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Home My WebLink AboutApplication - 52 OLYMPIC LANE 8/20/2012 Con str uction Permit - 7 TOWN OF TODAY'S DATE ORTH ANDO $250.00—Full Repair ;-2- MA 01845 $125.00 -Component Important: Application is herebv made for a permit to: When filling out forms on the El Construct a new on-site sewage disposal system* computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your F-1 Repair or replace an existing system component—What? cursor-do not use the return A. Facility Information key. 5,z_ 0 A Kj 6 VQ Address or Lot# k A"Pd ve-r?__ enan City/Town 2.®*TYPE OF SEPTIC SYSTEM*: 0❑Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name Address jWdWefe-nMrNm`abo\Ye4 City/Town State Zip Code Telephone Number 3. Installer Information 24 0 Name Name of Company Address 0 City/Town State Zip Code "?' �V Y --- ;71 Telephone Number(Cell Phone#if possible please) 4. Designer Information �G A 1) IV O-M tJV6A 6071- A11.4i"k ef;V6�-IAI Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 �I tl n tl 0 S stem o TODAY'S DATE flt�'llt� �i I�k`�°!It 254.00-Full Repair $125.00 -Component PAGE 2 OF 2 A. a ility Information continued.... 5. Tvve of uildina Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has een issued by this Board of Health. Name Date Application Approved By: (Board of Health representative) Name Date Application Disapproved for the following reasons: For Office Use gnly: 1. Fee Attached.. Yes No 2. Project Manage-t-Obligation Form Attached? Yes No 3. Pum-12,System? If so,Attach con of Electrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Sarre scale as approved plan) 9. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (ie��dra su�o �aepr Aa system) For glans by i WQ'`I �'P1�ty"./�� ev 1� Relative to the application of ! , � (hisla ley's,nan le) And dated 5 6 ; II riggaaas date) Dated rR ay s a aaFT With revisions dated V (Lass revised date) 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 pdor 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 manager, 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..Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or M)7 company. a. Bottom of Bed—Generally, this is the first (1") inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but sloes not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal O (or e-mail to: heaitBtci,c 1tQ�.tL 11�2b'l, Itlt m,da R �aim) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a 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. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other thin sbilple exeaw ion)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systetns 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. Detertvination 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 ebanrber, 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. Undersigned Licensed Septic Installer: i . ro ( V k:ra� , fttc} 6F 2 �,�.. A aryl ° .- Print:) 'a (°1 Qgne( Commonwealth of Massachusetts Official Use Only Permit No <L Z_ Department it Set-vices Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] Qcaveblank) APPLICATION I ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(ME,Q,527 CMR 1.2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: August 20,2012 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) 52 Olympic Lane Owner or Tenant Ral Dudani Telephone No. Owner's Address 52 Olympic Lane North Andover,MA Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utilit✓y Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Etches and high water alarm panel. Date ' t 1 ":r =sue table may be waived by the Inspector of Wires. No.of Total Transformers KVA TOWN OF NORTH ANDOVER Generators KVA PERMIT FOR WIRING 0.o mergency rg tmg Batte Units FIRE ALARMS No. of Zones — �' No. of Detection and This certifies that . . .11. . . �: . . . "� . t. � ai ° . . . . . ? Initiatin Devices has pen-nission to perforn7 . . . No.of Alerting Devices l No.of Self-Contained t Detection/Alertinf Devices wiring in the building of . . . . . . .t.�� ;�� .�. . . . . . . . . . . . . . . . . . Ma El — Local F1 ❑ Other Connection at . . . . . . .. r. ° ,P . . . . . . . ,North Andover, Mass. ee r ) c No. f Devices or Equivalent / }r f S c Data Wiling: ( ELECTRICAL INSPEC OR No.of Devices ar E uivalent p r ,rdn Telecommunications Wiring: Check# C I I r Nt.l �,.__._.__. ... ._.___. .-.____.___.. _ _._, _n. No.of Devices or Equivalent 3 1111 1 Vesired, or as required by the Inspector of Wires. pal policy.) -- . Work to Start: lneetions tou-ccicstr u�=a��rC.�� ..=u== AEC 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjrrry, that the information on this application is true and complete. FIRM NAME: David W Meehan LIC.NO.: 81296A Licensee: David W'Meehan Signatuu� I,t�ra, %t LIC.NO.: 8126A ll (If applicable, enter "exempt"in the license number line.) Bus.`l'el.No . 978-587-7518 Address: 4 Mulberry Drive Peabody,MA 01960 Alt.Tel.No.: 978-535-4022 *Security System Contractor License required for this work;if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragemormally re- quired by law. By my signature below,I hereby waive this requirement. I am the(check,one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. __