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Miscellaneous - 793 FOREST STREET 4/30/2018 (2)
NO m �W ,,Liberty INSURANCE May 12, 2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Re: Property Address: 793 Forest St, North Andover, Ma 01845 Policy Number: H3S21868627040 Underwriting Company: LM General Insurance Company Claim Number: 031694714-0001 Date of Loss: 3/9/2015 Attn: Town/City Official Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Pursuant to M.G.L. c. 139, � 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, � 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, X99, if you intend to initiate proceedings designed to perfect a lien pursuant to Mass. General Laws, Ch. 139, � 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws, Ch. 111, 5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Date ....3.Z��.............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......................................................................................................... has permission to perform .............................. wiring in the building of����........-�;-�,r".l `��C.,.1n► o A..... at ...... .�...�.-� �r0�i c'4. ................................... North Andover, Mass. ............... ....................... Fee'S.5..�............. Lic. No. 5 -t.(015 - ..M t�.................................................................. ELECTRICAL INSPECTOR Check # ,20zomoU Y'qZ— Ir A 477 U 1A Commonwealth of Massachusetts Official Use ly ` Permit No. I "t Department of Fire Services o Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: o 3 . z�5 . 2,613 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 7q3 FOyge.%.+ 5-A Owner or Tenant Owner's Address Telephone No. (a5'7 -r-) Sqq.- Baa o Is this permit in conjunction with a building permit? Yes LJ No ❑ (Check Appropriate Box) Purpose of Building F'ls R�s,�,rn-�- ��ycUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd [:1 No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:�- Completion of the following table may be 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 Above ❑In- E] rnd. rnd. No. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches q No. of Gas Burners No. of Detection and Initiating Devices v No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number. ' ' Tons "' """"""""''"" KW """""""""' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local El Muni cipal [:]Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Q3 . LA, 2CA3 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 cover ge is in force, and has exhibited proof of same to the permit issuingc� office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) t�o d f 5 a't Z= y n X certify, cinder the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. _ LIC. NO.: Licensee: o" LIC. NO.: / (If applicable, enter "lxempt" in the license number line.) 0 Bus. Tel. No. — fP a:3 Address: f 4 i'%A q9 15S Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department ofTublic 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 ngent. Owner/Agent PERMIT FEE: $ 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 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 S 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 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 EN Failed IN Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: , SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: vv lE �, .� Date: 3 FINAL, INSPECTION. Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors mments: Inspectors Signature: U Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com Q The Commonwealth of Massachusetts Department of Industrial Accidents 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 Legiblv Name (Business/Organization/Individual): Address: City/State/Zip: Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. [:1I am a general contractor and I ployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ Ne construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. I 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: Policy # or Self -ins. Lic. #: Job Site Expiration Date: City/State/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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. T do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 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 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 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 owner of 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 requirements 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 number(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 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 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 permit/license 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 burn 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia �; rw` alnLaufiig t , _ • W . cn LU ^� Cl) wLU t 4Z4 M LLI ly ,VO C.Q C 1 I � '4, 4 6 (Y1 3 ��7.2.- -5 - -9 -T-- Date..... ................... "Z 16 TOWN OF NORTH ANDOVER 0 sop,p PERMIT FOR WIRING This certifies that ............................. has permission to perform ............... wiring in the building of ....... K.ao� ..... 4�':.. .................................... -f at ................ . ..... . ..... , North Andover, Mass. Fee .11/Y.:! -o.. Lic. NoIW�.Ye .......... ...... ELECTRICAL INSPECTOR Check# Cy_v lily iy i 41, 1 ;v!IC i 577XV Permit No. f 1 Occupancy ar Fees Checked APPUCA71ONFOR PERMUTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED BV ACCORDANCE WrrH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street dt Number) Owner or TenantIv-5—se- Owner's , e- Owner's Address is this permit in conjunction with a Purpose of Building Existing Service New Service Amps / ' Number of Feedets and Ampacity Location and Nature of Proposed Electrical Work /,4 No. of LighdnS Outlets No. of Hot Tubs No. of Transformers Tota -- KVA No. of Lisbdns Fixtures Swimming Pool. Above Below Oafleeraoots KVA yound ground No. of Outlets No. of OU Burma Emergency Battery No. of Freer Lighting units No. of Switch Outlets No. of Gas Dumas FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Tota Toru No. of Detection and No. of Disposals No. of Hest Total Total Po Toro KW Initiating Devices No. of sounding Devices No. of Dishwashers Space Area Hestias KW No. of Self Contained DetwdowSouodtns Devices Local F Municipal O No. of Dryers Heating Devices KW Connections M No. or Water Heaters KW No. of No. of Siam alasis No. Hydro Massage Tubs No. of Motors Tota HP Yssua =ODWW Pa0=1lDdzapransftdM=du*GaledLm Ihwaans9LJ* tYiit;t=vePaic,Yr duftCd orieatakmequiakt jam NO 13 Ihaveaftnoedvddproafofstm 10th G3z YM M8ywhatectrd1YfiS, Pk=idcaledtetypeef wvaVby dlebac. P61 RANM -M BOND 0 mm o Es dVatledEbc alWadr S - Anl WbiklDSW _ i FeCdonDateRgz*d k RA ci - LioaseNa Budn&nT@t Nn v� u u 1b1 NQ 1 ��J 9�Q yo�D — ?rJ67 owt,WSIINS' AtANCEWArMklamnmdvidleLiosw„d ftm*=UaAu*a*s�b�rrielec}ivaia�tasa4iadbyMesmche�eaGal�llLawa a rddaniy9gftwond>Bpmr�[appicatiQt� fetaquie(rnt (Please check one) Owner Agent D Telephone No. PERMIT. FEE $ C L� Commonwealth of Massachusetts official Use Only _ -- Permit Flo. Department of Fire Services Occupancy and Fee Checked J;- BOARD OF FIRE PREVENTION REG ULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (�%-IEC). 527 e_y1R 12.00 (PF -I LSE PRI,VT LV LVK OR TYPL :VFORJL4TION) Date: 4_9 - �CI . 6_l' City or Town of: � rE• .-1�-�Jy�=(L To the InspecttJr ref Il'ires: B\ this application the undersign -'i 'e not of his or her intention to perform the electrical work described below. Location (Street & Num Owner or TenantV_��Ilel Telephone V Owner's Address Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Utility A thorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of deters New Service amps Volts Overhead ❑ Undgrd ❑ No. of :tileters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: bbl• /1. %�� 141//Y/ ,4 Completion 01 the (ollotivinQ table may be waived by the Inspector of'P"'res 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 Above ❑ In- a Swimming Pool Qrnd. t o. o mergency Lighting grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS�Noof�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 b No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ [Municipal El Other Connection No. of Dryers Heating a fiances b PP KW Security S stems:" No. of Devices or Equivalent :No. of WaterNo. KW of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hvdromassaae Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail ii'desired. or as required /)Iv the inspector of 1Vires. Estimated Value of Electrical Work: (When required by municipal policy.) i Work to Start: Inspections to be requested in accordance with \/IEC Rule 10. and upon completion. 'tt 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 undersi,med certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) 1 certifti, under the pains and penalties ojperjury, that the in=ornyn-thij- tpph' t' i is trite acrd complete. FIRY1 `JAMIE: ADT Securitv Services, Inc. _ 1,IC..N0.: 1533 C icensee: Y4 Signature tf unplicanle. ter "e.tentpt" in the lic,'nse number ltne.l _ Bus. Tel. No.: 603 'J )q ;900 'ddress: 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-,030 Security System Contractor License required for this work: if applicable, enter the license number here:.) Cc* c'< t WNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally auired by la,•.v. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's aeent. vner/.gent�� ;nature Telephone No. PER,WT FEE:. i / 'v 6286 Date../ `° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING rv(",52 c .. j i /This certifies that .........1.1....... . . .............. ........:t.. has permission to perform ..........1 R-.!...�.q%..... Sri ' fir_ r!r! ............. wiring in the building of ......... #t.y.-..slo ...... !. .1o.i ............................ at ` 3 ..6!�O t 5 ...................^ North Andover, Mass. od /.�33C t Fee ...�-,�..-...�.. Lic. No42, q (�................. ...................... ,c�►<,.. ELECTRICAL INSPECTOR c Check 4 OA Commonwealth of Massachusetts -- Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2_X6 Occupancy and Fee Checked [Rev. 9/051 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (EIEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE L /VFORILL4TION) Date: 1A_ � . Q� City or Town of: &, AbVbi VOL To the Inspector of Wires: By this application the undersigns ,_;, v�4 node of his or her intention to perform the electrical work described below. Location (Street & Num Owner or Tenant 'Z Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and -Nature of Proposed Electrical Work: / Yes ❑ No Telephone (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ . No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Completion of the following table may be waived by the Inspector of GVir No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans es. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above El In- El Swimming Pool arnd. o Emergency tg ting grnd. Battery 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 g No. of Waste Disposers Heat Pum Number ....................................................... 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 Kit 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 No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BQND ❑ OTHER ❑ (Specify:) certify, under the pains and penalties of perjury, that the inform( (pplication is true and complete. FIRM INAtME: ADT Security Services, Inc. LIC. NO.: 1533 C Licensee:�A C2.�'. Signature O ;476�, if (If applicable, Ater 'exempt" in the license number line.) Bus. Tel. No.: 603-594-5900 Address: 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-5930 *Security System Contractor License required for this work; if applicable, enter the license number here: .5.5 CC C^<. -i 6- 3 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. 1 am the (check one)❑owner El owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: �d , Date. . - 3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING -' This certifies that .....�:•.-- ........ . has permission to perform ........ 7. .. // ................ . plumbing in the buildings of ._ .:� ..�... l.4 :!.�......... . at ........ North �./ndover, Mass. /J Fee ... Lic. No. ... !'"- .......... -PLUMBING INSPECTOR Check # 5;24 ► y, 41y".y r.7, I ',!IC j a f' Yel I I 011 #1 C V II Yr r, Perttdt NO. < Omupwicy & Fen Checked APPUCATIONFOR PERMIT TO PERFORM ELECTRICAL WORK Atl. WORK TO BE PERPORMED IN ACCORDANCE WrrH THE MASSACHUSSTS ELECTRICAL CODs, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) pate Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street 3 Number) Owner or Tenant Owner's Address J, Is this permit in conjunction with a Purpose of Building permit: Yes No ✓IC Existing Service Ampa�. olts New Service Amps...,.V otts To the Inspector of Wires: (Check Appropriate Box) Underground Underground Utility Authorization No. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Metes No. of Meters No. of Usti g oatleu No. of Hot Tubs No. of Tnnshmen Total KVA No. of Lighting R:sera Swb=Wns Pool' Above ground Below Oarerstas KVA No. of Recaptab on" No. of OU Buemn 90113W No. of Emergency Uo tng Battery Unite No. of Switeh Ouden No. don Burnam FIRE ALARMS No. of Zona No. of Ranges No. of Air Cond. Total Tone No. of Delectim and No. of Disposals No. of Heat Total TOW Palm TOM KW Inidattag Devices No, of Spm Damon No. of Dishwuhen Space Ara Haft KW No. of Self Contained Detection/S000diM De Local a Mmictci OUra No. of Dryers Heating DrAm KW ComrecdM o a No. of Water Hessen KW Na at No. of slips Beilmh No. Hydro Mugge Tuba No. of Moron Total HP ha.MoeCoMW P UUMtlDgE ;iMU&dlVlareada8' ckno Maas lhwauaetLie*haa=Fbkirfdr;tbI — crihzb*ddegiiAw YE IhmesttbmltedvddpaWof==iDlzOliim Y$S aytitmhmd,eaedYB 0widcillefletypeet'covqVby raW&XE 1= 0 am 0 WC&ID&M c1 EtI i -iD* EWr*dVarreefHeWWWP*$ Jnr im�taifarrDmlead Re*- ---ri s itec d.- s! /:�� ey 9.1.E AtTiiNa zy g�?sW _17�29- yae -- 7(5762 OWi�WSIIVS[JRANiEWANFIt;lanawaedatlheLiotree �gdteira�loeoo►vageoritasubemiosdat}:valmtasrec}iedbjrMas®aa�elalaslLaws ardthetmp+9grraeonlirpenri�pic�mwi�afivagiimlers (Please check ori) Owner � Agent Telephone No. PmtMrr FEE 3 Signature or Uwner or ^gain MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location -7 New rs ` v O N APPLICATION FOR PERMIT TO DO PLUMBIN( Date 'j - ,w ✓ 7 )w ers Name (_ Permit # Amount of Occupancy Renovation ❑ Replacement FIXTURES Plans Submitted Yes 11 No 0 (Print or type) �,- Check one: Certificate Installing Company Name Ir`�.Of��rvjd E�L-C9- 11 Corp. Addresses ZZ -U Partner. X5 r Kkk Dmqp t9 Business Telephone ' P�� 7S�-(s3� irm/Co. ' Name of Licensed Plumber: d Insurance Coverage: Indicate the type of jq5uFmT5e coverage by checking the appropriate box: i Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the NfNiikc-uset {ate Plumbing Code and Chapter 142 of the General Laws. Title City/Town APPROVED (OFFICE USE ONLY V Type of Plumbing License icense NumDer Master Journeyman ❑ Date ... l2.................... ;•�;�o� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING This certifies that .......................... / ..... '> . ....... has permission to perform .:r-!...... wiring in the building of ........` � ......... ...7 .................................... GG. at ........ _ ...- ..................... . North Andover, Mass. Fee rte.'K.......... Lic. No. /> z%7 -y , ELECTRICAL INSPECTOR Check # ';/2� 5' 9 Pa -&-Q ----( ©d7— 7s $ ed%17&67rd15X W 057 V0 40 -W 4 ?g&. S4c41 44' BOARD OF FIRE PREVENTION REGULATIOWS 527 CMR 12:00 APPLICATION FORPERMI TO PERFORM ELECTRICAL WORK All work to be performed in accordance ' h the Massachusetts Electrical Code SZ7CMR 12:00 (Please Print in ink or type all information) Date ? To um lase ct r of Iffl. uca. Town of North Andover Official Use Only Permit Occupancy & Fee Checked The undersigned applies for a permit to perform the electrical work described below. 70 Location (Street & Number n (" V if ST Owner or Tenant &a / � TY vs 4— Owner's Owner's Address _ VO K X Is this permit in conjunction with a building permit Yes 0 .nr ._ Purpose of Existing Service Amps Voits New Service o o Amps a 0 Voits Number of Feeders and Ampacit, Location and Nature of Proposed Electrical e�,tf 97 No 0 (Check Appropriate Box) Utility Authorization No. Overhead 0 Undgmd a Overhea Undgmd 0 No. of Meters No. of Meters INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaleYES NO valid proof of same to the Office YES = NO s If you have checked YES please indicate the type•o coverage bychecking the appropriate box. INSURANCE a BOND - OTHER - (Please Specify) Estimated Value of.Electiical Work$ startInspection Date Resquested ltJ I a Rough Final Work d under t e JS 1 s of Signed under t e�P�Ina�e�e�s�of` FIRM NAME t� ,eg pet (Expiration Date) LIC. NO.— (A I 'T 1 '4 a— NO. r 4410 L, t� , y• I e`er[ VY K f Bus. Tel No. �J Z � — �o 1? t " &3 $ % Address ��� Att Tel. No. ,525% v (off_--- [f OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Generai Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE $ 2 Total No. of Lighting Outlets O No. of Hot fuse No. of Transformers KVA a Above a In 0 No. of Lighting Fhdures Swimming Pool gmd a gmd a Generakas KVA No. of Emergency Lighting No. of Receril2cles Outletst2/ No. of Oil Burners Battery Wits -33 No. of Switch Outlets No of Gas Burners 1 FIRE ALARMS No. of Zone No, of Dabection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No_ of Sounding Devices NoJ of Self Contained ( No. of Dishwashers Space/Area Heating KW DetectiordSounding Devices > ( A Wnicipal a Other No. of Dryers Heating Devices KW Local Connection No. of Water Heaters KW /f 1 No. of Si ns No. of Bailases Law voltage /� Wirin CaOC A-C,bl No. Hydro Massage Tuds r No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivaleYES NO valid proof of same to the Office YES = NO s If you have checked YES please indicate the type•o coverage bychecking the appropriate box. INSURANCE a BOND - OTHER - (Please Specify) Estimated Value of.Electiical Work$ startInspection Date Resquested ltJ I a Rough Final Work d under t e JS 1 s of Signed under t e�P�Ina�e�e�s�of` FIRM NAME t� ,eg pet (Expiration Date) LIC. NO.