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Miscellaneous - 175 WEBSTER WOODS 4/30/2018
Am C1c SM CLAIMS DEPT. May 02, 2012 Ccmmerce Insurances - The Commerce Insurance CcmPdny5M Citatncn Insurance Company SM Members of The Commerce Group, Ines" 11 Gore Road, Webster, Massachusetts 01570 (508) 949-1500 www.Commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: PAUL A JALBERT / CYNTHIA A JALBERT Property Address: 175 WEBSTER WOODS LANE Policy#: TY5239 Date of Loss: 04/28/2012 File#: YVK863-WRAW23 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. DENA BRIGGS Telephone: (508)949-1500 Ext: 15389 Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15389 On this date; I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. May 02, 2012 Ccmmurc CcmpanieS .... COME GROW WITH US CIC 254 (Rev. 4/95) MAIL M47 Y Location_ No.Date N0RTM TOWN OF NORTH ANDOVER /0 9 41 Certificate of Occupancy $ �'�s'••°''�� Building/Frame Permit Fee $ J�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ A/Z Check 74 14 ' 8 J� Building Inspectdr TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: i6) C, m SIGNATURE: J vl C cq--'� Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re wired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service 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 ❑ l�45.#jNElk 3.ICcErj Licensed Construction Supervisor:nn S - X 6 7 S %l Yew; iT AL)E fJ. �}N�QyEI1. License Number Address ji ZO) Expiration Date S e Telephone 3.'2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 3 g 3 Z,1 C (sJ 1 V. IV, 1' juA c V Registration Number Address n g2.2©o;L Expiration Date Si Telephone Wo M X Z O V v (M O z M 90 O r v M Z 0 SECTION 4 WORKERS COMPENSATION (NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... Pf No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ =Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other A Specify 97 Ee(G Brief Description of Proposed Work: , /_ T To 56,11111- -Va SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be r OMCIAL.USE ONLY Com leted b rmit applicant ao (a) Building Permit Fee 1. Building Z 2,©� Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC)7 5 Fire Protection 6 Total (1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I , as Owner/Authorized Agent of subject property Hereby authorize �� G �� E. i''6� x/ /� cEN ��-0^) to act on My behalf: in all matters relative to work authorized by this building permit application. Date I JI�.l lllllll V va v ea a.�.+ --- SECTION 7b OWNER/AUTHORIZED Ac;Eiv I Llr.%..l.AXLA I ivy. ,as Owner/Authorized Agent of subject property sem_ Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Namcr Si nature of Owner/A "ent Date NO. OF STORIES SIZE BASEMENT OR SLAB ND S17.E OF FLOOR TRVMERS 1 2 3 SPAN DWENSIONS OF SILLS DIMENSIONS OF POSTS DM---NSIONS OF GIRDERS HEIGI-IT OF FOUNDATION THICKNESS SVE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND nr..nrrnrrr� •rn r.rn•rrtA nt �:eC T TNF !1 iSU ll "U11Vlt �vtvr�c�. i L:L i v ..r, . tea.. W �a a� ��� •� F FORM. U - LOT RELEASE FORM C (L �e 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�Ta I btrzTT PHONE 9 7 q- &C7, - 4 Z) b LOCATION: Assessor's Map Number SUBDIVISION STREET as- W z bsf,, w!P4, PARCEL LOT (S) ST. NUMBER 1 % J *****************************************OFFICIAL USE MEND5IONS OF TOWN AGENTS: n g, -V ,5 b- ATION ADMINISTRATOR TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED, 5<- i PA�� DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED_ SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT z RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm The Commonwealth of Massachusetts f.-4 = Department of IndustrialAccidents RIO office o//nsestigatiens ' V 7 �� 600 Washington Street '� ice= �:/ e == : M' Boston, Mass 02111 �L-L1-t�' -' Workers' Compensation Insurance Affidavit name 1C EGI� 0,0NS/ajC-t;ci#j �LG NN C `i K6En1 1 local* no Zl •/7` EGU i !/ je)-a6- city A/A &Na d Ufn d&. phone# 772 671'•5441 I am a homeowner performing all work myself. ^ 1 am a sole proprietor and have no one working in any capacity . Rw.. .a,. C'G:.3.`.t•'Y.�, ::Q,�f. r:i N..1ini. •id 1 am an employer providing workers' compensation for my employees working on this job. company name: .. address: City: phone # insurance co policy # .-T.., �,r .res,•. .�� -� -r��y'y.,+r'. .. ..•..... .. .: a.>.., .. • ... ........,...........r:7r..3f.rr...s .......... irs.«:rr<�r...rii� I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers'.compensation polices: Failure m secure coverage as required under Section 25A of 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 5100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the fns and penalties of perjury that lite information provided above is true and correct. Signature O ,t �f/ `mow 1 Date Q ~ L `b - Print name �ENu e- f� B" . _ ._.._._. phone # -7'%'? - Oro S7�o I fficial use only do not write in this area to be completed by city or town official ,..z...... ..:_...._ city or town: permit/license # r'IBuilding Department ❑Licetisingl3dard ❑ check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone t{; riOther (revised i/9S PJa) A ' • ., ... '_ �1LC �d�l/IIId'IZI d� r!�(,l6tkJCU BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR y Number: CS 058245 :, Birthdate: 03/24/1943 Expires: 03/24/2002 Tr. no; 18312 Restricted To: 00 KENNETH B KEEN 21 HEWITT AVE..r �i :�✓' N ANDOVER, AAA 01845 Administrator 13 °l2. �am,wonuealaF o`✓�liexuu�uuel� HOME IMPROVEMENT CONTRACTOR Registration: 108383 Expiration: 8/18/02 Type: 08A KEEN CONSTRUCTION CO. G�po Kenneth Keen 2 ADMINISTRATOR 1 Hewitt Ave No. Andover MA 01845 v Ll \ l ` --- ` v CA d C � — m CA n CD n Z CO) CD CL O n. C C CL y o v CD CDCL O CD CD o CD mm C CD y� CD CL O CO) cc O CD 0=3 0 0 o (� o 7 0 R. r)x Jr,- i� O x wOQ 7' G a � L7 n l< � CL R n 0 rocn cn Z 11 N° 2623 Date.zl `.. .....�......�✓....... •`.'.'�� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Iry This certifies that.-..`...:rl......!.. 11 ....................................................... �..has permission to perform ............L.• !....................................................... wiring in the building of... C..... `.`..": ......................... at/./J ..........i �..................... North Andover, Mass. Fee....! .t�� Lic. No ................. .. ':. ...................... ELECTRICALINSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer V Official Use Only Permit No. �j �o� BOARD OF FIRE PREEV NT O REGULATIONS 527 CMR 12:00 Occupancy & Fee Check6o � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 5227 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for apermit to perform the electrical work described below. Location (Street & Num % ber / 75- ii, Zkdog Zl,?- Owner or Tenant Owner's Address_ 2 6/ 5;201 Is this permit in conjunction with a building permit Yes &;I, No ❑ (Check Appropriate Box) /� Purpose of Buildings __ A @ �C Utility Authorization No.Do Existing Service Amps Voits Overhead ❑ Undgmd —❑ No. of Meters New Service ' -20a Amps G voits Overhead ❑ Undgmd t�r No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work_ No. of Lighting Outlets No. of Hot fuse Total No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of,—Receptacles Outlets. No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners No of Air Cond 9 0 Heat Total Tons Total Total FIRE ALARMS Nb. of Zone No. of Detection and Initiating Devices No. Ranges / No. of Di osal r/ No. Pumps . Tons KW No. of Sounding Devices No./ of Self Contained / No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW q Municipal ❑ Other Local Connection No. of No. of Low Voltage No. of Water Heaters KW Si ns Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equival nt YE — NO = have submitted valid proof of same to the Ofrics-YtP NO = If u have checked YES please indicate the type o coverage by checking the appropriate box. / `INSURAN — BOND = OTHER = (Pleas—ee Specify)��— G_ Estimated Value of Electrical Work$ ! f (Expiration Date) Ci — �" C.�j� Work to Start I ection Date Resquested Rough ��� Final Signed under the Penalties of perjury: FIRM NAME LIC.NO. 1 Licensee Signat r LIC. NO. Address us. Tel No.7S7 SI -5-5 Alt Tel. No. i V -.2 OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required b Massachusetts Agent Pleas g (Please heck one General Laws. And that my signature on this permit application waives this requirement. Owner A C y O p (Signature of Owner or Agent) Telephone No. PERMITTEE $39 3. Date.:. � _ G No 4.607 O.F" TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that . './. .`'.. .........../,/ ...... •�� .................. • • • • has permission to perform .../.!�.!J• -5 .............. plumbing in the buildings of ...��. �.. «� • • .. • • • • • • • • • • • • • at.%.,?.� . !! .'.6 • • • • • • • • •, North Andover, Mass. Fee..�%1.. Lic. No. .......`.t PLUMBING INSPECTOR Check # 03.) L WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building I Owner., Date_ Permit # �7 Amount t{,r Type of Occupancy • New Renovation F1 Replacement F1 Plans Submitted Yes No (Print or type) _— D, f� �. Check one: Installing Company Name s F� Corp. Address Z A4 &F40,4 Partner �.afo i !Oh O/�L1P Business Telephone Y,714 Z,96 ' 1P W577 Lj Firm/Co. 'Name of Licensed Plumber. / J A4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy a Other type of indemnity n Bond ❑ Certificate 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 r -]Agent 11 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 Massachusetts $�pte Plu ' Co e hapter 142 of the General Laws. y: ....,, -- APPROVED (OFFICE USE ONLY Type of Plumbing License /q 7.s-3 License Number Master Journeyman Er a i :\ ...---.--........O-..-... :. • nnonn■���■nnnnnnnnnnnnnnnnn ..•nennnmmmnnnnnnennnnnnnnnn MM ...... • nnnnnnn�■nnnnnnnnnnnsnnnnn ■. . .. • ■��■�■nnennnnnannnnnnnnnnnnn s•..•nnnnnnnnnnnnnnnnnnnnnnnnn . ,: .. • nnannn�■nnnnnannn�nnnnnnnn MA I: 19 IWO .. • nnnnnnnnnn�nnnnn■��nnnnnnn (Print or type) _— D, f� �. Check one: Installing Company Name s F� Corp. Address Z A4 &F40,4 Partner �.afo i !Oh O/�L1P Business Telephone Y,714 Z,96 ' 1P W577 Lj Firm/Co. 'Name of Licensed Plumber. / J A4 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy a Other type of indemnity n Bond ❑ Certificate 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 r -]Agent 11 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 Massachusetts $�pte Plu ' Co e hapter 142 of the General Laws. y: ....,, -- APPROVED (OFFICE USE ONLY Type of Plumbing License /q 7.s-3 License Number Master Journeyman Er .ATE OF USE & OCCUPANCY own of North Andover Date /a -6 D THISCERTIFIESTHAT ,TED ON o / 9? %J Wf � 6�e4 WV0dS Zai ,e— ►S //u fc F011LZ IN ACCORDANCE NS OF THE MASSACHUSETTS STATE BUILDING CODE AND ATIONS AS MAY APPLY. 4,8XMSj 3,5fa1/ 04,d"z CERTIFICATE ISSUED TO CA p �/ % °'��'6� k k ADDRESS --23I VU//l9v IS7< 501)e c? `J Building Inspector C/) m m Cf) Cl) m .. .: E v CO)CD CD O J CA .7 U3 O CA C� 0 C y i-� d n O CD a, CO) CD CO) Pp N 51 cn cn n 0 cn n �j 0 cn o. ►A1 ?SCD 0 �_ O -• eIi o Q N rn aO m y CD m n Z y m .. C �• ?�_ VJ .. CL m CD CD =r C CO) G* N ? m 0CD 2 O:O n' 7 .� d O 0 y 4 w • CD o' C yi= n,r^,. : U2 o U ®y a CD 1a® m w 3 o y 01 y y a d t Q o w y y C co m VJ y � � � O m'A��� m 'd H to wm o � o f> CO) CD st � CD z =W:` R � C., �� 0 N . t C/' o A m` 0 0 '"' o o t's, tz ' 4 d C o CL W o O r z o A M z M MCI �. M M� x M y y o o z N N -o 2665 Date....l.....��. pOR7M °�<��`° '•'"° TOWN OF NORTH ANDOVER . y ' PERMIT FOR WIRING This certifies that ........ /7..Q,?/..e..... /.. ).2°ft. ....... has permission to perform ..........5t ..< ........:''?nn.. � .......................... wiring in the building of ...... ...t�i .. . v) ....................Vass. .... a',,.... 1... Cf ...O�.:e .......:��...,.:.... , North Andover Fee . -3,1. a . Lic. No. (,�..1��. � ...........1.. r ...................... ELECTRICAL INSPECTOR Check # 447— WHITE: Applicant CANARY: Building Dept. PINK: Treasurer The Commonwealth of Ma °fife U" Only ' Massachusetts P.nmtr N.. � Dc rtrncnt o Occup& cY k C"ed PQ j Public SoJcty � 3/90 (leave bt.,,ti<) BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.00 APPLICATION FOR PERMIT.TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Mauachusetts Electrical Code, 527 ChtR 12:00 (PLEASE I?Ma IN INK OR TYPE ALL INFORH&TIOPT) Date.d r���� City or Town of Al � To the Inspector of Wires: The undersigned applies for a permit to Perform the --I, a.,..,._t.._.._,__. Location C-ner or Owner's Zs this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd � No. of Meters New Service Amps / VoltO s verTtead ❑ Undgrd ❑ No. of Metcri Number of Feeders and Ampacity Location,and'Ilature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle outlets No, Of Switch Outlets Wo. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs O=R: No. of Hot Tubs Swimming Pool Above In- f.rnd• ❑ Prnd, ❑ No. of Oil Burners No. of Gas Burners No. of Air Cond. Total tons No. of beat Total Total I um s Tons KtJ Space/Arca Beating KW Heating Devices, KW KW No, No. o Si. ns Ballasts No. of Motors Total IIP No. of Transformers Total KVA Generators KVA No. of Emergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices _ No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local❑ Municipal Connection ❑ Other Low Voltage (' _ _ / r i INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage o its substantial equivalent. YES.W NO I have submitted valid proof of same to this office. YES NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 11 BOND 11 OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ xpiraC on ate Work to Start Inspection Date Requested: Rough Final Signed under the penalties,o£ perjury: FIRM NAME- QU1 A I LTC. fl,l. Licensee�2 .�L W�'c it Signature LIC. N0. Address J L`ScXtC W. , c f� / „� ./ 6 �1(�a� uus. Tel. No. > � Alt. Te 1. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or stantial equivalent as required by Massachusetts.Genera l Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Signature oOwner or Agent Telephone No, PERMIT FEE S 4 f Location �rg-4 Ct T i � � w-Pb-�LQ WS l.�-) Date No. i i r i� - q — D c) 3 � � NORT1y TOWN OF NORTH ANDOVER 2 Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee Other Permit Fee TOTAL Check #-1 C 14041 Building Inspector AUG- 2-00 WED 12 =27 S. E. Cumm i nsis. Ass.v-G i at BS P. 02 CERT/F/ED PC0 r PLAN S.e. CIAMM OS & IIS MIA TES P,o. 8oX MY PLAISrdW,, N.M. 0386$ rpt ro�v� �eoo�-aa�►-aoea **Ak reoa)-mW-azfa �,��,+� 3�t1--s�a� `r(,wsFeiec0t 8-q-0, -qua-e- VL 1rls— IL �iVc T9s s6, ty AL AL �1ilc EDGE OF FLAGGED WEILANDS 1 I -LOT 9 E �; j 1.17 ACRES + N z 'uoa + �11lc EXISTING �OtINpAT10K M 00 51[ t My. w1,40.2' N 68:2y 'in" E WEBS TER WOODS LANE SCALE 1" = 60' ! HEREBY CERTIFY TO TOWN OF NORTH ANDOWR, MA BUILDING DEPARTMENT THA T THE EX/STING FOUNDA 77ON DRAWN ON THIS PLAN IS LOCATED AS SHOWN AND THAT lT DOES COMPLY TO TH£ MINIMUM BUILDING SETBACKS TO PROPERTY LINES. DAM. AUGUST 1, 2000 TAX MAP 109--A / LOT 9 CAMPBELL FOREST NORTH ANDOVER, MA. MINIMUM SETBACKS: FRONT -- 30 FEET S/DE -- 30 FEET REAR -- 30 FEET Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 ?l\(W\ i T NORTy O tteO � '9ti O o <OLMK wKM 1• �9SSgcHuS��Ay APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS Z75- webst-sr W oto Gail e LOT NUMBER 9 SUBDIVISION DATE REQUEST FELED / ZI/7 /0 O DATE READY FOR INSPECTION / 4�3 �06 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCV6RE DO S NOT MEET ALL APPLICABLE CODES. SIGNATURE CIAL USE ONLY ROUTING CONSERVATION DATE Xjj J PLANNING DATE D.P. W. — WATER METER 6e _ DATE Z —11— '�>tn D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRION THE INSPECTION REQUEST DATE. SIGNATURE P AUTHORIZATION Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13.54 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Mr. Kenneth, Gran&Ufa President Mesiti Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Telephone (978) .685-OSQ • Fax (978) 688-9573 '. 1 t�cws� July 14, 2000 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. GrandstafF A The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the following: I . Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system- 3. ystem3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and facii1ities in the event __-:--...._.......... that Mesiti Development or its agents fail to adequately perform maintenance of the pumping station. Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town' or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T . ours, J. Wilkin Hmurc' .E. Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of +I%,- above he above grant ofgonditional use. 3568 Date.. 2 j: f.v ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . �! . `• r ! : • '" �; has permission for gas installation ...:'1 ._,,-�............ • . in the buildings of-:: ? " .............................. at % /-) . �. ?. .e..'fir- ...... North Andover, Mass. Fees. Lic. No: ,� �`11�.. :. t/,-�-!� -? ...... GAS INSPECTOR WHI7 V TE: Applicant CANARY: Building Dept. PINK. Treasurer Y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING T ' Type or print) Date L 19 NORTH ANDOVER, MASSACHUSETTS Building Locations 5 Owner's Name New E7 Renovation ❑ Replacement ❑ Permit # Amount S r!�' Plans Submitted ❑ ;Pant or type) 4/ R k5o� �C _ /J07 (`6* /' Check one: Certificate Installing Company Vame �e �/�/ ( ❑Corp. address �T L �`5_Cl(❑ Partner. 3usiness Telephone oj— _ 81-170irm/Co. vame of Licensed Plumber or Gas Fitter T NS(iR.A-4CE COVERAGE Check one, have a current liability Insurance policy or it's substantial equivalpnt. Yes No ❑ fyou haNchecked ves, please mdi e the type coverage by'checking the appropriate box. _iability insurance policy Other type of indemnity ❑ Bond ❑ Dwner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the vlass. General Laws, and that my signature on this permit application waives this requirement. Check one: iignature of Owner or Owner's Agent Owner ❑ Agent ❑ hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the )est of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in :ompliance with all pertinent provisions of the Massachusetts State Gas C e a a e 1 I of th e • 1 Laws. Bv: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber2;�q4� "ityiTown ® Gas Fitter 717rise ivumoer [IV APPROVED (OFFICE USE ONLY) I oumeyman a' ;Pant or type) 4/ R k5o� �C _ /J07 (`6* /' Check one: Certificate Installing Company Vame �e �/�/ ( ❑Corp. address �T L �`5_Cl(❑ Partner. 3usiness Telephone oj— _ 81-170irm/Co. vame of Licensed Plumber or Gas Fitter T NS(iR.A-4CE COVERAGE Check one, have a current liability Insurance policy or it's substantial equivalpnt. Yes No ❑ fyou haNchecked ves, please mdi e the type coverage by'checking the appropriate box. _iability insurance policy Other type of indemnity ❑ Bond ❑ Dwner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the vlass. General Laws, and that my signature on this permit application waives this requirement. Check one: iignature of Owner or Owner's Agent Owner ❑ Agent ❑ hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the )est of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in :ompliance with all pertinent provisions of the Massachusetts State Gas C e a a e 1 I of th e • 1 Laws. Bv: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber2;�q4� "ityiTown ® Gas Fitter 717rise ivumoer [IV APPROVED (OFFICE USE ONLY) I oumeyman Ct , �.'� Date.i�-.... . N2 457? TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that ... ...... has permission to perform,'S! .?.� . ...................... . plumbing in the buildings of .................... at . ,�.7 �-?- -�- ��! ......North Andover, Mass. Fee, .... Lic. No.'s 9!/7. ............ . —PLUMBIIN,G SPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MAS �S �`A ^`CH ,,USETTS Building Location (�� C W&" U L," Oh' Owners Name ow Type of Occupancy Date ©U > i A Permit '?�anount Q� New Renovation Replacement Plans Submitt Yes No (Print or type)�/ ni 4 ^(` Check one: Certificate Al` Installing Company Name t 1 1 c' L Corp. Address d td - ❑ Partner. ,s Business Telephone Firm/Co. Name of.Licensed Plumber. Uttf k/A- L.L c' Insurance Coverage: Indicate the f insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 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 Massachusetts State Plumbing r 142 a eral Laws. By: 71—gl7=31Licenseariumoer Type ofP�ling License Title City/Town =cense um er Master Journeyman ILd APPROVED (OFFICE USE ONLY 11�� .r a •r WIWI io;10, (Print or type)�/ ni 4 ^(` Check one: Certificate Al` Installing Company Name t 1 1 c' L Corp. Address d td - ❑ Partner. ,s Business Telephone Firm/Co. Name of.Licensed Plumber. Uttf k/A- L.L c' Insurance Coverage: Indicate the f insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 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 Massachusetts State Plumbing r 142 a eral Laws. By: 71—gl7=31Licenseariumoer Type ofP�ling License Title City/Town =cense um er Master Journeyman ILd APPROVED (OFFICE USE ONLY 11�� No 2797 Date .... L`.... ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies ...."*.-/..................................... C/ has permission to performA .......................................................................... wiring in the building of ...... .:.................................. I................ at .-170 1 n�-✓'{—«�� f"�! North Andover, Mass. .....,...................................................... .. Fee N ............... Lic. No .%, ..7F :.......%.:r S ..' '�........................... • ELECTRICAL INSPECTOR Check # 7? WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I HE (VMMUI VWL1 LT H Ui''MA,Ji,"4(,HUSKJ IN DEPART/14E'NT OFPUBLICSAFETY BOARD OFFIREPREVENTIONREGUL 4T10N.4S270212:00 Ultice use only Permit No. % Occupancy & Fees Checked 77 APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED 1N ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 t"MR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datg� Town of North Andover The undersigned applies for a permit to perform the electrical work described below. _ Location (Street � Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [Z No 0 (Check Appropriate Box) Purpose of Building �� ��t i ,i (� ' l n jCi&Q-jam t �I A �,�j � Utility A uthorization No. Existing Service Amps�/ Volts Over'-ead Underground M No. of Meters New Service Amps 42/"jolts wb Overhead Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 4a No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total Ct Oalra KVA No. of Lighting Fixtures y Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners _ No. of Emergency Lighting Battery Units No. of Switch Outlets,. - No. of Gas Burners , \ �, '— � Gc..'� 1`hC1i� ` t �V�- CX PA V Wo FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons Iys-kVO No. of Detection anr6nt��. s No. of Disposals No. of Heat Total "Dial inniating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained _--•. No. Heatine Devicesb • Detection/Sounding Devices otryers KW OL - - t C ZSe.1/wtr�/� Local Municipal Other E3 Connections No. of Water Heaters KW . No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP --I OTHER hs wm:Co�ag Rrsu"1othemqwamtsdMasmdifdNGffnalLam Iha,,eaa atlnbhyhisLm=Pbhcymdm'irgCarpl&CmuaWcris ;alecgmalat YES NO E2 Ihmest.bnittadvandpbdbfsarnetodrOi&aYES rJ NO IfyubawdWWYES,pkasemdc&theNxcfwmaWby gti. wsURANCE M BOND OTHER ❑til( ) workoSw h> D*RaVested FW RM uxiarm R NAME �,a> apeY� \ Dale r v E'lin&dVakeduatim1waik $ ),5 Rough �Jb �\ \ (NCK\� Frol _ Lioa>SeNo fr7a= BttsirtessTel.Na • I•' 1 ly ' ' .�' b b'eI 1 1 1 r A r �• • . • ib a+. ap :•• n a . • r. �. • ; a. (Plea 7,:7gent - Location-//� No. 6 Date �A /c,2d/-ilo TOWN OR NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14428 G� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Section for 0iiicW Use BUILDING PERMIT NUMBER: DATE ISSUED: ,a , SIGNATURE: ✓ �t Building Commissi r/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel jDbQ Iq oil Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required I Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ 1 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Signature Telephone 2.2 Owner of Record: r -► I T-,:�S ().V Name Print SECTION 3 - CONSTRUCTION SERVICES I 3.1 Licensed Construction Supervisor: ` Licensed Construction Supervisor: Address 3-4L 91, Telephone 3.2 Registered Home Improvement Contractor Company Name 7,1 tl� UZ il /9 L) N� Address for Service : I -/ �L- P% ti Uoeo 4 LcL Address for Service: Not Applicable ❑ License Number 3 —ZbaZ Expiration Date Not Applicable ❑ /Ds3S3 Registration Number q - F, coz, �1 Expiration Date re Telephone M M X z O \V V v m z t SECTION 4 -WORKERS COMPENSATION (M.G.L C 152 § 2506) ed and submitted with this application. Failure to provide this a Workers Compensation Insurance affidavit must be completNi in the denial of the issuance of the building rmit- Si ned affidavit Attached Yes .......1) No.......0 SECTIONS Descri tion of Pro osed Work check an a livable ❑ Alterations(s) .� Addition ❑ New Construction ❑ Existing Building ❑ Repair(s) Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 -ESTIMATED CO ESTE a cON Cost OSTS to be Item _ .. , t_. _ __..:� ,,.,..t;,•.,. 1. Building 2 Electrical OFFICIAL USE ONLY (a) Building Permit Fee will result � Multi her n (b) Estimated Total Cost of / />f V Building Permit fee (a) x (b) 3 Plumbing 4 Mechanical (HVAC 5 Fire Protection Check Number 6 Total (1+2+3+4+5) SECTION 7a OWNER AUTHORIZATION LOBE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . as Owner/Authorized Agent of subject property to act oil Hereby authorize MN, behalf. in all matters relative to work authorized by this building pennit application. Date Si nature of O��ver ,_--- SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 4 4 c . G ,as Owner/A thorized Agent 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 -r_fiL 1.4. l�G 4 t Date ... of SV_E NO. OF STOR1ES BASEMENT OR SLAB t SIZE OF FLOOR UMBERS SPAN DIMENSIONS OF SILLS DUA NSIONS OF POSTS DMENSIONS OF GIRDERS 1tla(i11-1-01 FOUNDATION S11.E Ol, FOOTING MATERIAL OF cHNINEY IS BUILDING ON SOLID OR FILLED LAND IS 111JI1,DING C(.)NNI:CI l:D TO NATURA1, GAS LINE IT IICKNESS X 9 . The Commonwealth of Massachusetts R Department of Industrial Accidents = oficeoi/nyesftatims ;a 600 Washington Street ='l Boston, Mass. 02111 —� Workers Compensation Insurance Affidavit ;4 1)cant•in ormf'D"°`�at)on:� . - :.lease� RI . eat .w -: name: (ON.SL1C1 is ` /Lc NN_t°/h ksE�l do hereby certify under dieloins and pen allies of perjury that the information provided above is true and correct / 2 - IV •oo Print name KEA%A1 E th • iA� C ekl' official use only do not write in this area to be completed by city or town official city or town ❑ check if immediate response is required contact person: )revised J/75 NA) permit/license # nBuilding Department ❑LiceiisingSdard ❑Selectmen's Office ❑Health Department phone#; nOther • - ` x- ✓fie �anvmanuiea a`'✓�CrooacLuulelia 'a. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 Birthdate: 03/24/1943 Expires: 03/24/2002 Tr. no: 18312 Restricted To: 00 KENNETH B KEEN 21 HEWITT AVE. N ANDOVER, MA 01845 Administrator �/rQ V� ar�vaw�uuvoll� o�. iffaa�sc/ruael�'a HONE IMPROVEMENT CONTRACTOR j Registration: 108383 Expiration: 8/18/02 Type: DBA KEEN CONSTRUCTION CO. Kenneth Keen ADMINISTRATOR 21 H2MItt Ave No. Andover MR 01845 ti G A �k6 E- . I G%', IV 01- KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978)691-5201 Jalbert, Cindy & Paul Webster Woods Ln., Lot 9 N. Andover, MA 01845 Mobile Phone: (978) 852-9216 Date: 11/12/00 Contract #1541, Appendix A Remodel Basement (see attached drawing): • Frame, insulate & blueboard basement to create approx. 787 sq. ft of finished area including % bath. • Frame & blueboard ceiling of finished area just below existing steel I -beams. • Plaster veneer walls(smooth) & ceiling(sand swirl) • Supply & install one 3'0" x 6'8" smooth masonite hollow core door • Supply & install five 2'6" x 6'8" smooth masonite hollow core doors. • Supply & install one 5'0" x 6'8" smooth masonite hollow core double door unit • Supply & install 212" colonial casing around all doors and windows • Supply & install 5 %-" "speedbase" at base of all finished walls • Supply & install approx. 72 sq. yd. of carpet ($1300.00 installed allowance) • Supply & install approx. 160 sq. ft of ceramic tile in bath & entry ($435.00 tile allowance) Plumbing: • Move existing exhaust vent for water heater to facilitate ceiling height • Rough -in fixtures in % bath • Install customer supplied bath plumbing fixtures Total price: $19,5Wnineteen thousand five hundred eighty dollars) All extras to be paid in full upon ordering. Price does not include permit fees, plumbing fixtures, any electrical work, or painting. Payment schedule: $1000.00 due upon signing contract ?d akeok 4� 42 $ 5000.00 due the first day of work (plus permit fees) $ 3500.00 due after fanning is complete $ 5300.00 due alter rough plumbing, insulation & plastering is complete $ 2480.00 due at completion of work except flooring $ 2300.00 due at completion of contracted work l i st er Robert A. Keen 11 -15 - Date m m C m m Cl) m Cos CSD az CD O d .7 CL n� � O O p arcc C C .... CA CD 0 CA O O y C!� O CA am d c� CD O CD CD 3. y CD O CD 0 CD C CA s � o >• -1 O C• N OCT N = CZ O CO) =1 0 �Cl) m p m C7 Z y m .-► C �. 7D CA ? a .. a o =r oA. :rd y CD O O N p No -i ? o _ > > o CO) cc 0 ca CDN � CA H CL C/) /�m m y co O O C m p o yam. wH 0 . zcn 01 C CA C �^ -• 0 m : `CA cn H O go z b?0 ® o A ►�-� y ,� A Cn ? I A 1� v` CD y :� r w 0 7 S F CA O: n� O o n O M w G p w G r n pr ;-� O G a- ro r 71 py O G 0°. ' O G CL fD U C O O a y 7d y 7d y H ro 1 Q Q Immi 0 g. 0 c L Location / D� %-V/�� c � No. 3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ v cMust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14013 / Building'lnspector TOWN TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: C Building Commissione qn ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Lp�' 1.2 Assessors Map and Parcel Number: Signature Telephone zo 109,11 a,91 1:75— We, Y ey Lo ao-u 6.-)We Map Number Parcel Number Not Applicable ❑ p 06 o G / 02 , Zoning Information: Expiration Date 1.4 Property Dimensions: /1.3 Company Name / / 7 Zoning District Pr osed fJse I Lot Ar& (so Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 30 / 6,(", 3 t 30 1.7 Water SupplyM.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal * On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name(Prin4 Address for Service �?Z,6 $ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: � `r eq j� 5-Se°ll Licensed Construction Supervisor: _yLp ��' � / �i/: / 1. �.�✓` Address 7 '. !-:�3QO Signature Telephone evr"7FP 6 7 — -i;-7(L 0 Not Applicable ❑ p 06 o G / 02 , License Number Expiration Date 3,2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone t Ne, M X z L' a SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes ...... V No ....... ❑ SECTION 5 Description of Proposed Work check au a Ucable New Construction XExisting Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: L) I� XZ6 r;/� fia171'/ oZ•^ G 2 6U6 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building p2 60 v (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 6 D O 3 Plumbing Building Permit fee (a) X (b) �� q f- p 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 (p 0 O Check Number r SECTION 7a OWNER AUTHORIZATION 10 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER//AAUTHORIZED AGENT DECLARATION as (aer/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 l/ Print Na Signature of 0e/A e Date / NO. OF STORIES SIZE -3 )c S; BASEMENT OR SLAB SIZE OF FLOOR TIMBERS lsr % �cJOjL2 "S SPAN �Co DIMENSIONS OF SILLS DIMENSIONS OF POSTS 6S 24 DIMENSIONS OF GIRDERS 4u z z6 ' i-e_e HEIGHT OF FOUNDATION THICKNESS -6", SIZE OF FOOTING ` X MATERIAL OF CHIMNEY G cZ IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verity that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner frcm compliance with any applicable or requirements. *'APPLICANT FILLS OUT THIS APPLICANTGait ��e, LLe PHONE 667 -63nc> LOCATION: Assessor's i'vlap Number / D i PARCEL SUBDIVISION LOT (S) STREET 16dA L ST. NUMBER�zS USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED Z DATE REJECTED c COMMENTS Oro - TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPT EeOR-HEALTH DATE APPROVED L, DATE REJECTED COMMENTS p v. C WORKS - SEWER/WATER CONNECTIONS PUBLIC DRIVEWAY PERMIT FIRE DEPARTMENT 1'�to-QVAr:% hV- wireA t OoVo-deT&J-) P - RECEIVED BY BUILDING INSPECTO Revised 9\97 jm ` -- U 19UPAY 2 3 2WQ BtltlrGii�It� i TME NT DATE The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: City Phone I am a homeowner performing all work myself. I 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. Wi r.mm�anv name'0--7,,, "e' --7,nt llr�0�/ / /1�t�5� �G �����5/�. �l/ �U'✓� Address o2,31 sc, 7t 6"-7 S 1` ;2 .City- Al'lry-4 /&ilw"-Vel' /'ta, ©/Sy, Phone -#707'S) 6$7- 5.300 Insurance Co Uril led .:—,,17S Co Policd /V �'19ox yf3 yy % -oo Comoanv name: Address Citv: Phone Insurance Co. Policv m 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 51,500.00 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. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pain and penal ' s of perjury that the information provided above is true and correct. Signature / Date 5 / 3! e0 u �yj 5 57-.5 76 v Print name 17 /�ss�/% __Phoneme Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensino Building Dept ❑Check if immediate response is required p licensing Board r—, Selectman's Office Contact person: Phone: 11 Health Department 0 Other In accordance with the provi . sions of MGL -c'40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properiy licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: -9 5,V,12 1Y, hr Location of Facility Sigha6e oYPermit Applicant Ji /L�/ 6U Date 7.J. NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Growth Management Bylaw Exemption Staterrnent Town of North Andover Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant an Building Permit (below) Address of Proper~/ for Pemit (below) W4 Map and Parcel 'Purpose of Application (check below) Phone Number of 41plicant Single Family Two Family (o ss 7– ,S`3p U — 1 the undersigned applicant for the above propertty attest that the attached building permit for which this form is completed does comply with the E<EMPTiON section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me cr env party to this permit from the requirements of obtaining other permits required prior to the issuance of the _uiiding Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit iq issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with ane or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. ZThe lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of ,his Sec:icn 8.7 of the Zoning /taw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conaitions of 8.7.6.oare met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Sec ton "senior' shall