Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 300 WEBSTER WOODS 4/30/2018
"%w Date....... ? ".1�'..... A` " Of ,HORT eJ ' � 0� TOWN OF NORTH ANDOVER PERMIT FOR AS INSTALLATION This certifies that ...� f�-S ...... ......... has permission for gas instJallation_. - �..........:- .......... . in the buildings of ...-`+ ?..... ................... at `-'�' .. !! <C� ...�� !�� eth Andover, Mass. Fee:i ...... Lic. No.. �?-... `� U, ..: ....... . GAS INS�OR Check # �i/yG 6769 r MASSACHUSEI S UNIFORM APPLICA7MN FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date d n r _ Owner's Name New Renovation Replacement ❑ G SU B-BASEM ENT BASEMENT IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 5TH. FLOOR 7TH. FLOOR. LTH. FLOOR. (Print or type) Name Address rerrnrt # .Amount Plans Submitted ❑ "au,o yr .Licensed Plumber or Gas Fitter 1-2- _ -1 1/ 1' 1 Check o e: Certificate Installing Company LJ �Ofp• 0 Partner. FimgCo. INSURANCE COVERAGE I have a current liability Insurance'poiicy or it's substantial equivalent Check one: Yes 131 -- If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity M Bond Nor:] rl Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance Mass. General Laws, and that m signature on this ermit-- coverage required by Chapter 142 of the MY �' P application waives this requirement Signature of Owner or Owner's Agent Check one: er t hereby certify that all of the detailAgent s and information 1 have submitted (or ent ered) ed) in � application • e �d curate 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 Chanter .142 of the General Laws. By: Title City/Town, _ (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas itter Plumber 0 Gas Fitter icenArum 0"Nfaster 0 Journeyman rA �a w v� U a Z '' a v, F w a z O w. a F z J w Q Q x x �i W C O F Z w w F Z ;5 C Q o 0 "au,o yr .Licensed Plumber or Gas Fitter 1-2- _ -1 1/ 1' 1 Check o e: Certificate Installing Company LJ �Ofp• 0 Partner. FimgCo. INSURANCE COVERAGE I have a current liability Insurance'poiicy or it's substantial equivalent Check one: Yes 131 -- If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity M Bond Nor:] rl Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance Mass. General Laws, and that m signature on this ermit-- coverage required by Chapter 142 of the MY �' P application waives this requirement Signature of Owner or Owner's Agent Check one: er t hereby certify that all of the detailAgent s and information 1 have submitted (or ent ered) ed) in � application • e �d curate 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 Chanter .142 of the General Laws. By: Title City/Town, _ (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas itter Plumber 0 Gas Fitter icenArum 0"Nfaster 0 Journeyman 1 ase (-On nonwealth of Massachusettr Department o jll .f Industrial Accidents �.. Offce o ,f Investi atio ns . . to 1 � a ' n 600 W e . ashinoQton Street c: Boston, M,q p�111 ww4'-amass.; ov1din Workers' Compensation �usurance.A:�iic�avilt: g�lders/ContractorslEi 4_ DLcant Iaformation eciriciaas/Plumbers Pease Print Lea-b}v Name (Business/Organization/individual): /1 Address: d City/State/Zip: Are you an employer? Check the aPProP • nate box: Y�7` l • ❑ I an a employer with 4. Type of.project (required): em to to ❑ 1 am a general contractor and I p y s (Hill and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or 6 'New construction ship and have no employees listed on the attached sheet I 7• ❑ Remodeling rThese sttb_contractors have ❑ working forme in any capacity. _JaGorkea-s' S Demolition [No workers' comp. insurance S. [� We area comp. Insurance. a corporation and its 9 ❑Building addition required.] offic:rs 3. ❑ I am a homeowner doing all work right of exemption a exercised. their l 0:0 Electrical repair or additions Myself eruption Per MGL 1 l.� 5 (No: workers comp, c. 152 Plumbing repairs or additions insurance required.] t I. (4), and we have no employees. [No .workers' 12:0 Roof repairs *Any appiicant.that checks box # 1 .must also fill out the section below P- -Insurance required_] 13 ❑ Other t 7 iomcowners who submit •this a=iFdavit indicating il. -; ars uunk•• ee? L�j;=r; . . wittg their workers' compensation policy information. xConrractors (hat chcol, this box mast "tau Engin hire utside coniractur6 rnu3i su'rnnii a new atntiav attached an additional sheet showin��-r��ancf etors and thetr woricets' romp. poli 11 finding sech.aerproork'coeneaiioc5 rnronnation. r rr�, empLnyees Below is the ofi P cs and job site Insurance Company Name; Policy # or Self -ins. Lic. #: Expiration Date: Sob Site. Address: Attach a copy of the workers' compensation policy declaration aQ City/State-/Zip: Failure to secure coverage as required antler Section 25A of Pee (showintg the policy number and expiration date) fine up to $17500.00 and/or one-year imprisonment; as well MGL c. I52 can lead to the imposition of criminal penahies of a Of up to .5250.00 a da against P civil penalties in the form of a STOP WORK ORDER and a fine Y a=ainsi insurance vio}ator. Be advised that a copy of thisstatement may be forwarded to the Officeof Investigations of.the DIA for insurance coverage verification. I do hernhr) r-OPWA, ..—d__ .r J� _....--, w•= �•�.ane penalties �of perjury' rhal the in or .f mafion provided above is True and correct official use nntp. Dn not write in this area, to be conrple1ed by city or town nciaL Cil, or Town: Permit/License ;r Issuing Authority (circle one): L Board of Healtb 2. Building Department 3. Elect inspector City/Town Clerk 4. Electrical Ins fi. Other P r 3. Plumbing Inspector Contact Person: Phone #.: Information .nd Instructions N a Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined. as ".. --ver-y 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 incluriin.g the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, associati on or other legal entity, employing employees. However the owner of a dwelling house having not more than :three ap arirnents 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 o r local licensing agency shall withhold the issuance or renewal of a license or permitto operate a business or to construct huildings in the commonwealth for -any applicant who has not produced acceptable evidence o.f 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 wor% unial acceptable evidence of compliance with the insurance requirements of -this chapter have been presented to the contrasting authority," Applicants Please fill out the workers' compensation affidavit completely, by checking the bores that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their c„-nificate(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 afficlavit maybe submitted to .the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the. affidavit. Theaffidavitshould be returned to the city or town that the application for the pennit or license is being