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Miscellaneous - 61 GRANVILLE LANE 4/30/2018 (2)
Li G,ea,Nvi// La.✓E BUILDING FILA � CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 419 Date: September 11, 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 61 Grandville Lane MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Walter Ericsen 61 Grandville Lane North Andover MA 01845 Building Inspector f o r CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 419 Date: September 11, 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 61 Grandville Lane MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Walter Ericsen 61 Grandville Lane North Andover MA 01845 Building Inspector ` NORTH '9 TO" 0 : Andover No. 4t/ i5p dower, Mass. 4 T O �-�•- L A � 1 1 COCMICMEWICK V �d ADRATED i?� 5 S BOARD OF HEALTH PER. MIT T DFood/Kitchen / Septic Syystem BUILDING INSPECTOR - ' ♦ �. THIS CERTIFIES THAT .���... .........e............................. . . . .. .. . ... has permission to erect........................................ buildings on .��........ .4�R .....1 �....... Zgh.... .. .....to be occupied as.... 1!!'� . . .. ......... .......r! ►o ....... .I ................. mney ..................................... �.......w provided that the person accep ng this permit shall in every respect conform to the terms of the application on file in t . Fina a 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. PLUMBINP INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPEC OR UNLESS CONSTRUCTION STARTS s .. ................................. Serviced ac_ , ��f BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough O G% Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done VFIRE'DEPARYMENT Until Inspected and Approved by the Building Inspector. Burner Street No. A. 4� SEE REVERSE S1DE smoke Det. f AONTN 1 O tt�ao Baa �O ►O.r `••�` k to O� w � 1 •e row � 5 mu APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION 2 `S Buildina Permit# � 1 ADDRESS/LOCATION OF PROPERTY : G . Map Parcel Lot Number SUBDIVISION DATE REQUESTED.FILED/READY FOR INSPECTION l� CLOSING DATE ON PROPERTY: FIVE(5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Perrmit Issued to: ` ��� c ���5 Address SIGNED IR01IN CONSERVATION ,((7I�� PLANNING GC /Ver DPW-WATER METER SEWER/WATER CONNECTION " NOTE DPW MUST INDICATE TWAT THE WATER METER HAS BEEN INSTALLED IOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST DPW Signature Fife: Application for OC form revised Jan 2007 p v NORTi4 ,• O �tLEC 16�-r� OL O TA_� [OCMK lwKx y1' ' 7�Q0Rwreo 9SSACHUS��_ PUBLIC HEALTH DEPARTMENT Community Development Division 0E12TI FICAr2 OF C09V1-E'.GJ-,/ AL CE As of: September 11 , 2009 This is to certify that the individuaCsu6surface disposal system received a SMISTACTORT IM(PEC`ZIOY of the: Construction of a New On Site Sewage U'Tosa(System ,r, . By. (Peter Breen At: 61 (aka-Lot 4) Granvilre .Gane Map-106.C; Parcel 52 NorthAndover, WA 01845 7Ffe Issuance of this certificate shall not 6e construed as a guarantee that the system wid 7func ' sat' actoriCy. WicheCe Grant Tu6fic YfeaCth Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Date.. f�—..�.. ..... pORTI� °�'"`°;•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� ` This certifies that .............. E„5-C? USIA... / 5,/l�j...... ,F has permission to perform ...... 6� �c1Hb�s .............:..................................................... wiring in the building of......l u�� % /3 T / �2...... ...�1!!�C....L .............��,..,North Andover,Mass. Fee...� Lic.No.1.7�7 * 1 ��LECTRICAL INSPECTOR Check # 7/1 8559 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code MEC,527 CMR 12.00 (PLEASE PRINTINM OR TYPE ALL INFORMATION) Date: oZ / p City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �j -III � Owner or Tenant Telephone No. Owner's Address -315 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Bog) Purpose of Building LVO J Se Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service obV Amps 120 /ate Volts Overhead❑ Undgrd ® No.of Meters I Number of Feeders and Ampacity4 O Location and Nature of Proposed Electrical Work: L i rZo Completion of the followin table may be waived by the Inspect-r of wires. t, 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 t No.of Luminaires Swimming Poo, Above ❑ in o. o mergency ig g ted• d. ❑ Batte Units -- No.of Receptacle Outlets No.of Oil Bu-rners ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: _ __....