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Miscellaneous - 458 FOSTER STREET 4/30/2018 (2)
458 fOSTER STREET �. 210/104.6-0014-0000.0 C i i N0. 7521/3-1 0 0 0 0 � J, 1� �� ��sem-, �,;�0 e�E , �...�� a- �.,cev �1����� �� � �� h��� c � • � I f I Commonwealth of Massachusetts i 0 City/Town of NORTH ANDOVER MAS - 1 SACHUSETTS System- ;I y em Pum in Record ping Form 4 �(4 V DEP has provided this form for use by local Boards of Health. The SZy d mu! be submitted to the local Board of Health or other approving authori RECIfIVED A. Facility Information Important:When filling out 1. System Location: forms to the /JERcomputer, use J Q only the tab key Address to move your cursor-do not ------,--Y--C—J------ ----/Town -- --- -- ---------------- use the return Cit y State -Zip de --�C--o`-- ---- key. 2. System Owner. C Name ----..-- - - - - -- renin ---___.----- Address(if different from location) - - ---_.— --------— ---- - ----------- City/Town .—...-----------------. (, Zip Code Telephone Number g4. . Pumping Record -- --- Date of Pumping 2, Quantity Pumped: Date Y p Gallons - Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No Condition of System: 6. Sy em Pumped By: Name -------- ----- ------------ - Vehicle License Number Company 7. Location where contents were disposed: Si ature of Haul �-- - Date -- -._..----- - -- - http://www.mass.gov/dep/water/ provals/t5forms.htm#inspect t5forrn4.doc-06/03 System Pumping Record•Page 1 of 1 RECEIVED .► � .. JUL - 6 2005 OWN Off, NORTH ANLN OV OWN OF NORTH ANDOVE U^ 1� �S" T"E? ?U11�()'�?� s R�aC) HEALTH DEPARTMENT 3 T a I t:M QWNER & kl)o SSS — S'YSTEMt LOCATMN 6 us lVo i DATE OF PV"NQ, S _ .. Sauer rank. Ni. t S V NA t`VKIS 0?l $g,'3i1�tG`E: tfUU'ttNb C! . f#1 k,i�iabPdt XV �3�-SE ___ _ BAFYLB3 IN FLAE�l, LEACHTI OXC9381VE SOLIDS���. �t�k:T3eLQ RUNBACK $OLrO CAR MOVE �...SJCfER EXP I AIh _. FORM U - LOT RELEASE FORM JCTIONS: This form is used to verify that all necessary approvals/permits from and Departments having jurisdiction have been obtained. This does not relieve ,plicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANTllU�'sy ► ,r�S PHONE 70 LOCATION: Assessor's Map Number lc)q 9 PARCEL / SUBDIVISION LOT(S) STREET I o-si'g ST. NUMBER 4/S *OFFICIAL USE ONLY R AT OF TOM VENTS: CONSERVATION AD INISTRATOR DATE APPROVED DATE REJECTED COMMENTS r TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEA DATE APPROVED DATE REJECTED / DTIC INSPEC R- EALTH DATE APPROVED DATE REJECTED i Z o 4} COMMENTS T `L �'v i � -,� ?� c S��G�S i S Z.).m �/�'i./Z'�.,C.x �/ C.—u-C ii �'7 ,�L�.• �.- // oL c-'tet.-�/ PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm 4 Town of North Andover NORTq Office of the Health Department F: Community Development and Services Division William J.Scott,Division DirectorArgo " °o•- -+-•,�±' 27 Charles Street ��IV CH Susan Y.Sawyer,REHS/RS North Andover,Massachusetts 01845 (978)688-9540-Phone Public Health Director (978)688-9542-Fax Date: October 12,2004 Address: 458 Foster Street,North Andover,MA 01845 Re: Application for: Addition and Garage Dear Mr. Rogus: Your application for an addition and garage at 458 Foster Street has been reviewed by the Health Department. The application was denied on October 12,2004 for the following reasons: 1. ❑ Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable 4. X Undersized septic system according to existing information on file. Please see attached assessors information indicating 3 bedroom,7-room system. To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house,septic system and proposed project in scale If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project If#4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerel viewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Residential Property Record Card PARCEL_ID:210/104.6-0014-0000.0 MAPA04.6 BLOCK:0014 LOT:0000.0 PARCEL ADDRESS:458 FOSTER STREET PARCEL INFORMATION Use-Code: 101 Sale Price: 297,500 Book: 05666 Road Type: T Inspect Date: 08/04/2001 Owner Information is ONLY available in the Tax Class: T Sale Date: 01/28/2000 Page: 0051 Rd Condition: P Meas Date: 08/04/2001 Tot Fin Area: 2307 Sale Type: P Cert/Doc: Traffic: M Entrance: C North Andover Assessors Office in the North Tot Land Area: 1.03 Sale Valid: Y Water: Collect Id: RB Andover Town Hall. Grantor: NOVAK,JOHN Sewer: Inspect Reas: S Exempt-B/L% / Resid-B/L% / Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CP Tot Rooms: 7 Main Fn Area: 1362 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 Story Height: 1.75 Bedrooms: 3 Up Fn Area: 945 Bsmt Area: 1362 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 160,736 Ext Wall: FB Half Baths: 0 Unfin Area: Bsmt Grade: 2 R 101 A 0.03 135 Masonry Trim: Ext Bath Fix: Tot Fin Area: 2307 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 174918 Str Unit Msr-1 Msr-2 E-YR-Bit Grade Cond%Good P/F/E/R Cost Class Kitch Qual: T Eff Yr Built: 1975 Mkt Adj: 1.2 SE S 80 1988 A A ///91 200 Heat Type: HW Ext Kitch: Year Built: 1969= Sound Value: Fuel Type: O Grade: AG Cost Bldg: 209,900 VALUATION INFORMATION Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Vall: Current Total: 371,000 Bldg: 210,100 Land: 160,900 MktLnd: 160,900 Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Prior Total: 281,300 Bldg: 171,800 Land: 109,500 MktLnd: 109,500 Att Gar SF: %Good P/F/E/R: /100/100/83 Porch Type Porch Area Porch Grade Factor P 42 W 150 SKETCH PHOTO W 150 Sq.Ft. 10 10yfi 195 FU"0.75/B/FM C 1260 Sq.Ft. 28 28 458 FOSTER STREET L w r 642 Sq. 102 Sq.Ft. 6 7 17 Parcel ID:210/104.B-0014-0000.0 as of 10/12/04 Page 1 of 1 r s 1 COIF MONO WEALTH OF MASSACHUSETTS - ;'� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE R'I\TER STREET, BOSTON MA 02105 (617) 292-550U TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ,4��F /,O5-e12 ,— CERTIFICATION ( 1 Property Address: N0 0 r, _ Name of OwnerV UG 1, p 5 Address of Owner: Date of Inspection:JI �S Name of Inspector:(Plee ase Print) 1am a DEP ap roved system i pector pursuant to Section 15.340 of Trtle 5(310 CMR 15.000) Company Name: N v e✓ is }, c Mailing Address: V;z ,Q.-'al j A_4 n� �l At/ Telephone Number: _ ? CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs F rther Evaluation By the Local Approving Authority Fails i Inspector's Signature: Dater s The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS Cm OF NORTH DOVER/ TOWN OF NORTH ANDOVER/ r BOARD OFHEALTH AUG 171999 E revised 9/2/98 Pagc l of 11 �� Tinted or Recycled Paper f r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'roperty Address: IL i 8 ` A—s ter �'�"°/ Jwr : v V 4 N �� V 4# r 1 Date of Inspection: Y-�- INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health;will pass. 4 � Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipets) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 1 5 IP revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Property Address: s ¢C t f'✓o N owner: z),—6 H/V w o V Date of Inspection: C. FURTHER E UATION IS REQUIRED BY THE BOARD OF HEALTH: pkConditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 11)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER +F 5 t 1'. revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: A/.T p 5 f 2 �7 /v ' A/ .L D Vic Owner- L/a H A/ h/o ✓f}�' Date of Inspection- D. SY TEM FAILS: You must indicate either " e r 'No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility-or system component due'to an overloaded orcogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. +Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: N. j-N You must indicate either "Yes" ' toeach of the following: The following criteriay to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No , s . y"^ , the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. 