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HomeMy WebLinkAboutMiscellaneous - 1041 FOREST STREET 4/30/2018 (2)l Date. ...:..... . 4 TOWN OF �TH ANDOVER 0 1 - PERMIT FOR PLUMBING This certifies that................ . has permission to perform .:.::..' .'. `.. ...................... . plumbing in the buildings of ..., .-'.................... at ...�..... .`.. ............ North Andover, Mass. L .�� �1 Fie .` ...... Lic. No... ..:. - �. PLL09ING INSPECTOR Check # __ I --f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS \ Date Z A\0C0 Building Location �Ok\ 'FocL4, — bt'' Owners Name Permit # Amount Type of Occupancy \ �.�.... New 0 Renovation ❑ Replacement Ld- Plans Submitted Yes No FIXTURES ° (Print or type) Check one: Certificate Installing Company Name<i 11 Corp. Address is 10 Partner. Business Telephone Seib .40c)_ ,fig yy Finn/Co. Name of Licensed Plumber. yrs d`r Cc.� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity a Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and instal compliance with all pertinent provisions of the Massachuset YSignature o 11 Agent 1-1 I ed (or ntered) in above application are true and accurate to the perfo under Permit Issued for this application will be in Plum i g Code and Chapter 142 of the General Laws. Title Type of Plu{zfbing LKnse / City/Town icense NUMDer Master journeyman a PROVED (OFFICE USE ONLY Z m O z m c A�oL c h ? 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'awejj 'uollepuno=l '6u!loo_l ' uo!Ieneox3 (wnw!u!W) :SNO11O3dSN1 suolloadsu! ou JO -610 MOO) MR13d (INV 'SS3W1GV 'Sa38Wf1N 10111d 1S0d MO138 SW311 01 0311W11 lON -1SI1)403HO/S31ON JNi(iiin8 1b213N3J Location No. C:171? O S-71 70%.1 - S -7i - Date ll -d6 0 NOR*M TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ sAcMust<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 36 TOTAL $ Check # I Lto uQ� �1Jt�v iiivi{64-1- Building Inspector %o -i° _ d/ 1.1 Address: 1.2 Assessors Map and Parcel Number: (Property r-0 r e S � s'� 10,5 b 477 777/ -.yo Signature Telephone Map Number Parcel Number Name Print Address for Service: 1.3 Zoning Information: Property Dimensions: 3.1 Licensed Construction Supervisor: j1..4 AVM)Ks &rIk'?J65 ?(ir Zoning District Proposed Use Lot Area Frontage (ft 1.6 BUILDING SETBACKS ft LicensedlConstruction Supervisor: Front Yard . Side Yard Rear Yard Required Provide Required Provided Re red Provided 64-23,,F v 1 o 1.7 Water SWply M.G.I-C.40. § 54) 1.5. Flood Zone Information: / Zone outside Flood Zone !dam 1.8 Sewerage Disposal System: Municipal ❑ - Public {f Private ❑ on Site Disposal System A SECTION 2 - PROPERTY OWNERSII]P/AUTHORIZED AGENT 2.1 Ow er of Record Name Print) Address for Service 477 777/ -.yo Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ LicensedlConstruction Supervisor: 0,1- �0 / f � �� � - / U S4-,,J, License Number Address 1 q 7�- ��J " �� f�AA UA v Expiration at� --,r Si na a Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ KfA< � Po - -r I 3 Company Name Registration Number Address Expiration DW Signature Telephone SECTION 4 - WORKERS COMPENSATION (M G.L. C 152 § 25c(6) 1� 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 build' ermit. Signed affidavit Attached Yes ........ No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Pro osed Work:: C U d SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item 1. Building Estimated Cost (Dollar) to be Completed by permit a licant 6po QFFICIAl�t3SE UNLY (a) Building Permit Fee s� Multiplier 2 Electrical d ® (b) Estimated Total Cost of Construction 3j `� Q/ v oO " 3 Plumbing E v a Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection G n 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORfZATidN TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1,04 u t -t peck f e , as Owner/Authorized Agent of subject property Hereby authorize_ � ,e -4 Lp e ��s � -r � f ifo4 -, to act on My half, in allAatters relative to work authorized by this building permit application ��� n Jj�/K / ature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, J 14 00 d v C S- / as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief / /J rl CJ C: C- C'l/ -C K W O G iC� J 2 •c .� LPtriNa e of weer nt Date NO. OF STORIES SIZE �(o~ BASEMENT OR SLAB V ti�h�0�t2- !o Fi SIZE OF FLOOR TRVIBERS 1 2 ND 3 RD SPAN in DINIENSIONS OF SILLS z DMIENSIONS OF POSTS w DEVIENSIONS OF GIRDERS S 5 ( " �, D !�• HEIGHT OF FOUNDATION r7t 10 `` THICKNESS G '` SIZE OF FOOTING 0, X In MATERIAL OF CFMWNEY IS BUILDING ON SOLID OR FILLED LAND I D IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U.- LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE 17ff — 711f —.)-ya y LOCATION: Assessor's Map Number lC�; D PARCEL 01 FO SUBDIVISION LOT (S) STREET 1�o��� �l . ST. NUMBER 10 *1 f bl? l s; I*****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS Of TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED I b DATE REJECTED COMMENTS r)—J C (IY`!Jb U (h) Gv- v VTOWN COMMENTS DATE APPROVED DATE REJECTED F D INSPECT R -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED III °I DATE REJECTED CO PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT I RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 Im rl lf� 116 oX _b7 71 Y- c3YOr O-e%,LrTj" MA fS Ir /—, --," c. w } 'r Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer /providing workers' compensation for my employees working on this job. Company name: �` 6A -F Address I J J7M__e' e'er City� eek, wtrA_� 01jes-D Phone #: �?79 - Lt (o t ° "7 Insurance Co �%Nr! Policy # Company name: Address City Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify u er th pains and penalties of perjury that the information p vided above is true and correct. Signature 2 Date /� /D - Z Print name :: r) C, R At1Qi`� Phone #q7 L %,S L Official use only do not write in this area to be completed by city or town official' ❑Check If immediate response is required Building Dept Contact person. FORM WORKMAN'S COMPENSATION A. Building Dept C] Licensing Board O Selectman's Office 0 Health Department 0 Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Loc4tion of Facility) SignAture,6f Permit Applicant ' � G Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck software version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 10-2-2001 DATE OF PLANS: 03/11/01 PROJECT INFORMATION: ADDITION TO THE PEASE RESIDENCE 1041 FOREST STREET NORTH ANDOVER, MA. COMPANY INFORMATION: GREAT WOODS POST AND BEAM COMPLIANCE: PASSES Required UA = 171 Your Home = 167 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 868 30.0 0.0 31 WALLS: wood Frame, 16" O.C. 727 19.0 0.0 44 GLAZING: Windows or Doors 110 0.470 52 FLOORS: Over Unconditioned Space 850 19.0 0.0 40 FLOORS: over outside Air 18 19.0 0.0 1 HVAC EQUIPMENT: Furnace, 80.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date 0 MAScheck INSPECTION CHECKLIST 'Massachusetts Energy Code MAScheck software version 2.01 DATE: 10-2-2001 Bldg. Dept. Use C] [7 C7 C] C] C] C] [] CEILINGS: 1. R-30 Comments/Locatio WALLS: 1. wood Frame, 16" O.C., R-19 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.47 For windows without labeled u -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location 2. Over Outside Air, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 80.0 AFUE or higher Make and Model Number AIR LEAKAGE: joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating [] I [7 I [] [] I equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table 74.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 74.