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Miscellaneous - 24 ROSEDALE AVENUE 4/30/2018
Town of North Andover ,,ORTH �w• tiID Y Building Department �,? y�`., ,�6*6 °o 4. 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 ►PP`yCy/ APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS L T F—, DATE REQUEST FILED 6- 2-1- 0 t - DATE READY FOR INSPECTION 6' 21 - 0T 2.-2 TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF '" 'HE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE-- NV�>-y+�2�-`��5� --K j R OFFICIAL USE ONLY ROUTING D.P.W. - WATER METER L -1 WWW DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR_10 THE SPECTIO QUEST DATE. SIGNATURE / PW AUTHORIZATION Location (9 Lf ? 6S�4 a I e- A Ve-- f No. 3/17 Date HORTp TOWN OF NORTH ANDOVER .• 0 9 Certificate of Occupancy $ 5 S'— '� Cw�s Building/Frame Permit Fee $ Foundation Permit Fee $ /DO Other Permit Fee $ TOTAL $ /5 5 r --- t Check # ti /� 6j ' - Building Inspector ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING UI3 nDATE ISSUED: SIGNATURE: Building Conun4ioner/IRTector of Buildings Date JI -3-0:7 SECTION 1- SITE INFORMATION 1.1 Propetty Address: 4 1;: 1.2 Assessors Map and Parcel Number: c0 22 Map Number Parcel Number 1.3 Zoning Information: --:5 ee4 c t L 1.4 Property Dimensions: i Cry Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided `SCO CP 0 2-© 1.7 Water S ly M.G.L.C.40. 54) 1.5. Flood Zone Information: Public pRvate Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal X On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes NO 2.weer of Record Il0'V`''e 41-15 u Name (Print) Address `or Service : Si nature Telephoneg75 -72e> 3<t;�50 CEL ^ 0) 75 82_4�> (�p(A20 Y� �.�V 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: - Not Applicable ❑ Licensed Construction Supervisor: 1 is i j`�► ✓ [[����j b.ZJf[ License Number Address n Expiration Date Signature Telephone Ic _ I 6N Not Applicable Company Name I ¢l Registation Nu mber'ti,�,, y � Ass Expiration Date SignatureTelephone CO- CDO SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin rmit. Signed affidavit Attached Yes ...... No ....... 0 SECTION 5 Description of Proposed Work (check all applicable) New Construction Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Provosed Work: ALc WrTInN 6 - RCT"AATRn CnNCTR1TCT10N CnSTS )t>— Q -t=> I i - 5(N11� - /0''x[1\h- Item Estimated Cost (Dollar) to be Completed by permit applicant OFFiCIALUSE ONLY } 1. Building/jp� on C) (a) Building Permit Fee Multiplier 2 Electrical,��,r� 0W D (b) Estimated Total Cost of Construction 3 Plumbin 6>CN> Building Permit fee (a) X (b) 3 3 4 Mechanical HVAC 2 ^ XC -0 5 Fire Protection 6 Total 1+2+3+4+5 Z?—moi 4!:� Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 0 3A )b6 I, _= as Ox+ner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1. 1, t��yi r1> l�C� 1 V as ONvner/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 p Print Name., Signature of Owner/Agent Date f GLS J NO. OF STORIES Z SIZE 2.200 '7F BASEMENT OR SLAB SVE OF FLOOR TIMBERS 3 2 X SPAN'2— tt QG r DIMENSIONS OF SILLS 2 ^ XC -0 DIMENSIONS OF POSTS 1 -ZIILp � DiMI'NSIONS OF GIRDERS 3-2.A J I II m I ITOF FOUNDATION 1— 0 e THICKNESS I C> `t �I/L 01- FOOTINGtt 1.�1 VJ X tf) MATERIAL, OF CHIMNEY CA&e IS 131TILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 'Y —J FA BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 059321 Birthdate: 08/23/1962 1.4 Expires: 08/23/2004 Tr. no: 6959 i Restricted: 00 DAVID M MERMELSTEIN 41 CHESTNUT ST N ANDOVER, MA 01845 Administrator r✓ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: v QMELGJ 1 C* �F�G�' `J s3 MtAiN �( 'Nord j Location: = c�T� `2� lam AVE i�ori't1-� lIt�v i•,1� Ci 1 ��-1�' Phone # �-W^7Z'�-) -3x�o30 I am a homeowner performing all work myself. 17 a sole proprietor and have no one wonting in any capacity' F-1 I am an employer providing workers' compensation for my employees working on this job. Company name.- Address ame: Address city. Phvr* #: Insurance Co. Policy # Compares name: , Address: Phone #k Failure to secure coverage as required ander Section 25A or MGL 152 can lead to the kr;mibon of crkr*W penalties• �:a�#rtie uprto Z7.5Q and/or one years' irrPmonrnent as Neekw-a penaties-osheinrmOa-U-QP fm-ci€..(,3H1QEi0I�rfayr e: understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ob hereby eaertdy render the d penalties or iay incl the infa►mation p+vvided above is true and correct Signatu pate d52-� Print name Phme.078> 72c2 -36o3b Official use only do not write in this area to be completed by city or town dWar City or town __ FerrrlLicensina. Building r -]Check if immediate response is required t. � E.IG�'t?3%n� Boa sa/Cch"aws O Contact person: Phone # n Healt(? Departr, El father 5:34_ OCTi�, 2039 TO: DAMpRC DESIGN FR: rmwp *72021 —: Z/? �IC20,, CERTIFICATE OF LIABILITY INSURANCE 10/29/20 3 PRODUCER (800) 333-7234 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street Natick, NA 01760 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GENERAL LIABILITY Select ext 3102 v INSURERS AFFORDING COVERAGE NAIC # INSURED David McFa—m stein INSLRERA Western World Insurance Co. DBA: Damarc Design & Construction Co. 100 Main Street North Andover, MA 01845 INSURER : ��-- INa RER C. — — ---- —---- INSURER D:---- INSURER E: MED EXP (Am, one person) COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W7H RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN VW( HAVE BEEN REDUCED BY PAID CLAIMS. NSR ILTR D'L NSRE YPEpP�gURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY j NPP7924171 07/30/2003 07/30/2004 EACH000jRRENCE $ 13000,000 CONIMER:IAL3ENERALLI.AtBLFY CLAIMS MADE! I OCCUR $ r 000 v MED EXP (Am, one person) $ S'000 A X PERSONAL 8 ADV INJURY S 1,000,000 _ GENERAL AGGREGATE $ 2,000,000 I GEN'LAGG-REGATELFRrAPPLIESPER. POUCY JEFF LCC PRODUCTS -COVPJOPAGC $— 1,000,00 AUTOMOBILE LIABILITY ANY AUTO COMBNEDSNGLEUMIT (Ea accident) $ ALL OWNED AUTOS SC}-1EDULED AUTOS BODILYINJl1R1' (Per person) S HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (Peraccidenq $ PROPERTYDAMAO-E (Per acddenq c I GARAGE L1ABILRY AUTO ONLY- EA ACCIDENT $' ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGO $ EACH OCCURRENCE $ —EXCESSIUMBRELLALIABILr1Y I OCCUR � J J CLAIM511ADE i AGGREGATE $ DEDUCTIBLE ! $ I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WC 5TATU- OTH- TORYLIMITS R E.L. EACH ACCID=NT $ ANY PROPRIETOPIPARTNER'EXECIL. OFFICERWEMBER EXCLUDE:,'r s,IALPdesci bexSIO i E.L. DISE/SSE- EP. EMPLOYEE $ EL. DISEASE- POLICYLIMB $ S .:�ECIALF'ROUSIONSbn;oty ( _.�.��,.� OTHER i — DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Milton Long 24 Rosedale Avenue N. Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRRTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Rose Ross ACORD 25 (2001188) OACORD CORPORATION 1988 GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8. 7.6 of the Torn of North Andover Growth ;Management Bylaw. The applicant shall proN ide all of the necessaryinforrmmatatTioonn1Iaai1ss requesstee11d below. 51 le -1-S DC�V-qp VLEgm 0 De Permit Applicant Property address Map / Parcel X 78 72.E 3<PaC > e:=�i1 CAL.finvnq Applicant's Phone Number 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 EXT-MPTION section 8.7.6 of the Growth :Ltanagement 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 building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is 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. y This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as ofthe e/f%dive date of this bylaw, provided that no additional residential unit is created. 