Loading...
HomeMy WebLinkAboutMiscellaneous - 146 JOHNSON STREET 4/30/2018 t-�' i i :a g y d OR.TH Aid OVER.BILD]I UG DEPARTMENT TAP �y 1600 Osgood Street CHU North Andover Tel: 978-688-9545 Fax: 978-688-9542 B USIMS FORM FOR TOWN CLERK DATE: ' NAME: ADDRESS: e e ZONINGDI8TRIC T:, Type of)BusjNEss:. Arse 69 c� -� +✓P �Q� S 1310 DINE`LAYOLTT PR.OVMED: YES NO - AMAEL-F,PARKMG G SlIAMS: ZON[I G EY LAW USAGE: 'IES NO lzt lllaDI SIEC'POR SIGNA.TUPX t BUSMSSFORMFORTOWNU RX 2AO Rome Occupation(1989132) An accessory use conducted within a dweEng by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use•of the building for liAng pluposes. Home occupations shall "bu`t not'Iimited to the following uses; personal services such as -famished bit an artist or instructor, but not occupation involved with motor vehicle repairs, beauty padors, animal kernels, or the conduct of retail business,or the manufacturing agoods,which impacts the residential nature of theneighborhood,, 4. For use of a dwelling in any residential district or multi-fitmily district for a home occupation, Mae -following conditions shall apply. a. Not more than a total of three(3) people may be ernpjoye,in.tlie.liome occupation, one of wham shall bethe owner ofttaehome occupation and residing in said dwelling; b. The use is carred on strictly withinthe principal building; c. `There shall be no exterior alterations, accessory buildings, or display which are not:customary with residential buildings; - d. Not more than.twmt,five(25) percent of the existing gross floor area of fha dwelling unit. so used, not to exceed one thousand (1.000) sgaaxe feet, is devoted to'such use. In connectionwith such use,there is to be kept no stock in.trade, commodities or products which occup3r space bevondthese limits; e. There will be no display ofgoo&or wares visible from the streq, f The building or premises occupied shall not be rendered objectionabIG or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust; noise, disturbance, or in any other way become objectionable or detrimental to any residential use Mfl inthe neighborhood; -g. Any such buil ' shall include no features of desi r ' , i _ d.7ng �.not caste m but �s for res_dentiaT �?se. Signature D r i Date ...,..:../., / ............. �NORTH TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �Ss�cHU J This certifies that ,�.._. -1...••................................................../.... has permission to perform ....... ..... `,-s`k- ................................ ........................................................ wiring in the build of......... .. .7� at ..... ...:.....\1... ....n✓5 ....................... ..'...........,North ndover,Mass. -20 Fee..- .,a'� .........Llc.No. a,& ELECTRICAL INSPECTOR Check# `�� le �1 T Official Use my - � Commonwealth of Massachusetts � , f Department of Fire Services Permit No. Occupancy and Fee Checked a 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 W INK OR TYPE ALL INFORMATION) Date: l -- 2 2_ Zo/ City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,5 Owner or Tenant �e 5. ` Telephone No. 4/7 1 Ro Owner's Address 5 .� Is this permit in conjunction with a building permit? Yescf�q '`No ❑ (Check Appropriate Box) Purpose of Building F11111,6I4 Utility Authorization No. - Existing Service 2,7p Amps /1y /ZZ$ Volts Overhead❑ Undgrd No.of Meters t New Service Ams / Volts Overhead Und rd p g ❑ No.of Meters Number of Feeders and Ampacity ` Location and Nature of Proposed Electrical Work: c, .;�C tW C Completion of thefollowing 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 Swimming Pool Above ❑ In- El o mergency Lig tmg rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: . "...."'""""...""""".."'.."'."""'""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipalConnection El 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: (When required by municipal policy.) 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 ❑ BOND ❑ OTHER ❑ (Specify:) X certify, under the pains and penalties of perjury,that the information on flus application is true and complete. FIRM NAME: . 0�0 e.s �Cj C0-l\e LIC.NO.: ;Zo-o c,G ."41 LIC.NO.:Licensee: S44 x (If applicable,en�jr "exempt"in the license number line.) Bus.Tel.No.• `I�_TvLj Z��P Address: s ��—�-��, ,�/� S a� A,vaov�-• PAA eV (14-S Alt.Tel.No.: 111- 2 58-(ti 7e( *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $� `^ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the.provisions of M.G.L.c. 143,§3L,the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: J r Inspectors Signature: Date: ROUGH INSP TION: Pass 0 LZ Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signat,re: EuL Date: 7-Z S FINAL INSPE TION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com I f The Commonwealth of Massachusetts Department of Industrial Accidents a , d I Congress Street, Suite 100 < Boston,MA 02114-2017 t www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information F �- o Please Print LeEibly Name(Business/Organization/Individual): Address: G40-4- L s City/State/Zip: A/AA- W ©/ LI 5 Phone#: �D� Are you an employer?Check the appropriate box: Type of project(required): t�M.L am a employer with employees(full and/orpart-time).* 7. F1 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.FJ I am a homeowner doing a11 work myself [No workers'comp.insurance requt}ed.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.I 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 the policy and job site information. n Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: / ') b�� S O n/ �� City/State/Zip: -AA/ • u(gg S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ains airApenalties ofperjury that the information provided above is true and correct. Signature: Date: tP — 2ey.20� 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#: 1 � I 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 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 operate 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 be 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 contact you regarding the applicant. 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 NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia S s r T"CommONW LTH OF MASSACHUSETTS BOARD Of ELfCTl1C`1ANS t'SS'UES THE .,FOLLOWING LICENSE ASA REG t'STERED MASTER E:LECTR I C,I AN JQS>E<PH. G ELKHOURY 2-7::CHARLES ST NOKTH ANDOVER: MA 01845=1664 .20056: A<,;<>;>07./31/; 6.; :! ;; 3927 i 4 Date...... jv° .... .... .. N - f NORTH 1 3?°•t;�`".:•_�."�o� TOWN OF NORTH ANDOVER F 9 PERMIT FOR WIRING �sS�cMusf� This certifies that ...5..i ...Y!... 'A Iq 4111 ......................./.......................... has permission to perform .......5..-S... .``.i. .. ..Y.".1. �................. wiring in the building (—... r <n....... ���►��..l S�!^....�. ...... ............... . .North Mass. Fee.. S..c J. Lic.No...�`/ N............ „,. .. ........ .... .. ................... ` ELECTRICAL INSPECTOR cko n�J �t�1qqqq 35.0o PAID WHITE: Applicant CANT 0dQb5ept. PINK:Treasurer TBE09 11'I01 ffE4L2H0FMASS4CHVS'E17.'S' Office Use only DFPARTMFM'OFPUBLICSAFBIY Permit No. BOARD OFMEPREY M70==CMCAL LZ* Occupancy&Fees Checked kVJ4PPLICATIONFOR PERMIT TO WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00p G} (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 9 / / 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) G1,1, S d SI-,. Owner or Tenant 66, Owner's Address P Is this permit in conjunction with a building permit: Yes 0 No a (Chock Appropriate Box) Purpose of Building ,PsI���J�l Utility Authorization No. Existing Service Amps / volts Overhead a Underground a No.of Meters New Service Amps /Volts Overhead M Underground No.of Meters " Number of Feeders and Ampacity t Location and Nature of Proposed Electrical Work 5PC U r No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below 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 Connections No.of Water Heaters KW No.of No.of Si s Bailasis N�.Hydro Massage Tubs No.of Motors Total HP OTHER__ ..S- 6t/riV 7r7 hlsutarlceCo�uage Futs<Iarttothett�urta��CaateralLaws Ihaw aamlLiabtkhmraneePdgml&gCompicie�'=Cox aWcrtssjqartiale4naknt YES 7-1 NO Ihmest br�N }idptoofofsarne1othe0ffKr-YES U NO a If}cuhaw dxdwdYES,plea9erdc*tlerAxofooArWbydrdagthe appicp box. WSURANCE FVJ BOND OTHER F-1 V.2%espedfy) ETiraticnDw p� Es vakxdEb(tical Wok S Wcdc m Start L� �/- �I / h>rec im Rec , d Rao Fatal Sighed urr mTx Rnbqs of FIRMNAME �/% man .� ,��sLr/� L; NQ 22 s, _ ,e _9 Vs e-11 17;7y'6 AtTeLN6. OWNER'SiNSURANMWAMT Iamawat dAtheL>mmdmm the IImrarrre 0rllS AhkT90leqzu1atastegmWbyeCciedLaws and ft"Vmftlecn this pamtappfiCahatwanesfista#unert (Please check one) Owner r7 AgentEl d Telephone No. PERMIT FEES J GC/ Nr Date.......° 5 5 � 7 - .... .2............. f ,�ORTM oa;.'?`"-:-3. TOWN OF NORTH ANDOVER Illililliffask PERMIT FOR WIRING C �,SSACMUS� This certifies that ...... e P .......!- P �." ...�............... .................. .......................................... has permission to perform .... ........ c).V'. .�— .................................. ...... .. . ...... wiring innl the building of....�..4?�:.:1. .v1..y..... =.S. .. ................................ at..../...1.�......j........��'U°'.... r ........................... orth Andover,Mass:,f F ..........( v. Lic.No./} / . %...>E�= ... .!..: .;!''�.:!.. 4 / PECTOR C � 0 3/26/99 08:41 1 250.00 PAID WRITE: Applicant CANARY: Building Dept. PINK:Treasurer THE C0W01Vtii M.rHOFMASS,4a S= Office Use only L DEPART3IDVT0FPUBLICS4= Permit No. BOARD 0FMEPREVF.IVI70NRE9JT47T0AtS 5VCMR 12* Occupancy&Fees Checked APPLICATIONFOR PERMTl 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 !9 A, 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) Owner or Tenant t r�! Owner's Address 6,wle,<-r l/l k,j l Is this permit in conjunction with a building permit: Yes 1J No a (Check Appropriate Box) cs0$'02.3-3 Purpose of Building F-R/LL-( Utility Authorization No. Existing Service Amps / Volts Overhead Underground a No.of Meters r New Service Amps� lts Overhead Underground No. of Meters Number of Feeders and Ampacity �r/; Location and Nature of Proposed Electrical Work ",f sn/ No.1 of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ground No.of 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 Pum s 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 F7Connections F7 4lo.cf Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER Ir mnceCo�erage.Rasuantbthe Wm=azcfMam�GatetalLaws I have a amut Liability kurwm Rey trig Car ft CZrdM Caeragecr Z ajqx±d a:�n� YES NO I ha�esutxrtdvaclptoofofsarr,emtheo� YES ' /' NO Ifjcuha�eticedYES pl�seit,dicthetypeofcoveageby�ed�tgthe RIISURANcE BOND F OTI>E, Q (Pry spm) Exp¢aticnDale Estirr 29ed VakiedElxti-a Wait S Work 10 Stat V/C� hq)ecirnDate Rawested Ratgt Final FIRM NAME Pees ofpegtay /� V9GL✓ f� LrseNa '�f� 2g lre 2]LEZ&==-f LiXnseNo Adm �. -Ptj L( J f�ivt/f� ifs L/ Bt,sircssTdNa AIL Tel.Na OWNER'S INSURANCE WAIVER,Iamawarethatthe Limsedoesnothavethe inSL= eoaet@txitssksW leiq valttasm4medbyMssadasemGafra1Laws and dritmy signtaeon this peuntappfim6atwai�es this m4muTxm (Please check one) Owner Agent Telephone No. PERMIT FEES 12/01/98 09:59 FAX N84'31'20"E 13=30.00 89.14, 385.42' R� �s =44.18 S81'53'30"W 1�8.s600 R=30.00 G 0 L=21.74 LOT 38A o La m C in -7 R=60.00 N T L.=154.99 lb (n / rCn – -G' 0 cry _ N O Z m. N j E. y m o iWN .i Nrx Sro45 r 0 °aRt LAO 174 76 0.2 This plan is for the use of the Building Inspector $-88`46'20-W of the Town of No. Andover, for the purpose of determination of zoning compliance. It is my opinion that the location of the foundation complies with the requirements of the Zoning Bylaws of the Town of No. Andover, for the R3 zone_ This plan is the result of a survey performed on 11/30/98, based upon the approved AS—BUILT subdivision plan recorded in the Registry FOUNDATION LOCATION PLAN of Deeds. LOT 38A N OLD CENTER LANE This property is not within the 100 Year Flood NORTH ANDOVER, MASSACHUSETTS Zone as it is shown on the FIRM Community SCALE:1 u=f 0' NOV.30,1998 Pone[ No.250098 005 for the Town of No. Andover. MA. NEW ENGLAND ENGINEERING SERVICES, INC. 33 WALKER ROAD - NORTH ANDOVER, MASSACHUSETTS Erf: (978) 686-1768 1c Uiiab U U tAA --------- Hµ� �p� I -sr-, W N84'31'20"E F R=30.00 89.14' 385.42' R� 5 L=44.18 S81'53'30"W L�r07 00 R=30.00 8,96 L=21.74 LOT 38A 04D Cm .i C3 Z Z pR Nr � p R=60.00 L=154.99 N V a . 3].4±' L Z4.7� M Z W N }� r1 T v, j �k OF � E. N KUN co O N0 arm Q Q �aaAt LAO 76..0,x' This plan is for the use of the Building Inspector 88645'20"yy of the Town of No. Andover, for the purpose of determination of zoning compliance. It is my opinion that the location of the foundation complies with the requirements of the Zoning Bylaws of the Town of No. Andover, for the R3 zone- This plan is the result of a survey performed on 11/30/98, based upon the approved AS—TILT subdivision plan recorded in the Registry FOUNDATION LOCATION PLAN of Deeds. LOT 38A N OLD CENTER LANE This property is not within the 100 Year Flood NORTH ANDOVER, MASSACHUSETTS Zone as it is shown on the FIRMA Community SCALE:1 u=6O' NOV.30,1998 Ponel No.250098 005 for the Town of No. Andover. MA. NEW ENGLAND ENGINEERING SERVICES, INC. 33 WALKER ROAD _ NORTH ANDOVER, MASSACHUSETTS (978) 686-1768 Location t No. t Date - O: NORTiy TOWN OF NORTH ANDOVER .3? 1'bOL �a Certificate of Occupancy $ �~ Building/Frame Permit Fee $ 4- '�SSAC/1U`+E� Foundation Permit Fee $ > Other Permit Fee $ Sewer Connection Fee $ LO ` Water Connection Fee $ ti TOTAL $ . ~ p H • Building Inspector 1,-39.C'j rrjibjy public Works {'EIZMI"1' NU. '7cD AI'1'LICA'1'IOtV I(()IZ I'L {tMl"t' "I'O 13011,1)****** *NOIZ"1'll ANUOVl�:lt, MA nl tP N(1. �� LOr.NU• Z. RE((1R1)OF MUNI HSUIt, / �` DATE IIOOK Q PACE L 1+' rtlnl. sllu mv. OrND. UR + OS �g Oo G! ` Q -/� Z';'aa 2-32- I O( ,(IIIIN , lc(c- �O�ln oN {'111t1Y 41:1y11N111)I H(: C W /JOMg- +� 1)%\'N1-K'S NAL11c --t- � �QO / N(1. O( SllNtllS � Z SIZ(: 2(/ �„ Ila O3 tNVNr:R'SADI)Itf:SS Al ? L `O I dO L., BtiSFr.IINf(112SIAli � — AR(I►IIECI'SNAME Jc- SIZE0FrI(x)R Ilt.fnFRS x jb I 2 X 2 3 BI III DER'S NAME SPAN DIS IANCE10NEAKESI BUIIDING Q DIMENSI(NJSO( SIUS � X INSI'ANCEIROM S'fREE1 2o/ DIAIENSIONS(NI'OSIS � ' DIS I ANCE FROM LOF LINES-SIDES Z 0 REAR . © DIMENSIONS OF(;IRDERS O ARVAOrLor 2ACftC f FRONIACE s-- IIEIGIfrOFF(N)NDAlION THICKNESS IS B1111.DIN(;NEW SIZEOF FIX)IINC, n �. X ISBl1ILDIM;ADDITION L MAI-ERIALOFCIIIMNEY /c 7ti_IS BI111.DIN(;ALTERATION b IS BUILDING ON S(XM)OR Fit LED LAND O Wit 1.BUILDOVICS A BUILDING CONFORM TO IS BUILDINGCONNECIED�101OWNWIER BOARD OF APPEALS ACTION,IF ANY 0 IS Bl11(.DING CONNECT EI)1O TOWN SI:WER IS BUILDING CONNE(.-I L'D TO NA rtlRAI.GAS I.INE INS 1 tl(-i ioNS 3. PROPER I Y INFORAIAIIDN ►.ANDC06T O DO O ESI. BI IX;. COST 1,60000 PAGE I FILLCNrf SECTIONS 1-3 ES f. BI.IX;. COST I ER S<1_ rT. Q • ES f. BI DG. COS I PER K(X)M OQ EI.'C-FRIC P,II FERS MUST BE ON(NITSIDE(N-Bl111 DIN(; SEI')IC PERL11 r No. a AnAC1IED GARAGES MUST C(NFMIA ro SFATE FIRE RE(;IILA TIONS a. PI.ANSMUST BEFILED ANT)APPROVE 1)BY.IAIIIDI NGINSPECr(Nt -AILI)IN(: INSI'F:CTDR DAIS FII fit ,'O / Q �Si L/ OWNERS Ili[N C(NJI R.IEI.N CYNJI R.1 ICN zL 7� �S k i WT 2 1 1998 S!(;N-\fl)R .(1:OWNI?R(1K qrl/I�lIRN2171i1)AGLNr WA+Ch Cor Ceti-trRtt_ A^tlr�l8 � `( 1'I:RAII T GRAN 1 ED - 19 _ . �a L119M - ab r 6O a Ald . a � f * dna to NOR7' own of - 9 over L No. ° M °o - __ SAKE dower, Mass., a 19�� '9~ CO CHIC HE WICK ir'�• TED P'9 `G BOARD OF HEALTH i Food/Kitchen . PERMIT Septic System n. THIS CERTIFIES THAT.....B BI�.,K .� 49tS �D BUILDING INSPECTOR .. .( Foundation has permission to erect. �. ...... . . 5 .V.......5. p ........... ............ ............. buildin son ..... .. .. . . .. .. hough { ,S../... ... ....�.�r �.�.......... ......... / //.. p� y to be occupied as....... Chimney provided that the person accept this permit shall in every res ct 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 C '1 RPERMIT E Final EXPIRES IN 6 MONTHS O ELECTRICAL INSPECTOR `�� UNLESS CONSTRU N T S ` (90,J Rough 1 ...... .... ... ... .............. ................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � r • 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 andlor landowner from compliance with any applicable or requirements. FILLS OUT THIS SECTION" APPLICANT C - I�OMc I nIC. PHONE_417- - s^3° LOCATION: Assessors Map Number_I�—_ PARCEL SUBDIVISIO�NN d C` lm-L,44) = LOT (S) �-,- �� ST. NUMBER 46P STREET �-!y ��� ..,..- - --------*.-**.•* .*************"OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: /CONSIERVAT­ION I TRATATE APPROVED DMIN S DATE REJECTED COMMENTS 1 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS , FOOD INSPECTOR HEALTH DATE APPROVEDDATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS �./,PUBLICC WORKS - SEWER/WATER CONNECTIONS U� 34 49 DRIVEWAY PERMI 1 _ JFIRE DEPARTMENT d •Z"7 �� RECEIVED BY BUILDING INSPECTOR DATE �'lze -Fam�,ao�ulea�i a�_ , ,�,laeLivaeC�a DEPARTMENT Of pUBIIC SAF . CONSTRUCTION SUPERVISOR Number -. ' Expires: irthdate: CS ' 926143 0'S 2 /29/ ` Y / 9/2000 S 1940 Restracted, Tn ' 00 ENRY:J' SE DMAN 636 CNICKERING RD N ANDOVER, MA 01845 PROPOSED DWELLIN SILL ELEU. _= 2s7.p� F. C.F.C. E�E - 259100 �• / '` .. V. = 23.00 �. WALNUTTf!EE / 21 `".25'---7- 25' / PROPOSED �'rELLIIJc/ 262 / / / -U .., . /. SILL/ELEV. 2 273 C10 G ELE v'/_ 266p y 270.5 0 / O / rn / 2 V / / ? WIDE SyyE / / / / / 28E -� SEMEN R / / O 105-01 / — 288 X290 / 294 EXISTING HOUSE i C() / dor_ s NP 844 APPLICATION FOR WATER SERVICE CONNECTION . L North Andover, Mass. � 19 Application by the undersigned is hereby made to connect with the town water main in �I�"���7r;7� subject to the rules and regulations of the Division of Public Works. Street, ISThe premises are known as No. 22 or subdivision lot no. l�� Streit Owner — � Address Contractor Address /'A pp I i ca n�Vsre , C�5 ; 6d'-p C)0 PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to oil to make a connection with the water main at {�{ subject to the rules and regulations of the Division of Public Works. �1 Street oard PublicWorks By Inspected by Date See back for rules and regulations TOWI,j OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOGD STREET, GEORGE PERNA Telephone(508)685-0950 _!RECT0R Fax(508)688-9573 NOer.. 2 0�91� � - O L O it • r y � Y gSSACNUSE� • DRIVEWAY PERMIT Date: LOCATION: (�7j �'o ��s�, 191 BUILDER: phone: OWNER: LH� &166 _ maZ;c,—phone: �g2— The North Andover Superintendent of Highway Utilities&Operations MUST be notified of the grade and set-back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: N° 1352 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 19 g Application by the undersigned is hereby made to connect with the town sewer main in�,I��K � Street, subject to the rules and regulations of the Division of PublicWorks. I_(' The premises are known as No. 1,46 �( � se'-Z, Street or subdivision lot no ��Zr.8j�� -A� Owner Address Contractor Address pplicant's Sign re PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to �L)1-t 4LI l 42 to make a connection with the sewer main at n Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations f j i N° 843 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. 19 Application by the undersigned is hereby made to connect with the town water main in— J0 43QG/ subject to the rules and regulations of the Division of Public Works. ) Street, The premises are known as No. A Street or subdivision lot no. �G OU 11 Owner Address Contractor Address 4icantr'sSig ture PERMIT TO CONNECT WITH WA EJR MAIN The Board of Public Works hereby grants permission foN014, to make a connection with the water main at_ subject to the rules and regulations of the Division of Public Works. "" EE Street Board of Public Works Inspected by Date See back for rules and regulations r i TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOCD STREET, U?845 GEORGE PERNA Telephone(508)685-0950 =".RECTO,' Fax(508)688-9573 F NC"iH O410 O lOm � A 4 s QSSACHUSES DRIVEWAY PERMIT Date: f'�6 LOCATION: 14 BUILDER: phone: OWNER: (100'4 t��le 1ve phone: (2-5 30 The North Andover Superintendent of Highway Utilities&Operations MUST be notified of the grade and set-back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: LL LV 1 ±u JOHN W. & I-JNDA' E. PARKER PARKER Bk. 1358 P 137 LROSION CONTROL g t SPREADER 50 EXISTING NORWAYP S RUCE 246- 248 260 252 254 56 258 262 2 266 8 270 2' 0. 1 1 ' / / 9' / 115.1 0 / .0 / o , LOT 3 � ILO I I 7, I PROPOSED DWELLIN9 / / SILL ELEV. o / r C.F. ELE G.F. EL V. 21 .251 WALNUT T�?EE PROPOSED 4ELLIN01 / / SILL/tLEV. 27,360 / C.F ELEV,/= 200 / ELEV. = 2/0.50 / / o M / , r 1 y Growth Management Bylaw Exemption Statement Town of North Andover Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant an Building Permit(below) Address of Property for Permit(below) C— r'..�,r-..,T�4�741- A llL•e Hc Map and Parcel : Purpose 9f Application (check below) Phon Number of Applicant: - Single Family Two Family � � a- P o — I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit ig issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration,or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. ylaw. The lot(s)were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning This application is for dwelling units for low and/or moderate income families or individuals,where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents,where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section"senior'shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density,(buildable lots), below the density,(buildable lots), permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction,dedication to the Town,or other similar mechanism approved by the Planning Board that will ensure its protection. adjThis application represents a tract of land existing and not held by a Developer in common ownership with an acent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e.all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that Year,one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. jinatu r ee o r or Authonze�Agent�,hosgnd�the���ttached'�BuildingPermit Date This torr must be attached to the Building Permit upon application for such permit. j , The Commonwealth of Massachusetts Department of Industrial Accidents _- MIca of/BYestlgatlons - 600 Washington Street <.3 Boston, Mass. 02111 Workers' Compensation Insurance Affidavit 14 J. location: .S 30 ❑ I am a homeowner perfo ing all work myself. pI 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. address:... . insurn ice co, )01 icy phone� # _. ❑ I am a-sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: addrgss. _.. stkYr phone i3 insurance co policy# company:name• address:. city:' phone# intarance co u�Y# Failure to secure coverage as required under Section 25A of ICL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signatures Date _/CI — 2 Print name_V C l--k --Phone# Z _ 30 official use only do not write in this area to be completed by city or town official city or town: permit/license q nBuildiug Department ❑Licensing Board C] check if immediate response is required Selectmen's Office ❑Health Department contact person: phone q; -Other (rmud 3/95 PIA) 10/27/98 03:50 $508 664 0872 MOYNIHAN LUMBER oolro(Is M4:'check COMPLIANCE RF?OFT Massachusetts Energy Code ! Pemit # ! MA.Scheck Software-Version 2.05, 1 I r.;heck-.d by/Date ! I I CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: i or 2 Fazdly, Detgched HEATING SYSTEM TYPE: Other (Non-Electric Resistance) / � DATE: 10-26-1998 ' cJ�hNSo�Y J / DATE or PLP.NS: 10/26/'98 TITLE: BENDIKIAN PROJECT INFORMATION: 42X28 W/ 34X22 GARAGE el— NORTH ANDOVER C01-tP,IANCE: PASSES Required UA J 5'14 Your Home - 554 Area Q. Cavity Cont. Gla.ing/Door Perimeter R-Value R-Value U-Value UA CEHIINGS 196$ 30.0 0.0 69 WALLS: Wood Frame, 16" O.C. 2984 17.10 0.0 266 GLAZING: Windows cr Doors 2 e 4 0.330 94 t r S :r:,rw1W'r- 747 :,^l.JeS' 1Jh :.S ..4 Z' v'.°4rn 24 G!;ZIWG: Windows or Doors 13 0.320 4 DOORS 42 0"160 7 DOORS 16 0.270 4 FLOORS: 0Tver Unconditioned Space 1816 19.0 0.0 86 :{VAC EQUMMNT: Boiler, Gas Steaz,, 78.0 7*77 COMPi LIANCE STATEY—rNT: The proposed building design drrsc::i.bed here is consistent with 'they building, plans, specifications, and other calculations submitted with the perm:ic application. The proposed building has bean designed to meet tha require:ne:its of the Massachusetts Energy Code. The heating load foz this building, and the cooli::g lord if appropriste, has beon de �!!rmined using the applicable Standard Dec-,ign Conditions found in the Code. The M/AC equipd;e.nt selected to heat or cool_ the building shall be no greater than 1:25% of the design .loaf as specified in Sections 780CMR 131C and J4.4. Builder/Designer Date 10/27/98 08:50 $509 664 0872 MOYNIHAN LUMBER i102.003 va 4ec'k INSPECTION-CHECKLI5T lae9achusetts 1✓norgy Code LPLSchcck Software Vere-Jon 2.01 01Z)IKIAN )ATE: 1026-1998 ildg. l )apt. iSe i I CEILINGS: i 1. R-30 I Corrauents/Locat?on I I 1. Mood Frame, 16" O.C., R-11 Comment S/Location 1 I WINDOWS AND GLASS DOOM 1 1 I I. TJ-value: 0.33 1 For w;".rdawa without labeled li-vulur�•s, describe foalu rc ,': 1 4 Panes Frame Typo _ Thormal 517eak7 1 ) Y(1 1 No I Comments/Location ( } 1 2. U-value: 0.56 1 For w3.udows without labeled U-valuos, describe features-;; 1 # Punos Fe=e Type Thermal Sm ak? ( J des 1 ) No I Comments/Location ( 1 3, U•-value: 0.32 1 For window:: without labeled U-values, describe feature.. 1 11 Panes Frznae Type Thermal Sreak? 1 1 'res ; ) 2do I corrdre;nts/Location I DOORS: U-value: O,i6 I Comi ant!,/Location_ f ) I 2.. U-value: 0.27 I Colua' ants/Location I FLOORS: ( 1 1 I. Over Unconditioned Space, R-19 I Comments/Locution I I 14VAC EQUIPMENT: 1 I 1. Poiler, Gas Steam, 78.0 AFU: or higher Make and Model Number I I AIR LtA1KAGE: ( ] I JOinte, penetrations, and all other Suoh openings in -the buildirq I envelop© that are sources of air leakage must he eealed. When I installed in the building envelope, recessed lighting fixtkires 1 shall moot one of the following raquireTarmts: I 1. Type IC rated, manufactured with no penetrations betwklen the 1 inside of, the receszaed fixture and ceiA ing cavil. and Soalec or I jaske.ted to prevent aix lezkage intr, the unconditioned space. ( 2. Type TC r:3t«.d, in accordance with -Standard ASTM E 283, with no I more than 2.0 cfm (0.944 Ids) air movement from the the 10%27/�J8 08:50 $508 664 0872 MOYNIHAN LUMBER 3.008 `con¢itiored space to the ceili.ag cavity. The lighting fixture I ohall have been tested at 75 ?A or'l.57 lbs/ft2 pressure l differeneo and shall be labeled. I I VAPOR RETARDER: j 1 Required ?n r_he warza-in-winter side of all non-vented fr-sled I ceilings, wrsll::, and floors. I 6 I MATERIALS IDENTIFICATION: J I Materials and F,cnuiprrent must he identified so that compliance can I be determi,.ned. Manufactklres ,manuals for all installed heatiuq I snd cooling ocnaipment and service water heating equipment must be I provided. Insulation R-values, glazing 'J-values, and he.aging I equipment efficiency murt be clearly marked on the building plans I or specifications. I I DUCT INSULATION: J shall be insulated 1 Duets insulated per Table �7A.4.7. . I DUCT CONSTRUCTION: J I All accesziblc3 joints, seams, and connactions of supply sa,d return 1 ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I Icanufacturer's installation instructions. Mesl: tape :Ray by 1 omitted where yaps are less than 1/6 inch. Duct tape is not I permitted. The HVAC Systorc must provide u means £or, balancing I air and water syetems. I I TEMP.s.RATURE CONTROLS: J I Thermostats are required for each separate FIVAC system. A manual I or automatic maar_S to partially restrict or shut off the ,eating I and/or cooling input to each zone or floor Shall be provided. 1 1 HVAC EQUI)?MENT SIZING: I Rated output capacity of the heatjljg/coo.lirag system is I not greater than 125k of the design load as specified I in Sections 790CMP 1310 and 34.4. I J I SWIMMING POOLS: I All heated swimming pools must have an onloff heater swit71-. and I rEgixx.re a cover unless ever 23% of the heating energy i;+ from non-depletak,le sources. Pool pumps recnzirea a time clock. I 1 HVAC PIPING INSij)LAIPION. I LMAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insuia+red to the following levels (in. ) : f PIPE SI2,ES (in.) I MATING SYSTEMS: TEMP (F7 2° 'RUNOtrT$ o•.,,^ 1.25-21' 2.5-411 1 Low pressure/temp. 201-250 3.0 1.5 1.5 1.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 l Stearn condensate any 1.0 1.0 l.S 2.0 1 COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 r r 10/27/98 08:51 $508 File 0872 MOYNIHAN LUMBER l�j 00 4%008 I rafs.wge�ant ae7ow 40 1.0 1.0 1.$ 1.5 I i I CIRCUJLATIAIG HOT i4TER SYSTEKS: I Insulate Circulating hot water pipes to the following levels (in.): I I P1PE SIZES (in.) NON-CIRCULATING I CIRCULMING .MINS 6 RST 1JOUTS I HEATED'WATER ',t'.EJAP (F') -. RUNOUTS 0-1" 1 01.25" 1.5-2.0" 2.Q+" ! 170-1.80 0.5 J 1.0 1.5 2.0 140-160 0.5 I 0.5 I 100-130 0.5 1 0.5 I --NOTES TO FIELD (Building Depawtm®rnt Use Only)-------------- ----- VA L o l 3 A 0 2' 11993 07? : 09 978-649-9450 RA- MECHANICAL I1,1C Pr1GE C12 i /11 F.sR21019 RIGHT-J SHORT FORM le Heine; PROJECT 1.FSR T .b#; Htg �_lg r; COUNTRY ESTATE BONSS Outsidt db 0 87 Inside db 70 75 Cam 3c� /A /Ys aly 4I • Design;I7 -70 12 /yG Daily Range - M Inside Humid. - 50 R.A. MECHANICAL' INC. Grains Water - 30 16 LOMAR PARK Method Simplified PEPPERELL MA Cmst. glty Average `j7Y-,V-73 - e6 q/ Fireplaces 1 HEATING EQMPt ENT COoLI ril EQUIPMENT 1aloe CARRIER CORPO Make CARRIER AIR C tide Carrier Trade WEATESAMATE 38CKC BRAV070-12 3OCKC01030/31/32 f�'iciency 80. 0 AFUE Efficiency 10. 0 S`�RR eating Input 69000 Btuh Sensible Cooling 18900 Btuh sting Output 56000 Btuh Latent Cooling -8100 Btuh egating Temp Rise 48 Deg F Total Cooling 27000 Btuh tual Heating Fan 1070 CFM Actual Cooling Fan 11'7 0 CFM tAir Flow Factor 0. 029 CFM/Btuh Clg Air Flow Factor 0, 053 CFM/Btuh ace Thermostat Load Sensible Heat.Ratio 93 R-00M NAMI AREA HTQ CLG SQ.FT. $TUE BTUH CFM CFM Intent ER BEDROOM 304 7957 3901 229 209 3 210 6721 3310 193 177 4 ; 233 5378 3005 ' 155 161 - BATE 155 2588 ' 1452 74 78 FOYER. 231 ` 4245 2454 121 131. ER BATH 150 2630 ( 122 141 2 231 4627 2837 :133 15'l 112 1482 417 43 22 IONS n D 1625 3721,x, 20006 1070 1070 lation Air p 0 . (� 0.92 RSM ( ' 19405 Cooling 157 1 AL 1625 37211 1x977 1070 1070 ^b- 10/22/1998 07: 09 978-649-9450 PA MECHAP]I(1AL IN:: • � F' GE ir? _� T d RSR 21 G 19 RIGHT-J SHORT FORM e name: PROJECTI.RSA T b#: F r: COUNTRY ESTATE H.OMRS Htg Cig L.6 r 3$ A M4 Outside db 10 87 Inside db 70 75 Design TD "I G 12 Daily.Range - M B R.A. MECFMICAL INC, InsiC1C Humid, 50 16 -LOMAR PARK Grains Water - 30 PEPPERELL MA Method Simplified V2,?-y3) -,�G `!/ Const. glty Average Fireplaces 1 HEATING EQUIPMENT COOLINGI;QTJIpMEN'I' M e CARRIER cURpo T e Carrier, Weat:hermaker 9 Make CARRIER AIR C 5 XA060-�16* rade WEAT-MERMATE 38CKC E ciency 91.7 AFUE 38CkC04230l31 H tmSLIput, 60000 atuh Efficiency 10. 0 SBBR He ing Output 56000 g� Sensible Cooling 27300 Btuh He ing Terrgp Rise 35 dent Cooling 11700 Btuh Ac al Heating Fan 1460 Deg F Total Cooling 39000 Btuh Ht Air Flow Factor CFM Actual Cooling Fan 1460 CFM 0. G 3 5 CFM/Btuh C1 Air Flow Factor 8 actor 0. 053 Cpq�/gt,� sF a Thrrmostat Load Sensible Heat Ratio 90 -� ROOM NAME �gp, kiTCr T CLG �..� � �...-HTG r.. CLO SQ BTUH BTUH CFM i CFM B LY ROOM 12 515 �� � DI NG 416 10929 439 r 210 4259 + 5e9 8R P 2302 AST/X1TCAN 330 7409 , 1'99 123 FO' R/STAIRS 67.14 260 359 LA 210 4122 998 145 .ST Y i 190 2001 ( 1130 70 60 LI N Gy NG 4745 2417 166 ' 129 238 6579 2806 231 150 1ST ZONE n D 1676 41630 Ven latioriAir 27295 1460 1460 Equi . @ 0. 92 RSM 0 0 Late t Cooling 25112 3051 TOT 1676' 41630 28163 1460 1460 Country Estate Homes, Inc. Em Ad AkMIEN LEI Lai 00 00 O O O O O O 30 X 42 COLONIAL 4 BEDROOMS - 21/2 BATHS - 16 X 26 FAMLY ROOM - 2 CAR GARAGE UNDER 1433-10710 r 1000A ONO nsn� 051 OEM on MEN MEN ENO 000 loon 0 0 ENO elm I IMIMMI ME e aim— IM row- oil Lin I �� . — �' M � - _ -_ _ _ - ��� - - ■!,NJ - x1111WME M Na 11111111 111111 M moll � = 11 �IIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII����I �Iq IIIIIIIIIIIIIIII IIIIIIIIIIIIII : �Iq .. .. .. .. III � IIS I ' C::: C : • NIM ■■ .. _. /_ ■■ ■■ nou • --- r i ■■ ■■ Ono _sem I, uquw III HIM uuuw uuuw uuuw ��■��ilii —__ iiniiiii�l'fI'II'Ifl 11111111111 .(11�1�I�11111�1�I�111�1�11111�:�111�I�11111�I�I�1�111�I�111�I�1�111i1j1�111�1�111�111�1�11111�1�1�111�1�1111111�1�1111 l���■ �I�1�1�1�1�1�1�1�1�1�1�1�1�1�1�1`�tl�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l �tl�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l IIIIIIIIIIIIII q� 111111111111111111111 III 111111�I�11i�l�1�i1111�1�1�!!!.. . ... . .�.i.�.�.�.�.�.111111 11 -- ---- -- I III =111111111111111111t111111111111111111111111111111111111111111111111111111111111111111111t11111111111111111111,11IlItl Jill!, 11111 1111111 � IIII ,11111111111111111111111111t11111111111111111�111111111111111111111111111111111111111111111111111111�1111=11111111 `, I 1111111111111111111111111�11,i,bid,1,ld,l„I,I,I,I,I,I,I,I,I,I,I,I,LI,I,I,I,I,I,I,I,IJ,1,1,1,1,1,1,1,1,,1,1,1,1 - j 11111 Id,l,ld,l,hhl,l,l,hld 1,1;1,1 II�i� Il IIIIIIIIIIIIII II� 11111 IIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIII ..... I.■.. i• , 11111 30 X 'Ill IIl1l � • III�IIIIIII�1111111 , ill III' Ill Iii lIl III lIl III ■IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 111 �II IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Ill � ID II 42 COLONIAL I(o X 2(o FAMILY/GARAGE UNDER'l 4 5EDROOMS 21/2 5ATHS 1 14,13/40 '. 21611 310" 510. 3'0" 216" 416. 10'23/411 113i/411 31011 2110'/4" 11134• 1011 3'4' 315" 2'10" X 4'9' 5FV5' X 4'9" 4 b'O" SLIDING 1 EC) I 2'10 X 4'9' 2'10' X 4'91 - .a BREAKFAST KITCWEN 0 :0 LAV STUDY 1 0 214■ o 1 LIN o 1918��4 116" 3141/411 X �0 316" 116" n DESK _ ° o . ►n v 1 . 1 " - t FAMILY ROOM 3'0' 16 60 �b o 10 _ C14 r� i t lV i!1 3113/ 4'6" 5'63411 k `fl 4 co 210" X 4'9' 2'10" X 4'9" DINING ROOM FOYER LIVING ROOM if L—v -. In 2'105X4'9' 2'10' 2'10" X4'9" a. 4'5' 110 X 4'51 O 210 X 116 0" 1,6 — `Q C � :4101114 1 0 n 4161 11011 416" 316" 110. 31611 310" $1011 310" 3161 1101 31611 I6'O" 14'01 1410" 141011 FIS 00 10110 3-10 1/4" , 110" 16 of 8'0" 810" 5'0" 8'O' 6'D" 4'6" 816" 110" s 2 ' X 4'bl i5W X 4'9' Ln In ON 0 tn D = 7F ,iLK-IN WALK-IN L� cLoST CLOSET Eo M BAIN ATP BEDROOM #4 - wrn r4' 214' _ LAUNDRY .r { Z 141 2+6 " 1- - - - - - - - - - - - - - I _ :a ` Attic- - - - I 316 5+33,u r,, 14n 4 i I 31p� 411O1�4r �.. I 5'0' I Ion 301 . I t I I •� C •05 T N d C o N L � L. C L.N - I I 3`0" 2 - '0" O I I - c� = I Ell O I vo I I I' M 5EDROOM ' 5EEDROOM #2 BEDROOM #3/I - - - - - - - - - - - - - - � =� o 2'l0' x 4'9' 2'10' X 4'9N OPEN TO DELOW 0 O 2'10' X 4V 1'10' X 4'9" 1'10' X 4'9' 2`10' X 4+9 <V 5W X 4'04' n 416u Toll 41611 31611 ,1p" 316x1 11011 11011 316" 11011 3162 I6'O" 14'O" 14'O" 14'0" 141 +p" 10 -110 4-10 i zy- 16'0" 13'0 10'011 110" ' 510" 5'6' -------------------- ---------------------------- ------------------ -1 - O1 r------1- ' 1 C"_4 r -------------J ►' 1 1 ►' L------------� ►' - - ---- ------ -•-� 1 FOUNDATION ' ----------- ------L------- 101 Concrete Wall / 8,01 Pour TOL. (-) 10' Dp x 1'8' W Cont, Footing ; 1 ; I ; GARAGE FIN16H 1 - 1 All good constructed walla and � cellhg to have 5/8' type 'X' Fra rated Wallboard hetalled [3401 , 5 . 2 ] 4' Concrete Slab ; p C.4� oO ; ' -V1 X 5 - 3 1/2" Dia.Lalic Columns O ; ; I :O GARAGE 5ASEMENT With 2'6 W.xl'O Dp. I Strp Footing , 1 o; I ;4'0� 6'O" 6'0' 6'O' 6'O" 5'h%c" 414" 6'0" 160r 6'0' 5121130 ►' 1 1 1 i 1 r 1 i i .1 1 '► 1 1 = o; I �------ ---------------- ---------------- ---------------- ---------------- -------------- ----------------� --------------- ---------------- -------- -- i -- ---------------- . O -fl 1 I 1 1 O cv4' � r——————————————————————————————————————————————+—————————————————————— -- —————F'-- — — 1 �-----------�� -------- - 3 2x12 Center Beam (type -------------- - ; ►� i BEAM POCKET 1 , r -4 6' Wx6' DpxS' H0ra9'd) I3402 . 8 .6 ] _ '► ; Shim beam wfLh steel shine or hard brick p ►� 4' Concrete Slab L — J 1 Slope 1/8 per foot ; I ; 20 minute fire door (mina ' lj T.O,C, (-) ' 4'Gnin) Step down Into Garage O i 1 ►• --------------------------------•----- --- -� 1 / 1 1 1 , -----� ►. --------+-------------------- -------i r-----------------------------I r--------------------------------- ---J ; ` - 11 ------------ " --------------------------- - - 4 -------------------------------------- 11 r------- „ r---------- LV 14'01 3'D" 8'0" 3'O" 14'O' 16'0" 42'0' FOUNDATION PIAN 10,110 - f.nM 10110 5-1O Conthwus Baffled Rigg t w 1 x 12 Ridge Board i 9 i x 8 Collar Ties -9 4'0' O.C. ROOFiNG Composite Roofing Building Paper Sheathing 2 x 10 0 i6' O.C. r e GEfLiNC Fascia Board 2 x 8 40 ib' O.C. Overhanging soffit m R30 insulation with vent Vapor Barrier V2 Wallboard. co cA 3 a) 0o FLOOR WALLo 2 XplO .9 16 O.C. Sidin ,Air Barrier n Shel'ing,2 x 4 Q 16 O.C. p - R1I Insulation,Vapor Barrier V2' Wallboard °D FOO 3/4' Sheathing 2X log 1220L. R20 insulation SiL i - 2x6PT., 1 - 2X6K.D. [ 3402 . 8 . 4 ] Continuous Sill Gasket 2X Fire Blocking VZ' Dia. x 12' Lg. Anchor Bolts Q 8'O' O.C. (max) 3 - 2 x 12 Center Beam FOUNDATiON 3 1/2' Dia.Lally Columns - 10' Concrete Wall J 10'02 Pour SEE FM PLAN FOR LOCATIONS) _- 1O' pp x 1'8' W Cont. Footing - Dampproof exterior surface - - �//\/� t SCJ 4' Concrete Slab -- - cj (���`/ I HRUOUV _ . - -_ _ - LA Poll 10110 lO ,_ ..,...�.� ___�-.,...���........-. �.._.z........,..,� ��...._.-._...._-._._.,„._...r.. ...�.. .,._.._. -- -...._�....,r........�..__....�.�...-�.. �_..,._.�...._....._.._.._._..� .._.....e,_�..................,....�.o.._..-_ ......_..._. .....�....-_._.....- .......�.�_. w�.... ..._..�.. _— - r �..w �-'.__,_...._...�,__.__.�.-»�... .._.....�� _ .__�..__ e....�.-..ter Continuous Baffled Ridg t - _ PROOFING CONSTRUCTiON 2 x 6 Collar Tles 9 16' Asphalt/Fbsrglass ;Roofing puilding Paper Sheathing >Z 2x10916O.C. 9 2 x 8 9 ib' O.C. CEILING O 2mul& Q Vo O.C. b' Overhanging SoffR cf� ' WALL _ FLOOR siding SheathingAir BarTler O 2 X 10 g 12" O.C. sheathing 2 X 4 -0 Von O.C, Insulation Y ror Barrier V2 Wallboard FOO Sheathing GILL 2x10916" O.C. R20 (nsulatbn 1 - 2xb P T.,1 - 2xb K.D. _ . Continuous 8111 Gasket 1/2' Dia.x 12' >_g. Anchor Bolts 9 8,0' O.C. (max) GARAGE FiNi5H All wood constructed walls and ceiling to have 5/8" tie Y fire rated Wallboard ImLalisd 13401 . 9 . 2 O :m FOUNDATION 10' Concrsts Wall / 8'0" Pour 10' Dp x 1'8' W Cont. Footing -- -- -- -- - -- -- - -- - SECTION THRl� FAMILY I-MASTER , 10110 8-10 Ii4 = t o . . . . . . . . . . Vaulted calkgAm see Section Thru Fangg/Mastv LYL Beam Flush Frans 00i LYL Beam Flush Frame 444=- RId9e and Valley Rafters are 2 x 12 - r All members an 2 x 8 44 K' O.C.41NLOa All Rafters ara 2 x 10 6 16' OL. ATTIC FLOOD FRAMIROOF FRAMING Val - 1,02 V8■ .1,0. MAXIMUM ALLOWABLE SPANS FOR JOISTS/RAFTER SPAN NOTES= JOISTS/RAFTERS t Span Tables fort Fust floor joist C 3405-2 I Second floor 4 useable attic jobt C 3405-1 u' r' 16' Attic no futons room C 34064 3 • ^"' Cape attic floor Joist t 3406-2 7 FIRST 2 x 0/12 2 x Ion 2 x bn 2 x 10/12 2 x t2n Rock over attbs C 3406-6 1 2 x 10/16 12x" Cathedral Roof Rafters 13406-3 3 SECOND 2 x 6/* 2 x 8/2 2 x I0/* 2 x 10/16 2 x 10/I2 2. Maximum span for 2 x 8 ceflN jobt for ArW nrnsr worts 2 x Ion 2 x" cape attke is 15' 111 L 3406-2 3. ATTIC 2x6/'.5 2x6112 2xDn 2x6/K 2xOK wo nnua door w 2 x an CAATTIC M"am use 2 x 6/16 2 x 4A& 2x" 2 x 6n 2 x&/12 ROOF 2 x 6/? 2 x do 2 x SAA ?x lon6 2x10/16 oast Arno 2 x b/* 2 x 10n CATHEDRAL 2 x a/* 2 x ton 2 x 10 2x10/16 2 x 10/12 10110 10 -10 CERTIFICATE OF USE & OCCUPANCY Town of North Andover �j Building Permit Number q a Date r710 0Y cl THIS CE/RTIFIES THAT r THE BUILDING LOCATED ONCJ7 Co' -- MAY BE OCCUPIED AS ��'?q �� TAY4')y o��S�a 1 UNgOp/tIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. "°"'" CERTIFICATE ISSUED TO L9 ^ 9'd 3: �,_ ` •�hit ,, // �- / 1 p ADDRESS A-,,:, ,% a .J F 'Js ""'` Building Inspector r T rAORTfy Town of _ 9 o er L � �o _ � LAKE J � dower, Mass., G2 19 O CHICHE WIC K �'�• (G BOARD OF HEALTH PERMIT T Food/Kitchen Septic System C BUILDING INSPECTOR THIS CERTIFIES THAT...... .(/ �...IV..... v.. .®D ................. ............................................ Foundation has permission to erect............ ............ ............. buildin s on ......1.41. 4......�AASO M..................o .. Rough ea'(�"'' to be occupied as....... S../..... ..�.......... ..... ..�......... .......... .1....... .�+ //.. � Chimney provided that the person accept this permit shall in every res ct conform to the terms of the application on file in P P P P 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 INSPKTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRE IN�*c S 6 MONTHS o LECTRI AL INSPE UNLESS CONSTRUC N T S (v a v I Service ... ... . .. . ......... ...... ................. ................................ BUILDING INSPECTOR Final-- Occupancy inial Occupancy Permit Required to Occupy Building l L`� U 1'LaN GAS INSPECTOR P c< >l. G ��r Display in a Conspicuous Place on the Premises -- Do Not Remove s OCA@ Rn gh� No Lathingor D Wall To Be Done G FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. ' Burner r Street No.-�_`4e��% ` Smoke Det. Date/.- 3804 ate/.- 3804 NpR,M TOWN OF NORTH ANDOVER 3g �� •. 0. PERMIT FOR PLUMBING ,SSACMUSES + !his certifies that . . . - . . . . . . . . . . . . . has permission to perform { plumbing in t e buildings of . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. �"J Fe 5. . . . .Lic. No.7j,73. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 12/10/98 13:29 235.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer (Type or Print) }•.:ir. NORTH ANDOVER ,Mass. Z: - Building Location Permit Owners Name v New Renovation Replacement Plans Sybm tted F TU F ' z to N 2 Y { • F O x h- O • W X J P. ••' .< ' Ll h 41 � !� � � Q Z Cs < ¢ 2 O = a1 66 a p W f. W ¢ S ¢ 93 ,t A to to _ I V W a! X < Cr C3 in in fL IL �WaC o a a Z. 10 W d Wv44 Jcc r- = O !- < X < Y Xa . a O > 0 Q to W ota o o H SU8-,BSMT. 4 BASEMENT I 1ST FLOOR 2ND FLOOR a L4 I I I 3RD FLOOR ATH FLOOR 6TH FLOOR 6TH FLOOR 7TH FLOOR ' 8TH FLOOR t (Print or Type) Check one: Certificate Installing Company p y Name ��,c_rJ�O� ls�e.2�5 p �l� ❑ Corp. Address 1 Dl�„aS, Partner. [ Firm/Co. Business Telephone ` (8\- qt+,_g5g14 Name of Licensed Plumber: a,o�V ems, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [ Other type of indemnity [::] Bond ❑ Insurance Waiver: I, the undersigned, have been made aware' that the licensee of 1 this a plication does not have any one of the above three insurance coverages. Signatur o ownerlagent of property Owner Agene,. ❑ 1 !bogaby ccady Wal all of We dclails and Wasnamion 1 ba.c subjniu d( cntctcd)in alwa.c semicalion ue live Z444 to dw bp d wI - k"rkdge aad tl W all plumbing wet and installations lice I'm mcd undeicatiow will Ye♦• IKta will)w vq�µ�� Ws""<of the MasHdwaclla Slate;MumbiatCads and C Laptct 142 of tlw ctal wL ( i Y Titleature of 'Licensed Plumber City/Toon: � Tv a of Plumbing License II ADOWM7r1 70FFICF USE ONLY1 License Number 12 master ❑ Journeyaf i C Com+Jin 14 � N2 2 Date/ TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ,SS4CHUS This certifies that, -R'.....:.......:-.-. IL has permission to perform ...... ......... ............... wiring in the building of ...... ......... ........................... I North Andover,Mass. Fee-4,.-::':':':n Lic.4/.��.Z. ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office use only THEOOWONWE4LTHOFM4SS�4QHUSE77.�/ DEPARTM NT OFPUBLICS4FVy Permit No. r-'?// BOARD OFMEPREVEW0NREGUTATIONNS CW 12.09 �j j Occupancy&Fees Checked APPLICATION FOR PER.MIT TO PERFO ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 n (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat l Town of North Andover To th Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) a� Pd Owner or Tenant Y ' W2 (// f /fJ Owner's Address ,/I/J Is this permit in conjunction with a building permit: Yes[Z] No (Check Appropriate Box) Purpose of Building �,�i/1 p ��L1�G� Utility Authorization No. g -2,32. Existing Service AmpsVolts Overhead Underground M No,of Meters New Service 2— Amps/,0/-2�A' olts Overhead Underground M 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 Below Generators KVA groundg1:1round 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 LocalMunicipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER InstrmreCaaage Pitrsu�rtbthetagtwat �GalaalLaws IhawaomatLmbkyhEw&=Pol yindudigCanpi& ' CoArdWcrilsskstrmalec}iva YES NO thaw%btnaedvabdpwofofsatnetotheOlfim YEs r7 IfyuhmtdvJWYES,pk=indic*theNxofwmaWbychedd gthe INSURANCE BOND OTHER (P1 mSpo*) EViatim D* Estimated Vahie xal Wak$ Waxo'sw hgteWmDraetieRegt>sWd Rough Z-1: FM v�� ou �PGJ��-���o ave�C%�1 ,_ LLiitar�seerNra� �? /7F RMNME Bai=TeNa 97 armY .� �e M a AI.TUNia OWNER'SINSU%kNCEl WANER;Iamawatethatthelit edmnotfhein�raneoo�a��erzuss rtialequivaler astecpliedbyM Gar IL and @gatmysternthispan kWpficahmwaims this tacpanat (Please check one) Owner a Agent Telephone No. PERMIT FEE$ Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record FEB o 6 2008 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health.Other fo c q information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: _ When filling out 1. System Location: C - forms e computer, use only the tab key Address to move your cursor- not �yrt.� St a Zip Code use the return key 2. System Owner: - Name Address(if different from location) City/Town Stat Zip Code Telephone Number B. Pumping Record l '=�) a 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank er(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. SymrPumpied Vehicle BY N2rrt -? c License Number Company 7. Locati where c tents re disposed: Sign re 6f H6uIer Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1