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HomeMy WebLinkAboutMiscellaneous - 48 EMPIRE DRIVE 4/30/2018 J �'� j i ji 1 f Town of North Andover ZONING BOARD OF APPEALS Albert A Manzi III,Esq. Chairman Ellen P.McIntyre, Vice-Chairman Richard J.Byers,Esq. Clerk of No oT b q,to D.Paul Koch Jr.Esq. Allan Cuscia t° L p Associate Members Michael A Liporto Deney Morganthal 7 p0447oD Doug Ludgin 9SSACHU Town Clerk Time Stamp Any appeal shall be filed within(20) Notice of Decision days after the date of filing of this Year 2014 notice in the office of the Town Clerk, per Mass.Gen.L.ch.40A,§17 Property at: Empire Drive(Orchard Village)North Andover,MA.01845 NAME:Orchard Village,LLC HEARING(S): April 8,2014 ADDRESS: Empire Drive 2007-005 The North Andover Board of Appeals held a public hearing at Senior Center,at 120R Main Street,North Andover, MA on Tuesday,April 8,2014 at 7:30 PM on the application of Orchard Village,LLC for property on Empire Drive,North Andover,MA.01845. Petitioner is requesting that the Zoning Board request recommendation regarding the acceptance of Empire Drive as a public way,for which the Zoning Board of Appeals is authorized to act instead of the Planning Board pursuant of the Comprehensive Permit Act, G.L,c.40B,ss.20-23. The following voting members were present:Albert P.Manzi III,Esq.,D.Paul Koch Jr.,and Allan Cuscia.The following Associate members were present Michael Liporto,Doug Ludgin and Deney Morganthal. Upon a motion by Ludgin to approve recommendation of the roadway for street acceptance, subject to the final review of the Conservation Commission and Town Counsel Cuscia second the motion Voting in favor for recommendation of street acceptance at Orchard Village,LLC, Empire Drive but subject to a final review; Albert P.Manzi,D.Paul Koch Jr.,Allan Cuscia,Michael Liporto,Morganthal and Doug Ludgin. 5-0 The Board voted and recommends in approving this Street,Empire Drive as a public way,but subject to final review of the Conservation Commission and Town Counsel. North Andover Zoning Board of Appeals Albert P.Manzi III Esq.,Chairman D.Paul Koch Jr.Esq. Allan Cuscia Michael Liporto Doug Ludgin Petition 2007-005 Page 1 of 1 URBELIS&FIELDSTEEL,LLP 155 FEDERAL STREET BOSTON,MASSACHUSETTS 02110-1727 Telephone 978-475-4552 CAROL HAJ)AR MCGRAVEY Telephone 617-338-2200 OF COUNSEL Telecopier 617-338-0122 e-mail chm a&Maw.com o � god Joyce Bradshaw,Town Clerk August 20,2014 @ (E. p North Andover Town Offices Al IG 2 1 2014 120 Main Street North Andover,MA 01845 BOARD OF APPEALS RE: STREET ACCEPTANCE DEED AND EASEMENTS EMPIRE DRIVE Dear Joyce: Enclosed for your records is a certified copy of the Deed to the Town of the fee in Empire Drive and related Easements,in accordance with the acceptance of Empire Drive as a public way by the 2014 Annual Town Meeting. Please let me know if you have any questions. Very truly yours, Carol Hajar McGravey CHM/kmp Enclosures cc: Zoning Board of Appeals(w/enc) Curt Bellavanoe(w/enc) Gene Willis(w/enc) Bruce Thibodeau(w/enc) Dote110.523 os-14-2014 10:10 Ct f o=-17160.' Essar Month Land Court Rnistrs (Sows Abm this Lim Reserved(m Reiistry of ftdsl QUITCLAIM DEED (Empire Drive—Street Acceptance and Easements) The undersigned,Orchard Village LLC,a Massachusetts limited liability company,with an address of 277 Washington Street,Groveland,MA 01834("Grantor"),in consideration paid of less than One Hundred and N0/1100($100.00)Dollars,the receipt b and sufficiency of which is hereby acknowledged,and for good and valuable consideration, Z grants to The Inhabitants of the Town of North Andover,a Massachusetts municipal corporation,with an address of 120 Main Street,North Andover,Massachusetts 01845 ("Grantee"), A with QUITCLAIM COVENANTS .o 0 the fee interest in that certain roadway commonly known as"Empire Drive"(the d "Street"),situated in the Town of North Andover and shown and depicted on a plan entitled"Street Layout Plan of Empire Drive Located in No.Andover,Mass.Scale 1" .4 40';Date January 1,2014,Christiansen&Sergi Professional Engineers Land Surveyors, 160 Summer St.Haverhill,MA 01830"be filed with Essex County(Northern District) w Registry of the Land Court(said"Registry")herewith ate. (the R "Street Layout Plan"). Said Street is also shown and depicted as Lot#34 on a plan < entitled"Definitive Subdivision Plan"ORCHARD VILLAGE"in North Andover,Mass., record owners: Agnes M.Kmeic 1996 Realty Trust 1001 Turnpike Street,North o Andover,MA 01845,Kmeic Family 1996 Realty Trust 1001 Turnpike Street,North a, Andover,MA 01845,Applicant: Orchard Village,LLC,44 Great Pond Road,Boxford, MA 01921,Date:April 2,2009, Christiansen&Sergi,Professional Land Surveyors,160 Essa se.WWCourt 14 A true copy of Land COW D," I10.ria,21 CerWata l't1 b 0 Book — papa — ReO%*mj Lff&t_tOM.LD