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Home My WebLink AboutHealth Permit # 10/6/2005 Commonwealth of Massachusetts MaP-Block-Lot ® Board of Health 107.A-0068- North Andover Penn itNo Is .,, P.I. BHP-2005-0291 SSACbU Ea F.I. - —- --- ---- FEE ®Sa' $250.00 Disposal Works Construction Permit Permission is hereby granted 'John Soucy m'� to(Repair)an Individual Sewage Disposal System. at No 795 JOHNSON STREET' as shown on the application for Disposal Works Construction Permit No. B HP-2005-029 Dated October 06,2005 Issued On:Oct-062005 - ........: — Bold orHalth..r,,,.;_ z bate C...�.. . cam? AORTH F NORTH ANDOVER ° : ¢ PERMIT FOR WIRING �9SSA C�HU'5 This certifies that <.. .. ..............................................,................ .J. ...................... has permission to perform ........... .....3!�.....` ........... :::f r k wiring in the building of...,+ 1.... :r. . r7. c' 0-, ~j . = ' o Andover,Mass.at............ ...... t ELECTRICAL INSPECTOR -7 by Check # i fix, 3 1 Commonwealth of Massachusetts Official use only Permit No. t ti, 1� t lf�"j� Department of Fire Services —'- 7 �" Occupancy and Fee Checked POAFD OF FIRE PREVENTION REGULATIONS Rev. 11/99 (leave blank 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 PRI]VT IN INK OR TYPE ALL INFO vfATION) Date: 'f' City or Town of: ,� ci�rt 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) Owner or Tenant t i Telephone No. Owner's Address Is this permit in conjun,elion with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Purpose of Building �,�,'<;,�,� �;�� T-;-,crrr>- ��-�;� t> Y Existing Service��7� Amps �" / ,/ Volts Overhead❑� Undgrd❑ No.of Meters d',��':� C> New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: p Can letion o the follawin table n7ay be waived by the Inspector of YVires. No. of Total No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans Transformers I{VA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above In- o.o �mergency ig� g No. of Lighting Fixtures Swimming Pool ,Lnd ❑ nd. ❑ Battelt Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS of Zones No.of Detection id No, of Switches No.of Gas Burners Initiatin evices No.of Air Cond. Total No. of Alert' g Devices No.of Ranges Tons Heat Pump Nu ber Tons KW No. of Se -Containe No.of Waste Dispose d P Totals: Detecti /Alerting Devices No. of Dishwashe S ace/Are Heating KW Loca ❑ Municipal ❑ Other P g Connection No. of Dryers Heating Appliances KW Security Systems: No.of Devices or E uivalent No. of Water KW N o. of No,of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors �' Total HP / TeleNo of Devices or E u valent OTHER: Attach additional detail if desired,or as required by the Inspector of if'ires, 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 BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: l �''r" (When required by municipal policy.) Work to Start: ' ,"r't'3 ;;;><; Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of petjury, that the information on this application is true and complete FIRM NAME: G_ LIC.NO.; 4�, f qp'pliceb/e,,,aytel "et re Opt"in,the license number line.) Sign�tu e ` Bus.Tel.NoO` OWNERS INSURANCE WAIVER: I am aware �) Alt.Tel.No.: th�t the Licensee does not have the liability insurance coverage normally regpjrq y law. By my signature below, I hereby waive this requirement. I am the(check one)El owner ❑ owner's agent. i ! Osv°nor/ gent E7RHITFEE; $ Signature Telephone No. 1 or -no nwealthi of Massachusetts — TODAY'S DATE plicati n for a2pfic Disposal System = "Construction Per it ® TOVN OF $ 250.00— Full Repair $125.00 --Component_ NORTH ANDOVER, MA 01845 Fee (CIRCLE ONE Form 1A PLEASE) A. Facility Information Important: When filling Application is hereby made for a permit to. out forms on the ❑ Construct a new on-site sewage disposal system computer, g p y use only the tab key to 1311kepair or replace an existing on-site sewage disposal system move your cursor-do ❑ Repair or replace an existing system component not use the return key. 1. Location of Facility VQ - ------ ------ ----- Address or Lot# - - - - - - -------- p m erum Cit R -- Y State Zip Code 2. Owner Information --- s- Name -- -- - -- - ---- Addres (if different from above) -- r � City o - St ate Zip Code = J:_1 Tele t -- H� Numb 3. Installer Information Name - Name a Comps A dress -- City own f State Zip Code r s Telephone Number(Cell Phone#if possible please) 4. Designer Information V.. . Name Name of Company Address �- - - ,, City/Town State Zip Code --- — ---------- Telephone Number(Best#to Reach) *****TURN OVER FOR PAGE "2" PLEASE***** Application for Disposal System Construction Permit•Page 1 of 2 Z 1 Z abed.IP19d uoiaona;suoO uaalsA,jesodsi4 Aoj uoi;eopddy ON —sad :(Rluo uo!;on l;suoo mou)z subld.bold s ,—oN —sdd :(Aluo ugpon,l;suo3 Mau)pyng-sV uminpunol -p '^ ON :. � sad �tuuadlp0ulaa!g o oa q�p.l�`asj I zutiaxs S ulud �ON sad tpdgipa.lV uugd uoxlp. ilgo-td-gpupN l-iafosd 'Z ON , , sad zPdpvjjV aad t VIUQ asn eoujo jo:j :suoseaa 6ulnnollOI ayj JOJ panoiddesr® uoijeollddy ale(] aw N (an!;a;uasaaday y;la }o p 8) :�5� panda Vd. 7e"ojddy ale(] 111(� Jaw - - - - yllrHIPMOG slil;Rq ponss! uaaq sey aouWidwo0,;o a;eol,!pop a l!;un uo!;eaado u! we;s�(s aq pue :ranopUV y.UoN JO ump.L ay;ao,;suopelnfia,d lesods!®aoepnsgns!eool ay;se llem se `opoo le;uewuoa!nu_g oil;jo 9,911!1 jo suo!s!noid ay; y;!nn ooueploaoe ui wo;sAs lesods!p o6eMas a;!s -tic)paquosep-a.lale ay;¢o aoueua;idew pue uo!;ona;suoo ay;a nsue o; seeiBe pouBisaapun ey.L IUOMGOJBV '13 suo11e- ,, - - --- :mol j Alle® pa;elnoleo Aea aad suopeE) :moij U ise 9 1b ------------- 6ulplln8;o adAj :aaujO❑ (;uosaad;i )Iaauo)aapulaE) a6egae0 ❑ 6ulllann4 UippEl jo GdAJL 'S ....penuiluoo uoijeWi0jUl Ajjjj3B=j J® (3 `d31d d6 MJOd 1010) aa Z0 3NO 3 I iced �� _A-as 09Z ,1. ® ! _ WJ� uoilmJlsuo 31da S,1.t1401 W04SAS iesoasia 314des Joi uoi4eosl t ._ .. spasnpesseW jo g1jea nuowwoo INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 9 "-)3 4,t S_4 relative to the application of 9,-1;A. dated a a forplansby /��, &%!a, and dated 1®0 with revisions dated eitIl� I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction.steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Unde tg d Licensed Se Installer Date: — � Di 0 sal Works Const ction]? it#