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- Mailing Address Mailing Address North Andover MA 01845 Massachusetts Department of Environmental Protection City/Town State Zip Code City/Town State Zip Code Bureau of Resource Protection - Wetlands DEP File Number: 1041 Forest St. WPA Form 5 - order of Conditions 242-1096 Street Address City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP 0180 Assessors Map/Plat Number A. General Information Important: From: When filling out forms on North Andover the computer, Conservation Commission use only the tab key to This issuance if for (check one): move your cursor - do ® Order of Conditions not use the return key. ❑ Amended Order of Conditions To: Applicant: Property Owner (if different from applicant): David Pease Name Name 1041 Forest St Mailing Address Mailing Address North Andover MA 01845 City/Town State Zip Code City/Town State Zip Code 1. Project Location: 1041 Forest St. Street Address City/Town 105D 0180 Assessors Map/Plat Number Parcel/Lot Number 2. Property recorded at the Registry of Deeds for: Essex County Book Page 56600 (plan 40697B) Certificate (if registered land) 3. Dates: 7/30/01 8/15/01 9/5/01 Date Notice of Intent Filed Date Public Hearing Closed Date of Issuance 4. Final Approved Plans and Other Documents (attach additional plan references as needed): Conservation Plan for 1041 Forest Ave. 7/16/01 Title Date Title Title 5. Final Plans and Documents Signed and Stamped by: Bruce Eaton Name 6. Total Fee (from Appendix B: Wetland Fee Transmittal Form) Date Date Wpaform5.doc • rev. 8/29/01 Page 1 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 242-1096 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above -referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: ® Public Water Supply ® Private Water Supply ® Groundwater Supply ❑ Land Containing Shellfish ® Fisheries ® Storm Damage Prevention ® Prevention of Pollution ® Protection of Wildlife Habitat ® Flood Control Furthermore, this Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: ❑ the _proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes. ordinances, bylaws, or regulations. Woaiorm5 aoc • -ev 8/29/C1 Paae 2 of 7 r Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 242-1096 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Findings (cont.) 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection" [or, "MA DEP"] "File Number 242-1096 10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order. and may require the submittal of any data deemed necessary oy the Conservation Commission or Departmerfor that evaluation. Wcaiorm5 acc • rev 329/0: Pan.,J ni' Massachusetts Department of Environmental Protection l� Bureau of Resource Protection - Wetlands DEP File Number. WPA Form 5 - Order of Conditions 242-1096 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Findings (cont.) 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. Findings as to municipal bylaw or ordinance Furthermore, the North Andover Conservation Commission hereby finds (check one that applies): ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Municipal Ordinance or Bylaw Citation Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically. Chapter 178 of the Code of North Andover _ Municipal Ordinance or Bylaw Citation The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of intent referenced above. To the extent that the following conditions modify or differ from the pians. specifications. or other proposals submitted with the Notice of Intent. :he conditions shall control. NDWC.—=C • - __... PaOP. 4 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands i WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cont.) Additional conditions relating to municipal ordinance or bylaw: See attached Conditions DEP File Number: 242-1096 Provided by DEP This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions #4, from the date of issuance. 9/5/04 This Order must be signed by a majority of the Conservation Commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office (see Appendix A) and the T` if different from applicant). Signatures.- On ignatures: On 5th Day before me personally appeared Scott Masse Of Sept, 2001 Month and Year to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. Notary Public This Order is issued to the applicant as follows: by hand delivery on Date My Commission Expires by certified mail. return receipt requested, on -a.e Woaform5.doc • rev 3,1291,' Paae 5 of 7 Massachusetts Department of Environmental Protection l Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 242-1096 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP C. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act, (M.G.L. c. 131, § 40) and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. D. Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below. North Andover Conservation Commission :ca:cr-: _. =29 : Pace E c`- Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number. 242-1096 Provided by DEP D. Recording Information (cont.) Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. ------------------------------------------------------------------------------------------------------------------ To: North Andover Conservation Commission Please be advised that the Order of Conditions for the Project at: Project Location DEP File Number Has been recorded at the Registry of Deeds of: County Book Page for: Property Owner and has been noted in the chain of title of the affected property in: Book Page In accordance with the Order of Conditions issued on: Date If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is Document Number Signature of Applicant dvoa*orm5 coc • rev 8!29/0' Pace 7 of 7 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. I� Fermi Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix E — Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information 1. Person or party making request (if appropriate, name the citizen group's representative): Name Mailing Address uny/ i own State Zip Code Phone Number Fax Number (if applicable) Project Location Mailing Address Cityrrown State Zip Code 2. Applicant (as shown on Notice of Intent (Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability (Form 1)): Name Mailing Address City/Town State Zip Code Phone Number Fax Number (if applicable) 3. DEP File Number: B. Instructions 1. When the Departmental action request is for (check one): ❑ Superseding Order of Conditions ❑ Superseding Determination of Applicability ❑ Superseding Order of Resource Area Delineation Send this form and check or money order for $50.00, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston. MA 0221 N2atorm5 -oc • ADDendix E • neo 5/29/0' Paoe 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands �J WPA Appendix E — Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see Appendix A). 4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. moaform5.occ • Aooenaix E • rev 9/29/0' Pane 7 of 7 DEP FILE # 242 - 1096 Therefore, the North Andover Conservation Commission (hereafter the "NACU) hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the State Regulations, the local Bylaw and Regulations, to protect those interests noted above. The NACC orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced below. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent the conditions shall control. 11 GENERAL CONDITIONS 18. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 19. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of property rights. However, the NACC, agent of the NACC or the Department of Environmental Protection (DEP) reserves the right to enter and inspect the property at all reasonable times until a Certificate of Compliance is issued, to evaluate compliance with this Order of Conditions, the Act (310 CMR 10.00), the North Andover Wetland ByLaw and Regulations, and may require any information, measurements, photographs, observations, and/or materials, or may require the submittal of any data or information deemed necessary by the NACC for that evaluation. Further, work shall be halted on the site if the NACC, agent or DEP determines that any of the work is not in compliance with this Order of Conditions. Work shall not resume until the NACC is satisfied that the work will comply and has so notified the applicant in writing. 20. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 21. The work authorized hereunder shall be completed within three years from the date of this order. 22. This Order may be extended by the issuing authorit\- for one or more periods of up to one year each upon application to the issuing aUthority- at least thirty days (30) prior to the expiration date of the Order t i'veter to Sectio1: VIII (B)(p.33) of the _Horth AiztioT,er tA,"etia,,,j Re�i�httiv�r� . C: �\"in'�kordi ( A )( . DEP FILE # 242 - 1096 23. The NACC reserves the right to amend this Order of Conditions after a legally advertised public hearing if plans or circumstances are changed or if new conditions or information so warrant. 