Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 182 OLYMPIC LANE 4/30/2018 (2)
,�� t W Date...../.�.... ,10RTM TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ..PJ ' .....,. ............................................................. has permission to perform .Vz%!ll....il.!C.1 ? wiring in the buildingof .( ..��i 111. U ...................... at .......... .................. ,,-North Andover, Mass. Fee? ......, Lic. ./ �?` 7.......!r'.. ELECTRICAL INSPECTOR Check # 5b5J M -'-'&P WW,U Of Jiro BOARD OF FIRE PREVENTIOI APPLICATION FOR PERM All work to be performed in accoidauc w (PLEASE PR11VT 1iV INK OR TYPIi ILL lilt!' : it REGULATIONS Occupancy and Fee Checked I Rev. i Il991 (leave Mani., TO PERFORM ELECTRICAL WORK the Massachusetts I:•lucirical Code NEQ, 527 CNIR 13.00 TION) D21C: U'- �) L )AP To the Inspector of 6Vi,•es; her intention to perfomi the electrical work described beiov,% 2 n City or Town of: i A By this application the undersigned gives n ice o his or Location (Street & Number) Owner or Tenant Owner's Address -. Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps � / _bolts eI Sen•ice Amps ! vults Number of Feeders and Ampacity Location and Nature of Proposed Electrical IVork: f– Yes [Q1– Telephone No. 121(-90—t No ❑ (Check Appropriate Box) Utility Authorization No. Overlicad ❑ UnJgrJ {{----�� t,.1 No. of Meters . Overhead ❑ Undgrd ❑ No. of Meters. Conrelntinu ntrh. r-11 ....... ,_sr - No. of Recessed Fixtures - - - .�• �•-••x No. of ceii.-5usp. (Paddle) Fatts uura ara oe 1012—ab V the Iris• ccior of Wires. No. o otat 'i'ransfornery No. of Lighting Outlets No. of Riot Tubs Kv�� Generators KVA No. of Lighting Fixtures ` Swimuning Pool A ove ❑ In- ❑ o, o mergettcti tg ttrttg No. of Receptacle Outlets rud. rnd. No. of Oil I3iirners Batte Units , FIRE I►LAR:1•IS \o. of Zones No. of Switches ',�, No. of Gas Burners i o. o etectio 1 as Initiating Devices ' No. of Ranges No. of Air Cond. Tans No. of Alerting Devices No. of Waste Disposers Heat Pump I um er 'onso. Toiais: -I.KW 111 o e ontanncd \'o. of Dlsliivashers Space/Area Heating KW \� � � Detection/Alertin Devices Local ❑ luniteipa Connection Other No. of Dryers Heating Appliances Ktiy Secnrjty Systems: i\o. of WaterIN Ileiters Keil t o' of No. of of Devices or E uivilent , a Data Wiring:I No. Hydrontassage Bathtubs Sins Ballasts No. of Alotors Total HP No. of Devices or E uivalent ' a 1! A) •iritng: No. of Devices or Envivni'ant I V 11714' tt: n••.•�•• rs...r.rransr aerarr y aesirea, or as required bs• the Inspector of {Vires. IMUR.OUtiCE 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 erage is in force, and has exhibited proofofsame to the permit issuing office. CHECK ONE: INSURANCE co(K BOND ❑ OTHER ❑ (Specify:).._. Estimated Value of Electrical Work:' -)D 0 , (When required by nnuuicipal policy.) (Expiration Dzic) Work to Start: l 7�, ' 1, U S Inspections to be requested in accordance with MEC Rule 14, and upon completion. I certifT, under tine pains an►d penaldes of perjiny, that the information all flus applicalivtr is true alld colliete. FIRnI NAME: c. W cVLIC. NO. - –j- 9 E Licensee: �q. �L 'AT:, &>��� Signatur . `O.: -� (If applicable. enter ••aveurpt..ill fire license numberrle.) I3us. Te1.1o.• X903- tee- To p Address: �_"R\ j o. SG.J. � .a, :fit c�. e �a N Alt. Tet. No.. - OWNER'S INSURANCE WAIVl�� am awn that the Licensee does not have the liability insurance coverage normally required by law. By niy signature below, I hereby waive this requirement. i ann the (check onc) ❑ owner ❑ otivner•s aLettt. Owner/Agent Sigmature 'Telephone No. •AL•YttlllT -rc: s 34° Location /eC71 � No. �// Date 3 d ? 4V Check # el C TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL 164,8 _ `/ Building InspectorU TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: _a ^ `aVD SIGNATURE: BuildingCommissioner/Inspector of BuildingsDate SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -i'82 OLu T1C Lan`P !/ 10.6 W3 n,t Map Number Parcel Number a 1.3 Zoning Information: 1.4 Property Dimensions: i GR 313 ISO ZoningDistrict Proposed Use Lot Areas Fronta e ft 1.6 BUILDING SETBACKS ft . Front Yard Side Yard Rear Yard Required ' Provide Required Provided R red Provided 8� 9-32, 1.7 Water Supply M.G.L.C.40. 54)' 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public K Private 0 Zone Outside Flood Zone X Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNER /AUTHORIZED AGENT 2.1 Owner of Record Kim ) Fs2 OLiA m o i c Name (Print) Address for Service . Signature Telephone 2.;2 Owner of Record: r Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ ' Licensed Construction Supervisor: d 10 2y$ License Number ,.[ 0 6 3 w c` fi�erin ho -e HA eu h )W N $183 2 Addres 3/19/200{ 7$ % 2 Expiration Date Sign Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ S�e,q C $ 0 0 y Company Name P�e_ 4-��fer�h � �(. Alla, c�tnz Registration Number Addres � $/ 11 /2oo�j _ 7 3 7 2. `� 7 � Expiration Date ori nature Telephone T M X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 9 SECTION 5 Description of Proposed Work (check all aoolicable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: adds i Rorl of C(as<-C"s r4Ad I 1iiIn1:1M ill C: r bet ri i,c4ri nri 'Za'mc) -Re, 6� �+ ��a►..�irr��� SF. _Ti 6 - F.STIMATF.D C.0NSTRTTCT10N COSTS Item V Estimated Cost (Dollar) to be Completed by permit applicant OFFIC1A US9.,0NL'Y -' . 1. Building i Gd ` -� (a) Building Permit Fee Multiplier 2 Electrical f i C C C` '� (b) Estimated Total Cost of Construction ai ooD / 3 Plumbing G Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection D 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT 019 CONTRACTOR APPLIES FOR BUMING PERMIT s Owne Authorized Agent of subject property Herr aufforize to act on My behalf, in11 ma rs r ativ to work authorized by this building permit application. 2 - W/a a3 Signature,A/ONV4 Date T— I SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Anent Date NO. OF STORIES 2 SIZE 2 XI ' - BASEMENT OR SLAB ' r(o s -r 14'c,I SIZE OF FLOOR TIIVIBERS 1>x 2 3 SPAN 121 J DIMENSIONS OF SILLS X R '31-ctd<&J DUVIENSIONS OF POSTS DIMENSIONS OF GIRDERS I-II-IGHT OF FOUNDATION THICKNESS 10 SIZE OF FOOTING ' X MATERIAL OF CHIMNEY v IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I I S FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT % �6 Il I( k I I� LOCATION: Assessor's Map Number Ob SUBDIVISION Lpf a PHONE 090 6 rl Sl0 3 PARCEL D1,31 LOT (S) STREET �?� 2 O�yy�p<< LGty1-e-- ST. NUMBER '?�a ************************************OFFICIAL USE ONLY*********************************** RECJWMENDATIONS OF TOWN AGENTS: 1 CONSERVATION ADMINIST�KTOR DATE APPROVED _ DATE REJECTED 03 COMMENTS COA4. 4 19f ?ra;dJ P, N. no a,2em,- d5 C', too � o� �rono� TOWN PLANNER • COMMENTS c FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH P� COMMENTS. t Xc i C [- .J ' DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT Need RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 Im ivame C& The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Please Print --------------- Location: 10G:? A City l -I 4 erh i l l 1 ii10► D l 32 Phone # cl-7 e 37 2 �� y !� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Pyne # Company name: , Address City: Pyne # Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.afine up to $1,50Q.f)0 I and/or one Years' imPrisonment_as_wvlLas_c bAjxnaltieslnsheimn-d-a-STOP]IYDW-ORDER_and afore cf_($iDO.QD)��aY m� l a understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verircation. / do hereby certdy under the pains and Signature Print of perjury that the information provi*d above is true and correct Official use only do not write in this area to be completed by city or town official' City or Town 0erm3/1icensi nq 7 7' x{79 f ;• ❑CheckYimmediateI] Building Dept response is required p Licensing Board E] Selectman's Office Cmtact person. Phone # I] Health Department R Other !;=RJ I Tr_ C,NAVqti4 "? tAQRfAC.� This plan was not prepared from an Instrument survey. Offsets and distances shown 'should not be used to establish property lines. This Olan Is Intended for mortgage-purposcs only. I certify that the structure nM shown on this Plan - VVAiin conformance with the zoning setbacks in effect at the time of construction. 1 certify that the parcel shown is 1107 located within a flood hazard area, as depicted on FEMA Flood Insurance Rate Maps for rnmmmity No, MORTGAGE LOAN INSPECTION LOCATION: SIE f yM F AN F . NQRTN 14 COV R SCALE: I = I0 -C DATE: 7 REGISTRY:. NG I E -FX �— TITLE REFERENCE:.ESt. = ISM P;L,126 PLAN REFERENCE: COREY & DONAHUE. INC. Enclneen Z sur c'yere 1!18 C,Ambridge (tnRtl, %vnhnrn. MA DISOI . GT1ze l�omvrreaizuraa/,�i a� /G�aaac: :t> ,BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS.;. 01.0248 i Birthdate 03/19/1953 j1 I,,,�, Expires 03/1912004 Tr. no: 20436 r Restricted. A00 STEVEN C MCGLEW °. 1063 WESTERN AVE:\, �,� -� HAVERHILL, MA 01830 ; Administrator i ge t� ✓/ze Ur omvnzd,u„ea�/ �gaac�ivae�d i I Board of Building RegulatioM,and Standards HOME IMPROVEMENT CONTRACTOR Registration 108004 Expiration. 8/1112004 -Type Individual STEVEN,G:.MCGLfW, Steven McGlew 1063: Westerrr'Ave., 2 Haverhill, MA 01832 >Administrator" - JAI jub tu AV r r r { t r x, T' s r t � i : .«.---:" --..--.w _._..___.__---F-» _--;.•_.._moi- ... _........._•h -'-•-•_.-r, _. .�.,-�.,._.�- ` � ..,. _ __ i k f _. _..-.-_. --#_ ...,..,...,,.,�..-«..._...-»....__{-...,.._i.. ,y..�.,..-..moi._.__.{•_._-,-+ ..- ._----i--•--F--•. .R ».�...�.........._,.�.,__. _--i-.�.._ .}_ ... �...}.._..... �..-..,�.- �' - i-- � r A i IV t LA 71 I i 1 r • f t ` .ualla6le lose'r..u.er,-ou rr�il�i t . 9e1 Jrices, ino(ow- lelalni9 d c anspe ZP)rilin ' I I t i i 1 DATE JOB CHARLES A. McGLEW & SONS, INC. Building • Remodeling • Custom Cabinets • Interior Finishing • Sunspace Designing ' Telephone 372-9744 — 372-3104 1063 Western Avenue, Haverhill, Ma 01830 DATE JOB 4 • } 4 E Q�. 07 f - - t L + , o X. t , , , i 3 t k rr-77r 77- IM t T•` it h Y V+ L , , -,ry _ _-T ------# - +----i----- - , i , j f i i � t • i q f Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director May 8, 2003 9 `� d �� s d, k Yangkil Kim 182 Olympic Lane North Andover, MA 01845 Re: Application for an addition to an existing home at 182 Olympic Lane Dear Yankil: Telephone (978) 688-9540 Fax (978) 688-9542 Your application for an addition at 182 Olympic Lane has been reviewed by the Health Department and denied for the following reasons: 1. ✓ Missing information 2. ✓ Passing Title 5 inspection of septic system may be required 3. ✓ Location of structure not acceptable To address the problem(s): If #1 is checked, please supply the bolded items: a. Floor plan of the existing dwelling (all floors) and a floor plan depicting the proposed addition. Alt rooms must be accurately named; b. Certified plot plan showing house, septic system and proposed project in scale, including any associate grading. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If #3 is checked: a. The proposed the project must meet all current Title 5 setbacks. The addition in the front of the house may meet these setbacks but a more accurate plan is needed to determine this. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, rian J. LaGrasse, Health Inspector Cc: Building Department File BOARD OF APPEALS 688.9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688.9535 L_b4 mwa.�.,w,.+ P„.rw�ll,.a•m,-1 ,,� i ww,. ._...�,wi t I I � 1 1•�,,. ��... 1 I i I I I •• _ - I � t i I I I I I .00 I i d • I _ AA I AII I • E JI t 1 . I i T _ f _ III t j � . L.... L... ,F..... .-- � --- - - J.. ..._� ��.-1.......•�r� .n.ui.,l+,r '--T"-_._I 'N>✓lkaaeN.eraR.D6 _ s I + .........�I-... to ._ _., I. .I{._... .. y .F.�'-- SGSG Il `._ { _. i..,_._. I-_ I ,• �.., � ��'m11nR+*�LLye'n�N'J'}:'wGt`I>F+K�v:��b✓i'n+•,ti-.:�i{b[^i[�YTiei: � -IS__.�._. ?,3G(.'tirKKsi[ _I �I z i ! , 1 I i __ tv ki y ' I , • {g I I l id i Date... -�2 N2 2017 A* TOWN OF NORTH ANDOVER PERMIT FOR WIRING D 7- . -4 , A This certifies that ................................ has permission to perform ............... ......... wiring in the building of ....... 'z' .... ....... A ... ................................................ . . . . . . . . . . ........ . o", ! . . . . . . . ..... ". Fe .. . ....... LiAol ......... -? .... ......... . North Andover, Mass. ............ ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Office Use Only 01lTe (�opimIIglUettl ofitt���>:�uj�eits Permit No. mai 11cparttncnt of Vubiic $afctq Occupancy ,& Fee Checked BOARD OF FiRE PREVENTION REGULATIONS 527 CMR 12:00 X90 peeve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 11/10/99 City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrlcal work described below. Location (Street & Number) YANGKIC. RIM Owner or Tenant 182 OLYMPIC LANE Owner's Address (978) 691-5108 Is this permit in conjunction with ot building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utiffty Authorization No. Existing Service . Amps __J Volts Overhead ❑ Undgmd ❑ No. of Meters New Service Amps _.J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Ttansformers Total No.` of Lighting Outlets No. of Hot 1Lba KVA No. of Lighting Fixtures Swimming Pool Above In- KVAgmd. ❑ grnd. ❑ Generators - s No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of (las Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No.of Heat Total Pumps lona Total KW No. of Sounding Devices No. of Soil Contained No. of Dishwashers Space/Area Heating iCYV DetectiowSounding Devices . of Dryers Heating Devices KW Municipal Clothe'No. Local C1 Connection No. of No. of Low Voltage No. of Water Heaters KW Sign Ballasts Wiring BURGLAR ALARM No. Hydro Massage Nibs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES G NO O 1 have submitted valid proof of same to the Office. YES O NO O if you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE 0 BOND. O OTHER O (Please Specify) (Expiration Date) Estimated Value of Electrical Work i 584.00 Work to Start 11/9/99 Inspection Date Requested: Rough Final 11/12/99 - Signed undor the Penalties of perjury: 1'211C— Licensee 1 �. — FIRM NAME LIC. NO. Licensee nnnal d A Arnnkg SignatureLIC. NO.. 1231.0--- Bus. Tel. No. ( 203) 741-4008___ Address 111 Morse Street, Norwood MA Alt. Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the License* does not have tl» Insurance Coverage or Its substantial equivalent as r•- qulr•d by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please chock one) 1. 35.00 ... Telephone No.. PERMIT FEE i ._ Location l CJ y C //,7 IV Q - No. / Date o7 a �aRTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �'�s'••°''�� sACNust Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ v� Water Connection Fee $ =" OTAL $ 7 Building Inspector 1 l) 8 03/09/99 Div. 11:58 390.00 PAID Public Works a v _ n _ y y m • Q C d v _ n _ y y m • Q C d � n 0 o N 7AV a z y>= Z Z m z rti A? V rZr. z N •• = D Z Z o T '7 --- = Ln LA Z rr; 1 2 y m n t- -� m. + T Y ? R' z m z W tori, v. V 7 _ in V m N Z — oa r ;r m r th z to — �' v. w C y c C)<5�c (y— O m -4Z S y \A ? C z X m �E- A V J D x rD -, I m _ r rL- to ..� _ n _ y y m • m tr, m v: m � 0 o N •• � s C z ti Ln LA rr; Y m Z — =• ... m m th z to — �' v. w C O m r \A ^� �E- A !9 I IG I a tNIMM � 0 o N C ? Ln LA rr; Y m Z — =• ... m m th z to — �' v. w C O m r \A ^� �E- A rL- to ..� rn o _p � N 71 T z N . a tNIMM FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT V4A)6-LO LOCATION: Assessors Map Number SUBDIVISION PHONE PARCEL LOT (S) STREET ��.V,0 P/C.LI ST. NUMBER ****'********OFFICIAL USE ONLY"'** REC NQATIONS OF TOWN AGENTS: - CONSERVATION ADMINISTRATOR DATE APPROVED DATE, REJECTED COMMENTS TOWN PLANNER DATE APPROVED r1� DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED 1CyIVS CTOR-HEALTH DATE APPROVED ,R �� DATE REJECTED COMMENTS 44 PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT ft - FIRE DEPARTMENT j/ RECEIVED BY BUILDING INSPECTOR DATE _ 7 P -S, t'.V, A MA, IV 1v p _7 A Ep . . . . . . . . . . . X� Z :LOT 23 V 2 41 "00000� New Addition.. �.. Ll 6. 0 V. AT H A_W Kj%* JAC), 1;_4 IP FAM'Y This -plan was not -prepared.from an Instrument- MORTGAGE LOAN INSp�2-1 ON sufvey. Off sbts and.dittances shownshould-not: LOCATION- AW 2 0M -y -W .be;;used to establish, property lines.- J J\!C TH AU PPVFF\ F Thls-olan is, Intended J ov-motk gaqo-purpo,scs.% SCALE- DATE"45" A , onlyr. REGISTRY- N 0 F SS E X I certify thM the structure' .132 !shown,�o'n this*.