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Miscellaneous - 135 Avery Park Drive
i Date. .. .1�1 mAr.... .. NOtt TM 0* 14, ,s1ti OA ' TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION . y SACHUSE�t y This certifies that . . 111.99C1!�6 . . . . . . ./. . has permission for gas. inn-s-tallation . (//141 ��Q.tC �-// in the buildings of . . . . . . . . . . . . . . . . . . . . . at . . ., a!�'�"� . ri North Andover,.Mass. —, Fee. .5' . . Lic. No..X3- .. . . . GAS INSEC P T G Check# 8202 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY m{ / y ed' MA DATE r PERMIT# JOBSITE ADDRESS OWNER'S NAMEy G OWNER ADDRESS'Ale- TES(�`� FAX --� TYPE OR PRINT -J OCCU;nNOVATION:El PE COMMERCIAL EDUCATIONAL J RESIDENTIAL Z ' CLEARLY NEW: REPLACEMENT:0 PLANS SUBMITTED: YES[]_i NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - COOK STOVE DIRECT VENT HEATER __ - DRYER FIREPLACE �._._._�l.- ( - FRYOLATOR FURNACE - - - - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _ _ . , - 1 .. TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1---- OT HER L-111=1 ML—J i-_. I!�j INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES _.__ NO E] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAG BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ©.I BOND 1--( 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 0 AGENT �I SIGNATURE OF OWNER OR AGENT 1 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. PLUMBER-GASFITTER NAME LICENSE#_ �3�"3tI SIGNATURE MP U2<GF JP .J JGF LPGI ] CORPORATION LTJ# PARTNERSHIP D#=LLC]# COMPANY NAME: % Q �- C ' F �.Z �"e - ,C.�-_ ADDRESS CITY - / ?//4-- STATE ZIP _-Cef r I_ TEL FAX /s-tv CELL 9 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ —E] -`- FEE: $ PERMIT# PLAN REVIEW NOTES /-1 C. The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/ln(liviZdual): �%o/*- Address: 3 City/State/Zip:� c cl tom. piila/� Phone#: 936—ZC Are yo.4 an employer?Check the appropriate box: Type of project(required): l. am a employer with 7 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or p -time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 131i Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they ace 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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. ( Ad Policy#or Self-ins.Lic.#:_ G SG -C,�S �� Expiration Date: Job Site Address: City/State/Zip: r Attach a copy of the workers'colwpensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains and penalties ofperjury that the information provided bove is true and correct. Si atur . Date: 00/Z Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - 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 ofhire, 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 loeal 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 Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachvsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 TO,#617-727-4900 eA 406 or 1-877:MASSAFB Revised 5-26-05 Fax#617-727-7749 ww=w.mass.govfdia Date `O- ...... ...................... AORT" °f< °:•�"� TOWN OF NORTH ANDOVER • �s = ' PERMIT FOR WIRING CHusE� This certifies that i.-."' has permission to perform ..- �`"`".:`'.�....................................... wiring in the building of.... ' ` ....... � .. ,North Andover,Mass. at............. . Vy ... .... ... 1 ................................... . Fee.! ............. Lic.No.� ...........0. . ........ . ......... .... ............. ` Eisc mcnt INsp c ok v Check # 8031 COmownwea&o/Mabeac4adett6 Official Use Only cc�� Permit No. -e-..d/ 2apari`.m.ent of3 ire Serviced Occupancy and Fee Checked .L1A, > BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ML '),5 7 CMR 12.00 (PLEASE PiUNT 'OR TYPE ALL INFORMAT ION) Date: 3'69 City o Town f': � � , �I/�i�` To the Inspector of Wires: By this applicati he dersigned gives notice of hi�r her intention to perform the electrical work described below. Location (Street & Number) -Dr. Owner or Tenant L- fj �L 6" Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ISn (Cheek Appropriate Box) Purpose ol'Building Utility A thorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No, of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Situ r .ty11 I(,-trrri Conn pletion ofthe following table mrrn be++wined bn the Inspector of IVires. No.of Recessed Luminaires No.of Ceil.-Susp.