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HomeMy WebLinkAboutMiscellaneous - 38 BRIGHTWOOD AVENUE 4/30/2018 (2)im M tlLv 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 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 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the 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. "Sir 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: -5 f 1 4– — / 7" *** No e: �ermit Extension Act–Permit/Date Closed: �� ��'' Reapply for new permit ie Date..�..- -7 .v . 4�4' ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that'....'!-?'�- ........................ ......................................................... v has permission to perform ................................................ ............. wiring in the building of . rr.................................................... at-7?J ...... n'North Andover, Mass. WS Fee...................... Lic. No;�— U..................................................: Check# 8221 �omnwnweaGtk o ///asdachu�e Official Use Only Permit No. O a, aC.JePartmeni o��ira �ervicad 6'ccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev; 1'/07j ._ (leavebiank) APPLICATION FOR PERMIT TO PERFORM -ELECTRICAL WORK All work.to be performed in :accordance with the Massachusetts Electrical Code (NfEC), 527 C 12.00 (PLEASE PRIVT IN INK OR TYPE ALL LVORA TION) Date: City or Town of:J ff? To the Inspector of Wires: By this application the undersigned gives notice of his or•. r intention to perform the electrical work described below. Location (Street & Number) Z, j �li'�/C/✓ Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:. - YesX No U (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No, of Meters Cmmnletfon of the followine table may be waived by the Inspector of Wires. No. ofltecessecl 1_,�:rnr.r:;zr•es Idc. of Cert. ;Srrs r addle Fans I • �' No. of Total :.r"Insfcirnrers YYf1 Na of J.,ur©uticfs No. oflfot'fuhs � � � (rcrrcrators -- - - - - - — ---- ---- — - =Abo, c - 7n---=�,u Swirnrning PDOI ❑ 01 PA No. of i,uniivair•es 'I -EI . rnd. _JBaffo y Unit's No. of Receptacle Outlets a No. of Oil Burners. '. FIRE ALARMS No. of Zones ° No. of Switches No. of Gas Burners o. of Detection and -Initiating Devices No. of Ranges No. of Air Cond. To yl No. of Alerting Devices eat Pump um er ons No..of e - ontame No. of Waste Disposers Totals: Detectfon/Alertin Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ i unicipal ❑ Other Connection Heating Appliances IOW Security Systems:. Equivalent No. of Dryers No. of Devices or No.- of Water Heaters I{W o. o o. o Slas Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP e ecommumcat�ons u ingg: No. of Devices or E uivalent OTHER: �.. _a _��:.. ,.� ,I- ..;7 :f,l.. .,,J ..,� h,..l.a !.. orinr• of Wires. -- /1{{U{:7{ IJf{QIIrU/Wr ucwas y awau ca., yr w r cal uu cu uy .rrc amr.w.-• � . - --- Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with I\1EC 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 DQ BOND [IOTHER ❑ (Specify:) I certify, under the pains and penalties of periurY, that the information on this application is true and complete. FIRM NAME: 3 LIC. NO.: Licensee: Signature LIC.NO.:f (If applicable, enter "exem t" in the licznse nwnber line.) Bus. Tel. No.- id Address: v Alt. Tel. No.: ia *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 ❑ ownerIsagent Owner/Agent Telephone No. PUMT FEE: S =� Signature , / 7 D -22=- Af bi ct Po w P %3 m Date. 7--/ . G. j1.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... J... .... /.. ... ...... ............. . has permission to perform .....�.. .. ? ... �.............. plumbing in the buildings of . ..It ......................... at .. 3.b .. (; t cr ( i` u c d .............. North Andover, Mass. Fee .... Lic. No.. .. .......C! ....J. �.... . ,6C PLUMBING INSPECTOR Check H 5;'20 MASSACHUSETTS UNIFORM APPLICA (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Owners N of New ri Renovation rl Replacement FOR PERMIT TO DO PLUMBING Date 6s Y Permit # S~% Zo Amount A C Plans Submitted Yes ❑ No ❑ (Print or type) / Check one: Installing Company Name W1114 +P c� � Corp. r) F i f Address Partner. Firm/Co. Certificate Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ 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 ipg a ationerformed u er Permit Issu d for this application will be in compliance with all pertinent provisions of the Massa u tts St Plu bing Cbhe and Chapt 142 of PvGeneral Laws. BY i a u icense um er Type of Plumbing License Title City/Town icense um er Master 13" Journeyman ❑ APPROVED (OFFICE USE ONLY i it Date .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................................................ . .......................... has permission to perform .................................. wiring in the building of ............lc � .... /.................................................. - 1241 at ......... ..... .. . I ..,-.e .. �orth Andover, Mass. ....... . ............ ........ I ....... Fee............ Lic. No. ............................... ................... Check # 6 7/a (((/// ELECMICAL INSPECTOR Su33 ?moo`' emmd?ZZUSww 67 v Dy eut 4 P06& Satiety BOARD OF FIRE PREVENTION REGUL APPLICATION FOR PERMIT All work to be performed in accordance W (Please Print in ink or type all information) Town of North Andover Official Use Only Permit No. JZQ�s Occupancy & Fee Checked. ONS 527 CMR 12:00 ERFORM ELECTRICAL WORK The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number 3 8 ' ✓ r 1 b C�p D Owner or Tenant Y'c V 1 to 6 60Jt1 Owner's Address 3 & l✓ r t Q �1, 4.� bb �, Rut, Electrical Code 527 CMR 12:00 Date 2" Z y D 7 To the Inspector of Wires: Is this permit in conjunction with a building permit Yes )W- No 0 (Check Appropriate Box) Purpose of Building Ki % cA,� Utility Authorization No. Existing Service Zbb Amps 12-a—Vvir, Voits New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work KI Overhead 00— Undgmd 0 No. of Meters Overhead 0 Undgrnd 0 No. of Meters — IS e �� Total No. of Lighting Outlets 7 N No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fbitures Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting r No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices i Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremgn6ts of Massachusetts General Laws ` I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO valid proof of same to the Office YES = NO - If you have checked YES please indicate th a of coverage by checking the appropriate box. INSURANCE BOND - OTHER - (Please Specify) __69 (Expiration Date) Estimated Value of. Electrical Work$�� b 6 Work to Start 2 . ? q.ay Inspection Date Resquested Rough Z D N Final Signed under t Pprnatties of -De rjury: r FIRM NAME i t.'G G S -a r to 1 Q LIC. NO. t Z N"AR L,%,ev-ti_ Q%Ct NO. 12.310-1 J2 i' BOXY 1210 �i'/k�slJsl1J H Lei No. v (oa3 " 0i24- 3c3J Address d3 No. lee • OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) � �l Telephone No. PERMIT FEE $ �, (Signature of Owner or Agent) 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. 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: Address City: Phone* Insurance Co. Policy # Company name: Address c Y Citv: 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 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 hue and correct. Signature Date Print name Phone #. 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 m ❑ Licensing Board ❑ Selectman's Office Contactperson: Phone #' ` ' ' _ ❑ • -'Health -Department r. ❑. Other. FORM WORKMAN'S COMPENSATION ' ` • Location 3 4B -eRt�r 14 ft)oyD Az,,k No. ly 18 c-:P- Date 13 0 "ORT" TOWN OF NORTH ANDOVER S Certificate of Occupancy $ f''•°' ACMUS E Building/Frame Permit Fee $ s T Foundation Permit Fee $ Other Permit Fee $ TOTAL $ / Check # J q' 17 V 6 2 i!f--- - Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: 49 B ' din Commissioner/IREMtor dBuildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3 � 51✓ 1(H -r oxy+J 911 Q Nomti�f ,oak/m- Map Number Parcel Number 1.3 Zoning Information:/l 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rapired Provided RecMired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record WV(P C M12 3 �6 Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Nair a Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ra/wi�p ,� l j"�r� � yo lu ) Licensed Construction Supervisor: C,, 060.5 3 License Number 6 IQ 6 ! A'a' 1IO(p � Z06 I Address In --276— 3230 7,15 00 Expiration Dat Signa�t rci Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ D 31(,,N I V-�. i 10 'i ? 1 Company Name Registration Number IG 1Z6 I Zoa9�Z' 1i,)tq M4 Address Z•7/- 3 z 3� Expiration bate Signaturj Telephone i SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the builong permit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check all applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) X Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: kMV6")(5- W t(ti MOP T s WU'1 6 (w� (d%N g N AQVi; OW R ewnwG) 1n1 n4z ftp � E=z . 6t 1. oj5- .