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HomeMy WebLinkAboutMiscellaneous - 50 AVERY PARK DRIVE 4/30/2018 MAP l06 8 ?ARCEL ---- µORTy of 48e..'+bo h ti A SSRCHtE9E CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number S Date THIS CERTIFIES THAT THE BUILDING LOCATED ON D74a D Ue IC' /� , _DR . MAY BE OCCUPIED AS 61 Le- -�q �/ �/ �S�CI Iry c IN ACCORDANCE WITH THE PROVISIONS OF THEAfASSACHI SETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. /O eom M-5, 3 8,47-A-5, .3 S)(a // viv CERTIFICATE ISSUED TO N s�>A-) �-F• Building Inspector erector Town of �' 4 over 0 170 LA E o dover, Mass., q CRg aov♦ COCHICKEWICK V 7,p ADRATED P"1?? 7 CP — _ �too 0? S 4 BOARD OF HEALTH Food/Kitchen Septic System PERMIT T BUILDING INSPECTOR THIS CERTIFIES THAT V N ! ............................................. ............................ ............. ..................................... Foundation �`C has permission to erect...... ......... buildings on .jl7 ... .............�........��.... ......A � Rou h � r �� Chimney to be occupied as / �� / Q !/.�. ....5.....w. ...'' V/V `! /'� y provided that the person accepting this permit shall in every respect conform'to the terms of the application on file in Fina 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 INSPECTO VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS l`/f UNLESS CONSTRUCTION STAR ECTRIc SPE o Rou �I ....................... ... . .. .. ..... ..................................................... BUILDING INSPECTOR • Occupancy Permit Required to Occupy Building GAS INSPECTOR ou C� ( �C) L 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. f�ze �amv�szan�vc�it�fi a�✓lr!aaxzc�iuee(,td BOARD OF BUILDING REGULATIONS f License: CONSTRUCTION SUPERVISOR Number CS 014197 Birthdate: 04/24/1957 Expires: 04/24/2004 Tr.no: 19084 Restricted: 00 MARK F RAE 85 JOHNSON ST NO ANDOVER, MA 01845 Administrator Location Avery /),4,?( Peluf— No. Date M°RTS TOWN OF NORTH ANDOVER - U . i Certificate of Occupancy $ s'•••°Eta Building/Frame Permit Fee $ scHus � Foundation Permit Fee $ �d Other Permit Fee $ TOTAL $ `sp Check # "5060 15 4 4 0 Building Inspector J t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH,A ONE OR TWO FAMILY DWELLING �..,. TWs SCCtiOg#'pr�ICi&1-U�e Unt BUILDING PERMIT NUMBER: � � � DATE ISSUED. / ic SIGNATURE: N Building Commissioner/In ctor of Buildings Date SECTION 1-SITE INFORMATION z 1.1 Property Address: O.r 1.2 Assessors Map and Parcel Number: 06.23 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Y Zoning District Pr os, '�Jse Lot Area(sf) Frontage ft 1.6 BUILtb1 Nd3. ftCk.s`d)-e. Front Yard _ Side Yard Rear Yard Required' `tI Provide,';-, Required Provided Required Provided 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Water SupplyM.G.L:C.40� 44�,", ✓ / Public Private ❑ Zone Outside Flood Zone $ Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record loo Ahdaver a Kp,:2 sa St,ifs --300 AY 41 Name(PrinK Address for Service 68"7-s"�oc� Signature Telephone 0 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION_SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number ioo . sem i3 _ s sr� no . Address L �a576� o g��/oma O Expiration Date Signature Telephone �. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number r Address r z Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) y 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. i Signed affidavit Attached Yes...... No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction V Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Deinolifion ❑ Other ,❑ Specify ' Brief Description of Proposed Work: yA 626farl r eCBWsaL / �� $�, / Z0, S 7yr-Zv- ✓7 Lc� a Z S aJ V N1 e SECTION 6-ESTIMATED CONSTRUCTION COSTS x^,h Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee jJ Q Multiplier 2 Electrical (b) Estimated Total Cost of 0 O O Construction a IJ 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC l (� 