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Home My WebLink AboutBuilding Permit #89 - 4 ALLEN STREET 8/3/2007 Ole 1 F1 BUILDING PERMIT TOWN OF NORTH ANDOVER F 40 APPLICATION FOR PLAN EXAMINATION * t Permit N0: (Vlx Date Received �� p�gAT�D G -7CFIu Date issued: 0 3 U 7 IMPORTANT Applicant must complete all items on this page wx p. Zs ASIA u TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family 9"Addition ❑Two or more family , ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg d Others: ❑ Demolition ❑ Other c � y✓ .,.� , .. fit@AsX, ^ ASCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) —r G7 OWNER: Name: -:: 1_QS�" Phone(�7g � 5 `T Address an �q W-01 "'; "�` ' �-t ""1i �a Eva; .a, "a,. �*�S'z�.✓�9�t��,V�� ."�iY�� (rT� a�s,+ ,p; " b m -k 9 L �.: �.:.,,'�a za�AS>�>_ _:?`yw ��k� ��i s'^ir��,Kry yU•�,r3'..sek., ARCHITECT/ENGINEER Phone: 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: $ 2 000 FEE: $ :I Check No.: v��0 Receipt No.: C?0 y(" NOTE: Persons contracting with unregis Bred contractors do not have access to the guaranty fund Si nature of A en t�wraer _.. r=. S�Fgnataa o fln rac a "M _ .. . ,. _.. 'N' T Location Z/ No. p`1 Date HORTq TOWN OF NORTH ANDOVER 3? • _ OG f49 9 Certificate of Occupancy $ '�'�S'•^°''�t�' sBuilding/Frame Permit Fee $ — �cHuSE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �� 20460 Building Inspector 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 ❑ 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 DA EJECTED DATE APPRO7VED CONSERVATIO COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS i 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 Located at 384 Osgood Street fRP ►iTMEN Temptpeh°sttes � ib l�Catecat 924 /laln 5tre@ k ¢ a s # y g MENEM 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 I i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 o 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 DEPARTMENTMFORM07 Revised 2.2007 ORTH Own of F Andover No. 89 _ �' s� o _F'�� 74 dover, Mass.,_ RA'r E D P" U BOARD OF HEALTH Food/Kitchen PERMITT. D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ ...... .................................................................................................... Foundation has permission to erect........................................ buildings on ....1-14 ...// .............................................................. Rough e..... Chimney to be occupied as...................... .............. provided that the person accepting this p rnift shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL. INSPECTOR UNLESS CONSTRUCTION TS Rough Service .................... ....... .. . .......... . .............................. .................. BUILDING IN PECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR. Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Der. • 1 I I LOCATION ts LINES ACC URATE LOCA ICON MOM NORTH' I LOT 6 7 WS REQUIREUAN R INSTRUMENT SURVEY. I;I , 1 100' 1 1 1 , , 'II I i II LOTS 68 & 69 C11 ' 10,000 S.F. I 1 y' 0 to G,PW1 ,rye i V/,11 11 2y1 � O LOT 48 o I 121 o--B— 1.7 q ' I 04 ---� St � •; � 1.5 STORY I 6WIDLIA NC j 261 2�t 100, I , I'I ALLEN STREET p I ,o ' a to 20 .i0!•INIS. ASC* 500W05 1lAUfiETANI )� #9931 X111 vi p f, AOIXtES3 I CUENTIt 0116-0232- ' OSP :/1► ' l i FIELD@ W , o l 1 4 Alin Street Nortll Andover NW I APABoV—J& JL4. 'mss 1 CERTREOTO. DATE 65-0-2008 + Counapide Home Loans MORTGAGE INSPECTION PLAN 6 A ICAIV SUYENNc �/r;� ; I:iOMPANY ++wt+:res-tltte com , ur Rosrnn,,ne. t I 866-W-8,985 r!W Md7 31"- NAWdhhrm, A 0441 ' Residential Title 6. 76317n1-av3-M rAN1'M14V1-Ter1 wm..A;tCefea.taaeon crow S ekes, C. I,reltonet-1. Ptd Deed recirded at rm=Nwth County ~r;, '•,.. a Registered lend Su rweyor,do R 9I hereby catfythatrte above Martpage Yf Deeds Book: 74j4 Page: 96 r Inspectton Plan wasjp pored far. Plan Reference:j?j_0282 L,C.Celt it Countewlida•Home Loons Drawrh pe Town of:North Andevor Assessor Map in connection with a Row Modgage ' 1 and is NOT intendad'orrepn3sented Parcei'# r Dated: to be a Land a Properly Survey. No Addf?ss: rsh 6edover MA comers ware set,and It cannot be BOrf0lNer Irmothv A. Lost And Align % i cat- used fo`esfabfFahingifenoe'age'a` Client Na e: Reetdenitel Tate build ng renes.The land shown hereon la based upon client furnished; The subiect WELUNO Iles In Fkad Zane:: Gs shown do NWiorlal Flood Insu»nce program Flood Rate N p information,apd may lie subject to Dated: CommuNly Panel: I rtttiherOuN%lea,1Ygk(nga, . The IxafwO he original dwelling shmm hereon either was in complianlrawith low epplicahle2on4 fl{jytawe In eRatwhan Eaaementa sed Rig o!Way. No cvrrabuc{ed Ih respect to hortm=1 dimensionm requlrernente only),orfs wmmptftom vklmion eMoreements don uMler responablilty Li extended herein to th hens 0.L Tr VII,Chapter 40ASeWon 7unleae oummiee notedorshown hmeor, A connomtoryins nment Survey Is Land Owner or occupant It is nc JsM=jrcs are shown less than t•from propmty 2 required Zoning Seftck tin& intended to be recorded. FOR ALL m200i flw INCIFtmES WWACrASCOFeGSTON orals e[vwdl W1 KrMIDN a+um wow 1 A7 t aaaegr Tnn/Tnn•.r FLOORPLAN Borrower:Timothy Last File No.: 0525MI06 Property Address:4 Allen Street Case No.: City:North Andover State:MA Zip:01845 Lender:Countrywide Home LoanslLandSafe Mhz i 1z1 1� 34.0' 6 ------� IZ ltl�ia�{ Bedroom Bath .0� Bedroom 0 r N 0 N N Living Room Kitchen 29.0' 11.0' Sketch by Apex IV WindowsTM AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Code Description Slze Tolels _ ! Breakdown Subtotals_ GUU First Floor 1055.00 1055.00 First Floor Q �` GAA Garage 230.00 330.00 '; 27.0 x 36.0 918.00 - 6.0 x 21.0 126.00 1.0 x 11.0 11.00 ` i. t 2 i TOTAL LIVABLE (rounded) 1055 3 Areas Total(rounded) 1055 • en Sftet, No r $6991 " PROPERTY Style.................Cape Year Built.........1937 l� Rooms...............6 E' -- - Bedrooms..........2 "+ Garage 1 Car Office `�� _ s................1 Bath 978-687-4465 - ={ - —111111 _ G age............. - Heat................ Steam/Gas Direct -. Basement......... Finished, 300 sq.ft. 978-482-3519 " " - ' <.. ,_ _ Listing#........... 70374110 Cell 978-337-0769 R OOMS Email WOW!! Living Room...... ...13 x 17, FP, Hdwd Margus.beery@NEMaves.com BeautifullyDining Room.........09 x 12, Hdwd updated Home in great Kitchen................ 12 x 13, Hdwd location, walk to everything. Nothing to do but enjoy the beautiful Master Bedroom... .11 x 14, Hdwd new granite kitchen with tileflooring Second Bedroom.....11 x 11, Hdwd and breakfast bar which opens to a Family Room.........11 x 27,Tile R dining area. The fireplaced living room Laundry............... 09 x 11, Tile offers hardwood flooring and the new Walk-up Attic........Expandable Area finished family room is great for playtime or entertaining.A spacious offers approximate 250 sq.ft. t _ laundry room with loads of extra 16111=_ storage adds to the lower level.Full bath newly tiled w/bead board,pedestal LISTING sink,faucet and lighting fixtures. ,.. Expandable attic space of approximate Listing Agent...... Margus Deery 25o sq.ft. has a walk-up staircase in place.Large level fenced backyard, Lot Size............... 10,019 sq.ft. 1 car garage and replacement Living Area......... 1,055 sq.ft.,plus windows are a few other features. 300 sq.ft. in LL 0In! Assessment......... $281,400/2006 FEATURES Taxes.................. $3,134.80/2006 Range.................... Yes Sewer/Water....... Town/Town Dishwasher.............Ye s Sellers Disclosure. Yes Disposal..................Ye s Microwave ..............Yes Book/Page.............7414/96 Trash Compactor......Yes Exclusions:Washer, Dryer, drapes in • Cable Available........Yes child's room Disclosure:Refrigerator Negotiable RESIDENTIAL BROKERAGE 100 Andover Bypass NOTICE TO PROSPECTIVE HOME BUYERS, North Andover,MA 01845 Information about the property descnbed above was provided solely by seller(s)without verification by the broker(s)therefore broker(s)is/are not responsible 978.687-4465 for the accuracy of the information contained herein. Buyer should take any and all steps necessary to verify said information. Offering is subject to prior sale, price change,or withdrawal without notice. Owned and operated by A'RT Incorporated. An equal Opportunity Employer. Equal Housing Opportunity i Oen Sit,, ®r&Andow i �4 Formal Fireplace Livingroom Entrance Blit Formal Dining Room 1 4 1 { i Y :b `J f _a - t fill i Custom Granite Kitchen i Lower Level Family Room 1 4 Nor& Andover Ali- a . r _ ,y y, Niglio Front and Rear Views PLAN OF LOTS .-NCA nr GEO. PLUS�SELL ES NOTHCkN I T. D��Ds LAWt�CNGE, DIST. or,,SSEX,d5. SITVATCD ill MASS DEC J,1400 R ECCIVED AT 8:4eArT.•-4 RECuR,,eD N° ANDOVER, ETA6 MASS. 800x rax, PAGE 600 A°°a+1 A R R, SAxEoAN fULY, 1400 Reg iaee�. SVRv EYED Axo DRAwn BY JOHN FT{ANKLIN, C.E., SCALE 6OFT. n 9 10 11 U �z 13 ra 39 40 41 42 ti 43 ree+ � a - 4-a � e 5° T. 72 Sl SO 49 47 0 65 e zoo 66 67 615 64 -J70 71 72 -13 °� � I$ S0o0 JOOa _ JOYO 5600 5ti O ,er RUs�SILL SELLER'S STATEMENT OF PROPERTY CONDITION THE SELLER AUTHORIZES THE BROKERS OR SALESPERSONS TO PROVIDE THE FOLLOWING INFORMATION TO PROSPECTIVE BUYERS.THIS INFORMATION IS BASED UPON THE SELLER'S KNOWLEDGE,BUT IS NOT INTENDED AS A GUARANTEE OF THE CONDITION OF THE PROPERTY AFTER SALE OR THE CONTINUED SATISFACTORY OPERATION OF ANY SYSTEM.THE BUYER SHOULD INDEPENDENTLY VERIFY ALL INFORMATION BE ORE PURCHASE. Property Address �� ANSWERS YES NO UN KN I. TITLE/ZONINGB DING ORMATION I. Seller/Owner lMIX— 4 lb e S.' J t Howlonggo�wpned? r 2. How long occupied?_ Appro to year built? < /� ❑ ❑ 3. Have you been advised of any title problems or limitations(for example,deed restriction,lot line dispute,order of con- ditions)?If yes,please explain ❑ ❑ a)Do you know of any easements.,common driveway,or right of way? If yes,explain 4. Zoning classification of property(if known) !� Y ❑ ❑ 5. Has your city/town issued a notice of any violation which is still outstanding?If yes,explain ❑ ❑ a)Have you been advised that the current use is nonconforming in any way?Explain ❑ ❑ 6. Do you know of any variances or special permits?Explain ❑ ❑ 7. During Seller's ownership,has work been done for which a permit was required? If yes,explain. ❑ ❑ ❑ a)Were permits obtained? ❑ ❑ ❑ b)Was the work approved by inspector? ❑ ❑ ❑ - c)Is there an outstanding notice of any building code violation?Yes No Explain ❑ ❑ 8. Have you been informed that any part of the property is in a designated flood zone or wetlands?Explain (See Flood Zone disclosure Page 3) ❑ ❑ 9. Water drainage problems?Explain YES NO UNI xiv II. SYSTEM UTILITIES INFORMATION DO YOU KNOW OF ANY CURRENT PROBLEMS WITH ANY SYSTEMS LISTED BELOW? ❑ ❑ 10. Has there ever been an UNDERGROUND FUEL TANK? If yes,is it still in use? If not-used,was it removed? (See Hazardous Materials Disclosure Page 3) ❑ ❑ 11. HEATING SYSTEM:Problems?Explain a)Identify any unheated room or area b)Approximate date of last service c)Reason 12 DOMESTIC HOT WATER:Type:7 RIS__ Aged Problems?Explain n�, Burners owned or rented? 6riZy�dive . ❑ ❑ 13. SEWAGE SYSTEM:Problems?Explain Type:Municipal Sewer Private If private,describe type of system: (cesspool,septic tank,etc.) Name of service company Date it was last pumped Frequency ❑ ( ❑ During your ownership has sewage backed up into house or onto yard? Yes No Explain ❑ ❑ ❑ Is system shared with other homes? Date a Title 5 inspection last performed Copy attached. Yes No ❑ 1QI ❑ 14. PLUMBING SYSTEM:Problems/Leaks/Freezing?Explain Bathroom ventilation problems?Explain 15. DRINKING WATER SOURCE:Public private AV If private: a)Location b)Date last tested Report: Attached Not attached ❑ ❑ c)Water quality problems?Explain ❑ ❑ d)Water quantity problems?Explain e)Flow rate(gal.min.) f)Age of pump ❑ Elthere a Miratio system? Agell}ype of filtration system SELLER'S INITIALS y, , BUYER'S INITIALS 113 1YUACHU3S=S � ASSOCIATION 1 r MAssFoRMs- REALTOR' OfREALTORS' J e..e.,.