HomeMy WebLinkAboutMiscellaneous - 515 WAVERLY ROAD 4/30/20186
...........................
Date ........ ) ... //S // _r
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
yxo,,.�? . ..........................................
has permission for gas installation
inthe buildings of ............. ........................................................
at ........ 5Z 1 ....... Rd ....... . North Andover, Mass.
Fee,.�.&� ... Lic. No. .... .....................................................................
GASINSPECTOR
Check ##4
10210,
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY R
__JjPE MIT#
__I MA DATEj&Z&d,447
�OW
JOBSITE ADDRESS NER'S NAME
G
OWNER ADDRESS Sj — ITE FAX
TYPE OR
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY
NEW: RENOVATION: D REPLACEMENT: 2" PLANS SUBMITTED: YES 7-J NOD
APPLIANCES -1 FLOORS- BSM I 3 4 5 6 7 8 9 10 11 12 13 14
BOILER L::j L:J
BOOSTER E:j M2
CONVERSION BURNER
COOK STOVE A
DIRECT VENT HEATER
DRYER Lu . .. ... .... ...... ------
FIREPLACE L --j —.j
FRYOLATOR
FURNACE E—J J 7- L
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS . . . . . .
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
. ....... . .. ..... -.1 ..... ........ . ... ...
. . . . . . . . . . .
F=---: 7-1 F _3
INSURANCE COVERAGE
the MOL. Ch. 142 YES lafo El
I have a current liability insurance policy or its substantial equivalent which meets requirements of
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 2-111" OTHER TYPE INDEMNITY 0 B 0 N D ED]
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 E3 AGENT DI
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliagpSwith all Pert' ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME* 10!�. r-- "'SIGNATURE
�?k- , LICENSE #
MP El MGF E] JP 2JGF D LPGI F CORPORATION D# PARTNERSHIP 0#= ILLC E]#
COMPANY NAME:E-�a—� Z�.4, a"A 7� 14 ADDRESS
CITY STATE ZIP ]TEL
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7he Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, SWte 100
Boston, HA 02114-2017
www.mass.gov1d1a
Workers, compensation insurance Affidavit- BaUder5/Contractors/FIeqtricians/PlWbers.
TY r -n wfTH THE PERAUTTIN X�00 -
JL%j Please Print-ht9INY
Aj)� P"
Name (Business[OigaiiizatiOnfindvdaal): J"' HA t4d fi
Address:
City/State/Zip:_
AreyouaaemPJGYe�j6��cktli app'ropriatebox:
Phone 4:
10 1 am a employer wjth___,_�mployees (ftill and/or part-time).*
2.� A�am a sole proprietor Or Partnership and have no employees Working for me in
any capacity. [No workers' COMP- insurance required.]
3.E] I am a homeowner doing all work myseLt [No woikers' comp. insurance required.]
<1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
I, 1,�� , 1, , ��
proprietors with no OUIP oyees.
5.Fj I am a general contract . pr I ja,nd- 1,.h.ave hired the sub -contractors listed on the. attached sheet.
These sub-contraqtors �Ejv6 6#loyees and have workers' comp. insuranco.1
6.Fj We are a corporatipli and its officers have exercised their right of bxemption per MGL c.
av6 no' niploy6�. [No workers' comp. insurance required.]
152, § 1(4), arid We h
T-Ypeof,projectOrequired):
7. F1 Nd*'d6nstr66fion
Remo
8. El ' dellfiP;
9. 0 Demolition
10 E] Building addition
I LE] Electrical repAirs or additigns
IZU] prmbing repairs or additions
13% Ro6f re�airs
14.Q Other-
'�bkgj ni-dst�� I Moutthe section below showing their workers' compensation policy informatiom
-Any applicant that chdGks 0
j,this� aM�avjt indicating they are doing all work p4 then hire outside contractors must subn-dt anew affidavit indicating such
th
i 1-jorneowners who subF� _ _ ntities have
tContractors that check this b6k must attached �m additional sheet showing the name ofthe sub -contractors and statq whqther Or pot oseP
comp. policy number.
employees. Ifthe sub-contractois have employees, they must pro -vide their workers'
am an emp loy er til a t is providing -workers I comp en sation in suran cefor my emplby ees. Below is thepolicy and)0b site
information.
Insurance Company
Policy # or Self -ins. Lie.
ExpirationDate,
Job Site Address: City/State/Zip:
Attach a copy of the workers' cO.Mpepsation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c. 152, §25A is a criminal violation punishable by a fnib up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
ofperjury that t1z e information provided above is true and correct
Idoherehycerti under thepains and-gau4es
fy _ I
0ifficial use only. Do notwrite in this area, to he completed bY city or town official.
City or Town:
Permit/License
issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for theiremp �es.
Pursuant to this statute, an employee is defmcd as "...every person in the service of another under any contra'ct of W91
express or finplied, oral or written."
An employer is� deffied as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enf6rprise, and including the legal representatives of a deceased employer, or the
receiv&'6r. trustd6 6 f an individual, partnership, association or other legal entity, employing empl6ypP9. - However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occup-anti'ofthe'
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage ie4uired."
Additionally, MGL chapter 152, §25C
(1) states "Neither the commonwealth nor any of its political subdivisions shall
enter intp any contract for the erformance ofpublic work until accep'table evidence of compliance with the insurance
I p
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the Workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
nec6sary, supply sub-'contractor(s) name(s), address(es) and phone number(s) along with their certiRcate('s) of
insurance., Limited -Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy. is required. l3e advised that this affidavit may be submitted to the Department of Industrial
Accidents for confimation of insurance coverage. Also be sure to sign and date the affidavit. The affidd-vit should
be returned to the city or town that the application for the permit or license is being requ�sted'
not the Department of
IndustrialAccidents. Should you have any' questions regarding the law or if you are req*ed to obtain a workers'
compensatiorl policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurahc'e license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office ofInvestigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which -will be. used as a reference number. In addition, an Applicant
thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy inf6imation (if necessary) and under "fob Site Address" the applicant should -write �'all locations in (citv or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be p'rov-ided to the -
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i -e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Comt-nonwoalth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-NMSSAFE
Fax # 617-727-7749
Revised 02-23-15 www.niass.gov/dia
C t35
J&
CERTIFICATE OF USE & OCCUPANCY�/
Building Permit Number
. ('53 0 iq
Date. ->— 7 _02 0<0 V
THIS CERTIFIES THAT
THE BUILDING LOCATED ON lo -,/- 3 -0 -5- 1,�S— L) e r,
MAYBE OCCUPIED AS f-) /,,) Z EA7�1 J,5-i-aJI otvaer--
_�Ou jP le v D/ cv o -
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO
J-7,5- 4fA t --f r C Y cio
----,Inspector
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Town of North Andover 0ORTH
0 4o
Building Department 0
27 Charles Street 0
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
AT*
CHUS
APPLICATION FOR CERTIEFICATE OF OCCUPANCY INSPECTTON
ADDRESS SIS VJCt\)UV
LOT NUMBER.- SUBDMSION
DATE REQUEST FILED. 4 let)
I
DATE READY FOR INSPECTION
TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN TIES TIME
FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE
CHARGED IF THE STRUCTURE DOAS NOT MEET ALL APPLICABLE CODES.
SIGNATURE
ROUTING
D.P.W. — WATER METER DATE LZ— �?-43
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIOR TO THE INSPECTION REQUEST DATE.
SIGNATURE 7 DPW AUTHORIZATION
Date...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
`114
.............................
This certifies that . ...................................
has permission to perform
wiring in the building of.2�)-L'.Ut.-A .......... .............
Z
at .... ...... 1Z �/� ........ . North Andover, Mass.
......... . :;
Fee ... 1-51" Lic. No../_.")�.— .....
AL INSkCTOR
--Check#
5 1". 16, �_
I
4
11�_
Commonwealth of Massachu tts
Department of Fire Servi es
rVi
BOARD OF FIRE PREVENTION RE ULATIONS
APPLICATION FORIPERMIT
All work to be performed in a4cordance with,
(PLEASE PRINT IN INK OR EA
City or Town of. (Jon "
By this application the undersigned gi'�es
Location (Street umber) �5) -7
Owner or I t �, V'^. r-1 A A
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps Volts
New Service Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Official Use Only
Permit No. 5- 4��2 , /
Occupancy and Fee Checked
,[Rev. 11/991 (leave blank)
0 PERFORM ELECTRICAL WORK
Massachusetts Electrical CXod( EC 527 CMR 12/0
)N) Date:
�J S1
Ap— To the Ins ector of Wires.-
intenqon to perf"the electrical work described below.
Telephone No.
) <1 — /"<� t —_
Yes NO -X" (Check Appropriate Box)
Utility Authorization No.
Overhead 0 Undgrc!F� No. of Meters
OverheadEl UndgrdE:l No. of Meters
Cnmnlptinn nftho t'nlln; fnAID —, )�� -;,"d 1- il" T--- rW;_
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans -
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
t,
Swimming Pool Above In-
grnd. grnd.
No of- Emergency Lighting
BaiieEy Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAi��ISNo.
of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number I Tons JKW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
uni�dpal
M El Other
tion
No. of Dryers
Heating Appliances KW Q�Security
System -
ces or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANC BOND F1 OTHER El (Specify)
Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, undertAepains andpen It* !f jury that the information on this application is true and complete.
FIRM NA. S=Q C 1A r-�
, , Y)�� A ies o per LIC. NO.:
Licenseec.� r, \ 1A1 /, 1AD.Z_ — Si_2n_aturV-Q,&S C -I,,, __JIC. NO.:SSCO 0()()-7--�
(Ifapplicable, enter in the lice A numb Alt. Tel. No.:
oea�t Vi M
Address: \5. 4 . 6.4A- A Qkus. Tel. No.J-�72-r, .6-7-09 13
a , GT VA 7
OWNER'SINSURA CEIAIA1171 ity insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (chec one) [I owner El owner's a t
Owner/Agent
Signature Telephone No. PE"IT FEE:$
k1l
P'�
fw_...m
01)
NOTES
BA -(�)
0
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CIARDELLO
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Ln
E I EXISTING
N'2 FOU - NDA110
F 0
AM - 5—
�V T =51.6 T.O.F.=63.73
r I
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u T
_Q -x
INCLUDING MARENGO STREET
AREA=61,104 S.F. 34.8,72'
=1.40 ACII
L,540.85
W - RL""( I F\ U A L)
AVE UBLIC-66 WDE)
(P
1. SEE BOOK 727 PG. 397 FOR SITE DEED. SEE ASSESSORS
MAP #22 LOT #1 AND #25 FOR SITE.
2. ZONE DISTRICT OF SITE IS R-4, SUBJECT TO COMPREHENSIVE
PERMIT.
uj
(L I HEREBY CERTIFY THAT THE BUILDING IS LOCATED ON THE
a.
0
1 LOT AS SHOWN
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L64.EV
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EN D
PLAN OF LAND
IN
NORTH ANDOVER, MASSACHUSETTS
DRAWN FOR
HIGHVIEW LLC.
1501 MAIN STREET—SUITE 47
TEWKSBURY, MA 01876
SCALE: 1"=40' DATE: JANUARY 11, 2006
0 20' 40' 80' 120'
TM 22 TL 4/5
MERRIMACK ENGINEERING SERWES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
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PLAN OF LAND
IN
NORTH ANDOVER, MASSACHUSETTS
DRAWN FOR
HIGHVIEW LLC.
1501 MAIN STREET—SUITE 47
TEWKSBURY, MA 01876
SCALE: 1"=40' DATE: JANUARY 11, 2006
0 20' 40' 80' 120'
TM 22 TL 4/5
MERRIMACK ENGINEERING SERWES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
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Town of North Andover � O�
V%ORTH
_' -4.
, '16
Building Department
27 Charles Street
North Andover, Massachusetts 0 184 5 94
(978) 688-9545 Fax (978) 688-9542
CHU
APPLICATION FOR CERTIFICATE OF OCCUPANCY If INSPECTION
ADDRESS 511 W
Iwo, 0
LOT NUMBER SUBDMSION
DATE REQUEST FELED
' I
DATE READY FOR INSPECTION It:,;
TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUMED
ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN TIES TIME
FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WELL BE
CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGNATURE
OFFICIAL USE ONLY
ROUTING
1. D.P.W. – WATER METER 4) �-- —1 Z W DATE I- lz_– 11 _67-4
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIOR TO THE INSPECTION REQUEST DATE.
SIGNA
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that . . . . — . . P.- . !"'. . . . .
has permission for gas installation .... A .'�. ... /�� C'. .'-. . .
in the bu ildings of ... ..........................
-'11 - ( 11
at ............ North Andover, Mass.
Fee. Lic. No../ . ......
GAS INSPECTOR
Check
4 4 4 "1
MASSACHUSETTS UNIFORM APPLICATION, FOR PERMIT TO DO
(Print or Type)
TTING
C
,T"1r111
Z
Cr
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Mo 41ije 114�e- Mass. Da t e 0`7
City, Town
Building Permit #
AT: Location -5/SwAo Owner, s
Name
New
Renovation[]
Plans Submitted Yes[] No[]
Type of Occupancy:
Replacement
SUB—BSMT.
BASEMENT
1STFLOOR L
2ND FLOOR
3RD FLOOR
4TH FLOOR
STKFLOOR
OTHFLOOR
E LOOR
7T IKI:F :q4
8TH FLOOR
(Print or Type)
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I �crcby certify that all of the details and Information I have submitted (Of entered) In abo PPIiCation ate true and accurate to the best of my
knowlcdle and that AU Plumbing work and lAst"AtiOns Performed under ve'a
Provisions of the �Ussach Permit issued for this APPlication wiI.I be In
"Otts State Gas Code and Clupte, 142 of the General Laws. ComPU&ncO with L11 Pertinent
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
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knowlcdle and that AU Plumbing work and lAst"AtiOns Performed under ve'a
Provisions of the �Ussach Permit issued for this APPlication wiI.I be In
"Otts State Gas Code and Clupte, 142 of the General Laws. ComPU&ncO with L11 Pertinent
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
umber -10
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.aster lumber or Gas itter
Journeyman /W — I OS -0 V
License Number
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1 0
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Date. (:��? - /'� - 0 ?
............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . . 'Z> ��A F. .........................
has permission to perform ... k.�
plumbing in the buildings of ................
at ..... (A LA. /4.Q. ............ North Andover, Mass.
Fee. Lic. No../ ........ 97 ... Q ......
'PLUMBING INSPECTOR
Check # 13 '- '( �-
5722
'IV
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 PLUIMBING
fPrint or Type)
Mass. Date Permit#,
Owner's Name
Building Location -------
Type of Occupancy
VN
New Renovation Replacement Plans $rfb<ted Yes El No 0
P
FEATURES
Installing Company Name Dukrcec- P*,44q- --
Address
Business Telephone? ve- gog-f
Name of Licensed Plum.ber ffAwtc-s -buferee—
Check one: Certificate
- � Corporation
7- Partnership
:-- Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes 3�-� No
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 7:1 Bond —
OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one�
3ignature of Owner or Ow—neCsAqen—t.--- Owner 1-.� Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will
be in compliance with all pertinent provisions of he Massachusetts Sta lumbing cle and Chapter 142 of the General Laws.
By
na u e oFUicense u r
f Li
Title 4cense� Master Journeyman
CityfTown License Number—M-1-6-SOY-il
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Installing Company Name Dukrcec- P*,44q- --
Address
Business Telephone? ve- gog-f
Name of Licensed Plum.ber ffAwtc-s -buferee—
Check one: Certificate
- � Corporation
7- Partnership
:-- Firm/Co.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes 3�-� No
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 7:1 Bond —
OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one�
3ignature of Owner or Ow—neCsAqen—t.--- Owner 1-.� Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to
the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will
be in compliance with all pertinent provisions of he Massachusetts Sta lumbing cle and Chapter 142 of the General Laws.
By
na u e oFUicense u r
f Li
Title 4cense� Master Journeyman
CityfTown License Number—M-1-6-SOY-il
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . D(-. 0. P-. r� '-7 .... ./.-/ ..................
has permission to perform ..... K). C- .............
plumbing in the buildings of .... /'� 4<�,( ....................
at .... �—/. ) 7. . . ��. A9. /-. . ( .............. North Andover, Mass.
F - 3 Lic. N o. . /0). .6. Y. (711
ee..� — Y - . U.
PLUMBING INSPECTOR
Check # 13 ') (4 %--
5721
7,
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
i�lrint or Type)
AJO, A)J0 V.Sx Mass. Date P -.,Permit#
Building Location --S-16 W"irktv led, Owner s Name 4 h
N5 V Type of Occupancy
N e w Renovation Replacement Plans Submitted Yes __! No D
FEATURES
Installing Company Name—D
q Art- B'%ev,, 0 Check one Certificate
Address 77 4hg:,J rwe P_ Corporation
W M4 Z- Partnership
Business Telephone ;L S -S
Firm/Co
Name of Licensed PlurRber -TArqE5 T,
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Y e s 5�� No -_
If you have checked yes-, please indicate the type of coverage by checking the appropriate box
A liability insurance policy iw� Other type of indemnity 7. Bond
OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insu(ancp coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application �vatves this requirement.
Check one
Owner Aclent
Sictriature of Owner or Owner's Agent
I hereby cerlify 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 application will
ns of the Massachusetts
be in compliance with all pertinent provis;io,. - Itate Pfumbing Code and Chapter 142 of the General Laws.
By _6 .....
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Title Type of License: master Joutneyrnan
CityfTown License Number - 4/ - -
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Address 77 4hg:,J rwe P_ Corporation
W M4 Z- Partnership
Business Telephone ;L S -S
Firm/Co
Name of Licensed PlurRber -TArqE5 T,
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Y e s 5�� No -_
If you have checked yes-, please indicate the type of coverage by checking the appropriate box
A liability insurance policy iw� Other type of indemnity 7. Bond
OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insu(ancp coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application �vatves this requirement.
Check one
Owner Aclent
Sictriature of Owner or Owner's Agent
I hereby cerlify 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 application will
ns of the Massachusetts
be in compliance with all pertinent provis;io,. - Itate Pfumbing Code and Chapter 142 of the General Laws.
By _6 .....
igna re o icens um r
Title Type of License: master Joutneyrnan
CityfTown License Number - 4/ - -
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that . F. -r ....... /��. /-.7/ ..............
has permission for gas installation " * & ' f '-. .-� .........
in the buildings of ... 14. ............................
at ... �A- /. ... ?�'. Y. _r
...... /,, .......... North Andover, Mass.
Fee. . Lic. No. !i�'. ........
J GASINSPECTOR
Check# k
/-.k 4 4 2
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Typo)
Mass.
.Date L Permit#
Building Location Owner's Name
N o w R"" Renovation 0 Replacement 0
Type of Occupancy
Plans Submitted Yes 0 No C:)
Installing Company Name 4) o tR)L 4g -,Z_- Chock one: Cort1ficato
Addres3 -7 zJ
T7� n P, 0. Corporation
9,T 0 Partnershlp
BUSInOS3 Telephone 508 SS 557.5- 0 Firm/Co.
Name of Licensed Plumber or Gas Filter -
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial OquIvalent which meats the requirements of MGL Ch 142.
Y 0 N o 0
It you have chp.cked yes, please Indicate the typo of coverage by checking the appropriate box.
A liability Insurance policy O�'� Other type of Indemnity 0 Bond 0
OWNE ' RS INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 o . f the Mass. General Laws and that my signature on this permit application waives this requirement,
.-Check one:
Owner 0 Agent 0
:�31.qnalur'� of -owner or Owner's Agent
I lluruuy cavury inat aii or ine celalis anc; information I have submitted (or entered) In above application are true and accurate to
t he bost-of my knowledge and that- all plumbing work and Installations performed under the permit Issu&d for this application will
be In compliance with all pertinent provisions of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws.
By jype_ of License Q
UJ-Mumber
SwG a s f I t t e r 41 na��tlure of Lic s d Plumber o as Fitter
Citv/'Town 0 Journeyman conso Number,,
A:-PROV I� �N�
j
---MEN
an
MEN
1 ST FLOOR
MEN
0
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mom
mom
0
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NONE
MEN
No
So
MEMO
EMEMENEENOWN
Installing Company Name 4) o tR)L 4g -,Z_- Chock one: Cort1ficato
Addres3 -7 zJ
T7� n P, 0. Corporation
9,T 0 Partnershlp
BUSInOS3 Telephone 508 SS 557.5- 0 Firm/Co.
Name of Licensed Plumber or Gas Filter -
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial OquIvalent which meats the requirements of MGL Ch 142.
Y 0 N o 0
It you have chp.cked yes, please Indicate the typo of coverage by checking the appropriate box.
A liability Insurance policy O�'� Other type of Indemnity 0 Bond 0
OWNE ' RS INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 o . f the Mass. General Laws and that my signature on this permit application waives this requirement,
.-Check one:
Owner 0 Agent 0
:�31.qnalur'� of -owner or Owner's Agent
I lluruuy cavury inat aii or ine celalis anc; information I have submitted (or entered) In above application are true and accurate to
t he bost-of my knowledge and that- all plumbing work and Installations performed under the permit Issu&d for this application will
be In compliance with all pertinent provisions of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws.
By jype_ of License Q
UJ-Mumber
SwG a s f I t t e r 41 na��tlure of Lic s d Plumber o as Fitter
Citv/'Town 0 Journeyman conso Number,,
A:-PROV I� �N�
j
I
Date. 0.3 .......
0',,,-- "
TOWN OF NORTH ANDOVER
0 PERMIT FOR WIRING
IF "FR—W
Tfq --4—
ACHU
This certifies that-:-Z�..Gaae-)Ar. .........
has permission to perform �%A..Avk— .::Tpek��P .....................
wiring in the building of. ..........................................
at ... ................ . North Andover, Mass.
Lic. No.A .. 15J.70 ... �.. .. �.-x-�.
INSPECMR
Check # OA) /"7-
4726-4 ,S- 6-C- Rvo * / 7 4 /65
TDE COAMONMEAUH OFAASSACHUSETIS Office Use only
DEPARTAMWOFPUB11CSAFETY Permit No. 7 ol 4/9
BOARD OFFMPRLVEMONREGULAHONS 527 CM 12 M
Occupancy & Fees Checked
APPLJCATIONFORPERAIRTTOPERFORMELE=CALWOIZK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
q ?
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the eleatrical work described bel
Location (Street & Number)
P / A
Owner or Tenant )VlohaifiaLi
Owner's Address U /fC.7 A
nU ////Y lei 6u
Is this permit in conjunction with a building pen -nit: Yes =-No (Check Appropriate Box)
Purpose of Building Utility Authorization Nclair
Existing Service Amps Volts Overhead M Underground No. of Meters
No. of Meters
New Service AnI Wolts Overhead r-71"Vn—derground
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
—Tota—1
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
ground
ground
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
FiConnections
Other
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER-
hMMXGDV2rag-- Rusu=todrmWmyiffzofMn�GffrralLaws
Iha,& aameriLmbihtyhi%m=PbhryiwkdTCmplefe Opqp5em Ccwa�gecrits mbsMnfWe#vakit 'M [�NO
Ibawatmoadvandpfo4ofsanrtodrOffio,-- YES r77T r -7p If�wInwdrckpd YES, ple2wm1caed)etA1mofoowWby
checking the VptQEnale box --- F_J L --J _j
MER F ftase Spec,�)
WSURANCE BOM 4&&& a&?
%-� B#26c�Dalc
EstmabdValneofEloc"Wbik $
W01k to Staft hWedmDa1cReWes1Ed Rwgh Final
4 ; 1 1&7 -::: R, '-;of ;1
I-KnwNo
Bustress Tel. No.
' � 17�� —
AddItess. ClLe�- �,L 1.0- 7� / At Tel No. 9 6/A2.
OWNER'S INSURANCEWAIVER, lam awate that ffeLicense does nothave theinstrancemvetage orits sLftxy`epvalcntaswqLmed byMassa�- Ctnerall-aws
"dial my sigmueon this permttapplicton watves dis tegWitertent
(Please check one) Owner A-ent
�Signature ot Uwner or Agent lelephone No. PERMIT FEE A
Location:
I am a homeowner performing all work myself
EJ
I am a sole proprietor and have no one working in any capacity
am an employer providing workers' compensation for my employees working on this job.
Company name:,..
Address
Phnnp *7
Insurance Co. Polia #
Compgny.name:
Address
citc. Phnnp*-
insurance Co. Poligy
mG 2 can ead to -the imposition of criminal penalties of.a fine up to $1,500.00
Failure to secure Coverage as required under Section 25A or L 15 1
andior one yeare irriprisonfftent-as-mmfl-as-ciyil.penaftiesin-thelmn-da-STOP.WiDRK-ORDERaW-a.fh. e-of-($I-O.OM)-ajziayigainst.me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification.
I do hereby certiry under me pains and penalties of pedury that the WWW6017 provided above is true and correct.
—Date—
Signature
Ptione
Print nam.
do not write in this area to be completed by city or town officiar
official use only .
Permit/Licensing
City or Town ----------
El
Building Dept
Licensing Board
E]Check,f immediate response is required
Selectman's Office
Phone
Health Department
Contact person:
0
Other
TBECOAMONREALTHOFAMS4CHUSMS Office Use only
DEPARTA1EW0FPUBUCS4FL7Y
Permit No.
BOAMOFFREPREVEMONMGULAHONS527CM12M
Occupancy & Fees Checked
APPLJCATIONFORPERMTTOPERFORMELE�T
' L 0
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CCDE, 27c ®R12 -:00W
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work ed below.
Location (Street & Numbyr)
1 1
Owner or Tenant
Owner'sAddress— 2io, bu XYIX=4�c 121,11. 04-60
Is this permit in conjunction with a building permit: Yes [D—NO F-1 (Check Appropriate Box)
Purpose of Building A /to a) //041 Utility Authorization No./ NAr
Existing Service Amps Volts Overhead UCqderground No. of meters
New Service Ampst �()/,;�)Volts Overhead =,-Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
gr
ound
E3
ground
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
Connection
No. of Water Heaters KW
No. of No. of
igns
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER.-
hwranceCc)wraga Rusu=todrmp=ia&ofMass�GardLa-,As
Ibaw acuuentLmbi*kBtzancePbhqyff rhxhng Cayptle2tel2LaadoosQ=critsabsuntWeqLnvalert YES � NO
IhawmbmttbdvalidpfcofofwwtDdrOffim YES lf)uu hawchWked YES, pba�em&aje- thet)peofcowta�p by
checkingthe bo
INSURANCE F, ---T BOND MIER Mease Specify)
-BT6lfcnDate
E1matDdVakr,ofEbdncalWbjk $
I I I -
101PA Z
and diat my signancon this peimt application waives this fequiturent
(Please check one) Owner Aoent
Signature ot Uwner orTgent
Rough Final
AIL Tel No -f 2f -
oritsabst?ntuleovaleriasroc#*edbyMassaiRLIMC,aiffdLax,vs
Telephone No. PERMIT FEE ccv
Name:
Phone #
city I am a homeowner performing all work myself
El
1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees woridng on this job.
Address
Phone #7
Co
Address
Phone$k
Ci
er Section 2M or MGL 152 can lead to,the imposition Of crinin2l penalties of.a fine up to $1,5W-00
Failure to secure coverage as requIred und _ORK_oRDER-a)d-afme-of-($IMM)-ajciayagainstme� I
nt_as_weu_as-chni-penaftiesb-thelj=O.a-STOPW verific on
and/or one years' in"PrisOnMe to the office cf Investigations of the DLA for coverage 3fi
understand that a copy of this statement may be forwarded
/ do hereby cerW under the pains and penalbes of peflury that the ff#onat,0n provided above is &w and Correct
Signature
Pbone-#-
Print name
official use only do not write in this area to be completeq by city or . town dficiar
permit/Licensing
city or
El Building Dept
r-lCheck f immediate response is required
Phone
Contact person:
.[] Licensing Board
f-1 Selectman's Office
El Health Department
El Other
ff
Date ... ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... 10-1 <�Z ....... .� .....................
has permission to perform ........ /� .............................................
wiring in the building of ............... zx..-;:�� ...............................................
at ......... North Andover, Mass.
T
Fee.)..;�.!2 . . .... Lic. No . ............. I ............ I
...... L� ..... 1� ... .. ........
Check # 2 2 � V? ELEcrRICAL INSPEcrOR
4-7/2" 7
MERRIMACK COLLEGE
PAYMENT VOUCHER
DATE: 3 -Sep -03
PAY TO: Town of North Andover
27 Charles Street
North Andover, MA 0 1845
CHECK STUB Quarterly Permits
INFORMATION: October to December
FOR Gas, Plumbing and Electrical
WHAT: $250.00/each
TOTAL PAYMEN— $750.00
DISTRIBUTION,
Account No. Amount
10-6010-6339 -------------- ---------- $750..00
-----------------------------------------
--------------------
APPROVALS:
Locationotc—*3 �0
No. 530 )) 4 Date -0-3
,,4011,rN TOWN OF NORTH ANDOVER
Certificate of Occupancy $
4[ C)
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
pj/( I"
6 6 9 4
V ' guilding Inspector
N /F
FOURNIER
50,00,
LOT #3
AREA = 15,378 S.F.
. -0-35 AC.
30.7'
34.9'
co
t --
GN
N/F
THORNE
Y�'530 PA'�L
54-03
Lq
29.93'
LOT #1
'2A.7 I
C14
-p�
90
0
(o
CD
100.11'
WAVERLY
LOT #2
" I HEREBY CERTIFY TO THE TOWN OF NO. ANDOVER
DUILDINC DEPT. THAT THE FOUNDATION IS LOCATED ON
THE LOT AS SHOWN AND THAT IT DOES CONFORM PLOT PLAN
THE TOWN OF NO. ANDOVER ZONINC RECUL4TIONS
RDINC SETBACKS FROM STREETS & LOT LINES.- OF FOUNDATION
LOTO
IN
NO. ANDOVER, MASSACHUSETTS
DRAWN FOR
HIGHVIEW, LLC
20 0 10 20
SCALE: 1"=20' DATE: JULY 25, 2003
JlERWACK ENGRYEERM SERVICES
0712512003 66 PARK STREET
STEPHEX-t. ��qlyslu' R.L.S. DATE VlVDOV_FR, MASSACHUSEM 01810
Location
;58 C)
No. Date
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
6 3 5 _3
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
,k1'Pl,l(-.'ATIONTO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: -t- A -i- �3 DATE ISSUED:
o,1
30(
,53
SIGNATURE: Building Commissioner/Inspector of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:
I -v-1-3 Waverly Rd1H,3vu7-1-1uaAje- PZ-
-------
--22 1 and 25
Map Number Parcel Number
1.3 Z(-miingInforniation:
1.4 Property Dimensions:
R-4
/00
Proposed Use
Lot Area (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
Required
Provided
Required
Provided
3 0 ' 3,�r' S
15,
/ -�7 '1 3
3 0 '
13
i.' , �Wiiej SupptyM.G.1-('.40.§54)
1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
ilublic Plivalc
Zone
Outside Flood Zone
municipal On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED
AGENT
2.1 Owner of Record
Irene Fournier
509 Waverly Rd.,No, Andom-ex-,-Ma
��,a n i e. (P 6 n t)
Address for Service
S;guature Telephone
2 2 O\vner of Record:
------------- --
Name Print
Address for Service:
S6
,znature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable 0
R u s s e 11 F . a h e r n ___M-ejdje_r,___RF ACD_Lj,_C
I .1censed Construction Supervisor: 029340
I License Number
103 AiliantiC' Av.,Seabrook, Nh 03874
Address
2/27/04
9 7.9--, 3 0 5 8 0 Expiration Date
Suniaturc Y-01one
.,.2 Regi�tered Home I
. "0111Pany Nanie
Address
V7
Not Applicable R
Registration Number
Expiration Date
MU
M
z
0
0
z
M
0
on
r
M
r
z
0
I SECTION 4 - WORKERS CON11PENSATION (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 ol'the building permit.
Signed affidavit Attached Yes ....... t3i No ....... 0
SECTION 5 Description o Proposed Work (check a)Dplicable)
New Construction R
Existing Building 0
Repair(s) 0
Alterations(s) 0
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brie t'Description of Proposed Work:
construct duplex dwe'Lling
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by pen -nit applicant
OFFICIAL'USY ONLY
1. Building
$90,500
(a) Building Permit Fee
Multiplier
2 ["Jectrical
9,500
(b) Estimated 'rotal Cost of
Construction
3 Plumbing
10,000
Building Perinit fee (a) x (b)
4 Mechanical (FIVAC)
81000
5 Fire Protection
2,000
6 'rotai (1+2+3+4+5) $120,000
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
j.Irene Fournier as Owner/Authorized Agent of subject property
Ffcrct)\ ifflthorize g 11 �qq p 1 1 F - Ab P rn , Membp r , R F A M T,T,P to act on
M.\ be hall' ill all matters relative to work atithoiiz ed by this build ing pennit application.
Signature ol'Owner Date 441 n/n3
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
Ruc;,c;pl 1 P_ Ahprin., Mernber.,REAM T,T,(,- —,as 0,,Nmer/Authorized Agent of subject
propert * y
I lereb ' v declare that the stat - n and into i to- _. fo ng application are tnie and accurate, to the best of my knowledge
and belief,
Ahern, P T.T.r
Print Name
4ZI Z03
Si�njmre oI Ovvner/A) � it Date
loll 10 IN
NO. OF STORIES 2 _ ci SIZE 40-X 28-
BASEMENTORSLAB basement
SM"OFFLOORTIMBERS 211X 10., 2 "x loll 2NE)2"x 101, 3RD 211X 811
SPAN 141
DIMI, NSIONSOFS[LI.S 211 X 610
I)I1M.I_`NSIONSOFPOSTS4" X 4"
DiMI'NSIONS01"GIRDERS101, X 1211
1 tI:IGTI ITOF FOUNDA YION 8 1 TIUCKNESS 10 11
SIZE01:1100TING, 10,, X 2011 X
MA'I'I:IUAl.OFCI-f1N%EY mpt,,1
IS BUILDING ON SOLID OR FILLED LAND Sol i d
IS BUILDNG CONNECTED 1-0 NATURAL GAS LINE will hP rnnnPrf-.PH
C� 3
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***********************
j:rq I- d, 1 Y
APPLICANT s S C �t,-r /-I,. ez
PHONE e 0,�
LOCATION: Assessor's Map Number_a�lqa PARCEL -1-4,I)
SUBDIVISION f -?,p LOT (S),_?,
STREET ST. NUMBER -,W"
*****************************�nOFFICIAL USE
REC0MMffNVAT1,0NS; OF/YOA AGENTS:
Comm
11
ER
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED—
DATE APPROVED
DATE REJECTED
DATEAPPROVED
DATE REJECTED
I
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT /4
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9\97 im
N/F
THORNE
50.00
N/F
FOURNIER & HER13ERT
LQT
AREA
-15.378 &F.
=0.35 AC.
29.93
PROP. lolx2o-
PAR KING SPACE
AGE
DER*
Ld
0.
CL
w
z
34.91
as
&=mums
WAVERLY ROAD
"S'
PLOT PLAN
NOTES
PROPOSED LOT CONSTRUCTION
FOR
1. ZONE DISTRICT R-4
2. EACH UNIT IS A 3 STORY 3 BEDROOM
UNIT-
ARTHUR L. FOURNIER
WI TH A GARAGE UNDER
IRENE HERBERT
3. SEE ASSES�ORS MAP #22 LOT#1 FOR
SITE.
SEE DEED BOOK 727 PAGE 397 FOR SITE.
0 20
40 80
SCALE: 1 40'
DATE: APRIL 16, 2003
ME.R.R11OCK.- ENGINEERING SER\ACES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
TOWN OF NORTH ANDOVER
Office of theBuilding De)artment
.1
C01111,111111i'lly Development and Sei-vices
27 Charlc� Street
North 01845
D. Rnkrl Nicetta,
11),ifilditto Commissioner
April 4,2003
Russell Ahern
DBA RFACO, LLC
103 Atlantic Ave.
Seabrook , N.H. 03874
Dear Mr. Ahern-.
6 0
FAIX (9 1 S" 12
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. -
I ) 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 forin 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
GROWTH MANAGEMENT BYLA'W EXEMPTION STATEMENT
TOWN OF NORTH ANDOVERBUJILDING DEPARTMENT
This form shall be used to assist the Building Department in their determination of exe tion under section
8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall proovide all of the
necessary information as Tequested beloyv. I-o 7—__?
/Iz� i� 5 -e-(( /C /� (le� /-1 ei" 41-41C W A t/z, (6
124--6 <f�d
Permit Applicant
1�i' -7 A - (-) -2 ;) <-
_Z6?7,,�A wt,�_ A4�_ . _/ ?� J S
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.
- This 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.
Ile 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 by the planning board that will ensure its protection.
- This application represents a tract of land existing and not held by a Developer in common ownership w ith 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.
This 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
ENEMPTION.
PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A
DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS.
BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED
BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE.
FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE
CHECKING OFF OF A ABOVE EXEMPT9N WHICH DOES NOT COMPLY,
NOT IS GR S FO WHETHER DONE To My KNOWLEDGE OR
U T BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT.
AP ICANTS SIGNA-1 uEE
DATE
TFJIS FORM TO BE ATTACHED TO TBE BUILDING PERMIT APPLICATION
he Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
S- et� A e
Name: --------
Location: 2 (,,-YtV
cit\/ 1,U A 1`7 v't Phone #
F71 am a homeowner performing all work myself.
F-1 I am a sole proprietor and have no one working in any capacity
121 1 am an employer providing workers' compensation for my employees working on this job.
Comoanv name: Ve G A,1-eJ-r
Address i LVY -7
City: 0,/
�- 7 C-"/ Phone #:
(A-) Policy#
Company name: I
Address
City: Phone #:
Insurance Co. Poligy # $1,500.7 ...... .
ailure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to
and/or one years' imp ris onment.as.wefl.as.civ.ii.penalties in 1he Iormofa STOPWORK -ORDJERand -afine.of.($10.00) -aday.against me.' I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
e Ith
clo hereby certify under theoins an p e a a information provided above is true and correct.
Date
Signature
e -26'0 01,? 6'
Print name //I-- t, A Rbon
Official use only do not write in this area to be completed by city or town official
City or Town. Permit/Licensino
Building Dept
nCheck If immediate response is required Licensing Board
El Selectman's Office
Contact person. Phone Health Department
Other
INSURANCE IN TOUCH WITH BUSINESS
Direct Assignment Operations
P.O. Box 4965
Orlando,FL 32802
February 7, 2003
ORANGE STREET DEVELOPMENT INC
1501 MAIN STREET
TEWKSBURY, MA 01876
Customer Service 1-800-842-9482
Fax Number 1-407-649-2918
Claims Reporting 1-800-832-7839
Policy No: 995X814803
Effective Date: 01/15/03
CNA has been assigned as the servicing carrier for your Assigned Risk Workers Compensation Insurance policy. We have
contracted with The Travelers and its affiliate Constitution States Service Company to service your policy, and we welcome
you as a customer.
We have received your application and premium. Your policy will be issued shortly. In the meantime, should you find it
necessary to file a claim or communicate with us, please note the following:
For Claims Reporting: For Policy Services:
1-800-832-7839 1-800-842-9482 x3755
CNA
Direct Assignment Division
P.O. Box 4965
Orlando, FL 32802
The Claim Reporting system is a toll-free service that is available seven days a week, twenty-four hours a day. Usage of
this system has been proven to provide significant benefits, with the immediate assignment of a Case Manager, automatic
production of the First Report of Injury form, and earlier resolution of employee claims.
Safety and Loss Prevention are critical concerns to any business. We have long been a pioneer in the field of accident
prevention, having the experience, resources and capabilities to provide a complete range of safety services. Your policy
will include more details regarding these services.
Please keep this information available. Reference the above policy number on any correspondence and have it available
when contacting us or submitting correspondence.
0
It is our pleasure to work with you. If we can be of service, please call.
Sincerely
JENNIFER MCMANUS
Account Manager Underwriter
Orlando Service Center
Cc: FRED C CHURCH INC
ONE MERRIMACK PLACE
LOWELL, MA 01852
NOTICE OF ASSIGNMENT
COMBOLD_
EMPLOYER: OR2%NGE STREET r.EVEJ,.OPj4ENT INC 000267563
1501 MAIN ST
TEWKSBUR'j, KN 01876 COVERAGE GROUP
0267563
The Waiver of our Right to
Recover eron othexs Sndcrsenlent
r� polic"es,
is available OR PO�'
Contact you,, _:tger,,t for details.
AGENT :.,RED C CNIJRC14 INC
on ONE MERRIMACK FL
PF;OOUCER'- LOWELL, 14A 01852
AGENCY FEIN: 042445292
7.'f _-1C _0fu75N_6T__0 P
STATUS OF EMPLOYER
co.-Poration
Coverage under this ass'Lgnment
applies to Massachusetts
operations Only. For coverage
outside of Massachusetts, contact
the appropriate Pool Or Plan for
that state,
INSURANCE COMPANY'
CONTINENTAL CASUP�LTY CO
MS. TINA SMITH
p 0 sox 4965
ORL&NMO, FL 32802-4965
(800) 842-9482
T' MA I SD
PREMIUM
CODE TOTAL A.DWJA11,
REMUNERATION
__1 ----------- ---------- -----------
CONTRACTOR-EXECUTIVE SUPEPVTSOR 56.06
$62,800 2.65
$28,000 16,60
$1,664
$4,648
5403
CARPENTPY-NOC
9845
ExPLOYERS T-,IAB:LITY 1001100/500
$6,312
STANDARD PPEM31UM 0900
S 2 44
EXPENSE CON-STA14T
$6,556
EST'FMATEP, ANNUAL PREMIUM
$284
017% ASSESS. 4.5% OF ST.MDARD PREM.
-----------
$6,840
EST - ANNUAL PREM. pLuS ASSESSMENT
REQUIRED OF -POSIT PREMIUM
$6,840
INSTALLMENT BASIS, Aj,,nual
COMMENTS
Coverage effective ^'.';Ol AM Or'
(:opies of inGured's four most recencl -y filed
Form. 9418 or DET Form is
the application. Please
did not
forward these
accompany the app).icaci.on as required in Part V1
listed
of
above.
records imynediately to tbe inz-,;rance company
PREPARED13Y,. Joanne Shea
VATEOFNOT10E- 01/7,5/03 EXT 530
voLuMARY DIRSCT ASSIGN149NT
COPY: EMPLOYER
p LETTERIV� .365757
The Workers' Compensation Rating and Inspection Bureau of Massachusetts
161 Arch Street -Boston, MA 02110
(617)439-9030 - FAX (617)439-6055 - www.wcribrna.org
04/15/1996 00:11 1111111111105
MASclhpc)� COMPLIANCE REPORT
Massachusett-8 Energy Code,
MAScheck,Software version 2.01 Release 3
CITY: Noxth Andover
STATE: Massachusetts
HOD; 63�2
CONSTRUCTION TYPE: I or 2'Family, Detached
HEATING SYSTEM TYPE: other (Non -Electric Resistance)
DATE: 10-17-2002
COMPLIANCE: Passes
Maximum UA = 334
Your KoAie - 259
PAGE 02
I Pemit
Checked by/Date I
I
The'heating load fortliis building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the -Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design �qad as specified in
sections 780CNR 1�10 and 14.
Builder/Dezigner 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,, 3.6" G.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: Over Uncondition0d Space
560 1910
0.0
.26
HVAC EQUIPMENT: Furnacej_ 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 ineet the requirements of
the Massact.ugetts
Eriergy
Code.
The'heating load fortliis building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the -Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design �qad as specified in
sections 780CNR 1�10 and 14.
Builder/Dezigner Date
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