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Home My WebLink AboutMiscellaneous - 20 NORMAN ROAD 4/30/2018Date .. �-A l ....... TOWN OF NORTH ANDOVER -. PERMIT FOR GAS INSTALLATION This certifies that:.t9.1,,?If ....................... has permission for gas installation ..., s,,, y.f n .............. in the buildings of ... P f� f. � . � .............................. at.. .U..../Uo n d:14,...P.� . Fee.Lic. No. Check # SS /'S' 5522 .... , North Andover, Mass. /GAS INSPECTOR 1- 1 l n t Fri�T•_•:.!//iiiiiiii�iiiiiiiiiii ��T•,�..l�i�iiriiri�ii�ii�ra�e�aai rii�?•"�..�iiiiiiiri��iiiiiiii �•:•:;! w�irii+��rriiii�is�■iii c�T•_ �lii�ii�rii�i�r�o�i■��ri�t�i 1I1 �I77/_ i-it�p1rC 9lY. "IW i i I "IW i "IW Date. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. .�. �� ' �................... has permission to perform L .............................. . plumbing in the buildings of ...-.1..�........................ at ..:?.`'.. h .. !`. ` ` ." ....�.1............. .North Andover, Mass. r Fee. Lic. No.. 7 3.! ?.. ...... PLUMBING INSPECTOR Check # ' 6920 IN 0�1�3 �1_ ItrIA ibACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING (Print or Type) ass. Date 20_4L� 4�'4T a Building Lo do .Owner; me Type of Occupancy New ❑ Renovation ❑ Replacements Plans Submitted: Yes ❑ No ❑ B.P. # SEWFR * FIXTURES .stalling Company Name .. n _.el isiness Telephone ime of Licensed Plumber or Gas Fitter SEPTIC # z " z a Ln z CL 0 Ll ►�z-y a J lid ----�---.----� ®--- MMwiisiii� • M ... ' M ommmmm�i MM MM MM .stalling Company Name .. n _.el isiness Telephone ime of Licensed Plumber or Gas Fitter SEPTIC # Check one: Certificate 0 Corporation ❑ Partnership 'tT Firm/Co. have a current Ii bllity Insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142. Yes 1 No . 0 f you have checked Yes, please indicate the type of coverage by checking the appropriate box. liability Insurance policy Other type of indemnity ❑ Bond ❑ 1WNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on thls permit appllcatlon waives this requirement. ignature of Owner or Owner's Agent Check one: Owner 0 Agent ❑ reby certify that all of the details and information I have submitted (or entered) In above application are true and accurate to the best of tnowledge and that all plumbing work and Installations performed u r the permit Issued for thi a Ilcation will be In compliance with ertinent provisions of the Massachusetts State Plumbing Code and h to 42 of o G aral Law . By Title Signa re of L't' velL__� City/Town A DOD f%A ICT inn....... ..�� __._ __ Tvn. nit t. z " z a Ln z CL 0 Ll ►�z-y a J lid Check one: Certificate 0 Corporation ❑ Partnership 'tT Firm/Co. have a current Ii bllity Insurance policy or Its substantial equivalent, which meets the requirements of MGLCh. 142. Yes 1 No . 0 f you have checked Yes, please indicate the type of coverage by checking the appropriate box. liability Insurance policy Other type of indemnity ❑ Bond ❑ 1WNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 42 of the Mass. General Laws, and that my signature on thls permit appllcatlon waives this requirement. ignature of Owner or Owner's Agent Check one: Owner 0 Agent ❑ reby certify that all of the details and information I have submitted (or entered) In above application are true and accurate to the best of tnowledge and that all plumbing work and Installations performed u r the permit Issued for thi a Ilcation will be In compliance with ertinent provisions of the Massachusetts State Plumbing Code and h to 42 of o G aral Law . By Title Signa re of L't' velL__� City/Town A DOD f%A ICT inn....... ..�� __._ __ Tvn. nit t. �j E s s �-i "7j I� a 3 F NORTH TO�M OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION This certifies that .. (. ! -? !fi .1�.. f 2l? !.( r. = ........... J � has permission for gas installation ..�G'.r . X2�:. �.-- ...:... . in the buildings of .. 17 — r ° at ...� �... �`�- !