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Home My WebLink AboutMiscellaneous - Exception (192)bI A clt(leas t' P <3i1iters Ii)c >s'poratkd 3.. 17 E:l treat �To+ Robert Nicetta Town of North Andover 27 Charles Street w'iA 01944 North Andover, MA 01845 978 526 8375 ( FAX No: 978-688-9542 Date: July 15, 2004 Project No: 2 0 3 6 Project Name: BrookSchool Hou s TEL No: 978-688-9531 Item No. of copies Latest Date Architect'sField Report, Brooks 'School Observatory Hill Houses A and B 1/ea. 8Jul04 Notes Copies to: John Trovage Brooks School 1160 Great Pond Road North Andover, MA 01845 Brett Murphy Murphy Construction Co.Inc. P. 0. Box 1510 Newburyport, MA 01950 Sent via: O Mail O Fax, No. pages (total): For your: O Review O Distribution O Express O O Record O Information O Messenger O Approval O 0 August 2W301...lnvlsDidi&Dokt,,Anhitu—d Plannminroryurctrd mm Id—h— If enclosures are not as noted, please inform us immediately. Confirmation requested: O Yes O No Extra Copies Given to: By: Peter Miner Architect's Field Report FIELD REPORT N°: 20363A-003 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: July 7, 2004: 1 PM PROJECT: HOUSE A ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: ARCH'S PROJ. NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: WORK IN PROGRESS: #715 20363 BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Overcast 65-70°F Clear Foundations: 85% Demolition: 0% Rough Carpentry: 0% Doors/Frames/Hdwe: 0% Windows: 0% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 0% Masonry: 0% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 0% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% • Foundation has been back filled. • Exterior footing drainage is in place. • Bulkhead and pre -cast steps have been installed • Wire mesh and vapor barrier is in place ready to pour floor slab. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 Architect's Field Report FIELD REPORT N°: 20363B-003 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: July 8, 2004: 1:00 PM PROJECT: HOUSE B ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 01845 PERMIT NO: ARCH'S PROD. NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: WORK IN PROGRESS: #716 20363 BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Overcast 65-70°F Clear Foundations: 85% Demolition: 0% Rough Carpentry: 0% Doors/Frames/Hdwe: 0% Windows: 0% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 0% Masonry: 0% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 0% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% • Foundation has been back filled. • Exterior footing drainage is in place. • Bulkhead and pre -cast steps have been installed • Wire mesh and vapor barrier is in place ready to pour floor slab. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 '�rs•r� r �:fir+:��it��ta <' 1'�anr��tr= Inii)r�3��r�t,-ti EI;,1 tr�,,,t To: Robert Nicetta M,wdwLcr Town of North Andover 27 Charles Street lL.\ IIN Q44; North Andover, QY8 .^6 $ 3 ; !. FAX No: 978-688-9542 Transmittal Date: July 19, 2004 Project No: 2 0 3 6 3 MA 01845 Project Name: Brooks School Houses TEL No: 978-688-9531 Item No. of copies Latest Date Architect's Field Report, Brooks School Observatory Hill Houses A and B 1/ea. 16Ju104 Notes Copies to: John Trovage Brooks School 1160 Great Pond Road North Andover, MA 01845 Brett Murphy Murphy Construction Co.Inc. P. 0. Box 1510 Newburyport, MA 01950 Sent via: O Mail O Fax, No. pages (total): O Express O O. Messenger If enclosures are not as noted, please inform us immediately. Confirmation requested: O Yes O No Extra Copies Given to: By: Peter Miner For your: O Review O Distribution O Record O Information O Approval O OA.,.#ZaA30lunlswis Dielib DeNm ArthRerb.el Pbuen l�rmpentN urow U—k - Architect's Field Report FIELD REPORT N°: 20363A-004 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: July 16, 2004: 8 AM PROJECT: HOUSE A ON OBSERVATORY HELL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: #715 ARCH'S PROD. No: 20363 OWNER: BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 PRESENT: Peter Miner, Olson Lewis Dioli & Doktor Architects WEATHER: Overcast 70-75°F Clear EST. % Foundations: 95% Structural Steel: 0% COMPLETION: Demolition: 0% Finishes: 0% Rough Carpentry: 5% Painting: 0% Doors/Frames/Hdwe:0% HVAC: 0% Windows: 0% Plumbing: 0% Gypsum Wallboard: 0% Electrical: 0% Mill and Casework: 0% Fire Protection 0% Roofing: 0% Specialties: 0% Masonry: 0% Finish Carpentry: 0% WORK IN PROGRESS: • Basement floor slab has been poured • First floor deck framing was underway. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 Architect's Field Report FIELD REPORT N°: 20363B-004 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: July 16, 2004: 8:00 AM PROJECT: HOUSE B ON OBSERVATORY HILL BROOKSSCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: #716 ARCH'S PRoJ. No: 20363 OWNER: BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 0184 PRESENT: Peter Miner, Olson Lewis Dioli & Doktor Architects WEATHER: Overcast 70-75°F Clear EST. % Foundations: 95% Structural Steel: 0% COMPLETION: Demolition: 0% Finishes: 0% Rough Carpentry: 0% Painting: 0% Doors/Frames/Hdwe:0% HVAC: 0% Windows: 0% Plumbing: 0% Gypsum Wallboard: 0% Electrical: 0% Mill and Casework: 0% Fire Protection 0% Roofing: 0% Specialties: 0% Masonry: 0% Finish Carpentry: 0% WORK IN PROGRESS: • Floor slab has been poured. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page I of 1 011Z011 .t, ow t 1..),.�, I t & I.io Llo r 7Jlr Y`"F+-' i�ri97ftc i`t:� �� 1��A1117 P1"r �111iE)1: 17 �.'Y t71.i(� I:Im .-�trcet 01 044 a7 ^(, 4 366 P To: Robert Nicetta Town of North Andover 27 Charles Street North Andover, MA 01845 FAX No: 978-688-9542 Transmittal Date: July 26, 2004 Project No: 2 0 3 6 3 Project Name: Brooks School Houses TEL No: 978-688-9531 Itan No. of copies Latest Date Architects Field Report, Brooks School Observatory Hill Houses A and H 1/ea. 26Ju104 Notes Copies to: John Trovage Brooks School 1160 Great Pond Road North Andover, MA 01845 Brett Murphy Murphy Construction Co.Inc. P. 0. Bos 1510 Newburyport, MA 01950 Sent via: O Mail O Fax, No. pages (total): For your: O Review O Distribution O Express O O Record O Information O Messenger O Approval O OA.,.tt 31W vwm..W.th- If enclosures are not as noted, please inform us immediately. RECEIVED Confirmation requested: O Yes O No Extra Copies Given to: By: Peter Miner JUL 2 8 2004 BUILDING DEPT. Architect's Field Report FIELD REPORT N°: 20363A-005 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: July 26, 2004: 8 AM PROJECT: HOUSE A ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: #715 ARCH'S PRoJ. No: 20363 OWNER: BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 PRESENT: Peter Miner, Olson Lewis Dioli & Doktor Architects WEATHER: Overcast 70-75T Clear EST. % Foundations: 95% Structural Steel: 0% COMPLETION: Demolition: 0% Finishes: 0% Rough Carpentry: 25% Painting: 0% Doors/Frames/Hdwe:0% HVAC: 0% Windows: 0% Plumbing: 0% Gypsum Wallboard: 0% Electrical: 0% Mill and Casework: 0% Fire Protection 0% Roofing: 0% Specialties: 0% Masonry: 0% Finish Carpentry: 0% WORK IN PROGRESS: • Second floor deck framing was underway. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 Architect's Field Report FIELD REPORT N°: 20363B-005 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: July 26, 2004: 9:00 AM PROJECT: HOUSE B ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: #716 ARCH'S PROD. No: 20363 OWNER: BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 PRESENT: Peter Miner, Olson Lewis Dioli & Doktor Architects WEATHER: Overcast 70-75°F Clear EST. % Foundations: 95% Structural Steel: 0% COMPLETION: Demolition: 0% Finishes: 0% Rough Carpentry: 5% Painting: 0% Doors/Frames/Hdwe:0% HVAC: 0% Windows: 0% Plumbing: 0% Gypsum Wallboard: 0% Electrical: 0% Mill and Casework: 0% Fire Protection 0% Roofing: 0% Specialties: 0% Masonry: 0% Finish Carpentry: 0% WORK IN PROGRESS: • First floor framing is complete. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 Item No. of copies Latest Date Architect's Fi13 Report, Brooks chool 1/ea. 18Aug04 Observatory Hi 1 ouses A and'''B 4 Transmittal Notes Copies to: John Trovage Brooks School 1160 Great Pond Road, North •/ Brett 1 I 1:€111 `street To: Robert Nicetta Date: August 20, 2004 Box 1510 Town of North Andover. 27 Charles Street Project No: 20363 IA 01.944 North Andover, MA 01845 Project Name: Brooks School Houses g7$�,5236-1"a8(,13 972 5'26 9375 ( FAX No: 978-688-9542 TEL No: 978-688-9531 Item No. of copies Latest Date Architect's Fi13 Report, Brooks chool 1/ea. 18Aug04 Observatory Hi 1 ouses A and'''B Sent via: O Mail O Fax, No. pages (total): For your: O Review O Distribution O Express O O Record O Information O Messenger, O Approval O OA.V,t 2W3 Olsan I<wis Ui.li 6 U.ktarArchltrrYs and Planners lnroryoratrd tuww..Id.rrh.rom If enclosures are not as noted, please inform us immediately, RECEIVED. Confirmation requested:. O Yes O No Extra Copies Given to: By: Peter Miner AUG . 2 5 2004 BUILDING DEPT. Notes Copies to: John Trovage Brooks School 1160 Great Pond Road, North Andover, MA 01845 Brett Murphy Murphy Construction Co.Inc. P. 0. Box 1510 Newburyport, MA 01950 Sent via: O Mail O Fax, No. pages (total): For your: O Review O Distribution O Express O O Record O Information O Messenger, O Approval O OA.V,t 2W3 Olsan I<wis Ui.li 6 U.ktarArchltrrYs and Planners lnroryoratrd tuww..Id.rrh.rom If enclosures are not as noted, please inform us immediately, RECEIVED. Confirmation requested:. O Yes O No Extra Copies Given to: By: Peter Miner AUG . 2 5 2004 BUILDING DEPT. Architect's Field Report FIELD REPORT N°: 20363A-007 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: August 18, 2004: 4:30 PM PROJECT: HOUSE A ON OBSERVATORY HELL BROOKSSCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 01845 PERMIT NO: ARCH'S PROJ. NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: #715 20363 BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Slight Overcast 75-80°F Foundations: 95% Demolition: 0% Rough Carpentry: 60% Doors/Frames/Hdwe: 0% Windows: 50% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 80% Masonry: 0% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 5% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% WORK IN PROGRESS: • Roof is 80% complete. • Windows and some exterior doors installed • Exterior siding has been stated. • Duct work has been started • Masonry for fireplace and chimney 70% complete. • Interior partitions framed. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 x Architect's Field Report FIELD REPORT N°: 20363B-007 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: PROJECT: PERMIT NO: ARCH'S PROJ• NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: WORK IN PROGRESS: August 18, 2004: 4:30 PM HOUSE B ON OBSERVATORY HILL BROOKSSCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 #716 20363 BROOKSSCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Slight Overcast 75-80°F Foundations: 95% Demolition: 0% Rough Carpentry: 30% Doors/Frames/Hdwe: 0% Windows: 0% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 0% Masonry: 0% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 0% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% • Framing has reached the second deck, with both major gables in place. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of i 01S011 LcWt I)lttil(.>(t1rtl)1" C` f% 1'�anne>r- lncott>nl°71cci I'i F,Im .qtr t To: Robert Nicetta �i<tlti �i. =ti r Town of North Andover 27 Charles Street i?1944 North Andover, MA 01845 520 4 3$0 P 9/8 � 12 6 `3 '5 ( FAX No: 978-688-9542 Date: August 4, 2004 Project No: 2 0 3 6 3 Project Name: Brooks School Houses TEL No: 978-688-9531 Item No. of copies Latest Date Architect's Field Report, Brooks School Observatory Hill Houses A and B 1/ea. 3AugO4 Notes Copies to: John Trovage Brooks School 1160 Great Pond Road North Andover, MA 01845 Brett Murphy Murphy Construction Co.Inc. P. 0. Box 1510 Newburyport, MA 01950 Sent via: O Mail O Fax, No. pages (total): O Express O O Messenger If enclosures are not as noted, please inform us immediately. Confirmation requested: O Yes O No Extra Copies Given to: By: Peter Miner RECEIVED AUG 0 9 2004 BUILDING DEPT. For your: O Review O Distribution O Record O Information O Approval O — OA.,ntMW Ot..elnub Dt.H&D ktwAmhitedsd"Pl ewnlwwpwteA mwu..Wrthr Architect's Field Report FIELD REPORT N°: 20363A-006 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: August 3, 2004: 8:30 AM PROJECT: HOUSE A ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: #715 ARCH'S PROD. No: 20363 OWNER: BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 PRESENT: Peter Miner, Olson Lewis Dioli & Doktor Architects WEATHER: Slight Overcast 75-80°F EST. % Foundations: 95% COMPLETION: Demolition: 0% Rough Carpentry: 50% Doors/Frames/Hdwe: 0% Windows: 0% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 0% Masonry: 0% WORK IN PROGRESS: • Exterior walls and roof framing in place • Some interior partitions framed • Roofing proceeding. Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 0% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 Architect's Field Report FIELD REPORT N°: 20363B-006 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: August 3, 2004: 9:00 AM PROJECT: HOUSE B ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT No: #716 ARCH'S PRoi. No: 20363 OWNER: BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 PRESENT: Peter Miner, Olson Lewis Dioli & Doktor Architects WEATHER: Slight Overcast 75-80T EST. % Foundations: 95% Structural Steel: 0% COMPLETION: Demolition: 0% Finishes: 0% Rough Carpentry: 10% Painting: 0% Doors/Frames/Hdwe:0% HVAC: 0% Windows: 0% Plumbing: 0% Gypsum Wallboard: 0% Electrical: 0% Mill and Casework: 0% Fire Protection 0% Roofing: 0% Specialties: 0% Masonry: 0% Finish Carpentry: 0% WORK IN PROGRESS: • No additional work on this house over the last week. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 F] Location 1%40 No. �%l.5� Date �oRTh TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ *ArgoE<�' Building/Frame Permit Fee $ 'I CNUs Foundation Permit Fee $ fJ Other Permit Fee $ TOTAL $ "6 Check # 414�* 1�P 17347 �' ^ -Building InspE(G(Or • _< tnm o P@® r� �. N �• A y V- m QZ z y b _ • � .rt p UI :r 13 1 0 N d - L 3 > CL > A m = O rt m c3 a C a 02 � m m S � c a 2 tn 0; It W C ,.r p O y E 5 o rr Fn' N M a, ? as a y E PL 5r 3 • � b r� c � N � y 7 O� z y b Z -4- d - L i 0, -43, C p .p p o C moo � 0 p M 0 0 Mcr M, m H O m a 3• c� m 17 (D tD � 90� m a• m� am m o� om� y1 a SAM 30 m Z *. ,••ate �' � O 44 i LA c � N 7 v 6, Z -4- d - L i s S Z � S S � ca C ►aG �L 0 N aM M M =M 3 7 0) ° o' n, ., n p 7 Vf fD CD° -A 0.-0 _., _ a �Q d o _r . 0 iD H o M , o 3. m a� . 3 o o� ° cr a o'J d M D. 0 M ®a �M�'��. it o ?� 9.1" ' M� foam lr -o Z r� �M o i�wo 'A n a V� o Z 0, rt r, -6 _ • = U f� N f� O V a M j O O W C CL � M M c c tn a« C rr O N E : o cr M� a, ? aj a N E 'O cD M -� 0 rt N aM M M =M 3 7 0) ° o' n, ., n p 7 Vf fD CD° -A 0.-0 _., _ a �Q d o _r . 0 iD H o M , o 3. m a� . 3 o o� ° cr a o'J d M D. 0 M ®a �M�'��. it o ?� 9.1" ' M� foam lr -o Z r� r i• Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code RES check Software Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\MURPHY-A.rck PROJECT TITLE: MURPHY CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW /WALL RATIO: 0.22 DATE: 06/24/04 DATE OF PLANS: 05/29/04 PROJECT DESCRIPTION: BROOKS SCHOOL HOUSE A COMPLIANCE: Passes Maximum UA = 363 Your Home UA = 317 12.7% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value -F or UA Ceiling 1: Flat Ceiling or Scissor Truss 1086 30.0 0.0 38 Wall 1: Wood Frame, 16" o.c. 1831 19.0 0.0 82 Window 1: Wood Frame:Double Pane with Low -E 397 0.350 139 Door 1: Solid 60 0.360 22 Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 1086 30.0 0.0 36 Furnace 1: Forced Hot Air, 92 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 Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MECchec,� and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer - Date REScheck Inspection Checklist Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 DATE: 06/24/04 PROJECT TITLE: MURPHY Bldg. Dept. Use Ceilings: I. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation Comments: Windows: 1. Window 1: Wood Frame:Double Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door 1: Solid, U -factor: 0.360 Comments: Floors: 1. Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Heating and Cooling Equipment: 1. Furnace 1: Forced Hot Air, 92 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 cfin (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. i Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table MAT 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. Heating and Cooling Equipment Sizing: L ) I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and MA Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ) All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 OF or chilled fluids below 55 T must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by PiP�e Sizes Piping Systemy etc Range ( F1 2" Runouts T' and Less 1.25" to 2"52. , to 4„ Heating Systems Low Pressure/Temperature 201-250 Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runouts Circulating Mains and Runouts Temperature ( Fl lip to V Up to 1,25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by PiP�e Sizes Piping Systemy etc Range ( F1 2" Runouts T' and Less 1.25" to 2"52. , to 4„ Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 715 Date: December 30, 2004 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1160 Great Pond Road House A MAY BE OCCUPIED AS Single Family Dwelling 2150 s.f. 2 car attached garage IN ACCORDANCE WITH THE PROVISIONS. OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Brooks School 1160 Great Pond Road North Andover MA 01845 f4 Tdwn of North Andover Building Department 400 Osgood Street North Andover MA 01845 978-688-9545 Fax 978-688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: '�)CboL <, Sc-Anoo` A/C -o G_se� �o►� R cel © � � e,s 17 -a? Oq DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: ` /' ��' os, - FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK ANDSIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARD $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Signature OFFICIAL USE ONLY ROUTING D.P.W. - WATER METER t 1A DATE 12- 3-Dd, D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. 7. SIGNATURE/W AUTHORIZATION APPLICATION CERTIFICATO OF OCCUPANCY revised 11. 15.2004 iA v Location 6 G. t'oti No. rl f Date (9` —(1-011( TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ s'•^' • It Building/Frame Permit Fee $ /1CHu5 Foundation Permit Fee $ Other Permit Fee rrrr p4(4- $ r7, TOTAL $Q Check # 7536 MA�-- `� Building Inspector BROOKS SCHOOL OBSERVATORY HILL HOUSE A Town of North Andover Office of the Building Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner CHIMNEY APPLICATION AND PERMIT Telephone (978) 688-9545 Fax (978) 688-9542 DATE L 01qPERMIT # � /5� LOCATION i0 S(!"eCk ?C'+r�C)l t2 c, . OWNER'S NAME t`00 BUILDER'S NA MASON'S NAME MASON'S ADDRESS C C � A Cr C_ % S1. (© c,J /-,- MASON'S TELEPHONE 91f 1 a4 l MATERIAL OF CHIMNEYi REScheek Compliance Certificate Massachusetts Energy Code RES check Software Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\MURPHY-A.rck PROJECT TITLE: MURPHY CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW / WALL RATIO: 0.22 DATE: 06/24/04 DATE OF PLANS: 05/29/04 PROJECT DESCRIPTION: BROOKSSCHOOL HOUSE A COMPLIANCE: Passes Maximum UA = 363 Your Home UA = 317 12.7% Better Than Code (UA) Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R, -Value R -Value U -Factor VA Ceiling 1: Flat Ceiling or Scissor Truss 1086 30.0 0.0 38 Wall 1: Wood Frame, 16" o.c. 1831 19.0 0.0 82 Window 1: Wood Frame:Double Pane with Low -E 397 0.350 139 Door 1: Solid 60 0.360 22 Floor L All -Wood Joist/Truss:Over Unconditioned Space 1086 30.0 0.0 36 Furnace 1: Forced Hot Air, 92 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 Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MEC chec.� and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date i REScheck Inspection Checklist Massachusetts Energy Code RES check Software Version 3.6 Release 1 DATE: 06/24/04 PROJECT TITLE: MURPHY Bldg. Dept. Use Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o. c., R-19.0 cavity insulation Comments: Windows: 1. Window 1: Wood Frame:Double Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door 1: Solid, U -factor: 0.360 Comments: Floors: 1. Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Heating and Cooling Equipment: 1. - Furnace 1: Forced Hot Air, 92 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 cfin (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: Ducts shall be insulated per Table J4.4.7.1 Duct Construction: [ ] I 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. [ ] I The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] I 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. Heating and Cooling Equipment Sizing: [ J I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I 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. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 T must be insulated to the I levels in Table 2. Table I: Minimum Insulation Thickness for Circulating Hot Water Pipes. Heated Water Temperature Up to 1„ Up to 1.25„ 1.5" to 2.0" Over 2„ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pine Sizes Piping System Types Heating Systems Range ( El 2" Runouts VandLess 1.25" to 2" 2.5" to 4„ Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) y 0, Location //(a iJ 7/ � t ��i4'' Date 7//z--/,6/-oL, No. / Nom,. TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ '� s'"�•°' Eta Building/Frame Permit Fee $ bb ^ ACMUS Foundation Permit Fee $ Other Permit Fee $ 3 060 v TOTAL $ Check # Qa'�-'73 A/ftv�u�rP•�.�T BIW/ - 17439 Building'Ivs—pector BROOKS SCHOOL OBSERVATORY HILL HOUSE A TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. 7/5' DATE ISSUED:h A h SIGNATURE: Building Commissioner/Inspector of Buildings SECTION 1- SITE INFORMATION t 1.1 Property Address: 1.2 A WOO1 Map Number • 1.3 Zoning Information: 1.4 Pi 174 Zoning Distrid Proposed Use 1.6 BUILDING SETBACKS ft Lot Areas ' N� �� () ( Front Yard Side Yard R !red Provide Required Provid �eq 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public Private ❑ Zone Outside Flood Zone I / SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ?Alp\�4s �,C\A l l ob �19,R-N7ybmb \4�� Name (Print) Address for Service : Signature Z©1�N 'T z6VPtC-AE Telephone 2.2 Owner of Record: �� 3�� f�� S�y!►�� A5 Name rint Address for Service: lie Si ature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ::y tN `M Licensed Construction Supervisor: License Number 0`C3\ Address Expiration Date ign re Telephone LjbA4^J 3.2 1256gistered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone O z M 1Jo 0_606a c� s 7 1 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) 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 buildng permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: p SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant , , ` „QFFICIAL z ,._. JSE i�3NLY . . 1. Building 00 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of ConstructionO OD I 3 Plumbin Building Pe t fee tel X tb) `4 nN: 10 tio O aq,. 00 5 43 7 o -x� Mechanical HVAC 5 Fire Protection , 6 Total 1+2+3+4+5 Check NumbeZ� SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Q " ` '� + ''' 0 V-11 i C_ as caner/Authorized Agent of subject property Hereby authorize Imo( U CZ P 6-I Y k -S (R_() 0 —110 AlJ to act on My beha , m a m —reTative to work authorized by this building permit application. 12 Si a of er Date l SECTIOtlb OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE V Lmk BASEMENT OR SLAB n SIZE OF FLOOR TIMBERS 1&1 01 )t l T -T 2 ND Q X 1 3 SPAN - 14'-k6' o0c* ac�'_Vf DINIENSIONS OF SILLS - ZX DIN ENSIONS OF POSTS ► �' DIMENSIONS OF GIRDERS - \ 1} X F `Ly L HEIGHT OF FOUNDATION ' THICKNESS ' SIZE OF FOOTING " X " MATERIAL OF CHIMNEYV-- IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE AK BROOKS SCHOOL OBSERVATORY HILL HOUSE A TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING fz; ' ,i•,q{�',?n 5 S K t t ....x.,. C4 BUILDING PERMIT NUMBER: 71S' DATE ISSUED. SIGNATURE: S Z Building Commissioner/Inspector of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ByIbNNIS Up a `1 1 p g� N t. Map Number Parcel Number SWIS 11 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (so Frontage ft 1.6 BIJU DING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Simply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private p Zone Outside Flood Zone Municipal 1� On Site Disposal System 0 s � nvtv�ll• mJlJlfiVl. C.. VV SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record aw�s Name (Print) Address for Service Q1 %- -1 Signature Telephone 2.2 Owner of Record: r�� a"Pe jes .SCS°/Mo(- A5 ll 6 O 6 Woo Name rint Address for Service: Si gature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number;4 � P\OGa �� ( Address bs — k \c) /� O �•t��t Expiration Date /SignAlre Telephone 3.2t;gtstered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone O Z M 00 O M r rM 0 Z a ,q,D Qr�afior6 s 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 buildng permit. Signed affidavit Attached Yes ....... Mr No ....... ❑ SECTION 5 Description of Proposed Work check au a Ucable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant g bI�F`, C -L USE"ONLY ' u 1. Building o D Q (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction QC7 3 Plumbing Building Pe t fee (a) X (b) I` n ti: *Q& a d .. C o ' . =494 -1�� to 4 . 00 19) �( r� , DD -7' a o 4 Mechanical HVAC 5 Fire Protection i, ;� 2C\ Ga, 6 Total 1+2+3+4+5 Check Numbe SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, U k "1 `� a v/11 (t_ a caner/Authorized Agent of subject property Hereby authorize M U IL P tl Y Cd°�-S i TZ -U C -1-10 A% to act on My beha ; m a m re ive to work authorized by this building permit application. — pplicatio.- 1 j 2SL- Si a of VAner Date SECTIO b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE 1t+ t�\� BASEMENT OR SLAB "(� SIZE OF FLOOR T HERS 1 k 1) T'T 2 NDX 3 RD SPAN 14'- 1 DINIENSIONS OF SILLS - ZX DINIENSIONS OF POSTS DINIENSIONS OF GIRDERS _ 4 X q o HEIGHT OF FOUNDATION ° THICKNESS ' SIZE OF FOOTING I " X{ ' MATERIAL OF CHEVINEY 191. IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A� FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is usedto verify that all -necessary approval /permits from Boards and Departnients having jurisdiction have been obtained. This does not relieve the applicant and' or landowner from compliance with any applicable requirements. a a a a a 0 IF WE 8 0 a 0 a R.Wa a wo an a as WE a a 0 a a 0 a a a a E. 0 a a 0 a 0 a a 0 0 WS.R *.a , a W a a a a a a a 0 a a 0 ....... now APPLICANT —PHONE a ASSESSORS MAP NUMBER V. LOT NUMBER SUBDIVISION -LOT NUMBER .STREET & C2_0 A 7—STREET NUMBER 0 a an as a wow&= now owns offaw a a warm _Nwx man OFFICL4L us, ONILY In 10* WE an a a an as a a, sawn's a M� a WE ass a Ws a ass Wwwn a as a a a a a a am as a a's Mass a WW a a a a W'.0 a aWWW, REC0>flAEND, ATIONS OF TOWN AGENTS $11119110 31016.11,21 A's 0, 11.04 SEE a W.Mosemmon,son a 0 a noal&mnanwnn man no Y 7, t, DATE APPROVEDpq ' COINSERVATIONADMIN17011OR DATE REJECTED COMMENTS IM ]DATE REJECTED , PUBLIC WORKS - SEWER NNECTIONS WATER _7 2 AY PERNUT 6, D K(A C WZe1-S /A IT -4 DATE AWROVEI TIREDtW_R!r DATE REJECTED CONMENTS r DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED g" DATE APPROVED SEPTIC INSPECTOR - HEALTH Z5 DATE REJECTED N-1 COMMENTS 4 _Wd , PUBLIC WORKS - SEWER NNECTIONS WATER _7 2 AY PERNUT 6, D K(A C WZe1-S /A IT -4 DATE AWROVEI TIREDtW_R!r DATE REJECTED PER RECEIVED BY BUILDING INSPECTOR g" Z5 N-1 _Wd PER BROOKS SCHOOL OBSERVATORY HILL The Commonwealth of Massachusetts HOUSE A Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Companyname: G-`lwL- Address ©• `i o X k S to i1 -l6-4S-o3&1 Insurance Co. .�t4 Q> Policy # MUvyc S t l & Company name: Address Citi Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as -wellas_civil.,penattiesin-theformDf-a STOP WORK.ORDER_and_a.fine.of.(.$1D.0.00)_a�day.againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the !✓ Print name and penalties of perjury that the information provided above is true and correct. s al s=o4- # `y7 ' -c-1-UV Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept [-]Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other AGORD' CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MM/°°/YYYY, MLWH-2 02/24/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Landmark Insurance Agency Inc:. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198, Massachusetts: Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845=.4190 Phone: 978-688-8829',' Fax:978-975-3987 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Worcester Insurance - Co. 26182 INSURER 6. Huron Insurance Company Murphy Construction Co:, Inc INSURER C: Guard Insurance Group P.O. Box 1510 INSURER Di. Newburyport'.'MA'01950 INSURER E: COVERAGESw. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDlY IRATION DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 $ X COMMERCIAL GENERAL LIABILITY CB6E0347..r .: 01/19/04 01/19/05 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE. a OCCUR MED EXP (Any one person) $5000 X Business Owners 01/19/04 01/19/05 PERSONAL &ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATE LIMIT APPLIES PER: . PRODUCTS-COMPIOPAGG $ 2000000 ; . POLICY JECTT LOC B AUTOMOBILE LIABILITY ANY AUTO BMA8931322* 01/19/04 01/19/05 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) BODILY INJURY (Per person) $ X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ ANY AUTO EXCESSNMBRELLALIABILITY EACH OCCURRENCE $ 1000000 A X OCCUR El CLAIMS MADE BE6EO347 : 01/19/04 01/19/05 AGGREGATE $ 1000000 $ $ DEDUCTIBLE $ X RETENTION $ O WORKERS COMPENSATION AND TORY LIMITATUS ER C EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE .:. MUWC511468 01/19/04 01/19/05 E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE- EA EMPLOYE $ 1000000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below El: DISEASE -POLICY LIMIT $ 1000000 OTHER DESGKIPr IUN OF UI'LKA I IUNS I LWAI IUNJ I VCKIULC.J I cA%,LU.IIUNJ lauucu or r-NUvrtQoecN I I JrCMwL rRvvrarvlva 7 Op CERTIFICATE HOLDER CANCELLATION BROOKS5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Brooks Academy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn .: James Pug, BuSln@SS Mgr IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1160 Great Pond Road North Andover MA 01845 REPRESENTATIVES. AUTF RESENTA E -17 i n (2001/08) CORPORATION 1 BROOKS SCHOOL OBSERVATORY HILL HOUSE A North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number q 1.S is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: '�� c�.N•� p S l �n S � � �} �,� 2 �tPt�i �� R� e r� 1 (Location of Facility) Signature of Kermit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector o�.No!TM �h it �.�.. ^.• ooc �ss�a+nsE4 PROJECT NUMBER PROJECT E2 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL. L-t— BROOKS SCHOOL OBSERVATORY HILL HOUSE A PROJECT LOCATION: �C7�.�DI `S ��kiOdl--� P�+� NAME OF BUILDING:0U NATURE OF PROJECT: Go /.(ST/L J Gi1A v of NfAA) W °60 Dw�Lt, �htb W/ !M(TALcac'D �� IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE' BUILDING CODE, - I, jo41►3 -r d LSO&A REGISTRATION NO. ;blip 1 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS. AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT'o ARCHITECTURAL' STRUCTURAL MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,.TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,; ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B_.' PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT E WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review; for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures,for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING I5" UPON COMPLETION OF THE WORK, 1 SHALL SUBMIT A FINAL REPORT AS TO SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCU SUBSCRIBED AND SWORM TO BEFORE ME THIS DAY OF NOTARY PUBLIC MY COMMISSION !EXPIRES I. 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(C) "PigH PM 9N3 (0 – — – — – — – — – — – 40 V Irdi s}}asngessey�'xanOPUV WON Ina vooz'vI :aJe „o -,I = a/t s9Eoz NOISIA92I :unsex :a}eQ :ateaS :ON qo[ NOLidIHJ59Q 9.I.da ON altunsae} 5LE8 9ZS (8L6) 98Ei 4Z5 (8L6) puod }sax pgtit L v t66tOt�NI'eaSaq}-fq-xa}saqDueyQ}aax}SI3Lt — asnOHTTiHt�iO}L'tLIaSClO Nb��ei�1111�IQ1��vl� (T1 •ouI'siauuetd pue spa}tuaxV Slav G1001.J xo}xoQ 19IIoIQ stinal uostO ^ p.- " jQoti�s SiIOoig m 8 T mO E Q m v y D1 O m $ 6 a E o m m m E N N m Ni m _Tp6 6 o �d m a m 9 E m m rl cn m m m y N v m w —! �m 0 n a o � r* s � W 10 i1 cc O• EP �m� Oft a� 114Wm �- ao U3 nm 0. ctn naj c O E m F U3 ai w a nE m a? 0 c r« • F a 0 5 O z 0 00 0 0 CLw 0 N 0 CL N 3" N 3 =iD? y m N a(D 0 (D m roc 3 Oo CD 0-. ° _ n cr o� — 0d CD oo m o 0 � o �r CL 0 o �• .d c� a o !R Z 0CL o dna N �� 0,• • CD CL z H G z a z 0 MI L Location b No. 7/(4 Date o- a of ,.ORTM TOWN OF NORTH ANDOVER OL 9 r Certificate of Occupancy $ 1 /d �� s'••° 5 ��' Building/Frame Permit Fee $ %tl %5Cr ACMU Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $� Check # k,943 r� 1734.E ``Building Inspedr m � � o n a m �* o raj� m it cc o W m 3 m 3 :cr O. o Un m m CL cN nry al.C @ O E T CL m E a? 0 c rt e Ol Z oma�, 7 . p?i m CtD y N ? N p, ( m 0 c 3. m 7 m c A -, tD o CD A. y 0 .0 �, O = C aCD co d o _Fr 1 y CD m c�% CL Ot °' 3 -o O 0 O C C :�� 0 ' r+ i C C ° cr a `•�— N CD d y CD M s; T 0O . 