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Miscellaneous - 31 GLENORE CIRCLE 4/30/2018 (2)
3 1 r i I I I I f3' ,i nQ yeti�V CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 3 ( 0 Date THIS CERTIFIES THAT THE BUILDING LOCATED ON o 3 �r r r^? �d� �� C £ (r'/e��'✓/�',r� MAYBE OCCUPIED AS SAJ LS7tZ I/ ON Cl IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO I/LQ le'tt ,,4��0� Lo a- /0, Building Inspector NORT#q Town of - Andover 0 93 6A i _a�� 3 dover, Mass., 4 a 9 T ADRATED S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /��leA41eve.r �j e8 / �CJ/► 7 BUILDING INSPECTOR THIS CERTIFIES THAT.... ...........�!I . 31!�.A Foundations has permission to erect............... ..................... buildings on .z7i 1" 3 / -e to be occupied as.1D.. A��►7�.. .��. a �/...c. ..�5?�a�1...�/NC�rr cSlti f C �dA!1��'f 1►S��/�41e V— Chimney provided that the person accepting this permit shall in every respect conform to t e terms of the application on file in Final,c.( ._ this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. f I ,�/ 47 A1,0 PLUMBING INSPECQR VIOLATION of the Zoning or Building Regulations Voids this Permit. ��� � �� -7 PERMIT EXPIRES IN 6 MONTHS F ��`2 UNLESS CONSTRUCTION STARTS ELECTR C INSP CTOR ................. - ........ ................... BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS JNSPECT Display in a Conspicuous Place on the Premises — Do Not Remove (f ,o No Lathingor D Wall To Be Done W2,� FIRE DEPARTME T Until Inspected and Approved by the Building Inspector. Burner Rrrawt Nn /1 Q Irb Town of North Andover t%ORTy Building Department 3?°y`t1E °b;�ti°L 27 Charles Street o North Andover,Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 A04ATED �SSACNUS�� APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS 31 (;(,en c)r e C k ' (1e LOT NUMBER � UBDIVISION DATE REQUEST FILED t '0 DATE READY FOR INSPECTION A TEN(10) 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 STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. -WATER METER OJ-- —1-T-U) DATE 12-/0 -03 D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR3-Q THE INSPECTION REQUEST DATE. IGNAT DPW AUTHORIZATION 99b2 Date...... . ... .... .. .. ... TOWN OF NORTH ANDOVER low, p PERMIT FOR WIRING ,SSAC IN This certifies that .... ............................. ........ has permission to perform .......... ......... �.......... wiring in the building of............! ,k!69V71-Y............................................... at.....31...... ........o.1...........Cfl/.(................... North Andover,Mass. Fee...................... Lic.No.MA,3-16 .... ................. .... . . . P ILi41CAL INS EC�'TORW" Check # -Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 9992- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN INK ORTYPEALLINFOR1lMATION) Date: Z L City or Town of. NORTH ANDOVER To the Inspeetor 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 ( eA.,,ti�-1 `r-� Telephone No. Owner's Address 'C�,-„vi Is this permit in conjunction with a building permit? Yes O No ❑ (Check Appropriate Box) Purpose of Building - j? Utility y Authorization No. Existing Service Amps / _Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd 8 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W L 0-457 Com letion of the ollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 3 No.of Hot Tubs Generators KVA No. of Luminaires 3 Swimming Pool Above ❑ In- o.o mergency ig tmg rnd. rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiating Devices Tons No.of Alerting Devices No.of Waste Disposers Heat to p Nu .ber •o ns� KW No.ofSelf-Contained Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of No.of Devices or E uivalent Heaters , No.of Data Wiring: Si as Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail ifdesired, or as required by the Inspector of Wires. Estimated Value o Electrical Work: 3cop r � (When required by municipal policy.) Work to Start: 7,2- t Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CC VERAGE: 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 covs!;Pgris in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE R BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties o p ) P , P fperjury,that the information on this application is true and complete. FIRMNAME: �� C� 1,M LIC. Licensee: Cela�L✓�l DOA- i Signature (Ifapplicable enter "exempt"in the licens number line.) LIC.NO.:-&'Z7 kq�— Address: c,tf� (�4 �"� Bus.Tel.No.:hb3 3?L-7 o �.� 1 Sb 1, M-P *Per M.G.L c. 147,S. 57-61,sec ity work requires Department of Public Safety"S"License: Alt.Lel.No.No. ), g� 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. $ ELECTRICAL PERMT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG.SMALL 1 I.ROUGH INSPECTION: Passed- Failed-[ ] Inspectors'comments: Re-inspection required($50.00) -� 3- (Inspectors'Signature-no initials) Date 2.FINAL ECTION: Passed—[ Failed—[ .] Re-inspection required($50.00) Inspect s'comments: (Inspectors' ignafure-n initials Date 3.UNDERGROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ Inspectors'comments: dof (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAS: Passed—[ ] Failed—[ ] - Re-inspection xequired($50.00)•.