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HomeMy WebLinkAboutMiscellaneous - 40 RIDGE WAY 4/30/2018 r40 RIDGE WAY 210/098.6-0072-0000.0 j i Date....�............�r........5....... V,►ORT#f TOWN OF NORTH ANDOVER _ 9 PERMIT FOR WIRING s`4ACMU5� This certifies that C- L .......................................................................................................................... has permission to perform ..,.� .� � ..tJ 1 `� �� � wiring in the building of.......J./•.............................................., ........................................... at ............... �...... ?..........................................NordiUdover,Mass. v Fee��U...`.............Lic.No. .. +t ............. ELECTRICAL INSPECTOR Check# r f 250 5 f. - (L11\ Commonwealth of Massachusetts Official Use Only a 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2 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) Owner or Tenant jTelephone No. Owner's Address Is this permit in conjunZZLF,1, h a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building E 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: g)/le—c j44!-,E 0,� aw6yv�' Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA J No.of Luminaire Outlets No.of Hot Tubs Generators / KVA IS No.of Luminaires Swimming Pool Above [jIn- El o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Gas Burners No.of Detection and No.of Switches j/ Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Dis osers Heat Pump Number Tons J.KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S P g ace/Area Heating KW Local F1 Connection Connection ❑ Other SystemNo.of Dryers Heating Appliances KW Security Devices Y No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivalent OTHER: -766x. Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: t/1Z-t5 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 covera in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA=NCE 2 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains anipenalties of perjury,tlzat the informatio n this application is true and complete. t" FIRM NAME: . �- Gt LIC.NO.-At6 ? Licensee: Corr Signature LIC.NO.:C7v-7$5�f (Ifapplicable,enter `exVPt"in the 11 ense umbejr me) Bus.Tel.No.•41W 3PZ 92e Address: /O /V I-;!FA0 XzW5e-,L,-, 'I'dd14 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. 1 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 A 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. ❑ 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 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: i Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: K Date: /i 041--5-- FINAL INSPE ION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com t 14 4 jhe Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 "' d Boston,HA 02114-2017 0 o�< www mass.gov/dia a�M Sy�v ' Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMCTTING AUTHORITY Please Print Le 'bl A ' licant Information Name(Business/Organization/Individual)' Address- City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required); yto em ees frill and/or part-time).* 7. ❑NeVv'donstrubtlon 1• aemployerwith_� p 2.❑I am a sole proprietor or partnership and have no employees Working forme in 8. odeliilg any capacity.(No workers'comp.insurance required.] 9. Demolition 3.0 lam a homeowner doing all work myself.(No workers'comp.insurance required.] 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.E]Electrical repaixs or additions ensure that all contractors either have workers'compensation insurance or are sole i, loyees. l2.`,•��".Plu`trlbzng repairs or additions proprietors with no emp 5.❑I am a general contractor I have hired the sub-contractors listed on the attached sheet. 13.Fj goof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.[]Other 6.❑We are a corporation and its.officers have exercised their right of exemption per MGL c. 152,§1(4),and ive have no employees.[No workers'comp.insurance required.] t .*Arty applicant that check§box i#1 must also fill out the section below showing their workers'compensation policy information. fi Homeowners who submit,box mst attached. additional are aheoing all work pd then et showing the name of the sub-contractors and state wheth hire outside contractors must submit ar or affidavit those.pntities,have such. tContractors that check ibi employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. f am an employer'that is providingworkers'compensation insurance for my employees. Below is the policy and job site information. / /. ( 4 Insurance Company Name: Expiration Date: �" Policy#or Self-ins.Lie.#: City/State/Zip: Job Site Address: rs' co Attach a copy of the svoxkempensation policy declaration page(showing the policy number and expiration date). olation punishable by a&b up to$1' 500.00 Failure to secure coverage as required a d ivy enaltiesZinthe form of a25A is a aSSTOP nal LWORK ORDER and a fine of up to $250.00 a and/or one-year imprisonment,as well p day against the violator.A copy of this statement may be forwarded to the Office of Xnvestigdtions of the DIA.for insurance coverage verification. c v hereby certify n r the ains"a peva es ofperjury that the information provided above is true and correct. _ ate: Si ature: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town' Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their en'iployees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of here, express or implied,oral or written." An employer is defriied 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 receivefor 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 b6 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 applicarit-who has not produced-acceptable evidence of compliance with the insurance coverage xequi'red" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contact for the performance of public work until acceptable evidence of compliance with the insurance r requirements ofthis 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'contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Viability 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"fob 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-MASS.AFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia ' '>GOMMONWEALTH OF MA$SAIit1SE:TT:S;,;< ;; ' • • E`L.ECTR`lCIANS...—. ISSU ES .T.:HE FOLL OWING<'L:'I'CN S E AS:<'A €t1 G' J`I7URNE:YMA:N:::; LECTR..."�< r ?w.;. C:UFTti' FORBES NORTH`"` END 'R`O J 'r Ow C' 8 ,f<;:;:<t>< .,:. 01469-1 125 ':::COMMONWEALTH OF MISSAL HUS s E`1:ECTR'I'C .. UES TH.E<;:.F..,:OLLOWING R LjS ... E13 MAS;T...ER E:fl' U„ F01ABES ELECTR-I C T- 10 10 -NORT .., s :r7OWN-SEISD M,A>.01469--1125 16 44 GENERATOR APPLICATION DATE: LOCATION: "7U Plo6c- �JA"L/ OWNERS NAME: <T�R�/C.