______._.___.. -.__---__. Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters KW Signs Ballasts . Data Wiring; No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value o Ele trical Work:. �D O • OV (When required by municipal policy Work to Start ` Q Inspections to be requested in accordance with MEC Rule 10,and upon completion. d INSURANCE COVERA : Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the vairM,andpenaldes of perj , that the information on this application is true and complete. FIRM NAME: e [ LIC.NO.: w Licensee:tAk.1LQ Signature �y� LIC.N .: �. (If applica§l enter"ex mpt-in the lice number line. Address:I OEM 34 A IyrBus.Tel.N17 kb *Per M.G.L c. 147,s.57-61,sec ity work requires ent of Public acivil affety"SAq!'License: �t L cl.No. ' � �Q� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑o Owner/Agent wner Downer's agent Signature Telephone No. PERMIT FEE: $ •s- .r' �G( 0 U Ap Y l The Commonwealth of Massachusetts k- I Department of Industrial Accidents -. Office of Investigations ilii;? r 600 TEashington Street ` Boston, MA 02111 t'1 www massgov/dia . Workers' Compensation Insitrance Affidavit. Builders/Contractors/Electricians/plumbers Applicant Information Please Print Lee-lbl Name (Business/Organiration/individual): deSoo5z- Address: W c City/State/Zip: C7t O one Are you an employer?Check the appropriate box: I.�I am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am.asole proprietor or partner_ listed on the attached sheet,t 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working forme.in any capacity, workers' tromp.insurance. [No workers comp.insurance 5. 9• ❑ Building addition ' p ❑ 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 I I.❑ Plumbing repairs or additions .. myself. [No-workers'comp, c. 1.52, §1(4),and we have no 12. Roof insurance required.]t ❑ repairs ,. �N ] .employees. [No workers' comp. insurance required.] 13.[]Other 'Any applicant that checks bort#1 must also fill out the section below showing their workers'compensation poi icy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside conuaetors must submit a new affidavit indicating such. 4Contractors that check this box must attached an additional sheet showing the tramp of the sub-contractors and their worm'comp"polis; v,s,ayon. I am an employer that is providingworkers compensation insuranc for my employees; Below is the information polio,and job site Insurance Company Name: ' V%A t2✓'e C e C Policy#or Self-ins. Lie. 1 — Expiration Date: j Job Site Address: ( G 4'W�/i LJ City/State/Zip:IU , w Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as requited.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 thei and penalties of perjury that the information provided above is irrie and correct Si Lure: Date: Phone#: FF,1s l use only. Do not write in this area,to be completed by city or town ofciaL Town: Permit/License 4 Authority(circle one): d of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: y Information and Instructions �l 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,.assoaiation,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 tnrstee 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 shaU 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 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 woric 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 requiredt to carry workers' compensation insurance. If an LLC or LLP does have d% 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,notthe 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 numberlisted below, Self-insured companies should enter their Self-insurance-license number on the appropriate dine. 