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Building Permit #259-11 - 72 SUGARCANE LANE 5/1/2018
- BUILDING-PERMIT of g10RTH Cr Jab�4o TOWN OF NORTH ANDOVER t6 L APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received RA •,�' �` . � �p�raso a•�A4 y Date Issued: �SsJ9cHuS �s,v • IMPORTANT:Applicant must complete all items on this page '��=_:E�-..i ".*��y�'.�.,`;cT _:'�r,����•`-?+�-�'�!.`�i.'��`;n'P"'`_i:.= T3"r :d'�;�>:'2rr•:.`-v.�o-q,,._- _ - :ur--rt-.- - .;�:�:..L��.z±.. _ ,:::irG'nir <-..:1.•�- .�jr .';y.`r':�;;_'."_.�, _ r�il_3i:w'•*' - - _:a!^-•' _..ri' -,a�t^ --'-:es•. ��1�=^a ^ice`= __...,,,,y:.-.'-4 c...a''�'-S:.sY}:: i•• _ �.};2."�_ -- _ R-f�-:a' _4?•l' '__✓_-L..... Z. �,...��:�• ✓°-_ar �.r�- - :^`�' ...''ti�•�Y _.✓"''-�t�y.-u� -?;:tra�:l:=,zr�.•=,�:c�r.—:.Y�':,.,.:.r��:::e - r.. :.��?`"'•'��-1 •� _ - --."�`�.:_r�•.tlr rr'T.`4"l:L''-'"• 93-, - - +:'^i;t. ..� r �'s`-'.. -.�.,L_ k'�..r-.r.:.. •?f a.4:rera.. '�.a1 `R-.�._ - =..a• "��t- •a-._.rr.�d`c��".... t'.-�t�r"-,•a--' _ --r�i:�.�.. _�. ,t;..��-_:�:==�'¢,�.'•:��s�-'•�,.. 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Y S,�.L-r`.rt` ...i�,.-F::'ii�,2sT....,-�]'Y AY•'.•9.Y4_. -�' :fin:4H5=.,- C'y.:- Cf...Lic� _.,1,1�s:�d'i lry ':C_� _ - rr•.t' - - �-.'{c ;:-K- r.'••J•.r_, e��o-Y, ?�iR.a-,• .c.4..:�G.,�^.T,r�"I�.�r,• �>.T�+T.•.:'.,�'.-�'_ -„i�ry �Ji.._ _ -,r,'r�i-'`;r2.`w•mr+'-'-[c•.i�.���-Ju�._:::..Sr'•w.�N o,x�-rs-d':i',:._ -_-�•.'.c.=r<�is,Y�'#�n'u�:r•uv�+-� e. - is_ �t 's rt'2._ ,� ;�:.-k+�-- �i:4:.5,a'.v:ck_. r = ..'�.T.�;`l.rp�'��:� :�.7 - •�d._'ia_.�:i._ ;sc`/,:.a;�..�s�i1:�;^=a���xy�'�:�t�-''•��'y;.,..,.r--x�,F.•,:.�- }�:F7 �'�i:J _ 1� �,,,�.t..r.*: ti,a�,�,_: i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family. Addition ' Two or more family Industrial Alteration No, of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other ',-`a.•� �:� � -a''�' p wu_4,..i�'-y- 3 --'�i,v rDT�.W�/ ��� - baa-,i1 � �” ¢'. `!Y - a tG�'itr=.r=.; _�"�r: 4;��"..��,k=-^r'�:'1 .,.4`�2��'Ll,+-�;'6xi�1�`� �tl' �� ,52 T'� � Z-.-y� li��1��� � � �^R� .� '�����( �p1j/a'��� I L y"5"=.�E':3[is"-•. r{ teIi`w - -.0 _{'••' bM1i1 � �i .�`'"'!n^.� +yS� -z=r..:�,,, r.���:E,,_r',.3e�� ! `z?7:r,��''•'F+� n,�' �1`_'-,�m''�3* a.t�� rwt�`14 a,'r'�'a-h' Suter n','Y�-•:��s�*:'�'r�.�'��1�-r.s t 1 _.._.__....._. _...�.... S a;�-x7•.-. ��.C+'-:'r3c-.:,=-",.�A:r_e.�r`�.:_..Gt.cis.-.�r.,Jtial-.�=?.=�"~�l++s?�G.'"�a'�,1,'L !`�.--^,a.'��� ��<}•�9i �'e�'� s�.,F'.ar��ca i5�'� .Jw,�'��'Jt+�+��' a ..:� :L_ .-Z4'S,'+_-.�..:SL. ..'•�\, .tit•.... S'if 4. _.,,,..n.. :._.. .�.�fir....w� NY7`T�.=•(� -... µ1` � � R� DESCRIPTION OF WORK TO BE PREFORMED: _�.. 17�L°de��•ef.�� 6,civse 5c-,r�r ,, Vie® r rr lo?r� Lt�T,si� Gv����G &o Identification PIease Type or Print Clearly) l OWNER: Name: o�c� Q.�`�`� Phone Address: 2 S 1 f? ~= ;_L tom• - Wim:_.; - - - -*��4�.. � .h ..'r�a��S's� �`.�1 :�:��K.,F.,� s�i^�t, T:"�_E�•�^�-°'-�-a-x:.•`4: tiF�=i+r��:;'�+i.To-��lr',�n:-?„''s,;kCx�"-�>r.'.ti�,�z.7�7-' .= - ___ _w.: - i'yer7 -'.ff s'3- '-''''r .4-Q%t=`u�<.,srr ;W��3_-••-. .,,,• y.'Fw'='�.:F �1. e ra-:L� �i.^•,•n,. '.'�i� "-s'��'`' �r r a�.rJ-�fr-w--1: � �+ ¢ .ter _ yy .�•t" �s..,.,.y OR 10114- E .• .� WOW i-�i EN, ia ,: ,,ik, ., .. .k 'rr �i.:j,t.Vic, : -�> SRI, .•z. �: ;.2£ ' ', -4 .z•>;3+�G,";nw-'r �•.��,;5 �W. r'c" .,�, - r a'-.i�•.'t ;'k3 s- ,e�:'��'? �/Yom- 1�•� "J.aa` ,; .= ,v' ^,w_•.e3. �, -,'l•r`•'q':'`.`4 t'{'.a�",v'-' �• is t-Ua '�r-�� , :«`3^' � `F++s_}elfdp:•# ��,. � .w` ,,TJX- ya- -L'�`"`•<A:' - .3_ss -, 2! i s'� .M �,.5, .t�;'f �'r;,,$ 5 s e P- _ ,Mrzart� t u -7;r�•��7aa `�•,,r�B_.zUan. :fl ]at'G.-'^ .tyi�9 tri$•U°"^" ,k" F` L�:�T'S,it`x nl 7 T � �• ti '3a'rJ<rr•JveJ= 've lei--a�-rt,'.ra .a y vti a ?r`� r r %Kf R f ,.r•s t. .r x?• o '�Fn, r S r, �,4g x x7 r& �fty tit rr r•:c :e r,Fa M1Th t.. .-?.-"d..'--+ - n .,"5r r- €,,T f� •c= �5 ".I'Y:, ,' "E�,:,• T�sl � .`-,3�.r. 1 �,1x.1 qC zy�T s. ��.,'�?��' ��b :.0'4� ",i� 1n`�`YZyo-�= 'ie-'��'fd�a'i� r- n.J �'�e 7��y{ _�� �.r�>;s, ,i'�•'.'� _�'��`' a :iJ" '�~ �1 Jj�°L-�„•�,'y'F-;i�'��x/71��r�'�_ ,.��_:•�"T•'�F':..It !, .':00` 5,•,"'..----"jtJ -'.y :.v{:SeNF:r: - -T ,x'�•- ��' •� ,ppy�j� �j.`: ..t•-7Y:•,. ,G`�3vr i�_ S. "�.'r ',L'-7I.iGiil'!✓„. 'i4r n '� 5' 1i¢a _ {u2+ x4;- y.h• ..r �svta.. f'�r'r ''1`�v 2.!�•,�yF ? �v ��,r� - = i3E'>='r �1 -_c'? "'-'",3.,•�•c,. ' L• �i :� :d'-# •'iy:.. t?i�Y"7• -' .aa_.L JJ J ar�yt•i:,:Jt?t - R y:r1• ~- � ��' L .JL:>-.._�. :�� �:,_ ..:.��::° :%r�4�j,u.,,`�.s.. .'��§a•o -�:-� .,+ 7 7e3f-�- iy':i=t5'isihs����_.:r.=- •i;4 lv.� _ ,. '�'..�.-.: _ 1:.P- p.'"+�� ,� �g•�y_�_... -,.�•.n::-�o.P r.._ rc,:.•s..,cyw -sa.-vy :d .�� -.,::.r.-r�_`.`';.'�"'�vr.s�,.,.,- e.., ���'L-�.. _ �+r'�` -,'l;T, .r,�"r7�,r,•.�; - a-.•iaac., -i�k"',: �_. ., �... .�'Y^`nk�%r �.. T:.:S'S -,_r`^.�r_ _•15�:�=::-„w����i�:...� :a3�� _ .���_.,.:% ..�.:�r"L,'-:�., .�;r-� .r<�_ -.:a m.:'_': i'.::..>,. ;e=�,: �.St3, _•i rv,:c,..: F��;s.�i5�..,-.�. ]��La.=�'.,,. ,_��rt_ •��1r- --•�`- .::,.--.,�-'�'��•.:ehr,...._,,'a-.�;;.f�..y�1,:.?_�r',r-�;d'�'�r_.W-.�,c=r�� "� ...�U,-_- „�,;�:�.rrr: •:.�:.,,�:r,�7+...,t-,w�r�•�.�'��tr•�.�^�"t R.7�c� 7 .,.ax�etr 1• t--_ _� �I - --L;rY.14au_ty .,�.^F. _ ..�.0 _�1_.'y:�;<_ -d.-.cL:ct 1�;� �S���.'..y.�:J .a.�t�-'M'C�;�e�,t' 'Iti•) �;i�7�'.a�'i�'i- - �6 'r; ,i. �r1eF-?ti- a' � v r._ �r -k_ - •a--.,��..,��?��'rTr ��tia�'-� -••.y^ _ _ •�'(:.:, .:'Fi2 _ . __�I137.���.G R1t. , yI•��v �}FlY^ 15: ..:�::..� :,'.Z'!.a.'I4�J.',±��r b.._• ARCHITECT/ENGINEER Phone: - ,I I Address: Reg. No. FEE SCHEDULE.BULDING PERMIT-$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON125. $ 00 PER S.F. Total Project Cost: $ FEE: $ 2� I Check No.: �� Z� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accesi to the guar- nd .,v�s�..ivx�r?A�g�n�:auuner:: _.- - .���'' nri�i-rn.`r �F.,..� _=-'� ��__ -- _. ....•� ....__- - -' i ' Plans Submitted Pla ns Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DIS7Tanning/Massage/Body Public Sewer Art Swimming PoolsWellacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED' PLANNING &.-DEVELOPMENT COMMENTS CONSERVATION Reviewed on Si nature a COiviMr_k-!TS HEALTH Reviewed on Sianature r COMMENTS Zoning Board of Appeais-.'Variance, Petition No: Zoning Decision/receipt submitted yes Planning- award Decision: Comments Conservation Decision: Comments Water$ Sewer Connection/Si nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384'0! ood Street 31 N' ,rA�1`p c• of - - a" .Y,la, ..�. . :•:+!•� .'."t'-..'^ H.'- 1�='::=t Dimension I Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No - DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified forp p - icku Date Doc.Building Permit Revised 2010 i Building Department Z. The following is'a list of the required forms to be filled out for the appro riate mit to be obtained. . permit P P Roofing, Siding, Interior Rehabilitation Permits --❑ Building Permit Application 4 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or--Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check-Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit - New Construction (Single and Two Family) Building Permit Application ❑ .Gentled Proposed Plo` n � lai r ❑ Photo of H.I.C. And C.S.L. Licenses . ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording _ must be submitted with the-building application Doc:Building Permit Revised 2008 Location /a VF 412 'r-4 ti No. � � Date j NORT1y TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ t5p Z S s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �� 2345 Building Inspector ORTH TONM of Andove 0 No. h o = A Edover, Mass., ' COC HI C ME WICK AORATED P`P�t�� BOARD OF HEALTH Food/Kitchen Septic System pr. RMIT T .. D ....� BUILDING INSPECTOR 111:2 q` ........... ............................................................................... THIS CERTIFIES THAT.............. .... . Foundation has permission to erect. .............:...................... buildings on .... Z ...... S. E''....0 /� .............. Rough .��,!!!,A. ..�.... 1!l�G� 1 ...../4.1 to be occupied as........ . .. . �!�71. ........ ... .............. .......v ..... � �...... Chimney e provided that the person accepting this permit shall in every respect conform to he terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6NTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ON TS Rough .... Service BUILDING EC INSPTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner, Street No. Smoke Det. SEE REVERSE SIDE . r _ ...... u 3N I j w 4 Y ^ l r .. ..."._. . . - Vtnt:eUl'Gtntsuu,ci'Tum:o-•r�.„-..�..__.....«......�.. Homeowner Information Contractor Information Name mpany ame street Address(do not use a Post Office Box address) tractor!Salesperson/Owner Name I �ZG� �v�tZ ItsDe's 04d.t/D cnyi7own Stare Trp Code iumtlen Address(must inciudc a sire:address) �n O� `X h;4 eA /l B Daytime Phone Evening Phone .itylfown . State Code tvlailiog Andrus fit different from Business Phone gedcral Employer M or S.S.Number .. t•v,equrrcstear moa tune mf ramie Gmmf pm-lu®Ee L.VM ndW pincer ee,—s b—.- The Contractor agrees to do the followingwork for the Homeo mer. adwrim /�it/lr�of �Alrfss!¢Nt G rr'.t�®,r u�41iS .�r0 �e®1i'1! IV;vol Jf f�C/..�f,lvsf`tr w,�f�! 1L•/7 LCQe� E Gera'/)4,4"f I��AITs^,� . f.l s dl9 t -� I! ` /1�1p�s /� r�ts '.✓ X� /�6ad�J,—�a9c c: y Nl i� i Fi.v i f I/ C4. r AM. A.7 iff far D.¢Pa�- PAi.✓IF &44f A-2 Al:4,�!!! Required Permits-The following building permits arc required Proposed Start and pletioti Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permfta will be excluded from the Guaranty Fund provisions of V Date when contractor will begin conbaeted work. MGL chapter 142A.) 0 Date what contracted work will be substantially.completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum ofy� y (s) Payments will be made according to the following schedule. " S-AD,GtlJd upon signing contract(not to exceed 1/3 of the total contract price pr the cost of special order items,whiehever is greater) $ .D 0d by+/_/ or uponcompletionrf 1AX—l' l" ee ofo,c 1I yet/a Vii✓ S 149 Ager —by !_!_ or upon compicaon of <_f&oc`'4!r /3a/�.�o a Pe X11 earl, S Z Z11''d ,upon completion of the contract (Low forbids demanding full payment until contract is completed to bods party's satisfaction) The following materialloquipment must be special s to be paid for -ordered before the contracted work begins in order s `, W be paid for T to meat tYie completion schedule.(") , r NOTES:(•1 including all finance charges(**)Law requires that any depositor down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the torsi contract price or(b)the actual cost of am,special equipment or custom made material which must be special ordered in advance to meat the completion schedule. !^totes-Wamuh-1s an cartes-watnaty beine emvided by the connsehrr+ Ho Yes tact term etf diP ren7anty muee t,e attached m the cantraetl Subcontractors The r.OntractoT agrees to be solely tespoastble for completion of the work described re gatdless of the actions ofany�third artbeon . p -vlsutrader utilized by the contractor. The convector further agrees to be solei Y responsible nsibie for all payments to to all subcontractors for materials,and labor der i Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this doctunent,the contract shall not imply that any lien or other security interest has been placed on the residence Review the following cautions and notices carefully before signing this contract- Don't ontractDon't be pressured into signing the contract.Take time to read and fw ly understand it Ask questions if something is unclear. • Make_surr the contractor has a valid Home Imrirovement Contractor Miriseration Ile low requires most home improvement contractors and subgomracmts to be registered with the Director of Home improvement Contractor Registration. You may inquire about contractor registration by writing to the Directar at One Ashburton Place,Room 1301.Boston,MA 02108 or by calling 617-727-3200 of 1-800-22;-0933. • Does the contractor have insurance? Check to see that vour contractor is properly insured. • Know your rights and responsibilities. Read the Important information on the reverse side of this fort and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may canctl this agreement if it has been signed at a place otter than the contractofs ngrmel place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery.not later than midnight of the third busine s da}'foilowing.tie signing of this agreement See the attached notice of cancellation form for an la nation of this right. ght DO NOT SIGN THIS CONTRACT IF THERE ARE ANI'B tK'SPACESJt.! Two idwoul"'pies of the centro"corse be esuMivtd and sWeed.Ont Copy should gore the hon eo nm.TBc -/void be kept by the-actor, i meowner'S Sign o tractor's Signatu — oE Date Datefi i Massachusetts - Uepailment of Public Safety 4 Bo:trtl of Building Regulations and Standards Construction Supervisor License License: CS 72487 MATTHEW P DESMOND " 19 UPLAND ST N ANDOVER, MA 01845 Expiration: 3/22/2012' C is7tusiiasictac r Tr#: 29377 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 143109 Type: Private Corporation Expiration: 6/18/2012 Tr# 297392 DESMOND CONST. INC. MATTHEW DESMOND 19 UPLAND ST N'. ANDOVER, MA 01845 Update Address and return card.Mark reason for change. Address 1-a Renewal [] Employment ['j Lost Card DPS''CA1 0 50M•04104-G101216 ie ��naanc�nuea/l�z '✓ ,uulz+.seoll3 License or registration valid for individul use only Office of Consumer Affairs&Bitsiness Regulation g before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR J Registration: , 143109 Type: Office of Consumer Affairs and Business Regulation Exp'iration: 6!18!2092 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 DSIfIOND CONST-INC i MATTHEW DESMOND 19 UPLAND ST � �_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street i iliiFi i ' Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): s F��✓ Address: City/State/Zip:yo /?,s4o✓,.,, .,eye d/ y _ Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 1 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7• E] Remodeling 2.F_1 I am a sole proprietor or partner- , ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9, ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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. i Insurance Company Name: 4/0, N,,t'✓A, .�J✓,�� &� Policy#or Self-ins. Lic.#: A.1 C z:y Expiration Date: ;. Job Site Address: .7Z f6bil�re•�►�� �� �/ � Arr.OF✓►2; jw/� City/State/Zip: Q/ jf� 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. Ido hereby certify unde i pains andpenalties ofpeijury that the information provided above is true and correct.' Si ature: Date: Phone#: 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#: , 6. DATE(MM/DD CERTIFICATE OF LIABILITY INSURANCE /Y./ 9/17/20100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT sulliv NAME: an Insurance AX Sullivan Insurance & Financial, Inc. PH/C"N ); (978)372-2790 F ,No): (978)373-2281 487 Groveland Street , ADDRESS:ksullivan@sullivanIF.Com, PRODUCER 00000440 CUSTOMERJD_M. Haverhill MA 01830 INSURER(S)AFFORDING COVERAGE _ NAIC# INSURED INSURERA:COmmeTCG Insurance 34754 INSURER B:Citation 40274 Desmond Construction, Inc. , DBA: Matthew INSURER C-AIM Mutual. Insurance Company 33758 19 Upland Street INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1091701090 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADL BR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ '5500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES PREMISESS((Ea occurrence)_ $ 50,000 A CLAIMS-MADE 1XI OCCUR ZS1282 7/7/2010 7/7/2011 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 500,000 JECT X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 100,000 ANY AUTO BODILY INJURY(Per person) $ 300,000 B ALL OWNED AUTOS CNZGY 9/12/2010 9/12/2011 BODILY INJURY(Per accident) $ 100,000 X SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS Business Auto $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ L+ WORKERS COMPENSATION TORY IM TSJ JOTH ER AND EMPLOYERS'LIABILITY Y/N __ WC STATI ANY PROPRIETOR/PARTNER/EXECUI ❑ N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) WC7019598 8/23/2010 8/23/2011 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Construction Operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE. Diane Fraioli/KJG - ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD i _. �4 _. _ _ _ . . f,_: _ ___._ .____.__e__._____ . �F OSx`~• �,r,�; :: �} I 4 �{ _ � � � � '.,._: i � '41`� � — __..._, y �� ,� I � ' rte' _:, �� i1 ��- t 4� i i' - i �,--,,,,�.c,S�. � __ �.'s / .... �x..: _. \... .,.J� ,�1__ �....._.�....,�... ._.. ... _. ..___.._.,,.... .,wwr ,. _ „�st �4s '�� � T _, r ,, � a ,� y ---� ._. �.. �_ ,. ,i _ --- --�- _ _..._. .. � ._, _.r-��.�._... .._�.� .��_�__._ _- ..�..�.--tea,. �,,.-�,������-�� � �,�,.��'-��.�...����J C..� � ,' J COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS � d DEPARTMENT OF ENVIRONMENTAL PROTECTION e W � e TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 72 Sugar Cane Lane_ North Andover_ Owner's Name:_Linda Eaton_ Owner's Address: 72 Sugar Cane Lane_ —North Andover,MA 01845_ Date of Inspection:9/5/2003_ Name of Inspector:—Neil J.Bateson — Company Name:_Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ —Andover,Ma.01810_ 'Telephone Number:_(978)4754786 CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority F Inspector's Signature: , �' Date: 9/5/2003_ A g — The system 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 is a shared system or 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. Notes and Comments: ****'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. Page 2 of 11 OFFICIAL INSPECTION FORINT—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ 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: i 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. Answer yes,no or not determined(Y,N,ND)in the 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-xfiltration 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. ND explain: 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 distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORINT - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINT PART A CERTIFICATION (continued) Property Address: 72 Sugar Cane Lane- -North Andover— Owner:_Eaton_ Date of Inspection: 9/5/2003_ 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 CNM 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINT PART A CERTIFICATION (continued) Property Address: 72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ D. System Failure Criteria applicable to all systems: You must indicate`yes"or`no"to each of the following for all inspections: Yes No _ _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ No Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ NoAny portion of a cesspool or privy is within 50 feet of a private water supply well. _ _ _No__ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No)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. You must indicate either`yes"or`no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Page 5 of I I OFFICIAL INSPECTION FORD-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection: 9/5/2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner,occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes Has the system received normal flows in the previous two week period? No_ Have large volumes of water been introduced to the system recently or as part of this inspection? Yes _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _Yes_ _ Was the facility or dwelling inspected for signs of sewage back up? Yes Was the site inspected for signs of break out? _Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? Yes_ _ 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 Soi;f Absorption System(SAS)on the site has been determined based on: Yes no _Yes_ _ Existing information. No Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)f3 10 CMR 15.302(3)(b)) Page 6 of 11 OFFICIAL INSPECTION FORINT-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x 9 of bedrooms):_660_ Number of current residents:_4_ Does residence have a garbage grinder(yes or no): No_ Is laundry on a separate sewage system(yes or no):_No_ Laundry system inspected(yes or no): Seasonal use: (yes or no): No_ Water meter readings:_Yes_ Sump pumps(yes or no):_No_ Last date of occupancy:_Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped 2 years ago,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping:_Inspect tank&tees_ TYPE OF SYSTEM X.Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _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) Tight tank _Attach a copy of the DEP approval Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_10 years old,4/3/1993, As built plan_ Were sewage odors detected when arriving at the site(yes or no): No_ Page 7 of 11 OFFICIAL INSPECTION FORINT —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM. INSPECTION FORM- PART C SYSTEM INFORMATION (continued) Property Address: 72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ BUILDING SEWER(locate on site plan)X Depth below grade:_42"_ Materials of construction:__cast iron _X_40 PVC _other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"PVC thru wall to septic tank. 4"PVC in house,no leaks. SEPTIC WANK: X locate on site plan) Depth below grade:_30"_ Material of construction:—X—concrete_metal_fiberglass_}polyethylene —other(explain) If tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions:_101x 5'x 4' Sludge depth:_7"_ Distance from top of sludge to bottom of outlet tee or baffle:_20"_ Scum thickness:_1211 _ Distance from top of scum to top of outlet tee or baffle:_S"_ Distance from bottom of scum to bottom of outlet tee or baffle:_17"_ How were dimensions determined:_Difference in sludge&scum depth to tee length_ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.)._Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL. INSPECTION FORINT—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORINT PART C SYSTEM INFORMATION(continued) Property Address:_72 Sugar Cane Lane- —North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (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.):_D-box level&distribution equal.No evidence of leakage._ PUMP CHAMBER: (locate on site plan) Pump in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 1 l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINT PART C SYSTEM INFORMATION(continued) Property Address: 72 Sugar Cane Lane- -North Andover– Owner:_Eaton_ Date of Inspection:_9/5/2003_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type _X Ieaching pits,number:_2_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions:— overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok.No sign of ponding to surface.Camera inside of pits thru outlet in d-box. Pit#1, liquid 8"from invert.Pit#2,liquid 12"from invert._ 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 or no): 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.): Page 10 of 11 OFFICIAL,INSPECTION FORINT—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ SKETCH OF SEWAGE DISPOSAL SYSTEM ties to at least two permanent reference landmarks or stem including Provide a sketch of the sewage disposal sy � benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. A to Tank=33' A to D-Boz=67'4" mouse B to Tank=4914" Driveway B to D-Boz=100' Water Meter Pit# Septic 1 Tank D- Boz Pit# 2 Page 11 of 11 OFFICIAL INSPECTION FORINT—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINT PART C SYSTEM INFORMATION (continued) Property Address: 72 Sugar Cane Lane_ _North Andover— Owner:_Eaton_ Date of Inspection:_9/5/2003_ SI I E EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 Feet Please indicate(check)all methods used to.determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_4/3/1993_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: _ You must describe how you established the high ground water elevation:_As per test pit data on design plan._ _ rD 0 co o : as rr Den DellSymantec Acrobat ErZrp (10 �g w Documents Acce"ntkn pcAnywhere Reader 4.0 3 " tax collector rOutlook t - ModemTest pdriver.aspc... 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Dell Support{ WATER BILLING HISTORY 3170323-PARKER- EATON, STEPHENMETER #1 : 3170323dhdl --------------------- 72 72 SUGARCANE LN to it CYCLE SERVICE PRIOR CURRENT USE WATER SEWER FEES TOTAL c_ 1 2000-13 10/01/1999 1019 1205 186 507.78 0.00 0.00 507.78 Internet 2 2000-23 01/14/2000 1205 1222 17 46.41 0.00 0.00 46.41 Explorer 3 2000-33 03/31/2000 1222 1232 10 27_30 0.00 0.00 27.30 4 2000-43 06/21/20011 1232 1248 16 43.68 0.00 0.00 43.68 5 2001-13 09/20/2000 1248 1281 33 90.09 0.00 11 .00 101 .09 6 2001-23 01f03f2001 1206 1306 20 54.611 0.00 11 -00 65_60 .