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Building Permit #131-14 - 20 LAVENDER CIRCLE 8/9/2013
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION__ � `` i -Print 1y PROPERTY OWNER 1..04?,t AA- '�` k" A-51-A-01_ - - Print 100 Year Old Structure yes MAP NO:q PARCEL] ZONING DISTRICT: Historic District yes Machine Shop Village yes . no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family 11 Addition 0 wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands 0 Watershed District ,'!%Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Ple se Type or Print Clearly) k OWNER: Name:_CO LI N A- 1-- t�� � I, IV� Phone:Q-7g- v1q 2�1 j Address: �7,,o L•�t✓�� � C(l�Cly �1- l���V . CONTRACTOR Name: J 04+tN 9-T_ Q L--D Phone: 6e.]23 Address: / r Supervisor's Construction License: `l 57 -6 Exp. Date: J Home Improvement License: -7 Exp. Date: ;�" oM At `f O - 'S coGo ARCHITECT/ENGINEER , \©AQ,�A Phone: Co 2 i�o 00 Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� , 3 a CC) FEE: $ 3 84,, o c-) Check No.: C Receipt No.: ci( r? �^ NOTE: Persons contracting with unregistered contractors do not have access to the anty fund Signature of Agent/Owner �SigLLature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ` Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPEOF`.SEWERACGE.DiSPOSAL Public SewerTanning/MassageBody Art ❑. . Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS f HEALTH Reviewed on Signature I COMMENTS e Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW T'o`go Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT = Temp Dumpster on site yes no Located at 124 Mair, Street Fire D_ epartmerit signature/date`"` ' COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A=F and G min.$100-$1000 fine NOTES and DATA— (For department use El Notified for pickup - Date t E Doc.Building Permit Revised 2010 r' J Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apoaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.?ted with the building application Doc: Doc.Buil,ding Permit Revised 2012 I ass��� es ITome Tm ®vement &6mle Contract This form satisfies all bast requirements of the slate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard Ianguage to protect homeowners. Seek Iegal advice if necessary. Any person planning home improvements should first obtain a copy a da Massachusetts Consumer Guide to Home Improvement"before agreeingto any woxlc on your residence.You may obtains tree copy by calIingthe Office of Consumer Affairs and Business regulation's Consumer InfoamationHotline at 617-973-8787 or 1-888-283-3'757 or on our website. ' Homeowner Worlm atiom Contractor Information N e Company Name -6 crml Mf J011 Street Address(do not use aPost Of-fzce Box address Yl 1�[/I 1� Contractor/Salesperson/OwnerName p City/Tov state fie— LPSL b rn -��o'l c� Zi Code Bgsiness Address(txnhst include.a sire t address) 0 eTc�- /knj:�o v� /I �4- O GSA v' ,1� / -^� D'aytimePbone Al Eve . gphone City/Town V3� / State ip Code -- 3 3`fi Mailing Address(It different from above) Business Phone federal Employer ID or S.S.Number HomermpmvementcontmetorRez.Number Expiration date Lnw ragn;res that most home improvement contractors linve a valid ratistntion nninber The Contractor agrees to do the following work:for the Homeowner: (Describe in detanthe worIcto completed,specifyingthe type,br d,and grade of materials to be used use additional sheets ifnecessa S,_�e, 6&� ) - Reiluired Permits-The follgwii lg building permits are required proposed Start and Completion Schedule-'The following schedule will and will be secured by the.contractor as•the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (owners who secure their own pelrn its'wM be exel-aded from the Guaranty Fund provisions of I 2 3-MGL chapter 1I42A.) i Date when contractorwill begin contractedwozlc. S l Date when contracted work wilt be substantially completed. Total Contract Priceand Payment Schedule The Contractor agrees to perform the work,furnish the material and labor speciffed above for the total sum of. Payments will be made according tote following schedule: V O•upon signing contract(not to exceed 1/3 of the total contract price br the cost of special order items,whichever i ()�y / / or upon completion of s greater) or upon completion of Gi S $5i8.0O upon completion ofthe contract. (Law forbids demanding full• a anent until.ennt 'ozl.�.tc � �. . g P y act is,,,,-p.,,.,,d�o„a�party's satisfaction) . The ibllowingmai.•erial/equipmentmustbespecial $ ordered before the contracted work begins in order to be paid for to meetthe completion schedule.(**) $ to be paid for Including all finance charges Law requires that any deposit or down payment required by the contractor before Work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. x rens warranty-Ts an express wars an bein rovided b the contractor? 