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Miscellaneous - 221 WEBSTER WOODS 4/30/2018
p INSURANCE* July 26, 2016 The Commerce Insurance Company'm Citation Insurance Company'"' 11 Gore Road, Webster, Massachusetts 01570 508.949.15001 www.mapfreinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MA 01845 Board of Health or Board of Selectmen Town/City Hall RE: Our Insured: VIBHASH DESAI / JAGRUTI DESAI Property Address: 221 WEBSTER WOODS LANE Policy#: BDZYCK Date of Loss: 07/26/2016 File#: MPNY18-KHYXX3 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. DONALD LIBERTY Telephone: (508)949-1500 Ext: 15147 CLAIM REP, CAT RESPONSE Toll Free: 1-800-221-1605, Ext: 15147 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. July 26, 2016 CIC 254 (Rev. 4/95) MATE, M7; .F- Date/............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION T�,is certifies that.. �t ............................... . has permission for gas installation in the buildings of. . at .................................... . North An over, Mass. FeeC�.. Lic. No. 73.? .3 ... .�..c� . .... . GASIN SPEC Check mip G TYPE OR PRINT CLEARLY -MAS&ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATEW—LWPERMIT# JOBSITE ADDRESS OWNER'S NAME SSC OWNER ADDRESS T rf FAXL OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL[] RESIDENTIAL[e NEW: D RENOVATION: ❑ REPLACEMENT: APPLIANCES 1 FLOORS- BSM BOILER BOOSTER CONVERSION BURNER (� COOK STOVE DIRECT VENT HEATER DRYER FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCI MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER _ I OOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER PLANS SUBMITTED: YES[] NOF] INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [ZNO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 9^ OTHER TYPE INDEMNITY Q BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ] AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are a and accurate t e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in m Iia wit IIP ant provision of e Massachusetts State Plumbing Cod and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE # ATURE MP L✓ MGF ] JP (] JGF LPGI ® CORPORATION Imo'# PARTNERSHIP ]# LLC ©# C� COMPANY NAME. ¢' C ADDRESS CITY a STATE ZIP TEL FAX p CELL EMAIL i1_MQ Qror C- r—,nw,,n _ h o 11 Date s // .... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..,,r..6'� has permission to perform .... `� �, , L �................ . plumbing in the buildings of.. at .................................... , North dover, Mass. Fee .G•2 .. Lic. No..�37�... .. . PLUMBING INSV CTOR Check # -� f� f P TYPE OR PRINT CLEARLY HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY d MA DATE 3-P)fl6# # JOBSITE ADDRESS�'�'�"'" �bSYpil' OWNER'S NAME r..�Ct I r OWNER ADDRESS TE6���FAX � OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL L;' NEW: ❑ RENOVATION: 0 REPLACEMENT: FIXTURES 7 FLOOR- BSM BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM IF— DEDICATED GRAY WATER SYSTEM i— DEDICATED WATER RECYCLE SYSTEM r` DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER IF— FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER PLANS SUBMITTED: YES ❑ NO❑ M� w INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES e0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY e OTHER TYPE OF INDEMNITY n Rmmn 1-7 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applic< and that all plumbing work and installations performed under the permit issued for this application will Massachusetts StatePI ing Code and Cha ter 142 of the General Laws. PLUMBER'S NAM ,� ,t1,l�p CHECK ONE ONLY: OWNER ❑ AGENT true and accurA to the best of my SIGNATURE COMPMilf _M the •` a �"�9 Date. - < `' - N° 440 ' 011.,+ TOWN OF NORTH ANDOVER is a .,._'. 0 PERMIT FOR PLUMBING ss�cNus� This certifies that . ................ . F . has permission to perform ... ............ plumbing in the buildingsof..111 ......... .................. 