Loading...
HomeMy WebLinkAboutMiscellaneous - 203 HIGH STREET 4/30/20181 7 4 b G Date ......... TOWN OF NORTH ANDOVER o PERMIT FOR GAS INSTALLATION This certifies that ..................... has permission for gas installation ... 7-11-4-� .................... in the buildings of M/'q'7 r... .................. . at ................North Andover, Mass. Fee. 3 P. . .... Lic. No./ .. ?.� ... /GAS INSPECTOR'� ---I Check# -) ;- LZ / r MASSA S TTS UNIFORM APPLICATION FoRhERMIT TO DO GASFITTING G / t (L ) &) . Mass. Date (( ,-)L 20 (v Permit # Building_Loca/tipn / I Owner's Name j2 f !'t Type of Occupancy �S7 New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name Address 611 A,- Busmess Telephone Name of Licensed Plumber or Gasfitter Check one: C]—Gorporation ❑ Partnership ❑ Finn/Co. Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes iT.. No ❑ If you have checked des, please: indicate die type of coverage by checking the appropriate box. A liability insurance policy ❑/---- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MGL, and that my signature on this permit application waives this requirement. 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 the permit issued for this application will be in compliance with all pertinent provisions of the Nas§aehusetts State Gass Code and Chapter 142 of the General .haws. By Type of License:. /—/// X�— Title $Plumber ,,aster Signa i sed tuber/Gasfitter City/Town ❑ Gasfitter ❑ Journeyman. LicerlseNumber d— APPROVED OFFICE USE ONLY • • • All • • ■■■■■■■■■■■■■■■■■■ • . • . . IMM ■■■■■■■■■■■■■■■■■■ .• ..• ■■■■■■■■■■■■■■■■■■ ..• ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ Installing Company Name Address 611 A,- Busmess Telephone Name of Licensed Plumber or Gasfitter Check one: C]—Gorporation ❑ Partnership ❑ Finn/Co. Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes iT.. No ❑ If you have checked des, please: indicate die type of coverage by checking the appropriate box. A liability insurance policy ❑/---- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the MGL, and that my signature on this permit application waives this requirement. 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 the permit issued for this application will be in compliance with all pertinent provisions of the Nas§aehusetts State Gass Code and Chapter 142 of the General .haws. By Type of License:. /—/// X�— Title $Plumber ,,aster Signa i sed tuber/Gasfitter City/Town ❑ Gasfitter ❑ Journeyman. LicerlseNumber d— APPROVED OFFICE USE ONLY 7446 Date. ,//. a .......... TOWN OF NORTH ANDOVER .. PERMIT FOR GAS INSTALLATION SACMUSEtS i This certifies that . �z .�. L ,...!/ . :........ , has permission for gas installation .....1 1,13 ................ . in the buildings of................... . at ........... North Andover, Mass. Fee ..3d ...... Lic. No.../..2.2. f3AS INSPECTOR Check # ,,� 3 / / G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIING (Print or Type) ,Mass. Date / 20_/�L Permit # Building Location o S_ 141 6g -� Owner's Name. Owner Tel# Type of Occupancy RL' Sj.D New Q Renovation 11 Replacement 9--' Plan Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name r L(—AA&, , ,, & " A(9 Address D a L L p t)iL;�L, .s % P- AL6 6v)O _ bass Business Telephone # 2--)r r Name of Licensed Plumber or Gas Fitter Check one: D�Corporation 11 Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current f bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box.. A liability insurance policy ❑� Other type of indemnity ❑ Bond ❑ Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. GeneralLaws, and that my signature on'this permit application waives this requirement. Check one: Owner ❑ Agent Signature of Owner or Owner's 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 the permit issued or /plication will be in compliance withal[ ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene 1 By T se: —� • •Plu Sign Litensed Plumber or Gas Fitter Title • Gas er 11 •Master / i 1 License Number �J �./ Cityrrown oumeyman APPROVED (OFFICE USE ONLY) Location No. 7) 3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 'IFo nda Ionfi'Pe'r it Fee $ r,►aj Oth [Fermit Fee $ t A��• Sewer7Connection Fee $�_ �i1 Ando e rboveT TOTAL Fee $ ) `$ i �✓ { J Building Inspector Div. Public Works PE&3tIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP dd0. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK 'PAGE ZONE SUB DIV. LOT NO.I LO IONO3 .- d V ; c- I.�- PURPOSE OF BUILDING���- t O ER'S NAME fit} G NO. OF STORIES SIZE NER'S ADDRESS Or 1 i ri "� W V,,d iiQ BASEMENT OR SLAB ARCHITECT'S NAME BUILDER'S NAME V� // ,/✓I fyL, V �t SIZE OF FLOOR TIMBERS IST 2ND 3RD SPAN DISTANCE TO NEAREST BUILDING -'�' _ DIMENSIONS OF SILLS DISTANCE FROM STREET .F Q It POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION (,-�✓` VWV .1,q _ -V� - IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE) IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER S (- Caw V L( I h IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILE7, D APPROVED BY BUILDING INSPECTOR DATE FILgQ YIGNATU E OF OWNER OR AUTHORIZED AGENT F E E CONTR. TEL. # CONTR. LIC. #-- PERMIT GRA TE D 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST SOD r EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN I✓ I 'NV1d 101d S30V1d3M SIHl 'a3SOdwim3df1S '013 's3ovbi -VE) 'S3HOMOd H11M 'SDNIa11f18 d0 SNOISN3WIa 10VX3 aNV S3N11 101 WOUA 30NV1SIa aNV 101 d0SN01SN3WIa 10VX3 MOHS1Sf1W N01103S SIH1 ZL I AONVdfl000 L 08033V JNIa11na 0NIIV3H ON_ I PJC I ' 4' L P"L 1.W.9 JIa1J313 110 SWOON dO 'ON L SVO Sa31V3H llNn 0.1.H INVI4VS `JNINOIl14NOJ SIV SOdVA SO a.1.M IOH WV31S _ _ Sa313VS 400M 'S10J 4 'SW9 1331S 'SlOD V 'SW9 a39WI1 Nana SIV lOH 43JS03 i 3JVNan3 SS313d1d I 1SIOf QOOM 9NIIV3H LL I ONIWM 9 O4V0 3111 aO013 3111 SHnixiA NS340W 0N1300a llOa _ a3MOHS 11V1S 13AVSO 9 aVl `JNI9Wnld ON 31V1S NNIS N3HJ11)1 S3ONIHS DOOM ASOiVAV1 S319NIHS 11VHdSV 13SO1J a31VM ('X13 L) WW 131101 a3HS GbVSNVW 1V13 ��13a9WVJ X13 C) H1V9 dIH 319V0 ONI9Wnld OL 3ooaLNoN 5 �I 3aOI�doS 11 a00d °JNISIM 3WV83 NO 3NO1S kdNOSVW NO 3NO1S X19 S34NIJ SO 'JNOJ _I a0013 8 'SdIS JI11V 3WVa3 NO XJIa9 kdNOSVW NO XJIS9 — _ _ C E _ l _ F—� 3WVa3 NO OJJn1S ASNOSVW NO OJJn1S 3111 'HdSV `JNICIIS 'MA NOINWOJ ONIGIS SOIS39SV O.MGdVH ONIGIS 11VHd$V H1SV3 S310NIHS DOOM 313aJNOJ ,dV S109dVlD Moll 6 II S11VM b N3HJ11X Na300W S3JVld 3a13 V3aV JI11V 'N13 V3aV .1.W.9 'Nil W006 V3H Q 1.W.9 ON '/r °/L 1/1 lln3 V3aV 1N3W3SV9 £ C Z I _ 4 N13Nn 11VfA Aa4 aIRSVld Sa3Id O. MIJaVH 3NOIS SO XJIa9 3NId 'X.19 313dDNOJ 319dDNOD HSINIA IICIH31NI 8 NOI1VGNnod Z N0u:)n 11SN00 t, s1N�vlavdv _— S3JI330 —_ AiiWV3 'I11nW S31S0!S AlIWV3 3l0NIS ZL I AONVdfl000 L 08033V JNIa11na i tz to LA. o Q 0 m - 0 u N Z z c m L O C r tri oc O u ,a Z u z °° - O. L O C9 O u IA Z u � W L 3 V ` C ii OC p u Lu CL Z < u L CD C d C W m m - o m Y O a. C OC U a c= U- ¢ CO U- a Q U. m W PlAmrae'll'i Pµ s� tri Tm- NO H v o .�' •4 a. C E a a.r u U AAL •z a � W o :m � C c� V �r v I I y O i:. y 4 �° °' •E CAM CD _D �- " °' •� c _ w Z U m � o H V d 3 a > Lu h � (� W b X Zu LU U y QG a o0 W a. ar C •O U J Z a 6V► O •= O "Z 00 c u N a e V � O t � •C c Q d ♦�.. m NO i o Z A H o .�' a. E a AAL W � C aow— c � m o V 0 W W a o0 a i o Z A PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street Nor(h Andover, MFISSiK III ISO IS () 11345 (61 7) 685-4775 In accordance provisions 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 111, S 150A The debris will be disposed of in: p"�'V'�1 y" 4r/`'`' p (., 4 CL 1 v�v� 37 (Location of Facility) Signature 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. OF N°NTH, OFFICES OF: m Town of APPEALS ; NORTH ANDOVER ss CONSL--11VATION "`N"° DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street Nor(h Andover, MFISSiK III ISO IS () 11345 (61 7) 685-4775 In accordance provisions 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 111, S 150A The debris will be disposed of in: p"�'V'�1 y" 4r/`'`' p (., 4 CL 1 v�v� 37 (Location of Facility) Signature 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. 