[ Inspectors'comments: (Inspectors'Signature-zto initials) Date 5.INSPECTION-OTHER: Passed—[ I Failed— Inspectors' comments: Re-inspection required($50.00) (Inspectors'Signature-no initials) Date 1)OOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE Ili TBE AREATO BE INSPE ACCESSIBLE AND A RE-I�rSpECTION OF$50.00 IS TO BE � D IS NOT . CHARGED. . The Commonwealth of Massachusetts V Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg><bly Name(Business/Organization/individual): � � Address: LA-,'� 6 City/State/Zip: (��n�-c� /Jy� Phone#: q 3 7 m to Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with '- 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sh%et. 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers' comp.insurance. [No workers' comp.insurance 5. ❑ We ate a corporation and its 9. E]Building addition required.] officers have exercised their 10.Otlectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roofrepairsinsurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] *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 a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: ( ivy CuCity/State/Zip: , , ti( ,� 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. Ido hereby certt& nder thepains andpenalties ofperjury that the information provided above is t ue and correct~ Si nature: l Date: 2 Phone#: .? Official use only. Do not write in this area,to be completed by city or town official. City or Town: Per # 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#• i Information and Instructions 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(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 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 uld 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 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia i a u Date....../.`...2�.. N°RTN °f,"`°:•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that ................................... ..................... has permission to perform .......... ...... A......d.. .%............................... /� wiring in the building of........./.!......-7—% ...................................................... at..&/ ..................................... North Andover,Mass. Op Jr ✓ �...""... Lic.No. .... ... Fee...... ............................... .. E&CTRiCAL INSPECTOR V Check # t 2- 6 b Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. j BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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 W INK OR TYPE ALL WFO"ATION) 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) 3 Owner or Tenant . 1F-, A. Telephone No. 111 �:r5 -Srl 3 Owner's Address L Is this permit in conjunction with a building permit? Yes a No ❑ (Check Appropriate Box) Purpose of Buildings i t ,�,,,1 r�L� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d �' ❑ No.of Meters New Service Overhead Ames / Volts ❑ Undgrd ❑ No.of Meters 4 Number of Feeders and Ampacity r Location and Nature of Proposed Electrical Work: �� Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers VV No.of Luminaire Outlets No.of Hot Tubs Generators KVA No,of Luminaires (p Swimming pool Above ❑ in ❑ o.o mergency ig g nd. rnd. Batte Units No.of Receptacle Outlets 5b No. of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatina Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump ��-T ons KW No.of Self-Contained Totals: _ .._.-. Detection/Ale Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other Conn No.of Dryers Heating Appliances KW Security Systems:* ,, No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts. No.of Devices or Equivalent mmunic No.Hydromassage Bathtubs No.of Motors Total HP TPI ecoations icing: OTHER: en No.of Devices or E uivalt Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �0O0 v� (When required by municipal policy.) Work to Start: I 0 cc Inspections to be requested in accordance with MEC Rule 10,and upon completion. i 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 cove a is in force,and has exhibited proof of same to the`pe�rut issuing office. CHECK ONE: INSURANCE Lf BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and enaldes o p ) P (perjury,that the information on this application is true and complete. FIRM NAME: '�/�f��� LIC.NO.: Licensee: "`�-rl h-(?t' /''� r✓.4—c t Signature (If applicable enter"exempt'in the license number line.) LIC. Address: �,c.(�AJ�-c.� A46WAle O< D, ���^� N Bus.TeL *Per M.G.L c. 147,s.57-61,se unty work requires D „ � Alt.Tel.No.: epartment 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 [Iowner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ Z' 0 4 I { I The Commonwealth of Massachusetts k- ! Department of Industrial Accidents Office of investigations- 600 nvestigations600 Washington Street i Boston MA 02111 www n:assgov/dia . Workers' Compensation Imi.wance Affidavit.- Builders/Contractors/Electricians/Plumbers A170Iicant Information Please Print Leaibl O Name(Business/Organization/Individual): Address: City/.State/Zip: Phone #: . Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(foil and/or part-time).* have hired the sub-contractors6. New sub-contractors Q construction 2.