Mot-M Attest �s ,�7Y(14,, �.iG Malar at Deeds Summer Street.Haverhill,MA 01830"recorded with said Registry as Plan No.18083-E (the"Subdivision Plans"). Said Street is also more particularly bounded and described in a metes and bounds description attached hereto as Exhibit A. In addition,Grantor hereby conveys all of its right,title and interest in all easements affecting the Street hereby conveyed and shown on the Street Layout Plan and the Subdivision Plans,including,without limitation,the following easements: 1. Drainage and Utility Easement over a portion of Lots 35,36,3,4,5,6 and 7 as shown on the Subdivision Plan affecting 41,446±square feet("Drainage Easement #1"); 2. Drainage Easement over a portion of Lots 21,22,23,24,25,26,27,28 and 29 as shown on the Subdivision Plan affecting 8,969±square feet(`.`)rainage Easement #2"); 3. Drainage Easement over a portion of Lot 17,as shown on the Subdivision Plans, affecting 741+square feet("Drainage Easement#3"); 4. Drainage Easement over a portion of Lots 19 and 20,both as shown on the Subdivision Plans, affecting 397±square feet("Drainage Easement#4"); 5. Drainage Easement over a portion of Lots 29 and 30,both as shown on the Subdivision Plans, affecting 405+square feet("Drainage.Easement#5'D;and. 6. Drainage Easement over a portion of Lots 31 and 32,both as shown on the Subdivision Plans,affecting 453±square feet("Drainage Easement#6"). Drainage Easement#1 and Drainage Easement#2 shall be solely for the purpose of operating,using,maintaining,repairing and/orreplacing the underground sewer lines, drainage lines and water lines,if any,and any and all appurtenances thereto. The Grantee shall not have any responsibility or liability for the maintenance of the detention pond located in Easement#1 or the maintenance of Easement#2 or any other facilities on any lot and the Grantee hereby accepts only the maintenance of the sewer lines,drainage lines and water lines,if any,and any and all appurtenances thereto. The Orchard Village Homeowners Association shall remain responsible for all facilities other than the underground sewer lines,drainage lines and water lines referenced herein,as provided in the Declaration of Orchard Village Homeowners Association dated January 14,2011 and recorded as Registered Land Document No.102,494. However,Grantee is responsible for restoring any areas that are disturbed by any work performed by Grantee within all Drainage Easements to as close to the original condition as possible and shall be responsible for the cost associated with the restoration of said Drainage Easements. Said Easements are granted together with the right to access said easement areas and to pass along,across.,under and through said easement areas for all purposes for which the easements are created,in common with others legally entitled thereto. In addition,and without limiting the foregoing and without limiting the easement purposes,the right is granted in each case for the Grantee to enter,construct and maintain such facilities as are necessary and convenient for the easement purposes and for any other municipal purpose. This conveyance is subject to and with the benefit of easements,restrictions,covenants, conditions and takings of record,insofar as the same are now in force and applicable,and without limitation to which,this conveyance is made subject to and with the benefit of the following: 1. North Andover Conservation Commission Order of Resource Area Delineation(Mass DEP File#242-1425),dated May 23,2008,recorded with said Deeds in Book 11203, Page 235,which matters affect the street and easements conveyed herein; 2. Findings and Decision on the Application of Orchard Village,LLC on application for Comprehensive Permit by the North Andover Board of Appeals,dated June 24,2008, recorded with said Deeds in Book 11427,Page 192 and filed with said Registry as Document No.101,303,as amended by Amendment to Comprehensive Permit issued by the North Andover Board of Appeals to Orchard Village,LLC,dated December 9,2008 recorded with said Deeds in Book 11427,Page 214 and filed with said Registry as Document No.101,304;which matters affect the street and easements conveyed herein; 3. Matters shown on plan dated April 2,2009 filed with said Registry as Plan No.18083-E, including rights of way,easements,notes,approvals,restrictions,conditions and all other matters shown thereon,which matters affect the street and easements conveyed herein; 4. Covenant by Orchard Village,LLC with the North Andover Board of Appeals,dated August 13,2009 filed with said Registry as Document No.99,463 and 99,465 as affected by the Form J Lot Release Form affecting lots 8,14,17,18,22,23 and 25,filed with said Registry as Document No.102,424,as further affected by the Form J Lot Release Form affecting