HomeMy WebLinkAboutMiscellaneous - 5 CIDERPRESS WAY 4/30/2018 C 117 R 16 5 S LI/�/
Date..................................
NORTH
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
4 ^ i
♦ S"' "'.I'^.".*--"
,SSACMUSE�
This certifies that ................./.-..<........ ! /.......................................
has permission to perform &euj ���"�;�/ &S
.. .................................................................
wiring in the building of....... 1T`� �1�� ..... G ...
at.......�.4 ..IJ>;?/�.IAAL5 5....... ..
� ,�......... orth Andover,Mass.
22
EL CTRICALINSPECTOR .r /
Check # "
' Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. -/
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev, 1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME ) 527 C R 12.00
(PLEASE PRINLL T FNINK OR TYPE AINFO"ATIOA9 Date:
City or Town of. NORTH ANDOVER To the Inspector of fres:
By this application the undersigned gives notice of his or her intention to pei the electrical work described below.
Location(Street&Number)
Owner or Tenant 4t M
�. Telepho e No.
Owner's Address g
a
Is this permit in conjunction with a building ermit? Yes No rr"ll
Purpose of Building (Check Appro riate Bo )
� //� Utility Authorization No.
Erisdug Service Amps / Volts Overhead ❑ Und d
�' ❑ No.of Meters
New Service /62_ Amps. p /,�f/ Volts Overhead❑ Und d of
�' �. No.of Meters
Number of Feeders and.Ampacity�O �%pff 9�,
Location and Nature of Proposed Electrical Work: C /�
Com letion of the ollowin table may be waived by the inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans 0.of otal
Transformers KVA
No.of Luminaire Outlets � No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above In- 0.OfEmergency g
d. Eld. Batte Units
-! No.of Receptacle Outlets No.of Oil Burners ; FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o-Of etection and
hidtiatifigy Devices
No.of Ranges No.of Air Cond. Toig-
Tons No.of Alerting Devices
No.of Waste Disposers eat ump umberI ons IKWo.of elf- ontained
Totals: " Detection/Aler(inDevices
No.of Dishwashers Space/Area Heating KW Local❑ unicipal
Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
o.of ater o.of No.of Devices or Equivalent
Heaters Ili o.of Data Wiring:
Signs Ballasts. No.of Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors Total HP elecommunications firing;
OTHER:
No.of Devices or Eg uivalent.
l
Attach additional detail tf desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (Why required by municipal policy
Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the sins and enald ofperjury,that the information on this application is true and complete.
FIRM NAME:'�, t,v ,✓,1 [.
LIC.NO.:
Licensee: �^ Signature
a l: p LIC.NO.:
(Ifpp 'cable enter "exempt"in t e license number line.)
7 es-
Address: �l/�_ Bus.Tel.No.:
Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lie.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
Signature Telephone No. PERMIT FEE:$
of . /s' �o
6 tt 6 O-j4
w
i
1
J
Date. .
p� NpRTIy�,►p TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACMUS�
This certifies that . . . .r� �:�/. . . !��� ^. . . . I. .f.'.r. . . . . . . . . . . . .
has permission to perform . . . . . . . . . . . . ... .
plumbing in the buildings of
at . . . . .). . . . . . I:'.L .�:�, .'�! x. 5. . . . . . . . . ... .. North Andover, Mass.
. .
PLUMBING INSPECTOR
Check
U
i
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date
Building Location r S Owners Name /Uig �1���r���1 Permit#
,/ Amount _
Type of Occupancy S ,� J`
4
New Renovation 0 Replacement 0 Plans Submitted Yes � No
FIXTURES
z
w a o
o wCOOCC X � E
a W � w = 0� a a x
w H H
kb H
� �
o
�
amm
MFLaR i I
zD FIDQZ
3M FLQR
4M FLOM
SIIi KOM
6MROM
7M FLOM
8M FLaR
(Print or type) / Check one: Certificate
Installing Company Name �/�, �/i F1 Corp.
Address
D El Partner.
Business Telephone te 6 tJ9
Finn/Co.
Name of.Licensed Plumber:
Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box:
Liability insurance policy 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
threeinsurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are.true and accurate to the
best of my.knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State PlumbinCode Ch r 142 of the General Laws.
