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Home My WebLink AboutMiscellaneous - 180 AMBERVILLE ROAD 4/30/2018r North Andover Board of Assessors Public Access µORTq pE ��e ••�y0 Y � Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 Forth Andover Board of Assessors. roperty Record Card Location: 180 AMBERVILLE ROAD Owner Name: DUDANI, GULSHAN Owner Address: 180 AMBERVILLE ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 0.29 acres Use Code: 101 -SNCL -FAM -RES Total Finished Area: 3912 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 638,600 609,100 Building Value: 461,000 430,200 Land Value: 177,600 178,900 Market Land Value: 177,600 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2259515&town=NandoverPubAcc 3/19/2013 M 0 N LL 0 a 0 w W J J W m Q O 'Go VJ -a C/) W U � a 0 U Q J W aQ oa a f6 O -O O y0 m F- 0 J 0 co 0 CL Q 0 to 0 0 a 0 0 N co 0 0 U r n @ t ISE 'O m C 0 03 (O ❑t�L'Qj �� CEO -a Q C7 y o o` O'L'CU.Pw0 N a' c r O O Cp A)sC O.yi CL IZ r- w awe ' Z T� _ Z N 4-. Z Z1Z H c c 'aW JJ 0 € J o o y MZ do O 0 N 0 V• , k 0 V ONQ'o cc Zoo °IO LL �� Z Z o N z o; Via) CO �LL FCD 0 'Oo a' MV A co - ° Q z�kNN Q Q �U:o� O Li a) 0) W 3 m 9 tO 1 m Wrn cD CO # a p�O co - 'V C-0, } 0 , 0) L]' E � OCDN Zj m'[L Q! �' O Up0 W; is .... m '° C �" r r;r ,. co U F -a f° -i O 3 . �° O O)�,,..; 'a( T \ m �� 70- Z r . Z i(f) ,-w U LL T OIL o, T 0'o) -r6'1=�..i J —j W M, C. i 0d -) LL CJ FT>60 w A(D 9'U a) � U) U'U U Q 3 N ` � > ;ip O U c�rQ'C iE 9 N O rO T (� EI Q y y U �] ��@ � J'� !> m U) ' LL Z (n Cn ry m 041 THIMOj. \ _E w U) c -ml amLLM y`� .IA UY�OiOw;••0f d 13 �lm�nU.a,a t9 ..i Yy c0 (0 N.. O`M )n v uiQv i m 0 rnm; T Ta 00%, 0, 'o" IM N N (�'r O m e ° dC �Ctco q () �..i SIL J a E F Q E.. a g.. ry n 1O .r v. �. ~ N W w W�CC' a o may` -' Lc�aa h LL EC�!Q CO O C' N'— �O N Sr z Z LL F,D ° ° a"c L }• a.U[0 o a) O,O LAW U �Z)<Z)-' �W>UU:do o N o .. Z W O N m N O Q o;LLW� W �x m5 v y ty IN'N .. L) (1) o LL =yam,.. N i� o Oc 0 as X10 �. c6��:�. a 2!m1°'mLPsY _ _ U' iCi co N H o Z_ O � Ix �- OWN{{9 P E O{X'c*0. � C� (A U) ." Q 1- }CO ILL 2 W CO Y W C� COQ N N J W U W = J W N J J — Q O U N'C� Q a Tr}; U' 'LL .o Q �o Z � W E� d Z = Yd) 1rHop: —lZ Q�N -A), _ a y a H _ °'( 2, a>1 H c r m m U a`) 2CDo o Zw� � c:~~ a': v I W T Z °om of 'a)9 lc Oco Y O Q c) u),� w�,� LL - z LL a Cn 0 to 0 0 a 0 0 N co 0 0 U Sdar0lity January 13th, 2017 Inspectional Services 120 Main Street North Andover MA 01845 Notice of Cancellation This letter is to certify our proposal to install Solar (PV) at the property listed below has been moved into a cancellation status. Adetunji Onamade 180 Amberville Road North Andover MA 01845 Permit #: 936-2016 & 13154-1 SolarCity Corporation and Adetunji Onamade will not be moving forward with the proposed installation. We would greatly appreciate reimbursement for the permitting fees paid. If you have any questions/concerns, please contact myself directly. Sincerely, 4 Allison K 1' a ""'0 elley Permit Coordinator T: 978-215-2383 E: Allison. kelleyCa)-solarcity.com hj bi-ss --� �5aj '-7 800 Research Drive, Wilmington, MA 01887 T (888) SOL - CITY solarcity.com AL 05500. AR M-8937. A7 ROC 243771IROC 245450. CA CSLB 888104. CO EC8041. CT HIC 0632778/ELC 0125305. DC 410514000060/ECC902585. DE 2011120386/ T1-6032. FL EC13006226. HI CT -29770. IL 15-0052. MA HIP.168572/ EL-1136MR, MO HIC 12894BAIM. NC 30801-U. NH 0347C/12523M. NJ NJHIC913VH06160600/34EB01732700. NM EE98-379590. NV NV20121135172IC2-0078648/82-0079719.OH EL.47707.OR CBIB0498/C562. PA HICPA077343. RI AC004714JReg 38313. TXTECL27006, UT 87269505501. VA ELE2705163278. VT EM -05829, WASOLARC•91901/SOLARC•905P7. Albany 439, GreeneA-486, Nassau H2409710000. Putnam PC6041, Rockland H-11864- 40-00-00. Suffolk 52057-H. Westchester WC -26088-H13. N.Y.0 #2001384-0CA SCENYC: N.Y.C. Licensed Electrician. #12610 #004485.155 Water SL 6th Fl.. Unit 10, Brooklyn. NY 11201. #2013966-0CA All loans provided by SolarCity Finance Company, LLC. CA Finance Lenders License 6054796. SolarCily Finance Company. LLC is licensed by the Delaware State Bank Commissioner to engage in business in Delaware underlicense number 019422. MD Consumer Loan Llaense 2241. NV Installment Loan License 11-11023/ 11-11024. Rhode Island Licensed Lender #20153103LL. TXRegistered Creditor 1400050963-202404. VTLender License #6766 CD 0 qq CD CD CD 0 Official Use Only Permit No. ear s: o rra arvicab Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev.1107] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12;00 (PLEASE PRINT IN IAFK OR TYPE ALL INFORAMTION) Date: �'� a 11G. City or Town of: IVOY'4h Adid OVyeff To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location (Street & Number)—J-4 Ambery e k(k Owner or Tenant— onama&j ' Telephone No. 7— — 2 Owner's Address 190 Afterville Is this permit in Conjunction with a hatildins_+ oermit? Ves No ❑ (Check Appropriate Box) Purpose of Building_ e$l I Utility Authorization No. Existing Service Amps / Volts Overhend ❑ Undgrd ❑ No. of Meters New Service Amps l Volts Overhead ❑ Undgrd ❑ No. of Meters i Number of feeders and Ampac:ity Location and: Nature of Proposed Electrical Work: install Solar Electric- Photovoltaic (PV) system [3(,] ` panels rated 1 kW (51 STC Grid Tied. In conjunction with a Building Permit Completion of tisefolloiring table mtaj, be waived bF the Inspector of Wires. No. of Recesses[ Luminaires No, of Ceil.-Susp. (Paddle) Fans No. osforrteers IC to TranNo. of Luminaire Outlets No. of blot Tubs Generators r{VA No. of Luminaires Above o In- Swimming Pool rnd. rnd ❑ o. o �nergency rg mg Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. or Vetection an InitiatingDevices No. of Ranges Total No. of Air Cond. Toros No. of AlertingDevices No. of Waste Disposers 1•leat limp Totals: Number Tons KW No. of elf- untamed Detection/Alerting Devices No. ofDishw�ashers SpacclArea Heating KV4' Mucal Local ❑ C nnec ion Ei Other No. of Dryers Heating Appliances KW ecarrty systemw No, of Devices or Equivalent No. of'ervatcrlt, Heaters o. or No. or Signs Ballasts Data Wiring: No. of Devices or T uivalent No. I3ydromassage Bathtubs No. of Motors Total RP Telecommunications Wiring: No. of Devices or Equivalent OTHER: i Attach additional detail If desired, a) -as required by tine Inspector of INire>s. Estimated Value of Electrical Mork: I ODO (When required by municipal policy.) Work to Start: ASAP Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) i cerfify, matter thepains andpenalties ofperjuiy, beat the h forrrur[lon on this uppiication is true and complete. FIRM NAME: SOIARCITY CORPORATION LIC, NO.:1136MR Licensee: MATTHEW T. MARKHA.M Signature LIC. NO.:1136MR ;tfaPpiica'' k, enter "c einpi" in the license nnmlber Tinel Bus. 'ret. No., 774-253-916D MS$. Alt. TO. No.: 774-258-8505 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" Licenso: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee doer not halve the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 'I am the (check one) Q owner 0 owner's agent. Owner/AgentPERMIT FEE. $ SignatureturaTelephone No. f1" Office oft"onsumer AlfiaiA an'd BUSilICSS Regulation 10 Park, Plaza •- Suite 5170 Boston, NftissachWsettS 02 ] 16 florae Improvement Contr(eictor Repistration Repistratioa 168572 Type: Supplement Card t_ xp iration: 3/8/2017 SOLAR CITY COFtRQRA'i ION MATT MARKHAM 3055 CLEARVIEW WAY SAN MATED, CA 94402 Update Address and return card.1.1ark reason for change, Address Renewal Fmplo�vment Host Curd .R ��r. (, rd.,....,.. .fir>i ,��€•.Tt. ltiv hv'� Office ofCoasumer Alfirbx e4 Businew: Red;oiusion I •icense or registration i;did Cur isrdividd nese only ' U.HOME IMPROVEMENT CONTRACTOR before the expiration date. If found eeturn to: Office of Consumer Affairs and Business Regulation � Rogivrotion: 10572 Typo: 10 Park PLnn - Suite 5170 E:xttirdttt'rrt: ;;Ir?nr7 Supplement Card Boston, VIA 021116 MATT MAIU'l „gid 24 ST MARTINSIkLLi 131LD2UN1 UALBOROUGH, MA 01757. 1�nterseattsn — Ze9 valid vaitEtout signature E1.F(TRILIANS ISSUEti THE. M IJiWING LICENSE AS A• REGI `'1 CIiC:I.1 MASTER FLEGT-R l i:. -I AN � !s±�I..GftCi"I'Y {:i?kl'tiT2A`1lnk ��rd rlAs 'HFW T nA XHAM ""AINT MARTIN OR � �i I'fI [fC UN 11 ': i AARI KDidOUC i KA 0I 1521. The Commonwealth of Nessach usd es Department of IndrlrstrialAccidents Djke of Invesdga6fis I Congress Stree4 Suite 100 ' Foston, ISA 02114.207 Imm mass govIdia Workers' Compensation Insurance Affidavitc Buiide rs/ContractordElectricians/Plumbers A leant Ilitformattaan please Print Legibly Nand+`(ButiuesdOrganization/Fndividual): SolarCity Corp. Address: 3055 Clearview Way P.bone #: 888-765-2489 Are you an employer? Check the appropriate box. 1. 0 arts a employer with 5,000 4. D 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ i arts a sole proprietor or partner.- listed on the attached sheet. ship and have no employees working for ire in any capacity. tWo-workers' comp, insumce regtdred.j 3. ❑ I air a homMmer doing all work rayb'eii: [flu workers' comp. insurance required) t These subcontractors have employees and have workers' comp. insuranto 5.0 We are a corpora on and its officers have ext:raiwd their ri& iii exealp`duit gal iriitGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): b. n New construction 7. (] Remodeling R. 0 Demolition 9. Q Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions I2.0 Roof repairs 13EPther Solar/PV *Any applicant that checksbox N t must also, rill out the section below showing their wa t o, compcasatian potlay informistion. i biomcawncrs who submit this affidavit indicating they are doing all work and then hirpatusidt conuacwrs mast submit a new affidavit indicating such. tContrretm that check (his box must anaehed wt additional sheat showing the name of the subcontractors and state whether or not thnso entities have employees. if the sub-eontraclors have t ntployces, they must provide their workers' comp policy number. 441#1 all employer Chert is provNina workers' coaapensalioel insurwtee for my employees. Belong Is fits policy anti jah site informations. Insurance Company Name: Zurich American Insurance Company Policy -9 or Sclr-ins. IUc. #: WC0182015-00 Expiration Date: 9/11 /2016 Job Site A,ddrass: 1 �kiberVi Ile RJ City/State/Zip: Q r t lover /SIA AORt±h a copy of the workers' cormpemsatimn polity decloration page (showing the policy number and expiration date). Failure ro secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of ceaninal penaltics of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the forrti of a STOP WORK ORDER and a fine of tip to $250.00-a day against the violator. Be advised that a copy of this statement maybe forwarded_ to the Office of Investigations of the DIA for insurance coverage verification. I do hereby vert J& un er file parirts atld pettaftes of periury that Ilse aaeforrtlatlon protlided above is true and correct. Phi' U, f,{tr iul WC orsly. DO Ml wrke & Citic area, to he cautpfeted l y lily or taw`. ofT1cial. City or grown: PsrmisfLiegitse i Issuing Authur'tty (circle oae): 1. Roars of H hh 2. d3andi:a M craze ?, ri Orc_eaw. Qp: L 3; g.1-o-imb.i s rrcrwnfty Contact Person: Phone #; AH CERTIFICATE OF LIABILITY INSURANCE C R PAT {MM10DlY1'YYj E CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY 09i'171201s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder 1s an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in Lieu of such endorsement(s). PRODUCER CONTACT MARSH RISK& INSURANCE SERVICES RHONE-. ......... . FAX 345 CALIFORNIA STREET, SUITE 1300 .1AI4.N4. Exl1:..., _..._ ....._ _... _......... .. .......i (A!C Nol..................................... CALIFORNIA LICENSE NO, 0437153 I_ -MAIL SAN FRANCISCO, Ch 94104 T ............ . _...._.._.. AMON Atn; Shannon INSURERjSj AFFORDING CQVERAf3E, NAIC # ?98301•STND-GAWUE-15.16 INSURER A; Zurich American Insurance Company 115535 INSURED INSURER D: NIA NIA SolarCity Corporation - t- 3055 0earview Way INSURER C.: NIA !NIA San Mateo, CA 94402 .zNsulxER,o c American Zurich Nsurance Company 40142 GENT AGGREGATE LIMIT APPLIES PER INSURER E.:.. _... _ 6,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: SFA -002713836.08 REVISION NUMBERA THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _...... ..._ _-.. _T...— ............. _._..._....... .. ........ ADPL.SUBR'POLICY INSR - ..._...... _........._.