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HomeMy WebLinkAboutMiscellaneous - Exception (519)2 APR -16-02 03:57 PM EASEANES 1 978 649 3839 P.01 BASBANF,.S ASSMATES Wetland Consulting 39 Hardy St. Dunstable, MA 01827 (978)649-3839 April 16, 2002 Jim Carroll 100 Johnny Cake Ad. N, Andover, MA 01845 This letter is confirm that on April 5, 2002, I inspected the property at 72 Prescott St. and the adjacent lots on Summit Ave. in North Andover. Vpon walking the site, identifying the vegetative species and observing soil probes in several locations, I did not find any area that would be considered a jurisdictional wetland resource area under the Massachusetts Wetlands Protection Act or the North Andover Wetlands Bylaw. Only one soil probe had indicators of a high water table, however, there were no wetland indicator plant species and the area was less that 100 square feet. There were no other indicators of hydrology. If you have any questions please do not hesitate to contact me. Thank you. sincerely, Leah D.Basbanes, M -A: Wetland Consultant/Biologist --- _ _ ....,....�. �, ..... C NOTA: SURFA E WATER 55.35r 1. 45.33'. .RUNow ,WILL BE,. MITIGATED `O . 2 �. I BY A.% -.METHODOLOGY L 32 AGRED TO BY ` NORTH AREA 14, S.F. ANDOVER DPW ' . BASED ON CONDITIONS. ENCOUNTERED 4' F IN THE FIELD: -71 r� DECK L.. l 16.7' 7.0' EXISTING SHED --• N TO BE 1RA(ZED _ TWO FAMILY 131.0 130 16.2' . ZONING: R4 MIN.. LOT AREA=15,500SF MIN. LOT FRONTAGE=100' MIN. FRONT SETBACK=30' ` MIN. SIDE SETBACK=15' MIN. REAR SETBACK=30' NORTH 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Date G i/! J /—Owners Name Permit # Y -� T Amount ? 7 ,� e of Occu anc New Renovation rl Replacement ' Plans Submitted Yes No FIXTURES (Print or type) Installing Company Namejt),�-,Hv) Check one:_ Ce 'ficate torp. c Partner. /" �y Firm/Co. Name of Licensed Plumber. / �%f�+/� 14 ic-.�c�(�� / Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity❑ Bond 11 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 OwnerE]Agent ❑ 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 ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachi'/fdi, 1 ` 142 the General Laws. Cityfrown APPROVED comm usE orn,Y T pe of Plumbing License icense er Master Journeyman Date "�R'M TOWN OF NORTH NDOVER Of i. ��o ;�,ti0 w • OL PERMIT FOR LUMBING This certifies that .. Y�,fFds�.� ).. If has permission to perform .... .�e ": u'� , 14//1 plumbing in the buildings of..:'S-%!.."c.......................... at .. ��... S� r?I. ?^ ! . r.... .......... , North Andover, Mass. Fee.? Lic. No..' VI .1 . ..... � .�.� ...... . PLUMBING IN PECTOR Check # t� 7847 Commonwealth of Massachusetts Official Use Only �� Department of Fire Services Permit No. _ ad Occupancy and Fee Checked FS w BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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 IN INK OR TYPF, ALL INFO MATION) Date: X- pO -- D City or Town of: \.I o jy- To the Inspector of Wires: By this application the undersigned ves notice of his or her intention to perform the electrical work described below. Location (Street & Number) V�(►��(►u— t Owner or Tenant Owner's Address U Is this permit in conjunction with a building permit? Yes Purpose of Building Existing Service JOS Amps oZ C / 6 Volts New Service Amps / Volts Telephone No.%Vus No ❑ (Check Appropriate Box) Utili , Authorization No. Overhead Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: un, --b Completion of the following table may be waived by the Inspedor of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires. Swimming Pool Above ❑In- El rnd. o. o Emergency Lighting Battery atter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches ` No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWl l ,25 Municipal Oth Local ❑ El Other Connection No. of Dryers Heating Appliances g PP K�'�t Security Systems:* No. of Devices or Equivalent No. of Water Kms, 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 ifdesired, oras required by the Inspectoroj'Wires. Estimated Value of Electrical Work: rDn . (When required by municipal policy.) Work to Start: a -V 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 cove ge is in force, and has exhibited proof of same office. to the permit issuing oce. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under thains and penalties o pe►juty, that the information on this application is true and complete. FIRM NAME: S[,p & S1 t lz LIC. NO.: Ilk 10 p V, Licensee: ;� (,� Signature �L� '�G LIC. NO.: bt Z� (/j applicable, enter -ex ernpl"ukthe IiceuS�r:umber line. Bus. Tel. No.: q7l of- 32 Address: i 1A 0� i r �;¢'� �i �%ot 00.. ®l Alt. Tel. No.: X17 6 9 -3-1 %3 *Security System Contractor License required for this wo if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ ,S— "= Signature Telephone No. V� Z'r0 i P-1� ��q e-7- PA-� Date ../—D/�****:7��y ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... ................. ................................ has permission to perform .... -k)—. -K ............. ...... ........ wiring in the building of .............. ............ . ...... ..................... at .... ..........N ................. )- — ............ 7. North Andover, Mass. Fee.�ea3 ......... Lic. No .............. ........... \ ..... � Aa ........................... ............ ELECTRICAL INSPECTOR Check it 41/,62 Date.. if ..ngz TOWN OF NORTH ANDOVER PERMIT FOR WIRING (-'? I This certifies that ........ ...... ......................................... ;�54� ............. ............ has permission to perform ..... ......... wiring in the bdilding of ... ............. a ........................................ at ... rth An ............................... ........ . No dover, Mass. ---- ------ - Fee. . ...... Lic. NA..��IAP� ..... -1" 1 ---ICAL-i*NSPR' . ..... �EL Check # k I 7587 `1�IS Permit o. !�l OccupttrScy e Cher BOARD OF FIRE PREVENTION GULATIONS 527 CMR 12:00 APPLICATION FOR ERMA TO PERFORM ELECTRICAL WORK All work to be performed in rdare with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number a/ — l/ c�/Jli2/I7/ i✓ J0, Owner or Tenant 6� ale_a( C-11& .0 S_2 'Un6 r✓ Owner's Address 'S�4m&r Date k/A/,/ /'S . o To the Inspector of Wires: Is this permit in conjunction with a building permit Yes r✓ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead 0 Undgmd 0 No. of Meb New Service _DO Amps �Z� Z Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead Undgmd 0 No. of Met( INSURANCE COVERAGE. Pursuant to the requirernen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checidng the appropriate box. °..i INSURANCE - BOND - OTHER (Please Specify) (Expiration Date) Estimated Value of.Eiectriwl Work$ Work to Start Inspection Date Resquested ough Final Signed under the Pr9alties, of ju FIRM'NAME / it DA LIC. Naa-..M Z Licensee 15"Ew %L/D Signature LIC. NOa2d Z Address .50 DAWWXA,D,4PP Me OWNER'S INSURANCE WAIVER: I am aware that the Licenses t General Laws. And that my signature on this permit application (Signature of Owner or Agent) / Alt Tel. No. re the insurance coverage or its substantial equivalent as required by Mass requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting jhting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Bumers Ba Units No. of Switch Outlets No of Gas Bumers FIRE ALARMS No. of Zone _ No. of Detection and Total No_ of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices _ NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices _ 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Sailases Wiring No. Hydro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requirernen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checidng