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HomeMy WebLinkAboutMiscellaneous - Osgood Street (2)This certifies that ... ...... has pen-nission to perforin 4A -S... 1r-7q1r. A& ............ wiring in the building of .... M 4kl D174 ................... at -57 7. �9—SlqOV ...... North Andover, Mass. �0' Fee U ...... Lic. No... Check 4 ELECTRICAL INSPEC� R/ 11324 S LI�N Commonwealth of Massachusetts a Department of Fire Services. BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. i I !i i Occupancy and Fee Checked tev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: 1-1 • cPO . )2 - City 2City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gds notice of his or her intenti n to perform the electrical work described below. Location (Street & Number) Owner or Tenant r4 3.1 L 61 n Q ra Telephone No. WORK Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility. Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed EIectrical Work: 6A3 Foe 1.1clGrz u.uwau uut- j u , — . y.... -- -� ---- -- - Estimated Value of Electrical Work: .j ®� (When required by municipal policy.) Work to Start: a '�o� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEBOND ❑ OTHER ❑ (Specify:) I certify, under the ains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: - 14��//�"1 �i f�O Vy n 0-�A N ECEG7/Z1- C -L LIC. NO.: Licensee�J`i tES I�- Ly -/0 u VI � -; �4 N SignatoLTC. NO.: fIf applicable, enter "exempt" in thePo. ense ni er line.) y(� Bus. Tel. No.: Address: 65—Lewezc dRTt-e t4D-� Nc a . 01 �6 y Alt. Tel. No.: *Per M.G. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent- Owner/Agent I PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A pen -nit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and, long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed:** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed L Re- Inspection Required ($.) ❑ Inspectors Comments: - Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: ' Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL, INSPECTION: Pass Failed 0 - Re- Inspection Required:($.) ❑ Inspectors Comments: Inspectors Signature. Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 ,Y www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): Ah E S KQ tf'Yo v vz ;a,,Z14 t,4 Address: 65- [you, el- City/State/Zip: L City/State/Zip: )J' 1 tkar &y, N . 0 j Lsf 6 y Phone #: �9 ) ' � G 6 -15 a I a Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. El am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have ,forking for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3.E:1 I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy andjob site zformatioii. isurance Company Name: olicy # & Self -ins. Lic. #: Expiration Date: ib Site Address: City/State/Zip: Itach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine F up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of tvestigations of the DIA for insurance coverage verification. do hereby certify undpns and penalties of perjury that the information provided above is true and correct. N .lone L7 a Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. \ However the Vol owner of a dwelling house having not more than three apartments and who resides therein, or the occupant, of the S. 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 I Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have an questions regarding the law or if you are required to obtain a workers' Y any g g Y q compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. a; , The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 evised 5 -26 -OS wwW macc anv/din f 2085 �Nol 0 4L Date ..... //S—/ ..(� TOWN O,F NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ........... * t * '* 'C- ********* has permission to perform ......... ......... wiring in the building of ... D< .... 0 ..... ....................................... Q.5,�jdjc� �l (—`)/2... North Andover Mass. 7at ...... ........ ... 