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HomeMy WebLinkAboutMiscellaneous - 317 HILLSIDE ROAD 4/30/2018 (2) 317 HILLSIDE ROAD 210/025.0-0030-0000.0 BUILDIN" FiLow C Date.... ............... NOwriy 0 . TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SSgCHU This certifies that .....................2.. y per-��, ........ ..A has permission forfn .......... wiring in the building of 6.6).-C........................................................................ ................... at ..... . ...................North Andover,Mass. ................................................................................ Fee...Q. ...........Lic.No. ).S.* ..... .. ......... ................ .... .......................................................... uELECTRICAL INSPECTOR Check# P) ' ILCommonwealth of Massachusetts Official Use Only o Department of Fire Services permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ),527 R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Insp ctor fires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) f 2ND 1/s . Rj Owner or Tenant _r 615 4jo"ji le- Telephone No. Owner's Address S One Is this permit in conjunction with a gilding permit? Yes No ❑ (Check Appropriate Box) Purpose of Building M V 6., 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: sdo Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total i Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o,o mergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: "' ""' ' ""'......""""" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent t No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pen lties ofperjury,that the informal this ap catio s true and complete. FIRM NAME: v p / LIC.NO.: Licensee: Signature LIC.NO.: f (If applicable, r "exempt"in the license number line) Bus.Tel.No. Address: nSo k 0 a 1/n n2-&��U d/te!!!� 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 [PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed ' 3 on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an ry electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the Ff notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***.Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: J Pass EN Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R Failed ❑7 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL IN CTION: Pass 01 Failed (, I S Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: G - S - I S DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com i� J The Commonwealth of Massachusetts Department oflndustrialAccidents M . I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/Individual): j Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type Of project(required): 1.T am a employer with _employees(full and/or part-time).* 7. ❑New construction -2.FI am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11XElectrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suck #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-co'ntractors have employees,'they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is thepolicy and job site information. Insurance Company Name:_ �l� �� R 1 P 2 :j Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: v City/State/Zip:gLV/' Attach a copy of the wor ers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification Ido hereby certify der ze p ' s and penalties of perjury that the information provided ab ve is true and correct. -- Signature: p Date: 13 �f 7 Phone#: On" S 20 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and 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 d: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 foi•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' compensatioii'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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017, Tel. # 617-727-4900 ext. 7406 or 1-877-NlASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i i° 'COMMONWEgLTH OFA � , o ° AS SACHUSETTS�"`.;. I BQAR4� e ELI~GTRICIANS iSSUE5 THE FQLLQWIN �^ A q; L1�ENSE I , REQ �OURNEYMAN.,ELECTR IG ?w` .