lots 3,10,15,19,21,24 and 35(a/k/a Lot I on an unregistered subdivision plan as approved and on file with the North Andover Zoning Board of Appeals),filed with said Registry as Document No.103,077,as affected by Form J Lot Release Form filed with said Registry as Document No.103,742 releasing Lots 7,9,11,12,16,20,26,and 33,as affected by the Form J Lot Release Form affecting Lots 4,5,6,13,27,28,29,30, and 31 filed with said Registry as Document No.104,771 on Certificate of Title 16291, as affected by the Form J Lot Release Form from the Subdivision Covenant for Lot 36 filed with said Registry as Document No.105,437 on Certificate of Title 16291,as affected by the Form J Lot Release form affecting Lot 32 filed with said Registry as Document No.106,576 on Certificate of Title 16291,which covenants affect the street and easements conveyed herein; 5. Permit issued by the Massachusetts.Department of Transportation to Kmiec Family Realty Trust dated March 11,2010,recorded with said Deeds in Book 11979,Page 265. Completion of Work submitted to Massachusetts Department of Transportation via certified mail,return receipt requested on May 8,2014,which permit affect the street conveyed herein; 6. Order of Conditions issued by North Andover Conservation Commission to Orchard Village,LLC(Mass DEP File#242-1459)dated March 12,2010 filed with said Registry as Document No.100,368.Partial Certificate of Compliance of Order of Conditions (Mass DEP File#242-1459)pertaining to Lots 12-16 filed with said Registry as Document No.107,731. Certificate of Compliance of Order of Conditions(Mass DEP File#242-1459)pertaining to remaining lots approved April 9,2014,which matters affect the street and easements conveyed herein; 7. Easement from Orchard Village, LLC to Massachusetts Electric Company, dated November 17,2010,filed with said Registry as Document No.102,129,which easement affects the street conveyed herein;and 8. Massachusetts Department of Environmental Protection Order of Conditions (Mass DEP File #242-1510) dated June 8, 2011 recorded said Deeds in Book 12685,Page 330,including without limitations,the ongoing conditions contained therein. Certificate of Compliance of Order of Conditions(Mass DEP File#242- 1510)recorded with said Deeds in Book 12975,Page 322. This is a conveyance in the ordinary course of business and is not in contravention of the Grantor's Limited Liability Company's Certificate of Organization,as it may have been amended. Neither this instrument nor any other record at the Registry of Deeds discloses that this conveyance is in contravention of the laws of the Commonwealth of Massachusetts and the Grantor limited liability company appears from the records of the Commonwealth of Massachusetts Office of the Secretary of State to exist. No additional or appurtenant rights benefiting the property granted herein or the Grantee,other than those explicitly set forth in this deed,are created or conveyed hereby. The Seller has not elected to be treated as a corporation for Federal or Massachusetts income tax purposes. Being a portion of the premises conveyed to Grantor by deed of Louis Kmiec,Jr.,et al, dated May 11,2010,and with said Registry on Certificate of Title No. 16291 as Document Number 100,653. IN WITNESS WHEREOF,Orchard Village,LLC has caused its seal to be hereto affixed and in these presents signed by its Managers,duly authorized,this day of -Agri l 2014. Orchard Village,LLC B .Torrisi,Mafiager Duly Authorized ]@2� &Mc A By:- Ro ert Messina,Manager Duly Authorized COMMONWEALTH OF MASSACHUSETTS Essex,ss On this 23reog April 2014,before me,the undersigned notary public,personally appeared Alfred J.Torrisi,as Manager of Orchard Village,LLC,proved to me through satisfactory evidence of identification,which was❑ photogra hic identification with signature issued by a federal or state,governmental agency,L]oath or affirmation of a credible witness,]personal knowledge of the undersigned,to be the person whose name is signed on the preceding or attached document,and acknowledged to me that he signed it voluntarily for its stated purpose in his.capacity as Manager for Orchard Village,LLC,and that he has the authority to act in that capacity. � z Name: Notary Public My Commission Expires: DAMILLE MIRAGLIDTTA DALY Notary P4blic M�Ualon Fx4A4SAPICFIrds Feb.."12,2021 COMMONWEALTH OF MASSACHUSETTS Essex ss w On this Z.