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Miscellaneous - 33 LEANNE DRIVE 4/30/2018
Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Tamer Khayal & Aghareed Abdallah Property Address: 33 Leanne Drive Policy Number: HP2655302 Date/Cause of Loss: 4/22/2014, Water/Refrigerator Leak File or Claim Number: 29586-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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. Ryan Werner On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. / Signatu,V'e and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street N. Andover, MA 01845 RE: Insured: Property Address: Policy Number: Date/Cause of Loss: File or Claim Number: Luis & Janet Barros 33 Leanne Dr. XL8567 3/15/2010, Water Damage 22487-W Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL 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. Wade Anderson On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Date.. Lj:. Lf .. . L TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ....... .... ............... -'t has permission to perform .....F plumbing in the buildings of .................. at. �.. ..�. �.`��,.�. .. .'......... North Andover, Mass. Fee .%)...1, ' .. Lic. No. . 3 G .l ._ c?��........ . PLUMBING INSPECTOR Check # 5205 i �. 'I.MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING .+. (Print or Type) Mass. Da t e City, Town r. Phrrni.t tl, �, Q� Building � �� ,� _ Owner's—_.— AT: I.ocatioti_�_ ,P r _ p7ame'`�(,V(C,`v_i _.dZ Type of oc(nipallcy New Renovation ❑ Replacement: ❑ PI FIXTURES ` ltd. ❑ Sul>mi.tt:eci: Yes ❑ No (I'rinl or'fypc) Chcck Onc: Certificate Installing Company Namcut/, Corp.Add 1�• . ❑ I'artncrship ❑ Finn/Company nes.; ciel;itune �f 3 � (`�'�- Nan1e of l.icensed Plumber or Gaslitter + I hereby certify that all of the details and information 1 have submitted (or entered) in above appliculiun are true and accurate to the best of my L`. knowledge and that all plumbing work and installations perfornsed under Permit issued for this application will he in compliance with all Pertinent I 't' provisions of list Massuchllsesio Slate bias Ctlde and Chapter 142 of the General I aws. yb.. ( have informed the owner or his agent that I do not have liability insuruuce including compacted upetations coverage.. r� Siporale W Owwf/Asee1 , I lune a current luibilily insurance Policy to include complcicd operations covc:tlgc. ❑ Fon L4 1240 HonHi a WA1114E14• aNr: 1989 Signature of I.icensrcl Plumber �ae Type of Plumb' License —�1-i�d-- Juurneyotan . License Number « z X N V1 1. Y7 J N Z Y O Z < = > W Y J N �' < 0< ~ Y) W W 01 Z N W z < 1- K W Y) K P = Z Y! O W Z Z Z 0K 1 - VK �= Y) 10 y K W )'. 0 W < �. � y yy., Z .t O t9 < L '� O x K OO W 1. I.. OC W < W tie G i < J V) D < cc us Jcc Z tie p a C p W F• O dCC Z. O Z1 N h 1C Z 6 O O O F' N Z 4 W W 1- W O Ne V W Y < < S 0 N < < 0j J < K K W, < O N W {7 7 G < 3 K C7 O sus=8811AT. 111A8EMENT- 18T FLOOR I — 2NO FLOOR 3RDFLOOR 4T11 FLOOR 6T11 FLOOR 6T11 FLOOR TTHFLOOR STH FLOOR .1111. (I'rinl or'fypc) Chcck Onc: Certificate Installing Company Namcut/, Corp.Add 1�• . ❑ I'artncrship ❑ Finn/Company nes.; ciel;itune �f 3 � (`�'�- Nan1e of l.icensed Plumber or Gaslitter + I hereby certify that all of the details and information 1 have submitted (or entered) in above appliculiun are true and accurate to the best of my L`. knowledge and that all plumbing work and installations perfornsed under Permit issued for this application will he in compliance with all Pertinent I 't' provisions