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HomeMy WebLinkAboutMiscellaneous - 246 CANDLESTICK ROAD 4/30/2018N `O p O C7 � Z D o N m O ~ O C"7 O � O � O o n 0 a 6f 136 Date ..... .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... P ..... klA.mu .•............................................ has permission to perform ................ 604M ......... wiring in the building of .........7 ....... ye.al-v 0 ............................... at ............ rth Andover, Mass. Fee. Lic. No. L3 - ?9J–AN) ........ i��P� ELECTRICAL Check # a—' -c? -Lt DEMMMWOMMMSUEFT Fennitf. 60 3� BQARDOFFTIREPRL'V[1mmamAmmSl7adRat Occupancy R Fees Chucked APPLICA71ONFOR PERMIT 70 PERFORM ELECTRICAL WORT( ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL UMRMATION)—DS— Town of North Andover To the Inspector of Wires: j The undersigned applies for a permit to perform the electrical work described below. Location (Street d< Number) � QOO I Owner or Tenant o t? Owner's Address 45� w1f is this permit in conjunction with a building permit Yes [ONo a (Check Appropriate Box) Purpose of Building I/- c t? Utility Authorization No. Existing Service Amps./ Volts Overhead Un&MowW No. of Meter New Service Ampa...L Volts Overhead M Undwgi andNo. of Meter Number of Feeder and Ampacity Location and Nature of Proposed Electrical Work i n v /-10 d Na of Ugbdna Outlaw No. of Hot Tuba Na of Tranbrmata Total KVA Na of Ugbdng Rituta swimming Pad, Above ground Below ground Oeaerapaa No. of Emergency Ughtina Battery Univ KVA I No. of Receptade Oudeta No. of OU Bumms - Na of Swiwb Outlets No. of On Boman FIRE ALARMS No. of Zana No. of Rangers No. of Air Cad. Told Taos No. ofDabcdon and Na of Disposals Na of Haat Total Told ponys Ton Kw Initialing Devices Na ofSounding Devices No. of Dishwuben Space Ane Heating Kw No, of Se f catb4nd Detecdonao� Devic" Lod Odw Na of Dryer Heating Devicaa KW Q,Muddpd Connecdom 0 No. of Weser Neaten Kw Na Of Na of sizas Bailnis No. Hydro Mange Tabs Na of Molon TOW HP itet==C0M6 A1QiW10#zros}iarabafMa�l6ellaC�tosllawa Ihwactnsv i*ti4yimw=ic yinddr;C7m crfgAtg@j a0vg" M lhaves hniftdvaidpodofsirre1DfE0 iZ Y$4 140uhn yE5.PbwidMtrtpof wymWby k tilts ws<>� " ice rl aMDo E�maddVakzdBBcft Wak S Wadcbsoat insptxtirnD*Rec r*d Raft FEW RNNAMof awe IiNaNn Btisioe:Ti1Na 4,a -7ml Ad*M owe UWI�R's1N5tJRAI�EwANHt;Iamawaed�etiheLica��dEirssane Alt'I1�Na � -73-15.3 atddletrrrys�elaeonfiepatrit�picsdienwtlireafiea>Qi�s � � BB fmQnMWLM (Please check one) Owner a Agent Telephone No, pgpyKM FF.E S Location ��✓ No. A/f Date i TOWN OF NORTH ANDOVER M10 Certificate of Occupancy $ Building/Frame Permit Fee $ AC MUS Foundation Permit Fee $ Check # Other Permit Fee $ w TOTAL $ O ` ' Building Ins f 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 Commissionerfias or of Buildi SECTION 1- SITE INFORMATION 1.1 Property Address: -2Y � ail 6+LeS-hZJ< �a 1.3 Zoning Zoning District Proposed Use 1.6 BUILDING SETBACKS (ft) Date 1.2 Assessors Map and Parcel Number: j06 Map Number Parcel Number 1.4 Property Dimensions: Lot Area Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided E1.7Water Supply M.GL.C.41 34) I.S. Flood Zone Information: 0 Private 0 ZOpe Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System C SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT �.t vwticl ut ICCCUra -- J&�, -4 '10,AA YQ W4 Z4(. C&A A Lex-f-tek k�- Name (Print) Address for Service a,7.g 1.7f- tbd9 Telephone 2.2 Owner of Name Print + T, iECTION 3 CONSTRUCTION SERVICES Address for Service: I.1 Licensed Construction Supervisor: lcensed Construction Supervisor. / 7� S� • �roa�x� 9 L-k.�f`c�-�e- v�,(RfJ• dd ressWgnature Telephone 2 Registered Home Improvement Contractor )mpany Name o 3y-oJ "-e— ( ,4A4 -S (dress Telephone 9.699 Not Applicable ❑ 01o338 License Number o7-0-67 Expiration Date Not Applicable ❑ F zo REcEIVEn Registration Number Dz - I3 - o7AUG 19 2005 Expiration Date BUILDING a, SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6). Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. —Signed affidavit Attached Yes ....:. K No ....... 0 SECTION 5 Description of Proposed Work (check nn nnnri,.htP New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑. Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Vt ti �11i✓ .SW al�.t VA DMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SECTION 6 - ESTIMATED CONSTRUCTION COSTS X Item Estimated Cost (Dollar) to be Completed by permit applicant `L` sm`i PZ P" xr A 1. Building I / (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) za4715-Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ­'� '�-r I tJ % 40-.-, Hereby My_§-cb Signature ofC SECTION 7h as Owner/Authorized Agent of subject property &:Yn +- �1&4� JZ-<_ to act on to work authorized by this building permit application. Q� Date' z AI1THnRT7.Ril A(-FNT_n1VPT ARATTnM vl� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print a Signature of Owner/A ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR T MBERS 1 2 3 SPAN DMENSIONS OF SILLS DIMENSIONS OF POSTS DMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF C1IIIvvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE . a FORM - U - LOT RELEASE FORM INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. Ivan Bass O ■ ■ ...........................guano ............................. ■ . ■ ■ APPLICANT f —(0."..., �v v� PHONE % 7�'B/ %S ` &0 � ASSESSORS MAP NUMBER 10(0,4 LOT NUMBER Zo I SUBDIVISION LOT NUMBER C&-, eSig-r STREET AT . ........................ STREET NUMBER o2 OFFICIAL E..O..N ............................................. USLY .. SOFT GENTS DATE APPROVED CONS ER ATION ADMINISTRATOR �R4 TOWN PLANNER COMMENTS D INSECT - HEAL SEPTI SPECTOR - TH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED _ 0 T A - TT iT•�m•+rte PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT CONIMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED TE RECEIVED AUG 19 2005 BUILDING DEPT. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Name: 0", t�Jij YoU A - Location: 21 Ca Z I- d Please Print - ?8- q) s"- l �0 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. Company name: (,k i lt., CEJ 4- PV) ,, z Address W r L -GL Q -�tff--f7 Company name: , Address City: Phone # 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 $1,_AW.7 and/or one years' imprisonment.as_we4.as-civil.penattiesjnlhelmm-da-STOP.MRK ORDER and -a fine-of-($]D.O.DD)-ajdw.against me, I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Print Official use only K. do not write in this area to be completed by city or town official' ds-, City or Town Permit/Licensi El Check if immediate response is required ' Building Dept D Licensirlg Boal Contact person: Phone # p Selectman's Office Health Department Other —A""""" . Ad0RD CERTIFICATE OF LIABILITY INSURANCE OP ID PT FAMIL03 01/05/05 PRODUCER PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB International New England 299 Ballardvale St. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington MA 01887 POLICY NUMBER Phone:978-657-5100 TaX:978-988-0038 INSURERS AFFORDING COVERAGE NAICik INSURED INSURER .A Scottsdale Insurance Co an INSURER 3 A, I , d GENERAL LIABILITY Family Pools & Patio Inc. 70 S. Broadway Lawrence MA 01843 INSURER C. INSURER O: INSURER E A rnveo a r_ee X COMMERCiAL,ENERAL-LABILITY CLAIMS MADE a OCCUR THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T1E INSUREC NAMED ABOVE 7OR THE POLICY PERIOD INDICATED NCTVVITHSTAJOING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER. COCUMENT'/V'TH RESPECT TC WHICH -HIS CERTIFICATE MA1 BE ISSLED OR MAY PERTAIN, THE INSURANCE AFFORCED BY THE POLIO ES DESCRIBED 1EREIN IS SUBJECT -0 ALL -HE -ERNS. EXC_USIONS.WND CONIDITiC"JS CF SUCI POLICIES AGGREGATE LIMITS S1CM/N MAY HAVE EEEV FECAJCEO BY PAID CLAMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYI DATE IMM/DDIYY) LIMITS REPRESENTATIVES. GENERAL LIABILITY AUTHORIZEDR PRESENTATIVE ernen �e i�nnw .ne. EACH OCCURRENCE S1000000 A X COMMERCiAL,ENERAL-LABILITY CLAIMS MADE a OCCUR THD 12/31/04 12/31/05 ce} SIOOOOO MED EXP (Any cn=_ person) S eXcl PERSCNOL & ADV INJURY 51000000 X $2500 ded QENERALA.CCREGATE s2000000 GEN'LAGGREGATE LIMIT AJP_IESPER: POLICY PRO- JECT Loc PRODUCTS -CGtdp/OPAC3 52000000 rmp Ben. 1000000 AUTOMOBILE LIABIUTY ANY AU -0 COMBINED SINGLE LIMIT S (Ea aocidan:) ALL OWVED AUTOS SCHEDULED AUTOS BODILY INJURY C (par person) HIRED ALIT0^o NON-CAWNED AUTOS BODiL" IN,U<Y (Per acrid=nb S PROPERTY CAMAGE S (Par axid?nti GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AU -0 OTHER THAPd EA ACC 6 AUTO ONLY: AGG S EXCESSfUMBRELLA LIABILITY OCCUR CLAJN13 MADE EACH OCCURP.EI ICE S ACGP-EGA.TH S S DEDUCTIBLE S RETENTON $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PNYFROPRIETOR.PA3TNERF-KECU-IVE OF=ICERAMEMBER EXCLLCED? WC6926440 12/31/04 12/31/05 X TCR'I LIMITS ER E.L.EACIHACCIDENT S100000 E L. DISEASE - EAE%/P_0YEE $ 100000 If yes, describe unOs E.L. DISEASE - POLICY LIMIT S 500000 SPEC AL PFCVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS vcn I min I Q nvwon CANCFI 1 ATIAN 8LAm-0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAUL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZEDR PRESENTATIVE ernen �e i�nnw .ne. -LDCORPORATION 1988 Vor 1Jr 4uu;j 1J. CJD Z f 0000174'] t-MILY F'UUL`J die an�n�a�� � Board of B�uildin ((;�g, uIations One Ashburton Pace, Rm 1301 Boston, Ma..A2108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 07119/1960 Number: CS 010330 Expires: 0711912Q .. x.Z Restricted To: 00 WtLLIANI C POULOS 70 S BROADWAY LAWRENCE,, MA 01943 KAI W 60M -U 4 ot21E F'AL+- 01 14273 op for maeo and change of address notification. P �pW �OR�W OON '6' m 66 mao aomaodd 000000 a d amm O o O N Vl Y1 eF C � W rn -i-n V1 Y1 O=ff-••m.<-.