7� The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of suction 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens 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 part of development project which voluntarily agreed to a minimum 40 °o permanent reduction in density (buildable lots) below the density 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 or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction. Conservation Restriction. dedication to the Town. or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and 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 parcel. This application represents a lot which is ready for a building permit ( 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 submit an approved FOR.\I U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL NFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS Al -LOWED UNDER ONE OR MORE OF THE ABOVE EN7ENIPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF TIiF INFORMATION PROVIDED ,A.ND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AVN EXT-MPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUB,1IIT7AI, OF MISLEADING OR INACCURATE INFORMATION OR T H E CHECKING OFF OF A ;ABOVE EXEMPTION WHICH DOES NOTCOMPLY, WHETHER DOVE TO MY KNOWLEDGE CE OR NOT IS AGR Z REFUS AL B HJ, BUILDING DEPARTMENT TO ISSUE A BUILDING PFR\tIl'. APPLICANTS SIGNA CURE DA"IT. THIS FORM TO 13E ATTACIIED TO TI IE BUILDING PER -NUT APPLICA FION Town of North Andover E NORTH Office of the Zoning Board of Appeals F? •' ' Community Development and Services Division « 27 Charles Street North Andover, Massachusetts 01845 'Ss�cNus�t D. Robert Nicetta This is to certify that twenty (20) days Building Commissioner have elapsed from date of decision, filed without filing of an appeal. North Andover, MA 01845 Dates �.,. Joyce A, Bradshaw Town Clerk Any appeal shall be filed Notice of Decision within (20) days after the Year 2003 date of filing of this notice in the office of the Town Clerk. Property at: 24 Rosedale Avenue Telephone (978) 688-9541 Fax (978) 688-9542 NAME: J.K.J. Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA HEARING(S): 9/9/03 ADDRESS: 24 Rosedale Avenue PETITION: 2003-031 North Andover, MA 01845 TYPING DATE: 9/15/03 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, the 9`h of.,'.4' September, 2003 at 7:30 PM in the North Andover Middle School Auditorium, 495 Main Street, North Andover upon the application of JXJ. Realty Trust, David Mermelstein, Trustee, 98 Main St., North,-." Andover, MA, for premises at 24 Rosedale Avenue, North Andover, MA requesting relief for a dimensional Variance under Section 7, Paragraphs 7.1 (Lot area) and 7.2 (Street frontage) and Table 2; and a Special , k Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-law in order to raze an existing single family i structure on a pre-existing, non -conforming lot and replace it with a new single family structure on a pre- existing, non -conforming lot. The said premise affected is property with frontage on the West side of Rosedale Avenue within the R-3 zoning district. The following members were present: William J. Sullivan, Walter F. Soule, John M. Pallone, Ellen P. McIntyre, Joseph D. LaGrasse and Joe Edward Smith. Upon a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to GRANT a Special Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-law in order to raze an existing single-family structure on a pre-existing, non -conforming lot and replace it with a new single-family structure on a pre-existing, non- conforming lot per Plan of Land in North Andover, MA. Prepared for owner/applicant, Milton Long c/o David Mermelstein, JKJ Realty Trust, 98 Main St., North Andover, MA, Date: June 13, 2003, Rev: August 12, 2003 by Stephen E. Stapinski, R.L.S. #29876; Merrimack Engineering Services, 66 Park Street, Andover, Massachusetts; and 24 Rosedale Ave North Andover, Ma. By Damar C. Design, Architectural Design & Building, 98-100 Main Street, North Andover, MA 01845 Date: 6-4-03. 1. The existing house will be razed and removed. 2. The existing garage will be razed and removed. 3. The old septic system on the Maplewood Avenue side will be removed and filled according to the Building Commissioner's instructions. Voting in favor: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse and Joe Edward Smith. Ellen P. McIntyre recused herself. Upon a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to allow the petitioner to WITHDRAW THE PETITION FOR THE VARIANCE WITHOUT PREJUDICE. Voting in favor of the withdrawal: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse, and Joe Edward Smith. Ellen P. McIntyre recused herself. ATTEST: A True Copy Page 1 of 2 Au O r Town Clerk Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 Town of North Andover of NORTH ,.•o ,.'�a Office of the Zoning Board of Appeals o? •':' -`' Community Development and Services Division 27 Charles Street ,s +AVID 1' North Andover, Massachusetts 01845 4SS+CHUSE` D. Robert Nicetta Telephone (978) 688-9541. Building Commissioner Fax (978) 688-9542 The Board finds that the applicant has satisfied the provisions of Section 9, Paragraph 9.2 of the Zoning Bylaw that such change, extension, or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-031. M60CP45 Page 2 of 2 Town of North Andover Board of Appeals, Chairman Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 DEEDS ESSEX NORTH REGISTRY �O�F LAWRENCE, MASS, ..._. A TRUE DOPY: ATTEST- RFGISTER OF 000 m o ?0 5 0 CL z r, °,moo ? z cD m m Ol C _ H c 7 o W. c x to s d C O' m o O 0 CD N a W 0-0M - O Om x > 2 o co c r« 02 H CL o 0(�� � DD m �L13a w a X. 0 0 c 0 > > E y CD - i Q x � ,.• O I p H � re 0 d aj N fD fD 4; m E FL Z a 3 cD 0 o o CD �t1 0 o om�. y fD :4 CL: > tt n -o �■ y UO � � y o � � O ;u ",v rn z 0 w -44� 0 Edp 0 � O vow 1 CD � w a W m m C 7) m 0 m � d CA CO) 'O O CO)CD Z CO) CO n� r C � ? C CL _• y � n•� C9 ..t CD o p CD o rF CLQ CD !D O CD ao CD CD Qv y 5.0 COD I II F p V J n 0 V J O z cn V / CO) W! 9 A m S_ a" < mCL H y m=2mcc) m m CLC-)H ?'O H. d .d-► O H n m n 0 = Mn coo -40 m H O OS • m :L o� o �= CD m N CD cro Oioum• H 5.0 — d y O CCD ♦y 4 u CA C m m r o r) :�. � ^* = :0l: W o F b CD ?� o CDA :� 16 CD r :c n% CA 10 !R � CD a=_ O „�~• :� 0- z rn w J 4 0 c cn w 7� z T O Wcn -n 7� " o � ;o o t O ►n � N ;n o o w r z Cb Cn y g n zr O O x 0 c 4 N Date..../V,-7.......... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACHUSE� J This certifies that . ..: has permission to perform ........ ........................... %'.. wiring in the building of............... . �..: f !-?•ri-�........................................ .........: �/ /c ! - r '"`�J ... , North Andover, Mass. Fees:".. e......... Lic. No?'.,?............ ��.. �-.:. .. ELECTRICALINSPE.(R Check # '- / 76u, Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. (d Occupancy and Fee Checked 120 [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: q - il" o 7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Lf t►C o S CAO:. �r' C', Owner or Tenant 0i ra To re C e S Telephone No. Owner's Address 5q- t,44 e Is this permit in conjunction with a building permit? Purpose of Building Existing Service Zoa Amps / Z�O l 2YO Volts Yes 2 No ❑ (Check Appropriate Box) Utility Authorization No. Overhead Y Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Ft A� Completion of the olloMn table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- ❑ rnd. rnd. o. o Emergency Lighting Batte Units No. of Receptacle Outlets % (a No. of Oil Burners FIRE ALARMS TNo. of Zones No. of SwitchesNf © o. oGas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number .... .......................... Tons KW .............. No. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts . Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under thepj ains and penalties of perjury, that the information on this application is true and complete. i FIRM NAME: r K k [JLr Cko,4d1eX P' CeC r`t`G LIC. NO.: Z4 i iZ Ile Licensee: !?tie f f ' LJW,�IIF - Signature ,, l LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) f • Bus. Tel. No.:.�? Address: .5� i & Lie 5q,/ et- vy llf 6 O ? Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Dee of Investigations 600 Washington Street Boston, MA 02111 j www.nzass.gov/dia . Workers' Compensation Ins6rance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �-104 Please Print Leaibiv Name (Business/organization/Individual):_ i'40"' L�'f (�C -10 C— Address:_ :�' /9 A () e�- City/State/Zip: 51 4�°GVl Ltl �� OW F Phone #:. Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ 1 am a general contractor and I Type of project (required): employees(full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. am asole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These subcontractors have S. 0 Demolition working for mein any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its q, D Building addition required.] officers have exercised their 10 F1 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No -workers' comp. c. 152, § 1(4),'and we have no 12.E:] Roof repairs insurance required.] t employees. [No workers' 1317 Other comp. insurance required..] M„y eppucan[ znar Cn=Ks ooxV t must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, lContractors that check this box must attached an additional sheet showing the name of the sub-contructors and their worker;' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce ' under the pains and penalties of perjury that the information provided above is true and correct aLm-tore: Date: 7 Phone #: Q 7 0 —c/7 7 4 Qgwial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.ot compliance with the insurance 'coverage required." Additionally, MGL chapter 152, §25C(7) states' Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should, be returned to the city or town that the application for the permit or license is being requested, not -the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the numberlisted below. Self-insured companies should enter their Self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, , please do not hesitate to give us a call. The Department's address, telephone and fax number: f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA €12111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE - Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia b R 0 _N i �4 a ° o m n m Q d o 9 H ZO �® P) dC � CCD CJ) d z � z z n �m Yj 6 H o M 0, 'n xm Ch Q 9 H ZO �® P) dC CCD m z n e— C/) M m C/) 0 m CA CD a Z CD O CL r. m d CDo � n o p CL Cr so CD o CA 00 CD 0 d O CA F 0 CO) LTJ O CCD 0 CD 9- 1i� W Mo. m �, '+ z ►y� el tV � CJI r Ccr Go a00 w r =CEO m n y m � c 3. C' m m nIrm = m t.t y -4OOy O �: 0 CDCD m a �= omc,' "o Z�n y_. m ? Sm :S L : = ..gym : • O � � O O y :u Now, 0 0 — o �• m1p y � d y a' =, y Q : a A�i l - vs `yto O O �• G :�� %glob 0 -= Ir o' CD tCD o �C - � CL t Cl) t� . 0 '� C �� o= :f . Mo. m �, '+ z ►y� el tV � CJI r � o w r �? o o w c w �. ( o b o C n gg O t.t ry z 0 4 Location -? c,5, cJa 1c Aj-.,- No. i _ Date �' O3 NORTh TOWN OF NORTH ANDOVER 3? ' • OG � 9 Certificate of Occupancy $ NUS Building/Frame Permit Fee $ -- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 q,8 C7 Check # V •) 6r / , �J Building Inspector m 0 0 JN N /F 'k DAWE 9 (v) N O M n Go 3 It P MPP���oOoR�vP�Ei " I WEREBY CERTIFY TO THE TOWN OF NORTH ANDOVER BUILDING DEPT. THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN" 12/10/03 STEPHEN E. S P S , -&L. S. DATE PLOT PLAN OF FOUNDATION IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR DAMARC DESIGN & CONSTRUCTION CO. 98-100 MAIN STREET NORTH ANDOVER, MASSACHUSETTS 01845 30 0 15 30 SCALE: 1"=30' DATE: DECEMBER 10, 2003 II)WkRIWMCK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 REScheck Compliance Certificate Massachusetts Energy Code RES checkSoftware Version 3.5 Release 1 Data filename: Untitled.rck TITLE: 24 Rosedale Ave CITY: Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 11/24/03 DATE OF PLANS: 06/01/03 PROJECT INFORMATION: Damarc Design COMPANY INFORMATION: J&J Heating & Air Cond 17 Arlington St Dracut MA COMPLIANCE: Passes Maximum UA = 385 Your Home UA = 375 2.6% Better Than Code (UA) Ceiling 1: Flat Ceiling or Scissor Truss Wall 1: Wood Frame, 16" o.c. Window 1: Vinyl Frame:Double Pane with Low -E Door 1: Solid Floor 1: All -Wood Joist/Truss:Over Unconditioned Space Furnace 1: Forced Hot Air, 92 AFUE Furnace 2: Forced Hot Air, 92 AFUE Air Conditioner 1: Electric Central Air, 10 SEER Air Conditioner 2: Electric Central Air, 10 SEER Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA 1184 30.0 0.0 41 1912 13.0 0.0 121 377 0.350 132 63 0.400 25 1184 19.0 0.0 56 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES check -Version 3.5 Release 1 (formerly MECchecl and to comply with the mandatory requirements listed in the RES checkInspection Checklist. 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 780CMRI101$ and AA /') Date 1,L IQ -05 e .� REScheck Inspection Checklist Massachusetts Energy Code RES checkSoftware Version 3.5 Release 1 DATE: 11/24/03 TITLE: 24 Rosedale Ave Bldg. Dept. Use Ceilings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Above -Grade Walls: 1. Wall l: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: Windows: 1. Window 1: Vinyl Frame:Double Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door 1: Solid, U -factor: 0.400 Comments: Floors: 1. Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-19.0 cavity insulation Comments: Heating and Cooling Equipment: 1. Furnace 1: Forced Hot Air, 92 AFUE or higher Make and Model Number 2. Furnace 2: Forced Hot Air, 92 AFUE' or higher Make and Model Number 3. Air Conditioner 1: Electric Central Air, 10 SEER or higher Make and Model Number 4. Air Conditioner 2: Electric Central Air, 10 SEER 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: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: [ ] I Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] I 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. ( ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I 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. I Heating and Cooling Equipment Sizing: [ ] I 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. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 °F must be insulated to the levels in Table 2. r r Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runouts Circulating Mains and Runouts Temperature ( F) Up to 1„ Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes NOTES TO FIELD (Building Department Use Only) Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) Date... : �! .: �',7 . . TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION N This certifies that ............... Mhas permission for gas installation`. ................ . in the buildings -of ........... at . �r. �`'"�"%` �! „ North Andover, Mass. Fee. Lic. No.... ''bX!' ....... GA$'INSP TOR Check # y 4649 OCT -28-2003 12:57 E.C.S.I. 603 642 9223 P.01 w 111 Route 125 - Kingston, NH 03848 P.O. Box 1147 - Atkinson, NH 03811 Tel: 603-642-9200 Fax: 603-642-9223 U. No. Andover Board of Health - Sue Ford From Mary Rourke/ECSI-NH Ext. 204 Fax: 978-688.9542 Pagest 4 (Includes cover sheet) Phonot Date: 10/28103 Ret Mass Notification CCI 0 Ursent X For Review Q Please Comment X Please Reply 0 Please Recycle We will be doing Asbestos abatement work in No. Andover, MA LCALL is notifying as r"uirwl. Please roview attached sheets) for additional information- N you have *mdwmh peas* cal6 Thank You Whem ComaJiance Builds Confidence OCT -28-2003 12:5? E.C.S.I. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. !rr Commonwealth of Massachusetts 603 642 9223 P.02 )100001383 Asbestos Notification Form ANF -001 Number Affix Asbestos Notification Decal Here A. Asbestos Abatement Description a. Is this facility fee exempt - city town, district, municipal housing authority, owner -occupied residence of four units or less? " Yes 0✓ No b. Provide blanket decal number if applicable: 2. Facility Location: INSTRUCTIONS 3. 1. All sections of this roan must be completed in orc* to comply with 4. DEP notification CMR requireme5nts of 310 and the 0Wkkin 0tooa��g ret notification requirements of 4S3 CMA 9.12 24 ROSEDALE AVENUE a. Name of FaoilitX NORTH ANDOVER C city/Town d. State Blanket Decal Number 24 ROSEDALE AVENUE Street Address_ 01845 _ 978 726.3630 e. Zip Code f. Telephone Number Worksite Location: BASEMENTANTERIOR �� ��� 0 F_ a. Building Name/Buildin® Location b. Building # o. wing d. Floor e. Room Is the facility occupied? E] Yes 1✓ No Asbestos Contractor: ENVIRONMENTAL COMPLIANCE SPECWLISa. Name� GEORGETOWN___-� Q1$33 c. C/Town d. Zip Code AC00040T 1. DOS License Number IVINNY PORCELLA h. Facing Contact Person _ JOLDIB A. BATIsTA 6' a. Nam of On -Site Su rvisor/Foreman " T' JPU a. Name of Pro act Monitor PRO SCIENCE $' a. Name Asbestos Analyftal Lab 9 11/03/2003 s. PMhtt SUM Date mmlddl yj__ 7:OA-3:30P c. Work hours Mon -Fd. 10. a. What type of project is this? R✓ Demolition Q Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: i]✓ Glove bag Encapsulation © Enclosure [� Disposal only D Cleanup Other, specify: 0 Full containment SOLD SSROAD b. Aedtass 6036429200 e. Telephone Number g. Contract Type: Coll Written ❑ Verbal L_ -- Lb, Describe 1 b. Describe 12. Is the job being conducted: ✓) Indoors? 0 Outdoors? 7 Gu T7T. M aM001ap.doc • 10102 Asbestos Notification Form • Pape 1 of 3 M OCT -28-2003 12:58 E . C . S . I . Commonwealth of Massachusetts Asbestos Notification Form ANF -001 603 642 9223 P.03 i(100001383 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or en ul ted: a. Total pipes or ducts ear D. I Ota other s aces square c. Boder. broaching, duct, lank d. Insula ' sudeoe Malmo$ Lm. A. �S . R �g cement e. Corrugated or layered paper = ;; f. Tl/Sprayer pipe insulation. Lin. ft. coatings Lin.ti 0• Spn3y-on firepr�ng _..1 � S. fi h. Transhe board, wall board i. Cloths, woven fabrics —� J. Other, please specify: G -----J k. Thermal, solid core pipe 60 AT,ROOF,tNSTC Insulation Lin. K. _j sq. ft. I. specify 14. Describe the decontamination system(s) to be used: 13CHAMBER WET REMOVAL 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (a): 6 MIL POLY BGS OR LND DRMS, PRPLY LBLD, AND DISPSD OF IN APPRVD LANDFILL 16, For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: - !b• TAIeE c. Date f mmldd/ of Authorization d. OEP Waiver # e. Name of DOS Otriciai III. DOSrt�Title g. Date (mm/dd of Authorization ` . DUS—W-3 -� /YyyY) h. OOS Waiver A( 17. Do prevailing wage rates as per M.G.L. c.149, § 26, 27 or 27A -F apply to this project? Q Yes ✓) No B. Facility Description 1. Current or prior use of facility: PRIVATE RESIDENCE 2. Is the facility owner -occupied residential with 4 units or less? O Yes RJNo MI 3 LTON LONG 28 ROSEDALE AVENUE N an=lap.doc • 10,02 198.100 MAIN STREET I MA 1845 _J 19.78.726.3630 d. Zip Code e. Telephone Number (area code and extensbn) Asbestos Notification Form - Page 2 or 3 � J# OCT -28-2003 1258 E . C . S . I . • Commonwealth of Massachusetts Asbestos Notification Form ANF -001 B. Facility Description (cont.) 5. NIA-.......�...._._ -_.._ a. Name of General Contractor G. CitVrr d. Zip Code AMERICAN ASSURANCE f. Contractors Workers Comp. Insurer 603 642 9223 P.04 100001383 Decal Number 11027637 1 6. What is the size of this facility? 14,4& -Vv 1 t& I a. Square Feet b. Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary), Note: Transfer a. Name ofTranspg¢dr_ _.� --Ib. Address Stations mustTM 1 comply with the--�..-...,....._....�. c. City/Town d. Zip Code e. Telephone Number Solid Waste Division 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 ISERVICE TRANSPORT GROUP P 0 BOX 2132 , (BRISTOL, PA c. Cit /Town 3. ia. Refuse Transfer Station and C i c. Ci /Town 4. JA & L SALVAGE INC. a Final Disposal ite Location N 11225 STATE ROUTE 45 c. Final Dismal Sita Addrase ,OH e. state D. Certification 19007 f 44432 f. Zip Code The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the infomration contained in this notification is true and correct to the best of his/her knowledge and belief. 0 GnM01ap.doc• 10/02 (MARY ROURKE 1(6031642-9200 i 1111 ROUTE 125 Q. Address KINGSTON, NH h. City/Town 11012012003 1 0364$ i. Zip Code � Go To Top Asbestos Notification Form - Page 3 of 3 0 TOTAL P.04 MASSACHUSETTS UNNORMAPPUC, ATON FOR PERMIT TO DO GAS F frnNG (Type or print) '� Date NORTH ANDOVER, MASSACHUNETTS' Building Locations S< V Owner's Name New El"" Renovation ❑ Replacement ❑ Permit #� Amount $ ✓�< 1 41e— Plans 12Plans Submitted ❑ (Print or Address �� /,�— Cl ,t, G C7W� 11Je' r�8 �'�✓ �i C }-i Check one: Certificate Installing Company Corp. ❑ Partner. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter✓b C`�'� "�'y �� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13No ❑ If you have checked yes, please id to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i 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 instal tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac e s State Gas Co -and Chter 142,yf the Gene yl Laws. By: Title City/Town APPROVED (OFFICE Use ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Z% S? Gas Fitter License Number Journeyman � Ij a a z p W d FF a z z10 w W '; z F-4 p R` d Gw w x w w o ww w U z z 0 0o z 00 w H w ` a d� x o w o a c� a U a SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3 R D. F L O O R 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or Address �� /,�— Cl ,t, G C7W� 11Je' r�8 �'�✓ �i C }-i Check one: Certificate Installing Company Corp. ❑ Partner. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter✓b C`�'� "�'y �� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13No ❑ If you have checked yes, please id to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i 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 instal tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac e s State Gas Co -and Chter 142,yf the Gene yl Laws. By: Title City/Town APPROVED (OFFICE Use ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber Z% S? Gas Fitter License Number Journeyman Date ` ... .� . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......................... has permission to perform ....:,... ..;-.`..................... . plumbing in the buildings of !'?:.:. n .�.-��- ........ . at .... ;%.... -!�: '- P� �............. North Andover, Mass. Fee,`. ._-J.... Lic. No. .�/�'a... ... ... ............ PLUMBING INSPECTOR Check 9 ?� 5:�2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS r/ Building Location „� A 3 C4,gze— Owners Name � e Date � of � C /�� �'1 �5�� Permit # Amount Type of Occup2'ncy New ET/ Renovation 13 Replacement 1 Plans Submitted Yes No F1rVTT iT? F C (Print or type) y� i� Check one: Certificate Installing Company Name/� _ �.(� e- Q �""C 11 Corp. Address �02 L���� �"�� ` _ Partner. �I77, \Rusmess Te ep one ('a 3 `_ A 7 a Firm/Co. 'Name of Licensed Plumber: A-6 ,P_�'j�4 "U4 }e ?. Insurance Coverage: Indicate theAype of insurance coverage by checking the appropriate box: Liability insurance policy (j��� Other type of indemnity © Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature IOwner 11 Agent ri 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 anynstallations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MA010usetts State Wbingjk!�.Re an�oapter 1421,4f the General Laws. IBy: Title City/Town APPROVED (OFFICE USE ONLY ` Type of Plumbing License '� !S-' License um er Master 01", Journeyman ❑ .J r --.-IMMMINMMINWOMMOM -....----.-.--- ■'=OWN oNO MMOM■MNNO IMOM loom UMMINIMMMOMMMOM No WIN C" 1 �1:1 .�U.IM.M-..MMIMMMIMMIMIM IN „sOMMIMMM■ MMINOMMOMMOMMMINIMIMM (Print or type) y� i� Check one: Certificate Installing Company Name/� _ �.(� e- Q �""C 11 Corp. Address �02 L���� �"�� ` _ Partner. �I77, \Rusmess Te ep one ('a 3 `_ A 7 a Firm/Co. 'Name of Licensed Plumber: A-6 ,P_�'j�4 "U4 }e ?. Insurance Coverage: Indicate theAype of insurance coverage by checking the appropriate box: Liability insurance policy (j��� Other type of indemnity © Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature IOwner 11 Agent ri 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 anynstallations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the MA010usetts State Wbingjk!�.Re an�oapter 1421,4f the General Laws. IBy: Title City/Town APPROVED (OFFICE USE ONLY ` Type of Plumbing License '� !S-' License um er Master 01", Journeyman ❑ tj Date ... ..... .... ...... 2. '. , TOWN OF NORTH ANDOVER 0c - PERMIT FOR WIRING This certifies that ...... 1V ........... has permission to perform .... K)..0— til ........ 4-ame ....... viring in the building of ..... ..... tec4-1.1-Y .... f �1 ............. at .... Pysejc j?.................. . Andover,NM Fee.330 ....... Lic. No. ..... ........... \� ....... . ....... ..... I�sp.� CTRICAL INSPECT R Check # 3 e:�; 5,;37 7,71s Gmm2a uz?w 657 zlo"k-4 4 P06& s*4 BOARD OF FIRE PREVENTION REGULA APPLICATION FOR PERMIT TO All work to be performed in accordance with the (Please Print in ink or type all information) Town of North The undersigned applies for a permit to perform the electrical work Location (Street & Numberr Owner or Tenant \` /s Official Use Only J / �455717S Permit No. - 527 CMR 12:00 Occupancy & Fee Ch ed RFORM ELECTRICAL WORK sachusetts Electrical Code :Z�;6L/ Date To the Ins ctor of ores: Owner's Address / X C__A7e6 cS7` 'iV4-1 / [ l7`'— /W - f' Is this permit in conjunction with a building permit Yes 0 No q (Check Appropriate Box) g Purpose of Buildin Util' Authorization No. Existing Service Amps Voits Overhea Undgmd 0 No. of Meters New Service aza2l Amps �010 oats Overhead I Undgrn No. of Meters Number of Feeders and Ampacity / e �ll. Locati(In and Nature of Proposed Electrical Work ' Total No. of 6ghti.g LightingOutlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers SpacelArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection I No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydra, Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen8ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER (Please Specify) expiration Date) Estimated Value of. Electrical Work= � � �iY/ r Work to Start Irfspection Date Re ested Rough Final FIRMunder the Pena X14 1 FIRM NAME � � C. NO. � vZX �/ Licensee Signature LIC. NO. �- 7 /the el No. �7'7 Address 1. No. s� OWNER'S INSURANCE WAIVER: lam aware that the License d of havurance coverage or its substantial Au'ivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) v Telephone No. PERMIT FEE 3.36f-� P $ (Signature of Owner or Agent) Location: City Phone aam a homeowner performing all work myself. 1-1I am a sole proprietor and have no one working in any capacity F1 I am an employer providing. workers' compensation for my employees working on this job. Company name: Address City: Phone #: Insurance Co. Policy # Company name: Address City: Phone #: Insurance Co. Policy # •.- 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 andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION FORM U - LOT RELEASE FORM Io "a�-off INSTRUCTIONS: This form is used to verify that all necessary approvals/permits frc Boards and Departments having jurisdiction have been obtained. This does not relie, the applicant and/or landowner from compliance with any applicable or requirements_ *********************APPLICANT FILLS OUT THIS SECTION****** APPLICANT- LOCATION: Assessor's Map Number 600C- SUBDIVISION 0dG SUBDIVISSIION STREET PHH"LO. E9 78 835( 05 PARCEL LOT (S) ZZ ST_ NUMBER . Z -t **" "" L)FFIGFAL USE ONLY ** CONSERVATION ADMIN! TIRATOR COMMENTS AGENTS: DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS TH -ToW N Wclll 12 sE k1 EC--- COMMENTS CZ COMMENTS DATE APPROVE[ DATE REJEOFED DATE APPROVED. DATE REJECTED "13LIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT RE DEPARTMENT st /p-211 =o-:� CEIVED BY BUILDING INSPECTO Ased 9197 jm DATE Town of North Andover Office of the Zoning Board of Appeals. Community Development and Services Division 27. Charles Street North Andover, Massachusetts 01845 f NORTH 1 0 40.0 ��SSwCMus t� D. Robert Nicetta This is to certify that twenty (20) days Telephone (978) 688-9541 have elapsed from date of decision, tiled Fax (978) 688-9542 Building Commissioner without filing of anappeal. Date,;9 Joyce A, Bradshaw Town Clerk Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk Notice of Decision Year 2003 Property at: 24 Rosedale Avenue NAME: J.K.J. Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA HEARING(S): 9/9/03 ADDRESS: 24 Rosedale Avenue PETITION: 2003-031; North Andover, MA 01845 TYPING DATE: 9/15/03 - The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, the 9`h of, =: September, 2003 at 7:30 PM in the North Andover Middle School Auditorium, 495 Main Street, North Andover upon the application of J.K.J. Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA, for premises at 24 Rosedale Avenue, North Andover, MA requesting relief for a dimensional j Variance under Section 7, Paragraphs 7.1 (Lot area) and 7.2 (Street frontage) and Table 2; and a Special Permit from Section 9, Paragraph 9.1 &-9.2 of the Zoning By-law in order to raze an existing single family structure on a pre-existing, non -conforming lot and replace it with a new single family structure on a pre- 0 existing, non -conforming lot. The said premise affected is property with frontage on the West side of Rosedale Avenue within the R-3 zoning district. The following members were present: William J. Sullivan, Walter F. Soule, John M. Pallone, Ellen P. McIntyre, Joseph D. LaGrasse and Joe Edward Smith. Upon a motion by Walter F.. Soule and 2nd by John M. Pallone, the Board voted to GRANT a Special Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-Iaw in order to raze an existing single-family structure on a pre-existing, non -conforming lot and replace it with a new single-family structure on a pre-existing, non- conforming lot per Plan of Land in North Andover, MA. Prepared for owner/applicant, Milton Long c/o David Mermelstein, JKJ Realty Trust, 98 Main St., North Andover, MA, Date:. June 13, 2003, Rev: August 12, 2003 by Stephen E. Stapinski, R-L.S. #29876; Merrimack Engineering Services, 66 Park Street, Andover, Massachusetts; and 24 Rosedale Ave North Andover, Ma. By Damar C. Design, Architectural Design & Building, 98-100 Main Street, North Andover, MA 01845 Date: 6-4-03. 