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Miscellaneous - 5 STONEWEDGE CIRCLE 4/30/2018
i 1'� Commonwealth of Massachusetts Official Use Only .1 Department of Fire Services Permit No. 3� ! i� BOARD OF FIRE PREVENTION REGULATIONS Date Issued: APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD( All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5/18/15 City or Town of: North Andover, MA To the Inspector of Wires: Hy this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) 5 Stonewedge Circle Map: Lot: Owner or Tenant Michael Luzzo Telephone No 617-392-0029 Owner's Address 5 Stonewedge Circle,North Andover, MA Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building g Utility Authorization No. / Existing Service Amps 1,e) / "-"O Volts Overhead ❑ Undgrd [J No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of a generator and transfer switch Cont lotion of the following table may be waived by the Inspector of Ghires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators 1 KVA 20kw No.of Lighting Fixtures Swimming Pool Above ❑ In- 1:1o.of Emergene—y—E—igfi—fing rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent 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 Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of it"ires. i114SURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licen- see 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: INSURANCO 130ND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: $2250 (When required by municipal policy.) Work to Start: 5/26/15 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under die pains and penalties of perjury,that the informadol on this rrppl- anon s true and complete. FIRM NAME: Coleman Light& Power LIC. NO.: A:20560 Licensee: Kris Coleman Signature LIC. NO.: E:33749 *Per M.G.L. c. 147,s. 57-61,security work requires Department o afet, ` LIC.NO.: S: (hfapplicable, enter "exempt"in the license number line.) Bus. Tel. No.: 978-458-8800 Address: 4 Etta St,Chelmsford MA 01824 Alt.Tel. 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. 1 hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Phone: r Insurance on File: Will Fax: Permit Fee: Receipt#: Date: Date...... ............................ TOWN OF NORTH ANDOVER Oft PERMIT FOR WIRING SSAC14U v..... This certifies that ....... . ................... has permission to perform .... .....&...1.0.......... wiring in the building of.............. ................................................................ at ................................. North Andover,Mass. Fee Lic. ................. .... .. IRUICA NSP CTOR Check# 3307 GENERATOR APPLICATION DATE: -5 11 s 115 LOCATION: 5 5- 00f-Wtd- c-9, OWNERS NAME: , MAi..UnmL vk 1:::LG GENERATOR Im ac-) NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: K65 (Dle-ry-\o,.n uj Coltman UJi+ 4A ow PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: 0)wut, (4t,'e OFT- bcv-4c cc, w� *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL The Commonweam ofMassachusetts DTarIinient of Indus W Acddents Offlee of Invesfigadons I Congress Streg Suite 100 Boston,MA 02114-2017 kv wwwm�rssgov/din Workere Compensation InsuranceA�davit: BuildersfContractors/ElectridansRumbers Applicant Ieferl$ati°n Please Print Leably Name(Business/Orgaaimtionitndmdual): G� Address: City/Sta#e/Zip: tYt d � CISZ Phone#: FS - 4S 9 S S GO Are yoemployer?Check the appropriate bog: 1. am a employer with 4. ❑ I am a general contractor and I �'Pe of project(required): employees(fitll and/or part-time).* have hired the sub-contractors 6. r-1New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [Noworkers camp.insrance comp.insurance. required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I an a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workes comp. right of exemption per MGL insurance requirtrd.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees [No workers 13.[3 Other comp. required.] `Any apprtcartthataltedcsbooc#tnwdd ofilloutthesecfionbelowsfvMngtheirwaiurd'cmVws9bcnPdicyinfamdion. t Homeawneas who submit this abdicating they are doing all work and then hire outside conftactms must submit anew atlidavit indicating such xContracas that dmkthis box most attar ind an additional sheet showing the nam ofthe moors and state whether or not those enffm have empioyees. If the sib-Cordtactatshaveert0afln they must pwidetht#r workerd comp.pdicy moibet. I am an empoyw that is proAc ing workers =r pmss ion insrranoefor my errptoyees Below isthe policy and job site information Insurance Company Name:�e— 40Lr+fC-0rjd#or Self-ins.Lic.#: WC Q 8 W E _TK 3®5 Expiration Date: Z'3 Job Site Address: City/State/Zip: Attach a copy of theworkers eornpelsation policy declaration page(showing the policy number and soration 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. as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day the violato. Be that a copy of this statement may be forwarded to the Office of Investigations of the D iasrz<ance v verification. I do kereby eer* perjury that the information provided above is3rue and correct Sim: Date IZ� IA f Phone# ��S ' 45�; - �GO Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(cirele one): 1.Board of Health 2.Budding Department 3.City/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Fold,Then Detach Along AN Perforations �;COMMONWEAtTH OF MASSACHUSETTS MODEM g Ll EL' C fR I C I ANS !SSliES .THE FOLLOW-f -'L f CENSf; AS: #I.;R1 `JOURNEYMAN ELECTR I C I ASN''`` .:;:XI{'1' OPHER M COLEMAN ' —- :Z STATE OF NEW NA1YJPSHIRE 4 ETTQ" 5 BtNMW OF E gg SAFEfY&L J GTi1 LN[SFORQ.: . AA 01824-4733 NAW-KRISTOPHERI COMM: 3374 : E,` 01/3;1. 