Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 41 FERNCROFT CIRCLE 4/30/2018 (2)
41 FERNCROFT CIRCLE 210/103.0-0105-0000.0 ✓ i if 01 - a r , , � l ' i vx�m vo N15; 510 if Zhu vyvq's�- GcR IGUUvv\ - t r a lot + 't� I LA-)t krA 0-asS } ` G Y�to v�ck4cb C-u.o vi c, �,�.o1��w� �oO�t- F�vG 5�4rc o SIC, i t 1 1 2p'.^i 1�{_ ..r..y.r ....ar.-�..a.,.r..r��... .�n. .•v�v. "_�t,.a,s+4 1 a aYSe Lt►cw G".aQ { Location No. Date • • TOWN OF NORTH ANDOVER , Certificate of Occupancy $ Building/Frame Permit Fee $? V---- Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# °� 1 Buil ding Inspevtor j Commonwealth of Massachusetts Sheet Metal Permit Date: Permit# Estimated Job Cost: Permit Fee: $ ✓kU Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# / j g0z-1 Business Information: Property Owner/Job Location Information: Name: Ci4A/c, a . ex Scr0-5 Name: Ij Street: q( Pf`m,,,t. 54 _ Street: ( fir n eiru City/Town: A�,A(4, City/Town: /Vv(4 , 4Ajvv, Telephone: -Igl (so'q ,3 Telephone: Photo I.D.required/Copy of Photo I.D.attached: YES_ NO Staff Initial J-1 /A 0-1-urestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family I—,-�Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. ver 10,000 sq. ft. Number of Stories: k Sheet metal work to bempleted: New Work:lz Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: W- (—A ell INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes ❑ If you have checked Yes,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 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. r Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],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 metalwork and installations performed under the permit i ed for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General ws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments 4 Final Inspection Date Comments Type of License: By Master Title ❑ Master-Restricted City[Town ❑Joumeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted Q!T License Number: 1 Q y Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval 1 PROPOSAL Callahan A/C&HEATING SERVICES PROPOSAL#: 112489 91 Belmont Street North Andover,MA 01845 DATE: 9/8/2016 www.callahanac.com REP: KJM 978-689-9233 TO: JOB LOCATION: FRANCIS HEBB 41 FERNCROFT CIRCLE 70 Lake Shore Road NORTH ANDOVER,MA 01845 Boxford,MA 01921 DESCRIPTION Total INSTALLATION OF A NEW 2-ZONE HEATING AND AIR CONDITIONING SYSTEMS(GAS PIPING AND ELECTRICAL NOT INCLUDED)CONSISTING OF THE FOLLOWING:FOR FIRST AND SECOND FLOOR ADDITION A_CARRIER MODEL# 59SP5A060EI7--14 GAS FIRED 96%HOT AIR FURNACE 60,000 BTU B_CARRIER MODEL#24ABB324AO03 13 SEER 24,000 BTU CONDENSER(R410A) C_CARRIER MODEL#CNPVP3017ALA COIL D_ALL NECESSARY REFRIGERATION PIPING E_ELECTRICAL BY OTHERS F_GAS PIPING BY OTHERS G_PVC FLUE AND COMBUSTION AIR PIPING DIRECT TO OUTSIDE H_30 x 30 CONDENSER PAD[PRECAST] I_ALL NECESSARY DRAIN WORK WITH CONDENSATE PUMP AND PIPING J_INSULATED AND SEALED DUCTWORK WITH FLEXIBLE BRANCH LINES TO REGISTERS K_CENTRAL RETURN REGISTERS L_2-APRIL AIR HEATING AND COOLING MODEL# 8463 DIGITAL THERMOSTAT M_ZONING PACKAGE(2-DAMPERS, 1-CONTROL PANEL) N_SHEETMETAL PERMIT AND INSPECTION O_REQUIRED DUCT PRESSURE TESTING P START-UP AND TEST PAYMENT SCHEDULE: 1/3 DEPOSIT UPON ACCEPTANCE OF ESTIMATE 5,000.00 1/3 NEXT PAYMENT DUE UPON COMPLETION OF THE ROUGH 5,000.00 BALANCE DUE UPON COMPLETION 5,000.00 PAYMENT TERMS SEE PAYMENT SCHEDULE ABOVE Total All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. All covered by Workman's Compensation Insurance's. Equipment warranty by manufacturer. Contractors labor warranty for one year. AUTHORIZED SIGNATURE: DATE: CUSTOMER ACCEPTANCE: DATE: **A signed copy of this proposal and deposit must be received for us to schedule this installation. (This proposal may be withdrawn by us if not accepted within 30 days.) Authorized !?lair@' Partner in Comfort Pagel Callahan PROPOSAL A/C&HEATING SERVICES PROPOSAL#: 112489 91 Belmont Street North Andover,MA 01845 DATE: 9/8/2016 www.callahanac.com REP: KJM 978-689-9233 TO: JOB LOCATION: FRANCIS HEBB 41 FERNCROFT CIRCLE 70 Lake Shore Road NORTH ANDOVER,MA 01845 Boxford,MA 01921 DESCRIPTION Total NOTE: THIS FURNACE WILL QUALIFY FOR A$300 REBATE FROM"GASNETWORKS". PAYMENT TERMS SEE PAYMENT SCHEDULE ABOVE Total $15,000.00 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All covered by Workman's Compensation Insurance's. Equipment warranty by manufacturer. Contractors labor warranty for one year. AUTHORIZED SIGNATURE: DATE: CUSTOMER ACCEPTANCE: DATE: **A signed copy of this proposal and deposit must be received for us to schedule this installation. (This proposal may be withdrawn by us if not accepted within 30 days.) Authorized AD11take, Partner in Comfort Page 2 r Page 1 Residential Heat Loss and Heat Gain Calculation 9/14/2016 In accordance with ACCA Manual J Report Prepared By: Callahan A/C & Heating For: Francis Hebb General Contracting 41 Ferncroft Circle North Andover, MA 01845 Design Conditions: Lawrence Indoor: Outdoor: Summer temperature: 72 Summer temperature: 87 Winter temperature: 72 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 95 Daily temperature range:Medium Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Infiltration 2,220 3,384 5,604 14,481 Windows 8,692 0 8,692 10,389 Walls 1,778 0 1,778 6,884 Duct 0 0 0 3,715 Glassdoors 1,145 0 1,145 1,379 Floors 0 0 0 1,248 Fireplaces 0 0 0 1,093 Ceilings 587 0 587 1,084 Doors 154 0 154 596 Skylights 0 0 0 0 Misc 1,200 0 1,200 0 People 1,500 1,150 2,650 0 Whole House 17,276 4,534 21,810 40,869 (2 tons HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. OP ID: PS DaTEItaM[Do[xYYvI .,� CERTIFICATE-OF LIABILITY INSURANCE 1 111612015 TH[S CERTIFICATE 1S ISSUED ASA 1tflAi TER OF ENFORAAATiON ONLY AND CONFERS NO RIGHTS UPON THE CER 7IFICATE.HOLDER_THIS CER-11FICA`tE 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 INSIJRER(S); AUTHORIZED REPP.ESENTA 11VE OR PRODUCER,AND-THE CERTIFICATE HOLDER.. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION:15:WAIVED,subject to the terms and conditions of the.poiicy,certain Policies may require an endorsement. A statement on this certificate_does not confer rights tothe certificate holder in lieu of such.endorsement(s). PftOD1.1iE2 CONrP.CT Pete.SU I Ivan NAME: Foster Sullivan'Insurance PHONEy78-686-2266 (FAX 163 Main St. Arc.N,,.Ext: arc No:97$-686-64'i 0 North Andover,MIA 01845 E-MAIL p$uilivan@fostersuilivangroup.com Stephen Sullivan PRCER cUsrora R rD i:CALLAA INSURER(S)AFFORDING COVERAGE NAIC t INSURED Callahan A C and Heating IINSUIRERA.-LIBERTY MUTUAL INS,CO. 123043 Services,Inc. iNsuRsR3.:GUARD INSURANCE COMPANY Kate Callahan ; 91 Belmont Street INSUR=-RC: North Andover,MA 01845 IN13URERD: j INSURER E. 1 INSURER F: COVERAGES CERTIFICA T E NUMBER: REVISION:NUMBER: THIS ISTO CERTIFY THAT THE POLICIES OF INSURANCE-LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP.,THE POLICY PERIOD INDICATED. NOT-WITHSTANDING ANY REQU IREMENT,TERM-OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IJ1itiICH THIS CERTIFICATE-MAYBE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY.THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. jLIMITS SHOtNN MAYHAVE SEEN REDUCED BY PAID CLAIMS. LTRI TYPEOFlNsuRANCE JNSR y/" i ?DUCYNLRdBc4 lnaa°amnrr[n P61[DD ( LIni1T5 ( G-.'---RAL LIABILRY # I { crl OCCu=eENC= Is 1,004,00 FciE I U YET'Icu 140 tI00 A X COt.INIERCIA_GENERAL LVET I!r X CBP4016154 10912512015 09125/2016 1 P? USES Ica et^us ,- I s , I �CLAIMSa.14DE I X I OCCUR W,�Y-'i Exp tfi ry oris p=rronl I c S,Qoo I CONTRACTUAL LIAB ( ; PERSONAL&ADV GWJJRY (s 1,000p j I G&NERALAGGRcGATc 15 Z,Dt1D,4a '1AGGPEGATEL1,41TAPPLIESPEER: it PROGJC -Ct:?nF10PAGG I c 2;4Q4,40 (POLICY I-XI PSC LOC ' I I 1 1 AUTOMOBILE LIABILITY ){ I 1 �CO PINED SINGLE LIr;,R S 1,004 00C A P:aY Act a t IBRD 5S4iI35 j 09/25/2015 r 09125/2016 ' l I BODIL,.