1 revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B �^ �J'* CHECKLIST t4 /V/ Prj'''� '/operty Address: V-5 O C IQ, f IV. .L/d Y Owner: J m # W Af© v 41 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) / 115.302(3)(b)I The facility owner (and occupants,if different from owner) were provided with information on the proper-maintenance-0f Subsurface Disposal Systems. e - r fit` r r •a r� ;r r revised 9/2/98 Page 5ofII r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION f Iroperty Address:f s? /'�o s �fff (' Y 4+S 4 N0 d Y e C,,, Owner: .T#w No ✓ I't" Date of Inspection:' 4p- -/ FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms (design):+ Number of bedrooms(actual):3 Total DESIGN flow Number of current residents: Garbage grinder(yes or no):-,E/FS Laundry(separate system) (yes or no):L--/Q If yes, separate.inspection required Laundry system inspected ( es or no) Seasonal use lyes or no): (yes / Water meter readings,if available (last two year's usage Igpd): /,y Pll Sump Pump(yes or no): ! .'3 ,r Last date of occupancy: f-,:Up( d Y COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: eased on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: lyes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: -V y v S System pumped as part of'nspection: (yes or no) � If yes, volume pumped: gallons Reason for pumping: TYPE 9F,SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach Eopy of up to dater operation and maintenance contract Tight Tank ' Copy of DEP Approval I Other APPROXIMATE AGE of all components, date installed lit known)and source of information: / Sewage odors detected when arriving at the site: lyes or no) ' ! V r revised 9/2/98 Page 6ofII r ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _ SYSTEM INFORMATION Icontinued) 'roperty Address: 1c; S i e e S ! , /1/. �9 v Owner: .� ty A(,o W /94 Date of I pection: r-,7 ,7f BUILDING SEWER: (Locate on site plan) rr Depth below grade: r Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Af�gL. Diameter 4,1 t' Comments:(condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK: (locate on siteIan) p 9 � r,�:. i t Depth below grade: Material of construction:!/concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age— (sage confirmed by Certificate of Compliance_(Yes/No) 6 Dimensions: "-t 'ice Sludge depth: of I Distance from top of sludge to bottom of outlet tee or baffle:3zf Scum thickness: /r, Distance from top of scum to top of outlet tee or baffle: ] Distance from bottom of scum to bottom of outlet tee or baffle: /V How dimensions were determined: /)/-/ C!?--t 'omments (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) T1.C14 r� � os /a ��/J� T/ ti 4-1lpe" Svc r yey � U GJV !� GREASE TRAP: (locate on site plan) rl Depth below grade:_ r Material of construction:_concrete_metal Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to'top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7ofII e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO�R/MATION,(Iccontinnuued) 'roperty Address: SS �D J�f �' fY. � r► _L/ o I/ C Owner: # n/ n/a it R K,. Date of Inspection: i'jr-97 TIGHT OR HOLDING TANK:/ , Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level, Alarm in working order: Yes No Date of previous_pumping: _ Comments: 4 1 (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) -o �- T o o 17 PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 ` r � ,1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(continued) `rope+rty Address: „� Jr- * 5\1 IV" R N( V Jwner: _ J o y N /)/.0 l4 k Date of r-If SOIL ABSORPTION SYSTEM(SAS): �� (locate on site plan,if possible;excavation not.required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number:_ leaching trenches,number, length: leaching fields, number, dimensions: 7� y overflow-&sspbol, number:__:c A, Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: j Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 i. �Y 4� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p SYSTEM INFORMATION(continued) Q . opertyAddress: O0 S �' �J I iM• 4/,2>D C l 1 S .Jwner: p V R l� Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate '` Deep SITE EXAM Slope Surface water -Check Cellar J khallow wells Estimated Depth to Groundwater Beet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data ^ Describe how you established the High Groundwater Elevation. (Must be completed) ,.- t �� 4(,, Sys.-z. ' 74 , A° revised 9/2/98 Page 11 of 11 458 FOSTER STREET JS-2005-0312 Proiect Detail Report Printed On: Wed Oct 13,2004 Project Name: GIS#: 5836 1Project No: JS-2005-0312 _ Owner of Record:ROGUS,JOHN J&LEE ANN Map: 104.B 1Date Submitted: Oct-13-2004 458 FOSTER STREET roe•..... .+ao — - --- �- - - --- - Block_ 0014 iStatus__ _ Open __— NORTH ANDOVER,MA 01845 Lot: iWork Category: Work Location: 458 FOSTER STREET -—— - +-- - - - ---- - ----- — — ------- - - Zoning: Proposed Use _ istrtct: ���'• .rs� land Use: 101 fiProposed Use Detail - Subdivisions _-- Description Form U-Addition&Garage Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0147 Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Form U Signoff-construct BHP-2004-0690 Oct-13-2004 DENIED JS-2005-0312 Addition&Garage GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) D ll:�'I'E OF PUMPING: �'OZ QUANTITY PUMPED Q GALLONS CESSPOOL: NO 2YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE _EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) i i SY:ST'EN1 PUMPED BY: CONIMENTS: C'ONTENT'S TRANSFERRED TO: Address , . _ S Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes. action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department • TZ' WN OF NORTH'ANDOVER-~ - ; �•,,, SYST M PUkPING RECORD ►)ATF: _ .. �; 7.003 �1 STJ:M OWNER & ADDRESS . SYSTEM LOCATION �- (example: left frost of house) . UATF OF PUMPINC: -Z- d.3 QUaNTiTY PUMPco/� CALL():>> ::i:aSl'UUL: NO YES` SEPTIC TANX: NO YES .r NATURE"OF SERVICE; ROUTINE EMERGENCY uIlSERV:ITIONS s' GOOD CONDITION. - FULL TO COY>rR HEAVY CREASE !BAFFLES 4N 1'LACL ROOTS LEACHFIELD RUNBACK- EXCESSI-VE SQLIDS FLOODED SOLIDS CARRYOVER RWHRR (EXPLAJN) >>'a' E.&I PUMPt. t3Y: • -' �' c.•ual tii FLATS: TRANSFERRE0 TO: \ P i " r..1 f f}"(`,tyf�•rtiv .t tr ' d - TOWN OF'NOZTH ANDOVEIL OYSTEM PUWI NG RECORD E DATCP y d M _ SYSTEM OWNER&:4DDRESS �-" R�N - ` y5 Fs4e� sT DATE OF PVMQg��{�{�U Qu UMPED l�0 D . ANTTTY�P CESSPOOL NO YDS < $BPTIC TANK NO- YES —Z NATURE OF SERVICB;;,R.QYIINE EMERQENCI` OBSERVATIONS; ' li QOOD CONDITION`,"'"FULL'TO COVER HEAVY OREASB " . BAFFLES IN LACE ROOTS LEACHFIELD RVNBACK BXCBSS.m SOLIDS 'FLOODED SOLID CARRYOVER_ OTHER EXPLAIN SYSTEM PUMPED BY COMMENTS; CONTENTS TRANSFERRED TQ`!"