11 at. U-:-� 5A,. . . ' . , North Andover, Mass. Fee.).?. ... Lic. No./(, 7 ?J ........ �I . G.,% s'�...... . PLUMBING INSPECTOR WHITE: Applicant-�CANARY: Building Dept. PINK: Treasurer usmtaumoj 'James Ja run KT osaaor .L asaao.12mgmnl jo a Z 1.7!10 asn 3OLUO) CRAM unno, X - ' ad aouqdu= 'SsI I=UOD a1RJO ZVI =dmD Pue apo 2u!gmld omS M2mgmssuW ag3o mots!noid 1wupmd Is gl uc oq Minn uopmlldde snR J03 Panssl 3?=d MPM paced suopH Pus 3IJonn Smgmnld Its Pus a8pajnwux 4mjo lsaq aql of axm= pus anu ase uopmgdde aeoge ur (paww Jo) pal}rmgns aesq I uolleuuogu►pm sltgap agl3o l�R �9 q I lua8d launnO artue[�rS aausmsm =np anoge 21DJO auo I{ue ansq IOU saop uoueorldds SnPJO aasaaoq aql XT M&t' apsm uaaq ansa `p2u2.!=Pun aql I :Janteb aouemsul puog E 4n=pui jo od,4 mxpo 6ogod aouemsm 63IIIgv-j xoq mapdoadde arR 8uploago 4q aSBJanoa aouwnsmjo adVl arR aimlpul :a eJanoD xrusmsul tmgmnId posaaarlP 2=.R /O/—hay ouogoalaZ ssauisng 0 APPY •�wJed E 'dwJ 0 amet.I husdmoD Bmllstsal mmU!MD :auo �aagD (ate Jo 1upci) S��LLXl� ON � sQA paurmgnS weld � luamaosldajj us nmOjo oclXj. lunourd G � MEG 13 uousnoua-I 12n marl Bulpling &UaSfMVSSVIA.7 `IMOaAV HI'dON (laud Jo adrCZ) DNuoA au., OQ OZ .LIb iac, 2I03 Noj ,vDI'Iddv I1I2iOmKa SZZaSl1HDVSSVW a/s- _.N° 2292 TOWN OF NORTH AN PERMIT FOR WIRING This certifies that.a !? r !. S t -..i � C {� i ! L. �........r- t ........ . � has permission to perform ....�.J:e �......................................... �......................................... wiring in the building of .M.P ............. �. i at, t.�...........��..'.° l....... N..k �-c 2„ ... V. , North Andover, Mass , Fee....�..73.:dJ. Lic. No. P�31 .............:. ........:?........ l.(.............. 'EI;ECTRICAL INSPECTOR Cir V1, � WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1—N, TBE60M110NWE4LTH0FM4SSr1CHUSETIS office Use only �— DEPARTMEYTOFPUBLICS9FBT>t' Permit No. (T V ,, l Z BOARDOFMEPREVEMONRWMTIONS5rCM IZ* ug Occupancy &Fees Checked APPUCATTONFOR PERW TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 •. L, (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1 a Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L0 f Owner or Tenant Owner's Address 3 Is this permit in conjunction with a building Purpose of Building Yes No To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. 0 Existing Service Amps Volts Overhead Q Underground Q No. of Meters New Service b V Amps a°/-2Volts Overhead [::] Underground No. of Meters —�-- Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting OutletsNo. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures /I Swimming Pool Above Below Generators KVA Fe ground grourid No.'(?f Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units rl V �tJ No. of Switch Outlets No. of Gas Burners 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 Local ❑ Municipala 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 >tts WXCCo�age: Laws Q IhmaamecrtLiabl*h w&=Pc ymdJ&9CaT9i ClAtrdWCritS WJAMtd W0103lat YES NO Ihaw%hrVtdm&prodbfsame1othe06= YES " NO r7 If}whaeedwdcedYES, cdukthe4peOfMA dWbydedaigdx apq>xx LAQkfiJ �)- —CJ --0 INSURANCE n BOND (� OUiER mwSIedY) �+�+ E�p6ationDea6e Estimskdvaluec>t 1Wak$ WorkbSlatt y �..�0.��.1iVmdcnD* d R60 Final Sigiedunda�ieP G XP �� g FIE2MNAME - `'� �� � liariseNa Idoarsee � tWr� � Sigt>ahae Lioa>SeNo BIa¢ mTd.Na 9-7 -� 95�5-6 OWNER'SNSURANCEWALVEP,iamawmdAtheLkawdaesmtheitam=wvw, ecrirssiEwtaloWaietastegLmWbyNimsmhB&COVEdImNs anddiatm * aUeatthsprm� n thtstet nad (Please check one) Owner Agent 3 73 Telephone No. PERMIT FEE $ Location No. i� Date 2''c;k- r l TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _-ZS• TOTAL $� Check # Building Insp4cfor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ?17 DATE ISSUED: .2-16 —c)OO/ SIGNATURE: //// N - I Of SECTION 1- SITE INFORMATION I Date 1.1 Property Address: o �- % 3 1.2 Assessors Map and Parcel Number: 106-8 %%8' Map Number Parcel Number DC w Gk� L 1.3 Zoning Information: Zoning District ProposedCse 1.4 Property Dimensions: 53 1W ao2� r Lot Area (s6 Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required —4 Provided RequireEr Provided 3v' ° 3 ' 36-11, 30 1201 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: Public W Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ;k On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record C'�-� • ��/ �rt'sT �-� � X37 ��� ��. S��-.