HomeMy WebLinkAboutMiscellaneous - 94 CORTLAND DRIVE 4/30/2018`—
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This certifies that . V-P-Ij i,.. C-0�'J ...................... .
has permission to perform
plumbing in the buildings of. P,(
C �r��� .....................
at ....... 6,.L,�..�. �. • � } ... • . , North Andover, Mass.
Fee. .. Lic. No. ?�?,� ...i c���.•.................. ...
�
PLUMBING INSPECTOR
Check 699
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
-
) I a"
CITY - D !� - �'�� � - -- - -- - MA DATE PERMIT#---)
_ _ - f
JOBSITE ADDRESS(1,1 i L .. -- OWNER'S NAME rl� r�,��
P
OWNER ADDRESS TEL 9��?Z ?Z�c_ _ �J FAX
TYPE OR
OCCUPANCY TYPE COMMERCIAL [ EDUCATIONAL Q RESIDENTIAL t
PRINT
CLEARLY
1
NEW: RENOVATION: REPLACEMENT: 177 PLANS SUBMITTED: YES 0 N 01
FIXTURES 7 FLOOR-4 BSM 1 2 3
4 5 6 1 8 9 10 111
12 13 14
BATHTUB
CROSS CONNECTION DEVICE
-_
DEDICATED SPECIAL WASTE SYSTEM __-._-.--__--- ; ------
DEDICATED
DEDICATED GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEMf _ _ _, .__ _ i _....
DEDICATED WATER RECYCLE SYSTEM ` ? - ; ...w_..—
DISHWASHER _..__.._I n__.. _J __-- __.__...._._._. ......_._ . _. _ I _...__.J .._....-_.! J
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/ AREA DRAIN _ --J --i
INTERCEPTOR INTERIOR
KITCHEN SINK _.___.I 1
LAVATORY
ROOF DRAIN
SHOWER STALL--
SERVICE I MOP SINK-..-__--
TOILET _I
URINAL
WASHING MACHINE CONNECTION-- ----- j
WATER HEATER ALL TYPES
WATER PIPING
OTHER ------ ._------ - ..__._ -- - - ._... -- ' -- --- - - . _ : --J -- ------ -!
-------._ ............... -._..... ...-._..___--__..-- ... .............I _.. _-- _-- I __- ! ._._ ...... _._...__ -_ I _ _-.---.._.._.....___.! ..__.. __ .-_ I -._. __--
i
I '
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES'} NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
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 Chapte 142 of the
Massachusetts General Laws, and that mysignature on this permit application waives this requirement. 1
CHECK ONE ONLY: OWNER k 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 in oompilance with all Pertinent provision of the
Massachusetts State Plumbing Coda and Chapter 942 of the General laws. :kz r
PLUMBER'S NAME _. -.L�N7....... _... _. __.__..I LICENSE # L1o�7C! -�' SIGNATURE
MPJP CORPORATION F1# PARTNERS}{IP[#,_...LLC f1# _...
COMPANY NAMENT -.!� SIJ _..--._-_--- ADDRESS
CITY / �y,F�' STATE A ZIP j�j f' $%� TEL 7 �Z
�! -- - - ------ ---- i-
FAX CELL EMAIL
The Commo lth M h tt Print Form
nwea of assac use s
Department of Industrial Accidents ?
Offke of Investigations i
kvi I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Agglicant Information Please Print L'ehibly
Name (Business/Organization/Individual): C.-liN%Z P6 ','1iO4- f
Address:
04(l
0 Phone #: 177 7Z 7 7E
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. 1 am a sole proprietor or partner-
listed on the attached sheet.
' 1 ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.t
required.]
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'
comp. insurance required]
Type of project (required):
6. 0 New construction
7. Remodeling
8. ❑ Demolition
9. ❑ Building addition I,
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs I
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating su
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities haV,E
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. i
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job i
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Expiration Date:
i
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties hof a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification. I
I do hereby certify under the pains and penalties of perjury that the information provided ab ve is true and correct.
Signature: - _-- 6151%- 7Z /l?f�
ane #: '279- ZZ -7 "7Z
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Common
Division c
a
Board of
AIML
PL32799-J
License No.
KEVIN
121 Tf
TEWK
JOUME
05/01/2014
Expiration Date
005055
Serial No.
i
Date .....9.'.........` . . .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. �rJU�TT� ...-5r ................................... Z(„, .............................
has permission to perform ................