the appropriate box. °..i INSURANCE - BOND - OTHER (Please Specify) (Expiration Date) Estimated Value of.Eiectriwl Work$ Work to Start Inspection Date Resquested ough Final Signed under the Pr9alties, of ju FIRM'NAME / it DA LIC. Naa-..M Z Licensee 15"Ew %L/D Signature LIC. NOa2d Z Address .50 DAWWXA,D,4PP Me OWNER'S INSURANCE WAIVER: I am aware that the Licenses t General Laws. And that my signature on this permit application (Signature of Owner or Agent) / Alt Tel. No. re the insurance coverage or its substantial equivalent as required by Mass requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ Fli is ,TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATIOAi7000flSTRUCTAFB RFatOYAT ORD)MOUSHAONEORTWOFANIiIYDNFI;I,IN(i _ .. +��s�.4 BULDING PERM NUMBER: t7'7/ � A � �\ DATE LSSM: ) g — SIGNATURE: BuM Commissioner r of tW - Date SECTION I• SITE INFORMATION 1.1 Property Address: `'1 -� I l S ��= 1.2 Asmm Map and PuWhuanba: V M"ri 5 rpt, .161 '�;o 5d L6 r ? MapNembcr Pared Number �1.3 f tion: L 1.4 hvpertyDimeasims: � �zminghdf �es��+►pL bdi��3 ib� Zai Distrid Use LctAmaA Frorna & 1.6 BUIIAING SETBACKS ft Front Yard Side Yard Rear Yard ReqWfed Provide Baead Provided Provided 0 t5 1 1.7W&W S"tyM.GLM 34) 1s. fbod24mldmmim: 1.1 Sew -p mpmdSptam: r bue a Fdnte o zoea OokWFbWZ= 13 1dML*l a O.saem osa Sysrom a SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT , 2.1 Owner of Record /' R Arv►GS �+ C 4rrb f5 Nam (Mat) Addtm for Service Jq/A2S V Si V Telephone '9l8 Ca 3 338E 2:2 Record: Name Print Address for Scniom . t S' tme Telephone SECTION 3 - CONMUCTION SERVICES - 3.1 Liemsed Constmc im Supervisor: Not AppimaMc 0 JA^eS V Cgrro G( Licensed Camf Won Supervisor: Q Address L.iceeseNam)xr . G 5- b 3 Seg 3 Gam(- q 7 -P3-S3,6(. Expiratim Date S Telephone. . '1 -1q -o3 3.2 Registered Home lmprovameat Coomador Not AppfieaWe 0 Company Name Registration Number A Expiration Daft signatuic T go m 3 z 0 0 z m 0 �a = r v� m r r z 0 . .a Location 9-//. SvrA1`"'+ S-' No. trA4_q Date ip `L ' y 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ <�M / Q Check # 3 &3,t5 165:6 //D (a) J Building Inspector 1 . SECTION 4 - WOREERS COMPENSATION (M.G.L C 152 # 25c{6) Workers Compensation lnsumow affidmit must be completed and submitted M& this application. Failure to provide this affidavit will in the denial afthe issuance ofthe buMM 2!M1 Siped affidavit AttWW Yes ....... No.......0 SECTION 5 Dheri tion of Prt'• Work eirodraB ble . New Construction' X - E)us* BWld rg 0 Repair(s) 0 Alterations(s) '0 Addition -G.. A%=M Bldg. -0 Demolition • 0 Other 0 Specify IIA&fllftwrintinn nfPmmwd Wmi a Cfi('7'iAN R . RCTikt17T11 MNCTRII[''ITAN t^riCTS . item Estimated Cost (Dollar) to be - eted by Mmit avolicant ,.� ; Ir OFF[CIAIi.i5E .ONLYA 1. Building (S -7 O (a) Building Permit Fee Mwtiolier 2 Electricali I OD 0 -(b) .Estimated Tota) cost of - .Construction p (� V a a ti o J. 3 Pluraft Building_ Permit fee (a) z (b) �01 b n D 4 Mechmicd AC _ O OO 5 - FireProtection 6 00 6 Total 1+2+3+4+5 0 Check Numbet SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIWVG PERM b as Owner/AuthoruzW Agent of subject property Hereby authorize to act on " My behalf, in all matters relative to marl: authorized by this building permit application.