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HomeMy WebLinkAboutMiscellaneous - 95 LYONS WAY 4/30/2018 (2)r G tS"\ Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Richard & Robin O'Neill Property Address: 95 Lyons Way Policy Number: VN3254 Date/Cause of Loss: 12/31/2012, Water/Washing Machine Leak File or Claim Number: 28760-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to the p rsons named above at the addresses indicated above by First Class Mail. Sianatdre and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Rbad, Suite 303 PO Box 1098 Londonderry, NH 03053 ® MAPFRE Commerce INSURANCE" December 09, 2013 The Commerce Insurance Companyw Citation Insurance Companyw 11 Gore Road, Webster, Massachusetts 01570 508.949.15001 www.commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: RICHARD W ONEILL / ROBIN ONEILL Property Address: 95 LYONS WAY Policy#: VN3254 Date of Loss: 12/31/2012 File#: HPRJ20-CCMPN8 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. ANGELA LUHTA Telephone: (508)949-1500 Ext: 15371 Claim Representative I, Property Toll Free: 1-800-221-1605, Ext:15371 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. December 09, 2013 Date. 12 LF TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... 5-�V- eic'T.— has permission to perform .... f-` f%. a, wiring in the building of ... 1V � L ........................ at..1 ' 4 yo NS . LV#� ............ ..N Andover, Mass. Fee Lic. N 09 . A o.. ......r"Lt- Check 5-!j� 29 ELECTRICAL INSPECTOR 011 11263 y�J 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the \\\ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has-been accepted by an Inspector of Wires appoint.dpursuapt to M. G.L c. 166, § 32, an electrical permit shall be issued to the person; firm oc'corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be.deemed.by- the .Inspector_of __Wires abandoned -and .invalidafhe . or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. 8 — Permit/Date Closed: 0 Permit Extension Act — Permit/Date Closed: *** Note: Reapply for new per it y Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS J Official Use Only Permit No. 112-L 3 Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC , 5 7 Cr 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMAT10A9 Date: / V. la City or Town of: NORTH ANDOVER To the Inspector ofWires: By this application the undersigned gives nice of his,or her intention toperform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes Telephone No. No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps New Service Amps Number of Feeders and Ampacity Volts Overhead ❑ Undgrd ❑ Volts Overhead ❑ Undgrd ❑ Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires a No. of Ceil: 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- ❑ rnd. rnd. o. o Emergency Lighting Batteiy Units No. of Receptacle Outlets 20 No. of Oil Burners I= ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiatingDevices No. of Ranges I No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers 1 Heat Pump Totals: Number TonsKW .......... ...........Detection/Alerting No. of Self -Contained Devices, No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water W Heaters K No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as regttired by the Inspector of Wires. Estimated Value of Ele tri 1 Work: kdo (When required by municipal policy.) Work to Start: ,Zf%� Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE CO GE: 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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Eff BOND ❑ OTHER ❑ (Specify:) X certify, under the ins an pe allies o p(rjury,at the information on this application is true and complete. J FIRM NAME:. � C iG er LIC. NO.: 6 Licensee: a Signature-��1/�-- LIC. NO.: (If applicable, enter A the lice a nttm `erine Bus. Tel. No.: L Address: 1r%% Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. 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 PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed �. on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule R — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: i Inspectors Signature: Date: ROUGH SPECTION: Pass • Failed Re- Inspection Required ($.) ❑ Inspectors mments: Inspectors Signature: V Date: FINAL, INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com L 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 11 Name Business/Oreanizati6n/Individuall: 1AJ1,0 '� t l P!' ��.� Po rte Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. am a employer with �. 4. ❑ I am a general contractor and I _ employees (full and/or part-time).* have hired the sub -contractors am a sole proprietor or partner- 2.❑4hip listed on the attached sheet. t and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. JNo workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 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.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9.❑ Building addition 10.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. :ontractors 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 iformation. A 1 __1111 isurance Company Name: d�l!7 6 olicy # qr Self -ins. Lic. #:_ - -1;3935T Expiration Date: ib Site �ddress: WCity/State/Zip: /V,, ",ler MA 't - ttach a copy of the workers' compensation policy 4claration 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 ne 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 Lvestigations of the DIA for insurance coverage verification. do hereby ce�fl! under the pains andon aXiek of perjury,that the information provided above is true Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # FA 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." k 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 d6'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 evised 5-26-05 Fax # 617-727-7749 www,mass,gov/dia �1-4 .............. '.a "�� has permission perform v-- .'.'...'..j''..'''''''''' plumbing in the of. ... ............. 81.............................. North Andover, Mass. Fee .7.7,#0..Lic No. `a\- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u,p POWNER TYPE OR PRINT CLEARLY CITY -North Andover _ _ MA. DATE 112/5/2012 ! PERMIT # OWNER'S NAME JOBSITE ADDRESS 95 Lyons Way Richard O'Neill ' _ - - _ - ADDRESS: Same �- _ _ _ TEL: FAX: _ _ OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL ❑■ NEW: ❑ RENOVATION: ❑■ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑E FIXUTRES 1 FLOORS- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GASIOILISAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING / INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES R NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted (or entered) regarding this Knowledge and that all plumbing work and installations performed under the permit issued for this provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME: William F Healy III _� LICENSE # 113077_ COMPANY NAME: Bill Healy Plumbing & Heating__ ADDRESS: C CITY: I Methuen - -- -- -- - --- - STATE: Ma ZIP: 01844 r FAX: _-- -- TEL: 978 258 7267 CELL: 1978 569 4928EMAIL: FilliamFHeaIy@aol.com j MASTER ❑■ JOURNEYMAN ❑ CORPORATION ❑ # ___-; PARTNERSHIP ❑ # LLC ❑ # e� hereby certify that all of the details and information I have submitted (or entered) regarding this applicatic Knowledge and that all plumbing work and installations performed under the permit issued for this ap�licE provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: William F Healy III - LICENSE #[T1 077 _ I N COMPANY NAME: I Bill Healy Plumbing_& Heating_ _ ADDRESS: CITY: Methuen STATE: Ma ZIP: 01844 to the best of my e with all Pertinent Rd FAX: -- ---- -I II TEL: 978 258 7267 JI CELL: 978 569 4922 EMAIL: WilliamFHealygaol.com— _ MASTER M JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION 0 # PARTNERSHIP ❑ # LLC ❑ # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - GOWNER TYPE OR PRINT CLEARLY CITY North Andover MA. DATE 1215/2012 PERMIT # JOBSITE ADDRESS 95 Lyons Way_ OWNER'S NAME Richard O,Neill ADDRESS: Same TEL: FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL ❑■ NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NOW FIXUTRES 1 FLOOR- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑N OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted (or entered) regarding this applicatic Knowledge and that all plumbing work and installations performed under the permit issued for this ap�licE provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: William F Healy III - LICENSE #[T1 077 _ I N COMPANY NAME: I Bill Healy Plumbing_& Heating_ _ ADDRESS: CITY: Methuen STATE: Ma ZIP: 01844 to the best of my e with all Pertinent Rd FAX: -- ---- -I II TEL: 978 258 7267 JI CELL: 978 569 4922 EMAIL: WilliamFHealygaol.com— _ MASTER M JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION 0 # PARTNERSHIP ❑ # LLC ❑ # If a� e� s NORTH O p CHUS This certifies that Date 10 �� '"•. �/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .1Y.