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Commonwealth of Massachusetts
City/Town of
i Record
System Pumping
Form 4
1"D
JAN 2 6 2007
-.�d'HANIDOVER
DEE M1 MENT
DEP has provided this form for use by local Boards If-Hi3alth.-The-Sy-st-effi-IRL
be submitted to the local Board of Health or other approving authority. .
A. Facility Inform.ation
1. System Location
q-, 0A---- k�u'�Se_
Address
Cityfrown
2. S ys tem Owner:
Name
Address (if different from location)
CityfTown
M
State
ping Record must
Zip Code
->taxe
Z' Code'
Telephone Number
B. Pumpin*g Recbrd
1. DateofPumping -6a-te 2. Quantity Pumped:
Gallons
3. Type of system: El cesspooi(s) [9-8-6-�tic"Tank El Tight Tank
El Other (describe):
4. Effluent Tee Filter present? E] Yes n -N -o If yes, was it cleaned? El Yes 0 No
5. Condition of Syste
6. SystemfuTpeq- By�
Name
Vehicle License Number
Cbi;pany
7. Location where cont6nts-were t-rl-
U� - �7-
Signatur of au�le
http://www.mass.gov/deptwaterlapprovaltd
t5form4.doc- 06/03
1-746 '_7
Date
irms.h"nspect
System Pumping Record - Page 1 of I
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
18979
�_Puilding Inspect8r
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT WAZ RENOVATA., OR DEMOLISH A ONE OR TWO FAMELY DWELLING
BUILDING PERMIT NUMBER. sag DATE ISSUED:
-11
SIGNATURE: . , —
Building Commissioner/I of Buildings Date
SECTION I- SITE INFORMATION I
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:'
27 FuLLevelysow �&*v
A112 1 Olz2 �1
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoninz District Proposed Use
Lot Am (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required PlWi(W
ReqWred Provided
1
1.7 Waier Supply ACLI-C.40. 54) 1.5. Flood Zone Infonnation:
1.8 SewerW Disposal System
Public 0 Private D Zone — Outside Flood Zwe 0
Municipal D On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT
Historic District: Yes No
2.1 Owner of Record
&&-'RT- BAUC-Tr .CA Mew U) &d*
Name (Print) Address for Service:
174
Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
.0ECTION 3 - CONSTRUCTION SERVICES
r' I Licensed Construction Supervisor:
Not Applicable 0
��VWW6WAAI &VIN
Licensed Construction Supervisor
q ?qS
License Number
1?1421-41140
Expiration Date
Telephone
CC -a WI -W/.540)
3.2 Re istered Home Improvement Contractor
gi
Not Applic" D
AWAQ 4&Aj9C,&K-6W7*A1,rSS.1-&n
Company Name
Registration Number
Z9 --07
C6 -7,--;Al n -=5
Add
n/
/ 74,7, o�'X /-, '7 V
Expiration Daft
P�P—
MzE0±= Telephone
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SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this iffidavit will result
in the denial of the issuance of the buildigg permit.
Signed affidavit Attached Yes ........ 20' No ....... 0
SECTION5 Descriptiono Proposed Work (check appBcable)
New Construction O� Oft-stiOl3w1ding 0 Repair(s) 0 Alteratio Addition 0
lots rm k.:.4
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
15AJISHS,tsemam-uSIA�& 6,
5.v atcr
4ot% 7V 4r FAmioi I?c)ovh
I SRCTION 6 - RSTIMATRD rnNsTRurT1nN COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
1. Building
Z31
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
.4 Mechanical (HVAC)
5 Fire Protection
.6 Total (1+2+3+4+5)
CheckNumber
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN V
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNUT
1, Awr as Owner/Authorized Agent of subject property
Herebyauthorize to act on
My behalf, relati to work authorized by this building permit application.
A -1 . I'[
SignaturKWW5r — Date"
I SECTION7b OWNER/AUTHORIZED AGENT DECLARATION I
1, 7566v- A, 4JA%v- 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
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I Sr 2 NU 3 KD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION' THICKNESS
SIZE OF FOOTING x
MATERIAL OF CHEANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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CA
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance 'With the provisi6ri of MGL c 40 S'54, � condition of Building Permit
at: is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by NIGL
, 117 S 150 A. - .-
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
I OA.
The debris will be disposed of in:
Fire Department Sign off-
Dumpster Permit
f4,0 rkM fiO J-1- 6aW /A@
(Location of F i y
Signature of Permit Applicant
Date
The Commonwealth of Massachusetts
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le2ibly
Name (Business/Orgar�zation/Individual): 01,)6NS COMING BASC,11&.17- S_Y'Sr6,n
Address: 9(,0 -7_aeA3P1KC -RTAW-7-
City/State/Zip: (�N70A) 4 Phone#:
Are you an employer? Check the appropriate box:
I am a employer with Z / 4. El I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
El I am a sole pToprietOTor partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity. workers' comp. insurance.
[No workers' comp. insurance 5. El We are a corporation and its
required.]
3. 0 1 am a homeownet doing all work
myself [No workers' comp.
insurance required.] t
officers have exercised their
right of exemption per MGL
c. 152, § 1 (4), and we have no
employees. [No workers'
comp. insurance required.)
Type of project (required):
6. F-1 New construction
7. Remodeling
8. Demolition
9. E] Building addition
10. El Electrical repairs or additions
I I -El Plumbing repairs or additions
12 -El Roof repairs
13.[:] Other
*Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy infoTniation.
I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy andiob site
information.
Insurance Company Name: L486>tY MUT14.4t—
Policy# or Self -ins. Lic. #: WC2-315-344359-66- Expiration Date:_ 5- ZY - 06
Job Site Address: 2 7 Fou,& Ne
Aftj A)AP City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do hereby ify u der nalties ofperjury that the information provided above is true and correct
� �r
aigag. - C Date:
Phone #:
0Jf1cial use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
05/261200S 13:04 VAX 1 781 659 4725 Andrew G Gordw Inc Ia00I
%Rlf 40/ Zvva 1z:zj PAGE 002/002 LMG
m
bby26.2005
NAUGUMN & CO
90 TURNP= ST
CANTON, MA 0202 1 -
RF— Certincate of Wwkws Campea"tim Lmmmft
tuarc& OWEM IMINM FRWEIED BASEIAM
%07IRNPUCEST
CANTON, MA 02021
IA"mty Modad Group
PO Bcmi 7202
Poiftnam9k Ng 03M7202
Td*6omC(W0653-7893
Fax (6" 431-5693
PolicyNumber.- W(24IS-3443SM15 Fffmfivc 51244M5 Eapkz&m- 5/24,2006
Covasge affzdcd mmW Waim CaMmamfim Law of&C &Swmg gsk(* MA
EM&M LjAjW.
BedMyh*wyBYA=idcmt S 5W,000 Efth Accidcat
BodHyb�mybyDimcam 3 Embramom
BofthqWYbYmW= s SK000 raficylinift
As of &a doe. &t kmcd bYLAcaYJh*mI Fim banaft Ce andler Me
policy rMcd abom
71c m=nn= affw" by Ote Rood po&7 is xdject to aU ibc amnK mckdom md =,&6,at
aftered by my rcquhmmt. tam cc cc&&gn army or OdKr &cmsft vj& . md a ot
It"Ma to Which ah ccadcaft
This cartifiede is asmd xs a F - orinjimmomfim ady =d coafmx so x4* apm yv% dAe cmff
This tafificase is " as ias� policy and dom mot an=W kcdoMWer.
policy R" abom W &Uff GO cuvmgc aZm*d by dke
If dus policy is camodIcd bcf= &e sbdod cqiratim dair, Liberty AfidmI vK7R ca&m rom to nefify you of swch
CascensfiaL %.0
AUnKROMROKEWWATM
La3EKrYJdUrULALVASULA]IMGIt0M
cc: Insmek Pnxbmm cdXccoffd:
OWEM CORNM FINMHED RASEMENT ANDKW G GORDON INC
960 IXMNrME Sr P 0 BOX ",g
..CANTOK IWA CMI NORVASU, MA 02061
03126Z2905 THU 12:36 M/n NO $1441 Q002
A9P
BD
PRODUCER
Kaplansky I I
n'
114 Harvard S
Brookline HA
Phone: 617-731
INSURED
R%� t
D A
960 T
Canto
f-OVEKAI.PIE4
TK POLICIES OF INSURANCE LISTED BELOW KkVE BEEN ISSUED TO THE INSURED t4wM ABCApE FOR TNE PoL ICY PERK)o N)ICATED. NOTynIsTANDImG
ANY REOUFRB*NT TERDA OR OW)MON OF ANY CONTRACT OR OTHER DOCUNIENT WITH RESPECT TO V"CH TKS CERTIFICATE WkY BE ISSUED OR
WAY PERTAIN. T�C INSURANCE AffOFdXD BY TIE POLICIES DESCRSEO WREIN IS SLALECT TO ALL THE TEFW. 04CLUSIONS AND CONDITIONS OF SUCH
POLICES. AGGREGATE UINTS SFIOWN WAY KAVE BEEN REDLOM) BY PAID CLAAG.
LTR
NSO
TYPE OF INSURANCE
POLICY MAIGER
DATE PWAXXYY)
rLx-JLT"P'IKAFIVN
DATE OWAXYM
Lmn
A
GENERAL LIABILITY
CON94ERCIAL GENERAL LIABILITY
Ia.,Yms wcE 0 OCCUR
X Business Owners
R0309626
02/10/05
02/10/06
EACH OCCURRENCE 1000000
PREMISES (E,-omo4mcumm,) 100000
IAM OP (" one parson) S 5000
PEJISOI�m & ADV NAM $1000000
GENEPAL AGGREGATE 1; 2000000
GWL AGC*?EGATE LMT APKIES PER.
POLICY F-1 ' F] LOC
JECT
PRODUCTS - cowtop AGG s2000000
AUTOMOBILE LASLM
ANY AM
ALL OWNED AUTOS
SCHEDULED XJt0S
HM AUTOS
WON-OV*4EDxJTOS
COhIBINED SINGLE L04T
jEs scadeort)
8004LY KJURY
(Per P—)
BODILY KJURY
jPer oedd@M
PROPERTY DAMAGE
(Per 80cidam
GAPAGE LABILITY
ANY AUTO
ALTOOKY-EAAOCIDENT $
OTI�EIR 1W EAACC f
AUTO ONLY: AGG S
EXCESSAAABRELLA LL#AKJVY
OCCUR FICLAP& MADE
DEoucn&-E
RETENTION $
EACH OCCURRENCE 6
AGGREGATE
VVOF*QM CO&IP94ATION AM
ElIPLOMRS'LIA"m
ANYPROORVOWAMNERAE)ECUTIVE
OFFICEP4MEWNR CKCLUDECI?
H yes, Oemft uww
SPECIAL PROVISIONS bWow
IT9�ylt F TR
E.L. EACH ACCIDENT
El. DISEASE - EA BAPLOYEE S
E.L. DISEASE - POLICY LILOT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHCLES I EXCLUSIONS ADDED BY ENDORSEWENTI SPECIAL PROVISIONS
(;I:K I I1*K;A It MULIDEK
CANCEUAMN
SHMAD ANY Of THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THMEOF. THE ISVANG INStWR WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO TW CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SKALL
NIOSE NO OBLIGATION! OR LIABKM OF AM KIND UPON IM ROMM ITS AGENTS OR
REPRESENTATIVES.
AC % 0 ACORD CORPORATION 1988
�C\ r"
Board of Building Regulations and S`=a
ndar&
One Ashburton Place - Room 1.301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Regis�- 137943
Tvpe: SuppWvierd Card
Expkatim: lrZW007
OWENS CORNING BASEMENT FINISHING
DANIEL WALSH
960 TURNPIKE ST.
CANTON, MA 02021
S-CA1 0 SM404A"10121c,
67
Board Of BaWag Regshfioss mid Stamdards
HOME IMMOVEMENT CONTRACTOR
P
.nistratio\
R-'\ 137943
�19'j brpk�EWMMM7
OWENS CORNINk*0
KWWWXE'SH "'Z�
960 TURNPIKE ST." .
CANTON. MA 02021 -
Card
- j
Update Address and return card. Mark reason for chang
[:] Address [] Renewal 0 Employment [:] Lost Card
License or registration Yard for individul use only
before the expiration date. If found return to:
Roard of Building Regulations and Standards
One Ashburton Place Rn 1301
Boston, Ma. 02108
Admhdstmtor Not valid without signature
130CA International Evaluation Report B �po tilooll
0
C oil I Pit
A ;` I
1 E
description
OWENS CORNING Basement Wall Finishing
SySteMT11 is an alternative to conventional wall
framing and gypsum wallboard. The Basement
Wall Finishing System"m consists of PVC
support lineals, base, batten, and cove mold-
ings, and rigid prefinished fiberglass panels.
Panels are prefinished with a fabric cover.
Basement Wall Finishing SysteMTIl is primar-
ily intended for installation in residential
applications. Refer to Figure I at the end of
this report for illustrafions of the Basement
Wall Finishing SystemThl.
The Basement Wall Finishing System"Im shall
be installed in accordance with the manufac-
turer*s installation instructions and this report.
Installation typically consists of either me-
chanical fasteners or adhesive fastening or a
combination of both to the supporti-ig sub-
strate. Thermal resistance (R -value) for the
fiberglass panels is 11.
Basement Wall Finishing SystemTh, panels
meet the requirements for classification as a
Class I inten'or finish as tested in accordance
with ASTM E84 and also has demonstrated
that it will not spread fire to the edge of the
specimen or cause flashover in the test room in
accordance with the testing requirements
specified in Section 803.6(2) of the BOCA
National Building Codel,1999.
condition of use
This report is limited to applications and
products as stated herein. BOCA-n intends
that this report be used by the code official to
determine that the report subject complies with
the code requirements specifically addressed,
provided that this product is installed in accor-
dance with the following conditions:
• OWENS CORNING Basement Wall Finish-
ing System"" is intended for finishing walls
in basement applications. Other applications
are outside the scope of this report.
• The maximum permitted area of the PVC
moldings shall not exceed 10 percent of the
aggregate wall and ceiling area of the room.
• Installation of the Basement Wall Finishing
SySteMTM shall be in accordance with this
report and the manufacturer's installation
manual.
Basement Wall Finishing System"m shall be
installed over cast -in-place concrete or
concrete masonry unit walls, or wood or
metal stud framing. Supporfing structural
systems shall conform�ing to code require-
ments for that system and are outside scope
of this report.
IN The electrical wiring in the chase at the
bottom of the Basement Wall Finish Sys-
tern"m shall conform to the requirements of
the code and is outside the scope of this
report.
Items requiring
verification
The following items are related to the use of the
report subject, but are not within the scope of
this evaluation. However, these items are related
to the determination of code compliance.
V Concealed electrical. mechanical, or plumb-
ing components shall be inspected prior to
the installation of the Basement Wall Fin-
ishing System"M panels to verify compli-
ance with related code requirements. Evalu-
ation of these components is outside scope
of this report.
V Framing supporting the Basement Wall
Finishing System""' shall be inspected prior
to the installation of the panels to verify
compliance with related code requirements.
Evaluation of this framing is outside scope
of this report. AIL
Research Report
21e24
MANUFACTURER:
OWENS CORNING
ONE OWENS CORNING PKWY
TOLEDO, OHIO 43659
DIVISION 7 — THERMAL AND
MOISTURE PROTECTION
Section 07200 — Insulation
DIVISION 9 — FINISHES
Section 09540 — Special Wall
Surfaces
EVALUATION SUBJECT:
BASEMENT WALL FINISH
SYSTEMTM
PRINTED AUGUST, 2000
Page 1 of 2
CopynghtC 2000,
BOCA Evaluation Services, Inc.
A Participating Member
of the NES, Inc.
Page 2 of 2 Research Report No. 21-24
information submitted
a IntegreXTm Testing Systems, Report No. 73143. dated April 17,
2000, containing results of physical testing.
• IntegreXTm Testing Systems, Report No. C423-99065, dated
August 19, 1999, containing results of physical testing.
• Omega Point Laboratories, Report No. 13060-103216a, dated
May 14, 1999, containing results for fire testing in accordance
with ASTM E84 for rigid fiberglass wall panels used in
Basement Wall Firtishing SysteMTM.
Omega Point Laboratories, Report No. 16218-106644. dated
April 13,2000, containing results for fire testing in accordance
with ASTM E84 for moldings used in Basement Wall Finish-
ing SysternTM.
Omega Point Laboratories, Report No. 13060-103213a, dated
June 7. 1998. and Report No. 13060-104470a, dated March
24, 1999, containing results for fire testing for full-scale room
comer testing in accordance with requirements contained in
Section 803.6 (2) of the BOCA National Building Codel]999.
OWENS CORNING Product Literature, dated May 1998.
OWENS CORNING Submittal Sheet for Basement Wall
Finishing S�ystem (BWFS), dated April 2000.
OWENS CORNING Basement Wall Finishing SYstem
Installation Manual, dated January 2000.
application for permit
To aid in the determination of compliance with this report, the
following represents the rn�inimum level of information to
accompany the application for permit:
• The language "See BOCA Evaluation Services. Inc. Research
Report No. 21-24" or a copy of this report.
• Plans indicating the aggregate area of the room and the area of
the PVC moldings being used.
• Plans and specifications of any electrical, mechanical, or
plumbing items installed within the wall system.
• Details and specifications of the supporting construction to
which the system is to be applied.
product identification
All OWENS CORNING Basement Wall Finishing SysternSTM
manufactured in accordance with this research report shall bear
the following idenfification:
"See BOCA Evaluation Services, Inc. Research Report No.
21-24."
.AIL
%12
All Molding
Snaps
into
PVC
Support
Grid
Existing Foundation Wall
or Interior Partition
2.5" Glass
Fiber Board
Panel with
Facing
PVC
3
r
eG
B
I
cinI
0
w
a
gs
a
its
rd
h4
Cove
Molding
rt
PVC Support
Lineal
(top, bottom,
vertically
every 48")
PVC
Molding
Vertical PVC
Batten Molding
Base
Figure 1 *
Sketch of Basement Wall Finish SystemTm
Showing Typical Components
*THIS DRAWING IS FOR ILLUSTRATION PURPOSES ONLY. IT IS NOT
INTENDED FOR USE AS A CONSTRUCTION DOCUMENT FOR THE
PURPOSE OF DESIGN, FABRICATION OR ERECTION.
NOTICE TO REPORT USERS 0
This report is subject to annual certification. Reports that are not certified shall not be used or referred to. To determine the status of certification of this
report. contact BOCA Evaluation Services. Inc., or consult the latest edition of the BOCA Intemational Product Evaluation Listing published periodically
in the BOCA magazine.
L_
This report is subject to the conditions listed herein and to the specific product, data and test reports submitted by the applicant requesting this report.
Independent test were not performed by BOCA Evaluation Services, Inc. and BOCA-ES specifically does not make any warranty, either expressed or
implied, as to any findings or other matter in this report or as to any product covered by this report. Evaluation reports are not to be construed as
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Please contact BOCA Evaluation Services, Inc., with any questions you may have regarding thk report. Additionally, please contact us if you
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I
4051 West Flossmoor Road *Country Club Hi i 111s, IL 60478-5795
telephone (708) 799-2305 a tax (708) 799-0310
e-mail: boca-es@bocal.org 9 hftp: //www.bocai.org
FORM U - LOT RELEASE FORM
4�
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 Lb,,K, (0&411,06 SS'F PHONE
L LOCATION: Assessor's Map Number PARCELN 2;?
S SUBDIVISION LOT (S)
t
TREET_ FUU4Y ln6l&kd 26,qd ST. NUMBER
FS(I
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR
COMMENTS
TOWN PLANNER
COMMENTS
N r-.,FP.O INSPECTC
INSPECTO
CO
DATEAPPROVED
DATE REJECTED
DATEAPPROVED
DATE REJECTED
DATEAPPROVED
DATE REJECTED
DA'
REJECTED
1 40
PUBLIC WORKS - SEWERIWATER CONNEC
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
2 7 Fullermeadow Lane
The Barrett Residence
On January 24, 2006 1 spoke to Mrs. Barrett on 27
Fullermeadow Lane. Mrs. Barrett would like to enter into
an agreement with the Health Dept. regarding her Title V
(Conditional Pass). Mrs. Barrett would like to go forward
with refinishing her basement and needs sign off from the
Health Dept. and would like to fix her cracked Septic
Tank in the spring.
Barrett will need to provide the Health Dept. with the
following
1. Written estimate from a Licensed Septic Installer
2. Written commitment between Installer and
Homeowner with financial deposit.
3. Title V re -inspection 6 months after the agreement has
been signed.
Cc: Building Department
j — /,-/ - C' I -
Date ..............
"ORT01
TOWN OF NORTH ANDOVER
0
PERMIT FOR PLUMBING
AC04US
This certifies that ... ...... ...............
has permission to perform ...... ILA— 17 ........................
.�/' '( .I /'("
plumbing in the buildings of ...........................
at . . .,�. / ... r�� ( .(-� /�. . rl( . . 7,, North Andover, Mass.
Fee. d.� .... Lic. No.. . (� .3.2 . ......... � T ........
PL6M'B'1'N`G' INSPECTOR
Check # L/'/3 � ,
5239
Q� 3 Y,
41
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO'PLUMBING
(Print or Type)
f Mass. Date ermit #
Building LocatioQCQ,h52&ZV_VQ62da wner's Naiftsk)�2n���
-Type of Occupancy Residential
New H Renovation Replacement Plans Submitted: Yes El No El
FIXTURES
Installing Company Nanne Heritage Htg. &P1g. Co. Inc.
Check one: Certificate
Address 3.1 ant Street IX Corporation 714
Stoneham, Ma 02180 F-1 Partnership
Business Telephone 781 -
A3_8 -_713-6— F-1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insuiance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No 1-1
If you have checked )��s, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy IN Other type of indemnity Ej Bond 11
OWNER'S INSURANCE WAIVEri: 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 C)wner's Agent Owner EJ Agent EJ
I hereby certify that all of the detail� and infou-nation 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 pofmit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State PlumbinVode and Chapter 14 of the.General Laws.
-i- --f1i — - 1, 1 "?
Title Sig a ufe o c nse ru 1-11 F707
City/Town Type of Liconse Master I y,, Journeyman Fj
APIPPOWD (0TF1C_EUSE__0N_CYj_ License Number 8322
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BASEMENT
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2 N D FLOOR
3RO FLOOR
4TH FLOOR
5TH FLOOR
6TIi F L 00 H
7TH FLOOR
STH FLOOR
Installing Company Nanne Heritage Htg. &P1g. Co. Inc.
Check one: Certificate
Address 3.1 ant Street IX Corporation 714
Stoneham, Ma 02180 F-1 Partnership
Business Telephone 781 -
A3_8 -_713-6— F-1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insuiance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes N No 1-1
If you have checked )��s, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy IN Other type of indemnity Ej Bond 11
OWNER'S INSURANCE WAIVEri: 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 C)wner's Agent Owner EJ Agent EJ
I hereby certify that all of the detail� and infou-nation 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 pofmit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State PlumbinVode and Chapter 14 of the.General Laws.
-i- --f1i — - 1, 1 "?
Title Sig a ufe o c nse ru 1-11 F707
City/Town Type of Liconse Master I y,, Journeyman Fj
APIPPOWD (0TF1C_EUSE__0N_CYj_ License Number 8322
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(flmmonweafg ol Ma6iackud&s official Usc Only
2,pa.-�,..l .15im S .. icaj Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perrom-ted in accoidance with the klassachuscits Electrical Code (NIEC), 527 CNIR 12.60
(PLEASE PRINT IN INK OR TYPEALL INF-ORMA 77ON) Date: - V 0'. �—' I L-) It D ') �-
City or Town of: ��) To Me hispeclor of Wire's:
By this application the undersi-iied gives notice of his or her intenti perforni the electrical work d
z: - 0 .. .... ) I - ) k' y
Location (Street & Number) ')�l V,\\jLr '��jt.C'SIL Fftft a P
Owner or Tenant o" I- TcleplioneNo.01_)�
Owner's Address
Is (his perinit in conjunction with a building pcirniii? Yes [J"' NoE] (Check Approprinte Box)
Purpose of Building Utility Aulljorization No.
Existing Scrviccl�ly_� Anips Y�0 / '140IVolts Overhead [3"""' Undgrd No. or IN-leters
New Service A nips Vults Overhend Undgrd No. of IN-leters
Number of Feeders 2nd Arnpacity
Location and Nature or Proposed Electrical Work�'�_t
Completion orthe folluiving table may be iraiml bv dic 111SPAZctor of Wires.
No. of Recessed Fixtures jNo.
of Ccil.-Susp. (Paddle) Falls
No. of Total
Transformers KVA
No. or Lighting Outlets
No. of I -lot Tubs
Generators KVA
-No. ofLighthrg.Fixtures
Above [I In-
Swimming Pool grnd._ Zrnd.
No. ol Emergency Lighting
Battery Units
No. of Receptacle Outlets C)
No. of Oil Burners
FIRE ALARNIS
jNo. of Zones
No. of Switches
No. of Gas Burners
Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Hc2tPutip
Totals:
N-uniberiTons
lKW
No. of Self-Cont2ined
De(ectiou/Alerting Devices
I
I
No. of Dishwashers
Space/Area Heating 1(W
Local 0 ly"unicipal D Other
Connection
No. of Dryers
Heating Appli2nces KW
Security Sys(ems:
No. of Devices or Equivalent
No. of Water KW
Henters
No. Of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydroinassane Bathtubs
b
No. of Motors Total ]UP
Telecommu n ica t ions lirin F:
D g
No. of evices or Equivalent
OTHER:
Anach additionai detad ifdestred. or as required by the inspector oj wires.
INSUR.10CE 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 cove
,9ge is in rorce, and has exhibited proororsanie to (lie permit issuing office.
CHECK ONE: INSUPLANCE Ej� BOND [I. 0'111ER [] (Specify:) � �� N�'�
Estimated Value of Electrical Work: \ )_0 C) (When required by municipal policy.)
Work to Start:
I certify, untler the
FIRM NAINIE:
Licensce:
(1fapplicable. enj
Address: 1�)
OWNER'S IN!
required by law
Owncr/Ag, cnt
Signature
(Ex�jrati6n Dale)
inspections to be requested in accordance with MEC Rule I 0,and upon conipletion.
a�dpenalttes ®rf that the injorniation on this application is true and coinplet,
r-\ LIC. NO.:
LIC. NO.:
)E 11 Sionature.
cl) 1.
I . the ficem%nuniber line.1 Bus. Tel. No.:
AII.Tel.No.
JRANCE NVAIVER: I ain aware lhatfthe I icell-See does not have the liability insurance coverage norma ly
By my signature below, I hereby waivc this requirement. lain the (check otic) [] owiler [] owner's agent.
Telephone No. —FP—ER MI T T- E- E: S