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HomeMy WebLinkAboutMiscellaneous - 50 WILD ROSE DRIVE 4/30/2018r v 01 P, 71* 7 Date .!�/�.7**"/*�*-� ........ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that.. L'Ie..'s ..... ............ D ...... S ... .... > .. V ./ .Q- ................. . p has permission to perform ... ... I ....e,. ...) P -. �. � b.... -(, e ^ r� J ................................... plumbing in the buildings of..... 4,-3. e! " - Q . ............................................................. at .... North Andover, Mass. FeAd. Lic. No. i7-cl W IY4- .................... .......... r ................................................................... q4 6-- PLUMBING INSPECTOR Check 4t 1 + MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I � -F6'14 � I CITY I MA DATE r �f ( PERMIT # �'-wj JOBSITEADDRESS��j OWNER'S NAME P OWNER ADDRESS �' IN i _ `� S� TEL[ _ =FAX TYPE OR OCCUPANCY TYPE COMMERCIAL�j4 EDUCA ZONAL © RESIDENTIAL PRINT CLEARLY NEW: E] RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES 0 NO Ell S O FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 k BATHTUB CROSS CONNECTION DEVICE _(f DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM { { # { ._ _ I { _ ) . _ _� { E {I — DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _4 _......__ I FLOOR/ AREA DRAIN 1 __ _._._4 _-__-_► __ __ I _.� _.__ _ f __.__. i ___._ _.� .___._.__i __._ _ l . ___.._f _ .-__€ . - -41 { { �J INTERCEPTOR (INTERIOR) KITCHEN SINK (-._.-_.1 n LAVATORY ROOF DRAIN _ i _� _... .__—{ —__! _._.J _ _ .__..._� ._ ._! __.__._� _ _.._ i . _.__. _ _� _I _ ___( ► ► I SHOWER STALL SERVICE / MOP SINK TC4LET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ..._-..._.I --- 1 J1 J -71 INSURANCE COVERAGE: 1 nave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES .. NO E1 , If YOU CHECKED YES, PLEASE INDICATE TH YPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND E 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 0 AGENT IEII T SIGNATURE OF OWNER OR AGENT O 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 com fiance ith I ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME >" LICENSE # . f> L SIGNATURE IMPEll CORPORATION W# PARTNERSHIPQ# LLC� _E COMPANY NAME ✓111,+ �. ADDRESS CITY I --- - - .. _..._..._M STA�� ZIP_'� _ __—II TEL .- y FAX —J CELL r: r;'�✓ _ MAIL f, '► -Qe �._/� rt? :!!! jo 4 . t ti y The Commonwealth of Massachuseds Department of Industrial AccMiks Office of Investigations 600 Washington Sheet .Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contrav Anplieant bformation Name (Business organizaiion&dividual):S � 6 i Address:Xlr,�r, city/state/zip:' r3� Phone Are .ou an employer? Creek the appropriate box: Type of project (required): 1. VI am a exnployex with _ �• ❑ I am a general contractor and I 6, ❑ New construction employees (full and/or part-time).* have Hired the sub -contractors 2. C] I am a sole proprietor or partner- listed on the attached sheet. 7• Remodeling ship and`have no employees These sub -contractors have 8. El Demolition working forma in any capacity. workers' comp. insurance. g• F1 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 1111Plumbing. repairs or additions myself [Noworkers' comp. c. 152, §1(4), andwehaveno 12.QRoofrepairs insurancere ed. employees. [No workers' � � 13.