HomeMy WebLinkAboutMiscellaneous - 86 BROOKVIEW DRIVE 4/30/2018 (2)K)
Liberty Mutual®
INSURANCE
November 13, 2015
Town of North Andover
Attn: Building Inspector
120 Main Street
North Andover, MA 01845
Liberty Mutual Insurance
New England Region Central Property Unit
75 Sylvan Street
Danvers, MA 01923
Tel: (800)566-0323
Re: Property Address: 86 Brookview Dr, North Andover, Ma 01845
Policy Number: H3221818670470
Underwriting Company: Liberty Mutual Fire Insurance Company
Claim Number: 032795500-0001
Date of Loss: 10/23/2015
Attn: Town/City Official
Pursuant to M.G.L. c. 139, § 313, please .be aware that a homeowners insurance claim has been made
involving loss, damage or destruction of the above captioned property, which may either exceed
$1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch.
143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with
Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien
pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass.
General Laws, Ch. 111, § 127B.
This letter should not be construed as a waiver or estoppel of any of the terms, conditions or
defenses afforded by the policy or applicable law.
Please direct your notice to the attention of the undersigned and include a reference to the above
captioned property address, policy number, claim number, and date of loss.
Sincerely,
Liberty Mutual Support
Liberty Mutual Insurance
New England Region Central Property Unit
1-800-566-0323
This certifies that . In e .. ��.. 'IP -4 ..-�/
has permission for gas installation.twly. ,��,64-C,.�.. , .... .
in the buildings of. �-(... �3(�.,� .U�c./!?i�, , , , ....... ,
at%l!Cl yrtl,/.......................... . North Andover, Mass.
Fee&O-.-1). Lic. No.../. O. ff. //:7 .................... ? .. .
GASINSPECTOR
Check # -Y,,W--Ie
8660
hereby cerlii that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER/GASFITTER NAME: _._itt f e"LICENSE# c SIGNATURE `
COMPANY NAME: :L't- ADDRESS: ria an.'r % � S`
r
CITY: %i_ rrr e, i n __ STATE: ilk ZIP: n (k.2 t' FAX:
TEL CELL: 9745--- Fr/ 5a z/O EMAIL: 76tLL 'L461 - c �
MASTER , JOURNEYMAN F1LP INSTALLER ❑ CORPORATION ❑ # PARTNERSHIP 0 # LLC 0' P_ton,1
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT -TO PERFORM GAS FITTING/WORK
GOWNER
TYPE OR
PRINT
CLEARLY
CITY: ty k4 rt MA. DATE: V -/!v / 3 PERMIT# O (10(0
JOBSITE ADDRESS:_,- r%��� t//,eco/ /�� OWNER'S NAME: U i�
ADDRESS: TEL:a_eZ? -0-3-FAX:
OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL, -
NEW: E]RENOVATION: ElREPLACEMENTc PLANS SUBMITTED: YES ❑ NO ❑
APPLIANCESZ
FLOOR--• Bsmt 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
INFRARED HEATER
LABORATORY COCK
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
VNIVENTED ROOM HEATER
WATER HEATER
INSURANCE COVERAGE
I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES)g�NO ❑
If you have checked YES' please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
hereby cerlii that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER/GASFITTER NAME: _._itt f e"LICENSE# c SIGNATURE `
COMPANY NAME: :L't- ADDRESS: ria an.'r % � S`
r
CITY: %i_ rrr e, i n __ STATE: ilk ZIP: n (k.2 t' FAX:
TEL CELL: 9745--- Fr/ 5a z/O EMAIL: 76tLL 'L461 - c �
MASTER , JOURNEYMAN F1LP INSTALLER ❑ CORPORATION ❑ # PARTNERSHIP 0 # LLC 0' P_ton,1
Ilse Common wea tl ofMflSSoclatasetts
.Deparhizent o, f 1,, dus&irrl ACcaderats
OfflCe Of " 71VeSP`&gadojZ$
I �apigress S'tt eeiT sriite 100
Boston, MA 021I4=7'017
mini.2naSS gov/diti
Workers' Compensation insurance- Affidavit: Builder-s/Contrac>to r•s/FIg
__,,,_..._...�-...,._..-.................., .-....t ..............
Nate (Business10rganization/indMduaI)
Address:
S•
Phone #: ids K- �5 -
Are you an employer? Cheek -the appropriate box
1. aI am a employer with.