�� �� �U. �� �2 Name (Prin Address for Service Signature 2.2 Owner of Record: Name Print Telephone Signature Telephone StCTION 3 - CONSTRUCTION SERVICES 3.1 .Licensed Construction Supervisor: _rz Licensed Construction Supervisor: Address 657 5 -300 Signature Telephone 3:2 Registered Home Improvement Contractor Company Name Address Sionature Teleohone Address for Service: Not Applicable ❑ (26 v6y,_�23/ License Number /y/o Expiration Date Not Applicable ❑ Registration Number Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction 14Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: woo C( ec/� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building t / T (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction % - CJ �( V 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. -Signature of Owner Date SECTION 77/b OWNER/AUTHORIZED`/AAGENT DECLARATION I, /�� /CJS sl as Cr/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 Na �/ ld Od Signature of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2 ND3RD SPAN DIIv1ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 oP-N uEcK FORM U - LOT RELEASE FORNI INSTRUCTIONS: This arm is used to verify that all necessary appro\ials/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. FILLS OUT THIS SECT ION********************�* 56-7-5'760 APPLICANTC� �2/ �r�f G�� PHONE LOCATION: Assessors Nlap NumberI'D /3 PARCEL l �d SUBDIVISION_ ca. Aell rCre--�S7t LOT (S) _ STREET 1A-) e-YJSlLle--r %0 ds 6swt•'Q ST. NUMBER �� f * ** * * ***** ** *******OFFICIAL USE ONLY***** ** * ********** s RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS - VeCU< (�:) dIj OflglNw' dfAA TOWN PLANNER COMMENTS t FOOD INSPECTOR -HEALTH i SEPTIC INSPECTOR -HEALTH COMMENTS PUBLIC WORKS - SEWER/WATER C01 DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED DATE /1-6d v } CER TME717 PL Q T PLAN S.E. CUMM/NGS & ASSQCIA TES N WEBSTER WOODS LANE 'r ALBERT T �r TRUDEL No. 3CM9 �EGISTE�`�dC;°:1' LAN SCALE I" = 60' / HEREBY CERT/FY TO TOWN OF NORTH DATE: MARCH 13, 2000 ANDOVER, MA BUILDING DEPARTMENT THA T THE FYISTINC f 0004 /XA/ DRQ WN MIN/MUM SETSACIfS.- FRONT - 30 fEFT ON THIS PLAN IS L0C,ATED AS SHOWN SIDE - 30 FEET AND THA T /T DOES COAIPl Y TO TUE REAR - 30 !7f -ET MINIMUM BUILDING ��ETBACf<S TC PROPER TY L INES 754-CPP73 11 Cyt - .4 Is -a ala l '3col ss" Is 6u I w w " n - =1 - -Kzt AC t in T 7r-1 1 ra ra —a.. r ———.. aOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 069234 Birthdate: 05/09/1954 Expires: 05/09/2002 Tr. no: 23903 �.Restricted-To:', oo ALAN G RUSSELC 400 MAIN ST GROVELAND, MA 01834 Administrator I C/) m m U) 0 m I y e O o CA CD 0 Z CO) e O 'O• CL r. c � ? c CL = y 0 n O � CD CDCL O ■.�. Cr " d CD Sr CD O CD C CD y CL v y —• o co CD s y O 1 Z O O o CD C CD m _ O �• N O Cor o fA SnO c.O.y O m m C3 o y n c. C9 rn Z =r-CHIm CA •� s m CL V-0 CL �m H O �O m N o N gym : m = > > 0 'A ® 2 .-r � O n 0 az CS CD CL -+"'' m C I C=D CD H Cn � oma nCD o ® * z Lvi N C d C (n _p• CL os O o •^ O �CD o V! tx C2 m ie d. c ®I� r , �f Co � , aO C13 ow Cs: n C O w C/) W, Ao C/) o W 0 0 � til po w - b EL ; A x tT! r" n b Ix w Pd aha r M Ix °�'� n � zITI aGc ar Q. R. o. w M C a. � R. x r to 0 c 3 4 U G Date. .%:.1..-.�-.:... MORTH TOWN OF NORTH ANDOVER py`4t `io ,e 1q.�o p PERMIT FOR GAS INSTALLATION This certifies that ..? * . .1�. �........................... has permission for gas installation .... in the buildings of ... <...................... at North Andover, Mass. Fee. ��.�.':. Lic. No...� 7 ! .....Q;..