❑ Other comp, insurance required.] XAny applicant that dhecks box#1 must also fill out the section below showingtheirWorkers' compensationpolicy information. t'Homeowners who sabnritthis affidavit indicating they ere doing all. work and then hire outside contractors must submit anew affidavit indicating such. TContractors that chmkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' comperasation insurance for my employees BeloW is the policy andjob site information. /1-1 4 Insurance Company Name t Policy # or Self ins. Lic. #: -- _ Expiration Data: Job Site Address: 01' IMUZ City/State/ZipYj t Attach a copy olthe workers' compensationpoliey declaration page (showing the policy number and expiration date). Failure to secure coverage as req' dunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a tine 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 fma of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the AIA for insurance coverage verification. I do Hereby telt& uqi r#,flafns andpenaw y ofperjwy ha, the information provided above is true and correct. r official use ogly. Do not write in this area, to be completed by city or town official. City or Town: PermiffAcense # Issuing Authority (circle one): 1. Board of Health 2. BuildingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Information 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 tri. the service of another index any coziiract ofhire,• express orimplzed, oral or written.." An employee is defined as "an individual, partnership, association, corporation ox other legal entity, or any two or more of the fore$6ing engaged in a j oint 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 owner of a dwelling house having notmore 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 ofpubiie work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensaiion affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone numbers) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to carry workers' compensation insurance. Tian Li C or LLP does have employees, a policy is required. Be advised thatthis affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit 'rhe affidavit should be retumed to the city or town that the application for theper mit 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 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 and printedlegibly. 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 thatmust submit multiple permit/license applications in any given year, treed 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 stamp ed 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 orpermit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you iu 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: `rho Co ORWOalth o aS�ar !v._.SPtEs - Dopaftent d1aduAVal Acciclants Woe ofhivesuga-am 600 W48W -(oa Stoet Boston, MA 021 It TQ1, # 6X` 221' _4900 0yd 406 Qx 1-877-W..SAM Revised 5-26-05 FaY, # 617-727-7749 wmmus.gov1d a CQ1:COMMONWWfA OF MASSACHUSETTS FLICENSE Date. 7�2 . 4, -.0-7 ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ........` .:c' . Y : :............. has permission for gas installation ........... in the buildings of�.,............................. . at 0..4 North Andover, Mass. Fee..... ... .. Lic. No.. X�r�: � ... /'� ��,.L� ,., y. _:........ . GAS INSPECTOR �v Check # 5396 49 v .1 MASSACHUSETTS UNIFORM APPUCATON (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations S-0 SCJ a, I Owner's Name New D Renovation 1:1 Replacement TO DO GAS FITTING Date 2-4 / 6 % Permit #YS U � %C Amount $®� Plans Submitted (Print or type 1 S / Name 1k 1 S /e�ilitl/LC -e_/�"4 H Che k one: Certificate Installing Company /- r Corp. Address SD X !f JYu' -'� 11 Partner. �-0 Biu -4-; !U� usmess Telephone q, j yy Firm/Co. Name of Licensed Plumber or Gas Fitter LZ/D INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D"_ NoO If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— Other type of indemnity 0 Bond 13 Owner's Insurance Waiver: 1 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 Agent - - --• »• »•• �• •••� »�.u..� u��u „imiaL U11 uavo suomnteu kor enterea) in aoove apps ation are true and accurate to the best of my knowledge and that all plumbing work and installat• ns pe med under Permit Iss d for this pplication will be in compliance with all pertinent provisions of the Massachuse tate Co a and pter 142%f the eral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed ('dumber Or Gas Fitter Plumber Gas Fitter (cense Number [-Q—"aster Journeyman U OU ww a v; C7 v� W o pq F x rA zz O W F a z o z ;Dz F W w -• w > Z W > w a E" vii m z O F z o a> o a H o SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type 1 S / Name 1k 1 S /e�ilitl/LC -e_/�"4 H Che k one: Certificate Installing Company /- r Corp. Address SD X !f JYu' -'� 11 Partner. �-0 Biu -4-; !U� usmess Telephone q, j yy Firm/Co. Name of Licensed Plumber or Gas Fitter LZ/D INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D"_ NoO If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy 0— Other type of indemnity 0 Bond 13 Owner's Insurance Waiver: 1 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 Agent - - --• »• »•• �• •••� »�.u..� u��u „imiaL U11 uavo suomnteu kor enterea) in aoove apps ation are true and accurate to the best of my knowledge and that all plumbing work and installat• ns pe med under Permit Iss d for this pplication will be in compliance with all pertinent provisions of the Massachuse tate Co a and pter 142%f the eral Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed ('dumber Or Gas Fitter Plumber Gas Fitter (cense Number [-Q—"aster Journeyman Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use, by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: LeftRight front of house ft/ Right rear of house, Left / right side of house, Left / Right side of building, n o building, Left / Right rear of building, Under deck Address Cityfrown —� State a Zip Code 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Ty of system: E]Other (describe): state Zip Code ; Telep-Tione Number Date 2. Quantity Pumped: Cesspool(s) ❑ Septic Tank 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc - Company 7. Location where contents were disposed: Gallons ❑ Tight Tank No If, yes, was it cleaned? ❑ Yes ❑ No Waste Water F5821 Vehicle License Number Date t5form4.doc- 06/03 System Pumping Record • Page 1 of 1 Date ... �/ ... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ,� This certifies thati t.. X,;7 �-f=.�...., ,. ,. . . has permission for gas installation tel.:-e�.-... /�• in the buildings of.r. �:t :� �..��.•r!••••••••••••• at, North Andover, Mass. 1 Fee...<�, / . Lic. No../' �! .......................... GAS INSPECTOR Check # � 4591 LAP MASSACHUSETTS UNIFORM APPUCATIOAt FM (Print or Type). to 00 Mass, Date 1 Gi 121 6m! New p Renovation ..p ITT TO DO GASFITTING Permit # ?