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HomeMy WebLinkAboutMiscellaneous - 26 DELUCIA WAY 4/30/2018�J- A ; + ./ 11 Town of North Andover — Health Department COMPLAINT FORM DATE. Wednesday, December 08, 2004 Time of Report: 10:00 a.m. Report taken by: Pamela DelleChiaie TYPE OF COMPLAINT: Housing/Sewage COMPLAINTANT NAME: Vincent Mitrino ADDRESS: 26 Delucia Way (off Waverly Road) PHONE: 617.293.4780 COMPLAINT AGAINST: Neighbor's house ADDRESS: Apartment type house with 10 or so units PHONE: Not given COMPLAINT: Neigbors' property in front of and adjacent to his property is leaking raw sewage; bubbling up and running down the sidewalk. Public Works came out on Sunday, and stated they would contact Health Dept. if a health hazard. ACTION: Susan Sawyer and Michele Grant went to the property 12/8/04 at 2:50 p.m. to investigate. At approximately 3:00, Mrs. Mitrino called and wanted to know the procedure for follow-up on complaints. Told her that SS and MG were on their way there. She will be on the lookout for them and will speak with them at this time. Notes: 4:15 p.m. — Debora Mitrano, wife of caller spoke with Ms. Sawyer & Ms. Grant, and gave them her contact information — 978.258.6167. She is also the Assistant to the OHCD Exec. Director in Somerville. Health staff spoke with Mike, Maintenance Supervisor at the apartment complex — 508.509.2025 (lives at site). The problem is a private sewer pump that is broken. He will arrange to have a contractor come out. Also received a contact number for Able Realty — 978.688.8880 — owned by Steve Baker. Ms. Sawyer left a message for Mr. Baker today notifying him of the issue. Debroa Mitrano — called Steve Smolak ( Delucia Way Developer) to see if he could help 12/9 Health Dept tried to call Able Realty, left 2 messages 12/13 AM Steve Smolak relays message through J. Diozzi that he would hire excavator out of good will to ck the problem. PM Call received from Vinnie Mitrano. Homeowner yelled at Michele Grant and Susan Sawyer. He was abusive and the conversation had to be terminated. He was told that Susan would return his call within 10 minutes. S. Sawyer called Steve Smolak immediately. He has called Dig -safe and they have come out. He has hired Davco Exc. To address problem. He will let me know when. May be Mr. Mitrano or Mr. Baker's force main. 10 min. later — S. Sawyer called V. Mitrano and left a message of known details Letter written to homeowners. Fax on Tuesday 12/14 S. Smolak informed Health office that work will be done Wed, then contractor called and said Wed or Thursday. A message was left for Mr. Mitrano. 12/14 Letters faxed Town of North Andover — Health Department COMPLAINT FORM DATE: Wednesday, December 08, 2004 Time of Report. 10:00 a.m. Report taken by: Pamela DelleChiaie TYPE OF COMPLAINT: Housing/Sewage COMPLAINTANT NAME: Vincent Mitrino ADDRESS: 26 Delucia Way (off Waverly Road) PHONE: 617.293.4780 COMPLAINT AGAINST: Neighbor's house ADDRESS: Apartment type house with 10 or so units PHONE: Not given COMPLAINT: Neigbors' property in front of and adjacent to his property is leaking raw sewage; bubbling up and running down the sidewalk. Public Works came out on Sunday, and stated they would contact Health Dept. if a health hazard. ACTION: Susan Sawyer and Michele Grant went to the property 12/8/04 at 2:50 p.m. to investigate. At approximately 3:00, Mrs. Mitrino called and wanted to know the procedure for follow-up on complaints. Told her that SS and MG were on their way there. She will be on the lookout for them and will speak with them at this time. Notes: 4:15 p.m. — Debora Mitrano, wife of caller spoke with Ms. Sawyer & Ms. Grant, and gave them her contact information — 978.258.6167. She is also the Assistant to the OHCD Exec. Director in Somerville. Health staff spoke with Mike, Maintenance Supervisor at the apartment complex — 508.509.2025 (lives at site). The problem is a private sewer pump that is broken. He will arrange to have a contractor come out. Also received a contact number for Able Realty — 978.688.8880 — owned by Steve Baker. Ms. Sawyer left a message for Mr. Baker today notifying him of the issue. Debroa Mitrano — called Steve Smolak ( Delucia Way Developer) to see if he could help 12/9 Health Dept tried to call Able Realty, left 2 messages 12/1-3 ANI Steve Smolak relays message through J. Diozzi that he would hire excavator out of good will to ck the problem. PM Call received from Vinnie Mitran. Homeowner yelled at Michele Grant and Susan Sawyer. He was abusive and the conversation had to be terminated. He was told that Susan would return his call within 10 minutes. S. Sawyer called Steve Smolak immediately. He has called Dig -safe and they have come out. He has hired Davco Exc. To address problem. He will let me know when. May be Mr. Mitrano or Mr. Baker's force main. 10 min. later - S. Sawyer called V. Mitrano and left a message of known details Letter written to homeowners. Fax on Tuesday 12/14 S. Smolak informed Health office that work will be done Wed, then contractor called and said Wed or Thursday. A message was left for Mr. Mitrano. 12/14 Letters faxed Dellechiaie, Pamela From: Pam Dellechiaie[pdellechiaie@townofnorthandover.com] on behalf of Dellechiaie, Pamela Sent: Wednesday, December 08, 2004 4:38 PM To: Sawyer, Susan; Grant, Michele Subject: Complaint Follow -Up - Delucia Way Importance: High Sensitivity: Confidential Im 71 COMPLAINT FORM -Housing - _... Here are the follow-up notes CITY OF SOMERVILLE'MASSACHUSETTS Joseph Curtatone, Mayor GI Debora Mitrano Special Assistant to OHCD Executive Director i Office of Housing and Community Development City Hall • 93 Higghland Avenue •Somerville, MA 02143 Emai cl-it 00, EX1 2500 • TTY (617) 666-0001 *FAX (617) 625-0722 Email: dmitr-O@ci.somerville.ma.us • www.ci.somerville.ma.us ® 2 44, S4�v� �x C zvzu t--- Location )d No. 3 Date /01-0 2 NORTIy TOWN OF NORTH ANDOVER 4L 9 « Certificate of Occupancy $ Ss�cMusE Building/Frame Permit Fee $ 3 l Foundation Permit Fee $ Other Permit Fee $ 3 97 y TOTAL $ Check # 35-8 (G�� ,� l' Building Inspector � G�v-cis 804�'d .04� 0 vi = oLLI �- M LLJo n- a t� N Z� f- LO Q d Hm ()3 P 2 H 00 Oo o OJq DN tr4)F } U Z) 0 oom °Ld WN L w cn � U Lu W r I� z t� O Q N cii D 0 0 Z O y r�, Q a r� W m z M U Q >- wLL, Q z d~ A �— z C) z J -io IE aZw woL,X w F -o W rO`� w Z o Q 0 in �' ti = O U f- Q z W z W O Q O z 00N0 w Q J O N a o W 00 _M z ? 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COD c m CM c O .c o� 0 CD O o r.L 0. cmcc S 10 C 1 �, !O O J •O O z t O CLh C GO 0 0 w LU w 0 Location No. Date �aRTM O��t.