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HomeMy WebLinkAboutMiscellaneous - 26 ANDOVER STREET 4/30/2018 (3)'7°i Date.. �Z:'.22?— 0 77 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that / j1A& 41 e k /Lr G has permission to perform .. rZ �.�U/,e �h�A�9� ....................... ....... .... ........... wiring in the building of ......................6. R 10 ....................................... at .......0 . ..... . �%P / ........5 ...........`... North Andover, Mass. Fee ... .'�..�ic. No...(r ' f ................ !.......................... ELECTRICAL INSPECTOR � Check # 7914 n Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 9f/1111 Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMRTO 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: LZ' Z City or Town of: NORTH ANDOVER To the Inspector of Wires By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) �� v1 cdn (" f16- -I-, k Owner or Tenant I' C 4o,, -c,( 11 yCLU, n Telephone No. Owner's Address ►p Cyt i:— Is sIs this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead RL Undgrd ❑ No. of Meters New Service 'ZQ0 Amps /Zo / 2`(O Volts Overhead ❑ Undgrd B No. of Meters i Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I� E -_FE E b L I EL Ser vii( Com letion 4f the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above El El o. o mergency ig ing rnd. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. o Detection and No. of Switches No. of Gas Burners ,_.�, _„ r _ . No. of RangesNo. of Air Cond. Tons l llialla�l4 LCY��,GJ No. of Alerting Devices No. of Waste Disposers Heat Pum P Number - ` ” Tons " " " "' .K "" ""'"' No. ofSelf-Contained Total No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Detection/Alerting Devices no. of uisnwasners 5 ace/Area Heating KW P g inw11UP!" focal Connection [:]Other No. of Dryers Heating Appliances KW Security Systems:* No. Devices No. of Water Heaters KW o No.f No. of of or Equivalent Data Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Ennivalent d Attach additional detail if desired, or as required by the Inspector of YVires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: . Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCFeR—BOND ❑ OTHER ❑ (Specify:) I certify, under the pains anndpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: a i-doO e— z!��I r'/ C c1 cc -,Y- ` LIC. NO.: 6 Ce I Licensee: cS t' pl'l�� /�/GYp(pc SignatureIC. NO.:AJt (.,c, (If applicable, enter` exempt" in the license numbIr line.) " - %a Bus. Tel. No— Address: Io © W�Y`l In S eider ��'(`�� Alt. Tel. No.: ZYL - 5-3d *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 35� �. Date ................................ i ea" "T" TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ..!`?.. �... `'� -�'a'`' ....................................................................... has permission to perform ... �`e. �!° t r f -m t o cl e_ ............................................................. wiring in the building of ... �yS ^'".....0 '� r, v i c,, ............................................................ at ...,....... , North Andover, Mass. Fee .... Lic. No. �� .1. _ a ........ "y`. `!. ......................................... a ELECTRICAL INSPECTOR Check # �� q a 551 ja 0 \ 77wCwnwmw8d& sf r BOARD OF FIRE PREMMON REGO APLZ.,ICATION FOR PERMTT TO PEE cityorTownof V AN�Ovd'IL- _ The undem4pd applies for apenrA to petfoan the electaicd Location(St reef Pant No �/ oca pajV & Fee MO" E ' ONS 527 CAS 1100 ORM E LECTRICAL WORIK Date d y O below. Owner orTened ff,Ns/%J.q�tJ . A,PI ,L/,L'C ST�v?:On1 o;aner',Add /7S' )UlOoL$'x- o6v Pi9S5 Isflvspertnitiacartjurtctionartifta idingpes�it Yes a'l No ❑ peckAppropxiaUB4 P,meof BwwingS��v�u o,� UtiayAulh o No- 1y7 931 E:i�Sareice300 _AtarZ4L—/ !8—Volts Oveaead [IUndgrd KKfo. ofMeteas�_ NawServica Amps f Volts Overhead❑ UndgxdO No. ofAddm NutaberofFeedets mdAmpwiV Location and Naiure of Proposed EleddadWolk $A; T Of s fJo� [/� f't! 6&4r �' "J *Js , , No. Ont3ets o. of lrmrtmas No. 017hat loos Swb=zdmPo0i❑ ,� ••• ••� —'— -- -- — A o. .