9 Fee ...... Lic. No. .. .................... ��ELEcrm WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �i ThHE09MA'IONWFALTHOFA AMCHUSiE77s Office Use only �/ DEPARTAMI TOFPUBLIMFETY Permit No. l 5 BOARDOFFMPREVEM ONREGULAHOAS5VCW?12-00 Occupancy & Fees Checked APPUCATION FOR PERMIT TO PL MFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DatS_ > Town of North Andover To the Insp or of Wires: The undersigned applies for a permit to perform the electrical work described below. A (--4— Location (Street 6 Owner or Tenant Owner's Address ��� Is this permit in conjunction with a building permit: Yes M No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground a No. of Meters New Service AmpsVolts Overhead Underground No. of Meters Number bof Feeders and Ampacity Location and Nature of Proposed Electrical Work Ni. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA groundg1:1round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Btnners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cend. Total Tons – No. of Detection and No. of Disposals No. of Heat – Total Total Pumps Tons KW Wtiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. oiDryers Heating Devices KW _ ® Connections ® No, of Water Heaters KW No. of _. No. of Bailasis No. fTydro Massage Tubs No. of Motors Total HP OTHERCC .• e - - . 4145r' : :. a I . ;:i; .� . a I'Maiw9lo 1116 il I -Ill Sol.. :r it .1. • ee r e i lir '.i• • e • :• :. U., 0 M.--•I•C.:' 1 • r •• _ . • :••• .er It +. of ••..ue 1c Now, fill no* M11" " MI 044- e FMMNAME c Lrmm � r�urQ� Sis�>atlue I�ca>seNo Btsir;essTeLNa Arlrir�c_—�..�4 A 1,0 e--��`-- OWNER'SiNSURANC� WAIVM l amawatethatthe�� atdfiatmysigtr�taernthispetmita�p&�atwai�esdus tec�msrr�rt. (Please check one) Owner ® Agent ® AkTeLNa testedbyMmx�imsGanalLaws Telephone No. PERMIT FEE N-1 7 TINA"s(2-�we�. j14Dt9Y -- . 448,1 SCENIC EA SEMEN T .OT 2 LQI 3 - LOT 4 45742 S.F. °1 1.05 Ac. CD rn 324. I'l EXISTING OPS FP FOUNDATION 31.99' � � r v TII_ITY EASEMENT " 150.00' 73,62' ..I 57,52, 01-20'47"W oF tir,� 03,48' STEPHEN M, GOOD I L. G 1 <) MEI�:SGUC E WIDTH} No, 59049 LIC -- VARIABL 1911 a,H1,0. a� V 4wn Ski WE HEREBY CERTIFY THAT WE HAVE EXAMINED Si �� THE PREMISES AND THAT ALI. APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY, IT WAS PREPARED TO THE ZOWNG LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND P,ECORCS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LCCATEO F.E.M,A./H,U,D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY, THIS PLAN COMMUNIT7 PNEL N0, 250098 0005 C SIIi11u A NnT RR iiacn Ana DIDr1raCD7V LINE�DETERMINATION V P�ATCI\ R A'2 T„' nrn„nv inr , ,cv v� d.; w nu. �IAw,-ft-Im ,a ivOi LVI. ON IMu IN AN ESTABLISHED 100 YR, FLOOD HAZARD ZONE, CERTIFIED PLOT PLAN LOT 3 OSGOOD STREET; MARCHIONDA & ASSOC.,L.P. NORTH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR BROOKVIEW COUNTRY HOMES s2 ON Mf AVE, SUITE I STOPJEHAAM, MA, 02180 P.O. BOX 531 (617) 438-6121 NORTH ANDOVER, MASS. SCALE: 1"=40' DATE; 9/8/99 Location 6,57 ��6 000 Sf CID, �/ / C) No. Date ,40RTN TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ B ilding/Frame Permit Fee $ u Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /2 33 '13578 �,, /",I/ Building Inspector rN T 0 u p u V z \ t W z ;z `Ll z z < W Z L C ` U Q 3 J X f1LLI C � 3 vi < �n t �2 ? } z n W W T N z z Z Z_ Z LL, — p u V \ t W z M `Ll z z < W Z L C ` U Q 3 J f1LLI C � 3 vi < �n z Z b_ o Ae x .. - 9© m a i z z z- :: b In zz n < n `w Z C O V U V W W W v) — F- Z `9 Z Z Z W cr n :n n n — p u V t W \Y M `Ll a W Z L C ` U M f1LLI � � J Z b_ o Ae x z — F- `9 W cr — N W < aj ¢ ¢ m Z t W \Y `Ll a W Z L C ` U FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all —necessary approvals/permits from Boards and Departments having. jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*******'*************** APPLICANT C l/ c v c o� -. c m1 - PHONE S ' LOCATION: Assessor's Map Number PARCEL 6 SUBDIVISION �5 0 0o S Tr c c_ LOT (S) 3 -qTPFFT 51doIP 5 -le c r ST. NUMBER *************************************OFFICIAL USE AcS Mv, RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm 16 -711 -Vo DATE - DERA IKENT OF PUBLIC SAFETY{, CONSTRUCTION SUPERVISOR LICENSE Numb�F = Expires: Birthdate pp' � + B1b6$3 61�L3�2080 01f13�1954 tJc x r-wr ( I- j '` Rest��bte6 Toy r 00 U j ``' BpVIU A KINDBCD NIL[ POND POBX ;531 1 N AKDOVER, NA 01845 156635 RestrictedITo: 00 00 - 35,00 cf enclosed space { (N6 C.112 S.601) IA.