// ............... has permission to perform ..... . plumbing in the buildings of ./Q�4!�r...r�.%ti!!�........ . at . �.. Z�rp,�kj ..w �- ,North Andover, Ma'Ss. Fee. ' - ' ... Lic. No.....'y .. .......................e PLUMBING INSPECTOR Check # r MASSACHUSETTS UNIFORM APPUCRTION FOR PERMIT TO DO PLUMBING • c ��MA. Date• % r �! l l Permit# Y/T�tn, �ily f� f Building Location: �� (,/Xl Owners Name- 2641d U/1 Olye BGG Type of Occupancy: Commercial ❑ Eiiucational ❑ Industrial ❑ Institutional ❑ Residential SYSTEMS New: ❑ Alteration: [Y Renovation: ❑ Replacement: ❑ Plans Submitted: Yes Er o ❑ CIVTI IDGC i INSUKANUt GUVtKALat: I have a current liabilityinsurance policy or its substantial e(privalent which meets the requirements of MGL Ch.142 Yes tnNo ❑ If you have checked Yes, please indicate the type of coveragl) by checking the appropriate box below. A liability insurance policy d Other type indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER. I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this hermit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submit l ed (or entered) regarding this application are true and accurate to the gest ;?my Knowledge and that all plumbing work and installations performed under rt ' for uation vm'il be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code anti Chalie�ra By Tide CitylTown APPROVED (OFFICE USE Type of License: VV -/-Y(- Pumber S gnature of Liceed PlumbeK.-_ mpaster license Number. []journeyman DEDICATED SYSTEMS Z 2 v le > z > z sn :9 m iC rn H Y } FA-� Z to v r- Q w W tr 0 Z Q a. W W z = t„ a9 LA za LU !H y a S �_ a s m : to aC to > d . O Q on D Q Z Cr.on O to Z rn U W Z OC a � C9 W rn 3 3 Uj 0 't.LU F 3 0 0 3 2 2 Q 2. N >> d O z 11A f- LU 1- m a• } F � Q a W O p 92_ Y g g aC in m Q E- 0 3 3 3 O Q O t7 t7 SUB BSMT. BASEMENT 1r FLOOR 2ND FLOOR FLOOR i 4T" FLOOR s 5m FLOOR VT" FLOOR 7T" FLOOR+4 8T" FLOOR Check One Only Certificate* Installing Company Name:, (' all t ���k�Ii lug ❑ Corporation Address: A CRV/rown: Partnership Business Tel: --)a LAD _Fax: L 'icompany Name of Licensed Plumber. INSUKANUt GUVtKALat: I have a current liabilityinsurance policy or its substantial e(privalent which meets the requirements of MGL Ch.142 Yes tnNo ❑ If you have checked Yes, please indicate the type of coveragl) by checking the appropriate box below. A liability insurance policy d Other type indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER. I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this hermit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submit l ed (or entered) regarding this application are true and accurate to the gest ;?my Knowledge and that all plumbing work and installations performed under rt ' for uation vm'il be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code anti Chalie�ra By Tide CitylTown APPROVED (OFFICE USE Type of License: VV -/-Y(- Pumber S gnature of Liceed PlumbeK.-_ mpaster license Number. []journeyman I The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 U www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibl� Naive (Business/Organization/Individual): Address: City/State/Zip: p �,,� h Phone #:��� _ Are you an employer? Check the appropriate box: .1111 am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).' have hired the sub -contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet, ship and have no employees These sub -contractors have working for me in any capacity. 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. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ 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. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lain an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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-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 do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. 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 CIerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Richard & Robin O'Neill Property Address: 95 Lyons Way Policy Number: VN3254 Date/Cause of Loss: 11/11/2011, Water Damage/SkylightLeak File or Claim Number: 25725-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 313 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to the per ons named above at the addresses indicated above by First Class Mail. ANDERSON AD 50 Nashua PO Londonc and Date RMENT CO., INC. id, Suite 303 1098 NH 03053 0 ; 31 Date. ........... NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ......... has permission to perform ...•+...1�,�t'.. wiriinqng in the building of ................� .......� �....�? ..�� v� at.,t..... !��` .............................. . North Andover, Mass. Fee..,%fib... .... Lic. No. AJ 45.....................................................`5.,� ELECTRICAL INSPECTOR Check # ,ter. Commonwealth ®f massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Use Only Permit No. _ 10131 Occupancy and Fee Checked :ev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL AVO RKAll work to be performed in accordance with the Massachusetts Electrical Coder)c , 527 MR 12.00 (PLEASE PRINTHINKOR YYPEALL JYFOr2YON City or Town of Date: By this application the undersi ed gi s ' of his or her ' t tio�o perform the electrical To the, ecrorw k described be Location (Street �& Number) _ �� i � �� low. Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building perm! . Yes Purpose of Building No ❑ BLDG PE1dMIT #_ Utility Authorization No. Existing Service Amps __/ VOIts Overhead ❑ Undgrd n No. of Meters New Service Amps _ / _Volts Overhead El Number of Feeders and Ampacity Undgrd No, of Meters Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers Heaters KW o.. 1`Iydromassage Bathtubs (.'ompletzon of the of Ceil: Susp. (Paddle) Fans Of Hot Tubs Swimming Pool end e E] No. of Oil Burners vo. of Gas Burners Vo. of Air Cond. To :e/Area Heating KW Ing Appliances KW Signs Ballasts of Motors Total HP ' wing table maybe waived by the Ins ector of Wires. No. of Total. Transformers KAVA Generators KVA o. o mergency ig ring ❑Qnif...... T7�_i._ 'ME ALARMS INo. of Zones lo. of Detection and Initiating Devices o. of Alerting Devices o. of Self -Contained etection/Alerting Devices )cal ❑ Municipal Connection ❑ Other curity Systems:* No. of Devices or Equivalent ita Wiring: No. of Devices or Equivalent 3 lecommnmcatlons wlr ngg: No. of Devices or Eauivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value o� ec *cal Work: 6 3? . (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with AMC Rule 10, and upon completion. INSURANCE C GE: 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 cove ge is in force, and has exhibited proof Cof same to the permit issuing office. HECK ONE: INSURANCE M BOND ❑ OTHER I cert, sender fh e ins an en Zf' o � ❑ (Specify:) f � ry, at the information on this application is trace and completA FIRM NAME �r �tr�� Licensee: LTC. NO.: Signature (Ifapplicable, enter " p in the qiqlmseLTC. NOWAddress: ��� Bus. Tel No.: *Per M.G.L. c.141, s. 5 -61, recur*ty work requires Department of Public Safe "S" Licen fit' TeI. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required g law. $ y s*gra e e w, I hereby waive this requirement. I am the (check one) n owner ❑ owner's agent. Owner/Agent Signature Telephone No.' pE RMIT FEE: $ G'I, w ELECTRICAL PERMIT NO. INSPECTION REPORT: ~ ELECTRICAL INSPECTOR - ]DOUG SMALL aJJGI.Wla %_VJULUV1AW. 2. FINAL INSPECTION: Passed - [ ] Failed - [ ' Re -inspection required ($50.00) Inspectors' comments: (Inspectors' Signature - no initials) Date 1,rl - 3 UNDER GROUND INSPECTION: Passed - [ I Failed - (] Re -inspection required ($50.00) - [ ] Inspectors' comments: k I - (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. R \_\ The Commonwealth of Massachusetts ,Department of Industrial.Accidents Office oflnvestigations 600 Washington Street ` Boston, MA 02111 www mas.. gov/dia Workers' Compensation liasurance Affidavit: Builders/Contractors/Electricians/Plumbers NaM()(B.usiness/OrganizpationAndi�vidual): u/e, Address: i��'I �'lI�I.Pi PI jinr� City/State/Zip:. Phone #: lrl q,V :7 aol Are you an employer? Check the appropriate box: ' 1.E] Ina employer with 4. Q I am a general contractor and I employees (full and/orpart time).* have hired the sub -contractors 2. ElI am 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.orkers' comp. insurance. [No workers' comp. insurance 5. L!d We are a corporation and its required.] officers have exercised their 3. E. 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.] ? employees. [No workers' comp. insurance required.] Type ofproject (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10.Vlectrical repairs or additions I 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. `t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now -affidavit indicating such,. 'Contractors 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. 9ked Insurance Company Name: _ ,�,(e _ Policy # or Self -ins. Lic. #: W W (1 �5 Expiration Date: . � Job Site Address: D City/State/Zip: Attach a copy of the workers' compe ation policy declarati n 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-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 maybe forwarded to the Office of %Investigations of the DIA for insurance coverage verification. I ado hereby cerci nder• thepains and a es fperjury that the informationprovidedabove iss ndcoYr correct. Si afore: l�afw tom/ 71j/ 1 11 19 F Phone #: % , Z 7 P �9� G - Offzcial use ox y..Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): X. Board ofRealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbinglnspector 6. Other Contact Terson: Phone Town of North Andover cf yORTb� Office of the Building Department O >S4cD Community Development and Services Division * s 27 Charles Street " Too North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Date: November 1, 2002 To: Richard O'Neil Address: 95 Lyons Way From: D. Robert Nicetta, Building Commissioner Re: PERMIT PICK UP We have attempted to contact you with regard to your Permit # 75 pick-up since 8/9/2002 Telephone (978) 688-9545 Fax (978) 688-9542 This Permit has been ready for If you do not come into this Office to pick up and pay the fee, an inspection will be conducted and appropriate action taken if we find that construction has begun or has been completed. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PL-uNNTNG 688-9535 Location gS 1 y,:N s No. -S Date o47., 2 - TOWN OF NORTH ANDOVER 3�0�,•`•o ,�,hC F + : ; , Certificate of Occupancy $ s�CMUs <� Building/Frame Permit Fee $ S� Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # Co/� roti 16054 Building Inspector n . SECTION 4 -. WORKERS C.OMPENSATION.(M,G.L•:C.152 § _25c(6) Workers Compensation Insurance affidavit must bio completed'and submitted with this application ' Failure to provide this affidavit will result in the denial of the issuance of the buil - 5i ed affidavit Attached Yes ....... No j SECTION 5 I?escrition of Pro osed Work chec$' a .. heabieor New Construction ❑ ldinJRp❑ At adthonEg tw':.:❑ P. ,Accessory Bldg• 0 _ Demolition ❑, Other : ❑ Specify Brief -Description -of Proposed Work. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b "'t a ' icant 1. Building hh (a) Building Permit Fee. . lXV� - Multi lien tedTo 2 Electrical (b)._....... . tal Cost of ,. .1000 Construction 3 -Plumb' Burl Permit -fee. Building Permit 4 Mechanical AC ,. r.. 5.. ..Fire Protection .. -.. . — s L i — , Chrrtr Nnmher :7 SECTION 7a-OVVNER AUTHORIZATION TO BE COMPLETED WHEN,. . OWNERS AGENT.OR.CONTRACTOR APBLIESTOR BUILDING PERMIT - as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application- pplication.Si ture of Owner Date Signature SECTION 7b OWNER/AuTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby a that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and beli _ P ' ame signature of Owner/A ent Date ............. , ... NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 PD SPAN . DIMENSIONS OF SILLS DIMENSIONS OF POSTS DR ENSIGNS OF -GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL, OF CHMgEY IS BUILDING ON SOLID OR FILLED LAND.." IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT -��—� ��---�� �� PHONE_ LOCATION: Assessor's Map Number /'G / PARCEL -P SUBDIVISION LOT (S) STREET ST. NUMBER *********** ***************************OFFICIAL USE O Y*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMM TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED _ DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT J� FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm 6 2— TE_f__ Tel: 978-688-9545 Please print. DATE —II JOB LOCATION %S Number "HOMEOWNER n whc d 1J, ,o, Number PRESENT MAILING Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION /- Von --% GU Street Addres 'Alz,l/ -1 8 Home Phone Owe t � �'*a •sass. �'�+ Section of Town '7 – T.Z& –V Y77 - Work Phone A/- Andi ve,y M 0194/r City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies Building Department minimum inspectic comply with said procedures and requir HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFI understands the Town of No. Andover s and requir, , ents and that he/she will / A Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. V 7 C/) DO Cf) m 0 y d � d CO)CD C'7 n .Z y CL ? O CZ CO) nC CD o p CD o Cr d CD Er CD O • CD 0oao �. C O CO) CD n0 CO) CDI �CD 0 v I n O z cn OZ5•A 1 O N CD • OAp C ?fO/J � m O O 7 C7� to m3Z b O `O N Oar: cr CA , 0 �• ca O Q N _zO • CD So O -0 R �m o n ti 0 o 0 ycKn� m r ti C CA V Z •� ?o y _I CD 0 ._► fi d► m G T CD N ? m new m N y p = O H n a� p n p C a -I OZ5•A 1 O N CD • OAp C ?fO/J � m O O 7 C7� to m3Z b O `O N Oar: cr CA , C rrtN CA 4CDm • CD %m •-► l7 O K r O r ti C CA V .0 o x CD -- s • It CD �g O. x x O CD N o m a� p 1 O -w . CD 0 V' rA V CD z O O r O r ti C � 7 n x x � G w �g O. x x L 0 9 . O C Locations ` �(JtiS (VA No. �� Date I ,►ORT" 4 TOWN OF NORTH ANDOVER O S Certificate of.Occupancy $ �7s'••�°'E<� Building/Frame Permit Fee $ SICMUS Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # 06' ✓ Building Inspector T V\ A u L— 7— c9 I iL Ot 5 M 52.2' 0 IT 3 1 S.F. �4j6� 54.5' 1 Ac. p T L=84.43' ewsnNG L— ! 4 0=80'37'2.5 52,772 S.F. 40.12' >ouNonnoN 1.21 Ac. 43.1' LYONS WAY 6=40.40' DRAINAGE � D=77-09;37" EA T= SEMENT 23.93 R-30.00' 6= 7.42' A=07'05'15" AGE o. 44' h^ 0269.30' p�1 9' o STEPHEN M. MELESCIUC No. 39049 6=26.45' 35.4' 0 0=2515'16" N35'3169'41"W o 50.' o �- ro 5 > >>35� 33.14' N35'31'41"W 98.76' � 34.9' PROP. DRAINAGE _ 42.8 EASEMENT S35'10'41 "E 107.86' SWOH �� (F -ND.) 318.22' N35'3 '41"W 271.47' 254.5' W j Q LOT 5 Q � 55,367 S.F. 1.27 Ac. o� Q Q HAROLD PARKER STA TE FOREST S35'33'33' 249 p6 z �a m S34'43'39"E 9.697- � V i Mall WE HEREBY CERTIFY THAT WE HAVE EXAMINED .X� 51,51[o)THE PREMISES AND THE STRUCTURE IS LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, WITH THE STRUCTURES SHOWN LOCATED COMMUNITY PANEL NO. 250098 009C BY AN INSTRUMENT SURVEY. THIS PLAN DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED SHOULD NOT BE USED FOR PROPERTY IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. LINE DETERMINATION. CERTIFIED FOUNDATION PLAN LOT 5 LYONS WAY MARCHIONDA & ASSOC.,L.P. NORTH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR MESITI DEVELOPMENT GROUP 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 231 SUTTON STREET, SUITE 2F (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS 01845 SCALE: 1 "=60' DATE: 5/31 /01 �' CERTIFICATE OF USE & OCCUPANCY i Town of North Andover Bullding Permit Number 1e � THIS CERTIFIES THAT h X7`5 THE BUILDING LOCATED ON / X Date //—f� —07 f)®/ MAY BE OCCUPIED AS lAeS&2e&'%I N ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. /v /Pco M5/ a ,S CERTIFICATE ISSUED TO ADDRESS 01',31-5 b—lkN S? 