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HomeMy WebLinkAboutMiscellaneous - 275 WEBSTER WOODS 4/30/20184s G Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B Building Commissioner or Inspector of Buildings City Hall NORTH ANDOVER MA 01845 Board of Health or Board of Selectman City Hall NORTH ANDOVER MA 01845 Re: Insured(s): STEPHEN NEYM^,N & KATHLEEN NEYMAN Property Address: 275 WEBSTER WOODS LN, NORTH ANDOVER MA 01845 Policy Number: 0082250 Claim Number: BOS00013108 Date of Loss: 11-21-2010 Company: Safety Indemnity Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number. Date of loss and claim or file number. Lisa Monette, Adjuster 11/23/10 Safety Insurace Company Homeowners Claims Unit P.O. Box 55098 Boston, MA 02205-5098 Phone: (857) 233-8618 Fax: (617) 535-5833 CC012.001 4135 Date...��. l'� . ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING ................................................ This certifies that ...:�...... has permission to perform ,.../ :? '.......................................... wiring in the building of ............................................. at ....?..2,5......�.} . ..... ,North Andover, Mass. Fee l... ....... Lic. No:).21..°- ELECTRICAL INSPECTOR Check #_ J O I'cial Use Only Permit V%30'`e _ V °d P -A6 - S4#0 Occupancy & Fee Checke BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (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 & Owner or Owners Is this permit in conjunction with a buildig permit � L Purpose of Building � t Existing Service 2-0 Arnps_L Date 10--/0 —0 To the Inspector of Wires: C/i o o (k S ell No ❑ (Check Appropriate Box) �Se-r-,./ E -,q. 0 / 7–'1- U Voits Overhead ❑ New Service Amps Voits Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work / / h i Authorization No. Undgmd LAY No. of Meters Undgmd ❑ No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have s valid proof of same to the Office YES = NO = fl °u h ve ch ked YES please i dicate a type of cQvef age by checking the appropriate box INSU – BOND = OTHER = (Please Specify) Y �,7G�CI /�Cf �ivt �VGc b C� / O —Z (Expiration ate) Estimated Value of Electrical Work$ _ NO. Z l C �2— L Address !l7 t•(V ( ��'��M U ".G I BAIt Tel. 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) U/ Telephone No. PERMITTEE $ . Dr (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures No. of Receptacles Outlets Swimming Pool No. of Oil Burners grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices No. of Sounding Devices No./ of Self Contained No. of Di sal Heat Total Total No. Pumps Tons KW N. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have s valid proof of same to the Office YES = NO = fl °u h ve ch ked YES please i dicate a type of cQvef age by checking the appropriate box INSU – BOND = OTHER = (Please Specify) Y �,7G�CI /�Cf �ivt �VGc b C� / O —Z (Expiration ate) Estimated Value of Electrical Work$ _ NO. Z l C �2— L Address !l7 t•(V ( ��'��M U ".G I BAIt Tel. 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) U/ Telephone No. PERMITTEE $ . Dr (Signature of Owner or Agent) Town of North Andover O* NORTH Building Department �� y_. ttt�eo k6rt 1,00 27 Charles Street 0 North Andover, Massachusetts 01845 7° (978) 688-9545 Fax (978) 688-9542 O <OL ILNL KM 1 9 SACHUS APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS v 7S W e4 .fir bvd Lam, LOT NUMBER , SUBDIVISION_-0,i�wah-e_L/ Fozea- f DATE REQUEST FILED - Y/ZO`p DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTyFff-D'VES NOT MEET ALL APPLICABLE CODES. 11 SIGNATURE "OFFICIAL USE ONLY ROUTING CONSERVATION DATE PLANNING DATE D.P.W. — WATE METER Q,zj DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNA / PW AUTHORIZATION I , 1 CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 9a Date "7 `` —a(qo /. THIS CERTIFIES THAT THE BUILDING LOCATED ON �,�f1 l8 _7�1a'7,5_ V el MAY BE OCCUPIED AS ��'� )CA f'h!