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Miscellaneous - 230 WEBSTER WOODS 4/30/2018
l,. a Liberty Mutual® INSURANCE November 13, 2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 230 Webster Woods Ln, North Andover, Ma 01845 Policy Number: H3221215897012 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number: 032794908-0001 Date of Loss: 10/16/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, � 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Irm C.t IVAUVIUIY vvrAl l.Ln Vr rnti. �,nv.w� �•• w �- • DFPARTI1 W0FPUBUCS4FE7Y Permit No. BOARDOFFIREPREVFIMONRD91TAHONS5VaRIZVO cf -off Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover To {� �To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) c�— Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building Existing Service AmpsVolts New Service AmpsVolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes J o a (Check Appropriate Box) h Utility Authorization No. Overhead M Underground r r: : ' }No.`of Meters Overhead [MUnderground =1 No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below eneratofs KVA round and No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units 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 a Municipal Connections _ Othe of Dryers Heating Devices KW of Water Heaters KW No. of No. of Signs Bailasis Hydro Massage Tubs No. of Motors Total HP 4 _r Pad0fsametothe0ffM YES mhrr- 11� dovWft YES M NO M lfycuhavedrdWYES, pleas✓indicatelhetypeofamWby Esti n*dVatled ]xoWade $ hW"orlD*Retltreslad . Rao I Frlal 1Scn - r�iePF�tallesofp7_ �lt? rTi!�' 0Stgrtahne C`�� - Ltoel�eNO ��� p Bud= TdNo. T ALTU%�- INSURANCEWAMikIamawwthattheLio wdriesmthavetheinsutarea %uWsitsst>bsraMe#valmltasre4t byMassadumG=WLaws (rieasercheck one) Owner a Agent signature ot Owner Of Agent Telephone No. PERMIT FEE $ a (_2) 11y441 D 4c y z 8^ o /�7-0-x C,11- OP o� f FORM U- LOT RELEASE FORM a 1 I 1 0 - INSTRUCTIONS: 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 ! U/ De e w PHONE '��� LOCATION: Assessors Map Number % c1b PARCEL S^ SUBDIVISION LOT (S) STREET i �s� CN ST. NUMBER °�✓ NDATIONS OF � 2 TION ADMINIST OFFICIAL USE ONLY AGENTS: COMMENTS Mkz+ INO-ve pre co TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED % DATE REJECTED I0L I 1 0 q DATE APPROVED DATE REJECTED 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 DATE Revised 9197 jm spr,'J XU TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION t 1.1 Property Addr: 1.2 Assessors Map and Parcel Number: Name (Print) Address for Service Si a elephone � b% ,� � � S 1� Map um er Parcel Number Name Print Address for Service: Signature Telephone 1.3 Zoning Information: SECTION 3 - CONSTRUCTION SERVICES 1.4 Property Dimensions: 3.1 Lic ed C nstruction Su icor: Not Applicable ❑ Zoning District Proposed Use Lot Areal(so Frontage ft 1.6 BUILDING SETBACKS ft lfi�asor: Front Yard Side Yard Rear Yard Required Provide Required Pr ded Required Provided .7 Water Suppty M.G.L.C.40. 34) 2`i 1.5. Flood Zone Information: Zone Outside Fl Zone "R 1.8 Municipal Sewerage Disposal System: ❑ -a%7 Public Private ❑ 3.2 RegistereA.Home Improvement ntractor On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of„\ ecord Name (Print) Address for Service Si a elephone � b% ,� � � S 1� 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Lic ed C nstruction Su icor: Not Applicable ❑ Licens Construction License Number lfi�asor: v A ess v Vo Expiration Dat Signature TclepTione 3.2 RegistereA.Home Improvement ntractor Not Applicable ❑ 1 a� Company Name 1 Registration Number A ess Expirati Date Sin re Tele hone ou M Z O v m 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 u Iding permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify \ vv- i�NQ NMI Brief Description of Proposed Work: �\ J -U SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAI: U.SF ONLY 1. Building 000 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 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'_P / �� e tiJ as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all r a 'v rk authorized y this building permit application. Sin Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I;;11 7aL 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 int ame Si of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS iST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t ,0 Mue►d WS �at� aMa �Modn . � \ .9L) WJO4d azo LL -88 98-88 6L— '' aNV-LL3M 00 i L4S p ltd'=b8 zv ingi E3A� 141.E 3� 1 rJ aN1f1L3M ` -�-� v� 1 09 / S �.90N t r O � f ` i d %• 1 Zd WdT2:TT TOW b0 -upf �9��ibFzT9 'OH 3,40Hd :aha! diindJ �7h;;d�]ItJ[Jt;3 3Izhs>0W txU7�� e BOARD OF BUILDING REGULATIONS _ License: CONSTRUCTION SUPERVISOR Number: GS' 032472 Birthdate . 03107j1947 Expires: 03/07/2006 Tr. no: 17366 Restricted: 00 WENDELL W HOLMES 23 DADANT DR WILMINGTON, MA 01887 Acting C mis oner _ 1 w.M- Jlze-�orvnzaaeaea�!/ o�✓�,Ciaaac�c..cael�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 110127 Expiration 10/6t2006 Type individual HOLMES POOLS WENDELL HOLMES 23 DADANT DR_ WILMINGTON, MA 01880 Administrator In License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not va id without signatur L� ...... .. ..v.a.vv ..uva YvuVaauuab aaU .. Vln 111�JW 1. p I am a sole proprietor and have no one working in any capacity I am an employer providing woikers' S4IDpany namer v k. �r_1200 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 au&urn one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 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. 'perjury that the information provided above is true (revised 39S P1A) 1 N 0 t to T 4 10 M a a a a co C W W a i t a a a — N— = O° OO CDy N Qp N 1w.,.r W _. N r V "4 's ,fl H 'a .N• C .j1 N m W -Si��.p N� A� • �CNW ��Cpp� Q n Cp CD -a 7 C 0, N W' o Q 3 • Q N O Q -Q N Q Q 7 J !R W m —� n n 'f�Yc\ / W 7 OD tQ N • m� m� Om w m m T Q Q_ n Q_ N W n mn CD a m Cooc000 W v a a m ooa0oaoDEmODcoca 0 og 0 0 0 00 0 0 0 o_��_._. OOa oo"=.;.O o_o _o 0 N _ 27 v o z m M M m im o -a T Mm m T o Z J !R n n n 'f�Yc\ / a E C �E r r ILE�Tj -•-' N •--� 7o N alp N 0� Om Om Cmy N w �• •• N �• V V .C. IV �• Z7_ _O _ .Vl• 79 .S w 37 4.pN �pOWAN.�IR -moi .m.` 3 A �7 • `C G N�� N ca c o 300 z .=� C� x� a�-�•o mm o �9 �3 `C•'o"�3 • `° ca. o2, —• m � m za r-� � o 22, 97"— _ m • �� m� om ca ca S D a. d N .OX.r a _a .p 10 N CD N 71 em oa m 0 —•0000poo o o oh -o ? C= = C= em eo om am 0 0 0 0 0 0 0 0 p���_ O O Q =6P4O A 0 0 0 0 NOS O�•GOo��.p al, WOm O• •O O N 0 O � Y z m ,�, m FEE -2G-01 MOM 12 : 14 S. E. Cumm i nes Ar- .or- i Cates P'. 02 ?-ekm,4 i�� °' 8 CERTIFIED PLOT PLAN O s� -L4 3 S.E. CUMNINCs & ASSOCiA rES P.D. Box y337 PLAISTOw N.H. 03865 -frmg Cvq ed 3k aw mom (60$)382-5065 FAX (6031-382-5216 SCALE DA TE.i I fNEREbf c.clTiir i iv ivrriv yr ivv(Trn ANDOVER, MA BUILDING DEPARTMENT THAT THE EXISTING FOUNDA 77ON DRA WN ON , THIS PLAN /S LOCA TED AS SHOWN ANO THA T IT DOES COMPL Y TO THE MINIMUM BUILDING SETBACKS TO PROPERTY LINES. LOT 30A MINIMUM SETBACKS: FRONT --- 30 FEET SIDE - 30 FEET REAR - 30 FEET m ul m C/) 0 CO) CD 0 Z CD O d CL S CL O o v CL CT � d CD O F-0 . O O to CD CA 10 CD O k -J d CD 0 rp CD CDa CD CA CD O CD W117 MAM Ic C E� O 0 2 O -• vi O c H EL O :5 m CL 0 m c� HC7d0 m Z =r -C y 00 a) m CO) Tt a ..* a oC y C �o m oN �m m 2 ED m• �, o 2 r. O G yCD O C ?� N 7R NO m m y CD CL 01 m H = jo d C H GC2 CL. O• W _ CL O .••r O C CO, A H O CD gat �Ce co �. rCCD) --�: CD: �? _ 0 .. VI o C=Cr, 03 Cl)1 = MAI vw� s ao. SCD. 0 Rcc w Io EL o v o 0 0 rte'' n b r �� 7 t� p, 0 �1 5 Cl) CA a x WZ GO) x s � . � � Kms, 0 Rcc G� [ WC?�'fiL-1 ��oo�G.+14 o• w0�)4,40 MAP Town of NORTH ANDOVER PARCEL i • ��1�(MYfi�1 �w �3�c'CDt7L BUILDING PERMIT INSPECTION REPORT PERMIT NO.: UNIT NO.: PROJECT: 'S -r INSPECTION DATE: /0-31-052 FLOOR: WING: BUILDING NO.: REMARKS: 'tt, p"L- �-- &-,)so=-t--1'"1rn (1) 2�1/� w e e h cs1bt46 upuu-n L`�-14�fL11 '� fL �k 0 2 S%"2"2. ��-��� It /�(� a�iL I'��_79-w� • 5i(0.1 N OMg-2k �ZGt C 2 c u.