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATIOK TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 77/b OWNER/AUTHORIZED AGENT DECLARATION I, /��� -i I`�1 s 1 as< w/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Na / Q Z/!? -Signature of Owner/A eritX Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 3 SPAN 6 a DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS - SIZE OF FOOTING lill X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I �U-) • FORM U LOT RELEASE FORM INSTRUCTIONS: This `crm 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 complianc-e with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS APPLICANT PHONE G7- 3nc7 LOCATION: Assessor's Map Number ��� PARCEL 7 3 SUBDIVISION- � � f LOT (S) STREET AeIrY P,7 .Y— ST. NUMBER USE ONLY*********************************** RECOMMENDATION OF TOWN AGENTS: CONSIJRVATION ADMINISTIRATOR DATE APPROVED t DATE REJECTED COMMENTS l WrJS&(,4)- d i TOWN LA NER DATE APPROVED 7 6 DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED 12 SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED SY BUILDING INSPECTOR DATE Revised 9197 jm F) M (-4 (A . -- P !�— 141 01 - 0 co 0 LI— — — — — — — — — — — — — — — — — — T cc) 01) z Go00 co BLDG'ISF,,.TBACK — — — — — — cn c! cot ,81Lg 0 0 (6 (-4 0 S 0 CO 0 a.Lj 5 (Al<X LL. cy) CL C1310102" cl) N79*1 cl? A 00'9LZ=8 (0SO 0) CO9001pw t, 1165 0Q' (0 00 • co a) 4 rn Rzr co LV Q) ti U 4Y, C3 ro '56 (A 8ASEW JB737 1 0 JOIROP SFw 1i�T QARAQE Zaa 0 .46 0 CA 4�- 10 rri -n T 8 K, co Cal P co ...... CD C4 a) co CC) (.4 0) 0 co Ull -4 co 00 1b C0 C0' !1c (3 (0 q 11-1 co C0 I I \j I co 00 (o/c';:� I "I 0 LAJ co 00 co co co 00 tn I a) ORIQNAL MAN OF RECORD DATE 4-15-K RM #5 4-3-97 'AUD Br.• Engineering Alliance, Inc. wxcr. Campbell Forest REMSED SEWER PLAN MAY 13. 19H (0 SHEETS) �n (0 Land Planning Consultants North Andover, Massachusetts 40D. REV. 3--23-2001 LOT 24 ONLY 198 Con(mi Soso Phone(181)231-1340 Jur"SION Saugus,MA 01906 Fsr(781)9414662 Pfiwjrcr NO.: 98-0foo AppUmni: Campbell Forest, LLC rwo rn7j.* Dra. 'Vo 'Sol DIM FZC X"q. Me 231 SUTTON STREET MODIFICATION TO SITE PLAN I of 1 DISION Dr.• "D. mwyLls" Ps CHSCAID BY.• DCV SUITE 2F I r)T?4 NORTH ANDOVER,MA 01845 , Growth Management Eylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested'below. Name of Applicant an Building Permit(below) Address of Property fcr Pen rit(below) Nlao and Parcel :,(°4p Purpose of Application (check below Phone Number oaplicant Single Family Two Family I the undersigned applicant far the above property attest that the attached building permit far which this form is completed does comply with the E<EMPTON section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me cr any party to this permit from the requirements of obtaining other permits required prior to the issuance of the�uiiding Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only of c!21[y accepted when the Building Permit iq issued. Based an 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 ane or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement.restoration,or reconstruc;icn of a dwelling in existents as of the effective date of this by-law,provided that no additional residential unit is created. The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Secicn 9.7 of the Zoning ytaw. _This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents,where occupant/of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section"senior'shall mean persons over the age of 55. I This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density,(buildable lots),below the density, (buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open spaca and/or farmland.The land to be preserved shall be protected from deve!ocment by an Agricultural Preservation Restnc,'ian,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel an the effective date of this Section 8.7 shall receive a ane-time exemption from the Planned Growth Rate and