4 COMPLAINT NUMBER 41 1'r.36- ADDRESS:2c)" llif;ll UWNERiPHYLIS ROCK nf7DRLSS-.18 KORINTH IAN WAY, ANDOVER DA'FL .- APRIL i7!8, 1IJ9k� CLOSE DA 1 E ; PHONE- -. 681-1132 PHONE -,-e: 4'10-;2376 INSPECTION DATE: ORDER L DATE: COMPLAINT: RECENTLY HAD AN ENERGY PROGRAM DONE, ASSES FOS IN CLLI-I)R ANO EiF-W[-.R WASTE PIPE VENTING OUT OF SON'S BEDROOM INSTEAD OF ROO[--. A C T I LIN W4(d MA( /10�- U;ru Vja/ � ��q2 A* , *k j'I"I // !hlan,WIQ�, wo k, l��6�5� pith ����o Pn�l �iuvvunrAAi il�7�a2 �Wa��e �A�a,o VJOn�v) Ma�,��l� r'<c�vea ��i��tiy. Au v, ,�l ua-�c w� a rrpGkQ. GUvsP GGo/c� �1z7/viz 0 RECOVERY EXPRESS, INC. NON -HAZARDOUS 197 Portland Street Boston, MA 02 14 SPEMAL WASTE C (617) 523-7740 ` Ind AN 0 F(QST i' GENERATOR Name: Location of work if different: Phyllis Rock Address: 18 Karinthian Way Address: 203 High Street Andover, MA 01810 North Andover Telephone: 508-470-2376 RQ Hazardous Substance Solid N.O.S. (Asbestos) NA -9188 Amount of Waste: Removal Company: Asb e s tos—Free,— Tnc Address: 4 Rail rnari Avaniio Wakefield, MA 01880 ;' "Telephone: 617-245-4403 Recovery Express, Inc. 197 Portland Street Boston, MA 02114 (617) 523-7740 Name: Address: Signatuo�,_ ate: .z 6-�. Signature: Date: DISPOSAL SITE Name: CT Val San Waste Disp In }Y615 Shawinigan Drive Address:Chimn 413-785-1581, Signature: - Telephone: Date: 6 f '?, G -� Z- . c� n ;. FINAL CLEARANCE ANALYSIS, INC. Asbestos Consultants SAMPLE REPORT CLIENT: Asbestos Free Co. DATE: 5/22/92 4 Railroad Ave. Wakefield, Ma. CONTRACTOR: Same as above JOB SITE: 203 High St.. N.Andover, Ma. JOB # FCA 1543 ANALYSIS Sample # Sample Location/Comments Volume Results Clearance Airs FCA 1543.1 Average flow rate= 12 LPM 1380 L .0039 f/cc Final Air Quality Tests After Asbestos Removal From T111is Site Are Less Than Or Equal To The Recommended Airborne Concentration; Level --Of 0.01 f/cc. Analyzed By: 'T/S. Lab Director: PAT Laboratory Identification No. 01510001 DLI Certification No. A A 000085 83 WOODRUFF ROAD CLINTON, MA 01510 508-537-9035 508-368-4308 .................................: 11�assact)�Tseits Uei).�rf)nc�ni of Cnvironmentai Protection _..4396. ...............` f)uteau of Waste Ptet'ention -- Air Quality Transrrritta/i DWP AQ 04 ASIMS103 Removal HOtlf icati011 .............................. t . f OWf AQ 06 motilication Prior to Construction or Uemolition Facility lD (if known) y Permits for Asbeslos rot arruer,onrr................. r...: AIJpIICaIJ%IltY `: tenni; N^ ...... _......... Rev ewer UCIIIbilIl011IIlCnovalio ll (gw1olinns involving asbestos : rern,nnnnn (aoeiJcA containing ilialerial (AGM) and general Demolition/Renovalinn De-dsonOa e.,.........__..... i operations are re.Ijulated I)y the DCpalililellt Of 1 ItvtrOnrnClllal Protection (DEP), Bureau of Waste Prevention — Air Oualily ........... ...... Division, under Regulations 310 CM117.00, 7.09 and 7 15. Notification to the REGIONAL OFFICE of general demolition/ (General I'rujcct Vescriptian 1. Facility ..... Phyllis ... Rock ................................................... Naar 203 High Street .............................................................................................. Addrrss North Andover, MA 01845 .......................................................................... 508-470-2376 ........- .................... I ...........................-................................ telephone Size 2,400 ............................................................................................. $Qlbw feet 2 .................................................................................. . Numbel of 80015 Was the Facility built pour to 1980? , LN Yes E_) No Residential ............................................................... funrnl nr friar a'r u!! �:i4iP is the Facility Occupied"? 