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Miscellaneous - 81 LYONS WAY 4/30/2018 (2)
r_ Date ... !.. .��<- ...................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thiscertifies that................................................................................................................. has permission for gas in tallation.r.. <�>Z>....................... ............................. in the buildings of.. L.1 O' . *3c.�............... North Andover, Mass. at ......................................... Fee)c --..... Lic. No. �.�......................................................................... GAS INSPECTOR Check # `l-02 3 t " 14�- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY N. ANDOVER MA DATE 611512015—PERMIT # 112 " -y4 JOBSITE ADDRESS 81 LYONS WAY OWNER'S NAME I CHRIS GLENDON GOWNER ADDRESS SAME I TE 617-875-6000 IFAXI TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL F� RESIDENTIAL RI CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER [�-_ �❑ COOK STOVE DIRECT VENT HEATER ��❑ DRYER❑� �❑ FIREPLACE - FRYOLATOR FURNACE GENERATOR GRILLE ❑ 00 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ���❑ (��❑ OVEN �� �❑ POOL HEATER 1] ROOM 1 SPACE HEATER ROOF TOP UNIT [�❑[ j0 TEST UNIT HEATER (WENTED ROOM HEATER WATER HEATER ( �❑ OTHER C��❑ 00 ❑ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY F-1BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i plianc with allpertinent ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , PLUMBER-GASFITTER NAME I BRUCE J. LIPINSKI I LICENSE # 3735 IGN URE MP ❑ MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION Q# 99 PARTNERSHIP❑#LLC ❑#0 COMPANY NAME: NEW ENGLAND GAS SYSTWEMS INC. ADDRESS 1102 LOCUST ST CITY I DANVERS STATE MA ZIPJ 01923 TEL 978-774-7030 FAX 978-739-430 CELL 508-843-4724 EMAIL newenglandgas@yahoo.com N 0 n x n a z b 0 z z 0 m M m y v> Dv c� C, � b a b Z r c z m o z mcn C m cn O # m p 4 cr CDC ❑w o z El oz ITIz a r z b 0 z z 0 y The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 v< www.mass.gov/dia • ' O•IAl SV Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pli tubers. TO BE PILED WITH THE PERMITTING AUTHORITY- Name (Business/Organ ization/individual) Address: City/State/Zi �c5 C� �1C�93 you an employer? Check the appropriate box: Phone #: o�is 1- - f A-` * 1 LJ 1 am a employer with `�.� employees (frill and/or part-time)-* I -N 2. ❑ I am a sole proprietor or partnership and have no employees Working forme in any capacity. [Noworkers' comp. insurance required.] 3. Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4•❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general con tractor and I have hired the sub -contractors listed on the attached sheet. t These sub -contractors have employees and have workers' comp. insurance 1 6. ❑ We are a corporatiori and its, officers have exercised their right of exemption per MGL c. 152 R1(4) and we have no employees: [No workers' comp. insurance required.] Type of project (required); 7. ❑ NOW'd6nstri d ion 8. [] Remodeling 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additions 12� 2 Plumbing repairs or additions 1 0 RoofrepZS r�. 1 OtherVX *Any applicant that checks box #1 must also sill out the section below showing their workers' compensation policy information. i Homeowners who sh,ecks his 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 state whether or not those, entities have e es, they must provide their workers' comp. policy number. I-- Tftha sub -contractors have employe X am an employer tliat is providing workers' com ensation insurance for my employees. information. Insurance Company Name: Nt L Below is the policy andyob site Epiration Date_ 1s Policy # or Self -ins. Lic. #: 1 City/State/Zip"" "';"'��' Job Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure. coverage as required under as civil pen enalties?in the form of criminal25A is a TOP violationpunishable ORDERIand a fine of p to $2500.00 0.00 a and/or one-year mprisonment, as well a p ay be forwarded to the Office of investigations of the DIA for insurance day against the violator. A copy of this statement m coverage verification. X do hereb cert u der the pains a penalties of perjury that the information provided abov�is true and correct. Date: in this area, to be completed by city or town official. Official use only. Do not write l. 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 Phone #- Contact Person: .- 4' Information and Instructions V 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 blre, 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 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'contractors) name(s), address(es) and phone number(s) along with their certificates) 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 IndustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatiori 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 "fob Site Address" the applicant should write •"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 61.7-727-7749 Revised 02-23-15 www.mass.gov/dia Date . /-?