Development Scheduling provisions far the purpose of constructing one single lamely dwelling unit an the parcel. This application represents a Idt which is ready for building permits,( e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such Ume as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to ccuracy of the information provided and that the attached building permit is allowed an E;<EMPTiON s cited ave. Further I understand that the submittal of misleading and or inaccurate information, r the checks g off of an above item which does not comply, whether done to my knowledge �/ict, is g unds for re' at by the Building Oepartment to issue a Building Permit. ��r o Signature of Owner b A on d A e ho signed the Attac ed Budding Permit Uate This form must be aft.1c.hed to the Building Permit upon application for such permit BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: ,l Ur n-S—r - No r PA. 62s7 ec� �/f2�2. Location of Facility Si e o errnit Applicant V7;1/0 " Date i NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector t The .Commornvealth of Massachusetts Department of Industrial Accidents W.y Office of Investigations Boston. plass. 02919 cl'�r Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity (moi I am an employer providing workers' compensation for my employees working on this job. J Companv name: � i n/eS4 r✓ G LSC e-sl 1-i Address /00 ��/�c��D5✓:f��Ss SU f _. OlJ City' k04 t UL V f,,r Ra C3 Phone# (2 2 5 G 5 7 ` Insurance Co. , S Sr--,4-nC,e C=0 . Policv# to Lz O /��5-� � Comoanv name: Address Cibl: Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition cf criminal penalties of a fine up to 61,500.00 and/or one years'imprisonment as well as Wallies in the form of a STOP WORK ORDER and a fine of(s1 oo.00)a day against me. I understand that a copy of this statement ay be fo rded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify and the ins and. Haiti s of pe ' ry that the information provided above is true and ccnect. j Signature Date Print name Phone# SS 7 7~7(O Official use only do not write in this area to be completed by city or town official' City or Town P=rmit/Licensina ❑ Building Dept ❑Check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other } 1500 APPLICATION FOR SEWER SERVICE CONNECTION r Z North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in fZ, Stfeet,- subject to the rules and regulations of the Division of Public Works. l JrC� lqUP✓' �i/� The premises are known as No. Stet or subdivision lot no. Owner / ��� � ��i/ Address Contractor Addre 9 Applicant's Sididture PERMIT TO CONNECT WITH SEWER MAIN Division of Public Works hereby grants permission to C', -�e Gt / �� � 6Z— The C to make a connection with the sewer main at / >�r f C r� %tel kUe Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations 7 N2 - 964 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. k9- t � e!/ f�•� %�t J2 Application by the undersigned is hereby made to connect with the town water main in � street; subject to the rules and regulations of the Division of Public Works. L� The premises are known as No. J� �P. �� / �� 11 �� Street or subdivision lot no. Owner lkle")CY-1" Address Contractor Address �A s Applicant's Sig ure r PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to CU �� �(/ G�+� �� L C to make a connection with the water main atG�� Street subject to the rules and regulations of the Division of Public Works. � Board of Public Works ' Inspected by Date See back for rules and regulations { l II I L r1 U G TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone(508)685-0950 Fax(508)688-9573 MORTN �O�tt�eo ,6'9q.o OL A # - q AC US DRIVEWAY PERMIT Date: 3 - LOCATION: -LOCATION: 5d ���� >��'v� ��`� z4- BUILDER: phone: OWNER: ����rDe C phone: 7 y The North Andover Superintendent of Highway Utilities&Operations MUST be notified of the grade and set-back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND. OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01 845 J. William Hmurciak, Director Timothy J. Willett Telephone(978) 685-0.9.10 Staff Engineer Fax(978) 688-9573 Additional conditions for lot 24, Campbell Forest April 5,2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lot 24 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for this lot so that the construction of the home can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into the residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. 