3 a 0 1� ° C om Q7 �iiD V1 a CMD0 oll CL o � m x n 0 z Z v r� 7J IV'--* Z 6 > b (' S n C 1 ` . V) rn b (' S � o -ri m WIN WA it RD WaD4TO I Y F.1111 MIA ill944 `77i X 2 6 4 380 h 9185 6837:f \,,liilc�lP t� L'Iann�•r: In�,•r�,,•rilicl To: Robert Nicetta Town of North Andover 27 Charles Street North Andover, MA 01845 FAX No: 978-688-9542 Transmittal Date: J , 3 2004 Project No: 2 0 3 6 3 Project Name: Brooks School Houses TEL No: 978-688-9531 REM No. of co ies Latest Date Architect's Field Report, Brooks School Observatory Hill Houses A and B 1/ea. Notes Copies to: John Trovage Brooks School 1160 Great Pond Road North Andover, KA 01845 Brett Murphy Murphy Construction Co.Inc. P. 0. Boz 1510 Newburyport, X71 01950 Sent via: O Mail O Fax, No. pages (total): For your: O Review O Distribution O Express O O Record O Information O Messenger O Approval O O ASW MO OI-.1•oi DYY i Q11MAw�Owb V N...v. 1.t-,-.f.� �.r�11ArAt.� If enclosures are not as noted, please inform us immediately. Confirmation requested: O Yes O No Extra Copies Given to: By: Peter Miner Architect's Field Report FIELD REPORT N°: 20363A-009 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV:. September 2, 2004: 8:30 AM PROJECT: HOUSE A ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: ARCH'S PROD. NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: #715 20363 BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Clear 65-70°F Foundations: 95% Demolition: 0% Rough Carpentry: 80% Doors/Frames/Hdwe: 30% Windows: 50% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 90% Masonry: 60% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 20% Plumbing: 30% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% WORK IN PROGRESS:. • Windows installed • Exterior siding continues. • Duct work continues. • Plumbing work has started • Masonry for fireplace and chimney 80% complete. • Interior partitions framed. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 Architect's Field Report FIELD REPORT N°: 2036311-009 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: September 2, 2004: 8:30 AM PROJECT: HOUSE B ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: ARCH'S PROJ. NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: WORK IN PROGRESS: #716 20363 BROOKSSCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Clear 65-70°F Foundations: 95% Demolition: 0% Rough Carpentry: 70% Doors/Frames/Hdwe: 0% Windows: 15% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 90% Masonry: 60% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 0% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% • Roof has been installed • Interior partitions are being installed • Windows are being installed • Chimney is 60% complete • The main house if framed and the garage is ready to receive the roof trusses. • The fireplace has been started. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect 20363 Brooks School page 1 of 2 Architect's Field Report Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 2 of 2 c ,r i 7 f:lm To: Robert Nicetta Town of North Andover �ianiLC?t`•' 27 Charles Street ' MiA 01 Q4 I North Andover, MA 01845 )%i : '0 4 3$6 p U7e, ; 6 ,,375 f FAX No: 978-688-9542 Transmittal Date: August ;0 2004 Project No: 2 0 3 6 3 Project Name. Brooks School Houses TEL No: 978-688-9531 REM No. of copies Latest Date Architect's Field Report, Brooks School Observatory Hill Houses A and B 1/ea. Notes Copies to: John Trovage Brooks School 1160 Great Pond Road North Andover, MA 01845 Brett Murphy Murphy Construction Co -Inc. P. 0. Box 1510 Newburyport, MA 01950 Sent via: O Mail O Fax, No. pages (total): For your: 0 Record O Distribution s rr buti n O Express O O Messenger O Approval O OAq` 2W Ob" L—h DL &DNf If enclosures are not as noted, please inform us immediately. d `�• _`� Confirmation requested: O Yes O No Extra Copies Given to: By: Peter Miner AUG 3 1 2004 BUILDING DEPT. Architect's Field Report FIELD REPORT N°: 20363A-008 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: August 124, 2004: 8:30 AM PROJECT: HOUSE A ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 01845 PERMIT NO: ARCH'S PROJ• NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: #715 20363 BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDOVER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Clear 75-80°F Foundations: 95% Demolition: 0% Rough Carpentry: 70% Doors/Frames/Hdwe: 0% Windows: 50% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 90% Masonry: 60% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 10% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% WORK IN PROGRESS: • Roof is complete. • Windows and some exterior doors installed • Exterior siding continues. • Duct work continues. • Masonry for fireplace and chimney 80% complete. • Interior partitions framed. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page i of I Architect's Field Report FIELD REPORT N°: 20363B-008 ARCHITECT: Olson Lewis Dioli Doktor Architects & Planners, Inc. DATE OF OBSERV: August 124, 2004: 8:30 AM PROJECT: HOUSE B ON OBSERVATORY HILL BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 01845 PERMIT NO: ARCH'S PROD. NO: OWNER: PRESENT: WEATHER: EST. % COMPLETION: WORK IN PROGRESS: #716 20363 BROOKS SCHOOL 1160 GREAT POND ROAD NORTH ANDovER, MA 0184 Peter Miner, Olson Lewis Dioli & Doktor Architects Clear 75-80°F Foundations: 95% Demolition: 0% Rough Carpentry: 50% Doors/Frames/Hdwe: 0% Windows: 0% Gypsum Wallboard: 0% Mill and Casework: 0% Roofing: 0% Masonry: 0% Structural Steel: 0% Finishes: 0% Painting: 0% HVAC: 0% Plumbing: 0% Electrical: 0% Fire Protection 0% Specialties: 0% Finish Carpentry: 0% • The main house if framed and the garage is ready to receive the roof trusses. • The fireplace has been started. In general, the work appears to be satisfactory and in accordance with the documents approved for the building permit except where noted above. The materials and workmanship appear to be consistent with standard construction practices and meet the requirements of the Massachusetts State Building Code. REPORT BY: Peter Miner, Architect Olson Lewis Dioli & Doktor Architects & Planners, Inc. 17 Elm Street, Manchester -by -the -Sea, MA 01944 978-526-4386 20363 Brooks School page 1 of 1 r Transmittal Cover Sheet Detailed, Grouped by Each Transmittal Number Brooks School Athletic Facility Project # 03.036 Erland Construction, Inc. 1160 Great Pond Road Tel: 978-725-6319 Fax: 978-725-6320 North Andover, MA D. 0i- 0038 Transm'ttdd Tom „"_ bra SitE n Xk Bob Necetta Gail Daly North Andover;Town of Erland Construction, Inc. 566 Main Street 83 Second Ave North Andover, MA 01845 Burlington, MA 01803 Tel: Tel: 781-272-9440 Fax: Fax: 781-272-0601 Acknowledgement Required Package Transmitted Far ","'4 �iaelivered V#a�"�� rcicng �umbe ..�dA ,a,.';Ta .< ,.._ Information, Review Mail ,.-C.c, Company name�� ` s ontact Maine 1 �OGpies Nbtesk A Ernest Guigli and Sons, Inc. Michael Casasanta 1 Erland Construction, Inc. Mark Robinson 1 Enclosed please find a copy of the testing report for the Brooks School. If you have any questions please feel free to call me. Signature Signed Date Prolog Manager Printed on: 7/7/2004 Erland Construction Page 1 q Of Massachusetts Inc. n ,3 "The Construction Tasting People" 2004 w� FIELD REPORT ;�; tl PROJECT: Brooks School PROJECT NO: 888 Athletic Center LOCATION: North Andover, MA WEATHER: Overcast, 75' DATE: June 22. 2004 CONTRACTOR: Erland Construction PURPOSE: A site \isit x\ as made to the referenced project to review the foundation subgrade conditions. Footing construction �Nas to commence adjacent to the existing ice rink near Line R-1. Due to environmental concerns and excess water in the area, limited foundation excavation was completed this date. It is our understanding the petroleum contaminated soils are located in the general area of excavation. An environmental consultant from ECS was on-site to screen the soils for segregation in this respect. The contaminated soils are suspected to be concentrated around the roof drain and foundation drain in this area. The presence of groundwater and/or perched water in the stone needs to be addressed for the ne\\ construction. In summary, the subgrade will need to be adequately dewatered to protect the competency of the tine -grained and sensitive ;glacial subgrade. The protection of the glacial subgrade is also very critical where it supports the existing footing to be exposed. At this tinge. the groundwater can not be dewatered without environmental consideration. Excavation in the area. as such, will likely result in a wet subgrade with no means of proper dewatering. The contractor is therefore to excavate to about one foot above the design BOF grade. The final excavation to expose the bearing subgrade will be made once some means of dewatering can be established for the area. Should you have any questions or require additional assistance, please do not hesitate to contact our office. UTS cif NIassachusetts, Inc. Kevin M. Martin, P.E. Geotechnical Engineer kmm28/uts04i060804.rpt L 5 Richardson Lane, Stoneham, Mossachasotts OZ180 • (781) 438-7755 pax (781) 438-6Zi6 Website: http://www.utsofmass-com • Email address: goneroloffice@atsofmoss.com Location C •' No. ri it Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Ficv�-w_� $ 10— I TOTAL $ I Check # F 5 C:), Building Inspector BROOKS SCHOOL OBSERVATORY HILL Hni I. -,F R Town of North Andover of HORTry Office of the Building Department Community Development and Services Division William J. Scott, Division Director * --�-• ` 27 Charles Street �ssks� D. Robert Nicetta North Andover, Massachusetts 01845 Telephone (978) 688-9545 Building Commissioner Fax (978) 688-9542- CHIMNEY APPLICATION AND PERMIT DATE o W PERMIT # '7/& LOCATION 1/60 9 s"C"_C&-V ` aac� ' OWNER'S NAME4-OCAC00 BUILDER'S NAME M C0 V1S-�-, C-0. MASON'S NAME 6(j r on MASON'S ADDRESS Cgs r1 trC r S _ Ro L'i 1 t SL. MASON'S TELEPHONE MATERIAL OFCHIMNEYA� INTERIOR CHIMNE4,", re—6!� 1ec-K EXTERIOR CHIMNEY _8Lr � L NUMBER AND SIZE OF FLUES /?LIZ THICKNESS OF HEARTH CCmCse �`13iI�e 5�OV C Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: Yts DATE �3 -(S icy SIGNATURE OF MASON / /G�� CONTR. LIC. # EST. CONSTRUCTION COST/CONTRACT PRICE T000 PERMIT GRANTED e I A/Pjr� FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 68 8-95 30 HEALTH 688-9540 PLANNING 688-9535 ( I Office of the Planning Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Julie Parrino Town Planner Any. appeal shall be filed Within (20) days after the Date of filing this Notice In the Office of the Town Clerk Petition of. Brooks School Notice Of Decision Telephone (978) 688-9535 Fax (978) 688-9542 Date: April 7, 2004 Date of Hearing: March 23, 2004, Decision: April 6, 2004 Premises Affected: 1160 Great Pond Road, North Andover 01845 Referring to the above petition for a special permit from the requirements of the North Andover Zoning Bylaw Section 4.136. So as to allow: the construction of two, single family houses and associated site work and utility connections located in the Watershed Protection District on the property of Brooks School. After a public hearing given on the above date, the Planning Board voted -to APPROVE, the Special Permit for Watershed Protection District, based upon the following conditions: Cc: Applicant Engineer Abutters DPW Building Department Conservation Department Health Department ZBA Signed: f Al erto Aji les, Chairman George White, Vice Chairman Felipe Schwarz, Clerk Rick Nardella John Simons James Phinney RECEIVED Ar_ .,) 2004 BUILDING DEPT. SOAFD OF APPEALS 688-9541 BLTILDINGTT 68R 9 45 CONSERVATION 688-9530 HEALTH SRS' -9540 PLANNING 68R )535 1160 Great Pond Road- Brooks School Special Permit - Watershed Protection District The Planning Board makes the following findings regarding the application of Brook School, 1160 Great Pond Road, North Andover, MA 01845, filed on February 13, 2004. The area affected is located on the property of the Brooks School, 1160 Great Pond Road in the R-2 Zoning District, Map 90C, Lot 25 and Map 103, Lot 28. The lot was created in 1928 and is subject to the Watershed Protection District provisions for lots created on or prior to October 24, 1994. The applicant is requesting a Watershed Special Permit for the construction of two single family faculty houses, driveways, associated grading, utilities and stormwater management. Activities will be located with the 325' Non -Discharge Zone associated with bordering vegetated wetland resource areas located in the Watershed Protection District. Actual construction located within the 325' Non -Discharge Zone is limited to the construction of one of the faculty houses, a portion of the driveways, portions of the drainage swale and parabolic swale, catch basins and underground groundwater recharge systems. FINDINGS OF FACT: In accordance with 4.136 the Planning Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds: That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning Board bases its findings on the following facts: a) The proposed structures will be connected to the North Andover Town sewer system; b) A covenant will be placed in the deed restricting and limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit of clearing is restricted to the minimum necessary to construct/renovate the structure and appurtenances. The location of the houses will be located in a cleared maintained field. 2. There is no reasonable alternative location outside the Non -Disturbance Buffer Zone, for any discharge, structure or activity, associated with the proposed project. 3. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: a) The specific site is an appropriate location for the proposed use as all feasible storm water and erosion controls have been placed on the site; b) The use will not adversely affect the neighborhood as the use is accessory to an existing school facility; c) There will be no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use is in harmony with the general purpose and intent of the North Andover Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: a) Town of North Andover Planning Board Application for Watershed Special Permit filed by Brooks School on February 13, 2004; including: • Narrative, dated February 27, 2004; • Turf Management Program, dated 2/12/04 (2 pages); • Recharge Calculations and plans prepared by John Scott, P.E. of RFS, dated 2/23/04; b) Plans entitled: Observatory Hill Faculty Housing Project Cover Sheet, dated February 13, 2004; Sheet Cl, General & Civil Notes, Legend, Symbols, and Abbreviations, dated 2/13/04; Sheet C2, Watershed Protection District Plan, dated 2/13/04; Sheet C3, Proposed Site Plan, revised 2/27/04; Sheet C4, Erosion Protection Details, dated 2/13/04; Sheet C5, Civil Details, revised 3/12/04; c) Engineering Review Letters: Prepared by VHB, dated March 8, 2004; Prepared by RFS Engineering dated March 12, 2004; The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would require a public hearing and modification by the Planning Board. 2) PRIOR TO ANY WORK ON SITE: a) A performance guarantee of two thousand dollars ($2,000) in the form of a check made out to the Town of North Andover must be posted to insure that construction will take place in accordance with the plans and the conditions of this decision and to ensure that the as -built plans will be submitted. b) The limit of work as shown on the plan must be marked in the field and must be reviewed and approved by the Town Planner. c) Erosion controls consisting of haybales and silt fence must be installed along the limit of work behind the proposed houses. The locations of the erosion controls must be approved and reviewed by the Town Planner. d) The site shall have received all necessary permits and approvals from the North Andover Conservation Commission, Board of Health, and the Department of Public Works and be in compliance with the above permits and approvals. 