-- )g �>Yc- C� - FORM - U - LOT REILEASE FP; INSTRUCTIONS: This form / ;;x-is used to verify that all-necessaryapproval � 3 ` 0 Departments.Navin aPP val!permits from Boards and D eP g Jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. �i.EtE/Eit.E■iEit/iE'i■/■■ili.■tE.EiiiE■i■it■EE/■tE•i'iE■Wee a ass'!.■'//■■/Et:t.IS it/lEtt APPLICANT PHONE ASSESSORS MAP NUMBER �f!3 LOT NUMBER 7 SUBDIVISION LOT NUMBER STREET STREET NUMBER ass E�iE•ii'!'Eowns-/'/■t-t'i■I'.i/■i■�i.E.EE.iE-. fEEiii■/'•EEEsEiii,■/.E/i•/iiiEEi//.ice//,*EEE 01MCIAL USE UNLY ,E'i/■l ii ilEfE//'i!//�i.•ti/i/.i�/iE/i'.■ii■iiiiE/E.i/Eii//_it■ti,■i.i ii./.130110RECO ATIONS OF TOWN AGENTS WE Ni//■ i/■'s./EaaE:// ep Et.iE/tEES/EiiiEs.it//iniiii./iii!'EiEittEEt/EE'///E/IE�E■ CONSERVATION ADMINiS tZ OR DATE APPROVED Ila l V,! DATE REJECTED COMMENTS • "3 /06/ it M p�aROZ� d 's TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED ;FOODZC OR-HEALTII DATE REJECTED CTOR- DATE APPROVED j DATE REJECTED COMMENTS A � PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR - DATE asscl iTQvn �Qf�NORTfi HANDOVER MA SACHUTTS system Pumping S Reca�d y Form yr JAN 2 . 22007 i ,., T`)V1 F•int N e In �ir DEP..has prov(dad this form for use by local Boards of Health.;Ih 5�+stern{54Wm'ping Record must be submitted to the local Board of Health or other approving-authoritp; A Facility Information .. =, Wneri(illIng out', 1 System Location :;;forma on the Jnn computer, �. only the tab key Address to move your cur -do not; � ` � AQ . use the return Clty/Iown State Zip Code key "' 2 SystemOwrier r Nems Address(if different from location ' City/Town State Telephone Number Y1 umping Record: a • 1 Date of Pumping — 2. Quantity P Da um ed: .. to tY P .. . . .. alloris 3 Type of system ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑'Other(describe) 4 Effluent Tee Filter present?.❑ 'Yes.❑ No If yes, was it cleaned? El Yes ❑ No .: 5 :Conditlon of 6 Sy em Pumped By Z ' F s r Name ;, ,> /1VehiGe Ucenge Number r t i(c / Company', , tj{".9.4.I 7 Location where potitents were disposed; o'L t ,I. , , i. .. v ::' .;-:.' .,,.•., , tgnatureofHaular:;,.,..,,:;:.,.:,.;...., . . Date h //www mass ov/de pp ' dP g plwafer/a rovals/t5forms,htm#inspect t5formCdoC 08/03 System Pumping Record•Page t of i V.t .'. ` aachusetts y� n .0ANDOVER MASSA HU i'1� :.� H = ! te ;P.umpit� Record `j;s�;.l,:. OCT 5 200T .�•��.N,t•Q•fm,..•.titli•'f<�\.}:..1."t': 1 t, air r/j �t } t'�iL'Y.t':•Y'.�r ti_s '1 ,i t +••.": i.,u!n{;1i•r.;,".i'. ;. '. � TO NOF NnR`Ti ANDD R DEP..has provided this form for use by local Boards of Health, the be submitted to the local'Board of Health or other approving aufhy4temLG mgt ec rd must A .Facility lnforrotion :1,,-7M*n'(sling out 1 System l.ocatlon: y use,,, �S '.ony the tab key Address " to move your:: WW!•do not `use the rotum ;jr' Clty/Town State v key; � ;. •,:,;,.,; p Code 7 Y Name t C� ' ;t Address(If differ n from location stir o ) „ Clty/Towrt::.,; State ^V' zj ` Telephone!Number r•ttl ,: . mping:Re o d: .,. .�!Jti: :'=':is ,.ti.i.i�.kf:t::'�"rr�?ltari.;t9i1.1 ((Yy(,•t.`"•, .. of Pumping ' Date 2. Quantity Pumped: �� • Gallons ?'YpQ 9 system::, ❑ cesspool(s) PSeptic Tank y •_ ❑ Tight Tank C]'Other(describe); . Effluent Tee Filter present? ❑ Yes•,�lo' If yes, was It cleaned? ❑ Yes10 - •.Ii•1( ?`='•;�'�'+'Si!'S Coliditlon of:System;'" ".. ':a• � 1 ler r, tt-I�$ t r / �j,�i•f.`Y.6�!1Lt .i /� .>,:!t 8 Sy P.umped By: .411:. `.•.•' 1 t•' .. .'r G FY :r.� Vehlole U N 1. t4+ "+„'i1' f.�:;.,,y /} came umber p e y., '•�l <t:it ';` +<' ✓Yin ,V 3: ...,/� �... ;ysji., nl/t•%41.':(�rAR1p�Aylyl-a'')''!,r 61.'i''y` 1:lVdir•�a"•••,.,•., , �:%: •.y'; .;r.�:�};?L,._,: '^o,. •:I�an.i•.. f ,. l.ocatlon where contents yvere'dlsposed: 1 1� x•. 'tiff.:J�y�r.iS'•Y•,'ti'.�jvt•.'L..,2tit!! r:r!!;a;t.,. ..,',i.tt,��N.r.ti:y.�.:•'M' .. i , Date 'I http://www.mass.gov/dep%wafe�/approvals/t5foims,htm#Inspect t5forrn4.doa'06/03 . r System Pumping Record•Page 1 of i ( 6 ORT A Y�EB,_f` S� HUSETT Q; w Rec'o' d iso ; j :f;C',t �'i.)��('I t i;rny;�,C,•'.. SEP 0 8 2008 DEP hoi provided lhljYlor/ i r r .eo Q ao o U9lose' 1GVINva[v`�2:HT. �1PsaQ4lEF •o c y racillCy In(orrn��'on • ���'•�- "--�; :.. Sys:; ^ !x�l'on � '•�=�� ..•s,, �. -------��1._5��I2, _cam,/,— Syslam Owner, I' ' rldCfeia (114Vflflnl rcm 1pGyUCn' •o c. a :� -- ''pumping Rekord - - _ ,11 1 • wry �. Tyra 0I aysl6m; !'� .. . .... y e�F Erfluan; Tea Fllla( pf9wr? oy � 6„�'.Condl�Jon'Qr.Syf` m 55; ve 5 , . . i�a,�!r1 `!1'�`,',r � '�/ung rw.f�i� 'i�,r��n•''4�IJ".ffl'J,1� ^'. VoflIG9 'JGd r,,, — 1 !oca cn wnare corllanls ware c;s sac o slarie,p ova)sJlblorms �,.,.; ���� Commonwealth of Massachusetts Zbut City/Town of No. Andover System Pumping RecordJU(,rowNForm 4 HEAOFNDEP has provided this form for use by local Boards of Health. Other forms may be information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms the W� om utoter, use only the tab key Address to move your No.Andover Ma 01845 cursor-do not use the return City/Town State Zip Code key. 2 System Owner: rea Name feh0! Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate I ( 2. Quantity Pumped: /Con Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank El Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. S�-1 Pumped: n /n i a— Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: wart's Pre-tre tment Plant, 20 So. Mill Bradford, Ma 01835 gn ture a e Dater Signature of Re eiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 At Location No. Date NORTFTOWN OF NORTH ANDOVER O F R 9 Certificate of Occupancy $ ITE<� Building/Frame Permit Fee $ sACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ! Check # 1DR i 7736 �~�-�-- `� Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: r M igIfl X ic SIGNATURE: 11ps —al Building Commissioner/I dr of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number j 1.3 Zoning Information: 1.4 Property Dimensions: 2 748(0/ /5-0 �wV Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomntion: 1.8 Sewerage Disposal System: Public ❑ Priv atc Zone Outside Flood Zone Municipal ❑ On Site Disposal System X SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT v m 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: tName Print Address for Service: O y z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 7� 3.1 Li n Construction Supe r: Not Applicable ❑ Licensed Cons�tntction Supervisor , f CS 09A434 O 90 KESmolf D License Number Add ss Q 05/a7 /Zco.( Add 0 ���'� ���7�/ Expiration Date ic Signature, Telephone r 3.2 Registered Home nprovement Contractor Not Applicable ❑A V/.4 , ow S.,V� v Company Na e '43 S 7,, m 03221 Registration Number r Ad Mss . p Q g/09/,:a-co 6 r � 7 g—SS-? - a7 7� Expiration Date Z� Signature Telephone v' t SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the builling permit. Signed affidavit Attached Yes......X No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition X Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: n n v2'�/X��{ CAGE. LOOM O\IM— -- i2 xr4r PR4l orl PM aF ��fT/oil Kr?t.l}�C ll og(q oN F cox; EAIMY Or- 60STRW& &E SIOG �n/T C546 �CCOA� (.,T gw6(.0 IgLe- /yu(r Wi&o.