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HomeMy WebLinkAboutMiscellaneous - 75 SHERWOOD DRIVE 4/30/2018Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 Facsimile (214) 488-6766 CLCAT@CL-NA.COM ***************"*******AUTO**3-DIGIT 018 810 T3 P1 95000059000 Building Commissioner or Inspector of Buildings 120 MAIN STREET { North Andover, MA 01845 Qunning�am �iindsey Form of Notice of Casualty Loss to Building C Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3.131, No insurer shall pay any claims (1) covering the loss, damage, or destructions, to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss; `damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified. mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 258196007 Policy Number: 258196007 o Company Name: BAY STATE INSURANCE COMPANY C) Cause of Loss: ICE DAM U') Date of Loss: 3/4/2015 0 Insured: Mark & Kelly Gilbert Property Location: 75 Sherwood Dr C Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3.131, No insurer shall pay any claims (1) covering the loss, damage, or destructions, to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss; `damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified. mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town, under the provisions of this section, or for,amounts not disbursed to a city or town under the provisions.of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 'N 0 i 66 el, — � Date .............3�.........,— ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... 115 .. -5- . C, . , . ...... /— ��,7 .......................... ...... ... ... ... ... ...... has permission to perform .... ......... ...... wiring in the building of ....r.. ` .......... . . ....................... at..;P�> ........ 'V'l- 1. ................. ,North Ando r, M Fee... .... Lic. No .............. ELECTRICALINSPECTOR Check# Common -wealth of Massachusetts official use Only Department of Fire Services [fRevermit No. _ A/ BOARD OF FIRE PREVENTION REGULATIONSccupancy and Fee Checked _ . 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM All work to be performed in accordance with the Massach Massachusetts Electrical WORK Code ( EC), 527 CMR 12.00 1 (PLEASE P1M TflrINK OR TYPE ALL WORMATIOA9 Date:City or Town of: NORTH ANDOVF_RTo thc ector By this application the undersigned gives notice of his or her intention to perform the ele electrical wofr dies described below. �(y ' Location (Street & Number) 17,5" t5 �®r r� , Owner or Tenant Owner's Address Telephone No.`J 2'f; ^ �SS-�13, s �. Is this permit in conjunction with a building permit? yes Purpose of Building El NO ❑ (Check Appropriate Bog Existing Service Amps /volts Utility Authorization No. New Service Amps Overhead ❑ Undgrd [] No. of Meters / Number of Feeders and.Ampacity Volts Overhead❑ Und grd ❑ No. of Meters Location and Nature of Proposed Electrical Work: n1 t co IL Com letion of the followin table may be waived by the Ins ector of Wires. No. of Recessed Luminaires No. of Cell: Sus No. of No. 1�'• (Paddle} fans Transfo ' Total of Luminaire Outlets rmers KVA N o. of Hot Tubs Generators I{VA No, of Luminaires/2— Swimmind• nd• � g g pool Above ❑ In- o, o mergency rg - tt No. of Receptacle Outlets Bae Units No. of Oil Burgers � AT No. of Switches FIRLARM„c No. of Zones No. of Gas Burners No. of Detection and No. of Ranges Indtiatin Devices . No. of Air Co d. Total No. of Waste Disposers Heat Pump Number Tons ns No. of Alerting Devices Totals: "� ..........-...-- ......._. No. of Self Contained No. of DishwashersDeteetion/Alertin Devices Space/Area Heating K W Local ❑ Municipal No. of Dryers Connection ❑ Other �' Heating Appliances Imo' Security Systems:* No. of Water No. of No. of Devices or E uivalent Heaters KW No. of Data Wiring: Si s - Ballasts. No of DeviceLor Eq 4, No. Hydromassage Bathtubs No. of Motors Tel communications Wir agent Total HP OTHER. No. of Devices or E°uivalent Estimated Value of Electrical Work: Y'B 0 each additional detail if desired, or as required by the Inspector of Wires. Work to Start: (® (When required by municipal policy.) ® �� _Inspections to be requested in accordance with MEC Rule 10, and upon completion. the licensee LANCE CO GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the lieensee.provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Com' BOND ❑ OTHER 'El certify p ❑.(Specify:) . under the gins and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: L.ft.o �% t�'�G�, �% Licensee: LIC. NO.: V 2a4 R:e Signature t (Ifapplicable, enter exempt to te license number line) LIC. NO.:� Address: f 0 K r Bus. Tel. No.: ;?9 SG _?