3) PRIOR TO THE ISSUANCE OF A BUILDING PERMIT: a) The Planning Board must endorse the final site plan mylars and three copies of the signed plans must be delivered to and reviewed by the Planning Department. b) The decision must be filed with the North Essex Registry of Deeds. One certified copy of the recorded decision must be submitted to the Planning Department. c) No pesticides, fertilizers or chemicals shall be used in lawn care or maintenance within 325' of Lake Cochichewick or within 325' of wetland resource areas. The applicant shall incorporate this condition as a deed restriction, and a copy of the recorded deed shall be submitted to the Town Planner and included in the file. 4) PRIOR TO THE ISSUANCE OF A CERTIFICATE. OF OCCUPANCY: Foundation Plan: Immediately upon completion of the house foundations and prior to further construction activities associated with the site, the applicant shall complete a plan prepared by a Registered Professional Land Surveyor (R.P.L.S.) which accurately depicts the foundation locations and their proximity to wetland resource areas and watershed buffer zones as shown on the approved Watershed Site Plan. Said plan shall be submitted to the Town Planner for review to verify that the setback limits under the special permit have been met. 5) PRIOR TO THE RELEASE OF THE PERFORMANCE BOND: a) The applicant shall submit an as -built plan stamped by a Registered Professional Engineer or Land Surveyor in Massachusetts that shows all construction, limits of disturbance, existing topography, storm water mitigation structures and other pertinent site features. This as -built plan shall be submitted to the Town Planner and the Department of Public Works for approval. The applicant must submit a written certification from the design engineer that the site was constructed in accordance with the approved plan and any changes or deviations from the approved plan must be specifically noted in the certification letter. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 6) In no instance shall the applicant's proposed construction be allowed to fiuther impact the site than as proposed on the plan referenced in Condition # 1. 7) No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 8) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 9) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 10) This Special Permit approval shall be deemed to have lapsed April 7, 2006 (two years from the date of issuance) exclusive of the time required to pursue or await determination of any appeals, unless substantial use or construction has commenced within said two year period. Substantial use or construction will be determined by a majority vote of the Planning Board cc: Applicant File RECEIVED MAR 4 2004 BUILDING DEPT, Introduction NARRATIVE Application for Watershed Special Permit PAR 2 2004 Observatory Hill Faculty Housing 4ORr Brooks School P ,rv; Stormwater Management The Building Requirements of the Zoning Bylaw require implementation of best management practices in regards to site drainage. Special Permit requirement 4.g. requires groundwater recharge for projects involving new impermeable areas in the Non -Discharge Zone. The site is designed to transport runoff in long and gradual grassy swales to assure that treatment is provided for the low levels of sediment, etc., which may be present from time to time. The layout directs stormwater away from the Non -Discharge Zone. The one proposed catch basin will have a deep sump and be equipped with and oil and grease hood, similar to those on several recent projects constructed on campus. During construction, erosion and sediment control measures will be implemented (see plans) to alleviate the possibility of a muddy discharge off site. Groundwater recharge will be accomplished by intercepting clean roof runoff from the two houses and directing it to buried chambers for infiltration into the ground. Percolation and soil classification testing was conducted by Norse Environmental. Calculations for recharge are attached which follow the methods in the Massachusetts Stormwater Management Standards. The infiltrators are situated downgradient of, and a minimum of 30 feet horizontally from, the foundation underdrains of the basements to avoid short-circuiting of the recharge. In addition to the Norse testing, RFS conducted three general test pits on site. The soils were consistent with that found by Norse and there was no refusal down to 9 feet. General Requirements for Watershed Special Permit 1. Encouraging the most appropriate use of land. The School has long provided some faculty members with on -campus housing, and having resident faculty is an important element in the School's programs. 2. Preventing overcrowding of land. Though a boarding school with some resident faculty and staff, there are fewer persons per acre on the large 165 -acre campus than would be typical on a fully developed portion of the Town's R-2 zone, which allows 1 -acre lots. 3. Conserving the value of land and buildings. The architectural design of the proposed buildings and treatment of the site will be in keeping with the high quality of buildings and grounds on the campus and on neighboring parcels. 4. Lessening congestion of traffic. The persons who will occupy the houses are presently commuting to the campus over town roads. 5. Preventing undue concentration of population. See 2., above. 6. Providing adequate light and air. There will be adequate separation of buildings for adequate light and air. 7. Reducing the hazards of fire and other danger. The Fire Department has been consulted as to emergency access and there is a nearby fire hydrant. 8. Assisting in the economical provision of transportation, water, sewerage, schools, parks, and other public facilities. The project will not overburden town utilities, transportation, or schools. 9. Controlling the use of bodies of water, including watercourses. The project design respects the fact that Lake Cochichewick is the Town's water supply. 10. Reducing the probability of losses resulting from floods. The scale of the project and its relation to the Lake mitigate any increase in the potential for downstream flooding. 11. Reserving and increasing the amenities of the Town. Brooks School itself is often mentioned as an amenity of the Town, and this project is entirely consistent with the character of the campus. a. The specific site is an appropriate location for such a use, structure, or condition. The project is consistent with the long-established campus, both as to appearance and use. b. The use as developed will not adversely affect the neighborhood. The high standard of established architectural and site design will be maintained. An existing mature stand of blue spruce trees will remain in place, and will screen the two houses from the view of the nearest neighbor. c. There will be no nuisance or serious hazard to vehicles or pedestrians. The location of the houses far from any Town road precludes any such hazard. d. Adequate and appropriate facilities will be provided for the proper operation of the proposed use. All necessary utilities are readily available for straightforward connection to the proposed buildings without need of extensive upgrading. No Town -owned utilities need to be modified in any way. e. The Special Permit Granting Authority shall not grant any Special Permit unless they make a specific finding that the use is in harmony with the general purpose and intent of this Bylaw. We believe there is nothing about this project that is inconsistent with any Town plan, regulation, or policy. Specific Requirements for Watershed Special Permit 1. Certification of no degradation. The undersigned, a Registered Professional Engineer in the Commonwealth of Massachusetts, hereby certifies that this project, if constructed in accordance with the plans, will not result in any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. 2. No reasonable alternative location. The School has looked at quite a number of sites for these houses, and has concluded that other possible sites, such as the top of Observatory Hill or the west side of the Classroom Building, have the effect of robbing the School of potential sites in the future for major projects in the School's master plan, namely a new science building, an arts center, and a new dormitory. Furthermore, the School does not wish to take out any of the existing playing fields, which are quite valuable to the School's program. Although it is possible to move the two houses higher on Observatory Hill, this creates driveway problems and increases the visual impact of the two houses on the rest of campus (particularly in the major walkway between the Library and the Academic Building). The vista south to Observatory Hill is an important visual feature for the School, and placing the houses farther uphill would compromise this vista. Also, if the houses were closer to the Observatory, light from the houses might interfere with the night time use of the Observatory. 3. Waste treatment. There is no industrial waste treatment associated with the project. 4. Groundwater nitrogen. It is the School's policy not to use fertilizers in the Non -Disturbance and Non -Discharge Zones. Attached is a copy of the School's Turf Management Program. Other than fertilizer, there should be no other potential activities associated with the project which might raise the levels of nitrogen in runoff or groundwater. 5. Downgradient nitrogen or phosphorus. See 4., above. 6. Other supporting documentation. The submitted documentation is believed to be complete, but the applicant stands ready to provide additional materials should the Board dictate. For Rist-Frost-Shumway Engineering, P.C. J hn L. Scott, P.E. S nior Civil Engineer of A44ssq J tL cyG(P scan a CMS 29134 SIONAN by/ NARRATIVE RECEIVED Application for Watershed Special Permit MAR 2 2004 Observatory Hill Faculty Housing BUILDING DEPT. Brooks School North Andover, Massachusetts February 12, 2004 Introduction Brooks School proposes to construct a pair of single-family dwellings for faculty housing. Each building is intended as a residence for a faculty member and his or her family. The site location is adjacent to Thompson House, a faculty residence, on the south fringe of the campus. The project includes the two dwellings, an extension of the Thompson House access drive, and connection of water, sewer, electric, telecom, and gas utilities. Each dwelling will be two stories with attached two -car garage, full basement with bulkhead, and on -grade rear patio. Architecture will be consistent with the established character of the campus. Watershed Protection District A significant portion of the school campus lies within the watershed of Lake Cochichewick. Attached with this application is a campus plan on which the various zones of the Town's Watershed Protection District are shown. A portion of the proposed project lies within the Non - Discharge Zone of the District, which triggers the need for the Special Permit. Drainage on the south side of campus is somewhat unusual. A wetland along Great Pond Road flows into a piped drain network constructed many years ago. This network picks up inlets along Maple Drive and from the rear of the library, and discharges to a narrow ditch channel below Thompson House that empties into the lake near the school's boat house. See plan. The wetland and stream channel qualify as "wetland resource areas" tributary to the lake, as defined in the Zoning Bylaw. As the lot was created well before 1994, there is no Conservation Zone and dimensions of the Non -Disturbance and Non -Discharge Zones are as shown in Table 2 of section 4.136 of the Zoning Bylaw. These zones are shown on the plan. Note that the only point along the channel which dictates zone boundaries for the proposed site is the point of discharge of the drain network. For this reason, flagging of the narrow wetland along the channel down to the lake was deemed to be unnecessary for this application. Stormwater Management The project is well beyond the 100 -foot buffer zone around any wetland, so the Wetlands Protection Act does not apply. As stormwater runoff from the project is not contaminated by contact with hazardous substances, the discharge is not subject to the Massachusetts Stormwater Management Standards. Nevertheless, the site is designed to transport runoff in long, broad, and gradual grassy swales to assure that treatment is provided for the low levels of sediment, etc., which may be present from time to time. The swale directs stormwater away from the Non -Discharge Zone. The one proposed catch basin will have a deep sump and be equipped with an oil and grease hood. During construction, erosion and sediment control measures will be implemented to alleviate the possibility of a muddy discharge off site. General Requirements for Watershed Special Permit 1. Encouraging the most appropriate use of land. The School has long provided some faculty members with on -campus housing, and having resident faculty is an important element in the School's programs. 2. Preventing overcrowding of land. Though a boarding school with some resident faculty and staff, there are fewer persons per acre on the large 165 -acre campus than would be typical on a fully developed portion of the Town's R-2 zone, which allows 1 -acre lots. 3. Conserving the value of land and buildings. The architectural design of the proposed buildings and treatment of the site will be in keeping with the high quality of buildings and grounds on the campus and on neighboring parcels. 4. Lessening congestion of traffic. The persons who will occupy the houses are presently commuting to the campus over town roads. 5. Preventing undue concentration of population. See 2., above. 6. Providing adequate light and air. There will be adequate separation of buildings for adequate light and air. 7. Reducing the hazards of fire and other danger. The Fire Department has been consulted as to emergency access and there is a nearby fire hydrant. 8. Assisting in the economical provision of transportation, water, sewerage, schools, parks, and other public facilities. The project will not overburden town utilities, transportation, or schools. 9. Controlling the use of bodies of water, including watercourses. The project design respects the fact that Lake Cochichewick is the Town's water supply. 10. Reducing the probability of losses resulting from floods. The scale of the project and its relation to the Lake mitigate any increase in the potential for downstream flooding. 11. Reserving and increasing the amenities of the Town. Brooks School itself is often mentioned as an amenity of the Town, and this project is entirely consistent with the character of the campus. a. The specific site is an appropriate location for such a use, structure, or condition. The project is consistent with the long-established campus, both as to appearance and use. b. The use as developed will not adversely affect the neighborhood. The high standard of established architectural and site design will be maintained. An existing mature stand of blue spruce trees will remain in place, and will screen the two houses from the view of the nearest neighbor. c. There will be no nuisance or serious hazard to vehicles or pedestrians. The location of the houses far from any Town road precludes any such hazard. d. Adequate and appropriate facilities will be provided for the proper operation of the proposed use. All necessary utilities are readily available for straightforward connection to the proposed buildings without need of extensive upgrading. No Town -owned utilities need to be modified in any way. e. The Special Permit Granting Authority shall not grant any Special Permit unless they make a specific finding that the use is in harmony with the general purpose and intent of this Bylaw. We believe there is nothing about this project that is inconsistent with any Town plan, regulation, or policy. Specific Requirements for Watershed Special Permit 1. Certification of no degradation. The undersigned, a Registered Professional Engineer in the Commonwealth of Massachusetts, hereby certifies that this project, if constructed in accordance with the plans, will not result in any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. 2. No reasonable alternative location. The School has looked at quite a number of sites for these houses, and has concluded that other possible sites, such as the top of Observatory Hill or the west side of the Classroom Building, have the effect of robbing the School of potential sites in the future for major projects in the School's master plan, namely a new science building, an arts center, and a new dormitory. Furthermore, the School does not wish to take out any of the existing playing fields, which are quite valuable to the School's program. Although it is possible to move the two houses higher on Observatory Hill, this creates driveway problems and increases the visual impact of the two houses on the rest of campus (particularly in the major walkway between the Library and the Academic Building). The vista south to Observatory Hill is an important visual feature for the School, and placing the houses farther uphill would compromise this vista. Also, if the houses were closer to the Observatory, light from the houses might interfere with the night time use of the Observatory. 3. Waste treatment. There is no industrial waste treatment associated with the project. 4. Groundwater nitrogen. It is the School's policy not to use fertilizers in the Non -Disturbance and Non -Discharge Zones. Attached is a copy of the School's Turf Management Program. Other than fertilizer, there should be no other potential activities associated with the project which might raise the levels of nitrogen in runoff or groundwater. 5. 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E O c v f0 V y 0 N �' _ C 0 •C y > l4 L N m f04 Y O _- U fV L- 0 :~ ca �' C-0 d o E O c O a m m y e ;c c vyi C 0 O c O p° y L co o Z m 0 O 0 i L y v w N w L o p O. 'C O p_ N o 3 p O '� N o 4)v v g c '� C E j3 m c G1 L '= !n IT .. O L y U C rn C. O > C Q .y y O U U) y c p O f0 d O o m V :, y 3 @ p m c p O Y 0 0 L N a o a) r O y cm c vJ a y 0 .Q v 'c io p t m o .- y U - m w j y � O. O y a m a. 0 >` w Z 0. N .O C O N tq O N y 'p CL U w C w f0 M U r> (aa > >, N 0, 2 CO IC E 0 io w a� Q3o Ec' ai y y ayi d.5 w 0 rn0� v U) U N N o 0 U y O— C (CO `1 Q d ) O = O >. N co (0 V 0 Q O N _ O 0 N N O. Oa � .Ta. c r >, Y N y O O' M !� C .0 N Il'j 00 tNo O �p N y O C y` O Qf N O= N O I- N p y E .0`r m O p v c t p O y 0 O y o p tm L m m Z O $ 5.0 Z F- y Z �- 0) r c Z lL w Z 4 O B R O O N N N • 04 16 71� PermitNumber REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code RES check Software Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\MURPHY-B.rck PROJECT TITLE: MURPHY CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW/ WALL RATIO: 0.22 DATE: 06/24/04 DATE OF PLANS: 05/29/04 PROJECT DESCRIPTION: BROOKS SCH-0 L HOUSE B COMPLIANCE: Passes Maximum UA = 363 Your Home UA = 317 12.7% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor Ceiling 1: Flat Ceiling or Scissor Truss 1086 30.0 0.0 38 Wall l: Wood Frame, 16" o.c. 1831 19.0 0.0 82 Window 1: Wood Frame:Double Pane with Low -E 397 0.350 139 Door 1: Solid 60 0.360 22 Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 1086 30.0 0.0 36 Furnace 1: Forced Hot Air, 92 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 Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly NEC checl and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date l-e REScheck Inspection Checklist Massachusetts Energy Code RES check Software Version 3.6 Release 1 DATE: 06/24/04 PROJECT TITLE: MURPHY Bldg. Dept. Use Ceilings: [ ] 1. Ceiling l: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation I Comments: Above -Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation I Comments: Windows: [ ] 1. Window 1: Wood Frame:Double Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: [ ] 1. Door 1: Solid, U -factor: 0.360 Comments: Floors: [ ] 1. Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 92 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 cfin (0.944 Us) 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: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: [ ] I Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] I 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. [ ] I The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] I 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. Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I 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. I Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 T must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulatine Mains and Runout Temperature ( Fl lb to lot 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. NOTES TO FIELD (Building Department Use Only) Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pigg System Types Range ( F1 2" Runouts VandLess " to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) a\ REScheck Compliance Certificate Massachusetts Energy Code RES check Software Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\MURPHY-B.rck PROJECT TITLE: MURPHY CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW / WALL RATIO: 0.22 DATE: 06/24/04 DATE OF PLANS: 05/29/04 PROJECT DESCRIPTION: KS SCOOH HOUSE B Permit Number Checked By/Date COMPLIANCE: Passes Maximum UA = 363 Your Home UA = 317 12.7% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1086 30.0 0.0 38 Wall 1: Wood Frame, 16" o.c. 1831 19.0 0.0 82 Window 1: Wood Frame:Double Pane with Low -E 397 0.350 139 Door 1: Solid 60 0.360 22 Floor L All -Wood Joist/Truss:Over Unconditioned Space 1086 30.0 0.0 36 Furnace 1: Forced Hot Air, 92 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 Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly NEC checl and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date REScheck Inspection Checklist Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 DATE: 06/24/04 PROJECT TITLE: MURPHY Bldg, Dept. Use Ceilings: I. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation Comments: Windows: 1. Window 1: Wood Frame:Double Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door 1: Solid, U -factor: 0.360 Comments: Floors: [ ] ( 1. Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation I Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 92 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 cfin (0.944 Us) 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: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. I Duct Insulation: [ J I Ducts shall be insulated per Table MAT 1. Duct Construction: [ J I 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. [ ] I The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] I 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. Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and AA Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] I 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. Heating and Cooling Piping Insulation: [ J I HVAC piping conveying fluids above 120 °F or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Heated Water Temperature (Fl UR to V T.Zp to L�5" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. emulation Thickness in Inches by Pie Sizes Pigg System Types Range ( F1 " R1d3I9111T VandLess 1.25"5o 2" 2.5" t4 4" Heating Systems Low Pressure/Temperature Low Temperature Steam Condensate (for feed water) Cooling Systems Chilled Water, Refrigerant, and Brine 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 Any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) 12/15/2004 14:43 FAX 9785268375 OLD OG(011 Lewis D1011 DIIIAM • v:-: rht� \r.:hitr�t- f! lr�.tnurr� li►:•rt,.fdl.•c) c. �J 17 1.1111 To: Robert Nicetta Maucbe+ter Toon of Horth Andover 27 Charles Street N91 0t 94 4 Horth Andover, 971.26 43$6 p 978 526 8375 f FAXNoc 978-688-9542 &D ARCHITECTS 0001 Transmittal Date; IZ•��'64 Pr*d No; 20363 NA 01845 FwodName: Brooks School Rouses 7U.No: 978-688-9531 Bain No. of 92& Latest Date ,41oft, /q t 4( �r 1/ea. 6' Brooks school 1160 Great 'Pond Road Horth and over, a 01845` /7Vjjbb^ !,] 25-rI Z/4J Brett Httrphy Notes Copies to: John Trout Oe' Brooks school 1160 Great 'Pond Road Horth and over, a 01845` /7Vjjbb^ !,] 25-rI Z/4J Brett Httrphy Murphy Construction Co.1nc. P. 0. an 1510 Hevburyport, MA 01950 974- 463-rlkfr Sent via: o Mailapress 00 Fax, No. pages (total} Y°1m p Review O Whibution Irdonriation O Messenger O Approval O If enckmues are not as rioted, please Worm us imuae&teiy. Confumation requested: O Yes O No Facts Copies Given to: By: Peter miner .c December I6, 2004 Mr. Robert Nicetta Town of North Andover 27 Charles Street North Andover, MA 01845 RE: Final Affidavit The Brooks School House B on Observatory Hill 1160 Great Pond Road North Andover, Ma 01845 Mr. Nicetta, I certify that 1, or my authorized representative, have inspected the work associated with Permit number #716. To the best of my knowledge, informati on, and belief the work has been satisfactorily completed in conformance with permit and plans approved by the North Andover Building Department and with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances and ready for occupancy. Jolt► T. Olson, AIA son Lewis & Dioli Architects Architects & Planners Inc. 17 Elm Street Manchester, MA 01944 Cc; Jim Pugh, John Trovage, Murphy Construct CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number. 716 Date: November 15 2004 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1160 Great Pond Road House B MAY BE OCCUPIED AS Single Family Dwelling 2150 s.f. 2 car attached garage IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to. Brooks School 1160 Great Pond Road North Andover MA 01845 ) building Inspector Town of North Andover Building Department 400 Osgood Street North Andover MA 01845 978-688-9545 Fax 978-688-9542 r*, APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: S ,e_sjoA0�-y /-/,,/ DATE REQUESTED FILED/READY FOR INSPECTION / Z - /y - b`/ CLOSING DATE ON PROPERTY: /Z-/6 - a4 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARD $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Signature OFFICIAL USE ONLY ROUTING /D.P.W. - WATER METER NIA -r::ft DDATE IZ-3 -04 D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURMPW AUTHORIZATION APPLICATION CERTIFICATO OF OCCUPANCY revised 11. 15.2004 m m m m X m v m v■ y .O C � y Cl) n Z y ■ �• r ca O CL y � o o v CD CDCL o m CD CCD O 0 C O rA d D y CD S v CO) O Z CD O CD C CD O 'Ct I WE C Im d _ O -•yl Q N Ec ®vs l � o L m C7 O H m a c m Z �� H o' .��► im .d► m C T CD aad �_ m CA A Sy o �CD C c O� C �H a CO rn a .. (� m o cn O m H o n c nm o COD 3 0 0 d a zv, aos c cn N ,116C Cn -CCD � H� nmCD A: _ CD Q 7 a. r� Z � o C O CD C2: � Z S. ti CD ,a c m (n O � :� cn .-i H � o CD C o Cn (c to O ~ Cr1 O G i7 0 O w G) G C O n O z tri d o dtz A S W v lu I omi 0 0 c c - O m m x m C m �o m v m G x = Ln? < LAm o ajj sl a m-, O ,, Z o 0, cu s Ln m f, ° O > > CL O a92 O j � -+ M � a r r* — m CL 50 m m c CL C Lnn cu A. p N E o =� CL N Cr m a fl! N aj a T E c- a� 3 O "* °,moo c ? n. A rn �?c 3 :r0) o =, (D n fp N O O O = O -0. • iD n 81 (D O m a 3 °' o' c c 0 � CD cr CL r CD CD 00 ah d n: . %— ir o,.; n� CD ND- 0, .9 r ie ' • CD N O z 0 O C --^---c_SCHOOL e .. - . .1.. A Location No. r Date "°"T" TOWN OF NORTH ANDOVER c w a • ` = Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee $ _ Other Permit Fee Fi+1e4-t $ "7o TOTAL np— !nt Division HERMIT Telephone (978) 688-9545 Fax (978) 688-9542 PERMIT # /6 0(D V S'�' Check # o 17537 1w n Building Inspector % i1 MATERIAL OF CHIMNEY INTERIOR EXTERIOR CHIMNEY 3 yr NUMBER AND SIZE OF FLUES % - cK._ % % X lZ__ THICKNESS OF HEARTH y Cc7+�L•re,�� '" %3��/� ��L�nt Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: ytS DATE Oq SIGNATURE OF MASON / L-'�--- �7 -�.-�. CONTR. LIC. ## EST. CONSTRUCTION COST/CONTRACT PRICE -?'Ooc PERMIT GRANTED 8 r cJ Alyl� FEE �9 — ROBERT NICETTA, BUILDING INSPECTOR INSPECTED .gym SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVA-1-ION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Iw Location Y40 C rhq Date F NORTH TOWN OF NORTH ANDOVER _ G .. 9 Certificate of Occupancy $ CMust�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $- Check #•� 17444 Building sector BROOKS SCHOOL OBSERVATORY HILL HOUSE B TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH -A ONE OR TWO FAMILY DWELLING n: �r BUILDING PERMIT NUMBER. DATE ISSUED: 7>'� FDNfvm; s a 074&0 SIGNATURE: Building CommissioneE22ELxctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Address: 1.2 Assessors Map and Parcel Number: �Proppeerty �!o\ `Ww�� c1 i 1 b 95 V ` oO V In Map Number Parcel Number 1.3 Zoning ormation: 1.4 Property Dimensions: � - a S��e�m�\ Zonin District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. si) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone Outside Flood Zone Municipal X On Site Disposal System ❑ Public Private . ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENTJ10 w iu u Sif ICt: 8S 0 2.1 Owner of Record Name ( nnt) Address for Service: Signature Telephone 2.2 Owner of Record: /tj-2j Td✓1 �j (0 61eel? i— �e4 Na Address for Service: e0 Sianatyfe Telephone SEC ION - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signa re Telephone l ; 3.2 egistered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 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 bu4ng permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Descri tion of Proposed Work check au applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: S� 19=X.1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant a 1 '(}gI+CIA�, USE Q1vI,y 1. Building alzolp 4 (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 04.1 3 Plumbin Building Permit fee tel X (b) Fr)6we,eo4 �� '• e'�a 3s . c a iu �� • '^' ^7 Mechanical HVAC 5 Fire Protection 1Nt \ 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ` J O In �✓O ✓'oy S C, as er/Authorized Agent of subject property Hereby authorize n J ayo t t_ y c o k. STt Z. U C TC 0 G`, to act on My behalf � 11 matt relative to work authorized by this building permit application.S /2 / Si atur of er Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si ature of Owner/Aent Date 10 RONNIE NO. OF STORIES SIZE e46 X b t Llh t BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 T 2 kl 3 tVc� SPAN DIMENSIONS OF SILLS yt DIMENSIONS OF POSTS t " \ SA DIMENSIONS OF GIRDERS - )OR I I f I Uy HEIGHT OF FOUNDATION THICKNESS " SIZE OF FOOTING \Z' X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND \� IS BUILDING CONNECTED TO NATURAL, GAS LINE 13 BROOKS SCHOOL OBSERVATORY HILL FORM : U - LOT RELEASE FORM HOUSE B - INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits Boards and Departrnents having jurisdiction have been obtained. This does not relieve the applicant and' or landowner from compliance With any applicable requirements. l.sessss.asssss■..ss■�ssss■ss■ss■ssssss■■■sss■■�■sesssssssasss.s 0. ss a e. a s. a APPLICANT �ZaG -S SC R-00PHONE 8 ZS ZB�j ASSESSORS MAP NUMBER Cy LOT NUMBER 2-6 SUBDIVISION LOT NUMBER STREET & R EST CSO ti D TLa A 7 STREET NUMBER 160 Issssass s.*gas s■ a a a aam'sWON sssrssssss■■ssss.sssaassss.seSasso ssAnn awe s.ssasa OFFICL4 L USE ONLY Iaaa..aaaa* soma sss.aamassasan*asassssassaamass.ss■as■assas.aaussaaawaaMona. ■ RE C 1NEVENDATIONS OF TONIN AGENTS ss.ssrasssr'i ss.Gass■OWN Masseuses .ssss.ssssss.sass ssDas .s ,....saaa, e `f DATE APPROVED 7 �% CWSERVAnONAD1,,ffNISr11TOR DATE REJECTED J J CONMEN"M v�wu�ciy �c�c FOOD INSPECTOR — HEALTH - SEPTIC INSPECTOR — HEALTH COMMENTS PUBLIC WORDS — SEWER / WATER DATE REJECTED r. N,wzt ,syAss CJF�F. Qa9� ��b PTzrPT VTM RV -PI M T iTNTr- TtTCPFrTnlR nA' BROOKS _ D_ -S SCH99L OBSERVATORY HILL FORM - U - LOT RELEASE FORM HOUSE B 1NSTRUCRONS: This form is usedto verify tha t all: necessary approval/ permits from Boards and Departments having; jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. MEN an Nunn man APPLICANT 2- S Z8Q ASSESSORS MAP NUMBER y LOT NUMBER SUBDIVISION LOT NUMBER & R EIk-`7 'Po P �2_4o A -k:,> STREET TREETNUMBER Ionm* a as was a am* was moSIM-10 a won An WE a IN ME* a am a a ME ME Massa so am Sao a a am a WE a =.a as a W-W ams a -OFFICIAL USE ONLY IN as son a REG N&MMATIONS, OF TOWN AGENTS son sommommomp mWM,mMMM, Won asawan.we a a 0 a a Oman 1011100,11MEET mmm �an a0a00 DATE APPROVED' CWSERVAMNADTOR DATE REJECTED CONEVMM I i J 6) FIF/W1,030,1�0 fA/ i, �J 2WYam � BROOKS SCHOOL OBSERVATORY HILL The Commonwealth of Massachusetts HOUSE B Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City __ Phone # F -1 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. d Company name: c ► n—li��l ��Wvc �oQ-t (Zn -� Address OeX 5 t O Citv: `P0y\ VVVA © lel ;0 Phone #: (21 l P)- q�o 1; -OS81 Insurance Co. Policv # mci. wc- `s 1 t 4{o e) Company name: Address Ci!y Phone #: Insurance Co Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment as well_as_civil..penaftiesin-theform cfa_STOP WORK_ORDER..and_a fine. of.(.$1.0.0.0.0) allay against -me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. f do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Print name At VlCAA Pi, y Phone Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MM/DD/YYYY) MURPH-2 02/24/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI01 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Landmark Insurance Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198 Massachusetts Avenue : ` ALTER THE COVERAGE AFFORDED BY THE POLICIES BELON North Andover MA 01845-4190 Phone: 978-688-8829 , Fax: 978-975-3987. INSURERS AFFORDING COVERAGE NAIC # { INSURED INSURER A: Worcester Insurance - Co... 26182 INSURER B: Huron Insurance Company Murphy Construction Co , Ino..INSURER C: Guard Insurance Group P. 0 . Lx 1510 .. INSURER D: Newburyport'MA 01950 INSURER E: COVERAGES FAN HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING YREQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR YPERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH nI Irlcc Gnr:RFrCTF I IMITR RHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR 'NSRGENERAL NSR TYPE OF INSURANCE POLICY NUMBER Y EFF DATE MMIDDIYY POLICY EXPIRATION DATE MMIDD/YY LIMITS LIABILITY EACH OCCURRENCE $ 1000000 PREMISES (Ea occurence) 5100000 B X COMMERCIAL GENERAL LIABILITY CB6E0347. 01/19/04 01/19/05 MED EXP (Any one person) S 5000 CLAIMS MADE FKOCCUR PERSONAL &ADV INJURY 51000000 X Business Owners 01/19/04 01/19/05 GENERAL AGGREGATE I s 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 5 2000000 POLICY JECT ELOC B AUTOMOBILE LIABILITY ANY AUTO BMA8931322 01/19/04 01/19/05 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY 5 (Per person) — BODILY INJURY $ (Per accident) X $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE 5 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC S ANY AUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 AGGREGATE s 1000000 A X OCCUR 7 CLAIMSMADE BE6E0347 01/19/04 01/19/05 $ DEDUCTIBLE 5 _ S X RETENTION so WORKERS COMPENSATION AND ITORYLIMITS ER E.L. EACH ACCIDENT $ 1000000 C EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 MUWC511468 01/19/04 01/19/05 E.L. DISEASE - EA EMPLOYE 51000000 E.L. DISEASE •POLICY LIMIT $ 1000000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS O p CERTIFICATE HOLDER CANCELLATION Brooks Academy Attn.: James Pug, Business Mgr 1160 Great Pond Road North Andover MA 01845. RD BROOKS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIc DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ORD CORPORATION I BROOKS SCHOOL OBSERVATORY HILL HOUSE B North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) • -. Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector PROJECT NUMBER: OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL. BROOKS SCHOOL OBSERVATORY HILL . HOUSE B PROJECT TITLE: O SF:2 L.L uSo-S PROJECT LOCATION: ?g�i_ S S G�� L- 1 I b D GylLir�rT P� t20 . , NAME OF BUILDING: L4wcS.7 �7 NATURE OF PROJECT: GDM STe J CGT-W>.Z� 0-(-' N turf WbdD 171N �z�-�- I ►,t b W� 4Ti�1 G}h,(r� 6 A/� 6rz IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE; I, Joiw T bLSar l REGISTRATION NO. 3t o1 BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, . COMPUTATIONS. AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL D OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES. FOR THE PROPOSED USE -AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B 'EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT E WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116;0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures.for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with,6the progress and quality of the work and to determine, in general, if the work is being performed in a.manner consistent with the construction documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILD 101 UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AST ' B° No. 0 SATISFACTORY COMPLETION AND READINESS OF THE PROJ COR O o ° IGIVA7 J{ Of SUBSCRIBED AND SWORM TO BEFORE ME THIS rod DAY OF _ NOTARY PUBLIC IV MY COMMISSION EXPIRES j17� V0�7?/Y120�ZCl1PCGGlf2. 0�,�./��lJ(zld?,UQP�1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 073615 Birthdate: 05/16/1966 Expires: 05/16/2006 Restricted: 00 JASON K MADDEN 185 ORCHARD BYFIELD, MA 01922 Tr. no: 24800 Commissioner m m X C m X CO) CO) F, m W -I �m Sao � a . m m �0 N � aj V -n 3 °c 0 � VJ o r >> c a5 El� in n m fD CL cLn c fD E E 3 cr m a, CL a O c rt OPin P < z o ° .04do O z go S ? � C N H H m N aM ° m 0 > >oc 3 x cG z d o o' n, 10M V) 00 >y cr'x 2>4 CL o� C to H y l (D c�a%a) > C mCL 3' V 0 0 c c `^ N C 1 � • O T a CD' x 0) Owti ZN' H O► (� 0 „ F vi m m I as o -PO �/y I 0 m x 1 0. 0 Y. 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U O Q = J O Y �� m � W iD m - fO - Z. - m m F N N N N - N N N N O lV N N N N N N N N N N Pf N lV N m N N N N y O N O N O '- N p N p m 0 N m 0 0 Ur Ur m N O O m N O O N O Z m O m O n O! m O cv O n O m0 J � w w w w w N w J < s s� I a s c s�� g s s s s s s e } � a a a m� � n a a m '�-❑ � a a a a� a a a� 8 ii O a t7 Z y a e ro YYYNiiI O m F fn � Z W Y � 3 N N i 4 J! 11277 Date.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .............. ...... ..�i ..................................................... has permission to perform ............................. 6C)II ...................... .... ..... ................... 72 6;t plumbing in the b)uiJdings of ....... .......................... at ................................................................. 6�tort Andover, Mass. ... .. Fee.......... ....... Lic. No.2#.d.,-/ .... ........ ................................................. P MBIN INSPECTOR Check # 1� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,. CITY %•� MA DATE'r I X-3 . PERMIT#. I IZ11 JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COM IAL Q EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES Q NO FIXTURES Z FLOOR--' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE T}t((( DEDICATED SPECIAL WASTE SYSTEM ( { DEDICATED GAS/OILISAND SYSTEM I __Jl DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM i _[ I I I _! DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _I .____.-[ _..__ _N_____► _�I I _______1 ___.__I - .___1 .__._�I ...__._? ___._1 ._...._1 1 ..._.._! FOOD DISPOSER i -. I�. I . _ _� J .._..__._. ---__-� _ __. 1 1 = FLOOR/ AREA DRAIN _I . _� � ( i [ _1 _ .__. __ ...__-_I _w.J .__._-..1 —11—[ INTERCEPTOR (INTERIOR) __j --._._I __._._JI KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATn, " HEATER ALL TYPES PIPING [IF IF ..__._222=7012_77 _.__ ._ _._I _...__ 7_7 77 7 _.1 __ . _-! ----.--.1 INSURANCE COVERAGE: 1 have a current liability insurance policy or its subst I -equivalent which meets the requirements of MGL Ch. 142. YES -_, - NO Q IF YOU CHECKED YES, PLEASE INDICATE H E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -1 OTHER TYPE OF INDEMNITY Q BOND QI 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 Q AGENT �Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r PLUMBER'S NAME S Gv d I LICENSE # 3 116 c( I SIGNATU MP Q JP CORPORATION Q#PARTNERSHIP Q# LLC 0� COMPANY NAME �`—�. —"�- � :11 ADDRESS S I CITY i"1 2 f/_� _.._._ _..._ STATE %A� ZIP TEL TEL FAX �CELL �EMAIL L N ❑ LU m 4.0 w W LL Fl r•! e The Commonwealth of Massachusetts _ Department of IndustriaZAccidents ^- 1 Congress Street, Suite 100 Boston, MA 02114-2017 �r www massgov/dia Woi kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/i'lumbers. TO BE FILED WITH THE PERMITTING AUTHORTTY. Name (Business/Oiganization/Individue Address: City/State/Zip: M ' Type of project (required): Are you an employe - G7iecicthe appropriate ox: em to ees full and/or part-time).* 7. 4ZOde:9 'C0action 1. I employer with _ P Y ( 2. am a sole proprietor or partnership and have no employees working forme in 8, any capacity. [No ,,kers. comp. insurance required.] 9, ❑ Demolition 3,❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 10E] Building addition 4,❑I am a homeowner and will be hiring contractors to sole conduct all work on my property. I will 11. [] Electrical repays or additions ensure that all contractors either have workers' compensation insurance or are proprietors with no employee`s. 12T .�]:Plumbing repairs or additions 5. ❑I am a general contractor and I have hired the sub -contractors listed on the attached sheet 13TI Roof Tepairs These sub -contractors have employees and have workers' comp. insurance.t 14.n Other 6. ❑ We are a corporatiori and its, officers have exercised their right of exemption per MGL c. 152, §1(4), and eve have no employees. [No workers' comp. insurance required.] *Any applicant that checks box #i must also fill out the section below showing their workers' compensation policy information. chdie su Homeowners who submit•this affidavit indicating they are doing all workth nthe hire outside contractors must b e of the sub contractors and state wheth rsu mi or not thoseentitf esh ve tContractors that check this box must attached an additional sheet showing comp. policy number. employees. If the sub -contractors have employees, they must provide their workers' ' compensation insurancefor my employees. Pelow is the policy and job site I am an employer that is providingworkers information. insurance Company Name: Expiration Date: Policy # or Self -ins. Lic. #: /J � /J J( 6 o G�eq � di1 C /�� City/State/Zip: �/1'!lo'©f��l' /moi Job Site Address: I the olic number and e; p r tion. date). Attach a copy of the workers' compensation olicy declaration page (showing p Y Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up too $25250.00 a 0.00 a fine of up to $ and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. Ido hereby ce> y under tliepains andpenalties ofperjury that the information provided shove is true and correct. —_3 / one_34- 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk d•. Electrical Inspector 5. Plumbing Inspector 6. Other Phone Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their empl'o`yees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual; partnership, association, corporation or other legal entity, or any two or more ofthe foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receivet'orr trustee 6f 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 opdrate a business or to construct buildings in the commonwealth for any applicaritwho has'notproduced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Pleasb fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees 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 maybe 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 IndustrialAccidenis. Should you have any questions regarding the law or if you are required to obtain a tiv6rkers' 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 "fob 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia t , 8/15/2016 21107 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/21107 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Date: August 15, 2016 This certifies that Roberto Cannella has permission for gas installation Upgrade Gas Lines per engineered drawings for entire campus in the buildings of BROOKS SCHOOL at 1160 GREAT POND ROAD , North Andover, Mass. Lic. No. 3953 ❑ ❑ ❑ o 1/1 T 10872 Date!!/. / TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..... L ... ) ..... P ... 6 ...... .................... has permission to perform ........ 75PrA. plumbingin the buildings of .... t ....................................................................................... ............................... -,,North Andover, Mass. Fee�P.P ... Lic. No.?....... ....... ...................................... 'PLUMBING/NSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - _ CITY . — -_ MA DATE PERMIT # JOBSITE ADDRESS _ � � OWNER'S NAME t; G 6 OWNER ADDRESS 1 0... _ _. _ _�. EL+ _FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL.. RESIDENTIAL PRINT CLEARLY NEW: t RENOVATION: (,� REPLACEMENT: PLANS SUBMITTED: YES ( NO[] FIXTURES Z FLOOR -4 BSM I 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 3 CROSS CONNECTION DEVICE - DEDICATED SPECIAL WASTE SYSTEM _J J _I DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER i DRINKING FOUNTAIN FOOD DISPOSER _ __. E _- __-_- -- _-------_.... FLOOR/AREA DRAIN INTERCEPTOR INTERIOR _ KITCHEN SINK - LAVATORY ---JI_ ROOF DRAIN i .J , SHOWER STALL _ SERVICE / MOP SINK - TOILET i ! URINAL WASHING MACHINE CONNECTION �.. _ _ __. _ .. _..__ r _ i ...._ ' .. WATER HEATER ALL TYPES -_ - WATER PIPING I- . _ 1 M-77- INSURANCE COVERAGE: I have a current Ilabiiity Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESV NOM.! IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND E] OWNER'S INSURANCE WAIVER: I am aware that the licensee dges not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws; and that my signature on this permit application +M aiyes this requirement. VAvid Ara,�"c,&rw CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. D" _ 0 ArR_ v a,k, -1 PLUMBER'S NAME [David .Aramburu- .. LICENSE# 1 SIGNATURE MPQ1 JPD CORPORATIO #�PARTNERSHIPO# LLC EY COMPANY NAME I CfeSfiNOO-d—M echatllCal. ICI_C ADDRESS CITYN. orthboro ------ STATE ZIP __...__0.'I..S.�Z_._ TEL F5.6.8.5.98-74.73-7-77= FAX _ . ... . _1 CELL��- EMAIL L salesfi%=st.Ogrlmachanical com- _ __ _ _ j I TOWN OF NORTH ANDOVER PLUMBING PERMIT FEES Fees adopted by the Board of Selectmen: 6.24-2002 , Effective 7.1.2002 1. Rate schedule for New Building, Additions and Alterations (Residential, commercial or Industrial & Education) 1/10`h of 1.5% of the estimated cost of construction or the minimum fee, whichever is greater. 2. Residential (One (1) permit per building/unit required) 4. Miscellaneous Fee Minimum Fee Electric or Gas Hot Water Heaters (Plumbing Replacement Only) $30.00 ea. Residential BackflowPreventers (Lawn Sprinkler & Sprinkler Head for Boiler (s) 25.00 ea. Commercial Backflow Preventers 60.00 ea. Capped Sewer Lines for Demolition 30.00 ea. 5. Special Fees Repair and Maintenance Permit (for condominium (s) Townhouse (s), Commercial, Industrial and Educational), up to two (2) plumbers, (must have licensed plumber on staff). $250.00 per quarter. Log must be kept for inspection when permit is renewed each quarter or as requested by the Plumbing Inspector. Other fees, if not listed, to be determined by the Plumbing Inspector and shall not exceed $250.00. The applicable fee will &able w ork begins out the pro Rmbil� Permit. 500,00 d —� U I q Minimum Fee Fixture Fee Single Dwelling $55.00 $5.50 Single Dwelling – Renovation to Existing 25.00 5.50 ea. Single Dwelling – Addition 25.00 5.50 ea. Condominium/Townhouse – Unit 45.00 5.50 ea. Replacement of Existing Fixtures Only 30.00 2.50 ea. Reinspection Fee 30.00 ea. 3. Commercial & Industrial (One (1) permit per building/unit required) Minimum Fee Fixture Fee Large Building $175.00 $5.50 ea. Large or Small Building Divided in Store, Office Office Manufacturing Units, etc. 85.00 5.50 ea. Additions Renovations 85.00 5.50 ea, Reinspecton Fee 30.00 ea. Per trip 4. Miscellaneous Fee Minimum Fee Electric or Gas Hot Water Heaters (Plumbing Replacement Only) $30.00 ea. Residential BackflowPreventers (Lawn Sprinkler & Sprinkler Head for Boiler (s) 25.00 ea. Commercial Backflow Preventers 60.00 ea. Capped Sewer Lines for Demolition 30.00 ea. 5. Special Fees Repair and Maintenance Permit (for condominium (s) Townhouse (s), Commercial, Industrial and Educational), up to two (2) plumbers, (must have licensed plumber on staff). $250.00 per quarter. Log must be kept for inspection when permit is renewed each quarter or as requested by the Plumbing Inspector. Other fees, if not listed, to be determined by the Plumbing Inspector and shall not exceed $250.00. The applicable fee will &able w ork begins out the pro Rmbil� Permit. 500,00 d —� U I q i�7/12/2016 20876 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20876 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Date: July 12, 2016 This certifies that Steven P Carr has permission to perform install 2 new treatment room sinks, toilet, lavatory ,shower, water cooler, kitchen sink, dishwasher, ice maker and 2 floor drains plumbing in the buildings of BROOKS SCHOOL at 1160 GREAT POND ROAD, North Andover, Mass. Lic. No. 15366 1/1 `\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT T4 PERFORM PLUMBING WORK . , CITY N b Nd1 MA DATEb PERMIT JOBsi t'E ADDRESS jI Q T�DoN�J �O OWNER'S NAME �ov/ls oe OWNER ADDRESS I 4o TEL. d6 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL CLEARLY NEW: 0 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 1fl 11 32 i3 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GASIOIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY MATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER �- .. DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR •KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL ...__ .. - ERVICE f MOP SINK TOILET URINAL " WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _. WATER PIPING _ ... OTHER S,N INsl�RarlcE covERa�e: I have a currenthabil' insurance policy ar its substantial equivalent which meets the requirements of MGL Ch, 142. YES 7, 1 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Fj BOND 0 OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Lavas, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT I hereby oertify that all of the details and information I have submitted or entered regarding this application are true rate to the best of my knowiedge and that aH plumbing work and installations performed under the permit issued for this application will be in compli With all Pertinent of the provision Massachusetts State Plumbing Code and Chapter 142 of the General Laws, PLUMBER'S NAME _Steven CarrLICENSE # 95366 SIGNATURE MP [] iP r-1 CORPORATION IEI#E PARTNERSHIP #=LLC [D#27150996 COMPANY NAME I SPC Plumbing 8 HeatingADDRESS 12 Concord SL CITY Methuen STATEMA ZIP 01844 TEL 978-815-3.936 FAX 978-20&1081 . CELL978.815-3936' EMAIL spephGyedzon.net The Commonwealth ofMassachusetts _, r1 Department ofl'ndt, strial Accidents 1 Congress Street, Smite 100 Boston., MA 021.14-2017 wwlw. mass gov/dirt Workers* Compensation Insurance Affidavit: Builders/Contractors!Electricians/Plumbers. TO BE FILED MTB THE PER.?