=_., Shortcut to 7 2001-33 04/0412001 1306 1327 21 57.33 0.00 11 .03 68.3301 Printkey 8 2001-43 06/21/2001 132.7 1412 85 232.95 0.00 11 -00 243-05 9 2001-18F 10/30/2000 1281 1286 5 13.65 0.00 35.00 48.65 ■ 10 2002-13 09/24/2001 1412 1569 157 590.51 0_00 5.55 596.06 11 2002-23 02/06!2002 1564 16311 61 174.19 0.00 5_55 179-74 ' Outlook r 12 2002-33 04/09/211112 1630 1647 17 41 .99 0.00 5.55 47-54 ;Express,. 13 2002-43 06/1112002 1647 1661 111 34.58 0.00 5.55 40.13 l 14 2002-CRD 09/25/2001 1564 1569 0 -12.32 0.00 0.00 -12.32 ~ x .15 2003-13 09/13/2002 1661 1774 113 395.32 0.00 5.97 401 .29 �. 16 2003-23 12116/2002 1774 1802 28 76 .58 0.00 5.97 82.55 Netvaorl17 2003-33 03/13/2003 1802 1828 26 70.40 0.00 5.97 76.37 :: Zz' Neigh. - . 18 2003-43 06/16/2003 1828 1886 58 187.74 0.00 5.97 193.71 REVIEW CHOICE # or <ENTER> MORE HISTORY: r N' Telnet . . Telnet �J My Doc... Start : [nboh - ... �..._-� Lexmar... �:A 3: 1 PM R Tel: (978) 475-4786 Fax: (978) 475-5451 13ATES®N ENTE RISES, INC. Excavating-Water.& Sewer Lines-Septic Systems &Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspecti®n Report Property Address: 72 Sugar Cane Lane, North Andover Owner: Eaton Date of Inspection: 9/5/2003 My report contained herein does not constitute a guarantee of f tore usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson.Enterprises, Inc. Date.... + TOWN OF NORTH ANDOVER 41 PERMIT FOR WIRING S CHUS 6. This certifies that ....... ..................... ......... ..... .......... k has permission to perform .......... .................................................................. wiring in the building of...........a7w:�.............................................. ...... . ........ at...-2.... ...7- ..... 47Sj ........................... North Andover,Mass. '7 ..............Z.. j .. .......... Fee..................... Lic.No. ELECMCALINSPECrOR Y Check # 9293 Commonwealth of Massachusetts Official Use Only t Department of Fire Services [Permit No. 9 Z G �� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ` [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC),527 CMR 12.00 YY (PLEASE PMT IN OR TYPE ALL INFORMATION) Date: a 21 O City or Town of: NORTH ANDOVER To the I pect of Wires: By this application the undersigned gives notice of his or her intention to Location (Street&Niunhcr) perform the electrical work described below. Owner or Tenant Owner's Address Telephone No.' Is this permit in conjunction with a building permit? Yes Purpose of Building f. h NO ❑ (Check Appropriate Bog) Utility Authorization No. Ezisting Service JIB Amps / c�6) Volts Overhead ❑ Undgrd©--- No.of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Z� Completion of the ollowin table may be waived b the Ins ector o Wires. No.of Recessed Luminaires No.of Ceil.-Sus No.of Total p.(Paddle}Fans Transformers KVO, No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In o.o Emergency d• ❑ d. ❑ Batte Units g No.of Receptacle Outlets No.of Oil Burners FIRS.., ALARMS No.of Zones No.of Switches (, No.of Gas Burners o.of Detection and No.of Ranges No.of Air Cond. Total Initiating Devices Tons No.of Alerting Devices No.of Waste Disposers eat PumpNumber Tons _ hKW- No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW cal❑ Municipal Connection El Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or E uivalent 1K�' Heaters No.of No.of Si s Ballasts . Data Wiring; No.Hydromassage Bathtubs -------------No.of Motors No.of Devices or E uivalent Total HP Telecommunications Wiring: ! OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. a d� Work to Start (When required by municipal policy.) 2 Q Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: the Iicensee. Unless waived by the owner,no permit for the performance of electrical work may issue unless 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 ❑ (Spec I certify, under the p ' and penalties o er'u that the informatzo on this application is true and complete. .fP J t1', FIRM NAME: 141 r Licensee: LIC.NO.:A? Signature LIC.NO. (If applicable, enter 'exempt-zn the license numbe ne.) — Address: � Bus.Tel.No.: �2hi�6�riSipz� *Per M.G.L c. 147,s. 57-6 ,security work requires Department of Public S�ty"S"License: Alt.TelLic'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 agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 1 .f �� �,� � � .