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Miscellaneous - 12 MASSACHUSETTS AVENUE 4/30/2018 (3)
+ 12 MASSACHUSETTS AVENUE 210/002.0-0003-0000.0 _ / L 1 Date......�1:. ...�.1...... µORTI� "° TOWN OF NORTH ANDOVER p PERMIT 'FOR WIRING SSACMUS� 3 1f a s This certifies that ....... ............. ... l............... has permission to perform .. .. .44P7 .... wiring in the building of...... f at........Z.....,...../ #S...............S.../..... .. ..: ...........................,North Andover,Mass. Fee..�.�„�1�..�..�"�.. 'Li .Nd:s.�'..��.�..... �...... . ._........ t Q 35"8 PELECTRICAL INSPE R Check 1107_Z— 10455 �y Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD tr N All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 -r 1*� (PLEASE PRINTT ININK OR TYPE ALL INFORMATION) Date: //- 7 _ // \ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfotm the electrical work described below. i�- Location(Street&Number) /j/JGS� l Owner or TenantJ� ,,��, Telephone No. \ Owner's Address Sin•c r Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) �J ell Purpose of Building Utility Authorization No. Eidsting Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters lz'% Nnmber of Feeders and.Ampacity 1 . .Location and Nature of Proposed Electrical Work: - ._� (�o tt WIV`"C ✓lGw ci,4s t c%�� 5 �1 �h�C �td'c,�-•u .Mo.,+ i't, heaa C 1YtS5 0 4'J w t+' at5 Q{.eer r Completion of the following table may be waived by the Inspector of Wires. No,of Recessed Luminaires No.of Cell.-Busy.(Paddle)FansNo.of TotalTransformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators ICDA No.of Luminaires Swimming Pool Above ❑ 'In ❑ o.of Emergency Lighnng nd. rnd. Battery Units - No.of Receptacle Outlets No.of OB tiff'ners FII?X AL.A.RMS No.of Zones No,of Switches No.of Gas Burners NO..Inof Detection and • Initiating Devices ` No.of Ranges No.of Air Cond. T ootal No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I.Tons 7M No.of Self-Contained Totals: Detection/Alerting Devices cal No.of Dishwashers Space/AreaHeating IOW Local[IM n i cion ❑ Other No.of Dryers Heating Appliances KW Security Systems.` No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1<0pr},0 A (When required by municipal policy.) Work to Start: //—7 t/ 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 4 A&Jc,r, 0re!5. Z e- (ALL Vv4 S) LIC.NO.: /5_6 7,(4 Licensee: tV a✓!ci c �_ r c,ri Signatures � _ LIC.NO.:0 szotc" (If applicable,enter"exempt"in the lice a number 1' e.) �— Bus.Tel.No.:56%- 9 97-S 3'-2 Address: .3? ����« �:�64yi/� /I�tr o t S`f° Alt:Tel.No.:/k00-6/ f t•>-S2Z *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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 I PERMIT FEE:S The Common wealth of Massachusetts l Department of Industrial Accidents Office of Investigations ; 600 Washington Street it Boston, MA 02111 www—wass gov/dia . Workers' Compensation Inshrance Affidavit: Builders/Contractors IElec tricians/Plu�bers A licant Information Please Print LeQibt �p v Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: . Are you an employer?Checkthe appropriate box: ' [2. .❑ I�d a em 10 er with 4, Type of project(required): p Y ❑ 1 am a general contractor and I G. ❑New construction employees(full and/or part-time).* have hired the sub-contractors [] I am.a.sole proprietor.or partner- listed on the attached sheet t �• ❑Remodeling ship and.have no employees These subcontractors have 8. ❑Demolition working for mein any capacity, workers' comp.insurance. [Na workers'comp.insurance 5. 9• ❑Building addition p ❑ We are a corporation and its required.] 10. Electrical repairs etl ] officers have exercised their p rs or additions 3.❑ I din a homeowner doing all work right of exemption per MGG I 1-❑Plumbing repairs or additions myself,[No-workers'camp. c. 1.52, §1(4),'and we have no 12,❑Roof repairs insurance required.]t .employees, [No workers' comp. insurance required.] 13.❑.Other 'Any applicant that checks bob#I must also fill out the section below showing their workers'bompensation policy information, t Homeowners who submit this affidavit indicating they am doing all work and then hire outside conttactots must submit anew affidavit indicating such. --- #contractors th8t ehecic this box must attached an 8dditional shsct showiirg i_he name of the sub-contractors and their 4icr.Ua;s'comp.pcli,^y tnfo;,a6oa, I ai*ra an ew ,10par that fS,,PrgV!d1k1g:w0,,rcer3,coi,4pensado a aa2sura„2cef0,r my ertapinyees: fed®av is€!re policy andjob site information. ” Insurance Company Name: Policy#or Self-ins.Lie•#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'.'compensmtion 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cedfify under the pains and penalties ofperjury that€lie information provided Alcove is true and correct. Sienature:- Date: Phone#: [:::w only. Do not tome;n Mis a:ea,to be c.��:,p19ted by c y o:tawis official n; Permit/License# thority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: I t } f V C3MtVtON1NEALTH OF MASSACHUSETTS f r ELECTRICIANS r� ASA EG JOUtNETPEAN"ELECTRICI N k 1 1 ESxTHE A VE L1 ENSE TO FRANCIS R RICHARD a m: • � 4: -ter X18 :FAULKNER STREET {n j i jAYE:R q 01432 ;1612 +a Permit Listing Report Date by Work Category Range:]ssued between 77/22/2070 And 71/22/2070 Printed On:Tue Jan 25,2011 Work Category Address(Work Location) District Zoning Owner Proposed Use And Details Est.Cost Permit Type Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check# Commercial Alteratio 52-54 WATER STREET(-52 G-B WATER STREET REALTY TRUST&C/O CR $4,950.00 WATER STREET) Building BP-2011-435 OPEN Nov-22-2010 DAIGLE FAMILY TRUST REPLACE EXISTING ROOF,PERMIT 435 $60.00 4626 530 TURNPIKE STREET GB PICO TRUST&JOHN F MC GARRY,TR $7,500.00 Building BP-2011-436 OPEN Nov-22-2010 Salem Five Cents Savings Bank MODIFY WINDOW FOR DRIVE-THRU $90.00 3331 Work Category(COMMERCIAL ALTERATION)TOTALS: ESTIMATED COST: $12,450.00 NUMBER OF PERMITS: 2 FEES INVOICED: $150.00 FEES PAID: $150.00 BALANCE: $.00 Demolation 16-18 DUTTON COURT LAWSON,ROGER JR&JUDY $1,400.00 Building BP-2011-434 OPEN -Nov-22-2010 LAWSON,ROGER JR&JUDY DEMOLITION OF GARAGE,PERMIT 434 ' $30.00 7813 Work Category(DEMOLATION)TOTALS: ESTIMATED COST: $1,400.00 NUMBER OF PERMITS: 1 FEES INVOICED: $30.00 FEES PAID: $30.00 BALANCE: $.00 Mise ' 12 MASSACHUSETTS EXXON MOBIL - , $14,000.00 �— AVENUE / HVAC6t �� BP-2011'106 > OPEN Nov-22-2010 EXXON MOBIL ` _ HVAC � ;$168.00J 850018 u Work Category(MISC)TOTALS: ESTIMATED COST: $14,000.00 NUMBER OF PERMITS: 1 FEES INVOICED: $168.00 FEES PAID: $168.00 BALANCE: $.00 GeoTMSOO 2011 Des Lauriers Municipal Solutions,Inc. Page I of 2 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit NO: fel Date Issued: I� IMPORTANT:Applicant must complete all items on this page LOCATION ' WI N Mob A Print PROPERTY OWNER E e Print MAP NO 'a PARCEL: '�'�'J ZONING DISTRICT: Historic District yes no Machine Shop Village yes no I TYPE OF IMPROVEMENT FResidEential D USE { Non- Residential j ne family ❑ New Building ❑ Industrial ❑Addition ❑Two or more family El Alteration No. of units: Kcommercial Repair, replacement ElAssessory Bldg El Others: I, ❑ Demolition ❑ Other �--, � .� �.- e an S _ ® Watershed District D;Se ti '_®Wellt [IRM dpetlands t. ti .4 b I - DESCRIPTION OF WORK TO BE PERFORMED: V1?U C+U F I'1. L,(µ+ P"vCJ �-W«- �'"'w f , a //��7 Identification 4: Date OWNER: Name: Address: TOWN OF NORTH AMDOVER -,. A FOR MECHANICAL-INSTAL-hA C- CONTRACTOR Name: 1/1 n of °Ro",,."oo PERMIT Address: LL-Z 0 » Supervisor's Construction License: f L=—j SAC %3 Home Improvement License: f ies that • This certifies mechanical installation • �� { ITECT/ENGINEER rt„ission ford ARCH t has pe CX v o North Andover , in the buildings of` ' Adgress: , f DING PERMIT:$12.00 PER$9000 at �" j t�r'.T t ' GAS INSPECTOR FEE SCHEDULE.BUL Fee/d-- j,�C. N°'' PINK;Treasurer / U CANARY:Building CePt' Total \\-\ V"Project Cost: $ � U pcaM - WHITE:APP _ Check Noi2 con NOTE: Persons contracting with unregister a tractor have access to the guaranty fund aSi _:._ontractor :..,., ::.... .�.....::., .r..-i Signatureo_f_'Agent/Owner . : I File list Management He1n: ►s 002.D 0003 12 MASSACHUSETTS AVENUE Details` Peo le Fixtures Ins ections Certificates Conditions A royals Documents I Permit Na MP 2017 0004 ] Work CategoFA Misc I,s� 1 Tracking No BP 2011 106 Estimated Cast $14,000 �. y q e ' Work Locatjo 12 MASSACHUSETTS AVENUE l� Dig Safe Status Expired li Tax id inspector p Zoning ° Date Submitted 11/2212010 Use Group '` Approved On�JA Fire Grading t I Approved By li' Live Load r Amended 0f Occupancy Load j f Expires On 0512212011 Construction Clas - - Date Issue 11122{2010 — - 11 k t � G k Comment IMOBILE STATION AT 12 MASS AVENUE,PERMIT 106 { Desc.of Work I.- Fees 1Edit ; Preview Permit Preview wlerge GIS Ma New Notifications Close P i Start :: ` a. ( Inbox MicrosoFt Outlook 1 G�Building,Electrical&Mec,.: _ 11:34 AM -- - - - _ _ - Tuesday, Dec 06,2011 11:34 AM l��ltJ1J0Vl1V�Gi"�OUV � t�i`�JVvg QltV�a 37 FEDERAL HILL ROAD • OXFORD, MASS. 01540 MEMBER TELEPHONE: (508) 987-5322 To: Frank Montero, Engineer MHF Design Fcm@mhfdesign.com From: Daniel R. Moore, Project Manager LaMountain Bros., Inc. Date: December 28, 2011 RE: Mobil Station, 12 Mass Ave., North Andover, MA Dear Frank: Please accept this letter as verification that all product lines installed at the above referenced location were tested at 60 psi for 1 hour. Also, all tank sumps and dispenser sumps were hydrostatically tested for. 24 hours. All testing was completed on December 14th by LaMountain Bros., Inc. and were witnessed and verified by the North Andover Fire Department. If you have any questions or require any additional information, please feel free to contact me in my Office at 508-987-5322, on my cell at 508-889-4654 or via email at dmoore@lamountainbros.com. Thank you, la)niel R. Moore �C Project Manager La Mountain Bros., Inc. Date..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING US :50X? C-4!!F-e-7- Thiscertifies that ............................................................................................. has permission to perform ..... .. Cee6..........,.R ................ wiring in the building of......... ........... ....................... at........LP.......�"5....At46��7................. .North Andover,Mass. Fee A- Lic.No..a' .4! ............4 ELECTRICAL INSPEMRIf k: Check # 6665 ,..af.a Permit No. BaMOFFIREPREYF11t MR GULATIgI 527adR,a•N 0=pw1q 3 Pees ectad �•..�.•� APPUC IHONFOR PERIO f M PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT 1N INK OR TM ALL INFORMATION) De Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 1A p&:j S / Owner or Tenant sh—M Y4-rn r--&n1 Owner's Address ls this permit in conjunction with a building permit: YesM No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service t7� Amps�Volts Overhead Underground No.of Meters New Service Amps...../ Volts Overhead Underground M No.of Meted Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work L 4v 04J u�CQ S �jM D Na of Lighting Outlets Na of Hat Tubi No.of Trsmbno,ra Told KVA Na of Lighting Rat" Swirmtdm Pod- Above Below datetaoara KVA yound yowd No.of ReceptWA Outiva Na of OH Burners No.of Finagsaq Lighting Buttery Uniti t Na of Switch Oudeu Na of am Barran Na of Ranges Na of Air Coad ToW FIRE ALARMS No.of Zorm Tam r Na of Disposals No.of Had Tote! TOtd Na of Ddecdoa and ?mums TOM No.of Dishwuhers Space Amer Hewing KW No.tiating�"D 3ormding Deviate Na of Self Conwined Na of Dryers Heating Devices KW t aJsomdng Devices LoafMnrddpi E3q� No.of Water Hewn KW No.of f,of � mr Coeetiom Sh= Beilds No.Hydro Mwuge Tuba Na of Motors Told HP oTw>?kx — D r'e- eo iJ k r aoD �Ll AJ 4-•Z i s .t C hsuW=CVMW Anal 1Ddzreg<ie Md GemdLmm 1ha eauaertLit�yhasceP�Yiridr�Ck�m>pi� crlhaksha agjv Wast YES NO Q lhneslftriledvafdproddsanebhDIDta Y$9ti ayoutsedredoedYB4,Ph=hJ ft1xrpecfaovwrby ELMS Z".. ri s W5URA1NlZ � am on= � �Pfr�eSpeary) WbMDStag" DoeRalnsbd FAmdadVazdEkcd*WhkS ODD Sigiedundat twerksdpajury►. ("NS linl FMMNAME MArst1is LimaNd. cizallo Addmp /,9 - UDQnf .N� t-�• O,��o� �resTliNa CJwv WSIIV,AJRANMWA1VEK,I nawmtntzLizwftpt�a,eiramlce ��Na 3 997� / zddietrryeaaeondispemitappl®dQiw"afirequimlet �97��e� z��bY �Ca�illit (Please check one) Owner a Apo Telephone No. pBRM1T FEB s __ � �._ � ��� Y ,, 4 �`� Date... /x................ AOR TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4o ,ssA CHUS This certifies that ....... ................................... has permission to perform ..... wiring in the building of... ................. ..................... .................. .................^. ......... North Andgy fr,Mass. ... . .. .. ...... Fee ... Lic. ........ ICALINS COR Check # 8092 j elmmonweaR o f/f'ladeackwelb Official Use Only o�� cc��r� p c7 Permit No. PC)/02 i eUeParEment ire�erviced Occupancy and Fee Checked / BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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 PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: f dAh bJK nvc,/ 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) / iYIO�S S FtLil�� Owner or Tenant _cy w. Mil a4,,(e. Telephone No. Owner's Address SQ61M 0 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 6—(A5 :S 4 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: t'L'Gttiy,h G f o4Ao&r 1^ ekce�f— CG7n id usl V, $0,vs,,g Completion o the ollowin table may be waived by the Inspector 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 Swimmin Pool Above ❑ In- El o Emergency Lighting g rnd. rnd. Battery Units a No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of nd Detection a Initiating Devices Total f Alerting Devices f Air Cond. No.o No.of Ranges No.o C g g Tons No.of Waste Dis posers Heat Pump Number. .Tons KW No.of Self-Contained p Totals:: Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local El Connection E] other No.of Dryers Heating Appliances KW Security ystems:* rY No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Equivalent No.Hydromassage No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Ejectlical Work: p2 �y (When required by municipal policy.) 3 Work to Start: 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 9 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the to ormation on this application is true and complete. FIRM NAME: T/ F✓mj lcia dl LIC.NO.: A//1.317 Licensee: 2%or nQ 5 /T'aPr,firth Signature LIC.NO.: 455747 (If applicable,enter"exempt"in the lic nse numb line. Bus.Tel.No.• 7 — �' 971 Address: a&(l OIC455 Av , d Yfp9lty �A �� 71 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security ork requires Department of Public Safety"S"License: Lic.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 a ent. Owner/Agent PERMIT FEE: $14 5 Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street W= Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): —?'orn(41 ��J .4 c q Address: (,o M A 89 City/State/Zipa 010. dam Phone.#:17 g ip'�77 Are ou an employer?Check the appropriate box: VType of project(required): 1: I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ElNew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractor s have and have no employees 8. ❑ Demolition workingfor me in an c employees and have workers capacity.Y p �' 9. Bu'ldin addition [No workers'comp, insurance comp.insurance.$ ❑ g required.] 5• ❑ We are a corporation and its 10. lectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: CO3 ✓xinzeyc Q Policy#or Self-ins.Lic.#:' �-� i'7,c) Expiration zi,5-Ab(? Job Site Address: 12 A77-)-4 A sem.. City/State/Zipjpj,� 4 o7 t« 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification Ido hereby certify nder the pa' s an enalties o perjury that the information provided ab ve is tr a and correct Si ature: 'All 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." !' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a Joint enterprise, and including the legal representatives resentatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to,opera'te�a business or to construct buildings in the commonwealth for any .: applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contactg regarding ou din theapplicant. Y g Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in -. (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is 1J0T required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address telephone-and fax number: The Commonwealth of Massachusetts Department of lndusteal Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 6.17-727-4900 ext 406 or 1-877-MASSAFE Revised 1122-06 Fax# 617-727-7749 www.mass.gov/dia ` 1 - May. 3: 2�06� 11 �6�+��• Station#11639:'1VorkOrder#150443 Date: Vla� 18th.200f�0' 4�d8ee 1P 1! 9 . . - Y. ..... CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING !' Crompco Corporation ugz 1815 Gallagher Road Phone: (610) 275-7203 Fax: (610) 278-7621 Plymouth Meeting, PA 19462 Mork Order 4150443 Client Triformation Station 411639 Date:May 18th, 2006 Integrated Process Technologies, 'Mobil Service Station j Reason:Investigation LLC(Accounts Payable (Non- 112 MASSACHUSETTS AVE Compliance:No ;Compliance)) '.North Andover, MA 01845-3413 1 Invoice# 'County: Essex Permit# IVR Air Quality# 367737 1 P.O.#78660954 ....... .. ........ ... . ..... _ -- . .... - _.._.. .... ._.. ......_ .. ....... ................ 1 Testing was conducted in accordance with all applicable portions of Federal, NFFA,and local regulations. Epulp Grade Test �Resttlt 003 Special EZY-3 i Pass b04 Swpar. Y 3 Pass: ....... 1002 ;Regular QY-3 jPass SOS SFXbse Oil IaZY 3 Pass Equlp # Grade Test (Result 002 Regular ;Petro-tits Line .Pass CI03 , Speclel Retro�tlte Un® Pass :.. ._ 1.004 ,Super Petro-tite Line Pass _.. .: . SpaceConfined l=grm Result - - ._... _. .. _ Confined Space Entry Form Completed Additional Costs PARTS: Fill Adaptor Cep(flet top),Fill Adaptor Swivel Brett Vignali EZY-3 Locator Plus*70-3946 Petro-Tito Line Testing*PAC0126120307R Ulrich Griswold EZY-3 Locator Plus*55-9416 Petro-Tits Line Testing*PAC0172120307C http://www.crompeo.cormworkorderpop.php?sid=018A7F219CA56872&workorderid... 5;18/2006 MaY, ,.32006r11: 10 AM Station#11639: Work Order##150443 Date: May 18th,200J0. 01-1 .��be Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639/WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 S 19462 7203 May 18th, 2006 FAX: 610-278-7621 ._.......... ----___....__.._______.__...__._._.__ __._._._..._._._.�_�.._..__-........_._.....__. TOTAL TANK VOL(gal): 6085 TANK #/PRODUCT 003 /Plus r SLAVE TYPE: ULLAGE VOL(gal): 3378 WALL TYPE: Single PRODUCT VOL(gal): 2707 MATERIAL: Fiberglass PRESSURE SENSOR CALCULATION 44.5000 X 0.026 psi = 1.1570 PSI(1) (INCHES OF PRODUCT) (WEIGHT OF PRODUCT) 5.0000 X .036 psi = 0.1800 PSI(2) (INCHES OF WATER IN (WEIGHT OF WATER) TANK) Line 1 + Line 2 = Total Positive Head Pressure in Tank = 1:3370 PSI(3) j 40.0000 X 0.036 (Water Table = 1:4400 PSI(4) Outside Tank) 0.049 (Brine Filled DW (INCHES OF WATERTank) 3 OUTSIDE TANK) 0.0 (Double Wall Dry) Total Head Pressure Minus Outside Water Pressure = -0.1030 +/-PSI(5) Always add .5 PS! = 0.3970 PSI(6) NOTE: If Line 6 is less than .5 PSI, Line 7 shall be .5 PSI 1 TEST PRESSURE = 0.5000 PSI(7) TIME PRESSURE Depth of Groundwater Determined: (psi of:vacuum) By: Tank field observation well BLOWER STARTED: 940 0.0000 Where: next to tank(s) TEST PRESSURE REACHED: 948 0.5000 BLOWER TURNED OFF: 955 0.8000 TEST BEGAN: 1000 0.7600 TEST ENDED: 1005 0.7500 j WATER SENSOR CALIBRATION TANK SYSTEM i......... .. _.. __.. . Added Product in Tank(inches). 44.5000 100.0000 90.0000 90.0000 (ml): Water in Tank (inches): 5.0000 .!ol 7�1 mol 7141 .!al ,P5 ianktop to grace �incnes): 44.5000 Average: 93.3333 Diameter (inches): 92.0000 Water Intrusion Test Period: Began: 1010 ;Bottom to grade (inches): 136.5000 Ended: 1040 Groundwater (inches): 40.0000 Calculation for test period: 1 93.3333 /3780 = 0.0247 / •45 X 29.6296 60 = (min) Ave. Cal. °A" Time of Factor Test -- ._.. THE ACOUSTIC CHARACTERISTICS OF A LEAK REVEALS WATER SENSOR INDICATES _....... .... .. .--. _ .... .. ...-.__- .. _..... _.._ P-NO WATER INTRUSION TIGHT TANK !r-WATER INTRUSION This underground storage tank PASSES the criteria set forth by the http:/'www.crompeo.com/workorderpop.php?sid=018A7F219CA56872&workorderid... 5/18/2006 Md l: '83 2 0 0 6 rN]. ]AM M Station#11639: Work Order#150443 Date: May 18th,2006°' 9-; �0 8be 3 U.S. EPA r NOT APPLICABLE r ULLAGE (DRY) PORTION LEAK' INCONCLUSIVE This underground storage tank FAILS the criteria set forth by the ji U.S. EPA 1 r BELOW PRODUCT LEVEL(WET) PORTION LEAK This underground storage tank FAILS the criteria set forth by the U.S. EPA r Inconclusive I , i , http:/,'www.crompco.com/Nvorkorderpop.php'?Sid=018A7F219CA56872&workordcrid.,. 51'19/2006 May, °'r.t 06rN������:��: Station#11639: Work Order#150443 Date: May 18th,200E 0' 91—"e 4P . 4/ 9 Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639/WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 EZY 3 Locator Plus TOTAL TANK VOL(gal): 7950 TANK #/PRODUCT 004/ Premium TYPE: I—SLAVE ULLAGE VOL(gal): 4889 ! WALL TYPE: Single PRODUCT VOL(gal): 3061 MATERIAL: Fiberglass PRESSURE SENSOR CALCULATION ]....._.......... ...... .,.. ... ...._.. ............ ........_.... :.: ..,_r..., ...,. ... . , ...... . ... .. 38.5000 X 0.026si = 1,0010 PSI(1) P , (INCHES OF PRODUCT) (WEIGHT OF PRODUCT) 4.0000 X .036 psi = 0.1440 PSI(2) (INCHES OF WATER IN (WEIGHT OF WATER) TANK) 1 Line 1 + Line 2 = Total Positive Head Pressure in Tank = 1,1450 PSI(3) 40.0000 X 0.036 (Water Table = 1.4400 PSI(4) Outside Tank) (INCHES OF WATER r:0.049 (Brine Filled DW OUTSIDE TANK) Tank) 0.0 (Double Wall Dry) Total Head Pressure Minus Outside Water Pressure = -0.2950 +/-PSI(5) Always add .5 PSI = 0.2050 PSI(6) NOTE: If Line 6 is less than .5 PSI Line 7 shall be .5 PSI TEST PRESSURE = 0:5000 PSI(-,) TIME PRESSURE Depth of Groundwater Determined: (psi of vacuum) By: Tank field observation well BLOWER STARTED: 940 0.0000 Where: next to tank(s) TEST PRESSURE REACHED: 949 0.5000 BLOWER TURNED OFF: 955 0.8000 TEST BEGAN: 1003 0.7800 TEST ENDED 1008 0.7600 Added _._ _.__ ..... -_-- !Product in Tank(inches) 38.5000 WATER SENSOR CALIBRATION TANK SYSTEM .... .. . ...... 90.0000 110.0000 80.0000 (ml): Water in Tank(inches): 4.0000 Cal #1 Cal #2 Cal #3 Tank top to grade (inches): 43.0000 Average: 93.3333 Diameter(inches): 92.0000 Water Intrusion Test Period: Began: 1010 Bottom to grade (inches): 135.0000 Ended: 1040 Groundwater(inches): 40.0000 Calculation for test period: 93.3333 / 3780 0 0247 / .05 X 29.6296 = 60 = (min) 1 Ave. Cal, °A" Time of Factor Test THE ACOUSTIC CHARACTERISTICS OF A LEAK REVEALS WATER SENSOR INDICATES. �... .. _._ . ;r:NO WATER INTRUSION P'TIGHT TANK r WATER INTRUSION This underground storage tank PASSES the criteria set forth by the http:/,www.crompco.comhvorkorderpop.php7sid=018A7F219CA56872&workorderid... 5/18/2006 M a Y, ,. . 2 0 0 6,r 11. 12 Station#11639: Work Order#150443 Date: May 18th,200J10. 9,108, 5� � 5/1 U.S. EPA r NOT APPLICABLE ULLAGE(DRY) PORTION LEAK r INCONCLUSIVE i This i inderomi rnrl 5tnrmoP fRnk FAiI 9 the rritt-rim net fnrth by thQ U.S. EPA BELOW PRODUCT LEVEL(WET) PORTION LEAK j This underground storage tank FAILS the criteria set forth by the 1 U.S. EPA C Inconclusive ... . http://www.crompeo.c,omiworkorderpop.php?sid=018A7F219CA56872&workorderid.,. 5/18/2006 May, 3 2 U6�.1 1 13�+��: Station#11639: `'Fork Order#150443 Date: May 18th,200J, �' 9!t$be 6P. �� 9 . . , r,,.....AM Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639/WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 FZY 3 Locator Plus TOTAL TANK VOL (gal): 9816 TANK#/PRODUCT 002 / Regular :SLAVE TYPE: ULLAGE VOL (gal): 5450 WALL TYPE; Single PRODUCT VOL(gal): 4366 MATERIAL: Fiberglass 1, :... .., . .. PRESSURE SENSOR CALCULATION .. _ j 43.0000 X 0.026 psi = 1.1180 PSI(1) (INCHES OF PRODUCT) (WEIGHT OF PRODUCT) 2.5000 X .036 psi = 0,0900 PSI(2) (INCHES OF WATER IN TANK) (WEIGHT OF WATER) Line 1 + Line 2 = Total Positive Head Pressure in Tank = 1.2080 PSI(3) 40.0000 X 0.036 (Water Table = 1.4400 PSI(4) Outside Tank) (INCHES OF WATER r:0.049 (Brine Filled DW OUTSIDE TANK) Tank) 0.0 (Double Wall Dry) Total Head Pressure Minus Outside Water Pressure = -0.2320 +/-PSI(5) Always add .5 PSI = 0.2680 PSI(6) NOTE: If Line 6 is less than .5 PSI, Line 7 shall be .5 PSI = 0,5000 PSI(7) TEST PRESSURE TIME PRESSURE Depth of Groundwater Determined: (psi of vacuum) By: Tank field observation well BLOWER STARTED: 1036 0.0000 Where: next to tank(s) j TEST PRESSURE REACHED: 1040 0.5000 BLOWER TURNED OFF: 1046 0.8500 TEST BEGAN: 1051 0.8406 TEST ENDED: 1056 0.8400 ............. _.... .... ............ ._._._ -. -.._....... _._ . ...... . _. I... .. _._.. .. .... WATER SENSOR CALIBRATION TANK SYSTEM ... ..------ . .... ...... ....... .._.. .. - Added 100.0000 90.0000 100.0000 Product in Tank(inches). 43.0000 (ml}: !Water in Tank(inches): 2.5000 Cal #1 Cal #2 Cal #3 Tank top to grade (inches): 49.5000 Average: 96.6667 i Diameter (inches): 92.0000 Water Intrusion Test Period: Began: 1100 ;Bottom to grade (inches): 141.5000 Ended: 1131 !Groundwater(inches): 40.0000 Calculation for test period: { / .05 X 60 30.6878 96.6667 / 3780 = 0.0256 = (min) "A" Time of Ave Cal. Factor Test - THE ACOUSTIC CHARACTERISTICS OF A LEAK WATER SENSOR NSOR INDICATES 57 NO WATER INTRUSION P TIGHT TANK 7 WATER INTRUSION This underground storage tank PASSES the criteria set forth by the http:i,www.crompeo.com/xvorkorderpop.php7sid=018A7F219CA56872&workorderid... 5/18/2006 May, 8. 2 D 0�rl 15 AM 1,—ge 7P,. I Station#11639: Work Order#150443 Date: May 18th.2006N 0'' 8 V U.S. EPA r NOT APPLICABLE r ULLAGE(CRY) PORTION LEAK r INCONCLUSIVE This underground storage tank FAILS the criteria set forth by the U.S. EPA r BELOW PRODUCT LEVEL(WET) PORTION LEAK This underground storage tank FAILS the criteria set forth by the U.S. EPA r:Inconclusive ........... ...... http:"/'Www.crompeo.com/xvorkorderpop.php?sid=018A7F219CA56872&workorderid... 5/18/2006 Nl a Y, '8. 2)0 6 11 : I 5MAt Station#11639: Work Order#150443 Date: May 18th, 21006110- 9"Ut'n,; 7p.-. 2',/' 9 U.S. EPA F NOT APPLICABLE rULLAGE(CRY) PORTION LEAK r INCONCLUSIVE This underground storage tank FAILS the criteria set forth by the U.S. EPA r'BELOW PRODUCT LEVEL (WET) PORTION LEAK This underground storage tank FAILS the criteria set forth by the U.S. EPA Inconclusive ............. http:/,'www.crompeo.com/,,vorkorderpop.php?sid=OI8A7F219CA56872&work-orderid... 5/18/2006 May, ' 8 r.2 J 0.fi rY 1. 1�6 F�M: Station#11639: Work Order#150443 Date: May 18th,2006N O. c 0 ge 8, Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639/WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 EZY 3 Locator Plus ...._.... _-.-----.......:. TOTAL TANK VOL(gal): 1000 TANK # / PRODUCT 001 !Waste Oil TYPE: r SLAVE ULLAGE VOL(gal): 594 WALL TYPE: Double PRODUCT VOL(gal): 402 MATERIAL: Fiberglass .., _ PRESSURE SENSOR CALCULATION 27.0000 X 0.033 psi = 0.9720 PSI(1) (INCHES OF PRODUCT) (WEIGHT OF PRODUCT) 27.0000 X .036 psi = 0.9720 PSI(2) (INCHES OF WATER IN (WEIGHT OF WATER) TANK) Line 1 Line 2 = Total Positive Head Pressure in Tank = 1.9440 PSI(3) 7'i 0.036 (Water Table PSI(4)o,0000 x o.a000 i Tank) Outs de 1 0.049 (Brine FIlled DW (INCHES OF WATER Tank) OUTSIDE TANK) 0.0 (Double Wall Dry) a Total Head Pressure Minus Outside Water Pressure = 1.9440 +/-PSI(5) j Always add .5 PSI = 2.4440 PSI(6) NOTE: If Line 6 is less than .5 PSI, Line 7 shall be .5 PSI = 2,4440 PSI(7) TEST PRESSURE TIME PRESSURE Depth of Groundwater Determined: (psi of vacuum) By: Double-wall Dry Interstitial BLOWER STARTED: 1036 0.0000 Where: outerwall riser TEST PRESSURE REACHED: 1047 2:4400 BLOWER TURNED OFF: 1056 2.5900 TEST BEGAN: 1101 2.5000 TEST ENDED: 1105 2.4900 WATER SENSOR CALIBRATION TANK SYSTEM Added 0.0000 G.0000 0.0000 Product in Tank(inches); 27.0000 Water in Tank(inches): 27.0000 Cal #1 Cal #2 Cal #3 Tank top to grade (inches): 35.0000 Average: 0.0000 Diameter(inches): 48.0000 Water Intrusion Test Period: Began: Bottom to grade (inches): 83.0000 Ended: Groundwater (inches): 0.0000 Calculation for test period: / 3760 / .05 X 60 0:0000 o.0000 = o.0000 = (min) "A" Time of Ave. Cal. Factor Test ;. _ _.. ..-. .. .. .__.. .. _.. THE ACOUSTIC CHARACTERISTICS OF A LEAK REVEALS: WATER SENSOR INDICATES . ..... .. .... __.......... ..............._ _....... .. r NO WATER INTRUSION P.TIGHT TANK WATER INTRUSION This underground storage tank PASSES the criteria set forth by the http://www.crompco.com/workorderpop.php7sid=018A7F219CA56872&workorderid... 5)'18,12006 0. 1 May. '8N 2D06,,,1j.:j7AM Station'11639: Work Order'150443 Date: May 18th,2006IN 911 Up 9 k9 77 U.S. EPA W NOT APPLICABLE ULLAGE (DRY) PORTION LEAK r—INCONCLUSIVE This underground storage tank FAILS the criteria set forth by the U.S. EPA BELOW PRODUCT LEVEL (WET) PORTION LEAK I This underground storage tank FAILS the criteria set forth by the U.S. EPA Inconclusive ............. http:i,'www.crompeo.com/xvorkorderpop.php?sid=OI8A7F219CA56872&workorderid... 5;18/2006 ti9a.Y. .ii. �2N ,r11i 1�$RP�: Station#11639: Work Order#150443 Date: May 18th.200J0. ai0� 10�. 10/19 Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639 ;WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 Petro Tite Line-test Line Number: 002 Test Pressure: 60.00 psi Grade: Regular Net Volume Change: 0.00100 gph Material: Geoflex (green) Bleedback Length: 120.00 ft. Allowable(gal): 0.15800 Diameter: 2 in. Measured (gal): 0.07100 Wall: Double Pump Manufac: Red Jacket F American Suction Pass Type of System: �� pressure Result: r Fail r Inconclusive �........ __._.. ... . -.-.._._-. .. - Pressure. .. .. Volume. . Time' Procedure (ps) (gal ) Comments; Before After Change 08301 Connected line tester to: Shear Valve Port Before 0.After 10.0000:0.000010.0000 . .. 1:...:. Pressurilzoedrline to at or above TEST PRESSURE:.,, .. ... .:. 0840 for 1/2 peat 0 0 90 0 :0.0000;0.0000 0 0000 _.._ _ __ ......................................... --. _. _... ..... 0910]Stabilization for 1/2 hour ;90.0 60.0 :0.0000 0 0000'0 0000 : .....: : 1 '0.060 i0 00000 0033 010 0000 0940 Started Line Test - ' 0955 Line Test Continued 161.0 :60.0 10.0330 0.0340:10.0010 i '1010,Line Test Continued 60.0 60.0 0 0360 0 036010 0000 1 Bleed Back 60 0 10.0 '!0.0370 0 108010 0710 Petro Line Number: 003 Test Pressure: 60.00 psi Grade: Plus Net Volume Change: 0.00300 gph Material: Geoflex (green) Bleedback Length: 120.00 ft. Allowable(gal): 0.15800 Diameter: 2 in. Measured (gal): 0.08400 Wall: Double Pump Manufac: Red Jacket 1-7American Suction Id:Pass Type of System: Wpressure Result: r Fail I-Inconclusive ....... .,.- - ....-.... ........ _. ... . Pressure Volume (gal) jTime Procedure (Psi) _ (Comments; -- -............. . .Before After Before After 'Change .......... _. .................. ...._.._._ _ . ........ .. .. ................_.. ..._.-._.__ . _. ..... ----- _... 0830 Connected line tester to: Shear Valve Port 0.0 0.0 :10.0000 0.0000 10.0000 1.. _ 08401(Pressurized line to at or above TEST PRESSURE for 1/2 hour pretest. 0.0 90.0 !0.000,0.000010.0000 j 0910,Stabilization for 1/2 hour 190.0 60 0 0.0000.0.000010.0000 . ... \. 0940 1 Started Line Test ;0.0 ;60 0 0.000 0 033010.0000 http:/;'www.crompeo.com/NN,orkorderpop.php?sid=018A7F219CA56872&workorderid... 5/18/2006 May.v'3r_2�06rr],: 1_9AM Station X11639: WorkUrderX150443 Date: NZay 18th.2006NO. 97 8, 11'x,; 11i 1� 0955 Line Test Continued62;0 60 0 ,:0.0330:0.035040.0020 1010 Lne Test Continued 6I 0 60 0 0 0360 0 0370 0 0010 �..... � ,...:: .: a ::... t,. . Bleed Back 60.0 0.0 0.0080'0.0920:0.0840 ..... . ...... I http:/,www.crompeo.com/workorderpop.php?sid=018A7F219CA56872&work-orderid... 5;18/2006 May, '8, �2006r11,�0A��: Station X11639: Work Order X150443 Date: May 18th,2006N0 970$, 12P . 12119 Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639 J WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 Petro I ite Line Test Line Number: 004 Test Pressure: 60.00 psi Grade: Premium Net Volume Change: 0.00100 gph Material: Geoflex (green) Bleedback Length: 120.00 ft. Aliowable(gal): 0.15800 Diameter: 2 in. Measured (gal): 0.09600 Wall: Double Pump Manufac: Red Jacket Vii.American Suction W.Pass Type of System: P.pressure Result: r Fail r Inconclusive _._. _. .. _.___... - Pressure Time l i Volume(gal) Procedure (psi) ... 1;Before .... Comments; Before After,Before After Change . .---- _ _. .. --- _ . _ 0830Connected Ino tactor to: Shear Valve Dort ;0.0 110.0 0.0000;.0.0000i0.0000 Pressurized line to at or above TEST PRESSURE 10840�for 1/2 hour pretest. 0.0 90 0 ;0.0000 0.0000 0.0 000 _. ... ..........._. __ ...... ........................... .......... n for 60,0 ... . .. 0940 Startle'daLione Test/2 hour 900 0 60.0 0 OOpp' 0,0000{0 0000 ..... . ..... 0 035010 0000 '0955.11Line T. .61.0 160.010.0350'0.036010...... .. - _._ _ ---- ... _._......... .. 31010;Line Test Continued ;60.060.0 :0.0370 0.0370{0.0000 Bleed Back 60 0 0 0 10.0100 0.1060::,0.0960 , 8.,...: ...,. „,. . ... http:i;www.crompeo.comiNvorkorderpop.php?sid=018A7F219CA56872&workorderid... 5/18/2006 May,..,..`jJv- rY�: M: Station#11639: Work Order##150443 Date: May 18th,2006N10- �'G�'. 13�'. 1Y'9 Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639 1 WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 1 / . Corporation Confined SpaceProcedure 1 PRCS(PermitRequired Confined Reclassification1 1 1Submersible PumpSumps and 1 1 Check this box only if no sump entry occurred at this site (no requirement to fill out anything further) Note:This form must be filled out for each sump that is being entered. Equipment Number: Containment;Type: Grade: 002 Sump- STP (1 Piece) Regular To be entered by(list all Description of Permit Required Purpose of Entry: Confined Space: possible entrants): Fuel Submersible Pump Sumps General equipment maintenance Brett Vignali r activities(Excluding any activity Ulrich Griswold SuUnder Dispenser Containment which might release fuel vapors) Potential Hazards: Iv Atmospheric 177 Other All sumps are to be considered as PROS unless they are reclassified following this procedure. Prior to entry steps 1-6 below must be completed: ... 1. Conduct atmospheric air monitoring to verify there are no actual or potential atmospheric 1hazards: 42aexlinitiial Tedi RB�ault Allts+wableIts .. :: ;Oxygen 120.7 Between 19.50/c - 23.50/c % LEL l :Less Than10% ;Carbon Monoxide 0 Less Than 25pom :_. _.. Have all electrical hazards bees:::. : n locked/tagged out? P.-Yes No .......... . 13. If atmospheric hazards are below the above allowable limits AND all electrical hazards have been eliminated (if required),the PRCS can now be reclassified as a non-PRCS as Hallowed by OSHA 29 CFR 1910.146 (c)(7). ---- .. ..... ..----- .. . - _ ..-... --- ...__ ..._ .... -- 'The confined space shall be continuously monitored using the multigas meter while any individual is performing work in the confined space IThe confined space shall be continuously ventilated using the forced air blower while any "individual is performing work in the confined space i ,No work activity in the space is allowed which might re-introduce atmospheric or electrical ;hazards. 4.Can the PRCS now be reclassified to a non-PRCS? jv Yes -Certified by: Brett Vignali -Date: May 18th, 2006 http:/Y'ivww.crompeo.com/Nvorkorderpop.php?sid=018A7F219CA56872&workorderid... 5/18/2006 Ma Y,�I 2N6rrI:23AM Station#11639: Work Order#150443 Date: May 18th. 200Ei1o' 9'-O8., 13F,, Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639 /WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 Crom co CorL3oration Confined S ace Entr4 Procedure Certification of PRCS (Permit Reauired' L%1 1A1T11-i-ft%-ZP 51Mrs 21M. 111,111M Dispenser Containment Sumps Check this box only if no sump entry occurred at this site (no requirement to fill out anything further) Note:This form must be filled out for each sump that is being entered. Equipment Number: Containment Type: Grade: 002 Sump- STP (1 Piece) Regular To be entered by(list all Description of Permit Required Purpose of Entry: possible entrants): Confined Space:r Fuel Submersible Pump Sumps General equipment maintenance Brett Vgnali activities(Excluding any activity Sumps Ulrich Griswold Under Dispenser Containment which might release fuel vapors) S Potential Hazards: ly Atmospheric Other All sumps are to be considered as PROS unless they are reclassified following this procedure. Prior to entry steps 1-6 below must be completed: j11. Conduct^atmospheric air monitoring to verify there are no actual or potential atmospheric 1haz d7t = coral Yfed R sO)ta m Atictwa FIJMK (Oxygen20 7 Between 19.5% 23.5°/0 . . _ i i% LEL i1 Less Than 10% !..... _ Carbon Monoxide 0 Less Than 25ppm j2. Have all electrical hazards been locked/tagged out. l✓Yes j I No ........, .,..... ..... ...,.... .,.,. ......... .. ......... ... _........ .. _..._. ........_....... j j3. If atmospheric hazards are below the above allowable limits AND all electrical hazards j jhave been eliminated (if required),the PRCS can now be reclassified as a non-PRCS as allowed by OSHA 29 CFR 1910.146(c)(7). The confined space shall be continuous) monitored usingthe multi-as mete (individual is performing work in the confined space -- ,_ g r while any, ,,,,,,,,,,,,,W,.,,,' The confined space shall be continuously ventilated using the forced air blower while any individual is performing work in the confined I space No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. ACan the PRCS now be reclassified to a non-PRCS? Yes -Certified by: Brett Vignali -Date: May 18th, 2006 http:/;www.crompco.comixvorkorderpop.php?sid=018A7F219CA56872&workorderid... 5118/2006 M d?`1IF1`�Q rr�._..: Station#11639: Work Order#150443 Date: May 18th,2006N 9 708. 14 P '19 I : -Go to step 6 No Go to step 5 .f Ventilate the space for 15 minutes and repeat steps 1 4 �,..._ ........ ...,,..._... 6. The non PRCS ma,,. , y now be entered to perform general work No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. http:/;www.crompeo.comhvorkorderpop.php7sid=018A7F219CA56872&workorderid... 5/18/2006 May,�a3Y�2�06r�!.'�S P�: Station#11639: Work Order#150443 Date: May 18th,200f�0' 9'�� 15F . !5/'!9 Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639/WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 Crompco Corporation , Confined Spdce) Recldssificdtion to Non-PRCS Entry into Subriversible Pump Sumps dnd Under Dispenser Containment Sumps F Check this box only if no sump entry occurred at this site (no requirement to fill out anything further) Note:This form must be filled out for each sump that is being entered. Equipment Number: Containment Type: Grade: 003 Sump- STP (1'Piece) Plus To be entered by(list all Description of Permit Required purpose of Entry: possible entrants): Confined Space:Fuel Submersible Pump Sumps General equipment maintenance Brett Vignali I`Under Dispenser Containment activities(Excluding any activity Ulrich Griswold Sumps which might release fuel vapors) Potential Hazards: WAtmospheric r Other All sumps are to be considered as PRCS unless they are reclassified following this procedure. Prior to entry steps 1-6 below must be completed: 1. Conduct atmospheric air monitoring to verify there are no actual or potential atmospheric �:..: i I Hazaxi f... . in�ttal Telt ltesuls . . _ . . i wi. (Oxygen 120.8 Between 19.50/a 23.50/c % LEL.. _ 0 ...... - .. __._. .._- ...Less Than 10%. ...... ..j 1Carbon Monoxides , 0 Less Than 25.p-m 2. Have all electrical hazards been locked/tagged out? r Yes sr-No j. . ............. ..... _ .. _.... . . ... __._.. . .. __ . . ..... 3. If atmospheric hazards are below the above allowable limits AND all electrical hazards have been eliminated (if required),the PRCS can now be reclassified as a non-PRCS as allowed by OSHA 29 CFR 1910.146(c)(7). j ....... ----_.._ . .........__..- -.._. . _ .._... ._. ....... . . --... ....._..� ::The confined space shall be continuously monitored using the multigas meter while any individual is performing work in the confined space i i The confined space shall be continuously ventilated using the forced air blower while any individual is performing work in the confined space No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. 4.Can.t. ... ..,:... he PRCS now be reclassified to a non-PRCS? j FYi Yes -Certified by: Brett Vignali -Date: May 18th, 2005 http:/,www.crompeo.com/workorderpop.php?sid=018A7F219CA56872&workorderid.,. 5/18/2006 May, .3 r.? 6 rY j. .�:��: Station#11639: Work Order#150443 Date: May 18th,200E°' 9708, 16 F;. -Go to step 6 No -Go to step 5 i.:........ :..:.. ..... S.Ventilate the space for 1::.,.. p 5 minutes and repeat steps 1-4. ...: 6.The non-PRCS may now he entered to perform general work. No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. I i May, I 2Nri 'I : 26AM Station #11639: Work Order#150443 Date: May 18th,200J0- 16�,. �0,/19 Go to step 6 No Go to step 5 15.Ventilate the space for 15 minutes and repeat steps 1-4. .......... ............ ....................................... .......... ........ 6.The non-PRCS may now be entered to perform general work. ................ ............... ..................................................................... ..........--................. ......................... No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. http:i','www.crompeo.com/Nvorkorderpop.php?sid=018A7F219CA56872&workorderid.,. 5/18/2006 MaY. ,. . 2)u6r1�i 27 AM Station#11639: Work Order#150443 Date: Say 18th,200JC, 97A 17r„� 1 7/ 19 Crompco Corporation Mobil Service 12 MASSACHUSETTS AVE Customer Copy 1815 Gallagher Road Station North Andover, MA 01845- Site #11639 /WO Plymouth Meeting, PA Phone: (610) 278- 3413 #150443 19462 7203 May 18th, 2006 FAX: 610-278-7621 1 Crompco Corporation Confined Space Entry Procedure Certification of PRCS (Permit Required Confined Space) ReclaSSifiCdtion to Non-PRCS Entry into Submersible Punip Sumps and Under Dispenser Containment Sumps r'Check this box only if no sump entry occurred at this site (no requirement to fill out anything further) Note:This form must be filled out for each sump that is being entered. Equipment Number: Containment Type: Grade: 004 Sump- STP (1 Piece) Premium To be entered by (list all Description of Permit Required Purpose of Entry: possible entrants): Confined Space:1�Fuel Submersible Pump Sumps General equipment maintenance Brett Vignali activities(Excluding any activity Ulrich Griswold Under Dispenser Containment which might release fuel vapors) Sumps Potential Hazards: y!Atmospheric Other All sumps are to be considered as PRCS unless they are reclassified following this procedure. Prior to entry steps 1-6 below must be completed: 1. Conduct atmospheric air monitoring to verify there are no actual or potential atmospheric :,hazards: Hazard fal T1tasuts All ow"leUmits LZ d .. aCxygen 20.7 Between 19.50/c 23.50/c LEL i0Less Than 10% Carbon Monoxide ;0 Less Than 25ppm i i2. Have all electrical hazards been locked/tagged out. Yes r-No 13. If atmospheric hazards are below the above allowable limits AND all electrical hazards ;have been eliminated (if required),the PRCS can now be reclassified as a non-PRCS as j ;allowed by OSHA 29 CFR 1910 146(c)(7). T...... _............. ....._.... ..,.......__.._.__,... .„.,..........__._.. _ ... ...... ....,... .. ........_._....._........... .., _. .......... IThe confined space shall be continuously monitored using the multigas meter while any individual is performing work in the confined space The confined space shall be continuously ventilated using the forced air blower while any individual is performing work in the confined space I No work activity in the space is allowed which might re-introduce atmospheric or electrical i ahazards. II4.Can the PRCS now be reclassified to a non-PRCS? :Yes -Certified by: Brett Vignali -Date: May 18th, 2006 littp./'�v w w.6;i uuipw.oath/`wutkui aripup.plop?sid—O 1 S A7F219C A56872&w uikui dei ia... 5.18/2006 ��a Y. D, 2��6 rN!: c 8 P�: Station?11639: Work Order#150443 Date: May 18th,2006N -Go to step 6 �.... No ..:.:. � -Go to step5 'I � S.Ventilate the space for 15 p minutes and repeat steps 1 4 6. The non PRCS may now be entered to perform general work No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. I j i http:/,`www.crompeo.comhvorkorderpop.php?sid=018A7F219CA56872&workorderid... 5/18/2006 MaY, ,.I�•�N 06 11 ; 29AMI Station#11639: Work Order#150443 Date: X1ay 18th,200JC, 9�0P: . 18P; ��V 19 { -Go tostep 6 IF No -Go to step 5 5.Ventilate the space for 15 minutes and repeat steps 1-4. �...... _... ..... . _.__. ... .. ... .......... . �6. The non-PRCS may now be entered to perform general work. No work activity in the space is allowed which might re-introduce atmospheric or electrical hazards. http:l www.crompco.comiworkorderpop.php?sid=018A7F219CA56872&workorderid.,. 5'18/2006 MaY. ,.3�.2)Obr11 :300. Station#11639: Work Order#150443 Date: May 18th,200EU' 9'µ08, 19P-, 19/i9 I ! F IMPORTANT LEGAL DOCUMENTS Mobil Service Station 12 MASSACHUSETTS AVE North Andover, MA 01845-3413 Re: 2006 Compliance Test Results Crompco Work Order#150443 Test Performed on May 18th, 2006 Dear Station Manager(Facility #11639); Enclosed are the•2006 Compliance Test Results for testing performed by Crompco Corporation for Exxon/Mobil. These test results are important legal documents that are required to be retained at your service station in the "Environmental Compliance Binder" in case an inspection would occur by a state or local agency: Upon receipt, please put the results in the binder as requested by Exxor./Mobil. The 2006 compliance tests performed at your service station are indicated below. For specific testing detail, please refer to the enclosed test report. j X ;Tan�(5.)..:.,.., ... .. � ..1 a X Ljne s) and/or Leak Detector s)' ;;Cathodic Protection i Monitor Inspection I Vapor Recovery Other(See Report for Details) ......:. If you should have any questions regarding the test results enclosed, please contact Jennifer Slentz or Sue Hickey of Crompco Corporation at 1-800-646-3161. Sincerely, Jennifer Slentz Compliance Administrator cc: ExxonMobil Houston Records Center I I http:/,www.crompeo.comiworkorderpop.php?sid=018A7F219CA56872&workorderid... 51'18/2006 i Date......(.!. 533 pORTH 3?pe`,e "� �ppL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SS�ICHUSE� This certifies that ....... � .......�= g .R C ! t i r ........... ... . ............................... has permission to perform ........T`e.!n.) wiring in the building of M.a.L... ..... Q.:..�... .v at....C.A....lY 1.s�.��...���..................................North Andover,Mass. Fee...,l .:. Lic.No.b�.U ............................................................... ELEC7RICALINSPECTOR 10/24/96 11:25 {� pip WHITE:Applicant CANARY: Building Dep?"00 PAR Treasurer i. _r = •i Office Use Only L�3 (19 M04WIMl0 of ss usetts Permit No. v 11C{ittYfplEIt1< of Public $afl tq Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (0- k %--q City or Town of_' �Jo+ To the Inspector of Wires: The udersigned applies for a permit to perform ethe electrical work described below. Location (Street & Number) __ t'4, V\v`6 SS (A\J%t Owner or Tenant ffvoa,k— ®t Owner's Address � +^^z- Is this permit in conjunction with ek building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. (pd7 5-r9O Existing Service _ Amps ._J _Volts Overhead ❑ Undgrnd n No, of Meters New Service /0 A Amps /-t3 Volts Overhead Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _ /'�1 jSte—+@ t/�C-Z 45�0A/S-1ZyC4—/4r1 P,3 S No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grind. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ❑Other ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage TUbs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Complete perations Coverage or its substantial equivalent. YES 93-, IrO ❑ 1 have submitted valid proof of same to the Office. YES O ❑ If you have checked YES, please indicate the type of coverage by checking the appro�ba�te bot. �_g INSURANCE &10 BOND ❑ OTHER ❑ (Please Specify) I' Estimated Value>of Electrical 99rk$ (Expiration Date) Work to Start _/�- �� b Inspection Date Requested: Roush l // Final Signed under th naltles of perjury: FIRM NAME_-t97,® R--U-c-TIzt L moi./C LIC. NO. 1l j'® Licensee ,n4, 1tml Signature LIC. NO. �3d Address 'tel f�/3�- S% u c4.$ Q l9U�, Bus. Tel. No. _�/7' 3 ly S3 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE$ so- ,0,0 (Signature.of Owner or Agent) 9T33x-6565 'w,...,.:y:•r.-r;1..��.t, p%�.iwy:r y:�„�.`.r�rSr'_r wy.ur��„y-''�-r.�;,;,+n..:-..+m.''..r+w r., _- ..y«,,.�.+�..F. .-�..'�;'�.._• "Ti _ Date.../.:.a� . 6610 HOR7M 3:p,`,r``�-•°'11e��pL TOWN OF NORTH ANDOVER - O ` . PERMIT FOR WIRING ,SSACNus� t This certifies that ....... .� .0...... � ........ a 4...E�,.:�...:...:::........•• ti has permission to perform ..........t:..<.til.. ....... ........ l.?.Z wiring in the building of �.�>..� ... Mas e at........�:.......... ........ �......... ... ..........:.............. ,North Andover;Mass. Fee...... .?..: Lic.No. ............. ............................................................... 4 ELECTRICAL INSPECTOR t IO J r 12/27/96 15:01 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 9 e �lA uw Office Use on 1 r . 0wta� of 1. sar411sdw hermit No. i8cpurttucnt of vubUc f4dau Occupancy,& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date /2D 'T•E�--�--]F---- " City or Town of To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with I% building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of � Building Utility Authorization No. E.-dating :erVlc$ Anips % volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps--J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical opo t cal Work , No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd: ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Soun ing Devices No. of Self C ntained No. of Dishwashers Space/Area Heating KW Detection/So ding Devices No. of Dryers Heating Devices KW Local Mum ipal []OtherC ❑ onne tion No. of No. of' Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro M:asssge Tubs No. of Motors Tolai HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Compt'eted Operations Coverage or its substantial equivalent. YES VINO ❑ 1 have submitted valid.proof of same to the Office. YES �6 NO ❑ If you have checked YES, please indicate the type of coverage by checking the appy riate box. INSURANCE Cr BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work$ (Expiration Date) Work to Start Inspection Date Requested: Rough ' Final Signed under therattles ofperjury: FIRM NAM Liconsas J NQS 1 LIC. NO �f 3� =`"'„ id (�h 'J Signatur LIC. NO. Address �/�)� / �A7T�7 �� J�Y�i/�(/S CJ)96(� B . Tel. No. Alt. Tet. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agana X-6565 Date...z) .U`. . ..!� -4° 534 NORTh o: O� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUS� This certifies that .....R. .<. ......... - has permission to perform ........ 1.e �.............i. .............................. . �p wrong m the building of........1°�.U. .tA...,....t}........... ....r2....0........................ at....J. ....... .5....... "!►( ....................................North Andover,Mass. Fee—A.$.A.��.. Lic.No. .I JD ............... C (z {r ELECTRICAL INSPECTOR 10/24/96 11:25 20.00 RAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer r:r �} %� Office use only .� a (�,aauau L 3 li tl�Dlfltll of 66$rl�llSClli Permit No. lJ Q OWartwitut of pubur *afttg Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OfJ TYPE ALL INFORMATION) Date 1d _181 9 City or Town of o �C�►►�OV�` To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street S Number) M A &-% ptjz Owner or Tenant Owner's Address �Ar✓k t� Is this permit in conjunction with it building permit: Yes � No ❑ (Check Appropriate Box) Purpose of Building ski(Ont 510°RZ Utility Authorization No. 007-'59I i Existing Service �_ -JAmps Volts Overhead ❑ Undgrnd � No. of Meters t New Service 02 Ampsy Volts Overhead �� Undgrnd ❑ No. of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed Electrical Worker ^ WIC-1 60!�ke)C T Q%JW i Aalzl 5A t(__T' Sri _Rt 0 L1 0 0) 1��S Q A)SI G Q%kt IP au rz--v—I . No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle OutlNo. of Emergency Lighting ets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal []Other ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage 7ltbe No. of Motors Total HP OTHER: OCT z 1996 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Complet2,dQperations Coverage or its substantial equivalent. YES L4-<0 O I have submitted valid proof of same to the Office. YES LINO 0 It you have checked YES, please indicate the type of coverage by checking the approp�riato qwc. INSURANCE G"BOND O OTHER O (Please Specify) a--f7 Estimated Value_Z2—of E.lectrlc 1 Work i (Expiration Date) [ � r Work to Start � 91/2 Inspection Date Requested: Rough_LN 1 Final Signed under th naltles of_perjury: FIRM NAME S� it,6L�__26�C LIC. NO. 1I3O Licensee -1 g /� t /7-1 A4/N/ Signature LIC. NO. ��3 0 Address 3'11 t!i�'' /fit_ U�GrS o/�d�v sus. Tal. No. �D/7 to'5-5-9- — AIL Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner (PleaseAgent check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE$ CQ 5,Q, 0 Q �� ?f33 x-6565 w X42Date... . 2640 l_ of NORTH TOWN OF NORTH ANDOVERi h• a o A PERMIT FOR INrCSTALLATIONt E - kf �9SSHCHUSEtt - s This certifies thatlf� f, 3 has permission for g installation * y.�. .f.. . . . . . . . . in the buildings of . . r. _ . . . . . . . . . . . at . . . . ° . . , North Andover, Mass. F Fee./IM � Lic. No.l if W . . . . . . .. . . . . . . . . . . . . . . . AM INSPECTOR WHITE:Applicant J( CANARY: Building Dept. PINK:Treasurer. - GOLD:File Office Use O (� 119mmonw>alt4 of Aaoar4uttto Permit No. ! 0 060 Mcparicatut of Joublic $afttg Occupancy,& Fee Checked 3ls 0 leave blank oo BOARD OF FIRE PREVENTION REGULATIONS 527 CMA 12.00 ) �lJ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of AJ. AA/b0VGel_- To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) �� A411-is Ave Owner or Tenant Iyi'0/3r 4- 0" Owner's Address SR^oft Is this permit in conjunction with at building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps—J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps; J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work T ��� C�°l�/o�X LJ g,1/TS CAAla •T ? CC U r�rs No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. 1:1grnd. ❑ Generators KVA No�of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ElOther ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring I � Ir` 'r (1 11 I, No. Hydro Massage Tubs No. of Motors Total HP ' OTHER: MAY L 4 1996 1 INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent."YES --ANO ❑ 1 have submitted valid proof of same to the Office. YES ANO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. 54 C^7 INSURANCE CL80ND ❑ OTHER ❑ (Please Specify) / 7 (Expiration Date) Estimated Value of Electrical Work$ / Work to Start S— �' y(a Inspection Date Requested: Rough Final��(iC�*,/ Signed under the Pknalties ofperjury: FIRM NAME Ao 4ZClL ;XJ C,, LIC. NO. II$O licensee Z)'O/4 r./ C 4P/7k rN/N i Signature ~ LIC. NO. /3 0 Bus. Tel. No. ��- �)Q"6 5-5,gAddress 3y/ A/T7Q19C ST SAUGuS MA• d/flab Alt. Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE$ (Signature of Owner or Agent) x-6565 /i �a�� �� �C� ;, �� r, ® o qma 1 qy _ — _� T Mr ICE COLO _ - a a � Super.s'onday G �� r� 1 II�IVIIuII�I ��I WI—f .,C.,Caen 1 1.65,$11.751!1.85) , �S L—me i !-7-- IP — 1 Ello - ,' '_ �, � ® •�..71"x" fiA_'1 ' �� a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING M M OTHER THAN A ONE OR TWO FAMILY DWELLING X -^ ..<,ar ..ri. Z '. ..:.'• s Section for Official Use OnI BUILDING PERMIT NUMBER: _ DATE ISSUED: SIGNATURE: 0 Building Conunissioner/I for of BuildingsDate SE�Ia4 1 SITE Il �t3$}iAC' t 1.1 Prepaty Address: ��ryS M o3t� M+�tzT� 1.2 Assessors Map and Parcel Number: 12 M0,ssKCtig5E Nta N• N Z�o Yt R1 M ti p I SMap Number Parcel Number Te\ 04181 X89 -2 19 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District P,--A Use Lot Aea(sf) Frontagge(ft) 1.6 BUILDING SETBACKS(ft) M Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. S4) 1.5. Flood Zone Information: 1.8 Sewerage Disposal Sysm te : Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SEGTf€Dl�1 ' OL+"R Y Cbl`ct25J1lATlidll�i r.i x�AGINIT` 2.1 Owner of Record ' ��xot.► luloatE-�s MA,tLKEll N6, Name(Pint) Address for Service: m Signature Telephone 2.2 Authorized Agent Name Print �"�'� p C 35 Z I�•t F2 tom►P t kG' �o t� Z Address for Service: SotiZ r+�otzo M A o t1'� Z _ Signature Telephone Z M 90 3.1 Licensed Construction Supervisor — Not Applicable ❑ itiR Coo 8 2- Address License Number 0 q0 6 1�N'T lC_ C-0 @�Ptl Ttr t--t ikG t.VS C, l tJ L -n Licensed Construction Supervisor: _Ci Z r Expiration Date -�5 l�r�r� ED 1`t l0 0 (0 0 o C. r Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v LA�l�T•tC_ Cc�RoQr{� Iwtt4�_ti�G INS �• Company Name _ Registration Number m o. x ��Y ,,,�t_� t�P. o k -1 Address r Expiration Date Z Signature Telephone - W= as Owner/Authorized Agent rized Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name C- Signature of Owner/Agent Date SECTUON M.