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Miscellaneous - 72 GREAT POND ROAD 4/30/2018
TWAYN OFNIMM, ANDOVER NORTH ANEWYVER, MASSACHUSETYS 0190 Permit Number Date Issued Expiwion D * �v - - I' eat Jackie sLaw, —Permit Ap I , pli Ion, t- 130 - 12 Pu rsawit to Q.L- � RZA and 520 CMR'7.04 et se .(asameaded) THIS PERMITMUST BE FULLY CMP 1ATED PRIOATO CONSWERA-RUN N of App knmt C 0 rn Mott Celt '4(t"(Addlx-*&s 84 �e-u) Sxd-e-m 61-r�e+ L 17- L-;2- f Fl;-'bO int vp C)/ U0 kNAMe Of ERAMUr (ifdWM-111: fk'GM fiPP6Maid ) Wget NIA I ZIP S!s no 0 UO -W lmf�s) etill twe rtyf) 0 ken haf4- �3 rhoma $4YMA44FM GR4.7 la tiL clo-Afimm MA I zill gil*r coftild Nae, Y -mf Descr�ptbum,,kmtiamamd, perpme or pmpasLA ovuch.- Elam* dewrll* il*aaa btiflum of o1wil trench ,rued"! its p ;v ()W&Ndta destilp(lu of wbal: B4,0r]9 Mudded) to be Isidia propowd uvmcl (�eF pipeshabic Cants c4-c'..1i'Phare use FMTI'c plat if"Platl-1110ml spa tv U w*dedl. "�MoQcJ of 0-- -300j cl C) n -),e , —7 re -f-) C A LL.) -'i I 0--P G iC i YY1 &4e- A, y 7 n d (,b c, c (-/ k1 le d -4r I ) 6urroul-)dInc 6ro-Ae- cyon ccrnpl,e-fion p( �k)-P- q-&�k. r-,emof4 Ell 1 4- 44r '*-2n s c_cra_n cle— Cerr) 6U r• o q-0 e) 5 -7 N`9=C Of COW[WOVI PWAAM (ar.0 40A ", �y "Q0 Ckf'90 021), .9 m*dP*Umw* 14E 16o( Liefti* Grade a/4, C 14• )o,3 By SIGNING THE5 FO'R'Nfi THE APPLI CANtt OWNE% AND EXAVkTOR ALL ACKNOWLEDEM -7 'IMINCT.7tirvir air 771'E, AND CERITFV THAT TI EY ARE FAMILIAR WITH, OR, Rluom wN WORK, WILL BECOME FAMILIAR. NVITII, ALL LAWS. AND RE(A1011ONS APPLICABLE TO `WO;7A'K PAOVOMD, TNCLIMING OSFIA REG ULAT ION& GA- r -.112A, W f NtR U0 0, wq,; AND ANY AIMUCCASU MUNICIPAL, ORDINANCM BY-LAWS ANDRE-CsUI--ATIo4N-$-ND THEY Cox"FNANT AND4CUEE, WAT Alt WOW DONE U-NDER THIE PERm.rr issuED FOR SucH WORK, WILL COMPLY'T"FWWWR WAU RESPECTS AND W THE CAYNDITIONS, SET FORM] BELG%', THE UNDERSIGNED OWNER AUTHORIZU TIfF APPS ICAN'T TO AYPLY FOR 111EPERM371" AND, THE EXCAVATOR TO UNDERTAKE SUCH WORK ON -JV.F, I-1,K(AE1jV OF *IHE OWNER.AND AI -90, POR TIFE DUPLILTION OYCON'tSTRUCTiON, Alb-MORIZES PEWSONS DI)LY TA9 ?tI1i1 IGTPALrn,'T0:ENTE-R UPDN THE PRGPEKTY TO, MACYNTT 11R, AlNO Pvc'r TRZ W10W mi, Post coNroakirry v;,r.m Tim cosiomaNs mnicum iumro AND THE L-1"2 THE UNDER-SlGNE[9APPLI]M-NT, OWNER&ND EXCAVATOR AGREE 40INI'LVAND SEVERALLY TO REIMBURSE `1711E MUNICIPAIATY FOR ANY ANII ALL CO.Ml AND EXPENUSS INCLIMCED, By TR,EM.,tINI,C-IPALrrY!NCaN-.'wECR,ON'WITIITIII,SPIERMIT,ANDT!3'F-,WO "XCON VIJ C-114,10 THCREMTKDEF, INCLUDING BUT NOTLIPTO ENFORCING THE RIF.QVIKEMPATWOF SmAlt%. LAV �01),CWDIUONS OFPERMTr-, fW?b M-7tPIS"S MADE TO ASSURE COI PLIJANCE. 7WRE-WI.Us AND MiiFAS1-fRE:5'TAKEN RV T"A NIAJNIMFALITV To PROT, ECT UtE PUBLIC WHERE THT. APPLICNIST OWNER OR KXCAVALTI)R, HAS FAILED 110 COMPLY THEREWrM INCLUDVING FOLICE, DETAILS AND OTHER REMEDIAL %fPA,;U-kf-'3 DEEMED NECESURY BY THE MUNICIPALITY. THE fJ'1vDLMIGNtDUTL10%NT, OWNT-RAND EXCAVATOR AGREE JOINTLY AND SEN"ERALUV TODInEM'. MEMNIFY, ANLYHOLD HARMUS,4 THE M'UKICTP.&[X-n* kNDALL OFMT ACTNTi, AN0)KM1rW1k%ES M -OM, ANY ANVALL LIASILITI'. CAUSES OR ACIR ON", COST--;�AND TA'.r M— jzs P RESIrUING FROM OR ARISING, 0VT 10f AM! W JURY, RkkTH, 11OS,'%L OR DAMACT TO. AN -Y' PERSON ORPROPRRTN'DLf'RjNG'rFjRWORX Uj4jDrj.R -tilts VEmIlT. APPLICANTYSIGNATUKE so Ago; DATE --L' of L LWAVATOIR SI CNATURE (IY DIFFERENT) OWNLER'S, St (IF,DfFfE,1WN--j) v itfl: a g � DATE Y zll� 'VON Wf-fAA �t, jTf,�- V'. 4 CONDITIONS AND REQUIREMEMS MR -91 AND 5G MR, 7.40 ea ftq, RY jigning the A.PpIkalion, r1t4V under�frmft and Ween to xwipipb� witb ilte; follivxin licant j: 0 13 irc0b may1w cxp:voa up1mt1h for w; pirwngn1j; of ve Oinp�; *(11 thmijgj) ;OD, ofcknrAer . and an 'Y accon*=,img, replatiams; have'hean trzt 2nd thiis. pernnit it, invalid -unk,;u and crilil -.qnh1mqyirevvAds haveWin: ow Red, -milli try than exzavvLw applins OT i EV Y bermitkoctitfilw, PC W n limited w the c-dWkbnwnf of iL -rolid exca.vaddri. number with the ,un&r&rpan,4,VIan4 damage provent*m 9m, liw, said ,sysimm is defined ihswbom 76D afcbaplxr I M (DIG S.kl?E; 4 � 1. Trenches, mmy pom. a 3W&Bmt bWth, ar.4 sakaq hawd. Pursuaru to Secthn t of Chap Va, ad &e General , Laws, an excavMar ALM nol {ea- A iiny c9cm, trench. Lmaiendedwithw Ciro making vary nM 'Y ftt0g=Xd kmard that may exist as a wult of leaving said opem Irand Unfillenddl- S.Uava1cV9 shmidl moult ftgubtl� pramulpwd ky I!* Impa=eM, of, PlIM, S'day iufi ortlerw fiats it F1t f alit Ul. re mi sdety b&=Asz!ks6cialed,,mith, e =avhliem 9md Vw wmcbc� an d. 1b.0poed wts ft V-irtd 41 r retv, awbebiled by sM d depwrnerd, im orke 16,Mh-e nrmy teasiAleble eficift.0 ellminate uld 6amy FAMAS, ttfiinlh mHy L-winde try -Bring, barric-WrY4 or aftmuc ptowc*l opm,vendhcafiwLwcA&-a&,AimLrX� ift,m In my Injudlinp. qcN*j11 MAI VNAh ibc kdVaril wkv, sladards rmAcmd by dic Omwffliowd Sd, and HeWth AdniffiWraian on c%:wvmiciw 21,1 alk 1926 et-omm, allwtw subpPoP -T-'xgrmplioffl-� FX,el f-6-2 t srAjccf w, i;bWj:r 146 Anil ootw mp1gyWiv1dw-d.s 11cm-W44-Y qpvatc Shld quiptaw by dr. r)e ��ofpuhspweiyptlr-;ulinttri qiidi:hap.terA 111,is'pe a d rm� lillw". lix, o-pea-RxT e any excavalion is comerwedy twir By nppj3jpg,jbr, aaM1l'pS rand jigij)fnZ tWpvnali; the ripp, limit Wi c4, act as to 411* lblk.w1alp, 411) Ihm (b -q I W* renal: and, und4r.-EW4, dr, mpWkans pffq=lzatcd by (hc Dqpartment ofPubbcSiikPy wi& reprd.un o>nsoxtion related excavatiam and mnjdh safety; (2) That be bio re4d rind w)&,mmsit, the excwm&mz:29 CMR 1.9%,650, eueq- en tidel Smbpwt P SxawzticAis- as: YwQ ts.uffy tuffier cipaw4iry - ; nn4,, (3) that b,- -a *,4 -Atlh npfx, h45 , regard to the pmpcsed b-tnrh exu%ation on,p&,Wr poaperty or proposed exermwflon nf ri cW oi Mwn pull ir-mmy that, finns the, bisis ofthe pertait *plicalirxn, camplW wilh the requEn:fftents of seclibns. 40. 40D This peand Miall be,p9ed iia *bA*w sileotdr. iraxhi. FM amitiomd 41hr5rALivit give, viat 6t:Depw1awt%,0(pUW- saky"s "Y'assite 21 3 1 P ugo, b --4 he DEPARTMENT OF PUBLIC SAFETY Hoisting Engineer License Number: HE 100698 Expires: 04/06/2013 Tr. no: '18,117 Restricted: 2AAC KEVIN M HOAG 84 NEW SALEM ST WAKEFIELD, MA 01880 Commissioner r k*. RCERTIFICATE F LIABILITY INSURANCE 1 THM 10ERTf CATI E It USUED AS A. MALTTER OF i11f+EJfr11i MONI ONLY AND CONFER2 NO IfiMN—T$. UPN THF- CERTIFMATE, H ERB. THM CERTIFMTTE DOEB. NOT AFFMATIVIELY OR NEGATIVELY AMEND, , IEXTEI'I D Dt .AYL fER THE CCRfERAME AFFORDED BY THE POLXMI 'BELt7W. TM CERTIFICATE OF INIURANCE DOEI 140TCONSM, UTE A CGHTRACT BETWEEII THE MBU4ING INBURERIth, AUTHGRIZY RE ENTATME;Oft IPA OUCER.-AN9D THE CEFMFLCATE HOLDEFL IMPORTYUttT:: tf that awtM3do Iualder 1& an ADDITIONAL :INBRED, the puff.w1owl must The dmdwx*! . Qf -BUEMOATION It fi4faAttVED sdWedt to tads turfing'and tend ttom of the pdituLBoa bdn pailaWs array T aquin= an wftnafmck A debit w tft coMftaIs dares no awftr r gift to the car ttloata bauff to aeu ar'-sue amdolswuNdW awTeurNUuWsurr iVWAai:p ytu: IGR 1 NUTW IK$1:7.Dt 1PU31ttiez IIhsuman e i �$' 'IvTapwn-wsa 3 L1F7YT1lli�ll RaCLL Drive �V+";r p '' 6 'l xzP*IIic%dIItM*r. I i IetMni irde: Ap M :xai'A eY,IPar l 4 aommit,2vdnstcm TnSS�TJTRW Ccmwamy Peabody .ice. 0,19rr0 nMam m ;a thartex, Oak Fire 'Tra¢avr ante Co -256,15 mmmeliaberty Hwtual Inz.Co. Sao Cam `dank, .Inc. mzezgmcy IKovixammtai Rentai$., lue. atae ;o INUAtrix Imsur nce 84 new Salem St.. ad�atee F 'Wakefield MA 018801 U rsa771 0 IC 11 ,.j UY Ef ad ,-sir gay : r -b-i a a KH— 1* 1,000, E A4 I Gmt—r=t5ztUMaIc m* Oak , f agou aaACK-Owd192n 41,000, IM V=fj 2 1 L*sbIILty* ft(id ML&ppc ;$$,.4Np0,0" LI= N#71�eFdi 730Fiali,�i7:dtAtpidhdY�.'Li� - �ef+i,rYsiec$asdu�gi®a�:Rp»i�N ;$10,000 Sade Pmllsati.gdd CoaftItUwp >f"MIM&I Liabdut7, :64ah12al6 is 4$0,�0 za&h c, zeviaa.ta] pa rr` .zr l yr -maims r POWUMT 1TPMi 601 Eft: L0128/12-10128/121 $L,000,000 BadIly Zft2UW . PMaparty Via414000,000 tMAkta : ita, - RW PaIlUtigM, CandIt-LOM $1,600,.040' s to c. Bl*V PO$$ut za C adLtIcf Deftatible, 410,0M Radh VonUltiM To4mof North Andbwer 3134 Osgood Street North Andover, M 01845 aad•-s s �a , B$dtxa" AdI — Mcit.- --� -sem eii�af#'Yx'i'a i1Ws; (Hi Thu af Aflf =n p0my LM awTeurNUuWsurr iVWAai:p ytu: IGR 1 NUTW ' 'O11 . �2��" M M :xai'A eY,IPar l 4 aiMaptretlua�f'{P. p '¢ i. A� milli i U" sera un _ CMA d-iceitt"Aftipf2fitaoil k'A04 JL'6 6 evo minas dgEliMnGftst MicMsM' VIN wr PNC M Cti.iMll�Tt+w ®JI'f�t , . ... Vow- �diYS dTE� NNW ZIM . f+iTJ>L �'' �,$11i32 X. gGLHxmlg�rd Gsadr a 1,001)"3100 _ -Ei� C6a+.iO R 1-000 A4 I Gmt—r=t5ztUMaIc m* Oak , f agou aaACK-Owd192n 41,000, IM V=fj 2 1 L*sbIILty* ft(id ML&ppc ;$$,.4Np0,0" LI= N#71�eFdi 730Fiali,�i7:dtAtpidhdY�.'Li� - �ef+i,rYsiec$asdu�gi®a�:Rp»i�N ;$10,000 Sade Pmllsati.gdd CoaftItUwp >f"MIM&I Liabdut7, :64ah12al6 is 4$0,�0 za&h c, zeviaa.ta] pa rr` .zr l yr -maims r POWUMT 1TPMi 601 Eft: L0128/12-10128/121 $L,000,000 BadIly Zft2UW . PMaparty Via414000,000 tMAkta : ita, - RW PaIlUtigM, CandIt-LOM $1,600,.040' s to c. Bl*V PO$$ut za C adLtIcf Deftatible, 410,0M Radh VonUltiM To4mof North Andbwer 3134 Osgood Street North Andover, M 01845 aad•-s s �a , B$dtxa" AdI — Mcit.- --� -sem eii�af#'Yx'i'a i1Ws; (Hi Thu af Aflf =n TEL: PROJECT MANAGER: 0 Fil Date.............I.% ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that....—I ........................................................................................................................ has permission to perform .... 4..JA.(2 wiring in the building of ...... .... ................................................... 2 0 at Q ..... ....................................................................................... North Andover, Mass. Fee,............ ; ................ Lic. No. �Zl........ ................ ELECTRICAL INSP OR Checko �q5 14 9 5 (DCS - 13 Commonwealth) of Massachusetts Department ®f Dire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1106 Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: Y/3//3 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to erform the electrical work described below. Location (Street & Number) 7/— terra t- Iy�� /e, Owner or Tenant 7E��t2l�Ar��' Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes V No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 'Z a0 Amps Ze, -1a Volts Overhead ❑ Undgrd No. of Meters New Service 0M Amps 120 Z yi� Volts Overhead ❑ Undgrd No. of Meters -4- Number of Feeders and Ampacity / /,�L Location and Nature of Proposed Electrical Work: l rfIQf Gur P6!/f/�t; il/t��I e- �'e- Y j Completion of the following table may be waived by the In ector of Wires. No. of Recessed Luminaires70 No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires /0 Swimming Pool Above ElIn- El rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets 10 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches a No. of Gas Burgers No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Z Tons No. of Alerting Devices Disposers IVo. of Waste Dis p % Heat Pump Totals: Number I' ' - Tons KW .......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection No. of Dryers y 1 Gas Heating Appliances KW Security Systems:' No. of Devices or Equivalent No. of Water / 6.4y KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail ifdesired, oras required by the Inspector oi nares. Estimated Value of Electrical Work: Z d),O 06 (When required by municipal policy.) Work to Start: V M / Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the ams a d enalties ofperju�ry-,� that the information on this application is true and complete. FIRM NAME:. �Gt Gil /d kl-e /0v!"alt Glee_ LIC. NO.: /ZG7,W Licensee: D of l Axn,,°S Signature fif applicable, ent "exempt" in the license number line.) Bus. Tel. No.: 71I��' Sl /'8S6S Address: /, e,2, �/ 5t/�Y� �G�Alt. Tel. No.:ZL - 3Z 5332 *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 ARMIT FEE. $ 3__ Signature Telephone No. --7;:Io ArJ cln*a-) 3 fin. ejet.Q- ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the i 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 R — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M V Failed Re- Inspection Required ($.) ❑ Inspectors omm nts: . Inspectors Signature: 14 PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: FINAL INSPEC Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 12 ZC Dr/r, Z Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidints 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): Alli l ' ^0—, 4ojj Address: / 12 4!!� t'nlY,01 City/State/Zip: ,5,0'W S //) Phone #: �71 521 X.5 t % Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction _ e�oyees (full and/or part-time).* have hired the sub -contractors listed the attached sheet. ❑Remodeling 2. I am a sole proprietor or partner- I ship and'have no employees on 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 10. Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks 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 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 un=.de�r�t to pains and penalties of perjury that the information provided above is true and correct. Sip- �G`"'71� //%' — Date: �'// /�� Phone #: ZYl -5-2/ 5 65_ 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 „, t 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 -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 l dustrial .Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, # 617-727-4900 eyt 406 or 1-877,7MASSAFE Revised 5-26-05 Fax # 617-727-7749 www mass.goV/dia This certifies that has permission to perform .. ,,` I . . . . . . . . .... . . .. . plumbing in the buildings of. . 641cQ .. . . . . . . . . . . . .... . . at ... �'?. �/�,�� , North Andover, Mass. L Fee . 2� 6Q'- . Lic. No. Az.m .. f, ................... ... PLUMBING INSPECTOR Check # pe i� rn'� U ou - � -77 UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY � Q_ _ , MA DATEf - / _aQ (I PERMIT # _C1% I I JOBSITE ADDRESS % _ OWNER'S NAME 5) 547 POWNER ADDRESS _ TELE_ _ _]FAX TYPE OR PRINT CLEARLY OCCUPANCY TYPE COMMERCIAL � EDUCATIONAL NEW: pl RENOVATION: a REPLACEMENT:E11 FIXTURES 1 FLOOR- BSM BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _ FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK _ LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ! (— RESIDENTIAL 0' PLANS SUBMITTED: YES a -NOD M0®®w 17771177771IL"7_1117- 111.773--_ �= INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO ©1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW T LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITYE11 BOND Q to 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER _i AGENT 0 E 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 wit Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C PLUMBER'S NAME LICENSE # /.