requested, not the Department of Industrial Accidents. Should you have, an), questions reg*&—rdirg the lam, or. if you are required to obtain a workers' .compensation policy, please call the Department at the nri�nber:lis+wd "below. Self insu,-ed companies should enter their self-insurance license number on the appropriarw line. City or Town Officials Please be sure that the afrmdavif.is complete andprinted legit}y. The Department has provided a space at the bottom of the affidavit foryou to fill out in theevent the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiMicense number which will be used as a reference number. In addition, an applicant that must submit multiple permitilieense applications in arry given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially starnped 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 Iicenses. A new affidavit must be filled out each year. Vkrhere a home owner or citizen is obtaining a licenses 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 Commonwtaijth of Massachusetts Dtpariment of1xmdustrial Accidents. Office of Iavesfigatirons 600 WashL igton Street Boston, MA 02111 Tel. 4 617-727-4900 eo;t 406 or 1-8:?�-MASS.4FE Fax 4 617-727-7749 Revised 5-26=05. wwur.mass.aovldia Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... &..... &774-&-7d ...... ..... ..................... .......................................... has permission to perform ...... (-c?I.... .................................. wiring in the building of ............. &;.I.r ............................................. at —3. 4F Ae ... ...... North Andover, Mass. Fee. �Lic. No..06/� ......... . ........... ELEcrkicAL INS CTOR Check # it 84911-) r Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked 1 Rev. '1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrica4Code (M ), 527 MR 2.00 (PLEASE PRINT WINK OR TYPEALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the ctor Wires: By this application the undersigned gives notice of orher intent' n to perform the electrical work described below. Location (Street & Number) Owner or Tenant ---T ^,-[ e -i Telephone No d Owner's Address Is this permit in conjun ' n w'th a u* ' g permit? Yes � No ❑ (Check Appropriate Boz) Purpose of Buildingp��• Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: P.l No. of Recessed Luminaires of Luminaire Outlets o. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No, of Dishwashers No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Above ❑ In- ❑ d. d. No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Tons Heat ump Number Tons KW Totals: -...._.._._._........._.._.._...._ ....___...._.... Space/Area Heating KW No. of Meters No. of Meters table may be waived by the Inspector of Wires. No. of Total Transformers KVA Generators KVA o. of Emergency Lighting Batteg Units FIRE ALARMS No. of Zones o. of Detection and Initiating Devices No. of Alerting Devices No. of Self -Contained Detection/Alerting Devices Municipal ❑ Other Local❑ i�'nnnarfinn No. of Dryers Heating Appliances KW Security Systems:* No. of Water 1Vo. of Devices or Heaters KNo. of W No. ofSi s Ballasts . Data Wiring: No. of Devices or No. Hydromassage Bathtubs No. of Motors Total RP Telecommunications OTHER: No. of Devices or Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of E ectrical Work: (When required by municipal poIicy.) Work to Stark Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: 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 issumi Office. r CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify) N I certify, under the ' s rid p ties of perjury thatAe information od th�Fpplraallll�tr �nd com�l Q�J FIRM NAME. c LIC. NO.: � Licensee: Signature - LIC. NO.:� f/ (If applicable, enter ` emp{ " in a lrcens n tuber line.) 7 Bus. TeL No.: -© 224 Address: (/ Alt TeL No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally 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: $ i e\ The Commonwealth of Massachusetiis Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 C = www.nxass gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors0ectriciaas/plumbers Name Address: City/State/Zip: Phone #: . Are you an employer? Check the appropriate box: 1. ❑ i am a employer with 4. ElI am a general contractor and I Type of Prelim (required):: 'employees (full and/or part-time).' have hired the sub -contractors 6• ❑ New construction 2. Z I am a.sole proprietor. or partner- Iisted on the attached sheet $ 7• ❑ Remodeling ship and have no employees These suis -contractors have 8. Q Demolition' working for me .in any capacity, [No workers' comp; insurance workers' comp. insurance. 5. ❑ We are a corpoma n and its g (� Building addition required.] 3. ❑ .1 am a homeowner doing officers have exercised their 10.❑ Electrical repairs or additions all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No -workers' comp. c..152, § 1(4),'and we have no IZ,[] Roof repairs insurance required.] t .employees. [No workers' 13.❑.Other comp. insurance required.] • -• rr•• ; w• over mus[ also nit out the section below showing their workers' compensation policy in Home t owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box mustattaehed an additional sheetshowing the name of the sub•convactom and their workers' comp, policy inflDnnation. 1 am an employer that.isproviding:workers' compensation insurance for my employees: Below is.the information. Policy and job site Insurance Company Name: Policy # or Self -ins. Lic. 4: Expiration Date: Job Site Address: Ciiy/State/Lip: Attach a copy of the .workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500:00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cert der the and enalties of perjury,drat the information provided above is true and correct Of icia1 use only. Do not write in this area, to be completed by city or town official City or Town: PermWLieense # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and. Instructions m 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 wri tem" 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'covemge 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 certificates) 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 appropriateli a. 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.mustsubmit multiple permittlicense applications in any given year, need only submit one affidavit indicating•current policy information (if necessary) and undor, "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 bum 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 of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 421 11 'T'el. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7744 www.mass.gov/dia Acadia Insurance 1. The Insured: Acadia Insurance Company Administered by Berkley Risk Administrators Company, LI -C P.Q. Box 939. Pierre, SD 57501-0939 2510 E. Irwin, Pierre, SD 57501 Phone (605) 94&2144 Fax (605) 945.2048 Toll Free (800) 634-4589 NCCI Carrier Code 33391 CERTIFICATE OF INSURANCE WCIP EFFICIENCY PROFESSIONAL SERVICES, INCORPORATED 65 MERRIMACK STREET LAWRENCE, AAA 01843 Policy Number. W"8-28-002035.00 Risk ID: Tax ID#: F 262797146 Policy Period: From: 7/1/2008 To: 7/1/2009 Date of Mailing: 10/16/2008 The Cerpficate is issued as a matter of information onty and oonfers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the Policy listed below. This is to certify that the Policy of Insurance described herein has 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 Policy described herein is subject to all the terms, exclusions and conditions of such Policy. MRS., ENO',..M1.. \.•J .F '�wV•''. .f a. r Part One Workers' Compensation Statutory Part Two Bodily Injury by Accident $100,000 each accident. Employers' Liability Bodily Injury by Disease $500,000 policy limit. Bodily Injury by Disease $100,000 each employee. Should the above Policy be canceled before the expiration date thereof, the Company will endeavor to mail 30 days written notice to the below named Certificate Holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the Company. Certificate Holders Name and Address: Sterling Resources Funding Group 177 Crossways Park Drive Attn:Donna Pipolo Woodbury, NY 11797 Agengy Name and Address Unassigned Date issued; 1oil 612008 BA3140 Date .. y... '/y.............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .4-� ....................................................... has permission to perform wiring in the building of . ...................................................... at North Andover, Mass. Fee ..5/. S........... Lic. .... .......... .. ........... ......... 0 ELECTRICAL INSPE R Check # Commonwealth of Massachusetts Oficial Use Only i. ^ ... Department of Fire services Permit No. IfrC� G/ Occupancy and Fee Checked l` f BOARD OF FIRE PREVENTION REGULATIONS (Rev, 1 1/99) leave blank APPLICATION. FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the-Missachusetis Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMXTION) Date: City or Town of: To the inspector of Wires-, By this application the undersigned gi ves notice of his or her intention to perform the electrical work described below. Location (Street & Number) ���(t S j� i"-pb UD S -F- Owner or Tenant --kp '},) � n L I7-pri< Telephone Owner's Address B this pef mit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / _Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps _ / Volts Overhead ❑ Und rd g. ❑ No: of Meters Number of Feeders and Ampacity Location and Nature.of Proposed Electrical Work: l��rl;�l� l�i�`C. �..-ii1?Y1c�.-•. (•��t�r�r:) T� Corn lelinn n th.c 0110win table m be waived b the.Ins eclor o Wirer. No. of Recessed FixturesNo.• of CeJI.-Susp, (addle) Fans °' ° 0 Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No, of Lighting Fixtures Swimming Pool ove ❑ n- ❑ o. o mergency g s ng rnd, rnd, Batte Units No, of Receptacle Outlets No. of Oil Burners FIR+E ALItMS No. of Zones No, of Switches No. of Gas Burners o. o etection an Devices No. of Ranges No. of Air Cond, ON lnitiatin to Tons No. of Alerting Devices No, of Wastc Disposers 4 w beat ump um er ons . o, o e - ontatne Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW un c a ❑Other No, of Dryers Local Connecttion 1leating Appliances KW ecunty ystems: o; o atero ° No, of Devices or Equivalent Heaters KW o, o Data Vylring: SI ns Ballasts No; No. of Devices cr E uivalent Hydromassage Bathtubs No. of Motors Total UP a ecommunicarl, u lyal OTHER: No, of Devices or E uivalent INSURANCECOVERAGE: Un1eSSWaivedbytheOWrier;nOpe1Trlif o 'iinnaldetailifOrm fderired, Or as required by the lnspecrnrofWire.f. the licensee protides proof of liability insurance including "completed operatio ercoverage orfulce f is substantial e tivalentelectrical work may e un The ss undersigned certifies that such ct v rage is in force, and has exhibited proof of same to the permit issuing office. CH1 CK ONE: INSURANCE $OND �•• OTHER ❑ (Specify:)_• t_ Estimated Value of Electrical Work: (When required by municipal policy.) piston Datc) Work io:Stan: Inspections to be. requested in.aceorda-ice with MEC Rule 10, and upon completion. 1 Certify, under (lie pains acrd penalties of perjury, that the lrrforifialloir on this applicarlorr is true and complete. FIRM NAME: ) L 21 L. 1 LIC, NO.: Licensee: )M f,� 1�gnature / (l�apphcahl Hier"es !"i lhellcen�rium rlirre.J'�:' LIC. NO.;-�-Y1-.-Q--� Address: J , OX $us. Tei: No,; OWNER'S INSURANCE WAIVER: 1 am awake that the,Ljcensee does n Ohave cher liabili i eI.' covera8e normally , cl. No.: Gel. required by law. By my signature below.; 1 hereby waive thistei),Itjrt:ment; 1 am the (check one) ❑owner ❑ owner's agent. Owner/Agegt Signature Telephone •No, P`RrYIIT FEE;'$ �`� Mt� IlY-� � r This certifies that . . . has permission to perform Date. :3�, e I! TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING plumbing in the buildings of ............................... at.......... ,North Andover, Mass. r Fe ...... Lic. No....... .. ...... . ,................. rf �L r GING INSPECTOR Check it r° ! i • ;� No 3 % Date..../....1-.�1.... ,�OR7M '•�+ TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING CHU J� r This certifies that.... J......... has permission to perform -10 wiring in the building of ........ = n 1 ,North Andover, Mass. Fee..-.�.2 .......... Lic. No ........... ......... ..� ..........'Pr ......................... ELECTRICAL INSPECTOR Check # ///, WHITE: Applicant CANARY: Building Dept. PINK: Treasurer VADEPARTMFIVTOFPUBLICSAFETY Permit No. BOARD OFMEPREI�EMONREGULAT101 N5270212:00Occupancy &Fees Checked PUCATTONFOR PERMIT TO PEUORMELEClRICAL 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 The undersigned anolies for a hermit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Purpose of Building Existing Service New Service 620 U I t Yes I I. -I -No u (Check Appropriate Box) Utility Authorization No. ` Amps / Volts Overhead M Underground M No. of Meters Amps,2— d^ / yv Volts Overhead Tnderground E3-00" No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work k/ dt /- No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground 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 Detection and No. of Zones No. of Ranges No. of Air Cond. Total�/ Tons ;3 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 LocalMunicipal 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 E OTHER Instraroeev� Rasuancbtheteglmana�afM�ad�cierteal Iha%eaama'tliabkyhst==Pbbtyixk&gCm#At Cc Itmest>htnadvalidprmfofsatnebthe06im YES �' RqSURANICEC� °i WakiDSlart LZ6 Ute_, SigitadutxlaMPle afisofpsjcay FIRMNANffi rageoritssubslarfiale#valent YES NO Ifjwhaved/wWYFS,pimeatdtc*thetMxcfw&aWIrydcckirtgthe Expitatiort Date,. E d Vah dEled nml Wak $ Rough 6'jLr C--4Final �� Z = I�oenseNa 1,, -??33 ,,,T r Iixrlsel W Bus¢IessTd.Na 97F 5'5- a3 ,Ff A go AtTaNh OWNl]R'SII,SURANCEWAIVFR;Iamawatethatthe1 dm m*mWby&bssadx&tls Canal Lam anddatmysigt WatthispCm*applir�bottvvaiaftre4a,unerilL (Please check one) Owner o Agent J L.. �-'—�Telephone No. PERMIT FEE Date . . Z.1- G N2 49C5 NORTH e <��.