The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 401 ANDOVER STREET 4/30/2018 (4) �� ,, .. ', �i' �' i �� North Andover Board of Assessors Public Access Page 1 of 1 NORTp North Andover Board. of Assessors 0;4gao+.a y.0 F •� 9 roperty Record Card Click Seal To Return Parcel ID :210/024.0-0033-0000.0 FY:2013 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales Summary Residence Detached Structure Condo 401 ANDOVER STREET Commercial Location: 401 ANDOVER STREET Owner Name: PLUM 2 TRUST JOHN F MCGARRY,TRUSTEE Owner Address: 401 ANDOVER STREET t45 res �qft EAR AMIN 0250 http://csc-ma.us/PROPAPP/display.do?linkld=2251114&town=NandoverPubAcc 3/26/2013 North Andover Board of Assessors Public Access Page 1 of 1 NORT// North Andover Board of Assessors UEML i Bey f roperty Record Card Click Seal To Return Parcel ID :210/024.0-0033-0000.0 FY:2013 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales ', ~ Summary s Residence Detached Structure Condo 401 ANDOVER STREET Commercial Location: 401 ANDOVER STREET Owner Name: PLUM 2 TRUST JOHN F MCGARRY,TRUSTEE Owner Address: 401 ANDOVER STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:32-2 Land Area: 0.74 acres Use Code: 340-GEN-OFFICE Total Finished Area: 10800 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 1,570,200 1,540,500 Building Value: 1,264,000 1,242,800 Land Value: 306,200 297,700 Market Land Value: 306,200 Chapter Land Value: LATEST SALE Sale Price: 0 Sale Date: 02/01/1984 Arms Length Sale Code: N-NO-OTHER Grantor: OSGOOD,BENJAMIN Cert Doc: Book: 01773 Page: 0250 http://csc-ma.us/PROPAPP/display.do?linkld=2251114&town=NandoverPubAcc 3/26/2013 Commercial Property Record Card PARCEL_ID:210/024.0-0033-0000.0 MAP:024.0 BLOCK:0033 LOT:0000.0 PARCEL ADDRESSA01 ANDOVER STREET FY:2013 PARCEL INFORMATION Use-Code: 340„ Sale Price: 0 Book: 01773 Road Type: T Inspect Date: 07/13/2012 Owner: Tax Class. T Sale Date: 02/01/84 Page:T 0250 Rd Condition: P Meas Date 07/13/2012 PLUM 2 TRUST Tot Fin Area:_10800 Sale Type: P Cert/Doc: _ Traffic: M Entrance: C JOHN F MCGARRY,TRUSTEE Tot Land Area: 0.74 Sale Valid: N Water. Collect Id: RRC Y -� � - Address: Grantor: OSGOOD,BENJAMIN _ Sewer: Inspect Reas: C 401 ANDOVER STREET Exempt-B/L% / Resid-B/L% / Comm-B/L"0/100 Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 COMMERCIAL SECTIONS/GROUPS LAND INFORMATION Section: ID: 101 Use Code 340 ry _ ..NBH-D CODE: 32 N,.BHD. �CLASS: 2 ZONE: GB CategoryGrnd-Fl`Area-StoryHeight Bldg-ClasiYr-Built _ Eff-Y -BuiltCost-Bldg:Se9 CodeMethodS qFtp AcresInflu -Y/N ValuClass 4 5400 20 C 1984 1984 1,279,600 1 P 340 S 32047 0.740 ..� 306,189 Groups: DETACHED STRUCTURE INFORMATION Id Cd B-FL-A Firs Unt w -4 1 340 5400 1 1 Str , Unit Ms-r-4- Msr-2 E-YR-131f Grade Cond%Good P/F/E/R Cost Class 2 340 5400 2 1 AS S 18300 0.00 1984 A A 50///50 22,400 3 VALUATION INFORMATION Current Total: 1,570,200 Bldg: 1,264,000 Land: 306,200 MktLnd: 306,200 Prior Total: 1,540,500 Bldg: 1,242,800 Land: 297,700 MktLnd: 297,700 SKETCH PHOTO A sao6 sR/ Fs 77- 60 60 gn .y w .. is ... s .....,.,... .'°+...... "..,77,'sw,.,p,-' +:L. 401 ANDOVER STREET Parcel ID:210/024.0-0033-0000.0 as of 3/26/13 Page 1 of 1 9-14-15 Town of North Andover, MA 1600 Osgood St. North Andover, MA 01845 Building 20 Suite 2035 RE: BP#912-14 Please find the enclosed Building Permit and Final Construction Control Affidavit.We are now construction complete and this permit can be closed out on your end. If you have any questions or need further information please feel free to contact me at any time. Thank You Kristin Kristin Champagne I RE Consultant Structure Consulting Group 49 Brattle Street I Arlington,MA 02474 (P)781.454.9134/(F)781.791.7704 kchampagne(&structureconsulting.net www.structureconsulting.net Qe V i I Final Construction Control Document s To be submitted at completion of construction by a Registered Design Professional for work per the 8t"edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Number:N/A Project Title: Andover 2 MA Date: August 31, 2015 Property Address: 401 Andover Street,North Andover,MA 01845 j Project: Check(x)one or both as applicable: New construction X Existing Construction II Project description:Verizon Wireless Telecommunications facility(AWS)installation at existing site. Install new antenna and associated radio equipment to existing antenna mounts on the roof. I Derek J.Creaser, MA Registration Number: 49195 Expiration date:6/30/16 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Mechanical Fire Protection Electrical X Other Describe: Entire Project for the above named project. I,or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. j f2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. + 4. This inspection report does not include modifications to the tower structure. Those modification inspections are strictly the responsibility of the tower owner&general contractor performing such installation. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or SVA OF electronic signature and seal: DEREK J. y� CREASER CML ami No.49195 Phone number: (978)557-5553 Hudson Design Group,LLC -8t0MAt. O 1600 Osgood Lndg,Bldg 20N, Suite 3090 North Andover,MA 01845 Email: info@hudsondesigngrouplic.com Building Official Use Only Building Official Name: Permit No. Date: Version 06 l 1 2013 tkORTh own of _E ndover O "`,• uhf ,,I •t No. ver, Mass, 3-44eLAKE A_ coc"Ichewrc■ X01' s � BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ...26M...Z....� S�r�et...-. ... .. tA R.. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on . I..... .... ......... ........ .. ..... .............. Rough 1 to be occupied a4tv. ..Gri � .......................... ... Chimney eres respect conform he terms of the application that the person e tingthlspermit shall Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ........................... ............ ... .......... .. .. ...:�:� Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Datel�/2 ./`v..... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING sSACHU _� /� - This certifies that ..t e 4 IV ................... ............................................................1........ ............. (:��7;W, . has permission to perform . Q'p- ..... ........ ..................................................................... wir*mg in the building of...........e& ............................c n1 ................................. at :........................................................................................................./N�rth Andover,Mass. Fee..............................Lic.No3�....... ................................ ................................................... 2Qiq ELECTRICAL INSPECTOR Check edc electrical design and control inc. w II' robert b. carter president 323 andover street wilmington massachusetts 0.1887 Office:508.657.0900 cell: 617-312-3811 MA. License #A 12950 edcelectrice—comcast.net 1 n N Commonwealth of Massachusetts Official Use Only 1 M Permit No. Department of Fire Services "l Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code Q),527 MR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: f;I City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notic of his or her intention to perform the electrical work described below. Location(Street&Number) CJ A n Zyorr S� . Owner or Tenant Telephone No. " 97T 6 67 6,svl Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Abd No.of Receptacle Outlets No.of Oil Burners 3 13 No.of Switches No.of Gas Burners I No.of Ranges No.of Air Cond. No.of Waste Disposers HeaPump. Numbe ...... No.of Dishwashers Space/Area Heating it No.,of Dryers Heating Appliances it i No.of Water KW No.of Heaters Signs j t 111o.Hydromassage Bathtubs No.of Motors it OTHER: j Adai of Wires. Estimated Value of Electrical Work: 5 00 (Whey _ Work to Start: tri .' Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE n BOND ❑ OTHER ❑ (Specify:) I certify,under the pains,and pe aloes ofperjury,that fi information on this application is true and complete. FIRM NAME: -Iv lit, A[ y h �q� 1^'� LIC.NO.: Licensee: Signature_- LIC.NO.: /li /a 9 50 (If applicable,enter "exempt"z the license number line.) , Bus.Tel.No.•q5 l3 65-7 d`t'az, Address: 3 h��i? ( . �vr i,��" �R Alt.Tel.No.: 6 t 2 31 A 3-6 1 1 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am awgre that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE.$ (Z Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the iq permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the .+ notification of completion of the work as required in M.G.L.c.143,§3L. v Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence".during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IN Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass r?] Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass F?1 Failed(] Re-Inspection Required($.) ❑ , Inspectors Comments: Inspectors Signature: Date: ]FINAL INSPECTION: Pass 0 I[Z Failed (] Re-Inspection Required($.) ❑ Inspectors Comments: L All Inspectors Signature: ate: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 13 pZl "J Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 MR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: f a Lacim City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notic of his or herr,intention to perform the electrical work described below. Location(Street&Number)_ O An X�rr 61 1 Owner or Tenant Telephone No. &tQ--3:3�97T G 67 00 Owner's Address f'] sib Fr,e ,!S Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: rep iA i r, 61 d Completion of the following table may be waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Ceil: TransSusp.(Paddle)Fans Total Trsformers � KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rnd. grnd. Battery Units ;R No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump JAR Tons KW No.of Self-Contained Totals: ""."'.""'."'..""""....................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No..of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Dao.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:' 5 ZJ0 (When required by municipal policy.) Work to Start: >a ? Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA-NCE nr BOND ❑ OTHER ❑ (Specify:) I certify, under thepainslandpen I ies ofperjury,thatfi information on this application is true and complete. FIRM NAME: . LIC.NO.: Licensee: Signature LIC.NO.: 4/c3 9 50 (Ifapplicable,enter "exempt"z the license number line.) �) Bus.Tel.No.• -)8 65-70't0-,-,, Address: 3 3 �� '� . Alt.Tel.No.: 6 11 31 A 3 I 1 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent ! PERIMIIT FEE: $ (Z Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance:with the provisions of M.G.L.c. 143,§3L,the A permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the .. �► notification of completion of the work as required in M.G.L.c.143,§3L. y Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending'through August 15,2012. ❑ Rule 8—Permit/Date Closed: **Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass[N Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: 17 Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ F Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: ate: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth ofMassachusetts , - - Department ofladustricclAceiclents Office o f Investigations 600 Washington Street Boston,MA 02111 www.mass gov/clia Workers'Compensation Ynsurance Affidavit:]Builders/Cont°actors/.Electrxeians/Plinnber.,q _Applicant information Please Print Legibly Name(Business/Organization/tndividual): C-7��'r 4 n J '–�)0 5'/ h " e!:z Ya 4V'� Address: S4 , fit. City/State/Zip: 60 (rh),S 15i�.:> Phone#: 9'7 9 G S ' Ci9 d 1�i. Are you an employer?Check the appropriate box: Type of project(required): .1.91 I am.a employer with 5 4• ❑ I am a general contractor and I 6. ❑New c6ustraction employees(full and/or part-time).* have lured the sub-contractors 2.[l I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and'haveno.employees These sub-contractors have 8. ❑Demolition working for mein.any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corpora]on and.its 1011 Electrical repairs or additions required.] officers have exercised.their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions Myself [1Noworkers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insuran-cerequired.]i employees.[No workers' 13.0 Other comp.insurance required.] X.Any applicant that checks box#1 must also fill out the section below showing their wbrkers'compensationpolicy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached m additional sheet showing the name of the sub.-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolley and joh site information. Insurance Company Name: Policy/#or Self ins.Lic.#: J Expiration Date: Job Site Address: i �r�``� �� City%State/Zip:_ 1'7A d 1 "S Attach a copy of the workers'compensationpoliey declaration page(showing the policy number and expiration crate). Failure to secure coverage as req Aedunder Section 25A of MOL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby cert&under file pains and penalties ofperjury that the information provided above is true and correct. - Signature: Date: Phone 4: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6 Other - -Contact Person; Phone M Informati®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,• express or implied,oral or wxitten." An employes is defined as"an individual,partnership,association,corporation ox other legal entity,ox any two or moxe of the foregoing engaged in a joint enterprise,and including the legal representatives of a•deceased employer,or the receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having notmore than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or ou the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer,, MGL chapter 152,§25C(6)also states that"every state or local,licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth fox any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fu out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)andphone number(s)along with their certificate(s)of insurance. Limited Liability Companies(GLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are notrequired to c�Yworkers'compensation insurance. If an LL C or LL P does have employees,apolicy is.required. Be advised that this affidavit maybe.submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affiidavit. The affidavit should b e retumed to the city or town that the application for the penult or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workexs' compensationpolicy,please call the Department at the number listed below. Self-insured companies should enter their Self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to fill in the permit/license number which will be used as a reference number. In addition an applicant p that must submit multiple permit/license applications in an given year, p pp . r need only Y�• Y y submit one affidavit indicating current PORGY information(ifnecessary)and under"Yob Site Address"the applicant should write"all locations in .(city or town):'A copy of the affidavit that has b eon officially stamp ed or marked by the city or town.may be provided to the applicant as proof that a valid affidavitis on file for future permits or licenses. A new affidavit must be filled out each year,'Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves eta.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call, The Department's address,telephone and fax number: The CouuAouw.oaM o;FMassa.,�hv.:SPtts Department ofIndwWa1.Accidenta Qfoe QfJiRVQ&tigA&n3 60 Waftg o a.Sjroot Boston,MA 02111 TOL 617727-4900 727-4900 ext 406 Qx 1-8777 AS A FE Revised 5-26-05 `ay, 617"727"77¢9 `WWW-MmS,gQV[CHa I j H 5 1 • j ;COMMONWEALTH OF MASSACHUSETTS; e o o iield=1019FAMNLOU :,BOARD OF ELECTRICIANS ISSUES THE FOLLOWING 'LICENSE I AS A RE G JOURNEYMAN ELECTRI C,I�ANcc ,�'•. is KEVIN J YORK 'i 1Lu N 7 CATAMOUNT"ROAD ` TWKSBURY MA 01876 1210 34643E 07/3:.1/16 27489 j _.. SVV SgACHV WEALTH OF ° ° COMMON • ° BOA:. NS EEECTR ELCE.NSE pS, p ... : . EEOWI RG LE TRI OJ aN\� z :1 SSOES 1 K I R 0 icy ' ', 7 C pT pMO�NT R� 6 1210 0181 27 490 �. 