1. The existing house will be razed and removed. 2. The existing garage will be razed and removed. 3. The old septic system on the Maplewood Avenue side will be removed and filled according to the Building Commissioner's instructions. Voting in favor: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse and Joe Edward Smith. Ellen P. McIntyre recused herself. Upon a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to allow the petitioner to WITHDRAW THE PETITION FOR THE VARIANCE WITHOUT PREJUDICE. Voting in favor of the withdrawal: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse, and Joe Edward Smith. Ellen P. McIntyre recused herself. ATTEST: A True Copy Page 1 of 2 o � Town Clerk' Board of Appeals 978-688.-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 Town of North Andover o, �oRTH Office of the Zoning Board of Appealstoo o? •`�'��• "�' �` Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 cMusEt D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 The Board finds that the applicant has satisfied the provisions of Section 9, Paragraph 9.2 of the Zoning , Bylaw that such change, extension, or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the . grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-031. M60CP45 Page 2 of 2 Town of North Andover Board of Appeals, illy I Su))livan, Chairman Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 I —.4 r rn ESSEX NORTH REGISTRY OF DEEDS LAWRENCE, MASS. 10- A TRUE GOPY: ATTEST-:, WGISTER OF DEED -I r I Jr c7l 41 Qy\ iiAl i.0 rD ILI V, I Y: m rc- D,�mmx= s S z„ 0CoMM Z O �rnZz�rn C/l s b fl ' U1 ->o F42>0 .mZ7 to v/ W W Z -- 00>0= y i z m 0 v)mm 0y�m z-<A�m (AAmM-0 M A'O*, >mr m mmm\mo2mom o D O ;u0 O Om<<= O (Azm 0U) —i co PO r- m n 0 _ U) m IU) N d D r m n ;5 Z 11= v O oC mo d my r M OCO > m y z '' p <-I e :a z O m �� O0c©� U) M rm -�, o> N 0 Z� pp O 0 O CA O A m 0 0 ^m^ 0 U) C� '00 o_ Wrnz �o 0 ren pD G? m N 0 n m L4 (Amm Z rrn 0 O v > 0 -0-0 u, A J z IL J 0 W v a� N 0 N � W 0 W -� X00 z p O O m M I -0U)�00 r- 0� ;o m G7 � m Tw*CSG) ;o-1pDA o0On,� Z 0 o��C0 >rl mo Q Z>C, nm C: z X o m 0 .> N mN m r� r-- Location �ojp a00 t /k No. 3 1 (a Date ` 3' 03 0.1 NO*Tp, TOWN OF NORTH ANDOVER • L 9 o •. Certificate of Occupancy $ s�CMUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Z a z- $ TOTAL $ Check #I L _t a 6L6<< ,,AA AA (C --- Building Inspector ii TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI& RENOVATY2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMTT NUMBER: DATE ISSUED: vJ 11-3-03 SIGNATURE: Building Commissioner/12twor of Buildings Date SECTION 1- SITE INFORMATION 1' Property Address: 1.2 Assessors Map and Parcel Number: _2 d 1� 1\ I r_>0v W 17 J� Map Number Parcel Number 400* - 1.3 Zoning Information: 1.4 operty Dimensions: Fr Zoning District Proposed Use Lot Area -Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 600 -?,d 772 1.7 Water S 1.5. Flood Zane information: apply M.G.L.C.40. 34) Zone 1.8 sewerage Disposal System Public pate ❑ Outside Flood Zone X Municipal i On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes NO 2.1 Owner of jecorl "Addressr�7g Name (Print)* -c'�-- Signature + Telephone 2.2 Owfi ,r of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ C�,�vI Eelil F__4 Licensed Construction Supervisor: U/_T :.// License Number - Address flWlo �C&E.V, 11b. Expiration Date Signature Telephone C-JfD,.L 3.2 Registered Home Improvement Contractor Not Applicable ❑ ICompany Name Registration Number 0 oAddress Expiration Date Signature Telephone Ma M X z O W rn r SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this a5 in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... No ....... ❑ SECTION 5 Descri tion of Pro osed Work check ell applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ T75ition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: -Go oq G - ��� SPI/ -11T Pte' el, iT-A~1VMV 1 will result ��L 11V1\ O - r,J l ll�ltf 1 r,L �. Visna Item ia�v v a aviT vvv a.. Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USIA ONLY 1. Building C; � (a) Building Permit Fee Multiplier 2 Electrical I N A _ (b) Estimated Total Cost of staetetirrn ) 3 Plumbing Building Permit fee (a) x (b) 16 D 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ,tom - Check Number SECTION 7a OWNEK AUMUK1GAHVP1 lV DL %-V1YL Lr,1r,L ♦vr1r.n OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I M ( _. as Owmer/Autliorized Agent of subject property Herebv authorize C�bv� d F�-7 to act on My behalf, in all matters relative to ork authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHOkIZED AGENT DECLARATION I, ��v I � � � ,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 &ntNanie � Signature of Owner/Anent Date N0. OF STORIES 2 SIZE BASEMENT OR SLAB RD SVE OF IM FLOOR TBERS I 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I II-toI IT OF FOUNDATION THICKNESS V 1. Ol FOOTING X MATERIAL, OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS WJILDIAIG CONNECTED TO NATURAL GAS LINE V- 0- Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 Building Demolition Affidavit DATE 10- V7D —0 oT4 PROPERTY LOCATION 2-4 NORTFj 11X yt,�� 6*° O [OCMK �WKM �9Se 4rto r'`���5 MO=� VE-HOLI'TWN Of E - AjIF T CONTRACTORS NAME & ADDRESS 'o1LDMR-7- TxsY, % --,> DEMO C641944--TbV—. r YQ00EQ- jARZe:.Y,%� DEPARTMENT SIGN -OFFS DIG SAFE NUMBER ,-00 -�,>' BLDG. INSPECTOR DATE RECD 0 ..4 �% L�iOmtA7209'I,U/Pp((iL ���./l�Gcraoac�%%rte BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 059321 Birthdate: 08/23/1962 y� Expires: 08/23/2004 Tr. no: 6959 �j Restricted: 00 i DAVID M MERMELSTEIN 41 CHESTNUT ST (.�e.•�, ` N ANDOVER; MA 01845 Administrator s North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: d (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Name: - � V i D A::)Z�r-' CEr.,- C� v��IG�.' �8 M,ntN sl Nom f Location: - 24 tx��`, F nVE i�ca1--I1 t�tJc�vE�._ c�►r� Q itY Phone %P-) 723 -3&-30 7 I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees worldng on this job Comoanv name: Address City'. Phone* Insurance: Co. Policv # Company name: , Addreis. CriV: Phone* Failure to sense coverage as required under Section 25A or MGL 152 can kW tathe imposition of airrrnal oFatfine upr to $I.&and/or one years' impmonrneutAs_ -chd )�daya9aia�t me. understand that a copy of this statement may be forwarded to"Office of Investigations ct the DIA for couefage verification. / do hereby certify under`.th d pena/t/es of erjury the the 6rrorrrration provided above is true and signatu' =--�' Date 10--2g�i�� Print frame'\/lD P1.e.#078 -72.C7 Official use only do not write in this area to be completed by city or town afficiaf City or Town Building Dept ❑check;mm8diate response is,ege,:ed ❑ Licensing Boa ❑ Selectmari's C Contact person: Phone # ❑ Health Depart, ❑ Other QCORQ CERTIFICATE OF LIABILITY INSURANCE DATE 0 3 PRODUCER (800) 333-7234 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, NA 01760 Select ext 3102—�� I�NSURERS AFFORDING COVERAGE NAIC # INSURED David Mermel stein - I IIN ��UG a. Western World Insurance Co DBA: Damarc Design & Construction Co. IINy--- 100 Main Street j IIN nEPc --� --- - ---- ----- - -- - —i..