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HomeMy WebLinkAboutMiscellaneous - 336 BOSTON STREET 4/30/2018 (2)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. *****************************//APPLICA-NT FiLiS OUT THIS SECTION**'F***"*******'t**" APPLICANT PHONE(97���'�1� a LOCATION: Assessor's Map Number ria PARCEL r,7 SUBDIVISION LOT (S) STREET� Pt c - ST. NUMBER ,,- OFFICIAL USE ONLY**,******,********** 1 RECOMMENDATIONS OF TOWN AGENTS: ;J CONSERVATION ADMINISTRATOR DATE APPROVED 4 DATE REJECTED COMMENTSl '1 tri 6' J S S TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUIL-DING INSPECTOR DATE Revised 9197 jm 12�06/I997 12,25 FROM Corey & Donahue. Inc TO M and M P. OI/ r. LOT 2 90,062 S,F, r �l MALO N JOS NO: 170649 5T0 N ST VIC.E�0NS hdo&TLAGE a 11-11S MORTGAGE INSPECTION WAS PREPARED SPECIFICALLY FOR MORTGAGE PURPOSES AND IS NOT TO BE RELIED UPON AS A SURVEY, NOR IS THIS PLAN TO BE USED TO OBTAIN BUILDING PERMITS, VARIANCES OR THE UXE. o i CERTIFY TNA T THE STRUCTURE_ '� SHOWN ON 711"115 PLAN �61AS -_IN. CO[d€ORMANCE vdi"}i THE LOCAL ZONING SET13ACKS IN EFFECT AT THE TIME OF CONSTRUCTION OR i5 EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS, G.L. TITLE v1.1, CHAPTER 40A SECTION 7. a! CERTIFY THAT THE PARCEL .SHOWN IS NOT LOCATED )MTHIN A FLOOD HAZARD AREA AS 4EPICTED ON FEMA ,FLOOD INSURANCE RATE W - APS. FQR COMMUNIl-Y # 2 SLOg8—•DATED . FLOOD HAZARD AREA HAS BEEN OETERMINEO BY SCALE. ACCURATE .DETERMINATION CANNOT BE MAOE UNLESS A VERTICAL CONTROL is ococnpuFn, MORTGAGE LOAN INSPECTION L0CA7ON:_3L(a_ BnSTbN L SCALE: DATE::.' REGISTRY: -_N o - - - TITLE REFERENCE:.,o�_����: �----' PLAN REFERENCE-.- COREY EFERENCE: COREY & DONAHUE, INC. ENGINEERS & SURVEYORS 198 CAMBRIOG£ RE)_ Mi! I1RN, MA 01:801 MetLife Auto & Home® Homeowner Operations Field Claim Office Attention: Claims P.O. Box 6040 Scranton, PA 18505 (800)854-6011 March 30, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Claim Number: Date of Loss: Sally Bament JDF00924 OL March 12, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 336 Boston St, North Andover, MA Sincerely, Ciro M. Brasil Reis - Cat Team Metropolitan Property and Casualty Insurance Company Claim Adjuster (800) 854-6011 Ext. 7440 Fax: (866) 958-1622 Email: cbrasilreis@metlife.com MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI MPL MA-REGDEPT Printed in U.S.A 0698 N MetLife Auto & Home® Homeowner Operations Field Claim Office Attention: Claims P.O. Box 6040 Scranton, PA 18505 (800)854-6011 N1c�tL�f�— May 7, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Sally Bament Claim Number: JDF15032 04 Date of Loss: February 2, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 3B, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 336 Boston St, North Andover, MA Sincerely, Home Ops CAT Team Michael Scott Metropolitan Property and Casualty Insurance Company Senior Claim Adjuster (800) 854-6011 Ext. 7440 Fax: (855) 411-6689 Email: MetlifeCATteam@metlife.com MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI. MPL MA-REGDEPT Printed in U.S.A 0698 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed a on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and may be -deemed by- the.Inspector_of-Wires abandoned.and.invalidif_he—._ .. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effector existence" during the qualifying period beginning on August 15,298 and extending -through August 15, 2012. 8—Permit/Date Closed: Note: Reapply for new p 0 Permit Extension Act —Permit/lfate Closed: Date ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... OV6--n4 . ............ ...... r .. ........ has permission to perform ........,/� ............ wiring in the building of ..M4/.K ...... ....................................... at -3o .40S7 -0.,S1 ..................................... .. NorthAndovei, Mass. Fee ... Lic. No. .................4 . ; r. ELEcmcAL INSPECTORR U 17 Cheek # 7�- 0628 l ommonwea�� o� ff/ad�achuJe ..UePar>`mertt o��ire �ervicee RCIAREM UVBOARD OF FIRE PREVENTION REGL' APPLICATION FOR PERMIT TO All work to be performed in accordance with the M (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOI City or Town of: _Ngn A iPJ� By this application the undersigned gives notice of his or her Location (Street & Number) Owner or Tenant Owner's Address S-236 &e&n Is this permit in conjunction with a building permit? Purpose of Building gasdulce, Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity 9�� -6 27 Utility Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ 2Ga Z �3�q No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires VIIUW fi No. of Ceil: Susp. (Paddle) Fans luoie May ae waived by the Inspector of Wires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Rot Tubs Generators KVA ` o - No. of Luminaires Swimming Pool Above ❑ IIn- ❑ o cy ig ing rnd. rnd. Baa ne Units Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners. o. o etection an Initiatin Devices No. of Ranges i- No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers heat Pump 1!?pireber ions KVPd No. of Self -Contained Totals: Detection/AlertinDr Devices No. of Dishwashers Space/Area heating KW Local ❑ Municipal El Other Connection No. of Dryers heating Appliances Kms, Security Systems: No. of WaterNo. Heaters KW No. of No. of of Devices or E uivalent Data Wiring: Signs Ballasts No. of Devices or Equivalent No. hydromassage Bathtubs No. of Motors Total IIP Telecommunications Will: No. of Devices or Equivalent I f1"1'M1ER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: -50 , © (When required by municipal policy.) Work to Start: F:EA 201 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties of perjury, that the information on this application is true and complete. FIRM NAME: � LIC. 1lNO.: Licensee: Ar)IJ tp�Y� W C�Lc,z _ Signature LIC. NO.: (If applicable, enter " zempt 'in the lic se number line.) Bus. Tel. No.: Z Address: '-1 tn!; AA Alt. Tel. No.: ' *Per M.G.L. c. 147, s. 57-61, security work requires Depa nt of Public Safety "S" License: Lic. 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 erl Owner/Agent Signature Telephone No. I PERMIT EEE: $45.001 l�orounoruuealth o/ Official Use On] cc�� nn Permit No. partment ol5ire Jervicae BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:AnsVect9rof Ci or Taws of:h' Nn Ak n en(J SVroTo the Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) _3 ro -(fin erre . Owner or Tenant Telephone No.CIWfo�.7Q3—JQ Owner's Address _S -6 Is this permit in conjunction with a building permit? Yes Purpose of Building RaSduia, Existing Service Amps Volts New Service Amps / Volts Number of Feeders and Ampacity No X (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: 7nk�ZvC� G2r� Q mj ( ' v.�cdusal.l S J No. of Recessed Luminaires vnu-in No. of Ceil: Susp. (Paddle) Fans iaore m De waived by the Inspector o Wires. No. of Total ' Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA 2,O No. of Luminaires Swimming Pool Above ❑ In- El o mergincy ig ing rnd. rnd. Battea Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS ENo.Zoff ones No. of Switches No. of Gas Burners, 0-o etection an Initiating Devices No. of Ranges i No. of Air Coad. Total No. of Alerting Devices No. of Waste Disposers Heat Pump Number I Vons KW No. of Self -Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of WaterNo. Heaters KW No. of Devices or Equivalent Data Wiring: as Si ns Balts Si Ballasts No. of Devices or E .uivalent No. Hydromassage Bathtubs 11No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Ly"Igw:F Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �� , © (When required by municipal policy.) Work to Start: FE'02j W1 _ Inspections to be requested in accordance with NEC 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. FIRM: NAME:15mieminr ' LIC. NO.: Licensee: _Ar)f3 r_CA 1�0C Signature LIC NO.: (If applicable, enter " xempt" in the tic se number line.) Bus. TeI. •No.: Z Address: E`� 034416 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Dep a nt of Public Safety "S" License: Lic. 