&W *Per M.G.L c. 147, s. 57-61, curity work re wires � Alt. Tel. No.:OWNER'S INSURANCE W q ePL��jublic Safety "S" License: WAIVER: I am aware that the Licensee does not have the liabilityLic. No. required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner coverage normally Owner/Agent 01 owner's agent Signature Telephone No. PERMIT FEE: $ 3 j ELECTRICAL PERART NO.. INSPECT oN REPORT: ELECTRICAL INSPECTOR - DOUG SMALL s u — L 1 xauea —1 Re -inspection required ($50.00) - [ ] Inspectors, comments: (Inspectors' Signature - no initials) s. Date 2.' FINAL lNSP TION; Passed — [ Failed —[ � Re -inspection required ($50.00) Inspectors' comments: (Inspectors' Signature - no initials) 3. UNDER GROUND INSPECTION: Passed — [ I Failed — [ ] Re -inspection required ($50.00) - Inspectors' comments: (Inspectors' Signature - no initials) - 4. INSPECT(Laspectors' DATE CARID: NAli: Passed — [ — [ ] Re -inspection required ($50.00) - [ Inspectors' ature - no initials) 5. INSPECTION - OTHER: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ Inspectors' comments: Date /� - a Date Date Date DOOR TAGS ARE TO BE I+'IG]GED OUT AND LEFT ON SITE IFTHE *AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. a The Commonwealth of Massachusetts UT Department of Industrial Accidents Office OfTnvestgations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Dame (Business/Organization/Individual): & C . '/ r Address: 14) ® /, �9 City/Sta.te/Zip: -7�/lyS' ka'c-c, en /,y Phone #: VO Are yqu an employer? Check the appropriate box: I . I am a employer with D —part-time).* 4. ❑ I am a general contractor and I employees (full and/or 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet t ship and have no employees These sub=contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work myself. [No workers' comp. right of exemption per MGL C. 152, § 1(4), and we have no insurance required.] t employees. [lNTo -�Jorkers' comp. insurance required.] "may applicant that chMks Box 41 m� �t also sill cut the e seciion Belo••, shc:� nb thei workers' comms= t Ho --h 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. [1 :Roof repairs 13.❑ Other owneth w os ubmitthis affidavit and dating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. n's On Riney mtormanon. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Qe-- �� 'Ill, ell �N'tihi�P Policy # or Self -ins. Lic. #: W G Gi Y3 , lJ A Expiration Date: Job Site Address: i,� 4aC/yy a _—� City/State/Zip: / A A Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sinature: �� - 4a � -dIq Official use only. Do not write in this area, to be completed by city or town official f City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. Ci.ty/Town Clerk 4. Electrical In 6. Other spector 5. PIumbing Inspector Contact Person: Phone m m m 14x cnm YI EP m H � d CO3 cm) 10 O CD !7 Z vs CL O �• C _ ? C d = CO) Q C.) 0 o CD CDCL O cr CD CD O CD C OCD V!� CL. O CA � O CD C2 CA O CD Z o CD 0 CD 9 O rk�W C 0 ��� 0 d _ So y < m y m �a.0 m y ?-o co -4C •O y T zr aar*a a m - �OOy y -1 Z O n z O y� n . a y � o,COO CL C�� - O O y O O : CL -+ O CIO W d y C d o• .co a toO y H •yr'p O Ccw .�► 'Co" m O ' CA m r,. moo: ?m W, CL a'o sem: C 70tz 7 0 0 O gym: sem: C 70tz 7 0 1 • z h y 0 c all - al 7y -3737 -7-5-- Date .................. / ................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .: ........................................................................................... has permission to perform .................................................... wiring in the building of ... .................................................. lek at North Andover.,,.Mass. Fee. ...... No/) ................ . � . ........... EECTRIc�L �S) Check # 8623 jo 4 /� L Official Use Only �{ Cfommonwea th o addacLeffi t c;� Permit No�a3 vUeparEment` o��ire erviced - -.. _. Occupancy and Fee Checked9 � BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] heave blank; IJ . APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), X27 CMR 12.00 (PLEASE PRINT Ila%WK OR TYPE ALI,INFORMATION) Date: City or Town of: 3 , '� N& `p,� 4-� To the Inspector of Wires: By this application the uaijersigned gives not' c of his or her intention to perform the electrical work described below. Location (Street&Number) 1�1� (( �\�.Siral v0 \Jc Q Owner or Tenant ` E `` b. In 0- (- T Telephone No. Owner's Address S i.