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HomeMy WebLinkAboutMiscellaneous - 91 JOHNNY CAKE STREET 4/30/2018 (2)Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... .. ............ has permission to perform .......... � GV H .C� `" wiring in the building of .......... .. A -P!.. b ................................................. . ..... North Andover, Mass. ES Lic. No. ........ ... p4u��. ... �i��PEt.i . . ............ ELECTRICAL PDR .Check 4 '1 0763 10763 i cid a0i aCi o y ro w ��3 ,i �M o b N m m W y , .d 51 .-. � '•+ o b o. 4. C7 .DC7 a� p C.� n •�W O C CV .-Oy •'~ .>~ a 3aS 0 0 c 05co,0 bo o v y o on x •p � '� N .O b U � ~ G � b 3 U C) •O tom+ •^ y ct ah o rp ai ;, 00 a ❑�❑ 00., 00 1012=0 N O W." p Op N .Wp. CO O 14,4" al O N 'd cvJ '0 '00.0.0 00N y C,Om.� Cal 8 3 El, U 4O OC .0 �+ t❑D Oa C) 8 >,.aW N O r- 0- 0- d O• In p O C O t' cpi a'V p C a O G yid0 VI bo �. ���' .SC p 'ti >� N b •N O y O a w p oq a •. a a Ute 0 O'er b u ,y O y o C p v w'j o U ai ¢, 0 3 ° 4° 2 •� o y D O o ,w w U O y p bA F7, .ti O +O — o U' 4. mV NWC 0 a0i 0 a` �•� y ro.�`" tia o a.` ❑ E2 00 FA Commonwealth of Massachusetts I11 -ficial I'"""" Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS L"cs y O� I ticasc hlanl t APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK \II work to he I>rrfurincd In accordance c%Ith the �tassach.I;rlts FiccUlc.Il (- ole I�Ih(^1. `'7 (-'\IIZ I _ 1111 (PLEASE PRINT IN IAW OR ITPE .I Ll, lAlOR,1 /.-1 /10N) Date: Cit'' or Town of: — �/ ` 1 0,-CF—Tn t17C 17 )Cc-101- 0/ t6 i VS. Itv this appliccllinn the undcrsl nod l�cti notice ,f hI� car her !nt�ntion lu perl'Ornt the CICctncal ��olk desci111ccl hckm Location (Street S Number) Mi ner or Tenant C , Ossner's Address Is this permit in conjunction Nidi a building permit? 1 es ❑ helephone No. ?b No V (Check Appropriate [lox) Purpose of Building l tilils Authorization No. F,xistin­ SerN ice \Ings \'anti New Service Alllps Volts Numhcr of hccdcrs and ;\ntpacih Location and Nature of Proposed F:Iech'ic:ll \fork: Overhead ❑ I ndhrd ❑ No. of'Meters Overhead ❑ I nd„rd ❑ No. oI-'Meters .1 1.11 ... .......1•l., :,,. :, .,n..l !n lin om"" l.rl ,'/ ;1 1'' I UL/ I(I'l,.1 ,l.li llll...n,. — U n ' ,. . .... . I.sUnlaled /,lluc tt I -I tnc,ll `:`,;Irk hen rcyUlrcd by nnuocip.11 n;hc v o b'rk to SLart9 InspectUrll, In he requested In ,Lcu,rdancc �!lh 'vlF+ Rill 10. ,Ind Ih,ln nn,Icu,,:I 1NSUR,\.NCI? C \"F: ZA(,V: I role -%%an cd by the owner. nu pcnm1l for !hc perinrrlrnlk..: It CICC IIIC 11 '.vi)rk:n,I'. „n: olid the Itccn.scc prOvidcs prooI*oHiahlllty IIItiUraneC InrlLid mij "cnn,plctcd npc;aUnn" cos _rau(: )r i I , , Ill ,I;II lu,ll �_,tjII .Iici1 undersigned certifies that Such cu�cra;,e tS in lurcc, and ha, exhibited pruol ;l sanl� t;, the ncrnt!t I;;Um ,,flue CHECK ONE: INSURANCE X BOND ❑ O FIAER El(SPcclfi y:) �,4- l l �t I Vl-ey—P I cerdi/'v, under Nie pains acrd penuldie,s crf eijury, dial rhOt)raSf,�,, Ifilrnuip'On u0,,g ufr/ltd rl i.s true and cunl/11el". MRM NATE: leI.1C'. NO.: Licensee: Silinature LIC. N0.:2t Il,l/ylhl lhi,', r'11hT 'elt,1111.)f r ..... nce/r r mlrrrh v iin' I 13Us. Te 1. No.:�` j :address: �3� �n�Gf Sf O((r SfG:� 0j,6p �' Alt. Tel. No.:. 5W 79'8 9��55 `ecurlty System Contractor License required for this work: tf applicable, enter the license number here OWNER'S INSURANCE WAIVER: I ant aware that the Licensee cions nod h/nr the hahlltt�� ut;nrmnce civ.crasc n(Mlit, y required by law By my sl !nature below. I hercl,v ',vatse this requirement I am the (chcck ;roe) ❑ owner ❑ owncr's U!cIll Owner/A(lent Signature Telephone No. PE_RIMT F. S -D`5' Iq _ No. 111 Total No. 111 Recessed l'unllllalres No. 111 Ccil.-Susp. (Paddle) Fans --- �I ra1151U1'llll`1"S t�\ A ❑ — Nn. of 11,11ninairc Outlets No. of hot Tuhs Generator" K% , -- — _ Abosc ln- ❑ ❑ u. o smcr; cncy ..1; tin' No. of, Luminaires Sainunin� Pool „rod. ; rod. 13aticry Units T�_� ___•_T-__, . No. of Receptacle Oullets No. 1) 1' Burners hIRE ALAR'1S No. of Zones — - - No, of Detection and Nu, of Sstiitchc.s No. 4) 1' �;aS Iiurne1, _ - 1nitiatin�gy De, ices--- ---- No. of Ranks Tota' No. of ,lir Conti• Duns _ Ile -,It Pump Number pons 1 K No. of \Icrtin� i)cviccs ------ - No. of Self -Contained tin. of, WasteI)isposcrs Totals: 1 Detection/Alerting Devices ------ Spacc/Arca 'Heating lit\ Winlelp:ll.No. Local ❑ ('onnection U of Dishssashers — N I1. 'It 1)t"�l`1"y Ilcatin; 1ppiianccs l�\\ —rData Security Svstems:'�� No. Id I evict'\ Ir Y'lluk lrl'Ill- N'o. of \\ rater N N, o. of -SII• I>f Wirin>;: heaters Sitins 3aflasls I No. of De+ice.