—k is Bdiw Dints No. o. Gas =less n e o. No. of o. 0 Tiotaltons No. ofDdectiom = ' Devscas No. ofDisposais o. of Head pmvps otal Total Tone LW No. of SoanAag vias No. of Dis S o. ofseycoldaiaz& Detection/ SowA Devices o. of D:yess satsz�Local ❑ BrI lion Other ❑ o. of Waiter—&a—ics KWo. Sign--N0-GfBanwt LOW Voltap o. YdmsaCe T."), No. of ymtm TotalEp 0 4iSIIRA = COVERAM pom uttetten gaarmecds eSbdasmdwsetta GennlLaws ' IimAe t comer Lieb2ity ins UM policy g Cmnotas OBS C0 WW or to sabsiadial%=Ilat 'IES ❑ No ❑ S Ilmstn*udwlt ywdorsmuto*dsuffice. Yt� NO(31EYart7 dui.aYFs.pleueimatauau�pea2eovc+be�r c WSMUNCE 0 BOND E3 OTMR ❑ (pUut bpktimt Dae meauft value dmcoke Weak $ OG 6 t W/ /l1e4ESntl WC& to Saa + Dae Rtpbud RUG& Sigted MWUfA%e pmahke ofpetjaq F0M HAZ= /Y' • S DNI ^Je� No Liomsaa i ,V -C 8 bI - -Lic. NO.1 Addmss �Q /g01( �l �i/Vss/SOti6 Bas.TeLMD. ' A><TeINo. OWtWS M13R.ANCEWAVIER: Iam awt¢eUe¢13n >icrosee duet ani bxaattue iaootsaice eovsragt air its avbsxaaisl tquisaimtu tego4edbY Ddtscedms�tt General Lsavc , aadOta uy sig�m m►13rispem�s eppticaimswtiv.c Ssis ngaieenm2 CAvner ❑ lits❑ Talq*=* No. pe�itFas 3t `a Sipo m of oma air Agant f zjvv� tl�k ldlylW 41�pl<llfl La c L Ptemdtliio il7re Conownwea ft O f Ist�ttts D� of //Wev °�°p�' I cin v BOARD OF FIRE PRE'7MMOx REG" S 527 CUR Mo i Yev Y; APLUCATION FOR PE M11 TO PEE(FORM ELECTRICAL WORK QlyorTmmof Date d 7 O The undersigned epplieo for apeniA to pesfotmthe electrical Locefian(Street "Numb") .470 /yNUQko&'& 1 //J i' OwnerorTenent 4AJlb7AL) SX&l -f snT, oivnoesAddtass /els' /9A10okfk- v PAST Is tispermit in conjumlim wAhabdiogpermit Yes 8�'No ❑ PookApps*wisB4 Pt:rpoaeofBuilding SXAWte S7AWof-J UnityAutho»zefianNo. !V793/ Exist service 2W An pa_jZ!gL 1 ao8 Folic Odd ❑ Uadpd ;. m etem New erviee Amps f Volts Overhead❑ Unead Metets•s?�`'�i� - CJ NuatberofFeedets and Ampacsbg e i n...+inn —A W&we a Prnre m4 Rlwrhir.l Wrxk AA;Al* AYA -- -----z------- — "-- -- - - - 04,7�0 - NO. Of Liddimg Odlab NO. ofmTibs No. A No. of Lwthw F-=tmw w—=mirg ❑ No. is No. of OiL A No. Batttw Ups No. ofswRck Outlets Ho.;?d;;B rutAla= No. orzom No. of RAUM No. of Aa daltom No. of E gDevico No. of o. Of Red Pompe Total Total Tons LW Me. of SamuTmg Devices xo. of Dishwadan SpacelAna xw Ito. n/Sma Devices o. of Doyen LOCAE3 A Other ❑ 0. aieZ 0. o. ofDowt LOW Voltap Witiac NO. ydto s No. a lbtKu Tdg HP OTMM 14UPAIM COVERA[31t• Pamumttoffie nqukosde d4wadmsas 1 wwdLaw Ihmt a =at L3aA W I N ., -oa policy *,*,Ai, Ca®iaa opudimu Cavae w its sowxddtgwni= yo ❑ No ❑ lh tvdUsMeedvdUpwdaftw*to*&af. YES❑ xo❑ SyatLmedadsadt[ES,pLw �zSBset a�cowrabrbY [ WSEIRANCE e Rolm ❑ OTM ❑ (pl w 9p«iljlj I�intian Dae Ed— Vdn of ]+7eotacal Wadt Szroo 9 Wads to Suet �'t'o 1 Do RegUOU& F=& // a !rani SipnadwAa*A peAltin dpcVW MMM= of, SON! ^4f— Lt bio Ltamwa /b►Gs p �4 /401' Z4 S'Some Hos. Tel W. ' � P& T.Ilk OWMMIS 11MRANCE WAVIS R: Ian am &A to mat dons rA boaft barwo covaga wits atibawdd ogwaiwL as ngsbdW Assubun s limenl Laws , wAftt.vW'S I sa anthispumfs gspliatianvrob s d* xagaioa+aL Owner❑ Ape❑ Tekpbma xa. pssmitFees ! a Sipa d oweatr a Ag at 5F-vl� V G t 0 4z- mp!� aIr— CoA cy-F'r - � `q`�`�' i a�/?/acs c c \ i Tha Corn► wmmdlt& of. De ,rd of PW 91- BOARD OF FIRE PREVEMON REDO,APIS.ICATiON FOR P TO PEH CityorTo mof P. Theuedemired applies for apem&topetfomlthe deetacd LoCetion(SkWt 5RMPandtlo � oaaapa W & Ftt fSW&W 1200LECTRICAL WORK meta d y O below. v Owor Tened !J iAJl/JldA) �L$"/�.I// G'C ner .Sn %! OA-/ Isibispemdincesijumiimvithabddingperm;i/Yes e --'No ❑ Pock Bob PuposeofBuMiag .K�!te M-/—id1-j Ut&pAU&Mbmf=No- EzisftSavice20 Ampa_-&�L /_a�Loohs Offend ❑ Unrigd ®'9o. ofMeieaJ:_ . NewSetvice Amps ! VoBs Overload❑ Undgrd❑ No. CfMstsw Number of Feeders and Ampacity T --..:— —a u—U— .,an...,....•a W -41r A.#; I A>A m 4ti ( dAr all 0-1 IITSMWCE COYERAM Po=ftmtbengviof a s odtii Lseso Ihex a taaet Y 3 a POW tadodhf CmsmLet Camp ar b s>s legai%IUL YEi ❑ NO ❑ Inaa� asl tdvdidpmaf adsaae m 9dr .. Tmo No ❑ Ityaride a .e YE5.p�ee fadlnte 8ti atoove �e by RiSORANCE e-1-31mo ❑ OTIl m ❑(plan 9peeigtj varve of Ekaftical Wads s o Mvkdm Dat G 6 Wade m std �`b Dao R Raaf+ all // »ut S*Ad=deme Penalties ofpcm: I+'DZ :wa A' S DNl �, Lic No A*hn�O. /�DY W 7�NSt40t4 Bot.r.LNa. ' ALTdNo. OWNER'S WSORANCEWAVJER: Ism seoae eA to licsrsoa Boa not bmft *AvwvA wnrop arts s F& l agar¢. a by m aftIm Oemal LM . WAftt -t*ya -b Vphad- t- 9sis nqutwm c. Osva r ❑ ADO Telgbome No. ; Pemi[Aies d `a Sipum®s of Orme cr Atut .. int -d ois--- Location 8y -ass No. A57 Date 1 � TOWN OF NORTH ANDOVER 40 Certificate of Occupancy $ SS -- Building/Frame Permit Fee $ j� -0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 00 Check # k '17667 � 1 f[ '17661 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAM RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ' Section for Official Use Oal BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Buildin Commissio g.gk r of Buildin Date %K-1. l Property Address: 1.2 Assessors Map and Parcel Number: Aiaciam A - 7'114ss oas Map Number Parcel Numbs . 1.3 Zoning Information: Zo 1.4 Property Dimensions: AL % Y 5rzill a STAT a0 / Q `Sd d3 OWL Zoning District Proposed Use Lot Area Franta it 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yazd Regaired Provide Required ded Required Provided 1.7 Wow Supply MGJ-C.40. 34) 1.7. blood Zone b8oemalias 1.9 Sewc ap Dsp SyateE public ❑ Private ❑ zona Outside Flood zoos ❑ Mmieilal On Sito Disponi System ❑ 2.1 Owner of Record -7'1?_0MA1 y 60;ePa'guW/ rp Name (Print) Address for Service: A2 • A D CLAD%. Ai A p J,5' S Signature Telephone 2.2 Authorized Agent Jrc.A� /i"-FA;7 &) z��159,oiac zewg,6 `nza Name Pri A.4 .sisvyc1✓ Address for Service: ^# Signatu Telephone %e" G9 ( 3.1 Limsed Construction Supervisor S Not Applicable ❑ 6,s, 068 S/ y Address License Number ,—, ✓30x �9 Licensed struction Su Sur: K21 0, Y _ Expiration Date Y 7407 6 Sign Tel hone 3. ed Home Improvement Contractor Not Applicable 0 Co y Name Registration Number --------- Expiration Date Signature Telephone SECTION 4 - WORIMS MA3it3k ( t L C ] 2W `. 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 unit. oe Si ned affidavit Attached Yea ....... No ....... 0 SECTION S - PIt©F)P.S.SiONA . D ;111 1 It)MI S RYfL' S Rt?8; BUI f6 AND ST$UCTaBB5 STJB3EC'?:TO CONS'1f'BUCTI01V COlklimAillfin 751E CMR 1116 CC�N'i iIIeTG MOHB TitAI D kS,9t1)� GF, OF ENC'f.OSl *ACE) 5.1 Registered Architect: Name: Address Signature S:Z )tte�s Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ lame: Registration Number Expiration Date kddress signature Telephone Area of Responsibility Jayne f Registration Number Expiration Date address ignature Telephone ame Area of Responsibility ddress Registration Number .gnature Telephone Expiration Date 3 .Vow— -771 7W�e'l r _ . Not Applicable ❑ w )mpany e: �D a4,& r3199 7 'VqX/ 0X0 -",4 010"72 :sponsible in Charge of Construction 951 3 1? 1-c y�). 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*********************** 7 17- (i3S/ APPLICANT/NSMA41 sT/9Gk I(kiA1s � 4) `C PHONE.$10 - 7�3 LOCATION: AssessoPs Map Number PARCEL 3--f--- SUBDIVISION LOT (S) STREET B�VDbL�rL R;Y PRSS ST. NUMBER_ 45 ******** ��OFICIAL USE ONLY******* ********** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED / DATE REJECTED v ,SEISTI KSPECTORA.4fAeTH DATE APPROVED 3r� DATE REJECTED COMMENTS Govt 7`-' 16 PUBLIC WORKS - SEWER/WATER CONNECTIONS U�7e C7C1Gjl (�'Jr/ we)cll- DRIVEWAY PERM rr Ngz /FIRE DEPARTMENT. RZZ 60nem, S- e r RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit. Name },ys yri p „J / J Please Print Name: 71*014& G•� LA C /�iNs �A�v iot.�o Location: /ZS / "S 0 Yom- i9 Y — ?K55 O / a Se'Kyt ee S 4, ml 'e.✓ City P, Ati a 6 LlffK- W4 Phone # F] 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 N this job. Address Pd• Any A 0/A/ dy9-,,?06 Insurance Co. "0- Policv # W6009 -91J40700 Comaany name: Address City. Phone #. Insurance Co.. Policv # 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' m onment_as weU.as_civtl_Renatti She form nfa..STOPWORK_ORDER.and_a.fineof. ($1Q0.00)-aJday against.me. I understand that a c# this statement may be forvAdo to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify unjdet the pains Sig Print that the information provided above is true and correct. s Ai %pfd 7-1,'i2w.0 /�:i2tm Date &-;t ?- a y hone# 978 6If-o4400 Official use cnV do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department o Other 2463 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. P" ✓ ,9 2"4 Application by the undersigned is hereby made to connect with the town sewer main in A'e/ Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. /(1/ 14" .Ie,-!�/ tj. tXia2 Street or subdivision lot no, Owner Contractor Address Address Applicant's Ygnature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to K tfk to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Street Divis' n of Public Works By C77��J AU71- inspected by Date See back for rules and regulations C � lec 9,4 ':�s C, vt - .,. .......41. 46 / North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance wj h the provision of MGL c 40 S 54, a condition of Building Permit Number 4a0 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: i9y LA q),.4 Ze,6 o, sp,vs)(Location of Facility) Sigriatuie of Permit Applicant 8 -7,7 -AU Date NOTE: Demolition permit from the Town of North Andover must be obtained for tht project through the Office of the Building Inspector 'C. p 'C. cfl O00 V m .. 1 in vN CD-� •. w NO' W L!1 N V 'n � j Qo co p A U, m Y n cn 'C. Kinsman Service Station, Inc. c/o: 68 Catamount Road Tewksbury, MA 01876 (508) 783-2556 (978) 682-6351 Town of North Andover Building Department 27 Charles Street North Andover, MA 01845 Re: Relocation of Existing Business August 26, 2004 Dear Sir: The purpose of this letter is to notify the Town of North Andover that I am planning to relocate my existing business, Kinsman Service Station, Inc., within the Town. Current planning includes the possibility of leasing & renovating the vacant service station on the Andover Bypass (near Merrimack College). This property is zoned for General Business. According to the landowner, all gasoline storage tanks have been removed from the site, and it has recently passed a 21-E inspection (totally clean). My plan is to renovate the existing structure (new paint, windows, doors, etc.) and the site (new paving, landscaping, etc.) for use as an automotive repair business & MA State Inspection facility. This is an approved use, per the Town's Building Codes. At this time, I do not plan sell gasoline at this location. I do not intend to operate a convenience store (food & beverage sales). I do not plan to sell cigarettes & tobacco products. The business has ceased operation at the following address effective Friday, August 6, 2004: Kinsman Service Station, Inc.lJack's Mobil 498 Chickering Road, North Andover, MA 01845 Thank you in advance for your advice & cooperation on this matter. Sincerely, -7- #a' Fred J. (Jack) Kinsman, Owner CC: Town of North Andover Department of Public Works Town of North Andover Department of Public Health Town of North Andover Fire Prevention Division 0 JA 'ON 133HS 'ON L33rONd I :A8 03>103HO :A8 NMVNO JM US390% ON JNIMV210 t00Z '£Z kwnWr MV0 ,OZ =„ L :31VOS o3 u lsed JHW S210Jl3AMt1S • S83NNVld • Sa33N19N3 •out Isjuc}jnsu� _ 0U.0—£69 (£09) j 610£0 ealysdwcH MON 'uueloST` C L� quo ellns 'pool selliS £01 Sty l0 VW '83AOONV H18ON "L 311nS '.13381S 3>IIdNNn1 £SS SEWN 4NDINnQ :803 038Vd38d 9*S L0 VW 'N3AOGNV Hi8ON (SZ L 31noN) SSVd—A8 83AOONV SiV l 21, -7. 6E ss07 sz akW C# NYIa I&ION00 SNOISIA38 31V0 AS NOIldIb0S30 'ON V . c? = uom T SOS DIHcIVZID Ql3j:jad0't NOUN I ,001 6 z Of C13AI3338 'VW 'J1008V3d 'ONI833NION3 W V 1 :M 038Vd38d -',0-+=„ L :31V0S 'L86 L `9Z 1Snonv :o31Va '„'dUOO SSOND ON18VH0 2103 S113SnH0VSSVW '83AOONV HIMON NI NVId NOI1VV48UNOO„ ( L • SaDMa adaZt NVrld 1� �. a = CL a. O y �o d CDCL O v � CD C � O cp C O �O co) y C I d y W m m m y m CO) S 0 mi R V r� Cl) zcn� cn o� O� VJ O o� +H cn cn r dp O H CD n a � 9 m Z ?2 y m 0 T O H tN� � b �m S s IN N O N Ci CD2 G �N7 d �.co CL ... j—.1 O C d c y p m co') N CK O Q C — C CCL .W d S'm. H 'O N N 0 mC@ y 3 mcil co m O � • y CD CD N H � :N o�� 3 im m d 0 C� a.� C7 : • 0 1 r v o �. a = CL a. O y �o d CDCL O v � CD CD r. cp C O �O co) y C I 0 mi R V r� Cl) zcn� cn o� O� VJ O o� +H cn cn r dp O H CD n a � 9 m Z ?2 y m 0 T O H tN� � b �m S s IN N O N Ci CD2 G �N7 d �.co CL ... j—.1 O C d c y p m co') N CK O Q C — C CCL .W d S'm. H 'O N N 0 mC@ y 3 mcil co m O � • y CD CD N H � :N o�� 3 im m d 0 C� a.� C7 : • 0 1 r v o S. CO) C2 O CD z CD � V I o CD 0 mi R V r� Cl) zcn� cn o� O� VJ O o� +H cn cn r dp O H CD n a � 9 m Z ?2 y m 0 T O H tN� � b �m S s IN N O N Ci CD2 G �N7 d �.co CL ... j—.1 O C d c y p m co') N CK O Q C — C CCL .W d S'm. H 'O N N 0 mC@ y 3 mcil co m O � • y CD CD N H � :N o�� 3 im m d 0 C� a.� C7 : • 0 1 r v o ° aoql r. cp O wa 0 c CD 'n 3 Ap S18CTIQN . l>fFS iP'1E N MJF PROP0610 �VORH '(check atI 1�� . New Construction 0 Existing Building V Repair(s) Q1 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition 0 Other 0 Specify Brriieff Description of Proposed Work: _ ff/R.. 6tu � Cs/A5,f,L4eDM7!, Asp! 2 lezi4xaC,u, v,S�m sy USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A-2 0 A-3 0 lA ❑ A4 ❑ A-5 0 IB ❑ B Business C Educational ❑ 2A 0 F Factory 0 F-1 0 F-2 ❑ 2B 2C 0 0 H High Hazard ❑ 3A ❑ IInstitutional 0 I-] 0 I-2 0 I-3 ❑ 3B ❑ M Mercantile 0 R residential 0 R-1 0 R-2 ❑ R-3 ❑ 4 5A ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING MELDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: A-114 Py►'+e Proposed Use Group: Existing hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREAS EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area Total Height (ft)1 r 4 - ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application 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 ' Nate Item Estimated Cost (Dollars) to be Completed by permit applicant d' ' 7i:C'i � •r�i� 1. Building a's 0 0 b (a) Building Permit Fee Multi liar 2 Electrical(b) Estimated Total Cost of . 00 Construction from 6 3 PlumbingBuilding �S� Permit fee (a) x (b) 4 Mechanical (HVAC) 0 S, J-0 5 Fire Protection 0-0 6 Total (1+2+3+4+5) Check Number NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlVIBERS l Z RD 3 RD SPAN DENIENSIONS OF SILLS DEMENSIONS OF POSTS DW ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CEIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE This certifies that Date./J��..�1... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ..................... has permission to perform..r�!y-t--.-. plumbing in the buildings of..._.......�.. . at w ............... !a..... , North Andover, Mass. Lic. No.......... ......... . P.LLMS1 IN,S�PEc, Check # � � 2--�` � 6225 M `3y � -D MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBP (Type or print) 1 NORTH ANDOVER, MASSACHUSETTS (�� f„ i,(o I� �q`I `� �4Date Q 7 Building Location l I /wnersName �� 5�1-� Permit # Amount e of Occupancy r 6 New 1:3 Renovation 1:1 v Replacement Plans Submitted Yes No ❑ FIXTURES (Print or type) �`� `� f j Check one: Certificate Installing Company Name ) I lj �'1 b+�°�T t' �S —t-�%� Corp. r C/ 0 Partner. 0 Rrrn/Co. Name of Licensed Plumber: Insurance Coverage: IndicaMtielype of insurance coverage by checking the appropriate box: Liability insurance policyEL 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 t I hereby certify that all of the details and information I have submitted (or entered) in above application are we 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 Massa setts State P bing a and Chapter 142 of the General Laws. By: Signat ol EicenseurlumDer Type of Plumbing License Title CityfTown kens mer Master Journeyman ❑ APPROVED (OFFICE USE ONLY MASS AY Mitt Romney Kerry Healey Daniel A. Grabauskas John Cogliano Governor Lt. Governor Secretary Commissioner PERMIT - NORTH ANDOVER Permit #: 4-2004-0558 Subject to all the terms, conditions, and restrictions printed or written below, permission is hereby granted to TOWN OF NORTH ANDOVER to enter upon the State Highway known as ROUTE 125 ANDOVER BYPASS ROAD for the purpose of installing a 6" sewer service to #145 Andover Bypass Road from the existing sewer manhole located within the shoulder area on the westerly side of the roadway to the westerly location line at station 44+85. The Grantee will install a 1" water service from the existing 8" water main located within the shoulder area on the westerly side of the roadway to the westerly location line at station 44+80. The work will be p.rformed as per plans on file at the Massachusetts Highway Department District Four Permits Office. A copy of this permit must be on the job site at all times for inspection. Failure to have this permit available will result in suspension of the rights granted by this permit. The Completion of Work Form shall be sent to the Grantor via certified mail as soon as possible after the completion of the physical work. No equipment, trucks, etc. shall occupy any part of the traveled way except between the hours of 9:00 A.M. and 3:00 P.M. No work shall be done under the terms of this permit on Saturdays, Sundays or Holidays. Provisions shall be made for the safety and protection of Pedestrian Traffic during the construction period. If it becomes necessary to open the roadway surface in a larger area or relocate the existing work area to a location other than specified in this permit then the Grantee shall apply for an additional permit to cover this project. WORK HOURS: 9:00 A.M. thru 3:00 P.M. Monday thru Friday. The Grantee shall notify the District Permit Engineer or his Representative at (781) 641-8451, two (2) days prior to the start of work. No work shall be authorized without said notification. The Grantee shall make contact with the Area Contract Specialist III via Pager (7:30 AM to 4:00 PM Monday through Friday ONLY) Pager Number (781) 387-0255, forty-eight hours prior to the start of work. RECEIVED "DV 80r s 2004 Massachusetts Highway Department • District 4 • S19 Appleton Street, Arlington, MA 024KUPV$9 pfd . 10 The Grantee shall notify Dig -Safe at 1-888-344-7233 at least 72 hours prior to the start of work for the purpose of identifying the location of underground utilities. Dig -Safe # 20044002243 No trees shall be cut or removed under this permit. All work shall be in compliance with the 1988 Edition of the "Massachusetts Highway Department Standard Specifications for Highways and Bridges", and Supplemental Specifications Dated December 11, 2002. No work will be performed on the day before or the day after a long weekend which involves a holiday on any highway, roadway or property under`the control of the Massachusetts Highway Department or in areas where the work would adversely. impact the normal flow of traffic on the State Highway System, without permission of the District Highway Director or his Representative. Uniformed Police Officers shall be in attendance at all times while work is being done under this permit. All personnel who are working on the traveled way or breakdown lanes shall wear safety vests and hard hats. The furnishing and erecting of all required signs and traffic safety devices shall be the responsibility of the Grantee. All signs and devices shall conform to the 2000 edition of the Manual on Uniform Traffic Control Devices (MUTCD) with the Commonwealth of Massachusetts Amendments. Cones and non-reflecting warning devices shall not be left in operating position on the highw_ ay when the daytime operations have ceased. If it becomes necessary for this Department to remove any construction warning devices or their appurtenances from the project due to negligence by the Grantee all costs for this work will be charged to the Grantee. Flashing arrow boards will be used at all times when operations occupy the roadway and shall be available for use at all times. All warning devices shall be subject to removal, replacement and repositioning by the Grantee as often as deemed necessary by the Engineer. When in the opinion of the Engineer, this operation constitutes a hazard to traffic in any area, the Grantee may be required to suspend operations during certain hours and to remove his equipment from the roadway. Page 2 of 5 At any time during the operation when a traffic delay of over twelve (12) minutes occurs and the situation is worsening, the Grantee will begin to suspend operations. Two way traffic shall be maintained at all times. Care shall be exercised so as not to disturb any existing State Highway Traffic Duct Systems or any underground structures that exist. If said system is disturbed, it shall be restored immediately to its original condition. Also any damaged Traffic lines shall be restored to their original condition. All expenses for restoring conditions shall be charged to the Grantee. The Grantee will be responsible for any damage caused by his operation to curbing, structures, roadway, etc. The Grantee shall be responsible for any settlement which may occur as a result of the work done under this permit. The Grantee shall assume full responsibility for the structural integrity of any trench located within the MassHighway Layout. This responsibility shall remain in place for a period of three (3) years after the completion of the physical work, this time frame starts when the Grantor receives the Completion of Work Form from the Grantee. The Grantee shall respond to trench maintenance requests by the District Highway Director or his representative within two (2) working days. Non -response within the specified time will result in the required maintenance work being done by the Grantor, with all the expenses charged to the Grantee. Failure to respond to trench maintenance shall result in denial of future Permit requests. The Grantee shall be responsible for any ponding of water which may develop within the State Highway Layout, caused by this work. No work shall be authorized during snow, sleet, or ice storms and subsequent snow removal operations. The Highway surface shall be kept clean of debris at all times and shall be thoroughly cleaned at the completion of this permit. At the completion of this permit, all disturbed areas shall be restored to a condition equal or similar to that which existed prior to the work. Whenever trenches are cut in the traveled way the surface shall be cut in straight lines using a concrete saw or other accepted methods equipped to cut the full depth surfacing and including Page 3 of 5 the reinforcing steel on concrete roadways. The excavation shall only be between these lines. The cutting operation shall not be done with a backhoe, gradall or any type of ripping equipment. Controlled Density Fill (CDF) shall meet the requirements of Section M4.08.0 of the Massachusetts Department of Public Works Standard Specifications for Highways and Bridges, 1995 Metric Edition/1988 Edition and Supplemental Specifications dated December 11, 2002. CDF must be batched at a concrete plant, is flowable, requires no vibrating, and the finished product must be excavatable without the use of power tools. The material shall flow under and around the pipe or conduit, providing uniform support without leaving voids. Flowable mortar shall be discharged from the mixer by a reasonable means into the trench area to be filled. Filling operations shall proceed simultaneously on both sides of pipe or conduit so that the two fills are kept at approximately the same elevation at all times. An external load shall be applied to the pipe or conduit, sufficient to hold it in place before filling. A permanent patch shall then be placed consisting of 2" of binder and 2" of modified top (Class I Bituminous Concrete Pavement - Type I-1) to meet the existing pavement surface grade. After the work has been completed the Grantee shall use the Infra -Red Method as a surface treatment a minimum of one (1) foot beyond the limits of the trench. All utility companies whose services are located within or adjacent to the proposed installation areas shall be notified in writing of the proposed installation at least 48 hours prior to the start of any excavation in said areas. This is independent of the required dig safe notification. Any grass areas disturbed within the State Highway Layout shall be graded, loamed to a depth of 4" and seeded. If the sidewalk area is disturbed, it shall be restored, full width, in kind a minimum of five feet beyond any disturbed area. It shall be the responsibility of the Grantee to replace all pavement markings which have been disturbed by this permit. These pavement markings shall be restored within ten (10) days after this work is performed or as deemed necessary by the District Highway Director. Any bound marked MHB shall not be removed or disturbed. If it becomes necessary to remove and reset any highway bounds then the Grantee shall hire a Registered Professional Land Surveyor to perform this work. It shall be the responsibility of this land surveyor to submit to this office a statement in writing and a plan containing his stamp and signature showing that said work has been performed. Page 4 of 5 Grantee assumes all risk associated with any environmental condition within the subject property and shall be solely responsible for all costs associated with evaluating, assessing, and remediating, in accordance with all applicable laws, any environmental contamination (1) discovered during Grantee's work or activities under this permit to the extent such evaluation, assessment or remediation is required for Grantee's work, or (2) resulting from Grantee's work or activities under this permit. Grantee shall notify Grantor of any such assessment and remediation activities. This permit is issued with the stipulation that it may be modified or revoked at any time at the discretion of the District Four Highway Director or his representative without rendering said Department or the Commonwealth of Massachusetts liable in any way. The Grantee shall indemnify and save harmless the Commonwealth and its Highway Department against all suits, claims or liability of every name and nature arising at any time out of or in consequence of the acts of the Grantee in the performance of the work covered by this permit and or failure to comply with terms and conditions of the permit whether by themselves or their employees or subcontractors. APPLICANT'S REPRESENTATIVE: J. William Hmurciak TELEPHONE NUMBER: (978) 685-0950 No work shall be done under this permit until the Grantee has communicated with and received instructions from the District Highway Director of the Massachusetts Highway Department at 519 Appleton Street, Arlington, Ma. 02476-7009. The permit shall be void unless the work herein contemplated shall have been completed before October 29, 2005. Dated at Arlington this 29th day of October, 2004. LFR/lfr Massachusetts Highway Department, By Patricia A. Leavenworth, P.E. Acting District Highway Director Page 5 of 5 SEWER MAINS TEt_EF`�;C'�: WATER MAINS STORM DRAINAGE Ramey Contractors - Engineers. Inc. "i6 68�-619' Fri -XV 976-689-8492 ROADS EQUIPMENT RENTAL 33 OAK KNOLL ROAD TANK REMOVAL METHUEN. MASSACHUSETTS 01844 I PAVING I Y �+G U ` i 1. V. C) jq_Qq Fjoure Lane Giosure on jvvo-Lanr- ROBC LISM jF I ers USE POLIC E OFFICER,. OR 1 - cypical Applic 30 r! 00 1"'i MAXIMUM Cne Laric- -1 Traffic tape 30 rr, it OC, ti) MAXIMUM 7 i OF; FEET (optional, iopbonal E < OXE LANE',"� OF; 014�wr\ W W RM XX FT/ /R(01AD' WORK CF. WORK XX Fl xx m ICY "Itt SEE FI)iE-,- i t ion the rneer;;rlc ,EAE' coces useo iriwlE figufc. op USE POLIC E OFFICER,. OR 1 - cypical Applic 30 r! 00 1"'i MAXIMUM Cne Laric- -1 Traffic tape 30 rr, it OC, ti) MAXIMUM 7 i OF; FEET (optional, iopbonal E < OXE LANE',"� OF; 014�wr\ W W RM XX FT/ /R(01AD' WORK CF. WORK XX Fl xx m Sec;. 6H.0'. Paee bH-., December 200(; Shoulder Work with Minor Encroachment (TA-6) Figure 6H-6, - .......... 5 ap H�f`�'" ; Lr I ROAtEiI``i --- �if ®1?yy'2'.i' doi. / i � I I 11 • I j �I I I I I Note: see Tables 6H-2 and 61-1-3 for the meaning of the I symbols and/or letter i codes used in this figure. s r 3 M::. Truck-Mounted a Attenuator I (optional) 1/3 L � 1 I 1 I f A , ar I Typical Application 6 Sec;. 6H.0'. AMASS Completion of Work You may proceed with the work described within this Permit which has been issued to you by the Massachusetts Highway Department (MassHighway). Your attention is called to the time frame allowed for completion of said work. If an extension of time is required or alterations to any of the permit conditions becomes necessary, application for such changes should be made as soon as possible to the District Highway Director. Upon completion of the work, please fill out this form and forward it to: Massachusetts Highway Department, District Four, 519 Appleton Street, Arlington, MA 02476. 161 By Authority of the Massachusetts Highway Department District Four Highway Director. Dear Sir. 1 hereby notify you that the work outlined and authorized under the terms and conditions of MHD Permit No. has been completed in accordance with all requirements of MassHighway. The date of completion: Permit Grantee: Signed: City/ Town: — Date : Massachusetts Highway Department. District 4. 5,19 Appleton Street, Arlington, MA 02476. 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