(P (Paddle)Fans TransTotal Trsformers KNA No.of Luminaire Outlets No. of Hot Tubs Generators KVA e In- o. o Emergency rg mg Above No.of Luminaires Swimming Pool Abovund. ❑ and. El Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of Zones of No. of Switches No. of Gas Burners No. In Detection and Initiating Devices � No. of Ranges No. of Air Cond. TotaTonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number-.. Tons KW No.of Self-Contained 1 Totals: Detection/Alerting Devices g Municipal No. of Dishwashers Space/Area Heating KV1 L�L❑--U� nBon ❑ Other No. of Dryers Heating Appliances KW / No.Security Systems:' ( of Devices or/r) E uivalent No. of'Pater• No. of No. of ata Wiring: ' Heaters KW Signs Ballasts No o Yevi ec or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Aaach additional detail if desired, or as required by the Inspector of I'Vires. Estimated Value of Electrical Work: �U. (� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE � BOND ❑ OTHER ❑ (Specify:) I certify,under the ains and penalties of peajurp, that the infort ion on this application is true and complete. FiRM NAME:'. t L LIC.NO.: /Ozj. C- Licensee: Pin �A` i'1 r��i�. Signature LIC.N0._A- n�j D (ffopplicoble,enter in[he license nt Hoer line.). Bus.Tel. No.,(.rr` l�6/ L�/r k Address: �..`> \['sir i- `�� { �t 1 �'�i; r (7v^ I'�J!a -,) �� Alt.Tel. No.: *Per M.G.L.c. 147,s. 57-61,security work require`;Department of Public Safety "S"License: Lic.No. �S C C.,C) 1 u y OWN'ER'S INSURANCE\WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by lain. By my signature below,i hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: CXJ t 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisionsof M. L.c.143,§3Lhe ,t 5 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be fithe 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 u firm or corporation stated on the permit application. Such entity shall be responsible for the electrical permit shall be issued to the person, 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 maybe_deemed_by.the_Inspector_of_Wires abandoned_and_invalid ifhe—__. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on thepermit application. 1 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 conceming 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: IL **Note:Reapply for new per ❑Permit Extension Act—Permit/Date Closed: r �--- Date... -�..�../G......... NORT1{ TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'T CHus� This certifies that ...............................5,`�I..........�e �t�� ..................T........................ has permission to perform .......... .�w.�'E:f ................................... wiring in the building of.............. ..:..........?! .............................................. at.............. North Andover,Mass............. 00 „ Fee...—``—..fe�..—. Lic.No., .................... ........ ............ ..., ��.... ELLRICALINSPECTO R r Check # -� 8151 ' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 71 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07.1 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. WORK All work to be performed in accordance with the Massachusetts Electrical Cede(MEQ,,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the In e" for of Wires: By this application the undersigned gives notice of his or her intention to perform the, ectricai work described below. Location(Street& Number) Owner or Tenant �. pL Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building , �4 / Utility Authoriiation No. Existing Service 2 Gc/ Amps y 2v I e l 6 oats Overhead ❑ Undgrd❑— No.of Meters New Service Amps t Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �, z1f, .5- Completion Com letion o thefiollowing able rna be waived by the Ins ector of Mres. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans o.of ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No,of Luminaires Swimming Pool Above ❑ n- ❑ o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 13 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.oI Detection an InitiatingDevices Tonnss No.of Ranges No.of Air Cond. TotalNo,of AlertingDevices No.of Waste Disposers eat Pump Number ons No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances 3 KW Security Systems: / No.of Devices or Equivalent No.of Water o.o o.o Heaters kW i Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP elecommunicattons trtng: No.of Devices or Equivalent OTHER: Attach additional detail if desired,, or as required by the Inspector of 111ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 3— -/q —el K Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: /,;, LIC. NO.: ,�E 9gy 3 3 Licensee:��,r��f /,F j �f _ Signature- -�4 Ly�IrC.yNO.:�g .3-3 e/f a1rltlicuble. en r `rxen:1N-in tfte license rrrrnrhee lime.