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Miscellaneous - 375 JOHNSON STREET 4/30/2018
:r.' � -ways• , � .., s f...w. r v z r .10tt 71. O A D Y ' ,s^ACNU'�t, CERTIFICATE OF USE & OCCUPANCY i TOWN OF NORTH ANDOVER Building Permit Number �3yB THIS CERTHUS THAT THE BUILDING LOCATED ONS 0- Date / a 3 ono S 4 -- MAYBE -. MAYBE OCCUPIED AS V l fV,CP j E r -A -m, L y IN ACCORDANCE WITII THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO /—'- 4-e %" AV ly r yn A Lf 3175- --1 0 AAl C Q V. S J, Building Inspector v 0 b �m c o c = 3.n= c eo cv 0 m C o :opo o 0 y Ec mom a: -4tts y Lam: c ao R `" H ' y L y �p cm O J mono y Q • t C y y cc c V� _O m CLU o y m m d =0 Z m m0L 8�V N O O _ J QC ~ a mAp. � CD y m 0� = O COL y OH W +-' CO m r.+ �r� c +- � 'E v y G) a �' 10 cm A c FE Me- i_ `4bo �acoo E U w 9L w G140 C w w ° «� V) V) �m c o c = 3.n= c eo cv 0 m C o :opo o 0 y Ec mom a: -4tts y Lam: c ao R `" H ' y L y �p cm O J mono y Q • t C y y cc c V� _O m CLU o y m m d =0 Z m m0L 8�V N O O _ V O a � o Cl) y O Z cn CO) ® E o CD (J) �D o v v (n ev •� co C. O a ca 3� �D O Q o a CL. Qi e S c Q ts Q CLH W N W W LLI 19 ujW QC ~ a mAp. � CD y m 0� = O COL y OH W +-' CO m r.+ �r� c +- oc 'E v y G) a �' 10 cm �*gm 32 o FE Me- i_ Am �acoo V O a � o Cl) y O Z cn CO) ® E o CD (J) �D o v v (n ev •� co C. O a ca 3� �D O Q o a CL. Qi e S c Q ts Q CLH W N W W LLI 19 ujW 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: Lawrence & Elaine Pare Property Address: 375 Johnson Street Policy Number: HP2424142 Date/Cause of Loss: 3/15/2015, Weight of Snow/Deck Collapse File or Claim Number: 31724-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 Dellechiaie, Pamela From: Dellechiaie, Pamela Sent: Thursday, May 12, 2005 9:46 AM To: Sawyer, Susan Cc: Grant, Michele; Willett, Tim Subject: 375 Johnson Street Importance: High H i, o !S 04— �d/�-S Just received a call from a new homeowner at above address. He is do sewer. How ve claims that there is�waste and an odor in his yard. H/O feels this is an emergency/health issue, and wants someone out there today. Upon questioning, No told me that the problem started about two weeks ago. Mr. Pare believes the source of the waste is from the homes on Lisa Lane in back of his property, as they are raised up and the land slopes downward onto his property. I told the homeowner that I would advise you of the situation, you would call him, and let him know when you could go out to take a look at it, hopefully today. Mr. Pare feels that it is an emergency/health issue, and that you should go out right away. H/o is anxious, and a little pushy. I left a voice mail message with Tim Willett, also, to ask him if there are any sewer problems going on in the area. W: 978.659.4378 and H: 978.685.6415. Michele - FYI - you may go out with Susan. 8a8l IR100141d8, Putty & BIOM0 41410 Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com Dellechiaie, Pamela.vcf Date . -7-. 4, , - 0 ?�..... . 't TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... F-�41, e�f ,,4 ....... . has permission for gas installation A) f- LO . � �.�.... . in the buildings of . %� U h A at 3 r)s Sd h ro �" �" ,North An over, Mass. Fee... l Lic. No. X30 is (a .,'- I> 0211 IN � �G•..._.� GAS INSPECTO Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) r i ,MA Date Z 96 Receipts st`PermhM 47 Building Location ersName , a 1.1ap: Lot: Zone New Renovation ❑ Type of Occupanc Replacement ❑ Plans Submitted: Yes ❑ No ❑ I y INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes W No ❑ If you have Aecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy / 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. Checkone: Owner Agent❑ signature of Owner or Owner's Agent I hereby certily that all of the details and information I have submitted (or entered) in above applicaton are the and ascurate to the best of my knowledge and that afl plumbing woek and installations perfor .ormed under the permit issued fapplical,o ' be in compliance with a!I pertinent provisions of the Massachusetts S:a:e Gas Code and Chapter 142 of the Gene L ' s. Az A - 3y Type of nse: lumber Si azure of Licensed Plumberor Gas Firer Title JGtf'rer !aster Uoenservumber Ciy /Town Joumeyman APPROVED (OFFICE USE ONLY) i ',Y Installing Company Name_ I 9-tp�L Checkone: Certificate Address 2-17 `( y j per„❑ Corporation EstimateValueof Work: ❑ . Partnership Business Telephone 6 C%_ Firm/Co. Name of Licensed Plumber or Gas Fitter .. ���� t— 14 INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes W No ❑ If you have Aecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy / 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. Checkone: Owner Agent❑ signature of Owner or Owner's Agent I hereby certily that all of the details and information I have submitted (or entered) in above applicaton are the and ascurate to the best of my knowledge and that afl plumbing woek and installations perfor .ormed under the permit issued fapplical,o ' be in compliance with a!I pertinent provisions of the Massachusetts S:a:e Gas Code and Chapter 142 of the Gene L ' s. Az A - 3y Type of nse: lumber Si azure of Licensed Plumberor Gas Firer Title JGtf'rer !aster Uoenservumber Ciy /Town Joumeyman APPROVED (OFFICE USE ONLY) Date ... O!..... `( r. TOWN -'OE NORTH ANDOVER PERMIT FOR -PLUMBING P This. certifies that ................... }iaslpermission to perform nI u' plumbing in th^e-buildings of .. M0 .. Y�1.7 .................... . ...... . No rt Andover; Mass. Fee 1. . Lic. No.�•>. 0L - -.�1n2`r�. ��%(� C) l1 PLUMBIN INSPECTOR Check W G 6102 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (1�llilt Ur T F1G) MA Date Recei t# Permit# 7—_ P F3uildir.g (.ocation ��� a'ner'sNs; �e , � , � Map: Lot: Zone: Type of Occupancy '04,1i New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ I - FIXTURES Installing Company Name i.�� /� Checkone: Certificate Address %% ZLt.�LL(il E� �uwj ❑ Corporation EstimateValueofWork: ❑ Partnership Business Telephone G o3- -T 3 0�+ Al Firm / Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current i,5bility insurance policy or its substantial equivalent wh;ch meets t -Ie requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have t, -'e insurance coverage_ required by Chapter 142 of the Mass. General Laws, and that my signature on t its per ; it app!:cation waives this requirement. Checkone: Owner Agent Signature of Owner or Owner's Agent I hereby certiPj that a!I o` the details and in'orna'ion I have submitted (cr entered) in above app!!c `on a: e t.-ue and accurate to fie best of my knowledge and gnat all plumbing work and installations perform r the per sued fcr Gnis application will be in compliance with all pertinent provisions of the Vassachuseis State Plumbing C a. Chapter t _ Ce Ganeral Laws. By Sign ureofLicensed?lumber Tide Ci:y /Town A PROVED O=FIC= USE ONLY) Types o' Lim^sat f.'zster � Jc_r;;=yr;a, ❑ LicenseNunber /3o r„ � R"r jc-zcz— ai�m�ii noun Installing Company Name i.�� /� Checkone: Certificate Address %% ZLt.�LL(il E� �uwj ❑ Corporation EstimateValueofWork: ❑ Partnership Business Telephone G o3- -T 3 0�+ Al Firm / Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current i,5bility insurance policy or its substantial equivalent wh;ch meets t -Ie requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have t, -'e insurance coverage_ required by Chapter 142 of the Mass. General Laws, and that my signature on t its per ; it app!:cation waives this requirement. Checkone: Owner Agent Signature of Owner or Owner's Agent I hereby certiPj that a!I o` the details and in'orna'ion I have submitted (cr entered) in above app!!c `on a: e t.-ue and accurate to fie best of my knowledge and gnat all plumbing work and installations perform r the per sued fcr Gnis application will be in compliance with all pertinent provisions of the Vassachuseis State Plumbing C a. Chapter t _ Ce Ganeral Laws. By Sign ureofLicensed?lumber Tide Ci:y /Town A PROVED O=FIC= USE ONLY) Types o' Lim^sat f.'zster � Jc_r;;=yr;a, ❑ LicenseNunber /3o r„ � R"r jc-zcz— Town of North Andover Building Department NORTH 400 Osgood Street North Andover Ma 01 845 O L 1NOnn ATIUUVCI, 1V1AJJa� iiuov�w v�.,� (978) 688-9545 Fax (978) 688-9542 �J^p TED PP"i�y APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 37T L h,u 4, S i -- LOT NUMBERS SUBDIVISION DATE REQUEST FILED L ' O DATE READY FOR INSPECTION 13, • 1- O TEN (10) 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 STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING D.P.W. — WATER METER '��� DATE I f 3U o D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTIONREQUEST DATE. ;1A SIGNATURE / DPW AUTHORIZATION Location ZyI33�iS �o�Nso•► s�- INo. ` 8 Date TOWN OF NORTH ANDOVER P Certificate of Occupancy $ Building/Frame Permit Fee $ wCMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �6 415 , i4, — Check # d 17367 * r Building Inspector x.315 3-a3--cc( CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE.' 1 "=50' DATE 5/7)2004 Scott L. Giles R.P.L.S. Frank. S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. }-Im u %;,k lots p SJR. I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BYLAWS OF NORTH ANDOVER WHEN BUILT LOT #4 , 77.44 LOT #3 27,564 S.F. PLAN #14,526 N.E.R.D. rod pd -)iron / 121'35 LOT #2 OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. 149.72 LOT #1 L=5.66' R=1000.00' L- 0 T Z O �z m or 13872 ©% m rA 1 Location 4343ns --t e �o 3 aq o q No. y Date NOR7p TOWN OF NORTH ANDOVER F w f Certificate Occupancy V of $ cMUst< Building/Frame Permit Fee $ Foundation Permit Fee $ O 0 Other Permit Fee $ ` TOTAL $ �S 4 Check N 17151 M 1A ` Building Inspector M TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 77,� BUILDING PERMIT NUMBER: DATE ISSUED: _C--- 3 _aD0 `{ SIGNATURE: Allk Building Commissioner/1for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: of 8 Pr (�,t3) Map Number Parcel Number 1.3 Zoning Information: Zonin District Ii osed Use 1.4 Property Dimensions: Lot Area s ---- Fronta e (ft) - 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReclWred Provide Recpired Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record P,, -,4--e,, w AA,- ---3 "So"i- Name nt) Address for Service Si nature —0 Telephone 2.2 Owner of Record: Name,Print Address for Service: Si ature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Superviso : -,�c n Addr 01911 lure < Telephone Not Applicable L' �� a� a License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date _ Signature Telephone Ma rn X ic Z O J L•J SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work checkall a ble New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: o2l��/ (��. 1 O \L o 0 u-1 1 3 SAat� JNd'er— N.,-v-) � 1A^ le- , I SECTION 6 - ESTIMATED CONSTRUrTION rnCTC I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFfCIALUSEONLY`� 1. Building D �'P �� (a) Building Permit Fee Multiplier to $ , a pen K acs oF' 2 Electrical ' + (b) Estimated Total Cost of Construction 02� 3 Plumbing 000 Building Permit fee (a) X (b) O 4 Mechanical (HVAC)ap pptj 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 0Cl.11V1\ /a V W 14EK AU 1 "gJK1LA I IU1V JU BE CUMYLE IED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize ' to act on My ]t; in all mat ers relative to work authorized by this building permit applicat* l 1 Si ature of Owner Dates �� ' 6 `-1 SECTION 7b OWNVV7dJTHORIZED AGENT DECLARATION property I Hereby declare that the statements and and belief of Owner/, a Owner/Authorized Agent of subject S' on the foregoing application are true and accurate, to the best of my knowledge s- 14 Date NO. OF STORIES oZ SIZE BASEMENT SIZE OF FLOOR TINIBERS 2 -l -f LO 1STZ t� t 0 2 3 RD SPAN I DIN ENSIONS OF SILLS Z r �- DINIENSIONS OF POSTS f, a L `{ DIMENSIONS OF GIRDERS to ib —1 ]EIGHT OF FOUNDATION '1 _ 4 THICKNESS 1 -4 -- SIZE OF FOOTING t c 'F Z.0 X MATERIAL OF CIDNINEY IS BUILDING ON SOLID OR FILLED LAND So 1, at IS BUILDING CONNECTED TO NATURAL GAS LINE u %&S t.�61 FORM - U - LOT RELEASE FORM tJ° we--, 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. in memo mean on Doom Bananas onnomessed Room manganese SON ONE a NONE as APPLICANT Pe -4A- &Co LUA PHONE 3 7 ASSESSORS MAP NUMBER LOT NUMBER Loft 3 SUBDIVISION LOT NUMBER STREET 33VV J SO,J STREET NUMBER 375 I.seen ........■......■.....■.....■......■■...■■■ BEEN moon ...l.........ass .own OFFICIAL USE ONLY .....