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HomeMy WebLinkAboutMiscellaneous - 36 KIERAN ROAD 4/30/2018�0141IZ61-W AIZ6 lzle-- . - ,• L� I rccLtASt FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permi ts Boards and ^apartments having jurisdiction have been obtained. This does no`" from the applicant and/or landowner from compliance with any applicable or t relieve requirements. APPLICANT FILLS OUT THIS SECTION F APPLICANT �� 1 Q D� (qH u� t Sod vftS I �c , PHONE 7 . cl 2 • I LOCATION: Assessors Map Num�r PARCEL SUBDIVISION R-1 LOT (S) STREET 3(o t vaV% ST. NUMBER """OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: `l___� num"MIJ I KA I UK DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED UK -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS ------------- DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE 36 Kiernan Road: BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 TEL. 682-6483 Ext. 32 or 52 Ms. Conboy stated that 36 Kiernan Road has tied -in. She received the order from DPW and they're all set. AT . Ms. Conboy and is off notice from BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 TEL. 682-6483 Ext. 32 or 52 stated that 36 Kiernan Road hooked -up to Town sewer the agenda. Ms. Conboy is waiting for the tie-in DPW. A lengthy discussion regarding tie-in fees ensued. stated that the tie-in fee is $1,000 which does not included cost of the construction which will cost at lea Mr. Osgood Crouch, Chairman, Board of Selectmen was the least $1,000. Mr. there is a betterment assessment which allowsthe cost and stopbe paid over a twenty (20) years period which is bonded by the Town. paid MacMillan asked Mr. Crouch how do the citizens Betterment Assessment and how is it r• go through $60.00/quarter) Mr. Crouch stated that a the Townwould($50.00/year or warrants and go before Town Meeting. issue Special Town -Meeting might be held intheall,erouch believes a ,AORTH Of<"`D 'e1ti0 O 9 t i BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 or 52 LETTER OF COMPLIANCE CASE# 23 DATE: July 12, 1991 TO OWNER OF RECORD Mr. Curtis Davis 36 Kiernan Road North Andover, MA 01845 PROPERTY LOCATION 36 Kiernan Road North Andover, MA A Health Department ORDER LETTER dated May 10, 1991, was issued to you as owner of the above mentioned property. A reinspection of this property on July 11, 1991, and documents from the North Andover Department of Public Works indicate that violations of the State Sanitary Code and the State Environmental Code (Title V)described in the ORDER LETTER have been corrected and that there is compliance with the ORDER LETTER. A copy of this letter is being sent to the person (s) who made the complaint. If the complainants have any questions concerning the Health Departments determination of compliance, they are advised to call or write the Board of Health within ten (10) days from the date of this letter. Very truly yours, Allison C. Conboy, R.S.; HO Health Administrator ACC/ cj p NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street • North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Housing Inspection Report 03. COMPLAINT #_ COMPLAINANT ADDRESS OF PREMISES OCCUPANT DATE OF INSPECTION - HOUR INSPECTOR Form #HIR -1 Action Press 885.7000 NORTH ANDOVER HEALTH DEPARTMENT 120 Main Street • North Andover, MA 01845 Telephone (508) 682-6483, Ext. 32 Housing Inspection Report A COMPLAINT # COMPLAINANT ADDRESS OF PREMISES OCCUPANT OWNER / //ilt'G / OWNER'S ADDRESS DATE OF INSPECTION ROOMS/VIOL-ATION-. HOUR i M INSPECTOR Form NHIR-t Action Press 885.7000 o ) APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. tlf tet'- 199 ff� Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. r, The premises are known as No. or subdivision lot no. Owner ! Contractor ,-1 Address .k' Address �../ Applicant's Signature j PERMIT TO CONNECT WITH SEWER MAIN, --Street- The Division of Public Works hereby grants permission to �' c to make a connection with the sewer main at %��'— S'tet subject to the rules and regulations of the Division of Public Works. Byl\ Inspected by Date See back for rules and regulations ivision of Public Works BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 or 52 May 10, 1991 Mr. Curtis Davis 36 Kiernan Road North Andover, MA 01845 Dear Mr. Davis: On April 25, 1991, May 6, 1991, and May 9, 1991, site inspections were conducted of your property at 36 Kiernan Road. The inspections revealed that your sewage disposal systems discharging to the surface of the ground, in violation of 105 CMR 410.300 and Title 5 of the State Environmental Code 310 CMR 15.02 (20) . 