__ ...._ ._.. ...._...._... IN LTR TYPE OF INSURRNCE POLICY NUMBER MVIDD Y MM7D 1 LIMITS A X commERCIALGENBRALLIABILITY IGLOO182016-00 09101!2015 0910112016 G EACH OCCURRENCE S 3,000,000 CLAIMS MADE X OCCUR P oacu grrca� $, _ 3,000,QQO .I M SES LEa ... ..............._ _-- X SIR: $250,000 , I MEO EAP (Any one person) S 5,900 '.. .............. ...... ..... .... _..._.. .... ..... ... PERSONAL&ADV INJURY rtS 3,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE = $ 6,000,000 .... , PRO. X PCLICYFr I JECT i.... LOC ; PRODUCTS -COMPIOPAGG `. $ 6,000,000 - i ? OTHER • $ A ; AUTOMOaILE LIABILITY SAP0182017.00 :0910112015 0910112016 COMBINED NNOLEL MIT $ tf a acddenll...... .5.000.00 X • ANY AUTO BODILY INJURY (Per person) ': $ ALL OWNEDSCHEDULHO X ; AUTOS X AUTOS 1 ..... .. BODILY INJURY IPer accidenl); S ............_._ X HIRED AUTOS NON -OWNED AUTOS P _.... ,.......... PROPERTYDAM%iGE S (Per lI ... ;.. F.X. a accider ........... .....j.. ........._.. _......_....._ '. COMP/COLL DEQ: -$ $5,000 +. UMBRELLALIAB `'OCCUR '• � ` � !EACH OCCURRENCE ' $ j PXCESSLUIB ': CLAIMS MADE ! AGGREGATE $ OEC RETENTIONS i $ D ':WORKERSCOMFENSATlON `. ?0000182014-00(AOS) ;0910112015 ;0910112016 PER I ; OTH- ; i AND EMPLOYERS' LIABILITY A Y I N i 'WC0182015-� PRDPRIETORIPARTNERIEXECUTIVE ice) i F_x. .09101PL015 0910112016 1000 000 ,ANY N� NIAj EACH ACCIDENT :. fE:�.-----_.._.............. .....j? .._ , . ......... :OF FICEWMEMSEREXCLUDEO7 (Mandatoryin NH) WC DEDUCTIBLE! $500,000 N . E,L DISEASE -EA EMPLOYE ' S _ .............. .. .. ... . 1,000,000 yes, describe ander DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT I S 1.000,000 i i i DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space Is requTledl Evidence of insurance. SolarUty Corporation 3055 Gearview Way San Mateo, CA 99402 ACORD 26 (2014101) SHOULD ANY OF THE ABOVE OF -SCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR ,RED REPRESENTATIVE or Marsh Risk & Insurance Services Charles Marmolejo 01888-2014 ACORD CORPORATION. All rights reserved. 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Sc - - �-/- 0NORTH 0 TOWN OF NORTH ANDOVER .0 0. PERMIT FOR PLUMBING SACKUS This certifies that—. ...... .. ........... ...... has permission to perfor .................... plumbing in thebuildingsof .4 .e ....... at. /j ...... /4, -North Andover, Mass. Feel�� ... Lic. No......X PLUMBING'IWSPECTOR Check # (ki • �; 3�1 R MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location l Owners N 1-2/ _� Tvoe of Occun TION FOR PERMIT TO DO PLUMBING Date �'p� 0 ` D C� Permit #� 7 / J , Amount 7 New � Renovation Replacement1:1 Plans Submitted Yes 11No ❑ (Print or type) Check one: Certificate Installing Company Name �� C orp �j Address Partner. Business Tee one l p Firm/Co. Name of Licensed Plumber: 10surance Coverage: Indicate the ty of ieWrance 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 threeinsurance Signature Owner Agent ri I hereby certify that all of the details and information I have submitted (or entered) in above i , tion are true and accurate to the best of my knowledge and that all plumbing work and installations performed unde t for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumb / a r 142 of'the General Laws. By: igna re 01 Licensedum er Title Type of Plumbing License City/Town icense um ei MasterJourneyman El (oF> u USE oNLY fir' `4 i il.---�...�--....-..-...- ■ D ....-..---.M....�..==1WN= IMP/i��F,M W NNW��J�� MANPJPA..M. ...m--.--�.-�- OMM ..MM.M..-..M.... W IN =111-11arfolummmmmmmm MM =M WIN t # 1 M' ......N....W.-..-..--�.-. 1.M .---..-.....MMMMOMW.-- -� i 1ME ®.®.-.......M...O.. (Print or type) Check one: Certificate Installing Company Name �� C orp �j Address Partner. Business Tee one l p Firm/Co. Name of Licensed Plumber: 10surance Coverage: Indicate the ty of ieWrance 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 threeinsurance Signature Owner Agent ri I hereby certify that all of the details and information I have submitted (or entered) in above i , tion are true and accurate to the best of my knowledge and that all plumbing work and installations performed unde t for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumb / a r 142 of'the General Laws. By: igna re 01 Licensedum er Title Type of Plumbing License City/Town icense um ei MasterJourneyman El (oF> u USE oNLY fir' `4 Location 0 q I � !$C) `(, Pal No. J act Date Ib -31-0-3 NORTH TOWN OF NORTH ANDOVER i • OL Certificate of Occupancy $ ..— '^° • E<�' Building/Frame Permit Fee $ s•►cMus _ Foundation Permit Fee $ Q 0 Other Permit Fee $ _ TOTAL $ Check # '16857C�-�-- Building Inspector L TOWN OF NORTH ANDOVER BUILDING DEPARTMENT PYI.ICA'TION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING - , —BUEDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: Building Commissioner/Inspeci6i of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: . 1.2 Assessors Map and Parcel Number60 r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: C Goran is2rid )ropoiwuse I Lot area Fronts a 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Re aired Provide Required I Provided Required Provided 1 i I.7Warer SppplyUG.L.C.40. 34) I.S. F1na3ZooeInrocmation: Public �/ Ptivara ❑ -Zone Outsida Flood ae VI/ 1.8 Sew geDisposalSystem Municipal Oa Site Disposal System 0 SECTION 2 - PROPERTY OWNERSIDPJAUTHORIZED AGENT 2.1 Owe of Record /^ VE. 1�77,A YN jotk _s'04UC= Name (print) i Address for Service: 1 01772. ;Signature Telephone I 2 2 Owner of Record: Name Print Address for Service: Si natLre Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 ,Supervisor: I, /_5 11 _ -, Construction Supervisor: ( t622,5961-- Licensed �-License Number Addres Cl2 -- - d �z___ Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Compitny Name Registration Number Address Expiration Date _ Signature Telephone NW SECTION d - WORKERS COMPENSATION (M C_Y._ C 152 is 2K�•r�� Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result ,n the ,Tenial of the issuau,:e of the building parmit. Sl Wined atfl,dava Attached Yes .......❑ No... .... 0 SECTIONS Descri tion ofProposed Work (Check- an licable ) New Construction �C Existing Building 0 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. l] Demolition ❑ Other ❑ Specify Brief 1)Cscription of Proposed Work: SECTION G - ESTINYATED CONSTRUCTION COSTS tem Estunated Cost (Dollar) to be OFFICIAI, USE ONLY. Cott leted by pennit applicant I. Buildino c 7/7- (a) Btulding Permit Fee ` Multi lier Electrical �O© (b) Estimated Total Cost of Constniction Plumbing Building Permit fee (a) x (b) -I lvlech:mical (HVAC) 1p© �� Q S Fire Protection d�J 6 Total 1-?+;+ +51 Check Number SECTION 7a OWNER AUTHORIZATION TOB , COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Ownei/Authorized Agent of subject property Horeb autlaori« to act on Nl'r behalf, ut all matters relative to ivork authorized by this building perniit application. lJllaillrc; of l)R rlcr Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1•/Dzi 0 11 /S5 in _Sf/ ,as Owner/Authorized Agent of sul?ject property Hereby declare that tlne stateinents and information on the foregoing application are trite and accurate, to the best of any knowledge and behcl r l'rillt Name L-111-03 � _ D3 -- �ienantre of Ovmer/�Wth i Date Ems A11:11i NO. OF STO1IES SIZE I3.\SI:1` SEMEN f OPS SI kB .� av d m S1:� E OFFLOOR LOOR TIT` BERS 1 ' / 3 S.P: L� DIMENSIONS OF SILLS DINILNSIONS OF POSTS 4X L4 51NI .NSIONS OF GIRDERS / RYK111T OF 1'OUNDATION 710)" THICKNESS SIZE 01. 1.00 CINCI c2pil X P- ?vt__t rERral. OF C1111NANEY cle, Y C 1S I3[III-DING ON SOLID OR FILLED LAND IS 11T !II DING CONNECTED TO NATURAL GAS LINE Q j FORM - U - LOT RELEASE FORM a:� - S TRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Deparonents having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements, iRn..n............■...........a■....Er ......... �............■... lD°L.I.CANT /-- 1112 #amen YE. PHONE ASSESSORS :"YtAP NUMBER �%� LOT NUMBER - StJEDIVtSiON yiew F.Sg _LOT NUMBER, 71 f ,f STREET� iYl Vi' {...1...:. R STREET NUMBER gO 1 R H a 01 A . . tl......................................... . . • .. . . . . . . .. . . . . . . . . . . . . OFFICIAL USE ONLY ... '. " ... R a .... "............................................. w RECOMMENDATIONS OF TOWN AGENTS """""'"'""' .......................... s ............................. DATE APPROVED f0 / O -CONSERVATION �.Dty[MS TOR DATE REJECTED Mon 1 N"�05' ,�.� �T EDATG rlI'f'ROVED %QST . 1 4 2003 DATE U--11CTED c0Nf? NITS NORTH ANDOVER • EPNRTMENT DATE APPROVED PL DISPc DATL REJECTED DATE APPROVED SEPTTC Ii`iSPECTOR - HEALTH DATE REJECTED - C Pr_'D�.UC wORKS - SFWER 1 WjA TEA CONNECTTONS� j DUVEVAY PERtmrT -30 _o DATE APPROVED s— DATE REJECTED UECET,TED BY BULLDiNG INSPECTOR DATE i v ; « .20 Fl VIARCHIONDPI&ASSOCIATES 781 438 X65.4 C � / i, 7 CFzz 165 F - 170x5 i 16 j 2, r,7 TD THIS PLO PLAN ti `t Itl7r1F t;.1FPG ATi(7N -%RVES THE RI(4HT TO MAKE FIELD ANCES ;;a LW<Cas. TO nCAW.VE f- RttM SITE DRAINAGE, ULET �1f3ACN REQUIREMENTS, AVOID LEDGE OR r , (LC:wdkAtlDATF TsdE C(ASTRUCTICN OF THE HOME IN THE MOST OPTIIAUM WAY, THESE FIELD A')JJS7Adkyd LL+;Y OE MftOL W:1NfNJT CrNSui I-ATION WITH THE BUYER IN ORDS TD DCPEDITF 1e4E CaNSTItUCT10N OF THE HOME, PROPOSED SITE PLAN s_{;T 71.A FOREST MFW ESTATES NOR -111 ANDOVER, MA PREPARED FOR (-U, ,t: jjoMF CORP. OF NEW ENGLAND 2c)7 7uMPIKE ROAD — %AlE 200 :4SUiW"CWGM, MASSACHUSEM 01772 r,7.n^..rc.7s.w MARCHIONDA & As"SOC-L R ENGINEEiBNG ANO MMNa4G CGNSUL'Ch;T 3 02 mmTVALE AVE. SUIT I STDNEHAM. MA. 021HO (701) 538-6121 SCALE: t'Q2D' DATE: S/url/c:� ...__,... W 17-1 x8 I f � a J.i _ L 171x5 f j 2, r,7 TD THIS PLO PLAN ti `t Itl7r1F t;.1FPG ATi(7N -%RVES THE RI(4HT TO MAKE FIELD ANCES ;;a LW<Cas. TO nCAW.VE f- RttM SITE DRAINAGE, ULET �1f3ACN REQUIREMENTS, AVOID LEDGE OR r , (LC:wdkAtlDATF TsdE C(ASTRUCTICN OF THE HOME IN THE MOST OPTIIAUM WAY, THESE FIELD A')JJS7Adkyd LL+;Y OE MftOL W:1NfNJT CrNSui I-ATION WITH THE BUYER IN ORDS TD DCPEDITF 1e4E CaNSTItUCT10N OF THE HOME, PROPOSED SITE PLAN s_{;T 71.A FOREST MFW ESTATES NOR -111 ANDOVER, MA PREPARED FOR (-U, ,t: jjoMF CORP. OF NEW ENGLAND 2c)7 7uMPIKE ROAD — %AlE 200 :4SUiW"CWGM, MASSACHUSEM 01772 r,7.n^..rc.7s.w MARCHIONDA & As"SOC-L R ENGINEEiBNG ANO MMNa4G CGNSUL'Ch;T 3 02 mmTVALE AVE. SUIT I STDNEHAM. MA. 021HO (701) 538-6121 SCALE: t'Q2D' DATE: S/url/c:� ...__,... Management Bylaw Exemption Statement A;_ i catttrtdodet wilding DepatZmertt 'Pii,:j jciryn 3naa fret used to assist the Building (Department in their determination of exemptions under section 8.7.6 of the w „tit o,North Andevmf Grown, Management Bylaw, The building applicant shall pmvide.all of the necessari iniormation .,s r+uxttleEXr�rtl Geiaw. . ,':,un%zi t<fApplicant on Suiiding Permit (below) Address of property for•Femit (telow) 6111A116 Nl�up 411d Farcel : P rposZ of?pplication (check belowj- i'f�7crn Number of Appiicmnt jr_oe Single Family _ Two Family I ttx undersigned appiicant for 4a, above property attest That the attached building permit for which this .Qrrl7 tu. camptetad dotes comply with tate E:KZMP'IION Section 8.7.6 of the North Andover Growth ii,latrtag.mm*nt Bylaw, I also understand providing this form does not absolve me or any Parry to this permit to tarn the mquiremems of obtaining other permits required prior to the issuance of the Suilding Permit, t=14iview I urtdatm;nd Oil my interpretation of -the e: ENIPTION status is subject 'La review by the Building �,ela iar%rnernt and is only offtrally a=& -hied when the Building Permit ig issued. aas 4 on sactian VA of the Norm Andover Growth Bylaw the above lot and the worst as applied ror on the itov�^ tai, in the buildlns. permit application and associated attachments, complies with one or more of the ia�listvritlg sections as indicated bya cheat mark Tbia ix an apptfcstian for a building permit for the enlargement. restoration, or rewnstruc: ion of a dwelling in :a:.t�.azancs ax of the erfecove date of this by -taw, prnvidad that no additional residential unit is cremad. 