•o ,�O TOWN OF NORTH ANDOVER ,• 3? i • O F 9 Certificate Occupancy of $ Ir s�c►+ust Building/Frame /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # % 05+,o 6 3 + tay, 4-)10101) #11c'(rr/gyre— Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 3 =0,.�, AME, BUILDING PERMIT NUMBER: / 3 DATE ISSUED: F-2 D '2— L SIGNATURE: - SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: "f j A/ i G cvd C4 1.2 Assessors Map and Parcel Number: l Z 5 1--If 'E :. , . ., e2 'I . s em" 0� r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: pp l (rl��Lj�i�k Zoning District Pr oLS U Joe) Lot Area (so Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard , Side Yard Rear Yard Required Provide :"'` Required Provided R red Provided 0 1.7 Water Supply M.GL.C.40. 54) N 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public -9' Private ❑ Zone . Outside Flood Zone ❑ Municipal 1l-� On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record / 14 l� Address for Service .01ame ( rmt Signature Telephone I 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ �5�7e 4,o zt,� Licensed Construction Supervisor: License Number /� X/ -// 76gofJ'! ddress -�5 psigna%re Expiration Date Telephone 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone M M X Z O t� W v a m I FORM U - LOT RELEASE FORM _1;1c/ 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 .f Uj of < PHONE LOCATION: Assessor's Map Number ;?;z SUBDIVISION 4k /(/ C i a Gva y STREET PARCEL Ze �; LOT (S) 7 ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** I RECOMMENDATIONS OF TOWN AGENTS: / CONSERVATION ADMIN COMMENTS DATE APPROVED DATE REJECTED COMM FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTION /Y\DRIVEWAY PERMIT /� FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm 7 A -�//o z- TE 2l/_ z 7 2Q'. -c72 GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. SZc,dei-tov,a141 (01 / w c 129 Permit Applicant Property address y Map / Parcel 7 7F G 36,5- Y/ C-//, -__ Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 ofthe Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application fora building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit :on the , cel. 1 This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKIN OFF OFA ABOVE EXEMPTI WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS OUNDS FOR REFU AL BY BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. AP CAN SIG t DATE THIS FORM TO BE ATTACHED TO THE'BUILDING PERMIT APPLICATION .�ite ��ntnnz�-�ucaerzl�. o��Ifnu�rrii�wet�s BOARD OF BUILDING REGULATIONS icense: CONSTRUCTION SUPERVISOR Number: CS 053176 Birthdate: 02/1511958 Expires: 02/15/2003 Restricted To: 00 STEPHEN M SMOLAK 762 DALE ST NO ANDOVER, MA 01845 Tr. no: 6695 Administrator Name: STCV(s S MOI. gilt. ^ Location: 742- G-1 IL sl' City N. ANDa✓M. Mg. Phone CSS 'V/V/ am a homeowner performing all work myself. �l am a.sole proprietor and have no on6 working in any capacity f am an employer providing workers' compensation . . for my employees working on this job. /, N Bu�4w�n- ��; 276 S� rRIyra ED IRMWO cOveragd as ►m4Ep[ed under Section25A of 1 .1 2 C�h fGAd tO tf�'1m��M� d ElTiltifial and/or one y W WVrbinment as wen as clo penanks in the.forrn of a m kDd t&tb& V and aline ol`penani etaitne w to s1;spp oo understand that a copy of this statement may be forwarded to the df & of lm� of MA W v �9alnst rrte t do herby certify and the pauRs and peneories perfcny the Mwhafto PFOWded abmeis true arwCoftt Signature i Z Hate 7 Print name Phone # '7 ►titcial use only do not write in this area to be completed by city or town d icW OChsck ff irnmedrate msponse it requuad Building Dept zrtact person: Phone 'R fAfAk'S COMPENSATION p Building Dep f ' - - © L-tcensing Board El Selectrr an`s Off,�c6 Q / laalth Department D Cather MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: Haverhill STATE: Massachusetts HDD: 6413 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE; Other (Non -Electric Resistance) DATE: 8-1-2001 COMPLIANCE: PASSES Required UA = 475 Your Home = 438 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 1564 30.0 0.0 55 WALLS: Wood Frame, 16" O.C. 2241 13.0 0.0 184 GLAZING: Windows or Doors 332 0.350 116 DOORS 51 0.160 8 FLOORS: Over Unconditioned Space 1564 19.0 0.0 74 HVAC EQUIPMENT: Furnace, 85.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in Sections 780 1310 a 4.4. Builder/DKi gner Date' �� o and xobling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125a of the design load as specified I in Sections 780CMR 1310 and J4.4. [ ] SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 2011 of the heating energy is from non-depletable sources. Pool pumps require a time clock. [ ] HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant 2.5-4" 2.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 201-250 1.0 1.5 1.5 120-200 0.5 1.0 1.0 any 1.0 1.0 1.5 2.5-4" 2.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 MAScheck•INS,PEtTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 8-1-2001 Bldg.1 Dept.1 Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: [ ] I 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U -value: 0.16 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: [ ] 1. Furnace, 85.0 AFUE or higher Make and Model Number AIR LEAKAGE: [ J Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or Basketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: T p n (Location of Facility) Signature of Permit Applicant 7 �T=o ;., Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I� 101 3 F° 6 z y Q Co �w 1 °-♦ w um p nib o 0ai O � C o U a -0 m um o Ea 3 o 3 y o a © H c c M 4- .. a 0 E '� Ln c 0; =0 `� gun cp �; y o O o O \_ 1 u rn E a'a= ma W = N Ci a� O O Ltt y Nb - 0 cp C1 rt) w a rn C W E roc c c c E www ate._ o 0 U a� O as N u- n �,�.,CL in UJ a c Otao +• M p N w t r- O G .- m e in O ,-, Z O aj 22 c g 0 r g sinLn > ►- m I A m v u v o w° e a cn aa O z q cA �c 7 w° ao' E U ro w a Eos� U a a pG w O w u W m a rx u c� ro w p z d 7 ao' ii w A w w c co z cn -� o cn O CL z w . Q. v. 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U- Ln —,1 0 74 w�a ����o2c1 %yam/� DCC- i2�nm s -,P V., i3A--hs - sfzi/ utiWe ..,i 4, x 3 S 4 Be I a3 so© �;f�C� 5ji lr 11 o7 ©00 3 SO d y )c -2 ,� r) a m p MA r a "2-6 ,-30 130 2-4Y�� J 5, 4 / y y/I- qDO, rl1-r 0 m yo►D y- 55 4 OLS r-�ao v .0p f 6- 3 13 j aI— C z �o txj A i Ln 0) 0) N O OD 230.96, Obi D n rn I i b 230.96' OD / ' I•I cA Z0+ ING SETBACK UN� I w boy p I I o I m W Cc, r ► I ' I I V 0 I ' ► (D I '�! / o y 'val l PROP SED I I O A �Z I I g• Z C.F.0;/GF.