-w VO�ME�- (Le S i?04J'g6X- IAF SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAL USE ONLY Completed by permit applicant 1. Building p�7/7 cv (a) Building Permit Fee 11 Multiplier 2 Electrical (b) Estimated Total Cost of syn 7 Construction 3 Plumbing /5aa.a) Building Permit fee(a)X (b) �D i 4 Mechanical HVAC sT co 5 Fire Protection CM. Qp 6 Total 1+2+3+4+5 7 qa .00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT JENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT JI, S ,as Owner/Authorized Agent of subject property Hereby autho Wl� § AmSbAd to act on My behalf,in6l �ma�trs r ry Ito work authorized by this building permit application. J 11 O%�S/0f Signature of er T Date SECTION 76 OW NER/AUTHO R IZED AGENT DECLARATION 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 �J©F4�1 Print Name Signature of er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlbIBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS w 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 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *******************APPLICANT FILLS OUT THIS SECTION*********************** InN APPLICANT 61k PIVS* 6,11�f PHONE 9�d-SS.2- 077 LOCATION: Assessor's Map Number I C)Li (3 PARCEL r SUBDIVISION LOT (S) STREET I.®STS ST. NUMBER 4/S S ********* **********OFFICIAL USE ONLY** *********** R AT OF TOVENTS: CONSEVATION-ADFAM MSTRATOR DATE APPROVED DATE REJECTED , COMMENTS l TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEA DATE APPROVED DATE REJECTED DTIC INSPEC R- EALTH DATE APPROVED / ! DATE REJECTED COMMENTS i PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 '�+ 5�•" Workers'Compensation Insurance Affidavit Namemill t Please Print Name: A � SUn1S CN'�"XPR+SES (�OES(,� I�R�S�NS Location: 190 WWE /�.�. 0328 City Phone # ���- 85).-0 7 79 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity VN aI am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#- Insurance Co. Policv# Company name: Address City: Phone# Insurance Co. Policy# 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$1,500.00 and/or one years'imprisonment_as_vrell_as.civii.penalties in the lam of-a..STOP WORK_ORDER..and.a fine of.(.Sloo.00)-ajday against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify unY#r the pains and pe altiess erjury that the information provided above is true and correct. Signature /Ut,4 Date Print name A . AeSW Phone# 979�-SS2-0779 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Once Contact person: Phone A- ❑ Health Department ❑ Other Town of North Andover f 140RTI1 Office of the Health Department ;? •':° "''° Community Development and Services Division William J.Scott,Division Director '�'+ •-mss-.• �� '` 27 Charles StreetSACNUg t Susan Y.Sawyer,REHS/RS North Andover,Massachusetts 01845 (978)688-9540-Phone Public Health Director (978)688-9542-Fax Date: October 12,2004 Address: 458 Foster Street,North Andover,MA 01845 Re: Application for: Addition and Garage Dear Mr.Rogus: Your application for an addition and garage at 458 Foster Street has been reviewed by the Health Department. The application was denied on October 12,2004 for the following reasons: 1. ❑ Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable 4. X Undersized septic system according to existing information on file. Please see attached assessors information indicating 3 bedroom,7-room system. To address the aroblem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house,septic system and proposed project in scale If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project If#4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerel viewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 e f ----.. I 1� Tljfl t%ORTH Town of over �s� 0 0 No. 0 LA E over, Mass.,. COCHICHEWICK OOATED F"? BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT go 's BUILDING INSPECTOR .. ............................................................................................... Foundation has permission to erect.. y .a q buildings on.......4S.8.......F J% .................. ..... .. Rough .. ........ .... to be occupied as..&)jtk1.* P4 "OM &.6 j.#..Rjt4;!#j.4j....R.;!#P................................ Chimney provided that the person accepting*this 'in*every respect conform to a terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 1 V 4 15 / I q PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTES Final UNLESS CONSTRUCTIOM ST TS ELECTRICAL INSPECTOR 4V............................. Rough ........ .0Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i i ' REFER NCES ESSEX NORTH DISTRICT REGISTRY OF DEEDS: TOTAL AREA 44,867 S.F. 100% AREA OF EXIST. BUILD.= 1,595 S.F. 3.6% DEED BOOK 4739, PAGE 253. AREA EXIST. SHED = 85 S.F. 0.2% PLAN NO. 6638 AREA OF PROP. ADD. = 672 S.F. 1.5% OPEN' SPACE = 42,515 S.F. 94.8% ASSESSOR'S f MAP 1048 PARCEL 14 { ZONING: R-2 } IP FN0 203.2' I I I I i I N� I �) q ` LOT 5 �pplTidu 1 .03± ACRES i I I N , LOT 4 ---38.8•— co (V 1 1 , 1 � i PPv�� X 1 , Ito �� P ;l c - 1 1 �(9 , 1 1 1 1 1 i 150' USE") �• F- 0 P LAN O F LAND ?� JAMES , w 'N (OUKAE p' NORTH ANDOVER , MA _ NO. 458 FOSTER STREET JAMES W. BO S. DATE '' DJOHN J. & LEE A. ROGUS FOR PERMIT DESMM. AHO BRADFORD ENGINEERING CO . SHM OF 01tA""" A.H.O. BRM 3 WAS H I N GTO N S Q . REVISIONS BY w,JB HAVERHILL MA . 01 830 JWB PHONIE: MAJU SCALL. 1" = 30' (978) 373-2396 ` (978). 373-8021 ea j'8 -Erwaew0F&WErwrr.NU DAV- FILE NMF PERMI NA32701.DWG Fl NO: 115433 MARCH 27, 2001 1\ i Location ' No. I Date Sl V2 . e9� MORTM TOWN OF NORTH ANDOVER F 9 ` Certificate of Occupancy $ . o, <.�__. ,• • /'y� ori �SJwCHU Building/Frame Permit Fee $ -? Foundation Permit Fee $ Other Permit Fee $ A TOTAL $ ate` S Check # 17184 Building Inspector / A .I _ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. / DATE ISSUED: 10 SIGNATURE: � - Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ysa Fbsl-a� Is-IkE-r /o�3 Iy /V O, ;1011O F-9 M,/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided jdo' •/o' i00' a 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System oW J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes -Nox. rn 2.1 Owner of Record Name(Print) Address for Service: 1 Signature Telephone 2.22 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone M SECTION 3-CONSTRUCTION SERVICES fig+ 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 07ZY2-:5— O 0 Cb I,--VC, 03676, License Number mn Address /O f 3 �S— Expiration date Signa re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ SP T-KScoj, l3tJ/L�)id✓G' ' IZ 'Ic�c���V�� LLL %Z'7 U2`� Company Name rn 36 K0ne=-72 PGL PW MY 036-76 Registration Number r Address r 0 Z 4 //ZCIV q Z Expiration Date ^ Signature Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) \ Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes......W No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction )?4 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: , -6JV5' 2UL-T76,) o,G /q �X /y� � � �� paec,4 cw�8 X v�*77OC17FO 61°r7v SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beOFFIC>(AL USE Q ;y . Completed by pennit applicant .. 