�Oc? QOO NNO d OD C m^O!1- W W O W 0 O O O p 0 ='- a •-- a o� O O O 'o z :o 9, C q c = or m - • E e.am m c a m o '0'0'09 =N�� n.ddz a K� A � be oc be °o E as m d Cp V'lN E � a •- � 4 L N. .ON N. OD t, OC�Nr-- r 7D b %D Q Q N 60 Q Q N Tii..; =ua`� qk:. _ SaM3?: 3 u Ilan a "O moan MN :21 mn p� •.:11 C` E = aYP 00 ' g L LD Ell IN s B� o P g aQ Sit �„ 3 J. EQ 8 $-E PPY43 a:_^ SER Jul Ef fig` o'E'Ta I `rW a f � E IL z gQ o' ry� I 8B ' Eg E 1 i 0 `c •o _ o E ° g @ . T C oR > S. o go d Board of Building R One Ashburton N Boston. Mas Home Im rovemeri � p FAMILY POOLS & PATIOS INC t° GLEN WIGGIN { 70 & BROADWAY LAWRENCE, MA 01843 DPS -CAI 10 50M -04/04-G101216 . �iie �oarvmaivaea�li a�,./�iaaoac/uiael� Board of Building Regulations and Standards HOME IMP.R''O��VEMENT CONTRACTOR IRegistra�ion; 118204 ..E p1r`ationc��,Aignm 'g a ons and Standards Pike - Room 1301 W a usetts 02108 Co tractor Registration y =ET:, Re i tr t' g s a ion: 118204 �f Type: Supplement Card s Expiration: 2/13/2007 FAMILY POOLS & MOS A& GLEN WIGGIN != 7 0 S. BROADWAY -.,,'0 t' LAWRENCE, MA 01843 Administrator { Update Address and return card. Mark reason for change. Address ❑ Renewal ❑ Employment F� Lost Card ase or registration valid for individul use only re the expiration date. If found return to: •d of Building Regulations and Standards Ashburton Place Rm 1301 an, Ma. 02108 L(.c.d V, U3� ri^ Not valid without sirtna r Name_ _—J k-1 C1 H -t 10,14 Home phone] /6 -i'/) -(b27Wnnork Cross street/directions )A 16 FAMILY POOLS & PATIOS, INC. sales •. service • supplies 70 South Broadway, Lawrence, MA 01843 Tel: (978) 688-8307 • Fax: (978) 688-1949 �'`� 5C+ 4 Od_4— ZOOS-- NO -- We City I o CSL #010330 HIC #118204 WC #4951074 LIAB #01098398230 �1r7 7G Cell phoneAdd'1 # O I,?ys,. Estimated start date Estimated completion date We propose to furnish and install one 1 bI�Z -4 3LI�Z Grerc-t-'an 9 t De4o swimming pool for the sum of $ 1420b - THIS PRICE INCLUDES: • Manual vacuum cleaner kit • Leaf net • 8 Ft Steps ' �) • 3 -Step Stainless ladder • Wall brush • Handrail reQ¢ Rope & Floats • Extension pole • Filter s-}�ta re • Initial balancing chemicals • Test Kit plumbed no more th ft from pool • 8 to 12 Wk supply of maintenance chemicals • Surface skimmer(s) Z- • Pump & motor I VLT_ (supply depends on pool size) • Copings__ • Choice of liner THIS PRICE ALSO INCLUDES THE FOLLOWING WORK TO BE PERFORMED BY A LICENSED ELECTRICIAN: Bond and ground pool - wiring of a 220 volt filter pump - one 110 volt plug - wire and install one 220 volt indoor time clock - outside wiring to be done in PVC pipe - sixty feet of electrical run from service panel to filter (*note: runs over sixty feet will be subject to an extra charge)_ Initials IN ADDITION TO THIS PRICE, ADD E,�D ID HOURS OF MACHINE TIME AT $ fS 6 PER HOUR = $ �. THIS PRICE DOES NOT INCLUDE: _ Initials Any machine time in excess of that estimated above. Additional machine time to be billed at the same rate as above due with the second pool payment. All hours of trucking will be charged at $ 7 per hour per truck due with the second pool payment. Any dumping costs incurred for disposal of ledge, large rocks, or soil - re -seeding of grass around pool - spreading of loam - trucked in water - patio or fence around pool or any accessories except as noted below - additional fill, if necessary, for proper backfill or reshaping of hole - dis- posal of large rocks - fuel connections - heater venting - fuel storage tanks - permits - repair of damage to sprinkler systems or any buried . items (ex. dry well, electrical lines, cables, etc.) in the access and pool overdig areas - plumbing to filter in excess of 25 feet - stumping and/or removal of stumps. brush or debris. Homeowner is responsible for repairs of damage to known or unknown buried items. Water or soil conditions (ex. clay, peat, live sand, excessive rock, etc.) requiring a stone pack of the hole will be subject to an extra charge of $_'minimum to $maximum. Use of the above mentioned stone pack will be at the discretion of the job supervisor. Customers must supply access for all trucks and equipment. It is the owner's responsibility to obtain the building and electrical permits or to assume the costs of necessary permits. _ Initials OPTIONS Diving board ( ) Main drain Solar cover ( 1 7-rVil ) 12S Pool light S i PW COwj Lok �Sa Heater k )P7 Environpoo Pl he Caretaker w/Electronic Valve, 16hd Additional floor heads ( ) Polaris Vac -Sweep Polaris retrofit only SwimoutBuddy Seat TOTALS Basic Pool Price Estimated Machine Time Options Subtotal 5% Sales Tax Total Less 10% Deposit Balance of Contract $ I4 uo' I S(rv' 77 -2 Y $ •Z-3Lf Me S S"� $ 1401 r q 01.) $ e�4[.II PAYMENTS: 1/3 EXCAVATION 1/3 BACKFILL + EXTRAS . 1/3 SYSTEM START -up The buyer hereby agrees to pay, in full, the total amount of this transaction upon start-up of the installed pool.Your salesman or job super— visor will meet with you two to three weeks prior to excavation at which time all decisions including pool size, shape, liner print, and all options must be final. Changes after this date will be subject to extra charges where applicable. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Credit card payments not accepted on contract amount. BUYER� date ...Q. et G z x U x o � �' a a z U x a a c� —coW w" a 0° w u co w w :3 :3 ts: w a G rA cn o cn c c� c� e 0 .ate W O c O O .c is $c� 2 2ECA c c O O CEO to y H CD 3 r :gym s W O y CL.83 L:m t Z O cm �0 m o m v�_O o Z c o m c v' o. c c0 COD z WO Irmo C r ti CML O C Z O, O ui CM C..3 a g = w �0=� C z a CLS � 9 U 0 I Ccm O•— � p� M FE m m CL O p LO e_ca o a 0. C Q co c ev 2 CL CD C40 Z C a) CL �..� co O C C c C4* 'c 0 ro V) ox W 19 W 0 Location c2q(., No. .21? Date 0.4 MORTH TOWN OF NORTH ANDOVER i • OL S Certificate of Occupancy $ ssACMUs t�' ; Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ &Z Check # Building Inspector TOWN r. ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ? 7- T, k BUII,DING PERMIT NUMBER: C�l /7 DATE ISSUED: SIGNATURE: Date J SECTION 1- SITE INFORMATION l 1.1 Property Address: 2 V� c4o-4� 1.2 Assessors Map and Parcel Number: zo l Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Public ❑ Private ❑ Zone Flood Zone information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ "Ek-11IUIN 2-FKOPER'I'Y OWNEKSHW/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service q 9%s-1( Signature Telephone 1 2.2 Owner of Record: Name Print I �ilgnature a SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Shaj>j � zz"y Licensed Construction Supervisor: 2 -Le 1� p c- 1c,uJ ti Address, Signature Telephone 3.2 Registered Home Improvement Contractor Address for Service: Company Name 2�e- +znP1E Me- - c Address A _ js7F) 51.E-7�FS Not Applicable ❑ 0L 7,-2 '-A) License Number 5;- %7 , Z -co -A--- Expiration Date Not Applicable ❑ i Zy 11 L -- Registration Number 9 NO/ Expiration Date SECTION 4 -WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �co�� 2 v C---/- & r Sa-2 U c4zj r, -e - I SECTION 6 - ESTI MATF.n CONSTRTrf TTnN t-ncTc Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY - I . Building a Building Permit Fee Multiplier ` 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) / (p 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number ..a.:,i,iaviis vvri��ic Au invtcu,A11V1V TV t3L (:VMYLI~;'lli;ll Wt1N;N OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Ownfr/Authorized Agent of Abject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. .Signature of Owner Date SRCTTnN 7h nWNFu/ATTTNn1DT71Vn A1'Ti V'r T\L`rT A D A TiIIAT [Herebv as Owner/Authorized Agent of subject operty declare that the statements and information on the foregoing application are true and accurate, to the best of my knewledge d belief • Print Name Signature of Owner/Agent Date NO. OF STO%ORSL�AB*� SIZE BASEMENT SIZE OF FLOOR TINIBERS 1 sr 2 3 RD SPAN DIN ENSIONS OF SILLS PDRIENSION,S1 NSIONS OF POSTS OF GIItDERS GHT OF OUNDATION THICKNESS E OF FOOTING X MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM?©Q► INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This. does not relieve the applicant and or landowner from compliance with any applicable requirements. rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr rrrrrrrrrrrrrrrrrr■ APPLICANT 1P� PHONE 7 7 ooak4e ti 7Y 73'f' _r ASSESSORS MAP NUMBER ® OT NUMBER Q SUBDIVISION LOTNUMBER ,Z STREET ('44.)d STREET NUMBER p �rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr r■rrrrrrrrrrrrrrrrrrrrSam rrrrrr■ OFFICIAL USE ONLY I anon ME r r rr rr arrow as rrr r soon rr'•r rrrr an r r r an r r r rr r mono arra on r swam r rr r r r an r r r■. RECOMMENDATIONS OF TOWN AGENTS IorrrrrKnown man rrrowns rrrrrrrrrrrrr CONSERVATION ADMINISTRATOR MMUFM S A9 () 9— Y(A C TOWN PLANNER COIv4viHNT3 FOOD INSP -13TOR -'HEALTH �E , C CTOR - LTH 1 PUBLIC WORKS - SEWER / WATER CONNECTIONS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED a DATE REJECTED DRIVEWAY PERMIT e(eyl DATE APPROVED FIRE EPARTMENI DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR _ DATE ern-�� - y_ :..' . t .. °.• c. :: � A+. Y��� a �:,w......e�!" `�' _ »o..++,aa+.�w � P.... a..-...• _ .. • rJ .. ,. w.h wh., N..�..,.r..Y. Ao N``IiSriV•.. 'yZyn�I,�{ sf �� •A M *.M•yi �+ • • a 'h t s � ��,*`� Y �d,9.T�a.Yp„L •a•_i,i"` G"'Ne "� ":� .fit' s: ~,: ,° - • .I .. _e �* , �4;a �'�'�'dy� aKy;, =: "},1, 1�.• xr'[.. _ tk a• !4t '�. T/j { Y + f •.} J �. iL�..)� a � � ,�.� ' • 11 � . � ,T Mgr <�vR .:S si +'. •� .t �, +,. ,., � - R �`- � �-!` �1:. � `j iJ - � I *d� �,� "77f"J . ._ : + ... .`• u �,}`� � - „�/. �', qty` • . ry i �" �y � �= - ., a �t:?Y r=te`• :4 ..�.wy- "+.. �• if pr rs T'' -a iYti'�},t;�,:i,w a rr ;F.'•'..Me.a „}s{`�e. / �' i"e1-,.�^X,-E'i...,�. �,,�.�. •� r� A� }� .•r'+ii.4 rt'-"4 �_�' Tiria•Ya s?� :..f��.a-+s "•..'Lf'^ �1;1��+..�, i;,z, .'�, _•��»� �e+.t-iii+;•�x-. ,!'�'3�,:: Y`..e��;�;:=1-41=-r r �':�F � ` '=e'r,.2"" . ��Y�..::*.,.•��e 4'Sit .',�hpjnS�i7•� � `y(�,q�y ,i.zZ � Mex 'tyw +'t"� ..1• ' ���`��:�. i.i•�}� � .+; ,,"�`� � aa.5 :*'� "may',, tt• •i <_.. ,� f•+' •:f w s '� 71'`'3: M + .'�.' v _ `, r' )-iLlf'CA `+ •G...•i'y;'W .1.F� .-�'S'r' :rs.a y :•},�,t"►4 �i"ir't it �►`w f :ice w .,: •�..• r,%. • ; .a• ,. h CP ray b . +" _ = + ; 7 � .!,` a `; � •w...s ��v+ ..•<: .����,y„u1�j}�. �=.: .'; ": r .eta �..