> )r ;'aluisalen; -- — munirltions 1'decom\Vu .No. llydronlassage Bathtubs No. Ui''Ioulrs --- i_otal III' No. of Devices or F:Iluivatcnl - OTHER: -- I UL/ I(I'l,.1 ,l.li llll...n,. — U n ' ,. . .... . I.sUnlaled /,lluc tt I -I tnc,ll `:`,;Irk hen rcyUlrcd by nnuocip.11 n;hc v o b'rk to SLart9 InspectUrll, In he requested In ,Lcu,rdancc �!lh 'vlF+ Rill 10. ,Ind Ih,ln nn,Icu,,:I 1NSUR,\.NCI? C \"F: ZA(,V: I role -%%an cd by the owner. nu pcnm1l for !hc perinrrlrnlk..: It CICC IIIC 11 '.vi)rk:n,I'. „n: olid the Itccn.scc prOvidcs prooI*oHiahlllty IIItiUraneC InrlLid mij "cnn,plctcd npc;aUnn" cos _rau(: )r i I , , Ill ,I;II lu,ll �_,tjII .Iici1 undersigned certifies that Such cu�cra;,e tS in lurcc, and ha, exhibited pruol ;l sanl� t;, the ncrnt!t I;;Um ,,flue CHECK ONE: INSURANCE X BOND ❑ O FIAER El(SPcclfi y:) �,4- l l �t I Vl-ey—P I cerdi/'v, under Nie pains acrd penuldie,s crf eijury, dial rhOt)raSf,�,, Ifilrnuip'On u0,,g ufr/ltd rl i.s true and cunl/11el". MRM NATE: leI.1C'. NO.: Licensee: Silinature LIC. N0.:2t Il,l/ylhl lhi,', r'11hT 'elt,1111.)f r ..... nce/r r mlrrrh v iin' I 13Us. Te 1. No.:�` j :address: �3� �n�Gf Sf O((r SfG:� 0j,6p �' Alt. Tel. No.:. 5W 79'8 9��55 `ecurlty System Contractor License required for this work: tf applicable, enter the license number here OWNER'S INSURANCE WAIVER: I ant aware that the Licensee cions nod h/nr the hahlltt�� ut;nrmnce civ.crasc n(Mlit, y required by law By my sl !nature below. I hercl,v ',vatse this requirement I am the (chcck ;roe) ❑ owner ❑ owncr's U!cIll Owner/A(lent Signature Telephone No. PE_RIMT F. S -D`5' Iq 9366 Date .` �aORTh ?°�.,�'°„•:;"o TOWN OF NORTH ANDOVER 0.9 . PERMIT FOR PLUMBING ,SSACMUS� This certifies that. 57e-�Xee.... !.fix 0:�................ . has permission to perform ..�-��?j-z,�eov!7.�1/��.s� 'Sf /. . plumbing in the buildings of .... /..!...✓..!.................. . at ..... rl.. xoi .P?44, ST ZS"�. North Anddovet,, Mass. Fee.OLic. No.. /P p ..... PLUMBING INSPECTOR Check N t I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT,,*TO"PERFORM PLUMBING WORK CITY �......_��%rn_v`­__--.. MA DATEIh43/.�. ,..._� PERMIT # r AME JOBSITE ADDRESS OWNER'S NAME"— __. POWNER ADDRESS __._.�...... _ ._. .-.,........-I TELI 17.x._. iFAX TYPE OR OCCUPANCY TYPE COMMERCIAL [ .,.j EDUCATIONAL [._� RESIDENTIALJW PRINT CLEARLY NEW: [,-, I RENOVATION: [._] REPLACEMENT:, PLANS SUBMITTED: YES �,] NO<<.... FIXTURES Z FLOOR- BSM 1 2 3. 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS, CONNECTION DEVICE V Fir DEDICATED SP.ECIAL'•WASTE SYSTEM ._1 GASIOWSAND_SYSTEM [- fl i DEDICATED DEDICATED GREASE SYSTEM r it. II �r �r u DEDICATED GRAY WATER SYSTEM - - r DEDICATED WATER RECYCLE SYSTEM --- — r r DISHWASHER DRINKING FOUNTAINI�� I FOOD DISPOSERI sI� t (- �( i FLOOR AREKDRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK, I 1 i 11 -l( rt LAVATORY; ti ­j f i !I ii r I (. �I F- ,ROORDRAIN ;'.'' _ SHOWER STALL," f r. jl `fir it ._ .�.._. I �_'(- —I :� SERVICE 1 MOP SINK - TOILET 1­17-,177 L URINAL, i; 6 ji C '�i .^ it I" WASHING MACHINE CONNECTION ALL WATER HEATER TYPES II 1C '- 1i7Ir _ (.; .._ i �i ,i ►� _ __ __ WATER PIPINGF­­ -.. - -1 I l+ : ri� �_ II I� �....-- [7 OTHER _.. .,...:.'I m.:_11 _ _a(_ _ : -. n t I =r • _t .�l.. ..I... �1 :��.�I.—_-IL.,_ li-._.�-�I_.._. �r. ..II.._.._ 11-_.._ lr I _.Irk -i _ _. _._ _...--- --___�I. INSURANCE COVERAGE: which meets there requirements of MGL Ch. 142. YES[— NO q [- 1 have a current liability insurance olic or its substaritial a uivalent , _�L policy equivalent IF YOU CHECKED YES, PLEASE INDICATE TH PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE OF INDEMNITY ] J BOND[ -I 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 L_.] AGENT rwl SIGNATURE OF.OWNER OR AGENT I hereby. certify that all of the details and information I have submitted or entered regarding this application arp true and accurate to the best of be in mpli nce with ertinent provisi knowledge of t ' and that all plumbing work and installatioris performed under the permit issued for this application will J Massachusetts State`Plumbing Code and Chapter 142 of the General Laws. i PLUMBER'S NAME Ste hen G Ritchie LICENSE # 10355 / SI NAT MP I a.,_] , JP .. ] CORPORATION [�, j # 2551 PARTNERSHIP_..Tf #I I LLC I )# I...... COMPANY NAME i Worcester Gold Corporation � ADDRESS Worcester----- - CITY "Worcester � STATE MA ZIP 01608 TEL 5-087-9-8-995-5 _...�... ...�._ .____.__---_..._._______.._...._._..---_..___._____._____________.__._._....______.