00, es all terms of the warran must be attached fo the contract Subcontractors-The contractor agrees to be solelyresponssible for completi of the work described regardless ofthe actions of any third party/subcontractor utilized by the contractor. The contractor tin ther agrees t be solely responsible for all payments to all subcontractors for materials and aborunder this a Bement Contract Acceptance-Upon signing,this document becomes abinding contract under law. Unless otherwise notedwithiathis document,the conVact shall not imply that any Lien or other security interest has been placed on the residence. carefully before signing this contract. Review the following cautions and notices ° Don't be pressured into signing the contract.Take time to read and fully understand it. Aslc questions if something is unclear., ° alce sure the contractor has a valid Home 7m rovement Contractor Re 'stration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofl3ome Improvement Contractor Registration. You may inquire about contractor registration by writing to the-Director at 10 ParlcPlaza,Room 5170,Boston,MA.02116 or by calling.617-973-8787 or 888-283-3757. ° Does the contractor have insurance? Aslc the Contractor fox his insurance company information so that you can eonfv m coverage,or ask to see a copy of a"proof of insurance"document. ° Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. contractor in writing at his/her main,oMce or branch office by ordinary mail,posted,by telegram sent or by You may cancel this agreement.if it has been signed at a place other than the contractor's normal place of business,provided you notify the delivery,not later than midnight of the third business day following the signing o£this agreement. Seethe attached notice of cancellation form,for an explanation o£this right. D®XOT'81Q4X TB- IS CONTRACT Two identical copies ofthe contract must be completed and signed. Onecopy ART.ANY BL""•`;C SPACES 111 opy should go to tIte home ' er. The other copy otddbe lceptbythe contractor, Homeowner's ' f' gnat e C4 is or ig iature Date Conniraefo:r Arbifxaaion The Home 7mpiovement Contractor Law provides homeowners with the light to initiate an.arbitration action(as an 'alternative to count action)if they have a dispute with a contractor. The same right.is not automatically affoxdedto a contractor,however. The contractor would have to resolve any dispuute he/she has with a homeowner-in court unless both parties agree to the optionai[clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner herebyinutaall y agree in advance that , in the event the contractor has a dispute concerning this contract;the contractor may submit the dispute to a private arbitration f=which has been approved by the Secretary of the Executive office of Consumer Affairs and Business Regulation and the consuunex shall be required to sx� t to-such arbitrati .provided In Massachusetts General Laws, chapter 1 A.. Homeowner's Signata re ontractor's Signatauxe NOTICE:The signatures of the patties above apply only-to the a ement ofthe parties to alternative dispute resolution initiated by the contractor: The homeowner may initiate alterative dispute resolution even where this section is not separately signed by the parties. EComeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 14.2A)and other consumer Protection laws (i.e.MGL chapter 93A)may not be,waived in any way, even by agreement. However,homeowners may be excluded from certain rights if tti.e contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded`h:om all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worlananlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty:for worlananship or materials, 1n addition to guarantees or warranties provided by the contractor,all goods sold-inMassachusetts carry an implied warranty of merchantability and fatness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lavdally agree may be added to the terms of the contract as long as'they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline(listed below). ]Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Patties are also advised not to sign the document tmtil all blank sections have been :tilled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept b the p y contractor. Any modification,to the,original contract must be in writing and agreed to by both patties. Contracted work may not begin until both parties have received a fiMy executed copy of -the contract,and the three day rescission period has expired. Accelerated Paym6xits A contractor may not demand payments in advance of the dates specified on the.paym.ent schedule in caseswhere the homeowner deems himllxerself to be financially insecure. However,in instances where a contractor deems him/hF.;rself to be financially insecure,the contractor may requite that the balance of fixnds not et due be Y laced ina'o' t accotunt a P m escrow s a prerequisite to continuing the contracted work. Withdrawal of fLmds:from said-account would require the signatatres of both parties. Additional Information .If you have general questions or need additional information about the Home Improvement Contractor Law or other contact;: consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Impiovement" Consumer Information Hotae Office of Consumer Affairs and Business Regulation 10 Park plaza*,Room 5170,13oston,• aa 02116 617-973-8787, 888-283-3757 orvisittthe 0CABRwebsite t11t n-//www .