/y -////UJ� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO CA fA� e% ��ps_� Ae o . tia P ADDRESS 3� s �! / 61f) 11 `S C/ Ile C2F •, =A�NU �� Building Inspector �4 (U y O "Cl M w LLJ w I C c' C O•— ca p 'o y m m � O � �3 O � O d a- CM< C Cu co ca Z t5 C CD CL V CO) O C C ey d CO2 D . 0 U w w Ccw 0 J cn cn M w LLJ w I C c' C O•— ca p 'o y m m � O � �3 O � O d a- CM< C Cu co ca Z t5 C CD CL V CO) O C C ey d CO2 D . 0 U w w Ccw 0 2:-," Locatiolrr--�., — n�,� � -�� No. Date NORTH TOWN OF NORTH ANDOVER .F 9 t Certificate of Occupancy $ sBuilding/Frame Permit Fee $ 40 cd �CHUS Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 15915 -Building lr s ectv� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ya BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map Number Map and Parcel Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R aired Provide red Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record N��� Name (Prinf) Address for Service: Signature Telephone �y 2.2 Owner of Record: Name Print Address for Service: d Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 1 ENNu-f- 2. Licensed Construction Supervisor: I Z � � W i 77' n[ Address / re Telephone Not Applicable ❑ License Number License r % ` Z 'J Expiration Date 3.2 Registered Home Improvement Contractor )</, 0E�) Co,)3frz,0C Not Applicable ❑ / �3�3 Company Name N,n Registration Number S ` Address4&�� b — S 7J0 ExpirationDate re Tele hone ou M X z O Q a m O z M 90 O mn ic r Q M _r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this. application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Desch tion of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) B Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - F,STTMATF.n ir0NfiTR1Tf TTAN rncT-Z ItemEstimated Cost (Dollar) to bet� Completed b ermit a licant p M.za�f� d� E�a8�s f f r �� a. L k (a) Building Permit Fee Multiplier apk�.fJ�3x, :kf fr .�: 1. Building Z 2 /6 2 Electrical J (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC)aaD 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 14 WvvilraAvinVJK L.A11gX'N 1U BE UUMYLEIEL WHEIN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNE.RIAUTHOR,IIZED AGENT DECLARATION PE I IJ ,aeAAuthorized 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 Sigue of jr/Agent Date L / 1 ` - �iie �an�noozco o��i�Gczgvacfu�del76 ` I ' 4{ w BOARD OP -BUILDING REGULATIONS t,j ' License: CONSTRUCTIONSUPERVISOR f - Number: CS. 058245 i BiOdate.03/24/1943t j� ' t Expires ;03/24/2004 Tr no: 20021 I - Restricted:,f00: KENNETH B KEEN'4 21 HEWITT AVE 'moi, a N ANDOVER, .MA 01845 Administrator. i Board of Building Regulations and:Standards HOME IMPROVEMENT CONTRACTOR is Re -t-m on 9 1;08383 j Expiration 8/1812004 j T.y"p`e DBA KEEN CONSTRUCTION.CO j Kenneth Keen 21 Hewitt Ave No... MA 0184;5 Aadjpinistratnx r .z.,,.r..v.,,,.,.... I am a sole proprietor, general contractor, or homeowner (circle one and have hired the contractors listed below who have the following workers' compensation polices: company name• address: wai city: phone # insurance co pohcy #` I do hereby cert under tie,,tffiih!j aW penalties o perjury that the information provided above is true and correct. Signature�� �` ✓L J Date % ' 3l,) "© 5Zj14 � Print name -� - �- �- - E><!� � Phone # official use only do not write in this area to be completed by city or town official ...._ city or town: permittlicense # nBuilding Department �LicerisingBoard — —" ' " check if immediate response is required oSelectmen's Office 01-fealth Department contact person: phone #; 00ther r:_t =x ``"_ __• Th a Commonwealth of Massachusetts Y Department of Industrial Accidents -._ % Officeof/otrestigalions a 600 Washington Street f ,s` i— ���.:�: Boston, Mass. 02111 ~— Workers' Compensation Insurance Affidavit e N. name: f E /J c21i4tZ, u c 7� B J �� E A1 IJ e I h .z.,,.r..v.,,,.,.... I am a sole proprietor, general contractor, or homeowner (circle one and have hired the contractors listed below who have the following workers' compensation polices: company name• address: wai city: phone # insurance co pohcy #` I do hereby cert under tie,,tffiih!j aW penalties o perjury that the information provided above is true and correct. Signature�� �` ✓L J Date % ' 3l,) "© 5Zj14 � Print name -� - �- �- - E><!