By: igna oI Licensea riumDer
Type of Plumbing License
Title7
City/Town Licenseum er Master Journeyman
APPROVED(OFFICE USE ONLY
`�. The ComrnonweizZth ofllfassachusetts
Department.ofrndustraal Accidents
Office ofInVesfib ations
..600 Washington Street
Boston, ALA 02111
www mzzss gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
,kD licant•Information
Pease Print LLgji y
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box:
I.❑ I am a employer with 4. ❑ I am a Type of project(required):
employees(full and/or part-time).* have hir d the sub nto
trac orractor ands 6.
❑Neu construction
2.FTI am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity. workers' comp.insurance. 8' Demolition
[No workers'comp, insurance 5. ❑ We are a corporation and its 9' ❑Building addition
required.] officers have exercised their 10.❑Electrical repairs or additions
` 3.❑ I am a homeowner doin ail work right of ex
g emption per MGL 11.
Myself repairs or additions
myself [No workers'comp. c. 152,§1(4)�and we have no
in required.] t employees. [No,'vorkers' 12,[1 Roof repairs
comp.insurance required.] 13.❑Other
4�y Tires^t that ch;krs boy iZ of.
the section be.ow Enos,aT
s ._^�;workers'com^e^.s�; s.... _ ;o-
'£loriteowners who submitttus affidavit indicating they,are dog aL'wo,-and= r ••,Po� , '.
# Lq_ € .hen hire outside eon*sactors 11i _'t.;sbG,it a new affidavit indicating such.
Coniracgrs that she^,,,;t„�box nxt.st ached�additional sheet showia;the name of the sub-contractors and their workers'coPolicy
mP• information.
ram an employer that isproviding workers'compensation insurance for my employees Belotiv is the policy and job site
information.
Insurance Compiny Name:
Policy#or Self-ins.Lic.#:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number.and expiration date).
Failure to secure coverage as 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 fonn 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
Investigations of the DIA for insurance coverage verification e forwarded to the Office of
-1 do hereby certify under the pains and penalties of perjure thrzt the in formation provided above is true and correct
Siffiature:
Phone#:
Official use only. Do not write'in this area, to be completed bar cite or town official
City or Town: Permit/License#
Issuing,Authority(circle one):
I.Board of Health 2.Buildinb Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing I�aspectar
6. Other
Contact Person:
Phone'#:
Information an- d .Iustructious
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person inthe service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,-associzaLtion,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise,and including t1ae Iegal representatives of a deceased emplover, or the
receiver or trustee of an individual,partnership,association ox-other legal entity,employing employees. However the
owner of a dwelling house bourns not more than three apart eats and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintemmce,construction or repair work on such dwelling house
or on the grounds or building appurbenant thereto shall not because of such,employment be deemed to be.an employer."
MGL chapter 152,§25C(6)also states that"every state or Io.ca1 licensing'aaency 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 cajonpliance 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.perfozmance of public work um--til acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill-out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es) and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability,partnerships(LLP)with no employees other than the
members or partners,.are not required to carry workers'comp ensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. .Also be sore to sign and date the affidavit The affidavit should
.7 f •+. _t"-MM 1 i 4 t. t-_r-_t .ng q..teSs..e,Q,'n Qt the'
be.mt'uueu to the ciaf u: that the amilica --tui she Tlerj�jt'QT license Ss be' re � ' D part—m'.nt at
Industrial Accidents. Should ynn have any Tat-stionse mgrdi, ...s r � I. . . .
1- to r the iFi or:1 yG':r �`reYvired to ouTain 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'&space at the bottom
of the affidavit for you to fin 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to than you in advance f6r your cooperation and should you have any questions,
please do not hesitate to give as a call
The Department's address,telephone.and.fax.nnmber._..
The Commonwealth of Massachusetts.
Department of lndustrial Accidents
-Office of Inwesttaations
6()0 Washin�tan Street
Boston.,ILA 02111
Tel # 617-727-49Q0 mt 406 or 1-9"'7-K*kS.S;AFE
Revised 5-26-05 FO:#6.17-727-7'149
vrW-vV masS._0V/dia
Date.. . .
„ORTM
0 4. TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SACH
This certifies that . . . .. . . . . . . . . . . . . . .
. . . .
has permission for gas installation . . . . . . . . . . . . . . . . . .
in the buildings of . . . .e.,., . . . . . . . . . . . . . . .
