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Miscellaneous - 59 WINDKIST FARM ROAD 4/30/2018 (2)
N O O NORTH ANDOVER BUILDING DEPARTA ENT 1600 Osgood Street North Andover Tel: 978-685-9545 Fax: 978-6889542 BUSHESS.FOl?MFF01? TOW aEff BATE: �/ Z 1 /20/ s NAME: j ha P-ae-k� gl A 11 + P",s ep-k ADDRESS; 0 t9 KONINGDISTRIOT: t TYPE OF BUSINESS.: e Cow�r�•-rte. G O<G BUILDING DIS G LAYOUT PROVIDED: YES NO A.VAILAI3LE PARKING SPAM:, ZONING BY LA V" USAGE: YES NO BUILDING INSPECTOA SIONATUPIE BUSINESS FORM FOR TOWN CLER K 2.40 Home Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use -of the building for living purposes. Home occupations shall 'inclizde,'but riot*limited to the following uses; personal services such as famished by an artist or instructor, but not occupation involved wthmotor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufaduring of goods, which impacts the residential nature of the neighborhood. d. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the of ier of thd hbme occupation and residing in said diw1ling; b. The use is carried on strictly withinthe, principal building; c. Thefe shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; - d. Not more than twenty- five (25) percent of the existing gross floor area of ;the dwelling unit. so used, not to exceed one thousand (1000) square feet, is devoted to 'such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these lirnits; e. There will be no display of goods or waxes visible From the street; £ The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, M smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of desig. not cust6mary> in buildings for residential use. Signature Date , KORTH, k .r NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street �4r + Building 20 Suite 2-36 North Andover C«us 5 Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: !r-- V ` / Ly NAME: �C.C� 11 �-- �✓� -� r �,. S cyS', J -✓1 �' d% aa -S 4 A// ADDRESS: .�j 141 , I1i IA411 d 1 Pq- ZONING DISTRICT: TYPE OF BUSINESS: 0,1 / "o, , la '--- BUILDING ' BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: Gvf f q ZONING BY LAW USAGE: YES BUILDING INSPECTOR SIGNATURE: (� , BUSINESS FORM FOR TOWN CLERK WAI .J + 2.40 Home Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use• of the -building.. for living purposes. Home occupations shall 'include, -bit not'limited to the following uses; personal services such as f rnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufac u ing oFgoods, which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the: own'Or of thd home occupation and residing in said divelling., b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customw with residential buildings; . d. Not more than tweets five (25) percent of the existing gross floor area of ;the dwelling unit . so used, not to exceed one thousand (1000) square feet, is devoted to 'such use. in connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within. the neighborhood; g. Any such building shall include no features of design_ not customary in buildings for residential use. - -1-J7 — > Signature 0 Date ` 90U: Dateg �-P'I/ . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..�{1.�t G✓�.. �/.�r/....�?` h4 ........ has permission to perform.. OJ7.1,107-. st-✓�?'� plumbing in the buildings of . eA4A. -.. !�g at ..JrCf ..G.Jr.��Je�li"�..!�! '! .•N rth Ando er, Mass. Fee. 2v Lic. No....0�ffi .... . G.. .. PLUM ING INSPECTOR Check # / �� V MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town;/ � 6 ( 11 �© i!C- , MA. Date: �� f l Permit# _ Building Location: 151 Idi �c� 1� Fa - a Owners Name- /4(ex,,4, ro S ct�— Type of Occupancy: Commercial Educational industrial institutional ` ❑ ❑ ❑ ❑ Residential �. New. Alteration: ❑ Renovation: 0 Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTI IRFA VSURANCE COVERAGE: have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes X No ❑ f you have checked Yes, please indicate the type of coverage by checking the appropriate box below. % liability insurance policy 9 Other type of indemnity [] Bond ❑ )WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142. of the Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ signature of Owner or Owners 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 oris application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 740-C _ -2f —a 3y I Type of Licenser %✓/�� +fie Plumber Signature of Licensed Plumber ;itytrown ❑ Master License Number: 2 S r iDDBAVCn fnrcit c ncr- Am v► ®,Ioumeymam DEDICATED z SYSTEMS 00 NJ z V 1. V1 CNG Cr z i N Z Z a ��—, i19 z Q N Q t'1 OC N Z o ;. < Z N W 3 N pto Q y Q Q z a p Z v� uJ v CL 4. 3 s ozi d < o w 3 3 LL UJUa cc a a a Q a m m e c g= x 5 5 O H 3 3 3 0© a a cQacc a 3 SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3R° FLOOR 4' FLOOR 5T" FLOOR I eH FLOOR f" FLOOR 3T" FLOOR �+ /1 Check One Only Certificate # `t -c I installing Company Name: ,} at✓/ti 1 ❑ Corporation CtTm4ddresState- Partnership y❑ / 7 7 7, f cj' S 3usiness Tel: Fax: ❑ FirmtiCompany t r, Vame of Licensed Plumber: -SK lq W tA- A VSURANCE COVERAGE: have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes X No ❑ f you have checked Yes, please indicate the type of coverage by checking the appropriate box below. % liability insurance policy 9 Other type of indemnity [] Bond ❑ )WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142. of the Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ signature of Owner or Owners 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 oris application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 740-C _ -2f —a 3y I Type of Licenser %✓/�� +fie Plumber Signature of Licensed Plumber ;itytrown ❑ Master License Number: 2 S r iDDBAVCn fnrcit c ncr- Am v► ®,Ioumeymam The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers nniiennt Tnfn,-m m4:__ Name (Business/Organiza6on/Individual): -a OLL/ -I.