�LJ® Is this permit in conjunction with a building permit? Yes . No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 Amps 1�.� / 3ROVolts Overhead Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of.Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: it. V,0c�aX � 0.3A 'N •�t 0 Completion of the following table may be waived by the Inspector of Wires. No. of Recessed LuminairesNo. l of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. ❑ grad. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches l I l No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. TotaTonal No. of Alerting Devices of Waste Disposers P eat Pum _ffNo. Totals, iVumber " " " - Tons J.K.W o. of Sell -Contained Detection/Alertina Devices No. of Dishwashers Space/Area Heating KWLocal .� ❑ Municipal ❑ Other Connection No. of Dryers ry Heating Appliances " : KW Security Systems:* No. of Devices or Equivalent No. of WaterKms, Heaters No. of No. of Signs Ballasts - Data Wiring: No. of Devices or Equivalent Hydromassage Bathtubs No. H Y b No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail ij"desired, or as required by the Inspector of'Wires. Estimated Value of Electrical Work: It O®. (When required by municipal policy.) Work to Start: 1D k. Inspections to be requested in accordance with iVIEC 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 ag is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE. [ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and_ enaI ' of perjury, that the information on this application is true and complete. FIRM NAME: Es" EA t Lk'►L-J V i ca-�, LIC. NO.: AL U Licensee: N4\ e Lo-�- Signature. (�.re� LIC. NO.: -1-7-: S v6 (If applicable, enter "exempt" in the license number line. \ Bus. Tel. No.: 00% S lb � Address: l to Croc`� b 01 V. —Or- . 4 \! i �Jod'b . 'i Alt. Tel. No.: 0111 06 -11 ?1 *Per M.G.L. c. 147, s. 57-61, sec rity work reel uires bepment 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 FPERTI.IT FEE; �a— Signature Telephone No. �l..6 46 �.. The Commonwealth of Alilssachusetts Department of Industrial Accidents Office of Investigations 600 Washine�on Street Boston, M,Q 0.2111 wwrv. mass.govIdia Workers' Compensation Insurance.A-ff1_1daVit: Builders/Contractors/Eiectricians/pinmbers Acant Information Name (Business/Organization/Individual): �,— C., C,o Address: J�j' City/State/Zip:—T �141-\p ---isr Are you an employer? Check the appropriate box: 1 Phone I am a employer wtth 4. ❑ I am a general contractor and I I mployees (Hill and/or part-time).* 2. ❑ I have hired the sub -contractors am a sole proprietor or partner- ship and have no employees listed ort the attached sheet I These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5.. ❑ We are 3. ❑required ] I am a homeowner doing a corporation and its officers have exercised.their all work myself. [No. workers' comp. right of exemption per MGL c. 152, § 1(4). and we have no insurance required.] t employees. [No .workers' comp• insurance re uired Type of project (required): .6• ❑ Naw construction 7. ❑ RemodeIing . 8. ❑ Demolition 9. ❑ Buiiding addition 10:❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12:7 Roof repairs q ] 13.❑ Other + 11 , applicant,that checks box # I .must also fill out the section below showing their workers' compensation poftc} information, +..' nomevwnefs wlio submit •ibis aMda.vit iiidicaririg they ar- dain. zi'EE+a{; ;ltd [her, nlre Glliside ccyniractiOn oli ,info (t1 tion a 'Conuactors that check this box.must attached an additional sheet showing the na.cse.hi the tsicicam rndavir indicating such. n ztactom and their workers' comp. pol iev information. i fo an employer thus is providing workers' compensation insurance for m3' a to ees. Below is the policy information. � Y p cy and job site Insurance Company Name: CAS', �S Policy # or Self .ins. Lic. #: Expiration Date: ® 0 Job Site Address: L,>O Q City/State/Zip: . r� 0 Q41— 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 e inst the violator. Be in the form of a STOP WORK ORDER and a fine, advised that a cop), of th of up to 5250.00 a day ais statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern under the pains andpena/iies ofperjury rhal the information provided above is true and correct Signature:t (/�-� � Date: � ` fz� °I Official use onip. Do not write in this area, to be conrpleted'by city or town of cud City or Town: Permit/L,icense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone # �7Y%/� 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 ".. ever -y person