p PERMIT FOR WIRING 'C ..... This certifies that ...... ....�i� ............. has permission to perform .........-`.WP......t 7 ........ _7 ......... Ag ......... in the building of A- 4y ..... ..................... at I ....... CK 71. ��f. �614W .... Wm��/.A-V`North Ando crl 44Z Fee ... Lic. No,,-., .2 .. .......... ............... N LECMICAL I ECTOR Check # 4515 C0mft10!P?:'1'ealfh OfMassachusetts assae - - - - , :! ,cifle Only t;llUselii`s l tis - 2y �/ DePartmeit:` e¢ Fire Services Pern►it No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/991 (1mve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INT'ORMATION) Date: , _ 0 - City or'Town of � /-)dTo the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant o V Telephone No. �jp� 77�f-7s f0 Owner's Address r Is this permit in conjunction with a building permit? Yes 2-- No ❑ (Check Appropriate Bog) Purpose of Building Utility Authorization No. Existing Servicei;5Z-a--o Amps //U to2.-)-0Volts Overhead ❑ Undgrd Q"' No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letio ora. a. 11 ta61 b rve W d b th I ' No. of Recessed Fixtures n e owtn No. of Cell.-Susp. (Paddle) Fans e e vaa ns eetor o tres. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool ove ❑ In- rnd. rnd. o. o mergency lg ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I 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 g No. of Waste Disposers Heat Pump Totals: Number Tons KW `" No. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E] Municipal ElOther Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW °' ° N0• ° Signs Ballasts ecunty ystems: Na of Devices or Equivalent Data Wiring - Na of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP oZ Telecommunications Wiring: Na of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 ❑G �BOND ❑ OTHER ❑ (Specify:) p (apiFXon Date) Estimated Value of Electrical Work: a2 © 0 y (When required by municipal policy.) Work to Start: — Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME:%�t//rV O /=G �C— Lis _ { 7— P LIC. NO.:gs J 1 3 Licensee: &,lP✓t jwltyp Signature u LIC. NO.: (If applicable, enter "exempt"in the license number line.) Bus. TCI. Address: 3- Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hcnc the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am die (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telenhnne Nn -PERMIT F, Date.... ......—e22 .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... )t�"f ly .......................................................................... has permission to perform............ ............. pl' wiringin the building of .................................................................................... ....... North Andover, Mass. Fee..�..'�.....`-� ...... Lic. No�' .J`rS........... .................% ................. ELECTRICAL INSPECTOR Check# 4649 TBE COMMONWFALTHOFMASSACHUSETTS Office Use only DEPART111BNT0FPUX1CSVETY Permit No. 6�Q BOARDOFFIREPREVLNHONREGULAHONS527O RI200 dv Occupancy & Fees Checked APPUCATTONFOR PERAIRT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT 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) � y Lam! e 6 _C % t/( &v -c., a/) ,C /—A 1 Owner or Tenant r, /� V rJ-e e e N Owner's Address Is this permit in conjunction with a building permit: Yes zr' ' No 71 (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps�Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1 i f r 1¢-4,t2 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA A round round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of 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 Dryers Heating Devices KW Connections � No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP 6THER- • kW[anCBCD Rusuanttothe ofMwmdmseMCffffallaws Ihawaol=LdAtyhmuanceFbhcyiwkdngConlplele QL=tions ComWoritssubstanuegtumkg YES NO IhawabnMdvvaanddploofofsametodrOffi�YES If3ouhavzc dYES, pleaseirKk&thetypeofco by Igthe atehox it��ll INSUIWICE La BOND OrIIffR Woikto Sart kq)ectionDateRegtlested �=3 3 Est rrmdVahteofFle�tlWotk $ 3 0 Cj Ra# I Final OARMNAME 441 U!it/n c7--96 3 b—g 9 rT .P.�s7'—>y{e'/%,<, _ LiomseNd. 1¢ f _ ioe>sae A� � P 2T%�61 (//ill Signattue 4 Li mseNo 5 J JJ—� BuwmTeL No. Arm 76 '? Gv P i s. (/ f /l .CT Al -c 2/l/AL,,,, �i 4 0-2- 4. - Z AIL Tel. No. OWI WS INSURANCEWAIVER, lam aware that thol-mw does nothavetheit%u•�uloecoveiageoritsstlhstaItialegtuvaleltasiaptedbyMassachtutsGar al Laws and that my signal= on this permt application waives this isquitermi (Please check one) Owner M Agent Telephone No. PERMIT FEE Signature ot Uwner or Agent