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HomeMy WebLinkAboutMiscellaneous - 182 HILLSIDE ROAD 4/30/2018 (9)zM E'3 B e 7� Date.......I..../.N°' 0114 ..�.� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....1.«..:.:.`.!.`...`. +- f ` lie "k ,? �, w S ..... �............................ . has permission to perform r . v l ` ' . %� ....... ..... ........................ .......................... wiring in the building of ......)e I �.:...�`..J........................................... ¢4 le �f . �� ....................... ,Mass. o!....... ...... ,. North Andovec Fee. �.' ......... Lic. No .....1 ...'. ........... C......... ,p ELECTRICAL INSPECTOR C C9 --- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TIM L'QAffi1QNWEAL7Y10FAL4SSQ(,RUSE7' 7S Office Use only �2��VTOFPIIBIIC.�4F�7Y Permit No. Z7 BOARD OFFIREPR EVE W0NREGUTAT70NS 527CM 12.00 Occupancy &Fees Checked FORWARD APPLIC4 Tic FORPE�IIT TOPFJ? FOR MELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 f (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. P4AP PARCEL Location (Street & Number) j Z Owner or Tenant 1 OVA AJ Z A 0 C2 µ--0 0 Owner's Address -51` . . tom; Is this permit in conjunction with a building permit: Yes No F-1 (Check Appropriate Box) Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A60,/,t- No. 60✓w Overhead 0 Underground Overhead r --J Underground Utility Authorization No. No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Licfrting Fixtures Swimming Pool Above Below Generators KVA ground and No. of Receptacle Outlets No. of oil Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burlcrs FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other No. of Dryers Heating Devices KW Conncctions No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP I _ 11 f DTHER- - - • II : i .. i .� I d .- '! 1. I I •II ,� •. I•,:i • ��. �!' :. •• •. � � ., .I II :. I : i � I• II!:• .t.• •!V • KI ! 1 "•II •- � • '•' "• :•/:. •��i• 11 .1 V.I. 1 •" • .! : -. • :•!1 .� 1 - 11 w .- � V j `►1. ucul- /YI .II.l. •fill" sll� `( Fin Rough (26I R valueofIl Fire $ all Lioa>9eNo `. ? _ 7 a 5 BusumTeLN,b AIL TeLNa OW,U1 SINSURA%10EWAIVEP,lamawared-AtheLice sedoes notlaethemsurarmcmuaWort,aistat>balegxvakriasmgLuadbyN alsetfsGmiallaws arrlthatmyogiatmcnimspemnrtappbmbcnwaiwsthism m mt (Please check one) Owner ® Agent �, l Telephone No. PERMIT FEE $ �� • y Signature ot Uwner or Agent 4 Location // //5 i,/. , No. - �� g Date HpRT�y TOWN OF NORTH ANDOVER � • p O 9 Certificate of Occupancy $ • Building/Frame Permit Fee $ Foundation Permit Fee $ s�CHust Other Permit Fee j'60k $ m Sewer Connection Fee $ C Water Connection Fee $ TOTAL Building Inspector ,3.54: Div. Public Works Q N N L" LL; z — z z G c: z Q � 011 ko 1 i .r a a W z r Y } - Y J -K iC W J Ic i Z z N H w y C C[� i N Nz r n v r yG V Z C7 Z 2 V VI�e C U J CJ z N L` z uzi � w c � < p J1 A N Q ... V d z Ui ` z vy VY ID w_ y z z u N N 2 ^ a y '�+ _ LLJ z N U < 11 • .., Y C W r Y ^ Z z Z z LL Z z C:25 t� c 0m r;, x n z i UI u z z c: z 011 ko 1 i y a a W z r Y } - Y J u FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ******.****-*******************APPLICANT FILLS OUT THIS SECTION!******""" i APPLICANTt/C) f'l /�02U {�U PHONE 1797-17 7.2 �LOCATION: Assessor's Map Number z} PARCEL SUBDIVISION LOT (S) 7 i STREET �/? //� lli�L" /��JL ST. NUMBER USE ONLY********** RECOMMENDATIONS 0 TOWN AGENTS: o2J / Dvn9 h vie /,,vc/ /foo f CONSERVATION ADMINISTRATOR DATE APPROVED AI�(r�DATE REJECTED COMMENTS IV b We �''°��5 L TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 j TE Town of North Andover,. OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 Please print. /} q DATE Z_ J JOB LOCATION / 27 Charles Street North.Andover, Massachusetts 01845 HOMEOWNER LICENSE EKE�IPTION r// 1, f VAORTH �Ot4«io ,"1�0 9SSACHuSEt Fax(978)688-9542 Number Street address Section of town "HOMEOWNFER" 76 tui Z004--14* ? 