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Miscellaneous - 80 SETTLERS RIDGE ROAD 4/30/2018
Date ........ 1176 Z ................................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ has permission to perform ....... .................................................................................................. 7- wiring in the building of .................. 1'�� ........................................................................ at ..... C ............... A— North Andover, Mass. Fee..:*...... Lic. No. ��9.3 -' 3 ................... 14 ................ .. ....... 4p ELECTRICAL INSPECTOR/ Check # P Z\1- Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 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 C), 27 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:SJ 13 City or Town of. NORTH ANDOVER To the Ins ect of Wires: By this application the undersigned give�n9tice of his or her intention torfot/he elecal yvork described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a buil7=71L ''Yes Ll� Purpose of Building S� No. No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / V010 Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters /,.,tl,., fnnn... ;v tnhlp mm) hp. wnived by the Inspector of Wires. Attach additional detail if desired, or as regwre y e nsp Estimated Value of lectrical Work: 2(When required by municipal policy.) Work to Start: k 2 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 cov age is in force, and has exhibited proof of same to the it issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) 0 I certify, under the pains andpenalties o erjury, that t to in tion on this app kation is true and complete S, FIRM NAME:. V U LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, e exemp ense nuter l' Bus. Tel. No., Address: U Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Departinent 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 PERMIT FEE: $ Si¢nature Telephone No. ..�,,, .�..,,,. , .,..,,.,...,.....b No. of -, -- - Total No. of Recessed Luminaires No. of Ceii. Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 3 Above In- Swimming Pool rnd. ❑ rnd. ❑ No. of Emergency ig ting Battery Units No. of Receptacle Outlets 2 No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Hear Number Tons KW "" No. of Self -Contained No. of Waste Disposers tap " •.• Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal ❑ Other Local ❑ Connection No. of Dryers Heating Appliances KW Security Systems:- No. of Devices or Equivalent No. of WaterKms, Heaters No. of No. of Ballasts Data Wiring: No. of Devices or Equivalent —signs Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: �— �X S� C.w� db 4.I ector of Wires Attach additional detail if desired, or as regwre y e nsp Estimated Value of lectrical Work: 2(When required by municipal policy.) Work to Start: k 2 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 cov age is in force, and has exhibited proof of same to the it issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) 0 I certify, under the pains andpenalties o erjury, that t to in tion on this app kation is true and complete S, FIRM NAME:. V U LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, e exemp ense nuter l' Bus. Tel. No., Address: U Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Departinent 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 PERMIT FEE: $ Si¢nature Telephone No. a J � .- • .+�JJ1utilJdJ.�-+.�f.•-a-f ��.a.�-I�J-L� ��� N.�.•�'llJ4.*.®.�.1 J-'o-u.4 ®J�•'�a'•i • .G. wC'J-�lt'P.1-7.11V t.7�rL'tL�.IV�.Y! �'asse$� r • �C+'aiTeri--r � � �te�ns�eciionxet�uixer� (��0.00)w j � . �st�iectaxS' cfl a fs: i (ins iectoxa' 'zgxtafu�re .now RIB) Pate 'asseci--Z � �'af�er�--r � ate-xns�eetZo�xe�ui�rea��$�OAD)�j � asPectoxs' comments, (lns ectoxs�,�ignatuxe -no znifiajs) Pate. , O � E CALKA M -a WA +0XMC-9-1131. seri--[ ) raiieri•- 3ecfbxs' eoaoamextfs; ( is ectoxs',fzgaatura-iowiiaxs) �nspectio; e a •-• F Iailer - j - ' 3 e nsp ecii actoxs' coximenfs: Pate .. �lus�p ectoxs' �zgnatuz'e � xto xnitza�s) . � �'iate ' i The Commonwealth of Massachusetts Department of Industrial Accidents 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): Address: S', City/State/Zip:A U-G,A 11`1 Phone #: '9'k 613 VI Are u 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. 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.] i employees. [No workers' " comp. insurance required.] Type of project (required): 6. EVeconstruction 7. deling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. E] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I 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. #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: Ak& �} Policy # or Self -ins. Lic. #: S L Ll 10 Expiration Date:9,110)n Job Site Address: 51D City/State/Zip: k" A&I, Attach a co rpy of the workers' compensation policy declara ' n 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 )f 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. r do hereby certify of perjury that the information provided gbovie is true and correct. s/z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Date .�.1.71-1.1.q .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that, L� C4-,2-, 6t .1 . ................................................. ... ........... . .............. has permission to perform ............................................................. wiringin the building of .................... ..................................................................... at ...... ......� ......... ! ?.. -......2 . Wh Andover, Mass. Fee .......... Lic. No.33 ...... H.Qr .. ....... 4: T, V�- ... e. ... . ........ .... ELECTRICAL INSPECTOR -10 - Check # (Ole Commonwealt4 o f MaeJa-C1 setts Official Use Only cc�� Permit No. 2epartment of Jim Sevvicea Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORIN ELE TRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME ), 527 •MR 12.00 (PLEASE PRINT IN INK OR TYPE L FORMATION) Date: Z City or Town,of �P,{ To the Inspe for o Wires: Bthis application the under ned ives notice of his or her intention to perform he electrical work described below. Y PP g g -,-_ , ') �-, n Location (Street & Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No LL-ff (Check Appropriate Box) Purpose of Building `j ! !i►G Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Z(� K (�% �'GU 3Ci1�e4 c�l 3 Com letion of the following table may be waived by the Inspector of Wires. Attacn aaadiunut uetuu ty dcal—, v, uo .may.+.• �� •••� -• r-----• -s -- --- Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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, ' surance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof ofAe r;thepp .t issuing office. CHECK ONE: INSURANCE BOND EJOT11ER E](Speci I certify, under the pa' penalties of perjury, that the inform�on on this application is true and contplet� FIRM NA E: U -4G 2.1 �-�. LIC. NO.:. Licensee• � 1L Signature ili` LIC. NO.:�� -- (If applicable, ter ,exem " in the 'cense number i .) Bus. Tel. No.: Address: ^A ilk. /0 Alt. Tel. No.: *Per M.G.L. c. 14 , s. 57-61, security w 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 a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. e�!— 0-";?, /,", Aw4w ki No. of Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA �J No. of Luminaires AboveIn- Swimming Pool rnd. Lirnd. ❑ o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection an No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Tota Tons No. of Alerting Devices Heat VumTotals Number. Tons........ o. of Self -Contained No. of Waste Disposers .......................W Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Municipal ❑Other Local [I Connection No. of Dryers ea Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of o. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommumcahons ►rmg No. of Devices or E uivalent OTHER: Attacn aaadiunut uetuu ty dcal—, v, uo .may.+.• �� •••� -• r-----• -s -- --- Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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, ' surance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof ofAe r;thepp .t issuing office. CHECK ONE: INSURANCE BOND EJOT11ER E](Speci I certify, under the pa' penalties of perjury, that the inform�on on this application is true and contplet� FIRM NA E: U -4G 2.1 �-�. LIC. NO.:. Licensee• � 1L Signature ili` LIC. NO.:�� -- (If applicable, ter ,exem " in the 'cense number i .) Bus. Tel. No.: Address: ^A ilk. /0 Alt. Tel. No.: *Per M.G.L. c. 14 , s. 57-61, security w 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 a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. e�!— 0-";?, /,", Aw4w ki IL ; GENERATOR APPLICATION DATE: �p/�t/i`I LOCATION: � Je- OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: e c) 2 V uc� PHONE NUMBER: 976P" 62Lo5 .587ool (ELECTRICA GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: R,2, *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVALO�.=A.�� a 1 North Andover Board of Assessors Public Access ..b E pORTH q O t,�ao • •yA 9SSACHUS�t Click Seal To Retum Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Y Parcel ID :210/061.0-0109-0000.0 FY:2014 SKETCH Click on Sketch to Enlarge Page 1 of 1 UMN Iroperty Record Card Community: North Andover PHOTO Click on Photo to 80 SETTLERS RIDGE ROAD Location: 80 SETTLERS RIDGE ROAD Owner Name: KENT, GERALD, & KELLIE TRUSTEES KENT REALTY TRUST Owner Address: 80 SETTLERS RIDGE ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 0.68 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3134 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 604,300 641,100 Building Value: 390,800 416,500 Land Value: 213,500 224,600 Market Land Value: 21.3,500 Chapter Land Value: kt I I'-,ciLLuc. tsuux: aioi rage: iso http://csc-ma.us/PROPAPP/display.do?linkld=2435934&town=NandoverPubAcc 6/11/2014 1* 10 N Date ....... 6. /3, �/ ..... "****,*,*, .. . ............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that j VV\ V�, f /-q� " / .......................----------------------------------------------- - has permission for gas installation ... gw r 4n--- ................................................................. in the buildings of k el... l . .....................N................................................ . at...... 6� .................. orh Andover, Mass. Fee ..:�� . . ........ q .......... ............ GAS-iN-SP-E-CMR Check #/ W .............................. .0 -�j 'r � 01 -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' r GG TYPE OR PRINT CLEARLY CITY . � l�-.A-A-1.0,1 ,� MA DATE G � � i&PERMIT # l7'' JOBSITE ADDRESS —Y�, Ste_ ns �.0 OWNER'S NAME F T�e-1 7- OWNER ADDRESS _ S� e TELT FAX .� OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL Q NEW: [ RENOVATION: E] REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO Q APPLIANCES Z 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-- -_ ._ I -... _ .�1 . I^-�... I DRYER FIREPLACE-� (.—� 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT - OVEN POOL HEATER ROOM / SPACE HEATER (OOF TOP UNIT ,UNIT HEATER �JNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 1[3'NO E 4 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ®I BOND E] 3 09 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT Q SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge 4 and that all plumbing work and installations performed under the permit issued for this application will be in com iance w' all Pertinent ovisi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME S •� _ _ LICENSE # 3�_� S N RE MP ED MGF Ell JP ® JGF D LPGI © CORPORATION # 3 3 �l _ k PARTNERSHIP E3# LLC E]# COMPANY NAME: _.._._=T_ADDRESS ►y_�C S�__�_^ __ ____._ __� CITYq 0 L) �r� - - _-f STATE ZIP D l8 Y . _ TEL ? & FAX CELL j �> �3EMAIL Axl H O z H w a w 41 ° ❑ a z O W NEl COD} OH a Z LU CO w 5 a LLILU O L U) g a w a U J H °- a < x w 1- LL H 0 H U W Pi U' r�7 O a, I N The Commonwealth of Massachusetts Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston, MA. 02111 VV www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organi'zationllndividual):, Address: City/State/Zip; Phone #: 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. Q New construction employees (full and/or part-time).` have hired the sub -contractors 2. El am a sole proprietor or partner- listed on the attached sheet. �• E] Remodeling ship and'have no employees These sub -contractors have 8. Q Demolition working for me in any capacity. workers' comp. insurance. g, El Building addition [No workers' comp. insurance 5. Q We are a corporation and its required.] officers have exercised their 10.[] Electrical repairs or additions 3. ❑ I am a homeowner, doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers' comp. c.152, § 1(4), and we have no 12.Q Roof repairs insurance . re uiredemployees. [No workers' required.] 1311 Other comp. insurance required.] zAny 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 sire 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. #: ExpirationDate; Job Site Address: City/State/Zip: Aftach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 maybe forwarded to the Office of Investigations of the DTA. for insurance coverage verification. I do hereby cert under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: 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. PIumbing Inspector 6. Other - - Contact Person: Phone Information and Instruction's ' 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 maybe 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 (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The ComMoar walth ofMossochvsPtts Depa7rtmeut ofladustdal .A.ccideuts OffXce of Investigatio.m 600 Washiwoa Street Boston MA 02111 Tel, # 617-727-4900 at 406 or 1-87WASSAFF, Revised 5-26-05 Fax # 617-727-7749 '�tt��_mace an�rfrlia I* GENERATOR APPLICATION DATE: LOCATION: OWNERS NAME: V--e-tj t GENERATOR kw Zo NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: —� PHONE NUMBER: ELECTRICAL RESIDENTIAL "f 6 /�- 1-71 1�7f b�fZ 0 GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: o v s� *ZONING DISTRICT: � 2 *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL -. NRATION DF „I 01U8 Date ..... _ /. �..2'"./-.. //. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ,7.�'��. �� �.�... '......... ............................. ......... .... has permission to perform i...........54vZ..-............................................ wiring in the building of ......... 5 ✓ �.?z. ....... A..!ee...' ............... at ....... A)...... T4-1=Ie....1..4.. U. .�P�LECTRIC&L ...... , North Andover, Mass. � l/ Fee..? 7-. �...''Lic. No5/...3.1�..,, ....................... ItV(9 EC ' Check # ���� / A Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. _� 2 O 1 BOARD OF FIRE PREVENTION REGULATIONS Occupancy 1/07] (leave and Fee Checked leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pertormed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.00 (PLEASE PRUTININK OR TYPEALL INFO TION) Date: I City or Town of: A To the I s ector of Wires: By this application the undersi ed gives not' e of his or her int nt'on to perform e e ectrical work described below. Location (Street & Number) f Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a bu' ding p it? Yes No ❑ MI BLDG PERT # Purpose of Building % Il / Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / VoIts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wl 7ti 3 �Ly Y1 ny,��, No. of Recessed Luminaires 11w. nyaromassage Batntubs -No. of Motors Total HP I I r .620 0—fig eaute may ae watvea ay the inspector of Wires. No. of Ceil.-Susp. (Paddle) Fans No. of Total. Transformers KVA, No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ in ❑ o. o mergency ig mg rnd. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. TotaTons No. of Alerting Devices No. of Waste Disposers Heat Pump Number *""" Tons """"""""""'* KW No. of Self -Contained Totals: "'"""'""'"'"'""""""' Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Securiiy Systems:* No. of Wafer KW No. of No. of No. of Devices or Equivalent Heaters Signs Ballasts Data Wiring: ;. No. of Devices or E uivalent -telecom mumcations Wiring: No of Devices or Equivalent OTHER. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of flectrical Work: (When required by municipal policy.) Work to Start: <91 2 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO RAGE: 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 equi alent. The undersigned certifies that such coverage is in force, and has exhibited proof of s e tojthe pe 't issuing ffice. CHECK ONE: INSURANCYenafttie§-,&erJy BOND ❑ OTHER ❑ (Specify:) , /� �f I cert, render the pared4at1he&*rmat1og_o tis application is true a come let _ FIRM NAME. CIO v\ LIC. NO.: �- Licensee• �. S612 LIC. NO - (If applicable, ente em t" i�i ense m er line. Bus. Tel. No.: P Address: otJ n er li )*Per M.G.L. c.147, s. 57-61, security work requires epartment oy "S" Licen Alt. LIC. oO. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL F PECTION: Failed – [ ] Re -inspection required ($50.00) - [ments: (Inspe tors' Signa re - no i Itials) z Date 2. FINAL INSPECTION: Passed Failed – [ ] Re -inspection required ($50.00) Inspectors' comments: C/— - no initials) Date 4. INSPECTION – SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed – [ ] Failed – [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: A 1 (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. 9419 Date. �A411 .. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING °SACMUSE J This certifies that ...�"��'..�—��.���1/�.......... ...... . has permission to perform ../Ea ..................... plumbing in the buildings of ........... ..... . /tlPrS 1 6rih Andover, Mass. r Fee uV . Lic. No.... ..... .� ........ PLUMBING INSPECTOR Check # ��� DEDICATED GREASE SYSTEM L—A--A --Jl --- J__I I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY _ I ROOF DRAIN SHOWER STALL _ SERVICE / MOP SINK --__J ( _ — TOILET — I URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING _ OTHER f _ uj INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY as / OTHER TYPE OF INDEMNITY n BOND E] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 01 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mpl e with ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME C LICENSE # SIGNATURE MPD' JPD�r' CORPORATIONEI# PARTNERSHIP# LLC Ek COMPANY NAME C/6� — Q .Q E ADDRESS CITY II STATE ZIP d (' _ TEL RT FAX � CELL EMAIL — i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY V MA DATE PERMIT # JOBSITE ADDRESS log �OWNER'S NAME POWNERADDRESS �' TEL 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL RESIDENTIAL �— PRINT CLEARLY NEW: El RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES NO® FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM I DEDICATED GREASE SYSTEM L—A--A --Jl --- J__I I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY _ I ROOF DRAIN SHOWER STALL _ SERVICE / MOP SINK --__J ( _ — TOILET — I URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING _ OTHER f _ uj INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY as / OTHER TYPE OF INDEMNITY n BOND E] OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 01 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mpl e with ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME C LICENSE # SIGNATURE MPD' JPD�r' CORPORATIONEI# PARTNERSHIP# LLC Ek COMPANY NAME C/6� — Q .Q E ADDRESS CITY II STATE ZIP d (' _ TEL RT FAX � CELL EMAIL — i H z° 0 H U W a w o z N El p F- rA W � W r7. w O W z oCl) w 5 a W CLU W u d w p zz a a � w a � U J IL IL v� Q � w x w LL W H °z 0 F U a z a a c�7 p h The Commonwealth of Massachusetts • - Department ofludustriglAccidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriicians/Plumbers Applicant Information Please Print LeWb Name (Business/Organization/Tndividual): ld/ro R t SGV Address:A fia �e City/State/Zip:_ 6 o 6) A 00 t Phone M 'I T ' TOO Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (fall and/orpart-tim.e).* 2. I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. x 7• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working forme in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. F1 Building addition required.] officers have exercised their 10.❑ Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing. repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' comp, insurance required.]-1311Other "Any applicant'hat checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they Sze 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. X am an employer that is providing workers' compensation insurance for my employees Below is the policy antlJob site information. Insurance Company Name: S. Q Alc , Policy # or S elf -ins. MG. #: b _-D . N-1 Expiration Date:IL lob SiteAddress:.S�4 s t d cY P City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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. Xdo Hereby cer ' under tliepains and enalties ofperjury that the information providd drbo/V is true and correct. - Official use only. Do not write in this area, to be completed by city or town offrcial. City or Town:. PermitaAcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Information and iustructi®n8 . 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 ofits political subdivisions shall enter into any contract for the performance ofpublic 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) amdpbone numbers) 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 notrequired to carry workers' compensation insurance. Llan LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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. Anew affidavit must be filled out each year. More a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves etc.) said person is NOT xequired 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: Tho Commonwoaltf of M-assachvse-tis - Mp.aftent offadustdai Accidazits 41�ce 0£ I11vestigatims. 6.00 Wa$b toa Stxeet Boston? MA. 02111 TQJ, # 6x7 -72? -4900 oyt44G or 1-877�MASSAFB Revised 5-26-05 Fay ,# 61T727-7749 'tvtvW-Mass,govf dia Location 80 S� (��'S�ck� "Cj No. L4 b I Date a 3'd3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ It Building/Frame Permit Fee $ �GMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a5 0 0 4k Check # a y Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Q(�Y [ . • • i+34 1 K•• 01,171,51 BUILDING PERMIT NUMBER: /D DATE ISSUED: SIGNATURE: Building Commissioner/1ctor of Buildings Date SECTION 1- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 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 Required Provided 1.7 Water Supply M.G.L.C.40. 54 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System. 0 SECTION 2 -. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Sc Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: ,J Name Print Address for Service: t Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: k 6N W6+ . K6F� Licensed Construction Supervisor: Address re Telephone 3.2 Regiftered Home Improvement Contractor Company Name Iry '1T . /1 Not Applicable 0 License Number Expiration Date Not Applicable 0 /o 23 T3 Registration Number Ad�ddrr�jw�h q (� QO _ l ° � �l "S Z� Expiration Date ` V M X Z 0 W. Q rn �J W 0 z M 90 0 on r Q M z 0 SECTION 4 -WORKER$ COMPENSATION (At 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 buildin unit, Si Yned affidavit Attached Yes ....... No ....... ❑" SECTION 5 Descri tion of Pro osed Work check all a licable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) � Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: S�-A Pie A,, L?f} 56- __m SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com leted b ermit a licant ' :`fir *�rW"m I. Building :. x Y F s E 4�4� :z� P �y oo (a) Building Permit Fee 2 Electrical Multi Tier (b) Estimated Total Cost of � � ' 7/� � 3 PlumbingConstruction 4 Mechanical HVAC Building Permit fee t,1 X tbl 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 II ` as Owner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by this building permit application, to act on Signature of Owner SECTION 7b OWNER/AUTAIIORIZED AGENT DECLRATION Date .property ,a&1Pmdc0Authorized Agent of subject Hereby declare that the statements and information on the fore and belief going application are true and accurate, to the best of my knowledge M NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR lTIv1BERS l SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUMDING CONNECTED TO NATURAL GAS LINE IZ—Z—off Date SIZE 2 THICKNESS X a vm Th a Commonwealth of Massachusetts aie Department of Industrial Accidents Oiiiev#11fl estigalions a cam. 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit location: �i( n�W ♦ A[J �� city N f! N d J £It phone # Fj I am a homeowner performing all work myself am a sole proprietor and have no one working in any capacity _ _____.---_____...__...__.__„a,,,„M,,.,,,,...,�.