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HomeMy WebLinkAboutMiscellaneous - 455 WOOD LANE 4/30/2018Xv N MW Date .. iJo/2 y1141.... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that - 1.� c A .................... .......f........�,� .......... ............. has.permission to perform ................ ..........:... plumbing in thebuildings-o . ..... ........ ............ at ........� ......� 1 3 t�C'.......................:..............:.., North Andover,.Mass. Fee.... Lic. No..... .............................. 1 � PLUMBING INSPECTOR Check # J w( (� IN-, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 1/V t , "_ 76jW -r!f MA DATE �Z D/�,�-I PERMIT # !��' JOBSITE ADDRESSJ1 >OC�-�� DINNER'S NAMEF y OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL RESIDENTIAL Fj PRINT CLEARLY NEW: El RENOVATION: REPLACEMENT: El PLANS SUBMITTED: YES ❑ NO[] FIXTURES -1 FLOOR-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE v ✓ y j - DEDICATED SPECIAL WASTE SYST M DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM DEDICATED (NATER RECYCLE SYSTEM _•_ _ - -: _ j - i __ DISHWASHER ` } DRINKING FOUNTAIN FOOD DISPOSER - - - FLOOR I AREA DRAIN INTERCEPTOR (INTERIOR) - - - KITCHEN SINK -- ti LAVATORY ROOF DRAIN ! - SHOWER STALL SERVICE ! MOP SINK TOILET URINAL - - WASHING MACHINE CONNECTION - - -= WATER HEATER ALL TYPES 3i ' - - - - tNATERPIPING , -- - �--' � -- �---- -_ •--� _�. OTHER I - a t 1 I I, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ✓ NO —I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [✓ OTHER TYPE OF INDEMNITY L__! BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement CHECK ONE ONLY: OWNER 0 AGENT F SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will �gliance with all Perteinee tt.,proov'ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME J rA P K G0 LJ V91A �—(LICENSE � � l� � �a ; SIGNATURE MP[j✓ JP [j CORPORATION E&s 4'L�PARTNERSHIPS# :­_-] LLC [41 COMPANY NAME i F &A."V_ CWJVEIA I LIC. ADDRESS 1q.5 CITY �_C'1tELa-ts>`o2iJ STATE Mf�ZIP� D18�3TEL[-_q78-251 aOc FAX CELL EMAIL LP k.AN rr` @ -OC A4 LJIM 731 AJ Co F -r a V CL O El Z N ❑QI W F O � 7 � 3 LU a. W a a Q9 tii W LL I Date... ...... ......h�1.... ... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas anstallation ...... e4z ........................................... in thebuildings of. ................................................................................................ at ... ............. North Andover, Mass. Feer A' ..... Lic. No. . .............. .................. .................................................. GASINSPECTOR Check # 510?A-D 9619 I 1 Ii ;C\- ry MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY a MA DATE[/ PERMITn JOBSITEADDRE$SE77—. oz) OWNER'S NAME�--- % . OWNER ADDRESS TEL[—�FAX TPR R OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW:{] RENOVATION: REPLACEMENT:[ PLANS SUBMITTED: YES(] NO[] APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 fi 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER `- --- - -- COOK STOVE DIRECT VENT HEATER - — DRYER _ FIREPLACE _- 1 - lµ FRYOLATOR FURNACE �_ v_ - GENERATOR —., Y -- --- - - -� _ GRILLE INFRARED HEATER a _ LABORATORY COCKS — MAKEUP AIR UNITS -- OVEN _ POOL HEATER "F- - ROOM I SPACE HEATER -7- ROOF ROOF TOP UNIT TEST c UNIT HATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabilily insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Ot'NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE INDEMNITY [--j BOND (� OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT 0 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i iwwi`Mall P zine t provision of the . Massachusetts State Plumbing Code and Chapter 142 of the General Laws. fy�n-cc-e PLUMBER-GASFITTER NAME I JrQatiltc G0LJd151A LICENSE-1bZ20 SIGNATURE MP [✓MGF 0 JP ❑ JGF Q LPGI F1 CORPORATION DVn C1 PARTNERSHIP LLC �- COMPANYNAME: F&Aa4tC 4°oVVEtA 10C.. ADDRESS_1P12114CC-7"o1:1 s -r � CITY STATE MA Z{P p186� TEL q78 -251-180a FAX gla,251-tool CELL= ]EMAILIFP-.49L?- er F4PLV1-fBiAJi , Com The Commonwealth of Massachusetts Department of Industrial Accidents ` u Office of Investigations 600 Washington Street Boston, MA 02111 bwww.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: la Il 1—� /Y( -Q"M City/State/Zip: M y V -d Phone #: Are y an employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. ❑ required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. # These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 1.52, § 1(4), and we have no employees. [No workers' comp. insurance required.] -S -/,f C, Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑�Vluerical repairs or additions 11.bing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is provid,m workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 6 (t" n Policy # or Self -ins. Lic. #: %R f e q—Z? T Z 6 Expiration Date: 2J~ Job Site Address: W<-7— (�) 0C)d Z—/L— City/State/Zip: /V r Aidz)&-e— 61 Yr Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfify Mder the pains andpenalties ofperjury that the information provided above is true and correct. Phone #: q 1 2�--I -- f Or", nu O Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Page 1 of 2 YFrom: "Thomas, Wayne E (REG)" <wayne.e.thomas@state.ma.us> Subject: Corporation Sent date: 09/23/201411:30:34 AM To: "drew@fgplumbing.com"<drew@fgplumbing.com> ' Hi Andrew, This email should serve as notice that the Board has extended the period of time to change the Master plumber of record for your current corporation until November 30, 2014. You may continue to operate the corporation as stated in 248 CMR 3.03 (1) 248 CMR 3.03 (1) 3. Death of the licensee of record a; It tete event its licensee of record dies. a usiness mast notif the Board in writing of said death wr thin fifteen (IS) days4 b. So long as all other individuals perfonning plumbing or gas fittinst of the bits ness are validly licensed, tie bns ess way eontuiue operatkg for sixty (60) days. For ggood cadrse sltotlro the Beard 111ay extend this period. ?gage 4: ✓-AWWJ Executive Director Board of State Examiners of Plumbers and Gas Fitters 1000 Washington Street - Suite 710 http://webmail. covadhosting.bizlmaillmessage.php?index=2&mailbox=UGx 1 bWJpbmcgQ... 9/23/2014 Page 2 of 2 Boston, Ma. 02118-6100 1-617-727-6388 This email and any files transmitted with it may be confidential, the disclosure of which is governed by applicable law, and is intended solely for the use of the recipients to whom this email is addressed. If you are not one of the intended recipients you are notified that disclosing, copying, distributing or taking any other action in reliance on the contents of this email or any attachments is strictly prohibited. In a separate email, please notify the sender immediately if you have received this e-mail by error and delete the original email from your system. http://www.mass.gov/dpl http://Webmail.covadhosting.biz/maillmessage.php?index=2&mailbox=UGx 1 bWJpbmcgQ... 9/23/2014 TOWN OF NORTH ANDOVER ti Building Department 1600 Osgood Street ^� Building 2- Suite 2-36 Building Dept"SSACH�s���y North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: TEL :a0 a - 31" NAME OF COMPLAINTANT: Jo A/- ADDRESS.::.... 1.5.5_ dOO41 4AAle- COMPLAINT TYPE: Electrical: Plumbing: Gas: Building: Property Owner: Address: .33 61vPPu/ Other: 12114eq Signed: 33 �iE'Per✓ bee. /1"1 Complaint Form - Revised 6.2007 f Location �� 1 No. Date TOWN OF NORTH ANDOVER • o� w a ; ; Certificate of Occupancy $ � CNs ��' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17714 wilding Inspecd'rr- V TOWN OF NORTH AN -DOVER BUILDIl®1G DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING se ,......:..,,.. BUILDING PERMIT NUMBER:::,2 �� C/ DATE ISSUED: 1411 �% ,f./ %/ SIGNATURE:f 6/ zwt-f // Building Commissioilr/1 for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: SS w© o 0 1.2 Assessors Map and Parcel z Z Map Number Number: ! z D Parcel Number 1.3 Zoning Information-. Zoning District Proposed Use 1.4Q Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re aired Provided 1.7 Water S ly M.G.L.C.40.154) Public C•T Private 0 Zone 1.5. Flood Zone InformatiOn: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: R�- On Site Disposal System ❑ _ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ' � i S l" I' L ; Stt1 Ct: Yes �y o t/ 2 ]F Owner of Record Nsme (Print) Address for Service i 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 ❑ -k IFo x,9101 ` C" e4 It LicVhseA Construction Supervisor: �/ 0.S8 Z 7 iA/ n ` �' License Number Address 0/0 8/ZOO co " I& g' C 8 G O 7 86 Expiration Date S nature Telephone 3.2 egistered Home Improvement Contractor Not Applicable ❑ Company Name / y Z Registration Number Addres ` /� Q �//9 /z S/ O ��✓ Expiration Date 1\ tgnature Telephone Qs SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. affidavit Attached Yes .......❑ No ....... ❑ —Signed 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: a / / �. 0 Doh ✓,` E1 1 1 i 1a 3 A �, S Pe r, U N I �— Q S+al' V/v F" 6A-r?.�-�(�KIbff� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be om leted b permit a licant €?FI~ CIALIUSa , NLl ., G }. 3y� a _ 'y . „b„ 8 1. Building 'y��o� • `—^ (a) Building Permit Fee Multi Tier x lab, 4 SS OP 2 Electrical (b) Estimated Total Cost of Construction / q 9 / / 3 PlumbinE Building Permit fee (a) X (b) r C' 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNEER/S' AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _ as Owner/Authorized Agent of subject property Hereby authorize &` X to act on My beI I' '' 11 11 lersrOative to work authorized by this building permit application.�� Si iature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent NO. OF STORIES Date SOME SIZE BASEMENT OR SLAB. SIZE OF FLOOR TINIBERS 15 z 2 !y `" 3 SPAN g ` DIMENSIONS OF SILLS DI 4ENSIONS OF POSTS DIMENSIONS OF GIIZDERS �® HEIGHT OF FOUNDATION _ _ _ THICKNESS_ SIZE OF FOOTING X MATERIAL OF CHIMNEY - IS BITILDING ON SOLID OR. FILLED L UND IS BUS DJNG CONNECTED TO NATURAL GAS A r 0 to 105'1 TURNAROUND AREA PROPOSED (— PARKING _J —1 #455 WOOD LN. 19' I EXISTING DRIVE I � 1os't NE WOOD I�► PROPOSED PARKING PLAN CLIENT: AL MA TTHEWS LOCATION. NORTH ANDOVER, MA. SCALE. 1!--40' DATE. 8/26/04 CHRISTIANSEN & SERG1 IAMD SUR, M°, S 160 SUMMER ST. HAVERHILI." 01830 TEL 978-373-0310 @2004 BY CHRISnWWN & SERGI INC. 31' W Z 24' PROPOSED DRIVE DWG.NO.:04056001 or FORM - U - LOT MLEASE FORM INSTRUCTIONS_ This form is used to verify chat ill - C necessary approval / permits from Boards and Departments having jurisdiction. have been obtained. This does not relieve the applicant and` or landowner from compliance with any applicable requirements. �ssssaaaassssassas•rss�ss:aass■sssrasaseassassssasa ass�aaasasssssssa,sasssaaa■ APPLICANT78- 83-0801 PHONE ? ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET 0000 1,.� /!G' Isssasasra•sasrrs..... TREET NUMBER seassrssasaatass.aaasssasa a aasaBias s.sa.sasssasaasasssssssaa■ OFFICIAL USE ONLY �usasssass.rsasaassaaasaa.aaaasa.saaesa.asaasassaasaass.ass.asaasaaaassEa.assaa-ra■ RECOMMENDATIONS of TOWN AGENTS �ssssasass�.saris-sasasassasaaaas.■sassass�aasrasass.asaarsssaassaaa mass assaaas■ CONSERVATIONADMiNISTRATOR DATE APPROVED DATE REJECTED COM AENTS TOWN PLANNER DATE APPROVED DATE REJECTED CONMEN S DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED SEPTIC INSPECTOR - HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORDS - SEWER I CONNECTIONS DATE APPROVED DATE REJECTED I SCALE: 1" = 30' JUNE 25, 1984 MORTGAGE POT PLAN r� 355 WOOD LANE NORTH ANDOVER, MASSACHUSETTS OWNER: ROBERT S. 5 ELLEN A. RARKLI! �c 1 J i i 4�9 -, NOTE:. -THIS IS NOT A SURVtV AND IS TO BE USED FOR MORTGAGE PURPOSE' ` ONLY. N.B.- DO NOT USE OFFSE7S FOR ESTABLISHING LOT LIVES FOR THE ERECTI OF FENCES WALLS. HEDGES ETC. . Ila I HEREBY CERTIFY ThAT THE BUILDING ON THIS PROPERTY IS LOCAT SHOWN ON PLAN AND COMPLIES WITH THE LOCAL ZONING SET BACK REQU; MEN7S. . CYR ENGINEERING SERVICES, m I FURTHER CERTIFY THAT THE ABOVE DWELLING IS NcIT 300 CANAL STREET LOCATED IN. A FLOOD HAZARD ZONE . LAWRENCE, MASSACHUSETTS. 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 exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. MA j e -WS ysS" 424001 A691l� Permit App cant Property address Map / Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any, party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the budding permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permitt application and associated attachments, complies with one or more of the following sections as indicated by a check mark. V This is an application for building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. ,1 This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly 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 part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to bepreserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready fora building permit ( 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 submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS G OUNDS FOR REF SAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) 41 Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Afdavif Name Please Print Name: &A�,4 td �7C/ Location: 4906d City Md ,y of Phone # ) 00040% 8 G I am a homeowner performing all work myself. ® I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance Co. Policv # Address %Z hfG�Ai�1S �� City "0 ydle� Aks, Phone #: o (7,0' '?2? 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..penaftiesin theform of-a_STOP WORK_ORDER..and..a fine.of.(.$1A0.Q0.)._a dayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under" pains and penal s of perjury that the information provided above is true and correct. Print name E0,1Y41 116d6N44- Phone# 5)96S610280 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required I] Licensing Board ❑ Selectman's Office Contact person: Phone #: E] Health Department r-, Other 'teal i � ` �ttttttt S M i c - 4 .14 7: ;.} Of t �' •� tires -40 a, s= h_ �a K �t Fl � ��.. I , • ,` �YJ t�r � tf S. ,�• a �Y�� C* - � J T 1 J , --6,- "� r T" _:., ¢ ♦�� t C g• R'Fc qs•t��, �'s �Y •�^4pgi.� �y���j �,Y` `:` � y,�d ;# K`s � @{ ��`��V' ,,ti�,3�tat•Y�'tK�N, .d � I .�:.� �`�.°, " °' , : � � �.r • 411 � � 11 i C x s. ATix.. .,. u� A MECcheck Inspection Checklist Massachusetts Energy Code .MECcheck Software Version 3.2 Release la DATE: 10/08/04 TITLE: MATTHEWS PROJECT Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 cavity + R-19.0 continuous insulation Comments: Above -Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity + R-13.0 continuous insulation Comments: [ ] 2. Wall 3: Wood Frame, 16" o.c., R-13.0 cavity + R-13.0 continuous insulation Comments: Windows: [ ] 1. Window 1: Vinyl Frame, Double Pane with Low -E, U -factor: 16.000 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: [ ] 1. Door 1: Solid, U -factor: 3.000 Comments: [ ] 2. Door 2: Solid, U -factor: 3.000 Comments: [ ] 3. Door 3: Solid, U -factor: 3.000 Comments: [ ] 4. Door 4: Solid, U -factor: 3.000 Comments: [ ] ( 5. Door 5: Solid, U -factor: 3.000 Comments: Floors: [ ] 1. Floor 2: All -Wood Joist/Truss, Over Unconditioned Space, R-30.0 cavity + R-30.0 continuous insulation I Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 78 AFUE or higher Make and Model Number Air Leakage: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 Us) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R -values and glazing U -values must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 °F or chilled fluids below 55 °F must be insulated to the I levels in Table 2. Table]: Minimum Insulation Thickness for Circulating Hot Water Pipes. Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runouts Circulating Mains and Runouts Temperature ( F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release la Checked By/Date TITLE: MATTHEWS PROJECT CITY: Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: I or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 10/08/04 DATE OF PLANS: 05/01/04 PROJECT INFORMATION: 455 WOOD LANE NORTH ANDOVER COMPANY INFORMATION: R.S. HEBERT BUILDING & REMODLING COMPLIANCE: Passes Maximum UA = 10 14 Your Home = 917 9.6% Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1540 38.0 19.0 29 Wall 1: Wood Frame, 16" o.c. 4968 13.0 13.0 233 Window 1: Vinyl Frame, Double Pane with Low -E 15 16.000 240 Door 1: Solid 18 3.000 54 Door 2: Solid 18 3.000 54 Door 3: Solid 18 3.000 54 Door 4: Solid 18 3.000 54 Door 5: Solid 18 3.000 54 Wall 3: Wood Frame, 16" o.c. 2500 13.0 13.0 120 Floor 2: All -Wood Joist/Truss, Over Unconditioned Space 1540 30.0 30.0 25 Furnace 1: Forced Hot Air, 78 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 Massachusetts Energy Code requirements in MECcheck Version 3.2 Release 1 a. 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O�-�J „Z/t 6 r v ► r � slslor �oalJ ONI1slx3 of x N011vinSNl ,Z/1, 2 iv �J00-1j Is6i W0li is6i --'0'0 "9[ b llvm „ 17xt AV3d 01 OVIS ,100?�133NS „4/S S151U(' �OOlJ 101. „v!. x J7/2 t 1 NOuvinSNI ,z/ i �001J ON003S W0IJ ON0035 SIIVM ONI(llAia NO »OOJ1J31-IS „8/9 — 0.0 1, @ l IVM ,9 „i=XZ SON1130 A0MA3HS C13HSIIdIJ ,Z LJ NOIIVInSNI ,Z t s3ssnd.1 Jowi 0112113NION3 a ONIHIVIHS „Z,/l. GNd 113J 9 [# N3AO i aw 'JanOPud DIJON 99LO-999-sc6 V0/ L 0/50 pamsul /pnH Me YG OUd OI�7�JIIOIN�N �8 OIaQ71[lti .LlI�Ii�II uoiloaS mels dW `aanopub 4PON •s•u auel POOM 99V IOafoad SMG. �eW uagaH u%OSbJ3D6# -BaN/'O!l r NOR7M Of t,��c r�1ti O 9 OWL SSACHU$ This certifies that Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .......................... has permission to perform ...P. A . t Z � a -- plumbing in the buildings o at.. .?!?;...l.oP. Fee ..... Lie. No. iG Check # 0 6423 f . AI ?I .fl � r ............... . . kL...... , North Andover, Mass. .�.. ..... ...... PLUMBING INSP TOR MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 4z— Cclocl C.. New APPLICATION FOR PERMIT TO DO PLUMBING Renovation ® Replacement 11 FEKTURES C Date Z _ i! (J —r Permit # L Amount S�"2„ '° Plans Submitted Yes ❑ No ❑ (Print or Check one: Certificate Installing Company Name i c - - �1 V c �; Corp. Partner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity E 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 Own er El Agent 0 I hereby certify that all of the details and informatio haebmitted (or entered) ' above applic i ar a and accurate to the best of my knowledge and that all plumbing work a d insons performed un Pey ssued r t 's plication will be in compliance with all pertinent provisions of the Mas chuMate P g dei�tfd C"""apt 2 o e General Laws. OVED (OFFICE USE ONLY Type of Plumbing Lic se sense IN um er Master Journeyman ❑ io This certifies that TOWN OF NORTH ANDOVER PERMIT FOR WIRING ................................ has permission to perform ............................................. .................. wiring in the building .......... ................................................ of .... ; at ............................. I North Andover, Mass. Fee:,.�........................ ...... . —.../ ................... -A-..... Lic. NAC.y ELECTRICA Mwcm Check # 57 21 IrmLuiv ylulyV rJU.LllyriL3 • DEPARTM1AT0FPIIBIICSAFE7Y Permit No. ;IC9 BOARDOFFMPREVEM NREGUTAT70NSR7 12-M Occupancy & Fees Checked APPLICATION FOR PERMIT TOMA!SMAMTS ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE E CTRICAL CODE, 527 CMR 12:004 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) i Date L Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described 1 w. Location (Street & Number) 45-5-6- OND Z A1. Owner or Tenant LT -F h -D IV( "-I 1�GWJ Owner's Address�- Is this permit in conjunction with a building permit: Yes p Noc� (Check Appropriate Box) Purpose of Building ��� I �J \ 5 �� � l'L1 1� f� T �� Utility Authorization No. Existing Service Amps /oVolts Overhead M Underground IZI No. of Meters New Service Amps/ Volts Overhead =3 Underground [z] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work GY t=.uUC-9P W 112 1 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above 0 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 FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Plumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW ��A fio. of Water Heaters KW No. of No. of Connections signs Bailasis 4,No. Hydro Massage Tubs No. of Motors Total HP OTHER. >Comn@m AustratttatheregtmmrraiS�GararalLavus a IhneaammtLiabtTdyh>s =pcficyitrJu 9c mpi* Comwcrl wom"egtriv�llt it YES NO Iharewbmmadvafidptoofof=wio he0� YES � r)uuto edged®dYES,pleaveirtdiralettyp heect'ovaage oby dtaddtgihe bmt. IBJ INSURANCE r7-111 BOND p OTHER p ) EornaledVair ofFb riral Whric S WodctDSW d hnpectionDateRegtres d F�u� °fes`SA`�5 p p4� � "FIRMNAME iuceriwe \Tole Sign = Arkirm ;rC alai Lioa=No. V05W 7 L LiomWM BusirmTd Nn o< D 1/U14. 6/5,'-G AlTdNa OWNER'SMURANCEWANFR;IamawaethattheL=wdoesmthawthenumnoec mWcrgs alepvalatasregtl WbyNbsmd>«senst coWLaws ardthatmystgnattrreonth�pearit waivesthisrequirerrralt. (Please check one) Owner Agent Telephone No. PERMIT FEE S signature of Owner or Agen ice, v 0 f� I rm (luivVyluiv YrrJui n Ur �r r>ta xit,n v.wl 1 u DEPART WW0FPUBL1CSAFEI'Y BOARDOFFIREPREVE ONRB UTA770NSSl7Ctti1R12{D Permit No. Occupancy & Fees Checked �� ! APPLICATIONFOR PERAff TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 4 2L (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat J � 5 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perforin the electrical work described below. Location (Street & Number) ` t j (J 0 D_) (, A/. Owner or Tenant _ L f w (D YVl W. N L W Owner's Address S 14 ti"` �- Is this permit in conjunction with`l a!! building permit: Yes P3 No (Check Appropriate Box) Purpose of Building '� {� Utility Authorization No. Existing Service AmpsVolts Overhead 1:3 Underground No. of Meters New Service Amps Volts Overhead [MUnderground Im No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets n No. of Ranges No. of Disposals No. of Dishwashers 1 of Dryers of Water Heaters Hydro Massage Tubs ER• Coverdm PtEntto No. of Hot Tubs Swimming Pool Above " Below No. of Air Cond. Total No. of Heat Space Area Heating ubmbedvalid pudafsam ioftO6re YES 19 boot LANCE BOND GIM aShat �4i 4 h�ec�onDateRecltrs�d K 4 No. of Transformers No. of Emergency Lighting Battery Total KVA KVA FIRE ALARMS No. of Zones Total Total No. of Detection and Tons KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local r7 Municipal r7 Other Connections gait . YES� NO M Y)au have dvckBd YES, please indican die type cf am W by Estirn*dVair&@Bcmcal Wok $ Rol# I alal utd r e cfpHjtty NAME 5 u CLT ► C Lio=Na Y© C L G; lldtl,4L7> w rti signaane ' Lioa>seNo Buss Tel. Na (% 74i) 9Y 6 ld 2 c_' ic �/5 A AkTd.Na (� 78) 6 9 2 - 33 1 'S IlVb'URANCE WAIVER; I am awae that the Lloane dues not halve the insutane oage arirs subbrar>aal egtrivala�t as fegt�ted by Ntassad>usc�ts Goleta` Laws rrry Sigrlahae rn this pt�rrt applic�rn wanes t)1� tegtmanai e check one) Owner M Agent Telephone No. PERMIT FEE $ signature or Owner Of Agent