- -- __ FAX 5087578114-_ CELL I e -EMAIL office m Imb.cam I f fD ` N � o C rt d � td (D a z (D n. y � r � z Z t m x � ' z cn 0 4 N 3 z rn n z o DN z Z z y r cn b 0 z z 0 r cn Date. .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r This certifies that ...... :'. ` .. ? ....... has permission to perform ... ...... .... , . ...... • .... . plumbing in the buildings of ... ..... l .................. . ........... North Andover, Mass. Feel' Lic. No........ .... - -tr n,,.//t......... . PLUMBINGJH , ECTOR Check # `���� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 't Owners Name Date&T'2,a-cc'a- - C Co�T Permit# A cs' .. mount Type of Occupancy Rl2 - New El— Renovation Replacement 13 Plans Submitted Yes No ❑ FIXTURES (Print or type) Check one: Certificate Installing Company Name GFIV-00-('sab�- kw,6r1 & ❑ Corp. Address P 0 . �> o x Z:Lo ksb.sn-`l c-- . o.Cb,) Partner. D-Km/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑. Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent ❑ 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 w d installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of Mass�eltso Plluumb ng Code and Chapter 142 of the General Laws. By: Signature ure oi 1-icensea riumDer Type of Plumbing License Title Vao -� )-- City/Town icense Numoer MasterJourneyman E]APPROVED (OFFICE USE ONLY PATRICK J. DONOVAN ASSOCIATES, INC. claim and Foss .adjustments P. 0. BOX 110 TQ - WAKEFIELD, MA 01880©�� 0 rR Tj_ TEL. (781) 245.5540 -- FAX (781) 245-7016 of NEgL F July 22, 2002 Building Commissioner City or Town Hall North Andover, MA 01845 Insured Property Address Insurer Policy Number Type of Loss Date of Loss Our File # AUG 7 2002 1 : Michael & Jill Howard : 91 Johnnycake Street, North Andover : Merrimack Mutual Insurance Company : HP1932610 : Water Damage :7/21/02 : WAP33772 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. / Lt_ y Vern Laws, Adjuster VL/so INDEPENDENT INSURINCE ADJUSTERS Massachusetts �, lwkul , 1-6cation�' cc, No. 39 z Date 4///Lv MORTh TOWN OF NORTH ANDOVER 0:..�o ;• 1ti0 • . • OL p Certificate of Occupancy $ Building/Frame Permit Fee $ ��b''••"'�<�' CNuFoundation Permit Fee $ SSAst Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL 7 n f l� 98 09:21 j $ V wilding gspector 25.00 pAiD Div. Public Works Y _rm� § z � G - � z - 7 \ uj � lk)q & Q \ � ! = � � d � ( .0 2 . � _ ] ' § = \ \ � § ` § \ > : � 5 _ uj; . & � \ / 2 § \ a ) ) 7 z _ < ! 2 Y _rm� § z � G - � z - 7 g 7 � lk)q \ � ! = � � � ( .0 z . � _ ] k 9 = \ k � § ` § \ � : � uj; . & � \ / 2 § \ a ) ) 7 z _ < ! 2 } ! \.T ! 2 / ) ! CA L z - g = � ) ` ! = � ; z � § k ` k = \ k � § ` § \ � : � ) . & � \ c1 ui 11:41 0a t :/% c o a m c a c r w O � L o c� � w° � a C� � a � o w � o x ot U G w" o x r w" W o x ch C w o x w W w 6 cn o ui F O W a CD 0 E co Z 0 D CO2 CD V CL CD O CD Q _m CL H O Q. CO2 cc cc CA 'c L O v co CLCA c c o .c o co m m 0 co 3� co cc O � c O CD Z 5 CO)CD c ir r J� :/% c o m c ., c r O � L J C o H c �Am! OC.) sj•a-o c � co J2 E a CD CE m� :.. ts d: CD a utC � m c� 60 'r cm me N TO E ` : m m L too:p m3 t C m h c �• y 0 N m L C v C� c O =u L Hm; C=M m CC N m mor yZ O •Ci c L O d C_ �c c m dco yr N O �„ L H CC A C P W E p.Z �� �, = o LU L3 a � 0 g m CL F O W a CD 0 E co Z 0 D CO2 CD V CL CD O CD Q _m CL H O Q. CO2 cc cc CA 'c L O v co CLCA c c o .c o co m m 0 co 3� co cc O � c O CD Z 5 CO)CD c ir r J� FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from,compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION ,,' APPLICANT H I i d'. I I I I 1:JZ1 j2j�� LOCATION: Assessors Map Number SUBDIVISION STREET 011 JQ6V)Q=9J ,�• PHONE �J OFFICIAL USE ONLY*** RECOMMEhLDATIONS OF TOWN AGENTS: . CONSERVATION ADMINIVRAT DATE APPROVED DATE - REJECTED_ PARCEL LOT (S) ST. NUMBER COMMENTS d S C) � .l_ dV1LJ _oe&,W,0 - TOWN PLANNER DATE /APPROVED rl� DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH IC I TH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE 09/08/98 TUE 11:04 FAX 978 356 5488 Ipswich Bank U002 MORTGrAGE INSPECTION PLAN BOSTON SURVEY, INC. 97-03*742 P.O. Box 220 Charlestown, MA 02129 (617)242-1313 MAIN (617)242-1616 FAX APPLICANT: MICHAEL W & JILL P. HOWARD LOCATION. 91 JOHNNYCAKE STREET DEED/CERT- 4078177 CITY; STATE: NORTH ANDOVER, MA PLAN REF 8083 W00 DECK Z groRy 44040+1- S.F. TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: offio l �'I(J(i a �QP4�1��� 0 D Est. Cost3w Address of Work, Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner -occupied ::;z6wner pulling own permit Other (specify) Notice is hereby -given that: For office Use Only Pemit No. —3 / Date OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL C. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: *t- Owner Name 1 RECEIVED PAYME nate...%:% ,� '' . APR NORTH TOWN&fe ffTH ANDOVER O=0''"ttED NOAIT FOR GAS INSTALLATION 1- A f This certifies that ...�... :�f :'. , :.)... ..... t , ? :. ....... has permission for gas installation .. f ` : ':�.'. F':.C....: in the buildings of ' ............. . at ... ; `!....1 �G ": s , f . ':. f�11 �l North Andover, Mass. Feel..:? : —Lic. No.l�.,7..: .......................... GASINSPECTOR WHITE: Applic6 CANARY: Building Dept. PINK: Treasurer GOLD: File .0 G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date �/ 19� Building--/ Locatin �o�i.nntic a le ay1F Permit # ) Owner's/ Name a New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ Installing Comoanv Name ___gdvvt lY T /q . v / -9, r.,- T c - Address �% 51 /Z,.;.. n 57" Business Telephone e e`3 R� Name of Licensed Plumber INSURANCE COVERAGE: Ch?0crp. one: Certificate ❑ Partnership ❑ Firm/Co. Check,Olie I have a current liability insurance policy or its substantial equivalent. Yes No ❑ If you have checked yes, please i dicate 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. Signature of Owner or Owner's Agent Check One: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j City/Town APPROVED (OFFICE USE ONLY) Ty p >of License: �"t, I ,(4, X C3'Plumber Signature of Licensed Plumber ❑ asfitter License Number 1 Iff Master ❑ Journeyman „ • • . Installing Comoanv Name ___gdvvt lY T /q . v / -9, r.,- T c - Address �% 51 /Z,.;.. n 57" Business Telephone e e`3 R� Name of Licensed Plumber INSURANCE COVERAGE: Ch?0crp. one: Certificate ❑ Partnership ❑ Firm/Co. Check,Olie I have a current liability insurance policy or its substantial equivalent. Yes No ❑ If you have checked yes, please i dicate 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. Signature of Owner or Owner's Agent Check One: 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j City/Town APPROVED (OFFICE USE ONLY) Ty p >of License: �"t, I ,(4, X C3'Plumber Signature of Licensed Plumber ❑ asfitter License Number 1 Iff Master ❑ Journeyman . Date ....... � ..... . �} MENS �• ���®ply NOR7{, 9 {,,,WN OF NORTH ANDOVER Otts.o 66hO QQR 1 PERMIT.F R GAS INSTALLATION This certifies that . .......................... ... . �. has permission .for gas installation in the buildings of ......: ... .......................... at .. ... C��:...:'� ;North Andover, Mass. Fee.. r;' :l . Lic. No:. .......................... GASINSPECTOR WHITE: Applic fpt CANARY: Building Dept. t PINK: Treasurer GOLD: File f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) dr��i dCY�t" ,Mass. Date "/'�� / / G 19� BuildingTQM G ? �,h G Permit # ��� Location Owner's Name (� New ❑ Renovation ❑ Replacement Plans Submitted: Yes O No ❑ Installing Company Name �, dam'{,r- / �g r��`• �- "e, Address 7J � 5m Business Telephone -- Name of Licensed Plumber INSURANCE COVERAGE: Check 'e: Certificate rop ❑ Partnership ❑ Firm/Co. Chec ne I 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 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142of_the General Laws. n City/Town APPROVED (OFFICE USE ONLY) Type of License: -/ o `p .r 1 Plumber Signature46ff Licensed PlumkJer ElG Gasfitter License Number 67") Master ❑ Journeyman F H73 NOR7M kpttt�ao �"�ti0 � 3a ,• .r .. , _ � oc Ip- A i SS US Date ..........711,71. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that / ........�............ e..�.�.1.:?.�. f ...... .......S. �.. has permission to perform 7- ­*...f2 ..... ................... wiring in the building of �Sl j { � � ................. ' ............................. ..... ........................... at ......... L. �....J . �1. !'. �?.!:. r... �. �. �.�.....a �.............. orth Andover, Fee fli . -. � O. Lic. No.. Z� Y .................... .. .... ........�:... LECTRICALINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Q PS I r - On VS.- U.I - n ie Commonwealth of Massachusetts ' t'••ralt ':n. Department of Public Sofcty BOARD OF FIRE PREVENTION REGULATIONS S27 CIAR 12-00 3/90 Occu,..,oc, s r.e CTeeRea %leive ptanM APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI Work to be performed In accordance with the Massachusetts Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL I2IFORHATION) Date 9-,5--.97 City or Town of /1027;V 4/1,0,0 � To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 9/ ✓4 ymeyY 5-T2EET Owner or Tenant /y1/ny,4ELy, ✓/ // .