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Home My WebLink AboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (52) 1160 Great Pond Rd—Holcumbe House i Date...."...C;.................. o?°;t:�``°-.' "°°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 14US This certifies that ...... ................................... .................. has permission to perform .....—I"Q ..... wiring in the building of........ .................. at......................... ........... No Andover,,—,,,Imlass. Lic.NQ��K&3)q ...`. .:. ?�.Fee....tl� ... .... I L i;�P c�o� ELECTRICAL INSPECTOR/ Check # 8114 i Commonwealth of///assachaaeftl Official_t Use Only , rr c� Permit No. .(JePartmanl o� }ire Service® BOARD OF FIRE PREVENTION REGULATIONS [ev.1 07]y and Fee Checked (leave blank) !' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed to accordance with the Massachusetts Electrical Cod 4EC) 527 Cv1R 12.00 x (PLEASE PkINT IN INK OR TYPE ALL l FORMA170N) Date: City or Town of: � - a�rS,,E '�- To the Insp clor of Wires: By this application the undersigned gives notice of his or her intention to perform the elec ical work described below Location (Street & Number) /166) Oji ner or Tenant RC00 S D l 4 .t iSE3 d,�,Z Telephone No, 0N1ncr's Address Is this permit in conjunction with a building permit! `' yes'II. , No El (Check Appropriate Box) Purpose of Building �I✓3ta� t-nJ�t� Utility Authorization No. Existing Service Amps / 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: i'.JLA fZE/J06&-r_1 1�1> t•'hC,,1 — 75ixIGCEE TO Z r6yneL Completion o the ollowin table trial•be�,uit-ed b} the inspector o/lY;res N•o. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total I'ransforiners KVA No. of Luminaire Outlets No. of Hot 'Pubs Generators K V A No, of Luminaires 120 Swimming Pool Above ❑ n- ❑ o• o .mergency tg t trig e rnd. rnd. Battery Units No. of Receptacle Outlets 30 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches '2_(' No. of Gas Burners o. of Detection and InitiatingDevices No. of RanTons ges No. of Air Cond. ons No. of AlertingDevices No, of NN'aste Disposers . teatPump Number Tons KN No. o Self-Contained Totals: . .................. Detect ion/Alertin Devices -No. of Dishwashers Space/Area Heating KNV Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KNN; Security ys.iems:* No.of t)evices or Ec uivalcnt N'0. 0 %N atcrNo. o No, or Heaters K\V Ballasts Data NViring; Signs No. Of Devices ur Ft uivalent !.NO. Hydromassage Bathtubs No. of Motors Total IIP Tele-in municanuns NN iring: ` No. ol'Devices 0r E1 uiTalent tC_ i O rifER: Attuch udditiunul detail tf desired, or as reyuwre,l hr the I,upecr,,r u" Ib';,i•_; Lsumated Value of Electrical Work .0 f (When required by municipal policy.) Work to Stan:q I Ie.( I of Inspections to be requested in accordance with MEC Rule 10, and upon completion INSURANCE COVERAGE:ERAGE: 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 2r ❑ OTHER ❑ (Specify:) I certify, under the�j gins and penalties of perjury, that the information on this application is true and complete. . FIRMNAME: � C,%itl'iC�fL �O.�T�' Try LIC. NO.: Licensee: j14L1/1:> f/)4Z66o'4'� Signature r'r '—' LIC. NO.: (If applicable. etv r .esf�rnpi .to the license number line.) Bus. Tel. No.;77b'-6YZ_ Address; T_' /Jr L�nUv'i Si Mt—a 44 sr AIt. Tel. ;N'o.`%J.f 3 7;- 7}y 'Per NI-G L c 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No ONVNER'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) E] owner E] owner's agent. Owner/Agent _ Signature Telephone No, PERMIT FEE; S z�— i F � � �� f�2`�`^ C� --j d '_' ¢�` �I I . i � r �. Y Date.`/. 7.;/. . ... .... NORTH - - Of TOWN OF NOR A DOVER a' O A ' , PERMIT FOR GAS INSTALLATION i; 93SACHUSEt - F' E This certifies that t . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas.installation . ' — 43. . . . �T in.the buildings of ./7 °�' �. S �. . r . . . . . . . at . . .� .41r. .r �/no :' . . . . . ., North Andover, Mass. Fee. .SR. . . . Lic. No. . . . . ` CL!. GAS INSPECTOR �1 Check# ! i ' 384: MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GAS FITT NG (Type or print) Date O NORTH ANDOVER, MASSACHUSETTS Building Locations 11� Permit# Owner's Name Amount$l . � 1� � New Renovation ❑ Replaceme Plans Submitted ❑ � w � w w o w w o o z° o z F w x z v w x CE 0 a w C7 H z Q x w w a w [-� � E• x a Z , Q w Q a � H � m m 'z O F z x o x 3 c .aa ° °x a w° F SUB-BASEM ENT > o BASEM ENT i. 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . F L 0 0 R 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) , Che one: Certificate Installing Company Name 1 Corp. Address Partner. Business I a ep one d ❑ Firm/Co. Name of Licensed Plumber'or Gas Fitter zV II INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes ❑ No If you have checked es ple ndicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waive : I,am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ 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 performed 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. By: Signature of License Plu er r G Title ❑ Plumber City/Town, Gas Fitter icense Number Master _ APPROVED(OFFICE USE ONLY) Journeyman t Date. . . "oR'" TOWN OF NORTH ANDOVER S PERMIT FOR PLUMBING b 4A—.•x"15 ,SSACMUSE� This certifies that . . . ?� has permission to perform . . . + �.4 {i. '. .�. . . . . . . . . plumbing in the buildings of . . . P. . . . . .t.t. . . . . . . at . . r .0. . .-6-,� 'f. `. . . . . . . . ., North Andover, Mass. C' Fee. . .~. .Lic. No."16e a. . . . . . . . . ILUMBING INSPE,TOR Check ,y 7691 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Lers DateBuilding Location 0 Name �1 Permit# qt /M C u M 6 Amount r L 7 — T_ype of Occupancy Y New Renovation Replacement ' Plans Submitted Yes ❑ No FIXTURES rW O Iz O O O . � *l to 19z F 7 rF .a U a ca A a A a C �� M FIOat 3M FLOOR ` 4IR RDD 5II3 FIlOCE2 6M FL" - 7MFLOCR SII3 FIOQt (Print or type) Qhec one: Certificate Installing Company Name MCorp Aj Address ❑ Partner. Business a ephone Firm/Co. Name of Licensed Plumber: Insurance Coveraee. Indic a the pe of insurance coverage by c ecking the appropriate box: Liability insurance policy Other type of indemnity a Bond Insurance Waiver: I,.the and•rsigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted ntered)in above a do a true and accurate to the best of my knowledge and that all plumbing work and installations erform er Permit sue Ifo s application will be in compliance with all pertinent provisions of the Massachusetts Sta Plum ' de t 1 f the General Laws. By: SignaLure ot L1c=s6Z7TDmer Title Type of Plumbing License ' City/Town r ense er Master Journeyman APPROVED(OFFICE USE ONLY Date. ...... { 0 NpQT e 1 - �� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION :__.. .� �ISS ACHUSEt i This certifies that . . .. . . . . . 'r has permission for gas installation . .1.. . . ... . ...`. ... . . . . . . . . . . . . in the buildings of . .Tj.& . . . . .f at �% �. . . �?:l:j /7`. : . `. . . . . . . . . North Andover, Mass. Fee. /-?. . . . . Lic. No9.ol.'.r. . . . . . . . . . ! Lls ry. . . . . . . . . . GAS INSPECTOR Check# 1 a 31* 53 MASSACHUSETTS UNHORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date . 3 NORTH ANDOVER,MASSACHUSETTS c Building Locations Permit# Amount$ r O C1 Owner's Name A)C�+O M O New Renovation ❑ Replacement ❑ Plans Submitted ❑ xt C7 o o O o 90 09 c� o o r o A v a A a H o SUB-BASEM ENT BASEMENT 1tS T. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR or type) o : Certificate Installing Company Name orp. Address I J� - F� ❑ Partner. Business Telephone - v ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter V INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked L,please indicate the type coverage by checking the appropriate box Liability insurance policy �� Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in alcove application are true and accurate to the best of my knowledge and that all plumbing work and installa' S-peirlbrm under P sued r this application will be in compliance with all pertinent provisions of the Massachus State s e d Ch ter 42 e General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber City/Town ❑ G4 itter License NurnDer T1113aster APPROVED(OFFICE USE ONLY) ❑ Journeyman VY/VVi6VVV LV.LV KAA VVVVIVVVLV AdAL , INV. WjVVL i Ail State Abatement Professionals, enc, 4 Wilder Drive,Suite 12 866.565-ASAP ' Plaistow,NH 03865 Fax:603.378.0610 FAX - rA NF4 91 Number of pages iinckmUng cover shect:. To:PC Froin: Ove Ir OEq� fiesional!,AU State AbatemenrProInc. Scott Ctaley i Phone: Phone: (603)378-0600 i Faxphonep�•- —t)8-(Og$-1?sY1O? Fax phone: (603)378-0610 CC: REMARKS: ❑ Urgent ® For your r view ❑ Reply ASAP ❑ Please comment _L� A Asbestos-Masonry Cleaning•Selective Demolition•Shot/Sand Blasting•Mold Remediation V9/VO/fVVO I0:40 rAA OVddfOVOIV AJAr, lm— WJUUz F All State Abatement Professionals, inc. 4 Wilder Drive,Suite 12 866-565-ASAP Plaistow,NH 03865 Fax:603-378-0610 I April 3,2008 Town of North Andover Board of Health 120 Main Street North Andover,MA 01845 I Phone#: (978)688-9540 Fax#: (978)688-9542 Re: Asbestos Abatement @ Holcombe House, 1160 Great Pond Road To whom it may concern: All State Abatement Professionals,Inc.(ASAP)is scheduled to perform work for the above referencedPro')ect on the following dates: Start Date: 4/4/08 End Date:- 4/4/08 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information,please do not hesitate to contact me. Sincerely, Scott Curley President JSC jab Enclosures Asbestos•Masonry Cleaning•Selective Demolition•SZOOVZnd Blasting•Mold Remediation 04/03/2008 15:28 FAX 6033780610 ASAP, INC. Q003 COMMOntiiweafth of Massachusetts l 100070220 Asbestos Notification Form ANF-001 Decal Number impo s"1- Mienfilling out A. Asbestos Abatement Description When farms to,u 1 a.Is this facility fee eon�p,�,use ty exempt- fawn,district,municipal housing auatority,owner-occupied only the to key residence of four units or less? Yes Q No to more your cursor-do not b.Provide bla*et decal number if apply: � �Decal Numberuse the return key. 2. Facably Location: BROOKS SCHOOL 11160 GREAT POND ROAD a Name of Fadlity b.9"AM North Andover [MAIMAM MI 1(978)725-84 Q Citylfown d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Wbfksite Location: 1.All QW10M of Wt. HOLCOMBE HOUSE I 12ND fan nW be a&Adit NameGuelft Location b.BuilftA 0.1Mng d.Floor e.Room Weipleted in ear to comply wft 4. Is the Witty occupied? ❑Yes ❑1 No MPnodficadw requiemenb 91310 CNet M 5. Asbestos Contractor. Of and tne,oiVIMM i ALL STATE ABATEMENT PROFESSIONALS 4 WILDER DRIVE SUITE 12 Sa"(DOS) a. b.Addre "0�b011PLAISTOW ® 6033780600 requirements of d53 CMR 6.12 C.C' Kowa d.Zip Code e.Telephone Number A0000331 Contract T t uoense r 0• Yoe: 91 Written C1 Verbal J.SCOTT CURLEY PRESIDENT Penson i.COMM Person':Title 6 JEFF CURL.EY ASOMM a.Name of On-Weon:m9n Dreman DOS Cu'rbTrcdGon Number 7 Al SPECTRUM SERVICES I 1AA0001152 a.Name of Pfoied Monitor b.PMot, Monitor DOS Certlficatlon Number l3. A7 SPECTRUM SERVICES AA000152 a.Name of Asbeqtte Anal0ofb.Asbestos An Lab DOS CeAifl n 0 9 0 prole 008 04/0412008 a Dade b.6rd Debs 0 7-3:30 0 10. a.What type of project is this? o ❑Demolition Q Renovation �. ❑ Repair ❑Other.please specify: D.Desalbe i 11. a.Check abatement procedures: - C 0 Glove bag Encapsulation �o ❑Enclosure Disposal only �MLL ❑Cleanup ❑Other,specify: Z ❑Full containment b.Describe �< 12. Is the job being conducted: Indoors? ❑Outdoors? anf001ap.doc•10102 Asbestos NotMc:ation Form•Pepe 1 of 3 I i 04/03/2008 15:29 FAX 6033780610 ASAP, INC. 1004 Commonwealth of Massachusetts 100070220 Asbestos Notification Form ANF-001 °eca'N""'°er A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encamulated: 24 J ,0 a•Total Plies or duili(linear IQ D. I ow Wier sunaces a Boater,breanhir g.duct.lade � � d.InvAsling cemerd burfsce coatings lin.ft. it e.Conullated or layered paper 1 f.TroweYSprayer ooatMgs L -� pipe lnsulstim Un. .IL �L'in''�� S4•fl 9.Spray-on fimom dn9 Un� h.Ttansite board,wall hoard L. J i.Clotns,woven fabrics Un.ft. }Other.please specify: Un�� k.Thermal.solid core pipe 2a insulation Un.ft. Sq.ft. I specify 14. Describe the decontamination system(s)to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM. 15. Describe the containerizationldisposal method to comply with 310 CMR 7.15 and 453 CMR 6.14(2) DOUBLE 6 MIL POLY. 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: JOE PAPPARELLA a.141010 Of LW-P 31111 0.Twe 0410312008 1084W988 c.Pate mmki of AuUoriaetion d.DEP Waiver 9 f:VELYNA CORRIA e.Name of DOS Official 1.DOS 0116181dle 0410312008 08-127-NB IS! 9.Dale(meVdd/yyM of Authorization h,DOS Waterer 9 0 17. Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A-F apply W this project?❑Yes 91 No ° B. Facility Description o 1. Current or prior use of facility. MOUSING �o 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes d No BROOKS SCHOOL 11180 GREAT POND ROAD 3' a.Facility Owner Name b.Address NO.ANDOVER,MA 01845 978 725.8284 o C•CWTown d. 0 e.Telephone Ntrmeer area code and extension LL 4 NORMAND GRENIER 1160 GREAT POND ROAD � a.Nerve of Faciri I Own z On-Sle Manager b.OrrSMe Manager z No.ANDOVER,MA 10180 978A25.6284 Q C.CWTown d.Zip Code e.Telephone Number(ase code an0 wM01ap•doc•10102 Asbestos Nordic9tion Fom1• 2 3 04/03/2008 15:29 FAX 6039780610 ASAP, INC. 0 005 � r Commonwealth of Alhlssachusetts 100070220 I , Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) 5' a.Name of General Corrector � I C b.Address C. /Town l d.2 Coda e.Telephane Number Low code and exttnslon f.Conbacws Worker's can.bns m 9.Policy Number h.Exp.Date(mmid 6. What is the size of this facikty? 5900 3 a Square Feet b.Number of favors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): ALL STATE ABATEMENT PROPESSIMALS, 4 WILDER DRIVE,STE 12 NOW.Transfer a.Nance of Transwrter tn.Address Stations must IPLAISTOW,NH 03865 603 3784600 coaft vAh V* c.CW/Town d.Zip Code &Telephone Number Sold Wask Division 2. Transporter of asbestos-containing waste material from removatrtemporary site to final disposal site: Regulahwo 310 CMR 19•000 J.O.BJROLLOFF,INC. PO BOX 6037 a.Name of Transporter b.Address CHELSEA,MA —� 02150 617 387-1495 a Ckif/Town 0.Zip Code e.Telephone Number 3. IWA, a.Refuse Trareftr Station and Owner b.Address e. own d. Code e.Teleghone Number 4. ITURNKEY LANDFILL(WASTE MGT NH a.Final DeRqul Site Location Name b.Final Disposal Site Location Owner's Name 7 ROCHESTER NECK ROAD ROCHESTER c.Final Dmuosal 8b adomd. (Town NH 03839 (800)847.5303 6.State L Zip Code U.Telephone Number �o D. Certification N The undersigned hereby states,tinder the JUDITH BERMNSKY O penalties of perjury,that helshe has read the a.Name b.Authorized 3t nature o CommormMealth of Massachusells regulations {OFFICE MANAGER 1 104/032M ®� for the Remmral,Conteimmers or C.PosklonITiUe d,Date Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information (603)378-0600 ASAP,INC. cm0ned in this notification is he and vowed e.Teleotwo Number f. to the best of NsRter WWWedW and belief. 14 WILDER DRIVE,STE 12 a.Address PLAISTOW,NH —� 03865 K Ci town i.Zip Code 2 Q an1001ap.doc•10002 Asbestos NotMcatlon Form•Page 3 of 3