2121 1� ov anma Technologies June 12, 2013 North Andover Building Department Attn: Mr. Brian Leathe 1600 Osgood St North Andover, MA 01845 Verizon Site: Andover 2 MA Site Address: 401 Andover Street, North Andover MA 01845 RE: Final Construction Inspection and Affidavit Dear Mr. Leathe; A site visit was conducted for a final inspection of the wireless telecommunications installation as part of the required CCA. The visit took place on 6/12/2013 to inspect the completed site. The site work consisted of installing internal radio equipment in an existing shelter, replacing antennas with frame mounted antennas behind vinyl screen, fiber cables and related hardware. The site is complete as per construction drawings(Rev 0)dated 01/17/2011 by Aerial Spectrum, Inc. Construction of completed work is,from the inspection site, allowable access and ground observation, satisfactory to the best of my knowledge, in accordance to the following standards: • ANSI/TIA/EiA-222-G-"Structural Standards for Steel Antenna Towers and Antenna Supporting Structures". • Massachusetts State Building Code, 81h Edition If you need further information, have any comments or questions, please do not hesitate to contact our office. Sincere�� SN OF 1 A L G 14 G1S7EP� sS�ONAI�G Paul L.Mucci, P.E. MA Lic. #40619 PO Box 875 Westford MA 01886 r 4 ..�. � �� .� SSV "a � � S ._ .. � _ `}' + � .. � '.i- 1. � � J� r.. C _ � _� , .. ,. C i � � •l�4• tp♦ •' r: �y:. � _3 r. {. ;at � ` �� . 3' *�}�. �f; ,.,wk�h R�.k a �� . 1 � Technologies June 12, 2013 North Andover Building Department Attn: Mr. Brian Leathe 1600 Osgood St North Andover, MA 01845 Verizon Site: Andover 2 MA Site Address: 401 Andover Street, North Andover MA 01845 RE: Final Construction inspection and Affidavit Dear Mr. Leathe; A site visit was conducted for a final inspection of the wireless telecommunications installation as part of the required CCA. The visit took place on 6/12/2013 to inspect the completed site. The site work consisted of installing internal radio equipment in an existing shelter,replacing antennas with frame mounted antennas behind vinyl screen,fiber cables and related hardware.The site is complete as per construction drawings(Rev 0)dated 01/17/2011 by Aerial Spectrum, Inc. Construction of completed work is,from the inspection site, allowable access and ground observation, satisfactory to the best of my knowledge, in accordance to the following standards: • ANSUTIA/EfA-222-0-"Structural Standards for Steel Antenna Towers and Antenna Supporting Structures". • Massachusetts State Building Code, 8t'Edition if you need further information, have any comments or questions, please do not hesitate to contact our office. Since �ytN OF -PK L G Paul L.Mucci, P.E. MA Lic.#40619 PO Box 875 Westford MA 01886 Date . /.P7! . �ti�CL&L l'6vs ` TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . � LL.{� Gj / � ,fir -- , , , , , , E- EYE has permission to perform . . . . . . . .4z.�.00 . wiring in the building of . . 0 . �h� �!. . . . . . . . . . . . . . . .. . . . . at . �%1� 0��-/G �7 i:, , , , , , , ,N rth Andover, Mass. 1 Fee . 1�0= Lic. No. . .a . . . . . . . � ELECTRICAL INSPECT R -Check# 11156 Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:__a b-711 spect2 City or Town of. NORTH ANDOVER To the In �of ices: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) el()f A.-t!o v¢r Owner or Tenant ly��on •_,c ml( t LL Telephone No. Owner's Address Is this permit in conjunction with a building ermit? Yes ❑ No (Check Appropriate Box) Purpose of Building 0 d tAC Utility Authorization No. - Existing Service Amps / Its Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: P e c Lorinc cc c 4 Q,,.., ov a ckr, 60 ung Completion of the following table maybe waived by the Ins ector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency ig ting No.of Luminaires Swimming Pool rnd. E] rnd. ❑ Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Gas Burners No.of Detection and No.of Switches i' Initiatin Devices No.of Ranges No.of Air Cond. Total Tons 30 No.of Alerting Devices No. of Waste Disposers Hear talp Number -Tons..........KW No.of Self-Contained ................... Detection/Alerting Devices t Municipal No.of Dishwashers Space/Area Heating KW Local ElConnection E] Other Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.ofMotors Total HP No.of Devices or Equivalent OTHER: c kr.4c A& to 61C u 7 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 30 b 0 (When required by municipal policy.) Work to Start: 10ia /2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C V GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Z BOND ❑ OTHER ❑ (Specify:) I certify,tinder thepains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . AIC d T LIC.NO.: :215,26 Licensee: Ka(,6:p �� Signature _ LIC:NO.: /190S R fap plicable,enter "exempt"in the license number line.) Bus.Tel.No.: Address: Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. I 1 , r • ,YJ.R-1Meni`UALP.dry'J7.0�i-'I(Y'-L�.J�•�X®�'.�{'p`y��(+('[ '(� •t.L11�1�.Lt�a.4C.R�.l�1.�3'��®�� • _ '10 11 �'�ssei�•-,C-�- 3ns,�ectpxs'cozunze�ts: ` (.Cuspeefoxs5szgaak e-oto�fhllals) Pate • 'asse +aiier�� to ns Bctio�xeo�uixe Ospactors,ftna azohd-ua s) Slate ?assed•-( � �'azlec�--j ) ate••�nspeetZo��et�uiret�(��4.40)�[ ] rispectoxs°comments: (lnspectoxs�azgnatuxe- o?nifia7s) Pate ' � I Mspr,crfON—BES,'►ICLE: Failed--j � �e��nspectzonxequixe�(�50.40}�� ' 'pap tbxs9 eom)neits: . (Xnspectozs',�zgnatuze�nonftials) Date • I t 'e r�•,j � �'aite2!�•� �- 'ate�nsp ect�on xec�[rixed( 50.0 D)�[ � ectoxe CDJThkT1mts: - I • 5 l ' ��sp eetoxs'�zgna•Enxe�xio�nit�a�s) , date F d i r The Commonwealth of Massachusetts Department of Industrial Accidents l Office of Investigations 600 Washington Street Boston,MA 02111 >� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / ` Please Print Legibly f Name (Business/Organization/Individual): �� 1 (� �'t ag zqk e_e� Address: City/State/Zip: os44 /,�,,,r�.�r - Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.1� I am a employer with 4. ❑ I am a general contractor and I 6 P (full and/or part-time).* have hired the sub-contractors F1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ?• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor me in an capacity. w kers' comp.insurance. Y p n'• 9. F1 Building addition [No workers' comp.insurance 5. [Ke are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 13. Other /�o ��G t comp.insurance required.] %ny applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. Cam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 'nformation. Insurance Company Name: ?olicy#or Self-ins.Lie.#: 6 NO Expiration Date: 2 S 2©i2 M `ob Site Address: /2 Cytie. r /C. ti el City/State/Zip: AIM kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ►f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. 'do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. >i nature: Date: .7 Z,/-;� 'hone#: SCJ 9 /7 // Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . CA . . . . . . . . . . . . . . . . . has permission for gas installation .� Rcj--rte (�, ti��y �C, in the buildings of. ` *P. j i-��. . . . . . . . . . . . . . `` . . . � . . at . . . . . �.� . . . . . . �cS.�.P� . , North And ver Mass. Fee .).40!�. . Lic. No. .� GASINSPECTOR Check# 8373 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY NORTH ANDOVER =�r MA DATE 10/012 PERMIT# JOBSITE ADDRESS401 ANDOVER ST OWNER'S NAMEMCGARRYMANAGEMENT LLC GOWNER ADDRESS .*» µ TELt. _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:Ej PLANS SUBMITTED: YES NDE] APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERl BOOSTER ,i .. CONVERSION BURNER m L_7_ _m COOK STOVE l __ DIRECT VENT HEATER ' = ._. . .� DRYER FIREPLACE _ g P � P FRYOLATOR _ - FURNACE � g _ . . ..I , ...,''n ' `. .`_.� 1 ,_ GENERATOR GRILLE I INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT i __. OVEN , ; POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT i 1 4 __, TEST UNIT HEATER � 77 UNVENTED ROOM HEATER WATER HEATER '. OTHER ! I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli c ith II Pertinent precision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME J F HUTNICKry _ LICENSE# 15212 _ SI URE MP 01 MGF El JPEI JGF ,rrj LPGI CORPORATION 01 2840 PARTNERSHIPC# LLC # — COMPANY NAME: CALLAHAN AC&HTG__j ADDRESS91 BELMONT ST CITY NORTH ANDOVER STATEMA ZIP01845 � TEL78 689-9233 _ FAX „ CELL' � EMAIL PLUMBING@CALLAHANAC.COM 1 The Commonwealth of Massachusetts Print Foy Department of Industrial Accidents Office of Investigations r I Congress Street,Suite 100 _ Boston,M4 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information - Business/Organization Name: Address: Y/ r rel` City/State/Zip: Are you an employer?Check the appr V l 1.[r I am a employer with o9 S or part-time).* 2.❑ I am a sole proprietor or partnersb employees working for me in any [No workers' comp.insurance req 3.❑ We are a corporation and its offic their right of exemption per c. 15: no employees. [No workers' coml 4.❑ We are a non-profit organization, with no employees. [No workers' *Any applicant that checks box#I must also fill out **If the corporate officers have exempted themselves organization should check box#1. I am an employer that is providing worke Insurance Company Name: ll_1_01 Insurer's Address: �DILI#2 City/State/Zip: 01 X1 J 917, � Policy#or Self-ins.Lic.# C &)G Attach a copy of the workers'compensi Failure to secure coverage as required and fine up to$1,500.00 and/or one-year impr of up to$250.00 a day against the violator Investigations of the DIA for insurance co I do hereby cert,under the pains//an��d��p Si ature: I�/ ,rte— G 6461 Phone#: Official use only. Do not write in this City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Depar 6.Other Contact Person- CO.MMONWEALTH OF MASSAGhtUSETTS • • . COIIIIIfIIQNWEALTH OF MASSAC:HUSTTS I-Lc'IMBERS AND GASFITTF2S L IDEM 5 QS A ,�,OUMEYMAN pLU1VlS R . QSUESTHEABOVELICBNSETO< ►'LUM>�I�t3S ANIMA GQuFIT1"ERS RE TE,RcD AS �1 PLUMSING G 15: ISSUES THE ABOVE LICENSE HU7::NICK ' >*�FIEy P- UT MV PLYh1lUTH ST ;!. NII K 0�1LL,AFi�1N Alfa Cc] I7IIIQNN B 1-°M0NT sT. ME ThIU_ tJ MA .0184`4 GfaIS S 2]881 05/01/14 148'.0 NC1''i�TM ANDOW `R . M'F 01845'- 3Dr 40 65/01 1478],.8. :COMMONWEALTH OF MASSACHU�:�TTS ' ' ,_. - - • P UNIREFAS AND GASP! �,ICENSED ,Ny A .Ma ST'ER PL. MDR ��h'tl •+ ,ISSUES THE`,BQVE'LICENSE 60 PL—O.UTH ST MA . :1184.F+ 42 h t,Y�': ' . • . • ., 1 ...Y �� I+�If�ktfa 1'.i �� .�.. .-gid � 4 j TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO• f 3J Date Received Date Issued: '2 ORTANT:Applicant must complete all items on this page LOCATION H 0 I O� Print PROPERTY OWNER c G i S Print MAP NO: —PARCEL: �)3 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other " '' `� qt vQ�T�lood lainF - ® Waetlands � Fy�atershe`dDistr'ict ® Septic"1 t®resell x ,. l Apr t r .V . DESCRIPTION OF WORK TO BE PERFORMED: h �0 u a 1 Identification Please Type or Print Clearly) OWNER: Name �cjzon C.u►celess -1�c�5-1,n C1CLQm�ne Phone:�81-45y- g13� Address:q� ��Q 'fie- �-1�6T 4Yl IOP C' ` Li-i`l CONTRACTOR Name: 5a)rl n C_Ci CUa&4 Phone: (on -3�g-�3 a y AddresO: &4� , SLC l��l o Y� I� ©a`1�� 9 Supervisor's Construction License: $�5`6� Exp. Date: -7— Home Improvement License: Exp. Date: - ARCH ITECT/ENGINEE> Q u� MU CG Phone: o?� - (�e20� o►8ro3 �6 � `� Addressa. cl►rte YI)R Reg. No. In FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �C?,� FEE: $ ./eo` oe Check No.: /'2 6 y Receipt No.: X23 117 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �- ---- -- ----_ -- _ _ _ _ -: Si nature of:contractor-,.��.:' Signature= Agen caner. :':. _9_-_—_.---.—___--- Location No. _ / Date ✓r 2�� TOWN OF NORTH ANDOVER 0 R 9 Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 3 z ((�� lfh / �7 /6uf1ding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Fublic WERAGE DISPOSAL w ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑ ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPR VED PLANNING & DEVELOPMENT El ❑ ( ` I COMMENTS A"'711 Ae j i f 1 CONSERVATION Reviewed on Signature i COMMENTS HEALTH Reviewed on Signature COMMENTS I I Zoning Board of Appeals:Variance, Petition No: Zoning DecisioNreceipt submitted yes Planning Board Decision: Comments .*Conservation Decision: Comments Water &Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date a p gn tore/date COMMENTS I ORTH To" of oAndover No. 3S h LAKE O dover, Mass., 110 COCHICHEWICK AERATE D `sS BOARD OF HEALTH Food/Kitchen -,PER T T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ........N �T.Ge/ /' `' Foundation has permission to erect........................................ buildings on ..�� ...... . '/ �'.... �.�a..[(.1..... ��.........:................... Rough to be occupied as......... 4a..... �. r.. Chimney provided that the person accepting this permit shall every respect conform to the ms of thfa application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection Alteration and Construction of Buildings in the Town of North Andover. �'�� ✓/��^! o�r /�ppr PLUMBING.INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS Rough. Service BUILDIN INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner. Street No. SEE REVERSE SIDE Smoke Det. E gORTH 1 - ° *L`° Town of North Andover Office of the Planning Department Community Development and Services Division �9 ''�••��''1� 1600 Osgood Street SSACHUSE North Andover,Massachusetts 01845 To: Jerry Brown,Building Inspector Re: Building Permit for Bell Atlantic Mobile of Mass Corp.Ltd,d/b/a Verizon Wireless Antenna Swap at 1275 Turnpike St. (a/k/a Boston Hill)&401 Andover St. �`Date: March 16,2011 cc: Carl Gehring, Gehring&Associates,LLC Jerry, At the March 15,2011 Planning Board meeting,the Board voted to allow the applicant,Verizon Wireless, to replace their existing wireless antennas located at 1275 Turnpike St. and 401 Andover St., with new antennas without the need for a Special Permit. The Board's vote was as follows: On a motion made by R. Glover and seconded by C.LaVolpicelo,the Planning Board votes that the replacement of existing antennas with new antennas at 1275 Turnpike St. (a/k/a Boston Hill) & 401 Andover Street, as requested by the applicant Verizon Wireless, does not meet the criteria specified in the Zoning Bylaw Section 8.9.7, and therefore a Wireless Special Permit is not required. The vote was unanimous. If you have any questions,please let me know. Judy Tymon;AICP Town Planner J G, Y 6A"I W Z V Vo r ke,--r C irn p a-a3u_TirH 'd b ml irrt - Address: �ity/State/Zip:&443i*"-O—WRI-4--- Whine #: Are, 1,011 an employer? Check the appropriate box: Type of project(required): I am a employer _J or and I with 30 LF I -a m a general contract 6. f m-p 0 eoyees (fill and/or part-timehave hired C the sub-contrar-tors I New construction 7. 2. am a so:e-oroDrietor or partner- listed on'ne attached sheet. + J Remodeling s,11- and have no employees T`n -se sub-contractors have 8. Demolition working for me in any capacity. workers' comp, insurance. 9. LJ Building addition [No workers' comp. insurance We are a comoration and its r . d" 10 Electrical repairs or additions equire j officers have exercised their 3.El I am a homeowner doing all work right of exemption per MGL 11 F71 Plumbing'repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.17 Roof repairs insurance required.] t employees. [No workers ' 13 comp. insurance required.] k10therTt*=M_ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information—. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: n-ce Policy #or Self-ins. Lic. Expiration Date:. Job Site Address:4c)1. City/State/Zip:_'nL3.& Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMG1—c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of'up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi erthe pai san penalties ofperjury that the information provided above is true and correct Signature: Date: Phone#:W"I Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License ll Issuing Authority (circle one): Board 3, CiT 1. Bo, ' of Health 2. Building Departrnen ty/1 cjvri Clerk 4, Electrical Inspector 5. Plumbing 11 -1spr- V". Other Contict Person: Phone 1! DcImI.