1 -iia lots) werwwxs ceaord prior to May 6, 1Sid are exempt from the provisions of this SeGion 9.7 of the Zoning IaYiNEsr, 'This appWCaUan is for awetlrng units ror low and/or moderate income families or Individuals, where all of the ccaiaitiona of 8,1,6.sAa* m met andlor mpnserim Oweil(ng units far senior residents, where occupanci of the units Is r"u'iecetd to senior persons through a properly executed and retarded deed restriction running with the land. For :27: of tnia Secdan aienitar' ihall mean persona aver the age application is a part of it develapmarit prvioz whlch voluntarily agreed to a minimum 40% permanent reoucium in oaruity, (buildable lots), below the density, (buildable lots), permuted undarzoning and feasible given the dnvimrtrnental cmndttlona of the treat, with the surplva land equal to at::least ten buildable acres and permanently ae:ugarated as open spa= andlWanniand. The land to be preserved shall be protected from development by an .;"gr1QWJtVra4 Immservation gaatncs;on, CGnSerV"Qn RestriGlon, dedltuitien to the Town, ar other similar mechanism approved 1;ly the Ptanning 8aard that will ensure Its protection. -Mix appd aUan represents a tray of land existingg and not held by a (Developer In common ownership with an ciaQwt•parcal fhc on the ative data of this SeGlon 8,7 shall receive a one-time exemption from the Planned Growth R=C Aact Oerelapmant Scheduling provisions for the purpose of constructting one single family dwelling unit on the iaart» i. This xppiicarion repcescnta a lot which is ready for building pormlts, (Le, all other permits from all ocher boards and att�titissiona have been racaived and the prefect is in compliance with those permits), and the Development Schedule -isms oat acrrnmmadats issuing a building permit In that Year, ane building permit will ba issued per Year per C*wtiopment until such time as the Development Schedule saraommodatas issuing building permits. Applicant must :tacraraly ai*rov4W form U with this E<SMPTICN, Flftrts+e provide any and ail information that would assist the 8uiiding Oepartment in making a determination' th;ai yractr° appiioaon Is allowed one or more of the above EXEMPTIONS. L, signing u tiove I attest to Via accuracy of the information provided and that the attached building permit is atl+ow.ad an E<EMPTION as cited above, Further ( understand that the submittal of misleading and or n:c rr«eza inT ion. or the cher ting off of an above it which does not comply, whether done to my naaieo5r�u nor, grounds for weal by Me ildin epartment to issue a Building Permit. f, ;Harare or wncr or Aumom_ne Agent Who sr the Attacriad 8uiloing Permit Oate hens rprm Muer ba 3IT'ach6d co the Building Permit upon application for such permit `J . Jft� �i7orr�ircc��rcuecz� a�`.••/�izd;lrcc/r BOARD OF BUILDING REGULATIONS 91 License: CONSTRUCTION SUPERVISOR Number. CS 077396 Birthdate: 03/02/1962 t`.,. Expires: 03/02/2004 Tr. no: 77396 Restricted To: 00 DAVID M STILSON 222 SEAMES DR MANCHESTER, NH 03103 Administrator DUILDING 17EPARTMENIT DEBRIS DISPOSAL FORIvf Irl accordance with the provisions of MGL c 40 S 54, a condition of Building permi� defined by NIGL c 11, S 150A — 15 drat the dcbrss resulung form this work shall be disposed of in a t Nwnber properly licensed solid waste sposal facility as The debris Njil be disposed of in: S Location of Facility SignatuAfrnut Applicant Date `e Buuilding inspector Demolition permit the Budding the Town of North Andover must be obtained for this project through the CTfacc of numlt UUHY; 1 401 739 6457; Aug -6-01 4:52PM; Page 1/1 CERTIFICATE OF INSURANCE ISSUE DATE: 816/01 THIS CERTIFICATE IS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Huila Home Corporation of NE 205 Nafiane Road, Suite 211 COMPANIES AFFORDINO COVERAGE Warwick, RI 02886 COMPANY A Pacific Employers Insurance Company COMPANY B Legion Insurance Company WORKER'S COMPENSATION and WLR C4 3091748 COMPANY C rn� iso n nr n _ COMPANY D Ace American Insurance Company THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EFFECTIVE EXPIRATION TYPE OF INSURANCE POLICY NUMBER GATE ' DATE LIMITS GENERAL LIABILITY ----- •-•—....__. _ COMMERCIAL GENERAL LIABILITY GL4-0292043 GENERAL AGGREGATE $15,000,000 511101 ON AN OCCURRENCE BASIS 511/02 I PRODUCTS-COMP/OPAGG. $15,000,000 � __ PERSONAL &ADV. INJURY $15,000,000 ADDITIONAL INSURED: I EACH OCCURRENCE $15,000,000 FIRE DAMAGE (Any one fire) $1,000,000 MED. EXPENSE (Anyone person) $5,000 — ,..._ AUTOMOBILE - •--• -• __ _ COLLISION DEDUCTIBLE LOSS PAYEE: I COMPREHENSIVE DEDUCTIBLE _CAL HO 7681773 I COMBINED SINGLE LIABILITY LIMIT $1,000,000 ADDITIONAL- INSURED: 511101 I 5/1102 I (Owned. Hired & Non -awned) I EXCESS LIABILITY - - i i EACH OCCURRENCE i AGGREGATE WORKER'S COMPENSATION and WLR C4 3091748 511101 5/1/02 EMPLOYERS' LIABILITY STATUTORY LIMITS I....................... MA, NV, SCF C4 3091815 EACH ACCIDENT............................................................... 5/1/01 $1,000,000 i 511/02 I DISEASE -POLICY LIMIT $1,000, 000 i — -- — __....... PROPERTY DISEASE -EACH EMPLOYEE _._ __. _...._... $1,000,000 � """' ' LOSS PAYFE: I ( REAL AND PERSONAL PROPERTY, INCLUDING WHILE IN COURSE OF CONSTRUCTION: -- -- --.. _ PER OCCURRENCE LIMIT MORTGAGEE: SPECIAL FORM (INCLUDING FLOOD AND EARTHQUAKE) DEDUCTIBt.F PER OCCURRENCE OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES Residendal construction, North Andover, MA Town of North Andover 27 Chafles Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WE WILL ENDEAVOR TO MAIL &Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. REPRESENTATIVE J__�)A � %��^� The C0mmQ0Wealth of Massachusetts Department of Jndustnal Accidents Qfrlce of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print �m a homeot�vner performing all work myself, — PhQrl =1 am a sole proprietor and have no one working in any capacity Xempl� i a;n an oyer providing workers' cQrnpensetlon for my employees'rking an thi$ lob fess rz' Phone mnEutjnce Co Fs to sura coverage 3s regtkrm under SeCtion 25A ar MGL 752 Can lead to the fm asltlan d -,va a. Ana }Vua' impnscrwnartt as well as cM penalties in the form of a STOP WOW{ ORDtcR ertd a a ofpS100 C��O as dans up to S1,5Gb.pJ unaersr xlG toot a copy or this sc>i�neni rn� y be far hw�rded to the Office of lnrestlgattdna ar the OIA for co y a8'l^4i m4. I � rage �[U'Fticapon. �� 7� nycvfy unlcY Ina pains anU penafa'es of perjury that the irrfcvrnefran pmviciYd above is truo and cn?e9Ct. SI5naiu7 e_ Pri n;ajn Phone # use aniy do not vrnte in this area to be completed by city or lawn Official, JC:% �fmm�ui�ra,rsK:uoiTrequir� Building Qept Q Budding D, -,Qt ❑ Lico/7-Sing Board 0 Selectman's Offica phone Cl Health Departme,w Other Seal: By: HP LaserJet 3100; 13034798572; Sep -12-03 11:23AM; Page 2 Permit Number 1' RESchec4. omflliance Certificate Checked By/Date 1995 ME REScheckSof e Version 3.5 Release lb Data filename Ji lfileslCST1SHARE\MecCheck\ModelEnergyCode1MASCHECK1Lot 71fv,rck TITLE. Lot 4 Wellington. Elevation # 1 CITY: Northover STATE: ivlass ' usetts HDD: 6322 CONSTRUCtON TYPE: Single Family DATE: 091121 PROJECT INIF RMATION: Forest View, i {{ North Andovet,', A. rC1N4PANY LN„ ORMATION: Pulte Homes c>kf L LLC I NOTES: Customer pur .'. ed elevation 1 I with flonda room, 2 walkout b-tys(front), 2 itional windowa palladium feature wuidow elev. and R-15 wait*11ation. i r; COMPLLANC� ;Passes Maximum UA1* 6604 >'cttr Home U ^` 604 0.0% Better T aft Code (UA) Gross Glazing Area or Cavity Cont. or Poor j' Perimeter R -Value R -Value U -Factor iJA Ceiling 1: FlatjCtlilirtg or Scisaur Truss Ceiling 2: FlatEgeiling or Scissor Truss Ceiling 3: Cath ral Ceiting (no attic) Wall 1: Wood F acne, 16" o.c. Wall 2: Woo&F"ame, 16" ox. Wali 3: Wood %me, 16" o. c. 4Ya114: M'00A*me, 16"o.c. %V11 Woodi ame, 16"o.c. Wall 6: WoodtItame, 16" ox. Wall 7: Wood f me, 16" ox. Window- 283 U. 'Vuiyl Frame, I )uuble Panc with Low -E Window: 285 INinyl Frame, Double Pane with Low -E Window: 204&.: Vinyl Frame, Double Pane with Low -E Window: 6-M48 slider: Vinyl Frame, Ikuble Pane with Low -E Window: 285', �: Vinyl Franc, Doubir Pane with Low -E 1216 38.0 0.0 36 660 38,0 0.0 20 280 38.0 0.0 8 576 15.0 0.0 44 396 15.0 0.0 30 576 15.0 0.0 44 576 15.0 6.0 44 120 15.0 0.0 9 120 15.0 0.0 9 1080 15.0 0.0 28 11 0.340 4 72 0.340 25 19 0.340 6 39 0.300 12 284 0.340 97 I Sent By: HP LaserJet 3100; 13034798572; Sep -12-03 11:23A1t1; Page 3 Window; ?86 ,' inyl Frame, DUllble Pane with [,ow -E 120 0.340 41 Wbtdow: 186 iN inyl Ftame, Double Pane with Low -E 46 0.340 16 Window: 3 10':Vinyl Fratne, Doubk: Pane with Low -E 49 0,340 17 Window: P59tS fixed circle to Vinyl Fnme ;Ii 10,11ble, Pane will, Low -E 30 0.340 10 2-8x6-8 servi6p oor: Solid 18 0.180 3 Door: 3.0xb-8i'" 2 sidelights: Solid 33 0.280 9 Floor 1: All -WO Joist/Truss, (Ivor Unconditioned Space 1216 21.0 0.0 54 Floor 2: All- Joist/Truss.. cwcr Unconditioned Space 429 21.0 0.0 19 Floor 3: All Joist/Truss; Ovor Unconditioned Space 242 21.0 0.0 11 Floor 4: All- d Joist/Truss, Ovcr lhiconditioned Space 240 30.0 0.0 8 Furnace 1: For Hot Air, 81,5 AI )P COMPLIANCE, STATPMkN'I : The proposed building design described here is consistent with the building plans, specifications, and other talc !I ibons submitted %� ith rhe permit application. The proposed building has been designed to meet the 1995 MEC requirements `S check Version 3.5 Rclease I b (formerly MECchec4 and to comply with the mandatory requirements listed in the RLS check ection C c.kli liuilder,'Desigr [late � �" 0 f; 'a `:I I Sent By: HP LaserJet 3100; L 75 v Q 13034798572; Sep -12-03 11:23AM; Page 4/e III M I. 11 �eea Page 4/e erJ et 3100; ;I 13034798572; Sep -12-03 11:23AM; O .a E d U c3 o N a c a m Cl G G .y ® � N L 8&88880 cacoca000 h ni 0 GhhNN U N M to !LY r N O n ;aZobb0o T x _ C w h M cV IN 0 J U U U U U U U �,dovcccio z E w - E y E E E E Q O O O Q O .. C•-NM�U']cDn000J0 NM V u')[D Page 5/B 9 erJet 3100; E.'. -I 13034798572; Sep -12-03 11:24AM; Page 618 By: HP La: O O O I` �J erJet 3100; E.'. -I 13034798572; Sep -12-03 11:24AM; Page 618 E 14 O O O O O O O C C w sJ W W t w t w g W s W g W A W 8 J Jq Jp J J J Q yy q tJ�y 2 O o 0 fi 0 0 0 0 0 ca w o00000'0 h- N 1t O V J 0) --- H� Of., c0�N pM V"iN N r qq G1 C2 Opt WQD09h.-C' li CCYVV, '' u7 CO x _ nr r to r r� n C N 7 Cf 0 C >> > � �- T �Qoc�oon©o �" Gi Ai N N tU tV O y E E E E E E E 2 � LL LL LL LL LL lL lL U. a n a� E � a _ w � �n�tn(0(D8 0 NN fbNC14 J r N M O r„ N C7 E 14 13034798572; Sep -12-03 11:24AM; Page 7/8 IMME NONE MEMO ME mmmmom Page 7/8 Sent By: He LaserJet \ a 310C; � \ � r � ( � { 13034798572; Sep -12 })} � \ � } d< d} � \ } a { 5 { £ } � i b 1 � \ f � ° EE() §kkk } 0000 � 1 � 0 @@2@ \ � \/\ kNwN� _Q @7�N� : { a m j\ o � � \ , q � � \ \\\\� � � \ � r x T/ :\2n � } �� SSSS ƒ) E E ( 0 m 0 m �{ 7772 /7. \\ 7777\ i\ ƒ\ (\b( T 0Q k4\0 �\} \ 7777 i» �i m\ -oa 11:24&% Rage eZe \ \ ) Forest View Estates Drawing Date:10/01/03 10/ 1/03 15:51 HYDRAULIC DESIGN INFORMATION SHEET Job Name: Forest View Estates Location: Lot #71 - 180 Amberville Road N. Andover, MA Drawing Date: 10/01/03 Contractor: Superior Plumbing, Inc. 89 Sanderson Avenue Dedham, MA Designer: WCD Calculated By:SprinkCALC CSC Systems & Design Construction: Combustible Reviewing Authorities:Fire Department SYSTEM DESIGN Code:NFPA Hazard:13D Remote Area Number: 2 Telephone:(781) 461-1541 Occupancy:Residential System Type:WET Area of Sprinkler Operation sq ftl Sprinkler or Nozzle Density (gpm/sq ft) 0.100 1 Make:VIC Model:V2720 Area per Sprinkler 200 sq ftl Orifice:7/16 K -Factor: 4.20 Hose Allowance Inside 0 gpm Temperature Rating:155 Hose Allowance Outside 100 gpm CALCULATION SUMMARY 1 Flowing Outlets gpm Required: 123.0 psi Required: 63.3 @ Source WATER SUPPLY Water Flow Test I Pump Data I Tank or Reservoir Date of Test I Rated Capacity 0 gpm I Capacity 0 gal Static Pressure 100.0 psi I Rated Pressure 0.0 psi I Elevation 0 Residual Pres 78.0 psi Elevation 0 1 At a Flow of 1540 gpm Make: Well Elevation 0" Model: Proof Flow 0 gpm Location: Lot #65 Source of Information: F&W Partnership - Methuen, MA SYSTEM VOLUME 29 Gallons Notes: Single Head Calculation forest View Estates Drawing Date:10101103 10/ 1/03 15:51 HYDRAULIC CALCULATION DETAILS HYDRAULIC FLOW LOSS QTY DESCRIPTION LENGTH C ID gpm psi TOTALS Hydr Ref W Required at.Hyd Area 2 23 44.2 psi 1 1-�" x 1'14" CPVC Reducer 2' 120 1.610 23 0.1 1 Pipe 11�" 40x21 CSC 0' 120 1.610 23 0.0 0 1'-�" Thrd 90 Ell CI 0' 120 1.610 23 0.0 1 11-�" Thrd 90 Ell CI 4' 120 1.610 23 0.1 Elevation Change 710" 3.0 1 11-�" Thrd Globe Valve CSC "F15" 0' 0 1.610 23 0.0 1 11-�" Fingd Back Flow Valve Watts "70 0' 0 1.610 23 0.0 1 1;-�" Thrd Gate Valve Kennedy 0' 120 1.610 23 0.0 1 11-�" Thrd 90 Ell CI 4' 120 1.610 23 0.1 Fixed Flow Flow Loss 100 gpm 1 Pipe 11-�" PVx15 CSC 50' 150 1.602 123 15.8 Hydr Ref Rl Required at Source 123 63.3 psi Water Source100.0 psi static, 78.0 psi residual @ 1540 gpm 123 gpm 99.8 psi SAFETY PRESSURE 36.5 psi Available Pressure of 99.8 psi Exceeds Required Pressure of 63.3 psi This is a safety margin of 36.5 psi or 37 % of Supply Maximum Water Velocity is 7.7 fps Forest View Estates Drawing Date:10101103 