of list Massuchllsesio Slate bias Ctlde and Chapter 142 of the General I aws. yb.. ( have informed the owner or his agent that I do not have liability insuruuce including compacted upetations coverage.. r� Siporale W Owwf/Asee1 , I lune a current luibilily insurance Policy to include complcicd operations covc:tlgc. ❑ Fon L4 1240 HonHi a WA1114E14• aNr: 1989 Signature of I.icensrcl Plumber �ae Type of Plumb' License —�1-i�d-- Juurneyotan . License Number « Date .. . .f ...... ° TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .�..� �.!1 s .7`..... ".:........... . has permission for gas installation ..../2 Ic `.'` . ..` ...... . in the buildings of Q�- r" ` ! Y. ^.......... 0 .............. at ..1. { ..... . , North Andover, Mass. Fee.. ? Lic. No.. �3 `.Z.. . AS INSPECTOR Check # 2C t 3:99 I ti MASSAC111USETTS UNIFonM APPLICATION FOR PERMIT TO UO GASFITTING (Print or Type) r • ly , - Dale o� CQ 19 fiuilcling fermis # .— - - Location - r -G' Ovmerli-,. New Renovation n Re placelnrlll I L1 I Ion., Submillecl: Yes p No p N Z0 CIE to N •� l a7 � � VI � � , 0 I ...- sue_asMr._I I_I-_. I - I��I._ WFMENT ._L- L_.L-I--•I ( I__ !.�.I....I. I I I �_._�. .r._ ... r _.+ 1 i�_.. IST FLOOR - ••--- � I --I ....I _I _.I_.I ._.I ...I _..I... I _.I.. I I ..I_...i:.. l I _IRI. _ I..._.I. _.I._ I ._I.... I --Ir --)— ,,. 7Nn I-LOOR (_1._1_.1.._.1 _l .I :.� _.I ►.I... I .. I... I .. -I._ .I.. I_ I....I..I . I .. I ... I _ I _. I _..I_ -- 111FLOCIR i STltfl(1nR. ( fT1 rI.O(R_.I..._..I.......1._._.!:-I��r 7711 FLOOR I. P;I; rI.C>ot�- i•1: CCheckulte. Certificate :�1 ' Ins1r711ing Cempatty t-4 011ie �"` �-�+—� 11 Corp• �aE/1„_,1;, Addlcss _ lidlo .._-----••-- �`� .l� • ��g�S — l7 partnership cc' ❑ Firm/Co. Business Telephone Nome of Li&ised Plumber or Gas Fitter INSURANCE COVERAGE: Check one 1 have a current liability insurance policy or its substantial equivalent. Yes n No p "?k If you have checked yes, please indicate the !ype covelcge by checking the appropriate bux. ;fit A liabilityinsurance y '.i polis ❑ Other type c f indemnit" ❑ Bond n OWNER'S INSURAMCE WAIVER: I am aware Iot Ilre licensee (1003 not have !Ile in-,trollcc, coverage req -9i red by f�`( Cllnpier 142 of Isle Mass. General Laws, and 11)(31 illy sign ottire on Ihis pet rniI applicali�,n wr7ives Ihis requirement. Check one: _----._. ,—___ —_ _-------- OwnerA f.] i 5 Sigl-hur ill Awnrr n> Ownrr'( A(lenlAgent L] i I berrly crr111y Ilml nil ill the dclalts and Information I love +rdwnhlcd ;or cnlrrcrn In Iha above •.dlcalton are Uun •+ rnW:"t' �rw,r'Ird•Ir PM11(al all phenhinp work arwl Incl Mlatirn(i prrfnrn(erl (xvier lire lwrmll Is$urd IW till$ a�dlcallon will he In dcornpllance 1 wilhr all pertinent Mnvl(irr,( ill 11w MatlaclIII%rll$ Stale Gas Coda and Chapter 142 of the Genaral Laws. ree Check # DAte /1f PROVED (Office Use Only) Typo f Llcenso: �lun7ber ❑ Gasfiller Signature of Licensed Phinlber or Gas Filtor ! Q00(master C] Journeyinnn License Nuntbnr '`` eSCN7q Of �ba• y�' K Y ,sSACHU`�Et CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number o2 o� Date 7-- Z 3 ` ooa THIS CERTIFIES THAT THE BUILDING LOCATED ON �D/t-? 51k 3 3 Ze- d ,v iv e- D R i 0,6 MAY BE OCCUPIED AS V IN ACCORDANCE WITH THE PROVISIONS OF TA MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. c -P //a B,4'r'A S . 3 .5 O i/ 1/.4-' vr-A � CERTIFICATE ISSUED TO �rbB )(1-11e- W [ P&.tJ * c S Auiiding Inspector" ector m m //M� V/ 0 m _v C � HCD 0 Z y v. �. e'' C1 =• y n� � o d 0 v CD CD o CL cr CD CD O CD ov w C CD V)• CD Q O CO) CcCD 0 CrrJ cn l J 0 cn 0 cn r: �o O 2 O -• to O Q N d O <cc O -0 C4 to m C-) Z (a C* .