24. Where the Department of Environmental Protection (DEP) is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 25. The conditions of this decision shall apply to, and be binding upon, the applicant, owner, its employees and all successors and assigns in interest or control. These obligations shall be expressed in covenants in all deeds to succeeding owners of portions of the property. 26. The term "Applicant" as used in this Order of Conditions shall refer to the owner, any successor in interest or successor in control of the property referenced in the Notice of Intent, supporting documents and this Order of Conditions. The NACC shall be notified in writing within 30 days of all transfers of title of any portion of property that takes place prior to the issuance of a Certificate of Compliance. 27. The proposed work includes: Construction of a house addition and porch within the buffer zone to a BVW. 28. The work shall conform to the following (except as noted in the remainder of this document where revisions may be required): Notice of Intent filed by: CEC Land Surveyors, Inc. (Representative) 7 Winter Street, Suite 4 Peabody, MA 01960 Site Plans prepared by: CEC Land Surveyors, Inc. (Representative) 7 Winter Street, Suite 4 Peabody, MA 01960 Dated 7/16/01 Stamped by: Bruce P. Eaton, P.E., R.P.L.S. 29. The following wetland resource areas are affected by the proposed work: Buffer Zone to Bordering Vegetated Wetland (BVW). These resource areas are significant to the interests of the Act and Town BvLaw as noted above and therein. The applicant has not attempted to overcome the presumption of significance of these resource areas to the identified interests. DEP FILE # 242 - 1096 30. The NACC agrees with the applicant's delineation of the wetland resource areas on the site as shown on the plans dated referenced herein. 31. The NACC finds that the intensive use of the upland areas and buffer zone proposed on this site will cause further alteration of the wetland resource areas. In order to prevent any alteration of wetland resource areas a twenty five foot (25') No -Disturbance Zone and a fifty foot (50') No -Construction Zone shall be established from the edge of the adjacent wetland resource area. The Conservation Administrator and/or other agents of the NACC do not have the authority to waive these setbacks as established under the local bylaw. No disturbance of existing grade, soils or vegetation is permitted in the No -Disturbance zone. (See Section IIID) & Appendix G of the local Regulations). 32. This document shall be included in all construction contracts, subcontracts, and specifications dealing with the work proposed and shall supersede any conflicting contract requirements. The applicant shall assure that all contractors, subcontractors, and other personnel performing the permitting work are fully aware of the permits terms and conditions. Thereafter, the contractor will be held jointly liable for any violation of this Order resulting from failure to comply with its conditions. 33. The owners of the project and their successors in title, in the event they proceed to alter areas subject to the Commission's jurisdiction under the order, agree that the Order does not in itself impose upon the Town any responsibility to maintain the proposed drainage system and that said Town shall not be liable for any damage in the event of failure. By acceptance of this Order, the owners agree to indemnify and hold harmless to the Town and its residents for any damage attributable to alterations undertaken on this property pursuant to the Order. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage or any other form of wdFer damage. Maintenance of the drainage system, if accepted by the Town as part of a public way, becomes the responsibility of the Town. 34. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage or any other form of water damage. DEP FILE # 242 - 1096 PRIOR TO CONSTRUCTION 35. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department or Court have been completed. 36. This Order shall be recorded by the applicant at the Registry of Deeds immediately after the expiration of all appeal periods. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the North Andover Conservation Commission on the form at the end of this Order prior to commencement of the work. Any Order not recorded by the applicant before work commences may be recorded by the NACC at the applicant's expense. 37. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words "Massachusetts Department of Environmental Protection, File Number 242-." 38. Any changes in the submitted plans caused by the applicant, another Board's decision or resulting from this Order of Conditions must be submitted to the NACC for approval prior to implementation. If the NACC finds said changes to be significant, the NACC will call for another public hearing (at the expense of the applicant). Within 21 days of the close of said public hearing the NACC will issue an amended or new Order of Conditions. Any errors found in the plans or information submitted by the applicant shall be considered as changes. The proposed project may be still under review by other local or state boards or agencies. This may result in changes to the project plans or wetland impacts. If any such changes occur a revised plan and an explanation of the revisions shall be submitted to the NACC for review and approvat prior- to the start of construction. No work shall begin on a project until written approval has been granted b%- the NACC. DEP FILE # 242 - 1096 39. It is the responsibility of the applicant, owner, and/or successor(s) to ensure that all conditions of this Order of Conditions are complied with. The project engineer and contractors are to be provided with a copy of this Order of Conditions and referenced documents before commencement of construction. 40. Prior to any work commencing on-site, the applicant shall submit to the NACC for approval, a detailed sequence of construction, including the construction of compensation and retention areas, installation of sedimentation/ erosion control devices and re -vegetation to be completed before other work begins on-site. 41. Wetland flagging shall be checked prior to start of construction and shall be re-established where missing. All wetland flagging shall remain visible and enumerated per the approved plan(s) throughout the life of the project and until a Certificate of Compliance is issued so that erosion control measures can be properly placed and wetland impacts can be monitored. The proposed limit of work shall be shall be clearly marked with stakes or flags and shall be confirmed by the NACC. Such markers shall be checked and replaced as necessary and shall be maintained until all construction is complete. Workers should be informed that no use of machinery, storage of machinery or materials, stockpiling of soil, or construction activity is to occur beyond this line at any time. All flags used for the above purposes shall be of a color different from other flagging used on the site. 42. A row of staked hay bales backed by trenched siltation fence shall be placed between all construction areas and wetlands. The erosion control barrier will be properly installed and placed as shown on the plans approved and referenced herein and shall be inspected and approved by the NACC prior to the start of construction and shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. All erosion prevention and sedimentation protection measures found necessary -during construction shall be implemented at the direction of the NACC. The NACC reserves the right to impose additional conditions on portions of this project to mitigate any impacts which could result from site erosion, or any noticeable degradation of surface water quality discharging from the site. For example, installation of erosion control measures may be required in areas not shown on the plan(s) referenced in this Order of Conditions. Should such installation be required by the NACC, they shall be installed within 48 hours of the Commission's request. DEP FILE # 242 - 1096 43. The applicant shall have on hand at the start of any soil disturbance, removal or stockpiling, a minimum of 15 hay bales and sufficient stakes for staking these bales (or an equivalent amount of silt fence). Said bales shall be used only for the control of emergency erosion problems and shall not be used for the normal control of erosion. 44. A check payable to the Town of North Andover shall be provided in the amount of $1,500 which shall be in all respects satisfactory to Town Counsel, Town Treasurer, and the NACC, and shall be posted with the North Andover } Town Treasurer through the NACC before commencement of work. Said / deposit of money shall be conditioned on the completion of all conditions hereof, shall be signed by a party or parties satisfactory to the NACC, and Town Counsel, and shall be released after completion of the project, provided that provisions, satisfactory to the NACC, have been made for performance of any conditions which are of continuing nature. The applicant may propose a monetary release schedule keyed to completion of specific portions of the project for the NACC's review and approval. This condition is issued under the authority of the local ByLaw. 45. The applicant and/or the legal owner of that portion of land upon which these Orders of Conditions have been placed shall provide to the NACC prior to transferring, or assigning any portion of said land to another party, subject to said Orders of Conditions, the "Compliance Certification Form Affidavit" attached via "Appendix A" signed under the pains and penalties of perjury, stating that said applicant and/or owner has read these Orders of Conditions and is in compliance with each and every condition. This document shall apply to each of the conditions referenced herein and shall be provided to the Conservation Department at least five (5) business days prior to the closing of said land transaction. DEP FILE # 242 - 1096 46. Once these above mentioned pre -construction requirements are complete, the applicant shall contact the Conservation Office prior to site preparation or construction and shall arrange an on-site conference with an NACC i representative, the contractor, the engineer, wetland scientist and the applicant to ensure that all of the Conditions of this Order are understood. This Order shall be included in all construction contracts, subcontracts, and specifications dealing with the work proposed and shall -supersede any conflicting contract requirements. The applicant shall assure that all contractors, subcontractors and other personnel performing the permitted work are fully aware of the permit's terms and conditions. Thereafter, the contractor will be held jointly liable for any violation of this Order of Conditions resulting from failure to comply with its conditions. The applicant or contractor shall notify the NACC in writing of the identity of the on-site construction supervisor hired to coordinate construction and to ensure compliance with this Order. A reasonable period of time shall be provided as notice of the pre -construction meeting (e.g. 72 hours). DEP FILE # 242 - 1096 DURING CONSTRUCTION 47. IMPORTANT: Immediately upon completion of the dwelling foundation, and prior to further construction activities associated with the site, the applicant shall complete a plan prepared by a Registered Professional Land Surveyor of the Commonwealth (R.P.L.S.) which accurately depicts the foundation location and it's proximity to wetland resource areas as approved under this Order of Conditions. Said plan shall be submitted to the Conservation Administrator for approval. 48. Upon beginning work, the applicant shall submit written progress reports every month detailing what work has been done in or near resource areas, and what work is anticipated to be done over the next period. This will update the construction sequence. 49. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts on any of the foregoing. 50. No exposed area shall remain unfinished for more than thirty (30) days, unless approved by the NACC. 51. No re -grading in the buffer zone shall have a slope steeper than 2:1 (horizontal: vertical). Slopes of steeper grade shall be rip -rapped to provide permanent stabilization. 52. There shall be no stockpiling of soil or other materials within twenty-five (25) feet of any resource area. 53. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage system, or wetland resource area. 54. All waste generated by, or associated with, the construction activity shall be contained within the construction area, and away from any wetland resource area. There shall be no burying of spent construction materials or disposal of waste on the site by any other means. The applicant shall maintain dumpsters (or other suitable means) at the site for the storage and removal of such spent construction materials off-site. Hm\-e\-er, no trash dumpsters will be allowed within 50' of areas subject to protection under the Act or local BvLaw. DEP TILE # 242 - 1096 55. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 56. During and after work on this project, there shall be no discharge or spillage of fuel, or other pollutants into any wetland resource area. If there is a spill or discharge of any pollutant during any phase of construction the NACC shall be notified by the applicant within one (1) business day. No construction vehicles are to be stored within 100 feet of wetland resource areas, and no vehicle refueling, equipment lubrication, or maintenance is to be done within 100 feet of a resource area. F, DEP FILE # 242 - 1096 AFTER CONSTRUCTIONM 11 57. No underground storage of fuel oils shall be allowed on any lot within one - hundred (100) feet of any wetland resource area. This condition shall survive this Order of Conditions and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland protection ByLaw. 58. Fertilizers utilized for landscaping and lawn care shall be slow release, low - nitrogen types (< 5%), and shall not be used within 25 feet of a resource area. Pesticides and herbicides shall not be used within 100 feet of a wetland resource area. This condition shall survive this Order of Conditions and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland Protection ByLaw and shall remain in perpetuity. 59. Upon completion of construction and grading, all disturbed areas located outside resource areas shall be stabilized permanently against erosion. This shall be done either by loaming and seeding according to SCS standards. If the latter course is chosen, stabilization will be considered complete once vegetative cover has been achieved. 60. Upon completion of the project the applicant shall submit the following to the Conservation Commission as part of a request for a Certificate of Compliance: a. WPA Form 8A — "Request for a Certificate of Compliance." b. A letter from the applicant requesting a Certificate of Compliance. c. The name and address of the current landowner. d. Signed statements from the individual property owners shall be submitted with the request for a Certificate of Compliance indicating that they read and understood the recorded Order of Conditions prior to purchasing their property. e. The name and address of the individual /trust or corporation to whom the compliance is to be granted. f. The street address and assessor's map/parcel number for the project. g. The DEP file number. h. A written statement from a Registered Professional Civil Engineer and Registered Professional Land Surveyor of the Commonwealth certifying that the work has been conducted is shown on the plan(s) and documents referenced. above, and as conditioned b%- the Commission. C. W illNis i JO( C.2-12_:i,ii„ y .. DEP FILE # 242 - 1096 i. An "As -Built" plan prepared and signed and stamped by a Registered Professional Civil Engineer and Registered Professional Land Surveyor of the Commonwealth, for the public record. This plan will include: ➢ "As -Built" post -development elevations and grades of all filled or altered wetland resource areas including the encompassing buffer zone which is regulated as a resource area under the local Wetland Protection Bylaw. ➢ Distances from structures to wetland resource areas. Structures include (but are not limited to) septic systems, additions, fences, sheds, stone walls, pools, retaining walls, subsurface utilities and decks. ➢ A line showing the limit of work and the extent of existing erosion control devices. "Work" includes any disturbance of soils or vegetation. ➢ Location of all subsurface utilities entering the property. 