�.�ww�r..�r ,g�r�•)/�� ',*�,�;a•rr'.f� ,�p` '� P ...i ='='v,1 .y4 �' Wsrrww.i�e!•.. ..'-,. `. '!-..M,..,.y,r,�,,,,,� ...:...r-+,sem....-.,— i„w'il��*••v .�► �: '*J.w�'i + ".!yrrl�:::i}�, ��tru. ,{ F" i. .°� _.t'.;.'"• E 1• ~.Y • .;�3..W - - ti.G hh. yj eb,r. �''` - _' ....». , .e g�Vw: -:.. .,. -- - ..a..,w_.. _.,. .�-..« - r+'' � 4 +,.' ` .•:. :.ter....-.�..., �... moi'', N• _ - - The Commonwealth of Massachusetts .Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print WW 1'11 Lt 1,I/Location: Z � �> clk S41 l2 City A/07t 4,fLl cn Phone # 0 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. Com an name: Address City' Phone #: Insurance Co. Policy # Company name i Address citx- IYl � V�-Vy V) Phone #' 7 i 5 and/or one years' imprisonment_as well_as_c7Lv4IRenattiesiniho.f=-d—aSIQP.WORK-ORDER.and..aline_otJ.$]Do.WJ-a-nay-gainstme, understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for doverage verification. I do hereby certify unfler the pains and penalties of pedury that the information provided above is true and correct. V Cinnnti ira ' lC,: -79 � � "�etV . Date b- /- Print name �}� �J� M l �y1i`�� Phone # 93 -q75 -4F8 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept []Check if immediate response is required 0 Licensing Board E] Selectman's Office Contact person: Phone #: 0 Health Department 11 Other se�rWiv®ol�bdwwG.+ai ".v�y ' _ _ —� _ _ _ _ _ _ _ _ _ _ _ _ ..._.._.�._..,1�_.i u .. ..Y.._v�ya� . - ,.. ., � ........ J .. .. q . • ., ,, ....., e Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax. (978) 688-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, anda condition of Building permit# the debris resulting from the 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 /at: �r�-- Facility location 4 � 1 ee Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I 0► N u 0 EEO SO Cb C) O r L LMS CONSTRUCTION INVOICE #1 7225 11 TEMPO DR DANVILLE NH 03819 (978)975-90083 OR (603)382-6161 TO JUDY AND TOM YOUNG 246 Candlestick RD N Andover, MA 01845 (978)975-1609 Stated from Judy Young on March 5 ,2001 that the followu-ig invoice is done to the customer request INSTALL A 1 ' DOORMER 1- REMOVAL OF OLD WALLS FROM OLD CLOSET AERA 2- FLOOR WILL BE RAISED WITH 2X10 TO MATCH EXISTING FLOOR 3- REMOVAL OF OLD ROOF AND INSTALL A WAIL AND NEW ROOF LINE TO TO MAKE DOORMER 4- INSTALL A ANDERSON ONE SIDDED FRENCH DOOR TO NEW DOOR.MER WALL 5- INSTALL NEW CLOSETS WITH BIFOLD DOORS 6- .INSTALL SMALL BOOKCASE IN CENTER OF ROOM 7- INSTALL NEW DOORWAY GOING INTO NEW ROOM WITH A SOLID SIX PANNAL FRENCH DOOR 8- INSTALL A 3X 18' DECK TO NEW ROOM 9- ALL WALLS WILL BE BUILT WITH 2X4 CONSTRUCTION 10- ALL WALLS WILL BE INSULATED TO CODE 11- FLOOR WILL BE 3/4 TG PLYWOOD 12- ALL WALLS WILL BE BLUE BOARDE AND PLASTERED 13- ALL FINISHWORK WILL MATCH EXISTING HOUSE 14- ROOF WILL MATCH EXISTING HOUSE 15- SIDING WILL MATCH EXISTING MOUSE HEAT WILL BE REWORKED INTO NEW ROOM 1.6- INSTALL 4 RECESSE LIGHTS TO NEW ROOM TOTAL FOR WORK BEING DONE $24,920.00 TWENTY FOUR THOUSAND NINE HUNDRED AND TWENTY DOLLARS O -'1-E IULIF VVILL BE PAYED AT S TART $12,460. 00 TINE USS WILL BE PAYED AT RUC -,H INSP - AND PE! 'kUDER Cif T ECTIO S WILL �A � OUSAND FOUR T HUNDRED AND pLEA TION THANK YOU FROM LMS CONSTRUCTION ISI SOU CAN, NOW REACH US AT LMS CONSTRUCTION (Cl/rA-i_OL . Coxl i In the event of non-payment, the custo -V' 0nthly service charge. mer will e responsible fora � � Cust°mer ivl�i also be resgonstble for ani 1a courts or any other legal parties � v''�'er or federal fees die to Thank you Lrns Construction Customer Signature LMS Construction S date, _dates j -BRIM 'i �% �����> ABoard of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 129116 Expiration: 7/8/01 Type: DBA LMS Construction Shawn Lemay 26 Temple Drive Methuen MA 01844 ADMINISTR) BOAR[ License: C( Number: I Birthdate: 751. Expires: Restricted To: 00 SHAWN M LEMAY 11 TEMPO DR DANVILLE, NH 03819 m 3) m U) 0 m y CD a Z CD 0 O1- r CL =. .o 0 o p CL c CD o a v co CD CD y CD 0 CO) d 0 CO) O CO) CD 0 CD �, y co CO) 0 CD 0 CD C C = C d Z O �• Vl 0 Q N nodc. 0 10ti Fao0 0 Cl) y C) an m z •p ?-C vi O ._•► .d.► m H T mCL Mn m c co am" c -� o i=r CCD a =c Q moo= n o Z y. c°; ,,• W o m �• a H = iT1 So CL O ? ? m CO) C + m c, b e cm d N cn .� ti C. ID 9 ��m H r"• VI y CA m cc,: z CID � 0 cn z ►"� O a =r CCD y P cl =a_ n b: cl c yny I C/) r� d C/) z PTJ� b M EL OQ a' � �; ro OQ r•' �' ro OQ ►� r M n�z p OQ z' o CL rCArb �' �' �. -p x Y o rA Location No. S Date /') 1 HART" TOWN OF NORTH ANDOVER SQL 9 > ; ; Certificate of Occupancy $ I•�s ",.,°' t,�' sAcMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -Building Inspector TUWN UY NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT& OR DEM�wyO[LISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ` DATE ISSUED: SIGNATURE: Building Commissioner/Ing3ector of Buildings Date e- —� SECTION 1- SITE INFORMATION _ 1.1 Property Address: nn n 1.2 Assessors Map and Parcel Number: Ao`�qq Map Number Parcel Number 1.3 Zoning Information: Zonin District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zane ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIDPIAUTHORIZED AGENT 2.1 Owner of Record n a Name (Print) Address for Service Signature Telephone 2.2 O y Tier of Record: Name Print Address for Service: s 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 ❑ Companya e v Registration Number Address Expiration Date Si nature Telephone T M X z O T v n M 1 r O Z M 90 O mn ic r v M r r Z 0 V� � SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 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 I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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, belie -.f ct� �1 Print Name i ature of Owner/Agent NO. OF STORIES 0 j Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TMOERS OT 2 ND 3 PD SPAN DIIv ENSIONS OF SILLS DIN ENSIONS 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 The Coninionlvealth of Massachusetts Department of Industrial Accidents Office of18114=19atfoffs 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit ❑ 1 am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity ❑ I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the.following workers' compensationpolices: . Failure to secure coverage as required under Section 25A of MCL 152 can lead to the Imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of it 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 pains and pen Iles of perjury that tire information provided above is true a d correct. r / Q Z Signature �� � ~ ate Print name Ci GLS_ h,E. Phone 0 official use only do not write in this area to be completed by city or town official city or town: - permit/license # OBuilding Department OLicensing Board O check if immediate response is required OSelectmen's Office Otlealth Department contact person phone #; 00ther (remed 7/95 PIA) g� 4 ,. 1 D rn [p 3 CO O -% 3 .c e' O y CD z o v F= -s cn n M o o s co z 'm a ,-. O 3 CD m 00n • , V o —+ o z Cr (D V O SM O\ V Cn O %V • v n . —1 z o c� z Li{ Castricone Roofing & Siding REPAIRS FREE ESTIMATES Telephone (978) 682-4266 MARIO CASTRICONE 31 Court Street, North Andover, Mass. 01845 I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and ,onditions, on preMises below described: Owner's Name........ �, ................. .......................................................................................................................................................... Job Address....... ...... .. ............Ci : �...i.... State... ...................... SPECIFICATIONS 3... ...........C9..? ,, ELJ ........ 1���.�.`�.-...'4x% .,t...... .. ....... .................O—Ml�.��axk........................................... -... , . ....... �? Cx .....;, ... ILO ...... ......... ' ..... �..... .3�..................................................... ................................................................................ .................... �....................... ............. ............................. .�.....k.....� �,�,.....; �,..�. ?,:....... :. ............ ....... n ....a.. ......c�:•A! ... ............................ U.. ....................... ............... ....................... .................... ........................................................................................... (3&A:.r ...... V .. .... �. k T ..... . ............................................................................................................................................................... ..................................................................J .....C..::.................................................... ................................................................................ ... ........... Materials and labor to cost $ ........5 �' m ....................... Payables... . �� ..............................and balance in............ monthly installments of $ .........................................each, payable on ........................................day of each and every month thereafter until paid in full (..............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by cgntractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding ofily if in writing and signed by all parties. Cover attic storage cleaning not included. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in operation. �� � IN WITNESS WHEREOF, the parties have hereunto signed their names this ................. � ......... day of.. ' ....: ...r ?t,0 Accepted: (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) P'......... i :4 ..................... Representative Signe JV'�;?. ? ....(:.f ..: � �E� .................... Owner Signed...................................................................................... Owner Signed...................................................................................... 1p a c�a G u p w vro Gy cn 94 O0 z � w t w Z U w" w W t is O w � w °0 r�G " cn ca r=. O z � d O :3 a; G ri. E� w w A w w � cp z +� � cn .