-. T'jL1"'-TE - - oo?j N Item Estimated Cost(Dollars)to be 'CLI Completed by permit applicant 1. Building (a) Building Pennit Fee 2 Electrical WtiDlier (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit foe it) (b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number A J., NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS I ST 2ND 3RD SPAN DENIENSIONS OF SILLS DENIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHDvMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 7777777� 4. SECTION 4-WORKERS COMPENSATi01!I(11G L C 15� `=25c(6} Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. !` Signed affidavit Attached Yea....... No.......0 SECTION 5-PROFESSIONAL DESIGN AND CONSTRUCTION SERYICES. FOR BUMDI NGS AND STRUCTURES SUBdE�'i'TO , CONSTRUCTION CONTROL PURSUANTTO 784 CMR 116:(CONTA?N2NG AiORE THAND 35,Ot�GF.OF ENCi.OSIi D SPACE) 5.1 Registered Architect: Name: Address Signature Telephone 54 RegistemO Profess oaal,E steeer{s} Area of Responsibility Name: - Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Company Name: Not Applicable 0 - Responsible in Charge of Construction S�OTION b#)ESCREPTION OF PROPMED.,WORK;(check all applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: C X lsT-i N q t,- 0 3 k S� AT io r► DD i> PtGK. . L 1 T ?P,,QE —10 �PSScto�, O F CA tiloDET %` zn�c-k 5E4' �N ;US> ORt)UY Ai!II)CON5TRLTE"IIONTYPE USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 0 A-3 ❑ 1 ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business 0 2A ❑ C Educational ❑ 2B ❑ F Factory ❑ F-I 0 F-2 0 2C ❑ H High Hazard ❑ 3A 0 IInstitutional ❑ I-1 0 I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 0 5B ❑ U Utility 0 Specify: M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I l=x�o a r`�v��Kt T t-ti Ems M�RKec T 1t lc., ,as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application o S.t�,�,r;p ,E - (5 A�-rn.�t L•-rre�.� `-zs-a Signature of Owner Date n'I� �� +YDS� ��� �'A }«S, `.��k4>awx v'�°'.�� .3,-r•,.,:..r.aa�_ - } � . IL ilfilm r FK-' f z i S I l MR 1 ' j I f I 1 t�2 C�Xl STI►�[y 1 TO BE FIELD VERIFIED TO BE FIELD VERIFIED 8" PROPOSED INTERNALLY A ILLUMINATED BLUE FASCIA BAND (TYP.) 0 I o iV I LA PROPOSED WHITE FASCIA AS EXISTING (TYP.) EXISTING CANOPY COLUMN (TYP.) TYPICAL EXXONMOBIL FASCIA ELEVATION SCALE: N.T.S. SM MAN=X AM 9UM MM UM rmrsxeI"umooert. nacrion :. ..m..,o.�.�,... .. ..o.�...�. oa a m aa� uwm m m rao�em � as mom. F=AIL P®OMM MWA MR ACMAL LORI m°CANOPY FABCA AM S l&T 811� A06.m!fsAel as s>m DETAIL � ML AM .IvZolm +eOF caru�6 L.H. HOHLBR 3 P. DBCOU m !• men vemev All.mm o 9 WATERTIGHT TOP COVER KLICK—RAIL® BRACKET 0 BALLAST BOX . o FLEXIBLE FASCIA 24" LAMP , 0 BRACKET �� a PRISMATIC LENS 12" EXXON WHITE ACM— BOTTOM TRIM WITH DRAIN HOLES s GUTTER EXXON IMAGE PLUS SIGNSTRUT ILLUMINATED CANOPY FACIA 970 PITTSBURGH DRIVE DELAWARE, OH 43015 DRAWING # 98-3410 PHONE40368-4120 740-368-4121 ExxonMobil Refining and Supply Company - 1800 West Park Drive,Suite 450 Westborough,Massachusetts 01581.3927 _ - E)�(onMobiI Refttttttg & Si[ppiy April 3, 2001 To Whom it May Concern: ith a ExxonMobil Corporation's New England Fuels Marketing District, wual place of business in Westboro, Massachusetts, does hereby authorize the employees of Bohler Engineering, P• and represent ExxonMobil C. to apply for ermits and/or approvals for lications for required p Cor oration in filing of any app e of convenience store/self-service p operation and maintenanc the construction, op appearing before any governmental gas stations, including, but not limited to, app 9 agency at general meetings or public hearings addressing such construction/improvement of ExxonMobil retail facilities. ExxonMobil Corporation Walter Valencia New England M&R Coordinator Subscribed and sworn to before me this �day of 2001 Notary Public My commission expires on -7 Da to I Town of North Andover NORTH O?Ob�t�eo `t��•OO� Office of the Building Department Community Development and Services Division William J. Scott, Division Director ,�,.•o ,. 27 Charles Street 93 SAGHUS�t'(`' D. Robert Nicetta North Andover,Massachusetts 01845 Telephone(978) 688-9545 Building Commissioner Fax (978) 688-9542 I July 23, 2001 Bohler Engineering, P.C. Southboro Executive Park 352 Turnpike Road, Suite 105 Southboro, MA 01772 Attn: Steve Wright or John Stitzer: Enclosed please find copies of pictures taken at 3 different sites in regards to permit applications for canopy bands. On the pictures you will find notes in regards to existing signage that is not allowed and needs to be removed as well as a copy of the sign regulations for the Town of North Andover. The addresses are 498 Chickering Road, 350 Winthrop Ave. and 12 Mass Ave. I hope that the enclosed information will help you in rectifying the situations at the referenced addresses so that we may continue to process the permit applications in a timely manner. Respectfully, Michael McGuire Local Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Y � BOHLER ENGINEERING, P.c. CIVIL&CONSULTING ENGINEERS■PROJECT MANAGERS■ENVIRONMENTAL&SITE PLANNERS■MUNICIPAL ENGINEERS 352 TURNPIKE ROAD SUITE 105 SOUTHBORO, MA.01772■ Telephone(508)480-9900 Telefax(508)480-9080 LETTER OF TRANSMITTAL ® Via Federal Express ❑ Via Regular Mail TO: RE: Town of North Andover Mobil Station 120 Main Street _ 12 Massachusetts Avenue North Andover, MA 01845 ATTENTION: Mike McGuire (Bldg. Inspector) DATE: May 16, 2001 JOB No: W010794 WE ARE SENDING YOU ❑ Shop drawings ❑Copy of letter ®Attached ®Prints ❑ Diskette ❑Vellums COPIES DATE NO. DESCRIPTION 1 5/16/01 1 Sign Permit Application/Check for $130.00 1 5/16/01 2 Existing/Proposed materials pertaining to proposed canopy modifications. THESE ARE ❑ For approval ® For your use❑As requested❑ For review and comment❑Approved as submitted TRANSMITTED ❑Approved as noted❑ Returned for corrections❑As discussed REMARK S: If you have any questions or need additional materials, please feel free to call. X5 hv Sincerely, COPY TO: File SIGNED: Eric I. Dickinson O TOWN OF NORTH ANDOVER �.j 0 SIGN PERMIT APPLICATION N 0 Site Owner �� � /ism/� ,Fi< �t,�. i�,c Applicant ��— z Size of Proposed Sign 3 a " � � c Site Address L 4,,_ � � ��`` p I C+ T How attached: a) Against the wall Illumination: a) Not illuminated D b) Roof ( ) b) Internally illuminated c) Ground ( 1 c) Externally illuminated 'O o d) Other O Materials -s Proposed Colors: Background n Lettering- _ - 3 Border rn-`7-%--- � Note: No permanent/temporary sign shall be erected, or enlarged until m Required Attachments: an application on the appropriate form furnished by the Sign Officer has Photographs of building been filed with the Sign Officer containing such information including Material sample photographs, plans and scale drawings, as he may require, and a permit 0 for such erection, alteration, or enlargement has been issued by him. 1.4 Site or Plot Plan (Required for all free-standing signs) Such permit shall be issued only if the Sign Officer determines that lire M Color sample sign complies or will comply with all applicable provisions of Ifie By-Law. 00Drawings of proposed sign Ln Other, specify 4 N Will sign overhang any public road or walkway Yes ( ) No (� If Yes, Name of Agency who will provide liability insurance: v AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: �i -, < � � SIGNATURE OF APPLICANT O N revised.jm- 8198 Sh `. I� T • �' ��''!-l� r '�. a �:. .. Al- ... ,W 1.9Gy.0 y�'ygy • .a� ioil APA RON • ' tx 4, 'h ' w "� 't � s sem• Zi. yK 5 Bohler Engineering, P.c. Civil, Consulting, Traffic and GeotecTinical Engineers•Surveyors•Site Planners 352 Turnpike Road, Southborough,MA 01772•Phone 508-480-9900•Fax 508-480-9080 7 _ * •is,.. a.;cam, NUNN- 4'- k Fac.# 01-389 Mobil 12 Massachusetts Ave., N. Andover, MA Page 1 of 2 i • , - p�epOH�TiO�� y`, .•° Zoning Bylaw Review Form o Town. Of North Andover Building Department � All. 27 Charles St. North Andover, MA. 01845 9sSkcNuSEi Phone 978-688-9545 Fax 978-688-9542 Street: SR / 9455 Map/Lot: oZ Applicant: Request: Date: Please be advised that-after review of YourApplication and Plans your Application is /DENIED for the following Zoning:Bylaw reasons: Zoning Item Notes Item Notes A Lot Area F Frontage 1 Lot area.Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies 3 Lot Area Complies 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 9 1 Allowed Building Contiguous B ' ' G Conti g ng Area 2 Not Allowed. -i--Insufficient Area 3 Use Preexisting 2 Complies 4 Special p al Permit Required q 3 Preexisting CBA__ 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height -;-j a.S 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient 1 Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information . 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information 2 In Watershed � Sign 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined2 Sign Complies 5 Insufficient Information 3 Insufficient information E Historic District 1 In District review re wire d K Parking a 2 N 1 More Parking Required. Not In district 2 Parking Complies 3 Insufficient Information I - Remedy for the above is checked below. Item # Special Permits Planning Board. Item# Variance Site Ptan Review Special Permit Access other than Fronta e S ecial Permit Setback Variance Fronta a Exception Lot S ecial Permit Parkin Variance Common DrivewaySpecial Permit Lot Area Variance Con re ate Mousin .S eclat Permit Hei ht Variance Variance for Si n Continuing Care Retirement Special Permit Inde endent Elderl Housih S ecial Permit S ecial Permits Zoning Board Lar a Estate Condo Special Permit S ecial Permit Non-Conformin Use ZBA Planned Deveto ment.District S. ecial.P.ermit Earth Removal S eclat Permit ZBA Planned Residential S ecial Permit S ecial Permit Use not Listed but Similar R-6 Densi S ecial.Permit S eciai Permit for Si n Othe r Watershed Special Per�_1�it - SuppI Additional Information The above review and attached explanation of such is based on the plans,request for or Information submitted. No definitive review and or advice shall be.based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for this action. Any inaccuracies,misleading information,or other subsequent.changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled°Plan.Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. Building Department Official Signature Aati- pplication Received Applicon Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for the action on the property indicated on the reverse side: . t t � � 4`Y �L`f s t°( i`1 >c/Ys�v 1 '�'°e`F'v��•:.v<i g` b /va .. e. J Cc?NaP S �1 5� A 41 '7L— OIL) 7L-Oti Referred To; Fire Police Health Conservation Zonin .Board Plannin De artment of Public Works Other Historical Commission ZOningBylawOcnia12000 BUILDING DEPT i Location,. No. 5"27 T t Date 3 t TOWN OF NORTH ANDOVER Of� �a° i�1ti A Certificate of Occupancy $ Building/Frame Permit Fee $ cwUsEth Foundation Permit Fee $ CnyST. Other Permit Fee ?�z�eCr7t $ �� � Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 'P 4-7 Building nspector /24/% 11:42 25.00 RAID ±2 1046 a Div. Public Works PERMIT fe0. JAZ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. ✓ PAGE 1 MAP 4-40.Ala LOT NO. /Cyd 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. I I LOCATIONOSE OF BUILDING�� � Cl �� PURP NO. OF STORIES CQ OWNER'S NA ��T SIZE m ab ' a a � 1 Corp V-0 tyre t o OWNER'S ADDRESS �c1 C •�- W5r Ol_d d BASEMENT OR SLAB -- ARCHITECT'S NAME Y✓�-e leen 1Y11ei SIZE OF FLOOR TIMBERS IST ,v 2ND 3RD BUILDER'S NAME -t- 1 p SPAN DISTANCE TO NEAREST BUILDING 0 0/6' DIMENSIONS OF SILLS --- DISTANCE FROM STREET )(J POSTS DISTANCE FROM LOT LINES—SIDES( o REAR " GIRDERS n AREA OF LOT 2-1,600 FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW 4 r SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND C/�# 114 WILL BUILDING CONFORM TO REQUIREMENTS/OlF CODE /s IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY S IS BUILDING CONNECTED TO TOWN SEWER - �' ,�y., IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS CO/U9`i�Z \10� 1121pILc-r- 3 PROPERTY INFORMATION A r-e,a ���2CS 1N0ts LAND COST SEE BOTH SIDES �SISL�.0 EST. BLDG. COST Y PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PJ,ANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED /0 -ZZ- T BUILDING INSPECTOR SIGN�kIRE OF OWNS Q^AUTHORIZED AGENT F EU(^�(40-S 6 OWNERTEL.�i (y� � �K�� PERMIT GRANTED 7 3 CO CONTR.TEL.JI 0 19 9- CONTR.LIC.# GJ. H.I.C.# -- io4G2-- BL&®QG RECORD SOO 1 OCCUPANCY 11 SINGLE FAM _ 5 I THIS SECTION MUST SHOW EX CC=� NqlU OF DA1V 1STATQ FROM MULTI. FAMILY _ LOT LINES AND EX.VId4`r, t�lE LO , �GS. iWjIDR HES. GA- APARTMENTS RAGES. ETC. SUPERIMP(r THIS (� S I (y P Nt Q CONSTRUCTION AM 010(1 f � 1- L 2 FOUNDATION _ $ INTERIOR FINISH CONCRETE _ 3 1 2 13 l�� 3`g' ` CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER DRY V✓ALl _ _ _ UNFIN. V 3 BASEMENT I © ` A AREA FULL FIN. B'M'T' AREA _ �s ( Ir C7 1/1 1/2 1/. FIN. ATTIC AREA ` ` +I�Q� NO BM'T FIRE PLACES HEAD ROOM MOfKRN KITCHEN _ �\ 1 \1 4 WALLS FLOORS CLAPBOARDS B 1 2 3 DROP SIDING NCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING - HARDV✓'D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE - STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT A SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING I I MODERN FIXTURES _ TILE FLOOR lE DADO ix )c oell 3 6 1_k ILI, HEATING Mitibli J .,T 11 X X APELESS FURNACE ORCED HOT AIR FURN. TIMBER MS. b COLS. STEAM ti STE 805. TW IR OR VAPOR W D FT RS _ AIR CNDITIONING RADIANT H'T'G t UNIT HEATERS 7 NO. OF ROOMS GAS OIL • B'M'T 2nd- ELECTRIC 1st 13rd I` NO HEATING NORTH Town of over No. 52 ifT :: :r ; � LC E over, Mass., OeTbeez. 19% COCHI HE"v ICK "ATED BOARD OF HEALTH od/K-itchen ,3eis Systein PERMIT T D .. % LDING INSPECTO THIS CERTIFIES THAT...............................V Foundion 'on has permission 1.. ... ....................................... . on.1# F' 3" Rough V to be occupied as.................... ........ Chimney provided that the person accepting this permit shall in every respect conform to the terms 'the'application on Final 7 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. PLUM I BG IN ECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS V ELECTRIC LECT7SPECTOR •-111110 RouggI h Ic.......F.. ............................................................. ... Service BUILDING INSPECTOR Final INSPECT Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final P MW---Wmlq wq Wqp= a �111111gli 1111 -- -- - FIRE DEPARTMENT 111 ! 0 111 FIRE Bu ter S eet No. moke Det. Date. .,..... X12 1293 t NOR7q� TOWN OF NORTH ANDOVER f. p PERMIT FOR WIRING �� SSACMUS� CL 6 { This certifies that .....�.J....!I A."4....... �=4f.Cr ....'.. .......�.4�. i ..... S has permission to perform .......... :. ................................... ?t Qm �P d wrong m the building of....�r�..r.Y...... .............................................................. at...j CCV a........E�.14..`?�:... 1�:e..�......................... .North Andover,Mass. Fee. .1� '.�.... Lic.No,14-. � �......:..... o . ` sti ELECTRICAL INSPECTOR p WHITE:Applicant CANARY: Building Dept. . PINK:Treasurer F' MINI The Commonwealth of Massachusetts ""`" Use only Deporrmenr of Public Sofety r•,•" 39• BOARD OF FIRE PREVENTION REGULATIONS S27 CMR t o0e°'toner• • rre °to`r'e n ' 200 x/90 r (Nave blank) APPLICATION FOR PERMIT TO PERFORM All work to be performed In accordance w lh the Mawchuaerts NJeerrlgl Code. 7 CMR WORK (PLEASE PRINT IN IHR OR TE I ORHdTION) Date / City or Town of �e undersigned applies for a permit to To the Inspector of Wires: p perform the eleetr al work described below. Location (Street b Numberl 3 F/n 6 V? Owner or Tenant Owner's Address Is this permit in conJunction.with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building © 1C•Q Utility Authorization NO. Existing Service _Amps / Volts Overhead ❑ Undgrd❑ No. of Meters . Nev Service ._._.fps / Volts Overhead ❑ UndgTd❑ No. of Meters Number of Feeders and Aapacity Location and Nature of Proposed Electrical Work .6 Ems/ r 20 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting FixturesAbove❑ In• KVA Swimming Pool end.. No. of Receptacle Outlets Tnd• ❑ Cenesators KVA No. of Oil Burners No. of Emergency No. of GaLighting No. of Switch Outlets Batte Units s Burners No. of Ran es ALARMS No, of Zones 8 _ Ne_ „c ►�. r_-_ Total •N_ t. • cons No. of DisposalsHeat Total Initiating Devices No, of - Tons Total pesos KW No- of Sounding Devices No. of Dishwashers Space/Area Heating XW No. of Self Contained No. of No. Devices Fess Heating Devices KW Local❑ Municipal No, of o• o Connection❑Other No. of Water Heaters KW Low Voltage Si ns Ballasts W{r{n No. Hydro Massage Tubs No. of Motors Total HP OTHER t , INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabili _ty Insurance Policy including Completed Operations, Coverage or s substantial equivalent. YES U NO I have submitted valid proof of same to this office. YESt NO C3 If you have checked YES, please indicate the type of coversg�-by check -••� • �— 8 the appropriate box. / .wiiivui U yopp ❑ j j (Please Specify) �� Estimated Value of Electrical`{Work S �—` � p rat on ace Work to Start Inspection Date Requested: Rou Signed under thY enalties of per)ury; Final FIRM NAME �!/ /_^ GG�C'T Licensees .T LIC. N0. ,593? � Q �2 Signature Address HQ LIC: N0. /! us. Tel. No. _h�r-3— a_ �►'� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its su - stantial equivalent as required by Massachusetts Ceneral ws�d pat my signature on Chia permit application waives this requirement. Amer Agent (Please check one) Telephone No. . PERMIT FEE S '� Signature of Owner or Agent ID BIDS Date. . .`. . . . ..... . NORTH TOWN OF NORTH. ANDOVER o� y° ° 'PERMIT-FOR- GAS INSTALLATION oq O�OPy�S SSAC,Hje uSE,� This certifies that . . .r�. '. . .`�. '�. . `..{'? . ,.4.. r. . . . . . . . . . . . has permission for gas installation . . .f ' 7f,.` in the buildings of . . �1. . . . �... .... . ..... .'. ,r`. ... *.�. . . . . . . . . . . . j'. 4 at . . �`� . . .'�=!r . . . .�.;.; North Andover, Mass. G Fee. . �� Lic. No. / f . . . .. . . .�° " . 0 1!-t T,' i' —' GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File E MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or TypeW , Mass. Date �/" �'- 19 Permit # Building Location Owner's Name o• �� , /„��� �©C � -Type of Occupancy_ 'New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No❑ N H W in N N V N Q N Q O 0 = h W WW H V m t O O W ~ Q cc Z O O 2 W Z Q m o h y !. W O O 6 C r F- y tx N t7 v W W -9 = N Z Q cc O p > W . W W N W X Q X C jj; W W ►- W F' = a (! F Z J h Z F• W W O O > W F� W J W Z 4 W Q C F ! N m Z O X 0: O X Q W > W W 7 Z < R Q Q O O W O p H EC 'X O V' X LL n >t O C7 J V 0: 1 C a F- O SUB—BSMT. BASEMENT 1STFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6THFLOOR 7TH FLOOR eTH FLOOR h Fill I Installing Company Name CLIMATE AIR CORP. I ! Check one: Certificate . . Address 27 Roulston Rd. , F # Corporation 1813C Windham, N.H. 03087 ' I ❑ Partnership Business Telephone 1-800-222-2158 ` o i❑ Firm/Co. Name of Licensed Plumber or Gas Fitter ` Francesco`Premutico i INSURANCE COVERAGE: ti f I. I ! I I I I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Ll No O If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Q9 Other type of Indemnity O 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 O I hereby certify that all of the details and information I have submitted(or entered)in above application are true and rale to the best of my knowledge and that all plumbing work and Installations performed undo the per is d for this application will a in m fiance with all pertinent provisions of the Massachusetts State Gas Code and p due P n Chapter 142 o11h t3enb wa. BY 1e of License: L �eCG-I PlumberSighature of Ucense um er oras itter Title Gasfitter Master Ucense Number 10043 APyP/Tnow Journeymen c a i BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME d TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER _,.._ _.. LIC. NO. PERMIT GRANTED _ e _ DATE 19 GAS INSPECTOR I Location=/ /Yri 's� ft7uc.c r No. 5 -b Date /%•G -SL �F MOR711 TOWN OF NORTH ANDOVER p��t�ao . p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ 95"— I4 . Other Permit Fee $ Sewer Connection Fee $ $ Water Connection Fee $ TOTAL $ J Building Inspector o $? 049 Div. Public Works a �PEW.If1T xb. S~2�S �' APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. J PAGE 1 MAP M40. nz) T-1 LOT NO. (Do C) 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. "'00,1 �!f r LOCATION /� j� PURPOSE OFBUILDING OWNER'S NAME .t-/ Cl NO. OF BASEMENTOR/_ SIZE OWNER'S ADDRESS 4j. T l / �f G G� J� ARCHITECT'S NAMES-+ r� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAMESPAN!, SPAN DISTANCE TO NEARE T BUILDING > DIMENSIONS OF SILLS DISTANCE FROM STREET ..i "" POSTS DISTANCE FROM LOT LINES-SIDES 6 REAR ?'S� ! GIRDERS AREA OF LOT Zr FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW t) SIZE OF FOOTING 47 C /4kJ IS BUILDING ADDITION _.,. MATERIAL OF CHIMNEY f A-)1.4,A IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER S'LZ G�7L/y/ •s7—•aA IS BUILDING CONNECTED TO NATURAL GAS LINE i✓� INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES �f / EST. Bb COST PAGE I FILL OUT SECTIONS 1 - 3 r-'" __ _ � . EBT. BLDG. COST PER SQ: FT. PAGE 2 FILL OUT SECTIONS I - 12 -` ,v C N EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. _ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED l (� BUILDING INSPECTOR 9143MATURE OF OWNER OR AUTHORIZED AG F E E I95 OWNERTEL.N c PERMIT GRANTED CONTR.TEL.M Ste 87) E3 iSZ) NOV L, 1926 CONTR.LIC.# f H.I.C.# Q.l.� NOV - 5 1996 i:>f-97- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS V I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D __ PIERS PLASTER _ _ DRY VJALL _ UNFIN. 3 BASEMENT I P AREA FULL FIN. B'M'TAREA 1/1 �/, % FIN. ATTIC AREA _ NO B M'T FIRE PLACES _ - HEAD ROOM _ MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME I r BRICK N MAS N Y ATTIC STRS. d FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH Q FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR r TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE i FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING C NORTH Town of t 4Andover 0 L A E dover, Mass., N eY*AzM b 1954 COCMICME WICK �oRAT E D \7 - ARD O<HE-AL PERMIT T DFood/Kitchen Septic In • BUILDING INSPECTOR THIS CERTIFIES THAT ...tP .....................:... Foundation has permission to erect........................................ onT§...AWV. AdE....... to be occupied as F�c,cwa �. S v•e,� to..G r N i?ti�"f,QN.......4P. ......Y.....:�2...............................1 .............1�. ........ " provided that the person accepting this permit shall in every respeclrconform to the terms of the application on file in >� 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. - R gh Fin PERMIT EXPIRES IN 6 MONTHS ELETRICAL INSPE R UNLESS CONSTRUCTION ST TS. Rough ...............�. . ... ..... .. ..... ...... :. .. .. A..... . ................... Service BUILDING INSPECTOR Final 7 Occupancy Permit Required to Occupy Building GAS cTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected)and :Approved by the Building Inspector. Bum F DEPAR T Str t No. oke Det. 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH-NH PAGE 01/16 I LETTER OF TRANSMITTAL Jaworski Geotech, Inc. 150 Zachary Road NOV — 5 Manchester, NH 03109-5614 , JAWORSKI 35 (603) 647-9700 (603) 647•-4432 Fax' �^ j E�EO'1">P.CH, 111TC. November 1 1996 �•,� ,Attention: Mr, Nbichael Haberslsa ' ; G Mobil Station Sent to: Tyree Organization, Ltd., NE 4' tl No. over, MA 768 Washington Street i! g;,pp! ;' AubuMA 01501 '4Q i i� `M n+w7 N96498G WE ARE SENDING YOU: _Field work _ Lab work Figures/Drawings _ Report Other: Boring Logs&Pile S e� cs Copies Date Descrx tion 1 November 1996 Treated Timber-Pile Specifications 1 October 31 1996 Test Boring Logs JB1 thr2yf2h JB4 TBESE ARE TRANSMITTED as checked below: Remarks: For approval We elan to be on site 0700 hrs Monday x For your use to monitor timber ile installation. _ For review and comment COPY TO: Mr. Paul Buckle (Allied Pile Co.) Signed: Lawrence J. Dwyer 11/01/1996 19:04 ' 60: 64,74432 JAWORSKI GEOTECH-NH PAGE 02/16 TREATED TIMBER PILES PART 1.0 - GENERAL, 1.01 GENERAL REQUIREMENTS A. Include GENERAL CONDITIONS as part of this Section. B. Examine all other sections of the Specifications for requirements which affect work of this Section. C. Coordinate work with all other trades affecting or affected by work of this Section. Cooperate with such trades to assure the steady progress of all work. 1.02 MENTIONS AND REFERENCE STANDARDS A. Owner: The Owner is Mobil Oil Corporation, B. Engineer: The Engineer is the firm of Jaworski Geotech Inc., Manchester, New Hampshire. The Engineer is the authorized representative of the Owner for the work covered by this Section_ C. Contractor: The Contractor is the person or organization Identified in the Agreement as being responsible for the work under this Section. D. ASTM: Specifications of the American Society for Testing and Materials. E. AWPA: American Wood Preserver's Association. F. Code: Massachusetts State Building Code, Fifth Edition. 1.03 QUALITY ASSURANCE A. Comply with rules, regulations, laws and ordinances of the Commonwealth of Massachusetts, Town of Andover, and other authorities having jurisdiction. All labor, materials, equipment and services necessary to make work comply with such requirements shall be provided without additional cost to Owner. Page 1 of 7 11/0.1/1996 19: 04 '6026474432 JAWORSKI GEOTECH-NH PAGE 03/16 B. Field (Monitoring and Testing 1. Full-time monitoring of pile driving operations will be provided by the Owner. No piles shall be driven except in the presence.of an authorized representative of the Engineer. 2. Certification of quality of pile materials shall be furnished, in a form acceptable to the Engineer, at the time of delivery of materials to the site. 3. Approvals given by the Engineer shall not relieve the Contractor of responsibility for performing the work in accordance with the Contract Documents. 1.04 SUBMITTALS A. The Contractor shall submit the information specified herein to the Engineer for review one (1) week before the start of the work. B. Manufacturer's literature, including technical and performance literature for pile driving hammer, and other equipment for installing piles. C. With each delivery the Contractor shall furnish certification of the preservative treatment for piles. D. At the completion of pile driving, submit final as-driven pile location plan, certified by a Registered Land.Surveyor or Professional Engineer. 1.05 JOB CONDITIONS A. Site and Subsurface Conditions 1. Subsurface data are available from the Engineer on test boring logs dated October 31, 1996 prepared by Jaworski Geotech, Inc. The Contractor shall review and understand the test boring logs which are made available to the Contractor for information on factual data only. It shall not be interpreted as a warranty of subsurface conditions. Page 2 of 7 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH-NH PAGE 04/16 2. The Contractor shall protect adjacent property, public utilities, and structures, and completed work, from damage associated with pile driving. Damage due to pile driving shall be repaired at the Contractor's expense. 3. Obstructions in the fill exist below grade. The extent and location of obstructions have not been determined. 1.06 LINES AND GRADES A. The Contractor shall stake and be responsible for the pile locations and establish required elevations. A baseline and benchmark located on or close to the site will be provided by the Owner. B. The Contractor shall employ a licensed Registered Land Surveyor or a Registered Civil Engineer to establish lines and levels. Locations of as- driven pile centers shall be shown on a drawing in relation to the design location and submitted to the Engineer immediately after all piles are driven. Drawings shall include, pile identification by number, elevation of each pile top prior to cutting to nearest 0.1 (one tenth) foot, and deviation in inches to the nearest 0.02 (two hundreth) foot from plan location at cutoff elevation. PART 2.0 - PRODUCTS 2.01 TREATEQ TIMBER PILES A. Treated timber piles shall be Type 1 species such as Southern Yellow Pine or Douglas Fir. Each pile shall be in one piece cut from a sound live tree, and free from defects that will Impair its strength and durability. Piles shall be butt-cut above the ground swell, have substantially uniform taper from butt to tip end, and be free from short kinks. Piles shall most the requirements of ASTM D25. B. The minimum pile tip diameter shall be eight (8) inches and the maximum diameter three (3) feet below the pile butt shall be twelve (12) inches. C_ Length of piles to be ordered shall be determined by the Contractor. Splicing of piles will not be permitted. Page 3of7 11/0 ./1996 19: 04 6036474432 JAWORSKI GEOTECH-NH PAGE 05/16 D. Piles shall be pressure treated with CCA in accordance with the AWPA Specification C3-92 Standard for "Piles-Preservative Treatment by Pressure Processes." PART 3.0 - EXECUTIbN 3.01 EQUIPMENT A. Piles shall be installed with approved equipment. The proposed pile installation equipment and methods shall be subject to the review and approval of the Engineer before the start of driving. B. The leads of the pile driving rig shall be fixed at two (2) points; the points shall be at least half ('/2) the length of the leads apart in order to maintain the pile and hammer in axial alignment at the correct plan location during the entire driving operation. The leads shall extend to the lowest point at which the hammer must operate. C. Piles shall be driven with a double acting steam or air hammer, or diesel hammer, delivering a maximum of thirteen thousand (13,000) foot- pounds of energy per blow for eight inch tip diameter piles. When the determination of the final driving resistance Is being made, a steam or air hammer shall be operated at a speed not less than ninety-five (95) percent of the maximum blows per minute for which the hammer is rated by the manufacturer, When the determination of final driving resistance is being made with a diesel hammer, the energy being delivered to the pile shall be determined as the product of the weight of the ram times the observed or equivalent stroke for open diesel hammers; for closed diesel hammers, the energy shall be that indicated by an output gauge calibrated to measure total hammer energy, D. The use of followers will not be permitted. 3.03 INSTALLATION A. Driving 1. As part of preparation for driving, each pile shall be marked at one (1)-foot Intervals along the entire pile length, In addition, the footage shall be marked and designated at five (5)-foot intervals. Page 4 of 7 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH-NH PAGE 06/16 i 2. Piles shall be driven at the locations shown on the Drawings. Pile locations shall be checked during driving to maintain the correct pile location. 3. Each pile shall be driven to bearing in the natural inorganic sand to a minimum capacity of twenty (20) tons in compression. Pile driving shall be continuous from ground surface to final tap elevation without interruption. The average hammer blows for the final six (6) inches shall be a minimum of twenty-one (21) blows. If an abrupt increase of driving resistance is encountered, the driving shall be terminated when the pile penetration is less than-one-half ('/Z) inch in five (4) successive blows. 4. For piles which do not meet final driving resistance criteria in Item A.3 above, and which are not broken during driving, piles shall be terminated at the direction of the Engineer or his Representative after penetrating the natural sand bearing stratum at least twenty (20) feet. Piles not meeting final driving resistance shall be reviewed by the Engineer to evaluate that pile compression capacity achieves a minimum of twenty (20) tons. C. Obstructions 1 . The Contractor shall make reference to the test boring logs and available plans showing the site conditions. The Contractor is advised that obstructions, including wood and building rubble may be encountered within the fill. 2. Where obstructions make it impossible to install certain piles to the required depth, the Contractor shall attempt to remove or clear the obstruction by excavation. Excavation to a depth of ten (10) feet below the driving surface for the removal of obstructions shall be at the Contractor's expense. If the Engineer determines that obstructions should be removed by excavation or spudded to a depth greater than ten (10) feet, the Contractor will be reimbursed for the additional work of overcoming obstructions below ten (10) feet. If the Engineer determines that additional piles are required, in lieu of excavation, the Contractor will be reimbursed for the obstructed pile and additional piles ordered by the Engineer. 3. Piles abandoned because of obstructions shall be cut off or pulled out at the discretion of the Engineer and the hole filled with sand. Page 5 of 7 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH-NH PAGE 07/16 . l D. Cutting Off Plies 1. Pile tops shall be cut off square within one (1) inch of the elevations shown on the drawings. The pile cut-offs shall become the property of the Contractor and shall be removed from the site. 2. When piles are driven below the design cut-off grade, due to unexpected penetration, a limited number of build-ups will be permitted in accordance with designs provided by the Contractor and approved by the Engineer. Build-up costs shall be the responsibility of the Contractor. 3.04 TOLERANCES AND CRITERIA MLACCEPTANCE A. Piles shall be driven as close as practicable to the plan location. A maximum lateral deviation from the correct location at cut-off elevation will be one and one-half (1 '/z) inches for single piles and groups of two (2) piles and three (3) inches for pile groups of three (3) or more piles. A maximum deviation from design cut-off elevation equal to one (1) inch will be permitted. B. Piles that are damaged'below cut-off elevation during driving will be rejected. If upon comparing pile performance during driving with that of other driven piles, and based on knowledge of the subsurface conditions, the Engineer determines that a pile has been unacceptably damaged, the pile may be rejected. C. Plies indicating sudden or peculiar decrease in penetration resistance during driving will be assumed to be broken and will be rejected unless Engineer's review of available data indicates that sudden decrease in driving resistance is due to natural, subsurface conditions and continued acceptable driving behavior is observed. D. Except as specified under "Obstructions", piles that are rejected because of damage, mislocation or misalignment, or failure to meet the driving or minimum embedment depth criteria, shall be cut off below the limits of the structure and abandoned. E. When otherwise acceptable, installed piles exceed the specified tolerances, the Contractor shall provide an accurate survey to the Engineer, as specified, The Engineer will then analytically determine the allowable loads on individual piles, based on this survey. Page 6 of 7 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH-NH PAGE 08/16 PARI 4.0 - MEASUREMENT AND PAYMENT 4.01 MEASUREMENT A. Piles will be measured for payment on the basis of length along the axis of the pile in place below the design cut-off elevation_ 4.02 BASIS OF PAYMENT A. Work included under this contract shall include the total price for installation of the estimated linear feet of piles. The work shall include furnishing and driving piles and mobilization and demobilization which shall include job set-up, moving equipment including pile driving rig on and off the project, and other incidental work. B. Treated timber pile installation shall include the price for the installation of 40 to 45 feet long (20)-ton capacity piles. Final payment shall be based upon the actual total aggregate footage of piles driven and accepted based on the sum of the lengths of piles below design cut-off grade. C. Piles rejected In accordance with the provisions of these Specifications will not be paid for. In such cases, the Contractor will be paid at the contract unit price per foot for one (1) replacement pile installed and accepted, according to the provisions of these Specifications. If more than one (1) replacement pile is required to compensate for a rejected pile, the Contractor will be paid at the contract unit price per foot for only the longer of the replacement piles, Additional piles required to replace piles driven out of design location will be installed at no additional cost to the Owner. D. No payment will be made for pile cut-offs or pile buildups. - End of Section - 10/31/96 Page 7 of 7 11/01/1996 19: 04 6036474432 JAWUK�Kl UEUIEGH-1`4H r'AkAt Fly/lb TEST BORING LOG 1 Mobil Station V..: North Andover,Massachusetts TYPRI HSA N96499 6 1/2'ID 2'OD R'P', Octobvr 30, 1996 . SW Building Como %October"' In96 140 lbit. 30, Tyrce 0 rganization, Inc. x .4 mRiWestborough, Massachusetts DATE VEPM CASING AT IWASUZATION PE1001) Shawn Lyons 10/30/96 9.01 Vuring Drilling 1V � 1 D. Doisvert/R.Vorrier -;u RIM, I X 11%SUN. Stratum Sainple Peneir/ Description Change No. Depth DIOWS16" Rmovery 00 Notes S-1 5-7' 1-2 1.7 10 S-2 10-12- 1/12, 24-14' S-2; Very looms,brown,coame to fine SAND,fitUc Gravel and Silt,wet,petroleum odor. 15 .......... 3-3 15-111 WOR-5 24"W" ! 1.5.,5' 4-6 S-3; Mediumclen9c.gray,trkadivin to rma SAND,little Silt With wood,Patrolouln Oder. .....................................I......... ...................... ........................ Sa 18-20, 28-14 24'117" :S4: Wood(railroad timber),wet,odor. 20. (Flu) 23.01 S-5A 23-7A' 7-11 S-SA: Medium demo,medium Ant,SAND.litUe Sill,truce ..........I....... 25 S-513 24-25' 0-1s 12"1121 vrIaujcj;and wow. 24.0' .. ..... ............ . . S-5121: Tan,medium dense, fin.SAND,and S i I 3,6 28-301 3-5 24'!14` S-6: Tsui,medium donne fuze SAND.trace Silt,wet, 30 5.5 N TES: Prol'616orw u4cd: trace(1.10%), little(10-20%), some(20-35%). and(35-50%) Cabaive Co"I 1. �7ohcsionlem k)emity(Blow6/ft.) very oaft 0-2 -cry loote 4 o-4 eoR 2 podium stiff 4-8 loose d-10 medium dens Ntiff 10-130 C"a., donee 30-50 vary stiff 15-30 very deme So+ bard 30+ JAWODQ RSKI GEOTECH, INC. Rema&.- 711C 4n(ificuGan Knee represent the appr9xiiin4te boundary between mod b-pc*and the tmmitign may be gradual. Wov, level Ouidinsf hove been made it;The drill holm at Lbnc*and tuider conditions stated an the boring login. Fluctuation in the grguridwaser may occur due to 9thcr factor dwn[how kreaftlad at the Wrie memuraments were Runde. 11/01/1996 19:04 6036474432 JAWUKSKl ULUILCH-NH r'Hut lb/lb TEST BORING LOG ` Mob '.Y.i•y11 P•�'jj"ti•.41�:LI!�sFfi .e.•:I.I{!. j1,;.,�, ����� ;!,!,j �i,,u,i �:x..�,; ilSration 'u'th!;I';'a?�-S!'i'r.:yti'!xit'i>i�•i��� �!���ii5:a'i`.i!i�hi�ra,•a!an•Y".ri�lai�i�i'?i'I?I"r'.'!i'iivl'111i���..�.r'::;R''���!"Z i y gr,North Andover,Massachusetts TYPE: HSA N96498 SIZE: 61/2'llj 2-OD :."� 1.r October 30 and 31. 1996 #.¢R1,oil. . � „sr u ••' .. '•'`' . Comer October 30 and 31 1996 y V .,�iBu te0lbe. 70' i_ . Tyree Organization,Inc. O Westborough,Massachusetts DATE DEP7'II CA$gVG AT STABIMZATION PQtIOn .21!Shawn Lyons 10/30/96 9.0' 10,0' During Drilling R.Verner ado S3i1� rink°6��q� I 6� �I S�� I�,I �+!,��I I i FSI I� 'I^ d' !�'3ifo3�•'��'6'ul::ci',�S�c� �; ,yTgI�I G I ,'/I,i 'e �h;IS;I I ' '`d.' ,• e_I s.i el._�.,r; !M� a; �'I�dl I I�i.:il I• a ,-parli•�I�',d��ail>;,^•..,ar I Sample Stratum Penetr/ Description C:baAge ,I, No. Depth A)OWS1611 Recover (ft.) Notes S•7 3345' 5-13 2d"/2A' S-7; Brown.medium demo,coorec to Fine SAND,some Grovel. 35 7-7 little Silt , Glacial outWanh ' Uxcavation tornioated•35.0'. 40 45 50 55 60 NO Proportions uncd! truce(1-10%)• little(10.20%), some(20.35%), and(35.50%) �= - t oheaivo C,onsistcney(Blows/fiJ Gohesionless Donaity(blows/ft.) very soft 0•x -cry loose 0-4 soft 2-4 levee 4.10 medium stiff a-8 Indium douse 10-30 o°eoso�op�p<ba stiff 8-15 donne 30.50 QCui very taiff 15-30 very dense 50+ JAWORSKI hard 304- GEOTEcx. INC. Rmwrla5: The stratification linea reprcacnt the approximate boundary betwoun Soil(Ypcs and the tnansitioo may be gradual. watwr i GW7 lovol r adiMo have been made In the drill holes at limen and under conditions stated on the boring logs. Fluctuations in the muod-ater itany occur due to other factors than those presented at the time matsurwnenta were made. 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH—NH PAGE 11/16 TEST BORING LOG Ml 'Mob t 1to 1 S t Dr1 '}�,rl'vfi!i 1'•, �i0 " i!I �,i3,r4A,:�,,oar:i;i:P;'P',. a$!!• S;,'-'iiti7;p:: r t•;...n�r Ib i,K;N'n'iIS:R'..G9 iiR:ti�',S' A{�V,,:4:.F•. �;t,;,..;:..•.:. � F•}�E 7�i�:,,., .•'i' r�'•r;��'�7�^Z North Andover, Massachusetts TYM HSA Ss .Amp , N96498 ..r,, SIZE: 6 1/2-1D 2'OD '�''• y�/■r +• building�Q, 1996 NE Cornar i'1','October 31 1996 140 lbs. ''�: Organization,iTYFee Inc. t I li Pi�'! .. .:h G �. .:t7•if�i$�''i;:� .. ;I Westborough, Massachusetts DATF, pEYtH CAS`pVG AT S7ABD.IZATrQN PF�1t1CtU ills $Shawn Lyons 10130/96 8.0' ..91). Boil9vert/R. Verrier buMe Drilling 111111191,'','�y,�i'i'� ;�' ,Ir s Ifi 's:'i�:'''3 Simple Stratum , I Penetr/ Description Change No. Depth Illows/6" Recover (ft.) Notes s 3-1 5-7' 5-7 WtV S-It Mdiwn brown,c"Mc to rune SAND,little Silt with 7-4 glans,brick and woed. l0 S-2 10-12' 4-3 24'/2' S-2: Piacce of rubber tire -no sample. 2-2 15 S-3 15.17' 2 WOH 24724' S•3; Very loose.grey,medium to fineSAND,some Silt, wed, 20 SAA 20-21' 2,2 24'I2d' S-dA: Similar to S-3. PII . S-a13 21-22' 7-7 S-48: Loose,brown,coarec w Fina SAND,some(irnvcl, little Silt,wet,oror, 25 5,5 25-27' 7-10 24'/2d' S-5: Modiutn deme,brown,coarm to fine SANG,Rome 12-22 (Ravel,wet 30 NOTES- Proportions used: tnwr(1-10Q6), little(10-20%), some(20-357K), and(35,50%) Cohcaive Cansielency Mows/ft,) C_ghesionleea Density(Blows/fi.) ��;• very sof! 0-2 very loose pA sort 2-4 loose 4-10 b r meditun stiff 4-8 modium dense 10-30 b eoiulo'o M— stiff 061 stiff 8-IS dense 30-50 JAW0DQN vary stiff I5-30 vory dettsc 50+ hard 30t GW/�cATE+rIs, KI Reanarka.- '7'6e AndfictaUon linin mOpresont the approximato boundary between soil typos and the transition may be gradual. Wotci l['CH I level tvadiMe have been made in the drill holes at limes and under conditions stated on the boring logs• Fluctuultons let the. toaudwawr may occur due le other(actors then those rateated at the luno mcasurementa wero trindc• I I I 11/01/1996 19:04 6036474432 JAWURbKl ULUIEC;H–NH HAUS 1.2/lb TEST BORING LOG_ 1 Mobil Station �i5�Y1 ;'?"i51?i°,,3..1.,, �p ,..y'rl .�..,,... -'c;y,e:• ,,. •ry ,I 't r.5,5"a31'•i ME— IN .�.:'i�:i�'i:,:ri!a!:!cn i.� ,.!.�;6d"ui; ,ii;i!�.ih�� •n lei',�;.� I North Andover Massaehu p I tl r 6ettg TYPE: '..ttSA SSi�y -till::::, I I I'p P I i IISI''N96498 SI rplu:a;':: JB•2 q October 30 and 31 1996 r a'ao i ; ";tf ^iy i4 I17'1 7, � � „.,. ..�,iN'L141"IfIS:{ri�!::;:•�'%''' , ,�,•{� r I " • '�� III'si� � ..� ' �ia::�,i'•;:1',. �NE Building Gomer I p MAL ".gl II October 30 and 31, 1996 140 ib,.F. " y. Tyme OtItetnizatlon. Inc. �� �,�t''�Ni' I'3,; :I7;; Yl�'5„ �rr�7y{ +� ` I Si,I.,I.',r :.ir A:;a'10. I•YJ•�N: , ...'�- "R 1 ....,•`1:, -:. �;a t5�ty,�l'Westborou h, Massachusetts DATE I;I R 1D16I'1'II CASING AT STAHQNI2,AT10N PERIOD Shawn Lyons 10/30/96 B Q' During Drilling �." 1.)51I D_ Boisvett/R- Wrier Ip'I,' ITt•,' I��'IY � d >ZI 15 I, 1 1 ;��yei, S';�a,Q V.'ii la ¢,H:f!11'SP„. r I ,/ I Il, I��,{II i '�,, Y i lar �I��.;Sii'I•,i, I 1 y Penetr/ Description Change ' No. De th Plows/611 itecove (it.) Notes 6-6A )0-32' V 6-11 24'/74• S-6A: Sbnilar to 8•5, 30.5' s•� —...r _..—... _..... ._..... 18.21 _... ..........._...... S 6D: Medium dmge brown,fine SAND,trace Silt. 31.75' S S-6C: Medium dawme,grey,Mime to fine SAND,some Gravel. 35 S-7 3$-37' 7-9 2s_l1T S•7; MWiuin denge,giey,ware to fine SAND. 9.10 40 S-BA 4040,S 21.40 24"/74• S-SA; Similor la S-7,except vory denge. (01ttcial Outwagb) 40.5' S-913 40.5-d2' a1.62 S-gp: very dense,grey,fine SAND,some Grovol,dry. (Ti1Q f Exploration terminated-d2,0',' dS 50 T5 — NOTES: 60 Pfoporliansuggd; lraca(1.100, IiWe(10-20x), R91-(20-35%), and(35.50$) Cohesive Comristonoy(Blows/K) Coheuionle. better AI w./ft. emery soft 0-2 very Iooso 0•4 soft 2_d loose 4-IU madiLun sun`9 4.8 Indium acme 10-30 .0 o "na��:�•a°O end's stiff 0-15 dewcverMud 30-$0 JAWORSKI retirf 1$_i0 very dettgC SOt Mrd 30t GEOT,ECH, iNC� Ratnarb; The etratifit�tion lino reprrnetll the approXimnte boundary between soil types and the tramition reny 6L grt4unl. W:15cr l: s L�.(4 f11� level wings have been made in the drill holes at limen mv1 under eonditioua statod on t4c boring logs. FluctuoUolw in the Ltvutdwaler pray occur due to other factors Than those pregmted of the time mem,umments were made. 11/01/1996 19:04 6036474432 JAWORSKI GEOTECH—NH PAGE 13/16 TEST BORING LOG 1•, w n��:' s ,Mobil Station 's �' ;; ua 1'ys��• 1 I•I;.,:. 5 1 '� 11;hF'' -.�f�„��' r,..'J! .�7�Fi�11 '�ss'i�I 141�I�i�•'i:ii`iQ 1., rol.�i,N.��,,y111,�F�i:;�:1:�`�}j!•,�li�� ��;�,�,�, u SNOnh Andover, a: ,d as4;:I:v,:•n•� c r sr r, MQnxaohusetta TYP& R ii1: i��.-,�'idi`!RIF •I#�,r 't''' d S`� N96498 SA Ss SIZE! 6 1/2"ID 2" {r'j!;!i' r•"•R.. October 3l, 1996 M07.0 s.Y a'ati ,y"`s'• OD ,�, ���L';.•;;. 0-10ber 31 1996 .e• r.,'•,t;i,lv'i"r,' ,s+S s r,li„•s,sv..u,NW Building Center 140 Ibe- 30' .,.,,,,,;.,,.r,:,�•,,; . Tyre4Organization Inc. $rs � rI��r�yy:` yr14 t lm. I, ', �.: ,itli's'gx,rS,$111-104 111. 1� , 1T, . 1 1 aY ni �(�qQ41 AW iYF,!'L;k!i�' :, Westborpugh, Massachusetts DATE 1'' ��•���:��Iksf,::,�,,;:,sis:':::' DEVFTI CASING AT 6Tn)3U IZA7'IQN PiEJLIOD Shawn Lyons 10/30/96 10.0' R. Verrier During Drilling ^ ! ' i' I x+31 1 I I rs t Fig IHI .,, .�„ F,..'vfS '•'"l+�l 'sp.sn[••; e`� 'F�i� Sample Strahlln Penetr/ s D"cri tion Blows/6" Recover p Change �. 1Vntt»S 5 10 i 5-1 10.12' WOI-I-1 2d'/10' S-t: Wry e 1one,brown SAND,and Silt,with oslt,wood, 1-1 brick,wet. 15 S-2 IS-17' WOR/2 24"/16" S-2:: Very loon,brown,foie SAND,401MSift.truce wood Organics,wet, 20 S-3A 20.21' 6-9 24"/24• S-3A: Wood 1 foot layer),wd (Fill) 21.0' 5-38 21-22' 12-10 S-3B: Madison dense, gray,tncd'nun to fmc SAND,wm 25 S-4: Brown,cowlic to Ane SAND,truce Silt,wet.pctrnleum S-4 25-27' 16-21 24"/24- odor, 22-24 (0tacal Outwash) Ettploru ion terminated-27,0'. r 30 N T'E,Sz Propottionq new: (race(1-10%), little�'• 10-2- - - ivc "sten lowtt/ft ( 0%'), nome(20-35%), nntl(3S-SO%) .`• - 4-8 v�soft 0.2 mel C:ohesionitss Density(Hlows/ft) soft w`rY loon. 0-4 mdlWn.tiff 0 2-4 loose 4-10 , e ps O o 60 opo stiff 4-8 nY4 dcnxc 10-30 n 0 dean. 30_50 JAW01M!-_ very gaff 15-30 very dense SO w a�(�' herd 30t GEOTE `H� INC. R�aflte; The otraGFit ales lines reprcoca,the approximate boundary between noelVpesand the level readings have been tngde in the drill hods aL timer and under trattsitio0 mny be grudu,l. wnttr conditions stated on the boring logs. Fluctuations in the roundwmer mQy occur due to other factors than Ih ose presented at the time measur.t . o me were muck. 11/01/1996 19:04 6036474432 JAWORSKI UEUTECH—NH F'AUt 14/lb v ''Mobil Station TEST BORING LOG gPay � Y. �Bi?'.11ri GYiY°'u+ik,?� �'�'•,.r'irr'�' �r� � `�S,!�y,tN i'l..�i' �,4'. """" ' d I North Andover Massachusetts TYFE�;'�I r`•S k_+�f)I:.li%:° •HSA SSN46498 rr.7I'ti1'r,'�I,h'i.'y•.•�•;•':q•!,'•,RI;, ci+hSa,':'!S�.ti.:pl•�•c S•r:-:'-S�I i� 1E-0-a SIZB• 61/2•[D 7011 M210Qcober 31, 19 M' ' 1XIV.Oc[ober 31 1994 S6 building Wins 1 P 2 Coma 140lbs- : •, ,rc' y1ee Organization, Inc. 0Aim.,' i IS'is�Y,[►V•! I ,, y., V , . , y{•�I .i V,_ I"!I,i�:•'•Ir.�a:l .E. A Westborough, Massachusetts DATE - •• ' Dpi CASING A7' STABELIZA970N PF O F) Shawn Lyons lo/30/96 9.0' 'R. Vefrlcr Duriog Drilling 'S� 4� ''h � �� IYi,'�I�:I�+'I I{,��'I �i irl! Fn.` S I�h'w"¢'4' �' 1 i4[t• I ;� I y 1'j i 1 � 1�1�5r'�i7'v�l�;� i�' I4 I,�, ,I I�'' S i9%I•�;'ti,S`'�;��,:,I�l&�F,%'w'';''}'•;'`'i v I rj i lrS. L 1 la' �S ,.t�511 R'I I `L,-• y. '),i I I +1 1@, I q �yi' I ra'y!.f:�3�;�sy, ,try�..,•�'. � F,I��¢ I lyl�,�,!' ,i; �•''! 3 �Kl�gi,;.,tiigC.gi:e7'LK n.y �'S ! I 1�IP'e�,I I�'i,'Ifl�+'!�'fl'�i.blY.l': �• ;��•�);y I , ;�;I Sample Stratum/ I; 1,21dr/ 0mcripUon De th plows/6" RecoveryChange, It. Notes s i IO Sal 1A1Z 1-2 24/B" S-r, Vtry loose,brawn,Combe to fine SAND,Nome Silt, 2-1 15 S-2A 15-16' 1-1 2a-t24• S-2A;:Very loose,browq,Coo Ma to Fine SAND,Noma Silt will S-211 1417' 2-3 debris,wet, 16.0' 3-213 Very Coope,brown,fine SAND,trace orgaoicN,woe• 20 25 $-9 25-77' 6..4 24'/2d' S-t; Modiutn demur,eati,fine SAND,trace Silt,wel- 10-10 30 N 0 TE.S: ::�`�• Propo+sionti used; Irate(1-1091), little(10-20%), some(30-;15'%). end(3.5-50� __ _ Cahanive Cunninte low I ) _ very soft 0,2 CoAraianleas DenNlty(ilowg/1�) very IoaxO p,4 soft 2-4 loose u median stilr 4-8 4010 0 00 0 a oo�ap�a�o alifF 8-15 'a^ 'c m<lonpe �a50 J/�A� WORSKI vary aa1F ls'° vary de11Nt Sot Mara �o+ GEOTE01s INC. Remarks! T)e stratification linea represent Ute aPProximulc boundary between nail b'pea and the tmnnitian niay be gni4tud. Wuic, level roadingo have been(nada ut the drill holed at thnes and Wider conditions stated on the boring lop, 1'IuatualioM in die rotutrlwatar nmY occur duo to vUier foctom Ulan Uioae presented at die tune meneunun iA were 1pwle, 11/01/1996 19:04 6036474432 JAWURSKI UEUIECH—NH HAUL lb/ib TEST BORING LOG .Ymgmobil station . .......... Vii,�41,'Nodh Andover, Massachusetts TYPE HSA S5 N96498 SIZF; 6 1/2 11D 2'OD �0040bcr 31, 1996 �Iil`1 SE Building C 401 nrinhpr ij 1996 140 ib.. 30, M, I yree Organization, Inc, ; SOON,. "'OLRIENRIC96 yyi Westborough, Massachusetts DATE DEVFR CA$lYG AT STABEL17AII ON PUJOD IShawn Lyons 10131/06 9.0- During Drilling R. Verrior M!, ... ..... Sample 111k, Stratum 0, PeneArl Description Change, No. Depth Blows/6a Recovery (ft.) Notes 351 1 (C.-Incial Outwitalf) 37.0' 30 50/4* SA: Very dense,9MY,fineSAND,and Silt,dry. --L-- (Glacial Till) 401 — Split spoon mfimaj. ExlAbnolon termixiated 38.7'. 45 1 Sol 56 601 Proportions 446d; tram(1,10 liW-(10,20%). some(20-1596), (u-A(35.50 Cohesive�isrcncr(Blown/R.1 C-oheuionlem ensi Blow./k. vto%oft 0-2 very 100im 0-4 *Ott 2-4 loose 4110 umcdium artiff 4-8 mcclitun dense 10-30 ;tiff 8-15 46ttac nopl'.S 1A5 P o°, 30-$Q very stiff 15-30 very deme 50+ JAWORSKI hard 30+ R—rico: Tlxc antiricati*n linm repr"cnt tht approximutc boundary between.1011 WI)tR find the transition may bu gradual. Wwui GEOTECH, INC. level reading;have bftn made in the drill holes at times and under tonditiouif.5%tod an the boring log.,- Fluctuationt,in the groundwater may occur due to other factors than those pre;cntod at the luno memnimnuits wewc made. 10/29/96 TUE 11:31 FAX 1 508 871 8301 T1REE it"ESTBOROUGH 2001 � EXIST,'AREA•LIGHT,- " ' o,F As :. W/CdNC.. BASE (To BE. REMOVED) r IIST. AREA UGHT II � U1;'CONC. BASE 1 it I (TO BE. REMOVED) 1 a l 4 50'-9 3/4' B. . . ui 15- DUMPSTER 1 ;� 7Tn nE REMOVED; , Air a AlhO p v �- PROP-. 1220 SO. FT: x x—X' % REMOTE SNACKSHOP Jx PROPOSED 1 " CLOSURE i M.W EN x' EXIST. TRAA:ER . N TO 8E/REMOVED] w Y O sI cn PROPOSEDlop HAElDlCLW RAP.lP N EI) PROPOSED -f III WP W '.s 5i PROPOS I,t1111111� �! EX15T. STATION R :.,P 1 142 PVC 5' S10EW (TO BE REMOVED). EEP STICK TANK / AC UNIT EXIST, AIR TOWER REMOVED) (TQ BE REMOVED) EXIST-.(3) VENTS�;. . f li (TO"BE RELOCATE PROPOSED COD Sc�ER —��" Q z 4 Y W 1 v o 20' (TYP.) Q w ° `e EXIST. FILL O \ APPROX. LOC. OF (3) is -� EXIST. U.G FUEL STORAGE TANKS _x (TO RE11011 I Ld V.R. l QN o PROPOSED 1 AP COG BER �1 \•. O O \�(TYP. 2 P CES)" .O / w w ttEXIST. WASTE 01 w . oi% (TANK Tn REMAIN) r \ o� i r' a Ex:ST. IG. SIGN (TG RE!.tAfrJ 6t In — x I L Cp Bi:. r:E(ACED) W w l�;__ � �EXlsf.'CONC. (FQ'_:REMAIN) PROPOSED CAP- - COD BERM _ t ' i 1 i 1 ey. E>•IST, LOW LEVEL --_ - AREA LIGHT (TO REMAVN) EXt5T. EXIST. EXIST: / SPHAEXI PAVEMENT, MH SANS` EXIST. CURB ASPHALT RAVEMEr � _ U (TO BE REMOVED) - _ — 4 .EXiS i Location Z SSS �- No. Date 71b N°RTM Ot^tea° TOWN OF NORTH ANDOVER ,•'�,y0 F p Certificate of Occupancy $ « ; : Building/Frame Permit Fee $ Foundation Permit Fee $ ' Ss�cMus IR Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ g TOTAL $ _ o d.� Building Inspector ti 7980 Div. Public Works r •.TT No. o APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 I - MAP iJO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ,ZONE SUB DIV. LOT NO. LOCATION �'Z � JS �.� PURPOSE OF BUILDING `OWNER'S NAME J q A- 7 y� ��� NO. OF STORIES SIZE i J/'f A A _ OWNER'S ADDRESS //•l M X S S a�Vf- BASEMENT OR SLAB ARCHITECT'S NAME G'F SIZE OF FLOOR TIMBERS IST 2ND 3RD BUIL'DER'S NAMESPAN ksst 1 L- �(P�Efe-, --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW � SIZE OF FOOTING X Qe1 Nce 'E'>ft5fir�, QC�.�, `Pf ih� "I..0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION `F 1/ l Ff7 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 44CLa ;7 �LJ ,fJ C BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT �F E E V -a OWNER TEL.# (00 PERMIT GRANTED Q CONTR.TEL.# g3-;�" ,31 lz 19 w[©s CONTR.LIC.# H.I.C.# �! 7� QL- c,k 0 &419 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY sTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY_____]_ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- L APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ a 1 2 I3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT il AREA FULL FIN. B"M'TAREA _ 1/1 1/2 1/1 IN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMMGN _ VERT. SIDING ASP,.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR ! OOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING ORT s own of t over P0 No. y , _ ort dover, Mass., 19 9� ti O - IAKE COCHICHEWICK �Ao D PPa� 5 RATE E BOARD OF HEALTH P4 Food/Kitchen 1�E' Rm IT T D Septic System 11 BUILDING INSPECTOR THIS CERTIFIES THAT....................... .q.... ..........4.jn.ev .............................................................................. Foundation has permission to erect.%jQl.??d?,..... Q44uildm son ........./�........M.C?.S:S........ . ...V.��....................... Rough } to be occupied as.................�i /1.c.�s:C:e........c� A.4 ............. . ..Q�.T!,.(�ad 1....12etd p/..Uh�l�.'.: - Chimney provided that the person accepting this permit shall In every respect conform to the 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough 4 .........../—............ Service BUILDING INSPECTOR Final a Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F Rough No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. SEWER/WATER IFINAL DRIVEWAY ENTRY PERMIT �\ ✓12P. -CJG�IYI/!I?,dl2Clt�p/�'Z C�✓l/�JQ<.zC'Zf,Ii1P,��l I HOME IMPROVEMENT CONTRACTOI75 REGISTR01101\1 Board of Building Regulations and Standa.i ds ! ' One Asl'rbur-ton Place .... Room 1301 Boston , MassachL1S('tf:S 021.09 .;. . :. 1 HONE IMPROVEMENT CONTRACTOR A• Re.gistration 117692 Expiration 11/03/96 ype\-- INDIVIDUAL HOME IMPROVEMENT CONTRACTOR t Registration 117692 y >; RUSSELL. LAPORTE Type - INDIVIDUAL " RUSSELL P . LAPORTE Expiration 11/03/96 44 WESTFORD ST . . : I CHELMSFORD MA 01624 i RUSSELL LAPORTE � RUSSELL P. LAPORTE ' T � 16; _ WESTFORD ST ADMINUTFIAlOR CHELMSFORD MA 01824 ' � � ._ — II •._.Ian t - y ..., ._ r..., I - I COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY , OF ONE ASHBORTON PLACE MASSACHUSETTS. BOSTON,MA 02108 CAUTION EXPIRATION DATE 11/04/1995 FOR PROTECTION AGAINST RESTRICTIONS NONE E �J�y 3 LI -NO. THEFT,THEFT, PUT RIGHT THUMB �� PRINT IN APPROPRIATE r 5030 6 Russell LaPorte . 'OKI 6 BOX ON LICENSE. ' g 44 Westford St. g BLASTING OPERATORS m Chelmsford Ma 01824 m DUST Iff LUD PHO 10� a PHOTO(BLASTING OFR ONLY) FEE: 100.00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY q i HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER M E1Y J 1993 d 1 DOB: 11/04/19r 1 _ • THIS DOCUMENT MUST BE LL2LE,�� l « SIGN JL M tyjL ABOVE'GY.JTURE, N )r CARRIEDONTHEPERSONOF A -''91CU OF LICENSEE THEHOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. -..COMMISSIONER tiN (, , I Date.. '' 2411 F p0RT1y , TOWN OF NORTH ANDOVER �? `p PERMIT FOR GAS INSTALLATION �9SSACMUSEt - S This certifies that . . a4317.b,. , . . . ,, . .. , has permission for gas ins allation .i }4 in the buiMin. of : :. . , . C" at .E . . v ✓. . . . . . ., North Andover, M Fee. . . . . . ic. No.x3 . . . . . . . . . . . . . . a 04f, 3 GAS INSPECTOR ~ r� WHITE:Applicant CANA, Y: Building Dept. r PINK:Treasurer GOLD:File J ._ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING s (Print or Type) p NORTH ANDOVER Mass. Date building Location r G�/�!,} a�V�—� Permit # �a3 c , V� Owners Name • �' New Renovation D Replacement �] Plans Submitted FIXTURES N oC df ¢ .O = F V m ~ Ct _ a a. LU a d us � z O O to O va 1z- zd d xw re W yO rl 4a zw o y mwazo •a a aw tw -s al csW- z w us ` a > k t- a o z 0 «Fs = Q .w > w z 4 a a o o w _ o w l- Q o sua-13SMT. BASEMENT IST FLOOR 2ND FLOOR 3110 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) ,/1 Check one: Certificate Installing Company Name ��{� �'j �(� j�/t Q Corp. Address S7D /V"> Lz ('3 U R `1 Partn dKC.a - Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter 'D/944—j 0/-- Insurance ,/--Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that he licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent F7 1 hereby certify that all of the details and infotmation I have submitted (or entered)in above a pare true and accurate to the best*(my knowledge and that all plumbing work and installations performed under"Permit issh ed fo: this ap"lill, caa w be in oo pliaaes with . perttaeat provisions of the Massachusetts State Cas Code and Chapter 142 of the Cental Laws. By PE LICENSE: 1ximber Title Osfitter Signature of Licensed City/Town: 5�ter Plumbe r i Journeyman APPROVED (OFFICE USE ONLY) Licens Number