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Miscellaneous - 25 CARRIAGE CHASE 4/30/2018
Date.. !�..�/.4•••• TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that<<,:'�:.�..G. �1.. • 1• has permission for gas installation .. _? l ?.'✓ T. < :.......... • • .. • in the buildings of at!�!`•!'�`• •�•-�'`"f e• • • •, North Andover, Mass. Fee.?v,. .. Lich 9�•13. .20:Xj!PECTOR........... WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICAT[ON FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date t uilding Location �� ����� C '`�3� Permit o�— _ F Owners Name • New' I Renovation j] Replacement JB Plans Submitted D F1XTl.1R=1z (Print or Type) .+ Check one: Certificate Installing Company.'. Name ANDOVER PLBG. & HTG. CO., INCA( Corp. 2122 Address 5731 SO. UNION STREET Partner. LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 978 685-8383 Name of L.Icensed,y Plumber or Gas Fitter ..._ .,.. _.. 7 GEORGE -LAR 4 4.yF,1t.0r'�T4!! lnsiilii�ncr� Coverege:' Indicate the type of insurance coverage by `6edking the' appropriate box: 4 Liability insurance policy D� Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. a C4Q N N � tt V O cc t- cx 04 w tz to m is w t to o a CC W y 4 W W W J z d : W W _ W Q W p" W N us S t f tt = 4 W .J < a I- N Lu y O m T = U. O t.. Z CT U, O F N W = Q ,W W C W' -< d U. n t3 O J U a: I > Q n. 1— O SUR,-13SMI T. BASEMENT 1ST FLOOR / 2ND FLOOR 3RD FLOOR I 4TH FLOOR STH FLOOR I 6TH FLOOR TTH FLOOR STH FLOOR (Print or Type) .+ Check one: Certificate Installing Company.'. Name ANDOVER PLBG. & HTG. CO., INCA( Corp. 2122 Address 5731 SO. UNION STREET Partner. LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 978 685-8383 Name of L.Icensed,y Plumber or Gas Fitter ..._ .,.. _.. 7 GEORGE -LAR 4 4.yF,1t.0r'�T4!! lnsiilii�ncr� Coverege:' Indicate the type of insurance coverage by `6edking the' appropriate box: 4 Liability insurance policy D� Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 11 Agent E] I hereby certify that Ali of the details and information 1 have submitted (or entered) in above application are true and teearate to the best of my knowledge and that all plumbing .cork and installations performed under Permit issued for this application will -be In compliance with all milnent provisions of the Massachusetts Slate Cas Code And QAptcr 142 of the Ccnerai Laws. — By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber —"ee Gasfitter- Signalrure of Licensed Master Plumber or Gasfitt:er Journeyman License..Number Location aS &Iz i216f Ch .41 — c! No. 4-lql Date °t7 -)D HORTIy TOWN OF NORTH ANDOVER 0:'•'�q,o • L Certificate of Occupancy $ s�cMusEt� Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 40 x Check # 116 17072 r Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPA15 RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING $ 83 3 S ;5 ➢ '' % u $ BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: A/ ce,�� Building Commissi6ner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 25 g,(C .SL 0c3 % Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUELDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIPtAUTIIORIZED AGENT 2.1 Owner ofRecord ?0 Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: lame Print Address for Service: Sig,nature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Not Applicable ❑ `Constructionf,Supervisor: License�TA �(JL%1Q G d Construction Supervisor: �/ n ( s 06 License Number 171) O S ' Address l 06 ExpiratioA Dat Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 3 Company Name Registration Number Address b C� Expiration ate Signature Telephone I SECTION 4 - WORKERS COMPENSATION (bLG.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 ..... rr No.... SECTION 5 DesciA tion of Proosed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: r.� /� r� ,c1 Vaf Uk 1`1J(4J bm-t6 4 /4CJ 0 F(� , ! SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item ©� Estimated Cost (Dollar) to be Completed by permit applicant �'ICIAI,iUSE ONLY r 1. Buildin (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 3 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ( t , as Owner/Authorized Agent of subject property Hereby authorize Qi to act on My beh f, in all pia rs authorized by this building pen -nit applicationoth. Oq -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB 7. SIZE OF FLOOR TINMERS IsT2 ND3 RD SPAN DIN ENSIONS OF SILLS DRvIENSIONS OF POSTS _ DIN ENSIONS 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 I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR NumbeO. G$, 063220 Birthdate 01/31/;1966 Expires 01/31/2006 Tr. no: 15594 DANIEL L GOBEIL 80 MONROE ST HAVERHILL, MA 01.830 Acting Cotimiss' oner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RegistrM66: 132182 Ex-piratiow 11130/2004 :ryk DBA DAN GOBEIL CONTRACTING DANIEL GOBEIL 80 MONROE ST. HAVERHILL, MA 01830 Administrator I Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers` Compensation .insurance Affidavit Please Print 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. Address Oily: Phone# , Insurance Co. Pollcv # ComgM name: Adrr�s: . P. olure to secure co verage as regWred under Section 25A or KIM 152 cart hwdtathe iripos.ion cf akr* a! penaftjes:0j-a t andlor one years' imprisorrr ,reeJl as coal �eoalttes�o�6einrn� a $TQP fims�f (filal�D��rliag� understand that a copy of this statement may beforwarded to the Office cf Investigations ct the DIA for coverage vesiikMoW !cbhereby cotfyunder&apami qadpem4fep ofpe#WythatthesafarmaVwprov**daboveisbrmaWmrrmL evil `¢a f- 6 rQ g _ Print name�Q Official use only do not write in this area to be cw pkitei by city or town official m m X m N m y EP m y Cl) 10 CD !M Z CO) CCD � L r � � � o O. y C* v CD CD 0 CT %ac d CD Er CD O CCD CO CO C CD y� p. O y �CD 1p y C) 'CD Z CD o CD0 CD C =r 10 O Ot a B �N O Q N dO C ® .