� Q x O cn y COD W O i•i .y ~ :ccs UJ AL * * 0 FM4 � h z i 2 O O E L O Z O h o c O Q� c O �_ W Me y O O m � s- 0 CD H .0 CL Z" CD .o CD 0 0 co L ca cc O = CL CM< co =Cc C V C Z ts CD �..� Na c C C� c COD COD W O ui .y ~ :ccs UJ V O COD a N i 2 O O E L O Z O h o c O Q� c O �_ W Me y O O m � s- 0 CD H .0 CL Z" CD .o CD 0 0 co L ca cc O = CL CM< co =Cc C V C Z ts CD �..� Na c C C� c COD :ccs W O V V QC O O O A .=03 O i CD_ C/) m O = v CL h z E c 16- 0 �// C/) m c� O CJ n l� cm ei m c E Q�yr N R L m FA = C/) C T � _ m R zip z O Go O N C E m W u m o C :at3 � o C/) .16 L m m rf) ,0 C _C m m O � VN O Z O C O a c c O ` m c .o m� o N CO m m �0..CD O O .O= O C _2 H cm CJ CD O c Q 10 o=�� Z. =.&.. m i 2 O O E L O Z O h o c O Q� c O �_ W Me y O O m � s- 0 CD H .0 CL Z" CD .o CD 0 0 co L ca cc O = CL CM< co =Cc C V C Z ts CD �..� Na c C C� c COD — /- C- e N2 3 79 Date....... ;: ..../....................... TOWN OF NORTH ANDOVER to PERMIT FOR WIRING This certifies that ............................................................... ;< ........................ has Permission to perform................. - �............................................................ wiring in the building of ......... .......... /'` i:, . ......................................... 'T at ..... '-6� .......... .............. I .................. . North Andover, Mass. Fee ..................... Lic. No. ............ .......... - -4 ELECTRICAL INSPECTOR Check NSPECTORCheck # '\3 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I �\ TRE COMMU1VWE4UHUL'A14S MCH(JSUI7.S utnce use only DEPARMENTOFPUBLICS4FM Permit No. BOARD OFMEPREVEM70NREGUL4TIONN5270212:00 Occupancy &Fees Checked i PJAPPUCATIONFORPIRW TO PERFORMELECTRMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 t77// A (PLEASE PRINT IN INK OR -TYPE ALL. INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes" No (Check Appropriate Box) Purpose of Building �� r `�- �' d /lJ Utility Authorization No. Existing Service C9 Q Amps/ a Volts Overhead 1:1 Underground No. of Meters New Service Amps Volts Overhead 71 Underground 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 1:1ourid Below Generators KVA ground 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.a)fDisposals 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 M 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' - II5t7art0aCOra'c�' PtIISU3ltbthelegUGHT1t31lSOtYVIaSS'dd1�SCtet7H'dlL3ws Ilt-feaumatLialrTit kmr&=Pblicyhi&gCm#& Comag:aitssitbshatfiiateg Oft YES r- NO Ihawst>}x dWdvatidp�ofsarte1oftOTw- YES Ifjwha�edteda�dYF�,ple�eitrlica�/hetypecfoo�a'�ebytfted�igthe �BOND p�+ p () �► �r,Fo� C� affER a 6� '5� E*admD* 1 ValuecifEadtical Work $ Worl0&Xt IrspedwD*RgjesWd Rao y a Final — G Si radunder�teP ofpejtay (,'/LJ I�oetseNo /� -i6 o PO FIRM NAME L; Siwe LioaseNo ;?eT17 OWNERS RqSURA EWAIVER;larhmmdatlhelicmeedoes not 1}taautran wwq andiatmy rnfltispem4appliGtimvm' esdasmW'mTienL (Please check one) Owner a Agent Telephone No. AILTdNa tadbvMamdiEM G3taal Laws PERMIT FEE $ cP�S Code End Code Start :pv4s OPO:) Staple oldels I c Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: L� i WPA Form 8B — Certificate of Compliance 242-1322 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP 3. The project site is located at: 246 Candlestick Road Street Address Map 106A Assessors Map/Plat Number North Andover Cityrrown Parcel 201 Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Property Owner (if different) Essex North County Certificate 9712 Book 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 6/5/07 Date B. Certification Check all that apply: 113 Page ® Complete Certification: It is hereby certified that the work regulated by the above -referenced Order of Conditions has been satisfactorily completed. ❑ Partial Certification: It is hereby certified that only the following portions of work regulated by the above -referenced Order of Conditions have been satisfactorily completed. The project areas or work subject to this partial certification that have been completed and are released from this Order are: wpaform 8b.doc • rev. 7/13/04 Page 1 of 4 A. Project Information Important: When filling out 1. This Certificate of Compliance is issued to: forms on the Judy & Tom Young computer, use Name only the tab key to move 246 Candlestick Road your cursor - Mailing Address do not use the North Andover MA. 01845 return key. Cityrrown State Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Judy Young Name Ausgust 11, 2005 242-1322 Dated DEP File Number 3. The project site is located at: 246 Candlestick Road Street Address Map 106A Assessors Map/Plat Number North Andover Cityrrown Parcel 201 Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Property Owner (if different) Essex North County Certificate 9712 Book 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 6/5/07 Date B. Certification Check all that apply: 113 Page ® Complete Certification: It is hereby certified that the work regulated by the above -referenced Order of Conditions has been satisfactorily completed. ❑ Partial Certification: It is hereby certified that only the following portions of work regulated by the above -referenced Order of Conditions have been satisfactorily completed. The project areas or work subject to this partial certification that have been completed and are released from this Order are: wpaform 8b.doc • rev. 7/13/04 Page 1 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1322 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Certification (cont.) ❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above -referenced Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No future work subject to regulation under the Wetlands Protection Act may commence without filing a new Notice of Intent and receiving a new Order of Conditions. ® Ongoing Conditions: The following conditions of the Order shall continue: (Include any conditions contained in the Final Order, such as maintenance or monitoring, that should continue for a longer period). Condition Numbers: 75 C. Authorization Issued by: North Andover Conservation Commission 61jqk2 Date ofifssuaAce This Certificate must be signed by a majority of the Conservation Commission and a copy sent to the applicant and appropriate DEP Regional Office (See Attachment). Sigi sr- wpaform 8b.doc • rev. 7/13/04 Page 2 of 4 LI)Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 8B — Certificate of Compliance Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Authorization (cont.) Notary Acknowledgement Commonwealth of Massachusetts County of Essex North DEP File Number: 242-1322 Provided by DEP On this f 4-t,Of JLM)G 'Poo Day Month Year before me, the undersigned Notary Public, personally appeared S'(',of4 I1M fse Name of Document Signer proved to me through satisfactory evidence of identification, which was/were Massachusetts License Description of evidence of identification to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its stated purpose. As member of North Andover City)Town Place notary seal and/or any stamp above Conservation Commission A. GZ/> Signature of Notary Public Printed Name of Notary Public J- ,2aG9 My Comm' sio xpires (Date) Sig ature of Notary Public wpaform 8b.doc • rev. 7/13/04 Page 3 of 4 Its DONNA K WEDGE NOTARY PUBLIC '-r" MONWEALTH OF MASSACHUSETTS "orrm. Expires Aug. 7, 7.009 North Andover City)Town Place notary seal and/or any stamp above Conservation Commission A. GZ/> Signature of Notary Public Printed Name of Notary Public J- ,2aG9 My Comm' sio xpires (Date) Sig ature of Notary Public wpaform 8b.doc • rev. 7/13/04 Page 3 of 4 Massachusetts Department of Environmental Protection L7Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 24vided Provided b by DEP D. Recording Confirmation The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of Deeds or the Land Court for the district in which the land is located. Detach on dotted line and submit to the Conservation Commission. To: North Andover conservation commission Please be advised that the Certificate of Compliance for the project at: 242-1322 Project Location DEP File Number Has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaform 8b.doc - rev. 7/13/04 Page 4 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales Suite 402 Alford Cummington Hatfield Monterey Richmond Ware Amherst Dalton Hawley Montgomery Rowe Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784 1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Fax: 413-784-1149 Belchertown East Longmeadow Holland New Ashford Savoy Westfield Bemardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemont Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg Chester Granville Leyden Otis Springfield Williamstown DEP Southeast Region Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor 20 Riverside Drive Chicopee Greenfield Ludlow Pelham Sunderland Worthington Lakeville, MA 02347 Clarksburg Hadley Middlefield Peru Tolland Wareham DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Worcester, MA 01608 Ashby Athol Douglas Hudson New Braintree Shrewsbury Webster Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston Fax: 508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield TDD: 508-767-2788 Barre Fitchburg Leominster Oakham Sterling Westford Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Weymouth Boxborough Hardwick Medway Phillipston Townsend Wilmington Boylston Holden Mendon Princeton Tyngsborough Winchester Brookfield Hopedale Milford Royalston Upton Winthrop DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincelown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Lakeville, MA 02347 Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Avon Duxbury Halifax New Bedford Rochester Wellfleet Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport TDD: 508-946-2795 Bourne Easton Harwich Norwell Scituate West Tisbury Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plympton Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole Boston, MA 02108 Arlington Ashland Cohasset Hull Middleton Reading Waltham Concord Ipswich Millis Revere Watertown Phone: 617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland Fax: 617-556-1049 Belmont Dedham Lexington Nahant Rowley Wellesley TDD: 617-574-6868 Beverly Dover Lincoln Natick Salem Wenham Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherbom Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform8b.doc • DEP Addresses • rev. 6/4/07 Page 1 of 1 r L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: 1 WPA Form 5 - Order of Conditions 242-1322 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: When filling out forms on the computer, use only the tab key to move your cursor, - do not use the return key. -Q IG�I From: North Andover 1. Conservation Commission 2. This issuance is for (check one): 3. To: Applicant: Judy a. First Name 246 Candlestick Road d. Mailing Address North Andover e. City/Town ® Order of Conditions ❑ Amended Order of Conditions Young b. Last Name 4. Property Owner (if different from applicant): c. Company MA. f. State 01845 g. Zip Code a. First Name b. Last Name c. Company d. Mailing Address f. State g. Zip Code e. Cityrrown 5. Project Location: 246 Candlestick Road North Andover a. Street Address b. Cityrrown Map 106A Parcel 201 c. Assessors Map/Plat Number d. Parcel/Lot Number Latitude and Longitude, if known (note: electronic filers will click for GIS locator): e. Latitude f. Longitude 6. Property recorded at the Registry of Deeds for (attach additional information if more than one parcel): Essex North a. County b. Certificate (if registered land) 2777 274 c. Book d. Pag 7. Dates: 6/30/05 7 p a. Date Notice of Intent Filed b. Dat(f Public Aearing Closed c. Date Is9bance 8. Final Approved Plans and Other Documents (attach additional plan or document references as needed): Plan of Land - ,1Tro0ostcl In - &r_r'"n� Too) 0 a. Plan Title The Neve -Morin Group, Inc. John M. Morin, P. E. b. Prepared By c. Signed and Stamped by VdMqevision 1"= 20' Date e. Scale f. Additional Plan or Document Title $ 360.00 V. Total WPA Fee Paid. a. Total Fee Paid $ 42.50 b. State Fee Paid g. Date $ 317.50 c. City/Town Fee Paid wpaform5.doc • rev. 311105 Page 1 of 9 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings 1. Findings pursuant to the Massachusetts Wetlands Protection Act: DEP File Number: 242-1322 Following the review of the above -referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: a. ® Public Water Supply d. ® Private Water Supply g. ® Groundwater Supply b. ❑ Land Containing Shellfish c. ® Prevention of Pollution e. ❑ Fisheries f. ® Protection of Wildlife Habitat h. ® Storm Damage Prevention i. ® Flood Control 2. This Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. A description of the performance standards which the proposed work cannot meet is attached to this Order. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). Inland Resource Area Impacts: Check all that apply below. (For Approvals Only) ❑ Buffer Zone Impacts: Shortest distance between limit of project disturbance and wetland boundary (if available) linear feet Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 3. ❑ Bank a. linear feet 4. ❑ Bordering Vegetated Wetland a. square feet 5. ❑ Land Under a. square feet Waterbodies and Waterways e. cu.yd dredged b. linear feet c. linear feet d. linear feet b. square feet c. square feet d. square feet b. square feet c. square feet d. square feet r. cu.yu ureugeu wpaform5.doc • rev. 3/1/05 Page 2 of 9 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: 242-1322 B. Findings (cont.) ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 12. Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 6. ❑ Bordering Land Coastal Dunes Subject to Flooding a. square feet b. square feet c. square feet d. square feet Cubic Feet Flood Coastal Banks Storage e. cubic feet f. cubic feet g. cubic feet h. cubic feet 7. ❑ Isolated Land Subject Rocky Intertidal to Flooding a. square feet b. square feet b. square feet 16. Cubic Feet Flood Salt Marshes Storage c. cubic feet d. cubic feet e. cubic feet f. cubic feet 8. ❑ Riverfront area Land Under Salt a. total sq. feet b. total sq. feet b. square feet Sq ft within 100 ft c. square feet d. square feet e. square feet f. square feet Sq ft between 100-200 ft e. square feet f. square feet e. square feet f. square feet Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only) s. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below 1o. ❑ Land Under the Ocean a. square feet b. square feet 11. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 12. ❑ Coastal Beaches a. square feet b. square feet c. c/y nourishmt. d. c/y nourishmt. 13. ❑ Coastal Dunes a. square feet b. square feet c. c/y nourishmt. d. c/y nourishmt 14. ❑ Coastal Banks a. linear feet b. linear feet 15. ❑ Rocky Intertidal Shores a. square feet b. square feet 16. ❑ Salt Marshes a. square feet b. square feet c. square feet d. square feet 17. ❑ Land Under Salt Ponds a. square feet b. square feet 18. ❑ Land Containing Shellfish a. square feet b. square feet c. square feet d. square feet 19. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above 20. ❑ Land Subject to Coastal Storm Flowage a. square feet b. square feet wpaform5.doc • rev. 311105 Page 3 of 9 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: 242-1322 C. General Conditions Under Massachusetts Wetlands Protection Act (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion .has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall. be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection" [or, WA DEP"] "File Number 242-1322 wpaform5.doc • rev. 3/1/05 Page 4 of 9 If you need more space for additional conditions, select box to attach a text document Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: 242-1322 C. General Conditions Under Massachusetts Wetlands Protection Act 10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been.fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. 18. All work associated with this Order is required to comply with the Massachusetts Stormwater Policy Standards. Special Conditions: See attached wpaform5.doc • rev. 3/1/05 Page 5 of 9 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: 242-1322 D. Findings Under Municipal Wetlands Bylaw or Ordinance 1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No 2. The North Andover hereby finds (check one that applies): Conservation Commission 3. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: a. Municipal Ordinance or Bylaw b. Citation Therefore, work on this projectmay not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. 4. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw: North Andover Wetland Protection Bylaw Chapter 178 a. Municipal Ordinance or Bylaw b. Citation The Commission orders that all work shall be performed in accordance with the following conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. If you need more c. The special conditions relating to municipal ordinance or bylaw are as follows: space for additional See attached conditions, select box to attach a text document Z wpaform5.doc • rev. 3/1105 Page 6 of 9 DEP FILE # 242 -1322 Therefore, the North Andover Conservation Commission (hereafter the "NACC") hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the State Regulations, the local Bylaw and Regulations, to protect those interests noted above. The NACC orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced below. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions should control. GENERAL CONDITIONS 18. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 19. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of property rights. However, the NACC, agent of the NACC or the Department of Environmental Protection (DEP) reserves the right to enter and inspect the property at all reasonable times until a Certificate of Compliance is issued, to evaluate compliance with this Order of Conditions, the Act (310 CMR 10.00), the North Andover Wetland Bylaw and Regulations, and may require any information, measurements, photographs, observations, and/or materials, or may require the submittal of any data or information deemed necessary by the NACC for that evaluation. Further, work shall be halted on the site if the NACC, agent or DEP determines that any of the work is not in compliance with this Order of Conditions. Work shall not resume until the NACC is satisfied that the work will comply and has so notified the applicant in writing. 20. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 21. The work authorized hereunder shall be completed within three years from the date of this order. 22. This Order may be extended by the issuing authority for one or more periods of up to one year each upon application to the issuing authority at least thirty days (30) prior to the expiration date of the Order (Refer to Section 8.3 (p.37) of the North Andover Wetland Regulations). 23. The NACC reserves the right to amend this Order of Conditions after a legally advertised public hearing if plans or circumstances are changed or if new conditions or information so warrant. C:\Winword\OOC\246CandlestickRoad.doc 1 NACC 8/11/2005 DEP FILE # 242 -1322 24. Where the Department of Environmental Protection (DEP) is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 25. This Order of Conditions is issued under File No. 242-1322. 26. The conditions of this decision shall apply to, and be binding upon, the applicant, owner, its employees and all successors and assigns in interest or control. These obligations shall be expressed in covenants in all deeds to succeeding owners of portions of the property. 27. The term "Applicant" as used in this Order of Conditions shall refer to the owner, any successor in interest or successor in control of the property referenced in the Notice of Intent, supporting document's and this Order of Conditions. The NACC shall be notified in writing within 30 days of all transfers of title of any portion of property that takes place prior to the issuance of a Certificate of Compliance. 