-600 rn X00.00'cm) 7i 0) Ol N 1 c z D " fj D II DEL UCIA WA Y v ® o N PO b yC4 z C Z* OD b y n h w txj 0 om�Zn z Z D ,,. mD Z r- M D D cn m O -i* y ~ o �0�� M c- o F�, c z v1 — ` J r m 1 *t (n - r 0_ QI r 000D D m O II Z r z 2 'V D �� Z p_ N 00 y O v C Z ymD C-) p y on m o~ 1 y oos� y M D A o N =w z � m c o Z p (� p c D D u i2o p p Dm (n X �II 1 N z m o II p cp u �co 00 oo n o o� ��pUa CO,yy�b Z v w Ln II p Z — C p o �'a o f �F'<� r O O Ui � r,, m x o c D y J �� D m v woo rn U) CA 0 W `FyOR S171 135 N V 1 Location C; No. 1,66 t TOWN OF NORTH ANDOVER /� 1 • pL 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # (�61L 17208 \. � ,/' Building Inspe� it • + $ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ' IiL4, Oi' JfCW tI�C`OHI BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: lyv t Building C missioner/I for of B SECTION I- SITE INFORMATION I.1 Property Address: 1.3 Zoning information n2 Date 1.2 Assessors Map and Parcel Number: C,2Q 62 57 IQ - Map Number Parcel Numb 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts geft) 1.6 BU70Private ING SETBACKS ft Rear Yard ront Yard Side Yard ired Provide Required Provided Re red Provided 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Watery M.G.L.C. {0. 31) Zone Outside Flood Zoite 0 Municipal 0 On Site Disposal System 0 Public 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ownttr of Record _ A y, r �V 1.2 Owner of Record: Address for Service: Telephone Address for Service: JI lint.., SECTION 3 - CONSTRUCTION_ SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature i KeglSnontc IMPI—,..,,.,. pis dmpany Name 3 address , sUl X19 21 Telephone Telephone T Not Applicable License Number Expiration Date Not Applicable C4 131 �3 I Registration Number 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 rmit. Si ned affidavit Attached Yes ....:..0 No ....... ❑ SECTION 5 Descri tion of Proposed Work 10ther a "cable ❑ Alterations(s) 0 Addition ❑New Construction ❑ Existing Building ❑Repair(s)Accessory Bldg. ❑ Demolition ❑ Specify Brief Description of Proposed Work: ko SECTION 6 - ESTIMATED CONSTRUCTION COSTS �✓ Item Estimated Cost (Dollar) to be -nit Completed by En applicant (a) Building Permit Fee 1. i Buil) ©/� Multi lier (b) Estimated Total Cost of 2 Electricals Construction Building Permit fee (a) X (b) 3 Plumbm 4 Mechanical (HVAC) 5 Fire Protection Check Number 6 Total (1+2+3+4+5' SECTION 7a OWNER AUTHORIZATION To BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property to act on Hereby authorize-- behalf; in all matters elatrve to work authorized by this building permit application Date Si nature of Owner SECTION OWNE AUTHORIZ ENT DECLARATION as Owner/Authorized Agent of subject I, 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 Sim NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 SPAN DEN ENSIONS OF SILLS DIMENSIONS OF POSTS DiMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING 0TERLkL OF CFMVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL, GAS LINE Date SIZE THICKNESS X I� I/ � C�r 3 _a ct 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. ..................i........�.n...fi..........................................°J APPLICANT �� } i--1� , I9 J r 1 J t )/+A.) D PHONE % 76 -2 5 ASSESSORS MAP NUMBER LOT NUMBER Y /C3 - SUBDIVISION fi'C LOT NUMBER 3 STREET L STREET NUMBER b OFFIC USE ONLY �JREC NDATIONS OF TOWN AGENTS MEN DATE APPROVED ,/_ j a CONSERVATION AD TRATOR e nATR R�JFCTED TOWN PLANNER COMMENTS FOOD INSPECTOR - HEALTH fz,�d A z�ZA - SEPTIC INSPECTOR - HEALTH / COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED _. DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE m m x m m x m F, CA CD.p a Z CD O 0r dd C a� .0 .p o O p CD C cr �d CD O C S.O to O CD CO) -o CD 0 CA d CO) CA F O y d C) CDO P� CD no 3, H CD CA O CD 0 CD c_ CCP E -g 0 _ O �•y O C NJ a0S® .0 y .♦ a o O m Cl) CD yC)c.0 3 m Z CD S•Cp Fn mti p H �m m = O 0®yo 10 't O () O OZyn :�: W ,. O O tj 0 � co) a SCAM 00' � E:�i ♦:� GO ►� m 0 CD ®CD y R. 0 �0 n z y a �'�cr � cn o CCD Ci Co • cn _r ^ SO � p W oc Z m o Cn 1a: CD Op CD aC -o c o n � o cn 5" �, d cn O w� C H o cn m 70 o x :j ;o o r'' toSrD tai y ni o o w M o A.. x O O Cri o D r )nq 0 g- 0 c G��SEtis 804 ti Nco W �Q a� rn = o a O M W Q � fl) ow F- F- U- >b N p Z c' LtJ �LLJ`� o Z W�0 ROF��� m W o co o W U O N d II azpm O W -u > Q Oo U Z ori I II II z cD f Q J V) rn Z Z Q 0 oQ Y Q0a oQOQ Li W m� w zo F- w o f-- U>- a >- W N Z p a + o J Z U �+ w ~ F W = d O Z FII (!) X 2� <0L,0 a W W w z LJD Ii Z Z 1 L O o N w CDj o�o O o Q C) o z Upujp � a W J o N p W G d' 00 rrJ C)- T�rGl Vi,)D 7 ar j o �. ,00.001 41 11; oc Az { >CO f { co i 3Nn NOVBI3S ONINOZ ,96.OfZ j W . i o O ECL .: v C N j0� { Location Jam' / t) 11JA No. Date S -(0 -05 - Of AORTN "(0-0S- pORTN TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ ITS ACM""CH tt�' Building/Frame Permit Fee $ `+iia Us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I i Building Inspector a 1 00 M "l z O v al M I 0 0 z M 90 r v M r UNIONS r z G) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT EPM& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s tii1D BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I-(or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map Land Parcel Number: i Baa Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rewired Provided 1.7 Water Supply M.G.L.C.40. 34) Public 0 Private 0 1.3. Flood Zone Iaformuion: zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT . i,; 7,11 t; , i"ti ! Ct: 2.1 Owner of Record Name (Pent) whx Address for Service 4. Signature Telephone 2.2 Owner of Record: A Name Print Address for Service: Sipfiature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable If License Number Expiration Date Registered Home Improvement Contractor i Not Applicable ❑ L inName Registration Number Address Expiration Date Signature Telephone 00 M "l z O v al M I 0 0 z M 90 r v M r UNIONS r z G) SECTION 4 - WORKERS COMPENSATION (M. .L C 152 § 2! Workers Compensation Insurance affidavit must be co eted and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No....... SECTION S Description of Pro sed Workcheck rH applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ with this application. Failure to provide this affidavit will result Alterations(s) ❑ 1 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work:- obu'[& //vike TO 6)074e4c� ca*?� pk"Ic k rem �` Gwt Sy 76' Z 2 41T- . . SECTION 6 - ESTIMATED CONSTRU CmTTON CnCTC Item Estimated Cost (Dollar) to be Completed by pennit 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 tb1 / _�- / 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number .ac. a. AAv— is V11 Ll G�A 111Vk%"+11vLn 1V O 1.V1VLCL.L' 1riU WlMfJ OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize/ ~ ► r `� %i t�%Ci to act on My behalalmer el ork authorized by this builduig permit applicati Signature o ' 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 areLnx"and accurate, to the best of my knowledge and belief Print Name Signature of Owner/.Agent -111-1 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THVIBERS1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIIZDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X — MATERIAL OF CHIMNVY IS BUILDING ON SOM OR FILLED LAND IS BUILDING CONI) CTED TO NATURAL GAS LINE ecK Al-b��' - �12f�(i FORM U - LOT RELEASE FORM 6666 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 SECTIO ZSTREET'_3, PPLICANT V ��C`C`C3�'C �%CC2A�1�1�1 PHONE Q S OCATION: Assessor's Map Number PARCEL UBDMSION ``l LOT (g) r C �. Y`�P`C� ST. NUMBER Zb OFFICIAL USE ONL CONSERVATION ADMINISTRATOR DATE APPROVED nerc ow Terre., TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RovWW 9Wjm of Np oTN TOWN OF NORTH ANDOVER ,.�; ..••, ooL OFFICE OF a BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 °gar.° •�_ty D. Robert Nicetta, Telephone (978) 688-95454 Fax (978)688-9542 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please print DATE: - JOB LOCATION: Number Street Address Map/Lot HOMEOWNER VINLg:+iTlT �•� oZ ��wt? / %%`02''�� Name Home Phone Work Phone PRESENT MAILING ADDRESS S %w S6M City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and req uireg�entt d that he/she w,j�lI < ply with said procedures and requirements. ��% / /// HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL I10.AR1)OF. UTE, AIS(iXX'9541 CONSITVATION688-9530 IIF, U;fIIOXX_)540 I'I..WNIM,oXX-9535 ERJ"� I 0 w O O z wy v P4 /y W J= F O Z a o a Q Y `NGoQ O ` O U w a is. .o'c a°4 w ir. ca cn cn w O O z wy Y /y W J= F O Z o �: Q Y `NGoQ w O O z wy O ` O C .o'c CL W ' O c O t- E a O..S fA V O `v `oc E • O Z' h N o 3 — W y m C O SO s w��=occm y C ca ow 0V m I NZ O C O C a � m � • C : 3 O H COL. :a N •S~ IV m W o O .0 Z t "r IL y o H � CL at,,. � Z O C.3 a Egg C �=�a�m� M, 0 w a Z im I H 0 H E CL a� env C40 0 o. EL - CO) 0 cc C cc y a� CL. CA C C CM C O■� 32 M co 0 CD 310 0 L L C. Q. C Q cc zCD CD CLCA C 16 ti C14 4) ^! 00 W O U-) W U 0'.) fnH F W LO LLI 00- � 0 0- a: N ^I I _00 D� WLLJI� }. Q o^0 H N O Z CL W Q W. m W a O O J z O 3 UO o O o M -U-) M FQ� w J Z) 0-J N in I II II II <6m zZm� OO LL)Z Q N cr 0 Ozzo Q N n Q+ H O M _U Q r cr o W FWWQ A z d. n r F W (n a O'W � QO�� ~-Oo O 1� tiJ O LLIQ � L Z N �ZY� O [� P Q W Q Z �OQO U. ^1 U z ON vU�o 0 V) ODr- V M_ z ` W � 16 O ,00'001 A N 0 9 / / Nps I'L7Nnoj 26.9 00 / M / 64 l w oa o I '; 00 3Nn )Ova13S ONINOZ ,ss•ofa W g<i � �E OC Z F- z O U Z D 3 z O z ti C14 00 W O U-) fnH F W LO m v,0 _00 D� WLLJI� }. Q o^0 CL W > W. m W a O J z O N w J O ,00'001 A N 0 9 / / Nps I'L7Nnoj 26.9 00 / M / 64 l w oa o I '; 00 3Nn )Ova13S ONINOZ ,ss•ofa W g<i � �E OC Z F- z O U Z D 3 z O z Town of North AndoverREDEIVED Building Department 27 Charles Street FEB 12 2003 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-95#tJILDING DEPT. ))q 2--3— 03 µoRTH Q 4Y�eo ,b q O L T 'i 64 T 'pp Cot.N(M,vNw V ��SSRCNUS '7. APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER SUBDMSION t( )f/6.,* U e / L w� DATE REQUEST FILED ; DATE READY FOR INSPECTION .? IJ P% j FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORD AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TaIE FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS W - BE CHARGED IF THE,,OoSTRU,�TURE.JJOES LVOT 1�ETzALL APPLICABLE CODES. SIGNA OYPI IAL USE ONLY ************************************************************************ ROUTING CONSERVATIO 7-7 /If � DATE PLANNING DATE D.P.W. — WA ATE BI QST INDICATE THAT THE WATER METER HAS BEEN INSTALLED THE INSPECTIOI%REQUEST DATE. f) The roadway must be constructed to at least binder coat of pavement to properly access the lot in question. Prior to construction of the binder coat, the applicant shall ensure that all required inspection and testing of water, sewer, and drainage facilities has been completed. The applicant must submit to the Town Planner and the Department of Public Works an interim as -built, certified by a professional engineer, verifying that all utilities have been installed in accordance with the plans and profile sheet. The interim as -built plan shall be prepared in accordance with the definition listed in Section 1.3.3 of the Town of North Andover Subdivision Regulations and Section 5.14 of the Town of North Andover Subdivision Regulations. g) The applicant shall adhere to the following requirements of the North Andover Fire Department and the North Andover Building Department: 1) All structures must contain a residential fire sprinkler system. The plans and hydraulic calculations for each residential system shall be submitted for review and approval by the North Andover Fire Department. Plans and hydraulic calculations for each residential system must also be supplied to the Building Department. h) The applicant is required to pay sewer mitigation fees at the Department of Public Works. Proof of payment must be supplied to the Planning Department. i) If a sidewalk is to be constructed in front of the lot, then such sidewalk must be graded and staked at a minimum 7) Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a) All necessary permits and approvals for the lot in question shall be obtained from the North Andover Board of Health, and Conservation Commission. b) The residential fire sprinkler system must be installed in accordance with referenced standard NFPA 13D and in accordance with 780 CMR, Chapter 9 of I� the Massachusetts State Building Code. Certification that the system has been installed properly in accordance with the above referenced regulations must be {/ provided from both the North Andover Fire Department and the North Andover Building Department to the applicant. The applicant must then provide this certification to the North Andover Planning Department. c) Permanent house numbers must be posted on dwellings and be visible from the road. " d) There shall be no driveways placed where stone bound monuments and/or catch basins are to be set. It shall be the developer's responsibility to assure the proper placement of the driveways regardless of whether individual lots are sold. The 5 Planning Board requires any driveway to be moved at the owner's expense if such driveway is at a catch basin or stone bound position. e) Prior to the final release of security retained for the site by the Town, the following shall be completed by the applicant: a. An as -built plan and profile of the site shall be submitted to the DPW and Planning Department for review and approval, in accordance with Section 5.14 of the Town of North Andover Subdivision Rules and Regulations. b. The applicant shall petition Town Meeting for public acceptance of the street in accordance with Section 5.11 of the Town of North Andover Subdivision Rules and