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Miscellaneous - 95 LEANNE DRIVE 4/30/2018
f mI r This certifies that. has permission to perform /Prl`.c-9?.1..c-�.� ?`UC �1 wiring in the building of Z. \ Y\ ;-A-"Vy� CA, J ................ at ..... _ Q.('� o._........... , North Andover, Mass. Fee . I S p 2 . Lic. No..4�- Z, Hb ...... I .r l.W ELECTRICAL INSPECTOR Q r Check # v 1 X200 Cornmonwea& of Massaekuaalfi Official Use Onl "'Q QPermit No. / MUM 1J1pari?mant of - ire Sarvicae BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee CheckedRev. 11/99] (leave blank) 'a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (INI ), 527 CM11 12.00 (PLEASE PRINT IN INK OR TYPE :ILL IWORNM77ON) Date: City or Town of: 1VQ1 TJ d cw{.t✓' To the Inspector of Wires: By this application the undersigned Lives notice of Itis or her intention to perform the electrical work described below. Location (Street & Number) Owner or "Tenant 'Z ,`MM -er 41 ", V1 Telephone No. 128 065-1/,?7 Owner's Address SA M .p Is this permit in conjunction with a building pe`rinit' Yes � No ❑ (Check Appropriate Box) Purpose of Building S,1q �E t-�•►�. 1 Y Utility Authorization No. Existing Servicc Anyns / / G �`olts Overload ❑ Undgrd IVo. of llelers t New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of 1Ieters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �,' 1-c 4 En ,y-7 s s! er '., Completion of the following table nray be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Farts No. of Total Transformers KVA No, of Lighting Outlets No. of llot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. E]rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets /,C> No. of Oil Burners FIRE ALARRIS No. of Zones No. of Switches /d No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices No. of Waste Dis osers p Heat Pump Totals: Number Tons KW No. o elf -Contained Detect ionn/Alerting Devices OWNER'S INSURANCE WAIVER: lain aware that the Licensee docs not have the liability insurance coverage normally No. of Dishwashers � Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Drvers Heating Appliances Security Systems: No. of Devices or Equivalent No. of WaterNo. Heaters KI of No. of Sio'ns Ballasts Data %Virin No. of Devices or E uivMent No. Hydromassage Batbtubs b No. of'Motors Total IIP Teleconmunicntions N1'iring: No. of Devices or E uivalent OTHER: Attach additional detail ifdesired, or as required by the hispector of Wires. INSUR_-rCE 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. � / L/ // 0� CHECK ONE: INSUR.,kNCE BOND ❑ OTHER ❑ (Specify:) � ,'� ,� ; %'/• �� 3 3 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal police.) Work to Start: S" / Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjure, that the information on this application is true and complete. C F1R.INI NAMME: � w, � rt•Ann L)FC'T:�rC�: S@ if1�j"C �' LIC. NO.:�i / / ta,)-!V v�/� ,, Licensee- i x�r �, Gr•. j� Y--, n,\ Signature �i� LIC. NO.: - "exempt - 16{e. (If al)plicable, enter in the license number Bus. Tel. No... � %B `7 'd J le /1"M 0/9 Y9 S-6 ;AO Address: 2v � n o,,h 51 M ,Fon Alt. Tel. No.: y;78 33 .t" OWNER'S INSURANCE WAIVER: lain aware that the Licensee docs not have the liability insurance coverage normally required by law. By my siL»ature below, l hereby waive this requirement. I am the (check onc) ❑ owlier ❑ owner's agent. Owner/Ancil PERMIT FLE: S No. Signature Telephone IJP C,9 k f , 2- �- �? - Pj� /-5-L-/1P, 4 of The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): (��.� . t?rct nn L f e y 5 J (' � r✓, 7.0— Address:_ -7 City/State/Zip:_ , �J d le A:j n Ac) o r'�'�/� Phone #: S" S -G 7D AWyou an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 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 ��1 111 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. E3 I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] 1 employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontract2rs that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formcition. tsurance Company Name: f] :)licy # or Self -ins. Lic. #: —7-h►✓ t3 d V(, d�y 3 K .(�? Expiration Date: ,3//-3 )b Site Address: 9 Sf City/State/Zip:_ /YC>, - FL �9 i do,-, !A v9 ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. dL- Lone #: t,'% -6 3.3 s' S`17a Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. r City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-7277749 evised 5-26-05 wWw_ma-,-,.anv/dia .•This certifies that Chas permission to perform ^v plumbing in the buildings of .....� N'7ty�.. , , , , ... . . . at ... " . 4 �,•-, rte-• .w.,i.. , , , G�LNorth ndover, Mass. Fee .... Lic. No... PLUMBING INSPECTOR Check # / / o y r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY +1, _ MA DATE I PERMIT # JOBSITE ADDRESS %5 OWNER'S NAME�,. 1 OWNER ADDRESS —_ 5u,d,.� TEL _ _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL © RESIDENTIALa____ PRINT CLEARLY NEW: RENOVATION: B' REPLACEMENT: PLANS SUBMITTED: YES Q NOEr FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM =A_._._._, I L .-._1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN1 FOOD DISPOSER11_..__._1 FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) I 1 i ...._.-_..._1 n! I � I -..! __-._._....., _I _.____I KITCHEN SINK i _ ._.._..I __--.....J _! .---.-_._( _ __._.{ ......_ .._1 ._-_. _-� ..___1 __-� -----.__.-f __.._..__I I = LAVATORY ( _/J __.:._! _....._.._1 _.__.___1 __...___I _.__.__d ___J -____( ._._...__.J ._.___- (------..J d ► ROOF DRAIN d ( ._....__.._d I _ E _1 J d ._.__� ._----�--.__-1 ._._.._._C _..--.---� _i I SHOWER STALL _) � I _---__ ( ._ I ( 1 —._I d d ( _—_ I _-__l SERVICE / MOP SINK _ i _.__.._..I __._._.i t __--_I _ f _ J ..___._.f .__.TI J . I E _ -.. .__. I _I TOILET URINAL WASHING MACHINE CONNECTION IF-73,_I __.1. _ j _ _ _ _AF-77 WATER HEATER ALL TYPES # _ 1 I I __--F _. I _ _I - ! .___..1 ..____.I ._._. _ ...- I "VER PIPING f .� iI _ ! i . I I i .. d ... _I R__ ! d i I d I _ _ _ .__.. _._! _l _---.-._.1 __. _ _ —! .---_ - _. _._ _._ . .. _ _____1 � I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Q NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYOTHER TYPE OF INDEMNITY D1 BOND _M_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 01 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 TO'a ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.� J _ j PLUMBER'S NAME -. ��,-. __(,v (s,__—"^ LICENSE # 1%83 E SIGNATURE MP nl'— JP Q CORPORATION Q# _ f PARTNERSHIP Q# LLC COMPANY NAME (,Q)p�� 1�,d,N�-1 J-s _— ; ADDRESS 5. er NVI _ CITY j STATE fti- j ZIP 0 —j TELC/ n _ 88-7 W7`7 FAX �� CELLy7$3 77/ /yy EMAIL W H O z o H W a N N IN, ` � o r z u) El O ~ W H W ZIL LU 3 C W o a � � a W LU WO � LU O zz p" W F- a J CL a x w F- LL W F O z 0 H U a a C�7 O The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: a 88 % 4 1 City/State/Zip: �h � Int Phone #: 978- I87 c8$ 7 7 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 have hired the sub -contractors a sole proprietor or partner- listed on the attached sheet. I 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.] 3. ❑ I am a homeowner doing officers have exercised their 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.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11 -EJ Plumbing repairs or additions 12.❑ Roof repairs 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 such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site %nformation. Insurance Company Name: ?olicy # or Self -ins. Lic. #: Expiration Date: `` lob Site Address:_ /lz A/yN �e J)22 City/State/Zip: attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. oni A M Ufficial use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia I%- ajrVu6!s M r4 PO W. LLI14 vim. I r-4 c ci 0 ON 0 Lu Nk-A r-4 0 -i tnLu r 0 < (DY) uj 0 0 co Ln 3: LLI Lr)tn WLLJ 3: UJN Y co COW cn C) m LL, M. 11 1 LU 4 • cL LL Cl) CL�ul 0 L) co CL CC) Date. �- . ng ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................. has permission to perform................................. ........... ........ wiring in the building of ..................................................... ...... .......... . NorthAndover, Mass. ed Fee .i.P .. . ........ Lic. No�Y,!��. ....... ELECTRICAL INSP R `° Check # -1371 8147 vv.RAfi1IIVI1WCd1Ln OT mc-tssaCl/ S Official Use Only . Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacbusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFO RM14TION). EDate:_.. City or Town of: NORTH ANDOVR To the Inspector of Wires:. By this application the unders' Igned p4ves notice of his or her mention to erform the electrical work described below. Location (Street & Number) L Owner o 0 ;„ j or Tenant _z,P N - n Owner's Address r Telephone No. �8&•,%Zqq Is this permit in conjunction with a building permit? Yes Purpose of Building ,� No ❑ (Check Appropriate Boz) 1-i V fS g b al a MC hir� Utility Authorization No. Existing Service;Q(Z Amps % / olts Overhead ❑ Undgrd No: of Meters New Service Amps / Volts . Overhead Undgrd ❑ No. of Meters Number of Feeders and Ampacity V 1u4S 1:1 Location and Nature of Proposed Electrical Work: Q No. of Recessed Luminaires c.om tetion o the ollowin table may be waived by the I ector No. of Cel-Susp. (Paddle) Fans No. ofTotal No. of Luminaire OutletsTransformersrA No. of Hot Tubs No. of Luminaires Swimming Pool ❑ jn_ AboUJI Generators KVA ❑ o. o mergency tg g No. of Receptacle Outlets 1 ^ - dve No. of Oil B d' Burners Batte Units No. of Switches FIRE ALARMS 7NO. of Zones No. of Gas Burners o. of etectiou and No. of RangesIni No. of Air Condi, otal tis � Devices ( No. of Waste Disposers eat u1nP Tone Number Tons No. of Alerting Devices No. of Dishwashers Totals: �` Space/Area No, of elf - Contained ned `— ion/Alerting Devices Heating KWLocal❑ Municipal Other No. of Dryers HeS� APP�nces KW Connection Security Systems:* No. of Watero. Heaters KW of o, of No. of Devices or E uivalent Si s Ballasts . Data Wiring: No. Hydromassage Bathtubs . No. of Motors Total HPelecommnuications No. of Devices or E uivalent OTHER; No. of Devices or Egt�ent Wires. Estimated Value oAttach additional detail if desired, or as required by the .