- S4POP of Owner Date SECTION 7b OWNER/AUTRORIM AGENT DECLARATION I J Atee S C.441rd I as Owner/Authorized Agent of subject property :. Hereby declare that the statements and information on the foregoing application are true and arcuate, to the best of my knowledge and belief . � A►�s C�•�r� ll Print N _ 'imiatuir oYOwnedA=t Date f40. OF STORIES SIZE -BASEMENT OR SLAB SIZE OF FLOOR TIMBERS V1 5&=221 3RD aA I SPAN DIIAWSIONSOF•SILLS • r DMWSIONS OF POSTS 1- DIlUENSION5 OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING�J X MATERIAL OF CHIIANEY is Y¢A IS BUILDING ON SOLID OR FILLED LAND i IS BUILDING CONNECTED TO NATURAL GAS IAdE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *APPLICANT FILLS OUT THIS SECTION ***** APPLICANT78 ,,LWJ, 5 ,� �r,� PHONE �18 �a3'�J86 LOCATION: Assessor's Map Number PARCEL Asa SUBDIVISION LOT (S) STREET 01 + 11 SUjma% ' STfek ST. NUMBER 9 6 4 CONSERVATION ADMIN OFFICIAL USE ONLY AGENTS: DATE APPROVED DATE REJECTED COMMENTS EIV 3 0 2045 2 DATE APPROVED DATE REJECTED _V l nn / ,� )p vtj 6 ,/ 1e �fz 1t"� a FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS I� q PUBLIC WORKS - SEWERNVATER CONNECTIONS DRIVEWAY PERMIT �� //%(/ , 7 FIRE DEPARTMENT RECEIVED BY BUILDING I Revised 9197 jm TE NOTE: SURFACE WATER RUNOFF WILL BE MITIGATED 16.77' 81.90' BY A METHODOLOGY LOT 3 .� AGREED TO BY NORTH ANDOVER DPW BASED ON CONDITIONS ENCOUNTERED AREA = 12,843 S.F. w IN THE FIELD. w w o EXISTING BARN 28 ZONING: R4 TO BE RAZED G' w MIN. LOT AREA=15,500SF —T — — — — — —� r 5 6 _ MIN. LOT FRONTAGE=100' - 1 (— I 1 DE MIN. FRONT SETBACK=30' �ECK I MIN. SIDE SETBACK=15' 5.7' I MIN. REAR SETBACK=30' I N � _ cA--1_T_� I� X28 l L—J 7.0' PROP. TWO FAMI -1Y ' O. F. = 129. EXISTING \ 12" V. C. N RTH I DRAIN ��8 � 15.6' � 1 X5.7F W 35 v v N R -OP. -NEJM! WA TE V `��. GISTS & SEWER SEPM 126 1, 100.00' SITE PLAN 4,6 FOR LOT 3 SUMMIT ST. IN NORTH ANDOVER, MA. PREPARED FOR JIM CARROLL DATE. APRIL 4, 2003 CHRISTIANSEN & SERGI PROFESSIONAL ENGINEERS � LAND SURVEYORS PLAN SCALE. 1 " = 20' 160 SUMMER ST. HAVERHILL, MA 01830 TEL. 978-373-0310 20 0 20 40 FT © 2003 BY CHRISTIANSEN & SERGI, INC. DWG. N0. 98002006 V Z Q CL gg uiO 0 Oz 4� Q W = F- O LL z 0 L 0 W z Q O C3 � F�- W U rb Q.4 (n t z aan b 9t 0 .o O O O cc rSZ O cm y O y .E i O CD _O h 0 'tea, W O ci cc C CPU y r�l O CM C O C cc m 0 CD f+ 3� 0 L cc d ca � C as its CL C co Cc w CcW M Uw a-- `R wile xw W4 z � � ^� % W a � z Z - a ° wcx ° cn cn .o O O O cc rSZ O cm y O y .E i O CD _O h 0 'tea, W O ci cc C CPU y r�l O CM C O C cc m 0 CD f+ 3� 0 L cc d ca � C as its CL C co Cc w CcW ai wile � c o o c� O N C a� «• m CD 'tet c m a'- E E v� •i � 3 = cm m� N _ m •� 4 •W O w � Z C y A C �m O 73 _ mo acs c o �mm .�wca CD m �1. . CmC 'Cara 10 f- H o CL m W .y H = O.t�C 'E v Z .0H Z o C.3 a CM m��Ag us � m3 o f•- z $ aM m .o O O O cc rSZ O cm y O y .E i O CD _O h 0 'tea, W O ci cc C CPU y r�l O CM C O C cc m 0 CD f+ 3� 0 L cc d ca � C as its CL C co Cc w CcW s,��/'/ F-, /� � Town of North Andover �oRTH O�t1�e° Building Department 3? ya ; o 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 RA AC HU51 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 9 LOT NUMBER DATE REQUEST FILED DATE READY FOR 1 ON S\9 wh t4 STC?,e- ' FIVE (5) 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 CONSERVATION DATE PLANNING DATE D.P.W. — WATER METE DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED RIO TO THE IN, PECTION REQUEST DATE. ATURE / DPW AUTHORIZA GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Delxarunent in their deternuna(ion of exemption under section 3.7.6 of the Town of North.Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. LOT m..ST`�', property address ivlar / arcel Permit Applicant / � V � 7--7 applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property auest that the auuched building pemtit Ibr which this Ibrm is cumplard Docs :Qnip Iy with the E\EMPTION seaion 8.7,6 ol'the Growth lvlanugement Bylaw. I also understand providing this form dues nut absolve me or any piny to (his permit from the requirements of obtaining other permits required prior to the issuance ol'the building permit. Further I undcrv=d that my interpretation of the exemption status is subject to review by Uie Building Department and is onl. ,gy,cially accepted when the building