HomeMy WebLinkAboutMiscellaneous - 30 PROSPECT STREET 4/30/2018 (5)(603) 894-6465
(800) 621-1189
(603) 894-7044 FAX
Air Quality Experts, Inc.
Asbestos Removal
23 Hall Farm Road Residential-Commercial-IndustriaI
Atkinson, NH 03811 AirQualityExperts@AQENH..Com'
r mm I n I
rg -� toil
March 4, 2011 TOWN OF NORTH ANDOVER
I HEALTH DEPARTIMMENT
North Andover Health Department
146 Main Street
North Andover, MA 0 1845
Dear Sir:
Enclosed please find a copy of notification sent to the state for an Asbestos
Abatement Project.
The job will take place on March 14, 2011.
Project: Anne Waldrep
39 Prescott Street
Any questions concerning this matter should be directed to my attention.
Sincerely,
Christoph er Thompso n
President
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
M MW
---
INSTRUCTIONS
1. All sections of this
form must be
completed in order
to comply with
DEP notification
requirements of 310
CIAR 7.15
and the Division
of Occupational
Safety (DOS)
notification
requirements of 453
CMR 6.12
9�- C
N
ILL
Commonwealth of Massachusetts
1100121648
Asbestos Notification Form ANF -001 Decal Number
A. Asbestos Abatement Description
a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied
residence of four units or less? F71 Yes F� No
b. Provide blanket decal number if applicable-.
2. Facility Location:
JANNE WALDREP
[a. Name of Facility EMA
North Andover
c. Cityrrown d. State
I I
Blanket Decal Number
139 PRESCOTT STREET
b. Street Address
101845 F7
e. Zip Code f. Telephone Number
3. Worksite Location:
JIBASEMENT 7 F- 1
a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room
4. Is the facility occupied? R,/ Yes R No
5.
Asbestos Contractor:
JAIR QUALITY EXPERTS INC
a. Name
IATKINSON
c. City/Town d. Zip Code
[AC0001 67
f. DOS License Number
6. IBRUCE W HOPKINS
a. Name of On -Site Supervisor/Foreman
7. FN/A
a. Name of Prpject Monitor
8. [N/A
a. Name of Asbestos Anal)�ical Lab
9. [37/147/2011
a. Project Start Date (mm/ddLyM)
17AM-5PM
c. Work hours Mon -Fri.
10. a. What type of project is this?
Demolition 2] Renovation
Repair El Other, please specify: b. Describe
11. a. Check abatement procedures:
E 23 HALL FARM ROAD
b. Address
16038946465
e. Telephone Number
g. Contract Type: R] Written El Verbal
nv' Glove bag
El Enclosure
n Cleanup
El Full containment
El Encapsulation
Q Disposal only
Ej Other, specify:
b. Describe
12. Is the job being conducted: 2 indoors? F� Outdoors?
E anfO01 ap.doc - 10/02 Asbestos Notification Form - Page 1 of 3 0
L V,
IAI�
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N
0
0
LL
Commonwealth of Massachusetts
Asbestos Notification Form ANF -001
A. Asbestos Abatement Description (cont.)
IF0012-1648
Decal Number
13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
encai)sulated:
187 1 10 1
a. Total pipes or ducts (linear ft) 1). 1 otal other surfaces (square ft)
1. Specify
14. Describe the decontamination system(s) to be used:
IGLOVE BAG PROCEDURES
15. Describe the containerization/disposal methods to comply with 310 CIVIR 7.15 and 453 CIVIR
6.140 (a):
2 PLY POLY
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
I- ___1 F :1
a. Name of DEP Official b. Title
I I E
c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver#
e. Name of DOS Official t. DOS Official Title
g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver#
17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? [] Yes [Z] No
B. Facility Description
1. Current or prior use of facility: IRESIDENTIAL
2. Is the facility owner -occupied residential with 4 units or less? 0 Yes El No
3. =ANNE WALDREP F397PRESCOTT STREET'
a. Facility Owner Name b. Address
[NORTH ANDOVER, MA 1 101845 1 1
1 C. City/Town d. Zip Code e. Telephone Number (area �Je
4. F_
a. Name of Facility owner's On -Site Manager b. On -Site Manager Address
I - I E7-7 I
c. City/Town d. Zip Code e. Telephone Number (area code
0 anf001 ap.doc - 10/02 Asbestos Notification Form - Page 2 of 3 0
c. Boiler, breaching, duct, tank
d. Insulating cement
surface coatings
Lin. ft.
e. Corrugated or layered paper
187
pipe insulation
Lin. ft.
h. Transite board, wall board
I
g. Spray -on fireproofing
Lin. ft.
Lin. ft.
I
i. Cloths, woven fabrics
Lin. ft.
So. ft.
k. Thermal, solid core pipe
I
insulation
Lin. ft.
1. Specify
14. Describe the decontamination system(s) to be used:
IGLOVE BAG PROCEDURES
15. Describe the containerization/disposal methods to comply with 310 CIVIR 7.15 and 453 CIVIR
6.140 (a):
2 PLY POLY
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
I- ___1 F :1
a. Name of DEP Official b. Title
I I E
c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver#
e. Name of DOS Official t. DOS Official Title
g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver#
17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? [] Yes [Z] No
B. Facility Description
1. Current or prior use of facility: IRESIDENTIAL
2. Is the facility owner -occupied residential with 4 units or less? 0 Yes El No
3. =ANNE WALDREP F397PRESCOTT STREET'
a. Facility Owner Name b. Address
[NORTH ANDOVER, MA 1 101845 1 1
1 C. City/Town d. Zip Code e. Telephone Number (area �Je
4. F_
a. Name of Facility owner's On -Site Manager b. On -Site Manager Address
I - I E7-7 I
c. City/Town d. Zip Code e. Telephone Number (area code
0 anf001 ap.doc - 10/02 Asbestos Notification Form - Page 2 of 3 0
d. Insulating cement
Li
Sq. ft.
f. Trowel/Sprayer coatings
Lin. ft.
Sq. ft.
h. Transite board, wall board
Lin. ft.
i. Other, please specify:
So. ft.
1. Specify
14. Describe the decontamination system(s) to be used:
IGLOVE BAG PROCEDURES
15. Describe the containerization/disposal methods to comply with 310 CIVIR 7.15 and 453 CIVIR
6.140 (a):
2 PLY POLY
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
I- ___1 F :1
a. Name of DEP Official b. Title
I I E
c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver#
e. Name of DOS Official t. DOS Official Title
g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver#
17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? [] Yes [Z] No
B. Facility Description
1. Current or prior use of facility: IRESIDENTIAL
2. Is the facility owner -occupied residential with 4 units or less? 0 Yes El No
3. =ANNE WALDREP F397PRESCOTT STREET'
a. Facility Owner Name b. Address
[NORTH ANDOVER, MA 1 101845 1 1
1 C. City/Town d. Zip Code e. Telephone Number (area �Je
4. F_
a. Name of Facility owner's On -Site Manager b. On -Site Manager Address
I - I E7-7 I
c. City/Town d. Zip Code e. Telephone Number (area code
0 anf001 ap.doc - 10/02 Asbestos Notification Form - Page 2 of 3 0
Commonwealth of Massachusetts
Asbestos Notification Form ANF -001
Ll� �' -
Note: Transfer
Stations must
comply with the
Solid Waste
Division
Regulations 310
CIVIR 19.000
C
�c
N
C
B. Facility Description (cont.)
5. a. Name of
Workers Comp.