in the service of another under any contract ofhire, 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, orthe 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 ap artments and who resides therein, or the occupant of the dwelling house of another who employs persons to do ma.int=ance, 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 o r local licensing agency shall withhold the issuance or renewal of a license or permitto operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence ob�f 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 compl-etely, 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 affi�a.vit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Aiso 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 lam, or if you are. required to obtain a work�as' compensation policy, please call the Department at the ntL nbere :limed below. Self-;nsw-ed companies should enter their self-insurance license number on the appropriate line. City or Town Officiais Please be sure that the. -affidavit is complete and printed leQibty. 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 permitAicense applications in art}, given year, need only submit one af. davit 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 Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a licens- or permit not related to any business or commercial venture (i.e. a. dog license or permit to burnleaves 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 Iitvesfigatioas 600 Wasla ngton Street Boston; MA €12111 Tel. 4 617-727-4900 e) -t 406 or 1-977-MASSAFE Revised 5-26=05 Fax 4 617-727-7749 wwVi'ma'isS.Dov/dia if DateAw .:�� ",O RT :��o TOWN OF NORTH ANDOVER Aw PERMIT'FOR PLUMBING S SACMUS This certifies that .. has permission to perform plumbing iLl'lvc—L huildings of ..� .:.. ........... Z.......?' .......... North Andover, Mass. FeeO.�. Lic. No.. ...... ..... ............ . PLUMBING INSPECTOR Check # ' 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO Do PLUMBING tFhin or Ty* AZ,2�j,�ear- _ Mass. Date 2–Z7 , Permit * UU lO Building L*cation :S�e�r�c�� Ownet'r N Qr^d� �- 75 j Type of -Occupancy Si491e- dl�J L' New p Renovation nt ❑ Plans Submitted: Yes ❑ No 3 — FWURES- installing Company Name_ Address v Business Telephone ` 11 Name of licensed Plumber Check one:. L�Carporation ❑ Partnership ❑ Fimt/Co. Certificate ZZ -41t L INSURANCE COVERAGE: I have a cwrent ! nity Insurance policy or Its substantial" equivalent which meets the requirements of Mhl- Cit. 142: Yes No O If you have checked yZ, please Indicate the type coverage by checking the appropriate bmL A liability insurance policy � Other type of Indemnity ❑ . Sond ❑ 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 requlremen. Cheat one Owner ❑ Agent ❑ S,Qnature of dwner or owner's Anent I hereby certify that all of the details aid infamation I have adw tted for afta U in above appGption are true and accurate to the best of my knowledge and that ail plumbing work and installations per caned under the pomdt iscied for this *gftation will be in compliance with ant Pertinent provisions of the Massachusegs State Plumbing Code ai>d Chap f42� Gertaral Saws, BY, Type of License:. Master ❑._._.-- " Journeyman C u NL t.ioense ftmber > Z 1 Date .l. _Ze/ _ e °:;`"-,•�•"°° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that// ........ .arc Wil. f ...................................... has permission to perform ...... ......................... wiring in the building of .....:..��1� r�i ..................................... ....... at ... .?.o..... , North Andover, Mass. Feed: � ............. Lic. No `.../G!/..... ........... . �f9:*EL....... 1!l�r .. ...... .... ..... ECTRICAL INS E Check # 8557 0 _, N Commonwealth of Massachusetts official Use only Department of Fire Services Permit No. J��r,Z r BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked' [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORAfATIOA9 Date: City or Town of Ael C-9 X ya d'jv Gr am/— 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) 5 IA n P, Owner or Tenant— C_ �� l4 &fiTelephone No 7? GS$ 3 Z 3 ? Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building R �e_-v)G e Utility Authorization No. Existing Service U"v Z� Amps �v / j,,7-9 Volts Overhead ❑ Undgrd P_11'� No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity J Location and Nature of Proposed Electrical Work: l ,0S t Q i 1 ti 2r 192,2,-12�G�-1 QA&Z Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In ❑ o. of Emergency Lighting nd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges a No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat PumpNumber --' Tons '_"" KW "___ * No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW- Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring:. .Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. 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 J 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:) ,� Estimated Value of Electrical Work: �o5'6_0 (When required by municipal policy.) (Expiration Date) Work to Start:S Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cert, under the pains and penalties of erjury, that the information on this application is true and complete - FIRM NAME: e CaLIC. NO.: Licensee: Signature r .LIC. NO.: r— Ir J� (If applicable, enter "exemptj" in the license number Zine.) Bus. Tel. No. = j OWNER'S INS CE W R: I am aware t the Licensee does not have the liability insurance coverage normally required by law. By my signae below, I hereby waive this requirement. I am the (check one) ❑owner ❑owner's agent. Owner/Agcn / �" PERMIT FEE: $ � Signature �v'�t Telephone No.%�%C�'� 0 N2 2" $ 6 Date.................... ......... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING i This certifies that .. ................................................................... .............. has permission to perform . .: �- 4-� ^�:..................................................... wiring in the building of�......°G............................:. at . .....:....... t T' ��.. . ...................... , North Andover, Mass. Fee.. S ................... Lic. No . .. ...... ..... .... ............ ._,...........:.................................... l'ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer v� THE CO�YiMONWE4LTH OFiVL4SS,,I II,:SET13` DEP. EVT0FPUBUCSAFE7Y BOARD 0FFIREPREVEM0NREGUL9770NS 527CVR 12-00 Office Use only Pc reit No. � O - Occupancy & Fees Checked AFFLICA TTONFOR FER lflT TO FFvFORM==CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL, CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. IMAP PARCEL Location (Street & Number) 7 ,S'... -SI-11F A? G4-106?,O 0%? 1 Owner or Tenant /2 AZ 4` 7"r0 4� S Owner's Address Is this permit. in conjunction with a building permit: Yes Q No (Check Appropriate Boa) Purpose of Building /Z S/® Ill 71 Z- Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground ® No. of Meters Number of Feeders and Ampacity - - --- - -- Location and Nature of Proposed Electrical WorkUf� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above. Below Generators KVA - around and No. of Receptacle Outlets No. of Oil Burners No. of Emer-gency Lighting Battery Units No. of Switch Outlets " No. of Gas Burners ITRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and T452. of Disposals No.. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained d Detection/Sounding Devices Local r7l Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of signs Bailasis No, Hydro Massage Tubs No. of Motors Total HP OTHER nr 1 v .- r :r...: • 71.1 i• I :. II :n:nl.. .....:::II. - �. .. q : 1 7J II I`b I .0 •- ••1. I I •II ,• • IF.::1- ••: • 1.• .• ••' : - •. IA " 1•..1 !1 :.- I : I � • 1• uu:. . r• • ••: • �l r • I - •iu- 'J► � • • - •�:•r.• r:e•- ua•cl;• I - r • .• - • • :•a .• I - .I• ••171!' •O 1 • • M. 1, . • 1M• •.1. •:•I 711" FE IR•7 • AHI r / 1/��•:•1.• •711' •:• w�l: J.:• •: I - •" 711'" • •: I L•1• I Estm@JbdVahrdElacbxalWcd, Roueh I Fil l 1'em"1 b 6 Li Liar�see /7G R2 r -f /% �fJ/%/ ✓Et v— S; e o� -�r / V1.1 uffl eNo � �/ 7 D BumxssTeL1\b- c/P V7 AcYhess t�`7 / 11� Ary�J -C L114o • e'`�A- D /bio/ A>tTeLNT0- OWNER'S INSURAi`K:B WANER, IamawatethaktheLiar>ce toes t%rtlntve theitistuatxeoaits st�tar��legtm-a�4asrbyA� �x�r�ilLaws andthatmysi mbmcnthisFmntLa lvamr tinsmltuern2ri (Please check one) Owner = Agent Telephone No. _ PERMIT FEE S JiEmawre of Jwner or tcnL N2 2187 Date... ........................... ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that C_.--� ✓ -�... . has permission to perform `......L.....�.~.�..............�.�......�;i,�-� ...................... . wiring in the building of -�-....y�+.'................................ ............................... . NP, h Andover, as Fee L><c. ELECTRICAL INSPECTO R / 10/15 13:44 15.00 PAID. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N° 2182 Date ..�.�.�..:�.f�.:.�.