—v/ocabx•/ If you want to verify the registration of a contractor or if you have questions or need additional.information about the contractor registration component of the Home Improvement Contractor Law, contact: specifically Director of Home Tmprovement Contractor Registration Office of Consumer Affairs aud•Business Regulation 10 Paxk Plaza,Room 5170,Boston,MA.02116 617-973-8787, 888-283-3757 or visit the 1-UC website at 11 n://wwlv.rnass.trov/ocabr/ Go online to view the status of a Home Improvement Contaactor's Registration: 111,1.71://db.state.ma.us/ho�lleimnroyement/Iiceu.seeTist as . For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Sectioin Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6S2-4.800,508-!755-2548 or 413-734-3114• Version 2.1 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 32,392.00 m $ - $ 388.70 Plumbing Fee $ 48.59 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 48.59 Total fees collected $ 585.88 20 Lavender Circle 131-14 on 8/9/13 finish Basement � NORTH Town of EAndover No. so h . ver, Mass,LAKI P coc..rc.0 w.c.. 1' �.9 ASR-1TED S ll BOARD OF HEALTH PERMIT L D Food/Kitchen Septic System THIS CERTIFIES THAT ............C.v.f.�!!� BUILDING INSPECTOR .. Foundation has permission to erect .......................... buiIidi2ns on .. �........L V: '.:. .,/..............,.....,, Rough tobe occupied as ...... .4! �1r...... ............P. 'Araw....................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final *3aq w- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR ON TS Rough Service ..... . .. .. ........ ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 OPage No. i of � Pages POSA .. outj6, MA Uc.#122153 BERTH® D y �' •Int�xt Painting L CONCONSTRUCTION �..L.C. .Virinorows (603) 339-1465 .$ding,t Soffit •Doors •Renovations Fully Insured•Over 15 years Experience•Free Estimate PROPOSAL SUBMITTED TO /NONE 97Y ---7/1/- (j DA . S�•- / BEET JOB NAME 20 CITY,STATE ANDP CODE JOB LOCATION cYa VI&c' We hereby submit specs icalions and estimates for S T IlL X. `` `'�-.�e. ;f,-ti s`'�/����ie'S /�' •°^ /�/G' �cmc-;f-�s WE ftopo E hereby to ftar t material and labor—complete in accordance with above speclFAWNons.forthe sum of dollars Paymentvvs:to be made as fo@o � . - AD material is guaranteed to be as spedfled.All work to be completed in a Auftrized wodarianKl a manner aocordng to standard practices_ Any alteration or Signature: deviation from above specif ations mvdwv extra costs will be executed only Zk upon wrrlten'orders,and wM become an extra charge over and above the estate All agreernents c o nDrtgent 4m' aftilcm accidents or delays beyond Note:This p may be A o ur oontrot. withdraam by us 1f not aocdpted whim " days. ACCEPTANCE OF PSOPOM6-Tire above prices.speoffiwa*m and cwndltions ani safisfactcxy and are Hereby accepted.You are authorized to do tfre work as specifled.Pa ment will be made as oufted above. - Date of Acospla r ., 113 Signature: _ -------- Page No. of Pages PROPOSAL do�OUf�i ,�ry'`1 A7 �T�t�.p�� MA Lia#122153 z BERTHOLD Y. O V V Jt ON J-LC.InUF[ Lia#PT38 y •vitro.xL Painting 603 3391465 :Siding and Soffit •Windows Carpentry •Doors •Renovations Pully Insured•Over 15 years Experience•Free Estimate i PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME CITY.STATE AND P CODE JOB LOCATION /1 l�n 0 We hereby submit specifications and estimaatter. -s fo / 70 e e T 7'� x WE F%OPOSE hers h by to furnismaterial and labor—canptete in accadance,x8h abrnre speci6gtions,fnrfhe semn of dollars(S Z- Payment to be made as Mom -. AB rrratetiat is guaranteed to be as gmdfled.AD work to be completed in a Authorized wWWnwlke maturer a cors g to standard pratxises. Any akeredion or Signature: deviation from above speciMmIlons bwdwrg extra costs vA be executed a* - upon wrFltart Offers,and will becoft an extra charm over and above the estimate AN ergreertretris Wm aftilm.accidents or d� and 7t Is pr oP�d may be bey our cowl. whh&awn by us if no accepted within ACclsrrmcs OF PROPOSAL—The above prices,apedfca*= and condlions are satisfeatOfy and are hereby accepted.You are ffi tafized to do the work as specified.Payme t will be 713 made as eu8inad above. / Date of Acceptance erre: �/ — ---- Page No. 3 of L J Pages ��10Oak�avlfo�0 ROPOSAL BE [OLD CONSTRUCTION -]—LC. ��#testi ss InL/Ext.Painting (603) 339-1465 :SS g an Sept •Windbws • pentry Doors •Renovations f Pully Insured•Over 15 years Experience•Free Estimate f 1 P OPOSAL SUBMITTED TO PRONE DATE STREET JOB NAME { 1 CfTY,STATE ANDCODE JOB LOCATION We hereby submit spedficaftons and estimates for f�, :.L—'-1-5�•�,�� !� �std �®�r� f/`''-�-t � �.11�ct �! ��c�� C® l �.�t i �S 7�Y° ✓, r- loo 0 leo 0 111 ed 71 Q Ki Z /4" AVE PROPOSE hereby to turnish material and tabor—complete in accordance with above specifications,tar the sum of: dollars(S ), Payment to be rode as follms: AD material is guaranteed to be as sped6ed.AN work to be cohoated in a Authorized worknanke manner accorr5ng to standard practices. Any atteradon or Signatum. deviation from above specificallons involving extra costs will be executed only upon wrfiten-enters,and vA become an extra charge over and above the :Tt is prop may be �� esfimale.AN agreernetrfs contingent upon ablates,acciderb or delays beyond SYS our control. wDlydrawn by us if not aocopted within ACCEPTANCE OF FSOPOMU—The above prices,speff=*m and conditions are satiefsolmy and are thereby accepted.You are authorized to do the work as specified.Payment will be made as outOned above. " bate of Aecaptance: soft": Page No. '/ of �) Pages PROPOSAL MA Lia#122153 BE [OLD CONSTRUCTION _LC. FLuc.#P'r38 y •InL/ExL Painting ,339-1465 �� � � .Siding and Soffit Wi • ndows ` nay Doors •Renovations Fully Insured•Over IS years Experience•Free Estimate I - P`PEAL SUB TO+ . PHONE �r o DATE MEET JOS NAME / CITY.STATE AND ZIP CODE JOB LOCATION We hereby submit specifications and estimates for: / `le r"C_ 60 00 �/ WE Tb t�r j'+Gfi.�o PRUPC�8O(,3(,EH=e77aerialLor x �c�ewan above spedficmions,roc the sum of Payment to b&4&de as follows: AG material is guaranteed to be as sped6ed.AD wodc to be completed in a Authorized wodm mBa moaner wording to standard practices. Any aaemdon or Signature: ''�-- de"on from above Weckallons mvdving extra costs will be executed only upon written orders, and will becorm an extra charge over and above the estbmade.A6 agreements caMin"ulM. Mces,accidents or delays beyond Z.pmpd;M may be our oomoi. wandraxm by us If not aooepted wftNn days. ACCEPTANCE OF PBOPMAL-The above prices,spectlimMons and conn tions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment ill be made as oufted above. AJ / Date of Amerce:-c -7 3 Signature: v -- 0 a r I : t 0DD � V " r II•-11 VT o� 3 ID'-0V4' rn —Z1 O r F z OR g �� II • rV4' I I II � FINISH II I Ol, II I II O lu D� 0 7 JOANNA RECKHopkis Residence Basement Floor Plan ARCHIrEcr N 20 Lavender Circle New/Proposed �1 cu North Andover,MA 01845 15 Rockrldge Rd.,Andover,MA 01810 SCALE: •.IIW 0,.-r� ft.�, � om 0 Flu � N r z � tl uj > Z a m �� rn Nz m ii I'r° i d r g r II $� rIlI R 1. I 1 11 � it rn it it it it it II O IL�I1I o Hopkins Reldence JOANNA RECK ARCHITECT Basement Floor Plan u 20 Lavender Gircle ExistingVemolition moll w Worth Andover,MA 01845 15 Rockrldge Rd.,Andover,MA 01510 scAIE:affi•.I-.0- ph. ob■ The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): fefU�� Address: � City/State/Zip: Q (Ie /"r 1�/ U L hone#: GO?-,�?� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. K Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' insurance.# 9. EJ Building addition com [No workers' comp.insurance P• required.] 5.�We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o work ' right of exemption per MGL y � workers' comp. 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other ' comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereft4erdfv under the pains and enaldes oUeft that the information provided above is true and correct �i Signature:'C-_ -- -- ---- - _- _. _ _�_�_�s._-- - -- _113a — 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#• Massachusetts -Department of Pudic Safety Board of Building Regulations and Standards Cons truction'Sup&viso r j License: CS-054526 _�.1 I.. , CHARLES E BE "', 7 771 10 PINEWOOD RD s SALEMNH 030019 Exp¢.ation Carriissionr. 02/17/2014 . 1 i - c- p__A, I ieanrr�iQn.roecc� oz.-V[lailcccsct�efl� Office of Consumer Affairs&Busibess Regulation OME IMPROVEMENT CONTRACTOR egistration 122153 Tyf ei piration: 7/26/2614- LLC F JOHN BERTH LD CONSTRUCTION LLC John Berthold 15 POPLAR RD SALEM,NH 03079 Undersecretary JOHNB-2 OP ID: NB ACORO° DATE(MM/DD/YYYY) `.,..� CERTIFICATE OF LIABILITY INSURANCE 08/07/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ACT PRODUCER Phone:603-890-6439 NAME, Planright Insurance-Salem 224 Main Street Suite 3C Fax:603-890-6521 1MCA N E)d:ONE Fac No): Salem,NH 03079 IL James A Santo ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Concord Group 20672 INSURED John Berthold Construction LLC INSURER B:Merchants Insurance 23329 15 Poplar Rd Salem,NH 03079 INSURERC: INSURER D: INSURER E: INSURER F.: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,00 B X COMMERCIAL GENERAL LIABILITY BOP1073298 06/08/2013 06/08/2014 PREMISES Ea occunence $ 50,00 CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 500,00 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaacddent $ 1,000,00 A ANY AUTO C673280-5 03/16/2013 03/16/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB iOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTWE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Corina Hopkins ACCORDANCE WITH THE POLICY PROVISIONS. 20 Lavender Circle North Andover,MA 01845 AUTHORIZED REPRESENTATIVE G;; ©1988-20.10 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Location No. , DateIJ o - TOWN OF NORTH ANDOVER ,O o Certificate of Occupancy $ Building/Frame Permit Fee $ C s J0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# r VL 1- 67 f b Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING t:� � ,�� �' .a r�# � �:• � '1� SDC L��l� !71 BUILDING P..ERMIT NUMBER: �}g(o DATE ISSUED: �� � T&aE 14 z j n � FbU mmootI mm4 0 SIGNATURE: rI Building Commissioner/Inspector of Buildings Dat SECTION 1-SITE INFORMATION 1.1 Property Address:+a o 1.2 Assessors Map and Parcel Number: l�oi- a�1 ��a�rende� Crrcycl �ac�n Farm f4kr i�l�e�,n,r`t�e , tVbd�vjs���+ Spxcia� P�rMit N Qlac�" as recorded a+ 4i\ 1aulrenee �g;s1p Map Number Parcel Number p 1.3 Zoning Information: 1.4 Property Dimensions: -3 Sr�tal4 Far►��I�l s�denc� Li ZoningDistrict Pr os se �— Lot Ar s Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide E2T±ed Provided Re aired Provided Qa 01110 IV p a . t s- 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 ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT yy �! 