("WIII nl'Public .tiafct� Bu:u'(I of Building' Re�ulaliuns ; Construction Su License tn(I ar'(Is pervisor License: CS 7888$ JOHN G MCGILICUDDY 14 BENNINGTON STREET QUINCY, MA 02169 ;.� Expiration: 7/11/2012 Tom: 207 I �. 'U ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/24/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: VP, CIC,LIA, Michael Tarpey Tarpey Insurance Group Inc A/cC.N Ext, 617.527.6070 aCN„617.527.1980 343 Washington St. E-MAIL ADDRESS: Newton, MA 02458 PRODUCER CUSTOMER ID#: VP, CIC,LIA, Michael Tarpey INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Norfolk & Dedham 23965 Structure Consulting Group, Inc. INSURER B: Twin City Fire Insurance Co 29459 49 Brattl a Street INSURER C: Arlington, MA 02474 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2011-2012 Term REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD LIMITS GENERAL LIABILITY R0105 5 5 10/05/2010 10/05/2011 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- X LOC $ POLICY JECT AUTOMOBILE LIABILITY 91022321 01/06/2011 01/06/2012 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE X $HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR U0908417 10/05/2010 10/05/2011 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB C A LAIMS-MADE AGGREGATE $ 5,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION 08WECNN659 01/03/2011 01/03/2012 X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY B OFFICER/MEM ER EXCLUDED XECUTIVE❑ N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE For Illustrative Purposes Michael Tarpey, VP, CIC,LIA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ACORD,m AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Tarpey Insurance Group Inc Structure Consulting Group, Inc. POLICY NUMBER Arlington, MA 02474 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance Garage Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMIDD/YY) DATE(MM/DDM') LIMITS AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ Automobile Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) A Excess/Umbrella Liability INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMIDDNY) DATE(MMIDDrM LIMITS A $ Other Liability INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commercial Property Record Card PARCEL_ID:210/024.0-0033-0000.0 MAP:024.0 BLOCK:0033 LOT:0000.0 PARCEL ADDRESSA01 ANDOVER STREET FY:2011 PARCEL INFORMATION Use-Code: 340 Sale Price: 0 Book: 01773 Road Type: T Inspect Date: 05/10/2006 Tax Class: T Sale Date: 01/31/84 Page: 0250 Rd Condition: P Meas Date: 05/10/2006 Owner: Tot Fin Area: 10800 Sale Type: P Cert/Doc: Traffic: M Entrance: C PLUM 2 TRUST Tot Land Area: 0.74 Sale Valid: N Water: Collect Id: RRC JOHN F MCGARRY,TRUSTEE Grantor: OSGOOD,BENJAMIN Sewer: Inspect Reas: R Address: 401 ANDOVER STREET Exempt-B/L% / Resid-B/L% I Comm-B/LWO/100 Indust-B/L% / Open Sp-B/L% I NORTH ANDOVER MA 01845 COMMERCIAL SECTIONS/GROUPS LAND INFORMATION Section: ID: 101 Use-Code:340 NBHD CODE: 32 NBHD CLASS: 2 ZONE: GB Category Grnd-Fl-Area Story Height Bldg-Class Yr-Built Eff-Yr-Built Cost Bldg Seg Type Code Method Sq-Ft Acres Influ-YIN Value Class 4 5400 2.0 C 1984 1984 1,185,900 1 P 340 S 32047 0.740 297,684 Groups: DETACHED STRUCTURE INFORMATION Id Cd B-FL-A Flrs Unt Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class 1 340 5400 1 1 AS S 18300 0.00 1984 A A 50///50 22,300 3 2 340 5400 2 1 VALUATION INFORMATION Current Total: 1,540,500 Bldg: 1,242,800 Land: 297,700 MktLnd: 297,700 Prior Total: 1,540,500 Bldg: 1,242,800 Land: 297,700 MktLnd: 297,700 SKETCH PHOTO _ 4 El ATTIC/2SBK/FB 5400 Sq.Ft 60 60 401 ANDOVER STREET Parcel ID:210/024.0-0033-0000.0 as of 3/22/11 Page 1 of 1 ANTENNA CONFIGURATION LTE CELL PCS CELL verfVnwiretess 400 FRIBERG PARKWAY WESTBOROUGH,MA. 01581-3936 (508)330-3300 -ir08 TRUE NORTH NOTE: A E R I A L ANTENNA CONFIGURATION IS LOOKING FROM BEHIND SECTOR ?11.11 E CTR U M EX/ST/NG HVAC£OU/PMENT PROPOSED VERIZON FRAME MOUNTED ANTENNA SCOPE 20 Blanchard Road,Suite 4 BEHIND VINYL SCREEN (TYP. OF 4 PER a,o SECTOR,TOTAL OF 12)TO REPLACE EXISTING Budington,MA 01803 -'+A ANTENNA(SEE SCOPE) tel:(781)272 6200 fax:(781)272 6225 n 1. REMOVE(2)EXISTING ANTENNAS(ALPHA SECTOR)AND REPLACE e-mail:sgumey@aerialspectrum.com WITH NEW CELL ANTENNAS P/N WPA-70063 -EOIN-2. (TYP.) 2. REMOVE(2)EXISTING ANTENNAS(BETA SECTOR)AND REPLACE SITE NAME: WITH NEW CELL ANTENNAS P/N WPA-70063.6CF-EDIN-0. ANDOVER 2 MA 3. REMOVE(2)EXISTING ANTENNAS(GAMMA SECTOR)AND REPLACE WITH NEW CELL ANTENNAS P/N WPA-70063.6CF-EDI144. 4 REMOVE MA SECTORS)(ANDREIPLA EWITH NG (1 NEW PCS ANTENN(ALPHA.BETA AND AS P/N MG CONSTRUCTION EXHIBITS D3.800T2+45. APPROX. LOC47ION OF 5. REMOVE(1)EXISTING ANTENNA(ALPHA SECTOR)AND REPLACE VERIZON EQUIPMENT WITH(1)NEW LTE ANTENNA PM X7C-665.2. ROOM LOCATED/N ATTIC 6. REMOVE(1)EXISTING ANTENNA(BETA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C-0650. 7. REMOVE(1)EXISTING ANTENNA(GAMMA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C-6654. F ❑ ❑ 8. ALL REPLACEMENT ANTENNAS TO MATCH EXISTING CONDITIONS- HEIGHTS. 9. RECONFIGURE/RELOCATE EXISTING ANTENNA MOUNTS AS❑ 0 01/17/11 FOR CONSTRUCTION NECESSARY TO ACCOMODATE HORIZONTAL SEPERATION, PROPOSED AZIMUTHS,AND ANTENNA CONFIGURATION. NOTES: PROFESSIONAL STAMP SEOTo L J a 11011 T A 1.NORTH SHOWN AS APPROXIMATE. 2.SOME EXISTING AND PROPOSED INFORMATION NOT SHOWN FOR SN QF, CLARITY. 3.ANTENNAS AND HARDWARE TO BE INSTALLED IN -Qa PAUL L, ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS. M 4,CONTRACTOR SHALL FIELD VERIFY SCOPE OF WORK,VERIZON WIRELESS ANTENNA MOUNT LOCATION AND ANTENNAS TO BE INSTALLED. S.CONTRACTOR SHALL NOTIFY ENGINEERS IF FIELD CONDITIONS e DIFFER FROM DESIGN. DRAWN BY: SPG 1 EX/STING VENT/DOGHOUSE EX/STING V/NYL SCREEN CHECKED BY: PLM 2 PROJECT NUMBER: 3154 SITE ADDRESS: 401 ANDOVER STREET ROOF PLAN B D 4 B 16 3z NORTH ANDOVER, MA 01845 SCALE:J6"=1'-0" _ SHEET TITLE: THIS PLAN SHEET/S TO BE USED/N CONMUNC7/ON W/TH CURRENT ROOF PLAN STRU A /5 R RNC PROP 5 /NS TION SHEET NUMBER: A-1 SCALE: THIS PLAN TO SCALE WHEN PRINTED AT 24"x36"8100%SCALING ANTENNA CONFIGURATION SCOPE NOTES: 1.NORTH SHOWN ASAP PROPOSED I vereonwireleSS /� /� 1. REMOVE(2)EXISTING ANTENNAS(ALPHA SECTOR)AND REPLACE 2•SOME EXISTING AND PROPOSED INFORMATION NOT SHOWN FOR LTE CELL PCS CELL WITH NEW CELL ANTENNAS P/N WPA-7006346rF-EDIN-2. CLARITY. 2. REMOVE(2)EXISTING ANTENNAS(BETA SECTOR)AND REPLACE 3.ANTENNAS AND HARDWARE TO BE INSTALLED IN 400 FRIBERG PARKWAY WITH NEW CELL ANTENNAS P/N WPA-700636CF-EDIN-0. ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS. WESTBOROUGH,MA. 3. REMOVE(2)EXISTING ANTENNAS(GAMMA SECTOR)AND REPLACE 4.CONTRACTOR SHALL FIELD VERIFY SCOPE OF WORK,VERIZON 01581-3936 WITH NEW CELL ANTENNAS P/N WPA-700636CF-EDIN-0. INSTALLED.ELESS ANTENNA MOUNT LOCATION AND ANTENNAS TO BE (508)330-3300 4. REMOVE(1)EXISTING ANTENNA(ALPHA BETA AND GAMMA 5.CONTRACTOR SHALL NOTIFY ENGINEERS IF FIELD CONDITIONS SECTORS)AND REPLACE WITH(1)NEW PCS ANTENNAS PIN MG DIFFER FROM DESIGN. D3-800T2-45. 5. REMOVE(1)EXISTING ANTENNA(ALPHA SECTOR)AND REPLACE ��j//,• WITH(1)NEW LTE ANTENNA PM X7C-665-2. 6. REMOVE(1)EXISTING ANTENNA(BETA SECTOR)AND REPLACE NOTE: WITH(1)NEW LTE ANTENNA PM X76665-0. A E R 1 A L ANTENNA CONFIGURATION IS LOOKING FROM BEHIND SECTOR $ P E CTR U M 7. REMOVE(1)EXISTING ANTENNA(GAMMA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C-665<. 20 Blanchard Road,Suite 4 8. ALL REPLACEMENT ANTENNAS TO MATCH EXISTING CONDITIONS- Burlington,MA 01603 HEIGHTS. tel:(781)272 6200 fax:(781)272 6225 9. RECONFIGURE/RELOCATE EXISTING ANTENNA MOUNTS AS e-mail:sgumey@aerialspectrum.com NECESSARY TO ACCOMODATE HORIZONTAL SEPERATION, PROPOSED AZIMUTHS,AND ANTENNA CONFIGURATION. SITE NAME: EXIST/NG NNYL SCREEN PROPOSED VERIZON FRAME MOUNTED ANDOVER 2 MA ANTENNA BEHIND VINYL SCREEN (". OF 4 PER SECTOR,TOTAL OF 12)TO REPLACE EXISTING ANTENNA APPROX. LOCATION OF (SEE SCOPE) CONSTRUCTION EXHIBITS VERIZON EQUIPMENT ROOM LOCATED/N ATTIC 0 40Pt A.G.L. VTE ERIZON_ANNNAS EL. I I I I I I I EXIST/NG ROOF LEVJ£L 11 U 0 EL 38't A.G.L-------------- . 0 01/17/11 FOR CONSTRUCTION PROFESSIONAL STAMP �ytN OF, ?� PAUL L N ONAL DRAWN BY: SPG CHECKED BY: PLM PROJECT NUMBER: 3154 SITE ADDRESS: 401 ANDOVER STREET NORTH ANDOVER, MA 01845 SHEET TITLE: EXISTING GRADE �FL. Of A.G.L. - ELEVATION SHEET NUMBER: ELEVATION z 4 0 2 4 B 16 A-2 SCALE:Yi=1'-0* _ 1 THIS PLAN SHEET/S TO BE USED/N CON✓UNCDON W/TH CURRENT SCALE: THIS PLAN TO SCALE WHEN "RICTU D PROPOS /STAL DON PRINTED AT 24"x36"8100°/.SCALING ANTENNA CONFIGURATION LTE CELL PCS CELL VMZonwiretess • 400 FRIBERG PARKWAY WESTBOROUGH,MA. 01581-3936 (508)330-3300 TRUE N�TH NOTE: A E R I A L ANTENNA CONFIGURATION IS LOOKING FROM BEHIND SECTOR $P !.0 T R U M EX/ST/NC HVAC EOU/PMENT PROPOSED VERIZON FRAME MOUNTED ANTENNA 20 Blanchard Road,Suite 4 (TYP.) BEHIND VINYL SCREEN (TYP. OF 4 PER SCOPE j O SECTOR, TOTAL OF 12) TO REPLACE EXISTING Burlington,MA 01803 Za ANTENNA(SEE SCOPE) tel:(781)272 6200 fax:(781)272 6225 n 1. REMOVE(2)EXISTING ANTENNAS(ALPHA SECTOR)AND REPLACE e-mail:sgumey@aerialspectrum.com WITH NEW CELL ANTENNAS P/N WPA40063-6CF-EDIN-2. SITE NAME: 2. REMOVE(2)EXISTING ANTENNAS(BETA SECTOR)AND REPLACE WITH NEW CELL ANTENNAS PIN WPA-70063-6CF-EDINd. ANDOVER 2 MA 3. REMOVE(2)EXISTING ANTENNAS(GAMMA SECTOR)AND REPLACE WITH NEW CELL ANTENNAS P/N WPA-70063-BCF-EDIN-4. REMO 4 HA BETA AND GAMMA SECTOVRS)ANDREPLACE ENTH(1NG ANTENNA NEWPCSANTENNASPNMG CONSTRUCTION EXHIBITS D3-800T2s45. APPROX. LOCATION OF 5. REMOVE(1)E%ISTING ANTENNA(ALPHA SECTOR)AND REPLACE IVER/ZON EOUIPMENT WITH(1)NEW LTE ANTENNA PM X7C-685-2. ROOM LOCATED/N ATTIC 6. REMOVE(1)EXISTING ANTENNA(BETA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C-6650. 7. REMOVE(1)EXISTING ANTENNA(GAMMA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C-665-0. r — — — — ❑ ❑ 8. ALL REPLACEMENT ANTENNAS TO MATCH EXISTING CONDITIONS- HEIGHTS. 9. RECONFIGURE/RELOCATE EXISTING ANTENNA MOUNTS AS ❑ NECESSARY TO ACCOMODATE HORIZONTAL SEPERATION. 0 01/17/11 FOR CONSTRUCTION PROPOSED AZIMUTHS,AND ANTENNA CONFIGURATION. PROFESSIONAL STAMP L — SfQ'GR NOTES: u ?j• '1 1. NORTH SHOWN AS APPROXIMATE. 2.SOME EXISTING AND PROPOSED INFORMATION NOT SHOWN FOR jM QP CLARITY. 3.ANTENNAS AND HARDWARE BE INSTALLED IN PAU& ACCORDANCE WITH MANUFACTURER (JL RECOMMENDATIONS. M a 4.CONTRACTOR SHALL FIELD VERIFY SCOPE OF WORK,VERIZON WIRELESS ANTENNA MOUNT LOCATION AND ANTENNAS TO BE INSTALLED. 5.CONTRACTOR SHALL NOTIFY ENGINEERS IF FIELD CONDITIONS DIFFER FROM DESIGN. 9 DRAWN BY: SPG 1 EXISTING SENT/DOGHOUSE \EXI.577NG NNYL SCREEN CHECKED BY: PLM 2 PROJECT NUMBER: 3154 SITE ADDRESS: 401 ANDOVER STREET ROOF PLAN �� B o a e 1s az NORTH ANDOVER, MA 01845 SCALE:X"=1'-O" _ SHEET TITLE: TH/S PLAN SHEET/S TO BE USED/N CON✓UNC7/0N W/7H CURRENT ROOF PLAN TRU TURA A YS RNC POS T LA 0 SHEET NUMBER: A-1 SCALE: THIS PLAN TO SCALE WHEN PRINTED AT 24"x36"8100%SCALING ANTENNA CONFIGURATION SCOPE NOTES: 1.NORTH SHOWN AS APPROXIMATE. VeriZonwireleSS 1. REMOVE(2)EXISTING ANTENNAS(ALPHA SECTOR)AND REPLACE 2.SOME EXISTING AND PROPOSED INFORMATION NOT SHOWN FOR LTE CELL PCS CELL WITH NEW CELL ANTENNAS PIN WPA-700534CF-EOIN-2. CLARITY. 2. REMOVE(2)EXISTING ANTENNAS(BETA SECTOR)AND REPLACE 3.ANTENNAS AND HARDWARE TO BE INSTALLED IN 400 FRIBERG PARKWAY WITH NEW CELL ANTENNAS PIN WPA-70063-6CF-EDIN-0. ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS. WESTBOROUGH,MA. 3. REMOVE(2)EXISTING ANTENNAS(GAMMA SECTOR)AND REPLACE 4.CONTRACTOR SHALL FIELD VERIFY SCOPE OF WORK,VERIZON 01581-3936 WITH NEW CELL ANTENNAS P/N WPA-70063-6CF-EDI144. WIRELESS ANTENNA MOUNT LOCATION AND ANTENNAS TO BE (508)330-3300 INSTALLED. 4. REMOVE(1)EXISTING ANTENNA(ALPHA,BETA AND GAMMA 5,CONTRACTOR SHALL NOTIFY ENGINEERS IF FIELD CONDITIONS SECTORS)AND REPLACE WITH(1)NEW PCS ANTENNAS PIN MG D3-800T2*45. DIFFER FROM DESIGN. S. REMOVE(1)EXISTING ANTENNA(ALPHA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PN X7CE65-2. 6. REMOVE(1)EXISTING ANTENNA(BETA SECTOR)AND REPLACE NOTE: WITH(1)NEW LTE ANTENNA PM X7CE650. A E R 1 ANTENNA CONFIGURATION IS LOOKING FROM BEHIND SECTOR. $P E CTR U M 7. REMOVE(1)EXISTING ANTENNA(GAMMA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM XTCfi6S4. 20 Blanchard Road,Suite 4 8. ALL REPLACEMENT ANTENNAS TO MATCH EXISTING CONDITIONS- Burlington,MA 01803 HEIGHTS. tel:(781)272 6200 fax:(781)272 6225 9. RECONFIGURE/RELOCATE EXISTING ANTENNA MOUNTS AS e-mail:sgumey@aerialspectrum.com NECESSARY TO ACCOMODATE HORIZONTAL SEPERATION, PROPOSED AZIMUTHS,AND ANTENNA CONFIGURATION. SITE NAME: EXIST/NG WNYL SCREEN PROPOSED VERIZON FRAME ANTENNA BEHIND VINYL SCREENNTED ANDOVER 2 MA (TYP. OF 4 PER SECTOR,TOTAL OF 12) TO REPLACE EXISTING ANTENNA APPROX. LOCATION OF (SEE SCOPE) CONSTRUCTION EXHIBITS VER/ZON EOU/PMENT ROOM LOCATED IN ATTIC E040Pt OSLD VERIZON_ANTENNAS L. A.GI 1 I I I I _EX/ST/N_C ROOFLEVEL_.......... EL. 38't A.G.L. 0 01/17/11 FOR CONSTRUCTION PROFESSIONAL STAMP ,YM OF, aa� RMA L. 111 f ? DRAWN BY: SPG CHECKED BY: PLM PROJECT NUMBER: 3154 SITE ADDRESS: 401 ANDOVER STREET NORTH ANDOVER, MA 01845 SHEET TITLE: EXISTING GRADE aEL. Of A.G.L. ELEVATION SHEET NUMBER: ELEVATION 2 4 O 2 4 6 16 A-2 SCALE: _ TH/5 PLAN SHEET IS TO BE USED/N CONJUNC7TON W/TN CURRENT SCALE: THIS PLAN TO SCALE WHEN "R""., U REFERENCED PROPOSQ/N TA UON PRINTED AT 24'x38'8100°/.SCALING ANTENNA CONFIGURATION verronwireless LTE CELL PCS CELL 400 FRIBERG PARKWAY WESTBOROUGH,MA. 01581-3936 (508)330-3300 aX TRUE FORTH NOTE: A E R I A L ANTENNA CONFIGURATION IS LOOKING FROM BEHIND SECTOR. SPE CTRU M EX/ST/NG HVAC EOU/PMENT PROPOSED VERIZON FRAME MOUNTED ANTENNA 20 Blanchard Road,Suite 4 (7YP.) N BEHIND VINYL SCREEN (TYP. OF 4 PER SCOPE Buriin tOR,MA 01803 a,O SECTOR,TOTAL OF 12)TO REPLACE EXISTING 9 -L ANTENNA(SEE SCOPE) tel:(781)272 6200 fax:(781)272 6225 n 1. REMOVE(2)EXISTING ANTENNAS(ALPHA SECTOR)AND REPLACE e-mail:sgumey@aerialspectrum.com WITH NEW CELL ANTENNAS P/N WPA-700636CF-EDIN-2. 2. REMOVE(2)EXISTING ANTENNAS(BETA SECTOR)AND REPLACE SITE NAME: WITH NEW CELL ANTENNAS P/N WPA-70063-6CF-EDIN-0. 3. REMOVE(2)EXISTING ANTE NNAB(GAMMA SECTOR)AND REPLACE ANDOVER 2 MA WITH NEW CELL ANTENNAS P/N WPA-70063.6CF-EDIN-4. 4 EXISTINGREMOVE(1) MA SECTORS)ANDREEPLA WITH(1 NEW PCS ANTENNCASPIN MG CONSTRUCTION EXHIBITS D3.800T2+45. APPROX. LOCATION OF 5. REMOVE(1)EXISTING ANTENNA(ALPHA SECTOR)AND REPLACE VERIZON£OU/PMENT WITH(1)NEW LTE ANTENNA PM X7C-665-2 ROOM LOCATED/N ATTIC 6. REMOVE(1)EXISTING ANTENNA(BETA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7CE65-0. 7. REMOVE(1)EXISTING ANTENNA(GAMMA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X708654. r — — — — ❑ ❑ 8. ALL REPLACEMENT ANTENNAS TO MATCH EXISTING CONDITIONS- HEIGHTS. I 9. RECONFIGURE/RELOCATE EXISTING ANTENNA MOUNTS AS ❑ NECESSARY TO ACCOMODATE HORIZONTAL SEPERATION, D 01/17/11 FOR CONSTRUCTION PROPOSED AZIMUTHS,AND ANTENNA CONFIGURATION. PROFESSIONAL STAMP SE NOTES: L �o e jT A 1. NORTH SHOWN AS APPROXIMATE. 2.SOME EXISTING AND PROPOSED INFORMATION NOT SHOWN FOR .TM OF, CLARITY. 3.ANTENNAS AND HARDWARE TO BE INSTALLED IN 7Z PAUL L. ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS. 4.CONTRACTOR SHALL FIELD VERIFY SCOPE OF WORK,VERIZON WIRELESS ANTENNA MOUNT LOCATION AND ANTENNAS TO BE INSTALLED. y� 5.CONTRACTOR SHALL NOTIFY ENGINEERS IF FIELD CONDITIONS DIFFER FROM DESIGN. I1�T�– 0 DRAWN BY: SPG Q y�G10 n� 1 EXIST/NC VENT/DOGHOUSE EX/STING WNYL SCREEN CHECKED BY: PLM 2 PROJECT NUMBER: 3154 SITE ADDRESS: 401 ANDOVER STREET ROOF PLAN 6 0 4 6 16 32 NORTH ANDOVER, MA 01845 SCALE:%"=1'–O" _ SHEET TITLE: TH15 PLAN SHEET/S TO BE USED/N COWUNCAON WITH CURRENT ROOF PLAN S U RA . IS R R P SHEET NUMBER: A-1 SCALE: THIS PLAN TO SCALE WHEN PRINTED AT 24"x36"8100%SCALING ANTENNA CONFIGURATION SCOPE NOTES: 1. SOME EXISTING WN AS APPROXIMATE.PROPOSED IYergonwireleSS 1. REMOVE(2)EXISTING ANTENNAS(ALPHA SECTOR)AND REPLACE 2.SOME EXISTING AND PROPOSED INFORMATION NOT SHOWN FOR LTE CELL PCS CELL WITH NEW CELL ANTENNAS P/N WPA-700636CF-EDIN-2. CLARITY. 2. REMOVE(2)EXISTING ANTENNAS(BETA SECTOR)AND REPLACE 3.ANTENNAS AND HARDWARE TO BE INSTALLED IN 400 FRIBERG PARKWAY WITH NEW CELL ANTENNAS P/N WPA-700636CF-EDIW. ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS. WESTBOROUGH,MA. 3. REMOVE(2)EXISTING ANTENNAS(GAMMA SECTOR)AND REPLACE 4.CONTRACTOR SHALL FIELD VERIFY SCOPE OF WORK,VERIZON 01581-3936 WITH NEW CELL ANTENNAS P/N WPA-700636CF-EDIN4. WIRELESS ANTENNA MOUNT LOCATION AND ANTENNAS TO BE (508)330-3300 INSTALLED. 4. REMOVE(1)EXISTING ANTENNA(ALPHA,BETA AND GAMMA 5.CONTRACTOR SHALL NOTIFY ENGINEERS IF FIELD CONDITIONS SECTORS)AND REPLACE WITH(1)NEW PCS ANTENNAS P/N MG DIFFER FROM DESIGN. 1)3600T2+45. 5. REMOVE(1)EXISTING ANTENNA(ALPHA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C665-2. 6. REMOVE(1)EXISTING ANTENNA(BETA SECTOR)AND REPLACE NOTE: WITH(1)NEW LTE ANTENNA P/N X7C665-0. A E R I A L ANTENNA CONFIGURATION IS LOOKING FROM BEHIND SECTOR SPE C T R U ll 7. REMOVE(1)EXISTING ANTENNA(GAMMA SECTOR)AND REPLACE WITH(1)NEW LTE ANTENNA PM X7C6654. 20 Blanchard Road,Suite 4 B. ALL REPLACEMENT ANTENNAS TO MATCH EXISTING CONDITIONS- Burlington,MA 01603 HEIGHTS, tel:(781)272 6200 fax:(761)272 6225 9. RECONFIGURE/RELOCATE EXISTING ANTENNA MOUNTS AS e-mail:sgumey@aerialspectrum.com NECESSARY TO ACCOMODATE HORIZONTAL SEPERATION, PROPOSED AZIMUTHS,AND ANTENNA CONFIGURATION. SITE NAME: EXISTING VINYL SCREEN PROPOSED VERIZON FRAME MOUNTED ANDOVER 2 MA ANTENNA BEHIND VINYL SCREEN (TYP. OF 4 PER SECTOR,TOTAL OF 12)TO REPLACE EXISTING ANTENNA APPROX. LOCATION Of (SEE SCOPE) CONSTRUCTION EXHIBITS VERIZON EQUIPMENT ROOM LOCATED/N ATTIC rE�L.040Pf OA.GSL D VERIZON_ANTENNAS I I l l !I l ,jbf,!/ST/NC ROOF LEVEL EL. 38't A.G.L. 0 01/17111 FOR CONSTRUCTION PROFESSIONAL STAMP �SM OF ?� PAIR L. M -� Q DRAWN BY: SPG CHECKED BY: PLM PROJECT NUMBER: 3154 SITE ADDRESS: 401 ANDOVER STREET NORTH ANDOVER, MA 01845 SHEET TITLE: EX/5T/NDE C GRA SEL.of A.G.I. ELEVATION SHEET NUMBER: ELEVATION z 4 D 2 4 a 16 A-2 SCALE:Yi=1'-0- _ THIS PLAN SHEET IS TO BE USED/N CONJUNCTION WITH CURRENT SCALE: THIS PLAN TO SCALE WHEN STRUCTURAL ANALYSIS REFFRENCE9PRO D INS AL ON PRINTED AT 24"x36"8100%SCALING Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movements of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine NOTES and DATA-- For department use i I ® Notified for pickup - Date i Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit ' ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products t NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I ' Addition Or Decks ❑ Building Permit Application r o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ? ❑ Mass check Energy Compliance Report (If Applicable) Q Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Neter Construction (Single and Two Family) o Building Permit ermlt Appllcafilon o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products E 10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i all cases if a variance or special permit was required the Town clerks office must stain the decision from the Board of Appeals fait the appeal period is over. The applicant mut then get this recorded at the Registry of Deeds. One copy and proof of recording . ust be submitted with the building application l f i Doc: Doc-Building permit Revised 2008mi l I 9279 Date. 1AS-./. /.z- NORTH TOWN OF NORTH ANDOVER 0��..ao ,•1tiO PERMIT FOR PLUMBING ,SSACMus R This certifies that ��+-�. 1r . . !�?S has permission to perform . . . . . . .?. . . . . . . . . . . . . . . . plumbing in the buildings of .�f'. . . . . ....!M � . . , . at. . ,�,!��./�h�"°�' .Sr. . . . . . . . . . . . . . .. North And/ower, Mass. Fee, 1 PULic. No.1 SW / IC! PLUMBING INSPECTOR Check # / 7 )OO i! � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING I City/Town:WCYA-h /-1i �C �iP , MA. Dater/; 61a0ll Permit# Building Location: Ar&_p C Sk( g—Q-k Ownersu 1f SSoCia�S J i Type of Occupancy: Commercial&-" Educational ❑ Industrial❑ Institutional ❑ Residential❑ Ne . Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED Z S SYSTEMS LU z W Y tA OU r� LU Z F- Y Q J Q Z CA W W \ a _ W Z Cr H Z Q 0 Z ar N to W h to = 0 Q W �'- W_ H H G Q C' OJ Q W Q Z OC {/� =ciao J Q Q Y = 0 OC 3 = Z O W H J Q = W W f� to W W U H = a F' U > > 0 d Z Z !A F- F� _ V 1A W Q H N I= m m o o LL = Y g g ° X' 3 3 3 0 acc 3 SUB BSMT. BASEMENT FLOOR —FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Check One Only Certificate# Installing Company Name: {'Cl LiJ V V! t vt`�j�� Y�/�cj -rAAG, ll 7 Se A'-V--City/Town: �, j,� i rin� Corporation '�?� Address:JCA eCON r�"G-City/Town: V v A 4�A t 1"t State:_MA ❑ Partnership Business Tel: `Q, � 9 S�>`�,' Fax: � �� ❑ Firm/Company Name of Licensed Plumber: ofty:n. t, 1-' Ai INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes l, No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner 11 Agent E]Si nature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter'142 of the General Laws. Of By Type of License: Title_ F1 Plumber Signature c6f Lice ed plumber ❑ Master City/Town, ❑Journeyman License Number: VV APPROVED(OFFICE USE ONLY) — � d��3 �� ,� ,� � . . � 1� �� Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ .......................................... has permission toa-rform,.,-.e... ....................................... wiring in the building .-I......... ............ ......................... at .............................. North Andover,Mass. .... Fe/ ... Lic.NOP.4j.��vx ................/-�... ........ ............. LECMCAL INSPECTOR A, Check # ZAO-V 8565 mi� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �c$ cru BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked / —'' [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ME9),527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Insp ctor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) y0 f �.00 ( /J=/&I` Owner or Tenant r Owner's Address Telephone No. L�j}/ ,� �e �y( � � Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building �/YbA Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Pro/posed Electrical Work: d / i L ge d Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers kVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool AboveElIn- o.o mergency 1g` g d. rnd. ❑ Batter Units — No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No,of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number To p ers -. ......._..................ns........KW......-. No.o Self-Contained Totals: Detection/Alertin Devices �j No,of Dishwashers Space/Area Heating ICW Local❑ Municipal Connection ❑ Other No.of Dryers Heating� g A ppliances KW Security Systems: No.of WaterNo.of No.of Devices or E uivalent Heaters ICS NO °f Data Wiring: Si s Ballasts . No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications Wiring: No.of Devices or Equivalent OTHER: ' Estimated Value of Electrical Work: Attach additional detail tf desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove3gris in force,and has exhibited proof of same to the pe -1 issuing office.ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the information on this application is om PP true and c lete. FIRM NAME: � a P --. Licensee: LIC.NO.: Signatur (If applicable, enter"exe pt"i e�Iienu line LIC.NO.: Address: Bus.Tel.No.:*Per M.G.L c. 147,s. 57-61,securk requires Department of ublic Safety"S"License: Alt.L cl No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $AX6-P�" I, v r The Commonwealth of Massachusetts Department of Industrial Accidents p ` Office of Investigations 600 Washing, on Street Boston, MA 02111 t'1 www.nwss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Le-gibly Name(Business/Organization/Individual): / Address: © �j City/State/Zig: Phone #:_. Are you an employer?Cheek.the appropriate box: 113 I am a em to er with 4, Type of project(required): P Y ❑ l am a general contractor and I 6. ❑-New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am.asole proprietor or partner. listed on the attached sheet.x 7. odeii emng ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers' comp.insurance. g, ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11 Plumbing repairs or additions myself.[No-workers'comp. c. 1.52, §1(4),and we have no 12. Roof insurance required.]t employees. ❑ repairs [No workers' .❑. comp. insurance required_] 13 Other' •Any applicant that checks bo>r#t mustalso fill out the section below showing their workers'compensation pot icy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet sho-i -tt-e name of the sub-Contract,^oand their workers'comp.policy information. lam an employer that rs providing workers'compensation insurance for my.employees: Below is the policy and job site information, Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/Stats/Zip: �. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forty Investigations of the DIA for insurance coverage verification. aided to the Office of Ido hereby cern y u e th p ins a en les of perjury that the information provided ove is a and correct Si tore: Date: / l Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information a end Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is.defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the ownerof a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who.employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal-of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirernmts of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone munber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also*be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the nurnb=lined below. Self-insured companies should eras thee. self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete And printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. 9 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax 4 617-727-7744 Revised 5-26-05 www.mass.gov/dia TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 No or" 10- p Permit NO: Date Received I C •-1 v +► i � Date Issued: /6 (-14U �ssws�� IMPORTANT: Applicant must complete all items on this page LOCATION L-1 01 Print � PROPERTY OWNER j4 Print i MAP NO. PARCEL: , c.J 3 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: repair, replacement ❑ Assessory Bldg k*Commercial Demolition Moving(relocation) ❑ Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED < ,r-k I I N C w 14 So 14-:2Ie&e /V Identification Please Type or Print Clearly) OWNER: Name: /"I Phone: rl 7e--&Z'6- /I I Address: L4 U I /4_v.,d.��vcr S!�• /te�r t4 CONTRACTOR Name: fi;; ��,�, ori . Phone: 7F1 Address: Glel 14eee. c.c_,ezj. . .;j rl' , yvt e Ira j-e Supervisor's Construction License: Exp. Date: Home Improvement License: 1 I Le Exp. Date: l ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERM/T. 512.00 PER 51000.00 OF THE TOTAL EST/MATED O TVSED ON 5125.00 PER S.F. Total Project Cost :$ 130 FEE:$ Check No.: �'� Receipt No.: Location No &0-0 Date E NORTH TOWN OF NORTH ANDOVER k O�t .•o ,•,+ Certificate of Occupancy $ ♦ i • o� .... ; �'�s'•"'tt� Building/Frame Permit Fee $ iJ JACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I � 19693 i ---Building Inspedior TYPE OF SEWERAGE DISPOSAL ,— Tanning;'Massage/Body Art E, Swimming Pools Public Sewer i Tobacco Sales Food Packaging/Sales WellI� Permanent Dum ster on Site Private(septic tank,etc. LJ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ` THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i I COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ r COMMENTS FIRE DEPARTMENT - Tem Dum ster on site es Temp p e y no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Signature& Date Driveway Permit • Page No. of Pages. gcpr'srnUcr, C At S CC.ISTRUCIION CM1PA27 IC Rag.0111492 99 Rear Washington St. G MELROSE,MA 02176 PROPOSAL' 1 W.7)662-3346 PHONE DATE 0 k, wry�_,... �' i''✓j J JOB NAME/LOCATION / r JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: We Propose^hereby to furnish material and labor—complete in accordance with the above specifications, for the sum of: J :/ Ju k I ±�vY �'l H� A 11-e rl dollars ($ J 3 ). r Payment to be made as follows: Etions erial is guaranteed to be as specified. All work to be completed in a professional according to standard practices. Any alteration or deviation from above specifica- Authorized i I volving extra costs will be executed only upon written orders, and will become an Signature arge over and above the estimate.All agreements contingent upon strikes, accidentsys beyond our control. Owner to carry fire, tornado and other necessary insurance. Note:This proposal may be rkers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within days. ptance ®f Proposal —The above prices, specifications nditions are satisfactory and are hereby accepted.You are authorized Signature the work as specified. Payment will be made as outlined above. Signature f Acceptance: �i STPAUL WORKERS COMPENSATION G TRAVELERS AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (GKUB-7915644-5-06) INSURER: THE TRAVELERS INDEMNITY COMPANY 11347-MA INSURED'S NAME : CIAVARRO, PAUL DBA C & S CONSTRUCTION RATE BUREAU ID: 000051189 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 025541755 ENTITY CD 001 CIAVARRO, PAUL DBA C & S CONSTRUCTION 99 R WASHINGTON STREET MELROSE, MA 02176 CARPENTRY NOC 5403 IF ANY 16.48 .� ROOFING NOC & YARD EMPLOYEES, DRIVERS 5545 3993 47.57 1899 ROOFING-BUILT UP-YARD EMPLOYEES & DRIVERS 5547 3993 19.72 787 CARPENTRY-DETACHED ONE- OR TWO CC= FAMILY DWELLINGS 5645 11979 9.03 1082 o� o CARPENTRY-DWELLINGS-THREE STORIES OR LESS 5651 IF ANY 9.03 r o. nom• o os o i DATE OF ISSUE: 06-12-06 DS ST ASSIGN: MA SCHEDULE NO: 1 OF MORE 001118 sTPauL TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-7915B44-5-06) i RENEWAL OF (6KUB-7915B44-5-05) INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 11347 1. INSURED: PRODUCER: CIAVARRO, PAUL DBA ALLAN INS AGCY INC C & S CONSTRUCTION PO BOX 511 99 R WASHINGTON STREET SALEM MA 01970-0511 MELROSE MA 02176 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 06-28-06 to 06-28-07 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: z MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee policy applies to the states, if any, listed here: C. OTHER STATES INSURANCE: Part Three of the COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A o� m� D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE ons, Rates —"– 4. The premium for this policy wilionl be s subject to verification and cined by our is of hangeuby audit to be invade ANNUALLY.Rating a Plans. All required info j ST ASSIGN: MA DATE OF ISSUE: 06-12-06 DS OFFICE: ORLANDO INDUS AFF 161 24F9N PRODUCER: ALLAN INS AGCY INC ooiin Board of Building Regulations and Standards "HOME IMPROVEMENT CONTRACTOR Registration:. 111492 Expiration: -12/29/2006 i Type: DBA C&S CONSTRUCTION&ROOFING CO PAUL CIAVARRO:` 99 REAR WASHINGTON ST Ii MELROSE,MA 02176 Administrator i F NQRTH Town. of 4 over 00 No. C' LA dover, Mass., V• 9 At ISO COCHICMEWICK y� ORATED iP? 2 BOARD OF HEALTH PERMI Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............... ........................... ............................................................. Foundation has permission to erect........................................ buildings n... d 1........ .......... ............................ ...... Rough to be occupied as ... ....... ................................. Chimney .................................................................................................... provided that the person accep g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARS Rough ..... .... ... ......... Service............. UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. F NORTH O 4 of _ _ 4 L over No. p p 3 _ z • OL �. o = over, Mass., Ap /S COC MICKE WICK ADRATED BOARD OF HEALTH PERMIT D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT L .......................................... ............... ..............::........... ..................................... ...... ........................ Foundation has permission to erect........................................ buildings n-41.6? ..... ........................ ............... Rough tobe occupied as ... .. .......................................................................................................................... Chimney ..... ................ provided that the person accep g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STAR S Rougl, ............. ,�,,��,.. Service .... ... .... . ............. ....... UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE j Smoke Det. Building Setback ( Front Yard Side Yard Rear Yard RequireKj Provided Required Provides Required Provided / / r Dimension Number of Stories: - Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i NOTES and DATA— For department use i Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:1313FORM05 Created JMC.Jan'_01)6 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits i I L3 Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks o Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) o Building Permit Application a Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract L3 Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the 1 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 the building application Doc:INSPH TIO.NAL SERVICES DEPAR'r31EN'r:BPFORIN105 Page 4 of 4 62 '18 Date...... ...;7-.a..s........... 1..... .. . ... 'e TOWN OF NORTH ANDOVER PERMIT FOR WIRING L717hiscertifies that .......................................................... .................................. .......... has permission to perform........... ......... ................................................ wiring in the building of.... . ..... .................. ................................................................................ .North Andover,Mass. Fee/01U..7....... L i c.No.. ................ ......... ELECTRICAL INsp`�Mr Check # Dr>FAJUNWOFP[1Bit 'SUW Pemdt No. RD BOAOFFMPREVFvnuivl.=II 527adR,a, Occupancy&Fees Checked i A.PPUCATTONFOR PERIVII'f TO PERFORM ELE=CAL WORK , All,WORK TO BE PERFORMED IN ACCORDANCE WTrH THE MASSACHUSSrS ELECTRICAL CODE,527 CMU 12:00 (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) Town of North Andover To the Ins or of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street d:Number) --awff r or TenantZ,,-- 7,77777 Owner's Address is this permit in conjunction wi uildin t: Yes No (Check Appropriate Bos) ? Purpose of Building Utility Authorization N5. Existing Service Z�/ Volts Overhead Undergo No.of Meters New Service ' ' Amprn ..b' Volta Overhead Underground No.of Meter: Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of usli g outlets No.of Hot Tubs No.of Trani linea Total No of Lighting Iintttra Swimming Pool' AboveBei, KVA Kv b No.of Receptacle Outlets No.of W Burner No.of Emergency V aha Battery Units No.of Switch outlets No.of Gas Borates No.of Ranges No of Air Coed Tool ! FIRE ALARMS No.of Zones Toes Na of IRspoaals No.of Hat TonalTotalNo.of Defection send Pumps Ton KW Initiating Devices No.of Dishwashers Space Ara Heating KW NO.of souaft Dewces No.of salf Co ata6tedw No.of Dryer Heating Devices KW DetecdOwSoun�trg Device Lacni Municipal othas No.of Water Heaters KW No.of No.of connections sign Boil" No.Hydra Massage Tabs No.of Motors Total HP Irtstsancet'a7�m¢Plaritbletor}ileneOdMnred�elsC,ialml ThareaaatsYl�ehl,YhsatxRtyirrltdr; ar�sub�tlYt�gtivalQY YINJ:3, iNgo I�st>br�FPDJA p�dsadtohO�t Y19 "YouhatecftededYKPkraadraleftetypetfw=Vby MIRANCE 0 �leeeeSped» F dveiecfEMfoi DAN= D�� WodtbSert i�te�tDateRe�}Tabd Ra* SyWundeffizRnftafp f9RMNAM C i C;omrm�G�Cy � ,q,Cf Van �. LiamreNo vi �iclL�� /�� gni Bulilas'tliNln AtTaLNo, 7/-2 OWMUSM>1tANlCEWANQL•IaraaweeiatzLimw dteiinuBnaecae�eotisa>b�$Iegtivaimtasaar�tredbYMl�dsstdCalaalLwit and drat rrry ssrtt�on die pmrrtappiwdvlw"dre requit3treut (Please check one) Owner [--:- 3 Agent Telephone No, PERW FEE &AMME11141WI Ur M,VA aftrAUY Permit No. 4-/a BQARDUFF�BPRE'VFIVIIIR��X;[JIA7710i11�6S17(�1Z� •�Vit-r� Occupancy 3 Fen Checked APPUCATIONFOR PERMITTO PERFORM ELECTRICAL WORK AL.L WORK To eE PFAPORMBD IN ACCORDANCE Wmt THH MAssACHussrs ELL mim coDs,527 CMR 12:00 / (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Da Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street d:Number) 7 ---0wtrer or Tenant Owner's Address Is this permit in conjunction wi Yes o (Check,,A.�ppropride Box) ? purpose of Building /` Cl' a. ' iility.Authorizatiion No. t' Existing Service ?% otter Overhead Underpoun t'No.of Meters New Secvis� �� Ampg�Volts Ovedwad U rtdergr+ound No.of Meted Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work !.�•��r- �r =1174 Na o[Lighting Outlets Na of Hat TWO No.otTraoaaxtosn Tont No.of Lighting MUM Swirnmins Pod Above / KVA Oarerawn KV `, No,at Raceptacls Outlets No.of OH BuroateU011 Around No.of Emergency LightLrg Baltary Uoiu No.of Switch Ontbu No.o!dr Homme No.of Rams Na of Air Cond. Told Taos FIRE ALARMS No.of Zones No.of Dispouls Na d Hat TOW Tod Na of Dabction and y Pa Ton Kw Initialing Devices No.of Dishwuhen Space Ara Heating KW No.of Sounding Devic" No.of Self ConwinW ers Heating Devices KW Detaodrnr/3ovoderg No.of Dry !.Deal muWcipd � a No.of Wader Heaton Kw Na d din Connutione 3100 s No.Hydro Mwape Tebe No.of Mown Total HP ttstsanaeGaeie� Ihneaans9L PWilhaautaxtbsbFbetie4liimdui�; lhmea*rnedmM;x fc( miDtzGfttf(71a1r9r�a r�ste�lYeyiiroa6ywt haedaladz �p DFas PZVRANCE --Ba ODER [:I Ae*a*h PVAzdEkckW 1 WodcbSw f 11�e�rnDatRecFle4d Ftotgp e S�gredurlds Pa>atletC .-, �7 / BudnsTal,Nn �JWI�'SII ,SI�AI�WAN1�;IamawaehtiheI� �dteaaxaneaneageor�st��irlegtivalstasi��by�du9elbC�ILaRt anddv1ffysiV"cnlh6p "firaonet (Please check one) Owner Ment Telephone No. pBRMrI'FBE s /a'7' `c. c= U�,c c, cil A �o r S � C 2^ Date.. . HORTM w OE „ao ,,,ti0 �? . TOWN 'OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SwCHUSEtt This certifies that . . . . . . . . . . i has permission for gas installations in the buildings of atNorth Andover, Mass. Feet?`' �. . . . Lic. No..��.z. . . .� T . . . . . . . . �f AS INSPECT R Check# C/ 532- 5 MASSACHUSErfS UNIFORM APPLICATON FOR PERMIT TO DO GAS FPrrING (Type or print) Date // — 7 -- a NORTH ANDOVER,MASSACHUSETTS l. Building Locations ` O 1 ' " w ' ` """ Permit# 3`�3 Amount$ Owner's Name New 0- Renovation 0 Replacement ❑ Plans Submitted ❑ c H o c c GO z W a3c z 9 O Aw 0 44 UE 4i O O O• W A U a a 0 1 1 N SUB -BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Cffeone: Certificate Installing Company Name U A 4. J-6.ti-�-`' ��C' Corp. Address �` -ny ElPartner. La,,-, usmess a ep one 13 7 p 3 ❑ Firm/Co. xc Name of Licensed Plumber or Gas Fitter R .,,. J -,-, INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No If you have checked Yes,please indicate the type coverage by checking the appropriate box. 13Liability insurance policy M Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ A nt ❑ i hereby certify that all of the details and information I have submitted(or enter in above j6plication are true and accurate to the best of my knowledge and that all plumbing work and installatio pe rmednd•r Pe issued for this application will be in compliance with all pertinent provisions of the Massachu et S ate G s Code d Ch p r 1 the General Laws. Signature of License lumber Or Gas Fitter By: ® Plumber / Q d ?-? Title City/Town ❑ Gas Fitter icense um er ® Master PROVED(OMCE USE ONLY) ❑ Journeyman r� Date.../.v/. .�l..Q3 NORT►, + TOWN OF NORTH ANDOVER PERMIT FOR WIRING "O•AT o SACHUSE'� This certifies that ..Aw .4K... .......................................... has permission to perform .......... P �'.'. .:.... �!:!� �G `........................... wiring in the building of...c!.�.1�a..fa.:.:.t.y!�.� ah� .. .... ............................... at... .....:..................................<,.....�......3 o�.....�.:., orth Andover,Mass. Fee,3.. a:w.... Lic.No... oZ 170.!.......... Q... a ............ ELECTRICAL IN PECMR Check # 4815 The Commonwealth of Massachusetts V/- Office Use only Department of Public Safety Permit# 3 Board of Fire Prevention Regulations 527 CMR 12:00 Occupancy&Fee Checked a 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date October 31, 2003 City or Town of No.Andover To the Inspector of Wires: The undersigned applies for a pen-nit to perform the electrical work described below. Location (Street&Number) 530 Turnpike Street Owner or Tenant John McQarry Owner's Address 401 Andover Street,No.Andover,MA Is this permit in conjunction with a building permit: Yes 0 No = (Check Appropriate Box) Purpose of Building Utility Authorization No. 170513 Existing Service Amps Volts Overhead =Undgrd =No.of Meters New Service 1200 Amps 277/480 Volts Overhead =Undgrd ]No.of Meters THREE Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work [[�,2.of Lighting Outlets No.of Hot Tubs No.of Transformers `No.of Lighting Fixtures Swimming Pool Generators No.o.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units N-o.of Switches No.of Gas Burners FIRE ALARMS No.of Ranges No.of Air Cond. Tons No.of Detection No. of Disposals No.of Heat Pumps kw No.of Sounding No.of Dishwashers Space/Area Heating kw No.of Self Contained No.of Dryers Heating Devices kw Local No.of Water Heaters No.of Signs Munici al P No.of Hydro Massage Tubs INo.of Motors Low Voltage Wiring Other: .-INSURANCE COVERAGE: Pursuant to requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial w equivalent YES F X NO I have submitted valid proof of the same to this office YES I x NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ,FX BOND F OTHER F (please specify) 2/2/2004 Estimated Value of Electrical Work (Expiration Date) Work to Start October 31, 2003 Inspection Date Requested: Rough Upon Request Signed under penalties of perjury: Final Upon Request FIRM NAME Dumais Electric LIC.NO. 12170A Licensee Mark A. Dumais Signature (�� LIC.NO. 26665E Address 8 Newport Street Bus. Tel.No. 978-683-9438 Methuen,MA 01844 Alt. Tel No. 978-685-4553 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or it's substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (please check one) Telephone No. Permit Fee 3,40 169-6) (Signature of Owner or Agent) TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING T OTHER THAN A ONE OR TWO FAMILY DWELLING e r� w { x n a -�'c ✓„...tet x3' �, .''+'�•N ;This Section for Official Use Onl BUILDING PERMIT NUMBER: DATE ISSUED: ` Z SIGNATURE: t Buildin Commissionerff or of Buildin Date 1.1 'Property Address: 1.2 Assessors Map and Parcel Number: n�/n Map Number Parcel Number ,p /• Axn v�� 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Areas Frontage fl m 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided as ` ss/ \.3,<-/ �-o , \J5l y7� 1.7 Water Supply M.G_L.C.40.§54) 1.5. Flood Zone Information: Sewerage Disposal System Public W Private ❑ J� Zone Outside Flood Zone W Munici a On Site Disposal System ❑ 2.1 Owner of Record Cw,,f x ,uv F ?bllA Name(Print) Address for Service:Zfam L 97f- ?6 - rn Signa. Telephone 2.2 Authorized Agent -,%ar1Ae,-"/1C6AFy /–02-T�}L N %ZOST" 4a/ ,A'Z'I'2 sj'/Ua. 1,iyoo1-C�/l.4 Z Name Print Address for Service: 97,F1-6 O Signature Telephone Z 3.1 Licensed Construction Supervisor Not Applicable ❑ 'DA k1 Address License Number O �O/XAIZAV AVZYCK s' 11 Licen nstruction S sor: �///Q 9 7,` to Expiration Date lure Telephone / r Registered H,,06 Improvenf6t Contractor Not Applicable ❑ v Company Name. Registration Number M r Address r Expiration Date ^Z Q Signature Telephone Location N"`n U�r , No. Io Date � � � � � ' U Z. HART" TOWN OF NORTH ANDOVER f � 0 n ♦ i 4 Certificate of Occupancy $ • �'�S''•• E<�' Building/Frame Permit Fee $ b swCHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ o Check # Sag 16017 Building Inspector SEcrIox a wQlc > s © ass s 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 Yea......X No.......❑ SECTION 5-'PRO L riESGN AMCON gEA VICtiS F t?> 1iDIN+ S Aim STRuESEt"I Q cQxs uc ifQN CO 1 t1Pr�1 �Ta ( 11!1 ; ► 5, rC F o> FNCIabSK- s�►A�� i .... nL . 5.1 RegisteredAtfhitect:x J g t Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date, Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Mj Company Name: Not Applicable ❑ Responsible in Charge of Construction • Y. ._p New Construction ~❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ A4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A 0 C Educational ❑ 2B 0 F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ 1-1 ❑ I-2 0 I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 0 5A ❑ S Storage ❑ S-1 ❑ S-2 0 5B ❑ U Utility ❑ Specify M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 1-21 BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT gmmy as Owner of the subject property Hereby authorize_`%�i�l//C7 zf�C lJ6'f� to act on My behalf,in all matters relative two work authorized by this building permit application • ii is as Signature Dat 01.510-1 I, ��✓ MC 6/9R�Y as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Y'a S tore of. er/ gent oate Item Estimated Cost(Dollars)to be w Completed by permit applicantma�m 74 ' 1. Building (a) Building Permit Fee ), Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a) X(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number `ryti �++ l7tb,�. z"�.*,sll,n i.2 .3,..t P t$' 7 Y'3,�� l�rr/!hf i r:D.,i u '� (�ZdW K df -'r` 't .✓,Ir.`� x"' ::,, Bks-?,,'.s,'S 3;lW i. P k t ,t C t .v ° i tip` f i 31st, x s," 1f�� art. NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IS71 2 N 3RD SPAN DEMENSIONS OF SILLS DE .NSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X i MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE :e�a, -ss sem,u I s Z w The Commonwealth of Massachusetts Departs;-nt of Industrial Accidents tn ' d Office of Investigations Boston, Mass. 02111 °+M 5�lb Workers'Compensation Insurance Affidavit Name Please Print Name: Location: Ci Phone # 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: - Addressl/ City h� L-Z 5/< Phone# Insurance Co. Policy# Company name: Address Ci : Phone#: Insurance Co Policy# 7111111111111 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..penaftiesin2hefnrm nfA STOP WORK ORDER,and_a-fine_of_($1D0m)-a4ay against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signatures I��D — Date / " Dom. Print name-2Us1')A1 -Phone# 0/ 71 %5 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin Building Dept ❑Check if immediate response is required p Licensing Board Selectman's Office Contact person: Health Department Phone#: � A Other North AndOer 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: I (Location of Facility) ign re of ermi pplicant 619 ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ` NORTH E own ® - Andover O dover, Mass., S ADRATED pPa` ``5 44 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT3,0WMa BUILDING INSPECTOR N G�a N N .................................................................................. Foundation has permission to erect..��Z V.P �..h....... buildings on ...y 0�........A N e V't r Z g .................................................................. Rough to be occupied as....w.� O . � © Chimney - p" ............................................... ............................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La s relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 01 1 *S 0� 00W PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR Rough ........................................................................ Service BUILDING INSPECTOR 1, Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. t RECEIVED MICHAEL S.GiAiM0 .'ROBINSON & COLELLP JUN 2 " 2o05 One Boston Place NORTH ANDOVER Boston,MA 02108-4404 PLANNING DEPARTMENtlain(617) 557-5900 Fax(617) 557-5999 mgiaimo@rc.com Direct(617)557-5959 May 31, 2005 BY FACSIMILE Mr. Lincoln Daley,Town Planner Town of North Andover 400 Osgood Street North Andover,MA 01845 Re: Verizon Wireless—401 Andover Street,North Andover Dear Mr. Daley: As we discussed last week,you were recently provided with the mylar plans for the above- referenced wireless communications site,which is a rooftop site that was the subject of an application to the Board and subsequent litigation that has since been resolved. My understanding from our discussion is that you are authorized to sign them on behalf of the Board but that you were awaiting confirmation that the litigation involving this matter had been finally disposed of. Enclosed is a copy of the Final Judgment and Order of the Federal District Court disposing of the appeal brought by Verizon Wireless. The disposition of this matter was by agreement between the applicant and the Town parties, including the Planning Board. The Final Judgment and Order includes an agreed-upon form of Special Permit, and that Order, including the Special Permit,was recorded with Essex Registry of Deeds on April 15, 2005. My client and I will very much appreciate your prompt attention to signing the mylars, as they are planning to obtain the building permit as soon as the Building Department is cleared to do so by your office. I am providing a copy of this letter to Mr. Cloherty, who served as Town Counsel in this matter. I have also copied the Town Clerk(with enclosure)in order to make sure that there is a copy of the Final Judgment and Order, including the Special Permit, in her file on this matter. Law Offices Sincerely, BOSTON ✓�� HARTFORD Michael S. Giaimo NEW LONDON STAMFORD Encl. GREENWICH c: John Cloherty, Esq. (by fax w/o enclosure) North Andover Town Clerk(regular mail w/enclosure) NEW YORK David Tivnan (Verizon Wireless) SARASOTA www.rc.com BOSTI-859371-1 K 9457 PG 332 ..7 l✓7CHOIT I UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACIHi1SE CELLCO PARTNERSHIP d/b/a ) , VEMON WIRELESS, plaintiff, ) ) V. ) _, THE TOWN OF NORTH ANDOVER, MASSACHUSETTS,TIE TOWN OF ) " NORTH ANDOVER PLANNING BOARD, ) C.A.NO: 03CV10362MEL � �> and JOHN SIMONS,ALBERTO ANGLES, FELIPE SCHWARTZ,RICHARD NARDELLA ) GEORGE WHITE.and JAMES PHINNEY, ) as they are the Members and Associate ) Members of the Town of North Andover ) Planning Board, ) Defendants. ) } c.� 0- P' NAL jVRGb=AP.OR11AR The Joint Motion of the plaintiff Cellco Partnership d/b/a Verizon Wireless("Verizon Wireless"),a Dolawam general partnership with ars office at 400 Fribc�g Parkway, Westborough, Maasaebusetts, and with a principal place or business at 180 Washington Valley Road, Bedminster,New Jersey and the Defendant Town ofNorth Andover C Town"),a duly constituted municipality in Essex County,Massachusetts,with its principal office located at 120 Main Street,North Andover,MA; and the Defendant Planning Board of the Town of North Andover("Board"),a duly constituted board with an office located at 120 Main Street,North Andover,MA and the Defendant members,associate members and former members of the Planning Board,represented by counsel,for Entry of final Judgment having come be€ore the 8 s O 947 PG Y Court, and all interested parties having been served with'notice thereof,and a hearing having been held,it is hereby ORDERED as follows: 1. Verizon Wireloss nzay locate its wireless communications tower and wireless communications facilities on and within an existing-building at.401 Andover StrW,North Andover C'Site"). The installation and operation of the wireless conrununications facility at the Site shall be pursuant to a Special Permit,to be issued by the Board forthwith and without any rarther hearings,subject only to those conditions set forth in Exhibit A halo C the Special Permit recision"),and the variance previously issued by the North Andover Zoning Board of Appeals,without the need for any further permits of approvals other than a building permit from the Towne of North Andover Building Inspector. The Planning,Board shall,promptly upon request by Verizon Wircless,endorse mylar plans and take such other actioin related to its authority that may be necessary or appropriate to effectuate and facilitate the obtaining of a building permit and occupancy permit by Cetlm.The provisions of the North Andover Zoning Bylaw pertaining to post-construction and annual nukofrequency emissions monitoring and reporting to the Planum Board Sections 8.9. d i and 8.9.8 a shall not be enforced against l� g 8 ( sf ){) ( )) g the Plaintiff. The Plaintiff repremts and Fees that it will operato its facility in compliance with applicable Federal Communications Commission reyuiremernts. 2. The Defendant Town ofNorth Andover,through its municipal boards and officials,shall upon application and the prosentation of any plates, fees and other information as may be required by the state Building Code for such documents, forthwith issue any necessary building.permits,electrical permits and certificate of occupancy for the construction and use of 9 • ' 9457 PG 33 thepoPo sed wireless eommunicado.ns facility at the Site in accordance with the Special Permit Doc ision. 3. Upon the issuance of build' permits permits by the Town of North Andover asset forth above,the Plaintiffshall file With the state court a stipulation dismissing its state zoning appeal Land Court Dept.Misc. No.287982. 4. In the event Verizon Wireless applies to the Town of North Andover for zoning permission for any facture wireless communicates n facility that is not the subject of this Judgment,nothing contained in.this Judgment or the state Stipulations of Dismissal entered pursuant hereto shall operate as w" is to or collateral estoppel with respect to any claim or defense asserted by any party in any litigation aTWng out of any such application. 5. l±ash party shall bear its own costs,including attorneys' fees,and:there shall be no damages awarded. lamer,I United States District Court Dated: 2,004 10 • BK 9457 P6 318 EXikl MIT A SPECIAL PEP-MIT On the application by Verizon Wireless for a wireless service facility special.permit and a site plant special permit with respect to property located at 401 Andover Street,North Andover, Massachusetts owned by John McGarry,Plum 2 Trust,401 Andover Street, North Andover pursuant to a deed recorded at Essex Registry of Deeds,Book 1773,Page 250, the;Planning Board,pursuant to the Judgment and Order of the Federal District Court issues the requested special permits as follows: Wireless Service Facility Specc et Permit The Planning Board snakes the following findings as required by the North Andover Zoning Bylaw Section 8.9: Finding of Pact; 1. The antenna arrays am to be.affixed behind the parapet of an existing structure and painted the same color as the structure to camouflage the facility and minimize visual impact. Ancillary equipment and generators will i ]ccatsd within the Structure and behind the parapet. The installation will be in accordance with plans entitled "Telecommunications Installeton at Rolle 125 North Andover,MA"prepared by Daigle Engineers,Inc.,dated April 25,2001,Drawings No. S-1 and S-2 as most recently revised on January 2,2003. 2. The Radio-Frequency emissions of the facility meet applicable FCC guidelines and regulations. 3. The carrier has demonstrated that the facility is necessary in order to provide adequate service to the public. 4. The plan meets the requirements of the Wireless Service Facilities By-law Section 8.9. 5. A zoning variance for relief of 520 feet from tate 600 foot"gall zone"setback was granted on August 1,2002 by the Zoning Board of Appeals. 6. Ad quate and appropriate facilities will be provided for the proper operation of the proposed facility. 7. The use as developed will not adversely affect the neighborhood as indicated by the submittals and reports referenced in this decision. Site Plan Special Permit The Planning Board makes the following findings as required by the North Andover Zoning Bylaw Section 8.3: 11 BK 9457 PG 3% Findings of Fact: 1. The use will not result in any nuisance or serious hazard to vehicles or pedestrians. 2. There will be minimal alteration to the exist ng site or sttucture as a result of this facility. Finally,the planning Board finds that this praject gencrally complies with the Town of North Andover Zoning Bylaw requirements as listed in Sections 8.3,8.9,and 10.3 but requires conditions in order to be llnlly in compliance. The Planning Board hereby approves the requested special permits subject to the following conditions: !, The grant of the special permit is subject to the following terms and conditions: 1. The antenna arrays are to be affixed behind the parapet of an existing structure and painted the same color as the aftWurc to camouflage the facility and minimize visual impact. Ancillary equipment and generators willbe located within the structure and behind the parapet. 2. Discontinuance and Abandonment: a) At such time that a licensed carrier plans to abandon or diswnlinuc operation of wireless service equipment,such carrier will notify the Town by certified US mail of the proposed date of abandonment or discontinuation of operations. Such notice shall be Aden no less than 30 days prior to abandonment or discontinuation of operations. In the event that a licensed carrier fails to give such notice,the wireless service equipment shall be considered abandoned upon discontinuation of operations. b) Upon abandonment or discontinuation of use,the carrier shall physically remove the wireless service equipment placed on the site by the carrier within 90 days from the date of abandonment or discontinuation oruse. "Physically remove,shall include,but riot be ligated to: i. Removal of antennas,mount,equipment shelters and security barriers instal led by the carrier(unless the same will continue to be used by the owner)from the subject property. ii. Proper disposal of the waste materials gmarated by the carrier from the site in accordance with local and state solid waste disposal regulations. C) Given the nature of the facility,no escrow is required tender Bylaw section 8.9.9.c. d) The equipment shall be deemed to be abandoned or discontinued if it has not been used for the purpose for which it was originally constructed for a period of six(6)months or more after the use commences. Once abandorunont or discontinuance has occurred,the carrier shall remove the equipment placed by the carrier frown the subject property within ninety days. 12 I BK 9457 PG 33 3. Performance Guaramecs: a) Given the nature of this facility,insurance shall not be required under Section 8.9.11.&of the Zoning Bylaw. b) Given the nature of this facility,no escrow is required under Section 8.9.1 Lb of the Zoning Bylaw to cover annual maintenance of the facility. c) Tho Special PermitIoldershall annually,on January 15,file a declaration with the SPCA certifying the continuing neon ofthis facility in compliance with tht standards of the Federcl Communications Commission,Federal Aviation Administration and the American National Standards Institute, 4. Teems of Special Permit: a) A Special Permit issued for any wireless servfcc facility shell be valid for three(3) Years from the date of its isau mcc.The special perniit may be renewed under the same criteria as the origitW speer]Z it,provided that the application for renewal of the special permit is made prior to the expiration date of the original or any renewed,special permit. Additional measures governing the admimi stration of the special permit are found in Section 10.3 of the Zoning Bylaw. b) After the wireless service facility is in operation the applicant shall submit to the SPGR- within 90 days or the issuance of the Special Permit,and at annual intervals from the date of issuance ofthe Special Permit, preexistent and current measurements of acoustic noise from the wireless service facility. Such measurements shall be certified and signed by an acoustical engineer,statim;that noise measurements are accurate and meet the Noise Standards sub-section 6.13.14.5 of this bylaw.Measurements shall be taken at a location that is 30 feet from the property lime of the subject property in the direction of tho nearest residences. c) The applicant and co-applicant or their successor in interest shall trtaintain the wireless service equipment in good condition, Such maintenance shall include,but shall not be limited to,painting, structural integrity of the equipment. 5. The applicant shall submit ss-brant plans to the Planning Board upon completion of the construction authorized by this special.permit. The failure of the applicant to submit as- built plazas within 90 days of commencing operations at tfie site shall entitle'the Planning Board to revoke the permit until such time as the as-built plans are submitted. 6. Prior to the start of construction: a) A construction schedule shall be submitted to the Planning Staff for the a 13 • 9457 PG T purpose of tracking the coustruction and informing the public of anticipated activities on the site. 7. Prior to FORM U verification(Building Permit Issuanpe): a) The final site plan mylars must be endorsed aeai three(3)copies of the signed plans must be delivered to the Planning Department. b) A certified copy of the recorded decision must be submitted to the Planning Department, g. Prior to verification of the Certificate of Occupltttcy:. a) 'The applicant must submit a letter Crom the architect or engineer of the project stating that the construction and operutions substantially comply with the plans as endorsed by the Planning Board. 9. ,Prior to the final release of security: a) A final as-built plan showing fuW construction and location of the wireless hardware shall be submitted to and reviewed by the planning Staff. 10. Any stockpiling ofmatenals(tint,wood,consnotion material,etc.)must be shown on a plan and reviewed and approved by the Planning StaZ Any approved piles must remain covered at all times to minimize any dust I problems tharmay occur with adjacent properties. Any stock piles to remain for:longer d=one week must be fenced off and covered. 11. In an efTort to reduce noise levels,the applicant.shall keep iat optintuera working order,through regular maintenance,any and all equipment that shall emanate sounds from the structures or site. 12. No equipment or either equipment that will emanate noise-exceeding levels cited herein shall be placed on the exterior of the structure. Such equipment shall be enclosed as shown on the plans. 13. All site lighting shall.provide security for the site and structures however it must not create any glare or project any light onto adjacent residential properties, 14. The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 15. The provisions of this approval shall appy►tit and be binding upon the applicant, its employees and all successors and assigns in interest or control. 16. Any revisions shall be submi ted to the Town Plarmor for review. If these revisions will Have a substantial impact on the exterior appearance of the facility,the applicant must submit revised plana to the Planning Board for approval. 14 . BK 9457 PG 324 17. This special pawitshall be deemed to have lapsed 3 years kom the date the permit was issued pursuant to the order of the Court,useless substantial use or construction has commenced. Substantial use or construction in the event of a dispute,will bo dcter ned by majority vote of the planning beard based on the facts and applicable law. i 15 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT 'NEGk\ PHONE S_ IOJy LOCATION: Assessor's Map Number PARCEL SUBDIVISION 11 LOT (S) _ STREET u leu �- ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS t�f��aS 4 Za PLANNE DATE APPROVED Qoo 6-� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEry PERMIT FIRE DEPARTMENT d D 1X RECEIVED BY BUILDING INSPECTOR DATE Revised 9417Im i i, TOWN OF NORTH ANDOVER BUILDING DEPARTMENT I M APPLICATION TO CONSTRUCT'REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BURMING OTHER THAN A ONE OR TWO FAMILY DWELLING µ - - Section for Official Use OnWERN 10ic BUILDING PERMIT NUMBER: �-y� DATE ISSUED: p 6 O ic SIGNATURE: lV� Buildin Commissioner r of Buildings Date fl.IProperty Address: 1.2 Assessors Map and Parcel Numbs Map Plumber Parcel Numbs 1.3 Zoning Information: 1.4 Property Dimensions: v Zonm Distrid Proposed Use Lot Area Fronts A 1.6 BUILDING SETBACKS(ft) m Front Yard Side Yazd Rear Yard, Required Provide Required Provided Provided 1.7 water S pply M.G.L.C.4o. 54) Is. Hood Zone I¢fonnation: 1.8 S--W Disposal System: Public ❑ Private ❑ zone Outside Flood Zone ❑ Mmmicipal On Site Disposal System ❑ 2.1 Owner of Record Name(Pfint)` ` Address for Service Signature Telephone m 2.2 Authorized Agent N e Prin Address for Service: Z Signature Telephone Z 90 3.1 Construction Supervisor Not Applicable ❑ Address O SLicense Number r 1-� Li Construction Su ZbY 6on Dat 17 1077 3 Si a Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number m Address r Expiration Date Z Signature Telephone G) Location No. 1301 Date NORTH TOWN OF NORTH ANDOVER O'. 