'ds,CKUSBuildin nspector C/) m Cl) m _v y COD CD C2 Z y CL o n• CL =• y �-1 owl OCD v CD O cr o' CD o 0 C O y _• CD CL O CO) CO CD I C� cn w n O cn O cn ocpr y 0 0 W -4 Z S D. ` m m 0 ti m Q • cm Z 0 N go o CLm 9 O —4 o 'O"o :_ Or m .0�. p Sq O OZ y a a � mc � OL � O O N CD O '� C CD N Q Ca = N d Q a06_..�= N 1CD Am►. r► w * TO O O � co o :4. : d � N Ci wIL O m N MOM m go 06 H w� C O OZ b ` -C\ o w omi 0 9 0 ~Lr,* .- V �!I O 2 0 CL v 0 �Q 1 Richard and Robin O'Neill 95 Lyons Way North Andover, MA 01845 (978) 989.0900 November 20, 2001 Town of North Andover Building Inspector Town Hall North Andover, MA 01845 Re: 95 Lyons Way, North Andover Dear Sir, Per your request, I am writing to inform you that we have ordered wrought iron railings for the front steps of the house located at 95 Lyons Way. Should you have any questions, please feel free to contact me at the above telephone number. Thank you. fccay y rs, W. O'Neill Location ��-? /vavAl ay-ao No. Date Check # —511) if TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /1-0( 1476 6 //q/(C.- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO VONSTRUCr REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING �.a r.sx BUILDING PERMIT NUMBER:13- 0, tDATE ISSUED:, �0 C� .44 41 �-, Q� SIGNATURE: V / / "L- Q_ Building Commissioner/I ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: (Lot 5, Lyons Way ) 106B 157 95 Lyons Way Map Number Parcel Number No. Andover, MA 1.3 Zoning Information: 1.4 Property Dimensions: R2 Single Family Dwelling 55,361 s.f. 269' Zoning Distrid Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS (ft). Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 30' 35' 30' 42' 30' 250' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public :R Private 0 Zone Outside Flood Zone IR Municipal jd On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record _ MPG Realty, Inc. 231 Sutton Street, No. Andover, MA Name (Print) Address for Service Signa Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ David G. Donovan Licensed Construction Supervisor: CS 076045 License Number 35 Donovan Way, Tewksbury, MA 01876 Address 4/17/2003 978-640-9610 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Tele hone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. Signed affidavit Attached Yes .......2 No ... ....0 SECTION 5 Description of Proposed Work (check all annlicable ) New Construction *1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) 0 1 Addition 0 Accessory Bldg. ❑ 1 Demolition 0 1 Other ❑ Specify Brief Description of Proposed Work: -------- --- Construct 4 bedroom residential single family dwelling; 2 story colonial, 2J baths, 3 car garage under, 14x20 family room, 14x12 sun room, 4x12 front entrance, 12x16 wood deck, zero clearance F.P. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be41, FF (}'ICIAi; USE Y Completed by -nit applicant M` pen 1. Building (a) Building Permit Fee p K +(. O.." p $214,400 Multi lier 2 Electrical $ 18,000 (b) .Estimated Total Cost of © 00 Construction / 3 Plumbing $ 13,500 Building Permit fee (8) X (b) 4 Mechanical HVAC 15,000 5 Fire Protection 6 Total 1+2+3+4+5) $250,900 Check Number NEC; IIUIN "/a UWINEK AU 1'riUKlLAl'lUf4 TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT MPG Realty, Inc. as Owner/Authorized Agent of subject property Hereby authorize David G. Donovan to act on M fin < utters relative to .ork authorized by this building permit application. "3�Zc�o t Sign ure of r Date I SECTION` M—AVANER/AUTHORIZED AGENT DECLARATION I I, MPG Realty, Inc. 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 Si at r/A t Date , NO. OF STORIES 2 SIZE 32x54 BASEMENT OR SLAB Basement SIZE OF FLOOR TIMBERS i ST 91". IJdists2 9J" IJoists 3 SPAN 16" o/c DIMENSIONS OF SILLS 2 x 6 DIMENSIONS OF POSTS 4" steel DIIMENSIONS OF GIRDERS 1211 steel HEIGHT OF FOUNDATION THICKNESS 10" SIZE OF FOOTING " X 20" MATERIAL OF CHIMNEY zero clearance (wood) IS BUILDING ON SOLID OR FILLED LAND solid IS BUILDING CONNECTED TO NATURAL GAS LINE V P C FORM U - LOT RELEASE FORM JV INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS S t -e tt 5 S7- S ;7 0 APPLICANT L 6i,2Z15 PHONE LOCATION: Assessor's Map Number ©� PARCEL /y % SUBDIVISION, LOT (S)J!'" STREET Gc Gv ST. NUMBER g S ********************************* O F F I C lA L USE REC 1MENDATIOiNS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED /+ DATE REJECTED_ COMMENTS / 9 Al TOVjj,�iV PLANNER COMMENTS FOOD INSPECTOR -HE TH SEPTIC INSPECTO HEALT COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER1WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT Y�jjJ/}�/L.� ECciVED S BUILDING INSPECTOR Revised 9197 jm DATE �-D0 JRM—a9720131 11:51 AM MARCH I ONDA&ASSOCIATES -4 ti 781 438 3554 P.01 0 PR. DR INA G ENT b PROP. 7RfEf1N in / 1 S ti w c� •. LOT 5 7 55,361 $. F. xw2l.27 Ac. 1 111x5 wi # SEDIMENT ASIN ` DET. BASIN OUTLET S UCT. NJ �+ OUTLET S UCT. (SEE DETAIL) (SEE DET IQco �) TR CT_ PROP_ RET. WALL,��,� "d 10 �Q PROPOSED SITE PLAN LOT 5 LYONS WAY MARCHIONDA & ASSOC.,L.R. NORTH ANDOVER. MA ENGINEERING AND PUNNING CONSULTANTS PREPARED #OR MESITI DEVELOPMENT GROUP 52 MONTVALE AVE. SUITE I STONEHAM. MA. 02180 31 SUTTON STREET — SUITE. 2F (781) 439-8121 NORTH ANDOVER. MASSACHUSETTS 01845 SCALE; V-40' DATE: 1�8/Q1 u Building Value Calculation -for Property at..... LOT# 5 Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 25 16 400.00 65 $ 26,000.00 Brkfstnook - 65 $ - Dining Room 16 13 208.00 65 $ 13,520.00 Family Room 19 16 304.00 65 $ 19,760.00 Study 13 9 117.00 65 $ 7,605.00 Living room 14 13 182.00 65 $ 11,830.00 Garage 16 31.5 504.00 35 $ 17,640.00 Entry 18 12 216.00 65 $ 14,040.00 Mudroom 9 6 54.00 65 $ 3,510.00 Sunroom 16 12 192.00 65 $ 12,480.00 Sittingroom - 65 $ - Walkin closet 9 8 72.00 65 $ 4,680.00 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry 7 15 105.00 65 $ 6,825.00 Bedroom 1 22 16 352.00 65 $ 22,880.00 Bedroom 2 17 13 221.00 65 $ 14,365.00 Bedroom 3 17 13 221.00 65 $ 14,365.00 Bedroom 4 15.5 15 232.50 65 $ 15,112.50 Bedroom 5 - 65 $ - Bathroom 1 9 8 72.00 65 $ 4,680.00 Bathroom 2 15 10 150.00 65 $ 9,750.00 Bathroom 3 15 8 120.00 65 $ 7,800.00 Bathroom 4 - 65 $ Bathroom 5 - 65 $ -pr, G c'), 0/ 4 0 o o1v `P J� 0 p �- 16 lS () 0/J-4rr 0" The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, plass. 02111 Workers' Compensation Insurance Affldavit Name Please Print Name: Location: City Phone # F7I am a homeowner performing all work myself. F7I am a sale proprietor and have no one working in any capacity NFIEW Will I am an employer providing workers' compensation for my employees working on this job. r Ld Address ,61;-, City A%r9r4 0 /�l r/5' Phone Licensing Board C> Selectman's Office Health Department Insurance Co Un4 lel %aae-�, P, e,- ..bio . Policy # Al C0,4 r,24// 3 Comoanv name: Address Citv: Phone #: Insurance Co. Pollcv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties or a fine up to S1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine cf (5100.00) a day against me. I understand that a copy cf this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pa s and pen ties of perjury that the information provided above is true and correct. Signature Date % �r %o Print name xzl �' Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensine ❑Check if immediate response is required Contact person: Phone #: Building Dept C] Licensing Board Selectman's Office Health Department Other H FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town Of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and"dated Der'i- , 19 qq and/or by the Covenant dated 4 C 19 —92_ and recorded in District Deeds, Book S 3 9L Page 60 or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book Page has been completed/partially completed,fto the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled "pef,uifri► _ LVoNS Wo S�bd;yicIoIVPIW �nyor MA Section (s) , Sheets Plan dated T4N a4 , 19 91_ recorded by the bpX —Nat'► 1 S'f'r i cf' Registry of Deeds, Plan Book or registered in said Land Registry District, Plan Book Plan s*/3�f,Sa , and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) I hereby certify that lot number (s)/ ! on �-yONS ul�}y Street(s) do conform to layout as shown on Definitive Plan entitled "_G.YDpS W►y y Nof�iudov�� /W t9 Section Sheet (s) 1-/y " 17-115J-1, *iteraed Land Surve o P�SH OF MASS\ a o STEPHEN M. 0 MELESCIUC N A No. 39049 1. 