6. What is the size of this facility?
1100121648
Decal Number
C. Asbestos Transportation and Disposal
1. Transporter of asbestos -containing material from site to temporary storage site (if necessary):
[AIR QUALITY EXPERTS, INC.
a. Name of Transporter
I -
c. City/Town d. Zip Code
2. Transporter of asbestos -containing waste material
ISERVICE TRANSPORT GROUP, INC.
a. Name of Transporter
[BRISTOL, PA
c. City/Town
d. Zip Code
[3/11/2011
c. Positionrritle
[6038946465 ___J
a. Refuse Transfer Station and Owner
c. Cityrrown
d. Zip Code
4. IMINERVA ENTERPRISES INC
f. Representinq
a. Final Disposal Site Location Name
1�000 MINERVA ROAD
c. Final DisDosal Site Address
JOH
e. State
f. Zip Code
D. Certification
The undersigned hereby states, under the
penalties of perjury, that he/she has read the
Commonwealth of Massachusetts regulations
for the Removal, Containment or
Encapsulation of Asbestos, 453 CIVIR 6.00 and
3-10 CRAR 7.15, and that the information
contained in this notification is true and correct
to the best of his/her knowledge and belief.
I I
b. Address
I I
e. Telephone Number
from removal/temporary site to final disposal site:
FPO BOX 2132
b. Address
[8779999559
g. I elephone Number
[CHRISTOPHER THOMPS
lChristop her Thompson
a. Name
b. Authorized Signature
[3/11/2011
c. Positionrritle
[6038946465 ___J
d. Date (mm/dd/tyyyy)
JAIR QUALITY EXPERTS,
e. Telephone Number
f. Representinq
M ROAD
a. Address
IATKINSON, NH 7
103811
h. City/Town
i. Zip Code
0 anfOO 1 ap.doc - 10/02 Asbestos Notification Form - Page 3 of 3 0
............
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
17(l
This certifies ).,/ ....................
has permission for gas installation ............
in the bui
....................
at ......
.......................... North Andover, Mass.
.... Lic. .. ............
No. 1 .4 -'�A--S 960 R
GA INSP -
Check #
6424
10,4
MASSACHUSETrS UNIFORM APPUCATON FORPERMrr TO DO GAS WFIN9
(Type or print) Date
.
NORTH ANDOVER, MASSACHUSETTS
Building Lo�ations
Owner's Name
New Renovation El Replacement
SU B-BASEM ENT
FASEM ENT
IST. IF L 0 0 R
FN D. IF L 0 0 i
3 R D IF L 0 0 R
4 T H IF L 0 0 R
5 T H IF L 0 0 R
6 T H IF L 0 TIR
7 T H IF L 0 0 R
8 T H IF L 0 0 R
Permit# W/ '-/-a Z,/
Amount $
Plans Submitted
>4 z z 160
>
Z
W UW ;9
I- z >
z
W > z Z
(Print or type)
Check one: Certificate Installing Company
Name Corp.
Address
ElPartner.
-7 14
Busjnes—sTe =ep one _3'
Finn/Co.
Name of Licensed Plumber'or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability insurance, policy or it's substantial equivalent. Yes NoO
If you have checked Yes, please in ic e the type coverage by che 1.1
Liability insurance policy rM�0` cking the appropriate box.r
Other type, of indemnity 1:1 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that'my signature on this permit appfication—waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
I hereby certify that all 13
of the details and information I have submitted (or entered) in above application are true and accurate to the
best o - f , 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 Massachusetts State GE"de and C�apter 142 of
4the General Laws.
-.7 - -
Title
City/Town,
APPROV, ED (OFFICE USE ONLY)
Signature ofe
Plumber
Gas Fitter
Xaster
Joumeyman
sed'Plumber Or Gas Fitter
4 ZZ, L
License Number
Date. ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
CHU
This certifies that ...... ..................
has permission for gas installation ..'. C.13
.....................
in the buildings of . . ..........................
at ..... F. C North Andover, Mass.
Fee. Lic. No.
S. ......
/dA INSPECT6
Check
6404
MASSACHUSETrS UNIFORM APP11CAT'ON FOR PERNIrr TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date
Y
Building Loqations
Permit #
Owner's
Name
Amount
New El Renovation
Replacement
Plans Submitted
C4
0
U
U
R
W
g
C9
Z
C9
z
f7 -
z
Z
C4
U
Z
C4
>
Z, <
Z
>
0
0
<
>
z
0
0
0
Z
W
U
�U B-BASEM ENT
4
U
rg
>
B A S E M E N T
IST. IF L 0 0 R
!N D. IF L 0 0 R
3 R D . IF L 0 0 R
4 T H . IF L 0 0 R
5 T H . IF L 0 0 R
TT H . IF L 0 0 R
7 T H . IF L 0 0 R
8 T H . IF L 0 0 R
(Print or type)
Name Check one: Certificate Installing Company
Corp.
Address
Partner.
Business I elephone 19 lWe�— 7-7 7 3; Firm/Co.
Name of Licensed Plumber'or Gas Fitter
N
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. Yes13 NoO
If you have checked Yes, please indicate the type coverage by checking the appropriate box.
ty naurance policy U Other type of indemnity 13 Bond 13
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that'my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent Check one:
Owner 13 Agent 13
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of , my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Sg&?nd Chapter 14
Q,9f the Lziuwal Laws.
By:
Title
City/Town
APPRO ED (OFFICE USE ONLY)
Signature of 1
Plumber
[3Gas Fitter
rs/Master
Journeyman
sea.,Plumber 01; Gas Fitter
7 —ce—n—s eTu- m S e r
-2— t41-06
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
-B-k
This certifies that ............. / .... I ... 7 .................
has permission to perform .......... ..,116
..................................
wiring in the building of ....... ..........................
at ........... ... e..e.p. ............. .............. North Andover, Mass.
ele 44.* 1�1�
Fee ..................... Lic. No.
Check #
6811
i
23
10/19/2004 14:43 9783742337
HAVERHILL HEALTH DEP
PAGE 01/01
usete5 6ii—only
Pand No.
-ftqarfteyu of F&e Sff vim.