� -�............... . North Andover, Mass. Fee.Lic. No../.�'.�.`... tom. ...... GAS INSPECTOR Check # Y G ? .I'- 5 5G5b MASSACHUSEIIS UNIFORM APPUCATON FOR PERMIT TO DO GAS FI rnNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTSS, � Building Locations 0 A A, ►T ►�! n Permit # S^ L Amount $ ,� 0 4A �^� S G Owner's N me New ❑ Renovation Replacement Plans Submitted (Print or type) Name Address Name of Licensed Plumber or Gas Fitter Check o -Certificate Installing Company Lffforp- Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance po ' or it's substantial equivalent. Yes El NoO If you have checked yes, lease ' icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity M Bond 1 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 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 and installations performed under e Issued for this application will be in compliance with all pertinent provisions of the Massachuse9A Stat&Basl/de an er 142 of the General Laws_ BY: Title City/Town i APPROVED (OFFICE USE ONLY) S' e6ure of Licensed1Plumber Or Gas Fitter Plumber Ga Itter License um er aster rl Journeyman Date. R'" / f' TOWN OF NORTH ANDOVER 3j •`tom. • �L _ PERMIT FOR PLUMBING 41 This certifies that .. �! .0# f? f ?. !"... � ! .r. ................ r �' has permission to perform ..... P . .......................... . plumbing in -the buildings of ....13. s c L at ... � ............... . North Andover, Mass. Fee. ..... Lic. No. `... PLUMBING INSPECTOR Check # I rf G 7k 6632 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, MASSACHUSE SQ,� Building Location� Owners Nay New of Date G Permit # L Amount ij"" Renovation ReplacementDaPlans Submitted Yes No ❑ FIXTURES (Print or type) Check o Certificate Installing Company Name l orp Address Partner. Business Telephone Firm/Co. Name of Licensed Plumber: Irl" 4 azz Insurance Coverage: Indicate theof insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance 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 and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuketts S Plu g ode and Chapter 142 of the General Laws. By: igna re o icense mer Type of Plumbing License Title U City/Town 1c se um er Master Journeyman ElAPPROVED (OFFICE USE ONLY i 42 Broadway Wakefield, MA 01880 Tel: 781-245-4403 • 800-649-6160 • FAX 781-245-1892 Dear Health Officer, Please find enclosed copy of the DEP Notification which is verification of an Asbestos Removal being performed in your district. If you require any further information, or have any questions, please contact Asbestos Free, Inc. at 781-245-4403. Thank you, Frank L. Arsenault President FLA/b 0 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. INSTRUCTIONS 1. All sections of this forth must be completed in order to comply with DEP notification requirements of 310 CMR 7.15 and the Division of Occupational Safety (DOS) notification requirements of 453 CMR 6.12 Commonwealth of Massachusetts Asbestos Notification Form ANF-001rvumour_._ � ��VED A. Asbestos Abatement Description SEP 2 0 2005 DEPAR-HENT a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied rpsidpnrp of fnur units nr 1pss? n Yps n Nn b. Provide blanket decal number if applicable: 2. Facility Location: /John Resch a. Name of Facility Rlo. Andover ir'iPr c. Cityrrown d. State Blanket Decal Number 20 Norman b. Street Address 101845 (978) 376-5043 e. Zip Code f. Telephone Number 3. Worksite Location: Basement J Q a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room 4. Is the facility occupied? F/ Yes ❑ No 5. 6. 7. 8. 9. Asbestos Contractor: ASBESTOS FREE INC a. Name WAKEFIELD 01880 c. C" /Town d. Zip Code AC000133 cense Number ITERRENCE J SHARKEY Slowe lEnvironmental Remediation I 7-5 cc —w 10. a. What type of project is this? ❑ Demolition R1 Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: ❑ Glove bag ❑ Enclosure ❑ Cleanup ✓❑ Full containment ❑ Encapsulation ❑ Disposal only ❑ Other, specify: 42 BROADWAY b. Address 781-2454403 e. Telephone Number g. Contract Type: ❑ Written ❑ Verbal L Contact Person's Title b. Describe b. Describe 12. Is the job being conducted: M✓ Indoors? []Outdoors? anf001ap.doc - 10/02 Asbestos Notification Form • Page 1 of 3 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) ■ 100022753 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encs sulated: 80 1 130 a. I ofal pipes or ducts linear otal other surfaces square 14. Describe the decontamination system(s) to be used: 3 stage decon c. Boiler, breaching, duct, tank d. Insulating cement surface coatings Lin. ft. e. Corrugated or layered paper 80 pipe insulation Lin. ft. Lin. ft ft. g. Spray -on fireproofing Lin. ft. jlSq. i. Cloths, woven fabrics Lin k. Thermal, solid core pipe i. Other, please specify: insulation Lin. ft. 14. Describe the decontamination system(s) to be used: 3 stage decon 1. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (a): 16. fall acm to be doubled bagged in 6 mil labelled asbestos removal baps For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: b. Title d. DEP Waiver# 1. DUS Mcial Title h. DOS Waiver# 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes Q✓ No B. Facility Description 1. Current or prior use of facility: Residential 2. 3. 4. Is the facility owner -occupied residential with 4 units or less? 21 Yes ❑ No b. Address e. Telephone, Number area code and extension b. On -Site Manager Address e. Telephone Number (area code and extension) ■ an1001ap.doc • 10/02 Asbestos Notification Form • Paoe,2 .of 3, ,■ d. Insulating cement Lin�� f. Trowel/Sprayer coatings Lin. ft ft. h. Transite board, wall board jlSq. Lin �9 tt Q� i. Other, please specify: Lin. ft. So. ft. 1. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (a): 16. fall acm to be doubled bagged in 6 mil labelled asbestos removal baps For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: b. Title d. DEP Waiver# 1. DUS Mcial Title h. DOS Waiver# 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes Q✓ No B. Facility Description 1. Current or prior use of facility: Residential 2. 3. 4. Is the facility owner -occupied residential with 4 units or less? 21 Yes ❑ No b. Address e. Telephone, Number area code and extension b. On -Site Manager Address e. Telephone Number (area code and extension) ■ an1001ap.doc • 10/02 Asbestos Notification Form • Paoe,2 .of 3, ,■ Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 B. Facility Description (cont.) 5' a. Name of General Contractor c. C' /Town d. Zip Code f. Contractors Worker's Comp. Insurer 6. What is the size of this facility? 100022753 Decal Number b. Address e. Telephone Number area code and extension Policy Number h. Ex . Date mm/dd a. Square Feet b. Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): Asbestos Free, Inc. a. Name of Transporter Wakefield 101880 a Cityfrown d. Zip Code 2. Transporter of asbestos -containing waste material (Recovery Express, Inc. b. Authorized Signature a. Name of Transporter Boston 7 c. C' frown 02114 d. Zip Code 3. d. Date (mm/dd/vvw) (a. Refuse Transfer Station and Owner 1 I c. C' frown I d. Zip Code 4. JA & L SALVAGE INC I. Representing a. Final Disposal Site Location Name 11225 STATE ROUTE 45 c. Final Dis osal Site Address OH e. State 144432 f. Zip Code D. Certification The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. 42 Broadway b. Address (781) 245-4403 e. Telephone Number from removal/temporary site to final disposal site: 1180 Canal Street b. Address (617) 523-7740 e. Telephone Number b. Address Frank L. Arsenault a. Name b. Authorized Signature President F ---- c. PositionTfle d. Date (mm/dd/vvw) (781) 245-4403 1 JASbestos Free, Inc. e. Telephone Number I. Representing 42 Broadway Q. Address Wakefield 101880 h. Cityfrown i. Zip Code anf001ap.doc - 10/02 Asbestos Notification Form - Page 3.of 3