❑ I am.asole proprietor or partner- listed on the attached sheet.i 7• ❑Remodeling ship and have no employees These su.&eontractors have 8. ❑Demolition' working for me.in any capacity. workers' comp.insurance. d [No workers'comp,insurance 5. ❑ We are a corporation and its 9 El Building addition required.] officers have exercised their 10 Q Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.Q Plumbing repairs or additions myself.[No•workers'comp. C. 152, §I(4),'and we have no 12.[]Roof repairs insurance required.]t employees, [No workers' comp. insurance required..] I3.Q Other *Any applicant that checks bolt#I must also fill out the section below showing their workers'compensation policy infomtation t Homeowners who submit this affidavit indic:atting they are doing all work and then hire outside contractor;must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional shwt showing the name of the sub-contractors and th-.ir workers'comp policy information. 1 am an employer that.is promding workers'compensation insurance or f m1'employees: below is the policy andjob site information. �J' Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/state/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). `f Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signafore: Date: ti Phone#: F107ffxiadl aseonly. Do not write in this area,to be completed by city or town off,at r Town: Permit/License# 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 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 license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has riot 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," b, Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their cmificate,(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 j 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 iisted below. Self-insured companies should enter their self insuranoe-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(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 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.When 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 02111 Tel. # 617-7274900 e xt 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#517-727-7744 www.mass.gov/dia Date.. . �.? <-. ` . ... .. i NpRTM pf i �.o ,tip 3= TOWN OF NORTH ANDOVER • X 0 PERMIT FOR GAS INSTALLATION ,SSACHUSEt _ This certifies that . . . . ` !. . . . . 1../ T. .( .�! . . . . . . . . . . . has permission for gas installation . . .(!. 3-/.t: . . . . . . . . . . . . . . . . . in the buildings�of . . . . . 1�. ./� `/. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . North Andover, Mass. Fee.? ..,'. Lic. No.. ' . - •. . . . GAS INSPECTOR Check# 1016 63 : 0 MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS G (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations C 1 Permit# 3 l v Amount$ Lys P<�/z Owner's Name New Renovation Replacement Plans Submitted Ua � o � �a W W O V F" �• f5 Ha -+ y N w a O 0 O z F C V U W '" Z E- v' �+ C > d w m � � Q x a o`nc w � � � q F � z w > a F m z o z p W x O x tz 3 0 .da o a > A a F o SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR a 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR a 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name (v \� 0 Corp Address S Partner. Business a ep one Name of Licensed Plumber'or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance•policy or it's substantial equivalent. Yes If you have checked es please indicate the _pe coverage by ch13 ecking the appropriate box. No� Liability insurance policy Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: IAm 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 submitted(or entered)in above Agent io13 n are true and accurate to the best of my knowledge and that all plumbing work a d install ions perfo ed under P it su or this application will be in compliance with all pertinent provisions of the Mas ach se State G ode and apt of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber F917:4 City/Town: 0 Gas Fittericense Number Master APPROVED(OFFICE USE ONLY) [j Journeyman Date. 1 q t . "pR'M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s o� •"s ,SSACHUS� r This certifies that f �. .�. . . . . . �; ' . . . . . . has permission to perform . . . . A,. . . . . . . . . . . . . . plumbing in the buildings of . . .1? .n. . . 'r . . . . . . . . . . . . . . . . . . . . . at . �.� . !'. .r.f .¢,��A <. . . . . . . . . . . . . .!. . ., North Andover, Mass. Fee. . Lie. No. �-a_ -... . . . . . . . . . . PLUMBING INSPECTOR Check # 7701 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location -�/ �r✓,r -p�Y Owners Name � Date Permit# 7� Amount 143 Type of Occupancy New ©Renovation rl Replacement Plans Submitted Yes No FIXTURES � h- 3 rnw � U SMEM t lSl;Rfm M HACIt �HDQt 4M 3~I M SIH H10�2 6TH ffiaR - 7IH1FLOCR 91H R-aR (Print or type) --.