� CiqICO�/�.: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: I Ay"NM/fKF(AD PHONE NUMBER: ELECTRICALAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVA GI.�� Z3` Date.... .......... OF NOgT�y,h TOWN OF NORTH ANDOVER PERMIT FOR WIRING s,CHU Thiscertifies that ................. ........ 46 .................................................................... .... .... .............. has permission to perfori-n-AlAd kllnem................. .......r wiring in the building of..0 ............. .................................................................... at ce— . ................�/........................................North Andover,Mass.. 2 -3S6-V Fee..../0...................Lic.No. .... ......... ........................... ELECTRICAL INSPECTOR Check it fir Commonwealth of Massachusetts official UsOnly a Department of Fire Services Permit No. 122 I ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH.ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Q Owner or Tenantai / Telephone No. .1 NOwner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) -- Purpose of Building;' ho � ,-e Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters 3 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters r Number of Feeders and Ampacity M Location and Nature of Proposed Electrical Work: j,Q� ,r �12 Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- [j No.of EmergencyLighting rnd. grnd. Battery Units No.of Receptacle Outlets It No.of Oil Burners FIRE ALARMS I No, of Zones No.of Switches No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.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 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 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:) Icertify,under the p ins and enalties ofperjury,thattlte information this application is true and complete. FIRM NAME: LIC.NO.:, Licensee: Signatur LTC.NO.: (If applicable,enter "exe t"in the license imb r line) Bus.Tel.No.4TV'102 Address: % &! p/-- . —�,!/1 z1 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"Li nse: 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 rE1ZMIT 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 t 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. ❑ 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($.) ❑ Inspectors Comments: r Inspectors Signature: Date: SERVICE INSPECTION: Pass❑' Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INCTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INS CTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: on 4 Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com e Commonwealth of Massachusetts ^. Department of Industrial Accidents M X Congress Street,Suite 100 021142017 -- Boston,MA ^~yV q�r www mass.gov/dia 7Al S� Workers'Compensation Insuraned Affidavit:Builder/Contractors/Electricians/�lnmbers. TO BE FILED WITH THE PEg'�UTTG. UIlVTHORWTY- Please Print Le bl A ' licant Information Name(Business/6,gariization/tndi°idual): Address: , �9 #: city/state/Zip: Phone �' RYA•1 . aired - eck t e appropriate box: Type of project(req ) er?Ch .. Are you an employer? . Ar P y " 1 am a employer with employees(full and/or part-time).* 7. ❑N6w'constr6dfion ltemodelllig 2. I am a sole proprietor or partnership and have no employees working for me in $. any capacity.[Noworkers'comp.insurance required.] 9. Demolition o workers'comp.insurance required.]t 10❑Building addition 3.E]I am a homeowner doing all workmysel£CN and will 4.[I I am a homeowner l be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additig�s ensure that all contractors either have workers'compensation insurance or are sole 12_'. .Pliunbing repairs or additions " proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11[j Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other 6.[IWe are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have no employees:[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: i Homeowners who submit•this aWavi idicating they are n additional doingshowing the all work andname of the sub contractoen hire outside rs and state whethers must subn-dt a r or not fhosent tieindicating ve such. tContractors that check this box must attache. employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. employer that is providing-workers'compensation insurance for'my employees. Below is the policy and job site Taman . information. Insurance Company Name:—Jj—Y—/ Expiration Date: Policy#or Self-ins.Lic.#: U City/State/Zip: Job Site Address: declara on age(showing the policy number and expiration date). Of the workers' compensat' policy p 1500.00 Chaco ab to$ , Attach COPY able b a fin ' tion punishable y p Failure to secure coverage as required under MGL c.152,§2 A is a criminal viola p and/or one-year imprisonment,as well as civil penalties forwarded to the the form office o Inveeof a STOP WORK sttigations of the DIA for ins2uranER and a fma of up to e e a day against the Ilator.A copy of this statement maycoverage vers on• U er t'a anis andpenalties �uty-tliat the information provided above is true and correct. X do hereby tify p Date: Si atur Phone#: Official use only. Do not write in this area,to be completed by city or town official permit/License# City or Town- Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: �l f �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 ofthis 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 numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If anLLC 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 wokkers' 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 thai must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"fob Site Address"the applicant shouldwrite"all locations in (cityor town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia 4 fiOMMONWEALTH OF MALS, iI SET :CTi2'f C I`ANS �< SUES TH;E..:..F>OLLOW I NG L 11 E'N51 `'. }>r RE ;I 'T RE<3 MASTER;;;;,E,VECT RBES ELECTRIC BURT Lcn 10 NORTH'>: `NTI 01469-1 125::;:: b411 'S 16 44 COMMONWEALTH OF MiSSACIiUSE; Y • • -• • ;.BOARD OF ELLE R'"1 C I'A N;S;::;>:>;<<;•>� :,:>: I SSUE,S.::T. E FOLLOW I NG>"'t l'C` # NSE AS.:<>' 1< R£G' JOURNE:yMR;N: ELEClR' . .. .., %F,.%�:.�;•'.�a �,�I , 6C Z ::C;URTQf :VFORBES •J!. lei � 10 s` f N W. RTH"�` +��. � '�!i' ::: Qin'%:• k. `Tt7:WNSE'ND '"1A 01469-112X. 3j854 , >> 'f"'p31:/ 7i : > <r,;:::9936 9 - - - Date....... of NOR7Fr,�O TOWN OFMORTH ANDOVER PERMIT FOR PLUMBING CH This certifies that........4w.w. .}.............4 ?u-'' .............................................. has permission to perform..... .... ....... ........................................ plumbingin the buildings of............................................................................................. at...... 0.....�t. t ................ rth Andover, Mass. Fee . ....Lic. No.I........ .�a... .......... ...................................... L LUMBING INSPECTOR Check# Date.....l -.�.l.w......� �......... ! ORt N M F 4 O .■e . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION •�4 CHU t� j Ilk -� Pit LC.��- This certifies that ....SGA!.uw!4+�..................................................................................... has permission for gas installation ..... .�.. ,,, -.-................ inthe buildings of................................................................................................................... at..... ... 7c. .�................................................... North Andover, Mass. Fee-' ?.' .... No. .../.4.! F.. � ......... ........... ......... ............................... �GASIN�PECTOR Check# r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK A� MA DATE faPE CITY J � ._ t OBSITEADDRESS .�C��. OWNER'S NAME GOWNER ADDRESS :TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL EDUCATIONAL � RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:' , PLANS SUBMITTED: YES NO APPLIANCES-1 FLOORS BSM 1 2 3 4 5 7 .._6. 7 8._.. . 9.._. 10_ �_�. .; 12 13 14 BOILER BOOSTER =; 3 CONVERSION BURNER E COOK STOVE DIRECT VENT HEATER --- DRYER FIREPLACE FRYOLATOR FURNACE _ GENERATOR ry GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT µ 1. _ OVEN POOL HEATER ROOM 1 SPACE HEATER m ROOF TOP UNIT 5` TEST . _. UNIT HEATER UNVENTED ROOM HEATER ' WATER HEATER OTHER f � I INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESjII NO ` .... I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICX OTHER TYPE INDEMNITY W.y,' BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER i,, ; AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co lianc A all Pertinent pr ision of the Massachusetts State Plumbing Coodde'and Chapter 142/ooff the General Laws. PLUMBER GASFITTER NAMEC.U�����r .! .. / �% LICENSE#/ w SIGNATURE M MGF JP' JGF LPGI CORPORATIONX# (—J� PARTNERSHIP, . # LLC # COMPANY NAME:6 (%L�r f�.c� ✓�C/L� —p—A/zo-DDRESS �`._ _. . . .....m.. . _..,. CITY'?�� E ...... .._. .._ . ....__ _. STATE ZIPI�/;5 'TEL �O �t� y .. CELL �... EMAIL; y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS ZvoOWNER'S NAME(2z 556� POWNER ADDRESS—��X;fPTEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL) PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR BsM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: ` ` I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES` NO ❑ IF YOU CHECKED YES,PLEASE INDICATE ETTHE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW / ` LIABILITY INSURANCE POLICY`{[I 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E] AGENT E]51GNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application wi a in co iance wi all ertinent provision of the Massachusetts State Plu�mijng Code and Chapter 142 of the General Laws. - -Z- 1 iv xa'14=� PLUMBER'S NAME�I J' LICENSE# �� � URE MR�[J JP❑ CORPORATI01 #/y;� PARTNERSHIP❑# LLC[j# COMPANY NAMES ll � �� ,>�L�- ADDRESSI CITY STAT99W ZIP ��d� TEL FAXC ` CELL EMAIL OP ID:JT CERTIFICATE OF LIABILITY INSURANCE DA05/29/2015 05/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: J•T.O'Neill Durso&Jankowski Ins Agcy LLC PHONE 978 688-7000 FAX 11 Saunders Street A/c No Exc: . - ,(A/C,_N.)_978-688_-_7.001 North Andover,MA 01845 E-MAIL DOR l Durso&Jankowski Ins.Agcy. AEss:jtoneildurSoankowski.com._..__@ _ l.__. PRODUCER CUSTOMER ID#:KANNA-1 _ INSURER(S)AFFORDING COVERAGE __ __ __ N_A_IC# _ INSURED Kannan&Pricone Plumbing& INSURER A:Liberty Mutual Insurance Heating, Inc. -- 3West Ayer Street INSURER B:Atlantic Charter Insurance Co._ Methuen,MA 01844 INSURER C:ACE/USA_ INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDL SUBR ! POLICY EFF ' POLICY EXP - -- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER i MMIDD/YYYY !MM/DD/YYYY I LIMITS GENERAL LIABILITY EACH OCCURRENCE -�S 1,000,000 A X COMMERCIAL GENERAL LIABILITY .BKS56003225 04/01/2015.04/01/2016 'DAMAGE TO REIJTED -"-- --- -- .. . PREMISES(Ea occurrence)_S _ 300,000 CLAIMS-MADE X :OCCUP. MED EXP(Any one person) s 15,00 PERSONAL&ADV INJURY S 1,000,000 LG AGGREGATE �S 2,000,000 GEN'L AGGREGATE LIMITAPPLIESPER: i OD PRUCTS-COMPIOPAGG ' S 2,000- POLICY ---- ;S AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT I S 1,000,000 -� (Ea accident) A X ANY AUTO BASS6003225 04/01/2015 04/01/2016 - i BODILY INJURY(Per person) S X ALL OWNED AUTOS I - ------- ---- BODILY INJURY(Per accident).S SCHEDULED AUTOS — (PROPERTY DAMAGE S X HIRED AUTOS (PER ACCIDENT) X NON-OWNED AUTOS S UMBRELLA LAB X I OCCUR EACH OCCURRENCE S $,000,000 A US056003225 04/01/2015 i 04/01/2016'AGGREGATE 5 CLAIMS-MADE ' _ DEDUCTIBLE X RETENTION S 10000 ---- - -- S --- — -- WORKERS COMPENSATION X i WC STATU- iOTH- AND EMPLOYERS'LIABILITY YIN ! L TORY LIMITS_I-�' ER B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WCV01161700 06/01/2015 i 06/01/2016 E.L.EACH ACCIDENT s —1,000,000 O FFICERilMEMBER EXCLUDED? _ ----- •- _ C (Mandatory in NH) 6S62U62E24978014 06/01/2015 06/01/2016 j E.L.DISEASE-EA EMPLOYEES 1,000,000 I`yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT j S 1,000,000 ii I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Plumbing&Heating CERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE Durso&Jankowski Ins.Agcy. ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 395 Date. .. �� ...... apQTM TOWN OF NORTH ANDOVER 3�py 4i�e° ,+,•yOL PERMIT FOR MECHANICAL INSTALLATION 10 y SSACHUSEt This certifies that . lug'!�!�`-. . . . .Y• : !� " L.. • • • • has permission for mechanical installation . . . . . . . . . . . . . . . in the buildings of . t G-e—'.�.k t(�S. -� . . . • • • • • • • • at .,�. L � �. ��. . . . . • • • • • •, North Andover, Mass. Fee.l. .�. . . Lic. No.. ��.� -. Yom? GAS INS WHITE:Applicant CANARY:Building Dept. PINK:Treasurer / Commonwealth of Massachusetts Sheet Metal Permit Date: Permit Estimated lob Cost: � " 1 Permit Fee:$ Plans Submitted: YES NO� Plans Reviewed: YES NO Business License# w 1 Applicant License# ) I S7 Business Information: Property Owner/Job Location Information: Q a '� c� �E� �� �. e•. Name: � 1 � � Nam Street. Street: � 11 !�0 d �� City/Town: City/Town:�►`' ` Telephone: \-Sry !S Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES NO Building Type: r Condo/Townhouses Residential: 1-2 family Multi-family Commercial: Office Retail Industrial Educational Institutional g Building Cubic Footage: under 35,000 cu. ft.� over 35,000 Cu.ft. Renovation: Sheet metal work to be completed: New Work:�. HVVAC� Metal.Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: INSURANCE COVERAGE: I have a current lia- bility insurance policy or its equivalent which meets the requirements of M.G.L.Ch.942 Yes) J No[I If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy`1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 912 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only "^'" owner ❑ ent A � 9 Signature of Owner or Owner's Agent By checking this boi$,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 992 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments 'type of License: By Master Title ❑Master--Restricted VV Cityll'own ' ❑Journeyperson Signature of Licensee Permit# E]Journeyperson-Restricted License Number: Fee$ Check at www.mass.qov/dpl Inspector Signature of Permit Approval Sheet Metal Residential Guidelines/Inspection Checklist Yes No NIA Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual"D"calculations ,X Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean-properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-off} r OMMONW........... TH OF RCA' fil1SETTS ,• • • mow • ?. EJOARQ:4F S H E E> 7 ISSUES THE FOLLOWI l.G'<: `j'CE N`S E.r > :><_ > .� ?'`MASTER—U.NR) STR I,CTE D~ oc' ..... ...., LYON F .. :' W'.''- . t�L c y :<9' v L 01905-17t " .v .. TOWN OF NORTH ANDOVER 1600 OSGOOD STREET Building 20 Suite 2-36 NORTH ANDOVER MA 01845 FURNACES BOILERS ROOF TOP UNITS AIR CONDITIONERS EMERGENCY GENEREATORS Date : 11/9/2015 The undersigned applies for a permit to install the following at: Location 40 Ridge Way Owner of premises Bryce Chicoyne Address40 Ridge Way Name of mechanic Peter Lyon Address 9 Devlin Way Lynn Ma.01905 Building occupied for residence Material of building Wood Kind of fuel natural gas Chimney sidewall vent No. Of flues Size_ Chimney Thickness Lining If steel stack location Diameter Height DESCRIPTION OF HEATING APPARATUS 95%condensing furnace Kind of heater how many One makeTrane BTU Input40,000 Location in building basement Protected against fire as required How protected See the State Code(Pertaining to Chimneys, Smokestacks and Heating Apparatus) ROOF TOP UNITS OR EMERGENCY GENERATORS Make Weight Dimension Length Width Height Location of building how supported Size of roof timbers Material of roof timbers Span of roof timbers Distance on center Protected against fire as required How protected AIR CONDITIONS Kind of apparatus 1 .5 ton Split a/c System make Trane HVAC FORM REVISED 11.04 _ The Commonwealth of Massachusetts ^ = - Department of Industrial Accidents - — office otlnyewoolions 600 Washington Street, 7`4 Floor Boston,Mass 02111 Workers'Compensation Insurance Affidavit:Building/Plumbing/Electrical Contractors Applicant information. :. Please PRINT-leeibly � " name: address: city state: zip: phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ❑Remodel ❑ I am a soleproprietor and have no one working in any capacity. ❑Building Addition I am an employer providing ork'(errs''compensation fo y employees working on this job. company name:V l� j rl � C� address: V •O •t 7 ci W, L N/q `-f-)" ohone#•�� n insurance co. I l "'' Policy# (: ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices: company name: address: city: phone#• insurance Policy# U CO p Y Company name: address: city phone#• insurance co. policy# !AttacFi'additional sheet if necessary Failure to secure coverage as required under Section 25A of 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 hereby ee er the %ins aldpenafties ofperjury that the information provided above is e td correct Signature ^ i Date 1 ��Q Print name C 1—. Vti Phone# ((, fficial use only do not write in this area to be completed by city or town official ity or town: permit/license# ❑Building Department ❑Licensing Board El check if immediate response is required ❑Selectmen's Office ❑Health Department ontact person: phone#; ❑Other revised Sept.2003) .w Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",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 section 25 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, 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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,7d'Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 Universal Mechanical Contractors Inc. 9 Devlin Way Lynn, Ma. 01905 Phone 781 -595-9222 Bringing Quality and Comfort to families for over 30 years. Nov. 5, 2015 Page 1 of 2 Proposal Submitted to: DM Construction Location: Chicoyne residence Darren Martino 40 Ridge Way - 44 Addison Ave. Ext. No. Andover, Ma. 01845 Methuen, Ma. 01844 Phone: 978-902-3380 Email: darrenmartino@comcast.net Estimate Submitted for HVAC work for future finished basement. Install exhaust duct for new bath terminating at the closest location. Does not include bath fan. Install new, Trane gas fired furnace with a/c and duct system to service the new finished basement. M# TUH1 B040A924 furnace, 95% efficient, 40,000 btus input. M# 4TTB3018, 13 SEER-outdoor unit, 1 .5 tons. M# 4TXCB031 , cased cooling coil. A Honeywell, Pro- 6000, programmable room thermostat shall be installed. An Aprilaire damper system shall be installed to provide fresh air to the basement space during system operation. Phone 781 -595-9222 Email peter@getair.org Fax 781 -595-9643 Page 2of2 ice includes sidewall venting for the furnace and low volt wiring. The outdoor condensing unit shall be located on the right side of the home. Return and unit plenums will be lined with acoustical insulation. Supply branch ducts shall be flexible round. Installed price $ 12,475.00 Warranty: Two years all parts and labor Ten years Trane functional parts. Five years on room thermostat. Price includes: equipment, materials, labor and sales tax. Price does not include: duct blast test if required by the inspector, electrical wiring, gas piping, furnace venting. If in agreement, circle and initial desired option, sign and return proposal for our records. Payment: $ 4,475.00 on start of work followed by progress payments. Submitted by: Peter Lyon Date: 11 /5/15 Accepted by- Date: Date: Pricing valid for 30 days ect SummaPro Job: wrightsoft® � � Date: Sep 07,2014 Trane furnace By: Universal Mechanical Contractors, Inc. P.O.Box 555,West Lynn,Ma.01905 Phone:781-595-9222 Fax:781-595-9643 Email:peter@getair.org Project • • For Chicoyne, Darren DM Construction Job: 40 Ridge Way, North Andover Notes: Design Information Weather. Boston Logan Int'I AP, MA, US Winter Design Conditions Summer Design Conditions Outside db 5 OF Outside db 91 OF Inside db 72 OF Inside db 72 OF Design TD 67 OF Design TD 19 OF Daily range L Relative humidity 50 % Moisture difference 37 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 13434 Btuh Structure 8234 Btuh Ducts 4392 Btuh Ducts 3585 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 17826 Btuh Use manufacturer's data n Rate/swing multiplier 0.96 Infiltration Equipment sensible load 11322 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 1568 Btuh Ducts 594 Btuh Heating cooling Central vent (0 cfm) 0 Btuh Area (ft') 945 945 Equipment latent load 2162 Btuh Volume(ft) 7560 7560 Air changes/hour 0.47 0.24 Equipment total load 13485 Btuh Equiv. AVF (cfm) 59 30 Req. total capacity at 0.70 SHR 1.3 ton Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80 AFUE Efficiency 13 SEER Heating input 0 MBtuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 557 cfm Actual air flow 557 cfm Air flow factor 0.031 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.85 BoWdalic values have been manually ovenb*n Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2015-Nov-18 05:28:12 C wrilghtsoft' Right-Suite®Universal 2012 12.1.07 RSU17876 Page 3 /4CCt1 ...r\Documents\WrightsoftHVAC\Darren-Chicoyne.rup Calc=MJ8 Front Door faces:N UNIVE-1 OP ID: LS ACORO� DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/06/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT A James Lynch Insurance Agency NAME: Y 9 Y PHONE FAX 297 Broadway ac No ext:781-598-0700 (AIC,No):781-599-0580 Lynn,MA 01904 E-MAIL Thomas R Ross ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Ins Company INSURED Universal Mechanical Cont.Inc INSURER B: Peter Lyon 9 Devlin Way INSURER C: Lynn, MA 01905 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDTYPE OF INSURANCE 51 UBR POLICY NUMBER MMIDDY /YEYYY MM LICY EXP LTR DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE I—XI PREMISES Ea occurrence $OCCUR 8500040425 06130/2015 06/30/2016 RENTED 500,000 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECOT [7] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000 000 Ea accident _ A ANY AUTO 1020001502 06/30/2015 06/30/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY STATUTE I I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 9109150608 0613012015 0613012016 E.L.EACH ACCIDENT $ 500 OFFICER/MEMBER EXCLUDED? ❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 50 If yes,describe under DESCRIPTION OF OPERATIONS below I I I I E.L.DISEASE-POLICY LIMIT $ 50 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DM Construction ACCORDANCE WITH THE POLICY PROVISIONS. Bryce Chicoyne 40 Ridge Way AUTHORIZED REPRESENTATIVE North Andover, MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i 7 5L) 6 Date. �3. �.... .... 4Fi[ NpRTH k f 1 � TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION ,SS'qCHUSE� This certifies that . . .��d.(�.U. . . `�. . . . . . . . . . . . . . . . . . has permission for gas installation . . . .� /g.k. f.-r . . . . . . . . . . . . . in the buildings of . . . !. C. ::. . . . . . . . . . . . . . . . . . . . . . . at .Z-1 o. . . e0r.�-d /:. . . • North Andover, Mass. Fee).Y. Lic. No.. ':�?.,3.7. . . . . .��. . .��n . . . . . GAS INSPECTOR Check# 2440--o 140--o MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 4k.,-,dO V CA , MA. Date: Permit# Building Location: yQ R-1 061,0/ Owners Name: 0111 cayl 1C Type of Occupancy: Commercial ❑ Educational❑ Industrial❑ Institutional ❑ Residential IR New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES �goa y fA W W Y Haa WO N = N N m = 0 t7 J } � Z t/>' O � W W Z Z W O Q� tp W W W m O F. a FW- W _ W > IZ O W O u. V W W Z fn = W ~ Z W Z LU } Z y J ~ f' m W O Z O t— W 2 W W o oc a s > o �a °� > > > 3 0 V G o u. 0 0 _ 2 g O a SUB BSMT. BASEMENT 1 FLOOR -PL1 FLOOR 3Ku FLOOR 4 FLOOR 5 FLOOR 6 FLOOR -YTR FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: APOLLO PLG &HTG INC El PO BOX 466 Corporation .306 Address: 1 SRA'i*1jm ST City/Town: TAWRFm F. State: mA ❑Partnership Business Tel: 978-688-1755 Fax: 978-683-5933 ❑FImUCotnpany Name of Licensed Plumber/Gas Fitter: Robert M. Demers Jr. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes® No If you have checked Yes,please Indicate the type of coverage by checking the appropriate box below. A liability insurance policy In 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Ownees Agent By checking this box LEF,1 hereby certify that all of the details and Information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: BY ❑Plumber Title ❑Gas Fitter g• 4ata:�of �icensePlumber/Gas Fitter ®Master �� City/Town ❑ rn Joueyman License Number: APPROVED OFFICE USE ONLY ❑LP Installer FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO GAS FITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER GASFITUM LP INSTALLER LICENSE NUMBER: PERMIT GRANTED❑ Imo& GAS FITTING INSPECTIOR - s QQ pp Date. 88 5 /. MORt1r l °f,,�•• ..'� TOWN OF NORTH ANDOVER a s PERMIT FOR PLUMBING �SS�cNusE� 1 This certifies that . .A.�A.��.G.� .�_. �. . . . �. S. . has permission to perform . . . . . t PC t plumbing in the buildings of . . . . . . . . . . . . . . . . I at . . .C,T�a . /�.,. 4�. �,..�*. y. . . . . . . . . . . . . ., North Andover, Mass. Fee.1/9. Lic. No. , 2 . . . . . . . . . . . ��}/'� . . . . . . . . PLUMBING INSPECTOR Check ff -- -�—�-- Y 7 ,-o MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: A%. 1-:4,j cxi?^- . MA. Date: a/ /// Permit# Building Location: 1/0 KJt>G-C Owners Name: Giilc -lw e- Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES ,as- DEDICATED as nv�Scq Z SYSTEMS O 0o W O 17 z 99 z z 14- ;2 z V) Z °C 5Zy s z Z y� t� � d U. N 3 G O W H n ? DC 011 O W 3 z a 0 3 a. Y QQ = LL, u� Q C f- t=3 > > O O O Z Z Q a m c 'o i 5 5 o°e vim, x 3 3 3 0 a 3 SUB BSMT. BASEMENT 1 FLOOR I ` 2 FLOOR 3 RDFLOOR 4 FLOOR T5 FLOOR 6 FLOOR 7 FLOOR C FLOOR Check One Only Certificate# Installing Company Name: APOLIU PLG & HTG INC PO BOX 466 R Corporation 3 01/6 G Address: 1 SHATTLXK ST City/Town: LAWRENCE State: MA ❑Partnership Business Te878-688-1755 Fax: 978-683-5933 ❑Firm/Company Name of licensed Plumber: Robert M. Demers Jr. INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142oft a Gen ral Laws. Zf By Type of License: Title ❑Plumber Si ature of Licensed Plumbe City/Town ®Master License Number: APPROVED OFFICE USE ONLY) ❑Joumeyman FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER LICENSE NUMBER: PERMIT GRANTED DATE` PLUMBING INSPECTIOR T` 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 c 11, S 150 A. The debris will be disposed of in: FA A (Location of aci ity) I�0 r (yam Signature of Permit Applicant kl 11 2N Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Location No. late ..,e ppRTN TOWN OF NORTH ANDOVER 3?0�tt•.ao �a,�Ot Certificate of Occupancy $ Building/Frame Permit Fee $ S�4 sAcMusCK E�� Foundation Permit Fee $ s Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector _ RAID 8780� 09/28/95�T3:08 1,544.50 0 7 8® Div. Public Works Lot SY� Location O�Rr.C�A P No. I Date NORTH TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ + • Building/Frame Permit Fee $ Foundation Permit Fee $ O0 a� Hus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ (@ oe ullding inspector 09 47!95 1�vd" PAID 8779 Div. Public Works Location Ng. V Date 3 � Q MCRTh TOWN Or NORTH ANDOVEW 4, O • 1 _ • 0 O Certificate of Occupancy $ Building/Frame Permit Fee $ sACM�s��' Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ �� O ti�, �►� Water Connection Fee $ l_ TOTAL $ Z i Idi g In c 8 7 iv. is Works 49� co� 3�� PE&JtIT Ivo. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 440. LOT NO. 12 RECORD OF OWNERSHIP ]DATE BOOK :PAGE ZONE SUB DIV. LOT NO. • Y5 Z$'- LOCATION qo Q'(,()L .S r, PURPOSE OF BUILDING ` ^� -04- OWNER'S � OER'S NAME aiyV v`•_ �_LI�•+a "'v`� n NO. TORIES tSI (7 OWNER'S ADDRESS ` LLO&pjY SEMENT R SLAB AkCMITECT'S NAME t13t/1 �l7TWCW� �„�1s SIZ OF FLOOR TIMBERS IST Z061r. 2ND Zx/Q 3RD BUILDER'S NAME `V�, �Y /<<.+C�pL SPAN ` /V�M1�GV l DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS A)<6 DISTANCE FROM STREET 311 POSTS (JK DISTANCE FROM LOT LINES -SIDES �S .� /� REAR GIRDERS -s (,Lf�5/v AREA OF LOT G l FRONTAGE HEIGHT OF FOUNDATION O l THICKNESS IS BUILDING NEW ` ,eS SIZE OF FOOTING d ff X 7�/ v IS BUILDING ADDITION �a MATERIAL OF C L�'L f IS BUILDING ALTERATION IS BUILDING e1w SOLID O FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER f` BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER .,QHS IS BUILDING CONNECTED TO NATURAL GAS LINE Y� INSTRUCTIONS /,��K.Sa 1 3 PROPERTY INFORMATION �1 / LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 PERMIT FOR FRAME/BUILDING EST. BLDG. COST PER SQ. F617. cam_ 1rJJ PAGE 2 FILL OUT SECTIONS 1 - 12 EBT. BLDG. COST PER ROOM �— /.�� ;Jy� 'zz; `te,�:� SEPTIC PERMIT NO. T ELECTRIC METEPS MUSN OUTSIDE OF BUILCMTE7 �_ .r.�ii :EE PAID. , -- ��, 4 APPROVED BY AZILED MUST CONFORM TO STATE FIRE REGULATIONS L4 P ANAPPROVED BY BUILDING INSPECTOR - D57t� YIc LDING INSPECTOR SIGNATURE OF NE OR AUT D AGENT z .. F E E 11*14 REGULATED BY PARA. 114.8-S. B.C. OWNER TEL.# PERMIT GRANTEDCONTR.TEL.# � �T 19 g/�' DATE FEE PAID __/c0 w S ( g� CONTR.LIC.# �.S, (� I H.I.C.# �C AUG 3 0 OM PERRMJT FEE S C2 EES FDA ... 1.0 U .__-. OW fRAME PERMIT i ,'62 x'17`( -' a7� � CIO lGa`" n3oP BUILDING RECORD 1 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 I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION Q FOUNDATION 8 INTERIOR FINISH CONCRETE3 1 2 I3 CONCRETE BL'K. P_INE _ BRICK OR STONE HARDW'D PIERS PLASTER _ _ DRY WALL —_ UNFIN. 3 BASEMENT AREA FULL I FIN. B'M'T' AREA _ '/, 1/1 l/, FIN. ATTIC AREA _ NO 8 M'T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING 9AR13\410 _ ASBESTOS SIDING COMle1CN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MAS UNRY ATTIC STRS. & FLOOR _ BRICK ON FRAME 1' •- CONC. OR CINDER BLK. STONE ON MASONRY WIRING S ONE ONF AME SUPERIOR POOR - � ADEQUATE NONE -- - -4, ' 5 OF 10 PLUMBING GABLE I BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK , SLATE NO PLUMBING T TAR 8 GRAVEL STALL SHOWER ROLL ROOFING I MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I 1/ HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. TEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOO RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL •�, B'M'T 2nd ELECTRIC •,.;- m 1 sr 13rd I NO HEATING _ '• NORTH own of �0 6Andover No4 4 : o . 4: . ` ` A or dover, Mass., `f" 19W C0riIC Mt WICK %S�RATED P'PG��� BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D1 ` I BUILDING INSPECTOR THIS CERTIFIES THAT��� .Iv"1�X�......`" ......h. llY�ll. .. c�12► 11�IZS. ...... ....................... ounda ion has permission to erect... .... 1fiftuildings on ..:�..i40*eA.OA�{.............. . ..' .. Itougl, c� to be occupied as.4` Gl ... 1. �4.t1.Cq...... 24r-m.. .3.... QtZ...... !Q!444�.�... .. atc Chimney provided that the person accepting this permit shall in every res ij ect cto the terms of the applicatio 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough Final PERMIT EXPIRES IN 6 MON11� PEE PAID UNLESS CONS U �I ;Q�z30 ELECTRICAL INSPECTOR Rough .. .... .............. - .. .. ........... Service BUILDING I ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT r 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 local or state law, regulations or requirements. ****************Applicant fills out this section**********`******* APPLICANT: iw.:t xe,,-61-4 Phone LOCATION: Assessor's Map Number I Parcel Subdivision / a7,q .4A1Da)t32 14,etuL&a Lot(s) Street St. Number ep _ *** ************************ ********** *********** Official Use Only RECO A S OF TOWN AGENTS: 7 Date Approved 'E ation Administrator Date Rejected Comments 1L 6 Date Approved nS Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected &--y-T 7-?"LjV-) PP Date Approved Z rs Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 3d �/ 5 - driveway permitep Fire Dep4rtment - a-�- �4 'o� CG:CL..�� c�Cl3 e ftetived by Building Inspector Date AUG 3 0 1995 s FROM LAND PLANNING BELLINGHAM PHONE NO. 508 966 5054 P01 Z � t LOT i �.� �. � ` b j '' �• f0lr ,�a GAk:341 �►p .7 '{ SLAB :333. 7o t���110FM� 332 �,ti w i I NYr � fit+xSC o C" -d .31807,0 t In 34C 3'�Z NOIT: ALL UTILITY LOCATIONS ARE TO K tlELI) VERIFIED BY THE GRADING f $ITE PLAN SITE CONTRACTOR. lnl � CDkNELL C. ninry LOT AS Fs Zo' s •p' R s Zo' NORTH ANDOVER t4TAM NORTH ANDOVW NA LAND PLANNING TOLL BROTHERS, INC. sNcnmttntc t stnem Mo WAXT r m mu lel ltD ASR= NUIMNAK VA 09019 WAVM90. VA 0W1 9ee-4130 FAX (600) W-6054 B-15-95 i " -•t0' I NAB 4-5- FROM LAND PLANNING BELLINGHAM PHONE N0. : 508 966 5054 P01 OPS SP ACS . . I� 50 auFF•ER ZONE ,l r-� LOT 45 28,690 S.F. LOT 44 LOT 46 FOUNDA17QN. AS(3t tIL T TC 343.15 4 N —37' 114.93' -2 9.3 7' Nr+t4 RIDGE WY Y W RO "RO 6R. (50' WIDE -- APPROVED WAY) 9�G Q. SETBACKS. F-20' S-0' R-20' (20' betw. bld9s.) FOUNDATION A —BUILT --... LOCATE AT I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED LOT 3 ON THE LOT AS SHOWN ON THIS PLAN AND THE NORTH ANDOVrR ESTATTIS LOCATION DOES CONFORM WITH THE FRONT, SIDE, NORTH ANDOVER, MA AND REAR SETBACK REQUIREMENTS SET PORTI I IN AIWA M FOR THE TOWN'S ZONING BYLAWS AT THE TIME OF TOLL BROTHERS, INC. CONSTRUCTION. I FURTHER CERTIFY THAT THE 1000 WEST rARK DRIVE STRUCTURE IS NOT LOCATED IN THE SPECIAL WEqTRORO, MA 015RI 100 YEAR FLOOD HAZARD ZONE. THIS PLAN IS NOT LAND PLANNING TO BE USED FOR THE ESTA81..ISHMENT OF PROPFRTY , LINES, ERECTION OF FENCES, OR CONSTRUCTION OF ENGINEERING Et 3URYFY 1E7 HAECh'ORD A4ENUF. HELIdNGHAM, 1fA 0201D ADDITIONAL STRUCTURES ON THE LOT. (Wl) 000-41'Rl FAX 1600) M-6064 MAP NO. 0006C COM NO. 2`0098 DATF- 6/2/93 - - `w MILLER ENGINEERING, INC. GEOTECHNICAL/SOIL BORINGS/ENVIRONMENTAL/CONCRETE/STEEL/ROOFING/ASPHALT INSPECTION Mail all correspondence to: 100 SHEFFIELD ROAD • P.O.BOX 4776 • MANCHESTER,NEW HAMPSHIRE 03108 • TELEPHONE(603)668-6016 • FAX(603)668-8641 October 4, 1995 Mr. James Bagley TOLL BROTHERS INC. 55 Rosemont Drive North Andover, MA 01845 RE: Foundation Lot #45 North Andover Estates North Andover, MA Project No. 40076. 