�i0uJ,4,eD Owner's Address SAME (S08 685- 8/c30 Is this permit in conjunction with a building permit: Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization 110. Existing Service _- Amps / Volts Overhead ❑ Undardi 7 ilo. of Meters _ New Service Amps / Volts Overhead ❑ Undgrd ❑ (to. of Meters Hurtber of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners , BNo. of atter Emerunigency Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices g No. of Self Contained Detection/Sounding Devices Local Municipal 11 ❑ Other Connection No. of Ranges g Total No. of Air Cond. tons No. of Disposals eat No, of Pumps Total Total Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW Signsf Ballasts / _� irinoltag _.�IA6114e6Zt2je�H No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO —_ I_f.you have checked YES, please indicate the type of coverage by checking the appropriate box. SURANCE ❑ BOND OTHER ❑ (Please Specify) ii C>7 cc Expiration Date a6 Es f!'timated Value of Electrical Work S .24S- 1 i �c== tfj UVIr to Start 9-17-97 Inspection Date Requested: Rough Final 9-19-9-7 Ved under the penalties of perjury: j� 1** NAME A.D.T. SECURITY -SYSTEMS NORTHEAST INC. LIC. No. 1231C �( �EU nsee DONALD A BROOKS Signate NO. 1231C .--� nddress 60 William Street, Wellesley, 8 s. Tel No. 413-732-4400 --` Alt. Tel. No.617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S 3.S Ot3 signature of Owner or Agent Date./ a/`z1,�9'� �.TO 3882 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING •� This certifies that ................ has permission to perform ... w ......................... plumbing in the buildings of .................. orth Andover, Mass. Fee, -2.c?,. '... Lic. No..C� 3 3.7 . .... .... . "PLUMBING INSPE TOR 12/10/98 13:34 20.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PU ING (Print or Type)„ ui T� /,1YnA Mass. Date 19-2L Permit # J (N 2 - Building Location _ 6Awner's Name/%G!/SLJ71,11L16&&j Type of Occupancy /�t5 1 -0 E I New ❑ Renovation ❑ Replacement 2"*' Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name ktr £eT .Sr?mm 4TA� c) Address Check one: ❑ Corporation 1 r r;/W1"&/\J. YYIH U 1 [I Partnership usiness Telephone 7 / 0151"/Co• rName of Licensed Plumber 7- frr S�? MM rK,0-0{. Certificate INSURANCE COVERAGE: I have a current 1}'�biiity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q' No ❑ If you have checked,, please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld 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 ❑ 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 poormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum Ag Code and apter of the eral Laws. By Title re of Licensed Plum r City/Town Type of License: Master % Joumeymah C] APPFiONED OFFICE US ONLI� License Number • Y • • • � 1 Installing Company Name ktr £eT .Sr?mm 4TA� c) Address Check one: ❑ Corporation 1 r r;/W1"&/\J. YYIH U 1 [I Partnership usiness Telephone 7 / 0151"/Co• rName of Licensed Plumber 7- frr S�? MM rK,0-0{. Certificate INSURANCE COVERAGE: I have a current 1}'�biiity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q' No ❑ If you have checked,, please /indicate the type coverage by checking the appropriate box. A liability insurance policy ld 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 ❑ 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 poormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum Ag Code and apter of the eral Laws. By Title re of Licensed Plum r City/Town Type of License: Master % Joumeymah C] APPFiONED OFFICE US ONLI� License Number v r c z a z co V m A O s N z a m c m O O c r O z O a V .r A -moi O z O z m s -4 O O O V r c z Q z 0 In m m N A 4, 2 Un 7 Date ... llfd�.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... -.,4 .. - T .......................... .... . .. V7 ................... has permission to perform ........ ......................................... wiring in the building of ........... ........................................... I - -at ............. .. /- ..... . North Andover S. 4 Fee ... h -:.4L Lic. Noh.w.( ....... �./o .... ... .... Check #-3��-A Commonwealth of Massachusetts Official Use Only . Department of Fire Services Permit No. 7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME7r- City 527 MR 12.00 (PLEASE PRINT IN INK OR TY A INFORMATION) Date: or Town of: To the Inspe for of Wires: By this application the undersigned gives notice,o his or hehinterltion toapgrform the electrical work described below. Location (Street & Number) (J Owner or Tenant M Telephone No. Owner's Address 1-1 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the followin table mav be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners NO. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat lPump Number Tons KW No.Detection/AlertingofSelf-Contained Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances Kms, Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. o. Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of El ctrical Work: Foy r (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the fiains Andpenalties of perjury, that the information on this application is true and complete. FIRM NAME: nnT coriirf; +v cervi rcc 1P ri inr tAn LIC. NO.: 1 S3.Jr Licensee: John S. Bassett Signature (If applicable, enter "exempt" in the license number line.) Address: required by law Owner/Agent Signature JRANCE WAIVER: I am aware that the Licosee does By my signature below, I hereby waive this requirement. Telephone No. LIC. NO.: 1533C Bus. Tel. No.: 603 594 nig $ Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE: $ 4,< , n Location No. f.%- Date Z� / %^ca--- ��^T� TOWN OF NORTH ANDOVER Of•',a. .6.6 A 4L 1 Certificate of Occupancy $ Building/Frame Permit Fee $ AMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # A Al -z-- 157'15 %/ �BuOding Inspector 4 � ,.1 4.0 /i//;2 Date.................................. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ........� :.. "!.. (Cl..` 5.. f... f .v2 ........... .............................. has ,permission to perform........ �(- erform/�F ............................. wiring in the building of .................l..l(tL ............................................ at ........ .. j. .,..1....,1 rJ��i? ?. yl.. !' . ...................... . North. r, Mass. Fee . 3.0 .: (�Lic. Nof Al <.. 1� ................. ELE ICAL INSPECTOR Check # % THEC0MM0NWE4LTH0FM4SS4CHUSETTS DEPAR rMEW 0FPUX 1CSAFE7Y BOARD OFFIREPREVEMONRMUTA77ONS527CNIR12.00 Office Use o Permit No. Occupancy & Fees Checked APPLICARONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 9J Owner or Tenant Owner's Address t - i- Is this permit in conjunction with a building permit: Yes Purpose of Building Existing Service Amps /s;b z 4�Wolfs-- New Servi&e Amps / Volts Number of Feeders and Ampacity Location afrd Nature of Proposed Electrical Work 939 No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals a No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs No. of Hot Tubs Swimming Pool Above ground No. of Oil Burners No. of Gas Burners _ No. of Air Cond. No. of Heat Total _ Pumps Ton: Space Area Heating No 0 (Check Appropriate Box) Utility Authorization No. _ Overhead Underground �� No. of Meters Overhead Underground No. of Meters QTi/�iC'' A'®OIn 5 j� 7j No. of Transformers Total KVA Generators KVA No. of Emergency Lighting Battery Units TotalI FIRE ALARMS No. of Zones Tons ------- Heating Devices KW No. of No. of Si ns Bailasis No. of Motors Total HP Total No. of Detection and KW Initiating Devices • KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Other Connections %==CO P alat>ttothefflV=naysofM G,,, Laws bawaamaltLAIlityhmua mpbkymdxb gCmpCovtWorrtsst>bsUffialegtuvala�t YES NO hawsubn>dtedvalidproofofsarrreiptheOffio� YES r—q) ff}ou} eclted y ,p ofm by heddggthe box IIL��'�JJI L�J WJRANM EEr BOND a OtIIER ( s y)tq - 6 .., RMNAME censee Signature Jdress-K EMnia1edVakEdEbcfixalWcqk $ lxemeNo. LicffwNo BusiimTel.No. JVI�IFR'S INSURANCE W — Alt Tel No. AIVFR;Iamawarethatthc imwdoesnothavetlleinswm=covaageoritsRtsWWequivalaxasmgrmedbyMa%achtmMG=t-alLaws jdiatmysigrtattueonthispamitapp � thisrt�ernent lease check one) Owner Agent signature II\ '� O Telephone No. PERMIT FEE • VU o wner or gen TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r+ BUILDING PERMIT NUMBER: DATE ISSUED: / —�` / oZ o O a SIGNATURE: cc,, Building Commissioner/lEgWor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 91 :720 14A-1UYCAKC- S77 �MS3 Map Number Parcel Number 1.4 Property Dimensions: s5 1j /rt t`/ 460/0 �S . f ` /< in District Pr osed Use I.at Area Frontage ft 1.6 BUILDING SOB&C- KS yo Front Yard Side Yard Rear Yard Required-*,--" ftt de RequiredProvided Reqaired Provided d j C) 310 3CA f- D 1.7 Water Supply M.G,j.,:�.40.A 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTV OWNERSHOAUTHORIZED AGENT 2.1 Owner of Record M is &A EL -d-- 7 ) L -L /-40wAR 1rJ Of/ TVA n)M'\4CAJC6 � 7_ Na (Pri t Address for Service: tg Telephone 2.2 Owner of Record: Name Print Address for Service: I Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ G L kAkJ2 W L LC H