+r1ITTING AUTHORITY. policant Information Please Print Le6ibiy Name (8usiness/Organizationfindividual): I C t I L) t'-'► &, -1- l Ad&es8:_� Z t'c 3•.i C i_, ' D J i City/ statelzip:p� iso i✓t ,-s 2 Mrd � � � `I � Phone k:—a(i �--� ! j _ -3 3 (- .are you an employer" "tci< we appropriate Dox: I . t ami espiayer witPtemployees full and/or part -tune).* 2.❑ t am a sale proprietor orpannership and have no employees working far tate in RV capacity. filo vvbrkcr' comp. insurance requirecl.j 3. ❑ I am a homeowner doing all vtnrk myself l'vo workers' comp. ins trance required. j ° 4.FJ I am a bonaem ger and will be hiring contractors to conduct all work on my properly. I will entre that all con Tactors either ave workers' compensation insurance a- arc sole proprietors with no employees. i am a e—feral contractor and I have hired the sub -contractors listed on tho attached sheet. Ther: sub -contactors ¢Zve employees and have woecc& cornp. irsu ance.t f 6.n We are a corporation and its of5cers have exercised theirrignt of exetrmtion per MCTL. e. #j 152, f 1(4), and we have n o employees. i No wvorkers' comp. insLm--tce requircd.I T3Ve of project (required): 7. New construction 8. Remodeling 9. [l Demolition 10 0 Building addition 11.❑ Electrical repairs or additions 12.02lumbing repairs or additions 13. Jr_1 Roof repairs 14. ❑ Other *Any applicant tlrzt checks box p 1 must also fill out the section beloi; shoMng their workers' camp..-asation policy information. ' Honteotivnets who submit this affidavit indicating they are doing an work and then hire outside contttacton must suis it a neve affidavit indicating such. =Contractors than check this box must attached an additional sheet showing the name of the sub -contractors a<.d state whether or not those entities have employees. if the suit -contractors have crnpioyaes; they mast provide thcir workers` comp. policy number. I ani an employer that is providing workers' compensation insurance for my employees Below is the policy! and job site information. Insurance Company Name: N o e— t o lie i P E E 5 a 1 s Policy g or Self -ins. Lic. r:a 3 9 4 4 Expiration Date: i Z IF I Job Site Address: & lm I 14-rJ 06 City/State/Zip: Amoavr-n Q/Tyr Attach a copy of the workers' compensation policy declaration page (showing the policy, number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 a�-id/or one-year imprisonment, )Misstatement ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A co may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Phone Y: and penalties ofperjury that the information provided al ove�is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Tovvn: Permit/License ## Issuing Authority (circle one): 1. Board of hearth 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone F! 6 X1. AM 1W Tann of North Andover, MA 20876 -Plumbing Permit- in Conjuncdon with a Building Permit ICommenial or Residentiall TIMFUNE ...... .. . .... Uar�iu� upcda��m'q.Lweu��, Tuesday, Jul 12, 2016 08:58 AM S.torais_i.m recemdYour request is in progress .- JuI12,20168:58 We'll let you know of any updates Na email. Feel free to check the Q — status at any time by coming back to this page. Plumbing Permit ReAM In Progress permit Fee vagelsmger "'47 Sttcr Academy 9y., W on Steven Carr 1160 GREAT POND ROAD, NORTH ANDOVER, MA rimer BROOKS SCHOOL Attachments (5 -OT1AN2100 I F-Tue-jul-I 2201612:57:.PDF Primary Contractor Search for your contractor using the search bar below. Either the Firm's Name or licensee 8 Is required. N— Plumber's (L Firm's t3uslnessl N FOCI 7 1'3ot6 LA , Uar�iu� upcda��m'q.Lweu��, Tuesday, Jul 12, 2016 08:58 AM 7/1/2016 20823 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.coml#/records/20823 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that SHAWN S FEUGILL has permission for gas installation Gas pipe furnace in the buildings of BROOKS SCHOOL at 1160 GREAT POND ROAD, North Andover, Mass. Lic. No. 16287 Date: July 01, 2016 1/1 31� AM R i Town of North Andowr, PAA INBOX shawn feugill glaaeg-M53 No acior r,quired... CD shawnfpnh@yahco.com Action that requires YOW attention will appear here 0 11 Aswffla st MEEPUM - - - ---------- ....... . Ed'a Pj RR -- - — – - ---------- Daft Created 2M2 160 GTAT P(M Fam I.m.5 This document was sent to the printer x T—ROSOMAIMS T.W�ll Friday, Jul 01, 2016 09:06 AM maCtt�rir� The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: f'C ci C/" 'Cr City/State/Zip: /t't fy L/e-1, i141 N 66-(f Phone #: �- X8'_60 9.31,5' 3 Arer1am employer? Check the appropriate box: Type of project (required): 1. employer with employees (full and/or part-time).* 7. ❑ New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8.Remodeling any capacity. [No workers' comp. insurance required.] 9. ❑ DemoIition 3_ ❑ I am a homeowner doing all work myself. [No workers' comp..insurance required.] t 10 ❑ Building addition 4.F] I am a homeowner and will be hiring contractors to conduct all work on my property. I will . ensure that all contractors either have workers' compensation insurance or are sole 11. ❑ Elec repairs or additions proprietors with no employees. 12: �, umbing repairs or additions 5. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. ❑ ' 13. [� Roof repairs These sub -contractors have employees and have workers' comp. insurance.1 6. FJWe are a corporation and its off�rcers have exercised their right of exemption per MGL c. 14. F1 Other 152, § 1(4), and we have no. ergployees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who snbmif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached. an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors fiave employees, ley must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company _k -i v- Sv -r .-, ce Policy # or Self -ins. Lic. #: PQ Expiration Dater: Job Site Address: /0 VO/— //6 & // Attach a copy of the workers' compensation policy declaration page (showing the policy number and ex iration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. 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 ins andpenalties ofperjury that the information provided above is true and correct Date- 7- - 6-01-3� 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone I 4 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 oMire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill -out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) 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 Depaftment of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor 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' compensatiod 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ��- � EP CERTIFICATE OF LIABILITY INSURANCE ATE (MM/DDIYYYY) P07/01/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Eric Jansen Hasbany & Regan Insurance Agen 254 Pleasant Street Methuen, MA 01844 HONE Ext): 978-685-3188 A/C, No): 978-685-9460 E-MAIL ADDRESS: erlC hasban .com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Utica First Insurance Company INSURED INSURER B: Guard Insurance INSURERC: Shawn Feugill INSURER D: Shawn Feugill Plumbing&Heating 11 Arcadia ST Methuen, MA 01844 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDYIYYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 5XIOCCUR PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A ART506212600 12/01/15 12/01/16 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2 00O 000 LICY PE�F—]LOC tHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB FCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I RETENTION $ $ B WORKERS COMPENSATION ND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N / A SHWC738831 05/26/16 05/26/17 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Fax 978-688-9542 CGRTIFICATF wni r1FR CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover AUTHORIZED REPRESENTATIVE Emily Crossman ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Location !Meg No. Dateco lei TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee vq ` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ A Commonwealth of Massachusetts Date Estimated Job Cost: 7<690, Plans Submitted: YES NO Business License # Sheet Metal Permit Permit Permit Fee: $ Plans Reviewed: YES NO ✓ Applicant License # Business Information: Property Owner / Job Location Information: Name: Name: , ; I�pr ��•c_�c. Q Street: Lq,.� Street: � � [ S City/Town: C �Qiy�� [ 060,17 City/Town: � Telephone: �� 9�Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2famil Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation. V HVAC V11 Metal Roofing KitchenExhaust System Chimney / Vents Provide brief description of work to be done: . `iii ♦ _ V � � �. INSURANCE COVERAGE: I have a current Iia_ biliiv insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yep-Ij No ❑ If you have checked Yes, indicate t type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 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 Owner's Agent By checking this boXD, I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Progress Inspections Comments Final Inspection Date Comments Type of License: By Master Title ❑ Master -Restricted City/Town ❑Journeyperson Signature of Licensee Permit # Elio urneyperson-Restri cted License Number: Fee $ [ _ El Check at wviw.mass.goy/dpl nspector Signature of Permit Approval 3 Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No NIA, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All wo kers performing sheet metal work onsite has valid Massachusetts sheet metal r p g ` license Vo e e son -to -a rentice ratios All sheet -metal workbemg performed with pr p e r,lourn yp x pp Fire dampers with access door properly installed and checked for operation - �/ Smoke and combination fire / smoke dampens with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doorsp p Y ro erl located (May also be verified by fire department during fire alarm testing) ` Smoke / atrium exhaust systems installed and operation verified May also be verified by fire department during fire alarm. testing) Stair pressurization systems installed (where required) and operation verified (May also O verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper 61dj anees, fire rated enclosures and essure testing required.-. xes<<:aiot� installs;::=iii. zequired 'oil equipment and -act penetrations in firC rdtc 1vAI -Y and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'•-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean -- properly sized filters installed (final inspection) Testing and Balancing report complete (final sign-ofl) / etal ecklist Detailed description and sketch of sheet metal system to be installed has been provided Allworkers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to- apprentice ratios Equipment sized per heating/ cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially. airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) r , / ^ t o r Announcements I Register for an Account I Login Need Help? For technical assistance in using this web application, please call the ePLACE Help Desk Team at .(844) 733-7522 a or (844) 73-ePLAC between the hours of 7:30 AM -5:00 PM Monday -Friday, with the exception of all Commonwealth and Federally observed holidays. If you prefer, you can also e-mail us at LPLACE_helpdesk@state.ma.us. For assistance with non-technical, please contact the issuing Agency directly using the links below. Contact Alcoholic Beverages Control Commission Contact Division of Capital Asset Management and Maintenance Contact Division of Professional Licensure Translation Information - Click Here Document Attachment: In order to upload required documents, this system requires Microsoft Silverlight which can be downloaded for free here. Convenience Fee: Please note there may be a convenience fee for all online credit card transactions. There is no fee for online payment by check. Home Manage Licenses, Permits & Certificates File & Track Complaints Please refer to the Licensing Entity's website for additional information regarding the status and discipline information shown below. For DPL information, please visit the DPL website. For ABCC information, please visit the ABCC website. Information Pertaining To: Sheet Metal Master 9717 Licensee Detail License Number. 9717 Licensing Entity: Board of Examiners of Sheet Metal Workers License Type: Sheet Metal Master Type Class: M1 License Issue Date: 04/12/2011 License Expiration Date: 01/28/2017 Status: Current Current Discipline: Other Discipline: Name: MITCHELL M MESSER Business Name: DBA Name: https://elicensiiig.state.ma.us/CitiZenAccess/GeneralPi-operty/L ic...LicenseeNumber=9717&LicenseeType=Sheet%20Metal%20 Master 8/1/16, 9:11 AM Page 1 of 1 ACOR 7 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FIAI/Cross Insurance 1100 Elm Street Manchester NB 03101 NAME: CONTACT Judith George CIC, CPIA, CPIW PHONENo, (AICExth (603)669-321$ IFAX /C No:(603)645-4331 NC, AIL ADDRESS: 7george@crossagency.com INSURERS AFFORDING COVERAGE NAIC # INSURER A Travelers Property Casualty Company 25674 INSURED Mitchell Messier Dba M J Mechanical 39 Lazarus Way Salem NH 03079 INSURER B :The Phoenix Ins Co 25623 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 GL & BA REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL BR POLICY NUMBER MNWD EFF MNMIDD/Y XP LIMITS North Andover, MA 01845 R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE a OCCUR NTED SES EaGE Eaawrrence $ 300,000 PREMIS MED EXP (Any one person) $ 5,000 6808559A02A1542 8/18/2015 8/18/2016 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Other Insurance Additional $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED S SCHEDULED AUTOS AUTOS BA8559A49715SEL 8/18/2015 8/18/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Pera.Zt $ NON -OWNED X HIRED AUTOS AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N PER TH- STATUTE 7TOER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ IF yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION dbelanger@northandoverma.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover, MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE Suite 2035 North Andover, MA 01845 J George CIC,CPIA,CPI ACORD 25 (2014/01) INSn25 rgmantl ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE 06/14/2016YY1t7 06/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s)- PRODUCER CONTACT NAME: P&0% M: (13M 362-67a5 (FAX No): (8M 677-0447 PAYCHEX INSURANCE AGENCY INC 150 SAWGRASS DR ROCHESTER, NY 14620 E-MAIL ADDRESS paychex@travelers.com INSURER(S) AFFORDING COVERAGE NAIC # (877) 362-6785 INSURER A : THE PHOENIX INSURANCE COMPANY MED EXP (Any oneperson) $ INSURED INSURER B: MJ MECHANICAL INC INSURER C : 39 LAZARUS WAY INSURER D: SALEM, NH 03079 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 826912609090661 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY C CLAIMS -MADE r—] OCCUR EACH OCCURRENCE $• DAMAGE RENTED PREMISES Ea occurrence $ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ rOLOAGGREGATE LIMIT APPLIES PER: PLICY PRO ❑LOC JECT THER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS (ElaccidentNED ) LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Pj30PERTY DAMAGE ( er accident) $ $ UMBRELLA LIAS EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A UB -2666P718-15 11/15/2015 11/15/2016 X STATUTE ETH E.L. EACH ACCIDENT [$100,000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required) 1 C flULUr-M NORTH ANDOVER BUILDING DEPARTMENT 1600 OSGOOD STREET, SUITE 2035 NORTH ANDOVER, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE L/1` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 10671 This certifies thal,../ tl� Date .f/(-`.�........ TOWN OF NORTH ANDOVER has permission to perform..../ plumbing in the buildings of PERMIT FOR PLUMBING ................... .............................. at./ .............. ............ j� . .. ... . North Andover, Mass. Fee.70C. Lic. No. 69 . . ............................................................. PLUMBING INSPECTOR Check #,. 56Y P MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ? i MA DATE kA o't Z. 6 PERMIT # JOBSITE ADDRESS 1.1 6 a c t�ar+.� OWNER'S NAME'�,rC A TEL OWNER ADDRESS FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL ? RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:I REPLACEMENT: PLANS SUBMITTED: YES ' NO FIXTURES Z FLOOR- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS -CONNECTION DEVICE ° DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM t_ , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM._ DEDICATED WA; ER RECvrL �E SYSTEM $�" ;.I--�`:., t-" � . f..�.."...1 _ DISHWASHER DRINKING FOUNTAIN` L FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY.. .. _._._ ....__ ROOF DRAIN SHOWER STALL T SERVICE I MOP SINK TOILET ( y i URINAL WASHING MACHINE CONNECTION I WATER HEATER ALL TYPES F 7 _ WATER PIPING OTHER _._,.�L, ... _� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1421 YES rVf NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY rte_ 30"JD 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 E] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the A of my kn wledge and that all plumbing work and installations performed under the permit issued for this application will compliance vvn' ertinent pr 'sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMED c, k .! 5� LICENSE # aA 77 SIGNATURE MP JP CORPORATION # 'a? 3 PARTNERSHIP€ # LLC J# COMPANY NAME'1'. (� , q Q �{ C ,� n C. r ADDRESS, ! • �.Q� YSe1 % n 6T� ._ p 1rQ.... .. STATE TEL 19 ' G �- Oo el - CITY ZIP 7 FAX ° - bFCELL� � EMAIL 619 91Sr-39� c C0Mc4 3 ,i "� F s., 0 t 1 t 4� Date ... F ..6 ..1Y TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation(........... !!:..°:........................ in th/e building...................................... .................... s of ., at ... .............. , North Andover, Mass. Fee.& .. . .... Lic. No. ............................................... GAS INSPECTOR Check # 36V f 60So I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK A d PERMIT # CITY t�«V.1,x« .r �_...r MA DATEv ,. JOBSITE ADDRESS ?w� 6d �cCcn 0 ex OWNER'S NAME OWNER ADDRESS h. b_v rte.. n TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT , . RESIDENTIAL , CLEARLY NEW: RENOVATION, REPLACEMENT PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8• 9 10 11 12 13 14 BOILER g w...aw.mw. Rww..rrr �< .r. ga n...<.«ixi .....w.r.,..a. r.r..u...+Ymw.w.,......rr B®OSTER I ( ft w I mr.m, CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER 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 liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES"�ln NO t I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY IXC OTHER TYPE INDEMNITY s< 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. C _ . SIGNATURE OF OWNER OR AGENT HECK ONE ONLY: OWNER AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate est of my kn wledge and that all plumbing work and installations performed under the permit issued for this application will be in =prntheMassachusetts State Plumbing Code and Chapter 142 of the General Laws. e w�n PLUMBER-GASFITTER NAME LICENSE #j.Z7 7 SIGN TURE MP MGF JP JGF E LPGI' CORPORATION # a7� 3 PARTNERSHIPS # ; LLC' #' COMPANY NAME:. ;q PX , ADDRESS �{ S 1 CITY r STATE' ZIPMD z7- TELA FAX�j9 i.Z7oZ $ CELL%T8% 3 3 7 REMAIL • Y. �..m��x. _.P i 4S__pC __ �OM_cG��S !l doa V Ll 'A 0 n Mr. Commonwealth ofHassaclaasetts . Deparbuentof. ndus%inlAceldde is Office of ffivestigations 6`©0 Wasfiington Street -Hoston, .MA 02111 wwlp.Maass gov/cir'a Wo rkex;,' Compensation bsurance Affidavit: Buffders/Contractors/Eleetriczawlt l*bers Applicant In rmafio . PXoase Print Leri .1y Name (Business/Organizationft0iduai): Vd lm,s I ��111'�61r'1��11f D.1 Address: p City/Slate/Zv ��'m6b6y5, d J �l �7 phone 4: / %t� � �� 9 6 6 Q " Are your art employer? Chetfiheappropriatebox: 1 I am a employer with. b 4. El I am a general contractor and S employees(i�alland/orpart )eiam * have hiredthesub-contractors listed on the attached sheet: � 2. Q lama a sale proprietor ox parEnez . - ship and :haveno- employees These sols-coniractorshave working for me in any capacity. workers' comp. insurance. 5. ❑ We ate a corporation and its [No workers' comp. insurance officers have exerolsed.their required.] 3. El I am a homeowner doing all work right of exemption per MGL myself [No workers' comp. c.152, §1(4), andwehavano employees. [No workers' insuranc€;requued.] ? comp. insurance required.] Type of project (required): 6. [ New construction f 7.19zlemodeling 8. Demolition 9. [] Building addition 10.❑ Electricalrepaixs ox additions 11.[] plumbing.repairs or additions 12.P Roofrepairs 1311 Otlier ;Any applicant that checks box#i must also fill ouithe seetion below showingtheir workers' compensation policy information. Homeowners who submit this affidavit indicatingthey ire doing allworlc andthen hire outside contractors must subm t anew affidavit indicating such. xContractors that chmkthis bo�mustattached art additional sheet showingthe Hama ofthe sub: contractors andthekworkers' comp. policy information. arta are emproyep that 1s ps'ovid1fig wo,-Jf'e.,s' competasatzon zrasurance foxY�y employees Borah 1s &epolicy afid job site information. i 1 (1 9 Insurance Campany Name:. MY ` U CLQ F Q /� = t— Rolicy # or Sem ins. LIG. #' �b �XJ C� \� / Expixatxort Date: (5 lob Site Address' f�lto ��Q�if6,ndloc�A" ity/state%gip: r-0 i 6 A{iat h a copy of tyre workers' compensatron-p olley declaration. page (Showing -the policy number and expiration date). Failure to secure coverage as xequixecxunder Section 25A. ofMOL o.152 can lead to the imposition. of eriminalpenalties of a fano up to $1,500.00 and/or one-yearimprisonment, as wellas civilpenalties in the foxm of STOP -WORK ORDER. and a tme ofupto$250.00aday againsitheviolator. Be, advised that a copy ofihisstatementmaybefoxwardedtothe Officeo£ Investigations of the D)A. for insurance coverage verifleation. do Hereby dei tliep *us and p rtie.s of pevjusy tliat trio information proviried a��Ye is ,ue/antico� ect. I Of use 0.n, Do riot w1ite in tlais area, to lie completer)by city or towxx official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. BuiidingDepartment 3. CitylTow>a Clem 4. Electrical Inspector 5. Plumbing Inspector f. Other - Ci Information an d Instructions Massachusetts General Laws chapter 152 xeq*es all. employers to provide workers' compensation for their employees. Pursuaait to iht`s sfatuufe, an e�npToyee zs defined as " ry poison tui the service o£ another under any contract ohire, exPress or•implied, oral orwxiften." .A.n. eW10y0s defined as "an individual, partnership, associaff.04, corporation or other legal entity, or anytwo oxmoxe of the Foregoing engaged in ajoint enterprise, and iucludingthe Iegalxepresentatives ofa.•deceased empla receiver yex,.or lite er ofrdstee of an individual partnership, assooiat�ion or other legal entity, employing employees. )Sowever the owner of a dwelling house having n.otmore than three apartments and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction. or repair work on sucli. dwelling house or on the grounds or building appurtenant thereto shallnot because of such employment be deemedto be an exaployez:" MGL chapter 152, §25C(6) also states that "every state or local liceusiug agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth fox any applicant who has not produced•acceptable evidence Of Compliance with the insurance coverage required:' Additionally, MGL chapptex 152, §25C(7) states "Neither the eommmonwealth nor au of Its polit! cal subdivisions shall enter into any contact forte performance ofpublicwork until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresentedtatheconixactingauthority.." Applicants ' Please M out the workers' comp ensaRou affidavit completely, by checking the, boxes that apply to your situation aud, if iiecessaxq, supply sub-confractor(s) name(s), addresses) andphone nutnber(s) along with their cerfficate(s) of insurance. LimitedLiabiliVCompanies (LLC) or Lim1tedUdbilifyPartuerships (LLP)withno employees otherthaathe members orpartners, arenotrequixedto caxryworkers' compensationiusurance, IfanLLC c LLP doeshave employees,apolicyisreq*ed. Be advisedthatthisafddavitmaybesub mittedtoiheDepartmentofIndustrial Accidents for conffimagon of insurance coverage. Also be sure to sign, and date the affidavit The affidavit should be xetuunedto the city rn town ihatih0 application for thepexmit or license is being requested, not the Dq�aximent of 7ndusfra.I Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation.policy, please call the Department at the number listed below. Self insured companies shouuld enter ihDir self insurance license number on the appropriate line. City ox Town Officials Pleasebe sure thatthe afizdavit is complete andpxinted legibly. The Department has provided a space atthe bottom of the affidavitfox you to fill out in the event the Office of Snvestigations has to confactyouregarding the applicant. Please be -sure to jM inthe pemeit/license number wMchwM be used as a reference number. In, addition, au ap�piicant thatmust submitmuliiple permit/license applications in any given year, need only submit one af(xdavit indicating cant policy information (ifnecessary) and under "Jab Site Address" the applicant shouuldwrite "alc l loations in (city or towo):' A copyo£6ieaffidavifthathasbeenofficiallystampedormarkedbythecityortownmaybepxovidedtothe applieantasprooftkatavandafCdavit•isonfile;foxfatmepexmitsorlicenses. Anewaffidavitmuistbefilledouteach year Where a home owner or citizen isobtaining alicense oxpermitnotxelatedtoany business orcommercialventuxe Q.e. a dog license o4mmit to burn leaves etc.) saidperson is NOTxequhad to complete this affidavit. The Office of l nvesi gations would like to thank you in advance for your cooperation and should you have any questions, please do not: hesitate to give us a call. The Department's address, telephone aad fax numb or: cpaten oSnduxzlccai off o -e o edtz a 600 Wa *n. ftcx � .BUstQn, 02111 T01 617 -7 -217 - Revised 5 -26 -os FaX 61742MM • �.x�ta�,g4vl�c�a ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/30/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Appletree Insurance 33 Indian Rock Road Bldg. 5 Ste. 3 Windham, NH 03087 CONTACT NAME: PHONE(603) 881-9900 AIX No: (603) 594-9840 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: NATIONAL GRANGE MUTUAL INSURED INSURER B : INSURERC: J. DIAS PLUMBING, HEATING I USURER D & COOLING P.O. BOX 452 INSURER E: TYNGSBORO , MA 01879 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD/Y POUCY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MPT309ON 5/3/14 5/3/15 EACH OCCURRENCE $ 1,000 000 DAMAGE TO RENTED PREMIE Ea occurrence $ 1,000,000 EXP (Any oneperson) $ 10,000 —MED PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER POLICY PRO- LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS _ AUTOS B1T309ON 5/3/14 5/3/15 COMBIcNEDSINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ eraccident UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N04UMB072414 7/24/14 7/24/15 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTNEN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A WC STATU- OTH- TORY ITS I FR E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) tTHE TOWN OF NORTH ANDOVER IS AN ADDITIONAL INSURED. WAIVER OF SUBROGATION APPLIES. CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: d.diasphc@comcast.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: d.diasphc@comcast.net ® DTI FICATE OF LIABILITY INSURANCE Roci 7i23/2014 CE IGHTS UPON THE THIS CERTIFICATEIS ISSUED AS A MATTER ROF NEGATIVELY AMEND, EXTEND OR ALTERMATION ONLY AND CONFERS NO THE COVERAGE AFFORDED BY THE POLICIES S CERTIFICATE DOES NOT AFFIRMATIVELY O BELOW. THIS CERTIFICATE OF INSURANCE AND THE O CERTIFICATE CATESHOLDER. CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER, endorsed. if IMPORTANT: If the certificate holder is aanA ADDITIONAL may require antendorsemhe (ent A statementies) must on his certificate doe® nlot confer Drights ,to the the terms and conditions of the policy, certainpolicies certificate holder in lieu of such endorsement(s). coNTACT AUTOMATIC DATA PROCESSING INS AGCY 250717 P: F: PO BOX 33015 SAN ANTONIO TX 78265 INSURED J. DIAS PLUMBING HEATING & COOLING INC. PO BOX 452 MA 01879 PHONE I(A/C, No): (AIC No EA) E-MAIL ADDRESS. INSURER(S) AFFORDING COVERAGE wsURERA. Hartford Fire Ins CO INSURER B : INSURER C INSURER D INSURER E : INSURER F: NAIL# TYNGSBORO CERTIFICATE NUMBER: REVISION NUMBER: COVERAGES ,A, DUCK IcsIIFn Tn THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE PULIIItJ Ur nvaurvvl �� - INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I ADO7. SURR POLICY NUMBER POLICYEFF POLICYEXP LIMITS INSR TYPE OF IN1'URANCE I WVD MM/DD/YYY I L TR BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _ AUTHORIZED REPRESENTATIVE FTHEOWN OF NORTH ANDOVER OSGOOD ST EACH OCCURRENCE $ NORTH ANDOVER, MA 01845 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) g $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER' POLICY PRO LOC JECT PRODUCTS - COMP/OPAGG $ 1 $ OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I (Ea accident) $ BODILY INJURY (Per person) S ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOSWNED PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE y DED RETENTION $ n'ORKERS C'OMPENS'A TION AND EMPI.OYER.S' I.L4RILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1, 0 0 0 , 0 0 0 A OFFICER/MEMBER EXCLUDED'IF-1N/A (Mandatory in NH) 76 WEG JY9686 05/03/2014 05/03/2015 E.L. DISEASE -EA EMPLOYEE 11,000,000 If yes, describe under E.L. DISEASE - POLICY LIMIT 11,000,000 DESCRIPTION OF OPERATIONS below ---j I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. ll Ii00-1V 14 MV%inu N{,l RB"VR/'1I IV1\. M11 11911W ICJCtltlCU. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _ AUTHORIZED REPRESENTATIVE FTHEOWN OF NORTH ANDOVER OSGOOD ST NORTH ANDOVER, MA 01845 ll Ii00-1V 14 MV%inu N{,l RB"VR/'1I IV1\. M11 11911W ICJCtltlCU. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD NOV-07-2014 10:09 From:xerox 1 978 649 0028 To:9786889542 P.2/2 J 4 s PO Box 452 Tyngsboro, Ma 01879 Phone: 978-649-0027 Fax: 978-649-0028 To Jim Hurley This letter is in reference to gas permit # 9439, BP # 099-15 on 7/29/14. Address of permit for gas installation is Brooks School Ashburn Chapel 1160 Great Pond Rd North Andover, Ma. l Jonathan Dias of J.Dias Plumbing Heating & Cooling Inc, Massachusetts master plumber license # 12788 request that this said permit be amended to cover the gas piping portion only of said project for which the gas permit was acquired. Furthermore J.Dias Plumbing Heating & Cooling Inc has in no way installed any portion of the intake or exhaust piping for the Lochinvar KBN 601 gas boiler at said project location, and claims no liability to installation, performance, inspection, competence or quality of said installation. Thank you for your time and consideration in this matter. Jonathan Dias, President J.Dias PH&C Inc. NOU-07-2014 10:09 From:xerox 1 978 649 0028 To:9786889542 P.2/2 4 PO Box 452 Tyngsboro, Ma 01879 Phone: 978-649-0027 Fax: 978-649-0028 To Jim Hurley This letter is in reference to gas pen -nit # 9439, BP # 099-15 on 7/29/14. Address of permit for gas installation is Brooks School Ashburn Chapel 1160 Great Pond Rd North Andover, Ma. I Jonathan Dias of J.Dias Plumbing Heating & Cooling Inc, Massachusetts master plumber license # 12788 request that this said permit be amended to cover the gas piping portion only of said project for which the gas permit was acquired. Furthermore J.Dias Plumbing Heating & Cooling Inc has in no way installed any portion of the intake or exhaust piping for the Lochinvar KBN 601 gas boiler at said project location, and claims no liability to installation, performance, inspection, competence or quality of said installation. Thank you for your time and consideration in this matter. Jonathan Dias, President J.Dias PH&C Inc. U-07-2014 10:09 From:xerox 1 978 649 0028 To:9786889542 To: r /Irn From. ./U4 C, Fax: Ya pages; Phone: Date: Re- rr. Ur9ent X For Review ❑ Please Comment X Plca5 RCPIV 0 Please Recycle L E' �` nnU j� vL) /lee XO Deborah Dias J DG.,Is Pijfnj�j,% jq(:!�Ihpq & CC,61 j 1�1'3 I'nc. -1 Industrial Way Unit I Tyngsboro, MA 01879 F- 978-649.0027 F 978-64,9-0028 Lid I a S.p O��d C L)t LI C, o t. ri c- t P. 1/2 PO Box 452 Tyngsboro, Ma 01879 Phone: 978-649-0027 Fax: 978-649-0028 To Jim Hurley This letter is in reference to gas permit # 9439, BP # 099-15 on 7/29/14. Address of permit for gas installation is Brooks School Ashburn Chapel 1160 Great Pond Rd North Andover, Ma. I Jonathan Dias of J.Dias Plumbing Heating & Cooling Inc, Massachusetts master plumber license # 12788 request that this said permit be amended to cover the gas piping portion only of said project for which the gas permit was acquired. Furthermore J.Dias Plumbing Heating & Cooling Inc has in no way installed any portion of the intake or exhaust piping for the Lochinvar KBN 601 gas boiler at said project location, and claims no liability to installation, performance, inspection, competence or quality of said installation. Thank you for your time and consideration in this matter. Jonathan Dias, PreskLent J.Dias PH&C Inc.