permA is issued. Based on suction 8.7.6 o(thc North Andover Growth Bylaw the above lot and Uhc work as applied for on Ute above lot in the building lies with one or more of the following sections as indicated by a check mark. permit application and associated aaachments, comp This is an application for a building permit for the cnlargement, restorution or reconswaion of u dwelling to ;xisteiive as of dhe aTmive date ofthis bylaw, provided that no additional residential unit is created. The lots) was / were crested prior to May 6, 1996 and are exempt from die provisions of seaion 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all ul'dhe conditions vi 5.7..6 are ma and or represents dwelling units Ibr scroior residents, where occupancy o1'tho units is restricted to senior wizuhs through s properly executed and recorded deed restriction running with the land. For purposes ofthis sealon "senior" shall 111-1 persons over the age of S5. This application is pari ol'a development project which voluntarily agreed to a minimum 40 %permanent reduaiun in density (buildable lou) below the density perrrtiticd undcr zoning and feasible given the environmental conditions ol'the tract, widt the stuphu land equal to at last ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected kom 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 nut held by a Developer in common ownership with an adjac rt parcel on the ePfoctive data 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 parcel. J This application represems a lot which is ready for a build•uhg permit ( all other permits from all other boards and .vmmissions have been roaivcd and the project is in compliance with diose permits), and the Development Schedule does not oaommodate 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 E\EmPT10N. ST THE BUILDING DETERJ�(NATION THAT THIS LPUCOATION IS ALLOWED UNDER ONEN THAT WOULD OROR MORE OF THE ABOVE E)CEMPTIO 5 BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE rNFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PER)YOT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE R4FORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR \OT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. CNoa �. c APPLICANTS SIGNATURE DATE THS FORM TO BE ATTACKED TO THE BUILDING PERMIT A.PPLICATION BOARD OF BUILDING REGULATIONS; i License: CONSTRUCTION SUPERVISOR Number,=-CS-, 063503 B it#fidatec-07/1:9/1965 Ezpiresc.07/1912005 Tr. no: 13375 ---------- {; Restrictetl:;,00 JAMES V CARROLL` 12 PIPERS GLEN l� ANDOVER, MA 01810 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesffgat(ons Boston, Mass. 1,14'. Woriters' Compensation lnsurarice,Affidavit Please Print -- '..tY..94 -.itC M�! lla i. '� •'uat.•:'u r\hrr..a r Ft:51 i-> � .. Name L. Location: ct Phone F1 am a homeowner performing all work myself. F I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Address 144 CAke -5 NOr`�A �.Jov 4Z Phone # 1-78 (018 G-7*7 0 `( Insurance Co. (Sura A 'C,1Svt'RQ['t� 2ip POlicY# SOW C 11 0 f!o Company name: Address Fallure to secure coverage as required under Section 25A or MGL 152 can lead to the Imposition of criminal penalties of a fine up to $1.500.00 and/or one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby ow* under the pains and penalties or pedury that the Information provided above is true and correct. Signature C-1 Dater "' 3 Print name Clear leS A C4M Phone .