10/ 1/03 15:51 LEGEND i I HYD REF Hydraulic reference. Refer to accompanying flow diagram. _ K FACTOR Flow factor for open head or path where Flow (gpm) = K x -\/P SIZE Nominal size of pipe. ID Actual internal diameter of pipe C Hazen Williams pipe roughness factor TYPE Type or schedule of pipe # FITS number of fittings as follows: 90 - 90 deg Ell 45 - 45 deg Ell T - Tee LT - Long Turn 90 Ell SPEC - Fitting other than above or fitting with hydraulic equivalent length specified by manufacturer. Pt Total pressure (psi) at fitting Pf Friction loss (psi) to fitting where Pf = 1 x 4.52 x (Q/C)^1.85 / ID^4.87 Pe Pressure due to change in elevation where Pe = 0.433 x change in elevation Pv Velocity pressure (psi) where Pv = 0.001123 x Q^2/ID^4 Pn Normal pressure (psi) where Pn = Pt - Pv Pdrop Pressure loss in pipe rise or drop to an open head. Phead Pressure at an open head. ELEV elevation from branch tee to open head. PIPE pipe length from branch tee to open head. FITS fitting equivalent length from branch tee to open head. NOTES: - Pressures are balanced to 0.001 gpm. Pressures are listed to 0.01 psi. Addition may vary by 0.01 psi due to accumulation of round off. - Calculations conform to NFPA 13 edition. - Velocity Pressures are not considered in these Calculations - Path #1 is from the most remote head back to the water source. - Later Paths are from the next most remote head back to previously defined paths forest View Estates Drawing Date:10/01/03 10/ 1/03 15:51 REMOTE AREA #2 PAGE 1 FLOW # OF LENGTH PRESSURE BRANCH LINE (GPM) PIPE FITS FEET SUMMARY TO HEAD HYD REF OUTLET SIZE 90 45 PIPE VELOCITY Pt Pt Pn ELEV ID T LT FITTINGS LOSS PSI/FT Pf Pv Pdrop PIPE K FACTOR PIPE C TYPE OTHER TOTAL ELEVATION Pe Pn Phead FITS PATH 1 FROM HYDRAULIC REFERENCE 3 TO W (PRIMARY PATH) HEAD 3 23.0 1" 1 0 914" 7.7 fps 30.0 30.0 0.12 gpm/sq ft 1.109" 2 0 1210" 0.129 2.7 0.0 K= 4.20 23.0 120 PV 0 2114" 813" 3.6 30.0 REF Al 1'4" 0 0 111" 4.8 fps 36.3 1.400" 0 0 0" 0.027 0.0 23.0 150 PV 0 111" 0" 0.0 REF A2 1�44" 0 0 10'11" 4.8 fps 36.4 1.400" 0 0 0" 0.027 0.3 23.0 150 PV 0 10'11" 0" 0.0 REF A3 1;"" 0 0 1'5" 4.8 fps 36.7 1.400" 0 0 0" 0.027 0.0 23.0 150 PV 0 115" 0" 0.0 REF A4 11'4" 3 0 68'9" 4.8 fps 36.7 1.400" 3 0 2710" 0.027 2.6 23.0 150 PV 0 9519" 1113" 4.9 REF W 23.0 gpm PATH 1 K= 3.46 44.2 psi w v O � p(LW) mYLL0) L o p(nHco EE a� a a oo T 0 (n a rn 0.0)0- M rnaM M LO N CD T M N 7 O 3 PD aa �cn m 0 �aF-cn _E N '� a warn 000 oao'T or�LO T a) tn O N N O O N � J fn a a o v, 3 (0 O N N O � L NQQN w02 � 00 T _O i o(j) T !n O J2 m )LL -J C 25 OiO O N o `-, N T T T E Q tm 3 O E C Lr 0 0 O LO M fl. a 0 0 M O LO N 0 0 N O LO N T O O O T L E a 0 25 OiO O N o `-, N T T T E Q tm 3 O E Forest View Estates Drawing Date:10/01/03 10/ 1/03 15:57 HYDRAULIC DESIGN INFORMATION SHEET Job Name: Forest View Estates Location: Lot #71 - 180 Amberville Road N. Andover, MA Drawing Date: 10/01/03 Contractor: Superior Plumbing, Inc. 89 Sanderson Avenue Dedham, MA Designer: WCD Calculated By:SprinkCALC CSC Systems & Design Construction: Combustible Reviewing Authorities:Fire Department YSTEM DESIGN Code:NFPA Hazard:13D Remote Area Number: 3 Telephone:(781) 461-1541 Occupancy:Residential System Type:WET Area of Sprinkler Operation Test sq ft1 Sprinkler or Nozzle Density (gpm/sq ft) 0.100 1 Make:VIC Model:V2720 Area per Sprinkler 200 sq ft1 Orifice:7/16 K -Factor: 4.20 Hose Allowance Inside 0 gpm I Temperature Rating:155 Hose Allowance Outside 100 gpm I I CALCULATION SUMMARY 2 Flowing Outlets gpm Required: 146.3 psi Required: 77.1 @ Source WATER SUPPLY Water Flow Test I Pump Data I Tank or Reservoir Date of Test I Rated Capacity 0 gpm I Capacity 0 gal Static Pressure 100.0 psi I Rated Pressure 0.0 psi I Elevation 0 Residual Pres 78.0 psi I Elevation 0 I At a Flow of 1540 gpm I Make: I Well Elevation 0" I Model: I Proof Flow 0 gpm Location: Lot #65 Source of Information: F&W Partnership - Methuen, MA SYSTEM VOLUME 29 Gallons Notes: Two Head Calculation Forest view Estates Drawing Date:10/01/03 10/ 1/03 15:57 HYDRAULIC CALCULATION DETAILS HYDRAULIC FLOW LOSS QTY DESCRIPTION LENGTH C ID gpm psi TOTALS Hydr Ref W Required at Hyd Area 3 46 51.2 psi 1 11,�" x 1'V" CPVC Reducer 2' 120 1.610 46 0.2 1 Pipe 11-�" 40x21 CSC 0' 120 1.610 46 0.0 0 1;.�" Thrd 90 Ell CI 0' 120 1.610 46 0.0 1 11-�" Thrd 90 Ell CI 4' 120 1.610 46 0.4 Elevation Change 710" 3.0 1 11�" Thrd Globe Valve CSC "F15" 0' 0 1.610 46 0.0 1 11-�" Fingd Back Flow Valve Watts "70 0' 0 1.610 46 0.0 1 11-�" Thrd Gate Valve Kennedy 0' 120 1.610 46 0.0 1 11,�" Thrd 90 Ell CI 4' 120 1.610 46 0.4 Fixed Flow Flow Loss 100 gpm 1 Pipe 11,�" PVx15 CSC 50' 150 1.602 146 21.7 Hydr Ref Rl Required at Source 146 77.1 psi Water Source100.0 psi static, 78.0 psi residual @ 1540 gpm 146 gpm 99.7 psi SAFETY PRESSURE 22.7 psi Available Pressure of 99.7 psi Exceeds Required Pressure of 77.1 psi This is a safety margin of 22.7 psi or 23 % of Supply Maximum Water Velocity is 9.7 fps Forest View Estates Drawing Date:10101103 10/ 1/03 15:57 LEGEND HYD REF Hydraulic reference. Refer to accompanying flow diagram. _ K FACTOR Flow factor for open head or path where Flow (gpm) = K x -\/P SIZE Nominal size of pipe. ID Actual internal diameter of pipe C Hazen Williams pipe roughness factor TYPE Type or schedule of pipe # FITS number of fittings as follows: 90 - 90 deg Ell 45 - 45 deg Ell T - Tee LT - Long Turn 90 Ell SPEC - Fitting other than above or fitting with hydraulic equivalent length specified by manufacturer. Pt Total pressure (psi) at fitting Pf Friction loss (psi) to fitting where Pf = 1 x 4.52 x (Q/C)^1.85 / ID^4.87 Pe Pressure due to change in elevation where Pe = 0.433 x change in elevation Pv Velocity pressure (psi) where Pv = 0.001123 x Q^2/ID^4 Pn Normal pressure (psi) where Pn = Pt - Pv Pdrop Pressure loss in pipe rise or drop to an open head. Phead Pressure at an open head. ELEV elevation from branch tee to open head. PIPE pipe length from branch tee to open head. FITS fitting equivalent length from branch tee to open head. NOTES: - Pressures are balanced to 0.001 gpm. Pressures are listed to 0.01 psi. Addition may vary by 0.01 psi due to accumulation of round off. - Calculations conform to NFPA 13 edition. - Velocity Pressures are not considered in these Calculations - Path #1 is from the most remote head back to the water source. - Later Paths are from the next most remote head back to previously defined paths forest View Estates Drawing Date:10/01/03 10/ 1/03 15:57 REMOTE AREA #3 PAGE 1 FLOW # OF LENGTH PRESSURE BRANCH LINE (GPM) PIPE FITS FEET SUMMARY TO HEAD HYD REF OUTLET SIZE 90 45 PIPE VELOCITY Pt Pt Pn ELEV ID T LT FITTINGS LOSS PSI/FT Pf Pv Pdrop PIPE K FACTOR PIPE C TYPE OTHER TOTAL ELEVATION Pe Pn Phead FITS PATH 1 FROM HYDRAULIC REFERENCE 3 TO W (PRIMARY PATH) HEAD 3 23.0 1" 1 0 9'4" 7.7 fps 30.0 30.0 0.12 gpm/sq ft 1.109" 2 0 1210" 0.129 2.7 0.0 K= 4.20 23.0 120 PV 0 2114" 813" 3.6 30.0 REF Al 119" 0 0 11111 4.8 fps 36.3 1.400" 0 0 0" 0.027 0.0 23.0 150 PV 0 1'1" 0" 0.0 REF A2 1'14" 0 0 10'11" 4.8 fps 36.4 1.400" 0 0 0" 0.027 0.3 23.0 150 PV 0 10'11" 0" 0.0 REF A3 23.3 1k" 0 0 1'5" 9.7 fps 36.7 PATH 2 1.400" 0 0 0" 0.100 0.1 K= 3.84 46.3 150 PV 0 115" 0" 0.0 REF A4 11,4" 3 0 6819" 9.7 fps 36.8 1.400" 3 0 2710" 0.100 9.5 46.3 150 PV 0 9519" 1113" 4.9 REF W 46.3 gpm PATH 1 K= 6.46 51.2 psi PATH 2 FROM HYDRAULIC REFERENCE 4 TO A3 HEAD 4 23.3 1" 2 0 9'4" 7.8 fps 30.7 30.7 0.12 gpm/sq ft 1.109" 1 0 910" 0.131 2.4 0.0 K= 4.20 23.3 120 PV 0 1814" 813" 3.6 30.7 REF A3 23.3 gpm PATH 2 K= 3.84 36.7 psi w v O r' L qr I M W M M L. V 0 L Q >1 0 0NF' E E d Q Q V � � i°oo T Nor O N =SO _ E.- .N a- N 0.0)0- T CD N rnaT(pN r- T N N jLL d CD N O N �a-f-cn _ E N Q anrn 000 oti°°v LO T ^` W LO L O N L J N d U a O 7 *, y w (u N p N v m O N N co E co Q Q M WOE is CO L a) T N �( > o(D T in�co a)*Q E w)(iJZw I s O LO IT O 0 It O O M O LO N 0 0 N Q 7 O N O L E Q. rn 0 T T No 0 0 0 � No I s O LO IT O 0 It O O M O LO N 0 0 N Forest View Estates Drawing Date:10/01/03 10/ 1/03 15:47 HYDRAULIC DESIGN INFORMATION SHEET Job Name: Forest View Estates Location: Lot #71 - 180 Amberville Road N. Andover, MA Drawing Date: 10/01/03 Contractor: Superior Plumbing, Inc. 89 Sanderson Avenue Dedham, MA Designer: WCD Calculated By:SprinkCALC CSC Systems & Design Construction: Combustible Reviewing Authorities:Fire Department SYSTEM DESIGN Code:NFPA Hazard:13D Remote Area Number: 1 Telephone:(781) 461-1541 Occupancy:Residential System Type:WET Area of Sprinkler Operation I sq ft1 Sprinkler or Nozzle Density (gpm/sq ft) 0.100 1 Make:VIC Model:V3610 Area per Sprinkler 190 sq ftl Orifice:1/2 K -Factor: 5.60 Hose Allowance Inside 0 gpm I Temperature Rating:155 Hose Allowance Outside 100 gpm I 1 CALCULATION SUMMARY 2 Flowing Outlets gpm Required: 161.6 psi Required: 83.2 @ Source WATER SUPPLY Water Flow Test I Pump Data I Tank or Reservoir Date of Test 1 Rated Capacity 0 gpm 1 Capacity 0 gal Static Pressute 100.0 psi I Rated Pressure 0.0 psi I Elevation 0 Residual Pres 78.0 psi 1 Elevation 0 1 At a Flow of 1540 gpm 1 Make: 1 Well Elevation 0" 1 Model: 1 Proof Flow 0 gpm Location: Lot #65 Source of Information: F&W Partnership - Methuen, MA SYSTEM VOLUME 29 Gallons Notes: Garage calculation Forest View Estates Drawing Date:10/01/03 10/ 1/03 15:47 HYDRAULIC CALCULATION DETAILS HYDRAULIC FLOW LOSS QTY DESCRIPTION LENGTH C ID gpm psi TOTALS Hydr Ref W Required at Hyd Area 1 62 52.2 psi 1 11�" x 1�-4" CPVC Reducer 2' 120 1.610 62 0.4 1 Pipe 11-�" 40x21 CSC 0' 120 1.610 62 0.0 0 1'-�" Thrd 90 Ell CI 0' 120 1.610 62 0.0 1 l'W' Thrd 90 Ell CI 4' 120 1.610 62 0.7 Elevation Change 7'0" 3.0 1 11-�" Thrd Globe Valve CSC "F15" 0' 0 1.610 62 0.0 1 14-�" Fingd Back Flow Valve Watts "70 0' 0 1.610 62 0.0 1 11W" Thrd Gate Valve Kennedy 0' 120 1.610 62 0.0 1 1'-�" Thrd 90 Ell CI 4' 120 1.610 62 0.7 Fixed Flow Flow Loss 100 gpm 1 Pipe 1'W" PVx15 CSC 50' 150 1.602 162 26.1 Hydr Ref R1 Required at Source 162 83.2 psi Water Source100.0 psi static, 78.0 psi residual @ 1540 gpm 162 gpm 99.7 psi SAFETY PRESSURE 16.5 psi Available Pressure of 99.7 psi Exceeds Required Pressure of 83.2 psi This is a safety margin of 16.5 psi or 17 % of Supply Maximum Water Velocity is 13.0 fps forest View Estates Drawing Date:10/01/03 10/ 1/03 15:47 V HYD REF Hydraulic reference. Refer to accompanying flow diagram. K FACTOR Flow factor for open head or path where Flow (gpm) = K x -\/P SIZE Nominal size of pipe. ID Actual internal diameter of pipe C Hazen Williams pipe roughness factor TYPE Type or schedule of pipe # FITS number of fittings as follows: 90 - 90 deg Ell 45 - 45 deg Ell T - Tee LT - Long Turn 90 Ell SPEC - Fitting other than above or fitting with hydraulic equivalent length specified by manufacturer. Pt Total pressure (psi) at fitting Pf Friction loss (psi) to fitting where Pf = 1 x 4.52 x (Q/C)^1.85 / ID^4.87 Pe Pressure due to change in elevation where Pe = 0.433 x change in elevation Pv Velocity pressure (psi) where Pv = 0.001123 x Q^2/ID^4 Fn Normal pressure (psi) where Pn = Pt - Pv Pdrop Pressure loss in pipe rise or drop to an open head. Phead Pressure at an open head. ELEV elevation from branch tee to open head. PIPE pipe length from branch tee to open head. FITS fitting equivalent length from branch tee to open head. NOTES: - Pressures are balanced to 0.001 gpm. Pressures are listed to 0.01 psi. Addition may vary by 0.01 psi due to accumulation of round off. - Calculations conform to NFPA 13 edition. - Velocity Pressures are not considered in these Calculations - Path #1 is from the most remote head back to the water source. - Later Paths are from the next most remote head back to previously defined paths forest View Estates Drawing Date:10/01/03 10/ 1/03 15:47 REMOTE AREA #1 TO W (PRIMARY PATH) 0 0 1'5" PAGE 1 FLOW # OF LENGTH PRESSURE BRANCH LINE (GPM) PIPE FITS FEET SUMMARY TO HEAD HYD REF OUTLET SIZE 90 45 PIPE VELOCITY Pt Pt Pn ELEV K= 5.60 30.7 ID T LT FITTINGS LOSS PSI/FT Pf Pv Pdrop PIPE K FACTOR PIPE C TYPE OTHER TOTAL ELEVATION Pe Pn Phead FITS PATH 1 FROM HYDRAULIC REFERENCE 1 TO W (PRIMARY PATH) 0 0 1'5" 6.5 fps 31.0 1.400" 0 HEAD 1 30.7 1:�44" 0 0 417" 6.5 fps 30.0 30.0 0.16 gpm/sq ft 1.400" 1 0 6'0" 0.047 0.5 0.0 K= 5.60 30.7 150 PV 13.0 fps 0 1017" 0" 0.0 30.0 0 2710" 0.169 16.2 K= 5.55 61.6 150 PV REF A2 1''4" 0 0 10'11" 6.5 fps 30.5 1.400" 0 0 0" 0.047 0.5 30.7 150 PV 0 10'11" 0" 0.0 REF A3 1144" 0 0 1'5" 6.5 fps 31.0 1.400" 0 0 0" 0.047 0.1 30.7 150 PV 0 115" 0" 0.0 REF A4 31.0 11'4" 3 0 68'9" 13.0 fps 31.1 PATH 2 