2. No water service shall be installed into the residence until all off site sewer facilities are approved by this office. Any violation of the above conditions will void both water and sewer connection permits. No refunds will be granted. Mesiti Devlo ent Printed Name Dat Division of is Works P6ted NaZ} Date CC:Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin - Mesiti Dev Group Fax:978-5578160 Jul 17 2000 1354 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER,,MASSACHUSETTS 01845 1 with"Ffmurciak w0"TM Telephone(978).685-0950 13irector � � y Far(978) 688-9573 J 4, zoo . 0 I Mr.Kenneth.Grandstaf President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover,Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. GrandstafF The Division of Public Works has inspected the sewer collection system and sewer pumping station,and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the.systern and pumping station subject tot e foIIo 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesio Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement dg of the receipt ip of this letter. 2. Satisfactory completion of an as-built plan for the Campbell Road sewerage system. 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station 4. A performance guarantee shall be provided in the amount of$25,000.00 to insure the proper maintenance and operation of the pumping station, 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct,repair,replace, add to, service, inspect and operate the pumping station and related equipment.and facilities in the event _..._........ _ that Mesiti Development or its agents fats to adequately perform maintenance - --...:�............... ...: of the pumping station. - Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable' costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend,and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims,judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the"Town'or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. VeryT . ours, j J.Willi Hmurnin .E. Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant of onditional use. sid el up K eth Giiaqd sident Date: FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and 'dated Dec, 14 , 19 J(. and/or by the Covenant dated Mav a , 19 3A and recorded in District Deeds, Book 4 $$0 Page -1 a4 ; or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book , Page has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled " Campbe•ft 1=ortSf S(46L/i�/ P14N Section (s) , Sheets 1 - 7 Plan dated 19 gE recorded by the ESSPx _r1a�t�, D r si-ri ct .egistry of Deeds, Plan Back or registered in said Land Registry District, Plan Book Plan-�*/ a7 8 '� , and said lots are hereby released from the restriction as .to sale and building specified thereon. Lots designated on said Plan as follows : (Lot Number (s) and street(s) ) Loi -Aro 3 amJ a-$ 3;L So K u1 e bs •ve K4v a 'v� b• (To be attested by a Registered Land Surveyor) LorS ZY,zS L ors ! -ru•w !"S ; L07S l,s —I Ae v Z 3 I hereby certify that lot number (s) God ZS 7-,� 37-i BA on sOnP4,+,� btA%JV' (AW-A wklnlyle Ujoow L..." �-jNr Z�Wt,tJf Streets) do conform to layout as shown on Definitive Plan entitled Section Sheet (s) VI 0' IV4S ALRT T 061CGJ, TRUDEL Z� R gistered Land Surveyor S No. 36869 AFF s s��NA( LANA SJ 1 of 2 r C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated I9 Covenant dated and/or 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book or registered in Land Registry Page g• ry District as Document No . and noted on Certificate of Title No. Registration Book, in Page acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the Lots designated on said plan as follows: EXECUTED as a sealed instrument this S day of "�� / _ Ig _ C l y Majority of the Punning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS ss Then personally appeared AI L-5,•,r) L(-xi-Lecqw�, one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary blic My Commissi n Expires 2 of 2 , e � � ✓fie i�anvrnareeuea�i a�✓�(�ac�uuteab � BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 4t> Number: CS 069234 Birthdate: 05/09/1954 r I' Expires:05/09/2002 Tr.no: 23903 - I Restricted To: 00 ALAN G RUSSELL _/ 400 MAIN ST GROVELAND, MA 01834 Administrator f i I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 8-23-2001 DATE OF PLANS: April 18,2000 TITLE: Lot 24 "The Hampton" PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 100 Andover Bypass Suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 594 Your Home = 591 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1752 30.0 0.0 62 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1752 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment s ecte to heat or cool the building shall be no greater than 5he desi load as specified in Sections 780CMR 1310 J4.4 Builder/Designer � Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 24 "The Hampton" DATE: 8-23-2001 Bldg. l Dept. l Use I I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ) I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.35 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U-value: 0.49 I Comments/Location I I FLOORS: [ ] i 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ) I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated; manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or i gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ J I Materials and equipment must be identified so that compliance can • I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be i provided. Insulation R-values, glazing U-values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. _ I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I ( ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.) : I PIPE SIZES (in.) NON-CIRCULATING ( CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 i 0.5 1.0 1.5 I 100-130 0.5 I 0.5 0.5 1.0 ' I ----NOTES TO FIELD (Building Department Use Only)------------------------- ORTFy Town o �� � . ,oAndover % y 01--.1-1.."'..".. 0 IL C.� ___ = - . o, ndover, Mass., T O L A K E COC MICMEWICK '%-ATE DU ���5 CH IT FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT .......6A. .... ............ ................. ... ...c........ has permission to excavate and pour foundation at �a T �� /�UCl2 �i4/2 /` �i►C for the purpose of.....� .�` �'s �/9 � U �1�/z cS/.0 /� /���/(��/VC� ................................(..7.. .................... ......................... .. The person accepting this permit must return to the office of the Buil?g)nspector a certiJfied plot plan show of building thereon before Foundation will be inspected. �O V��93 �S BLDG, PERMIT FEr / LESS FDA FEE_rt oP - / p DUE FRAME PERM T �3 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 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. ... .................... ........ .................. MALIANG INSPI.".0 OR NORTH of LEDown , Andover f- °�A�o�H,� �,� dover, Mass., ORATED SS E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 00 // BUILDING INSPECTOR THIS CERTIFIES THAT............... .......6 e has permission to erect......... ................. buildingsSSD Foundation 4.0 c/►� ........... . "i..... ..... Rough t0 be occupied as. ..D. Qoo -3-� Al�1 '3 S al/1W dee /. �•1 J�- `C_ Chimney P / A. .. .. ... ..... . .. ...... ....................5..... ........................... 