OcctTmay md Pei CVxW
130ARD OF FIRE PRWENTION REGULATIONS En 91053 , - �
APPLICATION FOR PERMITTO PERFORM' ELECTRICALWORK
uffz T04WITOV Dab;
City or Town 6f.- -[T�T AvNcbv-c-r- To Ow Impemr of Wires:
By this WPHC4100n ON
punotmofbis imenfica to PW&m 63.0ketrical work dmri)cd Wow
L0c4tumM&eiat&Nmnber) 31 ?rv._Sc_0t1E 61t,
OwnerarTm=t 4-t" idcd4rcp . --
Owner's Addrtss ca- Tekph"e AN%
- -.!g R vvc-e--
h this PWV* im.mmiumem WRh a buaft pumda Yes (c b, ,, k A p p -m, &
Papmof Ud* Auftarhmdon No.
Edsdng Service Araps i Volts Ovakead [] 'Un*4 n 1%. af Neftm
&'W.§Wft Amps _yoks OvWheW D Undpd No. of Mde"
Nmmbw of Feed&* and AMpadty
Lomdm and 14stgre of ftmosed WaMmi Work. 1,q i
No. ofAmema LmWnsk"
No. of cal4upip. QW&) pas
f4ft
Trmyormn jcvA
No. of i4m*udm Owk1s
ft of Not T�Abz
KVA
Me Of Luminah"
mmuning !22!= 0 jib- 0,
1149. er
No. of Re&qft& Outku
No. of On Burnom
FM ALARMS 1�9,
of Zmes
No. 9f 6whches
NIL of Go alums
IN& OtAftWeVAm and
NAL of Rangei
No. of Air Cm&
r4c. af Alm -&g Dew=
No. ofWasta Dhpomn
Tamui—
Irm
pocaf
No. of Dbhwasbers
SpacafArea ffindag KW
NO. Of Dryen
ReadegApplemas KW
N a, V Wn —W—'
of
N4
I
41L 'Of
m R02ft
--vu
[4,
of or
No. Hy&vmusage Balhtaft
0. of MWturs TOWEP
B44mted V" dmecumd WO& Aawk aMUmad A' 2W lf&sb 14 or W peq&n 4 by ik JWpemr Of Fm
(WhWmp!Wby=mi*9pWky,)
f.0,be
W0* ia mmt 2 '7 in dwmb= vii& MW Jhk 10, and qm C=Vkfwm
ECURAM= COWMA"'.—Uldw vuvcd by ft ownw, no pa=zt far &a paam=m of chmulad wv& my mm ude*
the wvcmp orft m*atR&W 0*&SIML rm
.rcm*),,wzder&W0, md
an d* #Ap&mam & &w and compkm
MW NAM: Jr- N6.
tJC-NO.-.
Bft Tat No.;
AA&i%m
*Smm�Y SYAm Cmm*Dr 1*== mpavd for On wot*,- if TOT. No.;
amucablc� mnu*a--
OUIM'S INSU&4NCE WAWM- I = gwm *g am Jjm8eidow nd hm &e habft kmme covaage uQuaally
.rcquimdbyWw, DYMY SOW= below, I hmbvvmn tb=,raV*=e& likmthe(cbeek
ow) Q ownm Q owriees amt.
pm Wu PETS.- $
4A -
If.) c 19 Lf �c-
Location
Date
40ftTh
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee,
Other Permit Fee
-SbWer Connection Fee
Water Connection Fee
$
$
Building Inspector
Div. Public Works
PER111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE I
M A P
LOT NO. -0
-Aro.
2 RECORD OF OWNERSHIP IDATE
)K ;PAGE
ZONE qq
SUB DIV. C -0
I
H.I.C. #
LOCATION SXo-,e:f
PURPOSE OF BUILDING
OWNI
NO. OF STORIES SIZE
OWNER'S ADDRESS
.2
13ASEMENT OR SLAB - jf
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 3RD
ND 42x
BUILDER*S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
� ff-1
POSTS
DISTANCE FROM LOT LINES - SIDES/�2j� /f Y,&REAR
yOA
GIRDERS
AREA OF LOT FRONTAGE Ma
HEIGHT OF FOUNDATION
THICKNESS
IS BUILDING NEW
SIZE OF FOOTING
x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM Td REQUIREMENTS OF CODE
ye5
IS BUILDING CONNECTED TO TOWN WATER
y
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
Ye-�5
IS BUILDING CONNECTED TO NATURAL GAS LINE
0 Akl A /�Xf' INSTRUCTIONS
SEE BOTH SIDES
PAGE I 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 FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILEA
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E
.PERMIT GRANTED
19
11
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
YOOV� DUILDING INSPECTOR
OWNER TEL. #
L1q,-?02
CONTR. TEL. #
CONTR. LIC. #
H.I.C. #
BUild"V'NO RECORD
I OCCUPANCY 12
SINGLE FAMILY
V
SI-ORIES
MULTI. FAMIL
OFFICES
APARTMENTS
I
CONSTRUCTION
2 FOUNDATION
CONCRETE
CONCRETE BL K.
BRICK OR STONE
PIERS
8 INTERIOR
a
PINE
HARDW D
PLASTER
--6RY WALL
UNFIN. V
FINISH
1
2
13
3 BASEMENT
AREA FULL
FIN. B M*T AREA
114 1/2
FIN. ATTIC AREA
tLO 8 M T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN__
4 WALLS 9 FLOORS
CLAPBOARDS
B
1
2 3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
CONCRETE
EARTH
HARI'll D
COMIACN
ASPH. TILE
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. & FLOOR
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR IVI Po R
ADEQUATE N NE
5 ROOF
10 PLUMBING
GABLE
I
I HIP
BATH 13 FIX.)
GAMBREL
MANSARD
TOILET RM. f2 FIX.)
FLAT
-�IHED
WATER,CLOSET
ASPHALT SHINGLES
V
LAVATORY
WOOD SHINGES
KITCHEN-SiNK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATI;7G
WOOD JOIST
PIPELESS FURNACE
_y
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & I.S.
HOT W T'R OR VAPOR
WOOD RAFTER
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
OIL
7 NO. OF ROOMS
j7M - �Tj�
21d
3,d
LECTRIC
N HEATING
0
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
C,
J , '.
I
I
1vf
lt� W ,C1fXd4
'Z, , .
a Y9, d, Ar
111'e- V/ 1?"galc �IF6#
lee, w
41EYv RF,4R Dal?10,Fle �#-r w f , /;? /0/ 7-C11 ROOF
LLI I FM
Effi Effi H
IVFW WINDaW-S
LL. I I L -L ---L
H+
e
F V14T)OAI
XT
POOP
+
6,49A 65
EEE
FRONT FLFW10Y.
� / ��fe � 7S, �, �- �r— 5 f—
k
Ian
Any appeal shall be filed
'4�49 &'
within (20) days after the
date of filing of this TOWN OF NORTH ANDOVER
Notice in the office MASSACHUSETTS
of the -rown Clerk.