►C ?� y �d�►O. CD C CD �omd C y N O IV = m n > > N !D O o Z�.n O N C-) Q C3 =CD :a d aN0 o 0 . co o ? —*- 4C CD 'a ■- CD 1 CL CD p N IDN N d C CL W- � g C% a N m �O N COD N ` -p eCCC.D, w a CD �Go �=:tib CD Fa ZH Sr a�► r s `—cc,: CD , cc, CO :Z L r N c o C 0 _. ZO :V G 'd O C/ r t 9 rA 9 rA 1 z 0 w y 0 0 c Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax (978)688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 33 /e,,4ti�/jf LOT NUMBER 3 S DI SION DATE REQUEST FILED D Z . DATE READY FOR INSPECTION -7 f B FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIG - FF'S MUST BE COMPLETED WITHIN THIS TIlKE FRAME. A RE -INS C N FEE OF I ($25.) DOLLARS WILL BE CHARGED IF S C DOES NO ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVA __ D , ,, 2�r � DATE ATE D.P.W. —WATER D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIO THE MPECTION REQ ST DATE. TUBE / DPVQAUTH0 MZATION F� 363k� Date................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .:1..�.r.......!! ..... ................6.i.. has permission to perform .. 'E' A" S r` v < < �- wiring in the building of f 3 3 3 L l ti' j v �2 ......................I....................... .............................. at ....� �O �. U 1° �U ...... `� S Andover, Mass. Fee .................0 Lic. NoE.3!a 5..........4....��..!�......J.�.�.`.1r.�.�%� f ` ELECTRICAL INSPECTOR Check # THECYIMVI0NWE4L2H0FM4S►.SAa1USEM office Use only DEFARTA1UV0FPUBMCS4FM Permit No. BOARD OFFIREPREVEWONREGULATIOAND70212-M Occupancy & Fees Checked VAPPLICATIONFOR PEi?Aff TO PERFORMELECTRICAL, WO ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 41- (PLEASE PRINT IN INK OR TYPE ALL IN Dat D Town of North Andover To the 4spar of W ices: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) -73 L ,7,le 1 Owner or Tenant /gyp f/P ' 6v Owner's Address � "?Oii- .,r� / W l•, Is this permit in conjunction with a building permit: Yes EM"No (Check Appropriate Box) Purpose of Building ��j/ e��/f'�� Utility Authorization No. ®-�,9 Existing Service Amps--L—Volts Overhead [:3 Underground EJ New Service AW Amps/_Volts Overhead = Underground Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work . A No. of Lighting Outlets No. of Hot Tubs No. of Lighting Fixtures Swimming Pool No. of Receptacle Outlets No. of Oil Burners No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. No. of Disposals No. of Heat No. of DishwashersSpace Area Heating No. of Water Heaters KW Massage Tubs I No. of Motors OTHER lhmeahTw adwlidpodcf'sxwvheOfCic Y6 p NO C NSURANt..lL E3` BOND OnIt Q .3 S oa• 7VodcbSlat ` 0, teduttdCi;&sir 1RMNAME IWNE RS R SURANCE WAIVER; Ianawm*attheLioei wimmtt td the my sigttaitseon this pts wanes tins tajgttitsrloz;. 'lease check one) Owner Agent ?obs rawspee Below KW HP FIRE ALARMS No. of Meters No. of Meters _ f Total No. of Zones No. of Detection and bitisting Device No ofSounding :Devices - No. of SelfContained DdectionlSosading Devices Local Municipal Other Connections lattiaiti¢i►taiatt YES M NO VdWadc.S Imo'_.`J ��✓1/ Lit�nseNo �.�/a ����//ff BtscttssTd.Na � - `� AhLTeLNa 98y� ei�noeeo�e�et�sti�tlet}a+alattastec�IbyMa�rltse� (s>eral Laws Telephone No. PERMIT FEE $ 3 �-o 3 3 Date L....... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ........ I ... has permission to perform .... .............. V-- ...................................................... ........... wiring in the building of . .... . ..... xz.. at . ......................................... . North Andover, Mass. Fee.