mean p.ersans over the age of 55. �i This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open spaca and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit an the Parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an E<EMPTiON as cited above. Further I understand that the submittal of misleading and or inaccurate info rmatic o e checking off of an above item which does not comply, whether done to my knowiedg . or not, i groun4 for refusal by the Building Department to issue a Building Permit. ignature of wn or Aurhonzed Agent who signed the Attached Budding Permit Date This form must be attached to the Building Permit upon application for such permit ._-- - - ✓lie %arrvncaruuea�� a��-l�GlX;klO,crt-rlJeCt � ; s . OEPARTNENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: CS 06.9234 0510912000 0510911954 Restricted TO: 00 ALAN G RUSSELL 400 MIN ST- l�..... vl �iyzt✓ GROVELANO, NA 01834 I MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I MAScheck Software Version 2.01 I I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 5-23-2000 DATE OF PLANS: April 18,2000 TITLE: Lot 9 "The Lincoln" Permit # Checked by/Date PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 594 Your Home = 591 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1752 30.0 0.0 62 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1752 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 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 equipmen selec to heat or cool the building shall be no greater tha 1250 of the ign load as specified in Sections 780CMR 131 J4.4 Builder/Designer Date Z �� i MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 9 "The Lincoln" DATE: 5-23-2000 Bldg.I Dept.I Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ l I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ J I 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No i Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ l I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ l I Joints, penetrations, and all other such Openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can FROM : MCKENZIE ENGINEERING GROUP,INC PHONE NO. : 6179412662 Apr. 12 2000 12:30PM P3 - M W t tr9l•�8 PIE 6 4 9—nn r e� Q f1 C -nn / W nn Lo \ .40 U 1�� ti Q 1 - M W t tr9l•�8 PIE 6 4 9—nn r e� Q f1 C -nn / W nn Lo \ .40 FROM : MCKENZIE ENGINEERING GROUP,INC PHONE NO. : 6179412662 Apr. 12 2000 12:30PM PS 0 cagy CO 1513 APPLICATION FOR SEWER SERVICE CONNECTION 2000 North Andover, Mass. t9 Application by the undersigned is hereby made to connect with the town sewer main in subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. Owner L�'Wo ke it ��� L -Lc Contractor �A'3f-el W002 Street �r f 2°3( � "� J &i'� F—r Address Add applicant's Si re PERMIT TO CONNECT WITH SE ER MAIN The Division of Public Works hereby grants permission to rN to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by s reet— Division of Public Works By :7�U Date See back for rules and regulations e y e e A����' �i r17ic� c�� c� g tr t E APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass�9-- Application by the undersigned is hereby made to connect with the town water main in'"��7`/�✓�C'Sfrp- subject to the rules and regulations of the Division of Public Works. /r e 1 The premises are known as No. I T � f-t,c'"Z 7"/ � � �l � Street or subdivision lot no. r' Owneru,W,:) ?'jr �r L LC Address e Contractor Addres5ss �r 1/0l /Applicant's Signore----� PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to i to make a connection with the water main at'�;'r��/ p subject to the rules and regulations of the Division of Public Works. Inspected by Date MUM= �Board of Public Works By— fV See back for rules and regulations TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William IImurciak, Director Timothy J. Willett Telephone (978) 685-0.9.10 Staff Engineer Fax (978) 688-9573 Additional conditions for lot 9, Campbell Forest May 8, 2000 This Division agrees to sign the .Form U, and issue water and sewer permits, for lot 9 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for this lot so that the construction of the home can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into the residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. 2. No water service shall be installed into the residence until all off site sewer facilities are approved by this office. Any violation of the -above conditions will granted. Mesiti DevlopVent eviV' Division of b 'c Works CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin void both water and sewer connection permits. No refunds will be P�-,,s s—e—lv- rinted Name Printed Name Date -9 co Date TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 685-0950 Fax (508) 688-9573 NORTH 0 9 Qogwreo4i.vP �,�S DRIVEWAY PERMIT Date: LOCATION: 17,5 BUILDER: phone: OWNER: �� �e l�o��� phone: S7 - `5 oU The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND. OBTAIN APPROVAL VOIDS THIS PERMIT. 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