5-9- 9'>' �� 4-170 - dao 7 Name Home phone -- Work phone PRESENT MAILING ADDRESS /8'q s City/Town State Zip code _ The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-vear period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Offfcial, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with 'said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICL-%L Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. BOARDS)F APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 U) m 7) m 0 m CO) CD 'O C-) Z O O � r d o O � Y .o 0 o p CD CL CO CD 0 w _2 10 d d O O CA 'C c O c y d C) CD O rrt CD CD y� CD CO2 0 O CD O G CD 0 °_ O -• N p Q N' d O m .fl C4 _' cI p m C', �m„C'jn� m ? m aim = ti m O m N G O = m m CO 7 p p C2 O G y n: .Z p m c =r H ea o � _� ~ • CD m N CD 0 `a c Snm m Z N C. O y N ' _ G O Cr CO) N op CA tCA n•► m N N L CD 1W_► N: .'O : CCD O -� CD C � � �► cp 3 cn � — � O . p tCD �.C. C : p C � m ' . : CL. rm n� �C,c: o: C O : CID: CD o U q OCDT c �i a o T c fD CD o 7 tr m �' T o ] m n� ] pw n °o � C � z x z O y 0 0 c Nov.24 ':: 22:58 0000 SANFAX200 series MORTGAGE PLOT PLAN EK SURVEY 17 ROYAL STREET, LAWRENCE, MA. 01841 Tel. 308•--975--1.13 MORTGAG0R O �.� DEED REF, 5-57(4 PG. ug, ADDRESS OF PRINCIPLE BUILDING PLAN REF: X430 _1aZ aI/aSI�` ,•Qp. DATE OF INSPECTION _ �SlAt/� !/� /�4� t t .ir -/A 30, QIP_ iU 011e P. 3 0 3 'e - 107M Ibb mortgage Inspection was prVarbd .��� ' I FURTHER SATE THAT IN MY PROF ONAL pwotfltdly for rnartpdge purposes and Ar not to o� 7' OPINION the prfnalp),��rrtruaiNrs/s and aco"*o y 4 rolled upot au a Nun" Eft 11AWY RUBEL butt�uAdings, _ to rewpotsu blttty f'br danag.s ee No. �� s with the setback regttkennents of the local edbnce by anyone other Coon the said mortou xonptt ing crilnances„ and that no enchroacfirttts Ind Its UiWgns In ronnectlon 10th Its propooidgI �fCTI. VJ of mam jor lrn"vesntsr either way domes nortgag+ flnandhg to said mortgagor. ° 01 prohwty lines ex0opt as ubxawi. ,IMT*1CAII0N TO: . �1. Propetty Is not In a Flood Hazard Area. rlr tztt�tlflbu t is bond on iho 100a�llM of = y tnwkwe 133. Property b In n F1aodl' Nasard �rww if oth" 01111 doe nbt represent d prapefty VIUMy, themkIri � Fload Fia=ard d3. Iftfftaft +tp»tminsd�fta 0 t.th131 FIWWUI Mnood ood &34t» shown arm not tb be Xl"d fa' the utabllth►nent of lnsuronce We Mop Pdnoi f Z 5DO f 6 -000& C (,#I?_ 1q.3 property Ithm 2442 Date..l"./ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation 'J. in the buildings of....�f"Ill�Cf.�—l..%'............. at .. /. s, .. /`y GAN . /L?., ...... North Andover, Ma ee sp ,0.. .. — Fee. � Q .-� Lic. No. ........................ -� GAS INSPECTOR WHITE: Appli nt CANARY: Building Dept. PINK: Treasurer GOLD: Fil 0i Y O � , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI ING t (Print or Type) NORTH ANDOVER. Mass. Date l uilding Location �,Z ; j d c� Permit #/ �/,✓L� S Owners Name%es`e:- Zah car' Lf I lc> s New 77 Renovation Replacement Plans Submitted - D io D �-� FIXTU0 (Print or Type) Installing Company Name ANDOVER PLG. & HEATING CO., Address 57371/2 SO UNION ST Check one: Certificate IN .Corp. 2122 Partner. LAWRENCE, MA. 01843 [_J Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter GEORGE I ADnctc Insurance Coverage: Indicate t e type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of Insurance Waiver: I, the undersigned, have this application does not have any one of the Signature of owner/agent of property indemnity Q. Bond 0 been made aware `that the licensee of above three insurance coverages. Owner 17 Agent _ I hereby certify that ail of the deuils and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and flat all plumbing worst and installations pezfomtcd under Permit iuued for this sppGcation witl_be in mpunee with all patlnent provisions of tho htarrachureUs State Car Cude sn4 Chapter 14: of the Cenezai L►wa. TYPE LICENSE: By Plumber Title Gasfitter. Signature of Licensed City/Town- Master Plumber or Gas. fitter Journeyman 99ft� APPROVED (OFFICE use ONLY) License Number MEN MIMIKNIEM MEN MINE, KMMMMMMEMIMMMMMI ARM MEMIMMUM mom ME MENOMONEE (Print or Type) Installing Company Name ANDOVER PLG. & HEATING CO., Address 57371/2 SO UNION ST Check one: Certificate IN .Corp. 2122 Partner. LAWRENCE, MA. 01843 [_J Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter GEORGE I ADnctc Insurance Coverage: Indicate t e type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of Insurance Waiver: I, the undersigned, have this application does not have any one of the Signature of owner/agent of property indemnity Q. Bond 0 been made aware `that the licensee of above three insurance coverages. Owner 17 Agent _ I hereby certify that