(" Smit SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant licant1. OFFICiALf USE t3�ILY , 1. Building - Q R (a) Building Permit Fee Multiplier 2 Electrical r, O (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) �D 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My e alf, in all matters ryli4tivf to work a4torized this building permit application. <gnh5re of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMMERS 1 2 3 SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DEMENSIONS 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 Sao 0 z W i 7 3 :moo me e 00 h •+ C O CJ V •O. C CD : aR R o A Q L N ID Ea ` D c o a N E� CD C, in : O c m � m = N cm Ncm CL Ce O �� is �:mo zz o cm �►CM r N p, Ca 7 C=2 � tai N O O :000 C=,c. c Q o imc .o O Z �... c � •y dZ R C Z CCD; Q*ui C3 CD F cm L3 cm 0 o V� a ®� 42 O C b- CL 0 C3 O ZCDCL O y O! CO3 O MA c CO m a- I- = }r 3 a� � 0 0 ® a cc _ a 0- cmQ CO2. C oCIO w J� CL. o }; CO2 ts C CD CL C.3 h � C C C cc a 0 °o ° w cd ° �° a w C2o (3) co w x o w' ca. z CO U) o cn 3 :moo me e 00 h •+ C O CJ V •O. C CD : aR R o A Q L N ID Ea ` D c o a N E� CD C, in : O c m � m = N cm Ncm CL Ce O �� is �:mo zz o cm �►CM r N p, Ca 7 C=2 � tai N O O :000 C=,c. c Q o imc .o O Z �... c � •y dZ R C Z CCD; Q*ui C3 CD F cm L3 cm 0 o V� a ®� 42 O C b- CL 0 C3 O ZCDCL O y O! CO3 O MA c CO m a- I- = }r 3 a� � 0 0 ® a cc _ a 0- cmQ CO2. C oCIO w J� CL. o }; CO2 ts C CD CL C.3 h � C C C cc a J IV j UVv ��� aI2 � .SZC RRD.S3�do _PA NT RY .ARCH ClAAU - Nj. :a ---- cr.. P�ORC H -' ,� �� . 'f- A b� ep- DM NG IWOM IM N %A4 cr AXA 44 Che 4) ,4 s�vd z Note: This drawing is an artistic Lllcsignod: 11/5/200 interpretation of the general appearance of - Printed: 1 1/5/2003 the design. It is not meant to be an exact rendition. 17 kwvn N: I � 7 ✓ize '�arn�rnanue�� a�.%l�{�d�.a,�-�u;kC( BOARD OF BUILDING REGULATIONS _icense: CONSTRUCTION SUPERVISOR . Number -:QS �. 080539 Bfrtthwaft �E#965 ;i Expires 2/0512006 Tr. no. 80539' j ' Restricted: 00 KEVIN P HARRINGTON / 21 LINCOLN ST ANDOVER, MA 01810 Administrator i ynV4pF.lR kns 1 Ne Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 110479 Type: Private Corporation Expiration: 10/20/2004 DESIGNING KITCHENS INC RAYMOND BADMAN 246 MAIN ST. N. READING; MA 01864 0 �, r Update Address and return card. Mark reason for change. —' A ddre�S...', Renewal Employment Lost Card North Andover Building Department Tel: 978-688-9545 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 c11,S150A. The debris will be disposed of in: (Location of Facility) Signatur I of Permit Applicant 2�ta�pc� -� Date NOTE: 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 Department of Industrial Accidents Office of Investigations Boston, Mass. 02919 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone 7 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F1 I am an employer providing. workers' compensation for my employees working on this job. Company name: Address ,r�A City: f+� < tliUt. 1 ° — Phone #. - 71 q l W Z, A -S-03 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 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 pen ties of perjury that the information provKW above is true and correct Signature Date 2J, 1310 Print nametill) Phone # 779 —340— 6A Official use only do not write in this area to be completed by city or town official' El Building Dept OCheck if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone #: E] Health Department 0 Other FORM WORKMAN'S COMPENSATION 4 0 a a Location No. Date N o TOWN OF NORTH ANDOVER Certificate of Occupancy $ sJ�CHU Building/Frame Permit Fee $ Foundation Permit Fee $ s Other Permit Fee $ TOTAL $ Check # 1� S 5 1 > 0 % Building Insp for v C- TF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING O BUILDING PERMIT NUMBER: s / DATE ISSUED: SIGNATURE: zow`C Building Commissionerff for of Buildings Date NJKUIIUN 1- SITE INFORMATION 1.1 Property Address: � �� NEUIION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT 1.2 Assessors Map and Parcel Map Number Number: a Parcel Number � 2.1 Owner of Record 1.3 Zoning information: Zonin District Pr6posed Use 1.4 Property Dimensions: /3L -7 Lot 4ea s Frontage ft 1.6 BUILDING SETBACKS ft getG'1nT `J la %4'IJLJ Front Yard Side Yard Name (Print) Rear Yard Required Provide Required Provided Required Provided 7 1.7 Water Supply M.G.1—C.40. 54) 13. Public ❑ Private ❑ Zone Flood Zone Information: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ NEUIION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT � 2.1 Owner of Record II getG'1nT `J la %4'IJLJ Name (Print) Address for Servic : lgnatu Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 'Licensecf Construction Supervisor: a�3/ -71 OR License Number Address Si nature, Telephone �0 Expir ion DAte 32 Registered Holme Improvement Contractoor-( Not Applicable 0 R6 tick deers 1 C:rAJ 3 7 Company Name Registration Number Adr Ad res 2 g Expiration DA Si ture Telephone I SECTION 4 - WORKERS COMPENSATION (11LG.