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HomeMy WebLinkAboutMiscellaneous - 40 WEBSTER WOODS 4/30/2018J of OR , � M • CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number / 3- Q Date THIS CERTIFIES THAT THE BUILDING LOCATED.ON_ota6 -7V-'1D a)e6 SVPR &;Oaa�S ZI,j MAY BE OCCUPIED AS v//V A- Dj w f )I l IN ACCORDANCE WITH THE PROVISIONS OF TH1, MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. IO ROQ MS/(=D '�� ,C3,4 7 h S, a 6�ot// u ti V Z P� CERTIFICATE ISSUED TO (,� fj1 I)� 70,reS/ ADDRESS &,h h fJ-eP PA s F Building Inspector 1 W fA co l t<.7 N � o��j . x z w U o �. O u A m S4 co a a ` U w° a o m° cn cn MLLJ 0 .A z c Qvv •ate, o. :m= CF QO cc m C E m_ m 0 N N g„ ID 3 = C m _ m O' �• O �Eg 0 00 cm0 c F �s: o Na 5 Itooh m C2 h O ' Z O C. 0 CL Q: o CD C: N •o N '.2 O COD Lu CO � •O 0 +_••' LL _m +" C �•' C W •E v •N o V m O O:E C Vi d m� O� g .a O O O�z� ..K m v O E co 0 0 D I ca .y ♦r CL O CD Q m CS CO2 O O V .y 0 V CD co co O O CL fl. cm4 c �Cc TJ O O Z v a) C. CO) C C _c �. y Town of forth Andover of NoRTN �c�LeO r6 ti Building Department yti ., o _ o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 [OC w1C .Y.iKM it Teo �9SSAC 110���y APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS -�/'O We- 6Efer 1000 -IS La1vt C- LOT LOT NUMBERS t SUBDIVISION e DATE REQUEST FILED %%/Z._ ZZ_ o DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS `DIME FRAME. A RE -INSPECTION FEE NTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE SWC OES OT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION DATE PLANNING DATE .2L 3Lff/t DATE ,, - I) P W MII4T TNMTi ATF TTTAT TT -M 117ATT7-D X,rv= HAS BEEN STALLED Location 04910 !" wQbs�- " Cw! No. / 3 Z) Date 17-11-01 NORTH TOWN OF NORTH ANDOVER 0*4,,A° :"'.Y 3?� SOC D " Certificate of Occupancy $ . E<�' Building/Frame Permit Fee $ %3 C.. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 13 Y3 Check # 1"— 'i L� 7 3 7 44 ( CIL_ Building Inspector Date tea. ,Y TOWN OF NORTH ANDOVER PERMIT FOR WIRING r This certifies that ...�!�• ...{�.��� �? .�L................ has permission to perform ..1�/`..G�.f �. ✓bPN'��r�T , l��,K!�?�-�-f wiring in the building of ..l.. at . .. f ..� . In.o P / (�.�...z.,.l�.il�C.�� . ,North Andover, Mass. Fee6�- .�R ... Lic. NozM-v ... yvt.... . ..... ELECTRICAL INSPETOR Check # V 11319 " • Official Use Only Common wealth of massachusetts Department of Fire Services Permit No. I I 1 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 ININK OR TYPE ALL )NFORMATION) Date: / % 2 I Z 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) %y()lA) h S 4@/ w g I %X% Owner or Tenant 16 eA /7 e f �_�' CA -,I vl /,�,l 5 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [�' No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service a ObAmps 0/ -2, ZLYolts Overhead ❑ Undgrd [P--' No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: k7C-,5,e--y1,ec,,t f )" oG)C ri J ---1n Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans v No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. gmd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons """""""""''' KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No, of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Y Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1®�. UU (When required by municipal policy.) Work to Start: Id, 1-2 /Z Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: - t i !?3A 12L//c,, u t Z LIC. NO.: Licensee: i^} c1:.� U% �.y �� Signature LTC. NO.: _ (If applicable, enter "exempt" in the license number line) Bus. Tel. No.•% 751 7( • S b Address: Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ 7� Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed 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 M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 1fl Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH SPECTION: Pass ? Failed Re- Inspection Required ($.) ❑ Inspectors omments: Inspectors Signature: Date: FINAL CTION: ss ? Failed Re- Inspection Required ($.) ❑ Inspect s C ments: n. Inspectors Signature: V Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 S� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizati6rAndividual): -6 /-1 &L"I 6 J ! ,rt Address: k /km C ,S City/State/Zip: P&CL 46 Mg Phone #: �J % S' Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. UYI am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have w4[king for mein any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. " contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site ?formation. isurance Company Name: a olicy # or Self -ins. Lic. #: Expiration Date: :)b Site Address: City/State/Zip: .ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify under the pa' and penalties of perjury that the information provided above is true and correct. i nature: �"'� Date: zone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of. insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. '* City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1.877-MASSAFE evised 5-26-05 Fax # 617-727-7749 www.mnss anv/clic CERnFI D PLOT PLAN S.E. CUM!/NGS & ASSOC/A TES P.O. BOX 1.137 PLA/STOW; N.H, 03863 TELEPHONE MOX -382-5085 FAX t603I-382-6216 VOvhr 1:L /3 OR (S501^t-T) Lf -S-000( i. �` s1 11-29A / / \4AAO SETBACK / ;j) % N / / SSit1. ��a 4919 i i i L07 26 p 1 48,924 SFt / s .i' 6a z'2 01D L 1 p1.Z2 46 SCALE 1" = 60' i► l HEREBY CERT/FY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THA T THE EXISTING FOUNDA TION DRAWN ON THIS PLAN IS L DCA TED AS SHOWN AND THA T IT DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. ql N05'23' 50"W DA TE- JULY 2, 2001 TAx MAP 10.9-A /I OT 26D CAMPBELL FOREST NORTH ANDOVER, MA. MINIMUM SETBACKS. FRONT - 30 FEET SIDE - 30 FEET REAR - 30 FEET n cn m z D r 7 m z c m m < m Z m O C: O czi) m � m = z m p Oz � n ccn n z �_ O z 0 p z G.i m �t m D \�\ m _ C � C> I m O m C -/ N° 3 Date......f.... c TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......M.'' V^ �!,�...�.. :........ � .. (.F L ............................................ has permission to perform ....... c. ti1.. ........................... wiring in the building of .........1.�..! ...:......1 } F.. �.� !.............................. Gt, !' Ai f t U r &-I L (,7� at.....r%//...............:..........................................��orth Andover, Mass. ' Fee.3:.dd.. Lic. No..��.. ► %��% ........... . . ............. ..F .... RIG�AL INSPI�CTOR i Check # _L"L WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 4 DEPARTAiE7VT0FPUBMC& FE7T Permit No. BOARD OFFIREPREVE W0NREGUL4T10AN 527CMR 12.-60 VAA Occupancy &Fees Checked PPUCATTONFOR PERMIT TO PEUORMELECTRICAL wORIT ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELE MCAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL. INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to per Location (Street & Number) Lj r� Owner or Tenant A6 c, �� Owner's Address the electrical work described below. L e-- AnDS I Awe. (0 Is this permit in conjunction with a building permit: t Purpose of Building N'9_(A) Existing Service Amps Volts New Service Qb Amps JaLO tc�4OVolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Worts Yes JM No (Check Appropriate Box) _ � Utility Authorization J2340 Over ead Underground No. of Meters Overhead Underground No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above El Below Generators KVA gro6nd wound No. of Receptacle Outlets No. of Oil Burners No. of Emergency g y Li ghting Battery Units No. of Switch Outlets No. of Gas Burners _ A. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons e�— No. of Disposals No. of Heat Total Total No. of Detection and _ Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal ED Otter" Connections No, of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER {:• I. 1 :` V '•1 ! a Ili • :•',:' 1]•:�d.••♦ • • :� ` •:✓. as :.. I .� - .I n :• •: ►I ► •� 1' 1 �� .7 t/ err •: • SP-' v OWMM'S NK JRANCE WANQt; aocl�atmysigt�taemtkls}XII13�1Q1� tBC�Ti3)t. (Please check one) Owner a Agent r 'fit A wt Telephone No. PERMIT FEE $ I CQ Z, -3sv'j,-a,� 331, t I I N O, HORtry try O l 3 v Town of s �' -0;C''. NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT L/SS v PERMIT NO.: PROJECT: X ��� 1=�& DATE: '7' ��' UNIT NO.: FLOOR: WING: BUILDING NO.: / 0� c�26 90t-- j aveb.5-�er� c4 _ �LOO D� REMARKS: L t k ? W/ti`s LEL 9-0-13 0M 12 it C9 Nit 1, �cf? r i� NGD►l� �j o� �41�) S a 1 yt •ati a` Excavation - depth and soil conditions Framing - Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains - Insulation - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept - oil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: —Cof 0# Inspector Inspector Inspector Form Mb Action Presa, 685-7000 Location L42� * '�D tPe44Ce a)oocOS 4A No. /1 i. z _ Date1-1-6-0001 Check # / �:)0 3 14.6 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ U. Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING The g,fcir iltKall usi Q>ul BUILDING PERMIT NUMBER: DATE ISSUED: / SIGNATURE: &C�� Building Commissioner ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: d %— tq 1.2 Assessors Map and Parcel Number: oK /063 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R.;2— _s/ c �y N �� �/r 3 -7 Zoning District ProposedOse Lot Are! (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided Sol i 301 7 5 f 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public W Private p Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ;re -7-,-5r --231 s5,a 71��, S � � f,� �f' /V /r3ryP Name (Prin6 Address for Service �a,w, 4�;Z� 6 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - C NSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 06 U 6'.,�2 3 License Number Address 4� , a,/ " 6 5 7 '. 6�300 Expiration Date Signature Telephone 6�5-7-5-7(L0 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone J� M r 0 z M 0 mn r M r r z G) V SECTION 4 - WORKERS COMPENSATION (XG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction V Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work 9 map eyzickrt s x�� 62ff,-/ ev root, �%� Pim r��7c e V .110, e/o n e*YY °3 Ff' § 1,2 X toPO4 QIP r. /-- I SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1 Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier K y Sa tel' 2 Electrical (b) Estimated Total Cost of Construction ` �C•' (y 3 Plumbing Building Permit fee (a) Y (b) 4 Mechanical HVAC 5 Fire Protection b 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 behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, l -i / � JS s &! / as (fir/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 1, Print Na P Signature of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS lsr 2N[D 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 L 1463 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 6 19 Application by the undersigned is hereby made to connect with the town sewer main in ��i � �� Soeet, subject to the rules and regulations of the Division of Public Works. The premises are known as No. �Je 10 S /�/- ZJ&o Z, Z Gl >0 Street or subdivision lot no. 26 /,97— 55�0 l )r-,-,rzzz Owner Address Contractor Address r Applicant's Signatu PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission toC4 / r, � Z�<f X5,1 to make a connection with the sewer main at We -45 ( e,— a&er(g Lgi. Al 'e Street subject to the rules and regulations of the Division of Public Works.. Inspected by Date Division pf Public Works By See back for rules and regulations S�e_ A 911�1�owl-1 ( (0-,7 e f,40O z-eS l' 1 TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (508) 685-0950 Fax(508)688-9573 Date: c q LOCATION: �,f% ��� til% d 24 BUILDER: phone: OWNER: phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: s NO 925 --,l;kPPLICATION.{FOkWktEklgtRVftC-CONNECTION-3,-I PVP Zl­.'._;4 ;Ivioi )ti n: );'1 9% f';_)idw 2nism v3irw rii,,,- joy :)i!d 'I Andover S. , 19 uq it) noi, qorth. .2� U Application by the undersigned is hereby made'to cohnect with the town water main in 'Store, subject to the rules and regulations of the Division of Public Works. v. 1,G `1{. 1 ;1. ;W f-",� 9d it 'a" -9 The premises are known as No. e.5 L, Street or subdivision lot no. 1;,W,)9 10 1311'!UM 07-n15 d L1,CZ 4� 41' 1 (2 b>,94e� 4,>Y 7� are, PA Owner Addressis V r( 'j)2 d111D I `J 1 '11 Contractor /Address �quiq 2,&A ;):,.r, not to -1 z.r rijiw aqJ 9h3 qdl lo 9d I PERMIT TO CONNECT. -WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at Z4 Ne Street subject to the rules and regulations of the /Division of Public Works. Board of Public Works By Inspected by Date Se e - See back for rules and regulations TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. Willett Telephone (978) 685-0.9.10 Staff Engineer Fax (978) 68.8-9573 Additional conditions for lots 14 and 26, Campbell Forest December 13, 1999 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 14 and 26 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these two model homes can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. 2. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation t e ve conditions will void both water and sewer connection permits. No refunds will be granted. Mesiti DeWmorp Printed Name Date ivision of Printed is Works NaO16 CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin Date Growth Management Bylaw Exemption Statement Town of North Andover Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of.North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) C'd,wPbe11r,,e16- 646 yo Webster- cvavds e Map and Parcel: iota Purpose of Application (check below) Phone Number of��pplicant: ✓Single Family — Two Family 97f� bS7`._ oo I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit far the enlargement. restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this See, an "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination" that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTUS2N as cited above. Further I understand that the submittal of misleading and or inaccurate informs on, o he checking off of an. above item which does not comply, whether done to my knowledge or no /is group s for refusal by the Building Department to issue a Building Permit. ozc h�6 ignature of Owd#po6ir Aut onzed Agent who signed the Attached Budding Permit Cate This form must be attached to the Building Permit upon application for such permit a y_N DEPARTMENT OF PUBLIC SAFETY CONSTRU04SUPERVISOR LICENSE " i Nunber, Expires. r9234,":95189/2888 Birthdate;, t � i �CS .� 8518911954 j Res#r �ed�to�3` 88 ALAN 0_►USSELL 499` IG IIV. 6ROVELAND , MA 81834 in --I O in m aj 0 5 m Z r« -% =ro rn a � O" y M N am 0 C > > o c 3 x 3 3 -9 0 EPEP � co =0) o c' m O O n fD 7 y .t `° D 3= = o m �. 0-3 x 0- a cD (D0 0 ft C -0 < -n-a m > :o ��ei M 0.3 a 0CL lb =. O C � O Oc�rc - C 0 0;V C fD E O Q' c 0 �Q• c' 4K# * r0►1� Q LnO N �p fD LD ajNCD m M CL tp m� a 3 c�� :' C➢� I CDmn s �h o � `LCD W� C cm Iraw a ?� o :•Z o _ nk O ID 5A v 00 b' z 4b Z vp A Cl) m Cf) Cl) m CA co 0Z E; . O d CLCD�■ Op CL Q CO) CD O L-� CA god O CA O COP) O CD CD y� CD y c m 2 O -•00Q' M SaOto y , =Elm m n CD OOdo T Z S- y --q ? o a 06 CD ti O N p S' m m O OZy� CD CA r _ 0 CL.m 3 ��. /r/^ cc O ?S VJ m N mc c n c H mow: o m zCL W ao�� N lr '^ ? N O C yp�mm�e W H �ooc z -- o _rot � o �y� o CP; :C .?*M- c D CD 06.0 a 5 mmi O ° ~ w F G 0 a " Azr- G CL 0 'd y � ro ro x 0=3 0 9 0 c FORM U - VERIFICATION 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 requiremerLts. ****************Applicant fills out this section***************** APPLICANT: �,D�// �ot�st frs� fi �v. �'P. Phone LOCATION: Assessor'.s Map Number fi r% (9 Parcel Subdivision Ca0''6e / s & . Lots) a 6 Street Websfe'-GvMQ's 6aile � � Ila- St. Number 10 ************************Official Use only********** RECOMMENDATIONS OF TOWN AGENTS: 7,%7_-'%16 Date Approved 11-7_1J60 Conservatilon Administrator Comments i �Cb Toti;n P- ner Comments Food Inspector -Health Septic Inspector -Health Comments Date Rejected _ Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected SeeQ[c!� Public Works -sewer/water connections driveway permit Fire Department Icej i��edc�r��� s(Jr��1�Ger o pe(' 4,e'JeJ. Ci LTO AdL WVAD z-,(& /-7 Received by Building Inspector Date The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: Citv _ _ _ _ Phone # ❑ 1 am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity T1I am an employer providing workers' compensation for my employees working on this job. C'mmn2nv n2me �.2s���F7Pi%i�f`Pst GC' �ut''Si 1 �PI/ 6"1-7 Address 3/ SL" 7L4,7 / /��74. S e, f ft°' .