—Check one: Certificate Installing Company Nam2e F1 Corp. Address 9 6 11 Partner. usmess Telophone Name of Licensed Plumber: „ /YJ� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E/ llOther type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned,have been made aware that the licensee of this applicatio three insurance n does not have any one of the above Signature Owner ❑ Agent ❑ I hereby certify that all of the details and informa' e submitted(or entered)in above application true and accurate to the best of my knowledge and that all plumbing w rk and instal tions perf rider Permit Issued fo application will be in compliance with all pertinent provisions of Mas chuset State P b n ode and ter f the General Laws. By. igna ure o icon e u er Title ype of Plum in cense City/Town icenselurr/ er Master Journeyman APPROVED(OFFICE USE ONLY Location_Z0/ 9 4&1 G 0,- - //, I No. 3 Date 0-2-3 0 ,&ORTot TOWN OF NORTH ANDOVER F p _ Certificate of Occupancy $ `5 f C°' Building/Frame Permit Fee $ %U Building /Frame Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 y 161 3 0Ig /UC --- �= Building Inspector TOWN ORNORTH _ . - . BiJILDING DEF APPLICATIQNTOT'ONRPRII R11P ..WMV :: JDAM OR::1)E610LiSS AONSQR FAMILYIIWB G BUMDWGPERMU N[7MBER Baildin SECTION 1-SITE DWORMATION Z 1.1 property Addrrsev .- ._ 1.3 Aaseswma Map and Parod Number: - 0 L6' 7 .9( (SImee. Cir-le.. Map.Number Par oe1.lV . umba . 13;zcoingmformation c� 1a District Use 'IA Area - L6 BUIIAING sE'MM R Front Yid . Side.Yard .. Rea>_Yard.....: .... ...:. -rai provide Provided 1:7wata"IyM.ci],CAk -M) 13,.Fba�7mera?a�oton_.,_.•... +.. . 160 rerw u rriV,re o SEMON 2-PROPERTY OWNMMPIAUTHORIZEDRGENT' 2.1 Owner of R word rn 12 Name(Ptint) r Address for Service: ` S4' qatm T _ 2.2 owner of Record. , Name Print _ Address for service: go " O si T 171 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Consmic6on supervisor-- Not Applicable ❑ c}rvleS q <A rra 11. Licensed cqustrpohon$uperwtsot: N .= Ntrmbes<' 4r t7�- 6 . Addrexs: s Telephone. . ..._. .. ....._ Date ....... 3.2 Ra&cred E1ome Imptorvep►ent_Cauhpctor, NotApp)ioable ❑ Company Name _ 12egrspaponiNumber., Address:. .. . . Expkation Date Z Si Telephone- Cf dQ SS O �o( i � LB �£ o � .sc) o —S, L $� C' O Q 'p Srl'��14�7 z q�x oil o L4 M�vCi�vlb w��ah'r2f sz� x ))Z°ISx �Ix �� � o o g 9 ►41,vg w/bum SZ1�! ' aim/hvp�w -' ooa 000 $ � _ ops = cz1x,uh�h�� y/ xh� S••Vh NO_! 4N��/ ✓ �rti / � O� � �� w i SECTION 4-WORKERS COMPRNSAnON.(ALc.L,c.is2.1 .250(6) workers Compensation Insunmce afdavit skust<bo Q0bip1d4and submitted<VA%this appaicatr"dq,'Fa to to provide this affidavit wi1l result in the denial ofthe issuance of tare S" affdavit Anached lies. No.. .tl I SEGTI0N5-Det tloa•offtWosedWork chccicall _ . New Conshuction �(• ?atistmB:Buildi :© Repair(s): D A►teiatiaais(sj` :.0: Addition `Cl Accessory Bldg. C1 Demolition ❑;,. Othe 0 Specify BriefDescription-of Prod Work- cc) orkcovc4- T.oa . t �ooD.. S7o � .frte,e. .:. SECTION 6-ESTIMATED CONSTRIICTiON COSTS Rem .. Estimated Cost (Dollar)to be Convicted "t Iicant I. Building 5 5 *0 (a) Building Permit F.ee_.. . lier 2 Electrical ( i (7©� (b)_.Estim"pd Total,Cast of._. .._P1um " / cabhuctian 3 .. . ..... r Building Penitfee:(+):x'(b) 4 Mechanical AC. .. $. .Fire Pmtection...- p V. 6 Total (1+2+3+4+5). 1 f O Cheek Number. . SECTION 7a-OWNRR AUTHORIZATION TO DYCOMP'LETED HBN.. OWNUS AGRIVT.OR.CONTRACTOR APPLM FOR BUILDING' as Ower/Authorized Agent of subject property Hereby authorize to act on My behalf,in all mattes relative to work authorized by this building permit application. Signature of Owner Dam SECTION 7b OWNEWAUTHORIZRD AGENT DECLARATION I, C r�eS CA s QQ l� �f PS r Qat as OwnedAuthofved Agent of subject ley Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief C�wt�les ACArref( Pant Name e S tore of Owner/Agent Date. C No.OF STORIES SIZE BASEMENT OR SLAB HSe SIZE OF FLOOR TD&BERS i31 2RP SPAN . DIMENSIONS OF SUS lc f DIMENSIONS OF POSTS 1 DIlv1ENSION3OF.GIRDEIb4 DIGHT OF FOUNDATION THiCK1�3S SIZE OF FOOTING pal % MATERIAL OF CHRvMY 5rICA IS WELDING ON SOLID OR FILLED LAND..: ` y IS BUILDING CONNECTED TO NATURAL GAS LINE e _ . i - 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 SECTION `V APPLICANT b C-A A' oVeRe-4 q Q P PHONE 7 S 666--7 767 y LOCATION: Assessor's Map Number 3? PARCEL I SUBDIVISION &rr in n FEACe- LOT(S) STREET 31 lenof ee Cl rc I a ST. NUMBER OFFICIAL USE ONLY REC N TION F TOWN AGENTS: cbN79"fid"D04isTRAToR DATE APPROVED DATE REJECTED COMMENTS TOWN NER DATE APPROVED 1 DATE REJECTED__[ _ COMMENTS /A' �/1'J�l fjl/yL Q�J r �hu� Md� ac FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT J f 1 v(�Z ✓/v RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 im Deeds 0 1 Ice, V'121' r o oTH Town of North Andover N ,� Office of the Planning Department 0? ' °p Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 CHuse Kathy McKenna Telephone (978) 688-9535 Planning Director Fax (978)688-9542 Notice Of Decision ti t�J - rn Any appeal shall be filed i,iS is w c:;rtiiy that WOQnty(20)days Within (20) days after the a nfapsed frorri d taof dectslon,filsd out filing of f1t5 AI 6 1. ith Date of filing this Notice Date._- � D 7,,' ie�iat�A,f3rpdshaw - 1.11 tiie Office of the Town iovw,RGle* OD Clerk t7 _o Datc: December 17, 2002 Date of Hearing: December 3, 2002 Petition of: North Andover Realty Corporation, 100 Johnnycake Street, North Andover MA Premises Affected: 31 Glenore Circle, North Andover, MA 0144.5 Referring to the above petition .for a Watershed Special Permit, the application was > > _ • �,t : .. .. .,,��►� Cnn4�nnc A lZ�IiGowl 101 of thn Nnrtlt Anrinvor �... c . Zoning Bylaw and M.G.L. c.40A, sec. 9. So as to allow: Cortstruct.ion of 1,460 s.f. of paved driveway and grading within the Non- Disturbance Zone of the Watershed Protection District. After public hearings given on the above date, the Planning Board voted to APPROVE the Watershed Special Permit, based upon the following conditions: Signed: John Simons, Chairman Cc: Applicant Richard Nardella, Clerk Engineer Felipe Schwarz Abutters George White DPW Building Department Conservation Department Health Department r""'-_ ropy ZBA r f lrj: •� ROARI)OF AITEM,S 688-9541 111.i11DING 698.9545 CONST Rvf1'I'lON GR&9530 IIT AI fII 688-9540 I'L,ANNING 535 688.9 V i w.