1.400" 3 0 2710" 0.169 16.2 K= 5.55 61.6 150 PV 0 9519" 11'3" 4.9 REF W 61.6 gpm PATH 1 K= 8.53 52.2 psi PATH 2 FROM HYDRAULIC REFERENCE 2 TO A4 HEAD 2 31.0 11-4" 0 0 4'7" 6.5 fps 30.6 30.6 0.16 gpm/sq ft 1.400" 1 0 61 0" 0.047 0.5 0.0 K= 5.60 31.0 150 PV 0 1017" 0" 0.0 30.6 REF A4 31.0 gpm PATH 2 K= 5.55 31.1 psi V0 CL 0) 0) M 0 0 0 T O Q O (n U) O(Am ME 0 _ E ._ Q Q D) Q N N LO (M (0 (p co ^T` W L 00 0 `� `�FQ d N O N _ E 5 'w a an.rn O O O O C6,1 O r - T N N u3i 7 O cn J N d C O 7 0.9:2 3 i cacyo(D0CU 3�aLL a co O Of (D Y U) < < wo2� OD ' N TID Q > O O S Q E nU--j Of O O LO O LO Iq °. tm LO 3 M O O O M O LO N O O N O LO T O O T LL 040 EO O Vv N a y — N in O t Q. O O O O LO O LO Iq °. tm LO 3 M O O O M O LO N O O N O LO T O O T LL 040 EO O Vv N a y — O O LO O LO Iq °. tm LO 3 M O O O M O LO N O O N O LO T O O T LL Ila r.0LIEII- A c JunaxaUri HiX NU, yt64(b6103 Its,. n:` -02 FORM I LOT RELEASE The un.dersiped, being a majority of the Plamling Board of the Town of North Ajidover, Massachusetts, hereby certify that: ;.t_ The zequircmerits for the construction of ways and municipal, services called f4 -r the Performance Bond or Surety and dated March 4, 2003 an&or by t:hc Covenant dated November 9, 1998 and recorded in District Deeds, Boob 5247, Page 76; or registered in'i/A Lard. Registry District as Document No. N/A and noted on, Certificate of Title No. N/A in Registration Book N/A, Page Nr/A; Lvi.s bcetx completed/partially completed,, to the satisfaction of the Plazming i3oar�. to adequately sme the enumerated lots shown ort die following Plans: - Lots 67A, ,68A. ff9A, ,-70 X, 71 A. and! l2A as shown on a plan of land entitled. �41'1a2� of Land, Forest View Estates, North Andover, MA, prepared for Pahin NoTr Corp, of New England, 257 Turnpike Road, Southborough, Massachusetts 01772.,'. drawn by Marchionda & Associates, L:.P., dated April 14, 2000Scale 1 „=40', Recorded with the Esse,. North District Registry of Deeds as .P)a* Nutnber 13761; and Lots 23, 24, ?S, 26, 27, and 18 as shown on a plan of land entitled "Dertitzye Subdivision .Jams for Forest View Subdivision, P Oute 114iS.alcrta Tumpilm North .Andover, Massachusetts" prepared for Mesial Development -' Corporation, l l Old Boston Road, Tewksbury, Massachusetts 01 r/ 6 by NI;1J-9 Z Design Consultants, Locus Map Scale 1°'=600% Tax Map Composite SMaIC77 1 "'=2-00%dated September 22, 1997, revised through 11/3/98, an recorded with il,- Essex North District Registry of Deeds as Plaza Number 13362 and as affected by corrective Plan Recorded as Plan, Number 13727, r an.d. said lots are b,ezeby released from the resnict:ion as to sale and buildin R A�.,��" '? -specified. thereon.. The lots designated on said Plans which are the subject of this Lot Release; are as follows. (Lot Number (s) and strect(s)) Lots 67A, 68A, 69A, 700.71A. and 72,x, as shown on a plan of land. erti�jcd "Flan of Land, Forest View ,Estates, Nom Andovcr, M. A,., Prepared for PWte .jozne, C-o�. of New England, 257 Turnpike Road. Southborough, Massachusetts 017 72", drawnby Marchionda & Associate -s, L.P., dated A.pnil 1.4, 2400, gceje :.� 7 y C':�l'ult�l±p!• �'�,�r2gr. K'V�1=nrnz ],Cert [ic;leas: _dor, iC�; i 1. 1'•!U ),I jNfV,':) M is."11L I'LiVIK,& N JUHN,WI f AX NO, 97847H703 1 "^10', Recorded with rhe Essex North. District Registry of Deeds as P1 -Zn dumber 1-376 It; and Lots 23, 24, 25, 26, 27, and 28 as shown on a plan of land entitled "Definitive Subdivision Plans for Forest View Subdivision, Route 114/Salem Tumpike, Forth Andover, Massachusetts" prepared for Mesiti Developrruml Corporation, 11 Old Boston Road, Tewksbuznr, Massachusetts 018716 by MIT - Design, Consultants, Locus Map Scale V=600', Tax Map Composite Scale" 17'=200',dated September 22, 1997, revised through 11/3/98, and recorded with the Essex, Worth District Registry of Deeds as plan Dumber 133612 and as affected by corroctiire Plan Recorded as Plan Number 13727. b. (To be attested by a Registered Land Suxvcyor) Lets 67A, 68A, 69,x., 70A., 71A and 72A as shown on, a plan of land entitled "Plan of Laaad, Forest View Estares, North Andover, MA., Prepared for Pulte Home Corp. of New England, 257 Turnpike Road, Southborough, Massachusetts 01772.", drawn by Mambionda & Associates, L,P,, dated April 14, 2000, Siz;ale 1. "=40', Recorded viih the Essex North District Registry of Deeds as 'lar. I*Tumber 13761-, :md Lots 23, 24, 25, 26, 27, and 28 as shown on a plan of land entitled. "Definitive Subdivision Plans for Forest View Subdivision,, Route 714/Sa.lem Tumpike, North Andover, Mass4achusetts" prepared for Mesiti Developmcnt Corporation, 11 Old Boston Road, Tewksbury, Massachusetts 01576 by N1714P Design Consultants, Locus Map Scale 1"=600', Tax Map Composite Scam,', 1."=200',dated September 22, 1997, revised tbsough 11,/3198, and. recorded With the Esse: North. District Registry of Deeds as Flan Number 1.3362 and as affec"�ad by coxreclive flan 1R.ecor6ed as Plan Nwnber 13727 � a T", do d o confoxnn to layout as shown on the above refere ted Plans. R.egister'ed Land Surveyor 1 C. `1.e Town of North Andover, a municipal corporation situated in. the. County of Essex;, Commonwealth of Massachusetts, acting by its di-alyl organized .Planning Board, holder of a Perfonnance Bond or SureNy dated. March 4, 2003, and/or Covenant dated November 9. 1999, from. N'lesitlR Moore'sFall, LLC of the i,ity/Town of North Andover, Essex County, -Massacbusetta recorded with the Essex Month District Registry of Drseds, 6':\Pulte\1et twItU$G FV\PQT J -Lo{ Rghp ic,00 ._ . .. • + • �. nn in,nF M vvnnl lv✓L1 !A0 )X-1 , IW -41 JIJ f Uv i\��`r _ — __ — UIt Boob 5247, Page 76, or registered in Land Registry District as Documut No. NI; �. and noted on Certificate of Title No. Irl'/.A., in Registration Book N/A, Page N/A, ackno,,vledges satisf-action of the terms thereof ani. brr(,�-by releases its right, title and itzterest in the lots desiggiated above on sss.d plans as follomts: Lotis 67A, 68A., 69A., 70A, 71A. and 72A, as shown on a plan of land entiti.cd "Plan of Laud., Forest View tstates, North Andover, M.A, Prep=d. for Pulte Horne Corp_ of New Englund. 257 T=pike Road, Southborough, Massachusetts 01772"', drawn by Marchionda & Associates, L.F., dyed. .AFpnl 14,20 ' 00, Scale !"=40% No 0% Recorded with the Essex rEh Disf� t registry of eeds. as Plan Number 13761; and Lots 23, 24, 25, 26, 27, and 28 as shown on a. pian of laud entitled "Definitive Subdivision Plans for Forest View Subdivision, Route 114/Salem Tumgike. North. An•dom, Massachusetts" preparedfor Mr-siti. Development Corporation, 11 Old Boston Road, Tewksbury, N1assachusctt�. 01876 by MHF Desip Con.sultmits;, Lacus Map Scale 1."-1600=, Tax Map Composite Scalc" F =200 %dated Septembcr 22, 19977 revised through 11/3/9$, and recorded with the Essex Forth District Registry of Deeds is Plan Number 13362 and as affected by com.etive Plan Recorded as .Plan Number 13727. F-X.ECtJTED as a .scaled instnurtcnt this 8th day of A�aril, 2003. ti Majority of tla� �'" PlanningBo1,0�di` of the To%.,n, of North Andover C:`I!'ulta 10( r-Imfia FvTorm J -ins PclasrA)r, �!QIA)k L., 4' A PI U L I L 4 J COMMONWEALTH OF MASSACHUSETTS ,A,pjl 8, 2003 I Them personally appeared w. I one of the above meml-� ts, of tic Pjaming B=d of the Town of'NoTth Andover, Massachuserts and acknowledged the foregoing iiistmment to be the ;dee aCT and deed of said Pluvudng Board, before me, otarvy, My commission. Expires, ReromST virw!Porm 3 LMT Rcl"c CAPiAmN)ot rricase rVkFami J -1-v RvIowe,doc 4 ES940K LAWRERM- MASS, , D1.1rPUR, Y:4. " Bond # 929262655 h Aggregate Limit $ FORM F PERFORMANCE BOND AGREEMENT NORTH ANDOVER PLANNING BOARD AGREEMENT made in consideration of approval of the within subdivision by the Planning Board and the acceptance of the security bond on this day of September, 2002 by and between the Town of North Andover, a municipal corporation acting through its Planning Board and Pulte Home Corporation of New England having a usual place of business at 257 Turnpike Road, Suite 200, Southborough, MA 01772 hereinafter referred to as the "Applicant" and "Owner" owner of the land shown on the following plans: Lots 12A, 75A,116A; 77A, 78A and -79A as shown on a plan of land entitled "Plan of Land, Forest View Estates, North Andover,�MA; Prepared for Pulte Home Corp. of New England, 257 Turnpike Road, Southborough, Massachusetts 01772", drawn by Marchionda & Associates, L.P., dated April 14, 2000, Scale 1 "=40', Recorded with the Essex North District Registry of Deeds as Plan Number 13761; and Lots,13_ t :7-5 16'17"U as shown on a plan of land entitled "Definitive Subdivision Plans for Forest View Subdivision, Route 114/Salem Turnpike, North Andover, Massachusetts" prepared for Mesiti Development Corporation, 11 Old Boston Road, Tewksbury, Massachusetts 01876 by MHF Design Consultants, Locus Map Scale 1"=600', Tax Map Composite Scale" 1"=200',dated September 22, 1997, revised through 11/3/98, and recorded with the Essex North District Registry of Deeds as Plan Number 13362 and as affected by corrective Plan Recorded as VPlan Number 13727. for title to the property see deed from Mesiti-Moore's Fall, LLC to Pulte Home Corporation of New England dated June 28, 2000 recorded at the Essex North District Registry of Deeds at Book 5793, page 267, and deed from Moore's Fall Corporation to Mesiti-Moore's Fall, LLC dated November 6, 1997 recorded at the Essex North District Registry of Deeds at Book 4886, page 292 and deed from David White to Mesiti-Moore's Fall, LLC dated April 30, 1998 and recorded in the Essex Registry of Deeds at Book 5039, page 249, agree as follows: 1. The applicant hereby agrees to construct the ways and install the utilities in the foregoing subdivision in accordance with the following: i. Application for Approval of Definitive Plan (Form C) dated ii. All the conditions of approval of the Planning Board in their decision dated April 13, 1998, which are specifically set forth in Exhibit 1 and attached hereto and made a part thereof, this Performance Bond Agreement; and iii. All the requirements of the Subdivision Rules and Regulations of the North Andover Planning Board dated and revised February, 1989 under the authority provided by Section 81 Q of Chapter 41 of the General laws (Te. Ed.) as amended; except for the waivers which have been granted by the Planning Board as specifically set forth in Exhibit 2, and attached hereto and made a part thereof, this development agreement. Any modifications to a previously approved subdivision plan pursuant to M.G.L. Chapter 41, Section 81 W would necessitate a separate performance bond agreement to be completed in addition to the performance bond agreement filled out for the definitive subdivision approval; and IV. In accordance with the Subdivision Plans and profiles submitted by the Applicant and approved by the Planning Board; and 2. The applicant acknowledges that the waivers that are specifically designed in Exhibit 2 are the only waivers that are acknowledged and approved by the Planning Board as of the date of the approval of the Subdivision Plan; and 3. The Applicant agrees that the subdivision shall conform to all the requirements of the Subdivision Rules and Regulations except as waived by the Planning Board in writing if the development is not consistent with the Subdivision Rules and Regulations, the waivers granted thereto, and the conditions of Approval, the Applicant agrees to bring the development into compliance within twenty days of notice from the Planning Board of noncompliance; and 4. The applicant agrees to construct the ways and install the utilities within two (2) years from the date of endorsement of the Subdivision Plan and Profiles, and furthermore agrees that construction shall be completed two years from the date of commencement of construction, or such further time as may otherwise be mutually agreed upon by both parties in writing. Failure to complete construction and installation within the time specified may result in rescission of approval of the plan, or may result in the Planning Board, by a majority vote, voting to seize and utilize the surety funds to complete the construction and installation of the ways and utilities. Prior to su94 sei�ure of surely funds, however, the Planning Board shall provide the surety, on 6y'fnotice, an opportunity to complete the construction and installation of the bonded improvements remaining uncompleted. In the event the surety shall determine to complete the improvements, the parties shall thereupon agree upon a schedule for such completion, taking into account the nature of the improvements remaining to be completed, the weather conditions, and such other factors as reasonably impact the schedule. 