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: a SITE VISIT INFORMATION SITE SKETCH --- ;_ _ l a T � ,�I,� SII ,•_.,��._ j� ✓ Dimensions of home � -- I � - �I��iL.��.� ✓ Meter Location ✓ Distance between gen and house I I ✓ Main Panel ✓ Fuel supply:existing and/or proposed ✓ Note whether the site has a full ✓ Any/ALL Sub Panels ✓ Distance between gen and fuel supply basement, crawl space, or slab ✓ Property Lines ✓ Proposed wire runs and dimensions of i ' F 1 - � I _ I i i j a ; '•-� - {—�- r ' -� l I I i i- 1 --f Interior l Total Wire Run Len hs Wire Run Actual Add 10' Interior ! Exterior Wire Run Actual l I I Total Add 10' Exterior one oKeicn ,.neCK1151: ✓ Dimensions of home ✓ Generator Location ✓ Electrical trench route & distance ✓ Meter Location ✓ Distance between gen and house ✓ Gas trench route and distance ✓ Main Panel ✓ Fuel supply:existing and/or proposed ✓ Note whether the site has a full ✓ Any/ALL Sub Panels ✓ Distance between gen and fuel supply basement, crawl space, or slab ✓ Property Lines ✓ Proposed wire runs and dimensions of each Ge�ntoi wizi( 6e 8�ee-1 Arn Mx-- hrrvl.2� /o �rzf �m fhe �ra�oane �q�ks', an of y DRYER: ALL TYPES OV This certifies that ��wje FIREPLACE: VENTEDIUNVENTE P • .. ...... �.. ..... . . FRYOLATOR R(, has permission for gas installation FUEL CELL R ••'•••••••••••• in the buildings o PLUMBING/GAS FITT NAME: OSTERMAN PROPANE, LLC at .3G . ................................. . / N rth •nd ver,,/Mass. Fee'.�U. Lic. No WA19!1,� � - .. . CITY: STERLING GAS INSPECTOR Check # S�J TEL: 978-422-0204 FAX: 978.422.057 NAME OF LICENSED PLUMBER/GAS FITTER: 8051 I have a current Lalbilily insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES u NU u If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent OWNER'S NAME: TEL: FAX: I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. (OFFICE USE ONLY) Type of License: Permit # ❑ Plumber 0 Gasfitter i ❑ Master ❑ Journeyman Signature of Licensed PlumberlG itter Inspector: ❑ Undiluted LP Installer Fee: ❑ Limited LP Installer License Number: G? F 8 % /-P MASSACHUSETTS UNIFORM APPLICATION TO DO GAS FITTING CITYITOWN: 'X Andover STATE:';!MA APPLICATION DATE: 12/8/2012 JOB ADDRESS: ,336 Boston St GOCCUPANCY TYPE: ,RESIDENCEg tJ,S TCS PLANS SUBMITTED: YES ❑ NO NEW ® ALTERATION ❑ REPLACEMENT ❑ REMOVAUDEMOLITION ❑ 1 NATURAL & LIQUEFIED PETROLEUM GAS: PIPING - EQUIPMENT - APPLIANCES - SYSTEMS J ENTER TOTAL F ^ _ AIR ROTATION UNIT FU11 BOILER: ALL TYPES GA BOOSTER GE; Date.. Z�!/•Z....... • • BROILER IL BURNER: ALL TYPES IN 14ORTH CO -GENERATION UNIT IN ' Of ,� 1•' °'° o COFFEE ROASTER IN COOK APPLIANCE HOUSEHOLDAM o n TOWN OF NORTH ANDOVER a PERMIT FOR GAS INSTALLATION COOK APPLIANCE COMMERCIAL -_ �, : ,::•=•.,. DECORATIVE APPLIANCE DRYER: ALL TYPES OV This certifies that ��wje FIREPLACE: VENTEDIUNVENTE P • .. ...... �.. ..... . . FRYOLATOR R(, has permission for gas installation FUEL CELL R ••'•••••••••••• in the buildings o PLUMBING/GAS FITT NAME: OSTERMAN PROPANE, LLC at .3G . ................................. . / N rth •nd ver,,/Mass. Fee'.