•.T- 31 Glenore Circle/Lot 7 Berrington Place Special Permit-Watershed Protection District i The Planning Board makes the following findings regarding the application of North Andover Realty Corporation, 100 Johnnycake Street, North Andover, MA, 01845, submitted on October 31, 2002, requesting a Special Permit under Section 4.136 of the "Zoning By-Law to allow the construction of 1,460 square feet of paved driveway and grading within the Non-Disturbance Zone of the Watershed Protection District. FINDINGS OF FACT: In accordance with 4.133 the Planning Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds: 1. That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of.water in or entering Lake Cochichcwick. The Planning Board bases its findings on the Following facts: a) The proposed structure will use the Town sewer system. b) A deed restriction will be placed limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit ofcicaring is restricted to the minimum necessary, e) l ertific ition Lias been provided by a registered professional engineer that the new structure will not have an effiect on the quality or qu,'117tity of runoff entering the watershed protection district. f) The construction plan has been reviewed by the town's outside engineering consultwit, V1113, and with the application of the erosion control, and use of organic low nitrogen fertilizers, there will be no degradation to the quality or quantity of water in or entering Lake Cochichewick. 2. There is no reasonable appropriate alternative location outside the Non-Disturbance Zone for any discharge, structure or activity, associated with the proposed project. The design is intended to make use of the existing, cleared pasture area and preserve an existing portion of woodland on the north portion of the lot. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: .7 , a) The specific site is an appropriate location for the proposed use as all feasible storm water and erosion controls have been placed on the site; rr b) The use will not adversely affect the neighborhood as the lot is located in a residential zone; c) There will be no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use is in harmony with the general purpose and intent of the North Andover "Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: a) flan titled: Proposed Sitc flan for Lot 7 Berrington Place North Andover, MA Prepared by: Christiansen h% Sergi 1 AO Summer Street Haverhill, MA 01830 Scale: 1"=40' Date: October 25, 2002 last revised December 2, 2002 b) The Town Pkuiner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would regL&e a public hearing and modification by the Planning Board. 2) .Prior to issuance of a building pennit: a) A performance guarantee of one thousand ($1000) dollars in a form acceptable to the Town of North Andover must be posted to insure that construction will take place in accordance with the plans and the conditions of this decision and to ensure that the as-built plans will be submitted. b) All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner. ': T r A ,1f c) No pesticides, fertilizers or chemicals shall be used in lawn care or maintenance. The applicant shall incorporate this condition as a deed restriction, a copy of the,deed shall be submitted to the Town Planner and included in the file. 3) Prior to release of the Performance Bond: a) The applicant shall submit an as-built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as-built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved plan. b) The Planning board must by a majority vote make a finding that the site is in conformance with the approved plan. 4) In no instance shall the applicant's proposed construction be allowed to further impact the site than as proposed on the plan referenced in Condition# 1. 5) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 5) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 7) This permit shall be deemed to have lapsed after a two- (2) year period from the date on which the Special Permit ,Vas granted, or December 17, 2004 unless substantial use or construction has commenced. cc. Applicant engineer file I I MAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 i I 1 Checked by/Date I { TITLE: PLAN NO./9421 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-22-2003 DATE OF PLANS: 3-4-02 PROJECT INFORMATION: COLONIAL HOUSE COMPANY INFORMATION: BRUNO ASSOC. 