ail of the deuils and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and flat all plumbing worst and installations pezfomtcd under Permit iuued for this sppGcation witl_be in mpunee with all patlnent provisions of tho htarrachureUs State Car Cude sn4 Chapter 14: of the Cenezai L►wa. TYPE LICENSE: By Plumber Title Gasfitter. Signature of Licensed City/Town- Master Plumber or Gas. fitter Journeyman 99ft� APPROVED (OFFICE use ONLY) License Number c C Nov.24 22:58 0000 SANFAX200 series MORTGAGE PLC)` PLAN _ EK SURVEY 17 ROYAL STREET, LAWRENCE, MA, 41841 Tel. 508--975-1413 MORTGAGOR DEED REF. sl(o PG. —.:2' ADDRESS OF PRINCIPLE BUILDING PLAN REF:-`" IWO Ni�.Sr DATE OF INSPEC110N - 90 6 14 301 0 N� -form flee X8.3► •io� 0 P. 3 c �+t 407—F 10TH 'this mortgage inspeation wm prepared ����N ''-; 1 FURTHER SKM THAT IN MY PRCFEMONAL pootArdly for tnWtgdye purposes and to not to o� 7' a OPINION the grin M etruature/s and am"ooy nitsd a* a st,twsyt EX-111tV1~Y ftcapto 1butbundings, —A eA4 RUDEI 0 I�f 1<ity � doMa a • No. 389$U V3 With the setback nsq*r sntx of tho Wool rliamoo by dnyons other on tfie said mt�rt�a ea `� xoning or4nunoes, and that no enohrdachmwdv and ate asst" h aonnectton rith It r prgm*od-�FcistE�`�° of major improvements either way darous natperoe flnanafiQ to said mortgagor. s'oNAI Lk 10 prbpwty lines except an ate. 3MYMCA'110N M d't. property Is not h o Flood Hazard Area. 30% uw lfttW is .b4oad on th• loon of mmy Mwkon 13 z Property I: to a F oQ4 kMWd Arra, ,f ath" and duo not riprowt. d prtpu ty oUmy, therntotyl ` lAfottn4lltxt 1>a MiutAdwt! io �� Fled HcixW �Kbbtb� 9hnwrt ors -net to be iJtNsd fa' rho w�trsbilir}�rnont of Flood tlumrd data tnlned $oro = f�adoroC Mood.. -ftbtIrbPety lines, lnsuranas Rett• Map Pdnal f z � 9� oo* C VIZ 1q3 c o 0 Date ......Ute.. . -z. ......:� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 01 This certifies that ........ ... `... r ................ J.................. ................................. has permission to perform{ `-�- ..:i......................................................................... ,c wiring in the building of . �.. � at............................................................................... . North Andover, Mass. Fee ...Nf ..... ..... Lic. No .............. .... `. .....'� .....17.................... G ^ ELECTRICAL INSPECTOR Check # 45.5 TBE COA MONHEUTHOFMASSACHUSETTS Office Use only DEPA)U31EVT0FPUXJCS9FE7Y Permit No. S BOARD OFFIREPREVEVHONREGUTA77ONS527CNIR12VO Occupancy & Fees Checked APPLICATION FOR PEI UTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 �� I� . (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dater 03 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) l � Z "( 'LJ_ Cz;- t (�'C yc�( Owner or Tenant `Z s'}"VL 0 Owner's Address Is this permit in conjunction with a building permit: Yes �No M (Check Appropriate Box) Purpose of Building iLC S 't—cUtility Authorization No. Existing Service Amps�Volts Overhead Underground E No. of Meters New Service Amps / Volts Overhead Underground r__J No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 71 77 A7 7 t IF No. of Lighting Outlets lo No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA to round round No. of Receptacle Outlets 3 S No. of Oil Burners No. of Emergency Lighting Battery Units No! of Switch Outlets Z% No. of Gas Burners FIRE ALARMS No. of Zones —�s No. of Ranges No. of Air Cond. Total Tons No. of Detection and _ Nub. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No_ of Motors Total HP OTHER - Coverage. Ptlt�mt>otheiagtritanarisofMassadn9elcsGalaalLaws ItimaamatLdAtylr�na =Pobc7'ir ddngCornplt CDvewcr is m eW art YES /NO Iba%est>hii*dvafdp ocfofsa 1odrOlii= YES 1,171 Fyouha%edrdkedYES,pYwnica ethet Wofcoveragpby chec�Igthe box INSURANCE OTHER Ff=Speafy) IFxpila6mDaie EAm*dW0dCiDSW S l6 �A 3 I�g�� Rough cx� mal VahteofDactric$ FIRMNAME U�ce,S . Lice ee LA �( �c .A <: c� M ��o.� �t-� +, Sig►>aaue\J�� — x Lioa>seNo Z r— BttsQrtessTel No. 20? A�lchess,—g `^-1 .v v owl 5 fy`f i Sy t ,✓t� Sr L S Alt Tel No. O)VMR'SIN WAIVER,IamawmdAtheLioewdoesnothavetheira=mcovaageoritsatsutalegnvaialtastegttitedbyMassachtmisGffralLaws and that n-ry signature on this permit application waives this regtmarl ll (Please check one) OwnerAgent F-1 o �, Telephone No. PERMIT FEE $ Igna ure ol Uwner or Agent Name The Commonwealth of Massachusetts , Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for rry employees working on this job. Company name: Address City Phone # Insurance. Co. PolicV # - s Company name: i Address City: Phone #7 Insurance Co. Policy # Failure to secure coverage as required -under section 25A or MGI. 152 can lead to the imposition of criminal penalties of.a fine up to $1,50D.00 and/or one years' unpnsorwnerit-as-we[Las-cn44xmakms-wAhelmm-da-STOPY4DW-ORDIRand-arm-ct(sjjDD-m)-aidayagainstmm. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification. / do hereby cwtfy under the pains and penalties of perjury that the information provided above its true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town afficiar City or Town Permit2icensing Building Dept ElCheck y immediate response is required licensing Board p Selectman's ice Contact person: Phone #. Health Department n Other Location i Say 1�5I�-� W No. /V Date .3 - C/ 3 NaRTM TOWN OF NORTH ANDOVER • OOL • Certificate of Occupancy $ 0 C2 'sswcNust�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check # 3 y 16230 XP`(,;'- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING h ;.. ... 'TI�i�1 � �a,� �I�at Ilse UIQ BUILDING PERMIT NUMBER:DATE ISSUED: D SIGNATURE: " Building Commissioner/I for of Buildin2 Date SECTION 1- SITE INFORMATION 1.1 Property Address: �$zth1� SIse 9 • 1.2 Assessors Map and Parcel Number: 17EC Z7 Map Number Parcel Number Q % . .���dOP12�; .M� 1.3 Zoning Information: R3--5 Zoning DistrictProposed Use 1.4 Property Dimensions: 2.5, 05 18 7 N Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegWred Provided Required Provided 36 Z' 30' 3s, 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 4 Private ❑ Zone Outside Flood Zone 1.8 Se erage Disposal System: Municipal On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Jah Jft Lfkd)?A �d t 2z 7q►' i&I !j Ar, m,4Name (Priv Address for Service : 17 7 IS'q-�99L Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: � � Liceri ed Construction Supervisor: +� Address y S r Telephone Not Applicable ❑ License Number I &' (-/, �!/ Expiration Date 3.2 Registered Home 11I``mprovement Contractor 7616AU S .L • a�,Irl L L') Not Applicable ❑ / % �j 7 i 7 -a Company Name AA � / rs- /V ( 1 Q ,AVS Registration Number 'r is / l Address / ( 11 7� b 7 _�.S Expiration Date S nature Telephone T rn X ic Z O v rn SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. —Signed affidavit Attached Yes ...... X No ....... ❑ SECTION 5 Description of Proposed Work check all a licable New Construction [I Existing Building ❑ Repair(s) 11Alterations(s) [I Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: kv c• ,FHM Fm�- a SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building/ O 4, �� (a) Building Permit Fee Multiplier 2 Electrical —7 S.40• (b) Estimated Total Cost of Construction 3 Plumbing S_ 6O • Building Permit fee (a) X (b) 4 Mechanical HVAC SDS 5 Fire Protection "Wla 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH.DING PERMIT I, 1-) r\ Z& .a as Owner/Authorized Agent of subject property Hereby authorize S to act on My beh , all matt s re o ork au orized by this building permit application. An Sir tore of Owner Date SECTION7bOWNER/AU HORIZED AGENT DECLARATION h I, D t Zd 6tma as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print e Si atur of Owner A ent IV NO. OF STORIES '7/ 1AR Dat SIZE 1 bxZZ BASEMENT OR SLAB Sava 6 SIZE OF FLOOR TIMBERS i s 2 p 2 ND3 RD SPAN DIWNSIONS OF SILLS Z 2x 6 PT DIMENSIONS OF POSTS DIIVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION ' THICKNESS /d SIZE OF FOOTING Zzi " X j) MATERIAL OF CHIlVINEY Z L l IS BUILDING ON SOLID OR FILLED LAND 5 L ! IS BUILDING CONNECTED TO NATURAL GAS LINE Y6j TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road, North Andover, MA 01845 978-687-2635 fax 978-689-2310 Agreement for Construction Services March 9, 2003 Between: Constr. Spvsr. # 055417 HIC # 107679 Fed. ID #04-3516982 Client: John and Leslie Zahoruiko Contractor: Tara Leigh Development, LLC 182 Hillside Road 185 Hickory Hill Road North Andover, MA 01845 North Andover, MA 01845 978-989-9992 978-687-2635 Location of Work: 182 Hillside Road, N. Andover, MA 01845 Description of Work to be Completed: Family room/bedrooms addition; see attached Scope of Work/Plans Attachments: Scope of Work Plans Limited Warranty Proposed Work Schedule: Proposed Start Date March 31, 2003 Proposed Completion Date May 30, 2003 Payment Schedule: At Time of Agreement 20% $16,136.80 Foundation, floor frame Complete 20% $16,136.80 Frame, roof Complete 20% $16,136.80 Windows, siding, rough mechanicals Complete 20% $16,136.80 Completed, including insulation, plaster, trim, paint, flooring, deck 20% $16,136.80 Total as Proposed 100% $80,684.00 1 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road, North Andover, MA 01845 978-687-2635 fax 978-689-2310 Permits: By this Agreement, Client acknowledges its authority and authorizes the Contractor to apply for and acquire all necessary construction -related permits (From time to time there are additional permits and approvals required prior to building permits, which have not been provided for in this Agreement. These may include Special Permits, Conservation Commission Conditions, Planning Board Approval, or Zoning Variances, among others, and these are not included, if necessary). Unless specified in attached Scope of Work, costs of permits, as well as any costs for application or documentation required to apply will be passed through to Client, over and above the terms of this Agreement, for reimbursement. Client acknowledges that no work can begin until all necessary permits are in hand, and that Contractor will use good and reasonable efforts to acquire the necessary permits, but Contractor does not control the timely issuance of said permits. Client agrees to endorse all applications as required to acquire permits. All work and schedules, as well as that of any subcontractors, will be subject to all applicable permits being available on a timely basis, and will be performed by licensed and insured professionals whenever required. General Conditions & Definitions: 1. This Agreement constitutes the entire agreement. 2. Any changes are to be documented in writing and signed by all parties. Any changes will be paid for at the time of the change request, prior to the changed work being undertaken. TLD, LLC reserves the right to not accept specific requests for changes if and when acceptance of those change requests adversely affects integrity of work product or schedule. 3. Additional work will be billed at the rate of $45.00 per hour for licensed labor, $28.00 per hour for common labor unless otherwise agreed. 4. Work sites will be left in equivalent condition to those existing prior to contracted work; unless specifically agreed, no existing site conditions will be improved. 5. Any specific work hours which are restricted by local statute, agreement or association, and which adversely affect contractors' normal work schedule will cause completion time to be extended accordingly. 6. Completion time will be extended due to any delayed inspection services, beyond those specified by the current Massachusetts State Building Code. 7. Contract will be considered Substantially Complete when all work has been initially completed; repairs and warranty are beyond the scope of Substantial Completion and final payment will not be withheld due to repairs and warranty items. 8. Non-payment or delayed payment according to the Payment Schedule will result in work stoppage for the duration of any payment delays, and completion time extended accordingly. 9. Late payment will result in a finance charge applied to the entire balance due at an annual rate of 18%. 10. Only those work items specified in the "Scope of Work" and "Plans" are included in this contract, and this specifically excludes any items not specified, such as upgrades to electric service, water service, furnace/boiler, or other unspecified systems. 2 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road, North Andover, MA 01845 978-687-2635 fax 978-689-2310 Scope of Work Construct an addition/extension per attached plans and specifications (including 16`z 22` family room, two lower level bedrooms) including all demolition, cleanup, disposal, site stabilization and redressing. Demolish and dispose existing deck. All materials and specifications to match as closely as possible/available with the existing structure, including 2x6 wall frame, plywood sheathing, Andersen windows, vinyl siding, plaster finish, painted trim, R-19 walls, R-30 ceiling, R-19 floor, 10" thick poured concrete foundation, 4" thick concrete slab Construct 28'x10' pressure -treated deck with stairs to grade Replace sliding door in existing dining area Electrical to include wiring for CATV (3), telephone (3), wiring for ceiling fan in family room. HVAC to be extended from existing circuits. Gas fireplace with wood mantle trim (per Heat -N -Glow options provided) Wall paint, (2) coats linen flat Provide access through existing basement to new bedrooms Demolition, reframe, enlarge and finish lower bathroom/utility area Allowances: Carpet in bedrooms $24.00 per yard materials and labor Tile $600.00 materials and labor Tub, toilet, vanity, sink/counter, faucets $1,000.00 materials Revisions 3/9/03: New 75+- gallon HWH ($1500.) (2) Additional gable -end windows ($600.) Oak floor in Family room; reflects change of additional carpet in BR's and Oak ($1,784.) 3 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road, North Andover, MA 01845 978-687-2635 fax 978-689-2310 Additional Conditions for Residential/Home Improvement Contracts ONLY: 1. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 2. All home improvement contractors and subcontractors shall be registered, and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617) 727-8598 3. Client is entitled to a three-day right of cancellation under MGL c.93, ss48; MGL c. 140D, ss 10 or MGL c. 255D ssl4, as may be applicable. 4. Client is entitled to owner's rights and warranties under the provisions of 780 CMR R6 and MGL c. 142A. 5. Unless otherwise specified or notified, there is no lien or security interest given on the residence as a consequence of this contract. 6. Any and all necessary construction -related permits are necessary for work to commence. 7. It is the obligation of the contractor to obtain such permits as the owner's agent. 8. Any owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guaranty Fund. 9.The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in MGL. c. 142A. Owner Contractor This Agreement is available to contract only at the time of presentation. Agreed this �/ day of March, 2003, by: Client Contractor 2 MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename: Untitled TITLE: Zahoruiko Addition CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 03/14/03 DATE OF PLANS: 3/11/03 COMPANY INFORMATION: Tara Leigh Development LLC COMPLIANCE: Passes Maximum UA = 114 Your Home= 100 12.3% Better Than Code yaLA 13-17—ana 3 Permit Numb& Checked By/Date COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building, and the cooling load if Standard Design Conditions found in the Code. The HV/ be no greater than 125% of the design load,4s specified ite, has been determined using the applicable nent selected to heat or cool the building shall 780CMR 1310 and J4.4. Date 3 Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 352 0.0 30.0 11 Wall 1: Wood Frame, 16" o.c. 486 0.0 19.0 27 Window 1: Wood Frame, Double Pane with Low -E 165 0.280 46 Basement Wall 1: Solid Concrete or Masonry, 8.0' ht/4.0' bg/8.0' insul 352 0.0 19.0 16 Furnace 1: Forced Hot Air, 90 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.3 Release lb and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building, and the cooling load if Standard Design Conditions found in the Code. The HV/ be no greater than 125% of the design load,4s specified ite, has been determined using the applicable nent selected to heat or cool the building shall 780CMR 1310 and J4.4. Date 3 MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.3 Release lb DATE: 03/14/03 TITLE: Zahormko Addition Bldg. Dept. Use Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 continuous insulation Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-19.0 continuous insulation Comments: Basement Walls: 1. Basement Wall 1: Solid Concrete or Masonry, 8.0' ht/4.0' bg/8.0' insul, R-19.0 continuous insulation Comments: Windows: [ ] I 1. Window 1: Wood Frame, Double Pane with Low -E, U -factor: 0.280 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments: Heating and Cooling Equipment: [ ] I 1. Furnace 1: Forced Hot Air, 90 AFUE or higher Make and Model Number I Air Leakage: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfin (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm -in -winter side of all non vented framed ceilings, walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: Ducts shall be insulated per Table J4.4.7.1. Duct Construction: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. Temperature Controls: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: HVAC piping conveying fluids above 120 °F or chilled fluids below 55 °F must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range ( F) 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runouts Circulating Mains and Runouts Temperature ( F) UUto 1„ Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range ( F) 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT :;�L6J ,J_,;�I!'P/yyjJ v� PHONE LOCATION: Assessor's Map Number g C PARCEL Z SUBDIVISION tN% LOT (S) _ STREET �S IAQ_ ST. NUMBER P7 Z ************************************OFFICIAL USE ONLY*********************************** REC9MMENPATI9N%0F TOWN AGENTS: VATION'AD'111iINISTRA DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED 'i r DATE REJECTED 1� "I _/, L SEPTIC INSPECTOR -HEALTH DATE APPROVED . DATE REJECTED COM PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENTC'�o,131/C de Ie RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm FIVER 3 p► NNINCr, ujip, TMENT TE 3- /z -b3 Name PIS L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City AJ t .A4"r I A44l Phone # I am a homeowner performing all work myself. 01 1 am a sole proprietor and have no one working in any capacity ED I am an employer providing workers' compensation for my employees working on this job. Companv name: Address City Phone # Insurance. Co. Po1icV# Company name: Address City: Phone #- Insurance Co. Policv # Failure to secure coverage as required. under Section 25AMGL 152 can lead to the imposition of criminal penalties of.afine up to 61,500.00 and/or one years' imprisonments welLas_civil.p�enalties 'Fto"the lcnn-dAs3MP WORK ORDERand_a.fine_of..(,$]D.O.OD)-atlay.against.me I understated that a copy of this statement may be forwar Office of Investigations of the DIA for coverage verification. /do hereby certify under the par and penalties of p ' ry that the information provided above is true and correcctt Signature Date / � 43 Print Official use only do not write in this area to be completed by city or town official' 7& City or Town nsing. El Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:`'CS\ 055417 Btrtl date 04105/':960 Expires 0¢/05%2004 Tr. no: 21586 Restricted: 60 THOMAS D ZAHORUIKO 185 HICKORY HILL RD -- N D- N ANDOVER, MA 01845 Administrator Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 107679 Expiration: 8/5/2004 Type: Individual THOMAS DAVID ZAHORUIKO Thomas Zahoruiko 185 Hickory Hill Road�� North Andover, MA 01845 - Administrator North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: C k N15 ' -VSSS (Location of Facility) Signature f Permit Applicant 3) Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Nov.24 ':: 22:58 00E0 SANFAX200 series MORTGAG'" PLOT PLAN E.K SURVEY 17 ROYAL STREET, LAWRENCE, MA, 01841 Tel. 50$•--975-1 413 MORTGAGOR _. �,$���,. ..... DEED REQ', 3 6'/& PC. X79 ADDRESS OF PRINCIPLE BUILDING PIAN REF': /x.030 • Z N/ct.Sl �'D, DATE OF INSpECT1bN . o i' / 4 .fie ....`.,...� �,./{.�: //�C 30 � 1:1. 3 PRdPos�� S lTE PLAN.NDD\TIN . 47-.3 i / iV7 Liz ------ Q y s woos �r�sTi N6) / /i IOM 'this mortgayy InxPeatton was prepared ���''' ; I FURTHER SAIL THAT IN MY PRU¢EMONAL protRrdly f`or htartQdp• pUtpasas and Ta not to o� OPINION the prfnclp�,(�M uaiUre/s and aoo&**wy * rolled M U VU RUbEI 7 twtbUlldln �4 t�tbx � �t tllltV�Y tltteiptl/ �► I* n=tty fbr dWno�ss 0 No. DEL with the a.tbadc r•gUk m*nts of the. load Y gene outer do the said mortga N xaniny odinanoes, and that no w%,hroacfilm�r Ind tt% ossr� h Por eatlon with its pa~apoa�od4 , RE'c�stE�;�° of major tmprowm•nt>� sttharc way dvross aort0otts flnon�7q to sold mortgagor. " b� ro stt . ( tKKO V h Y Man r XCspt asaircrrt►. ""MrFICAVON TO: . M't. property is not to a flood Hazard Aron. his .*t 0clum 4 boaW on Atria IbWott of v&wy Ina ks m a z Prvp+cty Is m a MOCA' ftard Ao, )f,.A" Ond does, nbt rapr0Wt d Pt'ap y Jt'Vty, ttter'efcuvl 3. IAfottrloudn Is MatiuMdiMt tb tn• Flood Hczwrd. .ffabtu 1hown ora not to. be AvW for the � sblt>r�mmt of Flood Hazard cie�etminsd 1Fo�a = FWai t Flood iropetty (Ri•s, Insurance Mot Mop Panel# z 3DO f 6 -000fi c Gly /q3 Tko S�-IL-)P-- �t,6U�T1ot� 7--AkbRVIIo a Slb--�Xt - R.DDIT1oy-1 \b2 K \)-X4 l DE KD- , N , ANDoNtt, , M a � 3 -- 0 — ZZ o- 5 g gvlis1x3 v o Q _ Q 4 N Z o _ AV o -- 0 — ZZ o- Ek+STIN6 WM-L Co Is6 RFMvv� 5Rw(E I � d a � _ (►Jiw N n ADD f 47 �I RO I. T N I G R, A( -,C J .o noWl �u A v N � 8 a f C� D 2 y ✓�i 4 3 J .o noWl �u A v N � 8 rifT O z w Q P4 O c u $ w E ay > u $ cn 04 o U z z Q� �,� GG G ° '� o w o a :c U c w W w p•, o c� G w a w �.1 W o cG c� c w a p H w z d o c i% z w " A w v G CO L cn ° cn 0 ns c c w o � c H v C.a d� ac Ods I s o s.► m don" Ea 0� v cm w ,$ L: u tm Lyv E os CO) C y y O A. N : co 0 o, :m O m L > -oa c y •O O r m 232:2 f•" m y m c •c N ~ w y m O m W = y m f LL N G.,C O = Z ocLLJtm E �� m O V m p m = H" COD Q m. O:0 2 �0CA= O s CL.- Co ::Ip O O obi CO O 0 s Z O CL O y C CO cm cn I ®�_ O — •E Ca m co CL ~ .�..• � O.a 0 O � O � N C o .0-0 � cc v J .� •G1 O cl) C Z co C� C •CA A LU C) U) U) crW W W U) Town of North Andover Office of the Conservation Department Community Development and Services Division 27 Charles Street �� Julie Pam -no North Andover, Massachusetts 01845 Telephone (978) 688-9530 Conservation Administrator Fax (978) 688-9542 March 14, 2003 Thomas Zahoruiko Tara Leigh Development LLC 185 Hickory Hill Road North Andover, MA 01845 RE: Proposal to build an addition at 182 Hillside Road Dear Mr. Zahoruiko: This letter is in regard to your proposal to construct a 22' by 16' addition to an existing single family home located at 182 Hillside Road. A drainage ditch exists along the northern and eastern property boundary line and you inquired whether .the ditch is a jurisdictional wetland resource area. I have reviewed the property and it appears the ditch is conveying overland flow from the surrounding properties. The ditch is approximately 200 feet in length, one to two feet in width and approximately one foot in depth. The ditch is not flowing from a resource area and appears to flow into a culvert under Route 114. Vegetation surrounding the ditch is dominated by a quaking aspen overstory. Bordering vegetated wetland along the ditch appears to be very limited. I am of the professional opinion that the ditch would not be subject to protection under the Massachusetts Wetland Protection Act and North Andover Wetland Protection Bylaw. Work may proceed without a filing with the North Andover Conservation Commission. The addition must not be constructed so as to interfere with the natural drainage flow of the ditch. If you have any questions, please feel free to contact me. Sincerely, Administrator cc: NACC Robert Nicetta, Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Nuv.24 ':' 22:58 00E0 SANFAX200 series MORTGAGE.. PLOT P -LAN 1:1. 3 EK SURVEY 17 ROYAL STREET, i.AWRENCE, MA. 01841 Tel. 508--975--1413 MORTGAGOR _ DEED REQ', PG. Z:7F., ADDRESS OF PRINCIPLE BUILDING PLAN REF. X030 1�It4NLbll 2t X14 ,_ DATE OF INSPEC110N _ Nov, iL/ 46 r//e 30 /0/ - , ' t 47- 3 U N i Ile T PL E PLAN r V . 1 hRoP• t � r► N�) , r � IOM M)a mot•tgo a Inspecu0n was perparsd ,�'�1 ';h' i FURTHER SAIL cT2pH�AT IN MY PRq�ONAI. P*Ct�Y for htotgdge purposes and b not to o� � OPINION the ifi_nW�M volare/s and cooav*wy 4 tNt>td 1t cud stlrity4- Ek IAJI%WY 6acdp4 Y '� twtbuildlnys, �Q to n••t% 'Tty fot• dd�d RUDEL �; with the satbaeic —"`— ��ss No. 389at� t^agttk�rtrtents o! the. tonal vtllonail by dn" other thdn the said margo w '� xonlny adInanows, and that no wtohre'achmwdv Ind hu "'WOns Ia omectlon vM Its W*ov"- STE'�`�° of mci* Im"v month etthot gray dam" n�OdR+ fly cn. 01 g. to sold mortgagor. " '�oN,�c tt,Kobo prohwty Ilnas axaopt an eiKmvn. MTMCATION TO: . jjT, property Is not !h a Flood H=and Arno. r1c*uff0otfatt 4 bond (A tho It>rot M of W"y tnarkwo 13 Z Prcp.cty Ism n tlaadl' ftord AIA(h &01h" Ond dM >nbt t9Prt tit d y �clrvey, tfi�Idr�I d& ((lfotfiQuork Is Mftu"oliAt tb ins Flood Hazard, 4fabis 1howtt ore not tb be pend for th• ea�x WIthinent of Road Flaznr'd tir ttnbnird iFo10 � !'bdaot Road it^ap�tty lits••. Insuronos Rats Map Pond f z 3Vof6 -Qpo'G c ���, Jq3