Ale,-
"), . . . .
at .. . . . . . . . . . . . 5 5
. . . . . . . . . . . . . . .. NN J
rth Andover, Mass.
Fee. ./.60. . . . Lic. No../... . . . . . . . . . . . .
GAONSPECTOR
Check#
Y
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FI ITING
(Type or print) Date
NORTH ANDOVER,MASSACHUSETTS
Building Locations r r Ir
Permit#
ount$
Owner's Name I rll�
New Renovation ❑ Replacement ❑ Plans Submitted ❑
d
U a
U
N w F�
O W F zW
W a O O F
V F Z
Zted+ mw o x 3 a a ? OF aU
> c W 10c °U x > 5.
aW'
o
SUB -BASEMEN T
BASEMENT
IST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) �� Check one: Certificate Installing Company
Name
❑ Corp.
Address k ❑ Partner.
/ 7b
usmess Tdle7phone -( ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check�--opn�
I have a current liability Insurance policy or it's substantial IJ
equivalent. Yes No❑
If you have checked yes,please' cate the type coverage by checking the appropriate box.
Liability insurance policy El 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 ❑
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and hapter 1J2 of General Laws.
By. Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber l S 7
City/Towns Fitter 1-icense Number
HMaster
APPROVED(OFFICEUSEONLY) ❑ Journeyman
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
U1 600 N"ashington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib1V
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance.
9. ❑Building addition
` [No workers' comp. insurance 5• ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp, c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.] t employees. [No workers'
comp.insurance required.] 13.❑Other
;.Any«^au ant that checks box#1 must also fill out the section below sh-mvi g thW,.work=1 compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers comp policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the police and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as 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-yeas 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 certify under the pains andpenalties of perjury that the information provided above is true and correct
Signature:
Date.:
Phone#:
EEc
only. Do not write in this area, to be completed by city or to:#:
n: Permit/Licen
hority(circle one):
health 2. Building Department 3. City/Town Clerk 4.ES.Plumbing Inspector
son: Pho
a
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apattu ents 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 j
necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,.are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city'or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future pewits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Inwestibafiions
600 W&-,hmgton Street
Boston,MA 02111
Tel. # 617-727-4900 ext 4-06 or 1-877-MASSAFE
Revised 5-26-05
Fax#617-72.7-7749
www%mass..Qov/dia
BUILDING PERMITof"U Dr 6�tio
TOWN OF NORTH ANDOVER 024a;y. Op
APPLICATION FOR PLAN EXAMINATION
Permit NO: J Date Received
Date Issued: °
I ORTANT: Applicant-m..utst. complete all items on this page
LOCATION S' 101f p}CSS \/Vt/ 0A j t (drn"Pu)
rint Uf
PROPERTY OWNER I a&/Y101 L�C
Print
MAP NO: UgC_PARCEL: ZONING DISTRICT: l Historic District yes no
Machine Shop Village yes 'OTO-7
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Buil One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Se Well Floodplain Wetlands Watershed District
Water/Sew
DESCRIPTION OF WORK TO BE REFORMED:
(-ih If w�►h�c6e Rj►n�P. bru te/
en ' icatio Please Type or Print Clearly)
OWNER: Name: ,,n �C Phone: 7 " V- ,�
Address: 1 C ,� t� PL, N, 40"e'r, l�lSr
CONTRACTOR Name: W C Phone. -657Z- 3-5"'
Address://Y' (j JAS
Supervisor's Construction License: Ex . Date:
�-- p
Home Improvement License: Exp. Date:______t�,/ti
/J
ARCHITECT/ENG INEER(��SAL&yt hj,% Phone: —/'F/ (o t; 6
Address: H6,,q-� 01 , AA � 6 ZF�2 Reg. No. 4,6 U
FEE SCHEDULE:BULDING PERMIT: ,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ z o61 x IZ -.'I 6W k 1Z/S 4 FEE: $ JQ?? + 166• fi=b T' 146 rl:r N -Ito
Check No.: NO O Receipt No.: ;2,:7-q'7
NOTE: Persons contracting with unregistered coy ractors do not have access to the guaranty d
Signature of Agent/Owner Signature of contractor
P ans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
ublic Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
" y
CONSERVATION Reviewed on Si nature
COMMENTS
yo
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions. f7' 75�
Total land area, sq. ft.: 36 -_2 } L
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA- For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
Building Department
The following is a list of the required forms to be filled.out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location
No. /-
--/ Date
NaRTN TOWN OF NORTH ANDOVER
3?0:� .•e : 1t.00L
h 9
Certificate of Occupancy $
�'�J''•°•tt�' Building/Frame Permit Fee $
AC Mus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ I '�
Check #
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Building Inspector
NORTH
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 656 Date: duly 16, 2010
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 5 Cider�ress Wa ay t Meetinghouse Commons,
North Andover, MA 01845
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MAY BE.00CUPIED AS residential dwelling, unit 2 IN ACCORDANCE WITH THE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER
REGULATIONS AS MAY APPLY.