28 BERKELEY ROAD N, ANDOVER, MA 01845 COMPLIANCE: Passes Maximum UA = 712 Your Home = 517 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1945 30.0 0.0 68 WALLS: Wood Frame, 16" O.C. 3201 19.0 0.0 192 BSMT: Conc. 8.0' ht/7.0' bg/8.0' insul 1948 19.0 0.0 88 GLAZING: Windows or Doors 432 0.330 143 DOORS 78 0.330 26 HVAC EQUIPMENT: Furnace, 87.5 AFUE -----------------------------------------------------=------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in Sections 780CMR 1310 and J4.4. / Builder/Designer Date TITLE: PLAN NO./9421 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 1-22-2003 Bldg. I Dept. I Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-19 I Comments/Location I BASEMENT WALLS: [ ] I 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 interior cavity I Comments/Location I I WINDOWS AND GLASS DOORS: [ l I 1. U-value: 0.33 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U-value: 0.33 I Comments/Location I HVAC EQUIPMENT: [ ] I 1. Furnace, 87.5 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 MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I ( DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return i ductwork located outside conditioned space, including stud bays or ( joist cavities/spaces used to transport air, shall be sealed I 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 I permitted. The HVAC system must provide a means for balancing air and water systems. I I TEMPERATURE CONTROLS: [ l I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I ( HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 1250 of the design load as specified I in Sections 780CMR 1310 and J4.4. I SWIMMING POOLS: [ l I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in. ) : I PIPE SIZES (in. ) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I 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: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I 1 CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hot water pipes to the following levels (in. ) : I I PIPE SIZES (in.) I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 I 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)------------------------- — ffie �an�rnaruuea a�, lla�acu�ueaeltd BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 063503 Birthdate: 07/19/1955 Expires: 07/19/2003 Tr.no: 12903 Restricted: 00 JAMES V CARROLL � 12 PIPERS GLEN ANDOVER, MA 01810 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. 01 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. Company name: oQ Address +fX`) �Sh✓tn`��'r4k2 ^ City: W, 4�- ova 2 rn AS S Phone#: T7 u3 6 " 7 ? ciy Insurance Co. r2r Unlcx ns u tP nKl r-0-jig Policv# N n,.,y C 1 I n 3 16 Company 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$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature C" 4 G",,,,-� - ��� Date g " 1 a-'�* Print name_ C 6 r fb l l Phone# V9 46(6-7)-99 Official use only do not write in this area to be completed by city or town official' [] Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board 0 Selectman's Office Contact person: Phone#: n Health Department 0 Other FORM WORKMAN'S COMPENSATION ir °I r�„■��A 1 ,�I � � ( r :.� '� � .. ISSUE OAT! PRODUOER THIS OERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLY AND OONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED EY THE I YI. c . ROBERTS INS AGPOLICIES BELOW, CY INC 1060 OSGOOD ST COMPANIES AFFORDING COVERAGE N� ANDOVER MA 01845 i UOMPANY A LETTER WESTERN .. .. WORLD INS CO ........ ........... . COMPANY Ixrzuluo LETTER 8 NA`dOVER T " ..NSURA1v�'zC'L✓ I COAT PANY NC ANDOVER REALTY CORP L�En C JS LIABILITY 1 I U 0 R NN CAKE RD COMrANY N ANDOVER MIA 0 18 4 5 LETTER C GUARD INS GROUP COMPANY ..... . E LETTER covERXq�A �• . ....._. _. THIS 16 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAYS BEEN 133UED TO THE INSURED NAMED ABOVE FOR THE POLIC" PEH;OD 'GICATED NOTWITH8TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANv CONTRACT OR OTHER DOCUMEI,[T W'7H RESPECT' 70 ',VHlr THfS CE; FICA MAY BE 16$UED OR MAY PERTAIN, THE INSUCMANCE AFFORDED BY THE POLICIES DESCRIBED-HEREIN 16 9UOJECT TO A:'. THE TEEMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE 8EBN REDUCED BY PAID CLAIMS. Lam. TYPE OF INSURANCE POLICY NUMOER POLICY CFFiCTIYE POLIOY EXPIRATION LATE(MM/DbA ) DATE(Mmc)fYY) LIMITS I 004AALLLVIILITY NPP770574 3-7137 02 373703 OENERALADOFlEOATI a2 Cj i � OCAIM ERCIAL GENERAL LIABILITY PRODUCTS-COM�,C P,AGG� El � _�,� CLAIMS MADE X OCCUR. I ... .. PERSDNAL 6 AOV NJURY 8i, U�• `;;! ......... ... ....., CWNRA'S i CONTRACTOR,?ROT. I:1CHi Orr RMENCE � , u FRE DAMAU Wry one fltil MED.EI.PENSE(Ary one peryun) j 0 C AUTO400"LIA61LrrY ADN 5069646 2OG 02 2706 /03 COMBINP.D SINGLE it ANY AUTO LIMIT `,n r, ALL OWNED AMB .. .., . 