— (A I 'T 1 '4 a— NO. r 4410 L, t� , y• I e`er[ VY K f Bus. Tel No. �J Z � — �o 1? t " &3 $ % Address ��� Att Tel. No. ,525% v (off_--- [f OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Generai Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE $ q -)L/ Date../- ��.".a.5!..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that i.G � f-: t- ....c' .......................... has permission for gas installation .. 4. .............. . in the buildings of C. L :... ..................... . at..�.�.?. �.��.:...f:........... .., North Andover, Mass. Fee. .`' .... Lic. No.. � . � . z .... .....0 ...."*% -. ...... 1 GAS INSPECTOR Check # / ? '-// c/, 4925 MASSACHUSETTS UNIFORM AP (Print or Type) ko, A- „jav k Date Building Location /7J j:Qre)7 Map: Lot' New 13Renovat'o ❑ / Gr SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR r 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR TION FOR PERMIT TO DO GASFITTING 3-0 -11— 20OY Receipt#L Permitfk . OwneesName i " k Zone: _ Type of Occupancy Replacement ❑ 8TH FLOOR I I I I I III I I I I I I InstallingCompanyName Townsend Propane Serv�i_ces. Inc. Address 27 Cherry Street, i Danvers, MA 01923 Estimate Value of Work: Business Telephone . 978-777-0700 Name of Licensed Plumber or Gas Fitter �Glr,Ji! /X tit� Plans Submitted: Yes ❑ No Cl Checkone: Certificate ❑ Corporation ❑ Partnership ❑ Firm/ �— Pizzo . INSURANCE COVERAGE: I have a currenj liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have diecked M please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indbmnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage. required by Chapter. 142_ of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner❑ A�entO Signature 0 Owner or Owners Agent I hereby certifyat all of the details and information I have submitted (or entered) in above application are true and accurate to the best of m knowle a and that all 6hibin work and installations performed underthe itissued for this a Gcation will be in compltancei ' Y d9 P 9 P P PP all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General laws. t t �• y S S m, _, z' Ype •4 a fi•e� Y f . �� L''- B}? �� s J . �p xi B T of LlCense y r r gnature of lumber or Gas FIttef� r r a < r rr t d' �'. :.� t.. Zt�2d£ i* g "'K•�rr 4. '. "'� c' {` 34 ?;1 Title +•• Gasfitter.�-�x s ."�\ F. � } ter.,2 <z�•` r'r.- n h4 "�' li. {• rri.z.+1'ss CIiy�TOwnY i.eSsrY fX_' ' = s .166fileyrnan' �r APPROVED, (OFFICE USE ONLY). ` ` �, ,�r ,,+,r' �N <� i'3 ?Z�n R r�r1 y d j kir n1 y. i 4. pSr17/00 r a► N W (� Z< < == Go W O < iL Cr W h W Co Z, W > O N J<¢~ Q O N ¢ WrL _ O m O Z I.- W S W V Z M U. w <= Wcc Z z; y W i W H} < N cc W Q O rA ¢ O H ¢ Z W � N < V YC 0 O�- a x <¢ O> W. m < J Cr W Z SO Z N Z O U 0 d O F. W O O X> ai H 0 G 4 t- Z W GO Q 2 W > I.. W s — D Cr F < W _ -i O O a i.. W y= W F• O 8TH FLOOR I I I I I III I I I I I I InstallingCompanyName Townsend Propane Serv�i_ces. Inc. Address 27 Cherry Street, i Danvers, MA 01923 Estimate Value of Work: Business Telephone . 978-777-0700 Name of Licensed Plumber or Gas Fitter �Glr,Ji! /X tit� Plans Submitted: Yes ❑ No Cl Checkone: Certificate ❑ Corporation ❑ Partnership ❑ Firm/ �— Pizzo . INSURANCE COVERAGE: I have a currenj liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have diecked M please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indbmnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage. required by Chapter. 142_ of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner❑ A�entO Signature 0 Owner or Owners Agent I hereby certifyat all of the details and information I have submitted (or entered) in above application are true and accurate to the best of m knowle a and that all 6hibin work and installations performed underthe itissued for this a Gcation will be in compltancei ' Y d9 P 9 P P PP all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General laws. t t �• y S S m, _, z' Ype •4 a fi•e� Y f . �� L''- B}? �� s J . �p xi B T of LlCense y r r gnature of lumber or Gas FIttef� r r a < r rr t d' �'. :.� t.. Zt�2d£ i* g "'K•�rr 4. '. "'� c' {` 34 ?;1 Title +•• Gasfitter.�-�x s ."�\ F. � } ter.,2 <z�•` r'r.- n h4 "�' li. {• rri.z.+1'ss CIiy�TOwnY i.eSsrY fX_' ' = s .166fileyrnan' �r APPROVED, (OFFICE USE ONLY). ` ` �, ,�r ,,+,r' �N <� i'3 ?Z�n R r�r1 y d j kir n1 y. i 4. pSr17/00 t Location..!-� No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �ss.......at Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # y 3 /—� 18446 �'. Building Inspe 6 APPLICATION TO CONSTRUCT REPA BUILDING PERMIT NUMBER: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT R, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 43 DATE ISSUED: SIGNATURE: 1/� (/( Building Commissioner/I for of B SECTION I- SITE INFORMATION I.1 Property Address: 1.3 Zoning Zoning District Proposm Use 1.6 BUILDING SETBACKS (ft1 Date 1.2 Assessors Map and Parcel Number: 05-T)3 Map Number Parcel Number 1.4 Property Dimensions: Lot Area Front Yard Side Yard Required Provide Reqwired P 1.7 Water Supply M.QL.C. W. 34) 1.5. Flood Zone Information: Public Private 0 Zone Outside Flood: SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT /.t Uwnerof/Kecord V11^ Name(Pri ) i Signage 2.2 C+wner of Record: Name Print SECTION 3 CONSTRUCTION SERVICES relephone Rear Yard Provided 1.8 Sewerage Disposal System: 0 Municipal 0 On Site Disposal System 1�J�- t , . - Address or Service : - q? -10 - Z°!oi Address for Service: I.1 Licensed Construction Supervisor: iia Qe-t.L�,o-s .tcensed Construction Supervisor: o ! D L- LAI tr cA, S .ddress 0 rl�9O d�07 g re Tele hone 2 Registered Home Imprr000vement Contrr for )mpanv Name (dress ja a Not Applicable ❑ D1®3.30 License Number 07—(4-o Expiration Date Not Applicable ❑ - 1197,o4 Registration Number ©Z- r3 -D7 Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6). •. VIAO/� �,uNc„sauon insurance amoavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....:. No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction I Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition U. Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: �M 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item L Building Estimated Cost (Dollar) to be Completed by permit applicant 1 kD r& - S_ p MIN (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction i S 3 Plumbing Building Permit.fee (a) x M C o . 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT A 1 I, S(A as as Owner/Authorized Agent of subject property Hereby authoriz Gi.1 _ to act on My behalf, ii < I 1� rs r 1 v to rk authorized by this building permit application. Si nature of O r Date SECTION 71b WNE AUTHORIZED AGENT DECLARATION Hereby declare that the and belief of NO. OF STORIES BASEMENT OR SLAB ,as Owner/Authorized Agent of subject information on the foregoing application are true and accurate, to the best of my knowledge I SIZE OF FLOOR TIMBERS h— SPAN MvIENSIONS OF SILLS DIMENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CH]NINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE SIZE 2 1 THICKNESS X E E w O T. /P Ra o w cn c� a o cc wo ao' U w a o � a c+ a C rL, ° f .l o M E U O O vI U) cc W W W U) c c 85 c� o � c+ C a o h ` CD t ECFa • m o •:L dft d �o r.+ of� � a'3 C C, � y • �, 0 3 • > OAP Goo c t ro •mo CM M v"•� cc ca c aGor-L ov�o cc"Osla m r o ... �: 0 CL CD c • = o act � am 0 H 0 omof m C Z o HCL=0 7! C C2�;; cc o CD amNip M E U O O vI U) cc W W W U) 149.51' LA O \99-04\PLOT.dwg N 08'54' 21 "E l36., W ......: NO2•5 00 /-/C/"�7 �=k /��// PS LOT A-1 43,583 S.F. �f6 43 i 42.0 -- DECK PROPOSED DWELLING �A A .01 41.5 0 0 0 _ I S00'27 54"E 91 12.21 01 S07'49'42"W cn S08'17'01 "W 7.79' 69.3a, 37.76' S14'02'44" W ` ��.. S123.92' FOREST STREET 1.33'35"w PLOT PLANFV LOT A-1, FOREST STREET .����` NORTH ANDOVER, MASS.andover WI s an" C consultants tants �'^a.LE Prepared for '; S & R REALTY TRUST Inc. _ f' SCALE:1 "=40' DATE:11-17-03 1 East River Place, Methuen, Mass. a� suM�y Irk cr FORM - U - LOQ' RELEASE FORM INSTRUCTIONS:. This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from comIngo IIIIIIIIIIIIIIN 1111!113111111141pliance with any applicable requirements. APPLICANT � l � PHONE J ASSESSORS MAP NUMBER ® LOT NUMBER SUBDIVISION LOT NUMBER STREET STREET NUMBER 123 ......... ................ OFFICIAL iC1AL USE ONLRF,Y ................ .........-. �.. CO ..........IONS OF....WN AGENTS ................................... y ■■ ■■ ■ ■r■■■■■■ ■ ■■■r ..................................■........■ c DATE APPROVED C SERVATInON STRATOR I \ I I . il{'� ► DATE REJECTED coiv>Iv1 m N I Nif WIRA(h I TOWN PLANNER COMMENTS F D INSPECTOR - S C INSPECTOR - r COMMENTS 7 PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE FAMILY POOLS & PATIOS, INC. sales service • supplies 70 South Broadway, Lawrence, MA 01843 Tel: (978) 688-8307 • Fax: (978) 688-1949 CSL #010330 HIC #118204 WC #4951074 LIAB #C1098398230 Name Addre Home phone it $� -�({(��Work Cross street/directions tJ1i11 Estimated start phone 7of Y24 Z`I e)%Add'1 #. completion date We propose to furnish and install one A 3 b Z (gam i� t.