�Af TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION •ri,;„ gertifies that /Ojp... `L � - has peinussion for gas mstallationj. .................................................................... in buildings of... �^'�. ^! p................................................................................ at .... Q...� y dYl S - ........................ . North Andover, Mass. Fee ....�..�.....�...... Lic. No. ... .................................................................. GASINSPECTOR Check #2— �z�je-� P,,w ou+bcO� QV41 '%\ 01 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY &NIXA __ _ _ -m MA DATE 2 01 PERMIT# /l j�2 I JOBSITE ADDRESS g// C Y�i1[ S , Gt/�� OWNER'S NAME E�5 ,CES dli� I GOWNER ADDRESS i��d' TE•G��'17�' FAX - TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAM CLEARLY NEW: Ej RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES NOX APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 13 14 BOILER - BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER. . _...__ _ _ _..,_. .J=== _ FIREPLACE FRYOLATOR FURNACE -A z GENERATOR.. - GRILLE INFRARED HEATER�� LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT _ I' TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER-dT—HER F - — H INSURANCE COVERAGE have.a�current liability insurance policy orits substantial equivalent which meets the requirements of MGL. Ch. 142 YES ]l NO YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ij OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. � CHECK ONE ONLY: OWNER 0 AGENT 4 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are ue and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicatio will be 'n o liance with all P� inept provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME `Q$�AA z , D,CL_ LICENSE 1 SIG TURE, MP 0,.MGF Ejl JP ® JGF D LPGI ] CORPORATION ©# PARTN RSHIP �]I #= LLC [I#= COMPANY NAM ADDRESS CITY OQC �� STATE =ZIP 1 / ]TEL q - 7 FAX CELL 7S SSSfIVIAIL -7-Oj✓.y l �z�je-� P,,w ou+bcO� QV41 '%\ 01 Cr LL i 4 - The Commonwealth of Massachusetts Deparbu nt of lntlustrinlAecielents Office of Investigations 600 Washington. Street .Boston, .1V1A 02111 www.massgov/ciia Workers' Compensation Ynsurance Affidavit: Builders/ContractorslElectxic�iansffliin Annlicant Information - . Please Print LE Name (Busyness/Organization/individual) : 7�Y E- A gpi&/MI Z #A67A(f Address: 0* M t City/8tatoM1)& OX&47 Phone#: Are you an employer? Check the appropriate box: 4. ❑ T T Type of project (required): :1 A T am a. employer with am a general contractor and 6. ❑ Now construction, employees (full and/or part time).* 2. ❑ T am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. t 7. ❑ Remodeling ship and`have no employees These sub -contractors have El8. Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its 10.[] Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised.their right of exemption per MGL 1111 Plumbingrepairs or additions myself [Noworkers' comp. c.152, §1(4), and we have no 12. Q Roof repairs insuraucere ed �'. a employees. [No workers' 13.❑Other 71,r comp. insurance required.] 'Any applicant that: checks box 41 must also fill out the section below showing their workers' compensation.policy information. 1 -Homeowners who submit this affidavit indicatingthey tie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that cheekthis box mast attached an gdditional sheet sliowingthe name of the sub. -contractors and their workers' comp. poiicy information. f am an employer that isprovidirig workers' compensation insurance formy efilyloyees Below is the policy and joh site information. 1 Insurance Company Name:, /l%Td�1 �9�KeC'D'Q11APJ Policy # or Self, ills. Lic. ff: W O Z 1 JZLA Expiration. Date: 3' Job Site Address: �RA1 O&Alfkek City/State/Zip: Attach, a copy o#the workers' comp ensation-policy declaration page (showing the policy number and expiration date). Failure to secure ooverage as requiredunder Sectlon25A ofMGL c. 152 can lead to the imposition of criminal penalties of a tine up to $1,500.00 and/or one=year imprisonment, as well .as civil penalties in the form of a STOP WORM 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 ATA for insurance coverage verification. . f do Iiereby certififuriO.