�Inspector of Wires. ^' `fEle Ocal Work: .` (When required by municipal policy.) Work to Start; 1 IR`a Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov rage is in force, and has exhibited proof of same to the permit issuing office.. CHECK ONE: INSURANCE BOND ❑ OTHER I certify, under the erurlties t�a E3 (Specify: s`%i�:C WX Tv �P� �,�.1 t the informadolL on this application is true and complete. FIRM NAME: -7j ✓' Licensee: I G�fL •� •� Signature I L LIC. NO.: & q • tgnatzrre LIC. NO.:!" 3 (If applicable, enter "exempt" to he license number (�,�e.) L Address: rr��I \ eC S• `'�f IV ZY O3d (�' Bus. TeL No.: *Per M.G.L c. 147, s 57-61, security work requires) Alt TeL No.: .. epartment of Public Safety "S" License: LicTe. 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 Signature Telephone No. PERMIT 1 .f ' . j ' 4 The Commas wealth of musachusear Department of ndustria[Accidents Office of Investigations 600 Washinoign Street Boston, MA 02111 ww.m s gov/dia Workers' Compensation I blrance Affidavit: Builders/Contractors/Eie unliMt Information ctriciaits/pfambers t r !~ase Name(Busintss/Orgataization/Individtml): Address:_W Lx,- City/State/Zip: x, City/5tafe/zip: IV 4& rIV o����one #:. Z 7- 686 Are you nn employer? Check the appmpriate,box: ' 1. ❑ I rim a employer with 4. am a general corutraetor and I �Ploy� (full and/or part-time).* . 2. I am.a.sole proprietor or pm•tnm- ship and have no employees working for me in any capacity, [No workers' comp. insurance required.] 3. Q I am a homeowner doing all work myself.. [No -workers' comp. insurance required.]'t have hired the sub -contractors Iisted ori the attached sheet f These su.}i-contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c.. 1S2, § 1(4),' and we have no .employees. [No workers' comp. insurance re uired_ Type.of project (required): 6• ❑ New construction 7. [] Remodeling 8• Q Demolition' 9.Q Iding addition 10. lettuce] repairs or additions 11.[] Plumbing repairs or additions 12.[] Roof repairs q ] I3.{].Other I "Any applicant that checks bcrZ #I must also fill out the section below showing their workers' compensation poitty mfotma6on t liomw c *who submit this affuinvtt ind.Osting they ale doing all work and then him-omsidecontractors must submit a new affidavit indi 1 ;Connectors that check this box roust attached an edditi mal sheerShowing the name of the ung suciL x�00�� °1d �°v t"o�=' comp. poffcy inrnnnation. infortnafio f arra an employer that.ts provrding:workM, comperrsadojz insurnwe for uiy. enrP�Y Below ir.the policy and job site n. Insurance Company Name: ' Policy # or Self -ins. Lic. #: Exltindhon Date: Job Site Address: City/State/Zip: Attach a copy of the.workers' comtpensation policy declaration showia� p81'� ( a secure coverage as the policy number and expiration date}. Failure to required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-year imprisonment, as well as civilpenalties in the form of a STOP WORK ORDER and a nine of up to $250.00 a day against the violator. Be advised that a copy of Buis statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby c �nd�'a arn� a d�erz r / r/ n es o rlury tha7 the utfnrma6on Provided above is be and r.,,...W Ofjiciaf use only. Do not.,write in this area, to be completed by aify or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Cierk 4. Electrical Inspector 6. Other �� Contact Person Phone #: S. Plumbing Inspector Information and Instructions Massachusetts General Laws chapter 152 requires all emp 3 oyers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more ofthe'fbmping engaged in a joint enterprise, and including the legit repmerrtaiives of a de=ased employer, or the receiver ortr igm-of an individual, partnership, association or other legal entity, employing empioyees. 'lioweverthe owner -oft dwelling house having -not more ti a three aparimerrts~and who resides therein, or the occupant of the dwelling house of another who employs persons to do maiTficriance, construction orrepair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such ftployment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or- local licensing agency shall withhold the issuance or mnewal'of a license or permit to operate a business or to constrict buildings in -the commonwealth for any applicant who has not produced acceptable evidence -of compliance with the insurance coverage required." Additionally, MOL chapter 152,4.25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performmarrce of public work until acceptable evidence of compliance with the insurance requ=nc ras of this chapter have been presented to the contracting authority." a Applicants Please fill out the workers' compensation• aErdavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address.(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no. employees otherthan the members or partners, are not required to cavy workers' cornpensation insurance. if an LLC or LLP does have empioyees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for corifirmation of insurance coverage.. Also be sure to sign and date the affidavit The affidavit should, be returned to the city or town that the application for the pet'mit or license is being requested, not,the Department of Industrial Accidents. Should you have any questions regarding the 'law or if you .are required to obtain a workers' compensation policy, pinsccall the Depwtnent at the numberlisted below. Self-insured companies should entertheir self-insumnce".license number on ihe'appropriete line. City or Tower Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sive to fill in the permit/li=me number which will be used as a reference number. In addition, an applicant that. must submit multiple pennittlicense applications in any given year, need only submit one affidavit indicating•current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of -the affidavit that has been officially scrimped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or ioenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business .or commercial venture (i.e. a dog license of permit to bum leaves etc.) said person. is NOT required to complete this affidavit The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. , The Depamnent's address,"tsiephone and fax number: The Commonwealth of Massachusetts Deparfinerit of Industrial Accidents Office of Iauesfigatiii ons ' 600 Washington Street Basion, IIIA 02111 Tel. 4 617-7274900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax;9 617-727-77499 www.man.gov/dia Date. . �AORTk TOWN OF NORTH ANDOVER 9 �T PERMIT FOR GAS INSTALLATION ' This certifies that . �� Z...�'j .f?� .......... has permission for gas installation .:7D V t4 .................. in the buildings of . !L. d. ........................... . at.. �� {.!Z !c r . Z ......... North Andover, Mass. Fee.zJ.A: Lic. No..z??iy.. �..�4-�.l GA INSPECTOR Check # ) 6436 a MASSACHUSETTS UNIFORM APPUCATON FOR PERNffr TO DO GAS FITTING (Type or print) NORTH MDOVER, MASSACHUSETT , Building Lwations I rm-TANTi Owner's Name New Renovation Replacement Plans Submitted Permit # 3 Amount $ (Print or type)G�� (�j V ^ �� , i heck one: Certificate Installing Company Name � ` '"� Qlz�, Corp. Ad a s / Partner. rA uMness lelepobne I 7<577 Firm/Co. Fitter T, of Licensed Plumber'or Gas Fitte- C)Ot-I'7 i? 1n -7 INSURANCE COVERAGE Check one: 1 have a current liability Insurance, policy or it's substantial equivalent. Yes 13 No � If you have checked Les, ple dicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 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 0 Agent 0 hereby certify that all of the details and informat n I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work n' n ations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the tts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town, VED (OFFICE USE ONLY) Signature of Licensed Plumber Or, Fitter Plumber IS Gas Fitter License Numbei Master Journeyman Ed w w Z, O = C z F wx z U w v, z F- C O a > w w v, d x x a wa w F o N m °o 9 x o> x 3 a A d C7 o w e SUB-BASEMEN T U C > D o0 F O BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 17T H. FLOOR — TA 8TH. FLOOR Ed (Print or type)G�� (�j V ^ �� , i heck one: Certificate Installing Company Name � ` '"� Qlz�, Corp. Ad a s / Partner. rA uMness lelepobne I 7<577 Firm/Co. Fitter T, of Licensed Plumber'or Gas Fitte- C)Ot-I'7 i? 1n -7 INSURANCE COVERAGE Check one: 1 have a current liability Insurance, policy or it's substantial equivalent. Yes 13 No � If you have checked Les, ple dicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 13 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 0 Agent 0 hereby certify that all of the details and informat n I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work n' n ations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the tts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town, VED (OFFICE USE ONLY) Signature of Licensed Plumber Or, Fitter Plumber IS Gas Fitter License Numbei Master Journeyman 9 11 iSSwC64U CERTIFICATE OF USE & OCCUPANCY Building Permit Number 253 Date Au est 29, 2002 THIS CERTIFIES THAT THE BUILDING LOCATED ON 95 Leanne Drive MAY BE OCCUPIED AS Single Family Dwelling ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Brookview Country Homes PO Box 531 North Andover Ma 01845 00 Building Inspector m m U) cn O a y Z CD O CL r O d Q =. n� .o O CD o p CL Q ? —1 CD O CD �oCD CA '0 CD O CO) d Cie d C O C CO) d CD O r� CD y CD 0 O CD O CCD 5 t-. Q H = Gp Qm y " m O C � W �d.diO N T -40 m y G y N CD — -� = m m C a CD t_d O N' C2 W O m CL O W m � COR m .+ N O O7 N N d Q C � N �1 m ' ' cc m .� C. -S g o � O •Q► . Gya CD m C3 1 � O d Oo n � _ s :N �.bf o� � o Ll rt Cn %Cw v l / � z `f.�C��J r v, %N \` wA� tz a /� ^ O � vrmvrAz:, 11! z 0 0 I� H 0 0 c Town of North Andover tAORTH Ottteo )6,.i Building Department �? gz : *p Q 27 Charles Street o North Andover, Massachusetts 01845 .V _ (978) 688-9545 Fax (978) 688-9542 F o 'pA COtwl[MM1fM V RCHUS '�Rh APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS gAPU De, v C LOT DATE REQUEST FILED DATE READY FOR INSPECTION 9 /Zo/O.- a( FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS Tn�,4E FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLr CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONS TIONf 'ii" ' DATE 0 I��f%/ 1 DATE 0 -2— D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. Co A SIGNATURE / DPW AUTHORIZATION 3 Town of •;,s=,<��s�'' NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.:� PROJECT: I DATE: UNIT NO.: FLOOR: WING: BUILDING NO.:bfz- I�p REMARKS: -/ W0 -P ni — S e,4-1* —cam Siall U"dMi' c Excavation - depth and soil conditions Framing - Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains - Insulation - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept - ,jil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: —Cof 0# Inspector Inspector Inspector Form #995 Action Press, 685-7000 Location No. a 3 Date Zv N�RTM TOWN OF NORTH ANDOVER S 9 Certificate of Occupancy $ 'S v cHus Building/Frame Permit Fee $ s� Foundation Permit Fee $ �� Other Permit Fee $ TOTAL $ 45-9, Check # C/—, ? 41 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: c�2 53 DATE ISSUED: 6--30 a D Q , SIGNATURE: Building Commissiona for of Buildin2 Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �7 y Map Number Parcel Number ' g Information:i N 5 / /� "► , ! t � Zoning Di 'd Proposed Use 1.4 Property �/ Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3s 1 1.7 Water Supply M.G.1-C.40. 54) 1.5. Flood Zone Information: Public Private ❑ Zone Outside Flood Zone , 1.8 S WVW Disposal System: Municipal On Sita Disposal System ❑ SECTI 2 - PROPERTY OWNERSHII'/AUTHORIZED AGENT 2.1 Own�eerr of Record , Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Lt s d Construction Supervisor: Licensed Constriction Supervisor: � r � ,r J / US�6orJ S N5-1 Address �0 C� 8Y - (� re Telephone Not Applicable ❑ ns �3 License Number 4 ExpirationV Da 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature _ Telephone \J SECTION 4 - WORKERS COMPENSATION (MLG.L. C 152 § 25c(6) . 'A Workers Compensation hnsurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the b1iijoing permit. Signed affidavit Attached Yes ....... jV No ....... 0 SECTION 5 Description of Pr osed Work(check all applicable) New ConstructionExist g Building 0 Repair(s) ❑ Alterations(s) ❑ Addition 0 INX Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify 1 Brief Description of Proposed Work: �)N• l C / '`rl' !t t�9 � V 9 t U'V0 dell SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pemit applicant 1. Building 2o6-400 (a) Building Permit Fee so Multiplier 2 Electrical 000 (b) Estimated Total Cost of 767 �3 C, 0 0 D Construction i 3 Plumbing /0 . 000 Building Permit fee dal x (e) _ � /`j /u S 4 Mechanical HVAC /0 0010 C 4 5 Fire Protection / - 6 Total 1+2+3+4+5 , 000 Check Number 9' 13'15 Dui trs,e SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT le' A 014 l Owner/Authorized Agent I f�%3Zp �Z ,Las of subject property -le Hereby authorize � S P 9<< '9 S to act on My behal all nt ers eI tive to work authorized by this building permit application. Signatt O e Date SECTION 7b OW�NjER/AUTH ZED AGENT DECLARATION I ' S as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief . Print Name Si a e of r NO. OF STORIES Z SIZE BASEMENT OR SLAB 6f 5 e' 7 - SIZE OF FLOOR T ABERS 1 ST 2.r D 2ND '0 3RD2 SIZE SPAN % DIMENSIONS OF SILLS D1IvlENSIONS OF POSTS /J S DIMENSIONS OF GIRDERS N - ZXi D HEIGHT OF FOUNDATION 71101, 1/0" THICKNESS SIZE OF FOOTING 0 x 30 X MATERIAL OF CHEMNEY Ze*CO /r9Pe v C IS BUILDING ON SOLID OR FILLED LAND 5V A O IS BUILDING CONNECTED TO NATURAL GAS LINE e- y FORM - U - LOT RELEASE FORM PC rn! o u 5 INSTRUCTIONS' This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ....■..■.r....■.r..■■..r..■■■...■■...■.■■■■..�t..t■■.....rr......r....aama■ APPLICANT ° o Cy� c �,J (vu N T yo c s PHONE 'S S ASSESSORS MAP NUMBER 1 ` LOT NUMBER -7 SUBDIVISION / PC` FS �a e -S LOTNUMBER • S STREET % el ti v e ` `' c STREET NUMBER / S ..................................................t0a....a..t.....a......a..■ OFFICIAL USE ONLY .............................'...-...rrt.tt..was ............................... RECONDA NDATIONS OF TOWN AGENTS 2*0000 L- r- S C_e DATE APPROVED Z� CONSERVATION ADM NISTRATOR DATE REJECTED COs l/ IC COMMENTS FOOD INSPECTOR --HEALTH jeuee. .. SEPTIC INSPECTOR - HEALTH COMMENDS PUBLIC WORKS - SEWER / WATER CONNECTIONS 69-5 111.4 C OMIvfENDS RECENED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED w APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in L-,eG'C !�! K t � �__, ;creel, subject to the rules and regulations of the Division of Public Works. The premises are known, as No. or subdivision loth no. Owner Contractor ./'1 Address Addre � � /� pp' ants Signature PERMIT TO CONNECT WITH SEWER MAIN Street The Division of Public Works hereby grants permission to F z & — " �!f ! �/ Street to make a connection with the sewer main at ` Works - subject to the rules arAregulations of the Division of Public Works,. inspected Date Division of Public Works By See back for rules and regulations c APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made to connect with the town water main in �� ✓j�C Street, subject to the rules and regulations of the Division of Public works. 0 The premises are known as No. or subdivision lot no. Owner Contractor vii? 2 d/r� x 5 31 i Address WAdd 200. d2o giant's Signature Street PERMIT TO CONNECT WITH WATER MAIN The Board of Public works hereby grants permission to to make a connection with the water main at t=64- �n t/r�4 I , Street subject to the rules and regulations of the Division of Public works. Inspected by Date J Board of Public Works By See back for rules and regulations l G r,kwt , t J.WILLiAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 364 OSGOOD STREET, 04645 'o DRIVEWAY PERMIT Telephone (978) 685-0950 Fax(978)688-9573 DATE f LOCATION �l S LEA- A/ E -J-::,P- I J E BUILDER phone OWNER (3RococviEuJ0UT r' komg-' > phone 4 t8 - 658 - �-s5 i THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. 4 A' 'i -f -CA �5 SrCi (j/+i Ciel The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Q60 66-( rte cot/ -V Te s //0 /4 e S City /1/, /?,yoD J/C C Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing. workers' compensation for my employees working on this job. r..mm�anv name• Aro ° 1L t/r C v �r7u •v P / l 0 •`� j Address P o g 0 k S-3/ ` City AV. 11N:!�70 r/r le, Phone #: 7 00 Insurance Co. - - TP�'J l,fs ` 4 � � Policy # G✓C Companyname• 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 penalties of a fine up to $1,500.00 and/or one years' imprisonment 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 that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the ins and 91naltles of perjury that the information provided above is true and correct. Si 9nature Date - ° Print name �, s i•p 4 ra /I'19� P.�., S Phone# �l9 6��-�JSr� Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION i Z � � oo atT W O Z fA O O 0 P a ] Cn Z OC, cn O co C CA O N .4 O C ma m O V < z Uo GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the 776 ZVI ormation requested below. re ,/dv le //oA e Permit Applicant 52g 6n- 6 $-S g S �9-S e, -f Property address X Map'/ Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. _ X The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. UNDERS THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE OFF O VE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR iUND FUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PE S /e,U / It SIGNATURE DATE ' THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM FORTH Q 4T4EU ��7t �o 0 ~ �. COLp ry.WNN �' In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: Facility location Signature of Applicant .5-11,0101 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Al ti•.-'._ _" "`- ...,.�.. _ _ �^ '�`� @ ........ "`ova tee eaaae''t .. A ry _ XV �.. 4 �f .'�`_ �• � �• _ ten" \ �,' ` � ��v. '�� "'��{li . � • - �.'�* , _ _ ter' -+-, �^ �... —...-, � ,�„ y ��_ y _2 ZAIQ Lo '�•'�" ate.. - ��� ��+�.� v �� .. � `• ','` tir �O` s� '`r •,`�'�,, ,,,�„�� - 245 '- kill 270 \ 276 a 7 _ • ^�O ti � `••_., •"~. � `� � '`` \. `y \4 �. � � �` 'ter \ \ � ^,� 1 ., ` • `, ` r. ,_� `'� '• n_ ,` •`^� ``. n•�.., , \ `ter � \ ..` MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit If MAScheck Software_Version_ 2.01 Release -2 Checked -by -/Date CITY: North -Andover STATE: Massachusetts HDD: 6322 - CONSTRUCTION TYPE: 1 or 2 Family,.Detached HEATING -SYS -TEM TYPE Other (Non -Electric Resistance) DATE: 11-9-2000 TITLE: LEANNE DRIVE PROJECT INFORMATION: BROOKVIEW- COUNTRY HOMES INC PO BOX 531 N ANDOVER MA COMPANY INFORMATION: J&J HEATING - &- AIR COND- 17 ARLINGTON ST DRACUT MA COMPLIANCE: PASSES Required UA - 56 -3 - Your Home = 515 Area or Cavity Cont. -Glazing/Door Perimeter R -Value R -Value U -Value --------------------------------------------------------------------------- CEILINGS 1536 30.0 Q..0 WALLS: Wood France, 16"-O.C. 2450 13.-0 0.0 2 GLAZING Windows. or Doors 38-3- 0,400 1 GLAZING: Windows or Doors 42 0.460 DOORS 39 0_400 FLOORS: Over Unconditioned Space 1536 1-9.0 -0.0 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------ COMPLIANCE STATEMENT: The proposed building design described here is consistent- with - .the_ building plans-.,_ specifications, and other_ calculations submitted with the permit application. The proposed building has.been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been_ determined using the applicable -Standard Design_ Conditions found_ in the Code. The HVAC equipment selected to -heat or cool the building shall be- no- greater- than_ 125% of thedesign load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date 'Massachusetts Energy Code MA6check- Software Version 2..01 Release 2 LEANNE DRIVE DATE: 21-9-2000 Bldg,.( Dept,I Use j GEIJ!JNGS-:- [ } f i ( Comments[Location C } fi 1. Wood,Frame, ,16" OX., R-13- (- -Oomments/Location WINDOWS ANDL GLASS- DOORS-.. U-xvalue�:. 0. -4 - . 4 -Fur For s indoors -without labeled Z - value -a, . describe. features :. Panes Frame Type.Thermal -Break? [-] Yes [ ] No C ervts-/Loca-tfo�n- E 7 fi 2.-U-va1u€:-0.46 For windows without. labeled. U--Aralues,- describe Ie-atures :. (= I Ba -nes Frame Type-, Thermal Break? j ] Yes [ ] -No . C Comments -/Location - r { DOORS:- [ } 1. U-vra_1ue : - f0-. 4 Cemmerfts-/Locati:en - FLOORS-- [ } r 1. -Over Unconditioned -Space-, R-19 Comments/Locatiom ( ( HVAC SQUIPXENT: [ } i i. -Furnace, . 92.-0- AFUE -or #igher Make and Model: Neer 2. Air Conditioner, -1'0.0 -SEER fi - AIR LEAKAGE-:- [ ] (- Joints-, penetrations-,- and ail other such.. openings.: ire --the building ( envelope that are sources- of air l e-, must be- -sealed_ -When. Installed- in the building envelope,- recessed lighting fixtures ( shall meet one of the following- rets �. 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 203-, with- no more- than- 2_4 cfm- (4.944 L/s-) air movement from the the conditioned space to the aceiling -cavity. 'The lighting fixture C shall have -been tes-ted- at 75 PA- or 1.57 lbs/ft2 pressure difference and shall be labeled. C, ( 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 coo-lingequipment-and service water heating- equipment must_ be ( provided.- Insulation R -Values-,- glazing U -values, and heating ( equ,ipmen_t efficiencymust be clearly marked on the building pians or:specifications. (- -DUCT INSULATIOK-. [ } ( Ducts-- sha-lL-be insulated per Table J4.4.3.1. .1. I (- DUCT CONSTRUCTION:-. All accessible -joints, seams, and connections of supply and. return (: ductwork located outside. conditioned space, including stud bays. or Joist cavities/spaces -used:to - transport air, shall be'sealed ( usinq mastic, andd 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. C TER T!URE CONTROLS-:_ [ ] ( Thermostats are_ . required- for each separate HIVAC- system.- A manual (= or automatic means. to partially restrict or shut off the heating- (- andlor cooling input to each zone or floor shall be provided. ( - HVAC EQUIPMENT SIZING -- Rated output- capacity ot the -heating/coolingsy-stemis (_ not greater than 1254o€ the design. load as -specified ( i -n Sections..780CMR 1310 -and J4.4. 1 ( SWIMING POOLS-:- [ ] I Ali heated swimming -pool% must have an on/off heater switch and (= require a cover unless- over 20$. of the- heating. energy is from r non-depletahle sources. Pool pumps require a time clock. (- HVAC PIPING INSUI;ATItiN [ } ( HVAC. piping_ conveying. fluids above. 120- F or chilled fluids (_ below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) ( HEATING- SYSTEMS-- ' TEMP IF) 2" RUNOUTS 0-1" 1.25-2" 2.5-4 f Low pressure/temp-_ 201-250 1.0 1.5 1.5 2.0 ( Low temperature 120-20-0 0.5 1.0 1.0 1.5 steam condensate any . 1.0 i.0 1:5 2.0 ( COOLING- SYSTEMS--:- ' ( Chilled water or 40-55 `0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 I CIRCULATING HOT' -WATER 7SYSTEMS : c ■ insulate circulating -hot water pipes to the following levels (-in.): t UEATED WATER TEKP -(F) �. 1?0180 �- 140-160 140--130 FIPK SIZES (in,) NON -CIRCULATING f -CIRCULATING MAINS-& RUNOUT RUROUT-S- 0-1" 0-i.-25" 1.5-2-0— 2 A+ G.5 1.0 1..,`5 2.0 t3.S 0.-5 1.10 1.5 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department- Use Only) ----------------�-----T-- < Lnm o 0) ° 7a O n m In z o .6 O -4 (D zr n m -0 -0 M m CD D 0 N ;D 0 CD m X o �? �0r 3, � O - �,fD n y 0 -, o fD n fD O O � M W 0-0 fD = _ D cr a � � '� m S. r* ° ? :O d .13 :D H C a ° T v . CD d O fD : C1 in m 3� a CL w a ^' :Q �, QJ� C O O c <<r0 - < _ ,. _ C E 5 v�Q. U3 N m O ° cD cD ,. (1) a n p o E m mCL 3 a cnD 0 �- CD :� c 'TI NCO m `5 0% c ' COD.."" " ('D K . o � � z 0 9j U( O O � *�* U) a) m m V/ U r�M CA CD P -40.Z CD O CL r, d O )r.oco � O o p CID Q CD O ao c= CD v .0 EF CD O CA C'). C O C CA d C7 CD O �M CD CD CO) CD CO) ti O CD 0 G CD ED" cn 2 O z cn rO -• N p Q N D So a: cc) ,p y a CD o to n o co o n 0g CA =r CL n m CD W CD O CO N p O 3E = cD W CD toM. 0 p O N C7 . O c = CL a y = CL to o sic CD CO CD CD c» c on CD (f1 0 o O d N H d d lb,CD Q N < : to N S O CD m N .Z• �ta � ;�'O cz, cm O `' 0 o N W� C0= c b o � C Z CL •o C7 n CD O c p =. 0 CD rD (D, 'TJ d a�a 7 °= � • 77 oGc x � r z0 °= 'It oCa 7 o -n °= n rD vCo 7' � ao W o z V) n In O.. o �1J z 0 N UN O C Building Value Calculation - for Property at..... LOT# Addy Pn77 Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 23.5 14 329.00 65 $ 21,385.00 Brkfstnook 4 4 16.00 65 $ 1,040.00 Dining Room 14 14 196.00 65 $ 12,740.00 Family Room 28 16 448.00 65 $ 29,120.00 Study 12 10 120.00 65 $ 7,800.00 Living room 18 14 252.00 65 $ 16,380.00 Garage 26 24 624.00 35 $ 21,840.00 Entry 15 13 195.00 65 $ 12,675.00 2nd floor foyer - 65 $ - Sunroom - 65 $ - mudroom - 65 $ - Walkin closet 16 7.5 120.00 65 $ 7,800.00 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry 14 5.5 77.00 65 $ 5,005.00 Bedroom 1 19 16 304.00 65 $ 19,760.00 Bedroom 2 14 14 196.00 65 $ 12,740.00 Bedroom 3 14 14 196.00 65 $ 12,740.00 Bedroom 4 14 14 196.00 65 $ 12,740.00 Bedroom 5 - 65 $ - Bathroom 1 5.5 10 55.00 65 $ 3,575.00 Bathroom 2 14 8 112.00 65 $ 7,280.00 Bathroom 3 14 13 182.00 65 $ 11,830.00 Bathroom 4 - 65 $ - Bathroom 5 65 $ iv 13� '� a s moi/ vti��2 02 3 Oj � o U N CO w Q F- w W>_ Y O ItW Q z 0 W eellllllllllllllll�e ■ ■ ME U-1 I Wl! 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No. Date NORTH TOWN OF NORTH ANDOVER i?: O F p i • Certificate Occupancy $ of Mus t Building/Frame Permit Fee $ A -3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # q.5 15 '-' S 0 _I;f/V r6441 /T Building Inspector ?,rrME� as 3- cf toA Us � VNO Q �`- 3 ' LEANNE DRIVE N24' 93 '25"W y 127.11' c 7. '4�a 32.1' m"gz,6c.-vzN 22.6' v Ex. Foundation T.F. Elev.=243.20 r a. o �r O. LOT 7 39.5' 34185 S.F 0.78 Ac. --------- —132.4` EXISITHO DRAINAGE EASEMENT o --- — -- ----- '90 — — — — — — — L------- I-------------_---- •09°32"w 2 art",:,I��,�. STIIHEN M. cluc 17.97' EXISITNO NO CUT EASEMENT N215 -55'50"W 84.31' —' N2 10 THIS PLAN IS* �-�'WFGR ZONING PURPOSES ONLY, IT WAS PREPARED FROM EXISTING PLANS .AND RECORDS 11 WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION. N25'34 2q "W\ 42.52 M �7,� 4 G r ., WE HEREBY CERTIFY" THAT WE HAVE EXAMINED THE PREMISES AND THE DWELLING IS LOCATED AS SHOWN_ THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY WHEN CONSTRUCTED, ALSO, ACCORDING TO THE F,E,M,A./H.U.O. FLOOD INSURANCE PATE MAP, COMMUNITY PANEL NO.250098 0006 C DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLODD HAZARD ZONE. CERTIFIED PLOT PLAN LOT 7 HERITAGE ESTATES i MARCHIONDA + ASSOC.,L,P. NORTH ANDOVER, MASSACHUSLETTS1 ENGINEERING AND PLANNING CONSULTANTS DRAWN FOR j 62 MONTVALE AVE. SUITE I BROOKVIEW COUNTRY HOMES, INC. STONEHAM, MA, 02160 P.O. BOX 531 (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS DATE: 12/4/01 SCALE: 1"=¢0' 10'd t-95 esv Ts.L s3ioiooss"T"aN0IH3aVW Wt:l ZO:OT T00z-OT 3Q Yu78 Date.....(.'. G d .�: TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... '1 .................... �............................. has permission to perform !..V ... ....1..%.<.� �' e.. ............. ...`` ....... ..................... ,wiring in the building of ........... . c ........ C cJ .......................................... �! G .........r. c...........Andover M at .............�.......... ........4orth 'Fee.. No.. - %���.5/.. � ,.. Check # 1 ELECTRICAL INSPE� -7� \ �% � TSE' OF office Usc y DMARTMENTOMBLIC. 9F +l;'1 i' - Permit Na 3 O 7,p moor Z04RD0FP=PRffi YVrMVR Gff-4 fflW.l7CAf nW Oaropaacy dr Feas Chcciccd APPLICAUON FOR PERW TO PDRFORMH ECMM WORK ALL WOw M W PERFORUM M ACOMDANCE Wmnm MASSACiit) m B B=W-,%LCWE, 527 CMR I2 OO (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) &- L C.',V,-JP A kr- ZD -7z J fJ Owner or Tenant 3wner's Address d s this permit in conjunction with. a building permit: ����Yes � No Q (Chan Appropriate Box) haposeofBuilding _ �0X-AttnT/ 4TL' Utility Authorization No. ;xisting Service Amps V/ofts Ovatmd E] Undagmtmd Q No ofMeters 1 w_ Ampsgg/J&Vofts Ov=head Q UndeWound C3 No. ofMks — lumber of Feeders and Ampacity ocation and Nature of Proposed Elecdricai Wattt`'6,-MofteF. Na of LightAg Outlets No. of Hat Tubs Na ot7amfameis Total KYA '40. ng Fixtures swimming Pool Above Below GeneMICAP KVA do. of Receptacle Ontlels Ha ofoff Bdaas Na OfFAW@eecy LigW" Battery Uaits Jo. of Switch Oudets Na of (las Bomas FIRE ALARMS Na of z4nEs la of Rsages Na of Alt Cond. Trial Tons Na ofDetectionaad la of Disposals No. of Heat Tocol T-atal ?abs KW bitwingmnioes Na of3am dWX Doncat a of Didnvadxn Spme Ann Heating KW Na of SelfCaa4ueed D�8 Devices Local Mnoicgr•i Connections �: - Other aofDryets HeeftDcvices KW x of water Resters KW Na of - Na of Si Bailsais x HydgMaaageTubs Na ofMotars Tad IIP Ansuantbfiewagti�rta�aQvfaseilsGeuaalIsrts - ea 'WOMC&P* YPS No eptoafafsamet�fte�Yf [ffND V.4M:E O, BEIM l: - Cly - 0 00, ----. - _ -_-- ��ieQt�ffijlElititZ1 Wat1RS�11$IBC�I@tirltllt. se check one) Owner Agent 1:3 Telephone No. PERMIT FEE