�^;•.',�oo� TOWN OF NORTH ANDOVER -� PERMIT FOR PLUMBING SS.4cmus� This certifies that .. U . z. G�.�.,4!.. •t•'•��� • • •! • • • • • • has permission to perform ... �1.... f��.�!.'. ......... . plumbing in the buildings of .. .5 !.!. ........... • .. . at ....LA. �.... s . I !!(. G. c . � �, North Andover, Mass. Fee. ��. " . Lic. No. -4. -7/7/ ......... ...... PLUMBING INSPECTdR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 3 004;'4� Owners Name Type of Occupancy NewET' Renovation Replacement El FIXTURES r • M a 1 OF -lieu i f ` ate Permit # Amount Plans Submitted Yes j� No ' . M ID (Print or type) Check one: Certificate Installing Company Name l- e - `y Corp: Address C P S Partner. Gti r'01f,7 . Business Telephone ® Firm/Co. Name of.Licensed Plumber. IC. -e d:f, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M 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 F1 Agent Q 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 instal tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus State Pluryyb C,gle-and Chapter 142 of the General Laws. , 'Title City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License icease umber- Master. Journeyman ❑ Date... `. :.�. �.... ° TOWN OF NORTH ANDOVER P t PERMIT FOR GAS INSTALLATION This certifies that . ..:d`i ff Ilk, has permission for gas installation ....&:! 4t..� ��.`.:.: ........ in the buildings of . % `:. .' . .`.......................... . at..J. .. . *. .f ...........l ..... , North Andover, Mass, Fee. 7?:... Lic. No.. ``.�.r.1. .. �:? ....... /GAS INSPECTOR Check # > > 36,3 MASSACHUSETTS UNIFORM APPLICATON FOR P47 TO DO, eGAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS 2 Building Locations -) 0d ����f�t� Permit # Amount $ a-zl I - Owner's Name New Q Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) vamp 19 h k one: Certificate Installing Company Corp. Address ❑ Partner. Business Telephone — ( ® Firm/Co. Name of Licensed Plumber or Gas Fitter �10%& �pQ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No[] If you have checked ypa, please indicate the type coverage by checking the appropriate box. Liability insurance policy 15d, 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: [3Signature of Owner or Owner's Agent Owner [I 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 Massachusetate Gas Cojegnd�l apter)A2 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumbbr Or Gas Fitter ❑ Plumber 44 7 7 ❑ Gas Fitter LI' Number Master ❑ ourneyman 2ND. F"OR 1:00M2111110 �-,�Wmm (Print or type) vamp 19 h k one: Certificate Installing Company Corp. Address ❑ Partner. Business Telephone — ( ® Firm/Co. Name of Licensed Plumber or Gas Fitter �10%& �pQ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No[] If you have checked ypa, please indicate the type coverage by checking the appropriate box. Liability insurance policy 15d, 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: [3Signature of Owner or Owner's Agent Owner [I 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 Massachusetate Gas Cojegnd�l apter)A2 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumbbr Or Gas Fitter ❑ Plumber 44 7 7 ❑ Gas Fitter LI' Number Master ❑ ourneyman Location �0 -9 p0 WoA L 4J . No. /-38 Date ?-/l ^0�?Jo r TOWN OF NORTH ANDOVER Check # 151.?- 01, jJI((6 ,736 i Building Inspector Certificate of Occupancy $ �', J'• w�sEt�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �`3 �'9' TOTAL $ Check # 151.?- 01, jJI((6 ,736 i Building Inspector Location 1[a�aI # 300 (.ff-Ph s4rWo oA [ ,,v, No. 13 Date 1-�q )-0/ TOWN OF NORTH ANDOVER i _ •' O L A ' Certificate of Occupancy $ Sro ',^O' E<�' Building/Frame Permit Fee $ sACNUs Foundation Permit Fee $ Other Permit Fee TOTAL Check # / 3 L? ` I DO, Building Inspector 1.1 Property Address: C7 1.2 Assessors Map and Parcel Number: �a�6 res fJlr �� szo-K. 3(X W e�s� er woo -(s L h. Map umber Parcel Number Signature Telephone 1.3 Zoning Information: 1.4 Property Dimensions: —� Signature Telephone Zoning District ProposedTJse Lot Area sf) Frontage ft 1.6 BUILDING SETBACKS ft Not Applicable ❑ C', Cz5ge % Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3(D" YL 73 ' 381 30 ` O` 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone 0 Municipal * On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHM/AUTHORIZED AGENT 2.1 Owner of Record Name (PrinK Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ C', Cz5ge % Licensed Construction Supervisor: eS �G� �3� License Number Address ,4,/7 ~ 6.3C3 Expiration Date Signature Telephone Is 657 - S"76 0 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.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 ...... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ J Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: cS �c - -w . f/ 6� r� ori s , 07 i V SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE.ONLY 1. Building 9,;7rors�� 3� d (a) Building Permit Fee Multi lier rr 7`6D` 2 Electrical (b) Estimated Total Cost of Construction 7` > 3 3 Plumbing Building Permit fee (a) X (b) _ v 4 Mechanical (HVAC)'�- 5 Fire Protection 6 Total 1+2+3+4+5) D 6 Check Number SECTION 7a OWNER AUTHORIZATION TO BE 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 7b OWNER/AUTHORIZED AGENT DECLARATION I,as Oxer/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 Na Signature of Owner/A ekXDate NO. OF STORIES SIZE 3 8 BASEMENT OR SLAB SIZE OF FLOOR TIMBERS is IM ` f SPAN DIMENSIONS OF SILLS llIMENSIONS OF POSTS C DIMENSIONS OF GIRDERS Sy,e-,-C_ HEIGHT OF FOUNDATION THICKNESS 4 4 SIZE OF FOOTING le" X Z%� MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE pim FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. "**APPLICANT FILLS OUT THIS SFC T ION*************. ", S,'�.ett APPLICANT Cc7stZ / �D�e'S GLe PHONE (J'7 -�3ac> LOCATION: Assessor's Nlap Number �d (0 PARCEL % -70 SUBDIVISION �'��,1/�� f LOT (S) STREET %(J L� � f� r -c 1�D�S C i d ST. NUMBER 3dc7 USE O NLY***t*****t******** * It COMM COMMENTS 'IONS OF TOWN AGENTS: FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERfWATER CONNECTIONS DRIVEWAY/,PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm o Uj CZ) c:) CD M ;? Cr < I p The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: Phone (� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. S/ /-/e / A es/f,- 0",v. Cv Address o2 31 Sc, ft 6%1 S7` •City' 416r`l-4 x�w&y��' /t't0, ©/Sys Phone' :07S) 687- 5300 Insurance Co UriczeePO 014W �i7S, Polio # N W19a %73 yyt/ -oo CCM02ny name: Citv: Phone '�.t Insurance Co. Policv m Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of riminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civic penalties in the form of a STOP WORK ORDER and a fine ci ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pain and penal ' s of perjury that the information provided above is true and c--rrect. Signature �� Date / /o Zz Print name ��0 a � / ,SSS-// Phone --7--5760 5 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required p Licensing Board �j Selectman's Office Contact perscn: Phone f: Health Department 171 Other 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: Rea Location of Facility Si ' e o ermit Applicant y 11DI01 i Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 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 exemptions 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 Property ter Ferrit (below) a 3r� webs��r c�odQls C� � Nlap and Parcel :`o Purpose of Application (check below) Phone Number of Applicant: Single Family Two Family loth' 7– .S' c7 1 the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the E<EiMPTiON 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<EMPTi0N status is subject to review by the Building Department and is only offically 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, complies 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, restaradan, or reconstruction of a dwelling in existents as of the effective date of this by-iaw, provided that no additional residential unit is created. The lat(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Sec icn 9.7 of the Zoning Ty—law. This application is for dwelling units for low and/or moderate income families or individuals, where all of the ccncitions of 8.7.6.care met and/or represents Owelling units for senior residents, where cccuparmcy of the units is restricted to senior persons through a property, executed and recorded deed restricion running with the land. For purposes of this Section "senior' shall mean p.ersans over the age of 55. .i This application is a part of a development project which voluntarily agreed to a minimum 4011. permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental canditicns of the tract, with the surplus land equal to at least ten buildable aces and permanently designated as open soaca and/or farmland. The land to be preserved shalt be protected from deve!ooment 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 application represents a tide of land existing and not held by a (Developer in ccmman ownership with an adjacent parcel an the effective date of this Section 8.7 shall receive a ane -time exemption from the Planned Growth Rate and Oevelopment Scheduling provisions for the purpose of constructing one single family dwelling unit an 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 Oevelopment 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 Oevelapment Schedule accommodates issuing building pernits. 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 the accuracy of the information provided and that the attar ed building permit is allowed an E%<EMPTiOabove. Further I understand that the submittal of misleading and or inaccurate inform,atio or the the king off of an above item which does not comply, whether done to my knowledge or ot, is roundsfo fusal by the Building Oepartment to issue a Building Permit. igna ure of Owner or onze ent who signed the Attached Budding Permit o to U This form must be attached to the Building Permit upon application far such permit Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Mr. Kenneth. Grandstaf, , President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 July 14, 2000 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station Dear Mr. Grandstafp The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the foIlowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Croup, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipmentand facilities in the event .----__.._....--_--_-.--- ........... ..... _ that Mesiti Development or its agents fad to adequatelyperfonn maintenance of the pumping station Mesiti Dev Group • 1 Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T ours, lk� f J.Wi. ism Hmurc' .E. Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant ofponditional use. I I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-27-2001 DATE OF PLANS: March 19, 2001 TITLE: Lot 21 Boxborough PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 556 Your Home = 548 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1534 30.0 0.0 54 WALLS: Wood Frame, 16" O.C. 2268 11.0 0.0 202 GLAZING: Windows or Doors 484 0.350 169 DOORS 96 0.490 47 FLOORS: Over Unconditioned Space 1582 19.0 0.0 75 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 applicable Standard Design Conditions found in the Code. The HVAC equipment e e ed to heat or cool the building 25% f the d sign load as specified in shall be no greater than Sections 780CMR 1310 an J4.4 Builder/Designer Date t MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 21 Boxborough DATE: 3-27-2001 Bldg.I Dept.I Use I I CEILINGS: [ ] i 1. R-30 I Comments/Location I I WALLS: [ ] ( 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: I # Panes Frame Type Thermal Break? [ ] Yes i Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I 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 I gasketed to prevent air leakage into the unconditioned space. I 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: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can [ ] No 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.): HEATING SYSTEMS: Low pressure/temp Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant (in.) 1.25-2" 2.5-4" 1.5 2.0 1.0 1.5 1.5 2.0 0.75 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 PIPE SIZES TEMP (F) 2" RUNOUTS 0-1" 201-250 1.0 1.5 120-200 0.5 1.0 any 1.0 1.0 40-55 0.5 0.5 below 40 1.0 1.0 (in.) 1.25-2" 2.5-4" 1.5 2.0 1.0 1.5 1.5 2.0 0.75 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 �{ Ui ✓�ie anwwnaxa t a�✓ acsutJe b BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR s Number: CS 069234 S I 1 Birthdate: 05/09/1954 Y Expires: 05/09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL 400 MAIN ST GROVELAND, MA 01834 Administrator Building Value Calculation -for Property at..... LOT# 21 Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 24.5 14 343.00 65 $ 22,295.00 Brkfstnook 6 10.5 63.00 65 $ 4,095.00 Dining Room 14 13.5 189.00 65 $ 12,285.00 Family Room 22 18 396.00 65 $ 25,740.00 Study 14 13 182.00 65 $ 11,830.00 Living room 14 13 182.00 65 $ 11,830.00 Garage 25 22 550.00 35 $ 19,250.00 Entry 18 11.5 207.00 65 $ 13,455.00 Mudroom 9.5 5 47.50 65 $ 3,087.50 Sunroom - 65 $ - Sittingroom 11.5 16 184.00 65 $ 11,960.00 Walkin closet 13 6 78.00 65 $ 5,070.00 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry 8 3 24.00 65 $ 1,560.00 Bedroom 1 22 18 396.00 65 $ 25,740.00 Bedroom 2 15 13 195.00 65 $ 12,675.00 Bedroom 3 16 13 208.00 65 $ 13,520.00 Bedroom 4 14 13 182.00 65 $ 11,830.00 Bedroom 5 - 65 $ - Bathroom 1 8 6 48.00 65 $ 3,120.00 Bathroom 2 14 8 112.00 65 $ 7,280.00 Bathroom 3 14 10 140.00 65 $ 9,100.00 Bathroom 4 - 65 $ - Bathroom 5 - 65 $ - ov,v �9_. ao"ZG��Uoa t 9 oP Cf, i G, r,c� o (' � ti s� F�4_1 aj� <Ln Z Ln m o m Z �* M �D C -p � H 13 Ox � � > >oc 3 � o CL 10 � tC s d O� m m ° o (DCD ro y 0 CD O 'Op O 2 _+ C 7 C. a••� (D D O a(DC Q0 cr o:r'� C -T3 n.o 0CD:0 m 3 `y m C M a� C Ul o o' 3 O Or - H O (D W �. fD -erWO C �A TO E 17 :2b CL TO Q) 54 ***a m v'i 0 : ` : z 0 J, S } .