4. ❑ 1 tom• a general contractor and I
employees (full and/or pati time).*
have hired the sub -contractors
2. ❑"I am a sole proprietor or partner-
listed on the attached sheet,
ship and have no employees
These sub -contractors have
working for me in any capacity_
employees and have workers,
[No w-oflcers' comp. insurance
comp. ins+Trance
reTaired-] .
5- ❑ We are a corporation and its
3 _ ❑ I am a homeowner doing all work
officers have exercised their
myself [No workers' comp_
right of exemption per MGL
insurance required_] t
c.152, §1(4)-, and we have no
employees_ [No workers'
camp. insurance required -1
Type of project (required):
6. ❑ New construction
7. (}'Remodeling
8_ (3 Demolition
9_ ❑ Building addition
10_❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
Any applicant that checks box -1 must also Xll out The section below showing their workers' compensation policy information"
tHomeowners who submitthis affidavit indicating they ark doing all worlc and then hire outside contmetors must submit a new affidavit -indicating such.
#Contractors that ebecIc Iters box must attached an additional sheet showing the name of the sub -contractors and state whether or notthose entities have
employees_ Itthe sub -contractor have employees, they mustpmvide their worker' comp. policy number.
p mzz au et'nployer drat is providfng -workers' cope petisatiop: irts"rance for MY etnployees Below is thei policy and job site
iP2fDilP2ah011-. � _ "
Insurance CompanyName;
Policy # or Self-i&.Lie_ # __�ojj°_ "1- %7. 30 �z2 pirationDate: —a7
rob Site Address:y) ����l�c/���e - Ct/5tate/Zip-�LU�
Asch a copy of the workers, compensation policy declaration page (showing trine policy member and exphmflon date).
Failme to secure coverage as required under Section 25A of MGI. c. 152 can lead to the imposition of criminal penalties of a
fine up to $1;500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER. and a fine
of up to .3250.00 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_
Ydv hereby c� yrunderilie paitrs acrd petealties ofperjttry that ilie in}onlratio�c provided above is true mrd correct
Phone it,_ S--2 9 r,F
Official use on4L Po not iyriie &thus area, to be co» pleted by city or to offudal,
Cita! or- Town: PerimitUcense g
Issaing Authoxity (circle one):
1. Board of Health 2. Building Departmtent 3. CityMwa Cies lc �_ 11 lecte-acal Inspector S. Plumbing Inspector
6 othii
A %---1- --& IM
CONTROL #H376629 H376629
If this license ' rs IMPORTANT I
lost or
Division destroyed,'
of Professional notify !
Suite 710 Licensure1000Your Board at :the:
Boston, MA 02118-6100. Washin
gton St.,
If Your name or address shown
Renewal correctOf name or address oninsuIs changed, � Your board
noti
This license is
Always refer to proper mailin
subject to the Your license g of next
as.amended. It is a provisions of the number.
or assi an Personal Privilege, General Laws i
assigned to 9e, and must not be loaned
Person or Y other' person. Kee `
Posted as required b P this license o a
WARNING THIS law. n Your
�..'
ENHANCED SECURITY FeA
Your
HAS
j��8
CONTROL# � 3IMPORTANT ,
or destroyed, notify your Board at the:
los
If this license
Professtionat Licensure, 1000 Washington St.,
Divis►o Mp021i8-6100.
Suite 710, Boston, notify your board
is changed, ailing of next
to insure proper m number.
If your name or
address ddressor our license num '
of correct nam�ation. Always
refer to i
Renewal ApP subject to the provisions of the General Law
This license is subj ersonal privilege, and must not be loaned
Th amended. It is a P person.'
Keep this license on your
or assigned to any other P law
person as required by
or posteT
WARMING HIS DOL UMEtJT HAS ,
— - ,-
i Eh1ttANCD SECURITY FEA;UF'E `V
COMMONWEALTH OF MASSACHUSETTS
'PLUMBERS AN[3-ZASFITTERS
REGISTERED AS.A;,PLUMBING":CORP
ISSUES THE ABOVE LICENSE TO:
MI.CHAE-L. 'M MARCOUX l�
MC CO. PLUMBING HEATIrNG, L
10KESHORE DR N
DRACUT 'MA 0 3 826
3.185 05/01/14 168170=: r.}
COMMONWEALTH OF MASSACHUSETTS
PCo. aERS AND GASFITTERS
LICENSED AS A MASTER PLUMBER
'I SUES THE ABOVE LICENSE TO
MI:CHAEL..MARCOUX
10:8 LAKESHORE DR
DRACUT 'MA b1826-1008
10917 05/D1/.14 168168
.
Date.(/,/� !�.... .
NO RTh
Of
3? �` TOWN OF NORTH AND R
O T
n" PERMIT FOR GAS INSTALLATION
�,SSACHUSE��h
This certifies that ...................
has permission for gas installation .. L4. 1�4 .................
in the buildings of ... ./.' !?f r. -f .... .
atrte.. , , , , , . ^,, North Andover, Massa
Fee..... Lic. No.. `7 )� ?... .....�-`-.....
sl
Check #
6452
� z
-installing Company l
s
Business Telephone
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
orJ�ypel
New ❑ Renovation ❑
N
ALL( Type of Occupancy
Replacement w/
0 (/ Permit ig C�
ame d
Plans submitted: ' Yes ❑ No 0
I
•
f
s
..
■
f
•
•
•
�-®®.-.,-
MW
WM
NO
FA 'R 1=2 01411
WWM
mom
MIM
L I _ i t Yet YYt GUI Check ane Certificate
Q Corporation
Dame of Licensed Plumber or Gas Fitter
1
❑ Partnership
INSURANCE COVERAGE:
I have a curmntl billty Insurance policy or its substantial equivalent, which meets the requirements of MGL Cit 142.
Yes No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity D Bond p
OWNER'S INSURNACE WAIVER: I am aware that tthe licensee does not have the insurance coverage required by Chapter
142, of the Mass. General Laws, and that my Signature on this perml lcation elves this requirement
Check one:
Signature o owner or owner's AgentOwner ❑ Agent ❑
ZI
i hereby certify that all of the details and Information I have submitted for enteredii in above application are true and accurate to the best of
my knowledve and that ail plumbing work and installations performed under the pe s ued for this applicatio {t be in complia ce with
all pertinent provisions of the Massachusetts state Cas Code and Chapter 142 of the G ne I L .
Type of LicensesWJ/1 "J
By ❑ Plummer a re of L ceased 1 tuber or Gas Fitter
Title ❑ G tier
{Yityllovm ter License Number
APPROVED {OFFICE USE ONLY)
0 Journeyman
N2 1 669,1 1
Date ......... ...
t
TOWN OF NORTH ANDOVER
= p PERMIT FOR WIRING
This certifies that ................. w J ►1 C e (= I PC r� C t Cd
.
............................................
has permission to perform ...... : N C[ ........................
wiring in the building of 8 , olo..k'.P.!:<..k �}.. ��� �' BOO P -�-
l at �..O.f..1..d......' .�-6.....0 t? qA y,,,,p..c....02? , North over, Mass.
i
Fee.P,.K> .. Lic. No..Li f1j ... ! : �:....'.:................
S
tot
,ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
7 S 9, Q4 0; X.5.Ss W" 05,,5775
Tiyworrre.r � P.efll� S�
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No. / ��
Occupancy & Fee Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance + with the Massachusetts Electrical Code 527 CMR 1200
(Please Print in ink or type all information)
TMM of North Andover
Date
To the Inspector of Wires:
The undersigned applies for a permit to perform the eteatical work described below.
Location (Street & Number
Fe "I ii
Owners Address
is this permit in conjunction with a building permit l Yes No ❑ (Check Appropriate Boot)
Purpose of Building Utility Authorization o. % �/ / r
I
EAsting Overhead ❑ Undgmd ❑
I yy Service 2 Amps 2 0 Vats Overhead ❑ Undgmd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical
OTHER:
INSURANCE COVERAGE. Pursuant to the requirements of Massachusetts General taws
I have a Liability insurance Policy irmdudi aced Operations Coverage or its substantial equival YES NO=
haye�F�� valid proof of same t0 the Office ES = O = N you have checked YES please indicate the coverage OY checking the appropriate lsox
NSU E SONO = OTHER =. (Pleise
(Expiration Date)
Estimated Value of Electricai Work$
Work to Start '2`: `xl `� inspection Data Resquested Rough FtiC l�C� Final
Signed underthepenattles of pertu
FIRM NAME /rx ,. % e vAic�_ l'�c f�r7 a C'a i9 UC. NO. //5x4
Licensee (�Cl�7 S G-G�.w r -C . r c a Signature 1 �� ,& R-.. %,14' —LIC. NO.
O Bus. Tel No.y KE -6- " `-6
Address o`%2 ���tit� /JS �l re /!f ( _ _ Alt Tel. No.