BOARD QF APPEALS
NOTICE OF. DECISION
Th" to COMY ftt twt,---ty (20) daya
�'� ftwd fMm &W of dwisign ffi9d
WkhoUt fifirig of an appML
Dat
Joyce A. Brdftw
Town clak
Date
B K
4 3 8 ]"1 PE 16
,N'D'RT.H
4NDDVER
G L
b
August 17, 1995
Petition No. 040-95
Date of Hearing.:��st�8 1995
Petition of Peter & Eleanor Cox
Premises affected 30 Prospect Street
iation from the require:-.,erts
Referring to the -above petition for a var
of Section 7, para. 7.1,7.2,&7.3 and Table 2 of the Zoning Bylaw so as
to permit relief of 4,655 S.F. of lot dimensional area frorn the
required 12,500 S.F., relief of 9.92 feet from the street frontage
requirement of 100 feet, relief of 12 feet for the shed from the side
setback requirement of 15 feet, relief of 27 feet for the shed from
the rear setback requirement of 30 feet, relief of 2.5 feet for the
garage from the side setback requirement of 15 feet and relief of
12.9 feet for the deck from the rear setback requirement of 30 feet.
The applicant is also seeking a Special Permit under Section 9, para.
9.2 so as to expand a legal non -conforming structure.
This decision will not address the reliefs requested for the shed.
d of Appe-7-Is
After a public hearing given on the above date, the Boar
and hereby
voted to Grant the Variances & Special Permit-
4- +-r):
authorize the Building Inspector to issue a ee-,
Peter & Eleanor Cox
for the construction of the above work, based upon the
conditions: See attatchmdnt.
ATTEIST'_
'&,ie Cqpy.
Town Ckeric
Pe e,
,&Irth Aqhror)
Board of Appeals,
William Sullivan, Chairman
Jos a Dallone
Sc len McIntyre
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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR,12:00
Office Use Only
Permit No. .366) —
Occupancy& Fee Checked
3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ZZ 30
(X)� or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to
Location (Street & Number
rm the electrical work described below.
Owner or Tenant 1(-t- C "—I-> 1k,
Owner's Address
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
Purpose of Building A -S i Zlevr C ef - Utility Authorization No
Existing Service 100) Amps -L2-0-1 q6 Volts Overhead Undgrnd
New Service — Amps —Volts Overhead Undgmd
Number of Feeders and Ampacity
No. of Meters 1
No. of Meters
Loc ation and Nature of Proposed Electrigal Work* a?, WJ F400rz_ AJJifT1qtu
Cr
No.
of Lighting Outlets
F3
No. of Hot Tubs
No. of Transformers Total
KVA
No.
of Lighting Fixtures
Swimming Pool Above i —,
grnd.
In-
grnd.
Generators KVA
No. of Emergency Lighting
No.
of Rece.otacie Outlets I;t 0
No. of Oil Burners
Battery Units
No.
of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No at Detection and
No. at Ranges No. rf Air Cond. . iotal
tons
In*itiating Oevicps
No. of Sounding Devices
No. at Self Contained
No. of Disposals
f H�,era' Total 'Tital
No.7o
P.umas Tons KW
No.
of Dishwashers
Space/Area H,,miting
KW
Detection/Sounding Devices
Municipal
Local n Other
Cannectio
No. of Dryers
Heating r lFcAl
Devices
No. of No. Of
Low Voltage
Nu.
of Water Heaters K1.1V
Signs- Ballasts
Wiring
No.
Hydra Massage Tubs
No. of Motors Total HP
OTHER:
Lellbf-6 SeP—V i CE. . tfr'dTXN-r-9,' El PE To COPA rOILM WIN N&W P—OOF PITCO
7-0 a #-0 PCOD11
INSURANCE COVERAGE: Pursuant to the requirements at Massachusetts general Laws
I have a c :�� nt Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES Z_ NO 5<' I
U�m
have submirtled valid proof at same to the Office. YES :: NO Ix If you have checked YES. please indicate the type of coverage by
checking the appropriate box.
INSUfANCE Z BONO :--- OTHER -_7 (Please Specify)
14" . (Expiratian Cate)
Estimated Value of qlectical Work S OC) 0_!i�— —
Work to Start 2, Inspection Date Requested:. Rough W"Ll, CALL- Final
Signed under the Penalties at perjury:
FIRM NAME MAieli nt%"GJ ELetmawmu LIC. NO. Q2_91L_j�
Licensee MAIVI 5200"� Signature I FF LIC. NO. QJq I e6
Sus.Tel.No.
Address IoSiZ IVIAS:�Lj c2T- Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws. and that my signature on this permit applicaean waives this requirement. Owner Agent
(Please c
—telephone No. X_Jv _/;911'$1`pERMIT FEE S
(SignafiTl`at b�;ner or Agent) X-656 5
,-Z
Date .... 2.
q- 366,
%40RTH
TOWN OF NORTH AN D 0 VE R,
0
4L PERMIT FOR WIRI.NG.:?�
All
u
This certifies that ... '41 .......
- Z�4-4
..........
has permission to pe ..... ......
rform MM .. .....
� 4��-e
w ng in thebqilding
iri of ........ ......... .. .... .... .... .................... .
. ............ ......
at ... xw ......... North
.... e4-Avkee-i .... A. 0 as s,.: -
Fee ... . .. ..... Lic.
..... ........
WHITE%�"M:57 CANAR'AlMing DOM.
ELECTRICAL INSVE4�,rOR
BOARD OF FIRE PREVENTION REGULATIONS
(Rev. 11/99) For Oftice Use 0 . My
Permit Number' -7
O=upancy & Foe
APPLICATION FOR PERMIT TO PERFO M' ELEC CAL WO
(Mi. WOFX TO U PWOUM Wrnj nM MASSAGWWM WXMCAL CODE 527 Oa 12-00)
PLEASE PRINT IN INK OR TYPE A LL INFORmA-nON Date: 2
City or Townbf:
ctor-ofWlres:
gned gives notice of his or her intenton to perform the electrical work described ibeloW
By this application the unders�i To the Inspe
Location: (Street & Numbeii,
Owner or Tenant: W.7,
Owner's Address:
Is this permit in conjunction with a Building Permit? Yes a.,- �Noo (qheck Appropriate Box)
Purpose of Building:1- /C 11, , /I/ Utlllty Authorization #:
Existing Service: Amps
C -,Volts
Overhead 3----
Underground.0.
# of
Meters
New Service: _Amps
Volts
Overhead 0
Underground.0
of
Meters:
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work:
No. of Recessed Fbotures
No. of Call.�Suap. (Paddle) Fans
No. Of Ughting Outlets
No. of Hot Tubs
No. of Lighting Fixtures
SwimmIng Pool: Above ground a In Ground c
No. of Receptacle outlets
No. of oli Burners
No. of Swkrhas
No. of Gas Burnam.
No. of Ranges
No. of Air Conditioners TOTAL TONS:
No. Of Waste Disposals
Heat Pump Totals:
Number— TONS: KW:
No. of Dishwashers
Space /Area Heabng:. KW
No. of Dryers
-Healing Appliances KW
No. of Water Heaters KW
No. Of Slgfts'—# of Ballasts:
# of Hydro Massage Tubs
-No. Of Motors— Total HP
No. of Transformers Total KVA
Generators KVA
# of Emergency Lighting Battery Units
Fire Alarms of Zones
# of Detection & Iriftlating Devices_
# Of Sounding Devices:
#Of Self Contained
DGISCIloh/Sounding Devices
Security Systems..
No. of Devices or Equivalent
Data WIring, No.. of Devices or Equivalent
Telecommunications Wiring., No of Devices or
Equivalent
OTHER;
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may Issue I unless the licensee provides proof of liability insurance
including *Completed operation' coverage or Its substantial equiva The undersigned certifies that such coverage Is In force, and has exhibited proof of same to the permit
Issuing office. CHECK ONE, INSURANCE
BOND C3 OTHER 13 please specify:
Est I mated Value of Ele I ctrical Work ; ------ (When required by municipal policy)
Work to Start: 2
Inspections to be requested In accordance with MEC Rule 10, and upon completion.
Firm Name: i Corti under the pains an . d penalties of perjury, that the informs I tion on this application is true and complete.
Licensee:t L
Slg�nature-
-71f Fopplicabie, onto ex
in the llco�
W. nu;.,� �—llnn.)
Address:
21 All. Tel. #
Bus. Tel. #
. '�;e ------------
vvm'v=K; IBM aware that the Licensee 009JS nor n vooneliaollity insurance coverage normally req iredbylaw. By my signature bel
waive this requirement. I BmthO (check one) Ownera OR Agento a O—W. I here—by
Signature of Owner/Agent
Telephone#
PERMrr FEE. S
P6'4)�W
m
N
Date..
40RT#1
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
....... .. ..
has permission to perform ...
plumbing Jn the buildings o .........
at ................ ............. North Andovdr, Mass.
Fee. Lic. N o.,IZAlell.
P
LUMBfNG INSPECTO'R-
Check # 7-V
6431
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETr,&S/
Date,// -,,2(,o — OS—
Building Location 39 P, —CS C6 �amee�g Permit #
f, V Amount
Ty�yofo4pancy
New [3 . Renovation Iff RepLrn�t Plans Submitted Yes, No 13
(Print or type) Check one: Certificate
Installing Company Name ri Corp
0 Partner.
In-'Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box:
"'tiability insurance policy Other type of indemnity Bond 0
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
I hereby certify that all of the details and infor
best of my knowledge and that all plumbing �
compliance with all pertinent provisions of the
D (OFFICE USE ONLY
7" ner 0 Agent 11
Ow
�su
ion I have su tted (or entere n =ab e ape
d
and insta ions c)erform=etMr Is. d
of
Vire true and accurate to the
r ,
is
application will be in
of the General Laws.
Master Xf Journeyman 1:1
T
TOWN OF NORTH ANDOVER
0 41
j . PERMIT FOR WIRING
2.
71'
CHU
This certifies that ..... b ....... ::;�"44— 14�71Z'--77
... ........................... — ..............................
has permission to perform ...... .........
wiring in the building of ......... /V .............................................
It 1"
at ....... .............. ........ No h dover,Mass.
Fee ..................... Lic. No. �f 9.�. ............
ELEcrRICAL INSPECTOe"
Check #
5 7 2- 6
�01
A
28 arLmeAl
BOARD OF FIRE PREVENTION REG TIONS
C
APPLICATION FOR PE TO PERF
. (ALL WORK TO BE PERFORMEDNiM THE MAMCHUWM
PLEASE PRINT IN INK OR TYPE ALL INFORMATION
City or Townof: Lv—
By this application the undersigned gives notice
Location: (Street& Number)_
Owner or Tenant: kv,17-
Owner's
her Intention to
(Rev. 11199) For Office Use o nly
Permit Number -7
Occupancy & Fee
CODE 527 ChM 12-00)
Date: 2- 6.
To the. Inspector'of Wires:
the electrical work described below,
Is this permit in conjunction with a Building Permit?' Yes
N �oo (qhack Appropriate Box)
Purpose of`BuiIding:—X-.,.-/'r Utility Authorization #:
Existing Service,�'-� Amps Overhead 3 Underground. 0 #of 'Meters
1z"Volts —
New Service: —Amps--l—Volts Overhead 0 Underground.13 # of Meters:
Number of Feeders and Ampacity-
Location and Nature a f Proposed Electrical Work:
No. of Recessed Fixtures
No. Of Call.-Susp. (Paddle) Fans
No. Of Ughting Outlets
No. of Hot Tubs
No. of Ughting Fixtures
Swimming Pool: Above ground o In Ground o
No. of Receptacle Outlets
No. of Oil . Burners
No. of Switches
No. of Gas Burners.
No. of Ranges
, No. of Air Conditioners TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number- TONS:. KW:_
No. of Dishwashers
Space /Are . a Heafing:_ KW
No. of Dryers
Heating Appliances KW
No. of Water Heaters KW No. of Signs: #of Be
[lasts:
# of Hydro Massage Tubs No. of Motors Total HP
No. of Transformers Total KVA
Generators KVA
# Of Emergency Lighting Battery Units
Fire Alarms of Zones
# of Detection & Initiating Devices
# of Sounding Devices:
#of Self Contained
Detection/Sounding Devices
Security Systems:
No. of Devices or Equivalent
Data Wiring, No. of Devices or Equivalent
Telecommunications Wiring: No of Devices or
Equivalent
OTHER;
R
INSURANCE COVERAGE: Unless waived by the owner, no permit for the Performance Of electdcal'work may issue'unles the licensee provides Proof of liability insurance
including 'Completed operation' coverage or Its substantial equi he undersigned certifies that such coverage is In force, and has exhibited Proof Of same to the permit
quiva T s
Issuing office. CHECK ONE. INSURANCE, ��BOND 0 OTHER a Please specify:
Estimated Value of Ele . ctrical Work (When required by municipal policy)
Work to Start:
Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
Firm Name: -
LIC. #
Licensee: Signature:
(if app,11--ccabia, onto in 9 license u er line) LIG.#
oA:;;
Address: Bu . Tel.# Alt. Tel. #
-----------
OWNER'S INSURANCE WAIVI:K: I am aware that the Licensee does not have the liability insurance -1�3v-a�rage norm�allreu�,rodb, law�.
