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Miscellaneous - 35 MAY STREET 4/30/2018 (2)
17 C' Date..� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION fi This certifies that .......................... Y has permission for gas installation .... . . . ........... Z' . . in the buildings of j .. .... ...... at ......... North Andover, Mass. Feel!/;2. Lic. No.. GAS INSPECTOR Check J4 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) _ s G I* Aja K), Atjj©j `e L Mass. City, Town Building AT: Location E, Date Permit # Owner's ll Name 6� e,5 r 5 4 a Type of Occupancy: New ❑ Renovation ❑ Replacement[21- Plans Submitted Yes ❑ No ❑ (Print or Type) am/ }� Check One: Installing Company Name -CV4V; V; A- 1 yY � "-gym b/ �« 6L6& i ❑ Corp. Address w Business Telephone ❑ Partnership ❑ Firm/Company Name of Licensed Plumber or Gasfitter Certificate 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 Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. By TYPE LICENSE: lumber ignature of Licensed Title Plumber or Gasfitter City/Town ❑ Gasfitter APPROVED (OFFICE use ONLY) ❑ Master ❑ Journeyman License Number FORM 1243 HOBBS 8 WARREN. INC. 1989 i ig COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN PLUMBER ISSUES THIS LICENSE TO �e JOHN J OLIVIERI JR ::0 PHILLIPS ST .� JORCESTER MA 01604-1771 19926 05%01/08 265763 COMMONWEALTH. OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS i I{ -FN: -4T: n AC A RA/SCTj-D Ml Ilflflr,T'R JOHN J OLIVIERI JR ti 10 PHILLIPS ST WORCESTER MA 01604-1771 s� r 10307 05/01/08 265764 ` 1, i; 114: 3_q629 ri7ffrT ACORD. CERTIFICATE. OF LIABILITY INSURANCE DATE MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 10111/M/DD/YYY1') 10/11/06 PRODUCER THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION Chittenden insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 487 120 Front Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LIMITS Worcester, MA 01613-0487 INSURERS AFFORDING COVERAGE NAIC # INSURED John Olivieri DBA INSURERA: NATIONAL GRANGE MUTUAL INSURER B: Olivieri Plumbing & Heating 10 Philips St Worcester, MA 01604 INSURERC: INSURER D: INSURER E: X COMMERCIAL GENERAL LIABILITY COVERAGES 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. SPOLICY LTR INSRE TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE IMMIDDIYYI LIMITS A GENERAL LIABILITY BINDER126791 09/01/06 09/01/07 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To RENTEDPREn $500 000 CLAIMS MADE 51OCCUR MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 000 000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY BINDER124772 09/01/06 09/01/07 EACH OCCURRENCE $1,000,000 X OCCUR ❑ CLAIMS MADE AGGREGATE $1,000,000 X I RETENTION $ 10000 $ WORKERS COMPENSATION ANDWC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED') E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Proof of Insurance Town of Sherbon 19 Washington St Sherborn, MA 01770 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL •(_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ^-.4" or -''J /{e z' DMK © ACORD CORPORATION 1988 CERTIFICATE OF LIABILITY INSURANCE ATE(MMIDDIYYYY) PRODUCER (508) 829-2912 10 06/2006 THIS CERTIFICATE IS ISSUED A$ A MATTER OF INFORMATION Walter Henry Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1089 Main St. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TNF COVERAGE AFFORDED BY THE POLICII::S BELOW, nO.La in MA 01520- INSURED INSURERS AF OliviGri Plumbing & Heating Inc. INBURERA:AIG 10 Phillipe St. INSURER B: Worcester MA 01609 - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER ANY 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. SR ADD•L F TR INSRO TYPE OF INSURANCE POLICY NUMBER POLICY EFF6CTIVE POLICY EXPIRATION -"--^---`- GENERAL LIABILITY DATE MM/DO/YY DATE MM/DD/YY LIMITS j�+L'VuitKEkgGUIKPENSATIUNAND $9•]4858 eMPLOYERS' LIABILITY _ I / COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS MADE 0OCCUR DAMAGE TO RENTED PREMI8E8 E9 omurranoe •-• I / I I M>;D EXP An one rson d PERSONAL QgOV INJURY 3 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 9 POLICY JECTPRO. RLOC PRODUCTS -CO P/OPA00 B / / AUTOMOBILE LIABILITY I I I I I / COMBINED ANY AUTO SINGLE LIMIT (Ea ecclden) e ALLOWNEDAUTOS BCHEDULEO AVTO8 BODILY INJURY . E.L. (Perperson) i HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per eccldent) 3 --�— PROPERTY DAMAGE fPerecUdenl) 6 GARAGE LIABILITY •~ ANY AUTO AUTOONLY-EA ACCIDENT s OTHER THAN EAACC s AUTO ONLY' '- EXCESS/UMBRELLA LIABILITY AGG d ~ OCCUR ID CLAIMS MADE EACH OCCUR CE d ... Ij HJ DEDUCTIBLE I I I I I F j�+L'VuitKEkgGUIKPENSATIUNAND $9•]4858 eMPLOYERS' LIABILITY 10/OQ/2006 10/04/2007 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMDER EXCLUDED? E.L. 11 Yee. 4069Cribe under SPECIAL PROVISIONS below OTHER E.L. DESCRIPTION OFOPERATIONBILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/BPECIAI PROVISIOND d $00,DDO 500,000 i-00 000 1 HHrd L.GLLA I ION 1 TOWN or SAERBORN l ) - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF, THE ISSUINO INSURER WILL ENDIFA.VOR TO !/TAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 'flt THE LEFT, BUT 19 WASHINGTON STREET FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN'r' KIND UPON THE INSURER ITS AGENTS Or REPRES T. —VES. AUTHOprzeO EPR6SFNTATIVE ••• SH Q MA 01770- ACORD 23 (2001/DB)1108) INSD25 (01ps).on ELECTRONIC LAGER FORMS, INC. - (800),327-064 O ACORD CORFr'DRATION 1988 Pepe 1 Of 2 Location i � o sir,, -4 No. __:'7 Date N�RTh TOWN OF NORTH ANDOVER 3?• •�0 f 9 Certificate of Occupancy $ �'+s • Eta' Building/Frame Permit Fee $,% s +cavus « Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check # 1/,2,3 181166 Building Inspector TOWN OF NORTH ANDOVER BUELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Section for Official Use Onl BUII,DING PERMIT NUMBER: � � ^ DATE ISSUED: SIGNATURE: Building Commissio er r of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: lef-S C ® !/ \ Map Number Parcel Number 1.3 Zoning information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 WELDING SETBACKS (t1) Front Yard Side Yard Rear Yard Required Provide Required I Provided Provided 1.7 water Supply M.G.LC.40. § 34) 1.3. Flood Zone Iaiomntion: 1.8 Sewerage Di Wosv System: Public ❑ Pinata ❑ zona Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 of Record //Owner C.p�tfXV � S �S Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent I p 5.2�,� Name Print Address for Service: Signakurg/ Telephone r 3.1 Licensed Construction Supervisor Not Applicable ❑ _Z;Mr �_ AddressLicense Number zt ppwk Licensed Constructs upervisor. Expiration Date Si tu% Telephone C1' 3.2 Rstared Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone .0 T 3 -4 --rZ, O Vl%-A 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. Siened affidavit Attached Yea .......❑ No ....... ❑ 5.1 Registered Architect: Name: / /' 14tidTl-c2J S-1. we -.-c A In i (OA), - Address y �'��f�c�/�-v►f ��b'J� 18- �gOZ Signature Telephone �P R 16c, C- 1 d:\"j c'i"kf c Not Applicable ❑ Company Name: {nlt� (�% �r �,r�a,v2Rs AAV4-0/9z3 7-)9 ?,o -CO Responsible in Charge of Construction���5 7 L,,2,;L5 r Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number 1 Expiration Date Name Address Signature Telephone �P R 16c, C- 1 d:\"j c'i"kf c Not Applicable ❑ Company Name: {nlt� (�% �r �,r�a,v2Rs AAV4-0/9z3 7-)9 ?,o -CO Responsible in Charge of Construction���5 7 L,,2,;L5 r i.: `R:+r,T:x,^'-y., f.'1-,x+rte .�, New Construction ❑ -.nY:^ :. -:f :.:�fi.'.•< is vn, Existing Building ❑ ..,.;. - Repair(s) 0 Alterations(s) Addition 0 Accessory Bldg. ❑ TYPE Demolition ❑ Other 0 Specify Brief Description of Proposed Work: T.� 2�ofc- Z•� Foo (� cgu,< ns /,,v o¢ Aew uuw�/ ca,>°�„v y� , /� ,+��a., 4- � A10 Z S,?- 37 -At 41J t?,2 CC 04 U#'r 4o0 ztaW A6LA acus 44ee 63 J(i 11911Wa / 1.4ff+nAL4 t�w j 141+NJttA+ A �{e""�41'✓cn-:,�::, '^^a;•.}:a, '1'tI4,! - - ..� rk't;r + y:: USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 0 ❑ IA 1B ❑ 0 B Business 0 2A 2B 2C ❑ 0 0 C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B 0 ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R -I ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ 0 S Storage ❑ S-1 0 S-2 ❑ U utility 0 Specify: M Mixed Use ❑ Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area (sf) - Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize_ J m OF FI!A` OF My behalf, in all matters relative two work authorized 6y this building permit aj Si of r Owner of the subject property '�--om i kAcarr) to act on -J -/ 6"/03 Da 17 as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print N 7, 0 G,, --� yQs Si of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed by permit applicant 1. Building oor0oa (a) Building Permit Fee Multiplier 2 Electrical(b) Zst 0 0 Estimated Total Cost of Construction l / �7' 31 DD© from (6 3 Plumbing 4n. U �10010 Building Permit fee (a) x (b) 4 Mechanical (HVAC) 00 5 Fire Protection �O 6 Total (1+2+3+4+5) 7 t aO O Check Number ?.�., x�tse y£ �-r3{{{{; a#'<F^y. �tff�c' ,4�; ^�,..�;r�,,ypi c,., , fr;..�s{u{. y� <z -y �;iUa7 f=� ;{. , .iPo a �• r, ..� X ;��E�'� �1)✓+Zh } �){Y�� c�'�p^(' �{'tt{{�) J' '� .3.1,�}, gIC���jj:,r. ,�[�.Nt. � 'k}�j yjf{ � y. •�3Q_y ' -�,. �y,,,A -,{C . A. ) r y iu'rti J$/ v�;rk��•,•. '+ �q,,,'2 ' ,t+ ,:. L': '$ar ✓ .d fi t� .i%eF_'?�• f i iii` > e ;wird , �q3 i' ##c� +i G.�'"')T ".5.. f .Ex r y �S; '.t y,�� .�x � �C`k1�.�"f � . S' r��,Y � � f�.� r�'�`�3d�' ! �.0 ��,. �"�+��M1 NO. OF STORIES SIZE . � Y� BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ryvak�w,�yyi,+,c7(J1'yyy+.'.�5,(�k`t'i,..K.�My'a,-5`."_`{ ;,.y`bt�h�r`bff2.3 •`•'.�i"-• 1.k'..�%l" ti.~t` h.I�.,..e fi =f. *.TY •` n�lZ+ di�c».J+,�SVF6 it .h. '�y�.' M��c THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BUILDING DEPARTMENT CONSTRUCTION CONTROL AFFIDAVIT In accordance with Section 116.0 of the Massachusetts State Building Code, I, David Foster being a professional engihee /architect, certify that I have reviewed the plans for Prescott House - Interior Renovations, 140 Prescott Street, North Andover, MA and to the best of my knowledge such plans conform to the provision of said code, all acceptable engineering practices, all applicable laws and ordinances. And, further, that I will observe the construction as specified in Section 116.2.1 and submit reports as required by Sect. Architect or EngMee Seal SUBSCRIBED AND SWO 4 ON THISDAY OF �,PAY PUe '<< A.D. 20F" Z MY Ci = N i COMMISSION = A*- EXPIRES : J ',9�' V 31/08...O F CONN NOTARY PUBLIC MY COMMISSION EXPIRES I - � - --- �'' ^��e Pomim:o►zu�¢a� o�✓i�,a°°aclzuoetta BOAAMOF, BUILDING. REGULATIONS - License:.CONSTRUCTION SUPERVISOR: Number;, 045457 ; at .4:0-310811964 Expires�.0310WOO Tr no 11098 t ResM,� Oil JAMES H BURNS' 22 PAUISH LN_, BOXFORD, MA 01921 4 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Ofte of /nvest/gaftns Boston, Mass. 02111 Workers' Comps WUW Insurance Atlydavtt Please Print Name' Location: city Phone I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity PI am an employer providing workers' compensation for my employees working on this job. D„ n ,i_ / _ 2 1.1 ./ r I Si I�ZS momilt `-I%-O r0© Po11cv e iN C XL,t���.�? .S Comoanv name: Address City: Phone # Insurarm Co. PoYcv Fdkm to same coverage a. required under Sec Uon 2M or MOL 152 cm teed to the hnposom or akninal andtor oneYears ' i PSl�pss Ane up t0 =1,50mprisarrneot_as.viral_as-chi,paoaldaeJo]hs>��f�8'TAPYaIDIiKAROERmd.aAoed.(,f1II0.GM-m�d*gelrwma I understand that a copy of this stdament may be forwarded to the ofr49 of Inwndgeyons of the DIA for cove," veriicayon. 1 do hereby cw* unobrr pains an)'per�iH b8 ofPOWY diet the Inftmedw Pro tW above Is bus and Canso. Print nameAM.FS> P$ d-,Ocn6 OMIcW use only do not write In this area to be compietsd by city or town OT4gr City or Town P i ❑Check iI immedate response /s requked ❑ Budding Dept ❑ Lkenft Bosid ❑ Selectmen's OlftCe Contact person: Phones ❑ Health Department Other CO) m m m m CA Im COD CD Z CD O CL aas a� .,o 0 o v Q pop CD o CD 0 7 C44 d O O 'O� c� 0 CA d CD O CD CD y CDCO3 FA m D ca tV O CD ow S, 0 O d p fTli CD GO .rt C Z CD c =r y o -4 a Go c -4 s'CD ? !R ' >�CA m O 3 ?s O oZS C, Sr C y .�%-'� CL o maH t t w - �0CD CL m3 Ox COD . CIO C *4a Q ti 2: CK m : 41946 ..w m m o� oaf NK: �� do*=r cmo �, CD : Qsp 0 0 :� z 0 0 RV �o o��ez Aj�omb iglaul ju r:�u ll: t z N re v 1w Z2 0 c p ,� O T oO� zcp o r ` I -P o��ez Aj�omb iglaul ju r:�u ll: t z N re v 1w Z2 0 c GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace comers and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations '/Y " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). <� Crawl space access. (min. 18x24). 3 Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves s Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. '/ of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36 " high, Baluster max space 5" on center. Over 8' above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. HkltF 2 -- or,• PAvsr— / T Z -;Z:�/—�t FINISH: Handrails returned to wall/newall post. K CrC 14�7W,, Guardrails required alongside open cellar stairs. 0o,1 moi; D S Exterior grading complete. Ild� � --- Certificate or occupancy required prior to occupying_s ructure� Q j Temporary Stairs required for inspection. Re -inspection fee - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure ✓ �ili�� lr2 -� % I C: S38IdX3 : N NOISSIWW00 U AN 2. - : o SdHIM NOISSINWOD XW (Dllilfld AHVION) J,eOOZ 4W,v/y dO AVQ SIHJ. Hid 3H03Hg Oi NHOAkS (INV (IMUDSgf1S Nl H.LVQ 'IVHS I' 2[HIl LVNOIS 'IVNIOIHO - a 68£5 *ON ,o r 'SS2[HQQV dAOUV 3H L H0d ADNVdfl D 0 :4 DMILLUD V LSHfl6:iH I `TH03HHHH L 'H.L'IVRiAN0IiiW0D 3HJ, 30 S21QOD RHI d0 SNOL,VIflOHH QNV Sd'If1H 'I IV QNV SNOIJ,VDI3ID3dS QNV SNV'Id XW H.LItk1 X IdWOD SNOIJ.VAONdH 21H.L J.VH L QNI3 (INV •VIS 'aaeopuV gjJ0N ` c)9JIS 1100saad OT,i IV (13,LVD0'I A.LHQdOHd dHI QHI:)HdSNI 90/LM: NO 3AVH `dAL,VJ.NHUM QgNOISSV AL1i HO `I .,VH L A3LLHgD ARHHHH `J DHJ IHDHV LIAVQIddV 3H L SV `I ONIQN�d J N�Y�iJ HVd�Q NOI LDHdSNI ONIQ IIflg HHJ. 30 SHMHO 30 1AV'I dO SNOL,V'IOIA ON HHV HHHH,, J.VH L QNV `QH,L.LIwfffIS NHgg HAVH SJ.IAVQIdAV 'IVIHHJ.VN (INV SIVAOHddV QHHIfl6HU 'I IV IVHJ. `HHH LHIl3 H L IVdtk1N0Y1iY�i0� 3H L QNV HHAOQNV 30 NAML dH L dO SEQOD dH L OZ (INV SNV' ld QH,L,LINgflS HH,L OZ SWH03NOD ?MOA& SIH,, ,LVH., QNV KTv# JINHdd H3QNIl ltun utslnN ,g,utA& 30 NOI.LVAON2118 gHJ. QHSIAHMIS SVH HH J.VHl SAYS QNV S21SOdHQ `NHOr&S A If1Q ONIHg OHIA `VIV/aalso3 •O P!Au(I QdHVHddV �I'I'IVNOSHgd `DI'Igfld kHVJAN V f Uaull laJlUUaf `3w HH0dga ` gojuj/i 30 AVQ PuZZ SIHJ. NO SII:4Sf1H3VSSVW ILIO H.L'IV2lMNOWWO3 21H.L 4 11 [A.24401-101'-- � 0 --. q,e.rl- 2C,&61-, f C C,PSP J") FORM U -LOT RELEASE FORM 14 I ( I (oz INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTIO APPLICANT I�P.���� �c �u, Ing _ Cr��P �rr� , ��r� PHONE�� Qt/74 LOCATION: Assessors Map Number PARCEL 1-0 SUBDIVISION LOT (S) STREET I SI�p S CO`ifi S i ST. NUMBER 1'- C OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT / %7a y es RECEIVED BY BUILDING INSPECTOR DATE R*v1W W Jm CA m m x m N m Lq C2 y .0 So C � COD CD O MZ y D.O _ C =C da. y a� � O d o Co v CDCL o Q� =r d CO CD O W C � y� C36 Cl y O CD I So C2 GO O '0 Z CD oCD C CD C/) to tx Oq cn O ° E r i �- roti r 4 � f g b � � P -fir Tp 7N� O III D 0 =r T nD 1 X m Y F '0 v I Q Omi 0 9 0 OWK was CL 0 c 91 13 Date. ?/, �k.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... has permission to perform ................... plumbing in the buildings of at. . Ak exO J7 ........... -4 No Andover, FeeCheck # Mass. .70.$P... Lic. No,/ -f ........ PLUMBING INSPt'CTOR .0 :i, F PLUMBING: PIPING -FIXTURES - FIXED APPLIANCES -APPURTENANCES Z ENTER TOTAL AMOUNT FOR EACH SELECTION (LIMITED TO FIVE (5) NUMERALS ALTERNATIVE TECHNOLOGY A DISPOSER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUMBING CITYITOWN: U APPLICATION DATE: f STERILIZER JOB ADDRESS:SC ... PLANS SUBMITTED: YES NO❑ POCCUPANCY TYPE: COMMERCIALRD-'RESIDENTIAL❑ URINAL NEW ❑ ALTERATIONgj REPLACEMENT ❑ REMOVAUDEMOLITION❑ F PLUMBING: PIPING -FIXTURES - FIXED APPLIANCES -APPURTENANCES Z ENTER TOTAL AMOUNT FOR EACH SELECTION (LIMITED TO FIVE (5) NUMERALS ALTERNATIVE TECHNOLOGY A DISPOSER SINK: MOP SERVICELJ ASPIRATOR DRINKING FOUNTAIN STERILIZER DRAIN: AREALJ FLOOR EJECTOR ❑ STORAGE TANK 0 BACKWATER VALVE I EMBALMING Lj AUTOPSY URINAL BAPTISM: FONT SACRARIUM 0 FOOD CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM BAR SINK 0 GLASS WASHER WATER CLOSET BATHTUBLA WHIRLPOOLD ICE MAKER WATER HEATER: ALL TYPES BIDET INTERCEPTOR: ALL INTERIOR WATER PIPING: CROSS CONNECTION DEVICE KITCHEN SINK r OTHER NOT LISTED 7 DEDICATED: ACID WASTE SYSTEM LAUNDRY CONNECTION C DEDICATED: GASIOIUSAND SYSTEM LAVATORY DEDICATED: GREASE SYSTEM PIPE RELINING WORK ONLY [� El' DEDICATED: RECLAIMED WATER ROOF DRAIN DENTAL FIXTURE 1 EQUIPMENT 0 SINK: 1.2.3 BAY PREP.Fj DISHWASHER I SINK: CLINIC FLUSH RIM PLUMBING INSTALLER — FIRM -COMPANY INFORMATION CHECK ONE ONLY � ` iL7 67 -❑Corporation Business # NAME: ADDRESS: Partnership Business #0 pOV � ��.' STATE: ��,�'.�� CITY: .�� .<� .- ZIP: ,. 3 PLuH13 j & & Q cA TEL. E� ��'�,..__� FAX: . EMAIL: A.) ❑ LLC Business #0 Ac, co/y ❑ DBA 1Unincorporated NAME OF LICENSED PLUMBER: i INSURANCE COVERAGE I have a current liability insurance policy or, its substantial equivalent, which meets the requirements of MGL. Ch. 142 YES �NO ❑ If you have checked Yes, please indicate the type 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 OWNER® CHECK ONE ONLY AGENT Signature of Owner or Owner's Agent OWNER'S NAME: TEL: t I FAX: 1 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) Permit # Inspector Fee: TYPE OF LICENSE: lumber ester ❑ Journeyman (/ lftnaWe of Licensed Plumber License Number: �� The Commonwealth of Massachusetts Department of Industrial Accidents f. Office of Investigations 600 Washington Street + Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information Please Print Legibly Name (Business/Organization/Individual): Address: oris'' Citv/State/Zin: /6/�-,6 Phone #: !�7 8 Are you an employer? Check the appropriate box: 1. DI am a employer with, 4. E] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.[-umbing repairs or additions 12.❑ Roof repairs 13.[�J-Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. z. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an Additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name - 7 7-a a�,: /e Policy # or Self -ins. Lic. #: "��% a2f Expiration Date: Job Site Address:) c(!) EMS C= d rF sj- P - A -M11 Vl& City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a file up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Phone #: ezY ZIN q 2Y, 3 Uffuiul use only. Do not write in this area, to be completed by city or town official City or Town: Permit/Licensc # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: l eb L26 e A. Cr p'• c O`2rA A• III a rA�' cpi 220 �. �ii � � � �'► pVp y eD iii '17D'th - d Cn o n: o�oA A� n o eo ' fs It n 1A a O 00 7Q�On . ,��, j � �n N r. O * hq •� 4 A i7 't! n 15 z `S eo eD rn OINK b ° ceo ° IRS O c m o Q r'.. r* O A+ ►t ° OR CL ra mr�� �� e rp m to A�� g y rA k n C 1 N� b N Np p� CL ;3 Location --��r No. (,/� Date MOR,M TOWN OF NORTH ANDOVER Of ••ao ,a,�•C 3: � •a OL f 9 Certificate of Occupancy $ a 4 ; Building/Frame Permit Fee $ �CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �d• �� Check # C;1,9"5 -g14 191 U1 `Building Inspec, or Date D q-oi -Ob COMMONWEALTH OFAWSACHUSETTS TOWN OF NORTHANDOVER 27 CHARLES ST APPLICATIONFOR CERTIFICATE OF INSPECTION (�) Fee Required (Amount) () No Fee Required t torn Accordance with the provisions of the Massachusetts State Building code, Section 108,1 S, I hereby apply fo; Certificate of InTeet4on for -the below -named premises located -at 4he following cess: Street and ` f Number Wo d i9rP 3 e of Name of r Premises Purpose for which Premises is Used U Uy's c` Licenses (s) or Permit -(s) Required, License or Permit Certificate to he issued to Address I Owner of Record of Building Address NcIme of Present Holder of Name of Agency, if any Certificate by-OMer governmental Agencies: SIGNATURE OF PERSONS TO WHOM CERTIFICATE IS ISSUED OR HM AIITHOIRIZED AGENT INSTRUCTIONS: A ncy Telephone, TITLE DATE 1) Make check payable to: Town of North Andover 2) Return this application with your check to: RuildywDepg -2 North Andover MA 01845 PLEASE NOTE: `YDD shoo , Application form with accompanying FEE must be submitted for each building or structure or part thereof to be cert 3) Application andfee-mustbe receivedbefore-the certri4catewill be issued 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # EXPIRATIONDATE. FORM SBCC-3-74 REVIS£B 2f99ime TOWN OF NORTH ANDOVER INSPECTOR'S NAME OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE INSPECT4ONikEPORT-FORM CLASSIFICATION PASSES INSPECTION y%es Vno 0 DATED 0 4 -6 t4-65 OWNER e P YlpS� S CCB o -,(q Care / C �-eSGo� `Aa)lAsP BUILDING NAME OR -NO. STREET LOCATI TYPE OF OCCUPAWY .- .{day -Gare-Genter -0 -Attd. -O CaM -0 -Gym fl AM School 0 Common Victualer's 0 Liquor 0 Place of Assembly 0 C11,.II_ I ►l.. -, — I—_ _ � I -1.. OCCUPANCY NUMBER 4OwJade-ster4es -# -wd-eco►taancy jW-floor - ase r: a side EXIST SIGN LIGHTED EXIT SIGNS EMERGENCY LIGHTING SYSTE M SPRINKLER SYSTEM SMOKE DETECTOR FIRE ALARM SYSTEM operable -0 operable 0 operable 0 operable 0 -expiration -date ANSUL SYSTEM - FIRE ALARM SYSTEM operable 0 ELECTRIC EQUIPMENT PROPERLY PROTECTED EGRESSES LAWFULLY -DESIGNATE EXISTINGS yes 0 no 0 .-yes 41 -no � dry cell 0 wet cell 0 gage pressure yes 0 municipal 0 unobstructed 0 yes 0 -yes -0 yes 0 yes 0 yes 0 fires .11 STAIRS PROPERLY RAILED yes 0 HALLS AND STAIRWAYS LIGHTED yes 0 RADIATOR GUARDS yes 0 COMPLIES HANDICAPPED PERSONS LAWS yes FIRE RESISTANT CURTAINS OR DRAPERIES HOW HEATED NO. FIREPLACES yes 0 BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS no 0 no -►o no no no 0 , -,o 0 no 0 no 0 no D -no 0 no FOR INSPECTOR USE ONLY Revised 2199 ,IMc 0 . . 1. , ...r 0+ 0 00000 000�o nn�nn r Q � R n tP C� N W N O O O O 00 o,tn1� V 0 rr o a0000 CL CL Oil ll � mcn o N � ► Q � nn�nn r � � n tP C� N W N O O O O 00 o,tn1� V 0 � n r 0 rr O ►ts ,,,, H � � H x n o � 0 y � H � C � O y o � �• C N o o m 0 � � z �o 0 O m o ci � o x o 0 � dC 0 m X 0 m 0 on z Cn mo m 0 O z 5 2) 0 0 Q ((D (D AA) N C 0. (D CD v cD ai a (Q 0 0 Q (D CD 0 O 0) (Tt Lai! w /bo - .e 0L Town of North Andover BUILDING DEPARTMENT Genesis Health Care Corp Mr. Raymond Mead 200 Brickstone Square Andover MA 01810 Re: 140 Prescott Street Dear Mr. Mead, June 13, 2006 Please be advised that attached document noting the Zoning Board of Appeals decision of April 13,1973. The Board of Appeals voted for approval of a Special Permit under Section 4.122 (17) of the Zoning By -Law as to permit a Nursing Home located at the north side of Prescott Street at the corner of Chickering Road and known as 140 Prescott Street If you have any further questions, please let me know. Sincerely, Gerald A. Brown, Inspector of Buildings Cc: Curt Bellavance, Director File ,- Community Development Division, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com ATTEST: A True Copy Town Clerk John J. Lyons, Town Clerk Town Office Building North Andover, Mass. Dear Sir: TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS April 13 , 1973 Prescott Nursing Home, Inc. Prescott Street Petition No. 6-173 A public hearing was held by the Board of Appeals on March 12, 1973 upon applica- tion of PRESCOTT NURSING HOME, INC. requesting a Special Permit under Section 4.122 (17) of the Zoning By -Law so as to permit a Nursing Home located at the north side of Prescott Street at the corner of Chickering Road and known as 140 Prescott Street. The following members were present and voting: J. Philip Arsenault, Esq., Chairman; Dr. Eugene A. Beliveau, Clerk; Arthur R. Drummondt Frank Serio, Jr. and William N. Salemme. The hearing was advertised in the Lawrence Eagle -Tribune on February 24 and March 31 1973 and all abutters were duly notified by regular mail. Walter P. Hughes, 13 Lockway Rd.9 Andover, represented the petitioner. He explained that it is proposed to remove the present Shady Knoll Nursing Home and construct a new facility on the two acres as shown. There is an approved subdivision for town- houses which will be operated in conjunction with the nursing home. It is proposed to have 130 beds; 122 -'single rooms and 5$ double rooms. 73 parking spaces are -pro- vided. The Zoning By-law requires. 600 sq. ft. of area per bed, making 78,000 sq. ft. This proposal has 105080 sq. ft. of area which is well over the requirements. There are adequate water and sewer facilities from Chickering Road and Prescott Street. Three ways of egress are shown; one on Prescott Street and.two on Chick- ering Road. No one else spoke. There were no abutters present. One person notified the chairman by telephone that she was opposed. The petition was taken under advisement and was again discussed at the meeting held on April 9, 1973, with the same Board members present. A letter was received from Police Chief Lawlor stating he objected to the two access ways on Chickering Road because they would constitute a dangerous safety condition. Mr. Serio made a motion to GRANT the special permit with the conditions that there will be no entrances on Chickering Road and that there will be one 30 -foot entrance on Pres- cott Street at the location shown on the plan and that the structure will not be �; eft 35 feet in height. Mr. Salemme seconded the motion and the vote was s. M�,y 2 2006 .lAY 2006 30ARD 0F,A_PPEALS a APSILM TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Date .. AP#1 s. 1973 ........ Petition No...47t73............... Date of Hearing... March 12l .197 Petition of .... Prescott Nursing. ing Home, Inc. ................................................. Premises affected ... Prescott.$treat.................................................... Spec Permit under. Referring to the above petition fora requirements of the ................. North AndoverZon=J By -Lax, Section 14..122.47) ................................. so as to permit...the. erection. of, a ,Nursing Home ...................................... . After a public hearing given on the above date, the Board of Appeals voted to . GRANT..... the Special. Permit ................. and hereby authorize the Building Inspector to issue a permit to ..Prescott Nursing Home.,, .Inc......... . for the construction of the above work, based upon the following conditions: 1. The structure is not to exceed 35 feet in height. 2. A 30—ft. access road will be located on Prescott Street. Signed J. Philip Arsenault, Esq. Chairman Dr. Eugene A. Beliveau� Clerk Arthur. R.. Drummond ........................ Frmk.$erlo,. Jr. .......................... William. K...Salemme........................ Board of Appeals Location LL' d No. Date HpRT1y TOWN OF NORTH ANDOVER ' 9 4 Y + ; . Certificate of Occupancy $ ;' Ss�no • E<� Building/Frame Permit Fee $ 1 MMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # c2 2 Ov tt T Bwlding InspectQfr CJ 0 rp rro� S a OJ E-2 �o O 0 N O N V cd A ko H cis O N O O O z w � Ia, a od x iF2, i a 0 WD W fm P-40 Fro S. - ign Service & Instailat�i k.p Don Sullivan r op r 268 Csh res Street Farms g o 38 5 n 5-9 2 a .603 998 ail: ssign ispsa er.com eet t N� 9 0; b 0 00O ry rL O 0 (D CD }i 'O a G'Is M R rKrE=i i CA O b 0 co W 0 T N_ G 0 PA., � • M CD � O � b �Oy CD 0. O pd A CLCD 0 a b 0 00O ry rL O 0 (D CD }i 'O a G'Is M R rKrE=i i CA O b 0 co W 0 T N_ G 0 PA., 6 5ti8 �0 dW `JanoPud 4PON 199aIS }}OOs9Jd 0�L asaappy a}!S aaeOglleaH s!sauaE 8ZOOHJN! :d! Ae/unS u eld al! S , N ------------------------------------------ -... - - -- --- ----------------------------- - - -- - - - -- - - - - - --------------------------------------------------------- Z `-'................... -'--. ---------------------- = 96 S6 �� i i LZ SZ SZ � j . i ,89 L V`J v A ,6 m �o 6L ,Z9 O ,BZZ o ,6L W i 6 �o-a $� ,Z8 ,Z8ryl gs,St, ss� o� ,6 qs,S£ -- --- - - - --- - -- - ------------------------ -------- - -- Lb '•. EEL 19 SZ l SAMH u eld al! S , gnventory Detail E01 ..z�:-_ r��isu�oarr � Si n Co g— I?y P_ rescott House Genesis Eldercare... j -- ..�� " iaf _� (�l"CSCODUSfl - Genesis ElderCar- Network :0141, ,* ' 140 Prescott Street ' yw - o Existing Sign Type �� PS -Pylon Sign �He"g Width Depth 24" 9G" �7" Letter Height N/A OAH Above Grade 73" Sign Material Mount AL -Aluminum DP -Double Pole Face Type N/A Face Material N/A Retainer Type Retainer Size N A N/A V.O. Height V.O. Width N A NIA Surface Color Surface Material Notes: N/A N/A Available Height Available Width N/A N/A Double Face Illuminated No N-Nonllluminated E02 = K :rr� :.. YE: ; _.. {# 4 �i � y Sign C_o_py Please Use Front Entrance > Existin Si n T e DS -Directional Sin Height 3" Width 7" Depth N/A Letter Height OAH Above Grade 61" Sign Material Mount AL -Aluminum FW -Flush (W Face Type N/A Retainer Type Face Material N/A N Retainer Size N/A N/A V.O. Height V.O. Width N/A N/A Surface Color Sur ace Material Notes' PMS485 BK -Brick Available Height Available Width N/A N/A Double Face Illuminated No N-Nonllluminated For signs and fascia having an overall height greater than 25 feet, measurements are estimates only. Survey ID: INGH0028 Genesis HealthCare Site Address: 140 Prescott Street North Andover, MA 01845 11 A Q ƒ �M ƒ E�4:s¥ � � - sh°^ ¥n \ � ®k±kae�eecla� Q«« M .. e R4-1 M \\� k � � ) \ � R � ■ §/ � � —7!r � � CAS ] / s ± 2 �2 k $ � J.9 7 % § 4 4 ® k� 7 �7]\US e = t ■ f # t 42 — 41 I _ 42 ,#e E§.= � 2 y m� $ o 4,1 %\ b a *\2ƒ §kjj/ � � —7!r � � CAS ATTEST: A True Copy Town Clerk John J. Lyons, Town Clerk Town Office Building North Andover, Mass. Dear Sir: TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS April 13 , 1973 Prescott Nursing Home,, Inc. Prescott Street Petition No. 6-173 :-Ail A public hearing was held by the Board of Appeals on March 129 1973 upon applica- tion of PRESCOTT NURSING HOME, INC. requesting a Special Permit under Section 4.122 (17) of the Zoning By -Law so as to permit a Nursing Home located at the north side of Prescott Street at the corner of Chickering Road and known as 140 Prescott Street. The following members were present and voting: J. Philip Arsenault, Esq., Chairman; Dr. Eugene A. Beliveau, Clerk; Arthur R. Drummond, Frank Serio, Jr. and William N. Salemme. The hearing was advertised in the Lawrence Eagle -Tribune on February 24 and March 3, 1973 and all abutters were duly notified by regular mail. Walter P. Hughes, 13 Lockway Rd.9 Andover, represented the petitioner. He explained that it is proposed to remove the present Shady Knoll Nursing Home and construct a new facility on the two acres as shown. There is an approved subdivision for town- houses which will be operated in conjunction with the nursing home. It is proposed to have 130 beds; 12 single rooms and 58 double rooms. 73 parking spaces are pro- vided. The Zoning By-law requires.600 sq. ft. of area per bed, making 78,000 sq. ft. This proposal has 105,580 sq. ft. of area which is well over the requirements. There are adequate water and sewer facilities from Chickering Road and Prescott Street. Three ways of egress are shown; one on Prescott Street and two on Chick- ering Road. No one else spoke. There were no abutters present. One person notified the chairman by telephone that she was opposed. The petition was taken under advisement and was again discussed at the meeting held on April 9, 19739 with the same Board members present. A letter was received from Police Chief Lawlor stating he objected to the two access ways on Chickering Road because they would constitute a dangerous safety condition. Mr. Serio made a motion to GRANT the special permit with the conditions that there will be no entrances on Chickering Road and that there will be one 30 -foot entrance on Pres- cott Street at the location shown on the plan and that the structure will not be more than 35 feet in height. Mr. Salemme seconded the motion and the vote was RE��• MAY 3 1 2006 BUILDING nFpT VA °)a P 49 f. joHl, J. April 13 , 1973 Prescott Nursing Home,, Inc. Prescott Street Petition No. 6-173 :-Ail A public hearing was held by the Board of Appeals on March 129 1973 upon applica- tion of PRESCOTT NURSING HOME, INC. requesting a Special Permit under Section 4.122 (17) of the Zoning By -Law so as to permit a Nursing Home located at the north side of Prescott Street at the corner of Chickering Road and known as 140 Prescott Street. The following members were present and voting: J. Philip Arsenault, Esq., Chairman; Dr. Eugene A. Beliveau, Clerk; Arthur R. Drummond, Frank Serio, Jr. and William N. Salemme. The hearing was advertised in the Lawrence Eagle -Tribune on February 24 and March 3, 1973 and all abutters were duly notified by regular mail. Walter P. Hughes, 13 Lockway Rd.9 Andover, represented the petitioner. He explained that it is proposed to remove the present Shady Knoll Nursing Home and construct a new facility on the two acres as shown. There is an approved subdivision for town- houses which will be operated in conjunction with the nursing home. It is proposed to have 130 beds; 12 single rooms and 58 double rooms. 73 parking spaces are pro- vided. The Zoning By-law requires.600 sq. ft. of area per bed, making 78,000 sq. ft. This proposal has 105,580 sq. ft. of area which is well over the requirements. There are adequate water and sewer facilities from Chickering Road and Prescott Street. Three ways of egress are shown; one on Prescott Street and two on Chick- ering Road. No one else spoke. There were no abutters present. One person notified the chairman by telephone that she was opposed. The petition was taken under advisement and was again discussed at the meeting held on April 9, 19739 with the same Board members present. A letter was received from Police Chief Lawlor stating he objected to the two access ways on Chickering Road because they would constitute a dangerous safety condition. Mr. Serio made a motion to GRANT the special permit with the conditions that there will be no entrances on Chickering Road and that there will be one 30 -foot entrance on Pres- cott Street at the location shown on the plan and that the structure will not be more than 35 feet in height. Mr. Salemme seconded the motion and the vote was RE��• MAY 3 1 2006 BUILDING nFpT VA °)a P 49 "' , .4 Prescott Nursing Home, Inc. —2- April 13 , 1973 The Board found that there is more than enough area per bed# 600 sq. ft. per bed is required# making 78,E sq. ft. This petition has 1059580 sq. ft. The peti— tioner has complied with the requirements of Table 2 in that there is more than enough total land area. The Board finds that the conditions for approval under 9.31 have been met as follows: 1. The specific site is an appropriate location for such a use, structure or condition. 2. The use as developed will not adversely affect the neighborhood. 3. There will be no nuisance or serious hazard to vehicles or pedestrians. 4. Adequate and appropriate facilities will be provided for the proper operation of the proposed use. AD very truly yours, 7D OF APPEALS . Philip Arsenaultt Esq. Chairman r +`A��o AvR��7n 1855 ....t;X TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Date .. AP#1. 1-3. r. 1973........ . Petition No.. .4-1'73 ............... Date of Hearing... ?