�R1<:AF1 E LAVO i.E i I THAYCR:: 5T ETFIUEN MA 018k4-261 7 1 28664:'` 07/31/16 39232 I O pNw ® ® EALTH p1-�,_, ° F Al.: X.- -. sQ S 1�SUES SHE �LEICIA NS L tCE��c N .:. L AI/0!E ECTR! k C 1 4 AYkjTpy ST ��THUFOP 1 1648 MA 01844-26:` 1844 2 may, 3931 S�.i`'� i R C Interconnect Cable HN Black—Ll HN Red—L2 HN White—Neutral HN Green—EG End cap installed on last e Cu - inverter cable of branch circuit in 1111 111ttl 11111 1111111A -1"1 V — — — — =Zlk Module/Microinverter cl 1 X 16 SW280 ModulesSquare D,125A 1 X 15 SW280 Modules Main Lug End cap installed on last 275W(STC)PV Modules inverter cable of branch le Voc 36.lV, Isc 7.75A 100A,2 Pole,main circuit :ers 31 Enphase M250-60-240-2LL service breaker MICROINVERTERS o ' @240 VAC aOA,2 pole,backfed Three Lines Notes: Nominal Output Current 1 solar breaker 1. Wire Sizes are as indicated or larger. nnect - 2. All equipment is bonded by mechanical means or by a grounding 60 A, conductor 2 pole, 33he inverter grounding electrode conductor shall run unbroken to a grounding electrode to maintain MEC requirements 4. The system is grid intertie,no batteries. 5. The system has no DC Circuit—No disconnecting means 3 necessary.System complies with RAPID SHUTDOWN requirement O 6.Electrical In�tallation will comply with 2014 MEC and Commonwealth Solar Minimum Technical Requirements 7. All solar panels,equipment,and metal components will be Utility Grid bonded. 120/240V 8.All plumbing and mechanical roof vents to be clear from Dedicated Photovoltaic Single Phase photovoltaic array or extend above solar panels. System kWh Meter 9.Each module will be grounded using WEEB grounding washers. 240V,100A (1)1/C#8 THWN(Neutral) (2)1/C #8 THWN Three Line Standard Electrical Diagram for CONTRACTOR: Small-Scale,Single-Phase PV Systems BRIGHTSTAR SOLAR (1)1/C#8 THWN(Gnd) 611 HOSMER ST Site Name: Nobile Residence Serves as Equipment Ground. MARLBOROUGH, MA 01752 Site Address:317 Hillside Rd, N Andover 01845 Runs continuously from Site AC Size: 7.75 kW inverter to ground bus in main Drawn By: Mona Reese SIZE FSCM NO DWG NO REV panel I E1.1 Checked By: SCALE DATE ISHEET NTS 12/17/2014 Date....`. .- f NORTI�, 3?;.,;�`'°-:•.�."�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUSEt .. Thiscertifies that ....................................................................................:........ has permission to perform .......4-,�T!d n ....... ... ..................................................... wiring in the building ofd .. .......... .. ..... ....... ..................................................... at.....� 7....... ` .S/.[).,C— .........��11......... ,�rtA�ner,Miss. 3 Fee./l-��..^........... Lic.No............6 ...................... . ��.... ... ? / ` EL CT RICALINSPECT_OR ' Check # J b b 10810 Co-monw.&o/ SM W .6 O ficial Use Only a(Japarfmi o/.,lira iee6 Permit No. /b BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 1/07) leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AU work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12.00 (PLEA SE PR INT IN INK OR TYPE ALL INFORMATI01V Date: Z 2- - City City or Town of. A t 4Do,4l To the Insp ctor W--Wires.- By this application the undersigned gives notice of his or her intention toperform the electricsl work described below. Location(Street&Number)__ � j 7 �iG�S tAi= 2'rj Owner'or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Boa) Purpose of Building /,(/��� Fi9►ht�`� 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: fl/A:q5 Awnmy Completion of the folloi table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of celL-Susp.(Paddle)Fans No.of ots Transformers KVA ` No.of Luminaire Outlets No,of Hot Tubs Generators KVA No.of Luminaires SwimmingAbove - o.o ergency g Pool d. d. ❑ Battery Units No,of Receptacle Outlets 2s No,of Oil Burners F=ALARMS No.of Zones No.of Switches f `7 No.of Gas Burners No. fD—e Initiating Devices No.of Ranges No.of Air Cond. tal Tons No.of Alerting Devices No.of Waste Disposers �Totalsp min er Mons Detection/Alerting!o f-Con Devices No.of Dishwashers Space/Area Heating KW Local❑Connection ❑ firer No,of Dryers Heating Appliances Kw. )Security of Devices or E uivalent Heaters KW Signs Ballasts. No.o Water o.o o.of Data of evices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP ecommumca ons 1 tang: • No.of Devices or E uivalent Jr� OTHER: Attach additional detail l desired,or as re aired b the f Q y Inspector of wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE. Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 5b BOND ❑ OTHER [] (Specify:) I certify,under the pains and penalties ofperjury,that lite information on thi apI n is tate and complete. FIRM NAME: t7A V i D CL C&T2i CAL Co"-r 4c 1'i�it t (� LIC.NO.: Licensee: —OAV t b i4A", Signature LIC.NO.: e- •- • (If applicable,enter"exempt"in the license number line.) -i l yli5 Bus.Tei.No.: ilfi Address: 91 all iT ST J ,Q�} yr j� tilt► , �' r Alt.Tel.No.:`116- 3 7 T -j'73 ye *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: $ � �`3a-12� ��,� p� � ��iz��, The Commonwealth of Massachusetts Print Form Department of Industrial Accidents lip Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mas&gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibh Name(Business/Organization/lndividual): DAVID ELECTRICAL CONTRACTING LLC Address: 87 BELMONT ST City/State/Zip: NORTH ANDOVER, MA. 01845 Phone#: 978-682-6262 Are you an employer?Check the appropriate box: Type of project(required): 1.91I am a employer with 7 4. E] I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.'- required.] nsurance.{required,] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.[J Roof repairs insurance required_]t c. 152,§1(4),and we have no 13.E]Other employees.[No workers' comp.insurance required.] r *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 4 t 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy member. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: THE HARTFORD Policy#or Self-ins.Lic.#: 08 WEC C182933p Expiration Date: MARCH 1, 2013 /'�/ Job Site Address: 31 -7 a S� ./ � City/State/Zip: Sowy 4,co =►2 /'* 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 g q c. 152 can lead to the imposition of criminal penalties of a fine u to$1 500.00 and/or one-year imprisonment,P y p tsonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of u to$250.00 a da against the violator. Be advised P Y ag sed that a co of this statement may be forward PY y ed to the Office of Investigations of the DIA for insurancovpverape verification. I do hereby cerfify under the o erjury that the in ormation provided above is true and correct Si afore: Phone#: 978-682-6262 Oficial use only. Do not write in this area,to be completed by city or town offs at City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date" .l- . '- k' "oRTM TOWN OF NORTH ANDOVER `. o; "o PERMIT FOR PLUMBING ,SSAC14USE� -c-,-. Pte! This certifies that-1..�. . ��.� . . . . . . . . . . . . . . . . . has permission to perform ;..!. . . . . . . . . . plumbing in the buildings of, P yl-Vorth . . . . . . . at.ll.// . . . . . . . . . . . . .(. . . . . . . . . . . . , Andover, Mass. Fe*T f . Li c. Nod?! . . \. . . . . . �:�. . . . . . . . . . . . . . PL iNG INSPECTOR Check # V 6Q6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ,/ Date a60 Building Location 317 , j A o� op-'o PermitYv /E Amount Owner G. New Renovation Replacement Plans Submitted Yes D No FIXTURES cf. cf cf cf IP i 1 / BkSEVENr / >ISr.FLOOR 2m FLOOR �FLOOR 4M FUOOR 5M FLOOR 6M FLOOR 7IH FLOOR MH FLOOR (Print or type) Check ne: Certificate Installing Company Name {�i l� jA�f yH&Wj''%l 9 A r-6. orp. 1 Address Partner. Business a ep one _ Firm/Co. Name of Licensed Plumber: g C?S '4g— Insurance 19Insurance Coverage: Indicate the e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityD Bond D Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner Agent D I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Plumbing Code and Chaper 142 of the General Laws. BY Signature azure o� icen ea rIumDur Type of Plumbing License Title da� 0 9 City/Town ricense Mumoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY �1�so � Date...�....................... NORTH ` °f •``° '•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING • i � a �,SSACMUSEt This certifies that ............ .......44t ............................ has permission to perform ...............� (W�.! ! ' 'll�.......................... wiring in the building of...J............ , `, .................................... f at....3..j. 7....�/1(.(SD. ........r...... , North Andover Mass. Fee.F:S= Lic.No. 2�� ELE RICALINSPECTOR f Check # c� v 6 ,iYIi TBE COMMONWEUTHOFMASSACHUSETTS Officcey Use only DEPA)UAfl l'OFPUX1CS4F= Permit No. nl _ �C� / BOARDOFFIREPREVFV ONREGUTATIONS527CMR12.W Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 3/ ? Owner or Tenant G'IK/5 Al2 3f.f-I Owner's Address Is this permit in conjunction with a building permit: YesNo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead M Underground M No. of Meters New Service Amps / Volts Overhead El Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1"6 &--S)hWiAST�i4-4 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above D Below Generators KVA round round No.of Receptacle Outlets No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis ' No.Hydro Massage Tubs No.of Motors Total HP 'OTHER• - lo '7?> 6,c—/ CwRcu!7" kwranceCovemage PtuanttotheiarmTeMofMassad>uSEZGateiallaws Ihave actmentlimb&ykmn'ancePb yinckd%Cornplee 029rape&vetageorits substantial equivalart YES NO Ihave subrr wd valid proof of sarne tD the Office YES F)m have checlod YES,please indicale the type of corsage by chadingthe VpWalebox. ■�•1 INSURANCE = BOND a OTHER F1 prwe*cify) End Value ofDectrical Wodc$ WodctoS4lt h>SpectionDateRet�d . Rao � FinalSignedundotTrP of paw �,�. FIRMNAME �/P �' 'iC Iicww-No. Ii msee LimmNo A�3 `� BusirrssTel No. �t 7f W2 62-1.2— A`r`c vc� �> �T � Ah Tel No. OWNER'S INSURANCE WAIVER;Iam aware thattheLicensedoes nothave the ins<uancecoverageorits substantial egtnvalalt as recµtired byMmadnlaetts Catera]Laws and ttrat my agrnkm on this pwm q#caocn waives this Mquai mrr t. (Please check one) Owner M Agent Telephone No. PERMIT FEE$ Signature of Uwner or Agent No 3 - Date........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;TZOA;41-t- SS CHUS This certifies thatfP ...... . . ................................................................. his permission to perform ..... ........................................ ,Airing in the bu7ilding/Zof........ .......................................................... 9 at..........31e�lp // � ............... � .............I......v.......... t�',North Andover,Mag.,- Fee,ld&Q.. Lic.No. ...�?..... ....�: ...... .. EEc-rPICAL INSP.EftOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer -� lllLi�,.lJ1IlLIlV1/I//'-^�-Lll VL-1I/lXa./!}�..11V►l[illU - -"""---+��„' � DEPARTAIENTOFPURUCSAFM Permit No. ` o� BOARD OFMEPREYEVHONREGMT101 NS27CMR120 U% A Occupancy&Fees Checked PPUCATTONFOR PERAff TO PWORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. i Location(Street&Number) S/ Owner or Tenant C CL S US I Owner's Address Is this permit in conjunction with a building permit: Yes No a (Check Appropriate Box) Purpose of Building NULv A Jd t4 �✓� 4 �,� �y � Utility Authorization No. Existing Service II DDS Amps/ y /JV Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground r--J No.of Meters Number of Feeders and Ampacity J — 60 -4,h 60 A —,0 Location and Nature of Proposed Electrical Work _ No.of Lighting Outlets // No.of Hot Tubs No.of Transformers Total `7 KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units % / 6' No.of Switch Outlets No.of Gas Burners I-J3.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other' Connections No.of Water Heaters KW No.of No.of i Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 0 OTHER- lrwrd oeCaa�R=antbthen xemaZdMwmduscftGalaalLaws [ha%eaamertL ab➢ldykmr&rePbbcyerhtdrtgCa Tkt CouaageorilssdsialeWivalat YES NO Iha%emb nadvdlidp edofsametotheOli>oe YES MNO If}ouhawdodWYES�pkmemdc*thetypeefo mmWbydla k gthe INS<JI2ANCE [n' BOND GUiER Bqiratim Dat EMmE kd VakxdE 6M oal Weds$ WotkbStatt hipectimD*RaVested Rough Final Sigrxdunde MPdlal6saf*W.. FLRMNAME I3oa�seNa >Q J�6 �� Lioat9ee J L" d 9:��,�c .. Skmane Lioa>seNo ) BusinessTe1.Na 6R-,,2.6 C2 46 Ad&m ,- S6 � G /�r� 12,1C e Alt.TdNa OWNER'SPgRJRANC:EWANFR;Ianawatethatthef their>Stxat wmmEeorAsa*swtdeWnetataste#WbyMamdxs&CerealLaws andditmys althispaniappkabmvaik,esth mw'mnat. (Please check one) Owner Agent Q Telephone No. PERMIT FEE4�) vtJ Location ,3 I hlt f l=�� � W, No. C' Date NORT1y TOWN OF NORTH ANDOVER 3? ' 0c Certificate of Occupancy $ ��s'••°•t<� Building/Frame Permit Fee $ 3 QE swcNus Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ c. Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: J SIGNATURE: Building Commissioner/I or of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: .3/24�v5- 0030 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: IR L 2.61 JI.-I-1 ?!!Z 1 ZoningDistrict Proposed Use Lot Area Frouta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided RequWired Provided 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information' 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood lune ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) / G Address for Service f Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Q !!!�<Z-) ,q Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 7 Registration Number Gam/ �i��ii a j]y� fes/ Address '07 al Expiration Date Signature IVTele hone SECTION 4-WORKERS COMPENSATION(rvLG.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 licable New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: / e SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)tobe I , Completed b permit a licant � � • 1. Building (a) Building Permit Fee lier 2 Electrical .'-woo (b) Estimated Total Cost of i Construction 3 Plumbin Building Permit fee(e)x (b) 4 Mechanical(HVAC) 2 C / 5 Fire Protection V J 6 Total 1+2+3+4+5 O CSCTa Check Number SECTION 7a OWNER AUTHORIZAT16N 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 ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print N? Si ature of Owner/Agent Date x NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T.UVMERS 1ST2ND 3fw SPAN DRAENSIONS OF SILLS DINMNSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover NORTh - f .9 0t,t x.30 6! tiO O Building Department o , 27 Charles Street '- North Andover, Massachusetts 01845 IL (978) 688-9545 Fax.(978) 688-9542 °� <�< � KR �� �9SS.acu5���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit.# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 56a. The debris will be disposed of in/at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts y d .Department of Industrial Accidents ' Office of Investigations Boston, Mass. 02111 .ate SV0v,0W Workers'Compensation Insurance Affidavit Name -vivo 172 0 Please Print Name: Location �?17 /"I/// �i� �7 n City 1101 �� . Phone # I am a homeowner performing ail 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. Company name: I Address i Ci : Phone#: Insurance Co. Policy# Company name: Address City Phone#: Insurance Co Policy# 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 weft as_civil..penaltiesin thelnrm-of-aSTOP WORK OR,DER_and_a fine.of-(.$100.00)-a-day egainstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties of perjury that the information provided above is true and correct. Signature Date �I Print name Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing 0 Building Dept []Check if immediate response is required 0 licensing Board III p Selectman's Office Contact person: phone#: E] Health Department Other I ! I APte/ `� BOARD OF.BUILDING`REGULOIONS. r } Licexrse: CONSTRU.CTION'SUPERVISOR' NumDerCS 06756.0 t Birthdate-=10t25'/t966 f Explres 10/25/2601 Tr.-no: 21585 SHAWN M TNiLOMEY r , 61 PATR01T ST "� ` a N ANDOVER, MA 01845 Administrator e a.I. I ' I a o 30 t:;25, 45 3 a FRT ArF INSFTPnt�--___._.___- --=- / 7;k or B cl: t v 317 J Lor ' {I' A= 2.1, TS?-sr-:t � �J ° I 132.pU Y0418 PLAN 18 DARED ON A TAPE SUPWY ldtor AN NSTAUMENT SU RVEY)AND 90 TO BE THEAEFOAE.THE OFFSETS AS$NONM SHOULD NOT 9E USED TO ESTAsuam$,""USED FO a MCKWAGE PU s ONiV. I `( U 1 COUNTY DEED REFERENCE; PLAN REFERENCE; PLAN or LAND f gK 532 PG. 1\r, PL.RK cr FORM - U - LOQ' RELEASE FORM l� INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This.does not relieve the applicant and or landowner from compliance with any applicable requirements. ' �w........