– swimming pool for the sum of $ i THIS PRICE INCLUDES: • 1Vlanual vacuum cleaner kit • 3 -Step Stainless ladder • Rope & Floats • Initial balancing chemicals • 8 to 12 Wk supply of maintenance chemicals (supply depends on pool size) • Leaf net • 8 Ft Steps • Wall brush • Handrail 2 t r(. • Extension pole • Filter S �+ • Test Kit plumbed no more than 5ft from pool • Surface skimmer(s)-3-1 • Pump & motors% • Copia_ • Choice of liner THIS PRICE ALSO INCLUDES THE FOLLOWING WORK TO BE PERFORMED BY A LICENSED ELECTRICIAN: Bond and ground pool'- wiring of a 220 volt filter pump - one 110 volt plug - wire and install one 220 volt indoor time clock - outside wiring to be done in PVC pipe - sixty feet of electrical run from service panel to filter --(*note: runs over sixty feet will be subject to an extra charge)_ Initials IN ADDITION TO THIS PRICE, ADD ES AT 0 HOURS OF MACHINE TIME AT $� PER HOUR = $ 16 THIS PRICE DOES NOT INCLUDE: _ Initials Any machine time in excess of that estimated above. Additional machine time to be billed at the same rate as above due with the second pool payment. All hours of trucking will be charged at $-7 per hour per truck due with the second pool payment. Any dumping costs incurred for disposal of ledge, large rocks, or soil - re -seeding of grass around pool - spreading of loam - trucked in water - patio or fence around pool or any accessories except as noted below - additional fill, if necessary, for proper backfill or reshaping of hole - dis- posal of large rocks - fuel connections - heater venting -fuel storage tanks - permits - repair of damage to sprinkler systems or any buried . items (ex. dry well, electrical lines, cables, etc.) in the access and pool overdig areas - plumbing to filter in excess of 25 feet - stumping and/or removal of stumps. brush or debris. Homeowner is responsible for repairs of damage to known or unknown buried items. Water or soil conditions (ex. clay,eat, live sand, excessive rock, etc.) requiring a stone pack of the hole will be subject to an extra charge of $� minimum to $ maximum. Use of the above mentioned stone pack will be at the discretion of the job supervisor. Customers must supply access for all trucks and equipment. It is the owner's responsibilit to obtain the building and electrical permits or to assume the costs of necessary permits. _ Initials Notes: _ A _ OL • C OPTIONS `�� �'' �S� TOTALS Diving board (�' Basic Pool Price $ Main drain — Estimated Machine Time I fav Solar cover ( •-- Options S Pool light Heater ( ) Subtotal $ (O Environpool Plus ead 5% Sales Tax 54 1 Caretaker w/Electromc Valve, 16hd Additional floor heads ( ) --- Total $ ZZ 1 9 I Polaris Vac -Sweep -- Less 10% Deposit Polaris retrofit only Balance of Contract $ tm uddy Seat ! z SO PAYMENTS: 1/3 EXCAVATION 1/3 BACKFILL + EXTRAS . 1/3 SYSTEM START-UP The buyer hereby agrees to pay, in full, the total amount of this transaction upon start-up of the installed pool.Your salesman or job super- visor will meet with you two to three weeks prior to excavation at which time all decisions including pool size, shape, liner print, and all options must be final. Changes after this date will be subject to extra charges where applicable. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Credit card paymentsaccepted on contract amount. BUYER date ---=-- K7 P Q L. 0- A_CORD CERTIFICATE OF LIABILITY INSURANCE OIL P DATE I /05/0 FAIrtIL03HI 01/05/05 05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB international New England 299 Ballardvale St. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES Wilmington MA 01887 BELOW. Phone:978-657-5100 Fax:978-988-0038 INSURERS AFFORDING COVERAGE NAICrY INSURED INSURER .A Scottsdale Insurance Com an INSURER 3 Family Pools & Patio Inc. 70 S. Broadwa Lawrence MA OT843 INSURER: NSURER 7: NSURER COVERAGES TI -E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREC NAMED ABOVE =OR THE POLICY PEPIOD !NDICATED. NCTWITHSTAN7ING ANY REQUIREMENT. TERM OR CONDITIOW OF AFIY CONTRACT OR OTHER COCUMENT `N!TH RESPECT TC WHICH -HIS CERTIFICATE MA1 BE ISSLED OR MAY PERTAIN, THE INSURANCE AFFORCED BY THE PCLIC ES DESCRIBED-IEREIN IS SLIBJECT -0 ALL -HE -EPHE, EXC-USIOVS.A ND CONDITI:'dS CF SUC•I- POLICIES AGGREGATE LIMITS SNCM/N MAY HAVE BEEV REDIJCE7 BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYJ DA?E (MfvtlDDfYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1000000 A X COMMERCioL,ENE:.AL_IPPILITY I CLAIMS MADE OCCUR TBD 12/31/04 12/31/05 /05 PPEINISEs;Eaoxunnce} 5100000 °KP (Any cn= parson) S excl PER.SCNWL&P,DV IWURY $1000000 X $2500 ded GENERALP.PG3R,EGATE S2000000 GEN'LAGGREGATE LIMIT P•PP_IESPER: POLICY ECTF_ PRO- LOC JEC PRODUCTS -COMPIOPAG3 S 2000000 Em Ben. 1000000 AUTOMOBILE LIABILITY ANY AU -0 COMBIVED SINGLE LIMIT (Ea a:xidan:) S ALL OWNED AUTOS SCHEDULED AUTOS ' INJURY (Par D (Par ersoni S HIRED AUTOS NON -OWNED AUTOS BOU1L" IM,IUR'r {Par accidento S PPOPERTY CA0.',, E {Per ar_6d>n0 S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AU -0 OD -ER THAN EA ACC S AUTO ONLY: A33 S EXCESSNMBRELLA LIABILITY OCCUR CLA&IS MADE EACH OCCL'RPEIVCE S kG{3P.EC•P.?'_ S S DEDUCTIBLE S RETENTON g S WORKERS COMPENSATION AND B EMPLOYERS' LIABILITY ANY FROPRIET�)R'PDRTNER/EXECUIVE WC6926440 12/31/04 12/31/05 OF=ICER/MEMBEF. EXCLLCEC? X TC'w LIMITS ER E.L.EACF-ACCD=NT S100000 If yes, describe under E L. DISEASE - EA EVP-OYEE • 6100000 SP=CAL PFCVISIONS below OTHER E.L. DISEASE - POLICY LIMIT S 55000 00 DESCRIPTION OF OPERATIONS/ LOCA IONS 1 VEHICL ES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIaL PROVISIONS CERTIFICATE FIAI nFR. _ __ _ _ -------- ---- 6ANCELLAIIVN BLANK -O I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. / tS /i A TION 1998 IA i 91te , d Board of Building Rei One Ashburton P 0.M Sv Boston. Massa Home ImnrovementI FAMILY POOLS & PATIOS INC GLEN WIGGIN TZ, 70 S BROADWAY �- LAWRENCE, MA 01843¢ h. DPS-CA1 e'er 50M -04/04-G101216 IBoard of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration \ 118204 Exp_ tar tar ii on=j13/2007 E >j lement Card FAMILY POOLS 7T S'Elnf- GLEN WIGGIN r'cK 70 S. BROADWAY LAWRENCE, MA 01843 Administrator f 4 r Ions and Standards - Room 1301 setts 02108 tractor Registration A Registration: 118204 /7-) Type: Supplement Card . y Expiration: 2/13/2007 lZi 14 �A' Update Address and return card. Mark reason for change. Address [] Renewal [] Employment [] Lost Card Ilse or registration valid for individul use only re the expiration date. If found return to: A of Building Regulations and Standards Ashburton Place Rm 1301 Iln, Ma. 02108 LL4�p, LA Not valid without uor 1Jr tVU:J 1:7: CJO 7 f00�71747 t-kyllL'Y t UULb Board of Building �(Epu (ation.One Ashburton Place,m 1301 Boston, Ma.. 2108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 07/1911960 Number: CS 010330 Expires: 07/19120- �.;_,.,.. Restricted To: 00 WILL AM C POULOS 70 S BROADWAY LAWRENCE,, MA 01843 $-CAI 0 5 M-04M_(3i01216 Haut e 1 X 14273 1 top for receipt and change of addrow notification. a 4411 Or tMw I t 1 '' q'l 777 Y 3• o•' • ��� l7 Z = N s � tags I • •eoo a :' I g ' oS 4. 3�sm u5 -� 4Lu1'r ;Ura � � 3 Y �n � � .Pp rr � o "' .. = •00 .gym \ y 1. ° J $ 2 •In11F ZD �� z xw IL amn O e s, e q mn LU }i11G''- c� V ida< g e _j Z p In qk) Q LL i.. .� 000000�� 000 N co i 000^ SSG—. NN �O em CONi5 Y y N�5 pO�� OO OOCC-� mnL �mWP$F 00 �ii�€ §U g IR o. . yy�i 1.6 -,F2 �.s4 - v Z. :o a x,c - c EQ o Jn 3 yy.PP c �'a '._ 'may o-.M—,a • M. g .i�-T i. dd C tNp pa m • 66e 8'ss8 4kg@8Q8 0 o'ei to ..,=__:S a. e_i� a xz d z d • eie r d m e ss b.e N eo E ai E m rn �P • UNa0�Ht! 13I ODVMNmONON� O• N C ^ .-- .� .--' r— N Q SON d N t+1 CON N C.. dem e0 a0 mC •—N� g 'a i c LL •• ��yyh xxf. �� �C E� FE��dd q A 00 W b6a N OD � ° N M M N d 0 P• I—,cnu NN OD 1 OD OD Ni00 "" : (i O OD OD 4 4 j IiE;. (v7 �D "mow r d cr) _. ao ao 0o ao 8 r O F ID 00 OD ODOD a i ' • E @@E�� C 18 d 6D co v�o . F •� G _ G 9 Q ('7 ¢ N A (`7 OD (� °o A N E ° X .- OU o N a 1 OD .a 0€ I co .� c 'f o c € y� a Name Mi The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit L=� am a homeowner performing all work'-- myself. I am a sole proprietor and have no one working in any capacity Please Print v I am an employer providing workers' compensation for my employees working on this job. Company name: Wl c fir= Company name: , Address City: Phone # 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 $1,5MM- 00.0(3 and/or one years' imprisonment•as welLas_civil.penaltiesjniheinrmd-a.STOP W-ORK ORD02_and_afine-t-($1-00M)-a-lay 39ainst.me t understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage ver cation. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Print name (-� (.Pti K (', Official use only do not write in this area to be completed by city or town official' 01��M City or Town PerrnPUl.icensi ❑ El Building Dept, if immediate response is required [] licensing Board Contact person: El Selectman's OfficePhone #. ❑ Health Department ❑ Other I- Date... %5 ..... TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that .... ....... has permission for gas installation ............ .... ... ....... .... in the buildings of . ....... �North Andover, . Mass at .... . .,;, �M ............ Fee. %A—' Lic. NoZ�:� �GAS zzc�;R- ..... Check # 465L' b MASSACHUSEIrMS UNNORMAPPUCATON (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's New L!Q Renovation ❑ Replacement ❑ PERMIT TO DO GAS HUNG DateQ� Permit #---. 45`� Amount $ 7677 5 1� A- ked (l1 Plans Submitted ❑ (Print or type p Check one: Certificate Installing Company Name� i .�nb�n� Corp. Address ` �OX �'v Partner. Q. Business Telephone rti )S4 Name of Licensed Plumber or Gas Fitter s INSURANCE COVERAGE Check one: I have a current liability Insurance policy it's substantial equivalent. Yes No If you have checked yes, please indic the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D 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 0 Agent 0. I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the tts State Gas Code and Ce General Laws. ICity/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter emberR Gas License Number aster Journeyman x w G4 U OU rq W W RS O F o w z o w a z z z o z W ° W w H V v� Wa zdF d a F F �W» O z W O ai x W a OE. W A r O w A C7 U A. F O SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or type p Check one: Certificate Installing Company Name� i .�nb�n� Corp. Address ` �OX �'v Partner. Q. Business Telephone rti )S4 Name of Licensed Plumber or Gas Fitter s INSURANCE COVERAGE Check one: I have a current liability Insurance policy it's substantial equivalent. Yes No If you have checked yes, please indic the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity D 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 0 Agent 0. I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the tts State Gas Code and Ce General Laws. ICity/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter emberR Gas License Number aster Journeyman Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab Commonwealth of Massachusetts Title 5 Official Inspection Form RECEIVED Subsurface Sewage Disposal System Form - Not for Voluntary Assessments OCT 17 2017 793 Forest Street TOWN OF NORTH ANDOVER Property Address HEALTH DEFAM MtN I Peter Colantonio Owner's Name North Andover Cityrrown Ma 01845 State Zip Code 9-12-17 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be alterZ n any way. Please see completeness checklist at the end of the form. /([j///��/j A. General Information 1. Inspector: John DiVincenzo Name of Inspector J and S Development / Stewarts Septic Service Company Name 58 South Kimball St Company Address Bradford Cityrrown 978-372-7471 Telephone Number B. Certification Ma State s113386 License Number Sa 01835 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Signature Date Th5ttystern inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. *''This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner's Name North Andover City/Town B. Certification (cont.) Mn n1 AAR Jlt1lC I -1p %,VUC 9-12-17 Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc - rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins.doc - rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 793 Forest Street Property Address Peter Colantonio Owner Owner's Name Yes ❑ No ❑ information is required for every North Andover Ma 01845 9-12-17 ❑ No ❑ Yes page. Cityrrown State Zip Code Date of Inspection No D. System Information Description: Numberof current residents: 4 4 Does residence have a garbage grinder? 40 ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M 793 Forest Street D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: State 01845 Zip Code Date General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Stewart's Se 1500 gallons Site guage on truck To inspect the tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy 9-12-17 Date of Inspection ® Yes ❑ No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover page. Cityrrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: State 01845 Zip Code Date General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Stewart's Se 1500 gallons Site guage on truck To inspect the tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy 9-12-17 Date of Inspection ® Yes ❑ No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts H v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 18 vears Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line. 142' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 12" feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: Sludge depth: ❑ Yes ❑ No t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover page. City/Town t5ins.doc • rev. 6/16 D. System Information (cont.) State 01845 Zip Code Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29"— Scum thickness 0 9-12-17 Date of Inspection Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape measure sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both baffles are good. No leakage and the liquid level is good. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is North Andover required for every page. Cityrrown D. System Information (cont.) Ma 01845 9-12-17 State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Equal distrubution. No leakage and no solids carry over. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc - rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is North Andover required for every page. Cityrrown t5ins.doc - rev. 6/16 D. System Information (cont.) Type:El El 11 El leaching pits leaching chambers leaching galleries leaching trenches leaching fields overflow cesspool Ma 01845 State Zip Code 9-12-17 Date of Inspection number: number: number: number, length: number, dimensions: number: 4-46' Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure, no ponding and no damp soils Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio_ Owner Owner's Name information is required for every North Andover page. City/Town Ma 01845 State Zip Code 9-12-17 Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 page. Citylrown State Zip Code 9-12-17 Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ® drawing attached separately t5ins.doc - rev. 6/16 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover page. Cityfrown Ma 01845 9-12-17 State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 30"feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4-7-99 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Pulled file ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Taken from design plans on record. Water at elevation 142.50 bottom of system at elevation 146.50 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Peter Colantonio Owner Owner's Name information is required for every North Andover Ma 01845 9-12-17 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ly Title 5 Report P0,55 $ 5O ❑ Other: (Indicate) $ He Agent Initials White - Applicant Yellow - Health Pink - Treasurer 8049 NOR, o = w Y Town of North Andover HEALTH DEPARTMENT ,SSACMUS CHECK #: %O- -DATE: LOCATION: % 93 f /—e Sj d � H/O NAME: CCT/a/) T0/)/ 'O CONTRACTOR NAME: (-;e'S e/ a. Se, Z Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ly Title 5 Report P0,55 $ 5O ❑ Other: (Indicate) $ He Agent Initials White - Applicant Yellow - Health Pink - Treasurer ® '� Sw W o Q� >�2w UW zo 0 C—) J i�CD � it 0 U) rn P; C., 04 4 N 1 J i / /N t, --co BENCH MARK NAIL IN 10" PINE ELEV.=150.84 500 \GALLON SEPTIQ TANK a ft;�4 i l 1 1 1 1 ,- 1 Ile 3 I I � 1 1 0 4Zs)v 1 �C1N� 1 o SG11XS 37 76 0 N of TOP FND. =152.33 STS. 23 2 1 5.00' 79. L- I+ Location f'oy e5i S+ No. 3 n 9 Date a' 1-L)3 MOR,M TOWN OF NORTH ANDOVER O:„an ,a,1•C • . a OL 9 � ,�,� Certificate of Occupancy $ s',•a° • t<�' Building/Frame Permit Fee $ AC MUS Foundation Permit Fee $ 100— Other DD— Other Permit Fee $ TOTAL $ �� 5 Check # 1 C)3 16 ,� Building Inspector c ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING �g BUILDING PERMIT NUMBER: n DATE ISSUED: ) `a D .3 ' /tk C C"" —� SIGNATURE: J t Building Commissi MLEe2qE of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0,-,S jcye.Q Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 0-25 'x43 1 L4 Zoning District Pr osed Use Lot Ar Fronta ge ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard IkeqWred Required Provided Required Provided 30 37 ` V54) 30 1.7 Water Supply M.G.L.C.40.1.5. Flood Zone Information: Public ft"'—private ❑ Zone Outside Flood Zone ff—' 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 8—�— SECTION 2 - PROPERTY OWNERSHMAUTHORIZED AGENT r----H:istoric District: Yes NO �- 2.1 Owner of Record / R c c K� s�y� Ch N (Print) Address for Service: S 79 - (D -c; o Signature Felephdne 2.2 Owner of Record: :Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address V 1 g t ,k-SixAc4s:�> ` otb7 CP C)05— r Signa , a Telephone Expiration Date :Z j 3.2 Regi Home Improvement Contractor i s R Not Applicable ❑ V �^� ff j (4 `-1, (D Company Name YVI Sr Registration Number —AMrNs. )1 Expiration Date Si nature Te hone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25c(6) Workers Compensation Insurance affidavit st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build' rmit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Descriptio f Pyoposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: OOLWct SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) tobe Completed bypermit applicant OFF�CIA rtISE {) :: K W� x 1. Building(a) / Building Permit Fee Multiplier 2 Electrical )o k (b) Estimated Total Cost of Construction y a r1 "t as— 3 Plumbing / Q 14 Building Permit fee (a) x (b) _ 4 Mechanical HVAC f" K 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si afore of Owner/Agent Date NO. OF STORIES 2' SIZE 5L/y BASEMENT OR SLAB T SIZE OF FLOOR TIMBERS 1 2 ZX t 3 k I SPAN Ito -A 1 DMIENSIONS OF SILLS DIMENSIONS OF POSTS DINIENSIONS OF GIRDERS a xya` HEIGHT OF FOUNDATION STHICKNESS SIZE OF FOOTING Z` X MATERIAL OF CHIMNEY N� IS BUILDING ON SOLID OR FILLED LAND �J IS BUILDING CONNECTED TO NATURAL GAS LINE I ' Location No. Date NORTh TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame Permit Fee $ U 'K MUS Foundation Permit Fee $ Other Permit Fee $ lei TOTAL $ ./, .1',/Z) d Check # � t / Building Inspetor i♦3 149.51' N08.5T21 "E N W LOT A-1 to LP 43t583 S.F. WE 0 N EXISTING FOUNDATION 40 8' TOP FND. _152.33 .27 54 E 12.21 S08.17'01 "W . 37.76' 793 FOREST \99-04\CERT.dwg N 0 d-. 00 W W co J� O 0 W -P_ S07.49'42"W r� 7.79' 69.380 S14.02'44"W ` 23.92' STREET Sl, •3 W CERTIFICATION PLAN` LOT A-1, FOREST STREET'°°'' A\andover `"Je~`4xi NORTH ANDOVER, MASS.' ��"�' ` Prepared for on s I tan is y+" pz S & R REALTY TRUST Inc. ;# SCALE:1 "=40' DATE:12-30-03 1 East River Place, Methuen, Mass. "U`- W W P W 0 1 w d v O w cn u v v� Cd w A ,� ca r. ° =o x ate+ rd � � G4 �' 9 H a � a a x w ° z cn v cn N I = o �CD c :.o = y =' a Ass oft.: p CLC �,,^� ear • �: v• = 0 CD i cmc,.. O rO+ Cy C o o a Z vs o 3 .«• d: O y ;c C m .O y W O :1:Em • `o o � i a can dOl y o C! 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C Cal sa =� oor °° OH O O O Z N—=coo co C26 . o H o = = m m z 3 No � a o w h o ~ L Lil O rCZ,,, •�• Go az `� E o O4WD t cm H a o - Go m .o`H� O F— .0 064- a O a A-jla c(�f), C� c / 01 z 0 u C/) IN 4D 0 C Z 0 M CO) CD 0 L V CO) caO d CO) c 'o V cc c cc CO) 0 0 v 0 CLCA c CD CM C O C mm O r6 W4 A is - Ij 0 a 0 E � L O � v Z Q O h as � i o 'cv 'E m m HZ a� � � L _ d �. c Q h S 'o cv �o CIO � .m V V! cc c c — r cc a CO LLI U) W LLI 19 W U) 'i L ER m 3 F° z - H � a Z A o io: z t� H rX I ALN ct o O O L C Q L LL _ �; a V: M ++je AEn I z (a C H c c ,. 3 tn O O u w u T _ omcu a Q•• � � O : a ° oc ° cm� c .0 w 0) V E a, c Q C � '� a LEL am C3 � W 0 H V O C p COQ® w O tC., m4 LA 2-E2o� C c N ti U a r a5 q tn w C O � Z Oaj u g z3 > �- c+� i/ M" N� Eo =2 c "cam H 1:O Ip •O 1 R A O C CD0 ID MO y C a o y m3 CA •O =cca O c ECD m m o C CLS � m ; CC O m ♦ ,�,� 'flAc C 32 �: '• d C Z m HZ o �•. N_cco� m Q 'COL •o = o :m=3 N a0+ y m Lu O •N AD dt O C O L= CO2 C#12 a s CD $CL.0-ao a I c � y Q � y O O m m CD CD L- CD .c O � O• CD ® o eQv o a y C .� cc C3 ca C Z ai CL C, CO) cc C CL � C COD 0 U) V9 W 19 W 0 p� �0 O co � � � A o .ro > v e coW 6w " C7 —, a w a w E o z cn C o cn M" N� Eo =2 c "cam H 1:O Ip •O 1 R A O C CD0 ID MO y C a o y m3 CA •O =cca O c ECD m m o C CLS � m ; CC O m ♦ ,�,� 'flAc C 32 �: '• d C Z m HZ o �•. N_cco� m Q 'COL •o = o :m=3 N a0+ y m Lu O •N AD dt O C O L= CO2 C#12 a s CD $CL.0-ao a I c � y Q � y O O m m CD CD L- CD .c O � O• CD ® o eQv o a y C .� cc C3 ca C Z ai CL C, CO) cc C CL � C COD 0 U) V9 W 19 W 0 Fo(\e s+ (S-4-- (4 f\k, 2 `/z r rL i � i C l k Z '6f -QR Ur,J o v-- i�,1` z-(��G. - ►Sa. _ VSs a 7 ✓`,aro she r-� �x((_zZz _ ks Z`f.X�ll � S lto L1 y 295 _ ts� FORM U'- LOT RELEASE FORM-- /U w 1l 0_o INSTRUCTIONS: This form is used to verify that ail necessary, approvals/permits fr( Boards and Departments having jurisdiction have been obtained. This does not retie the applicant and/or landowner from compliance with any applicable or requirements. ILLS OUT THIS SECTION***************y APPLICANT \ C:— S71�n�1RL�Y q16 37o-046 PHONE LOCATION: Assessor's Map Number PARCEL -3_ SUBDIVISION— LOT (S)_ STREET 1O i Fc!)-j� I SI. -ST. NUMBER 7P3 --_""_"" ."""'OFFICIAL USE ONLY ****� AGENTS: CONSERVATION ADMINI ATOR DATE APPROVED / a y DATE REJECTED COMMENTS -PC (c9pr �(✓li �l ��p d7 f� +� f��� `� � A VTOW16 E DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SE TIC - INSPECTOR -HEALTH DATE APPROVED. 1 t o 0 DATE REJECTED L ! A Re, -,t c,,) A f C PUBLIC WORKS - SEWERIWA DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm a 149.51' N08'54'21 "E NO2. W ...���� 5. oO N 00 1 LA LOT A-1 U 43,583 S.F. co w' w -P_ m co -i _ 41 5 — r— DECK ---- o 0 N PROPOSED r DWELLING _ 4 I o) 5p0'27 5"E 12.21 01 07'.9'4"S42W 977S08'17'01"W I rn 69.38' I 37.76' S1402'44"W \ FOREST23.92' STREET S11.33'35"W \99-04\PLOT.dwg PLOT PLAN LOT A-1, FOREST STREET NORTH ANDOVER, MASS.aindover Prepared for conSultants S & R REALTY TRUST Inc. �n SCALE:1 =40 DATE:11-17-03 1 East River Place, Methuen, Mass. OF Rr wILLIAN? SUM GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. r2►cK� 54APICku K- 1 0+A I051i 31 Permit Applicant Property address Map / Parcel 012 q-6r1�-00g 0q L-� Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land. For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the cel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR RFFUSAL Br BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE D THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION ry Town of North Andover NORTF, ;,; :.`�=t';a„�• , Officef h o the Zoning Board of Appeals 3? P COlrimilllity Development and Services Division 27 Charles Street p � � � North Andover, Massachusetts 01845 �'Ss �CHUS ``' �' This is to certify that twenty (20) daysphone (9 7 8) 688-9541 D. Robert Nicetta have elapsed from date of decision, flied Tele Fax (978) 688-9542 Building Commissioner without filing of an appeal. Date /✓IV Jo i TE” A. Bradshaw �. Town CIerk�. Tru cop Any appeal shall be filed Notice of Decision within (20) days after the Year 2003 -date of filing of this notice Tov�zr� cl'r6< in the office of the Town Clerk. Property at: Lot A, Forest Street (Map 105D, Parcel 39) NAA,1E: Forest Glen Development, Inc. 130 Middlesex Street, HEARING(S): 7/8 & 8/12/03 North Andover ADDRESS: Lot A, Forest Street (Map 105D, Parcel 39) PETITION: 2003-021 North Andover, MA 01845 TYPING DATE: August 18, 2003 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, August 12, 2003 at 7:30 PM in the Senior Center, 120R Main Street, North Andover, MA upon the application of Forest Glen Development, Inc. 130 Middlesex Street, North Andover, for premises at: Lot A, Forest Street, North Andover (Map 105D, Parcel 39) requesting a Variance from Section 7, Paragraphs 7.1, 7.2, and Table 2 for relief of minimum lot area and street frontage, as well as, a Special Permit and Finding under Section 9, in order to construct a new single family dwelling on'a non -conforming lot. The said premise affected is property with frontage on the West side of Forest Street within the R-1 zoning district. The following members were present: William J. Sullivan, Walter F. Soule, Ellen P. McIntyre, and Joseph D. LaGrasse. Upon a motion by Joseph D. LaGrasse and 2nd by Walter F. Soule, the Board voted to GRANT the Variance from Section 7, Paragraphs 7.1, .7.2, and Table 2 for relief of minimum lot area of 43,583 and ti street frontage of 24.94' in order to construct a new single family dwelling on a non -conforming lot according to the Plan of Land in North Andover, Mass. Owners: William J. & Deana J. Hamel, Linda M. Emro Trustee, Ronald F. & Linda M. Emro and Anna M. Gilbert, Date: Sept. 30, 1999, Rev.: June 9, 2003, %f [by] William S. MacLeod, Professional Land Surveyor, #29644, Andover Consultants Inc., 1 East River Place, Methuen, Mass. 01844 and the Sample Floor Plans prepared for Gerard E. Welch, Inc. P. 0. Box 248 N. Andover; upon the conditions of: 1. George J. Zambouras, P. E. 17 Noble Hill Road, Beverly, MA will specify the Forest Street lot, map, and parcel information in an update of his August 4, 2003 letter. 2. The Plan of Land Mylar will specify the Forest Street lot, map, and parcel information, the ownership information, and will have a four -line signature Zoning Board block. Voting in favor: William J. Sullivan, Walter F. Soule, Ellen P. McIntyre, and Joseph D. LaGrasse. Upon a motion by Joseph D. LaGrasse and 2nd by Walter F. Soule, the Board voted to allow the petitioner) to WITHDRAW THE PETITIONS FOR THE FINDING AND SPECIAL PERMIT WITHOUT C PREJUDICE. Voting in favor of the withdrawal: William J. Sullivan, Walter F. Soule, Ellen P. McIntyre, i and Joseph D. LaGrasse. The Board finds that the applicant has satisfied the provisions:ofSection 10, paragraph 10.4 of the Zoning `f Bylaw and that the granting of this Variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. (1 Page 1 of 2 `J _Q I-p,i Board of Appeals 978-688-954] Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 �� 4 Town of North Andover cf NORTH , Office of the Zoning Board of Appeals Community Development and Services Division swkwwp 27 Charles Street s North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (978) 688-9541 Fax (978) 688-9542 Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Decision 2003-021. Page 2 of 2 Town of North Andover Board of Appeals, r William J. ullivan, Chairman Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 ESSEX NORTH R 1 � OFEEDS LAWRENCE, MASS. A TRUE COPY: ATTEST: IRMSTER OF OWD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit I Name 1,(\ tK.j STM Ch, (_V Please Print Name: Location: L6°r L .. 4bT Sr. City K) , 4,70c oe,Q Phone # I am a homeowner performing all work myself. E]�, am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. Company name: /address City. Phone - Insurance Co. Policy # Companv_name. S it 2 R-ect L'N ,dre 5 R� m�nc 5T . ty `i Nz.