61. The following special conditions shall survive the issuance of a Certificate of Compliance (COC) for this project: ➢ 25' No -Disturbance Zone and a 50' No -Construction Zone shall be established from the edge of adjacent wetland resource areas except in those locations approved under DEP # 242 - Future work within 100' of existing wetland resource areas will require a separate filing with the NACC (refer to Section XI (page 18) of the Regulations for performance standards within these zones) The Conservation Administrator and/or other agents of the NACC do not have the authority to waive these setbacks as established under the local ByLaw; ➢ Discharge or spillage of pollutants (Condition # 56); ➢ Prohibition of underground fuels (Condition #57); Limitations on the use of fertilizers, herbicides and pesticides (Conditions #5811. A( _l o,'! _/2000 E . ° DEP FILE # 242 - 1096 APPENDIX A - AFFIDAVIT )' on oath do hereby depose and state: (authorized agent applicant and/or current owner) (PLEASE CHECK AT LEAST ONE BLOCK) I • I am the ( position with applicant) (applicant name or company name) the applicant upon whom Order of Conditions have been placed upon by (DEP or NACC number) the North Andover Conservation Commission. Wor 2. I am the of (position with owner) (owner name) the owner upon whose land Order of Conditions have been placed up by (DEP or NACC number) the North Andover Conservation Commission - 0 3. I hereby affirm and acknowledge that I have received said Order of Conditions and have read the same and understand each (DEP File #) and every condition which has been set forth in said Order of Conditions. R 4. I hereby affirm and acknowledge that on this day of 19_ I inspected said property together with any and all improvements which have been made to the same and hereby certify that each and every condition set forth in Order of Conditions are presently in compliance. (DEP File #) 5. I hereby affirm and acknowledge that this document will be relied upon by the North Andover Conservation Commission as well as any potential buyers of said property which is subject to said Order of Conditions (DEP File #) Signed under the pains and penalties of perjury= this d w of (Signature - authorized agent of applicant or owner) C/) m C/) 0 m CA d CO) n Cl)CD Z CO) CD r C � � C C. = y -moo o C-) CD CD CL c� %oc d CD CD CD mw 3 C CD V;CD� CL O CO) � I ca CD B v CA 0 1CD Z a a o CD a 0 CD c?�c O -• C4o Q H ao�m ti �m 0 m n c CO m 06 C2 3 M. 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Q O W fJ } Z LL Z O u < N J < W a a < LL 0 O K 0 m z o a f � � o 00 o g z q W W ' Ld C 1 Wa m Z 0 u °u u It 11 it It a p o goi' U m m m u M j W W W W A O O� non rn z z a 0 J U ILm D O N O z F r1 N 0 z 0 N N W Z Z m O O F N u u 3 N N F N 1- WD WQ 0 0 0 W N JJ j f F LL LL u 0 N Irf m W W u W < ` < J N a a W F J z 0 0 i 0 C 0 0 z z Isn r 1 r z W M < W O O N 0 l I ' 0 K qc:7 • 0 W W cv J IK l7 4 ` W F ._ F Z W m O 0 li a t n�� 1 � III v c�2mx, 1 Isn r 1 r z W M < W O O N 0 l I ' 0 K qc:7 • 0 W W cv J IK l7 4 ` W F ._ F Z W m O 0 li a F AOyNFNTGI LI yNinnA��mtai•vaiF pn mZ -p vpnn D3N gm3 O pf �AD$�i FORM D - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary ° approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: IgNi:Fcu t Am vorr k(Ili- t-7--te Phone LOCATION: Assessor's Map Number Parcel Subdivision I'Orz w, A L 0 Lot s 1 Street "i (VEC-- si 5`I St. Number 10q I RECOMMENDATIONS OF TOWN AGENTS: '1S, ���lC-CCIkY Conservation Administrator Comnents Use Only************************ Date Approved Date Rejected a 'moo Date Approved �. Town Planner Date Rejected _ Comments Date Approved _ Food Inspec :or- ealth Date Rejected Date Approved Septic Inspector -stealth Date Rejected _ Co=ents Pu:.liC Wcr:;s - sewer/water connections /V14- - drriveJway permit - -- `C. `�V �' `. W-�'�f/� _+ .a.s-'W"/R'`'L lY F__ Department •_, Received by Building Inspector Date ii iw 2 11994 'HALS .ti )Ntii 11VATION ATE NORTI ANDO'VE'l� 111V1.4011N (11 1'1.l1NN1NG. & ILA H.l :f. 1 1.1'. N1:I .til )N. I )II t1:(:*I ( )I t CHIAINLY APPLICAHON ANO I'E13111' )CATION /T /�� �yr��T S 1 1'11 11111 "c111 It 0\ f'I 1\1i1!;Vi111111'a'111; 111'!1!! Ili1 i11ili!i�l i i!i 1'Lltcll'I. # - C� UNER' S NAME: 1I LDER'S NAME: 1� h�llr� U �3-- j'V�Avr ,� U t Cie 1cLs kSON' S NAME: kSON'S ADORE ISDN' S TELEPHONE: ���J v\Z �ly .TERIAL OF CHIMNEY: c- ITERIOR CHIMNEY: EXI ERIOR CHIMNEY: L -"- 11%i BER -"- 11%iBER AND SIZE OF FLUES: V N 1ac-c__ VL ckN2— IICKNESS OF HEARTH: :U cjl.ull)tey ot. ()-vicenCace con(aai ,to .ttte. Acqu.ilce►nell•'.5 u( the Gude and have Aticc.5 and ,gu.Cati.ow beeii neeebed: -- TE: . -Z� f / GNATURE OF MASON: :RMIT GRANTED: o� 'BERT NICETTA J LOING INSPECTOR 0053, SPECTEO: -- :h1ARKS: SOLID 8 CIt lit Ul 1I11:!) THIS PERMIT MUSE GE UISPLAVLU 014 ME 17RU11 SLS CERTIFICATE OF USE &OCCUPANCY _ Town of North Andover Building Permit Number 257 THIS CERTIFIES THAT Date NOVEMBER 16, 1994 THE BUILDING LOCATED ON 1041 FOREST STREET - LOT 3 MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR IN ACCORDANCE GARAGE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Andrew & Maurice Bldrs . , Inc. ADDRESS 369 Merrimac St. - Methuen, MA 01830 Ra chard A . Co Ian t uonBuilding Inspector Ass't _ e� L21b--- O F=4 in r E LU CL Q1 C J W it C93 H x ° o ev �o = c W 4 N m Ca W t o :C Co m � �..� o CDo \) x u O v D o v -Bco p .G G w G W p v G ct p G w z 0 w C/) w a: U CU/)w r2 w co cn cn O F=4 in r E LU CL v O F U � a o c� E \ z CD i ~ A o � CL M tin Ico = w o� > a 0 0_ c CO2 �� L m CO z C* w o) o O D CDO m O C C coo -a P C� Q U CD LL C3 .y Z vco CL Q ouCS CA 0cc uj LLJ C �=+ LL a a CO) C:i 5 r\ Z u • u r CL U Q1 C J W it C93 CA o �m ev �o = c W 4 N m Ca W t o :C Co m � �..� 81 CDo CU i y m m s � o 0 act a = m �cC. m� �a� o WC cc+=+'at •ca O.LLU A c ac E 5-0 040 cm U CD d iE -0O V� = R m N O v O F U � a o c� E \ z CD i ~ A o � CL M tin Ico = w o� > a 0 0_ c CO2 �� L m CO z C* w o) o O D CDO m O C C coo -a P C� Q U CD LL C3 .y Z vco CL Q ouCS CA 0cc uj LLJ C �=+ LL a a CO) C:i 5 r\ Z u • u r CL U c C93 __j o �m cm� c W 4 N m t o Z o � �..� 81 2 i v O F U � a o c� E \ z CD i ~ A o � CL M tin Ico = w o� > a 0 0_ c CO2 �� L m CO z C* w o) o O D CDO m O C C coo -a P C� Q U CD LL C3 .y Z vco CL Q ouCS CA 0cc uj LLJ C �=+ LL a a CO) C:i 5 r\ Z u • u r CL U (3 tg9ts THIS PLAN IS NOT FOR RECORDING PURPOSES OFFSETS ARE NOT TO BE USED FOR THE REPRODUCTION OF PROPERTY LINES SPECIAL FLOOD HAZARD AREA (FIA) IS NOT APPLICABLE � 1 ��T J '9EIFR = 274 90 ± F a2; 6 3! * RCec-'j 63 4 u/F He"IrA-.z 5v AJ r Srz-2 UIF GAv44Al U/F deAIAiL--75 "I certify that the foundation shown hereon is in compliance with the applicable Zoning Bylaws of the Town of Axm AAAwvci- with r- horizontal dimensional requirements." P.L»S.�, 7 -1s - `DATE "FOUNDATION CERTIFICATION" PLOT PLAN OF LAND IN MASS. SCALE: 1" _tea' FEE DATE: -4w-,' 15, 1-794 - D S C DEVELOPMENT SERVICE COMPANY 30 WOODLAND ROAD ASHLAND, MA 01721 (508) 881-6776 R- I�6-� Location r O/ZE N7� � i n l/� No. �,� s - ' � - " . � Date iE HORTF TOWN OF NORTH ANDOVER .,+ i? •� ' �t �� N A Certificate of Occupancy $ Building/Frame Permit Fee $ ,JSACMUSE� FQun ation Permit Fee $ 40ther 0�dr'At'Pee $ �i Sewer Connection Fee $ Water Connection Fee $ rI TOTAL ? ` Building Inspector - ' Div. Public Works PERMIT NO. U� + 94PPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE 1 MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP (DATE i BOOK 'PAGE — ZONE I SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDINGAQe/e� sTo oe W OWNER'S NAME ay�,, S la NO. OF STORIES SI OWNER'S ADDRESS %O 5T ST BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME M SPAN _— DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS i PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED�/rf% ,� / r SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE �•y PERMIT GRANTED l l1-719 3 PROPERTY INFORMATION xND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 'NV1d 101d S30b-ld3M SIHI 'O3SOdWIM3df1S '013 'S39Vt:1 'V9 'S3HOMOd HIM 'SVNIa'11f19 d0 SNOISN3W1a 17VX3 ONV S3NM 101 WOUA 3ONVIS10IONV 101JOSNOISN3WIa 10VX3 MOHSiSf1W N01103SSIH1 ZI 01033V JN1aiina dvull ;H S3dn1X13 Na300' d3MOHS llV. 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ONIBWnld O NNIS N3HDlI AdO1VAE 13S01D 831Vi ('X13 LI Wd Inc X13 EI Hlb vN19Wflld 01 3NON17533 dood H 3dOna3drr —I NIH -)IIA N2I3(jOw S3:)Vld 3d13 13AVd0 8 bVl 31VIS S30NIHS DOOM S310NIHS 11VHdSV 03HS_ IV -1,4 OdVSNVW _ 1368WVJ dIH 319V`0 d00a 9 d3ONID bO 'JNOD 3WVd3 NO XDId9 9NOSVW NO XDId9 3WVa3 NO ODDn1S 40SVW NO oxmis ONIOIS 'ld3A ONIOIS SOIS39SV IS dOdO �09dV1� S11VM y OOa OV3H 1W9 ON — I viev .JI11v Nil V3dV .1. W.9 'N13 I� 3111 HdSV _ —_ _ _ E � L—_ — N0YJW0H ��— — O Pn(IaVH 631Svld Sa31d 0 MQdVH HAV3 313dDNOD 'X.18 9138:)NOD l 9 I HSINIA Sao011 6 NOIIVON10d Z —I NIH -)IIA N2I3(jOw S3:)Vld 3d13 13AVd0 8 bVl 31VIS S30NIHS DOOM S310NIHS 11VHdSV 03HS_ IV -1,4 OdVSNVW _ 1368WVJ dIH 319V`0 d00a 9 d3ONID bO 'JNOD 3WVd3 NO XDId9 9NOSVW NO XDId9 3WVa3 NO ODDn1S 40SVW NO oxmis ONIOIS 'ld3A ONIOIS SOIS39SV IS dOdO �09dV1� S11VM y OOa OV3H 1W9 ON — I viev .JI11v Nil V3dV .1. W.9 'N13 I� ( 7C lln3 V38V� IN3W3SV9 £ —_ _ _ E � L—_ — — _ N13Nn llvM Ada — 631Svld Sa31d 0 MQdVH 3NO1S d0 X71d8 3NId 'X.18 9138:)NOD 313dDNO� HSINIA V0113INI 8 NOIIVON10d Z NOuonU1SN00 S1N3W1dVdV _ s3�1330 kIIWVJ Illnw S31d0!S _— A11WV3 910NIS JION Vd nOOO I r WOOD STOVE 1NSTALLAHON CHECKLIST F'="r.)ir (,(); 3 v2-�� Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stave installation and -not to the stove construction. .) Stove N A. New Used B. Type/radiant Circulating C. Manufacturer Lab. No. Name/ Model No. Collar size Dimensions) Height L.?ngth Width Chimney A. New Existing B. Size (flue area) C. Other appliances attached to flue (Number and flue size) D. Prefab (Manufacturer—name and type) E. Masonry/Lined Flue liner Unlined tyD• d manWacsurur F. Height (refer to diagrams) cap CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to ciaaram) Clearances and Wall Protection i.see stcve inStallat.cn c:earances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER !Z i• MIN. IZ`r htlt(. Fiji S_..sr5H HEARTH WALLCENTER. 13 Tva��uvea/�a�saczc�u�ei e �am�r v 6x-ecaAe tie, :lu��co Ja .-1lizCe 93cuzr:�� 411AUdle'n'91 gerda4oit6 and AnalanL William F. Weld �. tLc'%'cLrmacr�c . jtate C�iee �ue�c�vn� Governor i��te ��slilXc•r!!Nt �aCP - C �•�0� Kentaro 'I'sutsumi n. ��ireaaaaivae�ta 0,2108 Chairman :6171 727-32W Charles ,I. Dinezio Administrator SAMPLE SOLID FUEL BURNING PELLET STOVE AFFIDAVIT FOR PELLET STOVES SOLD WITH CARBON MONOXIDE (CO) GAS ALARMS (FALL I99t/WINTER t992 HEATING SEASON) To the State Board of Building Regulations and Standards: as on behalf of a manufacturer of solid fuel burning pellet stoves/heaters/fire place inserts (circle appropriate products). hereby certify that thefollowingpellet heating�a pliances. by explicit model identification; model(s): (1 ) o- L/t _ i ..IZE� 9Y Date. J. '719q6 wild, for use in Massachusetts, are equipped with a carbon monoxide gas alarm, in accordance with the requirements specified oil f ige 1 of this affidavit. MANUFACTURER: SIGNED: TYPE, OR PRINT NAME ABOVE: TITLE: N r On this day of l9j!?b'**'1hen personally appeared before me, the above named and made oath that the above statements by him/her, are true. BEFORE ME: tiOTARY PUBLIC MY COMMISSION EXPIRES: 19 PAGE 5 n_�p — Jhe "�vm�rrancuea �� A awac wjeffj w irl!Aakc JaA441 �erda,&,nd and Cu nriu r� %%illiam F. Weld jL. ,��sr /m�rcr�. ,_��a4ee (1we, :h��W 4WY Governor ��ee�����/tlie�Y&n ✓ ace ✓ ,'M Kentaro '1'snttiumi CiE7o<slan, v��uddCldf�leet.C6 0�7�8 hl71 ;_' -32(N) Chairman Charles J. Dinezio SAMPLE Administrator SOLID FUEL BURNING PELLFT STOVE AFFIDAVIT FOR PELLET STOVES SATISFYING 'NEGATIVE PRESSURE' TFSTINt; (FALL t99t/WIN"I F.R 1992 IIFATING SFASON) To the State Board of Building Regulations and Standards: Date 7 -1917/ I. as on behalf of a manufacturer of solid fuel burning pellet stoves/heaters/fire place inserts (circle appropriate products), hereby certify that the following pellet heating applliances. by explicit model Identification; model(s): /apMz c,J LJ- Y, (e% have been tested. or tested/listed (circle appropriate information) per the "negative pressure" test requirements of either ULC S627/CSA Standard B366.2, or draft standard ASTM E-91, revised draft 5/2391. and found to satisfy the applicable criteria of ULC S627/CSA Standard B366.2 or draft standard ASTM E-91, revised draft 5/28,91; additionally, burnbac did not occur either during normal or abnormal "negative pressure" testing. N1,"UFACTURF.R: SIGNED: TYPED OR PRINT NAME ABOV&- — TITLE: On this day of . 19_, then personally appeared before me, the atxwe named and made oath that the above statements by him/her. are true. BEFORE :NE: NOTARY PUBLIC MY COMMISSION EXPIRES: r, 19 1'.\(: F 4 fg�- -9-6 -1.es7- Sr Yi. 6-y� 9 1! ' INSTALLATION AND 8 MAINTENANCE INSTRUCTIONS 4� PELLET CHIMNEY ASSEMBLY General Assembly Instructions: This symbol on the nameplate means the product Is listed by Underwriters Laboratories. Inc. Styl P hound Metal -l=ab Type L.. ellet and Gas Vent Pipe ALIGN THE PIPE. PUSH TOGETHER. TWIST . LOCK. aL To unlock: REVERSE THE PROCEDURE. General Installation Notes I. The pipes are presealed with a fiber rope,- Do not remove the rope and take care when twisting, so as npt to bind up the rope. NOTE: It fly ash leakage occurs, seal casing Joints with a silicone -type sealer rated for use at 400° F or higher. 2. Consult local building or fire officials about restFic- tions and Installation Inspection in your area. 3. Metal -Fab Pellet Chimney (vent) and Fittings are intended for installation to form a continuous passage- way from the appliance to the termination of the chim- ney, either above the roof or horizontally through the wall, including the chimney cap. To comply with UL listings and Metal -Fab warranty, use o:!iy chimney parts defined by these instructions or Metal -Fah brochure. 4. Metal -Fab Pellet Chimney and Fittings are ap- proved for venting listed pellet stoves and gas and oil furnaces that do not exceed 570° F at the outlet temperature. S. A Metal -Fab Chimney Cap should be used on all installations, either horizontal or vertical, to prevent back drafts and to keep out rain and debris. S. To increase Pellet Chimney life, coat all exterior metals with high-temperature, rust -proof paint, partic- ularly in areas near the ocean. T. Inspect each part for damage, before Installing. 8. Maintain a 3" minimum clearance to combustibles when passing through a combustible wall, ceiling or roof. Always use a Firestop when penetrating a floor or ceiling. NOTE: Combustible materials Include: materials made of or surfaced with wood, compressed paper, plant fibers, plastics or other material that will Ignite and bum. Such material is considered combustible even though flame proofed, fire retardant, or plastered. 9. When horizontally vented, maintain a clearance of 24" from doors, windows and public walkways. 10. An increaser may be used. at any point in the chimney system to meet stove manufacturer's require- ments. 11. Before Installing, consider the design and con- struction of the building so as to minimize the need to pass through existing structural supports. 12. The maximum height of the Pellet Chimney should not exceed 60 feet. A support is required at 30 feet. 13. Elbow joints are designed. to fit tight and are not adjustable. All direction changes must be made at 450 or 900. Installation Instructions Direct Horizontal Venting (See Figure 1.) 1. Attach and secure the Stove Adaptorto the appliance flue outlet. Sheet metal screws may be used to secure the Stove Adaptor to the appliance flue outlet. NOTE: Seal as needed using sealer rated for 400° For higher. 2. On the same centerline as the appliance outlet, cut a hole into the outside wall, 67/8" diameter for 3" pipe and 9'/2" diameter for 4" pipe. Caution is needed to assure no wires or pipes within the wall are damaged. 3. Install the Wall Thimble by inserting the larger of the two parts on the appliance side and the other half through the outside wall. NOTE: The two horizontal cylinders of the 'e himble must engage a minimum of two Inches. 4. Install the Pellet Chimney sections to allow 3" minimum clearance to the exterior of the building. 5. It is recommended that a House Shield be used to keep the ash from forming on the exterior of the building. If used, secure the Shield to the wall using the screws supplied. 6. Install the horizontal Chimney Cap by positioning the Cap over the chimney end and securing by tightening the two bolts/nuts. . FIG. 1 AINIMUM :ARANCE HORIZONTAL VENT CAP 24" CLEARANCE TO DOORS. WINDOWS AND PUBLIC WALKWAYS USE ELD Rear Stove Exhaust, with Exterior Venting (See Figure 2.) 1. Begin installation by following steps 1 through 3 for direct horizontal venting. 2. Install the Tee to the chimney. Slip a Support Band over the lower portion of the Tee. Install the Tee Support so that the Tee extends through the hole approximately 3116". Rest the flange of the Support Band on the Tee Support and tighten the two bolts securely to the Band. NOTE: A minimum of 3 clearance to combustible's exterior surface from the vent Is required. 3. Install chimney sections vertically, starting at the Tee outlet. Attach a Wall Bracket approximately every six feet to secure the vent. 4. If the chimney is to pass through the roof or overhang, a hole 93/4" square for 3" pipe and 101/4" square for 4" pipe is required. See Figures 2 and 6. 5. Slide the Flashing over the pipe and secure to roof. Apply mastic tape where chimney passes through the Flashings. Apply a thick ring of mastic around the chimney. Slide the Storm Collar down into the mastic ring and secure. See Figure 5a. 6. Install any additional chimney sections terminating at the Chimney Cap. See Figures 5a and 5b for minimum height above the roof. -2- FIG. 2 SUPPORT BAND \ (SEE NOTE. FIG. 4) TEE CAP "'TEE SUPPORT 93'." for 3" PIPE 103'." for 4" PIPE 3" MINIMUM LEARANCE CLEARANCE— _-----WALL _-----WALL BRACKET (REQUIRED EVERY WALL 6 FT.) THIMBLE STOVE ADAPTORCLEANOUT TEEIOR TEE) FIG. 2 SUPPORT BAND \ (SEE NOTE. FIG. 4) TEE CAP "'TEE SUPPORT Rear Stove Exhaust, with Interior Venting (See Figure 3.) 1. When installing the chimney from the rear outlet, a minimum of 3" to combustible surfaces is required. 2. Attach and secure the Stove Adaptor to the appliance flue outlet. Sheet metal screws may be used Yo secure the Stove Adaptor to the appliance flue outlet. NOTE: Seal as needed using sealer rated for 400° For higher. 3. It is recommended that a Tee be used to transition to vertical venting for ease of clean out and inspection. 4. Mark 'on the ceiling the vertical centerline of the chimney. A plumb bob is normally used to locate the centerline. 5. Cut a 141/2" square hole through the ceiling. NOTE: When passing through a ceiling, It Is recommended that the hole be framed. Use the same size joists as are present. 6. On the ceiling side, install the Firestop spacer. NOTE: If attic Is directly above, install the Firestop spacer from the attic side. 7. Continue the chimney installation into the attic through the Firestop. Slip the Support Band over the pipe with the flange of the Band resting on the Firestop plate. Tighten the Band around the chimney, using the two bolts and nuts provided. 8. If elbows are needed to position the chimney away from obstructions, support the offset using chimney straps (plumber's straps). See Figure 3. 9. Continue the installation by following steps 4 through 6 for exterior venting. Top Exhaust Venting (See Figure 4.) 1. Attach and secure the Stove Adaptor to the appliance flue outlet. Sheet metal screws may be used to secure the Stove Adaptor to the appliance flue outlet. NOTE: Seal as needed using sealer rated for 400° FLor higher. 4 2. Install the chimney sections vertically, by following steps 4 through 9 above. -3- CHIMNEY STRAP (BOLT OR NAIL SECURELY TO STRUCTURAL BEAM —SEE NOTE)�� 900 \�\► ELBOW — \ FIRESTOP SPACERt; 914" SQUARE AND SUPPORT BAND.. 60' MAXIMUM (2) 450 (SEE NOTE. FIGA) '�.� FOR 4" PIPE ELBOWS 3" MINIMUM . 3" MINIMUM CLEARANCE CLEARANCE FIRESTOP F 14'.4" BETWEEN -- �+ JOISTS SUPPORT BAND FIRESTOP l SPACER CEILING STOVE ADAPTOR ` PLATE (Decorative 11 Cover) ..MI9" MIca to N. to 1111 3 r ComDustibloa 4\- -TEE 1 —" `-TEE CAP 91:" SQUARE FOR 3" PIPE 10Y." SQUARE FOR 4" PIPE 3" MINIMUM CLEARANCE TO COMBUSTIBLES CEILING PLATE (DECORATIVE COVER) NOTE: Chimney Strap — Use Y'." wide FIG. 3 (minimum) plumbers straps, 24 gauge (mini- mum) galvanized strips, with 16" or 'A" holes, capable of supporting 12 feet or less of pipe. �^ 914" SQUARE FOR 3" PIPE 60' MAXIMUM 10/ SQUARE HEIGHT FOR 4" PIPE 3" MINIMUM CLEARANCE FIRESTOP F TO COMBUSTIBLES SPACER AND SUPPORT BAND (SEE NOTE) CEILING PLATE (DECORATIVE COVER) 3" MINIMUM 30' CLEARANCE MAXIMUM BETWEEN 14'6" BETWEEN SUPPORTS JOISTS - FIRESTOP SPACER CEILING STOVE ADAPTOR - PLATE (DECORATIVE COVER) NOTE: During Installation of Pellet Chimney. the Support Band is to be tightened securely around the FIG. 4 outer casing. LESS • THAN �• 10' gp MASTIC 2 MIN. F i;. MINIMUM �. .I TERMINATION LESS THAN 10 FEET FROM RIDGE. WALL OR PARAPIT FIG. 5A HEIGHT ABOVE MORE THAN 10' ANY ROOF 10• SURFACE WITHIN 10' HORIZONTALLY 4 pit A irril 2' --- MIN. FIG. 6 PIPE "A" 3" 934" sq. minimum 4" 1034" sq. minimum Maintenance Instructions 1. it is recommended that the chimney system be In- spected and cleaned at ieast once each month during the heating season. Also, Inspect and clean the chimney system before each heating season. \� 2. For cleaning and/or Inspection of the Pellet Chimney, the Caps may be removed. To remove the vertical Cap, twist TERMINATION counter clockwise and pull straight off. To remove the MORE THAN 10 FEET horizontal Cap, loosen the nut on the retaining band and FROM RIDGE, pull Cap off. WALL OR PARAPIT FIG. 58 11ETALwF9;NC. MANUFACTURER OF PRODUCTS FOR ENVIRONMENTAL SYSTEMS P. O. BOX 1138 • WICHITA, KANSAS 67201 Lig Litho in U.S.A. 316.943-2351 • FAX 316-943-2717 Form tha 4- U W U FLOOR PROTECTION & CLEARANCES FLOOR PROTECTION The Whitfield Renaissance Pellet Stove must be i istalled on a noncombustible protective floor pad of minimum 3/8" thickness, or on a masonry hearth. The hearth or floor pad must extend a minimum of 6" from the face of the stove forward and from each side of the stove OR TO THE NEAREST PERMITTED COMBUSTIBLE MATERIAL IF IT IS LESS THAN 6" from the back or sides of the stove (See Figure 9). NOTE* FLOOR PROTCTION MUST EXTEND TO AREAS BENEATH THE VENT PIPE. Floor Protector must extend at least 6" from the face of the stove and 0" to the sides and rear of the stove. Noncombustible Floor Protection Figure 9 CLEARANCES TO COMBUSTIBLES The stove must be installed with the following minimum clearances from the side and back wall to the nearest combustible materials: See Figures 10, 11,and 12. 0 1" Clearance to back wall T 6" Figure 11 6" Figure 12 C 4 Section 4: Floor Protection & Clearances Floor Protection The Whitfield Prodigy II Pellet Stove must be installed on a noncombustible protective floor pad of minimum 3/8" thickness material or on a masonry hearth. The hearth or floor pad must extend a minimum of 6" from the face of the stove OR TO THE NEAREST PER- MITTED COMBUSTIBLE MATERIAL IF IT IS LESS THAN 6" from the back or sides of the stove. (See Figure 1). Clearances to Combustibles The stove must be installed with the following mini- mum clearances from the side and back wall to the nearest combustible materials. (See Figure 2). Floor protector must extend it F6"_ at least 6"from the face of the stove, and 0" to the sides and rear of the stove. Noncombustible Floor Protector Figure 1 - Floor Protector Size Figure 2 - Clearances to Combusible Materials III A- 6%* 0 oTOVE INSTALLATION CONFIGURATIONS YOUR WHITFIELD MAY BE INSTALLED AS: • A freestanding unit with a pedestal placed on a non-combustible floor pad. ` • A hearth set fireplace insert into a masonry or factory built fireplace. • A built-in stove placed on an insulated floor pad. • A mobile home heater placed on a non-combustible floor pad, while being bolted and electrically grounded to the chassis of the home. FLOOR PROTECTION Your Whitfield pellet stove must be installed 6tva n; rycombustible protective floor pad of minimum 3/8" thickness material or a masonry hearth. The hearth or floor pad must extend a minimum of 6" in front of and from each side of the stove (and 6" behind, in a freestanding/inside vertical installation configuration) or to the nearest permitted combustible material (if less than 6"). PA CLEARANCES TO COMBUSTIBLES The stove must be Installed with the following minimum clearances to combustible materials. 