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HomeMy WebLinkAboutMiscellaneous - 45 AVERY PARK DRIVE 4/30/2018 Location ZIC &41t4j ��.A,e- 14d No. o rY Date� �= y ®FF•yy } _;,,. TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $� �� =C Foundation Permit Fee $ Other Permit Fee L $ TOTAL $ Check#4� 1� 25098 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: ' i{ ` L-2_ IMPORTANT:Applicant must complete all items on this page LOCATION PPS Print - PROPERTY OWNER 'S O1%, Lv r-az_ Unit# Print MAP NW©3_PA.RCEL:O11--; ZONING DISTRICT: Historic District Gesno Machine Shop Village100 year-old structure TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other M �0; oodplam'y 7�r O�Wetlan¢ds� '� ®Wa etf I 1 ed s�ic't FF p S� t R1 r 1FPs `Syj cs nhal `'• 0 Water/,Sewer �� -� D SCRIPTION OF WORK TO BE PERFORMED: i k o wv E (rv� tw S r�r tC4 ti lr- z-� 9A � � w l.�,r-� nr NA/— - j L, , c �,r.F, , (-ec -�.� �r� 51�� 1 �S �k a.•�- n r�:(a� Identification Please Type or Print Clearly) OWNER: Name: 301,E L,J d e Phone: Address: ppwz�(_ -i r kv< CONTRACTOR Name: N t dta� C �,l�V^a%— Phone: LO A Address: 20 1 rz L E M N U Supervisor's Construction License: C S +11 o '3 Exp. Date: .41, 2,0, 2 Home Improvement License: j '}� Exp. Date: `f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BOLDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 19f 000 . FEE: $ (( t, Check No.: V( Receipt No.: �2 s0 F 8— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 77 �nature,of.Agent/..Ovine-r� -. :�r, :'.;�.;.�.. �-:.�.Signature_oficontractor': Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer SwimmingPools ❑ ❑' Tanning/MassageBodyArt ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature - COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 03/12/2012 11:46 5087527172 PAGE 02/03 ACC7R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDnYYY) �.. 03/14/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackstone Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 3144 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Worcester, MA 0161$ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC# INSURED INSURER A: A.E.1.C. Nimon Construction INSURER B: 20 Myrtle Square INSURER C: Gloucester, MA 01930 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN$URED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 4TR INSRD TYPE OF INSURANCE POLICY NUMBER DA M !D ! LIMIT$ GENERAL LIABILITY EACH OCCURRENCE 8 COMMERCIAL GENERAL LIABILITY PREMISES E0 OCturonca $ CLAIMS MADE 0 OCCUR MED EXP(Any one p?rson) $ PERSONAL 41 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY r7 PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Eo o=idpnl) ALL OWNED AUTOS SCHEDULED AUTOS (Par INJURY S HIRF,D AUTOS NON-OWNED AUTOS BODILY INJURY $(Per accident) PROPERTY DAMAGE $ (Per Eedidenl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ EMPLOYERSOMP�ENL A ION AND TORY LIMIT$ ER- A ANY PROPRIETORIPARTNERIEXECUTNE WCC5006043012011 10/13/2011 10/13/2012 E.L.EACH ACCIDENT S 1D0,000 OFFICERIMEMBER EXCLUDED? If yes,deacriM under E.L.DISEASE-FAF.MPI.OYEE $ 100,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER The workers compensation Policy does not provide coverage for Michael Nlmon. Job Site:45 Avery Park Drive CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELE.ED BEFORE THE EXPIRATION 1600 OSQOOd Strut DATE THEREOF,THE ISSUING INSURER"LL ENDEAVOR TO MAIL 15 DAYS WRITTEN North Andover, MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO S0 SHALL IMPOSE NO OIILICATION OR LABILITY OF ANY KIND UPON THE INSURER,ITa AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 26(2001108) 0ACORD CORPORATION 1988 t The Commonwealth o fMassachusetts Department oflndustyial Accidents Qffice of Investigations, 600 Washington Street sv Boston,MA 0211.1 Www-mass-gov/dia Workers' Compensation InsuritneeAffidavit:BuildersiConiractorsfE ectricians/Plumbers A licanlE Infolrmation please Print Legib Name(Businesslorganizationllndividual): I yy\0Y-': &S Address: 20Ttl- Cxty/State/Zip:_ G�';V e SS Phone Are you an employer?Check the appropriate box: _. T am a em to er with 1 4. [�p project(required):p y ❑T am a genexal contractor and Temployees(full and/or part-time). have hired the sub-contractorsew construction2.❑T am a sole proprietor orpartner- listed on the attached shaef. modelingship and have no employees These sub-contractors leavewoxking for me in any capacity. workers'comp,insurance. molition[No workers'comp.insurance 5. ❑ Weaieacorporation and its ilding additionrequired.] .officers hake exercised their ctrical xepairs or additions3.❑ T am a homeowner doing all woriC xighf of exemption per MGL mbing repairs or ddifionsmyself:[No workers'comp. c.152, §1(4),andZvehavenoinsurancere uired, i ofrepairsq ] employees.[Nb workerscomp,insurancerequired.] er =Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. 