=,. 1 of 3 FORM NO.700 ANSWERS YES NO UNKN ❑ ❑ 16. ELECTRICAL SYSTEM`.Problems?Explain 17. APPLIANCES:List appliances that are included13�r l/llC�� 4%3I�Ls�KihE� LLad�/� -� ❑ ❑ ❑ Any known problems? If yes,explain ❑ ❑ 18. SECURITY SYSTEM:None Type Age Company ❑ ❑ ❑ Problems? Explain ❑ ❑ 19. AIR CONDITIONING:Central Window Other None ❑ rxL ❑ Problems?Explain YES UNKN III. BUILDING/STRUCTURAL IMPROVEMENTS INFORMATION 20. FOUNDATION/SLAB: ❑ ❑ Problems?Explain ❑ 21. BASEMENT:Water Seepage D pn ssExplain ar4ount,frequency,and location f '❑ ❑ a) 5 Sump Pu�P�If yes,age location -��it1� Probl ,t�. 22. a) F: i'�le Lln��t6,1-�1-4 �u P ❑ Lam, ❑ Problems?Explain Location of leaks/problems ❑ ❑ 23. CHEVESEY/FIREPLACE:Date last cleaned Problems? Wood/Coal/Pellet Stove in compliance with installation regulations/code/bylaws? If not,explain ❑ ❑ 24. History of smoke/fire damage to structure,if any?Explain 25. FLOORS:Type of floors under carpet/linoleum? Axgg.,> 7� (JCC 76y� ❑ ❑ Problems with floors(buckling,sagging,etc.)?Explain 26. WALLS: ❑ ❑ a)INTERIOR Walls:Problems?Explain ❑ ❑ b)EXTERIOR Walls:Problems?Explain 27. WINDOWS/SLIDING DOORS/ ORS El El Problems or leaks?Expl I ❑ ❑ 28. N ULATION:Does house ave insul tion If yes,type --ny ate i��e Locati n i9ll��S'En�ii� �f' �=�� lfr�,erYa�-• �w� ��s��Fru-+ ❑ ❑ 29. ASBESTOS:Do you know.whether asbestos is present in exterior shingles,pipecovering or boiler insulation? ❑ ❑ Has a fiber count been performed? If yes,attach copy — (See Asbestos disclosure Page 3) ❑ ❑ 30. LEAD PAINT:Is lead paint present? If yes,locations(attach copy of inspection reports) If yes,describe abatement planlinterim controls,if any ❑ ❑ ❑ Has paint been encapsulated?If yes,when and by whom? (See Lead Paint disclosure Page 3) ❑ ❑ 31. RADON:Has test for radon been performed?If yes attach copy (See Radon disclosure Page 3) ❑ ❑ 32. INSECTS:History of Termites/Wood Destroying Insects or Rodent Problems?If yes,explain treatment and dates (See Chlordane disclosure Page 3) ❑ _ ❑ 33. SVS EMMING POOL/JACUZZI:Problems?Explain Name of Service Company ❑ ❑ 34. GARAGE/SHED!OR OTHER,STRU :Probl ms?Ex /1lIN GP �P YES No UNKN IV. MISCELLANEOUS INFORMATION ❑ ❑ 35. Do you know of any other problems which may affect the value or use of the property which may not be obvious to a prospective buyer?Explain YES NO UNKN V. C DOMINIUM INFORMATION El El f-136. If converted to condominium, documents recorded(Master deed/Unit deed etc.)? ❑ ❑ ❑ 37. PARKING:Is parkin ace included?If yes,is it deeded,exclusive easement or on? ❑ El F138. CONDO FEEutrent monthly fees for Unit are$ ❑ ❑ ❑ Heat included? Yes No ❑ ❑ ❑ Elec included? Yes No ❑ ❑ ❑ 39. ,R16SERVE FUND:Has an advance payment been made to a cZreser"Vefund? w much$ SELLER'S INITIALS((/ kc BUYER'S INI"IIA 0] MASSACHUSETTS ASSOCIATION, Q MASSFORMS- REALTOR' ofR TOR ^ ^^*•^ S,ee.da�sdnaudRd r.�.�e Form. 2of3 ANSWERS YES NO UNKN ❑ E-1 F-140. CONDO ASSOC.INFO:Is owners'association currentlyevolved in any litigation? If yes,explain ❑ ❑ ❑ 41. Have you been advised of any matter whi h iil kely to result in a special assessmen(dr substantially increase condo- minium fees? Explain YES NO UNI VI. RENTAL PROPERTY INFORMATION 42. NUMBER OF UNFrS:%— ❑ ❑ ❑ Has a unit been added///stibdivided since original construction? If yes,was a permiYfor new/added unit obtained? 43. RENTS:Numoer of units occupied Ren ' /month Expiration.date of each lease ❑ ❑ ❑ Any tena6ts without leases? ❑ ❑ ❑ Is 7der holding last month's rent Security deposit? )f yes,has interest been paid? If security deposit held attach a copy of statements of condition.Attached Not Attached ❑ ❑ ❑ 44. Is there any outstanding notice of any sanitary code violation? Yes No Explain VIL. ACKNOWLEDGEMENTS Seller(s)hereby acknowledge that the information set forth above is true and accurate to the best of my(our)knowledge.I(we)fur- ther agree to defend and indemnify the broker(s)and any subagents for disclosure of any of the information contained herein.Seller(s) further acknowledge receipt of copy of Seller's Statement of Property Condition. Date ` � 'D�' sell Seller' Buyer/Prospective-Buyer acknowledges receipt f Seller's Sta e' of op rt tion before purchase.Buyer aekn1,&dge that Broker has not verified the information herein d Buyer has been advi d e information independently. Date Buyer Buyer VIII. EXPLANATORY MATERIAL The following clauses are provided for descriptive purposes only.For detailed information,consult the Massachusetts Department of Public Health,the Massachusetts Department of Environmental Protection,or other appropriate agency,or your attorney. A.Flood:Hazard Insurance Disclosure Clause (Question#8) poisonous and may cause serious personal injury.Whenever such resi- The lender may require Flood Hazard Insurance as a condition of the dential premises containing dangerous levels of lead undergoes a mortgage loan if thelender detemimes that the premises is in a flood change of ownership,as a result,a child under six years of age will . hazard zone. become a resident,the new owner is required by law to remove said B. Hazardous Materials Disclosure Clause (Question#10) paint,plaster cover or encapsulate it with appropriate materials so as to In certain circumstances Massachusetts law can hold an owner of make it inaccessible to such child.Buyer should receive information real estate liable to pay for the cost of removing hazardous or toxic pamphlet from Department of Public Health. materials from real estate and for damages resulting from the release of E. Radon Disclosure Clause (Question#31) such materials,according to the Massachusetts Oil and Hazardous Radon is an odorless,colorless,tasteless gas produced naturally in Material Release and Response Act,General Laws,Chapter 21E.The the ground by the normal decay of uranium and radium.Radon can lead buyer acknowledges that he may have the property professionally to the development of radioactive particles which can he inhaled. inspected for the presence of,or the substantial likelihood of release of Studies indicate the result of extended exposure to high levels of radon oil or hazardous material and such proof of inspection may be required may increase the risk of developing lung cancer. as a prerequisite for financing the property. F Chlordane Disclosure Clause (Question#32) C.Asbestos Disclosure Clause (Question#29) Pesticide products containing chlordane were banned in The United States Consumer Product Safety Commission has main- Massachusetts on June 11,1985,following a determination by the tained that asbestos materials are hazardous if they release separate Department of Food and Agriculture that the use of chlordane may fibers which can be inhaled.Asbestos is a common insulation material cause unreasonable adverse effects on the environment including risk of on heating pipes,boilers,and furnaces.It may also be present in certain cancer.Although existing data does not conclusively prove that signifi- types of floor and ceiling materials,shingles,plaster products,cements cant health effects have occurred as a direct result of chlordane use,the and other building materials.The buyer may have the property profes- long-term potential health risks are such that is prudent public health sionally inspected for the presence of asbestos and if repair or removal policy,according to the Department,to eliminate the further introduc- of asbestos is desired,proper safety guidelines must be observed. tion of chlordane into the environment. D.Lead Paint Disclosure Clause (Question#30) G. Fair Housing Notice Whenever a child under six years of age resides in anyresidential It is unlawful to discriminate on the basis of race,color,religious premises in which any paint,plaster or other accessible material con- creed,national origin,age,gender,sex,ancestry,marital status,veteran tains dangerous levels of lead,the owner is required by law,to remove status,sexual orientation,disability,presence of a child,receipt of pub- all said paint,plaster or cover with appropriate materials so as to make lic assistance or other protected classification in the sale or rental of in inaccessible to a child under six years of age.Consumption of lead is covered housing. SELLER'S INITIALS J BUYER'S INTITALS MA SACHUSETTS ASSOCIATION MASSFORMS- REALTOR" �f REALTORS' o..o.,o.,n sd�e.aa<sma.ra xe.�r ae ro.m. 3of3 I PROPERTY TRANSFER NOTIFICATION CERTIFICATION This form is to be signed by the prospective purchaser before signing a purchase and sale agreement or a memorandum of agreement,or by the lessee-prospective purchaser before signing a lease with an option to purchase for residential property built before 1978, for compliance with federal and Massachusetts lead-based paint disclosure requirements. Required Federal Lead Warning Statement: Every purchaser of any interest in residential property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning.Lead.poisoning in young children may produce permanent neurological damage,including leaming disabilities,reduced intelligence quotient,behavioral problems and impaired memory.Lead poisoning also poses a particular risk to pregnant women.The seller of any interest in residential real property is required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspections in the seller's possession and notify the buyer of any known lead-based paint hazards.A risk assessment or inspection for possible lead-based paint hazards is recommended prior to purchase, Seller's Disclosure (a)Presence of lead-based paint and/or lead-based paint hazards(check(i)or(ii)below): (i) Known lead-based paint and/or lead-based paint hazards are present in the housing(explain). �(ti) LV A iSeller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing. (b)Recor and reports available to the seller(check(i)or(ii)below): (i) Seller has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards in the housing(circle documents below). Lead n ection Report;Risk Assessment Report;Letter of Interim Control;Letter of Compliance (ii) 'Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the ousing. Purchaser's or Lessee Purchaser's Acknowledgment(initial) (c) Purchaser or lessee purchaser has received copies of all documents circled above. (d) Purchaser or lessee purchaser has received no documents. (e) Purchaser or lessee purchaser has received the Property Transfer Lead Paint Notification. (f) Purchaser or lessee purchaser has(check(i)or(ii)below): (i) received a 10-day opportunity(or mutually agreed upon period)to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards;or (ii) waived the opportunity to conduct a risk assessment or inspection for the presence of lead- based paint and/or lead-based paint hazards. Agent' lrnowledgment(initial) (g) Agent has informed the seller of the seller's obligations under federal and state law for lead- bas paint disclosure and notification,and is aware of his/her responsibility to ensure compliance. (h) Agent has verbally informed purchaser or lessee-purchaser of the possible presence of dangerous levels of lead in - paint,plaster,putty or other structural materials and his or her obligation to bring a property into compliance with the Massachusetts Lead Law--either through full deleading or interim control--if it was built before 1978 and a child under six years old resides or will reside in the property. Certification of Accuracy The following parties have reviewed the information above and certify to he'best of their knowledge,that the information they ve p videed i e a c 4ate. eller Date e er Date c r Date Purchaser Date 4A e t Date Agent Date CLP, Fam 94-3.6/30/944 9102 11 J: