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HomeMy WebLinkAboutMiscellaneous - 135 MEADOWVIEW ROAD 4/30/2018 l 135 MEADOWVIEW ROAD 210/103.040048-0000.0 / I A, 7� A Location 1� ' No. 7� Date d 2/ MORTIy TOWN OF NORTH ANDOVER to 9 ` Certificate of Occupancy $ s i Building/Frame/Frame Permit Fee $ s+cMuse 9 x Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # 16855 Building Inspector A a �i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: 1 81 I o -0-�C-,2-acro 3 X SIGNATURE: C _ Building ComrrtissionerfipsREtor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O L o Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: FP-O- Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RegLured Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSEU/AUTHORIZEDAGENT Historic District: Yes No M 2.1 Owner of Record X�— �(Print) Address for Service Telephone 'Si lure O 2.2'Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: C� DI! W4e License Number mn 1dress Expiration'Date g re Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 102 "7 Registration Number Address (y r Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(ALG.L C 152 § 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 Yes.....^ No.......❑ SECTION 5 Descri tion of Proposed Work check air applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other )Z Specify_ ln'sU.' OWy� —bece 46 S rS Brief Description of Proposed Work: La` Y& U ia� teawl Vr 4rL SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to bealk $�b CLA ITSE ONLY � Completed by permit a licant � �� 1. Building (a) Building Permit Fee �� Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, `S-A"I as Owner/Authorized Agent of subject property Y Hereby authorize 4"6 C to act on y half,in l,mallers relative to work authorized by this building permit application. r tune of Owner Date f SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date r i" NO.OF STORIES SIZE -� BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Isr2 ND3 RDI' SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE tD FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT -A'btE,S ►'lac di, PHONE TO � /�fS� LOCATION: Assessor's Map Number 3 PARCEL SUBDIVISION _ LOT(S)-- STREET /)5_1 ,� �fi CyJ ST. NUMBER ***'•y:O FFICIAL USE ONL ** * REC MENDATIONS OF TOWN AGENTS: CONSERVATION ADMINI ATOR DATE APPROVED DATE REJECTED r' U 1 COMMENTS—k /00f TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED 4EPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 'UBL)C WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT IRE DEPARTMENT -------------- ECEIVED BY BUILDING INSPECTOR DATE !vised 9\97 jm NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-954 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant G Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector - I t _ a The Commonwealth of Massachusetts p N. Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 '��M 5y• Workers'Compensation Insurance Affidavit Name g nS (� Mlr.�`c►.�r)l l Please Print Name: 1 w'pr� Location: J,J ..L,&,44, -C ' City "Oat Q 1�3d Phone # 7 4 7Y-3$o3 l I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address --------------- Cifir Phone# Insurance:Co. Polkcv# i Company narne: _ I Address Phone* Insurance Co. Policy# Faiture to secure coverage as required:under Section 25A or MGL 151 can lead to-the ikiposition of crinrnal and/or one Yeats'impnsolvr Las welLassm44 enal lesmlhelcm -dA-S OP **-dof a $1,500,0(1 understand that a copy of this statement may be forwarded to the Offim of Investigationsage verb Won. insr 1 of the DIA far verification. /do under the pains and pe a/ ofpeg iry that the knbi isUbn provA*d above is true and correct Sig Date a a Pri name �1-f1weS � c'/JCi Phone-# Official use only do not write in this area to be completed by city or town dfioiar City or Town Perrnit/Licensi D Bidlo ng Dept bcheck if immediate response is required [] tiGe!l31t7()Boarlrf p s%ctmarfs ice Contact person: Phone# 0 Health Department Other 1 FROM G&T (TUE) 4 29 2003 9 :45/ST. 9 :44/N0. 5510281351 P ' 10'd 1H101 7k- T 7G� A` ' e 7'd CAI ►er LOU ,(j'JfiETfiKl WAVY �z L=- ATM l'F b't Auv r 9�rS``z BASEL?ON LINE$OF-OeQJPp,-,;:iY ONLY. A 1MXiE RCCU1fATe►1..r„�t`t� WILI-FIF►;%1.17[3}A'4tNgTn:?.1E!:7 :PAOR ON GAGIROrERTI_RTIY THAT TMEAMERICAN SURVEYING COMPANY TOwOE IN►sPEOTION► '1294 Maln Street, Welrharn, MApZgstIs ► O R ' n70MrWT4iANYrvYpATO�` ('�7) 893$477 NOT INT MUM-OR REPRI� ®o RVLIY.TO 94 A`�tD�P RTM M rt 1n� tion Plan RVEY. NO C019ED FkEM THe LOCATION OF THE ORJOfMAL RECORD �L'l!'1Q� SE USED FOR Pte- DLLMQ SHOWN HEREON EITHEq ppOK U FENCE. M2009 OR WAS►N LIANCE WITH RAd SUNT~AEOiST AY OF DL�EDS I Is RAI"ELANDASBr?tO AppL�I THE LOCAL. PUN ge�eq 2 a Z I ENC I8 BAgL+p ON OJ�1 M� BYLAVMs IN idF- CLf DRA flfM gyp' FEAT��INSTRUCTED WITH RE- MAP NN pER TOWN pp To FruffrtiH AND MAY 9B S►>=CYTO HORIZONTAL DIMENSIONAL ADORlrS6: iDATEDA� SR's TC �RTMER ON'T-,SAL3S, REQUIREMENT t ONLY).OR IS EXEMPT ...ra ✓ _ a RROPON :ANQgtQp�TgOR "10M VIOLATION SNFORCEM&I AC-• HBRMEINTOJ90AF10W!•14: ONBJIbILITY IS �(_ TIONUNPERIr"3.q.L.T�EVII,CHAP. _ TNELANQpy�NER GOA, $19C. 7, UNLI!B$ OTHERWISE SUBJECT DWELUNG LIES FLOOD ZONE PANT, rr IS NOT It"rMNOW NOTED OR SHOWN HEREON. A CON- A3 SHOWN ON NATIO 11COROED. FIAMATORY INSTRUMENT SUR NAL FLOOD IN ►a BUD VEE in►sus►ANCE RATE MAP DAT�F� _$ � E.gR�fiAM FLOOD SHOWN TO WHEN STRUCTURES LESS EFgA�ot4 COMMUNITY PANEL ivOR _ — ycSJ►CfC LINES. RECuIAEO ZONING 13Y DAT2 . I� _ _ -� - ��Avcs .��� -- - --- ----__ _ - - - _ -_---- ---- ----------- — 13s f�'1�-�0,��� ��� ,�- �e�I�+�e., w� h I,� ��f-CD�Q�d' � i �._ �� °�' i � _ � � `f .� ,���� a��'�� ,/� � � � i t �� ,� �___-- io �_____—� �o�C IQe-�' C��c�e�e ��. �� .�� i: y4i�t n7 ,-jt�,r i '. ._ p; � CA AV ,- NORTH y ToVM of Andover O to ..� J3 No. agYJY - _ �o LAo dower, Mass. /6—0740 74 d D 3 COCHICHEWICK ADRATED S BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System .•► PA BUILDING INSPECTOR THIS CERTIFIES THAT.�"�v.... ��S ��or'�'N (� CI'D/ ....................... ................................................. ......................... "". Foundation has permission to erect...4. ... �............ buildings on ....13S...A).#A.610 w.....vjs %&w JQAI Rough ...................... to be occupied as.... P .A00.....� CK....... Av�.....m ....� ......................... 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 th Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLU 03/y� 640MBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR t /� • Rough .... .................................................. ......`...... ~.............................:...... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. N° 2 J 9 5 Date��...:�..1�..:............. NORTI� °tt'�`° •�"p TOWN OF NORTH ANDOVER ° p PERMIT FOR WIRING �SSAcHUS� h jThis certifies that �- r.............:: ......�f"'^ ' ......... ..�.. has permission to perform_. ...... < ✓.�r- ' s••= •- •<- = 1�..•R' i U wiring in the building of � `3 at./. ............................ ... .. c c..r!'�................ ,North Andover,Mass. Lic.No%-�,�t :��'............................................................ ELECTRICAL INSPECTOR 10/26/98 09:44 25.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer kI Office use Only uhf Tammaa>rul'# a� �IaSarhu5r Permit No. ,90 �J _ !B,tpartaunt of Ilubllt OmfP2jl Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 9M 0eave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Eiectrical Code, 527 CMR 7200 (PLEASE PRINT IN INK OR TYPE ALL INFOR$1fAT1 )N) Date City or Town of /V��Th / " Alve-ke, To the Inspector of Wires: The udersigned applies for a permit to perform the electric work described below. Location (Street & Number) 3 � vo -i[� " ee_.,w Owner or Tenant 1M 0:yt Owner's Address �— Is this permit in conjunction wit a building permit: Yes ❑ No ! (Check Appropriate Box) 2 'S0� Purpose of Building eG'�f e— Utility Authorization No. Existing Service G0 Amps el -Volts Overhead ❑ Undgmd No. of Meters New Service Amps Volts Overhead ❑ Undcmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Eiectrical Work ;� e P A-\Y� l�� �t C LL-G— (A-0 6 AC7 l ' t2c20 S No. of Lignting Outlets I No. of He,,Tubs I No. of Transformers Total KVA No. cf Liohtinc Fixtures Swimming Pool Above? In- 71 crud. crnd. I Generators KVA No. c Emergency Lighting No. of Rececacle Outfi=ts I No. of C. Burners I Battery• Units No. of Switch Outlets I No. of Gas Burners I FIRE ALARMS No. of Cones i No. of Ranges ( No. of Air Cond. Total No. of Detection and tons Initiating Devices • No. of Diecosals No.of Heat ictal TotalPumps Tons KI-AJ No. of Soundine Devices e No. of Self Con:::.ned No. of D!snwasners I Space/Area Heating KW Detection/Souncine Devices No. of Dryers I Heatinc Devices KYR Locali Municipal n Other C Connectior. y No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the recuirer-,ents of Massachusetts general Laws �� I have a current `iability insurance Policy inciudin Compie w Operations Coverage or its substantial equivalent. YES ' NO G 1 have submitted valid proof of same to the Office. Y__ i 0 C It you have checked YES, pease indicate the type of coverage by checking the apprc ate box. INSURANCE BOND C OTHER p (Please Specify) (Expiration Date) Estimated Value of Electrical Work S WorK to Star. Inspection Date Requested: Rough Final Signed under the Penalties of perju FIRM NAME w -A LIC. NO. Licenseer�W t « t �` +AZ i Signature��/ ��o ` O LIC. NCO/_ S �Z 2 �-!�S' Vr• y�.A Bus. e. No. I 2-&—fie 8-(e—7 Oa Add Fes+ Alt. 76:. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee goes net 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 cheek one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-8565 N° 3 0, 0 6 Date.....I..'...... NOR71� + TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMus� This certifies that r f - �`-�r ............:............................................................................... has permission toperform .r��.� �'�s.:.. -! ..'^*'r� wiringin the building of............................... ..f,....................................... at... ........ ... '.... '. %tom :............................,-',1N&th Andover,-Mass. Fee,:��............... Lic.No�Z ��a, - L moi_ v / _ELECTRICAL INSPECTOR Check # � WHITE: Applicant CANARY: Building Dept. PINK:Treasurer ��� IIYG WIYlLYLV1VY►Iri4lL2 UT JVJ/A a]fjiLnV&]CI lJ U11we Use Only DEPARTMEIVTOFPUBLICS4FE77 Permit No. 2o9� BOARD OFFIREPREVEM70NRE9JL4TIOAN5270M120 UVAA Occupancy&FeesChecked PPl,1aTCATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date-,4C;— 'Z� 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) / 5 e LJ d Owner or Tenant =� Owner's Addressr Is this permit in conjunction with a building permit: Yes No r-4----(Icheck Appropriate Box) Purpose of Building Utility Authorization No./ .L�.L. Existing Service Amps� Volts Overhead a Underground ��' No.of Meters New Service /' Amps /� Volts Overhead 1:3 Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above [71Below M Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No:of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other 1 . Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER;— 4— htstrarreCo Rostlantbtttetagtstana� da�GenaalLaws •��• Thateaamett yhmr&=PbhyedUftCat ° amCotrrdgorits%kstatfalt*tivala# YES ET NO E Ifimesubmodwlidpw ofsmneiDthe0 i=YES U NO � If}°utmedxdwdYFS,1imethetpofby tr, Wpuprimebcx wsvRANCT LD'BOND OTIEx F1 ftwe )= EVirzemDale Fstirl kd VahteofElatical Work$ WaktnSW .� 5��hgxx imD*Ra>esWd Ra# Final Sigrtedundar�ieP�tal6es .. ` FVRM NAME Cr r 'C LloaiseNa / /C� 7 Lio� as1 N \I�7, e�,� Signalre Lioa>seNo : `622 AkTel.Na - OWNER SMJRANMWAIVER;I.amawalethatf elioaw dm nQt theitmrat amVaAsstbAx ialapw t,%legwWbyNb%adumC,nuALaws and thatmy signatuteal$1s p� tvaiws this lequilsl�. (Please check one) Owner a Agent E3 Telephone No. PERMIT FEE N2J .' G Date........:... .:........... F NORTI{ TOWN OF NORTH ANDOVER p PERMIT FOR WIRING cHUS r I ` This certifies that ........ ..:i. f1� ....................... has permission to perform .........................................................:.....l.. .......... wiring in the building of........................ .......!................................................... at.............................. ............................................. .North Andover,Mass. Fee...................... Lic.No.............. ............ ... ..........::.......fes.... f z ELECTRICAL INSPECMR a Check # t WHITE: Applicant CANARY: Building Dept. PINK:Treasurer XTO 3 G 9 2Date...... 4, 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING lo SSA CHUS . . .. ... ..... This certifies that ....... ........... . . . .. has permission to perform ........................... I............. ........ ....../..,............ wiring in the building of................... .......!...... at.... ...........................................................................North Andoveri Mass. . .................................. ,aFee... ... ......... Lic.No. .............. ... ELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer ®` Jrw WivEy1VlvrrvdlLlll fir JV1d%X1f LnLJJzJJ&3 voice use omy DEPARTALENTOFPUBLICSAMY Permit No. BOARD OF FIRE PREVEN770NREGUL ATIONS 527 CMR I Z-(l I D PJA Occupancy&Fees Checked PPLICATIONFOR PERA47T TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL.INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to performn�the _electrical work descr ed bet w. Location(Street&Number) Owner or Tenant Owner'sAddress Is this permit in conjunction with a building perm es No (Check Appropriate Box) Purpose of Building Utility Authorizatio No. Existing Service I o Amps I /?-Q Vo Overhead a Underground No.of Meters New Service /67 o Ampj,Zy".Di /� Volts Overhead Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work o No.o;Lighting Outlets. No.of Hot Tubs VNo.of Transformers Total KVA .No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground wound No.df Receptacle Outlets No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP x OTHER ka mb-,CaetagV Rvm ttothetagt>sanatso din&CoalLaws Iha%ea=ertLiabdtyhw&=Pbhcyni&ECatVkL- CaeaWorks9ksM We#vakrt YES NO IhmesthmtmdvaWprwfof=neiothe0llD-- YFS M NO © Ifjcuhm YESpkmeitt&*thcNx(ifo mpop bYdxckffgthe MJRANUCE a B(X D r GRER (PkaseSpm&y). Vaktec(EketiralWalk$ WaktoSM 6/-//0/ `htsl)xfirnD*RapesWd Final Sigtedia�da�iePb�tltiesofpetl�Y - , P FIRMNAME 1 / a>Seo ,mss ��Si Buskle%TdNa �A ..- Adtym 17a 'Ll.�.'''t� All.Tel Na OWNER'S 1NSURAAICEWA1V P I.amawatetA#rLioa�e th Yara xamara-dsRbsbtdc4mrdidtasmILmWby&lmmdmemGereralLaws and�atmycntttis ptm� tllis tec�men�. (Please check one) Ownc7 , Agent a Telephone No. PERMIT FEE$ i 'COMMONW'EALTH OF MASSACHUSETTS t OF .:ELEC.TRICIANS ME GISTER ED MASTER ELECTRICIANE r' ISSUES THIS LICENSE TO il FRE.DERICK BATTIAT.O y� . 3 PAWTU.CKET LANE.' C-ALEM NFi 03079- 1263,, X03'5 A , 07/3"/Al 688223 I Date.... . ..... .. . .... . OF NORTH o� y` °p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION Y' �9SSACMUSEt This certifies that . . /. h: . . . . . . . jl F. . . . . . . . . . . . . . . has permission for gas installation . . .� t . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . 3. . . . . . .. North Andover, Mass. Fee. .):?-. Lic. No.. . . . . . . . . . /GASINSPECTOR Check# 433c; MASSACHUSETTS UNIFORM APPLICATION FMfS1AW TO DO GASFrMNG 2�— tlMM or Type) Mass. Date_ 2 Permit L �3 Buldlrq 5 fm i nnult i 1'iy12,L7 owners Nacre TcJsT ry l MAUI S�-ti-7 7 cl WRQ-18- of occupancy New p Renovation..❑ Replacement, Plarw.Suw;;' ed: Yeso No < Z� ec. a a a u: G . a c a a: o a. �' �. W j a W.. I.. w o - _:- s e z o m ~ < c I o = w < m a y W: o a a. �. z r..: O > W °z s W = t ¢ = � a a COZC < < O WS O d s V. J ; 0 0 J. e: Y O Q. O SuB—BSMT. BASEMENT ST FLOOR i 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR Installing Company Name C. Check one- Ceffkaft. Address 5 N 4 '7)f . ❑ Corporatlom &4vu rr A . n;1 l S I ❑ Partners* Business Telephone ­7s k- ;j Ir9 - cc�or Fim�/Co. Name of Ucensed Plumber or Gas Fner J f xeh ZZ A8&,,2ta INSi IMIU°:CE CC VERAGM: I have ayecurreftlWAIty irmlr aao oe,poiky or Ift s t SgUIValent--which-meets the mquiremexrts a.MGi:�Ch:-142 If You have-dmkod�^ *Wicde**4ype=verage-by dweddng-theappaopdste boot. A KaWlty insuranoe.po(fcy) Other:.type-ocinderrrctity.Q Bond ❑ OWNER'S INSURANCE WAMM:I am-awwo that the licensee40"jmt-hava. the bmurance.coverage requimdby.. Chapter 142 of the-Mm General Laws, and Ghat my sig ohn-on•this-permit-applicstion waim this requirement Check one: signau"of Awmer-or.*WW:s Agent. Owner❑ Agent.❑ I hereby certify►that all of the details and information 1 hate submitted(or entered)in above application am true and a=afe to.the gest of my knowledge and that cap plumbing work and instailatiora pwformred under tM permit issued for Of application will be in eomplianp with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General By TIT of license: ,r Title Plumber Hato mer of Gas �t1er CRY/Town MWer License Number 131&Co. BELOW FOR OFFICE USE ONLY FINAL,INSPECTION SKE�CHEg PROGRESS INSPECTION FEE NO. �.. APPLICATION FOR PERMIT TO DO GASFITTING NAME a TYPE OF BUILDING LOCATION OF OU1LDINa PLUMBER OR GASFItTER Lie. X10. PERMIT avkAHtED DATE 20_ , GAS INSPECTOR l � IE t� 5 MfA w V NoI�Th1 %�IbVEI�� M�1. �PP�� CAS I_ /�V j OJELL- Si:Irl c Sy s TE," &Aj �PF'i�ovt:D D,4rt /JPj-gouIN6 /urhol,?lry �oN,�ITiows �I�PPRpVEp D/,jE R�45oNS D 10 SrP��I c Sv5TEN1 l.kJS"li0 LLA-FlOAJ L TG4U/JTtO1J )�.>C;-�,C►10&J UA-rCQ I i�Ss ❑ F41t- FINAL lV5p6—�-Tlolj 4PPROOE1> APHROOlAiG AUTHORITY -GIWI 4��IT�pJJAC, 1�5�c.i�N� X11=- aJy) QlSl�PPKwEV DATC RUM A PPI;pDVAL ,�T� , 9-Z F6 AP�►�o�r�G A�iNoRI �� i GILBERT REA M JOB � u r 0 6-y 4 44 Rea St. SHEET NO.laE "`e-OACKAJ V(Pc-f 6i NO. ANDOVER, MA 01845 CALCULATED BY DATE Phone 682-9864 ` CHECKED BY " DATE SCALE ��. J ...: C� '_... .. .... .......................... �... ... . k. U1 n (�1 �_ � In .......... .....__ .........._.1 ry ......... ......5. ........�.... .... .._. .... ..... rn �> o16 ..... ..... . .. r -., 5 w(nwI (4 ___i............. ..1.. ....� .... ...... ... ................. .. ... .. ...... �.J ' _._ .... N. IN Lilt PRODUCT 204-1ees Inc.,Groton,Mass.01471. Lot 30 Meadowview l 1. Ben Osgood APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at T.nt. 10 M .adorn ew . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete. within 12 inches of. the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 200 lineal (square) feet of effective absorption area, The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 2 feet from an stream,5 s am 20 feet from an dwelling or 1 f Y , 0 feet from an property line. Y nC Y !r' r Y I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE 5%8/69 Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover Massachusetts. e s. DATE 5/8/69 Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE c� 3 `� c ignature o nspecting Office Percolation Test 5 Minutes Soil Clay Garbage Grinder .4 BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. i Nv f f� .l- l:s� 1. NAME DATE 2. ADDRESS LOT NO. �° TEL. �> 3. NO. OF BEDROOMS DEN YES -2e' NO 4. GARBAGE GRINDER YES NO f- 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL g. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL i DATE , NAME OF APPLICANT LOCATION 3_0 Address of lot no, BUILDING: Dwelling Other SYSTEM: New X_ Repair GENERAL . DESCRIPTION OF LAND SUBSOIL: C1ayw2L_ G avel Sand PERCOLATION TEST � minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK tr-Z�_p -gallon capacity. LEACH FIELD ?,&V lineal feet of drain pipe. it iam J. D scoll , Engine. Board of Heal e-- Tr BOARD OF HEALTH 146 MAIN STREET f � TELEPHONE# (508) 688-9540 0('Y 2 ► ; �t APPLICA T tO:V FOR ABANDON::fE�VT L OF SUBS[`RFACE DISPOSAL SYSTEW (SEPTIC SYSTEM) Pursuant to Section 310 CMR 13.334 of the State Environmental Code, Title V Name 4fof iqvf �a one Address t : Contractor (tired for work: Name CL).rlo Phone 6 ��— ZZ 36 Address ,� k Date for scheduled abandonment The septic system at the above address has been abandoned according to Title V specifications. ignahire of Contractor Method of septic tank abandonment (check one). ( } removal ( } sandfill (/o) crush O other Name of Offal Hauler This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. Inspecting Agent Date J; ciomi I Town of North Andover. MA watershed septic System (+ Servicing Report Date: Homeowner: `amu Pumper Street � 3 Address: Phone PhoneX706 Nature of Service: Routine Emergency Observations: Good Condition Full to Cover Baffles in Place Leachf field Runback Excessive Solids Heavy Grease Roots Other (Explain) Description of Work: Comments: SEPTIC SYSTEM INSPECTION FORM i I ADDRESS BATE INSPECTED PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS : i WA-i ER QVALITy TESTI '- DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS Q�pUESTIONNAIRE 1. Name 4rt �` j{- ��P. . L n 2. Street Address �. �� `'.A,4- 3. .43. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool W--septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years e11-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes ] no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? annually O ❑ every 2-4 years ❑ every 5-10 years: ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your ewage disposal system'7 washing machine ✓ dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state thgrand and ty�ppe (liquid or powder) of detergent you use for: dishwasher ( 4=Z clotheswasher 12. Does your property have a lawn? (�r yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your law ? No. of applications per year O Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: Check here if your lawn is maintained by a professional landscape contractor. l 41 1. Name 2. Street Address 1�� S �� F-44<� ) 1 3. flow many members are in your household? S 4. What type of sewage disposal system do you have? .D. cesspool septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. ire the plans (drawings) for your sewage disposal system on file with the Board of Health? yes Elno <r do not know i i 6. flow old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ell-20 years ❑ over 20 years ❑ do not know a 3 7. Has your sewa�Pe disposal system been rebuilt or repaired? ❑ yes no ❑ do not know yez-, approximately how long ago? years. what was .done? F. blow frequently is your sewage disposal system pumped out? annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never { 9. Have you had any problems with your sewage disposal system? ❑ yes �no yes, what problems? ❑ rgpeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. F to many of each applia ce are connected to you wage disposal system? / a --aching machine dishwasher garbage disposal {/ dFeaumidaier drain sump pump toilet 'Wyf/pavement drains shower/bathtub 11, Please state th brand and type (liquid or powder) of detergent you use for: dishwasher clotheswasher D„/as, 12. 'Noes our property have a lawn? yes ❑ no Y � � If yes, approximately what size? less than '/4 acre ❑ 1/4 acre ❑ 1/2acre ❑ 3/4 acre `� 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your law ? No. of applications per year Season(s) of the year j 14. please state the brand and type (liquid or granular) of lawn fertilizer you use: I l Check here if your lawn is maintained by a professional landscape contractor.