1" Clearance Behind Stove 1" Clearance From Front Of 1' Clearance To The Corner Hopper To Back Of Stove , Although a 1" clearance to a combustible is a minimum, you should have at least 1.5" of clearance to allow the hopper lid to open all the way. Keep all combustible material at least 18"horizontal) ( y) away from glass. 10 { The Hearth Pad Must Extend A Minimum Of 6" To The Sides And Front Of The Stove. 1' In The Rear. 6" In The Hear In A Freestanding Inside Vertical Installation Configuration PA CLEARANCES TO COMBUSTIBLES The stove must be Installed with the following minimum clearances to combustible materials. 1" Clearance Behind Stove 1" Clearance From Front Of 1' Clearance To The Corner Hopper To Back Of Stove , Although a 1" clearance to a combustible is a minimum, you should have at least 1.5" of clearance to allow the hopper lid to open all the way. Keep all combustible material at least 18"horizontal) ( y) away from glass. 10 CO) 10 Cz. CD o C- r I a a� -o o o v CL Q CD ..:. Q o to o CD C 0 cm y _ 0 Cl' 0 CO) C) co 0 _ r� =r CD a, y CD CO) 0 0 CD 0 CCD 0 C V b n ^ n O off, 0 0 cn r: G; G1 o; z: GI CA CD cr CO3 _da �•C W O m n W C7 n a m W = ' M a T c . m := m cm = d y O CO H Q c ?m 2 O O CD s. n in o to O .y = O CD �� a te.. H, L CL " �► CD: N Q C CD m o C: W o cn o CD R n a I N CD H W O N oma: i n � �CD Cn Cn z cn x .ic z 0 0 c Date ......... �Z NORTM °f``°;•'44,0 TOWN OF NORTH ANDOVER is�.a -' -.• °t O p PERMIT FOR WIRING This certifies that . �i7.Ulr �' ���l.: ......... ........... ............................... has permission to perform ..... l%cl.�fi.`..................................................... wiring in the building of .....E'?.. ,........................................................... 1 �f/ — � at ...................''...��.%. c�i�.'.�.f ....r....7... ��.. ,North An quer, ,:Fee ...... :. .l,! Lic. No. 5..�1, 3 / ....... Gfaz"... i .,1 ELECTRICAL NSPECTOR r Check # OfficialUseOnly Permit No. Dy+wrtNrurt o6 ?»ia6lle Saaety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number i 0 Lk ` 1O C eS-\ S � Owner or Tenant bow 2 \ ecl J e_ Owners Address k U y i IPO r S r Is this permit in conjunction with a building permit Purpose of Building `\ ✓� Date o1 ' " cla To the Inspector of Wires: Yes M,-' No ❑ (Check Appropriate Box) Existing Service QQ Amps �U` `(O volts Naw Service Amps Voits r (umber of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead ❑ Overhead ❑ Authorization No. Undgmd 91 No. of Meters ( Undgmd ❑ No. of Meters OTHER: 1 1 OGc,. a"A C4 -f �v� ! �^e 1 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent ®E = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER Please Specify) (Expiration Date) Estimated Value of Electrical Work$ 'V"� Work to Start r2 ' �� d Inspection Date Resquested Rough Final Signed under the QenaRies of peryury: FIRM NAME �,}-_ was fe`=��cT� �(� LIC. NO. Lkensee \'�y` �`r",� Signature Pk� NO:t4 LIC. NO. )«�1 Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMITTEE $ �� (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets S No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices No.l of Self Contained a Flo. of Dishwashers /Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other — No. of Dryers Heating Devices KW Local Connection 10 No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring ` ) No. Hydro Massage Tuds_ No. of Motors Total HP OTHER: 1 1 OGc,. a"A C4 -f �v� ! �^e 1 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent ®E = NO = have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER Please Specify) (Expiration Date) Estimated Value of Electrical Work$ 'V"� Work to Start r2 ' �� d Inspection Date Resquested Rough Final Signed under the QenaRies of peryury: FIRM NAME �,}-_ was fe`=��cT� �(� LIC. NO. Lkensee \'�y` �`r",� Signature Pk� NO:t4 LIC. NO. )«�1 Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMITTEE $ �� (Signature of Owner or Agent) HOR71y 3j �ee '• OL F joilogdft 9 �,SSACHUS� This certifies that Date :,% '....... . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ........ �.,:. ! ............ �~ plumbing in the buildings of ...... :.:.......................... at. ..:/........r ............ • • • • • , North Andover, Mass. Lic. No.. r.'. ,� . ....... :......................... PLUMBING INSPECTOR • Check # 1 � " a 557 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location© Z C6 New E Renovation 0 71HFL" 81Hm" t (Print or type) Installing Company Name Address 1 �'-.(t10 of Occupancy S r Replacement 0 FIXTURES M IBJ (,6\( Date--- 11 ��­ / 1 40 Permit Amount Plans Submitted Yes 0 No 0, .Z Check one: Certificate ❑ Corp. 0 Partner. pFirm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0--:�; Other type of indemnity E]Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature OwnerEl Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the :Mas!jcetts tate PIumbinde 11 Chapter 142 of the General Laws. By' igna ure o 1cense um er Title Type of Plumbing License City/TownPPROVED �oFr-rcE uss ONLY um er UUU Master Journeyman A Date ..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ........................................... has permission for gas installation ................... , ....... . in the buildings of .......................................... at ............. if` ........ ...... ........ . North Andover, Mass. Fee......... Lic. No..... ... .......................... GASINSPECTOR Check # 4, , j i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) • /ill � ��j� � MA Date ­to/ a/ 20 O'Z Receipt# Perrmit# 175 Qwnet'sName a//!/. `�C ,//s 2 Building Location<O%% Map: Lot:— Zone:_Type of Occupancy New 3 ---Renovation C2Replace nt'❑ Plans Submitted: Yes ❑ No ❑ G Installing Company Name EASTERN PROPANE & OIL, INC. Address 131 WATER S T Estimate Value of Work: Business Telephone DANVERS MA 01923 800-322-6628 Checkone: Certificate Corporation ❑ Partnership ❑ Firm / Co. Name of Licensed Plumber orGas Fitter /y%�/L� '4r-Gv INSURANCE COVERAGE: 1 have a current Iia "ty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 5--l"- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner C3 AgentO Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed underthe permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen aws.� By Type of License: Plumber Signature o 'censed Plumber or Gas Fitter Title Gas -flitter Master City /Town Journeyman APPROVED (OFFICE USE ON License Number /— Revised 0511 mom MMEM ME MEN ME! §MMMMMMMMOMEN MOM MEEMN ME MESS MENEME ONE MEMEN No ME ME MEN MEMMEMEMMEENE MEESE SEEMS so mom ME ME EME ME No ME EM ME MOM ME EMENEEMEMEN No ME EEO SENSE MOM ME ME MEMNON SEEN EMENESEENEEN ME ME EMENEEN Installing Company Name EASTERN PROPANE & OIL, INC. Address 131 WATER S T Estimate Value of Work: Business Telephone DANVERS MA 01923 800-322-6628 Checkone: Certificate Corporation ❑ Partnership ❑ Firm / Co. Name of Licensed Plumber orGas Fitter /y%�/L� '4r-Gv INSURANCE COVERAGE: 1 have a current Iia "ty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 5--l"- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner C3 AgentO Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed underthe permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen aws.� By Type of License: Plumber Signature o 'censed Plumber or Gas Fitter Title Gas -flitter Master City /Town Journeyman APPROVED (OFFICE USE ON License Number /— Revised 0511 1t� T X m 0 m N O G] m Cl) CP H cn a m n O z JL e