Licensed Construction Supervisor: 0 78 y 1-30 t0 � (p � L �� �� 5 T License Number Adress IU Expiration Date gna re Telephone 3.2 Registered Home ImG f, ( Ct ("'Iprovement Con ctW k/ ,oNot Applicable ❑ r/ Company Name / 6-3 / A) np L �>�X /j ), n / Registration Number A ess / / ` / t,/ u ` vl�d pe&,�4 Expiration Date nature Telephone 1 r 0 C r V 0� r C A r 9 v v r r a I - LJ lot :A 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 buildin rmit. Signed affidavit Attached Yes ...... No.......0 SECTION 5 Description of Proposed Work(check all a hcable New Construction ❑ < , Existing .Building ❑ Repair(s) 0 AhernJons(s) Addition Accessory Bldg. ❑ Demolition 0 Other ❑ ,. Specify Brief Description of Proposed Work: A4n IRON TO k J w V 6? IYiv 5 7 -1 -.?2 Ae,v-VA6stj SECTION 6 - ESTIMATED CONSTRUCTION COSTS WWA Item Estimated Cost (Dollar) to be Completed by t applicant OItFICIA.U'<E C}NLi'Y 1. Building 000 (a) Building Permit Fee Multiplier 77 2 Electrical 0 C> d (b) Estimated Total Cost of Construction ' 3 Plumbing Q Building Permit fee (a) x (b) .� ®� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 b ooc> Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, -71 LL- 14 o txjA e as Owner/Authorized Agent of subject property Hereby authorize to act on My be < , in all m erE Yelative to W04)authorized by this building permit application. Si atu of Owner Date t� SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I r, P.Paj UJIZZLk as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the fore g 'ng application are true and accurate, to the best of my knowledge and belief� '�n ,,-) y✓ Y `tet � ��.�. � r �.. Pri t N e --� Si r/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T ABERS 1 ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DEIvENSIONS 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 F ORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ****************************APPLICANT FILLS OUT THIS SECTION APPLICANT_` � �(Q V1l �Z. C 1 1 %�" ti L PHONE !%g ' %9 f %— Oj, % � 1 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET'/ O/�A!/CAKE' 5 ST. NUMBER *****************************************OFFICIAL USE RECOMMEND CONSEAV71 101 COMMENTS TOWN PLANNER TIONS OF AGENTS: DATE APPROVE=D far; DATE REJECTED CIO/ DATE APPROVED DATE REJECTED COMMENTS ------------ FOODINSPECTO ..,-I — i _ SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTEn. PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT ff IT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm DATE ✓hg L/C1�f`vl'i1L4H!!/f'Y��[/7 (f i l�fiJ:fflfRfWGUJ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 007864 Birthdate: 04/18/1954 Expires: 04/18/2002 Restricted To: 00 GERARD E WELCH 1361 MAIN ST READING, MA 01867 Tr. no: 22315 r Administrator MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 6-26-2002 DATE OF PLANS: 2-28-02 TITLE: RESIDENTIAL ADDITION PROJECT INFORMATION: JILL & MICHAEL HOWARD # 91 JOHNNY CAKE ST. NO. ANDOVER, MASS. COMPANY INFORMATION: GERARD E. WELCH, INC. P.O. BOX 248 N. ANDOVER, MASS. 01845 COMPLIANCE: PASSES Required UA = 223 Your Home = 219 I I I I I Permit # I I 1 I I I Checked by/Date I I I Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value CEILINGS 493 30.0 0.0 WALLS: Wood Frame, 16" O.C. 321 13.0 0.0 WALLS: Wood Frame, 16" O.C. 135 13.0 0.0 WALLS: Wood Frame, 16" O.C. 186 13.0 0.0 WALLS: Wood Frame, 16" O.C. 420 13.0 0.0 GLAZING: Windows or Doors 190 0.370 GLAZING: Windows or Doors 75 0.370 GLAZING: Windows or Doors 16 0.350 DOORS 33 0.320 HVAC EQUIPMENT: Furnace, 95.0 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 thee irements of the Massachusetts Energy Code. The heating load for thi building, and the cooling load if appropriate, has been determined usin th applicabl Standard Design Conditions found in the Code. The C ent a ec ed t heat or cool the building shall be no greater th 2 % o t es' oad a specified in Sections 780CMR 1310 d J 4. r� S Builder/Designer Date S 0 UA 17 26 11 15 35 70 26 6 11 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 RESIDENTIAL ADDITION DATE: 6-26-2002 Bldg.J IDept . 1 Use J l J CEILINGS: [ ] J 1. R-30 J Comments/Location 1 I WALLS: € ) J 1. Wood Frame, 16" D.C., R-13 J Comments/Location [ ] ► 2. Wood Frame, 16" O.C., R-13 J Comments/Location [ ] ( 3. Wood Frame, 16" O.C., R-13 J Comments/Location j J { 4. Wood Frame, 16" O.C., R-13 I Comments/Location 1 I WINDOWS AND GLASS DOORS.