�A IRY tP=PSI S X ALL OWNED PLrGS I 1 I EODILYu:.fURY(P,a�der,i)1 S PROPEi f DAMAGE e X HIREDAUTOS + r tPs?iCCoI X r:utd•011NED AUTOS X UtdeRELLA LIAB X OCCUF ( EACH OCCUF RB CF I v 5,x04,00 A i Exc=SS I.IAa 1 C SIN c;T_aL� X1091251201510912512:016r IN c-EGFTE I s 5;00q,00 CU8809334 iDuc�lulE i I; !n?�...PIT-lOt4 s I Yv.,., FEN EN WORKERS COt,{P_t•1SATIOtd � (- I X I tie 1 AND EMPLOYERT LIABILITY tTGiY'LI5i,r5 B ur"PRo�IErOR�?AR-ri�VEY---JTIVE lta CAWC604073 1 09125/2015�09125120161.E 1_- I, , . �.�c;;,Ccr:�rar c b04 404 o [R e: CLUD ? N[A 1 ( ° 6Go 000 (Mandatory in Nti) 1 1 c1[OTS`;5E-F ti�iFLOY�S , It yr2�.das�3e tdzr. j( j DESGtIPnON Or OPERATIONS Maw i JE_ O!&�?8--POLICY Ll;dri!,' St10,404 DESCRIPTION OF OPERATIONS[LOCATIONS I VEEJICLES(Attach ACORD101,Additional Remarks Schedule,itmore spice Is required) EVIDENCE fax#978-688-9542 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE-ABOVE DESCRIBED POLICIES BE CANCELLED-BEFORE THE EXPIRATION DATE. "THER7=oF,,NOTICE WILL BE DELI1tERED IN " ACCORDANCE JJITH'THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 1600 OSGdOD STREET AUTORIZEDR6PR=3EN ATVE NORTH ANDOVER :MA 01845 G 1988-2009 ACORD CORPORATION.All rights-reserved. ACORD 25(2009109), . The ACOR.D name and logo are'registered marks of ACORD J �-S BCH�SETTSr y��RIVER'S LICENSE .�nd 9a END 4d NUMBER r ' "�NOt7E 05 -28= S9558529© DDR 4KNDr R34— ON '- t3Y14 Y•l7IYTiW�" �wb-:,� .j• E ,.-y ' :,'� � ' KEVIN J" • 24•�9TtF'� �, a 1022 MAPLE ST MANSFIELD,MA 02048:1629: DD OSP-2014 Rev0T•15-2009 rj r ,£OMMONWEALTH OF MASM HtfSETTS :; ID 0 a , BOARDMF SHEET.METAL WORKERS ;? £ ISSUES THE:FOLLOWING LICENSE AS A PIASTER-UNRESTRICTED',.-1, KEVIN J MCDONAL , „ 91- ELMONTS. . r' f T NORTfiI ANDOVER,I" 018 5X04 12404 15/28/2018 45125 W :.:D:. 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 �t 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 maybe_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. rV'rRulePermit/Date Closed: ***Note•Reapply for new permitxtension A.ct—Permit/Date Closed: Date 6 /.Z- �, ,. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . .fig . . . . . . . . . . . . . . . . . . . . has permission to perform . .Sv!v SE''�U�� wiring in the building of . . . . . . . . . . . . . . . . . . . . . . . . at . . . l / �w� c!� . . . . . . . . . ,North Andover, M ss. Fee . ;�.Q Lie. No. . J. ! . . . . . ELECTRICAL INSPECTOR/ i, 'heck# f f / Z. A `► 1! 001 Commonwealth of Massachusetts Official Department )Use Only Pernvt No. 100 of FirP Ser�- PC -------- l _ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) —_ — APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD All work to be performed in accordance with the Massachusetts Electrical Code(M IC), 5 7 CMR 12.00 (PI,I',9SLs PRINT IN INK OR TYPE: ,ALL IN 'D ATION) Date:_ City or Town of: _ T o the Inspe form o Wires: By this application the undersigned gi es noti e his her intention to perforth electrical work described below By this application the undersigned giocs Location (Street & Number) VIC Owner or Tenant J-� "K)A& Telephone No. Owner's Address -- -- -- .___...-------- ----- — ---- - - Is this permit in conjwictio with a .uildiug permit? Yes No ❑ (Check Appropriate Box Purpose of Building ? h ✓✓ Utility Authorization No. Existing Service[0� Amps _/V_ 1 �Volts Overhead Undurd No. of Meters I New Service ! Amps �v) / /bp volts Overhead Undgrd ❑ No. of'Meters , Number of Feeders and Ampacity �. Location and Nature ol'Proposed Electrical Work: I. e ,y 1I Completion of the following table gray be waived b_y the Insll ,;, )i Dt';res [No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Faris No.of Total Transformers K_VA_ No. of Luminaire Outlets 2 No. of Hot Tubs Generators KVA (----------------- — -� Above In- No.o mergency Ligl�in ---- -- - INo. of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units INo. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones J� -- ----— --- No. of Detectionand - -- , No. of Switches — No. of Gas Burners Initiating Devices h of Ranges No. of Air Cond. Total Tons No. of Alerting Devices — Heat Pump Number Tons KW No. of Self-Contained INo. of Waste Disposers ................._.................._ l Totals: Detection/Alerting Devices P I------------ --- ...-----__---------- No. of Dishwashers Space/Area Heating KW Local[:1 Municipal (l Other 4 ------__---- ._-_-- - -___--- Connection INo. of Dryers Heating Appliances KW Security Systems:; — ____-___` __ No.of Devices or Lquivalent No. oh Water KW No. of No. of Data Wiring: -- Ileaters Signs Ballasts No.of Devices or Equivalent Telecommunications W irim. �No. Hydroinassage Bathtubs No. of Motors Total HP No.of P;Devices or uivaten'_ OTHER: - - Attach additional detail ifdesired,oras required by the Inspect.r of E'--tirnated 'Value of Electrical Work: _ ' (When required by municipal policy.) Wolk to Start: Inspections to be requested in accordance with MEC Rule 10, and upon cornpletion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove- ge is in force,and has exhibited proof of m to tl} pernU issuing office. �;IIfiC:K ONE: INSUIZANCF BOND ❑ 0"I'IIER ❑ (Specify:) /0,Q 1 certify, tinder the pail sjjall d penalti s o etjury,thaaL�,t'I in ormation or flus application is true and complete. L FIRM NAME: uJ ,4 >� uc- Co LIC. NO.:�'J�� Licensee: - I Aeal ���� Signature LIC. NO.: (if applicable, e/e "exenr " 7n dne 1 dense aurnb 1 ,e.) Bus.Tel N - Address: _ I G >D" h % Alt.Tel. No.: J *Security System Contractor License re -ed for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does ,rot 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 N I'LIOU jI rj,- �= w' ................... Ot TOWN OF NORTH ANDOVER PERMIT FOR WIRING HU This certifies that ...—.. ec- t aNc . ..... .............................. ............................................................................ has permission to perform ........1.1........6K�.v...................................... wiring in the building of.......-A v at ............. ............ . ..................................... L orthAn Andover, ass. ................ . dee 7 ...............Lic.No. ................ ' . . .i...... . ELECTRICAL INSPEcF0 Check# 1 ' Commonwealth of Massachusetts Official Use Only ' Permit No. _ Department of Fire Services Occupancy and Fee Checked U. BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank) . APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .All work to be performed in accordance with the Massachusetts Electrical Code ,527 CMR 12.00 (PLEASE MUM NK OR TYPE ALL.INFORMATION) Date: 7 City or Town of: NORTH ANDOVER To the Inspec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) f-h Dl-- Owner or Tenant ^ �' S M C, Telephone No. Owner's Address Is this permit in conjunction with a uilding ermit? Yes No ❑ (Check Appropriate Box) c� 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: 0000'e 1 'e 0 YA Completion of the followin table may be waived by the Inspector of Wires. i to,. Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans ormers KVA -- No.of Luminaire Outlets No.of Hot Tubs ators KVA Above In- mergency ig tmg No.of Luminaires Swimming Pool rnd. ❑ rnd. Batter Units No.of Receptacle Outlets r No.of Oil Burners FIRE ALARMS I No. of Zones No.of Detection and r^ No.of SwitchesNo.of Gas Burners Initiatin Devices Total \r No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW.......... No.of Self-Contained j No.of Waste Disposers Totals: Detection/Alerting Devices Municipal ❑ Other No.of Dishwashers Space/Area Heating KW Local ElConnection I Heating Appliances KW Security Systems:Y No.of Dryers No.of Devices or Equivalent No.of WaterNo.of No.of Data Wiring: S Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: J_1 No.Hydromassage Bathtubs No.of Motors Total HP 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 cov ge 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: . l E'Cc S% S'f l S << LIC.NO.: Licensee: c SSignature LTC.NO.: =14 � (If applicable,enter "�xem�Pt' in�Ecieanui—er�i h ) Bus.Tel.No.: _ y� Address: SRtt!r7 a, �ZD x?'d ��11'h l Y-31 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License. Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent ,PERMIT FEE.$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed y 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 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass❑' Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ t Inspectors Comments: Inspectors Signature: Date: ROUGH SPECTION: Pass ? Failed Re-Inspection Required($.) ❑ Inspectors Comments: v Inspectors Signature: Date: FINAL ECTION: Pass 0 ' Failed Re-Inspection Required($.) ❑ Inspectors Cotnme Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts P It„Fprrn , Department of Industrial Accidents Office of Investigations M' ? 600 N%ashin-ton Streeta Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1 6C -z:) S+C S Address:___ 0 S LR C e00 1 QQ City/State/Zip: 0 d Phone#: V Are you an emplover? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' insurance.# 9• E] Building addition [No workers' comp. insurance comp. required.] Pq We are a corporation and its 10XElectrical repairs or additions 3 I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL - 12.[1 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees;they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Got nl r10 lysu_r4 Policy#or Self-ins. Lic. #: 6M - 5 K Expiration Date: S �f L� Job Site Address: �r17� /ted F-t �, City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify er t e p and pena/�'Qs of perjury that the information provided abo a is true and correct Si--nature: ..e.c1l�C Date: / _. 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): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I Commonwealth of Ma usetts QtYiSton lid{2egistrati` IF ``�` Baird'of Elecfn NICHOL W 55 SHET o BOXFOR 0 Master Elec a -a 008519 21639-A 07/31/2Q1,3. License No. Expiration Date. Serial No. r 0850 Date .. . . . . . . . . �rt`9ajs... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . 1N, N. . 1 [ has permission to perform . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings..of. . . . Q.`�� "`��'-'. . . . . . . . . . . . . . . . . -�41 Tpr,,jn rbI � ice. ` at . . . . . . . . . . . . . . . . . . . . . . . ,North Andover, Mass. �t3Zo1-5 4i,� . Fee . . .C.-�J- ic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IPLUMBING INSPECTOR Check# ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT#Vo JOBSITE ADDRESS �C1'A CM'�'j- /�. __jj OWNER'S NAME %C�`!ti, yi,�a✓ POWNER ADDRESS TELT T - FAX j TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:Ef REPLACEMENT: El PLANS SUBMITTED: YES NO FIXTURES 7 FLOOR- BSM 1 2 _ 4_ .._5._ 6 [i _..Y_7 _.._S_ 9_..... .,._1_0 1.-1_ 12 1_3 -I 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ _I DEDICATED GAS/OILISAND SYSTEM wl I l ...._..-.► I . _...._ _ _I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I I } I ....___J } I I J ..___...._i I f __1 ( _I DEDICATED WATER RECYCLE SYSTEM DISHWASHER -1 ._...__f _-_ _1 l f __....__I .__._.._I ..__ lJ __--.-! 1 _.__.a _ ,_.f I _._......a DRINKING FOUNTAIN i __....J ---.-_.I _.__.__I FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _l -1 .............-__._..._I - 1 i ....____} 1 I _-._..._...J==== KITCHEN SINK LAVATORY ROOF DRAIN i I I [ l 1 _j _ ......__i _.__J ._..