Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 567 SALEM STREET 4/30/2018
567 Salem St L D R C,` BWONGHLE' +Yy\n, ecwo.,,� - C � Commonwealth of Massachusetts Official Use Only _ -- Permit No. - Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ptev. Im] caveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(WC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA9 Date: 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. Location(Street&Number) 567 Salem St Owner or Tenant John Bissonnette Telephone No. 978.557.5965 Owner's Address 567 Salem St Is this permit in conjunction with a building permit? Yes fl} No ❑ (Cheek Appropriate Bog) Purpose of Building Solar Rooftop Array 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 31 40 Location and Nature of Proposed Electrical Work: Installation of Solar rooftop electric panels. No change of use or footprint. Completion of the follotvwg table may be imived by the lavector Of Wbes. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Faus Transformers Total rformers KVA No.of Luminaire Outlets No.of Hot TubsGenerators KVA No.of Luminaires Swimming Pool Above ® In- ❑ o.o mergency g d. d. Ba.UeM Units No.of Receptacle Outlets p No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners of Detection and In Riating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number ITons I 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 SecuritySystems:* No.of Devices or Equivalent No.of Water KW No.of No,of Data Wiring: Heaters signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Whingg No.of Devices or uivalent OTHER: Solar Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $31,522 (When required by municipal policy.) Work to Start: May,2016 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and soapier& FIRM NAME: Revision Energy LIC.NO.: Licensee: William Levay Signature .e.rt/ LIC.No.• 1173MR (if applicable.enter"exempt"in the license number line.) Bus.TeL No: .fiflq_679.1777 Address: 7A Commercial Dr. Exeter, NH 03833 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner [I owner's agent. Owner/Agent < f�, Signa re _ 2ie /4o/bo-riz-(1-�;on a-#,'*-Telephone No. 'FEE:$ n i•.� The Commonwealth ofMassachuseus DepaTrtment o,f•Indta:WW Accidents Office of Investigations 600 Washington Sow q Boston,MA 02111 ww w, as&. ovdd'io '4 orkerV Compensation Insurance Affidavit; Builders/Contract.orsJ]Eleetxlcians/Plumbers ARyli_cant Informative -- - Please Nut Lgg blj 'Nme (susiness/or ation/LTidividuai): ReVision Energy- William Levay Address: 7 Commercial Drive City/State/Zip: Exeter, NH 03833 Picone##: 603 679 1777 Are you an employer?C'beek the-a'ppropnote box: Type of projW(required): - 1. f I am a employer with 100 4. El I am a general contractor and I 6 a dew co'astrntGtion cmployees(AM and/or partAime).* have hired the sub-contractors 2.� I am a sole proprietor or pm-mer- listed on the anaded,sheet, Y 7. Remodeling ship and have no e�aloyecs 'These sub-coutractors have S. Demolition workiu,g for uric in airy capacity. workers'comp.insurance. 9, ❑ Building addition [No vorl ers' ec unp. mm rance 5• W '=a c nporadoo and its 14.M_ Blecugieal repairs oradditions required] officers have exercised their 3.iEl I am abameowner doing all work *lit of exemption per MGL 11,0 Plumbing tepaiworadditions myself. [No workers' mmp.. c. 152,§1(4),and vie have no 12.[-] Roofrtpairs insurance Toquixed.]f employees.'[to workers' comp insurance required.) j 1 13.0 Other . Solar installation ;Any applicant that checks box#1 must elm fill out the section below dimming their worktTtl Gm ensation policy information.' i•ioTneoasc,s who submit this afdavh indicating they are doing All Werk end 0=him Outside aontreams mug submit a neer affidavit indk*Ting such tantractors that check this box must aatachcd gn additional shect abowing the manor o tip suit-comctors and theme wotkere cmvp.pWicy infonnsfion. I am an employer that is providing workers'compensation insurnnce,f°air my employees. Below Is the policy and job site in,farmarFiom Insuraltmpany�lanu; Maine Employers Mutual Insurance Company Policy#or Self-ins lie.#: 510 1800408 Expiration pate,: 4/1/2017 n I Job Site Address: 567 Salem St - city/statetzip./l/44ri* c2v_ J�,iAAS INS— Aftacb a copy of the workers' compensation policy declaration page(showing the policy neper;and expiration date). Failure to secure cov age as required under Section 25A of MGL.c. '152 em lead to f�e imposition of crime'penalties of a fte up to S 1,500.00 aadJoT came-yeaa impriicumeu,4 as well-as civil penalties in the form of a STOP'th CRK ORDER and, a fine of tip to$250.0D a day against ft violator, Be advised tat a copy of this statement may be forwarded to the Office of Investigations of theDIA for insurance coverage verificatiom Ido hereby cenift,under the paha acrd penalties of perjury that tide Information provided above is Owe rind corneAct - Si Dater `71Z-7"Z-,l pb,one#. 603 679 1777 Officialuseonly. Der not wrke in this area,to be completed by city.or town e,f iat City or"Town: Permit/Ueense# Issuing Authority(eircle one): 1..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Impector d.Pint:Qbing Inspector 6.Other Contact Person: Phone#. 1 • . • .• /-- • • . •• - . •• • • • •• „tom .�„ —c; ..q� �, :�' ate ¢, 1�. �h, �' .•1G, q.n.; s.r�4. NtiYm,. r�.i.e:y"�m•'*- r.1• '•'r'� f" ,a.,_ ',��h _ •7Y,Y�.; -.rr� 1 �f; e fc`I= — �e.w�' �� e.Y'i.: a.—. 'I ';�^-' � r.} 1qL�a ':�' ,a,:,�R. M^M! ,� �;�:� �,� ���ec� ;v,•a.�I' 9f.oW.�� e �i rs. ;a :aF ,� n7tlpa `il r-+1 t",*- .w,�� a•1_,x'P�� +i _br; Y• w,awu tri'_ •, P-fin, s�{�i ..rRa�iY')Z�T.#h Nk nai t9�,ti art��.:..il 5=s. Hli`.R•�' r B.P f�:ne .x.+!¢ey r r.�..i,;'*4.. ..y i .kms.• aka;...) eR._ - •I: :,.::F.F R477- 7 IiN k H ;.._� nK —'.JNera*tribe` -•'' M! '1A."ekk f{ :{.1 ark.. •P�;,._ TN ^sri .�.'. ¢ IT"I_m.nth ke,::�=ittt" IA •i - ¢ d„ '� :f1 {i6.., •, k,�l:r.. ii ". �:� :-ip U�,.::: �'. ..•^'SF '�.I,afb "rR; ti4:." :ice p'tSik.li� .,,A' "1d- E.',5; 9L - - "a :•,a "tip .u, �9"�' 1 Y,'--ah'.Y t N':. ;!�'; .:�. ,y 41,. •" :31 .h• i". e, �`a,,. - }"3}. ,...,.a; ,5..'�. ,��'� ,... �#. "Wt 47"7!. ri �1(''h 9?iG'>1., 1 �'1?':a�$ jk t. lrr.Yl F "--- ,�. � "+.rte„ ff. :,S:r w '.:�ny.{l=i•li r .,t,y,i�•i4 fl i� WI¢r•IIWIpW •Yi<ifi� MIW11il• f r I � �vim•, .Y a¢ � n r� .��� �x,:7>'-��,�.:..1" ak:aln I •'il!', r, .�'�'�;�' e i ¢ ami �'•.a' moi- _ � ..ea.-: Yf .,. {u n•w.x.:�.o-r t.. � �a"��. �.,q/`_o- f+?:,;'9r. ;.gip,._ p „�:,,iyF � , ���:�i�l��klt wl�:•ti� I F •':�+.ek1r1�.•ek4:«� k d�"_1:'.3!'1tl �� �Yt!34�Y_4Pi@a.^�y9 i�iF., !f, rl� �fyF, I f sl 9J COMMONWEALTH OF MASSACHUSETTS r-JUJIUMMUdiUs o 113 UggLimmm BOARD OF ELECTRICIANS I ISSUES THE FOLLOWING LICENSE AS :A 4. REGISTERED MASTER: E L1 CTR I C I AN i REVISION ENERGY LLC ; WILLIAM N LEVAY lw 7 COMMERCIAL DRIVE W EXETER NH 03833-6630 ''` ; 0 x/16_' 392977 ����1�31A1'aYJ Iq �i� " i it i I s- I I I i __ __ - - 1 i y S _ i �' i I` I V � O � � � v � . � � � r `k f `I I 5/3/2016 Payment Receipt All r %.act V • �y'ti7�6�ay� • 0 q�AATED Ate\ Town of North Andover, MA $ 125.00 Paid Thanks for using the Online Service Center William *Electrical Permit#20124 April 29, 2016 Permit Fee $ 125.00 Total Paid $ 125.00 2-6 3 v Z Vi Po nt 4�� Powered by the ViewPoint Cloud platform i 1/1 r e —` ----- — -- ---------- ------ -- -------- -- -- — _ — — - r' ._---------- ____ .. Mc 20352 REVISION ENERGY, LLC Bangor rr � `' YOUR LOCAL SOLAR PROFESSIONALS-SINGE2003QMU 91 WEST MAIN STREET BANGOR,MAINE 64401 Fntrxom M l+umeu _- LIBERTY,MAINE 04949 52-7438/2,112 207-589-4171 Dcc 0 N PAY TO THE ORDER OF / 2z.�Y7 C` ii4x- DOLLARS r REVISION ENERG 8 II ® o MEMO a AUTHORIZED SIGNATURE �evoa�®levo e�memee��� n'0 20 3 S 211' 1: 2 1 1 2 74 38 2i: 20 L008 26 380 1 i 4/29/2016 e Date: April 29, 2016 20124 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20124 • �K Co TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that William N Levav has permission to perform Rooftop Solar Panels 31 Panels 7.75KW wiring in the buildings of BISSONNETTE. JOHN P. at 567 SALEM STREET , North Andover, Mass. Lic. No. 1173 1/1 Location 63A/9 W Date TOWN No. , NORT►, TOWN OF NORTH ANDOVER F O? : ,- _•�•• OOs Certificate of Occupancy $ Building/Frame Permit Fee $ L Foundation Permit Fee $ O Other Permit Fee $ f TOTAL $ Check # �` p 18694 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTnUCT REP_A RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING q,q BUILDING PERMIT NUMBER. � i V DATE ISSUED. `�Z-/ rlZo- V^` 7 C � 7 SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr-posed Use U Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided C75- zo 2z 3C) 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public U' Private ❑ Zone Outside Flood Zone ❑ Municipal 4, On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record 'j ►" 574;�-7 IC,�I'Rw. JyY11v Sv =J Sp Sf Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: itLt � j me Print Address for Service: St nature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ e3 Licensed Construction Supervisor: 3 35- License Number 6 �Vse U P,� �aw e 'Sao v�e� M Address `' 7 Sb 5 Ci O Expiration Date Signature Telephone � 3.2 Registered Home Improvement Contractor Not Applicable ❑ a Company Name • Registration Number Address z Expiration Date G) Signature Telephone .y F 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. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Descri tion of Proposed Workcheck au applicable) New Construction P Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7tion ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify 1 Brief Description of Proposed Work: Mew <S\n�e �7�,��, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be bF�`ICIAL USE Y)NLY Completed by permit a_pplicant ., 1. Building (a) Building Permit Fee Z©off Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing /Zm`' Building Permit fee tel X (b) 4 Mechanical HVAC O / C? 5 Fire Protection 6 Total 1+2+3+4+5 ?j p p Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, .as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorised by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 14 I, W L t, t8,, 'P JO Vy So yJ 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 tULL104v IUB wg&J Print Name Si ature of Owner/A en Date NO. OF STORIES SIZE BASEMENT OR SLAB LZ L a(Ake N SIZE OF FLOOR TIMBERS 1 ZX ib 2ND ZY10 3RD SPAN i371 DIMENSIONS OF SILLS 41Y6 DIMENSIONS OF POSTS Z,,< DIMENSIONS OF GIRDERS X[Z HEIGHT OF FOUNDATION $ 1 THICKNESS /6 " SIZE OF FOOTING Ze X MATERIAL OF CHIMNEY p CleARAIVC IS BUILDING ON SOLID OR FILLED LAND 5u l l IS BUILDING CONNECTED TO NATURAL GAS LINE C 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*********************** ll APPLICANT fjxJd IJ PHONE LOCATION: Assessor's Map Number PARCEL 5r SUBDIVISION I LOT (S) STREET �� J S� ST. NUMBER 547 ********* * * ********* ***********OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS 2 64 DRIVEWAY PERMIT FIRE DEPARTMENT? f UJ, RECEIVED BY BUILDING INSPECTOR DATE i Revised 9\97 jm Permit Number REScheck Compliance Certificate Checked By/Date New Hampshire Energy Code REScheck So$ware Version 3.6 Release la Data filename: C:\Program Files\Check\REScheck\L-23.rck PROJECT TITLE: Plan #L-23 /25-75 CITY: All Locations STATE: New Hampshire HDD: 7554 CONSTRUCTION TYPE: Single Family WINDOW /WALL RATIO: 0.16 DATE: 10/05/05 DATE OF PLANS: June 14, 2005 PROJECT DESCRIPTION: 30 x 42 Colonial 3,402 sq. $. 573 Salem Road North Andover, Mass. DESIGNER/CONTRACTOR: William Johnson 508-560-9060 PROJECT NOTES: Harvey Industries "Vicon" windows Classic Double Hung(Welded Sash) COMPLIANCE: Passes Maximum UA= 543 Your Home UA= 540 0.6%Better Than Code(UA) Gross Glazing I Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1702 30.0 0.0 60 Ceiling 2: Other 9 0.200 2 Wall 1: Wood Frame, 16" o.c. 3285 13.0 0.0 226 Window 1: Vinyl Frame:Double Pane with Low-E 423 0.360 152 Window 2: Vinyl Frame:Double Pane with Low-E 39 0.340 13 Window 3: Other 13 0.560 7 Door 1: Glass 40 0.400 16 Door 2: Solid 20 0.350 7 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 1691 30.0 0.0 56 Floor 2: All-Wood Joist/Truss:Over Outside Air 20 30.0 0.0 1 Furnace 1: Forced Hot Air, 85 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the New Hampshire Energy Code requirements in REScheck Version 3.6 Release la(formerly MECcheck) and to comply with the mandatory r u' ements list the REScheck Inspection Checklist. Builder/Designer Date D REScheck Inspection Checklist New Hampshire Energy Code RES check Sotware Version 3.6 Release la DATE: 10/05/05 PROJECT TITLE: Plan #L-23 /25-75 Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: [ ] 2. Ceiling 2: Other, U-factor: 0.200 Documentation must be submitted verifying the overall assembly U-factor. The U-factor must be developed in accordance with accepted engineering practice. Comments: Above-Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Vinyl Frame:Double Pane with Low-E, U-factor: 0.360 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ] Yes [ ]No Comments: CLASSIC- Z190UNC I 'R— 1?! M04, [ ] 2. Window 2: Vinyl Frame:Double Pane with Low-E, U-factor: 0.340 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: wof— [ ] 3. Window 3: Other, U-factor: 0.560 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: "� ��L�I Doors: [ ] 1. Door 1: Glass, U-factor: 0.400 Comments: SLl r7WF, [ ] 2. Door 2: Solid, U-factor: 0.350 Comments: r Floors: [ ] 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: [ ] 2. Floor 2: All-Wood Joist/Truss:Over Outside Air, R-30.0 cavity insulation Comments: � Heating and Cooling Equipment: [ ] 1. Furnace l: Forced Hot Air, 85 AFUE or higher Make and Model Number 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 1)Type IC rated, or 2)installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials. Ifnon-IC rated, the fixture must be installed with a 3" clearance from insulation. � I 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 installed in accordance with the manufacturer's installation instructions. [ ] 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-factors, 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: [ ] I All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric, or tapes. Tapes and mastics must be rated UL 181A or UL 181B. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). [ ] 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 of the heating and/or cooling input to each zone or floor shall be provided. Service Water Heating: [ ] Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of circulating system. [ ] Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 105 T or chilled fluids below 55 `F must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(Fl Up to P Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Ran2e FA 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(far feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) By : Alan Carroll Plan L • 2� Floor — Area Calculations Area of floor over uncond/t/oned space k ® Y 41 e G� Toni = I Co R I ,4rea ol'f/oor over outelds ell- '2.. x Ceiling — Area Calculations I (0 K 26 4 42 IZ 2,0 x 14 = ,4tilc Access to be deducted=�9.4J a Tota/ By : Alan Carroll Plan Wall — Calculations H3 ' I?nd f/oor y /st Floor P/an B NZ G f O C /it Floor E -7 Secf/on U/a�l CB�CU�c9f1011s !(/ork,4rea l Go x �, 09 ® 1 Co9D •"14 290 A., (.H 12 I4+2.6+2,0+ Z,ept2, 5 + 16tZ& t146 +2 +42* :i�® K �,�� � 1'2 9,T� 2ND 146iI By : Alan Carroll Plan L� 2� Window & Door - Calculations Tab/e o!'&woo ibr Doub/e MutV xhool d s Tay/e of&V V foo"Ca�e,�e�t ru,�ia'oma < 4v/ pax, Vidth 1'10" 2'2" 2'6" 2'8" 2.10• 3'0" 3'2" 3'4" 3'6" 1'5" 1'8" 2'0" 2'4" 2'10" 3'0" 3'5" 4'0" 4'9" 6'0" 3'5" 6 .3 7.4 8.5 9.1 9.8 10.3 10.9 11.4 12 2'0" 2.8 3.3 4 4.7 5.7 6 6.8 8 9.5 12 37 6.9 B.1 9.4 10 10.6 11 .3 11 .9 12.5 13,1 2'4" 3.3 3.9 4.7 5.4 6.6 7 8 9.3 11 14 1 4'1" 7.5 8.9 10.2 10.9 11.7 12.3 12.9 13.6 14.3 3'0" 4.3 5 6 7 8.5 9 10.3 12 14.3 18 4'5" 8 .2 9.6 11 11.8 12.6 13.3 14 14.7 15.6 3'5" 4.8 5.7 6.8 8 9.7 10.3 11.5 13.7 16.3 20.5 4'9" 12.7 13.6 14.3 15.2 15.8 16.8 4'0" 5.7 6.7 8 9.3 11.3 12 13.7 16 19 24 5'1" 13.6 14.4 15.3 16 16.9 17.8 �� 5'0" 7 8'4 10 11 .6 14.1 15 17 20 23.7 30 5'5"= 14.4 15.5 16.3 17.3 18 19 5'5" 7.7 9 10.8 12.6 15.3 16.3 18.5 21 .7 25.7 32.5 Ce%u/ath',table f960/.a#. rmdave Ce%u/atlfon tay/e for CaWmflt a dome Unli a&O Aced ol-o& X qum§S, • Sub raid/ Un/!sze .fired of and X qudn/iy = sub Tafd/ 2'°%55 15.5 26 403 35x35 lit , ;Bp i 5� 210x35 9.8 'L 194 6 x44' Z7 27 U value U value rotas Q.22. (0 rotas 38, 'j C�/cu/r9t hn tay/e fbr G/ass Doon.► Cf/c4I/",7 rah/e fbr other y/azo Un/f size .4md a!W X gwmfy Sub raid/ LIM s/za 4�e of un/t X qudn/ly Sub rald/ U value (00 U value Tota/ .4 Q Ca/cu/atfon tay/e far doolx Door 6&S 4n--a of im& X qua"/!y Sub rola/ 2'6" = 16.7 5'0" = 33.4 2'8" = 17.8 6'0" = 40 3b"= 20 8'0" = 53.4 Height = 6'8" u va I- u e Tota/ �r., . 1310.\ _ .... _� - -•---••- ----•-- 2 1kJ Department of Industrial Accidents JF Office of Investigations 600 Washington Street Boston, MA 01111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leszibly Name (Business/Orpnization/Individual): A-V-, (� L\b�yy SL Iyam] Address: 4�> ( IALC,k VAtp A4WR City/State/Zip: Phone 7X V7j�g C Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ 1 am a employer with 4. [S'l'am a general contractor and I 6. New construction employees (full and/or part-time).' have hired the sub-contractors 2.[1I am a sole proprietor or partner- listed on the attached sheet. t 7 ❑ 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 arc a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Phrmbing repairs or additions myself [No workers' corm. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' corm. insurance required.] 13.[:] Other 'Any Wlicmt that checks box#1 must also fill out the section below showing their workers'compensation policy infomution. t Homeowncra who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConmwwrs that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infoTn Wion. I am an employer that is providing workers'compensation insurance for my employees. Below is the polky and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: I Expiration Date: Job Site Address: S1 3 S-". City/State/Zip:_ otZ` -A 616 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Faihirc to secure coverage as require¢under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-yea 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 certify under the pains and penalties of penury that the Information provided above is true and correct S i tui : Phon #: Offlchd use only. Do not write in this area,to be completed by city or town offlcial City or Town: PermtMeense N Issuing Authority (circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone N: I FP01'? . , FAX NO. 9788618998 111,3r. 22 2885 01:^9P('1 P1 _'C'�05 !'UE t ;�Q �M VV�f hv��SM il�� F�.h :Ic, Itl �7C: l�IJ4 ORO CERTIFIC-------------- ATE OF LIABILITY MuRANCE 2%Zoos TN16 A R r I R 0 FRoo� " (781)861-1800 P (7b1)861.18d4 ONLY AND CpNfER9 NO RIG,-ns UwONTNE CERTIFICATE Northwest Insurance Agency F1aL0ER.TlilS CERTIFICATE D06S NQi ADENO,ExTENO O 238 Bedford Streee ALTERTNlA COVERAGE APFORpED BY THE FOI.ICIE®9ELOW I Lexilgt0n, MA 01420 1 INSURERS AFFORDING COVBRAGf I MAIC NeuReRJ Gr+ln to State tnsuriknCL 23809 ypress Construction IN UR`N B' I 31 $axonia Ave. ,Apt, 1 In3uRPRC. Lawrence, MA 01841 NsuaEaD i46UFPR 6. COVERAGES aNY LED 12 ROLICIREVOENT?ERA 0 CONDO )ON OF GJQY CONTR9-4—WINE BEeN ACT OR OTHER DOCUMENTT V111E H R EePECTOTO VvTi CHLTNIS CER D�SATE MAY 57 81 ISSUED 7F N%Ay PITTA N THE)'4& RAVCE AF!ORCCD BY HE POUGGE9 ntSCR BED HEREIN IL SUBJECT TOALL THE TERMS,=XCLLISIONS AND CONDI?10NS OF SUCH POuC;E.9 +AoORECrAT2 LIMI?S SHOwJ MAY w "S 8££N REOUC®9y PAID CLAIMS ML Of IM3VRANC5 r0-ICY NUd1B(F W EAvh QCtVRR2NC� 6 GEMEPAL LL441UYY ;11 C`JfA4L -ABILJTY MED EXD l aOft alxny er > CLA:L:;nuCE OCCUR VERSO-,4 6 A:OV IN,URy I OBWiRAiA00REOATE �3 11-�� I PROx:CTb•COLw!OP>�A S GEW.J.GGRESATE.titR APPLIES PER PAO- 'LOG A4 TOtM011I t LIAf II^T COMOINED flNOLE L'W1T 13 tEa wzo<'U AMY ALTO 1 .S'Q,LY IUJURY uL V."EO ATOS I (PG:MUM 3 I�c.rED:LEO ALTW N1380 ALr De I I i gp�LY INJURY 1 fiver occawU � a0.440N"CD AUTOS 1 I pgOP6RTY 7AA144E 3 �, (ier ACOe O^t! ALTO ONLY.LA ACCIDENT 1 GAGI WhiWTY I I �tiC MR �,+�ALTO OTMEQ TMAN I —L-T'O ONLY' AGO i -----•� i Eh.^.h Oc"PPENCE 9 I-N-x-C�E5b,1W8RYlJ.A WDI�t[v I AGGREGATE 3 I OCCUR �ClA1L16NA]E ! 3 I DED'JC:16LE I I 3 RQTLN�ION 3 WORNEA8 0011�SMSAION AND I wC7666859 OS/16/2�a Os j16/I005 I Y• 17� R EN Pl.OY"EJt9,LLA IWUTy I tt..each AC' 3 500,ODU ANY PROPRIrORIPAR'N;PAitCUTYe L;.OISEAB!•EAEWRLOYM.$ Sao 0 4 I OvrICEw►tlN9ER EaCwOEJ� I py�e yeti^r�w,oe. EL.d6EA8E-POL'•CY LIN,R i 50D .paECIAI PROY16101w4 DBDA' I i OE OP o Tion I L A ODED 0 EN 6¢ T;5 CUL I CERTIFICATE HOLDER CANCELLATION 6YIOULD ANY OPTHI AIOVS,DF✓KRJYIA POUCIE1i CA1 J.LJEG BPjORE TNG 6Yp{AAT4N DATE TM9REOP,TW,!JWNO 1i.WA6AWILL WDW'J0A TO NAIL I 3D -OATL WRSTTEN NOTCC TD T'tC(�nWCATt nOIOtA NAUCD TO T�+e LD1. Dur PAIIv TO NA0.YUCK MO'HCE SMALL IIIPOtE NO 09L:OATIOM PA LIABILITY Vale Realty Trust OF ANY 0VPM TMG INS ADGNIS ORR W&SSWTATIVIA 36 Hi 9hval a LAne AUT"OR Rt" IWA Andover, MA 02810 ®AC CORPORATION IB38 ACORD 1A(2001JU9) FAX: (978)863-8998 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMR)O/YYYY) w 08/04/2005 PRODUCER (761)438-5000 FAX (781)438-5028 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION New England Heritage Insurance Agency Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR DBA Robert F O'Neil Insurance ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 335 Main Street Stoneham, MA 02180 INSURERS AFFORDING COVERAGE NAIC a« INSURED Larkin & Larkin Development, Inc. INSJRERA NATIONAL GRANGE MUTUAL INSURAN 14788 662 Clark Road Unit u5 INSURER ARBELLA PROTECTION INSURANCE 001119 Tewksbury, MA 01876 INSURER INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTYVITHSTANDtNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRADULLTR NSR TYPE OF INSURANCE POLICY NUMBER OATS MM/0 m DarPOLICY EPPE:CTIVE- IR e MINI m N LIMITS GENERAL LIABILITY MPOO1934 08/01/2004 08/01/2005 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY PREMISES Ee ocwrence) $ S00 OO CLAIMS MADE OCCUR MED EXP(Any One per3onl S 10,00 A PERSONAL 6 ADV INJURY 1 1 000 00 GENERAL AGGREGATE S 2,000,000 —GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AOCS 2,000,00 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY 98097400001 07/22/2004 071221200S COMBIIEOSII13LEIIMIT $ ANY AUTO (Ea ettaenq ALL OWNED AUTOS BOO1lV INJURY S X SCHEDULED AUTOS (Pe Peram) 100 00 B X HIRED AUTOS BOD.LY INJUR'e X NON-O%VNEO AUTOS (Per soment) 300,000 PROPERTY DAMAGE S (Per aamem) 100,000 GARAGE LIABILITY AUTOONLY EA ACCIOENT S ANY AUTO OTHER THAN SA ACC S AUTO ONLY. AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S I f DEDUCTIBLE 5 RETENTION $ b 11, WORKERS COMPENSATION ANO WCB01934 08/01/2004 08/01/2005 TOR,LIMITS ER EMPLOYERS'LIABILITY E L F-4CH ACCIDENT S 100,000 00 A ANY PRO PRIETOR'PARTNER/EXECUTIVE _ OF EXCLUOE09 E.L DISEASE-EA EMPLOYEE 5 11 e.scW,.be Wcer 100,000 SrCIAL PROVISIONS 0810W E L DISEASE-POLICY LIMIT S 500 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES)EXCLUSIONS ADDED 6Y ENDORSEMENT I SPECIAL PROVISIONS Excavator The aggregate liability limits may be reduced by previous claims reported. Subject to terms, conditions, endorsements and exclusions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE 15SLMNG INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, William Johnson BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 36 High Vale Lane OF ANY KIND UPON TNF INSURER,ITL AGENT$OR REPRESENTATIVES. Andover, MA AUTH RIZ PRESENTATIVE mac. ACORD 25(2001/08) FAX: (978)475-4340 ©ACORD CORPORATION 1988 N°wTM Town of North Andover Town Qerk Time stamp Community Development and Services Division : p Office of the Zoning Board of Appeals `)� �4q sem. TM C-1 IkK 400 Osgood'Street North Andover,Massachusetts 01845 D.Robert Nicetta Telephone (978)688-954i i. :. Building Commissioner Fax (978)688-9542 P66y ru'L P46 This is to certify that twenty(20)days have elapsed from date of decision,filed without filing of an appeal. Any appeal shall be filed within Notice of Decision Date ��� (20)days after the date of filing Year 2005 Joym A,Bradshaw of this notice in the office of the Town Clot# Town Clerk,per Mass.Gen. L.ch. 40A, §17 Property at: 573 Salem Street NAME: William P.Johnson,36 High Vale Lane, HEARING(S): July 12,2005 M y Andover,MA =5r,- ADDRESS: for premises at: 573 Salem Street PETITION: 2005-016 r North Andover,MA 01845 TYPING DATE: July 15,2005 The North Andover Board of Appeals held a public hearing at its regular meeting in the Town Ha 4loor> meeting room, 120 Main Street,North Andover,MA on Tuesday,July 12,2005 at 7:30 PM upon t . _ application of William P.Johnson,36 High Vale Lane,Andover,MA for premises at- 573 Salem-S et, North Andover requesting a dimensional Variance from Section 7,Paragraph(s)7.1.2&7.2 and Tabl of w the Zoning Bylaw for relief of lot.width and street frontage in order to divide an existing conforming 10 into + two non-conforming lots. Said premises affected is property with frontage on the Southwest side of Salem Street within the R-3 zoning district. Legal notices were published in the Eagle-Tribune on June 27&July 5, 2005 and all abutters were notified by mail. The following members were present: Ellen P.McIntyre,Joseph D.LaGrasse,Richard J.Byers,Albert P. Manzi,K and Richard M.Vaillancourt. The following non-voting member was present: Thomas D.Ippolito. Upon a motion by Albert P.Manzi,III and 2'by Joseph D.LaGrasse,the Board voted to GRANT dimensional Variance from Section 7,Paragraph 7.2 and Table 2 of the Zoning Bylaw for relief of 30'of street frontage for Lot 1 and relief of 28.29'of street frontage for Lot 2 in order to construct two new single- family dwellings per Proposed Plot Plan,573 Salem Street,North Andover,Massachusetts,July 8,2005[by] Douglas E.-Lees,Registered-Professional-Civil Engineer-#40930,.Land.Engineeringi-Environmental----._ Services,LLC, 130 Middlesex Road,Tyngsboro,Massachusetts 01879,Sheet 1 of 1,Job#0807,30x42 Colonial,Project location:573 Salem Street,North Andover,Massachusetts,Contractor/Builder:William Johnson,Drawing print out date:06/14/05,Drawn By:Alan Carroll,P.O.Box 5066,Andover,MA 01810, House#L-23/Project#25-75 and 30x42 Colonial,Project location:573 Salem Street,North Andover, Massachusetts,Contractor/Builder:William Johnson,Drawing print out date:06/14/05,Drawn By:Alan Carroll,P.O.Box 5066,Andover,MA 0 18 10,House#L-23/Project#25R-75., With the following conditions: 1. The applicant shall provide a Mylar of the revised July 8,2005 Proposed Plot Plan. 2. The applicant shall convey the 30'deep strip of Lot I designated Parcel A and convey the 30' deep strip of Lot 2 designated Parcel B on the above plan to the abutting properties. Voting in favor: Ellen P.McIntyre,Joseph D.LaGrasse,Richard J.Byers,Albert P.Manzi,IIl,and Richard M. Vaillancvurt. ATTEST: Pagel of 2 A7r ue Copy TownClerk Board of Appeals 978-688-954I Building 978-688-9545 Conservation 978-6889530 Health 978-688-9546 Planning 978-688-9535 Town of North Andover of"°oT; OBoard of Appeals ffice of the Zoning p unity Development and Services Division 400 Osgood Street" North Andover,Massachusetts 01845 'ss,K"use D. l�ketr s l Telephone (978)688-9541 Building Commissioner Fax (978)688-9542 The Board finds that a Variance from 7.1.2 for lot width is not necessary because both proposed lots are over 100'wide at the front building line. The Board finds that applicant wild divide the existing parcel,and could provide conforming frontage and lot width by constructing a short cul-de-sac from Salem Street. The proposed plan with separate driveways onto Salem Street eliminates Town maintenance of a new public way. The Board finds that the applicant has satisfied the provisions of Section 10,paragraph 10.4 of the Zoning Bylaw by working with abutters to provide an acceptable plan to the neighborhood,and that the granting of this Variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw Furthermore,if the rights authorized by the Variance are not exercised within one(1)year of the date of the grant,it shall lapse,and may be re-established only after notice,and a new hearing. Furthermore,if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two(2)year period from the date on which the Special Permit was granted unless substantial use or construction has commenced,it shall lapse and may be re-established only after notice,and a new hearing. Town ofNorth Andover Board of Appeals, Ellen P.McIntyre,Chair Decision 2005-016. M38P5. Page 2 of 2 . Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 ESSEX NORTH REG RY C? f UWR,F� , MAS. A TR - Y. AT l� ^ EssexNorth County Registry of Deeds�' 381 Common Street Lawrence, Massachusetts 01840 / ' 09/29/05 JOHNSON SMC # 13 Rec: Tvue PLAN -150.10-0-1 DOC. 37161 C. P. 2O.00 K. D. 5.00 [opie's 4.5O # 14Rec: Type NOTC 50.00 DOC. 3D62 C. P. 4D V. R. D. 5.00 Copies b.Q-0 Total 160.50 # 15 Payment Check 16O.5O THANK YOU! Thomas J. Burke Register of Deeds � � � MAP 38 LOT 289 MAP 38 LOT 288 N/F BURKE N/F MAP 38 LOT 290 CAVANAUGH 30.00' N/F G `> N65'30'49"E N 16'37 55 E HUGHES 25.68' I _ DH FND R FND N73'53'10"E 79.60 S7322'05"E S78'26'35"E 57.60' 73.40'` 26.44 2 00' PARCEL B 3,964± S.F. S 78'26'35" E 1 1,F, yry' 58.93' 74.36' /y 69.88 56.25' 8.11' CYS 73'22'05" E of . M 10.75' S 7322'06' E PARCEL C 16.62' 2,205± S.F. N 65'30!49" E 28.30' i 3T N 735310 E y ry N 72'35 41 E �� LOT 2 11v Ln M co PROP. HOUSE DH/BLDR cqR FND 2 . LOT 1 AREA=32,126± S.F. RAZE MAP 38 LOT 86 N/F 3 REARDON 0+o (° oq o a n � o K N a ro }}a, o IN n N i IR FND 95.00' _ 129.66' N80'03'47"W PINRDOCK A "OF SALEM J SALEM A. STREET BE 57 1965 COUNTY LAYOUTn !qqo, *�� VARIABLE WMTH 4�C'ess *ASURI dN 8/lOfDS SUBJECT PARCEL: MAP 38 LOT 5 1 CERTIFY THE LOT SHOWN ABOVE IS NOT LOCATED WITHIN ESSEX NORTH REGISTRY OF DEEDS A FLOOD HAZARD AREA AS SHOWN OF FEDERAL EMERGENCY PLAN REFERNCES: MANAGEMENT AGENCY FLOOD HAZARD INSURANCE RATE MAP PLAN #3091 PANEL # 250098 0006 C DATED JUNE 2, 1993. PLAN #13742 1965 COUNTY LAYOUT "I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES DEED REFERENCE: AND REGULATIONS OF THE REGISTERS OF DEEDS OF THE BK. 819 PG.26 COMMONWEALTH OF MASSACHUSETTS." ZONING "� �C�G,. 6/100 ZONE DISTRICT R-3 A. MATTHEW BELSKI, JR. L.S. #37557 DTE MIN. LOT AREA 25,000 S.F. *MIN. FRONTAGE 125 FT MIN. FRONT YARD 30 FT MIN. SIDE YARD 20 FT GRAPHIC SCALE MIN. REAR YARD 30 FT OWNER OF RECORD: o 25 so 100 *MIN. LOT WIDTH 100 FT WILLIAM P. JOHNSON *RELIEF REQUESTED 1 inch = 50 ft. PROPOSED PLOT PLAN Land £nglneering & :SHEET 1 573 SALEM STREET EnvIrOnn7ental Servlces, LLC 1 NORTH ANDOVER, MASSACHUSETTS 130 Middlesex Road, Tyngsboro. Massachusetts 01879 Telephone (978) 649-4642 0807 SCALE 1" = 50' JULY 27, 2005 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR NumberGS, 043353 Birtlidate011613 958 Expires:t" 007 Tr.no: 6269.0 RestrictQ WILLIAM P tl X00 _� JOHNSONi 36 HIGH VALE LANEr,`�. ANDOVER, MA 01810 Commissioner NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: C23 S'a., is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signa" of Permit Applicant Fire Department Sign off: ' Dumpster Permit ate RTy T- own o 4Andover 0 ®r-, _ No dover, Mass., /O O „La_ LAKE I� COCHICMEWICK ADRAYED SSACHUS FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT .....w��,���....�0 IVs 0�.'--•••........... ....................................................... has permission to excavate n • p and pour foundation at .. .... ........................................................... for the purpose of... O I..a*/Q SA7'�i,�S?,,.�9,.f•�.��...v!�+.��.r....S�� .��...t��+Itar0 The person accepting this permit must return to the office of the Buildin Ins ector a certified lot Ian show 9 P P P of building thereon before Foundation will be inspected. �,, Z,da peg. �•oS•e�♦G 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. . . .........SEE REVERSE SIDE . BUILDING INSPECTOR NORTH ToVVn of 4Andover 9s 0 � _ LA E a1. h dover, Mass., D / - o?O 0 4 COC MICMEWICK ADRATE D P"p �y .S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ��.��� � . �m BUILDING INSPECTOR .. has permission to erect.. .... ......... buildings on Foundation Rough to be occupied as 11 11 .bbf*.. ... 1Ar....Stl� ��. t'���► Chimney .... , �........... ........... ....... provided that the person accepting this permit shall in every respect conform to the terms of thelpplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final C-0 moS _o l PERMIT EXPIRES 6 MONTHS �' RMIN UNLESS CONSTRU ON T TS ELECTRICAL INSPECTOR jL Rough At........... ................................... Service DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumex Street No. SEE REVERSE SIDE Smoke Det. _i i ...1.a i. J. i. L ...,._.�. .i_i._i_. _._ _ _ u_ I L 1.1]_L -TCCI_. �. __.T. I.l..J_.._C.17._[_ .. ::L. I.(. _7 I.J_.. r r r F _ �J_T.TI J� T -1 7. II L ._i.Ill l,�_�_C 1 CC I . 7 L' [ ] r f tl [.1 I r.. i i1_I� `1:.1..,LL !L Ll �.Il. I 1... l i. ... - i ( T?_._.l. `.r '--TCIIJ�_. 11'1_ I. ��T J...._. C J �LIL[I iJ 1 _ 7 =i._C 1t � j�j X Z� JamilROO11*7 /ire _�. I JT . IT. L7_(_I 1g, — r L 1 1 _:r f I r, iZ1 1 J _ ��.. _.. I i I, i i �1 C .�LT�.L�[�1"C'�.�L,: II .i. l �2 t � �]� �.1 i ` J__ [ �.-.l i_ - , i_!.�...rt1 i _.t�„-L� I 1�-.. �” _4...1 _ _.1:r_i_ J _1 �.1.i. .��-� -- /1 1 X I 1 - �JI�i CL = TQC_.1-511 . , I .�r�. !_ ; I � 1 ,._ �_ � ! I � f �. CSI l �Iir ._l _ _ :C�:- - — — i.�._.(. I. a. ---------------- — r1 _1. I. i- --- - - - - - - 7 J t ll Li.._i I,.1.C [ 1_f I__ �1 _t —____--- ---_— L _ t._ _ I. '1_ L . T C �7_.. 1 IrJ — --- _--_----— i L �� ,i � _ _ r r� �IT�J C � J ' 11z"�7:_ 1._��,. [ �, --_ ? _r� TT t� TLLT'_ i 1( 11 T I,J. t 4 �L 1 --=__ --=_==-- r T. 111111r-- 7��_�L . C -��?� �. I r!.,�Lt,Tlr1.� �-r_`I_ .L'�T�1 'll,- ,J�JJTT ------- ---------- _.i�--1 LJJ 1�,-i-,.W ,�.-�-s-!r l ULLULLU — - ,�.