310 CMR 15.02 (20) Discharge to Surface of Ground - No sanitary sewage shall be allowed to discharge or spill onto the surface of the ground or to flow into any gutter, street, roadway, or public place; nor shall such material discharge onto any private property. You are hereby ORDERED to have your septic tank or cesspool pumped IMMEDIATELY and provide a copy of receipt for service to this office. You must also continue to have the system pumped as often as necessary to prevent further discharge of sewage to the surface of the ground. Further, under the authority of 310 CMR 15.02 (12) and MGL Chapter 83, Section 11, you are hereby ORDERED to connect to the common sanitary sewer on Kiernan Road within 30 days. You have the right to be heard by the Board of Health if you feel this order should be withdrawn or modified. To obtain a hearing, you must file a written petition with this office within seven (7) days of receipt of this letter. You also have the right to inspect and obtain copies of all � M w Page 2 36 Kiernan Road North Andover, MA 01845 relevant inspection or investigation reports, orders, notices, and other documentary information in possession of the Board of Health; the right to be represented at the Hearing; and that any affected party has a right to appear at said hearing. Failure to comply with this order letter will result in legal action being initiated against you. Please feel free to contact me with any questions you may have in connection with this matter. ACC/cj p Very truly yours, Allison C. Conboy, tS.,;- CHO Health Administrator 4- - k wr� a I LVA "a Ms. Allison Conboy Health Administrator 120 Main St. North Andover, MA 01845 References Certified letter P 844 208 161, dated May 10, 1991 (received May 14, 1991) Attachment; Receipt for septic tank cleaning. Dear Ms. Conboy, Our septic tank was cleaned Saturday, May il. Note that we are interested in clearing up this problem; the septic tank cleaner was called nearly a week before we received the letter ORDERING us to do so. It is puzzling to me that having a septic tank backup (which is generally solved by cleaning -the tank) warrants an order to hook up to the sewer. Nonetheless, we are taking steps to connect to the sewer as soon as possible. Given the sluggish response we are getting from contractors, I don't yet know whether this can be accomplished within 30 days, though this is certainly our goal. (Note that the pipe which was found at the edge of our property is part of a perimeter drain for diverting the abundant ground water run-off from the hill behind our house. It is not connected to our septic system, and there is no "overflow" pipe an our septic system.) Si ncerel y I 2 Curtis Davis 36 Kieran Rd North Andover, MA 01845 �� 4�Aa ,r � .. ASP .. ...a• ANDOVER SEPTIC PUMPERS Tel. 475-2593 12 Dale Street Shop:, Locally Owned Station .0 dind Operate&4. ;Andover, 01 d EST. 195?AL ,.umped dry well dumping fee charges. 'X gg.ng 'Rbath e,d pipe DESCRIPTION Pu"m"pe d septic tank rz. ,.umped dry well dumping fee charges. 