`' Arq .fit .1M. Petition of .... Prescott Nursing. Home,,Inc............................................. Premises affected ... Prescott. Street . . ........ . . . . . . ...... . . . ........................... SpecJ41 Prmi under Referring to the above petition fora Whe requirements of the ................. NorthAndover. Zoning By -Laws Section k•122.(17) ................... I............. so as to permit ...the. ereetion. of. a ,Nursing Home . . . . . . . . . .. . ............. . .......... . . After a public hearing given on the above date, the Board of Appeals voted to . GRANT..... the SpecialPermit ... , , , and hereby authorize the Building Inspector to issue a permit to ..Prescott.Nursing.Home,, Inc. ............................................ for the construction of the above work, based upon the following conditions: 1. The structure is not to exceed 35 feet in height. 2. A 30—ft. access road will be located on Prescott Street. Signed J. Philip Arsenault, Esq.9 Chairman Dr. Eugene A. Be4ve4u2 Clerk Arthur.R...Drummond ........................ Prank. Set'!Qv..,Tr........................... William. N...Salemme....................... . Board of Appeals «..4W 04 1.,�� NORTH TOWN OF NO THAN66VER PERMIT FOR GAS INSTALLATION This certifies that.. G�'. 4" ...P<..f,?�.. , ....... . has permission for gas installation ... �� :.f .................... . in the buildings of ... s. ..G �.--........... . at ........... , North Andover, Mass Fee .. p ... Lic. No. `.� : ' �.... ... ,. ............... GAS INSPECTOR Check # 2. C Y �- 5333 MASSACHUSETTS UNIFORM APPLICATION F R PERMIT TO DO GASFITTINGJ" (Point of Type) / !".V��Z , Mass. Date 2C �S Permit Building Location 4li 1�( SCD %% S Owners Name / /?CS Cv 7 III 6 Installing Address Business T Type of Occupancy Coh New Renovation p Replacement , Plans Submitted: Yesp ' No p ►ny Name CA LL R Name of Licensed Plumber or Gas Fitter Check one: B—Corporation 0 Partnership D Flrin/Co. Certificate # ac r INSURANCE COVERAGE: I have a current,119161111Y Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Iff No D I( you have checked yes. please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Q/ Other type of Indemnity O Bond 0 OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent OwnerO Agent 0 I= hereby certify that all of the details and Infotmation t have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations Performed under the permit Issued for this application will be In compliance with aG pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene at laws. T e of Ucense: Title Plumber r u e of LicAsedPlumber or Gas Miter = asfiuor3 L�Lid CilylTown stet Ucense Number IU,Pittiv(f57bTTiZ Journeyman NEW MEN mom ►ny Name CA LL R Name of Licensed Plumber or Gas Fitter Check one: B—Corporation 0 Partnership D Flrin/Co. Certificate # ac r INSURANCE COVERAGE: I have a current,119161111Y Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Iff No D I( you have checked yes. please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Q/ Other type of Indemnity O Bond 0 OWNER'S INSURANCE WAIVER: t am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent OwnerO Agent 0 I= hereby certify that all of the details and Infotmation t have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations Performed under the permit Issued for this application will be In compliance with aG pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene at laws. T e of Ucense: Title Plumber r u e of LicAsedPlumber or Gas Miter = asfiuor3 L�Lid CilylTown stet Ucense Number IU,Pittiv(f57bTTiZ Journeyman All 1 VORTN 0 F . F Date �/- �11 5 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ;,SSACNUSE� � This certifies that ..ju..l :....... . has permission to perform � ............... . plumbing in the buildings of ... . at ../. !� . f'/. ............ , North Andover, Mass. Fee,. '✓. L'ic. No.... ......... . PLUMBING INSPECTOR Check __1%G� (1•� % 6446 V 'MASSACHUSETTS UNIFORM APPUCA 01ft a Typal New O ltASEMINT' ST FLOOR zrcafrac•!t IIRD FLOOR <TH FLOOR STHFLOCR 4TH FLOOR 7TH FLOOR STH FLOOR 6 rrrESCC 1'T Ranova m M PERMIT TO 00 PLUMBING 7(' U..ts._..._.. Pet." n —644a Type « occancy_ /y �,�5 %.✓ �, y4 ,, eptaee,Ttertt R Pl" SubmbAd: Yes ❑ No ❑ FIXTURES i :k l COC-14-WYNarrk-b' Kj5,j�FC Addrtss_re; S q Cixcic o. cati',.e �eJ"[itF i• a S e� ti �� . Busineas Te! ❑ r'arti'e''xt' ephone k G - 6 o rvec. Mune of L�^ ed Psi -- -R r, . Fay- • �c INSURANCE COVERAGE: 1 terve a curx It y htw r4e paw Or !tt mbGhrdW eqJYsle;t which mets the rad Yes No O J*nl xr s d MOL Ch 141 K Y� tm chad�ed Y#, piasra k-dlcate the type Com1g. by the oto bax A tiabillty tnsttni�-_- "Icy p Other t,pe Of k4&Tv tty Cl . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that ttv licetasetSl4ts not t,sve the trssuranea coverapa required �, Ct��tar 1 t2 of ttx Aiass. t3aneral Laws. snd t* my slgrs we On thls�pptiatbn wtM fts W&MenL Check one: Sgm— a = Owner ❑ A O I hareby W* tat a>? al tta dews wid infamu m 1 haver > ,d � e and tat all ptttrt&V work and instaltab= pwtmW for w *4 ki � 4ppka m rr� trw ted acx ixau to the bad at my ve�tln.crt provrsiorss Of the Stater PicartbinQ under t and testa � = Wtp be in axnptislo- -ft d rrUe . City/Town Type el License: mstar � �y L+oeftm Number/ - b s z a a c= a z `< r a c a .w s�¢ a a e � C o jL ' G a M C Wx o NJ J W q = N �[ C • ; .o, er e a s a r- v er Y< < a� i :k l COC-14-WYNarrk-b' Kj5,j�FC Addrtss_re; S q Cixcic o. cati',.e �eJ"[itF i• a S e� ti �� . Busineas Te! ❑ r'arti'e''xt' ephone k G - 6 o rvec. Mune of L�^ ed Psi -- -R r, . Fay- • �c INSURANCE COVERAGE: 1 terve a curx It y htw r4e paw Or !tt mbGhrdW eqJYsle;t which mets the rad Yes No O J*nl xr s d MOL Ch 141 K Y� tm chad�ed Y#, piasra k-dlcate the type Com1g. by the oto bax A tiabillty tnsttni�-_- "Icy p Other t,pe Of k4&Tv tty Cl . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that ttv licetasetSl4ts not t,sve the trssuranea coverapa required �, Ct��tar 1 t2 of ttx Aiass. t3aneral Laws. snd t* my slgrs we On thls�pptiatbn wtM fts W&MenL Check one: Sgm— a = Owner ❑ A O I hareby W* tat a>? al tta dews wid infamu m 1 haver > ,d � e and tat all ptttrt&V work and instaltab= pwtmW for w *4 ki � 4ppka m rr� trw ted acx ixau to the bad at my ve�tln.crt provrsiorss Of the Stater PicartbinQ under t and testa � = Wtp be in axnptislo- -ft d rrUe . City/Town Type el License: mstar � �y L+oeftm Number/ - b s a c= a z `< r a c a .w s�¢ a a e � C o jL ' G a M C Wx o NJ J i :k l COC-14-WYNarrk-b' Kj5,j�FC Addrtss_re; S q Cixcic o. cati',.e �eJ"[itF i• a S e� ti �� . Busineas Te! ❑ r'arti'e''xt' ephone k G - 6 o rvec. Mune of L�^ ed Psi -- -R r, . Fay- • �c INSURANCE COVERAGE: 1 terve a curx It y htw r4e paw Or !tt mbGhrdW eqJYsle;t which mets the rad Yes No O J*nl xr s d MOL Ch 141 K Y� tm chad�ed Y#, piasra k-dlcate the type Com1g. by the oto bax A tiabillty tnsttni�-_- "Icy p Other t,pe Of k4&Tv tty Cl . Bond 0 OWNER'S INSURANCE WAIVER: I am aware that ttv licetasetSl4ts not t,sve the trssuranea coverapa required �, Ct��tar 1 t2 of ttx Aiass. t3aneral Laws. snd t* my slgrs we On thls�pptiatbn wtM fts W&MenL Check one: Sgm— a = Owner ❑ A O I hareby W* tat a>? al tta dews wid infamu m 1 haver > ,d � e and tat all ptttrt&V work and instaltab= pwtmW for w *4 ki � 4ppka m rr� trw ted acx ixau to the bad at my ve�tln.crt provrsiorss Of the Stater PicartbinQ under t and testa � = Wtp be in axnptislo- -ft d rrUe . City/Town Type el License: mstar � �y L+oeftm Number/ - b .~ H. H 272 Newt Gent Pref 1971t perm Apps and by t subn May A 1975 CHF: ad zuNua ©FFI:cha r t H. H 272 Newt Gent Pref 1971t perm Apps and by t subn May A 1975 CHF: ad zuNua ©FFI:cha H. K. FITZGERALD, JR. & ASSOCIATES ARCHITECTS ENGINEERS 272 CENTRE STREET • NEWTON, MASSACHUSETTS 02158 * PHONE 16173 527-5030/527-5029 �� �1 TO �s . � . _ �".O . g e-.... _. � SUBJECT. . � W . _ Y'.0� e gg�,� U v k Y10� V %l c l'i , .I����s .. ._. DATE. _ _ . p��,J - A.�. A. twi eek • l N Lbw► its 1`�Svaa\tc CI`, b d�.•�. �r 11... _ ��'�P��+ �.o.v�'1 4 r. Q.r 1 BY A 9 p L v DATE SIGNED Form N -RI IMS The Drawing Board, Inc., Box 505, Dallas, Texas ` INSTRUCTIONS TO SENDER: INSTRUCTIONS TO RECEIVER: 1. KEEP YELLOW COPY. 2. SEND WHITE AND PINK COPIES WITH CARBON INTACT. 1. WRITE REPLY. 2. DETACH STUB, KEEP PINK COPY, RETURN WHITE COPY TO SENDER. G K K. tTZGERALD, JR. & ASSOCIATEB' AMB 04GMEMIS ala CENTRE 5•TRELT o NIZVrMN, MAMACHUSETTS 02156 • PHGbM E6173 527-M=/S27-5= elsSs- TOG SUBJECT- - t I n 41M1 r' q 1 f �"� V i� , �r�.►n DATE J '�� k Is G e s �� �1� c.�5S 't oL- r' 1n�(cr W�4e�l^ aS l,ppm� ylk r- ems ., t �� r 5 1 �tiS r I Q � 15`�L�Ghi,� cs G. \0 Q yld � �, ��, }�� �r. C_v y�•\(�� 1 ryy,L' t,�+�`,, -e Cc�zs BY r r_ DATE 1 SIGNED D-ETACH AND FILE FOR FOLLOW-UP 9 Monday - August 7, 1972 Regular Meeting The PLANNINs BOARD held its regular meeting on Monday evening, August 7, 1972 at 7:30 P.M. in the Town Office Building. The following members were present and voting: Charles W. Trombly, Jr., Chairman; Donald N. Keirstead, Vice Chairman; Fritz Ostherr, Clerk; William Chepulis and John J. Monteiro. Mr. Ostherr made a motion to accept the minutes of the previous meeting, with one correction - Southwest should be Southeast in the written decision of the George Farr subdivision. Mr. Keirstead seconded the motion and the vote was unanimous. RALEIGH TAVERN SUBDIVISION: Atty. Victor Hatem and Ben Osgood appeared before the Board to request the Board to lower the amount of the bank book being held on the Raleigh Tavern sub- division. They request the release up to the turnaround; they have a few minor corrections to make before the turnaround is completed. A letter was received from the Highway Surveyor recommending that $3:000 be released and to leave $1,000 to cover the remaining work to be completed. Mr. Keirstead made a motion to release $3,000 of the $1,000 being held, and retain $1,000 for the completion of any work to be done on Raleigh Tavern Lane North. Mr. Ostherr seconded the motion and the vote was unanimous. TOWN HOUSE DEVELOPMENT: Mr. John Callzrhan, surveyor and engineer, and Mr. Walter Hughes appeared before the Board with preliminary plans for a town house development off Prescott St. Mr. Hughes is planning to raze the Shady Knoll Nursing Home and build a new nursing home. They have approx. 7 acres and are interested in having a town house develop- ment which will be in conjunction with the nursing home and have the use of the nursing home facilities, programs, nurses, etc. It is primarily for elderly people and the town houses would be sold individually. They would meet subdivision rules and regulations as to'the roadway. They presented plans showing the layout. Discussion was held as to the definition of a town house and the new Zoning By -Law was studied. Further discussion was held as to condominiums and town houses. The Zoning By -Law requires that each town house have its own lot. The Building Inspector.said he would issue permits as long as the Planning Board approved the plans. They plan on having 30 town house units. Mr. Hughes said he would give a covenant or bond for the roadway. They could probably start on one part of the development immediately by fronting on Prescott Street and getting a plan signed "Not Requiring Planning Board Approval". Mr. Keirstead suggested that 24 feet would be wide enough for secondary drives; this is sort of a P.U.D. and he is agreeable to this type of development. He said the Planning Board will probably have something ready on P.U.D.'s for March town meeting. Mr. Hughes said he would submit plans that will show individual lots with 30 ft. setbacks, showing a roadway and showing 3,000 sq. ft. lots with 18 ft. frontage for each town house unit. Lengthy discussion was held and Mr. Hughes said he would rather abandon the plan than work on it in sections and not be sure of what will happen. They will appear before the Board again. Monday — September 11, 1972 Regular Meeting The PLANNING BOARD held its regular meeting on Monday evening, September 11, 1972 in the'Town Office Building with the following members present and voting: Charles W. Trombly, Jr., Chairman; William Chepulis and John J. Monteiro. Don Keirstead and Fritz Ostherr were unable to attend. Mr. Monteiro made"a motion to accept the minutes of the previous meeting; Mr. Chepulis seconded the motion and the vote was unanimous. /TOWN HOUSE DEVELOPMENT: Mr. Hughes and Mr. Callahan appeared before the Board and presented new plans of the town house development which showed roadways ---and separate lots of 31000 sq. ft. with 18 ft.'frontage. They explained that it would be a 20 ft. paper street from the turnaround, that it would'just shots on the plan to meet the Board's re— quirements but would never be constructed. ..Mr. Chepulis questioned the roadway being shown as a paper street, he'commerited that it was a devious way to get the Board's approval. Lengthy discussion was held on this.' The plans showed that the parking'areas were changed. The.main roadway is the same as before. It contains the same number of units — 30. All have proper setbacks, frontage and area. The Board said a hearing would not be necessary because this is not a subdivision. There are two large lots, one containing four acres and one containing three acres and fronting on Prescott Street. A new roadway will be constructed under Sub— division Rules and Regulations. They will present a linen and plans at the next meeting for the Board to sign as Tot Requiring Approval Under the Subdivision Control Law". PROPOSED SUBDIVISION OFF JOHNSON STREET: Scott Giles, Surveyor and Atty. John Willis appeared before the Board with preliminary plans for a possible subdivision off Johnson Street on land of Beckwith. They dere concerned about the length of the roadway and turnaround. The Sub— division Rules and Regulations specify 500 feet, but they wanted to know if the Board would approve a roadway of 11000 feet. The Board said it would be all right. Atty. Willis pointed out that it could possibly connect to a roadway through to Salem Street if Henry Donovan, owner of the adjoining land, was agreeable. He will pursue this further. They will present more preliminary plans at the next meeting. MELVIN WIEINER: F Atty. Harold Morley discussed the Weiner plan again with the Board. This petition had been denied by the Board of Appeals a -rid Atty. Morley wanted to discuss what could be done to the roadway and how to show frontage in order_ to get a building permit. He asked if a 40—ft. roadway would be acceptable to the Board. He will present more plans to the Board for its approval at a later date. October 2, 1972 — cont. D 0 0 JOHN WILLIS: Atty. John Willis appeared before the Board to discuss provisions of the Sub— division Rules and Regulations relative to the degree of grades and slopes on the roads.- He was informed that the regulations are still in effect allowing a 12% grade and that the proposed requirements would not apply yet. /WALTER HUGHES: Town House Development. .Mr. Walter Hughes and Mr. John Callahan appeared before the Board with a plan showing the roadways on the townhouse development. Mr. Hughes said they don't need a subdivision plan but are asking the Board to approve a plan so that the Building Inspector will give them building permits for the townhouses. He asked the Board if the plan was all right as far as the road way was concerned. He said they will build the road from Prescott St. to the turnaround but have no intentions of building the road to the remaining townhouses; that portion of the roadway win be just on paper and never be built. They plan to build the driveways as shown on another plan. He said this is not a subdivision because they are making two large lots actually fronting on Prescott St. They can't get bank approval or building permits until he receives Planning Board approval. A lengthy discussion was held about not constructing the roadway and the Zoning By—Lair requirement of each townhouse requiring its own lot and frontage. Mr. Keirstead said that we. have a zoning law that doesn't allow a development to be DObuilt such as is proposed. He thinks the problem is with the Building Inspector — how does he have assurance that he can issue a permit? Townhouses have to have frontage on a street. The Building Inspector had said previously that he would issue permits if the Planning Board approves the street. Mr. Hughes said he would forfeit the bond if necessary and that the Board could accept the road as it is -shown now. The Board said he will need a full set of plans, profiles, etc. for the road. Mr. Hughes asked if the Board would consider a 20—ft. road for the remaining 18 townhouse units. Lengthy discussion was held. Mr. Ostherr made a motion,which would also become part of a letter to be sent to the Building Inspector, that the road as shown on the plan, while it does not meet Planning Board requirements as to the roadway and turnaround; it is acceptable for the purposes of issuing permits. Mr. Montairo seconded the motion. Further discussion was held. Mr. Keirstead suggested that the Board give the roadway tentative approval as a preliminary plan; he said there -are two exceptions to the requirements, the 20—ft. roadway and no turnaround on the second road. Mr. Ostherr then made a motion that the Planning Board approve the plan entitled "A Site and Topographic Plan for Townhouse Development in North Andover, Mass. dated April 20, 1972' with the street as shown in brown on said plan; that we 0 tentatively approve this street as shown on this preliminary plan subject to the eventual submission of detailed specifications of the roadway. Mr. Monteiro seconded the motion and the vote was unanimous. Tuesday - October 17, 1972 Special Meeting The PLANNING BOARD held a special meeting on Tuesday evening, October 17, 1972 at 7:30 P.M. in the Town Office Building with the following members present and voting: Charles W. Trombly, Jr., Chairman; Donald N. Keirstead, Vice Ch.; William Chepulis and John J. Monteiro. Fritz Ostherr was out of town and unable to attend. Mr. Keirstead made a motion to amend the previous minutes using the word "position" instead of "petition" with reference to the Jay Road problem; and to accept the minutes with that correction. Mr. Monteiro seconded the motion and the vote was unanimous. PROPOSED SUBDIVISION OFF JOHNSON STREET: Atty. John J. Willis requested that the Board set a hearing date for the proposed subdivision off Johnson Street for which he had already submitted preliminary plans. Mr. Monteiro made a motion to set Monday, November 20th as the hearing date; Mr. Keirstead seconded the motion and the vote was unanimous. JWALTER HUGHES: Townhouse Development Mr. Hughes and Mr. Callahan presented further plans to the Board, showing the townhouse development divided into lots with the.required frontage. Mr. Callahan said he showed the plans to the Bldg. Inspector who said he would like approval from the Planning Board as to the roadway. Mr. Keirstead said the only solution is to file the plans as a subdivision and go through all of the procedures required as a subdivision. The road can be built with a covenant, utilities installed, etc. and then building permits can be issued. The clearest, simplest way is to file as'a subdivision.• He said if a plan was approved without a subdivision hearing, they would be taking a chance on whether or not they would get a building permit. When the By-law was drawn up,'the Board did not conceive that this type of a plan would be presented. Mr. Hughes suggested that the By-law be amended. He said it would have been fairer if the Board had told him from the start that a subdivision hearing would be necessary instead of having this trouble from meeting to meeting. Mr. Callahan said building permits could be issued right away for the townhouses fronting on Prescott Street. Mr. Hughes asked if there was any way to get a preliminary approval of this plan. Mr. Callahan asked if the Board would approve the roadway and they would covenant it just as if it were under a subdivision. Mr. Keirstead said the Board operates under state statute and would have to do as is required. He said the Board could approve the plans as a preliminary plan. Mr. Callahan said there is adequate area and frontage shown on the plan for each unit. Discussion was held on the installation of utilities, roadway, etc. ( 9 A lengthy discussion was held on this development, again. Tuesday - October 17, 1972 - cont. Mr. Keirstead made a motion to grant tentative approval of this preliminary plan under the.Subdivision Control Law; Mr. Monteiro seconded the motion and the vote was unanimous. Mr. Keirstead then 'made a motion to set a hearing on the tentative plans for November 20th subject to plans being received prior tothat time. Mr. Monteiro seconded the motion and the vote was unanimous. ` CHESTER C. SULLIVAN - PLANS: Mr. Sullivan presented corrected plans to the Board for signature as "Not Requiring Planning Board Approval" for the Peterson land on Salem Street. After thorough discussion, the Board signed the plans. Mr. Sullivan then presented preliminary subdivision plans to the Board for the ' development of the interior land on Salem Street. Discussion was.held on these plans. i.. Mr. Keirstead made a motion to grant tentative.approval to the preliminary plan of "Salem Gardens".' Mr. Monteiro seconded the motion and the vote was unanimous. Mr. Keirstead then made a motion to set a hearing on the tentative plan for November 20th if proper plans are submitted prior to that time. Mr. Monteiro seconded the motion and the vote was unanimous. DD JAY ROAD: or John Shields Nothing had been received from Town Counsevrelative to the Jay Road drainage problem. Mr. Keirstead said we should write to Town Counsel asking for whatever communication he has received and notifying us. He said he had talked with Town Counsel by telephone and was told that it was cleared with Mr. Shields and that Town Counsel is drafting the necessary legal papers to get the $2400. The money is in a 90 -day account and not available until January. Mr. Keirstead suggested that no action be taken on this tonight because the petitioners have gone before other town bodies to get this. If not successful in getting the money, the Selectmen suggested that Mr. Nicetta expend his money and then be reimbursed. Mr. Nicetta indicated he would not do as the Selectmen asked. Everyone can wait until town meeting and ask -7 for acceptance of the road and additional money for completion of the job but there may be a legal problem on whether the town can do anything on a private road. The real problem is that the catch basins are full of dirt and cannot take the water. Mr. Monteiro feels this is an emergency. The Board should take the $2400 and use it. The street could not be accepted if it is not in proper condition. Mr. Chepulis said that in an emergency the money could probably be taken out of a 90 -day account. Mr. Keirstead said if we did get the money, the catch basins can get cleaned. The law says the Planning Board can administer this money for the road. Mr. Monteiro made a motion that we expedite the receipt of the $2400. Mr. Keirstead suggested that we ask Toim Counsel to see if we can get the money immediately. Monday — November 20, 1472 3 Subdivision Hearings The PLANNING BOARD held a special meeting on Monday evening, November 20, 1972 at 7:30 P:M. in the Town Office Building with the following members present and voting: Charles W. Trombly, Jr., Chairman; Donald N. Keirstead, Vice Chairman; Fritz Ostherr, Clerk; William Chepulis and John J. Monteiro. There were over 50 people present so that the meeting was adjourned to the Fire Station meeting room. 1. HEARING: Walter P. Hughes – Townhouse Subdivision. Mr. Ostherr read the legal notice upon the petition of Walter P. Hughes, re– questing approval as a subdivision a parcel of land containing 7.2 -acres, approx., off Prescott Street at the northwest corner of Chickering Road. Chairman Trombly read a letter from Mary Seldon, an immediate abutter'*livingin Ann Arbor, Michigan, who suggested that the Board not approve the subdivision until she knows more -about what is planned. J. Elaine Griffin, Chickering Road, stated that she is not for or against the pro– posal, but she wants to be sure that the entrance is to be from Prescott Street and not Chickering Road.-. Walter Stamp, Jr., Prescott Street, stated that plans are not complete and that until proper plans have been presented, the hearing should be delayed. Mr. Keirstead noted that definitive plans have not been submitted and that nothing further can be done. Mr. Monteiro suggested that objections would still be in -� order. Nicholas Evangelos, 126 Prescott St., questioned the drainage of the area immediately adjoining his property. He feel there will still be a problem where the land abuts. He wants to know if the esthetics of the area will be maintained, how many trees will be removed, etc. The petitioner, Walter Hughes and the engineer, John Callahan, arrived. Mr. Callahan proceeded to explain the plans submitted. He stated he had discussed with the Building Inspector the space between the buildings and that interpretation of the Zoning By–law now -requires 25 feet from the lot line to the building, making 50 -feet between buildings and the plans now show that along with the proper lot frontage and area. The yownhouse complex will be made up of 31 units. They have adequate utilities. They will follow the natural drainage where possible and they want to keep the trees and natural topography of the area. They have also developed a recreation area. The units will be available to elderly people, who will also have use of the medical services of the nursing home. Mr. Hughes further explained that the townhouse complex would be used in conjunction with the nursing home. He believes the plans now meet all requirements as to subdivision and zoning. Mr. Evangelos was concerned about the care of the grounds because the present nursing home is poorly kept. Mr. Hughes explained that he will have ownership in the town– house development but not.with the nursing home.. Mr. Keirstead explained that before any action is taken by the Board, the sub– division plans are referred to various departments for recommendations from them ( �� and that conditions can be 'attached to the 'decision. \_ �� A November 20, 1972 - cont. Mr. Stamp asked about the townhouse development being under joint ownership and condominiums. Mr. Keirstead explained that condominium is a type of ownership and that it is not the Board's concern as to how the land is sold. The lots as shown meet the zoning requirements. The roadway, water, drainage, etc. are the concern of the Planning Board and that they are done properly. Drainage, water and sewer will be re- ferred to the proper departments. These facilities are not presently shown on the plans. - Mr. Keirstead made a motion to adjourn the hearing and continue it on December 4th on the condition that completed plans are in the affis Planning Board office by November 27th. Mr. Monteiro seconded the motion and the vote was unanimous. Nancy Stevenson, Colgate Drive,` asked if these units would be available only to the elderly. Mr. Hughes said they would like to sell them only to the elderly but that they could be available to others. 2. HEARING: Chester C. Sullivan; Salem Street Subdivision. Mr. Ostherr read the legal notice upon the petition of Chester C. Sullivan, requesting approval as a subdivision a parcel of land containing 9 lots, on Salem Street, land formerly of Peterson. Atty. Kevin Sullivan, 1360 Main St., Tewksbury, spoke as representing Chester Sullivan. Mr. Morris, the engineer, was also present. Atty. Sullivan said they propose to construct homes in the vicinity of $40,000. They have had percolation tests made by Sanitary Engineer Driscoll. The development contains 9 lots of 25900.0 sq. ft. or more. The Board noted that the brook should be shown on the plan with a drainage easement. The lots should also be renumbered. Shirley Jackson, Salem Street, lives across the street and said that area is wet 9 months out of the year. They are still fighting with the town because of the drainage problem the new street caused. Their driveway gets flooded. Mr. Morris, the engineer, said the drainage is running to the rear of the sub- division to the brook. Mr. Jackson said they,are havingproblems with sewerage with one acre of land. What problems will there be on 1/2 acre lots? Discussion was held on the Hatch & Jones Act and Wetlands. Atty. Sullivan said 10 perc tests were made on the front lots. Mrs. Jackson asked why they were re --zoned and the lots made smaller. Mr. Keir - stead explained that the Board felt that facilities would be extended and that large lots would,not be necessary. James Kerney, Salem St., asked if the town would maintain the roadway. Mr. Chepul.i.s explained that the Highway Dept. usually plows the road and services and collections are made after homes are built but that the street has to be accepted by the town before maintenance of the roadway is done by the town. Monday — December 4, 1972 Regular Meeting The PLANNING BOARD held its regular meeting on Monday eveningr December 4# 1972 at 7:30 P.M. in the Town Office Building meeting room with*the following members present and voting: Charles W. Trombly, Jr., Chairman; Donald N. Keir— stead, Vice Ch.; Fritz Ostherr, Clerk; William Chepulis and John J. Monteiro. There were over 30 people present for the meeting. Mr. Monteiro made a motion to accept the November 6th minutes; Mr. Ostherr seconded the motion and the vote was unanimous. PRELIMINARY PLANS: Andover Street. Mr. Monteiro and Mr. Chepulis were unable to look into the matter of -this proposed subdivision and had no report to make. Mr. Esposito was present and he was advised that,upon motion of Mr. Monteiro, the matter will be tabled until the next meeting, for report at that time, possible on the 13th; Mr. Chepulis seconded / the motion and the vote was unanimous. V HUGHES TOWNHOUSE SUBDIVISION: Mr. Trombly read a letter from the Board of Public Works with suggestions. Mr. Callahan was present and was in agreement with the Superintendent's suggestions. He presented new plans showing utilities, etc. He showed the site, topographic and drainage plans. He stated that the buildings were moved farther away from the Evangelos boundary so that there would be no interference. He showed the profile of the roadway and private drives; there is a 30 ft. paved roadway and 1$ ft. paved turnaround. Walter Stamp, Jr. again questioned the drainage on Prescott Street. After further discussion, Mr. Keirstead made a motion to take the matter under advisement; Mr. Chepulis seconded the motion and the vote was unanimous. SALEM STREET SUBDIVISION: Mr. Sullivan and his engineer, Mr. Morris, presented corrected plans showing the changes the Board had recommended. The area slopes gradually to the rear. Mr. and Mrs. John Jackson, abutters, asked several questions and were concerned about the "pond" to the rear of the development. There are no contours on the plan to show the pond that is there. Mr. Monteiro made.a motion to refer the matter to the Subdivision Control Sub— committee for report; Mr. Keirstead seconded the motion and the vote was unanimous. Discussion was held with those present relative to the Wetlands Act, Hatch -Tones Abtf,functions of the Conservation Commission, etc. , Mr. Chepulis requested permission from Mr. Sullivan to go on the premises, which he was agreeable to. Mr. Sullivan said that he will also build the houses. He said he will berm the entire street. It was noted that there are no catch basins in excess of 4.0 station. January 8, 1973 — cant. the motion because it is not provided in the statute. Mr. Willis said they will leave the brook exactly where it is and the road where it is; moving the brook is Conservation Commission province. Mr. Keirstead withdrew the motion. Mr. Trombly said if new plans are submitted and other conditions are met, then the Board can reconsider the subdivision. LAND/VEST, INC. Mr. Hamlen and Mr. Perkins of Land/Vest, Inc. appeared before the Board. The Planning Board had sent them a letter informing them that nothing would be done on planned unit development for this March town meeting. Mr. Trombly explained that at present the Planning Board does not have the time to prepare something for this town meeting. Mr. Ostherr said the P.U.D. Study Committee has not met since their last report to the Planning Board. Mr. Monteiro said he is opposed to anything coming before next town meeting — he has not had enough time to study it. Mr. Keirstead said they are sympathetic with the floating district approach and with minimizing apartments. Mr. Perkins said they don't want to let the matter just drop; they want to continue with the project. Mr. Monteiro stated that the townspeople don't grant any more apartments. Mr. Hamlen said he checked with legal counsel on the ability of the Attorney General to approve the P.U.D. lavas and there would be no problems. Mr. Keirstead explained PRD (PUD) legislation to everyone present and said that we hope to draft a law for North Andover that would comply with State legs— lation. Public meetings and hearings will be held when the time comes. Mr. Perkins wanted to be sure that the Board had a continued interest in PRD. Mr. Ostherr said the PUD Study Committee will meet again probably at the end of January or the beginning of February. Mr. Monteiro suggested to Mr. Hamlen and Mr. Perkins that they contact the Merrimack Valley Planning Commission; that they would have information available to them relative to PRD. 4 HUGHES TOWN1iOUSE SUBDIVISION: LL; Mr. Trombly read letters from the Highway Surveyor and Board of Public Works and the developer had agreed to what they wanted. After some discussion, Mr. Ostherr made a motion to approve the definitive plans with the usual conditions January 81 1973 - cont. and the stipulation that water facilities be connected to the existing main on Chickering Road; the drainage swail along Prescott Street be continued to prevent the drainage of water onto Prescott Street and that the plans be . changed to reflect these conditions; Mr. Teonteiro seconded the motion and the vote was unanimous. SALEM STREET SUBDETISION (SULLIVAN) : Mr. Monteiro said the Subdivision Control Sub-commitee reviewed the plans and the premises and have a report to make. Mr. Chepulis reported that near the center of the area is a little pond; that a brook runs through the property and there is a wet area near the abutting Smith property, an accumulation of surface water and the water was high. The Hatch -Tones Act should be complied with in this instance. At the present time he would have to disapprove the subdivision and have corrected plans show how to take care of the water problem. No topographical plan has been submitted. The plans do not show adequate drainage. Mr. Trombly read a letter from the Highway Surveyor which stated that drainage should be provided to prevent water from flowing onto Salem Street. The letter from the Board of Public ?forks Supt. states that the water system is in con- formance with their requirements._ The Conservation Commission reported that there are wetlands making it subject to the Hatch -Jones Act. There was a telephone memo from the Board of Health requesting a percolation test on every lot by an engineer before they will approve anything. (� j After some discussion, fix. Keirstead made a motiori to disapprove the "Salem `-•�' Gardens" subdivision for the following reasons:. 