- tlie.pains Mat the information provided above is true and correct. Oficial use o.nly. Do not write in dies area, to be completed by city or town official. City or Town: Permit/License 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical bspector S. Plumbing bspector 6. Other - - - Contact Person: Phone #: Informa�on and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an ernployee is defined as "...every person tri. the service of another under any contract of hire,• express or implied, oral or wxitten." An employer: is defined as "an individuate, partnership, association, corporation or other legal entity, or anyiwo oxrnoxe of the f 6regghng 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 notmore thawthree apartments` aodpho,xesides therein, or the occupant ofthe dwelling house of another who empleys persons to do maintenance; coAstructien, or repair work on such, dwelling house or on the grounds or building appurtenant thereto shall not becauseof such employment be deeii ed to be an emplpyer." MGL chapter 152, §25C(6) also states that "every state or local licensing ageucy.shalt withhold the issuance ox renewal of a license or permifto operate a business or to construct buildings in he`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 I ecessary, supply sub -contractors) uam.e(s), addresses) andphone numbers) along with their certificates) 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, if an LLC or LLP does have employees,apolicyiszequired. Beadvisedthattliisaffldavitmaybesubmittedtothe Department of Industrial Accidents fox confirmation o£insuxance coverage. Also be scare to sign and date the affidavit. The affidavit should be xeiruned to the city or town that the application for thepermit or license is being requested, not the Department of 7n dusirial Accidents. Should you have any questions regarding the law or ifyou 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 thatihe affidavit is complete andprinted legibly. +The Deparbnent has provided a space at the bottom of the affidavit for you. fqM. out in the event the Office of luvesiigaQi has to cpntact you x rciing�iie applicant. Please be -sure, to 0 in.the penmit/license number which will ba used as a reference number. In addition, an applicant that must submit multiple pezm t/iiceiise applications in any given 7reed`oniy submit one afRdavitinizcating current Policy hnformaiion (if necessary) and under "Job Site Address" the applicant should write "all locations in town):' A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit -ii 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 orpermit to burn leaves eto.) said person is NOT required to complete this affidavit. The Office of Investigations would Me 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 andfaxnumber: The GamonweaXth of Mo D_ apadment ofZudusixial A,ccidoz�t Office of JAVestiga.00,na 6bQ Wash ora. Sfxeet Boston, MA 02111 TO. # 617-727-4900 W 406 or x-877-WA.SS.AJFF, Revised 5-26-05 Fax # 617"727"7749 �'.u�aSs,g¢�fclia. • 12/16/2014 Division of Professional Licensure: License Search The4,r icial Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: JOSEPH R. DOYLE BOXFORD, MA NEW SEARCH "This Licensee has additional Licenses, click here to view them.** Licensing Board: PLUMBERS Et GASFITTERS License Type: MASTER PLUMBER License Number: 11821 Status: CURRENT Expiration Date: 5/11/2016 Issue Date: 7/17/1992 Exam Date: 6/6/1992 School: This web site displays disciplinary actions dating back to 1993. This license has had disciplinary actions taken during this time Click here to view this information. The page above has been generated by the Division of Professional Licensure web server on Tuesday, December 16, 2014 at 1:18:01 PM. © 2007-2011 Commonwealth of Massachusetts Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... http://I icense.reg.state.ma.us/public/pubLicenseQ.asp?board_code=PL&type_plass=_M &I icense_num ber=000011821 &color=&I b=PL Site Policies Contact Us GENERATOR APPLICATION DATE: Ck::5 cyIr,�e,.,� 4'1�-$IS-6ar,� LOCATION: l j GENERATOR kw 1V NO /INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PtA,' PHONE NUMBER: ,SOS yue- ELECTRICAL RESIDENTIAL GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: © d s, *ZONING DISTRICT: ^� l� "'PLANNING APPROVAL (IF IN WATERSHED) PJ JPV *CONSERVATION APPROV w�� h IV` Location e i LJk,3 r*A-t No. I C-) Datea6 TOWN OF NORTH ANDOVER s Certificate of Occupancy $ 'i, Building/Frame Permit Fee $ Foundation Permit Fee $ o� Other Permit Fee [-0D ,,_•$ 3 �) TOTAL $ 3 Check # � 14 64 1/ � BuhdingAni�pector TOWN OF NORTH ANDOVER UILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Il SeCt> :#-or. O#fxaall-Use=Oily - BUILDING PERMIT NUMBER:��^ DATE ISSUED: V�� SIGNATURE: Building Commissioner/I for of 8uildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: J/ 4 %o.Vj-y,,4y 106 Map Number 1.3 Zoning Information: 1.4 Property Dimensions: L3 / Zonin g District Proposed Use Lot Area (so Frontage (ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re Fred Provided 1/0 /Q 1-0- 1 3,1.1 1.7 water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: I.S. Sew"c Disposal System: Public 2< Privatc ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of' Record CMV 5 4Y0iy19- !1/i9y Name (Print) Address for Service : Signature 2.2 Owner of Record: Name Print Telephone -Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: STr"�/�rrS/ ?�► G6i2>/�/ Licensed Construction Supervisor: .S Tc �r- h/4 X Address i l7 i� Telephone Address for Service: 3.2 Kegtstered Home Improvement Contractor Company Name .S .Soaz E wig 5 T.SSF X Address y62 - tore Not Applicable 0 /Oz/(�' License Number Expiratio Date Not Applicable ❑ '17-20,V,6 Registration Number 02— Expiration 2 -.Expiration Date t . l 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. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) i New Construction Y" Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. I Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be9 X. �g s Completed by pern-dt applicant -01 1. Building (a) Building Permit Fee Q� Multiplier 2 Electrical (b) Estimated Total Cost of /, I Construction C 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC -21 5 Fire Protection b 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 My behalf, in all matters relative to work authorized by this building permit application. to act on Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION -�G0f2,sil / ,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 'i:,:IV �RA Gorz S, Print Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TFMRERS 1ST 2No 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS 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 C,/7R)J— C 4C,,1V PaA1 PHONE G83 ?Z7 ASSESSORS MAP NUMBER 106 SUBDIVISION LOT NUMBER .� NUMBER 6 STREET STREET NUMBER OFFICIAL USE ONLY REMRVAONADNMSTRATOR ATIONS OF TOWN AGENTS .................... . ■...........................`.r.�.. ....... . DATE APPROVED �I DATE REJECTED CON04ENTS a N � J r l s � %. ( t k v ami �� � ®C m--ILI �} COMMENTS RECEIVED BY BUILDING INSPECTOR DATE DATE APPROVED TOWN PLANNER DATE REJECTED CONINIENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS — SEWER ! WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE til to 0 w rr t- O ! zo, CN;' 10, -4 .01 > =M0 0 .1 rA 00 Ej OMZm CD Z � -<, > z � Cl 9) I, oa E` Rv >OG)m eb ..% --I;o M (0 CD 00 ch m Z CD 0 G) CD 0 M Cy > 0) 6r J m U) T > --j 0 =M0 0 i0 (n OMZm CD Z � -<, z � Cl 9) >OG)m o cl) 0 -0 ..% --I;o M (0 00 ch m Z CD G) CD 0 M > 0) 6r CD 0 '4t CD 4 C) C) CD C)cn 00 '0 UF CA C> p CL 0 0 CD C) 0. sW CL I'Y iul..aii r.Ar.uB.aL�''.. •..: .•�..iA�Mr .� � .�"r a'i;r' _ ._ •I - :v Ic^S CL 7777 Ve ' Ss sps x. : �'' •'eC � �� Gl ���r1►' °:fig ` €a COO Adoe F CD 1 0P w W' fur ftr -C D ��" �'Z�•o: - •1 � � � '6�g1 `• y. AllCDc idle 1. a �O ie C t A r •1 •t r C . R b a• JJ' Qy' 1 1 f, 11 n, r � sty ti• I' .� l Y � Cl) m m Cl) 0 m _o C � N CD� Z N CL Cl) O C. y a(O -v ' -o o � c o CD a� O cr CD CD o CD mm a. C O N CD C.O CO) >> I toCD OT L" cn cn n O cn C� O z cn n � VJ f G• e �?lRo a O �• Vi e Q h cnOt t7l �CO2 m qd C rte" ?� OCO) Z cc ,.0 pp w n O ,01s CA N o• �a + . c O m y CD N -10 O =r � p m 7 O m :� CDH fa O 0 .•w x N Cl 0 m T Mn oN O O y O W =rH a a O (o o �=r C :x ca C n� G O1 N y V CK ;� C � N CD O _? CA O c a CD FW CD 0 Z 9 • � � o CD CDU CO N O•-w O C . (n p 0 (n ~ 0 CU tz 9 7d til y �7 G cnOt t7l '?1 y qd C rte" ?� ;z b pp w n "� G O G CL G7 r �^i Q x O omi 0 0 c Date....... .. .. . ... ....... . N2 3 2,1- 5 �51C�l , VA TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that....,. n .. .......... .... ........................................................ has permission to perform ....... I, -G- ................. Z ........................................ wiring in the building of ...... ................................................ ........... ........... x ...... .... ............ . . North Andover,,, Mass. at ..... Fee,'k> 0.. Lic. NoA ..... L... ................ .............. ELECTRICAL INSPECMR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DEPARTMEATOFPUBLICSAFLTY Permit No. BOARD OFFIREPREVE WONREGMT10NN 527CMR 12'QD V%z:5�JAPPUCATIONFORPERW Occupancy &Fees Checked TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 0—)-0/ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) fr,,O� tj Owner or Tenant (YAPI .9,A17 Zan Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [a No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ! n o 77 17777=7 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals 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 Othrr No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Iris UXCCO�. R1sttatt1D1heragtmal1ff1lSdMmwhB&GauWLaws Iha%eaa=tLi bkyhurd toePobo1's ld%CarVkieaage iamCouarirsmbstff decgMkrt YES NO 1ha%ew mftdvAklptoofofsametothe0ffm [a . YES If}wha%edxciaEjdYES plmemlletheiypecfcomWbycfwckirgthe � EstirttkdVai<tecfEedliralWak $ WadcbSlatt ;/�'us '�.G0/ ._yi`lICISrI/ Final FIRM NAME 7'6 Siglaw L=W1--o J Bu!3h=Td.Na OWNERSN5URANC'EWAIVER;I.alnawatethattheLjmwdmnat GnrALaws afld thatmy sgrtatiseonthis pearr� �Catiat v� this l�Tl�. (Please check one) Owner Agent Telephone No. PERMIT FEE i' n 'P n ca�� Town of North Andover F N°RTN tLeo � 'q Building Department °t? , . 