# T 6"7 V I Off ciai use only do not write In this area to, be completed by pity or town official' 0 Building Dept ❑ Check if kwadlate response is required Building Dept (] Licensing Board C] Selectman's Office Contact person: Phone #: C] Health Department Other FORM WORKMAN'S COYPENSAMM North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: 30 ` AW C.oAA4 rez L o-" "-� (Location of Facility) V co,,� Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector L!,]I LJi L UJ 114 i hS I- ;��3tr•; I i 11 I� F � ��. tJl AiCORD,„ CERTIFICATE MJF LIABILITY INSURANCE DATE (41Nl 03/25/2003003 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION -� M.P. Roberts Insurauce Agency Inc ONLY AND CONPERS NO RIGHTS UPON TME CERTIFICATE HOLDER. THIS CERTIFICATF, DOES NOT AMEND, =Y,TEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED HY THE POLICIES BELOW. North .A dover MA 0.1845 978 683-8073 INSURERS AFFORDISIOCOVERAGE WWI= NORTH ANDOVER RRA.I.TX CORP. Irl:•u+efir: W.>;,STORtN WORLD INSURANCE CO 1 10UPER D: HANOVER INSURANCE CO 100 JOHNNYCAKE ROAD ; INSUR R NO. ,ANDOVER, MA 01e45 WSUP.ERD: UNITED STATES LIAJ3IZ,ITY INSURANCE - ,978-686-7724 IrisUrtere: GUARD INSURANCE GROUP COi1ERAOSS THE POLICIES Of !NS'JRANCE LISTED BELOW 4A-9 FUaN ISSUED YG THE INSUR'E'D NAMED ABOVE FOR 714E nL'V( PERIQD INDICAteD N01WITHSTANNNG ANY REQUIRtjACh'T, TERM OR CONDITION rf ANY 00N -RACY OR OTHER DOCUMENT WITH RESPECT TO WHICH 1HIG CERTIFICATF MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCL AFFOA^ED 3Y THE PCd_1CIE8 DESCRIBiD HEREIN 15 SUBJECT TC AU THE TERMS, E),CLUVONS AND CONDITIONS GF SUCH Po:ICIES, AGGREGATE UJITS SHOWN MAY HAVE BEEN REOLrED BY PAID CLAIMS. u"T TMDFINSURANCE —� POLICYNUhiBbR FF -Er "Nr C.p�7B;MMp01YyI PO -11r y LINTS GENERAL6iARI-ITY i F +=URRSN - f 1,000,000 X COMMERCL1LGENMALJANLITY I CLFIW'l 41AOC CI OCCUR Ii �PIR; CAMAG;'..tny0nebe'. t 30,000 EXP (Ar "..x s Im i) S 5,000 A TO BE ISSUEDI i 03113/03 �E:i 03!1311)9 i 1, 000, (100 I PERSCII,1L I Arll waLRY $ �i—._ ___ i _ 3ENEFtal4fy3RE,ATE 6 2,000,000 •�1/f9OR£f34*ELIM!TIPP:'E8PER: I ?Ro!LCtA_GO dPn�eAC,G S 1, 000, 000 POLICY I I MC X09 I - - ----..��,{_.-�......___ - --- --- AUTOMOBILE L'ANUTY _� -- -�—•--• I C0N,5 NED CINIULF .VT I ANY ALTO ` lee acxurar.,I I 1, 000,000 ALL OWNED ALM k I I � (3C711`i WJ'JRY I X ECHi3!U1.60AJT0c I �02IB IXrIRCAL- asUS M-01646 11 E/04 I FR1'AI.Y IltlUnY — . 8 I Oti V&NFOAL: i:106/03 I (1'OrG tlYrD i 1 II F ROPERTY COWGI: ;Pei aecden!) �— 7+ynA3EUApI'ytV I AUTC0140 -EA ACCIDENT S A4f-i c:'f+~Fu7 0TI1ERANY lu- -----f AL?C ONLY: �.��. A�-- I' EX�E88LIABILITY �— T• ! EACJ+.000URRENCE S 1,000,000 I ^ ; GCOLF, C ULR vf41!ADE I I 1 I Acit-RROM. g 1,000,000 I TO BE ISSUED I--� ; 0.3/5.3/03 103/7.3/04 D ' s I HO OLCTIGLE I S H-_ X , RET6NTON i 1a, Oa0 �---- �� f S NlORItl7.teooM?ENaATIONAN3 i9M%:�6'MVLw3nm I i I �10RYLI�IITB, 'X iYTOTit'C408345 O;i/_3/03 03/13/04_,..=aalF.craoEr.-s 500,000 E _ i �e.l_.aissti9e•eAsa!P6S'YZE s 50C,000 — i °'L. j18EASE-F'CLICYLIMIT S J00, 000 �— 1 0'TM ER I i f I i I CHSCRIPTIDN OF QFERATIOiJ3tl0^�ATI"Jtt3iJEWC:FSiEXC1�1910N9 ADD:C 3Y ENUORSC�IiENYiBF'EC;4L Pkp'flSfON5 —� lekx: 978-686-7724 CERTIFICATE HOLDER ADDITIONAL INSURED: IEJ_BU_R_EER LETTER: _ U.NCELLATION 11HOULJ ANv OF THE ASOYS QRSCRI&ED POUblta 0E iwiMLED REPORE THE EY.PMATICN TOWN OF NORTH ANDOVER DATE THRflCF, THE MUINO INBWARER WILL ENDEAVOR TO NAIL 10 ']AYA WRI'TEN 384 OS GOOD 5 T RPET - NOTICE TO THE CERlth'CATE XOLOUR NAM= TO TIM LEFT, b'UT FPIIWR`. TO p0 80 eyA'' NORTH AN..OVRR, MA 01945 IM"SE NC, 09MATON OR L:AGILT/ OF #,W MND UPON TI -15 IN9,ORGM ITS AOGNTS OR AC ORD 28-S (7197) MAscheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck software version 2.01 Release 3 TITLE: DX -29 / 22076 Permit # Checked by/Date CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 8-2-2002 PROJECT INFORMATION: 2 - 23 x 46 Duple2,449 sq. ft. per unit COMPANY INFORMATION: North Andover Realty Trust NOTES: Lincoln window units, Low -E Colonial COMPLIANCE: Passes Drafting Maximum UA = 837 Your Home = 823 Area or Cavity Cont. Glazing/Door ------------------------------------------------------------------------------- Perimeter R -Value R -Value U -Value UA CEILINGS 2799 30.0 0.0 98 CEILINGS 19 0.0 5.0 3 WALLS: wood Frame, 16" O.C. 4364 15.0 0.0 336 GLAZING: Windows or Doors 461 0.330 152 GLAZING: Windows or Doors 27 0.560 15 GLAZING: Windows or Doors 19 0.560 11 GLAZING: Windows or Doors 36 0.560 20 GLAZING: Windows or Doors 23 0.320 7 GLAZING: Skylights 16 0.400 6 DOORS 76 0.350 27 DOORS 33 0.540 18 FLOORS: Over Unconditioned space 2498 19.0 0.0 117 FLOORS: Over Outside Air 284 19.0 0.0 13 HVAC EQUIPMENT: Furnace, 80.