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 mill 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 f ituae 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, IMA 02111 Tel. #617-7274900 axt 406 or 1-8.77-MA.SSAFE Revised 5-26-05 Fax:9 617-727-7749 www.mass.gov/dia Date..P.` -a 7....... . WORTH 1 Of I F �p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION o. SACHUSE� This certifies that . . ... . . . . . . . . . . . . . has permission for gas installation CJS, . : 1 . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . ! , North Andover, Mass. Fee/ . . . Lic. No.�g`. .. . . . GAS INSP 7 Check# 6899 { JS MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date �, q- w NORTH ANDOVER,MASSACHUSETTS Buil dmg Locations Permit# t0, y/ _ Amount$ /ov Owner's Name NewEl Renovation Replacement Plans Submitted U .F vl F c o x z z c z e.W w F w w o ° a ° w . w F cx o x w E. G zw w m � d � x a w a� � F w F x a �- F H ° > w F U a H w W o x az > SUB-BASEM ENT B A S E M ENT 1ST. FLO O R 2ND . FLOOR s... 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name 4--,cO y 4r),*10 Ll `AC-A+l✓i� Corp. Address Y1 J'L"TT/G `"7 Partner. 0114 Ger IX-74j-r' Business Tel ep one z)i A J j-17. 576 -5 ® Firm/Co. 1, I fine of Licensed Plumber or Gas Fitter �Q w•ArS �C c�ov,G✓� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No If you have checked Les,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. Check one: Signature of Owner or Owner's Agent Owner Agent 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass ac setts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter . Title ❑ Plumber L9 P'y 0 City/Town [:] Gas Fitter1cenL".Num er ❑ Master APPROVED(OFFICE USE ONLY) mJourneyman weatfh ofMansachusetts DTartmerzt uf.£rdustrial Accidpn& i;l�,� I lse of.1mcstig ations . � �f 600 Nlarhh;rton S'tr'eet Boston, M4 02111 ww�v_�rrns.�grvldia . �, Workers, Cmation fioa Llskmee Affidavit~ RmUders/Coatz'acfor �• 'cant Inft►rnaa�ion s/ElectriciaQs/PiQm6ers \ PIease Print L 'bi Name(BLit=dDrgni�ioMndividual): C� �!�'oy.�;1j G �4ddress: 17 A T1 f Phone 4:. 7 Via¢' is Are you ac employer?Cheek.the Appropriate-boz: 1: I lima=Pinyer with 4. Type P*Ql ("U —. �] I am a general contractor and I `�: 2.XPi$ (fun andlorpart-tirnz). have hh-ed the sub_=mm xars 6. L"J ►pow constructi . 1�lam prapnetor or psrtnor- iiste:d on i3�e ariaci:ed suet t 7. ship and ireva no em I Q Remodeiing working for me.in P Thi suis-contractors have g any cap=ity. work' Coco in ❑L�moiition• e. worfcErs ootnp,itrsuranx 5. l] W� are a.Corporation and 9• (]13u�7ding addition ���] 3•Q I ain a homeowner doing ail work doers have exercised their 10.0 Electrical repairs or additions MYsel£[No•workers' rift of eoceinPtion Far MOL 11.�]P'iwnb' P' r. tS2, §1(4L.and•we have no ng repan or additions mswancr regpd]'t omPjayew12. s [No workeW ❑Roof *Amy aPPtjttgw �P• ir:susarieeracluired] I3.L].pth� diecks boa#1'const also fill am the aecfion is iow eho , K eowaata wbo.submit this a i davit indicating fhW amdDing an wn:g thairworkmt aor6peo Poi*in ion, Coatractots that cheap fliia box moat 'and thmi hha otaaide conuactats nnist ' an add tiaaal sties showing.tFta rmrrec Md n t'a sew afndavit iaB' oft6 cub. su I air,=enpiayer fha&is fl , roanecn><s and[imv infornraUOM > ►tg:wari:_ carp ago"inwraaceforInp.enm*&=. Be�e�.� Fad aaraiyob.ram . lnstaance Corgpany Name: Poiicy#or Self-ins, Lic.#: SExpilatron Date: ob Site Address: Attach a copy of the workers Capt �th'�tie2rp: pe°sati°a-.Policy axEaratioo show(Dg Fafhm to secw�e covets a as P ( e the Pofity Dumber aad e fine to g required tinder S:,c�ion 25A of I�1CiL e. 152 art lead xpitefion daeeJ, . up `I,ADO DO and/or one-year imprisonment,as wen >gs civil to dt°imposition of crnnirw Petalties of a- of nP m S250.00 a day against-the vicsiator. Be advised PmWfies in the form of a STDP WORK ORDER investigations of the DIA for insrmce cov a copy.of this ststemenf f a fine . erage verin-"cation; m$}'be forwarded to the Oin�of I do hereby cerfify under the Si Pis panirtfaririaVori p vvided above is&e and aaneet Phone-9 7 g'f Date �lciat=' c Orlfy, Dv not wf&e Ln.rids . area, /D he COrlr�1[p�ad l.. C*Or 90&..q