- Nasonty, only 16 - 1 6 2iFamily �Hopes ' failure to ;possess a current edition of the Massachu'selts State Building Code. is cause for revocation of this license. The Commonwealth of Massachusetts Department of Industrial -Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name 77 K - © v - /o T Please Print Name:-7�O r y e to A T-/ Location: � � �O -5-311 Cib/ / v �N�o✓c Phone # V/8 g ElI am a homeowner performing all work myse!f. I am a sole proprietor and have no one working in any capacity C� I am an employer providing workers' compensation for my employees working on this job. n � 0 moan nv name: CI Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties cif a fine up to 31.500.00 and/or one years' imprisonment as we!] as civil penalties in the form of a STCP WORK ORCER and a fine of (5100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the GIA For coverage verification. I do hereby certify unct e pains Signature Print nam ofPgrfury that the infcrmatien provided above is true and correct. Date c} Phone #&-"- Official use only do not write in this area to be completed by city cr town crucial' City or Town PermitlUcensina ❑ Building Dept Licensing Board Selectman's Office Health Department Other ❑Check d immediate response is required Contact person: e' w Q x O CA v U u G° E T- (n a cn OUW C z ,. z QQ O ca w C4 T G C U cz G w CL W a -C � G w � W W a0' v v cn C w U w C/) Q LSO. 0L G uz W Q w L4 C ` m z cn O E cn 0� C) -i m Ca CO O z �® im w CD .E Ca Ca CD Q _� CO3 O C O V �! 0 CD CD O ® .� os � C O O Z C3 y C ui 0 U) LLJ0 w W crW LU V) 'nuc 0 o � ♦ C N O C Cj C� m� o—CCD� N rm C m ice.. . N C o m •cam C" c ® CL= E a m m a cm N C :2 m O A : L C N m N m m � rn 20 ,t oc is 40 m CJ �x o` ecv E C N Q O p N m �O„ CO) Lu R 4 c CO)at ac E V� V N Z o ui L) m O E C W d m '� O M.5 m a 0� C) -i m Ca CO O z �® im w CD .E Ca Ca CD Q _� CO3 O C O V �! 0 CD CD O ® .� os � C O O Z C3 y C ui 0 U) LLJ0 w W crW LU V) LLaS169 NOW csnq SV8TO dW `JOAopud 'N 66/919 =10100 LOOSO M ' fm 'iS Poo�lSO Fwd uol tXmo4 :96od 399 xoe 'o'a 3�inW3s JNI1�H1la hHmoi,d paaputM piAeQ *SJVY lg 'Jw P91PufS1 a^oa SMI a -jW ',sgwnN 6vlmoi4 .9-.6 .O -A .9•.6 .o -.t .9•.6 .6-.L • N r --------------------------------------------------------------- yy I -------- ------------------------------ i of f f 1 a°s3 i f W d P: Id i i b f f eI i ► i B f ArA .4.41 .9-.9 �. L i ► I b .0I i .9 1 'v Ey a a ------�- • ----_------�---; °------------------------------ !_ -- - - -------------------------- ----- t E a J l -- -- F ! 1 1 �ad .,� p � i .► i W ' •. t ---------- -- -- ------- M-: M iii j t I 1 _ m ' � _ 1 • i --- ------ _• f 1 .► j j 1 1 Z i i O rn 75 dlj ; I I O j j � tw 6 b� ! ►' i 1 0 „t t fid_ ' i 1 of t 1 Yo. 9 1 a 7ttv a t Noles�auvala i 1 1 � i � fw f �• f 1 1 t� ` i `• i 1 I i\ i r j CI f I 1 .� I I `\ ' v`Ari .• ^ P 1 I I i i i; �ro.olMsts►atial� rn i .Q'.S 1 v , LL ------------------------------ ___________ ------- --- J 1 V _.-----------------------•-----•-------------•----•-•-- .._-..._--__-_�_ ___•-___•___•_-_-___ J ON &.9t b Location No. 3,5 Date F) 1 ho /9. TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ cmus Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ /0S Building Inspector 1'06 3 3 3 Div. Public Works �A AAr Location.1, No.' Date 7/2 �A5 Of "ORTH TOWN OF NORTH ANDOVER 6 6 0 9 Certificate of Occupancy $ 6 01 lot t Fee $ Building/Rame Permi Foundation Permit Fee Other Permit Fee Sewer Connection Fee Water Connection Fee s X6 TOTAL $ Xd' Insp or- ICII, /99-14:36 1,935.00 p,4Tt, Div. P�bli6works -A 92 z 7 z V) Z n 'c z a3 m :J — ci CYY G i mrri r D v D Ln r M ,F a z V. A fi s m y a z z z y _ r_; _ a � m v. 0� o r rz^ z m C m Z z m X Z ^_ _ U. m :7 n 'c z a3 m :J — ci CYY G i mrri r D v D Ln r M ,F a z V. A fi 7 y 7 � m v. z r rz^ z m C m �� z m X Z ^_ _ U. m :7 z o D N r. l.