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building Vans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design ad as specified in Sections 780CMR 1310 and J4.4. Builder/Designer C� Date 49'oA2 - aC0V- TITLE: DX-29 / 22076 MAscheck INSPECTION CHECKLIST Massachusetts Energy code MAScheck Software version 2.01 Release 3 DATE: 8-2-2002 Bldg.l Dept.l use CEILINGS: [ ] I 1. R-30 Comments/Location [ ] I 2. R-0 + R-5 Comments/Locati on Arr/C Py&xbj'`Mj "j1(A%&tA7a'q X0^5 WALLS: [ ] ( 1. wood Frame, 16" O.C., R-15 I Comments/Location WINDOWS AND GLASS DOORS: [ ] I 1. u-value: 0.33 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location LfiC/G©L�C{ Tx1i"—(Jti/G� [ ] I 2. u-value: 0.56 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location a i L f G 1 [ ] I 3. u-value: 0.56 I For windows without labeled u-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location e! 34 � �52ti? 1J/Ajd9k:9Z0>° [ ] I 4. u-value: 0.56 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location eA Xz [ ] I 5. u-value: 0.32 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location Ga/Vlll/ SKYLIGHTS: [ ] I 1. U-value: 0.4 For skylights without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location VjnFz-zj x V!57— 304 1 DOORS: [ ] I 1. u-value: 0.35 Comments/Location [ ] I 2. U-value: 0.54 byD 10i� Comments/Location__ FLOORS: [ ] I 1. over unconditioned Space, R-19 Comments/Location [ ] I 2. over outside Air, R-19 I Comments/Location HVAC EQUIPMENT: [ ] I 1. Furnace, 80.0 AFUE or higher I Make and Model Number AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing u -values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] i Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: [ ] i All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- Project dumber & Title: 12X-29 Z 22070 Calculations for Square Footage(s) of Ceiling(s) Fkt, Gelling E s Vaulted or Cathedral Ceiling L2 -----------�- ' Section ----------- ----------Len Length th a.) Ll + L2 + 1-3) X W = Area Width (W) L X W = Area Plan Ylew Attic Access Area Work Area Ceiling area calculations /QST 2 k Gv�lTJ 2-jx 151 A 2= z'j�% �, �c 2 14 2x— --7K5 + Sub total = Zg J1 Attic Access to be deducted Skylight total Sq. Ft, area to be deducted 5; 3 Total Project Number & Title: vX- 2 y 22076 Calculations for Square Footage of Walls A A H Ist Floor Plan p 2nd Floor Plan Z:-�L H3 Cs F E p c C Perimeter I (PI) = A + B + C + Perimeter 2 (P2) = A + B + C + D N2 2nd Floor D+E+F+U+H l P1 X HI lot Floor wall area (Al)"I = t P2 X H2 = 2nd Floor perimeter area (A2) I, Ist Floor Lin P3 X H3 = 2nd Floor wall area (A3) Al + A2 + A3 = Total wall area Section Wall calculations Work Area IST 2� 4 4 SE�fl 2+ 2�, 61 1 7 �' Z � �TzI � = .4 Sub Total = djDD Window Total 5q. Pt, area to be deducted Exterior poor Total Sq, Ft, area to be deducted = — 7 �l2 Total = 4 �� �✓� �� Project Plumber & Title: -Dx- 2q1220-7Co Calculations for Floors Floor Plan E 3 Length Q.) L X W = Area Area of floor over unconditioned (unheated) apace (L X W) ZK JK Total Area of floor over outelde afr L X W) �gsr �,�a zx i42 Zoe -7 - Total = 2 Project Number & Title: VX -:2 Calculations for Windows & Doors Table of areas for Double Hung window& Table of areae for Casement windows APPROXIMATE WIDTH APPROXIMATE: WIDTH 1'10° 2'2" 2'6• 2'8" 2.10" 3'0" 3'2" 3V 