Official City or Town: t Issuing 4 Per•mlMicanse# Issuing afhorKy(cirefe one): 1. Board of F3eaitb Z Suilttfing 6.Other Depzft+nent 3.CitylTDwm Cierk 4. Eiecttical Inspector $ PlDmbiDo las b P�for Contact Person: Phone#: iniormanon a- na instructions Massachusetts General Laws Chapter I S2 requires all emp 3 oyers to provide workers' compensation for their employees. Pursuant to this stttttsit,an enrpGryrr is dofined as"..:aver-yperson in the service of another under any contract effuse, expr=ss or implied,oral or writl=" An enq&yer is defined as"an individual partnership,asscidatiort,corporation or other legal entity,or any two Cr M01, of tine famping atgaged in a joint emir rise,and includii"g the Iagal representatives of a decsased amployer,bribe T=ivcr ortrsistm-of an individual,partnership,associatiam or other legal fully,eanploying employees. 'However the owner-of a dwelling house having not more than th=aisa::-tmentc and who resides therein,or the occupant.of the dweliing house of another who employs parsons to do me-imtenatce,construction or ria' work on such dwellinghouse or on the grounds or building appwttm=thereto shall net b===of sucb enrpioytme nt be d--rued to be an amployer." MGL chapter 152,§25C(6)also states oast"every state as-kcal 6cansing agency shall withhold the issnaaee.or renewal of a license or permit to operate a baseness or *o construct bul iMp is the commonwealth for any applicant Whe has not produced aocept abth evidence-of compysance WI&die..iasarauct coverage required," Additionally,MOL Chaptar I52, §25C(7)dziaS"Neither blies commonwealth nor any of its polificgl subtfivisions shall antxr into arty contract for the pacForrt ce of public wariC tam?accepsa}ile evidence of compliance with fixe irtsi mce. mquirsmcnis.of this chapter have been prasattsd to-the MCXx&actvtg auffx ri ." Appli®nfa Please fill out tilt workers',compensation,affidavit campl,---toly,by checking the boxes that apply to.your situation and,if necessary, supply sub-Cotttractor(s)n me(sl adtirs9(e5):aMd phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with nti emplayees othertlmn the members or.partnem,an not required,to carry work='cn.=npensation instum= !fan LLC or--LLP do=have employees,a policy is required. Be advised that oris affidavit may be submitted to the Depataeart of Industrial Accidents for confirmation of instatsncx coverage. Also �e sure to sign sod date the affidavit 'The ar5davit should be reunited to du city ar town that the spplicalion far flit pcirnif or lime is being requested,not'the Department of Industrial Accidents. Should you have any questionIs.ragaa-% srg tim..law or if you are repaired to obtain a workers` . oarrepermtaon poiiay,please-call the Depastment atthe-ntrmber.iistt±d below, ScIf-insured companies should enurthesir self-ice license r=bcr on fisc appropfi to iirzr. City or Town Mals Please be sure shat the affidavit is complete and primad hgzbly. The Dapwtnortt hes provided a spam at the bottam of the affidavit for yoir to fM Ott in.the-event the Office;of Invent p inns has to contact you regarding the applicant Please be sum to fill in the permit/ficenm ntmtberwhich Will be used as a,cfci number. In addition,an appiiont that must submit multiple pa mit/license applicsfions in any given year,nxd only submit one affidavit indicating-current policy"information(if necessary)and tmdsx"Job Site Adc}ress"the applicant should write"all locsfio s in (city or trowel)."A cM' of'ffte affidavit that has be :n.officiaily staimpesd or marked byt3-te city or town may be provided to the applicant as proof that a valid affidavit is on file for fut3at permits or licenses. A new affidavit must be flied out each year.Wheal a home:owner or citizen is obtaining a license: or pmmi:not related to any business or commercial vesuvin (Lt a dog license or permit to bum leav^s este.)said pMMn is NOT.required to-compiete this a zf fdaviL The Odra of investigations would 10ce to thank you in advance for your cooperation an, you have any questions, please do not.hesitate to jive us a tail. The:Department's address,telephone and fax number:. The Commonwealth of N�assac}�tz is Dcparfnieat of lmdus rW Accidents Qffice oaf Iav$stii�ions ' • 600 Wsshingtan Street Bosion, IviA x2111 TeL#617-7Z7-4900 cz t 406 or 1-977-h ASSAFE Fax 4 61 7-727-7744 lL vises3 5-26-!15 WWW-mass.govidia p D Date... .