---- - North Andover, MA 01845 F ; IN IN''__RER E THE POLICIES OF INSUR4NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERN, OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TOVfgICH THIS CERTIFICATE MAY dE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TY PE OF INSURANCE POUCYNUAIBER POUCYEFFECTIVE DATE, IMMU POJCYEXPIRATION LIMITS — E;CH000-RRENCE s 1,000,000 GENERALUABIL171' NPP7924171 07/30/2003 , 07/30/2004 CiAF141EF!:!�_ -ENERA �. LI4:lLf�r ! ('� ._ni._VADE I x L� A'A L cN,t 50,00 --- NEED EKD(Amj if,e CErsor.: i 5' 00 -- —.-- $ - A X _ I PERSONAL E ADV I-IULR' s 1,000,000 GENERAL AG PF.GATE S 2 , 000,000 _ __ GEr;Lti: REG.: 'vMFAPPLIES PER . � � PRODUCTS-COM=%OPHCa:... f---- 1,000,00 FeXtC.Y----- I.J'CT LOC LAUTOMOBILE LIABILITY 4;V"AUT:, CONIBNED SNi;I-E LINTS (Ea accick't) ��IN'UR' i LJSCIiEDL�LE, AUTO — 'Mgrs $ ,. person) HIREDAUVIS ---� i 3301LY!NJUF" II�+^1v44^F_.D?L40o (Pe' aCCilenq i 7 -------- _ PROPERTY DAMAGE c (Pe, acrdeaq I GARAGEUABILRY �I ANYAGT — AUTO ONLY EAr-_-CIDENT a OTHER j}{Ar! Ea, -CC S .THA— AUTO . EXCESSAJNBRELLAUABI..ITY EACH OCCLRREtaC- 5 t� OCCUR _J CLFUm15 MADE AGGREGATE 5 :rcC'U_ i IELF R77ENI 0, S WORKERS COMPENSATION AND EMPLOYERS' LIABILIT' _ WC S'GTLM O" - EL EACH ACCIDENT 5 . ANY PROPRIETOPPAR7E OFFICERNIErASEREXC! -L. :." EL DISEASE -EA. EMPLOYEE S K�_ crz."be uxV EL. DISEASE. POLC'i UMfi it S ECTAL FR+J Vi 310NS ba,:- OTHER I I � DESCRIPTION OF OPERATIONS! LOCATIONS ( VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVASIONS SHOULD ANY OF THE AL40YE DESCRBEC PCLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL _M_r, YS WRRTENNOTICE TO THE CERTIFICATEHOi-DER NAMED 707HE LEFT, Milton Long BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 24 Rosedale Avenue OF ANY K:ND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. N. Andover, MA 01845 AUT,IORIZED RE�RESEMTATIVE Rose Ross AGUKU 2� (20U VUB) OACORD CORPORATION 1988 s tv C 1 J M W z a■ .co R, U a v� 0 0 � c ` O a O U zco C 400TL z A •�mc O° w cn ob: w° U w O yyCD w�' CO u. U wcoo C2 C5 u. w w —' W ° cn Q E cn C 1 J M W z a■ R' .7g O Om CO) O O yO O • m m CD co CL = O� � � L e_ov o a CL CMQ C C4) — 'C C)Cc c Q J Co COD zCD V CO)CL c c •- c ev CO) 0 U) crw w w VJ .co 0 0 c ` O C 400TL •�mc CL ob: O yyCD f EQt O CF :0C : L �. •oa H �3 ? Cc cm ty c om.+, E h A m �y h O rn m e3p I� .� H O C caO m �E� c m o o.c.w L:m :.mow: s 42 o vs w C N Q , �i� acz m o� V H Z mc O cmCL= c O c •O :a N N m y0+ Z •N O W E CL C v c� Z o Q y O. = R m.9 O v - y•O CD H L •0.. O.y=...m R' .7g O Om CO) O O yO O • m m CD co CL = O� � � L e_ov o a CL CMQ C C4) — 'C C)Cc c Q J Co COD zCD V CO)CL c c •- c ev CO) 0 U) crw w w VJ Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk. Notice of Decision Year 2003 Property at: 24 Rosedale Avenue Telephone (978) 688-9541 Fax (978) 688-9542 NAME: J.KJ. Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA HEARING(S): 9/9/03 ADDRESS: 24 Rosedale Avenue PETITION: 2003-031 North Andover, MA 01845 TYPING DATE: 9/15/03 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, the 0 of September, 2003 at 7:30 PM in the North Andover Middle School Auditorium, 495 Main Street, North Andover upon the application of J.KJ. Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA, for premises at 24 Rosedale Avenue, North Andover, MA requesting relief for a dimensional Variance under Section 7, Paragraphs 7.1 (Lot area) and 7.2 (Street frontage) and Table 2; and a Special Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-law in order to raze an existing single family structure on a pre-existing, non -conforming lot and replace it with a new single family structure on a pre- existing, non -conforming lot. The said premise affected is property with frontage on the West side of Rosedale Avenue within the R-3 zoning district. The following members were present: William J. Sullivan, Walter F. Soule, John M. Pallone, Ellen P. McIntyre, Joseph D. LaGrasse and Joe Edward Smith. Upon. a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to GRANT a Special Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-law in order to raze an existing single-family structure on a pre-existing, non -conforming lot and replace it with a new single-family structure on a pre-existing, non- conforming lot per Plan of Land in North Andover, MA. Prepared for owner/applicant, Milton Long c/o David Mermelstein, JKJ Realty Trust, 98 Main St., North Andover, MA, Date: June 13, 2003, Rev: August 12, 2003 by Stephen E. Stapinski, R.L.S. #29876; Merrimack Engineering Services, 66 Park Street, Andover, Massachusetts; and 24 Rosedale Ave North Andover, Ma. By Damar C. Design, Architectural Design & Building, 98-100 Main Street, North Andover, MA 01845 Date: 6-4-03. 1. The existing house will be razed and removed. 2. The existing garage will be razed and removed. 3. The old septic system on the Maplewood Avenue side will be removed and filled according to the Building Commissioner's instructions. Voting in favor: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse and Joe Edward Smith. Ellen P. McIntyre recused herself. Upon a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to allow the petitioner to WITHDRAW THE PETITION FOR THE VARIANCE WITHOUT PREJUDICE. Voting in favor of the withdrawal: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse, and Joe Edward Smith. Ellen P. McIntyre recused herself. Page 1 of 2 Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (978) 688-9541 Fax (978) 688-9542 The Board finds that the applicant has satisfied the provisions of Section 9, Paragraph 9.2 of the Zoning Bylaw that such change, extension, or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-031. M60CP45 Page 2 of 2 Town of North Andover Board of Appeals, I Sullivan. Chairman Board of Appeals 978-689-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 Town of North Andover t NORTH , Office of the Zoning Board of Appeals F Community Development and Services Division , 27 Charles Street North Andover, Massachusetts 01845 ,SSACHUgEt D. Robert Nicetta Building Commissioner Any appeal shall be filed within (20) days after the date of filing of this notice in the office of the Town Clerk. Notice of Decision Year 2003 Property at: 24 Rosedale Avenue Telephone (978) 688-9541 Fax(978)688-9542 NAME: J.KJ Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA HEARING(S): 9/9/03 ADDRESS: 24 Rosedale Avenue PETITION: 2003-031 North Andover, MA 01845 TYPING DATE: 9/15/03 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, the 9`h of September, 2003 at 7:30 PM in the North Andover Middle School Auditorium, 495 Main Street, North Andover upon the application of J.KJ. Realty Trust, David Mermelstein, Trustee, 98 Main St., North Andover, MA, for premises at 24 Rosedale Avenue, North Andover, MA requesting relief for a dimensional Variance under Section 7, Paragraphs 7.1 (Lot area) and 7.2 (Street frontage) and Table 2; and a Special Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-law in order to raze an existing single family structure on a pre-existing, non -conforming lot and replace it with a new single family structure on a pre- existing, non -conforming lot. The said premise affected is property with frontage on the West side of Rosedale Avenue within the R-3 zoning district. The following members were present: William J. Sullivan, Walter F. Soule, John M. Pallone, Ellen P. McIntyre, Joseph D. LaGrasse and Joe Edward Smith. Upon a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to GRANT a Special Permit from Section 9, Paragraph 9.1 & 9.2 of the Zoning By-law in order to raze an existing single-family structure on a pre-existing, non -conforming lot and replace it with a new single-family structure on a pre-existing, non- conforming lot per Plan of Land in North Andover, MA. Prepared for owner/applicant, Milton Long c/o David Mermelstein, JKJ Realty Trust, 98 Main St., North Andover, MA, Date: June 13, 2003, Rev: August 12, 2003 by Stephen E. Stapinski, R.L.S. #29876; Merrimack Engineering Services, 66 Park Street, Andover, Massachusetts; and 24 Rosedale Ave North Andover, Ma. By Damar C. Design, Architectural Design & Building, 98-100 Main Street, North Andover, MA 01845 Date: 6-4-03. 