�'EcS e> c, /,o X12 P42 -o CZ 1) oc20- 15�-C�f2� oZ oC S fS R S' 6Tl N 8- D V!-- 0- d d N N2 2/073 •r Date...........F.........../ TOWN OF NORTH ANDOVER PERMIT FOR WIRING 44-* e This certifies that ...................................eS( �(Ot) .................................. ................. has permission to perform ...... wiring in the building of .....1..'..!. ........................... I ............. ............................. at ... ......... 0 . L.' ... 0 ... t .... L .... '—.�N/afth Ando-vor, Mass' Fee ... 3.1: ... Lic. NoJ1/?.-7/1� .............. . iiRTRICAL INS}ecroe Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer A - -r- TF -A A A �A "" �J� 4MAAL/-A A kJ 7 ) DEPARTMENTOFPUBLICS4FE7T Permit No. BOARD OFFD?EPREYEVIYONREGUL47YOAS527CW 12-M Occupancy & Fees Checked VA APPUCATION FOR PEMff TO PEUORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS EIWMCAL CODE, 527 cmR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat g. Town of North Andover The undersigned applies for a pennit to perform the.electrical work described below. Location (Street & Numb6r)-' Z,07- IAw,(N < LAus Owner or Tenant 17M�T /7-1 ' Owner's Address To the Inspector of Wires: nd Is this pen -nit in conjunction with a building permit: Yes [::] No � (Check Appropriate Box) Purpose of Building -22�M/2- Utility Authorization No. Existing Service Amps Volts Overhead Underground M No. of Meters New Service Amps Overhead Underground No.ofMeters .hRL��6 Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. ofHot Tubs No. ofTransformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground E] ground No. ofReceptacle Outlets No. OfOil Burners No. of Emergency Lighting Battery Units No- ofSwitch Outlets No. of Gas Burners FIRE ALARMS No. ofZones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. ofDispoWs No. of Heat Total Total Pumps Tons KW Initiating Devices No. ofSounding Devices No- of Dishwashers Space Area Heating KW No. ofSelfContained Detection/Sounding Devices Local Municipal Other No- of Dryers Heating Devices KW Connections r7 No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER lnsura=Cdver� RBsuftbtbenpmicrtsdMmwhjs&GmalLa%&s I ha%eaammLmbhyk&r&=PcbLymdL&ECmo&Opwa*�mCovaaWoritsakstwMeWi�� YES NO F1 lhawsubm0dvailidpodofsamelotheOffim YES r'j'�rNO If�utmdWWYESpimerdc*the4WcfwmE�pby&�dagthe W"i*bcDL INSURANU ED-�BOND F7 onm D ftffiespeffy) Work iD Stat Y- 6 -e / InspectionD&Rapesled FM SigrWUXkr&%MlfiesofPqjW FIRMNAME - QAJ-Lover a=7 -91C- 'AU0 Lioumm NIgNiF. L')a112600 Sip� b,,--i�—ummlsb — 27 9- �OA- &BiMTdN;a S-71-1-101aQ ?16X� L AA1 43079 AkTdN;a r-2 -3 Y -',d I/ OWMR'StWRANMWAIVM-lamaixmhtftlxmwdimnQt temmawymparilssub�WmiatasmWWbyMmxh�GmrjLT,�s "ibiffrys�m�,mtispan*app"mvm'%tsdismw*mneri (Please check one) Owner F-1 Agent 1:1 Telephone No. PERMIT FEE d� Ma o7M « s ,aswcNue6 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 98 Date THIS CERTIFIES THAT � V13C THE BUILDING LOCATED ON 4 _ _ c230 c_� I /4,vif- MAYBEOCCUPIEDAS i/�/U IN ACCORDANCE WITH THE PROVISIONS OF Tfit MASSACHI I STATE41UH DING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. /Q 1?&o l,'? , c2 S ,13/4 A 3 S Aa l l 0,4,ek CERTIFICATE ISSUED TO ADDRESS Building Inspector m m C m m 0 CO) CD r0-► Z cD O ar .� O O v CLCD Q cc .. w. a v COCD CO) CSD O d n CD CD CD a H CD CCD O CCD F C O•- d = CL cadc. CD to y =20 n CD C7 GoGo C2an T Z ?•C CA O� .�► 0 I O N "17 PCL o' CO =r G y H � O m o"wo;; \�CD a > >;V m -p O C13 m �O = O O y. n 0 C a yCD cc CD O N m • CL 14 CIDCA G Cy N N a d �C C W 47- a���a rA oif`� O) vi H `� w= W d Vf 'Mb m � cc 41DO n .� O O SCOCa � o C 'fl • c-) 0 c o �• 0 oCD.: 5 cin O z t� ~ M O OCQOGG ?� CIO i Cri7 r" roIrl OO a= 5. �OGQ ro O w r, C/) rn O �' rL Cl)cx K) Q 1 ?\ to i O O /+ 00 b ►-� - b f � n tz 0 C M Town of North Andover * NORTH tto , 6' Building Department �,?0v-1.0 0 27 Charles Street 04� North Andover, Massachusetts 01845 * ,� (978) 688-9545 Fax (978) 688-9542 V O ,M . [OLNI[ .wKR 1' �9SSAC14US���� APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS o2,36 LW e,6S /-et- (00c)4 6 l e LOT NUMBER 3(2 SUBDIVISION Cys Tell rf DATE REQUEST FILED 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 FE NTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRIJCTURtDOES OT MEET ALL APPLICABLE CODES. SIGNATURE -. �ZFFWkL USE ONLY ROUTING CONSERVATION _ DATE PLANNING/ DATE i D.P.W. — WATER TER DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED TION REQUEST DATE. A Location /YJ we 6 3 k J,/- No. NNo. --L DateQr� 0 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� / Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Cf Building Inspector Location i� -4-cR 30 Wr, Wod t n). No. ! Date 3-N-0001 NORTH TOWN OF NORTH ANDOVER `to .•,SOL ~ 9 Lam© Certificate Occupancy $ J of ��s'••°•'<� s�CHU Building/Frame Permit Fee $ ,4. Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # �� 3 ! f Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING <, ... _ _ _.. Ti;4 SCcttDl�.ftiri%C[a1.USC 4»i . _ BUILDING PERMIT NUMBER: DATE ISSUED: / =a.. SIGNATURE: Building Commissioner/In ctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: C4avX/7je res a,) (A)ekizer 41)rnds z4z Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R12- 4/3 e, Zoning District Pr osed')se Lot Area st) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 3a,' 67 ' 3 ' 33 ` 30 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record � Cc�ii��/�/�C/i// l'"U%t'S % � � � �i3� c�c�7�IJ71 �1`. $ y � �f� :.�f /L%. /,�i1c�3 ✓E� Name (Printf Address for Service �?Z, � 6$i-sc�o I Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ #— z � Cass eW -r--z Licensed Construction Supervisor: C� o 6 3 License Number Address 5IY O do % _ x:300 Expiration Date Signature Telephone v<fi' 657 — ej'i(o-U 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORIURS 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 ...... V No ....... ❑ SECTION 5 Descri tion of Proposed Work check au applicable) New Construction # I Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition 0 I Other ❑ Specify Brief Description of Proposed Work: ���[�71I1[�7.[��.�1�1u/:�11taI� �.fcY�a7[li�C�7`►C �. �� Item Estimated Cost (Dollar) to be Completed by permit applicant OFk ILIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier ` a 2 Electrical z (b) Estimated Total Cost of Construction c>2C e �QD� J / 3 Plumbing DIMENSIONS OF SILLS Building Permit fee (a) X (b) OP 4 Mechanical HVAC 5 Fire Protection DIMENSIONS OF GIRDERS 6 Total 1+2+3+4+5) HEIGHT OF FOUNDATION Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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;/AAUTHORIZED AGENT DECLARATION as (fir/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 N M Date NO. OF STORIES low SIZE S BASEMENT OR SLAB ��ra ecr e SIZE OF FLOOR TIMBERS 1 i 2 -3 RD SPAN p DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION r THICKNESS lo`" SIZE OF FOOTING a- X 20 " MATERIAL, OF CHIMNEY ©( IS BUILDING ON SOLID OR FILLED LAND c5d�i uj IS BUILDING CONNECTED TO NATURAL GAS LINE tl _of A* Qf FORM U - LOT RELEASE FORM IN1STPcUCTIONS: This `orm 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 s,'t-e,tt APPLICANT C1/ �OT��� GLe PHONE tiJy7-3acJ LOCATION: Assessors Niap Number J O 6 8 PARCEL l `I6 SUBDIVISION Cj Ae,11 f LOT (S) ?JCS STREET t i/ e PS j e R WO - h S -L- t-3 _ ST. NUMBER 230 **** *********OFFICIAL USE ONLY*********************** E DATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS TOWN COMMENTS ER FOOD INSPECTOTH SEPTIC INSPECTO COMMENTS DATE APPROVED DATE REJECTED_ f DATE APPROVED DATE REJECTED w0j"gi Sul DATE APPROVEL DATE REJECTED o� PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT O �e FIRE DEPARTMENTt/% ^^'fl �� Jk RECEIVED BY BUILDING INSPECTOR DA TEE Revised 9197 im Location �2'..��✓.� //l/Q�G 4�"�-' x.30 Date ,ay No. , Y .y NORT1y TOWN OF NORTH ANDOVER .