1. Building 22.3e_ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of o? c3 Construction / 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC �p?aO 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. -Signature of Owner Date t SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 51�1 EW P. ,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 ave- Print Name Signature of Owner/ ent Date NO. OF STORIES SIZE ` BASEMENT OR SLAB -- SIZE OF FLOOR TIIvMERS 1ST2ND 3RD ¢ SPAN _ DIMENSIONS OF SILLS S �� DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS\, i HEIGHT OF FOUNDATION - - ~'"" THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Y _ . FORM - U — LOT RELEASE FORM p; cti INSTRUCTIONS: This form is used.to verify that all necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. �f■a/ama■f/.//f/f-ftf-//ff/ff./tt/if/ff//sf////////f/f/Wt//.i/t./f'tft//////it/f ff/ APPLICANT PHONE ASSESSORS MAP NUMBER �Vc LOT NUMBER 7 SUBDIVISION LOT NUMBER STREETS STREET NUMBER D a t a a mmamaa am■sff//'t ma./'a s■ /■m/.a't.afa/lmtmmfa/STREEMBER■//■mmm/mm/am/■ OFFICIAL USE ONLY ONE tmmmmmm/.mmmmmarammass/aaanataamsa■a.ma■ass ama■aaam.a■am.a■man■/.tamamaa msa■a.ma RECO An ONS OF TOWN AGENTS saaa■ ■masma.man ma ■asaaaassaasammasaaaa/amam■saamaaaamma0a0aaa0aaaaaaa0 CONSERVATION Lji0/_R DATE APPROVED 9 Oy DATE REJECTED CoMmENTS unJ 3 > fob' -�'�b,v, jefot0ased TOWNPLANNER DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED ;FD:ECTO]COR-HEALTH DATE REJECTED DATE APPROVED 3 d - - i" DATE REJECTED COMMENTS ✓e PUBLIC WORKS-SEWER!WATER CONNECTIONS Yv 6 it tis��- . ��L.;. c,,y DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED CONEVIENTS RECEIVED BY BUILDING INSPECTOR - DATE Apr 16 04 10: 53a PHILIPS Q&R 9789757324 p. 2 �o �-r L/-� COMA101INT. LTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION — ONE WINTER STREET;BOSTON AIA 021DS (617)242-5600 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DA1'ID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Andress: /Y .4.Adn a eL' Name of Owner 044 & j p Address of Owner- Date of Inspection: 5 Name of Inspector:(Please Print► gy i4i V I am a DEP all oved system inspector pursuant to Section 15.344 of Tide 5 1310-OMR 15.000) Company Name: v e✓ o 0, A.r� Mailing Address: f�� 121 L&61)" Tefaphone N-rd— x���,7 v-71 CERTIRCATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: (Passes _ Conditionally Passes Needs F rther Evaluation By the local Approving Authority Fails pecto+s Si 0 Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system Is a shared system or has a design flow of 10.000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Envkonmentat Protection. The original should be sent to tfne system owner and copies sent to the buyer,if applicable,and the approving authority. • NOTES AND COMMENTS revised 9/2/98 Patt 1 of II .. ar,rtec+o.RecycMd Paper • i Apr 16 04 10: 53a PHILIPS Q&R 9789757324 p. 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1` SYSTEM/INFORMATION(continued) "roperty Address: 4,s 8 �S f 2 a� T /Y• !7 /Ir (/ C Js r ate of Inspeccon: XV if n/ N a s%f SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) eke we d- I I revised 9/2/98 Fagr1.0ofII r�' I I 4 I ZX/Z �b RIBS Yr`� i XG z ,�e 1-16- 9W7� -X4 y ��r�Irs 1 171 t ,3/ J/ 8 =7 F0d 2-)V / I .-X IO 3 2 X 2/ c;�ATr4at' 1 ZTA5 . iy 2 bio PT re � fl Ap suco)ffl (ba"I/Y z. 304f 3 'X,3%L 64V :v area_ Iva vvv a.rvr VLi�Li:T1J liV1WVL1UAILU W-j UV1 AC RA. CERTIFICATE OF LIABILITY INSURANCE bA;ZS001210 PRoaucEa THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HiU insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Doug Jones C10 Cedar 8940 E.Chaparral Rd.Hill I sur HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Scottsdale,AZ 85250 INSURERS AFFORDING COVERAGE NAIC 9 wsuREo tNsuRERA,Zurich-American Insurance Conwsnv Genesis Consolidated Services.Inc. tlrbuRER E: 21 Wvrthan Road Lexhgtan.MA 02421 ,Nsr+RERC: lN3UR(3t D: � �SN91{ItEA E' COVERAGES THE POLICIES OF INSURANCE LISTED OELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE[).NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDIttON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFOFMEO BY THE POLICIES DESCRIBED HEREIN IS 5MECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN HAVE BEEN REDUCED BY PAID CLAIMS. NSR D' IPOL�Y NUMBER LIMITS C'nVE POLICY EXrMATION LIMtT3 GEr WAL LIABILITY EACH OCCURRENCE i COMMERCIAL GENCA^I.LM81UIY PRZ - s CLAIMISMADE OCGI3R € uEDEXPfAeYmaP..) S ,•.-. PERSONAL&ADV INJURY S GEWRAL.AGGREGATE L i GEN'LAGGREGATE;-IWYAPPLIES PEJW PRUOUCTS.COMPIOPAGG S POLICY PRb- LOC AvtoksoomtLIABRITV COMBINE08tNGLEUMT I ANYAUTO i (Es lleodlnt} ALLOWNEDAUTOS I ) &GOILYINJURY S SC4rE0UlE0AtiTOS t tPer¢erson} l HMO AUTOS � ' � 9WILY AWRY }F {?eracckStleq L I NONAWNED AVTT)S t i PROPERTY DAMPIGE I j IPer tlCdd6ns} GARAGE L"WITY 1 AUTO[)1LV,GAACCI0Ef4T 11{S AMI AVTO ( 5KACC 11 _ i R AAUTOeONLY: AGG 14 i EXCESMURRELLA LIABILITY F,ACH OCCURRENCE f I OCCURCLAIMSWOE AGGREGATE S fb DEOVCTIeLE RETENTION I i I WORIMR9 COMFCNSATION ANO X WC STAt T DTH- EMPLOYERS`UAWLrTY A ANY PROPMET—PARTNEWEXE... WC 37-36-530-00 01/0112004 01101/2005 E.+;EACItApC�DE»r I _ S,ODD,ODD 10FriFKj RAAEWeR EXCW007 1 EL.OISEASE-EA6m4nUIYEE I 1,C}DO,OUO SPECU ROV�l�1FLSbelow i E.L_WEASE-POLICY OMIT I' ...1.000,400 OTHEII Location Coverage Period. 01/01/2004 01/01/2005 Cer�Iticate� 04MA003725667 1 CIlt:ntR: 1965-NH rsEscR�nwraF oPERArIowa r LDCAnaNsrvE�+ICLesr ExcursnNs ADDm eYEHDDRSErrEtITIsPEcIAI wTovtsrolrs Corcr')w is pIDYIdeO for Imtr SP Jeck"rn Buikfing d RemvdeGng.LLC R10se elnpbye9s Ifw-t@ 1 30 Kopec.g Lane not 5UbwftV*=ra a[ Petham,'NH 03076 CERTIFICATE HOLDER CANCELLATION SMQVLDAMOF hWAHOVEDESCRIBEDPOUCkCSBECANC.E.I. 09EFOftTHEEAMRAnON SR Jackson Building S Remodeling.LLC GATE THER&W,THE ISSUING 44UMR WILL ENDEAVOR To MAIL 30 oars YMnTEN 30 Kopees Lane NO Pelham,NH 03076 TtCB TO THE CERTvaGATE i1rJLt3EA NAMED TO THE LEFT,BUT FAILURE TO DO 90 SHALL #WPOOE No oBUGATM OR LUL9RITC of ANY WHO VPON TKC INSURER,rr5 Ae6NT5 on REPRESENTATIVES. AVTHOID2E0 REPRElENTATrvE ACORD 25(2001188) /OAACCO�RD CORPORATION 1988 S.P. Jackson Building & Remodeling, L.L.C. 30 Kopers Lane Pelham, NH 03076 (603) 870-0088 (603) 870-0080 (fax) Lic. No. 072425 Reg. No. 127029 CONTRA CT/Exhibit A April 14 2004 Client/Owner Name: John & Lee Ann Rogus Client/Owner Phone number(s) 978-685-8188 Mailing Address: 458 Foster Street N. Andover, MA 01845. ! Scope of work: New kitchen and 14'x 14' Screened porch with attached 8' x 8' deck. Site Preparation: Demolition of existing deck Excavation: S.P. Jackson Building and Remodeling, L.L.C. in conjunction with Excavation Contractor shall notify Dig Safe and insure that utilities are properly marked prior to excavation. Excavator to backfill to rough grade. Not included in contract is the blasting or removal of any ledge. Price to be quoted before removal if ledge is a problem. Concrete / Masonry: Deck& porch supported by 12"diameter piers on top of poured 24" x 24" concrete footings. All footings, s 4000 psi minimum compressive strength after 30 days. Framing: Deck frame 2x8 PT, Porch frame 2x 10 PT. All decking 5/4"x6" STK Knotty cedar fastened with stainless steel nails. Upright 4x4 roof supports