■...l.................. ......................................�......... .UC WAENDATIONS OF TOWN AGENTS �■ .l...l.■...l. ■.!.■..l.....■■...............I.'...........7Py ■.......■ �G���'rf�i' DATE APPROVED , ?/q CONSERVATION ADMINISTRMOR DATE REJECTED r II II 1.,f� Ik I:_d,'c_ .,0,nc� LD I CKSSOw, DATE APPROVED DATE REJECTED R 19 2004 CONMENT•S FSA 4NING DtirAi "MENT DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED _ z-- ?--- DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONWIENTS PUBLIC WORKS — SEWER / DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE cfFice CQI� Ga3 �8Q -i 3 go (401-7-Slc_(693 1 J J° Timothy J. Willett Water Si perintendent TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD S"TREE"T NORTH ANDOVER, MASSACHUSETTS 01845-2909 J. WILLIAM HMURCIAK, DIRECTOR, P.E. Telephone (978) 685-0950 Fax (978) 688-9573 AUTOMATIC LAWN IRRIGATION SYSTEM PERMIT DATE 3110¢ RECEIPT NO. HOMEOWNER PHONE LOCATION INSTALLER PHONE Note: The Installer shall verify that there is sufficient water pressure for the new irrigation system prior to the start of any work. General Requirements — I. Bypass Meter Set-up - A plumber shall set up a horizontal space for the bypass meter. The bypass meter shall be located before the house meter. Deduct meters are not allowed except for those homes with water booster pumps. Ball valves should be installed on both sides of the meter. II. Rain Sensor — A Rain Sensor shall be installed on all new irrigation systems. III. Backflow Preventor — The proper backflow preventor shall be installed. The backflow preventor shall be tested annually by the DPW, and the homeowner shall be billed for the test. Fill out the attached Design Data Sheet and submit to Dennis Bedrosian at the Water Treatment Plant, 420 Great Pond Road, for approval. IV. Sprinkler Head Location — All sprinkler heads and piping must be installed entirely on the homeowner's property. Sprinkler heads will not be allowed in the Town's Right -of -Way (R.O.W.), which is typically ten to fourteen feet back from the edge of roadway pavement. V. Bypass Meter Installation and Town Inspection After all work has been completed, call the DPW for bypass meter installation. The meter installer will use this Permit to inspect for proper meter set-up, rain sensor, backflow preventor, and sprinkler head location. This Permit must be present at the location for the bypass meter when the Town's meter installer arrives at the property. Bypass Meter Rain Sensor Backflow Preventor Sprinkler Heads Date Initials of itORTy 9 TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS T w 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 \Ac►+uSEt Telephone (978) 685-0950 Fax (978) 688-9573 DRIVEWAY PERNIIT June 1, 1999, Revised 06-01-02 (Please Print) r .--"I STREET & NUMBER: 3 %5 J'& K LOT NUMBER: CONTRACTOR: ADDRESS: OWNER: TP A) r ADDRESS: NO PROPOSED PLAN OF DRIVEWAY ATTACHED: PROPOSED SITE DISTANCE: TEL: FAX: TEL: DIG SAFE NUMBER: N SITE INSPECTION IS REQUIRED BEFORE FINAL SURFACE IS INSTALLED AND A FINAL INSPECTION WILL BE MADE WITHIN 48 HOURS OF NOTIFICATION OF COMPLETION. INITIAL INSPECTION DATE: BY: FINAL INSPECTION DATE: BY: FAIL URE TO COMPLY WITH THESE CONDITIONS OR TO OBTAINREQUIRED INSPECTIONS AND APPROVALS VOIDS THIS PERMIT APPROVAL OF THIS PERMIT DOES NOT RELIEVE THE APPLICANT FROM MEETING ALL OF THE REQUIREMENTS FOR SAFETYAND DRAINAGE. A SEPARATE STREET OPENING PERMIT IS REQUIRED FOR WORK PERFORMED WITHIN THE STREET PAVEMENT. Attachments made a part of this permit: Form U & Driveway Application Requirements Sketch "A" Proposed Driveway Plan, dated 06-01-99 Sketch `B" Typical Drivew Detail, dated 06-01-99 APPLICANT SIGNATURE: DATE: DIVISION OF PUBLIC WORKS SIGNAT DATE: 3 `� Form U d Drivema , Applications Rev 6-7-02 : 1959 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in �a�'' �� Street, subject to the rules and regulations of the Division of Public Works. l�r The premises are known as No. 3,5 -,,J,!5,� Lie Street or subdivision lot no. �r Owner Address Contractor Address Applicant's Signat PERMIT TO CONNECT �WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at �,, _ Kyt Street subject to the rules and regulations of the Division of Public Works.. Inspected by Date Division of Public Works By See back for rules and regulations r )07 APPLICATION FOR WATER SERVICE CONNECTION I 261::P4 North Andover, Mass. Application by the undersigned is hereby made to connect with the town water main in 'e'%1 Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. J7� �B �'`�� Street or subdivision lot no. Few guy G1 ¢ > � d4 1 ✓tet % 5¢v� l�� Owner Address Contractor S u yne,4r Address Appli ant's Signature � f PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to P40�1 V to make a connection with the water main at �7m "� K��, Street subject to the rules and regulations of the Division of Public Works. Inspected by Date ofl Board of Public Works By , See back for rules and regulations The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Location: !/ & D QAK art,,; ut City Pay sixu u W 103ft;- Phone (20 3 " 3gc-�. - G6 so am a homeowner performing all work myself. I%I am a sole proprietor and have no one working in any capacity F -1 I am an employer providing workers' compensation for my employees working on this job. Company name: 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 andlor 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 c er* ugdgr the pains and penalties of perjury that the information provided above is true and correct Print 0 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 FORM WORKMAN'S COMPENSATION Date 3- L Oq 0 Building Dept 0 Licensing Board 0 Selectman's Office Health Department 0 Other anual Trade -Off Worksheet 8T1 ermit 0. Builder Name fJ5Tr.ex710 'T'1C 1c�1 Data Builder Address • � ` � ' Checked By Site Address Zone []12 [113 []14 Submitted BY Phone..Date .. T . 0 , REQUIRED CeiilrtQs�, ; Sk•tiights, and - Fro -ors Over Outside Air Insulation x Net Descrintlon A -Valle 11.1.,.1..,. Ate= Ceiling T able 46.2.2a) 0 Floor Over Outside Air (Table J6.2.2a) ue , � J G• res �% Windows NERC or Ta -,)is J1.5.3a) J6.2.2e) �152- Doors Total Area '93 - Required ' U -Value * UA (fable 6.2.2h) x Area -----►:. - 0 3 3 I g a 7 't•' rte.. x 4i 1 1� 1111uyrj�, - gnu Doors Insulation D• sction R -Value -Val A 11. Required U Wails able Ja.2'.2b•c, ue , � J G• res �% Windows NERC or Ta -,)is J1.5.3a) J6.2.2e) �152- Doors Hasement Wail (fable Je.2.2� 12, NFRC or Tiot.!e J1.5.3b -_-_ (4 1 12 Sliding C3Cae� )Dors NERC or Tt^:e J1.5.3a) . 3 4 itz —74 (fable J6.2.2 In, Heated Slab ., tt fe UA 9 .i UA Total Area JF 23 d Founggkns .. Insulation Insulation x Area or Description Depth R - Value U -Value Perimeter »< UA ' t t-v!1s,e v e..e _ I YA NOW Over unconditioned (Table Space J6.2.2e) Hasement Wail (fable Je.2.2� 12, .ov 1398 ! ►{.g Unha,oted Slob ft (fable J6.2.2 In, Heated Slab tt able J6.2.2 in. ,Total Proposed UA must be less Total than or aqua! to Total (or Adjusted) Required UA proposed UA Statement of Compliance: The proposed building design represented in these documents Is consistent with the building plans, specifications, and other calculations submitted with the nprm;r �nn11na11nr% Suildvr/Designer Company Name 1l28,�t3 ...— Total 1� OR Required UA .;3Z L7 . AdJusted Required UA Cate 7-1A�.. 53.. ' .Od WeZT :O1 OE6T E ''jzS : 'ON 3NOHd O�jLiiina NHOf : WOad 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: (Location of Facility) Signature of P<& Applicant 3.18-04 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector o i z 07 o O �1 . h 2• z o U 4 C16.t o v CL o %t)LL any 0 r �'d '1� ; o _ o Ili w L C o U Q Q Q _ a 1 o o C QLL 07 m d .. �? EAS 01* = > 3 o G O t0 j '-te� 5 cuE u �' u 0 ~ ca o a�° ° � t} w n - 06 o ED X`, V �� V 4l U O. O m C ca N w o W CH V O 0-A N ° O m co ID w N C a C c ++ E Ca o= 'c E ._ HaZ a N a LULn t .00- o g ° o� o aia CUz ON vs ril E., : . : :.c ra zo kI Olt co to u x to 0 P� —0 r" u 00 10, Cli W. 1 W co x ***j m : . : :.c ra zo kI Olt t5 0 10, S + E ***j m cm ca ca 16 c CLW cr- Me 0 CM C=a co 0 cm go =CD co 4; :5 -wr cc, wig CL= C-3 C3 CD Im a cm.s .L cc 0 a C/) z 0 C/) PL4 0 '71 C cl) I) �D 0 Cf) z 0 u C/) C/) ts 0 CD .0 E z ca CD LA E CD L— CL CD a) CL ca Q CO2 S CL cop) �dm�l CD CL ca CM CD cc cc cc z Z CD CL CO2 \,Ix _ Y y•r i N /F Ks KEVIN SPAR 14 7p'_- MAD 1 A `l C• 1 8 N WE• 0 \ OE�INIr A Spp1 I ' 11 1 •` MING BASIN. G PROP. SE _� •_ , 3 ET. SUMP. \ —�" 5 ti �2" L OR SONE B� 5.0,,0��'257•0 `4 1 , LE ►N r PROP. IWA �. ETAIL (SEE D ; 3g_P qc .. 0 P`1 .i �6 lk loo,$. %.L' PROP' C 0 toe vool i 6 '\ • � _258• S ;.� +„, o - F 3 - - G 1Ni �, ,-,_ -. W rte+ •,. , • , fti� :I- cP PRoy. �*1 O s • �' �"�,� �LL1N rn 25 F 10 64 S 21 ' Ro S O ' ��2135 PROP p,TOR Ovo a, Lo c*� AREAJZ ��ODOR 3cr q?A',- P 1 I ., J 01 • PROP • ONC PR�y.216.0 tom`• • c. r` �\�1 � OR�� 1 , C. � 67.4 LTi,.. �- � \ � 1 • N' •, 2-72.016 \ �0 S��M�Ni i ilii iii ilii ii iii i iii ii ilii iii ii ii C� Massachusetts Department of Environmental Protection DEP File Numb Bureau of Resource Protection - Wetlands 1JUPA Form 5 —Order of Conditions Provided Provided by DEI 4` Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 S� D. Recording Information (cont.) Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. ------------------------------------------------------------------------------------------------------------------------ To: North Andover Conservation Commission Please be advised that the Order of Conditions for the Project at: 383 Johnson Street Project Location DEP #242-1159 DEP File Number Has been recorded at the Registry of Deeds of: Essex North, 6/30/03 at 2:40 P.M. Doc. 39363 County Book Page for: Joseph M. Pelich, Trustee of 383 Johnson Street Realty Trust Property Owner and has been noted in the chain of title of the affected property in: Document # 39352 book Page In accordance with the Order of Conditions issued on: 08/20/02 Date If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Document Number Signature of Applicant CERTIFIED AS CORRECT Jill Klmstrom Mann, otary Public My C mission Expires January 28, 2005 WPA Form 5 Rev. 02/00 Page 7 of 7 Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 CLCAT@CL-NA.COM Facsimile (214) 488-6766 ***********************AUTO**3-DIGIT 018 809 T3 P1 95000058999 Building Commissioner or Inspector of Buildings 120 MAIN STREET NORTH ANDOVER, MA 01845 Cunnin fihamAA Va l�Lindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 2409079 2409079 09 BAY STATE INSURANCE COMPANY ICE DAM 3/3/2015 C/O DEBBIE MATHIAS 383 JOHNSON STREET LLC 383 JOHNSON STREET Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Claim Number: Policy Number: m Company Name: m 03 CD Cause of Loss: o Date of Loss: Insured: 0 Property Location Cunnin fihamAA Va l�Lindsey Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 2409079 2409079 09 BAY STATE INSURANCE COMPANY ICE DAM 3/3/2015 C/O DEBBIE MATHIAS 383 JOHNSON STREET LLC 383 JOHNSON STREET Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. 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. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Location No. 62� Date NOS U� ,.0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ t Building/Frame Permit Fee $fib — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #a 8'7109L Building Inspector " TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / �3 DATE ISSUED: , / V ! SIGNATURE: Building Commissioner/InEeEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 3 S 3 `i oNAy soA) �;-,Zuur- 1.2 Assessors Map and Parcel Number: 0WIA lido Map Number Parcel Number 1.3 Zoning Information: R3 P -(--,S Zoning District Proposed Use lam 1.4 Property Dimensions: 1'5-1.A5;?. 