•,hos O O?O•t•`•D ` Certificate Occupancy $ of sACMUs Building/Frame Permit Fee $ ` Foundation Permit Fee $ Other Permit Fee $ " TOTAL $ �-S%'{�• tv Check # / 18!117 Building Inspector TOWN OF NORTH ANDOVER I BUILDING DEPARTMENT %PPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1.1 Property A 3UILDING PERMIT NUMBER: DATE ISSUED: Map Number C SIGNATURE: 1.3 Zoning Information: 1.4 Property Dimensions: Building Comniissionerftspe= of Buhdings Date l �V t SECTION 1- SITE INFORMATION iot Area Frontage ft 1.6 BUILDING SETBACKS ft 1.1 Property A 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: _ 10 l �V t ronin Distrid Use iot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required PrqVided RNUired Provided 101 lobl 113 - ;.7 water supply M G I C.40. S1 54) I S. Flood Zone Information: )R 1.8 sewerage Disposal system: ❑ On Site Disposal System 0 'ablic Private 0 Zone Outside Flood Zone Municipal SECTION 2 - PROPERTY ONMRSHIP/AUTFIORIZED AGENT t.l Owner ofecord v� � X30 \ ��") , \0 lame (Print) Address for Service : Signature Telephone 9)b 2.2 Owner of Record: Name Print Address for Service: ��ignature Telephone SECTION 3 - CONSTRUCTION SERVICES . E ;ompany Not Applicable 0 License Number . v Vo 6 Expiration Dat Not Applicable 0 Registration Number Expi Date ov rn X z O (V� v v rn O z rn go O — r v rn r r z 0 SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 & 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Workcheck Iicable New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 01 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work \ J SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by perrmt applicant. (1«FFTCIALI7SE'ONL'Y 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 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 ac 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 RI, ,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 t ame Si of Owner/ ent Date 6 - NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 gr 2ND 3 KD SPAN DINIENSIONS 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 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 C-0 ro 91`1 fd- o APPLICANT LV I PHONE,_ LOCATION: Assessor's Map Number L 6 3 PARCEL_ I SUBDMSION 1 LOT (S) STREET (Pe- �J S� �' pmt l'� ST. NUMBER o2 3 0 OFFICIAL USE ONL ADMINISTRATOR DATE APPROVED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised W Jm Ln V-7 All 3 � � -� J�-- / --',;art= —, / '\ 22 Ll I W-2 '�3 B 50 LL —1 N LL 0 LL -9 LL - LL -8 LL - 71 LL CS-E-V13ACK, 401 E6UT P INTS- v.5 147 \X" L T 30A T §Fl- ;ZJ, 0 =41, 4 SFt BB -B3 BB -82 B-81 BB -84- 7.1 960 - BB -80 CBA=34,4 BB -85 WETLAND Alliance, Inc —79 eArr-sYrtrants 86 lb Phow (781) 251 MA ft—F.—MI) 1-21 C*M)Wti romst DM. PF BB -71 t, yah—nor t name: �G o 1 13(e (_P city IU ii'Yl t' 10 ury hone # l � i in R � a' S (0 O 1 am a homeowner performing all work myself. C] I am a sole proprietor and have no one working in any capacity I am an employer pl 4\ 0 I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workeW compensation polices: -name:. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of s100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. 'perjury that the information provided above is true and correct official use only do not write in this area to be completed by city or town official # 1 / 1vIMI) �V l city or town: permit/license # nBuilding Department []Licensing Board [] check if immediate response is required []Selectmen's Office []Health Department contact person: phone #; —Other r . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: fS _ 032472 Birthdate.; 03/07/1947 Expires: '03107/2006 Tr. no: 17366 Restricted:00 WENDELL W HOLMES 23 DADANT DR WILMINGTON, MA 01887 Acting t:' m oner i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 110127 Expiration 10/6!2006 Type Individual HOLMES POOLS' WENDELL HOLMES 23 DADANT DR WILMINGTON, MA 01880 Administrator 13 License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not va id without signatur z z _T '9 1 2 p a i 7 t lie a a •', Y W D D d d N 0 O Nco IV Q• co a* Coy N ca N �. r p N N C.ji�� GOvpNQ ,O > m nn3� a �n7o 3Co,v3�c�=�. _Dv a 3 m o o o -v 0 o s o o� e m = m Q'r S_r — �' N N N N = c 6. n . ^_ FD m Fr o a co V $ .ia N a CD a 0 o�oo�oo v a --0000000 OOOD oo�OD aD co co 0 0 0 o 0 0 0 0 0 0 0 C) CD OONC2. P. O NO— O�%C O 0, W O -+J..�0. 14 10 0 O 9 0 Z m Zm r m m -4 > m m T mm O Z C ma �m 0 l S m O a t! :fro .�q•`T3 9 a Fn:a'Q3Pia� < 91. �O R°Eg,, av0 �o • �a �o C2 2E z x 00. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. ....................................................... -has permission to perform . .................................................. A. -wiring in the building of %-.! . ...................... ....... ..... �-k-,,North Andover, Mass. 6&1 Q Fee.3............. Lic. No3..... ......... ...... 7ELEMICAL INSPECTbR Check # 5718 A 1 rm UU1V11Y1U1Y Y/'rAA" n (Jr 1V"1J ftL1"v.u.i i u DEPARDIENTOFPUB BOARDOFFIREPREVE HON APPLICA71ON FOR PERM IT TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical w rk c Location (Street & Number) Owner or Tenant Owner's Address Permit No. Occupancy & Fees Checked ^ORMELECTRICAL WORK SSTS ELECTRICAL CODE, 527 CMR 12:00 Dat /;0(0 To the Inspector of Wires: below. S Is this permit in conjunction with a building permit: Yes L.J'Ro U (Check Appropriate Box) Purpose of Building — %i h /r I Utility Authorization No. Existing Service AmpsVolts Overhead [3 Underground ED No. of Meters New Service Ampsolts Overhead =3 Underground ED No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above _r1lBelow enerators KVA round and No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units 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 Plumps . 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 ,jNo. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• InAttanceCover�. Putstra�:tmthetegttitanats�GataalLaws Iha�eaamaltLtab>tityhlaaatoePbScyirrl>dalgCanpleleCovteaitssub�aiialequivala�t YES 0 NO ha esuhn&dva5d ofs=1DdleOff= YES r��`� ria IfyoulinchadodYES,pleaseittdicmtherypeofwrnw eby kWeWcnD*Regw" Est m*d VakteofEbctrxal Wotk $ Final S>gnedurder&I't3 1 sofpa�j� FIRMNAME /4 Q (eGf4eCO-C e`0/-7 1 0C Li=wNcL S . Litxx>seie sigrue uey LiomseNo -S-0 . Busi=TdNo. 5-5> 3aa OWNER'SINSURANCEWAMiR IamawwdrattheLicewdoesmthalvetheinsrimwm*sitsstbiaU*valatasmgiledbyNhsad>t�GemalLaws a-rI tatmyagnakneenlhispeuritapp)icalirnwai%Mlhiisw#emat (Please check one) Owner Agent® _ Ira Telephone No. PERMIT FEE $ signature of Owner Of gen Z Ln W m O W a -i % Z �V Err a ® O _� d m Ln�D C 0 ? H y -n N a o . CD C7 3c > >orm c 3 x C y H o' m n 1 o p cNo 0 CD :3CD (p � H r C G = O rD C —I fl. f��D M — > ` d --I C ? Q CD H " -4b O '� m ma —� 0 .. o n � p'C nw � - c' > > °y �. c� o O ppTo E �. a �3�Vm ti aj y D rD D n I�' j mn N �"0 0 CD CL ii m ^D�11 _ P- Er3 (D N z .-r r. �► �� O f �(D mns rt7l ay cCD l 1 o ox o OID v o Un y C �-0 .1 Cu COD 10 kA yz_� 4 m M m m U) m CO) 10 ,C) z . O O p.� d 0 CD CL Q .... a: C= co CD CO) .O CD O CD F d d O CA O CA d CD rF CD a, y CD COO 0 CCD 3 C CD oC ao ? •0 0 O C•i/i�Q y = C 0 a y .♦ 0 mC7 o ye�c� � m .to d-► m H ?� =r CL0-0a o Sr CD -40 0 0 0 H H '-I O 1 CD m � ri 0 H• n O W OD CO)mCL 3 fV/ m O H vJ cr O � C� m O W n h o o, JA to cn 0. d d; io -ca CD . H r. Cn y r O ^ O O W �+•� W d fAftoft �1 %ow 5 'Van H ..a O �. o z� cn bdCD `� r1 cn a o � c� * o� b 1 c CD n a y O_. = CD cn o 1�-----11 c ay M d 00 �n x H �n m cn 'Ptn? Com'' b w 7� �'" my �? m ro ��' A. tz00 cn CD cn a tz O y omq 0 9 0 c The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone n F -1 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. name: C � z2,6-,111 /-/ e /A esl 61/, Cr; Address Su ff Gr! S7� S e- 02 .City' /5�W&V ei' P- © /Flys Phone 6 7 - 5530 0 Insurance Co U12� Policd 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 rine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of (5100.00) a day against me. 1 understand that a copy cf this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the painand penal ' s of perjury that the information provided above is true and correct. Signature Date 1,741,410 Print name ���.? /7 -SSS /% _Phone �75 57-5 76 v Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensino 1] Building Dept ❑Check if immediate response is required 1] licensing Board Selectman's Office Contact person: Phone: Health Department Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined. by MGL c 11, S 150A The debris will be disposed of in: U, -n,2 S--J-,ef- IV 0 r*h, eF-7s-� Rec- Location of Facility Si6ffrwe oY5ermit Applicant :y ,� l2/za/oG Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Growth Management Bylaw Exemption 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. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant on Building Permit (below) Address of Properi/ for Per,7it (below) Map and Parcel ,"17e— "4 Purpose of Application (check below) Phone Number of Applicant • -4 Single Family Two Family i the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw, l 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 3uilding Permit. Further I understand that my interpretation of the EXEMPTION status is subject m review by the Building 0epartment and is only offically accepted when the Building Permit ig issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning ytaw, This application is for dwelling units for law and/or moderate income families or individuals, where all of the conditions of 8.7.6.oare met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean, persons over the age of 55. I This application is a part of a development project which voluntarily agreed to a minimum 401a permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open spate 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 appticatton represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel an the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit an the part.!. This application represents a lat which is ready for building permits,(:, e. all other permits from all other boards and commissions have been received and the project is in camptiance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I atte�cr to accuracy of the information provided and that the attached building permit is allowed an EXEMPTiO s cite ave. Further I understand that the submittal of misleading and or inaccurate information the the , tng off of an above item which does not comply, whether done to my knowledge orgat, is ounds fa efusat by the Buildin'`1, g (Department to issue a Building Permit. Signature of Owner or nze was signed the Attached Building Permit Date This form must be attached to the Building Permit upon application far such permit S 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. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant on Building Permit (below) Address of Properi/ for Per,7it (below) Map and Parcel ,"17e— "4 Purpose of Application (check below) Phone Number of Applicant • -4 Single Family Two Family i the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw, l 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 3uilding Permit. Further I understand that my interpretation of the EXEMPTION status is subject m review by the Building 0epartment and is only offically accepted when the Building Permit ig issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning ytaw, This application is for dwelling units for law and/or moderate income families or individuals, where all of the conditions of 8.7.6.oare met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean, persons over the age of 55. I This application is a part of a development project which voluntarily agreed to a minimum 401a permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open spate 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 appticatton represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel an the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit an the part.!. This application represents a lat which is ready for building permits,(:, e. all other permits from all other boards and commissions have been received and the project is in camptiance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I atte�cr to accuracy of the information provided and that the attached building permit is allowed an EXEMPTiO s cite ave. Further I understand that the submittal of misleading and or inaccurate information the the , tng off of an above item which does not comply, whether done to my knowledge orgat, is ounds fa efusat by the Buildin'`1, g (Department to issue a Building Permit. Signature of Owner or nze was signed the Attached Building Permit Date This form must be attached to the Building Permit upon application far such permit � .- ✓rte -���� ���� ,� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069234 Birthdate: 05/09/1954 Expires: 05/09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL 400 MAIN ST -ej , GROVELAND, MA 01834 Administrator 1518 APPLICATION FOR SEWER SERVICE CONNECTION r � North Andover, Mass. C / z Application by the undersigned is hereby made to connect with the town sewer main in W �i�Cc��1tke SEreet suhiert to the rules and reeulations of the Division of Public Works The premises are known as No. or subdivision lot no. 3 � � 7 ✓ 5 �� 2 f2 < S�2 Owner1�� j �2✓rl� Address Contractor PERMIT TO CONNECT The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date Address Applicant's Signat SEWER MAIN �,W�oLdl Street Street Division of Public Works By �f %� See back for rules and regulations s N'° 975 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 12, J Application by the undersigned is hereby made to connect with the town water main in �SG�����L�n Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. 7� w ,:f DULa- K e StweL or subdivision lot no. /0 Z - L c Owner�c, Contractor L V1,f 2 i � s Address A ppgns re PERMIT TO CONNECT WITH WATER MAIN, a��� The Board of Public Works hereby grants permission to �t� :i-�l/ l� Z—C to make a connection with the water main at 11� subject to the rules and regulations of the Division of Public Works. Inspected by Date Street Board of Public Works By ��IkAl See back for rules and regulations Oi�ed t �� J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 r y`StIED 0 6\ ]l 1 � 1 n DRIVEWAY PERMIT Telephone (978) 685-6950 Fax (978) 688-9573 DATE zcoo LOCATION BUILDER phone OWNER ell F—Ore-,J L L C phone 6_ � -5300 THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William Hmurciak, Director Timothy J. Willett Telephone (978) 685-0.950 ,Staff Engineer Fax (978) 688-9573 Additional conditions for lot 30, Campbell Forest May 12, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lot 30 in the Campbell Forest Subdivision subject to the following conditions. We agree to sign the Form U for this lot so that the construction of the home can begin at this time. The conditions are as follows. 1. No sewer service shall be installed into the residence until all off site sewer facilities are declared "active" by this Division. These off site sewer facilities include sewer lines and a pump station on Campbell Road, as well as sewer lines and two pump stations on Turnpike Street. At this time, the construction of these items has not been completed. , 2. No water service shall be installed into the residence until all off site sewer facilities are approved by this office. Any violation of the above conditions will void both water and sewer connection permits. No refunds will be granted. j Mesiti Devlop n Printed Name Date Division of bl' Works Printed Na CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin Date '5--1 Z -oo Mesiti Dev Group a Fax:978-5578160 Jul 17 2000 13:54 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Telephone (978) .685-0950 Far (978) 688-9573 July 14, 2000 Mr. Kenneth Gr~andsta 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. Grandstag 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 foIIowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Croup, 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 willw be allowed to reconstruct,air, replace, add to re p, service, inspect and operate the pumping station and related equipment. and facilities in the event ...