�f l t`Yk 1SS phw1a Powe to secure ccoverage as required under Section 25A or MGL 152 can lead tvthe imposition of criminal penaNies or.2 and/or one years' imprisawn) asVtettas-iota-STOP fixe-ctA$iAQW)_aj understand that a copy of this statement may beforwarded to the office of Investigations of the 6A for comrage veriBcati t do hereby cwW under Me Pw and Pemtties ofPelwy that the kWb matiorr provided above is true and correct Print name K \ . �S}�N tGl� �1L P�De # Official use only do not write in this area to be completed by city or town dficiar City or Town pew &fild ng DO (]Check if kwx?dble response is requ and pt L1Gensfng Boat Q Scllectrnan's 0,, Contact person: Phone # Health Depart, E] Other 1 ..� d�nmlYltll/�a4Ud O�ei�,{,�[lQ�,d r BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 054468 Birthdate: 09/03/1952 Expires: 09/03/2005 Tr. no: 3145 Restricted: 00 RICKY C STANICHUK + 75 RAYMOND ST �- 1 TEWKSBURY, MA 01876 Administrator 1 11/03/2003 08:03 FAX 1 878 25( 3338 MOORE LUMBER CHELMSFORD 0 001 Mcheck Compliance Ce irtufcate Massachusetts Energy Cc de REScheck50tlware VersioA3.5 Relea is 1a DM filename: C:VPr08ratn FileslChecl'REScbeck\MCKDfii3AY.rck TITLE, THE CATSKILL CITY: North Mjpyor STATE: Massachusetts liDD' 6322 CONSTRUCTION TYPE: l or 2 FaM I Y. Detached REAATINO SYSTEM TYPE: Other (N . a-Vectric Resistance) DATE: 11/03/03 DATE OF PLANS: 01/08103 FROMCT iNl;'ORMATION. LOTS A and C FOREST ST. COMPANY IN,PORMATIOi l: RICK DEBAY R,,c,— 5;-m4 AJt✓ COMR'LIANC'L: Passes Permit Number Checked By/Date Maximum UA � 470 Your home UA = 459 2.3% Better Than Code ga) Gross Glauing Area or Cavity Court. or Dom Ple R -Value R,_ V _alar; U Factor UA Ceiling 1; Cathedral CeUing (no attic) 432 30,0 0.0 Ceilins 2: Flat Ceiling or Scissor Truss 1216 30.0 0.0 15 Walt 1: Wood Frame, 16" o.c. 2 13.0 0.0 43 Wiindow I --Wood Frame:I3outhle Pane 1 183 Window 2: Wood Fram�e:Daubte Fane % : th Low -E � 64 0,500 l01 Window 3: Wood Fra=Double Pane w :h Low -E 12 0.330 21 Window 4: Wood J~rame:Uouble Pane w : h E 0.340 4 ,Low Win Window 5. Wood Frame:Double Pane w i.h Low -E 80 0.330 26 Door 1; Solid 19 0.350 7 Door 2: Glass 20 0.160 3 Floor ) : All -Wood Joist/Trus&ow out de Air 14 050 S Furnace 1: Forced Piot Air, 90 AFM ) 54 5 30.0 0.0 51 CONI PLIANCE STATEMENT; The prt ; )osed buulding design described here is cmuisteat with the budding pkv,,, signs, and other calculations submitted with the I wx'Wt apPficatian. The proposed building has been designed to moat tk Massachusetts ElleW "quire Code istedre the E ch chcck' 'ersioa 3.5 Release 1a (f0mwrly MFC chLO and to comply with the umtWato3T requireaneats listed in the RES checkI»9p ! cdon Cheeldist. The heating load for 26 buil ft and the Wotms load if aPPMdate� his beet detennined using the applicable Standard Dmiga 11/03/2003 08:25 FA3 1 978 254 3339 HOORE LUMBER CHELMSFORD Z003 *Ibn +, ATTIC BEAM A lfa ,�'� 1.9E h Icrollame LVL 06W.1 116�rjppy 1 rte, =vY PRODUCT MEI JS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED or�rt s� xr � a 13*ems larodfuct � r.,q, LOADS: Analysis is for a Header (Flush Beam) Memtx . Tributary Load iPfiddt:1V Primary Load Group - RNsWGMWl - Living Are.:, (psry: 30.0 live at 100 % dura6on,1 o.0 head SUPPORTS. Input Bearing VeMcalIkeacdonsObs) DoWl Queer WkIth LengM LivelTis i d/UprrNf *W 1 Stud wall 3.50" 3.s0' 282311100/013823 A$: Rim Board 1 Pty 11 R' x 91f4' 1.5E TmbefSlrarM L3L 2 Stud wall 3.50" 3.54" 588812 i5210 ( 9440 03 None 3 Stud wall 3.50" 3.50' 192314 ! 0 1 372 / 2343 A3: Rim Board 1 Ply 1 1W x S 114' 1 SP T'umberStrdndt LSL -See TJ SPECIFIER'S I BUILDERS GUIDE foi ' ietail(s): A3: Rim 9oard.63 l__M_N CONTROLS: PI axbnum Dwign i:ontral on Shear (lbs) -5292 4889 ' 2303 Passed (38%) RL end Span 1 under Floor loading Moment (Ft -Lbs) -11492 -11492 2448 Passed (51%) Bearing 2 under Floor loading Live Load Defl On) 0.275 :1.338 Passed (U590) NO Span 1 under FloorALTERNATE span load'arg Toted Load Dail (in) 0.353 :1.875 Passed (LI447) MID Seen 1 under Floor ALTERNATE span loaft -Deffaction Criteria: STANDARD(LJ..-1.J480,-rL:.240). -Bracing(Lu): Ail compression edges (top and i Mom) Must be braced at 2' 8' do unless detailed otlrerwise. Proper attachment and postlt"oning of LaWral braft b required to echierre tnember!-atift. -The load conditions comWered in this design 1 rratyab include alternate member pa ern Ioadng. AQQ=-NAL NO,� TES: -IMPORTANT! The analysis presented is outp . t trap Software developed by Tn* Joist (TJ). TJ warrants the slung of h9 produr7W by like software will be acootnplished In accordance w th TJ produ -; dosign ctitarls and code accepted design valuet, The specific product appliaruon, input din loads, and stated dimensions have been provided by I to wftere user. This 00ut has not been reviewed by a TJ Associate. -Not aU products are readily a 0lable. Check fth your supplier or TJ technical represetrtatnre for product evailahial. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS fS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -AIIowabie Stress Design methodology was us id for Building Code UBC analysing the TJ DtsftWon product faded above. -Nota: See TJ SPECIFIERS I BULDER'S GUI ' SES for multiple ply oonnection, ECT INFORM` ATION,i RICK DF -SAY LOTS A and C FOREST ST. NL ANDOVER :ripyci7ht q 2003 by Trun JOLnt, d V4yrrharu9ar ..,;no:7_j l71eY411aRr9 la a raciatarad ttadsmarx of Trus J. g. C:1P4ngt'wm FllHB\Trun JG13rktZ-B42M*0a1S i *Ml R M.aan OPERATOR INFORMATION: Tim Morrison G.V. Moore Lumber 3 Kem Dr Billerica, MA 01821 Phone: 07B-478-3010 timm®moorelum6er com 11,'03/2003 08:24 FA% 1 978 25t 3339 MOORE LUMBER CHELMSFORD zOU2 HEADER @ 2nd FLOOR HATH � o I a9E N iCrollane LVL QW11 1 VYim F"91rev RRODUCT MEI',;TS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED LOADS; Analysis is for a Drop Seam Member. Tribula! 1' Lord Wkhh:1, Prhwy Load Group - Residential - Living Arm ! r (ps0:30.0 Lim at 100 % duration,12.0 Dead Vertical Loads: Type Class lave Dead La : atioa Application Comment PoirUpbs) Floor(1.00) 2820 1000 VW I ° - St1PPORTS; Input Tiny VerticalilowAions(Iba) Detail Outer Width length Livaft dllJpm*w '. ft d wall 3.50" 3.5t1" 145515 I1 f 0 / 1986 L1: 610091% 1 Ply 1 314"x 9 Ile 1.8E Waollarrr® LVL 2 Shat wall 3.50" 3.50" 145515111011886 Lt: 8loclft 1 Ply 13140 x 9114.1.9E VlcrollannO LVL See TJ SPECiFIER'S / BUILDMS GUIDE fol, letall(s): L7: Slodting 2919N—COTROLS: Maximum DCsign i:ordrol Control Location Shear pts) 1978 -1932 :1151 Passed (31%) RL end Span 1 under Fhw loading Moment (Ft -Lbs) 2592 2592 11204 Passed (496) MID SlMn 1 under Floor loading Live load Deft ¢n) 0.012 ;!.089 Passed (L/999+) MID Span 1 under Floor loadrtg Total Load 090 On) 0-010 ,033 Pawed 4AD$+) MID Span 1 under Floor k*dlny -Deflection Criteria: STANDAR0(LL:LI380.TL; .r24o). -Brad%(U): All compression edges (top and ! otlom) must be braced at 2' 8' o/c unless detailed otherwise. Proper attachment and posiboeing of lateral bracing is required to achieve member:: ablilty. $�'I—S: 4WORTANTI The analysis presented is outf .1 from softare developed by Trus Joitit (TJ). TJ warrants the sang of its products by"sofheraro will be accomplished is accordance with TJ produ ::design erib da and code accepted design values. The specific product 40110IGaa, inputdesign loads, and stated dimensions have been provided by I to solbwre user. This autput has not boon reviewed by a TJ Associaw -Not aU productss are readily available. Check Ah your suppler or TJ techrscal representative for product availability. THIS ANALYSIS FOR TRUE JOIST PRODLK ' fS ONLYI PRODUCT SUBSMTION VOIDS THIS ANALYSIS.. -Allowable Sty Design rnethodology was us! d for SulIding Code UBC analyzing the TJ Distribution product fisted abom. -Norte: Seo TJ SPECIFIER'S i SUILDER'S GUI: IES far multiple ply connection. PR_0JE0 INFORMATION: RICK DEBAY LOTS A and O FOREST ST. N. ANDOVER Corr!xlgdt 4 2003 uy T_aa Joint, a W%lerhseiaaer ivaineaa Kictollamio is a _agis:arod tradpmnik of Trus Jo .at. -\E'aeg<� i.Lw»�\TcA" JoiattY'J-5oam\Ju6 F12os\Si._'!t4_awR OPERATOR .INFORMATION: Tim Morrison G.V. Moore Lumber 3 Kern Dr ®tleriod, MA 01821 Phare : 978-479-3010 tknm@mooralumber.com ZL03i2003 08:25 FAx 1 978 25( 3339 MOORE LUMBER CHELMSFORD �ua4 ATTIC SEAM @ FOYER 492rM. ?,;!K=*'1.9E I ilicrollamO WL lPap I a:, 11 er�BPRODUCT MEE :TS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Prodoid 11111ogrs:m is C.wwaOud. LOADS: Analysis is for a Drop Baam Member, Tnbutai 1 Load Width: i' Primary Load Croup - Residential - Wrop Arer (psi): 30.0 Live at 100 % duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Applieation Co wwwat Uritiorm(pl$ Floor(1.00) 105.0 35.0 0 To V Adds To ATTIC FLOOR Uni%mt(pl$ Fioor(1.00) 240.0 50.0 070 1 V Adds To ATTIC FLOOR . Uniform(psf) 5now(1.15) 580.0 240.0 0 To 1 V Adds To L—JU Input Bearing VerticalIteactimm(lbs) Detail Other WPM Length Lr^Vo i dlUOWTot id 1 Stut1 wall 3.50" 3.81" 357011 19110 / 5661 Li: Sloclong 1 Ply 1314* x 11718" 1.9E MicrolternS LVL 2 Stud wall 3.60" 4.16" 435011 117/0/6161 L1: Slodting 1 Ply 1314* x 11716" 1.9E Micrallan V LVL -See TJ SPECIFIERS / BUILDERS GUIDE fo; kWs): L1: Blocking -Bearing length requirement exceeds InW at: :ipport(s)1, 2 Supplemental handAare is required to sslisfy bearing requirements_ DESIGN CON •-Oeflechon Criteria: STANDARD(LL.LW0,TL , 240). -Bracing(Lu): All compression edges (top and :Bottom) must be brace at Z 8" ok unkm detatied otherwise. Proper aftachmeni and pomming of lateral braeft is required to achieve member : tabrldy. ADE3lTlONAI- NOTES: -IMPORTANT! The analysis presenW is out A from software developed by Trus Joist (TJ). TJ warrants the sung of its products by this sofbvare Will be accomplished in accordance witty TJ prodt ; It design criterla and code accepted design values. The specffre product application, input design loads, and stated dimensions have been provided 41 he sohmm user. Tftis output has rrvt been reviewed by a TJ Ash. -Not an products are readily available. Check i YM your supplier or TJ technical representative for product avallabfy. THIS ANALYSIS FOR TRPS JOIST PRODIJ : TS ONLY! PRODUCT SUBSTMMON VOIDS TENS ANALYSIS. Allowable Stem Design methodology was u:1 id for Widing Code UBC anatydng the TJ Distribution product Rated above. -Note. See TJ SPECIFIERS / BUILDER'S GU I )ES for multiple ply connection_ PROJECT INFORMAIJON: RICK DESAY LOTS A and C FOREST ST. N. ANDOVER Copyright m 2003 by Trus J=)Lat, a=eVemaeLoet Mvingea Miarollam& in a regiait6e6a triWe .rk CC Teua ::tat. c!