�......... Fee -'.7.:....... WHITE: Applicant Lic. No-,)27ze ..........:1:......",: ................................. % ELECTRICALINSPECTOR CANARY: Building Dept. PINK: Treasurer @� THEl00A010NW 4LTHOFMgSSAQRIS= Office Use only �J DFPARTAff W0FPUBLICS4= Permut No. 9 1 il BOARD OFFMPREYE MONREG JMTIOAND7CMR 12-M 24/—4!�' Occupancy & Fees Checked UV,dPPLICATI0NF0RPD?Aff TO MMORMaECTRICMOOWORI� ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat U Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address To the Inspec4r of Wires: Is this permit in conjunction with a building permit: Yes � No F] (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead a Underground r7 No. of Meters New Service Amps o / Volts Overhead M Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �r�777 � 6 77 777 / z" No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW. No. of Self Contained Detection/Sounding Devices Local r7-1 Municipal a Other No. of Dryers Heating Devices KW Connections IN o. of Water Heaters KW No. of No. of Signs Bailasis .No. Hydro Massage Tubs No. of Motors Total HP OTHER Instra=CamW R>rsuarvodtem#arrMdMassadzsdksGamalLam Iha%eaametLiablM'ybruwmPbbLymldTCaq)kt CDvw,agecritsskdaiUeWivalatt YES NO Ihaw9hn9tadNWpF00f0fS3n1e1DtheOlf = YES S LJNO If}wha%ed mk dYES,plemmdic*thet)WofwArWbyd�ad rgthe II CE a BOND r-1•LOTHEP, (PlemSpe*) EstimatedVakrdE6chral Wait $ WaktoSlat inspectimD*ReWested Rough Fslal sigt>adt><,deMP�f , o tf� rG �!L LioaseNa FIRM NAME ,,r �j Li.41 P � Sigt><mae � Li =1110 () ? 6 `3 BusimTd.Nb. Add _ ,. �AJo / % te-1-LA(IlkafiJIN AkTdNa i ,-?i -y7 2 % OWNEVSKWRANCEWAIVIIR,lamaiMythell iomsedm naWyetheimuma orilsstbswtale*ivala>tasm#tedbyMassadmolsCanallaws aodtatmysi neamcn hispmiaWpfiicmm% iAsftte�iart. (Please check one) Owner M Agent Telephone No. PERMIT FEE $ I N2 Date .... ,?7,%2" F ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. r Y..; ............................. has permission to perform .................. wiring in the building of .......................... ................................ ......... .................... North Andover, Mass. at ... Fee ............. Lic. N,5�g'qe'r ............. ELECTRICAL INSPECTOR SIM WHITE: Applicant. CANARY: Building Dept. PINK: Treasurer 7HECOWONKF.AL2HOFMRS•SAlCHI1SETls - - Office Use only — DEPARTMENTOFPUBLICSAFM Penni, No., 4 BOARDOFMEPREV© NONREGMTIOASD7CM ]2-'W Occupancy &Fees Checked - APPUCATTON FOR. PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 cMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ;Jo Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L rv! 4- J j , ap, 01 ) -A(- 2.5 Owner or Tenant Owner's Address r1) 4;2 j, L'A Al P1 K-5, J1- is TIs this permit in conjunction with a building permit: Yes MNo (Check Appropriate Box) Purpose of Building Utility Authorization No. `D Existing Service Amps / Volts Overhead M Underground r7 No. of Meters_ New:'Sfervice Amps o /.Volts Overhead Underground No. of Meters Number of Feeders and Ampacity "f Location and Nature of Proposed Electrical Work A,5. AS N4&4 M, dj� AVA17 V No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground. No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets - No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals Nd. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local o Municipal Connections Other No. of Dryers Heating Devices KW k 'No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER - - Instam=Com� Rantrattblheta#urKnt&Ammd G=rdLaws IbawaamotL2 iUyhEwd oePbliyi dukgCarM!N Cotaagecres ltialegnvala>t YES NO I1mest� nWdwlidptudbfsaw1otheOfoe. YES u If3wha�edtaci�edY1~.S,ple�ea a type1=11d, d gihe INSU11 1RANC�'E � BOND r7 OWER r-1 ExpiaimDat Ps nMWdVakte icalWait $ WolkbSlmt h>spatbmD*Requested Ragh . Fuld Sigredtaxla`�ieP�t>�escf' FIRMNAME MW EG kc 7Z lioaseNa LiNo o1U� Bts mTdNo. _ rrrq Y rS14`� [,0f) C�t��t+,._J Alt.TdNa��,. OWNER'Sr4SURANCEWAIVER;Imnatume bmwdmsaat lheitn�aattoeoa a�tss> Legt astacg>QadbyA se�Ga tIaws -andi atn-rySiteai ttr.paniWQhcatimwairsftm manes. (Please check one) Owner Agent Telephone No. PERMIT FEE $�®, .J Location ) d /.5 # ` 5� S't ey u, o o ff % 2)/i. No. 5/3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ ,,sJAC/1115Ei Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J3 qS Check # 13 5'22 "� Building Inspector 70448 Date. cl-..s=GG......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION At Ties certifies that. ()...... has permission for gas installation ..1D .f'. t/. -r t.? .............. in the buildings of 1:,XK e-. A ........................ at North Andover, Mass. Fee. 1?