90 ,�pyo ` Certificate of Occupancy $ 4 1'�J'•^"'tn Building/Frame/Frame Permit Fee $ s�cwust 9 , Foundation Permit Fee $ Other Permit Fee • $ ,7 r i` TOTAL $ Check # r 18528 k- e Building Inspector /! � i MIR 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. Si ned affidavit Attached Yea.......V No.......❑ 5ECIDX 5 PRa T � �7 �1 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total 1fi Not applicable ❑ - Name: Registration Number Address t+Signature Telephone Expiration Date Name Area of Responsibility " Address Registration Number j Signature Telephone Expiration Date Name ` Area of Responsibility, / Address, Registration Number Signature s fj Telephone Expiration Date •x� [ T. !>��£:TSS ;�"ik' ,�,"u`4�}<: he w Not Applicable ❑ Company Nank.�-�� Responsible in Charge of Construction NORT#q Twn o of . 4 over _ 3d / o dover, Mass., S COCMICMEWICK 7�ADRATED BOARD OF HEALTH PER Food/Kitchen Septic System BUILDING INSPECTOR I IT T D THIS CERTIFIES THAT.......... .............................. .. ""' ""'.. oun ation has permission to erect..... .............................. buildings on...��.��/........ Rough t0 be Occupied as .. ......................................................... Chimney . . . . .. . . lin .... .. . A provided that the person accepting this permit shall ery resp conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ......................... .. 404 ...t....�5401 ............................................ Senrice BUILDING INSPECTOR Final Occupancy Permit Required to Ocayy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) IX Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑� Specify Brief Description of Proposed Work: USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business W 2A ❑ C Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I histitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B0 M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 . 11 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION-IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: - Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No Rr SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT.OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Hereby authorize S V� to act on My bem relative two work authorized by this building permit tpficiti6n r Signature of Owner Date i as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Pri tName Signature of Owner/Agent Date Item Estimated Cost(Dollars)to be Completed b t applicant t All P Y Pill PP � 1. Building (1 �D (a) Building Permit Fee Multiplier 2 Electrical I (b) Estimated Total Cost of Construction from(6) 3 Plumbing TOO Building Permit fee (a)x(b) 13-SD 4 Mechanical(HVAC) q 5 Fire Protection l CXXC7 6 Total (1+2+3+4+5) Check Number z\ ,Y, ;TMS <.�,,Ys ,,-�• ,,� � �"� 4 s'�R�`"F,9 E �fi �'� �'� � 'Fr � �� a H ° r�� . ,� 'v�r? NO.OF STORIES S BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sT 2 ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS 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 INIM Kwn t The Commonwealth of Massachusetts > Department of Industrial Accidents Ofte of lnvesd0aftns Boston, Mass. 02111 Workers'Compensatbn Insurance Affidavit Name Please Print N ` Location: �J c1tv 01W) !401 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 employees working on this job. e . AA Arm�e J Cft 336 Irmirance.Co. S, -poky 10 Comoam name: Address City: Phone;Ak PoYcv! Feltue to secure coverage ar required under Section 25A or MGL 152 can lead to ftw imposition d akninal ps udit d,s Ane up to$1,500.00 arxYor orae years'in"arrraerrt.as.vv@i.n.c bA p naNn Jn be hm xfA STUP Y.WW OROOkAid.a Noe d.(SJCGJq-MAW Moshe ma. I understand that a copy of this statement may be forwarded to the Office of Investigations d ft DIA for coverage VNNWatlon. I doheroby u+nbr dhe pains andQ P@dUFY that the irdbrmetlon provided above is hue and caned. Slgnature Date Print name Pthxone#S�( Official use only do not write in this area to be completed by city or town dW r City or Town P si []Check Y immediate response Is requbed ❑ Building Dept Lkenabg Board ❑ Selectman's OHke Contact person: Phone oil ❑ Health Department Other DATE: 01/26/05 TIME: 09:10 AM 10: 5086551139 PAGE: 002-003 A�� CERTIFICATE OF LIABILITY INSURANCE 01/26/2 o 'RODUCER (508)653-3131 FAX (508)651-0129 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fair & Yeager Insurance ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Natick, MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOVV. . INSURERS AFFORDING COVERAGE NAJC# NSUREO W. S. Kenney Corporation, Inc. IN51JP,EP.A: Acadia Insurance Company 1 South Avenue INsURERE: St.Paul Travelers Natick, MA 01760 INSURER AIG Insurance 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 MAYBE 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, NSR D. TYPE OF INSURANCE POLICYNUMSER POLICY EFFECTIVE POLICY EXPIRATION LIHIITS NSR ATE MMJD TE MWDD GENERAL LIABILITY CPA005091815 04/09/2004 04/09/2005 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED a $ 250,00t CLAIMS MADE a OCCUR dED EYP(Anyone person) $ 5,00C A PERSONAL 2 ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2:O00 a 000 GEN'L AGGREGATE LIMIT APPLIES PEP., PP.ODUCTS-COMPIOP AG'G $ 2,000,000 POLICY M FRO )ECT LOC AUTOMOBILE LIABILITY 81067IH4451 03/24/2004 03/24/2005 COMBINED SINGLE LIMIT $ AMY A)JTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILTNJJUR'r $ $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS -. BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ {P'er accident; GARAGELIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC $ OTHEP.THAN AUTO ONLY: AGG $ EXCESSUMBRELLA LIABILITY CUA005091915 04/09/2004 04/09/2005 EACH OCCURRENCE % $ 5,000,00 C X OCUP. CLAIMS MADE " \ i ` J AGGREGATE $ 5,000,000 A $ DEDUCTIBLE $ P.ETENMON $ $ WORKERS COMPENSATION AND WC7692601. 07/01/2004 07/01/2005 X I TOP,YUM I ER EMPLOYERS'LIABILITY C ANY PROPRIETOP,IPARTNEPJEXECUTIVE E.L.EACH ACCIDENT S 500,00 OFFICERIMEMBEP.EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 Ifyyes.tlescribeunder SPE_ PROVISIONSbelmE.L.DISEASE-POLICY LIMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS)VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ICL corp. d/b/a Tweeter Center for the Performing Arts (Mansfield, MA), Clear Channel :ommunications, Inc. , SFX Entertainment, Inc. , their respective parents, partners, Iffiliates, and subsidiaries, and the officers, directors, employees, agents, and representatives If each are included as Additional Insured on the above general liability policy, as respects he operations of the Named Insured, it's agents, employees and representatives CERTIFICATE HOLDER 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, Tweeter Center for the Performing Arts BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 885 South Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Mansfield, MA 02048 AUTHORIZED REPRESENTATIVE Natalie Waters ACORD 25(2001108) OACORD CORPORATION 1989 / public benefits such as opportunities for co-location, improvements in public safety, and/or t reduction in visual and environmental impacts. 11) Performance Guarantees a) Insurance in a reasonable amount determined and approved by the SPGA after consultation at the expense of the applicant with one(1)or more insurance companies shall be in force to cover damage from the structure,damage from transmissions and other site liabilities. Annual proof of said insurance must be filed with the SPGA. b) Funds, sufficient in the opinion of the SPGA to cover annual maintenance of the facility, shall be placed into escrow and shall be held by the independent escrow agent who shall be authorized to expend the funds for the maintenance of the facility on terms to be agreed upon by the carrier and the SPGA as a condition of approval of the special permit. c) Annual certification demonstrating continuing compliance with the standards of the Federal Communications Commission,Federal Aviation Administration and the American National Standards Institute shall be filed with the SPGA by the Special Permit holder. 12) Term of Special Permit. , a) A Sp al=Permit issued for any wireless service facility shall"be valid fof three(3)years.. _ The-special'permit may-be renewed-under the same criteria as the original-special permit, I that the application for renewal of the special permit is made prior to the ► -expiration date of the original or any renewed special permit. Additional measures governing the administration of the special permit are found in Section 10.3 of this Zoning Bylaw(1998/36). Section 8.10 Lot/Slope Requirements 1. Lot/Slope Requirements:In the residential zoning districts the following provisions of this Section 8.10 shall apply: a. Purpose: The purpose of this bylaw is to preserve and enhance the landscape by encouraging the maximum retention of natural topographic features, such as drainage swales, streams, slopes, ridge lines, rock outcroppings,vistas,natural plant formations and trees;to minimize water runoff and soil-erosion problems incurred in grading of steep slopes; to encourage innovative architectural, landscaping, circulation and site design. For the purposes of this subsection,the term"natural"shall be defined as the condition of the ground surface as it exists at the time a subdivision or development is proposed including any man-made alterations such as grading, excavation or filling which may have occurred prior to the time such subdivision or development is submitted. No land intended for subdivision or development may be regraded or filled in such manner as to circumvent this bylaw b. Provisions: The provisions of this Subsection 8.10 shall not apply to building lots in a definitive subdivision plan submitted in accordance with M.G.L. Chapter 41 in order to obtain the protections afforded by M.G.L. Chapter 40A, Section 6. C. Defining the Slope: The slope of land at any point, stated as a percentage, shall be defined as the change in elevation over a horizontal distance measured perpendicular to the contours divided by the distance over which the change occurs multiplied by 100. The slope of land at any point, may be stated as a ratio(2:1, 3:1, 4:1, etc.). The first number of the ration indicates the horizontal distance and the second number indicates the vertical rise. 107 DATE: 01/26/05 TIME: 09:10 AM TU: 5086551139 PAGE: 003-003 IMPORTANT i If the certificate holder is an ADDITIONAL INSURED,the poticy(es) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. I ACORD 25(2001!08) 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 Permit Applicant D to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through h the Office of the Building Inspector � auf .. i-Ge� : BOARD OF BUILDING RtGULATIONS { Llcen$e QONSTRUCTION SUPERVISOR Numbcn`C 057118 r"° Blrthd�itex p�j�4�1966 f p2/14� 007 Tr. no: 8740.0 R��ttriCte�tY�Op =' �`t STEVEN M MORR'ILI� �i 1 256 PEARL ST NEWTON, \fes MA 02458{ Commissioner_j / i i PIERCE, DAVIS & PERRITANO, LLP COUNSELLORS AT LAW Brian D.Carlson t Joel F. Pierce TEN WINTHROP SQUARE„- �. Sean T.Delaney John J. Davis* BOSTON,NIA 021-10-1257 � 1 V Meredith P.Freed Judith A. PerritanoDavid C.Hunter t John J. Cloherty III* TELEPHONE(617)350-0950 MAY 1 9 20Q4 Danielle T.Jenkins* FACSIMILE (617)350-7760 Maureen L.Pomeroy Daniel G.Skri Of counsel: �10RTH ANDC" p Gerald Fabiano i traivi ING DEPAri'tv11=NT *also admitted in Rt ♦also admitted in PA May 17, 2004 talso admitted in NY Michael S. Giaimo, Esq. Robinson & Cole, LLP One Boston Place Boston, MA 02108-4404 RE: Cellco Partnership d/b/a Verizon Wireless vs. The Town of North Andover, et al. U.S.D.C., Civil Action No: 03CV10362MEL Dear Attorney Giaimo: Pursuant to our discussion, enclosed please find the duly executed Agreement for Judgment for tiling with the Court relative to the above-captioned matter. Thank you. Sincerely, PIERCE,DAVIS&PERRITANO,LLP d � � Jo J. loherty III s JJC/mj Enclosure cc: Julie Parrino, Town Planner Thomas J. Urbelis, Esq. Peter Roxo I Friday,February 21,2003•North Andover Citizen rk rparents.. should be mors�d outh wo e s saY Y . some parents from addressing the issue of levels exposure to drugs like marijuana is a :measures said Gallagher. `"This is€ was going adolescent drug use is that,"some parents factor. - According to Ruth,the students implicat . think it is j s ago,the have the idea that this is just a certain type of To solve the problem,Gorman said we ed come from "a lot of different groups think that.v e middle kid. It shocks them to hear that so called must first address it. and make up "a variety of types" from things like `good kids'are getting involved with drugs "We as a community need to be proac "preppies"to"ghetto and punkkids." wrong much as too.But it is not just one type of kid.It is all tive about this ... instead of blaming the "A lot of kids do it,"she said."They want The won ire free to different kids from all different incomes." school system, everybody needs to get to.fit in. It's the thing to do and they are supply lint want after Gofman said Youth Services works with together on this and talk about it. The afraid that if they don't,they might not fit in brothers an the time the school system and parents to promote biggest problem, as I see it is that parents anymore" 1 middle scl get home education about drugs and warning signs .don't communicate enough with their kids, .Ruth said that"a lot of(students)have the believes dri that kids might be abusing them. However, There needs to be an open dialogue.Drugs, same opinion;as,me,and are embanass&d economic.l' J Gorman budget and grant cuts will reduce those pro- alcohol and sex are not the easiest subjects, Our'school used to have a good name,and "Ibis isl firmed by grams in the coming months and years. but they need to be,on the table. Parents now we will have a bad reputation. But People hav+ He school He said that although they try,to target? need to be in tune with their kids,where most (students) really don't care. They; she said, s "at-risk"kids for one-on-one interventions, they are and what they are doing." think it doesn't matter." older studet Ji.In fact, the problem is :`all kids in general are at ; So far,one student has been charged with ; She,said many of her fellow students to look out surprised. risk." possession of marijuana and will appear in have expressed fear that they maybe false- drugs."Ani I with this .. Like many others,Gorman feels that the Lawrence Juvenile Court according to ly charged .if marijuana is planted in their instance, . decrease in the average age at which kids Police Lieutenant Paul Gallagher.He said lockers,most of which don't have locks .. . „ "The rxie ive years, begin experimenting with drugs is symp :another will be charged One parent of an eighth grade student 4where.,The h drugs at tomatic of a culture-wide desire to grow:up As far as the remaining seven stu- who declined;to be identified said she free:Most{ fast.Also,he said though he doesn't want to . dents, the middle school officials thinks more people should have been theirparen fiat keeps place all the blame on mass media, sheer -and Reste are handling disciplinary, aware. getting fife 4 TOWN ROUNDUP ' i.71i ' ASM Board President Diane Cell tower,battles "The boardmembers indicated next round of the;town's cell 'nec ce Bauer wrote to parents: "Alex New`Town Planner J. Justin that they didn't think the'sites' tower debate may be played out End ly brings a wealth of private school Woods had an interesting first were appropriate;" said Woods in a local courtroom. Acs I administrative and academic seek at his new job. who suggested that the decision "One of the attorneys repre- _plac experience. He shares;our com- Woo&attended his first North may have violated the strict senting the,companies told me to ons mitment to providing our stu-, Andover Planning Board meet= parameters of,the Federal,Com get.out my best suit, said lig d, dents a Montessori education and, ing as the'town planner and rec munications Act. Woods. Nei ;1e to the school's mission.of giving ommerided.