- Ptah 1YA _-i ..in donformance With the zoning . TITLE REFERENCE: -7 7�.:. -22L_ setbacks in'effect-at the tim(?*.of.construc ion. p PLAN'REFERENCE: ...... 1: C.'ertify that. the, p9rceI.'s1h6wn is LIQT iocatedp COREY & DONAHUE. IN w1thin: a flood. hazard area, as depicted r*171 A A M-4 I—^@ tv.%"�fn Onfin KA --.i ne fnr William F. Weld Governor Trudy t oxe Secretary, EOEA David B. Struhs Commissioner Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1 0 y� Address of Owner:. Date of Inspection: (If different) Name of Inspector: Yci-g ( I�(Jyk Company Name, Address and Telephone Number: ✓d� - � o 4177 144/ L FICATIO-e AMEN I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewa sposal systems. The system: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Insp or shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection If e system is a shared system or has a design flo" of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent !e !hr wstem owner and copies sant to the buyer, if applicable and the appro,ing autlwiit�. INSPECTION SUMMARY: Check A, B, C, or D `) (' A] S7ave PASSES: C J t/ not found any information which indicates that the system violates an of the failure criteria as defined in 310 CMR 15.303. Y Y Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: % One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX (617) 556-1049 • Telephone (617) 292-5500 0 M Printed on Recycled Papa 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A j �j ` CERTIFICATION (continued) Property Address: / 0 Y/AV1G [//� • �/� ��'�Ui��e`' Owner:�- Date of Inspection: `T B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: the SvStem hd5 a septic tank and soil absorption system and Is wlthill 100 fCei to a 5Ur(aLr water suF p: -y or tributary to a surface water supply. The system hay a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systen ha, a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D] SYSTEM FAILS: 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) / Property Address: 1 +7 © l y pc e, z � OwnedDate of Inspection: �( D] SYSTEM FAILS (continued): /l/J— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation:' Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flog% of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well' The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: r Owner: Date of Inspection: Check if the, following have been done: Pu ing information was requested of the owner, occupant, and Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving y ece vmg normal flow rates dur' g that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. — Tje facility or dwelling was inspected for signs of sewage back-up. e system does not receive non -sanitary or industrial waste flow The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or ees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non -intrusive methods. _ The faciiit) o .;-,cr (and occupants, if different frorr owner). were provided with information on the proper maintenance of Sub - Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �� v I ( MPI G `� J-1 lk/ I Lq() a --e v Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: gallon Number of bedrooms: �- Number of current residents: Garbage grinder (yes or no):,V0 Laundry connected to syste (yes or no):V'1S o Seasonal use (yes or n):31U Water meter readings, if available: -- Last date of occupancy: IV t i COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non -sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) _ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume puml)cr! gallons Reason for pumping. -C S TYPE OOSTEM V Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: ?-'q ye -" `r Sewage odors detected when arriving at the site: (yes or no) 'k/10 (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM. INFORMATION (continued) Property Address: l�oZ/y �r G l✓/y%y� Owner: Date of Inspection: SEPTIC TANK: Ye S (locate on site plan) Depth below grade: �D r Material of construction: oncrete _metal _FRP _other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 11-1' Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler`' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural intPQrity PvirtPnrP of IPakaQP Ptr ) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance front hottorr - «um t- hottnm of outlet tee or battle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.', (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM /INFORMATION (continued) Property Address: Owner:. �411'1Gf �t L• � /�/ —�f Date of Inspection: �T TIGHT OR HOLDING TANK:_ (locate on site plan) Ikl 14 - Depth below grade: Material of construction: _concrete _metal _FRP other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_�eJ (locate on site plan) Depth of liquid level above outlet invert:=--�—.7 / Comments: (note if le%c! and distriUut:c c �, e•. id^nce of —lids evidence of leakage into or out of box, etc.) Rn�c 9/1Ji n G�,/ fJ t T�or� PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �� H Ile, / Owner: 1 /1/ J44 /�1 e. Date of Inspection: L` r 9 P, y SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type leaching pits, number:_ leaching chambers, number:_ y, leaching galleries, number: leaching trenches, number,length: All) leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) 0 )yofT/ui/ of sla I-- Ilda-w1. v S/qh elf CESSPOOLS: _ ,A (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) NA Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p / SYSTEM INFORMATION (continued) Property Address: /O Q) y*')Qle. 1q/J' oa-e-- Owner: Date of Inspection: / SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER Depth to groundwater: Lr Meet method of determination or approximation: (revised 8/15/95) 9 1-k P q. bb�N 0 '00 ft4A Z' q 1 # . Iv, Z "Z Nib* dition LOT 23 LOT. 3AJ -Q r "0& N6W Addfth NewAddition M1. .0 R 77 'y "T+l 0 N MORTGAGE LOAN NSP -d from. an instrument+ Thi plan wia� not -prepare, AW 'h 0 .,.�urvey.� OftWs and�.dltta,nces showns ould not,: 7LO CATION: I E - Ly be�:used to establisf� prdpo.rty I nes. AIJ rCIVE %Jhls"Olain is, Intended. f or..,-morlto�qo- purposes. SCALE, I I Cr- 0 AT E..4' s� n-�on this - I ceftify that the structure*= �ow R. E G I ST RY:. N G ) F SS E Plan, WA In donformance with the zo I n n TITLE REFERENCE: stetbaCks fect:at the irnei.of. construe ion Wef t t* P PLAN'REFERENCE: I- ce-riffy that the,parcel'sh6wn is Iodated withim a flood hazard area, as depict.ed COREY & DONAHUE. INC� - - r- MA A A C1 P%^o4 Ine-lornme-C2 P-MiLl fnr 0. C., , —vag's -k . . . . + t sF 1y Y •� A R-I 3C il�io 2613J8 4'2 2'9 30- V I U d V4'i n t 5M6 4 .4., � <°, s A a :304fi030410,' `30411 30411 30410 �'�Fit` Y'rMf` '� i �� 1 M f S ``� f1 ` t x � h • '4 � } �qt� FOR rTi � tv . rl�,F �r4y4'Y'R'}'Y 4r Flt•' t \ t - `+ r��.����A"�ot1} !�-• `� I.. .'0',• % � �• V _ ^r4 < 4: ::t Lf: :.^t R�•iy�hY"' of T -L \ ''� .. ISI ISi «„r.�;' "fit ++•�— � ,,• r^: ,) � J � z x+' Mit; x„ .� '` � (( �,� r✓ - ,V •'t - h .. t t 518. Lv rte; � ,� ^' +w�sr�„ t ,.�,,� � {�,,�� 4�Gd,�'e�.,��'c4� � 'y t ,� � .. '�,.✓' 1 � `.. � - i ( [ 3q `''S� yam, '�`� >��{♦F`�°r3� �,j,; t d' t i k A b'" � T ... ' „L .p��T Yx //�•�► * .r }(,fir P 7-14N�xaSti�tx '� 1 m m C a] m U m y C � CO) C7 10 0 CD n Z y CD O 'C CLCL 3 C Coo CD o CD cr CD CD O CD w w a. C CD y CD ® CO) CD I CO) CDCD Z n o o CD 0 CD .... ?V,) S) n 40 p d rt o= O y -� CD � C mr,Q m C') Z ti m ...► C '- m �� y H n o x a rD =.dim CL CL T rn ?m r►�d m �.� O y C CO)tD P14 �5 m = O O m CA m to o O 0 ZS.Cl) O N C9 C aco) = : 4 EL AO m H94% CD CE 7 C7-0 CDL CC cu y O d H H c C - Q �• '� o C. N _ � a . .rt C m H H C O 1 mCD ; CD M ca O m • O ` CD O 3 p, ca o : _' !" 0 =caCD : A CD �o =C: M p d rt o M M n r o O z n o x a rD o� 0 C CD O C m Cl) T m U) 0 m CA 10 Z CD O ar d � rM d O o v CD 06r �d CD o av o cm CD N! CD 0 y d d O CO) O CA Er C) CDO w� CD v CD 3, CO) CD CO) 0 CD 0 C CD O -• y Q y _So5m 10 y O=mA m Cl) y n do T CD Z =r'fl y O ' d .d.► m y T ? CL. m 0 O CD H p N --1 o :EmmJi - a O_ O y m -0 O •O► O• 0 O O 10 _ O O O y 0 CD C �y� dip , Zp A r rn a= C2 c X CL to 0 O O m y :GN 0' O CD n ' HdX O O = y A ca so ►Q y W t0 tW CD d y • '! CD o" Z O ��o Z C� 0 CA 0 ? 0 cn cn r: 1 d c O o CD o rA C/) Q00 cn ^y ° m G a ^n O O x b �o cn �, O n` 7i O ;z O t� O p O x O a CS1 CO) O x p x y 0 0 c 0 Date..(.....?. -4-'........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING A tl This certifies that .............. 61, ........................................................................ 7,, _- .... has permission to perform ........... . ............................................ wiring in the building of .... .......................................................... at ... /......:............%.: ....... ........... I ........... . North Andover, Mass. Fee.,,. -.'521 ........... Lic. No . ..... .... ... ...................... INSPECTOR Check # 467 -J" THE COAMONWE9LTH OF MASS ICHUSE77S DEPARTMtYRMOFPUBLICSIFETY BOARD OFFIREPREVENTIONRF.GUTATIONS527CAM 12 00 Office Use only Permit No. W 23 Occupancy &Fees Checked 6-2) APPLICATTONFOR PERMIT TO PERFORMS CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICA ODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work.described below. Location (Street � Owner or Tenant Owner's Address _ 5am C Is this permit in conjunction with a building permit: Yes © No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service -,2)Q AmpsVolts OverheadUnderground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work S40- � ,7 n No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above 171 Below Generators KVA round ground No. of Receptacle Outlets l No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• IrUM=Covaage: Rmantrodrmq mmiemofNb%ad ucisCtmWLaws Ibawa=ertLiab&yhmm=Pbkyin kdTCompleti Cowaageori wbstntialecltririvalffrt YES NO IbaNewbmftdvandlaoofofsametotIrOffioe. YES F)ouhawcheckedYES,pleasein dletypeofeovaageby ohee'ingthebox �1 INSURANCE BOND 01IIER (PleaseSpecify) Expiration Date AX -S Estiir>a dVahicofF7oc"Wolk $ WorktOStart hlspectionDaeRNues(ed Rough Fuel Signed underlie Penalties of pffjuty: FIRMNAME i , Lice-mNo. // V,5 -y Lioel>see /!?-6 AeD u c j er Tr, Signahue i1off seNo _ �2 7 % 50 /�/lBu�sTel No. -71 AA+. ..�X/iG OWNII2' S INSURANCE WAIVER; I am aware that the Lime does not have the insurance coverage or its a*stantial equivalent as wquaed by Massachusetts Gffrd Laws andthatmysigmahrreonthispe mtapplicationwaivesthisrequirearrvrtt. (Please check one) Owner M Agent F1 Signature ot Uwner or Agent Telephone No. PERMIT FEE $ N° 1 7 6 0 Date .......:.,I :..�cl........ TOWN OF NORTH ANDOVER A PERMIT FOR WIRING a S Id This certifies that ....... .:` ":::.................................................. has permission to perform ..... .................................................................... wiring in the building of.. ............. .................................................... M f*at .,!..... .. .... �z<-c:....fi?'`"�.......... , North Andover Mass; <}j Fee . e2 ..... u .... Lic. No......2 ,� .............. .. _ 1. .......... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ,nit TH a' tl 7'CTi^ 1'►'.t1 r101 ��1iLl j= ®.[' 1 `(f&SrQ(�Cz Z%.� Office Use only MAP U DEPARTMFIVTOFPUBLIC.SAFETY Permit No. /7 too 0FFIREPREY=ON REG ULATTOV71?-pO � Occupancy &Gees Checked U PARZEL PERART TO PERFORM ELLCMC4L WORK ALL WORK TO BE PERFORMED 1N ACCORDANCE WITH THE• MASSACI-IUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRAT IN INK OR TYPE ALL INFORMATION) Date Ahcl 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) / O t .� p,'/,Q�-1 e, Owner or Tenant Owner's Address .w Is this permit in conjunction with a building permit: Yes 0 No Purpose of Building Existing Service 100 Amps / Volts New , Amps / Volts (Check Appropriate Box) Utility Authorization No. r Overhead EE Underground Overhead = Underground Number of Feeders and Ampacity Locati6n and Nature of Proposed Electrical Work �d'- .,',% .t ` ,o n —71, .,� No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA and eround No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No.'of Heat Total Total Pumas Tons KW htitiating Devices No. of Sounding Devices No. oi'Dishwashers Space Area Heating KW JA No, Self Contained Detection/Sounding ction/Sounding Devices Local Municipal Other No..4..f Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Sins Badasis No. Hydro Massage Tubs No. of Motors Total HP OTHER • •• ur:• r• • •• • •� - .• r - fur . � WC& IDStart - - - -hpec=DmRa4Ksted FIRM NAME 4 d�ci /✓G ✓ cX e r Esttma>ed Vah�l Walc S Rath ? ! t 4�/y� Fhal Li=iseNa / ( q ti t,( L sire �fls �- I NS :� -7 CP Tei Na Adm,/ `i es r►�°S.- N ll. o �a nt Tei Na OWNU'S RNS-ItANCE WAIVER; l an aware iha drI crose r or not hnre die asur au a ct t r ai as C mal Laws and tri mycrattrspeanswai estt>istasaceni (Please check one) Owner ® Agent Telephone No. PER"rffT FEE S + *��: t,`.t'�'•�,.,....,.�6/"'i'�,�:►.rir..+�+..7"-•��. i- ^.':7�"'� 3-'..:�!'Z:�.. ....'4 ^".•^'.L-..r4. _ Date .......... , '14---4076 NOR7M TOWN OF, NORTH ANDOVER , Pow p PERMIT FOR--PLUMBING CHUS This certifies that'' r ' 1 has permission I' perform..4 c�� --�`'" �` y. � - ..� t plumbing in the buildings of ... .. ........ atw ..... , North Andover, Mass.. x Fee, . ... .. Lic. No a PLUMBING INSPECTOR ry < " WHITE: Applicant .CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date L1 Building Location 1 Fj Z ��(.arLe Owners Name Permit # 47� Amount _ / Type of Occupancy GUKyC % l�l /il New El Renovation[3 Replacement ® Plans Submitted Yes ® No El FIXTURES (Print or type)j q �` i Chec one: Certificate Installing Company Name ��j e IQ it ail b V6901KO (�! � IT R Corp. Business Telephone 2- Firm/Co. Name of Licensed Plumber: v ` 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 this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work ant installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas chus State Plumbing C4 and Chapter 142 of the General Laws. 411 By: bignatire or Licenseaum er Type of Plumbing License Title C� '� 3 City/Town icense um er Master Journeyman APPROVED (OFFICE USE ONLY • ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ (Print or type)j q �` i Chec one: Certificate Installing Company Name ��j e IQ it ail b V6901KO (�! � IT R Corp. Business Telephone 2- Firm/Co. Name of Licensed Plumber: v ` 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 this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work ant installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas chus State Plumbing C4 and Chapter 142 of the General Laws. 411 By: bignatire or Licenseaum er Type of Plumbing License Title C� '� 3 City/Town icense um er Master Journeyman APPROVED (OFFICE USE ONLY Techno Metal Post Foundation Solutions of MASS. 9(' Medway Road Milford, MA 01757 Telephone: (508)478-0531l Fax #: (508)478-0531 Web%ite: www.t(./;hrtorntjta►post.com ff V BUILDING"k FILE /9c�- ozc7�11 �p Facsimile Cover Sheet 1 To !'Compa V&- . .. . ....... ly i Phone: From: Jeremy Sprague ..,---:..-Jv.a1met860@aoj.rom i Date: J- i Number of pages including ....... this cover Pg Message: 7 Cr it 7� 1: 39Ud T2S08,Lt,80S Elnouads AW383r 62:t?T 5002 -ET -90 JUN -13-2005 02:39PM FRO*- NIlTAL FCW OF NSM 819 ROUTE 87, BALLSTON SPA. NY 12980 618.894.2900 PHONE $18-885-8494 FAX T -415 P.003/006 F-375 'ORR Imcft wom REWRST Am ke `fo 1r - u -- -r m it IT=�li MIRA r�r • �'�iti"��� AN I •ISMAIMU QE affWj"W2L- 70W 1:39W 06-13-2005 14:21 JEREMY SPRAGUE 5084700531 TCSWLb80S 3f1° c[S AW3dW 6 a:ST 5008-60-! PAGE:3 2:39dd T£S08Zb80S 3 ouddS AW383f 6£:bT S002 -£I-90 TO P FROM O ' '7UN-13-2005 02:33PM FROW . �—�----- April 13, 2005 Mr. Michael R Humenpiller 20 S9eybem D ' Qumsbury, NY '12804 T-425 P-004/006 F-375 The Commonwealth of Massachus®tts Division of Professional Licensure 150 Fourth Avenue North, Suite 700 Nashville, TN 37249 h_a cam 8778874727 RB_ TEMPORARY PERMIT 2003 -034 -PE Afar Mr. Hutsenpi]ler, In accordance with Section a1R»e of Chapter 112, of The General Laws, you are hereby granted permission to practice PROFESSIONAL ENGINEERING in the Commonwealth of'.ftassachuserrs for a period of thirty days from. APRIL 13, 2003 or until such time as the aosrd noeds for final eetion on your application for ragia+radon in the Commonwealth of Mts'Achuaetb. The procedure for using your. NEW YORW SEAL 41. on a plan oe dommiant in Massachusetts ander this permit is to write under the seal the folhwing . TEMPORARY PERNUT 2005 -034 -PE Sincerely, Tan A. Elkins MassachuseM Cecr4nator 06-13-2005 14:21 JEREMY SPRAGUE 5084780531 PAGE:4 £:39bd j£S08Lb80S 3mudds AW3d3r 0b:tT S002 -ET -90 w Location al ,0 LAj No. 7" Date X, A7 • F TOWN OF NORTH ANDOVER fo a Certificate of Occupancy $ � Building/Frame /Frame Permit Fee $ s�►CHuso 9 C[S'�Tundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # L '4 (P qr5,-- 18279 Mi Ce,,— Building Inspector 1.1 Property Addtecc: ` - s.racir r rt e x w" rN _t C+iG.1tYfl.ClFau Pli€U'YciE'.L{SA TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APP11CATION TO (- )NSTRIJC'r REPAIR, RENOVATE. OR DEMOLISH A ONE OR TWO FAMILI' DWEL .INN Map :dumber 'um _ BUILDING PERMIT NUMBER: DATE ISSUED: 1.4 PropartyDimcnsions: SIGNATURE: Building Commissioner pector of Buildings Date IAV L�TtA11 • FTT!! T1TTAnli Trr�• 1.1 Property Addtecc: ` - s.racir r rt e x w" rN _t C+iG.1tYfl.ClFau Pli€U'YciE'.L{SA 1.2 Assessors Map and Pard Number: �!. Map :dumber 'um Parcx] 1.3 Zotift.1hfcmttatirm: 1.4 PropartyDimcnsions: Lonin L)istrid Prapasod Use 1 at Ares st1 t3 ' Frrxrta a fIl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard € Required Provide Rcquircd Provided Regidred . Provided l I.7Watcr Smpph"M.C.L.CA). -M) I.S, FkodZone hrvmctiom; 1"8 Sewerage r'kxpoxai Syxtemr ; 0 Private ❑ Zuno 0wsidc,F1W Zoe: bfuai:Pai U ('m Site t)ispnr.�I SyGtem rI 4iGA..fi I 2.1 C)wner cif Record 13 M z 0 3 Nh' le -k' }1 /tea�_. �_ Namc (print) Addresa Cor Scryice'R S C 'Z- ,LUQ- l0L�2 q-) �- _Lri / _ c- I (-) C., 2.2 Owner Name Print -- Address for .Scr,6cc: 3.1 Licxnsed Construction Supervisor: Licensed Congtruction Sup-rvisur: Addreo Sisnatum Telephone � - --- 0 z rn Not Applicable 0 �! Lioettac Number 0 1 3.2 Rogistcrcd Noma Impmvemcnt Contnnrtor _ Not Applicable U 3 oVA k) S tat �._. BC. fl en /euet-4.. S(,r.r.. m4'.,t)o �� Cum ny Name — I/-*� �iVti _071y1� L�}uc�c3Ak��h� Lv Registration Number �+.. Ad,,2S -e' Fxrnratior, ate 5iscnanuc_ 1"e:enhone �!. 3 Nh' le -k' }1 /tea�_. �_ Namc (print) Addresa Cor Scryice'R S C 'Z- ,LUQ- l0L�2 q-) �- _Lri / _ c- I (-) C., 2.2 Owner Name Print -- Address for .Scr,6cc: 3.1 Licxnsed Construction Supervisor: Licensed Congtruction Sup-rvisur: Addreo Sisnatum Telephone � - --- 0 z rn Not Applicable 0 �! Lioettac Number 0 1 3.2 Rogistcrcd Noma Impmvemcnt Contnnrtor _ Not Applicable U 3 oVA k) S tat �._. BC. fl en /euet-4.. S(,r.r.. m4'.,t)o �� Cum ny Name — I/-*� �iVti _071y1� L�}uc�c3Ak��h� Lv Registration Number �+.. Ad,,2S -e' Fxrnratior, ate 5iscnanuc_ 1"e:enhone p 'r- r- .' %J C - SECTION 4 - WORKERS COMPENSATION (M.G. L C 152 § 2506) Wc`rkCTS COMPenSdtiOlft Insurance aftdrivit must be completed and submitted with this application, Failure To_provide this nflidavit will Tresult in the denial of the issuance of the buil in permit. _§jjQ_red Affi"vit A=ehod Yes No ....... 0 SECTION 5 n~'VInHAh of D.,.- A IV b /- New CM qtrUction 0 Existing Building 0 Repair(s) I I Addition )0 Accesmory DIdg. IF— Demolition n Other n specify Brief ascription of Proposed Work: A C 1-4 SECTION 6 - ESTIMATED C0NSrRUC'j'j()N CovTs Item Estimated Cost (Dollar) to Ime OPFICIAL TME ONLY Com olated by pgmit npplicmt 1. Building (tt) Building Pcrrrdt Fee Multiplier 2 (b) Estirnatui Total Cost of Construction 3 Plurn'Dipl Budding Permit fee (z) m (b) 4 Mlechanical (IJAIAQ, Clieck Number -10 p 11 AAK' rel OWNERS AGENT OR �NTRAC�TORAP�PLIES P RUIL as Omiei-/Aur horized Agent of'subject propyzrty Ilercbv authorizv. Se -e- to act on My NIIaIjfl in iiII 1111111�I TelftfiVe to WUrj, authorized by this building p!mIlit upplication. Si nature of .),,vncr Date SECTION 7b OWNERIAU,rHORIZED AGENT OU'LARATION as 0v,.merC.th.L7-_ed Ager of subject property 1 leyttl)v ciecl.lrc rllftt IJIL -MATe'lleflTS and inli)nniition on the Ibregoing applivation tire. tr and belief tic nand-Clarldc, to the taxi ofiny knowbudge Print Name SigrlittweofC)unaer rat Date 'T SPAN L5 - DIMENSIONS OF SILLS DMENSIONIS OFPMN'S I)jMI;N',',]C)NS OF 01IMERS t 11: 1 (- I IT 01� FOUNDATION SLZY 01" FOOTING MATF.RJAT, OF CJ IIMNI-,)' IS BUILDING ON' SOLID OR Fa�LLD LAND TS 1'31JILDLNG CONNI'CIT'D -10 NATURAL GAS LINK. (7,71- ` , 17/'- M_ /a ac/ 1Pp/o Ste" FORM U - LOT RELEASE FORM / INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTIO APPLICANT S J LOCATION: Assessors Map Number PARCEL a to SUBDIVISIONPARCEL (S) — STREET_ D f c L/rhy p ST. NUMB ER_ZJ2 OFFICIAL USE ONL R i F TOVVJ 1, NTS: ------------- CONSERVATION ADMINISTRATOR DATE APPROVED - DATE REJECTED • v TOWN PLANNER DATE APPROVED DATE REJECTED r COMMENTS :F;O;O:D: TOR-H DATE APPROVED DATE REJECTED TIC INSPECT R T DATE APPROVED11117 DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE R*vWW W Jm 0 r `�� This plan was not prepared from an Instrument survey. Offsets and .distances shown 'should not be used to establish property lines.. .This plan is Intended for mortgago.purposcs o nly. I certify that the structureshown on this Pian - WAS In conformance with the zoning selbacks in effect at the time of construction. I certify that the parcel shown is L►OT located within a flood hazard area as depicted on FEMA Flood Insurance Rate Maps for b � 11�r� ,a t.7�w �,,�cJ C�Cc)L t� •T- -e PAUL <� poStMONE HI, •A No. 309&& a. j}r I MORTGAGE LOAN INSPECTION LOCATION: IE2 21 -YUP! NCETH AL E. SCALE: 1 - ltd DATE. REGISTRY:- NO. TITLE REFERENCE: K: IEnf�??�--- PLAN REFERENCE: F COREY & DONAHUE. INC. Entlneerz & SurycYcr$ Ing C'�mbridtCt Rnad, «'nh�zrn.1�A R160i w O O FM4 01 c o _cp c � o a O ` a C 1w 'ate CL c W O � O C t g A o 0 ao. EQ C gym.. O yyO. V �mm 0 d E� o m a w u4 Uw" c CL _+ h W 0m 3 G c■ -o CL c cn cn w O O FM4 01 CCM C O■� CACa O m m HZ LPL- NOW3 .0 O ® IS O O O d IE CMa O � c cc M C Z G) 0 CL O C C_ c E y Q c o _cp c � O C � m O ` C N O_ C 1w 'ate CL c W O � O C t g o 0 ao. EQ C gym.. O yyO. V �mm 0 d E� o m y r c CL _+ h W 0m 3 G CCM C O■� CACa O m m HZ LPL- NOW3 .0 O ® IS O O O d IE CMa O � c cc M C Z G) 0 CL O C C_ c E y Q _cp c � o c � � m W.0 • m ao. �mm C=D Oa ac� 0 � Z � o c■ -o CL LD Q t = H Go m CL o 4- id E a IC OLij CL a c.0 1 C* 32 �a am CCM C O■� CACa O m m HZ LPL- NOW3 .0 O ® IS O O O d IE CMa O � c cc M C Z G) 0 CL O C C_ c E y Q • ;r-';:"' ' '` BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 074251 Blrth`date 03/091.1963 Expires 03/09/2007 Tr. no: 8556.0 Restricted 00 JOHN K ESLER 78 TURNPIKE RD WESTBORO, MA 01581._. Commissioner �� ane t7�O rs7/Yi'Lt%Y�.GU. iidLU� G�..��GC.:c12tI/rP�d -- Board of Bu'ild'ing Regulations and Standards �7 HOME IMPROVEMENT CONTRACTOR � =1 RegistFati n: 138971 Exp irati o:n;-.:6/2/2005 Type Rrivate Corporation PATIO ROOMS OF. A.MERICA:_`, ,,-H,'N -SL-F_R - _ - 78 TURNPIKE RD. +IES i BOROUGH, MA 01581 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature rvlG-- - Yl/1/Y'1 20'-1" `. 27'-6' - ill -Ill n(D PEOP05FP NEW DECK (12'X98' APPVOX) 1.2X8 Pf I` ME @ 16" O.C. 2. I EDGED 6atP I/ 2"X5" I,A65 29" O.C. 5. J015f HANGEPS @ POTH END5 9. WI, SIDE J0155 5.2X8 PT TPIPLE LtAM 6. (8) 2-3/ 8V - 98" DEEP TECHNO PO5T5 - MODEI. P2 7.6X6 PO5T5 8, 51AIP5 9.3/ 9" % PLY OVMAY POP DOOM AITA 10. 5/ 4",X 6" PT DECKING ON OPEN DECK & 5TAIP5 SCHN0 P05f5 - F2 MAXIMUM COMPI;E5510N LOA17: 9600 05, Please refer to attached page5 for additional Info i Project: 5cale:l/8"=I' 0" Drawinq; Betterl ivi ng KIM I?�51n�NC� SUNROOMS 182 OI,YMPIC I,ANE A- 1 Action Blvd. Londonderry NH 03053 NOKTN ANDOVE<?, MA 01895 Phone (603) 537 9256 Fax (603) 537 9256 Date: 5/ 23/ 05 Sheet I of 2 J EO PPUF05Fn 3 5FA50H POFCH 12' X20' C APPVOX> A FFAM� 5TU SII �P5 + H p00r 5Y51FM C10'SHAN> 5fAIR &RAIL 36" NIGH RAJL II" TREAD 9-3/ 9" RIS 9" 6A11,15TER SPACE Project: el terlivin KIM pMN�51P 9 SU nB ROOMS ANE 182 OLYMPIC L 1 Action Blvd., Londonderry NH 03053 NORTH ANDOVER, MA 01895 Phone (603) 537 9256 Fax (603) 537 9258 5cale:I/8"=1'-0" 1Prawinq: A-2 5/ 25/ 05 -- — — 15heet 2 of 2 EO PPUF05Fn 3 5FA50H POFCH 12' X20' C APPVOX> A FFAM� 5TU SII �P5 + H p00r 5Y51FM C10'SHAN> 5fAIR &RAIL 36" NIGH RAJL II" TREAD 9-3/ 9" RIS 9" 6A11,15TER SPACE Project: el terlivin KIM pMN�51P 9 SU nB ROOMS ANE 182 OLYMPIC L 1 Action Blvd., Londonderry NH 03053 NORTH ANDOVER, MA 01895 Phone (603) 537 9256 Fax (603) 537 9258 5cale:I/8"=1'-0" 1Prawinq: A-2 5/ 25/ 05 -- — — 15heet 2 of 2 te6no METAL POSE' r DETERMINING TECHNO ,METAL POSTS :MODEL Na dart Type of work Maximum I Compression load (Lb) P1 Light residential (patio, verandas, steps, porch, etc.) 6800 (I 7!8 r} y �? Viedium residential (car port. solaritim. addition of] door, etc) � 9600 P i Heavy residential -- light commercial and industrial (cottage, 23000 1 Qj1i) mobile home. addition 2 floors, support teams, equipment shelter, etc.} P4 Very heavy work, these projects represent medium commercial 29000 (� } and industrial undertakings (bean support, etc.} Note : - For more information contact the engineer of Techno Metal Post Inc. - The maximum compressive charge include a security factor superior or equal to 2. z 0 P'- C3 LL (� z 0 J J o q J J L.3' D f1: UJ t� IM 0 J z z ER O W . Z uj2 0 w � a C'T q q cD cv CD o3 CO q c0 w ttT (D g q q cD w q cD p� cD t0 q tD cD eo q co aT co oo cD co cD q cQ co c0 co ev g r- q ti q � q n. CO ti w g r ti � m q r•- U9 n q g !-- � 0 0 ;•.. t` w r` m t~ c. q q r Co r• co t• CA ze 0 as cD 0�0 CJ1 c0 O q CT cD 0 0 m cD .O ce m ;D rn rn q tO 0 � IIf cO tD � � q to QF 0 rn (o rn CY3 T to tT to CT q N o o o (O 0 O o (0 O t0 O p 1 I l C1 N N N tf N at N tN N N IN N N N N N N N d N N d N N e! N d N rt N N ah N ST N P cD cD CD cD q q CO c0 fdT c0 cD cD CO tD q tD td t(T cD q e i } i 0 i C) (Pm I ! II w 1. rn I .,«�.�'.1 cn � m cn t{ `�` I `�' (Dim 0) N 0) N os N � t N a, N m C14 ar � N I T- ICT U') i 0 0 I to 0 In ICT 0 O U) { U3 to kn Ln @o FSP q M Q t[) O tE2 O q O tC3 q en LO O q La'T C� ifT to Ei) Q te5 d C7 tt? FC2 Cs lC'T O iCT q tCT to c6gi �. ^ 3 v� 7 � ep 0 to � d C f ui O LST CO Ci) 00 in CZ d.'? CYC 0 OD C^ FC) � G.i q it) . OD W) C D 0 co Loi ! gry � co f � co €�'i cot � 0 1 0 � � f AM 0 � CCF 162 UJ q N) CO ! 0 N> � M m `.M m ! � � C-1 cls � m � cam; �J M � 111 � n : o� €=3 co # :G ; min n co Q? q co 1-9 � M � M ah d i Go in st 00 co co M CD co o co co co NJ c` T O NOT cOYT c(n m M M tOT COT (O tO7 Cat c7 tO"T 0co m N v 'C' v cv d et p N et et t v et CN N N N N N N N " N N N N N N N N fl1 N N N N N N N N N N N N N N N N N N N N N N N N I N N N 1 ® O IFT rn tt aT rn d 02 v a) t7 aj a) st+ et a) et 1i v a) a aT I csT et rn at M �Y tt et cs v rn et a) cs ►+ [� P�- !� t` � � 1+ � P�' � ti Pr P 1• (e {�- 1+- t� st h VP w r r P Lo � cc P r Tom— r C+@ tk� r P CLQ pp N$ 0 C) O et tO C9 C? O N V C@ C^. O 40 go -e Q C LV 0. 0 = w07 1 r 1 P 1 T e r a j I T� P i� 4� � a T.. a T.. Q,.e a S"' a Cl r T" ."I C (L r e� 0- (L r" r NY O� I a N1i a CLI N (4 CLI ILI N iLl C� A I Ml iLl A A i A a. NZ a. NTLF G. CL �t (L iZ of 1 17) a1 C E '5 O 0 U � v CJ' O O Q CL 3 d 0L _O CC 'C20 W ;t O c9 y cCi 19 w Co O M L) v o 0-6 .3 Z 0 0 u. z J D V w LU z z LU 1 U 0 z Q a 0 ui z fj m fti 0 .1 Z 0 9) a 0 0 0 0 Q Q) Q tj d Q Q1:51 Q ti rN-iNJ h ti nN Z Z{+Z Z J Z Z Z Z Z Z Z t! t T -—i LO r- Lon, LO. t 1l I Qaae� �¢g¢",< i°;MM°�1 l MM MMIM Z Z Z Z Z Z Z Z Z Z Z I�'� ��p�� �� ai�ao � ��� 0 Z Z Z Z Z[ Z Z Z Z' Z Z Nf N r �f r tV Q Q �' 01 `rN �����a Q SiT lCT to tfT tf3 ��m�� ► Q3 ' OQ �% f` 1 ZZ ZQo CKS CL) tD I iCy CD 1 lfi ( tfi 453 f yr± Ln% N N lz ( l I 0 0 o I o 0 0` o 0 0 0 0 i I ► � r � � r � r- � r- � r � T �l I d r e-- va �- P r T r- 0 0 0 C O O Q O Q O O o Q Q Q Z Z Z Z Z c�a cYy rT e! t� c7 cn cis f m y, i Oa Os Cr a A) vt 4'i ci t� c f CA Q G's Q �I 0 I I 1 f I f �o"} �r1"ti ti � � °` ` E` ► r- r. � � � ;. rte. IIe �, �. � oIkl i E,►I III ���i� IO �' 01 `rN tJ3 r , Cn Cl CST N N m N U) I Q3 ' �% ,p fc CD CO cfl «a Q CL) tD I CD cD N Nd N N N N O to CSS CL H m 0) cu O mm u�� vtt ^� v v v "Ir °' °' �t et st to - c a f w -00 v 0 v o In v Cl) e7 b ri :t t°3 c•S r3 .11 c9 r> cr NC7i N cs N t33 N a N ct tT �tti+ aT rn rn O v aT @T v gs frt v� N N N C.f N N N CA N tD N [3)CDN Ny'OM0 HmcmNjlm) Ct� Q1 Cn CST O) CA Yi Cn CisChCCzm c+ OT OS C1 4T2 CT 39 m Q9lQIT !^ IT V- NI C r r fp Vj @ .O m ° 3 :A! eib r� r r CO CD towAt v- r t OC7f Ul OGS N W r P L O -. 0 x i3 G a v to C7 t7 0 o H 0 E rn U 4= G to Cfd! w v t0 Og r �- r r r r q. r ltd C9 Cp V^ c°' L C ts. LY !t€ N Q N CL N !�. N CL N CL HS "0I. M M 1^S M !�1 " c P e ea. C1 G. CL tL f i fa C! 6. LL 0 C Z .O 4"J. April 13, 2005 Mr. Michael R. Hursenviller 20 Baybem Drive Queensbury, NY 1.2804 The Commonwealth of Massachusetts Division of Professional Licensure 150 'Fourth Avenue North; Suite 700 Nashville, TN 37219 877-•887-9727 RE: 'rF MPOR.kRY PERN[IT 2005 -034 -PE DE:ar -Mr. Hutsenpiller, In accordance with. Seci on 81R -e of Chapter 112, of the General L,nus, you circ hereby ant -ed permission to pracdcQ PRGPES5IONAL ENGINEERING in the Commonwealth of N4assacl-u8ctrs os, a period o:- *-tirty days from: APRIL, 1.3, 2005 or until such time as the Board needs for fim: action on 'Your application for reo stranon in the Commomvcajtb of Massaclhuser-:_ The procedure For using :our: NEW YORK SEAL, on a plan or document in Massachusetts under this, permit is to vlrilte under the seal the following: TEtiiPORARY PERtiiIT -NLS SS,ACHUSF,'ITS 2005 -034 -PE Sincerely, Tara. D. Elkins Massachusetts Coordinator V 6% C71 � U1 N OZ>M> ,omx2 DD 0>SO"CD mZQZ>XOMom7mmpzzm�mp ZaZD�O ON -i 7,a>NC>mrnO>ZOjO��(ri �mN> 'n n - K �74AQDp79mC9 ZZ OOprC9 ��(!)>z O Om1�1T>AM oo��omGl�oD.�-O=�=ma r N Z Tp ZOC�rnzT.O� mO � > �ym0 v:z<a7a_Dprnum Z- (n D �o�OZ.z�m-<K:CI =(J) zmCila NZD��r mZvNZODC> Q< �CZpp��4 �(�, �. 7130 m Tim ���G ZZz-M >> m7Qac >(Zzr Z�DOzc mm Z p1=Z COrCS1N> OOm (n n r4 Z T��0-',r��c' 0m-zimp� D�� O ZZO �mml� M 'Q z Qom C: (r Q N Z (N '0 r N Z (}� n m Gl" 7Da T 70a m a T mD m. �NNo 7Q G; D _ _ a C31 (77 N Q m G; D r DO'V N O TOZy aO7 () Vic{ 11 II Oc �ZO����DZ� m 7Q O�601a-Q)>vlmcDmzz�tA.{ ,tNDD Omc>Z>nz 76. 0M QD10NmOC)>71 M0J'-D O>C OQ - �Dm7°>r71O��L n�� ,z o(D0--ATDA-imO rQ- r x mDo mOz ��O Z m T T O Z m- 713 N N Cfl m 73 7° m 70 713 Cm'1 6 �' z D Q m Z C m7a 5D �� >zmMmm mei (7) Z� C 1>ZQ A Z m 76p O711 mFSI r>- Z O- Z� Z� mzxuzo0 Z2 m-, i 71 Z T 713 (7) K: pOZ 7zQ7,10 m ZOp .-�>�Z �7aZ�1-c Om Z =N Om cn '�>a G;TO�OC1 p m (D71 70r =rnO(D zD73 N U1> DK m00 K m (S) r O O D p r D c > m-{mmZ m X m 76 G()QmO t�11T T m 7a m A>(Z)( mm z m� �I��'�"� D Tr m 713 K(rj) 'W > crN N Uj Q � > O r > O mm Q 7q I� Q a m a o rn � ;� =rr1=ggcaD COMM' + '3 if II IIII11 Z) 713Q rmE7130ZZIO .o00,. RSrz�071 Nm ���p��C O FO D y',I -,3Q :� CP M = _ � 7a C r 2 ,76Z�r Z O 971Om> <l7Q 713 rnZZ D D p Z r m mN w Rt Z Cm N N I II �Q-Nz cQ3 -n TO 6l O 73T 03 Q3 aOO-1NQ L XMC OOO II II II 71 K: L II NI:()Z tl Ic,aml�1777n X ITz Zp OZz,ZT cn>>D�-Q 79 D_i a� > $zmD () r G�SJ. rn Z1 z ZX -nc Np > N OT p O � O 70 O 713 z - S VA 101^O 2 3 r NW V ' > �_� Z z D D Sul MM� 73 z.Z m Y °r9 cs 17, 713 2 m 7713 a I -r[ S VA W0 WM 06'9 M19 M.9 d IOIOOI IIYM-� -st 0' T � 101^O 2 Oi 0.59 z D c_. n m z.Z N a W0 WM 17, W0 WM 06'9 M19 M.9 d IOIOOI IIYM-� -st 0' T � O(f) 2 Oi r z D c_. n m z.Z N a m 17, 713 2 m OQ a N O D O z Y 77 O D T n I Z I N C) a m a m D D m �(> D T r fflJ�� ZU3 M mm N Y r rn a � r J to 4 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property here y au ize`Betterliving Patio Rooms (d.b.a. — Patio Rooms of America) to act on my behalf, in all matters relative to work authorized by this building permit application for (address of job) , f, i I ` / A 2 Sig ture of wner Date Owner or Builder (as Agent of Owner) Must Complete and Sign This Section I, Jb kt-.� IC as Owne thori�s AQ ereby declare that the statements and information on the foregoing application for (address of job) lf,� l r . are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent 4�V/ U d� Date LR L;, 'S -pTov "I ses anAl 4-f ..ons 4-1 s tla�t i ou zCie 'IvUst add-tioTis ;77-trt - I I -. . I - , — 1. 1. ! - 1. Tl� % TORMA_U tn. a. -'s to b-_ e'._"' i as, par- 'Dunar ut lize F. encl s-unr=n7' aoldit"Ons 0 _rl, e>� Ist'l, oue (7 8 0 Cl Option I o r - _;MCC ~Gail a glazing but is omiy Cti-a'--tivon C-1 D_ L uj��, 119 Ulr 10;- sunz,00'17, of, aril, Con at, Il, Co-s'-n7ar-tion. Z�Llc! Year- a-,�var-_ 0, 1 S 0:7 'D Z I m�t-RIG-to "o assist C. a:,- ee� iin zmd utilizi:ng a a n. ad f� trgN 0,; 3-ul-l-Ooln" nna�, .4--a .7• cil Tat icatio- -,-Mn "n IS ,Mt larboll o u norn o 1 ;7. on E 's t !o UL- -a 7r 7' L T�e no, _ai ��zlergy com5,4n. _LI a_.x6/cf -Jscom CL Lt M Di LitZ C 7 jT v a"N ti� la -d Frar;..e lZiat, nn Fn, S b 1 e, 3 Tj, r, ca o :n's o 2- li'";.' Z e _.____4...__.. ..DO -L C." S.K.5cl, pU. 7, r4 7 1--- ff, Cr I., ZO:7.;";-,Z a-D.H Ti V v ,,..Yt_ o t r! -S nr lrtT'3 COT I_nsuaa inct Si a BIZ"611:.cr .Pt=_ ft `Cr a that n., d .2 S Sun7oczu 3 G 7. LIF 0 s ex'stin- resid--ntial Ul D bii,ucinz. In accordance w:,wh th!� undt-signtd y ackmo-,�vll,=dgef; t.hal shvle has rtad forr at, 171 1 n, i S Go cunmen� conc��:, 1 -ng sun-raonn 'c�or_ tneT'— f- - 1 i7l fg,-, z -0 P o F. ui) d in.z 0-,;rn el C) h ry i C Lily G cl) S_1 dR_ L4 _I f f� '- -71 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S.1 50 A. The debris will be disposed of in: (Location of Signa t re of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: C - City /V Vet -4x JCS /k"- Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: LS Lam- tV I1--� Addressv City %Jl.s f�U i•� [� = ytr( �, Phone* (,U 3 S 3 % 2 1N— Company name: Address City: Phone # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as _w aU.as.civil,penalties in 1be fmn d.a.STOP WORK ORDER..and..a .fine of.(.$100.00)a .m jday againste. 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 i and penafies of edury that the information provided above is true and correct. Date S ` S - Print name b Ar, -3 1 L%c 1 m Phone # 0, Official use only do not write in this area to be completed by city or town officier City or Town Permit/Licensi 11 Building Dept []Check if immediate response is required I] licensing Board E] Selectman's Office Contact person: Phone #. 0 Health Department O Other MAY -09-2005 02:18 PM BETTERLIVING 1 508 875 5756 P.01 F„w% IrE%srn II G vt- 61AMIL..1 I T INUU"NGE: DA (mmmorm Paonu a E.RTI IC A AMA ER O /0 05 Joseph MaKeone aNi.Y AND CONFEII,E NO Iafl{74Iri UPON THE QARTINIt;.A� JP P.C.oxMaKeons Insurance Agincy, Inc. ALTER THE COVEERAAGE AFFORRDEO BY THMGM. POLICIES SaL W , Box 333 ArIn Arbor MI 0106-0333 INSUREIiB•AFFORDING COVERAGE INSURED Pabo ROOMS of Now Haslmpshlre INGURIN A: 5ettedMimig Bun Rooms of New MURER E; - - - 1 Adan 13Ivd Units 6010, INR WRR:R 0; -- — I-ondonbarry, NH 03053 INSURERD: TME POLICIES OF INSURANCE LISTED BELCIW WAVE BEEN I ANY RKUIREMENT, TERM OR CONDrTION OF ANY GONT MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICI POLICIES. A0001SGATE LIMITS SHOWN MAY HAVE BEEN RI 6A_RA911 LIABILITY ANY AU'Na Oman UMIL7TY ] OCCUR CLAIMS MADE OI<OUOTIma RETNNTIOV >) �R� cwaRiUM noNAND TY 35 WEG W7597 v I n C l NOUKLU M-%m1au ABOVE FOR THE p R OTHER DOCUMENT WITH RESPECT TO 1 ABED HEREIN IS SUBJECT TO ALL THE TE BY PAID CLAIMS, 02/01/2005 ► 02/01/2006 02/0112006 02/0112008 02/01/2005 102/0112006 )LILY PERIOD INDICATED. NOTW 7HSTAN DING TVMtt OK INlTURANC! POLICY NUI A ftmi L WL"Y " 35 8BW KZ7087 FIRE DALdA4Q tA•ry OII� SI.) X COMMEFC ALORNERAL LIA111LrTV MHD_EKP (Am on�p�I�an) ! 10 000 _ CLAIMC MADE OCCUR ---- !2,000,000 O�NlRALApOp�aATE GEM'4AOUREGATE LIMIt APPLIES PUR; , ! ,•�• • Z,000•000 • POLICY PRO' agaT F7 !OC IIN� INGLE LIMIT s��dlvv T ��=438 A AIr010109ILELIAOILRT 35 UEG UH3910 (PQ PSEon) ANYAUTO Y ALL OWNED AUTO! PROP 3AMAa6 X ICNGDULeDAUTO! AUTO ONLY - EAACCIDENT R HIREC AUTOO 0 AUTO ONLY: ApQ NON47MV AUTO$ RAOH OOpuRRa<NCe 6A_RA911 LIABILITY ANY AU'Na Oman UMIL7TY ] OCCUR CLAIMS MADE OI<OUOTIma RETNNTIOV >) �R� cwaRiUM noNAND TY 35 WEG W7597 v I n C l NOUKLU M-%m1au ABOVE FOR THE p R OTHER DOCUMENT WITH RESPECT TO 1 ABED HEREIN IS SUBJECT TO ALL THE TE BY PAID CLAIMS, 02/01/2005 ► 02/01/2006 02/0112006 02/0112008 02/01/2005 102/0112006 )LILY PERIOD INDICATED. NOTW 7HSTAN DING MICH THIS CERTIFICATE MAY SE ISSUED OR tMS, EXCLUSIONS AND CONDITIONS OF SUCH LlMrtrs '— EACH O=OARBNCP- = 2 OOOIOgO FIRE DALdA4Q tA•ry OII� SI.) R _-_ ,_ _ S� MHD_EKP (Am on�p�I�an) ! 10 000 PERRONAL i ADV INJURY !2,000,000 O�NlRALApOp�aATE �_ PRODUCT• ooMPpPAos ! ,•�• • Z,000•000 IIN� INGLE LIMIT s��dlvv T ��=438 ' 090 ,1000 lbDILY INJURY (PQ PSEon) Y (II0�IUYjN� PROP 3AMAa6 AUTO ONLY - EAACCIDENT R OTHER AN bAACC 0 AUTO ONLY: ApQ - `' RAOH OOpuRRa<NCe � AGOMUT1 ! a Y LIMITS t* _^ t tno a i 100,001) E.L. CACH A0010INT C,L. 131994S • to EMPLOYE 6.L. D14RASE • POLICY LDAr 8 tiO� R)MOULC ANY RIM TNI AROM; DENCRIElD POLICM-0 DROANOELLCC #Warad TRE UPIRAnON Insured Copy PATS TNMMOP, TNR ISSUING MEURER WILL RNMVOR TO MAIL �,O_ DAYD Witi Tex NOTIOR TO TNN CEATIMAT! MOLDER NAMED TD TM LEFT, ELM PryWIVI TO DO RIO SMALL IMPOSE NO O$NOATION OR UAlNLITY OF ANT KIND UI ON'TNb INURNR, ITIS Aolm'ra aft �' TOTS 299 irEG sLII#&LlO*XOw#dr SO=ET 5002 60 kew i ADDITION / CHANGE TOrim Home Improvement Contractor Reg. Home Improvement Contract No. 138971, expires 06/02/05 SUNROOMS Eastern Massachusetts Office: Patio Rooms of America, Inc. - 78 Turnpike Rd - Westborough, MA 01581- Phone: (508) 870-1900 - Fax: (508) 870-5757 Western Massachusetts Office: Patio Rooms of Springfield, Inc. - 317 Meadow Street - Chicopee, MA 01013 - Phone: (413) 420-0140 - Fax: (413) 420-0147 New Hampshire Office: New Hampshire Patio Rooms, Inc. - I Action Blvd. - Londonderry, NH 03053 - Phone: (603) 537-9256 - Fax: (603) 537-9258 _ estate NY Office: Patio Rooms of Albany, Inc. - 70 Cohoes Avenue - Island Park • Green Island, NY 12183 - Phone: (518) 687-23379 Fax: (518) 687-2338 Sa"8 4,op 4,oco Original Contract Date: q- Addition/Change Date: L4 — 2_ 8 " 0-5 ^5 '*"' fl' �' '+'�+�' #x'i. P�, SA Ratr�ur.kv R�2 i yam, ,.�:r55. Tal" nr tft i � .s, p"yfi `�`i` R , �" Mri:) F tSL��t 1. i ,.J : '�Et �b'.. •w mx• .. ✓ad4 Owner's Name(s): '�; - J• ' Street Address: g a ; C._ City/Town: v C r -State: rAPr Zip: Home Phone: q�g— g Daytime Phone: E -Mail Address: Job Site Address (if different) Details of additional work or change in scope of work: " yn �- 06 V%-' �c (��' V--� CA n e 'e- I e) IS /I )atl -/0 n r 6 e- a "--2 e I 1 /1 a J V iII Aluminum Patio Room Home Improvement Contractor Reg. •Home Improvement Contract No. 138971, expires 06/02/05 SUNROOMS Eastern Massachusetts Office: Patio Rooms of America, Inc. - 78 Turnpike Rd - Westborough, MA 01581 - Phone: (508) 870-1900 - Fax: (508) 870-5757 Western Massachusetts Office: Patio Rooms of Springfield, Inc. - 317 Meadow Street - Chicopee, MA 01013 - Phone: (413) 420-0140 - Fax: (413) 420-0147 New Hampshire Office: New Hampshire Patio Rooms, Inc. - 1 Action Blvd. - Londonderry, NH 03053 - Phone: (603) 537-9256 - Fax: (603) 537-9258 Upstate NY Office: Patio Rooms of Albany, Inc. - 70 Cohoes Avenue - Island Park - Green Island, NY 12183 - Phone: (518) 687-2337 - Fax: 518) 687-2338 Contract Date: -7-2,, -d) Product Manager: Sc_e� ,' («Owner") Anor, do .K . ,�:Y9Ai.'����em:r rt,5,�Yi4 xfi uK.+, Street Address: ; �- �1� City/Town:V t ( State: CI1 Zip: �-�� Daytime Phone: .— E -Mail Address: Job Site Address (if different) Materials to be provided and work to be performed by Betterlivin Sun Rooms ("Contractor"): One unheated Betterliving® Sun Room: Color: .❑ White ❑ Sand ❑ Brown Style: ❑ Studio "A" Frame ❑ Fill -In Size to be approximately: 17— x I/ S x , e `z_ All glass to be: SINGLE PANE ❑ Double Pane Insulated A -Wall: ❑ Tempered Door(s) & Screen(s) ATempered Window(s) & Screen(s) Transom: apid ❑ Betterview Kneewall: / 18" ❑Other olid []Glass B -Wall: ❑ Tempered Door(s) & Screen(s) Tempered Window(s) & Screen(s) Transom:apid El Betterview Kneewall:18" El Other ,Solid ❑Glass Gable Glass: ull Glass w/transoms on A&C ❑ Glass ►w/6" fill block on ends to C-Wall:Tempered Door(s) & Screen(s) Tempered Window(s) &98" een(s) Transom: `Rapid ❑ Betterview Kneewall:❑Other Xsolid ❑Glass CUSTOM Wall: (if applicable — give details): Roof: oam Built-in Gutter System hermal "H" Color: ' White/White ❑ Sand/Sand Room to be built on: ❑ Owner's existing deck if properly footed and up to code - Contractor to add sub -floor and upgrades needed to meet code. NOTE: By doing upgrades Contractor will warranty owner's existing deck for l year Room to be built on: AFoundation built by Contractor (includes sub -floor) Steps to grade off ° wall(s) C1�- Additional Deck/Additional Work (dormers, open deck description, etc.): e 71% i i .n . n 41 !'� Town. of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street Noah Andover, Massachusetts 01845 Sandra Starr Health Director May 8, 2003 Yangkil Kim 182 Olympic Lane North Andover, MA 01845 Re: Application for an addition to an existing home at 182 Olympic Lane Dear Yankil: Telephone (978) 688-9540 Fax (978) 688-9542 Your application for an addition at 182 Olympic Lane has been reviewed by the Health Department and denied for the following reasons: 1. ✓ Missing information 2. ✓ Passing Title 5 inspection of septic system may be required 3. ✓ Location of structure not acceptable To address the problem(s): If #1 is checked, please supply the bolded items: a. Floor plan of the existing dwelling (all floors) and a floor plan depicting the Moposgd addition. All rooms must be accurately named; b. Certified plot plan showing house, septic system and proposed project in scale, including any associate grading. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If #3 is checked: A. The proposed the project must meet all current Title 5 setbacks. The addition in the front of the house may meet these setbacks but a more accurate plan is needed to determine this. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sin rely, a., Tian J. LaGrasse, Healtb Inspector Cc: Building Department File BOARD OF APPEALS 688.9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688.9535 � I -------- -.�- _._... I { rt I 1 I _ ------ r i Is t i 1t I Wf q I � r I i �lelr i T I I I I {- I a I I 1 I ♦ � ! I ' r ' rt I r I � }I I ` ; -�--�-�--�� -�- �--•--j�/,`® -� :--; - ` -,-syr-�,r���-_. �..�_.� i 3 I I I I I I f I I t F I— I _�.._T. i I r 4 I f I I , t .I , J 1'Z2flle 45/16 `--11 511e0 t .. ,F 'n 4*2 5/e 2'9 --``41196 co , + rn s. 'P�.,ti�ny`4y��1 i S . / f7f .i'i \ . I / • �'� .. . y, '. i "' F ie Z , .r .r•suur,.o r✓uY. . i 266e I ...... p� n 0 Solo 3088. M , • 11'10 5/!}— -- t t 10511 8' 1I � i Z .qm r x T. �. i; asz� 0 1 I55 ai 2ow l� J .4..aparun&u of .rim BOARD OF FIRE PREVENTIO1 APPLICATION FOR PERM ( 1 All work to he perfornic�i in accontanc w �J (PLEASE PRINT IN INK OR 7YPG ALL INF' City or Town of: By this application the widersi Location (St Setif 1Vuurbcr) Owner or Tenant --....5 Owner's Address 1 S?• Is this permit in conjunction with a REGULATIONS Occupancy and Fee Checked 4 Rev.11/991 (Icave biank) f TOP ELECTRICAL WOR471—K ith the Massachusetts Muctrical Code (htEC), 527 CMR 12.00 f,lTION) Dafe: U lao1k:� 5 To the Inspector of Wires: or her intentio11 to perform the electrical work described below. IL permit? Yes & No ❑ Telephone No. $ CoqI S 1 R r - (Check f1}iNr'opristc b�z�d, Purpose of Building Utility Authori7at}ou No. Existing Service Amps / Polls Overhead ❑ Undgrt! ❑ No. of Meters. New Service Amps / Volts Overhear! ❑ No. of Undgrd ❑ . e Meters• Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: E re No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) El Mir rvfV to Fails 101101601 table NO.0 na be,�airedby the ins talon o%lwrrs. 'fransfornrs oral rc KtiA NO. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swintudng PontA ova ❑ !n• ❑ a 0 mergency Lig rung rrr@. rnd. Battery Units No. of Receptacle Outlets No. of Ort Burners FIRE ALA MS No. of Zones No. of Stitches �; No. of Gas Burners 140. o etec on as Irritiatin Devices ' No. of Ranges No. of Air Conti. otal Tons No. of Alerting Devices \o. of Waste Disposers cat unrp Number ans ____ Totals: r o. o onto nc Detection/Alertin Devices No. of Dlshivashets Space/Area Heating KNY `� �� Local ❑urrrclpa ❑Other Connection No. of Dryers Heating Appliances KWBal ecur:ty sterns: No. o ater Heaters kip � °' ° t of Na o81)eAces or Equivalent Data Wiring: 1 a Sitl»s Ballasts Na of Devices or Equivalent No. Hydroinassage BathtubsNo. of Alotors Total HP a ecommunications iring: No of Devices or E uivalent ATV Ern. Attach additional detail ofdesired, Oras required bt• the 74spector of Wires I NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless censee provides proof of liability insurance hicludirrg "completed operation" coverage or its substantial equivalent. 1i:e certifies that such co erage is in force, and has exhibited proofofsame to rite permit issuing office.K ONE: INSURANCE � BOND ❑ 017HE•R ❑ (Specify:) timmted Value of Electrical Work:•rjo , (When required by municipal policy.) (Erp'rition Date) York to S(art: �p j 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion. certifj, under tire* pains and penalties of perjury, that the Information at this applicativn is true and complete. "111At Nantir: Or ,• - LIC.No..,2P 4E NO.: a � f applicable, ender ••crenipt .. in the license number Gne.) Btu. TeL No.' foo 3-595^ to b$0 ddress:�__ �i �.� o. Sa.� `Jt�a.+� :*ca... e. \a N C Alt. Tel. Na: WNER'S INSURANCE WAIVM I am awalee that the Licensee does not have the liability insurance corcragc normally quired by las•. By my signature below, I hereby waive this requirement. I am Ute (check one) ❑ owner on•ttcr's a dent. weer/Agent isuature IT FL 'Telephone No. PL••Rt11• G: S ��° RN. Falardeau Electric 17 Blue Jay Way Litchfield, NH 03052 Phone (603) 595-6680 Ma Lic 37294E Fax (603) 882-4115 Ma Lic 912MR NH 11131M June 20, 2005 City Of North Andover Electrical Inspectors Office 27 Charles Street No. Andover, MA 01845 Dear Sir: An electrical permit is needed for the fallowing address (Yangkil, Kim, 182 Olympic Lane, No. Andover, MA). A copy of my insurance binder is on file with your office therefore I am enclosing a check for $30.00 made payable to the City of North Andover for this permit. My Electrical License Number for the Commonwealth of Massachusetts is #37294E and #912MR. Kindly mail the permit to Mark H. Falardeau, 17 Blue Jay Way, Litchfield, NH 03052. Sincerely, Mark H. Falardeau cc: BL Room 893- palw .4' SPsS RECEIVED JUN 21 2005 BUILDING DEPT. u R, w D m n D r r n m Z -4 co CO CO W A A V N W W m N `2 o < 0 -0 -4 (~ N Z 0) � r o - 0°'0D z 0 Z o I .SII �un�u Z -4 0 0 c z r o°° cCD r -r n r � rrr m �a zO a) m xz C o b 0 -< N n O u, m 11y C) 71 x > O� CD -' D z n fD N m ca O � �- N o 0 _8§ O �. 0 o D r r D m CI -+ Co SD ID 0 o to 22 3 ., o En ZOS 00 n o N m� \V m K (D 0 v w o w�D X a- IOU [ Ico ;o:a -4 N (nD� C/) N m 0-1 N N 3 -< m O_ O V V A o m 0 o d UNi V -1 (� U 0 o Z n m ,4 m� 0 u R, w D m n D r r n m Z -4 co CO CO W A A V N W W m N `2 o < 0 -0 -4 (~ N Z 0) � r o - 0°'0D z 0 Z o I .SII �un�u Z -4 0 0 c z r o°° cCD r -r n r � rrr m �a zO a) m xz C o b 0 -< N n O u, m 11y C) 71 x > O� CD -' D z n fD N m ca O � �- N o a a a O �. 0 o m -+ Co SD ID 0 o to 22 3 ., o V CD 00 n o N m� \V 01 7 K (D 0 v a a a 0 o m to o 0 N w 0. Ico -4 N 7 O_ A d 0300 w 0 w - 3 ? a0 o o �i Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director May 8, 2003 Yangkil Kim 182 Olympic Lane North Andover, MA 01845 Re: Application for an addition to an existing home at 182 Olympic Lane Dear Yankil: Telephone (978) 688-9540 Fax (978) 688-9542 Your application for an addition at 182 Olympic Lane has been reviewed by the Health Department and denied for the following reasons: 1. ✓ Missing information 2. ✓ Passing Title 5 inspection of septic system may be required 3. ✓ Location of structure not acceptable To address the problem(s): If #1 is checked, please supply the bolded items: a. Floor plan of the Ubting dwelling (all floors) and a floor plan depicting the ro osed addition. AD rooms must be accurately named; b. Certified plot plan showing house, septic system and proposed project in scale, including any associate grading. If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If #3 is checked: a. The proposed the project must meet all current Title 5 setbacks. The addition in the front of the house may meet these setbacks but a more accurate plan is needed to determine this. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, 'Brian J. LaGrasse, Health Inspector Cc: Building Department File BOARD OF APPEALS 688.9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 i F i I - ti I r I .-a • � Y � 1 _ t I t Y� x _ I .. I LA- W I ! I - I , { I , I � w I j �_.., i t 1 I 1 i I . _. -- i . I ..--X1111-- ' _' _-_ __- _• �- _,_ �_.. _ I . f T-1 - .. __.�._J.. - �...... - I i �......_.�...- -+----•fes:; I --}-� tr,� •---�- "'-�i" "``f"' _'"�" ±-�.•'"` ; : I i I I ... -_ ...- I I �.... i r ` P I 44- -7. I � - -. .. - - - -- - - - - - -- - - - ia,r -- ri'- 1 I i _ I I I .._.�__- _._1__._._.14_ ._ �.__`_I __. __ _.. _.... + ___I__�.._._.4-__ _._ a_..+ __!_..--;.---—L..___,-.—---.�- ._ _.. ��_._�..•