� � Phone # official use only do not write in this area to be completed by city or town official ...._ city or town: permittlicense # nBuilding Department �LicerisingBoard — —" ' " check if immediate response is required oSelectmen's Office 01-fealth Department contact person: phone #; 00ther tet. 3o Y 13'7 ' KEEN CONSTRUCTION CO. 21 HEWITT AVE N. ANDOVER, MA 01845 (978) 691-5201 Neyman, Steve & Kathy 275 Webster Woods Rd. N. Andover, MA 01845 (978) 975-9887 Contract #1525: Appendix A Date:9/4/02 Finish basement: • Frame, insulate & wallboard basement creating @ 700 sq. ft. • Create 3/4 bath with contractor grade fixtures, fiberglass shower, standard vanity, integrated bowl top, and standard toilet • Create unfinished closet near water meter and under stairs • Plaster skimcoat walls • Supply & install single and 2 double doors( 6 -panel hollow core smooth masonite) • Supply & install trim on doors, windows and baseboard • Paint walls & trim (2 coats, 2 neutral colors) • Supply & install ceramic tile in entry from garage and in bath($2.25 per sq. ft. allowance) • Supply & install carpet in remaining area including stairs($1700.00 installed allowance) • Supply & install 2'x 2' revealed edge suspended ceiling Plumbing: • Supply & install all bath fixtures and necessary plumbing Electrical: • Supply & install 12 recessed ceiling light fixtures • Supply & install outlets and switching to code • Supply & install one cable and one phone(Cat. 5) outlet • Sutroly & install -mechanical -vent in hath lit 2 O z A v 0 a v cz o z z z A O O C G a� p G U a W b p ci G w x a � p a: G u. z A w v cxa z o cn c� o CD c o LZ C h O C v v a'o C� MCD o 0 CL p E c aC w oo U C m c R cum, m LL N G N ca 3 1► C °' N CM •O N :(Z RO *: E0� CL v m A m CC c cca ;mor m o ,�, CD�cao c y O C C S m:5 p M z W � •N dt � � Z "r CCD N O LJ E V Cf V m O O !E C_ V� CL m o fl = eyv a y'� C $ CL� am > ., ON IV J O C C a 0 W cr LLJ LLJ Cc LIJW U) CA Date./- ... ...... . N2 4715 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s i i SSA HUS This certifies that '. ..................... has permission to perform .... x f 1 -c plumbing in thel5uildings of ....................... at ....�.�........ North Andover, Mass. Fee.). :.. Lic. No...f �. .. } ........`:.... .._ .. ;: ........ PLUMBING INSPECTOR Check # ; i WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N° 2 $ Date. �!.. /.1� '.. /. ° t"`° '• '"a TOWN OF NORTH ANDOVER PERMIT FOR WIRING � 'SSlewustt This certifies that ...� (�.. F has permission to perform ......... .... .. f ...................................................... wiring in the building of ...... jam::`.: .. , North Andover, Mass. 1`+ Fee° .7Y......... . Lic. No: jj \ ... /` "�........................... ELEcmcAL INspEcroR Check #. j WHITE: Applicant CANARY: Building Dept. PINK: Treasurer JJJLi L"IMrLVl lrr A;e1&.WAAA WA AFJLC a 1-&AvULil fu q(� DEPARTMFIVTOFPUBLIC&QUY Permit No. BOARD OFMEPREVEMONMGULATIOAN527CUR12�0* Occupancy & Fees Checked J4V PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED 1N 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 annliPc re fnr n nPmit to nrfnrm the electrical work described below. Location (Street d Owner or Tenant Owner's Address Is this permit in conjunction a building permit: To the Inspector of Wires: Purpose of Building Existing Service New Service 0 es M No M (Check Appropriate Box) Utility Authorization No..�D� a i Amps / Volts Overhead 1:3 Underground No. of Meters Amps �/ 2 yovolts Overhead 1:3 Underground ©� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work We -"77,17 IF No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA ground ground 0 No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local � Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Si Bailasis No. Hydro Massage Tubs No. of Motors Total HP I O'IiIER . I om=Cmuage Laws Ibawacimail-mbilkyltnira= ' anid%Corrtplete CuArdwc dsafit rttdegnWat YES NO Ihaw whnittedvalid ptoofof lotheOHim YES No r7 If}cutmed,eckWYFS,pimeemdc*& ypeofWMrdWbyd `the X=E BOND OUTER ® V=mey) ExpuatcnDta� � Es�dvalue�ari alwcik $ WodcbStatt '��D/ lnspatwD*Req�led Ratgh Gia-ey Final Signed underlie %ultKs of FIRM NAME Lioatsee at /�A''�—'S LioerseNo �-� )31s¢tessTelNa 37� � �S� Alt. Tel. Na OWMR'SDsNJRANUWANER;Iamawatethatthelkmd id theic>stratrewywVorilsRkswWeqmdetasmgmedbyMmmducmCtriedLaws aod@-atmy-*Edncntispeat>$a ottwai distagmimiat. (Please check one) Owner r-1 Agent M > . I Telephone No. PERMIT FEE $ 1 p MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ' 4f (Type or print) NORTH ANDOVER, MASSACHUSETTS (' h Date Owners Name F /J Permit # Building Location 3, Amount _ Tvne of Occupancy New Renovation Replacement ❑ Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Installing Company Name (% /� _� 194 H F� Corp. Partner. Firm/Co. Name ofLicensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy LA 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 ignature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plur�bi`ng Code a�r dih r 14�f the General Laws. Title City/Town APPROVED (OFFICE USE ONLY Jlgnauure ui 1.iuu Jcu rlumum Type of Plumbing License 4ns'�:ze NEE= Master Journeyman ❑ `J 4 0 . Date.............!....... NORTH TOWN OF NORTH ANDOVER py ,,to ,t,tipL PERMIT FOR GAS INSTALLATION S This certifies that ......... `.................. . has permission for gas installation .. .............:........ . in the buildings of ." r..-,: ................................... at ................. :................... North Andover, Mass. Fee......... Lic. No........... .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS ni TFORM APPLICATON FOR PERMIT TO DO GAS FITTING e or print) PIUKIrl ANDOVER, MASSACHUSETTS Date 19 Building Locations t7`G'��IT '� 7 Permit 9 ✓ y � I" Amount S %0 �— Owner's Name New4 Renovation❑ Replacement F1Plans Submitted ❑ (Print or type) Address Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Firm/Co. INSUR,A (CE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type coveter=e by checking the appropriate box. Liability insurance policy (j Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner F7 Agent ❑ I hereby certify that all of the details and information I have submitted for entered) in above appiicarion are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Je and Cha e142 of the Genera[ Laws. By: Title CityiTown APPR0VED(t)Fr)c:. usF f)N1.Y) Signature of Lic;:nsed Plumber Or Gas Finer ❑ Plumber /�, z ❑ Gas Fitter tcense wumoer Master ❑ Journeyman .r • f� (Print or type) Address Business Telephone Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ❑ Corp. ❑ Partner. Firm/Co. INSUR,A (CE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type coveter=e by checking the appropriate box. Liability insurance policy (j Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner F7 Agent ❑ I hereby certify that all of the details and information I have submitted for entered) in above appiicarion are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Je and Cha e142 of the Genera[ Laws. By: Title CityiTown APPR0VED(t)Fr)c:. usF f)N1.Y) Signature of Lic;:nsed Plumber Or Gas Finer ❑ Plumber /�, z ❑ Gas Fitter tcense wumoer Master ❑ Journeyman Location No. 517Q, Date l%ao ,.ORTIy TONIN OF NORTH ANDOVER .a° .. 9 Certificate of Occupancy $ '�s'•CMU •°' E< Building/Frame Permit Fee $ sAs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # JIL�V 14354 Building Inspector 1 E rs0 WED 8 55 S _ E _ Cumm i ri-9 s Assoc i CL -t es P _ 02 CAERTfFIE,9 ISL OT PIAN $.E, ClIUMMOS & ASSOCIATES P.O. 80X 1007 PLA/S rOW, Nff. 00885 MLEMONE_rs®a�- ►a2�S0�3 FAX 66OV-082.5218' N 54 46'47" `y i O3 ... < 1 i4t < `i t►r WMpAn , ,a ?9�- f \ 444,4 q) -0v& -.P_741 c-2 Of AA Y4.s `�yl' ALE)EF ? ti TRUDEL No. 3"6 Q, h=225,00 oAM'P�3ELL SOREST SCALE 1" = 60'$Sr�WOODS NORTH ANDOVER, MA ,SATE OCTOBER 16, 2000 ODS LAIVE TAX MAP 210 11 HEREBY CERTIFY TO TOWN OF NORTH jdNDOVER YA BUILDING DEPARTMENT BOOK 06.B ,;THA T TIE EXISTING FOUNDA TION DRAWN L.OT 1 S 1:9N THIS PLAN IS LOCATED AS SHOWN MINIMUM SETBACKS FRONT — 30 FEET AND THAT IT DOES COMPL Y TO THE SIDE — 30 FEET 'IAINIMUR BUILDING SETBACKS TO REAR — 3Q FEET ;Qpt) r Tv r mIrc EDGE OF FLAGGED g `°•' WETLANDS to tot N a o l 1 LDS' f8 4-3,560 S F. 4 ?0r - f � i Z. % WMpAn , ,a ?9�- f \ 444,4 q) -0v& -.P_741 c-2 Of AA Y4.s `�yl' ALE)EF ? ti TRUDEL No. 3"6 Q, h=225,00 oAM'P�3ELL SOREST SCALE 1" = 60'$Sr�WOODS NORTH ANDOVER, MA ,SATE OCTOBER 16, 2000 ODS LAIVE TAX MAP 210 11 HEREBY CERTIFY TO TOWN OF NORTH jdNDOVER YA BUILDING DEPARTMENT BOOK 06.B ,;THA T TIE EXISTING FOUNDA TION DRAWN L.OT 1 S 1:9N THIS PLAN IS LOCATED AS SHOWN MINIMUM SETBACKS FRONT — 30 FEET AND THAT IT DOES COMPL Y TO THE SIDE — 30 FEET 'IAINIMUR BUILDING SETBACKS TO REAR — 3Q FEET ;Qpt) r Tv r mIrc Location /0 18 woos- a494 ��� Z'`` No. t52Q Date /�'.3 -06- TOWN q0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 0� �'�s'••°° '<�' sic Building/Frame /Frame Permit Fee $ 9 ust Foundation Permit Fee $ Other Permit Fee $ / ` S b, TOTAL $ Check # 14317 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: �!G� Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ©- f.- ` 1.2 Assessors Map and Parcel Number: Map Number Parcell Number if 1.3 Zoning Information: Raz s'/ 9k Zoning District. ProposedVse 1.4 Property Dimensions: g.3_ 5-7 0 Lot Area sfY Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided �� 3i � / 3z` 30/ O, 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 -;,?3/ A/ ✓e Name (Prin6 Address for Service �?Z, Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construc4ion Supervisor: Address =300 Signature Telephone eS 657 — 0 Not Applicable ❑ CIS d G �1 02 3 License Number Expiration Date 3,.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone I SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes ...... V No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: c 2 en 1 0 n 7a c 64J / r: �? YR n�j� ,rte 0nd ez- 15 X Z Z �a�,.► Ly La -&-K, . y x 12- Fr" PY►fravit' e F-G✓n Blew - anc-e F P f W b 6 d d eag SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building // p2s(p % 5 O (a) Building Permit Fee Multiplier ` J 2 Electrical (b) Estimated Total Cost of Construction '2 3 Plumbing Building Permit fee (a) X (b) 17 a O i 4 Mechanical (HVAC) 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, J `/Aa S. s as G er/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 4 ; Print Na -,;7// // 960 r Signature of Owner/A e Date NO. OF STORIES SIZEo- BASEMENT OR SLAB Pi� SIZE OF FLOOR TINMERS 1 " �2 1 SPAN (o 41 D DIMENSIONS OF SILLS (o DIMENSIONS OF POSTS '' vi e e C DIMENSIONS OF GIRDERS " Ye -e 2G IIEIGHT OF FOUNDATION THICKNESS 0 h SIZE OF FOOTING L d `' X 2-d MATERIAL OF CHIMNEY 4x A d IS BUILDING ON SOLID OR FILLED LAND 90tt,^ IS BUILDING CONNECTED TO NATURAL GAS LINE ye FORM U - LOT RELEASE FORM 1. r 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 APPLICANT C' .� lr �d7 eS✓ GGC PHONE 6 97-6-<360 LOCATION: Assessor's Map Number IO 63— PARCEL SUBDIVISION If �Ey LOT (S) % STREET w®o-/S L Px- -e ST. NUMBER a;2 7 S REC OF TOWN AGENTS: C SERVATION ADMINISTRATOR DATE APPROVED -9-_174,100 DATE REJECTED COMMENTS�7� Z COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ WORKS - SEWERNVATER CONNECTIONS Q k 3 "17 00 PUBLIC DRIVEWAY PERMIT 0� FIRE DEPARTMENT / 00 RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone n (—I I am a homeowner performing all work myself. 0 1 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. WJ r.r)mnpnv npmp- r` --7" �no/� ���5� � � C lAesi f.