•
wiring in the building of .......... ........................... I .......................................
at ....... �.Zl .... . .......... R ... ... .. .. .., North Andover, Mass.
.......... ..
Fee 3� .... Lic. No. .. .. .. — .. .... .........
tLEcnucXL INs �
Check # Pwrov
Commonwealth of Massachusetts Official Use Only j
Dep artment of Fire Services Permit No. S
a
Occupancy and Fee Checked
, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 2.0
(PLEASE PRINT IN HK OR TYPE ALL INFORMATION) Date: fit' S /3
City or Town oh NORTH ANDOVER To the Inspector of Wires.-
By
ires.By this application the undersigned gives notice of his or her i�r,
tentio to perform the electrical work described below.
Location (Street & Number) Y Courf n
Owner or Tenant A; I<e Uoc v 65 Telephone No.
Owner's Address Sri M
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
- Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: M`, ve �, - f —S fg t �� S &,; 4e
ad C9 C".,4 le -LS
Completion of the following table may be waived bV the Inspector of Wires.
No. of Recessed Luminaires
No. of Cell: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- El
o Emergency Lighting
rnd. rnd.
Battery Units
foo. of Receptacle Outlets Q
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switchescr::�No.
of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I Number
Tons
.............
KW
..........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
lio. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated' Value of Electrical Work: ,;SO 0 , o d (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability 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 [0 BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME- LIC. NO.: 13 qb
Licensee: ()o u � ,9-i`+1n rP 1 J Signature �%r.� /, t��i LIC. NO.:
(If applicable, enter "exe pt" in the licens umber line.) --p Bus. Tel. No.: r17� S'S/ Qa S 6
Address: 4N��cin.SCoMye , 84C. er l !1 Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent rARMIT FEE. $
Signature Telephone No.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
U1 600 Washington Street
Boston, MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information )-) Please Print Legibly
Name (Business/Organization/Individual): Dou Pe TTI fl cle
Address: yN lgno'sCunn Ave.,
City/State/Zip:
ve-
City/State/Zip: ffQ(J(fCA'/ C 1 /MA Phone #: ? SS % Qd,
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. [-I am a sole proprietor or partner-
listed on the attached sheet. t
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ 1 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
_ insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. E] Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.2lectrical repairs or additions
I LE] Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*AJy applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:.
Policy # or Self -ins. Lic. #: Expiration Date;
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify under thepains a penalties ofperjury that the information provided above is true and correct. -
Siunafiirw L'Z_ _ n2te
Phone #:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other - - -
11 Contact Person: Phone #: JI
d won
a
CERTIFICATE OF USE & OCCUPANCY
VIM
Building Permit Number 312 (10/21/05)
Date: FehniA
THE BUILDING
THIS CERTIFIES THAT
LOCATED ON 94 Cortland Drive
MAYBE OCCUPIED AS Single Famil Dwellin
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUII,DIN IN ACCORDANCE
OTHER REGULATIONS AS MAY APPLY. G CODE AND SUCH
Certificate Issued to: Meeting House Common
121 Carterfield Road
North Andover MA 01845
------------
Building Inspector
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 312 (10/21/05) Date: February,'
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 94 Cortland Drive
MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE
* WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE1AND SUCH
OTHER REGULATIONS AS MAY APPLY.
1
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Certificate Issued to: Meeting House Common 1
121 Carterfield Road
North Andover, MA 01845
.. I
Building Inspector
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Town of North Andover
Building Department
400 Osgood Street
North Andover Ma 01845
(978) 688-9545 Fax (978) 688-9542
APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION
ADDRESS
LOT
DATE REQUEST FILED
S
DATE READY FOR INSPECTION 2
TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE C0k1PLETED WITHIN THIS TIME
FRAME. A RE -INSPECTION FEE OF TWE Y -FIVE ($25.) DOLLARS WILL BE
CHARGED IF THE STRUCWRE DOES NM MEET ALL APPLICABLE CODES.
SIGNATURE
OFFICIAL USE ONLY
ROUTING
D.P.W. -WATER METER ,j i H �I DATE Ub
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIOR TO THE INSPECTION REQUEST DATE.
6 ),-u ant �,4� 4 ,
SIGNATURE / DPW AUTHORIZATION
Date - Y-- � -1A 4/...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... 4<1 ..........................
has permission to perform .......
.. . . .........
plumbing in the buildings of ..... /-7 .1 ........
at .... 1571. North Andover, Mass.
Fee. 414 ... Lic. No...t( 5a(- �. ......