} Bus.Tel.No.:4."2, - 2/e�,✓ Address: 5 t Alt.Tel. No.: �. *Per M.G.L c. 147,s. 51-6 1,security work requires De'partmeKof Public Safety"S" License: Lic. No. OWNERS INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance b coverage normally required l• 3 q y law. I y my signature,below, I hereby waive this requirement. i am the check one owner owner's agent, Owner/Agent Signature Telephone No. PERMIT FEE. S ���-, J t Date. TOWN O OR NDOVER O1 PERMIT FOR PLUMBING i o� �• X17+0•,r.o,O`,�9 SSACHU$ This certifies that . . .r . . . . . . . . . . L�G has permission to perform . . . .G��sE! l ,tii. . . . . �. . . . plumbing in the buildings f . . . . G . . . . . . . . . . . . . . . . . . 3. at. . . . . . . . . . . . . . . . . . . . . . . . .ar. . P/�. . . . :, North Andover, Mass.. l Fee.477 � Lic. No.. .`2.1nS~f . . . . . . . . . . . . . . . . . . . . . . . . . . . ./I?-`' PLUMBING INSPECTOR Check # i 7731 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS a ^� �p Date .�^/Y y Building Location J,,,�}¢ t✓ IA�'u � f Owners Name �llejoe(�'�Zd/t/ �p� permit Amount Type of Occupancy New Renovation Replacement 0 Plans Submitted Yes No ❑ FIXTURES O LEI O cc O O W a A A S A A M FLOOR M FLO CR 41H FLOOR MR-OCR - 7M FLOM suIRK= (Print or type) LCL Check one: Certificate Installing Company Name—;?, �, ���rs Corp. r Address Partner. Business Telephone Firm/Co. Name of Licensed Plumber: YnO X) /0/0 Insurance Coverage: Indicate the type insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance i Signature Owner ❑ Agent I hereby certify that all of the details and information I have submit r entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and ins ons rmed under 9(r&s application will compliance with all pertinent provisions of the Massac s to PIumbing of pp eral Laws. be in By: blgqwkm o ens um Title ype of ming er License City/Town �Z�'�/ icense um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY Er t Date.. ,°O R Try o� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SACNUSES This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . .. . .�' �. . lZ %l..!. . . . in the buildings of . . . . . . . . . . . . . . .. . . . . . . at . !. .. at . . . t�. . . . . . . . . . . . . . . .; North Andover, Mass. Fee.aS.�� . Lic. No... .. �Sf . T / GAS INSPECTOR Check# I 6421 MASSACHUSETTS UNIFORM APPUCATON FOR PERMI T TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Logations Permit Amount$ Owner's Name �f✓✓'V fyI->� i1J New D Renovation Replacement Plans Submitted a ' Cn h U W � yr 94 Z , x F m x 0 w e w a cw7 tW- z F x w a w w >. x z d w 0 .14a F' v� m z O z z o x x o x 3 0 -4 o 9 > c a F o SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 't 4TH . FLOOR STH . FLOOR 6TH . FLOOR 7TH . FLOOR. STH . FLOOR (Print or type) p f Check one: Certificate Installing Company Name_��7) ,! , _ T��h f�L� /ter" L LC Corp. � � Address 3 5 f�i' �c D /9�j,.,'V/ o, f o 3 E)c/ f El Partner. Business 1 a ep one p 3 _Z Firm/Co. Name of Licensed Plumber'or Gas Fitter vq)/0113 D, )cd )-A*L6�f- INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. yes No[:] '*a If you have checked ves,please inOc!to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati pej5brmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus St as Code pte of the General Laws. By: Sig tur of Licensed Plurdber Or Gas Fitter Title 1 13 Plumber *I j 2;a City/Town:. Gas Fitter License Number Master _ APPROVED(OFFICE USE ONLY) [3 Journeyman Location � oho j3 lJ-eq PA r ✓f No. 3 Date �- H0RTN TOWN OF NORTH ANDOVER F 9 + s ; « Certificate of Occupancy $ f"o, + ° y7s°',• E<� Building/Frame Permit Fee $ ��CMUS Foundation Permit Fee $ _' Other Permit Fee $ TOTAL $ � Check # f 15 L L ` f 'Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Thl3CGb019 fOCI�GIR IIs.only BUILDING PERMIT NUMBER: DATE ISSUED: ic SIGNATURE: 1��� BuildingCommissioner/In for of Buildin Date z SECTION 1-SITE INFORMATION 1.1 Property Address: C -r 1.2 Assessors Map and Parcel Number: '4"ll w resty�1J L Ui Srp-rt /06 6 /6 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 102 S�1=�/cam :�� �/ 75�/ {� ';? D /t Zoning District ProposedfJse Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided _, . 3C� .V-6 ,. 301 l6 ' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record /00 Ahdoaer 9 a,2-Sr Sife 3oo N /94. Name(Prin6 Address for Service a��' 6 $7-s Hca Signature Telephone 2.2 Owner of Record: (� Name Print Address for Service: ®1 z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Cy` .ce�C% <26 o6G ' .23% 0 Licensed Construction Supervisor: License Number Address 1 _ s/�/oma. 7' L300 Expiration Date aaso Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ goo Company Name Registration Number Address a. 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 building permit. -Signed affidavit Attached Yes...... 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: 3 c�- F —,'t X -err. /.?x-/ Y Sun rooms. 3 X l 3 Errn1,f err f-r C %Z X/(A Cyrsyal /�/ _ ero �e, ,- Gs�tC e— SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by pennit applicant 1. Building (a) Building Permit Fee p -f D P. V0 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC) / g 4 5 Fire Protection 6 Total 1+2+3+4+5 aG S o Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as(mer/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 Na �l Signature of Owner/Age Date i 133,518 311151111111 NO. OF STORIES SIZE $ 1 BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 r r%W;,757 2 3 RD SPAN "0 DIMENSIONS OF SILLS Jr DIMENSIONS OF POSTS << fc e DIMENSIONS OF GIRDERS - HEIGHT OF FOUNDATION THICKNESS d v SIZE OF FOOTING X .7-0 MATERIAL OF CIMVINEY 0 d IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE -e FORM U - LOT RELEASE FORM 0, OCD ti.. INSTRUCTIONS: Tris `arm 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 SECT ION******"************"'`* sit-e# APPLICANT ( c7al �f� �l�'Sf GGC' PHONE LOCATION: Assessor's flap Number /O 13 PARCEL SUBDIVISION �'a.�wLOT (S) STREET J e rT -e- ST. NUMBER 35' * ***** *** * **k t* ** ****OFFICIAL USE ONLY************* E **** ******* REC ENDATIONS OF TOWN AGENTS: CONSER ATION ADMINISTRATOR J DATE APPROVED 9(.70 DATE REJECTED COMMENTS D k -S-b-A-t W CJ-C-- • r Q — 01�44'u cA r " A-4 nq /TOWN P DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED !Et7 "o,� DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERWATER CONNECTIONS DRIVEW RT /� FIRE DEPARTMENT � 2, Q RECEIVED BY BUILDING INSPECTOR DATE /Revised 9197 jm Growth Manaaement Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Cepartment 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 information as requested'below. Name of Applicant on Building Permit(below) Address of Property for remit(below) ' 6 ,f/Cr�sGGG 35' yel,y Map and Parcel . Purpose of Application (check below) Phone Number of App cant • _,4 Single Family _Two Family 6cs I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the E<EMP-nCN section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the =uiiding Permit. Further I understand that my interpretation of the E<EMPTiGN status is subject to review by the Building Department and is only offrcally 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 existents as of the effective date of this by-law,provided that no additional residential unit is created. The lot(s)werelwas created prior to May 6, 1996 are exempt from the provisions of'his Secr;cn 8.7 of the Zoning ytaw. This application is for dwelling units for low andlor moderate incame families or individuals,where all of the canaitions 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 property executed and recorded deed restriction running with the land. For purposes of this Section"senior'shall mean persons over the age of 55. it This application is a part of a development project which valuntarily agreed to a minimum 4011.permanent reaucdon 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 spate 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 per from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in comptiance 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. By signing below I attest to ccurac/of the information provided and that the atta&.ed building permit is allowed an E<EMPTiQN s cited ave. Further I understand that the submittal of misleading and or inaccurate information, r the checks g off of an above item which does not comply, whether done to my knowledge ot, is g unds for re' at by the Building (Department to issue a Building Permit. _� / Signature of caner b A on d A e ho signed the Attac ed Building Permit Cate ate This form must be aftlIched to the Building Permit upon application for such permit. The .Commonwealth of Massachusetts Department of Industrial Accidents -� Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # F7 1 am a homeowner performing all work myself. F7I 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. Company name: d�tz''Si Address %00 300 City /V O! 4Lcloy c'.