■......//....... ...v■r..i.............■...■...■..........■...■..■... APPLICANT5e ,2,, PHONE ASSESSORS MAP NUMBER J LOT NUMBER U SUBDIVISION LOT NUMBER STREET /�'��/�/�c� � STREET NUMBER >12 S..■■■■■■■■■■■.■■.■.■■s....■.....■.■..■.■.■..■..■■...■.■■■■.■..■■■■■■■■■■.■.. OFFICIAL USE ONLY RECOND ENDATIONS OF TOWN AGENTS DATE APPROVED I I CONSERVATION ADMINISTRATOR DATE REJECTED COMP ENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMIvIEN"IS RECEIVED BY BUILDING INSPECTOR DATE NORTH E 0VM 0 Airidover No. a coc 'L dover, Mass., ORATED PP�\,`�� S u G n 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....40.24V .........NQ..... ........"�. I Foundation p .. ... ........ buildings on ...3............. ... .. . . Rough has permission to erect..f..�...�..�.�I . � �. ..�.�1 . ........R.................................... to be occupied as.. .... ��.r�v~/...�!Y.�. !. .orw(.)'.1.5...m.pl.y..44K.. k� 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 spection, Alteration and Construction of Buildings in the Town of North Andover. Men p 3b PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTSELECTRICAL INSPECTOR_ Rough .. . ...................................................................... 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. REGISTERED STRUCTURAL ENGINEERS MEMBER: ASCE, SEI, AISC, ACI, CSI 7� ��7� �r7�� yy��77 MASSACHUSETTS----08669 DENCO ENGINEERING, J.1MC. NEW HAMPSHIRE----01196 STRUCTURAL ENGINEERS CONNECTICUT------07487 NEW YORK---------37301 VERMONT----------02009 148 PARK STREET MAINE------------01519 NORTH READING,MASSACHUSETTS 01864 PROFESSIONAL ENGINEERING SERVICE SINCE 1958 (978)664.6733 (781)944.8440 FAX(978)664-9233 4 PROJECT: o l l_� PROJECT N0. Sc��- d� 3 17 H'LI.91L3F. (Zp, 0 , 14DOVEC BY: DATE: S - �L -® / CLIENT: A , G ft 15 W o(_D / RCN IT REVISED: REV. DATE: SUBJECT: 2-vg:�F SEAN SHEET NO. OF _ © 2001 DENCO ENGINEERING,INC. DLky �e�{j 3K '�31lacJ I) UALLEY 2�0 11SF - �34x9Z LVL R =930 _4.65D H of kf4 ff� KENNETH C O� DENNISON yG No.!3869 o STRUCTURAL .~. O � /�NAiL t� �pcation 13 No. S S Date xTOWN OF NORTH ANDOVER •• Cf, ,90 t •e ,�,ti ? 1 •• OOH F p Certificate of Occupancy $ Building/Frame Permit Fee $ �— Foundation Permit Fee $ ----- SACMUst t Fe Other Permie JZ� e Sewer Connection Fee $ —� Water Connection Fee $ -- TOTAL $ S `3/33 V v 'building inspector 25,i._1 i 4:� 6756 r+ rpr Div. Public Works PERMIT NO. uI/ r-� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 _-a- MAP h40. LOT NO. 2 RECORD OF OWNERSHIP iDATE (BOOK PAGE ZONE I SUB DIV. LOT NO. I LOCATION 30 ;Qs` e- U- PURPOSE D --Ty-,ACA�gn O U 00 JL OWNER'S NAME Cirdl�l l .res �r NO. OF STORIES SIZE OWNER'S ADDRESS ��V�a� BASEMENT OR SLAB _ ARCHITECT'S NAME V l! ! SIZE OF FLOOR TIMBERS IST 2ND 3RD ✓BUILDER'S NAME SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y�S IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY 1 IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDESC2 1 EBT. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 f SEPTIC PERMIT NO. ♦+ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY � ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEjjD ND APPROVED BY BUILDING INSPECTOR DATE FILED /l�o� R JSIGNATURE OF OWNER OR AUTHORIZED AGE N BOARD OF HEALTH F E E PLANNING BOARD PERMIT GRANTED BOARD OF SELECTMEN � P011 2 4 / / BUILDING WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BUILDING RECORD OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS 1 RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION g INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. ---III PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'T AREA _ 14 `/i 1/1 FIN. ATTIC AREA NO BMT FIRE PLACES r HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CUPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ ` 50D SHINGLES EARTH _ 'HALT SIDING HARDN'✓D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR EQUATE ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) — GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING WOOD STOVE INSTALLAHON CHECKLIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New sed B. Ty radian Circulating C. Manufacturer a VG _Lab.No. 6�6�50� oS e Name/Model No.'j O - Vis a Cellar size $ Dimensions/Height v2 `t Length -2 y `t Width 1 6" Chimney A. New Existing B. Size(flue area) _ C. Other appliances attached to flue(Number and flue size) _ None- D. Prefab(Manufacturer—name and type) _— asonry 'ned —.Flue liner I Mined type 8 manwacturerl F. Height(refer to diagrams) cap IG I 12'I hurl. aVER IC 4----T 2MIK 2 `.,I'1. 