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HomeMy WebLinkAboutMiscellaneous - 60 CIDERPRESS WAY 4/30/2018 BUILDING FILE Date.....d...—.A—.�.y..... ttORTly 1 3�;• ;•.��o� TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING '$s,CHUg� This certifies that ......................6t2i 44 CL �L"�� T' .................................................................................................. has permission to perform ............1."' ... f.. 11Z........... ..�........... LC wiring in the building of............ .!'iA ) �au,� ........................................................... at ... .... .gar ����..........� 6 ............. ,,North Andover,Mass. 2g� MEC Si Fee..............................Lic.No. .............,... -�?................./Ii�4 ..�'i�.......... Check# _ 71 Commonwealth of Massachusetts Official Use Only o Department of Fire Services Permit No. j qJ6 aM s BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeMCI' 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: Iq City or Town of: NORTH ANDOVER To the Inspector ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) &T P,ti 'hind Owner or Tenant ,r'� rL&M ev6iecySa Co m yt o (.G(::.— Telephone No. Owner's Address '7 6S vA�! 7E•.� , Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 6 E -cZj e, A-L, Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ( j,�I ot,Gr / O Completion of the following table may be waived by the Inspector of Wires. 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 ❑ In- El .o mergency Lighting rnd. rnd. Baotte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: """"'""""""""''' ....."....."' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of 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 E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o lec ical Work: -La-0 f-)y (When required by municipal policy.) Work to Start: 7- b t 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 force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) 1 certify,under the ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . t1 t�TvC CLIC.NO.: Licensee: L(�,Q,gU ature LIC.NO.: Z7 (Ifapplicable enter "exempt"in the license nam er line) Bus.Tel.No.• :5 �) Er'L-Z Address: _W -S 1 W �vyN 0?a S-b S Alt.Tel.No.• *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ ❑ 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 form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical 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 of ongoing construction activity,and may be 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 the 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. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 2 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: ' Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPEC ON: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comm s: Inspectors Signature. Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com l The Commonwealth of Massachusetts Department ofIndustria[Accidents Office of Investigations IF 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): PDV L � t_+—r-- tom_ Address: $ P A-C...i.t veru- AAtl C:- City/State/Zip: .A,+ OtW-Lf SPhone#: 2-2K Are you an employer?Check the appropriate box: Type ofsect(required): 1.[' i am a employer with�_ 4. El am a general contractor and I 6, ew 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.1 7• El Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.01 am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.0 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. ��`t�✓Wv-v�� ,v5 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 60 C_ S W^ City/State/Zip:_,(,l'� �C-�i ,,1� •vL Attach a copy of the workers'compensation-policy decla tion page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi under the pains and penalties of perjury that the information provided above is true and correct. - Si ature: Date: tz 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#: 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 ofhire,- express or implied,oral or written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 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 Con onwealthofMassach7usetts Dopaztment ofIndustdal A,ccidonts Office of Investigations 600 Washington Street Boston?SIA 02111 Tel#61.7-727-4900 ext 406 ox 1-877r IASSAFB Revised 5-26-05 Fax#617-727-7749 wt w-wass,govaa Date.!�4w......... OF r10RTly,�O TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING HU This certifies that...'......./...,.."