2.1 Owner of Record C 4/1 Amw A9 Mys Name(Print) Address for Service: Signature Telephone W 2.2 Owner of Record: I I,iame Print Address for Service: i z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ftf LA"n"NICCA Licensed onsti4ction Supervisor: P. 0 109 W Ado A i 8y License Number mn Add MA x-- 13-aooq ic 7 — Expiration Date Si ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Co4l4pany Name M Registration Number Ad ress z Expiration Date Signature Telephone t --Y 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 1 Brief Description of Proposed Work: jl l U new 'o" Lz f-n l r 1' JiL Q 09" *rn;-� CO 1- bm,ftal &-Ns a , SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be }° a} [CII"'USI+;ONLY ; Completed by Rermit applicant 1. Building , o tto'i87 Co (a) Building Permit Fee F�U,'1db 10,000 Multiplier 2 Electrical $ 004 (b) Estimated Total Cost of oa ' Construction S4�(o Som 3 Plumbing 000 Building Permit fee(a) x(b) 4 Mechanical HVAC 6.0� 0--bift&'SS v_o — '646.oo -, r-OLS 5 Fire Protection r'ola 4"*zso 6 Total 1+2+3+4+5 _Sae's Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CO`N_TR1ACTOORn APPLIES FOR BUILDING PERMIT 1, �_ Q�C RQ O app tb U f f as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTIOt4 7b OWNER/AUTHORIZED AGENT DECLARATION 4 1, Low as Owner/Authorized Agent of subject l prope y Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 6elegl��ylyiv M< Pri ame r iattue o wne A ent V Date L( f NO. OF STORIES SIZE 2,ZA(, , BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS 40 6?j '_'0_C2_'TgW@ 3M dK10160" SPANI q'MY a' VQL 15 1@ DIMENSIONS OF SILLS cl - n DIMENSIONS OF POSTS 3Y " LAII DIMENSIONS OF GIRDERS L4 x % L VL HEIGIIT OF FOUNDATION rl " u-C F-ta THICKNESS /Q SIZE OF FOOTING J /0" X �� MATERIAL OF CH]MNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE e 0 V Vr I , 1 FORM U'- LOT RELEASE FORM INST S RUCTION . Thi s form is used to verifythat al necessary I approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not 'applicant and/or landowner from. relieve compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT YJ' 1�+� \dn � L C' , PHONE�� -CLJ=!C1 Sc.--e 1>1aY� � Iy50"� eS recc,�ec) LOCATION: Assessor's Map Numbers �-s; ;s2� PARCEL F ` ----- SUBDIVISION f - LOT(S) STREET g )({�rP n�)�r C1���,�, � ST.NUMBER 3Z `OFFICIAL USE ONLY*"*************** RECOM D ION OF TOWN AGENTS: C ATION A MINISTRATOR DATE APPROVED 49J DATE REJECTED COMMENTS NNER DATE APPROVED DATE REJECTED COMMENTS _ FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. DATE-REJECTED COMMENTS PUBLIC WORKS- SEWERIWATER CONNECTIONS /U DRIVE AY P RMIT �7 FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm JUN-11-2004 03 :20 PM MARCHIONDA&ASSOCIATES 781 438 9654 P. 02 o � o t 0 76 LOT 22 17971 S.F. J 0.41 Ac. t9. 74.9' 41.8 N / L,J 61, TOP FOUNDATION r D ELEVATION-282.01 " � N60"06 43 E 21.6' 15.0 A —25.0' a 7"W z N29°53'1 ��ts�\ � 22.5' V I,"()fF F 5.93, --� 7 _N 2g 96 DRAINAGE & UTILITY 2' S� , EASEMENT ^ " LAVENDER CIRCLE WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT THE BUILDING IS LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS RELATIVE TO REQUIRED SETBACKS OF FROM EXISTING PLANS AND RECORDS THE MUNICIPALITY WHEN CONSTRUCTED. ALSO, ACCORDING WITH THE STRUCTURES SHOWN LOCATED TO THE F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY, THIS PLAN COMMUNITY PANEL NO. 250098 0006 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/1993 , THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED FOUNDATION PLAN LOT 22 PEACHTREE FARMS MARCHIONDA & ASSOC.,L.P, NORTH ANDOVER, MA ENGINEERING AND PLANNING CONSULTANTS PREPARED FOR 62 MONTVALE AVE, SUITE I PEACHTREE DEVELOPMENT, L.L.C. STONEHAM, MA. 02180 P_0. BOX 3039 (781) 438-6121 ANDOVER, MA 01810 SCALE: 1"=30' DATE: 6/10/04 FORM it- LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fr Boards and Departments having jurisdiction have been obtained. Om the applicant and/or landowner from.compliance with any applicable.or requirements.lie *APPLICANT FILLS OUT THIS SECTION ARPLICANT_�eaCht[e �- .