__.i __._J SHOWER STALL SERVICE/MOP SINK �_jTOILET _ URINAL WASHING MACHINE CONNECTION ._7 _ i WATER HEATER ALL TYPES WATER PIPING 1 _A_ i __._i .__.._ L OTHER _:.i ____...J _.. _} . ..__..1 1 INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES�I NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY D11 BOND Q 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. j nS` CHECK ONE ONLY: OWNER D 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _�-am a Y- ._ d - LICENSE# e17O f �— SIGNATURE VIP i JP EJ CORPORATION 0# PARTNERSHIP]# _ -_ _._ LLC f COMPANY NAME ' G,.Y C a _ ADDRESS 7� fv,�a1►➢' G?" _ - -- - -- - , �- CITY�NO./ n 0r�t/ NL/i� ............1 STATE ®ZIP O! S _ jl TEL CgTB__ Sl��'G_ FAX - j CELL_ . EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No r THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES a The Commonwealth of Massachusetts Department of IndustrialAccWnts Office of Investigations 600 Washington Street Boston,MA 02111 qu www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): T. lVtcG"144, Address: 976 P4vvr S 7—, City/State/Zip: /Vy,}�(p 4,c/v t A0/JPV9hone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ,fit employees(full and/or part-time).* have hired the sub-contractors 2.!�q I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. 9 y p ty• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certto under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: s+�3 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone It: r 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 employeiis 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 Industdal.Accidents Office of Intvestigations 600 Washington Stmet Boston,MA 02111 Tel.#617-727-4900 ext 406 az 1-877:MASS.A8.8 Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia A _ Commonwealth of Mas usetts —� Division of Registrati Board of Plumbi t i THOMA EN W 429 WAVti APT 1 o NORTH A ' C `O I� Journeyma � •u �� PL32701-J 05/01/2014 �GqM sve 004905 i License No. Expiration Date. Serial No. " Location No, ��/ �' Date NORTp TOWN OF NORTH ANDOVER O?O•t•`•D ,•,hO R n Certificate of Occupancy $ Building/Frame Permit Fee $ ��s ^°•'t�' Foundation Permit Fee $ JACHUSE Other Permit Fee $ 5 "� Sewer Connection Fee $ Water Connection Fee $ TOTAL $ r � � - *-Building Inspe n r I 02/23/99 11:07 75'00 PAIDDiv. Public Works 1'i'-RMIT NO. QAPPLICATION FOR PERMIT TO 13UIL1)********NORTII ANDOVER, MA Al%P NO. � 1 Oi'.NO. z Q�Q� 2. REcoftu of uwrrLRsulr DATE BOOK PAGE /ONE SUB DIV. 1.0I'N�O.��+ . 1.t)! A nun / �r�v✓c./fi r J �— /f/� � J�-'�' f'l1NPObF l BUII DING ;t�' yt/l - OWNER'S NAME 1/ �A� o NO.OF S 1" H IES SIZE OWNERS ADDRESS Gj— J �� BASFIAL't-IF OR SLAB ARCI III ECI'S NAME SIZE OF FLOOR TIMBERS 1 ST 2 HD 3 RD lit III DER'S NAME SPAN DISIANCF'TONEARESI BUILDING DIMENSItNJSOFSILLS DIS FANCE I ROM S IRE@T DIMENSIONS OF POS I S DIS FANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONT AGE I IEIGI R OF FCAINDATION T1 IICKNESS IS BUILDING NEW SIZE OF_I[XYIING X IS BUILDING ADDI 11014 MAIERIAL OF CIIIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID CWTH.LED LAND N`11.1.BUILDING CONFORM TO REQ 11REMEN'I'S OF CODE IS BUILDING CONNECTED-10 TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSfUCTIONS 3. PROPERTY INFORNIA ION Q LAND COST / �-w / ES F. Bt.[-)(;.COST (v O:x% PAGE I FILI.OLI F SEC IONS 1-3 Q�-� EST. BI.DG. COS I'PER SQ.FT. a EST. BI DC i.COS I PER RO( EI EC-TRIC f IE-I ERS Nit BE ON O(JTSIDE OF BUILDING SEPTIC PLftMI l'NO. A1-1ACHED GARAGES MOST ClNNFORMTOSTATEFIRE REGUI.A'I'IINJS a. APPItovfi) Hl': PIANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING NSPEC-1-OR ` DA IT_FII.f?D OWNERS TEI.b. jIGN• 111H1i 01:OWNER OR All l l I0RIZ)il)AGENT f v �-r IILC.b I'I RPITT l ARAN I1 1) 19 -- Town of North Andover f NORTH , OFFICE OF �r ,�` ° O� COMMUNITY DEVELOPMENT AND SERVICES 101 A � x 27 Charles Street North Andover,Massachusetts 01845 �4SSACHus���y WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions 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: Z) (Location of Facility) Signature of Permit A0 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through-the-Office-of the Building-inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Date.................................. NORTH °� °:•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACMUS� �1L.,�J 1tf Thiscertifies that ...::.. f.......r ................. Thi haspermission to perform f.