'X gg.ng 'Rbath e,d pipe ;cap End '81 �Z) INVOICE -PAY FROM THIS BILL TERMS'OF PAYMENT: NET 30 DAYS FINANCE CHARGE OF 1 1/2% PER MONTH WILL BE ADDED TO ALL PAST DUE BALANCES. THIS IS AN NO' LFiATE OF, 18%.' SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the "FETURN,TO" space on the reverse side. Failure to do this will prevent this card from being returned to you. The return receipt fee will provide you the name of the person delivered to and the date of deliver . For additional fees the following services are available. Consult postmaster for fees and check box es) for additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery. 3. Article Addressed to: 4. Article Number Mr. Curtis Davis P - R44 208 161 Type of Service: 36 Kiernan Road North Andover, MA 01845 ❑ Registered ❑ Insured Certified ❑ COD Express Mail Always obtain signature of addressee or agent and DATE DELIVERED. 5. Sign E — Addressee 8. Addressee's Address (ONLY if X� — requested and fee paid) 6. Signature — Agent X 7. Date of Delivery ra rorm sts i i, reo. lYtso DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name, address, and ZIP Code in the space below. • Complete items 1, 2, 3, and 4 on the reverse. • Attach to front of article if space permits, otherwise affix to back of article. • Endorse article "Return Receipt Requested" adjacent to number. flip U.S.MAIL �a PENALTY FOR PRIVATE USE. $300 RETURN Print Sender's name, address, and ZIP Code in the space below. TO N. ANDOVER 120 MAIN STREET BOARD OF HEALTH N. ANDOVER, MA. 01845 P 8, 4 4 208 161 Certified Mail Receipt No Insurance Coverage Provided -151 C--= Do not use for International Mail w%Eps*E.. (See Reverse) Sent to Mr. Curtis Davis Street & No. 36 Kiernan Road P.O., State & ZIP Code Nnrth Andover, MA Postage 2 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, & Address of Delivery TOTAL Postage & Fees $ 2.29 Postmark or Date_ WY�1.4��1 Paid,j sent on 5/15/9 *Janaa) 0661 aun : `008£ MO -d Sd N O 2.= `-S O AZ C UccH N — N r E a E " 9 W ui= ' 0 0 aye co m N m m 3 Z y a o c.v. Y _� _ CL W E U E O E O O M N N t v O c c a y w E S¢ 2 d a p E N 'C o o cc a uo 'ia a o ai p WQ ?o E� �Yw �'aA o.E CC •- N E ,e a E O c a> m caw h« yL~-.� c m y c cJ�iG L� aNit a LL U r fQ d U L O tL0 0 C n E W a¢A m Y N GL u C N U r O W d r 'i= d N E�oi U nm C A 3Aai� i -oj mW � �� «• 90 m5 � ` o ___. o. y c as ntXEE �Eot~I► dW Zd a _ E p W �` �+a 3 z -o EQ '�d n Ic �H -,5 U) m c. � U .L..r CC W — A_ —O —�aW V ?� T N C uci u] d (6 ��j-40M BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 or 52 May 10, 1991 Mr. Curtis Davis 36 Kiernan Road North Andover, MA 01845 Dear Mr. Davis: On April 25, 1991, May 6, 1991, and May 9, 1991, site inspections were conducted of your property at 36 Kiernan Road. The inspections revealed that your sewage disposal systems discharging to the surface of the ground, in violation of 105 CMR 410.300 and Title 5 of the State Environmental Code 310 CMR 15.02 (20) . 310 CMR 15.02 (20j Discharge to Surface of Ground - No sanitary sewage shall be allowed to discharge or spill onto the surface of the ground or to flow into any gutter, street, roadway, or public place; nor shall such material discharge onto any private property. You are hereby ORDERED to have your septic tank or cesspool pumped IMMEDIATELY and provide a copy of receipt for service to this office. You must also continue to have the system pumped as often as necessary to prevent further discharge of sewage to the surface of the ground. Further, under the authority of 310 CMR 15.02 (12) and MGL Chapter 83, Section 11, you are hereby ORDERED to connect to the common sanitary sewer on Kiernan Road within 30 days. You have the right to be heard by the Board of Health if you feel this order should be withdrawn or modified. To obtain a hearing, you must file a written petition with this office within seven (7) days of receipt of this letter. You also have the right to inspect and obtain copies of all Page 2 36 Kiernan Road North Andover, MA 01845 relevant inspection or investigation reports, orders, notices, and other documentary information in possession of the Board of Health; the right to be represented at the Hearing; and that any affected party has a right to appear at said hearing. Failure to comply with this order letter will result in legal action being initiated against you. Please feel free to contact me with any questions you may have in connection with this matter. Very truly yours, Allison C. Conboy, RV; CHO Health Administrator ACC/cjp !01 1M...,w.,.: Y x, x' t' ems} " r' . t + - _ • AF� VF n r 9t F r �•�. _ I 4zr � t� � � � V• w w / w •�,' vi vs r Via• {1L NJ CID cv rk in Iq Ir IN ZISS t�P;:}l'�t•tc' i r `}.�''i''�s+��y�k«'s'•/ rir, x Qii /plc ,�, � 1 : V P � •• � ``,� .. � - '� lc% V V rs: jC1 i u • � T ae� � } V "ti Z yam. •. ' '�-i- lO , L� � � �� ., f ✓ i ' 1 i �• �`� �"'�'r�� � ,mss '�, O �. ... � "'"�, �{ �` t��' 1.x3 t7,� �,.'°���7 ;..,/� '����.,��r � 'N �' V �F ��s'«�••'.,d v, � Y 2*`�V f• «,.•F4 �b L �Ss ,�r- 1 � ' N '��'c�^ (� ,Vct \.7 • � fig" ,� . A. J�• W�-,j�4"y+L'i�w ... " i-�' _.; ���/,/ �"-t "'"' a M1 E .'.4. %`-� �.�w� i. •� , �. �i C• �'�� . 'S'••:. 4 `►-G. V Q `` O "t Wit; � � f / +tj .'C� � • �O � k1'��` rig a <a'!. � �. a x'' � �� f ,'�, / / � � � ..^�/ , \/ � /. �� y ns t /G �� 1✓ / M ,V�e • • 'P �ry��y'6�y��• ��r ' E'�i � � ••yH/�.' 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Y d r Itr � °r r!} A)''rt,. . xA+ <e}4 1 �i7 J",-. d,�..��r +l •,�i /}i '-',iq � r ,��:. ,f%, y�•'xS� �5���#l7�,(?��.h7 :•'i.'x r •4�� y. �. '"` g �:.�f�rr ���f ,,tA�r � :I �' t err if `' y�-.� .irrb •4', .r}f. , s��; .�T3�„ ; iL41. !� `.1 g• rttT�.ri'r. ,�"S'�MG-t•t�`�'j�k r; Y+r r ! `�'.' 1L.: ,G'�' 1- r . I s7ri {,r x,t r➢ !rr .�E , CG,ta,da �h?ug.r,r (i' �V i> fN ✓ i f^e,3t�n•y.7,r4• , 1�y' � IN, c, �: : , .. E�^�j�l^y�i�, •i✓ V J '11' o t� }53 �j. ,.'.r a � �� r R.^ \'� rr r��'a. ���,r�r� t+'' ''+ .'ra '�! div. t•ll �'y •r � / l . . Z� ( r.'1;'i .B,L e !. ��, �Fj. �3 ! ° F''�s.� =%csrrt /:d •1 f .rrn i STEVENS ANALYTICAL LABORATORIES, INC. 38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114 FAX (617) 438-0173 V 4/29/ 4/29/93. LABORATORY NUMBER: 12640 SAMPLE DATE: DATE RECEIVED: SUBMITTED BY: NORTH ANDOVER BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MA 01810 ATTN: ALLISON CONBOY COLLECTED BY: CLIENT SAMPLE SOURCE: ' _(3; WATER SAMPLES (AS NOTED BELOW REFERENCES: 1) STANDARD METHODS - FOR THE EXAMINATION OF WATER AND WASTEWATER, 16TH EDITION 1985. 2) METHODS FOR CHEMICAL ANALYSIS OF WATER AND WASTES,_ EPA/600/4-79-020 REVISED MARCH 1983. SAMPLE SOURCE -Zia W Kieran Road -25 Essex Street Butcher Boy Rear Authorized by: FECAL COLIFORM per loo ml 10,500 240 <20 OAR Alan P. Stevens, Laboratory Director 1I A t STEVENS ANALYTICAL LABORATORIES, INC. 38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114 FAX (617) 438-0173 Allison Conboy North Andover Board 120 Main Street North Andover, MA Dear Ms. Conboy: of Health 01810 May 1, 1991 In recent months, we have implemented a purchase order system. All samples received by our laboratory now require a written purchase order number signed by an authorized representative of your company. If a representative from your firm is dropping off samples, a purchase order, as described above, must accompany all orders before we can begin processing your samples Likewise, if our field representative collects the samples or picks them up, a purchase order must accompany the samples. We do understand that many companies do not implement formal purchase order systems. This being the case, we ask that you submit a written statement by mail or fax authorizing Stevens Analytical to perform the work with a reference number for our use. This .can be a blanket number for a year's period of time if you desire. If a different address is necessary for billing purposes, we would also appreciate having this information at the same time the purchase order is issued. Please notify all necessary personnel of these changes. If you have any questions, feel free to call me at (617)438-6114. Thank you for your cooperation in this matter. Sincerely, Alan P. Stevens President i o H � V D m a ,\ rn m m H r r r `z vEf.,. m z z 1 O O �e c_ c c_ N N N S S = in mm o �C m CD m m 9 O N N N COMP. GRAB o = a V1 ► 1a. 1 1 c c v o 0 D D m m m D � m m m hi an n z rn m XE \ cm :ECD o m O H N n - ' O NUMBER (A D x cC r m � m_ CONTAINERS O