'I.;6.. ' 56744 1.12126 M 3. E XPiRE s: 01131120'fS Fold,Then Detach Along All Perforations 5� u.COMMONWEALTH OF MAS"CHUSmS.,.:. .::: t:C TR I'C I ANS I SSUES;,THE: FOLLOWI NG' L 1 CEilSE AS: A` E. STERED MASTER. ELECTR I C I Aft'. f :Z t '1AN LIGHT AND POWER LLCn. KR I STQIfR<- i'COLEMAN ... : 4 ETT >ST 1 ' J LASF:QRIl:;:.;:: °:.;11A 01824-4733 . :.. 01/ x ' :, ; ° 56743 205 <` a a< - o, o Is TH OF " M'aSSACHUSE.TTS 0 ELECTRICIANS + `ISSUES ,THE FOLLOWING REG I StERED M STER E E -T.N;' A'S A A ,RICI- W COLEMAN r L 1 GHT AND POWER LEMAN 4RETT,4PHR M COLLC J1 ¢ . ST J1 i tW i CHELMSFORD . 2056p A...;, MA 01824 4733 07431/l_6 56743 _- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK *A ' CITY _ ` MA DATE " � PERMIT# 1P JOBSITEADDRESS S j�itit'� ,t,2e,��I OWNER'SNAME POWNER ADDRESS TEL IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT ~ CLEARLY NEW: � RENOVATION:® REPLACEMENT:M PLANS SUBMITTED: YES NO�I FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ! 1 _._.._J l _.—.� J DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK ! J �i _! � I ( __—! LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET $ I _ J ( -j== URINAL _I -_- J 1 ( __. J J _J J .._ _} J -� WASHING MACHINE CONNECTION WATER HEATER ALL TYPES F WATER PIPING ( __ _- _ { j ( I +� 0 HER ! f ! ---4 — J I I -----} -_-? _-I INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY © BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' Rcp with all Pertinent provision of the (Massachusetts State Pi mbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME G d LICENSE# f7 ��3 Il SIGNATURE IMP JP© CORPORATION #L PARTNERSHIPD# LLC © COMPANY NAMEr � /; ADDRESS CITY 9 " d ... . 1STATE �e,n, ZIP Q -^J TEL FAX j CELL -c��?�EMAIL =-- �' ---- - --.._...-------- --- --- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL SPECTJOON NOTES Yes No X 4e�� THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date... 11163 . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 4�W J7 This certifies that.................................................................. has permission to perform... ...6Zf f ....!.... ............................................................ ff plumbing it)the buildings of...... .....'' ..(. at.... ......4... orth Andover,Mass. Fee .............Lic. No. /4.473.. ..... TKILUM- 131 G INSPECTOR Check# 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY U MA DATE S-ZT PERMIT# JOBSITE ADDRESS Tb���✓t°L� OWNER'S NAME" OWNER ADDRESS TE`1- 'FAX r TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALf PRINT PLANS SUBMITTED: YES NO CLEARLY NEW: RENOVATION:El REPLACEMENTS APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13" 14 BOILER _ _ _ _� -� . . ._ 1 BOOSTER CONVERSION BURNER COOK STOVES ------- DIRECT VENT HEATER �r j DRYER FIREPLACE -- _ FRYOLATOR FURNACE -- — -- - �"- GENERATOR - - -- GRILLE - INFRARED HEATER _ -- - -- - -- - - - �- LABORATORY COCKS - - - MAKEUP AIR UNIT - `� - IF - OVEN _ - POOL HEATER - ROOM 1 SPACE HEATER _ - ROOFTOP UNIT TEST - UNIT HEATER l _ UNVENTED ROOM HEATER I l WATER HEATER - - - �- OTHER - -- INSURANCE COVERAGE have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 10 IF YOU CHECKED YES PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIO OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licbnsee 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 © AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true ccuall er the best vi io knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli n ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ry PLUMBER-GASFITTER NAME _ LICENSE# l' SIGNATURE # LLC # J MP MGF JP JGF • LPGI CORPORATION # PARTNERSHIP® ® = COMPANY NAME: _ ADDRESS S� - CITY J _ I STATEE-11 Zip TEL 7 FAX CELL_ . I EMAIL ' i ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INS ECTION DjOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 0 0 r' ''� vp Date............°? .........�.`............. OF NORTiy,� 3 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ...n., 6 -CH � P �ss�cHus�4 This certifies that ...... c�...!...........5..................................... ..... ....................... has permission for gas ins lat' n ..�i� -.............. • in the buildings of...................nn�....�/��'+ �4 at...... ................... - Andover, Mass. Fee.°?................ Lic. No, 16071... ..... ........... ......................................... GASIN ECTOR Check# The Commonwealth of Massachusetts Department of IndustrialAcc�Accidents rs 1 Congress Street, Su ite=� Boston,MA 02114-2017 www mass.gov/dia Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. sV� Workers PERMITTING AUT'HORITY- TO BE FILED WITH THE Please Print Le ibl A licant Information ------------------- Name(Business/Organization/Individual): Address: 2� Z da' Phone#: Ci /State/Zip: Type of project(required): �' 3'P Are you an employer?Check the appropriate box: full and/or art-time).' 7. Q New construction employees( P I am a employer with�.I am a sole profor in �$. �Remodeling .❑ prietor or partnership and have no employees working 9 Demolition 2 ce required,] any capacity.[No workers'comp.insuranq insurance required.]t all work myself-[No workers'comp. 10 Q Building addition 3.0 I am ahomeowner doing will 11.❑Electrical repairs or additions 4•❑I am a homeowner and will be hiring contractors'to conduct all work on or Property- 12 0 plumbing repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 13. Roof repairs 5,❑I am a general contractor and I have hired the sub-contractors listed i°irnatn e attached sheet 14 ❑Other Thesesub-contractors have employees and have workers'comp. per MGL C. right of'exemption p , o workers'comp.insurance required•] 6.❑We are a corporation and its,officers have exercised their 152,§1(4),and we'have no.employees.[N enation olicy information• such the aze doing all work and then hire outside contractors a�e wheth new r affidavit oseentities have Any applicant that checks box#1 must also fill out the section below showing their workers'comp P fi Homeowners who siibuiif this affidavit indicating Y the name of the sub-contractors tContractors that check this boxi lust attached an additional sheet showing otiv is the policy andjob Site employees. If the sub-contractors have employees,they must provide their workers'comp.ff° Y ��ye� $el that is providing workers,compensation insurance f Y I afrt an employer information. Insurance Company Name: - Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: a showing the policy number and expiration date). of the workers'compensation policy declaration page( punishable by a fine up to$1,500.00 Attach a copy 25A is a criminal violation p Failure to secure coverage as required under MGL c.152,§ ER a of the DIA for insurance as well as civil penalties in the form of a STOP WO ORDER and a fine of up r i saran a and/or one-year imprisonment, be forwarded to the Office day against the violator.A COPY of this statement may coverage verification. er u that the information provided above is true and correct Y do hereby ce fy under the pains and penalties°f p 1 rY Date: Si ature: Phone#: t �. official use only. Do not write in this area,to be completed by city or town official.. Permit/License# City or Town: Issuing Authority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1.Board of H 6.Other _ - Phone#: Contact Person: iT ?F Information and Instructions tions , 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, ti express or implied,oral or written." 1j 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 fillout 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 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. Se selIf-insured companies should'enter their self-insurance 1; 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 anygiven 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 imass.gov/dia C:COMMONWO(LTW OF MAS Ht SETTS PL MB R GASF I_TI.! $ + ISSUES THE FOLLOWl L!`E 1.4CEW '" AS A MASTER PLUMBER : } � s t, PAS 11;K 'E MELVIe ,a 227 MA I19;f •} f+f0 TH ANDOVER 'A 01$45 2. 10 5 : Y 6Q3 .<. o /o t l)b 204075 CONTROL# J 2 012 6 IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law and/or regulations. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �f CITY ca(4� MA DATE . O PERMIT# v l w JOBSITE ADDRESS I ��TO(10 i �D c p (�r OWNER'S NAME GOWNER ADDRESS TEL ®r��FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL® RESIDENTIAN CLEARLY NEW: RENOVATION:El REPLACEMENT:® PLANS SUBMITTED: YES F1 NO `�f —A APPLIANCES Z FLOORS- BSM' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER -:j E::j ED 1:7j- =— - - - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ FURNACE �^ GENERATOR GRILLE -- --- _ _--� ----- -- - - - -- �--�— -- -- - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN - -- - -1 - - POOL HEATER € ROOM/SPACE HEATER �J ROOF TOP UNIT _ TEST _! UNIT HEATER UNVENTED ROOM HEATERS WATER HEATER OTHER INSURANCE COVERAGE 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 POLICYPcensee OTHER TYPE INDEMNITY ® BOND F OWNER'S INSURANCE WAIVER:I am aware that the I 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 E AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are t d curate tg the b f my knowled e and that all plumbing work and installations performed under the permit issued for this application will be in com Iia th all Pfy vision of the Massachusetts State Plumbing Code.and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME Q �i �� �LICENSE# 9LI ( v NATURE MP X MGF 0 JP ® JGF D LPGI® CORPORATION©#L=PARTNERSHIP®#III LLC[2# COMPANY NAME: � 1� ' ADDRESS Qj CITY dd Jp,( STATE bMZIP TEL FAXI, CELL _I EMAIL Sem ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTIODi NOTES Yes No / THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES s f f L 4246 Date... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0 .7 CHUSE� This':certifiesthat ...`!!!a� ..... f .............................................. i has permission to perform .... V—e, ............ .. ................................ wiring in the building of....l vdvUeR B l S ............................................................... at /04 #SS�New P Cis ,North Andover,Mass. Fee... 45 . - Lic.No.j,.83?14......� ELECTRICAL NSPE Check # Date....`� lS �NORTh TOWN OF NORTH ANDOVER 1- 9 * * PERMIT FOR GAS INSTALLATION s$�CHU56 Thiscertifies that .......W.. ................... ............................................................. has permission for gas Installation .....V .�? .....................: in the buildin sof..... .................z-.zo. t ................................... . . .. .... at. ..S. .......... /NA,-NorthAndover, Mass. Fee. .......... Lic. No.15.....`..1....... ..................................................................... GASINSPECTOR Check# /37q 09980 �1 The Commonwealth of Massachusetts Department of IndustrialAccidents s I 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 PERMUTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/Individual): dZ�P,f co, H . Address: City/State/Zip: PIA Phone#: 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. ❑New construction 2.gI am 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.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.F1I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and Nye have no.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 must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: _ Policy#or Self-ins.Lie.#: 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 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 c r ify nder the p ' and penalt' ofpef jufy that the information provided above is rue and correct Si afore: Date: st� 2G / Phone#: 67 gy Official use only. Do not write in this area,to be completed by city of 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#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract U ire, 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-contractor.(s)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The 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 GENERATOR APPLICATION DATE: LOCATION: OWNERS NAME: 1 o Ii LEQ Lu22n GENERATOR kw aO NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: �-e-JSoN� l(fie PHONE NUMBER: 761' ELECTRICAL ✓ GAS RESIDENTIALCOMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: TPLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL it �s pc ; • f '�. �"� ^Y 3,s .�s� -:7�e�-�t�' �y,� 'S�" ,c�, t_ v� s'• �' i� MN . s .» Ilk- _ - 3 "`° ^ r� • • a a[,t,s t"+xS" .. i1a > �� s ✓s its y4 `�}, �. ;- -,�. :- 7 C' `�• }ice' "�' _ t _ntis- $ . } - --.i> " r, " wi e`.r-et�r �Nt.., u�, �..k,- :.;4 _ •.� �' � .,.. ^ ;"""•s- t AKS`, `�'.�+` _�y d �� �� � ,r• • may. � �� �, f�^•'=?t /- °�, F a�►�,�,�p �W .. ;�.i �g �m �i 'r..'syS�r�^�'* .r.._ .b �it ..� _ �„#`. 1r y rf { i"y we zis' ; '' ftt44� pis t. y' x S aio-w< >. Y M gp rti'- t,�.y� ,�,� a V><3f✓-3Xyt_,. � y t.tt• "���'�w..7t�,-, '�'"` !-`4 e� �,S�MF` t-?t_t,+- �. 3-'a•�-��i�fyj3.Qg•��Ar 'F w '�-" �V-+i y+e�/ M-ih _ � �'FR V �t k` Ji '�� �^�hJ. w�y t-�Y"��(" �l p_ F k '•!l x�.�'Y �^1���� �17 �E1.t f if ��_�y�•� �r }��'�3,i YY++$�++�tu 2�jt§�� }�,� ""� �.hN. ' n F.f "' = r'N - . fix .} ; "-r tw t' .-t•. Y _ �'..' '� � ♦ i tS - � sp. ,13.> j��:'s � .%���rt... �^ � f✓"� S `� 'cif.+, If�y � - �.• _.�'' 3ir "b'S�i���,`•�a -Y••,�..�mttt`Au,.'?g. °sx S s '�'^P� s,. ,'� vgi scagqw ..^ t�� '. :-tfLLle- f-s `}.` °L}.� '.Y��� � .yrtf�I��� ,�•ri .La 5 MEW, Ali lAft v�� q t� t �� ,?1- 'a.�'4S�y �Sl�i;F" F �tsJ "s.:.s7 �, �+f'�� ./�.��5'!x•5.���.- .�• �__ ��yi � ..0•' 't"7,.� "1 4���€.y� f .,%S�ti��" �-�R`•.,s's' at�-vc<�`!` 'Y; z� ,&�'`.. 5��.``' 'Fr p� `x-s, t'� ��'y�.4T' �t# .L•f9�1 fit; art �'Y �,` - � �,Y. � �{�4�"f �;''-r ti• Yr �TFe� t t r '.., ,�y.. �:� Y�, i .,tf �, ��4;�'��€�JX�rr ..kf �r�i' .rF� � :d _ ` '-/, _ � `-: ,� f`" '•tA ■ North Andover MIMAP May 26, 2015 "d, # 106':6=0169 62' #11-3-3 1 -B-0037 -(41 q, 7 sk. _1 is aVt 11, d, lO&W-003311" S�l 771'06.6-0.171Nw. 1'06.6-0.171171 A& Aw Nt!? 106�B,- -72: ........... M& W, J,1_`,_ #40- 106,04�01�01 R2, ...... .7 0, vu, S),w ----•------ Aw. bo ......... 106-X,-R185 .....A!u A& .......... bl,f .......... A d, A, 0, 7, ...... .... ....... =0164; .�W- 194X zw. .77 -A . ... .& log.,70 1�9,8 A qQ q3 j wqt Aw— Rail Line Wellands Zoning Interstates 12 Exempt Lands U Businz I District 0 Busine! 2 District Horimmal Datum:MA Stateplane Coordinate System,Datum NAD83, I U Bu sina!s 3 District Meters Data Sources:The data for this map was produced by Merrimack a Busins!s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads 0 Genera Business DistrictNorth Andover.Additional data provided by the Executive Office of %7j Easements 0 Plannei Commercial Dev 0 4 Environmental Affairs/MassGIS.The information depicted on this map is 0 Corrido Development Dist for planning purposes only.It may not be adequate for legal boundary Dist E3 MVPC Boundary 0 Corrido Development�t Ds�t definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER E3 Municipal Boundary D. 12 Comdo Development Dist MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING :ndustrii District Zoning Overlay us D c( THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 0 nd in 2 OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 13 Adul Entertainment us 'I C]Downtown Overlay District 0 Ind in 3 District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Industri 0 S District (3 Historic District THIS INFORMATION 0 Water Protection Reside ce 1 District .14. Reside ce 2 District ❑Parcels IM Reside i ce 3 District C" US C Hydrographic Features dei ce 4 District Streams V=148 ft Ida ce 5 District rict de- -is �ge idential District i i "OMMONWEALTH OF M `SSACHt3SETTS BOARD OF PLUMBERS AND GAS.FITTE:RS ISSUES. FOLLOWING LICENSE;:. IS <, L1 NS ED ASA MASERLIJMBE PETER G THER I AULT 5 WASHINGTON STREP :., .. ra,•r_,�31�r 7 APT Q-* R1AD I NG MA 0186]-2506 1594f 05/ =� 1 228 01 THECOA MONWEALTHOFMASSACHUSETIS Office U e ly, r . DEPAnAMTOMMICS4My � f� BOAROOFFIREPREVEN170N�pNS527C1�I2a1 Permit No. Fol In I Occupancy&Fees Checked APPLICA77ONFOR PERMTTTO 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 WFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location(Street&Number) # � �e ��� ��� Owner or Tenant 741. � e Owner's Address111 ,6e_r-/- r G Is this permit in conjunction with building permit: Yes No (Check Appropriate Box) Purpose of Building /A� ` Utility Authorization No. Existing Service �� Amp=Volts Overhead Underground� No. of Meters New Service —&0 Amps//o/ 7eo Volts Overhead Under 'ound �j El Sr No.of Meters Number of Feeders and Ampacity - L 2 Te. Location and Nature of Proposed Electrical Work 17,7, "�� 777, ` �G�e No.of Lighting Outlets61 No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above Below KVA / Generators . round No.of Receptacle Outlets No.of Oil Burners ound KVA !/ No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas BurnersNo.of Ranges / No.of Air Cond. Total FIRE ALARMS No.of Zones.-- Tons No.of Disposals / No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices —� No.of Dishwashers ` Space Area Heating KW/ No.of Sounding Devices No.of Self Contained No.of Dryers Detection/Sounding Devices / Heating Devices KW Local Municipal Other--�� Vo.of Water Heaters � 5 KW No.ofNo.of ID Connections Signs Bailasis Jo.Hydro Massage Tubs / No.of Motors Total HP ['HER- T/t 10, TJ/ e�? -L.44 r uanceCovng&�' t0 ��tsGa>e�alLaws waawer,tLiabtlityhuurampbtlcy>r> ag �oe0alequivala�t Y1 S ve vabdproofofsamiodroffice YES ( NO kingthe ff�� box u c �spkwenfid&th/e�typeOfmwrwbY URANCE r Z, BOND ORIEREJ Y) l/�/d�' e� �/��S• Com. �S /v� �� • E' 'I)ak /2 kloSort TJ 7 VaWofl Wodc$ i �ciunda�ie DakReWested Rojffi Final NAME •4 /li���J l LicareNo. Lr(enseNo BusitmTel.No. ZFR'SINSURANCEW ' Al Tel No. �7� 5'S"8-/J7sz7 ANIIZ;IamawaredrattheLicedoesnothavedieiri,tnwmc0m%•eorits ie"ydlatas by malLaws atmysigmutecnftpwnitapph=onw&tivstagtlirerrent. se check one) Owner Agent Telephone No. PERMIT FEE$ tgna ure o wner or gen The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 See" Workers'Compensation Insurance Affidavit Name / it-/6�I? Please Print Name: Location: City / � Phone # 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 �� CiPhone# Insurance.Co. l2/�Y��r� Z�r ' Polipy# Company name: , Address Clty: 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_wtetLas_civil.penattiesin-thelminnfa-STOP.WORK_ORDER.antd_afine-d.($1110.DD)aiday.against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification, l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature //`iGG `� ����� Date Print name Phone,# Official use only do not write in this area to be completed by city or town official' City or Town PermiUUcensing Building Dept EJ Check if immediate response is reguired p Licensing Board E] Selectman's Office Contact person: Phone#. E] Health Department F-i Other t MASSACHUSETTS UNIFORM APFUCATON FOR PERAHr TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations f _� 1�r r di/�fP, Permit# /,P Amunt$ Owner's Name R�iO vt � �I (� New[a/ Renovation Replacement Plans Submitted w w o U v o � �A 00. ° O w 3 A c7 a E• O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR ELLI I I I I I I I (Print ortype /� 1 one: Certificate Installing Company Name i [l C vi e:c/c i4 1 Address �i- Fd�v ei ,� rr PAS f LL�JJ Partner. Business Telephone - -2>'7-5- 7d--7 6 Firm/Co. Name of Licensed Plumber or Gas Fitter INSI&ANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3 Noo If you have checked M.please indicate the type coverage by checking the appropriate box Liability insurance policy Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Ma�r6eneral Lawsthat ignature on this permit application waives this requirement. f r� ""�LCheck one: C 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 ®de and Ch pter 142 of the General Laws. —ter Signature of Licensed Plumber Or Gas Fitter BY Title Plumber /� 2-7q City/Town rl Gas Fitter License Number MM,aster APPROVED(OFFICE USE ONLY) Journeyman NQRTH Qf 3� & TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION CHUSEt This certifies that . ... . . has permission for gas installation �� . . . . . . . . . . . . . . in the buildings �._�. . . ., North Andover, Mass. FeeZ. . . . . . Lic. No.. . . . . . . . . . . . . . . . AS INSP CT,F R Check# 4219 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ' 1 Date 1/ - 't� - C'�o Building Location f tilt` We LC Owners Name Permit# �5,/gi Amount �� /� cv✓ Type of Occupancy �) s New Renovation rl Replacement 1:1 Plans Submitted Yes No ❑ FIXTURES CC F w w ° a CrCOO w1z z x ° w x111-0 cca x w x A x A A � A A F-� � ° pa �RgVIC BASEMENT M MOOR % MH M X3.1IL" 4M IMM 5M H-2 6II3 FFM 7MFIDOR gm H" (Print or type) � Check one: Certificate Installing Company Name %� / -� ,�-'("� A�j C -Corp. ,w Address .�� �►n �� �c'nf .J 7` Z. ,j FlPartner. Business Telephone 7,761 - j 7 _ ,l -7A 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 threesurance ` Signature Owner 71— 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 Massachus to Plumbing e and Ch ter 142 of the General Laws. By: Signature o r-icensea Plumber Title Type of Plumbing License 44 City/ icense um er Master Journeyman ❑ APPROVED(OFFICE use ONLY � ?�, I Date. `. .-5. �v "oRTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s o� _ •'a This certifies that . ... . . . . . . . . . ... ... . . . . . . . . . . . has permission to perform . . _ 7 plumbing iof,...the buildings `t-� . GAF.• .i. . . . . . . . . . rth Andover, Mass. Fee... .z. . . . .Lic. No.. . . . . . . . . . . .�. . . . . . . . GiPLUMBING} OR Check #,25'�,5 v 5444 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have-been obtained. This does not relieve 11ve applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT f PHONE F-SOC/ -q q3 LOCATION: Assessor's Map Number PARCEL SUBDIVISION ( VL _P:,�ry�ecs--� LOT(S) STREET )eo ST. NUMBER_ ************************************OFFICIAL USE ONLY*********************************** RECOMM D TIO OF TOWN AGENTS: G��2C/12l� CONS ATION DMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS ne;� TOWN PLANNER "- DATE APPROVED DATE REJECTED WA 57 02 COMMENTS Sf � Ili . S,t., -N r12.a FOOD IN ECT R-HEALTH DATE APPROVED DATE REJECTED Al A SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS F'EeMiTS To F>>; SE.co2irD Prt(o2 -mac ,Y Q6a1STeuc7-roAl PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY ERMIT % �w _ 02 7 FIRE DEPARTMENT 2 �2— RECEIVED BY BUILDING INSPECTOR_ DATE Revised M7 jm uL- I — 1 zs 0t r K 1 1 S : 3S S . E . 4umm I n9 s Rs50G I aL es r sae- CE/grmmo PL T PLAN S.E. CUMM/NGS & ASSOC/A TES P.o. Box fssl Pulsrog N.H. 08886 MEPNONE (603-382-0065 PAX (603)482-0218 STOWVEDGE CIRCLE ti�• Rpt 75.00' ssc ' AMEM T s� �w 4y 8 j TRUDEL H No.3wo q A 'F 0 1N •( � I � rye' e -0021 SD / t� Yyr� I I LOT 80,200 SF CSA=48,251 SF o P, fV c N A, A LL y dit. 1=34.80' R-185.00' N90-00'00-E 253.60' TAX MAP 210 BLOCK 106—B LOT2A AVERY PARK DRIVE NORTH ANDOVER, MA. : PREPARED FOR: I HEREBY CERTIFY TO TOWN OF NORTH ANDOVER BUILDERS ANDOVER, MA BUILDING DEPARTMENT 5:6 MULBERRY CIRCLE MINIMUM SETBACKS: THAT THE EXISTING FOUNDATION a;ANDOVER, MA. 01510 FRONT — 30 FEET DRAWN ON THIS PLAN IS LOCATED AS DATE: OCTOBER 11, 2002 SIDE — 30 FEET SHOWN AND THAT IT DOES COMPLY TO 'SCAIX 1" - 60' REAR - 30 FEET THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. 02-10183 Location No. G �r Date 0 Z t M�RTM TOWN OF NORTH ANDOVER ♦ � s Certificate of Occupancy $ Building/Frame Permit Fee $ ACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ SO Check # ILO 15956 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING N~it amya WELDING PERMIT NUMBER. DATE ISSUED: Lo MM SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Rd. M4/3 c,� A Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G L.C.40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System. D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record }� Name(Print) Address for Service: S Signature Telephone 2.2 Owner of Record: Name Print Address for Service: M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES ,.r Licensed Construction Supervisor: Not Applicable ❑ CSLio�nsed Construction Supervisor: — 0 /�//f�, License Number mn ..y 1 ryCr�f` 'tel ✓(,tl�^�— r'i"(J Address Expiration Date icic ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicabl Company Name M Registration Number r Address r z Expiration Date /) Signature Telephone �1� SECTION 4-WORKERS COMPENSATION(M.G.L, C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ _ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction,X Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: U (►�.�.. Lila SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be f}I CIAL USE ONLY. Completed by permit applicant 1. Building (a) Building Permit Fee t.25 Ar w/a Multiplier 2 Electrical (b) Estimated Total Cost of ///75 '� � S• 0-,3 Construction .�_gD r 3 Plumbing 000 ' Building Permit fee(a)X (b) ( ® �4 Mechanical HVAC) Duo 5 Fire Protection 6 Total 1+2+3+4+5 3 vw Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner/Authorized Agent of subject property t Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 5C... S"3— 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 P t Name ` Signature of Owner/A ent Date NO. OF STORIES oZ SIZE y BASEMENT OR SLAB ...� SIZE OF FLOOR TIMBERS tJ 1 r}oc/v 2 V 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS d-w Dll�IENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING j VOL/o,V yo X MATERIAL OF CHFVWEY IS BUILDING ON SOLID OR FILLED LAND a i IS BUILDING CONNECTED TO NATURAL GAS LINE d" Location �,5 �. No. Date Na^Th TOWN OF NORTH ANDOVER F - A .. A s Certificate of Occupancy $ +��sE<�• Building/Frame Permit Fee $ y ACMus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check #,40 '-3 15534 �1 /,`Building Inspe` r • FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from `"" Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANTf PHONE DF�OG! `lrr``�� J LOCATION: Assessor's Map Number—)OZ-6— PARCEL SUBDIVISION_(,A(_n � :�p fyeS4 LOT(S) . 62 STREET _�''l 14U�1� % ,P ST. NUMBER_ ************************************OFFICIAL USE ONLY*********************************** RECOMM D TIO OF TOWN AGENTS: CONS ATION DMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS �� /lb ,� , �✓ �2 � , ( �G ��� �� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS 5 C �L7,V7 FOOD IN PECT R-HEALTH, DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS /-.w To 55 SF.W&ED FQ(02- -rb �y Qofj otl PUBLIC WORKS-SEWER/WATER CONNECTIONS �� _ Z4 _p2 DRIVEWAY ERMIT 7- FIRE-DEPARTMENT / _FIRE DEPARTMENT 2 Z— RECEIVED BY BUILDING INSPECTOR_ DATE Revised 9\97 jm GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING 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. (64 t3 Permit Applicant Property address Map/Parcel cnz- in y- 471 11K 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 building 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. permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in 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 therovisions of section 8.7 of the P Zoning Bylaw. 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 be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town or other similar mechanism approved by the planning board that will ll etsure 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 Z nt Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and s 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 NO S REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. 'APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION z w The Commonwealth of Massachusetts Department of Industrial Accidents ` j d Office of Investigations A W f Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: ti. .�. n•• _ 6Location: City 0 Phone # I am a homeowner performing all work myself. i 71 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. Company name - Address t f�L,��w-- /�I�` Phone#: City. - Insurance Co. 2-3 a Policy# G d0 y Comoanyname: Address City Phone#: Insurance Co. Policy# 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 weU_as_civii.penattiesinTheform nfa_ST_OP WORK ORDFRAnd a fine_of.($1Ilo.flD)aday.against.me. 1 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 un ec-th sins d penalties of perjury that the information provided above is true and correct. Signature Print name J�`' '` S Z '`/' Phone# G 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 Q Licensing Board p Selectman's Office Contact person: Phone#: Health Department Other MAScheck COMPLIANCE REPORT I /y Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 I I Checked by/Date I I TITLE: PLAN NO 4216 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 8-14-2002 DATE OF PLANS: 11-24-94 PROJECT INFORMATION: COLONIAL HOUSE COMPANY INFORMATION: BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 COMPLIANCE: Passes Maximum UA = 324 Your Home = 212 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 2136 33.0 33.0 34 WALLS: Wood Frame, 16" O.C. 1344 19.0 19.0 46 BSMT: Conc. 8.0' ht/7.0' bg/8.0' insul 332 19.0 19.0 8 GLAZING: Windows or Doors 318 0.330 105 DOORS 58 0.330 19 HVAC EQUIPMENT: Furnace, 87.5 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in Sections 780CMR 1310 and J4.4 Builder/Designer00VV"&&!'0 Date r TITLE: PLAN NO 4216 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 8-14-2002 Bldg. 1 Dept. l Use I I I CEILINGS: [ ] I 1. R-33 + R-33 Comments/Location I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-19 + R-19 I Comments/Location I BASEMENT WALLS: [ ] I 1. Conc. 8.0' ht/7.0' bg/8.0' insul, R-19 cavity + R-0 continuous Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.33 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: 0.33 ( Comments/Location I HVAC EQUIPMENT: [ ] I 1. Furnace, 87.5 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing 1 air and water systems. I 1 TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. i I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids 1 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" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 i Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 I 1 CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hot water pipes to the following levels (in. ) : 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+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 I 100-130 0.5 1 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- 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) G 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 ORTH Town o �� : : ndover o ndover, Mass. /Cp 3 p?QO COCHICME ATED LSSA C H US�� FOR EXCAVATION FOUNDATION THIS CERTIFIES THAT .. ... ./v 0 rr....... ) ....../1�iQ!., ., .�............................................. has permission to excavate and pour foundation at .��.f....o? * �..�.....�. for the purpose of.#f j C��� �� I td// 44#41ter %5*14 .. �*AJC �. The person accepting this permit must return to the office of the Buildin Inspector a rtified plot plan show of building thereon before Foundation will be inspected. OPP` Q �A c /jftftAr 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. BLDG. PERMIT FEE C LESS FDA FEE-' OP 16 ,5 OV DUE FRAME PERMIT$Y6 55 BUILDING INSPECTOR NORTH E Town of ...;.,.r^ Andover 0� COCH,G I dover, Mass., O7 ADRATEDIwo S H E BOARD OF HEALTH PERMI T D Food/Kitchen Septic System // BUILDING INSPECTOR THIS CERTIFIES THAT ! AAA o � JdPs x .....�. .... ................................................. Foundation has permission to erect.................�.... ............... buildinga on .AO'a...A....��...OfoN� wcel C Clift. r .. .�............ Rough to be occupied as.1.0room O� 84 1.34 �grdff' Slb `e Rlual.yC� Chimney .................................................... provided that the person accep ing 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 Inspection, Alteration and Construction of Buildings in the Town of North Andover. 