® CO) �EDmo o C's O y C2 d !09 1 P1 Z ?'p tIi -4 so O� ._-► .-► m H T =r m ? d CO) W -40 m y p OE O O a > > O :c Cc y O C. N PL LE m ` Q c/� O m N CD CD m n � :� a pt � H�: y :. �J ti O. d Q C — ��_ a CD �$? (o,&H CL O H �CD m d a,� ,F a ��_ Q� ®o :0 V. 1 ® n S s t'} z =CD o Z-4 h3 0 Wo Cl) y VJ r; C WP- ELMn �:r b:CD CD C. CD 5 ' o� w? o 6Ca a- r == o UGC x r� GOD z w � p T OGC X o a O ziC Cb ( 10 y o �. H 0 0 c Date.`................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ....................................... .. ................ has permission to perform . . .......................................... wiring in the building of ..... . . at ........... rI ....... ...... . .... ............. . MorthAmdover, mass. ............... Fee..��k ........ Lic. . ........... . ..... -CA.L.iINSPECTOR Check # 5059 7wg emrxm Z g.4 -w o7 aq-4-4 4 P442. sem, BOARD OF FIRE PREVENTION REGULA APPLICATION FOR PERMIT TO P All work to be performed in accordance with he M; (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number CIS K0 Owner or Tenant 0/�ji tf J i &An,&2 ! O Owner's Address *1 -5- Is Is this permit in conjunction with a building permit Yes a No 0 Purpose of Building laslLt Existing ps %�0 Elis Voits Overhead 0 New Service Amps . Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 11917__ a I Official Use Only Permit No. ZC.. 6 1 Occupancy & Fee Checked 527 CMR 12:00 RM ELECTRICAL WORK Electrical Code 527 CM7s-�� 00 Date 0 I To the Inspector of'A res: (Check Appropriate Box) Authorization Undgmd 0 Undgmd a No. of Meters ( No. of Meters I Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In a %No. of Lighting Fixtures Swimming Pool gmd a gmd 0 Generators KVA / No. of Emergency Lighting No. of Receptacles Outlets L✓j No. of Oil Burners Battery Units No_ of Switch Outlets No of Gas Burners FIREALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices a Municipal a Other No. of Dryers Heating Devices KW Local Connection No. of No. of I. ow Voltage No. of Water Heaters KW Signs Bailases Wiriniq No. Hydro Massage Tuds No. of Motors Total HP V OTHER: INSURANCE COVERAGE. Pursuant to the requiremenSts of Massachusetts General Laws I have a c ent Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO h ubm valid proof of same to the Office YES = NO - If you have checM YES please indicate the type of coverage by checking the appropriate box. NSURANC a BOND - OTHER - (Please Specify) ["�G+�� / 5 �fi myV / / ' (Expiration Date) C,/o Z7 Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjuryn FIRM NAME(T �j % / �� G 2 / C_ LIC. NO. NO Bus. Tel �7ft %� 1% //�� /% C Address //4 tl,42� AltTet. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) . (Signature of Owner or Agent) Telephone NoPERMIT FEE I Date../ . /,/., -:.P. . !, 3 �'I ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION P12 This certifies that has permission for gas installation ............... in the buildings of ........................ at 7\6 . . . . . . �� ....... North Andover, Mass. FeC� ...... Lic. No......-............ _"7GASJN,SPE'CT0R Check # 45-17 MASSAC14USETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTiNG (Print or Type) N 14j—Dalio), �� Mass p // /� Installing Company Name f!IP- COQ Address_. -11 %3tL. o/L7 "S7� ` Building Location 1-5 �fjl/21Z 1.�1 LG ate Owner's Name_ New p Renovation p Type of Occupancy /�t S Replacement Q_ Plans Submitted: Yes[] No n Business Telephone 9 ) Check one: 3—Corporation O Partnership D Firm/Co Certificate # 41 �C Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes tom- No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy EEI-'-- Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent w Owner❑ Agent ❑ I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations Performed under the permit Issued for this application will be In compliance with ali pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the General laws. T e of U ense: Fl��r) Plumber Signature o cense Plumber or Gas rtter stiller aster License Number Tl1C O Journeyman BASEMENT gnomon Business Telephone 9 ) Check one: 3—Corporation O Partnership D Firm/Co Certificate # 41 �C Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes tom- No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy EEI-'-- Other type of Indemnity O Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent w Owner❑ Agent ❑ I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations Performed under the permit Issued for this application will be In compliance with ali pertinent provisions of the Massachusetts Stale Gas Code and