� lea s� �5' Phone#• 7 5) G 7 - s 30(a Insurance Co. , �5f G 0 . Policy# tU C- O/ 5"(v Comoanv name: Address Cih/• 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 51,500.00 and/or one years'imprisonment as well as nalties in the farm of a STOP WORK ORDER and a fine cif(S100.00)a day against me. I understand that a copy of this statement ay beLforded to the Office of Investigations of the DIA for coverage verification. I do hereby certdy and the ins and nalfi sthat the information provided above is true and correct. Signature Date O Print name Phone# 57S--7 76 p Official use only do not write in this area to be completed by city or town cmcial' City or Town Permit/Licensina Building Dept []Check if immediate response is required p licensing Board Selectman's Office Contact perscn: Phone Health Department Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: _l Urn 42 51-ff- _ /V 0 rY-lr ,s7 ,f�ec-iC' Location of Facility Si e o erniit Applicant i z D/ i Date J. NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1 c FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and 'dated Dec, IW 19 'Jq and/or by the Covenant dated Mav 9L9 19 39,_ and recorded in District Deeds, Book $$0 Page MY or registered in Land Registry District as Document No. and noted on Certificate of Title No . in Registration BookfPage has been completed/partially completed,' to the satisfaction of the Planning Board to adequately serve the enumerated lots shown o t� k n Plan entitled Carnbe.11 �o re5 Defhvi'�iy,e 5464 ii510N PIgN Section (s) , Sheets Plan dated December ., 19 _ recorded by the E�X t' North D i tri cL Registry of Deeds, Plan Book or registered in said Land Registry District, Plan Book Pian�/A7 8 Lf and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s) ) o {� t 3• f/i ro 3 2-� 3 a. So �C u1 e a i ve very Peid 've b. (To be attested by a Registered Land Surveyor) LorS ZV,ZSf Z-i L c rS ! 7p, !3 L oTS I,S" i?ILS Z 3 Ihereby certify that lot number (s) Lar-, ZS 7}} 31-i BA on JOnNNb beAVa, (AV-A w sMti. W000, ( Lb..+Nr ' Streets) do conform to layout as shown on Definitive Plan entitled Section Sheet (s) V� 0' M4s4 i � cti GJ ALBERT T. TRUOEL N R gzstered Land Surveyor o No. 36869 0� a °F t GISTCR( AC LANA SJ 1 of 2 -moi1..S�t YinAe hf C. The Town of North Andover, a municipal corporation situated in . . . the County of Essex, Commonwealth of Massachusetts, acting b its duly organized Planning Board, holder of a Performance Bond or Surety dated 19 and/or Covenant dated 19 from of the City/Town of County, Massachusetts recorded with the District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. Registration Book, , in , Page acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said pian as follows: EXECUTED as a sealed instrument this Z day of 19 1 Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS ss i-y-'b r Z_ �_, 19 q_r! Then personally appeared ,A�t�;,1� �5 - one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary blic Iia . My Commissl n Expires 2 of 2 .1 '1 2 6 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 2,ZZ- Application by the undersigned is hereby made to connect with the town water main in A vef R-,e%�� �_Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. LA 'I P Street or subdivision lot no. 77 10 XY 2-ZC- Owner Address Contractor Address LL W,PE -G� pplicant's S g ure -'r PERMIT TO CONNECT WITH WATER MAIN UJ ell I The Board of Public Works hereby grants permission to i h5l� to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. Board of Public Works ByL Inspected by Date See back for rules and regulations 1 753 APPLICATION FOR SEWER SERVICE CONNECTION 2 2 North Andover, Mass. G 1.9. - Application by the undersigned is hereby made to connect with the town sewer main in z r� /- Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. ! l� Stwceet. or subdivision lot no. 77 Owner Address 8 � a� Contractor Address Acants ppliSignatu PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at oe (I Street subject to the rules and regulations of the Division of Public Works.. Di 'sion ol Public Works By a)l Inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLfAM HMURCIAK, P.E. Telephone(978)685-0956 ' DIRECTOR Fax(978)68&9573 NORTH O tteo ,e 91. o p 99 .f 01•Pp`'�y j 9SSACHUS'- i DRIVEWAY PERMIT DATE z-o/4 LOCATION ✓e ce / 27 i BUILDER phone OWNER hone T _ 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. ' ��^^�.�3.-`1 � ✓,ie iDomvrreooturea`�i a�✓liGaazacrtu6e�`6 � ' `rt' • "' BOARD OF BUILDING REGULATIONS „ f License: CONSTRUCTION SUPERVISOR Number: CS 069234 Birthdate* 05/09/1954 Expires:05/09/2002 Tr.no: 23903 Restricted To: 00 ALAN G RUSSELL _ 400 MAIN STS % GROVELAND, MA 01834 Administrator i f a • • i'� \` 1 �/ /�1 } i lel �r.