�U. Lic. No WA19!1,� � - .. . CITY: STERLING GAS INSPECTOR Check # S�J TEL: 978-422-0204 FAX: 978.422.057 NAME OF LICENSED PLUMBER/GAS FITTER: 8051 I have a current Lalbilily insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES u NU u If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent OWNER'S NAME: TEL: FAX: I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. (OFFICE USE ONLY) Type of License: Permit # ❑ Plumber 0 Gasfitter i ❑ Master ❑ Journeyman Signature of Licensed PlumberlG itter Inspector: ❑ Undiluted LP Installer Fee: ❑ Limited LP Installer License Number: G? F 8 % /-P ti vs FommoNWgAL-rH-OF'-,MASSACHli��*.TT's. og S PittVI LICENSED AS AN LP GAS INSTALLER ISSUES THE A.F36 \fk LICENSE jjt LAWRENCE G FLEMING-,, 6. ' 349 STATEDAD - R OTTER RIVER MA 101436-`1124 ..- 1089 787250 Aq ;W cim.'ect mo vL m 0 r CONTROL # G0282.9,6 If this license is lost IMPORTANT �j . Division of Profe or destroyed, 7th Floor, Boston sionai Licens notify our , MA 02118, ure 1000 W Board at the - If st. If Your name or address of correct nameshown is Renewal q or address changed notify your board This license Pi�cation. Always insure is sub' ays refer to proper mailing of next as amended. It is Ject to the Your license nu oran pr4Vge and f the General Laws ? assigned to personal Privilege, Person or posted as squired Person Keep flys license loaned Y law. eon your i __ i Fold, Then Detach Along All pertorations ` In 17 N2 1161 E Date .... ...... .. ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ................... has permission to perform ... nZ,;... ....... ........................................ I wiring in the building of ... ................. ................................................. T -4 at.-. ........I ...... '(�. ............................. . North Andover, Mass' Fee..::......:'. . ........ Lic. NO. (4 ........................................................ %I ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0FJR-SS GYLNE' Office Use/only MAP DPPARTMF.NTOFPUBLIC.S4= Permit No. �� Y —�Zr 0FMEPR0 M70NREGUL�IIIAS527GtifR 12-00 Occupancy & Fees Checked PARCEL PERA/flT TO PERFORM ELECIRCALL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACFIUSSTS ELECTRICAL. CODE, 527 Cwt 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date 727 Town of North Andover To the Inspe--tor of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ; V I S� Owner or Tenant Owner's Address .-?&I 1)Vt q, t Is this permit in conjunction with a building permit: Yes r 11TNo (Check Appropriate Box) Purpose of Building /, )e&' z Utility Authorization No. Existing Service 1,V ZO/ (�✓olts Overhead Underground Z- No. of Meters f New Service Amps / Volts Overhead Underground No. of Meters Numper of Feeders and Ampacity Location and Nature of Proposed Electrical Work Nj. of Lighting OutletNo. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures I Swimming Pool Above Below Gencratot KVA °round ground No. of Receptacle Outlets No. of Oil Bumers No. of Emergency Lighting Battery Units No. 01'switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges fa I No. of Air Cond. Total -t2)'— Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumos Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Connections Other No. of Dryers _ Heating Devices KW No pf Water Heaters KW No, of No. of Sins Bailasis No, Hydro Massage Tubs No. of Motors Total HP YES Fpr No • .• m:• .1• • •« r • 1 •ilr •J• • • :.:. YES, pkme indicEietrNmofco,,er�bydraungf)c I LU • • : •' D • ICI• • ms ►:.n �� _ Work S •.. S. Simed I. �UA I •:. /1 �/ /,(� �/ :� sv �, �///moi ��� /_//� •: s • rl' • .a ' •.:a _ 1. �� I i� i I _ • j • i • "air- =:Cdcz nott - / ' N :M•. ♦ •.�! b t a :• KAK• ...a. , (Please• Owncr Agent Telephone No. • b Date. . ......... 4063 r 0' "OR D, + TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMUS 41 This certifies that !1.`f .. ... i?.' R has permission to perform..G' ....... plumbing in th buildings of ... ....... ................... c at 3�P . . ...........!�� . ... North Andover, Mass. Fee -9/. ��"- .. Lic. NoM,l'?- .?.- .... PLUMBING INSPECTn l/ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Q a MAP MASSAC SETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING PARCEL 0 D T e or NORTH ANDOVER, MASSACHUSETTS Date Building Location �' Owners Name f4R2k= as ft Permit # t 7 1 y. e Amount q/, Type of Occupancy New El--- Renovation Replacement ❑ Plans Submitted Yes ❑ No 0 FIXTURES (Print or type) n Check one: Certificate Installing Company Name �� l _ �O{�er��n,J ki-15 C © Corp. Address Z3 JQ.� `� bc� (� a �y-� Partner. r..- Mme- C��1 ' U Business Telephone '721 _ 2'7 0 _C4 0p /Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy a 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 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 Plumbing Code and Chapter 142 of the General Laws. By:$rte of Licensea rtum5er Type of Plumbing License Title 2 City/Townrcense Numoer Master ® Journeyman APPROVED (OFFICE USE ONLY tin:. .« •, • (Print or type) n Check one: Certificate Installing Company Name �� l _ �O{�er��n,J ki-15 C © Corp. Address Z3 JQ.� `� bc� (� a �y-� Partner. r..- Mme- C��1 ' U Business Telephone '721 _ 2'7 0 _C4 0p /Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy a 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 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 Plumbing Code and Chapter 142 of the General Laws. By:$rte of Licensea rtum5er Type of Plumbing License Title 2 City/Townrcense Numoer Master ® Journeyman APPROVED (OFFICE USE ONLY Location 336 Bo rjoy -s-k- No. l 9 / Date MaRT� TOWN OF NORTH ANDOVER • Certificate of Occupancy $ S�, — • Building/Frame Permit Fee $ s' - s�CHU Foundation Permit Fee $ ` Other Permit Fee $ — Sewer Connection Fee $ Water Connection Fee $ i TOTAL $ 36-1 Building Inspector IJv 3 345/27199 i1:35 351.00 PAID Div. Public Works q W Y (N ff m T i { - •dC i?I Z D r 6 r Z r W • m r-.. �o x rn Z - W � Z :i rn { Z f f LP Z i 1 � v Y Alql _ G _ - z 93, ` n R' - D W Y (N ff T i { - •dC i?I Z D r Z z D W O m r-.. �o Z rn Z - W � Z rn { Z f f LP Z i W Y (N ff Z z D ? O m r-.. �o Z rn Z - rn LP 1 � v Y Alql _ G _ - z ` n R' - D z r� - v 2^ r O Z b O l 1 ~ N = R -F, In U z- u M z _ rr_ ^ �- C � 7(- x- Z � - O N .r' J w O N !n 77 W Y (N ff U) m m C/) U) 0 COO) .p CD C-) Z CD O CL r d o. o o p CD CIO CD O .. ag to CD CO) co Cl) O CA d O CO) 'C O C CO) Er C) CD O r� co CD y. 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O anallaJ IOU scop siyl -pauie}go uaaq anew uolloipslmf BUTAeq sjuampedaa pue spieog woaj s1piad/sImidde Aiessaoau Ile ley} /qlaaA of pasn sl wao1 siyl :SNOIlonalSNI W2io=i 3Sd3i32t loi - n W2joA 12i86�i997 12:25 FROM Corey & Donahue, Inc TO M and M r �2 MALO P.@1/ a X .SOB IVO: o THIS MORTGAGE INSPECTION WAS PREPARED SPECIFICALLY FOR MORTGAGE PURPOSES AND IS NOT TO BE RELIED UPON AS A SURVEY, NOR IS THIS PLAN TO BE USED TO OBTAIN BUILDING PERMITS, VARIANCES OR THE LIKE. al CERTIFY THAT THE STRUCTURE !3Z SHOWN ON THIS PLAN YYA.S IN: CONFORMANCE MTH THE LOCAL ZONING SETBACKS IN EMCT AT THE TIME OF CONSTRUCTION OR IS EXEMPT FROM VIQLATIO;V ENFORCEMENT ACTION UNDER MASS, G.L. TITLE Al. CHAPTER 40A SECTION i. *I CERTIFY THAT THE PARCEL •SHOWN IS N0 -.T -- LOCATED WITHIN A FLOOD HAZARD AREA AS DEPICTED ON FEMA FLOC ID INSURANCE RATE bATI`D k S� F COMMUNITY FLOOD HAZARD AREA HAS BEEN -DETERMINED SY SCALE. ACCURATE •DETERMINATION CANNOT BE MADE UNLESS A VERTICAL CONTROL ,t", /c -v 1c ocoenpiu rn eov, o N ST r MORTGAGE LOAN NS'F'E:Ci10N LOCA1I0N:_3_1L_ Etn4:_�-.------- N OR7H AN. SCALE: l ' iQQ DATE: REGISTRY:_..No SAX - TITLE REFERENCE:��..`'-- w. PLAN REFERENCE: COREY & DO.NAHUE, "INC. ENGINEERS & SU.RJEYORS 198 CAMBRIDGE RD., WOSI N, MA 0.1:801 Town of North Andover f OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director r.. (978) 688-9531 Fax (978) 688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: 116 of Facili VSignatur—eof Permit Applicant �/� //4�7 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i ,.. .,_ ;._ . f;�._ .F ' � i :35 ='.� 'r z �-' c � �+ n s n C - �f. _ v �'+ n rn � v ,� � v r+-� � � o -c a � cn r-.- � ro ro ,,yy a �\\ m �' -r � .. — '-� ro _ t �o r �. "rn. � r 3 a .ro -gyp rn a O Cr �r �� N_ o V� an a� O � •+�- 0 f� O f_n .� � _� . ' W X. �� C a h: ate. �" a%, �n m i� o -i c� H �, e -a ' oo '�' � � � `� c� n� rw � .. �s '� � � ;:� ... a m m ,- "` ' ' a� \.-.a n. J e ,... v ao � ' �. w ' _ ._ The Commonwealth of Massachusetts Department of Industrial Accidents 011Ic8 91190511917#05 600 Washington Street Boston, Mass. 02111 Tf , .e'lu .�• rt :t•:tt•�•ntu . _ ::W;._ .;t .1'e�Ci:' +�.94►'!'il`�i'iU1F.: 'v,. Clio phone I am a homeowner performing all work myself. [l I am a sole proprietor and have no one working in any capacity I am an employerprovidingworkers' compensation for my employees working on this job. U i. alit a sutc prupriewr, gcncmi contracior, or nomeowner �ctrcte one) and have hired the contractors listed below who have the following workers' compensation polices: comoinY names 211 cc co. p,)„Fr - Failure to secure coverage as required under Section 25A of WGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of ;t STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a COPY of this s*ne to the Office of Invcstigations of the DIA for coverage verification. 1 do hereby d penalties of perjury that the information provided above is truean correcs.Signature DatePrint ;orrisPhone (�rfTcy AW/R52— official use only do not write in this area to be completed by city or town official city or town: permit/license # r7Building Department ❑Licensing Board C check if immediate response is required [—!Selectmen's Office F-Heaith Department contact person: phone p: rlOther (rwuw 1191 PIA) Commonwealth of Massachusetts Executive Office of Environmental Affairs p ®aartment of Environmental Protection William F. Weld Govemor TrudyCoxe Secretary, EDEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A �C�E.R—TIFICATION J j /nom Property Address: b S Address of Owner: Date of Inspection: F`� C�� S4M f differe t) Name of Inspector: U ! p of w Company Name, Address and Telephone Number: CERTIFICATION STATEMENT l�� V-fl-k—ti' 6 lir PA 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper functiort and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fail Inspector's Signature: Date: /�– G7," �Lv�l The System Inspe r shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SY M PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need/\to`bee replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street a Boston, Massachusetts 02108 a FAX (617) 556-1049 • Telephone (617) 292-5500 w ii Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3 3 6 06 S -j -6,-( S " ' Owner: l (J d+ 7 ("1 Mr Ile Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) �I %� _ Sewage backup or breakout or high static �water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 141. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system rias a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia --nitrogen and-nifrate nitrogen is equal to or less than 5 ppm. D] SYSTEM FAILS: �that I have determ ned the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATIO (continued) 336 gos'ja� ss �% �/�a e;�q Property Address: �y Owner: /0—(f —52 Date of Inspection: DJ SYSTEM FAILS (continued): �'), A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST I30 sTd S� Property Address: Owner: 1 Date of Inspection: Check if thePoll ing have been done: _ Pu ping information was requested of the owner, occupant, and Board of Health. _ Non f the system components have been pumped for at least two weeks and the system has been receiving normal flow rates d ing that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ A__ L it plans have been obtained and examined. Note if they are not available with N/A. "Th ry acili or dwelling was inspected for signs of sewage back-up. _ T system does not receive non -sanitary or industrial waste flow _ Th 'te was inspected for signs of breakout. _Afl,Wstem components, excluding the Soil Absorption System,.have been located on the site. �Tseptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or aterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _ The ' e and location of the Soil Absorption System on the site has been determined based on existing information or roximated by non -intrusive methods. _ The facility o-,%ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub - Surface Disposal System. (revised 8/15/95) Property Address: Owner: Date of Inspection: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION RESIDENTIAL: Design flow:ttallgn� Number of bedrooms: �� Number of current residents: Garbage grinder (yes or no Laundry connected to system es or no):,�e5 Seasonal use (yes or no): �� Water meter readings, if available: !/ Last date of occupancy: L v 1. I, �� p cY� COMMERCIAUINDUSTRIAL: Type of establishment: FLOW CONDITIONS Design flow:_allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non -sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: r System pumped as part of i s lion: (yes or no)_ If yes, volume pumped _gallons Reason for pumping: CGS g��rs `�— TjgXlt TYPE OFSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: ' Sewage odors detected when arriving at the site: (yes or no) _ (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 336 /yo S-)--0'4 S'1— '-1- Property Address. /j Owner: /d_ �P' �76 Date of Inspection: /,/,, Zj SEPTIC TANK: e (locate on site plan) t Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Sludge depth: Z4 W . G Distance from top of s4tdge to bottom of outlet tee or baffler Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) alf u 19 h r 17 o s/ --- L -e u.L GREASE TRAP:_ (locate on site plan) 144- Depth 44_ Depth below- grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or battle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: o5��( Ste- Jy D 0 Owner: t �! Date of Inspection: / 0 6 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: Qallons Design flow: rtallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ r 5 (locate on site plan) / Depth of liquid level above outlet invert: Comments: (note if level and distribut'.c^ equa!, evidence of solids carryover, evidence of leakage into or out of box, etc.) U e PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 m SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: / b SOIL ABSORPTION SYSTEM (SAS):�� (locate on site plan, if possible; excavtion not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type: , / �„ � p� 7 ��—. leaching pits, number: (/'t( cl " leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 TO: NORTH ANDOVER, MASS — Is -i9 y2J_ BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at _ go Y7 S T L• Y ;e� Z North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated A I PRI'L S 19]`—L. t--� /!�r s c S VLA--,) Reg. Prof.- Engineer/ Reg. Sanitarian SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 1 f l�� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �_ p, ;L 6 J R- e C- l- DEPTH TO GROUNDWATER Depth to groundwater: < r feet / method of determination or approximation: �% /2z- #-j-/ (revised 8/15/95) 9 g Y �gg o „ g Lu �z 2 u V�� � � x o � 03 �p Z/1 C -,OI Z/I II -.b - - - - - - - sp �.hF)j tux iv z NXw pX 11J IN !L I�------------I--------------J i — w �U Nxv- o � Q � N/l v`a2\n a to O Q �uu i O I v � I I I - � II + m I I s ' w 91. 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