o H � V D m a ,\ y 0 H Ir � vEf.,. m z 1 �e \' o �C m 9 O COMP. GRAB yy ` y *d z � D � hi O XE \ O NUMBER OF CONTAINERS O (0/ m n � o cr AC � CtC c c H g o H � V D m a ,\ y 0 H Ir � BOARD OF HEALTH Mr. Curtis Davis 36 Kiernan Road North Andover, MA Dear Mr. Davis: 120 MAIN STREET NORTH ANDOVER, MASS. 01845 01845 May 10, 1991 TEL. 682-6483 Ext. 32 or 52 coy", P ( cc2 Irk On April 25, 1991, May 6, 1991, and May 9, 1991, site inspections were conducted of your property at 36 Kiernan Road. The inspections revealed that your sewage disposal systems discharging to the surface of the ground, in violation of 105 CMR 410.300 and Title 5 of the State Environmental Code 310 CMR 15.02 (20) . 310 CMR 15.02 (20) Discharge to Surface of Ground - No sanitary sewage shall be allowed to discharge or spill onto the surface of the ground or to flow into any gutter, street, roadway, or public place; nor shall such material discharge onto any private property. You are hereby ORDERED to have your septic tank or cesspool pumped IMMEDIATELY and provide a copy of receipt for service to this office. You must also continue to have the system pumped as often as necessary to prevent further discharge of sewage to the surface of the ground. Further, under the authority of 310 CMR 15.02 (12) and MGL Chapter 83, Section 11, you are hereby ORDERED to connect to the common sanitary sewer on Kiernan Road within 30 days. You have the right to be heard by the Board of Health if you feel this order should be withdrawn or modified. To obtain a hearing, you must file a written petition with this office within seven (7) days of receipt of this letter. You also have the right to inspect and obtain copies of all 4 I Page 2 36 Kiernan Road North Andover, MA 01845 relevant inspection or investigation reports, orders, notices, and other documentary information in possession of the Board of Health; the right to be represented at the Hearing; and that any affected party has a right to appear at said hearing. Failure to comply with this order letter will result in legal action being initiated against you. Please feel free to contact me with any questions you may have in connection with this matter. Very truly yours, Allison C. Conboy, tS.,; CHO Health Administrator ACC/cjp J. J. Segadelli, Inc. Lot # 17, Kieran Road APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot # 171 Kieran Road . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover, Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed ea. I will install a con- crete septic tank of 1000 gal* in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 180 lineal (dam feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the -crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/41' (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the centerlines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE r�%./%i %, /%6 S� t Signayture of A4fplicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Olignature of Health Agent I have inspected the uncovered system indicated above and find everything done as descri ed. DATE 10 Signature I Inspecting Officer Percolation Test 4 mina Soil: clay Garbage Grinder No BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. sole. o� � o _ .� r �000f-�A� C►®..JL.7'p� to -40 aZ 6, d-6 7 2- IA- '� a 1. NAME e cL o%P/�i -4 c DATE i d � 2. ADDRESS LOT N0. '/ 7 TEL. 3. H0. OF BEDROOMS j� DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. W-14 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE September 18, 1965 NAME OF APPLICANT J. J. Segadelli, Inc. LOCATION Kiernan Road, Lot g17 Address of lot no. BUILDING: Dwellin X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND a high SUBSOIL: Clay X GravelSand PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1� nnn gallon capacity. LEACH FIELD 1f3GL_ lineal feet of drain pipe. William J. iscoll, Enginitrer .__. Board of He lth j 0fie Cnumi>t�n�lt;iettltlE of �us� �cllu�actt�, I)Nprntnren/ of PuLlic Safety Permit Nn. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:0() Occupancy R fee (1 -eked _ 3/90 (leavo blanla APPLICATION FOR PERMIT TO PERFORN't ELECTRICAL WORK All work to be peifomwd in accordance with the Massachuseltc Fier f6c,ll r „rte, ,27 CMR 12:00 (PLEASE PRINT 1N INK OR TYPE ALL INFORMATION) City or Town (if The undersigned applies for a permit to perform the electrica Date YL�/�% To the Incpeetor of \hirer Location (Street R Ninnber) �3 .2 z eKAZ /,1619,0 Owner or Tenant EI -12A6,6722 `ZA 1Vf 6:4X) Owner's Address Is this permit in conjunction with a building permit: Yes U No U (Check Approp iate Box) Purpose of Building; UtiLly Auth(ai;ation No. Existing Service _ Amps / Vnits Ovedwad 0 Undgrd ❑ No. of Meters New Service Amps /_ Volts Overlw,ld LJ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ___LHC OTHER: SFP — 6 INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial ,,lowalent. YES O NO D ! have submitted valid proof of same.to this office. YES O NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE U BOND ❑ OTHER❑ (Please Specify) nA✓ "riz (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME FhmQ Ai Pagllemni Final LIC. NO. TLq-q--,ax Licensee Box M 23 Mgdn St__ Signa �rre /L _.._ I.IC. NO. AddressAtkin -1 N -H- 03811-- _ _ _ ______ Bus. Tel. No. 1-6034%2AM All. Tel. No,4501_3 Qi DSS OWNER'S INSURANCE \•VAIVER: I am aware that the I.icensvo does not have the incuran(e r'ovei,w- ire �uhctintial Pquivalent ac rerliiirerl by Mascar huceltc .General Laws, and that my signature on this permit application waives this requirement. Owner Acent (Please check one) Telephone No._.-._------.--.---.-._._. - PER+.11I FFF 4�S �..----_-- (Signature of Owner or Agent) TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA A ove❑ In - No. of Lighting Fixtures SwimmingPool rod. �nul. Generators KVA No. of Emergency Li,hting No, of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No of Zones No. of Detection and _ 1i1't No. of Ranges No, of Air Conditioners Tons Initiating Devices No. of Sounding De% ices Heat Tota Tota No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Uevif ec _ No. of Dishwashers Space/Area Heating K\N MunicilMI local❑• Connection ❑Other No. of Dryers Heating Devices K\b' No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: SFP — 6 INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial ,,lowalent. YES O NO D ! have submitted valid proof of same.to this office. YES O NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE U BOND ❑ OTHER❑ (Please Specify) nA✓ "riz (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME FhmQ Ai Pagllemni Final LIC. NO. TLq-q--,ax Licensee Box M 23 Mgdn St__ Signa �rre /L _.._ I.IC. NO. AddressAtkin -1 N -H- 03811-- _ _ _ ______ Bus. Tel. No. 1-6034%2AM All. Tel. No,4501_3 Qi DSS OWNER'S INSURANCE \•VAIVER: I am aware that the I.icensvo does not have the incuran(e r'ovei,w- ire �uhctintial Pquivalent ac rerliiirerl by Mascar huceltc .General Laws, and that my signature on this permit application waives this requirement. Owner Acent (Please check one) Telephone No._.-._------.--.---.-._._. - PER+.11I FFF 4�S �..----_-- (Signature of Owner or Agent) -. ..-4p}„-��,�; yam,-•• ..;.,f•�..c- 431 �aOR7ry Ot<11.0 '•..�'O F A ,SSACH l "j 5'--.�-.w'�Vi:.�+•^-^Y+Z.. f"".+..o.,,"i5Lr'r^y�yy.' Date .....��.. ..�. ..�c..lP... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... P.L. A........l ...1>. .11?. ................................... has permission to perform .... W. ........... S 4 sk:p/i............... wiring in the building of ................ c...,1... `........................ at ........ ................. r..........................��d.................... , North Andover, Mass. Fee....�5.:.(!)... Lic. No................................................................ ELECTRICALINspECCOR C E i � I �, I r 10/96 15:50 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:.Treasurer I + 0V ' .TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .A.. - „ __ n v h'M" � � � ➢+y��F4 "�_ 3 5. '. 