/_ Name jZ L 1 Plans Submi ted. Yesp No p Installing Company Name Business Name of Licensed Plumber or Gas Flitter. Cheek one:= Certiflcataf ❑ Corporatlon- p Partnership A Firm/00. INSURANCE COVERAGE: 'I gave a cuffeA liability � insurance policy or Its substantial, equivalent,whk:h-meets the requirements ct_ MGLCK- •142.. Yes JR No ❑ if you have chedoed-IM4* sse*ndicda#etypesovage-by-checking theappropdate box A liability Insumnee.policy X Other.type-auxlemreity Q Bond- ❑ OWNER'S INSURANCE WAVER: I waware_that thelicensee.doesimt haves the insurance .coverage required.by Chapter 142 of the .Mass. General laws. and kid my signature on •this -permit -application waives this requirernent. Check one: Signature of.,Owner_*ryOwrw:s Agent-. OwnerO Agent 13 I hereby certify that all of the details and information 1 have submitted (or enteredl in above application ars true and accurate to.the beat 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 provisions of the Massachusetts State Cas Code and Chapter 142 of the General laws. By T of License: '414�17 147 ber na4tute um_ T Title JG;tterer License NumberCit/Town jneyman z .0 P dfz 40 O0 ol 99 Z 0 P 0 tu IL dl U. ji O 30- z 16 0 = C. IL 0 66 16 z 16 49 ol 99 Z 0 P 0 tu IL dl U. ji Location .5-0 alll ,1�6,3i v No. Date 613 �y ,.ORTF TOWN OF NORTH ANDOVER •. 0� O� n Certificate of Occupancy $ Building/Frame Permit Fee $ ss�cwust CHUS Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector S .Op PAIDiv. Public Works ng1i0199 10:55 w ? i C Lj z z G C U U, ? i C Lj z z G C U U, 7 7 z z � C r W � U M ✓ C � r M F iC O W W O G G G A 'z Z C U Z ¢ c: n W yr td i I "J w 'Al u z Id z w G C � L 3 a ti k O O' O u � C Z U z C z g z o w w - z z c c h� O z o � ? i C Lj z z G C U U, 7 z � � M M W W O G G G z 7_ C U 'z Z C U Z ¢ c: n W yr td i I "J w 'Al u z C7 Z_ G C ? i C Lj z z G C U U, 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" t Sv44N at ArV4 PHONE 71 / _ P 3v LOCATION: Assessors Map Number PARCEL SUBDIVISION Yo&W AA)0022 "T95 LOT (S) 15 STREET �Q t Lp DOSE ST. NUMBER 50 *****************************************OFFICIAL USE ONLY********************* *** ******* ECOMMENDATIONS OF TOWN AGENTS:�� koej� h 6�-- -t- +o,,i # � 4�p r6i ej CONSERVATION ADMINISTRATOR DATE APPROVED �` DATE REJECTED COMMENTS Ore[ �n�U L -CD 4) TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 jm TE 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: Vf- J63 R120 (Locatiga-o4 Facility) ignature of Permit Applicant S Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector < `{ L } '� I k _ - 3�f I� 1 f _ i A a � m rn rn = a ep y m � � n cn � '7 m_ � I �t' � - . i �o o � a �:... .v f.. e -r ,� y a rn � a s i m.` 'w �, c rn � �� ' .. { m j � � cn = ,y.. c � v... ' 'li .s x H b z � C T � ... if N •. �I.. m j - I m m^ 111 V'. X F C � � H Z t= W � .. m � ..y c -a a � _ � m � z H rn ---i � y S _� .�-- � s } � c � w e -r 1 l_ v :D � ' 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 c 11, S 150 A. The debris will be disposed of in: \ wblgnature or rerrrnL r�PPucanL Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Na CN Phone ❑ 1 am a homeowner performing all work myse!f. F7I am a sole proprietor and have no one working in any capacity am an employer —pll-oyer providing workers' compensation for my employees working on this job. Comoanv name' \I �NSE+IJ 1�1��ECopME�t3T (�o�P• k3 GLEuOALIE CMCJ ( e City Lt+r►ntoti M,Pr • Phcne --: Insurance Co R r C P-5 Pclicv m l t4- (A. 13a7 ?0A q. Com rens i tv Phone --* Insurance Co. Policy '- Failure Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imcesiticn of criminal penalties of a fine up to $1,500.00 and/or one years' imonsonment as we!1 as avii penalties in the form of a STOP WCRK ORDER and a rine of (5100.00) a day against me. I understand that a copy . statement may be forwarded to the Office of Investigations of the DIA fcr coverage verification. do hereny cera ; under fh coins 2nd enalties or pe.lury that the information provided above is true and co rrect. t, e Signature / Date Print na 4 Phone -,"r d - ea- 5U O Official use only do not write in this area to be ccmleted by city or town cricaf City or Town Permit/Lcensinc ❑C`er4 if immediate response is required Ccntac: Terson: Building Dept Licensing Board �j Selectman's Office ❑ Health Department F -I Other I IHT-17-1'T7 f 1L • Z)Z? L O 7- No f' 5u� RO163 R- L_E7 0RRAI AM MDE.! 3•.y��� '� 23.00' �I. 1 � E A O- .��pc. - � a3• � O F- J� \ N 29�S w cVN Q JCD .S � E I�X2`f EX/5T/NV �.C?NCi:ETE FOU/VGAT 1 O N 8 ,1 / �- ` sem• oQ- 0 Q2 TOTAL P.03 MAY -19-1997 12:55 `BUILT" FOUNDATlOI.." LOCATION LOT #5 - WILD ROSE DRIVE PREPA RED FOR TOLL BROTHERS, INC. '= 20' DATE. MAY 27, 1993 ZONING DISTRICT R-2 RESIDENCE 2 DISTRICT (PLANNED RESIDENTIAL DEVELOPMENT) N O T E : PROPERTY LINE DATA TAKEN FROM A PLAN BY THOMAS E. NEVE ASSOCIATES, INC. DATED APRIL 21, 1992 AND REVISED TO JUNE 26, 1992 I HEREBY CERTIFY THAT THE FOUNDATION ON THIS PROPERTY IS LOCATED AS SHOWN ON PLANS AND COMPLIES WITH THE ZONING REOUIREMENTS OF THE TOWN OF NORTH ANDOVER, MASS. ..0,N Gf ,0 . / + THOtAAS E. l NEVE , / N¢3172 IN MY OPINION, THIS FOUNDATION IS NOT IN A FLOOD HAZARD ZONE AS SHOWN ON THE U. S. D_ H. U. D. FLOOD HAZARD BOUNDARY MAPS. THOMAS E. NEVE, ASSOCIATES, INC_ ENGINEERS -SURVEYORS -LAND USE PLANNERS 447 OLD BOSTON ROAD - U. S. ROUTE s TOPSFIELO, MASSACHUSETTS 1211-5 TravelersPraperty Casualty A Nea6eta! 1' navel ersGrolLp WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 POLICY NUMBER .(IH -UB -278H245-6-99) NEW -99 INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA NCCI CO CODE: 13439 1. INSURED: JENSEN DEVELOPMENT CORP. 13 GLENDALE CIRCLE WILMINGTON MA 01887 PRODUCER: CATALANO INSURANCE AGCY P 0 BOX 609 METHU N MA 01 44 Insured is A CORPORATION Other work places and identification numbers are shown on the schedule(s) attached. 2. The policy period is from 05-13-99 to 05-13-00 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: 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: $ 100,000 Each Accident Bodily Injury by Disease: $ 500,000 Policy Limit Bodily Injury by Disease: S 100,000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: AL, AZ, AR, CA, CO, CT, DE, DC, FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MI, MN, MS, M0, MT, NE, NH, NJ, NM, NY, NC, OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, WI, HI "`— D. This policy includes these endorsements and schedules: a SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All rev fired information is subject to verification and change by audit to be made ANNUALLY DATE OF ISSUE: 05-12-99 CT DIRECT BILL OFFICE: HUDMA 126 DISTRICT: C-01 PRODUCER: CATALANO INSURANCE AGCY RT055 1 CONSERVATION DEPARTMENT Community Development Division July 7, 2006 Ms. Susan Blane 50 Wildrose Drive North Andover, MA 01845 RE: TREE CUTTING- 50 Wildrose Drive, North Andover, MA Dear Ms. Blane, The ensuing letter has been prepared to document my inspection that took place on .July 5, 2006 at the above -referenced property. It's my understanding that you want to remove the left oak tree that is growing with another oak tree and trim a large branch off the oak tree on the right side, along the left side property bound. Additionally, you wish to remove the dead branches on two (2) other oaks on the opposite side of your property. As discussed, the split rail fence was placed along the 25' No Disturbance Zone as a physical demarcation in the field. These trees are closely abutting the fence; therefore, are within the 25' No Disturbance Zone. However, this department has authorized the removal of the aforementioned tree and branches as they pose as a safety concern. I trust this information is sufficient for your needs. Should you have any questions or comments regarding this letter, please do not hesitate to contact me at your earliest convenience. Respectfully, NORTH ANDOVER CO RVATION DEPARTMENT Pamela A. Merrill Conservation Associate 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 918.688.9530 Fox 978.688.9542 Web www. http://www.townofnorthandover.com/conservel.htm — -0- k � � v o Ww cr- L4j foo )6 rQ wll co Z 0 0 a_ cr 0 0 LI; rQ wll co 05 W i-+ O 0 O FO U GCLI z z z z v A f° G ►•a W a w rx U w a w" w V) 10 v:c cs :U :W CDe �a At. c m (n C4 N :%,Lcj m C Q E O m c� LJ vs :E me E N A ti. O N go W C �: m -9 CO) C//) z cloiSEN U 4 CLCJ y m Cl) cr. C/) cm N a • � m C � m V y O reo w. CD CD = m 1 0 G N P3 ~ 4- NCD m N O W Co CD 1 j. •ce dt A C O C O O • y C3 .m c m cm V CO) d. m 1 � � m y��Q H s CL q- 1=0 I c i T Q t ecl G1 1 T� _C � � o C.) L a. m C) 0 - CL Q)'S i v .CL C C CD � C .y Q O cn Q cn I c i T Q t ecl G1 1 T� _C � � o C.) L a. m C) 0 - CL Q)'S i v .CL C C CD � C .y Q Location �No. f�!� Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ F undation Permit Fee $ a' ?e�ri11I Me $ 0�0 SFS' Sewer Coin¢cion Fee $ &ater Connection Fee $ T fx $ aD / 99mp Inspector '6551 Div. Public Works Location No. % D Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ /,.a Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee A11Connection Fee TOTAL �y. �•��3�� Building Inspector 1 t 3 4 Div. Public Works I r Location No. � � I Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ >t 4 ,�Auilding/_E[aTe Permit Fee $ ; Founr tib ir Nrmit Fee $ Other Permit Fee $ ��� �Wer gqConnection Fee $ IteY�C�Mftection Fee $ �J a-1, TOTAL " Building Inspector Div. Public Works Location i;j/ a eas'- fNo• Date Data 8� O DS OF NORTH ANDOVER Certificate of Occupancy $ 4L IIIding/Frame Permit Fee $ ssusE Foundation Permit Fee $ Other Permit Fee $ "-55e- Sewer Connection Fee $ O'E*'%3-c-0 1t9l-7 Water Connection Fee $ l b9t� - va TOTAL r Building Inspector !' J rI. {{ ! Div. Public Works C9 Me n VJ �19:9 ^� l � N w W J U O I W IL z � Z 1 �I R U -VI O 0 Q a W N M X m W r 0 � f F O U U m a a W J F W p H z Z Q WJ 0 rc rc _z p J O m J i F. a¢< y d 0 Z O J f I 1 = D0 Q. 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N113 > O m vm T n O w Oom yo f zo '` m z (hOD v> mW�, MOO w -+ 4 0 0 m ZOO o s -4j G m Mr 33m ?� c a� b►'+ NO D m W on DOZ oZ �y zm 23 DO vo N cm N:E 0 �� m C _A301.4'uZ N D v < o m vmz ;om 1 W Z mm O ►� rN r d C ►+ =r Dn z o a D' %An �+ Z y <ca �o a o o !"> OD m N 7D m 3 O z O m r a' o m m Z'13 v m V J 3N11 ONOW 0I03 4l Z z m _ �}co --i1l T� j=Ij�T T / (n 00 5: V y 0 q _ J) o ZZ 00 C0 OZ --jn n C m c0 ZD Mm n�00 p a 2D ���D Z m Op mD=y Afc) pcn -IC- MKZ ou� w d 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** - APPLICANT: ,DU+C�v�/)�2S �N'� Phone CJ��� ��� c(qd LOCATION: Assessor's M Number Parcel Subdivision 5 _ 02 wee c�v�cz - . �� -�S Lot (s) Street �����1��� �y� St. Number 150 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservati`ton Administrator Date Rejected Of Comments t � )> Ai- 242 - 6M de C ow,(%n u�'�l,Q Date Approved Town Planner Date Rejected Food Inspector -Health Septic Inspector - Comments Date Approved Date Rejected Date Approved Date Rejected -Public Works - sewer/water connections S is -. 5J4 Z 73 - driveway- prmit —1 / Z 16 llvN/ Fire Department 4-,- '�)_ __.. Received by Building Inspector Date 4 CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 106 THIS CERTIFIES THAT Date SEPTEMBER 17, 1993 THE BUILDING LOCATED ON _ LOT 5 WILD ROSE DRIVE 450 - Type B MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/2 CAR GARAGEIN ACCORDANCE & DECK WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 04, �T", �� CERTIFICATE ISSUED TO ' � OCL ADDRESS cHu s1� 'POLL BROS. INC. x1103- Philmont Ave. Huntington, VA c' Building Inspector St 0 W c� LS �► y- C3 fcl . `- O et C.3 V C CL CL cc . o y ~ ~- M m= aW C3 CC n N EC � 3�L..m 0 0 CD m m�a h = C40 �p y C N �'E o � m v m`o 0 CLC.) m is ocm 20 o.0 � r m �mo� Zo c n CL m (AA m C C = m m w o N H � H m$~ m y m = mLL.ui r.. C +• i- •y n� m C Z OC o 'r m •y O_ LU .o omen y C. O� 0:5 �. U3 m CO2 C 4 -m ro., 2 co O � J 0 � o � 0 0. �, LU Z A G ca � � v o a w R+ ou , m o c „ 0 } a LA �E _ O �O m m c4 cn w" w cq cn cn LS �► y- C3 fcl . `- O et C.3 V C CL CL cc . o y ~ ~- M m= aW C3 CC n N EC � 3�L..m 0 0 CD m m�a h = C40 �p y C N �'E o � m v m`o 0 CLC.) m is ocm 20 o.0 � r m �mo� Zo c n CL m (AA m C C = m m w o N H � H m$~ m y m = mLL.ui r.. C +• i- •y n� m C Z OC o 'r m •y O_ LU .o omen y C. O� 0:5 �. U3 m CO2 C 4 -m ro., 2 co � 0 � o � 0 0. LU Z G ca � � cc "' H O cc } a LA �E _ O �O m m Cw Z ow O 0C C� � GOL.. a O � coG co i Ilk 00aO O- � IRZ CL CMa ca � O o � � cc •d O O LL c Z c z r� V ca �7a=- C a � = oL c LL G CO2 Z_ � Z � z u CL u v TOWN OF ,I� • vlJn\l2C SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS 3� Chi Vl� So W , lcl Q-0�-- O� 292003 SYSTEM LOCATION (example: left front of house) r� V`n�S� DATE OF PUMPING: �� QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE 4 EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: SY r (� DATE: SYSTEM OWNER & ADDRESS G RECORD RECEIVED SEP 14 2004 TOWN OF NORTH ANDOVER SYSTEM LOCATIO*� - (example: left front of house) OF PUMPING: UANTI l� ` TY P ED: GALLONS DATE �Q CESSPOOL: NO YES SEPTIC T NO YES C� NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste �LN Commonwealth of Massachusetts��� City/Town of TO System Pumping Record Form 4 wN o� No�pPR MENS �O N�P��� DEP has provided this form for use by local Boards of Health. Other fo ay be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. V ren 1. System Location: Address City/Town 2. System Owner. Name Address (if different from location) City/Town Zip Code B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ 9 -6 -her (describe): State G (Oc"�Avv�!� Zip Code State ,— l q� Telephone Number Date 2. Quantity Pumped: 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: Gallons ❑ S tic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 6. Systerp Purnped By: Name Vehicle License Number Company 7. Location c /lr-- — A < t5form4.doc• 06/03 System Pumping Record a Page 1 of 1 ICN- Commonwealth of Massachusetts City/Town of a W° System Pumping Record Form 4 AUG Z� tU11 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other fo p skppgj�Te information must be substantially the same as that provided here. BeforeTlzmgmis To—rm—,-clheckwith your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of hou ,=rightnt ofrear of house, right rear of house, Iui ( City/Town 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record &'a3 ) ( 1. Date of Pumping 3. Type of system: E]ther (describe): ? left side of house, right side of house, Left ht rear of building, under deck. State Telephone Number 2 Q ft P d' Zip Code Date Uan y Umpe . Gallons Cesspool(s) ❑ Septic Tank ❑ Tight Tank v 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Lowhere contents were disposed: G.L.S. Signature If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1