Certificate Issued to: Meetinghouse Commons,LLC
Meetinghouse Road ,
121 Carter Field Road
North Andover,MA 01845
Building Inspector
Fee: $100.00
Receipt: 8344
O �tLp •�rO L 00
3,� p�'�- t,r• pL aL�
♦ 1 ++
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
Buildina Permit# 6S0
ADDRESS/LOCATION OF PROPERTY S CMig&l
Map 4y G Parcel 3 Lot Number U MIT 2
SUBDIVISIONGmmm's
DATE REQUESTED FILED/READY FOR INSPECTION 7/),5/)/) 11'711-77)
CLOSING DATE ON PROPERTY:
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES.
Permit Issuedtc: NAeJjmLm Camvws LCL
Address 1 S, Car a A
SIGNED
TING
CONSERVATION
PLANNING 0
DPW-WATER METER 0 I l�I ib
SEWER/WATER CONNECTION �✓
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
DPW v� l
Signature
File: Application for OC form revised Jan 2007
/ \ NOTES:
'L` \ MAP 104C 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM A
\ PIAN ENTITLED "PLAN OF LAND, MEETINGHOUSE COMMONS AT
\ LOT 28 SMOLAK FARMS, SOUTH BRADFORD STREET, NORTH ANDOVER,
MASSACHUSETTS"; SCALE: 1" = 80'; DATE: JULY 20, 2001 BY THIS
`ilk i OFFICE. RECORDED AS PLAN #14828 IN THE ESSEX COUNTY
r NORTH DISTRICT REGISTRY OF DEEDS.
r
2) THE INTENT OF THIS PLAN IS TO SHOW THE AS-BUILT LOCATION
OF THE FOUNDATION ONLY.
3) THE FOUNDATION SHOWN HEREON IS NOT WITHIN THE 100 YEAR
` AS—BUILT
FLOOD ZONE AS TAKEN FROM THE FL000 INSURANCE RATE MAP
FOUNDATION
FOR THE TOWN OF NORTH ANDOVER MASSACHUSETTS COMMUNITY
PANEL NUMBER 250098 0007 C, MAP REVISED: 6/2/83,
/ G
/�rOp2 T/�Nif 4) THE CONCRETE FOUNDATION SHOWN HEREON HAVE BEEN INSTALLED
ALLJ SUBSTANTIALLY IN ACCORDANCE WITH THE 408 SITE PLAN AS
APPROVED BY THE TOWN OF NORTH ANDOVER PLANNING BOARD.
I HEREBY CERTIFY THAT THE LOCATION OF THE TOWNHOUSE UNIT
NUMBER 1-4 FOUNDATION SHOWN HEREON IS THE RESULT OF A
c FIELD SURVEY BY THIS OFFICE MADE ON FEBRUARY 22, 2010.
4' � w z
1 ~� -_ _ _
9 25' NO
Q}1' D15TUORBANCE ov�yKN OF
CHRISR)PHER
AL FRANCHER
AL
AL / LICENSED LAND SURVEYOR DATE
!� ` ''L CERTIFIED FOUNDATION PLAN
\ MEETINGHOUSE COMMONS TOWNHOUSE UNITS 1-4
AL GRAPHIC SCALE MEETINGHOUSE ROAD
+\ u NORTH ANDOVER, MASSACHUSETTS
r B�gUpNrI r +'� PREPARED FOR
AL (r`r �1�°��, rr � ��� ,a, MEETINGHOUSE COMMONS, LLC
_ r I r \ \ (IN FEET) 121 CARTER FIELD ROAD
_—! —` / ~ \ \ NORTH ANDOVER, MASSACHUSETTS
I
r inch 50 tL
r AI Stilt Rood,SWM Dna
MEETINGHOUSE, ~~`+~ _ salt..H..Nampthin 03078
` 1 (403)883-0720
Not,s
IrUMI OO y ~+ \\ MHF Ottign Camulton4,ino. E.-KERS•PLANNERS•SURVEYORS
Ere
SCALE: 1" . 50' DATE: FEBRUARY 25, 2010 DRAWING DESCRIPTION BY OATS DRAWN BY: CHECKED BY: PROJECT N0. A
REVISIONS _ _ CMF 250508 1088cFP.Dwc
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tAORTH
01%M o t 4Andover
No.