}that the board, The telecommunications L'ez ie students the tools they need to be approve two applications for cell companies now have 20 days4o Brooks kicks math, P17111ori life-long learners." towers on High and Andover appeal the, town's decision to cut f Murenia was selected after an streets. either Superior Court or Land After four contests in a sixL, X4a or extensive search process that The board voted 3 to 2 in favor, Court. The other option is they contest season, the Brooks Ver ri-, began in August 2002.He is.cur- of granting the special permits may simply decide to sue the School with 84 points is in a two- C. id rently the Assistant Headmaster for the towers to Verizon and town• way tie for third out'of 185 ipa is for Academic Affairs at Cheshire Omnipoint. However; because' Woods did get the hint that the schools with.Brookfield (Con-. eac` Academy in Cheshire„Connecti- the companies were seeking spe to cut and has also served as its Direc- cial permits,:the vote needed to • for of Alumni and Development. be at least f64-in favor. :The North Shores #1 Retirement Chi • =--y— .L j Will Be Even Better In 200' Z DA) r • poRrH of IV q. sl ' �t,.° ,6Rio Town of North Andover ~ Office of the Planning Department * 7° Community Development and Services Division 20� JUN 19 PM 4: 13 i e 1600 Osgood Street E�cS North Andover,Massachusetts 01845 S S "`""5 NOTICE OF DECISION la 0,RT''l t ;t,n�rr Any appeal shall be filed MASS � within(20)days after the 1 f` •. s Bldg. - ZBA Con/Com Health, Fire Chief Police Chief Date: June 6,2008 Town Clerk DPW/Engineers Date of Hearings: May 20,2008,June 3,2008 Surrounding Towns Date of Decision: June 6,2008 Application of: Bell Atlantic Mobile of Mass Corporation,Ltd. d/b/a Verizon Wireless 400 Friberg Parkway Westborough, MA 01581-3936 Premises Affected: 401 Andover Street, 'MA 01845; Assessor's Map 24, Parcel 33, and within the General Business Zoning District. Referring to the above Application for a.Special Permit Renewal under the requirements of the North Andover Zoning Bylaw, Sections_8.9 3(a)ih.and MGL C.40A, so as to allow the applicants to operate a building mounted wireless service facility. Installed three arrays of four panel antennas for a total of twelve antennas located behind the parapet walls and placed communications eauipment in the attic of the existing building located at 401 Andover St. (Rte. 125) within the G-B zoning district. After a public hearing given on the above date, the Planning Board voted unanimously to APPROVE A SPECIAL PERMIT RENEWAL,based upon the following conditions: Curt Bellavance,Director North Andover Planning Board John Simons, Chairman Alberto Angles, Vice Chairman Jennifer Kusek, Clerk Richard Rowen Timothy Seibert Bell Atlantic Mobile of Mass Corporation,Ltd.,d/b/a Verizon Wireless 401 Andover Street Special Permit-Renewal of Wireless Service Facility FI V E D y The Planning Board herein approves the Special Permit Renewal so as to allow the applicants to operate and maintain an existing building mounted wireless service HA4YAstiJ1 oh4a arrays of four panel antennas (twelve total antennas) located behind the parapet ofthe existing building, an equipment room in the attic space, and an emergency generator on the rp bl the parapet within the General Business zoning district. This renewal is granted p 3l,�Iui} etts General Law, Chapter 40A and Section 8._9.12 of the North Andover Zoning Byla1 w, and *ill extend the above referenced Special Permit for a period three years. This Special Permit Renewal was requested.by Bell Atlantic Mobile of Mass Corporation, Ltd., d/b/a Verizon Wireless, 400 Friberg Parkway, estborough, MA 01581-3936. The application and additional documentation as cited herein was filed with the Planning Board on April 4, 2008. During the review process, the Applicant and its professional consultants also submitted various revisions to the plans along with various supplemental memoranda and correspondence in response to requests by the Planning Board, and by the various departments within the Town of North Andover that reviewed the project. All of these plans, reports and correspondence are contained in. the Planning Board's files and are hereby incorporated by reference into the public record for this hearing. The Planning Board makes the following findings as required by the North Andover Zoning Bylaw Section 8.9: FINDINGS OF FACT: 1. The specific site is an appropriate location for the project as it is located on a pre-existing building and will blend with the surrounding neighborhood for an aesthetic and understated wireless communication installation. 2. The use as developed will not adversely affect the neighborhood as indicated by the submittals and reports referenced at the end of this decision.. 3. The carrier has demonstrated that the continuation of the facility is necessary in order to provide adequate service to the public as indicated by the submittals and reports referenced at the end of this decision. 4. The plan meets the requirements of the Wireless Service Facilities By-law section 8.9,with the exception of the waivers granted. 5. Adequate and appropriate facilities will be provided for the proper continued operation of the proposed use. The twelve(12)panel antennas,equipment room, equipment and cabling are described in detail on the plans and reports referenced herein. The carrier's existing equipment shelter will be an unoccupied,unmanned, specialized area for the wireless communications equipment. 6. The Radio-Frequency emissions of the facility meet applicable FCC guidelines and regulations,the application is in compliance with all FCC &other regulatory requirements. 7. The application is for the renewal of the Special Permit and as such, no new structures,antennas, cables,or equipment will be constructed or installed. 2 i Bell Atlantic Mobile of Mass Corporation,Ltd.,d/b/a Verizon Wireless 401 Andover Street Special Permit—Renewal of Wireless Service Facility a� Finally,Planning Board find that the project is in harmony with the general purpose and intent of the Town of North Andover Zoning Bylaw and generally complies with the requirements of the Bylaw as listed in Section 8.3, 8.9, and 10.3,but requires conditions in order to be fully in compliance. The Planning Board hereby grants an approval to the applicant provided the following conditions are met: SPECIAL CONDITIONS: 1. Discontinuance Abandonment a) At such time that a licensed carrier plans to abandon or discontinue operation of wireless service equipment, such carrier will notify the Tc)wn by certified US mail of the proposed date of abandonment or discontinuation of operations. Such notice shall be given no less than 30 days prior to abandonment or discontinuation of operations. In the event that a licensed carrier fails to give such notice, the wireless service equipment shall be considered abandoned upon discontinuation of operations. b) Upon abandonment or discontinuation of use, the carrier shall physically remove the wireless service equipment placed on the site by the carrier within 90 days from the date of abandonment or discontinuation of use. "Physically remove"shall include,but not be limited to: i) Removal of antennas, mount, equipment shelters and security barriers installed by the carrier (unless the same will continue to be used by the owner)from the subject property. ii) Proper disposal of the waste materials generated by the carrier from the site in accordance with local and state solid waste disposal regulations. c) Given that there is no escrow, the Town may place a lien upon the property covering the difference in cost. d) The equipment shall be deemed to be abandoned or discontinued if it has not been used for the purpose for which it was originally constructed for a period of six (6) months or more. Once abandonment.or discontinuance has occurred, the carrier shall remove the equipment placed by the carrier from the subject property within ninety days. In the event that the carrier fails to remove the equipment, the town shall give notice to the carrier and the independent escrow agent that the equipment shall be removed by the escrow agent forthwith and the escrow agent, after affording written notice seven days in advance to the carrier, shall remove the.facility: 2. Term of Special Permit. a A Special Permit issued for any wireless service facility_shall be valid for three(3)years. The special permit may be renewed under the same criteria as the original special permit,provided that the application for renewal of the special permit is made prior to the expiration date of the original or any renewed special permit. Additional measures governing the administration of the special permit are found in Section 10.3 of the Zoning Bylaw. b) The applicant shall submit to the SPGA within 90 days of the issuance of the Special Permit 3 Bell Atlantic Mobile of Mass Corporation;Ltd.,d/b/a.Verizon Wireless 401 Andover Street Special Permit—Renewal of Wireless Service Facility r � renewal, and at annual intervals from the date of issuance of the Special Permit,preexistent and current measurements of acoustic noise from the wireless service facility. Such measurements shall be certified and signed by an acoustical engineer, stating that noise measurements are accurate and meet the Noise Standards of this Bylaw. This condition shall be in effect until such time as an additional carrier proposes equipment on this facility. At that time,this obligation will fall upon the proponent of the additional equipment so as to obtain a better measure of the cumulative effect of the facility. c) The applicant and co-applicant or their successor in interest shall maintain the wireless service equipment in good condition. Such maintenance shall include, but shall not be limited to, painting, structural integrity of the flagpole-style monopole and maintenance of the buffer and landscaping, as applicable. d) A certified copy ofthe recorded decision must be submitted to the Planning Department. e) The applicant must submit a letter from the architect or engineer of the project stating that the construction and operations substantially comply with the plans referenced at the end of this decision as endorsed by the,Planning Board. 3 In an effort to reduce noise levels, the carriers shall keep their respective equipment in optimum working order, through regular maintenance, any and all equipment that shall emanate sounds from the structures or site. 4 No equipment or other equipment that will emanate noise-exceeding levels cited herein shall be places on the exterior of the structure. Such equipment shall be enclosed as shown on the plans. 5 If applicable, all site lighting shall provide security for the site and structures; however, it must not create any glare or project any light onto adjacent residential properties. 6 . The original Special Permit granted on June 2, 2005 (recorded on April 15, 2005) and approved site plans referenced in Condition #15 by the Planning Board are herein. incorporated by reference. The applicant and its successors shall comply with any/all terms and conditions of the said Special Permit. 7 The provisions of this approval shall apply to and be binding upon the applicant, its employees and all successors and assigns in interest or control. 8 The applicant shall immediately inform the Planning Department in writing of any/all changes in name, company ownership, and contact information. 9 Any action by a Town Board, Commission, or Department that requires changes in the plan or design of the building as presented to the Planning Board, may be subject to modification by the Planning Board. 10 .Any revisions shall be submitted to the Town Planner for review. If these revisions are deemed substantial,the applicant must submit revised plans to the Planning Board for approval. 4 Bell Atlantic Mobile of Mass Corporation,Ltd.,d/b/a Verizon Wireless 401 Andover Street " Special Permit—Renewal of Wireless Service Facility. 11 In accordance with Section 8.9.12 of the Zoning Bylaw, this Special Permit approval shall be deemed to have lapsed after three (3) years from the date permit granted, that date being June 3, 2011. Prior to the expiration date of the renewed special permit, the applicant and its successors shall file a Renewal application. 12 The following waivers were granted in determining this decision: A. Section.8.9(5)(d)(iii)(3)-Tree cover on the subject property and all properties directly abutting the subject property,by dominant species and average height. b. Section 8.9(5)(d)(iii)(4)—Outline of all existing buildings,including purpose on subject property and all properties adjacent to the subject property. c. Section 8.9(5)(d)(iii)(8)—Identify the distances, at grade, from the proposed wireless service facility to each building on the vicinity plan. d. Section 8.9(5)(d)(iii)(12)—Line representing the sight line showing viewpoint and visible point from"Sight Lines". e. Section 8.9(5)(d)(iii)(13)—Location of all wetlands on subject property and within 100' of the proposed facility as approved by the Conservation Commission. f. Line representing the sight line showing viewpoint and visible point from"Sight Lines" subsection below. g. Section 8.9(5)(d)(iv)(1)—Sight line representation.A sight line representation shall be drawn from any public road within 300 feet and the closest facade of each residential building (viewpoint) within 300 feet to the highest point(visible point)of the wireless service facility. h. Section 8.9(5)(d)(iv)(2)—Preexistent(before condition)photographs. i. Section 8.9(5)(d)(iv)(3)-Proposed(after condition)photographs. �. Section — Siting elevations or views at-grade from the north, south,east and west for a 50-foot radius around the proposed wireless service facility plus from all preexistent public and private roads that serve the subject property. k. Section 8.9(5)(d)(v)(1)-Equipment brochures for the proposed wireless service facility such as manufacturer's specifications or trade journal reprints shall be provided for the antennas,mounts, equipment shelters,cables as well as cable runs,and security barrier. ' 1. Section 8.9(5)(d)(v)(2)-.Materials of the proposed wireless service facility specified by generic type and specific treatment. m. Section 8.9(5)(d)(v)(3) Colors of the proposed wireless service facility represented by a color board showing actual colors proposed. n. Section 8.9(5)(d)(v)(5)—Appearance shown by at least two photographic superimposition's of 5 Bell Atlantic Mobile of Mass Corporation,Ltd.,d/b/a Verizon Wireless 401 Andover Street Special Permit-Renewal of Wireless Service Facility - the wireless service facility within the subject property. o. Section 8.9(5)(d)(v)(6)-Landscape plan including preexistent trees and shrubs and those proposed to be added,identified by size of specimen at installation and species. P. Section 8.9(5)(d)(v)(7)- Schedule with the Planning Board a balloon or crane test at the proposed site, at the expense of the applicant,to illustrate the height of the proposed facility. q. Section 8.9(5)(d)(vii)(3)-Letter from the Massachusetts Department of Health approving the location of the site. 13. The following information shall be deemed part of the decision: a) Plan titled: Telecommunications Installation at:Route 125 North Andover,MA Prepared for. Bell Atlantic Mobile of Mass Corporation,Ltd. d/b/a Verizon Wireless 4.00 Friberg Parkway Westborough, MA 01581-3936 Prepared by: Daigle Engineers 1 East River Place Methuen,MA 01844 Scale: Variable Scale Date: April 25,2001,Revised January 2,2008 Sheets: 2 b) Application: Application by Bell Atlantic Mobile of Massachusetts Corporation, Ltd., d/b/a Verizon Wireless to renew the Special Permit for the existing Wireless Services Facility located at 401 Andover Street,North Andover,MA.for the renewal of a Special Permit Prepared for: Bell Atlantic Mobile of Mass Corporation, Ltd. d/b/a Verizon Wireless 400 Friberg Parkway Westborough, MA 01581-3936 Prepared by: Robinson &Cole,LLP One Boston Place :sem* Boston,MA 02108 C''' "- a C� F Scale: Variable Scale y t '' Dated: August 3, 2007 .� Pages: Tabs A-L ;gib�� ' • `!"� CC. Building Inspector .; Applicant Engineer 6