28. The proposed work includes: The construction of an inground pool and spa with associated concrete patio, fence and site grading within the buffer zone to a Bordering Vegetated Wetland (BVW) and a vernal pool jurisdictional under the North Andover Wetlands Protection Bylaw. A waiver was granted by the NACC from the 75 -foot No Build Zone setback from the vernal pool. The applicant has proposed to restore portions of the maintained lawn for conversion into an aggressive buffer zone enhancement area (1,775 s.f. or 6:1). These plantings will provide enhanced protection of the vernal pool species and associated habitat. 29. The work shall conform to the following (except as noted in the remainder of this document where revisions may be required): Notice of Intent filed by: Judith Young (Applicant) 246 Candlestick Road North Andover, MA 01845 Date submitted: June 30, 2005 Site Plans and NOI prepared by: The Neve -Morin Group, Inc., entitled, "Plan of Land - Proposed In-Gound Pool", dated June 24, 2005 with revisions made through July 18, 2005. Stamped & signed by John M. Morin, P.E. Other Record Documents: North Andover Conservation Commission Waiver Request Form; Letter from The Neve -Morin Group, Inc., dated, July 18, 2005. C:\Winword\OOC\246CandlestickRoad.doc 2 NACC 8/11/2005 DEP FILE # 242 -1322 30. The following wetland resource areas are affected by the proposed work: Buffer Zone to Bordering Vegetated Wetlands (BVW) and Vernal Pool. These resource areas are significant to the interests of the Act and Town Bylaw as noted above and therein. The applicant has not attempted to overcome the presumption of significance of these resource areas to the identified interests. 31. The NACC agrees with the applicant's delineation of the wetland resource areas on the site as shown on the plans dated referenced herein. 32. The NACC finds that the intensive use of the upland areas, and Buffer Zone proposed on this site will cause further alteration of the wetland resource areas. In order to prevent any alteration of wetland resource areas a twenty-five foot (25') No -Disturbance Zone and a fifty -foot (50') No -Construction Zone shall be established from the delineated edge of the Bordering Vegetated Wetland (BVW); and a fifty -foot (50') No Disturbance Zone and a seventy-five foot (75') No Construction Zone shall be established from the edge of the delineated Vernal Pool, except as shown on the record plan referenced herein. The Conservation Administrator and/or other agents of the NACC do not have the authority to waive these setbacks as established under the local bylaw. No disturbance of existing grade, soils or vegetation is permitted in the No -Disturbance zone. (See Section 3.4 & Appendix F of the local Regulations). 33. The NACC finds the applicant's proposal for 1,775 sq. ft. of buffer zone restoration to be adequate. The Conservation Department shall be given 48 hours notice prior to the commencement of any mitigation activities. It is the intent of the Department to meet with the wetland specialists to discuss the requirements, and to ensure compliance with all special conditions. 34. The mitigation activities shall be conducted in accordance with the approved plan referenced herein, and shall be supervised by a Wetland Scientist. 35. Silt fence shall be placed along the back edge of the restoration area, as shown on the record plan, and shall remain in place until all areas are completely stabilized against erosion. 36. Any erosion or sedimentation damage caused as a direct result of this project to any wetland resource areas shall be the responsibility of the applicant to repair, restore, and/or replace. If sediment reaches these areas the Conservation Department shall be contacted immediately. The applicant shall submit a plan for abatement of the problem and proposed restoration/ mitigation measures for approval and implementation. 37. The enhancement area shall be monitored for successful growth for an eight (8) week period immediately following planting and seeding followed by a two (2) year monitoring plan. The designated wetland scientist shall provide the Conservation Department with seasonal monitoring reports (spring and fall) for a period of two (2) full growing seasons. Monitoring reports shall describe, using narratives plans, and color photographs, the physical characteristics of the wetland replication areas with C:\Winword\OOC\246CandlestickRoad.doc 3 NACC 8/11/2005 DEP FILE # 242 -1322 respect to stability, survival of vegetation and plant mortality, aerial extent and distribution, species diversity and vertical stratification (i.e. herb, shrub and tree layers). A total of four monitoring reports for the enhancement area shall be submitted over a two-year period. 38. There shall be no increase in the post development discharges from the storm drainage system or any other changes in post development conditions that alter the post development watershed boundaries as currently depicted in the Notice of Intent and approved by this Order of Conditions, unless specifically approved in writing by the Commission. 39. This document shall be included in all construction contracts, subcontracts, and specifications dealing with the work proposed and shall supersede any conflicting contract requirements. The applicant shall assure that all contractors, subcontractors, and other personnel performing the permitting work are fully aware of the permits terms and conditions. Thereafter, the contractor will be held jointly liable for any violation of this Order resulting from failure to comply with its conditions. 40. The owners of the project and their successors in title, in the event they proceed to alter areas subject to the Commission's jurisdiction under the order, agree that the Order does not in itself impose upon the Town any responsibility to maintain the proposed drainage system and that said Town shall not be liable for any damage in the event of failure. By acceptance of this Order, the owners agree to indemnify and hold harmless to the Town and its residents for any damage attributable to alterations undertaken on this property pursuant to the Order. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage or any other form of water damage. 41. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage or any other form of water damage. PRIOR TO CONSTRUCTION 42. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department or Court have been completed. 43. This Order shall be recorded by the applicant at the Registry of Deeds immediately after the expiration of all appeal periods. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of C:\Winword\OOC\246CandlestickRoad.doc 4 NACC 8/11/2005 DEP FILE # 242 -1322 registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the North Andover Conservation Commission on the form at the end of this Order prior to commencement of the work. Any Order not recorded by the applicant before work commences may be recorded by the NACC at the applicant's expense. 44. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words "Massachusetts DEP, File Number 242-1322" 45. Any changes in the submitted plans caused by the applicant, another Board's decision or resulting from this Order of Conditions must be submitted to the NACC for approval prior to implementation. If the NACC finds said changes to be significant, the NACC will call for another public hearing (at the expense of the applicant). Within 21 days of the close of said public hearing the NACC will issue an amended or new Order of Conditions. Any errors found in the plans or information submitted by the applicant shall be considered as changes. The proposed project may be still under review by other local or state boards or agencies. This may result in changes to the project plans or wetland impacts. If any such changes occur a revised plan and an explanation of the revisions shall be submitted to the NACC for review and approval prior to the start of construction. No work shall begin on a project until written approval has been granted by the NACC. 46. It is the responsibility of the applicant, owner, and/or successor(s) to ensure that all conditions of this Order of Conditions are complied with. The project engineer and contractors are to be provided with a copy of this Order of Conditions and referenced documents before commencement of construction. 47. Prior to any work, the applicant must submit in writing the names, addresses, and business telephone numbers of all applicable contacts, (i.e., contractor, environmental monitor) responsible for the approved work and ensuring compliance with this Order. 48. Prior to any work commencing on-site, the applicant shall submit to the NACC for approval, a detailed sequence of construction, including the construction of compensation and retention areas, installation of sedimentation/ erosion control devices and re -vegetation to be completed before other work begins on-site. 49. Wetland flagging shall be checked prior to start of construction and shall be re- established where missing. All wetland flagging shall remain visible and enumerated per the approved plan(s) throughout the life of the project and until a Certificate of Compliance is issued so that erosion control measures can be properly placed and wetland impacts can be monitored. The proposed limit of work shall be shall be clearly marked with stakes or flags and shall be confirmed by the NACC. Such markers shall be checked and replaced as necessary and shall be maintained until all construction is complete. Workers should be informed that no use of machinery, storage of machinery or materials, stockpiling of soil, or construction activity is to occur beyond this line at any C:\Winword\OOC\246CandlestickRoad.doc 5 NACC 8/11/2005 DEP FILE # 242 -1322 time. All flags used for the above purposes shall be of a color different from other flagging used on the site. 50. A row of staked hay bales backed by trenched siltation fence shall be placed between all construction areas and wetlands. The erosion control barrier will be properly installed and placed as shown on the plans approved and referenced herein and shall be inspected and approved by the NACC prior to the start of construction and shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. All erosion prevention and sedimentation protection measures found necessary during construction shall be implemented at the direction of the NACC. The NACC reserves the right to impose additional conditions on portions of this project to mitigate any impacts which could result from site erosion, or any noticeable degradation of surface water quality discharging from the site. For example, installation of erosion control measures may be required in areas not shown on the plan(s) referenced in this Order of Conditions. Should such installation be required by the NACC, they shall be installed within 48 hours of the Commissions request. 