OVWNEFNS 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 appitcadon waives this requirement. Owner Agent (Please Check one)
T..A...b.....e u.. WRtAIT FEE $
� 3 _'An
Total
No. of Lightling Outlets
No: Of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Ughbnq Fixtures
Swimming Pool gmd C1
gmd ❑
Generators KVA
No. of Emergency Lighting
No. of. Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Surers
FIRE ALARMS No. of Zone
No. of Detection and.
Total
No.Ran es
No of Air Cond
Tons
Initiating Devices
IV
Heat Total Total
No. of 01posal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Soace/Area Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heatinq Devices
KW
Local Connection
NO. of
No. of
Low Voltage
No. of Warr Heaters KW
signs
Balases
Wiring
No. Hydra Massage Tuds
NO. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requirements of Massachusetts General taws
I have a Liability insurance Policy irmdudi aced Operations Coverage or its substantial equival YES NO=
haye�F�� valid proof of same t0 the Office ES = O = N you have checked YES please indicate the coverage OY checking the appropriate lsox
NSU E SONO = OTHER =. (Pleise
(Expiration Date)
Estimated Value of Electricai Work$
Work to Start '2`: `xl `� inspection Data Resquested Rough FtiC l�C� Final
Signed underthepenattles of pertu
FIRM NAME /rx ,. % e vAic�_ l'�c f�r7 a C'a i9 UC. NO. //5x4
Licensee (�Cl�7 S G-G�.w r -C . r c a Signature 1 �� ,& R-.. %,14' —LIC. NO.
O Bus. Tel No.y KE -6- " `-6
Address o`%2 ���tit� /JS �l re /!f ( _ _ Alt Tel. No.
OVWNEFNS 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 appitcadon waives this requirement. Owner Agent (Please Check one)
T..A...b.....e u.. WRtAIT FEE $
� 3 _'An
I,
NEVA
I
`, S .•
i
84 LAKE STREET, NASHUA, NH 03060 • 603-883.9924
February 17, 1999
Building Permit Department %
Town of North Andover
120 Main Street
North Andover, MA 01845 -
To whom it may concern:
This notice" is to inform \you: that DiRubbo Electric will complete work done
on Lots 3 and 5 at Woodlea Village. in North Andover, that was started by
Lawrence Electric of Methuen. ' It is understood that Johri ..DiRubbo will,.
have to re -apply for electrical permits on' these two "houses:. This releases -
Lawrence Electric from work that was started. `, R
'Sincerely,
Dale Moreau Sr.
r
Site Manager
.
-
' 4
` I
office\nandow.doc
,.c
N
a
Location �f 6/r��2�c) /o
No. Date �� d7--2
N
NORTH TOWN OF NORTH ANDOVER
n Certificate of Occupancy $ Soo
a ; ; Building/Frame Permit Fee $ L,-
�� Foundation Permit Fee $ �~
Other Permit Fee $
4r -y12/99 14:51
Sewer Connection Fee $
Water Connection Fee $ z.
TOTAL
1,515.00 PAID
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DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
. Numberi;:_ Expires: Birthdate:
CS 005693 '01(13(1080 01(13(1954
RestrAted.Toi _ 00
i
DAVID A 'KINDRED
30 MILL POND POBX 531 1
N ANDOVER, MA 01845
i
156635
Restricted To: 80
00 - 35,000 cf enclosed space
(MGL C.112 S.GOL)
IA - Masonry.only
i; 1G - 1 6 1 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
4
I
I
FORM U - IAT RELEASE POW
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 f'lls out this section*****************
APPLICANT:°dy'� da���l //�� S Phone
L40CATION: Assessor's Mato Number '� tMIX Parcel 3 r
Subdivision /_�O ��ST �t S• Lot (s) A/
S tz eet St . NU."=er
************************Official Use Only*******************x****
RE' NDATIONS OF TOWN AGENTS:
/-�
Date
Approved
J `
Ccnser-'at_on Ad-Non-
_nis gator
Date
Res ec ted
-J
Cc-, , er.ts
9
�,;n2�lanner����
Date
Approved
a
2 !
Date
Rejec-ed
Conr„erts
Date Approved
Fcod Tn==er----r- :ealth Data Rej ec-ed
Date Approved
S _ ._c In s4,,ec..cr-iiea_t:: Data Re; ec-__
Cor.,...e::..o '
Wcr:;s - sewer/water connections
` - driveway pernit
Fire �Zfa-
Received by Building Inspector Date
N2 835
APPLICATION FOR WATER SERVICE CONNECTION
North Andover, Mass. `� Z- 19�
Application by the undersigned is hereby made to connect with the town water main in �J��ycG�-f.� ��' Street,
subject to the rules and regulations of the Division
nn3of Public Works.
