Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 509 WAVERLY ROAD 4/30/2018 (2)
6 <1 C) 0 p 00 V 10909 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING '"% �,j P A44 .............. This certifies that ........ ...... ...................................................... 04 has permission to perform ............................................ ��K ...................................... plumbing in t he buildings of ....... \:!�AVV\AA- at ... ..... P—J. .............................. . North Andover, Mass. Fee ... No. M.t\r- ................... ......... .................................... PLUMBING INSPECTOR Check # \-2-7-ox\ 4i � 0\ f6u MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT # JOBSITE ADDRESS kt�P -\ OWNER'S NAME! L4VY y P OWNER ADDRESS TEL M-5— FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: F-1 RENOVATION: El REPLACEMENT: aj� PLANS SUBMITTED: YES NO FIXTURES -1 FLOOR— 8SM 1 2 3 4 5 6 7 8 9 10 ll 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 DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTER10k)-- KITCHEN SINK LAVATORY — — - - - - - - - - - - - ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER L L — . ..... -1 INSURANCE COVERAGE: I 6ave a current !!j�insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YEI* NO " INOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND F - 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 El AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicatio� are6rd and accura the best of my kn and that all plumbing work and installations performed under the permit issued for this application w ben ,,ian it ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. W PLUMBER'S NAME LICENSE # SIGNATURE MID ip F-1 CORPORATION.M#[J�,LPARTNERSHIP LLCF- 4_ COMPANY NAME ADDRESS1.1 Cd y_) STAT TEL CITY[Lin E ZIP 4 V-4 FAXI CELL EMAIL kuo�0' 4i � 0\ f6u a 0 El z ;D LLI 0- w U) w CL LLJ i� ui -ot co W� z CJ 0 CL a. I < 69 U) Lii CIO r,n z �O.VA ............... Date ... ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... I .... G. r--� pe�� ........................... has permission for gas installation ... ................................ inthe buildings of ............ ................................................................. at ........ ............ . North Andover, Mass. ............. Fee ... Lic. No. i'�Vr . .................................................... GASINSPECTOR Check# Q -2 C) ID I S." 7 -,?j 53 �'-z " MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK UT-- CITY MA DATEIJL 'I � JPERMIT# I I JOBSITE ADDRESS OWNER'S NAME1--�;j6-,'m-o6zvn, I OWNER ADDRESS AAJ2, TE FAX �j TYPE OR PRINT OCCUPANCYTYPE COMMERCIALF. EDUCATIONAL RESIDENTIAL[� CLEARLY NEW:L RENOVATION: n— I REPLACEMENT: PLANS SUBMITTED: YESIEJ NO L -9 -- APPLIANCES -1 FLOORS— BSM 1 1 2 3 4 5 6 7 8 9 1 10 11 12 1 14 BOILER — BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER L LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER LINVENTED ROOM HEATER WATER HEATER OTHER1 F— INSURANCE COVERAGE I have a current liability insurance or its substantial equivalent which meets the MGL. Ch. ETNO policy requirements of 142 YES I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF CO E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNiTY L] BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [j AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are tr and accurate to the bWst of my kno ledge and that all plumbing work and installations performed under the permit issued for this application will be in co ance 'th all erti provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE#IU SIGNATURE n6l- 04 MP 0 MGF EJ ip F -j JGF L] I PGI CORPORATION PARTN IP #[j� LLC [:]# COMPANY NAME] Gr�voyl CITY STATE ---1zIP TEL F12T Lqz-- FAXI CELLI JEMAILE �J�rn�M e k t �V�N --- q I -0-ml I XA F-1 0 w IL LU F- cn z (n LLI EL LU cl: w co z 0 0 CL Ln Llj mi uj U - z z z �L\— The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations io� 600 Washington Street Boston, MA 02111 T, www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contr�ctors/F-Iectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:\ Ci `� -CA' ; ;�' Phone #,: '4 1:4 � Are you an employer? Check the appropriate box: I am a employer with _ 4. E] I am a general contractor and I employees (full and/or part-time). have hired the sub -contractors 0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required.] 5. El 3. 1 am a homeowner doing all work myself [No workers' comp. insurance required.] employees and have workers' comp. insurance..* We are a corporati '+ onand its officers have exercised their right of exemption per kIGL C. 152, § 1(4), and we have no employees. [No -workers' insurance ,� t1—\,% tz�) Type of project (required): 6. E] New construction 7. Remodeling 8. Demolition 9. El Building addition 101-1 Electrical repairs or, additions 11. [1 Plumbing repairs or additions 12.7 Roof repairs 13 -El Other *,kny applicant that checks box 4 1 must also fill out the section below showina the I ir workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work anod then hire outside contractors must submit a new affidavit indicating such - Contractors that check this box must attached an addi.tional sheet showina the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have emp] . oyees, they must pr I ovide their workers' comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site in rmation. fo Insurance Company Name: A \'X k V" av_vlc�s �r_)�, Policy 9 or Self -ins. Lic. #:W C E2 Expiration Date: I Q) Job Site Address: City/State/Zip: _pLIVA�&O", Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a firie up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invest 1 gations of the DIA for insurance coverage verification. Ido hereby certify under thepailmandpenalties ofperjury thatthe information provided above is true andeorreet. L-\ --�, � _G_ -3 . '� �-A L-�. Official use only. Do not write in this area, to he completed by cily or town offleiaL City o r Town: Permit[License #, Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. P . lumbing Inspector el 6. Other Contact Person: Phone#: -COMMONWEALTH OF MASSACHUSETTS to);@ �;Ml 1 BOARD OF PLUMBERS AND GASFITTERS, j! ISSUES THE FOLLOWING LICENSE LICENSED AS A MASTER PLUMBER.� LARRY T GEMMA �lwu ,u) I WELLINGTON RD LINCOLN RI 02865-4411 129.79 '05/01/16 - 216782 CONINIONIiVEALTH OF NlASSACHUS;_: �iS L A -5-A N11ASTEL-P-UNRESTRICTED ISS!JES THE ABOVE LICENSE TO E D E R 1 CK J h OX H A 1-1 G E I'l F L U N 1 NG R V I C E S L L i N 1� TO N F. L H C 0 L h R! 02265-4411 3875 05/" 8/1� 16 2 5 2 3' z.COMMONWEALtH OF MAtS'AtHQsETTs -i (a,, '1147 57 IT 89,��D OF PLUMBERS. IND GASF I TTER� ISSUES THE FOLLOWING Ll CENSE .6j: . LICENSEd'AS A JOURNEYMA N PLUMBER v T LARRY T GEMMA 1 WELLINGTON RD LINCOLN Rl 02865 .411 251.42 0-/01/j6 216779 mig;g!_�:R -j 4 �1; F!l list.' 151%1 #_ggjLpwj=:iTj CC\ v Crum) T1, ffm vilf"t-0, mm U."ri el gg, ii 75 L L ,Noarb a' r-,Legi5trat'an of 51jut (Retal !Dcv�cc5 ;Lr)ab;UTg 5atisfieb tfje reqiiireinenb� of 015clicral Vat) Eljap ter 112, :butiwi 237 tbrougf) 25L Ell- 10 3j i5 ijer6o grailteb tfji.- certificate uo. 49C, 15 ctjbcjjrc to prlctice ae� a 3 �O A.A liren5eb "&beet �-Rll etal an tbi.- G" bilp of -lebutiarp 2012 3Sn Te5th"o-IJI f)-caf. i-' berelillto aff'xeb tbc Ital" cl tl)c C-XcclltiL'c Dircctar Of r1g l5onrb /_f 2012 0 ACC?R" CERTIFICATE OF LIABILITY INSURANCE T "D DffM) F61DA41E2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Farmington-Alliant Insurance Services, Inc. 40 Stanford Dr, 2nd F1 Farmington CT 06032 NT CT CNAO, E� Brenda DiBattisto PHONE FAX (A/C. No. Ext:860-269-2157 (AIC, No):860-284-0003 E-MAIL -ADD-REss..bdibattisto@alliant.com INSURER(S) AFFORDING COVERAGE NAIC # 7/112014 INSURER A:American Zurich Insurance Company 40142 EACH OCCURRENCE $1,000,000 INSURED INSURER B:Starr Indemnity & Liabilily Company 38318 INSURERC: GEM Plumbing & Heating Co., Inc GEM Mechanical Services, Inc. 1 Wellington Road INSURER D GEN'L AGGREGATE LIMIT APPLIES PER: F��7 RCO� [7] POLICY I I JPE LOC Lincoln RI 02865 INSURER E INSURER F: AUTOMOBILE COVERAGES CERTIFICATE NUMBER: 526044928 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLISUBRI INSR WVD POLICY NUMBER I (M`MLICY EFF DoffYYY) POLICY EXP (MMIDDNYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I Fv_� I OCCUR GL0654159204 7/112014 7/1/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTeD_ PREMISES (Ea occurrence) $300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: F��7 RCO� [7] POLICY I I JPE LOC PRODUCTS - COMP/OP AGG $2,000,000 $ I A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS — AUTOS BAP654159104 7/1/2014 7/1/2015 MBINE INGLE LIMIT (CEO, .,der,1S $1,000,000 X X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER 'DAMAGE (P.r.,cZ $ $ 6 X UMBRELLA LIAB EXCESS LIAB __ _T_ OCCUR CLAIMS -MADE 1000020187 7/1/2014 7/l/2015 EACH OCCURRENCE s5,000,000 AGGREGATE $5,000,000 DEDTX RETENTION $0 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/M MBER EXCLUDED' (M anclatory i NH) If yes. describe under DESCRIPTION OF OPERATIONS below NIA WC596960003 WC596960004 10/1/2013 10/1/2014 10/1/2014 10/1/2015 X I WC STATU- I JOTH- TORY LIMITS I I ER E.L. EACH ACCIDEN E.L. DISEASE - EA EMPLOYEd $1,000,000 E.L. DISEASE - POLICY LIMIT 1 $1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is included as Additional Insured as respects Liability arising out of operations (work) performed by the Named Insured. The insurance provided shall be primary and any other insurance maintained by the Additional Insured is excess and non-contributory. �"" I lrlll� I � "%JL_Ur_r% 1,/Ar-4t. r- LLA I lU N Town of North Andover 120 Main Street North Andover MA 0 1845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @) 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD z CL iu D > Z 0 oc ; ;*L 4o CA LU W 0 M z U. IM6 0 0 w z o < QQ 2w Pal 41 F 10 4 W M cz 0� to e UJ z N. 4" CE: C Q CC2 CO C.3 cc LL 4,va 0 ico L CF 41t —13 4D CL E.S 44: %�W' . 404k,: 0 CD 00 0 CM E cc 'n cm -!No ca GO w C) cm CLU co 0 cm cm. =c 0 ca CL Cc 0 = Cc Q CC -01 0 C, c 0 06. CcDa go tu , =0 3c: 'o CL�;,c CO3 WON LU go CL= -�s cc C=j 1 0 CO.) Co 0 C.3 cm LU CD!E L3 CD 0 q 06. ca :a CO2 co eg .0 C�a = C3 CD Z - C -L 4 - Cf) z 0 u C/) Cf) 0 .1.1 u 0 40. Izv L�pl E \j cc is z CL x G3 CM COD u 0 cf) �-7 u x 10 w bo C2 CE x bo \ r - 0 E 00 cf) cf) to e UJ z N. 4" CE: C Q CC2 CO C.3 cc LL 4,va 0 ico L CF 41t —13 4D CL E.S 44: %�W' . 404k,: 0 CD 00 0 CM E cc 'n cm -!No ca GO w C) cm CLU co 0 cm cm. =c 0 ca CL Cc 0 = Cc Q CC -01 0 C, c 0 06. CcDa go tu , =0 3c: 'o CL�;,c CO3 WON LU go CL= -�s cc C=j 1 0 CO.) Co 0 C.3 cm LU CD!E L3 CD 0 q 06. ca :a CO2 co eg .0 C�a = C3 CD Z - C -L 4 - Cf) z 0 u C/) Cf) 0 .1.1 u 0 40. Izv L�pl E cc is z CL G3 CM COD C13 co w C co I— = 4--d U) .NNW z1ft m w U) cr w > CM w CL 0 CL (r Cl. CM< w I w cia LL j -0 "FL 0 a) ca Z ts CD 0 CL CL CIO Ck �. + 5' FORM U - LOT RELEj;�3E 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*****-****************** APPLICANT r,,,S5L1 A PHONE LOCATION: Assessor's Map Number PARCEL Rk- SUBDIVISION19'10 2 6"flqve-7Z(� f `9 LOT (S) STREET f? 0 ST. NUMBER ,F USE I � RECOMMENDATIONS OF TOWN AGENTS: I rCONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED— COMMENTS— TO ,MPLANNER COMMENTS FOOD INSPECTOR -HEALTH S F_ W 'j- Iz SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATEAPPROVED DATE REJECTED - DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS 11 DRIVEWAY PERMIT FIRE DEPARTMENT I U60 N a LT1 _: I WZY& lyl 14 0 1 V, I Les i M13 2: 0 & to] Revised 9\97 jm 9/19 A �- T E 0-2y-03 TOWN OFNOR11-1. ANDOVER Office of the Building Department Coil] III unity Development and Services 27 Charles Street North Andover, Masslachusefts 01845 11 Robert -N]"Celta, Railding COMM) SV I 01hY April 4,2003 Russell Ahem DBA RFACO, LLC 103 Atlantic Ave. Seabrook, N.H. 03874 Dear Mr. Ahern: F/0%7 Please be advised that the 4 building permit applications for new homes on Waverly Rd. and Hawthorne St. in the Town of North Andover have been rejected for the following reasons: 1) Incomplete information 2) Driveways and parking areas not shown on plot plans 3) No surveyor stamp on plot plan 4) License copy unclear 5) Masscheck energy compliance report incomplete 6) Application for building permit incomplete 7) Plans not acceptable 8) Blue growth management form not complete 9) Plot plans do not show proposed decks Please be advised that only 2 of the 4 lots will be able to be approved upon receipt of completed and signed off paperwork as the other lots are on street fight of ways or do not have the required width. Respectfully, Michael McGuire Local Building Inspector Cc files PLOT PLAN PROPOSED LOT CONSTRUCTl'bN___ FOR ZONE DISTRICT,,.R-4: �2.' EACH`UNrT`l'S':W3 'STORY3-""8EDRE)OM FOURN-IER�',' 3. SEE ASSESSORS MAP #22 LOT#1 FOR SITE IRENE HERBERT SEE DEED BOOKo727 PAGE 397 FOR SITE. 0 20 40 80 SCALE: 1 40' DATE: FEBRUARY 11, 2003 MERRIMACK ENGINEERING SERMCES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUELDE"4G DEPARTMENT This ibrin shall be used to assist die Building Department in their determination of exemption under sectloll ,�� 7.6 ofthe Town of North Andover Growth Management Bylaw. The applicant shall provide all of the iiccessary irlforination as reqUested below. PerilliL Applicant -S j Property address Map / Parcel OY".5, .:%6jDPl1Ca11l'S Phone Number Single Family T�vo Fan�ly I ilic undersigned applicant for tlie above property attest that the attached buildingpermit for which this forin is completed d0CS t:onip I y with die EXEI'vl-PTION secti on 8.7.6 of the Growth Management Bylaw. I also understand providingihis forni does not .jb.�,)Jvc Inc or :iny party to this perinit fiorn the requiremems of obtaining otherpermiLs required priorto ilie issuance ufthe building p,:rimL. ftirdicr I und a stand di at in), uitcrprLtation ofthe exempt ion status is subject to review by the Bui I ding Dep a ru I I ell L an d is of I I y oNiciAly accj)ted %Yfien the building-ptainit. is issued. ;':,scd oil se ction 8.7.6 ofthe NorUi /�jidovcr Growth Bylaw the above lot and the work as applied for on die above lot, ul the bu I ld�ig P,:nnit appliwtion and associated attachinents, complies with one or more ofthe following sections as indicated by a check mark. This is all application for a building perm�it for the enlargement, restoration or reconstruction ofa dwelling in exiswrice as 0i'dic cifeclive date ofthis bylaw, provided that no additional residential unit is creaLcd. '11]e 101(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of die Zoning Bylaw. --- 'I'his application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of� 7 6 are nict and or represents dwelling units for senior residents, where occupancy ofthe units is restricted to senior citizens dirOLIJ) a prope:rly exLcuied and recorded deed restiriction running with the land. For purposes of this section "senior" shall inean, pcisons over die ag,� of55. -- . 11iis application is pan of a development project which voluntaffly agreed to a minimum 40 % permanent reduction in dcjislty (buildable lots) below the density per-n-Litted under zoning and feasible given the environmental conditions ofthe tract, with dic St:!-j)lUS land CLIual LU at least (Ln buildable acres and permanently designated as open space or fanTiland. The land to be preserved shall (j�: pr(ACLIed from development by all Agricultural Preservation Ret;�aion, Conservation Restriction, dedication to the Town, or other :;imilar mechanism approved by the planning board that will ensure its protection. '1111S application represents a tract of land existing and not held by a Developer in common ownership with art adjacent p:'Iccl Oil UIL: effectLvc (late Ufalis Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and !)L:veloprncnL Scheduling provisions Ior die purpose ofconstructing one single family dwelling unit on the parcel. 'Ibis appliwLion represcias a lot which is ready for a buildingpennit ( all other permits froin all other boards and ,:o(iiinissions hav�- been received and the project is in compliance with those permits), and the Developawrit Schedule does not .1,:colimiodaLe lssuin�o a building pernut in that year. One building permit will be issued per year per DeveloprilenE until such t "lle as 111� dC% C[UPHICTIL SChedl.11e aCcOMnI0daLc:; issuing building pennits. Applicant must submit an approved FORIM U with this PTION. -kSf' PROVIDE ANY �UND ALL INFOR&IATION THAT WOULD ASSIST THE BUILDING DEPARTIMENT IN Mi'KING A IT"R.-MINIATION THAT THIS /�J'PLJCATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE FXEMPTIONS. BY SIG. -MNG BELOW I A'I-rLSTTOTHE ACCURACY OFTHF INFORMATION PROVIDED AND THAT THE AYFACHED BUILDING PEIZ-�AIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHE R I UNDERsTAND THAT THE SUBMITTAL OF . NUSLEADING OR INACCURATE INFORMATION OR THE IL . CKING OFF -O.. A-133OVE i1vlPTION W'HICH DOES NOT COMPLY, WHETHER DONE TO MY KNOW-LEDGE OR ' 0 / - N%'l BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. L , .."'I'l"LICANTS SIGNATURE DATE 1.14! ! :.,S!--OR.'1v1 TO BE ATTACIED TO Tl -IE BUILDING PERMIT APPLICATION BOARD�O'F BUILDING PErULATIONS VISOR !�qNSTRUCTION SUPER 029UO 7 IWO .1 Tr. no; 16559 Fk(U$$ELL F AHEkN ASIDE A* 021 RIVF - . . HAVERHILL, MA 0163� it FAGE 01 Name* /,--F (,Iq //Z—V �� S- e t /_, -T- 6--A?V-P-e /� city /U4,) Phone # EJI am a homeowner performing all work myself. 71 1 am a sole proprietor and have no one working in any capacity IZII am an employer providing workers' compensation for my employees working on this job. Company name- (DfZ4^IC-f, 57 - Address q -7 Citv: 0 Phone 7 InsuranceCo. C/V4 Poligy# Company name: Address Ci!y: Phone #: insurance Co. Poligy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties af,a fine up to $1,500.00 and/or one years' impdsonment.as.wefl.as.ci.v.ii.penatties jnlboformcfa-STOP.W.ORK.ORD.ER.and-a fine.of..(.$ID.O.00.)-aday.against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification. / do hereby certify under Si information provided above is true and coffect. - —_�/ — — 2,!50 Print name /IZ t�/ eff /- AA Phone.# -'9 7k Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina E] Building Dept FlCheck if immediate response is required Licensing Board Ei Selectman's Office Contact person: Phone [] Health Department E3 Other NOTICE OF ASSIGNMENT COMBO LD. F-WILOYER: oRP.NGE STREET DEVELOPMENT INC 000267563 1501 MAIN ST TF.WKSBOWY, KA 018716 COVERAGE GROUP 0267563 T.n . e t,.jaiver of our Right to Recover erorn Othexs Sndcrsenent is available OR POo-'L Policies, Contact you,, ager,t for details. AGENT Fr.,ED C CN1JFC1j. INC op ONE MERRIMACK FL PRODUCER: LOWELL, t/,A 0 18 5 2 AGENCY FEIN: 0 42 4 4 5 2 92 IC0 �CN STATUS OF EMPLOYER Co.yporation Coverage under thiS aqsignmen�- applies to massachusetts -ions only. For coverage opera, .11 outside of j4assac:husetCSj Contact the appropriate 2001 Or plan for that state. INSURANCE COMPANY' CONTINENTAL CASUALTY CO MS. TINA SMITH p 0 Box 4965 op.LMDO, FL 32802-4965 (BOO) 842-9482 I- — ESTTMATED ,:EM ESTIMATED PREMIUM CODE TOTAL XWJAII-1 REMUNERATION -------------- ---------- ------------ CONTRACTOR-EXECUTIVE 56.06 CATZPENTR'Y -140C 54 0 3 9845 Zv, .,OYERS T-IAB:LITY 100/100'500 STANDARD PREM1'.Vi 0900 CONSTANT EST-rMATEC. ANNUAL PPEMIUME Di�,ASSESS- 4.5% OF ST.MDARD PREM. F,S?. ANN�UAL. PRE -14. PLUS ASSF.SSMENT INSTALLMENT BASIS. Ailinua $62,800 2.65 $28,000 16,60 $4,648 $6,312 $244 r3 , E, 5 6 $284 $6, 84Q, REOUIFIED OF -POSIT PREMIUM $6, 840 commENTS Coverage effective 12;01 XK or. 01/151,03 rn Copie's of- the ijjsuret:�,s four most recently filed Form 941S or DET For, is did not acc=PanY t'.je applicacion as required in Part VI 0! the application. Please forward these inm - listed above. _ed.iately to the inz,�rance company PREPAREDBY! Joanne Shea VATEOFNOTICE: 01/7,5/03 EXT 530 i 0 * VOWNTARY DT.RZCT ASSIGNKZNT * * LETTERID! . 365757 COPY: EMPLOYER The Workers' Compensation Rating and Inspection Bureau of Massachusetts 161 Arch Street - Boston, MA 02110 (617)439-9030 - FAX (617)439-6065 - www.wcribma.org 04/15/1996 00:11 111111111105 MASchpck COMPL'AANCE REPORT Massechusetts Energy code Wcheck Software V4r,4ion 2.01 Release 3 CT.TY: North Andover S'.T'ATS: Massachusetts HOD; 6322 CONSTRUCTION TYPE: I or 2'Family, Detached HEATING SYSTEM TYPE: other (Non -Electric Resistance) DATE: 10-17-2002 C014PLIANCE: Passes PAGE 02 Permit 0 che�_k_edby/bate I Maximum UA- 334 Your Home - 259 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U-Vblue UA ------------------------------- --------------------------------------------------- CEILINGS 480 30.0 0.0 17 WALLS., Wood Frarne,.A.'6" O.C. 1844 13.0 0.0 151 GLAZING: Windows or N -=s 136 0.370 50 DOORS 30 0.270 8 DOORS 19 0.350 7 FLooRs: ove., (inconditioned Space 560 19.0 0.0 26 HVAC EQUIPIJSNT: Furrace,.. 90.0 AFUE ------------------------------------------ COMPLIANCE.STATEMENT: The I propooed.building .7 design described here is consistent with tihe buiiding plans, specifications, and other calculations subrratted with ,-he permit application. The proposed building has been designed to ineet the reqoirements of the Massachusetts Epergy Code. The heating load for �his building, and the cooling load if appropriate, has been determined u3ijDg 6Q applicable Standard Design Conditions found in the.Code.. The RVAQ equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in S$CtiQn3 780CMR 1�10 and J4,4.. Builder/Designer Date TOW -N OF -.,NORTH ANDOVER BUILDING DEPAR'rwNf 1.).4 TQ 71. M DAM ILE of 4u)l WAV J.2 AsambarOw" WO rwvw 6 BL7EL-DLSG 51TOA Yaw yard —77 D6p" 4—wo > C�. AGINT m TY 0'-VKLRS"!AU:�Ii0kLZ3LD 0- v rx ix Swvwv 2771 (7 E.I#nimdx DOW j6jwzo �—ow u I m E"nom D4W 0 z m C) _ P, wpaaA_I�f Bstia� ToW C" of �,jvuw of _ r bf Location 15 No. Onlate TOWN OF NORTH ANDOVER A�Qwwdk Certificate of Occupancy $ Building/Frame Permit Fee $ A s S C14US*' Foundation Permit Fee $ Fee $ Sewer Connection Fee $ Water Connection Fee s TOTAL $ doe nspe r N2 9912 Div. P i orks 1856 -Z- APPLICATION FOR?EWER SERVICE CONNECTION'5 North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street or subdivision lot no. 4htei-q Owner Address e Contractor Addr Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to L-1 �25!t� 25M �Z to make a connection with the sewer main at vl_- IAJ ICIAF Street subject to the rules and regulations of the Division of Public Works.. ivisio/ of blic Works 11z— At Inspected by By - �/ �/ -- - :Zaoz Date See back for rules and regulations Vrc-e-!5 �5f---ee� �QOF�Jr loel->I�r 7, RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner 'shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, OT driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construct.ion of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. in all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to_the (town). 1216 'Z1 APPLICATION FORTATER SERVICE CONNECTION�� North Andover, Mass. Application by the undersigned is hereby made to connect with the town water main in re V e subject to the rules and regulations of the Division of Public Works. Street, The premises are known as No or subdivision lot no. Owner Contractor //Address Addres Aldplicant's Signature' Y— (JAY PERMIT TO CONNECT % The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date WATER Street Street Poard of Pub4 Works By See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1 " type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be, installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug type cover. J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 US i DRIVEWAY PERMIT DATE LOCATION BUILDER phone OWNER Allen, phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR, APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Teiephone (978) 685-095C. Fax (978) 688-9573 A t?r 1� L CA tjr L,- S/4WA-ruP-E TOWN OF NORT11 ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 7-ele-Pho,ne (9 78) 08 5-0-950 0 78") 6X,�-95 1-3 June 1, 1999 FORM U & DRIVEWAY APPLICATIONS PROPOSED DRIVEWAY PLAN - a plan which is required to show the dimensions ofthe lot, the location of the proposed driveway and the building(s) it services, the type of street pavement, type of existing sidewalk, type of curbing, location of any permanent structures within ten (10) feet of the driveway such as utility poles, hydrants, catch basins, stone bounds, etc. The plan shall be submitted to the: tngin�ering Department for review. If the plan is approved then a driveway permit can be.issued.(See Sketch:Plan Attached) CREATION OF A CURB CUT. - If there is existing curbing -where the new driveway is to be located, then it m ust,be removed to.create the proper rarnp from. thegutter. The - new,drivewayshalltot prottudd! into -the gutter. In any instance the new curb cut shall not allow surface' -water to enter: the propdrty-(See Sketch B)� EXISTING SIDEWALK SURFACES - If there is an existing curbing. and / or sidewalk the new driveway shall match the existing material and shall be a minimum of 4 "� thick. The contractor' shall provide a detail showing the thckness of material, number of layers, reinforcement and sxib-bas�. DIG SAFE NUMBER - The applicant shall and have a valid Dig Safe number CONTRACTOR - The Contractor doing the work shall have all insurances required and be in good standing with the Town. DRIVEWAY PERMIT - The permit shall be good for thirty (30) days and may not be transferred without prior written approval by the Town of North Andover. INSPECTIONS - The Contractor MUST notify the Town 24 hours prior to commencing construction. The cc)mpleted work must be inspected and signed off by the Town, within 48 hours of completion. C:-WORDDRIWWAYSTORM U & DRIVFWAY APPLICATIONS TYPICAL QFWEWAY N.T.S. NOTE: 1.) ALL DRIVEW0 APRONS TO BE PAVED WITH 3' 8TWMOUS CONCRETE. 2 ) DRIVEWAYS SHALL NOT BE INSTALLED IN LOCATIONS YmERE STONE BOUNDS ARE PROPOWO. I ol m Q) ts) 2117 lu QY 00 CN m Q) ts) 2117 lu I O,Z .9's .9's .9's O,f 119't 10,9 .9,q 71 X, a' q,t X.Ou LA 7,- 9c 9t � I c 1 -1 1 1 1 . . I I 9 & - - - I — — in cl cl n + In 0 . -cc) D J In 49,G -Id oo LAX �A., X b .0,9 At r_: ook 1.9,c co .71 — IQ 7 .9 Ulf Ox 00 L I I IF, m I vi v -4-3 Q) S -- CID CS) LIA -C s 6 J10) 3 u E D CL .q Mb -� fn Qj E wo ms t: lu c CL u � D .5 > 13 lu po m -r- CL -0 Q) CLI r ro C) > > 0 QJ -r_ - 0 cl -oc .&. - 10 2 Q) U-6 LL 0 C: CL CL S Qj 0 M - a- -Q P.- -0 m a ja Qj () t - 'r_ w r 2 M EL c'), r —u 0 u jt�) u 2 u q) .6 r U u rx U- -0 0 a CL q) 0 QJ J) -0 18) ul 0 :3 . Oj C) C4 Q EL -61 co Z -I-- q) Q S M -02 1? 1:15 ft_C r..g cc 'n mv 0 D -O 0 q) QJ x > E LL 'o JD Ll 12 LL P- X ju f CL EL Q x X CIO J) 0 x x :3 dl C3 ca LU UJ D 9) LY -4 U- -A IL C14 (L a G Q 10- CE LL iT Qj E wo ms t: lu c CL u � D .5 > 13 lu po m -r- CL -0 Q) CLI r ro C) > > 0 QJ -r_ - 0 cl -oc .&. - 10 2 Q) U-6 LL 0 C: CL CL S Qj 0 M - a- -Q P.- -0 m a ja Qj () t - 'r_ w r 2 M EL c'), r —u 0 u jt�) u 2 u q) .6 r U u rx U- -0 0 a CL q) 0 QJ J) -0 18) ul 0 :3 . Oj C) C4 Q EL -61 co Z -I-- q) Q S M -02 1? 1:15 ft_C r..g cc 'n mv 0 D -O 0 q) QJ x > E LL _0 '-p Qj 7t! P-13 ul CL u A In zn .!3 CL CL IA) 'o JD Ll 12 LL P- ju f CL EL x X CIO J) 0 x x :3 _0 '-p Qj 7t! P-13 ul CL u A In zn .!3 CL CL IA) 7�5: u X D q) 10 c 3 10 'D c A's 4) Ln 10 0 'o Ll 12 P- ju f CL Ln J) 0 7�5: u X D q) 10 c 3 10 'D c A's 4) Ln 10 0 M tj I M ka TZ 43 q), Co x S CU FL Ira rn ca ca co 0 > q) 22 43 q), Co x S CU 91 ja x N 40 C a La W'D C'u () .4u do M q) sp- 0 Ln 0 F— mc—Q -C To— —i3l I - 51 Q) ti 0 t 6 2, q) -13 -u G Z -13 CL ja Q) v lul x S. 0 , C sl -g > Ul 1 SP � u Its) r, 3p- > J? c o E 0 -2, > X --- 0- C) S -6 E W -Q'2 r. 1! 4: too ou O'd 0 0 fu jAlla IV Q x xe ,,3 o u 0 -u o Q.Zm U 0 to a 0 ID CL q):g EL SP _j [4 > > ci 'an S to C c Q) 4u -2 > nA - IL LLI vr� V FL 91 ja x N 40 C a La W'D C'u () .4u do M q) sp- 0 Ln 0 F— mc—Q -C To— —i3l I - 51 Q) ti 0 t 6 2, q) -13 -u G Z -13 CL ja Q) v lul x S. 0 , C sl -g > Ul 1 SP � u Its) r, 3p- > J? c o E 0 -2, > X --- 0- C) S -6 E W -Q'2 r. 1! 4: too ou O'd 0 0 fu jAlla IV Q x xe ,,3 o u 0 -u o Q.Zm U 0 to a 0 ID CL q):g EL SP _j [4 > > ci 'an S to C c Q) 4u -2 > nA - IL LLI vr� V I I I L . � j 4; 22 (L L a- L C4 I: Q� E3 12 LL OL4- LL LL —Z#i 4 LLI CN I I I L . � j 4; tu uol� LL vp Q1 E 0 X E 43 C4 JD- CL -t j) CL lu IL m D� l LO iL- 0 J) u 0 Q-5 OBUIU, "do q$noi firfluoop MOPL4m jo dol 1.01.9 CU A& LU x -u 2 b -x 0 0 .16. x X C4 - - -<i:Cl41h 0 — " jil — s: U-Q -Q -p ;a OBUIU, "do q$noi firfluoop MOPL4m jo dol 1.01.9 A& LU -u -Q -p ;a An 0 4 C) x LIOLr:,i,) c-4 ca ca cl r;o) C4 LL r4 LL LL ct) U= IL ip '- 'Ul— I L (PM9 .99) CA 19-,L (pnig 99) ZA 19-X U c IL W 0 0 7� ;3 1 c c U 19 J) - .0 1 L .5 .. .2 co -ro A q) CL 2" W -0 CL r PL LU ND U - s; m 0 00 B, 13 CL -u CU 'o e L- U 'U 'U ") 9 �q cu CL qj QJ Q) a 10 (3 (:) L) E q) a a Q s. "6 Q.) 76 13 a -u -u Z) u Q Q 0 Ql) I �j Q) 10 Q) ;3 'r Q-) m q) N 2 q) co .0 ?a '6 QL- - - N b .9 2)5 (D U- — - q) - M= u 'u 83 -0 a 0i LU a cu ! a — 43 - C Iz V Q) U CL q) :3 Q) -19 .2 (j 75 Q) (Z r c LL a m r CO z Q) I- E c G 2, t= 6 J) C,; C(i -s S. t: u u S; LLI 12 IL Q) A q) LU --I Q) -'T q) u Q.) -14 u -C a M z Z .9 r, -�, Z A - 0 LL Q) c N 0 , G c , -4-3 > E) Q) SD 1) Q u > 'i I c u N = < sj J-- < O� 3 1 e i u q) LL qu 'D M q) -A a u �.D C� -0 r1i f r 19 (j u IQ op LLI C) lu 91 �s 76 C14 C-4 < z a lu r- m V y a ru Q J� Z -C CU Q) (S) u E To a < \z w q) Q) Ln CL > Lu G) OL rl G t -2 12 a'- ::3 a :3 IQ .6 CP U u - 10 -C (j 'o a x � 0) ; J; -. u -u a -C x x x x x J, - lu 'U C) CL C4 C4 o ts) . . . I I z -u z -C U a CA u q) U a 2 a u Q -a cu j G :7) 4a) ro -C G -0 a m 4 vi Q -13 -T-0 V a = 12 ,) R 76 o 0 On, a :71 A2 13 N 12 M 'o u u 2 0 u G 0 -a 0 V u D 6 U cu G 9 u -n u rs > - a a .4- = -u a r :n G 12 a a rS u r. c� _q 'r CL :3 q) r- Z - Q) m x Qj r-,, In 0.) -u u '6 > u u -C lu 12 fo Q.) o -6 x! -9 Q) UQ a Q) x .0 - - x r. 41 > CL 43 v u pal '6 ttj) z L- in C) rL -C q) - -u q) u 13 0 q) -" 0 2 'D U r. -�3 Q) \,D 'o Ln if UJ U ,Q > Cc\ -92 m CQ 2 S -S� A� LU 10 1 Ai LE - vu c 6 L- Q) E) r7 :3 — , Ln 1"': � 4-3 00 1"': � I LU (UILU) U01 OL Ln LU 41 Nt m CL to OL W.., CL 4) CN4 X E C14 A IL x D G� rJ x r4 CL x 0 (L cc) Oa?yA 'p 0 a X U- 4 *4 V4, 4. gBulugdo qDnoi Rpffuoop MOPLP jo dol IL 0. L r--(Pmg ZA lg-,L (pnig ge) 270 ca LL go FL (q LL - ti IL 0. L r--(Pmg ZA lg-,L (pnig ge) (D Q) -C- Q LLI \ S) 6 Q U4 cl) C13 ::3 si LLI 7s Ul —j a g -o _Q 0- n CL -u -,g I _j Q CL LL < J) Q) CL tc) q) C(l CL LL C 6 -u C13 0 IZ t c) —"' (D Q) -C- Q LLI \ S) 6 Q U4 cl) C13 ::3 si -u 'U (S) i C-4 go _Q r M :3 -%t U- SO 62 Qj EL -u CL Qj E fj) DI LLI V- Ul —j a g -o _Q 0- n CL -u I _j C) Lij LL < J) q) C(l CL LL ,.S) a L c� U > -j < u 'a -.,r -,z -�z -u 8.9 u -u -b q) -u .9 u cu C, 7E .6 x x x x X -.a Q 'ro- r. -C C'41 r#4 -u 'U (S) i C-4 go _Q r M :3 -%t U- SO 62 Qj EL -u CL Qj E fj) DI -C q r= Q) -C q) V Q > 0 qu 0 W W C) rX L14 E 2s 0 rx co z -C 9) S; � �S o 1) -U q t= lo 2 u- u -a go q) r= r .Q q) Q) r M'Q x Qj 9L Q q) q) ') e 2 x A 0,6 5 Nu -D Q) q) ri S. d 2 9 9 (s) 6 0 Qj CL rL a t) C— U ::3 �g fl -,3 o U -S ca CL J. q) :d .2 -9 4) a 0 —, =! 9 V CL x >( a -Q > Q) L- cn Ca Q) -u q) U) uj -1 u -S ul cq x M :5 'D .2 — —. .0 ul S "4 Z- LLI _Q 0- n CL -u sp q) C(l .0 u 'a LU u E -u 8.9 u -u -b q) -u .9 u cu C, 7E .6 0 < '7 7�i -.a Q 'ro- r. -C .0 -u 0 m Q) u U) 0 < 12 Vo In 0 -u — u 6 u Mu > -C q r= Q) -C q) V Q > 0 qu 0 W W C) rX L14 E 2s 0 rx co z -C 9) S; � �S o 1) -U q t= lo 2 u- u -a go q) r= r .Q q) Q) r M'Q x Qj 9L Q q) q) ') e 2 x A 0,6 5 Nu -D Q) q) ri S. d 2 9 9 (s) 6 0 Qj CL rL a t) C— U ::3 �g fl -,3 o U -S ca CL J. q) :d .2 -9 4) a 0 —, =! 9 V CL x >( a -Q > Q) L- cn Ca Q) -u q) U) uj -1 u -S ul cq x M :5 'D .2 — —. .0 ul S "4 Z- LLI O.Z All .9's '9's O'c 'O'g .911 IS. X 'a'g 7n 9X>' co 11-7 P-9 Qj 17� 191C -C I AL 49,Q L 0 0 -.,t .0,9 .0 9-C .9,c CQ Ci .9,c H d Cl% AL 0 L - P[ - -- (a) cq m I 0 I N (S) Q) C 0 (13 LLI I FA 7:5 u Q 7s 3 u co 76 q) V-4 CL q3 rz u 'U c E, u Cc) q P J) cu or - CL po -Q 76 S 0 u lu In s PL ,� () LL c M -Z m m q) U LL u .0 "0 u u 2 LL cq cf) CL qj 0 (L q) -u CL q) q) q) fn q) 2 q) CL -r- -C r In VL § v x cu q) > CL a '30 0,2 0 0 CL Fes q) C 90 L- U - ,u IP u LP -0 -4— ZI CL .0 CL iZ4 CL Co 0 Q) rA) cl x w j Ln Uj LU U- lu -A eq C4 < C) x x X 15 C'4 LL :z rz u 'U c E, u Cc) q P J) cu or - CL po -Q 76 S 0 u lu In s PL ,� () LL c M -Z m m q) U LL u .0 "0 u u 2 LL cq cf) CL qj 0 (L q) -u CL q) q) q) fn q) 2 q) CL -r- -C r In VL § v x cu q) > CL a '30 0,2 0 0 CL Fes q) C 90 L- U - -C -..r ag jo 13 -c a U qj u -C rj q) CU q) ,u IP u -0 -4— ZI CL .0 CL U CL Co 0 Q) rA) cl x w j -C -..r ag jo 13 -c a U qj u -C rj q) CU q) u V o Ln !2l .2 LA o ,u IP u -0 -4— ZI CL .0 CL U CL 0 rA) u V o Ln !2l .2 LA o Q z O �p O _O �� x .D r V � N V E V E Q v. . i , I . -, q LL M X. U x 1711 sz_- S) LLI A_ - u M I u I k I C 12 N Lz Q W ci I x V4 I S 197 17 0 Ty'D Q _cn go 4 po ca -0 U N 13 -0 o o v CL 3 X 4) LO -2.q) SPj -0 ca E U- 0,-S '0 o .2 I L ru- > .1 fi a � 2 > X S, ,Ou x Wa �. I I p � 's V 0 U 2 -Q3 > 1-- 1.3 Jd > Ul w In CL Q) tu) F 13 > la 0 _0 r 6e Ox o u QU 9 2 0 kn r Mt , r E ;: u f,) a U--Ql � � & a 'UU q) OU u Q) o t 4) x ro LL -0:9 q) ul too -q iL AI -C :98 'D g Z-2 0 Q n a 2 L-A u 9 Ci PA7 > ku 41) CL 0 LL 4 LL cli Ul FL a - 17 0 Ty'D Q _cn go 4 po ca -0 U N 13 -0 o o v CL 3 X 4) LO -2.q) SPj -0 ca E U- 0,-S '0 o .2 I L ru- > .1 fi a � 2 > X S, ,Ou x Wa �. I I p � 's V 0 U 2 -Q3 > 1-- 1.3 Jd > Ul w In CL Q) tu) F 13 > la 0 _0 r 6e Ox o u QU 9 2 0 kn r Mt , r E ;: u f,) a U--Ql � � & a 'UU q) OU u Q) o t 4) x ro LL -0:9 q) ul too -q iL AI -C :98 'D g Z-2 0 Q n a 2 L-A u 9 Ci PA7 > ku 41) CL 0 LL 4 LL cli Ul LL w 17 0 Ty'D Q _cn go 4 po ca -0 U N 13 -0 o o v CL 3 X 4) LO -2.q) SPj -0 ca E U- 0,-S '0 o .2 I L ru- > .1 fi a � 2 > X S, ,Ou x Wa �. I I p � 's V 0 U 2 -Q3 > 1-- 1.3 Jd > Ul w In CL Q) tu) F 13 > la 0 _0 r 6e Ox o u QU 9 2 0 kn r Mt , r E ;: u f,) a U--Ql � � & a 'UU q) OU u Q) o t 4) x ro LL -0:9 q) ul too -q iL AI -C :98 'D g Z-2 0 Q n a 2 L-A u 9 Ci PA7 > ku 41) CL 0 LL 4 LL cli Ul 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. *************************APP LI CANT FILLS OUT THIS SECTION Y APPLICANT e- /'7 PHONE LOCATION: Assessor's Map Number PARCEL 1-.e, 7- -y SUBDIVISIONA_�So&_f fZIQ LOT (S) STREET_/�,--S ST. NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS (0 T LANiTEER COMMENTS FOOD INSPECTOR -HEALTH S2- W , �_ (-.*, ,-, — . SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED - &&J /, , r &, DATEAPPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT J1,2 - �/ P/,/ d - ? RECEIVED BY BUILDING INSPECTOR Cyn=SzMwML_ DATE 9\97 jm '11CUMM I CU 2- - -,> / - o,3 TOWN OF' NORTI-1 AN I)OVER Office ofthe Building Department Conimunity Development and ser6ces 7 Charles Street North Altdover, Abssachtx�efts ('11845 D. Roberl -.Ni.cctt,,i, "llildin" Commissioner April 4,2003 Russell Ahern DBA RFACO, LLC 103 Atlantic Ave. Seabrook, N.H. 03874 Dear Mr. Ahern. - PON , F C 1 ,,, I " 11 (" � 1 c ( 1.) 7/ ""'.) C, S 8 - 91 FAX (978 Please be advised that the 4 building permit applications for new homes on Waverly Rd. and Hawthorne St. in the Town of North Andover have been rejected for the following reasons.. 1) Incomplete information 2) Driveways and parking areas not shown on plot plans 3) No surveyor stamp on plot plan 4) License copy unclear 5) Masscheck energy compliance report incomplete 6) Application for building permit incomplete 7) Plans not acceptable 8) Blue growth management form not complete 9) Plot plans do not show proposed decks Please be advised that only 2 of the 4 lots will be able to be approved upon receipt of completed and signed off paperwork as the other lots are on street fight of ways or do not have the required width. Respectfully, Michael McGuire Local Building Inspector Cc files P4144 A .86 14C Sp 4 4 M/ __.. NOTES 1 ZONE DISTRICT R-4 2. EACH UNIT IS A 3 STORY 3 BEDROOM UNIT 3. SEE ASSESSORS MAP #22 LOT#1 FOR SITE. SEE DEED BOOK 727 PAGE 397 FOR SITE. 00-0�' --PLOT PLAN PR-OPOSED-- LOT CON STRUCTI07N*o� WA,�r FOR "OAD ARTHUR L. FOURNIER 0 IL IRENE HERBERT SCALE: 1 40' DATE: FEBRUARY 11, 2003 MERRIMACK ENGINEERING SER\ACES 66 PARK STREET ANDOVER,. MASSACHUSETTS _01 810 0 --m 80 U1 0 WTH NLANAGENIENT BYLAW EXEMPTION STATENIEN T TOWN OF NORTH ANDOVERBUELDRSIG DEPARTMENT HS lbrin shall L.,- Used to assist die Bw1ding Department in their determinabon of exemption Linder section o oi die Town ol'Nof I -h Ajidover Growth Management Bylaw. The apphcanj shall provide a] I of tile inforirialioji Lis i-eqUested below. /-w 7- �/ ApplIC11111, Property address Map Parcel Pilk�,111 I i's P11011c Nuillb�r Single Farridly T�vo Family .[I'll: uJl1J1rslg))cd JPPI-111 for die above property attest Ujiff, the atuched buildifigpermit for whidi this *I'orrrl is culllpl�lccj ';ompl.v w I Ulu I C EXE. 'N't-j"j, ION sea ion 8.7.6 ofthe Growth Man a gernent By law. I a I so understand pro vidilig Lh ' s itinii does lot [1:1 Or "ll� paly Io this pci-inji fi-001 die requirements of obLaining OffierpeirmiLs required prior to UIC iSSLI:uice ofille buildijl'g Ulld�XSLJfld dial 111), ulLelPf`l,.taLi0fl 0i'dic exemption status is subject to review by die Suild�ig DeparunCilL aiid is unly li-i Ui� building pcnnit. is issued. �j ls- �w scLijon S.7.6 oftlie North A-111-10-2ir Growth Bylaw die above lot and die work as applied for off die above lot. a, die bu Idif)g �:[)PhVakjil �ujd associated Ju3chillaits, complies with one or more ofthe following sections as indicated by a Qfieck, marki. Illis is :111 3PPlicLltioll I'or a building pern�t for the enlargerintrit, restoration or reconstruction of a dwelling in ef,�sLLjlce Lis �11', �11C'Al jale oft.1-iis byljw, provided Uiat no additional residential unit is created. '!Ile joi(s) wa, .. ........ ..... — s / wLrc (_TCULed prior to May 6, 1996 wid are exempt from tile provisions ol,seaion 8.7 ofthe Zolling Bylaw. _____ 'I ills ipplicatitin is i , or dwelling units for low and or moderate income families or individual I s, where all of the conditions 6 -a and or %preSCIILS dwelling units for senior residents, whereoccupancy ofthe units is rearicted to senior citizens cxL-cuted and recorded deed restriction rurulingwiLh the land. For purposes ofthis secfjon "senior" shall ineaa, �;� u I * 5 5. *1111� jppl lcjt'o" is Pa" o['a development project which voluntarily agreed to a minimum 40 % Permanent reduction in (um I c-libIc I ots) be]()%%' die density pemtiLted under Zoning and feasible given the environmental con dit ions of the tract, Nvid, Ule i"Ild CLIUJI to Lit le-aSt. (Lit buildable acres and PLTmunently designated as open sPuce or tfinlrdand. TIle land to be preserved sliall fr011, developmeTa by all Agricultural Preservation RestricLion, Conservation lZesUiction, dedication to tile Town, or other 1-:11j" 'sit) approved by die pJanning board UlaL will ensure its protection. -------- - !�I's �Ippj lull rLI)rcscias :1 Lraa 0i'land eXisLing and not lield by a Developer ul coninion QW11ership with all idjaCLIll. -N ;:I 'J:A� uf'Ljllj� S,:Ljjo[l �.7 and shall receive a onetime exemption front the Planned Growdi IULe uld !Of dic purpose of'ConfiLructing one single farriily dwelling unit on Uie parcel. rpr,:s�its a lot Mlich is ready for a building permit ( all odier perrytiLs froll, 11 od)er boards aiid niv,: ti�cm icec:ived and Uie project is Lit compliance with LhoseperrnwiLs), and the DevelopiriLlit Scliedule d"s not a _�.'l:lll10dj1C issIling, a building Prillit. if] dial year, One buildirigpermit will be issued per yearper Development unt I sucil Lillie as issuing building permits. Applicant must submit an approved FORIM U �vid' I U) is �:5i- PRUVIDI: A -NL) ALL INFORNIATION THAT WOULD ASSIST THE 13ULLDING DEPA.I�T&LEN-l' IN MPJ�ING !:RNIINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE E>MMPTIONS. k 'D AN EXEtQTION AS CITED ABOVE. G ACCURACY OFTHE INFORMATION PROVIDED ANDTHATTHE,A'J'I'.ACjjLD I'L -�,U I'IS ALLOWL J;,!;iI__k I UNDERS 'AND THATTI-M SUB NfIT7AL OF NUSLEADING OR INACCURATE INTORMAT'ION OR THE �!L-C-IN('i OFF O.FA 'kBOV-L -,`MPTION WHICH DOES NOT COMPLY, WTIETHER DONE TO MY KNOWLEDGE OR BYTHE BUILDING DEPARTMENT TO ISSUE A BUILDING PERNOT. T NATURE DATE ITO BE A'FTACl-TD TO ITIE BUILDING PERNff APPLICATION Location 5Z-3 vzf& 17 No. nate 690'... TOWN OF NORTH ANDOVER Certificate of Occupancy $ 0 Building/Frame Permit Fee $ U Foundation Permit Fee $ it Fee $ 41M Ae Sewer Connection Fee $ 60 Water Connection Fee $ eptp TOTAL $ ingonspector N2 9911 0A, tw biv. Pfiporks 1855 APPLICATION FORSEWER SERVICE CONNECTIOW North Andover, Mass. / Z Application by the undersigned is hereby made to connect with the town sewer main in 1-4 subject to the rules and regulations of the Division of Public Works. -�� 3 The premises are known as No. Z,64:-,�e cle,� or subdivision lot no. Owner Contractor Address 17 Address ILL- f- Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at V e- r subject to the rules and regulations of the Division of Public Works.. Inspected by Date . / �9 zne,3 Street, Street Street N Divi,sion of Public Works By See back for rules and regulations RULES AND REGULATIONS FOR GOVERNING THE INSTALLATION OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer or appurtenance thereof without first obtaining a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly or indirectly be occasioned by the installation of the building sewer. 3. A separate and 'independent building sewer shall be provided for every building; except where one building stands at the rear of another on an interior lot and no private sewer is available or can be constructed to the rear building through an adjoining alley, court, yard, o'r driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing, testing, and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35, PVC pipe. Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with barricades and lights so as to protect the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the (town). 1215 ,;1? APPLICATION FOR WATER SERVICE CONNECTION45 North Andover, Mass. Application by the undersigned is hereby made to connect with the town water main inj0a-� subject to the rules and regulations of the Division of Public Works. The premises are known as No. —,52--2 / " � �,e , V. or subdivision lot no. Street A4,Lay-�-z Owner Address Street, Contractor Address X I : 13r)li Appli ante's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at - subject to the rules and regulations of the Division of Public Works. Inspected by Date Street Board of Public Works By See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall. be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be I" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug type cover. J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 0 0 DRIVEWAY PERMIT DATE --------------- LOCATION BUILDER phone OWNER phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENTS OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Telephone (978) 685-095C. Fax (978) 688-9573 A Pr L t CA tJ—C 6, s 1 c:�WA-r LIZ E TOWN 0,17NORTHANDOVER DIVISION OF PUBLIC WORKS 3184 OSGOOD STREET 141 N10.RTH ANDOVER, MASSACHUSETTS 01845 ..jr 9 _5 7" W-0.950 elephone (V Eta 078) 6 _95 7 June 1, 1999 FORM U & DRIVEWAY APPLICATIONS PROPOSED DRIVEWAY PLAN - a plan which is required to show the dimensions of the lot, the location of the proposed driveway and the building(s) it services, the type of street pavement, type of existing sidewalk, type of curbing, location of any permanent structures within ten (10) feet of the driveway such as utility poles, hydrants, catch basins, stone bounds, etc. The plan shall be submitted to the:Engin6ering Department for review. If the plan is approve4 then a driveway permit can be . issued. (See Sketch Plan Attached) CREATION OF A CURB CUT, - If there is existing curbing -where the new driveway isto be located, then it m, ust..be removed to 1 create the proper rarnp. from thegutter. The new e driveway shall mot; -protrude into -the gutter. hn any instance the new curb cut shall not allow surface water to enter, the propdrty, �.(See Sketch %B) EXISTING SIDEWALK SURFACES - If there is an existing curbing and / or sidewalk thenew driveway shafl rnatch the existing material and shall be a minimum of 4 ",thick. The contractor; shall provide a detail showing the thckness of material number of layers, reinforcement and sub -base. DIG SAFE NUMBER - The applicant shall and have a valid Dig Safe number CONTRACTOR - The Contractor doing the work shall have all insurances required and be in good standing with the Town. DRIVEWAY PERMIT - The permit shall be good for thirty (30) days and may not be transferred without prior vvritten approval by the Town of North Andover. INSPECTIONS - The Contractor MUST notify the Town 24 hours prior to commencing construction. The completed work must be inspected and signed off by the Town, within 48 hours of completion. C:-W0RD\DRIVEWAYS\FORM U & DRIVEWAY APPLICATIONS ze, 'Jo PROFILE N.T.S. NOTE- 1.) ALL DRIVEWAY APRONS TO BE 'PAVED WITH 3- 431TUWNOUS CONCRETE. 2.) DRIVEWAYS SHALL NOT BE INSTALLED IN LOCATIONS VMERE STONE BOUNDS ARE PROPOIN.D. f 11 1— A 0 CL 0 LL 0 3i uj c� 'Jo PROFILE N.T.S. NOTE- 1.) ALL DRIVEWAY APRONS TO BE 'PAVED WITH 3- 431TUWNOUS CONCRETE. 2.) DRIVEWAYS SHALL NOT BE INSTALLED IN LOCATIONS VMERE STONE BOUNDS ARE PROPOIN.D. f ���5 WN TO OT ORTH AM)O - - N'F BUILDING DEPARTMF-"'- Iwo FAAWI, x ... ....... T "ORMAnom go I 'Y 7,rd yard - hv/i� -e) 1-7 0.040 row E— W�<I�IAVIIWkLZ" AGINT IM er(yv -gj -Apv� ;for" 4.4Z— C ra-4 OYS,;Y�l bq*� -0 m 0 z m 4vit AX*k4 YR . ....... 44 woft Sri, cor�ioa f>3SW4 Skil4ing 0 1 gcpajr�&) .7 r 5,6,0� ACZ-0^4� lu IC VCYV4:W tt%)l A dd�'J M gcnot4 6 sql-��JAJID cot(SI-RUCTION COSTS X iXr4W (:,Olt (DOUu) io be ( 77-7. Wl OPLY suildi4 P"E Ftc 366amt*d ToW Coot of comovdim BOM; ?,,-it f- k.) lo� 3 F" Pmwt 1 6 7oW SXCTION 7% DWNXR kYLITUOULZATION TO U COMrUiVID VVIU)q AGCNT ox cofg"MR APPLEE5 FOR Bunjw.,t YXXXIT u 0wnc/AufborizcJPgcilt of subi,6c� mpw� tc U. M, tXhili f. w &U-40clm rvlol w w u�o'zs� by thi� tu�iuj pvrmil oFpl;,Clm too au n ......... .......... . Helem 3.�:Jjw the lix aLlorms e ud tlo;uraic. I.,col o� "nN �jlo".fdjc FIT -Lr,! N fn, �,� 6,.ff* r )o rl � Avz- 4�4tv.z��, / .� /)- �, 4 .,- StjU�,�v ofoWrW,AJCXA D4t4 512-E OF F-00 ,�ER-s 7 3 ? _3 DC�(ENSJONS Of 5aL- "D Ll pq,�IoNs or O;Rpr.Rs I ") 111111111105 g7/. BOARD -OF BUILDING RECULATIONS CONSTRUCTION SUPERVISOR 029uo AO Tr. no; %Sam= RO RUMLLF $21 RIVERSID Av HAVERHILL, PAGE 01 -Elm he Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit SW Narne, Location: V /-7 city A- PhnnA It j 6 E:] I am a homeowner performing all work myself. E:1 I am a sole proprietor and have no one working in any capacity [K] I am an employer providin g workers' compensation for my employees working on this job. . Company name: (DrzAlj � a . . ve(a 4,t_eJ-r _;7�_ <� _ , _ Address eY 7.. City: 5 t9 e Phone#- Instirance Co. Pr)liry en e" e- V 3 Company name: I Address City: Phone #*.. insurance Co. Ploli 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 $1,500.00 and/or one years , impdsonment.as.weB.as.cLv.il.penaltiesiniheformcfaBT.OP.W.ORK..ORDER.,and-a.fine.of.($IDO.00.).aday.against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification, �Ct. do hereby certify under the ins a a' a a information provided above is true and cotm Signature Date- Rbon e it Print name //11 c Official use only do not write in this area to be completed by city or town official' City or Town Pt-rmit/Licensina Building Dept nCheck if immediate response i . s required Licensing Board E] Selectman's Office Contact person: Phone #: Health Department Other NOTICE OF ASSIGNMENT COM130 I.D. EMPLOYER: �)Ftj�,:;F, STRSi�T DEVE",OPMENT INC cOO267563 1501 yLAIN ST TEWKSBURY, 01376 COVERAGE iUFIOUP 0267563 of ou: Right to S Endorsex.ent ,Recover erorn 0, -hex r� PC)) iC4 eo�' ,;S available On PO." . . CC)n!*act youl, ctger,r- for details. AGENT FRED C C>1JPlCP' INC OR ONE MERRIMACK PL pROOUCER: xA 01852 AGENCYFEiN�042445292 jF-- 0 P 2 RAT I ON CONTF��C70R-E,\ECUTIVF SUPZ?�"'SQR C�kRF-E�ITRY -140C L T TY 00/l0Q/S0') P EM "CT�STANT ZS'P�-M-kTF,n ANNUAL PREMIUlM DARD PREM. L I... ASSESS - 4.5t OF ST"�N EST - IrVINTUAl PRZM'' PljljS ASSESSMENT INSTALLMENT BASIS: STATUS OF EMPLOYER Co.,poratiOn coverage urdor this assignment p lies to massach"Isctr's a P por covorage operations onlY, outside of massachusetcs, contact the appropriate Pool Or Plljn Eor �.hat state, INSURANCE COMPANY: C07JTINENTAL CASUP�LTY CO MS. TINA SMITH p 0 BOX 4965 ORLj,_,jDO, FL (BOO) 842-9482 rE -' ESTTMA-�F-L) RA CODE TOTAW NWJNI' REMUNERATION -------------- --------- ------- �606 $62,800 2.65 5403 16,60 9845 $6,312 5244 0900 $6,51`6 ---------- C REOUIRED DF -POSIT PREMIUM $6, 840 COMMENTS 51,03 01/1 C:Dve--'age nCly filej Form, 941S or DET Form is did not Please four mr,,st rece forward these "-'opies Of' ired in Part VI 04. the applicatiOn- accorr requ .'pany ,%e app,).jcac3.on as e company listed above. _ly - -_, jnz--,ranc t PREPARED BY, Joanne Shea CATEOFNOnCE: 01/25/(J3 EXT 530 VIDLUNTAAy DI"CT ASSIGN"DIT * * COPY: EMPLOYER LETTEAIQ� . 365757 The Workers, Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street - 13oston, MA 02110 (617)439-9030 - FAX (617)439-6055 - www.weribma.org 04/'15/1996 00:11 111111111105 MAScheck, COMPLIANCE REPORT MassEchusettS Energy Code MAScheck Software VOraion 2.01 Release 3 CITY: North Andovet STATE: Massachusetts ROD; 6312 CONSTRUCTION TY?E-. 1 HEATING SYSTEM TYPE: DATE: 10-17-2002 COMPLIANCE: Passes Maximum UA = 334 Your HoMe - 259 or 2'FaMily, Detached Other (Non -Electric Resistance) Permit # checked by/Date PAGE 02 The heating load for this building, and the cooling load if appropriate, has been deaterinined usiog the applicable Standard Design Conditions found in the*Code, The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CNR 1310 and X4. Builder/Designer Date Area or cavity Cont. Glazing/Door : Perimeter R -Value R -Value U -Value UA -------------------- ------ ---------------------------------------------------- CEILINGS 480 30.0 0.0 17 WALL$., Wood Frame,. .1.6" O.C. 1844 13.0 0.0 151 GLAZING: Windows or Doors 136 0.370 so DOORS 30 0.270 8 DOORS 19 0.350 7 FLOORS: Ove.- UnconditlonOd Space 560 19.0 0.0 26 HVAC EQUIPYENT: Furnace,- 90.0 AFUE ---------- -------------------------------------------------- COMPLIANCE STATEMENT: Theproposed building design described here is consistent with t:4he building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the re-Virements Of the Massac�uaetta Epergy Code. The heating load for this building, and the cooling load if appropriate, has been deaterinined usiog the applicable Standard Design Conditions found in the*Code, The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CNR 1310 and X4. Builder/Designer Date 62 I a I I I 0 I UA :7) Qj Ira ME C-� al Ki C: D cc Qj 0 'U a -- U q) 0 J� -0 q) C� .0 at ul 12 U , rL �2 C4 ITT IT o r: do U In CO -5 u = ca E C) Q),D r. Uw-- > Q) q) Z3 x Tul a -So co A 0 Z- -C CL 0 x > CL -C r V 10 11 1.3 E Zj .0 CL qj Z ID cl In T CU - -C LO Qj rr% Z" 12 G IL di lu .6. 'cu u QL LL c b —9 CL 2-0 Z LL m z cy EL rl) 11 2 0 LL ju LL C4 H :n ID IL -Q 00 0 -3 x # C4 IL _2 -0 CZ r4 x x x 13 To Ki C: D cc Qj 0 'U a -- U q) 0 J� -0 q) C� .0 at ul 12 U , rL �2 C4 ITT IT o r: do U In CO -5 u = ca E C) Q),D r. Uw-- > Q) q) Z3 x Tul a -So co A 0 Z- -C CL 0 x > CL -C r V 10 11 1.3 E Zj .0 CL qj Z ID cl In T CU - -C LO Qj rr% Z" 12 G IL lu .6. 'cu u LL c b —9 CL 2-0 LL m z a EL rl) 11 2 lu > C4 H Ki C: D cc Qj 0 'U a -- U q) 0 J� -0 q) C� .0 at ul 12 U , rL �2 C4 ITT IT o r: do U In CO -5 u = ca E C) Q),D r. Uw-- > Q) q) Z3 x Tul a -So co A 0 Z- -C CL 0 x > CL -C r V ca Tl CL CL Li V. lu q) to 11 1.3 Zj .0 CL qj Z ID cl In T CU - -C LO Qj rr% Z" ca Tl CL CL Li V. lu q) to 11 1.3 Zj .0 CL qj Z ID cl In T - -C LO Qj rr% Z" kO cz —le o 2, .0 lz LL X U - C14 a] r4 0 cl m X. Q) M ill (j) -4j m u co .Q E ID ptl > CE q) X) :n Liu CL -D um -u Z-0 r. !) Mq) U tj 'n (L q) M a > j > > > > u A a CL a_ 12 13 gq Qo) ca w :3 x Cc Q) M ill (j) -4j m u co .Q E ID ptl > CE q) X) :n Liu CL -D um -u Z-0 r. !) Mq) U tj 'n (L q) M a > j > > > > u A R MA, q) a x 'un r. 4) C Ln 10 tj ou ID "u, Y- —1) � ;�.a sp.6 r. .0 CL lui qo) 0, c In -i 2.9 = to :3 cn L-4 9 Q x FA t Q) .sl - 3 A LLI M c :3 q) LL CL a_ R MA, q) a x 'un r. 4) C Ln 10 tj ou ID "u, Y- —1) � ;�.a sp.6 r. .0 CL lui qo) 0, c In -i 2.9 = to :3 cn L-4 9 Q x FA t Q) .sl - 3 A LLI M c :3 q) LL (UlLU) LU Q) ND < r% U) a- n- () C- (-) 00 Q) C'4 X 'E 6� CL -I- 4LD LD CL IL C14 CN 0 CL _U) - e. IL -- s x lu (a ;i 0 Z CL C4 u C4 ft) (L ). (a CL =3 u 6'u C'4 10* Q M 4j) N g$uluvdo 45noi Rvmioop MOPL4M jo dol 1101,9 4 4 4 4 4 XL fall :8 LL lolul— (pniv gq) zA v -,L 't L (PM9 gg) CA lg-,L al LL cq r-4 9 LL M c,4 LL r'4 4 4 4 4 4 XL fall :8 LL lolul— (pniv gq) zA v -,L 't L (PM9 gg) CA lg-,L LL cq r-4 4 4 4 4 4 XL fall :8 LL lolul— (pniv gq) zA v -,L 't L (PM9 gg) CA lg-,L co -C u n n Qj 6 is Ul 4) G q) -90 C: U rx Q) u Co Q) co U It U Cc Q) > ca 2 q) cu 2 LLI u 0 25 Q) 0 -Q JZ— \D J2 J� 0 C-4 Co cl a- -U q) -C 10 .0 c U LL -u :z Q < 73 --I- -Q -lz u r. M-5 29 v >1 Q) cu Y C) 10 -Cj u 0 -r < 00 C: > < q- LU tL 'a G -6 x -Q g Q U 0 OM x x x x x cj -3 CL u LLI a Co lu 10 -C a u .9s 0-1 Cld -02 CL Q) > E3 sp-0 qj L) � m C) t U Q u ol 4) Z: u q) -u CO 0 lu U r - LU v (3 q) lu --0 W :n E3 o V Q) -0 u q) Q t M > rl) lei x -C n C, r IR - ,S) — -13 Q3 Q) U q) 14 1 'U �Y2 ;2 :a 12 jQ Q) 3 Q) CL -T.6 () -13 c -U � r .0 Q -D — .2 — q) x 13 > lu me > ia CL 13 ms " Z' U. -0 12 E 0) Qj Q) x Q 43 > 20 q "6 u q) ri X U q) u V ,cj G -u ul tj ic is C,4 Q) < El 7 ::3 — , Ln ('N -jJ 4ju 4ju x v In El 0, oz 19's 0,9 U9,q :%=x Ln JA 'ok I m 9& 7� 0 UJI i --q I 99,Q 0 cz .0,9 0.2 9, CP 9 9 Qj H 7 "r 9 U Ulf .0,L 16) mt�cr� 77 —�7 00 b En ba cle En I . ID I i S, ts (S) Q) Co E z N _0 "A A__ \S) 0i Oj S a -76 v3 F_ D I CL I -� 'ri qj a 2 QJ CL CL Q_ q) r. CL Q_.5 r: q) > In qu ju A 'a SP Q CL Nx r= LL t 4) F9> LL 76 L u Qj 1p Q) CU x X CU cli ul� -u Q) lu T F4 fa > ,u 40 q) 'U U is -T-;6 M Q CL _Q 0 Z co U Q) x 0 q) lu s o � > M CL q) Q) > CL r. QL > fU ,-v Q) .L. LL ZN -C 0 r. IP t: W X -C C u Q .t: LL ca W j J; 0-5 LL > 19 :, < x 4 W —A C4 k3 q) La 0) U_ u V 'D IL 00 IL A x x G-1 LL qj a 2 QJ CL CL Q_ q) r. CL Q_.5 r: q) > In qu ju A 'a SP Q CL Nx r= LL t 4) F9> LL 76 L u Qj 1p Q) CU x X CU cli ul� -u Q) lu T fa > ,u 40 q) 'U U is -T-;6 M Q CL _Q 0 Z co U Q) x 0 q) lu s o � > M CL q) Q) > CL r. :z -6 > fU ,-v Q) .L. LL ZN -C 0 r. IP t: W X -C C u Q .t: LL U j J; 0-5 LL > k3 q) La 0) U_ u V 'D qj a 2 QJ CL CL Q_ q) r. CL Q_.5 r: q) > In qu ju A 'a SP Q CL Nx r= LL t 4) F9> LL Qj 1p Q) CU x X CU cli ul� -u Q) lu fa > 40 -C spy R, -C 10 u 0 -�N u U -C -5 ui CL -C > CL sz) m &_ co cu L) u-7, X L) _63 C: A 0) Lp Qj 1p Q) > cli ul� -u 71 "1 co cu L) u-7, X L) _63 C: A 0) Lp 93 JLL c C LL C14 C(l E C4 m cl :4 zi - U7 X. .g I Ca M x - Q NI Wal (S) 1: I --o LU u C4 I I ( LA wo, 0 ly ca X wu E r 0 Q 9) go -5— T m -u > m 10) '18) IL w E q) 'n > 0 5-2 02 0 U r: > co u u o M > > > > CS) A u C4 G G q) C4 Ul a oj -0 x 'up 0 0 .6 0 0 4) -C Ln a Q r � I Q, -S 'o tj ,Zu c q) U -S 9 2 Mq) —q) C x qu In Q-2) 0) u xf 0.6 2 M r. -2 ou > to gn 4 > ID -C lu �ea ca [a (a 1c C14 uj N FL E q) a - G q) C4 Ul a oj -0 x 'up 0 0 .6 0 0 4) -C Ln a Q r � I Q, -S 'o tj ,Zu c q) U -S 9 2 Mq) —q) C x qu In Q-2) 0) u xf 0.6 2 M r. -2 ou > to gn 4 > ID -C lu �ea ca [a (a 1c C14 uj cz i Cc LL LL L G q) C4 Ul a oj -0 x 'up 0 0 .6 0 0 4) -C Ln a Q r � I Q, -S 'o tj ,Zu c q) U -S 9 2 Mq) —q) C x qu In Q-2) 0) u xf 0.6 2 M r. -2 ou > to gn 4 > ID -C lu �ea ca [a (a 1c C14 uj LU LL q, -#.-A st CL < fl- r. (a 0 CL C 00 C14 I ; X 'E 43 C,4 CL IL Cl C,4 Flu 00- Q 0 ca (L lu (pni, ge) L CL e (U) 00 a ba O'u LL (pni, ge) L :3 CD (S) LLI 7s q) G q) to u go CL -9 ,f 01 U I -ca IT "d > L) -u ts) (j) Q) -0 = U -g u �6 q) I- q) -C 0 io 40 Q W- 27 '92 00 IL cc C13 22 -6 (3 21. u Ci LU q) W q) U S' 1) o Ln 0 E a — Q) A q) I -C CG :3 Qj 0 10 -�3 -9 c r co Co ,rj kn m c) _0 CO C'i u q) E co G -r 0 ca CL 0 Z" m 01 0) 2 0 u U U4� -Q CO k) r- 4; co Za 1) > I �21 :3 -C 'at q) ;5 r- Q Cc; In D 2- cl 0 w u 12 U- a L- m c q) -C n CI - 0 rz Cl s; .9 m CL 12 F- -Q ]� v - :R 21A L- _. = CL 43 .5 CL x oj x x S: Q ul D 0 G s ,� Z'- 2 S LLI Lij v pL 0 -u q) n � U 32 - :3 C: I > M S u s LL) q3 0 q) q) CL -C 'D Q LU q) q) Z- —u iu -C > .0 -j 0 rz Q) "U u lu �s < c) OL -1Z qu) .c J) a u T) '10 -D q�3 C: > X -ro < u q) E co G -r 0 ca CL 0 Z" m 01 0) 2 0 u U U4� -Q CO k) r- 4; co Za 1) > I �21 :3 -C 'at q) ;5 r- Q Cc; In D 2- cl 0 w u 12 U- a L- m c q) -C n CI - 0 rz Cl s; .9 m CL 12 F- -Q ]� v - :R 21A L- _. = CL 43 .5 CL x oj x x S: Q ul D 0 G s ,� Z'- 2 S LLI 0 -u q) n � U 32 - :3 C: I > M S u s LL) q3 0 q) q) ou q-) -C q) q) Z- —u iu -C > .0 -j 0 rz Q) "U u lu �s -1Z qu) .c J) a u T) '10 -D q�3 C: > X -ro < = (T 5 al CL -CU Iz u . U 13 -C u CC) s u q) E co G -r 0 ca CL 0 Z" m 01 0) 2 0 u U U4� -Q CO k) r- 4; co Za 1) > I �21 :3 -C 'at q) ;5 r- Q Cc; In D 2- cl 0 w u 12 U- a L- m c q) -C n CI - 0 rz Cl s; .9 m CL 12 F- -Q ]� v - :R 21A L- _. = CL 43 .5 CL x oj x x S: Q ul D 0 G s ,� Z'- 2 S LLI (ot Date. �� -.. 2 �� . - C. .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... t. (-. n r. �e: .......................... has permission for gas installation .14 le. C�� . .—.' . . . . . . . in \ the buildings of ..... /�. / !� '.0. .(�� ........................ at ... L..,<. A?. .......... North Andover, Mass. Fee ... 7.). . Lic. No.. /O�>. k GA INSPECTOR Check# V 4454 MASSA HUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GASFITTING Building N ew 40 Renovation (3 0�-36 40, Permit Y _,o"6wn'er's Name_2USS&7/Q-.4� ,eAl Type of Occupancy_.:�:S/�,v Replacement 0 Plans Submitted: YesC] No C3 Insta.11ing Company Name AJUR777-now; Check one: Certfficate Address. -73 wc,47'W 0 R -A— A V 4% 0 Corporation -Loijell F nA, 4016S�_ [:1 - Partnership -Business Telephone ?779 0 Firm/Co. Name of Ucensed Piumber or. Gas� Fitter _j Mrs J; D&kree INSURANCE COVERAGE: I have a. current liability insurance policy or Its substantW equivalent which meets the requirements of MGL Ch. 142. . Yes 52,— No 0 If you have. checked'yes. please Indicate the type, coverage by checking the appropriate box A liability Insurance policy 2--l" Other type of indemnity C . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. GeneraJ Laws, and that my signature on this permit application waives this requirement. Check one: gnature of er or Owner's Agent OwnerO Agent 0 I hareby 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 knowiedge and that all plumbing work and installations Performed under the Permit issued for this application will be in compliance with all pertinent Provisions of the Massachusetts State.Gas Code and Chapter 142 of Aws, yDe Q T TIPla, � Ucense: Title 6mber Ju;re oIL'—Ljcen 'umber or �tter Gasfitter Oty/Town ter ucense Number A7 / -6 <5,C I/ ANT Journeyman NMI IMMENIMMIN INIMEEMIN MEN SEEKENEEMENEEN NONE INN 7TlKFLooR EMMEMMEMEMN MEMMENININNINSIMEM Insta.11ing Company Name AJUR777-now; Check one: Certfficate Address. -73 wc,47'W 0 R -A— A V 4% 0 Corporation -Loijell F nA, 4016S�_ [:1 - Partnership -Business Telephone ?779 0 Firm/Co. Name of Ucensed Piumber or. Gas� Fitter _j Mrs J; D&kree INSURANCE COVERAGE: I have a. current liability insurance policy or Its substantW equivalent which meets the requirements of MGL Ch. 142. . Yes 52,— No 0 If you have. checked'yes. please Indicate the type, coverage by checking the appropriate box A liability Insurance policy 2--l" Other type of indemnity C . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. GeneraJ Laws, and that my signature on this permit application waives this requirement. Check one: gnature of er or Owner's Agent OwnerO Agent 0 I hareby 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 knowiedge and that all plumbing work and installations Performed under the Permit issued for this application will be in compliance with all pertinent Provisions of the Massachusetts State.Gas Code and Chapter 142 of Aws, yDe Q T TIPla, � Ucense: Title 6mber Ju;re oIL'—Ljcen 'umber or �tter Gasfitter Oty/Town ter ucense Number A7 / -6 <5,C I/ ANT Journeyman 4n 0 cc 4L 7. zi �Tl w dK 0 lu la Q &6 AU 0 IL w 4c L6 2d 7. zi �Tl w Date(.:::/�'. .3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S'4CHUS This certifies that ....................... has permission to perform ..... ............... plumbing in the buildings of .... ................. at ... .............. North Andover, Mass. Fee. ... Lic. No.. .1.05 ... ....... ,PLUMBING INSPECTOR Check # 573) 8 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM (p,r i Y, +- M BIN(%, %-,.L y pe j 02 P r�" rt55 0 ol C -� , ow ity, own Building AT: Location New led., Mass. Dat'e- 0 3 :!&�< Ee rmit # Owner"s Name Aa Type of Occupancy: Ll�: �/- L7j Renovation Lj Replacement n FIXTURES Plans Suhmi i-t-pri - ri 47 (Print or Type) Installing CompanyName 0 Address Lou) e tk 4 VAq, Busine- T.1 I- 94-A - w < 3 - -) c- Check One: 11 Corp. Partnership — Firm./Company Certificate ep one C&LL- 946-608-966S- Name of Licensed Plumber or Gasfitter J" bulepk-&- 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 0 f mv knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with al' pertinent provisions of the N -Massachusetts State Gas Code and Chapter 142 of the General La%�s. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Sigiature of 0-ner,'Agent I have a current liability insurance policy to include completed nne-ritions cover r7l---.— By Title City/Town APPROVED (OFFICE USE ONLY) Fopm 1240 A M, SULKA 00 U I nature o mber =0 f Li sed Plu /Y1) Type of Plumbing License os4 q ��Iaster 11 Journevman License Number SEMMES MEN 1ST FLOOR emommons MEN soon Ensommon smommons 0 soon soon MONSOONS MEN SEEN sommoson sommosommom 0 Eii: MONOSSON (Print or Type) Installing CompanyName 0 Address Lou) e tk 4 VAq, Busine- T.1 I- 94-A - w < 3 - -) c- Check One: 11 Corp. Partnership — Firm./Company Certificate ep one C&LL- 946-608-966S- Name of Licensed Plumber or Gasfitter J" bulepk-&- 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 0 f mv knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with al' pertinent provisions of the N -Massachusetts State Gas Code and Chapter 142 of the General La%�s. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Sigiature of 0-ner,'Agent I have a current liability insurance policy to include completed nne-ritions cover r7l---.— By Title City/Town APPROVED (OFFICE USE ONLY) Fopm 1240 A M, SULKA 00 U I nature o mber =0 f Li sed Plu /Y1) Type of Plumbing License os4 q ��Iaster 11 Journevman License Number (1) z 0 F - w z V) (1) w 0 LU LLJ LL Cf) w w z 0. C) w z z LL 0 z LL 0 a 0 0 Z w CL 0 LL z 0 CL (L (5 z cl D m LL 0 w z w z C) z 0 m LL 0 z 0 0 -j LL 0 2 0 -0 C. CU a! Lij co 2 D —i CL 0 w z w cc w 0- cr 0 w 0 - Cl) z z z <- --2 - - -Z 6 - c, 7 Date ........ 1� ............ 0 .00 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..... P.�� 1'� ......... has permission for gas installation A- ....... in the buildings of .112 �� , /' '— .. ................................... at ... 4;. ........ North Andover, Mass. Fee ... 7 Lic. No.. 6, / ........ GAS I INSPECTOR Check# 4 4 53 MASSACHUSETTS UNIFORM APPUCATION FOR P*ERMIT TO DO GASFITTING (Print or Type) -C ��, C-15. AJQ 006_�� -,Mass. Date Permit # Building Location 569 0A "=:L— Owner's Name Type of Occupaancy 1,ddK_16o_TAi�11'1V New Renovation C3 Replacement 0 Plans, Submitted esO No Installing Company Name A) U f< f . — ±-T---T Check one: Certificate Address -73 WCAL-5ePA AVr- C3 Corporation Lowell KA, 616.S -D, —r— 0. Partnership -Business Telephone 0 Firm/Co. Name of Ucensed Piumber or. Gas Fitter -j D 11'e Pee INSURANCE COVERAGE: I have a. current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes P'. No C3 If you have.checked yes, please Indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity 0 . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permFa-pplication waives this requirement. Check one: &gnature or Cvner or owner's Agent OwnerO Agent 0 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 the permit issued for this a pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of pplication will be in compliance with all ral 'w'. Tr juretnotnLipcen Title umber or tter City/Town ucense Number A7 / -6 45"-C 11 APPF� NEON Now --NONE son on ,NEON EMONEENNIONE soon so MEN MEMO Installing Company Name A) U f< f . — ±-T---T Check one: Certificate Address -73 WCAL-5ePA AVr- C3 Corporation Lowell KA, 616.S -D, —r— 0. Partnership -Business Telephone 0 Firm/Co. Name of Ucensed Piumber or. Gas Fitter -j D 11'e Pee INSURANCE COVERAGE: I have a. current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes P'. No C3 If you have.checked yes, please Indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity 0 . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permFa-pplication waives this requirement. Check one: &gnature or Cvner or owner's Agent OwnerO Agent 0 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 the permit issued for this a pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of pplication will be in compliance with all ral 'w'. Tr juretnotnLipcen Title umber or tter City/Town ucense Number A7 / -6 45"-C 11 APPF� I WI C w 0 IV) 41) LU U. 0 .40, cc a. WI C 0 U. .40, C; 0 0 0 cc WI i w a. .c I 0 uj cc i w a. "I G - C- --I Date. '�� ........... 'I '400Ur" A 0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that DD�a 1 P .................. has'permis%sion to perform .... A. ............... plumbing in the buildings of ...................... at ... .................. North Andover, Mass. Fee. . L i c. No. . .... ........ ..... . �. >.6-N1 ....... tPLUMBING INSPECTOR Check # Y 0 (t " 573U V V MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ( 1) -,- 1 4-- rn " Wi- 6:1 P ,e 6-Z� &) 0, 80 0 Mass. ,City, Town Building AT: Location Date 09-3d—e_3 Perm i t # Owner - s Name d I LOAQLZ�7e—tl/ iel Type Of Occupanc y New Renovation Replacement FIXTURES Plans - Submittprl- V'C' I? A (Print or Type) Installing Company Name 117 - Add ress c--.j,r -o o — L LL,. M, �k , o I Business Telephone -.q ... C& LL -J 46 - 8 o Check One: Certificate El Corp. El Partnership El Firm./Company Name of Licensed Plumber or Gasfitter T, b C, o � -, g - -aL 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 m% knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliaric.- %4 . . provisions of the Massachusetts State Gas Code and Chapter 142 of the General La%%s. ith a]' pertinent I have informed the owner or his agent that I do not have liability insurance including completed operations coverag�. Sigiature of owner.'Agent I have a current liability insurance policy to include completed operations co�'era e By em i Lki Title tignature of 'c nsed Plum City/Town Type of Plumbing License I APPROVED (OFFICE USE ONLY) �Iaster El Journeyman I License Number FoRm 1240 AM SULK!N CO IN MEN son monommosso MEN M MEMO nommossomosom EMMONS sommossmosmonson on NONE Emmossommom NONE SEEMS Now NEMESES (Print or Type) Installing Company Name 117 - Add ress c--.j,r -o o — L LL,. M, �k , o I Business Telephone -.q ... C& LL -J 46 - 8 o Check One: Certificate El Corp. El Partnership El Firm./Company Name of Licensed Plumber or Gasfitter T, b C, o � -, g - -aL 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 m% knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliaric.- %4 . . provisions of the Massachusetts State Gas Code and Chapter 142 of the General La%%s. ith a]' pertinent I have informed the owner or his agent that I do not have liability insurance including completed operations coverag�. Sigiature of owner.'Agent I have a current liability insurance policy to include completed operations co�'era e By em i Lki Title tignature of 'c nsed Plum City/Town Type of Plumbing License I APPROVED (OFFICE USE ONLY) �Iaster El Journeyman I License Number FoRm 1240 AM SULK!N CO (1) z 0 F - w a_ (D z w m 0 0 cr CL (1) LLI F- ul �e co (1) z 0 F- 0 w CL z z 0 z r- U - (n 0 0 a 0 F- 0 Z Lil CL CC 0 LL Z I 0 LLI CL LLJ CL LL < CPz D m LL 0 LLI z w z cc 0 w a - U) z U) 0 0 z z LU LL (f) F - m .0 LL 0 z 0 0 0 i a. cc 0 w a - U) z U) 0 0 z z w F - z 0 w w 0 CL cc 0 w a - U) z U) 0 0 z z Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that%7:�S ..... Z_ -X-C ............................................................... has permission to perform'�k=-/Rr .. ajl?:� ..... ................ wiring in the building of ..... /17( .... ............................................. .................. . North Andover, Mass. at 6-11': a 4K.3340!7. Lic. No.414573 ............ SPECTOR E� Check# L 49- 4728 At 6-- THE COAMONMAUH OFAASSACHUSE7TS Office Use only DEPARTA&W0FPUX1CS4FETY Permit No. .4 767-E- A BOARD OFFMEPREVEMONRWULARONS527CAM]2-00 I Occupancy & Fees Checked APPLICARONFOR PERMIT TO PERFORM ELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION). Date �614&7 Town of North Andover To the Inspector of Wires: Ile undersigned applies for a permit to perform the electrical work Location (Street & Number) '9 Owner or Tenant Owner's Address ^9 V '160 /�m Is this permit in conjunction with a building permit: Purpose of Building Existing Service Amps Volts New Service lj!!�Z) Amps ,,!�2�Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes �No r7 (Check Approp - e Box) Utility Authorization No./ 7? 166 Overhead Undergro�/d No. of Meters 0 V Overhead �nderground No. of Meters No. of Lighting Outlets No. of Hot Tubs lbawabnitbdvandpodofsmrtDtbeCffKx-- YES Ea- No. of Transformers I YES, PJeasein&&thcmvofcoWra�PV Total 9 Eviationrup BbT�dValtr-ofElectdcalWok $ W0[ktDSla[t kq)Dc6onD&ReWestDd Rao Fmal KVA No. of Lighting Fixtures Swimming Pool Above F1 Below Business`lbl.No. Generators -'AlL Tel No, J9V KVA 4valerit as reclurted by Amchuser, Gemal I. ground (Please check one) Owner Agent ground M Telephone No. PERMIT FEE $ No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. ofDetection and No. of Disposals No. of Heat Total Total Pumps To2s KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal FiConnections Other No. of Dryers Heating Devices KW M No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTIJER- huanceCDWrage, Rrrsu&ttodrmqzmnvsofMmmdwseft3G=A lbawaamMLmMtyknrdnceFbhcyffrludmgCmpleteOpem PL critsabstmMequivalat --'�o M ED lbawabnitbdvandpodofsmrtDtbeCffKx-- YES Ea- r7p If haNe I YES, PJeasein&&thcmvofcoWra�PV chedcing TpTialebbox,--�,� L ---J INSURANCE L�r BOND r --J OUIER ft,0-- Sf mly) 9 Eviationrup BbT�dValtr-ofElectdcalWok $ W0[ktDSla[t kq)Dc6onD&ReWestDd Rao Fmal SignedundertrrPl�nAesofpq,pj:�.— F1RM NAME LmTNo /7XJW0 Licensee rj�" Sjgn&1re LicenseNo CIO Z� Business`lbl.No. Address- -'AlL Tel No, J9V OWNER� S INSUR�NCE WAIVEI� I am aware dial dr- Licer-m- does not have fl -)e nUar)(DC ODWrage or its sub�fial 4valerit as reclurted by Amchuser, Gemal I. aiAdiitmysigmtLuuonfispen-r�tapphcationviod,,�thsmqzcrrEnt (Please check one) Owner Agent = Telephone No. PERMIT FEE $ Signature ot Uwner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: city Phone # I am a homeowner perfon-ning all work myself I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers' compensation for my employees working on this job. Compa!2y name: Address cil)[. Phone Insurance. Co. Policv # Company name: Address Cify: Phone #7 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 $1,-sW.00 and/or one years' imprisonment-as-wefl-as-cix4l.penafties in-thelmn 4 -a -STOP W-ORK.ORDER-and-a fine -of -($J -0.0M) -a -day against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I 1 do hereby cerffy under Me pains and penaNes of perjwy that the infarmation proMed above is trw and corn9cl. Signature Date Print name —Pbone.# Official use only do not write in this area to be completed by city or town officiar city or TowTi Permit/Licensing El Building Dept nCheckff immediate response is required E] Licensing Board Selectman's Office Contact person: Phone A Ei Health Department Ei Other THE COMMONTWALTHOFAASS4CHUSEITS Office Use only DEPARTAIEWOFPUBUCSVETY Permit No. 4 7a F e BOAMOFFREPREVENHONREGLE4HONS5-97CAM]2-00 I Occupancy & Fees Checked APPLICATTONFOR PERMU TO PERFORM ELECMCAL WOW ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACFrUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION). Date �71� 1,4r Town of North Andover TO the Inspector of Wires: The undersigned applies for a permit to perform the electrical work Location (Street & Number) . q— // / / )AA/A0 A' h Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes [3-'N'o Purpose of Building Existing Service _ Amps Volts New Service A�2) Arnpsj��&olts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (Check Appropriate Box) Overhead M Underground Overhead �.Underground — Utility Authorization NoI3�za MNo. of Meters =1 No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground groiind M No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW 1:1 Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- lnsuranc-eCoWrdg-- RMUaMtDdr-mqim)aZofMa%admemColedLam lbaNcaomeritLabihtybEwx=PbhcymkjdngCmpletc YES YES NO fbavesubmWdvandptoofofsmrtotbeOffim r -,q) If ym harw YES, Plemnicaethe �Wof oowraWby drddngdr, 2atte box INSURANCE 13--*'BONDF-1 mER ED ftaq-- specify) EstimatedVArefEkb�Wbik $ WotktDSL%t— ]nspeWonDRkRW)estDd - Rough I Fmal OWNER�S INSURANCEWAIVIJR, I am ay.,are dki the License does nothave theinsuranceoovMge orits and dial mysignatureon thisperi-rutapplication waives (Please check one) Owner Agent 0 M" LicenseNo E BustnessTel.No. AIL Tel. No. eqLit,v,lmtasreqLutedbyMassa(-b-i,�kZGm�dLamA i eiepnone iNo. FERMI'I' FEE $ Signature ot Uwner or Agent Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Worke rs'Compensation Insurance Affidavit Please Print cily Phone # F-1 I am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers' compensation for my employees working on this job Comr)anv name: Address city- Phone #7 Insurance. Co. Policv # Company name: Address Cily: Phone#7 Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to -the irnposition of criminal penalties of.a fine up to $1,500.00— and/or one years' imprisonment-2s-yo-,U-as-civii.penaltiesin-lhelam-da-STOPW-ORK..ORDER-ar)d-afine-cf.($IJD-0-00)-ajdayagainst-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DkA for coverage verification. do hereby cerbfy under Me pains and penaffies of perjury that the Iffmnation provided above is true and coned Signature. Date Print name Pbone.# Official use only do not write in this area to be completed by city or town Gfficial' City or Town Permit/Licensing F-lCheck if immediate response is required Contact Derson: Phone #.- Building Dept Licensing Board Selectrnan's Office El Health Department El - Other Date ..... P ... /K TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................. has permission to perform ........ .................. —.e.r ............................. wiring in the building of ..... ................................ at .... ...... 22 ............ �z .... ........ .. . ........ . North Andover, Mass. Feel,� . .... . ..... L i c. N o. ( ........ \ ... .... I ........ ... . ........ 4 ......... ELEcrRICAL INSPEC�OR Check # 6 7, ThE COMHONWEALTH OFMASS4CHUSEM DEPARTA1W0FPUX1CS4FE7Y BOARO OFFIREPREVEMONREGUL47yoNS 527 CAp? 12 .00 Office Use only Permit No. (o 7 L/ Occupancy & Fees Checked APPLICATIONFORPERARTTOPERFORMELE WORK ,7 ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUS'STS ELECTRICAL COD 527 CMR 12: 0 (PLEASE PRINT IN INK OR TY PE ALL INFORMATION) ate Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work dfscribed below. Location (Street � Owner or Tenant Owner's Address Is this permit in conjunction with a building Purpose of Building Existing Service Amps 'Volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes ID No [� (Check Appropriate Box) Utility Authorization No. A510Pr Overhead Underground M Overhead Underground ED No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total of Lighting Fixtures No. of Receptacle Outlets /1) Swimming ool Above rn".f . N Oil s A U1 elow kound M Generators KVA KVA No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Ranges o. of AiMond. If Total Tons FIRE ALARMS No. of No. of Detection and Zones ........ I No. of Disposals NO -7f Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local --I Municipal Other N of Dryers Hea . ting Devices KW El Connections No. of Water Heaters KW No. of No. of I - Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- kwanceCovw9a lbawabiiWdvandpmofofsanietotlieOffim YES dwkinglbe . bo wup—& b Y-�, INSURANCE = BOND OIIER WotktoStatt — lnTocfionD*RaWesed FIRMNAME �=-Jl J1- OWNM'S INSURANCEWAIVEP, lam av,= duttheLmwdoes nothawthemwtanx and diatmysigiaWmftpemtappheahonwaivesfismqwmcnL COM90 (Please check one) Owner Agent Telephone No. Signature of Owner or Agent R k2a I[ A �RAIVIT No El AIL Tel No. ,ed by MmachLuells Gewd I-aws PERMIT FEE $ <,5U Location -50c1—,51/ WAU-el"L� N o. Date koft'rol TOWN OF NORTH ANDOVER A Certificate of Occupancy $ rev Building/Frame Permit Fee $ Foundation Permit Fee $ to Other Permit Fee $ TOTAL $ C�) Check # / C-1 S 17 6 3 5 2" lola Building Inspector I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT -k PP 1,11CATION TO CONSTRUICT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1.2 Assessors Map and Parcel Number: '-IUILDING PERMT NUMBER: o, DATE ISSUED: ,SIGNATURE: a ( Building Comniissioner/Inspector of 13/uildings Date �ECTION I- SITE INFORMATION I 1.1 PropertyAddress: 1.2 Assessors Map and Parcel Number: 1 1 - Aje- P44-1 -v rdWaverly R d 22 1 and 25 Map Number Parcel Number 13 Zcninghiforniation: 1.4 Property Dimensions: R-4 , -LA2-tn� I)j,,tnci Proposed Use Lot Area (so Frontage (tl) i.0 BUI LDING SETBACKS (ft) Front Yard Side Yard Rear Yard Requl red Provide Required Provided Required Provided 3 0 ' 30,1,- 15 0. Jo,',�- ;7 i � 7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal Systern: Public 4- Private E) Zone Outside Flood Zone municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT I Owner of' Record Irene Fournier nq wAuprly Rd.,N(n) Ant9over,Ma "'Zinic (11rint) Address for Service .Signature Telephone '.2 Owner of'Record- Naine Print Address for Service: gnaturc Telephone � SECTION 3 - CONSTRUCTION SERVICES i l,icensed Construction Supervisor: Russell F.Ahern,- RFArn T.T,r :.1C;ensed Construction Supervisor: I i 103-Atla-ri-ti.CC Ay.,Seabrook, NH 03874 Address :;IL,nature Y.t.,K.W-7, i.2 Registered 46me Improvement Company Name Not Applicable 0 029340 License Number 2/27/04 Expiration Date Not Applicable R Registration Number Expiration Date Ma M X z 0 I 0 z M 90 0 M z 0 I SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) I 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 ofthe building permit. Signed affidavit Attached Yes ....... i)� No ....... 0 SECTION 5 Descriiption o Proposed Work (check applicable) New Construction 2 Existing Building 0 Repair(s) 0 Alterations(s) 0 Addition 0 Accessor-N,, Bldg. n Demolition 11 Other 0 Specify Briet'Description ofIlroposed Work: construct duplex dwelling SECTION 6 - ESTIMATED CONSTRUCTION COSTS hein FAlinated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY I . Building V90,500 (a) Building Permit Fee Multiplier 2 Electrical 9,500 (b) Estimated Total Cost of Construction 3 Plumbing 10,000 Building Permit fee (a) x (b) -171 4 Mechanical (HVAC) 81000 5 Fire PrOteCtion 2,000 6 Total (1+2+3+4+5) $120,000 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN _T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Irene Fournier as Owner/Authorized Agent of subject property a uthorize g I-lereb\ , � gpi 1 p_Z' Prn, MpMhpr, IRFAro T,T,C' to act on MY behal 1'. In all matters relative to work authorized by this building permit application. Signature ofOxviter Date 4/10Z03 SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I 1. Ruc;,qP1 1 F. Abprn., Member.,RPA(ln T,T,(' —,as ON:vner/Authorized Agent of subject property I lei eby declaie that the statements wid inl' 6-natio2on for i-- ion re true and accurate, to the best of my knowledge and behol, ym 12 119 5; R I I —F ---Ah e r gember REAM [Irint Name 4Z10Z03 SigllatLLTe of Owner/Agent Date Spin loll RIM NO, OF STORIES 2 r SIZE 40-X 28, BASEMENT OR SLAB basement SVl_-'�0I-'F1_,OOR_I'IN1BERS 211X 101f I S�r 2 It x 101, 2 ND 211X 1011 32,,x 8-, SI'AN 14, DIME'NSIONSOFSILLS 21, X 61, 1.)1MI_.'NS10NS0FF'OSTS4'1 x 41, 1.)iM]-"NSIONSOI','C,IJ�I)ERSJO,1 X 1211 11]: [GI IT01- FOUNDATION 8 1 THICKNESS 10 SIZE OF FOOTING loll X 201, X MATERIAL. Ol'CHININEY M,,t.,,, 1 IS 13[Jl,l-.DING ON SOLID OR FILLED LA1,1D solid IS BUILDING CONNFCTF-I'DTONATURAL GAS LINE will -hp rnnnPr-t-_Pr3 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*********************** APPLICANT tZ, S S e 09 A PHONE LOCATION: Assessor's Map Number a PARCEL rt".1 11,J (r SUBDIVISIONArl6)'-? &�f0LIe-7- LOT (S)o STREET,�qZ�'-'T 6-�rIVVZ,� Pw ST.NUMBER 7 oaver�. d USE I RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED— COMMENTS TO)iVr4)PLANNER COMMEN 'CL-bl, &, A DATE APPROVED DATE REJECTED— FOOD INSPECTOR -HEALTH DATE APPROVED 5 F, (ig & f�_ DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT - RECEIVED BY BUILDING INSPECTO Revised 9\97 jm .1 11� // y /10 - C01- :2 -,?/-&3 TE_ NOTES 1. 2. 3. N/F GARAGE FOURNIER & HERBERT *UNDER" PROP. 10'X20' PARKING SPACE eli—c4vc. offy UNIT a 30.3 D UNIT A LLJ z 3&2' a: 0 LOT AZ i AREA ell :12,500 S.F. 0.29 9 AC. WAVERLY ROAD PLOT PLAN J PROPOSED LOT CONSTRUCTION ZONE DISTRICT R-4 FOR EACH UNIT IS A 3 STORY 3 BEDROOM UNIT ARTHUR L. FOURNIER WITH A GARAGE UNDER IRENE HERBERT SEE ASSESSORS MAP #22 LOT#1 FOR SITE. SEE DEED BOOK 727 PAGE 397 FOR SITE. 0 20 40 80 SCALE: 1 40' 009 DATE: APRIL 8, 2003 OF MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 1217 APPLICATION FOR WATER SERVICE CONNECTION�� North Andover, Mass. Application by the undersigned is hereby made to connect with the town water main in In Street, subject to the rules and regulations of the Division of Public Works. a 'r The premises are known as No, or subdivision lot no. 2 le V��- Owner Address Contractor eo--- z �? (1�1/*' 117 ;Addres Y Applicant's Signature X, 1/ 5. 0, -k4-e0,,-;'0 y�del- 7' PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date See back for rules and regulations or Street Street Boar of P lic Work -5 Location IP -1 No. ate TOWN OF NORTH ANDOVER Certificate of Occupancy $ :ICE CONNECTION Building/Frame Permit Fee $ lorth Andover, Mass. S. oundation Permit Fee $ T9r1_ r1th PPenreWFee $ ZOA ' ver main in Z�I'tIVZOI At]:1 Street Sewer Connection Fee $ Water Connection Fee $ Street V TOTAL $ .. g4 210,0, op BU1409 I pecto 'nwv, z/ Y;0k No 9913 Div. Pub$6�forks q 112 5 Appicant's Signature PE RMIT TO CONNECT The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date SEWER MAIN F�_ Street Division of Public Works Z�_ By .2 &61 See back for rules and regulations e;-7 (' he,, 6�1-1_4Y J.VVILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT DATE 0or LOCATION BUILDER phone OWNER_ 1 -fl phone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE A14D SETBACK FROM STREET. CALL THE SUPERINTENDENTS OFFICE BEFORE FINISH GRADING AND SURFACING FOR. APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND 013TAIN APPROVAL VOEDS THIS PERMIT. Telephone t978) 685-09, Fax (978) 688-9573 A F r L 1 cA tu -F 51(::714A--rL1P-E GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUrLDING 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. 4— Permit Applicant Property address Map / Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the 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. Ibis is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date ofthis bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. 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 bythe planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for thepurpose of constructing one single family dwelling unit on the parcel. . '/--, Tbis application rep resents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING 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 THEATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR G DEPARTMENT TO ISSUE A BUILDING PERMIT. t I — Z(/// ',X AftrtANTS SIGNATUR'V' DATE' TFIIS FORM TO BE ATTACEED TO TBE BUILDING PERMIT APPLICATION .//1� -67,,, ?zo,. L6lAea14l. ry/. ✓l/GC14Jt2Clul BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 029340 :�.. Birthdate: 02/27/1960 \ _ Expires: 02/27/2004 Tr. no: 16559 `— Restricted: 00 RUSSELL F AHERN 621 RIVERSIDE AVE �, —�eTL HAVERHILL, MA 01830 Administrator NUMBER DRIVER'S LICENSE 031545360 DATE OF BIRTH CLASS REST HEIGHT SEX 02-27-1960 D B 5.10 M EXPIRES 02-27-2007 AHERN RUSSELL F 621 RIVERSIDE AVE {rrr HAVERHILL, MA 01830-6711 c � -i � � - � rear > s• �� � �— �-/ �, ��.,u /�t � �% �� Name 1 nr�tinn• �. - A.,,v�,✓� /✓i Phone I am a homeowner performing all work myself. ElI 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. Address l S" U I t� iN S% 0 7 r`ifir 1° ,/ci ,f�� Phone #• 9 7t- q 7S x 9/'/- Company name: 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 well.as.civil.penaltiesinsheinrrnnfa-STOP WARK..ORDER..and_a.fine_of_($1DO.DD)-arlay.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 Signatu Print name /-,7,;5e-�/ of perjury that the information provided above is true and correct. l#v.'-I-e-C Rhone #�' ��3C6 Official use only do not write in this area to be completed by city or town official' City or Town PermitlLicensin I] Buildin De t ❑Check if immediate response is required Contact person: E] 9 p Licensing Board r-1 Selectman's Office El Health Department 0 Other NOTICE OF ASSIGNMENT EMPLOYER: ORP.NGE STREET AEVELOPMENT INC COMBO Lo.000267563 1501 MAIN ST TEWKSBURY, MA 01876 COVERAGE GROUP 07.67563 The Waiver of Our Right to Recover.Front Others endcrsement is available on Pool policies. Contact your agent for details. AGENT FRET] C CHURCH INC OR ONE MERRIMACK FL PRODUCER; LOYAELL, NF1 01852 AGENCY FEK 042445292 Ci.ASS�FICA7 ON Or CC ON STATUS OF EMPLOYER Corporation Coverage under this assignment applies to Massachusetts operations only. For coverage outside of Massachusetts, contact the appropriate Pool or Plan for that state. INSURANCE COMPANY: CONTINENTAL CASUALTY CO MS. TINA SMITH P 0 BOX 4965 ORLATIDO, FL 32902-4965 (600) 842-9482 CODE- TOTAL XWOlVio PREMIUM REMUNERATION' CONTRACTOR -EXECUTIVE SUPERVISOR 5606 5403 CARPENTRY -1400 EMPLOYERS LIABILITY 10011001500 9845 STANDARD P-REMIUM 0900 EXAENSE CONSTANT EST'MATEC ANNUAL PREMIUM DIk ASSESS. 4.5t OF STANDARD PREM - EST. ANNUAL PREM. PLUS ASSESSMENT INSTALLMENT BASIS: Arinua i $62,800 2.65 $11664 $7.8,000 16.60 $4,648 $6,312 $244 $6,556 $284 $6,840 REOUIRED DEPOSIT PREMIUM $6,840 COMMENTS coverage effective 12:01 AM or 01/15/03 Copies of the insured's four most recently filed corm. 9415 or DET Form is did not accompany the application as required in Part VI of the application. Please forward these retards immediately to the insurance company listed above. DATE OF NOTICE: 01/25/03 PREPARED BY! Joanne Shea EXT 530 * VOLVNTARX DIRXCT ASSIGsNroMNT " • LETTER ID' .365757 COPY: EMPLOYER The Workers' Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street • Boston, MA 02110 (617)439-9030 • FAX (617)439.6055 • www.wcribma.org MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 TITLE: Waverly rd CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-14-2003 DATE OF PLANS: 4/14/03 PROJECT INFORMATION: waverly road duplex COMPANY INFORMATION: Highview LLC 1501 Main st unit 47 tewksbury Ma 01876 NOTES: 20 x 28 Duplex COMPLIANCE: Passes Maximum UA = 334 Your Home = 247 Permit # Checked by/Date The heating load for this building, and the cool ' load if appropriate, has been determined using the applicab e Stand d Design Conditions found in the Cbde. The HVAC qui ent sel ea or cool the building shall be no greater han 5� of th i. o as specified in Sections 780CMR 1 J4.4. Builder/Designee %/ Date / Area or Cavity Cont. Glazing/Door ------------------------------------------------------------------------------- Perimeter R -Value R -Value U -Value UA CEILINGS 480 30.0 0.0 17 WALLS: Wood Frame, 16" O.C. 1844 13.0 0.0 151 GLAZING: Windows or Doors 136 0.340 46 DOORS 49 0.300 15 FLOORS: Over Unconditioned Space 560 30.0 0.0 18 HVAC EQUIPMENT: Furnace, 90.0 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 cool ' load if appropriate, has been determined using the applicab e Stand d Design Conditions found in the Cbde. The HVAC qui ent sel ea or cool the building shall be no greater han 5� of th i. o as specified in Sections 780CMR 1 J4.4. Builder/Designee %/ Date / i; II Y_ ii I. I I �.0 7 13 Nil - 3a %x Si'' �a i C 000- 6 i, ,` TIC/ 51,11....... �z'1� 51`�2 3y'I�(x��l'�� (�`��/`y,x s3'/2� IN Y �1 f q .r Iii r S, N S - x It, Ll ,` TIC/ 51,11....... �z'1� 51`�2 3y'I�(x��l'�� (�`��/`y,x s3'/2� IN Y �1 f q i:r CL �o a a� M C CL D O _t M c 6. u o U3 n m m CL e to c O E :3 0 Q � ° y Vf _a (D cD (D 0 O 0 C 3 m Q O H::� F -P In 0 ti H {D 0-0 O o _ x D (D 1G 0 CD 0 cD d �1 03 a r.. • af' o c °clb � o 1 = C 1 ^, �. � o H w � CD m �d r•. 0 o CL 0 ;L` a M. br y a :.. V1 o l J6 c N • K •� _ m x n 11 O C Z v 0 z z 0 U) 7) m m d S- CO) CD n y CLCoO �• r C CL ? C O y loo CO c v CD CD O CL cr % d CD CCD O CD w cc C O H CD O CACD F v CA O CD Z CD CD o 0 CD I I lip C C?•..4c o �• H O Q y = _d0 C ® y O -* �m C7 Z H ® ccaC a. = =r= co �a,..ao' CD Cl) O m y 0 y o m i m a a o,® c c m� ,o o o :M. :� o ZS.o o 0 O O. O CD� S. CL � CD N �' co c� D c COL m . :® M d m 3 [ ; y d d C W o -• _a ,F�.•'py, y OCD CA O V 1 y N Q O_ T 41- -bo :—O OV Er CD s z� o CD .� : �► CD :•Q� O C y o o 0 0 m o+ A o = '� o CD iQ �q $ o oil "� H w ° G w cp ` ° G a ZzG411 H O w o G to O ,V a� no G x o G a. rt 0 W r c4 COID O Ly C/) o O °�' n Q o a W lonq 0 0 c C/) :i C m C/) 0 m w w C CD CL c to CD 5 CO) CD 0 71 d O CA 10 C!� O CA n CD CD H� CO) CD ,o < c ?'0 $ d _ Cr ti C0 = m 10 y am a m m o H'C"DaC Z - g m ..r "d'� m tA_T CD �0 m y o o :E CD a co �• o . o z. C, m �om:0 _ a � CL co co o =r U) CD � . : 4% Co b n� o_ a®: :O C) m m� z E CL C:r cn ca r.7.CD CC co' ��► m �� ) 400CD ti O o" Z ju ro CA z� c O ' m C2 a . m a COD. 5 CD v d. �d CL c 3 oma: CA z �. 0 0 07 a Ya 2 0 m ^ D A cn �0,-• �cn ,�.� o�' w '?7 W '�i W '�7 w- 7d d G '.�7 w 7d OC4 0' r� r• ro z w n. 7d OAC 'Tp w O (n ^ ti al A . x ij to y0y I Q O t 0 in I X U L 'V� ---------------- ------------'- 1 1 I i in d) U O > 6 < U T- 1 0) E7 IT L4) CU xJ -.V) O CN u ,0,£ ,9,5 .0,9 ,9,5 _o x.a,t S,r x .a,c 0 ccs O, .n o � i :~ PI .9,5 9A Oh I �� ` •0.,11 ._ X9,5 ,9,11 ,0,9 `A Q U v� �r .9 ,9,E ' m 9 O 4 Ulf11- CU r — AL LL ZCI u _o ccs O, .n o � IN ,9,q .oaf ,0,8d .r�8 ,OI,Z — ,6,1' x ,a,Z . ,�,s; x ,a At x ,a,Z 0 _ o O� Y O � � Ln O x TS e ° zi 1915 Y [X� fn O ,0,8 9,q z� r U 4 Q O m t�—t O LL— o ->a ,9 6 .9,E ,9,E .9,11 • cn N(3 O Q, O Q CID O ,O,Z - IN 0 I ^ s �► S � m o S z S �>7E = i4 c m �u$y�E9 - q�uQ m �O 6 V x U 7a 4,u) u o CL `oma 90 �s 2o�oQ) Orvna° -i uJ) n.3� � 0 E � •�� r o � S C N N N � O y �= a LL 0 O Q -u J) r N R1 ^ �► S S S S S S �>7E 4) a CL i4 �' m �' - 6 x U 7a 4,u) u o :3 a 90 Qq)) u ov 2o�oQ) Orvna° -i uJ) n.3� n N N N � O y �= a LL 0 m m m in r O ul "i- X X U- Ju �•- LL N TY n kD N {�v Ln W 9 51 000 � C x � '; (11 b an cnn y u U U o a o 0 0 0 0 0 0 0 =3 `o Q O N N N Q RL S - CU Co ou„ 3� v-13 S > 12 o CL 9QD c 3 O Olc� � m m oo a U su0�� 0 � N vs6a �Oj00 ss u o U � 4 N � NI �>7E 4) a CL Fr= 9� ° O^= - ca - 6 x U 7a 4,u) u o :3 a 90 Qq)) u ov 2o�oQ) Orvna° -i uJ) n.3� ou„ 3� v-13 S > 12 o CL 9QD c 3 O Olc� � m m oo a U su0�� 0 � N vs6a �Oj00 ss u o U 13 •c l � mu mi ELM m� � O r ID uV r� c 0 Q ulu IL Qir'n$y> D. T a v � 4 NI ca - 6 x U 7a cu 90 Qq)) u ov w n N N N � O y �= a LL 0 13 •c l � mu mi ELM m� � O r ID uV r� c 0 Q ulu IL Qir'n$y> D. T a v � 4 a12 ca 6 x U 7a -6 ° �m,p Qq)) u ov w ,v 0 X Q z z 0 ' c� o' o = _ ;� x �p n � U. � U E U E Ln cil m U 0> m jS: V 1l A, U u i i i I 1 I I 1 0 c of .. �n cz 4 i- b of cz 4 M m � 0 ` W U LL p 6 u u o � U � O � V of o) � O � ` X07 v NU 0 u 61; aC La ip c .p '•�j '�'� L �b � � � �� ll U L � > U .SJ a� oQm s� SL � 0 U U U a' �e SOT II s9 vt)u�o�au�. S 0 E U.� SLY O U m V j V :6 U > b u p7 � p O `ppp�7 t U C S aQE ,S s U = 9 0 9� 6E O j� rj O u. N) _ u GI E u l N u C ; Sl, G E ,, O ,��vo sq�`G°�ou� rng omo �a..� 00 y 9 1 ' I C-6 0 x �—, lz c �— r6 W o w `� v v cr C 77 0 x �—, lz c �— r6 - Q ' CU pIF-4 --�4� >�Hunt °o a. y D=.��. S _� c 0- o� A Pp OLX m c q CL7Q z -x 0 O oo CL n - �ma,� 0�3 `ova. x ^� = N OO �CipZS r U�Sr N a �� �I_ uoS) r 96ulusdo 4Dnoj Renuoop mopWmJO dol CD 1 I 1 I 1 II t L Sl (pnto ,gg) �Z/I 6-,G L O ,b/- . O O�,t U r� u0)N - ' pIF-4 m OI�S2� S OLX FL M i OLX �� 7 1 CD I 1 I 1 II t L Sl (pnto ,gg) �Z/I 6-,G L ,b ,b/- Ul ni � ) 0- ° vg— w 4 u v U v u i v > v < 61 _ y 0 F -g S v 0 ` °m O My, u u ` •� � � � 1. � O 12 0 •- IL a O„Fi Q cn " o _ -j =- X03 ;via v o ^,7 Qj � V � ���m°moo o CL -0 b cn ° o� o o vis CL LLw :ZCL n-, ;,��g'` -OJ . O 11.E U ° 1 VRJp _/� n) 4 u �+ m - .2 o Ca � O u u m O Z7 mvs 2t7 O I Ul ni � ) 0- ° vg— w 4 u v U v u i v > v < 61 _ y 0 F -g S v 0 ` °m O �o c r s U v v 0 E T 9 o °� S> m= u 0 uOJs V O 3• ° u C Li. m C fa N o C ° 0T'SC sTc� jaQ v lu U" O U L W 3 m U S w p a U Q� 'U lu V Q-• Q a '° V U 0 O c ]L a 6) 1 E� 67 A •'' � W � 0 G jL m rq lII c N Cn 'C To 0 0 Q1 r U II. c � IL a .� T �. O �' � v is �0 � vis U6� vs� �J) 2(� >u >x�� L _ Ij lo O m m iL to m U� O OU �p S _Q & v vo�o51oo ma C7� V .Oo�oornuio of z u'�c� o o r d u Q uM c" -0 LLQ 71i `n } r � " _ S L L O 0 a -C o C� p El u 0 U v Q L y S E 0 v c p > ly -c :71(3 m m 0 •L S• •�aa q)nn j L G L1 00 c m�OCc spO O a7 U 0 U U o ua �C) v��'po�g w �o3 4�> 03-C 3 _a� �-e °� OO a" vogue m �9 ccpp S+ G S v U C U T O �� U6V Lo6c UW Oc UOg d%6UU 0EOB m > �l 0 t U S Z L 4I v .rs s° o N 0 o m E Ut=61U-u U a X 9 U fL 0 O B p V n O v O U= u 2 Q U 07 LUxq�� �� wu'��«s� = O`n`o >�`=•fl ��o voo -S `°os n� Maui ^>V-- .� c Q N L c O E o• S s o .i 4 7-u 3 EFm V U y _ 61 0 0 _ °smv �sL� �ovo� ung .40 vo�v0�6 Xo� Q, x P •� ` 111 12 0 •- Q cn " o _ -j =- v sg- o � = "0 Q` b LLw :ZCL ; o n N Q 2' c Q Q v O �z O � � O ° < m X X X X X N N N N N O �o c r s U v v 0 E T 9 o °� S> m= u 0 uOJs V O 3• ° u C Li. m C fa N o C ° 0T'SC sTc� jaQ v lu U" O U L W 3 m U S w p a U Q� 'U lu V Q-• Q a '° V U 0 O c ]L a 6) 1 E� 67 A •'' � W � 0 G jL m rq lII c N Cn 'C To 0 0 Q1 r U II. c � IL a .� T �. O �' � v is �0 � vis U6� vs� �J) 2(� >u >x�� L _ Ij lo O m m iL to m U� O OU �p S _Q & v vo�o51oo ma C7� V .Oo�oornuio of z u'�c� o o r d u Q uM c" -0 LLQ 71i `n } r � " _ S L L O 0 a -C o C� p El u 0 U v Q L y S E 0 v c p > ly -c :71(3 m m 0 •L S• •�aa q)nn j L G L1 00 c m�OCc spO O a7 U 0 U U o ua �C) v��'po�g w �o3 4�> 03-C 3 _a� �-e °� OO a" vogue m �9 ccpp S+ G S v U C U T O �� U6V Lo6c UW Oc UOg d%6UU 0EOB m > �l 0 t U S Z L 4I v .rs s° o N 0 o m E Ut=61U-u U a X 9 U fL 0 O B p V n O v O U= u 2 Q U 07 LUxq�� �� wu'��«s� = O`n`o >�`=•fl ��o voo -S `°os n� Maui ^>V-- .