waive this requirement. I am the (check one) Owner 13 OR Agento BY my 'sig-atut- below, I hareby�
Signature of Owner/Agent Telephone #
PERNUT FEE: S
Location
No. Date
o n , �,O*l TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
wu
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # 14-13
18,123 061
g Inspect
16%.j
1.1 Property Address:
kA1-1
Z,q v, JIN
sk
1.2 Assessors Map and Parcel
Map Number
Number:
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
LAA Area (sf)
Frontage (ft)
1.6 BURDING SETBACKS M
Front Yard
Side Yard
Rear Yard
Reqtlired Provide
Required Provided
Required
Provided
&G.L.C.40. 54)
WSW 0
1.5. Mood Zone Infonintion:
z0as Outside Hood Zone 0
1.9
!!tt
Sewerage D*wsal Systom-
9-� OnSiteDisposal System 0
'SECTION 2 - PROPERTY OWNERSEIMAUTHORIZED AGENT iC UjCtricf:
2.1 Ownerof Record
Name (Print) dress for Service
- �, , L � � I
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
ClSignature e ep on
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable 0
nch�e(
Licensed Construction SU rvisory
License Number
Address S4- -
Lr\�k4U Expiration Dat . e
Signature I c1cphone
3.2 Registered Home Improvement Contractor Not Applicable C1
/D
0 Ck 6\
Company Nam C -C �-. � I
Registration Number
P�a n,�,q
A, �dress
7-0 2 Expiration Date
Sig�ature Telephone
IV,
SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ........ 6 No ....... 0
SECTION 5 Description o Proposed Work (check
appReable)
New Construction 0
Existing Building 0
Repair(s) 0
AJteration�(s)
Addition 0
Accessory Bldg. 0
Demolition 0
Other 0 Specify
Brief Description of Proposed Work:
('AQ
SECTION 6 - ESTIMLATED CONSTRUCTION COSTS
Itern Estimated Cost (Dollar) to be
OMCIAL USE ONLY
Completed by permit applicant
.
I . Building
�
Buil ding Permit Fee
CC , C,
Multiplier
2 1 Electrical C C'C . ci
(b) Estimated Total Cost of
Construction
3 Plumbing GC,(:�s CC
Building Permit fee (a) x (b)
19 �
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5), 6 C; 0
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
F
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERN[IT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My "M �qiattersrelaftv �,"kauthonzedby this building permit application.
Signature ot'Mlier Date
SECTIONa -0WNER/AUTHOR[Z0 AGENT DECLARATION
A � �W—�k�c � &k e
I as Owner/Authorized Agent of subject
�1 I
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Narng�,\�
, ( (
Si ture of 6wne—R�ent Date
NO. OF STORIES SIZE
BASENIENT OR SLAB
SIZE OF FLOOR TRVIBERS I Sr 2"') 3 RD
SPAN.
DINIENSIOM OF SII -LS
D24ENSIONS OF POSTS
DItyIENSIONS OF GH�DERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERLkL OF CHEVNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDNG CONNECTED TO NATURAL GAS LINE
k
.0
'IN
Proposal Page No.
MICHAEL RODDEN
BUILDER - CONTRACTOR
47 Prescott Street
NORTH ANDOVER, MASSACHUSETTS 01845
Phone (978) 687-2934 tic. #028538
Of Pages
PROPOSAL SUBMITTED TO
PHONE
DATE
Ann and Cliff Waldrep
February 27, 2005
STREET
JOB NAME
Prescott St.
CITY, STATE and ZIP CODE
JOB LOCATION
North Andover Ma. 01845
ARCHITECT
DATE OF PLANS
JOB PHONE
HIr PrOpOSr hereby to furnish material and labor — complete in accordance with specifications below, for the sum of:
Nineteen thousand eight hundred
Payment to be made as follows:
,lob start - $9,000.00
000.00
dollars ($ 19,800.00
Plaster - $8,000.00, Completion - $3,800.00
All material is guaranteed to be as specified. All work to be completed in a workmanlike }\
manner according to standard practices. Any alteration or deviation from specifications be- Authorized
Si nature -� �, 7 f
low involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, acci-
dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be
insurance. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
We hereby submit specifications and estimates for:
LABOR ARID MATERIALS FOR. A TOTAL BATHROOM REMODEL.
Remove all plumbing and electrical fixtures. 'remove plaster walls and
ceilings, finished flooring and all wood trim. Provide rough and finish
electrical and plumbing -materials and labor as required. All ceiling and
wall areas to be fully insulated with. fiberglass Batts. Install new 1/2"
plywood underlayment. Finished walls and ceiling to be blueboard and
plaster skim coat. Tub, shower area walls to be permabase tile board.
Tile to be supplied and installed on floor and tub area wails.
All permits and job debris removal are included. Painting is not included.
Allowances are as follows:
1. All and materials and labor for electrical=X1,200.00
2. All material and labor for the=$2,500.00
3. Plumbing fixtures to include toilet, all cabinetry and tops, all faucets
and valves, tub, sinks, mirrors and any other accessories=$4,000.00
Arreptunre of Proposal— The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
I
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
in accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
dispose of in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be i d it in-
�Ispose q
t4 i;�
v) 0 N vk -
(Location of Facility)
k6lc(
Signature of Permit Applicant
(D
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
,. CERTIFICATE OF LIABILITY INSURANCE
A OPM
DATE
04 4/2005
11
PRODUCER
te
NORTH ANDOVER INSURANCE AGENCY, INC
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9 WAVERLY ROAD
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
LIMITS
A
INSURERS AFFORDING COVERAGE
NORTH ANDOVER MA 01845-2415
02/01/2005
INSURED
INSURER A: NATIONAL GRANGE MUTUAL
B: AMERICAN INTERNATIONAL
Michael Rodden
-INSURER
INSU ER C:
47 Prescott Street
INSURER D:
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
-1 POLICYF-1 JECT F-1 LOC
INSURER E�
Worth Andover MA 01845-
---w
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR1
LTIR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDIYY)
POLICY EXPIRAT10N
DATE (MMIDDIYY)
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx� OCCUR
MPP37395
02/01/2005
02/01/2006
EACH OCCURRENCE $ 1,000,
FIRE DAMAGE (Any one fire) $ 500,000
EXP (Any one person) $ 10,000
-MED
_EERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
-1 POLICYF-1 JECT F-1 LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
A
AUTOMOBILE
X
LIA131LITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
M7T47777
07/16/2004
07/16/2005
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY
(Per person) $ 100,000
BODILY INJURY
(Per accident) $ 300,000
PROPERTY DAMAGE
(Per accident) $ 100,000
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY
OCCUR FICLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE $
AGGREGATE $
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC6929368
01/01/2005
01/01/2006
X I TWC STATU-
ORY LIM TS I JOTH
I ER
E.L. EACH ACCIDENT $ -100,000
E.L. DISEASE -EA EMPLOYEE$ 100,000
E.L. DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER I I ADD11IONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
TOWN OF NORTH AMOVER FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES. 04ef:::::2
AUTHORIZED REPRESENTATIVE 'Ir
I NORTH ANDOVER MA 01845- oe-0- wvr--*-- I
ACORD 25-S (7/97) @ ACORD CORPORATION 1988
D?T�- INS025S (991o).oi ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page 1 of 2
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Date .....
)OVER
14G
%Veck #
5410
lover, Mass.
- ------------- ...........
ELEcrRicAL INSPECTOR
VBOARD OF FIRE PREVUMONF REGULAMNS 1111cY I I Ild _ZZ 10
[Rev- 11!991 (leave blank)
APPLICATION FOR PIMI��, TO PERFORM ELECTRICAL WORK
gcAnth the Mas=chusetts Mccifical Codc(NIEC).527 CNIR 12.00
All work to be perromictl in 2=1 �% &
(PLEIISE PRINTIN INK OR TYPE,4LL 11YRORMA TION) D.21c:
City or.. � hl
To the Inspector of Mires:
By this application the undersiagned gives notice of his or her id-tentiou to AerfOrm the electrical work described below.
Location (Street & Number) 3 ct /9A e_,< Ce 7-z- s 7 -
Owner or Tenant t" z_ //Z7 /9 L Telephone No.
Owner's Address zzi!��,//
Is this permit in conjunction'with a building permit? Yes rie &— (Check Appropriate Box)
Purpose of Buildingo Utility Authorization No. 2.
Existing Service 0 Amps 41'Olts Overhead � UndgrdE] No. of Meters.
New Service 2,V 0 Amps I �v / 7-40 Volts Overhead ED—' Undgrd No. of Meters:
Number or Feeders and Ampncikv E/Z V/ C_,E 40
Location and Nature bf Proposed Electrial Work: e)17 14 SV,_6
ofthefollotsinglablefilavbc nvivedby die lamector of Mies
No. of Recessed Fixtures
tio. of CeIL-Susp. (Paddle) Fans
INO. of Total
Transformers K
-VA
No. or Lighting Outlets
No. of Hot Tubs
Generators XVA
No. of Lighting Fixtures
Above rl In-
Swimming, Pool a
,rnd.
INO. 01 IS cy Liggliting
B!g= Uni
No. of Receptacle Outlets
111o. of OR Burners
FM j
of Zones
.No. of Switches
No. of Gas Burners
No. of Detection a�d
Initiating Devices
No- of Ranges
Total
'No. of Air Con& Tons
INa. of Alerting Devices
No- of 'Waste Disposers
ffeatrump
Totals:
I Number
ITons I XNY
No. oil belk-Cont-lined
yeteclloyperbft Devices
t-
Nto. of Dishw'ashers
Space/Area Reathigg KV
Local [] lklt[DiCip2l
Connection 11 Other
No. of Dryers
Heating Appliances ICNV
Security Systenw.
No- ofDevices or Equiv2lent
INO. Of Water
Heaters
No. of INO. of
Skm Ballasts
Data "Mritic-r-
NO. ofirl�vices or Equivalent
No. Hydromassage Bathtubs
No- of Motors Tobd HP
Telecommunications Wiring:
No. of Devices or Eauivident
OTHER: 511 A
Attack additional dwarl #denred. or as requwed by the Insfibcaror 9F Wires
ILNSUR--kN,CE COVERAGE: Unless W`Jived by the owner, no permit for the performance of electrical work , issdc unless
the licensee provides proof of liability insurafice includhigg "completed operation7 covei�gc or its substinfid equivalent. 17he
undersigned certifies that such coverage is in li�wc, and has c:diiibited proof of'same to the permit issuing office.
CRECKONNE: h\'SU1;UkNCE 0--DO,41) 11 OTHER f -
Y ) "I
tExpiration Da �c)
Estimated Value of Electrical Work* kWhen required by municipal poiicy.)
Work to Start. ?- 2_-� Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, an der th e pains and penalties of pfication is true and complete.
pedujy� that the hiformadon an this ap
FI It% I N A i� I E: C-46-emc , S &9L/ce Lic. NO.: 147114
Licensee: Signature LIC_ NO-:
&U&Iam4 -
'j. i. g�
(Yapplicable. ejaer -e-Tent I in the H . mmber rMe.) 6ibSI Bus.TeLNo..
Address: A/ AIL Tel. Njo.-
OWNER'S INSUR -kN-,CE x does not have the liability insurance coverage norroall
V.41VER: I am aware that the License
required by law. By Iny signature below, I hereby waive this requirement. I am the (cficck one) 0 owner E] o%,.-ncr*s agent.
.�Pwnery_Affent -EC
1 Teleolione'No. , -.-S
6323
Z. e
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ..............................................................................................
has permission to perform ... A,Pil—1 OXIA-0,
........... ....
wiring in the building of .................. 4�..x .................................................
at .... 30 .... /* 6 5 A!!�;z 7- 5;7-
.. ..................... ......................................... . North Andover, Mass.
45
Lic. No.
Fee.74� ......... . ..... 3 ........ P -AIC ... Aw
EcrRICAL INSPEc-rOR
Check #
Ais
A
-N
Commonwealth of Massachusetts
P71
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official�-JlseOnlv
/ .32-3
Pennit No.
Occupancy and Fee Checked
.Rev. 9.1051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All Nvork to be perforilled in accordance %vith the Massachusetts f]ectrical Code (N EC). 527 CMR 12.00
o'ie
(PLE.ASE PRbVTIiVLVK OR TYPE, -ILL INFORMATION) Date: 10-7 -
City or Town of: ,1 4 ii (12eg i/1- To 1he In,v eclor (?f kvire.v.-
*ec-"(()
d —gives'notice of his or her intention to perform the electrical work des
By this application the undersignL7 , cribed below.
Location (Street & Number) 'd �Z> C- J- 6p,-- C
Owner or Tenant r4-6 2V Telephone No.
Owner's Address A
Is this permit in conjunction with a building permit? Yes E] (Check Appropriate Box) x 7
Purpose of Building_ /t r- Utility Authorization No.- 4- 2 -
Existing Service 4-t Amps L q -Volts Overhead U4�", Undgrd No. of Meters
New Service Q-0 C- Amps - 'i CV01ts Overhead UndgrdE] No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: //? 10 d / r-1
f ir
C 1"t;nji !!?e !�)jjmvjna tilhIp nmy hp waived hv the hispector ol, I 1"ires.
No. of Recessed Luminaires
f Ceii.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
-No.
No. of Luminaires
Swimming Pool Above 11 In-
grnd. und.
of Emergency Lightini
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
—of
No. of Zones -04V
I ZEE
No. Detection and
No. of Switches
No. of Gas Burners
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
Heat Pump
Npm.h�r.
KW ...........
No. of Self -Contained
No. of Waste Disposers
Totals:
I
I.T.o..n.s.
J
Detect ion/Ale rtin g Devices
No. of Dishwashers
Space/Area "eating KW
LocalEl mun'c'PP'n 0 Other
Connectio
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KWI
No. of No. of
Data Wiring:
Heaters
Signs- Ballasts
-No. of Devices or Equivalent
Telecommunications Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
OTHER:
, 11tach a&fitional detail �/ desired. or (is required hY, the Inspector ey 10 1/ es.
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 cornpletion.
INSURANCE COVERAGE: Unless waived by tile owner, no permit for the performance of electrical work may issue unless
tile licensee provides proof of liability insurance including "corripleted operation" coverage or its substantial equivalent. Tile
undersi-ned certifies that Such COVera','e is in force, and has exhibited proof of sanle to the permit issuing office.
CHECK ONE: INSURANCE [] BOND [I OTHER [I (Specify:)
I certify, ander the pithis andpenallies ofperjury, that the ittlimination on this application is trite and complete.
FIRM NAME: &-c- I- ^ tr- LIC. NO.:
Licensee: J� c c -- Signature L I C. N 0.: f fhlf:2 C.?
(ffapplicahle, enter "exenipt in the license number flne.) Bus. Tel. No.: j� 6f - 7? c
Address: C, 5;-V /-I A /,*l 7 Z i i- r- A-1 Alt. Tel. No.:
*Security Systern Conti -actor License required for this work, if applicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I arn aware that the Licensee does not have tile liability insurance covCrage nornially
required by law. By iny signature below, I hereby waive this requirement. I arn the (check one) 11 owner 0 owner*s agent.
Owner/Agent [ PER,WT FEE. S
Signature Telephone No. I
1-01
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
01,11cial U�e 0111v
Pennit No. "S
Occupancy and Fee Checked
[Rev. 9.'051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All \�ork to be perfornied in accordance \\ itil tile 1%,111"Sacilusetts Electrical Code 0,11"C). 527 CIOR I 2.00
(PLEASE PRINT IN INK OR TYPEALL INFORA1 I TIOX) Date: I . C, ZO -7
City or Town of: .� 4 j L2 a v I- ),- To 1he —Ins�jec--Ior of[Vire.v:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant /,v Telephone No.
Owner's Address C1 "y �7 a ; --- -t-
Is this permit in conjunction with a building permit? Yes a"" NOE] (Check Appropriate Box)
Purpose of Building /1 Utility AUA tim No. 4 -
Existing Service c, Amps 4 L q -Volts OverheadE�j'-- Undgiric Iva. of Meters
New Service c- Amps i L -c,/ �Volts Overhead Undgrd eters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 0 J) / 7-1/
C- Iv
'mipletion ol the fiWolriae table inal; be waived bv the hisneetor ot'll"ires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
4
Generators KVA
No. of Luminaires
Swimming Pool Above In-
grnd. grnd.
-INIq---0O—.of mergenCy LigHting
Battery Units
of Receptacle Outlets
No. of Oil Burners
- -TNo.
FIRE ALARMS
1-01
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
01,11cial U�e 0111v
Pennit No. "S
Occupancy and Fee Checked
[Rev. 9.'051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All \�ork to be perfornied in accordance \\ itil tile 1%,111"Sacilusetts Electrical Code 0,11"C). 527 CIOR I 2.00
(PLEASE PRINT IN INK OR TYPEALL INFORA1 I TIOX) Date: I . C, ZO -7
City or Town of: .� 4 j L2 a v I- ),- To 1he —Ins�jec--Ior of[Vire.v:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant /,v Telephone No.
Owner's Address C1 "y �7 a ; --- -t-
Is this permit in conjunction with a building permit? Yes a"" NOE] (Check Appropriate Box)
Purpose of Building /1 Utility AUA tim No. 4 -
Existing Service c, Amps 4 L q -Volts OverheadE�j'-- Undgiric Iva. of Meters
New Service c- Amps i L -c,/ �Volts Overhead Undgrd eters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 0 J) / 7-1/
C- Iv
'mipletion ol the fiWolriae table inal; be waived bv the hisneetor ot'll"ires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above In-
grnd. grnd.
-INIq---0O—.of mergenCy LigHting
Battery Units
of Receptacle Outlets
No. of Oil Burners
- -TNo.
FIRE ALARMS
No. Of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices J
No. of Ranges
Total
No. of Air Cond. Tons
jNo. of Alerting Devices
No. of Waste Disposers
Heat PuFn
.
..Niimber
�p ..... ... ...... .
Tons
KW
..........
No. of Self -Contained
Tota s:
I
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
LocalEl Mun'c'PP' F-1 Other
Connection
No. of Dryers
Heating Appliances KW
Securi tems:*
ty 56s
No. of e vices or Equivalent
No. of Water
KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wir!'!ng:
No. of Devices or Equivalent
[OTHER, 9 ;rr
� litach c0clitional (letail or as requiretl bi the I hiq)eelor ol'Wilvs.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with 11,11EC Rule 10, and Uponcornpletion.
INSURANCE COVERAGE: Unless waked by the owner, no perinit for the performance ofelectrical work may issue unless
Z:, U
the licensee provides proof of liability insurance inClUding -completed operation" covera 'e or its substantial CqUiValCnt. The
undersi-ned certifies that SLICII COVel-a-e is in force, and has cxhibited proof of saine to tile pernlit issuing office.
CIIECKONE: INSURANCE El 13ON D F-1 0 Fl -1 E RE] (Speciry:)
I eerl�fjl, under the pains and penalties ofpe�jurj,, that the infitrination on thk al)plication is true and Complete.
FIRININAME: LIC. NO.:
I.' A*
Licensee: Signature .-4z- LIC. NO.:—f I a )C?
f �fapplicclhle. (wcr -e.wmpt lit lh1.'1i(-'L IISC 1111111hel. line) Bus. Tel. No.: 6" 7 -?—c
Address: C 1-11 /1 1--f F IT / I i AIt. Tel. No.:
*Security System Contractor License required for this work: if applicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I ain aware that the Licensee does not huve tile liability insurance cov�.:rage norniall�
required by law. By Illy Sil"llatUre below, I hereby waive this requirement. larn the (check one) 11 owner 0 owner . s agcnt.
Owner/Agent
Signature 'relephone No. 7PERMIT rEE.
RCQ.t� 0/<
0- - 7-,!:�'6
z — ) I—Oee- /*
OV plll�
101
PAGE 02
�TKUCTURAL
E N G I N E E A I N 0
MOLUTIONS, LLC
24 February 2006
Structural Inspection Report
30 Prospect Street
North Andover, MA
Prepared for; Gerald Brown, Building Commissioner, North Andover
A,ndrew S. Bradshaw, PE petforined a structural ftan-xing inspeption at the above referenced
property at 11.00 AM, Monday, February 20, 2006. This inspection w" at the request of the
Town of North Andover Building Commissioner. The purpose of this inspection was to ensure
framing members were installed in accordance with the approved construction documents,
I cedify that the framing for the addition at the above referenced address is in accordance with
the stamped construction documents within acceptable construction tolerances. I catify that the
framing meets the minimums set forth in the Massachusetts State Building Code and recommend
that the rough ffaming portion of this building permit be approved.
If you have any questions, comments or concerns about the information presented in this report,
please do not hesitate to contact me.
Cocerely
n r sVrWs �aw, PE
Owner
Structural Engineering Solutions, LLC
Z) -L 110 4
RECE/Wr)
ft 4.f
FE9 2 �-' 2006
BU/LD//VG D&P7..
Cell (978) 877-0601 Andrew S. Bradshaw, PE Fax (978) 486-9594
107 King Street� Littleton, MA 01460
www.aabse.com