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Miscellaneous - 80 PINE RIDGE ROAD 4/30/2018
NQ Location 630 No. ""2 Date r TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ $ 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� r —. Check # 14459 Building Inspector r 515•'a,iS "W S�Ly. i t F a --- Nt3D'Off'09"W C� 1 O� zu, 0 n -u -� o -7-= C:r o O� zzzxoc� rn m 7xcl Ui Z Z �1 0 Q � c � V i Q �07=S�Zr� mQOr*►�Xmi oo pp, z n Nrl-f =O 52���'nz2- n '9 rttG)mC2700cn z fli5` 0T rl m Om�"rD�O t F a --- Nt3D'Off'09"W C� 1 I i �1 0 Q � c � V i Q Q 0 if Check # r 3c,97/,� --Building Inspector Location e� D f No. c Date NORTq TOWN OF NORTH ANDOVER • » Certificate of Occupancy $� s�cHus 14U Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ rt TOTAL $ if Check # r 3c,97/,� --Building Inspector w -z z z r o C n m T93I cn m Q In o > � c S a - m ° '.' _ Z O O O z n rz y C O n n O ° m vm v v > .:i -j ;-1 ;-i 2 Z Z a' _ n Z C1 •o y '� ? Ln r O a s n d r r- .c n n n n r z cn r o c z m �" m Ccj c m m v; `n a C a m 61\ cq u rj — I.. Z�z r� � a s n � - O Q °} ^ � l.Jri n t'7 FORM U - LOT RELEASE FORM IANSTRUCTIONS: 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 or requirements. *****************************APPLICANT FILLS OUT THIS APPLICANT 91 L 099 PHONE 17 F a',6" - 6 6)-0 G LOCATION: Assessor's Map Number Z l�— SUBDIVISION STREET i i► ST. NUMBER USE ONLY*************************** PARCE- LZ 9 LOT (S) $ _B RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED 1110100 ` ` 1 DATE REJECTED COMMENTS U� W '�-LQh ("I ''s (0�3 / TOWN P COMMENTS ER FOOD INSPES-,TOR-HEALTH IC IN., CTOR-HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS 4� :S -r-- k9 e PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAYY PERMIT FIRE DEPARTMENT —4-1 � —` RECEIVED BY BUILDING INSPECTOR Revised 9197 jm TE � 3 , , � _ § M1 e °��„� � ;^''# <', f a :.�, m ��� �r,; y �t �' � .eie •ate ,'�'�`"�. �l 'v:� �''.$:_ •. .y ..�_�.w _ a :.:.'"n' ,.+�`.,bn a: _�',, 'd.. a N9..._..a sa=rn. q_ _i4 ""'?'r� s - *• k AvZZ em' .q-'g•'.6'�-`^Y`- Date y OVIN OF NORTH ANDOVER i2EGr1P t ..._-. ,,*�; � XF'G•^.'� �r, r • i.si. :fir -'t., ;�,fr.,,r r. b1 N P-1 t gTr;.S',. l a-�� R(I1(rl Sri, t .'.,i. ( 1 eft` c rY 1+ t:' ' Cot' Cal' ..,;grI wva/ Sjj of- .y, I ;, aRt 1-0 COMPLY A� L, OSITAIN AF P�;C;`,/AL VOIDS 'i HiS Pc Ac,a► F a; �5^3, Fdd 93 . ^ ' ' ,y7 �^ - . � ^ - , ' �.� ' ' '^8 '' ' '� ' �| — � ' '` / � ^ � .. �� '�- ' _' / ' ' /�^ �+' t� / � /�',, "��7} ^ �� /, ^ �� .'.�" �_— ' � . i 4 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software -Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM "TYPE : ZOther (Non --Electric Resistance) DATE: 1-18-2000 DATE OF PLANS: TITLE: PROJECT I-NFORMArTON red pine drive N.ANDOVER. Permit # Checked by,/Date COMPANY INFORMATION: RLI CORP:. A COMPLIANCE: PASSES Required_ -UA _ . 6Z-4 Your Home = 625 Area or Insul Sheath Glazing/Door Perimeter R -Value _R=Value U -Value UA ------------------------------------------------------------------------------- CEIL-ING.S 2.000 30._0- 0.0 71 WALLS: Wood Frame, 16-11 0 .�C . 3171 13.-0 0.0 2 61 GLAZING: Windows or Doors 360 0.35,0 126 DOORS 72- 0.350 25 FLOORS: Over Uncondi-tioned Space '2D-00 -19.0 95 BSMT: 8:0' ht/6.0' bg/0.0' insui. 