- b Cl/, ca/"o — Address x731 Su ft cv-7 S7`' S, , e off ! Gtv: k" Y-4 A,;74&y,-r lu a 4 / SY-5 Phone # (97S) 6 $ 7 - 5-30 0 Insurance Co. --XI-7S, eo Policy # Al a9Yo7 3,"73 V `%�1' -00 Comoanv name: Address City Phone Insurance Co. Policv m 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 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($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 hereby certify under the � ain and penal sof perjury pthat the information provided above is true and correct. l Signature iDate /r P1,26 �' 1#-k17--9) b 57-576 0 Print name �/a�, � / �sS�P/% Phone _ Official use only do not write in this area to be completed by city or town cmcial• City or Town Permit/licensing Building Dept ❑Check if immediate response is required ❑ licensing Board �-j Selectman's Office Contact person: Phone: ❑ Health Department 7 Other BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the previsions of MGL .. c . 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: -,o s�12 iY if Location of Facility Sig6arae oYP-ern-dt Applicant Date NOTE: Demolition'permit from. the Town of North Andover must be obtained for this project through the Office of the Building Inspector Growth Management Bylaw Exemption Statement Town of North Andaver Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of,North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested 'below. Name of Applicant an Building Permit (below) Address of Property for Penrit (below) Map and Parcel �Purpose of Application (check below) Phone Number of Alp�llcant: Single Family Two Family I the undersigned applicant far the above property attest that the attached building perm -it for which this form is compieted does comply with the EXEMPTION section,8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Suiiding 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 ig issued. Based an section 8.7.6 of the North Andover Growth Bylaw the above lot and the warts as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruc;icn of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) werelwas created prior to May 6, 139e are exempt from the provisions of this Seccn 8.7 of the Zoning ytaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where cccupanc/ of the units is restricted to senior persons through a properly executed and recorded deed restricion running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. ii This application is a part of a development project which voluntarily agreed to a minimum odea permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from 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 an the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit an the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such Ume as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or t, is g bun refusal by the Building Oepartment to issue a Building Permit. ignature of wrier or �51,1,e the Attached Building Permit Date This form must be attached to the Building Permit upon application for such permit f BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069234 Birthdate: 05/09/1954 I Expires: 05/09/2002 Tr. no: 23903 Restricted To: 00 ALAN G RUSSELL _ 400 MAIN STS GROVELAND, MA 01834 Administrator Mesiti Dev Group Fax:978-5578160 Apr 20 2000 12:13 P.03 FROM MCKENZIE ENGINEERING GROUP, INC PHONE NO..: 6179412662 Apr. 20 2000 11:14AM P3 Y �-OIL- Tt 1.6 { �.. k / �.. IPA eel �r STALUT Nit d 4,54 F T \ STAK UT EO 32 ENT 13'4.134.D e d� OP. 31.5 j V�142a da so "Q V. 1 : 5\ .20 oo __,.- �'' L-55.20' f'=30.OR}" 77.8 ON MR, wommmom i:� - Mesiti Dev Group Fax:978-5578160 Hpr 2U 2000 12;10 r.vo FROM MCKENZIE ENGINEERING GROUP,INC PHONE NO. 6179412662 Apr. 20 2000 11:14AM P3 OTttlf 1-11' iq S7AEtE0UT `\ —.._ �-- s' �- o�J-+•, .rya �v �` ,% � """" � '~'- pRd�`• r Vim. 0. 1 OL STAK UT EO be r DE ` =s►� �` DECK 0' � T 134-5 33 34.0 OP, 31.5 ~`�Y,=142.0 8 X1.0 SkfH+VO oo -W--,LA55 M 1 30.00" j 27.40 77.$8 d l 11493 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 41424 l i�� Application by the undersigned is hereby made to connect with the town sewer main in `ze- Street; subject to the rules and regulations of the Division of Public Works. The premises are known as No. 2 7 5 or subdivision lot no. Owner /%l r� r �i7�r Address Contractor Address -G Applicant's Signa ure PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at v Gam" �fE Street subject to the rules and regulations of the Division of Public Works.. Inspected by Date Division f Public Works By / See back for rules and regulations N® 959 APPLICATION FOR WATER SERVICE CONNECTION 4 North Andover, Mass. `EKG 17 lw-�— Application by the undersigned is hereby made to connect with the town water main in subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. • Owner �1),�cJi �t '�✓ Address Contractor Address ti l Applicant's Sig6 fure—'—� Street PERMIT TO CONNECT WITH WATER /MAIN The Board of Public Works hereby grants permission toLC�- to make a connection with the water main at �� �` ri� C1� 61 e Street subject to the rules and regulations of the Division of Public Works. Inspected by Date �- Board of Public Works By �� ��l�L See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 885-0950 Fax (508) 888-9573 yts«eo ,b�bryO� ;0 1J DRIVEWAY PERMIT Date:-%—�� 1 LOCATION: Z7,5 -1-()C�x�e� BUILDER: phone: OWNER: F , p hone: Gv 7- 53a6 The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: Mesiti Dev Group Fax:978-5578160 Jul 17 2000 1354 P. 01 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 J Vllh4* Hmumiak let ti, Telephone {978} G8S-0950 Director Fax (978) 68&9573 S July 14, 2000 Mr. Kenneth, Crrandsta� President Mesio Development Group 231 Sutton St. Suite 2 F North Andover, Ma. 01845 Re: Conditional Operation of the Campbell Forest Sewer Pumping Station. Dear W. Grandstaff- A The Division of Public Works has inspected the sewer collection system and sewer pumping station, and appurtances on Campbell Road related to the construction of the Campbell Forest and Lyons Way subdivisions. We hereby grant conditional approval for use of the system and pumping station subject to the foIlowing: 1. Completion of items 1 through 15 as listed on the July 10, 2000 letter to Mr Dennis Bedrosian from Maurice Harpin of Mesiti Development Group, a copy of which is attached. The work will be completed within 45 days of acknowledgement of the receipt of this letter. 2. Satisfactory completion of an as -built plan for the Campbell Road sewerage systeaL 3. Submittal for our review and approval a copy of the preventive maintenance contract for the pumping station. 4. A performance guarantee shall be provided in the amount of $25,000.00 to insure the proper maintenance and operation of the pumping station. 5. The Division of Public Works will be allowed access to the Pumping Station and will be allowed to reconstruct, repair, replace, add to, service, inspect and operate the pumping station and related equipment. and facilities in the event ----_. _...-_------ ............ . ... .. _ that Mesiti Development or its agents fad to adequately perform maintenance _ : of the pumping station. x Mesiti Dev Group Fax:978-5578160 Jul 17 2000 13:54 P.02 6. Mesiti development shall reimburse the Town upon demand for the reasonable costs of emergency repairs to the Pumping Station. 7. Mesiti Development Group and its successors or assigns shalt indemnify, defend, and save harmless the Town of North Andover and its Division of Public Works and their respective employees, officials and agents against all suits, claims, judgments or liability of every name and nature arising at any time out of or in consequence of the acts of the "Town' or its agents, employees and officials in the performance of the access purposes covered by this grant of conditional use or the failure of the developer and its successors or assigns to comply with the terms and conditions of this grana. Very T ours, I William Hmurc' .E. Director of Public Works The undersigned acknowledge the receipt of and agrees to the terms and conditions of the above grant of nditional use. e up K eth ,Mident Date: -i < Ln0 0 a)0 5 mI z cl Q fo ?D H 4! 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