... ...............4............................................................ -,-.j has permission to perform.................................... c. ......4 .................................... plumbing in the buildings ofd qll-P. ............. ..................... ............... I.................. North Andover, Mass. Fee-0).9kI Lic. No. .101> .7 ........ ...................................................... - , PLUMBING INSPECTOR Check# c&2 7 7t- / lz � S IMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE I f PERMIT# IUAW JOBSITE ADDRESS ! _�! ��°�9�`" OWNER'S NAME 3 POWNER ADDRESS TEL -- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL D RESIDENTIAL PRINT ,��( 11 4 CLEARLY NEW: Lam'! RENOVATION: REPLACEMENT: D PLANS SUBMITTED: YES 0 NOD FIXTURES-1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 fl BATHTUB I __I ._._ I I I I _ J====== C CROSS CONNECTION DEVICE I I i ..._ I i _ I ; _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM E DEDICATED GREASE SYSTEM _i I [ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN f .._._,_i .._..__( ..._____I _ I f ______► __..__� .____.. ..__..._J ._.__..! _.._.._ I ._...._1 _ ....._...� FOOD DISPOSER _._.__iIF—Il FLOOR/AREADRAIN ___-INTERCEPTOR(INTERIOR) i I � I I _.___i � _ � I 1 _ _ __.f 61 KITCHEN SINK ( 1 ! t 1 � { 1 ___- ILAVATORY ( _! _ .__� _____1 I 1 i J I J � f ROOF DRAIN =1 SHOWER STALL I SERVICE/MOP SINK .I _ I ____.I i l __ I _. __J TOILET- ------1 ___,. ..I : i _ _I _E ._ _ I ._____A= - f -- --Al_—_A!= 7 URINAL __._ __.J ___.__I _______I _ ( �._J ._-___.� _____i _---_ _ ( ._._._._l WASHING MACHINE CONNECTION { f __. A •___-__ J _ J I a _.1 WATER HEATER ALL TYPES WATER PIPING L-_ _. .-- OTHER _ _ _ _ 4 I __.._.� I t _.1 INSURANCE COVERAGE: �- 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES .,,.I NO IF YOU CHECKED YES,PLEASE INDICATE?THTYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND DI S OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F-1 AGENT 1]i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be incompliance w'h all Pe ' en vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME G _ _ LICENSE# 7 ( SIGNATURE L MP af JP CORPORATION 0# PARTNERSHIPD# 1 LLC �� S COMPANY NAME./�e/� DRESS CITY Qf`��G� ��STATE ZIP � �(© II TEL FAX ��CELL .��' �C ._._. MAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i _y Y The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street .Boston,MA 02111 Uf www mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print UAW Name(Business/Organization/Individual): A4 W) !V lV&Z?O!/ Address: )�.G f tf fl Ne.II(Y p6�, City/State/Zip: P,l 60m,&# Q 3076 Phone#:_ 603 _ k03 - /34/ Are ou an employer?Check the appropriate box: Type of project(required): 1.VI an 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.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 are a corporation and its required.] officers have exercised their 10.❑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.❑Roof repairs 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 aie doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert Idler the pains a p 7laIt Of perjury that the information provided above is true and correct. Signature: Date: Llle:� Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: r , 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 j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 Tel,#617-72.74900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax#61.7727-7749 www.mass,gov1dia Date...( .......................... NORTH, TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �':, ,83ACHUg� This certifies that .&c .................................................................................. has permission for gas instal at'on ...NPI,,................................................................. ...h- - inthe building/s�of ........................... !.............................................................. at....... ............................... .�--/'S ...................... North Andover, Mass. Fee.. 6......... Lic. No. .. 5/5 /`�d GAS INSPECTOR Check#OV, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY? h o ele MA DATE PERMIT# " I G- JOBSITE ADDRESS _ Q _ y¢SS VI/c ._— OWNER'S NAME GOWNER ADDRESS TEL IFAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL[ EDUCATIONAL ® RESIDENTIAL CLEARLY NEW: , _. . RENOVATION:E] REPLACEMENT:Ej PLANS SUBMITTED: YES Q NO APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER --1 E: 1 __.. : I j _ _ r E:. —1::J -,.. J �- BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR �. FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT L: TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER n�HER — � - --- --�� !