-.:.;. .................... Lic. No .............. ........... .................. ELECTRICAL INSPECTOR Check # � y• v is � • �. ` ' APPLICArTIONFORPERARTTOPERFORMELECTRICAL WORD AIL wMK TO BE Pmwaww IN ACD=ANM WrfHTE>E MASSAGRsS1'S Kamm cwE, 527 cmR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perf)nn the electrical work described below. Location (Street 1 Owner or Tenant 3wner's Address To the inspector of Wires: s this permit in conjunction with. a building, permit: hupose of Building sxisting Service Amps Vohs lew. Service Amps d> 'Vohs 0 UJ No LJ (Chert Appropriate Box) Utility Authorization No. Z25V1 orhead p urrdtsgmw [_7 Overhead C Underground No ofMders QNo. ofMeters lumber of Feeders and Ampacity oration and Nature of Proposed Electrical Work ' C!.✓ o�•s G Na of Lia6tin¢ Outlets I tate of rrnr Take I oto. of Regie Oaths -- Na ofOl B== Na of ftwyeay Ligdtiog BMM Uvim Jo. of switch outlets Na of Gas Barrels to. of Ranges Na of Air Con& TOM FIRE ALARMS Na of Z)Dft Tari la of Disposals No. of Hes W TOW Na afDelec nand Me T KW a of Dishwashers gppxAtesHerm KW NaefSoaft-Dwim NaafSc fCeabiiwd a of Dryers Hering Dcrices KW 1AW �musicipid Connection Other ' x of Weter Hewes KW Na of Na of Sign ftlm', r. Hydro Massage Tuba Na orMotors Taal HP aneCb9W PURUt1D#=gCtirema�a Gaootallr�►s . NO eatnAed l fi b yo I�p ��•'•� i iedo� IR'AhM 0 BOIL on"t :nsmtt � ti+» Thfiro0MIVa lINC S P-- -.- - -- timysg�teecxtthsprrrstapp6eshalwmrves�lstegtmerlerti. se check one) Owner Agent a Telephone No. PERMIT FEE_(„ oY� d Location No. S a Date �� �- a .. 9 # i a ass^cMusEt Check # '.5377 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �� k Foundation Permit Fee Other Permit Fee TOTAL $ $ pf ' Building Inspector m"L UrvIJra&ASSOC XATES 781 438 9654 P.01 *1 s EXISTING % owELUNc 14 2 r1 �-F. j4o u sem- 4 3 3 � 0.61 Ac. ?q Brei ? *9 • 31.1' 4,41# a�GO - 21.07�a2 SZ2'0 00, 4 • 4'? •S0 �` N21541"W 82.66' r �r 78,48. � P 1 ` %K 20.29 A - F, PROPOSED DRAINAGE,} SLOPE AND UTILITY EASEMENT 1 ,w PROPOSED �.�I`' `'` y'4e g 1 NO --CUT ti i EASEMENT STEPH' M. L) -MELES UC z CvZ No 3 049 v � '1��• , 9 Q' 1 oC'U .75 PG 5,175 PG I 102— WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THE DWELUNG IS LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. '7 WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE j WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.O. FLOOD INSURANCE RATE MAP, 6" AN INSTRUMENT SLRVEY. THIS PLAN COMMUNITY PANEL NO.250098 0006 C i SHOULD NOT BE USED FOR PROPERTY DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. COMFIED PLOT PLAN LOT 3 HERITAGE ESTATES MARCHIONDA 4 ASSOC.,L,P. NORTH ANDOVER, MASSAwHUSETTS 1 ENGINEERING AND WLANNING CONSULTANTS DRAWN FOR BROOKVIEW COUNTRY HOMES, INC, P. G. BOX 531 NORTH ANDOVER, MASSACHUSETTS 62 MONTVALE AVE. SUITE I STONEHAM, MA, 02180 (781) 438-8121 DATE: 3/14/02 SCALE: 1 "=50' H . Town of '`�__;� r'• NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.:y`y c;z PROJECT:52� jia`'AllV" �'r—I L1i ft DATE: UNIT NO.: REMARKS: FLOOR: WING: BUILDING NO. A© -f3 33 A-e4-v'!/r- 'Da - Excavation - depth and soil conditions Framing - Other: Date: Date: Date: Inspector Inspector. Inspector Footings and foundations and drains - Insulation - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Date: Date: Inspector Inspector. Inspector `ire Dept - vil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O # Inspector Inspector Inspector Form #995 Action Press, 685-7000 Location i��3 33 �e �NN-5 No. o?s �- Date TOWN OF NORTH ANDOVER V �� �a ,; �: Certificate of Occupancy $ g s�CMUS cMus Building/Frame Permit Fee $ Foundation Permit Fee $ ���• ,— Other Permit Fee $ TOTAL $ Check # 6q6 Building Inspector of Buildings Date I &,1v&,,1ryr%%T i CITU Y1%TV^1D1L4A1r1Fl1RT 1 1.1 PropertyAddress: 5-3 1eqVVC 1.2 Assessors Map and Parcel Map Number Number: y Parcel Number �00 !/rt(,J 1 Z g Information:1.4 /2S-1 Zoning District Proposed Use 92 Property Dimensions: o Lot Area i Frontage ft 1.6 BUILDING SETBACKS ft 7Z Name Print Address for Service: Front Yard Side Yard SECTION 3 - CONSTRUCTION SERVICES Rear Yard Required Provide R FredProvided Required Provided 3S" 1.7 WatS ty M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private 11 zone Outside Flood Zone 1.8 Municipal Disposal System: Ou Site Disposal System ❑ SECTIdN 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 er of ecord r �00 !/rt(,J ame rint) Address for Service 92 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constm ion Supervisor: License Number 19TI Address l8"�r -�'7z Expiration bate S&re` Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone C 2 rT C r r r SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this athdavi`will result in the denial of the issuance of the bVilding permit. Signed affidavit Attached Yes ...... No ....... 0 SECTION 5 Desc ' ion of KoAosed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Wor5 ov- e Z e, ' e I gF.r.TFON 6 - FSTTMATF.D CONSTRUCTION COSTS i Item Estimated Cost (Dollar) to be ,.„. A 5 Completed by permit applicant 1. Building Zoo O e) 0 (a) Building Permit Fee ”! co &0,o�p Multiplier 2 Electrical / O 600 (b) Estimated Total Cost of L O 3 `� Construction J 3 Plumbing /U f 000 Building Permit fee (a) R (b) J 4 Mechanical (HVAC) 0010 5 Fire Protection / , 0 0 0 6 Total 1+2+3+4+5 '© 0 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 69 e ,C, //o as Owner/Authorized Agent of subject property Hereby authoil ' ( / S 7 1P >' / / < < "'�'� S to act on My behal n a matters r lative work authorized by this building permit application. 4/ Signat ier Date SECTION 7b DOWNER/AUTHORIZEAGENT DECLARATION 1, �C �f 7-,l �j�j �� E / '"/ * <<'J g S ,as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief /7C',/�- lid' glra/0 S Print N7 �� y // SignaCe df Ownef/Agt-nt `-,— J Date FORM - U - LOT RELEASE FORM /#e e4 ,, INSTRUCTIONS: This form is used to verify that allnecessary approval /permits from ti. Boards .and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable ■ requirements. �...............■..........................■4..............a......a0aaaa00 APPLICANT fes• p� u, c > Fy �o n ,- 5 PHONE ` � S S� ASSESSORS MAP NUMBER` ( LOT NUMBER SUBDIVISION ' 7gj C Z F4 _S LOT NUMBER STREET Z-.e-,f,vti t Oe - I c STREET NUMBER .33 ........................................................................... OFFICIAL USE ONLY ............................. 'a......a.........■................. a........a.■. RECONENENDATIONS OF TOWN AGENTS f (-� DATE APPROVED' CO SERVATION ADN NISTRATOR DATE REJECTED COND ENTS ATO PRi DATEAPPROVED DATE REJECTED COMMENT S DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED jCUCC DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENDS PUBLIC WORKS — SEWER / WATER CONNECTIONS f ¢'-3v--v, DRIVEWAY PERMIT Z. A DATE APPROVED FIRE DEP AR DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 1 t Building Value Calculation - for Propertv at..... LOT# t-� Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 23 14 322.00 65 $ 20,930.00 Brkfstnook 4 4 16.00 65 $ 1,040.00 Dining Room 14 14 196.00 65 $ 12,740.00 Family Room 25 16 400.00 65 $ 26,000.00 Study 12 10 120.00 65 $ 7,800.00 Living room 18 14 252.00 65 $ 16,380.00 Garage 24 42 1,008.00 35 $ 35,280.00 Entry 15 13 195.00 65 $ 12,675.00 2nd floor foyer - 65 $ - Sunroom 14 16 224.00 65 $ 14,560.00 mudroom - 65 $ - Walkin closet 16 7.5 120.00 65 $ 7,800.00 Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry 14 6 84.00 65 $ 5,460.00 Bedroom 1 18.5 16 296.00 65 $ 19,240.00 Bedroom 2 14 14 196.00 65 $ 12,740.00 Bedroom 3 14 14 196.00 65 $ 12,740.00 Bedroom 4 14 14 196.00 65 $ 12,740.00 Bedroom 5 - 65 $ - Bathroom 1 9.5 5.5 52.25 65 $ 3,396.25 Bathroom 2 14 13 182.00 65 $ 11,830.00 Bathroom 3 14 8 112.00 65 $ 7,280.00 Bathroom 4 - 65 $ - Bathroom 5 - 65 $ Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978)688-9545 Fax(978)688-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 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. Permit Applicant Property address Map / Parcel 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 of the 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 Budding 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 ofthe following sections as indicated by a check mark. This is an application for a 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 parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved 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 CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity = I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance Co. Policy # Company name: Address City Phone #: Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' ❑ ❑Check if immediate response is required Building Dept ❑ Contact person. Phone A ❑ ri FORM WORKMAN'S COMPENSATION Building Dept Licensing Board Selectman's Office Health Department Other T s APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. A L,)rl 1 }q Application by the undersigned is hereby made to connect with the town sewer main in ��G k' �%� Street, subject to the rules and regulations of the Division of PublicWWorks. The premises are known as No. _ `� rkksLee J1 41 e- Street or subdivision lot no. _. Owner Contractor PERMIT TO CONNECT The Division of Public Works hereby grants permission to to make a connection with the sewer main at G subject to the rules and regulations of the Division of Public Works.. Inspected by Date Address Addre pr?Mnt's Signature SEW R MAIN / Street I Division of Public Works By See back for rules and regulations Application by the undersigned is hereby made to connect with the town water main in L.e=ggi'm-e L/T Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. or subdivision lot no. � r�ck1 i� � t f✓rj Owner Contractor Street RIO, Address ppicant's Signature PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to 'L' )l rul to make a connection with the water main at d761 e 1/�^ v Street subject to the rules and regulations of the Division of Public Works. Inspected by Date 1 % Board of Public Works By See back for rules and regulations �r ,i.WILL;AM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (976) 685-0950 Fax (9 78) 688-9573 DATE A F-2? L LOCATION 3 L E�X k) 41 BUILDER phone OWNER `J r CC) L) Le, r.4-) 6vu hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT, 41" MAScheck COMPLIANCE REPORT Massachusetts Energy Code i Permit # MAScheck Software Version 2.01 Rel( i Checked by/Date CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-19-2000 TITLE: HERITAGE ESTATES BRENTWOOD PROJECT INFORMATION: BROORVTEW COUNTRY HOMES INC PO BOX 531 N ANDOVER MA COMPANY INFORMATION: J&J HEATING & AIR COND 17 ARLINGTON ST DRACUT MA COMPLIANCE: PASSES Required UA = 617 Your Home = 615 Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value --------------------------------------------------------------------------- CEILINGS 1800 30.0 0.0 WALLS: Wood Frame, 16" O.C. 2479 13.0 0.0 2 GLAZING: Windows or Doors 510 0.400 2 GLAZING: Windows or Doors 96 0.460 DOORS 39 0.400 FLOORS: Over Unconditioned Space 1800 19.0 0.0 HVAC EQUIPMENT: Furnace, 92.0 AFUE - COMPLIANCE STATEMENT: The proposedbuilding 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 a pplicable Standard Design Conditions found in the Code. The HVAC u' t� selected to h t cool the building shall be no greater t n of he design 1 specified in Sections 780CMR 131 and .4. Builder/Designer Date_ .y �` Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 HERITAGE ESTATES BRENTWOOD DATE: 12-19-2000 Bldg. Dept. Use [ ] [ l [ l [ l r 1 CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.4 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ) No Comments/Location 2. U -value: 0.46 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.4 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 92.0 AFUE or higher Make and Model Number 2. Air Conditioner, 10.0 SEER AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, -recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s)-air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: ( ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. i MATERIALS IDENTIFICATION: [ ] i Materials and equipment must be identified so that compliance can i be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be i provided. Insulation R -values, glazing U -values, and heating equipment efficiency must be clearly marked on the building plans i or specifications. 1 i DUCT INSULATION: [ ] Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ ] i All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space; including stud bays or joist cavities/spaces used to transport air, shall be sealed i using mastic and fibrous backing tape installed according to the i manufacturer's installation instructions. Mesh tape may be i omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing air and water systems. i i 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 125% of the design load as specified i in Sections 780CMR 1310 and J4.4. i SWIMMING POOLS: [ j I All heated swimming pools must have an on/off heater switch and ` require a cover unless over 20% of the heating energy is from i non-depletable sources. Pool pumps require a time clock. i HVAC PIPING INSULA`T'ION: [ ] HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 211 RUNOUTS 0-1" 1.25-2" 2.5-4 Low pressure/temp.- 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: i Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 i CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): ----NOTES TO FIELD (Building Department Use Only)------------------------- PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUT HEATED WATER TEMP (F): RUNOUTS 0-1" 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 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- a -, •Lnm < o ' a O � �a � C mN O O z ai 0, a m T3 m O N O CCL 7 —•� a 0 (. O O 0 :3 c, fD M a 0- E D �. 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