�nk day of I q 2014,before me,the undersigned notary public,personally appeared Robert Messina,as Manager of Orchard Village,LLC,proved to me through satisfactory evidence of identification,which was photographic identification with signature issued by a federal or state governmental agency,(]oath or affirmation of a credible witness,❑personal knowledge of the undersigned,to be the person whose name is signed on the preceding or attached document,and acknowledged to me that he signed it voluntarily for its stated purpose in his capacity as Manager for Orchard Village,LLC,and that he has the authority to act in that capacity. _ ,�o�s �"Fs� Nome: Notary Public My Commission Expires:8 W7Z716 M••.... tri,. APPROVAL OF SELECTMEN We,the undersigned Board of Selectmen for the Town of North Andover,Massachusetts, hereby accept the foregoing conveyance,on behalf of the Inhabitants of the Town of North Andover,Massachusetts. Signed as a sealed instrument this �At o day of 'amu q-P— 2014. The Town of North Andover By: its Board of Selectmen J "a," COMMONWEALTH OF MASSACHUSETTS, Essex,ss. On this 22,ndo day of 2014,before me,the undersigned notary public,personalty appeared A :Botts. la.\\ei���aiciL�4aS�et�SR.�w�arsoc� and nhQh�a�0._Rit+...,etNfr proved to me through satisfactory evidence of identification, which were !a,-txQn&L\, b\k,\bxFnao rn ,to be the persons whose name are signed on the preceding document,and acknowledged to me that be/she/they signed it voluntarily for its stated purpose,and that he/she/they has/have authority to sign as a/the member(s)of the Board of Selectmen of the Town of North Andover,before me, �U1L`Orc\�•gc:�n.9_A�C tin Name: Vm vte e-r Pc Notary Public KARBRX ROBERTSON My Commission Expires: `d o l� raamm P1>e�1o. QOr10rQ ,8iR 0aYOACx1&M •r•.N:ei.: 15.2017 iY Exhibit A Legal Description:Empire Drive,North Andover,Essex County,Massachusetts Beginning at a stone bound,on the westerly sideline of Salem Turnpike,aka State Highway Rte.114,at its intersection with the northerly sideline of Empire Drive as shown on a plan entitled,Street Layout Plan of Empire Drive located in No.Andover,Ma.dated 1/1/2014,by Christiansen&Sergi,Inc.,Haverhill,Ma. Thence S 3130'10"E a distance of 100.00 feet to a stone bound; Thence with a curve turning to the left an arc length of 47.12 feet,a radius of 30.00 feet, with a delta angle of 90°00'00",to a stone bound; Thence S 58°29'50"W a distance of 15.99 feet to a stone bound; Thence with a curve turning to the left an arc length of 119.72 feet,a radius of 76.33 feet, with a delta angle of 89°51'38",to a stone bound; Thence S 31°21'48"E a distance of 126.04 feet to a stone bound; Thence with a curve turning to the right an arc length of 270.86 feet,a radius of 123.67 feet,with a delta angle of 125°29'30",to'a stone bound; Thence.N 85°52'19"W a distance of 127.25 feet to a stone bound; Thence with a curve turning to the right an arc length of 150.34 feet,a radius of 123.67 feet,with a delta angle of 69*39'12",to a stone bound; Thence N 16°13'06"W a distance of 36.85 feet to a stone bound; Thence with a curve turning to the left an are length of 139.52 feet,a radius of 135.00 feet,with a delta angle of'59012'54",to a rail road spike set in a drive; Thence N 75°26'00"W a distance of 19,.89 feet to a stone bound; Thence with a curve turning to the left an arc length of 64.14 feet,a radius of 35.00 feet, with a delta angle of 105°00'00",to a stone bound;. Thence N 00°26'00"W a distance of 117.72 feet.to a stone bound; Thence with a curve turning to the left anarc length of 51: 6 feet,axadius of 40.00 feet,. with a delta angle of 7500'00 to a stone bound; Thence S 75°26'00"E a distance of 45.52 feet to a stone bound; Thence with a curve turning to the right an arc length of 180.86 feet,a radius of 175.00 feet,with a delta angle of 59'12'54",to a stone bound; Thence S 16'13'06"E a distance of 36.85 feet to a stone bound; Thence with a curve turning to the left an arc length of 101.71 feet,a radius of 83.67 feet, with a delta angle of 69'39'12",to a stone bound; Thence.S 85°52'19"E a distance of 127.25 feet to a stone bound; Thence with a curve turning to the left an are length of 183.25 feet,a radius of 83.67 feet, with a delta angle of 125°29'30",to.a stone bound; Thence N 31°21'48"W a distance of 126.04 feet to a stone bound; Thence with a curve turning to the right an are length of 182.45 feet,a radius of 116.33 feet,with a delta angle of 89°51'38",to a stone bound; Thence N 58°29'50"E a distance of 15.99 feet to a stone bound; Thence with a curve turning to the left an are length of 47.12 feet,a radius of 30.00 feet, with a delta angle of 90°00'00",to a stone bound which is a stone bound and the point of beginning, Meaning and intending to describe Empire Drive as shown on a plan entitled,Street Layout Plan of Empire Drive located in No.Andover,Ma.dated 1/1/2034,by Christiansen 8i Sergi,Inc.,Haverhill,Ma. w` •� w �A '�' �MAINAOE� y E1E9�ENi foL � E/x�EME1R ` u+.M � •��'o�i.in �\; Z EMPIRE ... DRIVE +i•• '• i ! EAlF.EMT STREET LAYOUT .....•° ."' / PLAN .K»... EMPIRE DRIVE .. -- NO.ANDOVER,MASS. b. ®CH NSEN d SERGI,ING North Andover MIMAP July 27, 2017 17 EMPIRE DRIVE . 