__that ._ that Mesiti Development or its agents fail to adequately perfonn maintenance of the pumping station. Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesio development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very T . ours, i J. Wiildm 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. FROM : MCKENZIE ENGINEERING GROUP,INC PHONE NO. : 6179412662 Jan. 19 2001 12:44PM P2 x � I j 143� f 1 x3 f. + MM 61 1 / N08*3 , r4 1ViM - � r 45 1Q 12 �,' LL --1 WETLAND LL Q ,• S06"38 50 E ' LL�-10 LL -9 LL— raLL--5 I _ l / LL— LL -6 / -fgACK h PS SolOA �\ LOT i0A1r' CBA=414 SF' or vx BB -83 1 \ ---- \ OT 28+ BB --80} _ X69,960 SF 1 =` CBA=34,497 WETLAND BB --$5 � '•-- _�g ng Alliance, Inc. BB --$6 / Lalanning P.ons'ulta»ts 89\ \6�ent'1.3 et Phone (782) 232-i 4E �ugus, �ua''�r9 -�FaIMI) 9TI-2662 �OambZll Porest DWG, NO. 19. .,._ BB -71i nn� oo \ � ,`S/ 1,R :�N -1�o n, 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: 1-30-2001 DATE OF PLANS: January 8, 2001 TITLE: Lot 30 Lincoln PROJECT INFORMATION: r Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 594 Your Home = 591 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1752 30.0 0.0 62 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1752 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the app icab Standard Design Conditions found in the Code. The HVAC equipment selected o heat or cool the building shall be no greater than 2,S°s of t e esig load as specified in Sections 780CMR 1310 Builder/Designer Date % v�� \ MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Lot 30 Lincoln DATE: 1-30-2001 CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-11 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.49 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 92.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can I 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 I equipment efficiency must be clearly marked on the building plans I 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. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 Date.. �.,/ N2 48 --'3 4, TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING S CHUS This4nwtifi--es that .............. has permission to perform ........................ plumbing in the buildings of ................................... at ........ North Andover, Mass. Lie. N'lq�Jx ... l 1 rNSIPC�T`0* PtuR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM SING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location')1 U 2 g 5 U Owners LioL))3 e- A) Type of New LJ Renovation M Replacement a Date I l/-0 i Permit # D ` Amount Plans Submitted Yes ❑ No (Print or type) Installing Company Name (21,51 -le- e11Q1 1 ,Address r,A S 1c- ! -� Tisiness Check one: Corp. Partner 11 Finn/Co. Name of Licensed Plumber: 1A U lb i1 C JS 0 n Insurance Coverage: Indicate the type .of insurance coverage by checking the appropriate box: Liability insurance policy �-' ' Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus l#s te Pl mbi Cod 142 of the General Laws. By: $rgnai—re oiLrcensea Plumper Type of Plumbing License Title S City/TownicenselQum e�8'r — Master 'Journeyman APPROVED (OFFICE USE ONLY .J G. (Print or type) Installing Company Name (21,51 -le- e11Q1 1 ,Address r,A S 1c- ! -� Tisiness Check one: Corp. Partner 11 Finn/Co. Name of Licensed Plumber: 1A U lb i1 C JS 0 n Insurance Coverage: Indicate the type .of insurance coverage by checking the appropriate box: Liability insurance policy �-' ' Other type of indemnity ❑ Bond ❑ Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus l#s te Pl mbi Cod 142 of the General Laws. By: $rgnai—re oiLrcensea Plumper Type of Plumbing License Title S City/TownicenselQum e�8'r — Master 'Journeyman APPROVED (OFFICE USE ONLY Date............... ..... ,.o o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION t � , This certifies that ...:'' �'�—'��' �. '' l has permission for gas installation.. .,�f • ..installation................... in the buildingsof . ...... .. "..� ............. . at �. '�'. .. r' -K ' - '—� " North Andover, Mass. Fee.Z..... Lic. Nod.: .. ) �........ GAS INSPECTOR_ Check # `. 3619 MASSACHUSETTS UNT'ORM APPLICATON FOR PERMIT TO DO GAS MTIN(; �Type or print) Date., .19 NORTH ANDOVER, MASSACHUSETTS Building Locations . 951�/�? tj Owner's' New ©f Renovation ❑ Replacement ❑ Permitoe � ;Amount S �✓ V Plans Submitted ❑ (Print or type) f i S' '�. < 1 L� Name 1, Addresvt —Z/ & C14 S 7/ e— 14 -X G� elep Name of Licensed Plumber or Gas Fitter 0140 /_4-) A/C ~. Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ I Firm/Co. INSURANCE COVERAGE Check one;,.-'" I have a current liability Insurance policy or it's substantial equivalent. Yes QA No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liabilin, 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 I42 of the Klass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ A2ent ❑ 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Ch Ater 142 of the General Laws. By: Title CityiTown AP P RO VED usE ! )Ni. v) Sienature of Lic ❑ Plumber Gas Fitter r ❑''Master . r7 loumeyman .r �r (Print or type) f i S' '�. < 1 L� Name 1, Addresvt —Z/ & C14 S 7/ e— 14 -X G� elep Name of Licensed Plumber or Gas Fitter 0140 /_4-) A/C ~. Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ I Firm/Co. INSURANCE COVERAGE Check one;,.-'" I have a current liability Insurance policy or it's substantial equivalent. Yes QA No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liabilin, 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 I42 of the Klass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ A2ent ❑ 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Ch Ater 142 of the General Laws. By: Title CityiTown AP P RO VED usE ! )Ni. v) sed Plumber Or Gas Fitter G> icense i7moer Sienature of Lic ❑ Plumber Gas Fitter r ❑''Master . r7 loumeyman sed Plumber Or Gas Fitter G> icense i7moer Date..��.- /�/ J-'1/ N2 3003 .......................... ORTN TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ........... 6, ................. t ................................................................. has permission to perform ..... /.j ................................................ wiring in the building of at.............................................................. North Andover, Mass. ............. �-) ...... Lic. No. ...................... : ........................................ Fee 27J ELEcTRicAL INSPECTOR Check 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer IL /1V1 \ / I l.l[ ll/11 i Vl l Il[ JI.lyX l�/l. DEPARTMENTOFPUBLIMFM BOARD 0FFIRBPREVEN770NR59ffAT10NS 527CMR 12.W Permit No. 36Q3 Q3 Occupancy &Fees Checked J PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) .73 n IJ 4?-4,5J�� 4/t --)orfs 114-01 Owner or Tenant /I)& - Owner's Address Is this permit in conjunction with a building permit: YesC71INo a Purpose of Building Existing Service AmpsVolts New Service 22 c)eD _ Amps Volts To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. 1 CZ -:LL Overhead Underground Overhead Underground Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work' 771, e No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units 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 Municipal Othe�,���J No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Sig, Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Iruuancer' R>rs=ttDthetaquiiartaWckIvimxhus sCw�ilLaws Iha%ea Lmbdtyh'lstr mPbbcymdu&gCompktO eta6*a agecritssubstmMe*ivalatt YES E3/ NO Iha%estbtrilledvalidptoofofsanelDthe0ffix-YES NO Ifj uharedvdWYESpleaseircethetypeefwvaEebydakirtgthe el c✓ Lit BOND p alliER Eslim*dVahtedUe&x2l Wak $ WorktoStxt G G/7117 Insp�D*RoVesWd Rough D� � li, _ Final SigredutidaM%Mhiesofpajta} FIRM NAME mal ! (� C L- Lioa�seNa / 3 3 Lioatsee �.� .�.� Sigrae I;oen9erlo BtsirMTd% 47iF �b r� , t% Ai 37 S- Y- ! SSr OWNER'SIi,ISURANCEWAIVER;I.amawaretbattheLi e_do, prW theirsrr awmmForitsmbstanWe*ivalertasm*mrcdby agsCanalLaws aod�atmysigtatureonthis patt��pl�iatwai�es d� requaanait (Please check one) Owner Agent ® -ev Telephone No. PERMIT FEE I 'N2 2498 Opt"`O '•,ti0 0 Date ..iK...AA...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ri,?O S ` / This certifies that ...... /�.�..................... �..........�c1......................................... has permission to perform �! ......................................................................... wiring in the building of` at ....... (%)...4 ....... 4!� {'.��.S1' ....Li/.�1d.. L �v.. , North ov r ass. Fee.... G..7..... Lic. NA.PJ .-.....wl....�.................... r' ELECTRICAL INSPECTOR Check # J " �- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer DEPARTMENT OFPUBLIC& FETY Permit No. BOARD OFFREPREVLAWONREGUM770AS527CHR 12.00 4 JVA Occupancy &Fees CheckedL PUCATIONEOR PERAff TO P1C.RFORMEL,E=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dateg O Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building o0 jam/ ST , Existing Service �_ Amps / Volts New Service &,200 — Amps KYolts Yes FZ�T_No A4e (Check Appropriate Box) Utility Authorization No. �5 Overhead Underground ® No. of Meters Overhead ® Underground U2______No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 177 i 1"e &16%1 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA It and ID &_round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers 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 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 Inqx&reCuArg Rnstrarttothe regtmarentsd`M%mchm&Ck naralLmhs lha eaw=tLia7itylr Pbi ymdud gCar ' Cota'aWcritsst ieg.i rt YES ®/ NO wIhaswUxaAhNnCeEdvaid;4E] Ode YES NO ® IlyculmedadWYES,p�erdt*thetWcfo�a�byd�gthe bcDc BOND orll-m ® (Pleasespc*) /,:)-dk96) G Eslim ValuedEktrical Wait $ WoStatt i O ' Ut7 Ir>SpenIRecFteted R dc�ough 402" C'`ag" Fail Signed utx2r,ie Pl nalties of ' FIRM NAME it Lit Na � � 3 3 7/4 Sisran \ BusirtesTd.Na �l D �c! ✓ ,/� �✓ 1� O l AlTel. Na OWNER'SNR ANCEWAIVER,I.amawmthatt cLxe_ tett etheir» ares lqrivaletasm#-edbyMm�(,aviLaws and diatmy*UhimarthispMi*a onwaiwsthistewmi mart (Please check one) Owner Agent ® Telephone No. PERMIT FEE $ / Date ../7 -1? - e - N2 45C0 ",OR':'�o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �O..r° ,SSACMUS� This certifies that ...��! Y....f �� `................ has permission to perform ... .................... plumbing in the buildings of ... .� �..�............. . at ... �? .`�.. ! �: j .! , N�rth Andover, Mass. Fee Lic. No../ Q.. 77I/`, �.� .. . PLUMBING INSPECTOR Check N a 6 c WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATI (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 452 4 OR PERMIT TO DO ENG Date 7 / Name Permit # a v Amount ipancy New Renovation Replacement Plans Submitted Yes No p �j j1 Check one: Certificate (Print Company Name ( �(' i (!_ Corp. 11 Partner. EZ Firm/Co. Name of.Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity 0 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts if"" P bing C a�l nhapt�42 of the General Laws. ,D (OFFICE USE ONLY Type of Plumb' g License License Sumner Master rM Journeyman ❑ • i MMMMME •F ■■■■■■■■■M■■■■■■■■■■■■■■■■ p �j j1 Check one: Certificate (Print Company Name ( �(' i (!_ Corp. 11 Partner. EZ Firm/Co. Name of.Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity 0 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts if"" P bing C a�l nhapt�42 of the General Laws. ,D (OFFICE USE ONLY Type of Plumb' g License License Sumner Master rM Journeyman ❑ CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number bkc) a,, i/ cyo o THIS CERTIFIES THAT THE BUILDING LOCATED ON ©hc*,�?©<y V00 A Com( MAY BE OCCUPIED AS SIS '�� �' ��� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Rem �n 5, �? is 8AY-h S, 3 Spall V ud er- CERTIFICATE ISSUED TO C/ Mgr✓ f `` /?P& Lk ADDRESS -?31 F 'SSAC"Ug`` Building Inspector m M C m m 0 m FW d C — CA CO) CD SZ z y r C. O 0• e � � c C. �• y CD 0 v Q `� O =cr CD CD o CD C CD co). G'CD =0 y I CD O a G r�-i✓ ® O •` � � w 5 CA O CD.� 5 w a z 1 > J nDcl) n o 'd O x �% • y ` VCD W H C rn n � z r• VI Qq vi c r.�.cn y� O �• P/� O Q fN ®0 m n o co CD m Z =r -O co) •O�. .=s •O► m C =r m d CL = 0 � E6 -♦ O ® y O N O s ® 4,-� c9 2 > > -00 -� i0 0 O O H• C0! O O ®:Q c =_0CA � m O CD mMC ®�•oo'' 3 to �' C7.O . CA O d H H ®` VA C�� ® 1 C H 3 5 CD Q � C., •� a G r�-i✓ ® O •` � � w 5 CA O CD.� 5 w a z 1 > J nDcl) n o 'd O x �% • y ` VCD W H rD d p rD a G r�-i✓ � w 5 5 w x8 o zo r=�'G C, 0 n o 'd O x �% • y ` � � C rn z IW Qq vi �J W o 1 0 O Town of North Andover 0 pORTR ,� 4e Building Department �,? y.. to b� o L 27 Charles Street o fi North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 O wla COC MIC MwKM 9SS.4 45 APPLICATION FOR CERT]IICATE OF OCCUPANCY / INSPECTION LOT NUMBER SUBDIVISIONJr DATE REQUEST FILED 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 TM FRAME. A RE -INSPECTION FE TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUC DO NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING pu� Awt-i CONSERVATION DATE PLANNING DATE /6 /��?/6RJ D.P. W. — WATER METER DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. Z7-44 SIGNATURFa OW AUTHORIZATION Mesiti 1)ev Group -.Fax: 9.7875,578160 Jul 17 2000 1354 P.01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J. William 1f=rctak ,�. Ltd, +, Telephone (978) 685-0950 Director Fax (978) 688-9573 July 14, 2000 Mr. Kenneth. Grm st4 President Mesio 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- 1 The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the constriction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the foIIowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin ofMesiti 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. 3. #. Satisfactory completion of an as -built plan for the Campbell Road sewerage system. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. >. 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 facilities in the event _ that Mesiti Development or its agents fad to adequately perform maintenance of the pumping station. Mesio Dev broup 1=ax:9?8-5578160 Jul 17 2000 1354 P.02 6. Mesio development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shall indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town" or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grant. Very TO ours, J. William Hinircini Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant ofSonditional use. 3499 Date..?-.!. ..... PRTM TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... .. `.'o °., . l.. F : `r `�� has permission for gas installation .. A < <: .: `........ in the buildings of .. Ax!. �. -�-:. �/ ....................... at Fee.h ...... North Andover, Mass. Lic. No... e.� ? 4�— .......... GASINSPECTOR f G WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ✓IASSACHUSETTS UNIFORM APPLICATON FOR PERMIT or print) IwxIH ANDOVER, MASSACHUSETTS Building Locations New 91 Renovation ❑ GAS FITTING Date' 19 0a Permit 9 1 Amount $ U Owner's Name All roat- Replacement ❑ Plans Submitted ❑ (Print or type)n f Check one: Certificate Installing Company Name ��P% ` je �� ❑Corp. Address ❑ Partner. Business Telephone ® Firm/Co. Name of Licensed Plumber or Gas Fitter s 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 ❑ Aizent ❑ i hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pertormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat�,as Code and';h t;j 141 of theGeneral Laws. By: Title C ityiTown PROVED (OFFICE: USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber �g 7 f, ❑ Gas Fitter Llcefise Numoer i t Master 1141 Journeyman <"X TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... 4,r4r,-,Pd ..... .................................... has permission to perform Aq .J ...... F ............ wiring in the building of ...... ...... vIf&v .... A .............................. I C, k,014: at ............... 11; , 310......North Andover, Mass. Fee .0.4�... L i c. No.. ........ If ;0 ELECTRICAL INSP'ECT01i' Check # 5448 ne Commonwealth of Massachusetts Department of Public Safety BOARD OF FIRE PREVENTION REGUTAMONS S77 APPLICATION FOR PER All work to be performed to acc (PLEASE PRIVY IN M OR TYPE ALU City or Town of The undersigned applies for a permit to Location (Street & Number) 06ner or Owner's A 1200 13/90 .--- - _+ J Permit No. Occupancy o cee Qsetkea—���� (leave blank) IT TOP FORM ELECTRICAL WORK ace with the M chusens Electrical Code. 527 CMR 12:00 itOP Oh) Date _T ti , / To the Inzpector of Wires: electrical work described below. Is this permit in conjunction with a buiidin permit: Yes ® No ❑ (Check Appropriate Box) Purpose of Building \ 7 Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of lieters Au s / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service I- Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work L No. of Lighting Outlets No: of Hot Tubs Total No. of Transformers KVA No. of Lighting Fixtures g g Swimming Pool Above In- g grad. ❑ grnd. ❑ Generators KVA Receptacle Outlets No. of Rece p No. of Oil Burners No. Emergency Lighting Batteryunits No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of•Self Contained Detection/Sounding Devices ❑ l�lunicipai ❑Other Local Connection No. of Ranges Total No. of Air Cond. tons No. of Disposals Heat Total Total No. of pumos Tons Im No. of Dishwashers Space/Area Heating -KW No. of Dryers Heating Devices KW No. of Water Heaters kw No, of No. of Sizns Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP i OTHER.: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage,or its substantial equivalent. YES ❑ NO 0 -I have submitted valid proof of same to this office. YES Q NO [] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSL'P.ANCE BOND ❑ OTHER (Please Specify) �(1141 .d/ 5 Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough \\�Ua\ Final Signed under -the penalties of perjury: FIRM NAi � LD " .[ C (9' c C��-c- G(iil L. LIC. N0.AL 2 ! � Licensee x 914 6Yf- 2� O � Signature . LIC- NO_ Bus. Telho_JTj E+SX "3d 3t Address i p( ik-�dt�"� T �Yit�iCSQi?it- \ .r-�-V� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) m 0 AM JCANT: Paul Drew 230 WehsW Woods lane Nam Andmw, MA 01845 6WG. M0. DRAWMGTM: Proposed layout 0 i \ i 01 max �m� I II mi . J a �O o � �. CD o t' � rn � m 0 AM JCANT: Paul Drew 230 WehsW Woods lane Nam Andmw, MA 01845 6WG. M0. DRAWMGTM: Proposed layout "xii� Propsed Pool Pian PREPARED 81" AWN Lot 30A Campbell Forest Zap Wester WOads Wi! Argdw. `'M" Engineering Alliance, Inc. PROJECT P. 0410801 DATE: October 14.2004 Laid Phnning Cwmdteds 194 Ctnt ai Street MALE: NOTED DWG RLE NAME: 0410801.DWG Saugus. MA 01906 Tet p81) 231-1349 i \ i 01 max �m� I ; I; i z J �> �O rm-�`z `- i F r- Zv F/ 1 m cn o t' � rn � c "xii� Propsed Pool Pian PREPARED 81" AWN Lot 30A Campbell Forest Zap Wester WOads Wi! Argdw. `'M" Engineering Alliance, Inc. PROJECT P. 0410801 DATE: October 14.2004 Laid Phnning Cwmdteds 194 Ctnt ai Street MALE: NOTED DWG RLE NAME: 0410801.DWG Saugus. MA 01906 Tet p81) 231-1349 Location / d 1A ��af /,%e �-<ke Z&oO A Zti. No. 1116 Date a -6)z TOWN OF NORTH ANDOVER Certificate of Occupancy $ �6 0 Building/Frame Permit Fee $ Foundation Permit Fee $ b Other Permit Fee TOTAL Check # / ) dv 17 13746 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:Itf DATE ISSUED: / s r. SIGNATURE: M /* Building Commissio /In for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: G 01- /a Szo K 1.2 Assessors Map and Parcel Number: 0 O -9Y Map Number Parcel Number ao9 Webster (000,(L� 1.3 Zoning Information: R12- Sj _ Zoning District ProposedfJse 1.4 Property Dimensions: �oo2 I � 7 Lot Area sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R redI Provided 3d, 3 ' (3 r .. 301 %/5'' 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record C�7 A� )CO-7?51- Name (Prin Address for Service -� 6 $ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: se Licensed Construction Supervisor: Addr ss 65 7 '. !G�apo Signature Telephone -. Is,.7cf, 6,5 7 — Not Applicable ❑ 06 d G/,2 3 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 1 z M 90 0 mn ic r M r r z Q SECTION 4 - WORKERS COMPENSATION (XG.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 ...... V No ....... ❑ SECTION 5 Description of Proposed Work check all a Ucable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 02 12. P4 s. 3 . is 56 n Crew 2, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building -, OZ f/ (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction04 q? 3 Plumbing Building Permit fee (a) x (b) e 517 � 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 77b OWNER`IAAUTHORIZED AGENT DECLARATION I,as (mer/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 /S p Signature of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 SPAN Ad DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X tow MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND 2 IS BUILDING CONNECTED TO NATURAL GAS LINE M a► —i <_ a t Z Ln m �O O O l O m O Z O -� r« .. AZO ? a '' Q O M N N �D t rrn m -nN ' (DD O m 0 ��� 3> > �L A 00 �o c 3 r•`: fD 7 OO . r. O m� O� a -0 00 =, �• � x c cr 3 a mc0 cQ H •�ry a o O o m LO m 1 m O N �c o<' fD :�O 0 E 5 CL TO CL CD 3 fD L13 al D O' O (� (p O 'y 91 � � D � CL 0 I+' rl � � � 0 ,., i E :e ^ m ^> X11 f m a� 3 a? ON CD��y,.n s CL (D :� �c o CL �--•� ov CD z0 =CIO: It: �z o x. C/) M m C/) 0 m r•M COO 'C CD 0z CD O Cr CO d CL _. .p .0 O o p CD Q Q� CD O CA .p CD a O 7 0 CO) 'C c O c CO) m n CD O �F CD CO)CD CD CA O 0 1 I C �C• W C CS H = O C) Cocc,• � O CD m CD °� �. O N S. H m d 0 �_ C7 m CL oAC ` Z -.-CD - �"S N 3 c X00 �. = 5 O- m G TFn 0 CD -I O CO CD = O g m > >®o CD •I � O .•► Cfl p CA y Q. d D C7 C c C CA O _. CD N Cni O m � CD 7U+ CD o C CA o CD o m CD o 1 CD Ci � 5 � .�a�. 0 CA• � O C) Cocc,• � 9 z °� �. CL N S. w Co CL oAC ��ITo °� � m O CACD 3 c X00 �. Its 0 Y CACA 3 0 0, CA y Q. d D C7 C c C CA O _. CD N Cni O m � CD 7U+ CD o C CA o CD o m CD o 1 CD Ci � 5 � .�a�. 0 � o � w � 9 z °� �. � Cil w g � ►� ��ITo °� � � c d c� �o 10• K o- 7C ::r 0 Y 7 rA Immi 0 9 0 c Y MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-15-2000 DATE OF PLANS: February 24, 2000 TITLE: Lincoln PROJECT INFORMATION: Lot 12 Campbell Forest Subdivision North Andover, Ma. COMPANY INFORMATION: Campbell Forest, LLC / Mesiti Dev. Corp. 231 Sutton Street Suite 2F North Andover, Ma. 01845 COMPLIANCE: PASSES Required UA = 594 Your Home = 591 J I I I I I Permit # I I I I I I Checked by/Date I I i Area or Cavity Cont. Glazing/Door Perimeter ------------------------------------------------------------------------------- R -Value R -Value U -Value UA CEILINGS 1752 30.0 0.0 62 WALLS: Wood Frame, 16" O.C. 2356 11.0 0.0 210 GLAZING: Windows or Doors 542 0.350 190 DOORS 94 0.490 46 FLOORS: Over Unconditioned Space 1752 19.0 0.0 83 HVAC EQUIPMENT: Furnace, 92.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC 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 R MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software version 2.01 Lincoln DATE: 3-15-2000 Bldg.l Dept.l 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: [ l 1 1. U -value: 0.35 I For windows without labeled U -values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] I Comments/Location I 1 DOORS: [ ] 1 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: [ ] 1 1. Furnace, 92.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ) I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: 1 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can No � r be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating 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. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 100-130 0.5 1 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- ��i l/�crl�acl ', ✓fze _6o�rr�nnaruuea DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE NOW, Expires: Birthdate: , CS' 069234 0510912000 0510911954 Restricted Jot 00 ALAN G. RUSSELL cr4r 400 MAIN ST GROVELAND, MA 01834 The .CommonWealth'of ML ssachusetts Department of Industrial Accidents Olfics cif Investigations Boston, Mass. 02119 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity FV -71 I am an employer providing /workers' compensation for my employees working on this job. LALJ Comoanv name: �'2� '0 Z e / 1-lre5 Address C;2,31 Sc, ft cry S7` S f ,v a .City 414,Y-4 xzr,; W"e"- /,(a ©/ S y, 5 Phone #� (Ia 7S) 7 - 5-20 0 �d Pc)ci �i� �i7S �o Poiicv -oo Insurance Co U---71- Comoanv name: Address City- 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 $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of (5100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pain and Pena 'sof perjury that the information provided above is true and correct. Signature / Date 3 /S tic) ,�lv <' 2 Phone � �,7 6;-5-7--5 76 0Print name a,� / �sS�/% Official use only do not write in this area to be completed by city or tc.vn official' City or Town Permit/Licensing ❑ Building Dept []check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact perscn: Phone: ❑ Health Department 11 Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a property licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: /*A e.2s7 ec- ye (thy. ./y, /V, Location of Facility ? Si e of -Ffermit Applicant —3zz 3zo 2 Date NOTE: Demolition . permit t from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U - LOT RELEASE F0RM INSTRUCTIONS: This form is used to verity that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. **** *APPLICANT FILLS OUT THIS SECTION****.t*** 5'i;�U, 5�-7-5_7 G v APPLICANT L�,�,�.y�'!� ��j7�5,, GLS PHONEF7-��3©L> LOCATION: Assessor's Nlap Number f Obi l/f PARCEL�y SUBDIVISION. -i,P �f' �s LOT (S) / aZ, STREET (,cJ�i� S �G I' CEJ b Od ST. NUMBER USE pfd RECOMMENDATIONS OF T0WN AGENTS' �,eV � w r\�d -h sc s- u re — ecvis+ , r nS SERVATION ADMINISTRATOR COMMENTS TOWN COMMENTS ER FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ s i,,— . -I-,- DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS �,�(,(1 `Z �Z3-00 DRIVEWAY PERMIT FIRE DEPARTMENT z -Z`3 -off RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm � 5w 716` v Growth Management Eylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under sec:ion 8.7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant on Building Permit (below) Address of Propertj for Permit (below) Map and Parcel: Purpose of Application (check below) Phone Number of Aolicant • _A Single Family Two Family — 97—S3,0,0— I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the wilding Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officaliy 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 one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. ka;;71 e lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Secticn 8.7 of the Zoning This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met andlor represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly 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 4011C permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from deve!coment by an Agricultural Preservation Restriction, Conservation RestriGicn, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcal. This application represents a lot which is ready for building permits.(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Oepartment 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 informa r7ma the checking off of an above item which does not comply, whether done to my knowledge or not is groun for refusal by the Building Department to issue a Building Permit. cure of wn zed Agent wno signed the Attached Building Permit Date form must be attached to the Building Permit upon application for such permit \ , p � � NN •~ X � A goEd WUSS;:ZZ 0002 SI ',IpW Z99Ztib6Zti9 'ON 2NOHd ONI d oao ONId33NION9 9IZN6>IOW WOH-d ry 10,E in Ll OF Ed Wd8S:ZZ 0007- SZ 7-997-tib6Lti9 'ON 3NOHd DNI`df oNo ONId39NION9 9IZN3AOW WOdj 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) 685-0.9.10 Fax (978) 688-9513 Additional conditions for lots 10,1 1, and 12, Campbell Forest February 22, 2000 This Division agrees to sign the Form U, and issue water and sewer permits, for lots 10, 11, and 12 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. 2. No water service shall be installed into either residence until all off site sewer facilities are approved by this office. Any violation of the above conditions will void both water and sewer connection permits. No refunds will be granted. Mesiti Devopment Corp Printed Name Date DivisionlubVc Works Printed Name Date CC: Bill Hmurciak Jim Rand Mike McGuire Heidi Griffin N° 951 APPLICATION FOR WATER SERVICE CONNECTION �-, aNorth Andover, Mass. f' 7-2— Application 2Application by the undersigned is hereby made to connect with the town water main in subject to the rules and regulations of the Division of Public Works. The premises are known as No, or subdivision lot no. Owner Contractor l u te,4 ( e 6� oe--47e;L ll— S Z—,-,- � Street Z�l s)J syt �e � Address Address Applicant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to 1 to make a connection with the water main at �� ei Gt�cbC�-5 C� Street subject to the rules and regulations of the Division of Public Works. _ 7 Board o Public Works By G/% UL iajz1 Inspected by Date See back for rules and regulations /i 1 1 487 APPLICATION FOR SEWER SERVICE CONNECTION Zorn North Andover, Mass. Z— a Application by the undersigned is hereby made to connect with the town sewer main in subject to the rules and regulations of the Division of Public Works. /, The premises are known as No. -z "" q e, fes, " v ®� � ?'1<�f Street or subdivision lot no. lZ A4e,C/ For'e,-� L C Owner Joe, ;'� i (�e V/' Contractor �,�7-S3oo Address Address Applicant's Sign ture PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to Cwt �e f �� to make a connection with the sewer main at /deg subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (508) 685-0950 Fax(508)688-9573 Date: z2 LOCATION: ��,��✓ �tj�o✓s Z,e . /0-� Z - BUILDER: phone: OWNER: �e✓� �� z -c phone: 07-,536�n w'-, `r De ✓ 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: FORM J IAT 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,19 _9_9_ and/or by the Covenant dated Mow a9 19 59 and recorded in District Deeds, Book q R$0 Page Iy or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration BookIPage has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the pe enumerateSf d lots shown on Plan entitled 11Cam e) e 7vf$ P Section (s)!Sheets 1 ' 7 it Plan dated 19 gam_ recorded by the ESSpx Nortk D i strict- egistry of Deeds, Plan Book or registered in said Land Registry District, Plan Book Pian/ a7 84 and said lots are hereby released from the restriction as to sale and building specified thereon. L4 Lots designated on said Plan as follows: (Lot Number (s) and street(s)) b. (To be attested by a Registered Land Surveyor) Lors L ors ! �K-•+ 1-1,1 LoIrs I hereby certify that lot number (s) Low. ZS 71w_u 31_j 84 nrrrJG bGJf qac,. w�sScbr.. Wcoob".&w ZgLtg-.0- Street(s) conform to layout as shown on Definitive Plan entitled g wnT Section Sheet(s) on do O F MAsS � cti ALBERT T. a� C) TRUOEL R gi.stered Land Surveyor o No. 36869 0� a ��Fd'a'vECISTE�E� JQ,``' 1 of 2 73�gSft l -t ;1-0 J w m 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, , Page , acknowledges 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 day of 19 /Cm Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS ESSeX ss -,)'&6i�b-r 21, 19 q5 Then personally appeared Aj15;?» I2 b a W, 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. 6"' rl)7 Notary blic M a, 4-.006 My Commissi n Expires 2 of 2