� c Q N L c O E o• S s o .i 4 7-u 3 EFm V U y _ 61 0 0 _ °smv �sL� �ovo� ung .40 vo�v0�6 Xo� Q, x P •� Location No Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ /70, Other Permit Fee RN 2 $ TOTAL $ /70 zCheck # 16 460' Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 14l 1 LI("A t ION t O CONSTRUCT REPAift, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T�IseSec>lma, for Of%�ul ase `Oni'' 1 I3UILDINC PERMiT NUMBER: DA It ISSUED SIGNATURE:(CQ,cc,._ Build'n Commissioner/I ctor of Buildings Date SECTION I- SITE INFORMATION l . l Property ,4ddress: 1.2 Assessors Map and Parcel Number: �D i�laverly Rd and 25 Map Number Parcel Number 7-7.1 7,tx1ing lnforniaticnt: 1.4 Property Dimensions: _ R.-4 _—_ _ Du-P�ex�7wet t ; Zrniinl; Dist -ria Pr osed Use -- ---- 1.6 BUILDING SETBACKS ft Lot Area s From Yard Side Yard Required Provide R uired Provided _._. 3 0 1 151 i.7 Water Supply M.G.L.(.4Q. 14) F.S. Flood Zone Information: Public —X Private i; %ame Outside Flood Zone SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 (?.vner of Record Irene Fournier Rear Yard Provided 301 1 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ Name (Print) - — A I1id-OmP __r-r_Ma Address for Service : Signature Telephone 2.2 0caner of }2ecord: -- Nave Print --- ----- Address for Service: S'iRnattuc ----------------- Tele hone - SEC' ION 3 - CONSTRUCTION SERVICES 1 Licensed Construction Supervisor. --Russell F.�hern, Member, R -C-0 Ljx Licensed Construction Supervisor: 103 Atlant c Av.,Seabr001U—NK-03874 Address — -- ---- ----------- 9 7 8- 6 0 o 5aa Signature Telephone 3.2 Register d ]ionic Improvement Contractor Company Name— - ---- Not Applicable ❑ 029340 License Number _ 2/27/04 Expiration Date Not Applicable R Registration Number 3nire— -. 'Telephone -- Expiration Date r 0 Z M 90 0 wn 1 1 Y♦ 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 ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: z a SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAY. = % USE UNLY ' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 on Check Number SECTION 7a OWNER AUTHORI ATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T- 1, l r A g—e , as Owner/Authorized Agent of subject property Hereby authorize S- f /4kL4'11 ffn C Q L6 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, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief r me Si a e of O er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS 'DIMENSIONS OF GIRDERS 1-1EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL, GAS LINE TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING wr .; BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning Disirid Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zane Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner. of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone Ma rn X ic Z O O Z rn 90 O r v M r r Z 0 2 stcQ c -e 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 APPLICANT-P�15SP,rn LOCATION: Assessor's Map Number SUBDIVISfIO\N STREET 111\ >L CONSERVATION TIONS OF TOWN AGENTS: PHONE (D Q - pS g v PARCEL LOT (S) \)6-2 ST. NUMBER_Z:W USE ONLY—*** DATE APPROVED DATE REJECTED COMMENTS,5in6 J �Ohl-Gm;i' - hof tofs wf��tl, ware... TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 91971m i Town of North Andover NORTH � Building Department ?���t4�D �6* �o 27 Charles Street 0 w North Andover, Massachusetts 01845 4( (978) 688-9545 Fax (978) 688-9542 e.^ �► D .,. . CO[KI( .WKK 4DR4TID Building Demolition Affidavit DATE OWNERS NAME & ADDRESS 57 6"y 04�P PROPERTY LOCATION J-6? � P'e'2tl '�J DESCRIPTION I�eA'Z C)crw— S,-,— e CONTRACTORS NAME & ADDRESS /SOl )-?,9/',j 57- c t y 7AJ u3 GAS /YO 6-A- ' Z i DIG SAFE NUMBER V )- 'V,70 Z66 ;1, BLDG. BLDG. INSPECTOR DATE RECD )'� -4 - z/ 1 eJ -Z- 0 Connect Edit Terminal Help 4th INTRST: 0.00 2003 REAL ESTATE DEPOSIT: 04/30/2083 BATCH: 1 MAP: 022.0 BLK: 0001 LOT: 0000.0 LEGAL REF: 727 397 LOCATION: 509 WAUERLEY ROAD ist 2nd ;FOURNIER, ARTHUR L & IREN ORIGTX: 713.88 713.89 ;OR IRENE HEBERT B/L PD: 11.57 11.58 '304 AMES STREET CINTPD: 0.00 0.00 ,LAWRENCE, MA 01841 4th INTRST: 0.00 8.00 3218.77 16.20 TAX PD: 702.31 702.31 LEGAL REF: 727 397 ADJSMT: 0.00 0.00 �ASMNT: 241100 3163.23 CHGSPD 0.00 0.00 ;TOTAL BTR/LNS: 55.54 XFRFDS: 0.00 0.00 (TOTAL COM INT: 0.08 CHRGES: 0.00 0.00 8.00 0.00 0.00 UNPAID: 0.00 0.00 104/23/2003 895.49 16.19 0.00 0.00 879.30 *Sta►t (+j te BILL#: 2976Q 2980 3rd 4th TOTALS 895.51 895.49 3218.77 16.20 16.19 55.54 0.00 0.00 0.98 8.00 0.00 0.100 879.31 879.30 3163.23 0.00 0.00 0.00 0.00 0.00 0.90 0.00 9.09 0.00 0.00 0.00 8.00 0.00 0.00 (0)ptions, Interest <DATE>: - Select Payment I#, Options or enter Date Wednesday, Apr 30, 2003 03:26 PM T elnet - 1 fl 1 71 55 T elnet 10.1.71.55 0.88 0.00 0.00 3:26 PM INVOICE ABC PEST CONTROL 31 SUGAR HILL CIRCLE METHUEN, MA 01844 978-686-1808 ?16 6 l -/ I0 �9 TREATMENT SITE DATE: 17 03 TIME: TECHNICIAN: Bo orl LICENSE#: aq 332. AHtrO cGmran 09 WaV (e N (— TnS ec-� J ov peff rro�ic01s 1 JOB DESCRIPTION / NOTES h`t�t e ►' n Sp e c 4 (2 i 4t r i m R t l t h 4 P -icy a- j o 4"� �Ycmise S. F014 no evtdehc(�, ©� otCf-rve- t'✓►��5���`��`"7 cre-nit no Zv/i a t ✓� t G TARGET PEST METHOD CHEMICAL PROBLEM AREA % AMOUNT ✓\ Ls �N 5 Q C'(h n4'4—P LA161C1-14'4— e f ALL WORK HAS BEEN TECHNICIAN SIGNATURE CUSTOMER SIGNATU GUARANTEE DATE RILY COMP • • NOTICE POSTED / GIVEN---- YES_ NO AMOUNT $ Uv f u TAX $ _ DISCOUNT $ TOTAL $ qS- . 0c) I O 1=04 V� Cd W - 101 CD Q cv CL CA 0 CL H O V L O ts CD CLCA C CO CM C co O C M m 0 CD �+ co C O CD CLa cma ccC O CO Z CD CO)CL �i C c CO)CL r�lmml w 0 Ir w w w rrw^ vJ o w v cn 04 a v o w o sx v a :c U c w" a o a: w" O w m w °chi w" a: w w w m z cn .� o cn 101 CD Q cv CL CA 0 CL H O V L O ts CD CLCA C CO CM C co O C M m 0 CD �+ co C O CD CLa cma ccC O CO Z CD CO)CL �i C c CO)CL r�lmml w 0 Ir w w w rrw^ vJ r- c o as c c � o C y O C v V C CLM cc m C s o L o � Ea o c 1 r V :oa0 N E� C m �mc E IV : d o `� a Ncm CD 3 s •r Emr®o •> ey> m ® � y m E � � W. OI C • acoz o �. o v .N Z m O O . ` C �O _ m p OI C N H *l $CO2 ymo� m cc uiC3 •N ,. c •-� O C •`m dt O co •y C Z Q ci d O ;C :2 O 6/2 = m��y'� m C aim' 101 CD Q cv CL CA 0 CL H O V L O ts CD CLCA C CO CM C co O C M m 0 CD �+ co C O CD CLa cma ccC O CO Z CD CO)CL �i C c CO)CL r�lmml w 0 Ir w w w rrw^ vJ idle LIIIIl' UOIIWralt4 Uf fttliSaCllllS fta� " Departtnent of Public 4—'-,aft:tq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. 0 J Occupancy & Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK ORE ALL INFORMATION City or Town of �}�� x� � Date 1Ldo d f o ,—�_ To ,he Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street F Owner or Tenant Owner's Address Is this permit in conjun tion.with a buil ing permit: Yes ❑ No (Check Appropriate Box) Purpose of Building ,iLLf Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrnd _ No. of Meters New Service Amps —J Volts Overhead ❑ Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No, of Hot Tubs i No. of Transformers Total VA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local 1- t tunicipal I-^ Other l_ Connection L_ No. of Ranges No. of Air Cond. Total tons No. of Disposals Heat Total Total No.of Pumps Tons KW No. of Dishwashers I Space/Area Heating KW No. of Dryers I Heating Devices KW No. of Water Heaters KW No. of No. of _ Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs _ LNo. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES - NO - I have submitted valid proof of same to the Office. YES '` NO ! If you have checked YES. please indicate the type of coverage by checking the ap ropriate box. INSURANCE T BOND C OTHER = (Please Specify) Estimated Value of Electrical Work $ n Date) Work to Start Inspeclippdft EteyugstEeLg Ro h _ -Final�. Signed under the Penalties of perjury: $RINKS HOME SECURI FIRM NAME H5 MW 1141M P ILIC. N Licensee �VhFfr`#E�-rkf�ar. - .__LL C. NO. - -- ---- Address _ OFFICE: 508.667.0148 OWNER'S INSURANCE WAIVER: I am aware that t e ice�e d s not have th4 quired by Massachusetts General Laws, and that my signature on this permit app (Please check one) . Tel. No. Alt _ Alt. Tel. No. ce coverage or its substantial equivalent as re - waives this requirement. Owner Agent Telephone No. PERMIT FEE $ tom . (Signature of Owner or Agent) x-6565 a Date ......... . ... N2 TOWN OF NORTH ANDOVER -vow PERMIT FOR WIRING This certifies that ... ........ ...... ............................... has permission to perform ...... ....... ................ wiring in the building of ..... at ....... �Q.(Y ....................... 1. ......... . North Andover, Mass. P� **—*--***-- Fee3. I .... Lic. No... ............................................................. ELEcriucAL NspEcrm C 0'o01'/'q-d401q '�. 9 M. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �- - t tie Gommonweaan of Massachusetts Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 permit b. Cf 60 Uccuµuicy S Fee Checked 3/90 %leave blank) \ 51 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance With the Mauachusetu Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN IHR OR TYPE ALL IyN��F��ORMATION) Date City or Towa ofwcp To the Inspecto of Wires: The undersigned applies for a z--wI_r:,,n_ the electrical workscribed below. Location (Street & Numbe,.r))� VV L X � p2 —J rO ,e or Tenant ,IU SUE Owner's Address SAim 0 Ak-2— Is this permit in conjunction with a building permit: Yes ❑ No 1Z (Check Appropriate Box) Purpose of SuildinE Utility Authorization NO. Existing Service _(_Amps)`qbVolts Overhead Undgrd ❑ No. of Yzters�_ New Service Amps �� / ��A U Volts Overhead Undgrd ❑ No..of Meters_ Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work UfC-R E' L 16 ,11MC#L Fl&h 1a6 A If 7� /dd /WW No. of Lighting outlets No. of Hot Tubs No. of TransformersTotal KVAKVA No. of Lighting Fixtures AboveIn- Swimming Pool grnd. ❑ grnd. ❑ _ Generators (CdA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection andtons Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local 11 Municipal ❑ Other Connection No. of Ranges No. of Air Cond. Total No. of Disposals HeatTotal Total No. of Pumvs Tons KW No. of Dishwashers (Space/Area Heating KW No. of Dryers (Heating Devices KW No. of Water Heaters ;W No, of o. o Si ns Ballasts Low Voltage Wirin No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO C3 If you have Necked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND C] OTHER 1:1 (Please Specify) = 7fj — !!!!!!��—��— (Expiration Date) Estimated Value //of, nEle trical Work S / !/ Work to Start !� o�Inspection Date Requested: Rough Final ! �J Signed undeWe- he pe alties of perjury: FIRM NAMEl C r- 11 LIC. NO. Licensee Signa ture�L�I'C.��.—� Address - v Bus. Tel. No. Alt. Tel. No.OWNER'S INSURANCE WAIVER: i am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit t application waives this requirement. Owner Agent (Please check one) ^� \ Telephone No. PERMIT FEE S 17f U Signature of Owner or Agent) Csts� . 2722 CHU Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ ra� ...... 5 ..................... el has permission to perform ....... ............. ...... wiring in the building of ...... 0 4. M.A..C. & .......................................... ............ at .... LO .... 7 ...... /..!Y ................. . North Andover, Mass. Fee... .... Lic. No. ........................................................ ELECTRICAL INSPECTOR C �( I 11/27/95 10:04 0 PAID P�GOLD: File WHITE: Applicant CANAC� �m O�K: Treasurer Location LAO"" KAU No. -b �P-4- a)I Date 93 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 16 6 -- 8 LA lao— LA I C� C) - ,A A4 (c,"— Building Inspector ID, i, w 14 WAVERLY ROAD "' I HEREBY CERTIFY TO THE TOWN OF NO. ANDOVER 19UILDINC DEPT. THAT THE FOUNDATION IS LOCATED ON 1 HE LOT AS SHOWN AND THAT IT DOES CONFORM WITH THE TOWN OF NO. ANDOVER ZONINC RECULATIONS REGARDING SETBACKS FROM STREETS & LOT LINES. " I ,% STEPHEN nn /nn /nnnn PLOT PLAN OF FOUNDATION LOT IN NO. ANDOVER, MASSACHUSETTS DRAWN FOR HIGHVIEW, LLC 20 0 10 20 SCALE: 1"=20" DATE: JULY 29, 2003 1 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER. MASSACHUSETTS 01810 fl Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 pOR^r 0.44, e 0 L APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS r'�o I___ LOT NUMBER SUBDIVISION a � DATE REQUEST FILED //, DATE READY FOR INSPECTIONl TEN (10) 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 MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ************************************************************************ ROUTING D.P.W. - WATER METER ATE /�Q 71d D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED 9XPRIYR TO INSPECT N REQUEST DATE. AI�ATURE / DPW THORIZATIO c2 / �ZO Y-79' It Town of North Andover tAORTH Building Department �,� �t ^. °6 0 27 Charles Street o �+ North Andover, Massachusetts 01845 _ (978) 688-9545 Fax (978) 688-9542 ��SSacw�5��C) . APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION D ► l eLl . r '► r. ■ it � � ■ / / • LOT NUMBER SUBDIVISIONP DATE REQUEST FILED I� DATE READY FOR INSPECTION //jai �a3 TEN (10) 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 MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. - WATER METER TE ; OA�15}-� D.P. ST INDICATE THAT THE WATER METER HAS BEEN INSTALLED ORT INSPECTION EST DATE. GNATURE / DPW AUTHbRffATION