— �.. \ �� \l ` � ��� J / 1 l tv I NV ro4 \ ` ell + l s � I 00 MO)Co i CO co � m � ��� �� � I l} ,��� It li 1 1 �` I / �•.f t� � i 1 L4 r N y f / / � 40 �{ s ' (It Lul i 1 ' li i 1 I ! I 11 I � ' 1111 111 � 1� N / I / t\ ` 1 m 4 I ! ABY Ld clq I I MAScheck COMPLIANCE REPORT Massachusetts Energy code I Permit # I MAscheck software version 2.01 I I I I checked by/nate I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance; DATE: 1-9-2002 DATE OF PLANS: October 10, 2001 TITLE: Lot 27B "The Windham II" PROJECT INFORMATION: Campbell Forest subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 100 Andover Bypass suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 678 Your Home = 649 Area or Cavity Cont. Glazing/Door Perimeter R-value R-value U-value UA ------------------------------------------------------------------------------- CEILINGS 1821 30.0 0.0 64 WALLS: wood Frame, 16" O.C. 2883 11.0 0.0 257 GLAZING: windows or Doors 558 0.350 195 DOORS 94 0.490 46 FLOORS: over Unconditioned space 1814 19.0 0.0 86 HVAC EQUIPMENT: Furnace, 92.0 AFUE -------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design conditions found in the Code. The HVAC equipment s, ec to heat or cool the building shall be no greater than °6 Of/the des'gn load as specified in Sections 780CMR 1310 d .4. Builder/Designer Dat > U-�- n MAscheck INSPECTION CHECKLIST Massachusetts Energy Code MAscheck software version 2.01 Lot 27B "The Windham II" DATE: 1-9-2002 Bldg. ( Dept. ( use I ( CEILINGS: [ ] ( 1. R-30 { comments/Location I ( WALLS: [ ] { 1. wood Frame, 15" O.C., R-11 { comments/LOCaticn i { WINDOWS AND GLASS DOORS: [ ] ( 1. U-value: 0.35 I For windows without labeled u-values, describe features: { # Panes Frame Type Thermal Break" [ ] Yes [ ] No ( comments/Location I DOORS: [ ] { 1. U-value: 0.49 I comments/Lacation I FLOORS: [ ] I 1. over unconditioned space, R-19 I Comments/Location I { HVAC EQUIPMENT: [ ] ( 1. Furnace, 92.0 AFUE or higher ( Make and Model Number I AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building { envelope that are sources of air leakage must be sealed. when I installed in the building envelope, recessed lighting fixtures { shall meet one of the following requirements: { 1. Type IC rated, manufactured with no penetrations between the { inside of the recessed fixture and ceiling cavity and sealed or { gasketed to prevent air leakage into the unconditioned space. { 2. Type IC rated, in accordance with Standard ASTM E 283, with no { more than 2.0 cfm (0.944 L/s) air movement from the the { conditioned space to the ceiling cavity. The lighting fixture { shall have been tested at 75 PA or 1.57 lbs/ft2 pressure { difference and shall be labeled. I VAPOR RETARDER: [ ] ( Required on the warm-in-winter side of all non-vented framed { ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I 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 { equipment efficiency must be clearly marked on the building plans { or specifications. I { DUCT INSULATION: [ ] { ducts shall be insulated per Table 4.4.7.1. I { DUCT CONSTRUCTION: [ ] { All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the I 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 i air and water systems. I { TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual { or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I { HVAC EQUIPMENT SIZING: [ ] ( Rated output capacity of the heating/cooling system is { not greater than 1250110 of the design load as specified { in Sections 780CMR 1310 and 74.4. [ ] { SWIMMING POOLS: { All heated swimming pools must have an on/off heater switch and { require a cover unless over 20% of the heating energy is from { non-depletable sources. Pool pumps require a time clock. i [ ] { HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids { below 55 F must be insulated to the following levels (ire.): I { PIPE SIZES (in.) { HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" { Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 { Low temperature 120-200 0.5 1.0 1.0 1.5 { steam condensate any 1.0 1.0 1.5 2.0 { COOLING SYSTEMS: { Chilled water or 40-55 0.5 0.5 0.75 1.0 { refrigerant below 40 1.0 1.0 1.5 1.5 { [ ] { CIRCULATING HOT WATER SYSTEMS: { Insulate circulating hot water pipes to the following levels (in.): I { PIPE SIZES (in.) { NON-CIRCULATING { CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" { 170-180 0.5 { 1.0 1.5 2.0 { 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department use only)------------------------- Tow ORTIyn o �� �. _�0: 1- , 6Andover 0 No. 3 � - 70 � =. T �O Z-- LAKE O1 ndover, Mass., /—/ 4/ 0?00 a COCMIC EWICK y�. �d AORATED PP � SSAC HU5� P IT FOR EXCAVATION AND F THIS CERTIFIES THAT ...eo?.m�. .'ef 1....../..: .r� .................k.4.:.......................................................... P,4 Rk has permission to excavate and pour foundation at .�A................. ................../'!.v'� .. .......................,..... for theose ur P P .... . . .,t. . ..... ... i................. .... ...v r iron .�.......a.........y............... iu y' The person accepting this permit must return to the office of the :;7/g� Inspector a certified plot plan show of building thereon before Foundation will be inspected. /D� � ��-Q, — VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLDG. PERMI*I' FEE$ _ {oA LESS FDA FEE DUE FRAME PERMIT$ •— BUILDING INSPECTOR NORTH 0" Of Andover O No. 3 .7b - o LA o dover, Mass., y— COCMICMEwICK V AORATED PPa��S S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System l / �- � � BUILDING INSPECTOR THIS CERTIFIES THAT......... .Q�m � .SCJ tr'.(./.... 0/'!CSS........... ..�................................P�k* Foundation has permission to erect.............../..................... buildings on�t?fa7!�..' ..../9ue� ......... R �e'c► Rough to be occupied as/v� /?oom,.aS_ 3a'7:.(3.S . r ..s �/ .....o ��� t/�I;y Chimney, provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Law relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. lD6� 1G 6 '� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough ........ ............. Service ......................... .......................................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. r Town of North AndoverNORTH F qti Building Department �� y t�eo a 0 27 Charles Street o -= North Andover, Massachusetts 01845 (978)688-9545 Fax (978) 688 -9542 6 .. . $ACHUsS APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 3 /�v 2 r LOT NUMBER___d 7,Q SUBDIVISION �- DATE REQUEST FILED 7 v?� ov2 r DATE READY FOR INSPECTION 71-3a/©,21 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTIO OF TWENTY-FIVE ($25.)DOLLARS WILL BE CHARGED IF THE STRU D S NOT MEET ALL APPLICABLE CODES. SIGNATURE CIAL USE ONLY ROUTING CONSERVATI DATE_ ar2/0.,— PL DATE S D.P.W. —WATER METE DATE �- D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED THE INSPECTION RE T DATE. SIGNATURE/D THORIZATION pORT/1 Oa,U.. O w • Y ,SSACHU CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number Date -7-30 old O o? THIS CERTIFIES THAT //�� THE BUILDING LOCATED ON �o a7 a ' ���v�r y P,*R g DR.,v L MAY BE OCCUPIED AS cS N l�e- r4 LA- IN IN ACCORDANCE WITH THE PROVISIONS OF THE Xf A SSCHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. /D Caw m s, e7 Va 8,4-7.4.5, 3 5ta// UN D CERTIFICATE ISSUED TO /oo �NcJov�r c3y Pss Building Inspector OT a cRT' i ;� 13 ® Of 4 over qir nt� o No. .3 ;& o = A o dover, Mass.,-/— COCMICMEWICK 7 ORATED BOARD OF HEALTH Food/KitchenPERM IT T s w Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... C�........... !-.......................................... .................... Foundation , U 2— has —has permission to erect...............l....................... buildings on�Q/...a7! ..... �?... !.v.e!" ......... ��� RoughIP'll ���COD/� O7cJ�,�A��7 ( L77d// U���/' //V /e- ol/�J/ �l e�t/�,Uy Chimney to be occupied as. ....... ..... ........., .............. ... ......../.... ................ .... ... .. ... ................. r�.........................,1.... .......... .. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Law relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ��d Q �G 6 O� 7 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. O Y L — PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELE C L INSPE . ......................... .c.................................. ...... BUILDING INSPECTOR Occupancy Permit Required to Occupy Building &AS IN PECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fl/ F& No Lathing or Dry Wall To Be Done FIRIf DEPAR N Until Inspected and Approved by the Building Inspector. Burner i A Street No. j lI [:�KSEE�: REVER E IDESmoke Dec. 1S S �� o4— Location 6?ITS 3S No. Date �2- �O�TM TOWN OF NORTH ANDOVER F3? •. -_ • Op ` Certificate of Occupancy $ s'ACNUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 1 TOTAL $ Check # /73 l 5 J L 7 / ' Building Inspector cERnFlEo nor PLAN S.E. CUMMINS & A SSOCIA TES P.O. BOX =7 PLA/MW, N.H. 08805 TELEPHONE (6031-J82-5085 FAX (80M482-52M S07- 15'54"E 40.1' 00 QitiO7 Z i= 34.6' LOT 278 uJ 0 u. 61,741 OF B C A*32,690 OF 00 0 cn if) to Cal EDGE Q� TLAND A 0-61" o i1iOf day ALBERT T TRUDEL --" No.36869 0. 1 Tt 7AX MAP 210 0 BLOCK 108-0 0. Lor 27s I. FOREST WOODS NOR tH ANDOVER, MA. DA4-E.- FEBRUARY 8, 2002 SCALE I" = 60' Hi-Rf-8 Y CER TIF Y TO TOWN Of NORTH PREPARED RED f MES/TI DE Vf-t OPPEN T ANDOVER, MA BUILDING DEPARTMENT 100 ANDOVER BYPASS, SUITE 300 THAT THE EXISTING FOUNDATION ORA WN NORTH ANDOVER, MA. 01845 ON THIS PLAN IS L OCA TED AS SHOWN AND THAT IT DOES COWL Y TO THE m1mmum SETBACKS.' FRONT JO FEET IVINIYUM BUILDING SETBACKS TO SIDE JO FEET PROPERTY LINES. REAR — jo FEET 977510 r -Ascheck COMPLIANCE EPuRT { Massachusetts Energy Code ( Permit # MAscheck software version 2.01 { checked by/Date CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: other (Non-Electric Resistance) DATE: 1-9-2002 DATE OF PLANS: October 1999 Pr, TITLE: Lot 27C "The Bedford" PROJECT INFORMATION: Campbell Forest subdivision North Andover, Ma. COMPANY INFORMATION: Cambell Forest, LLC. / Mesiti Dev. Corp. 100 Andover Bypass suite 300 North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 605 Your Home = 560 Area or cavity cont. Glazing/Door Perimeter R-value R-value U-value UA ------------------------------------------------------------------------------- CEILINGS 1727 30.0 0.0 61 WALLS: wood Frame, 16" O.C. 2528 13.0 0.0 208 GLAZING: windows or Doors 466 0.350 163 DOORS 94 0.490 46 FLOORS: over Unconditioned space 1715 19.0 0.0 81 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design conditions found in the code. The HVAC equipmen se ed to heat or cool the building shall be no greater than 125% f the de ign load as specified in Sections 780CMR 131 34.4 Builder/Designer Date 11,11-1. n MAscheck INSPECTION CHECKLIST Massachusetts Energy Code MAscheck software version 2.01 Lot 27c "The Bedford" DATE: 1-9-2002 Bldg.l Dept. { use { I { CEILINGS: C ] 1 1. R-30 { comments/Location I { WALLS: C ] 1 1. Wood Frame, 16" D.C., R-13 1 comments/Location I { WINDOWS AND GLASS DOORS: [ ] { 1. U-value: 0.35 { For windows without labeled u-values, describe features: { # Panes Frame Type Thermal Break? [ ] yes [ ] No I comments/Location { DOORS: [ ] # 1. U-value: 01.49 { comments/Location 1 I FLOORS: C ] 1 1. over unconditioned space, R-19 { Comments/Location I HVAC EQUIPMENT: [ ] { 1. Furnace, 92.0 AFUE or higher { Make and Model Number 1 { AIR LEAKAGE: C ] I 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 1 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 I more than 2.0 cfm (0.944 L/s) air movement from the the { conditioned space to the ceiling cavity. The lighting fixture { shall have been tested at 75 PA or 1.57 lbs/ft2 pressure { difference and shall be labeled. { VAPOR RETARDER: [ ] { Required on the warm-in-winter side of all non-vented framed { ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I 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 1 equipment efficiency must be clearly marked on the building plans I or specifications. I { DUCT INSULATION: [ ] { Ducts shall be insulated per Table 34.4.7.1. { DUCT CONSTRUCTION: [ ] { All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or { joist cavities/spaces used to transport air, shall be sealed { using mastic and fibrous backing tape installed according to the { manufacturer's installation instructions. Mesh tape may be { omitted where gaps are less than 1/8 inch. Duct tape is not { permitted. The HVAC system must provide a means for balancing { air and water systems. I { TEMPERATURE CONTROLS: [ ] { Thermostats are required for each separate HVAC system. A manual { or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I { HVAC EQUIPMENT SIZING: [ ] { Rated output capacity of the heating/cooling system is { not greater than 125% of the design load as specified { in Sections 780CMR 1310 and 74.4. I [ ] I SWIMMING POOLS: { All heated swimming pools must have an on/off heater switch and { require a cover unless over 20% of the heating energy is from { non-depletable sources. Pool pumps require a time clock. I [ ] { HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids { below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) { HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" { Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 I steam condensate any 1.0 1.0 1.5 2.0 { COOLING SYSTEMS: { Chilled water or 40-55 0.5 0.5 0.75 1.0 { refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] { CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): l I PIPE SIZES (in.) I NON-CIRCULATING { CIRCULATING MAINS & RUNOUTS { HEATED WATER TEMP (F): RUNOUTS 0-1" { 0-1.25" 1.5-2.0" 2.0+" { 170-180 0.5 { 1.0 1.5 2.0 { 140-160 0.5 { 0.5 1.0 1.5 I r I 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use only)------------------------- n