�.. -,rra�vs�✓..w/.z�.�c%fei"%�".,�6v.�6.O/.0 � ,. , ..;,,. , . ... �;�'�a�� I am an employer providing workers' compensation for my employees working on this job. company name: _ address: city: - ohotie #t comoanv name: official use only do not write in this area to be completed by city or town official city or town: - permit/license # nBuilding Department O pLicensingBdard check if response is required OSelectmen's Office OHealth Department contact person: phone #; Fl Other (revised 3/95 PIA) Board of Building Regulations and Standards HOME IMPRbVEM'ENT CONTRACTOR Reej gistratl.on 108383 Expiration 8/1,%2004 Type DBA KEEN CONSTRUCTION CO. Kenneth Keen 21 Hewilt Aver No. Andover, MA 01845 I\ Admin�strafor �, ✓fie l�anvnaoozuie o�iUCpgdacszu4e6 f BOARD OF -BUILDING. REGULATIONS E I a �.. ' ° License ;CONSTRUCTION )SUPERVISOR ; Numbers=CS 058245,,;` j :Birthdate- 03124X13,43 EXpires:: 03/24/2004 Tr;I o: 20,021 G Restricted: '00 KENNETH•B KEEN R> AVE iork' 21 HEINITT N ANDOVER; .MA 01845 Adfgator. Board of Building Regulations and Standards HOME IMPRbVEM'ENT CONTRACTOR Reej gistratl.on 108383 Expiration 8/1,%2004 Type DBA KEEN CONSTRUCTION CO. Kenneth Keen 21 Hewilt Aver No. Andover, MA 01845 I\ Admin�strafor �, FORM U - LOT RELEASE 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT t 3 T /'_A +a( '� 'q_� LOCATION: Assessor's Map Number. SUBDIVISION n , STREET OD S _111EIZ PHONE'?/i PARCEL LOT (S) ST. NUMBER S *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMM TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY FIRE DEPARTM RECEIVED BY BUILDING INSPECTO Revised 9\97 jm TE 9 is Qj o i In ep c KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Kent, Jerry & Kelley 80 Settlers Ridge Rd. N. Andover, MA 01845 (978)975-1904 Contract # 1534; Appendix A Date: 10/05/03 Remodel basement: • Frame interior partition walls to create approx. 625 sq. ft. of finished area including office, family room and two closets as per drawing • Create'/2 wall -on family room side of stairs • Supply & install blocking and 2" PVC pipe to accommodate TV as discussed • Supply & install insulation and vapor barrier on all exterior walls and under stairs • Supply & install blue board and skimcoat plaster on finished side of new walls to smooth finish • Supply & install two 3'0" x 6'6" hollow core 6 panel smooth door units • Supply & install two 6'0" x 6'6" hollow core 6 panel smooth unit pairs • Supply & install one 3'0" x 6'6" 15 -lite pine door unit • Supply & install one 2'6" x 6'6" hollow core 6 panel smooth pocket door unit • Supply & install standard passage sets on all new doors • Supply & install molding on doors and baseboard to match existing • Supply & install 2'x 2' revealed edge suspended ceiling throughout finished area • Supply & install MDO plywood shelving in pantry closet • Supply & install approx. 83 sq. yd. of carpet in finished area and stairs from main house ($2241.00 installed allowance) • Paint walls and trim(2 coats, 2 neutral colors) • Supply & install 12' of cabinets as follows: • (2) 18" x 18" x 84" tall cabinets • (2) 18" x 18" x 30" drawer base cabinets • (2) 36" x 18" x 30" double door base cabinets • Supply & install 9' of granite counter Electrical: • Supply & install two zones of electric baseboard heat and two thermostats (one programable) • Supply & install ten recessed light fixtures on two dimmer switches in family room • Supply & install two 2' x 2' troffer fluorescent light fixtures in office • Supply & install two telephone outlets (Cat. 5 wiring) and two cable outlets • Supply & install one new smoke detector in HVAC room KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Supply & install outlets to code Plumbing: • Relocate six sprinkler heads to suspended ceiling • Cut in dampers for supply & return of existing HVAC ducts Price does not include cost of permits, moving secondary electric panel, shelving in walk in closet, or any work deemed necessary by the radon inspection company. Total cost: $24,844.00 (twenty four thousand eight hundred forty four dollars) Payment schedule: $1000.00 due upon signing contract C. 11 ''"{ I' S $7000.00 due the first day of work $8000.00 due when rough framing and rough electric is complete $6600.00 when job is done except for flooring $2244.00 due upon completion of contracted work Gomer ri lu��� Date l&nneth B. Keen Date 2 w O O H 0 z . • V � � o a • o � �I' C N o • � O o v v e N a, A w° oo aoG U w ca a+ ao' cz w a W o ao' w o ao4 m w w wo cn o cn w O O H 0 z . • V o • o � �I' C N o • � O d Occ �om 1 V Ea Q C O E w Sc a 'CD Cf mc t y to cr �i oLI•Z'3 :mm Q y m CD ca L4 co o E m cc cm Am m �• .r. k Qf ?_ c y Q � m L o V �t�v•oz o C d0 O C 3 _ � 4CDL :a o H 0 y LU o CD tot m w AD O y C C:5 y Z O C.3 a 5 � = A CL. - v ) IND 4 w 0 CD E O cc isZ o ca .E CLL O O cc :7 CIO O y O cc C CA L v a� CL CO2 c c c O■� 0 CC) m H = C 3 -a O L O C' �. cc O O Z s CL CA C LLI N Y/ 19 W ul lz LUW C4 M KEEN CONSTRUCTION CO. n 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted�'''���````���� fI- - - - t J ._._.. 1579 PROPOSAL All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. F.I.D. N0. �9-22 - G - _. MA. H.I.C. 108383 04-325-8052 C/S = Customer Supplied S + I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: e M 6el0 1 [1t, Construction related permits: %``° '• "� TOWN OF NORTH ANDOVER A PERMIT FOR WIRING This certifies that C ti ! `� r / c ........................................................................................... has permission to perform ...........!.:�..5 S m wiring in the building of .....° N ...................................................................... o° at ...... - C ...... . r5...>.!C),I.................. . North Andover, Mass. r �2 'e A Fee ... h. ........ Lic. No. ?.1. .2 ....................................... Im....................... ELECTRICAL INSPECTOR Check # �� S 4911 4 P1 rr Offi 'al Ue c Permit Nj. 71?V£ 00 Dyu PuG Sa�cty Occupancyhec BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 L , .4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accor� nce with the Massachusetts Electrical Code 5//27 CMR 12:00 �l (Please Print in ink or type all information) Date 1' • �`y To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work describb Location (Street & Number V D Ile L,5 K" Owner or. Tenant %i'/p( "i' l/(� %C e / Owner's Address t/ �'j'1 41 S `i v Is this permit in conjunction with a building permit Yes 9/ Purpose Existing No 0 (Check Appropriate Box) New Service Amps Voits Overhead a Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No. Undgrnd 0 No. of Mete Undgmd U No. of Mete OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability In Policy includpleted Operations Coverage or its substantial equivalen YES NO = have valid proof of same to the OffiYE NO = If yqu have/A`he�please ��e the type ofg�by.checbng the appropriate box. INSURANCE BOND = OTHER (Please Specify) �jCjM /Q c/-% (Expiration te) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under tha �Penatt' perjuFIRM NAMEs Gi V LIC. NLicensee OC 1gnature _ 4. LIC. NO. Tel No. �/ ! / Ove, e ✓d /r C" G - _,,t B Address AIt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass: General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE $ t/ Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures ' Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting, No. of Receptacles Outlets 13 No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone _ No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices _ NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices _ 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability In Policy includpleted Operations Coverage or its substantial equivalen YES NO = have valid proof of same to the OffiYE NO = If yqu have/A`he�please ��e the type ofg�by.checbng the appropriate box. INSURANCE BOND = OTHER (Please Specify) �jCjM /Q c/-% (Expiration te) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under tha �Penatt' perjuFIRM NAMEs Gi V LIC. NLicensee OC 1gnature _ 4. LIC. NO. Tel No. �/ ! / Ove, e ✓d /r C" G - _,,t B Address AIt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass: General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE $ t/ (flame r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone # QI am a homeowner performing all work myself. 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 jot Company name: Address City,I?tticirle# . Insurance Co. - - ---- Policy# Company narne. Addrt�s. frr . PIS Failure to secure, coverage as required water section 25A or W3L 152 cart legitto-the inveliof.crbn al.per� of arty andlor one years' imprisonments well-asttay understand that a copy of this statement may beforwarded to the Ofte of h esfigabons of the DIA for c7nveiage verification. / ab hereby c&tfy wx kr Has pairs and peneAws o/pegLVY Haat Hae ird+anrna#W p►ovi*d above is Lye and caomct Signature Date A Print name Oficial use only do not write in this area to be completed by city or town offx iW City or Town OCheck if immetkate response is reguked ba p Se/ Contact person: Phone A � Fret n Ott IR !- Z�l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIDO PLUMBING Cype or print) NORTH, iiuilding Loca - / Date J-0-ve-, Cq- / f' s �l Permit # Amount Owner's Name -- G.+e1 �4 New 01"' Renovation 0 Replacement FIXTIIRF 4 Plans Submitted n (Print or type) ( p Check one: Certificate Installing Company Name Corp. Address a L4 �� Partner. Business Telephone (A ? -3 Fa- '� � � Firm/Co. Name of Licensed Plumber: oa /Q/,�j�¢�� r e Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1E1 Other type of indemnity ri 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 1-1 Agent 11 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 Mas setts State Plu ng Code and C er 142 o he General Laws. By ig ure o (censea Plumber - Title ,1YPe u er Type of Plumbing License Title City/Town ticense Number Master Journeyman APPROVED (OFFICE USE ONLY MASSACHUSETTS UNIFORM APPLICATION FOR PERI4IT TO DO PLUMBING .ype or print) NORTH ANDOVER, MASSACHUSETTS VU ilding Locations Owner's Name New Renovation Replacement Plans Submitted 1 1 TTYT1rT12 F C Date Permit # Amount (Print or type) Check one: Certificate Installing Company Name El Corp. Address 13 Partner. Business Telephone 0 Finn/Co. Name of Licensed Plumber: Insurance Coverap-e: Indicate the type of insurance coverage by checking the appropriate box: 11Liability insurance policy H Other type of indemnity 1311 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 Ignature Owner 11 Agent n 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 Plumbing Code and Chapter 142 of the General Laws. I tue City/Town LAYYKU V ti) (OFFICE USE ONLY ' igna ure ot LlcenseUum er Type of Plumbing License kens um er Master 11 1:1 ❑ • -N _ ;P SII i it ........................M. MONO ................... i` MONO ...................0 ..1 /1' .....� ................... (Print or type) Check one: Certificate Installing Company Name El Corp. Address 13 Partner. Business Telephone 0 Finn/Co. Name of Licensed Plumber: Insurance Coverap-e: Indicate the type of insurance coverage by checking the appropriate box: 11Liability insurance policy H Other type of indemnity 1311 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 Ignature Owner 11 Agent n 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 Plumbing Code and Chapter 142 of the General Laws. I tue City/Town LAYYKU V ti) (OFFICE USE ONLY ' igna ure ot LlcenseUum er Type of Plumbing License kens um er Master 11 1:1 ❑ Date!!.. -CU . �...... 3715 NOR7q °;.�oo� TOWN OF NORTH ANDOVER Fo . F ~ PERMIT FOR PLUMBING SSAtMUs� This certifies that ...- ... (/�./`.}��/ .................. has permission to perform �.... �... . plumbing in the buildings of ............ at q:� ......... North Andover, Mass. Fee /..... Lic. No/. / 3.�.�1.. ............................. . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ZASSACHUSETTS UNIFORM APPLICATON FOR PERMIT/Do AS FITTING or print) IvuK'fH ANDOVER, MASSACHUSETTS Building Locations 2: e -- j e' �,.� Owner's Name ✓ New I ' Renovation ❑ Replacement ❑ Date Vyiy ', 02 19 9O Permit # Amount $ vcv Plans Submitted ❑ (Print or typ Name . r{ Address Business Telephone ,, r1 *!