1 Homeowners who submitthis affidavit indieatingthey are doing all work and then hire outside contractors must submit anew 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 in i am an employer that isproviding workers'coinpensation insurance for my employees .Below is tliepoldcy and job site information. Tnsurance Company Name:_ A 5 ( C . Policy#or Self-ins.Lic.#: eC S00(o O y-3o 1 2© l � L Expiration Date: l 0, l3'20 t 'Z— rob Site Address:_ t-hrts� Poi/k r City/State/Zip: fU© , ,k4ow r M A 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 Inc 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 If up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DTA for insurance coverage verification. do hereby certry under thepains andpena[ties ofpedury that Me information povide dabove is true and correct. mature- Date: t -2— Lone Lone#: Offrcial use ondy. . O not write in this area,to be completed by city or town official City or Town: PermitbLicense# Issuing Authority(circle one): , I.Board of Health 2.130dingDepartment 3.Ci Other 4.Electxic Other alxnspector 5.plumbingTnspecfor Information' and IIl • StrUlCtl®nS 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 ofanother anoter 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 bean employer." MGL chapter 152, §25C(6)also states that"everystate 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have,beenpresented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,i£ necessary,supply sub-contractors)namo(s),address(es)andphone numbers)along with their certificate(s) at 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 maybe submitted to the Department ofIndustrial Accidents for confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained to the city or town that the application for the permit Or license is being requested,riot the Department of the law or if you are required to obtain a workers' Industrial Accidents. Should you have any questions regarding 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 Jaumber. In addition,an applicant that must submit multiple permit/licens0 applications in any given year,need only submit one affidavit indicating current P olicy information(ifnecessary)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 maybe 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 notrelated to any business or commercial venture (i.e.a dog license or permit to burn leaves etc)said person is NOTrequired 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 C01-11MoMt;ai'd of txq1'R:8sa.,c7i�setrs DepwmeAt Of XnadWdal Accidents Office Of JnVe�tigatjonS 600 Wasson StrWL B astQa MMES.Q211 X Tel. 617-727-4.900 ext 406 or 1-877 MA.SS.AFE NORTH ® Of over . No. 664 - �, o , dover, Mass.,_��l • 1 L k. I� COC MIC HE WICK V RATED P'Pa�tG5 BOARD OF HEALTH Food/Kitchen PhtimlT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ CILAW,.....�V.?�.. ..............::................................. .............................................. Foundation has permission to erect........................................ buildings on �. .......1!! i ............ Rough to be occupied as. +�, .... .... �......&06n �.. Chimney rovided that the erson cceptmg t is permif—shall in of respect con tthe terms o he application on file in Final P P this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Altera ion and Construction of Buildings in'the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �+b$ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy 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 SSDE Smoke Det. Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements ofthe state's Home Improvement Contractor law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home.improvement"before agreeing to any work-on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information I[otline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information ,t Name Company\arae Street Address(do not usee'¢a Post Office Box address) Contractod:Salesperson!Owner Nmn ,ae 45- VEda Y 1� 11� k+ XA t-r mt'Ad c lit(vi �vr City/Torn State Zip Code Business Address(must include a street address) Daytime Phone Evening Phone Ciq•/Town �. State Lip Code Sailing Address(it different from above)� Business Phone Federal EmployeriD o,S.S.Number H.—it,--Cortm,w Rq.N—&,, Fpi"ien date L.w trquirts that most tyro! imprmrmrnt<ontncton ha,r p[�t �j^rrr}}} The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work lLtto��completed,specifying the t5pe,brand,and grade of materials to be used,use additional sheets if necce�ssaw ,[ YWtC� fT-`7AiL' (Jvt,�,7 5t-C .v+:G -Wll� fVii)T itY tt t 9x1 N(r�S C S �,Sa'(Ntt^((,),�, t.o�r-�Z^ti✓tG �tZ tti'�Ti&t1�'�' ``T��A eRs.t�f , Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits will he , excluded from the Guaranty Fund provisions of �+ t'Date when contractor will begin contracted work. MGL chapter 142A.) 2 �t, 'Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of: 000, (+) Payments will be made according to the following schedule: S upon signing contract(not to exceed 1/3 ofthe total contract price or the cost ofspecial order items,whichever is greater) S by / ! or upon completion of ,}}(� S by_!r__ or upon completion of -t') upon completion ofthe contract. (Law forbids demanding full paygncnt until contract is completed to both party's satisfaction) l9 The following mated al/equipment must be special S to be paid for ordered before the contracted work begins in order to meet the completim schedule.(-)- S to be paid for NOTES:(')Including all finance charges(—)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third ofthe total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Fxmress W'trrantc-Is lit express warrAniv being provided by the contractor' 10❑1'es fall terms ofthe warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-upon signing,this document becomes a binding contract tmder law. Unless otherwise noted within this document.the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and filly understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The tan•requires most home improvement contractors and subcontractors to be registered with the Director of Home improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confimt coverage,or ask to seen copy of a"proof of insurance"document. • Knowyour rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you ratify the contractor in writing at his.4ter main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing of this agreement. See the attached notice ofcancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES:'.' Two id.tic.l . ics of the ewna:.t must be completed and siyled.One copyshould go to the homeolrner.'lhe ot/pher tnpy stauld M kept be tlr_eontrwtor. U, 61 Home wner's' nature Contractor's Signature Date Date --- -` ; A-4 Massachusstt - Department of Pul lis — i - t Safe' Board of Buildinty Regulations and Standards !« OoCK�fficoe Construction Supervisor License HOME IJNPfnUEMENT G'rON?R? Q ,��L�� Registratton 108277 'Y eI License: CS 49103 Expiratron '8/1�126r12' DBA i Restricted to: 00 '3"�".c,�� ili S<li�i X17;. t»eµ.e !'.11 �.,�—• N" CONSTRU, O l MICHAEL C NIMON �, i j 20 MYRTLE SQ "Miryi � GLOUCESTER, MA 01930 eggs R& 1iauT ,utl,a i4.: ? r„ tr�3WrEnS Expiration: 4/9/2012 _ -('ummessiuiicr ':. Tr#: 23408 Dimension Number of Stories:_______—Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter lova ion, mast or service drop requires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 211AX—F and G min.$10041000 fine NOTES and DATA– For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products (::NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ,Addition or Decks o Building Permit Application ❑ Certified Surveyed-Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording rnust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Date. ./j".". TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . . . . . . . . has permission to perform . . . . .A/. . . . . . . . . . . plumbing in the buildings of . . . . �'// . . . . . . . . . . . . . . . . . . at. . . . 3� It.31 , Forth Andover, Mass. Fee /.vn .Lic. No. . . . . . . . . . s. . . . .J . . . . . . LUMBING INSPECT6'R Check # 5032 'S C 3 Z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS A�2 h A� Date Building Location y Owners Name �� v f Permit# r r �Lb—i._ 2 /� Amount Type `l Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES z x � z H � w x dz z coo -ot 'zw � �" H U O d E W Z A a z a a a J F Fd x W A x a F" x d W A x 3 F a x A 3 H4, a 3 a F i kSEVINr / ISI:ROM ► 1 / / za HIM 1 / M HJ" 41H MOM SII3 HAOM 6M Hj" 7II-I� SIH FLOOR (Print or type) ,/ // �4jJ Check one: Certificate Installing Company Name f� S /)Q— l� �`` 6 r ❑ Corp. 4/l Address coq's n J ❑ Partner. • N R Business Te ep one d O 3 �-9 S 093 1 � Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate..the!Xpe of insurance coverage by checking the appropriate box: Liability insurance policy I r Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chappr 142 of the General Laws. BY P � ignoicense�' m Type of Plumbing License Title /.0 8 C ? City/town 1cense Numuer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date. /...... ,,ORTN o� TOWN OF NORTH ANDOVER ti D ' - PERMIT FOR GAS INSTALLATION SSACHUgE 1 This certifies that f a.�. �.:. .1/r. !. 1. i`?�. .1/. . . . . . . . . . . . has permission for gas installation . . . T.,. . . . ,! r:. . . . . . . . . . . in the buildings of . . ./�/-ZI-s e.,��.". . . . . . . . . . . . . . . . . . . . . . . . . . at . . .5. ., l:� �;. . ;/.l/. . . . . . . ., North Andover, Mass. Fee. . Lic. No. . . . �. . . . �..e Wiz!? . . . . . . . GAS INSPECTOF( Check# 3 r r joiSro�\ t � EVIASSACHLISETTS UNIFORM APPLICATON FOR PMMIT TO DO GAS FITITVG �tType or print) Date ///-2,7s- I9 0 / NORTH ANDOVER, MASSACHUSETTS 17 Building Locations '�vel' Permit 9 Amount S Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ u m n = n r n — Cal Cn :n — �- s1) o -a :kSE .MENT I ' I B .\ sE .m E ,`( 'r Is,r. FLU O R 2 N D . F L 0 0 R 3 X D . F L O G R a'r Ii . F L U O It S T ii F L O O R 6T'If FLU U R 7'rli FLUU It 3T It F L U O R (Print or type) ] Check one: Certificate Installing Company lame CA S I l Ct ❑ Corp. Address q6 CA P; ❑ Partner. PA— 1U- 0-7 Business Telephone t1 oS S�S' C)p) -2 1 ❑ FirmiCo. Name of Licensed Plumber or Gas Fitter ��1'J t / vL (� o INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes Q'i No❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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 I42 ofthe Vlass. General Laws,and that my signature on this permit application waives this requirement. Checkone: Signature of Owner or Owner's Agent Owner El Agent ❑ I herebv certifv that all of the details and intormation I have submitted (or entered) in above appiication are true and accurate to the best ofmy knowledge and that all plumbing work and installations pertormed under Permit Issued for this application will be in compliance with all pertinent provisions or the -Massachusetts State G•z Ce d apter 1421 of the General Laws. Bv: Signature of Lic::nsed Plumber Or Gas Fitter Title ❑ Plumber City/Town ❑ Gas Fitter Lictnse wumoer �'�lasier APPRO'v"ED (m-u-use!)N,.v) ❑ Journeyman I I Date./.��! �.�??/. .... .. NOFTH of TOWN OF NORTH ANDOVER ♦ PERMIT FOR GAS INSTALLATION SSACMUSES .. e+T This certifies that . .. . . . . . . . . . . . has permission for gas installation'e.r'. . .(.cam . �/.! in the buildings of . . . .�. .. . . ... ? . . . . . . . at . .FZ.4 ,:1Jt-:—\�' `P . 4,1�4 > ....-1c' North Andover, Mass. Fee 7U.voLic. No.. / GAS INSPECTOR Check#-G:7,3 3 ,, 4 7 MASSACHUSETTS UNIFORM APPLICATON FOR PERN Hr TO DO GAS FMING r (Type or print) LDate /,l//3 /0 NORTH ANDOVER,MASSACHUSETTS Building Locations "7 �`�'� �� �l /�2 Permit# L p Amount$ 70 3 Owner's Name New Renovation ❑ Replacement ❑ Plans SubmittedCA ❑ x 'C2 146 U a C4 O �" F OW Z z F x z a F O w F O O O W F rnCW7WaW 0W zx CW4 0W Oa OE" AZU W F F z � UU W Z ¢¢ 04 Z Q 9 -< O O W waT - O W F x O 1 .L" .� A 1 0 a U I C4 9 A C, F 1 O SUB -BASEM ENT B A S E M ENT / 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . F L O O R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR min- (Print or type) n �� Check one: Certificate Installing Company Name l� ❑ Corp. Address ❑ Partner. �= fin- �/L 13 a 9 Business Teep one ,- o a 3 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter —7> �--- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑� No❑ If you have checked yes,please indi e the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 4 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas ode and Ch pter 142 of the General Laws. Yom) By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber / p 6 S- - City/Town ❑ Gas Fitter License NumBer ❑- Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date.�°�/�3f0/ NORTp TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING 40 ,SSACMUS� t This certifies that . A . . .. . . . .. .���. . . . . . . . . . . . I has permission to perform . . . � G! ?'�!?? k4. plumbing in the buildings of . „T/ � atAs. � ? � ? . . .3 North Andover, Mass. Fee _� `.''7�1.y . .Lic. No./.S-?B,,1;7� . . . Q�?-.:.-. . ;.>//� (. PLUMBING INSP�VR Check # � 5065 �33g MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT�TOODDO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 415' CIM" �2 Owners Name I` (�% S ( Permit# `''Dw Amoun IML- New Lv l # 3� T e of Occu anc S ©' Renovation Replacement Plans Submitted Yes No El FIXTURES Qn z H W>W x O a s � a � � v z Q a. w a a � p a W a W a w 00 0-1 H H x a A O A a W ® U con SLDESW WE" Mr ISE FLOOR M RDOR 3M FLOOR 41H FLOOR 51H R.00R sI HJ0OR 7IH FLOOR SIH FLOOR (Print or type) Check one: Certificate Installing Company Name �� S �e I It �� ❑ Corp. Address 6 S r e— (? ) Partner. Business Te ep onepl /� Firm/Co. Name of Licensed Plumber: D/1) b 1V�.�5Y-1 Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance 3 Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plymbing Code and Chapter 142 of the General Laws. By: 5ignaEure oi i-icensecirIUMDer Type of Plumbing License Title ID Q S 7 City/Town License Numoer Master Journeyman APPROVED(OFFICE USE ONLY 1_I _ A N2 347 Date.........'.�>rr. : NOR7M TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHus� This certifies that �``? -'z ............................................................... ......................... T � t has permission to perform ..... :..: ... ............................................................ . wiring in the building of... :........... ......................................................... at......W. -�1`�" '� l i� � f ,North Andover,Mass. Fee... .......... Lic.No ..:/7 �....... .:�ti....... .................. ELECTRICAL INSPECTOR P'51-'? �5 1, Check # -� WRITE: Applicant CANARY: Building Dept. PINK:Treasurer THECOMMONWEALTHOFAMSACHUSEM Office Use only JJ DEPARTARMOFPUBLICSAFElY Permit No. BOAROOFFIREPREVEM ONREGUTAHONS527CW]2 010 Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Yk Town of North Andover To the Inspector Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant _ 0 a D 1,"�J I C&D - Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building t'LL) 5- i' i v Utility Authorization No. AN161 Existing Service Amps / Vo lq Overhea E] Underground No.of Meters New Service aro Amps-J2QJ24LVolts if Overhead r-7 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons �No.of Disposals No.of Heat Total Total No.of Detection and -� Pumps Tons KW Initiating Devices No.of Dishwashers. Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER" k t`'! W"KeCoverage.Rusuanttothewgm ZofM%Mdu9easGei)a1L•Iws LbawactmeriliabilttykauancePbhcymdudnngComplctc onsCovmWeritsabswntdegtuvaletrt YES NO Il-�'.-'mNy tedvandpicofofsalnetD&Ofioe.YES rM 1youhavedrdodYES,plea9ein&&ttretyWofoovaageby cl>oclangthebox INSURANCE BOND F O I-IE2 r7 ftasespecify) L1/4 Expiration Date VahiecfEkbicalWoiic$ Wodcloslatt a hpectifflF&RMrsted Rough UMM <'_ Fvtal SigrledurrdffTeRnalliAf ' FIRMNAME" IicenseNd. 2,576� litmisw Signalum IicamNo L: Buss nessTel.No. 4z,-!> SAlt Tel No.OWNER'SJNSURANCEWAIVIJ;lam awarethattheLmwdoesnothavethemstlramwoc)v, a oritssubstantialequivalertasregtmudbyNb-%ad uscusGeralLaws and that my sigrlmhue on this pea r it application waives this legtmeinent (Please check one) Owner � Agent MTel ��/ ephone No. PERMIT FEE L. P signature ot Owner or Agent �7�� � 3 � � -; � .. � / �-� _�� �� 7 Locationk��A # 16 V-etkt PARK 31 , No. Date �oRTh TOWN OF NORTH ANDOVER y Certificate of Occupancy $ SSA�N�sE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 16 9 Check # o 15115 _ /r (tA- Building Inspector Ito CER TIRED PLOT PLAN S.E. CUMMINGS & ASSQC/A TES P.0 BOX =7 PLA/STOW, N.A. 03888 uJ�w. q TELEPHONE MOJV-382-8085 FAX 1603>-382-5216 WEBSTER WC>CJDS I..AN7E S31*42'06"E Mpp ^ 94.93' �f 'J 1 � N N !„ 0) a "'o P r �5- j Q00) Gi G OF M � a8.9MT T y� I TRUDU H f CPA LOT 32A r 43,578 S.F. �� 9FG'IST 2 (CBA=41,170 S.F.) `s�0 �1�S1S0 / \ /VQ� SeT$A 50' WETLAND 73\�4 Ck(/ SETBACK BB-78 S N� �541y LF "I.YF \ \ BB-77 ,i,. AO qs � or- BB-76 klL BN75 TAX MAP 109-A /LOT 32A ��,, 2, BB-74 CAMPBELL FOREST F �.9, w NORTH ANDOVER, MA. �� Q,c DATE: OC'T093 k ,26, 2001 Ili SCALE 1" = 50' l .HEREBY CERT/F); 70TORN OF NORTH All , � a��•�j AIVL)UVLIY, MA LYU/LUINC7 UtrArT/mc[v, THAT THE EX/ST/NG FOUNDA ROW DRA WN ON THIS PIAN /S !.OCA TED AS SHOWN AND THA T /T DOES COWL Y TO THE MINIMUM BUILDING SETBACKS TO MINIMUM SETBACKS. FRONT - 30 FEET PROPERTY LINES. SIDE - 30 FEET RFAR - J'0 FEET CPP LOT 37A.DWC Location ' 4� No. Date 4 `� �✓ HQRTIy TOWN OF NORTH ANDOVER 3?O•��. o ' 1yQ . _ _ O f y , • s v • � ; , Certificate of Occupancy $ � �= �ss•►cMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # i 14 S Building Inspect� 3 if � j t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING >T hl SCCC40g fi r Of€>�aai~i3sC Onll w BUILDING PERMIT NUMBER: DATE ISSUED. eD _,�� _ D rnrn SIGNATURE: Building Commissioner/In ctor of Buildings Date SECTION 1-SITE INFORMATION I I z 1.1 Property Address: 0 T"' 1.2 Assessors Map and Parcel Number: �o7ylt�6�?'.1/ �%'a?S� �;✓�!rii Si0'zt. � t�(y .� s/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District ProposedfJse Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3& 3 a" 0 X T 0 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone 0 Municipal On Site Disposal System 0 m] SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record (�ti 1 /Dy AI/,1sve� ion N /ire . Name(PrinK Address for Service: c - 6 c& Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ LiedSupervisor: �" X23 Construction Su rvisor: 06 License Number ,i3 Vis- 5ye goo Ad&ess �yy ic 7 S: CIO Expiration Date Signature Telephone �. X657 — 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number Address ENM Expiration Date 'Signature Telephone 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 bui ding permit. —Signed affidavit Attached Yes......V No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑, Specify Brief Description of Proposed Work: P Z era lY rev-,--a../e-e SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee ` K 7� QC1 Multiplier & 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) r (b) 4 Mechanical HVAC / / 5 Fire Protection i 6 Total1+2+3+4+5 ;c�a` Check Number SECTION 7a OWNER AUTHORIZATIO TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property 1 i 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//AAUTHORIZED AGENT DECLARATION I, l 2 / JS S E� as Cir/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Nai Signature of Owner/A e Date HEM f NO. OF STORIES SIZE 3v2 5 BASEMENT OR SLAB p yy SIZE OF FLOOR TIMBERS Isr SPAN /6"O/C: DIMENSIONS OF SILLS IK 4 DIMENSIONS OF POSTS el DIMI_NSIONS OF GIRDERS g� f-lElGIrr OF FOUNDATION > THICKNESS Ie SIZE OF FOOTING l0 X 7 MATERIAL,OF CI IIMNEY �p IS BUILDING ON SOLID OR FILLED LAND IS 13UILDING CONNECTED TO NATIYRAL,GAS LINE �: i 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 t the applicant� and/Gr landowner from complianc,, with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION`... APPLICANTcsZs je& ADrr'S Z GLe PHONE r LOCATION: Assessor's flap Number PARCEL y SUBDIVISION `a Aejl/ 1— 7O �f5 f LOT (S) --32A STREET V f rST. NUMBER 'S USE RECOMM OF TOWN AGENTS: I CQ> ERVATION ADMINISTRATOR DATE APPROVED 10 (/ DATE REJECTED COMMENTS f TOWN PLAT ER DATE APPROVED G DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS Aw� 4 DRIVEWA,Y PERMIT 3/3G�o� a FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm I v BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in.a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: I ) u✓n p sf-e r - �f10�`N�.C�s7 ,:�2 ec�.�' Ci��. <�l.'f' %f/���sQ;� • i� Location of Facility Si e OYPermit Applicant i Y210 " Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i 0 I Growth Management Bylaw Exemption Statement Town of North'Andover Building Department This form 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 /P�ennit(below) Map and Parcel �° Purpose of Application (check below) Phone Number of pp icant Single Family —Two Family _6 7—s-'12)o i the undersigned applicant for the above property attest that the attached building permit for which this form is rampleted does comply with the E<E1MPT10N section,8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me Cr ary party to this permit from the requirements of obtaining other permits required prior to the issuance of the wilding Permit. Further I understand that my interpretation of the E<ENIPTi0N status is subject to review by the Building Oepartment 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(at and the work as applied for on the above lot, in the building permit application and associated attachments, complies with ane or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement.restoration,or reconstruction of a dwelling in existents as of the efTec ive 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 Secicn 9.7 of the Zoning Ely-taw. This application is for dwelling units for low andlar moderate income families or individuals,where all of the conditions of 8.7.6.oare met and/or represents Dwelling units for senior residents,where cecuparecl of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section"senior'shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 4011.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 aces and permanently designated as open spaca 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 an the effective date of this Section 8.7 shall receive a ane-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcal. 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 farm U with this EXEMPTiON. Please provide any and all information that would assist the Building Oepartment in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I atte o the — racy of the information provided and that the attached building permit is allowed an EXEMPTJN as cited a ave. Further I understand that the submittal of misleading and or inaccurate informati66n, or the chec Ing off of anabove item which does not comply, whether done to my knowledge XAot, s rou s for r sat by the Buildirig Oepartment to issue a Building Permit. ignature ofwn Aut onzed entwha signed the heti Building Permit Date This form must be attache c the Building Permit upon application for such permit. The .Common vvealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 '�• �`� Workers' Compensation Insurance Affidavit Name Please Print i Name: i Location: City Phone # I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity 12m an employer providing workers' compensation for my employees working on this job. Companv name: tl',- r7 4VIP��/ A t Address S.0 z/tip,_-- t* We a�D�.�- s✓f��s s f"{._- 3e City-. /t1Or-WL c�o1!c'� "�5 Phone# Insurance Co. . 5?"i-7r 6 0 . Policv# LV G O / 5 S`� Comoanv name: Address CiN: 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 s1,500.00 and/or one years'imprisonment as well as na(ties in the form of a STOP WORK ORDER and a fine cf(6100.00)a day against me. f understand that a copy of this statement ay be fo rded to the Office of Investigations of the DIA for coverage verification, I do hereby certify and the ins andpqnalti s of pe ry that the infori mation provided above is true and correct. Signature F Date S Print name Phone# 57 7"" 260 Official use only do not write in this area to be completed by city or town official' City or Town PermitiLicensina Building Dept ❑Check d immediate response is required C] licensing Board r-1Selectman's Office Contact person: Phone 9: Q Health Department Other 1 059 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 14— Application by the undersigned is hereby made to connect with the town water main in 'p� ��� ter' Street,. subject to the rules and regulations of the Division of Public Works. i The premises are known as No. Gl - r Street or subdivision lotto. �2— �'ri� ao Owner Address Contractor Address pplicant's Sign PERMIT TO CONNECT/f WITH WATER MAIN The Board of Public Works hereby grants permission to c/} �)w to make a connection with the water main at L Street subject to the rules and regulations of the Division of Public Works. Bpard of Public Works By Inspected by Date See back for rules and regulations 4 1656 APPLICATION FOR SEWER SERVICE CONNECTION r� North Andover, Mass. �' ! -1 q'— Application by the undersigned is hereby made to connect with the town sewer main in (/e Siceet� subject to the rules and regulations of the Division of Public Works. �/ The premises are known as No. Ave Pe'2� — Z'- Tve or subdivision lot no.AJ,e2i'- T)ev~ (�qrp 'tt 3U/1,- 2F Owner Address Contractor Address 0 a&'4� Z�� Applicant's Signat PERMIT TO CONNECT WITH SEWER M N 61,jz) The Division of 'Public Works hereby grants permission to L� to make a connection with the sewer main at ' �`� ��� Street subject to the rules and regulations of the Division of Public Works.. �^ Divisiqln of Public Works By /^ _ e Inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. DIRECTOR Telephone(978) 685-095Ci 1 NORTH Fax(978)688-9573 O t �eo is q'y IL * w �9SSACHusEtc DRIVEWAY PERMIT DATE ,e 13 26VI LOCATION BUILDER hone OWNER 61-0 phone 5oe-4z3-ISz2- THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and dated Dec# 19 19 'J'q _ and/or by the Covenant dated Mow 9L9 , 19 3A and recorded in District Deeds, Book y g9 0 Page lay or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book ), Page has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled " Cam e ,11 roQ /lGTrN/hV8 SUbLitSlDN P�qN Section (s) , Sheets 1 - '] Plan dated December `� 19 JL_ recorded by theZ Nortk DistrictF egistry of Deeds, Plan Book registered in said Land Registry District, Plan Book or Plan -*/a7 8 4 and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Pian as follows : (Lot Number (s) and street(s) ) L*Iihrotoh 13• i ro 3 a-$ 3 Z So �C u1 e a i ve if ParK 6vg) b. (To be attested by a Registered Land Surveyor) Lors Z�,Z.sf Lam ! -rx a-- I hereby certify that lot number (s) Lo r_& ZS 7-+C,, 31-i Ba on nNfjl� -Ot,V Ir' awa w�Kst�,.. L jt;oos C.^-,.4 Z�,(Lk jLj Street (s) do conform to layout as shown on Definitive Plan entitled C-ay..p n 1 &—� Section Sheet(s) OF MgsX ALBERT T. TRUOEL R gisteredFr Land Suveyor o No. 36869 0 a AL SLA SJQJ� I 1 of 2 I�'v C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated , 19 and/or Covenant dated 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. Registration Book, Page acknowledges , in satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: EXECUTED as a sealed instrument this x S day of "wt 19 Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS �SS�X ss 19 9 Then personally appeared �t1�;,�� �� one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary Piublic My Commissi n Expires 2 of 2 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: 8-9-2001 DATE OF PLANS: April 18,2000 TITLE: Lot 32 "The Somerset" PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 100 Andover Bypass Suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 693 Your Home = 664 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1878 30.0 0.0 66 WALLS: Wood Frame, 16" O.C. 2919 , 11.0 0.0 260 GLAZING: Windows or Doors 573 0.350 201 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1910 19.0 0.0 91 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 the appl' Standard Design Conditions found in the Code. The HVAC equipment�lected to heat or cool the building shall be no greater than5a f the design load as specified in Sections 780CMR 1310 J4.4. Builder/Designer Date O J c .MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 32 "The Somerset" DATE: 8-9-2001 Bldg. l Dept. l Use I I I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ] i 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ J I 1. U-value: 0.35 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U-value: 0.49 I Comments/Location FLOORS: [ ) I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ J 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 1 ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ) I Materials and equipment must be identified so that compliance can 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: [ ] 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: [ ] 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 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-l" 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 I 0.5 1.0 1.5 1 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- ❑ •` 92. -Vomvrrwnweald a�✓ fzuJ�(�6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069234 Birthdate: 05/09/1954 Expires:05/09/2002 Tr.no: 23903 Restricted To: 00 ALAN G RUSSELL _ 400 MAIN ST GROVELAND, MA 01834 Administrator _ — —opt o. ' �� ���• t :�-• ` J � o,��/ ,gyp I \ 1kti �•y6•. co o -18 as BB-80 1 � BB-79 \ sl 0>>, sM '— BB-78 X 03 LOT (CBA=41,170 SF - _ 13 y EAS 20 WDE *15 \ 899, N07 \, 4 3 ut GRAPHIC SCALE r r a w r 1 Imh-M k Building Value Calculation - for Property at..... LOT#32A Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 15.5 15 232.50 65 $ 15,112.50 Brkfstnook 15.5 9 139.50 65 $ 9,067.50 Dining Room 17.5 15 262.50 65 $ 17,062.50 Family Room 24 16 384.00 65 $ 24,960.00 study/office 14 12.5 175.00 65 $ 11,375.00 Living room 15 13 195.00 65 $ 12,675.00 Garage 24 36 864.00 35 $ 30,240.00 Entry 12 11 132.00 65 $ 8,580.00 2nd floor foyer/sitting 14 9.5 133.00 65 $ 8,645.00 Sunroom 11 16 176.00 65 $ 11,440.00 mudroom - 65 $ - Walkin closet 9.5 10 95.00 65 $ 6,175.00 Basement Finished 65 $ - Balcony - 65 $ - Screened Porch - 35 $ - laundry 10 6 60.00 65 $ 3,900.00 Bedroom 1 16 24 384.00 65 $ 24,960.00 Bedroom 2 13 13 169.00 65 $ 10,985.00 Bedroom 3 13 13 169.00 65 $ 10,985.00 Bedroom 4 13 18 234.00 65 $ 15,210.00 Lav/Bar - 65 $ - Bathroom 1 9 10 90.00 65 $ 5,850.00 1/2 Bath 13 8.5 110.50 65 $ 7,182.50 Bathroom 2 16 11 176.00 65 $ 11,440.00 Bathroom - 65 $ - Balcony - 65 $ - . °1 q9 • — - I ftj or �O 1 � ORTh Town o Andover 0 No. I f 17 ~ - CON LAK O. dover, Mass., A?"31(:2oo/ E C 'CHIC HEWiCK A�RATEO �SSgCHUs FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT .........CA.NOP &/! ... ........... .................... .......... • -• ....... .... has permission to excavate and pour foundation at 2 4 --,1' im` 7 �/ C `P for the purpose l�rs/�tNG The person accepting this permit must return to the office of the Buildin Inspector a certified plot plan show of building thereon before Foundation will be inspected. 106 ,37/ 7 Al 00-6-D VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. .. `.................................................. BUILDING INSPECTOR NORTH E Town of tAndover p0 v.., No. f7 Co3 2 coc�,� y dower, Mass., ADRATED PPS` ,9S H BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System �' �L - BUILDING INSPECTOR THIS CERTIFIES THAT........ �n?.. l..... .!".CS.`........1- C // .................................................................. .. Foundation has permission to erect..........�.......................... buildings on ./ �� 'ys/ U�! / i�!�!�.�n' Rough to be occupied as.../..D/E�.00t"/o?-,Y 1//1/.3..51-0// vw;./ ... /.t/�C/ .. �I11/�./ alcy � 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. /406 ,3//7 5/ T PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ... . . ... Service / �%� C . ..... ...... 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. or Cf NOWTN, •ti0 p Ic - • ssACMusa _ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number l�� Date --r /THIS CERTIFIES THAT THE BUILDING LOCATED ON � � �� ,/�(J2r �,e���le . MAY BE OCCUPIED AS IN o-, / /Uri! /N IN ACCORDANCE WITH THE PROVISIONS OF thE MASSA HUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. /,j l?mel jwSi-? 9,6,1 YZ1S1 3 6Y 2 fl v ti CERTIFICATE ISSUED TO /00k�L/-Pi^ PASS c ull e 3 c c) Building Inspector i ' NORTH 6T 32A E 0" . o o `�No. (, �` /oZ3 aoo / o� CO,:.,, , y dower, Mass., sRATE�D1 Pf C) 1 ^ ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 'Q ��' m � m...:rS ... ... ......................... . C ..................................................... .. .. Foundation _- has permission to erect..... ... buildings onof�a 'y vu� RouP. gh�/HG to be occupied as /D/Row" o?KY 43 ��3 s�d�� vti�Yr i ri. .� .. .4�!i�� �d� �>e Chimney • Y'��-- provided that the person accepting this permit shall in every respect-conform to the terms of the application on file inFinal � this office, and to the provisions of the Codes and By-laws relating to the Inspection, Alteration and Construction of / CC! �off. Buildings in the Town of North Andover. PLUMBING INSPECTOR� VIOLATION of the Zoning or Building Regulations Voids this Permit. 09hi%lam 12 —)-I—,o PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECT R ECe e /�/��APc BUILDING INSPTOR F' 1 j�� Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough 7 R 'v Display in a_ Conspicuous Place on the Premises — Do Not Remove R 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. � s Town of North Andover � �kORTN oqti Building Department �? yttt�o .b+e o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 COC MK M.wKK 7' ��Q�qreo Pa` •(y 9SSACHUS�� APPLICATION FOR CERTIFICATE OF OCCUPANCY/ INSPECTION ADDRESSV-(f LOT NUMBER SUBDIVISION Cz�,V,O,6e/Z F�Vre.SO- DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRUC OES N T MEET ALL APPLICABLE CODES. SIGNATURE SE ONLY ROUTING CONSERVATIO DATE PLANNING !_ DATE -z 2? D.P.W. —WA METER \tNs7Ar �p DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIG INSPECTION REQUEST DATE. SIGNATURE /DPW AUTHORIZATION