1. The existing house will be razed and removed. 2. The existing garage will be razed and removed. 3. The old septic system on the Maplewood Avenue side will be removed and filled according to the Building Commissioner's instructions. Voting in favor: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse and Joe Edward Smith. Ellen P. McIntyre recused herself. Upon a motion by Walter F. Soule and 2nd by John M. Pallone, the Board voted to allow the petitioner to WITHDRAW THE PETITION FOR THE VARIANCE WITHOUT PREJUDICE. Voting in favor of the withdrawal: William J. Sullivan, Walter F. Soule, John M. Pallone, Joseph D. LaGrasse, and Joe Edward Smith. Ellen P. McIntyre recused herself. Page 1 of 2 Board of Appeals 978-688.-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 Town of North Andover f NORTH , Office of the Zoning Board of Appeals F? •':' Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845's Nrao et D. Robert Nicetta Telephone (978) 688-9541 Building Commissioner Fax (978) 688-9542 The Board finds that the applicant has satisfied the provisions of Section 9, Paragraph 9.2 of the Zoning Bylaw that such change, extension, or alteration shall not be substantially more detrimental than the existing structure to the neighborhood. Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-031. M60CP45 Page 2 of 2 Town of North Andover Board of Appeals, i111M J. Sulllivan. Chairman Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 .s""Nofrrry,,� Zoning Bylaw Review Form Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 �P'�T� Iffi7 Street: o? o S e cQ cn Map/Lot: & o C a .. .- Applicant: , f v,v 40 AP Request: gaz54 tti 5+ L.ejLj r, e- Z2 ep lae'e Date: 3 — — 53 Please be advised that after review of your Application and Plans that your Application is w "=15SEIVlED;. for the following Zoning Bylaw reasons: Zoning - 3 SR Remedy for the above is checked below Item # Special Permits Planning Board Item # Item Notes Setback Variance Item Notes A Lot Area Common Driveway Special Permit F Frontage Variance for Sign 1 Lot area Insufficient Independent Elderly Housing Special Permit 1 Frontage Insufficient Earth Removal Special Permit ZBA 2 Lot Area Preexisting Planned Residential Special Permit 2 Frontage Complies Special permit for preexisting nonconformin 3 1 Lot Area Complies 3 Preexisting frontage t-1 e S 4 Insufficient Information 4 Insufficient Information B use 5. No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies �� S 4 Special Permit Required e S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply y e g 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height 4 5 Right Side Insufficient Rear Insufficient 4 I Insufficient Information Building Coverage e S 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 D Insufficient Information Watershed 2 3 Coverage Complies Coverage Preexisting S 1 Not in Watershed `1 e S 4 Insufficient Information 2 3 In Watershed Lot prior to 10/24/94 j 1 Sign Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E 1 2 3 Historic District In District review required Not in district Insufficient Information i e S K 1 2 3 Parking More Parking Required Parking Complies Insufficient Information qe S 4 Pre-existing Parking Remedy for the above is checked below Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit . Setback Variance Access other than Frontage Special Permit Parking Variance. Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Non -Conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit special Permit Use not Listed but Similar Planned Residential Special Permit S ecial Permit for Sign R-6 Density Special Permit Special permit for preexisting nonconformin Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new permit application form and begin the permitting process. uilding Department Official Signaf.4a Application Received Application Denied Plan Review Narrative The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: Referred To: Fire Police Conservation Plannin Other Health Zoning Board Department of Public 1 Historical Commission Building DeDartmPnt I A Property Address: 1.2 Assessors Map and Parcel Number: Signature Telephone L eto 2.2 Owner of Record: Name Print Address for Service: o C. SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone a 8�1 Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor `\ W5 Not Applicable ❑ Map Number , Parcel Number Registration Number 1.3 Zoning Information: 1.4 Property Dimensions: Signature Telephone Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RecjWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record +, �hk, Qq Row 4PIK All e Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T rn M z 0 0 z rn go 0 r v M r r a. z G) SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) I � . % Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work check ail applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: - 0 � _ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be� Completed by annit applicant OFCIA.TS;ONf�'Y 1. Building (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 1, , 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. Sianattrre of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS 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 L 41 c-tr e, 1 A.7 CRS w ° r'L Con. (� ►`H.� wy ,, R-3 20 A.; Nq as090 J 3c> -;Lo 30 i PLOT PLAN -24. ROSEDAL.E AVENUE NO. ANDOVER , MASS. SCALE: I"= 30' JAN. 14. 2003 TROY , MEDE . C% .ASSOCIATES R!£GlSTERED LAND SURVEYOR 1455 MAIN STREET- TEWKSBURY . MASS. � n1n-r� :.DulEuwG ccruFa�Ms tW�EiZ M.G.L .CNAPTrR 40A. 5EC-noM -T. F•_ 5.B T (FAIR) NOTE; EXISTING DWELLING TO BE RAZED 1�05EDALE AVENUE (40' Pue�ue) I HEREBY CERTIFY TO THE BUILDING INSPECTOR THAT THE DWELLING IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES Lp`19 OF �i CONFORM WITH THE VWN OF MD. ARR VFX WRING REGULATIONSoff' �a REGARDING SETBACKS FROU.. STR€ETS AND LOT LACES. �� iucKw I FURTHER CERTIFY THAT THIS DWELLING 13 NOT LOCATED IN THE 4 FEDERAL FLOOD HAZARD AREA AS SHOWN ON MAP DATED 1574ft _ SA #3"" 4 TE REGISTERED LAND SURVEYORoyq( (AN THIS PLAN IS NOT FOR BOUNDARY DETERMINATION BOUNDARY INFORMATION TAKEN FROM: MiEk-D-FAkl: 0360 0 CD 0 A �C Ci c4J,v �- uS'e- �ylAPl£wooD que 25 J�5 d prrua�.,e / 1 Y�►U`G [ i8 Fi'�e- 4-a`� Ro,-s,:.-,-A(Q-. r� do e3 a ra.;,d i 1 L cL �4 U _ o ti Cr W \A F- Cr o Z z O N Z z z O O p W �— D 6 .L . CNAPTE fRFo40A.5EC-nu- J . Illi N_ CFtaD., LOCHS MAP u�- -a � J EXISTING SHED vt `��►-C� 1 22.121A-1 /...._. 30' Z cv h w c 0 EXISTING GARAGE NOTE EXISTING EXISTING DWELLING DWELLING TO BE RAZED 19.4' 9 y -,60.00,4.8' S F,03EPA LE AVENUE (4o' Pci>75uC) �] S,J-P C.- a %J� � �. Y �or� !r�`r ctri6t rv� Na�cc�w •!Kr%'� �� � �0