Loading...
HomeMy WebLinkAboutMiscellaneous - 450 CHESTNUT STREET 4/30/2018 (2) 77 I d Date.5. liv. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING s3ACHU This certifies that .................................................................... .......... has permission to perform .... .C..k..S.-e ...... .)4 ......... ... ............. ....... .... building of... to winng in the bui ................................................................. at jt�Q.....C.................. North Andover,Mass. 2 Fee, ..5..".......... .. Lic.NO. . .................................................................................... 520cl ELECTRICAL INSPECTOR Check# 13.151 J-ArA� 9]k-I 1(4 ! � Commonwealth of Massachusetts Official Use Only Permit No. 1 �� Department of Fire Services Occupancy and Fee Checked 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 CodeC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: 3111(4 City or Town of: NORTH ANDOVER To the Inspector of Wires: � By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) C-WA7 U-� S - Owner or Tenant C�.rac,;r-()Qn Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes R---No ❑ (Check Appropriate Box) Purpose of Building 9-0, 2p¢ ee m 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: !X sit 6-7 f f2e1 C> Completion of thefollow' table may be waived by the Ins ector of Wires. No.of Recessed Luminaires `l No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA � n No.of Luminaires Swimming Pool Above ❑ In- LJo.o mergency ig tmg rnd. rnd. BatteLy Units No.of Receptacle Outlets 7 No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches 3 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW_... __ No.of Self-Contained p Totals: - Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Munici al ❑ Other P g Connection No.of Dryers Heating AppliancesKWc' Security Systems:* No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Te1No.of Devicesons or E uivalent;' OTHER: Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value of Elc/;�icaI Work: (When required by municipal policy.) Work to Start: 7)t f lv 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 cover ism force,and has exhibited proof of same to the permit issuing office. f CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains tend penalties ofperjury,that the information on this application is true and complete. FIRM NAME: .MA[tTi S —C �<C LIC.NO.:o?(��'�'(q Licensee: 3e Sin Marb y Signatu LIC.NO.: F201 C (If applicable,enter"exempt"in the license umber line.) Bus.Tel.No.: 103r Address: �0 G r��G�lc fZa l �chi �'a- dl L. Alt.Tel.No.: *Per M.G.L c. 147,s. 7-61,security work requires Departdient 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 PEZMIT FEE:$ Signature _ Telephone No. r ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the 1 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c.166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the Y 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 n Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS CTION: Pass M V Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: 6"�ADate: 7` — G FINAL INSPE ON: Pass V Failed Re-Inspection Required($.)❑ r� Inspectors Comments: Inspectors Signature: Date: —A DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com r 4 The Commonwealth of Massachusetts Department oflndustrialAccidents e 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia � Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. _AunlicantInformation Please Print Le=ibly Name(Business/Organization/Individual):—rai(—r//��'j, &"QGloC Address: (� r%p;•�OG�C l7cl City/State/Zip:*�'kl) Cl FPhone Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. 0 New construction a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp..insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. leetrical repairs or additions pro'p'rietors with no employees. 12.Q Plumbing repairs or additions 5.F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.instuance.t 14.0 Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have na.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors that check this box mustattached 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 ppoviding workers'compensation insurance for my employees.'Below is the policy and job site information. I V� Insurance Company Name: r G WCC 1f' G( �} Policy#or Self-ins.Lie.#: d'6 G C aS ` Expiration Date: IO Job Site Address: 7 C0 `�" ion of ST City/State/Zip:./UU` t t^ 10�010vel_ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eerti under the pains and penalties of perjury that the information provided above is true and correct. tnSiatur �� Date: t5cY.e# Of use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their emplo_yees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of lure, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If 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 foi•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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia COMMONWEALTH°OF MASBACHl1Sf�TTS;:: ' o ® • • o BOARD`OI+ ELECTR 1AN$ < ISSUES THE FOLLOW:I'N.G Lfi qS A ; RESIST RE0 MASTER:,,Elf CTRI,C13�11V`` U,,'._Bki MARTINS ELECTRIC 1� .. A50N 8 MART IN S 4.0 GRE,YLflCK.RD w IJ TEWKSBURY MA 0876-]221 , 20886 " Nl NCHI r aAFiF7 -OFA t ELEC Rl of ANS: Ns ISSUES TIE FOLLOW 10 L I AS A REO JOURNEYMAN EL`E�TR I'O {�a JASON B MART I NS 0 D TEKSBUR`( 1 A 01`876 1221 20.1 :. o Date.. -21- . . . . . . . . 00RTPj TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies thatAV— . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has as permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in thepuildings of . . . . ...V' at 07- . . . . . . . . . . . . . . . . . 61 . .,t . North Andover, Mass. Fee,��`.r'. .&Z Lic. No//`` .-ff . . . . . . . . . . . . ----PLUMBING YeSiKTOR Check # 5129 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS J O l/ // �s/, Date_ Building Location �/5® .JI�S`1"�( eW—Owners NameKo— ���yC� Permit# Amount - n-p cYp Type of Occupancy 1 4 f' V New Renovation ri Replacement Plans Submitted Yes No FIXTURES E~ > O a w a C4 A A d MUM &A�lr ISE IMM �. M HIM 4M 11" SIIl(11IDCit 6MRDOit lip M FL" SII3 FIDCit (Print or type) / ? Check one: Certificate Installing Company Name ;/ 1 ��/>� %� 1-1 Corp. Address Partner. 0]J, A-1 /--/ Business Te ep oneT n 3 S;°J.3y g1G� Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 . Bond ❑ 3 Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner Agent ❑ I hereby certify that all of the details and information I have sub 'tted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work installatio s rformed under Permit Issued for this application will be in compliance with all pertinent provisions of the M s chu ett tle umbing Code and Chapter 142 of the General Laws. By: I a ure o ense umDer Title Type of Plumbing License City/Town IT i ense u er Master Journeyman E]APPROVED(OFFICE USE ONLY Date. ,,OQTM TOWN OF NORTH ANDOVER O p • . PERMIT FOR GAS INSTALLATION M � SACHUSEt This certifies that . . . . . . . . - �:. . .. . . . :. J 4f X!. .� . . has permission for gas installation . . � ��. . . . . . . . . . . . in the buildings of . . . . . . ..... . ... . . . . . . . . . . . . . . . . . . . k at . . . . . .. . . . . . . . .. ... . '..:. / . . . . . . . , North Andover, Mass. !fee. . .' . . . . Lic. No.// :ice. . . . . . . .. .. .. .. . . . . GAS INSPECTOR Check# l 3 ;' 22 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FITTING I ('Type or print) Date �- NORTH ANDOVER,MASSACHUSETTS Building Locations e-150 l1 � I Permit 29 z- -�' Amount$ Owner's Name i New Renovation ❑ Replacement ❑ Plans Submitted ❑ W z � d S °a w W � , � a �J 0 o O I � a°. F O SUB-BA SEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR e 6TH. FLOOR 7TH. FLOOR STH. FLOOR 1 (Print or type) �`� l "Ib //lone: Certificate Installing Company Name Corp. Address ❑ Partner. 'Q7 Business Telephone Fir n/Co. Name of Licensed Plumber or Gas Fitte;eL Ly°er:p 1 INSURANCE COVERAGE Check one• I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. 9 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 t hereby certify that all of the details and information I have sub ed(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and insta ati s pe I ed der Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse S to C e)n Chapter 142 of the General Laws. By: Sign ture of Licensed Plumber Or Gas Fitter ❑ Title u er _Z e-A 6,0, City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman 3.--- Date. . . . { "aR,,, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUSEt This certifies that . . . . . . . .?-^-' has permission to perform .�� -- . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of : .... . . . . . . . . . . . . . . . . at . !f�??. . . . . . . . . . . . . . . . . . . . . . . . . . . ., North Andover, Mass. Fee.3(x!°` Lic. No.. . . . . . . . . `,. —. . . \�KUMBIN�OJSECT(�R Check # 7 ell 5242 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS c� Date �7 Building Location V Permit# yh'2— Amount 20y °TJi Owner New n Renovation Replacement Plans Submitted Yes No f FIXTURES U cr H x x a Cn 3 a a a sLR» RiSEU r MUM -- MM" aMHDM sm HDM MiMOOR SIH HDM (Print or type) Check one: Certificate Installing Company Name (o /� Corp. Address 11 Partner. Business eleptione 0 3 ecr-�? n Firm/Co. Name of Licensed Plumber: T Insurance Coverage: Indicate.! type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and informs' n I ve mitt r entered)in above application are true and accurate to the best of my knowledge and that all plumbing wo nd' sta io s rf rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the ss hu Its t to lu bing Code an r 142 of the General Laws. By: na ure o i seTriumDer Type of lumbing License Title 7 City/Town is n um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY U Date.. . .. .AG. .. . .. . . -,1 °f NpRTM 1 4,O TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION _ 9 'SS cm This certifies that . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . .�:. ^~~�'�.... . . . . . . . . . . . . . . . . .. . . . at . . . . ... .. .. ... . .`.� . . . . . . . . ., North Andover, Mass. Fee. ,?. . . . . . Lic. No. . . . .. . . . F GASINSPECTOV- Check# . 'O��' 4i 30 MA%ACMSEM UNUMM APPUCATON FOR PERM TO DO GAS ffrMG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations _ / � C//t C7(d. Permit Amount$ Owner's Name ? Newp Renovation Replacement E] Plans Submitted 3 3 SUB-BASEM ENT BASEMENT 1.S T. FLOG-R ate` 2ND. FLOOR 3R Dr FLOOQR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. 'FLOOR STH. FLOOR type) Name one: Certificate Installing Company / 1 corp (Print orAle w �/ Partner. . � �7 Business Telephone C Firm/Co. ,r Name of Licensed Plumber or Gas Fitter Z 4al>ll INSURANCE COVERAGE Check one I have a current liability Insurance policy or it's substantial equivalent. Yes f Noo If you have checked Ys,please indicate the type coverage by checking the appropriate box. I iability insurance policy ( Other type of fixe mty 0. Bond 0 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 requiremerht. Check one: Signature of Owner or Owner's Agent Owner Q Agent I hereby oerafy that all of the details andinformation I ve su or entered)in above application are true and accurate to the best of my knowledge and that all phunbi g:work and l under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massa us S e C and Chapter 142 ofthe General Laws. M By. Signature of Licensed Plumber Or Gas Fitter Title Plumber L,�j� 2 City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) 19 Journeyman Y 3755 _ Z Date..................................a � f NORT1{� TOWN OF NORTH ANDOVER PERMIT FOR WIRING S$ CHUS This certifies that ......�. .... .. ............................................................. haspermission to perform .........:.......::...........................:................................ wiring in the building,of M1 at................................................................................North Andover,Mass. Fee�i�1 `v Lic.No.'E/FqC'( �f c . LECTRICALINSPECroR Check # — ThE C0W0ATVEALTH0FM4_S&4CffLS= Office Use only DEPARTMEr'VlOFPUBLICS4= Permit No. BOARD OF MEPREFEN170NREGMTIOAN 527 CM 12 00 Occupancy&Fees Checked 4ClV APPUCATIONFOR PERMU 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 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) -/6-0- cj& -3; nnl f r s-l" Owner or Tenant Tag F :g-0 Ce C-Z: Owner's Address 6'6 S 6c- f> 10 511r Is this permit in conjunction with a building permit: Yes r_0 No (Check Appropriate Box) Purpose of Building 1, Utility Authorization No. Existing Service Amps I Volts Overhead Underground 71 No.of Meters New Service o100 Amps 1,901 A-y Volts Overhead Underground r�M No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets o.of Hot Tubs No of Transformers Total Y KVA No.of Lighting Fixtures Swimming Pool Above Below Generato s KVA round ground No.of Receptacle OutletsO No.of Oil Burners No.of Emergency Lighting Battery Units 191 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 I 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 1 Other / Connections No.of Water Heaters KW No.of No.of Signs Bailasis - { No.Hydro Massage Tubs No.of Motors Total HP OTHER ihkarancecoycr c Pasuanttotheta�vrer>a �C aiLaws a�eaasra#I�1lttylrrnsarnel Cy¢ �gCar>plete Co�aa or is lgz4cr3 YES tr I NO I lmsLihm>rdvasdprmeofsmriDdrO�YES If}otitaa�ed lcedYES l eii thetypec�foova byd the INSURANCE [E] BOND[� OTE F-1 ( v) / Esmr,FkdvaluedFccbcal Wak$ WcckiDsw 1' oZ kqcfionD&ReCpated Rojgh WW C4/ Final Sigh uncle ft—Paraldes ofpajW _ FIRM NAME T ER to ri✓C G IQ`Z C` Lio3seNa 7/3 J a iatsee�„�ER a;� pej G.c Sirrrat<ne �G `— —= Y� Li�eNo Cl S 3 �. �� E�t�essTd.Na �' � $� •Cv S�—74, 3 3 Udress, ,5 � S���� S7' Ai Tel N'a r OWi�r"t'S'.NSL'RAi�WAP/ER;Iamaw.aetl�thel�cet�;�rmth�vet6eitmrat�arera�a-�sulag�ival��asr�tt¢edbyMse#SGencalLaws and i" em8rspmrEtal`pF mwaiWSthisttec;amldt (Please check one) Owner Agent Telephone No. PERMIT FEE$. ,..?00 °�� , 5 36 , DaterGa�. .�J. ...�. ... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING o �,SSACMU This certifies that ................SIC<(..x..�..�..:P...��.,Y�..`��.......................... has permission to perform ............1 V �..�. ..--,/L��� �.`Q . Mring in the building of � at.......... .... d1 / 11,North Andover�Mass., �lFee.3.j5 .�V.. Lic.No'-� !.�.......... .... �/!��•.� �z..��^^.. .... .. ELECTRICALINSPECTUR Check # 7/r / ThEG03M0ATV LTHQFM ' ' ©YU`E77N Office Use only w, DEPART/ IOFPUBLICSAFE7Y Permit No. V BOARD OF FIXE PREVE7MONREGUTATIOMS527CIM 12:00 Occupancy&Fees Checked 0)4 FOR PfRAff TO PERFORM ELECTRICAL WORK !� ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 cr m 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. - Location(Street&Number) j.,r Owner or Tenant C.-o j r k( Owner's Address S l`t�1�7✓ �� �� �/+�U G�� Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building V Gl/g/11A1 Z— Utility Authorization No. Existing Service Amps / Volts Overhead !l Underground No.of Meters e� New Service J O O Amps/ Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of LiAting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Rec;,ptacle 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.ofSelFContained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalI Municipal ® Other Connections L No.g)f Water Heaters KW No.of No.of Si Bailasis No.Hydro Massage Tubs ' No.of Motors Total HP i OTHER - — L->srarreCoeer�e Ptastrdrtbthetegmanatsa�C�ax�'aiLaws Iha�eaaataYLiab+7dyht4r��oeH�hcyurl azgCar>p� Co�aagecritssti�stat ltt�rivila� YES i k f NO 11;aveabTiiiteavasdpmoeafsmriD rOffi=YES U tvtl Ifywtasea>e�CedYES deaseird thetyped byd gti�e SiJI. tvcE BOND O OTHER (PL—xSpecify) EViritlon Date EtmakdValtrolElechniWork S WorkIDSW a- Il'/--offlnspcdmD&RffPdSh2d Reugh C-/i/ Fatal GA Sighedt d2tl teNnahiescfP --7 C) FIRM NANE 1 ' tie —4—oY Cc— Lio3seNa 1L � / �� S�a�e _. LioeNo /S7 e1 �i n BusirmTel.Na AiTel.Na OWNr'R'STiSLI2Ai�'CEWAI;Ir`�t;Iamawaetl�thelrlaesn� thea>strame�a'a�or�ss,�Satdal,rivala�astec�me3b7Mas�aaseLsC,�alIa� /Q� a��hac mysgit�zrn dis p�a7t.�ra�.fs�c ttt�rt. V I (Please check one) Owner Agent �i Telephone No. PERM iT FEE$... ... �I Location 16*f D, t` 4S-() `� � �*%� St- No. Date 10--10.01 NORTH TOWN OF NORTH ANDOVER OL •i , . Certificate of Occupancy $ 04 cMusE�A BuildinglFrame Permit Fee $ Foundation Permit Fee $ 0 Other Permit Fee $ _ TOTAL $ Check # 15207 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,R.KNOVATF,CRANG F THE TISE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAIN A ONE OR TWO FAMILY DWELLING PERMIT Section for ficial U,%�Only-'r-.. BUILDING PERNNUWER: 200DATE ISSUED: SIGNATURE: Building Comnijssionerlln� Date pector of Buildings Sicn'03. TLm 11�E1f�ATlit3 .a 1A Property Address: ----I-.2 Map and Pares!Number: 5T, Parcel Number L3 Zoning Information: 1.4 Property Dinionsions: 52EI-K 7Aming stria I�.w — W Area(d) 1.6 BUILDING SETBACKS(ft) rn Front Yard Side Yard Rear Yard Required equ Provide ®RIred. Provided I Re ired �::a �0_ Provided I.7WdSupply M.G.L.C.40. 454) Yan.Inforwim: Sewerve Dtvusal SystMn: Public 11 Prnmtc 0 7mc Owside Flood&rtc J h4muoiyal On Sitc M%noW S)Vlera U $FcnoXpPvW,F,RTy.own�q.W t"T - ' A _fA MOO -W 2.1 (-h-.ner of Record Name(Pri lure Telephone M 2.2 Authorized Agent Name Print Address,1)r Se—rvi ce-, SignatureTelephone z M J., .3.1 Licensed Construction Supervisor # Not Applicable 0 Address � -- --) ie ---- CS 04/3 -76 aj 5.6:7eZ:>y� 57- License Number 0 "n Liens- Construction Su o?IJ4r // ��// �75 r 76 33 Expiration Date ic re Signatu Telephone F 3.2 Registered lionic Improvement Contractor Not Applicable Company Name Registration Number M Address r Expiration Date z Signature Telephone Building Value Calculation - for Pro a at..... LOT# Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 20.5 14 287.00 65 $ 18,655.00 Brkfstnook - 65 $ - Dining Room i14 13.5 189.00 65 $ 12,285.00 Family Room 3 24 16 384.00 65 $ 24,960.00 study/office 10 14 140.00 65 $ 9,100.00 Living room d' 14 18 252.00 65 $ 16,380.00 Garage 24 21 504.00 35 $ 17,640.00 Entry 16 13 208'00 65 $ 13,520.00 2nd floor foyer/sitting 8 13 104.00 65 $ 6,760.00 Sunroom - 65 $ - mudroom - 65 $ - Walkin closet 13 8 104.00 65 $ 6,760.00 Basement Finished - 65 $ - Balcony - 65 $ - Screened Porch - 35 $ - laundry 7 13 91.00 65 $ 5,915.00 Bedroom 1 14 20 280.00 65 $ 18,200.00 Bedroom 2 7 16 13 208.00 65 $ 13,520.00 Bedroom 3 IF 14 15 210.00 65 $ 13,650.00 Bedroom 4 1 14 15 210.00 65 $ 13,650.00 Lav/Bar - 65 $ - Bathroom 13 16 208.00 65 $ 13,520.00 1/2 Bath 6 10 60.00 65 $ 3,900.00 Bathroom 2 9 13 117.00 65 $ 7,605.00 Bathroom - 65 $ - Balcony 65 $ - 4 "'a 5, N bkL^tlw":�F"e4ks`6.ft 2EL1'�" �$ - L ) q o `-( f SECTION 6—DESCRIPTION OE PRCP,OSFD WORK (cheek all applicable) NewConstructiott ( Existing Building it Rc:pains) - Alteration tsj Addition Acccs,wry Hldg. UcnZotition Othcr Specify 131icf rkscription of Work: -^ SEMON 7-USE GROUP AND CONSTRUCTION TYPE t GSE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly n A-1 A-2 L. A-3 -- Il A LJ A-4 i A-S 1}3 J 13 Busutcss CJ _ 2A- - C Educational t]_ _ 213 1'hacton' ❑ _.F-i 11 F-22C Li liz II I3igh Iard I U _ _.- 3A I1 I Institutional J I-1 1-2f-3 U 3 B (I L M Mercantile --- -- resident' U R-1 - R-2 U R-3 S Storage S 1 S-2 H !I latilit%' S;Pedify: 141 Mixed Use Slred Irv: S Special Use � � Specify: _ COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Usc:Group: �V A Yroposed Use Group: Existing Hazard Index 780 CMR 34: Proposed I livard Index 7$()CMR 34: SRC TION$'$>E 3I1�It ;. ICz �t`.�1a 11i1�► t3UILDING AREA EXISTING(it apptiliiblc) _ PROPOSM Ntnnber of Floors or Stories Include - Basennent levels Floor Arco per floor(sf) / S 1 Total Area(0) c 7—S! —ii Total Height ft ---� Independent Structural Engin ring Structural Peer Review Rcgtrired Yes U No - SECTION IOa Owner Authorisation- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR)BUILI)MC,PERMIT �DZ,P j ti f'�, 1-7TY 7-ra57 i, � ✓�`./ I'd '' �j ����J� as Owner of the subject property Hcreby authorize +��C to act on My behalf,i ma relative two work authorized by this building permit application f C S tore of c Date I I, ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate.to the best of my knowledge and belief. Signed under the pains and penalties off perjury Print Name Si tre o er/Agent "EcTiON 11-ESTIMATED CONSTRUCTION COST" Item Fmimaterl Cost(Dollars)to be OFit:ICULUSE ONLY Completed by pennit applicant 1. Building (a) Building Permit Fee X _ Multiplier 2 Electrical _ (b) Estimated Total Cost of ooc> _ Construction from(ti) 3 Plumbing �, ewo Building llenmt 1.ee (s),(b) 4 Mechanical(IIVAC) 5 Fire Protection DQ� 6 Total (1+243+4+4,z) � Ch�kNmnber _ NO.OF S"I ORII:S SIZE 2 � y I3ASEfvl7.iNIF OR SLAB - Si7,E OF Fl.tx}R TTMT3ER5 /✓ � IS1 Z "�, 3`+' x / SPAN DEMMENSIONS OF SILLSFT I)F,MI NS[ONS OF POS'T'S L L Y DIMENSIONS OF GIRDI RS � �, IZ ItEIGIII OF FOUNDATION �/ `I'HICKNT;SS IO SIZE OF FOOTING x NIAT UAL Ul:CUIMNEY IS BUILDING ON SOLID OR FII FD LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a N 2- FORM FORM U - LOT RELEASE FORM i �V Lam' a � 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. L"' lo --So—ot *****************************APPLICANT FILLS OUT THIS SECTION*********************f* APPLICANT DLP �/��T/ 1��T PHONE,-5t)9 1,1 4 Z gkZ1Z LOCATION: Assessor's Map Number _ PARCEL SUBDIVISION. LOT (S) 2- STREET STREET 4�f A/ ST. NUMBER ***********************OFFICJAL USE ONLY*** ** **** * *** ** RECO MENDATION OF TOWN AGENTS: CONSERVATION ADMI IST R DATE APPROVED #?d -di ' DATE REJECTED COMMENTS WN PLANNER DATE APPROVED /1-a y-U/ DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEP IC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS RIP, -3k,-,9 DRIVEWAY PERMIT FIRE DEPARTMENTI - %, RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm k •. *�i�.'` y ."' 4�'- ^^*�.. IF r T µNQ+«} . +.•,..�: x y a •`L.�__- .n *f ..,.a.n .F 4. 1x c, F h. ,I •-p f 71 I N F _•- da 11 '`E14 s ` " GrdWthMzri4gertm0r!t 8yjaw.- xemptivn Stateme�t Town of North`Andaver Building-Departs lent %"This farm shall be used to assistJthe Buildino Department in their detdrminatron'of exemptions under sec'ion-8.7.6.6 of the `1Town-of,North Andover Growh Mara ement3 l-aw. The buildin appIicsnt shall rovide ail of th2'necesary informations�as requested below. r '.r.$ ,- ::, •��,�;; r Name of Applicant Suis jng Pddrass o�Prt;pefty far Permit{ oei w) ' y Map and Parcel Purpose fApplicahorr(check below) ` aPhpne Number ofAppllcank Single Fainiiy Two Faml(y the undersigned applicant for the move property attest that the attached building p8nnit for;whtch,tltis_ , } form is completed does comply with the EXEMPTiON'section 8.7,6-of the North Andover Growth _ z Management-Bylaw.`1 also understand ProvidinjAhis form does-n.ot.$bsolve ri?e or any"party"tp this,permit froth the requirements of obtaining other permits;required prior'to theissuanei of the 6uildtng°P?rmlt .' t •. Further! understand that my interpretation of ti a ECEMPTION status is subject to review by the.8uildina Oepartment and is only oflzcaUy accepted when the 8uildmg,Permit iq-issued $as2d on section 8:7:6`af the lvottfl Andover Growth the atrave lot and the work as applied for ori the above lot, in.the building pem3it application and associated;attachments,carnplies with onir or more.of.the.a...,_ t following sections as indicated:by a check mark ` . r � -=�- This is ori_applicaddn for a building permit(or•the enlargement:restaratton,•�or recol?�tnrcxan.pf a dweAiiig m"�, + , : _ , `�=' '' " - existence as of the effective elate of this;bylaw provided that no additianat re3denuatriiit is created F r„ �. .;• R• The tot(s)werelwa3eated:pnorto May& 1996 are exernlst from the.provsions of this SeCion 8 7 of the Zoning sh.• Eytaw. r°c i s This apptication is for dwelling units for low and/or moderate income families or individuals,where all of-the* {' canditions.of&7.6.6are met andforrepre'sents Owelling units:far_.seriioa residents where.:occupancy of the.iinds is restricted to senior persons through a property executed and'recorded'deetlxestncuon running with the land purpases of this Secdon"seriioe'shall mean'p.ersans`over the age of 55-11 ,, ,* » fr x+ 47 This application is a part oft developmentpmjeC whirl vcluntanly agreed ko a minimum dtl"n permanent v;, s reducdan in density (buildable lots),below the density {buildable lots);.permitted under zoning and:feasible given thea environmental conditions of ttiotract,with'the surplus land.equal to at least tan;buildable`:acres.arid,permanently' "'designated as open space artdMr farmland.,The.land'ta be preserved'shall be protected fram'development b G Agricultural Pre"servation Reatrir:ion Consenrauon aestnchon;Aedicationto the' own or other similar mechanism, approved by the Planning 8oarVhat wilt ertsUre its protedlon ,„ r L +s � . This application repieaeh6-3 tray~of land existng.and not held by.a.Oeveloper in'cdmmon ownership iydh an adjacent • ent parcel on the effecbve`date of this SeCaon Si7 shall receive:a one-time exernptiart tram the Planned Growth= =Rate and—Development Scheduling=,provisions forthe purpose of Constructing ane single;family dwelling-unit ori the arse. - � t is applir aUon represents'a,lot which•is ready for building,permits.(i.eyatl other-perm"nrall other boards'arid , 'commissions have been received and•the project is incompliance with'those permits)Sand the Oeveloprment,Schedule does not accorrimodate'issuing a,building'pennit in that Year+'ane building permit will be,slued p�C'Year.per Oeveiapment unhi such time,as the Development Schedule acpmniodstes,issuing building permits,Applicant must; _ suppiy.approded form U.With thls'ECEMATION ; >i Please provide any and all infarmatlon'that-would!assist the Building t3epartment m making a determination that your application'is-:allowed one'or.rriore of the above,ECEMPT'iONS By signing below I attest to the accuracy of the.infontia lon provided and that the attached building permit is ''•allowed an EXEMPTION as citeF"rther[understand•that the:submittal of misleading and.or _ inaccurat ation or c!cing,�ff 6 an above item which does no#'comply,wr ether done to my fcnowl ge ot,is gr s f refusal' y theuiidrtt Oepartrrient torssue a Building,Permit ol ,gnature of nes r Autnogen no_;signed:the Attached Building.Permit Date is m is Farrust be ache to th a Suilding Permit-upon_application for such perm t. . ' a V+f •,J �n A� �:.. 171.' C<,1,//f.//!!✓IIII/F� BOARD OF BUILDING REWLATIONS. - License: CONSTRUCTION.S'(j VISO a° 'i Number: CS 043769 ! � y, k Birthdate: 11119/1948 Expires: 11/19/2001 Tr.no: 11776 Restricted To: 00 TERRENCE JOYCE Pte,./ 50 SECOND ST (.,G«..x NO ANDOVER, MA 01845 Administrator d T H The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ~` Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print eYc Name' �/q / Location' ,� d 7 D CjT - 7;V 0 T City XG' � �' Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity F7 I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance Co Policy# Company name: Address City: Phone#: Insurance Co 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$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of(sloo.00)a day against me. I understand that a copy of this s ent may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u r the ins and pe s equ that the information provided above is true and correct. �/b.� Signature ��' Date Print name Phone Official use only do not write in this area to be completed by city cr town official' City or Town Permit/Licensina ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#- ❑ Health Department ❑ Other I I MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I Permit # MAScheck Software Version 2.01 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: 10-29-2001 DATE OF PLANS: October 14, 2001 TITLE: Lot 2, 450 Chestnut St. PROJECT INFORMATION: 28x40 main box, 16 family room, 2 car under, 2850 sq. ft. COMPANY INFORMATION: Old Yankee Realty Trust, Ralph R. Joyce, Trustee COMPLIANCE: PASSES Required UA = 539 Your Home = 492 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1222 30.0 0.0 43 CEILINGS: Raised Truss 90 30.0 0.0 3 WALLS: Wood Frame, 16" O.C. 3272 11.0 0.0 292 GLAZING: Windows or Doors 379 0.320 121 DOORS 40 0.350 14 DOORS 38 0.490 19 HVAC EQUIPMENT: Furnace, 86.0 AFUE HVAC EQUIPMENT: Air Conditioner, 10.0 SEER ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shallbe no eat than 125% of the design load as specified in Sections 7 CMR 10 4.4. Builder/ s' n Date ,� �Ll 4 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 2, 450 Chestnut St. DATE: 10-29-2001 Bldg. 1 Dept. 1 Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location [ ] I 2. Raised Truss, R-30 I Comments/Location I Insulation must achieve full height over the exterior wall. I I WALLS: [ l I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.32 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I DOORS: [ ] I 1. U-value: 0.35 I Comments/Location [ ] I 2. U-value: 0.49 I Comments/Location I I HVAC EQUIPMENT: [ ] i 1. Furnace, 86.0 AFUE or higher I Make and Model Number [ ] [ 2. Air Conditioner, 10.0 SEER 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 [ ceilings, walls, and floors. I ' 1 MATERIALS IDENTIFICATION: [ y 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 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 1250 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 1 require a cover unless over 20% of the heating energy is from 1 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" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: ( 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 1 HEATED WATER TEMP (F) : RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1744 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 9� Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works, The premises are known as No. `7 /U lN� e �'� Street or subdivision lot no. Owner Ran 4 — Address Contractor Addr s plicant's Signature PERMIT TO CONNECT WITH SEWER AMAIN The Division of Public Works hereby grants permission to /)0 to make a connection with the sewer main at ��1 t'l J Street subject to the rules and regulations of the Division of Public Works.. Divis'on Public Works By Inspected by Date See back for rules and regulations 1115 APPLICATION,FOR:WATER SERVICE CONNECTION North Andover, Mass. t9— - Application by the undersigned is hereby made to connect with the town water main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. /' �`"�J Street or subdivision lot no. C>1 Le &1z Owner -�p� Address Contractor Addr s pplicant's Signature C PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to G' to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. Board of Public Works By 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. Telephone(978)685-0956 DIRECTOR Fax(978)688-9573 t1 O R TN O Eo 9 IO 9 y 9 5 �SSAC`HUSEt� DRIVEWAY PERMIT DATE LOCATION 41'�:> BUILDER phone OWNER ^ c �. hone i 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. X A Fr< < CA rJ l IS 5(GNA'T'✓ZE r i F ORTH - - own O Andover�. No. 00 LAKE - 0 O` dover, Mass., //—a COCMIC HE WICK y1. �d ADRATED P`Pa,`�5 7SSACHLISE FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ....©1..............:/./. .! ./�C ..../.�.:..�............................................................................. has permission to excavate andP our foundation at ... (1 ....� ... .�. . sv.... 7`/Ud .... for the purpose of.....C1.. �(......UN. I"...Sl..'!'r./ ... t� l�G'ti The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. gS C/�y SSD 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 NORTFI LED / own of - over No. g('9 0 ... . ......... ...... - = `'0� COCHIC Et dover, Mass., � .c,p ORATED S H � BOARD OF HEALTH PE-RMIT T D . Food/Kitchen Septic System = BUILDING INSPECTOR THIS CERTIFIES THAT........(P.101........y/�I.!V. .............�.....,...................................... .........._.../..........// Foundation ....................... buildings on.. .o /oZ y.�'a... �.0 u.�.. Rou h has permission to erect.............. g �.�`................... ................... /........ g to be occupied as L �b t� '/ C� /I jJN�A,'" //�J /�G �l�s1'� Chimney p r................,...................... ............. ................................................�5......y. .......... ............... provided that the person accepting this permit shall in every respectconform 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. c�► $C//y l 30f, 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 BUILDING INSPECTOR Final Occupancy. Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. 1 .r 61•�N r.. 1 ' • j 1 � II III r �► ILl1 ' � j OEM] 'LL : III t _ If „�I �,, IS 1 ► 11 . I --- �” ,,. mTrr a ,4 Ill' t i , z 'M MPu i Y ■ II � iu GST / K U. IF - ol- 1 //, - a /L L r , f � y - 1 Q i �-� -- ----�_:---- — — --! -— -— , r - _� — --- _ —— _---•----tet--- T E R41 EB FAI zz --r- � REAR � V T1 N L . FT _ L V A T I O 1/8' —to' 1. Al dim°rasions are to be field vernied by the Contractor and any cdjus:ments made accordingly. cc o o ,41 wcrik shcl�be completed in comp4mce with all applicable Building, Plumting, Electrical Codes. Any other Loed, State and/or Federal Codes ' �;-;,, , ,cy ;;pp!y to thisproject-shall be coFsidered as pori of the � 1 c�nsriction documents. i ' 1 RI i rr c nr� nap(�c qhs'! emoved and disaos�d o p(oca 'v - .� /r ^� -�♦ �C—_, i _ .--r.o P fv;r � n^�, �P'cr tc If:OMGV Q.:lir - �___ .;!JV be recurEJ sl i:li {r�' CtflerS.i:rider SErarCte contract and terry s. Plumbs r7rng, etc.) thru floor shalt AQ p.,netrotions (Plumbing, Heati i I n be completely Fre Caulked ;I 6. All walls adjacent to stairs shoe have Fre Blocking 'installed a jacent ^' to the stringers. D"NX 7. Any Bcbility by Carroll Designs either assumed or inpfied shall be !_ fruited to the cost of the Design/Droftng Fee for this projec only. If these crawngs are copied and used for any project other an that L C� listed'n the title block, this will remove Carroll Designs of all l'abiity 9 oc� oo - - = SH 2 OF 20'61'.2" i 5'g" 13'71%" ' 'r Ayp 5'0" '4"' 4'2" li'i��s• ' S'3i�` 3'O' 2�8• ( s,10ji4" 6'9" t9- 16T SLDNG all L------ LAV STUFAMILY OM KITCHEN BREAKFAST a IF 1 '�\�- `��L .. ?. _ .. _ � _ . - _ . - . - t-•-� � } - - 1. b'u• .G' av � I c MNG - ROO ' 2'p• 3'a'' 2V. 4'0' i 4'0 6'0" 3 0 • 3'Q• 3'0' i 3'0• 6,C 4Jo• 1 ( 3'0" 6'0" 3,6• , 13'6" FIRST FLOOR PLAN • 10056 3-9 I 11,00 7 00 ' 8 16 13'6" Q. . ; _ WALK—IN �- BEDROOM #4 ' CLOSET , z C-4 CLOSE �- Ili) C 0St1 co 6'0" SLIDING =�. 