1. The plans are not adequate 'under our existing regulations. 2. No topographical map was submitted with the definitive plan and one is required. , 3. The topographical map should show existing natural features, particularly a ponded area in the general vicinity of lots #1, 7, 8 & 9• 4. Additional drainage must be shown; specifically, two catch basins at the junction of Bannan Drive and Salem Street to intercept water that would enter from Salem Street. 5. Additional substantial drainage should be provided for drainage of the ponded area, as previously mentioned. 6. The Board of Health has advised that they require percolation tests by a sanitary engineer on each -lot before the lot will.be approved for building purposes. Mr. 14onteiro seconded the motion and the vote was unanimous. Mr. Keirstead announced to everyone that a letter had been received from the North Andover Improvement Society to notify several town boards and officials of .a meeting to be held on Jan. 24th at the Textile Museum to discuss the Hatch Act, wetlands, etc. However, this meeting is not open to the public. - 1 February 19, 1973 - cont. evening and it is not fair to make any comments on it tonight. _ Atty. Dolan said Air. Keirstead has not seen the letter. He would like to have the Board indicate that they can come in periodically to discuss the proposal with them. He would like to show the Board, probably at the next meeting, how they plan to show the "common" areas. MrF Ostherr suggested a working meeting with the Archdiocese, probably on the 19tht to discuss their points of clarification. Atty. Dolan said he would prefer just a dialogue between them and the Board and not get the people involved. Air. Ostherr suggested allowing about an hour for discussion with the Board and then allow questions from the floor. I4r. Ostherr made a motion to meet on March 19th with the Archdiocese; Mr. Monteiro seconded the motion and the vote was unanimous. QUESTIONNAIRE: League of Women Voters. A questionnaire was received from the League of Women Voters relative to Toi:.m Government. The Board could take no action on this because the questions pertain to individuals rather than a Board. Mir. Monteiro made a motion to accept the letter and notify the League of Women Voters that the Board could not make any comments. Air. Ostherr seconded the motion and the vote was unanimous. MISCELLANEOUS MATTERS: P.U.D. STUDY COn4ITTEE: Air. Ostherr said the conmittee will try to meet in another week or so. SOLID WASTE STUDY: Mr. Mcnteiro suggested that the Board make a decision on this matter at some time. tthere it is going to be placed might be asked of the toi.m and maybe a sub -committee should be formed to study it. SUBSIDIZED HOUSING: Mr. Monteiro said the Merrimack Valley Planning Commission has some material available and that we should ask for several copies of what they have, for the members and also Mrs. Stekert. PLANS NOT REQUIRING APPROVAL: Mrm. Ostherr made a motion to sign the following plans; Mr. Chepulis seconded the motion and the vote was unanimous. 1. Falanga. 2. Old N.A. Realty Trust. HUGHES PLANS: The Board was unable to sign the Hughes subdivision plans because there was not a linen of the utilities & profile plan. The meeting adjourned at 9:30 P.M. Chairman CChajrles H. Trombly, Jr.��� 1 �` •.� `.� sY",; s.-.%, r A� Se.cre ;any pe a " Monday — March 1.2, 1973 5 Hearings The HOARD OF APPEALS met on Monday evening, March 12, 1973 at 7:30 P.M. in the Town'Office Building meeting room. The following members were present and voting: J. Philip Arsenault, Esq., Chairman; Dr. Eugene A. Beliveau, Clerk; Arthur R. Drummond, Frank Serio, Jr. and William N. Salemme. Associate Members Joseph Mi.ragliotta, Esq. and Alfred Frizelle, Esq. were also present. There were 20 people present for the hearings. 1. HFA?IINr-,: Trombly Bros., Inc. Dr. Beliveau read the legal notice.in the appeal of TROMBILY BROS., INC. who reglzest.ed a variation of Sec. 6.3 of the Zoning By—Law so as to permit the erection of an Automobile Service Center located at the south side of Sutton Street at the corner of Main Street. Atty. Charles W. Trombly, Sr. represented the petitioners. The three Trombly boys were also present. The property is located at Sutton's Corner., The original . garage is to be torn down; four other buildings have already been taken down and the area has already been improved. The proposed building is located as shown on the plans. A variance is necessary because of the odd shape of the lot'and they cannot meet the 25 ft. rear and sideline setbacks. They propose to build a new service station and this would be a great improvement to the area since the corner has been cleared of old buildings and a new building.would be erected. Dr. Beliveau asked what the traffic pattern would be. Mx. Trombly said the traffic from !'sin St. i -d, .1 go out through Sutton St.; no traffic wi l l go o iit from the corner. The building wi)1 have 3 bays in front and one large i n:-pection area. The .R+.n r,n ra i- +1, +1..i 4---4- No ... -4-No one else .poke and there was no opposition. Mx. Dr-ui,mond made a motion to '..-- ce the petition under advisement; Mr. Florio seconded the in. -tion and VII ,rote V'.:33 unanimous. 2. HEARIN3: Prescott I,Iar.sing Home, Inc. Dr. Beliveau read the legal notice in the appeal of PRESCOTT -NURSING HOMEt INC. who requested a Special Permit under Section 4.122 (17) of the Zoning By—Law so as to permit a Nursing Home located at the north side of Prescott Street at the corner of Chickering Road and known as 140 Prescott -St. ,salter P. Hughes, 13 Lockl:ay Rd., Andover, represented the petitioner. He ex— plai.ne,d that it is proposed to remove the present Shady Knoll Nursing Home and construct a new facility on the two acres as shovm. There is an approved sub—. division for townhouses which will be operated in conji3net ion with the nursing home. It is proposed to have 130 beds; 12,single rooms and 58 double rooms. 73 parking spaces are provided. The Zoning By Law requires 600 sq. ft. of area per bed, making 7$,000 sq. ft. This proposal has 105,580 sq. ft. of area which is well over the requirements. There are adequate water and sewer facilities from Chickering Road and Prescott Street. Twee ways of egress are shown; one on Prescott Street and two on Chickering Road. No one else spoke. There were no abutters present. Mrs. Elaine Griffin, Chickering Road, telephone to the Chairman before the meeting, that she was opposed to the retition. March 12, 1973 — cont. L rio was concerned about the entrances on Chickering Road because it is suchily travelled way. rio made a motion to take the petition under advisement;:Mr. Drummond ed the motion and the vote was=unanimous. 3. HEARING: Noren Realty, Inc. Dr. Beliveau read the legal notice in the appeal of NOREN REALTY] INC. who requested a variance of Sections 6.11 6.21 6.3 and 6.5 of the Zoning By—Law so as to permit the relocation of lot lines in order to conform to present zoning and the allowance of the exist-ing lots formed under the earth removal permit; located at the south side of Holt Road, approx. 80 feet from the corner of Clark Street. Mr. Marino and Mr. Regazzine appeared before the Board as representing Noren Realty, Inc. and explained that there is a hardship because they were following the zoning requirements as to the sizes of'the lots; the last two lots have been formed to conform to present zoning. The first three lots were terraced to conform to zoning existing at that time; he said it would be costly -to make those lots conform to present zoning. He also asked that the Board allow the setbacks as they were in the previous By—law because it would be hard to set a building on a 50=000 sq. ft. lot with the present setbacks of 50 feet. A letter was received from the Building Inspector which stated that he had in-- formed'Noren ?Realty about the proposed zoning changas that would create this .] L ,; s L t __ YJi"V t'1G'tt oitu LlzC� t LLvnc tLVL vV �. i-'GQl' t>Ci Vj'G t 1!C r t jlj! Ljl� BV- a d LV j'ES'1�(Cj' ii complaint. He feels th=ere -is no hardship on which to base their appeal. The area could be properly graded so that all of the lots would conform to the current regulations. Mr. Drummond made a motion to take the petition under advisement; Mr. Serio seconded the motion and the vote was unanimous. 4. HEARING: Louis St. Pierre. Dr. Beliveau read the legal notice in the appeal of LOUIS ST. PIERRE who requested a variance under Section 6.3 of the Zoning By—Law so as to permit an addition to a dwelling which would be closer to the side line than is allowed; located at the west side of Chadwick Street and known as 77 Chadwick Street. Mr. St. Pierre appeared on his own behalf and explained that he would like to build an addition to his home. The addition would be to the living room area and would measure 7 ft. by 16 ft. and would be 4.8 feet from the side lot line. The dwelling on the abutting lot is approximately 50 feet away from the lot line. . _ Mr. Serio made a motion to take the petition under advisement; Mr. Drummond seconded the motion and the vote was unanimous. April 91 1973 -- cont. LOUIS ST. PIERRE: The Board reviewed the St. Pierre petition. Mr. Serio made a motion to GRANT the variance; Mr. Drummond seconded the motion and the vote was unanimous. The Board found that the addition would not be detrimental to the neighborhood since there are many older homes on small lots in the area.' That there would be a hard— ship, financial or otherwise, if the petitioner were.not allowed to provide addi— tional living area and that the addition would in no way derogate from the intent and purpose of the Zoning By—Law. STEPHEN R. DOHERTY: Mr. Doherty sent a letter to the Board requesting that his petition.be withdrawn without prejudice. Chairman Arsenault said the Board would waive the Board's rules and accept his request. Dr. Beliveau made a motion to allow him to withdraw his petition without prejudice; Mr. Serio seconded the motion and the vote was unanimous. This matter will be officially filed with the Town Clerk. PRESCOTT NURSING HOME, INC.:' ' A letter was received from Police Chief Lawlor stating that he objected to the two access ways on Chickering Road because they would constitute a dangerous safety condition. He said the state has plans for Chickering Roars and he doesn't if:ant access from Chickering Road. Mr. Hughes agreed not to have access on Chick— ering Road. mr. Serio rade a motion to grant the special permit with the conditions that there will be no entrances on Chickering Road and that there will be one 30, oot, entrance on Prescott Street at the location shown on the plan and that the structure will not be more than 35 feet in height. Mr. Salemme seconded the motion ?nd the vote was unanimous. The Board found that there is more than enough area per bed; 600 sq. ft. per bed is required, making 78,000 sq. t. This petition has 105,580 sq. ft. The pcti tioner has complied with the requirements of Table 2 in that there is miore than enough total land area. The Board finds that the conditions for approval under Section 9.31 have been met as follows: 1. The specific site is an appropriate location for such a use, structure or condition.. 2. The use as developed will not adversely affect, the neighborhood. 3. There will be no nuisance or serious hazard to vehicles or pedestrians. 4. Adequate and appropriate facilities will be provided for the proper operation of the proposed use. May 20, 1975 — cont. Still now be up to the Selectmen to pursue this action. The vote was unanimous. Mdre discussion took place regarding some of the points about the brief that were i 1 erroneous,such.as the figures on regional need from the Merrimack Valley Planning Com— mission. James Beattie, 11averly Rd.', extended a personal thank you to the BOARD and a hope that all was not in vain. Nicholas Artimovich Decision: Dir. Frizelle brought up a prior case, Timmons, in which the BOARD held the people to the minimum frontage and wondered if it should not be done in thiscase.• Other members of the BOARD felt that this case is really a little different. We can deny the petition completely'or have them divide the frontage they do have between the two lots. Dir, Frizelle voiced concern if someone else purchased the lot. Dir. Salemme8motion to grant the variance with the recommendation to change the driveway on Lot A to have a 151 width rather than 101, no further division of these lots shall be made and the vacant lot is to -be conveyed to Andrew Artimovich.was seconded by Mr. Di— Fruscio. Dir. Frizelle asked to have the hardship defined. The parcel contains 2.2 acres but does not have sufficient frontage, The petitioner is unable to purchase addi— tional frontage because of an easement of the New England Power Co. The vote on the motion was unanimous. Note: plans to be signed following the changes. _.. HENRY FIT7,uERALD — Rx;VIEW OF SPECIAL PER14IT OAT PRESCOT'T ST. I'IURSING HOME: It was noted that this special permit goes with the land because it has been -recorded with such. Dir. Fitz=zerald. architect ; Gtatad +i, + +�� _a; _ ___ _ r �, o •� „��•a o� uhtf 5peciai permit outline no' further access onto Chickering Rd., or~Rte. y125, and 30 ft. height of the buildings. Their first step was to conform with all the dimensional requirements. Fie did appear a week previous at the Conservation Commission meeting with the same plan he showed the BOARD. He felt that they have met with the intent of the decision. Our next step, he said, is to go back to the FHA which is funding the project and clear with'Police, Highway Surveyor. Asked the BOARD if he needed to come before them for another public hearing.. Mfr. Frizelle stated that they will have to conform to the conditions of the origi— nal plan and decision. The decision states that there will be one N-30 ft. driveway. The BOARD did not feel that another public hearing was necessary. N__ DISCUSSION — DR. PATTERSON CASE: A discussion took place regarding That avenue to take on this matter. Some of the members thought that he should be -informed that a public hearing should take place and if he was not in agreement then the BOARD would take action to raze the garage. Dir. Serio requested the BOARD to reconsider their opinion of the last meeting at which this was discussed. The members then decided to review all correspondence relating to this matter at'the next meeting. Mr. Salemme made a motion that the Chairman review the file and make a recommendation at the next meeting. 11r. Frizelle seconded and the vote was unanimous. The meeting adjourned at 8:30 P.M. _ Chairman Frank Serio, Jr.} Secretary _(rilda Blaks ctock — �� July 9, 1975 - cont. Sutton St. between the aforementioned openings which r:hall prevent ingress and egress to said street, the plans shall be amended'prior to signatures by the BOARD. A motion was made by MT. Frizelle to GRANT the variance on Sec. 4.131 (7) and delete the word "non" from "non—retail". The motion was seconded by Mr. DiFruscio. The motion was then amended to delete "and no other retail stores of any kind" from Sec. 4.131 (8) and seconded by Dir. Di.Fruscio. -The vote was unanimous.. Mr. Frizelle made a second motion to GRANT the Special Permit pursuant to Sec. 9.3 of the Zoning By—Law with the conditions as listed above. The motion was seconded by Dor. DiFruscio and then amended to include the provision that parcel B shall be deleted from the Variance and Special Permit. Mr. DiFruscio seconded and the vote was unani- mous. Dir. Serio advised Mr. Scalise to have the plans amended. CONTINUATION OF HEARING ON ARDON FARM REALTY TRUST; Mr. Noble sat on this petition.• Atty. Magnus Greenman, 185 Devonshire St., Boston presented a covenant running with'the land and stated that'he would'put it with the deeds to these 2 parcels; and, in addition, the BOARD could insert that as.a limitation of use and in that tray there would be no problem about the school childred being bur�sed. It will bind the grantees, their heirs and successors, he saidt and could be enforced by the Town by refusing to furnish bus transportation. Charles Wills, Trustee of Ardon Farm Realty Trust, stated that the public tray ends right at the Town line. The question of why didntt we construct 150 ft. of legal sireet is because we have been to the Planning Board and they would not consider our petition. �. Our only avenue of relief is to come to this Board, he said. Messers.Serio and Fr -i7 11-P felt that the Town could not avoid bussing the school children. I;r. Serio then read the minutes of the Planning Board meeting of Jan. 1974. I -Sr. Greenman stated that there is a hardship of natural barriers and there is nothing else they can do with the land. There would be no substantial detrim nt to the public good becau^e the lots would be 5 acres apiece. Also, there would be no derogation from the intent and purpose of the Zoning By --Law because there are only 2 sites and actual physical access from Stonecleave Rd. would be more than adequate. 2%,r. Noble commented that,basically, the abandoned right of way would be a continuation of the Kissile Site Rd. Would there be some way in which something could be done to lay out a permanent easement to allow for the State taking this for recreation? Iv:r. Wills stated that there would be no problem if the Town wanted an easement left for a future street. Mr. DiFruscio's motion to take the matter under advisement i,*as seconded by Mx. Noble and the vote was unanimous. PRESCOTT ST, NURSING HOP'S — Henry Fitzgerald representing stated that they had increased the parcel by 610 acre to accomod-ate parking and to meet FHA requirements. Ile felt that he should present the revised property line plan to the BOARD. The change allowed them to create a larger green area in compliance with the FHA. Mr. Frizelle had reser— vations about acting on a new set of plans and it is contrary to the By—Law to give official advice. The BOARD decided to obtain advice from Town Counsel on the matter. ARDON FARM Ra,,ALTY TRUST: Dir. Salemme made a motion to deny the request and Mr. Noble seconded. Daring a discussion, Member Frizelle stated that he of did feel that i n . _ h .t th e y had r: et the statutory requirement and that i -.e would be opening a hornet's nest because of so much land—locked land in North Andover. The vote on the motion was unanimous. t Auget�t 11, 1975 — cont. Mr. Noble made a motion to DENY ,the .variance requested under Sec. 4.129 (14) of the Zoning By—Law and Mr. Salemme seconded. The vote was 1:nanimous. 1 CHRISTOPHER ADAMS: During a discussion held by the BOARD, Mr. Frizelle read the latest decision to refuse an extension on the earth removal permit. The Building Inspector said that Adams has not really done anything except try to burn the stumps. The BOARD requested a letter from Mr. Foster stating such. A motion.was made by Mr. Salemme to designate the Chair— ma-n to write a letter to t1r. Adams in -reference to forclosing the bond within a 15—day limit in accordance with our decision of Nov. 22, 1974 and advise him that he is given until August 29th .to complete the work. Also, the Chairman shall write a letter to the insurance company informing them that we anticipate we may have to take the bond. The motion was seconded by Mr. Noble and the vote was unanimous.' Mr. Serio sat in on the following BOARD business. Letter from Arnold Salisbury, dated August 8, 1975 Re Dr. Patterson was read by the Chairman. The Covenant, which is on file, was also read. The Building Inspector felt that a zoning violation cannot be legalized with A covenant. The razing of the garage was on a plan which the BOARD filed, was recorded, and is part of the decision. Member Frizelle said he felt that this was a compromise — if it was not in the written opinion he questioned its validity. Upon motion of Mr. Noble and second by Bir. Frizelle to send a letter to Town Counsel stating that after discussing the matter with the -zoning enforce— ment officer it is the unanimous opinion that this matter of a covenant is not properly before the BOARD and we are, therefore, returning it to you to discuss with the zoning enforcement officer for the proper action the vote was unanimous. A copy of the letter is to go to Charles -Foster and Charles Trombly, Sr. E er from Arnold SalisburyRe Prescott St. Nursing ome and dated August 11th was ToYrn Counsel's ruling vas that no further hearings will be neces a.ry. A rioticn ade by Mr. DiFruscio to accept the 7etter and file it with the special permit. Sa1enime seconded and the vote ;aas unanimous. The meeting adjourned at 11 P.M. Chairman Frank Serio, Jr. Secretary uilda Blackstock CU LOUCESTER CONSTRUCTION COMPANY, INC. December 20, 1976 Mr. Charles H. Foster, Building Commissioner TOWN OF NORTH ANDOVER North Andover, Massachusetts Dear Mr. Foster: 1163 Walnut St., P.O. Box 302 Newton Highlands, Mass. 02161 (617) 965-1271 Re: Prescott Nursing Home Foundation Certification For your information and your records, I am sending you one copy of Foundation Certification for the above referenced project. In the event that you require any additional copies, please contact me. Very truly yo J"'Julian Goulet JG/j s Enc. CRArV,0 DEC 22 10 NMN ANS aftw44 SP1'. July 149 1978 Thomas H. Collins, Esquire 101 Amesbury Street Lawrence, Ma. 01840 Dear I4r. Collins: - Following up on your written request, I have made an investigation of the project Imown as Prescott Nursing Home constructed by Prescott Nursing Home Associates, which you claim violates the provisions of the North Andover Zoning By -Law and the special pennit issued by the North Andover Board of Appeals. My delay in answering was caused by the fact that I did not have in ray possession an a. -built plan of the project. On July 7, 19781 I re- ceived an as-b,.zilt plan prepared, stepped and certified by John Callahan, consulting ensineer. I have reviev ed the as -built plan along c,-.ith the Board of Appeals decision and all of the pertinent information in the files of the Planning 3oard, Zoning Board of Appeals and my oV*n files. As a preliminary step, I have verified that a special permit for the construction of a nursing home was issued dated April of 1973 granting the application of Prescott Nursing Fame, Inc. under Section 4.122 (17) to permit construction of a nursing home. The following conditions were im- posed: 1. The structure is not to exceed 35 feet in height; 2. A 30 -foot access road rrM be located on Prescott Street. Subsequently, ter. Henry K. Fitzgerald, Jr., the architect for the project, contacted the Board of Appeals, met with them and reviewed plans showing an added parcel for the nursing ho=ne property. This plan, which I recall seeing, showed the added parcel containing paring spaces to be used for the project. The total parcel of land to be used for the nursing home was designated as parcel "B". It was upon this plan that the Board of Appeals determined, based upon advice from Town Counsel, that a new hearing fora special permit was unnecessary since no building was to be placed on the added parcel. This sane plan was the plot plan submitted with the application for the building permit that was issued for the construction of the project. From the as -built plan, I have verified that the project complied with all the requirements of the special permit and the Zoning By -Law. The plan does shows however, that a portion of the parking lot encroaches upon r' Atty. Thomas H. Collins - -s July 1.4., 1978 -2- the land of Mr. Hughes and that the paved area was closer than four feet from the property line. Prescott Nursing Home Associates, through their counsel and architect, assure me that.the encroachment, including light standards, will be removed and that the -paved area will conform to the plan upon which the building permit was issued. They Have also agreed to modify the paved driveway at a corner of the nursing home so as to reduce as much as possible the possibility of authmobile accidents at that location. I am also requiring that an as built plan showing the revisions to the paved areas, certified by a registered land surveyor, be submitted at the conclusion of the work. In light of these assurances, my on-site inspections and the review of all of the documentation, I deem no further action necessary since the project will. be in compliance with the special permit, the North Andover Zoning By -Lair and the building permit. Very truly yours, C'rI4RI,S H. FOSTER 01 INSPECTOR OF BUILDINCA' CIE: ad CC: Mr. Walter P. Hughes D State Building Code Co.a-nission John J. Willis, Esq.; Town Counsel Frank M. Capezzera, Esquire at ZONING REPORT Charitable Home for the Aged I have requested an original license to maintain a Nursing Home X Rest Home (Check One) 19 0 Street City or Town from the DEPARTMENT OF PUBLIC HEALTH and have been advised to clear with the local zoning authority. Will you therefore kindly check one of the following: 1. ( ) The facility io a conforming use. No variance or special permit is required. 2. (✓) The facility is permissible under a special permit. A special permit has been issued. 3. ( ) The facility is a nonconforming use. A variance has teen issued. 4. ( ) Other. (Please explain.) Also, kindly supply one copy of any variance or special permit when the second or third block is checked. signature of Applicant Trade Name of Rome ?7 Date it Date y Please return completed form with supporting documentation to: Department of Public Health Division of Health Care Standards and Regulation. Long. -Term Care Facilities Program Room 560 80 Boylston. Street Boston, Massachusetts 02116 /V Signature and Title of"Zoning Au signature of Applicant Trade Name of Rome ?7 Date it Date y Please return completed form with supporting documentation to: Department of Public Health Division of Health Care Standards and Regulation. Long. -Term Care Facilities Program Room 560 80 Boylston. Street Boston, Massachusetts 02116 M s �r4 a� a 4 f - ,-LNR•; to Ul Cc u �' � �� � F�t°itiAT� rYfJ� •'1G6o, i O: T•i to 6 I1 � ' A A 1 . ffq" j gl!;41 SU O ' 19 NS1 •NOQ •t i I Pe65Gorr I.iL14ZhiNC* ti'bME , ENGINEERS 'S1 (� S�Yv�Y cM. :y Q 4 3E iif�`fs In j:s c4 j 11111l .8 fad a 7D' Sag FLA -211 $ L b �, I a Mill -Z 166 if t5C 167�w7[ —166 n. ec.a xN "" Oj � r�ca l� 160 n ':j dp^�8p»��r �X S zIEIG I. 2j3.E6 B� ij R� X38 Y as. d� (- X3 .82 3,. P'F t �y Ai- 1''C //VG Olt'"- a -� • A � NZ� F.H.A. PROJ�GT N'025 -15075 -PM n' S R t Ho 3292; A ` J •. �. �r « �. 4- •, .. xit i-�i" -ref. ";'w '.f: A ARCHITECT Pe65Gorr I.iL14ZhiNC* ti'bME , ENGINEERS 'S1 (� S�Yv�Y cM. :y Q 4 oMo L C AND ASSOCIATES 0 0V4 1i 7D' OCµy NEWTON. MASS. 02150 I•440• �, I a -Z ax l� A � NZ� F.H.A. PROJ�GT N'025 -15075 -PM n' S R t Ho 3292; A ` J •. �. �r « �. 4- •, .. xit i-�i" -ref. ";'w '.f: A ARCHITECT Pe65Gorr I.iL14ZhiNC* ti'bME , ENGINEERS 'S1 (� S�Yv�Y cM. H. !C FITZGERA40 JROA n y5 oMo L C AND ASSOCIATES 272 CENTRE STREET 1i 7D' OCµy NEWTON. MASS. 02150 I•440• �, I a io c6h'Q.wY4�iY , o r r —^ Z �, I a -Z 1�0 Date ...R/5P./......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ....... �..&.c . ........................... has permission to perform .... AJ. .... F Au..nr .... wiring in the building of ........r Li .......... at .... ZY. ... 0 ........ P ... # ........... 5.101. . ........ ....... . North Afidover, Mass. ........... Fee ... P.67 L i c. N o. . 1. S. 196.47 ....... �L) 5-QYJIYA� Et ECMICAL IN6E'CMR Check # 3 5391 7DEC0MM0N1VE4 7H0FMMSSACHUSE77 S Office Use only DEPAiUAfEWOFPUBUCSAFM �a Permit No. ..� BOARDOFFIREPREVMWONREGUL ONS527(Mn-� �5 Occupancy &Fees Checked APPUCATTONFOR PERMIT TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSST&ELECTRICAL CODE, 527 CMR 12:00 % J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /4/ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work describel ielow. Location (Street & Number) 0 P/ I 160 77. 47elf 77 , Owner or Tenant Owner's Address 1 Is this permit in conjunction with a building permit/7/0 : Yes � No a (Check Appropriate Box) Purpose of Building &LI),/� t /7` 042 r Utility Authorization No. Existing Service Amps_Volts Overhead Underground No. of Meters New Service AmpsVolts Overhead. Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work = No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures _ Swimming Pool Above 1:1and Below Generators KVA D round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER; hm mceCovsaw. Rina tflthe t whwxWofN1%md>tt MCertaalLaws IbareaamatLia3ky ma=Po ymckxbgCornplee CovaaWortsmbmatriagwvalat YESED NO Cl Ihaves>brt>WdvandproofofsmmiDtheOliio- YES If)mhavedrdeBYES,pleaseir c*theeAxofoovEWby drddriglhe INSURArICE BOND[—] MER (PleaseSpec�y) r` G LG F�¢atimDae WdcmS4tt Es�natedVaAreafDMcalWolk$ o D* Rargh Final Sig iedun ir- af'pe jury r FIRMNAME ,�'LS' 4 /1�/Y% �G G'7fr/� Gl �/1�f1 7`l �j�`ji G,�G Lica "M z. Sigrlaaue ��� Ferro eU Bu messTdI%. '7S1— %27 —3- fi AIL Tel No. 19g7— ?dczf 64 OWNER'SINSURANCEWAIVER;IamawaethatdreLiaerrsedoescothavethemarmmcorsageorilsakstarrialequivalentasw medbyMassad mMGenetalLaws antithatmysig mwcn thispmMapphcabm waivesthis requitatrert (Please check one) Owner 1:3 Agent M A Telephone No. PERMIT FEE signature of owner or Agen 1 tiL' (,U1V1iVJULV "rjtUJ a Ur iVVL37f %,rJV V s1 i o �•••w �.- �, DF.PA1eT11II+NTOMBLIC'SAMY Permit No. vl BOARDOFFMPREVEMOIVRBgJLA7YOMM7c&,U--M G/ Occupancy & Fees Checked APPLICATTONFOR PERMUTO7rnib7ed ORMELEClRMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE STS ELECTRICAL CODE, 527.CMR 12:00 kP EASE PRINT IN INK OR TYPE ALL INFORMATION) Dat r? S Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical ork elow. Location (Street & Number) Owner or Tenant Hec Owner's Address Is this permit in conjunction with a building permit: Yes o (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead 0 Underground No. of Meters New Service Amps__..L.V olts Overhead M Underground Q No. of Meters Number of Feeders and' Ampacity Location and Nature of Proposed Electrical Work No. R Lighting OutletsC I No. of Hot Tuba No. of Tnmaformers Total 7 11 Saw, KVA No: -of Lighting Fixtures Swimming Pool Above Below Generators KVA zround ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of des Burners FIRE ALARMS No. of Zones No=Ranges ` / No. of Air Cond. Total f Tons No. of Detection and ` No. of Disposals No. of Heat Total Total Puma . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Connections Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP ksum=ComW Rz&utbdletegmanegd-Ma=dl7se Li=M IlmeatxuatLidbx* twaaroel�it7+' c4m C nn. Ihavesubni0adva6dPoofof detJlfioe:' I dgdre box. MURANC.E BOND Gum WodcbStmt i 6 bnpecfimDaleRec}resbd P�11�- FIRMNANE Liam Y slat YES O NO 0 ffyvuherededledYES,pleasei dc*thetypeofcovmWby rgme-**) FstirrlabdVaireofE1wWcalWc& Raigh Final /� LioenseNo. l " / �! Bust=TdNa ALTdNa OWNER'SD61MANCEWAMT%IainmmdietftLio wdDPsnottmselheuauffftamrVaritsaibsarrialegAvWaltasmWacibyMasmd; andthatmy*iahaeonftwritWVkafiMwaivesdiiste#en at (Please. check one) Owner 0 Agent Telephone No. PERMIT 19 Signatureof Owner 7_26--v:� Rte'. Department of PUblic BOARD OF FIREPREVENTION REGUL.A C1 APPLICATION FOR PERMIT T PE All work to be performed in accordance th the (PLEASE PRINT IN INK OR TYPE ALL INFO TION) Jot. - To the Inspector of Wiires,/dr• ofN� : The undersigned applies for erm' Location (Street & Number) �r�Jld�i/i�vJ I /yd p.-ts Owner or Tenant preJlow Owner's Address (if different) J r'i.. Is this permit in conjunction with a building permit (Check Appropriate Box) Purpose of Building Existing Service-_ NEW SERVICE - Number of Feeders and i Amps AMPS f Volts VOLTS L Permit * k5'10. 327 CSR 12:00 Effective: 1198 FORM ELECTRICAL WORK assachusetts Electrical Code, 527 CMR,1/2:00 / DATE•.-��//�` O . to perform the electrical work described below F= Yes No]?-' Utility Authorization no. tl ti Overhead ,❑ ' Underground C] iofmeters OVERHEAD-[:].. UNDERGROUND❑ # OF METERS Location &Nature of Proposed Electrical Workry y `a''�*j �K/jTi+ �d/� L J.+,o�+%/><�f� ��� fa• t # Lighting Outlets # Hot Tubs # Transformers Total KVA # Lighting Fixtures Swimming Pool ABOVE/ IN - ground # Generators KVA ceptace Outlets # Oil Burners # Emergency Lighting Battery Units itch Outlets # Gas Burners FIRE ALARMS: # Zones # Detection & intiating Devices # Sounding Devices # Self-Confd Detection/Sound Devices Local❑ Muni.Connection r] Other Connection Location Low Voltage Wring nges # Air Conditioners Total Tons posais # Heat Pumps Total KW hwashers Space/Area Heating KW ars Heating Devices KW ter Heaters KW # Signs # Ballasts dro Massage Tubs # Motors Total HP moo. URANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws, ve a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ©ANO. ve submitted valid proof of same to this office. YES 2 NO n u checked YES, please indicate the type of coverage by checking the appropriate box. URANCE OND OTHER F1 (Please Specify) xpira ion mated Value of Electrical Work $0-11Oar,-"' Date) rk to Start A/Ze A `/ inspection Date Requested - Rough: Final: ed under th��pe/ e/penalties of perjury: //' M NAME 07P4/41�..q�aA►,� �ilkvy C/vrJ �K. Lic. # l�y0o/ Licensee ;%0*4 t Signature Lic. # .23274 Address /����d / ��y ��� ��'6✓/� /%/: 0i rov Bus. Tel. # N1 JFX? low, Alt. Tel. # OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or,its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (please check one) Tel. # cash Ck # erml ee (Signature of Owner or Agent) r IF 7 Date./ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........ : ....................... has permission to perform, -Irl LK, . . . . . . . . . . . . . . . . . . plumbing ,in -the buildings of ...... . . .. .. . . ........ at . ............ I NVor—t Andover, Mass, Fee/lf-�. . '.- Lic. No........ .......... ----PLUMBIZN�GPECTOR Check 5797 TO DO PLUMBING '�' , E�SS�1c�ius ,. —1i S E11�IFt�Ra ��i API�LtCA�'ION FOR FI�F;a`4Rii" (Print or Type? I / - . -J 02rlTiit : - Q u .11"Fries.- Date, �� n-- - Building Location° S r�T Owner's Name Type of Occupancy mm �_,C MI t� 'New Renovation Replacement d Plans Submitted: Yes ❑ No !FIXTURES ".- - `tnstadling Company Name: ODA NC • Check one:. Cer if—t.- • a � Address ( C.orporation � 19 p Partnership_ . �' �f!� Business Telephone Q Flrm/Co.' • W - Name -of Ucensed Plumbere��� INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which ``leets the requirements of MGL Ch. 142: Yes No C> If you have checked +des, please Indicate the type coverage by checking the appropriate box. A liability insurance policy other type of IndemnityBond OWNER'S INSURANCEWAIVER: I am aware that the: licensee does not have the insurance coverage required by Chapter 142 of the Mass.,General taws. aril Umt my signature on this permit application waives this requirement. Check one: . Owner O Agent p Signature of Owner or Owner's Agent ' i hereby certify that all of the d®tails And infortnatirA1 ha for teredi in above application are true and accurate to the best of my l,navrledge and that'ail plumbing wort: and ins;alla#icru ortied rde• mit iss;tad for this application will be in compliance with all pertinent provision,, sof U -a Massachusetts State R mbi ,rape' General Laws. -` ature of Lice u Title .. - Type of License: r [ Joumeynw City/Town APkXNE5(oF IC NL License Plumber „ z - m It cn En m o a w w ... �, HJ ' Id '. ._j a, V N C1 - i r. • ® N cif � 4 C � � 6 •iC _ , � Ul .ZM• � �' d, � � _ O W .� . a'. 2 A % a. Y A. 0 q V N 2 "C „� 4! �' ri O �C V ui X � a °2 3 4 4 ►- o a< a an sua-ssMT. BASEMENT .. 1 T FLOOR 1 -2ND FLOOR sRDFLOOR -ATH,FLOOR, _STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR EI I ".- - `tnstadling Company Name: ODA NC • Check one:. Cer if—t.- • a � Address ( C.orporation � 19 p Partnership_ . �' �f!� Business Telephone Q Flrm/Co.' • W - Name -of Ucensed Plumbere��� INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which ``leets the requirements of MGL Ch. 142: Yes No C> If you have checked +des, please Indicate the type coverage by checking the appropriate box. A liability insurance policy other type of IndemnityBond OWNER'S INSURANCEWAIVER: I am aware that the: licensee does not have the insurance coverage required by Chapter 142 of the Mass.,General taws. aril Umt my signature on this permit application waives this requirement. Check one: . Owner O Agent p Signature of Owner or Owner's Agent ' i hereby certify that all of the d®tails And infortnatirA1 ha for teredi in above application are true and accurate to the best of my l,navrledge and that'ail plumbing wort: and ins;alla#icru ortied rde• mit iss;tad for this application will be in compliance with all pertinent provision,, sof U -a Massachusetts State R mbi ,rape' General Laws. -` ature of Lice u Title .. - Type of License: r [ Joumeynw City/Town APkXNE5(oF IC NL License Plumber „ 9 I � � � . / ) � \ � \ !� � ] � , � � . \ \ � � f � 9 I t I Date ..Z!?- ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... :7n ...... ...... -::Ii�i:w ............................. has permission to perform ....... ..................... wiring in the building of . ......... 4.. w ...... ................................................... at .... ..... —.4-t ................. . N?o!r�fhdover, Mass. Fee....... Lic. No .............. ................ I/ �" ELECTRICAL ijS:�PtR Check # 5543 Deparonent of Public Safe BOARD OF FIRE PREVENTION REGULATI S. 627 CMR 92:00 APPLICATION FOR PERMIT I All work to be performed in accordance (PLEASE PRINT IN INK OR TYPE ALLINFO,TION) I To. the Inspector of Wiires,/Glw• of /The undersigned applies for Location (Street & Number) AreJe-a/r Ayif /,Yorrl,J' Owner or Tenant Permit # —0-4721 Effective: 1198 PE PORIA ELECTRICAL WORK the- assachusetts Electrical Code, -527 CMR 12:00 to perform the electrical work described below. Owner's Address (if different) GeoeDs J A. -Me l i... `oip✓j w Is this permit in conjunction with a building permit (Check Appropriate Box) Yes No]?'-' Purpose of Building Utility Authorization no. Existing Service - Amps Volts Overhead Underground NEW SERVICE - AMPS VOLTS OVERHEAD UNDERGROUND[] # of Meters # OF METERS Number of Feeders and Ampacity Location & Nature of Proposed Electrical Work L4t�f y L/'►a tn/-�//✓• �a'/xl L•/•Mp� �G4 /�tl �f� •��y� I # Lighting Outlets # Hot Tubs # Transformers Total KVA # Lighting Fixtures Swimming Pool ABOVE / IN - ground # Generators KVA # Receptacle Outlets # Oil Burners # Emergency Lighting Battery Units Switch Outlets # Gas Burners FIRE ALARMS: # Zones # Ranges # Air Conditioners Total Tons # Detection & Intiating Devices # Sounding Devices # Disposals # Heat Pumps Total KW # Self-Confd Detection/Sound Devices # Dishwashers Space/Area Heating KW Local Muni.Conn action Other m- # Dryers Heating Devices KW Connection Location # Water Heaters KW # Signs # Ballasts Low Voltage Wiring # Hydro Massage Tubs # Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws, I shave a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES � NO I Piave submitted valid proof of some to this office. YES [Ej� NO If you checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE OND [:] OTHER M (Please Specify) - cpua ion Date) Estimated Value of Electrical Work $ Work to Start 1O1Zd 1d V Inspection Date Requested - Signed under the penalties of pe rjury, FIRM NAME �� C�4/��.q/ tv�►,Y J09 /.- �/r✓dp /I.• Licensee prArd.1 t��f/i �id�. Signature Rough: Final: *l/6 -A Lic. # /,-Sloo4 Lic. # 27274 S Address 1/W441o►✓ / &ice .welt Wie6✓i,7 17.4 diaoej Bus. Tel. # 7d/ 1P.I.? f rWo Alt. Tel. # OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (please check one) Tel. # cash Ck # Permit Fee (Signature of Owner or Agent) 0 IF Date......... .....� ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....................... ....... has permission to perform ........ .... ate.. wiring in the building of ... N at ....... ..... ............... North Andover, Mass. Fe6�&..... . ...LicNo .... ) .. . Check# 5764 1 im I. ilwylU[Y VVE AL.L n Ur 10 DEPAR711W 0FPUBUCSAFEFY BOARD OF FIRE PREVE M0N RW Ul M0NS 527 aM 12.E APPLICATTONFOR PERA41TTO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the / O �electrical� S ork t Location (Street & Number) ! i Owner or Tenant Permit No. r Occupancy & Fees Checked RM ELECMCAL WORK ELECTRICAL CODE, Si% CINR 12:00r� Jn� — Date 1 ( V below. To the Inspector of Wires: Owner's Address v Is this permit in conjunction with a building permit: Yes o (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead a Underground No. of Meters New Service AmpVolts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work "D 17 /An �r No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total ill KVA No. of Lighting Fixtures_ Swimming Pool Above Below Generators KVA round and No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No, of Ranges r / No. of Air Cond. Total l Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tuba No. of Motors Total HP Ihmactmentli" Iha%esubrri&dvafid dzdd gthe � INSURANCE 1 1 WodClDStat FIRMNAME atMassad>tsdlsGataalLaws _ lCanplele CooritssubAa6alegtrivalatt YES 0—'NO 0 YES ffyvuhmedleclmdYES,plm>rldc*dztypecfby BOND rJ OMM (Plmsp *) 1 D E,&n*dValreofE7e�idWc&$ aS;C�C7 � ]re >ectcnDa4eRer}>es'ed rah Fuml �o sigtaane Jym OWNER'SHiSURANCEWADAEP,Iznawarel uftLio wdoesrothmdr eo.eWailssu6sla,>da aMvalatasmgzedbyMamd=MCanWL3ws anddatmyagna mcnftpwnkffficabmwaindlisle#ernert (Please check one) Owner IZI Agent M yy t?`� Telephone No. PERMIT FEE $ 1d Signature of Uwner Of Agent I 9e �T-6l9 I N r LLll Q / .- Location �✓ ` No. 1,30 Date �,. TOWN OF NORTH ANDOVER n Certificate of Occupancy $ Building/Frame 9/Frame Permit Fee $ J�o �ss._.....E Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Lam( i 7584 r Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTBER THAN A ONE OR TWO FAMILY DWELLING Sectioe for ficial Use [iBUBIO!LDMIN!GFP!ElRlMgrrPN!UE!MIBIEIR-..PMMITf,--p" DATE ISSUED: �f ,6 SIGNATURE: - Buildin conmitgIfioner or of Buildings Date - 1.1 Property Address: 1.2 Assessors Map and Parol Number. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonis Distrid Proposed Use Lel Area Fanta 1 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard RzqWred Provide Required Provided RegWred Provided 1.7 Water Supply M.G.L.C.40. 34) l s. Flood Zone' l.t Sewerage DisposalSystem: Public ❑ Prtaae ❑ zow onside Flood zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record //�� ,, CAA,' NS EC IR- �.F iz-C /(-/o�T Name (Print) Address for Service Signature Telephone 2.2 uthorized Agent .� QA v c \ r l � 11 —' zRic smisf- � /TNq� Name Print f Addressfor Service: �-f Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number ZlS L� Licensed Construction Supervisor: / dy7i E—xpiration Date (o r tun Telephone Registered Home Improvement Contractor Not Applicable ❑ 4 Company Name Registration Number Address-------..-..----- ---------------- ---- --.— Expiration Date Signature Telephone SECTION 4 - WORKZJ!S _ : �� 'spa;. :;zj;•,,ii;: 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. Si ned affidavit Attached Yea .......❑ No ....... 0 SECTION S - P.IIOFY.SiO'iAi Dom. STIETCTI(ih[ 5YdR1tS. ,:BI1DH�fS A1�H) S'I'lliiT"IRES StJ81lECT: TO " Ct?NS'FBITCTIOK COl�I't Di: P>t185tiA) ' TU 78f}_Cb R 116 t7WAAiiNG MOAE THAND`3S,M C F : ©F, B1�iCiASED FACS) 5. l Registered Architect: (Yl `3119 -dam Name: (�1} t Z ( Address Signature Telephone )mpany Name: LAO 1 V\An\ t S r -sponsible in Charge of Construction "j"-�,, Not Applicable 0 Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable 0 Jame: Registration Number address signature:+ Telephone Expiration Date 12 lame Area of Responsibility tddress Registration Number ignature Telephone Expiration Date ame .Area of Responsibility ddress Registration Number gnature-' Telephone Expiration Date )mpany Name: LAO 1 V\An\ t S r -sponsible in Charge of Construction "j"-�,, Not Applicable 0 ..F 111UP aS)�A �VORl1;: {cheek itll appi;ic b1�)' New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: �eMa-c a &Ykgan, 4nm Li\� r"4 1Zauiee- w_ Pr� �l S t� 06, Yui �i9,r.JT �rv�QFZrt/L Jig /1S USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly 0 AA 0 A-2 ❑ A-3 0 A4 0 A-5 0 lA 113 ❑ ❑ B Business ❑ 2A 2B 2C ❑ ❑ 0 C Educational ❑ F Factory 0 F-1 0 F-2 ❑ H High Hazard . ❑ 3A 3B 0 0 I Institutional 4 0 I-1 ❑ I-2 0 I-3 0 M Mercantile ❑ 4 0 R residential 0 R-1 ❑ R-2 0 R-3 0 5A 5B ❑ 0 S Storage 0 S-1 ❑ S-2 0 U utility 0 M Mixed Use ❑ S Special Use 0 Specify: Specify: Specify: COMPLETE THIS SECTION IF WASTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area Total Height ft I Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ 1 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, J�} ��,;L/ /�1L /r� 2 I INN tel , v, f i Gc,` Owner of the subject property Hereby authorize ) 0"Ae-3 U u r, -A S My behalf, in all matters relative two work authorized by this building permit application /4 W (- - � �- ` Signature f Owner - '10 Date to act on i Las Owner/Authorized Agent , Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name 'Agent Date .. "'- ^II1) � 1• FI . :1 - . . - 1 :j �• Il 1_:1.11 :1111 :11 Z i :: 4.... :.' . .r:c..'.-xif1'•5 -., . {,� iii}:_ �,..i .4 ?w, M 11 _ • �0'10 M11 1• Wilt—y 101 a 0 1 1% b•'q.v :p :. ^r., .n.�:.Fe .`[7..yt:' iii::: �.!.:.- ::15'J :'(tir;:lf%4.':l^. ` Y1�, ...L:Y: ,.�(, _^:j..� 1:,F(pa ,J/ 3.�7.• J: .'.': '~n,1 .IV n��,�:raa'r f:rr ,'�i •.ep. .-C:-�i: I.A,•:`.i`'i. :,�.�....r,l:. r. �.. Yg'Y:'.T��'s�..,r j�:=� ..t.e5: 'a .R :1 "�iJ .:'.t'i"rs. e,� ,�.ty,',�'+. y�,� y;, .•..:' •!� ^ � nl �4'.. �.'FT'CYi'.S:i.1r�.1J3'1'dJ. �� �'�+iY� .�.,t � ;:iJ1i L:L ... :i1 . �'� :'Nd•�: ,•r: .. '}�'.G fit. •+'�niX`!2*'�:. • OF ••I �dr `!?:'. r.'. "ix+s v. - �}: -r; ;l 3 ;.p_'}<•:'•li;. yy ..ira•'=^tyy i`.�r::l�(J,p.('Ir+�y-a•:..;i"Y5-}�t..�..-,•��f�rij:l:5t;j'J�Y�,� 'C :+r: .,f,:: ^'R';. yp�3r:'d'�,:i;!...r•JEas:'�'�:'��:.A .b'.. .ry. ? ,t:,E„i .e F ,"d;<"p.�%r:•4+�.�r;' ,,}}}} �1�))•... �'...:..r.�• i"�. �. X,t J1�i1.Pi�.!}h:w.. t�.. 1:+0�!:C.>rnJ.,f,: r �: ty. :�1: _;'i. - ' �` �'' 4 .lt, r tl.i::i1.C.'v¢...'i�f' i' T,.r"+ •ef P. �., �.�•,�•,s. �¢f{�s�f: , . t r - Y ':.'yE'{. • f • • 6,: J 4.�,r..«:'•.•`.,; .:{l'?(,.,"� :rr•�'�� '0' 1 { .. .. ... +a"'��.4:� �4 I<r � ,'V.n ,^�� " }'f � 1 J -=t �.:' Jlri6; �'•..1.�.�"-•2^}Y I' ��;�j �.1r•.'- 's • 1'i3 H j•E1 :J ' 'Lill ��(ti'1. } .7 • x :t..r..•; r.�. .>) Y:' �pi r :.a,.w. rn�i" .�.�. 11'f j(�/J' �''.��f .;.a L'..�%•_.�r.��i Y�in'9ti. •T '��� �;.:.'3.q ��E SIZE OF ••• TWBERS IST 2 A. ,/ DElIvIENSIONS OF i DB4ENS1ONS OF POSTS DMENSIONS OF i•D BEIGHT OF THICKNESS SIZE OF •• i MATERIAL OF nt IS BUILDING ON • u OR FILLED LAND IS BUILDING • a• TO NATURAL GAS LINE f.. at kt +.'s.Lt,t;r}4, ' tl.'�ic.IDAi7L ^•is:r'uiSavf'Y''+' NEW— {� 1 .. rti�i{,:. Jj•". 'iy:•�',• {• l '�'(fix-'•kx dC7;AM M LJ+(A ^v4 Zr .h i f r i L� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. C;), n (I . i Address city-`' iZ) loin Phone#7 Comoany name: Address City: Phone # Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.10 and/or one years' imprisonment.as welLas_civil.penakiesinThe form d -a -STOP WORK_ORDER..and_a.fine. of.(.$100.00).-aday.against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify unA the pains q1ndInalties of perjury that the information provided above /s true and coned Print name 1 �t--11'1r--1-, L Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other Town of North Andover o2 ` ' : ' L Building Department *� 27 Charles Street North Andover, MA. 01845Em 1ss�caus� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to alk)w such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one.home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Zip Code North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision 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 c11,S150A. The debris will be disposed of in: ftN /( t-caes s -T (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 09:07 FA% 781 933 4111 UNIVERSAL ��� 2 15:36 FAX 2752684 _ _DESIGN ORIGINS 0049194. TEST REPORT 09/05/97 Professional Testing Laboratory Inc. DESIGN ORIGINS 4•wt..., • .•v •. ...4 •.• Surface Flammabll� of carpets and Rugs (CPSC FF 1-70) GENERAL PRINOIPGE ' This test. method is Intended to measure the response of finished textile floor covering materials when exposed to an ignition source under controlled laboratory conditions. it is applicable to all types of textile floor coverings whether constructed from natural or man-made materials - TEST cRITER10N The uncharred area of the test specimen must be greater than one inch'in at least seven of the eight specimens tested in order to meet the acceptance criterion. TEST RESULTS. This Sample PASSES the Federal. Flammability Standard DOC FF 1-70. APPROVED BY_ l �the 5' ndr tam a d ameMed by NX*W VdW—y l &-J"wk a zmdlailmr does notcoirstbaa an endamanneM aesr5oa, or by Mgr «any Dawq atom TM; feprrt Is pmrided for Ute mdusim use d die diae•eo it Is sddrmzed.h may Ee 07M amt fond a mofdes. 7W Mpon � to thme samples rested and is not oeaessan7Y +nft cepon, or dieiAame d FWesdonal Tering tabonU rl: bw_ doom be used rardervw c4raarefarr in -re a ^s011mrr.. . - am t.60" m lab cede ,a � Thig (� stag mWv" to in entpro u Ine P� �-'j d � lmdcW or dndlar•produas. INS nbft to die mineral PL&t- • 706 -MR -392M Fars 74I; -n"0 707 09:08 FAX 781 933 4111 UNIVERSAL 0003 15:36 FAX 2752684 .. DESIGN ORIGINS 10OU3 Professional TEST REPORT Usting Laboratory Inc, DESIGN ORIGINS VAM 0049194 �F IMIN W105197 Regent 30 ............. I of 2 E M. E648-97 . CritiCal Radiant FIUX. of. Floor .Covering -psing A M� Radiant Heatlnergy Sciume, also ...... ...... referenced aS NFPA 253 and FTM Standard 372 05" -V "A' �F IMIN M Regent 30 01 V50975-3 -insM119Udginkamidance- i'm 2 cut pue me vwa, avan unna-maypaucr. Action Ad! a TO kf NO:'• 0825975 ulliq; WK 19=113i, 0. "K .1 . . . . . . . . . . TEFT. WSULTS EMML P. NCIPILO"""' 'Got ot-f9 :.t��- ' i him z Lid, t�kt f1dr ng. *sWffi5.'-exp0s 4 4zontalkinou ;.I.. In Pro, env tint, Thd fthpaiidJ-�dIAnt ro, ms gy env ronrnL 'aUOA'kevd _pI qS Ilk ngd on MO. iVtp.!M flames. o -com W4 - nnprsofaeiiil�4ifrinrhOse: -. U06&-surfi �-aii fiei�� viffi f ", tmifit."..Th6.tiitt.j*Uit.iga'ri averagexr-lb par -rgd IOM'fWk-huattW�Ajaie•. *hici indliatii th'e"4iVelo.rka dihittitep e r-w reqW red'td SuqpIriAAmd-prppagatI6)hAfi6 iet1611y,' fa-roorn- VO -does not '%Imbose a.ladiant'Aithpt:_0":0ekis:-tnI5 critical 4&e. ondot, or Oh .flame sread will accuni "p"Etw by "WOMW !_k'q'wwn for W spm1@rswpe oflwmftik. iid. ub 0off'M MosifM gh afibrawlift., byowwrany fwn ddo is p --w. b w on. fro, .adoeP dwalud sqi�ddm .-T14 *d 8*1ed C* to *Ali br—l" 714*01shwood0lacie . Oalton.AAWM 7M226-3283 F4* 706-226-6787 4 09:09 FAX 781 933 4111 UNIVERSAL 4 15:37 FAX 2752684 _ DESIGN URIGINS TEST. REPORT Professional . Testing . • . Laboratory Inc. 0004 [g004 0049194 0'9/05/97 2of2 vY4,v DE51GN ORIGINS ' yt ASTM E648-97 Critical Radiant Flux of Floor. Covering Systems Using -A Radiant .Heat Ener9Y Source, •also referenced as NFPA 253• -and FTM Standard 372 ::if.�:j•�: . >��/lit•.�l!,N'•N:�;' •s:<;: Ty—�— -- - IIGIGIIt IG.7YlW. . 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TEST REPORT ;'t�'.S:-my}; Yi;J•P...y y:.n;r.<ar :ftY'F'% ". if::r�'.!'�� "d o:ou• Fs <�ut ASTME662-97 Specific optical Density, of Smoke 'mx,-.c}�,rtf. �s3..'�iry.:t} o� r`-,::<xr ..:'.3• �r..T Generated by 8olld Materials, also -referenced as N FPA �i:c::>. r. t�k,�-'',,r-.: ;ir?�'.,:x.:�s j'l, t:`•?G.::�; ia�rk:i:R:.: >°"^�:�:'•^'J - ' �ir;.V� <:�fr4/S' � } r �;Cv <<�::� ri i! �u.1<rx� 'A+�•.�:��.�Ji:Z;;f' 2 58 ro -.t :r -:•a.. -:-. -... . ..... _...' a:k •P. c}"'. ?'ir.,•};il, -: - <u3sc�: .... ....: _:...... .,..._ .:: •.. tea: •='.lu'n».-:.: •.: ;-..Y,.n•..,. . ...•Cn. .. �.;� y -' c- :a..•xLivi?:-lrt�°4:a4. , ,yc.;4r„,c` '::;•': • :':fi': 3 "cu�'rl�:'` •h"'?"` .�%�:YL..:.,. .zyo:✓- ..?-.cRr:o S >•`? : c. . � ..-.•'z.aky..+r;,x;.sr'it�- ..:7�..S:.s.,:.::,v :}.>.,._:: ;.>.• p r.:.., in ,":ti ?:fi);;%_�="y„<=.'1`. �cC'?`R��YR�i!:<'fi tc: •.. i!..%C 0049194 t.. :. A:=M:i:.r•:c:f•>'fi (1 Regent 30 09/05/97. 2 Y50975-3 of ;'t�'.S:-my}; Yi;J•P...y y:.n;r.<ar :ftY'F'% ". if::r�'.!'�� "d o:ou• Fs <�ut ASTME662-97 Specific optical Density, of Smoke 'mx,-.c}�,rtf. �s3..'�iry.:t} o� r`-,::<xr ..:'.3• �r..T Generated by 8olld Materials, also -referenced as N FPA �i:c::>. r. t�k,�-'',,r-.: ;ir?�'.,:x.:�s j'l, t:`•?G.::�; ia�rk:i:R:.: >°"^�:�:'•^'J - ' �ir;.V� <:�fr4/S' � } r �;Cv <<�::� ri i! �u.1<rx� 'A+�•.�:��.�Ji:Z;;f' 2 58 ro -.t :r -:•a.. -:-. -... . ..... _...' a:k •P. c}"'. ?'ir.,•};il, -: - <u3sc�: .... ....: _:...... .,..._ .:: •.. tea: •='.lu'n».-:.: •.: ;-..Y,.n•..,. . ...•Cn. .. �.;� y -' c- :a..•xLivi?:-lrt�°4:a4. , ,yc.;4r„,c` '::;•': • :':fi': 3 "cu�'rl�:'` •h"'?"` .�%�:YL..:.,. .zyo:✓- ..?-.cRr:o S >•`? : c. . � ..-.•'z.aky..+r;,x;.sr'it�- ..:7�..S:.s.,:.::,v :}.>.,._:: ;.>.• p r.:.., in ,":ti ?:fi);;%_�="y„<=.'1`. �cC'?`R��YR�i!:<'fi tc: •.. i!..%C :.3•�2,1%rk=•,a; %ir7!'e:� rr:c •>`>h•, :::r.•- :cy�.%J•➢c.�.r.; o. r..•„.2::: `":Y..�'':7::.,., 4-Y�kc-?t:E. >'.^.�::s,. r:>.:.,. •: r�?�::: .,.z't,R•:or... . >+r•.. A:=M:i:.r•:c:f•>'fi (1 Regent 30 Y50975-3 i'` � <' •':�b5� sf. =ixiy •:f'i't �2,•. rc, - .. CULPlle f `rc ;i n: •�v,���J',r':}�(`(t!t i'i�t(i:�C',•�yy�'�kit'r'•.,C"� Y - , r . Action Bac*-' "3•' ��`= � Test No: ' x#82597: � ' 'Sr:S'��"o.'.y�;.=`rt:'a�.�•">-'Qn�•3;:i•.�-�.?:..�.s�7?=.�?s i�fi.'t? k. ^ .��, . ', _ - _ ♦� •ti '"••<-•;� ..fit l:�:.�`••-).:.ti :<}.j-ri''YrL'_'y' - . . TEST RESULTS . Y: r - .3 A?..,},<'' -`3•' Yp�S� .Yc5Lp3K=. .r -at?' P'-Y'>•r.`i;C,co i }�'f,..a'" .: 4;rL' -�•- .. :.0 ..,>, r k+k:: r.dFv .,.tt .. Q�r.•..<rvy M:eY'M'n•�=n'•{ C.'L9:K'^ .M!Y!G .�<C '- e ti .'•%=:�d�� MEN-IMi •RRI IP .: -ThfS procedure E `.designed ;'t ,: easute :,tfi .-.spe lfic optical •densliji'.'s3f-.: smoke . - . 9enerated'by the•pst peciM.en'.%voih 'a closed; iaarriber' �:Each• �geeimen is @xgpse�i-'toad 616Wicelly fieated-radfanbenergy,.soursce;f?o ltloned�to'provide' a o ant Hadiar�b , ".el. •of 2:5 watl3/squarB cm on thc'•5becirj dh ".surface:. Measui*rYji citx are recorded WdUgh-.a' phdthmetiie system employing-a.veMoal:beam of jight.'anctaphotb detectot�o5,M66e* d.to ' detect the f t la o6*' villtl(ifri:'e . , ete atf enuat�on ct lige transMttfianae air ed'tiy,smoke apcumu a. , chamber.', The 'ilgtit 't;raatl�smitbnc� measur eiYients.are Used; caiculate'apeci�c �optit�t-' de M, a'-4ua11i* tive vvalir4' ” I�h ran ;be taptordd-to esdrr�ate the smoke pdtetitlaj bf. materials. TWo • burning c onditions-can:.b6::simulatzd :by' the nest appair ws. ;The radiant;` heating in the' absence of,;jgnitbon :1s.:�efemed to`as 'the..tuon-darning ,Model.:;: -A -4aminp ..'Combustion in_'the-pm'd6a of-supportJng.radlbtlon constitutes -the Flaming. Mode,.) IF& roads aft WROM i %;3 l�o�r �po�eio� Peart•,for•i.*w0dsCsaope iaoa�e+� u�d� 1A 6 d6 ! I. M; IMS,1:7 amre�aeodOnecnaim�am.ea;a�Qb oe�oaUQqtlge� u.�va?�br�Ta'�r�ad ltk daeacor indla:�nep nduttae�ed 7Ms ieport id pr1hided for dw adwiie use d diadem fm ,;1"' My addeessad: -fl wry be u�dAs beely 1a *0 Ovd�t'� mpw-;gn ' paaaRated ar>fim ikL 'Two -pee app&s"b* m vMe samples ftpidw d it buC ;jddiarT►e d appaienOri�4iieA ar 5kpw.. peed". 7M9' ".epuA, arfie nameat PYufessFael teNnBlabora� � dgTltde be tand uedef auf6mansEehpe in adgatlsing:gr be;�errnipaLru•• `, 714 fa�IOQtlltoo� Place ton, «iA 3032i. •,• _SOB •. �: �' - '• • PF4 09:11 FAX 781 933 4111 UNIVERSAL 4. 15:39 FAX 2752684 __ DESIGN ORIGINS Professional Testing Laboratory Inc. TEST REPORT DESIGN ORIGINS 0049194 09/05197. '2 of 2 ASTM 'E662-97 . Specific Optical Densl1W of Smoke f+ .e.>> also d aS.NF A ' >:':: erate y ter -referenced . • � _�� ` �` - d •b Solid Ma ials, • _t;::` ''i4 ��Siis:i:'•a•'.'�ic.>:� �f:::•�.y::- ^:,'9�i 2:i•:>'y�F.+"r Gen • �:-:S'�:4�•::C:3:!5}_:Y,. .r .S�J:C:t}iA:V )�n�J..:.. .w..• ,7�258 ..: i.[�"u- _ _ •Y 71b';£i;� ,;.,>,r:43p%nt•'•'?ti�-Y`i ^�'�� j�K iiy=: ::i}+�I ,. y. lti�Y. _ j :} dent 30 „. •...'gin �<ir=,':::.. �:,.: _ .. • ' X50975-3 - �'n •riN�. 2av,:t}lY_�}!u::;1w ki:S'�S�i r .. • . <` ..Cut Pile 'Action Bae Y::.::•. No'.082597-5' ' ?�`; �Y. rG'+YN':{}�2:F..i::r ].�jf::..Y-=:n:%;ii�•:•t;S: ., - <.::�:. •: :•�Ay..::; :C..TRr: iC:Yry} Y.,.. W:•.,iw9.. ... :]:.: v:���:r� _ _ :Jti.: :•]3�{:�'i yr :li..� .: . - •- - �}:?f �i:wO�L �:; � ^Y v':t:i:.fJ. :4-vv^'.Srvii!•: _ - ::�}.'�:<�� �}�y:.. • 24 -Hours green F ' :c:'c : x�:= .•�;.ri. x_ ':::Y.C:::;�..�' r>; ., - IICn� Y� ..fi,�c..•.. C:S:�I-!:.� �•xr::::'.::v�<.- a- t 70"degre"' F and_ HOus CC��relative t1�. - .. �...��''fc:2.:oF,: ._.{k _{•_.?Ci,,. `vitt::;F.-:..,,:�:'Z:.i..,;3.•,j`%>... <,c: _o S::)'S^s:.. 2.5 Watts/sci Cit1 I . • � -'- �_�<'� � •'115 V• a _ _ Sr:.}t-�':;.��� • -- . �'��,11�N-•..•.'f�hR��F=}!7<:r --�-' v . - '-!c.-.:=•:w: i kr +».�;r..ir3't•. i'cw,.•' - fila -Y ' £i.A4stc:.:s^•MsE:: - r�3::>� :K..::LP:.'['':. _ - _ `•Iw`i£f%''�v'"i„ �.x.=,�=� 'i_'f_{r >, Mon=>=laming - -- -: �...=..r.,-, .,::.�:.:M:r�i:�.a> - - • • aS yjF' - Si •'.`•�-:. �aTC!���- b�:C{iwiw�:�.. w'u'�-": �• ):vCi its% �I x ^ T � ?k Y., .i:.t .ta-r�':Lli'�`#r-f5f`r fr _ - r.:K . .'. a:8. _ •`��:ts3"."--� ''-- ,i} 9z' • 4 • � I 1 'v;'r�;i'erir` f} : a •.�;.d`' i,- },' ' ••:}�:Y J' '3`• . .... ...... -N(axlnium'DenslCy'lDrni 172. 2 ato T9fn9 Dm-ti7nlnubesl X7.8 ' .. 2t):0' :' 1 64. td Cle r Beam WC) a _ 1 . •8 6 • _ . Corr: itiNax' Density lQMti � . ' .. ' �" • • 4 .3 • . . WrWtV at 1.5' minutes' 3 i 53 48 Density a, i4to 1016utes 40 Time t0 9t)9�b :Dm tininutesl Specimen Weight (graft) ' '13.2 13.0 AVERAGE SPECIFIC OFT1('AC DE14SIiY AAT'4:0 MINUTES: 47 ' APPROVED 131f a,d a� iaaa� •viruK+�y Iowldy d- X*w ;mt�r::,tas t1a,W�h' W an�+VINS� 'agtrtiorUieptodyA 1iomd he ur" in Its to pin f "�y va Ids y b; ll!e okkAl- aa,nf the a".10 idbw* w 1a k �Y idendd o eMerlsr praduAS TUIs mead nuAroAfds. 11:w sq �Y tothbse sa�Pls eaoedaa is aot Inamtive d APPMM* '` .- ' _ nmon,aa�.la�df�a��se�a�on.x�-�Ina��eavaaaa�rdm�ar�mg'aa�e�d�� : • '': � - .,' .,. FSX: 706-�26�b'7�7' Professional Testing Laboratory TEST RESULTS UNIVERSAL DESIGN ORIGINS TEST REPORT Neg 3.1 KV GENERAL P191111CIEW This method. is designed to as5ess the static propensity of carpet by controlled laboratory simulation of conditigns which are known from experience to be strongly contributory. to,excessive acxumulation ofst4bc changes. A carpet preconditioned 'to'equilibrium 'at controlled atmospheric. conditions -is walked on by a 'test subject In a. specified manner with specified shoe soles., The static charges which'build up on the tester are, monitored continuously by a recorder. . A neolite shoe sole has been chosen as the; primary reference material because its static performance, is much like that of many common leathers: It is a commonly. used shoe sole material and can be easily cleaned; While its chemical and physical propertles'are quite uniform. A chrome tanned- leather shde sole has .been chosen for a secondary reference material because it is representative of a certain class of leathers whose performance differs significantly from that of neolite soles on certaln.carpet fiber. Statistically, chrome tanned leather comprises a very small percentage of the shoe sole market, but roust be considered In critical applications.' Rrs fadj- is aoatedieed br dm 16Uonal %WWOO IamummY Aceedlta un negro for die spWfrr stype of amedhatlon aider L. Bade 1QC297• Thk ami+ aatcastlpaea►admsaaenL 4orapproealbrPffiTatairyagenga/ietlnkedSmt.1yto pin PMdortheproduacested 1 r" lids RpM is pmvidd fur the =dudse use of Ow cfmp m 4hM a is addressed. fe entry be mad to us "dim to ,�� share fim T�hls sa rained udhoubm ,rids reparl app m ady m Own samPles tested and is xwN neomly 1ndk2* d aPpasaN/ n�ari, or Oe nine of ftafesslo W Tesft laboratafs Inc. sfiall wt be used ufsfaanydra ngance in adra" to du: Gene" fad 714 Glenwood Place Dalton, GA 30721 . 706-226-3263 FOR: 706-226-6787 jr09:13 FAX 781 933 4111 UNIVERSAL .15:40 FAX 2752684 DESIGN ORIGINS Professional Testing Laboratory Inc., TEST REPORT DESIGN ORIGINS S008 UB AATCC Test Method 134-1991 Electrostatic Propensity f Carper 0049729 10/08/97 --PQG:'. of 2 AATCC Test Method 134-1991 Electrostatic Propensity f Carper K� . . . . . . . . . . . . Regent 30 ...... . . . . . TEST 1: Stop Testffileol-It6 Sole 14.688 -2.9. KV Y57419-0 W'il ON 40 ounce Rubberized Jute/Hailr Pad wo Cut -Pile-. An hilm". Action Bac Test NO: 093097-2 K� The carpet sample is conditioned to equilibrium and tested at 70± 20F and 20± 2% relative humidity. ...... . . . . . TEST 1: Stop Testffileol-It6 Sole Tested As Received -2.9. KV TEs,r W: step Tetmeather Sole W'il ON 40 ounce Rubberized Jute/Hailr Pad IWA-1 .8 � HE MOM nwtmft1qW bdowwwecanducMdlnacwrdmcew)MUWAAIWTestAteUwdl3"9WSecU=&&2 7SZEPTeStFr0C6dwW. TEST RESULTS Neg 3.1 KV 'Ihe n s�//t3 OF this test relate W Ute sarr�le of carpet I tirsstatic performance may be&UmdtnswL*Bas a readt of wow, s l dbmMg. 6ffnPerdWM mfaMm humMV. eM-" APPROVED BY: ns UMV is aamoMW by dw fAmmW %thmny Jabwmmy plgm. rw " #Pad& df m - awaubom*100 W. eppwMhyNmmffwaVMV.qUj swes C"Amumm for dw p� to ThTj nPm 15 P"4" fm " 0wk"iw0 we ut the CA� W "imn-ft badder. ft may be In ft aftetr go gfm pmdM amq*mm 1=:a�aa amm8bxwd mW-fam ibis rW- APFfis =9Y W *me - 9fttW and b not nectmWy-bufteam of appmmily khwar6fffflarproomm, Ms 'rM Grft PAwneof Pwftai.mul TesUn Uhmmmy, fte, sW m be used under mV dmawntance in advertising die gmend paWtr- '74A ftlftww� A ON-- ftft1* F2A 4%fMfi%-f Ivne -*balm _1200.2 cm— 1nr_*9xL.617n7 . . . . . . . . . . . . N TEST 1: Stop Testffileol-It6 Sole -2.9KV.. 2.8. KV -2.9. KV TEs,r W: step Tetmeather Sole -3.0 KV AA KV -3;1 KV Neg 3.1 KV 'Ihe n s�//t3 OF this test relate W Ute sarr�le of carpet I tirsstatic performance may be&UmdtnswL*Bas a readt of wow, s l dbmMg. 6ffnPerdWM mfaMm humMV. eM-" APPROVED BY: ns UMV is aamoMW by dw fAmmW %thmny Jabwmmy plgm. rw " #Pad& df m - awaubom*100 W. eppwMhyNmmffwaVMV.qUj swes C"Amumm for dw p� to ThTj nPm 15 P"4" fm " 0wk"iw0 we ut the CA� W "imn-ft badder. ft may be In ft aftetr go gfm pmdM amq*mm 1=:a�aa amm8bxwd mW-fam ibis rW- APFfis =9Y W *me - 9fttW and b not nectmWy-bufteam of appmmily khwar6fffflarproomm, Ms 'rM Grft PAwneof Pwftai.mul TesUn Uhmmmy, fte, sW m be used under mV dmawntance in advertising die gmend paWtr- '74A ftlftww� A ON-- ftft1* F2A 4%fMfi%-f Ivne -*balm _1200.2 cm— 1nr_*9xL.617n7 a M Q cm O � c CM GO o •— ID cm -� h � � •� em m a_� 3� as m eo 0 L cco CL cm< ca C 0 CO2 0 C ZCL � V CO) c C C •� C c COD D UA U) W W 1% W U) a a o w a a En C7 o �� aG w i�. ° rx w w rA cn cn cm O � c CM GO o •— ID cm -� h � � •� em m a_� 3� as m eo 0 L cco CL cm< ca C 0 CO2 0 C ZCL � V CO) c C C •� C c COD D UA U) W W 1% W U) Location NO A,9-sco# No. 18:-,) 00 �Z- Date �^ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee GtyN $ TOTAL .. Check # 4 4 � G 156U9 P, /0 M (C, --- Building Inspector CD Sll (D •" O (D O �.o-�-1o ( D D o =.-o m�@wU CD 3 N CL �3 :E O O m 3 ell. � is -n . o" CL � 5' cD r N cD m O o CD CL �o C) .� •� q Z z O r m I m r D O z r r z O i Im m D n m M vl _ton cn v �. ,3, z Q (D tQ O m � sy 0 a rL < O (D 0) 7� is CD c 0 ^ n m z O Ooaoo z-0 Sll (D •" O (D O �.o-�-1o ( D :3-O (CD o =.-o m�@wU O CD O (7 70 ty S N 3 to :E O O O 3 (D � is CD C• . o" CL � 5' to t0 T �n?a03 `Q O o CD CL �o D O (D SI) .� •� ....� N - p (D m (D Cn CD C)' (3D W v o m N Sl (D � v (D O CD WCTO ra _Q UY CL (D " co Q 3 3 (D � � (D �• � pq. CA -' O',' O (n O O :.N (D to '. (D Q M (rrQo T 2 0 Cr 0) Z O CD N 3 O c :3-O (CD o =.-o m�@wU D• N N 2 Q, :E O O - 0 ������3 3 o D CD C• y O u U) 0) 0CwQ�-0� tom 3 co T �n?a03 O o CD CL (OD 0. O D O (D SI) .� •� ....� N - p (D D Co0 (D Cn Co C)' (3D W v o m co o m w (D � v (D O Cr CD WCTO ra U UY CL (D " �r ,nr Q 3 3 (D � � (D �• � pq. CA -' O',' O (n O O :.N (D =3(n (D '. (D Q M (rrQo o� CL �a�M CD CD�� 3�� CD SCD 3C CD v 1 kbJ La. (po� Cr 0) Z � p �' O CD N 3 O c :3-O (CD o -o O cQ =.-o m�@wU CL y �a (D (D :: :E O O - 5 'a ������3 �.fD CD - v 0) 0CwQ�-0� tom 3 co 0 -0 CD �n?a03 O o CD CL (OD 0. O 042 (D (D Cn MCD _ � � C)' (3D W v o m co o m w (D � v (D O Cr CD WCTO 0 Cr UY CL (D " �r ,nr d ((DD O (D 3 3 (D � � (D �• � (D ID O. CA -' O',' O (n O O :.N (D =3(n (D '. (D Q M (rrQo o� CL �a�M CD CD�� 3�� CD SCD 3C y K ((D o � s-, m- z cDrno �vE . o. ,•moi 0 CD ' CD C >.** Q '� CL y �a (D ca fD n f � r X'. `1 S LrA N (D O -o 0 O w CD CL M N G) -v m 3 r D —1 z z O n 0 17 z O m X AZA �6 x m a � r AZA �6 x o.. W x C 3 01 ce = x ° o n_ S D° n_ i S. m Tb m ce Q v S m Z � ID s" h cF 3 R to fll R Cb 4D R S < p = 3Sl- 3 W 91 W x I'EIZMI"I� WAIVER In Lieu of a Permit... I, the undersigned, hereby authorize and instruct INNERFACE SIGN SYSTEMS, INC to complete the fabrication and/ or Installation of signage as required on: Project # R99206 Genesis — Prescott House I understand that the City/ County may elect to take legal action, which may result in fines and/ or legal costs or ultimately in the removal of the signs. INNERFACE SIGN SYSTEMS, INC. shall be held harmless of all Liability and costs resulting from the installation of this signage without the required permits. It is understood that if installation commences and the installer is requested (by the city on site) to stop work that there will be additional installation costs incurred for a 2"d trip or possibly the removal of the signage that was installed before being cited on the premises. Date_4 Authorize gent * Fabrication of Project will begin only after waiver has been signed and returned to INNERFACE SIGN SYSTEMS, INC. or permits have been obtained and a copy sent to INNERFACE SIGN SYSTEMS, INC. INNERFACE SIGN SYSTEMS, INC. 3'0 Webb Parkway I.ilhurn (Atl:u\la), Georgia 3004 I (I 9'1 ti 66 S(III 11 � Ii`)h 1 --0 179 1.i u \,\rtc.inncrlarrsiftn.ront ATLANTA OI:I Ito l'1' R(ISION GRI:ENVlLLE St; I IIARIMif I(IS AN(A LLS (:III1 \1;11 \If\II1111, I IN, INNAII NI\x ORI IAVS III \\ I I: Ni:%% YORK PHIL AIIi.I. VIIIA ?1101 Nix SI' LOUIS SAN IIIRGO 1.\\ 1:ItANCIS(0 \IASIIIN(;'I'ON O(: \\PSI VALM REACH m �►� b o o �' tTj > o'oro o H CD CD CD CD CCD OH CLCD N 01 N N UR (7 7� ° D CD NeD b CL o C)' o o b ao 0 CD CD M cN m CD ow •� CD � l l � 0, CDol C 7 . CDCD ac R o °. o� a. Z CD CD ° _ Q• r CY If. a JL zw ,� r- r�_C.�`-_,--+-�.I—YI--- ' ' . 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TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION 9 This certifies that ............................................ has permission for gas installation ............................. fn the buildings of .......................................... at .. ............................... . North Andover, Mass. Fee......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETT UNiF RM APPLICATION FOR PERMIT TO DO GASFITTING (Print at Type) _ r Mass. Date —z� _ :.1Vc?4Z/ Permit # ... �- a Building Location 76 AC3C6-tr S7- '' Owner's Name G Type New / Renovation p R Plans Submitted: YesO No ❑ 0stalling Coompan�y7 Name C-[1.�N1 4,-j /cx,t iZtr AAA,... %/ '/Ld. .-,,- rT1 Business Telephone_ J-? — 2 2,33 Name of Ucensed Plumber or Gas Fitter �41A �r•v (tel Check one: ,0f' Corporation ❑ Partnership ❑ Firm/Co. Certificate tr INSURANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes JP No ❑ ' 114 if you have ctecked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy e 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 Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent C3 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 ail plumbing work and installations performed under the permit issued for this. application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of a enerai T e of Ucense: f'fumber ign ure o ense um at or Gas titer Title aster � 34V10 Mostar Ucense Number AAP Journeyman 0 . N N S W y N N V of y 5 N 2 O N W J N W O 0 2 a: r .i r Z Z' ,0 t ri m U1 Fu- _� u�t 0 N a C d t- '< W = W V W z rlr W > W ... ' J Z x W W CC O :i1 > TL W H < W 0 Z O ^; O 1A rc '= O V S W 7 3 D 0 J 0 6 Y D to F- o SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR' 6TH FLOOR , 7TH FLOOR STH FLOOR IJ 0stalling Coompan�y7 Name C-[1.�N1 4,-j /cx,t iZtr AAA,... %/ '/Ld. .-,,- rT1 Business Telephone_ J-? — 2 2,33 Name of Ucensed Plumber or Gas Fitter �41A �r•v (tel Check one: ,0f' Corporation ❑ Partnership ❑ Firm/Co. Certificate tr INSURANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes JP No ❑ ' 114 if you have ctecked yes, please indicate the type coverage by checking the appropriate box A liability insurance policy e 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 Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent C3 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 ail plumbing work and installations performed under the permit issued for this. application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of a enerai T e of Ucense: f'fumber ign ure o ense um at or Gas titer Title aster � 34V10 Mostar Ucense Number AAP Journeyman 0 . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that, -...R .. c: f has permission to perfonfi . %./�:3..�" .�....................... • plumbing in the buildings of ./.?('Sr .77 .................... at ...`�.c............. , North Andover, Mass. Fee. �. Lic. No. .k. ? .'..: ....... 0L .. iN-- iy...... . O �LUM8IG INSPE TOR /J WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMI O DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 14o Pt"esCd # 51'- Owners Name Pre S CO# til 11 r5 rhf 4M -F- Permit # T Amount Type of Occupancy AJa t'S /nq KO Pri t New Renovation Replacement 0 Plans Submitted Yes No (Print or type) Check one: Certificate Installing Company Name W4, �e RO ck Corp ® Corp. 16o q G Address GO X 7 2 8 El Partner. k10 r�-k A halo Ver , 1-44. Business Telephone q 7A 9 7,s 4 2 9 9 0 Firm/Co. Name ofLicensed Plumber. QG b C r+ Q 14/1 C k C+i-e_ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy 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 perfoimed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State PP bing Cod#nd Ppapter 142 of the General Laws. BYSignature oi.Licensea Plumner Type ofPlumbing License Title 8 sQ7 City/Town License Number Master Journeyman APPROVED (OFFICE USE ONLY 0 Date . V". � TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING -•.gACMUSG� '� i� � This certifies that f? (_... : . has permission to perform plumbing in the buildings of�-:11. '.............. z! �. at . /�i?F ...t .....-.:�_..... - : l.... ,North Andover, Mass. Fee`s �.... . Lic. No. `r`... .. ............................. . PLUMBING INSPECTOR 09/04/98 14:39 45.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i + MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING y a ' (TType or print) NORTH ANDOVER, MASSACHU EMS Date 7 - Building Locations ��0 �/coSGGp/ 57`. Permit # �i Amount Tr� 5 G O 0 Owner's Name ' New E] Renovation 13 P Replacement ( Plans Submitted FIXTURES (Print or type) Installing Company Name Check one: , Certificate Corp. UPartner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 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 13 Agent 1 AX119 mal"11SOM SdWW0=LkM1mmazvo&xcum aar—a-lb I=M�ar4m best c f my VmaW1eclge and that all plimmtimg wa& and �7Code effials d imc #tis WW be in compliance with all pertinent provisions of the Massachusetts State7PIu7mbnd Ch Irf Laws. By:. Signature o +ce um T license Title Cj City/TownLicense Mumuer Master Journeyman ❑ APPROVED (OFFICE USE ONLY L� lug The Commonlecd1th of Massachusetts Department of Public Safety Utkcupxncy S Fee Checked BOARD OF ME PREVENTION REGULATIONS S27 CMR 1200 3/90 ;te, , plank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to W performed In accordance with the Mansachusetu Electrical Code. S27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE AIs. I ORRM TION) Date "— ,�tt or Town of N To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Number) 1 O (-�( O Owner or Tenant ( ICY' co !:�f Owner's Address • Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Nxi1 hti Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity r Location nd Nature of Proposed Electrical Work RAP V `�<—L i1.4 f N_ C 'Ti_'C�•-a r 1� ilk V �'r�, `� 1 a f �� ctV\ No. of Lighting Outle^sNo. of Hot Tubs No. of Transformers Total KVA No. of Lighting FixturesSwimmin 0d _ Pool Above ❑ In- EJ g grnd. grnd. Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Batter Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Sel Contained Detection Sounding Devices Local ❑ Municipal D Other Connection No. of Ranges No. of Air Cond: Total tons No. of Disposals No. of Feats Total Total Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Cleating Devices KW No. of Water Heaters Signs Ballasts Voltage Wiring No. Hydro Massage Tubs No. of Motors Total ICP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ® NO[] I have submitted valid proof of same to this office. YES® NO [] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE R BOND n OTHER r-1 (Please SDecifY) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME G t 6 C 1it[ ,r Ccs ` St' Licensee Address LM oOff` _Signature Expiration ate Final - - =�Y�L LIC. NOA 15 yl{ (o LIC. O % moBus. Tel. No.y-o$-584-"7 $'Sri 1 it J �"�1el. No. SbT-3$'$- ►f.bSo OWNER'S INSURANCE WAIVER: I am aware that_ the Licensee does not have the insurance coverage or its sub- stantial equivalent as reqifired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) / i�_ Telephone No. PERMIT FEE S RJ Signature of (timer or Agent) t, AWN- 4 qe-Co tca, TO 582 ' NOR7F, Date ..... ..l TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUS� This certifies that ....... C�.. r... ... ��........4 has permission to perform ...... e.�a.(C�.4.E.......� �.4:c�.... f.�.....�.-. �./ wiring in the building of .....1) . ��. f'. S..0 J :............... 40.%n£j - at .... IAO ......t� s�.�. S<v {....�� ............................ . North Andover, Mass. Z e c Fee..A. —. J Lic. NoA& yY'� ..............................................................a9 ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer h1A,SSACI-IIiSETTS UNIFORM APPLICATIO14 FOR PERMIT TO DO GASFITT111C t (Print or Type) 1 NORTH ANDOVER Mass. Date JOA -7 -q® (j kuilding Location '� +a Owners Name Permit ffARRE 530 NTS � itiC� 1� • New , i Renovation Replacement Plans Submitted Q T �r't . I1 (Print or Type) Installingmpany Name � �7� �, l , 4 .Address �jn I9cyy 9 7_A_ Check one: Certificate Corp. Partner. Firm/Co. Business Telephone: • &Afj(,f�j� ."' ;Name of Licensed Plumber or Gas Fitter ' ' Insurance Coverage: Indicate the type of insurance coverage by checking the ;. appropriate box: Liability insurance policy 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 coverages. to a or a v cn N r N z cn rn o w d, w x w q t- to a w y kw.- Q W W� w v w cc cc W a W o t- q > C w a z d 0 q W 0 0 z y a cc ,u x o c9 x w a o � 0 n0. tw— o 113ASEMERT 1ST FLOOR 2ND FLOOR 3RD FLOOR ,'4TH FLOOR ,5TH FLOOR 6TH FLOOR TTH FLOOR 8TH FLOOR Check one: Certificate Corp. Partner. Firm/Co. Business Telephone: • &Afj(,f�j� ."' ;Name of Licensed Plumber or Gas Fitter ' ' Insurance Coverage: Indicate the type of insurance coverage by checking the ;. appropriate box: Liability insurance policy 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 coverages. Signature of owner/agent of property Owrter Ayertt •.1 hereby certify that aU of tilt detsils and Information I have submitted (or cntered) in above application are true and accurate to the bctt of my knowledge and that aU plumbing work and InSLA11allons petfomtcd under Permit iuued for this application wW be In compliance with all pertinent provisions of the Masuchusetts State Cas Code snd CI aptet 142 of the Cenual Laws. By TYPE LICENSE: Plutrtber Title Gasfitter Signature of Licensed City/Town: Master Plutltbe or Gasfitter Journeynian APPROVED (OFFICE USE ONLY) L—%c etise tiuntuer Date..................... Of NORTH TOWN OF NORTH ANDOVER 1ti hfts..ee O PERMIT FOR GAS INSTALLATION r This certifies that ........................................... has permission for gas installation ............................ in the buildings of .......................................... at .................................... North Andover, Mass. Fee......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File /1 4- F(-7� mtrvr( I yr 11101'rA, I IL)N �;C INIVI L Fl[RE PRKEMON SYSTEMS j INSPECTION REPORT No. ....../....................... CONFERRED WITH 0 EXECUTIVE OFFICES REPORT TO STREET_ CITY & STA ATT. • PROVIDENCE, R. I COMPANY, INC INSPECTION CONTRACT N0...1. ........ BUREAU FILE ................ NO................................. BUILDING OR LOCATION INSPECTOR DATE —1 1. GENERAL a. Ie the building occupied according to information furnished by owner or owner's repre- sentative? h. Is occupancy same as previous inspection according to information furnished by owner or owner 's representative? c. Are all systema in service? d. Are all fire protection systems same as last inspection according to information furnished by owner or owner's representative? e. Is building completely sprinklered? f. Are all new additions and building changes properly protected according to information fur- nished by owner or owner's representative? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection according to information furnished by owner or owner's representative? (Explain any fire on separate sheet) i. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter arses and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all sprin er system main control valves open? b. Are all other valves in proper position? c. Are all control valves in good condition sealed supervised?}. 3. WATER SUPPLIES (See Section 17) /IV a. Was a water flow test made and results satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and prop- erly maintained? b. Are fire dept. connections in satisfactory condition, couplings free, cape in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold -weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water -flow indicators and retards in satisfactory condition? 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? e. Are quick -opening devices in service? f. Have dry valves been trip tested satisfactorily as required? g. Are dry valves adequately'protected from freezing? b. Are valve h0u a and heater condition satisfactory? _ 7. SPECIAL SYSTEMS (See Section 18) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? e. Were supervisory features tested and results satisfactory? 8. ALARMS a. Are water motor and gong test satisfactory? b. Is electric alarm test satisfactory? c. Is supervisory alarm service test satisfactory? 9. SPRINKLERS — PIPING a. Are all sprin ers fn goo condition, not obstructed, and free of corrosion or loading? b. Are all sprinklers less than 50 years old? c. Are extra sprinklers readily available? d. Ie condition of piping, drain valves, check valves, hangers, pressure gages, open sprin- klers, strainers satisfactory? e. Have sprinklers been checked for proper temperature rating? f. Are portable fire extinguishers in good condition? g. Is hand hose on sprinkler systems satisfactory? DUPLICATE TO - STREET CITY & STATE ZIP ATT. G-4273 PRINTED IN U.S.A. REV. 10179 • Explain "No" answers on Page 2 $NOL Applicable ORIGINAL SET 1 OF 2 F'UK I OF IN51't(: I IUIV Fl[RE PROTECTION SYS COMPANY, INC. INSPECTION REPORT - - . INSPECTION CONTRACT No. .........f' .................. N0.. f.r....L.�:., ........ BUREAU FILE ................ NO...... ........................... EXECUTIVE OFFICES • PROVIDENCE, R. 1. SET 2 OF 2 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve last trip tested 13. Wet Systems: No? Make and Model? �.5 t!- 14. Dry Systems: No? Make and Model? 15. Special Systems: No? Type Make and Model? Condition? CONTROL VALVES —p— -..U. V.VbCu 016115 16. No? Type? Yes I No Yes No Yes No I Yes No Condition City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves 17. WATER FLOW TEST Water Pressure? CITY PSI TANK PSI FIRE PUMP PSI Water Flow Test? (If none made. Why?) Size Pressure Flow Pressure Size Pressure Flow Pressure Test Pipe Located Test Pipe Before Pressure After Test Pipe Located Test Pipe Before Pressure After 1h t 18. Heat Responsive Devices: Type? ValveNo ...................... A ........ B ........ C ........ D ........ ValveNo ...................... A ........ B ........ C ........ D ........ ValveNo ...................... A ........ B ........ C ........ D ........ ValveNo ...................... A ........ B ......... C ........ D ........ Auxiliary equipment: No? Type? E ........ F........ E ........ F........ E ........ F........ E ........ F........ Valve No ...................... Valve No ...................... Valve No ...................... Valve No ...................... Location? Type of test? A ........ B ........ C ........ D ........ E ........ A ........ B ........ C ........ D ........ E........F........ A ........ B ........ C ........ D ........ E........F........ A ........ B ........ C ........ D ........ E........F........ Test Results? F........ 19. Explanation of any "No" answers. 20. 3i4.#fiie�t Recent changes in building occupancy or fire protection equipment. 10, _ 1 21. Adjustments or corrections made. N1 22. Desirable Improvements. Explain "No" answers on Page I in Item # 19 REPORT STREET. CITY & ATT.- 1. TT.- I[Crum l ur marn- i lulu PR#=ON SYSTEMS COMPANY,INC. INSPECTION REPORT , � - -, INSPECTION CONTRACT No. .......................... NO. .......... CONFERRED WITH rye BUREAU FILE ................ f ............... N0. EXECUTIVE OFFICES • PROVIDENCE, R. I. SET 1 OF 2 1. GENERAL a. Is the building occupied according to information furnished by owner or owner's repre- sentative? b. Is occupancy same as previous inspection according to information furnished by owner or owners representative! c. Are all systems in service? d. Are all fire protection systems same as last inspection according to information furnished by owner or owner's representative? e. Is building completely sprinklered? f. Are all new additions and building changes properly protected according to information fur- nished by owner or owner's representative? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection according to information furnished by owner or owner's representative! (Explain any fire on separate sheet) i. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air! 2. CONTROL VALVES (See Section 16) a. Are all span er system main control valves open? b. Are all other valves in proper position? c. Are all control valves in good condition sealed& supervised? 3. WATER SUPPLIES (See Section 17) a. Was a water How test made and results satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and prop - .A. m int.xi.p.d? b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold -weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water -flow indicators and retards in satisfactory Gond ti. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? e. Are quick -opening devices in service? f. Have dry valves been trip tested satisfactorily as required?. g. Are dry valves adequately protected from freesing? h. Are valve house and heater condition satisfactory? 8. 9. SPECIAL SYSTEMS (See Section 18) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? ALARMS a. Are water motor and gong test satisfactory? - b. Is electric alarm test satisfactory? c. Is supervisory alarm service test satisfactory? SPRINKLERS — PIPING a. Are all span ere in condition, not obstructed, and free of corrosion or loading?_ b. Are all sprinklers lose than 50 years old? c. Are extra sprinklers readily available? d. Is condition of piping, drain valves, check valves, hangers, pressure gages, open sprin- klers, strainers satisfactory? e. Have sprinklers been checked for proper temperature rating? f. Are portable fire extinguishers in good condition? g. Is hand home on sprinkler systems satisfactorv? DUPLICATE TO - STREET CITY & STATE ZIP ATT. INSPECTOR IM, f".; F &u� DATE 14 - j=_ X -I G-4273 PRINTED IN U.S.A. REV. 10179 • Explain "No" answers on Page 2 $Not Applicable ORIGINAL HELLIRE FpNj=0N RSTW COMPANXINC. INSPECTION REPORT INSPECTION CONTRACT No..%y.--. Z.3........ . BUREAU FILE ................ NO..o�Q..-./ .x/.30...... EXECUTIVE OFFICES PROVIDENCE, R. I. S . ET 2 OF 2 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve last trip tested 13. Wet Systems: No? 1 Make and Model? 14. Dry Systems: No? Make and Model? 15. Special Systems: No? Type Make and Model? Condition? 16. CONTROL VALVES I , Open Secured Closed Signs i City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves WATER FLOW TEST Water Pressure?--,,_ CITY Water Flow Test? (If none Smade. Whv?) PSI FIRE PUMP PSI Size Pressure Flow Pressure Test Pipe Located Test Pipe Before Pressure After 18. Heat Responsive Devices: Type? ValveNo ...................... A........B........C........D........E........F........ Pressure Flow Pressure ValveNo ...................... A........B........C........D........E........F........ Before Pressure After ValveNo ...................... A........B........C........D........E........F........ ValveNo ...................... A........B........C........D........E........F........ Type of test ? Auxiliary equipment: No? Type? 19. Explanation of any "No" answers. 20. Recent changes in building occupancy or fire protection equipment. 21. Adjultments or corrections made. 22- Desirable Improvements. * Explain "No" answers on Page 1 in Item # 19 G-4273 PRINTED IN U.S.A. REV. 2 MIC—IM A Size Pressure Flow Pressure Test Pipe Located Test Pipe Before Pressure After Type of test ? ValveNo ...................... A........B........C........D........E........F........ ValveNo ...................... A........B........C........D........E........F........ ValveNo ...................... A........B........C........D........E........F........ ValveNo ...................... A........B........C........D........E........F........ Location? Test Results? 20. Recent changes in building occupancy or fire protection equipment. 21. Adjultments or corrections made. 22- Desirable Improvements. * Explain "No" answers on Page 1 in Item # 19 G-4273 PRINTED IN U.S.A. REV. 2 MIC—IM A r ir�r vTi ► %JT I" LCI I Ii IPV M,11PACT ON -COWRSME INC. •j < INSPECTION REPORT .. „ INSPECTION CONTRACT =� e CONFERRED WITH BUREAU FILE ................ ^� EXECUTIVE OFFICES PROVIDENCE, R. I. SET 1 OF 2 REPORT TO STREET CITY & STA ATT. — h ZIP BUILDING OR LOCATION I. GENERAL a. Is the building occupied according to information furnished by owner or owner's repre- mrrnc;re� b. Is occupancy same as previous inspection according to information furnished by owner or owbel's representative? c. Are all systems in service? d. Are -all fire protection systems same as last inspection according to information furnished by owner or owner's representative? e. Is binding completely sprinklered? f. Are all new additions and building changes properly protected according to information fur- nished by owner or owner's representative? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection according to information furnished by owner or owner's representative? (Explain any fire on separate sheet) i. In areas protectedby wet system, does the buildingappear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all spriner system main control valves open? b. Are all other valves in proper position? c. Are all control valves in good condition sealed® supervised? Q. 3. WATER SUPPLIES (See Section 17) a. Was a water flow teat made and results satisfactory?_ 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and prop- erly maintained? b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold -weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water -flow indicators and retards in satisfactory condition? -- 6. DRY SYSTEMS (See Section 14) s. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? e. Are quick -opening devices in service? f. Have dry valves been trip tested satisfactorily as required? g. Are dry valves adequately protected from freezing? h. Are valve house and heater condition satisfactory? 7. SPECIAL SYSTEMS (See Section 18) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? DATE 8. ALARMS a. Are water motor and gong test satisfactory? b. Is electric alarm test satisfactory? c. Is supervisory alarm service test satisfactory? 9. SPRINKLERS — PIPING a. Are all sprinere in goo condition, not obstructed, and free of corrosion or loading? b. Are all sprinklers lees than 50 years old? c. Are extra sprinklers readily available? d. Is condition of piping, drain valves, check valves, hangers, pressure gages, open sprin- klers, strainers satisfactory? e. Have sprinklers been checked for proper temperature rating? f. Are portable fire extinguishers in good condition? g. Is hand hose on sprinkler systems satisfactorv? DUPLICATE TO - STREET CITY & STATE ZIP ATT. G-4273 PRINTED IN U.S.A. REV. 10179 • Explain "No" answers on Page 2 tNot Applicable ORIGINAL 131 rAYW tsUftlrj" 1, ........ INSPECTION CONTRACT • NO. 0-5 . .......... BUREAU FILE EXECUTIVE OFFICES PROVIDENCE, R. I. .... 10. Date Dry System Piping last checked for stoppage. — I I - Date Dry System Piping last checked for proper pitch. 12. Date Dry Pip, Valve last trip tested — 13. Wet Systems: No? Make and Model?-12.5� 14. Dry Systems: No? Make and Model? 15. Special Systems: No? Type ------------ Make and Model? 16. CONTROL VALVES City Connection Control Valve No? Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves 17. Type ? Condition ? fired Closed Z)t 1 2 OF 2 Water Pressure? _ WATER FLOW TEST UFFY Water Flow Test? -------- �PSI TANK --__Fsl FIRE PUMP (If none made, Why?) 7S, Size Pressure Flow Test Pipe Located Test pipeRefn— Pressure D) Si!42, Pressure Flow Pipe Pressure ressure After Before Pressure Pressure Teit Pipe Located Test 0 e Aft 18. Heat Responsive Devices: Type? Valve No A B C Valve No A B C Valve No A B C Valve No A B C D Auxiliary equipment: No? Type? ]V. Explanation of any "No" —answers. 20. Recent changes in building Occupancy or fire protection equipment. Adjustments or corrections made. .1 . 2. Desirable In--prol.c.tl. Type of test? Valve No A B C Valve No A B C Valve No A B C Valve No A B C Location? ------- Test Results? • Explain "No" answers on Page I in Item ,19 G-4273 PRINTED IN U.S.A. REV. 2 ORIGINAL SPECTION PRI)TWOIN SYSTEMS COMPANY, INC INSPECT19 REPORT - - INSPECTION. CONTRACT No. ..................... CONFERRED WITH • BUREAU FILE ................ '........ NO. EXECUTIVE OFFICES PROVIDENCE, R. I. SET 1 OF 2 REPORT TO STREET__.) CITY & STA' ATT.. -L22` BUILDING OR LOCATION GENERAL a. Is the building occupied according to information furnished by owner or owner's repre- sentative? h. Is occupancy same as previous inspection according to information furnished by owner or owners representative? c. Are all systems in service? d. Are all fire protection systems same as last inspection according to information furnished by owner or owner's representative? e. Is building completely sprinklered? f. Are all new additions and building changes properly protected according to information fur- nished by owner or owner's representative? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection according to information furnished by owner or owner's representative? (Explain any fire on separate sheet) i. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all sprin er system main control valves open? b. Are all other valves in proper position? c. Are all control valves in good condition sealed g supervised? 3. WATER SUPPLIES (See Section 17) a. Was a water How test made and results' satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and prop- erly maintained? b. Are fire dept. connections in satisfactory condition, couplings free, cape in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold -weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water -How indicators and retards in satisfactory cond 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? _ b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections! e. Are quick -opening devices in service? f. Have dry valves been trip tested satisfactorily as required? g. Are dry valves adequately protected from freezing? b. Are valve house and beater condition satisfactory? INSPECTOR--, DATE— GENERAL ATE- 7. SPECIAL SYSTEMS (See Section 18) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? 8. ALARMS a. Are water motor and gong teat satisfactory? b. Is electric alarm test satisfactory? c. Is supervisory alarm service test satisfactory? 9. SPRINKLERS — PIPING a. Are all spnn ers in condition, not obstructed, and free of corrosion or loadingT b. Are all sprinklers less than 50 years old? c. Are extra sprinklers readily available? d. Is condition of piping, drain valves, check valves, hangers, pressure gages, open sprin- klers, strainers satisfactory? e. Have sprinklers been checked for proper temperature rating? f. Are portable fire extinguishers in good condition? g. Is hand hose on sprinkler systems satisfactory? DUPLICATE TO - STREET CITY & STATE ZIP ATT. G-4273 PRINTED IN U.S.A. REV. 10179 • Explain "No" answers on Page 2 $Not Applicable AG1�16IA1 r INSPECTION . FM PROCoMpAn. SON SYS INSPECTION REPORT Rice NVPo. INSPECTION CONTRACT NO. I.Y..-.'LS��........ BUREAU FILE ..:............. EXECUTIVE OFFICES • PROVIDENCE, R. I. NO ... -..I...`3 10. Date Dry System Piping last checked for stoppage. _ 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve last trip tested 13. Wet Systems: No? / Make and Model? i 14. Dry Systems: No? Make and Model? 15. Special Systems: No? Type Make and Model? 16. CONTROL VALVES City Connection Control Valve No? Tank Control Valves Pump Control Valves _____ Sectional Control Valves System Control Valves 17. Condition ? Water Pressure?_''�G WATER FLOW TEST _ CITY PSI Water Flow Test? NL+� # TANK PSI Size Test Pipe Located Test Pipe (If none made, Why?) Pressure Flow Pressure oc. t Z UP 2 FIRE PUMP__ PSI Before Pressure Size Pressure Flow Pressure After Test Pipe Located Test Pipe Before I Pressure After 18. Heat Responsive Devices: Type? ValveNo......................A........B........C........D........E........F........ ValveNo......................A........B........C........D........E........F........ ValveNo......................A........B........C........D........E........F........ ValveNo .................... A........B..:.....C........D........E........F........ Auxiliary equipment: No? Type? I`J. Explanation of any "No" answers. ?0. Recent changes in building occupancy or repro�ec�tion equipment. Adjustments or correctio n's made. 2. Desirable Improvcmcnts. Type of test ? ValveNo......................A........B........C........D........E........F........ ValveNo......................A........B........C........D........E........F........ ValveNo......................A........B........C........D........E........F........ ValveNo..:...................A........B........C........D........E........F........ location? Test Results? * Explain `:No'' answers on Page I in Item HiQ 617 263-5957 v HODSON FIRE EQUIPMENT CO. JAN I `'.1gP i BOX 221 ACTON, MASS. 01720 Our Order No. Your Order No. Date JILAUILry 7„_1981 Via F. 0. B. S/ 1; Terms SOLD TO Proses t 110UQP Idttg Rome 14 Prescott Street, N rth Andover, Maas. 01845 Purchasecontrolled by our terms and conditions only. All shims must be made within 10 d&Ys ofreeeipt ofdoodo. PLEASE MAKE CHECKS PAYABLE TO ODSON FIRE EQUIPMENT CO. THANK YOU. TERMS; NET 30 DAYS Accounts over 30 days old will b3 subject to an interest charge of Of V/2% on the unpaid balance which is a rate of 1M per year. Inspection 0f Sprinkler System� 62 00 PRESCOTT HOUSE NURSP,'G HO NE, enc. A4 _---- Purchasecontrolled by our terms and conditions only. All shims must be made within 10 d&Ys ofreeeipt ofdoodo. PLEASE MAKE CHECKS PAYABLE TO ODSON FIRE EQUIPMENT CO. THANK YOU. TERMS; NET 30 DAYS Accounts over 30 days old will b3 subject to an interest charge of Of V/2% on the unpaid balance which is a rate of 1M per year. FIELD SERVICE EDINARDS Eowaaos ORDER N0. _ 7 A UNIT OF GENERAL SIGNAL ORDER REPORT - R O. CR D T APPROVAL 1 8 a Date: U6 ) J SOLD SAME AS "SQLD,'{O'•.UNLESS SPECIFIED SHIP TO J! Cott 401, ,s -c TO Name ame ame / treat /v Ae,) 4p A LIS treat City State C/O zlp C/O CI tate 'p ;USTOMER ORDER NO. MARKS Billing Ship Via Chg. Code Code Code I D fYPEOFSERVICE (Ciicleone onl ): Y CO PERFORMED WARRANTYSERVICE SERVICE 3 STOCK DEMAND 4 i SERVICE TOSALES ORDERS SERVICE LI NO. QUANTITY Y K NUMBER DESCRIPTION ?ROD S T CODE S C1V ;N'S—N O 3 DIRECTSHIPMENT TO CUSTOMERS UNIT PRICE EXT PRICE oe SERVICES REQUESTED// DEfjE TOTAL PRICE _ x r •r„ y,.� yr n e ov de t SER CE REPRESENTATIVE SERVICE MANAGER APPROVAL OVAL :ERVICE REQUESTED BY: PHONE NO. SHIP VIA CODES 00 BEST WAY 12 AIR FREIGHT 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 15 PARCEL POST INSURED 18, PICK UP 20 TRUCK 23' UPS 24 OTHER • SPECIFY 25 UPS BLUE LABEL $ /� CHARGE CODES 1 PREPAID 2 CHARGE 3 COLLECT ON SHIPPING CHG. 4 COD • MATL. PLUS FREIGHT 5 OUOTED CHARGE tip CUSTOMER COPY 1-410 rfev. r 1/vu EDWARRDS A UNIT OF GENERAL S I G N A L d FIELD $ERVICrzE DWARDS ,��„ " ORDER N04 6•��fi ORDER REPnRT o. SERVICES REQUESTED/ RENDERED- TOTAL PRICE $ SERVIC REPRESENTATIVE x SERVICE MANAGE'R APPMVAL SERVICE REQUESTED BY: C v1E R CREDPROVAL CHARGE CODES 00 BEST WAY Date: /-7 • 2 CHARGE 1 fl -SAME -AS -'SOL.(:) 70"U LESS,SPECIFi ID7ru SOLD .� ✓G yJ/ SHIP. �+'• . :•1 TOA J g 415LL/ 5 QUOTED CHARGE TO tir ;j1. Name z�� ��'! L/ � f f 4r. s!'. t. Street .� - treatY �j• •. ''^�:,;,'h. �o �/�[�1� {' r City r State Zip Citya. tate �. .. ...•• i..rt ip C/O C/O Y CUSTOMER ORDER NO. MA KS _�,j �/'t� Billing Code Ship, Via ode Chg. SERVICEMAN'S NO. Code D — . TYPE OF SERVICE (Circle•oneonly): FCO PERFORMED Z WARRANTYSERVICE SERVICE 3 STOCK DEMAND' 4 DI'RECTSHIPMENT .. " SERVICE TOSALES ORDERS SERVICE TOCUSTOMERS LINO. QUANTITY Y K NUMBER DESCRIPTION PROD UNIT PRICE EXTENDED PRICE 7 COOS I SERVICES REQUESTED/ RENDERED- TOTAL PRICE $ SERVIC REPRESENTATIVE x SERVICE MANAGE'R APPMVAL SERVICE REQUESTED BY: C v1E R SHIP VIA CODES CHARGE CODES 00 BEST WAY 1 PREPAID f T _ 12 AIR FREIGHT 2 CHARGE 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 3 COLLECT ON 15 PARCEL POST INSURED SHIPPING CHG. 18 PICK UP 4 COD. MAIL. PHONE NO 20 TRUCK PLUS FREIGHT 23 UPS 5 QUOTED CHARGE 24 OTHER. SPECIFY 25 UPS BLUE LABEL CUSTOMER COPY SERVICES REQUESTS /RENDERED:TOTAL PRICE 00, 00, FIELD SERVICE EDWARDS SE G EDWARDS C S OME ORDER N0. f"� �t 4 p SHIPVIA CODES A UNIT OF GENERAL SIGNAL OR DER REPORT - 0 ,L18 1 PREPAID, 2 CHARGE CREDIT APPROVAL 14 CUSTOMER TRUCK 3 COLLECT ON roMEANu. SHIPPING CHG. SERVICE flEQUESTEDBY: / 18 PICKUP PHONE NO.!` 20 TRUCK 4 COD- MATL PLUS FREIGHT Date: / Z., f SOLD 5 QUOTED CHARGE SAME AS "SOLD TO" UNLESS SPECIFIE 24 OTHER - SPECIFY J�+- f/moi/ TO /G 4:• ✓l�Q t /�4. �.lrl i SHIP P i ^r O „ Name y Street Street l`�' `l� �'' 41� Cit �� C/O State City tete p, p C/O CUS OMER ORDER NO. M ARISS.• e� i? ' Billing c De Ship Via �� Chg. S RVICEM,rAN'S N C/( P TYPE OF SERVICE (Circle one only): FCOPERFORMED 2 WARRANTYSERVICE SERVICE 3 STOCK DEMAND 4 5 DIRECTSHIPMENT SERVICE TOSALES ORDERS SERVICE TOCUSTOMERS LI NO. QUANTITY Y K S T NUMBER DESCRIPTION PROD CODE UNIT PRICE EXTENDED PRICE SERVICES REQUESTS /RENDERED:TOTAL PRICE 00, 00, CUSTOMER COPY SE . IICE REPFIE N AT / C S OME SHIPVIA CODES CHARGE CODES S ICE MANAGER APPROVAL 00 BEST WAY PRO AL DATE 12 AIRFREIGHT 1 PREPAID, 13' AIR PARCEL POST INSURED 2 CHARGE 14 CUSTOMER TRUCK 3 COLLECT ON 16 PARCEL POST INSURED SHIPPING CHG. SERVICE flEQUESTEDBY: / 18 PICKUP PHONE NO.!` 20 TRUCK 4 COD- MATL PLUS FREIGHT 23' UPS 5 QUOTED CHARGE 24 OTHER - SPECIFY UPS BLUE LABEL CUSTOMER COPY F416'Rev. 1.1/80 EDWARDS EDWARDs c e, FIELD SERVICE ORDER No. 215:9 Q^ C)Rni=R RFPnRT cCREDIT APPROVAL SOLD31 Ile- 141- Name Street C r'y Slate Zip VO �. SHIP, TO C/O Date: 'SAME'AS "SaLD7TCr-ML-E-s9'9PECIFfE" + a= , Name treet j City State ', •.` ,t 4 CUSTOM ORDER NO.MARKS .-- /�-{�` 2 CHARGE Billing CoDde Ship Via d� Chg. SERVICEMAN'S NO. Code TYPE OF SERVICE (Circle one only): FCO PERFORME 2 WARRANTYSERVICE SERVICE TO SALES SERVICE 3 STOCK ORDERS DEMAND SERVICE 4 COD- MATL DIRECTSHIPMENT 5 TOCUSTOMERS LI NO. QUANTITY Y K S T NUMBER DESCRIPTION PROD UNIT PRICE EXTENDED PRICE CODE 25 UPS BLUE LABEL ;E RVICEJS�EQUESTED/,RENDE RED: S!ErIC ,AAEPRE X (l-.f:f- SERVICE REQUESTED BY: 1 ma TOTAL PRICE 1$ G " - - SHIP VIA CODES CHARGE CODES 00 BEST WAY 1 PREPAID VAL P VAL DATE 12 AIR FgEIGHT 2 CHARGE 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 3 COLLECT ON 15 PARCEL POST. INSURED SHIPPING CHG. 18' PICK UP 4 COD- MATL 20 TRUCK PLUS FREIGHT PHONE NO. 23 UPS 5 QUOTED CHARGE 24 OTHER -SPECIFY 25 UPS BLUE LABEL CUSTOMER COPY o !u✓ 74C �'+C Z w t R..�w ��il•-� (elf) �/S�,ia •w lh /few fr n /S�IIA► / ej� COM ON'WEALTH OF MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, DIVISION OF NURSING HOLES AND RELATED FACILIATIES QUARTERLY FIRE INSPECTION REPORT Convalescent or Nursing Home Y, City or Town Infirmary . Pest Homes Public Medical Institution In accordance with the requirements of General Laws,. Chap. 1480 Sec. Precott House "'ursin the g Home " Name of Institution located at 140 Prescott Street North Andover,.•Tas8,::01$45 was inspectd on December 9, 19$1 by Lt. James'Tamagnine Name of Fire Inspector Report of Inspection Approved - v Disapproved_ Date Pecember 9, 1981 PLrASE RPTURNT THIS REPORT: Bureau of Health Facilities Room 530t 80 Boylston Street Boston, T;assachusetts 02116 *ONE COPY SHOULD pr S -'.N^' TO THF IP'SITUTION Signature Acting Chief, NAFD COJ'-'YlONWwlALTH OF 1, A, CH I J S P, T S OF PUBLIC HEALTH DIVISION OF NURSING H oj� . ri, F, S AND PELAT'ED FACILIATI"E'S 'P!;.' QUARTEPLY FIRE, INS -G'TION 130RT Convalescent or i!,uj,sjng Iriome Y C i., tv (d r T' Town Infirmary . fiLl:on accol-d!lce ',vith t 11 e Of Genaral L,Jws Coe. 1. t h Prescott House Nursing Name of institution at 140 Pre'scott Street ;forth Andover; Pvla s's .,0184 s 7nspectd on August P4, 1981 by Lt. James Tamagnine Nf,jne of Inspecto.t. Inspc-c-,,jon r.v�d Of oom 530) 0 - -ton Street fD�ton _3 � chusett!7, 02116 3"NT TO T'Ht� R`SI"'U""TON I Signature— - -- — - - j COMMONWEALTH Or• W SSACHUSr;TTS DF'YAP.TVF:Nm OF PUBLIC HEALTH, DIV1SlON OF NURSING HOMES AND RELATh;D FACILIATIFS QUARTERLY'FIRE INSPECTION REPORT T. Convalescent .or Nursing .Hams City or Town Infirmary Rest Homes Public *medical Institution In accordance with the requirements of .General Laws, Chap. 148, Sec. 4 the' Pres:cot.i. House Nursing. Home Fame. ofIn$titution located at :..14 •.Prescott Street . North Andover'. Mass. 01845 was inspectd. on May .29, 19$1 by Lt. James Fitzgerald Name .of Fire Inspector Peport of Inspection • f Approved T.�LlT/rl/�d Signature Disapproved Date_ May 29, .1.9.$1. Acting Chief NAFD PLT SE PrTLT-.r, THIS REPORT: Bureau of Health Facilities Room 530, 80 Boylston Street' Boston, 111 ssachusetts 02116 �0N COPY SHOULD. "r :.S =:N^' TO T?1�; IrzSITU�'ION. COMMONWEALTH OF MASSACHUSETTS ~' DEYARTPF.NT OF PUBLIC HEALTH, DIVISION OF NURSING HON�TES AND RELATED FACILIATIES QUARTERLY FIRE INSPECTION REPORT Convalescent or Nursing Home x ' City or Town Infirmary . _ - Rest Homes Public Medical Institution In accordance with the requirements of General Laws, Chap. 148, See. 4, the Prescott douse Nursing Home * Name of Institution located at 14.0 Prescott Street, North Andover, Mass. 01$45• was inspectd on February 24, 1981 by_ Lt. James Tamagnine Name of Fire Inspector Report of Inspection Approved x Disapproved Date February 24, 1981 PLEASE RETURN, THIS REPOPT: Bureau of Health Facilities Room 530, SO Boylston Street Boston, Massachusetts 02116 &ONE COPY SHOULD BE SENT TO THF INSITUTION Signature Acting Chief NAFD July 1, 1981 Prescott Mouse Nursing Home 140 Prescott St. North Andover, I-Ia. Dear Sir: Attention: Mr. John A. Holt According to your diagram showing more than one exit from the kitchen, permission is granted for the installation of a screen door on your delivery door to the kitchen. Very truly yours, CHARLES H. FOSTER INSPECTOR OF BUILDINGS CHF: ad PRESCOTT HOUSE NURSING HOME June 9, 1981 Town of North Andover Building Department 120 Main Street No. Andover, Mass. 01845 ATTN. Mr. Charles Foster Local Building Inspector Dear Mr. Foster: This letter is in reference to our conversation on June 4th regarding the installation of a screen door in the kitchen. Enclosed are copies of the kitchen floor plan. I have identified all kitchen exits and have indicated where we would like to have this screen door installed. NOTE: This door is used primarily for deliveries and is not the only exit from the kitchen. Also, there are no more than ten employees on at any given shift. I would appreciate your prompt response on this matter. If you have any questions,,do not hesitate to call. JAH/dmf Enc. T nk you, ohn A. Holt Admiistrative Assistant 140 PRESCOTT ST. NORTH ANDOVER, MA 01845 (617) 685-8086 01) 6 m ' 8 ;Ol r 4U, e N %1 dry iJ `N Rt*+btas ri W (� O �}r 0 •^ U') , O K Ri v iti O v C O 06 v o5 pp w �— y.r •� ctj w 40 rj rt � I 3TJ1 1�, N 3+ , d t4 y o ° -Uo er�c b.. r �' v • pj r ja+ \j v� d ZZ ? o o W C tn o0 ;.0 v m tv a1 `ti, w t, ytv ,` G Qn Location No. Date Check # 0 ��, -'Building dn`spector TOWN OF NORTH ANDOVER � A Certificate of Occupancy $ ♦ i ; s',..e ttt' s�CNUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $�—�- TOTAL $ lam/ cnd Check # 0 ��, -'Building dn`spector COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER APPROvEj) 1600 OSGOOD STREET �j Building 20 Suite 2-36 h APPLICATION OF CERTIFICATE OF INSPECTION 2007 () Fee Required (Amount) $100.00 Date: r () No Fee Required �p Accordance. with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby apply for II Certificate of Inspection for the below -named premises located at the following address: Street and /J Number 7 D /N t'SGS 1% ' S , e ? /7-- Name of — Premises Ae d co t/ Purpose for which Premises is '/ Used s�Ct Ile, 4 Licenses (s) or Permit (s) Required for the Premises by Other Governmental Agencies: Contact Person Telephone License or Permit Apencv (144-- ., Certificate to be issued to_ _r Address Iyb ;40^ e-Cc0 / Y Telephone Owner of Record of Building G e n e s' s H e l-1 1il O aA p (2c.n a aAa-f i o n Address 101 re Name of Present Holder of Certificate Name of AgeKcy, if SIGNATUR F PE IIS Tb WHOM -CE IS ISSUED OR HIS AUTHOIRIZED AGENT INSTRUCTIONS: TITLE /1s/"7 DATE F 1) Make check payable to: Town of North Andover 2) Return this application with your check to: Building Dent, 1600 Osgood Street, BLDG 20 STE 2-36 North Andover MA A1Rd5 PLEASE NOTE. Application form with accompanying FEE must be submitted for each building or structure or part thereof to be certified. 