� Ian(YJ�� LLC PHONE 9A �a See p►ar1 * i4soa US rew.d&) LOCATION: Assessor's Map NumberQ`I-fhe�C %)!9M � )kd% PARCEL__ SUBDIVISION pc�chi Fc��m \ll LOT(S) STREET O Ltn )e(- (('C ST.NUMBER "L ***'�`'` * ►' **' '"t��`* '*****.OFFICIAL USE RECO gNI TOWNAGENTS: RVAT110;tD)MIS DATE APPROVED y DATE REJECTED COMMENTS P NNE DATE APPROVED DATE REJECTED. II COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVE PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECT R DATE Revised 9197 jm I GROWTH MANAGEMENT BYLAW EXEMPTION STATMENT TOWN OF NORTH ANDOVERBUILDING DEPA::E s form shall be used to assist the Building Department in their determination tion under se ion 8.7. of the Town of North Andover Growth Management Bylaw. The applicant vide all of e ne ss information as requested below. La Rh Permit Applicant Property address Map/Parcel Applicant's Phone Number SingV Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building. permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date ofthis bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6,1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running ring with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved bythe planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING F OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT*FOrO FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPN DATE THIQE, CHED TO THE BUIL IN JG,PEl,RMIT APPLICATION [i iJ1.1� 06/16/2003 '14:59 19783276517 WILLOWS PAGE 02 NOTICE OF ASSIGNMENT EMPLOYER: PEACHTREE DEVELOPMENT LLC COMBO I.D. STATUS OF EMPLOYER 231 SUTTON ST SUITE 2E-F 000139954 Limited Liability Com NORTH ANDOVER, M.A. 01845 "OVERAGE GROUP 0139954 The Waiver of Our Right to Coverage under this assignment Recover from Others Endorsement applies to Massachusetts is available on Pool policies. operations only. For Coverage Contact your agent for details. outside of Massachusetts, contact the appropriate Pool or Plan for that state. AGENT WILLOWS INS AGCY INC TT'-- _.. INSURANCE COMPANY: OR 522 CHICKERING RD TRAVELERS INDEMNITY CO PRODUCER: N ANDOVER, MA 01845 MS JACKIE DENNIS P 0 BOX 3556 ORLANDO, FL 32802 (800) 443-4404 AGENCY FEIN:223 8 5 6 6 64 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE kSTIMAIED CODE TOTAL .ANNUAL PREMIUM REMUNERATION -------------------------------------- ----- -------------- ---------- ---------- RPENTRY-DETACHED PRIVATE RESIDENCES 5645 $0 10.62 $0 APENTRY-DWELLINGS-3 STORIES OR LESS 5651 $0 10.62 $0 EMPLOYERS LIABILITY 100/100/500 9845 LOSS CONSTANT 0032 $50 STANDARD PREMIUM $50 EXPENSE CONSTANT 0900 $122 TERRORISM CHARGE 9740 $0 RISK MINIMUM PREMIUM 0990 $500 ESTIMATED ANNUAL PREMIUM $500 DTA ASSESS. 4.5% OF STANDARD PREM. $17 EST. ANNUAL PREM. PLUS ASSESSMENT $527 INSTALLMENT BASIS: Annual REQUIRED DEPOSIT PREMIUM $517 COMMENTS Coverage effective 12:01 AM on 05/23/03 PATE OF NOTICE: 05/24/03 PREPARED 5Y: Joanne Shea EXT 530 * * SERVICING CARRIER ASSIGNMENT * * LETTER Ib: 419982 COPY: AGENCY The Workers' Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street• Boston, MA 02110 (617)439-9030• FAX(617)439-6055 •www.wcribma.org FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro rn Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from. compliance with p an applicable y pp cable or requirements. 9 meet s. *APPLICANT FILLS OUT THIS SECTION APPLICANT'aChtCee _ je1 ornent LLC PHONE see p ian 4 RS65 as recorded LOCATION: Assessor's Map Number_o 7Sc � dS PARCEL__ SUBDIVISION PeCtC'htrerz FctrM LOT(S) _ STREET �'I 11 n6e(- (f CLe ST.NUMBER4_ *******"OFFICIAL USE RECO2VDMEINISTRA-TOR F TOWN AGENTS: RVATDATE APPROVED y .DATE REJECTED COMMENTS 4el'010S12 //fro. TOWN PLANNER DATE APPROVED DATE DEJECTED. COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED. -------- DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVE PERMIT FIRE DEPARTMENT /7 p.7 RECEIVED BY BUILDING INSPECT R DATE ---- Revised 9197 jm AFFIDAVIT I, SCOTT L. MASSE,attorney for KENNETH W. REA do hereby depose and state: 1. I represent Kenneth W. Rea, owner of a certain parcel of land located on Rea Street, North Andover, MA and more specifically described in a plan of land recorded with the Essex North Registry of Deeds as instrument/plan number 14502. 2. 1 am duly authorized by Kenneth W. Rea to act on his behalf regarding furtherance of the above stated instrument/plan. 3. Authorization is hereby given that Gerry-Lynn Darcy, and/or Reach Tree Development LLC be allowed to act as the agent for Kenneth W. Rea regarding any and all matters relative to a certain Building permit(s)issued by the Town of North Andover for any lots affiliated with the above stated plan. Signed under the pains and penalties of perjury this day of J e 2003. S TT L. MA SE z 'd OifsB-ZES-BL6 sRaujo-v�d dI0 :EO co 91 unr 4 FORAM T COVENANT KNOW ALL MEN BY THESE PRESENTS THAT WHEREAS the undersigned has submitted an < I/ application; dated November 1, 2002 to the North Andover Planning Board for approval of a Definitive r4 h Plan of a certain subdivision bearing the name of Peachtree harm and shown on a plan entitled"Definitive Subdivision and Special Permit Plan Peachtree Farm in North Andover, Massachusetts" dated October 24, 014 2002, last revised May 16, 2003 (the "Plan") and showing 29 single family lots and 5 attached townhouses kx. and has requested that the Board approve such pian without requiring a performance bond, THIS AGREEMENT WITNESSETH THAT, for the consideration that the North Andover Planning Board waive the aforesaid requirement for a.bond,the undersigned covenants and agrees with the Town of North Andover as follows: : ••-.`t' `:. 1. The undersigned will not sell any of the lots 1-29 until.the construction of the ways and the installation of the municipal services necessary to adequately serve such lot has been completed in the manner required in the aforesaid application, and in accordance with the covenants, conditions and agreements thereof, except for the following particular items of work, the performance of which shall be exempt from the conditions of this contract: construction of the ways and the installation_.of the municipal services associated with the construction of the five(5)attached townhouses on to esi.gnated on the Plan as Lot B, which Lot B is exempt from this Covenant. 2. The undersigned agrees to record this agreement in North Essex Registry of Deeds as required by the Rules and Regulations of the North Andover Planning Board. 3. The undersigned agrees that this contract shall be binding upon his/her heirs, executors, and administrators,and particularly upon any grantees of the undersigned. 4. Nothing contained herein shall be deemed to prohibit a conveyance by a single deed subject to this covenant, of either the entire parcel of land shown on the subdivision plan or all lots not previously released by the Planning Board. 5. A mortgagee who acquires title to the mortgaged premises by foreclosure or otherwise and any succeeding owner of the mortgaged premises or part thereofniay sell or convey any lot, subject only to that portion of this covenant which provided that no lot be sold or conveyed until ways and services have been provided to service such lot. 6. Noting herein contained shall prohibit the applicant from varying the method of securing the construction of ways and installation of municipal services from time to time or from securing by one,or in part by one and in part by another, of the methods described in M.G.L. Chapter 41, Section 81-U, as long as such security is sufficient in the opinion of the planning board to secure performance of the construction and installation. It is the intention of the undersigned, and it is hereby understood and agreed, that this contract shall constitute a covenant running with the land. Lots within the subdivision shall respectively be released from the foregoing conditions hereof upon the recording of a certificate of performance executed by a majority of said Planning Board which certificate shall enumerate the specific lots to be so released. There are no mortgages of record or otherwise on any of the land in the aforesaid subdivision except as described below and the present holders of said mortgages have assented to this contract prior to its execution by the undersigned. ROBERT W1._E\.,ESQ. �--CKER? SEP.MANS,CHERIN,NIELI-E TT,LLC CNE IITERNATIONAl PL.,',8TH FL113CIa K0259882.1; IN WITNESS WHEREOF,the undersigned,applicant as aforesaid,does hereunto set his/her hand and seal this clay of May,2003. Description of Mortgages(Give complete names and Registry of Deeds reference): None Big Kahuna Properties,LLC Kenneth W.Rea,Manager I Owner 4 f Acceptance by a Majority of the Planning Board of North Andover COMMONWEALTH OF MASSACHUSETTS May Z';' 2003 Essex, SS Then personally appeared the above named Kenneth W. Rea and acknowledge the foregoing to be the free act and deed of Big Kahuna Properties,LLC,.before me. Nowt'Public My Commission Expires: Z o 3 f K0259882.1) FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Essex County, Massachusetts, .hereby certify that: a. the requirements for the construction of ways and municipal services called for by the Performance Bond or Surety and dated and/or by the Covenant dated May 20, 2003 and recorded in the Districts Deeds, Book 7827, Page 143; or registered in Land Registry District as Document No, and noted on Certificate of Title No. in Registration Book , Pagehas been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled "Definitive Subdivision and Special Permit Plan Peachtree Farm in North Andover Massachusetts" Plan dated October 24,2002, last revised May 16, 2003 recorded by the Essex North District Registry of Deeds, Plan No. 14502 or registered in said Land Registry District, , Plan Book , and said lots are hereby released from the-.restrictions as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street (s)) Lots 1 —9 and 20.—28 inclusive,Peachtree Lane and Lavender Circle b. (To be attested by a Registered Land Surveyor) I hereby certify that Iot number (s) Lots 1 — 9 and 20—28 inclusive, on Peachtree Lane and Lavender Circle do conform to layout as shown on Definitive Plan entitled "Definitive Subdivision and Special Permit Plan Peachtree Farn in North Andover. Massachusetts". Registered Land Surveyor 1 of 2 (K0259892.1) C. The Town of North Andover, a municipal corporation situated in he County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated 20 , and/or Covenant dated May 20, 2003 from Bi-- Kahuna Properties, LLC of the City/Town of North Andover, Essex County, Massachusetts recorded with the Essex North District Registry of Deeds, Book 7827, Page 143, or registered in Land Registry District as Document No. and noted Certificate of Title No. in Registration Book Page acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: Lots 1 —9 and 20—28 inclusive EXECUTED as a sealed instrument this ZD' day of Novemb r, Majority of the X/ eG ' Planning Board of the Town of North Andover ' " COMMONWEALTH OF MASSACHUSETTS ESSEX, ss. November 1�, 2003 Then personally appeared Mhlrl ry,' ,-erre-o-f-the above-named 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, JiomqV},(3Iti.[Do(%INotary Public V l My(torhmission Expires 2of2 'K0259882.1) FROM (WED)JAN 21 2004 6:21/ST. 6:20/No. 6802897119 P 4 a_I Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code RES checkSoftware Version 3.5 Release I Data filename;lC:lLaudani\Peachtree\ElouseD\housed.rck PROJECT TITLE:House"D" CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached 11L•ATINV SYSTEM TYPE:Other(Non-Electric Resistance) DATE:01/21104 DATE OF PLANS:4-10-03 PROJECT DESCRIPTION: Peachtree Farm DESIGNER/CONTRACTOR: Peachtree Development LT.c, COMPLIANCE:Passes Maximum UA=549 Your Hone UA=548 0.21%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Peritneter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1468 30.0 0.0 51 Ceiling 2:Cathedral Ceiling(no attic) 521 30.0 0.0 18 Skylight l:Wood Frame:Double Pane with Low-E 6 0.420 3 Wall 1:Wood Frame, 16"o.e. 2998 11.0 0.0 229 Window 1:Wood Frame:Double Pane with Low-S 323 0.320 103 Door 1: Solid 42 0.180 8 Door 2-Glass 62 0.340 21 Moor 1:All-Wood Joist/Truss:Over Unconditioned Space 2457 19.0 0.0 115 Furnace l:Forccd Hot Air,80 AFUE COMPLIANCE STXMNIENT: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts linergy Code requirements in REScheckVcrsion 3,5 Release 1 d (formerly MECchecl and to comply with the mandatory requirements listed in the RES cheekInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to beat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. FROM (WED)JAN 21 2004 6:21/ST. 6:20/No. 6802897119 P 5 Builder/Designer Dat, I FROM (WED)JAN 21 2004 6:23/ST. 6:18/No. 6802897118 P 4 Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoltware Version 3.5 Release 1d Data filename:K:\Laudani\Peachtree\HouscD\housed.rck PROJECT TITLE:Mouse"D" CITY,North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE:01/21/04 DATE OF PLANS:4-10-03 PROTECT DESCRIPTION: Peachtree Farm DESIGNER/CONTRACTOR.- Peachtree ESIGNER/CONTRACTOR:Peachtree Development LLc. COMPLIANCE::Passes Maximum UA.—,549 Your Home UA_548 0.2%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Pactor CIA Ceiling 1:Flat Ceiling or Scissor Truss 1468 30.0 0.0 51 Ceiling 2:Cathedral Ceiling(no attic) 521 30.0 0.0 18 Skylight 1:Wood Framc:Double Pane with Low-E 6 0.420 3 Wall 1:Wood Frame, 16"o.c. 2998 11.0 0.0 229 Window l: Wood 17rame:Doubie Pane with Low-L" 323 0.320 103 Door 1:Solid 42 0.180 8 Door 2:Glass 62 0.340 21 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 2457 . 19.0 0,0 115 Furnace 1:Forced Hot Air,80 AFIJE COMPLIANCE STATEML"•NT: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheckVersion 3.5 Release td (formerly MECehecl and to comply with the mandatory requirements listed in the REScheckInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and 14.4. FROM (WED)JAN 21 2004 6:23/ST, 6:18/No. 6802897118 P 5 +Builder/Des�g»er /�" nate �~ N R T!y Town ® Andover ® go; 4 q & leo yy dower, Mass., A o T OSA LAKE \ T LzzwsC , �V I COC MIC ME WICK DRATED P? CO SSACHUS FOR EXCAVATION- AND F THIS CERTIFIES THAT ...:Pg! ..NO rt)tt�_I.. ...�E'A?��..L�...Qln......................................... has permission to excavate and pour foundation at �.. ! ill!ki for the purpose ,. fc7 The person accepting this permit must return to the office of the Building Inspector a certified lot plan show of building thereon before Foundation will be inspected. 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. G.q &S SEE REVERSE SIDE ............... ........ . ......... . .. ......... BUILDING INSPECTOR NORT11 �- 6 e ® of : ; Andover No..49& - LAKE lover, Mass.," e COCKICMEWICK ��. .44 RAT E D 7 U BOARD OF HEALTH Food/Kitchen PERMIT Septic System Q � BUILDING INSPECTOR THIS CERTIFIES THAT........ 1 0�.► '�EI�. ... ....t .—t..�..?!�]�'1�.... ............ """"""""""' Foundation has permission to erect.....vuen;!;>............. buildings on ..AAP..#4eA1 AA-;M6E..cladic... w...." . Rough to be occupied as......•33/.�. ...sIAI.04C...rA S ,<<.I ....� Z�IV ..r............................................ Chimney provided that the person accepting this permit shall in every re pact conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laves relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough ..................... ......................:.... O.� Service EC BUILDING INSPTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT GS . �=c_ o�B 3oG� Street No. SEE REVERSE SIDE Smoke Det. PEACH TREE DEVELOPMENT,LLC 1118 Town of North Andover 2/20/2004 250.00 Cash Danvers Permit Lot 24 250.00 PEACH TREE DEVELOPMENT,LLC 1123 2/23/2004 Town of North Andover 55.00 l 55.00 Cash Danvers Lot 24 Permit Location �o`� 0�4-- -'i�14✓��� No. Date T4 IL pORTOI TOWN OF NORTH ANDOVER L Certificate of Occupancy $ ;�s',•' E<� Building/Frame Permit Fee $ S2�LO MMus _.• Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �kkzvoYLs Sear afrNl� t 17453 P Building Inspector r � Location No. 9` Date V40, TOWN OF NORTH ANDOVER 3+ .. '• oz + Certificate of Occupancy $ n . i $ Building/Frame/Frame Permit Fee $ scHust 9 Foundation Permit Fee $ -�G Other Permit Fee $ TOTAL $ 3 # Check # q700p r� 2 1 Building Inspector ', �..� moi"` � �' � z