163 0.0 47 HVAC EFFICIENCY: Furnace, 83.D A= ------------------------------------------------------------------------------- COMPLIAN.CE.. STAEUT24 NT : -The .proposed --bull-ding ..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 -"- J �bLi ±ng, and the .cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. -The -HVA -C equipment selected to heat or cool -the building shall be no greater than 1250 of -the design load as specified in sections-78DCMR 1-310 and J4:4. Builder/Designer Dat MAScheck INSPECTION CHE-CRMST Massachusetts Energy Code MAScheck -Software Version -2 .D DATE: 1-18-2000 Bldg. Dept. Use CEILINGS: ]: 1.- R-30 -Comments/Location WALLS? 7 1. Wood - Frame, 1611 O . C . , R-13 Comment-s_/_l,-ocation WINDOWS -AND.-GLASS-DLDDRS C ] 1. U -value, --0.3-5 For-wi-dowe--wit-hau-t 1_abe-led _U -vales,, des-cribe feature -s: # Panes -Frame Type Thermal Br-eak,> Ye -s -No Comments /-Loc-a-ti-ora DOORS-- -0.35 OORS-0.3-5 Comments /L --canon FLOORS: ] 1. -Dver Uncond tioned '._Space, ='19 C-ommerits yLocat ion BA-SEMENT -WALL-S: ] 1. 8-.0''ht6.0' b . % g/0.0 instil.; -R-0 -Comments/Location. HVAC EQUI-PMENT EFFI-CIENCY E l 1. Furnace, 8-5.0 AFUE or higher Make and Model Number THERMOSTATS:. E ]' Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ]-d-oints; 'pen -et -r -a -t -i -ons., _and -all other .-such -openings in the- building -envelope --that -are -sources -of -air 3-eak-age-must be sealed. Recessed lights -must be type I -C -ra-ted - and ins-t--a3-1-ed. -with -no -penetra-ti-ons. or ins-ta33-ed 3-ns3-de -an -appropriate-a3r'-t -ght -assembly-wi-t-h -a -0.5" -clearan-ce from-combustibi-e-ma-t-erial-s a-nd 311 -ciea-ranee --from �nsu-la.ti-on, VAPOR RETARDER : { i Required red on the--wa-rm=3-n --wi-iter .-si-de _o f --all-non=vent ed -framed ceilings, wall -s -and fl -o- rs . MATERIALS IFI CATION:. [- Materials- and equipment must-.-be-ident:i-f_Le-d_ so that complianc-e can -be determined. -Manufacturer manuals --fo-r all %nstailed -heating and cooling equipment and -service water'heating -equipment must -be pr-ovide&.. Insul-at-ion.- R-ualu.e-s -97-a Ing 1l -value -s, and --Beating equipment. efficiency must. be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts in unconditioned spaces must -be insulated to R-5. Ducts outside the building must -be -insulated to R-8.0. DUCT CONSTRUCTION: All -duct -s must be sealed -,with -mastic and fibrous backing tape. Pressure --sensitive tape may be used -for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS Thermost-ats -are r-equired for each :separate HVAC system... A manual or aut-omat-i-c--means to partially restrict or shut off the heating -and/or -co-o-1-Ing input -to -ea-ch z -one �or floor shall -be provided. HVAC EQUIPMENT SIZING. Rated -output capacity -of -the. heat ingfcooli-ag system is not greater -than 125-01, -of the idesign .load --as.. specifi-ed in-sectizons 7Z -O MR 3310 and J-4- # MI SC-REQUIR-EMENTS Refer to 78O CMR_, Appendix J for requirements relating to swimming pools, HVAC. piping conveying fluids above.. -12-0 F or chilled fluid -s below �55 F , and circa a_ting ho -t- - wa-ter sy stems . ----NOTES TO FIELD (Building Department Use Only)------------------------- L -- yz. e { WL The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name d t 09 Please Print Name:tnil�o!