PLUMBING INS ECTOR
Check # '/'� I )
6751
r
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT' DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
�:� terra
(Print or type)
Installing Company Name
Name of Licensed Plumber.
Insurance Coveraee: Indic,
Liability insurance policy
FIXTURES
vM Jh
type of insurance coverage by checki
Other type of indemnity
Check one: Certificate4jg�w
❑ Corp.
Partner.
Firm/Co.
box:
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 work and installations performed under Permit Issued for this application will be in I
compliance with all pertinent provisions of the Massach�uesetts Ste Plubin C e an a ter 142 of the General Laws.
By: 3cgnacure or Lic,ensea FlUMDuli
Type of Plumbing License
Title 4t9
City/Town LIcense 19urnuer Master Journeyman
APPROVED (OFFICE use ONLY `J I
Date. �!��%/ ........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
`
This certifies that .4 ! . a-, .................................
has permission for gas installation .``.. ...`............. .
in the buildings of A,01 `-. !. j .� ....................
at`........ . , North Andover, Mass.
C—~
r%!JU Lic. No.? l 5' �� L .. ... ... .......
Fee S INSPECTOR
/ GA
Check # 6 o 0 3 ) /
5391
i
MASSACHUSETTS UNIFORMAPFUCATON FOR PFERNIlTTO DO GAS FrMNG
(Type or print) Date i
NORTH ANDOVER, MASSACHUSETTS
Building Locations � % / (In — Permit # I
Amount $ /6D
Owner's Name
New Renovation Replacement Plans Submitted
(Print or type)
Name
A/1(1/m A/V s
Address I � L.��
Business Telephone (o
Name of Licensed Plumber or Gas Fitter
C e one: Certificate Installing Comp n y
Corp.
t Partner.
Firm/Co.
1
INSURANCE COVERAGE • Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13 NoO
If you have checked ,yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy [T Other type of indemnity 1:3 Bond 0
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 13 Agent 1
[ hereby certify that all of the details and information 1 have submrttea (or enterea) in above appucatron are true ana accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in I
compliance with all pertinent provisions of the Massachusetts State Gas Cod
ernd Chi 42���f the General Laws.
VED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber —2&§ L
Gas Fitter r7cense NumSer
Master
ourneyman
U
4TH. FLOOR
(Print or type)
Name
A/1(1/m A/V s
Address I � L.��
Business Telephone (o
Name of Licensed Plumber or Gas Fitter
C e one: Certificate Installing Comp n y
Corp.
t Partner.
Firm/Co.
1
INSURANCE COVERAGE • Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 13 NoO
If you have checked ,yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy [T Other type of indemnity 1:3 Bond 0
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 13 Agent 1
[ hereby certify that all of the details and information 1 have submrttea (or enterea) in above appucatron are true ana accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in I
compliance with all pertinent provisions of the Massachusetts State Gas Cod
ernd Chi 42���f the General Laws.
VED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
Plumber —2&§ L
Gas Fitter r7cense NumSer
Master
ourneyman
U
6275
Date..................................
(00, �,,ORT4
0,
0
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ ......................................
haspermission to perform_,..............................................................................
wiring in the building of ............
.................................................................... North Andover, Mass
"I
Fee �.�. L.'o ...... Lic. No ................
ELECTRICAL
R
Check #
I
DEBLUNWOFFEWKSWRY
BOARDOFFMPREVFN7YaVRBGUI477MM7adRzz-o
ii
m ikFtes ChecW
APPUCATTONFOR PERMIT'TO PERFORMED cnuCAL yVOM
ALL WORK To 8E PMFORMED IN ACCORDANCE wait THe MASSACHUSM Bt EM'cAL CoDH, 527 cMR 12:00
(PLEASE PRIM IN INK OR TYPE ALL MURMATION) Date .%-I--
Town of North Andover T61 the veapector of Wires:
Te undersigned applies for a permit to perforin the electrical work described below.
Location (Street & Number) C--n,�„ j� , a r 0 )1)T7�-�
Owner or Tenant � i a t-�� h.�t (� czA�i oS"-
Owner's Address
1s this permit in conjunction with a building pemdt: Yes No (Check Approprisk Bos) 'I
I Ll QC7 t30Ca
Purpose of Building 1 '`!1 A -f, — Utility Authorization No.
Existing Service Amps Volts Ovedwed Under
end � Flo. of Meters
eZ Ser lctr 3 Ampsj Z�Iz..q(Volts Overfed Undagmud No. of Meters �—
Number of Feeders and Ainpacity�
Location and N(((ine of Proposed Electrasal Work U i L�o 5(�
No, of i. &b t 06"
No. of fiat Tube
dVAvdEkftVk& S
WaktaSt t
,
No. Of TrsnsfanaersI
TOW
tint
_*WWI t"�q�7��iir
���.�e�is■mw�i
MMNAItrE
KVA
Na or Ughhdal Film=
Serirnm6nt 1W_ Aborti
0
Below
Licgrte0 L 1r A A A-
4n"
I
KVA
. .
vound
Adim
No. of Emerjoci Limit Bsu7 Unit.
Na of Raceptub Omtaat
No, or Oil Bumse
No. or switch Oadvis
I
No. of E}n Barnees
FIRE ALARMS No. of Zones
Mo, of ►
No. of A& Cool TOW
Tont
No. of Detection and
No. of Disponk
No. of Has TOW TOW
Ps
Tote
KW
iaitiatat Davk=
No. of Sona ft Devic"
"°`�•
No. or D}shwsstKrs
Spece Area Hcd t Kw
No. ofSWCMWftW
N t WftdSoandlnt Do,* es
L d mwdelpd l
00M
No. of Dryer
Hestia( Dsviees KW
Ca�nections I
No. of Water Neaten KW
No. of No. a
S
Bsitssis
No. hydro Munn Tds
Na of Motors
TeW HP
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Telephone No. FEE 4,,�/s3i15U1kVAV 01 UW Of P4M �....
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Pennit Na 26
WA1RD0FFIREMWV1 WR8GAAWM527GWUSD "®' �-
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APPUC.A71ONFOR PERMIT TO PERFORIMELEOWCAL WORK
. ALL wORK To BE PUFORMED IN ACCORDANa WTM THE MASSACHUSSTS M-ECTRfCAL CODS, 327 CMR 12:00 I i '. _
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DAMZ.
i
Town of North A*tdover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) (4 L� A k �' ,,,� - 1, V� t, JQ l
Owner or Tenant
Owner's Address
Is this permit in conjunction with s budding permit;
purpose of Building
.-b c -," /"
v"k;-J)
No
(Check Appropriate Box) LJ
Utility Authorization No.
Existing Service Amps / Volts Overt ed [:] UndergroundINo. of Meters
New Spice z Amps J 2c tilts Overbeed ®Undegimnd `4-4o. of Meters '7'
Number of Feeders and Ampecity I
Location and Naexe of Proposed Electrical Work LJ 1
Na of Dawns Outlaw
No. of clot Tubs
No. of Tri Ahmmn
Total
i
KVA
Na at U$kdN Axtates
Swimntir4 Pooh Above
Ilelotr
Gomm
KVA
nal
ural
M. of Emerseaq Ugh 4 Ile srp
I
Units
Na Of Receptiale Outlets
No, of Oil Btuan W
Now, of switch Outlet
No. of Go Bonen
FIRE ALARMS
Ma. of Zartea
No. of Ran&=
No. of Air Coad. TOW
Tape
No. of Detection ander
No. of Diaposab
No. of Had Total Total
Pump
Tons
l.'W
Gidatial Dances
No. of Souedlss Davie"
,*ro. of Diahwaahen
Space Area Heditts Xw
NO, of $df Cadair4d
I
DeaecdmdSoundbts Device
facet mwddpal
.�
od"T
No. of Dryers
Heating Dsvicas KW
ED Cortaectians
io. of waw Medan XW
No. or No. of
S
Baileaie
No. Hydro Maaaye Tube
Na Of moron
Total HP
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tree check one) Owns Agent v
1 0 Telephone No. PERMIT FEE S__
�...
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LocationT�C?''�#�/+9
` No. Date f a
N'60
TOWN OF NORTH ANDOVER
F A
41
Certificate of Occupancy
$
s,KHU
Building/Frame /Frame Permit Fee
9
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #
187*14
Building Inspector
4 -
TOWN OF NORTH ANDOVER '
•
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP
RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING
:: «y r ! ,r ,t ,.,j..'"f"Yt'?o". •^r^! 2" J 4µi.,
+y
BUILDING PERMIT NUMBER:
DATE ISSUED..