24 I 8 21t" 46 BEDROOM ; B -DROO 2 t ='0� I g'g" 3�0■ I - S'g" 6'6� ( 3,00 4V P. LW aj F`� L i __ off' ��� ! .� 13'5" 13,0" ! 13'6` SECOND FLOOR PLAN _Q1/4. = 1G. 100 4 9 t • 54'0" . ._ 21T84" 24'6" - -- -- f -- -----------------------�-_-__------- ------i----------------------l-------- --------------_-_----=__- -- ------ _- ----- ------__� - - ---- -------------- ------ ---------------- �• 1 - --� -- -- --� -- — - ------------=----------- -------------_—____------------ ---- ----- _ FO��IDATlON _ IH 40 1,: Al wood constructed '+t CSS erd - _ _- - / _ L . ceic to have 5/8` type 'X' �t a 10"Op x f8'W Conf-Foabiq -� ; t 1 1 , . rated Waibocrd 1 �� I t • i � � � i � � t 1 i t � t i , • /t I Z ' � - ti itt Z - 3 112* L o_ aly Colum J 1 L i L ►' i 1 4 ; ` f CL Cl I- ---1 t Fcc:iq it ragd)J --------- - --------- za tc l i -- -- - t SI �FC.< - - -- -- - ------- -- ---- ---- - --- --- - . . - --- ----- - - --- -- -- - - -� ` r-------------� r----------- ------- -------------• - 1 1 t 1 FOUNDATION PLA�! j - _ ; NO `J Ccntruces °aff-ed ='--^e `lent 2 x 12 Ridge Boerd .3 / 2 X O v^IiGr I�s -T O.C. } ROOFING Aspheit/Foerglcss RooFng _ Buidng Paper00 _ . 'LOOK 2 x i0'�w'fiood OC. ?_ 7777177 o.0 , ;0' Over^cndrg Sort w/ve�.i - c C� ts7 � O • - � i FLOOR 'ffALi CD 1•r—' c J/4' cneou�ra Sof ofCrr7Er - f TU 2 X 10 0_16' OC. Sr=.erchi e, 2 x 4 0 V 0f. hSLGt3C , Vcccr 3crrier - 1/2 Waited x 1 i 1 4+ . {K -"i - 2X1051b0Z1 . - 2 x6 �',' - 2x5 ^. - 1/2'-Dia x 12' La.Anchor 801t a E'0' 0E.(max) 3- 2 x 12 Center Becm FOUNDATION 31/2' Dia.idly Columns i 10' Concrete Wail / eO' Pour (SEE RN fwt MR Loc�►loksy� I ot 10' Op x re W Cont Footng -CT HRU HOU E LQ N T 1/4' 1'0" 4' Ccncrete Slav - _- _ - - - - - - - - - 10056 ' 6--9 s . f � V 1 - .12 f 12 CELLA 2x8 .5" 0� - is ,`Css MUG'60n f� R T ceress hsdatcn - 4 _ - Fascia P-Qd i0' OvenccngN Soffit w/vents _ 'HALL Sidrg,Ar Sarr - I FLOOR Sherihhg 2 x 5 0 16" Of- Sheaihing hsuctbn,Vc r Barrer i _ - 2 X10 0 �6' Or. 1/2' Walbocrd - I •R19 hs-JIatJ01i _ —. 1 ,� � �r n,-� --',r�nc 4r r rrr r r• r r r: rr..rr.:� rr r t; _ - _ j , � oi;c.�+:i��•��.. �., �:., c..JSucE���'L„JVd'�.c.:Sbouu2SlStSE'��f•�Sl,v'22f'tSi.F:1SLu2�J'u�6L;,,:w� c`��,:.;:u;lr fL 3 2 x 12 Center Perm l — 2x � P-i,' — i 2 x S KD. i rriLNQA - iQN z' 10' Concrete Wal / ab, Pour _ Concrete.Sfch - 10' Gp.x i'8' W Cont Fcotng SECTiON - FAMILY ARG - },'" = 1.0 _ 10056 7-9 . I f Fkah Fr=ed 8e= t Rt II to "111 iii ' I I I I tt AJ.`L0.) �� Terribers ra x'.0 '6' Of. Wr (UND.) E-!R-�"T FLOOR FRAMING QFC OND FLOOR FRAIyIINC? illli� I if 2 x Z 2iv7� ?C-xd i { 10, 1111 41!11 Iz ! Riu'ge EcQd ( � I 17 1 � r F'u h Formed?ecm 1 1 1 i I I i 1 TIT' :! I II ,t AII herr.ers �e Z s'Q d 1S` OAC. rill Ad mr-mben ae 2 M :6'0L.{UNDa 1 N 4 11L G { I ��1'MING ' Mar' �C71iC:1 L ,r.h)AY wcca �CCB �cG'� gt; —. - cage ! i / 1 - 2x6K.0. 1 x$ Fcscta - ntniotm Si GQsket 3 ' -w nth trtn � Co ► 1/2," Dia x 12" la AnGnor Bolts x 3 oder ' ~ @ 6,00 O.C. (mac a. t soffit ww.nts Roel ;<cf-ters � F� A ; SOFFIT110 ,,�- ;•� B f .���_ ,J -• �T �/ cr Ca-i. !' y;� �1T L KFC cr 1i_k — 2 :c 2x10 ;RrnJc5: - l-2x110 4 ;5" O.C. 2 — 2 x 10'RlmJa t 2 2 x 4 Top Pate s iiiooR , -2� - ;��� co v�ERI�t. FLOOR , . . . 1 2 = 10 4 0crcr�;e pct ?' \ � e i -- 2x10 9) 1 10 6' 0_C. • , . 1 ancrete Wdl / 8 0 Pctr ' - . I 10' p x 1T W Cont Footng 1 - 2x6P.T, 1 - 2xaa" KD. I 2X Fre Elc61rg • Ccriixcts c� C�ce, ,. - In Dia x i2" Li.Anchor Bcits _ 0 8 0 0 cc.(mex� -�- 3 - 2 x 12 Center Bean • nE S1LL 12- ,�o» R FIRE BLOCKING ,�2. , ,�oy , C 1� CONC. FDN. i�- = 1oa• 10056 9--9 / '12/06/2001 !E,:3b 6L38930733 MHF DESIGN PAGE 02/02 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM.A PLAN ENTITLED "PLAN OF LAND LOCATED IN NORTH ANDOVER MA PREPARED FOR KENNETH Vt. REA'". SCALE: 1`�-40'; DATE: 4/27/99 _MAP 98O LOT A,2 (re.v. to 7/12/99) BY CHRISTIANSON & SERGI, INC. - NORTH ESSEX REGISTRY OF DEEDS PLAN J13538. 2) THE INTENT OF THIS PLAN IS TO SHOW THE AS— ! + 127.07'-.. BUILT LOCATION OF THE FOUNDATION ONLY. Go tw MAP 98C LOT 2 z 25,596 Sq.Ft, �= 0.588 AC.+ MAP 98C LOT 1 20' I MAP 98C LOT 3 r a ,CONCRETE FOUNDATION i NO6'29'40.W -�- GRAPHIC SCALE ~_"T107`,34'43"W o xa 40 80 C35.14' �,��� (IN FEE 1 Inch - 40 ft I HEREBY CERTIFY THAT THE FOUNDATION SHOWN HEREON CEIRTMED PID ' PLAN IS THE RESULT OF A FIELD SURVEY MADE ON MAP 98C LOT 2 DECEMBER 5, 2001, CHESTNUT STREET NORTH ANDOVER, MASSACHUSETTS PREPARED FOR RALPH R. JOYCE 95 MAIN STREET CHRIliL? ?NORTH ANDOVER, MASSACHUSETTS 01845 FRk[dCH;n � tOS BrHee woo6, But»owe �' 116 F7,Aa B,slem,New Na,npeNth 0"3a7Q (673)U3-0744 1 rY 1ARF Datign Carist WGINKERS.P{ANGRB.0400RS SCALE: 1" a 40' _ GATE; DECEMBER 6. 2001 DRAWING DRAWN BY: N CKEA BY;�PRllfff—rro7 N.AME LICENSED LAND SURVE OR DATtn JJW OMF901 1 1149CFP2.DWG 33 • �a.s,�s.. F r f SACINIS°4� - CERTIFICATE OF-,M9 &0'CCUPANCY TOWN OF=NORTH ANDOVER Building Permit Number 360 Date 3 o700 3 THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS roo/�j o�I A ?�a/ p& c1v r J .v 9 A k,S�c�Y.vC� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS SATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO iii Ce/%tis ptiD tig ' Building Inspector ,4 , ' i 'ovvn . met dover - A of 0 n� No. go 0 L coc. lover, Mass., ORATED F'P�\��) OEM Elm 7 S H �c BOARD OF HEALTH WE Food/Kitchen FMKMI I I Septic System (P.101 n /_D � C �. = BUILDING INSPECTOR (THIS CERTIFIES THAT.........P.10 ........... A....... .........................,........ ................................... .............. ........... Foundation f�-iF. O/,�f C5— has permission to erect.............. ................... buildings on../P7"o 76. '41ST ill ti v 5..` Rough/ / / to be occupied as......... ... c9 b WI o�t S o�/� (JN Gl�r //V /C /Y� r4/!%Y W imney - e�...............,...................... .......... c ......................................... ..... .. ............�............... ` provided that the person accepting this permit shall in every respect-conform to the terms of the application on file in Final^ cc�,,,�,_ 3 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. car 8 1/ l 3 p f, PLUMBING INSPECTOR � S o �'�ti, GV`► VIOLATION of the Zoning or Building Regulations Voids this Permit. Lf 5 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTR CAL INSPE oY , .. BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR g Display in a Conspicuous Place on the Premises — Do Not Remove Oti P Y P Final No Lathingor D Wall To Be Done Dry FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i Town of North Andover of NORTh Building Department o 27 Charles Street � -= North Andover, Massachusetts 01845 _ (978) 688-9545 Fax (978) 688-9542 �` •� 7q a'sewwwwntw y1. ��SSRCHds��y I APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION " ADDRESS LOT NUMBER_ SUBDIVISION 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 UCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURF� IAif,USE ONLY ROUTING CONSERVATION_AjDATE 03 PLANNING DATE D.P.W. —WATER METER �L� DATE D . rST INDICATE THAT THE WATER METER HAS BEEN INSTALLED RI R SPECTI REQUEST DATE.SIGNATUORIZATI TOWN OF NORTH ANDOVER a µoaTH Office of the Building Department 2°.�*``°'•:'"o Community Development and Services 27 Charles Street ; North Andover, Massachusetts 01845 ���; ssACMU D. Robert Nieetta, Telephone(978)688-9545 Building commissioner FAX(978)688-9542 January 23, 2002 Mr. Ralph Joyce 121 Collins Landing Weare N.H. 03281 Dear Mr. Joyce: Please be advised that as of today's date this department has yet to receive any documentation and application for the retaining wall(s)at the Chestnut St.job location. This is an important part of the ongoing construction at this site and needs to be addressed in a timely manner, as no further permits will be issued. Under the Mass State Building Code Chapter 1 Section 116 a certified professional engineer's certified drawing and calculation's is required for retaining walls over 10 feet in height of unbalanced fill from footing to top of wall. Please contact me so that we may begin the process to rectify this situation in a timely manner. I may be reached between the hours of 8:30— 10:00 AM and 1:00—2:00 PM at 978-688-9545. Respectfully, - /0-6�, I ,K,�� Michael McGuire Local Building Inspector Michael McGuire,Local Building Inspector James Decola,Electrical Inspector JamesDio=J,Gas/Plumbing Inspector Plarming Department 688-9535 Conservation Department 688-9530 Health Depaitntent 688-9540 Zoning Board of Appeals 688-9541 TOWN OF NORTH ANDOVER o� Nei7Ty� Office of the Building Department Community Developmentand Services 27 Charles Street North Au€o-er,itlassachwetts€1845 �1°*�• R" � � D. Robert Nicelta, Te1q)1i ne M7R j 688-954-5 IBrtitiFing Commissioner FAX(978",688-9542 February 14,2002 Mr. Ralph Joyce 121 Collins Landing Weare N.H. 03281 Dear Mr. Joyce: Please be advised that as of today's date this department has yet to receive the engineered drawings and calculations for the retaining walls on the rear of lots I through 3 Chestnut St. This is a very important safety concern to this department and needs to be addressed ASAP. Please be advised that until such time as the appropriate paperwork is submitted and reviewed there will be NO OCCUPANCY PERMITS for the lots noted above. Please contact me so that we may begin the process to remedy this life safety issue in a timely manner,. Respectfully, 6, Michael McGuire Local Building Inspector Michael McGuire,Local Building Inspector James Decola,ElectricalInspector JamesDiom,Gas/PlumbingInspector Planiing Dcrartment 699-9535 Cons atim DT�amlmait 688-9530 health Departmcnt 688-9546 7orning Bo.ird of Appeals 688-954 i TOVVN OF N()RT.fl. A,Nf)OVER Office.of the Buil(fing Depaxinnent 0 AC } nit'Nice-ta, C,1 e 111filding connudssioner April 22,2004 W. Ralph Joyce 121 Collins Landing Weare N.H. 03281 RE: Retaining Wall problems 440,450,460 Chestnut Street,North Andover,MA. Dear Mr. Joyce: Please be advised that upon an inspection of the above noted properties it has been observed that there is washout occurring at the top of the slopes down onto the top of the wall and into the yards of the properties. This situation is in need of correction so that there is no further washout or damage to the homeowner's properties. Please contact me so that we may begin the process to remedy this issue in a timely manner. My office hours are 8:30— 10:00 AM @ 978-688-9545. Respectfully, Michael McGuire Local Building Inspector Town of North Andover tAORTH Building Department 27 Charles Street w R North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 CHUs APPLICATION FOR CERTIFICATE OF OCCUPANCY!INSPECTION ADDRESS LOT NUMBER 04G7i3 SUBDIVISION .. _ DATE REQUEST FILED 7/ Z Z42 3 DATE READY FOR INSPECTION FIVE (5)DAYS NOTICE PRIOR TO CLOSING DATE IS REOVMED ALL WORK AND SIGN OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME_ A RE-INSPEC N OF TWENTY-FIVE.($25.)DOLLARS WILL,BE CHARGED IF T MEET ALL APPLICABLE CODES. SIGNA OtRICIAL USE ONLY ROUTING CONSERVATION DATE PLANNING DATE D.P.W. —WATER METERDATE c D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED TO INSPECTION REQUEST ATE. IGNATURP 7 DPW A ORIZATIO