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 the Inspection, Alteration and Construction of Buildings in the Town of North Andover. /B 6 3r7,3 JS"-31, — PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina` UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR c�C 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 T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Location �D7 0�y -�-D ✓ I, v / e No. Date �aRT� TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s3 Check # 1 5 3 L 4 V Building Inspector FEB- 7-02 T H U 11 : 32 S _ E _ C u m m i n 9 s Assoc f a t e s P - 02 cmrl /QED PL or PLAN SX, CUMM/NeS & ASSOC/A M$ P-a BOX my PLA/STOW, N.M. 03865 7'ELEpNoAfe (6o$)-382-5086 FAx wm-382-SM R=27'. L A �* A S o��oc o ALBERT r v TAUq — g Na 368 ,Z;� �4 4 N /�9 r y a N ppr 7AX MAP 210 BLOCK 106-8 1..OT 24 LOT 24 CAMPBELL FOREST 47,859 S.F. NORTH ANDOVER, MA. CBA=39,550 S.F, PREPARED FOR: MESITI DEVELOPMENT 700 ANDOVER BYPASS, SUITE 300 NORTH ANDOVER, MA. 01845 UATE'- FEBRUARY 4 2.002 SCALF. I" = 60' N ^ l HEREBY CERT/!-Y TO TOWN OF NORTH ANDOVER, MA BUILDING D£PARTML'NT M THAT THE EXISTING FOUNDA TION ORA WN ON THIS PLAN /5 LOCATED AS SHO WIV ANO TFIA T l T DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO 7 goo PROPERTY LINES. F J MINIMUM 5E"7BACKS: FRONT - 30 FEET S/DE - 30 FEET REAR - 30 FEET Y:\Projects\1997-754 Cornbell Forest\CPf' IAT 24.dwq 02/07/02 08:01:44 AM EST ' I A,r - ,_ j Jlce �' l+� o�f�✓i��vuccr�tnS4�d ' BOARD OF BUILDING REGULATIONS a _ License: CONSTRUCTION SUPERVISOR Number: CS' 414197 Birthdate: 44/24/1957 ff Expires:04/24/2{H32 Tr.no: 25538 � Restricted To: 44 MARK t= RAE 744 CHESTNUT ST ..0 NO ANDOVER, MA 41845 Administrator i F X.10RTH 0 0 ► - :..4 over 1��T .......,:.., 1..,� s. 0 M., =- T �y. i T O i - -L A o - dover, Mass., COCMICMEWICK V SRATED Jllk? Cl BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D 73.0.1 r V �� BUILDING INSPECTOR THIS CERTIFIES THAT C•••• ••••• cq.e..P Foundationhas permission to erect...... r« p ..../.......................... buildings on.101-0... �.... ... .vv. ...... ........ . Rough c to be occupied as o e0o ISI� 3 .7 � A� 3 S�'' VN�''� r chimney .......................... .... 1............... .............................................................. . ....... 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. 1 d 6 QPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough . Service ... ... . .. .. .. . .................................................. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display ina 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. BOARD OF BUILDING REGULATIONS ►License: CONSTRUCTION SUPERVISOR Number: CS 014197 '!Birthdate: W24/1957 Z� Expires:04/24/2002 Tr.n4: 25538 Restricted To: 00' MARK F RAE _ 700 CHESTNUT ST NO ANDOVER, MA 01845 Administrator ORTH �. oven o �= �y._. T� �: 6Andover No. U F �L. COCHICMEWIC]( y�. 'I^ "r�A°,�,ATEo Ae�` �SSRC H U S�'C I T I FOR EXCAVATIONNoFOUNDATION� m lkkc THIS CEi2TJFJES THAT .,..... ,e�:.... .�.....�......... ..................... ........... r...................._.............. has permission to excavate and pour foundation at ..f�P .T... .r. ..t7. G! ........� ................ -e_ for the purpose of....�.�.a04Nb - c3;s.:�3A ..� tSa11. u.vcl,� cJ t�vc /�... /�av�/G'1�e NC's The person accepting this per must return to the office of the Building ns ector a certified plot plan show of building thereon before Foundation will be inspected. JD�a {3Y.0 JBLDQ PERMIT �� f LESS FDA +t oP - / p 'E WE FRAME PERM T �3 w VIOLATION of the Zoning or Building Regulallons Voids this Permit. PERMIT EXPIRES IN 6 N N The holder of tip+s Foundation Permit proceeds at own risk and uJitilaUt UNLESS CONSTRUCTION STARTS assurance that a permit for entire building stfucture will be granted. N O GO Iga ...�.. . ... .�.. .��............7.......1,-�.M........... . ........................ BUILDING INSPECTOR Town of North Andover * ttORTH Building Department ?