3'6" b 1'5" IT 2'0• 2'4• 2'10" 3b" ST 4'0" 4Y 60" 03'.5- 3,9" 3'5" O 3,9" X 4.1. D 4-5" M 4'9" M 51" 1� 5,5" 6.26 7.41 8.54 9.11 1 9.78 10.25 10.92 11.38 11.96 6.87 8.13 9.38 10.0 10.6111.25 11.88 12.49 13.13 7.47 8.85 10.21 10.89 11.6712.25 12.93 13.60 14.29 8.18 9.57 11.04 11.78 12.62 13.25 14.10 14.7115.58 12 8.80 10.29 11.88 12.67 13.57 14.25 15.16 15.82 16.75 9.30 11.02 12.71 13.5614.39 15.25 16.10 16.93 17.79 10.03 11.7413.54 14.45 15.46 16.25 17.28 18.04 19.09 Calculation table for D.H, windows Unit size Area of unit X quanity = Sub Total 21-0/4 c? 15.5-7ro 2 I3�.7 vo s 12.62- !8 47,27.1� 210 3fi `� ►"18 3.26 12 I�V4 9 5.43 6.59 6.99 7.96 9.32 11.07 13.98 4.25 5.01 6.0 6.99 8.49 9.0 10.25 12.0 14.25 18.0 4.84 5.71 6.83 7.96 9.67 10.25 11.68 13.6716.23 20.5 5.67 Total Calculation table for Glass poor& Unit size . Area or unit X quanity - Sub Total TotaliJl �j, l0 0 I Calculation table for exterior door& Door size Area or unit X quanity -. Sub Total 3'0" = 20.0 8'0" = 5336 Ar'aA nP vArfewm einnrs (618° hatelht) 2'0" 2-4- X 3.0. 3 D 3-5- M 4'0' !T-! 5,0. n 5'S" r0 J 2.83 3.34 2 At9 5.66 6.0 6.83 8.0 9.5 12.0 3.26 3.89 2'6" = 16.67 5'0" = 33.35 Total OV' - r7 R1 Wn" - AMA 5.43 3'0" = 20.0 8'0" = 5336 Ar'aA nP vArfewm einnrs (618° hatelht) 2'0" 2-4- X 3.0. 3 D 3-5- M 4'0' !T-! 5,0. n 5'S" r0 J 2.83 3.34 .4.0 4.66 1 5.66 6.0 6.83 8.0 9.5 12.0 3.26 3.89 4.66 5.43 6.59 6.99 7.96 9.32 11.07 13.98 4.25 5.01 6.0 6.99 8.49 9.0 10.25 12.0 14.25 18.0 4.84 5.71 6.83 7.96 9.67 10.25 11.68 13.6716.23 20.5 5.67 6.68 8.0 9.32 11.32 12.0 13.67 16.0 19.0 24.0 7.08 8.35 10.0 11.65 14.15 15.0 17.09 20.0 23.75 30.0 7.67 1 9.05 10.83 12.62 15.33 16.25 18.5121.67 25.73 32.5 Calculation table for Casement windows Unit size Area or unit X quanitg - Sub Total Calculation table for other glazing Unit size Area of unit X quani14 ° Sub Total Calculation table for Interior doors Door size Area of unit X quanity • Bub Total 4 (24.628 Z z-�16 TZMrOV Total 33.3�i Calculation table for Interior doors Door size Area of unit X quanity • Bub Total .54 r64 ._54 Total 33.3�i .54 r64 ._54 X" 55.35'• . 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U &�- 'a che(\w, A s 82' 44,1' ,38.4' summI r STREET W, (a w FOUNDATION LOCATION PLAN MlmAft M w9 CW rM o't8U Nor ao .arr &M if MMC"MXM M CLIENT: JIM CARRDLL DOW of ca�o+rakstrr.) uepvrs. M OJtitflpiMQ 81PALL #t0i K bIAED J►Y 1i1F CtJGVr fi7iR ANY A~ ova MN parr our "V►acar M WN w THIS CERrIFWAMN W MA" AND tJA "P rxnmr mow or AVAM4060 * sora M1G W ME AMM CUENT. ft*TND WW Fars AlAWW is roar CAMWOM PRPM OF C040VIUNM & SM W- AM A#r 04401MMMMW 61=4ewria6a W t SM Hoots so HeELRHa rurr WCAWN: LDr S S�dMW ST.,NQ.ANDOVER aamm carrAM Am= OWN== Wor o VM a► ANY awe SCALE: f "=30' DATE: 08/203 ENGMWM CHRISYUNSEN &SERGI PRO" 10 X#MW Sr OMMW!@JA% O1Ad0 M- i7A-in-010 can or C#Nsnum It sorb! W. O'WG.N0.:9800200 ' Location No. `` ()1-4 e3 ) Date 4i.�`ab0 -3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL ~ Check a .3 6 S� 116647 BuildiLM C -Ca-,—_ ng Inspector Inspector v z a a M V v 0 W LL. 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H C R Cc CJ J� .� Z CL V y m •s C cc Lij _0 Cn LU Cn crW LLJ cr- LLI ui V/ Town of North Andover Building Department �� 4��,��, ' 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �` •"" �` } Opo cowii«i:ntM,��� �gATe0 J% •��. 9SsgC USSR APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 11 SyvV% -%. I'J,. 9_T4" LOT DATE REQUEST FILED DATE READY FOR INSPECTION 20104 S� M 4 5TMQA- FIVE (5) 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 TWE STRUC DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE ROUTING CONSERVATION OFFICIAL USE ONLY DATE PLANNING DATE - WATER ME DATE D.P,W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED ;IG R TO INSPECTION QUEST ATE. ATURE / PW AU HORIZATION