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HomeMy WebLinkAboutMiscellaneous - 146 RALEIGH TAVERN LANE 4/30/2018 �_ i 146 RALEIG 210/107._-0000.0 � _ �J-�. Date. 9441 ".O RT"'� TOWN OF NORTH ANDOVER 0PERMIT FOR PLUMBING This certifies that . . .gev qe. . Aga-e Ile. . . . . has permission to perform . . . .j6f4//-arr. • AWi4 .r L plumbing in the buildings of . . . . . . . . . . . r at . . . . . ., ISorth Andover, Mass. Fee��,?,.S. .Lic. No.. PLUMBING INSPECTOR Check # �3 - W MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Y CITY O ®v' MA DATE 11PERMIT# JOBSITE ADDRESS ,!� �' Jy L OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT:�' PLANS SUBMITTED: YES []I N0©I FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ( __._ ._ ____f ____.A___....Al.-___..__1 I I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN —I .__._._{ ! ---__._I .-.._.__-� ._._...__.( .__..-.__-1 FOOD DISPOSER I 1 f ._--__-( i l _._.__.J 1 --_�l __...-_._I FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY -- ROOF DRAIN SHOWER STALL SERVICE/MOP SINK _( 1 ( �I I .._.__I � _j TOILET URINAL I -- - -- ----- WASHING MACHINE CONNECTION k _ _; S _ _) ._. l � i ..-------J .-7771 WATER HEATER ALL TYPES _! E ._. r J 4 _._f _ I. ___._l1= WATER PIPING _f { E --i _._._.E _ I __.-_-._ i OTHERIg S �f I ---i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[�.-I NO M IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ij OTHER TYPE OF INDEMNITY 0 BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT I0 SIGNATURE OF OWNER OR AGENT B hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � � PLUMBER'S NAME _tel'- �s- , hT _I LICENSE# / _ ! SIG URE MPO JP 9-- CORPORATION F-1# _ ;PARTNERSHIP 0# LLC�I - j COMPANY NAME ADDRESS / G�-��vo CITY T /�•>�s�U r_� d/$7� 31 TEL � -.-I STATE /ylf{. � ZIP FAX ]CELL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yesd-.No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 4 n r The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): &0 Address: City/State/Zip: lgo4 s/ 11A , Phone#: 7 S - 9:!;/ Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y p tY• 9. E]Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.FJ Roof repairs insurance required.]t employees.[No workers' comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.42111. Tel,#617-727-4900 ext 406 or 1-877,7MASSAFF Revised 5-26-05 Fax#617-727-7749 wv wjnass.govldla Date.. !.'.!'.?-..... .. _ HORTIy TOWN OF NORTH ANDOVER FO A • - PERMIT FOR GAS INSTALLATION 9 �•h �9sSA M 4' This certifies that . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . . . . e : . . . . at North dover, Mass. Fee.. :S Lic. No...S�o" Z. �I c f! GAS INSPECTOR Check# �12 8191- +I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: MA. Date: o /.;Z Permit# Building Location: f�G /JAZ c/"G N &P,!WW v /-//Owners Name: Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: U;j" Plans Submitted: Yes❑ No❑ FIXTURES LU W Y I— to I.- N Q = F Q O m = 00 W W V U) Fes- O W W ZO Z Z O W W W w O 1- � F- Q H FOw U) LU ag m O a I- o O w x > w 1- q W W F 0 U W W ZLu = N 0 W _ Er > V W Z (7 -� F- 1— O Z —� (� LL N = W F W W SUB BSMT. BASEMENT j 1 FLOOR 2 FLOOR 3 FLOOR 4 1 HFLOOR C-FLOOR '. -i'FLOOR 7 1 H FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: 2ft4'�T�� AzzG -'4 1�TG, ❑Corporation Address:}!/,31&C&W1:W0 4�f, City/Town-45;01f lsq y/ State: Li Partnership Business Tel: 9'72- VS'/ Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: GFo Gr py v FTl� INSURANCE COVERAGE: I have a current liability,insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes ❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. S natlj� r /L6 Check One Only �7yL Owner E4— Agent ❑ ure of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ❑Plumber ❑Gas Fitter Title ❑Master Signatur of L eci used lumber/Gas Fitter City/Town 09ourneyman License Number: f S'fa!I APPROVED OFFICE USE ONLY ❑ LP Installer , Y ate� w. H0RT1M. .. - ?�,,� •�,;.,';�;oL TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNusE� This certifies that . V . . . . . . . 'f has permission to perform,,.--41—."—"'a',,r. . . . . . . . . . . plumbing in the�bualdings of . G `. ... . .. . at.. . . . . . . . . . ./. . . . . . . . . . . r. r"�'`'�'�-,'North Andover, Mass. Feer. . . . .Lic. No—.1. . . . . . . . PLUMBING INSPECTOR j Check # 7221 4ASSACH4S39 4it�IIF APPLICATION FOR PERMIT ®�PLUMBING Z� Nai--777 Perm#t 00 M 6". gate �1% f1Of'a ka fte� � � Type 00 t3aoeepansg�,.,.— tvew CS �.enetvet#©++� dtte04®ae+7+eat 0 plane submitteC Vee No FIXTURN SC stp: SEWER iLldi I I i BASEMENT 3RD FLOC 41'H F1lt FLOORvo" 7rYs,s7llrst{ Gcrripany Nef!!e Check Ong: Certificate agareets�r�'7 porat#on VAO +t--- ��� f] paftP>ffirpkibp bus#nes® Teiepttone„� �t 1 0 ffrrnlGo, teal:me Of 6..Ieerased Pttrmpet Uta alaspitterY. i NSURiANCE COV11MAGE: haus a ctarrrrsf liability IA110fance laat#sy Or Ito ratadbatant#a1 041a1valent, which rnests the regwlrentents of FAQ.ch. 142 k Yes o foo 0 f if yc+►, have chewed LU, p10eee 1114914eta the type Of coverage by checking the appropriate box. I I A liability ineureance policy �t Other typo of Indemnity Q Bond 0 i II � OWNERI I�I$URNACE WAfVER' I ant aware that the licensee f bot have the leeurenoe coverage required by Chapter ! 142 of the, Mees.Genera!Le”, and that rely Signature on thio per rrtlt spp#Ie;otleroi we#Yat$ 4ttt8 requirement. 3 Sadnsture of CYwnor Or eir•aAgent Check one: Owner 0 Aponl 0 t hereby eertltr that ell of the detl,110 ano Infrirmatlo+n r )%Ov• mubrnlitt�gagj, 4 a -, m.Y "^o '•der o of abet all blurnal oet{or on work end Inetellotlons Perform P lies off true and accurete to the east of el lrartl-ens �roa,nlane or the Memtaoertueetts$tots Plumbing en6 t+he 4aa a permit r is application wlit be it, m cowier.ce carr, - 4 ii�nature of Lieerrae0 dffidrrrfttt j,'i Own t-S6 0 1 r TY06 of Lle4nbst D Jaurnc.ymx., l.dtanae tdtJrn80t„„�,� � r r f t � Location fit` (o 7'�r 1'��� No Date / c 4, TOWN TOWN OF NORTH ANDOVER ' F p Certificate of Occupancy $ ' Building/Frame Permit Fee $ sAcHu Eta foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ .�? Building Inspector iv 1) •. Div. Public Works PEWMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP +40. I LOT NO. 2 RECORD OF OWNERSHIP .'DATE (BOOK .'PAGE - ZONE _ SUB DIV. LOT NO. LOCATION C ` PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS 1; BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST .' 3RD BUILDER'S NAME �/ SPAN C1v DISTANCE TO NEAREST BUILDING Eq MENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X 13 BUILDING ADDITION MATERIAL OF CHIMNEY ' IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUI EMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST T.Q COST BLDG. PER S . FV PAGE 1 FILL OUT SECTIONS 1 - 3 EST. _ ` PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS ' PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED � ¢ G z2OUILDINO INSPECTOR SIGNATURE O NGGER OR AUTHORI AGVT F E E OWNER TEL.# ? �� PERMIT GRANTED19 CONTR.TEL.# CONTR.LIC.# y H.I.C.# j BUILDING RECORD 1 OCCUPANCY 12 t SINGLE FAMILYSTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI, FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA. APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _tel DRY WALL UNFIN. 3 BASEMENT AREA FULL IN. B M AREA _ 14 1/2 '/ FIN. ATTIC AREA _ N_O 8 M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIN'1) ASBESTOS SIDING _ COMfACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING 4 GABLE I HIP BATH 13 FIX.) GAMBQEL MANSARD TOILET RM. 12 FIX.1 FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING - TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS F 7 NO. OF ROOMS GAS OIL B'M'T2nd _ ELECTRIC 1st 13rd 11 NO HEATING i 01 52 t`, gis�;2t1 Re Ugq 2�iq$ �1re Y 06i � C�IMtiE15 ,1 4NDUVEq �awk,as t Sort b,M4, O,c A'_ � �MW�SSR 1 1 • it NORTH • 0VM Of ? over .Q No. L O - LA Eo dower, Mass., / 19 4- T' COCFIIC NE WICK ��� _ ,9 0R'4 TE D PPS\ C�l P� I S BOARD OF HEALTH. Food/Kitchen E K . . Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT.................. . ............ .......... .L?l.l..l../ .N......... .........: ........ "" Foundation `�' .. has permission to sre t....�� �� ...��.... ..... buildings on ..... ...l..y.(a....... .�'f .........ATAR ........!U..: Rough t0 be OCCUpled as �7 .: .... .... Chimney .......................... ......... ....... . ......... . ........ ....... provided that the person accepting this permit shall in every respeot conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Rough ............................................... Service BUILDING INSPECTOR Final Occupancy Permit :Required t0 Occupy Build'ing GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough p Y Final BeNo Lathing or Dry wall To ° Done FIRE DEPARTMENT Until Inspected- and Approved` by the Building Inspector. Burner Street No. Smoke Det. f PER\IIT NO.1r^^7 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PACE i ih MAP +40. LOT NO. 2 RECORD OF OWNERSHIP DATE ¢DOK ;PAGE ZONE I SUB DIV. LOT NO. r — LOCATION -t - PURPOSE OF BUILDING _ - TO• OWNER'S NAME _ NO. OF STORIES SIZE Jlv 1 1 -OWNER'S ADDRESS C `�- BASEMENT OR SLAB J ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST t+e— - .3RD _ r elf•.'•' BUILDER'S NAME 'Ao4 _ SPAN - �✓U DISTANCE TO NEAREST BUILDING. `f ('- I711NENSIONS OF DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR GIRDERS T� AREA OF LOT - FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X - IS BUILDING ADDITION MATERIAL OF CHIMNEY ' IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND - THIS CE WILL BUILDING CONFORM TO REOUI EMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER has OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER has pert IS BUILDING CONNECTED TO NATURAL GAS LINE to be oct INSTRUCTIONS 3 PROPERTY INFORMATION provide( - - LAND COST this of i( SEE BOTH SIDES EST. BLDG. COST G� Building PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER Sq. FT. - _ - EST. BLDG. COST PER ROOM VIOLATI PAGE 2 FILL OUT SECTIONS 1 -- 12- 11 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST B/E/.FILED AND APPROVED BY BUILDING INSPECTOR j DATE FILED - `- BUILDING INSP[C'TOR SIGNATURE O WiGER OR AUTHORIAP/AG VT C FEE j OWNER TEL.q 61 ` - PERMIT GRANTED _ CONTR.TEL.# % _ / -351 19 1 CONTR.UC.# H.I.C.It i .4^•�.»�rr�y;�ei„�y-F ,. ,r-:a,.sk-s+}-s+��:�..,.,..,��'7��d'� :::G3ic'.}�;��aF':'.,�t -"yY'- ; Date..... k4, 417 k- f NOR71{ - 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUSEt - __ I t This certifies that .7. ............:�%.!.` .G s..G...... v... has permission to perform I)v L Q .........t�. r... ...lt..rC�f............... E; wiring in the building of......L.... ... R..�/.��'Z ` /`f.�... .a..l. f ... at..... .... . �cl..Ctt%�4......4�...... ,North Andover,Mass. Fee...: Uv.. Lic.No. 5. 13 ...........; ELECTRICAL INSPECTOR 709/43/96 13:47 225.00 PAID * WHITE:Applicant CANARY: Building Dept. PINK.T3{reasurer I The Commonwealth of Massachusetts OffLet to* Onir Department of Public Scfcry fir i Occupancy ♦ foe (7wct�d 111—1 BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AN Work to be ps formed In accordance With the Mawchusctu Electrical Cods. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE /AU INFORMATION) —Date City or Toon of o z4W_071e12_ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street b Humber) Ot+tter or Tenant L r Owner's Address Is this permit in conjunction with.& building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service _Amps / Volts Overhead ❑ Und rd . ltg ❑ No. of Meters Number of Feeders and Ampacity, Location and Nature of Proposed E1 ctrical Work � 3 o , �ovzl No. of Lighting Outlets .� No. of Hoc Tubs No. of Transformers Total KVA No. of Lighting Fixtures 3 Swimming Pool Above ❑ In- rnd. rnd. ❑ Generators KVA No, of Receptacle Outlets 3 No. of Oil Burners No. of Emergency Lighting Baste Units No. of Switch Outlets 2 No. of Cas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cord. Total No. of Detection and tons Initiating Devices No. of Disposals I No, of Heat Total Total PueOs Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal El ❑Other Connection No. of Water Heaters KW No,ns Ballasts To. 01 LowWirVoltage Signg No. Hydro Mas Tubs Y sage No. of Motors T o to 1 HP OTHER.• - INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or s substantial equivalent. YES Q NO I have submitted valid proof of same to this office. YES NO ❑ If you have checked YES, please indicate the type of coverage D checking th �7�f Y 8 e appropriate box. INSURANCE lCJ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S tExpiticlon ace) Work to Start Inspection Date Requestedt Rough Final �� Signed under the enalties of perjury: FIRM NAME !Ji /� ce C T i2/� �U 1�a��_ LIC. NO. Sy LicenseeS. /��� ��/� Signature LIC. NO. Address �/� ,r�� / ,)1.001 i,1 us. el. No —77 / Alt. Tel. . OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurancNoe coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this pe it application waives Chis requirement. Owner Agent (Please check one � Telephone No. . PERMIT FEE Signature of Owner or Agent Lo1� P-IC413D or Ndl�1^M �N►�OVEI�, MA, ,��Qp�� CAtil I, � �� A.) ` SOPPLY Wnl ❑ WELL Ape ovcD D4C SS - - SEPT1c SY STEAA -pES►6A3 �PPf{ovC`� D,4r�� 1JPi?ov)NG AUT-�iol?)Ty a PCAAJ �LQN �4T �I SAPPPGVEp Co,�p�rro�S RQs4Ns = f CAV y) Oe -t,-,vi `,l�Fx4v4Tiolj ,"SPEC►0&j P/JrG E1 045S PAIL } ' t APPROVE D/JTC q-12-� APPROVIAvG AJT+fo�?ay C� INS%i01,1.G�i -(�.v �5p ADD Ir )J g 10 AL, T C- I�s�.i SNS ���-,o►�Y) Fw4L APPfZ)VAL APPS WVJ6 4u 1 Ho91 i S r e r S s t APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I h&reby make application for a per it for a sewage disposal installation at f y /fL�z �ti ✓1�. , 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 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 oflineal (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 an length and in two lines of tile will be g Y case, 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, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. 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 f / > 7 c Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE - -7 / Signi(ture of Health Agent I have inspected the uncovered system indicated above and find everything done as describ d. DATE $ Q )'A 7-4 A ignature nspecting Officer , Percolation Test ✓ �2 7 Garbage Grinder ! . BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 30 70 0 1. NAME C a.t r Te`S l e?►'1 �rk c-/�`n DATE 7 C? 2. ADDRESS ��fi g fiiu�i.�✓I LOT NO. TEL. 3. NO. OF BEDROOMS DEN YES )A, NO 4. GARBAGE GRINDER YES NO 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 9. 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 TOWN OF NORTH ANDOVER, MASS. R i 70 1. NAME - DATE 2. ADDRESS ! I % " t ii ,'f ' LOT NO. le TEL. 3. NO. OF BEDROOMS Ll DEN YES NO 4. GARBAGE GRINDER YES NO 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 9. 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 DATE P NAME OF APPLICANT LOCATIONy,� t Add e s of lot no, BUILDING: Dwelling Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND SUBSOIL: Clay Ivel Sand PERCOLATION TEST minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK ltp7p gallon capacity, LEACH FIELD lineal feet of drain pipe, e. William J. Rr' scoll, Engin er Board of Hea h Board{of Health North An over�Kaes. BEPTIC SYSTEM INSTALLATION MXX LIST LOT ' - A �ID DATE D'ISAPFt3CIti ED AVATION OK FAIL 3 c ✓ A: FAIL OK 1. Distance Tot- a. Wetlands b. Drains C. wen 2. Water Line Location - - - 3• No PPC Pipe It: Septic.Tank's .a. . -Tees -_Length & To Clean Oat Covers:w, b. Cement Pipe'to Tank On Both Sides of Tank - 5• Distribution Boa a. Covers & Box - No Cracks b. All Lines Flo-Ang Amoimts c. No Back Flow ti 6. - Leach Field or ch a. limen ♦.. b. th, - x apped Inds w " Clean Double"Washed Stone' ?. Leach Pits _ rr a. Dimensions 4 b. . Stone Depth R . c c. Splash Pads f. d. Tees f e. Cement Pipe to Pit - Both Sides. a f. Clean Double Washed Stone ' No Garbage Disposal } 9. Final Grading Inspection _- ar 10. = Barricading Covered System _11.' As Built Submitted_ --_-: ti - -- a. Lot Location - - - —- --- _ b. Dimensions of System c. Location -4th Regard_to Pere Test d. Elevations F x e. Water Table s Iy 4` y' :_t�-1.:J i �. i' >_ ,i'� •fir i.' ��-Z •) 1 l.. �i �i I- k3T '-)A''A. ,t� z 1 iYOe '�'. l_1 r / 1 Loc . /Subdiv. Plan Owner Investi_gator SOIL PROPILES--DATE 73 3. 4 - Elev._ -- Elev. — Elev.- =Eley. 0 - 0 0 Ties to Test 1- 2 2 - 2 2 - 3 3 - 3 3 - - ----- a G G r 9 9 - ---- - 9 �' - i - - ----- - -- --- 10 - ---- I.0 - -- - - 0 Benchmark Loc a t i o n---- - - -- --------- Ele-vation Percolation Tests-Date_ pit Number- 1 2 . 3 -4- S Start Saturation Soak-Mins.4 ..__-. Start Tn_st-Time = Dr_� of 3"-Time - - -- - - ( ------ ijr� Of --Time -- -- - -- -- -- --- - -- - - - iSins _ 1st 3"Drop- - --_--_- ins - 2nd 3"Dr_-op - - -- i 'rr rJ• t � 41- 2E Hf2E, t5 U, I LIT, 3 ii F. I I A#V Pt PE PtP 4P7X ; z: R cz©,riK G��c. ►r.sAS A �vsA`7'E5 ` I . l � r _ i q i it I � Ol PIE WL Opt =- � C17 _ I �. . - :;�. •, ' • ' �Iii Cst t�t�-E t25�. ,l�Y'G..i-�l�T��.'T"S f St AN C)I=N- FF i2^' 'i t�j ►. AN ! 1� ` NORTH ANDOVER, MASS . ��� Z� 19 8 I P, BOARD OF HEALTH FROM: ���F-t.JI(r P. . l.1 t�1 � DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at Site Location i North Andover, MA. I The grades and construction materials are as specified in my plans and r' specifications dated ��J. `� 1 198\ and 1 l7 2 19 g� Reg. Prof. Engineer/Reg. Sanitarian r� qR•; 1TI, Ra F tj �r �o v P � x i Q 1 t LNV PIPE- QUI OF NSE. I�-�1 E5u i L 1 IAIV_ pIPP- lAILD mw14 - 1-3 �. S wv Ptff.O U=E TM1tL I - .30 I N V_ ©1 PE I NTO Q.SOY, 1"-30.7,5 r. ', ►t'►v F. 92UT ®_e�x i3ca, �.c� SYSTEM • r.1V i 1J Q I T ( _ � y• 1 � IJ VT z (2.q A � qtr/t H OF 1?9ss (� I�D 971-kA A Nb o j c--- ?, FRAN u 0 22738 2 + . 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