A dover, Mass., �/1�2
L
COCHICHrwic
AD
RATEDPPS` C7
BOARD OF HEALTH
.Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
.........
THIS CERTIFIES THAT
Y.
... .......................................................................................................... Foundation
has permission to erect........................................ buildings Rough
to be occupied as.................. .....elll�.11/."�....................................................................... Chimney
provided that the person accepting this permit shall In every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
............... Service
BUILDING.. ........V �k
TOR
Final
Occupancy-Permit Required to Occupy Building GAS INSPECTOR
Ro
Display in a Conspicuous Place on the Premises — Do Not Remove Fina
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 1 y
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REScheck Software Version 4.3.0
Compliance Certificate
Project Title: Meeting House Commons
Energy Code: 2006 IECC
Location: North Andover, Massachusetts
Construction Type: Multifamily
Building Orientation: Bldg. orientation unspecified
Conditioned Floor Area: 3399 ft2
Glazing Area Percentage: 7%
Heating Degree Days: 6322
Climate Zone: 5
Construction Site: Owner/Agent: Designer/Contractor:
Building 1 Tara Leigh Development,LLC O'Sullivan Architects,Inc.
North Andover,MA 115 Carter Field Road 580 Main Street
North Andover,MA Suite 204
978-6876-2635 Reading,MA 01867
781-439-6166
"�IPKIL
' f d 3r H 1
Compliance: Maximum UA:1174 Your UA:1165
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 3769 30.0 0.0 124
Ceiling 1:Flat Ceiling or Scissor Truss 3769 30.0 0.0 132
Front Walls:Wood Frame,16"o.c. 1778 19.0 0.0 91
Orientation:Unspecified
Window 3:Vinyl Frame:Double Pane with Low-E 137 0.330 45
SHGC:0.30
Orientation:Unspecified
Window 4:Vinyl Frame:Double Pane with Low-E 39 0.280 11
SHGC:0.27
Orientation:Unspecified
Door 1:Glass 80 0.280 22
SHGC:0.42
Orientation:Unspecified
Sides:Wood Frame, 16"o.c. 7840 19.0 0.0 463
Orientation:Unspecified
Window 5:Vinyl Frame:Double Pane with Low-E 104 0.330 34
SHGC:0.30
Orientation:Unspecified
Window 6:Vinyl Frame:Double Pane with Low-E 26 0.280 7
SHGC:0.27
Orientation:Unspecified
Rear Walls:Wood Frame, 16"o.c. 1922 19.0 0.0 88
Orientation:Unspecified
Window 1:Vinyl Frame:Double Pane with Low-E 343 0.330 113
SHGC:0.30
Orientation:Unspecified
Window 2:Vinyl Frame:Double Pane with Low-E 13 0.280 4
SHGC:0.27
Orientation:Unspecified
Door 2:Glass 40 0.350 14
SHGC:0.31
Orientation:Unspecified
Door 3:Glass 60 0.280 17
SHGC:0.42
Project Title: Meeting House Commons Report date: 01/14/10
Data filename:K:\Zahoruiko\Meetinghouse Commons-No Andover\Townhouses\CD's\Building 1\Building_1.rck Page 1 of 2
r'
(j Orientation:Unspecified
Compliance Statement: The proposed building design described here is consistent with the uilding plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designe to meet the 2006 IECC requirements in
REScheck Version 4.3.0 and to comply with the mandatory require is listed in t e RES eck Inspection Checklist.
A
Name-Title � gnature Date
Project Title: Meeting House Commons Report date: 01/14/10
Data filename: K:\Zahoruiko\Meetinghouse Commons-No Andover\Townhouses\CD's\Building 1\Building_l.rck Page 2 of 2
/ f
NOTES:
MAP 104C 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM A
PLAN ENTITLED "PLAN OF LAND, MEETINGHOUSE COMMONS AT
LOT 28 SMOLAK FARMS, SOUTH BRADFORD STREET, NORTH ANDOVER,
MASSACHUSETTS"; SCALE: 1" = 80': DATE: JULY 20, 2001 BY THIS
OFFICE. RECORDED AS PLAN #14828 IN THE ESSEX COUNTY
AIL J NORTH DISTRICT REGISTRY OF DEEDS.
2) THE INTENT OF THIS PIAN IS TO SHOW THE AS—BUILT LOCATION
OF THE FOUNDATION ONLY.
AL / �` / AS—BUILT 3) THE FOUNDATION SHOWN HEREON IS NOT WITHIN THE 100 YEAR
FOUNDATION FLOOD ZONE AS TAKEN FROM THE FLOOD INSURANCE RATE MAP
FOR THE TOWN OF NORTH ANDOVER MASSACHUSETTS COMMUNITY
PANEL NUMBER 250098 0007 C, MAP REVISED: 6/2/83.
p i/�3/i G �� ' 4) THE CONCRETE FOUNDATION SHOWN HEREON HAVE BEEN INSTALLED
?,g i7TOp i NrT SUBSTANTIALLY IN ACCORDANCE WITH THE 40B SITE PLAN AS
APPROVED BY THE TOWN OF NORTH ANDOVER PLANNING BOARD.
/ SSR
I HEREBY CERTIFY THAT THE LOCATION OF THE TOWNHOUSE UNIT
— A NUMBER 1-4 FOUNDATION SHOWN HEREON IS THE RESULT OF A
FIELD SURVEY BY THIS OFFICE MADE ON FEBRUARY 22, 2010.
�j 25' NO
q DISTURBANCE
ZONE r K8 OF&4.t
atlli. '�a`I� VSs
_Q+ �8� CHRISTOPHER
8 FRANCHER
.i L 6'lt a
G
i LICENSED LANG SURVEYOR DATE
AL
CERTIFIED FOUNDATION PLAN
MEETINGHOUSE COMMONS TO NHO SE UNITS 1-4
9. GRAPHIC SCALE
JFOUAFDAr, ( \ o v 5o Too NORTH ANDOVER, MASSACHUSETTS
kDovc
PREPARED FOR
MEETINGHOUSE COMMONS, LLC
�f (IN FEET) - 121 CARTER FIELD ROAD
I Inch = 50 ft NORTH ANDOVER, MASSACHUSETTS
MEETI -` // ' 44 Stiles Rood,Suite Om
NGHOUSE ?AISM Salam,New Hamghiro 03079
_ 1 19 r'3 v (603)893-o7zo
` �I
-_�\ 1� �M7NOUS CONC 1 _ _� `\ MHF 0esign Consultants,Inc. ENGINEERS•PLANNERS•SURVEYORS
\\ i R L7o�� SCALE: 1" - 50' DATE: FEBRUARY 25, 2010 DRAWING
1L DESCRIPTION BY DALE DRAWN BY: CHECKED BY: PROJECT NO. NAME
REVISIONS CMF 250508 1 1088CFP.DWG
�Submitftte Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT :� T
COMMENTS N)A , ZSA C00-B
CONSERVATION Reviewed on dvl�/& Signature_
r
COMMENTS-DEP
HEALTH Reviewed on Si nature
COMMENTS o N S&6u WI 1U.0
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
r�
Planning Board Decision: Comments
Conservation Decision: Comments
_ �V I
Water& Sewer Connection/Si natur t �rivewa ermit /Wf ,` -
DPW Town Engineer: Signature:
Located '.-ih4 Os ood Street
;F.Ii�E`�E� IE�tT T���a�upstern.�ytrr des-:*✓'.. irro
Located 4t 1llatn Street,:r
dare.D.epa� a itsianah�ure-1ate /` �S1- 2-0/A .
.0m
M. - =
Alassachusetts- Department of Puhfic fi,ifct�
Board of Building
Re.'uiatiens anti Stanclartk
Construction Supervisor License
License: CS 55417
Restricted to: 00
THOMAS D ZAHORUIKOz
115 CARTERFIELD RD
N ANDOVER, MA.01845
Expiration: 4/5!2012
(" mmis�iuner Tr#: 21090