�tt V Mb' �o 27 Charles Street 1 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 COL wIt fwKw 1' 00, .acHu5���� APPLICATION FOR CERTIFICATE OF OCCUPANCY/ INSPECTION ADDRESS _ � 7 GCS LOT NUMBER r -/ SUBDIVISION ���� DATE REQUEST FILED z DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT ET ALL APPLICABLE CODES. SIGNATURE cf, OFFICIAL USE ONLY ROUTING CONSERVATIO DATE 7 6 PL G DA E I D i D.P.W. —WATER METE DATE l D.P.W. T INDICATE THAT THE WATER METER HAS BEEN INSTALLED P TO SPECTION UQUEST DATE. S ATURE/DPW A ATION 36u9 / Date... f NOFTM 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that ......7,0—/I.j........,f.,,/. j .......... ................. has permission to perform ........... ......5.'` / '..<... '..:................... wiring in the building of.... . F. /.;v•/ ... f.............................. at...... .............................. . ........ . .....•?/..,f>�.r/ F i North Andove ass. r Fee... .u. .. Lic.No.d..C. ...................�... . .............. CT�I�ALINSPECTOR Check # THEC0MM0NWE4LTH0FM4MCHUSE77S Office Use only DEPARTMENTOFPUBLICS4FRY Permit No. BOARD OFFIREPREVEWONREGUTATIOAN527CMR 12.110 U Occupancy&Fees Checked PPUCATION FOR PERW TO PIWORM aE=CAL WORK r ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat U V 9 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) �G p L/ he A tr Owner or Tenant `o lit- ra-d Owner's Address I fw �, :L (4)) /e5„l Is this permit in conjunction with a building permit: Yes= No � (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps/ Volts Overhead Underground Q No.of Meters New Service �d b Amps Q, d) Volts Overhead Underground No.of Meters i Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work rii P VAYJ d U 1 f S No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local � Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• hsutarceCo Pt>�ataibtheregtatana�ofMassad>tse>�C�alI.ar�+s . Ihawaamtl.mbihiyL>s==PcbLyni&gCanpi& CoA=Wcritset}n dat YES F1 NO Iha esulxnftdNd dpmdofsa 1othe06re YES FJ NO r7 Ifjmbmed-edWYES,pimem&*theWofmuaWbyclxckirtgtbe bcx o BOND o OTHER o ft= ) Fsbnvkd ValuedHechiml Wak$ WaktoSlat hgieWwD*Ra*xsWd Rc* F>elal SignedmckrTrP cfpjtey: FIRMNAME D C 6A LioaseNo. Lioam el-'�M{ 1 �/� Sig>a>ure I xaseNo �r7 (� T JA / Busrn eLNa Addw_.� A R✓I A AIL TeLNa ­2 1 OWNER'S W&IRANCEWANER;I.amaw=th1ftL oaseclo tcismuwmWorits&bUtWe#vaiatasre#Wbykbmadum(3a>aalLawS atddAnrys aeonthispm*appkaumvarAsftmw'mnad. (Please check one) Owner Agent U V Telephone No. PERMIT FEE$ o�,N`o°TM 1ti0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s ,SSAC14USf This certifies that .��� has permission to perform . . . . � e . . . . . . . . . . . . plumbing in the buildings of . . . * .� .� �.!'. .�. . . . . . . . . . . . . . . . . at. . .S`. C?. .`'w r./? !,-. . ./?e+ . . . . . . . . .. North Andover, Mass. Fee. ).. ? U: -Lic. No.. . . . . . . . . . . .$ .7L?. .(- . . . . . PLUMBING INSPECTOR Check # 5191 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIING (Type or print) s f ( r NORTH ANDOVER,MASSACHUSETTS Date "L Building Locations O P<" Owners Name ,�r��(L cp Permit#- -1 o u n t Amount 3��?3 Type of Occupancy New Renovation Replacement Plans Submi ettett d Yes No rl FIXTURES w as O ra A A as SLRME I,S)C RDM \ 1 ZD H-0011 2 a 3M KM 4M IMM 5M FLOCR 6M Hf= 7M1HD 9M HDM (Print or type) Check one: Certificate Installing Company Name(9 /.r�( F ❑r Corp. 1106 Address ',lt�d� / �orl Partner. Business Te ep one G,�j��1 )U � ) j Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checkirfg 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 three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State PlumpineRode hapter 142 of the General Laws. BY Signature o secyrmmoer Type of Plumbi g License Title � � ,,�,/ City/Town icense NumDer Master I(� Journeyman ❑ APPROVED(OFFICE USE ONLY "`...111 Date. . . .!�: ..'