— Address:_ H City/State/Zip: Vc4u G/(4✓' r Aa Y S O N z Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/orpart-time).* have hired the sub -contractors 2. (&,I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers I- 3. -El 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t e exercised thein right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required] *Any applicant that checks box uI must also Al out tae section below sno:Imb- :heir workers' ccmp__sa.: n policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Type of project (required):' 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 L❑ Plumbing repairs or additions 12.❑ Rcof rapairs 13.❑ Other Insurance Company Name: Policy # or Self -ins. Lic. Job Site Address: Expiration Date: 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. I do hereby cerVnr the pains and pe of perjury that the information provided ab9ve istj ue and correct r - — Date.: 61ACI Phone #: f 7 6' 7-7 7 S- Cy- f 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone t -pMMONWEALTI-d OF MASSACHUSETT "Rss iND1 71 FIRS LICENSED AS q JOURNEYMAN PLUMBS ISSUES THE ABOVE LICENSE TO: SHAWN C WHITE is I, PO BOX 1186 I, MIDDLETON �a MA 01949=3186 Il o, r 25491i 05/01/12 788605 Wt��, f ` CONTROL # Go 2 o p � - I f t is tiCe J 2 ! Div rase is t IMPORrANr �ooof r �'r( s onadestroYed notifyi tj of Cour name ol Li saon ;yq 02i 7g censure 70p Wa h n9tan trJ. f rrect dress It.. l gname �r addre sown is changed, Thi lice ns nptic,tron. Area to insure Proper notify Your as me e is gab' Ys ref per bo .ro °r ssi ndedtof i' a personale provision, orur ti erase 9U f n.;xt i 9ned the Mb ,r Pe or - Other a bson�eKeep this of ber boa .tis °�no_ste Y taw, ticense ed ft sur 77; 1 Date..:? .Z.I.- t. k.... i TOWN OF NORTH ANDOVER 9 -,z PERMIT FOR GAS INSTALLATION .N This certifies that.. .' S. ! E n "`i .. P kz4 '\ has permission for gas installation k'P— ...... in the buildings of ... ......... at �t l . �.-� . , orth Ando/quer, Mass. Fee �OuR . Lic. No.. .3 �- `.�. .. , .......C!`'7 -r-' . . , GAS INSPECTOR Check # / � T r w r� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date JUNE 20, 2011 Permit # Building Location 59 WINDKIST FARM RD. Owner Tel# 978-738-0610 Owner's Name ALEXANDER CROSETT Type of Occupancy RESIDENTIAL New F-1 Renovation❑ Replacement ❑v Plan Submitted: Yes❑ No[] FIXTURES Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter ERIC PELLETIER Check one: Certificate Corporation Partnership Firm/Co. INSURANCE COVERAGE: I have a cur�j liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have '''c ecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑✓ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I herebv certifv that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of m,. knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all City/Town APPROVED (OFFICE USE ONLY) is State Gas Code and Chapter 142 of the General . TypV License: 4umber Signature of Licensed Plumber or s Fitter • •Gas fitter • •Master License Number 303 -ss-' • -Journeyman ••- Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter ERIC PELLETIER Check one: Certificate Corporation Partnership Firm/Co. INSURANCE COVERAGE: I have a cur�j liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have '''c ecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑✓ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I herebv certifv that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of m,. knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all City/Town APPROVED (OFFICE USE ONLY) is State Gas Code and Chapter 142 of the General . TypV License: 4umber Signature of Licensed Plumber or s Fitter • •Gas fitter • •Master License Number 303 -ss-' • -Journeyman I .L '10147 Date. G... /W/,........//... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ....................... i "/",..s�lG� � ............................... ............................... has permission to perform ....'' ............................................................ wiring in the building of .....�Pr' " , — fro s c !f�`` North Andover, � at ......%................................ ................... Fee.... �......... Lic. No/�.?(,%ZY..................... ...................... ELECTRICAL IN ECTOR Check 7H �� / Common -wealth of Massachusetts official Use Only Department of Fire Services Perimt No. d ` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 1/07] (leave blank .� APPLICATION FOR PERMIT TO PERFORM E IAll work to be performed in accordance with the Massachusetts Electrical C� MEC) �- 527 CMR 12.00 yY ®RK (PLEASE PMTflV INH OR TYPE ALL WORMATI0119 Date: IyAle /b a a l ( \ City or Town of: NORTH ANDOVER , To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfoim the electrical work described below. Location (Street & Number) NQ ISi RirJ 0 of i Owner or Tenant 11 M/7,et)iAl., 8 C4Q,5 e 7_ - Owner's Address N0 Telephone No. D Is this permit in conjunction with a building�permit? Yes Purpose of Building NO (Check Appropriate Box) Utility Authorization No. Existing Service Amps /_Volts Overhead ❑ Undgrd 0 No. of Meters New Service Amps .