3001Y INJURY X ACHEDULED AUTOS IPBf p4mon) S X H:REC AUT08 BODILY INJURY X NON-OWNED AUT06 (PHf mcldeM) 3 6AAAaE LIABILITY - . ...... j PROPER-Y DAMAGE g I EECEss uAeam CUP 10 0 4 9 4 6 3/13/02 3/ 13 0 3 eAc;i OCCURRE&FF s 1 , .X UMBRELLA`On►i AOQREAATe F O'HCR THAN UMBRELLA FORM - VYORKER'S COMPENSATION NOWC 3 0 7 9 5 8 3 13 0 2 3 13 0 3 .X STATUTORY 1-IMI-9 -- f AMC CAGH ACCIDENT 6 C,7 MIS EASE_POL10)'LIMIT Q•5 0.), r' EMPLOY[R8'LIABILITY ,. ... L DI8PA8E EACH EMPLpVGE s 5(],.0 OTHER J DSbCIWT10h OPOPCRATION OOcAT1ON8NENICLEB/BPECIAL REM, -- FAX ; 978-475-0942 I EMTIFICATS 4OLDO CA1 LkA71bN 8HOLILD ANY OF THE ABOYE DESCRIBED POLICIES BE GANCEI I EU BEFORE THE EXPIRATION DATE TH6R&OF, THE ISBUING COMPANY WILL ENOEA'-/Of) To MAIL 10 DA-8 WRIMN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TME TOW'I O= NORTH ANDOVER LEFT, CUT FAILURE TO MAIL OUCH NOTICE ALL IMPOSE NO 03LIGATOf, 0=. Bi1I=DING INSPECTOR LIABI . ANY U HrAGENTS OR REPRE6EP;'"ATILL'3 27 CHARLES STREST I NORTH ANDOVER MA 0�S g 5 wTM Arn Res � Michael P Roberta �kCb,RC 29-5 (TIRO) P " Q�IICC?F±0 CORRQFA'fJON 199C North Andover Building Department Tel: 978-68&9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant , i-�? oa 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 ST.ATENIFN' TOWN OF NORTH ANDOVER.BMDING DEPARTMENT "Flies Norm shall be used to assist the Building Delxartmcnt in their deternunation of exemption under o of the Town of North Andover Growth Mattagentent Bylaw The applicatu shall prat lde a!I til'. '.. :lecessan tnlormauon as requested below, �� l� �bf� 4oT 7 --r�r —n—.. .ace ---- Property address v lap Parc Pernut Applicant Property Single FJMIJ'y Two F.unll� =ppilcant's Phone Number b I the undersigned applicant lur Ute above property aunt Usat tic auaJhed buiIduhg pernut Iur ssniJ thn Ic,rni u�:omply with the ENEMPTION section 8.7.6 ulthe Growth Mwhagennestt 13ylow. I also it d prior t provtdutgthu li,nn u me or any party to this permit ham the requirements ui•ubtaining udhcr permits required prior to he issu:ulce til the uuutl n� pcmtii Further I understand shat my LnterprcLation orthc exemption swtus is subject to review by Uta Buildmg Doparvncnt .c„u.>JP ,,l'i.�,ally accepted when the building peri-rut is issued. sed un season 8.7.6 of NAnd the orth over Growth Bylaw the above lot and Use work us applied for on Use above lot, ;n Uhc bu:!c,n u : pernut applicaum and associated auachments,complies with one or more ul the lulluwing sections as indicted by a�nc,:K n ..r 1'l-tis is an application for a building permit Lor the vrslargcmuu,restoratwn of rcconsuva un of . Uwclluig ui r..,t•,." �('Jsc ell"calve date ofthis bylaw,provided that no additional residential tint is created. The lot($)was/were created prior to May 6, 1996 and are exempt from Use provisions of seaiun 8 7 ul'the Zunuig This application is t•or dwelling writs Ibr low and or moderate ucume families or individuals, where all elute 7s 7 u arc ma and or reprarnts dwelling units for senior residents,where uccupwlcv of Use units is resuivtcd to scniur;u:cat: 1 ys a properly executed and recorded deed restriction running wiUt Uic Idnd. For purposes JI din sawn "sauur sn it u.<. �:rsons uhe:r Use age of'55 This application is part of a development project which voluntarily agved to a minimum 40%perntanemt reduction tit unsuv(buildable las)below the density pernuacd under zoning and feasible given the environmenutl conditions oldie u3,1,wlw surplus land equal to u last ten buildable acres and permanently designated as open space or farmland.The land to be prescrs a A.'' et protected from development by an Agricultural Preservaest tion Rna on,Conservation Restnction.dcd canon to the fos4'n, ui .,c:; s nuiar me&anism approved by the planning board Ulm will ensure its protalion. This application represents a"a of land existing and not held by a Developer in common ownership wius an.wt,;.n. pa tc!un the effective date of this Section 8.7 and shall receive a one time exemption I•rom the Planned Growth Rate;and Dcc clopment Scheduling provisions for the purpose of conslru ling one single family dwelling unit on the parol. This application represents a la which is ready For a building per-nut(all other pernuts from all other boards amu -vmun ss ons have been received and the projaa is in compliance with those penruts),and the Developmcltt Sdnedu!c sloe, ,avmmodate issuol;a building permit in that Year.One building permit will be issued per year per Development unut such!im, _,�c ucvelopment schedule accommodate issuing builduig permits. Applicant must subnut an appruycd FOR-M U-ui trhn E\,IMPTiON. _ASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTtvl[ENT IN M:t: _JE1ER:�,9NATION THAT THIS APPLJCATiON IS ALLOWED UNDER ONE OR MORL• OF THE ABOVE EXEMPr10,> 31 SIG\1NG BELOW I AT-FEST TOTHE ACCURACY OF THE INFORMATION PROVIDED AND THAT'l l!?: ,01"I'",.�''.' 3UiLDL\G PERvlIT IS.-kLLOWED i>N E\EtvtPTION rkS Cl fED ABOVE. rLRTHER I UNDERSTAND THATTHE SUBtv(3TTAL OF WSLEADING OR INACCURATE iNFORviATION'OR"FILL CHECKING OFF OF A ABOVE EXENTl-ION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE JiI \OT S GROUNDS FOR REFUSAL.BY THE BUILDING DEPARTtvtENT TO ISSUE A BUILDING PERMIT -—Y A CANTS SIGNATURE DATE PI'S FORM TO BE ATTACHED TO THE BW_DWG PERMIT APPLICATION DPW 7 1 4 Date .... -...... 'f,. OF NORT�y, ti o�'� " TOWN OF NORTH ANDOVER A RECEIPT HUS J / // [/ _ This certifies that .......( .�Tb L�BU-4) F! 1. has paid .. j for Received by ............................ ...G�,Gyl.... C/ //..`.... .. //""........................... Department ................................... .!.!:Cs......LN /' WHITE: Applicant CANARY:Department PINK:Treasurer DPW 7 1 3 Date ..... ..:'"1Z..:a�. OF NOR7�y, ti TOWN OF NORTH ANDOVER 0 m n *�%o RECEIPT •°,;rID , ty SS�CHUSE� This certifies that ... Q,/,r.r`� X has paid......................... ....... .. �1zV.,.09� ................................... for..�� <..'1. ... ...� .. .... ���. Received by ......................... . �1.....1/�.e ................................ Department ................................/..j1. (G......f/�/�1/�5............ '8 ?; r► APPLICATION FOR SEWER SERVICE CONNECTION 5 North Andover, Mass/. Application by the undersigned is hereby made to connect with the town sewer main in �=/( ��� elStreet, subject to the rules and regulations of the Division of Public Works. /f The premises are known as No. re- Ci'(— Street or subdivision to no. h2l) lo Owner Address Contractor AZli 1 nt's Signature PERMIT TO CONNECT 7H SEWER MAIN The Division of Public Works hereby grants permission to 2r ��� to make a connection with the sewer main at ��"���� Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations ORTH Town o Andover No. c> to r7 o ndover, Mass., 4--0; 9' �o?C�O T` Q = LAKE �. COCHICKE w ICK V 7 CHV74 IT FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT .... ,!!0 ......... ........ ............... C/'/'/N 7—>I. has permission to excavate and pour foundation atQ..... .........S.I. .....IC.J................... .... '�..........-.. for the purpose of...�. ..� ®!..!1 �. .�.� !�.! .....J(mac j e.....................G�pNC te_ The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. 393/ 1 f { VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS j The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. Oct I..FSQ- 4 f_; f-i:[:+OP r f J� 5 ....................... ............... DUE PERMIT �.��y� O BUILDING INSPECTOR NORTH Town ofAndover 0 0% _and 3 0 �o��,35 dover, Mass., 02 9 DRATED S H � BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ,I/ Cc_y� Ado 1J BUILDING INSPECTOR THIS CERTIFIES THAT..../!�A!ei�I........ UC I^ ea H.e' �o�' // / ;... ..................... ...................... Foundation has permission to erect...............t....................... buildings on .l�.a? ../... ,, 1....�,c nr! �� �?'V... ��. Rough to be occupied as.1DR4Vnj�.. .��p2,�.A".t ..S d/� �/A�c�rr �S/N IG �dAi//x i►5��1�4/C tL Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �,.� JI X 6 c ,y,9 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR •4CRough A. ... ............... ...................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i Location Ad / #,31 iCa_ t t (` &--, No. '0 Date ab-6 3 MaR,M TOWN OF NORTH ANDOVER Certificate of Occupancy $ cMusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �q yo Check # '3-5 16162 Building Inspector C�b-GU-CUU� lr1U IUUC� !111 Ur1�1�711t1I'{JCIY d. JGRUI U(9 iC Ji70J C. '.!! i —act-© 3 r� -(ykps oJ"'4a--Zn-o3 eN tU1� cl�C ,- LCA l ?' \ GLENMDRE ClR. fX/ST1WG fDUIVGATION T.0.F. EL, = I M3' L- ri'f e \ \ \ t EASEMENT ee\ �N of A444 \ L No. gM� G1 RN��JQ ti FOUNDA TION �'"� L LOCATION PLAN AORMW W° CW AW MW OEM w�u a CLIENT: JIM CARROI.I. »a mme sw u wr w uW a PC awn fm my Pr WW OMM MW Mr aWAW ANWEMr MITA na 7W CMFIL:ATL W IS IMW AM LIA/M WNW AMMOM W�&stlepr W. TO THE Adityll9r' CLENT. � aroc R nW NAWN c �N"w L0CAT/ON. LOT T OLENMORE CIRCLE �+�Or W MU=nW a� a FORTH ANDOVER, A1.4. SCALE: 1" 60' DATE: 2f 18fD'S CHRISTIANSEN &SERGI iAWXRWMM too &""ST. N11 at= ML. WR-j73-w$f �� QI' f� S�itil Ati2 LiM . 010�/0Q3 OUTER LIMIT OF ZONING DISTRICT: Wl NON—DISTURBANCE ZONE/ INNER LIMIT OF MIN. LOT AREA = 87, 120 S.F. NON—DISCHARGE ZONE MIN. LOT FRONTAGE = 175 FT. (150 FROM WETLANDS) MIN. FRONT SETBACK = 30 FT. 9 X/ o £ ST/NG MIN. SIDE SETBACK — 30 FT. HOUSE ` MIN. REAR SETBACK = 30' FT. 000 �\ LIMIT OF 100' ! L 0 T 16 _-,�XUFFER ZONE cp IM 1 \ SW 9 0 , �E� E SEMEN IDE W 318.55 \\ o \ 50' OfFSET-��� •• \ Z i ,. \ �\RO WETLANDS _ I \ TR E L/ E LOT 47 00 ARES = 125 373 SF • \ 55 / ` �(v EST\ I z 55' �� l PIT -A ol CH G ELEV.-182.5! CHA Iruo �• ,� �` N 1880? I r ,��• �Q / Q a, t o r A Q F• "V SEWER SERVICE EDGE OF INV 83 WETLANDSNOS I \ AZ D i 1 1 Z \�8 • I•• / R� OFF •�; 200 LONG �. '' 9 83 ///L°1 .E-14 .� t." . •" LO PAT 15L' ( '♦ / E-122N - —15 460 SF• t 84 I n `• \ I •♦0 z \ E-11 s v P•\ 0 .171� e E-16 1 i •y N/F McCOLLISTER E-17 ' ' L/ALIT OF \' l 100' FFER 1L E-10 Z0N . c-12 �' • . .9L �\ \� N/F TAKESIAN C-11 N � iL B-27 --180- OUTER LIMIT OF CONSERVATION ZONE/ B-28N/F GARBICK INNER LIMIT OF NON—DISTURBANCE ZONE (75' FROM WETLANDS) FM L s ti SEN PROPOSED SITE PLAN G T cn t: ViL FOR 0.28895 LOT 7 BERR/NGTON PLACE TER��iAL /N r NORTH ANDOVER, MASS. PREPARED FOR. I HEREBY CERTIFY THAT THIS PROPOSED JAMES CARROLL MODIFICATION TO THE PREVIOUSLY APPROVED OCTOBER 25, 2002 SCALE. 1" = 40' DATE: SPECIAL PERMIT FOR WORK WITHIN THE 0 WATERSHED PROTECTION DISTRICT WILL NOT REVISED: 12/2/02 RESULT /N ANY SIGNIFICANT DEGRADATION OF THE QUALITY OR QUANTITY OF WATER IN CHRISTIANSEN � ,�SERGI PROFESS/NAL SURVEYORS OR ENT /NG LAKE COCH/CHEWICK. \, �? n 160 SUMMER Sr. HAVERHILL, MA 01830 TEL. 978-373-0310 2002 BY CHRISTIANSEN & SERGI, INC. "PHILIP: 0. CHRISTIANSEN, P.E. DWG. N0. 01.039010