772C) Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) Public � Private ❑ 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone Outside Flood Zone K Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service S32 Signa re Telephone 2.2%Owne <Rrd: Name Print i Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: per+ tk-ow,e - & W Pe 2 1-C k -XM XEl1.t t� / /o IJ Licensed Construction Supervisor: Address Signature Telephone Not Applicable _ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Tele bone 1`h `1 0 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 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building Repair(s) Alterations(s) NK Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: L P L11,C - 5 ( b I u &, TV 164 1 oV rpt -1 (,r re -n aycr iI r I SF.C.TION 6 - RSTIMATRD CONSTRUCTION CnSTC I Item Estimated Cost (Dollar) to be Completed by permit a licant dS0 FFICIAL U'QIeTL ' 1. Building (41 (� (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) Opt' a 4 Mechanical HVAC�- 5 Fire Protection 6 Total 1+2+3+4+5) U 005 Check Number f) 3 f 0AA6 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN 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 OWNER/AUTHORIZED AGENT DECLARATION 1, "j O H Lapm as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si nater of e ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS I ST 2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY lS BLTLDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Y it 1 Department of Industrial Accidents Office of Investigations Boston, Mass. 62111 Workers' Compensation Insurance Affidavit Please Print Name- �101H N ket-U+A, P Location 3$'3 oft us o &.-> S -t ' City NnarrK AfJ1:�0Vbnz t*A Phone �am a homeowner performing all work myself. EI am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Com an i name: Address City. Phone #: Insurance Co Policy.# Com n 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 t1Si 9 nature `�,�� Date I l 1 tc3 ---,�— vl�dnt na nffirial use onlv 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 #.-- FORM WORKMAN'S COMPENSATION # 557`25-32 - Building Dept E] Licensing Board F1 Selectman's Office E] Health Department O Other Town of North Andover o� tAo DTH O0,, Building Department o 27 Charles Street * _ North Andover Massachusetts 01845 _ ry (978) 688-9545 Fax (978) 688-954201.— �KPP'� SACHUS� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# /,.A3 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: Facility location Signat e of Applicant It 117 lc'u Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Please print DATE _ Woy• /(o.0 Q4=0 9.,D JOB LOCATION S9 Number HOMEOWNER LICENSE EXEMPTION Street Address ►"M Map / "HOMEOWNER -Toy-N F 7 G,2G ism Name Home Phone Work Phone PRESENT MAILING ADDRESS Skhn� Noon-� City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of 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 HOMEWOWNER: 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 dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. JHOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFICIAL Town of North Andover t NORTII ' °"" '• �" Building Department p 27 Charles Street t North Andover, MA. 01845 "a44g i �,S •4 D. Robert Nicetta SACS4 Building Commissioner (978) 688-9545 688-9542 Fax Please print DATE _ Woy• /(o.0 Q4=0 9.,D JOB LOCATION S9 Number HOMEOWNER LICENSE EXEMPTION Street Address ►"M Map / "HOMEOWNER -Toy-N F 7 G,2G ism Name Home Phone Work Phone PRESENT MAILING ADDRESS Skhn� Noon-� City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of 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 HOMEWOWNER: 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 dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance 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 No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. JHOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFICIAL x Q ov u O LL T 0 u O (n p W z zz Q W � m G � -o fL -a to p P� C C U G U. O W a Cr- p 0G co " 1 a o a � W p u G a O u a 0L G G% z w A w v `C G] z b cn i O V) 6 z t C co O Q L O O C3 CDZ O y � O CD I Com_ H � � co.� y CD m m .� co o co CL F.. co ca � 3� CD Q � ; 0 Q L Q d CL CQ y C os c _ M cv e 'J 'fl •� O .CR C Z CD V CO) O C •C C _m d 0 U) Cn w L1J Ir LLJ L1J Cn tso mC a. s :- v�o� C H _O C l � S •Q� a C cO O m C r►oco � N � Y E <t m _ D «_ \F N .SEC n O m meE E N lC f m N .•i; O N _ CD 3 = :2 m CO) C Cc C O m a; �F ` v H m m � z Z � o0 os c c 'v �`acr i .5 m o m oo•«. cm m N m C _c C CD a� c N coo � N m o k— ca = m m w UJ c � c_,,, .._ •N rte.• O C CL is m Oma Z O uj 0 y G w .5=� OO5g y O S 0 �� m � t C co O Q L O O C3 CDZ O y � O CD I Com_ H � � co.� y CD m m .� co o co CL F.. co ca � 3� CD Q � ; 0 Q L Q d CL CQ y C os c _ M cv e 'J 'fl •� O .CR C Z CD V CO) O C •C C _m d 0 U) Cn w L1J Ir LLJ L1J Cn Date ..... "t` • "� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..................................r� C J e C' has permission to perform ..... o..... u ...........` „` Nn. ° °p. .................... wiring in the building of .......,... 5 ........................................................ 3`v,3 =1 0� k3 so '-j 'Z� Mat.............................................................................. North Andover, Mass. Fee .... . a.8.. Lic. No. A 1 `I. a � ...... .. c. (` ,A .'!'( �:-` ... .... ....... 7 _ ELECTRICAL I SPECTOR Check # L C Z f 4i rDfE C094- ro ALWOIF W,4SSACfvSE(I7S Department of (Pu6Gc Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use O If% Permit No. Occupancy & Fahecked 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) Date f To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number 363 .—J -Qt -(N S,DN -Si— Owner or Tenant_ S' y S ��'Ly t e --,D 4F*rz- s r wuL_ Owner's Address Is this permit in conjunction with a building permit Yes 0 No h( (Check Appropriate Box) Purpose of Buildinq Utility Authorization No. Existing Service 2 Amps 2�D f Voits O Undgmd 0 No. of Meters I New Service Amps Voits Overhead 0 Undgmd 0 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work E w f E -x 1 S -T'7 ^-lc— S7 7Z L-,NE cam, Q c A D J -n o nj , v 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 0 NO have submitted valid proof of same to the Office YES r NO 0 If you have checked YES please indicate the type of coverage by checking the appropriate box tNSURANCEX BOND t, OTHER 0 (Please Specify) f (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties of pedury FIRM NAME__. CrC1%ILC.t—� �l� CZ'r >`Lt c RC_ S�7'L✓t t_.ES I f1J LIC. NO.14 Licensee �`3 �"� S� C- c=am 1 Gy ¢' Signature LIC. NO. Address 5-7`�1 13a S'tt�n/ Q, C), 9;r-3 , 13 1 LA—t--Q- k c� I MA Bus Tel No. Art 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 1 General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ 3a (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 grnd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners 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 Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers SpacelArea Heating KW Detection/Sounding Devices 0 Municipal 0 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 v 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 0 NO have submitted valid proof of same to the Office YES r NO 0 If you have checked YES please indicate the type of coverage by checking the appropriate box tNSURANCEX BOND t, OTHER 0 (Please Specify) f (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed underthe Penalties of pedury FIRM NAME__. CrC1%ILC.t—� �l� CZ'r >`Lt c RC_ S�7'L✓t t_.ES I f1J LIC. NO.14 Licensee �`3 �"� S� C- c=am 1 Gy ¢' Signature LIC. NO. Address 5-7`�1 13a S'tt�n/ Q, C), 9;r-3 , 13 1 LA—t--Q- k c� I MA Bus Tel No. Art 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 1 General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ 3a (Signature of Owner or Agent) Name: Location: - city Phone # 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address Ci : Phone #: Insurance Co Policv # Com an name: Address City: Phone #: Insurance Co Policv # 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 $1,500.0( and/or one years' imprisonment as veep_as_civil.,penalties.in1he1nm-ofa STOP WORK ORDER_and.a.fine.of_(.$1A0_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. y I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature, Print name Phone # Official use only do not write in this area to be completed by city or town official' Permit/Licensinq City or Town r ❑Check if immediate response is required Contact personPhone . #. LJ Building Dept E] •Licensing Boan Ej Selectman's Of r-1 Health Departrr El Other AC OFD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/29/2003 PRODUCER 781-932-4148 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CUMMINS INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 155 NEW BOSTON STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SUITE 124 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WOBURN, MA 01801 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: CENTRAL INS. COS. ST. GEORGE ELECTRICAL SERVICES, INC. INSURER B: UTICA MUTUAL INS. CO. 574 BOSTON ROAD -- - UNIT 3 INSURER C: BILLERICA, MA 01821 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I OCCUR BOP 7904276 10/30/03 10/30/04 EACHOCCURRENCE $ 1,000,000 PREMISES Ea EWEDnce $ 100,000 _ MED EXP (Any one person) $ 5,000 PERSONALE ADV INJURY $ i'000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS)COMP/OPAGG $ 10001000 X POLICY PRO, LOC B AUTOMOBILE LIABILITY ANY AUTO BAC 3455138 05/26/03 05/26/04 COMBINED (aaccdejINGLELIMIT $ 1,000,000 ALL OWNEDAUTOS SCHEDULEDAUTOS BODILY INJURY $ (Per person) X X X HIREDAUTOS NON,OWNEDAUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY) EA ACCIDENT $ OTHER THAN EAACC $ ANYAUTO AUTOONLY: AGG $ EXCESS/UMBRELLALIABILITY EACHOCCURRENCE $ 1,000,000 A X1 OCCUR FICLAIMS MADE CXS 7904277 10/30/03 10/30/04 AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ X RETENTION $ O A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC 7904278 10/30/03 10/30/04 WC STATU 0E X TORY LIMITS R ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE > EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below NO E.L. DISEASE > POLICY LIMIT 1 $ 500,000 OTHEP. DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER TOWN OF NORTH ANDOVER WIRING INSPECTOR 120 MAIN STREET NO. ANDOVER, MA 01845 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTAT6S. , _ I g AUTHOR¢EM ESENI - - •-J ACORD 25 (2001108) ' ACORD CORPORATION 1988 Dear Mr. Pelich: I am in receipt of your letter dated July 28, 2003, your handwritten site plan calculations, and I have reviewed the proposed changes depicted on the architectural drawings titled, "Johnson Street Residence," which were prepared by Architectural Design Concepts and on the plan titled, "383 Johnson Street Realty Trust," which was prepared by Merrimack Engineering Services, 66 Park Street, Andover, MA 01810, Scale 1" = 40', Dated 8/1/03. In accordance with Special Condition 1(b) of the Watershed Special Permit dated December 23, 2002, I find that proposed changes are not substantial. Accordingly, I am administratively approving your request to move the location of from Johnson Street to Lisa Lane and to expand the approved 2 stall 24x24 garage and replace it with a 3 stall 24x34 garage as well as construct a breezeway attaching the garage to the back door of the existing house. Please feel free to call me if you have any additional questions. Sincerely, Woods, Planning Director cc: Community Development Dir, Conservation Administrator Director of Public Works Building Commissioner Planning Board Health Administrator Engineer Planning Board Assessor Police Chief Clerk Fire Chief Applicant BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover NORTh Office of the Planning Department °f Community Development and Services Division F A 27 Charles Street Are. North Andover, Massachusetts 01845 4SSACNUS�� Planning Director. hM2://www.townofnorthandover.com p (978) 688-9535 J. Justin Woods lwoods@townofnorthandover.com F (978) 688-9542 NOTICE OF MINOR MODIFICATION SENT USPS VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED , # r700;) 05 IU OOW 0894 4V w August 6, 2003 G-) Joe Pelich, Jr. 6 (� c 383 Johnson Street Realty Trust 44 Mitchell Road y-) r Ipswich, MA 01938 RE: 383 Johnson Street Lot 1 Administrative Approval of Minor Modification to Watershed Special Permit Dear Mr. Pelich: I am in receipt of your letter dated July 28, 2003, your handwritten site plan calculations, and I have reviewed the proposed changes depicted on the architectural drawings titled, "Johnson Street Residence," which were prepared by Architectural Design Concepts and on the plan titled, "383 Johnson Street Realty Trust," which was prepared by Merrimack Engineering Services, 66 Park Street, Andover, MA 01810, Scale 1" = 40', Dated 8/1/03. In accordance with Special Condition 1(b) of the Watershed Special Permit dated December 23, 2002, I find that proposed changes are not substantial. Accordingly, I am administratively approving your request to move the location of from Johnson Street to Lisa Lane and to expand the approved 2 stall 24x24 garage and replace it with a 3 stall 24x34 garage as well as construct a breezeway attaching the garage to the back door of the existing house. Please feel free to call me if you have any additional questions. Sincerely, Woods, Planning Director cc: Community Development Dir, Conservation Administrator Director of Public Works Building Commissioner Planning Board Health Administrator Engineer Planning Board Assessor Police Chief Clerk Fire Chief Applicant BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Date.?? ............................ NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . ........................ has permission to perform .................................. .............................. wiring in the building of.... .................... v 4 at.. ............................... .North Andover, Mass. Fee.Q ��Y, ....... Lic. No: �%. .................................................... ELECTRICAL INSPECTOR Check# le " 'I'Y L; A 1 01 TRECOMMONWF+ LTHOFMAS94CRUSL+77S Office Use only DEMRTMEATWOLICS MY Permit No. BOARDOFFIREPMIIFNHONRE131IIA770 117CMR12,OO f Occupancy & Fees Checked APPLICA77ONFOR PERMIT TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUATS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) J Date Z 0 Town of North Andover i, To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work des ri6'ed below. Location (Street & Number)--�j Owner or Tenant '� �Z,W ,t_} S t ��^ 1/�-�>t�z��-/ 1 ky S Owner's Address P `7 D c� ` N1 A. Is this permit in conjunction with a building permit: Yes No a (Check Appropriate Box) Purpose of Building Utility Authorization No. 1 Zq Z 3 Existing Service Amps volts Overhead Underground 1:3 No. of Meters New Service Amps ( /2goVolts Overhead r7TUnderground No. of Meters = Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t t4 0 6 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA It round around ri ,No. of Receptacle Outlets _ No. of Oil Burners No. of Emergency Lighting Battery Units 4No. 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 Signs Bailasis No. Hydra Massage Tubs No. of Motors Total HP OTHER• IhalveatbniXdvalidproofofsa W1DtheOfoa MULViCE a WbtkioSw FIRMNAME G YES ©/ NO M S,pleaseitXk*theq aofCD%Wdgeby OTHf o ftm> EWm*d VArofEbchiral Wdk $ D*_`%`4 Fmd Lio=Na M s,..l A A 1 --4 —LQ o � tessTelNo. _(, S L Q ti .� � iss Alt TdNa 9`7 8- -32,��O $ 6 z-- OWNER'SINSURAN(EWAM5lam drttheLiomsedomnothaveth-,ma no camWerAsa*sUtdegtti4fftasmgtmadbyMimadm CfnedLaws andd a mysignatiaeendnspemitappbcabmwaivesdlismW'mrtalt (Please check one) Owner Agent Telephone No. PERMIT FEE $ Signature or Owner or Agent Location g e No. _7 S Date /0-1- [ U NORT01 TOWN OF NORTH ANDOVER .. P Certificate of Occupancy $ b •'�� Building/Frame /Frame Permit Fee $ / C� cNusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check #� 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: / "[ Building Commissioner/1-or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: JY3 �3nfAU 5d1ti S7— 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ,� J/` / J /V % /V U ! V�/ \ 1.3 Zoning Information: Zoning Dist;ic—t Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide Rqttired Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record A 6z Name (Print) Address for Service :�� , 1�/��0✓ /l/\ Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed CJnstruction Supervisor: Licensed Constr>kction Supervisor: /Z6 �/+T &%� X f � 6�Q h�� !Address l/j(� M �A Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name , _ _ ,r, ` f VLT/ Registration Number M '� S Expiration Date Signature Telephone v rn G O Z rn 90 S O wn ic r v M ror as z a SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check aR a licable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: IF E00 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building �rJ�j CT�4 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - I, Lac O as Owner Agent�l property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief r� Print Name !r Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TITVMERS 1 ST2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ✓he iiamommawald of � is ivaetl3 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 051635 Birthdate: 0529!1935 Expires: 05292001 Tr. no: 8925 k Restricted To: 00 THOMAS J SAYERS 116 WASHINGTON ST GROVELAND, MA 01834 f Administrator i_� _ - ;��e r�in3nonr��� a�✓��.aa.tac�cc� _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 108503 Expiration: 08119!2002 Type: PRIVATE CORPORATION J N R GUTTERS, INC. Jonathon Raymond 114 Hale St. Haverhill, MA 01830 Administrator f r 9 DATE (MINDWY) MD. CERTIFICATE OF LIABILITY INSURANCE 09/05/,AO OUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION K. McCarthy Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IO Cummings Center Suite#101F HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. !verly MA 01915-6105 18 927-8899 1RED IR Gutters, Inc. .4 Hale Street, Suite 204 iverhill, MA 01830 M=oer_Gc INSURERS AFFORDING COVERAGE INSURER/: The Travelers Insurance INSURERS: Transportation Insurance INSURER C INSURER D: INSURER E: IE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING JY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR aY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH )LICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I I TYPE OF INSURANCE POLICY NUMBER l POLICY EFFECTIVE DATE MIDD/YY POLICY EXPIRATION DATE MM/D LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FXI OCCUR I 6 8 0 8 7 7 Y 616 5 I ND 0 0 06/12/00 06/12/01 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Arty one fire) $300,000 MED EXP (Any one person) $5,000 PERSONAL 3 ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY j ROT LOC PRODUCTS-COMP/OP AGG s2,000,000 AUTOMOBILE X X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Cail I 810 6 7 2 K7 4 4 8 I ND 0 0 06/21/00 06/21/O1 COMBINED SINGLE LIMIT (Ea accident) $500,000 BODILY INJURY (P -Pe—) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS LIABILITY X OCCUR F CLAIMS MADE DEDUCTIBLE X RETENTION $10000 I S FCUP 8 81D 13 3 2 I ND 9 06/12/00 j I 06/12/O1 EACH OCCURRENCE s4,000,000 AGGREGATE s4,000,000 S $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC222812100 09/20/99 09/20/00 09/20/00 09/20/01 WCS - OE EL EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $1001000 E.L. DISEASE - POLICY LIMIT $5 O O 0 0 0 OTHER :SCR' PTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEIYIENT/SPLUML PNUV1WUNS vidence of insurance ERTIFICATE HOLDER if ADDITIONALINSURED;INSURERLETTER: CAfjdELLAV6Wj S ULD ANY F Et3VEDESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION NR Gutters, Inc. ATETHER ISSUING INSURER WILL ENDEAVOR TO MAIL IJD___DAYS WRITTEN .14 Hale Street, Suite 204 NOTICET HOLDERNAM ED TOTHE LEFT, BUT FAILURE TO DOSOSHALL iaverhill, MA 01830 IMPOSE O �TI NOR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR Town of North Andover o� tAa h O Building Department �o 27 Charles Street North Andover, Massachusetts 01845 ?, 0 � G9 [o[..iiw Kr 1• � (978) 688-9545 Fax (978) 688-9542 9SSACHU`��� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: Facility location Signature of Applica G12,10'-7) Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. W= Free Estimates GUTTERS, INC, Fully Insured F' --110=11111111111111111111111 "Your Nome Improvement Specialist" GUTTER All Types of Home Improvement Seamless Gutters • Vinyl Siding and Trim Work www. jnrgutters.baweb.com- Haverhill, MA: (978) 372-4088 114 Hale Street, Suite 204 Nashua,NH: (603) 595-2272 Woburn, MA: (781) 937-4212 Haverhill, MA 01830 Portsmouth, NH: (603) 433-1811 Boston, MA: (617) 423-3559 Manchester, NH: (603)666-5502 Massachusetts: (800) 552-0030 FAX: (978) 372-0360 Toll Free Nationwide: (800) 966-9238 (in Mass Only) PROPOSAL YBpAITTEUO P °}�$ _ 6 8 6- 9 5 2 6 DATE olllln eeman DATE 2 6/ 0 0 STREET JOB NAME 45 Pinerid a Road 383 John son Street CITY, STATE and ZIP CODE JOB LOCATION Nn- Anc3over, MA 01845 No. Andover MA ARCHITECT DATE OF PLANS JOB PHONE 978-685-2357 fPie jJXIIpDSB hereby to furnish material and labor - complete in accordance with specifications below, for the sum of: Twelve Thousand and 00/100 dollars($ 12, 000.00 >. Payment to be made as follows: Due Upon Completion of the Joh We hereby st�micspe ficat� d estl ate f r: J—N—V W �! Sfitet SHTMrT.FS VVnM , CaTn MTTTT_nTT7f1 rrm nTL1n^C,7n ,," All material is guaranteed to be as specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any alteration or devia- V� tion from specifications below involving extra costs will be executed only upon Signature written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our con- Note: this propoa may be trol. Owner to carry fire, tornado and other necessary insurance. Our work- ers are fully covered by Workmen's Compensation Insurance. withdrawn by us not accepted within We hereby st�micspe ficat� d estl ate f r: J—N—V W �! Sfitet SHTMrT.FS VVnM , CaTn MTTTT_nTT7f1 rrm nTL1n^C,7n ,," m m m m 0 m CO) .p CD C. Z O. 0 CL =. aco -p -o o p CL Q CD O CA 10 CD O 0 CO) 0 y d CD rM CD CD a, y CD CO) CCD 0 CD C C?�O O S =y O C y dO S EO 10 ti » o o m c2 U2 (") d 0 -+ iii Z y - ?� y O� 010 so. ED. TI CL CL Er CD �0 0 y o m p y O =r m m N > >aq � o 0 otic ' ►-� c ap, y��... m �e =r r� o s dc O H c Cis :d v C d CD .� n - 0- y d 3m r7 y O. C/) o �� a y��m tC C O � W OEM p m A N lo _ . 0 C/) d C/) p ro con. n �' O omi 0 O C ,AORTIA 14 O p ,SSA- SEt Date. l /. `. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. `. V.� .�'....� . ................. has permission to perform ... ................ plumbing in the buildings of .. JJ c. /.i. J.'..... !�........ at ... ...... ...... ; ... , North Andover, Mass. FeeLic. No. ............ ....... ......... PLUMBING INSPECTOR Check # 577 MASSACHUSETTS UNIFORM APPLICATION,FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, Building Location tv CM Owners Name of 'Date /G' L `K Permit # f"% Amount / 9 d New rl Renovation Replacement 1:1 Plans Submitted Yes No /4 FIXTI JRF.S (Print or type) Installing Company Name Address f it V L Chec ne: Certificate Corp. Partner. ElFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ❑ Liability insurance policy �r 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 Signature Owner I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and instal] compliance with all pertinent provisions of the Massachu? City/Town APPROVED (OFFICE USE ONLY Agent entered) in above a* yoria;pplication e and accurate to the ►ec'�und r Pe d will be in A an Cha er 1General Laws. XPlumbing License ❑cense ur er Master Journeyman Date. ./�.. .6. ?..... p`i�I 'o ,see �L , TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ................... has permission for gas installation Y. P.......... in the buildings of ...?. ..`............... ................ at , . fi.......,! : c :. r, ......... North Andover, Mass. Fee.. .... Lic. No. ... .... -.^.... . ,-GAS INSPECTOR Check # ) • , i, 6 5J (-( .�✓" 9 MASSACHUSEPiS UNIFORMAPPLICATONFOR PERM TODO GAS FrFIING, (Type or print) Date NORTH ANDOVER, MASSA HUSETTS Building Locations rJ Permit # MI— !Amount $ c(o Owner's Name tT New Renovation ❑ Replacement ❑ Plans Submitted (Print Name Addre Name of Licensed Plumber or Gas Fitter V( Checke: Certificate Installing Company Corp. rlPartner. ElFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes E] No O If you have checked yes, please indicate the -coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1:1 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. Check one: Signature of Owner or Owner's Agent Owner 13 Agent i nereoy cer[try tnat au or the aetaiis and mtormation 1 nave submitted (or entered) in above application ar a and accurate to the best of my knowledge and that all plumbing work and installati perfor e nder P �ued is lication will be in compliance with all pertinent provisions of the Massachusett StateG _ d and � neral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber 9�7 G MGas Fitter License 1winber rl Master Journeyman 1-- U z F CA Ri � C4 � �i cn x F C7 M � N � �"' �z rn F W O O `�' p W F wxWww 0LTi > UFZ 0G wC4 F z O Ua0 z0 W 0 `1 U a� F O 1 SUB -BASEM ENT B A S E M ENT 13R 1ST. FLOOR 2ND. FLOOR D. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR - I ELI EEd (Print Name Addre Name of Licensed Plumber or Gas Fitter V( Checke: Certificate Installing Company Corp. rlPartner. ElFirm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes E] No O If you have checked yes, please indicate the -coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1:1 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. Check one: Signature of Owner or Owner's Agent Owner 13 Agent i nereoy cer[try tnat au or the aetaiis and mtormation 1 nave submitted (or entered) in above application ar a and accurate to the best of my knowledge and that all plumbing work and installati perfor e nder P �ued is lication will be in compliance with all pertinent provisions of the Massachusett StateG _ d and � neral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber 9�7 G MGas Fitter License 1winber rl Master Journeyman 1-- Location -:7—D ) iy J S4 J No. .164 Date c>)' 7 TOWN OF NORTH ANDOVER /r • o L i Certificate of Occupancy $ �7b'"•°''<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Feed Cal $ TOTAL $ i Check # /06 Building Inspector 11 C3 tj O 0 C2. w ta j -t 44 qmw Ob ev 16. CL CL 0 lz aG w M cn w C3 tj W, r, O 0 C2. w ta j -t 44 qmw W, r, O 0 C2. w ta cm 0 44 qmw Ob ev 16. CL CL 0 Location 1�3 12�A<ft ' f(et�� No. Date HORT1j TOWN OF NORTH ANDOVER O F A Certificate Occupancy of $ CM�s t�' Building/Frame Permit Fee $ 90, 0D ti Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 66 i 0 f Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING �r s� BUILDING PERMIT NUMBER: / DATE ISSUED: 3 (� to - o \ SIGNATURE: /V Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 383 �'ot.►>,,1�-Jou �-+e�-�� 05 1% G 007 ��� ' Y'�d • Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: z�. ai( Zoning District Proposed Use Lot Asea Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide Required Provided R red Provided 1.7 WaterS M.G.L.C.40. 54) 1.5. Flood Zone Information: Zone Outside -,Municipal 1.8 Se`w� posal System: Public Private ❑ Flood Zone V. % On Site Disposal System 0 SECTION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT Historic District: Yes No 2.1 Owner of Record 383 -�10N�l�a-t-t Reay. TRS-• zav �ame (Print) Address for Service 78 6a;5 •22 (Signature Telephone �+ C.CCL R?P�"FS�S' SSS" 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ eve C. Mbne7es Licensed Construction Supervisor: 0 U $1 l2 License Number AdIET + g 7p0J Jl • Address ! (O I Zai Z Oo 2 7 Expiration Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 rn W O z rn 90 O r v M r r z 0 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction hP1 Existing Building ❑ I Repair(s) CL..., I Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ Other ❑ Specify Brief Description of ProposedWork: f I SFCTTON 6 - F,STIMATF.D CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAI.IJSE ONLY 1. Building(a) Building Permit Fee Multiplier 2 Electrical 000 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC Z v 5 Fire Protection �- 6 Total 1+2+3+4+5 & b o 0 Check Number SECTION 7a OWNER AUTHORIZATION 'TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,�7�iEti C • {�IL�""3�S / 'a%'�J5w S'as Owner/Authorized Agent of subject property Hereby authorize !�2'—(eoclj C.to act on My, in all mat � elative to work authorized by flus building permit application �J I Si afore of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 5Z_1 ='AJ K46I of as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief 5TVVcw C • iyt e,� t--� Pri Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 RD SPAN DEVIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f ✓1ze �omvrrea�uuea�i o���aa�taclu�aella `\) BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number::CS: 005712 d d Birthdate 4:0123/19; Expires ,j 3r2b( — — Resiri f d: U0 . i' STEVEN C MATSES 202 SUTTON ST N ANDOVER, MA 01545.: i a: E Tr. no: 5747 Administrator 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: CRAKLC-5 Acle (Location of Facility) tail Signature of Permit Applicant ---g�Z/g Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector From: Doug Lucciano At: Catalano Ins Agency FaxID: To: Susan Date: 9/42003 02:43 PM Page: 2 of 3 AC ORD CERTIFICATE OF LIABILITY INSURANCE OP ID D YSTE-5 DATE (MM/DD/YY) 09/04/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DATE (MM/DD/YY) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Catalano Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Griffin Brook Dr, S#100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 07/23/03 Methuen MA 01844-1865 Phone:978-688-4667 Fax:978-682-9037 INSURERS AFFORDING COVERAGE INSURED INSURER A: Western World Insurance INSURER B: TRAVELERS INSURANCE COMPANY GENERAL AGGREGATE s2,000,000 System Builders, Inc. Seve Matses INSURER C: AMERICAN INTERNATIONAL GROUP 202 Sutton Street No Andover MA 01845 INSURER D: INSURER E: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE rT OCCUR NPP841272 07/23/03 07/23/04 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEa LOC PRODUCTS - COMP/OP AGG $1,000,000 B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS I810582H2476 04/01/03 04/01/04 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ 500 , 000 (Per person) BODILY INJURY $ 500 , OOO (Per accident) PROPERTY DAMAGE s250,000 (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY OCCUR F7 CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 3334627 04/01/03 04/01/04 X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE- POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS All operations usual and customery to the named insured. CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION 383JOHN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 383 Johnson St Realty LLC 383 Johnson St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR No Andover MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Catalano Insurance Agency ACORD 25-S (7/97) V ACUKU cUl<rUKA I IUN 1 yua Existing Residence — 383 JOHNSON STREET Furnish and install new HVAC, Plumbing and Electrical Services. Install all new flooring Sheetrock walls as required Paint all walls and ceiling Install a new Kitchen with appliances. FORM U — LOT RELEASE FORM INSTRUCTIONS: This form, is used to verify that all necessary approvals/permits fro, 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 6tl �� /LOCATION: Assessor's Map Number SUBDIVISION (STREET 353 'Sa99--,owr COMMENTS Z///1.17 — FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS --PHONE g1_6 -68S'3'SS --PARCEL LOT (S) QST. NUMB ER ****-OFFICIAL USE AGENTS: TOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERAVATER CONNECTIONS 111�_ PERMIT - Z7v j FIRE DEPARTMENT Mr -&W i(C Uh-M& c1�k_Qj) r a,,n j l AT Fac o�� heap S s 9 e'en..a AT" F'e � rc0,vd, GlrP1xv ,Z,0a3� RECEIVED BY 13UILDING INSPECTORDATE Revised 9W im 4/7 Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY; 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to INCLUDE SPRINKLER PLAN AND CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT be returned) TO HYDRAULIC In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. 0 I t ui z Cd 0 9 0- a 0 a -coo 0 //-- cc N o :• � Q 2 o r aC � C/) U) ui z -kq7t 0 0 v • ria c y p 'v ' m m 0 CD 3.0 O O p i O d CL C< C O C C z ts CL � �..± CO) C c C C _c C. CA E 0 U) frW W ccW LLI vJ r //-- cc N SAX•. � : C� Cj :• � Q aC � m C O � N g Q Q h . m �-- W. o 0 CL. _ �jIm� a L .gym 0: : Cf A c Do(1f� ;o 401 �o 00 A Q Slei m me 4z�j CLU m N m �F N CD a m T QyZ V O H d m C C 'O Q = m •: :moo � N opF- m_■. m WCO 'fNA 'C L r AD is m r dt CSv •N Z o LU L3 a CM m: COD O N •O .0 SME C) = =JeaMm� -kq7t 0 0 v • ria c y p 'v ' m m 0 CD 3.0 O O p i O d CL C< C O C C z ts CL � �..± CO) C c C C _c C. CA E 0 U) frW W ccW LLI vJ r Town of North Andover Office of the Planning Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Heidi Griffin Planning Director Any appeal shall be filed Within (20) days after the Date of filing this Notice In the Office of the Town Clerk Notice Of Decision Telephone (978) 688-9535 Fax (978) 688-9542 C= C.. CD C -D C� i' —+-< '� (V Zr: F'-1 1 t' ` :L G� c .' i!3 W�� �r>-:' Date: December 17, 2002 Do c Date of Hearing: Decemb=3, 2P & December 17, 2002 cn 1 N Petition of: William Barrett Homes, Inc., 1049 Turnpike Street, North Andover MA Premises Affected: 383 Johnson Street, Lots 1, 2, 3, & 4, North Andover, MA 01845 Referring to the above petition for Watershed Special Permits for Lots 1— 4. The application was noticed and reviewed in accordance with Sections 4.136 and 10.3 of the North Andover Zoning Bylaw and M.G.L. c.40A, sec. 9. So as to allow: For Lot 1; construction of a 576 s.f garage, driveway and grading and drainage structures within the Non -Discharge Zone. For Lot 2; construction of a 3,415 s.f residence, paved driveway, drainage structures and grading within the Non -Discharge Zone. For Lot 3; construction of a 3,738 s.f residence, a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone, and construction of a paved driveway, grading and drainage in the Non - Disturbance Zone. For Lot 4; construction of a 2,596 s.f residence a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone, and construction of small portion of the structures, a paved driveway, grading and drainage structures in the Non -Disturbance Zone. After public hearings given on the above dates, the Planning Board voted to APPROVE the Watershed Special Permits, based upon the following conditions: Signed: 6) /)"a 'S'% 0 Jdhn Simons, Chairman Cc: Applicant Building Department Richard Nardella, Clerk Engineer Conservation Department Felipe Schwarz Abutters Health Department George White DPW ZBA BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANINTING 688-9535 383 Johnson Street, Lot 1 Special Permit - Watershed Protection District The Planning Board makes the following findings regarding the application of William Barrett Homes, Inc., 1049 Turnpike Street, North Andover, MA, 01845, submitted on October 11, 2002, requesting a Special Permit under Section 4.136 of the Zoning By-L'aw to allow the construction of a 576 square foot garage and driveway accessory to the existing dwelling and grading and drainage structures within the Non -Discharge Zone of the Watershed Protection District. FINDINGS OF FACT: In accordance with 4.133 the Planning Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds: 1. That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning Board bases its findings on the following fact$: a) The proposed structure will use the Town sewer system. b) A deed restriction will be placed limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit of clearing is restricted to the minimum necessary. e) Certification has been provided by a registered professional engineer that the new structure will not have an effect on the quality or quantity of runoff entering the watershed protection district. f) The plans and documentation have been reviewed by the town's outside engineering consultant, VHB, and with the application of the erosion control, and use of organic low nitrogen fertilizers, there will be no degradation to the quality or quantity of water in or entering Lake Cochichewick. 2. There is no reasonable alternative location outside the Non -Discharge Zone for any discharge, structure or activity, associated with the proposed project as most of the buildable portion of the lot is located within the Non -Discharge Zone. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: a) The specific site is an appropriate location for the proposed use as all feasible storm water and erosion controls have been placed on the site; b) The use will not adversely affect the neighborhood as the lot is located in a residential zone; c) There will be no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use is in harmony with the general purpose and intent of the North Andover Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: a) Plan titled: Site Development Plan of Land Lots 1-4 Johnson Street North Andover, MA For William Barrett Homes Inc. Prepared by: Merrimack Engineering Services 66 Park Street Andover, MA 01810 Scale: 1" = 40' Date: August 30, 2002, last revised November 11, 2002 b) The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would require a public hearing and modification by the Planning Board. 