Chapter 142 of the General laws. T e of U ense: Fl��r) Plumber Signature o cense Plumber or Gas rtter stiller aster License Number Tl1C O Journeyman r 0 . z n r N v m n -J O 2 (A A m C) s m N b D3 0 m N N N a m n _1 O 2 w m r 0 'tf O w O T M 0 m L w to O z r -i Location No. �' i Date TOWN OF NORTH ANDOVER j.. 9 Certificate of Occupancy $ �'Ss�cHusEt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check t Building Inspector TOWN, OF NORTH ANDOVER I • BUIDING DEPARTMENT Name (Print) APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING - BUILDING PERMIT NUMBER:n' �-- j DATE ISSUED: e��, a Q ` C SIGNATURE: Building Commissioner/I for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property .Address: /` 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: `y/y 5i.s A> Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Req cared Provided 1.7 Water S M.G.L.C.40. 34) I.J. Flood Zone Information: 1.8 Sewerage Disposal System: uPP� Public ❑ Private ❑ 1 Zone Outside Flood Zoae ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service tgnature Telephon 2.2 Owner of Record: Name Print Address for Service:. Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Lic s onstruction Supervisor: Not Applicable ❑ �t3� - L - 1x -1K Licensed Construction Supervisor- / �✓ l v License Number Address lee 7!Y 2-727Expiration Date/ Si atureA elephone 1-9a 3.2 �gsted Home Improve t Contractor Not Applicable ❑ r j,� 2%�— Company Name Registration Number Address 0 Expiration Date G' Siliudture SECTION 4 - WORKERS COMPENSATION (MG.I. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this of 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 0 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -, "/-mss / G x Z 7 ,✓1% SECTION 6 - ESTIMATED Item 1. Building 2 Electrical 3 Plumbing 4 Mechanical HVAC 5 Fire Protection 1.6 Total: 1 +3±- 5 SECTION 751 VWRIER AUT1F Hereby authorize My be _ , n all matters 'Signa&re of C SECTION 7b Estimated Cost (Dollar) to be Completed by permit applicar (a) Building Permit Fee Multiplier (b) Estimated Total Cost c Construction Building Permit fee (a) x (b) a result W1 Check Number DRIZATION TO BE COMPLETED WHEN TO S FOR BUILDING PERMIT as Owner/Authorized Agent of subject property to act on to work authorized by this building permit application. O— U Date AUTHORIZED AGENT DECLARATION 1, ,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 Name Si ature of Owner/Agent Date MINES— NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2 ND SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMVMEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM . INS TRLJCTIONS: 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 c pliance with any applicable requirements. i.......r.■..r. ■......... • r.■..........■■..rrr...r............r......... APPLICANTS/ ei�� 1 ASSESSORS MAP NUMBER ?21) LOT NUMBER SUBDIVISION LOT NUMBER STREET g: g /e�/,�iP . - ::TREET .::. /.......5 ..NUMBER ..... ..... . OFFICIAL USE ONLY ...........■■.■■..■...■■..■■■'..■.■...■.■■■■.■.■.■..■.r..r■■....■.■..■■...■■. RECOrdN1EN I TIONS OF TOWN AGENTS ... ..,i...... ..■ ...../................................................ DATE APPROVED Q L 61 v coNURVATI ADMINISTRATOR Q DATE REJECTED DATE APPROVED ffTOWN P R DATE REJECTED CONB4ENTS DATE APPROVED FOOD INSPECTOR -'HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMNfF.TJTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North Andover „pRTh • p t„e° • �ti0 Office of the Planning Department Community Development and Services Division x 27 Charles Street North Andover, Massachusetts 01845 "SsaCHU t`y Heidi Griffin Telephone (978) 688-9535 Planning Director Fax(978)688-9542 Notice Of Decision a o Any appeal shall be filed C) o Within (20) days after the Date of filing 410s. -Notice o 3> r In the Office of the Town Clerk rn CD =n Date: May 10, 2001 Date of Hearin: April 17, 2001 & May 1, 2001 , Petition of: ""nock Building Associates, 248 Mill Road Chelmsford, MA 01823 Premises Affected: 25 Carriage Chase Road, North Andover, MA 01845 Referring to the atove petition for a special permit from the requirements of the North Andover Zoning Bylaw Section 4.136. So as to allow: the construction of a 16' x 22' deck within the Non -Disturbance Zone of the Watershed Protection District. After a public lwaring given on the above date, the Planning Board voted to APPROVE, the Special PerLnit for Watershed Protection District, based upon certain conditions which are on file at the Planning Department 27 Charles Street North Andover, MA Monday through Friday 8:30-4:30. Signed: c - Alison Lescarbeau, Chairman Cc: Applicant John Simons, Vice Chairman Engineer Alberto Angles, Clerk Abutters Richard Rowen DPW Richard Nardella Building Department Conservation Department Health Departipent ZBA BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEAI.,TH 688-9540 PL.ANIVING 688-9535 25 Carriage Ch#se Road Special Permit Watershed Protection District The Planning Board makes the following findings regarding the application of Hancock Building Associates, 248 Mill Road, Chelmsford, MA 01.823, submitted . on March 15, 2001, requesting - Special Permit under Section 4.136 of the Zoning By -Law to allow the construction of a 16' x 22' deck within the NoTDisturbance Zone of the Watershed Protection District. FINDINGS OF FACT: In accordance with 4.133 the Planning Board makes the finding that the _intent of the Bylaw, as well as its speyific criteria, are met. Specifically the Planning Board finds: 1. That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning Board bases . its findings on the following facts; a) The existing dwelling is connected to the Town sewer system and the proposed . deck have no impact on the sewer system itself; b) A deed restrjction will be placed -limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit of -clearing is . restricted .to the minimum necessary to construct the proposed desk; e) Certification has been provided by a registered professional engineer that the installation of the deck will not have an effect on the quality or quantity of runoff entering the watershed protection district. f) The construction of the deck will not result in the use of yard being increased, and the impervious surface of the lot will not increase. Furthermore, the limited amount .of excavation required to install the sono tubes .for the deck will not p9se an erosion hazard. 2. There is no reasonable alternative location outside the Non -Disturbance Buffer Zone for any discharge, structure or activity, associated with the proposed project as almost the Entire lot is located within the Non -Disturbance Zone and .the Non - Discharge Zone. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: a) The specific ,site is an appropriate location for the proposed use as all feasible storm water end erosion controls have been placed on the site; b) The use will not adversely affect the neighborhood as the lot is located in a residential zone; c) There will N no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use. is in harmony with the g" purpose and intent of the North Andover Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: a) Plan titled: Site Development Plan 25 Carriage Chase Road North Andover, MA Prepared by: New England Engineering Services 60 Beechwood Drive North Andover, MA 01845 Scale: 1" = 20' Date: March 8, 2001, revised April 16, 2001 b) The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town. Planner would require a public hearing and modification by the Planning Board. 2) Prior to *uance of a building permit: a) A performance guarantee of five hundred ($500) dollars in the form of a check made out to the Town of North Andover must be posted to insure that construction will take place iu..accordance with .the .plans.and ,the.Londitions. of.this decision and to ensure that the as -built plans will be -submitted. • b) All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner. c) No pesticides, fertilizers .or chemicals. shall be .used in lawn .care or . maintenance. The applicant shall incorporate this condition as a deed restriction, a copy of the deed shall be submitted to the Town Planner and included in the file. 3) Prior to release of the Performance Bond: a) The applicant shall submit an as -built plan stamped by a Registered Professional Engineer in . Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as -built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved play. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 4) In no instance shall the applicant's proposed construction be allowed to further impact the site than �s proposed on the plan referenced in Condition # 1. 5) No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 6) The Contractor shall contact Dig Safe at least 72 hours prior "to commencing excavation. 7) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. -8) This pennit_.shall be deemed to have lapsed after a two- (2) year period from the date May 10, 2003 on which the Special Permit was granted unless substantial use or construction has commenced. CC. Applicant_ Engineer File `pr 25 Carriage Ch9se Road Special Permit 4 Watershed Protection District The Planning Board makes the following findings regarding the application of Hancock Building Associates, 248 Mill Road, Chelmsford, MA 01.823, submitted . on March 15, 2001, requesting � Special Perm$ under Section -4.136 of the Zoning By -Law to allow the construction of a 16' x 22' deck within the NoTDisturbance Zone of the Watershed Protection District. FINDINGS OF FACT: In accordance with 4.133 the Planning, Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds: 1. That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning .Board bases. its . findings on the following facts; a) The existing dwelling is connected to the Town sewer system and the proposed deck have no impact on the sewer system itself, b) A deed restriction will be placed limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit of -clearing is .restricted .to the minimum necessary to construct the proposed deck; e) Certification has been provided by a registered professional engineer that the installation of the deck will not have an effect on the quality or quantity of runoff entering the watershed protection district. f j The construction of the deck will not result in the use of yard being increased, and the impervious surface of the lot will not increase. Furthermore, the limited amount of excavation required to install the sono tubes for the deck will not pose an erosion hazard. 2. There is no reasonable alternative location outside the Non Disturbance Buffer Zone for any discharge, structure or activity, associated with the proposed project as almost the .entire lot is located within the Non -Disturbance Zone and the Non- Discharp Zone. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: a) The specific site is an appropriate location for the proposed use as .all feasible storm water pnd erosion controls have been placed on the site; b) The use will not adversely affect the neighborhood as the lot is located in a residential zone; c) There will N no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use is in .harmony with the g" purpose and intent of the North Andover Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: a) Plan titled: Site Development Plan 25 Carriage Chase Road North Andover, MA Prepared by: New England Engineering Services 60 Beechwood Drive N .orth Andover, MA 01845 Scale: 1" = 20' Date: March 8, 2001, revised April 16, 2001 b) The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would require a public. hearing and modification by the Planning Board. 2) Prior to .issuance of a building permit: a) A performance guarantee of five hundred ($500) dollars in the form of a check made out to the Town of North Andover must be posted to insure that construction will take place iu.accordance .with ,the plans. and the. conditions. of .this..decision .and to ensure that the as -built }Man's will be submitted. P b) All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner. c) No pesticides, fertilizers -or chemicals shall be used in lawn .care .or ..maintenance. The applicant shall incorporate this condition as a deed restriction, a copy of the deed shall be submitted to the Town Planner and included in the file. 3) Prior to release of the Performance Bond: a) The applicant shall submit an as -built plan stamped by a Registered Professional Engineer in . Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as -built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was -constructed as shown on the approved play b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 4) In no instance shall the applicant's proposed construction be allowed to further impact the site than as proposed on the plan referenced in Condition # 1. 5) No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 6) The Contractor shall contact Dig Safe at least 72 hours prior "to commencing excavation. 7) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. -8)_ This .permit-sha l be deemed to have lapsed after a two- (2) year period from the date May 10, 2003 on which the Special Permit was granted unless substantial use or construction has commenced. CC. Applicant_ Engineer File �. ....::.:::............. AC�• � DATE(Iwoonn • ::. PRooucER ........... ..:.:....:::;::..::: •::::: 04/02/01 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOYLE INS AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR • ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 445 MAIN STREET, WOBURN !! COMPANIES AFFORDING COVERAGE MA 018h 1 COMPANY nauRED • A ACADIA INSURANCE COMPANY HANCOCK BUILDING ASSOC INC BPA NY EASTERN CASUALTY INSURANCE CO HANCOCK BUILDERS OF CHELMSFORD 248 14ILL ROAD BLDG f2, aoMPAP1Y CHELMSFORD MA •01824 COMPANY D 2: ',• •W� T... 0 C RTIFY THAT T • HE• POLICES F ES 0 INSURANCE NCELISTEDBELOW HAVE BEEN INDICATED, NOTWITHSTANDING ANY EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co L111 TYPO OP INSURANCE PoLIoY Nulllmill POLICY EPPECINN POLICY EXPINATHON DAZE (MMAIdYY) DATE (MMIDodY11) LM1TI< Fk °wa"+L UAEam► CPA 0 0 6 4 6 2 910 10 2 2 0 0 10/22/01 oENEHv�L AooRH3DATe s2,000,000 OOWM CIAL aEMIL UABLRY «A� MAS a PRODUCTS . COMPmP ,loo s2 0 0 0, 0 0 0 orrNeTa a ooNTIlAcroR s Phar PERSONAL & ADV INJ NY $ 1 000 000 EACH OCCURRENCE $1.000-00 0 FM UWAOE ft am am) x 250,000 AUTOMONU LMOIUTY ' MID UP (Arry on t S 5,000 ANY AUTO I OOMDNED SINGLE LIMIT b ALL OWNED AUTOIl • l! SOHMM A" HOaTiD AlIT00 I � LY ra" a ' NONOW= AUTOO•BODILY I KAM a (PM AOCI�f1) PROPERTY DAMME_pRAQlt a, NAELITY �, Avro ANY � AUTO ONLY • EA AOOIDENr a OTHGR THAN AUTO ONLY: EACH ACCIDENT 8 AOORECIATE 8 elluaa weILII� L UMOW A POW eAtN oocuRRENCE a oTNiA THAN UMaRCLLA Form AOOTE DATE a WC 0 0 6 05 0 632/01 s O 1 2 0 1 0 2 aoRIIENe CO MNSATIDN AND aw%oYERa• LIAOILm X THE PIIOPRIETOIv EL EACHENT 5 0 0 0 00 Opp APRumir oaa is 500,000 _ onMll EL CeraE EA emmom IS. 500, 000 cw,$PEC1AL ffm . oEaCRIPTIDII OP o/EIIMIONaaoCATIONaIYEN .• !J J SIWULD ANY OF TH R MOVE otlCl11E® PouClu EE ANCELLEo iPORE THE C HANCOCK BUILDING ASSOC INC HANCOCK BUILDERS OF CHELMSFORD XXPRATION DATE TNEREOP, TILE mulm COMPANY WILL ENDEAVOR TO MAIL DAYS WRMW NOT= To Ta CERSICATZ HOLDER NAMED TO 11M LEPT, 248 MILL RD UNIT # 2 Dur PAIWRE TO MAIL SUON NDnCE SHALL IMPoOE NO OOLIOATION ON CHELMSFORD MA 01824 UA01� Of ANY KID UPON Tm. PAm rrs ON REPIIE89MAWRL AUTHORIZED T1VE t ' Gerard F Boyl T� -Commowa*aa o1,1ffaaadwze. Board of f3uild.inq Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration= 100158 Expiration= 6/10/02 Type- Private Corporation HANCOCK BUILDING ASSOCIATES, INC. Robert McCrensky 248 MILL RD. BLDG. 2 Chelmsford MA 01824 Board of Building Regulations One Ashburton Ace Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 12112/1947 Number: CS 016524 Expires: 12/12/2001. Restricted To: 00 ROBERT L MCCRENSKY 19 HIGH ST CHELMSFORD, MA 01824 Tr. no: 11104 Keep top for receipt and change of address notification. m m C/) 0 m v. H C � HCD n n z y CD M. CL r c O � C C. O o v c� CDCL O c CD CD o CD w op 9. CD CL O CO)CM CD = Z� O d = Q y O Q N nO 5.m .0 Co �a m o Cl) v,eicn Z =r -C C-4, �1 0 lw wm v, .n a o asm CL -0 C36 y O -404 y O el N O IE � m :CD ep = O p n CD CL am .d �`�• '� rr^^ o VJ 7 (n o 0 CD CDg n H M �"► O d d VJ y r C _ ► ^ a t FFjjTT11 Ol CA ^^ i ® '' Im ca1 CA 'V p O 0CD o '' G'iCSI �: �. ''^^ _ V J W y to I—M CLQ: n hCAo c CD cn cnw -.n ITI w In0oo �o 00 d o ►��+ go W T .� r" p w R. b C Q PC O Z LZ H 09 0 c ,7-,p 5!_0 U- `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. APPLICANT �i�CGG/c ,�G/�Z i�� ���veii'�i� PHONE 2�� —Z7,�% ASSESSORS MAP NUMBER 0 LOT NUMBER SUBDIVISION AC p NUMBER STREETfi���L' [ � r STREET NUMBER 2� �...............OFFICIAL USE ONLY.............. ... ........ nommunums XCONS NDATIONS OF TOWN AGENTS man 008,90ME emu TE APPROVED N ADMINISTRATOR ATE REJECTED 6 ` 06 COMMENTS Ua A ad 0A dl c�, A/ 1 _ �L. TOWN'VEATTNER�i I FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERNIlT FIRE DEPARTMENT CONZAENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED S I ,1'D V DATE APPROVED Mimi'C1tx•0097 DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED MORTGAGE PLOT PLAN EK SURVEY INC. MORTGAGOR _ MDAPPo DEED REF. 3373 PG._ ADDRESS OF PRINCIPLE BUILDING PLAN REF. 9�4( DATE OF INSPECTION _ �V /, T /(o /yt�j sis s, -: 9 � %� 7a• �dp�Z #puad doh oZpa soUoinau);0 lusw4Rlig�4} •Aj P240 Qq 4l IOU wo ww149 t1 C)40 P°OW PAPoJ VMVR OW " PsWu4%sP PSH POO o -N& sµl 'Awns Apadwd D lLvcwdo4 lou mp PUP '"410 P 1=7DH Poold •WULIVIV 01 3wPY;n*14 61 Uo3vuLm;u1 '£ C1 sx*WLU A"m ;o tool s4} Uo poaaq 91 uogwgrp" a141 •os,ry P• D=H POQU o Ul 01 4mdad Z ❑ •owy PAW)i4 Pools o W lou 91 "dad 3M ' . :1 NOLLVJULLISO •umm" no idsoxs oeWI � Vm4oad gONVI 1Yy�� � s •.io6o6}aw P1ce of 6ulouot4; 0606 w suo oo Aox ast[ls sgwwsnoldwl Jojow ;o �a o�tillst �, pasodo4d 'M 4VA uoliaauuoo 4 ")wa q1 Pur, "UJ4**o.n0u0 ou 4p4; PUD %sour pio auluos �o� "505}.oW plos ata uo Jstao aUMuv Aq POUDII'J 'oN poolaol sol 10 sluswynbo.+ �poq}os s4} 411 8989£ a ottmp ao; AuIglsuadasa ou �01i1M '�WPnnqwand }nq �, .1 sld�p Jl3�liflg )o +�ati.irne a Rn uodn Pslloa � kmew000 puo s�sargoru;a Yldlot�lid *LR NOINIdO � �o al lou iy puo sasocUnd s6oB�l.+mow � �tjpoWa*dv IYNOtSS3d AN NI LVH1 RLYS U3H1MrU I 1 µ`,�� paadwd sax uol}aodsuJ 96o61jow s141 310N "/)-W5 90"/72 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ***********************"""APPLICANT FILLS OUT THIS SECTION APPLICANT �-fk Q'^ y ,'�� PHONE 69r-514 a LOCATION: Assessors Map Number 0 3 T' PARCELgfO-k-- 5-0 SUBDIVISION ��Q L` %cl /L-, f f LOT (S) L -c, STREET?-�- �� �'�� q CL -1 c -r 14--- ST. NUMBER USE ONLY********************************* RECOMMENDATIONS OF TOWN AGENTS: ktP T CONSERVATION ADMINISTRATOR DATE APPROVED COMMENTS_ q a J� TOWN A0 kNNER COMMENTS e01s �, -(�,te FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE REJECTED -P, -�A- Pi DATE APPROVED DATE REJECTED 921 DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm TE Fri C "' r p > C 0 7 G7 z C: r C Rf ''� R7 l7 `j OZ Z n y C Z > OZ M A H r C Cn 7 Z a N e c� m w r cn O o r x r v > I"rm O 7 Q.n p C6 C Z (� n '4 Cl � � r pi r r r C z = z z C cn n n c ? m cn� r+ rIf cn cn H C H z H r f0 r � r a1 m b 5 \ n m •� x X W � Fri North Andover Building Department DEBRIS DISPOSAL FORM Tel: 978-688-9545 In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: Av, �e�,,S f Ale Pt_ /9 S f/ k i -e To w(n Ou (Location of Facility) Sign ure of Permit A icant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print o k ✓i IC; e"-,4 -- Ca V-pe-i-�P✓- Location, > %> "o k— rite ✓rn �nC ✓S i- iU o � o 3 I Phone 663 > 6 7 3 % d I am a homeowner p6rforming 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. Comoanv name: Address Phone Insurance Co. Policv # Company name: Address Citv: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties or a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name hone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina ❑ Building Dept Licensing Ecard Selectman's Office Health Department Other ❑Check if immediate response is required Contact person: rnone - MORTGAGE PLOT PLAN EK SURVEY INC. MORTGAGOR /190AUD DEED REF. '3373 PG.? °�_ ADDRESS OF PRINCIPLE BUILDING PLAN REF.yqt -S eAdedm CSVr43F DATE OF INSPECTION Tlic1E /Si IM A). iamb✓&, /N14 T�i►��tk'Ait`� �v�.OE Sri, . / NOTE: This mortgage Inspection was prWaned ��'' I FURTHER SATE THAT IN MY PROFESSIONAL specifically for mortgage purposes and Is not to oTO c�, OPINION the principle structure/s and accessory oe relied upon as a s+urA)4 EK SURVEY *ociptW RUDEL �' outbuildings, _ "P11K n11 no responsibility bnsibanyone for darn syes No. WWO with the setback requirements of the local y other than the sold mortgagee zoning ordinances, and that no enchroachmerdm and Ib assigns In connection biilf Its proposod'rECIS1ERE of major Improvements either way comes mortgage finanotng to sold mortgagor. ��( LANcbJ property lines w=ept as shown. CERTIFICATION TO: al. Property Is not In a Flood Hazard Area. This certification Is based on the loccdJon of ssrvey rnarkers Lj 2 Property Is In a Flood Hazard Area. of others, and does not represent d property survey, therefore 03' IMatmation is Ihsuffidont .to Aetsrmins Flood Hazard offsets shown are not to be Psed for the establishment of Mood Hazard detetmined Ihm Not West Federal Flood property line& Insurance Rdte Map Pand# Zepp'e) w 9 1 1 1i 1 Operating with /nstantTune/FT-847 Operating with InstantTune and the FT -847 is simple! From an Instanfrrack tracking screen, just hit the 'Y' key on the PC keyboard to start tracking and tuning. InstantTune will set the FT -847 receiver to the proper frequency and mode to monitor the satellite beacon. When you can hear the beacon, just tune the main tuning knob to listen to a station or to find a clear spot in the transponder pass -band. InstantTune will automatically set the transmitter to the proper frequency. You can fine tune the transmit frequency with the sub -band tuning knob to correct for minor errors in the Keplerian elements or your PC's clock. If you select a new receive emission mode, Instan(Fune will set the transmitter to the appropriate mode depending on the type of satellite transponder. InstantTune is a DOS TSR and runs in the background That means that you can start tracking and tuning on a satellite, then exit InstantTrack, and run other DOS programs. This might be useful for running a telemetry decoder like AMSAT's TLMDC software. When you are done with a pass, hit the 'Y' key again to stop tracking and tuning. You can then select a new satellite and start again. Bells and Whistles InstantTune has many other features and can support sophisticated radio configurations such as dual receivers. Since this information is already provided in the User Guide, it has been included in this article as an appendix. Summary The vision of making satellite operation as easy as HF can finally be realized with InstantTune and the FT -847. Testing of this software has been completed including a field day run by Roger, MRS. It has been tested on machines ranging from a 20 MHz 386SX laptop to a 600MHz Pentium III. It has been run successfully under DOS 5, DOS 6, and in a full -screen DOS Window under Windows 3. 1, Windows95, and Windows98. InstaniTune is available on the AMSAT web site, www.amsat.org, for download. The software is free for any non-commercial use. Source code is also available for any adventurous souls who would like to add their own radios, port it to other operating systems, or are just curious as to how it works. n s ? _ 'r -- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIRRENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING O BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building CommissioneLA for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property A *ess: 23 1.2 Assessors Map and Parcel Number: a37 C>GSo Map Number Parcel Number f 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: I Lot Area Frontage ft 1.6 BUILDING SETBACKS h Front Yard Side Yard Rear Yard ReqWred Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Li sed Construction Supervisor: _ Ge 1 Licensed Construction Supervisor: JLG �N�LfTGLl� Ad ess // Si nature Telephone Not Applicable ❑ License Number /� /Z Expiration Date 3.2 Re ' tered Home Improvement Contractor Not Applicable ❑ Company Name vLJ�%SEA � Registration Number J Addr s Expiration Date Si nature Te hone 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify X ZS ' Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit ap licant _ OF ICIAL „'M ti" ONLY I . Building(a) �leU� '� Building Permit Fee Multiplier 2 Electrical .(b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC �t1 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 SECTIO -Wb OWNER/AUTHORIZED AGENT DECLARATION I, 104as ®*Rrt'r/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 Prin Si 5d- of Owner/A ent Date GGdd NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS e 2 ND 3 RD SPAN ' DIMENSIONS OF SILLS DIMENSIONS OF POSTS j DIMENSIONS OF GIRDERS 6 ,-/K��c/- HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X 41A, (�G civ is MATERIAL OF CHIMNEY -�— IS BUILDING ON SOLID OR FILLED LAND •-- - IS BUILDING CONNECTED TO NATURAL GAS LINE e- -- r Town of North Andover a� No DTN qti ytiZ 1' 1' 6 y 6 O L Building Department ti 27 Charles Street North Andover Massachusetts 01845 Z .r (978) 688-9545 Fax (978) 688-9542 ��4 `°`""" "• ��SSgcHus���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a 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 cl 1, s150a. The debris will be disposed of in /at: Facility location Date of Applicant e NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone 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: ,r/Coc cy /LIQ/ Sys 61 C1,4 Address :2yw Ci / - � Phone #: �?5'6—272-7 Insurance Co. �/�s� �/ �fisu•9i� �%s, �� Policy # 11U6 0060-S-0 3 Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. I do herby certify ybder the Print of�perye that the information provided above is true and correct. Date Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response !s required Building Dept Contact FORM WORKMAN'S COMPENSATION Phone # E] Building Dept E] Licensing Board F-1 Selectman's Office I] Health Department 0 Other ::: ��rrr. . . . ...... ....... ::.::.; ::: DATE (MMIDDNY) PRODUCER .... ....:: ............. 