3,M1 !2 —i- MIN. HEARTH CHIMNEY HEIGHT Hearth(non-combustible) \ t a NOV 2 4 ►Oo� A. Materials B. Sub-floor construction C(2y\C-r-C-+f, Q Vn C. Minimum dimensions(refer to aiaaram) Clearances and Wail Protection(see`^�eCtall tion clea�ncestcharrtt) A. Type of wall protection provided --ttei LA I r�-011oO��CC B. Clearances(refer to diagrams) n I \ FIREPLACE C0Rr1ER WALL/CENTER. 13 advent 108 Waite Road • Boxborough, MA 01719 • (508)263-0758 home NOV 2 4 ►4Q,� ' inspections INSPECTION REPORT PAGE 2 Date: EXTERIOR—HOUSE IDENTIFICATION * SEE REMARKS i Roof ❑flat gabled ❑gambrel ❑shed ❑with dormer ❑hi D / Roof covering ❑tar& graver asphalt shingles ❑roll roofing ❑metal Flashing—chimney Elwood shingle lead ❑copper ❑aluminum ❑water& ice barrier ❑tar patch Drip edge ❑wood shin les metal t/ Soffitt areas wood ❑aluminum ❑vin I Gutters ❑wood r&luminum ❑vinyl ❑cleaning neededt' Downspouts ❑re airs needed ❑wood aluminum ❑vinyl Splashblks ❑ alvanized ❑dama ed oc ❑Plastic ❑concrete I Underground leaders ❑ PVC ❑cast iron ❑orangeberg breakout area ❑normal ❑unknown Chimney(s) ©brick ❑stone ❑metal ❑concrete mason units �' Vents (plumbing) ,U PVC ❑cast iron ❑copper Siding ❑wood clapboards ❑wood shingle pressed board _ ❑aluminum ❑vinyl ❑asbestos ❑brick 4,4 1 ❑stone ❑other "[M:�,J clearance to soil normal Foundation ❑stone ❑masonry block ❑brick JZJ poured concrete ❑piers ❑wood post a normal shrinka e cracks Remarks 11A i I C.EYh t' 000-ea 108 Waite Road • Boxborough, MA 01719 • (508) 263-0758 dvent i home / inspections INSPECTION REPORT PAGE 6 Date: NTERIOR—CELLAR IDENTIFICATION SEE SEE REMARKS Wood damage ❑rot t:.!insect damage AT: ❑posts ❑stair bottom ❑windowsills ❑door sills A k ❑partitions 12 other Chimney brick ❑masonry block ❑stone ❑metal ❑ v needs pointing oors to garage metal-clad one side❑auto-closer❑step down 4" minimum Doors to bulkhead ❑solid core ❑hollow core ❑insulating door ❑weather stripped NA ulkhead ❑metal 11 wood � entilation El windows ❑dehumidifiers ❑crawl space vents ❑air-to-air heat exchan er®dehumidifiers recommended Insulation ❑sill areas joists walls 1 � 9 fiberglass El foam thickness: 3 1(l /) ,ELECTRICAL—UTILITY AREA Entry Cable ❑aluminum Q copper v Main fusing ❑pull-fuse -9breaker ❑switch ❑remote disconnect ervice amperage a ❑60 J2 100 1:1150 ❑200 1:1400 Service voltage 120 U240 Access location ❑ arae basement El other c. POvercurrent protection ❑fuses ❑nontam rinq fuses breakers GFI 4-1 'Main ground v buried El-water pipe El well casing kSub-panel ❑additional circuitsI� ❑drver ❑water heater Panel wiring wires compatible with overcurrent devices 'Elfeed-thru connectors ❑other wiring Distribution wiring romex ❑bx ❑knob& tube unction boxes covered recommend electrical repairs ,Remarks )v� z ^ rmS i�)Y\ l� C IJ , i v dvent 108 Waite Road • Boxborough, MA 01719 • (508)263-0758 home inspections INSPECTION REPORT PAGE 10 f at: Date: LIVING AREAS IDENTIFICATION SEE REMARKS Walls ❑ laster skim coat ❑d wall wood ❑ anel Ceilings Zlaster sk Floor/tile im coat ❑drvwall )A and ❑acoustic v Floors thin-set ❑mud-set Stairs hardwood Elsoftwo(:)TLJ carpet O vin l u Doors ❑railin s visually normal 11newel Posts visually normal yam, raised panel ❑flush veneer t^!solid core ❑hollow core metal ❑com osite L� Windows wood ❑ metal _0 doublehung 'U.casement ❑ awnina ❑tilt sash h� Structural ❑ma'or settlin ❑minor settling— Water signs ❑recent 10 probable ice dams condensation ❑leaks Fireplace ❑brick ❑stone ❑metal ❑heat exchanger needs grout repairs Damper ❑external control internal control ❑damper inoperative ❑hardware missing Location throat ❑chimne ca Chimney ❑cleaninq recommended L Remarks Lenlej < ON C- 1 4 dvent 108 Waite Road • Boxborough, MA 01719 • (508)263-0758 , home inspections INSPECTION REPORT PAGE 11 at. Date: ATTIC IDENTIFICATION SEE REMARKS Access ❑walk-up ull-down stairs ❑scuttle ❑alcove L Structure Qraftersa, ,joists:,;� collarties�, _ sheathin : L Chimney 0 brickl0concrele block ❑metal ❑ grouting repairs needed Plumbing vent ❑cast iron n PVCcopper ❑galvanized Leak signs Location: Ice dam signs Location: Condensation signs 9 Location: A4Ventilation y� 12 soffit Ogable ❑ridge ❑roof box ❑motorized fan n❑additional ventilation needed�soffits obscured . lel baffles needed ENERGY SYSTEMS Attic insulationfiber lass g ❑rock wool ❑cellulose Approx.thickness: ❑ureaformild hide visuallv noticeable Attic alcove insulation ❑fiber lass g ❑rock wool ❑cellulose Approx.thickness: 11ureaformild hide visual) noticeable Exterior wall insulation fiberglass g ❑rock wool ❑cellulose Approx.thickness. Floor ureaformild hide visual) noticeable insulation ❑fiberglass ❑rock wool ❑cellulose Approx.thickness: ❑ureaformild hide visually noticeable Remarks ,01 November 22, 1993 Mr. Wally Cahill Building Inspector Division of Planning & Community Development Town of North Andover 120 Main Street North Andover , MA 01845 Dear Mr. Cahill: Per our recent discussions, I am interested in gaining your approval for the installation of a wood stove at my home at 317 Hillside Road. Enclosed for your review is a copy of the home inspector's report as it applies to the chimney, a copy of the business card of the installer, the completed application and the application fee. My wife, Jennifer, or myself are available to meet you to complete an inspection on Saturdays, weekdays after 4 pm or during a weekday by prior arrangement. During the day, I can be reached at 617-935-8000. Should you have specific questions regarding the installation you may contact Bernard & Sons at 508-774-6024. Thank you for your assistance. Sincerely, NOV 2 4 Igg3 Ernest N. Agresti, Jr. (508)774-6024 ARTHUR BERNARD & SONS ' CARPENTERS& BUILDERS KITCHENS-ADDITIONS REMODELING CUSTOM FINISH WORK 115 Locust Street Fully Insured Danvers, Ma 01923 and Licensed 1 MORT�ACi� 0 L 4T' $ p s A-- THIS t_ �f THE EFOPLAIS ALATHE O FS A TAPE SURVEY 1!104 AN r,NSTF�USWENT SUR!"M O 68 TO r3£USED FOR MO''STAOE Ili ONLY. v THEREFORE.THE OFFSET AS SHOWM SHOULD NOT BE USED TO ESTABL13H 9 ACtf'£iQPY!,NEB. f E55�X COUNTY I GEED REFERENCE; PLAN R,EFE,RENICE; PPLANOF LAN Date. NpRTM TOWN OF NORTH ANDOVER a • PERMIT FOR PLUMBING a i • SSA�NUS This certifies that . . . . . . . -. . . . . . . . -r �-- -�-<J . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . at. .`-'?/ . . . .!`.-�J� . . . . . . . . .. North Andover, Mass. ` Fee.? .0. .Lic. No.1.pp,�4.e . . . . . . . . . . . . . GPLUM& SPECTOR Check # 5203 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) tm —4 Mass. Date Permit # a!9 Building Location cs Owner's Name 5 pe Type of Occupancy 2t 5 DEN tl r=�t_ New ❑ Renovation ❑ Replacement t!d' Plans Submitted: Yes❑ No ❑ FIXTURES 2 2 N N to 0 Z Z W h- Vf J Y o -4 N O W ¢ a F' N N 2 N Q ¢ ¢ Z_ ¢ NLL = Z = a F- J H W 0 N S F U W N Y ¢ a C7 Q a a X_ VZ ¢ 0N W >' a H N Z G a N ¢ a ¢ O Y. N N ¢ J 0 O W = L S 3 3W cc Z S Y a 0 F a Z Q W LL Y W h V > t O = a = N F' Z O 0 0 = Z W F' O 0 S = m 0 a Q O a J J a ¢ ac a a 0 < I h Y J m N D O J 3 Y r- N li t7 O O Q S ¢ 'm O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR/ 1rplalling.Company Name MM,4TAe[0 Check one: Certificate Address �� ? C:A C H(nA&) 4,AJ ❑ Corporation IY) E l NI' n1 Al A01,�c,l�/ ❑ Partnership ^ Business Telephone 1 2- rm/Co. Name of Licensed Plumber r,3 F,,-a T ftp �A,�yIrM�9 rr-4� INSURANCE COVERAGE: I have a current f bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' If you have checked,Yees. please /indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner El Agent C1Signature of Owner or Owner's 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 ormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum g e andapter of the eral laws. By re of licensed Plunuml Title Type of license: Master % Journeyman ❑ City/'Town APhXNEffT0_F_F1_C_E_UTEONL License Number �3 3`5 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR