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Miscellaneous - 54 LONG PASTURE ROAD 4/30/2018 (4)
Lo*-7PA sju RE J -- _ A49 Ilo 10 i Date....-2�..:a..�..... v f _, f Na DTI,1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING a ��SS�cHusE� r This certifies that ........................................��?.: �-s � �-....................... 1� _ has permission to perform ........-.................. L' � wiring in the building of.............._.. ...... at... -r..,f...s--.~A ..�.�). - r�.r L. . . ,North Andover,Mass. Fee�' ............ Lic.No:�/ G?'............... . ... ..� . LECTRICAL DOE Check # 8307 Commonwealth of Massachusetts Official use only Permit No. ,Q3 6 Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g/� 2-10 8 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. L Location(Street&Number) O m, k9G S*k-\J (' 4e- Owner or Tenant - Telephone No. Owner's Address S2,-o -7/s-Z Is this permit in conjunction with a building permit? Yes No ❑ (Check Approp)iate Box) - Purpose of Building v-712 Y CX- ;' Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd No.of Meters New Service /0`0 Amps 1,20 l..1 yo Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity - 10-0 p` -P Location and Nature of Proposed Electrical Work; . !:T �n� �G -y g-P.! -J C� Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA t No.of Luminaire Outlets No.of Hot'Tubs Generators ' KVA No.of Luminaires Swimming,Pool Above ❑ In- El o EmergencyLighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ....... ...................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterNo.of No.of Data Wiring: , Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: ' Attach additional detail if desired, or as required by the Inspector of Wires. j Estimated Value of Electrical Work: (When required by municipal policy.) r Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: S H Q f ti LIC.NO.: f/� 6 2- Licensee: Licensee: f•LQ RjN,� Signature t �_� LIC.NO.:.// 6 2— (If applicable, enter"exempt"inhe license nu r line.) Bus.Tel.No.: l 13`y 0032 Address: VA 3 C1,P.SFn v r _C I - r- (r'^ -o- A 0 7,02 � Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent. Owner/Agent i7dy Signature Telephone No. PERMIT FEE: $ �,y .a..., �., ;,,. c r ., The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UIP www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i Name (Business/Organization/Individual):� Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with I 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 11. Plumbing 3.❑ I am a homeowner doing all work right of,exemptton per MGL ❑ g re pairs or additions myself. [No workers' comp. c. 152, 0(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Otherfi-C.#--Q E-9(,'� comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C�Oi''t � ��Sy rte, �--� (Ha1� J ` C Cy Policy#or Self-ins. Lic. #: Expiration Date: �e Job Site 5te Address: t9 In��cS City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 'of up to $250.00 a day against the violator. Be advised that,a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce 'y u er th pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: z Phone#: LY-0 O —-3 Z 6 g Official use only. Do not write in this area,to be 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#: 4173 Date... .. � .. � NORTH °ft °:•'"� TOWN OF NORTH ANDOVER 0. F c. NA PERMIT FOR WIRING , �,SSACMUSEt This certifies that ..........4 /--..... 1 f �... /.. C....:......................... has permission to perform ......./Ufi•'P. ..../7. ...................................... wiring in the building of . CeU `f ��"y �Q 5fq�� ash at.... ........ .............. ........ ...............-.. ,North Andove ' ,117 Fee..V . .' (D.... Lic.N ELECTRICAL INSP R Check # �� IvI ClmnwnW- da&O/Vaeaacfuc aj FO I e 777 - � cc jj�� �c77 (Rev,11/99)wi�k 241rprarLawnl 0 ire�trvic� Pertnit Number. Occupancy&FeeBOARD OFFIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (AL1 WORK TO BE PERFORMED WrrM THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: L City or Town of: il, //n,i, c--I . To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electri I work described below. Location:(Street&Number) Za gz Ila Owner or Tenant: Owner's Address: Is this permit in conjunction With a i!din Pernit? Yes p J 9 'm—'Zo ❑ (Check Appropriate Box) - Purpose of Building• f-, �,; wc% tiiity Authorization#:_ 21 y_-Z U Existing Service: Amps ' V6/Its Overhead El Underground.d of Meters i r New Service: z��/ Amps',�?y / �J Volts Overhead ❑ Undergrourd � #of Meters: Number of Feeders and Ampacity: Location,and Nature of Proposed Electrica!Wcr;;: No.of Recessed Fixtures Ci No,of Cetl.-S,usp.(Paddle)Faris No. c,Transformers Total KVA No.Of Lighting Outlets i No. of Hot Tubs Generators ^ KVA No. of Lighting Fixtures -Z U Swimming Poo.: Aboveground ❑ :n Ground a #of Emergency Lighting Battery Units No.of Receptacle Outlets - / No. of Oil Bumers i Fire A:arnS #of Zones #cf Detection&Inliating Devices i No.of Switches � No.of Gas Bumers #of Sounding Devices: ,L=_ I #of Seif Contained fs No.of Ranges / No, of Air Conditioners TOTAL TONS: Deteciion/Sounding Devices I Z Local^ Municiba'Connection n Other o No. of Wasle Disposals Heat Pump Totals: Sacuery Systems: �.. . Number TONS:__ KW: _ No.of Devices or Equivalent N,,,.of Dishwashers / Space/Area Heating:__ KN Data Wiring,No.of Devices or Equivalent: No.of Dryers Heating Appliances KW Telecommunications Wiring:No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: #of Ballasts: OTHER; «of Hydro Massage Tubs o 9 Nc_of Moto^_ _Total H. _ INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of olectrical work may issue unless the licensee provides proof of liability insurance including"completed operation'coverage or Its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 3- /BOND o OTHER ❑ Please specify: Estimated Value of Electrical Work$ (When required by municipal policy) Work to Start: �U ^ v — G Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify,under the pains and penalties of perjury,that the Information on this application is true and complete. Firm Name: rr sir � LIC.# y 3 Licensee / ,`�� l= _ / f C� Signature LIC.# 5 3 / (!f applicable,ent "ex pt"in the rcen5iffumber line) Address: v Gf Sf B Te a 7`2-1G AI;.Tel.« _ OWNER'S INSURANCE WAIVER.I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) Owner❑ OR Agent c Signature of Owner/Agent: Telephone# PERMIT FEE:S Consnronmaatlh of//Jadaaclttc�el�! Fo 1 e s ly r� (Rev.11199) ` ' Pertnft Number. / 1JtPartnisr,�a �%n�arvicai Occupancy&Fee I BOARD OF FIRE PREVENTION REGULATIONS � a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WrrH THE MASSACHUSETTS ELECTRICAL CODF 327 CMR 12:00) PLEASE PRINT IN INK OR TYPE•ALL INFORMATION Date: e'/ Z-- City or Town of: i �n � n To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the etectri I work described below. -_ Location:(Street&Number) r 1117 Owner or Tenant: Owner's Address: Z. i — Is this permit in conjunction with a Bdilding Pennit7 Yes �❑ (Check Appropriate Box) rpose of Building•" 11- / /4 tility Authorizzation xisting Service: Amps / V Its Overhead C1 Underground.a T of Meters New Service: tee/ Amps/2-y /Z.v Volts Overhead C Undergroundf; #of Meters:_ _ Number of Feeders and Ampaclty: Location and Nature of Proposed Electrical Wcric: A/, —Ll a✓ � v v T No.of Recessed Fixtures No.of Cell.-5usp.(Paddle)Faris No. of Transformers Total KVA ONo.Cf Lignting Outlets No. of Hot Tubs Generators K`:A f No. of Lighting Fixtures -Z*61 Swimming Pool: Above ground ❑ In Ground o #of Emergency Lighting Battery Units No.of Receptacle Cutlets No. of Oil Burners Fir Z: U e A:arrt;S #of Zones of # Detection&!nttiztmg Devices No.of Switches No.of Gas Burners #of Sounding Devices: (J #of Self Contained No.of Rznges � No. of Air Conditioners TOTAL TONS: Detection/Sou riding Devices /0 2 Local Municipal Connection❑ Other o 4 Nu. of Waste Disposals Heat Pump T otals: Sscue.ty Systems. �.. Number. TONS:__ KW: No.of Devices or Equivalent No.of Dishwashers / Space(Area Heating: KW Data Wirino,No.of Devices or Equivalent: No.of Dryers ... Heating Appliances KW Telecommunications Wiring:No of Devices or Equivalent: No. of Water Heaters KW No. of Signs: #of Ballasts: OTHER; z of Hydro Massage Tubs No. of Motors Total HP j 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 equiva�le.I. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E✓ BOND ❑ OTHER ❑ Please specify: Estimated Value of Electrical Work$ (When required by municipal policy) Work to Start: A � 3 y — G Z. Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the Information on this application is true and complete. Finn Name: J"/' -3 I LIC.# Licensee, y��_/c _ / t Signature (If applicable,ent e� pt"in the 17censfiffumber line) Address: 'v "c I" �� — B01,71 Te x S"`2 G All.Tel.# OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) Owner o OR Agent o Signature of Owner/Agent: Telephone# PERMIT FEE:S LocationNo. Date r of NOoTM ,a TOWN OF NORTH ANDOVER j Certificate of Occupancy $ Building/Frame Permit Fee $ .. s�cMus a Foundation Permit Fee $ Other Permit Fee $ o' TOTAL $ ���> rd Check # • r J 145L. 0 �,-�-- r�. Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING w. y BUILDING PERMIT NUMBER: Q DATE ISSUED: /^8.__a 0a) M SIGNATURE: 1 Building Commissioner/InEed&or of Buildings Date SECTION 1-SITE INFORMATION 1.1 Prert Address: � 0 1 1.2 Assessors Map and Parcel Number: pZ o Map Number Parcel Number ^ 1.3 Zoning Information: 1 , (J 1.4 Property Dimensions: 1V 1 Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided Ov t' 00 a /nom' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 > SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name Pnt) Address for Servi q . 2-(a Siggatuk Telephone 2.2 Owner of Record: Nam .nt Address for Serf&: O q 7 ` L/ a m Si n dtu te Telephone SECTION 3-CONSTRUCT16N SERVICES 3.1 Licensed Construction �— o��A Not Applicable ❑ Lictftlsed Construction Supervisor: �F 1 License Number Addr �l��l `'� Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ML�)W� 6en, Cclf)4, d .mac I �' p� Company Name q 1�1 Registration Number r Address CIPo-� -)�-(-4S I © � Expiration Date /� Signature Telephone G 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.......El No.......❑ SECTION 5 DescriptIon of Proposed Work check all applicable) New Construction V Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Co�S�c� CL e,cs - r� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to befFFCIALSE t}NI>Y. Completed by permit applicant 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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property I Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. a Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 $0CI10ee) A Pri tm&t:�e F Siature f Own /A ent Date NO.OF STORIES SIZE a BASEMENT OR SLAB / SIZE OF FLOOR TMERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS Q (/y-- SIZE OF FOOTING X MATERIAL OF CHIM TEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM III n � INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ............ APPLICANT PHONE 3 �� ASSESSORS MAP NUMBER LJ LOT NUMBER as D SUBDIVISION IK� ?U-6 LOT NUMBER c STREET STREET NUMBER OFFICIAL USE ONLY RECOI^4ENDATIONS OF TOWN AGENTS DATE APPROVED ■...■.■ ... .................■........■.■............■■ ••moo ••■•••■■ COb&RVATION ADMINISTRATOR DATE REJECTED COMMENTS t 1 DATE APPROVED 0 U TOWN r DATE REJECTED COMMENTS DATE APPROVED FOOD S 1 ORHEALTH DATE REJECTED r DATE APPROVED Z Z b Cf;> S C ECTOR- TH -, DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS j -ZO DRIVEWAY PERMIT V q�.4V,A SkAA i,i 5n,_1 DATE APPROVED FIRE DEPARTMENT JSC!! �' ^'"i c G�� /�ZI�D(J DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE i MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Lawrence . STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: •1 or 2 family, detached HEATING SYSTEM TYP2 : ''0t"libt ,' (Non-Electric Resistance) DATE: 3-2-2000 DATE OF PLANS : 3-2 TITLE: New Home PROJECT INFORMATION:r.` Lot 3 Long Pasture Dr ' COMPANY INFORMATION-: Crowley Construction 138 Virginia Ave . -' .F '4 Lowell, MA 01852 COMPLIANCE: PASSES. Required UA = 949' Your Home = 700 Area or Insul Sheath Glazing/Door Perimeter 'R-Value R-Value U-Value UA -------------------------------------------------------------------------------- CEILINGS 1840 30 . 0 0 .0 65 WALLS : Wood Frame, 16" O.C. 3924 19 . 0 2 .0 222 GLAZING: Windows"bt Doors 695 0 .350 243 DOORS 80 0 . 350 28 FLOORS : Over Unconditioned Space 2998 19 . 0 142 HVAC EFFICIENCY: .Furnace, 94 :°0 AFUE "'Sf ----------------------i-- -----`------ --------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed buildipg has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code . The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date r + MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 New Home DATE: 3-2-2000 Bldg. Dept . Use CEILINGS : [ l 1 . R-30 Comments/tocaton WALLS : [ ] 1 . Wood Frame,', 16" O.C. , R-19 + R-2 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . �vU-value: 0 .35 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS : [ ] 1 . U-value: 0 .35 Comments/Location = FLOORS : t. ( ] 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Furnace, 94 .0 AFUE or higher Make and Model Number THERMOSTATS-": [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: ] Joints, penetrations, and -all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: ( ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 .0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape . Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT"SIZING: [ ] Rated output. capacity of the heating/cooling system is not greater'":than 1250 of the design load as specified in sections -780CMR 1310 and J4.4 . MISC REQUIREMENTS : [ ] Refer to 780 6MR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) -------7----------------- i � i t M C4 a R• ArlF \ f N d NIF ( SCNtJ£APE MARTINS tts 73B tJP tAtl 1<Y f19` 7'X+ tZ7` iP1�" 72R 1TPf 1Sd` 131 tJJ 4♦ r4♦ � T6EBJ' ♦ t1P 114 ff6 ,. iJQ.89' ♦ ~ � u? N Mt OF rn FAQ fliGA .�-"C __�� �\dam ���♦\ �\` '*� � '_` � ,♦ AkiPf/fttl J1R NES g 73P9 GOILOW ` \ �b• \ \ �. _ SE'pT7e WINK_ y - ♦ ` ♦` •.