5. The Applicant agrees to maintain all ways and utilities in the subdivision until the Planning Board finds that the subdivision is complete, and has received a favorable recommendation by the Planning Board for acceptance of all streets in the subdivision and action on a Town Meeting warrant article to accept the street, and the street has been accepted. Failure to maintain all ways and utilities may result in the Planning Board, by a majority vote, voting to seize and utilize the surety funds for maintenance of the ways and utilities. The Applicant agrees to record this agreement with the Subdivision Plan at the Essex County Registry of Deeds, and to forward recorded copies of this Agreement to the Planning Department within thirty (30) calendar days of the Planning Board's endorsement of approval of the Subdivision Plan. Failure to comply with this provision will result in automatic rescission of the Subdivision Plan. This agreement shall be and is binding upon the heirs, executors, administrators, assignees and successors in interest, and upon the grantee or successors in title. The applicant shall notify any new owners, heirs, executors, administrators, assignees and successors in interest that this agreement has been executed, and shall provide written proof of disclosure of this notification to the Planning Department. The Planning board, however, agrees that in the event the owners of the property and applicant notify the Planning Board in writing of a transfer of title to the property, transferee shall replace the existing bond with another bond acceptable to the Planning Board. The existing bond y shall remain in full force and effect until the Planning Board approves the subsequent bond. 8. The Applicant is the owner(s) of the record of the Premises on said plan. 9. The bond provided to the Planning Board shall not lapse. The Applicant agrees that if the bond or other security lapses or is no longer valid, all unsold loss shall be considered to be under covenant and not be conveyed or built upon and the Town shall not issue buildings permits on such lots in the subdivision; and the Applicant shall forthwith forward to the Planning Board alternative security acceptable to the Board. 10. The Applicant agrees that no amount of the security will be released to the Applicant until such time as the Applicant has completed the work in accordance with all decisions and agreements, petitioned Town Meeting and obtained a favorable recommendation from the Planning Board for acceptance of all streets in the subdivision and obtained Town meeting approval for all streets in the subdivision. In no event, however, will any cash amount of security be released to the applicant and no bond reduction in the bond amount shall occur without the express consent of the surety, providing the security under this agreement, which consent will not be unreasonably withheld. 11. Prior to the signature of the Planning Board of this document, the Applicant agrees to post sufficient funds to pay for the Planning Board consulting Engineer to perform a cost estimate to determine the amount of security to be posted for the subdivision and will post the amount as determined by this cost estimate for surety for the subdivision. 12. Prior to the signature of the Planning Board of this document, the Applicant agrees to post sufficient funds to pay for the Planning Board Consulting Engineer to perform a cost estimate to determine the amount of security to be posted as surety for the subdivision. 13. Prior to the signature by the Planning Board of this document, the Applicant agrees to post sufficient funds to pay for the Planning Board consulting Engineer to determine a cost estimate for inspections to be performed annually by the Planning Board consulting Engineer for two consecutive years to ensure on an annual basis the amount, if any, that was determined by the Planning Board Engineer. 14. Prior to the signature by the Planning Board of this document, the Applicant agrees, if required by the Planning Board, to post sufficient funds for reasonable attorney's fees associated with the submittal and reviewing of this legal document when reviewed by the Town's Legal Counsel. 15. The Applicant and Bonding Company agree that if there is any conflict between this\ document and any other documents, they may have relating to this agreement, this document shall supersede and be binding on the applicant and surety company. 16. When a majority vote is made by the Planning Board to seize the funds being held by the surety company, the surety company, within 21 days, must provide the funds to the Town. Unless the surety shall have on notice from the Town agreed in writing to complete the improvements in accordance with the provisions of paragraph 4 herein. . ' The flown of North Andover, acting by and through its Planning Board, hereby agrees to accept the aforesaid performance surety bond in the amount specified in this Agreement as security for the performance of the construction and installation specified herein. This document is executed as a sealed instrument. IN WITNESS WHEREOF we have hereunto set our hands and seals on this date: Signature Board Chair or Town P er, as authorize by vote of Planning Board :gnatu Applicant or its Authorized Agent G�-c�tc� art-s,clo,...f Date 6� Date Taxpayer LD. 0q—,3,1_ -2_97S I ji; '�,Owner or its Authorized Agent ivy,nr f S FyVbate n_��--- September 16, 2002 Signature of Bonding Company or its Authorized Agent Date Robert Porter, Attorney—in—Fact (PLANNING BOARD) COMMONWEALTH OF MASSACHUSETTS Essex, ss. 0011N Then personally appeared the above-named , who acknowledged under oath that the foregoing is the free act and deed of the North Andover Planning Board, before me, Notary Public My Commission Expires: (APPLICANT) COMMONWEALTH OF MASSACHUSETTS Essex, ss. 2002 Then personally appeared the above-named -:_!2) 6130 who acknowledged under oath that the foregoing is the free act and deed, before me, ivz�__C_zm�mission Expires: ERZZLOth A. Miller Nctary ppb, c Commonwealth oP Massachusetts 14 Commission Expires May 18, 2008 (OWNER) COMMONWEALTH OF MASSACHUSETTS / Essex, ss. �/� �Pi�vi1.1/1 %�, 2002 Then personally appeared the above-named J, ✓rl who acknowledged under oath that the foregoing is the free act d deed, before me, L:k W., lk�_ NotgOutlic My Commission Expires: Sizabath r. Nliii2i .Commonwealth o. iv":oSS9^,1US2i�s L4yCommission Expires Nlay 18; 2008 (SURETY COMPANY) COMMONWEALTH OF MASSACHUSETTS Essex, ss. , 2002 Then personally appeared the above-named , who acknowledged under oath that the foregoing is the free act and deed, before me, Notary Public My Commission Expires: Continental Insurance Company To be attached to and form a part of Bond No. 929262655 Effective Date: September 10, 2002 Bond Amount: $83,859.51 Executed by: Pulte Home Corporation of New England , as Principal and by: Continental Insurance Company , as Surety in favor of: Town of North Andover (Obligee) in consideration of the mutual agreements herein contained, the Principal and the Surety hereby consent to adding the following paragraph: It is a condition of this bond that it will be in force until September 10, 2005, and the Surety may notify the Obligee by registered mail sixty (60) days prior to the expiration date that they elect not to renew this bond. Nothing herein contained shall vary, alter or extend any provision of condition of this bond except as herein expressly stated. This rider is effective: Signed and Sealed: September 12, 2002 September 12, 2002 Principal: Pulte Home Corpk"7' of New England /7 By: `„''1 Principal Calvin R. Boye, Director of Treasury Operations Surety: Continental Insurance Company By: Attorney -in -Fact Robert Porter . POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents, That The Continental Insurance Company, a New Hampshire corporation, and Firemen's Insurance Company of Newark, New Jersey, a New Jersey corporation (herein called "the CIC Companies"), are duly organized and existing corporations having their principal offices in the City of Chicago, and StateofIllinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint John R. Stoller Julia T. Corcoran, Vincent J. Frees, Maureen E. Thomas, Bruce E. Robinson, Calvin R. Boyd, Jane K. Botting Colette R. Zukoff, Suzanne Treppa, Robert Porter, Individually of Bloomfield Hills, Michigan their true and lawful Attomey(s )-in- Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature — In Unlimited Amounts — and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their corporations and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the corporations. In Witness Whereof, the CIC Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 22nd day of March, 2002. • �``: + • 2n. �� "` The Continental Insurance Company iL , og Firemen's Insurance Company of Newark, New Jersey Michael Gengler Group Vice President State of Illinois, County of Cook, ss: On this 22nd day of March, 2002, before me personally came Michael Gengler to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Chicago, State of Illinois: that he is a Group Vice President of The Continental Insurance Company, a New Hampshire corporation, and Firemen's Insurance Company of Newark, New Jersey, a New Jersey corporation described in and which executed the above instrument; that he knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said corporations and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations. "_AT L* "OFFICIAL SEAL" DIANE FAULKNER Notary Public, Slate of Illinois My Commission Expires 9/17/05 My Commission Expires September 17, 2005 Diane Faulkner Notary Public CERTIFICATE I, Mary A. Ribikawskis, Assistant Secretary of The Continental Insurance Company, a New Hampshire corporation, and Firemen's Insurance Company of Newark, New Jersey, a New Jersey corporation do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the corporations printed on the reverse hereof is still in �mi�ony whereof 1 have hereunt�scribed my name and affixed the seal of the said corporations this 12TH day of o. The Continental Insurance Company `r Firemen's Insurance Company of Newark, New Jersey .0 Mary A. Ribikawskis Assistant Secretary (Rev. 10/11/01) ACKNOWLEDGEMENT BY PRINCIPAL STATE OF MICHIGAN ) )ss. COUNTY OF OAKLAND) On this 12th day of September, 2002, before me, the undersigned authorized employee, personally appeared Calvin R. Boyd, who acknowledges himself to be Director of Treasury Operations of Pulte Home Corporation of New England and that he as such employee being authorized to do so, executed the foregoing instrument for the purposes therein contained by signing the name of the Corporation by himself as such employee. My Commission Expires: March 26, 2006 ►r�si�1 Maa.lC S%yOAKUND rs E'v� k[i4.i�ii:�.1�1:1 Notary Public, Marcia G. 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CARWNA 04417 N. CAROLINA 6762 PENNSYLVANIA RA -0151660 PULTE NORTHEAST 10302 EATON PLACE, SUITE 180 FAIRFAX, VIRGINIA 22030 r T T 'OC. 6e Z Z yr Z — — CE Z IS 0.1 m m m m in z C�- p C> a zlis -- v _ ----- -- 0 ti ^o ate' T � m � Z Z � m E D z 46- D 2 I L I a v n a F------ IY 1 W 1 - n s AI � n � 2y to tiv s 8� n KF r� CT o N SUL 1/4' = 1-d SOME 7/6' = 1-d SCU 1/1= 1'-0' SCALE 7/4' = f-0' sGVE 1' = 1'-0' 9.NE 11/Y = 1'-,r TECT: DAYD 8 CRFFlIHS WLE 1 LrnnY nut HEST oauu[n'1s NRE aalrARm DN A I'DO'AD Dr u[, N+n nu1 T` AN A DULY LICENSED LICENSED ARCHIEC, ENDED BE IAS OF THE F01 -tome WE LLI l !� G T 0 1999 A,NS�NR6 ® OEIAWARE 6189 f81o0E i5LPN0 2754 MARYLAND 7145-R YAS1BA (1 718 9857 CONVENTIONAL FRAME NEW LAND 745--67 WASS IA 6718 .- 5. CARWNA 04417 N. CAROLINA 6762 PENNSYLVANIA RA -0151660 PULTE NORTHEAST 10302 EATON PLACE, SUITE 180 FAIRFAX, VIRGINIA 22030 m o o = VNIM'. DAM K OFFM nne �FY,Hi KEDDUADIISMREMARDMAPP0YEDBYM4R0,HAt PULT E NORTHEAST m I AN A DULY LEENH 11 N49 AKHfDCI M5 6E LAWS OF THE MGM WELLINGTON - 1999 _ ^ 'UNSIICIIDIS DELAWARE 6169 RHODE ISLAND 2354 NARYLMD 7745-R NASSACHUSSEFFS 9&57 10302 EATON PLACE, SUITE 180 NEW GARJERSEYOIJNA a39-13967 N 6718 CONVEN rIONAI; FRAMING S. O1N.. GAR NIA 6 A sJ62 FAIKFAX, VIRGINIA 22030 NSYLVANIA RA -015166B s O w, Tx mOL Yy mrz i -U) Azl_= AW ym L A 3�m mA z cyA n0� D 3 0 DR� 1 m o o = VNIM'. DAM K OFFM nne �FY,Hi KEDDUADIISMREMARDMAPP0YEDBYM4R0,HAt PULT E NORTHEAST m I AN A DULY LEENH 11 N49 AKHfDCI M5 6E LAWS OF THE MGM WELLINGTON - 1999 _ ^ 'UNSIICIIDIS DELAWARE 6169 RHODE ISLAND 2354 NARYLMD 7745-R NASSACHUSSEFFS 9&57 10302 EATON PLACE, SUITE 180 NEW GARJERSEYOIJNA a39-13967 N 6718 CONVEN rIONAI; FRAMING S. O1N.. GAR NIA 6 A sJ62 FAIKFAX, VIRGINIA 22030 NSYLVANIA RA -015166B { O O D 3 0 DR� n = DmW A O WE% OO W m O i~� m = m O U n � �o 1. 