- 1. OORS:1. U-value: 0.37 J For windows without labeled U-values, describe features: { # Panes Frame Type Thermal.Break? [ J Yes [ } No Comments/Location [ ) ( 2. U-value: 0.37 { For windows without labeled U-values, describe features: i # Panes Frame Type Thermal Break? [ J Yes [ } No J Comments/Location [ ] I 3. U-value: 0.35 } For windows without labslfld U-valucs, dcscribe f@atursS: { # Panes Frame Type Thermal Break? [ ) Yes € ) No { Comments/Location I I DOORS: [ ] I 1. U-value: 0.32 i Comments/Location I I HVAC EQUIPMENTS f l I 1. Furnace, 95.0 AFUE or higher I Make and Model Number I j 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 t shall meet one of the following requirements: ► 1. Type IC rated, manufactured with no penetrations between the 1 inside of the recessed fixture and ceiling cavity and sealed or J gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no { more than 2.0 cfm (0.444 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: 1 ) I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. 1 I MATERIALS IDENTIFICATION: ( j j Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be f provided. Insulation R -values, glazing U -values, and heating I equipment efficiency must be clearly marked on the building plans I or specifications. } I DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. I j DUCT CONSTRUCTION: ( ) I All accessible joints, seams, and connections of supply and return 1 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 ( omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing air and water systems. I ( TEMPERATURE CONTROLS: [ j I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. 1 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 i. Sections 780CMR 1310 and 34.4.. I ( } j 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-depietable sources. Pool pumps require a time clock. i ( l ( 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.): F I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP M 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 } Low temperature 120-200 0.5 1.0 1.0 1.5 i Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled watar 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: 1 insulate circulating hot water pipes to the following levels (in.): 1 I PTPZ SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS } HEATED WATER TEMP (F): R13N0UTS 0-1a j 0-1.25" 1.5-2.0" 2.4+a 1 170-180 0.5 1 140 1.5 2.0 [ 140-160 0.5 1 0.5 1.0 1.5 1 100-130 0.5 1 0.5 0.5 1.0 1 ----NOTES TO FIELD (Building Department Use Only) ------------------------- 0 �F- Lfrr 8 STRUCTURE LOCATION PLAN CLIENT. I.1a. Dv lrJ016E1Z oLcg, THIS CEF.'MICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: &11 VD, SCALE: I � is ('o' DATE: Z . 12 -OZ i4COUNTY LAND SURVEYS, INC,. ProfmlmrlL&nd&rve "'POBmr5AGkxmtc,INA0101-00-070292~ `A90IT1,00 / Gua"o- ' Zowio,6 2 I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS, WETLANDS, EASEMENTS, ORDERS OF CONDITIONS, ETC.) THIS DRAWING SHALL NOT BE USED BY THE,CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE, EXCEPT WITH THE WRITTEN PERMISSION OF COUNTY LAND SURVEYS INC. COUNTY LAND SURVEYS INC. TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFORMATION CONTAINED HEREON. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone (—j am a homeowner performing all work myself. =I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Com an name:44 C, Address v Ci _ Phone #: 9 1 / Company name: Address City: Phone* Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalUes.of a fine up to $1,500.00 and/or one ye p . onment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. 1 understand t t a c y of this st9tement may N forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cel(ify unle&e pglhs grid pergW 9f,'perjyry that the information provided above is true and Print name Official use only do not write in this area to be completed by city or town official' []Check if immediate response is required Building Dept Contact person: Phone FORM WORKMAN'S COMPENSATION N ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office 0 Health Department ❑ ©tiler U) m C m U) 0 m CO) '0 az CD O CLd CZ nC0 .0 O 0 0 a� Q � o CO! .0 CD O CA d d O y n� O CA d CD r� CD y CD 0 CSD O CD c ?� 0 m 2 s _yaQ N d0 a O .0 CO) -� =3OF CD Cl) o y Cl) d0 Z CO) � = to H ..+ =r CL = T m p CD CA O ? mCD = CD m -n•1 m W. 0 Z o 1 o Go O o C w?rty'i j p r a >0 co 0 CL rV/�J . -CCD O N V/ m n� c cc it n °3 `CD O cn 0a�r� a ►� N �l CD m ,.� O N :r)3 0 � • � � N `N � _ �c4 _ 0 CD cl:*, =r cn OCA bd C cn low &.1 S,Srp ca b: CD M I E Omi 0 0 c zOQ x a PV O x c CA ? ;v 0 o 0 ro W v -,Iq x M I E Omi 0 0 c