1176 136 / a Ar 41TO 6 0am PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION T -TS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Town of North Andover °f N°oT 61ti Office of the Conservation Department 0 Community Development and Services Division VL 27 Charles Street Alison McKay North Andover,Massachusetts 01845 Telephone(978)688-9530 Conservation Associate Fax(978)688-9542 February 7, 2003 Sean Szekely Szekely Construction Inc. 6 Mulberry Circle Andover, MA 01810 RE: Lot 2A Stonewedge Circle—242-990—Campbell Forest Dear Mr. Szekely: There are several items I would like to address in this correspondence upon recent findings. First and foremost, I'd like to emphasize the importance of your responsibility'to comply with the Order of Conditions associated with your lot. Condition number 26 of the Order of Conditions states that "the conditions of this decision shall apply to, and be-bind'mg upon, the applicant, owner, its employees and all successors and assigns in interest or control. These obligations shall be expressed in covenants in all deeds to succeeding owners of portions of the property." It is my understanding that Mesiti Development Corporation has interest in overall development completion and compliance;however"theyhave sold the lots to separate owners.Merefore, all of the conditions pertaining to the above referenced Order are binding upon you and your contractors until full.compliance is met. This being said, I would like to address issues pertaining to the stone retaining wall on the property. A modification letter with an attached modified site plan was sent to us from your engineer, Erik Heyland of Engineering Alliance, dated September 25, 2002 and received by us on January 16, 2003 in regards to a request-to rotate the position ofthe proposedhome. -1-had responded to this request in writing to Ken Grandstaff, of Mesiti Development on January 28, 2003. You were sent a carbon copy of this correspondence. The letter was written directly to Mesiti as a result of a recent agreement made by this department and Mesiti that Mesiti would be notified first of any modifications pertaining-to tbe development, as administrative modifications of privately owned lots may not be known. The last two sentences of the fourth paragraph was added and intended for your purposes and was only added because I had not heard from you upon calling until the next day and wanted to send out the letter as soon as possible. When you returned my call the next day, you had made it clear that the stone retaining wall shown on the new site plan had not extended any further than what was currently in the field. I inspected the property on February 6, 2003 and found that the stone retaining wall does not reflect the stone wall on the new site plan and does in fact extend around the property significantly. Therefore, I will not approve the current modification before me (although I have no issues with the request to BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNI ING 688-9535 rotate the house itself) until a full modification request and modified site plan, with current wall locations is properly-submitted by your-engineer. This-modification-shall be submitted-to this office by no later than February 24,2003. My site inspection also presented several violations to the Order of conditions. They are noted below. • The trash dumpster on site, which is located on the driveway approximately 50 or so feet from the protected wetland resource area, is extremely full and subsequently overflowing onto the driveway. There is also evidence of some construction debris behind the erosion control Emits, within the 25-foot-no-disturbance--area. The trash-dumpster-needs to-be-emptied immediately and any construction debris beyond the erosion control limits needs to be removed by hand. • Placement of the stone retaining wall in the area just beyond the rear of the driveway has caused someininor encroachmentinto-the 25-foot no-disturbance zone. Any-bouulders,-which may have exceeded past the erosion controls, in this area or in any other area on the lot, needs to be removed by hand. Snow stockpiling being pushed over the wall in this area may be a result of the encroachment, but does not excuse any disturbance within the 25-foot no disturb. Please attend to all matters referenced herein immediately. Do not hesitate to contact me with further questions or concerns in this regard. Thank you for your anticipated cooperation. Sincerely, Alison McKay, Conservatio 'ssociate Cc: Ken Grandstaff, Mesiti Development Corp. Ken Ahern,Mesiti Development-Carp. Erik Hayland, Engineering Alliance, Inc. NACC File Building File KoarH SS^cuus - CERTIFICATE OF USE & OCCUPi TOWN O1= NORTH ANDOVER Building permit Number d HIS CERTIFIES THAT Date_ THE BUILDING LOCATED ON /v . Tc�,v e w e c MAYBE OCCUPIED AS t—A—(M.c. C `< <( f�`--s I O� .Qil9 C IN ACCORDANCE WITH THE PROVISIONS OF THE MASSAC � CODE AND SUCH OTHER REGULATIONS AS MAY Apply. HUSETTS S CERTIFICATE ISSUED TO � ( t �YAC Mk-A - .eQ\04 et� �� nf -- C10RTH ova o E . � .. Andover No. d ~ f-_ 70 Zh o --- �A ,� do� 0 00 COC , MIC over, Mass. S,e 00ATEO P.P�\t� 5 S 4` . H 4 BOARD OF HEALTH -PERM Food/Kitchen IT T D Septic System � � • 4 4 BUILDING INSPECTOR THIS CERTIFIES THAT.. ..... .......... V�.�............. . ...... .... ............................................ Foundational has permission to erect.......... . buildings on .�.o..fQ��4.# ...tSAo vr. &Oe�je....00%. Rough — �'7 ......................... to be occupied as toroOm IR .. /..3. '�a��.l1.h.. r�..s/� �t RlS���yG� Chimney provided that the person accepting this permit shall in every respect conform to the Perms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to Inspection, Final (o Y 9 p Alteration and Construction Buildings in the Town of North Andover. i ob r3/ a y��d•�' ��9" PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. p'I Rough r PERMIT E ''IRES IN 6 MONTHS UNLESS CONSTRUCTION T TS ELECTRICAL INSPECTQR. 6 .. . . .. ........... ..... ... ....... BUILDING INSPECTOR anal Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in Rough p y a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE � // Smoke Det.