1 I11, Tin SW F. 112'=f -T__ STNL 7/C = I'4 YJIL 1'= 1'-0" TAIE 11/7 = 1' -If m o o = VNIM'. DAM K OFFM nne �FY,Hi KEDDUADIISMREMARDMAPP0YEDBYM4R0,HAt PULT E NORTHEAST m I AN A DULY LEENH 11 N49 AKHfDCI M5 6E LAWS OF THE MGM WELLINGTON - 1999 _ ^ 'UNSIICIIDIS DELAWARE 6169 RHODE ISLAND 2354 NARYLMD 7745-R NASSACHUSSEFFS 9&57 10302 EATON PLACE, SUITE 180 NEW GARJERSEYOIJNA a39-13967 N 6718 CONVEN rIONAI; FRAMING S. O1N.. 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Ott lc. . a The Commonwealth of Massachusetts ��'�� rer.te .10. �.._ Department of Public Safety xcu".cr a roe oKcked BOARD OF FIRE PREVENTION REGULATIONS S27 C!A 12W 3/90 (tuvt !,lank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance With the Mswchusetu Electrical Code, S27 CMR 12:00 (PLEA'gE PRINT IN INR OR TiPE ALL INFORM&TIONy Date City or Town of _ AJ e/r To the Inspector of Wires: Ilse undersigned applies for a perolt to perform the electrical work described below. Location (Street & Humber) Owner or Tenant?L;1.� ... - -Q C C5 f i�_ .ie !��' s. F Y 1 t't i e, v. rt• ' f� I / _ i G: i t? is Owner's Address ,5' ti t l e v\ j u: 7 l\ Is this pethit in conjunction with a building permit: Yes 0 No ❑ (Check Appropriate Box) Purpose of Bu£lding �c F � MP Utility Authorization N0. (D� f! Existing Service Amps /Volts Ove -head ® Undgrd ❑ No, of Meters New Service d..QL Amps__/ �y / � �f�'c Volts Overhead ❑ Undgrd ® No. of Meters j Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets NO- o; Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs OTHERS Na, of Hot Tubs Swimming Pool Above In- ILLn . 1 _1 grn No. of Oil Burners No, of Gas Burners No, of Air Cond. Total _ tons No. of Pleats Total Tota KW Space/Area treating KW Heating Devices KW KW No, of NO. o 51 ns Ballasts No. of Motors Total HP No. of Transformers Total 0 Generators RVA No, of Emergency Lighting _ Battery Units FIRE ALAKIS No. of Zonea No. of Detection and Initiating Devices No. of Sounding Devices �^ No. of Self Contained Detection/Sounding Devices Local L..1 '1 Municipal ConnectionoOther Low Voltage INSURANCE COVERAGE:• Pursuant to the .requirements of Massachusetts General Laws I have. a current Liabilit insurance Policy including Completed Operations Coverage or its substantial equivalent. YES® 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 � BOND ❑ OTHER ❑ (Please Specify) ____ estimated Value of Electrical Work S xpiration ate Work to Start Inspection Date Required: Rough_ Final Signed under the penalties of perjury: FIRM NAME Signatu Address OWNER'S INSURANCE WAIVER: I am aware that the Licensee stantial equivalent as required by Massachusetr,s General application waives this requirement. Owner Agent Tnip,h nnR No. LIC, N0, f4 , LIC. NO. Bus. Tel. No. (3 AI[. Tel. No. anothave the insurance coverage or its sub- s, and that my signature on this permit Please check one) PERMIT FEE S �I� Date..// ./ �✓ .... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING I �yIM AJA k) This certifithat Jtes...................................... ihas permission to perform . —�� ! .. � : �f ................. .. wiring in the building of ., !!..'�� /7 �!! ....... .................. at . A! 1.. 11 .b.el..!J.../ . Z-L—.�,. Jz 6.. , North Andover, Mass. ��// Fee ...........�. �. �.�. Lic. No ..... ... ..... �.....Q .... ...................................... Check # vr/ / % ;1—/— LECTRICALINSPECTOR 4850 Date. ��.. Lf f o?�.. •�,;:,'�,o� TOWN OF NORTH ANDOVER t '° PERMIT FOR PLUMBING This certifies that .... h eGa C �!^ � ....... has permission to perform .......... ................. . plumbing in the buildings of .. D. ��' ........................ 6 k- at ....( .............. . North Andover, Mass. Fee...).. ` . Lic. No. .. �1 PLUMBING INSPECTOR Check # / L • � i A ., Cc MASSACHUSETTS UNIFORM APPLIJIATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, Building Location New iZ Renovation rl Date .5 _ )wner Name4(IDPermit 0Y� Amount 21 r of Oc u anc a FIXTURES Plans Submitted YesNo ❑ (Print or type) Check one: Certificate Installing Company Name ' .SJC .11 Corp. I/VAddre s F1 Partner. Busm s ep one ri Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy El 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 El 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 stal ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass c e s State mb C de and Chapter 142 of the General Laws. By: ign r o ice se um er Type of Plumbing License Title L City/Town License 777771377- Master Journeyman ❑ APPROVED (OFFICE USE ONLY. Commonwealth of Massachusetts Official use only "--" MEW Department of Fire iervices Permit No.g� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ,is, [Rev. 111991 (lease blankl APPLICATION FOR PERMI TO PERFORM ELECTRICAL WORK All work to be performed in accordanc�w'th the Massachusetts Electrical Code (MEC). 537 G,ti4R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORiATION) Date: City or Town of.elt Lf e� To the Inspector cif ' Wire.s: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Nijmher) 180 /gym ev 1 t .—Aof Lot / % Plat Owner or Tenant _ P(p 1.1,e m -e 5 t Telephone No. 401-739-6700 Owner's Address 205 HALLENE RD, SUITE 211 WARWICK RI 02886 Is this permit in conjunrtion with a building permit? Purpose of Building THIP POLE Existing Service Amps / Volts New Service 100 Amps 120 /240 Volts Number of Feeders and Ampacity 3# 2 AL Location and Nature of Proposed Electrical Work: Yes ® No ❑ (Check Appropriate Box) Utility Authorization No. 1841-3417 Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd No. of Meters No. of Meters Camalelion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans of s Total TransKVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures A oven- Swimming Pool rnd. [Irnd. El o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices Heat Pum Number Tons No. o elf -Contained No. of Waste Disposers Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW S P g Local ❑ Municipal [I Other Connection No. of Dryers rY Heating Appliances Kir Security Systems: No. of Devices or Equivalent No. of aterKms, No. o No. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. H dromassa a Bathtubs y g No. of Motors Total HP No. of Devices or Equivalent OTHER: Attach additional detail iJ desired, or as required oy the tnspecror ui rr,res. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 00 (Expiration Date) Estimated Value of Electrical Work: $500.(When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under die pains'and penalties of perjury, Neat the information o t/ is application is true and complete.; - FIRM NAME: JAMES E. BUCHANAN ELECTRIC, INC. LIC. NO.: A15616 Licensee: JAMES E. BUCHANAN' Signature LIC. NO.: E32062 (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 508-865-3335 Address: P.O. BOX 544 SUTTON MA 01590 Alt. Tel. No.: " " OWNER'S INSURANCE WAIVER: I am aware that the Licensee does t t have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PER All T FEE. c,j Signature Telephone No. Date. Oillw TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS / This certifies that has permission to perform plumbing i,n the buildings of at .A. North Andover, Mass. Fee ..... Lic. No. ....... ............... PLUMBING INSPECTOR Check # 6L.69 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, MAS Building New ® Renovation 13 Owners N Type of Occupancy Replacement ri FIXTURES r Date l Permi o0 c Amount i Plans Submitted Yes No ❑ (Print or type) Installing Po�pppy Name Check one: Certificate .11 Corp. 0 Partner. zFirm/Co. Name of Licensed Plumber:41 r Insurance Coverage: Indicate ype of ' surance coverage by checking the appropriate box: Liability insurance policy El 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 El Agent El 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 n lilatT,115n-s p ormed under Permit Issued for this application will be in compliance with all pertinent provisions of the M ss ts State umbing Code and Chapter 142 of the General Laws. BY g r cense um er Title T pe of Plumbing License City/Town I 1 1 i en e I um er Master Journeyman APPROVED (OFFICE USE ONLY irO.t��ao'a�� 0 f Date..4* ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..,�/.1�(-, <:'..:.jam/...t.L..:.�t................v... ,✓ has permission to perform...:-�./1.:.......t.`�.:�,7,%...................................... wiring in the building ... at ../..!1.. J .%1I /l �J ��/ � ...1��-e.. ;1&9h- h- d er?Mass. Fee .../,tJ....... Lic. No/�/..� /C!........... ............................... ELECTRICAL INSPECTOR Check # 488 15 T -'AWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0; Date Received pate Issued: IlYIPORTANT Applicant must complete all items on this page '{,y'{s�lit,', iyg�l C ti -,�k`ktt :''g'r�.,'Y 'w tie a'�'So�.. P�''t?: ..'-ir +.d,•• - x`�. ii ILrOCAT10N 'rf` t. Y 221; r € OB 4P 01?ERT�Y k x _ �� >•-- ms`s . 1 ^ ", t , Hpn t �100�Ye Old Structure}�J1 ',yes) �Inox" t ` '}H'istoric ®istnct? yes , nog } iIVIAP NO�PARCEL,?ZONINQISTRIG�T[7��-5 . F;'7 o i fMachirieSh1/illageE.Y.eS';S..Mno;x: _t TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑ Addition 11 Two or more family [I Industrial [I Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - s ❑MWatershed District Septic-.fD-Well .. �,�,�❑ Floodplain..-.�UVetlantlsF. ..... . w - r .,.:.❑Water/,S.eWeI' . _ _ ......... ..�..�_..�k_U:.,:.� .. _.: ._: ',._..� .-� . _... DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) ARCHITECT/ENGINEE Phone: Address: Reg. No. ' FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of contractor - ignature of Qgent/Owner:.:. 9 .� _...-.. ....,. _ Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ['none: OWNER: Name: Address: ji `. -�� Phone ,� � .�. • _ .,�� IC`ONTRACTOR Name - Supervisors Constriictiori Licen se 2 .�. _ Ex _ .�. _ P'3{''_• ,'1 r;...y,.t fi- Exp -u.,-;a Ir`mrnrnvPment I ir.Pnse�_._ : _ ... ..._ • ...._, .-' ARCHITECT/ENGINEE Phone: Address: Reg. No. ' FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of contractor - ignature of Qgent/Owner:.:. 9 .� _...-.. ....,. _ Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot PI n ❑ -' Stamped Plans ❑ TYPE_OF'SEWERAGB DISP.O Public Sewer Tanning/Massage/Body Art ❑ ... Swimming Pools ❑ Well ElTobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF. U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Siqnature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision:. Comments Comments Water & Sewer ConectionlSignafiure Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osclood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Mair'' Street Fire Deparfinerif signature/date COMMENTS N 0 O CD 0zN D o -o as r- 0 O D r O vCD CD Ka) — CD m O CD W Q O C' CO C I � v O 10 z n O r -r O CD O m �=°<a - D<D 0. CD CD 0 0 = ��C0 3 m zN O = a �; �• y' -n rt =rsm CA Q m J N W CD m-0 N CD 2 `° ' n O Q 0 � � N O cU) n ° � R : Or W 3�� C. .� z� goo CD Q oo� N' S C .O Vi to i!1Cl) z ..; P. cuco 2cn CD 1 1 �p c—4 z } U) ic Oo eZ' Z '_' 0 • Oar goo qr F so o �, v_ h �_ i•, n (D •�r Z ^ CD �O qn�: K m 0 m: � o vs 3 V Zi �` .�. (p (DCL T d o C d4 ?� o=i rrD 2 p C OQ N O Oil d _S 3 O � O (D O Q ,r�r z< O n m v 'a z -i D `^ Z •o n mC n H m n 0 W Z c, z H m 0 O C O Z z -0 A O (D n (DD W D v o T m D 2 V Zi �` Ted Grab Interior Renovations Advanced Basement Finishing 1029 Humphrey Street Swampscott, Massachusetts 01907 781-430-0415 781-454-5609 (cell) advancedbasement@yahoo.com MA Home Improvement Contractors Registration # 140838 — Exp 12/17/2018 Construction Supervisor License # 89566 — Exp 11/24/17 Proposal To Renovate Basement 1/28/17 HOME OWNER: Iroso & Tunji Onamade 180 Amberville Road. North Andover, Massachusetts 01845 PROJECT DESCRIPTION 1. Areas to be created in unfinished basement CONTRACTOR SHALL supply all new materials needed to erect, according to State and. Local Building Codes, build all walls along walls to create and finish areas as designated on scale drawing. The areas are as follows. ➢ Family Room / Home Entertainment Area ➢ Work-out / Exercise Room ➢ Office ➢ % Bathroom ➢ Utility / Furnace / Storage Room ➢ Under Stair Pantry ➢ Sprinkler Room / Hot Water Closet ➢ Electrical / Plumbing / Storage Room 2. Ceilinz and Soft Preparation ❑ 1" x 3" spruce strapping shall be installed (as needed) on ceiling joist 16" on center to support weight of new drywall ceiling. 