3) Application and fee must be received before the certificate will be issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. Application for Cl. revised 5/07 jmc Pd CLASSIFICATION OWN BUILDING NAME OR NO INSPECTION REPORT FORM INSPECTION /'YES ) NO DATED STREET LOCATION TYPE OF OCCUPANCY - Day Care ❑ Auditorium ❑ Restaurant ❑ Cafe ❑ Gym ❑ Apt ❑ School ❑ Common Victualer's ❑ Liquor ❑ Place of Assembly ❑ EXIT SIGN LIGHTED EXIT SIGNS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STOREYS EMERGENCY LIGHTING SYSTEM dry cell ❑ wet cell ❑ yes no ❑ yes K no 0 vI _ FT_ operable k ELECTRIC EQUIPMENT VIOLATIONS yes ❑ FIRE RESISTANT CURTAINS OR DRAPERIES EGRESSES LAWFULLY DESIGNATED HANDICAP ELEVATOR STAIRS PROPERLY RAILED V N �__gU 14 A yes ❑ unobstructed ❑ yes yes V yes v no no ❑ no ❑ no ❑ no ❑ HALLS AND STAIRWAYS LIGHTED yes ❑ no ❑ UTILITY ROOM — CLOSETS yes no ❑ RADIATOR GUARDS COMPLIES HANDICAPPED P RSONS LAWS yes no ❑ HOW HEATED NO. FIREPLACES ves ❑ no ❑ BOILER ROOM CONDITION: INSPECTOR: BRIAN LEA T0: Prescott — Carol FAX: 978-687-2665 DATE: February 4, 2008 TOWN OF NORTH ANDOVER OFFICE OF Building Department 1600 Osgood St Bldg 20 Suite 2-36 North Andover, Massachusetts 01845 FROM: Jeannine McEvoy, Building Dept TEL: 978-688-9545 FAX 978-688-9542 Sending the Certificated of Inspection and the formed returned by Prescott for the Inspection done in July 07. Any questions please let me know. BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Location !y0 G"�-�'-G--+�-' No. a Date NORTsj TOWN OF NORTH ANDOVER ♦ L 9 e Certificate of Occupancy $ '�ssACMUsE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 01"— TOTAL $ Z ox az Check # 1`3S 17034 1 �—Building IvrSs�`pector nj COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE OF INSPECTION (✓� Fee Required (Amount) % S () No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,15, I hereby apply for Certificate of Inspection for the below -named premises located at the following address: Street and _ Number P Name of Premises /"--n e SG Purpose for which Premises is 5, .-vice,-si,(,-q ei � Used /v a /I S, V E= Licenses (s) or Permit (s) Required for the Pr ises by Other Governmental Agencies: Contact Person C e Tel is P6 - �ra8b License or Permit A_S n_Y Certificate to be issued to Address ;[/y:�'s.�i� Telephone Q78-G�S-�6P/ Owner of Record of Building Address r "t, _ s e .s Name of Present Holder of Certificate Name of Agency, if any WlA (itn �tPG. /V.2 SIG11�A VIRE OF PERSONS TO WHOM CERTIFICATE TITLE ' IS ISSUED OR HIS A UTHOIRIZED AGENT DAT INSTRUCTIONS: 1) Make check payable to. Town: Town ofNorth Andover 2) Return this application with your check to:Building Dqt., — 27 Charles Street, North Andover MA 01845 PLEASE NOTE: Application form with accompanying FEE must be submitted for each building or structure or part thereof to be certified. 3) Application and fee must be received before the certificate will be issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # Form revised 2103 jmc Certificate of Inspectionform 1-70,3 � /,`;W Y EXPIRATION DATE: a - -/- FORMSBCC-3 TOWN OF NORTH ANDOVER INSPECTOR'S NAME OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE INSPECTION REPORT FORM CLASSIFICATION 102 PASSES INSPECTION yesno 0 DATED /////// OWNER C -� ns r 5 S /` a/C',S / ,— _ BUILDING NAME OR NO. � � /,/-0/' e S GO 7`J/ S� STREET LOCATION Tr`� S C brr 14ze )s, TYPE OF OCCUPANCY - Day Care Center /f Aud. 0 Cafe 0 Gym Apt. 0 School 0 Common Victualer's 0 Liquor 0 Placeof Assembly 0 Other'e-- OCCUPANCY NUMBER (include stories # and occupancy per floor - use reverse side EXIST SIGN LIGHTED EXIT SIGNS EMERGENCY LIGHTING SYSTE M SPRINKLER SYSTEM SMOKE DETECTOR FIRE ALARM SYSTEM ANSUL SYSTEM operable A Inoperable operable /CJ dry cell 0 wet cell 0 operable gage pressure operable expiration date operable— 0 municipal Ar ELECTRIC EQUIPMENT PROPERLY PROTECTED EGRESSES LAWFULLY DESIGNATE STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED RADIATOR GUARDS f5 t- A 6 COMPLIES HANDICAPPED PERSONS LAWS FIRE RESISTANT CURTAINS OR DRAPERIES unobstructed, E X I S T I N G S yes -0' no 0 yes no 0 yes no 0 0 yes .d�' no yesle--Ino 0 j yes,j--- no 0 yes 0 no 0 yesArl no 0 yes ,B---" no 0 yes no yes1 no 0 0 ti yes 0 no, yes Iff no 0 D' HOW HEATED g %� NO. FIREPLACES _ yes 0- r BOILER ROOM CONDITION �C VENTILATION O G� UTILITY ROOM - CLOSETS �G NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS L; NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS FOR INSPECTOR USE ONLY Revised 2.03 JMc Use reverse for comments cCt!��2�Q/tom C_J 00, elo 0, i t ���[� �� Joseph S: [ aGi Mitt Romney �! ji, O�►'O�'.C�/� Commissioner Governor .Ke ycJ Chairman Lieutenant ThomaGafntnis rty Healey tieuteriantGovenor Kenti-Tsutsuml Edward A FlynnVice Chairman Secretary Thomas L Rogers Administrator 4 i } DEPARTMENT OF PUBLIC SAFETY INSPECTION CHECKLIST ` j Property Address , Name of Establishment j�a.rsco {�1®u� ° /U u rStN�Use Group Use of Building .780 CMR vl State. inspector .. ..Date and.Time.of Automatic Sprinkler System Fire Alarm System Fire Extinguishers Other (specify) MEANS OF EGRESS Posted Occupant Load Number of Exits Locked Exits Observed Exits Impaired? YES/NO Exit Signage Exit Lights Panic Hardware M yes / yO Ins ection LIFE SAFETY FE S 7 /v` O Presen in Building Functioning System Date of, Most Recent•Test 77;-Deficiencies Observed none write "NON ` YES I. NO I YES - NO Automatic Sprinkler System Fire Alarm System Fire Extinguishers Other (specify) MEANS OF EGRESS Posted Occupant Load Number of Exits Locked Exits Observed Exits Impaired? YES/NO Exit Signage Exit Lights Panic Hardware M yes / yO N� /v` O .yam Flu fly :Remarks '3-f qV r- 12(o vr- 69cb* G,,-v,cradim,r l: 14. i i ;•�+s w7i, w '' _. •..' .: _5�� .'lti;.. '" t.1'.,,� x.': ¢_' }• t„ � •'� �' ;,. � i•` 'ijtti`". k� q .a �� ERAL COMM'GENENTS a,• I CTT�IOON SUITABLITY UNEGRESS , . ,A;.; LIi u OF }l a ,R-� •,'I ..yfCi • l , .4 ' y.��� C.' ,r..•.�t..,:�t Y/�' { yl �;a,_.., .• 1. 1 1 1 MEANS ' 0F�=� ssh P.I.: }ll t ':, I a '� 1` Y 1;'4 ,�f',', f.. ♦`Pk �•'�1{•'.Y �rr'r E4 k� S+f W VxrQA4.1, ^ 1 r •t. t fO t . � i \�i a: ii aq. •Sry . 1... y'. 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' 1 - �•r MISCELLANEOUS COMMENTS^ A;l ',tom �. .i _... __ ._ _ _ _._ _ •_'__ .._Y•^.-.,...' ... __._-.,:... _.�.i _ _ -;• -�' }_ ..�, ,ir»�: f:t:n,aiz:C:i �.._.�...._. ..>f:2a:�r.tf .`±�'J-o • . . ._ •_•_•' _ -' _.__..,.. :. .. ff _.. ;, �, 11 � k'S' � � � �-r � � .,{ �•f ' rb' s ,Sr ... ., , ... _ 1 '�''f � •'+ tgCiji:•'i'.2 a�' t r Y 'r J ti! 1. ": , t�•,' ra yr + i' RECOM MEIVDATIONS � ....y._._ _. .__. r -n •,- f .. �.... .. ._.. _.._ t. ..� _ _ ._..._ __. t l/ t l y t. , } �'f• 1 � . . 1 � 4 .1 �xf 3 x' ' j { i ':'_7:: � ' vr:1 • iii` ' ' 71 tic ! State Inspector Name Print ) _ 1 .State Inspector Signature' Date L F Y . w O O LO o_r L O U N O O1 m N U ca O 0) (a L L O U cc �0J 0 W U) 9 bA�Il CD 0 C) 0 C) C) ri cn N ti0 di ,?+' lJ lJ w cu d u u u u b po y Cn Cn r-+ r -i r -i N N O c > U U U U U W O aaaa o Z O N tC v O Ems-+ U U z ;.�W00 O V V Cn En H O O U') O Cn C o 42) GJ o 0 00 a F., LO r-4 r-+ ;.. 1�. ;.4 ;. w A O O O O O O O w cin w o lz 0 0' r+ O a 04 U O O O O O � 0 41v w w w w w g OU '� U, v, U Building Pcrinit Number 2 -)JI Date—Dacvnber 2 10177 TaLS C -E Xf fr)ES THAT aV)-.T-DiXG CN )40 Prescott Strsct I Vx As a APr' Hc:. -a – 13 ` C ,vvis Lilli J',.177E T?T-1GvjETCjk1S Orj, TT&Z,R"SSAC1WSn.,jJ,,,S STA 7 F- 3UMy,)1x7G C01324 A:` TI 'IEGT21LA710NS AS .7�IAY A?FLY. CZRTa,jCj.FfjLrSSL7�,y) yo Prescott House -Iursingf Hty:,.ae Aj3ajjj�SS 3-40 Prescott Stjv Building Inspector - W 0 Q a YLr 0 In ct Y W Q ❑ W N_ m (L -� wH Z 0 z 0 CO a J Q m W jr itu. a O WO 0 NN m m a 0 w Co m N N ill a z m IW• 903 9O Z ti ,q tQ CO -N 4.3 'Z�i U U -P N 4) 0 EO aa� U) ri W w Z a ❑ Z a O FN N Q W W O O 0 0 m M ❑ Z N F N N m W m E F 0 0 J LL LL 0 W N IN m z tt 0 N W N❑ F Q a a z 0 LL LL 0 F 2 r C K' w a 0 w � 2 Z 0 LL 41 0 tcN w 0 i ILO G wI �Z W J W 0 x 0 Z 0 0 LL LL 0 w N_ N w f ¢ Z W f J F m 3 W Z N m 0 W u m W U 0 W U Q LL Z z z 0 ❑ m ❑ ❑ a O a m U H Q W F J a 0 _Z ❑ J D m In w ❑ 0 U LL 0 N H z w 2 W w w a 0 0 LL z 0 u 0 _Z ❑ J_ 7 m J J } z a LL z 0 u U Q y J w w a a a LL 0 ❑ K a 0 m w W z J 0 O r♦ Q O i � F OLL 0 } Z mK m C m ❑ a a j O W N y Z 0 0 u U u a Ir a m t9 l7 (7 W Q 0 0 0 0 a U m m m z F F a M J W W w~ m d 0 N Z Z � ° U eLL m D 0 It N ❑ Z F C11 D0 f� N W z z m 0 0 H W 'W N In m N F F p 0 0 W m I .J, 2 x LL LL u 0 N F m w w u N C LL w x a W x LL 0 0 rc a 0 m rc 0 m z z z a a F i z w IL w 0 f u U u U w w a m I z m - 0 . z TOWN OF NORTH ANDOVER, MASSACHUSETTS OFFICE OF BUILDING INSPECTOR • APRILyn Date: fz��./ This is a SPECIAL PERMIT to allow GLOUCESTER CONSTRUCTION, INC. to build a footing and foundation for Prescott Nursing Home on 140 Prescott Street, North Andover, Mass. CHF: ad CHARLES H. FOSTER d-a� /-/ ��� BUILDING INSPECTOR S PRESCOTT NURSING HOME BUILDING PERMIT FEE CALCULATION 57,558 Gross Square Footage 57,558 x $15/sq.ft. = $863,370.00 Est. Cost $863,3?0. x $3/1000 = $ 2,590.11 Permit Fee (nim rt rt rr N F- M :� fn Fl Cl rt n �. 00 rh rn Cn A A� �-i F-' F--� to � A• � O o o O nW r�r W 4. o •A� W A� F J- W O F '� M • • • • • • • • O •� .O t QV IET[ ~ '(D A O W (O A �5O O y .0 Qp `C ,O rt g A .ro St4 o : (D n W O i^p 000 ,C En Plo ... .......... .......... w In `� �j "' :a 'p 7• ►CC K :fD •3 p Q A ee (D = �• ►e e� .. o o 14% M n F.J. n rtV/ ........ ;Z ; ItIA "` yi ►� co •O o M1 ta o = o'r�rCM' O • i..t 1 :o O y �o tsl •(D Oq...... ......... Q N � o 0 O oa n - .. MC G1 m 0 U m 0 > m m n ' 0 m m i 0 D - m o o � m m m:mmD mD D.C:r .m mm�m llci Q0 Dn ZD m nm Dm m0� O 0 D p .. MC TOWN OF NOP.TE1 A[4DOVER INSPECTORS NAME OFFICE OF THE INSPECTOR OF BUILDINGS r INSPECTION REPORT FORM y CLASSIFICATION PASSES INSPECTION yesZp---n-o Q DATED "Z OWNER A-12saega/o BUILDING NAME OR NO. 2e6Z4,Z7 MIZE dJWZ!ZM6A�e--r STREET LOCATION /Cto &a (37 TYPE OF OCCUPANCY - Day Care Center ;= Aud . L-7 Cafe .C% Gym �% Apt. 1�:7 School Q Common Victualer's ,C7 Liquor ,Q Place of Assembly other it) UA4-x-- OCCUPANCY NUMBER (includP stories # arnd�ii ancy oar floor - use r verse side E X I S T I N G EXIT SIGN yes no Z:7 LIGHTED EXIT SIGNS operable Lam/ yes Z��--'rto = EMERGENCY LIGHTING SYSTEM op erable dr wet cell 4:7�7 SPRINKLER SYSTEM operable gage pressure yes z7 no z --- SMOKE DETECTORS operable yes Z�z— no yes FIRE EXTINGUISHERS expiration date 0a-91 yes �CZ�—n c, /-? ANSUL SYSTEM yes / tto % FIRE ALARM SYSTEM operable Zf4——tnunicipal Z:r yes / no = ELECTRIC EQUIPMENT PROPERLY PROTECTED yes L3� no Lam-' EGRESSES LAWFULLY DESIGNATED unobstructed 4� yes no /-% STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED yes LI;7-- no yes Lem no = RADIATOR GUARDS - yes /_ no COMPLIES HANDICAPPED PERSONS LAWS yes Z��tjo /17 FIRE RESISTANT CURTAINS OR DRAPERIES yes no L% HOW HEATED ' NO. FIREPLACES yes no BOILER ROOM CONDITICN VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS r NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORYC�t SHOPS use reverse for continents I t I I I 7d 74N7 CA cit rt rt rt 9 A ••. rh rh rh �o 0. Int eAo 11 0 P�j C M .......... � /}�► QV lET! LT x -re w CA h .......... a .......... n ......... CA orp e�+o Q.oz F' �O ep • Ci . r'S � y�.� ......... ......... f 'TOWN OF�- .Nutt`1:U AflDUVER INSPECTORS �7kN1E OFFfCE OF .THE INSPECTOR -OF .BUILDINGS INSPECTION REPORT FORM CLASSIFICATION PASSES INSP OWNER C&O BUILDING NAME OR NO. 4DA STREET LOCATION ON yes no Q DATED�- TYPE OF OCCUPANCY - Day Care Center°Q% Aud. Q Cafe L% Gym Q% Apt. C School Q Common Victualer's ,L7 Liquor = Place of Assembly .= other OCCUPANCY NUMBER (; „r-1 „riA qtr,.-; inc nnri nrr+iinnnrnv nor fl nn i- - tic rPvPrSP c; ELECTRIC EQUIPMENT PROPERLY PROTECTED EGRESSES LAWFULLY DESIGNATED STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED RADIATOR GUARDS COMPLIES HANDICAPPED PERSONS LAWS FIRE RESISTANT CURTAINS OR DRAPERIES yesono G' unobstructed Lam_ yes L no yes ZZ7�110 yes -/;�no yes no yes yes no HOW HEATED9,��� NO. FIREPLACES yes 0 no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS. NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS use reverse fox conunents E X I S T I N G EXIT S IGN �2 b yes �1lo �no C' LIGHTED EXIT SIGNS operable LO" yes EMERGENCY LIGHTING SYSTEM operpble dry cell G7 wetce 1 L.;% SPRINKLER SYSTEM operable -Z77 ----gage pressure 101 t, yes no L_% SMOKE DETECTORS operable �� yes no FIRE EXTINGUISHERS expiraticii date yes �� no Q ANSUL SYSTEM3'es FIRE ALARM SYSTEM operable Z-01,— municipal yes 1 clo L ELECTRIC EQUIPMENT PROPERLY PROTECTED EGRESSES LAWFULLY DESIGNATED STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED RADIATOR GUARDS COMPLIES HANDICAPPED PERSONS LAWS FIRE RESISTANT CURTAINS OR DRAPERIES yesono G' unobstructed Lam_ yes L no yes ZZ7�110 yes -/;�no yes no yes yes no HOW HEATED9,��� NO. FIREPLACES yes 0 no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS. NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS use reverse fox conunents 1 , J Location No. Date �ORrM TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ \s'^''� Foundation Permit Fee $ s ., .�sE_ PAM fIrcnit Fee $ Sewer Connection Fee $ FEB 2 1 199gr Connection Fee $ NO. Andover Collector $ Building Inspector Div. Public Works UUi MUNWLAl.1 t1 Of- [0AJJ¢1L) fU.)1,1 J Q TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE OF INSPECTION Date 02/03/92 ( X) Fee RequiAed (Amount) $75 bienniat� ( ) No Fee RequiAed In accordance with the pnov.u6.ion6 ob the Mamachuzett�s State Buitding Code, Section 108J-15, I heheby apply bon a CeAtibieate o6 Inzpeetion bon the below -named pnemisa xoeated at.the bottowing addtcess: Stceet and Number 140 PRESCOTT STREET Name ob PAemi6a PRESCOTT HOUSE NURSING HOME _ Putcpo s e bon Wh.ieh�enws ens .us U.6ed S L.ieer✓se (b) on Pmn.c t (.5) Requ;Aed qon t 1'J��-iu Se/ oy n '. 'oVvhYuiieiLi c t2Gie 3: Licem e oA ' PelLm t �N �V�cNC� �G• Name ob Agent, 1'b any - SNA I IS ISSUED OR HIS AUTHORIZED AGENT INSTRUCTIONS: 1) Maize check payable to: TOWN OF NORTH ANDOVER ..... ,04- llV'49 ticO-rZS K. TLE— z:.. (Q?....... .. VAT L 2) RetuAn thin apptieati,on with your check to: ' Building Dept., Town Bld*_gJ 1 120 Main St., North Andover, MA 01845 PLEASE NOTE: 1) App.eication boron with accompanying {gee must be zubmitted bon each bwi,Cd-img oA stAuctme oA part theAeob to be eeA.ti:b.ied. 21 App.e ication and bee mutt be Aeee ived bebone the een-ti4icate wiU be iz3ued. 3) The building o44iei.at .bhatt be noti6ied within ten (10) day,6 ob any eliange in the above .i.n b onmati:o n. _ CERTIFICATE # 39 .....' lN30'i8Vd3r1 lf; EXPIRATION DATE: 1 2/ 3 1/ 9 3 FORM SBCC-3-74 "*J VENDOR TClNAB REMITTANCE ADVICE DETACH BEFORE DEPOSITING0 0 3 5 5 01 REFERENCE DATE AMOUNT DISCOUNT PAYMENT CERT T E T C3 02/19/92 75.00 i Hca 75.00 i PRESCCTT HOUSE NSG. HOME VOUCHER TOTALS 75.00 .00 75.00 V V V U� ti113d ]SN3 J c�+ " rt p e7 rd cs. O14 NM m ov,ctcN N. I !n O .......... (0 �~•M O rt 01 to CQ• (p �, 0 cn CD rt En v 'SJ y O r'r K O n `_ •'d A '7d o m Q' n �o 03 n Q AN• (''1• Sj •� 'OS t0 • � �, n w .......... � � �• •tin � � N row o N O O O W.Z I_ o A x �* ~ A,co X, n Nrr cF �' w cn n cn A y Li �' � � `C 7�1 vii N. •� � cF '� M En c1� .. .. .. .. .. .... .. .. .. l0 i 0 N C-- cn n nto r1i cn 'to May N. C cp r a C -C) m to m �•ti °' H. w y a ......... rt to z C• . go • N 10' oo n o m o N. N. W H ; ' h' A � •� N .� IV N �.. Zil .(0 _cub A cb w N o n N F'• N rt O � r Y � n J O ti P" CA W W a A d rtrrrt N w 0 a f 000 C o 0 0 b w .` H ti t Q A a W W CA -� 1.0 rt w CA Q T. A ko A 0 a A h a' 0 0 `.. QO QO b ri 1 A w w ti a A d N w 0 a 000 C o w ti w T. A ko O a A h as rtn b 1 A w w rt CA •Qw A s ti o O n O O a R C eio C AI a h 0 a w o o n w t'S m b � n as ftl 17J O O .. O O m a � C o A 10 m m A 1.4 CA O m 4 l< j a A Z A iR A w ft :(D 1 h n J � r-4 2 O z Date j"/ G - (X l Fee Requited (Amount) No Fee Requited I ,In accordance with .the phovis.ion�s o6 the Massachu.6ett6 State Buied.ing Code, Section 100.9 I hc-eing aby app°y bon a Ce,�strbccate Ob Irtapectcon bay the beeow-named phemc�se�s tUCated at .the botiowddne .6: , Street and Num6eh Name o6 Pnemds e3 ' Punpos a bon Which ftem.c s ens " Lized L.icervs e (a) on. PeAm t (a) Requited 6o& -Vie LideM it on ' Peky)n it u h. ovehazmen.t genci.es: Agency C evXtf-i 6 tate to b e . s ued to— Addne3.s J,Yo Owneh ob RecwLd o6 butta.Lng grnlsis l ecc.i AddAa,s Name o6 PheA ent HotdeA o6 CeAti6icate r(.scn4± Abu,4t- /Uu jy/?�- Name n6.ASena, .('b any... ...... F TI �R r r 1 Q• 1 r FICATESSUED OR HIS AUTHORIZED INSTRUCTIONS: l) Maize check payable to: " 'Town of ' North Andover t v 1LL.�e,� 1 2.) Re.tunn thin appti.eation with your check to: ' Building Dept . , Town Off ice BuiIdi.�,�_ _ 120 Main Street, North Andover, MA 01845 PLEASE NOTE: l) Appt ieati.Qn bosun with accompanying bee muht be subin tted bon each. building on ztAuctune on pant the e' o j' to be eeAti.b.ied. 2) Apptication and bee must be kece.ived bebote .the centib.icate tai' e be .imued. 3) The bui td ing o b b.iciat a haU be not.i b.ied within ten (10) days o6 arty change .in the above .inbonmation. CERTIFICATE 0 ............. EXPIRATION DATE: & '-5 FORM SBCC-3-74 9215WJ2j!)j j VENDOR TONAB REMITTANCE ADVICE DETACH BEFORE DEPOSITING REFERENCE DATE AMOUNT DISCOUNT PAYMENT 012198 FOOD & DUMPSTE 01/21/98 75. 00 0.00 75.00 V PRESCOTT HOUSE N. H. VOUCHER TOTALS 75.00 0.00 75.00 czr.o—c oc._onoc TOWN OF NUI;Tit 14DOVER INSPECTORS NAME t OFFICE OF THE INSPECTOR OF BUILDINGS INSPECTION REPORT FORM CLASSIFICATION SSES INSPECTION yes= no = DATED OWNER BUILDING NAME OR NO. STREET LOCATION TYPE OF OCCUPANCY - Day Care Center = Aud. Z:7 Cafe L% Gym =7 Apt. /_::�7 School = Common Victualer's ,q Liquor = Place of Assembly = other OCCUPANCY NUMBER (incl udP stories r and occu am ---_y p -ex floor use reverse sidp EXIT SIGN LIGHTED EXIT SIGNS operable O E X I S T I N G yestlo = yesRno = ELECTRIC EQUIPMENT PROPERLY PROTECTZD EGRESSES LAWFULLY DESIGNATED STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED RADIATOR GUARDS COMPLIES HANDICAPPED PERSONS LAWS FIRE RESISTANT CURTAINS OR DRAPERIES sno /= unobstructed �',es ���no =I yes Z:% no 7 yes L�7 no = yes /.-:;7 no yes = no Z'-7 yes 1--:;7 no = HOW HEATED NO. FIREPLACES yes L= no BOILER ROOM CONDITICN a%o VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS use reverse for, conunents EMERGENCY LIGHTING SYSTEM operable / dry cell C7 wet cell Z= SPRINKLER SYSTEM operable gage pressure yes 1-- Z: SMOKE DETECTORS operable /= yes '--7 /no co FIRE EXTINGUISHERS expira ticti date yes no ANSUL SYSTEMyes = no / 7 FIRE ALARM SYSTEM operable municipal D yes /= no =, ELECTRIC EQUIPMENT PROPERLY PROTECTZD EGRESSES LAWFULLY DESIGNATED STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED RADIATOR GUARDS COMPLIES HANDICAPPED PERSONS LAWS FIRE RESISTANT CURTAINS OR DRAPERIES sno /= unobstructed �',es ���no =I yes Z:% no 7 yes L�7 no = yes /.-:;7 no yes = no Z'-7 yes 1--:;7 no = HOW HEATED NO. FIREPLACES yes L= no BOILER ROOM CONDITICN a%o VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS use reverse for, conunents O A�60� Location ca I No. - q ./� �rwoG80F%, Date /-2/0,2 /f-3 0 TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ �ss�c°�SEt`' Foundation Permit Fee $ erml ee C $ �- Sewer Connection Fee $ Water Connection Fee $ 4 TOT' $ �j € eo-p- S e . Nu/t�iN AAA %Y6/1�IF Building Inspector i�/ll1J�� 7.. t+Hiu f y 6768 Div. Public Works CUMMONWLALIFI U!- h1ASSAlPUl )tl IS . TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE OF INSPECTION Date 11/26/93 ( X ) Fee Requ,iAed (Amount) $75.00 Biennially- ) iennially) No Fee RequiAed In accordance with .the ptov.u6.ion6 o6 the Mahzachwsett6 State Bu,itding Code, Section 108,15), I hereby appty bot a Cent-i6.ieate ob In6pecti.on 6oA .the beeow-named pAemises .L'ocated at .the bottowing addtee/sa: S.theet and NumbeA 140 Prescott Street Name ob PAemi.6ens PRESCOTT HOUSE NURSING HOME _ PuApos e 6 oA wh i chem -us ens " ,s e L.ieervse (a) oA PeAm-c t (s) Requ,iAed 6ok .the PAemize6 by vt eA Go'vanmeWaCEyep« mss: License, oA PeAlnii Agency —T -T u rsl rn /�(As.5 eD7� a 5/ C Cents -i.cat to e izzue .to �sc� 1 u^si•�i� /-�orn� - AddAess . . / �U �esc.a Ir ST -f- r -e 1`/U7! OwneA o6 RecoAd o6 buLZd,4-ng j4oW b. S't64A,&->,7- AddAe66 Name o6 PAezent HotdeA 06 Ce4ti6icate ��7 Name ob Agent, .i6 any I ISSUED OR HIS A THORIZED AGENT VAT . . INSTRUCTIONS: 1) Make check payab.Le to: TOWN OF NORTH ANDOVER 2) RetuAn thiz apptication with youA check to: ' Building Dept. , Town Bldg. 120 Main St., North Andover, MA 01845 PLEASE NOaE: 1) AppZi.eat.ion 4otun with accompanying bee must be zubmitted UoA each building on e-tAuc tuAe oA pant theneo4 to be eeAt.i6.ied. 2) Apptication and bee muht be nece.ived k6ote the eeAti4ieate witt be i'mue.d. 3) The buitd.ing oU{.iciat ShaZt be noti.b.ied within ten (10) days o4 any change in the above .in 6 oAmation. CERTIFICATE # �9 EXPIRATION DATE: 12/31%95 M-339 - DEC 2 - `��- 199 FORM SBCC-3-74 0 b '-d - 0 0 0 0 0 aaaaa cr cr cr tr � 0 0 0 0 0 ;tr-rq• q G5* FL"GL"F� CD . m aa(nm" .. 00 00 zi5 r-rrrrrr 0 0 0 0 0 A A A n n 0 0 0 0 0 0 0 �s �3 :3 ITI 171��� 0 0 Z.Z ' oppop F. °0000 to rt 0h 0 0 Z.Z ' oppop F. °0000 on 4+, h+ h•• r N I— A ODN OD O w w ct ct c. rt old *4 ��� • • O O O : C `t O O O H O H H H �► H •cri 4- • 0 ?.� •x w rA En g� fp V �O rr 8 m y O • A m : to rt I ry • W � y a.r A O O t •. Q' 00 m G O 00 t ?• 00 00 .: M 4 one UD O 000 C � O � O Co 4-4 a .......... u .......... O > .�IDrl rr n = ;o A. •m O T r-• 3 O � �• Q c a m co n Q D � Q 0 0 b •A � w C ` ~• Q �1 0 O O .� �7 ,pp,J m 1_' M •C O a w o 0 -• M "' \ o o 4+, A w • • � : V1 M •cri 4- • 0 ?.� •x (h i •n ,O .. :2 • A m : to rt I ry • W � y a.r d ; a�0- %;I.• m G ?• M one O Co 4-4 u CA .�IDrl rr = ;o •m a m COMMONWEALTH OFMA,4SACHUSETTS TOWN OFNORTHANDOVER / 27 CHARLES ST APPLICATION FOR CERTIFICATE OF INSPECTION Date Fee Required (Amount) '/ Alf () No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby apply fog Certificate of Inspection for the below -named premises located at the following address: S%reet and Number co 77— ` _s 7 - Name of Premises Purpose for which Premises is Used .v c l H S r�c%4 it amu f Licenses (s) or Permit (s) Requfred for the Premises by Other Governmental Agencies: License or Permit Agency Certificate to be issued to Address /yo ✓4' e-Sccl-r' Telephone 9,7,r 6 6?S g -o g(., Owner of Record of Building Address _. -` „v S • s Name of Present R5hder of Certificate Name of Agency, if any L SIGNATURE OF PERSONS TO WHOM CERTIFICATE TITLE IS ISSUED OR HIS A UTHOIRIZED AGENT S /Pow v . DATE INSTRUCTIONS: 1) Make check payable to: Town of North Andover 2) Return this application with your check to: Building Dept. 27 Charles Street, North Andover MA 01845 PLEASE NOTE: Application form with accompanying FEE must be submitted for each building or structure or part thereof to be cert 3) Application and fee must be received before the certificate will be issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # / -/d / 26V 0 EAPIRATIONDATE: /// -`—' a 990 / FORMSBCC-3-74 REVISED 2/99 jmc TOWN OF NORTH ANDOVER INSPECTOR'S NAME OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE F INSPECTION REPORT FORM CLASSIFICATION PASSES INSPECTION yes no 0 DATED OWNER BUILDING NAME OR NO. STREET LOCATION TYPE OF OCCUPANCY - Day Care Center 0 Aud. 0 Cafe 0 Gym 0 Apt. 0 School 0 Common Victualer's 0 Liquor 0 Placeof Assembly 0 Other OCCUPANCY NUMBER (include stories # and occupancy per floor - use reverse side EXIST SIGN LIGHTED EXIT SIGNS operable 0 EMERGENCY LIGHTING SYSTE M operable 0/ dry cell 0 wet cell 0 SPRINKLER SYSTEM operable 0 gage pressureT 17 SMOKE DETECTOR operable FIRE ALARM SYSTEM expiration date ANSUL SYSTEM FIRE ALARM SYSTEM operable 0 municipal ELECTRIC EQUIPMENT PROPERLY PROTECTED EGRESSES LAWFULLY DESIGNATE unobstructed STAIRS PROPERLY RAILED HALLS AND STAIRWAYS LIGHTED w, RADIATOR GUARDS COMPLIES HANDICAPPED PERSONS LAWS FIRE RESISTANT CURTAINS OR DRAPERIES EXISTINGS yes no 0 yes no 0 yes 0 no 0 yes 0 no yes 0 no 0 yes 0 no 0 yes no 0 yes -ff-" 0 yes -I�' no 0 yes &---no 0 yes 19--� no 0 yes 0 no 0 yes 4KI, no 0 HOW HEATED NO. FIREPLACES yes 0 no BOILER ROOM CONDITION C �e4 /Z VENTILATION 60 A-- UTILITY CUTILITY ROOM CLOSETS Z. C l u A— a' a— W" NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS FOR INSPECT R USE ONLY Revised 3/98 ,JMC Location No. Date TOWN OF NORTH ANDOVER Check # C ��? TOTAL f Building In66ctor Certificate of Occupancy $ ',a''•'°' E<�' sACMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee C�-Z� $ !f` Check # C ��? TOTAL f Building In66ctor 1 l ocation iE t" -s re:) 40. ff Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Fond o FemFee $ ©� rmi/� $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ok4 "A3 r, kw e7 L-C)i Building Inspector 12/19/9513:32 �-M00 PAID 9479 Div. Public Works X COMMONWEALi ll.,, F 41ASSA rUsL 1 -IS - .� TOW N dF�'`i NORTH ANDOVER '{ -Y.,(L F I' F. '� ` 11 ;a�•I.. ef"fY'W, (f1►( r _,�., ~- � r �L is �,S�ni:F'•�v'—'�w"`C-. y •f r { M�{m �a� APPLICATION FOR;CERTIFICATE OF INSPECTION, . fa. -tR e _ f .. •j• Date (X) Fee :Requ i&ed (Amounit .-_ .. ww ._ r. ms'=s' •�+�..�_+:>''£,ec•>-iiti_. z - f _ ) ... No Fee: Regq, h ed _... _._a. ..-..s.pF:•� r'.:!'i.fi{.i%1i�-^..+� ... ,.-..:,�Crr.. - vx' s�!M,-'...w�_ •moi YJ�i sir,vi� • - .: - �•x,:: - . • .. .0 ,ti *4' .. _ •-:iJrJsl�FiW0.i�L1p1¢>y�y: u• ^*ewae*i.ex�sr. yr n:. >. . �:.'wae^vm aea: }tp7ur T �» 'tll,x,ay .. en.- .. - - ... .. :_.:_ .. .. —....w."1.• -,: ,. ..L +.r$r: r+.«..�`�'::o ::.,.iF,. «v,...,i' L' _ .._._' �. �i�_i a �..'w�x.a, :. �_.. ., In accordance with ~the pnovcsEond os"wee Maiaach"et�s_State &ceding Code,,Seciion 108,15, I hereby app.ey .Son- a Centi.s.caate_os :Inspection Soh the -6e.tow=narii6d^pnem�i�se6 toga,ted at the SottovtE address: , Street and Numbers Name o6 Premix ea ' — Purpose Sor Which -Wena Livens a (s) or Pehm i t (s ) RegLdAed Li.c.e.rtd e or ' PMM t Nursing Home Son—l� ienemiAes.. y ten ovnme _... gen-aa: _ enAg end Boa�Qf-eal th _- Town of North Andover _ Dumpster Permit - _ _- Town of North Andover License Dept. of Public Health �tJi t( �j iCa to t0 e .ussue t0 Prescott Hquse Nursing Home -. Address 140 Prescott Stree OwneA o{ Recotd 0 g A D S Group - Alan Solomo t, Presldpnt Address 300 Brickstone Square. Name os Present HotdeA o6 CeA�U6kca;Ce Prescott House Nursing Home - Name o6 Agent, 16 any Executive Dirgt d--ze- !�z IATUO�Z-Q-F -'- 4,k3--.-rU-Wff0M-=Fl CATE ,$SUED OR HIS AUTHORIZED AGENT ..... UP December 4 1995 VAI F- IN.S'-RUCTIONS: 1) Maize check payab.ee to: " Town- 'of Nortli Andover 2) Return thi6 appti.cation with youh. check to: BUiIdirig Dept., Town Office-Build'Lug-}- 120 Main Street, North Andover, MA 01845 PLEASE NOTE: 1) AppZi cation Sonm with accompanying see must be subinc tted Son each 6 Ud.ing on ztkuc tune on paha theneos to be' cv ii.s.ied. 2) Appti.cation and See must be keceived,be6ore the centi6i,ca.te witt be issued. 31 The building oSS.Eei.a,e shah be noti6ied within ten (10) days oS aity change in the above • • �� ,��M''®r, TOWN OF NORTH ANDOVER Fee $ Sewer Coonn�n//ec K $ �pL40ci mectlon Fee $ TOTAL -, 4 $ ee4Wu'i ding Inspector Div. Public Works ,. Certificate of Occupancy $ Building/Frame Permit Fee $ �,s'•ry��'''`�' • s�cMuse F pnda'oryPermit Fee $ Fee $ Sewer Coonn�n//ec K $ �pL40ci mectlon Fee $ TOTAL -, 4 $ ee4Wu'i ding Inspector Div. Public Works Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works COMMONWL-AL I li OI- A.IASS{1QIUSL I I S TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE.OF INSPECTION Date 8/15/90 (X) Fee RequiAed (Amount) $75. (Biennially) ( ) No Fee Requi/rLed In accordance with the ptovi,6ion6 06 the Ma6zachwse a State Bu-i.2ding Code, Section 108, 15, I hereby appZY boA a Cetti..bicate 05 In6pecti.on bon the betow-named pnemize�s kocated at the bottowing addnu-s: StAeet and Number 140 PRESCOTT STREET Name ob PAemiza - PRESCOTT HOUSE NURSING HOME �V Punpos e bon Wh,LchTk-em.us e,6 .vs 6-e Nursing Home — Licen,s e (.b) oA Puun t (s) Requited 6o& --the Pnemis m by otheA avamn-enta-t ge c ens : Li6m6 e on ' POunit Agency Food.Establishment License To Board of Health Milk License Town Board of Health Nursing Home License Mass. Department of-Yublic Health CeAti6icate to be tzsued to Prescott House Nursing Home_ AddAU,6 ' 140 Prescott' St'. , 'No: Aricloder, MA _ OWneA ob Recmd 0 ng Prescott Associates - _ Addhedb c/o ADS Management, 1 High St., No. Andover, MA 01845 Name ob PAment HoZdeA o6 CeAti6icate John Harris, Administrator, Prescott House Name ob Agent, .gib any ------ - Administrator SJ'GNATURE OF PERSON TO WHOM CERTIFICATE I ITT-E— IS ISSUED OR HIS AUTHORIZED AGENT August 17, 1990' tM INSTRUCTIONS: 1) Mahe check payabf-e to: ' Town of North Andover 2) Re tuAn t�" appt i.cation with your. check to: Bu lding Dept. , Town Of f ic-e 861Id.i.r�, 120 Main Street, North Andover, MA 01845 PLEASE NOTE: 1) Appti.cati.on bosun with accompanying bee must be zubmUted bon each building on .6�Auctuhe m pant xheneo b to be cen t i hied. 2) Appti:cati:on and bee murt be received beboAe the cvuU6icate w.iU be ZsAue.d. 3) The bui.ed%ng o64ici.ae zhaf-t be noti hied within ten (10) days ob any change in the above inbotunation. t r . CERTIFICATE # ... 72 3 EXPIRATION DATE: December 30, 1'991 FORM SBCC-3-74 VENDOR TONAS REMITTANCE ADVICE DETAV-BEI-- FORE DEPOSITING 0030944 REFERENCE DATE AMOUNT DISCOUNT PAYMENT o8/90 08/21/90 75.00 .00 75.00 PRESCOTT HOUSE NSG. HOME VOUCHER TOTALS 50e/6e5/2026 75.00 .00 75..-(". COMMONWEALTH OF MASSACHUSETTS W o%/TOWN OF NORTH ANDOVER Wt APPLICATION FOR CERTIFICATE OF INSPECTION Date 12110/87 (X ) Fee Required (Amount) $75 bienniaUy ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 108,15, I hereby apply for a Certificate of Inspection for the below -named premises located at the following address: Street and Number 190 P Name of Premises Pheacott HouA Nin "via HrmiP Purpose for Which Premises is Used Lana Tmm at P Faojli_tt� License(s) or Permit(s) Required for the Premises by Other Governmental Agencies: License or Permit Agency Cextijjicate oA Ude S Qacupanaj Na- Akylnupb 73Fda Po,,�mit #94;1 Lc-co;gAP to Majptaim a l rlo;YaP000cut Certificate to be Issued to Address /fD h 9 0/9f(5l, Owner of Record of Building Address Name of Present Holder of Certificate Name of Agent, if any &/eet :D, Tp�„H�S � SIGNATURE OF "RSON TO WHOM TITLE CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT eCx Ay- 19'1 !9 g`7 DAT INSTRUCTIONS: 1) Make check payable to: TOWN OF 14ORTH ANDOVER 2) Return this application with your check to: Building Dept., Town Bldg., North n over, MA. PLEASE NOTE: 1) Application form with accompanying fee must be submitted for each build- ing or structure or part thereof to be certified. 2) Application and fee must be received before the certificate will be issued. 3) The building official shall be notified within ten (10) days of any change in the above information. CERTIFICATE # 3q % - CK 23 /g8 EXPIRATION DATE: FORM SBCC-3-74 I• N v v v f�• C�1• C�1• Gi r 00 fl m w O P1 M M CLS n y rt O n (D m cr N � � c'1• cn rt ci O n . . . . . . . . C-) CO b o w, n rt `C lrSMi. n GI Q• � v on N. •t> G` w N. n OON. cn 7 '] N � .r cq � ~' N N ii 4Z O N O p ci W N � �cy' C O C lrSMi. W. Q• � p � N. cn 7 '] h - .r cq p O C O C . (��1• N, c4• A, � G7 `h O Gd A •� ,t�-ri En H :�. � n• V O fA . 2z .c ., A m A vI • � .z • N• OF .ORTM, OFFICES OF: o� "' �0°m Town of 120 Main Street APPEALSNorth Andover, . ,.=. BUILDING; •_: • �••• s NORTH ANDOVER Massachusetts O 1845 �s�t4 CONSERVA'T'ION eQ1CMUDIVISION OF (617) 685-4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR December 10, 1987 Mn. Atan Sotomont Pnes cosi House Nu ming Nome 12 0 Pnes Cott StAeet N6nth- AndoveA,MA Re: Biennia b Cert.T i jication Dean Mn. Sotomont: Pteas e netuAn the ence.os ed appt i.cation bonm and tem -c ttance ob $75 bon ce,�,U6icati.on bee at youic ea&Uest pozzibte convenience. At that time, this Depa&tment wiU s chedute an inspection 66 the Nu ming Home pnem-us es . Thank you. YOWLS tAut y, 5 C CJ Darr i,et McConaghy, Ass 't Bu -i tding Ins pec tm /g b enc. CO::1,01;IVEALTH OF .'ASShC1?USETTS f 7) BUILDING. DEPT. 3 /TOWN 0F� 120 MAIN NORTH ANDOVER, MA 01845 APPLICATION FOR CERTIFICATE OF INSPECTION DateNOV 1 51983 ( ) Fee Required (Amount) X ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 108,15, I hereby apply for a Certificate of Inspection for the below -named premises located at the following address: Street and Number 140 Prescott. -Street., -ND- Andover, Ma 01845 Name of Premises Prescott House Nurs' Purpose for Which Premises..is Usea-Long Term Care Facility License(s) or Permits) Required for the Premise's by Other Governmental Agencies: License or Permit Agency Certificate of Use and Occupancy No. Andover Bld. Permit 42451 Department of Public Health Licence to M int^in a C -OW loccan_tof-Nsg. Home Certificate to be Issued to Address 140 Prescott Street No. Owner of Record of Building Pres ` Address 140 Prescott Street No. Andover Name of Present Holder of .Certificate Alan D. Solomont Name of Agent-,.(�if any SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT Administrator TITLE DATE INSTRUCTIONS: 1) Make check payable to: TOWN OF NORTH A00VER 2) Return this application with your check to: _ CHARLES H. FOSTER., BLDs. INSP. 120 Main St. U North Andover, 'Ma. 01845 PLEASE NOTE: 1) Application form with accompanying fee must be submitted for each build- ing or structure or part thereof to be certified. 2) -Apel-ication-and fee must be received before the certificate will be issue 3) The building official shall be notified within ten (10) -days--of any chan8 — in the above ginformation.- /� 3 CERTIFICATE #/ �/ EXPIRATION DATE:_ � FORM SBCC7-3-74 DateNOV 18 1985 COMMONWEALTH OF MASSACHUSETTS BUILDING DEPT. TOWN OF 120 MAIN ST 14 OK I R N UOVtR, MA 01845 APPLICATION FOR CERTIFICATE OF INSPECTION ( X) Fee Requked (Amount) $75 evenu 2 qu. + ( ) No Fee RequiAed In aceondanee with .the pnovizions ob the Mai,saehu6ett's State Building Code, Section 108,,15, I hereby apply Son a Centi6icate ob InApecti,on ban the below -named ptemizu .located at the bottowing addtesz: StAeet and Number 140 Pneaeott StrLeet Name o6 Pn.emi6ea '�ph eQ � PuApoae 4on. Which-7l'Used Lona T e Eac t�__��__.� L.ieen,se(b) on PeAm t(6) RequiAed.6on�e nem.uses y ten oovennmevutax Agent ez.: License on PeAmit ZT�Eqicate to be izzued to Addnes.6 Owner o6 Recon o ting Addnesb Name ob Present HoZdeA o4 CeAti6icate Name ob Agent, .i6 any' .............. SIGNATUR-E'OF PERSON TO M CLXIIVICAlE— IS ISSUED 'OR HIS AUTHORIZED AGENT DANIEL MICHERONE, ADMINISTRATOR --INSTRUCTIONS: :.__1)..._Mafze check payable to: TOWN OF'NORTH ANDOVER 2). RetuAn thi.6 appf-i,cati.on with your theca to: ' ' 'CHARLES . FASTER, BLDG INSP 120 Main St., Notch Andover, MA. 01845 PLEASE NOTE: 1) AppZi.eaJ,i.on boom with 'aeeompanying. bee must be zubmitted . Son each building on btnuctme ok pant theAeo6 to be eet ti4ied. 2) AppZi.cat.ion and See muz t be heceived bebone the cetti6 icate Witt be i6.6ued. 3) The bu tding oss.cc,i.at 6ha t be noti,b.ied within ten (10) days ob any change .in the above :inbotmation. RECEIVED CERTIFICATE #.3 ........ EXPIRATION DATE: /���'� NOV 2 91980 ��Com3 ? FORM SBCC- 3- 74 . J � % NORTH ANDOVER BUILDING DEPT. �u � rY o r' 0 ,r%r . En rt L• a o ro [=1 w En En n Vf n O -" o p C .O cn H x rt :crnn to ER 7d `C :p o ; •fn ;rn o N. s N O cF i1, 9 O• _ = OG n U) CO N. 9.m N cF •� •co `G N. Qj N Cl) T, n N (-.4 p N fS O O Oy to n Qj :0. O A �D N. .Q 00 N. n A, lr+ W N N 0 O rl' � n k-4)ro N ?+ 0P) A N En � e °Oct, o m n En m ca co F- ci- +� o w C b w N. N. O O N• rt . 4-4 O ri- N N O h iZ P- O n. _ A � w � rY o r' 0 ,r%r . En rt O ro [=1 w En En n Vf n O -" o p .N .O cn H x rt :crnn � n 7d `C m^" y. Ll- -" o p .N .O : C0 �* g4 :crnn :p o ; •fn ;rn o .° cF i1, x CO N. ci" co cF •� •co Qj p 1-41 to Qj :0. N. .Q N C', i PPN co U) N c� c+ c+. M N 7 O O . K N N c+ 3 9 W ro M ~ o " N cn O r • rt M n OqG n m rt to 0 m o• C) FJ w V 0O O 00 n F'• K r O n w rt F'• 0 a n w b w O o Fes, rt PP. a o Fj rt O O 0 0 K O 00 H K ►3 `C H z En 0 rt cli OL) b w n rt rt O rt 0 w .ti w n F'• rt `C C)Qj 0 O' vi43 A }T{ I,, A +C 'C3 � .W .O co•CD :?C . K . .O A . .O cF • •O Cf- En +En lD •1Ci-j N. :C ct C4� i1, y C A x - c�n cF cf- OQ y c0 •O � • 0 •O QjN Qj .. cp :z co ci- C/' .►U ' 0 •K N • CD N.N .0 c0 .0 'C+' O c►. •cD (0 o O 3 CD Fa ta tnA 0 F rt O ►C � �ro+ A.......... O ro c) (A w rt 0 H z En 0 rt cli OL) b w n rt rt O rt 0 w .ti w n F'• rt `C C)Qj 0 O' vi43 A }T{ I,, A +C 'C3 � .W .O co•CD :?C . K . .O A . .O cF • •O Cf- En +En lD •1Ci-j N. :C ct C4� i1, y C A x - c�n cF cf- OQ y c0 •O � • 0 •O QjN Qj .. cp :z co ci- C/' .►U ' 0 •K N • CD N.N .0 c0 .0 'C+' O c►. •cD (0 o O 3 CD Fa ta tnA 0 F GRA[ WU FIRE PROTECTION SYSTEMS COMPANY INC. ),.,�. �� PEXECUTIVE OFFICES • PROVIDENCE, R. I. INSPECTION CONTRACT ECTION REPORT -'No. ......... NO. ........ CONF RITH REPORT OF INSPECTION BUREAU FILE ................ ?................. ......... NO...L.G.-...�.�/?ct... SET t OF 2 REPORT TO lyly1 BUILDING ORLSP T LOC 10 NED STREET h ' { INSPECTOR SJ j CITY & STATE �_ ` ZIP %' x'� GRINNELL OFFICE L _ PHONE N %� ATT. DATE c, 1. GENERAL Yes WANq,0 A. (To be answered by the Owner or Owner's representative) a. Have there been any changes in the occupancy classification, machinery or operations since the last inspection? Ile b. Have there been any changes or repairs to the fire protection systems since the last inspection? c. If a fire has occurred since the last inspection, have all damaged sprinkler system components been replaced? d. Has the piping in all dry systems been checked for proper pitch within the past five years? Date last checked (checking is recommended at least every 5 years) e. Has the piping in all systems been checked for obstructive materials? Date last checked (checking is recommended at least every 5 years) I. Have all fire pumps been tested to their full capacity through the use of hose streams or flow meters within the past 12 months? g. Are gravity, surface or pressure tanks protected from freezing? h. Are any of the sprinklers SO years old or older? (testing and/or replacement is recommended for such sprinklers) — L Are any extra high temperature solder sprinklers regularly exposed to termperatures near 300°F? B. (To be answered by the inspector) a. Have the sprinkler systems been extended to all visible areas of the building? b. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector? c. Are the building areas protected by a wet system, heated, including its blind attics and perimeter areas, where,accessible? 11!E d. Are all visible exterior o 2. CONTROL VALVES protected against the entrance of cold air? a. Are all sprinkler system main control valves and all other valves in the appropriate open or closed position? b. Are all control valves sealed or supervised in the open position Control No. Valves of Type Valves Easily (Sealed?) Valve Secured? Supervision Accessible Signs Open If yes, how? Operational Yes No Yes No Yes No Yes No (Suck d.?) Yes No CITY CONNECTION TANK PUMP SECTIONAL SYSTEM ALARM LINE 3. WATER SUPPLIES �� Pressure Fire Pump & Tank a. Water supply source? City-�{Gravity Tank Pressure fire Pump & City YeWaterflow Test Results Made During This Inspection Ye, S Pressure Fire Pump & Pond Test Pipe Located Size Static Static Test Size Static Static Test Pressure Flow Pressure Pipe Test Pressure Flow Pressure Pie Before Pressure After location Pipe Before Pressure After 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Do fire pumps, gravity, surface or pressure tanks appear to be in good external condition? b. Are gravity, surface and pressure tanks at the proper pressure and/or water levels? c. Are fire dept. connections in satisfactory condition, couplings free, caps or plugs in place and check valves tight? d. Are fire dept. connections visible and accessible? S. WET SYSTEMS n a. No. of systems Make & Model S ■�(? b. Are cold weather va ves to the appropriate open or closed position? If closed, has piping been drained? c. Has the owner or owner's representative been advised that cold weather valves are not recommended by NFPA? d. Have all the antifreeze systems been tested? e. Date antifreeze systems were tested f. The antifreeze tests indicate protection to: system 1 a 3 4 5 temperature g. Did alarm valves, waterflow alarm indicators and retards test satisfactorily? G4550 (Rev. 6/62) nRlr.lnlnl $Not Applicable 'Explain (No) Answers on Back of Sheet 2 G0001 FIRE PROTECInON SYSTDE COMPANY INC. EXECUTIVE OFFICES • PROVIDENCE, R. 1. INSPECTION CONTRACT NO. .......... INSPECTION REPORT REPORT OF INSPECTION No. ........ ,�'[i.............. BUREAU FILE ................ N0. '�,C. �'...�..�.... SET 2 OF 2 6. DRY SYSTEMS a. No. of systems Make & Model Date last trip tested b. Is the air pressure and priming water levels normal? c. Did the air compressor operate satisfactorily? d. Were all low points drained during this inspection? e. Did all quick opening devices operate satisfactorily? I. Did all the dry valves operate satisfactorily during this inspection? g. Do dry valves appear to be protected from freezing? h. is the dry valve house heated? 7. SPECIAL SYSTEMS a. No. of systems Make & Model Type b. Were valves tested as required? c. Did all heat responsive systems operate satisfactorily? d. Did the supervisory features operate during testing? Heat Responsive Devices: Type Type of test Valve No. 1...... 2...... 3...... 4...... 5...... 6...... Valve No. Valve No. 1...... 2...... 3...... 4...... 5...... 6...... Valve No. Valve No. 1...... 2...... 3...... 4...... 5...... 6...... Valve No. Valve No. 1...... 2...... 3...... 4...... 5...... 6...... Valve No. Auxiliary equipment: No. Type Location Test results 1...... 2...... 3...... 4...... 5...... 6...... _ 1...... 2...... 3...... 4...... 5...... 6...... _ 1...... 2...... 3...... 4...... 5...... 6...... —1 ...... 2...... 3...... 4...... 5...... 6...... & ALARMS a. Did the water motors and gong operate during testing? b. Did the electric alarms operate during testing? c. Did the supervisory alarms operate during testing? 9. SPRINKLERS — PIPING a. Do sprinklers generally appear to be in good external condition? b. Do sprinklers generally appear to be free of corrosion, paint, or loading and visible obstructions? c. Are extra sprinklers available on the premises? d. Does the exterior condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers and strainers appear to be satisfactory? e. Does the hand hose on the sprinkler system appear to be in satisfactory condition? 10. EXPLANATION OF "NO" ANSWERS (For Sections 1B thru 9): Yes 1 N.A.t I No* 11. THE INSPECTOR SUGGESTS THE FOLLOWING NECESSARY IMPROVEMENTS. HOWEVER, THESE SUGGESTIONS ARE NOT THE RESULT OF AN ENGINEERING SURVEY: 12. ADJUSTMENTS OR CORRECTIONS MADE: 13. LIST CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT, AS ADVISED BY THE OWNER IN SECTION 1A: No* DUPLICATE TO: STREET CITY & STATE ATT. G4550 (Rev. 6/82) ORIGINAL OWNER OR OWNER'S REPRESENTATIVE? Date ZIP $Not Applicable *Explain (No) Answers on Back of Sheet '1� rIORTI, 4 iv_, NORTH ANDOVER FIRE DEPARTMENT CENTRAL FIRE HEADQUARTERS 124 Main Street North Andover, Mass. 01845 Tel. 686-3812 28 October 1983 Mr. John Holt Prescott Nursing Home 140 Prescott St. North Andover, Ma. 01845 Dear Mr. Holt, Enclosed is a copy of the inspection report from Lt. Kenneth Long on 11 October. Lieutenant Long notes no deficiencies or problems. Thank you for your cooperation in this inspection. Our next inspection will be in February of 1984. Respectfully, William V. uolan, Chief t O;v'n2,1;rAL'TH OF UA Di:rARrL',EN'T OF I'U13I,IC Bli_'A STH, I)IVI310'4 OF NUR_:.uG 1101,iES AtiU REI4TE.D FACIfATIE3 FIRE I;�iSPECTI017 hF_;ORT Convalescent or Nursing Uone X ^Citp or Town Infirmary_ Fest :-fomes yj0blic I,xedical Institution Iii accordance v th the requircuIents of General Lay.'S, Chapter 148, Section 4,. the Prescott House Nursing Home of Institution located at 140 Prescott Street North Andover,, Mass. 01845 v's Inso cted en C`��' "C..i /jf'/� _�/.��L- by._ ~� Nnimze of H_;_* Irispf'ctor Report of Insspection Di sa2p: oti•ed • ___ Signature William V. Dolan Chief of Department Title P LUi _'t TRIS 1=. =il T TO: Etircau of Health i :ilitics zoom 530, �GO Boy'Lston. Street B:+st.cn, Ka::aci;usbtts 02116 hCNE COPY Sh-011-i,D BE S2i.T TO Ti3E I215I'iTUTION I. GENERAL Name of Ho... - Address FIRE INSPECTION REPORT 9;I1_1"EO NURSING HOMES, INTERMEDIATE CARE FACILITIES AND REST HOMES r Prescott House_N_ rsing__J-Ic)me-Phone No.685-8Q8 140 Prescott St . city_. North Andover M�s�� 01845 licensee Prescott House Nursing Assocates__._-_PhoneNo6HS-8086 — i - Address 140 Prescott St. ---_city North Andover. Ma -ss. OL845 _• _ . Alan Solomont cit Newt cIn Mass. managers y -- 130 Patients. Actual Patients at time of inspection •1 �� Licensedfo• , ' T Jf Shift III Number of attendants on duty: Shift I- _ Shift 11- — � Are attendants trained in evacuation—�>! ,use of hor:able fire e:tinguishen_.. - and fire Prevention Flashlights at nurses station L".i� Emergency phone numbers posted — n Z 1.✓ Evacuation plan posted �� �" `�---- • £ire drills for employees (How often)_ :/:o Date o1 last drill,_L—_ Distance from nearest fire station._.r --- — Nearest fire hydrant or available wafer for fire fighting pwpmcs_-------------/-- -- —' Automatic fire alarm last tesled, 3 �_ ` Y� Sy whom In Sprinkler s em Iasi tested �l' , By whom— r_� p - }zt r-- — — - ---- 2. BUILDING CONSTRUCTION Number of stories above basement _. Basement — Yes (— Outside wall construction: Wood Brick Veneer L�� M2sonryOther Root construction 5C ��,�Covering Any addition a alteration since Izst licensing __------- — Condition o1 Binding - RE COMMI.NDAI IONS: —.. — __ 3. LOUNGE OR LIVING AREA A- Hcaling Equipment: PROPER/Improper — Piping venting-clearanct adjusimenl-type unit -other. B. Electric Wiring and Equipment: PROPLR/Improper — Condition of wining appliances-cxlension cords -loading -inadequate outlelsgrounding-olher. C. E:Its: PROPER/Improper.— Inadequate locked blocked improperly identified of tier. D. Fire Protrtciion Equipment: PROPER/Improper — Fire extinguisher: Looalion Type numt,et-mainlenance. Sprinkler heads painled-deledor heads painted- ni her - E. Housekeeping: Good RECOMMENDAI IONS*' v — Fair Poor 215 i. HALLS A. Heating Equipment: P�ppER%ImProxr_ Piping -venting -clearance adjuStmenf•type unit of her. B. Electrrc.Wrung and Fqurpmenl:l ROPERAmproper — Condition of wiring -Appliances -extension cords-Ioading-inadequate outlets grounding -other. C. FxitS.� ROPE Improper _ nadequple-locked-blocked-improperly idenfified-olher. D. Fire Pintection Equipment:ROPER/ proper — Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted•deleclor heaos painted - E. Housekeeping: Good Fair Poor RECOMMENDATIONS: 5. BEDROOMS OR WARDS: A. Heating Equipment: PROPER/Improper —Piping-venling-clearance-adjustment-type unit -other. B. Electric Wiring and Equipment: PROPER/Improper — Condition of wiring appliances -extension cords -loading -inadequate oullets-grounding-other. C. Exits: PROPER/Improper — Inadequate -lacked -blocked improperly identified -other. D. Fire Protection Equipment: PROPER/Improper — Fire extinguisher: location -type -number -maintenance. Sprinkler heads painted deleclor heads painted - of her. E. Housekeeping: Good Fair Poor* RECOMMENDATIONS: 6. BATHROOMS K Heating Equipment: PROPER/Improper — Piping -venting -clearance adjustment lype unit-olher. B- Electric Wiring and Equipment: PROPER/Improper — Condition of wiring appliances -extension cords -loading -inadequate outlets -grounding -other. C. Exits: PROPER/Improper — Inadequate-lock(-d-biocked-improperly identified -other, D. Fire Protection Equipment: PROPER/Improper — Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painfed•deleclor heads painted - of her. E Housekeeping: Good RECOMMENDATIONS:_ Fair Poor 7. KITCHEN A. Conking Facilities: Grease accumulation in vent or duct -on fans -fitter -walls -oven -burners. -other, PROPER/Im rop er•Piping-venting-clearance-adjustment-type B. Electric Wiring and Equipment: PROPER/Improper — Condition of wiring appliances -extension cot ds. load ing-inadequate outlets -grounding -other. ' C. Exits: PROPER/Improper — Inadequate -locked -blocked -improperly identitiedolher• D. Fire Protection Equipment: PROPER/Improper — Fire extinguisher: location -type -number -maintenance• Sprinkler heads painled-delector heads painted• of tier. E. Housekeeping: Good_ G� Fair Poor RF COMMENDATIONS: 8. IAUNDRY ROOM — A. Heating Equipment: PROPER!lmproper — Piping v.nting.clearance-adjustmenf•lype unit -other. S. Electric Wiring and Equipment: PROPER/Improper — Condition of wiring -appliances -extension cords -loading inadequate outlets-grounding•other. PROPER/Improper — Exhaust insiallalion-lint accumufation-grounding-gas venting -other, dyer; C. Fire Protection Equipment: PROP[ R/Impioper — Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painteddetecior heads painted - other. D. Housekeeping: Good__ Fair_ - ---__ Poor RECOMMENDATIONS: 216 9. MECHANICAL RDDM A, HealmE Equrpment.'PROPCR/Improper — Piping-venling c]earance-adiustment•lype unit -other. Does hot water heale ve down -draft diverler? YNo Does hot waler healer have pressure relief valve? Yes) • No Are proper tools readily available to shut off gas applian es. Yes No Location of Master gas shut-off : /,_' c r' -,Q j B. Electric Wiring and Equipment: PROPER/improper — Condition of wiring appliances -extension cords-loading•iradecluate out lets -gr ounding-other. Does Electrical system have central disconnect? Yes _ No Proper sire fuses or curcuit breakers? Yes Wo Are major appfiances properly grounded? Yes No C. Fire Protection Equipment: PROPER/Improper — Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. D. Housekeeping: Good Fair Poor r RECOMMENDATIONS: 10. S1ORAGE ROOMS A- Electric Wiring and Equipment: PROPER/Improper — Condition of wiring appliances -extension cords-loadinginadequate outiels-grounding-other. B. Fire Protection Equipment: ROPER Zproper — Fire extinguisher: Local ion -type -number -mainteganee. Sprinkler heads painled-defector heads painted - other. t C. Housekeeping: Good Fair Pod Contents: PROPER STORAGE/Improper storage at: Gasofine-paint-oily rags -flammable liquids -other hazardous materials. RECOMMENDATIONS: Il. EXIERIOR A. Exposure hazards: North South_. a� •'�✓ �� East f✓ :i Chi . West /✓e',:� C� B. Oxygen Storage: PROPER/Improper — Bottles insecure -tips off -other. C. Fire Department Sprinkler or Standpipe Connections: PROPER/Improper — Caps off blocked -no gaskets -other. D. Root Gas Vents: PROPER/Improper — height -rain raps -other. E. Exterior Housekeeping: Good fair _ Pop Accumulation of: Gress and other vegetation -trash or rubbish. Improper incineralor-other. In the opinion of the inspeclor is this building readily accessible for rescue and fire fighting? Yes Does fencing present a problem from standpoint of rescue and_ evacuation? Yes No Does parking o1 autos present a problem?. Yes /Tjo Are fences kept locked Yes RECOIAMENDATIONS: No No I approve this lr9me as meeting minimum fire safety standards I do n 1 approve this home as/meeting minimum fire safely standards until recommendations have been complied with as set forth in this report. Iliccnsee or h4anager) / �.� (Ins clor) (Date) 217 iso EDWARD3 L A UNIT O F GENERAL SIGNAL FIELD SERVICE ORDER REPORT CUST ERCR IT AP ROV L Date • SAME AS "SOLD TO UNLESS SPECIFIEb, SOLDL TO �' f C D // r '/Li O� E_ SHIP TOs C/o e treet Cit / ,f r7y C_ 7 _ State Zip 7 C/o City CUSTOMER ORDER NO. MARKS Billing Ship Vial ChggICEMAN'S NO. Code ode Code / , — L D d TYPE OF SERVICE (Circle ,one only): FCO PERFORMED 2 WARRANTYSERVICE SERVICE TOSALES SERVICE 3 STOCK ORDERS DEMAND r 4 SERVICE - . Ol' E' S P, AEKIT 5� TO,CtJ _Al:AS: LI NO. QUANTITY Y K S T NUMBER DESCRIPTION PROD UNIT PRICE EXTENDED PRICE CODE SERVICES REQU STED/RENDERED: TOTAL PRICE I$ ' J SE x ATIVE ;ERVICE REQUESTED BY: i / ,i _. _. 4 I iS X - SHIP VIA CODES 00 BEST WAY RO A ATE 12 AIR FREIGHT 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 15 PARCEL POST INSURED 18 PICK UP PHONE NO. 20 TRUCK 23 UPS 24 OTHER• SPECIFY 25 UPS BLUE LABEL CHARGE CODES 1 PREPAID 2 CHARGE 3 COLLECTON SHIPPING CHG. _ 4 COD • MATL PLUS FREIGHT 6 QUOTED CHARGE CUSTOMER COPY F410 Rev. 11/80 EDWARDS FIELD SERVICE A UNIT OF GENERAL. SIGNAL, ORDER REPORT ORDE?; , CUSTOMERO. [CREDIT APPROVAL 12 AIR FREIGHT Date: l ae' e(3 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 3 COLLECT ON 15 PARCEL POST INSURED SHIPPING CHG. 18 PICK UP SAME AS "SOLO Td'. 4SlitS+; CI, E! �' SOLO SHIP TO —Name TO - x . ami `'i t. `ol Street City C/Qk I N 1 State Zip city . ck tett.z.wYi E.:�J' c. CIO CUSTOMER ORDER NO. MARKS Biiloling Shipp Via Cn SERVICEMAN'SNO. p �TVPEOFSERVICE (Circle one only): FCO PERFORMED 2 WARRANTY SERVICE SERVICE 3. STOCK DEMAND 4 �j bIRECTSHIPMENT SERVICE TOSALES ORDERS SERVICE TO CUSTOMERS LI NO. QUANTITY Y K NUMBER DESCRIPTION PROD UNIT PRICE EXTENOEDPRICE S T CODE 3ER I ESS REQUESTED/RENDERED: TOTAL PRICE $ SERVICE REPRESENTATIVE x 222-4,. SEO ICE AN AGER -APP AL SHIP VIA CODES CHARGE CODES 00 BEST WAY 1 PREPAID 12 AIR FREIGHT 2 CHARGE 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 3 COLLECT ON 15 PARCEL POST INSURED SHIPPING CHG. 18 PICK UP 4 COD- MATL SERVICE REQUESTED BY:20 TRUCK PLUS FREIGHT PHONE NO. 23 UPS 5 QUOTED CHARGE 24 OTHER -SPECIFY 25 UPS BLUE LABEL CUSTOMER COPY F416 Rev. 11/80 C-DWARDS IA''UNIT OF rF NF R AL SIGNAL FIELD SERVICE ORDER NO. 243.724 O'RDFR RFPnRT SOLD TO i4), / airy,. Name rpt-��1 street Cite r i ,r c D 1!1'�„ State/ Zip SHIP TOw CIO Date: Name treat city stateZip- CUSTOMER ORDER NO. MARKS �f i, r 13 AIR PARCEL POST INSURED Billing Code D Ship Vie Code � Chg. SERVICEMAN'S NO. Code L TYPE OF SERVICE (Circle one only): FCOPERFORMEDNiPMEN7 2 WARRANTYSERVICE SERVICE TOSALE'S S RVt E 3 STOCK ORDERS ' DEM4tJtf '� 4 SEFIVICE 20 TRUCK OIRECTSRECTS 5 T 1NE1;S LI NO. QUANTITY Y K S T NUMBER DESCRIPTION PROD UNIT PRICE EXTENDED PRICE CODE 25 UPS BLUE LABEL I SERVICES REQUESTED/ RENDERED: TOTAL PRICE $ . SERVICE REPRESENTATIVE x{ y '. SERVICE MANAGER APPROVAL SERVICE REQUESTED BY: x PHONE Na. SHIP VIA CODES CHARGE CODES 00 BEST WAY 1 PREPAID 12 AIR FREIGHT 2 CHARGE 13 AIR PARCEL POST INSURED 14 CUSTOMER TRUCK 3 COLLECTON 15 PARCEL POST INSURED '- - -SHIPPING CHG. 18 PICK UP 4 COD • MATL 20 TRUCK PLUS FREIGHT 23 UPS 5 OUOTED CHARGE 24 OTHER • SPECIFY I 25 UPS BLUE LABEL I CUSTOMER COPY C'] w o�u n t N CDCD .. .. .. 1• .. En cn cn OOo w C+ c* c+ n N. M r• N �J rt El t0 O K 0 0 ° � Is CCD m N• V En En C o N NCif' O y 0 .O Pall rt H n CD P. 00, O r) N 0 (0 F--' K rt r { M O . . . . . . . . . . En 0 rt : N �En • 'Fl rt (n N. n pi m Q4 cn rt ED F-' w m KO n il l Cl) 3 O M C' •� E ~ y C'] w o�u n n N CDCD .. .. .. IQ %--) O 'v .. cr OOo w 00 n N. � r• N rt El 0 0 ° Is CCD m ti N. C o N NCif' O y 0 .O Pall rt H n CD P. 00, O N 0 C'] w o�u d N CDCD .. .. .. .. .. n w 00 n N t0 El 0 0 ° Is CCD m 4-rl' N. 0 rt N NCif' O y 0 .O H n CD 00, c� N (0 F--' K rt r { M O . . . . . . . . . . cn : N �En • 'Fl rt G (n N. pi m F-' w m p t0 l Cl) •� N y �C a N ;s n w 00 N rt VL 0 0 ° Is tz m 4-rl' w 0 rt N, F--' F-' O y 0 .O �C a N ;s n N N. 0 0 ° Is tz m O O . . . . . . . . . . : N �En • 'Fl r�. 1•h �. O F-' w l •� y •� .K .b pw n :k :CD � r. rt .CA •O .c -F .�F• S� K N. to O YD co rt lizi �G A cOt� N Qj N• 41' . Cn . H (0 W r,d cn t=1 0 En rt rt `C 7c1 cin N. cn m o . rt w cc) b w m n co . rt »Z `C O c ..K N .CD En .0 :f) o <D :c C4- `i c* p .O .. .. .. .. .. CO n c1- Q4 .O .�! v w o r .cn rt N Q) .O El • CD tA tn tIA tn Copy sent fo i • Explain "No" Answers on Page 2. $Not applicable Report of Inspection _ HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 Inspection Report 617-263-5957 �: ,: ;Inspection Contract No. .1=8.0.... _ Conferred With Bureau File »........................ No. ....................... REPORT TO_ Prescott house Nursing Home BUILDING OR LOCATION Same STREET 14 Prescott Street INSPECTORTimpthy Washburn North Andover 3 9 y CITY & STATE DATE Mass. 01845 - 1. GENERAL Yes N. A.* No a. Is the buiiding occupied? e9600:1 b. Is occupancy some as previous inspection? ✓ �eQOt�ee areeeir c. Are ill systems in service? d. Are all fire systems same as last inspection? ✓ of protection eeeeedl a. Is building completely sprinklero JG . 21 f. Are all new additions and building changes properly protected? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection? (Explain any fire on page 21 ✓ i. In areas protected by wet system, does the building appear to be properly heated in all areas, including ✓ eeeee es®oe blind attics, perimeter areas and are a. exterior openings protected against entrance of cold air? eb©eeti 2. CONTROL VALVES (See Section 16) a. Are all sprinkler system main control valves open? ✓ WePel OosRer' b. Are all other valves in proper position7 000eee c. Are all control valves in good condition and sealed or supervised? e��Os 3. WATER SUPPLIES (See Section 17) 0�eee� eoeeea a. Was a water flow test made and results satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight) 5. WET SYSTEMS (See Section 13) / ✓ a. Are cold weather valves open or closed as necessary? b. Have anti-freeze systems been tested , d left in satisfactory condition? _ e. Are alarm valves, water flow indicator and retards in satisfactory condition) 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? _ b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? a. Are Quick Opening Devices in service? f. Has piping been checked for stoppage within past 10 years? g. Has piping been checked for proper pitch within past 5 years? h. Have dry valves been trip tested satisfactorily as required 1. Are dry valves adequately protected from freezing j. Valve house and hinter condition satisfactory? _ 7. SPECIAL SYSTEMS (See Sections 15 and 18) / a. Were valves tested as required? t/ b. Were all heat responsive systems tested and results satisfactory? G Were supervisory features tested and results satisfactory? E. ALARMS / a. Water motor and gong test satisfactory? I/ b. Electric alarm test satisfactory? c. Supervisory alarm service test satisfactory? 9. SPRINKLERS—PIPING •ecce, Ieeeee0; a, Are alleeeee sprinklers in good condition, not obstructed, and tree of corrosion or loading? _ _ b. Are all sprinklers less than 50 years old?— �s�teiei c. Are extra sprinklers readily available) eeeee;� d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, strainers eeeee, e. satisfactory? eeeeeeeee; _ a. Are all sorinkkrs of pr,�per temperature rating? eeeee* ALAIAL f. Are E ortable fire extinguishers in good condition? y� g Is hanl hose on sprinkler systems satisfactory? Copy sent fo i • Explain "No" Answers on Page 2. $Not applicable Inspection Report No....1.-80..... Building or Location Pre 14 Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 617-263-5957 Stre Inspection Contract No.......1.5.2......... Bureau File No.......................... 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve 1 p tested. 13. Wet Systems: No? Yv§ Make and Model? CENTRAL SPRINKLER CORP 4" 1977, 14. Dry Systems: No? Make and Model? 15. Special Systems: No? Type Make and 'Model Condition? CONTROL VALVES Open Secured Closed Signs 16 No? Type? Yes No Yes No Yes No Yes No Condition City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves Water Pressure? City p 5 PSI Tank PSI Fire Pump PS! Water flow test? r1 32 la 5 (If none made Why?) _ Size I Test Pipe Located Pressure ' Flow Pressure Test Pipe Located Size Test Pipe Pressure Flow Pressure Before Pressure After Test Pie Before Pressure After Ronm _ r 2h it -- --� P PU.2,6 P 18. Heat Responsive Devices: Type? Type of test? ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ 0 ........ E ........ F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ Valve No. ................ ...... A ........ B ........ C ........ D:.......E........ F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ B ........ C ........ D ......... E ........ F........ Valve No. ...................... A ........ B ........ C ........ D ........ E ........ F........ Auxiliary equipment: No? Type? Location?__ Test Results?- esults19. 19.Explanation of any "No" answers. 20. Recent changes in building occupancy or fire protection equipment. 21. Adjustments or corrections made. Y7. Desuabla impruvumenla. "J-',`, L 'Explain "No" answers on Page 1 in Item %t 19 NORTH ANDOVER FERE DEPARTMENT October 23, 1979 PRESCOTT HOUSE NURSING H014EE INSPECTION OF AUYILIARY POWER SUPPLY On Tuesday, October 23, 11979 an inspection of the Auxiliary Power supply of the Prescott House Nursing Home was conduc- ted by the.following individuals: Building Inspector Charles - Foster, Acting Fire Chief Dennis Currier and Michael Gleason Supervisor of Yaintenance Prescott House. The main power supply was shut down at I approximately 3:07 PM. Within 3 to 4 seconds the auxiliary power supply - diesel powered generator- came on line. All lighting was restored to normal. All corridor doors closed when main power was shut down. All doors to patient rooms on A wing closed. All doors on B wing with the exception of rooms 15 and 20. On C wing all doors with the exception of rooms 8,10, and 27. Note: Some these doors did in fact close at some point in time. The large elevator (#1) was operational and was tested to see if it worked by Fifefighter Gorden Rokes and Michael Gl- eason of Prescott House. It worked. The main power was restored at approximately 3:18 PM with no problems. The auxiliary power supply generator shut down at approximately 3:25 PM. Lt. Yen Long noted that the rooms located near the generator, the windows should be closed as fumes from the generator were entering the rooms. The test of the auxiliary power supply over-all was very sucessful. Dennis L. Currier Acting Chief North Andover Fire Dept. cc: Building Inspector Foster Alan Solomont Prescott House North Andover Fire Dept. File n FIRE INSPECTION REPORT SKILLEb NURSING HOMES, INTERMEDIATE CARE FACILITIES AND REST HOMES 1. GENERAL Name of Home Prescott House Nursing Home, Inc. Phone No. 6$5-0$6 Address 140 Prescott Street city North Andover, Mass. 01845 Licensee Prescott House Nursing Associates Phone No. 685-8086 Address 140 Prescott Street city North Andover, Mass 01845 Manager Alan D Solomont City d Licensed for 130 Patients. Actual Patients at time of inspection 1.28 Number of attendants on duty: Shift t 75 Shift II 1 Shift III 7 Are attendants trained in evacuation Te s, use of portable fire extinguishers Yes and fire prevention Yes Flashlights at nurses station Yes . Emergency phone numbers posted Yes Evacuation plan posted Yes_ Fire drills for employees (How often)_ Monthly Date of last drill 0ctober-1-9-79. Distance from nearest fire station ____811 OthS Of a mile Nearest fire hydrant or available water for fire fighting purposes - Two ft . 1_2_50 ft Automatic fire alarm last testedl'0/2/79 . By whom Edwards Alarm Company 10/2/79 B Hodson N. H. Fire Equip. Company Sprinkler system last tested y whom � , 2. BUILDING CONSTRUCTION Number of stories above basement Z Basement —y YXx No Slab Outside wall construction: Wood Brick Veneer_ MasonryOther Roof construction Ruilt—up . Covering Tar^ and Garvel Any addition or alteration since last licensing None Condition of Building Excellent. RECOMMENDATIONS: 3. LOUNGE OR LIVING AREA A. Heating Equipment: PROPERafler — Piping -venting -clearance -adjustment -type unit -other. B. Electric Wiring and Equipment: PROPER/Impcepec — Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. C. Exits: PROPER/4++prepeF- Inadequate -locked -blocked -improperly identified -other. D. Fire Protection Equipment: PROPER/ks;pcepeF— Fire extinguisher: Location type -number -maintenance. Sprinkler heads painted -detector heads painted - other. E. Housekeeping: Good X Fair Poor RECOMMENDATIONS: 215 4. HALLS A. Heating Equipment: PROPERAw43pFepar - Piping -venting -clearance adjustment type unit other. B. Electric Wiring and Equipment: PROPER/twjpfe r - Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. (' C. Exits: PROPER/lsprspar - Inadequate -locked -blocked -improperly identified -other. D. Fire Protection Equipment: PROPER/Iwfpfeper - Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. E. Housekeeping: Good x Fair Poor RECOMMENDATIONS: 5. BEDROOMS OR WARDS: A. Heating Equipment: PROPER/lwprsper. - Piping -venting -clearance -adjustment -type unit -other. B. Electric Wiring and Equipment: PROPER/Imprepea - Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. C. Exits: PROPER/4opfe& e - Inadequate-locked-blocked-im properly identified -other. D. Fire. Protection Equipment: PROPER/twrpreper - Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. E. Housekeeping: Good y — Fair _ Poor RECOMMENDATIONS: 6. BATHROOMS A. Heating Equipment: PROPER/W;pfepaF - Piping -venting -clearance -adjustment -type unit -other. . B. Electric Wiring and Equipment: PROPER/Fwfpfeper-- Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. C. Exits: PROPER/IrrpxeFQ; - Inadequate -locked -blocked -improperly identified -other. D. Fire Protection Equipment: PROPER/4"+gfepef- - Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. E. Housekeeping: Goody Fair Poor RECOMMENDATIONS: 7. KITCHEN CL�a►t�>, h�onitl�L�f A. Cooking Facilities: Grease accumulation in vent or duct -on fans-filter-walls- unit-other. ans-filter-walls oven -burners. PROPER/lwtpfepef Piping -venting -clearance -adjustment -type unit-ot her. B. Electric Wiring and Equipment: PROPER/Improper -Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. C. Exits: PROPER/Ifrpreper - Inadequate -locked -blocked -improperly identified -other. 0. Fire Protection Equipment: PROPER/Ifr+prepec - Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted detector heads painted other. E. Housekeeping: Good F Fair Poor Duct RECOMMENDATIONS: Steam Cleaning of Werk from_cooki,ng fa.ci l i ties I I 8. LAUNDRY ROOM A. Healing Equipment: PROPER/Improper: - Piping -venting -clearance -adjustment -type unit -other. B. Electric Wiring and Equipment: PROPER/kf+pfoper - Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. Dryer: PROPERrIR;prepe; - Exhaust installation -lint accumulation -grounding -gas venting -other. C. Fire Protection Equipment: PROPER/kap*eper - Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. D. Housekeeping: Good X Fair Poor RECOMMENDATIONS: — - - 216 9. MECHANICAL ROOM f A. Heating Equipment: PROPER/Impcopei — Piping -venting -clearance -adjustment -type unit -other. t Does hot water heater have. down -draft diverter? Yes No Does hot water heater have pressure relief valve? Yes No Are proper tools readily available to shut off gas appliances? Yes No Location of Master gas shut-off B. Electric Wiring and Equipment: PROPER/Impcgpec — Co dition of wiring appliances -extension cords -loading -inadequate outlets -grounding -other. Does Electrical system have central disconne 7 e No Proper size fuses or curcuit breakers? Ye o Are major appliances properly grounded? a No C. Fire Protection Equipment: PROPER/tmpcepoc ire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. X D. Housekeeping: Good Fair Poor RECOMMENDATIONS: Remove Wooden Blinds near Heat 10. STORAGE ROOMS A. Electric Wiring and Equipment: PROPER/lmpcgpec — Condition of wiring -appliances -extension cords -loading -inadequate outlets -grounding -other. B. Fire Protection Equipment: PROPER/4444per — Fire extinguisher: Location -type -number -maintenance. Sprinkler heads painted -detector heads painted - other. C. Housekeeping: Good Fair Poor Contents: PROPER STORAGE/Iagiwp@ storage of: Gasoline -paint -oily rags -flammable liquids -other hazardous materials. RECOMMENDATIONS: Storage of equipment./supplies at least 1A i nc!has below ceilings _ 11. EXTERIOR A. Exposure hazards: North South East _ Dumpster outsidekitchen area in hazardous location West B. Oxygen Storage: PROPER/4eper-- Bottles insecure -caps off -other. C. Fire Department Sprinkler or Standpipe Connections: PROPER/Icnpcgpac — Caps off -blocked -no gaskets -other. D. Root Gas Vents : PROPER/lmproW — Height -rain caps -other. Exterior Housekeeping: Good X Fair Poor Accumulation of: Grass and other vegetation -trash or rubbish. Improper incinerator -other. In the opinion of the inspector is this building readily accessible for rescue and fire fighting?® Yes No Does fencing present a problem from standpoint of rescue appevacuation? Yes Does parking of autos present a problem? Yes No Are fences kept locked Yeb. Ala RECOMMENDATIONS: Dumpster outside kitchen area poses hazard under eave of .roof. Should be moved out further or covered at all times. 1 approve this home as meeting minimum fire safety standards ave -beef -cam F4h. (Licensee or Manager) (inspector) 6 o./_16 / 7� (Date) // G 217 0 I NORTH ANDOVER FIRE DEPARTMENT October 16, 1979 Further Recommendations Sprinkler and Alarm System reports to be sent to the Building Inspector and Fire Department on a.regular basis. Notify both departments when tests are to be conducted on the Sprink=r ler system. Also when the Life Safety Inspection is made, notification to both departments will facilitate the certification process. Test of the secondary power supply to be held on Tuesday, October 23, 1979 at 3P.M. with Building Inspector and Fire Departments present. _ Dennis L. Currier Acting Chief a►' � kation for Fire Approval Fire Chief Dear Sir: On the direction of the Department of Public Health I hereby request that a fire inspection be made of my premises, and that one copy of the .report of the same be forwarded to the Department of 114jblic ;Health, Long - Term Care Facilities Program, Room 560, 80 Boylston Street, Boston, Massa- chusetts 02116. Please return the second copy to me. An application for a license has been filed for the conduct of Prescott House Nursing Home Name of Home 140 Prescott Street, North Andover, MA 01845 Address Prescott Nursing Home Associates ��� By: Prescott Nursing Home, Inc -General Partner _6j Name of Licensee or Proposed Licensee Authorized Signature Date Report of Fire Chief The following is a report based upon an inspection by �• Name of I� pector made under authority of G.L. c. 111, s. 71, of the above premises: ( ✓� said premises are certified as in compliance with the applicable local ordinances or by-laws, and any regulations thereunder relating to fire prevention and safety in buildings to be occupied by patients. ( } Said premises are disapproved for failure to comply with one or -more of such provisions of law. A full statement is attached setting forth the deficiencies occasioning this disapproval. Any appeal shall be to the Department of Public Safety under G.L. c. 111, s. 71. A copy of ti -as disapproval has been provided to th-e license applicant. alzt"_ Date Fire Chief (Sig".turn^ Report of Inspection y HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 Inspection Report 617-263-5957 Inspection Contract No. _A=79.. No. ....15.2 ........... Conferred With Bureau File .......................... No. ....................... REPORT TO_ Prescott House Nursing Home BUILDING OR LOCATION S STREET 14 Prescott Street INSPECTOR Tim Washhttrn North Andover ;�IJ CITY &STATE Mass. 01 845 DATE �'Ce ^n6Pl7 o^ir!o19-79 1. GENERAL a. Is the buiiding occupied? b. Is occupancy same as previous inspection?. c. Are ill systems in service? d. Are all fire protection systems same as last inspection? e. Is building completely sprinklered? f. Are all new additions and building changes properly protected? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection? (Explain any fire on page 21 i. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all sprinkler system main control valves open? b. Are all other valves in proper position? c. Are all control valves in good condition and sealed or supervised? 3. WATER SUPPLIES (See Section 17) a. Was a water flow test made and results satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water flow indicators and retards in satisfactory condition? 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? e. Are Quick Opening Devices in service? f. Has piping been checked for stoppage within past 10 years? g. Has piping been checked for proper pitch within past 5 years? h. Have dry valves been trip tested satisfactorily as required? i. Are dry valves adequately protected from freezing? j. Valve house and heater condition satisfactory? 7. SPECIAL SYSTEMS (See Sections 15 and 16) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? P. ALARMS a. Water motor and gong test satisfactory? b. Electric alarm test satisfactory? c. Supervisory alarm service test satisfactory? 9. SPRINKLERS—PIPING a. Are all sprinklers in good condition, not obstructed, and free of corrosion or loading? b. Are all sprinklers less than 50 years old? c. Nre extra sprinklers readily available? _ d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, strainers satisfactory? e. Are 311 sorinklers of prooer temperature rating? I. Are t ortable fin extinguishers in good condition? g Is hani hose on sprinkler systems satisfactory? r - Copy sent to Explain "No" Answers on Page 2. $Not applicable ie 016 No Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 Inspection Report 617-263-5957 Inspection Contract No. ....4-79...... No........1.52.......... Bureau File Building or Location Prescott house Nursing 11omP 14 Prescott Stroet North Ancloyov- MAgg 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve last trip tested. 13. Wet Systems: No? Make and Moder CENTRAL SPRINKLER COUP Oft1977 14. Ory Systems: No? Make and Model? 15. Special Systems: No? Type Make and Model Condition? CONTROL VALVES NO? I Type? Yes City Connection Control Tank Control Valves— Pump Control Valves _ Sectional Control Valves Tank Secured Closed S PSI Fire Pump Test Pipe LocatedI Size Test Pi Condition flQ PSI PressureI Flow I Pressure Before Pressure After 18. Heat Resionsive Devices: a S S S Water Pressure? City o PSI Water flow test? S D ........ E ........ F........ fit none made A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ Size I Pressure Flow Pressure Test Pipe Located Test Pie Before Pressure After C ........ n Valve No. ...................... A ........ B ........ ILI ValveNo . ...................... A ........ B ........ C ........ Tank Secured Closed S PSI Fire Pump Test Pipe LocatedI Size Test Pi Condition flQ PSI PressureI Flow I Pressure Before Pressure After 18. Heat Resionsive Devices: Type? Type of test? ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ 8 ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ D........ E ....... F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ D ........ E ........ F........ Auxiliary equipment: No? Type? Location? Test Results? 19. Explanation of any "No" answers. 20. Recent changes in building occupancy or fire protection equipment. 21. Adjustments or corrections made. 77. DeSirabin imprtwomenta. 'Explain "No" answers on Page 1 in Item 'ii 19 Inspection Report No. .._.3=Z9... Conferred With Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 617-263-5957 REPORT TO_ Prescott House Nursing Home STREET 14 Prescott Street North Andover CITY & STATE Mass. 01845 Inspection Contract No. ..... 1..52........ Bureau File No. ....................... BUILDING OR LOCATION same INSPECTOR Timothy Washburn DATE September 20, 1979 1. GENERAL a. Is the bu:iding occupied? b. Is occupancy same as previous inspection? c. Are ill systems in service? d. Are all fire protection systems same as last inspection? e. is building completely sprinklered? f. Are all new additions and building changes properly protected? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection? (Explain any fire on page 21 i. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all sprinkler system main control valves open? b. Are all other valves in proper position? c. Are all control valves in good condition and sealed or supervised? 3. WATER SUPPLIES (See Section 17) a. Was tivater flow test made and results satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?. b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water flow indicators and retards in satisfactory condition? 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? a. Are Quick Opening Devices in service? I. Has piping been checked for stoppage within past 10 years? g. Has piping been checked for proper pitch within past 5 years? h. Have dry valves been trip tested satisfactorily as requiredZ i. Are dry valves adequately protected from freezing? I. Valve house and heater condition satisfactory? 7. ,SPECIAL SYSTEMS (See Sections 15 and 18) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? 8. ALARMS a. Water motor and gong test satisfactory? b. Electric alarm test satisfactory? c. Supervisory alarm service test satisfactory? 9. SPRINKLERS—PIPING a. Are all sprinklers in good condition, not obstructed, and free of corrosion or loading? b. Are all sprinklers less than 50 years old?— c. Are extra sprinklers readily available) _ d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, strainers 0.0, oeU v •:a •oel 0*0 o0c+ 000 900 of No e. Are all sorinklers of proper temperature rating? I. Are I ortable fire extinguishers in good condition? g Is hanl hose on sprinkler systems satisfactory? I _ Copy sent to Explain "No" Answers on Page 2. $Not applicable Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 617-263-5957 Inspection Contract Inspection Report No. — ....L.5.2............ No....... .....1.9..... Bureau File Building or Location Pribrenntt HOUSE 'Nursing Home— 14 Preaentt Stroet Nnrt No .......................... 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve last trip tested. Ot 197 CORP 7 13. Wet Systems: No? Make and Model? CENTRAL SPRINKLER 14. Dry Systems: No? Make and Model? — 15. Special Systems: No? Type Condition? Make and 'Model Open Secured Closed Signs CONTROL VALVES NO? Type? Yes No Yes No Yes No Yes No Condition 16. City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves Water Pressure? �`J_ w Water flotest?— Size Test Pipe Located Test Pi PSI S IIf none made I Pressure Flow Pressure Before I Pressure I After 18. Neat Responsive Devices: Type? ValveNo . ...................... A ........ 8. ....... C ........ D ........ E ........ F........ ValveNo . ...................... A ........ 8 ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ 8 ........ C ........ D ........ E ........ F........ ValveNo...— ................. A ........ 8 ........ C ........ D ........ E ........ F........ Auxiliary equipment: No? Type? 19. .Explanation of any "No" answers. 91- 20. 4 20. Recent changes in building occupancy or fire protection equipment. Tank PSI Fire Pump. y?) I Size Pressure Test Pipe Located Test Pipe Before —PSI ow Pressure PreFlswrel After Type of test? ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ....................... A ........ B ........ C ........ D ........ E ........ F........ Location? Test Results? 21. Adjustments or corrections made., y , _ -I . _ J _ „/ J _. / '17. Deauable intprrweinen n r Pe- hP_ nl r C Kir 'Explain "No" answers on Page 1 in Item :f 19 PRESCOTT HOUSE NURSING HOME October 29, 1979 Dennis L. Currier, Acting Chief North Andover Fire Department Main Street North Andover, Massachusetts 01845 Dear Chief: 1 ' 'Enclosed are copies of our inspection and maintenance contracts with the Hodson Fire Equipment Company (Sprinkler System) and the Edwards Company (Fire Alarm System). %1, I have also enclosed copies of Inspection Reports sub- mitted by the Hodson Company for the first two quarters of 1979• The third quarter inspection was done in October, but we have not received our report yet. I am having to contact the Edwards Company for reports of their monthly inspections. These reports describe which zone was tested and serviced and what work was done to re- solve any problems. We are missing several of these. A complete set furnished by the Edwards Company will serve both of our needs. I shall forward copies when they are received. I can see you wish to maintain current files on facilities in the Town, and I commend you for that. Sincerely, Z/ � . konv Alan D. Solomont Administrator ADS/me j cc: Charles Foster, Building Inspector 140 PRESCOTT ST. NORTH ANDOVER, MA 01845 (617) 685-8086 Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 •Inspection Report 617-263-5957 Inspection Contract No. .._2.-.7.9... No. ...... 1.52......... Conferred With Bureau File .......................... No. ....................... REPORT TO_ Prescott Nouse Nursing Home BUILDING OR LOCATION Same STREET 14 Prescott Street INSPECTOR Paul Polevarzyk CITY & STATE North Andover DATE Mass. 01845 -� 1. GENERAL a. Is the bu;iding occupied? b. Is occupancy same as previous inspection? c. Are ill systems in service? d. Are all fire protection systems same as last inspection? e. Is building completely sprinklered? f. Are all new additions and building changes properly protected? g. Is all stock or'storage properly below sprinkler piping? h. Was property free of fires since last inspection? (Explain any fire on page 21 L In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all sprinkler system main control valves open? b. Are all other valves in proper position? t Are all control valves in good condition and sealed or supervised? 3. WATER SUPPLIES ISae Section 17) a. Was a ater flow test made and results satisfactory? J&4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? b Are fire de t con ecY :-4 K . n tons iselln actory condition, couplings free, caps in place and check valves tight? 5. WET SYSTEMS (See Section 13) a. Are cold weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water flow indicators and retards in satisfactory condition? 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good conditionT b. Is air pressure and priming water level normal? e. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? a. Are Quick Opening Devices in service? f. Has piping been checked for stoppage within past 10 years? g. Has piping been checked for proper pitch within past 5 years? h. Have dry valves been trip tested satisfactorily as required? i. Are dry valves adequately protected from freezing? j. Valve house and heater condition satisfactory? 7. ,SPECIAL SYSTEMS (See Sections 15 and 18) a. Were valves tested as required? b. Ware all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? e. ALARMS a. Water motor and gong test satisfactory? b. Electric alarm test satisfactory? c. Supervisory alarm service test satisfactory? 9. SPRINKLERS—PIPING a.: Are all sprinklers in good condition, not obstructed, and free of corrosion or loading? b. Are all sprinklers less than 50 years old? C. Are extra sprinklers readily available? _ d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, strainers satiefacteru?— _ e. Are 311 sorinklers of proper temperature rating? _ f. Are 1 ortable fire extinguishers in good condition? g Is han.l hose on sprinkler systems satisfactory? Copy sent to • Explain "No" Answers on Page 2. $Not applicable No Inspection Report No...ZnU ........ Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 617-263-5957 Inspection Contract Bureau File Building or Location Prescott House Nursing Rome No .......................... 14 Prescott Street, North Andover, Masa 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve laat trip tested. 13. Wet Systems: No? Make and Model? Central Sprinkler orp. 4 1 977 14. Dry Systems: No? Make and Model? - 15. Special Systems: No? Type Make and %ilodel Condition? CONTROL VALVES Open Secured Closed Signs NO? Type? Yes No Yes No Yes No I Yes No I Condition City Connection Control Tank Control Valves — Pump Control Valves — Sectional Control Valves Water Pressure? %a.s * S Cit a a5 PSI Tank PSI Fire Pump PS! 'r d Water flow test? a ---�/per �S (If none made Why?) Sin I Pressure Flow Pressure Test Pipe Located Size Pressure Flow I Pressure Test Pie Before Pressure Atter Test Pipe Located Test Pi Before Pressure After p I 8. Heat Responsive Devices: - Type? Type of test? Valve No A ........ B........C........ D ........ E ........ F........ Valve No.................. ..A........8........C........D........E........F........ . ...................... ValveNo A ........ B ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C ........ D ........ E ........ F........ . ...................... ValveNo A ......... 8 ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ B ........ C.. ...... D ........ E ........ F........ . ...................... ValveNo . ...................... A ........ S ........ C ........ D ........ E ........ F........ Valve No. ...................... A ........ 8 ........ C ........ D ........ E ........ F........ Location? Test Results? Auxiliary equipment: No? Type?` 19. Explanation of any "No" answers. 20. Recent changes in building occupancy or fire protection equipment. 21. Adjustments or corrections made. I 77. Desuabin Impruvnnronta rPL -a It X jeR/i✓ DOTS'/DC 'Explain "No" answers on Page 1 in Item 4f 19 Inspection Report No. A=7.9..... Conferred With Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 617-263-5957 REPORT TO_ Prescott Douse Nursing Home STREET 14 Prescott Street CITY & STATE North Andover, Mass. 01 845 Inspection Contract No. ...'..J.5.2......... Bureau File No. ....................... BUILDING OR LOCATION same INSPECTOR Paul. Polevarzyk DATE 1. GENERAL a. Is the bu;iding occupied?; b. Is occupancy some as previous inspection? c. Are ill systerns in service? d. Are all fire protection systems same as last inspection? e. Is building completely sprinklered? f. Are all new additions and building changes properly protected? g. Is all stock or storage properly below sprinkler piping? h. Was property free of fires since last inspection? (Explain any fire on page 21 i. In areas protected by wet system, does the building appear to be properly heated in all areas, including blind attics, perimeter areas and are all exterior openings protected against entrance of cold air? 2. CONTROL VALVES (See Section 16) a. Are all sprinkler system main control valves open? b. Are all other valves in proper position?,- c. Are all control valves in good condition and sealed or supervised? 3. WATER SUPPLIES (See Section 17) a. Was a%ater flow test made and results satisfactory? 4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?. b. Are fire dept. connections in satisfactory condition, couplings free, caps in place and check valves tight? S. WET SYSTEMS (See Section 13) a. Are cold weather valves open or closed as necessary? b. Have anti -freeze systems been tested and left in satisfactory condition? c. Are alarm valves, water flow indicators and retards in satisfactory condition? 6. DRY SYSTEMS (See Section 14) a. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? c. Is air compressor in good condition? d. Were low points drained during fall and winter inspections? e. Are Quick Opening Devices in service? f. Has piping been checked for stoppage within past 10 years? g. Has piping been checked for proper pitch within past 5 years? h. Have dry valves been trip tested satisfactorily as required? i. Are dry valves adequately protected from freezing? j. Valve house and heater condition satisfactory? 7. SPECIAL SYSTEMS (See Sections 15 and 18) a. Were valves tested as required? b. Were all heat responsive systems tested and results satisfactory? c. Were supervisory features tested and results satisfactory? e. ALARMS s. Water motor and gong test satisfactoryt b Electric alarm test satisfactory? c. Supervisory alarm service test satisfactoryT 8. SPRINKLERS—PIPING a . Are all sprinklers in good condition, not obstructed, and froe of corrosion or loading? b. Are all sprinklers less than 50 years old? c. Are extra sprinklers readily available? _ d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, strainers e. Are ill sprinklers of proper temperature rating? f. Are 1 -table fire extinguishers in good condition? g Is hen .1 hose on sprinkler systems satisfactory? Copy sent to — _ Explain "No" Answers: on Page 2. $Not applicable Yes I -N. A.t. j No DmPe� DPYe1► e�nees aoost� D�Bee)' teI►eneecee _ P inspection R ort No. ..............cy�....... Report of Inspection HODSON FIRE EQUIPMENT COMPANY 2 School Street Acton, Massachusetts 01720 617-263-5957 Inspection Contract No...... 15.2.......... Bureau File Building of Location Prescott House TiurSin .r llOme No .......................... resco reet Forth Andover Mass 10. Date Dry System Piping last checked for stoppage. 11. Date Dry System Piping last checked for proper pitch. 12. Date Dry Pipe Valve last trip tested. 13. Wet Systems: No? y . Make and Modell 14. Dry Systems: No? 0 Make and Model? 15. Special Systems: N07A)b Type Condition? Make and �Jlodel Ooen Secured Closed Signs CONTROL VALVES I NO? I Type? Yes I No I Yes o YesNoYes No Condition City Connection Control Tank Control Valves— Pump Control Valves — Sectional Control Valves el ( ) L c• Q �� PSI Tank PSI Fire Pump PSI Water Pressure? CitaJ7lJ 1 Water flow test? (If none made Why. )�i� Size Pressure Flow Pressure Size Pressure Flow Pressure Ten Pipe located Test Pipe Before Pressure After Test Pipe LpCated Test Pipg Before Pressor After I 18 Heat Fesponmve Devices: Type? . ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo.......................A........ B ........ C ........ D ........ E ........ F........ Valve No . ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ 8 ........ C ........ D ........ E ........ F........ Auxiliary equipment: No? TYPe? Type of test? ValveNo . ...................... A ........ e ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ B ........ C ........ D ........ E ........ F........ ValveNo . ...................... A ........ e ........ C ........ D ........ E ........ F........ Valve No . ...................... A ........ B ........ C ........ O ........ E ........ F........ __Location? Test Results? 20. Recent changes in building occupancy or fire protection equipment. 21. Adjustments or corrections made. ;17. Deeaable impnrvoment►. 'Explain "No" answers on Page 1 in Item :i9 19 En co CD C+- Cf- c+ N to 1�13A TiNl +N F 4 S3• Cf- CM, ZO F13OO to i �3 O c+ H O O Nct Q' ;sA c O O rt (0 • N N b 'S K oc� N co t�i� ci- ti Q' CF Fy „ 1--hl R' • ov�cicM �' N O N 2' ;CJ 0 ED ui w � �O t0 rt (n r- b to •O cy G mPI El O O n H ct .(D • L=1 A + •() 1-4 •n n :& :Oy 03 N .... ...... .......... •C+ • H N • x n 'c+ N• .0 O •'�*� N 0 b (n O :(D tocr c0 (D IJ W O A p F-:.(D N ta •H Noil N F' .......... :� A coP4 co coH rt En F4 CA 0 En rt 0 N. :Fj y :" m O O • *tet m O H y :y .0 m x CO c+ PC N (0 •O • R1 +" fi to M O 0 � a N qz�O 110 h + N N C0 W ti 0 ON Ln M o^� °, .......... o ro t tn ~ o n 9 n (o ~'R, Imo' G vNi V m tr' m• m a N y •� o N. to 1 CT pp tsl ti (0 .. .. .. .... .. .. .. to : b •o .11 N p� O W .......... N : . (n mO O o m• •� • C+ pi CF .�%• N rt C4- cF •O N. O •r M cp .. ..... .. ; . E iV . (D 0. 131 SAT o : :K . cn A C, O O F4 •11 rt ;3 : : 0 : (D n t ate NOV 61981 DING DEPT. C i-rY /'rCWN OF - - O MAIN ST. - _ NORTH ANDOVER, MA 01845 APPLICATION YOR CERTIFICATE OF INSPECTION (Amount)��/' _ a� ( ) No Fee Required (x) Fee Required In accordance with the provisions of the Massachusetts State Building ode,-Section.108,15; I hereby apply for a Certificate of Inspection for �Aie below -named premises located at the following address: 140 Prescott Street No. Andover, Mass. 01845 �treet and Number — - rTame of .Premises Pres -Home--- purpose for Which Premises .is Use Long Term Care icense(s) or Pe rmit(s)•Required for the Premises by Other Governmental 'igencies: License or Permit • Agency No. Andover_ $ld. PermitJi245J--- - - C'ertificate of -Use and;Occupancy — Department of _Public Iieal-th--_ -- .- License to-Maintain_,a-Gonval-esnerrt--o-r-Tursing Home Certificate to be Issued to Prescott House N»rG;,,g Home-.---.-- --- - -- -- - Address 140 Prescot No. Andover, Mass. 01845 t ___— --- — --- - Owner of Record of Building PreScAt Nursing Home Asso Address 140 Prescott StrPA*, -No-.a , Name of Present Holder of e- Soloment Name of Agen , if any Admin_istraror --- (SIGNATURE OF PERSON TO WHOM TITLE CER'T'IFICATE IS ISSUED OR HIS p�` 13� I YI -_- -- - AUTHORIZED AGENT — — jD DATE INSTRUCTIONS: I'ii 1) t o • TOWN OF. FORTH ANDOVER Mpayable- - -- - --- - ake check . 2). Return this application with your check to:CHARLES H. F0:5r.Rt BLDG. IIdSF . 01843 _ TOWN OFFICE BLDG.- i-N(Yi1'1`A�ND�VE 1 a FIA. iPLEASE NOTE: " 1) Application form with accompanying fee must be submitted for each build- ing or structure or part thereof to be certified. 2) Application and fee must be received before the certificate will be iss� The building official shall be notified within ten (10) days of any char,, _ in the above information. i EXPIRATION DATE: CERTIFICATE FORM SBCC-3-'Ih P,�e - ' / 7AZ CMTI1?jC1i`.iE OF, 7.r1\IS EC` ION Bate: Sep.tember 17, 1979 Charles H. Foster Wilding Inspector Dear Sir: I hereby recucst that a.,n .ins-pection be made of my premises for the Purpose; of isslain; a certifj.cate of use and occ!zPan. cy and the posted oecl3part :Load as required by the Conmmomrealth of iiwssac rasetts State Building Code. Please forward a copy of tl.is cer0ificafe to the Department of PAbl.ic Health, Long -Term. Care t a.cil.ities Program, Room 560, 80 Boylston. Street, Boston, Massacizusetts 02116 *In the case of MY nerdy erected building,, Piescott House Nursing Home Name of 1-1a:ue.� 140 Prescott -Street, No. Andover, MA 01845 !lddxess of Home Prescott. Nursing Home Associates Prescott Nursing Home,'Inc. - General Partner 3damne of Applicant(s�-�f coryoo.ratiori$ 1l.st correct corporate nmame Sigiiatur•e c) 0--- Appl.ican s Date 9/-26/79 CO,,,voI;i ALTH OF .•'ASSACHUSETTS X T o W i; O F TH_. AIJDOYER APPLICATION FOR CERTIFICATE OF INSPECTION (X ) Fee- Required (Amount) $50.00 - 2 years ( ) No Fee Required nce with the provisions of the Massachusetts State Building In accorda Code, Section_108,15, I hereby apply for a Certificate of Inspection for the below -named premises located at the following address: " ;] Mass. 01845 Street and Number x.40 Pies �. • North Andover Name o f Premises Prescott Nursing Home Purpose for Which Premises is Used License(s) or Permit(s).Required for the Premises by Other Governmental Agencies: • Agency License or Permit - Massachusetts Department of Public-�P Ith License Certificate to be Issued to Prescott Nursing Home Inc Address 1110 Prescott I.e1'_ North Andover, Massachusetts 018^ S Prescott Nursing Home Assocs:ates Owner of Record of Building ` Massachusetts 01845 I40 Address Name of Present Holder of Certificate ' Prescott House Nursin Name of Agent' if any SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT Administrator TITLE October 2, 1979 DATE INSTRUCTIONS: 1)Idake check payable t o• TOWN OF NORTH ANDOVER — Return this appwith your TOWN to: CHARLES H. FOSTER, BLDG. INSP. le OWN OFF ., VER, MA. 01845 f 2) PLEASE NOTE: " 1) Application form with accompanying fee must be submitted for each build- ing or structure or part thereof to be certified. Application and fee must be received before the certificate will be issu< 2) App days of any chan: 3) The building official shall be notified within ten (10) Y in the above information. #1 EXPIRATLON DATE: 12/2/79 CERTIFICATE -39- - FORM SBCC-3-7h c�0 c+ c+ c+ R c+ O O N. y Is 5z� O N. c+ F-4 F4j ► h M M cn m cr c1 k�l y -3 O O O b o 0 0Ca U) O .......... (� O cF T-4 rA O .COD n En rt m p b S : v p s n 00 n ; �-A 'Y •b ti •O Fi AEnC w tzjCD :::::::::: :° N• :� �I .0 N r+ o' 0000 O ;K m N• `C ro o S : c+ R• • Z c� A � m n En R 'Z N' R' r• cn n cn A . rt o •N M N. cif - N i p co .. .. .. .. .. .� .. .. .. .. .. (0 0 ct m .... ...... H y :H :( : `co `° 0 mo c+b H O O N � A N y cf• n m t+7 fD co A N �rt Ooc p t0 00 .O V En N N �' Nca o ti ct c0 ' c+' A Ca .►d U)p .0 o ;y 'C+- N. N. tW► `C c�'F .c+ O O : .O o n r °•w b o N • W 03 t+ 00 W �'• 00 rt o i3 CD A n n O S1, n y x x m Ln co A x y co co ci- O� A cf- m H N. u N cp O ^� R4 i 1 � � o t O 0 Ili O H x • Gl ta ta LOCAL BUILDM DEPARTMENT - CERTIFICATE OF INSPECTION Date: October. 27, 1977 ChaAtez H. Poster It. Building Inspector 93 Etm Street NoAth Andover,.Ma. 0.1845 Dear Sir: I hereby request that an inspection be made of my premises for the purpose of issuing a certificate of use and occupancy and the posted occupant load as required by the Commonwealth of Massachusetts State Building Code. Please forward a copy of this certificate to the Department of Public Health, Lang -Term Care Facilities Program., Room 560, 80 Boylston Street, Boston, Massachusetts 02116, In the case of any newly erected building. PRESCOTT HOUSE NURSING HOME r Name of Home 140 E&Ucott S At Notcth AndoveA, Mai 01845 Address of Home P&e/scot-t Nu a ung Home A&,&oc iatu Name of Applicants If corporation, ALAN D. SOLOMONT )ignature (s) of Applicant(s A/c correct corporate name) r" 510 O Q N 00 O COm Ln rT7 co i � 1 V � C 73 V `A O Ttf r D m F r m C3 D X tp m Ed > En D 2 C m m I m u.Lak n 0) OD w m W T � nCD 0, OD CD0o_D O Cl) N • 714 O' D 0 0)n < m C N a D 7 mn 0- :3� w _ /-�'? /7 7 / Y I /)/.�� FFFFF r saa —061r- 7 CX—A.L l- A- tY��O G '�' C7��—rU�Y',4c r � I 4 U '_ /-�'? /7 7 PERIODIC INSPECTION INFORMATION SHEET Instructions: This information sheet is not an inspection a permanent file card is typed for a new building or a new ing, this information sheet can be prepared by the building sheet from which the file card can sheet are identical to the items o sheet cannot be entered on the file not discarded. Street and Number/ 6 U Name of Premises (-.- Other Licenses or Permits Required be typed. The items of n the file card. If all card, this sheet should Owner of Record gf Building %'tl Address y6 .w w. A% - 1, Certificate to be I ued to ,,,;, Address I Jj a ZZ -" Use Group Classification 14 • 1 Public or Private Number of Stories y Class Certified Capacity (By Story or Type) Purpose checklist. Each time card for an old build - inspector as a work information on this the information on this be filled out and of Construction /-13 Date Erec Number of Rooms - Hospitals, Schools, Hotels (By Story or Type) Number of Dwelling Units Per Story, (I Emergency Lighting System Mans -of .-Detecting-and Extingu king Fire "`" 2� Fire A arm System ' Number of Elevators How Heated.d Boiler or Other Heating Apparatus 96 How Lighted 16.M €_E�.G, f g.w.a . ow Ventilated 11 Place of Assembly; Yes t% No Pt&Dose Used In Which Story V .--t Standard Booth Installed M Location Fixed Seating h/6 Number of Aisles and Width of Each t/& Fire Resistance of Curtains or Draperies Number of Sanitaries Location ' Number of Grade Floor Means of Egress Doorways Number of Separate Stairways Accessible Per Story ---a.70. �4A ,.d=f —'Number of Approved Independent Exitways Per Story. Remarks• Date Certificate Issued Date Certificate Expires Date Orders Issued Date Orders Complied Inspector Date FORM SBCC-1-74 TOWN OF NORTH ANDOVER, MASSACHUSETTS OFFICE OF BUILDING INSPECTOR Date: This is a SPECIAL PER14IT to allow GLOUCESTER CONSTRUCTION, INC. to build a footing and foundation for Prescott Nursing Home on 140 Prescott Street, North Andover, Mass. CHARLES H. FOSTER d-et'g" /-/ 9;�ac BUILDING INSPECTOR CHF: ad 9 PRESCOTT NURSING HOME BUILDING PERMIT FEB CALCULATION 57,558 Gross Square Footage 57,558,x $15/sq.ft. = $863,370.00 Est. Cost $863,370. x $3/1000 = $ 2,590.11 Permit Fee cc ` fV! i�.N a.�i..t }1i• , ,a.. -e`! •+��.�. ''I�. C^. a�..,; ;�l�r,✓�.t.� •.� Cj • ;'A `? •' .., "•'.', i. ro , , W' �,,N ',•N ';, � � y' t '•`y •iP:n .Na :,N � � f4";r_ ,,,'i•:.'r •w; E.•j �'JI.. Cil 0.3 ;!-w� ,l,- j;, ��t"f. 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O O� ^., a U 0\0 a U >H �'3 �D q � H H a `?' 1-- E-- � r; Cl' C) ca U) E5 R•' 0 U 0 O Sn at 4-1 N �+ ` H � �. U) z w 4.j 0 q ... ti 00 04 x H" p S•L J ;. �o E ' ° x 4J v . x a 04 c� p 4 H 5 YK to u3 Ln r a to 1-- E-- � r; Cl' C) ca U) E5 R•' t .1 BRIGGS ENGINEERING & TESTING COMPANY, INC. CONCRETE PLACEMENT REPORT . A/ Project No.: r,77, Forms Inspection .Project: -C )7 pl�-C Form Temp.:,,-! /./(T- '"7 Bracing: Straight: Ae,7 Date: Report No.: I 1 6 Weather: S Clean: Est. Ambient Temp. (OF) Est. Humidity Wet or Oiled:,- Hi el,9 Low ,3"-) Hi Low Corners: Est. Wind Velocity (MPH) Tightness: Hi Z Low Height: Steel Inspection Curing Steel Temp.: 11ttVertical: F, r -r How Lifted: Straight: 4M,> tot 1,)S 7 10, Clean: Corner Ties: Tied: Clearance: Noh-Compliances Type Who Advised How Corrected 2 3 4 5 6 7 Job Hours: ki Travel Time: Mileage:_ 1-011 I'S I P: Submitted: -(- - - I - - Approved: Dudvi "Itc?, MOR. ect No. /V-0, Project: oc ► CO ► vu UU ANY, ING. CONCRETE TEST SPECIMEN REPORT REPORT NO. FOR OFFICE USE Date of Placement: U _. r' C� _ Z6 No. and Type of Specimens Cast: /fir e a Ld Placement Location: r Specimen Nos.: Mix Proportions (by weight) 1 c.y.•Dry Amount Brand or Source ,Cement (lbs.) Fine Aggregate (lbs.) Coarse Aggregate (lbs.) A.E.A. (oz.) WRA (oz.) Water (gal.) /" f Other Sand Factor: Cement Factor: bags/c.y. Max. Size of Agg.: 3�tf Inches Humidity: .�l "•, Temp.: -7 ° Concrete Source: �J /'. .( Contractor: r, �3 1G Nov Temp. of Mix: er Slump: G� Mix Air Content:•'•' • � Duration: - r S By Whom Prepared: n _., • �. i" t ��Or Method of Transportation: r..P ,• r Storage Location:' - — Curing Box: Other:' Days Field Cured _Temp. _Humidity Days Lab Cured Temp.._ Hurr.;. j Plastic Field Unit Weight (p.c.f.) FOR LABORATORY USE Unit Weight: 28 -Air Dry Unit Weight: p,c.f, Unit Weight as received in Lab:_ /-43.Z_p.c,f, Oven Dry Unit Weight: p.c.f. Required Strength: (P.S.i:) Compressive _ ? ) ') Split Tensile Flexural TCCT DCci it Tcc Specimen No. Date Tested 3 Day 7 Day 14 Day 28 Day 373 7 �3 1G Nov G� REMARKS: Lb W 7 bQ�� (ZE;St� LTS Submitted: /Approved: (:i: i :a rvica CF -3 -:,- 1: FT, 10 t3l n: 110 uj C) ti t7FI z 10 100 13 in N co Li N) �D -j T Ln J�, to L4 3 C4 ro t. 0 (D cA, CI :Z) O G7 H t 0 W r\j Cl. ON 0 X pl- 7 x to N, rt ro 0 (D (D 0 rt P (D P) ft n :.,r (D 0 :I cl, � 0 ft I -t) 0 10 (D (D tito X (D ti rt p: n H. 0 x 5 - n c:: Cy (D (D rt 10 t3l n: 110 C) ti t7FI z 13 in L4 C4 ro t. 0 C, cA, CI :Z) O G7 H t 0 W r\j Cl. ON BIR.I.GJ4 ENGINEERING & TESTING COMPANY, INC. Project No.. A _ •— Project: ✓ fJ iy Date: t Report No.: 1 Q 2 9 Weather: , Est. Ambient Temp. (OF) Est. Humidity (%) Hi " Low .531 Hi r`I S" Low Est. Wind Velocity (MPH) Him Low , �C Steel Inspection Steel Temp.: c ,..•I How Lifted: Straight: r Clean: ,V Corner Ties: Tied: •�! F. Clearance: Non -Compliances Type i! 2 3 4 5 i I 6 7 Job Hours: Travel Time: Mileage: Submitted:_ CONCRETE PLACEMENT REPORT Forms Inspection Form Temp.: •`4ri %1 e..,t Bracing: Straight: Clean: Wet or Oiled: 'q i ! •c' cC Corners: Tightness: J � 1 Height: Curing Vertical: Horizontal: Who Advised I How Corrected LOUIS J.(1(� lnFi Tl r- Approved: PP 11...:11 ,i•ii �: .. n • ct 0 77 60/ Fj N N td (Do CD cn W oqbd td Wcon v o b tj H cyD P 0 • CD 11 ct co 0 M CD V(DFb O ,' dcc),,' a wti a 0 CD coo H 06 �dc� N 'U JC }O IDn tip 'y �Pi FJ CD N y 0 ED W . �•H o�p NHo�1 Z 11013 or G) - o Rl Qq & O a P �c�t a �► rn M 0 ct ct bd 0) (D p' CD �c�tWy Svtd ct�S Fa o CD CD b CD 0J ct• F) COnoct 0 � •I• cainMQ9N N0 �'� N-'~ct,-N NctF.y t� �1 J 0 CD CD 00 m N 0 ►d y cCD}- F(a'• F� CSD 0c) c(D Oo) ctp P C~D• 0)0 � co o ct- 0 H -y O O~ � y cw a ctO� ct• p a O CD O O CD d Moo 0 v pOO � Hw£ •Ft p CDFOb 'dd�p 03 Ct. a w .4 CD CD o l `t H 0N B• HN p ooN`t cn cn CD I- CD 0 oa ma Ccs 0) co CD W FJ • b' Pi CD CD dCo toi b F� to � MCD sv oCD M ~ �Nc�t A FJ- Cf V co O rn Cp CD N• CD o c w CDCD p .. 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APPROVED BUILDING INSPECTOR, Town of North Andover ^J f- -rC?IL,E iT h LATH PM- RF -VISION HK� i ;- ------ - -AD- o - 0 m2 S "`'}"i C -1 n m ' 4 n O 7r, • A -S O -S 0 m2 S "`'}"i C -1 n m C+ 'S O --1 C+ m n O 7r, • A -S O -S 3 fD 'S O• = O • ,.��fD n -n •S 0 C 0- • < in. m Or 0 • S C� m C+ C+ -+• 0 m f J• m :E N tv O O" 'S fL O O SL m O t+ < fb CD •S O• fl O O O J. N a- < O C+(�+ 0 M O N W fD fD O.. -�• -s N o O C+ =r s fi C+ 3 -� a m to o, c tv tv O = J••v O I ? 'S J-+• < N i m O 'S m -S fl J. : CL C+ i < O — 23 m w -+• • D v� m J• m a. 0 m 'S �• N m • S -S -+ ^s -+• C+ J. O (D � � .1 J. t7 J•ta � �� a. << tL -+, -h 0) m m << C< CL i O iw J• C+ to O O Q CL � << f3D O -0 O N i O J• = to O IV J• C-) C•+ C+ J. C+ m O C+ 'a O O --1 (D N N =O CLO -0to m m O tOn -0+► AS+ Ct. n 0) 'S --f Q *tz m < Ci -mss �•f a 0 C+ r- c► tr J. J. -0 m (D O — : 0 O C+ —•v 0 -S C+ J• • CC) _ J. J Jw fv-S N -0 O' o. on J. 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