02/07/00 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOYLE INS AGENCY INC ONLY AND CONFERS NO RIGHTS UPON .THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 445 MAIN STREET COMPANIES AFFORDING COVERAGE WOBURN MA 01801 COMPANY A EASTERN CASUALTY INSURANCE CO INSURED HANCOCK BUILDING ASSOC. INC COMPANY B 248 MILL ROAD BLDG #2 COMPANY C CHELMSFORD MA 01824 COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYpEOF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS. -COMP/OP AGG $ CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person),. $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY EACH ACCIDENT $ EXCESS LUABRJTY AGGREGATE $ UMBRELLA FORM ' EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKERS COMPENSATIOR AND WC 0 0 6 0 5 0 6 3 $ 2/ O 1� O O 2/ 01 � 01 X EMPLOYERS' LIABILITY TOR`SLIM& ER THE PROPRIETOR/ EL EACH ACCIDENT $ 500,000 PARTNERS/EXECUTIVE INCL OFFICEOTHER RS ARE: EL DISEASE-POLICY LIMIT $ 500,000 EXCL EL DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONSA.00ATIONSNEHICLESISPECULL ITEMS .:: :::::::::::::::::::::::.....::......::::::::.::::......::::::::::::::::::::.......:::::::::::::::: ................................ > I J' . . .. : ................... HANCOCK BUILDING ASSOCIATES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE INC EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 248 MILL ROAD BLDG #2 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CHELMSFORD MA 01824 BUT FAILURE TO MAIL SUCH NO C IMPOSE NO O OR LIABILITY RGATION OF ANY KIND UPON THE PAN GE REPRESENTATIVES. AUTHORED REPRESENTATIVE :.:::.::::.............. Gerard F Bo 1 n CERTIFICATE OF LIABILITY PkUUMkH A.,Scolniek Ina Agency, Ina. 301 Littleton Road P. 0. Box 330 Westford DSA 01886-9886 Hark Scolnick nonallo X78 _¢92-3330 fax NO 978- WSURf.7 Hancock Building Associates Hancock Builders of.Chelmsford 249 Dill Road, Bld. Y2 Chelmsford DSA 01824 3URANCt=DHA tLH / 14/99 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANY A Great American Insurance Co. COMPANY B National Grange, Mutual { CONPAnv .. 1 C' COMPAI:Y . L7 COVERAGES— THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAWD ABOVE FOR THE POLICY PERI00 INDICATED, NOTVATHSTANOING ANY REMNREMMENNT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTG'CATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS. _EXCLUSM-S AND CONDITIONS OF SUCH POLICIES LFAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, OR TYPE OFINSURANC" POLICY NUMBER POL(CYErrECTP/E POUCYEXPRATION DATE (UW00NY) OATH (MMJWW, I LIMITS GUIERAI U491JfY GENERAL AGGREGATE t 2, 00c, 000 A , X IIAFRCIALGEreRALUAsnm PAC9862351 �• --1—•• , 10/22/99 10/22/00 PR(IOVCTt•CONPgPA00 t1�000,000 1, GI A MS WOOF J OCCUR PERSONAL i ADVWURY S 1,000,000 __ OY/NER'S i CON'RACTOli3 PROT 1I EACH OCCURRENCF. S 1, 0 OO , OOO H— -I IIRREDAMAGe(Anvamme) s _50,000 !!! - { I . LIEOEXFlAnven...,. , I AU"0101061.E LIABILrY I _ I ANY ALTO { MIT75S87 i ALL JWNED AUTOS I B • X ! Sa EDUCED AUTO$ B WED AUT09 B 1 x I NDN•OmEr. Autos • I I GARAGE UADILTIY I . I ANI AVO 1 I I ' EXCE33 LIANLRY LIA•69CLLA FORM OTHe'R THAN UM6RELLA FORM i WC*KBRS COMPENSATION AND I EMPLOYERS wavTy -HE PROPRIETOR: INCL PARINEPSUECUTIVE OffICER6ARC� I OTNEP. OF 09/20/991 09/20/00 I{ I(per COMBINED slnxrLELIMIT I 11 SOO O .... 00 BoOLVIN4URY �s (Pap non) GOOLY 1144M mieanp [PROPERTY DAMAGE _� I 5500,000 $500,000 AUTO ONLY • EA ACCIDENT t OTHER THAN AUTO ONLY, EACH ACCIDENT f _ AGGREGATE f EACH OOOURRENCE t AGGREGATE t It FL FACH ACCIDENT I t EL D13EASE • POUCYLMRT� f EL OW -AM . EA EMPLOYE 11E CERTIFICATE HOLDER CANCEL•LAMON Hancock Building Assoc . , Inc. I SHOULD ANY OF THEAWVE DESCRIBED POUCIES BE CANCRLCD OErORE TK 248 Mill Road Bldg. 2 EXPIRATION DAT& TNER-DF, THE LC9 MP "G COANY WW" I�IMVCA TO MAL Chelmsford, MA 01824 f �,0AY3WCTTENMMCEYOTHE CIERMCATEHOLDER NAMED III/RLrFT BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIAR M RECORD PURPOSES OF ANY "0 UPON THE COMPANY. AO NTS OR REPRESENTATT V'JrHOR2_° REPRESENTA. ACORD 25.S (IM) Mark Scolnick 1988 t fie oor✓ wxazea" of l✓� � HOME IMPROVEMENT CONTRACTORS REGISTRATION ' Board of Building Regulations and Standards One Ashburton Place -- Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR - Registration 100158 Expiration 06/10/00 Type - PRIVATE CORPORATION HANCOCK BUILDING ASSOCIATES, INC. Robert L. McCre'nsky 114 Turnpike Rd Chelmsford MA 01824 HANCbCK BUILDING ASSOCIATES, INC, 248 Mill Road, Bldg. 2 Chelmsford, MA 01824-4126 Ate Board of Building Regulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 12/12/1947 Number: CS 016524 Expires: 12/12/2001 Restricted To: 00 ROBERT L MCCRENSKY 19 HIGH ST CHELMSFORD, MA 01824 Tr. no: 11104 Keep top for receipt and change of address notification.