�.) cr......... GAS INSPECTOR U WHITE: Applicant CANARY: Building Dept. PINK: Treasurer t > MASSACHUSETTS ill�iiFORM APPLICATOIv FOR PERMIT TO DO GAS G T moi, ype or print) Date NORTH ANDOVER, MASSACHUSETTS T— Buildine Locations L- 13 f/l/ Permit # 3 Amount S �a t Owner's Name New Renovation ❑ Replacement ❑ - Plans Submitted ❑ (Print or typeG 1P + (A Check one: Certificate Installing Company Name '- r r —/ �� c � Corp. Address 4-p.wr<r"er /ka, oiSr?� iness Telephone 49 (q -?k) (00(q- 10-13 Name of Licensed Plumber or Gas Fitter ❑ Partner ❑ , Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I herebv certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code a?�PChapter 42f e Gene 1 Laws. fJ By: Title C irviTown APPROVED (OFFICE USE (AL Y) Sip -nature of Licensed Plumber Or Gas Fitter " ❑ Plumber M' 7 Z h Gas Fitter Licenk Numo r `-1vlaster ❑ Joumeyman aanw�e ����a�ao oar �o��o (Print or typeG 1P + (A Check one: Certificate Installing Company Name '- r r —/ �� c � Corp. Address 4-p.wr<r"er /ka, oiSr?� iness Telephone 49 (q -?k) (00(q- 10-13 Name of Licensed Plumber or Gas Fitter ❑ Partner ❑ , Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I herebv certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code a?�PChapter 42f e Gene 1 Laws. fJ By: Title C irviTown APPROVED (OFFICE USE (AL Y) Sip -nature of Licensed Plumber Or Gas Fitter " ❑ Plumber M' 7 Z h Gas Fitter Licenk Numo r `-1vlaster ❑ Joumeyman Location /ale W c,7a U, Ag "L'u No. d q Date � y 6 v 40*TM TOWN OF NORTH ANDOVER •. • O - _ L R Certificate of Occupancy $ s��M�s Building/Frame Permit Fee $ Foundation Permit Fee $�---- Other Permit Fee $ TOTAL $ Check jo�, 3657 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 0 # DATE ISSUED: SIGNATURE: a6460%, Buf din Commissioneri7E for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: © f- f 2 1.2 Assessors Map and Parcel Number: /D�13 l78' tea/ 0P b s¢er woods C.an e Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonina District Proposed Use Lot Ar sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide Required Provided Re fird Provided a'S' 3" 30' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal Public r Private ❑ �f On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 31 ts,,,IYVW st see a F AA Name ( rint) Address for Service — 4;�4 A�, 6' ;7- "Sao Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ /-?4f l', ss Licensed Construction Supervisor: e S' O 6 9,2 3 y, License Number 6W31 5a7*1r- 5r swe ft! oz I—, - Address Address- _ G7 "?/"" 7 "3 .?®U Expiration Date Signature Telephone tS:fe � Ss�i- —76cI 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T M X ic z O u v a M to S,% a to 0 Z, M 90 O Mnicr v M r r z 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 ...... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction V Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ : , Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 53ary/f�2ic����is. n &r,V e WdU6- /dl -or t� ✓moi . f .s�;�1i �^OTr-+'� �yX 11.1 or r—ro-wfi v71fraµc,-e W ao.( de/� � � ter+✓ c�%Parry r,� %r �'. DD �' , *16 R F'A. SIECTIOR 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building ® (a) Building Permit Fee Multiplier �p • 2 Electrical (b) Estimated Total Cost of Construction ®• 3 Plumbing Building Permit fee tat X (b) + S&O 0:000 ! 0 �i 4 Mechanical HVAC 5 Fire Protection on 6 Total 1+2+3+4+5 Check Number I GP of I SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf. in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ? �5 S�G�' as Owner/ nzed A �eo 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 Name Si ature of Owner/Aa Date NO. OF STORIES SIZE a BASEMENT OR SLAB,. c SIZE OF FLOOR T]MP,ERS "T 2 ND�v 3 RD SPAN DIMENSIONS OF SILLS Dl]v ENSIONS OF POSTS DIMENSIONS OF GIRDERS2- HEIGHT OF FOUNDATION /p " THICKNESS e o `e SIZE OF FOOTING X 20 MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND aal IS BUILDING CONNECTED TO NATURAL GAS LINE 91 FROM : MCKENZIE ENGINEERING GROUP,INC PHONE NO. 6179412662 Jan. 20 2000 05:19PM R3 1Ne N ti co b ! w�� so Tv I Tv E AAl 0 T 13 —50,2$0 / 1 Lv / co�N HA1tBALES & / 2s. '� SIL.TATm FENCE ` G MH -16 ��• FORM J LOT RELEASE The undersigned, being a majority of the Planning Board of the Town of North Andover, Massachusetts, hereby certify that: a. The requirements for the construction of ways and municipal services called for the Performance Bond or Surety and *dated Dec., 14 19 _1_9_ and/or by the Covenant dated Maw a9 , 19 JA and recorded in District Deeds, Book 4 88 0 , Page 1.14 or registered in L* No. Land Registry District as Document _ and noted on Certificate of Title No. in Registration Book f Page ; has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown an Plan entitled " Cam 21rarf-Sj Whyihve Su6Luisim P1QA1 Section (s)!Sheets 1- 7 Plan dated py r Mher q. , 19 11 recorded by the ESsx N ortk District tegistry of Deeds, Plan Back , or registered in said Land Registry District, Plan Book , Plan '*/a7 8 4 , and said lots are hereby released from the restriction as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) LOTS Lars ! -rand,, 3 ; LOTS I hereby certify that lot number (s) Lors Zg rev 3'z -j 84 JonNfirs 1�. t&%Jkr (Awe k] gM.. W oo►�.►.,✓� Lb-+Nv r7tt.���! Street (s) conform to layout as shown on Definitive Plan entitled Section Sheet (s) ZY,ZS f Z'1 �S �►w Z 3 on do 0 F MAS�9cyGJ+ ALBERT T• ailf CD TRUDEL z; R gistered Land Surveyor 4 No. 36869 0C a 9ECISTE��`�JQ,� 1 of 2 C. The Town of North Andover, a municipal corporation situated in the County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated , 19 and/or Covenant dated 19 from the of the City/Town of County, Massachusetts recorded with District Deeds, Book Page or registered in Land Registry District as Document No. and noted on Certificate of Title No. in registration Book, Pageacknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: EXECUTED as a sealed instrument this -k"day of 19 Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS E�SSeX , ss -2/, 19 95 Then personally appeared A115;�1� 12 I OW , one of the above members of the Planning Board of the Town of North Andover, Massachusetts and acknowledged the foregoing instrument to be the free act and deed of said Planning Board, before me. Notary blic 5, zoos My Commissi n Expires 2 of 2 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. Willett Staff Engineer Telephone (978) 685-0950 Fax (978) 688-9573 Additional conditions for lots 7,8, and 13, Campbell Forest January 26, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 7, 8, and 13 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for these lots so that the construction of these three homes can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into either residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. Z. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violatioe aboonditions will void both water and sewer connection permits. No refunds will be granted. / Printed Name Division o lic Works Printed Nape CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin Date Date 147E APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. �G'! K 21, 4.9 -- Application by the undersigned is hereby made to connect with the town sewer main in C`''am 1� �rL Street— subject to the rules and regulations of the Division of Public Works. The premises are known as No. "(/e�5v� ��'rs �`�P Street or subdivision lot no. A Owner Address Contractor Address pplicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to mgr Le:� to make a connection with the sewer main at v e"? �� (.�tJirL� �l Strut subject to the rules and regulations of the Division of Public Works.. Inspected by Date DDn of Public Works By See back for rules and regulations N2 940 APPLICATION FOR WATER SERVICE CONNECTION r North Andover, Mass. '2. Application by the undersigned is hereby made to connect with the town water main in— subject n subject to the rules and regulations of the Division of Public //Works. 4n��4; The premises are known as No. "'��g�I-Ie2-4jG Street_ or subdivision lot no. c Owner Address Contractor 4 re/ 4 15r.oa PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to �'S" // '4v. to make a connection with the water main at subject_to the rules and regulations of the Division of Public Works. Inspected by Date 41 - Street Board of Public Works i RV (�' lv)l'�4A'* See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 685-0950 Fax(508)688-9573 DRIVEWAY PERMIT Date: LOCATION: 22/ BUILDER: phone: OWNER: A��7phone: ��7 S,,co The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 I I I I I Checked by/Date I I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 1-11-2000 DATE OF PLANS: December 1999 TITLE: Lot 13 "The Harvard" PROJECT INFORMATION: Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC. / Mesiti Dev. Corp. 231 Sutton Strret Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 511 Your Home = 502 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 2090 30.0 0.0 74 WALLS: Wood Frame, 16" O.C. 1915 11.0 0.0 171 GLAZING: Windows or Doors 442 0.350 155 DOORS 56 0.490 27 FLOORS: Over Unconditioned Space 1590 19.0 0.0 76 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MASche-ck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 13 "The Harvard" DATE: 1-11-2000 Bldg.I Dept.I Use I I CEILINGS: [ ] I 1. R-30 I Comments/Location I I WALLS: [ ] I 1. Wood Frame, 16" O.C., R-11 I Comments/Location I I WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I DOORS: [ ] I 1. U -value: 0.49 I Comments/Location I I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 I Comments/Location I I HVAC EQUIPMENT: [ ] I 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ l I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can 1 be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans I or specifications. I I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I I DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return 1 ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the 1 manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not 1 permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ J I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from 1 non-depletable sources. Pool pumps require a time clock. I [ J I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 1 refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) 1 NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 I 1.0 1.5 2.0 1 140-160 0.5 I 0.5 1.0 1.5 FROM : MCKENZIE ENGINEERING GROUP,INC PHONE NO. 6179412662 Jan. 20 2000 05:19PM P3 N F k to yco b �p ' ~ It MCC M-57 OT 1 3 SF 14ATALE ZFF1'ICE h /' � ,�' •,G �°tel'' u`r '� " 38.2 141x _ J 1G H-16 �� / f (34X) BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Budding Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: va S Location of Facility Sigl'iff rue 8n:1'ermit Applicant .Y I I �/�/ �lJ Date NOTE: Demolition . permit roni the Town of North Andover must be obtained for this project through the Office of the Building Inspector I . S J FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verity that all nec.essary 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 APPLICANT6Q,,aZ GGc PHONE W-9366 LOCATION: Assessor's Map Number /06 '13 PARCEL SUBDIVISION C2,�Aef/ Fir 2- LOT (S) /3 STREET 4,W. Steffi (IJ02 & L +� ST. NUMBER 22-1 REC0MMENDATI0NS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR USE DATE APPROVED - DATE REJECTED COMMENTS `'s �C (7-- ' ColIYv`�w TOWN PA, NER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED - ;A I�I PUBLIC WORKS - SEWERIWATER CONNECTIONS �V �(,Z6 - DU DRIVEWAY PERMIT 7q 0 (-z6-00 FIRE DEPARTMENT RECEiVED BY BUILDING INSPECTOR DA i t Revised 9197 jm Vv Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of.North Andover Growth Management Bylaw. Tile building applicant shall provide all of the necessar/ information as requested 'below. Name of Applicant an cuilding Permit (below) Address of Property `cr Permit (below) S e Map and Parcel : `; j� Purpose of Application (check below) Phone Number of AppJTicant: V Single Family Two Family — b 9 7—SJpd" I the undersigned applicant far the above property attest that the attached building permit for which this form is =mpleted does comply with the E<EMP'i fON section 8.7.6 of the North Andover Growth Management Bylaw. 1 also understand providing this form does not absolve me cr any party to this permit from the requirements of obtaining other permits required prior to the issuance cf the �_-'uiiding Permit. Further I understand that my interpretation of the EXEMPT ION status is subject to review by the Building Cepartment and is only officially accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with ane or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement restoration, or reccnstructcn of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Sectcn 3.7 of the Zoning Ty—law. This application is for dwelling units for low and/or moderate income families or individuals, where all of the =noitions of 8.7.6.care met and/or represents Owelling units for senior residents, where ec =panc/ of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 4011G permanent reducttcn in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract• with the surplus land equal to at least ten buildable aces and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Oevetoper in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the P!anned Growth Rate and (Development Scheduling provisions for the purpose of constructing one single family dwelling unit an the parcel. This application represents a lot which is ready for building pernits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Oevelopment Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Cevelopment until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved fort U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate infcrmat' a checking off of an above item which does not comply, whether done to my knowledge or not s grounds or refusal by the Building Department to issue a Building Permit. /lam/ o rJ Signature of QwnerW AWforized Agent wno sgned the Attached Budding Permit Oate This form must be attached to the Building Permit upon application for such permit " DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Birthdate: CS 069234 8510912000 0510911954 Restricted To: 00 ALAN G. RUSSELL �� x �✓ 400 MAIN ST GROVELANO, NA 01834 The .Commonwealth of Massachusetts Department of Industrial Accidents 0f'ics of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print I Name: Location: honeaCiti! Phone- F7 1 am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity FV j I am an employer providing workers' compensation for my employees working on this job. rimmo• A-7 , , /moo%% 1-�;.-e-s L L �° � T �s� �,' l� e/0- Ca Address 231 S0ff6r7 S111- Sir f t' ai= /v'y/ever /,(.a 4 /8Ys Phone - (/azo 6 & 530 0 Insurance Co Ur;,, �Pd `�� ci I/ ��S �O Policy # DO Comoanv name: Address Citv: Phone #: Insurance Co. Policv " Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pain and Pena s of perjury that the information provided above is true and correct. Signature /0( Date/ o o Print name �Zz z C. /zsS-e// Phone#�7 557-S76v Official use only do not write in this area to be completed by city or town affidal• City or Town PermiYUcensina ❑Euilding Dept Licensing Board Selectman's Office Health Department Other ❑Check if immediate response is required Contact person: Phone #: i tA c� s Jo _In =r IIP, n o. Z -� o fD o o 1 0O ? ? N - 'a=c y m ran N (D n _ o Q �,In -� 0 A o CD 3 (A 0 O O r � � D M>CL _�� Ma" (03 4 C (p I :� E D H O o a a (D O 3 C `° m c 3 t Ln CLn 0 n ai O O �� y D E E CL _ -, CL Z Q � 9' o m ? 'o S ' 7 O N . d w O. -0o a E. 3 °'0' :7 Z v CD ?� w a :A �~ C m ►-� (D D .r.L id's y � � I 0 v v i 7w 0 c O c•viaQ N = gag y ..� roc m n � m !7 G. n 117 ® Z N m �� y „_-* = .dim C T ff=5 CL w CO3 m CA o -� �■ , O ® N n .7� �� C7 Om O d z�.c, CA C7 o y " ' 3o'm co ' d r C' CJ/ m CD y p ►Tj a m : CD G d = I& d O 0 cf)CD O .0 CL ` d C 0 O '^ y �r H CL _ �• V/ H C^ CD 90 CD 1 CD CCD O CCD .Q j7 Go w �, Z m o C CD y � � � � �.CA CL o y CD � om CO CD m o CO) -v zCD 0 Z yr CD CK 7 O M C-3 C 0 :A: CD .�; o = (D -, �, x r" O GQ =r � x a GJ d CIO � Oil i z 0 J 4%3y 0 O C Location ! No. J Date -3/1 C/ 00 � r �aRT� TOWN OF NORTH ANDOVER G�r.ao ,a1ti O • • Certificate of Occupancy $ +1'�s''•• E<�' cBuilding/Frame Permit Fee $ S s�Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1— Check # �14 '13679 / � Building Inspector CERT/RED PL 0 T PLAN S.E. CUMMINGS & ASSOCIA TES N ``65.00' INEBSTFR �1V0�G�S LANE SCALE 1" = 60' / HEREBY CERTIFY TO TOWN OF NORTH ANDOVER, MA BUILDING DEPARTMENT THA T THE EXIS TINC E OtWDA 80AI ORA WN ON THIS PLAN IS LOCA TED AS SHOWN AND THA T /T DOES COtiP:L Y TO P -IE MINIMUM BUILDING SETBAC/<S T^ PROPER TY LINES. OF b? T ALBERT % TRUREL No. 36,,869 ' OA TE: MARCH 73, 2000 MINIMUM SETBA CItS• FRONT - 36) FL FT SIDE - 30 FFF T REAR - 30 ,- FET 754 -CPPB .r CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permiteumee, O /a_000_0 a o... THIS CERTIFIES THAT THE BUILDING LOCATED ON W 13 4 as 0) IPA Jr it W00ch L V 'e- _ MAY BE OCCUPIED AS 5ivFAt� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. . I Room s,,3'b 8,q*h5j a 5+4 AitAFh&4 CERTIFICATE ISSUED TO EMI Piet I To r,,-4 L L C- ADDRESS 431 1�-1 Su t+e Q F sAC""sBuilding Inspector Town of North Andover NORTH q 0 <�eOti Building Department �,? 9`t 'b'6 0 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 VV e MKNtwKw _ 1' S APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LliotklS �� P LOT NUMBER 13 SUBDIVISION A7iati,F�� DATE REQUEST FILED a 's- DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTUIT DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE v OFFICIAL USE ONLY ROUTING CONSERVATION DATE Z < 06 r , D.P.W. — WATER METER z5K 7TW DATE o — D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOTO INSPECTION REQUEST DATJE. g—m SIGNA / D AUTHORIZATION O —•ilio H �► � ap�m � y ® oZ y CC, �. T CO) ILP'�C7 a� H CL n b OD C m CD -� o m ti ca p -� �M �■ 1 o ® m CO) ® 0 G is. o• n =r CD 't j �t c ? y Cl) Z CO) $4 � r _. m CD CL C? C/) um 0 ; m y c 0 CD nCD m ncc• y O CA Im y: , m O d V ya d k.r-r '` o v ►a CO) CD As a C m ' _. CA CD /" m M nat N 'low:\ / N :� Cl) o co D ,W CD O CDD nO C=D r W W o C CD ca F 9 CD N .-► M C? �• .nom• 5'� L7 '= D CD COr7rr" 1 CO) ov ►--� CD {CDa CD r K ---1 4 CLR:CD � 0Leo co : o pCD imw cn cn 0 A w ti n _ ,l7 G n7 cn'�b"d)J o "'� x G CL a7 �O O n a Gyp ; r O 7dw It v' tin 0 %cQj z O 0 J J w CA v )mq 0 9 0 c CD1*4 1 Mesiti Dev Group Fax:978-5578160 Jul 17 2000 1354 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J! Alam Hmumlak �0"TM Telephone (Y78).685-050 Director Fax(978) 88-9 S7 (� 1 6 3 •�Y July 14, 2000 Mr. Kenneth, Grandst4 President Mesiti Development Group 231 Sutton St Suite 2 F North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear Mr. Grandstaff-. The Division of Public Works has inspected the sewer collection system and , sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the following: I. Completion of items I through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesid Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station, 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and faciilities in the event -------- --_----........ _ that Mesiti Development or its agents fail to adequately perform maintenance of the pumping station. riesiti Uev broup F ax; 9 (8-55 (81bu Jul 1 � 2000 13:54 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indent*, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the 'rown" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T?Y T.ours, i J. Willii1m Hmurc' .E. Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant ofSonditional use.