---_ - _-J I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES YJ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D�f OTHER TYPE INDEMNITY ®r BOND F OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P rtinen pro i ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ��o —_� LICENSE#� SIGNATURE MP[6 MGF� JP El JGF 0 LPGI© CORPORATIONF-11# PARTNERSHIP©#=LLC # COMPANY NAME:11f4/�d,� DRESS CITY STATE ZIP (� FAX CELL7F-`12� EMAIL_r.¢_1e �"Lean 2141 _ __ ROUGH GAS INSPECTION]VOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES " Yes No Jr 41 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I The Commonwealth of.1VlMassachusetts Department of lndash iglAccidents Office o fInvestigations 60013 Washington.Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Cont°actors/Electrricians/Plumberrs Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: cy City/State/Zip: &Ikwn r:/ d 30 76 Phone#: o � 13 _13 q l Areyou an employer?Check the appropriate box: Type of rot ect(required): general contractor and I ` 1. 4. ❑ I am a g T am a employer with� 6. New construction employees(full and/orpart-time)." have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 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 are 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•❑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 alsofill outthe section below showing their workers'compensation policy information. T Homeowners who submitthis affidavit indicatingtbey a-re 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 1s providing workers'compensation insurance for my employees Below is the policy anti job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 o_fthis statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert'under the pains anclpe It/i� fperjury that the information provided above is true and correct. - Signature: ` 2�" ` Date: l Phone# ®fficial 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.CitylTown CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - 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 employeris 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 b can pres ented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,apolicy 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 -P-lease be sure that the affidavit is-corn lete-and rinted le ilii : The De artmerithas rovide—lc a s ace at the boffom - P p g Y 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 whichwill 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(ifnecessary)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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license orpermit 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 acid fax number: Tho GoM41011wealth ofmbswhwotts Departmaiat offaduMat Accxdouts offzce ofwestigatiom 600 Wasbington Stx-ut Boston,MA.02111 TO,#617-727,4900 W 406 or 1-877MASSAFB Revised 5-7.F-(15 Fax#617-727-7749 'OMMON H OF MASSA • m. se PL�1�'J3,I31;F�S ANDASl=1TTCFP.;Se D As A r�a:�rfo PLUMBER f 7S$UES THE ABOVE LICENSE TO:• , GHAEL. Ul IC ELLER ! ?"0 KENNEDYHAPI i! N(�.�(151716 605 J,6:i ' •' y �� �,� �1,�2 , �-c- -. `COMMON1,14 W:MASSAC US FtS AND GASl=ITTCF;.S LICEf U AS A MASTER I'LUMECI? ISSUES THE ABOVE LICENSE TO: h1 TGNA.E,L ul KELI,ER 20 KENN.EDY a -'P-G05 151'57 -1:7-, 41.61 I, oQ No°7y�H 'Ji,}O4no nei49 SS'4CHUSE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 674-14 on 4/2/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 60 Ciderpress Way MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons, LLC 78 Great Pond Road North Andover, MA 01845 Bw ing Inspector Fee: Pre Paid $100.00 Receipt: 27400 Cheek : 3984 OE HORTM�H Yi sow .••. Y ACHU5E4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 674-14 on 4/2/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 60 Ciderpress Way MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons, LLC 78 Great Pond Road North Andover,MA 01845 Buil ing Inspector Fee: Pre Paid $100.00 Receipt: 27400 Check : 3984 Town of t ndover hver, ass coc MIc"t WICK �• e � BOARD OF HEALTH Food/Kitchen N PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect ........ ............... buildings on ....1 .�. `�.,l.�!::�: ...� /.�: ............... Foundati /J `�Ou h t to be occupied as h .. ........................... . ........................................................................... Chimney provided that the person accepting this.permit shall in every respect conform to the terms of the application in 5 on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. Ro IghfZ-fi�, PLUMBING INSfiPECTr 9' VIOLATION of the Zoning or Building Regulations Voids this Permit. ! /l`l Final 4sxj��� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL I✓NSPECTO UNLESS CONSTRUCTION. ST RTS 4 u --- Service ................. ..... . '100 ....,s.,r..,.. ��.-- BUILDING INSPECTOR GASINSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina' a- of q W No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. ` ^ . ��w�-- SEE REVERSE SIDE Smoke Det ���Py i I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 190,500.00 m $ - $ 2,286.00 Plumbing Fee $ 285.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 285.75 Total fees collected $ 2,957.50 60 Ciderpress Way 674-14 on 4/2/2014 New Single Family Home NORTH Town of � tAndover No. h ver, Mass, SQA coc"KHEWICA BOARD OF HEALTH PERMIT T L D Food/Kitchen Septic System THIS CERTIFIES THAT 16WO.... BUILDING INSPECTOR has permission to erect .......................... buildings on ............�a,...,..�. �.., ,,,� , Foundation h Rough to be occupied as ........... ..K.W. w .............. . . .. .......................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. _ Rough Final %W&P PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR O UNLESS CONSTRUCT54TWIlloo.w.S Rough Service ......... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. le0% 4 NOTES: < 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM A PLAN ENTITLED "PLAN OF LAND, MEETINGHOUSE COMMONS AT p1 14 yC1 / r, C SMOLAI( FARMS, SOUTH BRADFORD STREET, NORTH ANDOVER, MAP 104C LOT 29 OFFICE.MASSACHUSETTS PLAN x/14 2B DINT THEUESSEX COUNTY Y THIS s Y20, 2001 N/F ESSEX COUNTY NORTH DISTRICT REGISTRY OF DEEDS. nor IJ,12' GREENBELT ASSOC., INC. 4` q/s�ArO 2) THE INTENT OF THIS PLAN IS TO SHOW THE AS—BUILT LOCATION °A+jo�0tiv 11.21, OF THE FOUNDATION ONLY. 11.00' (64 qi okeQ w. 3) THE FOUNDATION SHOWN HEREON IS NOT WITHIN THE 100 YEAR P FLOOD ZONE AS TAKEN FROM THE FLOOD INSURANCE RATE MAP FOR THE TOWN OF NORTH ANDOVER MASSACHUSETTS COMMUNITY PANEL NUMBER 250098 0007 C, MAP REVISED: 6/2/83. UNJ) � 1pf. U •4) THE CONCRETE FOUNDATION SHOWN HEREON HAVE BEEN-INSTALLED I 4s, o dak SUBSTANTIALLY IN ACCORDANCE WITH THE 40B SITE PLAN AS '0 40,0 % APPROVED BY THE TOWN OF NORTH ANDOVER PLANNING BOARD. \ \ ( I HEREBY CERTIFY THAT THE LOCATION OF THE TOWNHOUSE UNIT NUMBERS 16-19 FOUNDATION SHOWN HEREON IS THE RESULT OF A ,9tL •y H« �\ �\, m W° _ FIELD SURVEY BY THIS OFFICE MADE ON NOVEMBER 8, 2012, AL MAP 104C — op — 25 NO ` L'NNISRPIIEi; (nt f LOT 28 DISTURBANCE } iRAl16116i S!c "'I ZONE .>tI1L. 11' No 90No N LICENSED LAND SURVEYOR DATE CERTIFIED FOUNDATION PLAN .- / \ / MEETINGHOUSE COMMONS TO%IWHOUSE UNITS 16-19 GRAPHIC SCALE CIOERPRESS LANE 0 70 00 00 NORTH ANDOVER, MASSACHUSETTS • i ,���'-1 --- � PREPARED FOR MEETINGHOUSE COMMONS, LLC (IN PGGT) 121 CARTER FIELD ROAD 1 Inch 60 EL NORTH ANDOVER, MASSACHUSETTS 7 d rs 44 Stllao Road, Sullo Ono Salam,Now Hompahlro 03070 (603)095-0740 MHF DaolOn Conoullanla,Ina ENGINEERS•PLANNERS-SURVEYORS 1" - 50' DATE: NOVEMBER 12, 2012 DRAWINGN0. DESCRIPTION *SCALE: ORAVtN BY: I CHECKED BY: PROJECT N0, NAME REVISIONSCMF 250508 2505CFP,DIVG r � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �L Permit N0: Date Received i Date Issued: IM ORTANT:Applicant must complete all items on this page LOCATION _:, C Print b PROPERTY OWNER Print 100 Year Old Structure yes o MAP NO: G PARCEL: ZONING DISTRICT: ( 1 Historic District yes Machine Shop Village yes no , TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential XNew Building ❑ One family ElAddition VTwo or more family 11 Industrial ❑Alteration No. of units:eTy WdF FO?JR—UN'�S ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: LIt, � Adpntiffcation Please Type or Print Clearly) OWNER: Name: LL Phone: - 7-Z63, . Address: 78, . J nA&%/ CONTRACTOR Name: rza. Phone-ct 7E-66 7-&? Address: 6J 1�1C• /Vy J� �� ` Supervisor's Construction License: —Exp.Exp. Date: Home Improvement License: N Exp. Date: AJ ARCHITECT/ENGINEER d�,SLJ� �Y� Phone:'78j- Address: MMAS . ;? Reg. No. ly FEE SCHEDULE:BULDING PERMIT:$ .00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /90 FEE: $ ZZE f e-6 Check No.: '99 Receipt No.: NOTE: Persons contracting with unregistered con Tactors do not have acces;to he guaranty d Signature of Agerit%Owner Signature of contractor- Plans SubmitteW Plans Waived ❑ Certified Plot Pla4l tamped Plans ❑ Location( O-z4144-ft 4J -A?j No. 674—4 Date Z �� . - TOWN OF NORTH ANDOVER s ' °r6 . : v0 Certificate of Occupancy • P � e x Building/Frame Permit Fee - Foundation Permit Fee $ 9 Other Permit Fee $ TOTAL $� Check# Z `: J ' Building Inspector Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE-OF*,SEWERAGEDiSP_OSAL- .. Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑. Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc.. -❑ . - :.Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ,.._DATE REJECTED DATE APPROVED PLANNING4 DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on ��icinature COMMENTS HEAL f"H Rei 14V 4 n Signature COMMENTS4L Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located'at 124 Mair Street - Fire Departrne►if signatureldate- { COMMENTS Dimension Number of Stories: 2 Totals square feet of floor area based on Ex _ q tenor dimensions.lZ&Os�—' .Total land area, sq. ft.: 3D ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-Chapter-166Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use + C-d - . C� El Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department -'The foi?owing is-=a 1i'st of the retluired.forms to be filled out for the appropriate permit to.be obtained. Roofivg, Siding, Interior Rehabilitation Permits L) Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 NORTH O �gLEO q� •� yb hb Y6_O'1 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Arno � BUILDING PERMIT# ADDRESS/LOCATION OF PROPERTY: 6o c ans Map Kc Parcel 3 1 Lot Number P/,4 SUBDIVISION: S DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE 5 DAYS NOTICE PRIOR TO CLOSING DATE IS RE UIRED ALL WORK AND SIGN-OFFS MUST BE COMP ED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLAR 0.00)WILL BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL AP LICABLE COD APPLICANT SIGNATURE Permit Issued to: l Address: �7 F N, R ROUTING TOWN ENGINEER SITE PLAN— 1� RIVE- WAY REVIEW 7 CONSERVATION U .P (AZ-q14 a� PLANNING R CH qq iR DPW-WATER METER SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File:Application for OC form revised Jan 2007/2011 ACHU CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 674-14 on 4/2/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 60 Ciderpress Way MAY BE OCCUPIED AS as single family home home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons, LLC 78 Great Pond Road North Andover, MA 01845 -'BAcifng Insp ctor Fee: Pre Paid $100.00 Receipt: 27400 Check : 3984 NORTI{ O�SSLED r �M 3� h671t— ti6Y6 OO 0 APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION �• DpA cee.i�wewKw�' 'x BU.LLDING PERMIT # SACHUSE nn ADDRESS/LOCATION OF PROPERTY: Co CTdt¢qins Map jC_ Parcel 3 Lot Number SUBDIVISION: Zx, S DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE.,(5)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMP ED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLAR 0.00)WILL BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL AP LICABLE COD APPLICANT SIGNATURE Permit Issued to: _6e�, l t��C Address: N ROUTING TOWN ENGINEER SITE PLAN— RIVE-WAY REVIEW CONSERVATION ] U .PyZ`<<�4 � � PLANNING ®_ C fl qo B DPW-WATER METER SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYAINSPECTION REQUEST DPW - SIGNATURE File:Application for OC form revised Jan 2007/2011 I ONORYH 1 o ,SSACH0 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 674-14 on 4/2/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 60 Ciderpress Way MAY BE OCCUPIED AS as single family home home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons,LLC 78 Great Pond Road North Andover,MA 01845 'K" '-� &t-- -"'Budring Insp ctor Fee: Pre Paid $100.00 Receipt: 27400 Check : 3984 ,NORTIJ Pj �tLeo / qti 3Z yf.fit M6 tb �0 APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION T Z -oyb 7pA�RTco CRUS y BUILDING PERNIIT # �i �SSA �� nn ADDRESS/LOCATION OF PROPERTY: 6(-) CTc-pins / Map KG Parcel 3 1 Lot Number--LJ/ SUBDIVISION: S DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE.LS)DAYS NOTICE PRIOR TO CLOSING D TE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPI� ED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARy� 0.00)WILL BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL AP LICABLE COD S. APPLICANT SIGNATURE Permit Issued to: Address: -7 F- N R ROUTING TOWN ENGINEER SITE PLAN— RIVE-WAY REVIEW - ----7 CONSERVATION PLANNING til, DPW-WATER METER SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPA.NCYANSPECTION REQUEST DPW SIGNATURE File:Application for OC form revised fan 2007/2011