90� aP 1 of 2Esso CoQ ►►N� SURv T,t fr4mwt c t 1 C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated 1 19 Covenant dated and/or 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. Registration Book, Pin Page acknowledges of the terms thereof ereof and hereby releases its right, title and interest in the lots designated on said plan as follows: EXECUTED as a sealed instrument this c,2ts - day of ��CFrc, i� 19 Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS �SSe�C ss ne-Pn1kpr 2-1, 19 cd Then personally appeared one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary P�Jic My Commission Expires 2 of 2 G. :...:Q...th Town of North Andover Planning Board This form represents the schedule for allowing the following lots to be considered as eligible for building permits under the Town of North Andover Growth Management by-law Section 8.7 of the Zoning by-law. Pursuant to 8.7 .5 this Development Schedule must be filed in the Registry of Deeds and be referenced on the deed of each of the lots below and be filed with the Planning Board prior to the issuance of any building permit or permit for construction. Name and Address of Applicant for Lots: Name of Development: MPG Req I ty corp I) old Best'alvfZ Tew bury, M 176 -Map and Parcel of Original Lot: IV4 P I &C a I -at 7a. Date of Application for Lots Division: 741Y 15 14 8 Lots Covered by this Schedule: Lot5 ( -'j L yoNs Wo The Planning Board by their signature below, or a signature of a duly authorized representative, do hereby establish for the above named development the following Development Schedule for the purpose of Section 8.7 of the Growth management By -Law. The applicant, their assignees, successors and or subsequent property owners shall conform to the following schedule that limits the eligibility of the following lots for building permits. This form must be filed in the Registry of Deeds by the property owner or representative and be referenced on each deed for each of the following lots. Such deed reference for the deed of each lot shall at a minimum reference the book and page in which this Development Schedule is filed and contain the language : " This lot is subject to a Development Schedule pursuant to the Town of North Andover Zoning By -Law all owners, representatives, and future purchasers should avail themselves of said restriction by reviewing the approved Development Schedule as filed in Book and Page The fact that a lot is eligible for a building permit is subject to the limitation of the number of building permits per year pursuant to section 8.7.2.d of the Zoning By -Law." The Planning Board hereby schedule the lot(s) for the above development as follows: Year Eligiblei Number of Lots Eligible M Building Office Use Building Office Use Date! Lot Eligibility Notes Coca�ete'ti Utilized Signature of Plannin and r Signature f�Propertty r ed Representative car Date rized Represertaiive Re LtrU to 3.2y -9 `t Date Ll o f� �a�oN /Tr(nZ/_ Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM V�tgLEO ,6¢'NOD �L ® ti 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, sl 50a. The debris will be disposed of in /at: E.L. Harvey & Sons, 68 Hopkinton Road, Westboro, MA Facility location Sig o pplicant `�I2C,lU� Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. N0- 961. APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. l �C 2i i9 --- Application by the undersigned is hereby made to connect with the town water main in -`2/ Street, subject to the rules and regulations of the Division of Public Works. i The premises are known as No. or subdivision lot no. 6( �; Owner Contractor jmL g le r S S� 5ulXe Address Address Applicant's S gna ureL PERMIT TO CONNECT The Board of Public Works hereby grants permission to to make a connection with the water main at z subject to the rules and regulations of the Division of Public Works. Inspected by Date WATE MAI f C i/ C� ✓' Street Street Board of Public Works By See back for rules and regulations 1 494 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 44-�� 27U Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. ci The premises are known as No. or subdivision lot no. rV°f'' ��✓ LO! Owner Contractor Street V Sv gnt - Sc) 1` z Address Address � Applicant'snature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to��� to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date Street ivision of Public Works By See back for rules and regulations All TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William IImurciak, Director Timothy J. PVillett Stat Engineer Additional conditions for lot 5 Lyons Way March 27, 2000 Telephone (.978) 685-0950 Fax (978) 688-9513 This Division agrees to sign the Form U, and issue water and sewer permits, for lot 2 in the Lyons Way Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of this home can begin at this time. The conditions are as follows. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. n No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation of the above conditions will void both water and sewer connection permits. No refunds will be granted. Mesiti op rp Printed Name Date Division of lig/Works Printed Nam CC: Bill Hmurciak Jim Rand 3-Z7-' 00 Date TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Mr. Kenneth Grandstaff, President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. Grandstaff- A The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the following: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system- 3. ystem3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and facilities in the event that Mesid Development or its agents fad to adequately perform maintenance of the pumping station. Mesiti Dev Group Fax 978-5578160 Jul 17 2000 13:54 P.02 6. Mesio development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the faihue of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T. ours, J.Wim HmurcE. Director of Public Works The undersigned acknowledge the receipt of and agrees to the tens and conditions of the above grant ofSonditional use. Date: LOCATION: BUILDER: TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT phone: OWNER: e,�rr/r % c>� phone: Telephone (508) 685-0950 Fax(508)688-9573 e North Andover Superintendent of Highway Utilities & Operations MUST be notified of the ade and set -back from street established in any driveway entry onto any street or way maintained by TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: MAscheck COMPLIANCE REPORT Massachusetts Energy code MAscheck software version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE:- Other (Non -Electric Resistance) DATE: 4-1-2001 DATE OF PLANS: January 24, 2001 LE: Lot 5 Lincoln PROJECT INFORMATION: Lyons way subdivision North Andover, Ma. COMPANY INFORMATION: Lyons way, LLC / Mesiti Dev. Corp. 231 Sutton Street suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 592 Your Home = 589 Permit # checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R -value R -value U -value UA ------------------------------------------------------------------------------- CEILINGS 1720 30.0 0.0 61 WALLS: wood Frame, 16"' o.C. 2356 11.0 0.0 210 GLAZING: windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned space 1744 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using thepp 'cable standard Design conditions found in the code. The HVAC a pm nt s ected to heat or cool the building shall be no greater tha .125 of t e design load as specified in sections 780CMR 13 4. Builder/Designer Date z MAscheck INSPECTION CHECKLIST Massachusetts Energy code MAscheck software version 2.01 Lot 5 Lincoln DATE: 4-1-2001 Bldg.1 Dept.1 use I I I I t] I I I I I CEILINGS: 1. R-30 comments/Locati WALLS: 1. wood Frame, 16" O.C., R-11 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.35 For windows without labeled u -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. u -value: 0.49 Comments/Location FLOORS: 1. over unconditioned space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 92.0 AFUE or higher 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 cfm (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 I I I C3 I I I be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall .be insulated per Table 74.4.7.1. 