�.....v .... i NORTH °f'"'°:•'"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ;,SSACMUS� This certifies that .....�� /..`'. .!.G.. ............................................... ........ has permission to perform ../'.!.!4'2/t?�..Sr . ............................ wiring in the building of.... G �!!! ?d .............................................•� �i ..... at.;.1....0(762 !2Z .......1.. ...:.. ... ... ,North Andover,Mass. t Fee. .� ..... Lic.No..&J.1.4........ :.. ........ .......... ELECTRICAL INSPE S Check #fes/O�y 8760 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. '7 � BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance.with the Massachusetts Electrical CodeEC M PLEASE PRINT IN Code(MEC),527 CMR 12.00 INK OR TYPE ALL INFORMATION Date: 1-/ City or Town of. NORTH ANDOVER To.the Inspector of Wires: By this application the undersigned gives notice of his or her intention o perform the electrical work described below. Location(Street&Number) Owner or Tenant I Telephone No. Owner's Address Is this permit in conjunction wit buil ' g mit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / _Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps _ / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Y L Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total ' No.of Luminaire Outlets No.of Hot Tubs Transformers KVA Generators KVA No.of Luminaires Swimming Pool Above El In- o,o mergency ig g d• i'nd. ❑ Batte Units —, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiatinv Devices Tons No.of Alerting Devices No.of Waste DisposersHeat Pump Number _ons KW _ No.of Self-Contained Totals: _.._._.._._...._... ... Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other 0 No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of0. No.of Devices or E uivalent J Heaters Kms' Sips Ballasts Data Wiring: No.of Devices or ' my No.Hydromassage Bathtubs No.of Motors Telecommunication Total HP s�'i'u'�g: No.of Devices OTHER: or E mvale Estimated Value of Electrical Work: ILM Attach additional detail if desired,or required by the Inspector of Wires. _ (When required by municipal policy.) Work to Start: �9?�' 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 cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penal ' s of perju that the in ormatio this application is true and c om lete. ME FIRM NA : P LIC.NO.: Licensee: C (If applicable, enter'exempt"in tl license number li Signature LIC.NO.: �q Address: A / Bus.Tel *Per M.G.L c. 147,s. 57-61,security work requires Deparlmerit'of Public Safety" "License: Alt.Licl.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hav e the liability required b law. B m signature Y q Irk'insurance coverage normally q Y Y y gnature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent Owner/Agent Signature Telephone No. P ERMIT FEE. S .V A�vl) The Commonwealth of Massachusetts �p Department of Industria!Accidents Office of Investigations 1' " 600 ff,izshinaton Street /I b `;. a i{i�i Boston, MA 02111 www.nzass.gov/dia . Workers' Compensation Insiitrance Affidavit Builders/Contractors/Electricians/Plambers A licant Information Please Print LeQebl Name(Business/Orgmization/Individual): Address: VU O City/,State/Zip: lel Phone #: ����4 `C Are you an employer?Check-the appropriate box: 1.❑ I am a employer with 4. Q l am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors b. ❑New construction 2.Q lam a.sole proprietor or partner- listed on the attached sheet.t ? ❑Remodeling ship and have no employees ese,sub-contractors have S. ❑Demolition working for mei any capacity. Orkers' comp.insurance. [No worker;'comp. insurance 5. We are a corporation and its 9. ❑ ilding addition uired 10. ' Electrical a req ] officers have exercised their repairs or additions 3.