�� City' /V ©!�7/t /�yyc�T �'`"( c?. ���s� Phone # �`�) 6 7 - S 3oc7 Insurance Co.. S Policv # KJ O / 6 Comcanv name: Address cit r Phone #: Insurance Co. Policv # Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as5iuinalties in the form of a STOP WORK ORDER and a rine cf ($100.00) a day against me. I understand that a copy of this statement ay be foNqrded to the Office of Investigations of the DIA for coverage verification. I do hereby certify ung theearins and Signature Print name of perry that the information provided above is true and correct. Date Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina ❑Check if immediate response is required Contact person: Phone #: ❑ Building Dept ❑ licensing Board ❑ Selectman's Office ❑ Health Department ❑ Other I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-28-2001 DATE OF PLANS: March 26, 2001 TITLE: Lot 26 Lincoln PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 592 Your Home = 589 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value ------------------------------------------------------------------------------- U -Value UA CEILINGS 1720 30.0 0.0 61 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1744 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using theap icab Standard Design Conditions found in the Code. The HVAC equipmen selected to heat or cool the building shall be no greater than 5% f he desi load as specified in Sections 780CMR 1310 .4. Builder/Designer Date �,�/ �MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 26 Lincoln DATE: 3-28-2001 Bldg.i Dept.l Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: L l I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 I For windows without labeled U -values, describe features: I 4 Panes Frame Type Thermal Break? [ ] Yes I Comments/Location I I DOORS: L l I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When i installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can ] No I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating i equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ l I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ l I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ ) I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: i HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 1 1.0 1.5 2.0 I 140-160 0.5 1 0.5 1.0 1.5 T NQ 0740 Date. TOWN OF NORTH ANDOVER n t y RECEIPT SS�CHUS�� This certifies that ................. �`J [l ............................... has paid .................... (�. . f� ................................... for...�tl........... j��- Received by .......................... Z.?.ut............ c Department r ` ................ a, �kts WHITE: Applicant CANARY: De paQnt PINK: Treasurer F Building Value Calculation - for Property at..... LOT# 26 - S ��?f/2 �i i .,. til ��M;!>�'K�'1•�w'•�"�S` �.. Room Length Width Sq.Ft. .fix-: Cost per Sq.Ft. a e.-� .En�^ v �,,Y,.,. Total Cost Kitchen 24.5 12 294.00 65 $ 19,110.00 Brkfstnook 10.5 6 63.00 65 $ 4,095.00 Dining Room 14 13 182.00 65 $ 11,830.00 Family Room 22 18 396.00 65 $ 25,740.00 Study 10.5 13 136.50 65 $ 8,872.50 Living room 14 13 182.00 65 $ 11,830.00 Garage 24 22 528.00 35 $ 18,480.00 Entry 20 11.5 230.00 65 $ 14,950.00 2nd floor foyer/sitting 19 11.5 218.50 65 $ 14,202.50 Sunroom - 65 $ - mudroom 6.5 5 32.50 65 $ 2,112.50 Walkin closet 13 6.5 84.50 65 $ 5,492.50 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry - 65 $ - Bedroom 1 22 18 396.00 65 $ 25,740.00 Bedroom 2 15 13 195.00 65 $ 12,675.00 Bedroom 3 16 13 208.00 65 $ 13,520.00 Bedroom 4 14 13 182.00 65 $ 11,830.00 Bedroom 5 - 65 $ - Bathroom 1 9.5 8 76.00 65 $ 4,940.00 Bathroom 2 13 8 104.00 65 $ 6,760.00 Bathroom 3 13 10 130.00 65 $ 8,450.00 Bathroom 4 - 65 $ - Bathroom 5 - 65 $ D(_ X00 3 r0*0p- /3 q31 - -F v� �v roiv S � R- �,�� CA �°