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 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. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 74.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 LOW temperature 120-200 0.5 1.0 1.0 1.5 steam condensate any 1.0 1.0 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 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 1 Date: 4/10/ 1 JOB TITLE: Lincoln - Lot 5 Xcel Fire Protection, Inc. 50 Northwestern Drive Salem, NH 03079 HYDRAULIC CALCULATIONS FOR Lincoln - Lot 5 North Andover, MA 4/10/01 W aj De s' ' r -DESIGN DATA - OCCUPANCY CLASSIFICATION Single Family DENSITY : 0.05 gpm/sq. ft. AREA OF APPLICATION: 512 sq. ft. COVERAGE PER SPRINKLER 256 sq. ft. Actual calculated spacing varies) NUMBER OF SPRINKLERS CALCULATED: 2 TOTAL SPRINKLER WATER FLOW REQUIRED: 26 gpm TOTAL WATER REQUIRED (including Hose): 26 gpm FLOW & PRESSURE (at Base of Riser): 26 gpm @ 65.9 psi SPRINKLER ORIFICE SIZE: 7/16 NAME OF ORGANIZATION: Xcel Fire Protection, Inc. NAME OF DESIGNER: ctt AUTHORITY HAVING JURISDICTION:N. Andover Fire s SPRINKLER SYSTEM HYDRAULIC ANALYSIS Date: 4/10/ 1 25.9 GPM TOTAL JOB TITLE: Lincoln - Lot 5 TOTAL HOSE STREAM ALLOWANCES WATER SUPPLY DATA TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 25.9 SOURCE STATIC RESID FLOW AVAIL TOTAL NODE PRESS PRESS @ PRESS @ DEMAND TAG (PSI) (PSI) (GPM) (PSI) (GPM) SOURCE 120.0 50.0 850.0 119.9 25.9 AGGREGATE FLOW ANALYSIS: Page 2 REQ'D PRESS (PSI) 65.9 TOTAL FLOW AT SOURCE 25.9 GPM TOTAL HOSE STREAM ALLOWANCE AT SOURCE 0.0 GPM TOTAL HOSE STREAM ALLOWANCES 0.0 GPM TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 25.9 GPM NODE ANALYSIS DATA Node Tag Elevation Node Type Pressure Discharge ft (PSI) (GPM) 1 0.0 TOP OF RISER 44.1 25.9 201 23.0 - - - - 9.2 - - - 201S 22.5 K= 4.20 9.3 12.8 202 23.0 - - - - 9.8 - - - 202S 22.5 K= 4.20 9.7 13.1 210 14.0 - - - - 26.4 - - - A1 5.0 - - - - 32.8 - - - Nodes with "S" indicate a node at the top of a sprig or bottom of drop pendent. The node without an "S" is on the branch SPRINKLER SYSTEM HYDRAULIC ANALYSIS Date: 4/10/ 1 JOB TITLE: Lincoln - Lot 5 PIPE DATA PIPE TAG END ELEV NOZ PT NODES (FT) (K) (PSI) Pipe: 1 1 0.0 0.0 44.1 Al 5.0 0.0 32.8 Pipe: 2 2015 22.5 4.2 9.3 201 23.0 0.0 9.2 Pipe: 3 201 23.0 0.0 9.2 202 23.0 0.0 9.8 Pipe. 4 2025 22.5 4.2 9.7 202 14.0 0.0 9.E Pipe: 5 202 23.0 0.0 9.E 210 14.0 0.0 26.4 Pipe: 6 210 14.0 0.0 26.4 Al 5.0 0.0 32.E Pipe: 7 210 14.0 0.0 26.4 Al 5.0 0.0 32.E Page 3 Q(GPM) DIA(IN) LENGTH PRESS DISC VEL(FPS) HW(C) (FT) SUM (GPM) F.L./FT (PSI) -25.9 0.995 PL 38.90 PF -9.2 0.0 10.8 150 FTG 4E PE -2.2 0.0 -0.179 TL 50.98 PV 0.0 -12.8 1.049 PL 0.50 PF 0.1 12.8 5.3 120 FTG E PE -0.2 0.0 0.057 TL 2.50 PV 0.0 12.8 0.995 PL 12.00 PF 0.6 0.0 5.3 150 FTG ---- PE 0.0 0.0 0.049 TL 12.00 PV 0.0 -13.1 1.049 PL 8.50 PF -3.6 13.1 4.9 120 FTG T PE 3.7 0.0 -0.265 TL 13.50 PV 0.0 25.9 0.995 PL 38.84 PF 12.7 0.0 10.8 150 FTG 3E+3T PE 3.9 0.0 0.180 TL 70.57 PV 0.0 15.3 0.995 PL 15.31 PF 2.5 0.0 6.4 150 FTG 2E+2T PE 3.9 0.0 0.068 TL 36.47 PV 0.0 10.5 0.995 PL 47.44 PF 2.5 0.0 4.4 150 FTG E+3T PE 3.9 0.0 0.034 TL 73.13 PV 0.0 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Date: 4/10/ 1 JOB TITLE: Lincoln - Lot 5 HYDRAULIC CALCULATION DETAILS HYDRAULIC QTY DESCRIPTION LENGTH C ID Hydr Ref 1 Required at Hyd Area 2 1 Pipe 1" Kx21 Copper 50' 150 0.995 1 1" Thrd Ball Valve United "80" 0' 0 1.049 8 1" Thrd 90 Ell CI 2' 120 1.049 Elevation Change 2010" 1 1" Fingd Back Flow Valve Watts "007 0' 0 1.049 2 1" Thrd Gate Valve Kennedy 0' 120 1.049 Hydr Ref R1 Required at Source Water Source120.0 psi static, 50.0 psi residual @ 850 gpm SAFETY PRESSURE Page 4 FLOW LOSS gpm psi TOTALS 26 44.1 psi 26 9.0 26 0.0 26 4.2 8.7 26 0.0 26 0.0 26 65.9 psi 26 gpm 119.9 psi 54.0 psi E E m as moo 3 0 Q ai :6 oVn=3 x �O _ E ._ V) c- U5 Q- o) a O (D O (p LO U L Q) y O O - lL T cr (n Ca «O - d O ca U) _ E ,F Q 0-0-0) O O O O O co N LO N L 0) V) V) N ^L � LL /L LL L � cv co a O LL Q O J O � C C Q O L � U � -5JZ V' N O o0 (O t7 N f r r acn— 0 LO v I 0 M O LO N 0 O N 0 L0 O O r Zw U O J N c4 0 N (o N Q O O E m n 0 0 0 0 0 0 V' N O o0 (O t7 N f r r acn— 0 LO v I 0 M O LO N 0 O N 0 L0 O O r SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 1 Date: 4/10/ 1 JOB TITLE: Lincoln - Lot 5 Xcel Fire Protection, Inc. 50 Northwestern Drive Salem, NH 03079 HYDRAULIC CALCULATIONS FOR Lincoln - Lot 5 North Andover, MA 4/10/01 -DESIGN DATA - OCCUPANCY CLASSIFICATION Single Family DENSITY : 0.05 gpm/sq. ft. AREA OF APPLICATION: 256 sq. ft. COVERAGE PER SPRINKLER 256 sq. ft. Actual calculated spacing varies) NUMBER OF SPRINKLERS CALCULATED: 1 TOTAL SPRINKLER WATER FLOW REQUIRED: 13 gpm TOTAL WATER REQUIRED (including Hose): 13 gpm FLOW & PRESSURE (at Base of Riser-): 13 gpm @ 38.6 psi SPRINKLER ORIFICE SIZE: 7/16 NAME OF ORGANIZATION: Xcel Fire Protection, Inc. NAME OF DESIGNER: ctt AUTHORITY HAVING JURISDICTION:N. Andover Fire SPRINKLER SYSTEM HYDRAULIC ANALYSIS Date: 4/10/ 1 12.8 GPM TOTAL JOB TITLE: Lincoln - Lot 5 TOTAL HOSE STREAM ALLOWANCES WATER SUPPLY DATA TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 12.8 SOURCE STATIC RESID FLOW AVAIL TOTAL NODE PRESS PRESS @ PRESS @ DEMAND TAG (PSI) (PSI) (GPM) (PSI) (GPM) SOURCE 120.0 50.0 850.0 120.0 12.8 AGGREGATE FLOW ANALYSIS: Page 2 REQ'D PRESS (PSI) 38.6 TOTAL FLOW AT SOURCE 12.8 GPM TOTAL HOSE STREAM ALLOWANCE AT SOURCE 0.0 GPM TOTAL HOSE STREAM ALLOWANCES 0.0 GPM TOTAL DISCHARGE FROM ACTIVE SPRINKLERS 12.8 GPM NODE ANALYSIS DATA Node Tag Elevation Node Type Pressure Discharge ft (PSI) (GPM) 1 0.0, TOP OF RISER 26.4 12.8 101 23.0 - - - - 9.2 - - - 1015 22.5 K= 4.20 9.3 12.8 110 14.0 - - - - 17.1 - - - Al 5.0 - - - - 21.7 - - - Nodes with "S" indicate a node at the top of a sprig or bottom of drop pendent. The node without an "S" is on the branch SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 3 Date: 4/10/ 1 JOB TITLE: Lincoln - Lot 5 PIPE DATA PIPE TAG Q(GPM) DIA(IN) LENGTH PRESS END ELEV NOZ PT DISC VEL(FPS) HW(C) (FT) SUM NODES (FT) (K) (PSI) (GPM) F.L./FT (PSI) Pipe: 1 -12.8 0.995 PL 38.90 PF -2.5 1 0.0 0.0 26.4 0.0 5.3 150 FTG 4E PE -2.2 Al 5.0 0.0 21.7 0.0 -0.049 TL 50.98 PV 0.0 Pipe: 2 -12.8 1.049 PL 8.50 PF -3.8 1015 22.5 4.2 9.3 12.8 4.8 120 FTG E PE 3.7 101 14.0 0.0 9.2 0.0 -0.358 TL 10.50 PV 0.0 Pipe: 3 12.8 0.995 PL 50.84 PF 4.0 101 23.0 0.0 9.2 0.0 5.3 150 FTG 3E+3T PE 3.9 110 14.0 0.0 17.1 0.0 0.049 TL 82.57 PV 0.0 Pipe: 4 7.6 0.995 PL 15.31 PF 0.7 110 14.0 0.0 17.1 0.0 3.2 .150 FTG 2E+2T PE 3.9 Al 5.0 0.0 21.7 0.0 0.019 TL 36.47 PV 0.0 Pipe: 5 5.2 0.995 PL 47.44 PF 0.7 110 14.0 0.0 17.1 0.0 2.2 150 FTG E+3T PE 3.9 Al 5.0 0.0 21.7 0.0 0.009 TL 73.13 PV 0.0 0 SPRINKLER SYSTEM HYDRAULIC ANALYSIS Date: 4/10/ 1 JOB TITLE: Lincoln - Lot 5 HYDRAULIC CALCULATION DETAILS HYDRAULIC QTY DESCRIPTION LENGTH C ID Hydr Ref 1 Required at Hyd Area 1 1 Pipe 1" Kx21 Copper 50' 150 0.995 1 1" Thrd Ball Valve United "80" 0' 0 1.049 8 1" Thrd 90 Ell CI 2' 120 1.049 Elevation Change 2010" 1 1" Fingd Back Flow Valve Watts "007 0' 0 1.049 2 1" Thrd Gate Valve Kennedy 0' 120 1.049 Hydr Ref R1 Required at Source Water Source120.0 psi static, 50.0 psi residual @ 850 gpm SAFETY PRESSURE Page 4 FLOW LOSS gpm psi TOTALS 13 26.4 psi 13 2.4 13 0.0 13 1.2 8.7 13 0.0 13 0.0 13 38.6 psi 13 gpm 120.0 psi 81.3 psi O N U7 co U—� C C c L C. 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IAN =r �O O - H �'O O m �: ? ; CD a3 C CD � H .+ CD �• /� Im a'o w� 0 c o �r- M�l cn cnw -� p= � � o m � n � Pd 8 r, C R•��g o g� xCA �t m 1p .: a) --I <_ Z Ln m O o j o EL z G'1 =r 0 O In :rC O S H N O n• 0 -+ rn C 7 3 o c 3 CL ai Cdm 0 o p A0(D O y n O M a CD Q 0 _ C CL ( O f�D ED nm (p t O Q, �« � � aj a O 'c ::V c O - 7 O m,_ O N �D O , < _ 2 C cr Ln 77 aj fD ? H' D loo E 3� d Q O CD .� N ➢�Qxm I _ _ CD cn cD w z •�' H o O o **416 A0 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ................... ...................... has permission to perform ....... . ........... ............... _'wiring in the building of ........ ....................................... C� at .......... 7.. .... ........ . .... .., ., North Andover Mase!,� I -A . 0 .. Lic. No. .............. fir. . vv * Fee ... .... x� . .... ................ CT ICAL INspEcrOR Check # 4554 Commonwealth of Massachusetts Official Use Only/�v ` Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR�AL FOATION) Date:�D City or Town of: � /Yl xjp(j Y-4 To the Inspect r o Wires: By this application the undersigned gives nAce of his orpegntqntion to perform the electrical work described below. Location (Street & N10 ber) s Owner or Tenant r d _ 99 � Telephone No. �X— Owner's Address 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: Installation of Security system Completion of the following table may be waived by the In.cnertnr of Wirec No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures AboveIn- Swimming Pool rnd. ❑ rnd. ❑ OR o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS [No. of Zones No. of Switches No. of Gas Burners o Detection and o. Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alertin2 Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or E uivalent O No. o Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. 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. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of E ect 'cal Work: (When required by municipal policy.) Work to Start: 6 1, Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pai s and penalties of perjury, that the information on this application is true and complete FIRM NAME: Licensee: John S. Bassett Signature (If applicable, enter "exempt" in the license number line) Address: OWNER'S INSURANCE WAIVER: I am aware that the Lidghsee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. mH LIC. NO.: 1 r �J :J(` LIC. NO.: 1533C Bus. Tel. No.: 603 594 5928 Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE: $ / Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGU_ I( z I V�Jv Official Use Only Permit No. �7 J Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PE MIT TOP RFORM ELECTRICAL WORK All work to be performed in accords ce with the Ma achusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR E A F AT Date: �,,,o/� City or Town o . To the Inspector of Wires: By this application the undersi d gid n�qFce o�9sher ' ten on to perforin the electrical work described below. - Location Owner or Ten Telephone No Owner's Addre ' /- t_i CI Is this permit in conjunction with a building permit? ;: Yes_. ❑ .., No (Check.! Purpose of Building Utility Xuthorization No. Existing Service . Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters Installation of Security system No. of Ceil.-Susp. (Paddle} Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures n,......1„•:,.....!•G,. ! tl.,...i.,.. tnhlo mm, Fw wnivail by [ho Inenarfnr of Wirec INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 153'1(' _ Licensee: John S Bassett Signature LIC. NO.: 1533C (If applicable. enter "exempt" in the license number line.) Bus. Tel. No.: S�3 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic; see 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 PERMIT FEE: $ Signature Telephone No. v No. of Total No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle} Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In -o. Swimming Pool rnd. ❑ rnd. ❑ o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. o Detection an No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers Totals: I. Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P b Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems: / No. of Devices or Equivalent 1 0. of WaterKW Heaters o. o No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: 14-,-aWd.,1 4 . i—d by theInsnertnrOfWires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 153'1(' _ Licensee: John S Bassett Signature LIC. NO.: 1533C (If applicable. enter "exempt" in the license number line.) Bus. Tel. No.: S�3 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic; see 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 PERMIT FEE: $ Signature Telephone No. 4243 Date ..? /.��.... "40RT1� "`° '"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ..... ��.: '� 7`dCC G1 /........................................................... Pas permission to perform ........ .. ..:... M.rZ.1................ `Miring in the building of ..........6.................................................... at .......5.......�................� ass. ............................. .... Lic. No.4.�¢, ELE CAL IiGSPECTOR Check # Official Use Only THE COMMONWEALTH OF MA55ACHUSETTS Permit No. Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked ------- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date—la��__-- — To the Inspect r of Wires: Town of NorthThe undersigned applies for a permit to perform the electrical work described helnr,.ro- Location (Street & Number 0 ,1 S __—_—--------------- Owner or Tenant_— 2Y -h r u _&A -k-------------=---------- Owner's Address_—L5 S_ -—='��l/dS2kL!/_li iz�j�� 15----------------------- rmit - Yes No • (Check Appropriate Box) Is this permit in conjunction with a building pe �✓ Purpose of Building_ C�Lye � _—._ ___---Utility Authorization No.—___----- - Existing Service— vv --Amps—__ /o?v rya Voits Overhead • Undgmd • ✓ No. of Meters New Service _ Amps_-- Voits Overhead • Undgmd • No. of Meters . -- -- -- ----- Number of Feeders and Am aci -- -- -- --- Location and Nature of Proposed Electrical Work_ bQ.seme-n INSURANCE COVERAGE. Pursuant to ure requiremen6ts of Massachusetts G ;ral Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = yf have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of 6ovf rage by checking the appropriate box. INSURANCE = BOND - OTHER = (Please (Exoiration Date) Estimated Value of Electrical Work$—_ Work to Start -Aa Signed under the Penalties of perjury: FIRM NAME__--___—__--- Address_ s �.% OWNER'S INSJRANCE WAI EI General Laws: Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... r ...... *Z1 s r(� has permission to perform ........ T f � 5 �. ................ wiring in the building of d%.! f 4 UQ �............................................ .......... ....................... �r�....u...........11".5... ,,Piorth Andover, Mass s..." Fee.................. L>tc. No.............. ............. . G� LEMICAL INSPECTOR Check # t(� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ttm wlr.crlvl VrrrrtL.ln yr 1,3 DEPARTApermit No. �VT OFPUBLICSAFNY - BOARD OF ME PREVEVI70NRE9JL4TIOAN527CMR12.0 Occupancy & Fees Checked APPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 _ ► u (PLEASE PRINT IN INK OR TYPE ALL. INFORMATION) Date ell �I Town of North Andover The undersigned applies for a permit to perform the Location (Street & Number) Owner or Tenant Owner's Address � 5 1 described below. W To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes a No (Check Appropriate Box)%� "rfj �oi0 Z�;`�`L Purpose of Building Utility Authorization 14o. i Existing Service �� Amps Volts OverheadUnderground No. of Meters New Service ,�, Amps/7y _Lj.��fVolts Overhead ED Underground ® No. of Meters Nurn4 of Feeders and Ampacity Location and Nature of Proposed Ele 1, No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No.. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers% Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs -71 No. of Motors Total HP ETHER' nRrd=C6xrdgC' P1II5mtiDt11em4muIIe$dWbzadxB&CtexrALaus ha%eaama tLiaWht',strd=Pcfigtitc uftCat>plde��fmCaaageorils%ibstafiala*,lat YES © NO hawWbmftdvdtidpmdof§mx1otheOE=YES U NO r7 If}cuhaediedWYESspl=mk*tlteWcfw&aWbyd laggr NSURANCE �� BOND Offlm ftweSpadfy) EViidm Dat Estlmod VahredBech2l Wcik $ NakioStatt hispacsialD&Rgxstad RUO Find i�tedunda�iePataltiesofpetjtsy, ' UtMNAAQE %/ c'r;�lCCrv, �: Lioer�eNa :I��'Zs'/) A / )WNER'S MJRANCE WAIVER; I.amawatethattheI ioasedoes not odthetmysig�seonthispatinit mv"' esd ism*Munat. Please check one) Owner a Agent ED Y. `. All. TdNa teit>suame geori i sWtialegu ebtasrgzWbyMmadnsetisCcxMLaws Telephone No. PERMIT FEE $ .111) Date .... � ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION - , — This certifies that,.?,,,. ...... eze -2 ........... . has permission for gas installation ........... in the buildings of ................... at ................ North Andover, Mass. Fee.... c. N0.1.6. V�01 . .... ..'44................... I GASINSPECTOR Ll Check # 3T 0 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 4 ✓1t't>t &IeV"4U►-., Owner's Name New ❑— Renovation ❑ Replacement ❑ Plans Submitted ❑ Permit # Amount $ (Print or type) �- _ one: Certificate Insg Company Name � � �' 1157 3VI !�.(l�� r��ivG- Corp. Address C��l /�difv���'-� ❑ Partner. Rismess Telephone ' - i - —Sc Firm/Co. S Name of Licensed Plumber or Gas Fitter% 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0- No[:] If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 01-- Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all ofthe details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts §I State'Pas Code and C�,happr 142 of the General Laws. .� VED (OFFICE USE ONLY) Signature of l MPlumber ❑ Gas Fitter ❑ Master ❑ Journeyman ,ed Plumber Or Gas Fitter /-r:!:i Icense Number q ��� S-2 ?- - 6 0�,r 13RD. FLOOR (Print or type) �- _ one: Certificate Insg Company Name � � �' 1157 3VI !�.(l�� r��ivG- Corp. Address C��l /�difv���'-� ❑ Partner. Rismess Telephone ' - i - —Sc Firm/Co. S Name of Licensed Plumber or Gas Fitter% 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0- No[:] If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy 01-- Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all ofthe details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts §I State'Pas Code and C�,happr 142 of the General Laws. .� VED (OFFICE USE ONLY) Signature of l MPlumber ❑ Gas Fitter ❑ Master ❑ Journeyman ,ed Plumber Or Gas Fitter /-r:!:i Icense Number q ��� S-2 ?- - 6 0�,r i~ -0 No 4low. NORT►r to O 9 • o •+ 4 ,SSACNUSE� 4-9-C 9 Date. . ,% . r'. /..' ./ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Ll 10 This certifies that-. ....... ..... . ha -permission to perform ..., ...................... . plumbing in the buildings of ..� ......... • ..... • . . at ....... .. , North Andover, Mass. c.o.1 1_ �?``' r , PLI;=1 INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS r L `Date ;2 r Building Location Owners Name ��,f i!V Permit # Amount Type of Occupanct I -- % New Renovation Replacement E] n0s Submitted Yes M No El FIXTURES (Print or type) / Check one: Installing Compan�y�rName �1as �����Cj/�yRL �.�t�ya f�-yG © Corp. Address Z?V 1%,. /LZ9-1) Partner -/-G &yfi 5 V -o' "/I Business Telephone qJ 17 T L- fj y Lj Firm/Co. Name of.Licensed Plumber , Insurance Coverage: Indicate the type of insu ce coverage by checking the appropriate box: Liability insurance policy E�— Other type of indemnity M Bond F] Certificate 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 x rgnature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse�ts�State qumbing Code and Chapter 1� of the General Laws. --- -_.._ APPROVED (OFFICE USE ONLY Type of Plumbint License icense um er Master Journeyman o 3c / ' 5 4 Date ...... 0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that............................�<..I.............................................�v .........::........ has permission to perform .....A . U 1....... f d< 1. P ................................ wiring in the building of .. r-�.��.�7 '!+'> rZ. �! J�?..� .4 ................... ................ North Andover Massc Fee.: ..7`i.p� Lic.No ' �� .....,.....v' .7 ...�...... LECTRICALINSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DBPAK1NP,7VTUFFUBLICS4FEIY 11 Permit No. BOARD OFFIREPREVEWONREGMTIOAN 527CMR I2.0 ' Occupancy & Fees Checked APPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL. INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant (Zjfh"1l Ahl t Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) JZ0f Purpose of Building Utility Authorization No. j Existing Service Amps�Volts Overhead a Underground No. of Meters 1 New Service '20d Amps /2 / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work' �?YM No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA j to No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond.Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total. No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers , Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Othrr Connections No. of Water Heaters KW I No. of No. of No. Hydro Massage Tubs -401FHER Motors Total HP 4h wartoeQmmp L'�asua>rbtheteq�anatEs�G Iha%eaamatLi bkyku==P bitye lxkgCotTide Co Iha%esubmi&dvaWpa fofseme1otlte0 i= YES U. ILIO j aPP� bCDL L M[JRA1 a BOT0 WH R WadciD&vt Sigrxduttda$ieFtmkitsafpjtffy. FIRMNANE .._... htgtectimD*RegtoW zo C signalute. A��='� OW ,4M'SII4URANCEWANFR; I.atnaw=lhattheliflasedm not andd, tmysignattseonthispatr1kTpliCM-Mwaitiesthistec�metnalt (Please check one) Owner a Agent and afmat YES [::f NO M Ifywhawdxcki dYFS,plme dc*thetypeofao r,Wbydnkigt o (Spm') � D,*. F9i<t *dVahtedMmftk9 Wdk $ Ratgh Final . I�oatsae ��11 1j=W1,o BtsimTdTsh �a , — AkTe1.Na Telephone No. PERMIT FEE $ Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 .1 �o�r rh O O 'Q� COL NI[NLwKR _ 7' APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER /D ` S SUBDIVISION ! yG 1S c DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING ONSERVATION C DATE / PLANNING '� DATE D.P.W. — W R ME DATE �l ��� Ci D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED TO THE INSPECTION A � ST DATE. / DPW AUfMRIZATION N2 3 5 Date.. .. ../ .. ........... 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING w� This certifies that ......... J'/) -J ........ ( .......... ....................................... has permission to perform ...................................... ...................................... AIR wiring in the building of .............U..... ...�..................................................... ................... North Andover,,,Mass. * 7 Fee., , ................ Lic. No.. . .................... ............................. ............................ . ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use ally Permit No. Occupancy and Fee Checked [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 MR 1 00 (PL,E4SE PRINT ININK 0R TY AL ARi�L4T10N) Date: RV City or Town ofif To the Inspector Lff WYir : By this application the undersigns"ives n(Jice of is or her intention to perform the electrical work described below. Location (Street & N Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ED,.- (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: ni-�r Nam } t Completion o the following table nrav be waived by the Inspector of Wires No. of Recessed Fixtures No. of Ceii.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o merbency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices b No. of Waste Disposers Heat Pump Number -........- Tons .......................................... KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Nlunicipal [I Other Connection No. of Dryers ers Heating Altl)liances KW No. of*Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, a• as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the perfonnance 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 c\hibited proof of same to the pertnit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: 5-S A *— (When required by municipal policy.) Work to Start: &WITInspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the gins and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ADT Security Services 111 Morse Street, Not-o(W, MA W062 LIC. NO.: 1533C Licensee: John S. Bassett Signatu sd ° d "SIC. NO.: 1533C 6fapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-278-1131 Address: Alt. Tel. No.:781-278781-278-1725 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 atm the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PEIt'1ti1IT FEE: $