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HomeMy WebLinkAboutBuilding Permit #565 - 39 HAWKINS LANE 4/29/2009 BUILDING PERMIT OF AORT#t q `�t�eo ib• �O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 2 ^"re"p S � Date Issued: IMPORTANT: Apprt-must-complete all items on this page -PROP:ERT"Y OZANER MAP NO-- � �'.:�1ACEL Y �O l�1G���TR�,'71 1Vaaclef�tp`V11ae des TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential New Building One family A7—da i 151 re family Industrial Alrergi-o No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other epic fibou pla'm- etlari�ls lizl/�tersh epi gastric# Wall br./sewex DESCRIPTION-OF WORK TO BE PREFORMED: '7 Identification Please Type or Print Clearly) OWNER: Name:__U Sc_,77' Phone: Address: 3 0` K�••-�c,,:-.l s �, .CONTACT Marne �'`�► �� �.�.��-�..... Phone "` ` Address: � ;pe asor >3ras#ru% n�Lacer� E 3 �'i lot :Imp�arerraenf�acense t D m � `Date: b . ARCH ITECT/ENGINEER �,,���,/+, '1�.� r ,�.> Phone: `"1 - 2-3 7_ Address: 30,o Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ p U , 0 v FEE: $ � L d Check No.: Receipt No.: / NOTE: Persons co tracting with unr istered contractors do not have access to the guaranty fund Signature bf- 4gent/O.hie"T S'igr�a ure o contr cto Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer - Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Priva=(s5epticMank, Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS +!� A CONSERVATION Reviewed on ! ;` Si nature4-t�--� COMMENTS r '�, �,U�,. (, / t'�) U U ,' / HEALTH Reviewed on Signature COMMENTS f/P � �� i� t "�-i c . i rte! Zoning Berard 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 Town Engineer: Signature: Located 384 Osgood Street F. R-E7DgPAPT�11!`ENT � ,em v s#erroh:s e -Located 124�Jain,:Stree# - Ftre a art ant, �,gnatuvei ete C0M#9It=( Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. � i 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 J Building Department The following 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 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. Date / ` f MORTM TOWN OF NORTH ANDOVER 3: �`. • o Certificate of Occupancy $ Building/Frame Permit Fee $ 6::�) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 61:4- 2 _ Building Inspector NORTIy Tovm of . tAndover �6 C _ _ AI(E dower, Mass., COCHIC HE WICK �,9SDRATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....Ttj.M........200%701 ....... ................... .. ......................................... . .......... ... .... Foundation has permission to erect........................................ buildings og ..3 g....... ......... nj AW.t#1.r [��............. Rough ... ............. . X2G to be occupied as...... ..... ....... .........�'A��.t �• r� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final Zoo PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU STARTS ELECTRICAL INSPECTOR Rough ...................... Service _ BUILD Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. T rBurnerNo. SEE REVERSE SIDE Smoke Det. Bk 11551 Pg235 #10281 DEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5,and as a condition of the approval of the proposed two(2)room home addition by the North Andover Board of Health,notice is hereby given that real estate Iocated at 39 Hawkins Lane,North Andover, Massachusetts,Assessor's Map 210/Lot 106.0-0124,as described in a steed from Thomas Scott to TMS Realty Trust, Thomas Scott,Trustee,dated December 161h 1993 and recorded in the Essex County Registry of Deeds in Book 03933 and Page 0060,is the subject of review and approval under the Town of North Andover Minimum Requirementsfor the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01(4). Said review and approval limits the maximum number of bedrooms at this dwelling to the existing four(4)Bedrooms. At the regularly scheduled North Andover Board of Health meeting held on March 26"2009,the Board voted unanimously to accept this deed restriction granted to them by the property owner allowing the existing septic system to be considered in compliance with.the requirements of Title V which otherwise would not be in compliance based upon the total number of rooms. Reference made herein to a future upgrade of the existing system shalt