( •. y Y LO (%� D n I -1 a a E z - ° of + s �o 5:7CD C m�®. v oCDC T t �.b: CD z o � o D : ,: v i i a U) m m U) 0 m y CD a Z CD CLd CL aco -00 Mt o p CL c� CD o -- -- ap co CD CA 10 CD Cl) 0 71 CO2 d d 0 CO) O c CO) 0 n CD 0 CD 3 y CO) .9 C C 0 ? _ �N O Q fOA dorm y m Es O9 00 m n Z NmwC =r -C N 0 .rt =w .9i w N T .-p o ?d y .homy 0 —I S' �mm�a a > > � 0 � om -w 0 3 .. n Oyn'0 oo ' c 1 1 " CO) l,J 1C Orr 5 O CD ' rr^^ N V J O fm n ° 1 C.D 1+� O y � WN y CL `a �+ :r IE a y CD A L oO O z ° ro �� -F J-cn CD cn N rte,,'; • ` m i4%b waw CD U) � z y C W � G reD ;oz G G a..5 C b C � CL g b M M n 1 L117-1 omi 0 0 c I o 00 W Y j / / 2N) 2A� S ilrli �+li\� I I'll' � I . • / or7in 1 ''6 ` I /f •• � J-''"�, era ��/ %` \�c'aP ! N Av 10N v / out No , r S80 5 ' 32 / / / -- — ,Qp��� N L — — �cc ` CO / I I / vy �b . ►\ ■�I111%��%I�r Em • s . • ' IIM w •. ,a�I � � • .w ■�I111%��%I�r Em • MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS j ``''� ` u �(�� .-� Date ] 3 ) CP Building Location306-.. we- S �er Hers Name � + � � Permit ## Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTIRES / ' • r' • r' , nnnnnMnnnn®nnnnnnnnnMMMMM _41MMMMMMMMMMMMMMMMMMMMMMM■M ,k,o.-MMMMMMMMMMMMMMMMMMMMMMMMM sNMM nnnn■�mmmmnnnnnnmmmmmmmmmm r n■�nnn�■nnnnnnnnnnnnnnemm�� o, nnnnmmmnnnn■■nnnnnnnnnmmmm (Print or type) Check one: Certificate Installing Company Name ttC VN 1� f Glj� ❑ Corp. Address- L W C W ❑ Partner. d H - 6`30-7-7 Bus.T� �e e one Le C-: r— - Sry Firm/Co. Name of Licensed Plumber: d7 12,1! ,& Insurance Coverage: Indicate the type of insurance coverage by checking theappropriate box: Liability insurance policy E& 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 11 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 Inst ns erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac settp lumbing Code C 142 of etr Mneral Laws. y: Title City/Town APPROVED (OFFICE USE ONLY ,,,Type of Plumbing Licenset- U& 15' o icense NumDer Master ❑ Joumeyman a v Date.................................. 6 r i TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............ ....... ...................................... .,.............................. has permission to perform ... ��K!T' �'l,��' ................ 1 wiring in the building of ..........e..........A. �CC�................................ at ........ ©©.5............ ,North Andover, Mass. as t Fee -P ............... Lic. No..... f 7AL57...................................................... �p ELECTRICALINSPECIAR Check # � 3 0 4Ak-99 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS t)Ilicci/ial Ise ( )ill% 11cnnit No. (9 Z Occupancy and Fee Checked [Rev. 9 051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All %%ork to he performed in accordance ttith the \I;ItiSilCllUSCttS f:lcctrical Code (\fF ). �'-' AIR 121.00 /I'LL ISE PRL\ T L I;� K OR TYP I L 1,VoalfkON) Date: DCih, or Town of:W ur To 1170 17S/?e71(;1-uJ i6 rrr.�: 13y this application the undersigne dives notice of lis or tel• intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Teleph Is this permit in conn junct' with a building �rmit. Yes M No ❑ (Check Appropriate Box) Purpose of Building 164 5 e— l K Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd [� No. of 'Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of :Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ('ompleIiwl (?/ the fr:llrn, it,,k /able ntuy I?e Itaind by the htay e h r of I Vil, No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- F71 «rnd. rnd. , o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners 1111FIRE ALARMS No. of Zones No. of Switches �4 No. of Cas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices j No. of Waste Disposers Heat Pump Totals: I Number 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 KW _ Security .5 stems:* No. of Devices or Equivalent No. of Water KW Heaters _ No. of No. of Signs Ballasts Data Wiring: No, of Devices or Eg ' -lent No. Hydromassage Bathtubs No, of Motors Total HP _ Iclecommunications Wiring: No. of Devices or Equivalent OTHER: I urh tJ.lNu;nw' Jrhttl ,/,h.ctrrcL ur UY rr 1u,rccl ht ,he hi, pc t ;r I f',: Estimated Value ofElcaricid Work:C)_0 (A hen required by municipal policy.) \kork to Start: Q 6P Inspections to be requested in accordance with .MEC Rule 10, and upon completion. INSLRANCE CO •ER. GE: L,nless waived by the owner, no permit for the performance of electrical work may issue unlcs: the liccnsce provides proof of liability • lsurance includin(.1," onnplctcd operation -coverage or its substantial equivalent. I he l.nldcrsi 3.ned ccrtitie", that sLIC11 cup i:, in ti)rcc, anh d aofs e .hihitccl proof same to the permit i_; ruin^. of tics. C I IECK 0N E: INS('R.\Nl'I-", )N, 1) ❑ t) FFII:R ❑ (Spccily:; I d elli .j,, wider the 1p ti .Y n al In 1l h's W hc�r%1`111, 11he • !fin .1nuffint on ,his ipplicalian A,1 1t•tte and ru enple c•. FIR�INI NANIE' - G e— - !Licensee: gnature 1AC.:'VO !,'„,y;li .w1c IL crq,t •: ill Ihr t u �, r , 1`r., 13us. Tel? •1 address: / ��[/�� t��� 004-V — Alt. Tel7101 Security System Contractor License required for this work; if applicable, elites' the liccilse IlUillber llcrc: OWNER'S INSURANCE NkAIVER: I and aw;tre that tilt'. LICCilsec i/U.'.'+n0i have the liability insurance CoVelnce Ill't'Illall\ Icquired by law. By my :;i,naturc below, I hereby waive this rcquircnlult. I ;mi the (check one) ❑ owner ❑ owncr's .Dent Owner/Agent .iigoatureT,_Icphc' ,t `i:,. PFR.VfIT F'F .� YI m m C m X m CA EP m W y C � d � O C2 Z CO) C O n• . U O CL = CO) o CD o v CD O 'CL C d =r CD o CD C O co —• 0 dO y W C S v CO) O Z o CD 0 CCD VJ C) O Cn C Cs) 2 0 C/) C C ?-O of _M, O dp 5.m 10 CO) aO m h mmaC2 CA ?� CA 03 CA o a�� _ m -40 0 CO O CO) m x IE0� o a ho=` Z 5 O LO). n ;to O N = w 0=3 0 9 cn 0- " cn m m H M CL m zz OQ H �' 01 y = S : CL Q. PO aGc Irl � r g �a m N H = 1 CO ' H )moi/ oC.) m •• o 39 �o � O O CO) to dd CL n c. o �CS _ w 0=3 0 9 cn 0- " cn o, M zz OQ Cil 7�tod �' � ora � °= n � PO aGc Irl � r g a O O 7d I 0 V" Lr O �7: u F- 1- LO v u n F- C) }. 8000 2101 11Y0 'NOMI dObO .... _ ...8000 80i 11Vm 'NOMI d08O ; I ` I 1 \ \ CY y a 0 v 1 J w> uj Om OQ( COUJ O.pu ry a _ I'50VO U id DO u JWt h' 0 II! I �r h 1. ;Aw SiN I I I OL�I VCU } I C> I m_. CO ri 4m u�i ' �II xw< I t711 Wa}i 1 't� IIS 1 iil wOrYu IY1-�Y� I I zZO I W �7ON ' -ou j S �' J I. I I U Ili 0�3Ir-a .0-.1 OM dM 1V Siq do 31d181 -•m_: I 1 80 180 01 bQ10YbiMOJ _ .: I. .. .S ?p �pQ� ' I I 1 ! I uo �I III '` 0*0 .71 JZ RW ,nFO J I I 1 I 1 rJW JPO I II' i., S1Sf 2114 CYL LLm'O2 I' Wf I '00.71uwo JJm wZO7 J LL0 w I i r�mNO� ' I z ` S1Sf 8li OPL <�o ao� I .I, a<0ac n zJrmOa I OI r w0 NO jf3js I - I :r ll. U, Ea uz � ; � I I IIYM 0% _ Om F`C O - I i � r1 • I - i O=W II I Oa 1 I j 1 In�rlu I 1 uja Ur I r-II� III I I j 1 \ f r,N) � 1 O I _ I wWOO-u .0-.1- z � I .rl�1 � .O-. 1 ri O-.� I .0 iwnmuU O not -- mi- I1 �' I L I ............... do Ti I ul W� s1sr�— al tl\ I i n u' gAr 811 Opt I; 6 I in ;I I. ! In lil0LI �TI- a1 —j QPL - J I •I;.III. I ( •nl L I i.0 ! j Biu I 07 �w ® u' U0, r p= 1 0=UJu l WWW t- >< JPO ® Vf <<`j I -C u�o <O o ce uta Q� �}u+�< �• <rp I dam .n hW f �. of j�o IL x I I nl zow I Q is o = �` .o W. o I mo I Qi O= `� < 0 i " w� U I I CUi )O 1 omaI u0 �u _ A °oma t j I %r� cls V -1Z I j Ora CL U)< l - 4 CO I 4 O V" Lr O �7: u F- 1- LO v u n F- C) ACORD. CERTIFICATE OF LIABILITY INSURANCE 702/06/2 06) PRODUCER (603) 382-4600 FAX (603) 382-2034 Insurance Solutions Corporation PO Box 1079 Atkinson, NH 03811 Dolores Magl is THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Scott Berube DBA Berube Construction 771 Salem Street Grovel and, MA 01834 INSURER A: Peerless 24198 INSURER B: INSURER C: INSURER D: INSURER E: nnVFRAnPA THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN, 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. Town of North Andover, MA DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS AUTHORIZED REPRESENTATIVE oy,�j�/��'�i� GENERAL LIABILITY CCP9571262 05/22/2005 05/22/2006 EACHOCCURRENCE $ 1,000,000 rA X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 PREMISES (Fa occurance) CLAIMS MADE � OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PROJECT POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRED AUTOS 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/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND TH- WC STATUS ORY LIMITS FIR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PERATIONS: CARPENTRY CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) FAX: (978)688-9542 ©ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover, MA 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 400 Osgood Street North OF ANY KIND UPON THE INSURWE TS AGENTS OR REPRES NTATIVESS.. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE oy,�j�/��'�i� INSURANCE SOLUTIO S CORPORATION ACORD 25 (2001/08) FAX: (978)688-9542 ©ACORD CORPORATION 1988 3560 Date... .NOR7M TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ -4 d 7- S S y 5 ................................................. ..................... co'? 04 has permission to perform ........ —11-� .. . . . .......... wiring in the building of ... ........................................ at .... 3dj ,.jNortI North AndoverMase. fee. ............ Lic. No. ............ .. . ................ I? XLEcrRICAL INSPEX Z/ ......... Check #- C �V. Commonwealth of Massachusetts Official Use Only t Department of Fire Services Permit No. tL' BOARD OF FIRE PREVENTION REGULATIONS ; Occupancy and Fee Checked (Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in acconimce with the Massachusetts Electrical Code (& C), 527 CMR 1200 (PLEASE PRINT W INK 0R TYPjEALE N'F AVfAT10N) ' Date: - . City or Town of.- r To the Inspe for or Wires: By this application the undersigneTd gives notice of his or her int tin to 1frform,the electrical work described below. Location (Street & Number) Owner or Tenant Telephone No. _ Owner's Address Is this permit in conjunction with a building permit? Purpose of Building_ Existing Scr,,ice Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity �► Location and Nature of Proposed EIectrical Work:: Yes ❑ No (Check: Appropriate Box) Utility Authorization No. Overhead ❑ Overhead ❑ Undgrd ❑� No. of Meters Undgrd ❑ No. of Meters No. of Recessed Fixtures "0.10 you loliolving No. of Ceil.-Susp. (Paddle) Fans rave mm oe waived by die Inspector o wires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- _C1o. o Emergency Lighung rnd. rnd. Battery Units No. of Receptacle Outlets ° : No. of Oil Burners FIRE ALARttiIS No. of Zones No. of Switches No. of Gas Burners 'J No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. TonsTota No. of Alerting Devices No. of Waste Disposers licatPumli Number Tons JKW No. of'elf- ontaincd Totals: Detection/Alerting Devices No. of DishwashersSliacelArea Heating KtiY Local ❑ Alunicipal ❑Other. Connection No. of Dryers Hcatiar Appliances K-yy ecunty Svstems: No. No. of Devices or E uivalent oatcr Heaters Key a o o. of Signs Ballasts Data Wiring: I-Accs No. of or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, oras 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 e.,iiibited proof of same to the permit issuing office. -- -- CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) ( Estimated Value o Electrical Work: SaIA i _10(When required by municipal policy.) Expiration Date) Work to Start: , Inspections to be requested in accordance with NEC Rule 10, and upon completion. 1 certify, under if, k pains and penalties of perjury, that the information on this application is true and complete- FIRM ompleteFIRM NAME: ADT Security Services 111 Morse Street, Now , MA 062 LIC. NO.: 1533C Licensee: John S. Bassett Signatu { IC. NO.: 1533C (Ifapplicable, enter "exempt" in the license number Un Bus. Tel. No.: 781-278-1111 Address: Alt. TcL No.: 781-278-1725 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have dic liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's went. Owner/Agent ` Signature Telephone No. PERMIT FEE:.5310�1__ Town of North Andover /NoRTH-%-4, Building Department 3�' gt�fur. 0 ' . hb'6 27 Charles Street 0 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 O •ur [-444 W K le AGHUS���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 300 GAJasws '/-a,'e LOT NUMBER SUBDIVISION(��o e,,.1% e 5 7L DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE ST ,gUCTVfgDONOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION. DATE PLANNING DATE D.P.W. — WATER METE DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED TO THE INSPECTI� QUEST DATE. IGNATURE / bPW AUTHORIZATI O � Town of ;,S1RCM05�4' NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: :38PROJECT. k8PW&M DATE. UNIT NO.: FLOOR: WING: BUILDING NO.: REMARKS: /0 #&0&7 o-7 5A J/ OAN D£/Z Es. Com- �j 6d-�1, 300, F1__:1-- 1% /, 15'/ 9 -- Excavation - depth and s it conditions Framing - Other: Date: %o' Date: b -3—d) Date: Inspector Inspector/rV�l �" Inspector Footings and foundations and drains - Date: ,5loq7�,- Insulations _ Date: ©�/ Other: Date: ( � Inspector /•`M �l/ - Inspector- MA 'lJ Inspector Electrical - ron�, Date: Inspector Plumbing and/or gas - rough - Date: `Z % '� Inspector Other: Date: Inspector Electrical - final Plumbing and/or gas - final Other: Date: % Date: C;r " 2 � _ Q 1 Date: Inspector Qi Inspector Inspector- -ire Dept - A burner, tank, stove, smoke detectors Final inspe tion Certificate of Use and Occupancy Date: Date: `a e ' C) Inspector i ( e: C of O # I pector Inspector Form #995 Action Press, 685-7000 CO) CD CDCL O d CL �. C) o p CL Q CD O a CDO to CD L-] 0) C7 CD O CD CD CA y 0 CD0 dc CD c E- O w 2 0 �• N o C y norm v2 Ao o m n H Cl) d CCO) 9 T CD Z = �c H O• �••r ~ m y T � m d?d O y m O m y p O -, N gym: m = > >my_i\ 0 2>4 O o .. to �' o 0 n o c y C) oo o m R r 11, aato Cr1 on to o < to I '' ^^ m VJ m mCD O W: \ / C C d y t't � � V) o• 5: /" .