____ -L__Volts Overhead UndgrdEj No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: /=o t------ r dF 1 RQ-wi/,,0 C Com letion of the followin table may be waived by No. of Recessed Lthe Frrs ector of Wires. Luminaires No. of Ceil.-Sus a j p. (I' ddte) Tans No. of Total No. of Luminaire OutletsTransformers KVA No. of Hot Tubs Generators KVA No. of Luminaires S Ab;(n_ Swimming Pool Above o. o mer Ngency ig g - No. of Receptacle Outlets d• ❑ nd. Batte Units No. of Oil Burners 1 F p_i.ARMS No. of Zones No. of Switches No. of Gas Burners No..of Detection and No. of Ranges Iniiiatina Devices . No. of Air Cond. Total Tons No. of Alerting Devices Totals: .._....___...... Heat Pump Number Tons No, of Waste Disposers KW No. of Self -Contained _.___ . ...._._ No. of DishwashersDetection/Alertin Devices Space/Area Heating KW Local ❑ Municipal No. of Dryers Connection ❑ Other r3' Heating Appliances KW Security Systems: No. of Water No. of No. of Devices or E uivalen Heaters KW No. of Data Wirin Si s Ballasts. vices or E uivalent No. of Det No. Hydromassage Bathtubs No. of No. HP Telecommunications Wiring: OTHER; //O VOL f No. of Devices or E uivalent 0 eCTb R Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. Work to Start:(When required by municipal policy.) 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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER I certify ❑.(Specify:) under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: 6n/ NV Licensee:A 0 AN LIC. NO.: �6 (If applicable, enter exempt ' in the license number line.) Signature LIC. NO.: _ f e Address: --��N� �j �� �,�Of, �� Bus. Tel. No.: ,i' / j6 *Per M.G.L c. 147, s. 57-61, security wore�%es Ali» Tel. Noc Safe.: 47p �Zr!/6 OWNER'S INSURANCE WAIVER: e that the LIn�ee doles not havety ,thelliabiIi Lic. No. required bylaw. By my signature below, I hereby waive this requirement I am the (check one)EI coverage normally Owner/Agent ❑owner's agent Signature Telephone No. PERMIT FEE: ,L�, ELECTRICAL PERART NO. INSPECTION ELECTRICAL INSPECTOR - ]DOUG SMALL R�PORT: d - •1 bl1TT/"1TT nrnTr. �r.,,r.» L J Inspectors' comments: r aneu — (inspectors' Signature - no in. 2. FINAL INSPECTION; Passed —Failed — [ ] Inspectors' comments: L kXu6t,ct;Lurs' aignarure -no: F GROUND INSPECTION:] Failed — [ ]comments: (Inspectors' Signature - no ii 4. INSPECTION — SERVICE: DATE CALLED NATIONAL GRID: Passed — [ ] Failed — [ i Inspectors' comments: (inspectors' Signature - no ini 5. INSPECTION - OTHER: Passed — [ ] Failed — [ i Inspectors' comments: (inspectors' Signature - no inti is) NVAYIE: Date Date - [ Date Date Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. yI The Commonwealth of Massachusetts Department of IndustrialAccidents 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 Legibly Name (Business/Organization/Individual): t`/ `l t l / v 51. �Y /"t) fWM 6 Address: �a {-{e44- City/State/Zip: M6r%1 A/, *4, Q V & Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* [�I have hired the sub -contractors 2. am a sole proprietor or partner- listed on the attached sh%et. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] 1 employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10-VElectrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other f v 11--1 -1 WI. Wb uvx tt r mus[ also rui out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are 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 N 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 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. A, --A r 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 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 employer is 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia FDATR (MMODNYYYY) ® CERTIFICATE OF LIABILITY INSURANCE 16/2011 UCERTIFICATE IS ISSUED AS A MATTEOF INFORMATION ONLY AND CONFERS NO UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVE OR NEGATIVELY AMEND, EXTEND OR ALT R TIRE GHTS COVERAGE AFFORDED BY THE pOLICIEIS 13t:LOW. THIS CERTIFICATE OF INSCERTIFICATEDOES HOLDER CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER, THE IMPORTANT: If the certificate holder i an certain ADDITIONAL INSURED, SU EI D, the endorsement, ntn A statement on this certiftist he eridoned. 11 icate does not conferDrights to the the terms and conditions of the policy, certificate holder In lieu of such andorsement s - CONTACT Tracy Loeschen _ _—. —.••• — PROoucER NAME _ --- — ppX PNONE (978)692-3397 AL✓cc,No); (97a)668 _S99a— r..,,. DeAngelis Inaura11ce -E-MAIL �,.�.,.• - 283 Dterrimack $tJCAAt ADDRESS-`—•, — PRO UCER l7000429b- C.uSrONeRtD_t+._ . IN AFFORDING COVERAGE NAIC A _ Methuen —_ MA 01844 INSURE NAt1 OI131 Nail E, Mutual Ing Co 42 —_ INSURED INSURER B ;. -- ..—.. - -- St Jean EleatriC INSURERC: �— 22 Henry Avenue INSURER D: _ .—_ —•- INSURER E—.. --.. .. --. --. ..