. . . .e. .l.. . . "ORTM o� °� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 1 �q3 SACWUSE��y This certifies that . ' . . . . . . . . . . . . . . . . has permission for gas installation . . . . .. `. . . . ... `.. ^ . . . . . ` in the buildings of . . �':'. : . �. �.r. . . . . .C<. . . . . . . . . . . . . . . . . . . at . . �. �-. . . �'%�`: . :'. :�. . f Thr. . . . . . . .. North Andover, Mass. Fee. . . .'. . . . Lic. No..,/ 3.".}. . . . . . . . . . . . .�. . . .: �P . . . . GAS INSPECTOR Check# 3rC, 0 MASSACHUSErIS UNH ORMAPPUCATON FOR PERMUr TO DO GAS FITTING (Type or print) Date � — �— NORTH ANDOVER,MASSACHUSETTS ��/� Building Locations ^� P8 V� QL` - Permit# 3 �o Amount$ Owner's Name [ 7 New Renovation ❑ Replacement ❑ Plans Submitted ❑ U U W W a a z o w H a z o z W O O �H WW W W W vA z Ud x a' W W a C4 O W H a z W Z �+ oa O z U O 0 H z H U o H z H w w a H O w O 3 A U a U x SUB -BASEM ENT B A S E M ENT 1ST. FLOOR r 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8 T H . F L O O R Name or type) +�� rn i�1 Check o : Certific te_) talling Company U"`tom' Co (7 Address Y'A 6 ❑ Partner. - Ol a-44"t' IMA 0773 ) �usinessTTelephone °��G�'7��Z/-1�y �a��._�-, ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter . ) INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1No❑ If you have checked Les,please mdic to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 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 Co �na 14 f t General Laws. By: nature of Licensed PIM 1 r Or as ' ter Title Plumber City/Town ❑ G Fitter tcense Number Master APPROVED(OFFICE USE ONLY) ❑ Journeyman 6 '3.73 S Date 5z ...... pORTM °�t�``°;• '"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SSACHU`�� .... This certifies that ..................................... .............. :-.:.............................. has permission to perform ...�.. ... ................:................................ { Wiringin the building of........:...................................................................:....... �� / at� ...................... ..�... r.:.�.....A ,North Andover,Mass. 'Pee..................... Lic.No.............. ... !........`................:. .......................... ELECTRICAL INSPECTOR Check # "` � THEC7D1� Ib1VWF.�9fLTHDFr1�9�5`4C ofeoe Use only DEPARTMF.WOFPUBLICS4FErY 373 BOARDOFFIREPR&EWOIV Permit No. J. RxvrATrOnssz�c�lzm Ocettpancy&Fees Checked APPUCATTONFOR PD M]!T TO PEUORMaE=C4L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WrTH THE MASSACHUSS!'S ELECTRICAL CODE,$27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover Date - To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) �� ,� Owner or Tenant Owner's Address__ )ti th Ty1r'lk!Z 'S t- "s this permit in conjunction with a building permit: Yes© No Q (Check Appropriate Box) 'urpose of Building cSt tS A;M t JJ - l,�iG Utility Authorization No. :xisting Service Amps / Vohs ,ew Service —�� Overhead Underground � No of Meters —� Amps / � / D Volts Overhead Ung No.of Mks umber of Feeders and Ampacity nation and Nature of Proposed Electrical Work lo.ofLight ing Outlets Na of Hot Tubs --��� MIX ofTwnsfonner, o:ofLightingFixtures Toga SwimmingPooJ Above Below , . kVA- ,. . ground KVA �.of Receptacle OutletsNo.of Oil Boners Na of Emergency Lighting Battery[huts of Switch Outlets No.of Gas Bunters of Ranges No.of Air Cond. Total FIRE ALARMS Tans No:ofZoEs o of Disposals Na of Heat Tota! TOW d'Detectiunrtnd of DishwashersPumos space Area Heating ranW Na 0fSoi0d*,Devices Na of SdrGontfioe�.`. Df Dryers Heating.Devicea KW D g� ' M Low MuO1C'� Other >f water Heatrs KW No.of No,of Connections Si Bailasis iydio Massage Tubs No.of Motors' Total HP r e Pl�ntbthetetltiteerlal� ��. - n - ��st>hsfa�ategti►aient YM � a Exn9tad�a5dp�oofafsaneblheOlLx YS ®. �}whatedtedoettYES, - *rWPt high _ !ME U L L Bt>�TdNb. 3ONSURANCEWAIVMlama�vmdmttheLxnw4 Lq the' J AEtTdNa 6 _._._.� �urdnoeao�aget� � db�,b�s>seltsGenaaiLaws c�ltSasPeffru��thisn�mu3rter>r. neck one) Owner Agent ,l Telephone No. PERMIT FEE f� ��