4S` ¢P�i N BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: J&4� A7�r Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Ad 1.2 Assessors Map and Parcel Number: 0 _�rj 0� ` Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft WELDING ILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHMAUTHORIZED AGENT Historic Ulstrlct: Yes No 2.1 Ownei of Record W IWAM Name (Pn t) Address fo Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Duval Roofing Licensed Construction Supervisor: P' o. Box 63 0 NOI* Reading, MA License Number Address �^ /0z7 L / Expiration Date t lure Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name R� b 2p2s' k p,�. Box 637 Registration Number Ad ess Notth ea �] % alsfA q ?�G6 ���5--7 / C7 Expiration Date Signature a" die M z G) --.--Telehone I + 0V ' .TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .A.. - „ __ n v h'M" � � � ➢+y��F4 "�_ 3 5. '. 4S` ¢P�i N BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: J&4� A7�r Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Ad 1.2 Assessors Map and Parcel Number: 0 _�rj 0� ` Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft WELDING ILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHMAUTHORIZED AGENT Historic Ulstrlct: Yes No 2.1 Ownei of Record W IWAM Name (Pn t) Address fo Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Duval Roofing Licensed Construction Supervisor: P' o. Box 63 0 NOI* Reading, MA License Number Address �^ /0z7 L / Expiration Date t lure Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name R� b 2p2s' k p,�. Box 637 Registration Number Ad ess Notth ea �] % alsfA q ?�G6 ���5--7 / C7 Expiration Date Signature a" die M z G) SECTION 4 - WORKERS COMPENSATION (AG.L. C 152 § 2506) 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 buildiag permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s). ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: Oi SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICE USRONL " 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (e) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 G Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, L JILLA711Y4 /A • rt-JlM lffk� as Owner/Authorized Agent of subject property Hereby uthorize CVALPeDpi4&r to act on My b 1 ' r tt r relative to work authorized by this building permit application. �- 28 fl Signature of Ownt I IDate SECTION 7b O N R/ UTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Prim -Name" SiNature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 1 ST2ND 3RD SPAN DA4ENSIONS OF SILLS DINIENSIONS OF POSTS DEv ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NOTICE TO EMPLOYEES NOTICE EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD, CT 06183 ADDRESS OF INSURANCE COMPANY (7PJUB-73OK535-4-04) 02-17-04 TO 02-17-05 POLICY NUMBER EFFECTIVE DATES ARGEROS INS AGCY INC 360 MAIN STREET READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE # DUVAL, KENNETH P DBA 184 PARK STREET DUVAL ROOFING NORTH READDNG MA 01864 - EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 006208 W20P1G02 TO BE POSTED BY EMPLOYER M M m ocM y M y °m l y ffi 'O C � CA 'C O CD St Z y 06 o C, a, [7 c d= y a� o p aQ O cr " m CD CD MW 9. c, o co n0 y tO C 5 p V* O CDz.p a % O 0 a C S, FL '? O O Z a 2r m 6*4 7 m 00 C a U2 m I coo0 to Go �a im a CO) 40 CL O M= 5 m_a?m Mn _i o m � o y IE Or 1 0 m CL 4b. CL 10 Q CL C c�- m EL JE m. to (AP m� co a a� �o o • o m m o+ Cv 0 I - �q 0=3 0 0 bd 'Tl 7dorf 7d 'rl ,o I" CA 1 0=3 0 0 i ✓fie loomvrizo�uueai �/�raaacfuceeCfa BOARD OF'BUILQIN REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 058443 i Birthdate: 12/10/1966 _ Expires: 12/10/2065 Tr. no: 10052 f� Restnctedr00 s KENNETHP DUVAL� 1/9 PO BOX 190/72:NORTFi ST (.., N READING, MA 0186.4: ` Administrator e - p� ✓fie v� o rn�noaz+�e o�✓�aoaaczuael�4 Board of Building Regulations and Standards HOME IMRROVEMENT CONTRACTOR 'Lz Re istrations 109288 Ex ;nation - 9/9/2006 _ DUVAL RUUrirvu ,r Kenneth Duval '1 ! 72 NORTH ST mar ! G -. •"`� N. READING, MA 01864 Administrator 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 c 11, S 150 A. The debris will be disposed of in: clla� / R J of Signa ure of Permit Applicant /VA/Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 91 B TI1e Commonwealth ofMassachuselts Department of Industrial Accidents oCea11MOMMPMnns 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit riarner local ton• :iv t►hOM� 1 am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my RITIMPTijAIJIMIT MMMMMMt ' rt North Reading, MA on C] I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed the following workers' compensation polices. � V who have IN 111. l: fl 144 c:L7 s•2r��1::.�?° 1:1'i :a�. h� '.l. .1. -l. ..Ln� :�I.a lNl �� ��ui..::n:- �i =SM1 phone 0, insurnnre eo. RR�ltT p a a Failure to secure coverage as required under Section 25A of MCL 152 coo lead to iht imposition of ecimitul penalties of* fine up to 51.500.00 and/or wit •ears' imprisonment as well u civil penalties is the form of n STOP WORK ORDER end a•flat of 5300.00 a day against mt. 1 understand thai a cupY of this statement may be forwarded to the Office of lovestigattons of the DIA for coverage verification. I do Isere y Under ria paint and penalties of per%ury that the information provided above is tree and corrcu. Print orticisl ace only do cot write in this area to be completed by city or town offitlai NEVA07j"Alm city or town: permitnicensttl - riBuilding Dcpartmtut OLitensing Board Q check if immediate response is required ©sciectmea's MCC (3Heatth Department cuotaet persoa: phone M. rov,Othcr ,-em:Nt rlw) no of Pages • �� Builders License # 58443 Home Construction Reg. # 109288 CertainTeed/Certification # 1911 nn 0 GAF Certified Master Elite o THE . R F 00 DI C COLLLCTIO (959) 944-9994 (995) 064-2559 Ceriaifted R "The Areas Oldest Roofing Company" L, P.O. Box 637, North Reading, MA 01864 PRO OS UBMI EDT / r` . , . C."�� lLr�.ei- — - , Z..� Pk9NE , DATE J ST. � JOB NAME CI TATE AND ZIP CODE • /1 r ✓ f; t..-�+n JOB LOCATION We hereby submit specifications and estimates for: Recommended "r c (Included in price) Optional (Not included in price) Rip & Remove all shingle debris from roof & job site: ® 1 layer 2 layers ❑ 3 layers or more Repair/or Replace any roof decking; not to exceed 50sq. ft. W__1041nstall 8" aluminum drip-edge/and rake -edge along entire perimeter. Choice of mill, white or brown ye,o,''Install ICE & WATER underlayment along horizontal eaves, valleys, sidewalls and sky -lights & chimneys (.-'Install 30# felt underlayment between roof deck and roofing shingles Install 25yr CertainTeed/GAF/Tamko or Owens & Corning traditional 3 -tab roof shingles ❑ 30 year Install 30yr CertainTeed/GAF/Tamko or Owens & Corning architectural roof shingles ❑ 40 year ❑ 50 year ❑ 60 year ❑ Lifetime " See manufacturer warranty policy for more details Install new aluminum vent -pipe flange (s) ,✓ Chimney (s) -counter-flash and re -step existing flashing ❑ Cut & Install new lead flashing 40-101, Ridge-vent/exhaust vent with low profile design, hidden by shingle caps ❑ Soffit -ventilation ❑ Roof louver -vents • Seamless style aluminum gutters - custom fabricated at job site ❑ downspouts ❑ aluminum leaf guards Other 't_ . .� ,rr►, ..�" c= e . e� I — —j t, Price includes all items above that are checked only / others may be priced separately upon -request. Pe Propose hereby to furnish material and labor - complete in accordance with above specifi tions, for the sum of: Total price not including options. dollars ($ w ). Payment to be m e as follows: 30% deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of $50 per week for all outstanding bills due upon day of Authorizeda�- completion. Signature - Accepting proposal means agreeing to the terms of the enclosed binder Note: This proposal may be /] rontrart- Please sinn rnntrnrt R return ton rnnv (white) with rfennsit- withrirawn by I Is if not arrantari within Ll riavc Location No. ��� Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ --- Check # Z- 17772 Building Insiffl�ctor