yz I
SIGNATURE:
'
Building Commissioner/I r of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
I
T YD
/d y � 3
AJ�Avf
✓Vt,A/J AMap
Number Parcel Number
J
1.3 Zoning Information:
1.4 Property Dimensions:
K' sfJ
Cid
3u -Z 3J
Zoning District Proposed Use
Lot Area Fronts R
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard i
R red Provide
ed Provided
Req± Provided
t.r waror supply M c 1 c.4o. s4)
1.s. Flood zone Information:
1.s s Disposal system:
p� pie ❑
zone outside Flood zone
Municipal X on site Disposal system ❑
SECTI N 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic District: Yes No
2.1 Owner f Reco
j
c zl C 114.4
Name (Print)
Address for Service
I
1
ature
Telephone
2.2 Owner of Record:
~*
I
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Su 'sot:
Not Applicable ❑
f7
Licensed Construction Supervisor.
v
License Number
Address
�% 1
l J/
Expiration Date
store
Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑ 1
Company Name
Registration Number
�
Address
Expiration Date 1
Signature
Telephone
00
rn
X
3
Z
O
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FORM U - LOT RELEASE FORM
7 -
INSTRUCTIONS: This form is used to verify that all necessary approvalslpermits from
Boards and Departments having jurisdiction have been obtained. This does riot relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT kotw, coyn(n6rnS L LC
PHONE q 8`�8 -Z63S
LOCATION: Assessor's Map Number
/d�C
I
PARCEL 3
SUBDIVISION (" I��iG l� �a�S210M&IJ
LOT (S) -I
STREET . GO r f Iq dD
i
ST. NUMBER
I
** ************************************OFFICIAL
USE ONLY
***********
i
i
RECAMMENDATIONS QF TOWN AGENTS:
-
1
C6NtERVATION ADMINI TOR
DATE APPROVED
DATE REJECTED
COMMENTS �QSS P�- -Co
6'f r..cG o �r��Sci-tiG-�1o•lcll to F - 1404.IS C.
f p cS� K6T owTSi d
%S
�elP na ( -F.
N/k
i
TOWN PLANNER •
DATE APPROVED
DATE REJECTED
II
S
COMMENTS Ch -
I
FOOD IN ECTOR-HEALTH
DATE APPROVED
I
NJA
DATE REJECTED
SEPTIC r SPECTOR-HEALTH
DATE APPROVED
DATE REJECTED
COMMENTS o m S'aW E R
II
PUBLIC WORKS - SEWER/WATER CONNECTIONS / G�..� le) 6 —eff.
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
Revised 9197 jm
DATE
I
M
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.3 Release lb
Data filename: Untitled
TITLE: The Nantucket at Meetinghouse Commons
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: I or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 10/13/05
DATE OF PLANS: 09/01/05
PROJECT INFORMATION:
Meetinghouse Commons
North Andover, Ma 01845
COMPANY INFORMATION:
Meetinghouse Commons LLC
COMPLIANCE: Passes
Maximum UA = 477
Your Home = 447
6.3% Better Than Code
Ceiling 1: Flat Ceiling or Scissor Truss
Wall l: Wood Frame, 16" o.c.
Window 1: Vinyl Frame, Double Pane with Low -E
Door l: Solid
Floor 1: All -Wood Joist/Truss, Over Unconditioned Space
Furnace 1: Forced Hot Air, 90 AFUE
Air Conditioner 1: Electric Central Air, 10 SEER
COMPLIANCE STATEMENT: The proposed building
specifications, and other calculations submitted with the
meet the Massachusetts Energy Code requirements in Ml
mandatory requirements listed in the MECcheck Inspecti
The heating load for this building, and the cooling
Design Conditions found in the Code. jhe HVAC
than 125% of the design load as spe ' ed in Sectifi
Permit Number
Checked By/Date
Gross
Glazing
Area or
Cavity
Cont.
or Door
Perimeter R -Value
R -Value
U -Factor
UA
I
1628
0.0
30.0
50
2356
0.0
13.0
186
379
0.340
129
35
0.340
12
1628
0.0
19.0
70
i
dscribed here is consistent with the building plans,
t pplication. The proposed building has been designed to
Version 3.3 Release lb and to comply with the
J cklist.
opriate, has been determined using the applicable Standard
selected to heat or cool the building shall be no greater
t 13 10 and J4.4. L� I'
Date L
i
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.3 Release lb
DATE: 10/13/05
TITLE: The Nantucket at Meetinghouse Commons
Bldg. [
Dept.
Use
Ceilings:
[ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 continuous insulation
I Comments:
I
Above -Grade Walls:
[ ] 1. Wall l: Wood Frame, 16" o.c., R-13.0 continuous insulation
I Comments:
I
Windows:
1. Window 1: Vinyl Frame, Double Pane with Low -E, U -factor: 0.340
For windows without labeled U -factors, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
[ Comments:
Doors:
[ ] I 1. Door 1: Solid, U -factor: 0.340
I Comments:
Floors:
[ ] f 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R-19.0 continuous insulation
Comments:
Heating and Cooling Equipment:
1. Furnace 1: Forced Hot Air, 90 AFUE or higher
Make and Model Number
2. Air Conditioner 1: Electric Central Air, 10 SEER or higher
I Make and Model Number
Air Leakage:
Joints, penetrations, and all other such openings in the building envelope that are sources of air
leakage must be sealed.
When installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfin (0.944
L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled.
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.
it
[ ] ( Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on
( the building plans or specifications.
( Duct Insulation:
[ ] ( Ducts shall be insulated per Table J4.4.7.1.
( Duct Construction:
[ ] ( All accessible joints, seams, and connections of supply and return ductwork located outside i
( conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed
( using mastic and fibrous backing tape installed according to the manufacturer's installation
( instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
[ ] ( The HVAC system must provide a means for balancing air and water systems.
I
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.'
I
( Heating and Cooling Equipment Sizing:
[ ] ( Rated output capacity of the heating/cooling system is not greater than 125% of the design load as I
( specified in Sections 780CMR 1310 and J4.4.
I �
( Circulating Hot Water Systems:
[ ] ( Insulate circulating hot water pipes to the levels in Table 1.
(
Swimming Pools:
[ ] ( All heated swimming pools must have an on/offheater switch and require a cover unless over 20%
( of the heating energy is from non-depletable sources. Pool pumps require a time clock.
( Heating and Cooling Piping Insulation:
[ ] ( HVAC piping conveying fluids above 120 OF or chilled fluids below 55 °F must be insulated to the
I levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp.
Insulation Thickness in
Inches by Pipe Sizes
Heated Water
Non -Circulating Runouts
Circulating Mains and Runouts
Temperature (F)
Up to 1„
Up to 1.25"
1.5" to 2.0" Over 2"
170-180
0.5
1.0
1.5 2.0
140-160
0.5
0.5
1.0 1.5
100-130
0.5
0.5
0.5 1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
NOTES TO FIELD (Building Department Use Only)
Fluid Temp.
Insulation Thickness in
Inches by
Pipe Sizes
Piping System TXpes
Ran e F
2" Runouts
1" and Less 1.25"
to 2" 2.5" to 4"
Heating Systems
Low Pressure/Temperature
201-250
1.0
1.5
1.5
2.0
Low Temperature
120-200
0.5
1.0
1.0
1.5
Steam Condensate (for feed water)
Any
1.0
1.0
1.5
2.0
Cooling Systems
Chilled Water, Refrigerant,
40-55
0.5
0.5
0.75
1.0
and Brine
Below 40
1.0
1.0
1.5
1.5
NOTES TO FIELD (Building Department Use Only)
The Commonwealth of Massachusetts
Department of Industrial Accidents
V+ Office of Investigations
s 600 Washington Street
Boston, MA 02111
^M s•� www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Amlicant Informa
Name (Business/Organization/Individual):
Address:
T',
City/State/Zip:jy Phone #: 5r
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet. I
These sub -contractors have
workers' comp. insurance.
❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (rei
6. XNew construct
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10F] Electrical repairs or additions
11.❑ Plumbing repairs lor additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box #11 must also fill out the section below showing their workers' compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit
TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. poli
iicating such
infor;nation.
I am an employer that is providing workers' compensation insurance for my employees. Below is the poli and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-yeaAmprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the "Office of
Investigations of the DIA for insurance coveragp�rification. j
I do hereby certify under the ins a saltie of perjury that the information provided a;wvels true and, correct
J �
Signature: Date:
Phone #:
Oficial use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Towu Clerk 4. Electrical Inspector 5. Plumbinlg Inspector
6. Other
Contact Person: Phone #:
J��• i %o..u.)t(rut:c:tcf.�� ���: �%l!.un1aT.��,r�.l.! �
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 055417
Birthdate: 04/05/1960
Expires: 04/05/2006 Tr. no: 21033
Restricted: 00
THOMAS D ZAHORUIKO
121 CARTERFIELD RD
N ANDOVER, MA 01845
Acting GdfnmisWoner
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