Cedar. Railings 2x4 Cedar with 2x2 square cedar ballasters. Roof rafters 2x 10 KD spruce. Roof plywood 5/8" CDX Fir. Roof sheathing 5/8" CDX fir. i S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 2 Roofing: Contractor to provide and install all materials necessary for roofing including flashing. All roof edges and cheek walls to have ice/water shield all other bare surfaces to have 151b felt. All roof edges 8"white aluminum drip edge. All ridges to have ridge vent. Shingles IKO Chateau architectural homeowner to choose color. Siding: To be replaced where removed for window, door and porch roof installation. Window & Door: Supply& install Anderson 30-C14-20 White with screens 30 degree angle grbay. Includes construction of roof over bay window. Supply& install Anderson Frenches ood glider FWG5068 w/screen &homeowner to choose color hardware. Window&Door to be white vinyl exterior/natural wood interior Soffits and Fascia and Exterior Trim: Soffits strip vented &trimmed in primed pine. Fascia primed pine. Rake boards primed pine. Trim boards to cover PT frame primed pine. Plumbing: Includes all rough and finish installing provided sink and faucet. Install provided dishwasher. Electrical: Includes 6 recessed cans in kitchen. Moving receptacles as needed for window&door installation. Includes 2 porcelain light bulb fixtures for porch & 1 box for provided fan. Includes box for 1 exterior light near porch door. Includes 1 double spot light and 2 exterior outlets installed on porch exterior. Homeowner to provide all ceiling, surface mounted lights and fan i S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 3 Kitchen Cabinets: Remove existing cabinetry. Install new DECORA cabinets Maple wood, Lexington door style with suede finish as per design by Wes parsons at Taylor& Stevens Cabinetry. Includes supplying & installing Granite counters Install cabinet knobs, customer to select and pay for knobs separately. Wall and Ceiling Finishes: Includes all plaster patching around window and door installation. Includes Knotty Pine lx6 tongue & groove ceiling in porch. Includes labor to install tile back splash in kitchen. Finishes / Painting: Not included Flooring: Install provided ceramic tiles in kitchen. Contractor to supply motar. Customer to supply tiles and grout. All landscaping and finish grades by others. General Requrrement,s. Permits and Fees: Permit for building transferred to our name. In the event that zoning or other issues preclude issuance of the permits, the Owner shall be responsible for making application for variances, reviews, etc, in order to obtain permit. S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 4 Insurance: S.P. Jackson Building& Remodeling, L.L.C. shall submit proof of insurance to Owner of$2,000,000 general liability insurance and workmen's compensation insurance for all employees. Owner shall provide adequate general homeowner's liability insurance to cover cost of work and associated protection as owners see necessary. General liability for any subcontractor shall be setat$300,000. General Contractor shall submit within 10 days of request a copy of proof of insurance of General Contractor and of all subcontractors. Verification General Contractor shall collect all verification inspections from municipal, electrical, and plumbing inspectors and present to Owners. Owners are allowed free access to inspect work at their own risk of injury. Warranties General Contractor shall comply with the Massachusetts Warranty guidelines. All installations shall be warranted for a period of two years after issuance of certificate of occupation provided payment is made in full. Sulbcontractors are responsible for presenting General Contractor with appropriate warranties, manuals, and pertinent product information as requested, to be compiled and presented to owner upon completion of project. Additional Work: Any changes in these specifications or reference documents shall be accompanied by a written additional work authorization form with price quoted signed by S.P. Jackson Building&Remodeling and homeowner prior to starting the addition work,or shall be executed on a time and materials basis at$75.00 per hour/per man plus materials. Interim and Final Clean Up and Debris Disposal Debris shall be removed and disposed of at approved landfill. S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 5 Total price for all work specified above: $ 59,914.00 Terms: Kitchen payment terms: Kitchen total $37,589.00 l st Payment due for kitchen cabinets $12,000.00. Cabinet check made out to Tiglor& Stevens Cabinetry. 2"a payment due upon delivery of window & slider and start of work $11,400.00 3rd payment due upon demolition of existing kitchen and floor$7,000.00 4h payment due upon install of cabinets $5,189.00 Final payment due upon completion of kitchen work $2,000.00: Porch & Deck Terms: Porch & deck Total $22,325.00 1st Ym a ent due upon on start of work $10,000.00 p 2n payment due upon completion of rough frame of porch& deck$8,000.00 3r payment due upon decking and railings completed $ 4,000.00 Final payment due upon completion of porch &deck $2,225.00. Definition of Allowance: The cost allocated in the proposal for a particular item. An allowance is usually provided for those items, the cost of which,is dependent on personal preference land owner selection, or in the inability and practicality of ascertaining a firm figure on a particular element of the work that may be executed by a third party. If the item costs more than the allowance, a charge for the extra cost markup is added to the contract. I, (we), the undersigned, understand and accept the above contract. q12 4 y Owner's Signature Date LI/L � 01& Ois Signat Date v4b 164;, S.P. Jackson Buil ' g&Remodeling, L.L.C. Date 1 � E ✓41 1(la7t"NONIlAe"IM D/1 f(1I71CZC/71lcW.GW t BOARD OF BUILDING REGULATIONS 3 License: CONSTRUCTION SUPERVISOR s F Number: CS 072425 Birthdate: 10/13/1964 i. Expires: 10/13/2005 Tr.no: 6059 Restricted: IG STEVEN P JACKSON 30 KOPERS LANE (. «� PELHAM, NH 03076 Administrator ✓jamn�mm�nuelltl,�i- �f Illlssaclulsc��a 1 Board of Building Rcgufatious and Standards IjOME IMPROVEMENT CONTRACTOR Registration: 127029 Expiration: 8/24/2004 Type: DBA JACKSON BUILDING&REMODEL a l EVEN JACKSON 30 KOPERS LANE .. PELHAM,PSH 03070 Administrator NORTfy Town of Andover No. 417 dover, Mass., 5 '3 "•1 O�yl 211 COCMICHE WICK y1. ADRATED `S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT /CC /� 0 V S .......N... ... ................. N. ................... ......::;...................................................... Foundation has permission to erect.. y.......................... buildings on H Ct Rough .... ........................ SGhtirV �OrCw $ K 1c� CS to be occupied as..............................................�.......................0'�N........'D��..............R...,e....p.......�...............N................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the nspection, Alteration and Construction of Buildings in the Town of North Andover. J018 a a O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough ...... . ............................... ........................................... service . .............. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Rough— Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. y REFERENCES ESSEX NORTH DISTRICT , ' REGISTRY OF DEEDS: TOTAL AREA = 44,867 S.F. 100% AREA OF EXIST. BUILD.= 1,595 S.F. 3.6% DEED BOOK 4739, PAGE 253. AREA EXIST. SHED = 85 S.F. 0.2% PLAN NO. 6638 AREA OF PROP. ADD. = 672 S.F. 1.5% OPEN, SPACE = 42,515 S.F. 94.8% ASSESSOR'S MAP 1048 PARCEL 14 ZONING: R-2 IP FND 203.2' I 1 1 1 I n.l 1 LOT 5 1 .03± ACRES i I I I `25- LOT 4 __ I a N ��� �j —38:8` •:•r.!i:•::.. lec T: ISn N —_ 32.6', p (gyp 1 1 � Igo � 1 � gp1 � t � � I 1r. PLAN OF LAN D +� °i JAME S �. N o w �. 0 gp {QUKhc. a NORTH AND (::) vER , MA . ` NO. 458 FOSTER STREET JAMES W. go >r> S. DATE PIRVARM FOR: JOHN J. & LEE A. ROGUS —2 FOR PERMIT DESIcNED: AHO BRADFORD ENGINEERING CO . sNMT 1 of 1 Dw►wN: A.H.O FIELD BRM 3 WASHINGTON S Q . REVISIONS BY cflEacm: WJB - HAVERHILL MA . 01 830 JWB 1" = 30' PHONEe(978) 373--2396 ` (978) 373-8021 9RADFDRD-90MWDRLDNETATT.NET D"w- MARCH 27, 2001 — N F- PERMIT\NA32701.DWG ME NO: 115433 Location 4 No. Date //--?0 _0 TOWN OF NORTH ANDOVER O't..•n .•.'gyp . ' Certificate of Occupancy $ }''�s'•••"'<t'+ Building/Frame/Frame Permit Fee $ � s�cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �Y-o 17203 Building Inspector 3 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT& OR DEMOLISH A OOR TWO FAMILY DWELLING NEBUILDING PERMIT NUMBER. © � DATE ISSUED: ic SIGNATURE: �R Buillng Commissioner/inspector of Buildings Date Z SECTION I-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ZI-58 Fv� 577-w -: /04-8 /Z/ Map Number Parcel Number RS 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide . Required Provided R 'red Provided v 1.7 Water Supply M.G.L.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 OWNERSHIP/AUTHORIZED AGENT Historic District: Yes NO rn 2.1 Owner of Record N41V 4- Z-� /�: tZ66 5. y Name(Print) Address for Service i Signature Telephone 2.2 Owner of Record: a Name Print Address for Service: Z ,1 rn Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: ©72 2 S O 3o 'A,Op 2 (-,v License Number Address 6V,2�—A�� v ovg 3l2-w� � 3 �� 8 Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v J �< �vl��e;✓Ly-.2�-rylvOc�L��G- Le-C . company Name / Z 7 G Z� rn Ko f L/V^ 1 N X 20 7� Registration Number r address rM / �J �1'1/��V , Y= - (f L U Expiration Date f/1• Si nature Telephone V A SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all apollicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ;N ST47-L SL I&4t Z12 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 32 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X tbl D 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number Z q`f D SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, C J as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION w QT9'Ci4E&Y / as Owner/Authorized Agent of subject property 4 Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief P Print Name ,�2,, Si nature of Owner/ ent Date T— NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 ST2ND 3RD SPAN DDvIENSIONS OF SILLS DIMENSIONS OF POSTS DRAENSIONS 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 V1/14/U4 17:4V tAA (01 601) 070L ULVbS1S UUNbULIVAI'LLI IQ.Iuol 11(9 5' TE{MwnnIYYYYI ACQRDL CERTIFICATE OF LIABILITY INSURANCE lztstir2oo DA PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doug Jones do Cedar bill Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 8800 E.Chaparral Rd,Suite 230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Scottsdale,AZ 85250 INSURERS AFFORDING COVERAGE NAIL# INSURED INSLwF1tc Zurich-Arnerlcan Insurance Comusav Genesis Consolidated Services,Inc. INSURER B: 21 Worthen Road LexhgWn,MA 02421 /NsuRERC: WSURER D: MVSUREtT E: 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 CONDI'fsION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTPlN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM%EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CtJVINS- erSR D' I POLICTMUMB� POUCTE GYNE POEiCYEIItIRATWN LIMITS GENERAL UAMITY EACH OCCURRENCE i COMMERCIAL"NEEPALL1A91LrTY PRISE3,(ED OMSeMel S , I MGD E%P(Any ani persort) S CWaSMADE F-1GC'GWR PERSDNAL&A9vUUURY I GENERALAOCREGATE s GEWLAGGREGATELIMITAPPLIESPOt. PROoUCTB.COMPlOPAGG S POLICY PRO M 4Or AUTOPOSItZ LIABu.1TY COMBINED SINGLE UNIT S (Ea seadsat) Arlt AtJTD ALL.OWNEDAUTOS SODILYINJURY 3 SCHEOULEDAUTOS lPsr pstrinl HRED AuTOS 9ODILY INJURY S NON-OWP40AUT05 - {Perautdenti PROPERTY DANIAGE E {Ptrictldint) GARAGELIABIUTT i AUTO ONLY-EAACCKXNT ! ANY AUTO OTHER THAN C=JtACC f AUTOONLV: A04 S EXCE-r,6MURRFA I A UABRITY ` EACHOCCURRENCE s OCCM CLAIMS MAGE AGGREGATE S _ S DEDUCTIBLE S RETENYION . S. S WORKERSCEIMPeNSATMAND x WCSTATtr- 0T14- EMPLOYERSrtaAarlrTY E.L.EACMACCIDENT _ i=._.._,... 1,000,000 A � � E� EcUTTME I WC 37-36-330-00 01/01/2004 01101=05 E.L.wsexxsE-EAEMwLOYEE It pyeass SPEQALP � Or45bdor ! E.L.01SEASE-POLICYUMIT S 1,00D,D00 OTHER I It CBsiilldete# 04MA003725667 Location Coverage Period: 01/0112004 01101/2005 Client#: 19SS-NH DESCMPTIONDF OPERATIONSI LOCATIONS I VOICLES r Z=W 57DNa ADDED BY ENDOR5Eua4T/SPECWL PROASIONS CDYdwge;s provided for olds SP JaCkt�On BuittErtg A Remvd9ting.LLC those employees iu0seX{IO but 30 Kopefs Lwe not subcontradmr9 of Pelham,INK ID3076 CERTIFICATE HOLDER CANCELLATION I SNDULD ANY OF t9r ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SP Jackson Bvi4ng d RIamocteling.LLC GATE THERea ,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DA"WAREN 30 Kwes Lane Pelham,NH 03076 NiCB OTTO THE CERTtflcwTE MLO"NAMED TO THE HEFT.MFT FnLLttRE TO DO SO SHALL BPo9E NO OBUGATWM OR LIABtLInr OF ANY Knou UPON THC INSURER,ITS AGENTS OR REPRESENTATIVES• AyTrlaRrzEDREDREaENTATtvE ACORD 25(2001108) 9ACORD CORPORATION 1989 `.��e �arrz�nvnu�ea`l� a�, llaJscu�rtfra�lJ v r Board of Building Rcgtilations and Standards HOME IMPROVEMENT CONTRACTOR it �- Registration: 127029 Expiration: 8/24/2004 Type: DBA JACKSON BUILDING&REMODEL JIEVEN JACKSON 30 KOPERS LANE PELHAM,NH 03070 Administrator ✓�ie t;an:rna�uuvulll a� `faauirlruvello t BOARD OF BUILDING REGULATIONSWAW , - License: CONSTRUCTION SUPERVISOR = Number: CS 072425 F Birthdate: 10/13/1964 i; Expires: 10/13/2005 Tr.no: 6059 Restricted: IG STEVEN P JACKSON 30 KOPERS LANE PELHAM, NH 03076 Administrator S.P. Jackson Building & Remodeling, L.L.C. 30 Kopers Lane Pelham, NH 03076 (603) 870-0088 (603) 870-0080 (fax) Lic. No. 072425 Reg. No. 127029 CON TWA CT/E.vhibit A April 14 2004 . Client/Owner Name: John &Lee Ann Rogus Client/Owner Phone number(s) 978-685-8188 Mailing Address: 458 Foster Street N. Andover, MA 01845. Scope of work: New kitchen and 14'x 14' Screened porch with attached 8' x 8' deck. Site Preparation: Demolition of existing deck Excavation: S.P. Jackson Building and Remodeling, L.L.C. in conjunction with Excavation Contractor shall notify Dig Safe and insure that utilities are properly marked prior to excavation. Excavator to backfill to rough grade. Not included in contract is the blasting or removal of any ledge. Price to be quoted before removal if ledge is a problem. Concrete / Masonry: Deck &porch supported by 12" diameter piers on top of poured 24" x 24" concrete footings. All footings, s 4000 psi minimum compressive strength after 30 days. Framing: Deck frame 2x8 PT, Porch frame 2x 10 PT. All decking 5/4"x6" STK Knotty cedar fastened with stainless steel nails. Upright 4x4 roof supports Cedar. Railings 2x4 Cedar with 2x2 square cedar ballasters. Roof rafters 2x 10 KD spruce. Roof plywood 5/8" CDX Fir. Roof sheathing 5/8" CDX fir. S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 2 Roofing: Contractor to provide and install all materials necessary for roofing including flashing. All roof edges and cheek walls to have ice/water shield all other bare surfaces to have 151b felt. All roof edges 8"white aluminum drip edge. All ridges to have ridge vent. Shingles IKO Chateau architectural homeowner to choose color. Siding: To be replaced where removed for window, door and porch roof installation. Window & Door: Supply& install Anderson 30-C14-20 White with screens 30 degree angle bay. Includes construction of roof over bay window. Supply&install Anderson Frenchwood glider FWG5068 w/screen&homeowner to choose color hardware. Window &Door to be white vinyl exterior/natural wood interior Soffits and Fascia and Exterior Trim: Soffits strip vented & trimmed in primed pine. Fascia primed pine. Rake boards primed pine. Trim boards to cover PT frame primed pine. Plumbing: Includes all rough and finish installing provided sink and faucet. Install provided dishwasher. Electrical: Includes 6 recessed cans in kitchen. Moving receptacles as needed for window &door installation. Includes 2 porcelain light bulb fixtures for porch & 1 box for provided fan. Includes box for 1 exterior light near porch door. Includes 1 double spot light and 2 exterior outlets installed on porch exterior. Homeowner to provide all ceiling, surface mounted lights and fan S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 3 Kitchen Cabinets: Remove existing cabinetry. Install new DECORA cabinets Maple wood, Lexington door style with suede finish as per design by Wes parsons at Taylor& Stevens Cabinetry. Includes supplying & installing Granite counters Install cabinet knobs, customer to select and pay for knobs separately. Wall and Ceiling Finishes: Includes all plaster patching around window and door installation. Includes Knotty Pine 1 x6 tongue & groove ceiling in porch. Includes labor to install tile back splash in kitchen. Finishes / Painting: Not included Flooring: Install provided ceramic tiles in kitchen. Contractor to supply motar. Customer to supply tiles and grout. All landscaping and finish grades by others. General RCqZ/.Z1''etnent,S. Permits and Fees: Permit for building transferred to our name. In the event that zoning or other issues preclude issuance of the permits, the Owner shall be responsible for making application for variances, reviews, etc, in order to obtain permit. S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 4 Insurance: S.P. Jackson Building& Remodeling, L.L.C. shall submit proof of insurance to Owner of$2,000,000 general liability insurance and workmen's compensation insurance for all employees. Owner shall provide adequate general homeowner's liability insurance to cover cost of work and associated protection as owners see necessary. General liability for any subcontractor shall be set at $300,000. General Contractor shall submit within 10 days of request a copy of proof of insurance of General Contractor and of all subcontractors. Verification General Contractor shall collect all verification inspections from municipal, electrical, and plumbing inspectors and present to Owners. Owners are allowed free access to inspect work at their own risk of injury. Warranties General Contractor shall comply with the Massachusetts Warranty guidelines. All installations shall be warranted for a period of two years after issuance of certificate of occupation provided payment is made in full. Subcontractors are responsible for presenting General Contractor with appropriate warranties, manuals, and pertinent product information as requested, to be compiled and presented to owner upon completion of project. Additional Work: Any changes in these specifications or reference documents shall be accompanied by a written additional work authorization form with price quoted signed by S.P. Jackson Building&Remodeling and homeowner prior to starting the addition work, or shall be executed on a time and materials basis at $75.00 per hour/per man plus materials. Interim and Final Clean Up and Debris Disposal Debris shall be removed and disposed of at approved landfill. S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 5 Total price for all work specified above: $ 59,914.00 Terms.- Kitchen erms:Kitchen payment terms: Kitchen total $37,589.00 1"Payment due for kitchen cabinets $12,000.00. Cabinet check made out to Taylor & Stevens Cabinefi-)�. 2nd payment due upon delivery of window & slider and start of work $11,400.00 3rd payment due upon demolition of existing kitchen and floor$7,000.00 4th payment due upon install of cabinets $5,189.00 Final payment due upon completion of kitchen work $2,000.00. Porch & Deck Terms: Porch & deck Total $22,325.00 1St payment due upon start of work$10,000.00 2nd payment due upon completion of rough frame of porch & deck $8,000.00 3rd payment due upon decking and railings completed $ 4,000.00 Final payment due upon completion of porch & deck $2,225.00. Definition of Allowance: The cost allocated in the proposal for a particular item. An allowance is usually provided for those items, the cost of which, is dependent on personal preference and owner selection, or in the inability and practicality of ascertaining a firm figure on a particular element of the work that may be executed by a third party. If the item costs more than the allowance, a charge for the extra cost markup is added to the contract. 1, (we), the undersigned, understand and accept the above contract. r o/O Y Owner's Signature Date a/L '� - 't-kd-o I a H Ow is Signa Date r S.P. Jackson Buil ' g & Remodeling, L.L.C. Date S. P. Jackson Building and Remodeling L.L.C. 4/16/2004 Page 6 NORTfj own of Andover 0 No. - T dover, Masse, y'.?D • D f� T O LAKE COCHICHEWICK ADRATE D P? C5 S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT......=710 h .0 k# i � PC) G BUILDING INSPECTOR .....................................................�. ,...................................... .....,............................................. Foundation has permission to erect...�M . .... buildings on ..#5.8......./om..S ...,,, ............ Rough to be occupied as............. � .M N........./N........... S tC. iN G .................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and Bv--Laws r�Isting to the Inspection, Iter 'on and Construction of Buildings in the Town of North Andover. /0 fC1 I Y 70 dm� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR S Rough -%0'00 M. .. . ............................................. ............... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and.Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.