14 Yes U No Is this Facility Owner-Oc(:upied Residenlial with 4 units or less? IN Yrs LI No 2. Facility Owner ..,Phyllis.. Rock ... ..... ....... ..._........... ...... ...... ..... ......... Naar, 18 Karinthian Way_._ ...... ........... .......... Ar,drrss Andover, MA 01801 ........................................................................................................ clynoµn 508-470-2376 ............................. 1 rlephnnr Asbestos Itemoval Description 1. Asbestos Contrador Asbestos Free, Inc. .................. Nanl.^ 4 Railroad Avenue —.1— ......................... Addrrss Rev. 1/91 1( -novation operations and denmlition/le.novalion operations involving ACM is required under 310 CMR 7.09 (2) and 310 CMR 7.15 (1) (b) twenty (20) days prior to any work being performed. 1 -Ile following information is required pursuant to 310 CM 117.15. 3. On -Site Manager ..................... Nor .......................................................................................... I ...... Address 04-/7011-n ................................... lelrphone 4. General Contractor Nine Address-------- ---- ., Telephone Goes Ihis project involve the removal and/or alteration of in;r Ashestos Containing Material (ACM) as defined rarl app:i ;'i in 310 ChM 7.00 and 7.157? [-I Yes 0 No If Yes, cor 1plete Sections C and D. II No, complete Sections D and E. Wakefield, MA 01880 -- _- Cit,9o'h'n 617-245-4403 l elrphone AC000133 -- (lrpaamrnl of ! abor and ladushies licens0 / Page 1 of 4 lElassaclnrsctts Alr,�partnrent of Enl�ironmenlal Protection ........................ �-� But eau o1 Waste 1'levention —/lir Quality Transtnittalt DWI' AQ 04 A,laesio a Removal Notification ....a UWP AQ [IG °"�i.ifi�:ation Prior to f;onstructian or Demolition FaciliityID(if kncr•,' Permits for/! :tlr stun 2. On -Silo Supeirir,"1 7. Description of techniques used for estimation Frank Arsenault Tape Measure --._... Nang SF06284 G•lt3rfmrn7nl L�:Ir.; anrf In!luslries C.criiliglion 3. 1lygienist ..................... Tes.tw.e.l.1....Grafig.................... ........................ Nang 4. Specific Worl,,sile Locnlions(s) (i.e. Building 1131110, =;umber, win,fluor, room, tunnel.) basement ...................................... -............................................................... ........................... ................................................ I.............................. 5. Is the, job beiuu conducted indoors or outdoors? indoors fi. I_stiln3ir:d ainrnirll of I:acb type, of AGNI to be handled Linear / Square FOCI boiler, breeching, duct, tank surface coatings ....................... thermal solid cure pipe insulation 1.2.5..../.......... U. Asbestos Removal May:..2.�.r.....1992....._ ..............._.............................. ....... ... 51,rrf Dafe ... MaY....22.a....199.2.....................................................1............ End Date flours of Operation X daytime ❑ evening U night Days of Operation I Mon. —Fri. ❑ Sat.— Sun. (Note: Any changes in these dates roust be reported to uie appropriate regional ollice. It a removal is postponed fa more than thirty (30) calendar days separate notification be required.) 9. Describe the asbestos removal procedures to be used. �7 glove bag ❑ enclosure N full containnie; Cl cleanup ❑ encapsulation ❑ disppsal only LJ other -please describe ................................................................................. corrugated or layered paper pipe insulation / 10, Transporter of asbestos -containing waste material from s' to temporary storage site (if necessary) to final disposal s. insulating cement ........ .../ Asbestos Free, In.c....................................... ................................................... Nana spray on fircproofin,r / 4 Railroad Avenue ........................... .................... Addless . trowel/splayer coatings / Wakefield, MA 01880 . ....... . . . . ... ...... ................................................................................ 04/101w? cloths, woven fabric ........617-245-4403 ............................................................................... Telephone tra bard, w311 board ............�.............. other— 1)103se describe............ Total in Linear Feel1.2 ..../............... Total in S quare Fe01 / Page 2 Rev. 1/91 ................................. Massachusetts Department of Environmental Protection 43967 Bureau of Waste Ptevention —/lir Quality Transmittal it OWP AQ 04 Asbestos Removal Notification-----�--- QWP AQ 06 Motification Prior to Construction or Demolition facility ID fd known) Permits for Asbestos 11. Transporter of asbestos -containing waste material from removal/ternporary storage site to final disposal site Recovery Express, Inc. Name 197 Portland Street Sheel Address Boston, MA 02114 City/Town 617-523-7740 Telephone 12. Refuse transfer station facility and owner (if applicable) 13. Final Disposal Site Meadowfill Corp. ............................................................................................................... Name Rte 2 Box 68 ................................................................................................................ Address Bridgeport, W. VA. ............................................................................................................... CilrlTown 304-842-2784 .................................................................................... Telephone ............................................................................................................... Ownel's Nara (Note: Disposal of ACM must comply with the Solid Waste Divisions regulations 310 CMR 19.00.) .............................................................. Name 14. Emergency Asbestos Removal Operations ......................................................................... DEP official who evaluated the emergency: Address ............................................................................................................ ................................................................................................................ City/rown Name ............................................................................................................... ....................................................................................................... Telephone Title ................................................................................................................ ............................................................................................................ fAv ev's Naar, Aulhnifly (Note: Transfer Stations must comply with the Solid ...................... Date ofAuthorira ..................................................................................... I. Waste Division regulations 310 CMR 18.00.) r General Vemolition1Renovation Description 1. Demolition/Renovation Contractor 4. Was the facility surveyed for the presence of asbestos containing material (ACM)? - ----- ------------ -_------- — - --- ❑ Yes ❑ No Name If yes, who Conducted the Survey? -- ------- ---.--------------------- .............. - - - --- -------- ------ Address ..................................................................................................... ,i'lPe Civown ............................................................................................................... .............. -- ..... ----- - -- — Department off aboi and Industries Certific+lion --- — / Trlcphace 5. If yes, who conducted the survey? 2. On -Site Supervisor Name ............................................................................................................ Nance ............................................................................................................... Department of Labor and Industries Certification / 3. Identify the specific Worksite Location(s): 6. Dernolition/Renovation Asbestos Removal Start Dale End Date Rev. 1/91 Page 3 of 4 hlass80115ell511PPar1111enl of Environmental Profecilon Bureau of Waste Prevention —Air Quality DWP AQ p4 Ashestos Itemoval Hotif ication DWP AQ OG [fotification Prior to Construction or Demolition Permits for Asbestos 7. Describe the demolition/renovation procedures to be used: 8. Emergency Demolition/Renovation Asbestos Removal Operations State or local official who evaluated the emergency: Name Title Aulhority (Note: Demolition/Renovation Operations must comply with 310 CMR 7.09 to control emissions to prevent a Dale ofAulhoritati(V7 condition of air pollution.) (General Statement: If asbestos -containing material is unexpectedly found or damaged during a Demolition/Renovation operation, all responsible parties must comply with 310 CMR 7.00, 7.09, 7.15 and Chapter 21 E of the General Laws of the Commonwealth. l notification a notice are but ase of filing not be limited to r a hazardous substaasbestosDepartmentncce to thawith the Department if applicable.) ) and/or Cedification I certify that I have examined the above and that to the best of illy knowledge it is true and complete. The signature below subjects the signer to the general statutes regarding a false and misleading statement(s). ................ A.sbes.tp.s...f.x.e.e...... Inc ............................ ............. Authorised Signature Print NamM Supervisor ................................. Posilion/rille M.ay.... 1.9 .... 1992 Dale Rev. 1/91 ..Asb.e.sto.....].x.ee,....Zno.................................................... liepresenting Page 4'( O O O M P 844 208 157 Certifi6d Mail Receipt No Insurance Coverage Provided ® Do not use for International Mail p= r, (See Reverse) Sent to Street & o. nthjan. P.O., State & ZIP Code 2t- Andover, MA 01810 Postage $ 2 2 9 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, & Address of Delivery TOTAL Postage $2 2 9 & Fees Postmark or Date sent 5/5/92 *JMd) ee&m'08©@s kE§ $ i{ \ )®� f 3 f ■ _ 9\ Q() } � k � §$ ) E & d {\ m . §� /) � -_ / \ k \ \E �/ E Z) cro a `wo E; � k 75 l:E s- - \\ \ k�\E \\ �\ \ - « (§ !s m k� /k� E k E aca /\$ \k �k�/� a / m) ��d/ - §® o \% k §/ \{j \\ � Z ) Si /( a■ - ��� \\\E } \� �\ §&Q§ f })( jk /2f■ §k § � �§ BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 HEALTH DEPARTMENT ORDER Issued under the provisions of The State Sanitary Code, Chapter II Minimum Standards of Fitness for Human Habitation 105 CMR 410.000 S Date: April 28, 1992 191l� To Owner of Record: Property Location: Ms. Phyllis Rock 18 Korinthian Street Andover, MA 01845 203 High Street North Andover, MA 01845 An authorized inspection was made of your property at the above address on April 28, 1992. This inspection revealed violations of certain regulations of the State Sanitary Code, Chapter II, as listed on the attached violation Form. You are hereby ORDERED to correct these violations within five (5) days from the date of service of this order, or as noted. Failure to comply within the allotted time period may result in a criminal complaint against you in the Lawrence District Court and may result in an assessment of a fine. You have a right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. This request must be made by you in writing within seven days after this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to be represented at the hearing. hju�(Iinom Allison C. Conboy, R.S.; CHO Health Administrator I DATE OF ORDER: April 28, 1992 TO: Ms. Phyllis Rock 18 Korinthian Street Andover, MA 01810 . LOCATION: 203 High Street North Andover, MA 01845 VIOLATION TO BE CORRECTED NO LATER THAN five days from receipt of this order letter or as noted. VIOLATION 1. Vent pipe venting into bedroom closet. - This is an improper plumbing connection. Vent pipe must be properly vented in accordance with accepted plumbing standards. Work must be conducted by a licensed plumber and proper permits must be obtained from the plumbing inspector prior to initiating corrections. 2. Asbestos in basement open, exposed, friable and deteriorating. - You must have a licensed asbestos removal company to correct violation. Please note removal must be conducted in accordance with all applicable State laws and regulations. Contact Paul Petrowski (Department of Labor and Industries Division of Industrial Safety 617- 727-1932). WV94,C� ) REGULATION 410.350 410.351 410.353 REINSPECTION /--- "L/) - �, 070 3 7.G �i��d a • Complete items 1 and/or 2 for additional services. • Complete items 3, and 4a & b. • Print your name and address on the reverse of this form so that we can return this card to you. • Attach this form to the front of the mailpiece, or on the back if space does not permit. • Write "Return Receipt Requested" on the mailpiece below the article number • The Return Receipt Fee will provide you the signature of the pers re, to and the date of delivery. Q 3. Article Addressed to: Ms. Phyllis Rock 18 Korinthian Street Andover, MA 01810 5. S ignature (Agent) I also wish to receive the following services (for an extra fee): 1. ❑ Addressee's Address 2. ❑ Restricted Delivery insult postmaster for fee. Number 208 157 er ype ier El Insured G Ifie ❑ COD Ex s Mail ❑ Return Receipt for Merchandise !R5eg, bate of , Addressee's Address (Only if requested and fee is paid) PS Form 3$1 1, November 1990 *U.S. GPO: 1991-287.066 DOMESTIC RETURN RECEIPT ilTED STATES POSTAL SERVICE Official Business 111111 PENALTY FOR PRIVATE USE, $300 Print your name, address and ZIP Code here N. ANDOVER BOARD OF HEALTH 120 MAIN STREET N. ANDOVER, MA. 01845 0 COMPLAINT NUMBER DATE.- APRIL ATE:APHIL- 07, 1992 CLOSE DATE: RDDRESS:205 HIBH P[H[LT PHONE: W0687-0949 OWNER:PHYLIS ROCK PHONE 0: 470-2376 ADDRESS:18 KORINTH3AN STREET, ANDOVER INSPECTION DATE: ORDER L DATE: COMPLAlNT:NEIGHBOR RECENTLY HAD A ENERGY PROGRAM DUNE. ASBESTOS IN CELLAR AND SEWER WASTE PIPE VLN|IN8 THROUGH NEIGHBORS BEDROOM INSTEAD OF VENTING THROUGH ROOF. SHE'S ALSO BEEN C/O ILLNESSES. ACTION: •SENDER: C,,6mplete items 1 and 2 when additional services are desired, and complete items 3 and 4. c_-_ Put your address -in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will rovide you the name of the person delivered to and the date of delivery. For additional fees the ollowina insult postmaster or fees and check box(es)-for 1. ❑ Show ti lestricted Delivery Extra charge) 3. Article Add iber Phyl l: 208 154 18 Koa AndovE 5. 'gnatu X v 6. Signature — X 7. Date of Deliv PS Form 3811, 1, ❑ Insured ❑ COD ❑ Return nature of addressee t DELIVERED. Address (ONLY if fee paid) TIC RETAN RECEIPT UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS Print your name, address and ZIP Code in the space below. • Complete items 1, 2, 3, and 4 on the reverse. • Attach to front of article if space permits, otherwise affix to back of article. • Endorse article "Return Receipt Requested" adjacent to number. mm� u.S.MAILO PENALTY FOR PRIVATE USE, $300 RETURN Print Sender's name, address, and ZIP Code in the space below. TO W N. ANDOVER BOARD OF HEALTH N. ANDOVER, MA, 01845 •SENDER: C6mplete items 1 and 2 when additional services are desired, and complete items 3 and 4. ; ,_ P&t your address-in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will provide you the name of the person delivered to and the date of delivery. For additional ees the tollowing services are available. Consult postmaster for fees an c eck box(es) for additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Number P 844 208 154 Phyllis Rock Type of Service: EJ ❑Insured 18 Korinthian Street Andover, MA 01810 C 4R i A. Registered ®Certified ❑COD OJ Q ❑ Express Mail ❑ Return Receipt for M Z MAY 13 Always obtain signature of addressee or agent and DATE DELIVERED. 5. 'gnatu Ad esse 8. Addressee's Address (ONLY if X5requested A and fee paid) tj 6. Signature — A nt X 7. Date of Delivery r-1 PS Form 3811, Apr. 1989 *U.S.G.P.o.1989-238-815 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER Print your name, address and ZIP Code in the space below. • Complete items 1, 2, 3, and 4 on the reverse. • Attach to front of article if space permits, otherwise affix to back of article. • Endorse article "Return Receipt Requested" adjacent to number. U.S.MAIL �O PENALTY FOR PRIVATE USE, $300 RETURN Print Sender's name, address, and ZIP Code in the space below. TO N. ANDOVER BOARD OF HEALTH N. ANDOVER, MA. 01845 O O 00 CO Cn a P 844 208 1.54 Certified Mail Receipt No Insurance Coverage Provided o Do not use for International Mail S TEOSTRTES POSTED SERVICE (See Reverse) Sent to Phyllis Rock Street & No. 18 Korinthian Street P.O., State & ZIP Code Andover MA 01810 Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, & Address of Delivery TOTAL Postage & Fees 2.29 Postmark or Date sent 5/11/92 ( _9bf) »& &R`08£6ui@S \E - §7■ � cLB%� ) rff `% d {\ m {E §■ cc \\ )t {{ raj §E. cc� #6t - §r� - ®5 -� § \ \{\oA // \\ kg t © k k \k- x //\ ` 7D 7Doo E2 %k / La ( \\ �\ he k12 to w)k &5 iewc -{ 12 6 E5 Of BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 HEALTH DEPARTMENT ORDER Issued under the provisions of The State Sanitary Code, Chapter II Minimum Standards of Fitness for Human Habitation 105 CMR 410.000 Date: April 28, 1992 To Owner of Record: Ms. Phyllis Rock 18 Korinthian Street Andover, MA 01845 An authorized inspection address on April 28, 1992. Property Location: 203 High Street North Andover, MA 01845 was made of your property at the above This inspection revealed violations of certain regulations of the State Sanitary Code, Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct these violations within five (5) days from the date of service of this order, or as noted. Failure to comply within the allotted time period may result in a criminal complaint against you in the Lawrence District Court and may result in an assessment of a fine. You have a right to request a hearing before the Board of Health if you feel this order should be modified or withdrawn. This request must be made by you in writing within seven days after this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to be represented at the hearing. h, Av�, Oaml Allison C. Conboy, R. CHO Health Administrator a DATE OF ORDER: April 28, 1992 TO: Ms. Phyllis Rock 18 Korinthian Street Andover, MA 01810 LOCATION: 203 High Street North Andover, MA 01845 VIOLATION TO BE CORRECTED NO LATER THAN five days from receipt of this order letter or as noted. VIOLATION 1. Vent pipe venting into bedroom closet. - This is an improper plumbing connection. Vent pipe must be properly vented in accordance with accepted plumbing standards. Work must be conducted by a licensed plumber and proper permits must be obtained from the plumbing inspector prior to initiating corrections. 2. Asbestos in basement open, exposed, friable and deteriorating. - You must have a licensed asbestos removal company to correct violation. Please note removal must be conducted in accordance with all applicable State laws and regulations. Contact Paul Petrowski (Department of Labor and Industries Division of Industrial Safety 617- 727-1932). (SIXTY DAYS (60)) REGULATION 410.350 410.351 410.353 cc: Karen Nelson, Director, Planning & Community Dev. Patricia Kelly, 203 High Street Peggy Jones, 203 High Street REINSPECTION