01 Dear Mr. Bagley: On October 2, 1995, the undersigned visited the above referenced site to visually review a foundation which had been damaged. It is our understanding that the foundation cracked when an excavator passed close to the eastern end wall of the foundation. Several cracks were observed on the interior of the wall. Cracks were also observed on the exterior of the north and south walls at the eastern corners. It was noted that the top of the east wall had been moved in several inches and was noticeably bowed. From my observations it appears that the surcharge load caused by the excavator exceeded the capacity of the wall to resist the lateral forces . Based on the information available at the time of this report, it is recommended that the foundation be cut and the damaged areas removed. Prior to the placement of a new wall, dowels should be drilled into the existing wall at one ( 1) foot on center for the height of the wall. This will serve to positively connect the two (2) sections of wall. You may also wish to consider the use of an epoxy product to prevent water from entering through the joint between the old and new walls . If you do opt to use the epoxy, it is recommended that it be applied from both the outside and inside of the foundation. If you should have any questions, or if we may be of further service to you, please do not hesitate to contact this office. Very truly yours, MILLER ENGINEERING, INC. James A. Murphy x Senior Staff Engineer JAM:ec cc: Mr. Mark Gates ; Land Planning Engineering & Survey Mr. Richard Colantuoni; Town of North Andover CORPORATE OFFICE: 100 SHEFFIELD ROAD • P.O.BOX 4776 • MANCHESTER,NH 03108 • TEL(603)668-6016 • FAX(603)668-8641 130 EAST MAIN ST. • P.O.BOX 11 • NORTHBOROUGH,MASSACHUSETTS 01532 • TEL.(508)393-2607 • FAX(508)393-8490 21 MARKARLYN STREET • P.O.BOX 1087 • AUBURN,MAINE 04210 • TEL.(207)786-4249 • FAX(207)777-1822 q JiL MILLER ENGINEERING, INC. Y GEOTECHNICAL/SOIL BORINGS/ENVIRONMENTAL/CONCRETE/STEEL/ROOFING/ASPHALT INSPECTION Mail all correspondence to: 100 SHEFFIELD ROAD • P.O.BOX 4776 • MANCHESTER,NEW HAMPSHIRE 03108 • TELEPHONE(603)668-6016 • FAX(603)668-8641 October 24, 1995 Mr. James Bagley I/ V TOLL BROTHERS INC. 55 Rosemont Drive North Andover, MA 01845 RE: Foundation Repairs Lot #45 North Andover Estates North Andover, MA Project No. 40076. 01 Dear Mr. Bagley : On October 20, 1995, the undersigned revisited Lot #45 to visually review the repairs to the foundation. At that time it was observed that the repaired section had been keyed into the old section of the wall. The repaired section appeared plumb and true and was founded on the footing. These observations indicated that the repairs were conducted in accordance with our October 16, 1995 letter. Should you have any questions regarding this matter or if we may be of further assistance, please contact us. Very truly yours, 0�� �1N Of � rya MILLER ENGINEERING, INC. FRANK K.MILLER rn ivi 3 �, � 1 ,p .N •. 3 James A. Murphy Fra At 0 P.E. Senior Staff Engineer Vice JAM:ec cc: Mr. Richard Colantuoni; Building Inspector ^^T25 CORPORATE OFFICE: 100 SHEFFIELD ROAD • P.O.BOX 4776 • MANCHESTER,NH 03108 • TEL(603)668-6016 • FAX(603)668-8641 130 EAST MAIN ST. • P.O.BOX 11 • NORTHBOROUGH,MASSACHUSETTS 01532 • TEL(508)393-2607 • FAX(508)393-8490 21 MARKARLYN STREET • P.O.BOX 1087 • AUBURN,MAINE 04210 • TEL(207)786-4249 • FAX(207)777-1822 CERTIFICATE OF USE & OCCUPANCY Tuvi 'i of Forth Andover Building Permit Number_ —44Q_(,1995 Date � �F�-k �?ga.196 THIS CERTIFIES THAT THE BUILDING LOCATED ON 40 RIDGEWAY (Lot 45(3) � i 1 MAY BE OCCUPIED AS S.F. DWELLING W/3 CAR GARAGE; IN ACCOR13AN(,X WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Kensington Woods LLi I Lnrs p 321 Commonwealth Ave. ADDRESS",Wayland. MA l4cmus Building Inspector i 1+ 11 i I • �pRT Town of �o . Andover No. 14 4 ill' 0 04 Aor dover, Mass., COC HIC ME-C AD" A T E D P.Pa\��� BOARD OF HEALTH s PERMIT T Food/Kitchen Septic System l BUILDING INSPECTOR THIS CERTIFIES THAT..... 11�1ZC�...... ......�.'.L1AAV-y.....�+wct .'►'lit`��'Z��.. : ......,.:...................... I oundation `��`3c0 l has permission to erect...4 . ..4....1 ?.. t�ll��buildin s on ..-_40.. f. ... �!,� l,,i..............;... �...... ....,.... ,� ou to be occupied as ��z�.: `,... ('rll.��f: . . .:`t� .:1: .t. . ....9.%/ ....: ....� 1. ..... " p'f/."4 ...{..Cc rk .{r�u+t(, 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. PERMIT EXPIRES IN 6 MOILT -I _ ,� �v 56?1111�plz�s DAA .�FEE PAID �Cc� UNLESS CONS U / IC z - % ELECTRICAL INSPEC OR t PERMIT FOR FRAMUBUILDING \\ /......�........\:`..':�.:: .. ..::..'. .:: .l............. ServiW i � ~BUILDING INSPECTOR tnal `� !�`�����• )ATE: FEE PAID Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough dfi 9r No Lathing or Dry Wall To Be Done FIRE DEPARTM N Until Inspected and .Approved by the Building Inspector. �� Burner - R�P �A PLANNING FINAL CONSERVATION FINAL Street No. �" ��� � SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Smoke Det. a Date.................................. t NnRTH 1 TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING SSACHUS� This certifies that .............:..:....:.. :................................................................... has permission to perform ...........................................:................................... wiring in the building of.......................................::.......................................... a..................... ....................................... ................ .North Andover,Mass, Fee..'.:................. Lic.No............ .............................................:...............:: ELECTRICAL INSPECr6R Check # r f Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. 7 Occupancy and Fee Checked zt�) IBOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC)„527 CMR 12.00 (PLEASE PRINT IN INK OR E AL FO ATION) Date: City or Town of: To the Inspecto of Wires: By this application the undersigne fives ice his or her i tention to perform the electrical work described below. Location(Street&Num r) Owner or Tenant P Telephone No -1 Owner's Address OL Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 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: Installation of Security system Completion of the folloiiin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above r-1 In- ❑ o.o Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.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 KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipal ❑ Other y Connection No.of Dryers Heating Appliances Kms, Security Systems: No.of Devices or Equivalent �+ No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.o.Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) /I -' (Expiration Date) Estimated Value of Elect 'cal Work: l08' (When required by municipal policy.) Work to Start: 4 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under t1wrPai6 and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable,enter"exempt-in the license number line.) Bus.Tel.No.,• 603 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li*see see 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. $ Location No. r to Date �' ' os- TOWN STOWN OF NORTH ANDOVER 3?O•,t`•D I•,hO O + ; ; Certificate of Occupancy $ ��s",n°•'<�' Building/Frame/Frame Permit Fee $ sAcHU 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # I83u4 // --a-uildina Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCI,REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING IN aft BUILDING PERMTr NUMBER: DATE ISSUED: f��3 X fj A ff 44100( .04 SIGNATURE. V,w Building Commissioneffl2TEtor of Buildings Date SECTION I-SITE INFORMATION I z 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: W) UAC&cMuh _U 00%4, Parcel Number L 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage(1t) 1.6 BUILDING SETBAeKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Requir=ed Provided 1.7 Water Supply AG.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: > Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 1 -i c E3 stri t %iles NO --i SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I HOW, i c . M 2.1 Ovm.erof Record /Name f Print)LI) Address for Service (D(�I -�) —6.7.. Telephone 2.2 Owner of Record: Name Print Address for Service: 0 z Si nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: 0 License Number M Address > Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number rw Address z Expiration Date Signature Tele hone Q SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check an applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ 11. Accessory Bldg. [I Demolition ❑ Other ❑ Specify ` Brief Description of Proposed Work: A+ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beOlCi ;"U ( ,y Completed by permit applicant , ,< 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction l 3 Plumbing Building Permit fee(a)X (b) I a 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 ' 1, 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 1, 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 TfNMERS OT 2 ND 3 SPAN DINIENSIONS OF SILLS DIN ENSIONS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I t&OAT11 9 Town of North Andover `"L °` Building Department 00 - ` 27 Charles Street o ,��} Af May,y North Andover, MA. 01845 'SA ,Ds��►,.tSE�� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE /D JOB LOCATION Kit U\� ��� I y\ �V�.t�� �� Iy I 1-7 LS y Number Street Address Map/lot .HOMEOWNER 1,,C)V l AL �� "t D�Ca Name Horne Phone Work Phone PRESENT MAILING ADDRESS J City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re qu ments. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL u Y The Commonwealth of Massachusetts d Department of Industrial Accidents s Office of Investigations Boston, Mass. 02911 M sy Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone'# Insurance.Co. Policy# Company name: Address City: Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A or ML 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment_as.welLas_civil.penaltiesin-the farmda_STOP WORK ORDER.and..ahne of.($1.00.00).aAayagainst.me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area.to be completed by city or town official' City or Town Permit/Licensing Building Dept []Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone#: Health Department Other Page# of pageS .. r Pr I Submitted To: Job Name Job# Address t Job Location t h� !� v j O Date Date of Plans Phone# V l�� ` V G Fax# Architect We hereby submit specifications and estimates for: nJ.� 1 Ile IoV ! o • '`""�'f' ,,_,�•^- ^''�F ..yam - .�,t . l . / n T � We-propose hereby to funis h material and labor complete in accordance with theabove specifications for the sum of: " Dollars with payments to be made=as follows: &y:afteratim or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays submitted ours' Note—this proposal may be withdrawn by us ff not accepted within - days... ' f acceptance of The above prices,specifications.and conditions are satisfactory.anctaue hereby accepted.You are authorized to do the a work as.specified. Signature Payments will be made as outlined above, ; Date of Acceptance • Signature i. NC3819. IN USA Page# ` of pages - 1 f r Proposal Submitted To: Job Name Job•# Address Job location -. J)ate Date of Plans Phone# Fax# Architect F c wet:�Y OU We f 3 J f i �A �. _ r '{ i" x We propose hereby to furnish'material and labor—complete in ar&rdance with t e r�v6 specifications for t'he'sum of: � Aad � ollars with pa ments to be made as follows: C'. , e Any Re dev' om above tions inv in a ra sts will be Re e ll ' r Y o extra charge,Q�and 00 submitted ' the estimate.All agreements contingent upon s nkes,-accidents;,'or delays ' beyond our control. Note—this proposal may be withdrawn us rfv of accepted within days. Ztcceptame of Propola The above prices,specif tions and conditions are Satisfactory and are Signature hereby accepted.You af ,,authorized to do the work as,specified. Payments will be made, utlined ve. _ Date of Acceptance 2,0 Zn-- Signature ��yy - y s*.."NC38t9. +MADE IN USA , .. 04/03/2003 THU 11: 28 FAX LNTERGRATED DP DANVERS Q001/001 AAl/)a /0,/ ,4) /V Z07 2 2 'd kv z 17 Alo. c :Pecc �� FORM U v 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*********************** APPLICANT iPHONE ���Cl� l "8 � LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOTS STREET 4ST. NUMBER *****************************************OFFICIAL USE ONLY********'"`**�*********** RE MMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINI RATOR D _PROVED ATE REJECTE s CO-MME os'ed ry r UVU J �, TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS 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 INSPECTOR DATE Revised 9197 jm xAORToi Town of 4Andover No. ? 77R-77 over, Mass.,-4 C0 .:...:..".00K RATED Is BOA" OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT..............................13 a 01 4 . BUILDING INSPECTOR .4* . ........ . .. ...... . . ......... ....i.............................................................. Foundation has permission to erect........................................ buildi S on ..... .................... ...................... Rough to be occupied as... .... Chimney provided that the person ac pting this permit shall in every respect conform to the terms of the plication on file in Final person t of the I this office, and to this pDrovi ons of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PEPdvffT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S T ELECTRICAL 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 Rough Final 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.