\ togram FiLe8\Trull doLmt\W-BnamWob Filaal;LCU.ama OPERATOR INFORMMATION< rrm Morrison G.V. IMoore Lumber 3 Kam Dr 9r'ilodoa, MA 01821 Phone : 9M479-3010 479-3010 Umm@omrelumber.com Maxis"n Design 1:00W Control I.Moon Shear (lbs) -5971 -4894 !W1 Passed (51 %) RL and Span 1 under Snow loading Moment (Ft -0s) 15200 15200 V526 Passed (74%) MID Span 1 under Snow loading Live Load Dell On) 0.267 0.358 Passed (U479) MID Span i under Snow loading Tatai Load Deft (n) 0.380 0.533 Parsed (L/337) MID Span 1 under Snow loading •-Oeflechon Criteria: STANDARD(LL.LW0,TL , 240). -Bracing(Lu): All compression edges (top and :Bottom) must be brace at Z 8" ok unkm detatied otherwise. Proper aftachmeni and pomming of lateral braeft is required to achieve member : tabrldy. ADE3lTlONAI- NOTES: -IMPORTANT! The analysis presenW is out A from software developed by Trus Joist (TJ). TJ warrants the sung of its products by this sofbvare Will be accomplished in accordance witty TJ prodt ; It design criterla and code accepted design values. The specffre product application, input design loads, and stated dimensions have been provided 41 he sohmm user. Tftis output has rrvt been reviewed by a TJ Ash. -Not an products are readily available. Check i YM your supplier or TJ technical representative for product avallabfy. THIS ANALYSIS FOR TRPS JOIST PRODIJ : TS ONLY! PRODUCT SUBSTMMON VOIDS TENS ANALYSIS. Allowable Stem Design methodology was u:1 id for Widing Code UBC anatydng the TJ Distribution product Rated above. -Note. See TJ SPECIFIERS / BUILDER'S GU I )ES for multiple ply connection_ PROJECT INFORMAIJON: RICK DESAY LOTS A and C FOREST ST. N. ANDOVER Copyright m 2003 by Trus J=)Lat, a=eVemaeLoet Mvingea Miarollam& in a regiait6e6a triWe .rk CC Teua ::tat. c!\ togram FiLe8\Trull doLmt\W-BnamWob Filaal;LCU.ama OPERATOR INFORMMATION< rrm Morrison G.V. IMoore Lumber 3 Kam Dr 9r'ilodoa, MA 01821 Phone : 9M479-3010 479-3010 Umm@omrelumber.com 11/03i2003 08:26 FAI 1 978 25( 3339 MOORE LUMBER CHELMSFORD (a 005 A LIVING ROOMlDINING ROOM BEAM 1.9E M arollam(S) LVL Peggy 1 �j� v".PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE � . APPLICATION AND LOADS LISTED Product Di�gratn i� �, LOAD& Ana lyslx is fare Header (s=lush Beam) Membe . Tributary Load %Vdth:1 W Pdmary load Group - Residential - Living Area! (pso.- 30.0 We at 100 % dumlon,12.0 Dead SUPPORTS: Input "aring Vertical leactions (WS) Detail Other Width Length LIveIRe , irupwTa ial 1 SM wall 3.60" 3.50" 225019, 510 / 3195 A& RIM Burd 1 Ply 1 1/2"x 91/4" 1.5E TimberStrandO LSL 2 Stud wall 3.50" 3.50" 2250 19, 3 / 0 / 3195 A3: Rim Board 1 Ply 1112" % 9114" 1.SE TiMb0rSVa1X1* LSL -See TJ SPECIFIER'S / BUILDERS GUIDE fat letait(a): A3: Rim Board DESIGN CONYROLS: Maximum Design :kwd of Cordroi LoeaUon Shear (lbs) 3M -2SIS A 51 Passed (41%) Rt. end S uin I under Floor loading Moment (Ft -Lbs) 7403 7483 I i 204 Passed (8796) MID Span 1 under Floor loathing Live Coad Deft (in) 0.221 ;1.242 Passed (LW4) MID Span i under Flora loading Total Load Bell (in) 0.314 ,1.483 Passed (WAS) MID Span 1 under Floor loading -Deflection Criteria: STANDARD(LL:U460.TL: ,240). aratr 4l.u): All compression edges (top and ottom) must be braced at 2' 8" o/s unless detailed cM*A se- Proper aftachmeat and positioning of lateral bracing is required to achieve member : ability. ADDITIONAL NOTES: -IMPORTANTI The analysis presented Is wq A from software developed by Trus Joist (TJ). TJ warrants the siring of Its produ* by ft software will be accomplished In accordance with TJ produ ; t design criteria and code accepted design values. The gpecde product appReafion, inputdesipn loads, and stated dimensions have been provided by ; ie sotiware user. This output has not beery reviewed by a TJ Assoaabe. -Not all products are readily available. Check 1h your supplier or TJ te&rfical represer►bative for product avaffabAlty. THIS ANALYSIS FOR TRUS JQIST PRODI.X . TS ONLY1 PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. 4ulovrable Stress Design methodology was us ; d for 8WIding Code USC snagtft the TJ Distribution product lislud above. -Note: See TJ SPECIFIERS / BUILDER'S GUIVS )ES for multiple ply connection. Operator Noteat SUPPORTS 2nd FLOOR PROJECT INF_08M ION: RICK IDEBAY LOTS A and C FOREST ST. N. ANDOVER ropyri.7hr G tca] 6y Trus Joinr„ a Wsyerhaeuser 'slsiaesz ml�allameris a regiatered trademark of 17ua J ..at. C;\YrAvrr t J0iatl'V-s.?unWn9 v4AQ-j1 ::CKI_swn OPERATOR INFORMATION: Tun Morrison G.Y. Moore Lumber 3 Kam Dr Biilledca, MA 01821 Phone, 97!3.479 3010 timm@momkimber.00rn Y M Date.//-/�. - d� ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9 - ' rL .. This certifies that .. (L k. t -t. S: f . . �: ... ................ . has permission for gas installation .................... . in the buildings of ..5w,,'(4,v.K ....................... at ..� `?,..f%?.<. f.z. C -t n , North Andover, Mass. Fee.Lic. No.. /. t t. �... �.�.-�.... . GAS INSPECTOR Check # 4924 19 MASSACHUSETTS (Print or Type)_-- A& Building Map:_ New Q UNIFORM FOR PERMIT TO DO GASFITTING ao C Wte 20 _"It I R"pt# POrmh Owner's Name k G^rGK 7 t9: ZOi L : 1 tType of occupancy ___—V Replacement C1 Plans Submitted: Yes 13 No U Renovation Q installing Company Name Townsend Propane Services.- Inc. Address 27' Cherry Street," Danvers, MA 01923 EstimaleValue'ofWork: Busine ssTelep6ne -- 978-777-0700 game of licensed plumber orGas Fitter Z-77_/,,jA� AMS Check one: 0witificsts U Corporation U Partnership C3 Firm / INSURANCE COVERAGE: I have a currenj liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yesm k No Q H you have Aeiked M please indicate the type coverage by che&ing the appropriate box. A liability Insurance policy Other type of Indemnity U Bond Q 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. Cheakone "A Owner 0 g on t u, Signature of Owner or Owners Agent (or entered) in'above application are true and accurate to I heribj 6k� tl�iiiall 'o'f the details and information I have submitted the best of performed rriy,6.,.o!��Cg!'and that all plumbingwo*andinstallati6nsperl id 6'ndi'r the permit issued for this application will be in compliance wrttt s ro all pertinento 'Vlsi6hs of the Massachusetts State Gas Code and Chapter i'42of tie G"ral Laws. the General S. - t lumber y -4. nature o lumber _4 gna re o P 4222t be U66n N6imr 4 Ca t r rr( �X 6j, 1 _7 p e y m a n F-PROVED,'(OFFICE USE ONNi...., ;:�_' - ,i ii �����i���iii� installing Company Name Townsend Propane Services.- Inc. Address 27' Cherry Street," Danvers, MA 01923 EstimaleValue'ofWork: Busine ssTelep6ne -- 978-777-0700 game of licensed plumber orGas Fitter Z-77_/,,jA� AMS Check one: 0witificsts U Corporation U Partnership C3 Firm / INSURANCE COVERAGE: I have a currenj liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yesm k No Q H you have Aeiked M please indicate the type coverage by che&ing the appropriate box. A liability Insurance policy Other type of Indemnity U Bond Q 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. Cheakone "A Owner 0 g on t u, Signature of Owner or Owners Agent (or entered) in'above application are true and accurate to I heribj 6k� tl�iiiall 'o'f the details and information I have submitted the best of performed rriy,6.,.o!��Cg!'and that all plumbingwo*andinstallati6nsperl id 6'ndi'r the permit issued for this application will be in compliance wrttt s ro all pertinento 'Vlsi6hs of the Massachusetts State Gas Code and Chapter i'42of tie G"ral Laws. the General S. - t lumber y -4. nature o lumber _4 gna re o P 4222t be U66n N6imr 4 Ca t r rr( �X 6j, 1 _7 p e y m a n F-PROVED,'(OFFICE USE ONNi...., ;:�_' - Town of North Andover Building Department 400 Osgood Street North Andover Ma 01845 (978) 688-9545 Fax (978) 688-9542 NORTH tt �' O OXQWr► t n gyp_ cocwcHcw.c. APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS / Cl T o J? (? S LOT NUMBER SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION TEN (10) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING rX.P.W. — WATER METER DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. Y 0" SIGNATURE / DPW AUTHORIZATION