Regulations. Prior to submitting a warrant for such petition the applicant shall review the subdivision and all remaining work with the Town Planner and Department of Public Works. The Planning Board shall hold a portion of the subdivision bond for continued maintenance and operations until such time as Town Meeting has accepted (or rejected in favor of private ownership) the roadways. It shy been recorded at thedeveloper'sl be the responsibility of 1Deed � insure that all proper easements have that all Planning, 8) The Applicant shall ensure m�entsnare satisfied and thatoconsstructtin, Board on Health and Division of Public Works uireand conditions. ed was in strict compliance with all app plans 9) The applicant shall adhere to the following requirements of the Fire Department: a) Open burning is allowed by permit only after consultation with the Fire Department. b) Underground fuel storage will be allowed conformance ire DepartmBntthe Town laws and and State Statute and only with the review andapproval of the F Conservation Commission. 10) There shall be no burying or dumping of construction material on site. 11) The location of any stump dumps on site must be pre -approved by the Planning Board. 12) The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 13) Gas, Telephone, Cable, and Electric utilities shall be installed as specified by the respective utility companies. 14) Any action by a Town Board, Commission, or Department which requires changes in the roadway alignment, placement of any easements or utilities, drainage facilities, may be subject to modification by the Planning Board. grading or no cut lines, 6 5 E I i z CL Vil"AL S. V: c 02 d11 "m c y O H Y/ 04: ` CJ C-7 d� cc O :0 Ae N 4 �•C"� • m o y $ '� 0cc u cm C l m CEO da co Cc= H A0 E W D cc COM a�b.:CD A O > IC Z yt••, O Cf acr •� P-4 ®off m cam Z � coo c 1- m y O. C •C Z W .. c to aZR.6 Z •E 0 � v � O CM C3CD o og.c GO CZ O� O� = COD C 1 0 O 4 v Q O MMQ O Z O D ,i7 CO2 0 V C. COD C /O� V Cc O CO) Q 0 _o uj CO w LU w LU VJ re re taxi LAJ n� Hb U a z. A SCJ \ �� U z w A p U n uo u i � �� v a v w z o w° C x C G i z CL Vil"AL S. V: c 02 d11 "m c y O H Y/ 04: ` CJ C-7 d� cc O :0 Ae N 4 �•C"� • m o y $ '� 0cc u cm C l m CEO da co Cc= H A0 E W D cc COM a�b.:CD A O > IC Z yt••, O Cf acr •� P-4 ®off m cam Z � coo c 1- m y O. C •C Z W .. c to aZR.6 Z •E 0 � v � O CM C3CD o og.c GO CZ O� O� = COD C 1 0 O 4 v Q O MMQ O Z O D ,i7 CO2 0 V C. COD C /O� V Cc O CO) Q 0 _o uj CO w LU w LU VJ re re taxi LAJ Town of North AndoverRECEIVED Building Department 27 Charles Street FEB 12 2003 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-951MALDING DEPT. 1q 2'3— 03 Of µORTH Q 41�,l0 �6 a L APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER--,,? SUBDIVISIONle, e /fid wR. DATE REQUEST FILED DATE READY FOR INSPECTION % r% FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORD AND SIGN OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25_) DOLLARS WILL BE CHARGED IF TH�oSTRU,�TUREPOESYOT 1 ETjAL.L APPLICABLE CODES. SIGNA ************************************************************************ ROUTING CONSER PLANNING D.P_W. — D.P_W�IU VATI o , �j DATE o2 0 r a DATE W O WA TER ATE T INDICATE THAT THE WATER METER HAS BEEN INSTALLED 11:10 DATE. f) The roadway must be constructed to at least binder coat of pavement to properly access the lot in question. Prior to construction of the binder coat, the applicant shall ensure that all required inspection and testing of water, sewer, and drainage facilities has been completed. The applicant must submit to the Town Planner and the Department of Public Works an interim as -built, certified by a professional engineer, verifying that all utilities have been installed in accordance with the plans and profile sheet. The interim as -built plan shall be prepared in accordance with the definition listed in Section 1.3.3 of the Town of North Andover Subdivision Regulations and Section 5.14 of the Town of North Andover Subdivision Regulations. g) The applicant shall adhere to the following requirements of the North Andover Fire Department and the North Andover Building Department: 1) All structures must contain a residential Bre sprinkler system. The plans and hydraulic calculations for each residential system shall be submitted for review and approval by the North Andover Fire Department. Plans and hydraulic calculations for each residential system must also be supplied to the Building Department. h) The applicant is required to pay sewer mitigation fees at the Department of Public Works. Proof of payment must be supplied to the Planning Department. i) If a sidewalk is to be constructed in front of the lot, then such sidewalk must be graded and staked at a minimum 7) Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a) All necessary permits and approvals for the lot in question shall be obtained from the North Andover Board of Health, and Conservation Commission. K b) The residential fire sprinkler system must be installed in accordance with referenced standard NFPA 13D and in accordance with 780 CMR, Chapter 9 of the Massachusetts State Building Code. Certification that the system has been % installed properly in accordance with the above referenced regulations must be provided from both the North Andover Fire Department and the North Andover Building Department to the applicant. The applicant must then provide this certification to the North Andover Planning Department. c) Permanent house numbers must be posted on dwellings and be visible from the road. " d) There shall be no driveways placed where stone bound monuments and/or catch basins are to be set. It shall be the developer's responsibility to assure the proper placement of the driveways regardless of whether individual lots are sold. The 5 Planning Board requires any driveway to be moved at the owner's expense if such driveway is at a catch basin or stone bound position. e) Prior to the final release of security retained for the site by the Town, the following shall be completed by the applicant: a. An as -built plan and profile of the site shall be submitted to the DPW and Planning Department for review and approval, in accordance with Section 5.14 of the Town of North Andover Subdivision Rules and Regulations. b. The applicant shall petition Town Meeting for public acceptance of the street in accordance with Section 5.11 of the Town of North Andover Subdivision Rules and Regulations. Prior to submitting a warrant for such petition the applicant shall review the subdivision and all remaining work with the Town Planner and Department of Public Works. The Planning Board shall hold a portion of the subdivision bond for continued maintenance and operations until such time as Town Meeting has accepted (or rejected in favor of private ownership) the roadways. It shall be the developer's responsibility to insure that all proper easements have been recorded at the Registry of Deeds. 