� ' --j ,K5 ,, �— ei „ e_ Name of Licensed Plumber or Gas Fitter ,ever IN Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [Er No ❑ If you have checked des, please indicate the type coverage by checking the appropriate box. Liability insurance policy 301*' 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 ❑ 11c1cVy certuy Mat aii or the details and mtormation 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 Massach s State Gas CO and Chapter .15 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed PlgUiber Or Gas Fitter ff—plumber "F/f Sgy ❑ Gas Fitter License Number er ED -Master ❑ Journeyman m x W F = F z w F z a C F w w E•» w C Ci z F z " r '" c. W e., x Ci C i z W i x W Z Z '� i x 'C Z C C C z W SUB-BASENI ENT > BASEM ENT r 6L� IST. FLOOR ` 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR F-T--rl 6TH. FLOG R 7T 11. FLOOR 8T 11. FLOOR (Print or typ Name . r{ Address Business Telephone ,, r1 *!� ' --j ,K5 ,, �— ei „ e_ Name of Licensed Plumber or Gas Fitter ,ever IN Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [Er No ❑ If you have checked des, please indicate the type coverage by checking the appropriate box. Liability insurance policy 301*' 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 ❑ 11c1cVy certuy Mat aii or the details and mtormation 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 Massach s State Gas CO and Chapter .15 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed PlgUiber Or Gas Fitter ff—plumber "F/f Sgy ❑ Gas Fitter License Number er ED -Master ❑ Journeyman 2672 Date. .4 ..efl ...... 1. A u EE } TOWN OF NORTH ANDOVER 12 PERMIT FOR GAS INSTALLATION M O 07 / CU G This certifies that .:.... ...... ................. . has permission for gas installation . 'I . ... ......... • • • z., in the buildings of ......... ....... ..... ........... at.� .�� ''. �.' : ��`� •' :` z �.'• ; North Andover, Mass. Fee.... Lic. No. ......... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer •= 9 � P� Shay BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No_ 11F6 tr Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) To" of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number &-o sc_- (t C-� ,S ict- I-) �Zti -') Owner or Owner's Address /14 fi .—e - Lo / V1 _ Date .J "5 i �r To the Inspector of Wires: Is this permit in conjunction with a building permit Yes m/No ❑ (Check Appropriate Box) Purpose of Building / ` ��t L— ��( rY�- Utility Authorization No. F03 / Li Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service 2�00 Amps 14L' Voits Overhead ❑ Undgmd M/11� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work c —61 OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a cun-ent Liability Insurance Policy including Comple Aerations Coverage or its substantial equivalent YES NO = have submitted val�roof of same to the Office YES"Cl = If you hive checked YES please indicate the type of coverage by checking the appropriate box INSURANCE b' BOND = OTHER = (Please Specify) G � � (Expiration Date) % Estimated Value of �^cal Work$ D�bd _ W_�� Work to Start `- 7 '1 `if Inspection Date Resquested 6,A4-4-� Rough Final Signed under. the Penalties of perjury: FIRM NAME_, Ms�i 1� t �� cc<-,&— �0�+�i'� C�� I_ . C LIC. NO. Signature " ' \ / ��\ LIC. ~(� , ' Y�us. Tel No. 4,013-s Address wo o� `1 ; 1 Su_� Alt Tel No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Total No. of Light8ng Outlets No. of Hot fuse No. of Transformers INA Above ❑ In ❑ No. of Lighting Fixtures J Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets <10 No. of Oil Burners Battery Units No. of Switch Outlets/ No of Gas Burners 3 FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond 13 Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a cun-ent Liability Insurance Policy including Comple Aerations Coverage or its substantial equivalent YES NO = have submitted val�roof of same to the Office YES"Cl = If you hive checked YES please indicate the type of coverage by checking the appropriate box INSURANCE b' BOND = OTHER = (Please Specify) G � � (Expiration Date) % Estimated Value of �^cal Work$ D�bd _ W_�� Work to Start `- 7 '1 `if Inspection Date Resquested 6,A4-4-� Rough Final Signed under. the Penalties of perjury: FIRM NAME_, Ms�i 1� t �� cc<-,&— �0�+�i'� C�� I_ . C LIC. NO. Signature " ' \ / ��\ LIC. ~(� , ' Y�us. Tel No. 4,013-s Address wo o� `1 ; 1 Su_� Alt Tel No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) No r-. Date .................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 8 CP N This certifies that. .................................................. t has permission to perform ........�............ �:.. ..................� wiring in the building of ............................... ....................................cam at .. .:..... �% ,.tr'Q�....................I ................... . North Andover, Mass" d Feed/ ��, ........... Lic. No r .. ................................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C 0 TOk r k Vol lip lo •..:.a . A �/ •t• air`° (D O CW fD .� Dor m = a O a0 0 N Co 0 3 Z N m O. 0+ -(D CD 0 n > > m 3 = 0 c Z ` m m m a o r m _ _ 69 64 69 69 .69 69 z 0 ! 0 N '?8 17 13:11 , C p C 0 21 j� 0 0 A i z z Z m m m 0 r -1 -i r 0 1 c n m r m r 3 1 ° 0 m r o z Q 0 m r j i i V 1 N �s w A T m 0 m 0 00 or O 1 9 m 0 A a > > m 1 0 1 m 1 N L1 m - m m 0 o N m> C 0 A S r 0 1 c r 0 c m n a m 3 1 ° 0 m r o z n 0 m r j i i Z o m 1 m n w a ->i 0 m i a a >° A � W 0 o N p ;; z M c 0 j 0 z N W A 0 .9 m z 0 > 0 z m 0 A f r a C w C in C_ > A > ° a I>> o N o N m> C 0 A S 0 f m o f m> r 0 N 0 2 3 1 ° 0 m r r o z r 0 z r o z 0 m r Z n m Z n m Z o m A m n w a ->i 0 m >° A z 0 ui 0 r 0 o 0 m p ;; p 0 m; z ,� a o m i Z W > n Z p > ° _i 0 �` p Vt 0 i -4 A A m ; m a a \ N -ni A 0 Z z ` m A( 0 \D 0 ci Z LQg rn 0 m A 0 Z m c ON i > m > A i jp m w m rA m a m A m a 9 Z a M m mol z Ic_" v A p o z r o z r o°>z z r z r 0 i q z Z 0 r r i * m i 8 m 0 m n 0 0 o 0 0 0 0 Z 0 n o i_ Z ,� C a 0 A 0 A 0 m a w 0 A Z Z Z m Z m a= 0 Z a z > i 61 A o 9 m a` r r i ; m > m r o 0 o i m o A m ° ni m ° 0 z m a .4o a a m H n 0 0 0 i 0 0 0 A r r Uv ; m -4 G'► t N i A > r * z m m f z > > .off r > z N I 0 M m i o Q N r > a r A m A N z m W - o > m i ° ` — m n a Z a � Q W A 0 0 � W .9 � I > Im ram C � •C Ummm. ce CD n z y 06 n. � O C. = y > CO Oir O v CD CDCL O Cr CD CD O CD C• CD CO) y �• O CD n O z cn aN PO on C O 0 Z Oi. Z m CL 7 m O C F to CD m O C, C 0 Ci CA y l • a —Cos 0Q y d m y OOO.O m !9 O 21 CD a -1 y m =r o G. � ..F0 wm y T ` CL o O. ?0 rT1 -1amy o Vol) -1 m - : O a O y O �-O_ .Oi 4 ID O y CC2 O O Oy O,io CL � CD CD m y � n-= cc CD y d. =r CS d•to C �r � O �1 �co � y d ce 'O CD bl ccD) •• b m i> .= yco CL 0 1 CD o Co h•! o n n O M a- GO �• C tri ro � CA w �- 7 C n .0�.. x a 0 c A* x a 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: Other (Non -Electric Resistance) DATE: 4-1-1998 DATE OF PLANS: 3/20/98 TITLE: Settlers Ridge Road Lot 6, #80 PROJECT INFORMATION: Settlers Ridge COMPANY INFORMATION: Tara Leigh Development Coro. COMPLIANCE: PASSES Required UA = 618 Your Home = 505 Perms Checked by/Date- Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 2170 30.0 0.0 77 WALLS: Wood Frame, 16" O.C. 3058 19.0 3.0 165 GLAZING: Windows or Doors 56 0.300 17 GLAZING: Windows or Doors 488 0.300 146 FLOORS: Over Unconditioned Space 2106 19.0 100 HVAC EFFICIENCY: Furnace, 80.0 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 has been determined using the applicable St in the Code. The HVAC equipment selected t shall be no greater than 125% of the des ig sections 780CMR 1310 and J4.4. ! � 4 Builder/Des d cooling load if appropriate pdard Design Conditions found cheat or cool the building load as specified in Date w MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 Settlers Ridge Road Lot 6, #80 DATE: 4-1-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C., R-19 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U -value: 0.30 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments Location [ ] 2. U -value: 0.30 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ) No Comments Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1. Furnace, 80.0 AFUE or higher Make and Model Number THERMOSTATS: [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ) Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating 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 ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. The HVAC 41 system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------- F CERTIFICATE OF USE &OCCUPANCY Town of North/Andover Building Permit Number 6 Da THIS CERTIFIES THAT THE BUILDING LOCATED ON ��• MAY BE OCCUPIED AS I ACCORDANCE WITH THE PROVISIONS OF TH MASSACHUSETTS TATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 4�() CERTIFICATE ISSUED TQ�� ADDRESS' Building Inspector a N c y CDC d y n Z y C C7• C CL =• CO) O n � CD o p CDCL O crd CD CDo CD C CD W CL v y COC I � v CO) O 'v Z CD O � CD O 0 r_. f W, L WE 0 o ciao m z Soca y o. sA-8 ,. 3 • m ? m n�of y OEm� a fC O oZ SRO CD:: W It iG � p a - O m N CCo. CL C y Ho 0 036 =� Q o n aR. N C.CD m CD H ti ti� O CA co :oSrff CD C. y :LIOCD: >f c � m d m CV CR c Ri ,\% v ``4. 1 z 4) W M . onq 0 0 c c� w r o `101, 'd �� oro - 'c g •V v' O �' O q� v ro O cx 11 ,\% v ``4. 1 z 4) W M . onq 0 0 c c� CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE. "=40' DATE /12/98 Scott L. Giles R.P.L.S. Frank. S. Giles 50 Deer Meadow Road North Andover, Mass. 0 GE .rrl E NJ► 1� p0 vs� eel 15N 1 CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING H DETERMINATION OF ZONING 72.;: BYLAWS OF NORTH ANDOVER CONFORMITY OR NON-CONFORMITY Al lAllfl WHEN BUILT WHEN CONSTRUCTED. P � ! /� 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: Other (Non -Electric Resistance) DATE: 4-1-1998 DATE OF PLANS: 3/20/98 TITLE: Settlers Ridge Road Lot 6, #80 PROJECT INFORMATION: Settlers Ridge COMPANY INFORMATION: Tara Leigh Development Corp. COMPLIANCE: PASSES Required UA = 618 Your Home = 510 Perms Checked by/Date 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 eat or cool the building shall be no greater than 125% of the design oad as specified in sections 780CMR 1310 an J .4. Builder/Designer ' �� ` F Date Area or Insul Sheath Glazing/Door ------------------------------------------------------------------------------- Perimeter R -Value R -Value U -Value UA CEILINGS 2160 30.0 0.0 76 CEILINGS 1 10 1.2 0.0 3 WALLS: Wood Frame, 16" O.C. 3058 19.0 3.0 165 GLAZING: Windows or Doors 488 0.300 146 DOORS 56 0.350 20 FLOORS: Over Unconditioned Space 2106 19.0 100 HVAC EFFICIENCY: Furnace, ------------------------------------------------------------------------------- 80.0 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 eat or cool the building shall be no greater than 125% of the design oad as specified in sections 780CMR 1310 an J .4. Builder/Designer ' �� ` F Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 Settlers Ridge Road Lot 6, #80 DATE: 4-1-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location [ ] 2. R-1 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C., R-19 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U -value: 0.30 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments Location DOORS: [ ] 1. U -value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1. Furnace, 80.0 AFUE or higher Make and Model Number THERMOSTATS: [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ) Ducts in unconditioned spaces must be insulated to R-5. r Ducts outside the building must be insulated to R-8.0. •DUCT CONSTRUCTION: [�f] All ducts 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: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- 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:�P.� Phonectm7�3� LOCATION: Assessor's Map Number Parcel J Subdivision Lot (s) iv" Street rJ' St. Number 8� ************************Official Use Only************************ RE AT S OF TOWN AGENTS: Conservation dministrator Comments kWW l_� VJ I I VL Date Approved 1 0 Date Rejected '$14 ©01✓� Q U�J� 1 Q �_ Date Approved Town Planner Date.Rejected Comments Date Approved Food Ins ector-HeaAth Date Rejected Date Approved 7L. i nspector-Health Date Rejected Comments Public Works - s.ewer/water connections - driveway permit ��\(�V Fire Depcirtment ' �. ' Z�- Ritcei,%d bj Burlding Ifispector Date SETTLERS RIDGE KOflD LOT G C#sol PV,oPosi:D SITE PLAN o 0404 ro Wo o N to � 252. r d; r CO 22 PROP. DWELu+JCf 24' ' N 32" �6 i35' 36 4i � i 0 r W� PROP. (N � nRMtwt4J � o 0) N 9 N321H 1 3VusV,3 `p cam+', © L'8L v- � ,81'SZ6 E - - O_ ' rr ZON��V� Rp pp -2 `RD 1 !• c' JOHN F. <? " is ' Z/1NO3U;KO `e L£ : �l / I - �i 0 i1► 6.' No. 20563 ZP 3 / Li t Tara Leigh Development Corp. L AT £ 2 �jMA 185 Hickory Hill Rd. N. Andover, MA 01845 �7i civ