� :... Lic. No. GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING t S (Print or Type) j `45 " �p N 0 U Mass. Date 19 Permit #t jfJk Building Location 5� S (r r R �'G ` Q� `Owner's Name ®� �-- �Q� m G Type of Occupancy, W I^ L. G -!/ti New Q Renovation ❑ Replacements n Plans mitted: Yes❑ No ❑ Installing Company Name lgorri` #1y F LLar Check one: Certificate Address 7 i1 AlP-14<<6V R17 ❑ Corporation N n 0 V am p- 1`909 9 0/r/ O j. Partnership ) Business Telephone i i$ V 95' 3 yz Cf ❑ Firm/Co. Name of Licensed Plumber or. Gas Fitter 6 3 S-'7 I Ll S�l?{� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes W No F I If you have checkedrimes, please indicate the type coverage by checking the appropriate box. A liability insurance poiicy 0 Other type of indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: S+gnature of Owner or Owner's Agent Owner -E] Agent E3 I hereby certify that all of the details and information I have submitted (or entered) in above application are true -and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. BY. T of Ucense: Plumber S+gna re of Ucensed Plumber or Gas Fitter Title Gasfitter 2 g aster Ucense Number �J City/Town Joumeyman APPROVED(OFFICE US F ONLY) fn H W W N N Y Z 2 U) S N 2 O W J N. W O U Z O W a C O O o O r __ ur s m w 4 y W ac o rA G W O U W N yzj 4 tt O ~ p �"' W S W V W �. 2 J F� Z W W V O ::1 > U. W !- W 1 •ri C a Z O Z W O to Z a ¢ W> = O c c7 W = LL z e d a O a W o 'U O e W I > p o a w M- O ' Suo— es$iriT, � BASEMENT 1STFLOOR 2ND FLOOR 3RD FLOOR _ 4THFLOOR STH FLOOR 6THFLOOR 7TH FLOOR STH FLOOR Installing Company Name lgorri` #1y F LLar Check one: Certificate Address 7 i1 AlP-14<<6V R17 ❑ Corporation N n 0 V am p- 1`909 9 0/r/ O j. Partnership ) Business Telephone i i$ V 95' 3 yz Cf ❑ Firm/Co. Name of Licensed Plumber or. Gas Fitter 6 3 S-'7 I Ll S�l?{� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes W No F I If you have checkedrimes, please indicate the type coverage by checking the appropriate box. A liability insurance poiicy 0 Other type of indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: S+gnature of Owner or Owner's Agent Owner -E] Agent E3 I hereby certify that all of the details and information I have submitted (or entered) in above application are true -and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. BY. T of Ucense: Plumber S+gna re of Ucensed Plumber or Gas Fitter Title Gasfitter 2 g aster Ucense Number �J City/Town Joumeyman APPROVED(OFFICE US F ONLY) Date. . 2 .. /. -: . ° N° 4325 t ` - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...tr..��L./! .j !.1 ..N!''........... . has permission to perform .... ................... plumbing in the buildings of .................. at ... ... 5.t. �� �:.`.. �l. .� Orth Andover, Klass. r ' Feer ... �... Lic. No. /U��.1 . .... PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer yi MASSACHUSETTS UNIFORM APPLICATION FO RMIT TO DO PLUMBING y+pe or print} ... � a�t�$ Fl..�'-� VV* MASSACHUSETTS Date —�•� �.••� wilding Locations Permit # 3 v Amount c�J t�;tx PJl' 2. Owner's Name •�---�-- New [ Renovation Replacement Plans Submitted 1:1 A (Print or type) Check one: Certificate Installing Company Name a t inn s kk v P 1 urns! _ H amt „� s, X� Corp. 1906— Address P . 0 . B o x 1701 ® Partner. Business Te ep one 225-374-1743---- ® Firm/Co. Name of Licensed Plumber: Stephen C. G a l i n s k y ,II s&jra_ncx Covetaae: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyED Other type of indemnity ® Bond insurance Welver: I, the undersigned, have been made askrarkthat the licensee of this application does not have any one of the above three insurance tgna re Owner11 Agent 11 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 installat' ns ed a it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate bin o Chapter 142 of the General Laws. By t a c Type of Plumbing License Title City/Town uteff Se-Numberte' Master rx Journeyman APPROVED (OFFICE USE ONLY 3355 Date.. ...�............. "ORT" TOWN OF NORTH ANDOVER 3r 'a a PERMIT FOR GAS INSTALLATION f 9 This certifies that .. (�. 1. . !�. j /'' / ....� � ... .... ......... . has permission for gas installation ... ... `............ . in the buildings of/. .. 3 /j K at .... . � ... ,.�f�.....`'` .. c � 1 n , No h_Andover, Mass. Fee. Lic. No..���._? G�/AS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer W ✓IASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO G G or print) e .-1 Q C-) iwmi n ANDOVER, MASSACHUSETTS Building Locations Owner's Name New Renovation ❑ Replacement ❑ Permit # Amount $ L4 Plans Submitted ❑ (Print or type)JaA vCheck one: Certificatej�ling Company Name i �orp. f'L Address % ©` ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Non If you have checked�es 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 ❑ 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Plumber ❑ Gas Fitter License L 0-11Glaster ❑ Journeyman Z v C � Z Fw., N Z n W �_ w x x z w z w C w -� zz _' w > w w LL SU B-BASEINI ENT BASEMENT 1 IST. FLOOR 0 2ND. FLOOR y I 3RD. FLOOR 4TH. FLOOR ST Ii. FL00R 6T H. F L O O R 7T 11 . F L O O R 8T 11 . F L O O R (Print or type)JaA vCheck one: Certificatej�ling Company Name i �orp. f'L Address % ©` ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Non If you have checked�es 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 ❑ 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Plumber ❑ Gas Fitter License L 0-11Glaster ❑ Journeyman Location �u�✓s�- No. -S�. _- Date 13467 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ $ /-s z� Building Instar TOTAL Div. Public Works Go a e i© I it p Z p b r y 1 ^ 2 S N N v: m i Y > > _ p Z v _ p m V. e m'.- > m 2 > Y 77c z y x ^ z m p all �5T i z 4 _� z 7 V1 w > F. fi �"n w In p z mFn Z ai m LA �C- ¢ C� m t w 2 p W _ T T p z z LA m „ A s d 1 lK a 11 c c c ^ i m r T iZ Y 52 Y Z � ~ �= v_zi V_Zi //T�� R; ^ far. �w .T.. y :• p X X X m T coVyT. BVI p p R ►i w T > \ m � � V o C r) 00 1 a 1 1 O Growth Management Bylaw Exemption Statement Town of North'Andover Building.Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Nam of A plicant on Building Permit (below) Address of Property for Permit (below) ttAff Map and Parcel: Purpose of Application (check below) Phpn Nu rrbS f Applicant: Single Family 110 —_ Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. , This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) werelwas created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction; Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. . This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(I.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit.is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. Signature of Owner or Authorized Agent - who signed the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit FORM U - VERIFICATION FORM INSTRUCTIONS; This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 51n�fW"S V2 -I/4 me,.,f LLC Phone LOCATION: Assessor's Map Number ��4 Parcel Subdivision .:8r,n-,c, �I1- Lot(s) Street p 0,^ 6Joof�- br iy� St. Number ************************Official Use Only************************ RECOMMz',"DATIONS OF TOWN AGENTS: / x Date Approved 1L++,j`"�� --- - -- CorCservation administrator p�Date Rejected Comments69&iL k 1 •I Date Approved Town Planner Date.Rejected Q Comments Date Approved Food Ins/pe/c�toLr--Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments 5 -A -10 Public Works - sewer/water connections�w - driveway p it Fire Department m / Received by Building Inspector Date ! �.J G �W ..:.. _.. r .rte^. _ _ -- F• -_ ,. _ - �� Ja® 16 8 ►=� r� ass 167a0 - _� I IqD o� o?� 5v y q f 9 o 5,n- a3010100 - - 1 - r _ _. - it .. � 1 lags MAScheck COMPLIANCE'REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 9-10-1999 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: 9/10/99 TITLE: PROJECT INFORMATION: SHERWOOD DRIVE LOT -15 NORTH ANDOVER, MA 01845 COMPANY INFORMATION: WILLIAM BARRETT HOMES 1049 TURNPIKE STREET NORTH ANDOVER, MA 01845 COMPLIANCE: PASSES Required UA = 768 Your Home = 725 Permit # ; Checked by/Date ; Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 1956 38.0 0.0 59 WALLS: Wood Frame, 16" O.C. 3474 15.0 3.0 232 GLAZING: Windows or Doors 816 0.350 286 DOORS 42 0.350 15 FLOORS: Over Unconditioned Space 1938 19.0 92 BSMT: 8.0' ht/7.0' bg/0.0' insul. 187 0.0 41 HVAC EFFICIENCY: Furnace, 86.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 131 and J4.4. Builder/Designe Date J �L/LJ✓yC.( IAll ko�' C 7:u No. 0732 -:;_.- Date ....�111� l%... 4 . �...1. TOWN OF NORTH ANDOVER RECEIPT This certifies that haspaid .............:9. .... S ..:................................................... for ....repit/ J..... ....... 7" / r Receivedby ..............1.i. ...... (.. L.......................................... (�C i� Department .............. ....................�Y.�%.................................. - r. WHITE: Applicant CANARY: Department PINK: Treasurer f z > n 7 C' 7:u No. 0732 -:;_.- Date ....�111� l%... 4 . �...1. 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