� SIGNATURE MP p' JP D CORPORATION 11 # PARTNERSHIP#� LLC S COMPANY NAMEIt /72ey� r� ADDRESS /Q �� _ _ E CITY uG f O°v STATE I N17" ZIP Q �p� / — - TEL 5 FAX CELL EMAIL F 1 The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations kvi 600 Washington Street Boston, MA. 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organization/Individual): Address:rLt�! ��— City/State/Zip: uC&nyPhone #: 979^ 6 6 6 - bl� 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).* have hired the sub -contractors 2. ® I am a sole proprietor or partner- listed on the attached sheet. 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 have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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 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. Ido hereby ce` rtt ,under th�e(ppaaimoi)®ns and penalt i/ee of perjury that the information provided above is true and cor�Crject L/ r / �� /J Phone #: f z? - 606 LCIP? 2 Official use only. Do not write in this area, to be completed by city or town official. City or Town: PermitUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An 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 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, # 617-7274900 at 406 or 1-877:N1ASSAFB Revised 5-26-05 Fax /# 617-727-7749 www.nlass,gov/dia. N U S313 se POIsOd 'o u0sJod �tej �q Pall �,,,e 01 P9u6tss'e 'o u,)slad )81-ilO Papuawu Gla dWA ,U()sjgd -e S� it A U. asugo!l SILA, q6@jjt\ud I Oqjqn, st 8su@oll S!La Ino ou JsnLu Pull Pau -Bol aq I suoist,\ojd aLkl 01 U�jj�eolIddld U99 aw �o skepAN 109J300 10 e 7P3lsO'J sms-1 1,818 jno� ()I lei le lackUlnu asuao!I adold ainsul. 01 SSOIPP 10 OLUeu Jno� 11 �woul S, umoks ssaipple . 10 aws JAOU 10 6U' fqllou so `04L pleoq luol, 0 UOISJAIG -Oovg,e��ZOVV4 OlOJCj 4 lainsueon vauoiss SNI 11 -IS U04"'Vem ()Oo 'Poollsop 10 Isol 'o , 09 jno� Allioll Oql ve P, lodv4l #'1O1 Lt400 a m This certifies that has permission for gas installation �,,,� . �I-W- f .. , , .. , .. , , . in the b—u�ildings off ... "a. �� . P.._:&-� . . . . . .......... . at ..... I.2— - -9C- App , J.. e j, , , North Andover, Mass. Fee .1 — Lic. No.. ! 3Z. 4. 'Mb ................... ... Check # i4� I Pe8641 V2 on V lnou— 13 GASINSPECTOR •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 CITY 8 — _ N C1 �e�L I MA DATE PERMIT # I JOBSITE ADDRESS _ 2e Gl OWNER'S NAME^ GOWNER ADDRESS _ - - - .- _ _ _ TEL�^ _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ©--I EDUCATIONAL ®I RESIDENTIAL ({— PRINT CLEARLY NEW:E] RENOVATION: [ REPLACEMENT: ® PLANS SUBMITTED: YES B--No E] APPLIANCES 7 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACEs 1 L—� I L_I - . - - [ ---- - - �- GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT�- OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER — UNVENTED ROOM HEATER l _. WATER HEATER _ J INSURANCE COVERAGE 774- --1 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES []NO �! BOX BELOW 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE LIABILITY INSURANCE POLICY- OTHER TYPE INDEMNITY BOND 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 © AGENT SIGNATURE OF OWNER OR AGENT 1 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 :Hent provisi n of the � Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ...may_' _--_ LICENSE # %� _ SIGNATURE 1 MP MMGF E-11 JP J JGF [_I LPGI __i CORPORATION []# = PARTNERSHIP[ #� LLC [ # COMPANY NAME: ADDRESS CITY STATE � ZIP _7�� TEL �� ' FAX CELL EMAIL t'n\\y rA H O z 0 U a w d j o oz � W r Ln ~ w ly E* a z U w 3 a � M w `" a Oco w � w N a o a a a Ln U J E, a CL a 60> N di FE w I-- LL V] W F °z o � � H U W a C�7 c7 `i Ar `4 The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): z Address: See eG«� e, City/State/Zip:,����(r� ���� 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).* have hired the sub -contractors 2.04 am a sole proprietor or partner- listed on the attached sheet. 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.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill 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. lam an employer that is providing workers' compensation insurance for my employees. Below is thepoldcy and job site information. Insurance Company 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,paiyrts and penalties ofperjury that the information provided above is true and correct. r MAIRWIMM Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License _/_ 11) Q / 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 employeils 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 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. # 617-7274900 ext 406 or 1-8777M.ASS.A.FE Revised 5-26-05 Fax # 617-727-7749 v ww.mass.gov1dia I U I K HUDSONr '�77 ... .... .... . Nif3 je7 0 7r -rROL #ooR4 our .N TAN'T "01" e Sat th' - Im 1,6c ,- Cl notify ,,",ington t e ('r destroyed, Li1000 censure, of Pro 021,8-rmoo. -lor' MA, OWS your board 7io, Boston' suite hono is changed, Wily . of next er mailing e or address s Sur se number. If Our namaddress 10 insure prop roe or refer to Your license I Laws correct na n Always I the General iof Renewal App )ns 0 t not be loaned ene the prov's" and MUS R ject to sub' vilege, on Your lj� his license i (tris j�cense is . personal Pr' Keep ded it is a as amen y other person, ned to an Lived by lavl- Or assig V,. ted as req 'Son or POS pe Boise Cascade Double 1-3/4" x 11-7/8" VERSA -LAM® 2.0 3100 SP DesignsT1301 10-00-00 BO B1 Total of Horizontal Design Spans = 10-00-00 Reaction Summary (Down / Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO 2,475/0 1,334/0 2,475/0 131 2,475/0 1,334/0 2,475/0 Live Dead Snow Wind Roof Live OCs Load Summary Tag Description Dry 11 span I No cantilevers 10/12 slope Friday, March 29, 2013 BC CALC® Design Report - US 09-00-00 OCS Build 2258 File Name: BC CALC Project Job Name: B.urka:rdt Description: Designs\FB01 Address: 72 Great Pond Road Specifier: City, State, Zip: North Andover, MA Designer: Gregory R Doyle Customer: Bob LeFleur Company: Doyle Lumber Co, Inc Code reports: ESR -1040 Misc: 10-00-00 BO B1 Total of Horizontal Design Spans = 10-00-00 Reaction Summary (Down / Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO 2,475/0 1,334/0 2,475/0 131 2,475/0 1,334/0 2,475/0 Live Dead Snow Wind Roof Live OCs Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% Pos. Moment 1 Standard Load Unf. Area (Ib/ft^2) L 00-00-00 10-00-00 30 10 09-00-00 2 Unf. Area (Ib/ft^2) L 00-00-00 10-00-00 30 10 07-06-00 3 Unf. Area (Ib/ft"2) L 00-00-00 10-00-00 10 55 07-00-00 4 Unf. Area (Ib/ft"2) L 00-00-00 10-00-00 10 55 02-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 12,615 ft -lbs 51.6% 115% 3 05-00-00 End Shear 3,974 lbs 43.8% 115% 3 01-00-12 Total Load Defl. 0516 (0.232") 46.5% n/a 3 05-00-00 Live Load Defl. 0702 (0.171 ") 51.3% n/a 6 05-00-00 Max Defl. 0.232" 23.2% n/a 3 05-00-00 Span / Depth 10.1 n/a n/a 0 00-00-00 Design meets Code minimum (0240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1 ") Maximum total load deflection criteria. Minimum bearing length for BO is 1-15/16". Minimum bearing length for B1 is 1-15/16". Entered/Displayed Horizontal Span Length(s) = Clear Span + 1/2 min. end bearing + 1/2 intermediate bearing Calculations assume member is fully laterally braced. Design based on Dry Service Condition. Page 1 of 2 Disclosure Completeness and accuracy of input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call (800)232-0788 before installation. BC CALC®, BC FRAMER®, AJST-' ALLJOISTO , BC RIM BOARD TM, BCI®, BOISE GLULAMT-, SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUD® are trademarks of Boise Cascade Wood Products L.L.C. ®Boise Cascade Double 1-314" x 11-718" VERSA -LAM® 2.0 3100 SP DesignsT1301 Dry 11 span I No cantilevers 10/12 slope Friday, March 29, 2013 BC CALC® Design Report - US 09-00-00 CICS Build 2258 File Name: BC CALC Project Job Name: Burkardt Description: Designs\FB01 Address: 72 Great Pond Road Specifier: City State, Zip: North Andover, MA Designer: Gregory R Doyle Customer: Bob LeFleur Company: Doyle Lumber Co, Inc Code reports: ESR -1040 Misc: Connection Diagram Disclosure ►I b —d --i Completeness and accuracy of input must i be verified by anyone who would rely on a output as evidence of suitability for particular application. Output here based c on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood • • products must be in accordance with UL current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" c = 7-7/8" or ask questions, please call (800)232-0788 before installation. b minimum = 3" d = 24" Member has no side loads. Connectors are: 16d Sinker Nails Page 2 of 2 BC CALC®, BC FRAMER®, AJSTM, ALLJOIST@ , BC RIM BOARDTm, BCI®, BOISE GLULAMTM, SIMPLE FRAMING SYSTEM@ , VERSA -LAMS, VERSA -RIM PLUS@, VERSA -RIM@, VERSA -STRAND@, VERSA -STUD@ are trademarks of Boise Cascade Wood Products L.L.C. .:6' ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA -LAM® 2.0 3100 SP DesignsT1302 Dry 11 span I No cantilevers 10/12 slope Friday, March 29, 2013 BC CALC® Design Report - US 07-02-00 OCS Build 2258 File Name: BC CALC Project Job Name: Burkardt Description: Designs\FB02 Address: 72 Great Pond Road Specifier: City, State, Zip: North Andover, MA Designer: Gregory R Doyle Customer: Bob LeFleur Company: Doyle Lumber Co, Inc. Code reports: ESR -1040 Misc: Connection Diagram Disclosure b d Completeness and accuracy of input must L be verified by anyone who would rely on a I output as evidence of suitability for T' • particular application. Output here based on building code -accepted design c properties and analysis methods. Installation of BOISE engineered wood .1 • products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call a minimum = 2" c = 5-1/2" (800)232-0788 before installation. b minimum = 3" d = 24" Member has no side loads. Connectors are: 16d Sinker Nails Page 2 of 2 BC CALC®, BC FRAMER®, AJSTDd, ALLJOISTS , BC RIM BOARD T-, BCI®, BOISE GLULAM—, SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUD® are trademarks of Boise Cascade Wood Products L.L.C. 1191 DateY. .1— ....... TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION P s i � • This certifies thaT..q.t:4 j ! ......... • .. • ... . has permission for mechanical installation o?..in the buildings of ..�� ..� � � 4?• • • • • • ...... • • • at �r a.. A �` .`+Pr ^d • • • • • • • • • , North Andover, Mass. Fee. ... Lic. No..4Z)/,.��.•,j. .......... .......... Q11 GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer L Commonwealth of Massachusetts Sheet Metal Permit Date : 4 0 13 Estimated Job Cost: Plans Submitted: YES NO Business License # 31 3 D Business Information: Name:�'oY>el�,►tY16 Q Arlt Street: -4 I -Jeoj') 0, V e City/Town: L D vi Z l l Ke O L 85 Z Telephone: G--$ �a 6 5a 34 Photo I.D. required / Copy of Photo I.D. attached: Building Type: Permit # t 1 1 Permit Fee: $ Plans Reviewed: YES NO Applicant License # 4 0 3 to Property Owner / Job Location Information: Name: ZD 6-evi � x (I-eLpIr Street: � Z (iryai 'Pooh 'ej - City/Town: tJ py_ \ A n J oy e Ir Telephone: ")4� YES / NO Residential: 1-2 family / Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. ✓ over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: n s k all Q Fvr N,aCc s' C-0 I' 1 cLn c-0 ri e sers 'FV Y' CAN 4 a 000 Q)TU Its, /o � ctS r2c� 1 -A -2—to r -j cv r 5 u—" %ACL L v G't S GtY� e t n � 5 . INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: 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 112 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 Owner's Agent By checking this boxEl, 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 sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date Progress Inspections Comments Final Inspection Inspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at www.mass.gov/dpi a Type of License: By ❑ Master Title ❑ Master -Restricted City/Town ❑Journeyperson Permit # ❑Journeyperson-Restricted Fee $ ❑ Inspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at www.mass.gov/dpi a Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper c1611'ances, fire rated enclosures and pressure testing required: Sri i:ri: res`kaints stal10A ��h&, required oft egtiipment and d�u,.tti. 3, m _ — Duct penetrations in fue'rate wall:, and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nuns installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) R • ( i Page 1 Residential: Heat -Loss and:Heat. Gai Calculation 3/31/2013 In accor dance with ACCA Manual J Report Prepared By: ;,toneff I`leetinq & Air Conditlonino 71 jean ave Lowell, Ma 01852 978) 996 5934 MA Master S.M. LIC #4036 For: Bob LaFlea!_r 72�Great -Pond°Rd North Andover; Massachusetts Design Conditions: North Andover indoor: Outdoor: Summer temperature: 70 Summer temperature: 88 Winter temperature: 75 Winter temperature: 0 Relative humidity: 55 Summer gr sins of moisture 100 Dail temperature ran e.:Medium Daily p 9 Tsui ding Component bens ole Latent IOUR Jotai Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH). Floors 0 0 0 30,944 Infiltration 2,968 4,077 7,045 21,639 V 11 mow YYJ -1,vLi VIZ!n Wails 2,843 0 2,843 9,873 Ceilings 4,296 0 4,296 9,476 Duct 0 0 0 4,436 D�oars1;040 0 1,040 3,6 10 <Yl!!Fi`ia-STL" ] 1 i t� rj Giassdoors u u u u Mise 0 0 0 0 Fireplaces 0 0 0 0 People 0 0 0 0 Whole House 22;968 4,077 27,045 93,136 ( 2.5 tons ) HVAO=Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates on!y, actual loads may a y due to weather and construction. differences. f Page 1 Residential Heat Loss and Heat Gain Calculation 3/31/2013 In accordance with ACCA Manual J Report Prepared By: Jone!! Heetinq & Air Conditioninc 71 jean ave Lowell, Ma 01852 978) 999 5934 MA Master B.M. LIC #4036 For: IBob LaF!,--a Hr 72 Great Pond Rd North Andover, Massachusetts Total CFM: 800 Roves Ceolina CFM Heatin€t C=" Both Fir 4 Floor 1 f fC1=FA• 7ON0' 1 11 SL 1 IVV/ L.elt U/ IVI. I VV - _-._-...___.________.__-____ Master Bedroom -- --- ---------......--- -- ---- -_...._ 238 ..._ 190 ------- _--------- _ 238 -... Master Bathroom -- ..------- --- -------- _....__ 38 ---....... _................ .- 35 --__.................. .. 38 Office - - - _._.... _._....- -------- _... --- ----------.__.. 54 82 82 Bathroom 2 -- -- ..__. - -- - . 39 - - - 36 ......- 39 Bedroom .3 42 F-11 rj3 master bedroom hall -- 30 ---._._.......... ........... -- 28 30 ✓•i•c - 24 18 24 . _....- - - . - _... .._. - -- - Laundry -- - ....... ...... _- -_--- - ---- -- -- . --- --- _...__ 2 --------- ...- _-------- ----------- 5 ---- - --- . _.__......._ 5 Hall - -- -------- - - -.._ --- 9 - 22 --- .. 22 guest bathroom - ._.. - -- -- ._..-- ---- 5 12 12 library - - _..-- -- 152 - - - - - ------ __.. 126 152 Entry Foyer - - ._ ---- - -.. - 67 94 94 First Floor right CFM: 700 _... - ------ -- -.. - ---- ...----------- -- -------- _--- _-- - - - - -- - -.................... Guest Bedroom .. -- .,_..._ . -- __.._-. 49 __ ._.. ------ . 63 -- - - - _... 63 . - - Guest Bathroom 22 25 25 Mud Room ---... - - - - - -- -- - --- -. ._....-. 47 76 76 Kitchen __.._... ---- ----------------- __. 141 -- 122 141 'Living Room --- -- --- ------ ----------- - 227 -- ---- ------ 215 227 1 Page 2 Total CFM: 840 Room Den Dining Room Bob LaFleaur 3/31/2013 Coolina CFM I'eatinca CFM Both 136 75 136 78 124 124 HVAC -Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calcu!atlons are estimates only, ac*_a! !pads may vary due to .weather and const u&i.on d!Ferences. Pane 1 Residential Heat Loss and Heat Gain Calculation 3/31/2013 In accordance with ACCA Manual J Report Prepared By: Jonelllleatina & Air Conditioning 71 jean ave Lowell, Ma 01852 978) 996"5934 MA Master S.M. LIC #4036 for: Boh I a -Fl- iaur 72 Great Pond Rd North Andover, Massachusetts Design conditions: North Andover inaoor: Outdoon Summer temperature: 70 Summer temperature: 88 Winter temperature: l5 Winter temperature-. 0 Relative humidity: 55 Summer Grains of moisture: 100 Daily temperature range: Medium Bunding Component Sensidie Latent I otai Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Whole House 22,388 4,€377 27,045 93,1138 ( 2.5 tons ) s -Si „3 s fV .t eft 1' J.S __— :l :s .5 _ _ ssFc. 0 _ ,- _ .Ti_9} ± F, _ Master Bedroom ----.._ 4,•i53 _ . -- -'- . _ _ 754 4,907 -i 3,751 Master Bathroom - -- -.. - - ... 657 - 105 762 - -- - 2,665 Office 935 307 1,242 5,919 - Bathroom 2 __.._.._ _._._._.. _._._ . 682 105 787 2,631 Bedroolm 3 '------ _ _ .._..._._ ---- -__-- 73° ..._ ..--_---...-.....- - --------------._ .. ----.--- _ 1 U5 843 _- -- 3,c"•1 v I I IdSICI JCdr7V11 1 IQII -------------- JJL ..--.._.. _._----- -1 V:! .____-...- . Vol ......... ..........--- G, V ! .'7 %k( i.c 425 61 486 1,321 _.---- ............ --------- Laundry -- _.-_._. - --__-. - -- --- - - -- - - - -- 36 - - --- -'-- 0 - - -- --. - 36 -------- - - 349 Page 2 Bob LaFleaur 3/31/2013 Building Component 3ensbble Latent Total Total Gain Gain Heat Gain heat Loss :BTDH (BTUH) -BTUH) (BTUH) Hall 160 0 160 1,578 guest bathroom _.... ............ - 86 - 0 86 852 library -- -- -- - -- ------------ 2,661 412 3,073 9,165 .Entry Foyer 1,167 509 1, 676 6,806 :First Floor right ____— - -- - - 10;738 --- 1,614 12,352 42;368 Guest Bedroom --------- - -- ._ - -..._ _.._..- -- -.. - — -- -- - 751 -- - --- - ---- ---._.-._. _. .---- 105 ------ - .._._.._. - --- ... 856 ------ - - _. _ _._...---- ---- . 3,803 Guest Bathroom ---------------. ---- 340 53 393 -- _.__._.. 1,511 Mud Room _ __._-------------------- ---- —---------------------------- - - -- ----- ------ - 723 _ - 158 --- -- ---. - 881 -- - --- 4,591 Kitchen --------- ------------- 2;160 __... _ -- - _-__-- 175 - - --------------- 2,335 _.__ - ---- 7,384 ._....... - .... Living Room 3,476 -- 465 - . _.._._...... 3,94-1 ..- --- _ 13,031 Den -- ------ - -- - ----- ..__._._.- -- 2,085 228 _.... 2,313 _ .------- 4,530 Dining Room -- ----------- ---- ---- 1,203 _ ----- ---__- 430 ----------- 1,633 7,518 Whole House 22,968 4,077 27,045 93,136 a n P tis � c HVAC -Calc Residential 4.0 by H%JAC Computer Systems Ltd. -1101 Load calculations are estimate: only, actual loads may var, due to weather and construction differences. PROPOSAL ` S A1zPAq � 1 1CGr1 C1�I �1 t.� 3 tom.. L.vvJ�11 i°'tct E. Ib52- i� h ten, N` r=i -4 ,, ct ei 6 S q -�, 4 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME - ty} r ADDRESS -4 L' \/i rye, I '�!' L)Cxr �,y c c� iY� ct C 1 PHONE NO. 2C' ,3U� ADDRESS '4L i`scu') i}t�sau t4L r i V1 Qrac:}cv�r DATE OF PLANS 2 f 1L> i3 ARCHITECT DATE "/Z ! 13 We hereby propose to furnish the materials and perform the labor necessary for the completion of % n 1 ct I �c, I,� � e otv- c, i Il-, 'r- k-� c t r 1 r. L u v U 1')'T u' �` u f C r>r r' �- V Cl C' L r c, i Q a �. + L L--1#- EJ r 1'1 Cc: 2 2 -rte cnDit;er 'T u N C.a 4-1 T) e., r +�. t e7 tZ ` u Q. , n r5 c,t r e+-q(Li n%'r icc-4vit,-- t3#"�,c a E h�ruo4cici n0 1 CTre ri-A I,r,r•1UA Cl. A 11+ lt( G 5 i G +'-�EY` G't1 (F 1 r' kerrr454G`s Ga ?u V, iYl Uci , J All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of E. r � c? e r, AE>i1Urr_1 CA - k a '1i Dollars ($ t 5. UOv= ) with payments to be made as follows. n -+e S 5 . cwc�, fJc, p.c h F k,- 5'i ct j rrw o A ,� �� u fv S° s'lc�r4 v }? 3 P A �, �, �' r� n u P Of,ev Respectfully submitted } { Any alteration or deviation from above specifications involving extra costs ! will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- / cidents, or delays beyond our control. r Note —This proposal may be withdrawn by us if not accepted within 3t'days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date Signature Signature a.w— NC 3818-50 PROPOSAL AcoRV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDYYYY) 3/29/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PROWLER Michael G Conway Insurance Agy PO Box 1744 77 East Merrimack Street CONTANAME: SONA SAY PHONE FAX (978) 454-5054 A/ No: (978) 453-2480 E-MAIL ADDRESS: SONA@CONWAYINSURANCE . COM NN264409 Lowell, MA 01853__ INSURE S AFFORDING COVERAGE NAIC # INSURER A: NAUTILUS INS CO INSURED INSURER B:QUINCY MUTUAL FIRE INS CO Jose Alzate INSURER C DBA Jonell Heating & Air Condi INSURER D: 71 Jean Ave Lowell, MA 01852 INSURER E INSURER F COVERAGES CFRTIFICATF NIIMRFR- RFVISInN NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AML INSR SUBRPOLICY WVD POLICY NUMBER EFF MM/DD/Y POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY }{ COMMERCIAL GENE RAL LIABILITY CLAIMS -MADE NN264409 8/13/12 8/13/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES a 0.ence $ 100 000 MED EXP (Anyone person) $ rj 000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER POLICY 7 PRO- RO LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO ALL O WNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS AFV205966 6/25/12 6/25/13 I EOMBcderft) SINGLE LIMIT ac $ BODILY INJURY (Per person) $ 100,000 BODILY INJURY (Per accident) $ 300,000 Pe'acE,atlenIDAMAGE $ 100,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) Ues, describe under SCRIPTIO N OF OPE RATIONS below N / A WC STATU- OTH- RY t IMIIS E.L. EACH ACGDENi $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICYLIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Renerks Schedule, if more space is re qui red) HVAC VCK IIrII.AI t HULUtK CANCELLATION TOWN OF NORTH ANDOVER 1600 OSGOOD ST N ANDOVER, MA 01845 I ACORD 25 (2010/05) The AC ORD name and logo al Phone: Fax: E -Mail: SD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HE PIRATION DATE THeRkOF, NOTICE WILL BE DELIVERED IN ACCO DANCE WITH THE P LILY IROVISIONS. 77HOED REPRESENTATIVE l © 1988-2010 ORD RPORATION. II rights reserved. registered marks of ACQA 11 gni I QiwE . U -M ca -4 - RIM Z Ol rr m m rrs :j L m ml 03 11 gni I QiwE . U -M ca 11 d m W ly (q 7 l�. 2 Q 2� o F' � V V) Q L' z C� 03 4- w r Z s� V x (L o 0 q � 0 l� 0 O ; tD cj - 11- w 00 ul Q sy Q. :3 o (a (L CP %0 N Q ` 0 22 00 ,� r cl � ed Q 04 0 A Legation 7.3 No. Date r TOWN OF NORTH ANDOVER F ; p Certificate of Occupancy $ * ` )j i n Frame Permit Fee $ 'li �•Ow+ne r�. ,SSACNUSEt� Foundation, POO(?"'? $ Ot3F(V,T6, Sewer Conneccn Fee $ Water Connection Fee p TOTAL Building Inspector Div. Public Works W Q a Y 0 0 m W q F IL a W N N N a t Q e, 8LW W Z IO Z 0 p N S m W LL 0 0 0 m y Z W N 1 O , i o IN I' Z AR, M"'� N N Z sJ M \ 0 z I Z 0 H z zz U O O It o J m u 4� W o Ix N Z w O D I H I W p to N j F u ~ z 1 i J 0 m NN W N O m 0 i 0 N F a u Z 0 W W F 1 p m N 0 J J N 0 J J I f i 1 Fx 0 m W ( 0 LL N W u 0 p F 4 0 N d d LL O LL O z r O 0 LL O tL < J O Z x 0 C J N < i w N < m 1 1 N y O Z N F N 1 V W 0 K < < A W Z I a pm LL I tA Y v 0 Z p SJ m N W C F < < W W z < z N Z 0 u N W W Ci u t o z xJ 1<- C ] N < m a 0 J LL 0 < W C N I N 00 p C 0 O O z z z I N sJ M \ U W WLo z I Z 0 H z zz U O O o J m u 4� 01 o Ix N Z D I H I to N 7 0 I u ~ z 1 0 NN W Z z m 0 0 F u u W W F 1 p m N 0 J J N 0 J J I f i 1 Fx 0 m W W u LL N W u 2 F I u W N d d p C 0 O O z z z sJ M \ U W WLo cr- z zz U O O V 4� 01 2 < u ~ � C _wayrsa Va OAnmp;mm¢O Oy 0T3' OA� 2NyO�nmImT � Q Ws3 'm�m D m0Z O 2m A 9.m pa ZZp DvO pZZOOOO 2�O yD_<I��mD _ p' zZ Z z ^ N 0IT = 0p; -z 1 N; 3 O ZG14OpDD3. ) nD Z D mC O O NO NO DwaO 13.1 3^DZA< Z3 O N N o D < < m< N ~ Z n NFI T Tl ill _ I I I I I I N 00 IIIIIIIIiI 111111111 I IIII _ �� =D=So D=OAvN nDym3 z �DmAA�O mi MWZy .�n0i mpNN D p D m Zp rDZDpOyOAm 0 C 0 pmZ D Z m „Np D D^2 DAn ;OZDDZN DQZZZO So0„�3Am = O O OA Om 0 A z OO Zn T D Z C A Z< A D �_ A O D D I I I I A Z v '^ Z N x Z Z v Q O LTJ- A Z Z p O I I I i 1-lam IW 11111 II I 1111 II IIII II II >01 ��N N ZM NrN ! �m14 D0 yZZ 'o C MX-1 D(n O 010 No* MRm mx 1 Lp N0� ;az_ rn W �OZ as M 0 �- Nim v r roo Z ��r Gf rN- D*D m ?�Z A =o O �v 0- v nz in mm m cl0 DO 3 J owry OFFICES OF:." Town of OEMAPPEALS NORTH ANDOVER 131.11I X)INC; ;s .: ;..• CONSHERVATION s """` DIVISION O HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIIIEC-1.011 120 Main Street North Andover. MassaclItlSCIISO 1 f14 i (6 17) 68r' •477 i In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. 71e debris will be disposed of in: (Location of Facility) Signature of Permit Applicant —va.9 L to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. It 41, a qoi�' r M' rrs� '� `m `vr;. ass omic ,m .+ pwn At ui W W V1W -D +_ ISO ]Li0 ob G . a' r•n� Lu F.. 0 ' ` �.�._. �'ffiF g..a, . via _ 9 1 x c m z.. 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