�.��+�-y Location: J- Jr -+e City 231 11 �" it Ca _ Phone # y 7 e - (&13- C o c 6 I am a homeowner performing all work myself F7 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working. on this job. Comoanv name: E L!r lim r,D Address q % 6 kJ City- �U 4 v t`«. Phone #: 9 7K — 6e/ol3 --COO 6 I r ( _ I nsurance Co. 1� r e t `'_ c� n, i t e S�fq - Poli_cv# o� t;- - O ui - S� Company name: t Addres City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature `�� ..4 Date Print name Wo b -e 1, n,,` s Phone # Official use only do not write in this area to be completed by city or tc+vn ficial' City or Town Permit/Licensino ❑Check if immediate response is required Contact perscn: Phone #.- ❑ Building Dept ❑ licensing Board ❑ Selectman's Office ❑ Health Department 71 Other Growth Management Eyiaw 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. Name /of Applicant an Building Permit (below) Address of Property for P/e�rmrit (below) �� r - G Ci / o l? P/' /°1 ..e. oC , Gr 4 z /llt Map and Parcel: Purpose of Application (check below) Phone Num er of Ap licant: • (/Single Family Two Family �Ze �6�-600 — I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the ECEMPT1CN 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 wilding Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Oepartment and is only offrcally_ 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 ane 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 vistence as of the effective date of this by-law, provided that no additional residential unit is created. V The lot(s) werelwas created priorto May 6, 1996 are exempt from the provisions of this Sectien 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 Oweiling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. it This application is a part of a development project which voluntarily agreed to a minimum 4011, permanent reducfon 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 aces and permanently designated as open spats 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 an the parcel. This application represents a lot which is ready for building permits,(Le, 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 EXEIAPTiON. 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 Cate This form must be attached to the Building Permit upon application far such permit Cl) m m U) 0 m y C � CH Cl) 10 0 CD n COF) a r. 0 CZ �• y O 0 CD CD o Cr �C d CD CD o D ca ca C CDCD CL cm O CO) Co C I 11 cn 2 ON 0 z cn C?oo m --4 06 �. m N y =mom cc 711 c) Noac 2. mm S fl ca 506= r .di. m H T -1� 0 -. =m m m y N cc.*. = = O N O C d O N A _CO.� CL ,. O O 1 O m m 3 co) � Z = N G =r Q W d I CD CA 0 -, CD m 2�N : �� �CD gyCD. '..' !9 O CD ?� C=. .A -Po 9 ?i CD �s :Z m it :. .� co') � .O ....: 0 : ... dd CL's _. t � R C, o ; c o o = '� O p ~ o ~ w C COO �7 phi r O :j 00 G w b cn 7C til O z � Cw/1 z 0 O in� < i, m o C o n m IM O z ,� U1 m C -0 N m o O O'vO�i� rm j O �' O C 3 CL IM A n M ' y O r. ca 0-0 0_ O = x D cr Gmw �. c1H. ami r„ cNn a m „ -v m 0 (D > R � C ^�3 -0 CIM 0 V -C ju E o -� 0 CL Ul d fD O O u} N .» _ Q X .,. 3 O O a 'o aj a N O ffl a 4 -Q a IVE M-1 O CLO : Z OA m'► ' n0 3 0 v ��.W :` i1 j: 0 CAI A �� CA ID o� 0 Se %ID4 �--� Al ~ N 70 z 4tq . o p Z z O 0 **fir Tp� CI C cn rY;�:r or•�a��ant� rw��Qr .19iifain No lam i Ir/ Boas ip'?; �■Q m m .w wo Him mm .._.