3. Wall Structure ➢ Contractor shall make wall alterations as indicated (approximately, as needed) on scale drawing. All wall structure shall be built according to state & local building requirements. S. Insulation & Wall Wrap ➢ All exterior walls shall be insulated so that all living areas and spaces are insulated according to code (as needed). The insulation value is R-13. ➢ To control moisture on partition walls that are directly adjacent to concrete wall, contractor install house wrap material on the back of partition walls 6. Steps ➢ Contractor shall open an angled wall on stairway to create an open feeling 7. Electrical Work ➢ A Massachusetts Licensed Master Electrician shall perform all electrical work. This project shall include the following. ❑ Up to 16-6 inch recessed lights in living areas. ❑ Up to 5 switches to control all recessed lights. ❑ Light fixtures for all unfinished areas separately switched. ❑ Up to 2 cable/broadband wall connections. ❑ Electrical outlets through living area per code. These outlets are controlled by a GF1(ground fault) breaker. ❑ Sufficient electric baseboard heat shall be furnished and installed. Each finished room shall have a separate thermostat to control heat individually. ❑ A separate and additional charge will be assessed in the event an additional sub panel is required to accomplish this electrical work properly. 2 ❑ The cost of electrical breakers cannot be determined until the electrician is on site. This cost will be allocated and billed when electrician has completed his work. 8. Finished Walls, Ceilinjus A Soffits ➢ All walls, ceiling and soffit of finished areas shall be enclosed with V2 inch "blue board". ➢ All blue board shall be veneer plastered to a smooth finish on walls and ceiling. 9. Doors ➢ All hinged doors shall be "6 PANEL" ➢ All doors shall include standard hardware and doorknobs. ➢ All doors to be installed with casing similar to existing casing on the first floor. JO.Baseboard, Door/Window Casing ➢ Contractor will supply and install new baseboard, door/window casing for all finished areas. I1.Plumbing ➢ Contractor shall install and supplied macerator toilet and create new pumping and draining system. ➢ Contractor shall create new water supply line for toilet. ➢ Contractor shall create proper drainage for new sink. ➢ Contractor shall create new hot and cold water supply line for sink. ➢ Contractor shall move hot water heater as indicated on scale drawing. 12. Fire Sprinklers ➢ Contractor will engage a licensed Fire Sprinkler Contractor to provide the necessary fire protection tasks. These tasked will include changing all 3 sprinkler heads in newly finished areas and installing new heads as needed. The contractor shall provide an estimate to the homeowner and this sub - contractor shall be paid directly by the homeowner. 13.Materials Supplied by Contractor ➢ Contractor will supply and install all materials and fixtures. However the fixture listed below shall be supplied by homeowner and installed by contractor. ❑ Bathroom sink and faucet ❑ Toilet and Toilet seat ❑ Shower base and Shower Walls ❑ Bathroom Tiles, grout, marble threshold, tile adhesive 14.Floorin ➢ Thos proposal allows for no flooring. ➢ Contractor shall install ceramic tiles supplied by homeowner for bathroom floor. 1 S.Paintin ➢ This proposal allows for no painting. 16.Permits ➢ All permit fees shall be reimbursed to the contractor by the homeowner. Homeowners acknowledge that 3 permits are required: Building, Plumbing and Electrical. 17. Scale Drawing ➢ Scale drawing attach shall be construed as an integral part of the proposal and agreement. All measurement are approximate and homeowners acknowledge the changes may be required due to building codes and obstacles in the unfinished basement. 4 18.Provisions ➢ Homeowner acknowledges the following and hereby agrees to abide by these provisions: 1) Reasonable access must be made to the premises during working hours. Z) Working hours are from 7:30 AM through 5 PM on weekdays. Contractor may request the option of working on Saturday with homeowner's approval. Said approval shall not be unreasonably withheld. 3) The basement area is a construction site, therefore, children and pets should not be allowed in this area. 4) All personal property must be removed from construction site and contractor shall not be held responsible for this property. S) Quite often, communications concerning the project and questions regarding the project will be done via "E -Mail". Homeowner agrees to reply immediately and acknowledges that these communications shall become a part or a change to this agreement. 6) Homeowner authorizes the reasonable use of bathroom facilities. 7) Homeowner is responsible to remove snow so that contractor shall have reasonable and safe access to work site, for entry and delivery of tools and materials. A Project Investment $ 24$G M ➢ Payment Due with Agreement $1000.00 ➢ Payment Due when Project begins $ 7000.00 ➢ Payment Due when rough Electrical Work begins $ 7000.00 ➢ Payment Due when Blue Board $ 7000.00 Installation begins ➢ Balance upon completion Commencement Date Project shall begin on or about z4wand shall be completed on or about `� _.. _. These dates are approximate. ccept by: (I Date: Iroso Onamade Accepted by: Date: AcQTunii Onamade Accepted by: cil Date Ted Grab 6 alewixojdde aje suoisuawip J A v b) 42'5 dimensions are approximate i 42'5 dimensions are approximate Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMENTS CONSERVATION ❑ ❑ COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water S Sewer Connectionit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE; Yes No. MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) Doc.Building Permit Revised 2012 The Commonwealth of Massachusetts Department.of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 a s< r. www.mass.gov%dia R orkers' Compensation .insurance Affidavit: B..uiiders/Contractors/Electricians/Piumbers. TO BE PILED WITH THE PERMITTING AU'THb.RITY. Applicant Information Please Print Legibly Natne (Business/Organization/Individual): Theodore Grab Address; 1029 Humphrey Street city/State/Zip: Swampcott, MA Phone #: 781-454-5609 Are you an employer'.' Check the appropriate box: 1. � I ama employer with employees (full and/or part-time).* 2,m a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3:❑ I am a homeowner doing ail work myself. [No workers' comp. insurance required.) ? 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no empioytcs: 5:Q I am a general contractor andl have hired the sub -contractor listed on the attached sheet, These sub -contractors have employees and have workers' comp. instuance.t 6Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §I(4),.and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. Q New construction 8. Remodeling 9. ❑ Demolition 10 [] Building addition I Q] Electrical repairs or additions 12. E] Plumbing repairs or additions 13.Ej Roof repairs 14.L] Other *Any applicant that checks box 41 must also fill out the sectionbelow showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating.theyare doing all work and then hire outside contractors must submit a new affidavit indicating such. `Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy# or Self -ins. Lic: # Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violationrpunishable by a fine up to: $1,500.00 and/or one-year imprisonment, as well as:civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do wins and penalties of perjury that the 112 Official use only. Do not write in this area, to be conipleted by city or town official City or Town: Permit/License # above is true and. correct Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other �� Contact Person: Phone M ,I ATTN: Inspector of Buildings Town of North Andover, MA RE: 180 Amberville Road CONTRACTOR: Theodore Grab 1029 Humphrey St. Swampscott, MA 01907 781-454-5609 Significant Notes: ❑ Wall Structure: 2 x 4 kiln dried members, bottom plate shall be pressure treated. ❑ Finished Ceiling Height: In all areas will be 80 inches or greater. ❑ Soffits and Duct/Beam Enclosures: In all case shall be 76 inches or greater. ❑ Insulation: R-13 Fiberglass with Kraft Paper Vapor barrier. ❑ Lighting: Entire living space will be fitted with recessed lighting ❑ Doors: All doors shall be a minimum of 30 inches wide and 78 inches tall. ❑ Finished Walls: All finished walls and ceiling shall be 1/2 Blue Board treated with a veneer plaster. ❑ Fire blocking around perimeter joist and horizontally every 10 feet on 2 x 4 studs. Owner Authorization As the owner or authorized agent of 180 Amberville Road, North Andover, MA, I hereby give permission to the following: Theodore Grab to perform work at aforementioned property. Said permission includes, but not limited to, acquiring all required permits and performing all work required to complete the project. AhTunji Onamade January 29, 2017 Mailing Address: 180 Amberville Road North Andover, MA 923745 Theodore Grab Certificate of Insurance (page 1 of 1) 02/13/201712:21:08 PM C40 AO CERTIFICATE OF LIABILITY INSURANCE DA21132017YYY' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER-NAME: Insureon (BIN Insurance Holdings LLC.) 1101 Central Expy. South, Suite 250 iuieon Allen, TX 75013 CONTACT -- PHONE 800-688-1984 ac Ne : (877) 826-9067 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC R INSURERA: Security National Insurance Company 1 879 10/7/2017 INSURED INSURER 8: INSURER C: Theodore Grab INSURER D: 1029 Humphrey St INSURER E Swampscott, MA 01907 INSURER F A AUTOMOBILE LIABILITYdent) ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD POLICY NUMBER POLICY EFF MWDD POLICY EXP MMIDD LIMITS A t/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR NA106833002 10(7/2016 10/7/2017 EACH OCCURRENCE $ 1.000.000 PREMISES E. occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLJES PER: POLICY ❑ jE F—]LOCPRODUCTS OTHER: GENERAL AGGREGATE $ 2,000,000 - COMP/OP AGG $ 2.000,000 A AUTOMOBILE LIABILITYdent) ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT $ Ea acddent BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per acadent UMBRELLA LJAB EXCESSLJAS H OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PER OTH- STATUTE ER E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) GtK I II-IL:A I It MULL1tK Town of North Andover, MA Building Inspector 1600 Osgood §t. North Andover, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE witpati-Lu74A%,umu%.vKf VKAi1VP1. mei 11lgnW iwa ,vCu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions_ Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine ran -ma nATA _. tFnr rjPngrfinent use) 1-0 C Q Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department Tine foIowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Torun Clerks office must stamp the decision from the Board of Appeals that the appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bF- snbm:ged with the building application Doc Doc.BuildiugPecmitRevised 2012 R, 0 c 4 � � z e 0 00 o Cl) m m CD0 m v y C � COO) Cl) 10 0 CD C') Z H CD 0 CL r FCo� CL c � y 0 c CO CD 0 CD CCD O w w �. C CD CO) CD CL0 y CO CD S v y O CD z CD o CD o 0 CD O c•v+ o Q vi = a O S m 3 0 m C7 Z v' ca U2 0 Z c ra ca O. . d O O O H W O =O C _ O to � 0 O O C) O G y. n : M C• as CL CoL U) IQ t CD Im CLg nc �s O N O H e"t O N d y C z e-+ • Cn � H O ' V ^^� C: u OO O z � E.ca - c 0 cn OCHco r.COD 0 a_ )MEMO. C. 2o Oil o 0-4 5. = �. �' ` r'' '� r a bd tD °' a C 7C ro W, X, N O O � i n f 0 C ►s r/ Town of North Andover BnildiagDepartment 27 Charles Street North Andaver, lVLu"Abusetts 41845 (978) 688-9545 Fax (978) 688-9542 • _ . s...�"33.x. ti`s .. _ -_c 0 , s.. 4._� . ADDRESS —M 0 LOTNUI R % / sUBDIVISMN Pores- DATE REQUEST F&M 01 y - 0�1 DATE READY FOR INSPECTION O ALL WORK AND SM-OFF'S MJST BE COAd LETFD TSS TIAnE A11� A IF RE -INSPECTION 4F T' ITS FIVE ($25.) DOLLARS WITS, 4 CHARGED. THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE CONSERVATION DATE PLANNING DATE D P.W. -WATER METER, DATE._' P.W. IVILIST INDICATE THAT THE WATER METER HAS BEEN INSTAL 7 .Rn P OR THE ��FC REQLST DATE. / DPW