+ y 7 r D ^7 t r� 7 N m m z lJx z Z l = T z T, m �W�°°��© z `\ z O o Z d O n 'c z a3 m :J — ci CYY G i mrri r D v D Ln r M ,F a z V. A fi r rz^ z m C m �� z m V ^_ z z o n r. v_ y Nt ^7 7 N \ lJx z �W�°°��© `\ z O o O ) ♦ h z ♦ ♦ Ilk z ^V' a U i ^ N v �j♦ 1 � fi v .r VN a e� 0 N .r v N v. n o D m 7 y u „ z. \ Z Z � Z Z D v Z ;7 L 77,yy G Z Y (� z (` .Z mR = n � z z z N 30 z C N N 'O w lll� a � 3. q S 0 2f, X33 pZ A 4 UDR 3 r) �® �! , o4oS'o ©foe a 63,a5 -3 ,::2 9v x6.0'0 = / 9 F S— FORM U - LOT "RELE,SE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ******.***********************APPLICANT FILLS OUT THIS SECTION************"" APPLICANT 1100COOVIPV1#eS PHONE 6 P d -6,S LOCATION: Assessor's Map Number 3,5 PARCEL aG SUBDIVISION (V6 V 00 D LOT (S) STREET (0`3(9'04 J ST. NUMBER �57 USE ONLY*********************************** REC)aWENDATIONS QF TOVYN_AGENTS: Sll,)&E f,490Y AONe- (/,0414 CONSERVATION ADMI COMMENTS X — T COMMENTS TOR DATE APPROVED DATE REJECTED NER L DATE APPROVE 2 DATE REJECTED' FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PE IT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\91' jm FORM U - LAT MMWE FORK INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 9'X06 rule � OvN) 'R � ��6 -, �5 Phone � 8 9 _ LOCATION: Asse=s=sor's Map Number �?J Parcel 21 t3 Subdivision 03-1 e / Lots; Street ��f0o4 -.ST St. Nu. -icer Use Only************ik******x**** RE NpATIONS OF TOWN AGENTS: Date Approved 17' �a q� C �cr'.'a'�OI'i �d':nlStra _or Dace Resected CC= er. -s rAIN d Date Approved Town Planner Date Rejecmed Cc=erts Fcod _nscec_or-:iealth JW /';7_14 Sert_c Ir. -pec dealt: Cor..._.... Date Approved Date Re-iec'::er, Date Apprcve•-4 Date Re;ec=ed r-) c rdcr s - se!de_/wa a connections - driveway per:lit G Fire DecartrLent b W)�Zq/�J) Receive^ by Building Inspector Date J.VVILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 /µOR7ry\ OF «eo �\ � O � m S ci SACHUS DRIVEWAY PERMIT Telephone (978) 685-0950 Fax (978) 688-9573 � I DATE L) ( �� LOCATION l d BUILDER phone OWNER�J bo�2 � hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. N° 821 APPLICATION FOR WATER SERVICE'CONNECTION North Andover, Mass., 19 Application by the undersigned is hereby made to connect with the town water main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. 3 (,CQgLv� r Owner Contractor Street a x-65510 Address ©o PERMIT TO CONNECT The Board of Public Works hereby grants permission to to make a connection with the water main at subject to the rules and regulations of the Division of Public Works. Inspected by Date WATER MAIN Street See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1. No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 41/2 foot rod and brass plug type cover. V N® 1314 - APPLICATION FOR SEWER SERVICE CONNECTIONS North Andover, Mass. 19 Z g Application by the undersigned is hereby made to connect with the town sewer main in 0 Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. _ or subdivision lot no. _ n Owner Contractor Street Address A X7 Addres Appli n44gLt�u1'rXr;4 PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to �v n to make a connection with the sewer main at L2 Qz Q 62rx Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Ae Inspected by Date See back for rules and regulations 5v 6- epi 49 y RULES AND REGULATIONS FOR GOVERNING. THE'INSTALLATION'OF SEWER SERVICES 1. No unauthorized person shall uncover, make any connections with or opening into, use, alter, or disturb any public sewer ,or appurtenance thereof without first obtaining -a written permit from the Division of Public Works. 2. All costs and expense incident to the installation and connections of the building sewer shall be borne by the owner. The owner shall indemnify the (town) from any loss or damage that may directly.or indirectly be ,occasioned bythe installation of the building sewer. 