51. The applicant shall have on hand at the start of any soil disturbance, removal or stockpiling, a minimum of 10 hay bales and sufficient stakes for staking these bales (or an equivalent amount of silt fence). Said bales shall be used only for the control of emergency erosion problems and shall not be used for the normal control of erosion. 52. A check payable to the Town of North Andover shall be provided in the amount of $5,000 ($3,000 for the restoration area and $2,000 for all other construction activities) which shall be in all respects satisfactory to Town Counsel, Town Treasurer, and the NACC, and shall be posted with the North Andover Town Treasurer through the NACC before commencement of work. Said deposit of money shall be conditioned on the completion of all conditions hereof, shall be signed by a party or parties satisfactory to the NACC, and Town Counsel, and shall be released after completion of the project, provided that provisions, satisfactory to the NACC, have been made for performance of any conditions which are of continuing nature. The applicant may propose a monetary release schedule keyed to completion of specific portions of the project for the NACC's review and approval. This condition is issued under the authority of the local Bylaw. 53. The applicant shall designate a Professional Wetland Scientist as the project's "Environmental Monitor" (EM) to oversee any emergency placement of controls and regular inspection or replacement of sedimentation control devices. The name and phone number of the erosion control monitor must be provided to the NACC in the event that this person has to be contacted, due to an emergency at the site, during any 24-hour period, including weekends. This professional must submit a letter on company letterhead stating they have been retained as the project's Environmental Monitor. The designated Environmental Monitor is subject to approval by the NACC. This person shall also be given the authority to stop construction for erosion control purposes. The ECM will be required to inspect all such devices and oversee cleaning and the proper disposal of waste products. Cleaning shall include removal of any entrapped silt. C:\Winword\OOC\246CandlestickRoad.doc 6 NACC 8/11/2005 DEP FILE # 242 -1322 54. ON EVERY MONDAY OF EACH WEEK, or otherwise arranged by the NACC, in which construction activities occurs on-site and for as long thereafter as ground remains unstable, it is the applicant's responsibility that the Environmental Monitor (EM) monitor the site and submit written reports to the NACC. The EM shall certify that, to the best of his/ her knowledge and belief based on a careful site inspection, all work is being performed in compliance with this Order of Conditions and that approved setbacks are being adhered to. The EM must visually inspect all sedimentation / erosion control measures and assume responsibility for their maintenance on a weekly basis and that they are functioning as intended. In addition, all wetland resource areas must be visually inspected for siltation, turbidity, and/or other water quality impacts. The reports shall also include current condition of erosion and sedimentation controls; describe any erosion or sedimentation repair and / or replacement; and describe any erosion or sedimentation problems and mitigation measures implemented. Such reports shall continue until the applicant requests a less frequent reporting schedule or an end to reports. This request must be submitted in writing and is subject to approval by the Conservation Administrator. 55. Prior to construction, the applicant shall permanently mark the edge of the newly created buffer zone along and beyond the proposed fence line with eight (8) markers evenly spaced every 25 -feet incorporating the following text: "Protected Wetland Resource Area". This will designate their sensitivity and assure no further inadvertent encroachment into the wetland. These markers can be purchased at the Conservation Department for $2.00 per marker. These permanent markers are subject to review and approval by the NACC. The applicant shall instruct all agents to explain these markers to buyers/ lessees/ landscapers and all persons taking over the property from the applicant. 56. The applicant and/or the legal owner of that portion of land upon which these Orders of Conditions have been placed shall provide to the NACC prior to transferring, or assigning any portion of said land to another party, subject to said Orders of Conditions, the "Compliance Certification Form Affidavit" attached via "Appendix A" signed under the pains and penalties of perjury, stating that said applicant and/or owner has read these Orders of Conditions and is in compliance with each and every condition. This document shall apply to each of the conditions referenced herein and shall be provided to the Conservation Department at least five (5) business days prior to the closing of said land transaction. 57. Once these above mentioned pre -construction requirements are complete, the applicant shall contact the Conservation Office prior to site preparation or construction and shall arrange an on-site conference with an NACC representative, the contractor, the engineer, wetland scientist and the applicant to ensure that all of the Conditions of this Order are understood. This Order shall be included in all construction contracts, subcontracts, and specifications dealing with the work proposed and shall supersede any conflicting contract requirements. The applicant shall assure that all contractors, subcontractors and other personnel performing the permitted work are fully aware of the permit's terms and conditions. Thereafter, the contractor will be held jointly liable for any violation of this Order of Conditions resulting from failure to comply with its conditions. C:\Winword\OOC\246CandlestickRoad.doc 7 NACC 8/11/2005 DEP FILE # 242 -1322 The applicant or contractor shall notify the NACC in writing of the identity of the on-site construction supervisor hired to coordinate construction and to ensure compliance with this Order. A reasonable period of time shall be provided as notice of the pre - construction meeting (e.g. 72 hours). DURING CONSTRUCTION 58. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 59. There shall be no increase in the post development discharges from the storm drainage system or any other changes in post development conditions that alter the post development watershed boundaries as currently depicted in the Notice of Intent and approved by this Order of Conditions, unless specifically approved in writing by the Commission. 60. Water quality of the adjacent BVW shall not differ significantly following completion of the project from the pre -development conditions. There shall be no sedimentation into wetlands or water bodies from discharge pipes or surface runoff leaving the site. 61. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts on any of the foregoing. 62. Dewatering activities anticipated shall be supervised and witnessed by the designated Environmental Monitor. This designee must be on-site while work specific to de- watering activities are occurring and until complete. Activities shall be monitored daily by the Environmental Monitor to ensure that sediment laden water is appropriately settled prior to discharge toward the wetland resource areas. No discharge of water is allowed directly into an area subject to jurisdiction under the MA Wetlands Protection Act and / or the North Andover Wetlands Bylaw. If emergency de -watering requirements arise, the applicant shall submit a contingency plan to the Commission for approval, which provides for the pumped water to be contained in a settling tank or basin, to reduce turbidity prior to discharge into a resource area. 63. No exposed area shall remain unfinished for more than thirty days (30), unless approved by the NACC. If soils are left to idle greater than thirty days, all areas shall be seeded with rye seed to provide immediate stabilization. 64. The contractor will take all steps necessary to control dust onsite so that adverse effects on adjacent resource areas and/ or habitat do not occur. C:\Winword\OOC\246CandiestickRoad.doc 8 NACC 8/11/2005 DEP FILE # 242 -1322 65. No re -grading in the buffer zone shall have a slope steeper than 2:1 (horizontal: vertical). Slopes of steeper grade shall be rip -rapped or biodegradable erosion controls to provide permanent stabilization. 66. There shall be no stockpiling of soil or other materials within fifty (50) feet of any resource area. 67. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage system, or wetland resource area. 68. All waste generated by, or associated with, the construction activity shall be contained within the construction area, and away from any wetland resource area. There shall be no burying of spent construction materials or disposal of waste on the site by any other means. The applicant shall maintain dumpsters (or other suitable means) at the site for the storage and removal of such spent construction materials off-site. However, no trash dumpsters will be allowed within 50' of areas subject to protection under the Act or local Bylaw. 69. During and after work on this project, there shall be no discharge or spillage of fuel, or other pollutants into any wetland resource area. If there is a spill or discharge of any pollutant during any phase of construction the NACC shall be notified by the applicant within one (1) business day. No construction vehicles are to be stored within 100 feet of wetland resource areas, and no vehicle refueling, equipment lubrication, or maintenance is to be done within 100 feet of a resource area. AFTER CONSTRUCTION 70. No underground storage of fuel oils shall be allowed on any lot within one hundred (100) feet of any wetland resource area. This condition shall survive this Order of Conditions and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland protection Bylaw. 71. Fertilizers utilized for landscaping and lawn care shall be slow release, low -nitrogen types (< 5%), and shall not be used within 25 feet of a resource area. Pesticides and herbicides shall not be used within 100 feet of a wetland resource area. This condition shall survive this Order of Conditions and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland Protection Bylaw and shall remain in perpetuity. 72. Upon completion of construction and grading, all disturbed areas located outside resource areas shall be stabilized permanently against erosion. This shall be done either by loaming and seeding according to SCS standards. If the latter course is chosen, stabilization will be considered complete once vegetative cover has been achieved. C:\Winword\OOC\246CandlestickRoad.doc 9 NACC 8/11/2005 DEP FILE # 242 -1322 73. Upon approved site stabilization by Conservation staff, the erosion controls shall be removed and properly disposed of and all exposed areas shall be seeded. 74. Upon completion of the project the applicant shall submit the following to the Conservation Commission as part of a request for a Certificate of Compliance: a. WPA Form 8A - "Request for a Certificate of Compliance." b. A letter from the applicant requesting a Certificate of Compliance. c. The name and address.of the current landowner. d. Signed statements from the individual property owners shall be submitted with the request for a Certificate of Compliance indicating that they read and understood the recorded Order of Conditions prior to purchasing their property. e. The name and address of the individual/ trust or corporation to whom the compliance is to be granted. f. The street address and assessor's map/ parcel number for the project. g. The DEP file number. h. A written statement from a Registered Professional Civil Engineer (and/or Registered Professional Land Surveyor) of the Commonwealth certifying that the work has been conducted as shown on the plan(s) and documents referenced above, and as conditioned by the Commission. i. An "As -Built" plan prepared and signed and stamped by a Registered Professional Civil Engineer (and/or Registered Professional Land Surveyor) of the Commonwealth, for the public record. This plan will include: ➢ "As -Built" post -development elevations and grades of all filled or altered wetland resource areas including the encompassing buffer zone, which is regulated as a resource area under the local Wetland Protection Bylaw. ➢ Distances from structures to wetland resource areas. Structures include (but are not limited to) septic systems, additions, fences, sheds, stonewalls, pools, retaining walls, subsurface utilities and decks. ➢ A line showing the limit of work and the extent of existing erosion control devices. "Work" includes as disturbance of soils or vegetation. ➢ Location of all subsurface utilities entering the property. C:\Winword\OOC\246CandlestickRoad.doc 10 NACC 8/11/2005 DEP FILE # 242 -1322 75. The following special conditions shall survive the issuance of a Certificate of Compliance (COC) for this project: ➢ Twenty-five foot (25') No -Disturbance Zone and a fifty -foot (50') No - Construction Zone shall be established from the delineated edge of the Bordering Vegetated Wetland (BVW); and a fifty -foot (50') No Disturbance Zone and a seventy-five foot (75') No Construction Zone shall be established from the edge of the delineated Vernal Pool, except as shown on the record plan referenced herein. Future work within 100' of existing wetland resource areas will require a separate filing with the NACC (refer to Section XI (page 18) of the Regulations for performance standards within these zones) The Conservation Administrator and/or other agents of the NACC do not have the authority to waive these setbacks as established under the local Bylaw (Condition # 32); ➢ Discharge or spillage of pollutants (Condition #69); ➢ Prohibition of underground fuels (Condition #70); ➢ Limitations on the use of fertilizers, herbicides, and pesticides (Condition #71). C:\Winword\OOC\246CandlesticIcRoad.doc 11 NACC 8/11/2005 DEP FILE # 242 -1322 I, 1) APPENDIX A — AFFIDAVIT (authorized agent of applicant and / or owner) I am the on oath do hereby depose and state: (PLEASE CHECK AT LEAST ONE BLOCK) (position with applicant) of the applicant upon whom the Order of Conditions (applicant's name) (DEP or NACC File #) have been placed upon by the North Andover Conservation Commission (NACC). and / or 2) I am the of (position with owner) the owner upon whose land Order of Conditions placed upon by the NACC. (owner) (DEP or NACC File #) have been ♦ I hereby affirm and acknowledge that I have received said Order of Conditions and have read the same and understand each and every condition, which has been set forth in said Order of Conditions. ♦ I hereby affirm and acknowledge that on this day of 20__, I inspected said property together with any and all improvements, which have been made to the same and hereby certify that each and every condition set forth in the Order of Conditions are presently in compliance. ♦ I hereby affirm and acknowledge that this document will be relied upon by the NACC, as well as any potential buyers of said property, which is subject to the Order of Conditions. Signed under the pain and penalties of perjury this day of 20 (Authorized agent of applicant or owner) C:\Winword\OOC\246CandlestickRoad.doc 12 NACC 8/11/2005 Massachusetts Department of Environmental Protection L7'�J Bureau of .Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: 242-1322 E. Issuance This Order is valid for three years, unless otherwise specified as a special (�-S condition pursuant to General Conditions #4, from the date of issuance. 1. Date of I sua ce SThisPlease indicate the number of members who will sign this form: 611— This Order must be signed by a majority of the Conservation Commission. 2. Number of signers The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also.must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office, if not filing electronically, and the property owner, if different from applicant. Si gn tures: % L Notary Acknowledgement Commonwealth of Massachusetts County of On this Day of Before me, the undersigned Notary Public, personally appeared Essex North A44 w fgws Month Year ' "71, Tr - Name of Document Signer proved to me through satisfactory evidence of identification, which was/were Massachusetts License Description of evidence of identification to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its stated purpose. North Andover C As member of City/Town ki DONNA K WEDGE NOTARY PUBLIC 0,17 COMMONWEALTH OF MASSACHUSETTS Wy Comm. Expires Aug. 7, 2009 Place notary seal and/or any stamp above This Order is issued to the applicant as follows: ❑ by hand delivery on Date COnServatlon ommisslon Signature of Notary Public Dum,g X. U)L) G47 Printed Name of Notary Public 7 acr�9 My Commi sion xpires (Date) Zertified mail, return receipt requested, on i l/ as Date wpaform5.doc • rev. 3/1/05 Page 7 of 9 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 F. Appeals DEP File Number: 242-1322 The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. Any appellants seeking to appeal the Department's Superseding Order associated with this appeal will be required to demonstrate prior participation in the review of this project. Previous participation in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the public hearing, requesting a Superseding Order or Determination, or providing written information to the Department prior to issuance of a Superseding Order or Determination. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act, (M.G.L. c. 131, § 40) and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. Section G, Recording Information is available on the following page. wpaform5.doc • rev. 311/05 Page 8 of 9 k, Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 G. Recording Information DEP File Number: 242-1322 This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information on Page 7 of this form shall be submitted to the Conservation Commission listed below. North Andover Conservation Commission Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. --------------------------------------------------------------------------------------------------------------------------- To: North Andover Conservation Commission Please be advised that the Order of Conditions for the Project at: 242-1322 Project Location DEP File Number Has been recorded at the Registry of Deeds of: for: County Book Page Property Owner and has been noted in the chain of title of the affected property in: Book Page In accordance with the Order of Conditions issued on: Date If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Document Number Signature of Applicant wpaform5.doc • rev. 3/1/05 Page 9 of 9