[] I am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself [No-workers'comp, c. 1.52, §1(4),and we have no 12. Roof insurance required.]t ❑ repairs q ] .employees. [No workers' comp. insurance required.] 13.Q Other *Any applicant that checks boil!{l must also fill out the section below showier their workers'com g pensation policy information, T Homeowners who submit this affidavit indicating they are doing all work and then hue 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-conttactors and their workers'comp.policy irftimration. 1 an;ars enjpw,yer that is proiidingmarkers'r compensation insurance for my employees. Below is the policy erred job site information Insurance Company Name: Policy#or Self-ins.Lie.#: 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 oxen fine up to$1.0 0.1 d and/o e-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a i of up to$250.00 a day the violator. Be advised that a copy of this statement may be forwarded to the Office of t Investigations of the DI f surance coverage verification. 1 do hereby certify un airs and penalties of perjury that the information provided above is true and correct Si tare: Date: �'� A/ Phone 9: 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.PlumbingInspector 6.Other Contact Person: Phone#: Information and Instructions V 'a 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 bmstee of an individual,partnership,association or other legal entity,employing employees. 'However the owneir-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 compiiance with the insurance requiremerrts 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 s� 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. Ifan 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.t3le 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 nurnber.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 NvilI 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 fift= 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 Departtwnt of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-8.77-MASSAFE Fax 4 617-727-7744 Revised 5-26-05 www,.mass.gov/dia Paul Davies Assoc.,Archite c ts May 28, 2009 Mr. Gerald Brown Building Commissioner N. Andover Building Dept Town of N. Andover N. Andover Final Report 61 Granville Lane N. Andover, MA The shear walls as required by the seventh edition of the Massachusetts State Building Code (One and Two Family) was inspected on May 22, 2009 and found to be deficient. Changes were recommended and instituted. It is my opinion that the shear walls are now in conformance with the Code Very truly yours 0 Paul L Davies, AIA Mass Reg. #3280 t, . O 635 Rogers St. Unit 4 Lowell, MA 01852 978-459-2154 NewR s 5-15a�1 MeyBezm Lot 4 Granville Lane 10:05arn N..Andover,MA 1 of 1 KeyHe=O 4.504a lanHeamEtigim 4.505e Matlaiab Database 978 Member Data Description:Beam A Member Type:Beam Application:Floor in 2d fur(2d fir load only) Lateral Bracing:Continuous Top Standard Load: Moisture Condition:Dry Building Code:IBC/IRC Dead Load: 12 PLF Deflection Criteria: Lt360 five,L240 total Live load: 30 PLF Deck Connection:Nailed Member Weight 10.8 PLF Filename:Lot4Granvdl Other Loads Type Trib. Dead Other (Description) Begin End VWdth Start End Start End Category Replacement Uniform(PLF) 0' 0.00" 13' 6.00" 168 420 Live 2d floor bedrooms(14'tnb @ 30/12) Additional Uniform(PLF) 0' 0.00" 13' 6.00" 50 0 Live wall am S is above tttiswafl to ort cel' /attic bad © 1360. 1360. Bearings and Reactions Location Type Input Length Nin.Required Gravity Reaction, Gravity Uplift 1 0' 0-000" Wall 5.500" 1.500" 4183# 2 12'10.750" Wall 3:500" 1.500" 4183# -- Maximttm Load Case Reactions used torappbiM pard badsWIhe bads)to ealryLg r hers Dead Live 1 1475# 27080 2 14758 2708# - Design spans 12'10.75(r Product:MASTER PLANK 29OOFb 1.75x9.26 3 ply Component Member Design has Passed Design Checks.'* Design assumes continuous lateral bracing along the top chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 13487.'# 19565.W 68% 6.46 Total load D+L Shear 36831 10360.# 35% 0.01' Total load D+L Max Reaction 4183.# 15986.# 26% 12.9 Total load D+L TL Deflection 0.6150" 0.6448" Ll251 6.46 Total load D+L LL Deflection 0.3981" 0.4299" LP388 6.45 Total load L Control: TL Deflection -- DOLS:Uve=100% Snmw--115%Roof`=125% Wmd=133°/a Design assumes a repetitive member use increase in bending stress: 4% WnufacturersinstalltionguideMUSTbeconsultedformulli-piycormectiondetailsandafbrnatives 1!!T � J ?1rG•r ','�11w "I'll AJ1podutnm1e mb,dw.w aftteirregwmAwowners D.Webster 1ww'` mood Disbihdion . ey QTY 71+1,r °� Copyipld(C)19W2W5 by Keyuok 6derydses6 LLC.ALL R*HrS RESERVED. N.Blledce,MA �/,/ECTE1111aNE5.LLC "'Passing isde6eled as ween It menber,tbor ioK beamorgirder,shor n en oris o-awing neets arpicatle desiW aft! farloads,Loa ft Cm ffh3m.mW Spare istedan this shed.The dbslgi mrd be renewed as mdior Twded assines in�ibbon toUnmanrbdvers s.cationbyaglalyiednpsigroradesigl New Res 3-18-09 MeyB zam rot 4 Granville Iane 10:37am N..Andover,MA 1 of 1 KeyHaa 04.504a kmBeamEggme 4.506g Materials Database 961 Member Data Description:Beam B Member Type.Beam Application: Floor in ceiling/attic Lateral Bracing:Continuous Top Standard Load: Moisture Condition:Dry Building Code:IBC/IRC Dead Load: 12 PLF Deflection Criteria: U360 five,L240 total Live Load: 30 PLF Deck Connection:Nailed Member Weight 10.8 PLF Filename:LoMGranvill Other Loads Type Trib. Dead Other (Description) Begin End Width Start End Start End Category Replacement Uniform(PLF) 0' 0.00" 13' 6.00" 168 420 Live walk afllo 14'tnb 30/12 13 6 O 13 6 0 Bearings and Reactions Location Type Input Length Min Required Gravity Reaction Gravity Uplift 1 0' 0.0w, Wall 5.500" 1.500" 3861# 2 12'10.750" Wall 3.500" 1.50(r 3861# — Ma)dmtun Load Case Reactions Used ft r"ybg pointbads(«the loads)to caeyilg members Dead Live 1 11 Wff 2708# 2 11530 2708 Design spans 12'10.75(r Product MASTER PLANK 2900Fb 2.0E 1.75x9.25 3 ply Component Member Design has Passed Design Checks." Design assumes continuous lateral bracing along the top chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 12448.# 19565.W 63% 6.45' Total load D+L Shear 3399.#" 103601 32% 12.25' Total Toad D+L Max Reaction 3861.# 15986.# 24% 12.9 Total load D+L TL Deflection 0.5676' 0.6448" L272 6.45' Total load D+L LL Deflection 0.3981" 0.4299" L/388 6.45 Total load L Control: LL Deflection DOLS: live=100% Snow--115% Roof"-125% Wind=133°/6 :r- Design asslunes a repetitive mom use increase in bending stress: 490 ' + Manufacturers installation gtddB MUST be consulted for mtdti-Ay connection details and alt9ina6ves I la Re.MAY r SIMS I?\ . f"% ear\''✓l if °t /9lpadkrl names nre tradneerf¢olaNrree6wners D.Weboier 'w Copyf(ghtn1N1i-20Xby Keyllatk SAwpdsM LLC.ALL RIGWS RESERVED. H.Block«,MA Ke Marx F.C'fGRPRiSF.S.LLf_ •'Pa�irg isdefircd n wtm rhe menbv.Nor bid,beamorgifdw.sham m fts dawtig rreets mocatie desigt etiteliafinL�,L6afg coe�lb .a1M spare istedan t&sheet 11ee destgl nest be resiewed by a qudaed desigeeror dsige omlas for this assuee5 i113a160on2CC0WWt0ff2MWUftChrerSqwAcatbns. Date.`/. TOWN OF NORTH ANDOVER >mr p PERMIT FORfPL'UMBING ,SSACHUS� X _ This certifies that . . . . . has permission to perform :: ` . . . . . . . . plumbing in the"buildings of . . . at .(w/ .,: . . . -. . . .. . . . ... �'� . . . . . North Andover, Mass. ._: . Fee.("'. . . .Lic. No./.�� . . . . . . �. . PMI 31UG INSPECTOR Check # 8055 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS 7-o9 Date Building Location CWA00 Oi#5 LAwG Owners Name -yA/7'1/? e/2iS'�5N Permit# .0,6QS Amount Gi Type of Occupancy New Renovation ❑ Replacement Plans Submitted Yes ❑ No ❑ FIXTURES W04 U o w z 3 o �D w w aQ z a� >aASK%*Nr -IM 1F'�LOCIR DM 5M HAO 6� ll M�It" M . l_MR 011l 111_M\ (Print or type) Check one: Certificate Installing Company Name 4 e o h o.w+n t iolom6 j r,5 fit- 1447ATi n! ❑ Corp. Address 4-1S T 17.1CnJ- VUO-y Partner. Business Telephone Firm/Co. Name of Licensed Plumber: TAh7CS Cc t,,,e—a'1 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass chusetts State Plumbing Code and Chapter 142 of the General Laws. By: 42=a ure Of icensea rlumoer Type of Plumbing License Title r? �v I City/Town icense INUMDer Master ❑ Journeyman p APPROVED(OFFICE USE ONLY