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
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MY Cm wftsion EVinn Oa.M 2015
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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