___G T'� �UQA Q1�sCJu � �M�31�I®�rj iI l�® �19�i # ii9 i sHill �. ?t1��r�itA� �:•' :a:.:;d. i.f�,, ° 4.aiiw.'"_ ..".. i�r Vit.._ .. -M I r a1 I/A lr/ y 1 �4. , 1 A I c Ss I P t r h06 I I of Ila I ——� d t—An , — I IT t 1 _ A I to - .i r 4 �-- d p°� i F- A _ I OL s la I - I I 4-T tP"�Z --ol < a-2 -_� ► I Z' al ►I �� i • � tPl �a � I � I I / d� fl- 9 M \ it I u�i I I ►IZ ill ,,. Ilp ill t,2-,II =N IPI I I =- I I • • G •W Q W y O W � If'f If�-tb �¢l ifs"t6 tl it i�'•�E' d6 �i � u�'►S� 12,15115511, 1 , o U -7r m Q�s TIT FUI kL ZA m Q�s TIT FUI Town of North Andover NORTH O 4tLeo �b'9� Building Department �? g° ^.'6 0 27 Charles Street o North Andover, Massachusetts 01845 * ,� (978) 688-9545 Fax (978) 688-9542 T O COCMICNt KR 1 ACHU APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION .IOTO_t LOT NUMBER— L� / S/UBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION Co - 7- O / FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL, WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION DATE PLANNING DATE S D.P. W. —WATER TP ETER D K T -T1,0 DATE (N-7-r)q l� s - 3�a - o ff D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURE P AUTHORIZATION Location r` i 0 k) `e' J `fes C (j No. I I LA Date ,.-. I- •1, 4) Check # ) c( `( 145"3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1 6).s Foundation Permit Fee $ Other Permit Fee TOTAL Building Inspector Ey - TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING pCONSTRUCT a t rn BUILDING PERMIT NUMBER: DATE ISSUED: L CD —c3) (D G9 SIGNATURE: �.. Building Commissioner/IE&wefor of Buildings Date 1.3 Zoning Information: SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: o / i 0J -q FCidC� �� rn Map Number Parcel' Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �nb l -J -A-)e Name (Print) Address for Service : z -11�1 lop Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licens d Construction Supervisor: 6S 1� 9 License Number Address Expiration Date 7 9 —4, 6, 3_(�Q 6 Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone it h SECTION 4 - WORKERS COMPENSATION (M. G. L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work Lcheck all a heable New Construction '; Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1 SFCTTON 6 - FST11MATFTD CONSTRUCTION COSTS i Item Estimated Cost (Dollar) to be Completed by permit a licant tt(3FFICIhLULSE C3NL 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction o<' 3 Plumbing Building Permit fee (e) X (b) —�� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER. AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB r SIZE OF FLOOR TINMERS 1 s 2 ND 3 RDF SPAN DEVIENSIONS OF SILLS DIWNSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U -.LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT �� ,' zn�,'_C PHONE �9 i-- ASSESSORS MAP NUMBER (0 � LOT NUMBER SUBDIVISION LOT NUMBER STREET 'PG ofg. �� CaC C, Rd STREET NUMBER OFFICIAL USE ONLY 111 01O �IlVIENDATIONS OF TOWN AGENTS r �^ AL DATE APPROVED Z CO S VATIONADNIINISTRATOR DATE REJECTED CONUVIENTS (JI -C i1.. n .� NMilli LN/UA_\ZIZIa COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED SEPTIC INSPECTOR - HEALTH CoMMENTS PUBLIC WORDS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED MAR 2 02001 1 LO J-�� L BUILDING DEPT. �a �G C5 r rd-l000l . S1S•}8,I }j i n a o 6rizx xTo A AJ 2!f.- � r; Rye CO +� p�0�-t IS z z � '� 11�S• � O N y fel �0 m 1'1 r+r " D eb e imp r 7 X N v $ x + M �- M e � P �QV A& 146 7 r 1 P gig 7 X N v Q Los gig 7 X Proposed 12'x14' screened porch for 80 Pine Ridge Rd. 14'5 6'11 5'3 2'3 existing exterior wal I I 2x8 C0 LO 2x1016" screen door 12'3 14'5 2x1 a 16" 6/c '4 Tl 1 3 2x12 beam 3 1/2" lally columuns Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # O a '-� the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: 13 Facility location Signature of Applicant coo I Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. C Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: Ci Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job - company ob.Com an name. o - Address Ci Phone # C Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form da STOP WORK ORDER and a fine of ($100.00) a day against me_ 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do herby certify under the pains and pene/fies of perjury that the information provided above is true and correct Si Date J- Print name I t�, h� rn .�- 1 ��)ti f C' Phone # l -C.) 0 00 Official use only do not write in this area to be completed by city or town official' I] Building Dept ❑Check if immediate response is required Building Dept E] Licensing Board Q Selectman's Office Contact person:_ Phone #.• El Health Department Other FORM WORKMAN'S COMPENSATION U) M) m Cl) 0 S CO) 'O .00•► Z CD O CZ r CL 3;NCC2 .p O o p a� C7 m CD O Q O O O CO CD CO) .p CD a O 7 lr� O CO) .p C• C CA d CD O CD CD CA CD CA I C C ?- p go = O �• N O Q N d O S O 1= y O O A CD C3 co N ao T Z= O N O .-► C 3 C m ca C 0012 N � O O O: m a > > G 0 O Z H• n W -406O •m �,� so o A mCD m N CD C'! C CK m d m O N = D1 N N a W, C o W I • n 'C col m ;� `a Z5 E o CO) O CD 4 :0:o 0 0 o• : O : cv 0 o ,J ; N . IFc O N : m m a�:�P. r ob c o o=: C/) O C/) nig = y :p °� � C Ix 111: z n e r x T CL n 0 U) M) m Cl) 0 S CO) 'O .00•► Z CD O CZ r CL 3;NCC2 .p O o p a� C7 m CD O Q O O O CO CD CO) .p CD a O 7 lr� O CO) .p C• C CA d CD O CD CD CA CD CA I C C ?- p go = O �• N O Q N d O S O 1= y O O A CD C3 co N ao T Z= O N O .-► C 3 C m ca C 0012 N � O O O: m a > > G 0 O Z H• n W -406O •m �,� so o A mCD m N CD C'! C CK m d m O N = D1 N N a W, C o W I • n 'C col m ;� `a Z5 E o CO) O CD 4 :0:o 0 0 o• : O : cv 0 o ,J ; N . IFc O N : m m a�:�P. r ob c o o=: C/) O C/) nig = arc :p °� Jr,-po� r4 Ix 111: z n e r x T CL n 0 r" C/)� 9 n 0 b y b � ro n O b t7l O n � a C Is I z 0 H 0 0 c N� 4734 Date..' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i/ This certifies that ` .... !.:. is -�- f....:� ..�� .......... . has permission to perform ._.r . f-�..................... . iD plumbing inthe buildings ofle .� ....................... . at ...- .............. ` 1 ........ ,North Andover, Mass. v 0 ` Fee Lic. No.......... ............ . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS /9/ / Date "C/ Building Location1`l.C9- Owners Name Permit # a' Type of Occupancy PAZ Amount L 6 5 New [or Renovation M Replacement ri Yes ❑ No FIXTIRES .J (Print or type) Check one: Certificate Installing Company Name 2LLI��`� Corp. Address Partner. ©'R02� Business Telephone el��-���3_6 Q� Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the typ f insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 11 Bond ❑ . Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent 17 I hereby certify that all of the details and information I e s miffed (or entered) in above appli are true and accurate to the best of my knowledge and that all plumbing work installa ons rme der Permit ued f s-apication will be in compliance with all pertinent provisions of the M act S in C 2 of the General Laws. By: 71"KNM 01 Lice. um er /�Type of ®Plumbing License / Title J 0 City/Town License 74umber Master Journeyman APPROVED (OFFICE USE ONLY S CERTIFICATE OF USE & OCCUPANCY TOWN, OF NORTH ANDOVER Building Permit Number T Date THIS CERTIFIES THAT THE BUILDING LOCATED ON F 0 PI'IV&-` l\ 1 d g e - MAY BE OCCUPIED AS d/y � F.4in i l L/ 1 A% IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 11 POO m, 3 413A.7-h' 13A.7-h'3 'Stall U'V7 -c- 0 of "ILD CERTIFICATE ISSUED TO ADDRESS i < Building Inspector le m m m 0 m C2 C d d CA Cl) CD a Z ca CD O 0 , r C C im SM C =• CO) O v CD CD cr CD. CD O CD ccp cc 9. C O co) CD CL. O y �CD I S v CA O 10 CD Z O O CD O CD A" crr-Oo m a 0 d o m .� C4 am 0 o c) �c a o P.m Mg N _ =r -o N --I .O.F 7 ,d.► m H T_ I a?� o m 40 m N o y CD = ® N m a 5 . .O•F Z.n M O N lJ : COS ami CD IF H o m CL 9 m H d y q - : o � = c c. m'� c a • C! 2 �e m m N H _ CD w O A mom C�� -o :- co m _ct CD CaDm .. Arm o _ m r d m CD 0 07 Q C 0 '� (_. `A1 C) 5 b O C CD O ^I o �^ CL ^• ry�.. O 1 rte^ V J CL _' cc (n � m to c o" �-.. zy C. 0 CL r� � o Fri 7d A" crr-Oo m a 0 d o m .� C4 am 0 o c) �c a o P.m Mg N _ =r -o N --I .O.F 7 ,d.► m H T_ I a?� o m 40 m N o y CD = ® N m a 5 . .O•F Z.n M O N lJ : COS ami CD IF H o m CL 9 m H d y q - : o � = c c. m'� c a • C! 2 �e m m N H _ CD w O A mom C�� -o :- co m _ct CD CaDm .. Arm o _ m r d m CD 0 07 Q '� (_. `A1 C) 5 b o ::I o �^ CL ^• ry�.. z r� 0 Q N -N\ z 0 si H 0 O C Date.. [f �-- r,1 f pORTN A O �O 02 ` TOWN OF NORTH ANDOVER ` PERMIT FOR GAS INSTALLATION _ 1 This certifies that ........': , r' `. '_ ' , . )< /-/ �as permission for gas installation 0 ............... ein the buildings -of .: �r � . ................................ At • .. / • • • • ` .oma:.. ` P` ` % , North Andover, Mass. Fee. r... Lic. No. ...f !:.. ........ GAS INSPECTOR! Check# 35 3 1 � MASSACHUSETTS U>tiTFORM APPLICATON FOR PERMIT TO DO G.AS PTI INC 1Type or print) Date % —,3 QOO % NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New Renovation ❑ Replacement ❑ Permit t� Amount S Plans Submitted ❑ r (Print or type �zme l Address v Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSUR,-kNCE COVERAGE Check one: I have a current liability Insurance poli or it's substantial equivalent. Yes ❑ No❑ If NAti have checked yes, please in ate the type coverage by checking the appropriate bot. Ligbiliry 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 1=1'_' 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 herebv terrify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and i ons pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the :Mass use Statasde aapter I i' of e General Laws. By: Title CIN/Town APPROVEDIOFric-;iUSF!WN Y) ature of Licensed Plumber Or Gas Firter EI,Plumber 1 3O ❑ Gas Fitter ICe iNoer �77osier , r7 loumeyman :r s fv e���■�w��������������■� r (Print or type �zme l Address v Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSUR,-kNCE COVERAGE Check one: I have a current liability Insurance poli or it's substantial equivalent. Yes ❑ No❑ If NAti have checked yes, please in ate the type coverage by checking the appropriate bot. Ligbiliry 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 1=1'_' 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 herebv terrify that all of the details and information I have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and i ons pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the :Mass use Statasde aapter I i' of e General Laws. By: Title CIN/Town APPROVEDIOFric-;iUSF!WN Y) ature of Licensed Plumber Or Gas Firter EI,Plumber 1 3O ❑ Gas Fitter ICe iNoer �77osier , r7 loumeyman -A iM I 2;62 Date..=..:-� ........ .... 01 TOWN OF NORTH ANDOVER PERMIT FOR WIRING I -Z ........................................ This certifies that .... ........................ has permission to perform ................ ...................................................... ��- 7 . ....... wiring in the building of .... .../... 41 ........................................ — at ..........P� ........ ..-........ North Andover, Mass. Feey, ... .... Lic. No . ............. .......................... .................. ELECTRICAL INSPECTOR Check # A WHITE: Applicant CANARY: Building Dept. PINK: Treasurer lba -\ IRE WA1MUIVWAte4LJH UP AL LN]E UH4t/aZ11.3 Permit No. DEPARTAiENT OFPUBMCSAFETY BOARD 0FFIREPREYE\rff0NRWMTI0NN527CNR12.0 Occupancy &Fees Checked APPLICATIONFOR Pf RMIT 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 J — a7 3 r cw Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street � Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Purpose of Building Yes M No M (Check Appropriate Box) Utility Authorization NoAl�� Existing Service Amps / Volts Overhead a Underground No. of Meters 11.0 New Service � Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �.. / le 0-/C," A4r, riI *I 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 I 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 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 r OTHER IrtstrarneCo R>isu;�rYO�theregtwarter>�ckivi�sadt>s�Ga�aalLaws Iha%eaauaitLiabti*kwr&oePchyatidmgCm#Ak Coterdgea'itsa stafiale4ivalat YES NO IhawsubmeadvalidpoofofsametotheOHne YES M NO F-1 If}wimedtedWYFS,pleasewdc&thetWcfc ywWbydeckirtgtte INSU�� 0 BOND OTi Q ( ) WorkioSlart Tr�eaial1�e12e d Signed uxierM lkrul6es ofpe jury: FIRMNAME Exp= Lim F0Taed VakrdUedncal We is $ Rough Final Lia seNa 13 Lion ZePpv L'i/ /r✓l � Sigr>axtne .�� .��.� �.�..,�� _ LkmseNo —� /fin T _ Business TdNia 1 s 7F S6 3 D�,7 All /O g g / CGA119U/1 0/874 &1TeLNh -7?r - e G.;- OWNER'S WSURANC'EWANFR;Iamawa drttheLicwsedm not theirs==oaemWorits le*rml1atasmgWrxtbyMwmchus CaxaalLam "filmy (Please check one) Owner M Agent a Telephone No. .PERMIT FEE r ' �,: / j r Y ,/� ,/l.', .. / y�," ^ t^/C,. � `� �y: ,Yiry,.i ^ M1 `i' yyI '1 �. � �` � `�� � �� �r .� - � �n �. �'•' ' �• i + // `� . - . y � �f �� „d;::,,,5'..�^ ..✓�` :'5..1' :`. t, /�/� ,y� �: �, max,'-: +� � 4✓` �'' / ^ _ t". 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