mean that a new system be engineered and installed which conforms fully to the requirements of Title V by using the actual number of rooms as the basis of the design of the new system. This review and approval is within the jurisdiction of the North Andover Board of Health and is subject to the following conditions: 1. A Title V inspection shall be conducted by a licensed Title V inspector hired by the Homeowner every three years to ensure the health of the septic system, 2. There shall be no change to the configuration or number of bathrooms nor change in the occupancy of the home without the upgrade of the septic system, 3. This approval will expire upon the entrance into any purchase and sale agreement for the home and at such time,the current Homeowner will be required to upgrade the existing septic system to conform with 411 the current Title V requirements. The upgrade of the septic system must be completed prior to the sale of the property. Failure to upgrade the subsurface disposal system will result in an immediate issuance of a Board of Health,Order to Correct, 4. This deed restriction would be lifted prior to, or at the time of the sale, when the septic system is appropriately upgraded or if and when the owners conduct a sewer tie-in. Signed and seal this , day of April,2009. s o Scott, T t N Commonwealth of Ma'w–&—husetts Essex,s.s. Date.April_�2009. Then personally appeared the above-named Thomas Scott and acknowledged the foregoing instrument to be his fres act and deed,before me. SNAUNA COLLEARY Notary Public Name e ��of� Notary Pukw MY Cm wftsion EVinn Oa.M 2015 I U7/09/2008 10:02 FAX 19788833147 M.P-RODERTS INSURANCE 8001 ;7S CERTIFICATE OF LIABILITY INSURANCEw►�EplwwaDlwrry os R S ITS aacr n4c 7HOIIS A MATS( �ppq�A O�gc,Od 9trt H41.DR. Ty�s cE�tTeRaiMlS u " TM��r..s,.�� AL YHE GGVBApaS DOE$ NOT AM6ND, ®REND OR dvvvr, MR 01845 8Y E IMES MILOW. halt pJCi?.�7Ait3 s R , Woumm 0 NAN:>N ►++WMR A. 188 STET nasweflt a 'B QOM, W1 Q1845 a c: rretllee-Liam- commm *4VJRM s: Tw Foum OF WwRANCE usilD HLOW HAVE BEEN MUM To THE IMSURQC NAImD AHOVE FOR TMN A�Il► rIR.78iM OR RONQIrpN OM ANY CQKn ACT OR OTHER DOCINI@NT YNYFI REBP6GT PERIOD WOK.A1ED.NOTNpTNgTAry MAY M,. INE M WAft* q IyrygOgpEO 8Y 1 FIE pOUd68 D ,R�p HiRFM1 IB Bf1B CECT TO ALL E 7EYi q, TE MAY 6E OR P�711[?lEBAO MATIIUWrs8Hp1WWYIIAVEBMREOWWBYFIYDCLAM, COND1flONSOFBIJCt{ POLICY Ml.�MLtJAs(f,ITY ilABFI �tIGE ; 0AWW OR OW. w 0 A CPPO060060 11./22/07 11/22/08 ®aNAL�AOVINJtIRr 00i i 0 F�P�mwj R�iQ11Rp uwr Aa LOC -COWWAM : UMMtY SCHMUDAUMS w� ' H HMAWN 17AM277013900 1/23/00 1/23/49 araaaww�oAurog a i l#ARA4E LM�IIlIY ��� _ ANYAlITO AUTQ0W4.6AACDIOMT i c3tNEArHAM EA ACC i AUTooIAr; , s WCONAMWO to LLAAWAY dCd,p CADOW W Efks1 1pLTE ; Li r I�TeIrTlawt s s D W U.TACHACc�T ; O 16DW913813 7/1/08 7/1/09 P.+~DRI1 M-EA>�plor,' � LO 0 01i1i1t LL.OoIt:.PONCY uw i Dl6C!llPfldNpROP6pRTN0l�JLOGITICIgfbPflldE914XCLUB10MbApCEpBYp pp /;PWAAL T Mq OF ANDOM, Imo► WHO=ANY aF Tr S AW"Dasc Mo PoL o ft aaCMQfiuJW!lgFt7RE THE EXtib►TmH 36 BARTI.AT STMT DATE TNERWP.THE ISSONc IroiUM WILL DNDFAV(*Yo Mom 10 AMOVZR, IID 07810 MOTU TO YW CeATWA71 HOlt7ER NUAW To fla LAn slur FILM To oo so%MLL avm No OeLs IM"oR UAW"aF AMY We uvr IM W@UMt,"I AMM OR ►T�s, AUT110RALED AEP�6NT'A I 0 A710N1YR8 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Businesstori anizationim vIdu4 �..,� 4�.- 1�`-�� ., C—_ Address: 1.V \_ 3,0 City/State/Zip: (� �� ��,,����„`� ►,, ti Phone#:��� Are you an employer?Check the appropriate box: Type of project(required): 1.16 1 am a employer with 2— 4. ❑ I am a general contractor and Y employees(full and/or part•-time).* have hued tete sub-contractors 6• ❑New construction 2.F1 am a sole proprietor or partner- listed on the attached sheet # 7 ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9. _$BuiIding addition [No workers' comp. insurance 5. ❑ Weare a corporation and its 10.El Electriealrepairs or additions required.] officers have exercised their 3.❑ Lim a horneowner 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. ❑ Roofrepairs epairs insurance required.)t employees. [No workers' 13.[] Other comp. insurance required.) Any applicant that checks box ill must also fin out the section below showing their workers'compensation policy information.' Homeowners who submit this affidavit indicaft they are doing all Mork and then hire outside conbacton mnst submit a new affidavit indicating suck contractors that check thus box most attached an additional sheet showing the umne of the sub-contractors and their wrorkefs'comp.policy inforn-Aetion. am an employer that is providing workers'compensation.insurance for my employees. Below is the.policy and job site Kformathm asurance Company Name: 'olicy#or Self-ins, Lic. #: Vv n 'S Expiration Date: ob Site Address: K6..�— %, � s City/State/Lip: U ►ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$1,540.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for inswance coverage verification. doh eby c nlfy under the pains and penalties of perjury that the information provided above is true and correct i atur Date: 'hone#: Of�j'tcial use only. Do not write in this area,to be completed by city.or town official. City or Town: Permit/Ucense# 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#- ENERGY CONSERVATION APPLICATION FORM FOR LOQ'-RISE RESIDENTIAL NEW CONSTRUCTION and ADDIT ZON' 780 CMR Appendix J s Applicant Name: Applicant dd'esb. Site Address: 3f I ' nwn• Use Group: 4pplicant Phone: "��tDate of Application: «�� l0 $`�533 _ Applicant Signature: 1-' \�-�"` Compliance Path (check one): ❑ Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil Package(A through KK from Table J5.2.1 b): fuels only) Heating Degree Days(HDD65) from Table J5.2.1 a: (For items d.through i., fill in all values that apply from Table J5.2.1 b:) a. Gross Wall Area _sq.ft f. Wall R-value R- b. Glazing Areal s f R- ------ ------- q. g. Floor R-value c. Glazing%0 00 x b:a)—_-._--- % h. Basement wall R_ d. Glazing U-value U. ----------- i. Slab Perimeter �! e. Ceiling R-value j. Heating AFUE ❑ Component Performance: "Manua!TradaOf#" (Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) ❑ Zone 12 11 Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J,[and HVAC Trade-off workshe ]' ❑ MAScheck Software et, if applicable Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy n rgy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR Cl Renewable Energy Sources Attach Mass Re istered Architect or Engince:r Ana! •sis ALTERNATIVE FOR ADDITIONS ONLY: a. utoss W all+Ceiling Area t'��+ sg,ft. b. Glazing Areal- l�sq.ft, c. Glazing%000 x b a) V► ❑ .4DDMON with Glazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: l v , h 11NT _�,• ih 2 3 R 9 2 r R-. 7 n For Bae - 9 I Glazing Area may be either Rough Opening o;Unit dimensions. 2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the ful! R-N'.:lue ov er the entire;ceilin not compressed,�Ner,-,:terior walls,and including any access openings.) arcs ❑ "SL"i`i2oam"ad ° addition (greater than 40/o blazing-to-wall and ceiling gross area) Attach "Consumer information Form"from '80 CA4R:". ppendix B. t�fi'�cia!'s Si nnature- ' I 3 169 Boxford Street North Andover,978-688-6335 A 01845 PH Building Contractor FAX:978-688-7207 Proposal To: Tom&Maureen Scott 39 Hawkins Lane All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma. 01845 specirirally exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Common vealfh of Massachusetts.inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Room 1301,tom,MA02106.(617)-727 8598 CC: Date: 4/13/2009 Job: Office/Exercise room addition Date of plans: 3/08 Archilteet: RICHARD BERNSTEIN ARCHITECTS Location: Same Section 1-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 4/20/09. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 7/18/09.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11-Warranty The Contractor warrants that the work fumished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair correct,replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection petfonned in connection with the agreed-upon work. Section 111-Scope of Work r , IzeVEaa wwn7 ny Page 2 of 5 iaaUdiaag Contractor 169 BOXford street North Andover,MA 01845 PH:978-688-5335 FAX 978.6M)O 0( General Proposal is based on final plans dated 3/09. Building permit will be provided by contractor. Owner to provide plans, structural engineering, and certified plot plan. No allowance has been made for any variances, board of health, or conservation approvals. Excavating Excavation required to install full basement area will be provided. Backfilling and rough grading will be provided. Any additional fill will be removed from site. Five trees will be removed as required, in side yard. Other trees may be removed, at additional cost to owner. No allowance has been made for removal of any ledge, repairs to underground sprinklers, landscaping,or lawn repairs. Foundation Poured concrete foundation will be provided as shown on plans. Footings will be 10"x20",walls will be 10"thick, "brick shelf'will be provided on interior of foundation as shown on plans. Four inch thick concrete floor, will be poured over crushed stone base. Concrete cutting will be performed to provide access to new full basement area. Exterior of foundation will be waterproofed to meet code. Building All frame, roof, and siding materials will be supplied as shown on plans/to meet code/ match existing. Floor joists will be 2x10, exterior walls will be 2x6, roof rafters either 2x8, or 2x10.All floor,wall, and roof sheathing will be fir plywood(3/4 on floor, 1/2 on walls, 5/8 on roof) . Exterior trim will be Miratek or equivalent Entire roof will have Grace ice&water sheild installed. Roof shingles to match existing. Exterior walls will be wrapped with Tyvek or equivalent . Pre-primed cedar clapboards will be installed to match existing. All structural engineered lumber will be supplied and installed as required. No allowance has been made to supply any window units, or interior door units. No allowance has been made to replace windows in second floor of existing house. Existing window in first floor bath will be replaced. Basement area will be petitioned off to provide separate area for wine cellar. Plumbing Gas piping for fireplace will be provided. No allowance has been made for any other plumbing work. Electrical Electrical work required to wire addition to meet code will be provided. Sixteen recessed lights have been included. Additional lights can be added at a cost of$75 per light. Surface mounted fixtures ( ceiling fans, wall sconces)will be supplied by owner, installed by contractor. Phone/cable/computer lines will be roughed in by electrician, to be connected by service provider at owner's expense. General layout to be approved by owner prior to rough. Heating/Air Conditioning A new separate forced hot air furnace, will be supplied and installed to properly heat addition. Cental air conditioning will also be provided in addition. One zone will be provided on first floor. No allowance has been made to heat or cool basement area. Existing exterior air conditioning equipment will be relocated as required. Insulation ����Iyi3aaa�Iln3a' Page 3 of 5 Building Contractor 169 Bo)6ord Street North Ar lover,MA 01645 PH:9786885335 FAX 978.688-X)00( All added areas will be insulated to meet code. Basement ceiling and exterior walls will be R-19, first floor ceiling will be R-30. Plaster All added areas will be blueboarded and skimcoat plastered. Walls and ceilings will be smooth. Wine cellar will be blueboarded and plastered. Interior Trim/Doors Interior trim will be supplied and installed to match existing/may be upgraded. No allowance has been made to Pp 9 Y p9 supply any interior door units, built ins, or wainscoating. Painting All interior and exterior painting will be provided. One coat of primer, and two coats of finish will be applied on all painted surfaces. Flooring Hardwood flooring will be supplied/installed/finished in new office and exercise room.Three coats of oil based urethane will be applied. An allowance $5 per square foot has been included for material ( may be oak or maple,to be determined). No allowance has been made to supply or install any flooring in basement area. Waste Removal All construction/demolition debris will be disposed of by contractor. Other Allowances An allowance of$3000 has been included to supply/install gas fireplace and mantle/surround. Items Not Included There have been no allowances made for any built in units, or millwork/panelling in addition.A proposal will be submitted prior to proceeding with interior trim installation. No allowance has been made for relocation of pool equipment,fencing, landscaping, retaining walls, lawn repairs. ReVEM wwn7nny Page 5 of 5 Bniiding Contractor 169 Boxford Street North Andover,MA 01845 PH:978-6865335 FAX 978-688-X= Section IV—Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of............... ... ...... ...... .......$ 100,000 Payment to be made as follows: Percenta alItem Description Amount 1 Permit obtained $3000 2 Foundation complete $20,000 3 Roof complete $25,000 4 Siding /windows installed $12,000 5 Rough electric / gas pipe / heat complete $15,000 6 Plastering complete $10,000 7 Painting /floors complete $10,000 8 Job 100% complete $5000 Total 8 $100,000.001 "'Notice:No agreement for Horne improvement contracting work shall require a down payment(advance deposit)of am that onedhird of the total contract price of the trial arrant of all deposits or payments w4tiar the contrador haat make,in advance,to order arWor otherwise obtain delivery of speael order materials and equipment,whichever is greater Contractor: Kevin Murphy 169 Boxford Street No.Andover, MA 01845 Registration No: 101874 Section V—Acceptance Acceptance of Proposal—I have read this document and accept the prices,spacifications and conditions stated. I understand that upon signing,this ro proposal becomes a binding contract You are authorized to do the work as specified. Po P P 9 P Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIG THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Date Signature Date DEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5,and as a condition of the approval of the proposed two (2)room home addition by the North Andover Board of Health, notice is hereby given that real estate located at 39 Hawkins Lane,North Andover, Massachusetts,Assessor's Map 210/Lot 106.0-0124, as described in a deed from Thomas Scott to TMS Realty Trust, Thomas Scott, Trustee, dated December 161h 1993 and recorded in the Essex County Registry of Deeds in Book 03933 and Page 0060, is the subject of review and approval under the Town of North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01(4). Said review and approval limits the maximum number of bedrooms at this dwelling to the existing four(4)Bedrooms. At the regularly scheduled North Andover Board of Health meeting held on March 261h 2009, the Board voted unanimously to accept this deed restriction granted to them by the property owner allowing the existing septic system to be considered in compliance with the requirements of Title V which otherwise would not be in compliance based upon the total number of', rooms. Reference made herein to a future upgrade of the existing system shall mean that a new system be engineered and installed which conforms fully to the requirements of Title V by using the actual number of rooms as the basis of the design of the new system. This review and approval is within the jurisdiction of the North Andover Board of Health and is subject to the following conditions: 1. A Title V inspection shall be conducted by a licensed Title V inspector hired by the Homeowner every three years to ensure the health of the septic system; 2. There shall be no change to the configuration or number of bathrooms nor change in the occupancy of the home without the upgrade of the septic system; 3. This approval will expire upon the entrance into any purchase and sale agreement for the home and at such time, the current Homeowner will be required to upgrade the existing septic system to conform with all the current Title V requirements. The upgrade of the septic system must be completed prior to the sale of the property. Failure to upgrade the subsurface disposal system will result in an immediate issuance of a Board of Health, Order to Correct, 4. This deed restriction would be lifted prior to, or at the time of the sale, when the septic system is appropriately upgraded or if and when the owners conduct a sewer tie-in. VAINSigned and seal this day of April,2009. T st o Scott, T st Commonwealth of Massachusetts Essex,s.s. Date:April 2009. Then personally appeared the above-named Thomas Scott and acknowledged the foregoing instrument to be his free act and deed, before me. SHAUNA COLLEARY r-�-, (_r_) aQ, ' Notary Public Name Notary PJir Commonwealth of Massachusetts My Commission Expires Oct.22,2015