16� 27 Charles Street o I, ":' o � North Andover, Massachusetts 01845 F 7° (978)688-9545 Fax(978)688-9542 o <OC MIL .wK• 1' SSACHUS���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION It .4 ADDRESS g/ Gd71S GU . LOT NUMBER SUBDIVISION LyD/7 S LcJa� DATE REQUEST FILED DATE READY FOR INSPECTION 1 QL I a 1 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 STRUXTURE , OT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATION DATE PLANNING DATE D.P. W. — WATER METER Oif 774J DATE /Z —//� eoD D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNA / DAV AUTHORIZATION Mesi-i Dev Group Fax:978-5578160 Jul 17 2000 13:54 P. 01 —' -- ....._....._._... . TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J VIM* Hmumlak' � Telephone (978).685-050 Director Fax (978) 688-9573 f July 14, 2000 Mr. Kenneth Grandst4 President Mesiti Development Group 231 Sutton St. Suite 2 F .. North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. Grandstaff- p� The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the conshuction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the following: I. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system - 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and facilities in the event _r _............. _. _ _ that Mesiti Development or its agents fail to adequately perform maintenance of the pumping station. .rte Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesio development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any tip out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very Tryours, I Wills m Hmu rci. E. Director of Public Works M' _ . The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant ofSonditional use. 3549 Date ... !i .. -..'` ..:. ... . TOWN OF NORTH ANDOVER OW PERMIT FOR GAS INSTALLATION A s i r f This certifies that ..::.. .. ..'.. . . has permission for gas installation ...... ................. in the buildings of . . `. . .`.'`. . ..,.� .... .. • • at .. . . ..... ..`��...... • . , North Andover, Mass. Fee`s % ...... Lic. No .. :... . ........ . 'f GAS INSPECTOR a,. r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATOR FOR PERMIT TO DO GAS FITTING 4Type or print) Date NORTH AN)QOVER, MASSACHUSETTS Building Locations / . Owner's Name New El Renovation ❑ Replacement ❑ Plans Submitted ❑ 19 Permit # 4- y _ Amount S ;b (Print or type) Address Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Business TelephoneO r3 . Firm/Co. Name of Licensed Plumber or Gas Fitter �,/`C�`�✓�.C.f� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: ❑ Signature of Owner or Owner's Agent Owner ❑ Agent i hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Tide City/Town APPROVED mFFICE USE ONLY) Signature of Licensed Plu r Or Gas Fitter ❑ Plumber ❑ Gas Fitter License iNumoer '7p - F�Master Journeyman la 7 Date . .......... No 4.55' 4, TOWN OF NORTH ANDOVER UP 0-1 PERMIT FOR PLUMBING 1 SS,4C04US� I a This certifies that ._. ,.. .... 2, � has permission to perform ._�............ ........ .......... . -- -'a'- plumbing in the>buildings of .. .. �.......... . at ...... J ......... �%............ . North Andover, Mass. Fee .1.1..... Lac. No.. .... ' PLUMBING INSPECTOR Check #I--]� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location TO DO PLUMBING i AmountDate Permit W of Occupancy r, New 0 Renovation 0 Replacement ❑ Plans Submitted Yes No ❑ ,ling type) Check one: Installing Company Name Al ❑ Corp. Address 11 Partner. U Firm/Co. Name of Licensed Plumber: Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy El Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner 11 Agent E] 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 insiallatio s performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts to lumbin d . dhapt 142 of the General Laws. By: Signature ot LicenseclPiumDer _ Type of Plumbing License Title City/Town is nse Num5er Master Journeyman ❑ APPROVED (OFFICE USE ONLY A q .y N° '2563 Date..... .<.71v...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............�S .......... ........ C ..:......... has permission to perform ,v . w '� !!� ........................... ............. .................... ....... wiring in the building of ..... t!1/M.. P J at ..... �- /.......�.>....!z11................. . N rth Andove eMass. Fe�� I.. j.0 Lic. No...,4 .1.3 ....... .. �. ......... ECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Officinal Use Only Permit No. of �`� 6��21�LMEXZ7q 057 WUSS,4C ?tS577S att Sam Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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) Date qi "7 _C) C) Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below Location Owner o Owner's Is this permit in conjunction with a building permit Yes li;�— No ❑ (Check Appropriate Box) Purpose of Building i �� - `� UtilityAuthorization No. .#7 Existing Service Amps Voits Overhead ❑ Undgrnd ❑/ No. of Meters New Service n2 O V Amps �Voits'?- ?0 Overhead ❑ Undgmd Lel No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical e 4J No. of Lighting Outlets No. of Hot fuse Total No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above ❑ In ❑ grnd ❑ grnd ❑ Generators KVA No. of Receptacles Outlets No. of Oil Burners No. of Emergency Lighting Batte Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Sounding Devices No./ of Self Contained Detection/Sounding Devices ❑ Municipal ❑ Other Local Connection No. of Ranges No of Air Cond Total , Tons No. of Di osal eat Total Total No. Pumps . Tons KW No. of Dishwashers Space/Area Heating KW No. of D Dryers Heating Devices KW No. of Water Heaters KW No. of Signs No. of Bailases Low Voltage Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of cover a by checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) %a Estimated Value of Electrical Work $ (Expiration Date) Work to Start Inspection Dat Resquested Rough ff G� Final Signed under the Pe es of peryyry �-� FIRM NAME_ A%A 4:" /�(/ i Z i` _� LIC. N0. _ 12 33 o T �— LIC. NO. �� L r✓//��„ti K� Bus. Tel No. Address 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) (signature of Uwner or Agent) Telephone No. pE �6 ` , RMITfEE $ Location /f tNo. U 6fDate TOWN OF NORTH ANDOVER Certificate of Occupancy $ \s„ rw„s t� Building/Frame Permit Fee $ •✓ -� �� Foundation Permit Fee $ Other Permit Fee $ 4 TOTAL $ z 4/ —) Check # �� ��d C-1 13t"53 Building Inspe6or MAY -23-00 T U E n 33,2' M �TlNC FOuNC Top fJ ax�0 j Tta19,48' Rm 175,00' a' 69.99' L=27,72' x'"12'42'18" ra 13, 92' T 3:B MP FOUNDA%N E6EV+.133 3r 3,2.42' N38'38'27"W 422,53' LYONS WAY 938' fly 271 334,78' B8406. 44,272 S.F. q 1,02 Ac, BUILDING L,, EXISTING FOUND TOP FOVNOA'90N 4' SE 6(ACK LOT 43, 761S.F 1.00 qc / P _ 0 1 40,12' T#23.83" 91,37- R-30.00, L%7,42' 4a07175115" 140, L4289 , a ~ w m x PROP. ORAIlYAGB O L4 76?el tAStAMENT A' 73 29'18" 535'29'20"@ g 4 WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THE STRUCTURE IS LOCATED THIS PLAN IS INTENDED FOR ZONING THIS PLA ONLY. IT WAS PREPARED AS SHOWN, THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE 0OD INSURANCE MAP,WITH THE STRUCTURES SHOWN LOCATED CI OUTYPNE NO, 250098009C BY AN INSTRUMENT SURVEY, THIS PLAN DATED 6/2/93 , THE STRUC7URE IS NOT LOCATED SHOULD NOT BE USED FOR PROPERTY IN AN ESTABLISHED 100 YR,F'LOOD HAZARD ZONE, LINE DETERMINATION. CERTIFIED FOUNDATION PLAN LOT 6 LYONS WAY MAPCHIONDA & ASSOC',L,.P. NORTH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR MESITI DEVEI OPMENT GROUP 62 MONTVALE AVE, SUITE I STONEHAM, MA. 02180 231 SUTTON STREET, SUITE 2E (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS 09845 SCALE. 1"=60' DATE:5/22/00 4 / L Location /a e � `7 /� � No. G�— 'Date NaR, TOWN OF NORTH ANDOVER •' 50 Certificate Occupancy $ + ; . of �' b'°•°'''t�' ,Ss4E Building/Frame Permit Fee $ CMUS Foundation Permit Fee $ / Other Permit Fee $ TOTAL $ U # Q-,)/ Check 3 6 1 7�`-�`--- / Building Inspector y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING OH'for i1 ICi 9C %11 BUILDING PERMIT NUMBER: q� DATE ISSUED: J v w� e SIGNATURE: Building Commissioner/I for of Buildings Date ZWW404P SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /0613 /6. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required rovide R fired Provided Re red Provided 36 '' S" 3G' /ys ' t54) 30 y� � 1.7 Water Supply M.G.L.C.40. 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal A? On Site Disposal System ❑ SEC ION 2 -PROPERTY OWNERSIiIP/AUTIiORIZED AGENT 2.1 Owner of Record vow g 6-f z. �� ate: s .gym sl- Name (Print) Address for Service 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 ❑ t r� 6y L) S -S Licensed Construction Supervisor: 0 License Number S'� s,-. Address q 5 4 J 7-573C .3C 6 Signature Telephone Expiration Datt 3;�-e �7 ` �� �- 5- rGv 7 2o0Q 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T M a. z R eTi rTin?V d _ wnvk-rRC rnMPF.NSAT1nN (M.G-1- C 152 S 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. Signed affidavit Attached Yes ......A No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction �1 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg' ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: J - �y-n n �Yx �o �� _ yx,z-�Q,- Z�,, r-e,Gu SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building o2y5oe � 300 (a) Building Permit Fee Multiplier O 2 Electrical (b) Estimated Total Cost of Construction a ys 3 D D, — 3 Plumbing Building Permit fee (a) X (b) �j 70( . 4 Mechanical (HVAC) 5 Fire Protection 5 Total 1+2+3+4+5 ely-3IO 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 permit application. j r Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, //, l 4�ee,-// as QmnwAAuthorized 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 /' SZ Print Name 7 O Si ature of Owner/A ent Date NO. OF STORIES 14, SIZE 3 -S '2- BASEMENT OR SLAB Q19<>e'.10^44- SIZE OF FLOOR TIIvMERS I5 9 ,� "ZTdiirs 2 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS Sfe� DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION ` iD " THICKNESS /d `' SIZE OF FOOTING V" X Zd MATERIAL OF CHIMNEY jo 0 ed IS BUILDING ON SOLID OR FILLED LAND 5Z 4,—d IS BUILDING CONNECTED TO NATURAL GAS LINE ° r r'' FORM U - LOT RELEASE FORi41 1114STRUCTICNS: 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. :r**************************'"APPLICANT FILLS OUT THIS SECTION****'****************** APPLICANT L I,O,I 7-S Z PHONE -S GO C7 i LOCATION: /assessor's Map Number %p (oJ3 PARCEL %6--(, SUBDIVISION�� �2S c.0 g:!z LOT (S) �o STREET G S Gu ST. NUMBER 0Y USE ONLY******************* r t************* RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED COMMENTS F^0 �� 4 TOVYN'PLANN-ER V COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS n DATE REJECTED_ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED 4 PUBLIC WORKS - SEWERIWATER CONNECTIONS W z'Z75 —00 DRIVEWAY PERMIT E5 FIRE DE ARTMENT -ilk RECEIVED BY tUILDING INSPECTOR DATE Revised 9197 jm 4 y y a s Q y - N _, rs sO a� O Z N T W Cn T_ � H v lmm9 m a V a 1"fl TM m W em c m C. -m c The .Commonwealth of Massachusetts Department of Industrial Accidents Offics of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: Citv __Phone #__ 7 1 am a homeowner performing all work myself. 71 1 am a sale proprietor and have no one working in any capacity AI am an employer providing workers' compensation for my employees working on this job. Ld Address 4;�?-3/ S'y�� 1Z, gzoi;,e ALF ,-- _tb-&Y City' 0 /,Y ys Phone Insurance Co. 0a lel &e2 , A F -r2:7S . 6- _ Policy # .1U W1 1:2 S// :3 Z/1451141 cep Comoanv name: Address Citv: Phone #: Insurance Co. PolicvTiiiii # 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 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine cf ($100.00) a day against me. I understand that a copy cf this statement may be forwarded to the Office of Investigations of the DIA far coverage verification. I do hereby certify under the Signz Print Official use only do not write in this area to be completed by city or tcwn amciai' '6 0 City or Town Permit/Licensina ❑ Building Dept ❑Check d immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact perscn: Phone 9: ❑ Health Department ❑ Other r, In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: 0 Location of Facility Sie ollrermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ger'' MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I 1 Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-7-2000 DATE OF PLANS: February 21, 2000 TITLE: Lincoln PROJECT INFORMATION: Lot 6 Lyons.Way Subdivision North Andover, Ma. COMPANY INFORMATION: Lyons Way, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 594 Your Home = 591 Area or Cavity Cont. Glazing/Door Perimeter ------------------------------------------------------------------------------- R -Value R -Value U -Value UA CEILINGS 1752 30.0 0.0 62 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1752 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------ ------------------------------------------ COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck-INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lincoln DATE: 3-7-2000 Bldg Dept Use I I I I 1 CEILINGS: I 1. R-30 I Comments/Location I I WALLS: I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: I 1. U -value: 0.35 I For windows without labeled U -values, describe features: i # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I DOORS: I 1. U -value: 0.49 I Comments/Location I FLOORS: I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no 1 more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: I Materials and equipment must be identified so that compliance can 4 I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ l I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 i Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I I PIPE SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 V-;-_- . , T 1484 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. f `� ZZ Application by the undersigned is hereby made to connect with the town sewer main in a-7(Street, subject to the rules and regulations of the Division of Public Works. j / The premises are known as No. 4!) �y(/�GG� Street or subdivision lot no. Owner Contractor Address Address 4G Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Z— LG Street Division of Public Works By Date See back four rules and regulations rz� �t✓la C�(��Ct a�r�5� NO `948 A APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 22 19— I Application by the undersigned is hereby made to connect with the town water main in'Z�-S �'�!G��i Street, subject to the rules and regulations of the Division of Public Works. n The premises are known as No. l ' ' S � Street or subdivision lot no. n Owner Ui_ _'/ Address Contractor Address v Aplicant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. V LLC Street— Board of Public Works By Inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. 6Villett Telephone (978) 685-0950 Staff Engineer Fax (978) 688-9573 Additional conditions for lots 3 and 6, Lyons Way February 22, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 3 and 6 in the Lyons Way Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these two homes can begin at this time. The conditions are as follows. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation of the above conditions will void both water and sewer connection permits. No refunds will be granted. Mesiti De p orp Printed Name Date 7 11 Division pf P lic Works Printed N1#e Date CC: Bill Hmurciak Jim Rand � � v TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 685-0950 Fax(508)688-9573 Q IAORTk 0 t,,ED '6gti0 a° .6 OL 0 T ArEO 101 R V X1,11"T4;7Ti li�l Date: ke 2 2 2oc� LOCATION: g/ S 10 6 BUILDER: phone: OWNER: ice 2-L_ C phone: The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS. PERMIT. Remarks: Approval: Town of North Andover Planning Board This form represents the schedule for allowing the following lots to be considered as eligible for building permits under the Town of North Andover Growth Management by-law Section 8.7 of the Zoning by-law. Pursuant to 8.7 .5 this Development Schedule must be filed in the Registry of Deeds and be referenced on the deed of each of the lots below and be filed with the Planning Board prior to the issuance of any building permit or permit for construction. Name and Address of Applicant for Lots: Name of Development: MPG RegI1'y Coca, 11 old 8ost'cnl R T'ew bury, M 176 Map and Parcel of Original Lot: P 1010 a 1 --at 79. Date of Application for Lots Division: 74 1 X Is,19'3 g Lots Covered by this Schedule: Lot.5 .5 l — 7 L oNs wa The Planning Board by their signature below, or a signature of a duly authorized representative, do hereby establish for the above named development the following Development Schedule for the purpose of Section 8.7 of the Growth management By -Law. The applicant, their assignees, successors and or sutsequent property owners shall conform to the following schedule that limits the eligibility of the following lots for building permits. This form must be filed in the Registry of Deeds by the property owner or representative and be referenced on each deed for each of the following lots. Such deed reference for the deed of each lot shall at a minimum reference the book and page in which this Development Schedule is filed and contain the language : " This lot is subject to a Development Schedule pursuant to the Town of North Andover Zoning By -Law all owners, representatives, and future purchasers should avail themselves of said restriction by reviewing the approved Development Schedule as filed in Book' and Page The fact that a lot is eligible for a building permit is subject to the limitation of the number of building permits per year pursuant to section 8.7.2.d of the Zoning By -Law." The Planning Board hereby schedule the lot(s) for the above development as follows: Year Eligible Number of . Building Office Use Building Office Use Lots Eligible Date: Lot Eligibility Notes ComoleWy Utilized Signature of Plannin and r Signature f Property C r ed Representative X Date :ed Representative ReIwr�l Im �7 3 Date N i+ FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a• The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and'dated DP r , 1 , 19 gam_ and/or by the Covenant dated 0 ct. a4� , 19 _ffg_ and recorded in District Deeds, Book S'3 q Page 6 or registered in Land Registry District as Document No.. and noted on Certificate of Title No. in Registration Book Page has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled ", �,; t►�► ��ONS Wg,r ��n nor Def$ubcii�c1oNPl411T 7 MA Section (s) Sht/ it Plan dated T Sheets _ 4 N Q a4 19 q$recorded by the s s ex Nor jj, Registry of Deeds, Plan Book registered in said Land Registry District, Plan Book or Plan Sol and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s)) "6 *7 I -vows ova., b. (To be attested by a Registered Land Surveyor) I hereby certify that lot number (s) 1-YDNS W14Y on Street(s) do conform to layout as shown onDefinitive Plan entitled Ne�lNclag H Section Sheet(s) �' 17- 5 Rei tered Land Surve o OF MqS� y� C o STEPHEN M. MELESCIUC cn A No. 39049 1 of 2 �i l9o�Fs��o`1oQ ��►�� SURV��. T'N- ` r wvt * '�t 1 A C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated Covenant dated � 19 and/or 19 from f the o the City/Town of County, Massachusetts recorded with District Deeds, Book _ or registered in Land Registry District as and noted on Certificate of Title No. Registration Book, Page satisfaction of the terms thereof and hereby right, title and interest in the lots designated as follows: Page Document No. in acknowledges releases its on said plan EXECUTED as .a sealed instrument this 22/S�day of ����� 19 1_ Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS �SSe7C ss —t)e-r-P4ker 1, 19 GC n -� �,LL Then personally appeared'�iyJ;, one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. 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