�-- ������`� �� S{ r The Comnwnwea[th of Massachusetts J! Department of lndustri d Accidend 1r k Dice of Investigations . �V4, 600 TfZashington Street rsl; •.' � Boston MQ 02111 j www.nzassgov/dia . Workers' Compensation Insiar-we Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Dwizafion/individual): ` Address: D/SG1J City/State/Zip. Phone#: . .^2 TE31 n employer?Cbeck.the appropriate box: a employer with 2 4, Type of project(required): ❑ I atrt a general contractor and I oyees(full ancUorpart-time).* have hired the sub-contractors 6 ❑New construction .a.sole proprietor or partner_ listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have workingfor me in g Q Demoiitian . any capacity, workers'.comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its 9 ❑Building addition required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing iii work right of exemption per MGL 11.❑ Plumbin n7yself. [No•workers'comp. c, 15 g repairs or additions „ P 2, §i(4j;'and we have no 12. Roof I s insurance required]t .employees. [No workers' ❑ repairs COMP. insurance:required.] 13.1 Other ;Any applicant that checks bo)#1 must also fail out the section below showing their workers'oompensation policmiLsty information. t Homeownerc who submit this affidavit indicating they are doing all work and then him outside conuactors ;Contractors that check this box must attached an additional shear showing.the name of the sub-cnntrn _ submit a new affidavft indicating such --e"4�e »- ».,•�� ,...,-,P.POUQy imm�nation. I am an employer that is providing:workers'compensation insurance or information. f my employees Below is the policy mad job site Insurance Company Name:_' Cy yL/ Policy;V or Self-ins. Lie.#: / Expiration Date: Job Site Address:�� City/StatelZip: Attach to 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 e.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 Y Investigations of the DIA for insurance coverage verification. :doltwereby certify un i pains ande perjury that the information provided above is true and conedre. Date: 2 Phone Off�ial use only. Do not write in this area,to be completed by.city or town offria( 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#: Date./DOVER"�°':'� TOWN OF NORTH A PERMIT FORACJMBING s i i SSACMUS� This certifies that . l . r. . . . . . . . . . . . . . . . . . has permission to perform . . . .o . .(t.S . � W plumbing in the buildings of . . . n. . . . . . . . . . . . . . . . . . . . at . . . 7Z. . .fi�-,ftP .'�A� -c. . . . . . . . .n. ., North Andover, Mass. Fee. .17.��.Lic. No.. k .?f. . . . . . . . ..l `` � . . . . . . . KUMBING INSPECTOR ` Check # Z y16 �f Y ` 8535 k`u6ce:�,A�iI1u�C 1 1.7 uniruruvl mrrLtvmi lurr run rentvu r i v vv rs.vtvtvenaa (Print or Type) / Date . , .200 Permit # Building Owner's �° VAT: Location 7a �� - � - �n• Name 4k? Type of Occupancy:_A New ❑ Renovation Replacement Plans • FIXTURES Submitted: Yes ❑ No z z N Q N N z be N O z z W W W sNc j to v �' y M a a ac H _z w a s � _ ~ H x O z _z o a. a w W N rn X N N V W y .Y a y t� ar 3 K oc m m C z a a t7 < d t)X. W O O a .d N i 4 W N G a J = p O. oG J 9 F d x �. x a x. td a O ~ z z a W " x to > !✓ o N r z o o to r W a N Q d S N y a: d O a J ,t o 3 Y J SUB-,8SMT, BASEM ENT 1ST FLOOR I 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TF FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check One: Cera fcat InstalEng Company Name Uptack Plumbing. & Heating, Inc[3 Corp. 1415 Addr°.ss 32 Rochambault Street ❑ _Partnership .Haverhill,' MA 01832 ❑ Firm/Company Business Telephone 9-78 372-8503 Name of Licensed Plumber or GasStter Leonard A. Hall 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 allplumbing work and irutallationv'performcd Under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that 1 do not have liability insurance including completed operations eovnagc.' , • SijasausotOrrnc/Arent � LJ I have a current liability insurance policy to include completed operations coverage, By ture of Licensed Plumber Title City/Town - 8678 67$ Type of Plum .'ng License Master ❑ Journeyman APPROVED(OFFICE USE ONLY) License Number