� ,4 rox. �Ua/nscot/r� 1 I I 1 1 I I 1 I I I I I I I I I I I I 1 I I 1 40 (mfiz,)be%m grade I I I I 1 I I ,i� Basement ; ; ' ---------------- ------------ -------- I I 1 � fP�,jecf /ocaEfon� 3//6" " :� 73 ✓a/gym ✓�i�s�st # .4//d/mengfone to be f,�/d ver/f%a'and changes m�e accord/ng/y. © - Co1vvyr#171?005= ,4/an Cabo// Contractor/Bu//der Exter/ors/d/ng; tr/m, mou/d/n s and detaf/5 are per bu//der Sp&,C1f/cat/ona f=fnfsh grade fs .17001 as /6 bear tap Of fbundatfvn. P_O.Box 5066, ,4ndo vel 1Y,4 01.6109 78-901-0/3/ BjfV10idour dDoora= Mfg, sfze desVn layout and decal/9perbu//dem douse A/Prb,/ect # at Vnw this draaing As //x /, It /s the scale as /nd/catea,' a �� 4' Drag Aril out date= 0d//�/05 3 125m .SOS ��O 900 �p , MLLIJ 0ly IV0 rm JFM FFTJ Ell LLU UELI ED EM I i i i u i Nates: aftlo - 0 -- # ,4//danens,€cns to be t'-/a'verii',-d and chanes made acco�dtn�/y. /r8"=/O" # Fxienicn Siding, 7nan, MOL'IdkgS and O&tai/s a-e pen Bili/den Specn'"icat t7l" 0 �] ' # -- FA&b gnFds is 4170,W',ae /G"be%m lop 0/'%undatlon, l!//ndow 4 Doors= M/'% 5&6,Deem,L ayout lUhen this dna l?g b //x/7, &is the sca/e as AftAWted, �' Dr�u�pn/rit out dale Odr/4/05 �8"`/O" C - Co r ht?005- ,4/� Carro// 2&D" 300" 70" 3a" o r----------------------------------------------------- --------------------- --------------� r - --- -- -------------------- --------------------- _ ----------------------- a8"X/3" ------------18"X l3"-------1 0 ' '' rr-- - L------------------------ Cam, tUa///80"Pour(/-/ � IO"dp.x?O"ru, cont/n. /tIqlzi g: ; 1 � 0 "scr x I9"d�c�_ /oof/ng //2 D,t� La/� 3 Co/umna c'" d D" _ 6 0" 6 O" 6 O"44 o ' ' 16 ----� L.— -- a ' L------� . Zk ' 4 Goncrete 5/ab II T i-I—I-1 � �q S/ope/or draH�ge , Irl III I I I 70!Ux 7p Dp x 70 At , a I ' concrete = r- - ,I I t I I I ✓rhhn beam u//th steel ' ; O x b-�6/6 sue/ded ur/re/abr/c shims yr ha-d bn�ck ; z o � I �� gypsum urs//board - I � ,� ongarage sloe " _ � 4"Cvnc,✓ete v�/ab �, � -• 4 (m/n)Step domn Into aarage 2D mmte f he door 417/m) 6 x d-�/6 ure/dedurde A&/'/V O p/aced at maid-dep th of the s/� co ; 4,5047/7-4-L .tiCl --------------------------------- ' O -----� :.--------------------- -----� r---------------------er--------------------------- i ---------------------------- " r--------------i " r--------------------------- a 140" 3D" 8D" 3D" I40" /6 p2 420 70," 580" Not&,6 # ,4/1 d/mens/ons to be f/e/d Yer/f/ed arca'changes made accard/ng/y. �' Yer//y ur/ndour and door rough vpen/r�s ur/th manufacturer spec/f/caf/oreg � �� � �®�� �/��/O� �' Under S/ab Yapor Barrier to have d `(m�,l veer/app/ng,jo�infs_ � �/ Concrete Slab Contro/'Amhl spac/ng =30/'t. (max. 3//6"=/O" ,4t offsets /anger than /O !'eel. f ro v,�e a minimum of 4 aper /e uiindoure For Bve/y 4500 sq- ft. 6aegs dred s. A r 7,46 o6/1& cordit hng shall determtiie the need for foundat ion dna/nage �gq f• - 9�J� Dampprovf/ng sha//bep//ed/7-om top of foot/ng to f/n/shgrade, Ba.�m�17t a/'La e Vhen this dra/v/ng/s //x /7/t 16 the sca/e as /nd/cated, t Dram/ngpr/nt out date- 061/4/05 © - Copyright?D05- ,4/an Carro// I6�2" 3b" �6 " /0 14 6 94 34" %04 ' 71x4 70" 3:5"X35" ?%D"X-3 V.9 rril _ e OnraA st K/fchosr� P ,�aY ✓fud o 4 ob y Q h A a �� ,4edva/caSluE/e�Cavt I i_ IINOY v I. a h ` NA I;: ov : h a a ii a �/n/rte - foyer fv as " ?%62"X55" ?%O"X 55" " ?ID X55" ?i'D"X.55" I - CZ IA� _ i 36" 70" 36 " 30" BD" 30" 3b" 7b" 36" 10 �6" 70If 4!" JPO" /�O" I6 p" 4?D a MQ I&g A:Xnnow /-1171/eyw Sa a" # !4/1 dimea k?m to be 17e/d ve�i/!ed and changes made accordiaq/y. # Yerify l(/indow and,Door Rough Openings,With 1Yftffacturer Spec/Ticattiona. 3/l6"=/D" Tempered G/az/ng shall be IMIAI/ed of a/I ru/ndours located near / ' a/7$a$C�. At = 9� tubs and mh/t/poo%s 4nyglar/ng�located c/a6er than/8"to the 11067r, # !!/hen Phis drau/ing!s //x 17, & Xs the scale as Ir dicated_ © - CoprVht?OOS: Q/an Carroll /6lJ" /3©" .5b" 8%3- " 7C2 .00 6 0 X MI6" vent vent a Fall E, o o an 'h 3 ht cio5�t cios�t ...:_ h1 Bafh o .. B�9ifi o � ,8adrvo� � a �J 0 h a � I I I I M W ; - r—Attic access +c1 I O I ry -----J Pulldown&ta" If,oSt 0 k I Iloculated cJ r - ....-:.......�: :...... ...... ..:. .. .. • II 14 Post , 34„ -1 I CoFFered ce///nom I I a o ,8edrvom ? - �� ��sdrvo�n3 / — — — — — — — — — -1 \ i = - - - - - - - - - - - - - � o o - e a X . a ?IO. a X 65. ,i 765 R, Post A Post 14 68"X55a h h 700, 36" 70" 3b" /w # /eo" Ol Ale A/0 leg w 4//ddTlensians to be and changes ma4e accordlnq/y. L -2�: ��e0�d ! /�Or /�� a� Yeri1�y lUfndory and Door Rough Openings with MarxiFacturer 5peclFicafions. 3//6 � tempered Cslazing 9hs//bB lrrsfa//ed at a//ruindours /orated nem q � f.� _46 49 tabs and ah/r/poo/s. ,4nyg/az/rxg'lace ead c%ser than /8 to the F/oo� MV �ve ' ' e lUhen this draming /s //x/7 it !s the sca/e a5 indicated. �iL7e17,4�LA 3G�. �f. -�.3 # Oraur/ngpr/nt ouf Cvpyr�ht 1D05= ,4/an Cuero// General Notes: Foundation Plan: t=ram i nca Plans: - - Indicates Smoke Detector location vapor Barrier with ro" (min.) over lapping Bearing 1 1/2" (min,) bearing on wood or metal, ,joints under concrete slab. Notches in the top or bottom of ,joists shall All substitutions and/or deviations from not exceed I/6 depth/,joist these plans are the responsibility of the Beam Pocket Shim beam with steel shims or No greater than 1/3 the depth/,Joist contractor. Contractors specifications take hard brick. The ends of wood beams shall Not be in the middle 1/3 span, precedent over any information presented in have a maintain 1/2" (min,) air space on top, these drawings,' All dimensions are to be sides 4 end. Maximum Allowable Clear-St2ans field verified by the contractor and any For Joists/Rafters adjustments made accordingly. Garage Fire Separation 5/S inch (min,) Type Property Zoning, Dimensional Set Backs, X gypsum board applied to the garage Spruce-Pine-Fir Grade No,2 or better Septic issues, etc., are the responsibility side, of the owner. LLvi�g Area (except sleeping r� ooms)- Basement ventilation: Install 4 (min.) Sliding Live Load 40 psf, Dead Load 10 per Smoke Detectors : or Awning type windows for every 1500 sq, 2 x 10 0 16' O,C, = 15' - 1 1/2" 1 I. In the immediate vicinity of bedrooms, ft, of floor area, 6'D" 110" ' Attic (no future rooms)- 2, in all bedrooms. ; (max.) (max.) Limited storage, LL 20 psf, 3, In each story of a dwelling unit, including _ basements and cellars, but not including - Dead Load 15 per 2 x 10 e I ro 0,C, = IS' - -1 1/2" crawl spaces and uninhabitable attics: ImE 4. 1 for every 1200 sq, ft, unit. Roof: Anchors bolts or _ ___ Snow Load 35 sf, Dead Load 15 sf Windows located near tubs, whirlpools shall --- - - p p have tempered glazing. Minimum Glazing App'd Equivalent 2 x 10 9 16 ' O,G, = fro - 2" clearance above floor 18 All structural materials shall be void of any Abbreviations Anchor Bolt 5pae ing defects that may diminish their capacity to function in an adequate manner, Structural Cir, - Clearance Engineering or any other professional - Concrete dia. ;Sts rwa services that may q be required shall be � dia. - Diameter provided b others, El, - Elevation d - Dee Stairw Width : 36" clear width above rail. p y Ex - Expansion Riser = S 1/4 (max.) Tread = 9 (min,) Exp. Ft - Foot or Feet Nosing Profile : 1 1/2" (max,) I/4 Shrinkage Gap ( min. ) Ft'g, - Footing Headroom : 6'-6" minimum 3/4" Sheathing h, - Weight Guardrail Oloenin Limitations - LVL - Laminated veneer Lumber �" max, - Maximum prevent obJect 5 (max,) min, - Minimum Triangular space 10 riser 4 tread 6" dia. (max,) O,C. - On Center Handrails : Having 34" min, 4 38" max, height PSL - Parallel Strand Lumber sq. - Square Measured vertically from the nosing sq, ft, - Square Feet LUS HangerL T4G - Tongue 4 Groove Handrail GrinT size �� Double Shear 5tra i of concrete Circular cross section: 1 1/4 min, 4 2 max. PI' ng T,O,F, - Top of Foundation Other shapes, perimeter: 4" min. 4 6 1/4" max. U,N,O, - Unless Noted Otherwise Cross-sectional: 2 i/4 max. _ _ LVL Beam Wallboard W, - Wide Flush f=ramed Beam Construction Materials: handrail (typ.) Framing_ Spruce Pine Fir No. 2 or better Wall Stud Size 2 x 4 -0 16" O,C. Wail Stud Length: Ist Floor: 104 5/8" 36" high (min.) 2nd Floor: 92 5/0 34" hi h min. Stat Guardrail ZV Guardrail F lan . L-23 � handrail/Guardrail 5b� Bb� Lab" //4 b " /5 P4 -IF - IFIF 17 � ILII ( a i� IFri— II II - - - - - - (I JL-,l (— —IF 11 /nsu/ated I—II- � IF 1I II II I . I II II II II l o v- - - - - - - - N II II II J II- J l'feta/Or�/v Edge /6 G7" I4 b2 /467 /4 b7 ,411h!7 �/OQrPIe � — - - - - - - - - - -�/cedlUvterSh/e/d - - - - - - - - I I I ♦ I I ♦ \-Composlfe Roo!/ng I I II 1I ♦ ♦ I I I �` ♦♦ � Contl�ious Ba/7/ed � 1 II II # d//danens vns to be Avid vanr/ed ana'changas ff fdaaccord/ng/y. # Yer/fy!U,l�dory avac/Door Rough OpBn�igs m/fh f'farwFacfurasr Spec/f/caf,(er� ' # Smoke Detectors efia//be located�!Ua/k Up dtt,�s. L ��3• �QQ/���Q7� # Ronol"v materia/s per Builder SpectrYcat/ons. //B v_/b" # l!/hen th/s dravky b //x/Z/V& the scale as ,f%Vedted, # Dr�v/ngpr/nf out dale= 01.6//4/05 © - Copyr/ght?005= d/an Carol/ ,4ccount fbrp/umb/ng , dra/ns /n fh/s area MVV ,� 11 � Quoe. �M c al a - 1-111- al `Vr I ry of 1 l Q V 4 I r I r I r l 41) { ) r ^1 r i il ;ILII I - ........... ......... .EF Li I I i Notes 4//members are?x /D e/b # ,4//d/mens/ons to be fYe/d ver/fled and charges made aceora'ing/y, / 2 {' # Framin P/ans areivru�fbr�farmation and canl7guraf,�n on/y. L ��J = irs� /aor �� 4 �tcfua ftam/ng methods are the respons/bl//ty oP the Insta//er, 3/Ib on mood 0,- MI /nd/cafes IWAO&&lour fYam/ng: ;-3-%s =�4 -/nd/cafes rua//s shove framing: �' Draruirgprint out date= Ob/I4/05 © - Copyrr�ht?005= .4/an Carro// J ............... ............ ............ 141 Ila NO Z4 J1 FM- Jrb nz ni- -j Lik —1 m 1 11 11 -.. , I I I [ L Ir T r 9 IF 1 9 r 9 -11 Ir T r -1 r -1 r q r 9 r v IF 9 r 9 L JL AlL JL —9 r Tr Tr n r -Tr T r --- ..........H ------- ILL ,4//members are 1 x/V IV A6"67-C, V-N-O-) -29 dP aF 411 d1ffl&,W1OMeo be AWd and changes made accord/rx�/y. oe FIdlflPV 1='1917,9 are MOM/1 for/reformat/vn and confYquraf/on on/y, �tctualf�am/rte methods are the reBponsfb///ty of the h'Vhf//&,'- 017'Wood or ffle'a/, # "J /red/cafes Beam Number 1At7(kdl69 N911.4 bellow W,1115 d,&,Ope Ao //,v /7, It lq the acd/s as illo'edlad CvpKyhl XO-6-- 41,fl7 CdMVII 9 eormIn lu 0 qp"07teviddle-, L r L r L J L J L 1 L J L J L J,[- I.-L' I L r L r L a r Q L r L r r /4 D r Attic wcew r Pulidow Ste" I r Inued leeBh1-/ II III 1 i r -i r -i r 9 r 9 r 9 r 9 r -i J L L I r r J I 1 L I Coffered ce///ng 1 L I r r J I 1 L L r r J I I L z I I r d J L L I I r r — — — — — — — — — - L \ r r L � r lr -ir llr -Yr -rr -Yr r r r L r ' B/ M L r jjnL 1 /4 ,4//memlbers are 1 x/O &7 /b Notes" • lliif"o �' ,4//dimensions to be fie/d verified and changes made accordlny�� 3/I6"=/O" a�' Fram/ray P/ans are shorn for/nforrnaf/on and coni'9urat/on on/y. 1 ,4ctua/fram/r�'meflx�ds are the re,ponsb///ty of [fie /nsta//er. # Beariyg ///1"�min.�on urood or mefa/_ i, a�' B�f =/nd/cafes Beam Number ` # o -/nd/sates urs//s be%ra fi�am/ng, -/ndlcateo ma/Is above fYam/ng. # lUhen this draur/V/s //x/, X b the sca/e as indbated. I Oraur/ngpr/nt out date= O6/I4/05 © - Copy��ht?005= .4/an Cairo// J a 0 0 0 _ a I u H u u u H u Rldge f/fp ol Ya//ey Raltens are 1 x /Z ,4//1nembers are?x /0 %V /6"OC, ,4//d/menslons to be F/e/v'ysr/FIBd and changes mad&acco122/ng,�6 Fram/ng P/ans are shoran for/nlormat/on and con /gurat/on 10)1/1. ,4ctua/Ih m/ng methods are the reepo)1s/b///ty of the /nsta//e� � �&arfng= ///1"(min„110n ur10od or meta!_ �' !!/hen this drau�ing'is //x /y it is the sca/&as indicated. � Draur�ig'�brmt 10ut date= 06//4/05 © - Copyrght 1005= ,4/an Cama// ge Yenf(conflmm,4/ �' Q//dilnens/o� to be fYe/D Yer�,s°d era'chimes msta'e accona',fng� F,�idsli!/oor # MafBrt�/s are per Buiyder Spec�ications. /x B�Cv//a-T�ls , ?FJ 40 4.C, S son Stro -Tie —SubF/oor !!/hen fh,&drarayig/s //x/y/t/s the scale as AiD/cated_ �' pr�ru,�ig pr,�it out date= 06/14/05 L S30(/each s,lde 1 , or egos/ ,Deader 1 1 1 ?k4,Sreaa'er 12 9 i .4tt,�F/oor FramgigRooF� I AN;-s&j?gw , 3/4 TSG Shaafh� //? P�ood Sap *Op �6 f��/ r - - - / LQ Fascia '' So/7'/f m/venf/ng9" - � �� 3/4"TSG Sheafh� F/n/ah F/oo ' �� Secand ?x v ?D/6"a '----------' x Z /O So//d Fie � Block � ✓�UbT/OOr sfr�lger 4'Lafera/Bracing /1BadBr -, to merasecf ru/fh ' q� --________-' boffomoFstrix�er I -1 i 1 'T ' ----- ' �` �_! ,- 9"Ti�sads Fhst F/oorFram�ig 3/4"AG Sheathriq //4"=1021 Ai7kh cq ' �_=====s=! LYL CenterB�am \ - _ V"Cont_Fa'n. ?D"ur,x Vv d , Ft' w/dampproOF/rx� 4=j 4=j , Basement Concnste S/a5 - Basement �_� -� u�/vapor ba�',�r beneath 114T1 CO- Copyr�hf?005= ,41dw Ca71011 o s= Rage Vent (cont f�iuous� # Af Il dI gas/ons lo be/Ye/d veri7'Yed and changes made accord/ng/y. + 1 x/?iP,U'g'e Boyd �' /7aterl�/s azsper Bu//der Spec/F/cef/ona # U/hen fh& aravriig,& //x/7, 1 A Elie sca/e ae A&o'L-afed. /X B Co/%T/e 9 � X140"O.0 d ff/c F/oor Framfig �Poo/,�iq 3/4"T!G Sheafh/ng //?"P/ OOd " /a tv/6"O,C, SoflYf u�/venfhg' a dl SBCO/1d�/oOr/r'amNl9' 3/4'TdG ShBafhiiq Second ?x/D �1�fh"D.C. Exterior lUa// z - - - ?x4gDl6lar, L YL or 5f8B/BBam z La//y column--.,t7.Sh$6om LCC La//y I or equal column Za//y boffam d bass ' p/afe embedded Ftsf Floor Frambg ,,�_ ii cancrefe s/� ' 3/4"TfG,gheathhig ' W 1 x�f0 Sa/!d Fie Back/mv �lpprox. �Lafera/Brat/nq (/J-Ix d (K.2)F*Ah ,Lally Co%r�r� Defall Grade - L Ga-age F,Gi%sh=5/9"Type -X (/-/3/4"x 9//?" - !Ua//boesro'on the Ggrayc ekd'e L Y,L CenferReam , f` ZO"a X/O'dp. Al �1 3/17 A La// Column /3"dp. Fig- 4 ig ry/damppinv!iq 4'(m/n)Can-�mfe.S/ab Basement ui/v�norbar%rbeneafh - _ - " //¢"-/L71 C - Co r/ hf?D05- ,4/an Cuero// o pyo To-wn o fAndover No. goo dower, Mass., S� O LAKE COCMIC MEW11 K T 'SSA Rq r o SAS HUS FOR r cl\Jib \"" - _ EXCAVATION AND FOUNDATION THIS CERTIFIES THAT � �O I�IVSO ry • ........................................................ ................................ ....................................................... has permission to excavate and pour foundation at 0 0� /fit IQA7'� o? gf� / v %r S� + �w�a i for the purpose of... .......... .......� ,,......- -....�................. ...........,...,............. Al The person accepting this permit must return to the office of the Building Inspector-a certified plot plan show of building thereon before Foundation will be inspected. !°�W^ Zia PC& �moS'o�G 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. 1 SEE REVERSE SIDE BUILDING INSPEC � Nvrc ray TONM Of Andover 0 TO 9s 10_ = A E dower, Mass., 0Zo o?G 0 _ COC MICMEWICK VVF ADRATE D PPS\ �2 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ABUILDING INSPECTOR THIS CERTIFIES THAT....... �.� �: ,r N S O N ................ ................................................................ .................... has permission to erect.. buildings on ... � Z V ' oun tion .......... �.....:. ............. .. �............ Rough ol�r Sty (I 't�wt (141to be occupied as.... ... ... O NiI*....... .. ... Va..w5f 0 . .�A!............................. . 1 Chimney provided that the person accepting this permit shall in every respect conform to the terms of the pplication on file m this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. as/So PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU ONUTTS Rough C Service UILDING INSPECTOR Final Occupancy Permit Required to Omupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location' 7 i No. c Date �aRTM TOWN OF NORTH ANDOVER 3 'o ,goo 9 _U i Certificate of Occupancy $ Building/Frame Permit Fee $ 620 sACMUs Foundation Permit Fee $ .�j Other Permit Fee $ TOTAL $ �y� Check # 1 $783 �/ 'Building Inspfctor IAORT#q T0VM of . ..... over No. • 5��O — C% t -.-7A 6 dower, Mass., 0 L.A, E COCHICHEWICK RATED P" BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT....... BUILDING INSPECTOR .... ... Foundation ............. .......... Rough <<�has permission to erect.. buildings on ... ......3 . 'to be occupied as.... V614kr S(06..&... ...bf ..................... . ... Chimney shall in every respect conform to the terms'o*i p**p*Ii'c-a*t'i*o'*n*"o,*n*"f'il*e—in- provided that the person accepting this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. j a/� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ISj Rough ASESSORS C ®Y "),ft T- :z Ta 4 1%-- C. Final PERMEXPIRES IN 6 M0NTHS?ERlWrr USSUED 0O.5 I PF-RMIT PENDING r7 ELECTRICAL INSPECTOR UNLESS CONSTRUCIFNJT'A TS Rough Service ........... ....... ............... UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises* — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 7 a: Date.!..0� . . . . ... .. w 1• F ,AORT#q 1 •. O ,.ao ,° tiO 3? �` TOWN OF NORTH ANDOVER IF' 10 � 9 PERMIT FOR GAS INSTALLATION ,SS�CHUSEt r '.14 , This certifies that . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation IY. . �,. in the buildings of .�. . . . . . . . at . . . . . . . . . . . , North Andover, Mass. s Fee ilZ. . . . . Lic. No. —moo. . . . . . GAS I�SPECTOH (, u Check 5437 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /�j N Mass. Date ; 3. cc Permit # ` 06 6 Building Location Owner's Name VA Lt 64 11y S (� 7 5A L 6 M Type of Occupancy New 80" Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No❑ a h W M Y Z ¢ N jA N V ¢ !— S N ¢ N ¢ O O N = H W W N. ¢ O V 10 N F' y W O O 0. C r1 � Q ¢ N C7 W W S ZUy W � O C > W Wcc J Z < S ¢ 0: W ~ W = h ¢ W > W F' J.-.h., .W 1.t r N m Z O 2 W v 0" $A S Wa o �, y o a. o suB—BSMT. 4 BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7THFLOOR 8TH FLOOR V 6 installing Company Name �� lj� P Check one: certificate Address I a y A6 ,60-FT �� Q Corporation 3,5" ice/ E!J G F [3. Partnership Business Telephone 9 0 Firm/Co. Name of Licensed Plumber or Gas Fitter R R y //f'�� INSURANCE COV RAGE: I have a currentAbility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O If you have checkedrtes. please indicate the type coverage by checking the appropriate box. A liability insurance policy LK Other type of indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner[] Agent ❑ Signature of Owner or Owner's Agent I hereby.cedify that all of the details and information 1 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 the Massachusetts State Gas Code and Chapter 142 of the General(as. gy. T f license: 7Q �� Plumber Signature of Li lumber or Gas Fitter Title asfiriec ®�a Master License Number _J CitylTown Journeyman APPROVED( i NL �� � BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE. NO. APPLICATION FOR PERMIT TO DO OASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING i 1 PLUMBER OR OASFITTER LIC. NO. PERMIT ORANTED DATE 19 GASINSPECTOR I Datel. . . . . . . . . . . 0 "O RT:'+o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Y • � : i •.. ,SSAC14USE� This certifies that . ./.J'. . j . . . . : . . . . . . . . . . . has permission to perform---. �..... . r . . . . . . . . . . . . . . . plumbing in the buildings of .'�!� ' ' ` . . /.. . . . . ' at . ..... . . -' . . . . . . .�. . . . . . . ., North Andover, Mass. Fee.//. . . .Lic. No.. . . . . . . . . �,.�..: . . . jj !. . . . . . . : . . . . . PL NTNG INSPECTOR Check # 6815 MA,S"USETfS UNIFORM APPUCATION FOR PERMIT TO 00 PLUMBING ow or Typal No . A OP . Mass. Date a° Pan&*, a OwnersNsnlq_ VAtF fi. p (7'Y 19 vs T S` SAL dam " Type d Occupancy New Lf Renovation O Repacan� ❑ Ptana �: Yes O No O FIXTURES z i a - z a 0 M O z z w n w Y �1 M < �; F Z C = a d < < O = 6 O O = t O C r r. W S < Sz ; Y d = �. It 0 N Z Z .W O a Ir V S !- V > 1� O r M ` t O i J j < O < O < F. s �t J M O O .r► ; S F t1 Y, O O O < ; 6 O O sue—esarr. BASEMENT IST FLOOR / I 2ND FLOOR ) F 3RD FLOOR 4TH FLOOR STH FLOOR eTH FLOOR 7TH FLOOR aTH FLOOR InstalCompany/Name I� MARTTN F + u^ T�jjr�_ Chedt One:. finQ CerHiate Address 124 ABBOTT �T 0 2135 LAWRENCE, MA 0184 ❑ Business Tde*4m 978-685- 1 O �iml/OO. Nims of licensed Plumber KERRY MA RTTN INSURANCE COVERAGE I have a current Wblib►instance po&.y Or its i equival eat which meets the requiremetft Of MGL Ch. 142. Yes E� No O It you have checked M.pease indicate the type=vMN by dledtinp the approprbtc boot. A WbOb,kauranoe pclky 9 Olher type Of Indwvv* ❑ _ sand O OWNER'S INSURANCE WAIVER:I am aware that the licensee does not haft the insmum caMerape requked by CtwA r 142 of the Mast General taw& and that my signature on this permit appliation wahres this requirement. Check One: owner O Agat O or s Pard J 1 IlMaby oartily that d d tlla detaYs and intons�ation 1 haw ro6rritlad for��h above tua ttlla and aoounlla to the bort d any k1lowNdge and the d pumbip work and h>1a�ns padornlad laldw the pamdt mind for this appkabon wN be in awro aoe vA b d parlirlant proririorW Of hila IUSAMAM a State Pkotft Coda and C7142 II . 8y Typa d Banat:Master[ Joureayman❑ CKy/Town tjmM Number a'1?Q - j I/ rII �3 BELOW poll OpplCs Uss ONLY • pROGREii INiYlCTIONi � nNAL INiPI[MOM ` p1t • q0. - AppUCJ1T10N PON pERMiT TO 00 PLUMBING NAMR•Typg OF BUILDING v LOCATION Op BUILDING . ►LuwER . PERMIT GRANTED DATZ ..__.r p MEING INipEOTOR NORTH °1"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS US . ....^.'e This certifies that .......,.....� : ........ ..................... ........-!..... ................................ has permission to perform ..*�..-:....... ..f...:.. ............................................ wiring in the building ofi....'�'�. �..,% �- �� at............. ................. ...................... .North Andover,Mass. Lic.NAI.S t ............ ELECTRICAL 14SPE Check 6436 i _ Commonwealth of Massachusetts Official t se Univ --' (z Department of Fire Services Permit N°. y` Occupancy and Fee Checked j% BOARD OF FIRE PREVENTION REGULATIONS '`(Rev. 9.05 •\G� ] (leilve blallk) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 111 unk to he performed in accordance!lith the Massachusetts f:IccUical Code( lEC . >>'L"vIR I?.tlO (PLEASE PMT IN INW OR TYP I , NF( R.1MT1oX) Date: City or Town of: t3 'rl- To the hT pec or ol'Wire.y: By this application the undersigned gives notice of or I ei intentio perform the electrical work described below. Location (Street& Number) Owner or TenantTelephone No. j�2"6135 Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. AFS J Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service r2t2p Amps /00 /040 Volts Overhead ❑ Undgrd []� No.of Meters !Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com,leliwl u/die fidlou inn able rnav be a awed 1w the his lerhW v/' fires No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above n In- ,❑ o.o Emergency Lighting rnd. rnd. 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 s No.of Air Cond. l Tot INo.of Alerting Devices D No.of Waste Disposers Heat Pump Number I Tons 7 KW No.of Self-Contained Totals: I Detection/ale.tin Devices No.of Dishwashers �' Space/Area Heating KW Local unicipal ❑ Other Connection No.of Dryers l Heating Appliances KW Security Systems:* No.of Devices or Equivalent + No.of Water No.of No.of Heaters 6 KW Si ns Ballasts Data Wiring: No of Devices or Equivalent _ No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: i IHach,ul(liriurrul rlrnril r/'(h"Sire(l, ur'(IS rOyuurIl by rhe llrspcLh)r u; II'irc:r. Estimated Value of Ele rical Work: (When required by municipal policy.) Work to Start: 1!� 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. `t'he undersi��;ned certifies that such coverage is in li>rce,and has exhibited proof of same to the permit issuill"office. CIIEC•KONE: INSURANCE' ❑ BOND ❑ OfFIEiR ❑ (Spccily:) I c•erlilj, wider the pnill.c ItIldpelruies of perjury,,/rut the infurmali 011 TINS(l 1)Ilcalion A tide wi(l eoinl Vele. FIRM NAME: LIC. i`�0.: ���— Licensee: ge .;ignatuoe LIC. 'VO.: /!npplicrrb/c, nler "r.:rrr/N"u h,..'h u�, wnrbc Bus. Tel. No. r Address: _ � �C - 11t. Tel. No. Security System Contractor License required for this work; ifapplicab ,enter the license number here: _ OWN ER'S INSURANCE WAIVER: tarn aware that the Licensee(100S 110l/1(llle the liability insurance coverage normally required by law. By Illy signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's al;ent. Owner/Agent .signature Tdc-phone I'lo. P,�R.,WT,FF_E. S i ,a MAP 38 LOT 288 MAP 38 LOT 289 ;yf N/F N/F BURKE CAVANAUGH L _ S 73'22'05" E S 78'26 35" E 69.68 56.25' i 16.62' N 65'30 49 E 28.30' 21.38' 0. N 73'5310' E I o N 72'35 41 E h 3 PROP. ry SCREEN PROP. PORCH DEC DECK 39.,B,.g. M i N #567 In EXISTING HOUSE 283, PROP. COVERED PORCH MAP 38 LOT 5 N/F MAP 38 LOT 86 FULGIONE N/F REARDON N p 00 1(0 O � � 1 t%a � LOT 1 32,126± S.F. i o 95.00' N80-03'47"W I i SALEM ZONING: R3 STREET MINIMUM SETBACKS: 1965 COUNTY LAYOUT FRONT – 30' VARIABLE WIDTH SIDE – 20' REAR – 30' OWNER OF RECORD: JOHN P. BISSONNETTE & KATHLEEN A. BASS 567 SALEM STREET ���N OF 104 4 NORTH ANDOVER, MA 01845 �� s cy 1 CERTIFY THAT THE STRUCTURE SHOWN ABOVE CONFORMS TO THE ZONING DIMENSIONAL REQUIREMENTS OF THE TOWN ENDRD BK. 10175 PG. 17 ouc� s -" OF NORTH ANDOVER AND IS NOT WITHIN THE FLOOD HAZARD No Es AREA AS SHOWN OF THE FEMA FLOOD INSURANCE RATE P� MAP COMMUNITY PANEL NUMBER 250098 0006 C, DATED GRAPHIC SCALE �Fss�°� JUNE 2, JOW 0 20 40 so qN�SURIN C .11 lc., q• L! 1 INCH = 40 FT p•� DOUGLAS E. LEES P.L.S. #48094 DATE II PROPOSED PLOT PLAN JOHN PREPARED a / SONN£1TE JOB# 27201 —� PREPARED BY 567 SALEM STREET Land Eng/neer/ng do SHEET 1 OF 1 NORTH ANDOVER, MASSACHUSETTS MAP 38 – LOT 335 En vironmento/ Services, Inc. 130 Middlesex Road, Tyngsboro, Massachusetts 01879 SCALE 1=40' SEPTEMBER 2, 2011 Telephone (978) 649-4642 Date..... Y NORTH °f,"`° '•�"� TOWN OF NORTH ANDOVER A PERMIT FOR WIRING �,SSACMUS� This certifies that .......... �.l. ...... Lc has permission to perform ............................0`.............................................. wiring in the building of...... �. S6 7 S'9� ST ......... orth Andover,Mss. ` Fee.. DoL Lic.No.303&G......... iL CfR1CALINSPECTQ�t Check # " 0834 U 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed.forin.Ager a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an D lectrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall_be limited as to the time ofongoing construction activity,and maybe_deemed.by the_Inspector_of_Wires abandoned_and_invalid.if.he—. . ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on Le-permit application. . ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. le 8—Permit/Date Closed: `� ***Note:Reapply for new permA\ ❑Permit Extension Act—Permi/Da Closed: sN Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code _ C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORM TION) Date: 1 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intenti erfbrm the electrical work described below. Location(Street&Number) ��7 C,�leM � Owner or Tenant ' fj;6j0/7fiv 7-7-e— Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building t7UU5e- Utility Authorization No. Existing Service ;2&a Amps I qv / AY0 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: Completion ofthefollowing table may be waived by the Inspector of Wires. ' No.of Recessed Luminaires No.of Ceil: No.of Total Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimmin Pool Above ❑ In- ❑ o.o Emergency Lighting 1 g rnd. rnd. Batter Units No.of Receptacle Outlets i ? No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices Space/Area Heating KW Local❑ Municipal ❑ Other No.of Dishwashers S P g Connection No.of Dryers Heating Appliances KW Security Systems:X Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent � OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the informatio i pplication is true I complete. FIRM NAM CB3L IC.NO.: License p Signa reZOIC.NO.: G 3!;�y P (If applica e, r "exem t"in 1 e license number lirW.) el.No.: 3.S"',•2- 7l/3Address: �d 14A •el.No.: *Per M.G. c. 147,s.57-61,security work requires D artment 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 Y required b law. By my signature below,I hereby waive this requirement. I am the(check one)Elowner [Iowner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. f r . �2�sse��-•( � �'ailed�j ) �e-xuspectZon xeguzxet�'($�'O.DD)�� � 3nspectozs'�oJntue�uts: (C'nspectoxs5 signature-X.o Mtza'Is) r Pate �'asse��-•j � •�+`aiTe�--r � � ��xus�eetsox�xeo�aixe�($ 0.00)-•[ � . Tuu�iectar¢'comments; fts&ctors'gignatare-7uo wilals) Slate � Passed-� j 'aiDed- [ Xte iys eetzonxe uixed($50AD)�[ Xns'pectors'com cents: , (Jtnspectozs' ignatuxe-tto?uitzaTs) Pate assed.--[ ) Failed--je�znspectionxequired( O.OD)» isDeetbxs'eoJmm.e�tfs; � (Inspectors'ftaature-io jnitials) bate r ' used—[ ailer- [ - 'Xtenspectionxe�tvxed( 50.0D)• [ pactoxs'coznm.ents; , �!ns�eetoxs'Hzgnatuxe••xto initials) Date ' 3ORTA(9,9 AM T033EMLED NOT The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual)' Address: City/State/Zip: ace) cam, /-1 Phone 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 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. �• E]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.E1 Electrical repairs or additions 3.❑ 1 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.❑Roofrepairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *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 ace doing all work and then hire outside contractors must submit anew 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). y 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 in!ur7 coverage verificatio I do hereby�cert �n#1111 ins and aloes ofp Jury that the information provided above is true and correct. -- Si ature• Date: J // Phone#: 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#: 1 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 joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permithicense 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 1 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 bum 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 Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tei.#617-7274900 QxJ 406 or 1-877rMASS.AFF Revised 5-26-05 Fax#617-727-7749 wwwanass,govfdaia .f j Date.... NOR71� °ft"`° '•_�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 2SACMUSE� This certifies that .............. ....A00000 .. ........................................ has permission to perform ......... QJ.. z.. .....Ae..'ck................. wiring in the building of...... . ............................... S at.... m,,........ ............................ CAL NS North Andover,Mass. Fee .-,6 .... Lic.No..aQ�1.E........ Ff . C�COR f` r Check # e r� 0554 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: j g bg I It 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. Location(Street&N ber) �j � "- _JefYl S Owner or Tenant ,` 1 e Telephone No.6,/ 20—75� Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building ��r�Se Utility Authorization No. Existing Service 2ro Amps Volts Overhead❑ Undgrd No.of Meters t New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 3 - Location and Nature of Proposed Electrical Work: S T Completion of the ollowin table may be waived by the Ins eclor of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool A ove ❑ - Elo.o mergency ig ng rnd. nd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump . ,um..er ons o.of Self-Contained Totals: --� - ��--- D.etection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local E] Conneecti MunicippE] Other on No.of Dryers Heating Appliances KW Security S stems:* No.of Devices or Equivalent No.of Water KW o.of o.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent 3 e ecommutncathons ;ring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Elect 'cal Work: (When required by municipal policy.) Work to Start: l Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: 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 D BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on dais plication is a and complete. FIRM NAME: ,f - /'� LIC.NO.: Licensee: P i��G�1'U Signa e % LIC.NO.: (If applicable,e»(er "exec t"it the license number lir .) us.Tel.No.iq 79- 3�- 7w1,3 Address: / i Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires D artment of Oublic Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware th t 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ © y 2- I Y Commonwealth of Massachusetts t)rreial t sc011IN FpelrllliltDepartment of Fire Services N `'`'_ =i BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9;051 Heave blank) APPLICIATIObN `FORrformed IIPERMIT'�Icc(lrdtlllce ITO PERFORM ELECTRICAL WORK chuyetts f.lectnca*Code CC . 52C�1R I?.I)0 !l'LE,I S'E PRLVT LV LVK OR TYPI LITI(�,�j Date:Cityr or Town of: Tn !lrcot•a I�irc�s'B this a lication the ul •r, .T' Y pp ldeisl�ntd Ives notice of or I er intentio perform the electrical work described below. Location (Street& Number) Owner or Tenant S Telephone No 7G : Owner's Address14 A Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building u 9 �dhi.� • Utility Authorization No. 4:fs-�; /� Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service 42010 Amps /�� /at,►p) Volts Overhead. .y.' h'ndgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com- 'om leNun a/the r>lIrrt�iii s/able mov be a uirc,d by/hc,/I,)c c7>r �/ll'ires No.of Recessed Lu ' minaires No.ofCeil.-Susp.(Paddle)Fans. No.o `Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool above In- ❑ o. o mergency ig ulg rnd: grad. Batter Units [ i . No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones L No.of Switches No.of Gas Burners No. of lnitiatinDevices Detection and � No.of Ranges s'• No.of Air Cond. Total � l Tons INo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW liNo.of Self-Contained ITotals: Detection/rile tin Devices No.of Dishwashers ! Space/Area Heating KW Local unicipal Ccinnection ❑ Other No.of Dryers Heating Appliances KW Security Systemsti z�.. No.of -ter No of No.of Devices or E uivalent Heaters KW Si ns Ballasts Data Wiring: No.of Devices or E uivalent No. Hydromassage Bathtubs No, of Motors Total HP 'f No. Wiring: OTHER: .No.of Devices or Equivalent Illuch acleliriurrul rlrmi/iJ rle.�ireel, or as required hr rbc•l mp(.0or II"irc:r. Estimated Value oFEle rirll Work: (W'hen required by municipal policy.) Work to Start: Irrspecti.ons to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: finless waived by the owner. no ernli + p t for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or itS substantial equiv:llent. fhe undersi-ned certifies that Such coverage is in trice,and has exhibited proof of saille to the permit 15:lllm_7 ot'tice. C'HEC'K ONE: INSURANCE ❑ I30�D ❑ t)ftitiR ❑ (Specify:) /ccrtijjr, ander the pains mid pen/ iav o1'per/rrr),,Nrat the in%rrr•matt on this rr>>licatiun is hnr and cumplcle. FIRM NA�tiIE: LIC. iN O.:;?2D l Licensee: :�inn<itui e LIC. "JO.: Ill;;h:!lr.�nble• �.race � - Address: 21 Bus. Tel. No. Alt. Tel.*,Security System Conti-actor License required for this work; if applicab ,enter the license number here; _ OWNER'S INSURANCE NNAIVER: i all/ aware that the Licensee d0eS 1701/7cll'e the liribility insurance covcraue normally required by law. By,my signature below, I hereby waive this requirement. I am the(check ane)❑ owner ❑ owner's u� Owner/Agent elft. :signature TilEilhont i�lo. ,P,F�,d��T,FFA'. S 1 1 I © � ^�J / f C ��