3. A separate and independent building sewer shall be provided for every building; except where one building stands at the rear of.another on an interior lot and no private sewer is available or can be constructed to the rear building ,through an, adjoining alley, court, yard, or driveway, the building sewer from the front building may be extended to the rear building and the whole considered as one building sewer.. 4. Old building sewers may be used in connection with new buildings only when they are found, on examination and test by the (Superintendent), to meet all requirements of this ordinance. 5. The size, slope, alignment, materials of construction of a building sewer, and the methods to be used in excavating, placing of the pipe, jointing ,testing,' and backfilling the trench, shall all conform to the following requirements. The sewer shall be 6"diameter SDR 35; PVC pipe: Minimum slope shall be 1/8" per foot. The minimum depth of sewer shall be four feet below finish grade. Sewer pipe shall be installed on a stable trench bottom of hard durable crushed stone to a minimum (6) inch depth below the pipe. After the pipe has been installed, crushed stone shall be brought up to the crown of the pipe. Care shall be taken to carefully grade and compact the stone, and prevent pipe displacement. The remainder of the trench shall then be backfilled in one foot lifts with mechanical tamping after each lift. 6. Whenever possible, the building sewer shall be brought to the building at an elevation below the basement floor. In all buildings in which any building drain is too low to permit gravity flow to the public sewer, sanitary sewage carried by such building drain shall be lifted by an approved means and discharged to the .building sewer. 7. No person shall make connection of roof downspouts, exterior foundation drains, or other sources of surface runoff or ground water to a building drain which in turn is connected directly or indirectly to a public sanitary sewer. 8. The applicant for the building sewer permit shall notify the (Superintendent) when the building sewer is ready for inspection and connection to the public sewer. The connection shall be made under the supervision of the (Superintendent) or his representative. 9. All excavations for building sewer installation shall be adequately guarded with+barricades and lights so as to protect,the public from hazard. Streets, sidewalks, parkways, and other public property disturbed in the course of the work shall be restored in a manner satisfactory to the (town). - ? • ,;t h , x Growth Management Bylaw Exemption Statement y Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the_:__'_-_____ - Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary inforrrgation as requested below. Name of Applicant an Build' n� Permit (below) Addres of Property for Permit (below) -- Q ✓P 4e.A,/ ps 60D S Map and Parcel: Purposef Application (check below) J - P o Nu ber of A li r Single Family. _ Two Family I the undersigned applicant for the above property attest that the attached building- - form is completed does comply with the EXErMP_nON section 8.7.6 of the North AndoverGrowth this Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement. restoration, or reconstruction of a dwelling in existence as of the effective date of this by -taw, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for law and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. his application is a part of a development project which voluntarily agreed to a minimum 40% permanent reductJon in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an -': adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructinq one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. , Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. r_ By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an TION as cited bove. Further I understand that the submittal of misleading and or inaccurate i forma on, or the the king o#f of an ahov4Jtem which does not comply, wh ther one to my knowledge r no is rgro ds for r sal by the 8 7ding Department to issue a Building ermi . 2a 7 ignatur t caner or Authonz Agent who signed the Attacned Building Permitate This form must be attached to the Building Permit upon application for such permi ''', � .W.-.--.._.__._-•�--- 11 � ' ��ivrrcoou.�sea� o���a°ac�uure(.�a 4�4•� 4`' i ✓1re ,' q• DEdARTMENT OF PUBLIC SAFETY g , CONSPRUC-TI4N SUPERVISOR LICENSE I i Namb�r Expires: Birthdate � , : y vim'- y •• 4l: {4 � CSM ���B856�3 81�13f 2080 0113(1954 �: Be Re'stt�Ctsd.<To' D�VI,D-A KINDRED 301l�Il[ POND P08% k531 :i N ANDOVER, MA 01045 I� .1 156635 11 Restricted lTo: 00 4 '' `I 08 - 35,000 cf enclosed spacef .� (N64 C.112 S.601) 1A,- Nason4 only 1G - 1 6 2 Family. Homes ` Failure to possess a current;-edition,of the i ( Ma'ssachu°se to State Building Code rs i 1 is cause foIr revocation of this license. MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Haverhill STATE: Massachusetts HDD: 6027 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 8-10-1999 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 687 Your Home = 675 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 2952 30.0 1.5 99 WALLS: Wood Frame, 16" O.C. 2340 15.0 3.0 156 GLAZING: Windows or Doors 423 0.480 203 DOORS 42 0.480 20 FLOORS: Over Unconditioned Space 2952 19.0 140 BSMT: 8.0' ht/7.0' bg/0.0' insul. 257 0.0 .57 HVAC EFFICIENCY: Furnace, 89.0 AFUE HVAC EFFICIENCY: Air Conditioner, 10.0 ------------------------------------------------------------------------------- SEER COMPLIANCE STATEMENT: The proposed building design represented in these - documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVA equ pment selected to heat or cool the building shall be no greater ttn n 5% of � design load as specified in sections 780CMR 1310 34.0. // Builder/Designer // "Y1'� V %(-�i�'e/ Dat MAiScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 8-10-1999 Bldg. Dept. Use CEILINGS: 1. R-30 + R-1 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.48 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.48 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location BASEMENT WALLS: 1. 8.0' ht/7.0' bg/0.0' insul., R-0 Comments/Location HVAC EQUIPMENT EFFICIENCY: 1. Furnace, 89.0 AFUE or Make and Model Number 2. Air Conditioner, 10.0 Make and Model Number higher SEER or higher THERMOSTATS: Adjustable thermostats required for each HVAC system. AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating and cooling equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 1250s. of the design load as specified in sections 780CMR 1310 and J4.4. 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O %I- L rD Q o 0 M > �m CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number .3-�`� _ Date ! �p?o /a v o 0 THIS CERTIFIES THAT THE BUILDING LOCATED ON' 65"!7 O5 � a�/ /o Z S �-- MAY BE OCCUPIED AS S 1 �,�� e �d gni 1 /gym IN ACCORDANCE If WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. p 8'Fm0W15 — c3�'� A�'�S �3 cS�aII UNDCleI — 1 r=l�tSkwcl mC4cCti l� �djentev ( of a, Q600) S o &0 "'" , CERTIFICATE ISSUED TO • 00 ADDRESS ��� O5 � oD.1� S-7 c Building Inspector cz 0 1 LU ° O m Q y O �� �• CA cm CD C a:. co N R C m O i •> a : M= C O N mO N N :mo av . _ = O c r-. '0 C acz � 01 0 0 C m c(1c�.s CN Z O ■ C O C C Q � y m C •O x m :mwo N H h m ~ m 0 cm COD L tg v.. C +-• •H CL== O C Z • v o o m 'Con g co O '2 O _ A a ` y•� p f— :a s a a..- CO � J �V T 0 a. co \ O � Q 0 a z a W) ¢ L or- C � O y �E C.).) 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O ,CD CD co V H C !A •� C _� ■CO) LLJ _0 U) LU Cn W w W U) NORTF{ 0 -4.1 t a u 16 6 OL O O cec.�wiw«aw oAr �9SSAC HU5T, APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: '� •( 05760 10 s 7— Z Z % 3 DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: ti 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 DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING CONSERVATION PLANNING DPW - WATER METER NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO,8' WWITTAL OF THE OCCUPANPY/INSPECTION REQUEST DPW Qli jl iauar t, - File: File: OC form revised 6/8198 C\