—._. • • ----- Methuen MA 01644 INSURERF: REVISION NUMBER: COVERAGES CEERTIFICATNUMBER:2010 Term TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS TERMS, INDICATED. NOTWITHSTANDING ANY REQUIREMENT, MAY PERTAIN, THE INSURANCE DESCRIBED HEREIN IS SUBJECT TO ALL THE ANCE AFFORDED BY THE POLICIES CERTIFICATE MAY BE ISSUED OR — LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, — R- POU Y EFF P LICY EXP LIMITS ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYY MMI DIYYYY 1, O O O 00 0 EACH OCCURRENCE $ r GENERAL LIABILITY �A14fAC+`ETTE'� $ 500,000 PREMISES_(E? oecurrenca)—_ X COMMERCIAL GENERAL LIA9II.ITY8/14/2010 /14/2011 MED EXP (Arty one Person) $ 5, 000 A CLAIMS -MADE I X•I OCCUR MP015610 — -- -' 1,000,000 • pF,RSONAL8A0VINJURY IF GENERAL AGGREGATE S 2,000,000 --..I PRODUCTS - COMP/OPAGG $ 2,OOD,000 GENT AGGREGATE LIMIT APPLIES PER' ' $ I X POLICY PRO- LOC i COMBINED SINGLE I,IMTi $ AUTOMODILE LIABILITY I (F� Aecltlenl) —_, ANY AUTO r..rs BODILY INJURY (Pi jrpon) ALI,OWNED AUTOS BODILY INJURY (Peraccldenl) s -- - SCHEOULED AUTOS PROPERTY DAMAGE (P& accidem) HIRED AUTOS $ NON -OWNED AUTOS $ EACH OCCURRENCE $ UMBRELLA UAB OCCUR AGGREGATE_ EXCESS LIAR �CLAIMS•Nu\Dr — DEDUCTIBLE $ RETENTION S WC, $TATu- OTB- T.O.RY_LIMI.TS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N E.L. EAChI ACCIDENT -- ANY PROFRIETOR/FARTNER/`EXECUTN5 ❑ OFFICERIMEMBER EXCLUDED? A — E.L. DISF,AS[ - EA EMPLOYE 5 IN) (Mandatory In NH) I K vet. describe under E.L. DISEASE • POLICY LIMIT $ DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addlilonal Remarks Schotlule, If morn ■pees 19 reQulrad) Certificate is iaeued in the interest Of the named insured and holder listed below. Subject to Company Conditions and exclu®ions. (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrTH THE POLICY PROVISIONS - Town Of North Andover Electrical Inspector AUTHORIZED REPRESENTATIVE 1600 Osgood Street Bldg 20r Ste 2-36 North Andover, MA 01845 David Segal/aLL ACORD 25 (2009!09)©1998.2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD ti1, w�j2 ; U l Date ....../ ... �....� ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING A FE This certifies that ............:......:..... has permission to perform .................... wiring in the building of ..... C.... ...................... S at ......S=... ......:.4 �.r ...................... . North Andover, Mass. Fec-l..... .......... Lic. No.8..... ............................ cc............................. ELECTRICAL INSPECTOR C WHITE: Applicant CANARY: Building Dept. PINK: Treasurer mom The Commonwealth of Massachusets Office use °"'" P.nntt NO. Department of Public Safety Occupancy a F« Chocked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1190 paave blank) APPLICATION FOR PERMIT TO PERFORM ELECTR CAL WORK All work to be performed in accordance with the Massachusetts Electrical Code.5 CM 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date tel` City or Town of /I/ , 4 �u 06 L)F To the Inspector of Wires: The undersigned applies for a permit to perform the eiectrtcal work described below. Location Owner or Owner's Address Is this permit in conjunction ,j with a building permit: ) Yes �No ❑ (Check Appropriate Box) Purpose of Building /C -e S /%fin 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 Ampacny Location and Nature of Propose-. Eiectrical Work �� U'�' �� YAll No. of Lighting Outlets i No. of Hot Tubs Total i Nc. of Transformers KVA No. of Li nttn f=ixtures g g Swimming Pool Above c_rnd. ❑ In- grnd. ' ;Generators KVA Nc. of Emergency Lighting No. of Receptacle Outlets ' No. of Oil Burners 9aaery Units No. of Switch Outlets ; No. of Gas Burners 1 FIRE ALARMS No. of Zones Total No. of Detection and No. of Rances I No. of Air Cond.;ons I initiating Devices Heat I No. Total Total Sounding Devices No. of Dispcsais of pumas tons KWWNc. of ! Nc. of Sell Contained No. of Disnwasners Space/Area Heating KW Detection/Sounding Devices No. of Dryers i Heating Devices KW Municipal Local ! ' Connection ❑ Other No. of Water Heaters KW No. of I Signs No. of Ballasts Low Voltage Winno \V No. Hycro Massage Tubs ; No. of Motors Total HP i OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General La s I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES i NO LJ 1 have submitted valid proof of same to this office. YcS ET NO ❑ If you have checked YES, please indicate the type of coverage by `cheecking the appropriate box. INSURANCE 'E SOND ❑ CT HER ❑ (Please Specify) D� (j ` © _y (Expirauon natal Estimated Value of �I otic 'I Work 5 Work to Start U J Inspection Date Requested: Rough Final Signed under the p nalties of perlury: FIRM NAME S4� %�1 v /qV-) r LIC. NO. 4�s Licensee C) / I / Va i, Signature Address f J C%/ Z�, �'/ Bus. LIC./NO. ,Rea 97%� Tel. Noy7t�- 66C 2 - 11 V7� All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent `# as required by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner L.J Agent ❑ (Please check one) Telphone No. PERMIT FEE S ,S,Cnatu. a of Owns or Apenn r No I i J 2 Date ...... 71..., /A!...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....Tp.!)a ...... vuh.:°.w /. ....... !L.. ........................... has permission to perform�v ......... v� �.. ............................. ... r / �, ill f eI wiring in the building of ..%— 4� ........Z .............. / �l 1.... >........................................... �'v f'u., ry V (� �� �' ✓......................... . North Andover, Mass. Fee .... Lic. No..k %/ ELECIRICALINSPECTOR C OU 09:16 435.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r Office Use � I 39 No- %* Q; X4.5.5,4(:' S£%%S Occupancy &Fee Checked a ^6 P-&& 54dr BOARD OF FIRE PREVENTION REGULATIONS 527 CMR :00 APPLICATION FOR PERMIT TO P�ERFORRMsachusettsI Eect�LECTR zCAL�W 12:WORK All work to be Performed in accordance with the Date lag I all information) To the In ect r of W res. (Please Print In Ink or type Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number n , l dd`s Owner or Tenant y Owners Address % d Li / T ij No ❑ M (Check Appropriate Bout) v 1 Is this permit in conjunction with a building permit Yes Utility Authorization No. 0 7 Purpose of Budding +1!`f S tf'i°�Nf / L�1 rJWt AmesVats Overhead C3Undgmd C1 No. of Meters E)dsbng Service Overhead ❑ Undgmd ❑ No. of Meters New Service Amps O ` Of Number of Feeders and AmPaclty Location and Nature of Proposed Electrical Work INSURANCE COVERAGE. Pursuant to the requiremen8ts of Massachusetts Generaor its substantial l Laws Of coverage ' by checking the appropriate box I nage a current Liability Insurance Policy including Completed OH�u have bons o racked YES please indicate theetypeYES = NO ffice Y have RAMCSubmitted validproof Of OTHER = me to trie 0(Please S�M � (Expiration Date) INSURANC Estimated Value of ElectWorInspection Date Resquested Rough Final — kf Work to StartLIC. NO. Signed under the Penalties 0 f ped Ale— FIRM /GFIRM NAME %Jy/�/� /J _LIC. Ucenaee Bus. Tel No. ------- W &V Ait Tel. No. pdd�a VER: I am aware lihave the insurance coverage or Ira substantial equivalent as required by Massachusetts that the Licenses does Check one) OWNER'S INSURANCE WAI permit application waives this requirement. Owner General Laws. And that my signature on this Agent (Please Telephone No. PERMIT FEE f (Signature of Owner or Agent) Total No. of Transformers KVA No. of Hot fuse No. of Li ht8n Outlet Above ❑ In ❑ Generators KVA Swimmin Pool and ❑ ❑ No. of Emergency Lighting No. of L ghting Fixtures Batt Units No. of Oil Burners No. of Receptacles Outlet FIRE ALARMS No. of Zone No of Gas Bumers No. of Detection and No Of Sw tch Outlets T012I Initiating Devices No of Air Cond Tons No of Ran es Heat Total Total KW No. of Sounding Devices No. Pum s Tons No./ of Self Contained No. of Diooaal KW Detection/Sounding Devices S ace/Area Hearin ❑ Municipal ❑ Other No. of Dishwashers KW Local Connection Heabn Dev+ces Low Voltage No. of D rs No of Winn Si ns Bailllases No. of Water Heaters KW No. of Motors Total HP — w,nm Massade Tuds INSURANCE COVERAGE. Pursuant to the requiremen8ts of Massachusetts Generaor its substantial l Laws Of coverage ' by checking the appropriate box I nage a current Liability Insurance Policy including Completed OH�u have bons o racked YES please indicate theetypeYES = NO ffice Y have RAMCSubmitted validproof Of OTHER = me to trie 0(Please S�M � (Expiration Date) INSURANC Estimated Value of ElectWorInspection Date Resquested Rough Final — kf Work to StartLIC. NO. Signed under the Penalties 0 f ped Ale— FIRM /GFIRM NAME %Jy/�/� /J _LIC. Ucenaee Bus. Tel No. ------- W &V Ait Tel. No. pdd�a VER: I am aware lihave the insurance coverage or Ira substantial equivalent as required by Massachusetts that the Licenses does Check one) OWNER'S INSURANCE WAI permit application waives this requirement. Owner General Laws. And that my signature on this Agent (Please Telephone No. PERMIT FEE f (Signature of Owner or Agent) LocationiT. �i y1 r. ��i`�af i ! 0�- 4 No. Date t r t .. j TOWN OF NORTH ANDOVER 1 Certificate of Occupancy $U Building/Frame Permit Fee $ �--� Foundation Permit Fee $CHU Ir 1 b O -®#I%rPermit Fee $ J Sewer Connection Fee $ bJ y 71:1-141- Water Connection Fee $ /082.61 TOTAL $ _ W I 'Ag I p ctor 931. 0,4,r 5 U` �.�f/ ' Div.46ullfic Works i a �Ia Y 0 0 m � a W 0 i _ t 1 '^ a N N FZ � W Z p 0Z LL i S 0 t _ m 1 0 OV 0 W W Z 0a ` I n lz p N d m 0 99 W d Z ^Q, 0 til ~ Z 0 d �J Z F m 0 � J N I � � I C µd W Z EI�N° i 1 a 0 J A 0 Z 0 a a W 0 0 m F a U U a a a to Q _G 0 0 yFj a J J H c iL U_ 0 N m W W U y d d W 0 J J F^ H �J W 3 o o C1 O 0 V I AL �g z a m � }} OW F s ` W W Fa 0 ZIL O _Z J U U U a F CIL a < d a U O W t Q V m m m t V i I 4 W W W w < M a 0 J A 0 Z 0 a a W 0 0 m F a U U a a a to Q _G 0 0 yFj a J J H c iL U_ 0 N m W W U y d d W J J F^ H J W 3 o o C1 O 0 V I � D 1 0 0N N 0�m O 0= 0OrA 1ti;°° (11 ZZ Opp AP°m OD qm mm 00(A m 00 0 Dv3i; O m =0-- N ZZ 0 pP�a w Zm zZ r A nD 0 NOn 0r N N;= 0 ;O as '� 0 _ VIm> r Z C NN Z �vZi < 3 o OZmn-/ r"u0iCN AD=A nv tv At 0= zA " Dm N Or?O-4D�D OyAmmn<Dm z 0O COW O= OG0 DOZ mHnmy Z o 0T0mN Z 0yC x O A D Z AA ` C 0 Z D A i -Si m A m aAe A G)v c^' Z N xZ 40�A a z A NN< c c m D�O(�" m D mZ D m 10 CD Cl (l D;N O CIZ m ~ O p A A rl0 C D W A N C1 2 N D A .. y (1 (1 y D O m ti A Z D D °o A A 3"m� 0060"Mam ` ZZ N A N 0y� O C Amm w Z D 0 ; D m y �m ./} CA D rZ�ooz�o I LL LL_L s Z D Z 7c 3o i GZl N i I Ir ; ; m N Z ti >Ox 0.1N N 0r0 Zm >0 0ZZ COX c �X0 > n oto 0D:E M im mx INA 66" ;az_ my3 TAM ��z C my5 r ySN v � r°O 2 Acir O oy0 � ��> m z�Z xo O �v T 4 v nz xn mm Nm � 00 D� r M ~11110 Z ~ (�� cz fnl 'C Y CA�=:2 T I N A Z' T y� �0N T ODDO A A Z W ;AT OO T T Z Z S O= Z D m ti A Z D D °o Z` m O m N ` ZZ N A � m O 2 � Q 0 D m I I la w Z I LL LL_L Z D l 1 I i I Ir �, >Ox 0.1N N 0r0 Zm >0 0ZZ COX c �X0 > n oto 0D:E M im mx INA 66" ;az_ my3 TAM ��z C my5 r ySN v � r°O 2 Acir O oy0 � ��> m z�Z xo O �v T 4 v nz xn mm Nm � 00 D� r M W F C � CIO CM) '0 O CD n Z CA CD o -o d ? O CL CO) aCO •� 0 to 0 0 CD C� O �e •r 1 CD CD O CD C• CD CA CD �O y CD 0 yCD O CD Z O � • CD O CD I� z O 0 c CD)4 p cyotr H :3p dO�m •� y � o m nmCL mc�o.� C9 m Cl Z y to _ §cp G O a two y O x O CL O TI CA -40md o CO)y IE= m m a o O o O . 0 .o» to -fto z:sy O O CY a o m 00 C ?y'%: CL ao �m to O o Oy ED , p -o am z CA o N =Im ? Q !�. „ CK CL CD IE �� E coo CD •, 3 0 y to `. co O0: �� oi CDCD CDO o� CD y d o CD o.'o O CA O C O_ A z O 0 c CD)4 p C. a :3p z � i17 rA QQ b C7 rA §cp G O a O ro O x O O z O 0 c CD)4 p FORM U - VERIFICATION 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 local or state law, regulations or requirements. ***************,*AppJplicant fills out /this section***************** APPLICANT:�,�Cdli L-! G Phone LOCATION: Assessor's Map Number %d % Parcel Subdivision l�i/l%lS �.4r2� Lot (s) Street _/,��?lc��f5 ✓ �i4�� St. Number 0 ************************Official Use Only************************ RECOM EN ATIO OF WN NTS: Date Approved jZ2 Conservation Administrator Date Rejected _2 Comments ' Date Approved Town Planner Y Date_Rejected Comments Date Approved Food.Inspector-Health Date Rejected '4� Date Approved ¢ C% Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections __ _T_11_C.J � 13 /9i - driveway permit Fire Departments Received by Building ) 2 7 MAScheck COMPLIANCE REPORT ' Massachusetts Energy Code Permit # ; MAScheck Software Version 2.0 Checked by/Date CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 4-28-1998 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: 4/28/98 TITLE: PROJECT INFORMATION: LOT -4 WINDKIST FARMS' NORTH ANDOVER, MA 01845: CO PANY INFORMATION: WI LIAM BARRETT HOMES 10 )49 TURNPIKE ST. NOrRTH,ANDOVER, MA 01845 COMPLIANCE: PASSES Required U - 856 Your Home %=136� Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 2272 38.0 0.0 68 WALLS: Wood Frame, 16" O.C. 3948 15.0 3.0 264 WALLS: Wood Frame, 16" O.C. 36 18.0 3.0 2 GLAZING: Windows or Doors 831 0.480 399 FLOORS: Over Unconditioned Space 2178 30.0 71 BSMT: 8.0' ht/7.0' bg/0.0' insul. 100 0.0 22 BSMT: 8.0' ht/4.0' bg/4.0' insul. 72 18.0 10 HVAC EFFICIENCY: Furnace, 86.0 AFUE 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 building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4.44. Builder/Designer�-� GC Date 03/13/98 13:27 FAX 508 6889556 ;i NORTH ANDOVER Growth Management Bylaw Exemption Statement Town of North'Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 9.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) IMV JQ,st F49* S I -.L L _ei") k INbKa. ,�- fi%rflawi V -D . Map and Parcel -, Purpose of Application (check below) Ph nn urnjer f Applicant Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this fort» is; completed does comply with the EXEMPTION section 8.7.6 of the North Andover 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 pefmits 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 Depament and is only officially accepted when the Building Permit i% issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement restoration, or rennstructran of a dwelling in exi once as of the effective date of this by-law. provided that no additional residential unit is seated. The lot(s) were/waa orated prior to May 5,19% are exempt from the provisions of this Section 9.7 of the Zoning ytaw. This appArldon is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 9.7.6.c•ere met and/or represents Dwelling unds for senior residents. where occupancy of the units is restricted to senior persons 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. Thio application is a part of a deveiaoment protea which voluntarily agreed to a minimum 40% permanent reduction in density. (buildable lots). below the density, (buildable lots), permitted under zoning and feasible given the envirnnmentai conditions of the tract. with the surplus land equal to at least ten buildable acnes and permanently designated as open space and/or fafmiand. The land to be preserved shall be pmtecte4 from development by an Agricultural Praenratlon 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 Meld Dy a Developer in common ownership with an adjacent parcel an the effective date of this Section 8.1 shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the ' parcel. _ This apprlcatlon represents a lot which is ready for building permits.li.e. all other permits from all other boards and commisslons have been received and the protect is in compliance with those permits), and the Development Scheduie 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 accmmmodates issuing buildigg permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making 3 determination that your application is allowed one or more of the above EXEMPTIONS. Sy 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 and or inaccurate information. or the checking off of an above item which does not comply, whether done to my knowledge or nor, is grounds for refusal by the Building Oepartmern to issue a Building Permit. ignature dt ner or Authonzed Agent who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit 2001 4 CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number / 7� THIS CERTIFIES THAT THE BUILDING LOC, MAY BE OCCUPIED WITH THE PROVISI( SUCH OTHER REGULATIONS AS MAY APPLY. Date IN ACCORDANCE STATE BUILDING CODE AND oq"' CERTIFICATE ISSUED TO+� L L c A ADDRESS ZQ Building Inspector WE ff M, � M � E uj am V 1" /CD� o o �y w V i C7 CLCco C O co Z p. H D O y m a �. c •. C °D CM CD COL E y O �O om O mm r o, 0 L H t lL � ' � o' � �° a �..� c E lro m N ci,vi t CD �: m `� ♦^ v OCL CM< C O co O •`I �y w U y 4 �Em � -o �6CD Cc y8m cm m O cm C/) CD c c a W L3 v� Z Cs We CO O d y o o V CO) cm Z C = m : 'COL. c N C H o y o F- o s O W CO 10 +_-� C 4- - d H U..y az`�c Z V! oc �E =, ' .y o D Cl) d C2CM H _ a ` y O H L Jam.. C.wm i V w w � o w cn w° U w cA V)cn E uj am V 1" /CD� o o �y w V i C7 CLCco C O co Z p. H D O y m a �. c •. 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V • LO has permission for gas installation ........................... . 0 in the buildings of .............. :.. .. -cam North Andover, Mass. Fee. `.:'...".. Lic. No... ..... ......................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer P. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) c NQ 'AMA?) Mass. Date 19Of 5' Permit # C77, Building Location�i'�% ZL), n d 5, -s . jar �YOwner's Name Q -L ,./ A/,=- V6 A Type of Occupancy Ir-, ld Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ , No ❑ Installing Company Name -Ecjstern Propane Gas Inc Check one: Certificate Address 131 Water Street yx Corporation Danvers, MA 01923 ❑ Partnership Business Telephone R'60--- 3� -<SGPIF ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter abi n's hoobaN UZE2, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. ° Yes No ❑ If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability insurance policy A Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe t issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of e e al Laws. By T e of License: Plumber t e o nsed Plumber or G fitter Title asfitter 96 Master License Number ly CXTown Journeyman APM04ED IC S ONL ��n�■��■��■ �MEN inn ��� '�iiririii�ii■n■�n�n SEE Installing Company Name -Ecjstern Propane Gas Inc Check one: Certificate Address 131 Water Street yx Corporation Danvers, MA 01923 ❑ Partnership Business Telephone R'60--- 3� -<SGPIF ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter abi n's hoobaN UZE2, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. ° Yes No ❑ If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability insurance policy A Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pe t issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of e e al Laws. By T e of License: Plumber t e o nsed Plumber or G fitter Title asfitter 96 Master License Number ly CXTown Journeyman APM04ED IC S ONL 3818 Date .�!� 0 TOWN OF NORTH ANDOVER p i7 PERMIT FOR PLUMBING :> �/ r`' This certifies that.C.l?+.!h.s!G�,�!'..:�.................... '� ,z has permission to perform .... ........................... o plumbing in the buildings of .... u.1`'!��. rCU at .. Lki f' : S . .................... North Andover, Mass. Fee .d.)... '... Lic. No. .`. ` .... ............................. . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR MIT TO DO PLUMBING .'ype or print) %\-t ° rA 8-J., V J rnA MASSACHUSETTS Duading Locations .5 j i.l> r...Q Ek LIT = rM UNA Owner's Name New 14 Renovation ri Replacement Plans Submitted FIXTURES Date 'u Permit #, Sr/ Amount (Print or type) Check one: Certificate Installing Company Name Galinsky Plumbing & Heating Inc. ® Corp. 1906 1! Address P • O. Bax 1701 Haverhi 11 . MA C1811 rl Partner. Business Telephone 978-374-1743 Finn/Co. Name of Licensed Plumber: Stephen C Galinskv a Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy nX Other type of indemnity a 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 ri 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 fo; this application will be in compliance with all pertinent provisions of the Massachusetts Site PWbi j Codi d �hjpter 142 of the General Laws. ' By: ,D(OFFICE USE ONLY 1Tyyp�e�o�f Plumbing License Licenser' umR'—tier Master Journeyman ❑ MMMMMMWMMMMMMMMMMMMMMMMMM i�-N*Zmt mmmmmmmmmmmmmmmmmMMMMMMMM' (Print or type) Check one: Certificate Installing Company Name Galinsky Plumbing & Heating Inc. ® Corp. 1906 1! Address P • O. Bax 1701 Haverhi 11 . MA C1811 rl Partner. Business Telephone 978-374-1743 Finn/Co. Name of Licensed Plumber: Stephen C Galinskv a Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy nX Other type of indemnity a 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 ri 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 fo; this application will be in compliance with all pertinent provisions of the Massachusetts Site PWbi j Codi d �hjpter 142 of the General Laws. ' By: ,D(OFFICE USE ONLY 1Tyyp�e�o�f Plumbing License Licenser' umR'—tier Master Journeyman ❑ Date..... ,pHTly TOWN OF NORTH ANDOVER ,6'6 PERMIT FOR GAS INSTALLATION SThis certifies that .: `' :....... :.. ". ...'.. `....... as permission for gas installation �! '- ..+� .:��. �' f �• ,J :�.�... in the buildings of -Y- • • • • • • • • at . `.���!�r ..........., North Andover, Mass. r/ Fee. ? .J .... Lic. No.4i-?.,...r?09/15/98 09:07 GAS INSP& PAID. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 00 .A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �j C] VQr Mass. Date 1 19 c Permit # � G Building Location s Newt/ Renovation ❑ 0i1Irc Owner's Name S Type of Occupancy AeQ f C! - Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name -Eastern Propane '&b.s Inc Check one: Certificate Address 131 Water SLreet X Corporation Danvers, NA 01923 ❑ Partnership Business Telephone n Ute - ❑ irm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked rtes, please indicate the type coverage by checking the appropriate box. A liability insurance policy A Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in abov pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss or this TO R will be in compliance wi h all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge ws. By T e of License: C Plumber Sig ature of Licensed Plum er or Gas Fitter Titleasfitter Master License Number City/Town Journeyman ' APPROVED (OFFICE USE ONLY N ¢ N N Y U Z ¢ N ¢ N ¢ Q � rn = H W W N¢ O U m S m O W Q O Uj a ¢ m (n W ►- a y ¢¢ W O F. 0 a¢ O w � _ N¢ N W O z U W = ¢ N z W a¢ O H O � = W 0 W F' N Z J a = ¢ t7 ¢ W W N ¢ z a W a a c z a¢ 7W- M m z O z W O N = a W> W a a o o W¢ o ru ►- SUB—aSMT, BASEMENT 1STFLOOR 2ND FLOOR 1 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name -Eastern Propane '&b.s Inc Check one: Certificate Address 131 Water SLreet X Corporation Danvers, NA 01923 ❑ Partnership Business Telephone n Ute - ❑ irm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked rtes, please indicate the type coverage by checking the appropriate box. A liability insurance policy A Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in abov pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss or this TO R will be in compliance wi h all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge ws. By T e of License: C Plumber Sig ature of Licensed Plum er or Gas Fitter Titleasfitter Master License Number City/Town Journeyman ' APPROVED (OFFICE USE ONLY Q s N Z N 9 m A O 9 m m b c m O a n O m a � m Q D Q C O T ,Ni r W v c m x p o = I Q m m b Date. ...,/ ....... „ORTH TOWN OF NORTH ANDOVER py t,ao ,a 1tiOL PERMIT FOR GAS INSTALLATION P This certifies that • • . ............ • • . fr: has permission for gas_ installation ... • `? • in the buildings of .. �J "? /111- •?? `........................ at ...>..`7 . t k /' .1.,./ ..... h Andover, Mass. ic. No. lc, Fee081.16f98.997c 70:W �fgjp AS INSPECTO• . WHITE: ADDIIcant CANARY: Building Dept. PINK: Treasurer 04 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS G or print) North Andover Date 7-13 1998 MASSACHUSETTS Building Locations Jrcl Windkist Farm Road Permit # 2a112 Amount $ Q -- Owner's Name William Barrett Homes NewX❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name Galinskv Plumbing & Heating Inc. ® Corp. 1906 Address P.O.Box 1701 Haverhill, MA 01831 ❑ Partner. -- Business Telephone 978-374-1743 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Stephen C Galinskv INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. ('hark one: Signature of Owner or Owner's Owner ❑ Agent ❑ i hereby certify that all of the details and mtormanon t nave sunminea for enterea) in aovve appncauun at •�� u,,.. �__ - _ _ 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 States Code nd Chaser ifil# the General Laws. ity/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber 10344 ❑ Gas Fitter License Num er ® Master ❑ Journeyman Z F z p M z W F c C = F W Gz w V F z y J E, 't W W V 0 z > 4s. Ew. r E» W`a* z -t -t F �' y q Z C z W a W Z U v C i Q C7 ^.; > 0+ F O SU B-BASEM ENT BASEM ENT l 1 IST. FLOOR 1 Z' 2ND. FLOOR 1 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7T 11. FLOOR RT it. FLOG R (Print or type) Check one: Certificate Installing Company Name Galinskv Plumbing & Heating Inc. ® Corp. 1906 Address P.O.Box 1701 Haverhill, MA 01831 ❑ Partner. -- Business Telephone 978-374-1743 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Stephen C Galinskv INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. ('hark one: Signature of Owner or Owner's Owner ❑ Agent ❑ i hereby certify that all of the details and mtormanon t nave sunminea for enterea) in aovve appncauun at •�� u,,.. �__ - _ _ 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 States Code nd Chaser ifil# the General Laws. ity/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber 10344 ❑ Gas Fitter License Num er ® Master ❑ Journeyman Date 3781 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that i?hrr .j. ... `. . .... ........... . has permission to perform ... Nq .. (4q .............. plumbing in the buildings of .... r -t .................. at .. S../ .t!�.l.y l! S..� .......... , North Andover, Mass. PLUMBING INS ECTOR 09/10/98 49:29 400.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i am"\ MASSACHUSETTS UNIFORM APPLICATION FOR P MIT TO DO PLUMBING 'ype or print) North Andover 7-14-98 MASSACHUSETTS Date building Locations 2. � LN -AV; Farm Road Permit # 3 .4 ic 1 Amount %,O oy Owner's Name William Barrett Homes New � Renovation Replacement Plans Submitted FIXTURES (Print or type) Check one: Certificate Installing Company Name Galinsky Plumbing & Heating Inc. ® Corp. 1906 Address P.O. Box 1701 Haverhi I I . MA 01 R11 rl Pier. Business Telephone 978-374-1743 Firm/Co. Name of Licensed Plumber: Stephen C Galinskv Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: .f Liability insurance policy L; 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 1:1 Agent 11 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 erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat�Plumbi Coded Cl a r IA of the General Laws. Type of Plumbing License n icen um er Master ® Journeyman ❑ VED (OFFICE USE ONLY