-► Cy Cn ? ,Wc y � � f\ m m t O O 0" O O n m o G � z C=O, �. ►�" c m w o m cn O� CA CD C3 to O CD z 0 w y 0 o ~� z 0" rS "t7 o mi 7" I.. 4 n C O n o ~� z 0" rS "t7 o r � � oG ? a a. 0 t-, n C O n \1 qo b 11 � y W r r� r A C_" d O d � O z �y14 n fA d z n t'a'i X 0 m O C CA m 90 O n 0 c Z 0 a; r � r 0 d � O z S n fA d z n t'a'i X 0 m O C CA m 90 O n 0 c Z 0 a; r � r d � O z S G4 a� H n t'a'i X 0 m O C CA m 90 O n 0 c Z 0 0 R �V r VJ n 0 z CP O —• Vl 0 Q y CA 24 d CL 0 CD C. O ® CA G w � 0 m n CO) 10 Cl) 0 Z O co n z CO) r CD o �, D7 H � � CU C C/) d. CO) m atri z :0 m o o m CD O O C/)�� C. M. d CD p CD 0 CD 771 O ic W -9 0 R �V r VJ n 0 z CP O —• Vl 0 Q y 24 CL 0 CD C. O ® CA G w � 0 m n CDCD O HIto Z O Hma= � n -a m CL- CD CO) r O D7 H � � C H =r CDy atri z co 0 O m H O _ �co \ �\ O O O m C. �n or* -w to O ic W O • Cf O N O 0 C 0 w w G w � ay _ O a CDCD O HIto C n -a m CL- CD CO) r O D7 H � � C H L N ^rte cn cnt a 0 as �r1 C/)G Pd w G as 0 w w G w � O a z d o r r-' C x o ^rte atri z 0-4 1 J a O O CrA I Ul 0 c Town of North Andover NonTH q Building Department 27 Charles Street o p North Andover, Massachusetts 01845 4( (978) 688-9545 Fax (978) 688-9542 cocwc raK 1• �4SSgcNus���y APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 30CD cvP_110,0 — toes LOT NUMBER �%' SUBDIVISIONiD��`� DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION NTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE ST1WC7bRE DOES OT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATION DATE PLANNING Z DATE (F12 Z7 U/ D.P.W. — WATER ME DATE O D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED t .1 i i i �• i, AUTHO /r i MAY -25-01 FR I 1 1 : 32 8 . E _ Cumrn i r�-3 s Assoc i at �s cARr/F/El' Pi or Pum s.E Cr avec & ASSOCIArES P.a sox mr grow, &c osaas nxpwom (800-88"Off Farr (008"S"" 139 (FORMERLY JOANNE DRIVE) r s ••`•.D 1 da3 BB -1 t 5O' AAN SETA LOT 21 A ` / BB -12 54.971 SF 88-14 BB-10 \moo.—.A,, OF �fgsf9 �*� • BERT T TRUDEL N a No. mug SCALE 1'* = 60' I HEREBY CER77FY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT 7NA T 7HE EXIS77NG FOUNDA 770N DRA WN ON THIS PLAN IS LOCA 70 AS SHOWN AND THAT IT DOES COMPL Y TO THE u%N/MUM BUILDING SETBACKS TO mOPERTY LINES. P.02 /, /55 USD ID -a 06/ %mNspr"ef /lo vs\e 0 3©© DA 7E-.- MAY 25, 2001 TAX MAP 109--A / LOT 21A CAMPBELL FOREST NORTH ANDOl2CR, MA. MINIMUM SETBACKS.• FRONT -- j0 far SIDE - J0 FEET REAR - 30 FEET TOWN OF NORTH ANDD, TOWN OF NORTH ANDOV : R BOARD OF HEALTH SYSTEM PUMPING RECORD -- - V &L2 I�all�: �1 STEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of h use) CIL. %1900 U.\"1,E OF PUMPING: QUANTITY PUMPED,A)o CALLOV,) POOL: NO YES SEPTIC TANK. NO YES L/ �.ATURE OF SERVICE: ROUTINE -4,---_ EMERGENCY UHSERV.-,�TIONS GOOD CONDITION HEAVY CREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER , lvS 'L:M PUMPED BY: C.UMMENTS: UNTFNTI TIZANSFEIZIZED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED 04HER (EXPLAIN) i Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS OIlici,il I :.e t lnh PCI-Illlt No. � t1q Z, Occupancy and Fee Checked [Rev. 9 Usk I leave l,lank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .111 '.%ork to he heilormed in acan•dance %011 the \I;u.achu�ctts FIC01-ic.11 Ct)& t\I'). i_' \111 12.00 +l'LLItiF1'RL`TI,Nl;\'KORTi•l.IL I.NF(.1141160LI ON) Date: City or Town of: T To 111c` llzvpeell,r u) I6'ir r.c: BY this application the undersigns gives notice of lis ur her intention h1 perform the elechical work described helilw. Location (Street & 'Number) Ow ner or Tenant �Tr Owner's Address Teleph Is this permit in conjunct' n with a building •rmit? Y"es U No ❑ (Check Appropriate Box) Purpose of Building)(/ic I Ltirty Authorization No. Existing Service Amps / Volts Overhead ❑ Lndgrd No, of ..Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ( "u11711leIiolI r,/ IIIc !o' llnli ir,v le,hle B„n l>r 11 Lill : 1 in; 1Il" hsr, '101* a• „r If ,, No. of Recessed Luminaires /� No, of Ceil: Susp. (Paddle) Fans o Tol T r Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool ,above ❑ In- ❑o. • J -nd. rnd. of Emergency Lighting Battci Units No. of Receptacle Outlets o No, of Oil Burners FIRE ALARMSVo. of Zones No. of Switches �4No. of Gas Burners No. of Detection and ! Initiating [devices No. of Ranges No. of Air Cond. Total Tons��No.g ofAlertin Devices No. of Waste Disposers Heat Pump Number Tons KW : No. of Self -Contained Torals: D a etection/Alertin Devices !V o. of Dishwashers Space/Area Heating KW � 4 Local ❑ MunicipalConnection � Other No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW o . of No. of Data Wiring: _ — Signs Ballasts No. of Devices or Eg . alent No. Hydromassage Bathtubs No, of Motors Total FIN Telecommunications Wiring: --- No. of Devices or E uivalent OTHER: Ir,;A,,J,.!fur:rrcr'•Irrul,J,!r,;;c,L .r,rsn',0111,0P1 rh h,r.r,c,.t,:r, 1 11, F_timatcd VAue ol'E •ctrirt) \Viirk:. (1\ lien rcyuired by municipal policy.) \4ork to start: Q Inspections to be requested in accordance with \IEC Rllle 10, and upon CoPletion. INSLRANC E CO •ER, (:E: Lidess waived by the owner, no permit fur the Performance of electrical work may i-aue u111e5 the licen.;ce provides rrooruf liability • lsur;.Incc inclLldin °' umplrted operation" covcra rc ur its. ubtilantial _qual ivcnh t. ` ( unden,i . ned certitie:; than such coke ;r,•c i:. in horse, :llld ha:; c hihitt:d Proof of ;;Lime to the crtnit i:;,uill" ofticc. Ill:CKU`v E: IM;( !U\t.i; Ilt;`,I) I)HIER tti �iilw:l I rrlifj, rrrr/er !bc;r ri s .r 1/pen r/ ircc ;,JI)r•r/trr'►' I !br ',%ur rrrrlifur .;n .:rii,' r/t/rl;�urinrt r:� rr �rr•,> *rl f- r; r;lil. r<•. f lr t_icensce: C ;is;Ilsttadl'e r Cly rel �}c'c Il.t ;t1 il;i 1 �• 1',i k'., 3 ��JCri(yj JCI-. %Z— O ;in�. T� il�Z ddress: 1It. as '`Security S)%tem Contractor License required f0l'this ifapplicablc, enter the liecn e number here: ()WNFR',S INSURANCE 14AIVER: I ;un nwclre that the Li hcmr the liability insurance (..>, :r l c nr rnlally acquired by law. By my signature beluvy, I hereby waive this rcquirunult. I nm the (heck unc)❑owner ❑ uv~ncr':, .,cunt Owner,'Agent i;;�laturc . _±�;,:�;; 1. , : ;._ n>~ R t•fIT �'rF'� F"t-� e/< a-27-eG � Ee 0