2) Prior to issuance of a building permit: a) A performance guarantee of one thousand ($1000) dollars in a form acceptable to the Town of North Andover must be posted to insure that construction will take place in accordance with the plans and the conditions of this decision and to ensure that the as -built plans will be submitted. b) All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner. c) No pesticides, fertilizers or chemicals shall be used in lawn care or maintenance. The applicant shall incorporate this condition as a deed restriction, a copy of the deed shall be submitted to the Town Planner and included in the file. 3) Prior to release of the Performance Bond: a) The applicant shall submit an as -built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as -built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved pian. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 4) In no instance shall the applicant's proposed construction be allowed to further impact the site than as proposed on the plan referenced in Condition # 1. 5) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 6) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 7) This permit shall be deemed to have lapsed after a two- (2) year period from the date on which the Special Permit was granted, or December 17, 2004 unless substantial use or construction has commenced. CC. Applicant Engineer File s Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number WPA Form 7 — Extension Permit for Orders of Conditions 242-1159 L11 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. General Information Important: When filling out 1 forms on the computer, use only the tab key to move your cursor - do not use the t k Applicant: Joseph M. Pelich, Realty Trust Name 725 Boxford Street maning Address North Andover re urn ey. city/Town „Q 2. Property Owner (if different): Same Name Brtm iamng Address City/Town B. Authorization MA. State State 01845 Zip Code Zip Code The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on: 8/20/02 uate for work at: 383 Johnson Street Street Address recorded at the Registry of Deeds for: Essex North County uemncate (Ir registered land) is hereby extended until: 8/20/06 uate Map 98A Assessor's Map/Plat Number Instrument # 39352 Book D-1 waa:-Q This date can be no more than 3 years from the expiration date of the Order of Conditions or the latest extension. Only unexpired Orders of Conditions or Extension may be extended. Date the .Order was last extended (if applicable): Issued by: North Andover Conservation Commission Date 7�i y�o s Date wpaform7.doc • rev. 3/1/05 Page 1 of 3 Massachusetts Department of Environmental Protection DEP File Number: I Bureau of Resource Protection - Wetlands WPA Form 7 — Extension Permit for Orders of Conditions 242-1159 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Authorization (cont.) This Order of Conditions Extension must be signed by a majority of the Conservation Commission and a copy sent to the ap i nt and the appropriate DEP Regional Office. Signatures: C Acknowledgement Essex North Commonwealth %J Massachusetts County of — On this Day 13 of '3Ld oZ00S Month Year Before me, the undersigned Notary Public, personally appeared S(x-R MC.sse.- Name of Signer proved to me through satisfactory evidence of identification, which was/were Massachusetts License Description of evidence of identification to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its stated purpose. As member of North Andover City/Town Place notary seal and/or any stamp above wpaformTdoc • rev. 3/1/05 Conservation Commission i" � � �62 Si ature of Notary Public t,,�qn4,4 a Wedgie Printed Name of Notary Public My Co xpire COMMONWEALTH OF MASSACHUSETTS (IMIy Com E>ft AM. 7. = Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 7 — Extension Permit for Orders of Conditions 242-1159 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Recording Confirmation Provided by DEP The applicant shall record this document in accordance with General Condition 8 of the Order of Conditions (see below), complete the form attached to this Extension Permit, have it stamped by the Registry of Deeds, and return it to the Conservation Commission. Note: General Condition 8 of the Order of Conditions requires the applicant, prior to commencement of work, to record the final Order (or in this case, the Extension Permit for the Order of Conditions) in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, it shall be noted in the Registry's Granter Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, it shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. Detach page 3 of Form 7 and submit it to the Conservation Commission prior to the expiration of the Order of Conditions subject to this Extension Permit. To: North Andover Conservation Commission Please be advised that.the Extension Permit to the Order of Conditions for the project at: 242-1159 Project Location DEP File Number has been recorded at the Registry of Deeds of: Essex North County for: Property Owner and has been noted in the chain of title of the affected property in accordance with General Condition 8 of the original Order of Conditions on: Date Book Page If recorded land the instrument number which identifies this transaction is: Instrument Number If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaformTdoc - rev. 3/1/05 Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 Acton Charlton Hopkinton DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales 9 Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Spencer Belchertown East Longmeadow Holland New Ashford Savoy Westfield Fax: 413-784-1149 Bemardston Egremonl Holyoke New Marlborough Sheffield Westhampton Littleton Blandford Erving Huntington New Salem Shelburne West Springfield Grafton Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Blackstone Buckland Gill Lee Northampton Southampton Whalety Charlemont Goshen Lenox Northfield South Hadley Wilbraham Weymouth Cheshire Granby Levereff Orange Southwick Williamsburg Townsend Chester Granville Leyden Otis Springfield Williamstown Princeton Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Milford Chicopee Greenfield Ludlow Pelham Sunderland Worthington Dartmouth Clarksburg Hadley Middlefield Peru Tolland 20 Riverside Drive DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Ashby Douglas Hudson New Braintree Shrewsbury Webster Worcester, MA 01605 Athol Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston Fax: 508 792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Barre Fitchburg Leominster Oakham Sterling Westford TDD: 508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Weymouth Boxborough Hardwick Medway Phillipston Townsend Wilmington Boylston Holden Mendon Princeton Tyngsborough Winchester Brookfield Hopedale Milford Rcyalston Upton Winthrop DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville, MA 02347 Avon Duxbury Halifax New Bedford Rochester Wellfieet Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport Bourne Easton Harwich Norwell Scituate West Tisbury TDD: 508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plympton Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole Arlington Cohassel Hull Middleton Reading Waltham Boston, MA 02108 Ashland Concord Ipswich Millis Revere Watertown Phone: 617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland FBX. 617-556-1049 Belmont Dedham Lexington Nahant Rowley Wellesley Beverly Dover Lincoln Natick Salem Wenham TDD: 617-654-6868 Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpafonn7.doc - DEP Addresses - rev. 7/11/05 Page 1 of 1 N O w O w c jr 0 0Z O cf' 0 o Z o � C) X o m 0 -1 s Town of North Andover Office of the Planning Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Heidi Griffin Planning Director Any appeal shall be filed Within (20) days after the Date of filing this Notice In the Office of the Town Clerk Notice Of Decision Telephone (978) 688-9535 Fax (978) 688-9542 C7 M C -- c) --•1 -i o -,;a C--) c-) f i r-, w C-') Z: c)r-'D< ACD M CD 70U)C7 Date: December 17, 2002 co m > Date of Hearing: December 32002 & December 17, 2002 -0 Petition oh William Barrett Homes, Inc., 1049 Turnpike Street, North Andover MA Premises Affected: 383 Johnson Street, Lots 1, 2, 3, & 4, North Andover, MA 01845 Referring to the above petition for Watershed Special Permits for Lots 1— 4. The application was noticed and reviewed in accordance with Sections 4.136 and 10.3 of the North Andover Zoning Bylaw and M.G.L. c.40A, sec. 9. So as to allow: For Lot 1; construction of a 576 s.f garage, driveway and grading and drainage structures within the Non -Discharge Zone. For Lot 2; construction of a 3,415 s.f. residence, paved driveway, drainage structures and grading within the Non -Discharge Zone. For Lot 3; construction of a 3,738 s.f residence, a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone, and construction of a paved driveway, grading and drainage in the Non - Disturbance Zone. For Lot 4; construction of a 2,596 s.f residence a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone, and construction of small portion of the structures, a paved driveway, grading and drainage structures in the Non -Disturbance Zone. After public hearings given on the above dates, the Planning Board voted to APPROVE the Watershed Special Permits, based upon the following conditions: Signed: V X06 Simons, Chairman Cc: Applicant Building Department Richard Nardella, Clerk Engineer Conservation Department Felipe Schwarz Abutters Health Department George White DPW ZBA BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 383 Johnson Street, Lot 4 Special Permit - Watershed Protection District The Planning Board makes the following findings regarding the application of William Barrett Homes, Inc., 1049 Turnpike Street, North Andover, MA, 01845, submitted on October 11, 2002, requesting a Special Permit under Section 4.136 of the Zoning By -Law to allow the construction of a 2,596 square foot single-family residence, a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone of the Watershed Protection District. And to allow construction of a small portion of the structure, a paved driveway, grading and drainage structures in the Non -Disturbance Zone of the Watershed Protection District. FINDINGS OF FACT: In accordance with 4.133 the Planning Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds: 1. That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning Board bases its findings on the following facts: a) The proposed structure will use the Town sewer system. b) A deed restriction will be placed limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit of clearing is restricted to the minimum necessary. e) Certification has been provided by a registered professional engineer that the new structure will not have an effect on the quality or quantity of runoff entering the watershed protection district. f) The plans and documentation have been reviewed by the town's outside engineering consultant, VHB, and with the application of the erosion control, and use of organic low nitrogen fertilizers, there will be no degradation to the quality or quantity of water in or entering Lake Cochichewick. g) This lot was issued an Order of Conditions by the Conservation Commission on August 20, 2002, DEP # 242-1159. 2. There is no reasonable alternative location outside the Non -Discharge Zone for any discharge, structure or activity, associated with the proposed project as the entire lot is within a protected zone. The structure, driveway, and drainage structures are designed to provide maximum setback from the wetlands on site. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: a) The specific site is an appropriate location for the proposed use as all feasible storm water and erosion controls have been placed on the site; b) The use will not adversely affect the neighborhood as the lot is located in a residential zone; c) There will be no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use is in harmony with the general purpose and intent of the North Andover Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: a) Plan titled: Site Development Plan of Land Lots 1-4 Johnson Street North Andover, MA For William Barrett Homes Inc. Prepared by: Merrimack Engineering Services 66 Park Street Andover, MA 01810 Scale: 1" = 40' Date: August 30, 2002, last revised November 11, 2002 b) The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would require a public hearing and modification by the Planning Board. 2) Prior to issuance of a building permit: a) A performance guarantee of one thousand ($1000) dollars in a form acceptable to the Town of North Andover must be posted to insure that construction will take 4 1 . place in accordance with the plans and the conditions of this decision and to ensure that the as -built plans will be submitted. b) All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner. c) No pesticides, fertilizers or chemicals shall be used in lawn care or maintenance. The applicant shall incorporate this condition as a deed restriction, a copy of the deed shall be submitted to the Town Planner and included in the file. 3) Prior to release of the Performance Bond: a) The applicant shall submit an as -built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as -built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved plan. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 4) In no instance shall the applicant's proposed construction be allowed to further impact the site than as proposed on the plan referenced in Condition # 1. 5) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 6) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 7) This permit shall be deemed to have lapsed after a two- (2) year period from the date on which the Special Permit was granted, or December 17, 2004 unless substantial use or construction has commenced. cc. Applicant Engineer File Conservation Town of North Andover NORTH Office of the Planning Department cf q tie° " a F� Community Development and Services Division _ 27 Charles Street e° .l - North Andover, Massachusetts 01845 "SS"�"USES Planning Director: http://www•townofnorthandover.com p (978)688-9535 J. Justin Woods jwoods@townofnorthandover.com F (978) 688-9542 NOTICE OF MINOR MODIFICATION SENT USPS VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED it 1002 l%J 10 VLMJ 0894 t �oS w "August 6, 2003 -! c) m' F Joe Pelich, Jr.CD € C. -C Ci 383 Johnson Street Realty Trust -0`' = G 44 Mitchell Road r f W -�' Ipswich, MA 0193 8- N RE: 383 Johnson Street Lot 1 Administrative Approval of Minor Modification to Watershed Special Permit Dear Mr. Pelich: I am in receipt of your letter dated July 28, 2003, your handwritten site plan calculations, and I have reviewed the proposed changes depicted on the architectural drawings titled, "Johnson Street Residence," which were prepared by Architectural Design Concepts and on the plan titled, "383 Johnson Street Realty Trust," which was prepared by Merrimack Engineering Services, 66 Park Street, Andover, MA 01810, Scale 1" = 40', Dated 8/1/03. In accordance with Special Condition 1(b) of the Watershed Special Permit dated December 23, 2002, I find that proposed changes are not substantial. Accordingly, I am administratively approving your request to move the location of from Johnson Street to Lisa Lane and to expand the approved 2 stall 24x24 garage and replace it with a 3 stall 2404 garage as well as construct a breezeway attaching the garage to the back door of the existing house. Please feel free to call me if you have any additional questions. Sincerely, Woods, Planning Director cc: Community Development Dir Conservation Administrator Director of Public Works Building Commissioner Planning Board Health Administrator Engineer Planning Board Assessor Police Chief Clerk Fire Chief Applicant BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ABATEMENT CONTROL SERV/CES, INC. ENVIRONMENTAUDEMOLITION CONTRACTORS FEB 19 2003 JANUARY 23, 2003 -- - -Y NORTH ANDOVER BOARD OF HEALTH 27 Charles Street North Andover, MA. 01845 978-688-9540 DEAR SIR/MADAM ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN ASBESTOS ABATEMENT PROJECT. THE JOB WILL TAKE PLACE ON: MONDAY, FEBRUARY 10, 2003 LOCATION: 383 JOHNSON STREET, NORTH ANDOVER, MA. ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY ATTEi,1TION. SINCERLY, FRANK BALOGH PRESIDENT 2 INDUSTRIAL WAY • SALEM, NH 03079 • NH (603) 898-9472 • MA (888) 870-9292 • FAX (603) 898-1846 IMMUCHOMS 1. All sections of this form must be cgmpleted in order to comply with the Department of Environmental Protection notification requirements of 310 CMR 7.15 (ten work/ng dayspnornobficatlon Isrequhso,ofany abatementprojew.. and the Department of tabor and Industries notification requirements of 453 CMR 6.12 (ten day's pnornotlricaban IS repu/red ofANY abatementproject greater than three I/near or square feet), 2. Submit Original Form To: Commonwealth of Massachusetts Asbestos Program P.0.8.120087-0087 3. This Form may be used for notifying the U.S. Environmental Protection Agency Region i of asbestos demolition/renovation operations subject to NESHAPS (40 CFR Subpart M). 6'o/l7/llo//WeaiUioINI#S58CbUsetts AstieslosNotilicatiooforllI_" W 13 AsbesmsAba�emeolDesciiptio� --- - - 1. Facility location:. W 764541 BILL BARRETT 383 JOHNSON STREET Name Address NORTH ANDOVER, MA. 01845 978-682-2397 clvrown Z/p we Telephone BASEMENT & FIRST FLOOR What Ls die works/te locatlon.PBul/d/ng name, 0 wing, 17ool, room 2. Is the facility occupied? t Yes ❑ No 3. Asbestos Contractor: ABATEMENT CONTROL SVC,INC. 2 INDUSTRIAL WAY Name Address SALEM, NH 03079 603-898-9472 0wown Lp code Telephone AC000362 Written DLI License a` Contract Type (Wratten or Yerbav 4. On -Site Project Supervisor/Foreman: ARMAND GOSSELIN Name 5. Project Monitor: SAME 6. Asbestos Analytical Lab: AS33772 DLICertvAcadon a' SAME &ICert/hcatlon 0 AMERICAN ENVIRONMENTAL CONSULTANTS, INC, AA000162 Name DLI Ced/ficatlon 0 2/10/03 2/10/03 7. Project start date end date specific work hours (Mon. -Fri.) 7 am 4 om (Sat. -Sun.) 8. What type of project is this? demolition repair renovaaon other (explain) ASBESTOS REMOVAL 9. Describe the asbestos abatement procedures to be used: glove bag endosure fd/ containment deanup el7gosulab"on disposal only otber(explwn r 10. Is the job being conducted 11 indoors ❑ outdoors? 11. Total amount of each2ypi�of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 10 or other surfaces (square ft.) Ly to be removed, enclosed or encapsulated: 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): Wet removal into 6 mil Poly Asbestos Labeled Bags. 14. For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency: Name Of DEPOfficlal Date ofAuthor/zaWn Walver Name a,'DIJ Offlaal Date ofAuthoriradon Oa/vera' Rev. 6/92 15. Do prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A -F to this project? ❑ Yes ❑ No Unear Square feet Linear Square feet Bd/a;btsad4iiq, dent 6rM wdam axdigs rherma4 scdidm p e nuaam n Canuga2aYar.HlercdpW�-p.'K/rsWSCcn rn."'W 47 rmenf SA'aytn &Oww4q Tian+e(/spays'avGrgs C:blhs AmwfaMe rrlw'e Gain' wdlluwnf Off- (PWW allsa ) Odiar(pease aie¢.ide) VAT 200 12. Describe the decontamination system(s) to be used: FULL CONTAINMENT 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): Wet removal into 6 mil Poly Asbestos Labeled Bags. 14. For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency: Name Of DEPOfficlal Date ofAuthor/zaWn Walver Name a,'DIJ Offlaal Date ofAuthoriradon Oa/vera' Rev. 6/92 15. Do prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A -F to this project? ❑ Yes ❑ No 1 Note., Transfer Sta&MML st aamp/yWffi the Solid Waste Dmgan regldd- &ans310QNR IB.00 1. Current or prior use of facility: RESIDENCE 2. Is the facility owner -occupied residential with 4 units or less? ® Yes ❑ No 3. Facility Owner: -BILL BARRET.T 383 JOHNSON STREET BAP Name Address NORTH ANDOVER, MA. 01845 978-682-2397 Gry/Town Zp code Te%phme 4. Fadlity's Owne(s On -Site Manager: Nam= Address OlY?own Zip code Telephone 5. General Contractor: ' Name Address 0/4'/Town Zip code Te/pphone co0h'a=ys wonlerS cow Insurer Polio' t 6W.. Lame 6. What is the size of the facility?; 1 0 0 (sq ft) 2 (# floors) Asbos�osTfaaspo�taGooandp%sposa/ 1. Transporter of asbestos -containing waste material from site to temporary storage site (if necessary) to final disposal site? ABATEMENT CONTROL SERVICES,INC. 2 INDUSTRIAL WAY Name' Address SALEM, NH 03079 603-898-9472 Gry/Town Z/p code Telephone 2. Transporter of asbestos -containing waste materials from removal/temporary storage site to final disposal site: Name []ry/Town 3. Refuse transfer station and owner (if applicable): Name Address Zip ode Telephone Address 0*r Town Zip code Telephone _ 4. Final Disposal Site: "BFI: IMPERIAL- LANDFILL B. F. I . _ - LocaCm Name Owners Name 1 1 . BOGGSROAD - :. ', - - Address ^:II4PERIAL-, PA-. 151.26 724-695-09.00 city?own Zip code Te%phme The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts Regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. 1/22/03 FRANK BALOGH ' Hint Name -Ai edSignarure DatePRESIDENT ABATEMENT CONTRO SVC,INC. 603-898-9472 f125lL/o4M* Repms _-&g Telephme ' 2 INDUSTRIAL WAY SALEM, NH 03079 / Addmss c otylrbwn Zip carie Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less)? ❑ Yes ❑ No Sticker # (from front of form): j-4 Town of North AndoverQf NoRff Office of the Planning Department 00 Community Development and Services Division 27 Charles Street �RArlo North Andover, Massachusetts 01845 'SsAcmU Heidi Griffin Telephone (978) 688-9535 Planning Director Fax (978) 688-9542 r_s Notice Of Decision; Any appeal shall be filed' r � o j —� Within (20) days after the C--) =1- ; Date of filing this Notice w > C-17.) In the Office of the Town DEC 2 3 2002 0 `-- = Clerk �J m�T Date: December 17, 2002 Date of Hearing: December, 2002 & December 17, 2002 Petition of: William Barrett Homes, Inc., 1049 Turnpike Street, North Andover MA Premises Affected: 383 Johnson Street, Lots 1, 2, 3, & 4, North Andover, MA 01845 Referring to the above petition for Watershed Special Permits for Lots 1— 4. The application was noticed and reviewed in accordance with Sections 4.136 and 10.3 of the North Andover Zoning Bylaw and M.G.L. c.40A, sec. 9. So as to allow: For Lot 1; construction of a 576 s.f garage, driveway and grading and drainage structures within the Non -Discharge Zone. For Lot 2; construction of a 3,415 s.f residence, paved driveway, drainage structures and grading within the Non -Discharge Zone. For Lot 3; construction of a 3,738 s.f. residence, a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone, and construction of a paved driveway, grading and drainage in the Non - Disturbance Zone. For Lot 4; construction of a 2,596 s.f residence a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone, and construction of small portion of the structures, a paved driveway, grading and drainage structures in the Non -Disturbance Zone. After public hearings given on the above dates, the Planning Board voted to APPROVE the Watershed Special Permits, based upon the following conditions: �y SignedAohnSimons, % Chairman Cc: Applicant Building Department Richard Nardella, Clerk Engineer Conservation Department Felipe Schwarz Abutters Health Department George White DPW ZBA BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 /-I 383 Johnson Street, Lot 3 Special Permit - Watershed Protection District The Planning Board makes the following findings regarding the application of William Barrett Homes, Inc., 1049 Turnpike Street, North Andover, MA, 01845, submitted on October 11, 2002, requesting a Special Permit under Section 4.136 of the Zoning By -Law to allow the construction of a 3,738 square foot single-family residence, a portion of paved driveway, drainage structures and grading within the Non -Discharge Zone of the Watershed Protection District. And to allow construction of a paved driveway, grading and drainage structures in the Non -Disturbance Zone of the Watershed Protection District. FINDINGS OF FACT: In accordance with 4.133 the Planning Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. Specifically the Planning Board finds: 1. That as a result of the proposed construction in conjunction with other uses nearby, there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning Board bases its findings on the following facts: a) The proposed structure will use the Town sewer system. b) A deed restriction will be placed limiting the types of fertilizers that can be used on the site. c) The topography of the site will not be altered substantially. d) The limit of clearing is restricted to the minimum necessary. e) Certification has been provided by a registered professional engineer that the new structure will not have an effect on the quality or quantity of runoff entering the watershed protection district. f) The plans and documentation have been reviewed by the town's outside engineering consultant, VHB, and with the application of the erosion control, and use of organic low nitrogen fertilizers, there will be no degradation to the quality or quantity of water in or entering Lake Cochichewick. 2. There is no reasonable alternative location outside the Non -Discharge Zone for any discharge, structure or, activity, associated with the proposed project as the entire lot is within a protected zone. It is not reasonable to flip the house layout and move the driveway out of the Non -Disturbance Zone as that would cause unnecessary alteration in the natural topography of the lot and cause possible conflict with the Residential -3 District building setbacks. i +a In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following findings: a) The specific site is an appropriate location for the proposed use as all feasible storm water and erosion controls have been placed on the site; b) The use will not adversely affect the neighborhood as the lot is located in a residential zone; c) There will be no nuisance or serious hazard to vehicles or pedestrians; d) Adequate and appropriate facilities are provided for the proper operation of the proposed use; e) The Planning Board also makes a specific finding that the use is in harmony with the general purpose and intent of the North Andover Zoning Bylaw. Upon reaching the above findings, the Planning Board approves this Special Permit based upon the following conditions: SPECIAL CONDITIONS: 1) This decision must be filed with the North Essex Registry of Deeds. The following information. is included as part of this decision: a) Plan titled: Site Development Plan of Land Lots 1-4 Johnson Street North Andover, MA For William Barrett Homes Inc. Prepared by: Merrimack Engineering Services 66 Park Street Andover, MA 01810 Scale: 1" = 40' Date: August 30, 2002, last revised November 11, 2002 b) The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would require a public hearing and modification by the Planning Board. 2) Prior to issuance of a building permit: a) A performance guarantee of one thousand ($1000) dollars in a form acceptable to the Town of North Andover must be posted to insure that construction will take place in accordance with the plans and the conditions of this decision and to ensure that the as -built plans will be submitted. b) All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner. c) No pesticides, fertilizers or chemicals shall be used in lawn care or maintenance. The applicant shall incorporate this condition as a deed restriction, a copy of the deed shall be submitted to the Town Planner and included in the file. 3) Prior to release of the Performance Bond: a) The applicant shall submit an as -built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as -built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved plan. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 4) In no instance shall the applicant's proposed construction be allowed to further impact the site than as proposed on the plan referenced in Condition # 1. 5) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 6) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 7) This permit shall be deemed to have lapsed after a two- (2) year period from the date on which the Special Permit was granted, or December 17, 2004 unless substantial use or construction has commenced. cc. Applicant Engineer File Jeri ey: Ur1on, inc.; yid bbd 5y14; t-eo-15-UU 1U:U4AM* rage 1 i 1 February 15, 2000 Susan Ford Health Administrator North Andover Board Of Health 27 Charles Smeet North Andover, MA 01845 Dear Susan, Subs Cat problem on Lisa Lane I wish to have an issue brought up at the February 17th meeting of the North Andover Board of Health. The issue is the health problem associated with the proliferation of cats in the neighborhood at the Johnson Street end of Lisa Lane in North Andover. After speaking with Howard Wensley of the Commonwealth of Massachusetts Department of Public Health, I believe the North Andover Board of Health has an obligation to find some solution to the cat problem in this neighborhood. I describe it as a health issue because of the fact that the cats, at last count numbering over 70, run freely through the yards on Lisa Lane doing all the things that animals do. These obvlously include defecating, breeding, eating, disturbing other pets, and scenting virtually everything that they come in contact with. There are people who have allergies to cats that are suffering tremendously from this situation, and 1 personally have been put on some very expensive asthma inhalers in the past year, having been diagnosed with a severe allergy to cats. People are unable to have gardens, houses smell like cat (inside and out), and entire yards have been turned into litter boxes_ It has gone beyond nuisance and reached a point where something must be done, especially with spring coming. This is a neighborhood with young children. many of whom are still crawling; not a pretty picture, and one that is causing people to begin the process of moving out of the neighborhood. It is not my intention to limit a person's right to own as many pets as they want, within a health limit by State or local standards. However, I do not wish to go on cleaning up after other people's pets on my property and can assure you that a cat has relieved itself at the bottom of my front steps for the last time. Please let me know if this issue can be discussed at the February 17th meeting of the Board. I will attend the meeting at 7:00 PM at the Town Hall conference room, if you tell me the item will be raised. Thank you for your help in this matter. Sincerely, Stephen P. Dawe 44 Lisa Lane North Andover. MA 01846 WATERSHED RESIDENTS QUESTIONNAIRE 1. Name -'tt cc L_.�j �. q c 2. Street Address � 6 3 1:15 C r 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no ❑ do not know _ 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years -- ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes ❑ no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes ❑ no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine V1, dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub _T 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher 0-0 c L: d clotheswasher W 15 12. Does your property have a lawn? [d yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre Q 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year L Season(s) of the year — 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ❑ Che�cY here if your lawn is maintained bye I�j professional landscape contractor. wr � I le a.� 0 r� .r � a 444, i vvz, U 01,14� J t C CL*1 s o �n.e �'kPdA'or' l S , e koRTh 1 3?...." ��'��� BOARD OF HEALTH t ' ♦ t _ ^ Y • �, ..' Y 120 MAW STREET��- 'ss usE��y NORTH ANDOVER, MASS. 01845 t:xt. 32 or 33 COMPLAINT FORM DATE: Jj CASE`s COMPLAINANT: ADDRESS: 3R 3 bin In se v\ PHONE # . OWNER: ADDRESS: PHONE-� ll1G��/ v 1✓ �//"/°4✓�,,.5 ACTIONS. /n63�� , �� / l^/�f140iy/Po��/7 a5 � '� � r �._ DATE OF INSPECTION: �/ Date 5/5/99 Complaint Complaint# - 'J Complaintant Neiman Address 27 Lisa Lane No. Andover, MA 975-9887 Action Owner of Property Owner's Address Comer of Lisa Lane & Johnson Street Phone# Date F 5/12/99 Complaint Complaint# 41 Complaintant I Darlene Torosian Addresss 126 Phillips Court Hm: 687-0067 Bus: 688-9227 Cats - nuisance, excessive numbers hanging out on my parch. Concerned about illness, wife is pregnant. OL Sent ❑ Tub drain is blocked, landlord checked it three times and on the fourth told the tenant to get her own plumber. There is a horrible oder coming from the tub. Tenant wrote a letter to the landlord regarding some things that needed to be taken care of, he Action did take care of some things but there is asbestos in the basement and has not done anything about it, Owner of Property Ronald Pierro I tenant has children. Tenant withholding rent and landlord is evicting her. Owner's Address 126 Phillips Court Phone# 1 688.7578 OL Sent ❑ Date 1 6/10/991Complaint Complaint# 42 Complaintant I Robert Bistany Addresss 47 Stevens Avenue Lawrence, MA 1688,4769 Donuts & muffins are in an open case where people (public) can handle them. There is a sign to use the wrappers that are in the box, he did not see the sign until after he handled the muffins by hand. He was very upset and thought this was not sanitary Action and told the manager. The manager said the system was staying this way. Owner of Property Marie Basket I Sue Ford called the complaintant, explained the code & allowance to self serve non -potentially Owner's Address Rte 114 hazardous foods. No. Andover, MA Case closed. Phone# OL Sent ❑ Date6/29/99 Complaint Complaints 49 Complaintant I Joe Giard Addresss 1419 Johnson Street No. Andover, MA 15 cats - all over the place Action Sandy Starr called 06129199, 11:00am & explained that cats are not regulated. Suggested talking to Owner of Property I neighbor & investigating products designed to repel felines. Owner's Address Phone OL Sent ❑ .4 —i ssr1T T T1TR7 \TTT1f T1T.1T 'JL'lr LJCSlll 1\lJ l'lULLt ULf1L' • � COMPLAINTANT: ` CLOSE DATE: ADDRESS: Gam( Ci PHONE: OWNER: ✓� PHONE #: ADDRESS: INSPECTION DATE: ORDER L DATE: COMPLAINT: ACTION: (,A6 FA Date /10/2000 Complaint Complaint# 96 Complaintant Kathleen Neyman Addresss Phone# 27 Lisa Lane 975.9887 Action Cats urinating on her house. House smells, wants something done. This has been an ongoing problem and no-one will do anything to help. Owner of Property Mary Hoag Owners Address 383 Johnson Street Phone# 978.683.6418 I OL Sent ❑ Mary Hoag 383 Johnson Street All animals vaccinated at Danvers Animal Hospital — 978-774-0045 2/11/00 Called Martha Parkhurst — MSPCA 1-800-628-5808 Researched Town ordinances — Lawrence, MA - None Methuen, MA -None Andover, MA - None Boxford, MA - None Georgetown, MA - Yes 2/11/00 Went to 383 Johnson Street w/MSPCA 2/15/00 State DPH received complaint — Howard Wensley called, could possibly fall under nuisance laws (122). 2/17/00 Request to be on agenda for BOH. Agreed to keep cats indoors. U_i IU/ _UUU 1:;..JG Z' lv QC.v(".UC- � , zurl -QVC U1 CHAPTER 418 FELINE REGULATIONS 418.1 Statutory authority; repealer 418.2 Permit required 4183 Fee 418.4 Sanitary maintenance of premises 418.5 Inspection for issuance of permit 418.6 Severability HISTORY: General References Animals - see Chapter 15 The Board of Health for the Town of Georgetown, Massachusetts, acting under the provisions of Chapter 111, Section 31 and 155 of the Massachusetts General Laws, as amended, has in the interest of and for the protection of public health and animal health. 418.1 STATUTORY AUTHORITY; REPEALER The Board of Health of the Town of Georgetown, Massachusetts, in accordance with and under the authority granted by MGL Chapter 111, Section 31, of the Commonwealth of Massachusetts, hereby adopts the following regulations at a meeting of the Board of Health- 418.2 ealth 418.2 PERMIT REQUIRED. No person spell keep within the limits of the Town of Georgetown eight (8) or more felines without a permit from the Board of Health All such permits shall expire on December 31 of the year of issue and may be revoked by the Hoard of Health for violations of this regulation. . 4183 S&NI ARY MAINMANCE OF PREMISES. The owner or persons in control of any building or premises in which felines are kept shall keep the building and premises clean and free from decaying food, dirt and stagnant water. d_r LJ/ _UUU R . 418.4 7. V JJ..J IAC. _J -VG i DLrl 7G tJ� CHAPTER 418 FELINE REGULATIONS INSPECTION FOR ISSUANCE OF PERMIT The building and enclosure shall be inspected by the Board of Health or its Animal Inspector and shall meet with its approval before issuance of any permits. 418.5 SEVERABILITY So far as this Board of Health may provide, each section of these regulations shall be construed as separate to the end that if any section, item, sentence, clause or phrase shall be held invalid for any reason, the remainder of these regulations shall continue in full force and effect. 418.6 EFFECTIVE DATE: 1 3 LLfi This regulation shall be effective on.3daaek34,1997. stablela:lfelinreg, wpd