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 Les .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work (J A -Ja Ploor A �. �V L) I SECTION 6 - ESTIhRATED CONSTRUCTION COSTS I Item 1. Building Estimated Cost (Dollar) to be� Completed b permit applicant O -? oil O A = �. ..;, . _., (a) Building Permit Fee Multiplier* � ;' ' 1_ 6.50 2 Electrical -(b) Estimated Total Cost of Construction %/ n ' 3 Plumbing , .� 0 Building Permit fee (a) X (b) 4 Mechanical,(HVAC 5 Fire Protection 6 l otai (1+2+3+4-!,',, 1 Check Nuinber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �/ I, / ` oi-,> e+J 6 O 0 J as Owner/Authorized Agent of subject property Hereby authorize ) to act on My behalf, in all s relative to wqrk authoriWd author'by this building pennit application. t f D -o i Signature of Own Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1p a AVAJj,A- J A As Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true.and accurate, to the best of my knowledge and belief Print iQnature of Owner/A&me / Date /0- dj— o 5 r FORM U .-LOT RELEASE FORM �` � oa 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*********************** APPLICANT_�.�Ce 'A C� PHONE -&13-4.7J-6 LOCATION: Assessor's Map Number ` PARCEL c;2 SUBDIVISION LOT (S) STREET ­9 2L si ---' ST. NUMBER 3.f **********OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: uuNstHvA 11UN ADMINISTRATOR COMMENTS DATE APPROVED DATE REJECTED TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 im TE North Andover Building Department Tel: 978-688-9545 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 c11,S150A. The debris will be disposed of in: 1z i t e)0 AJ (Loc t of na of Facility) Signature of Permit Applicant -/-,o L___ Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Name: City Phone f—'1 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity [21`am an employer providing workers' compensation for my employees working on this job. I d -Hoy lAev?S +- I�rCi; Address : (3( i2!r�n t , )e -y) , G4 -1l t- City AA)- L)f.2 A4Phone#: 5�7k---6 "a-3�:SQ Insurance Co..cmet Apaepxti k Policy # e51 P5! 13 /0 2=7 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 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. 1 do herby certify underjoe pains and penalties of perjury that the information provided above is true and correct. Signatu Date //-/ —ol Print name / �i vY/?LCK�4 �ra/�Pda/l �c� Phone#.?zV-6Sa-2srj, 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 ❑ Selectman's Office Contact person: Phone #.• ❑ Health Department Other FORM WORKMAN'S COMPENSATION MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 TITLE: PLAN NO 5766 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 8-5-2001 DATE OF PLANS: 8-5-01 PROJECT INFORMATION: SECOND FLOOR ADDITION TO EXISTING HOUSE BEDROOMS BATH ROOM LAUNDRY ROOM COMPANY INFORMATION: BRUNO ASOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 COMPLIANCE: Passes Permit # Checked by/Date Maximum UA = 155 Your Home = 115 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 220 30.0 0.0 8 WALLS: Wood Frame, 16" O.C. 1020 13.0 0.0 84 GLAZING: Windows or Doors 70 0.330 23 HVAC EQUIPMENT: Furnace, 87.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. i Builder/Designer Date Z--r—ty TITLE: PLAN NO 5766 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 8-5-2001 CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.33 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location HVAC EQUIPMENT: 1. Furnace, 87.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: t [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual 1 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 I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified 1 in Sections 780CMR 1310 and J4.4. I � I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I HVAC PIPING INSULATION: [ l I HVAC piping conveying fluids above 120 F or chilled fluids 1 below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) . 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 1 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 PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 1 140-160 0.5 I 0.5 1.0 1.5 1 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- /e iOosnfira#efofs{sk _x 8 KID of0 License CoF fth ° ` —0 Numbfrr� 'i73 }� �� 0112i1�bO�,:a fr: nos 13938 Resiricted Tbt,.0� FXfEDERICK APio xALAO � � z `.y ����� IIAA 'iY!!!45 Adtti'linisbattYr � f --i j Vit' /I 'q .l�P. V/Ol)L)IF09tIIiCllAi� O/... /�dJOCi1tIJP.ad Uqy�\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 123349 Expiration: 02/03/2003 Type: DBA PRO -BUILDERS & DESfGN CO FREDRICK PAPPALAROO 71 BRIGHTWOOD AVE_N N. 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