8) The Applicant shall ensure that all Planning, Conservation Commission, Board of Health and Division of Public Works requirements are satisfied and that construction was in strict compliance with all approved plans and conditions. 9) The applicant shall adhere to the following requirements of the Fire Department: a) Open burning is allowed by permit only after consultation with the Fire Department. b) Underground fuel storage will be allowed in conformance with the Town Bylaws and State Statute and only with the review and approval of the Fire Department and Conservation Commission. 10) There shall be no burying or dumping of construction material on site. 11) The location of any stump dumps on site must be pre -approved by the Planning Board. 12) The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 13) Gas, Telephone, Cable, and Electric utilities shall be installed as specified by the respective utility companies. 14) Any action by a Town Board, Commission, or Department which requires changes in the roadway alignment, placement of any easements or utilities, drainage facilities, grading or no cut lines, may be subject to modification by the Planning Board. on 15) The utilities must be installed and the streets or ways constructed to binder coat two ears from this approval. If the utilities are not installed, the streets or ways are not constructed to binder coat and the Planning Board has not granted an extension by the above referenced date, this definitive subdivision approval will be deemed to have lapsed. 16) The following waivers from the Rules and Regulations Governing the Subdivision of Land, North Andover, Massachusetts, dated November 2000, have been GRANTED by the Planning Board: a) Waiver to Section 5.4. La of the Regulations which requires an Environmental and Community Impact Statement when six or new lots are created. As two of the six lots that are being created contain existing structures, the determination has been made to waive this requirement. 17) This Definitive Subdivision Plan approval is based upon the following information which is incorporated into this decision by reference: Plan titled: Definitive Subdivision Plan, Delucia Way located in North Andover, MA Prepared for: Right Now Realty Trust, P.O. Box 985, Kingston, NH MDB Realty Trust, 415 Waverly Road, No. Andover, MA Prepared By: Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Scale: 1 "=40' Report Titled: Stormwater Management Report for Delucia Way In North Andover, Massachusetts Prepared For: Right Now Realty Trust Dated : March 28, 2001 Prepared By: Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 7 Town of North Andover RECEIVED Building Department 27 Charles Street FEB 12 2003 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-954&uILDING DEPT. Jr! 2--3— 03 pORTH o � -.0 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS C/le T LOT NUMBER ,� SUBDIVISION 6�/6!A cva DATE REQUEST FILED DATE READY FOR INSPECTION .� %� r% j FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE®STRU,gTURE POES,;IOT WET,�ALLL APPLICABLE CODES. SIGN. ROUTING CONSERV PLANNIN D.P.W. — D.P. W_ -MU r OFFICIAL Ug'E ONLY ATIO , G/ DATE o p G DATEZD f O a WA TER ATE INDICATE THAT THE WATER METER HAS BEEN INSTALLED THE 1NSPECTIO"QUEST DATE. A _ f) The roadway must be constructed to at least binder coat of pavement to properly access the lot in question. Prior to construction of the binder coat, the applicant shall ensure that all required inspection and testing of water, sewer, and drainage facilities has been completed. The applicant must submit to the Town Planner and the Department of Public Works an interim as -built, certified by a professional engineer, verifying that all utilities have been installed in accordance with the plans and profile sheet. The interim as -built plan shall be prepared in accordance with the definition listed in Section 1.3.3 of the Town of North Andover Subdivision Regulations and Section 5.14 of the Town of North Andover Subdivision Regulations. g) The applicant shall adhere to the following requirements of the North Andover Fire Department and the North Andover Building Department: 1) All structures must contain a residential fire sprinkler system. The plans and hydraulic calculations for each residential system shall be submitted for review and approval by the North Andover Fire Department. Plans and hydraulic calculations for each residential system must also be supplied to the Building Department. h) The applicant is required to pay sewer mitigation fees at the Department of Public Works. Proof of payment must be supplied to the Planning Department. i) If a sidewalk is to be constructed in front of the lot, then such sidewalk must be graded and staked at a minimum 7) Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a) All necessary permits and approvals for the lot in question shall be obtained from the North Andover Board of Health, an Conservation Commission. b) The residential fire sprinkler system must be installed in accordance with referenced standard NFPA 13D and in accordance with 780 CMR, Chapter 9 of the Massachusetts State Building Code. Certification that the system has been installed properly in accordance with the above referenced regulations must be provided from both the North Andover Fire Department and the North Andover Building Department to the applicant. The applicant must then provide this certification to the North Andover Planning Department. c) Permanent house numbers must be posted on dwellings and be visible from the road. " d) There shall be no driveways placed where stone bound monuments and/or catch basins are to be set. It shall be the developer's responsibility to assure the proper placement of the driveways regardless of whether individual lots are sold. The 5 Planning Board requires any driveway to be moved at the owner's expense if such driveway is at a catch basin or stone bound position. e) Prior to the final release of security retained for the site by the Town, the following shall be completed by the applicant: a. An as -built plan and profile of the site shall be submitted to the DPW and Planning Department for review and approval, in accordance with Section 5.14 of the Town of North Andover Subdivision Rules and Regulations. b. The applicant shall petition Town Meeting for public acceptance of the street in accordance with Section 5.11 of the Town of North Andover Subdivision Rules and Regulations. Prior to submitting a warrant for such petition the applicant shall review the subdivision and all remaining work with the Town Planner and Department of Public Works. The Planning Board shall hold a portion of the subdivision bond for continued maintenance and operations until such time as Town Meeting has accepted (or rejected in favor of private ownership) the roadways. It shall be the developer's responsibility to insure that all proper easements have been recorded at the Registry of Deeds. 8) The Applicant shall ensure that all Planning, Conservation Commission, Board of Health and Division of Public Works requirements are satisfied and that construction was in strict compliance with all approved plans and conditions. 9) The applicant shall adhere to the following requirements of the Fire Department: a) Open burning is allowed by permit only after consultation with the Fire Department. b) Underground fuel storage will be allowed in conformance with the Town Bylaws and State Statute and only with the review and approval of the Fire Department and Conservation Commission. 10) There shall be no burying or dumping of construction material on site. 11) The location of any stump dumps on site must be pre -approved by the Planning Board. 12) The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 13) Gas, Telephone, Cable, and Electric utilities shall be installed as specified by the respective utility companies. 14) Any action by a Town Board, Commission, or Department which requires changes in the roadway alignment, placement of any easements or utilities, drainage facilities, grading or no cut lines, may be subject to modification by the Planning Board. on r 15) The utilities must be installed and the streets or ways constructed to binder coat two ears from this approval. If the utilities are not installed, the streets or ways are not constructed to binder coat and the Planning Board has not granted an extension by the above referenced date, this definitive subdivision approval will be deemed to have lapsed. 16) The following waivers from the Rules and Regulations Governing the Subdivision of Land, North Andover, Massachusetts, dated November 2000, have been GRANTED by the Planning Board: a) Waiver to Section 5.4. La of the Regulations which requires an Environmental and Community Impact Statement when six or new lots are created. As two of the six lots that are being created contain existing structures, the determination has been made to waive this requirement. 17) This Definitive Subdivision Plan approval is based upon the following information which is incorporated into this decision by reference: Plan titled: Definitive Subdivision Plan, Delucia Way located in North Andover, MA Prepared for: Right Now Realty Trust, P.O. Box 985, Kingston, NH MDB Realty Trust, 415 Waverly Road, No. Andover, MA Prepared By: Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Scale: 1 "=40' Report Titled: Stormwater Management Report for Delucia Way In North Andover, Massachusetts Prepared For: Right Now Realty Trust Dated : March 28, 2001 Prepared By: Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 7 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Z-1 This certifies that ...C' . ...... ...................... ,has permission to perform ....... ......................... . plumbing in the buildings of ...... % ......................... :........ North Andover, Mass. Fee/ T. Lic. No.......... ................ ............ PLUMBING INSPECTOR Check # 2- 5 4 . � 39 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 26 V L l"q �� Owners Name S ly- S Permit # Amount Type of Occupancy rVj_ L New GY", Renovation ri Replacement 1:1 Plans Submitted Yes No (Print or type) Installing Company Name Address z -'Ac, fC GaC•v Check one: Corp. Partner tiusmess letepnone 4d 0 3 13r.-1 2 yAL y �U Firm/Co. Name of Licensed Plumber: YeyJ1iS'J tial . f C w u'6 -e Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ . Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance k Certificate Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perfor n; under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas setts State Plum n Codrn pter 14 of the General Laws. By: WgDA-Ure 01 Llcenseaum er /'� � Type ofPlumbing License Title City/Town icense Numoer Master Journeyman ❑ APPROVED (OFFICE USE ONLY 1' `1 11 1 M---..M-.-.M..----o.----- (Print or type) Installing Company Name Address z -'Ac, fC GaC•v Check one: Corp. Partner tiusmess letepnone 4d 0 3 13r.-1 2 yAL y �U Firm/Co. Name of Licensed Plumber: YeyJ1iS'J tial . f C w u'6 -e Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ . Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance k Certificate Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perfor n; under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas setts State Plum n Codrn pter 14 of the General Laws. By: WgDA-Ure 01 Llcenseaum er /'� � Type ofPlumbing License Title City/Town icense Numoer Master Journeyman ❑ APPROVED (OFFICE USE ONLY Date... A ate...A ..�. � ... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................... .ginn > \ ' has permission for gas installation 1.... _ � .............. . in the buildings of?....._ �- ................... r at r._7-%..::.: r?.. , North Andover, Mass. Fee s. . . Lic. No. e! � 9 ...(�.. ....� . GAS INSPECTOR i Check Z- 0.211 MASSACHUSETTS UNWORM APPLICATON FOR PEIMT TO DO GAS FIWING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date `� Permit Building Locations P # / Amount $ Owner's Name New I..J Renovation Replacement Plans Submitted (Print or Name Address Name of Licensed Plumber or Gas Fitter CSC one: Certificate Installing Company ❑ Corp. rl Partner. 1` Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [—] Noo If you have checked ye—s please mid' the type coverage by checking the appropriate box. Liability insurance policy Er Other type of indemnity [:] Bond 0 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 I Check one. Signature of Owner or Owner's Agent Owner ❑ Agent ❑ :+ 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 der Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu State Gas Coc nd ChXter O?of the General Laws. (OFFICE USE ONLY) attire of Licensed Plumber Or Gas Fitter Plumber /a $ Gas Fitter License Number ,�IvIaster Journeyman I TV -2 man (Print or Name Address Name of Licensed Plumber or Gas Fitter CSC one: Certificate Installing Company ❑ Corp. rl Partner. 1` Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [—] Noo If you have checked ye—s please mid' the type coverage by checking the appropriate box. Liability insurance policy Er Other type of indemnity [:] Bond 0 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 I Check one. Signature of Owner or Owner's Agent Owner ❑ Agent ❑ :+ 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 der Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu State Gas Coc nd ChXter O?of the General Laws. (OFFICE USE ONLY) attire of Licensed Plumber Or Gas Fitter Plumber /a $ Gas Fitter License Number ,�IvIaster Journeyman 4 2 13 Date.........d ................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING �AC' USo This certifies that ................. ............................ ...... .................. has permission to perform ........... / .................................................... wiring in the building of .... ......................................... ..� 6 , � atr .......... 1 A . . ..................................... North Andover, Mass. 7 Fee ..................... Lic. No . ......... ........ ....................... ELECTRICAL INSPECTOR Check # THECOMMONWEALTHOFMAS,SACHUSEHS Office Use only DEPARrMENNT0FPUX1CS4FE1'Y BOAROOFFIREPREVEN1 ONWU HONS527C[1�ZI2 g9 Permit No. _ L/Z/ G /,6 —3D Occupancy & Fees Checked APPLICA77ONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a bu Purpose of Building S Y\ci' e electrical work described below. 1 vL�a- permit: l� 1 Existing Service Amps / Volts New Service Amps / L / �--kWolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers! No. of Water Heaters KW No. Hydro Massage Tubs OTHER To the Inspector of Wires: MEN r-T V, Yes © No (Check Appropriate Box) Q ev-.. 140V i c Utility Authorization No. //63o,7 Overhead Underground El No. of Meters Overhead Underground lzr No. of Meters 1W. v1 nor IUDS Swimming Pool AboveBelow ground ground No. of Oil Burners No. of Transformers Generators no. or zmergency Lighting Battery Units No. of Gas Burners No. of Air Cond. Total FIRE ALARMS Tons No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Heating Devices KW Local Municipal No. of No. of Connections Signs Bailasis No. of Motors Total HP Total KVA KVA No. of Zones EDOther timlta=Cov$age Rnu�artttothetegtricanaysofMassad� Gaprallaws [haw awfferILiabllityhmr&mpbhyirxhdTCom4)1cfe 0LffafiOnSC0VerVori1sstbsta> equivabi YES No E [hadongbmitrmdvalidpioofofsatrtetothe 0l YES �"'T IfyouhavedudodYES, PJW&ir> ttCgWOfmvaageby 3�gdte box ��( /^ NSURANCE� BOND � mIER � may) G e n e y'4'. U e, ; I ' t Expkafiml),* volktoStalt h;pecaon� Rough EstirrtatedvahleofF7ec6dcalWodc$ gmdunderTlieftakiesof' — Furl IRMNAME ✓PJJ4e J ✓ cc� LioenseNo. _ '191 i�Ic 1��-, i. ,.moi •TJ ��� Siguahue i IiceNo ao �P�.f~Pr �ps'Si n ec' �p�..l M%� ©3� s�' BtlsulessTelNo. �p 3 :3� WNER S INSURANCE W Ah Tel No. A1VER,IamawarethatthelicensedoesnothavetheinsutanoemvUagea itssubstantialequivalentasognudbyMassachusettsGeneralLaws dlhatmysignaltmondopmmtappfi �gtmemer>t. fisie 'lease check one) Owner Agent M Telephone No. PERMIT FEE $ Igna ure o wner or gen Date ..�........ . ...... NORTH ,"to '.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING T14-ertifies that ..... ..... . ..................... has permission to perform ..*. —, - - —, - - ......................... I .............................................. wiring in the building of ... * .............................. ................................................. at .......................... ................................................... North Andover, Mass. Fee.' ..................... Lic. No.............. ............................................................... L/ ELECTRICAL INSPECTOR Check # VC - 2 / = V "I 4361 Ot I Commonwealth of Massachusetts Official Use Only memmn63 Department of Fire Services Permit No. / Occupancy and Fee Checked ' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC1509112 7 CMR 12.00 (PLEASE PRINT IN INK OR AY %NFO ATION) Date: City or Town of: ��(rI► , /M To the Inspector of fres: By this application the undersigned gives ngfiGe of his or her mteptiop to perform the electrical work described below. Location (Street & N Owner or Tenant a Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No.�/ i/ Yes ❑ No ©1 (Check Appropriate Box) Utility Authorization No. Overhead ❑ U,dgrd ❑ No. of Mleters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: —Installation of Security system Completion nfthe fnllnwinv tahle may ha wnived by the Incnae-mr nfWi No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. E] o. o Emergency Lighting No. Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners N_o_._oT Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I.Number I Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Heaters KW No. o No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th pain andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME:Se-Gur-ity cas LIC. NO.: 1 r3449 Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Date..! :. /-.q.`/....... W TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that .-Z .......... ..................................... has permission to perform -, ......................... Lt wiring in the building of .................... ......................................... 6 .................... at,-.--.;;� ..... ....... &4L4 . .............. . North Andover, Mass. Fee Z<—.. 0 a 7/ ... Lic. No.19 q 4 �- ... ..... ...................... "�<- ELECTRICAL INSPECTOR Check # • � ThECA0:�:10AWE4LTH0FAVSSACHUSL77S Officet,Use o/n�ly DEPARTXE7VTOFPUBLICS4FM1 Permit No. BOARD OFF7REPREVENTIONRECUL4170NS527CV1R12:00 V ' Occupancy &Fees Checked -PP PERMIT TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACII[ISSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 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 � s Owner's Address Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) Purpose of Building � jy .�� A� CN&, '. Utility Authorization No. Existing Service Amps —Volts Overhead M Underground No. of Meters New Service �— Amps Volts Overhead [= Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 12�-kyy\0 - C� 4`� nCZ No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 2round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Othe_ Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER lima lceC mage R=ad1othetaMxntsdMmm seItsC=xalLaws Iha,.eaama>tLihtlityfimm=PobymAx&gCar#,* C vaageeritsst lec iv a YES NO lba,•eabnffedvaWproofofmmlothe0fm YES n NO If}puha%ed YES pl =nfic*tlxtWcfc umybydakngtbe ;_N5'URANCE M BOND M OTHER � i Sp�Y) WdrkoStut W 1 i l C rAJ kSPCL =PAANAME L VI LA- S m Q V -CV/ L,5 it S omD w�j OWNER'S INSURANKMWAIVEP, Iamawm llattheLicenset3m notm+etheinst==a atrdtisatmysi�aemthispamitappficatratwai�es this reRtmarta>t. check one) Owner Agent Telephone E?giaattrnDr= Fstim&dVaie lWak $ c t grh Final w BtsimTdNa c�o3 �tt�'1 vo 0& A1tTeLNa Z2q —72 — (J 1 (0 1 - PERMIT FEE $ jCJ