The premises are known as No. �/��OC�` t e'f'L� � V� Street
or subdivision lot no. A
Owner
Contractor
FbI2
S r� m de.,(
6?6 " t/15S S
Address
Address 7
Applicant's Signat re '
2, A9 �-' 0�>
PERMIT TO CONNECT WITH WATER MAIN
The Board of Public Works hereby grants permission to �i�f C Pit)jA�J
to make a connection with the water main at �C�D�v °�V/i"l�l�Q�
Street
subject to the rules and regulations of the Division of Public Works.
Inspected by
Date
Board of Public Works.
By
See back for rules and regulations
RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES
1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town
of North Andover without a valid permit from the Division of Public Works.
2. All water services shall be installed a minimum of five feet below the finish grade.
3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964.
4. Service connections shall be 1" type k copper tubing.
5. All fittings shall be brass flange type Mueller or equal
H 15202 Corporations
H 15212 Curb stops
H 15402 Three part unions
H 8185 stop and waste valves
6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4�/z foot rod and brass plug
type cover.
GEORGE PERNA
DiR�CTO
TOWN OF NORTH{ .ANDOVER, MASSACHUSETTS
DIVISION OF PUBLIC WORKS
384 OSGOOD STREET. 01845
Telephone (508) 685-0950
Fax (508) 688-9573
� 9�0
2 _
Y
�L.
95SACHU5E�
DRIVEWAY PERMIT I
Date:
LOCATION:��v���"�ve
BUILDER: phone:
OWNER: l>l���t`��� G phone: egg — 6SS$
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: ,
MAScheck COMPLIANCE REPORT
,ssO-tusetts Energy Code
�Scl,!' ck Software Version
V
CITY*., Lawrence
STATES Massachusetts
HDD:\6235
CONSTRUCTION TYPE: 1 or 2
y HEATING SYSTEM TYPE: Other
DATE: 8-13-1998
DATE OF PLANS: 10/5/1998
it
TITLE: 28x55 Colonial
PROJECT INFORMATION:
Lot 1
50 Brookview Dr
N. Andover Mass.
COMPANY INFORMATION
Brookview Country Homes
COMPLIANCE: PASSES
-iquired UA = 590
,,_�ur Home = 514
2.0
family, detached
(Non -Electric Resistance)
Permit #
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 heat or cool the building
shall be no greater than 125% of the design load as specified in
sections 780CMR 1310 and J4.4.
wilder/Designer Date
Area or
Insul
Sheath
Glazing/Door
Perimeter
R -Value
R -Value
U -Value
UA
-------------------------------------------------------------------------------
CEILINGS
1404
30.0
0.0
49
WALLS: Wood Frame, 16" O.C.
2720
11.0
3.0
209
GLAZING: Windows or Doors
420
0.350
147
DbORS
21
0.350
7
FLOORS: Over Unconditioned
Space 1404
19.0
67
FLOORS: Over Outside Air
10
19.0
0
BSMT: 8.01 ht/7.0' bg/0.0'
insul. 160
0.0
35
HVAC EFFICIENCY: Furnace,
-------------------------------------------------------------------------------
90.0 AFUE
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
sections 780CMR 1310 and J4.4.
wilder/Designer Date
i
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
IScheck Software Version 2.0
"8x55 Colonial
DATE: 8-13-1998
Bldg.
Dept.
Use
CEILINGS:
1. R-30
Comments/Location
WALLS:
1. Wood Frame, 15f1 O.C., R-11 + R-3
Comments/Location
WINDOWS AND GLASS DOORS:
1. U -value: 0.35
For windows without labeled U -values, describe features:
# Panes Frame Type Thermal Break? [ Yes [ j No
Comments/Location
DOORS:
1. U -value: 0.35
Comments/Location
FLOORS:
1. Over Unconditioned Space, R-19
Comments/Location
2. Over Outside Air, R-19
Comments/Location
BASEMENT WALLS:
1. 8.0' ht/7.0' bg/0.0' insul., R-0
Comments/Location
HVAC EQUIPMENT EFFICIENCY:
1. Furnace, 90.0 AFUE or higher
Make and Model Number
THERMOSTATS:
Adjustable thermostats required for each HVAC system.
e
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 0.511
clearance from combustible materials and 311 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
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)_________________________
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 4ilyaw 918 Date fj/
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 6& BIV*16148W DRICOL
MAY BE OCCUPIED AS rAl"Old"/ N ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO %��0 �y�e 60o
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TOWN OF NORTH ANDOVER
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS/LOCATION OF PROPERTY : OCa ° eul f �j Dry V ,�,
DATE REQUESTED FILED/READY FOR INSPECTIONJ3
CLOSING DATE ON PROPERTY. �6 5
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND PERMIT SIGN -OFFS MUST BE COMPLETED WITHIN THIS
TIME FRAME.
A RE -INSPECTION FEE OF TWENTY DOLLARD $20.00) WILL BE
CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGNED
ROUTING
CONSERVATION `
PLANNING F -I
DPW - WATER METER E/
NOTE:
DPW MUST INDICATE THAT WATER METER HAS BEEN INSTALLED
PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
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N2 3938
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SACMUS �.
This certifies that . ...... ...................
has permission to perform , . ........ ......... .
plumbing in the buildings of;09T� ........... ... ....
at................ ............... , North AndCC�� ver, ass.
PLUMBING INSPECTOR. "
(02/16/9911:59 225.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or 7'ype)
'VO �V\ r Plass. Date- 1-3----- - 19.ti((]]/_� -
City, Town Permit it
Repl.aceltlt�nt
P 1 a lis
FIXTURES Submitted - Yes ❑ No El
(Print or Type) - zv Qn
Installing Company NameC"A _
Address
1lusincss Telephone 60___� -3
Check One:
❑ Corp.
❑ Partnership —
❑ Finn/Company
Name of ►censed Plumb r or Gasfit
Certificate
I hereby certify that all of the details and information f 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.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signatme of Owner/Agent
I have it current liability insurance policy to include completed operations coverage. ❑ I
4L
fay — Signature of licensed Plumber
Title _--
{� Type of Plutnbin license
City/"Down — O hister ❑ Journeyman
APPROVED (OFFICE USE ONLY) License Number
FORM 1240 Hotms & WARREN, INC. 1989
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SUB—.BSMT.
BASEMENT
_
IST FLOOR
t
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) - zv Qn
Installing Company NameC"A _
Address
1lusincss Telephone 60___� -3
Check One:
❑ Corp.
❑ Partnership —
❑ Finn/Company
Name of ►censed Plumb r or Gasfit
Certificate
I hereby certify that all of the details and information f 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.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signatme of Owner/Agent
I have it current liability insurance policy to include completed operations coverage. ❑ I
4L
fay — Signature of licensed Plumber
Title _--
{� Type of Plutnbin license
City/"Down — O hister ❑ Journeyman
APPROVED (OFFICE USE ONLY) License Number
FORM 1240 Hotms & WARREN, INC. 1989
30>J Date.`...G�...�.....
NORTH TOWN OF NORTH ANDOVER
e�+o` PERMIT FOR GAS INSTALLATION 9
A
This certifies that. �? ........... .. -!•-• ....... • • • • • --
has permission for gas installation_ ..
in the buildings of .-.K-,14,� . `...... . ....4 �.. - - - - LAD
at ..!� l':/.:t ��` `'' ... - . , North Andover, Mass. Z�
Fee4�s. L .. Lic.
+ GAS INSPECTOR
i
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
a
�-
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO O GASFITTING
(Print or Type) /
�10�::ai Date ( 19�
BuildingA \� Permit #��
Location. Iv JJ , 11
Owner's �
Name
New ❑/ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑
i
Installing Company Name
Address - � KK L
t
Business Telephone
Name of Licensed Plumber or Gas Fitter
Check one
❑ Corp.
❑ Partnership
❑ Firm/Co.
Certificate
INSURANCE COVERAGE: Check one
have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
'hereby certify that all of the details and information I have submitted for entered) in the above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
Fee
Check #
Date
APPROVED (Office Use Only)
Type of License:
Plumber
❑ Gasfitter Signature of Licensed Plumber or Gas Fitter
[a Aaster
❑ Journeyman License Number �a
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❑ Firm/Co.
Certificate
INSURANCE COVERAGE: Check one
have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
'hereby certify that all of the details and information I have submitted for entered) in the above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
Fee
Check #
Date
APPROVED (Office Use Only)
Type of License:
Plumber
❑ Gasfitter Signature of Licensed Plumber or Gas Fitter
[a Aaster
❑ Journeyman License Number �a
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