\ '.\ �` \ 11eeKK .. RR AREAul = �! *T"ixA�s:eastafearr t\ TOP : 4 rl�. f.. ; -� -F l-�` 7 1.94• t '\ -- --' .cirv. Ml it 1 1. BAR 4 ` - -\ \4 4 ` l 724 !2A t3D OF !LP'D+VfEi?ZmYE / `.♦•, 5 /!� � �T � '4 iPP I27 r24 fis LOT" 4 .-71:t.,_ , ii/ • Y E"d3Elft%iT r t 1! .��. -`� � � �i � •411 1r' � - rim IDA n � I u �n i pURiM q AUTOMATIC LAWN IRRIGATION SYSTEM PERMIT TOWN OF NORTH ANDOVER VL w -w�• # MASSACHUSETTS ��sSgcNus ALL INFORMATION MUST BE PROVIDED,BY A LICENSED PLUMBER, PRINTED IN INK AND LEGIBLE. IF NOT THE PERMIT WILL BE REJECTED. DATE: L z-2vi(J LOT#: LOCATION: " NUMBER I EET NAME BUILDER: NAME TELEPHONE NUMBER STREET NAME TOWN/CITY&STATE OWNER: � f NAME TELEPHONE NUMBER STREET NAME TOWN/CITY&STATE PLUMBER: NAME TELEPHONE NUMBER STREET NAME TOWN/CITY&STATE LICENSE NO. EXPIRATION DATE: SERIAL NO. IRRIGATION INSTALLER IF NOT THE PLUMBER INSTALLER: COMPANY TELEPHONE NUMBER STREET NAME TOWN/CITY&STATE INDIVIDUAL NAME TELEPHONE The plumber,must install the connection to the municipal water supply within the building,the water line to the outside of the building and the backflow device.A registered irrigation installer may then install the balance of the Automatic Lawn Irrigation system.NO irrigation heads will be allowed in the right of way(near edge of pavement).ALL irrigation heads MUST be at or behind the property line.All heads installed in the right of way will be removed immediately upon notification and said plumber or installer will not be allowed to perform any future work on the municipal water supply, until the heads are removed from the right of way. Sign below that you have read this paragraph and understand it. SIGNATURE OF PLUMBER DATE THIS PERMIT MUST BE POSTED-AT THE CONNECTION/METER LOCATION FOR THE INSPECTOR. INSIDE CONNECTION METER(IF APPLICABLE) BACKFLOW DEVICE RAIN SENSING DEVICE COMMENTS TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. Telephone(978)685-095( DIRECTOR Fax(978)688-9573 � NORrh OL F 9 SSACHUSES DRIVEWAY PERMIT s DATE LOCATION w r? BUILDER hone OWNER �o hone 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. r y! ' 1036 I APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. i Application by the undersigned is hereby made to connect with the town water main in 7 4iIVI'e A -Q J, Stree,' subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street or s bdivision lot no. ,� Owner Address Contractor Addj AppNcant's gnature c25610 .der 4 PERMIT TO CONNECT WITH WATER MAIN The Board.of Public Works hereby grants permission to Q�� . "J :z z AD to make a connection with the water main_-at, t/ Street subject to the rules and 'regulations of the Division of Public Works.. Board fPu lic Works By ! > Inspected by Date See back for rules and regulations i "See oe4 i I I 1 , r 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: 2 j 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 4%z' foot rod and brass plug- type cover. 1 ' i a DPW 30 Date f .... .~- NORTH, o�°:'"�� '�'•�°om TOWN OF NORTH ANDOVER 1 ►• 9 ,�:; RECEIPT ass gCHUS Cr ............. -- ...... .... This certifies that.....:...... ..................... . haspaid................. A............. L for .. ...... ......... .... ... ..... ............�.1. ...................... Received by............................ 1 Department ....................?... ..... ............ . WHITE: Applicant CANARY:Department PINK:Treasurer F I f f. GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested bellow. .��cm \ T Permit Applicank Property addre Map/Parcel 9,--)K 9 -)0-!::S5 Z 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 ofthe 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 ofthe 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 ofthe 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 desigiated 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 with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and 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 A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR OT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A B OG PERMIT. 'APPLICANTSII§IGNATURE DATt THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION I11C. VUJ11111U1/VVGC?1111 U/ /WU00CjU11UJUI(S ' Department of Industrial Accidents Office of Investigations Boston Mass. 02111 Workers'Compensation Insurance Aff1davit Please Print Name: 0 Location: City Phone am a homeowner performing all work myself. 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. III Company name: V� vim! (.w 1 `� (� 1 C✓� l� I� t� Address City' Phone#: - X e ioxl �� Go Insurance Co. � _ Policy.# GUC Company name: Address City Phone# C 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 penalties in the form of a STOP WORK ORDER and a fine of($100.00)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 do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date 9 Print name� �1 � Phone# r Official use only do not write in this area to be completed by city or town official' Building Dept []Check if immediate response is required Building Dept E] Licensing Board p Selectman's Office Contact person- Phone#: ❑ Health Department [] Other FORM WORKMAN'S COMPENSATION i Town of North Andover NORTH OL Building Department o 27 Charles Street 4( North Andover' Massachusetts 01845 4 (978) 688-9545 Fax (978) 688-9542 ACHLI 'i p i DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Signa re of Applicant Dat NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. r ORTH Town o �� �. ` ^: Andover 0 y i _ = _ o ndover, Mass. ��' Me?00 T O �+ LAKES COCHIC EWICK ADRATED SSACHUS� IT FOR EXCAVATION AND FN D AT I N THIS CERTIFIES THAT . � �vN i'..�lS �..bl.il �!�.. .............. . ............. .... ..................................................... P has permission to excavate and pour foundation at ..1►.� !Q �� �V Rcl .............`... ...... .. . .... ...... ............... for the purpose odO rQQ ... V 'Wk 10 A.. ...... '% FA V40 . . . . . ... The person accepting this permit must return to the office of the Building Inspector a certified plot plan show 3)wt1l��uy of building thereon before Foundation will be inspected. 'D ,o a a O 4150,- VIOLATION 15.0,'VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. ............. ....................... BUILDING INSPECTOR F 0;ZC RT H Town , of _ over No. z � o /- S -a o0 == L_ o y dower, Mass., � A- COCMICHEWICN V 7,9 A° RATED PP �(y S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... . '�� .�. ....... ��.w..ify �... .............. .. .. ..... ................................ Foundation has permission to erect..............I........................ buildings on .kO...3...W.' .y....xoy's..NOV. .Ad Rough to be occupied as 1 o f"Me..1 Wi ) 15 3 std II Uad I * Chimney ............... . ..... .. ...... ............... ....... ............................ ...... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M !O& jq PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough . ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in--a .Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. . SEE REVERSE SIDE smoke Det. Date... 10794 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING HU This certifies that................................................... has permission to perform..... ...................................................................... plumbin i the buildings of.. Z)A 4 .................... ,V,n, e ....................................................................... at....................... —cl" ...................................................... North Andover, Mass. YeeAQ.!�?.....Lic. No. ........................................................... I Check PLUMBING INSPECTOR Che # 77-2 3Z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING MBING WORK CITY _ MA DATE PERMIT# JOBSITE ADDRESS h ,� OWNER'S NAME POWNER ADDRESS TEL _____JIFAX , TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL Q RESIDENTIAL '' PRINT CLEARLY NEW: � RENOVATION: REPLACEMENT: [ PLANS SUBMITTED: YES EQ NOEI FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM C f _—I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I ._ i _ _._.( __ I _. .i J== I __ l 1 _ t I DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR lAREA DRAIN INTERCEPTOR(INTERIOR) E f _�_._ _ _.._! ____I _.I Q KITCHEN SINK LAVATORY __j ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER �_ _ _..__...._._.._.. _....._.._._.� -.( ._._.__j INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES _.. NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ,.Cs9 OTHER TYPE OF INDEMNITY 0 BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mpssachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E-11 AGENT E-11 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 compliance with all P inent provision of the (Massachusetts State Plumbing --Code and Chapter 142 of the General Laws. PLUMBER'S NAME�+Tt _ � I LICENSE# Ste, i SIGNATURE IMP 0 JP�' CORPORATION[-]J PARTNERSHIP P# LLC;�#I COMPANY NAME ��„�t1 _ ; ADDRESS CITY ; _ .__ ..__....._._...._(STATE ZIP TEL FAX CELL��EMAIL ..------ ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL 'INP CTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name(Business/Organization/Individual): Address: t% City/State/Zip a/�4oPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0/ram a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ` ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9 F1 Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ! I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self--ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certJer the pains and penalties of perjury tliat the information provided above is true a/nd correct i Signature: Date: ! 7 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# 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 their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Co onwoaltb.of MassacljusPtts Dep.aftent of Industrial Accidents Office of'Investigations 600 Washington Street Boston}MA 0.2111 Tel#617-727-4900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax#617-727-7749 wWW.Mass,govV/dia i i i COMMONWEALTH OF MSICHtSE�CS BOARD:.:OF II ,R PLUMBER A; ` �x SF1T�rf� 1 4 ISSUES THE F0Ll-OW10: LlCENSL L 3 CCNS, A A J(2`JRNFY tAN PLAT 4ESER � b W L..ACGNTE r S. r..' fa r`f j2 ;, PERRY.,A�IE �rck l�� ILU < lJFI LI ' A 18. 7 t Date. .//-. x .".`. .� ,,ORT" TOWN OF NORTH ANDOVER o� ,,.o ,•�ao p PERMIT FOR PLUMBING �,SSACMUS� j This certifies that . .���. l!i .1'! z. . . .!.?�. ... . . . . . . . . . . . . . has permission to perform . . . . . . . A's. . ... . . . . . . . . . . . . . 0 plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . at. . . , North Andover, Mass. n � Fee. .4)." . .Lic. No.. .fG}. !.`. . . . . . . . . . . PLUMBING INSPECTOR Check # 5—,I- V S 5432 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETT / _ Date Building Location .5 bah wners Name �r�w�� Permit# Amount ?0, Type of Occupancy S l , NewErRenovation Replacement Plans Submitted Yes ❑ No FIXTURES a � �a A A w w a c ra AEn RASEMM C7 A as AU FL" 4IH FIDQR SII3HIM 6M R" 7M)N BM gm HIM (Print or type) Check one: ! Certificate Installing Company Name 1 $ V'� �/ , ET Corp. �0 p Address 20 , Partner. r " :vr2fd1L. 41, Or ol� l Business Telephone � Firm/Co. Name of Licensed Plumber: dist✓ Insurance Coverage: Indicate the type 6f insurance coverage by checking the appropriate box: Liability insurance policy LLd" Other type of indemnity Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St um ' Cod d ClVpter 142 of the General Laws. BY igna ur ii Lce a um r T e of u bicense Title ( City/Town icense umDer Master ( Journeyman ❑ 4 APPROVED(OFFICE USE ONLY Date. ..... . . ,ORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION S4 CH This certifies thatz—. l . . . . . . . . . . . . . . . . . has permission for gas installation . . . ./A . . . . . . . . . in the buildings of . . . ' . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . /A. North Andover, Mass. Fee.?.G. Lic. No./(/,I/.6 . . . . . . . . ... . GkS INSPECTOR" Check# 4203 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS Ff rrING (Type or T print) f P ) Date NORTH ANDOVER,MASSACHUSETTS f Kti�� Building Locations L/ Permit# Amount$ Owner's Name Cd V u✓ iy- New Renovation ❑ Replacement ❑ Plans ❑ w c 90 ° a °a °a H `0 SUB-BA SEM ENT BASE ENT 1 t 1ST. FLOOR l 2ND. FLOOR 3RD. FLOOR Y 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or t)pe) hol � e / r one: Cei jcatedIgstalling Company Name Corp. `7y Address "�. �� ��� ❑ Partner. Business Telephone_ T?f . /-0 C// ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No[] If you have checked yes,:please in ' e the type coverage by checking the appropriate box. Liability insurance policy r T Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does Bot have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one. Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas C Ch142 a General Laws. By: ture of Licensed Plumber Or Gas EALW Title Plumber City/Town ❑ as Fitter Licensd Number LJ Master APPROVED(oFFICE USE ONLY) ❑ Journeyman f a 0/ NoDate.../.. ../L, ....... No 2827 y� �•ORT1i °`t >•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4SAcMusEt tM ( r This certifies that ....?�.......?-......... ..........G...�.............--'.`..�C.............. cc has permission to perform .......... .A I........ P.................... I wiring in the building of....... . ............................................. at...... ... ...... JN/ / � ��e?��,.........�.......-(Norah Andover. Mass:n Fel�..,s A... Q Lic.No./.f ...........� z��. .. !�:..!::4 /ECecrwcALItvsrecrox ` Check # >L i WHITE:Applicant CANARY: Building Dept. PINK:Treasurer = Cfommonwaa[lh o/M/ IacAudalb For Office Use Only (Rev.11/99) cc�� ec77 Permit Number: 1JaPart.`niart�o�J`ira�arvicae Occupancy&Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORT:TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of: /v To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location:(Street& Number) Owner or Tenant: t / Owner's Address: !7 Is this permit in conjunction with a Building . ermit? Yes ❑ No Check Appropriate Box) Purpose of Building: Utility Authorization#: �/Q C/ - -309 'Existing Service: Amps / Volts Overhead 0 Underground.❑ #of Meters y t New Service: Amps, z�/ / 2 Sid Volts Overhead ❑ Underground.Z;-� #of Meters: _ Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: No.of Recessed Fixtures No.of Cell.-Susp.(Paddle)Fans No. of Transformers Total KVA No.Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground o In Ground o #of Emergency Lighting Battery Units No.of Receptacle Outlets No. of Oil Burners Fire Alarms #of Zones #of Detection&Initiating Devices No.of Switches No.of Gas Burners #of Sounding Devices: #of Self Contained No.of Ranges No. of Air Conditioners TOTAL TONS: Detection/Sounding Devices r Local❑ Municioal Connection o Other o No. of Waste Disposals Heat Pump Totals: Security Systems: Number:__ TONS: KW: No.of Devices or Equivalent No.of Dishwashers Space/Area Heating: KW Data Wiring,No.of Devices or Equivalent,- No, quivalent:No.of Dryers Heating Appliances KW Telecommunications Wiring:No of Devices or Equivalent: No, of Water Heaters KW No. of Signs: #of Ballasts: OTHER; #of Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.�The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a /BOND Cl OTHER ❑ Please specify: Estimated Value of Electrical Work$ / (When required by municipal policy) Work to Start:_ — �� _ '557 Inspections to be requested in accordance with MEC Rule 10,and Qpon completion. I certify,under the pains and penalties of perjuryi that the information on this application is true and complete. C Firm Name: t /� �i LIC. Licensee: ? G S .c Signature' (If applicable,enie 'axe t"in the license nu ine) 1-7 / / Address Bus.Tel. 4M7 p- 7 Alt.Tei.# OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) Owner❑ OR Agent❑ Signature of Owner/Agent: Telephone# PEPUNTIT FEE:S (Jd,d-11 I �, .i GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY 0K)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION per.. OCCUPANCY FOUNDATION- CERTIFICATE OF USE SE &TOWN OF NORTH ANDOVER 8 Date uildin Permit Number T B S g THIS CER _ THE BUYLDING LOCATED ON t E OCCUPIE /� � �� �A✓�,� � � � MAY B D AS Q �. �Dko©ms `��v a - 11z 13,4-th 5 3 �fz / A�r BU�DnvG IN ACCORDANCE W�T� PROVISIONS OF MASSACHUSETTS ST CODE AND SUCH OTHER REGULATIONS AS CERTIFICATE ISSUED TO Uti 457 6� Building Inspector I Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/latera_I bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee-$25.00(Be Ready). Certificate of occupancy required prior to occupying structure. NORTH Town of _ 4Andover 0 No. 10L 00 ) o z- L o dover Mass. S COCMICMEWICK �d ADRATED 1 S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic Syste10 / o� BUILDING INSPECTOR THIS CERTIFIES THAT 6. �Ot.3 .................. .....oy..........A......................... Foundation � Gt�---g W.10 .... ..P... ft........ Rough_/O?�ihas permission to erect..............I........................ buildm s on..................... .... .... t0 be Occupied as ... 4 S+d It V sd* � ............. Chimney �� 2�"`'�--- �.. . �.. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. !0 t ,��. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permlt. '``= x ou PERMIT EXPIRES IN 6 MONTHS r UNLESS CONSTRUCTION ST TS EL CAL sP � y/... � ,� ! ....... ............ ..... s e BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building 'GAS INSPECTOR i Display in a Conspicuous Place on the Premises — Do Not Remove Rough 'Z No Lathing or Dry Wall To Be Done &7 PARTMENT Until Inspected and Approved by the Building Inspector. BurnerFlRE Street No. J4 SEE REVERSE SIDE Smoke Det. i 1� )UN Lobation � / No. Date 14-01 ,.ORTM TOWN OF NORTH ANDOVER 3: OL f 9 « Certificate of Occupancy $ s i � 1'�s''••"''t�' Building/Frame/Frame Permit Fee $ �r sic"usc 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J8 6 71 e Check # Nq� 14518 Building Inspector aidd Pam I 8 /ssvcD '—T7?4 ci- o l 140 t 167 t I . 125 � _ __30--� � \�FgsF� LOT 3 EX..FND. 192 t ; EL.=124.2 42' i I I yt I I EASEMENT " LONG PASTURE 1 EASEMENT `'� ROAD L=45' � 13� FOUNDATION LOCATION PLAN I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL ,CLIENT: CROWLEY CONSTUCTION (M CERTIFiGi/TION DOES NOT CONSIEFM��OTHER ED RESTRICTIONS SUCH AS COWWANTS.WEIIANMEASEMENTS. THIS CERTIFlCATION IS MADE AND LIMITED ORDERS Or CONDIIION$ETC) y TO THE ABOVE CLIENT. THIS DRAWING SHALL NOT BE USED Or THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OU71JNED ABOVE.EXCEPr WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE TM DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SEW TNG AND ANY UNAUTHORIZED USE LOCATION: NORTH ANDOVER,MA. 6 PROHM ITEUXURISTMNSEN d` SERI/ TAKFs RESPONSI8=l FOR THE UNAUTHORIZED USE OF THIS ANr INFOR- MATION CONTAINED HEREON. SCALE. 1'=80' DATE: 2/1/01 0��° MSC• . i'''�y,� S CHRISTIANSEN &SERGI �, R iso SUMMER sr 11AVER111U." 01830 TEL 978-57d-0310 �-n �� 19 �n.• 02000 BY CHRISTIANSEN & SERGI TNG DWG.N 5 4262 Date.../.. . . (�. // NORTI� " °f'"'°:•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACMUS� This certifies that ............ .....�...,1�.............. ........................K.................. has permission to perform �,/� . ........ . .. ....... ........................................................ wiring in the building of ...... at...... ... 1.......1�d.!?y.../..:.1�Sit. ..... .....grth;do e X 7Fee..... ,�.:. .. Lic.No/..��.....!L............. .. ... ...... XMNSOR Check # = - Commonwealth of Massachusetts Official Use 0 Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527/CMR 2.00 (PLEASE PRINT IN INK ORT A INFORMATION) Date: City or Town of: To the Inspector of wires: By this application the undersigned i,es otice o h' r her'ntention to perform the electrical work described below. Location(Street&Number) VL I Owner or Tenant Telephone N �a '��Owner's Address Address Is this permit in conjunction with a building permit? Yes ❑ No V (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity fi Location and Nature of Proposed Electrical Work: Installation of Security system r Completion of the follou4n table may be waived by the Inspector of Wires. e 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 AboveIn- 'No--.of Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices ti No.of Waste Disposers Heat PumpNumber Tons KW No.Detection/AlertingofSelf-Contained Devices No.of Dishwashers Space/Area Heating KW Local E] Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems Devices or Equivalent No.o Water Kms, No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNo.of Devices or Equivalent l 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of 1 tric Work: p? (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under"eainsndpenalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: �,3r Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.: 603 594 5928 Address: TT Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ J , � �,,., __ . ✓die-�omvnw�uuea� ✓�aaclucaella'� BOARD OF BUILDING REGULATIONS i' a:fCONSTRUCTION SUPERVISOR Number CS 05.8114 ,Birthdate�,02/2T/1961 �x _� V Expires 02/2712002 Tr.no: 16172 , 'Restncted To Ob ,yth. S n. r ✓ STEPHEN CRO.1,EY � 138VIRGINWAVE L'OWELL MA 01852 ' Administrator HONE`INPROVENENT CONTRACTORh 4 Registration: ''I14187 # Expiration: 8/11/01 Type DBA t CRONLEY CONSTRUCTION S IiX � STE N CRDYIEY� PHE SAVE ADMINISTRATOR 138-VIRGINIA- LOMELL NA 01852 i l i Date.................................. f NORTH 1 ° •`'° + TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUS� Thiscertifies that .>.........................................t./................................;.............. has permission to perf�,., '/�.f %/�� � � � �...- wiring in the building of... ........1.......4......... ...�1�~f'. . ............... ),. orfh Andover,Mass, Fee.."'�/ �� (Z'. Lic.No/- ....... ..?`�.r�/�J ELECTR[CALINSPECTOR '! r_ Check # W 560 Commonwealth of Massachuse is Official Use �ly� Permit No. U v Department of Fire Service CC 4' Occupancy and Fee Checked J - ;� BOARD OF FIRE PREVENTION REG LATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT PERFORM ELECTRICAL WORK All work to be performed in accordance with t e assachusetts Electrical Code(MEC) 527 CMR 12.00 (PLEASE PRINT IN INK OR T P ALL TN RMAT N) Date: —`0(7— Z�!5 City or Town of: ly0g.rg. c)a ( 15/?� To the Inspector of Wires: By this application the undersigned gives not' ' of his or intention to perform the electrical work described below. Location(Street&Number) /o 8— Owner or Tenant tf,,25 _d AIZ FV Telephone No. Owner's Address Is this permit in conjunction with a building permit?: -.Yes..❑ ; No L (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion o the ollowin table may be waived by the Inspector of Wires. 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 Above In- o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No:-of Detection and Initiating Devices No. of Ranges No.of Air Cond. Tonal No.;of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Heating Appliances Security Systems: No. of Dryers g pp Kms' No.of Devices or Equivalent No.o Water Kms, No.of No.of Data Wiring: Heaters Signs Ballasts I No.of Devices or Equivalent £ Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Eg uivalent 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: p? (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: I rq Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line) Bus.Tel.No.: 603 -594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent ��� r Signature Telephone No. PERMIT FEE: $ r