`..........................................................� l _ ..... wiring in the building of....:1/.. ... �.........I.. . +!��.//.................... at.�! .1, J:.,//�.�.% \. ,North Andover,Mass. ��..... . . . . .... ..... ..-� /1/ Fee � ..�� ( Lic.No/.-;-? ...........................................��AN/ ...................... y ELECTRICAL INSPECTOR J Check # f JJ � IJ • t Official Use Onl • <� Commonwealth of Massachusetts v...— r Permit No. U ✓ Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance� ith,&Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT INTNK OR TY AL� ?;R 'TION) Date: dt `7—0,5 City or Town of: C.(104 Vl�-?_. To the Inspector of Wares: By this application the undersigned gives notice of is or her intention to perf�he electrical work described below. Location (Street&Nu ber) Owner or Tenant Telephone No-0- o. �10- Owner's Address Is this permit in conjunction with a(wilding permit? .. 'Yes..❑., No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps l Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps I 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 olloMn 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 o.o me No.of Lighting Fixtures Swimming Pool rnd.Above ❑ In-rnd. 10Batte Units rgency Lighting - No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o Detection and No.of Switches No.of Gas Burners o. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g 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 Kit Security Systems: No.of Devices or E uivalent No.of Water Kit No.of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: r No.of Devices or Equivalent— OTHER: uivalentOTHER: Attach additional detail if desired,or as required by the Inspector of Wires. A 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:) (Expiration Date) Estimated Value of Electrical Work:(2�z (When required by municipal policy.) Work to Start: �� -v_ Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: Sac=_ity LIC.NO.: 15_13(' 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 Lic, 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/AgentPERMIT FEE: $ • SignatureturaTelephone No. � r Location �/ --1-- -�-•-U- - -*-�-� No. Date NORTh TOWN OF NORTH ANDOVER i 41 a } , Certificate of Occupancy $ CHU 1t' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspe ter G v TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: r DATE ISSUED: a ,y 0 M z_ SIGNATURE: tw( C( teal Building Commissionefflng=tot of Buildings Date' SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: yr hernGrOf4 Circle A(Or-F 11 AnP( 03 /over MA ol?g5- Map 14umber Pan Number _ 1.3 Zoning Information: 1.4 Property Dimensions: Y40'aIP-shad yy,?1 I 131-1 Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided D 1.7 Water Supply M.G.L.C.40.§54) 1.3. Flood Zone information: 1.8 Sewerage Disposal System: ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ public )( PrivateSECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record / /i 1 ir-4ae( ln/adano l yl F.7,-nOro�� Circle A1 A.d11 MA Name(Print) Address for Service Sig ature Telephone s 2.2 Owner of Record: Ahsorc HaN Y,yar-d Hl 1=e1-ncr -F Circle, Al. Andover- MA 0 Na e P 'nt) Address for Service: z CN R?fir-9�S- la�i; 6 11) M $a a Tele hone 90 SECTION 3 CONSTRUCTION SERVICES 3.1 Jjcensed C ction Supervisor: Not Applicable ❑ 71-71-7 Licensed Construction Su isor: 0 IG61 License Number 11-11 A ress Expir 'on Date Signa e Te phone r 3.2 egistered H e Improvement Contractor Not Applicable ❑ Company Na - �1�\ Registration Number r A re r. Expiration Date hi�gna re Tel hone 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.......❑ e e L�4 �/ 7rls4�r�2r yr SECTION 5 Descri ion of Pro sed Work check aH a cable New Construction id Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �Q'x ly ' elhe�C be- lace-0( i Yt yor4 S/'iP' IS a cubr cghs7y,y ►aO L . Plan. is �o i)se 1�' ;��o / � 6r , tags - ��ac-c�.►1en� persh��i rnan✓�utc�- rpc',�mm�nd4 oh irL r-e y/r'y4el,L_s SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 9 (a) Building Permit Fee(a 7°9 Multiplier 2 Electrical o (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(,)x (b) 4 Mechanical HVAC 0 5 Fire Protection (j 6 Total 1+2+3+4+5 3 9.o-to-7.q Ll 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 permit application. Signature of Owner Date SECTION 7b �OWNER/AUTHORIZED AGENT DECLARATION ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on a f egoing application are LTue and accurate,to the best of my knowledge and belief MchaE r' Ita►iol _ � Print Name �� 4!t Si a4ire of ent _�t NO. OF STORIES I SIZE 0 r X/y i BASEMENT OR SLAB �vq SIZE OF FLOOR TIMBERS 2ND3Ku SPAN i#{ DMIENSIONS OF SILLS A/A DINTENSIONS OF POSTS N-4 DRAENSIONS OF GIRDERS NA HEIGHT OF FOUNDATION NA THICKNESS SIZE OF FOOTING to'' ono7✓u'e - X MATERIAL OF CHIMNEY NA 1S BUILDING ON SOLID OR FILLED LAND-- 710 a lId IS BU ENFEr CONNECTED TO NATURAL GAS LINE n b Y JJC GT '_ E K SURVEY INC *HAVERHILL,MA Phone 978-469.11*65 4 Fax 978469-7046 MORTGAGOR A f(d W0 ; A!/({Y ,/_ W�OAA191.f DEED REF. _ J13 L PG. _910 ADDRESS OF PRINCIPLE BUILDING PLAN REF. gj -11 6fWOAe T GIA. DATE OF INSPECTION eco M4 rfld SCALE:1"-Wt 10.001 i Can KL �l S ,oC.w IOYI- � Lo1' 2Z A 1S P Z ia+1 40T Z3 Lar Zi �lo•ar �iy=8' l ClfPLC1 O T RUDEL CERTIFICATION TO: AiwLALf,figlftA& lam, fWt. Na 36M ThB��he principle structurels This Mortgage Plot Plan was prepared specifically for p, M mortgage purposes only and A is not intended or r±epresertted �^� AfCfs l� ��� with the local zoning bylaws in effect When constructed to be a properly line or land survey.This plan is not to be used y S� and]or is OMMM from violam tion enforcenent to establish any of the property Ines`Or any purpose.No lA� action under Mass B.L. Title VII,Chap.40A,Sec. 7. responsibility is extended to the land owner or occupant ■Subject building is not in a Flood Hazard Area. This certification is based on the location of survey marker O Subject bW ft is in a Flood Hazard Area. of others. Flood Hazard determined from the FIRM maps! -GOO G Gated Josa_zyg% T 'd -1a Wd8E :6 t'002 60 gall � ,/ 0 5,- • FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT PHONE L�- LOCATION: Assessors Map Number 3 PARCEL- O SUBDIVISION - LOT(S) 92, L S' STREET 41 Ferns-oP CrrG�e ST. NUMBER X11 FfrA &,�A Circ t e OFFICIAL USE ONL R TOWN S: CONSERVATION MINISTRATOR DATE APPROVED DATE REJECTED COMMENTS Vl 100 7)rW 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 Revlw W)m NORTH Town of An No. ? -__ o LA_ vodover, Mass., COCMICMEWICK RATEo P`*' 1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......� �a� �............��. ✓.. ...� .. ...................................................... Foundation has permission to erect....../PY.�y........ buildings on ......Y.t..........F'f_M�.tr�e1.�....._......Ct1►_."t. Rough . t0 be occupied as S A~� I.N ~ 4,s r Y�� CO 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. 'O V j*6 ,� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ARTS Rough ............................ t cuo� Service ........ ..... ..... ...... .............. ... BUILDING INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.