28 EMPIRE=DRIV 71 EMPIRE DRIVE /r 5 � •� •_ -,� ._'" � �`�'" EMPIRE DRIVE _ 10"7.0-0134 '` •, "'' 913 EMRIRE DRIVE �� t• 107.0-0135. 1- � t � 107.0-0140 67 EMPIRE DR /E-" " ` 25 EMPIRE DRIVE1f� f "' 0 T ° 107.0-0139' ,. L8,4.EMPfRE DRIV 107.0-0138 � t1, '^"- •s 63 EMPIRE DRIVE :, �4, ' �,-�' t 4+7,EMPIRE DR•I`VE �� k DRIV 10:7bC-0.136 107.0-0137 °�, � �I t,� 5A EMPIRE DRIVE ` 4 EMPIRE DRIVE ''`` - 38 EMPIRE DRIV Empire 1 "' EMPIRE•DR, E .` +� �l'Or7.0-0126 ?It� f1 53 EMPIRE DRIVE,,t*• 44 EMPIRE DRIVE t • � 60 EMPIRE DRIVE 58 EMPIRE DRIVE ` �x 107.0-0016 1101 TURNPIKE STREEJ X 4-. EVERGREEN DRIVE MVPC Bo ❑Site Address Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Interstates Meters Data Sources:The data for this map was produced by Merrimack r: Interstate '4011Th Valley Planning Commission(MVPC)using data provided by the Town of —Major Road. Gte o North Andover.Additional data provided by the Executive Office of —Roads ? ���t� r�e�00 Environmental Affairs/MassGIS.The information depicted on this map is i r EasementsF p for planning purposes only.It may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER ❑Parcels MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Jrwo w- THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY • s ,•, ; OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT `��� ; ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF .j� o�eTjp•�`�j THIS INFORMATION - ,gsACMUs�t 1"=56ft ^�• North Andover MIMAP July 27, 2017 931 TURNPIE STREET 834 CHES,TNUT'STREET - K107.0-0006 w 107.1-0085 107.0-0021 R2 984 TURNP,IKE+STREET' 5 EMPIRE-DRIVE( 1'07Ci-0146 107.C-0145 .`J � 107:1=0020 1 EMPIRE DRIVE 1'000 TURNPIKE.STREET° 846 CHESTNUT`,STREETr 107.0-0144 114 16 EMPIRE DRIVE 107:0=0019 7-EMPIRE- RIVE 107.1-0114 107.0-0143 m 1014 TURNPIKEfSTREET 3 \ 107.0=0106 w II EMPIRE'.ORIVE 107.1-0115 20 EMPIRE DRIVE 79-EMP_IREiDRIVE 107.1-0142 (o�O^% / �'` I9B' 107.1-0� 24 EMPIRE DRIVE 107.0-013 2 107.0-0131 / 107.0-0141 307.0-01 107.1-0133 32 EMPIRE DRIVE 307.0-0134 2s'EMPIRE DRIVE EMPIRE'DRIVE / / 107.1-0140 107.1-0118 67"EMPIR&D RIVE 107-C-0135 107.0-0139 34-EMPIRE:;DRIVE ,80.EMPIRE, VE / 25 EMPIRE DRIVE 107.0-0119 I1 63 EMPIRE DRIVE 107.1-01374 107.1-0130 . { 107.1-0138 107:1-0136 It 47 EMPIRE DRIVE 36 EMPIRE DRIVE 51 EMPIRE DRIVE 107.0-0129 107.1-0130 fi4{EMPIRE DRIVE 42 EMRIRE.DRIVE 38 EMPIRE DRIVE 107.1-0128 52-EMPIRE DRIVE 107.\-0122 107.0-0121 �(� 6� 99 RE; 107.11-0125 107.0-0124 7.06 t62 EMPIDRIVE ' 1 107.0-0123 107.0-0127 107.0-0126 48 EMPIRE"DRIVf 60 EMPIRE DRIVE E 58 MPIRE-DRIVE 107.0-001.7 1049 TURNPIKE STREET 107:C-o i-10 107..0-0029 1101 TURNPIKE STREET 107.1-0016 +EVERGREENtDRIVE:. E3 MVPC Be Zoning Overlay Zoning r3 Municipal Boundary ©Adult Entertainment Distric ,^.Busine s 1 District 13 Machine Shop Village Ove O Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line 0 Watershed Protection Dist 0 Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates 93 Historic Mill Area ■Busine s 4 District �10R7M Valley Planning Commission(MVPC)using data provided by the Town of Interstate ©Medical MarijuanaM Gene Business District Of t Ott° '�� North Andover.Additional data provided by the Executive Office of Major Road 13 Downtown Overlay District 0 Planne Commercial Dev '�< r 6.6 00 Environmental Affairs/MassGIS.The information depicted on this map is 0 Historic District 0 Comd Development Dist L for planning purposes only.It may not be adequate for legal boundary -Roads U Osgood Smart Growth(40 0 Cornd DevelopmentDist O to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER i r Easements 0 Hydrographic Features 0 Corrid Development Dist ._ MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Parcels Industri I 1 District ♦ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Streams CI Industri 12 District ; s ^ Jf OF THESE DATA THE TOWN OF NORTH ANDOVER DOES NOT Wetlands 0 Industri 13 Distract K c _ _ d^ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Industri I S District �. ' THIS INFORMATION O Exempt Lands Reside ce 1 District �1,rf °+etr°��'t•(y 0 Reside ce 2 District SSACHUS� 0 Reside ce 3 District de ce 4 District 1"=113 ft "�<de ce5 District de ce 6 District -a tesidentiat District 24.0' 14A' ai in i 14.0' 24.0' PROPOSED HOUSE NOT TO SCALE a D-IMEN I 1 - - #ON L STANDARDS (FROM AMENDMENT TO COMPREHENSIVE PERMIT ISSUED BY Tt E NORTH ANDOVER BOARD OF APPEALS,DATED 1219108,RECORDED IN THE NORTH ESSEX REGISTRY OF DEEDS,-BOOK 11427, PAGE 215) MINIMUM LOT AREA=5,200 S.F. MINIMUM CONTXGUDUS BUILDABLE AREA=4,050 S.F. MINIM.U.M.LOT FRONTAGE=40 FT.. MINIMUM FRONT YARD=25 FT."(45 FT:ALONG RT. 114) MINIMUM SIDE YARD= 10 FT. MINIMUM REAR YARD=20 FT."' R THE MINIMUM-FRONT AND REAR YARDS SHALL.BE REDUCED TO 15 FT. FOR EXTERIOR.DECKS,STAIRS,.LANDINGS,BALCONIES,COVERED AND UNCOVERED PORCHES,AND BAY WINDOWS. THIS NOTE DOES NOT APPLY TO THE SETBACK FROM RT. 114;FOR WHICH THERE SHALL BE A REDUCED SETBACK OF 35 FT.FOR SUCH FEATURES. "THERE.SHALL BE.AN INCREASED MINIMUM-REAR YARD SETBACK'OF 35 FT. FOR LOTS 18—21 AND LOTS 29--31, EXCEPT THAT THE REAR SETBACK ON SAID LOTS SHALL BE REDUCED TO 30 FT.FOR`EXTERIOR DECKS,. STAIRS, LANDINGS,BALCONIES,COVERED AND UNCOVERED PORCHES, AND BAY WINDOWS. : �.- �-i eQ -i t r Y .I i. C-S Y • 4t FND • • .• 272.0 Ak 271.0 NV. 2-62D • - s 1 0 EMPIREDR. I' 67 _ i 25.5 I 11.4' LOT 12 ToF 272.05 LOT 10 12.1' ' 61.5' _ I OF lygssq 20.5' --� MI AEL GI y LOT 11 .33191 FOUNDATION L OCA TION THAN,MT ,,BO��,W TPERlb77&MP6 NOF(7R187t4A=W&SERGF MG CLIENT., ORCHARD VILLAGE, LLC M&MW W.AWA,,, "R'0i UW IS VW CERT1F/G7KaIV 16 MWEMW WW TO TWAWW CLBMT pll0fifffrMCHRWnAAW&SM T4M NO RE PON&SL TY M9 TW WUPOUM UW OF nW LOCATION.•48 EMPIRE DR NORTHANDOVERMA. °R "'M°ORA"Y DATE. 7113111 SCALE I't--X' OASWONSGi®DATAOKYTIEARFORYSIMACTURE SN014W RBNOTLOWEDWAFL000NA7itimMMA8Sf OM ONFBA4 FLOW 4418fI UMNRATE MR COASKAWYNQ11 0010 00W A4TE3WAR ZDW--K PROFESSIONAL ENGINEERS&LAND SURVEYORS rc CHRISTIANSEN & SERGI, INC. 160 SUMMER STREET, HAVERHILL,MASSACHUSETTS 01830 WWW CSI-ENG2COM TEL 97873-0310 FAX 978-372-,.V80 DWG.NO.:06029.001.047 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the 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. Permits shall-be limited as to the time of.ongoing construction activity,and may be-deemed-by theJnspector_of-Wires abandoned_and-invalidaf_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 pen-nit 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 puipose 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 qualifyingperiod beginning on August 15,2008 and extending through August 15,2012. ule —Permit/Date Closed: �� - * *Note:Reapply for new pert " 0 Permit Extension Act—Permit/Date Closed: Date.....�.Z..'S. �... � NORTp TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that ......... ......... ( ................ ............................. has permission to perform ........... � e ........S�ISI 'T ............ wiring in the building of....0 L`.'fx`.&./.................................................... at..... ......... ..<C................ orth Andover,Mass. Fee....Vr......... Lic.No.......�. ................... .... SS0(7�^ E crRICAL INSPECTOR Check # y �7 05112 - �ommo�ceveaGt o� 7/ a_4 Official Use Only Permit No. epartrnnnt o sire�ervlaed -- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS L[Rev. II071 (leave blank) APPLICATION FQR PERMIT TO PERFORM ELECTRICAL. WORK ' All work to be perforined in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORIv MON) Date: City or Town of. A-Aj ,61)_� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perforin the electrical work descxibed`below.." Location (Street&Number)_^_ L Mf Owner-or Tenant Telephone No. 7S_5�2 99 Owner's Address _AktCCQ_t- dCoz e-a rq Is this permit in conjunction with a Iiuilding.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 Nuinbex of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C;_17 Completion of the fallowinP table maybe waived bathe Inspector of Wires. No. of.Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans ND.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA No. of LuminairesSwimming Pool Above El o"oi,mergency Lig rg rnd. Qrnd. Matte Units No.of Receptacle Outlets No,of Oil Burners FIRE ALARMS No.of Zones No.of'Switclies No. of Gas Burners JNo, of Detection and Initiating Devices No. of Ranges Total - — g No.of Air Gond. Pons No. of Alerting Devices No.of Waste Disposers Hea PPta P ri'urnbe;_Vons TW........... Dei cf ron/Aler`tin�ned Devicc-s _ Ii...."". , �' No. of Dishwashers Space/Area Akleating KW Loc, c ❑ Other onne � n No.of Dryers Heating Appliances KW ecrtrity Systems:Y y of Dev' E uivalent No. of Water KW No.of No.of Data firing: Heaters No. of Devices or Equivalent • v Signs Ballasts [No.Hydromassage Bathtubs No.of Motors TotalHP Telecommunications Wiring: No.of Devices or E uivalent THER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of EI ctrical Work: ��j` - (When required by municipal policy.) Work to Start: / Inspections to be*requested in accordance with MEC Rule 10,and upon completion. INSURANCE COER,AGE: 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 cern, under the pains and penalties ofperjury,That the in ormation.on this application is true and complete. FIRM NAME: -.:j' '��5 k LIC.NO.: zcensee: Ct.?''�� � Signao _ LTC.NO,: i— (Ifapplicabte, enter"exern t"in the license number ' e - : ,4 l k,_s, O c30 )—Bus,Tel.No.: Address: _ � � Ct--t n i�� l.�t'. Alt.Tel.No.: *Per M.G.L. c. 147, s.57-61,security work requires Department of Public Safety"S"License: Lic. No, 6 `� 3 t WNTER'S INSURANCE WAIVER:, I am aware that the Licensee does Trot have the liability insurance coverage normally required by IaW. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner 0 owner's agent. Owner/Agent 1P Signature 'Telephone No. E-RI>'1'IT FEE: $ AP;EGISTEREA SYSTEM CONT QAC•TO . -ISSUES iHEABCIVEUCENScTO.^ SECURiTY, SERVICES•, :.INC: I'A 'BP,OPF{Y SR 410:::U-N-IVERSITY."AVE :. —;•.FiES7W.QOD . MA':.U2.o90—�3]..J..:'::�:= • . r4 -':45 C' 07/31/13 :B'g9.17q .�'. •��- .��•It• ar��tJl-•fit(`; >�•ll�s-- �=•u-I�a;�� .. r•'•. - ••"F•16.TAon Dalarh AMON P5rUrzdcns Keep top for receipt and change of address notification. 1 DPS-CA1 v SIJ-16"J9.7�162069LICEhSEF0AM1 AJ ✓>%e'�n�nnenxa�ea.��.c��i12�a;t�a�.rr.:eG�`i 5i DEPART1ViENT OF PUBLIC SAFETY 1^ S License -- .i741 Number:'SS CO 000953 fgy Expires:-02107/2013 Tr.no: 195.0 S-License: ADT . MARKA BROPHY•SR' 410 UNIVERSITY AVE .. C 1 WESTWOOD, MA 02090 DIG SAFE •CALL CENTER: "(BSB)344-7233, Commissioner R 3 A 9078 Date. �. J.T-. 0. . MORTIy �'.� •° •��c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies ^� k a `.a L . . . . . . . . . . . . that 4.�:•`.��. . �. . . has permission to perform . . Lv . �4-AAS'. . . . . . . . . . . . . . . . plumbing in the buildings of . . at . . yn P.A.t, - . . ,w!--. . . . . . ., North Andover, Mass. Fee. .4 Z'. . ...Lic. No..Lc�3�.c� . . . . . . . . PLUMBING INSPECTOR Check # 10-4��2. Y WV MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: Woo mM4Ay Dvjr MA. Date:_ T-16 _0 Permit# Building Location: L1 0+(-, Owners Name: 0(LC VA4-k'0 V',UA6V— Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional❑ ResidentialEfl New:[3!2 Alteration: ❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No FIXTURES DEDICATED Z SYSTEMS W z } 2y D LA W Y O e z fA x N G o 9 2 Y Q of J Q W Uj 2 D: 2 a 2 a H 2 F h Z N LALULU Q m w aQC W ~ W Q �' Y O a X Q ~ Q ac O Q W O Q Z o}c 0 oc ae 2 U a ,L x J Q 3 LL H 3 Q d' 3 W 0 W H J Q ? C OC a. 0i11 O W Q x x x a 0 x z Q " 3 Ln a Y 2 w "i LUH H W I Q } 1— W u H H w O H H > > O O O 2 Q Q J X Q Q 0 x J Q ~ U Q Qr Q Q m m o p LL x Y 0 a 3 SUB BSMT. BASEMENT 1'FLOOR 2ND FLOOR r FLOOR 4'FLOOR 5T"FLOOR FLOOR 7T"FLOOR - 8"'FLOOR4 Check One Only Certificate# installing Company Name: GA UIMSKY PLl)l1'1iSI&X- el- I{lrA"('ial G° ) [Corporation 115101(0 r Address: P.0• WX 1701 City/Town: N AcJ IF-K RUL state: M-A - �]Partnership--------..-------------------------._....._. Business Tel: q'!$- 3144- 17g3 Fax: q l&-Soil—L41 Si ❑Firm/Company Name of Licensed Plumber: SMEPNEA C. GIALSIJgK? INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy LTJ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 ❑ Signature of Owner or Owner's Agent Owner 11 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. By Type of License: Title 2"Flumber Signature of icensed Plumber Master it APPROVED(OFFICE USE ONLY 0 ourneyman License Number: 10347 A I FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) I FEE: $ PERMIT# i i APPLICATION FOR PERMIT TO DO PLUMBING I i i NAME&TYPE OF BUILDING I i I I LOCATION OF BUILDING SKETCH I f I f PLUMBER I I I LICENSE NUNSIBER: I i I PERMIT GRANTED❑ DATE: I I i PLUMBING INSPECTIOR i i I a 1 r 7 t l 7l , Date. . . .... .. .. NORTH pF4 .o ° 6 3? TOWN OF NORTH ANDOVER pgf& FwaD • - PERMIT FOR GAS INSTALLATION • o a S-4CMUSEt This certifies that . .t_?c,4. yNsN l). . .� 4 has permission for gas installation . . . . . . . . . . 4 in the buildings of . . .0—C . . at . . . . . . . . ,ppNorth Andover, Mass. Fee�tti,.c7o . . Lic. No.l).'� Yd. . . . . .. GAS INSPECTOR Check# \025 Z A* 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING CITY/TOWN:,-.- c ------ _ _ � STATE:MA APPLICATION DATE:1..A�-16._Uv.__j i JOB ADDRESS: 4 GOCCUPANCY TYPE: COMMERCIAL❑ RESIDENTIAL PLANS SUBMITTED: YES❑ N0[] N!!V ALTERATION REPLACEMENT❑ REMOVAL/DEMOLITION[] l NATURAL& LIQUEFIED PETROLEUM GAS: PIPING-EQUIPMENT-APPLIANCES-SYSTEMS Z ENTER TOTAL AMOUNT FOR EACH SELECTION LIMITED TO FIVE(5)NUMERALS AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER:ALL TYPES GAS PIPING THERMAL OXIDIZER BOOSTER GENERATOR STATIONARY ENGINE TURBINE BROILER ILLUMINATING APPLIANCE UNIT HEATER BURNER: ALL TYPES INCINERATOR WATER HEATER: ALL TYPES CO-GENERATION UNIT INDUSTRIAL AIR HANDLER EQUIPMENT OVER 12 500MBH COFFEE ROASTER INFRARED HEATER FOTHER NOT LISTED? COOK APPLIANCE HOUSEHOLD KILN/GLORY HOLE I CRUCIBLE COOK APPLIANCE COMMERCIAL LABORATORY COCKS DECORATIVE APPLIANCE MAKEUP AIR UNIT DIRECT VENT APPLIANCE MECHANICAL EXHAUST EQUIPMENT DRYER: ALL TYPES OVEN: ALL TYPES FIREPLACE:VENTED 1 UNVENTED POOL HEATER FRYOLATOR ROOFTOP UNIT FUEL CELL ROOM HEATER-VENTEDNENTLESS 0 PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY Galins &Heating Inc corporation Business# sirs NAME: �'Plumbin 9 9 ADDRESS: P O Box 1701 -- -- Partnership Business#0 CITY:;Haverhill STATE:SMAZ1P. 01831 i ❑LLC Business#E=� , TEL:1978-374-174- FAX '978 521-41 EMAIL:;umber@aol.com t nDBA 1 Unincorporated NAME OF LICENSED PLUMBER/GAS FITTER: INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES n NO If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy F71 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� AGENT Signature of Owner or Owner's Agent OWNER'S NAME: TEL. _�T. a. �®, . .._ FAXL— � _� �� I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the General Laws. (OFFICE USE ONLY) Type of License: Permit# ❑✓ Plumber ❑Gasfitter ❑✓ Master ❑Journeyman ignature of Lics e umber 1 Gas Fitter Inspector ❑Undiluted LP Installer License Number: ` 10348 Fee: ❑Limited LP Installer ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �102 �1U Date.. ....,.':./i....... r + HORTM TOWN OF NORTH ANDOVER o PERMIT FOR WIRING ,s$ACHUSEt This certifies that , ` �j f ` " t.......................... ......................................................... has permission to perform .... 1.r.-......&.`Y........ .............. wiring in the building of.......1�t."'f '?r js ' N `� ............ .................................................. at. .�.T..1�.... ... .. .....��.�..: .<..�.r....��ft North Andover,Mass. Lic.No r !!, ,!RI,�.....��/-G=. . ... ' � ELECTCAL INSPECTOR Check # �_2_�� Comnaonyvea/ th Of Massachusetts Official use only ®epartment of Fire Services Perm7N6. /o z O BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/071 eave blank APPLICATION FOR PERMIT TO P All work to be performed in accordance with the Massachusetts PERFORM cal Code al od (TRtC�4L i�i�RK (PLEASE PRWRVINK OR TYPE ALL INFORMATIO �,527 CMR l2.00 City or Town of: NORTH ANDOVER Date: By this application the undersigned gives notice of his or her intention to ge foh the � 'work Wires: abed below. Location(Street&Number) ���- Owner or Tenant 7 d { Tele one No. Owner's Address - Is this permit in cc, ailetion with a building.r • ? v Pe t• Yes No ❑ (Check Appropriate Purpose of Building A� ` ,� / PPriate Box)P Utility Authorization No.�/ y 7O EA56ng Service �p / Volts Overhead ❑ Undgrd❑ No.of Meters Never Service �kUd Amps :p l2 O Volts Overhead❑ Undgrd E''No.of Meters Number of Feeders andAmpacity _ , _ Location and Nature of Proposed Electrical Work: Co letion o the ollowin table be waived by the Inspector o Wires No.of Recessed Luminaires No.of Cei1.-Sus No.o p.(Paddle}Fans f Ota! No,of Luminaire OutletsTransformers KVA No.of ITot'�`s�bs Generatory I dE°a 140.afLa+minair`s Swimming Pool.Above mergency fig No.of Receptacle Outlets d' d• Batte Units riting No.of Oil Burners FIRE ALARMS No:of Zones No.of Switches No,of Gas Burners o..o Detection an No.of Ranges Initis ' Devices No.of Air Coad: To Tons No.of Alerting Devices No.of Waste Disposers t Pump Number Tons ..of Ser ontained _ Totals: Deteetion/Ale Devices No.of Dishwashers Space/Area Heating I{qr Local❑ ani ' al OtherNo.of Dryers Connection Heating APPLiances OW Security ystems: o.of ater ICS o.of o.o No.of Devices or Equivalent Heaters Data Wiring: 5i s Ballasts. No.of Dvices or E uivalent }) No.Hydromassage Bathtubs No.of Motors Tom gp Telecommunications firing; y. OTHER: _ No.of Devices or nivalent- Estimated Value of Electrical Work: Attach additional detail if desired;or as required by the Inspector of Wires Work to Start: Inmen required by municipal policy-) INSURANspections to be requested in accordance with MEC Rule 10,and upon completion. CE COVERAGE: •Unless waived by the owner no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance includin °�c� .undersigned certifies that such coversg a is' eg completed operation"coverage or its substantial equivalent. The c ,and has exhibited proof of same to the permit issuing office. CIMCg ONE: INSURANCE OTHBR I certify, under the pains and penalties o er'u that the C formes on this application is true and complete. fPlry, FIRM NAME: C, �o Licensee: !� e.. X��� / LIC.NO.• s'v .t ear f( Signature {If applicable,en r'exempt"in the license number fine.) LIC.NO.: Address: n y Bus.TeL No.: *Per M.G.L c. 147,s.57-61,security work �s Department r Alt:Tel.No.: - OWNER'S INSURANCE W Public S ety"S"License: Lic.No. RIVER: 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. P PERMIT FEE:$ � d ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSPECTION: Passed—[q Failed—( J Re-inspection required($50.00)-[ ] Inspectors' c mments: i (Inspectors'Signature-no initials) Date 2.FINAL INS ECTION: Passed— Failed—( ] Re-inspection required($50.00)-[ ] Inspectors' co ments: AA _4 (Inspectors' Sig ture- ' initials) Date LZ 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 4. INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—WFailed—[ ] Re-inspection required($50.00)-[ J Inspecto s' comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED.