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Miscellaneous - 464 FOSTER STREET 4/30/2018
J 464 FOSTER STREET 210/104.B-0039-0000.0 ` i 1 i Location Al I/ �c'S_�LJC�IL r No. (4---(93 Date -a) U Y NORTH TOWN OF NORTH ANDOVER Oft . o '1q.� + ; . Certificate of Occupancy $ s�CMUs Building/Frame Permit Fee $ V Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -� t Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING mw BUILDING PERMIT NUMBER: 7 DATE ISSUED: SIGNATURE: �/✓`�_ — .� Building Commissioner/InSRector of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 PropertyXSA 1.2 Assessors Map and Parcel Number: 'A� cj� Map umber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: N f Zoning District Proposed Use Lot Areas Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R 'red Provided 0 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 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT is orio District: Yes No m 2.1 Owner of Record f P\(� �ASan, Name P Address for Service: Si re Telephone Q 2.2 Owner of Record: 1'nme Print Address for Service: O % Z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Mn Address Expiration Date Signature Telephone r• 3.2 Registered Home Improvement Contractor Not Applicable ❑ v C 1�1�1 Company Name rn Registration Number r Address r ^ � Signature Tel Expiration Date hone G) i 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.......0 No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction 41A-1 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: m4)0(�'CL'n_ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building dO (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of o Construction 3 Plumbing Building Permit fee tel X (b) 4 Mechanical HVAC Q 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 1, ,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 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 Pr i e o Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T MBERS 1 2ND 3 FD SPAN DUvIENSIONS OF SILLS DRvIENSIONS OF POSTS DM 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 FORM - U - LOT RELEASE FORM s r s 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. rwowns wwwwwwwwwwwwww.ww.wwwwwwwwwwResume ■www■wwwwwwwwwwwwrwwwwwwwwwwwwww,wwwwww APPLICANT ;A QZ ���_ _�PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISIONN LOT NUMBER STREET/ STREET NUMBER ....•swww*wwwwww MOWN wwwwswwfww.. wwww..w....w...w......wwwwww.w OFFICIAL USE ONLY '•••••••s w. ...wwwwww....w..w.,....sw.......ww.www..wwwww■wuwwwww..............ww.,ww.ww RECOMAffiNDATIONS OF TOWN AGENTS ..... .wwwww swu.•wwwwwwwwwwwwawwwwwwwwwwwwww.www•■.w.wwswwrwwwwwwwwwwwmemo wwwwww■ , � r DATE APPROVED CONAVAMNLINIS TOR DATE REJECTED COr iIlV1IIVTSJ�( k45, > s TOWN PLANNER DATE APPROVED DATE REJECTED COMVIENTS DATE APPROVED FOODC R-HEALTH DATE REJECTED DATE APPROVED r E C To - T I DATE REJECTED COMMENTS ' 4 K l�w.. r 5 b a_- dr PUBLIC WORKS-S !WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED COI%4ENTS RECEIVED BY BUILDING INSPECTOR . ..-... ..... DATE DATE APRIL 5.2001 SCOTT L.GILES,P.L.S. aEvlswns FRANKS.GILES, P.L.S. SURVEYING a e N e S OScuE t INC�N=2oFEEr 50 DEERMEADOW ROAD NO.ANDOVER,MA 01815 TEL(878).683-2615 � N MAP IaB.PG.37 D.N.FND(b Oe set) s 0 FOSTER STREET A TOV.M OF NORTH ANDOVER `• MCONSERVATWNCOMMISSION PLAN OF LAND I' uc.e111e,PD.2a i6 N0T'l0'IS"W LOCATION E 1121'(MEAS.) \ 3. '}� ~ ' 464 FOREST STREET NORTH ANDOVER, MA JDRAWN FOR pgF — SUSAN PARKER Pod Fie• °_M.FND. 5N'SON PIP / n m . E FOUND _y / .. /. 'sen NOTES. . MAP 1048 SEE PIAN 0034,14183 0 N.EPQ PARCEL 39 •17,783.23 Sq.S. / „/ SUBJECT PROPERTY 1.0Y611 A0. / S3 MAP 1018 PARCEL le MAD 1018,PARCEL 30 T / _' 000 FOSTER STREET 161 fOST R OT UT FARMER.PRIMP W i SUSAN �:f ♦ ALWANO.ASANO A ELEANOR PARKRR s0 LINDA ALSANO 5w3.PG.u2 BF 3314P(;53 12 f/ m `f � e- 144 lie C, (� H• 6T ,513Y\ def�APET,N O>tJOn � � s� PIPE FOUND' O) ry ez� ✓\ °,w����/ T SH OF AM FRAN Ir S. a FIX MAP 1018,PARCEL 11 h9 J'_ �/ U 1311 FOSTER STREET NOVAK.JOHN cm 1b�',.31 / / N 4 13 n OK.4311,Po.2113 u /-i•,�hq'a_>///// t FES S\ aP� / P AND sUF`�o FounDfy 9, 4 P6 A✓ / cl LOCUS z � � r weDBnD � c:,SP18KB.ORG pr,Of2YFt Town of North Andover Building Department 27 Charles Streeto North Andover, MA. 01845 �gssAC."tt D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. i DA`rE `�if" JOB LOCATION 4(0 ���� S�,ee A— Number Street Address Map/lot "HOMEOWNER Narfle Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirer-nents.-- HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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 ,r disposed of in a properly licensed solid waste disposal facility as defined by IVIGL c11, S150A. The debris will be disposed of in: (Location of Facility) Sign atu a of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 1 Bit VI -7M ( Roj f 1 i q ll J1.9 r / � y j NORTH ® ® -INAndover - .. I" T, dover, Mass., 'ya 7-e7yeJ COC 0 LAK MICME WICK ADRATED P?�,`�5 `S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ............ r..... o ... Foundation has permission to erect....9...... .......... buildings on ..... .b... ........ �,s4 0^.........�.......... Rough ,A� r� I ! r P.+4.?p drA, i r �/ Chimney to be occupied as...... ....... ..... .. ..... .......................... .. . provided that the person accepting this permit shall in eve respect conform to the terms of theapplication on file in P P P 9 P every PFinal this office, and to the provisions of the Codes and By-Laws r ating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. r/ IV 3 PLUMBING INSPECTOR/49� qty VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 7�P�Eg PERMIT' EXPIRES T TIN 6 MONTTiS ELECTRICAL INSPECTOR �.J 1�I LESS CONS 1 11 CONSTRUCTION STARTS • Rough . ................................................................... 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 T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and.EApproved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Irk rF w :. ��'•>?'l' 'S.o rte."' i..�..- � p r y/r 4 4� i r 4-64fOSTER STREET �1 J 210/104.6-0039-0000.0 i .j r Lot & Street y�41 �U5E6 Q5j Mapi, `3 CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# ��702 Plan Approval: Date: Approved by: Designer: Plan Date: Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit# Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date:. By: Certificate of Compliance: Approval: Date: �o L..O s �+ 3 I r I k 'X o< 40P44 � R[ !. _ f��♦ r ELEVA-r1 ONS. DCS 1 4 NA 6114 V. ED Pe VT OF HSE. IOCn.00 I Off.Z4 PIPE'VJV TO 10 A S � U i LT ' S�8 108.8 3 E T FT 10 5,Co I 108:1,774 I V (�f��'c u&ZP IN p. 10 S.3 1 �7 ' E D S P)'O5A L. v v o105.14 SYST EM P- D 104.70 lKiv. rl OUT v ox. 104.s3 104.74 I►J I►.1v. Ego vF rel IIU4 .30 1 04 .31 MoizTI-� ANDOVEM MAO I UV E U C� O� t:21 P E "2 104.30 104. 33 --------- Faq INV. 1✓tilt� O� pl [�E'�3 104 . 30 ► �L. Z � SE1JMI&! IGA � _ L MOwS � 1 5GALE I" = 20' Dsa,TE;0C)\!18,1983 (�ICHOi�CJ F K..o.M 11J S�1 01.117 dSS�GIdTES =fJG EPIGIAI EE2..S � QQ-CNiT'EC.TS � L�t.lt7 Pl_ANt�lE2S,dND Su2vE`r0jn.jS NOfZTH d�1vOv>_� O>_>=tGE P,d�1C_. Town of North Andover, Massachusetts Form No.2 MORrti BOARD OF HEALTH Oft.,... ,.�tio o � F w o 9 ';•b :,'' DESIGN APPROV A' ,SSACMUSEt� SOIL ABSORPTION SEWAGE 1 Applicant Site Location �4Y /25e S7 -7, ) 1 Reference Plans and Specs.-J. 45e—;�clgT�i� ENGINEER Permission is granted for an individual soil absorption s in accordance with regulations of Board of Health. CHAD Fee f/ l b Q Site System Permit No. // 7 �(�+ �� ��l �o� 7 _ � z� �� �� CG t,j� Town of North Andover, Massachusetts Form No.2 HOR7q BOARD OF HEALTH O'iao•a,'1O o 19 A DESIGN APPROVAL FOR ss"`"USE< SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant , /6�l Test No. Site LocationS7'' Reference Plans and Specs.-l• ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. // 7- ` i 8 4 � ' � I V. , Ac ..1 '+ 4 Z3µ ��/ •" ISOO Ga�.TsNtc 1 \ \ I t I • 1 i I i 1� f ` '� � wrWT I1iVY PC'51C•N A5 DuT►.T � VT OF HSE. IOCo.00 1 O'-7.24 A �' 4�.J U I L-r To I OS.TB 108.83 E TOF'T 105.Co I L) U Q V VI P NTO P. IoS.31 ,, los.l4 SYST EM Q_ D. 104.70 104.8 -7 1 r It w. PlPr-- OUTox 104.53 104-74 I1wolzTN ANC)wE IZ.� Ms. . .1v. � Q. �F RIPE. � IUB! .30 1 oG1 .3i I uv. >✓u c or- p i P G fZ 104. 30 1 04. 33 F o cz- NV. E.N0) J�:-- PIr--E'*3 104 . 3o ICao. Z ssw M'M aLi MowS le- 5 G o.LE 1 '" = 'zo SATE;IJov 18,1983 2161-+�f�D F .a►-1c:, Assoc la-rEs =►•1G . EtJG1NEE)ZS � de.�4-tITEGTS , Lpt-!E� Pl-�1.1NEf�S�pNa SuiZ.vEYOt�.S t�.l o�T 1•-+ p N t�o v a 2. O F>=1 G E Pls l2-K- No2TH atJ�ovr✓>z MA N Q� ' LaY di2.r=a=1.�3ac.� 1 \ E t O�4/ �;� I�jQp�a61 TANK •� '`` \\\ AA � PI f� r N 4 TP `on ELE�/a►TI ONS. �[/ �/`� Ai UT OF HSE. IOCn.00 : a,.Za lbjv PIPE I OA g U IIVQV PIP Lam' rj 7g 108.83 T ;T lob.C.1 ;G6-74 IbLY PIPE.INTO IOS31 - -- DINV Pt P �SVOSAI` os Ia - - SYSTEM I= V 104.70 iC4 g 7 IIJ\v p T 104.Sj 104.-74 IN + u✓ GNr J L'iv • '04 3G oq 31 IJ0IZTH LLNROVER. MO , v r_�:r-V� PIPE+z 104.30 I O_d 33 iNv E.u7 _.r til PE 1Y3 104 .30 FOr.Z I�..z� AEAJJ�M.t� '3CoLE I"s 20' DATC;I-Iovig�t9BB - eic.- e0 F �pMl1.:Srl p1,_Ip ASSOCIATES=NG ENGII.i EE e.S ALC RITE C.TSS LAND PLANNEeS ph+D Su2.✓EYOGS AIORTH pNOOV fie. OFGICE �de1C AIOe.TH dN�GV Ee.MA rd of Health rtr: :,ndover,Mass � sQBsMFACE DISPOSAL DESIGN CHECK LIST LOT # FoSR. ST t • 1 o.cr APPROVID DATE DISAPPROVED DATE Provided: Reason s Title V FAIL CE Reg 2.5 a submitted plan must show as a mimim=: a) the lot to be served-area dimensions lot #,abutters location and log deep observation hales-distance to ties C location and results percolation tests-distance to ties d design calculations & calculations Showing required leaching area ) location and dimensions of system-including reserve area existing and proposed contours (g) location any wet areas within 100' of sewage disposal system or disclaimer-check wetlands mapping h) surface and subsurface drains vithin 100' of sewage disposal system or disclaimer i) location any drainage easements -thin 100' of sessge disposal system or disclaizrer-PZaruiing Board files 3) knoun sources of meter supply within 200' of sewage dispoaEl e system or disclainer — — — — ) location -ot aay-prop o-sed-we11 to serve lot-100 from leaching facili location of water lines on property-10' from leaching facilitg location of benchmark n driveways o garbage disposals ) no PVC to be used in construction septic tank (q) profile of system-elevations of basement, plumb, pipe.. eP ,b distribution box inlets and outlets, distribution field piping and Other elevations maxi nm7n ground vater elevation in area sesage disposal system 44(s) plan must be prepared by a Professional Eagineer or other professional authorized by lard to prepare such_ plans Reg .6 Septic Tanks capzcities-150% of flow, eater table, tees, depth of tees, access, pu, ing cleanout c 10' from cellar kall or iuground sig Pool d) 251 from subsurface drains Reg 10.2 Distribution Boxes slope gr eater than 0.08 Reg 10.4 sump face Design Check List Page 2 ` FAII, OK ` Leaching Pits - Leaching pits are preferred -where the installation is possible teg 11.2 a) calculations of leaching area-ydn{nzun 500 eq ft 11.4 b) spacing 11.10 c) surface drains 11.11 d) cover mate e) i?'x2'x4" lash pad f) :tee elbow g) beads in pipe from d-box to pipe Leaching Fiel :eg 15.1 a) no great inn 20 minutes/inch b) 900 aq ft 15.4 c) rnstruction of field 15.8 ace drainage 2 % 3.7 e) 201 from cellar gall or inground s-wimming pool Leaching Trenches .eg 1.4.1 _c_arculatlons of leaching area-min 500 aq ft 14.3 spacing-4 ft min 6 ft with reserve bet-ween 14.4 c) dimensions 14.6 construction 14.7 a stone 14.10f) surface drainage 2% Doom ill Slop e — _s] pa- y_ __-�--be shouun) i b) y/x Z 150 = (to be shown) _ PUMS eg 9.1 a) approval 9.6 b) stand-by power SOIL PROFILE & PERCOLATION TEST DATA �/2 S/'qz -, 'Andover, Mass. Street No ((Lot No _)c/Subdiv. Pland Owner Sfl�9h�c�/ Investigator Observerr_ " ✓ A., ` SOIL PROFILE DATES 1_F1ev lZ 2.ElevT 3.Elev 4.Elev 0 / 0 0 0 U\ Ti-es Pits est _ 2 2 2 2 3 3 3 3 4 Opm 4 4 4 c1' 0 5 5 5 5 6 6 6 6 7 7 7 7 8 8 8 8 9 9 9 9 10 10 10 10 Benchmark Location Elevation Datum PERCOLATION TESTS DATES Pit Number 1 2 3 4 Start Saturation Soak-Minutes Start Drop of 3"-Time Drop of 6"-Time Mmms.lst 3" drop Mins.2nd " Drop Percolation SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No �� �O 5 i�� Lot No Loc/Subdiv. Pland Owner S Investigator &/A ()A6 }-L-LL) Observer SOIL PROFILE DATES 1_Elev 2.Elev 3.Elev 4.Elev 0 0 0 0 Z 1 1 1 Tres Pt�sTest 2 2 2 2 In 3 3 3 3 4 4 4 4 5 5 5 5 `� 6 6 6 6 l 7 7 7 7 s 8 s s 9 9 9 9 10- 10 10 10 Benchmark Location Elevation Datum PERCO;,ATION TESTS DATES Pit Number 1 ,y� 2 3 4 5 Start Saturation ' 2,140 Soak-Minutes Start �. Drop of 3"-Time Drop of 6"-Time CIH Mmms.lst 3" drop Mins.2nd " Drop Percolation +---4---� -+ + -+ t t y + 4- + +. ' +- - - + t +- +- + - + - } -+- + -+ f- + + I . + - }- + - t- r - +-�- - + - - + + + - + - - - - ---- rt- I + - -'�- - +..—�..--t + -t- +-- -- t i- -+ —+ "1---+—i----#— 4- t- .. _4- .j. {- - +- -+ - '+ -+ -t-Esc^';.,a. 'a�.} �4� y„,+ + ....T'^ _""�`` 7_"{ r�•T�"';#�';' 7 }., y.�l� T.^". I ^_-r s - -!;. + + .. .� - + +- -+ _+ _ _ + t _ ... _ +� +- -+-- - -+-- —+ —�-- + -+ AV - + + _ _ ri AVNO M All do i t d w I µ 1 TO: NORTH ANDOVER, MASS. Nov. 21 1983 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at Foster Street Site Location North Andover, Mass . The grades and construction materials are p,ec ed in my plans and specifications dated 7/19/83, Rev. . 19 .3I� dvi� - i'�t Nov. 18 1983 7/25/83 EE w� Reg. Prof.En'a'� r nitarian Board of Health North Anc_over_3*S3. BEPTZC SISTEK '✓o ��2 S INSTALLATICK CE130K LIST LOT'J ' 1 OVED DATE DISAPPRCrJED AV K Ream- Mit kz i FAIL OK 1. Distance Tot a. Wetlands b. Drains c.. Well 2. Water Line Location too' 3• No PVC Pipe Septic Tank a. -Tees -_Length & To Clean Out Covers b. Cement Pipe to Tank 0n Both Sides of Tank 5. Distribution Box �._ a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench a. Mmensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone' 7. Leach Pits ' a. Dimens ns b. Ston Depth c. sh Pads f d. eas e. Cement Pipe to Pit - Both Sides Clean Double Washed Stone 8. No Garbage Disposal 9. Filial Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations r e: Water Table lA4nu+x 5 �z� rS FORM - U - LOT RELEASE FORM 3 d I 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_ 197 r) �— & y—1 6 !7 APPLICANT c� vl�� 9 � �1'\ ` ? PHONE ASSESSORS MAP NUMBER LLOT NUMBER . SUBDIVISION LOT NUMBER STREET % � U ' STREET NUMBER OFFICIAL USE ONLY ....................-.........-..........-.................'--............-was................. RECOA4NIENDATIONS OF TOWN AGENTS ..-.. -.w.... .-.a...woman r..■■.....a..'...mom...............0■ a� ZZ DATE APPROVED �D CON ERVATION ADMINIS TOR DATE REJECTED COhiIlVffTIT°S tE.i�L=� �a11r�S c�.rvs.j -f�n `�Te�' � %Do��rc.�-! c�?c.�• � s DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD e€'°C R-HEALTH DATE REJECTED 3 DATE APPROVED 9EVAC ECTOR- TH DATE REJECTED COMMENTS PUBLIC WORKS—S /WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE J 1 P6 . t �°7 Town of North A n,�f,vp of the Health L . int ani j ries Street � ) r/�`"L/ Massachus RE: Subsurface Dis osarb zim.. _ jade Com letic �Cld� P Y r�' P U'�7 G>/� zUe( reJs� Dear Mr.and Mrs.Parker: O I V /_5 /a n y The septic system upgrade you started in August of 200: has been almost 2 years since the project was started and an appi obtained. The soil tests were conducted that September and are: the design approval is not issued under the current and valid soi. , __...... „C"cored to conduct additional soil testing. Please submit revised plans addressing comments one through 13,as listed in the letter from Noonan&McDowell,Inc. dated October 18,2001. You are hereby required to submit these revised plans by no later than August 21,2003. If the revised plans are not submitted by the aforementioned date the Board of Health may take additional actions. If you have any questions,comments or concerns,please feel free to call me at the number below between 8:30 A.M.and 4:30 P.M.,Monday through Friday. Thank you for your anticipated and appreciated cooperation. Sin ly rian J.LaGrasse Health Inspector Cc: Sandra Starr,Public Health Director Board of Health e-Tile — Joseph Serwatka,31 Kendrick Ave.,Lawrence,MA 01841 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688.9535 4�G: 1 GNB/ q3� bb `1 Ibis Hy-, cq— b7pq�ad� � -� 4�� 9 :else re Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Public Health Director fax(978)688-9542 p^1 July 23,2003 Phil and Sue Parker 464 Foster Street North Andover,MA 01845 RE: Subsurface Disposal System Upgrade Completion Dear Mr.and Mrs. Parker: The septic system upgrade you started in August of 2001 has not been completed at this time. It has been almost 2 years since the project was started and an approved septic design has not been obtained. The soil tests were conducted that September and are set to expire in September of this year. If the design approval is not issued under the current and valid soil tests,you will be required to conduct additional soil testing. Please submit revised plans addressing comments one through 13,as listed in the letter from Noonan&McDowell,Inc. dated October 18,2001. You are hereby required to submit these revised plans by no later than August 21,2003. If the revised plans are not submitted by the aforementioned date the Board of Health may take additional actions. If you have any questions,comments or concerns,please feel free to call me at the number below between 8:30 A.M.and 4:30 P.M.,Monday through Friday. Thank you for your anticipated and appreciated cooperation. Sin ly e`! rian J.LaGrasse Health Inspector Cc: Sandra Starr,Public Health Director Board of Health vvFile — Joseph Serwatka,31 Kendrick Ave.,Lawrence,MA 01841 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 14EALTH 688.9540 PLANNING 688.9535 �v� aA-- co -1k ck .;w° .,`>"+ 1-4 V BOARD OF HEALTH NORTH ANDOVER, MA 01845 iJ 978-688-9540 7 2 r,lj APPLICATION FOR SOIL TESTS DATE: - �. l-`� MAP & PARCEL: LOCATION OF SOIL TESTS: OWNER: TEL. NO.: ADDRESS: ENGINEER:' TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: Shed C \ 1 \ Pool Area \ l MAP 1046 \ / PARCEL 39 rea = 47,763.23 Sq. ft. j 1.0965 Ac. \\p / a 6`z O , \V V ' G � , a c 1 Q3 i \ Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH O� p��t�eo ib�tipe // 2(J�l 32 y� a * I1. ` APPLICATION FOR SITE TESTING/INSPECTION �•9 QORATED�PP,`�GJ SSAGHUS� Applicant ' Q- NAME Il ADD ESS TELEPHONE Site Location (o a ' Engineer NA E ADDRESS TELEPHONE Test/Inspection Date and Time 1 CHAIRMAN, O OF HEA FeeTest No.�ZO:2� S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 - SOIL EVALUATOR FORM Page 2 or 3 Location Address or I bt 1-40. On-site Review - Deep Hole Number Date: ��P �' Time: I V % -- Weather _ Location (identify on site plan) Land Use . 4 ,r'1. Slope (%) Surface Stones Vegetation r Landform Position on Landscape (sketch on the back) Distances from: Open Water Body i feet Drainage way � feet Possible Wet Area ,�/oo feet Property Line feet I Drinking Water Well --)/-0 feet Other DEEP OBSERVATION HOLE LOGS Depth from Soil Horizon Sol Texture Soil Color Soil Other Surface(inches) (USDA) (Muncell) Mottling (Structure.Stones.Boulders, Consistency, % Graven - �Li . L b f+ r'"i �'3 �', ° Cf .f..may. It'll .' t "3 L. 4-1 n. 71 1 iNIMIUM Parent Material(geologic) 0wpa,w8*drtx*. � { 6 } Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal HighScound water: DEF APPRON-M)t:oRM-t2107195 FORM 11 - SOIL EVALUATOR FORM Paas 2 of 3 f 7 7v�og- i Location Address or Lot l•io. 4+-C ¢ ey S �,-y�. S J--- N 4-A.-J 00 l/ On-site Review _ Deep Hole Number - - Date:' 0/ Time: I C7'' 5-0 Weather G 4Lt--'79r— 7p Location (identify on site plan) Land Use L A-C-U) Slope M ZSurface Stones >c- Vegetation - Landform i Position on landscape (sketch on the back) - Distances from; Open Water Body7�Q feet Drainage way feet f , ,. Possible Wet Area ,_,.Meet Property Line � �= feet (� � Drinking Water Well . - w feet Other DEEP OBSERVATION HOLE LOG* r�G /Wv oi✓iy�� 3a� � Depth from Soil Horizon Sol Texture Sol Color SON Surface(inches) pts Mue # otng (Structure. i Stones,Boulders,Consistency, % Graven rToT`.o t 0 114V r a Parent Material(geologic) - Deppmgedr : Death to Groundwater: Standing Water in the Hole: 'ev 0--J'oc— Weeping from Pit Face: A✓n+'�tt`" Estimated Seasonal High Ground Water: .s 140 G �.,.� �I�e•� e VEE APPROt•M FORM-12/07195 v�o� FORM 12- PERCOLATIQ TEST � 17� -1 Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test' Date: .. .,� �> v l Time:. Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" r . 40 Time at 6" Time (9"-6"► Rate Min./Inch Minimum of i percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ _.................._... ._.............. ..... Performed By: .....__.._......................:............-........................ ----_.._._...--- Witnessed By: V L /V v Q Comments: t DET AMOVEa y0jW-UW$VS FORM 11 - SOIL EVALUATOR FORh1 Page 1 of 3 No. Date: —// —pl Commonwealth of Massachusetts /do,, Massachusetts Soil Suitability Assessment-for On-site Sewage Disposal Performed By: �o �''✓= . cTWk �5- - Date: Witnessed By: .............. . . .... ..... . O 6�/ .... /i C7 -� ..... ..... Lorean Address or ' ��Gl��� -7! - Or�r's N-- P++1 L) P PA—�.�1e (a, Addr as,and rekphwc 1 464- New 04-ew Construction ❑ Repair ❑ 8� Office Review Published Soil Survey Available: No ❑ Yes Year Published J�d> .. . Publication Scale /%/Syp Soil Map Unit Drainage Class 8.......... . Soil Limitations ........................................... ............. x..... ......... ..... .. Surficial Geologic Report-Available: No ❑ Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) ........................................................................................................................................................ _ Landform ........................................................................................................................................................................................_........ . . Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes e Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) - .............................................................................................................. Wetlands Conservancy Program Map (map unit) ................................................................................................_ Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal KBelow Normal ❑ Other References Reviewed: DEP APPROVED FORM.12/07195 OCT 4 s . i FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Oji-site Review Deep Hole Number �-�/ Date: �"'/�-'�,/ Time: /d A • tyl Weather Location (identify on site plan) Land Use 1-4'64-J 11.E Slope (%) Surface Stones Vegetation 6--r—Ac;S Landform o 1 Position on landscape (sketch on the back) Distances from: Open Water Body T100feet Drainage way 'i450 feet Possible Wet Area ]I pO feet Property Line z '3T,0 t feet Drinking Water Well 7 I o0 feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling .Structure,Stones,Boulders,Consistency, % Gravel) L L I►4/X�D �r L� SPOSAL AREA Parent Material(geologic) Z T L L Depthto8edrock, Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM. 1210719S .• FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. —�,�. �.— On-site Review Deep Hole Number 7-- Z Date: Time: /D : 30 Weather Location (identify on site plan) Land Use 14-W Slope M z--;;' Surface Stones Vegetation 6 S S Landform JA a RAI � Position on landscape (sketch on the back) Distances from: Open Water Body:,--:;'100 feet Drainage way feet Possible Wet Area -:;�t O!Meet Property Line Do± feet Drinking Water Well fid© feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling Structure,Stones,Boulders,Consistency, % Gravel) D— �PD'� I= LL r �d—.' ,fw � lo�f�g6 1,9 MIA Parent Material(geologic) Z 6"S i45 -7-01 Depdvosodrock, 710 Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 22`7 i DEP APPROVED FORAM-1210719S FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches N Depth to soil mottles `/-7 inches ❑ Ground water adjustment ................. feet Index Well Number .. .. ... .. Reading Date ................. Index well level ... Adjustment factor .... ........ Adjusted ground water level .. ................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in a`l� rar'eas observed throughout the area proposed for the soil absorption system? !a If not, what is the depth of naturally occurring pervious material? Certification I certify that on Na J- q4 (date) I have Passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date — DFP APPROVED FORJ%1-12/07/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS /Ua, NFJ o ��� , Massachusetts Percolation Test` Date: 9--����/ Time: l� Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6") Z 1 Rate Min./Inch " Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed p:j Site Failed ❑ ..................................................................................... ......................................................... ...... Performed By: Witnessed By: D Comments: DFP APPROVED FORM-12/07/95 . i FORM 11 - SOIL EVALUATOR FOIt.N1 Paas 2 of 3 / 7 70 I Location Address or I bt iqo. llc-rr— ti--- On—Site Review _ Deep Hole Number _ Date: Qa/ Time: —,/a % 5-'o 'TQ 41 Weather & s a._ Location (identify on site plan) Land Use L-#4-k-12 OVS)ope (%) -Z"" Surface Stones N0 Vegetation Landform Position on landscape (sketch on the back) . Distances from: Open Water Body '>)<W feet Drainage way �Qfeet Possible Wet Area --Woo feet Property Line $A "= feet Drinking Water Well feet Other P.DEEP OBSERVATION HOLE LOGS ,/I--^J oGO.v o A.)� I3x Depth from Soil Horizon Sol Texture Sol Color Sol Other Surface(inches) (USDA) tMunsell) Mottling (Structure,Stones,Boulders,Consistency, % y Graven 0 7.5YrcY 'S' flirt c+d'vUc.z� G�13i+,. S Parent material(Qeoiogic) p�mg 0 Depth to Groundwater: Standing Water in the Hole: • (,o O^04 4t!:7— Weeping from Pit Face: 00%,r Estimated Seasonal High Ground Water: ? �/ DEP APPRONIM FORM-t2r07195 T"ICOM V lav1 1\L'tLL'tx0JLJ' 1'"rV.VI . INS TRUCTIONS- 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 1 ,b applicant and or landowner from compliance with any applicable requirements. .■■■r■■rrrr■rrAr■■�rrr■rrr.■■rrrrr■r......rr.�..r...rar...rrr.r.rr.a0sea .a. PHONE / ��ff "� r �{, ' 6 - b(� � o tT APPLICANT i t LA �_ L ASSESSORS MAP NUMBER (),Q LOTNUMBER ; SUBDIVISION 'S r/ ° l' LOT NUMBER ,S BEET : :. '..:.: .. 3 ':. ...S��NUMBER . .... 1...... OFFICIAL USE ONLY . ,rr...r■ • •■ '■rrrarrrrr■rr'rrrrrrrrr.rrrrrr..rr■rrrr r■■r■■rrrrrrr■rrrrrr■ RE TIONS OF TOWN AGENTS ■■ was ■rrrrrrrrrrrr■.............................. Lrrrrrr rrrrrrr ` t DATE APPROVED C 1, S' ATION ADMWISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER j DATE REJECTED COMIVIEEN 'S t DATE APPROVED FOOD INSPECTO�- TH DATE REJECTED _ DATE APPROVED. U v SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS — PUBLIC WORKS—SEWER/WATER CONNECTIONS r DRIVEWAY P 14 f DATE APPROVED F EP ` �, . r DATE REJECTED COMNffi—NTS RECEIVED BY BUILDING INSPECTOR DATE f Note to file: On August 15, 20011 spoke to the owner of 464 Foster Street about their proposal to add on a new garage with family room and loft area. After performing calculations on the existing septic system it appeared that there is enough leaching area under current regulations to allow this addition. Including the addition, the house will possess only 3 rooms that could be considered bedrooms. I requested the owner to get a Title 5 inspection done of the system to make sure that it is working as designed. With a passing Title 5 inspection, I believe that Health can sign off on this project. S. Starr SEWAGE PUMP STATION DESIGN COMPUTATIONS 464 Foster Street North Andover, MA OWNER & APPLICANT Phil& Sue Parker 464 Foster Street North Andover, MA 4 DATE: 10/3/01 Z t,OF irk JOSEPH ' J. s SERWATKA CIVIL v.369814 FGfs T e k, .r- PUMPALS DESIGN DATA: DESIGN FLOW 660 Gal/Day SOIL CLASS 1 PERC RATE 7 Min/Inch FORCE MAIN DIA. 2" SDR 21 PVC HAZEN-WILLIAMS COEFF. 150 PUMP: MANUFACTURER: PEABODY-BARNES MODEL #: SE-411 HORSEPOWER: 0.4 PUMP CHAMBER: STORAGE PRIMARY 165.0 gallons RESERVE 660.0 gallons VOL. IN PIPE RUN 0.0 gallons TOTAL 825.0 gallons DIMENSIONS LENGTH* 7.50 WIDTH* 4.75 DEPTH* 4.25 *INSIDE DIMENSIONS ELEVATIONS INLET INVERT 95.20 SUMP 90.95 OFF 91.70 ON 92.32 ALARM 92.72 STATIC HEAD: LATERAL ELEV. 96.75 FT PUMP OFF ELEV. 91.70 FT TOTAL STATIC HEAD 5.05 FT PUMP.XLS Y EQUIVALENT LENGTH: FRICTION LOSSES IN PUMP CHAMBER: 1 2"DIA 900 BEND 5.0 FT 0 2"DIA 450 BEND 0.0 FT 1 2"DIA CHECK VALVE 14.0 FT 1 2"DIA GATE VALVE 1.2 FT TOTAL LOSS 20.2 FT 21.0 FT FRICTION LOSSES IN PIPE RUN: 1 2"DIA 900 BEND 5.0 FT 1 2"DIA 450 BEND 2.5 FT 0 2"DIA 22.50 BEND 0.0 FT 1 2"DIA TEE 12.0 FT 15 LENGTH OF RUN 15.0 FT MISC. PIPE 1.5 FT TOTAL LOSS 36.0 FT b 36.0 FT TOTAL EQUIV. LENGTH: 57 FT DISPOSAL FIELD NETWORK COMPUTATIONS SYSTEM VARIABLES PRESSURE DISTRIBUTION LATERAL FLOW LATERAL INSIDE DIAMETER 1.50 ORIFICE ORIFICE SEGMENT LATERAL LENGTH EACH LATERAL 40 NO. FLOW GPM VELOCITY FLOW NUMBER OF LATERALS 5 (GPM) (FPS) (GPM) MANIFOLD INSIDE DIAMETER 2.00 8 1.34 1.95 10.72 MANIFOLD LENGTH 20 NUMBER OF MANIFOLDS 1 FORCE MAIN INSIDE DIAMETER 2.00 MINIMUM SYSTEM FLOW= 53.61 GPM FORCE MAIN LENGTH (W/FITTINGS) 57 ORIFICE SIZE 0.25 ORIFICE SPACING 5 LATERAL RESIDUAL PRESSURE 3 LATERAL ELEVATION 96.75 PUMP OFF ELEVATION 91.70 HAZEN-WILLIAMS COEFFICIENT 140 PRESSURE DISTRIBUTION SYSTEM CURVE COMPUTATION SYSTEM MANIFOLD LATERAL FRICTION LOSS FRICTION LOSS FRICTION LOSS STATIC DYNAMIC FLOW FLOW FLOW FORCE MAIN MANIFOLDS LATERALS LOSS HEAD (GPM) (GPM) (GPM) (Hf/100') (Hf) (Hf/100') (Hf) (Hf/100') (Hf) (Hs) (TDH) 20.00 20.00 4.00 0.97 0.56 0.97 0.19 0.20 0.40 8.05 9.20 25.00 25.00 5.00 1.47 0.84 1.47 0.29 0.30 0.61 8.05 X9.79 30.00 30.00 6.00 2.07 1.18 2.07 0.41 0.43 0.85 8.05 .10.49 35.00 35.00 7.00 2.75 1.57 2.75 0.55 0.57 1.13 8.05 11.30 40.00 40.00 8.00 3.52 2.01 3.52 0.70 0.72 1.45 8.05 12.21 45.00 45.00 9.00 4.38 2.49 4.38 0.88 0.90 1.80 8.05 13.22 50.00 50.00 10.00 5.32 3.03 5.32 1.06 1.10 2.19 8.05 14.34 55.00 55.00 11.00 6.35 3.62 6.35' 1.27 1.31 2.61 8.05 15.55 60.00 60.00 12.00 7.45 4.25 7.45 1.49 1.54 3.07 8.05 16.86 65.00 65.00 13.00 8.65 4.93 8.65 1.73 1.78 3.56 8.05 18.27 70.00 70.00 14.00 9.92 5.65 9.92 1.98 2.04 4.09 8.05 19.77 SEPTIC PLAN SUBMITTAL FORM LOCATION: 4 o1 ` S--y- e—9. 4: 7` f NEW PLANS: $160.00/Plan v REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: dQ — �—Q t OCT ' 40 1 DESIGN ENGINEER: DATE TO CONSULTANT: / n When the submission is all in place, route to the Health Secretary. Town of North Andover NORTH Of Office of the Health Department 0? °gip Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 November 5, 2001 Joseph Serwatka, P.E. 31 Kendrick Street , Lawrence, MA 01841 Re: 464 Foster Street Assessors Map 104B, Lot 39 Dear Engineer: Please address the concerns listed in the enclosed letter from our consulting engineer, and submit revised plans with the $60.00 fee. If you have any questions,please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Homeowner -�h t i Par ' Q4 - File SS/aero BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nmAnetwa Date: October 18, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/041A 464 Foster Street Assessors Map 104B, Lot 39 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated 10/3/01, by Joseph J. Serwatka. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the following is addressed: 1) If a pressure dosing system is to be used please provide headloss calculations for lateral, manifold and forcemain, for required head. Pump performance curve with plotted deliverly rate and head of system. 2) Place type of pump to be used on plan. 3) Please call me for further review of items 1 and 2 above. 4) Provide proposed spot grades for 2% slope over system. 240(10) 5) Label water line as either pressure or suction. 6) Provide class of pipe for forcemain and laterals. 7) Provide a note stating existence or not of surface water supplies within 400 ft. Public wells within 250 ft. and private wells within 150 ft. 220(4) 8) Specify pump controls. 220(4)(r) 9) Specify pump alarm equipment 231 (2) Land Surveyors Civil Engineers Environmental Planners 10)Specify pump alarm on separate circuit from pump. 231(9) 11)Specify manual operating switch for pump NA 12.01 12)Specify 6 inches of<=3/4" stone beneath pump chamber. 13)Provide buoyancy calculations for pump chamber 221(8) Respectfully, John L. Noonan, P.L.S.-P.E. G:office/forms/tonarev 1770041 a Land Surveyors Civil Engineers Environmental Planners 2 Project Request Record Town of North Andover Date: © // Client Id:ToNA Card Id:ToNA Client/Company Name:Board of Health Card':Tvue-Client. ' Contact Name M&..Sandra,Starr Phone: 978=688=9540. Title:Director = Fax: 978-688_9542' ryb?. Address: 27=Charles.Street Email:sstarr@townofnorthandover.com . , 1/lfll�i Notes: I Town : North Andover '�ifr f11� 'State. MA Zip Code 0.1845 �/ &6rcontacts;if:apphcak le.. Engine taller Name.�/n�E�if u 3G �d9 T /¢ Phone: �Titl'e•• Fax: Address. . Email: Notes Town: State:: Zip Code: r r',f yr Proiect: Project Id: 1770 Project Title: Town of North Andover,Board of Health (JOB NO) (PROJECT NAME&STREET ADDRESS) Manager:NOW Billin up: �I Billing CodJ:Fixed Fee l p C ract4a o:Project;Descriptions for each billing group , Applicant WiI&,/, sesso.s Man Lot Street ¢G -f- Type Type.of service, -S ¢--L- �,y��a✓ ���y " .fr i 11r r. v OfficeJforms/jbrqutona No. THE COMMONWEALTH OF MASSACHUSETTS FEE ! �O BOARD OF HEALTH r # 915 ILeft" APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair Upgrade ( ) Abandon ( ) - ❑Complete System X Individual Components Locatio2� O er's Name s� r � Map/Parcel# Address Lot# �y_ jift ho # Installer's Name S.J1 Desi er's Nam/ - Address ed ,r 4, Telephone# Telephone# Type of Building: ---e �� � Lot Size Dwelling—No.of Bedrooms 2 Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required)...,., gpd Calculated desig flow gpd Design flow provided i"!)gpd Plan: Date A°r40 Number of sh is evision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator < Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 1.5.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ------------------------------------------------- ------------------ No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARRENT" PUBLISHERS- BOSTON 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 n ca APPLICANT l�I��L�� Cj � �[,�Q�{ PHONE JLOCATION: Assessor's Map Number PARCEL UBDIVISION - _ LOT (S) S.TREET� � � (�(j,�IJ�I/�" ST. NUMBER' _ OFFICIAL USE.ONLY _ RECOM ATIONS OF.,T_OW- KAGENTS. t r - - CON VA ION ADMINISTRATdR DATE APPROVED - i - DATE REJECTED COMMENTS ,X-y ().:� Q t( S' I JlL (do , TOWN PLANNER DATE APPROVED - DATE REJECTED COMMENTS. FOOD INSP CTOR-HEALTH DATE APPROVED DATE REJECTED S C SPECTOR-HEALTH DATE APPROVED DATE REJECTED i L i COMMENTS Ca�T2� tam .5�+-serf �� e T' . du� �.or,�_�r�s © IJI -5, PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE i PLOT P - ='o'R, i�©RTC�S,Gz .PU Rte oSCs t3 ►J K lboblsep UPIo1,l: Pu6i.IG-RE=pM5_AN0 Evf DWCE ON -MSGrRt -JWQ> ' 1 .ADDRESS 4-G4. FosTE2. T2�E'[ 1oe`r0 QNDov E.cz - IvtO R''C"G,46 OR -SAM k F At=o L LI 0 K. ' 1 i �701 - e • � 8' --. . 115,2' _ ! . . : . i Dti S10 Hf�W►.l E,IJ,D,�' . PLA1.1 Co?> AO wle LU Nt � T . .. rSlpcQ..l. r OWNERS) : 2E—FItJ CERTIFICATE REGI STRY: 'Fs;mac- Mb reT(A I CERTIFY that the- Lot shown hereon DEED: BK. 16, F)[? P. that the `1 w �„� t lJ cr shown PLAN r CERT. OF TITLE: �/�l(TH T4f _present Zoning k N 0TE: of the o 1 of i R-T 4 A N Dr-)V E. The. premises do notln lie within - • .r.`-_..���•.^�� � .►;°��� OF �L a na desigted o :�`'tJa ��. 1, �<< Flood Hazard ' R03Cl2T Zone. cIL r1-T ROBERT G. GOODWIN , R.L.S. GOGG4Vt1V�� ;% G:u�n �'d Gocxl .•In \-� 0791SO 62 •CENTRA'L STREET ANDOVER, HASH. PATRICK J. DONOVAN ASSOCIATES, INC. C aim and Foss .`f�fjus[inents P. O. BOX 110 WAKEFIELD, MA 01880 TEL. (781) 245-5540 — FAX (781) 245-7016 March 12, 2001 Building Commissioner City or Town Hall North Andover, MA 01845 Insured : Philip Parker Property Address : 464 Foster Street, North Andover Insurer : Preferred Mutual Insurance Company Policy Number : PHOO100516872 r Type of Loss : Ceiling Cracks Date of Loss : 3/7/01 Our File # : WAP31981 Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Vern Laws, Adjuster 4 VL/soint t 5 20 ASSOCIATIO1 OF INDEPENDENT INSUR,ANCR ADJUSTERS ASSOOAnOW of MassaAusetts 6WUfNMff PATRICK J. DONOVAN ASSOCIATES, INC. "CLAIM AND LOSS ADJUSTMENTS" P.O. Box 110 Wakefield, MA 01880 (617) 245-5540 FILE FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS. CHP. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings \ City or Town Hall . OG� N. Andover, MA 01845 RE: Insured: Philip Parker & Susan & Eleanor Parker Property Address: 464 Foster Street N. Andover, MA Policy Number: PHO0100515672 Loss Type: Water Date of Loss: 9/22/95 » Our File Number: WAP21042 Claim has been made involving loss, damage or destruction of the above- captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143 , Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. Vern Laws, Adjuster Donovan Associates, Inc. Wakefield, MA On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. 10/12/95 No 3 Date.....9-,/o'� k// t10RTh °:'�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SS�cHusE� This certifies that ........�... ..�r..J......... ' has Permission to perform `'t/' ............. .....,...................................................... a � L wiring in the building of...... ". ,..1...... �.................................................. if o� ' �_ ,North Andover,Mass< at.......... cl.....�.. /�....�. /L�ic.No.F-.9�.� ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer DEPARTtYlENT0FPUBLICS4FE7Y . Pennit No. `�– BOARDOFFIREPREIYFV7YONREGUL4TIOASS27CMR12 0 ' Occupancy&Fees Checked APPUCATIONFOR PERMIT TO PWORMaECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date L$' Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. j Location(Street&Number) ?`�'f S Owner or Tenant /1I L Paalv Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building-?'-L94;4 /gip 115 e Utility Authorization No. Existing Service Amps Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work' -7`'-r�1/Y / �✓klf G E' C) I No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total i I KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA —goand ground No.,pfReceptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.,of Switch Outlets _ No.of Gas Burners No.bf Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained _ Detection/Sounding Devices —No.of Dryers Heating Devices KW Local Municipal Oto ' _ Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP r, OTHER Intra=Com:RrstavDtheregt*wrm s&C n WLam IhateatmrentLabtldyhstr =R)bcyetch&gCaq)ide Caaagporksst q ivalai YES NO TharesthmilWdv*lp afbfsamelotheOffi=YES M NO If}whawdradWYES plfmarkethetyWcfo =aWbydaad rgthe Eviation D& f FstJm tdd VahiecfT 7edti mI Wdk$ WotkiD> .!. hqxdwD*RapmWd Ram F'ml . 672 5'-- 0 si�tddtarcl��iePt3rtlUes �( �� �.- �C TIRMNAME LioaiseNn L(9S6 O t ia— '-J C 14 D-F r7tp o Sig Ire i/ ,+ Litxellb o �1 ITe1.Na a �C 1��=��1�5 7' ��✓7UJ�/P� �_mct ©��"l s AI<TeLNa X16 OWNMSINSURANCEWAIVER;I.a+naw=thattheLi=doesT not tlme$re*msamet n-isWxWto[ grivautasm*medbyMmmdmscasGarralLam a4ddatmysgrWm<n taspem-&tppficabon tutsre d (Please check one) Owner a AgentEl Telephone No, PERMIT FEE$ i5 U Date.l./:?�U. ?. . ... .. R 1M Of HOH1� o� � TOWN OF NORTH ANDOVER S ti p • PERMIT FOR GAS INSTALLATION SAG HU`�E� �l This certifies that // . . . . . . . . . . . . . . . has permission for gas installation :. . . . . . . . . . . . . . in the buildings of . . pel-.A.�. .e... . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . .. North Andover, Mass. Fee. .4 . :. . . Lic. No. .:. . . . . . . . . .t:J..:�. . , . . . . . GASINSPECTOR Check# 4181 MASSACHUSETTS UNH ORM APPUCATON FOR PE MT TO DO GAS FT.rr]NG (Type or print) Date 40.Z41ag NORTH ANDOVER,MASSACHUSETTS Building Locations y'd Y {mss 2 �7t���T Permit# y lam/ Amount$ 3 0, Owner's Name New o Renovation ❑ Replacement ❑ Plans Submitted ❑ U Z o PQ o o° H SUB-BA SEM ENT BA SEM ENT 11ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH. FLOOR HAI I I I I I I I I (Print or type) j - one: Certificate Installing Company Name � /f•'��iiw�f l�Gi' �o Corp. Address 9Y .tai! S//lll- 10f 111w fl:g'� AW 1016Y ❑ Partner. Business Telephone l p,71-66Y— 97r'8 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �ft�gsrt? �=�o��✓�y rT/ INSURANCE COVERAGE Check one: -- I have a current liability Insurance policy or it's substantial equivalent. Yes [a' No❑ If you have checked ,please indica type coverage by checking the appropriate box Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations perf xrned under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Signature of Licensed Pl r �Fitte � ❑ Plumber Title City/Town ❑ Gas Fitter ease ❑ Master APPROVED(OFFICE USE ONLY) Joum7meyman Location 7 e,111- 1 S No. � Date NO^TM TOWN OF NORTH ANDOVER T: � 0 16. is * : ; Certificate of Occupancy $ �,SSACHUSEA� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / Building Inspector r TOWN OF NORTH ANDOVER n- BUILDING DEPARTMENT j i APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: as 7ol SIGNATURE: Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: , 1.2 Assessors Map and Parcel Number: LA IF (C 0 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimstons: q lo Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS .ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Provided © 1 0 4 1 a 0 90 -f 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Infomtation: 1.8 Sewerage Disposal System: -Public ❑ Private Zone Outside Flood Zone Municipal ❑ On Site Disposal System 0 1 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENTO J r 2.1 Owner of Record / 1� l .. _ Tom. (4-\ Name(Print) Address for Service: O Signature Telephone <71 , 2.2 Owner of Record: Name Print Address for Service:. C n Signature Telephone n SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Z Licensed Construction Supervisor: C License Number Z Address t Expiration Date Signature t Telephone '.., 3.2 Registered Home Improvement Contractor Not Applicable ❑ C Company Name rn Registration Number r. Address r aaa� Expiration Date ^z Signature Telephone Y I } A y SECTION 4-WORKERS COMPENSATION(MG.L. C 152 § 25c(6) ! Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result, j in the denial of the issuance of the building unit. Signed affidavit Attached Yes........0 No.......0 ! I SECTION5 Description of Proposed Work(check all a licable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition I � Accessory Bldg. ❑ Demolition ❑ Other 0 Specify i Brief Description of Proposed Work: 172 f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item . Estimated Cost(Dollar)to be Completed b permit app licant 1. Building (a) Building Permit Fee O Multiplier i 2 Electrical (b) Estimated Total Cost of �- Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC v G 5 Fire Protection 6 Total1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN i , C • OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT P' I, s Ee)rAuthorized Agent of subject property l� Hereby authorize to act on My ' in all matters rel v to wok authorized by this building permit application. Si ture of Owner Date SECTION 7b OWN AUTHORIZED AGENT DECLARATION 1, ,as Owner/Authorized Agent of subject properly Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE • BASEMENT OR SLAB No SIZE OF FLOOR TIIv1BERS 1 2 3 SPAN DlNfENSIONS OF SILLS DDAENSIONS OF POSTS DDAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r r fd1V1 U ` 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. ■■rrrrrrr■rrrr�rr■■rrrr■rrrrrrrrrrrrrrrrr■■rrrrrr■r■rrrrrrrrr■rrrrrrrrrrrr■ APPLICANT P 1 0 0PHONE ro� la I�` q bv[ Vel ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION /1I/�" LOT NUMBER STREET �� r aSTREET NUMBER yr■rr■r■■rrr■■r■rrrrrr■rrr■rrrrrr■rr■■r�■rrrrrr■rrrrrrrr■■rrrrr■■-■■■rrrrr■■ OF>�ICIAL USE ONLY I �r■ OATIONA ■ ■■■Monsoons■r'■■■-pumas mass■■rr■■rrr■■r-■rr■r■■r■■■r■rrrrr■rrr . TIONS OF TOWN AGENTS ■■ rr■rr■rr■rr■■rrrrr.■.....■■r■■rr■r■rrr■r■r■ r■rrrrrrrrrrrn T DATE APPROVED b b� j lV 7� DMWISTRATOR j DATE REJECTED CO 16L DATE APPROVED TOWN PLANNER DATE REJECTED CONMEN"IS DATE APPROVED FOOD 1NSPECTOR;J1F=GLT1H DATE REJECTED DATE APPROVED. o 1/ SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY P J JJ / DATE APPROVED F l_` e DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE + NVn T11 Town of North Andover + Building Department 27 Charles Street * _ x North Andover, MA. 01.845 D•. Robert Nicetta SS��► S4`{ Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION LA C-0-�,—:A e 1 � ,Ce l t i] Number --L.Address t (� t-PsV �i/ / ntM(ap/lot "HOMEOWNER 1 _ cO.n ! lD fs t0 (O 1 `1 (Q Name 1 Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)' DEFINITION OF HOMEWOWNER:, Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, bylaws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE /Cy APPROVAL OF BUILDING OFFICIAL FORM U - LOT RELEASE FORM f '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 APPLICANT V�I wo Cj �(� I��/, PHONE JLOCATION: Assessor's Map Number PARCEL e � he lL JUBDIVISION LOT(S) S.TREET� � f �0:'�� j� M " ST NUMBER' ` y OFFICIAL USE ONLY RECOM ATIONS OF tOIIVN AGENTS - //-A/,/11A F CON VA ION ADMINISTRATdR - DATE APPROVED DATE REJECTED COMMENTS-_ `.� i TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS- FOOD INSP CTOR-HEALTH DATE APPROVED DATE REJECTED �SEPT1CiWSPtCTORmHEALTH DATE APPROVED L DATE REJECTED COMMENTS /� G•ii eJI i PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE P.LO-'r . P FOR. M©FZTGA C-k .Pu pL p 0'5 CS USE 0)4L-.`-< (.54 sea uPou PUB tc teog'M_AMD CVFDe9CE ON -NS GPDOW C� �DDRES S �Q- osT.�2 ST{LE 2 AND0.1 - MORTGAGOR - - SOVR.GE -Joy --, e PAa�_-EL --,NoMJ 0t4 PLA 14 (vAD 3 f 1 STS i . :.w le . p r 1,13ACRES± .. • .. F� o .-r E T S -c• rte. E E T. . OWNERS) : KE-SIN CERTIFICATE REGISTRY: E,,—<e.x._ Mbp—_- 't_k I CERTIFY that the- Lot shown hereon DEED•: BK. I GG �,jc'� Pel `l R A O D that the k w I`L I- t K) cm shown PLAN CERT. OF TITLE: (M(TLA luf_= present ZoningV--_r(-(_A,\x N OTE: of theo � of 1 2T I- �c (`1 P�V I✓(,,;, The. premises do not lie within a designated Flood Hazard cj. ROSERT Lone. GILLETT ROBERT G. GOODWIN , R.L.S. - �• % G :;, � ,_a COGUM14 82 •CENTRAL STREET , �/% Goo�w,•m ,> � 07M ANDOVER, KAaw: v v�"'i "' . _:`', - + `"► 'y`` �i''.�1�'� ORTH T - own o e7o ,. A•,,6 ndover No. O ndover, Mass., i8 � —a LAKEo0/ COCHICHEWICK ADRAT E D SSACHO IT FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ...72&` �.Q...... v U s�.� 14 le 0— f .................. ........................................ ................................................... has permission to excavate and pour foundation at -' �" for the purpose oL..`3..rd.....38 F- ea 4-- �a-p-a tf�— ............. ........................................ ......... Ws10�"J.....`....�1� r..�..:.../ JA The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. /Oct 48 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. ./.... .!....................................................................................... BUILDING INSPECTOR op NQRTIy ® oAndove r 11 C C p Twn f No. L'A dover, Mass., l 0RATED F"I)VLN H BOARD OF HEALTH Food/Kitchen PERMIT T D . Septic System UJILDING INSPECTOR THIS CERTIFIES THAT........7`..: . .l....ie.�...!��.Lso.................... .&/.......... .. Foundation q 8 Al ...... has permission to erect......7�.v......................... buildings on (S . ..4.. ........ ...... Rough ....... lei Aj WA re A Chimney F&#F Aof 9�- � cc .... ...... ..................... to be occupied as....................................................... ................................... provided that the person accepting this permit shall in every respect,conform to fie�%6r�ms 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ............................................................................... 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. Smoke Det. SEE REVERSE. SIDE- .v ! I I I I I I I I IPS Of '' wr I I I ! I I II I I II { I II ! I II I I II II { I II I i II E II I I ! ! I { II II II II II II II II If II li - `� II Il Location 1 `) t�, �.z C, No. Date �� D NOR,h TOWN OF NORTH ANDOVER a + ; , Certificate of Occupancy $ SSAC.'s<� Building/Frame Permit Fee $ 5' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ S' Check # .7 GcZ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: a r DATE ISSUED: a l�' SIGNATURE: Building Commissioner/I for of Buildings Date SECTdON I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I Lo ap Number Parcel Number 1.3 Zoning Mffoormalion: m 1.4 Property Dimensions: IZonin Distrix Proposed Use LalArea s FrTonta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40.t 34) 1.3. Flood Zone Information: �,/ 1.8 Sewerage Disposal System: Public ❑ Private tj/� Zone Outside Flood Zooe 01 Municipal ❑ On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r I Owner of Record py)I k I %, Po r— (o 4 Fc2�, P.�r S�= -,k-��ce r- Name(Print) Address for Service: Y Q/ Signawre TelePhon 2.20 of od-n. (-Z� N Addresi for Service:. C .2 n Sin re Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Z Licensed Constniction Supervisor: License Number Z Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number IT Address r Expiration Date z Signature Telephone 4T ! SECTION 4-WORKERS COMPENSATION(11ZG.L. C 152 § 25c(6) i 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.......0 No.......0 ! SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ , l I i Accessory Bldg. ❑ Demolition ffY Other ❑ Specify . I Brief Description of Proposed Work: ij ry C4 u i/' l i i i i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be } � fi Completed by permit applicant 1. Building �© (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee t,1 x (b) lSignatlir�-Xawner- chanical HVAC — Protection G al 1+2+3+4+5 Check Number N 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property uthorize - ( ,�q y 6' �(`U+'� to act on f ll matters reiati o w r onzed by this buildingpermit application. 6 -// --Date SECTION 7b OWNER/ UTHORIZED AGENT DECLARATION I, ,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 Print Name r OSig"natuuref Owner/Aent Date ORIES SIZE +t BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2ND 3RD SPAN DIlvIENSIONS OF SILLS DD/fENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFMVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 57'6 — R r- Living Bedroom Dining Room Den k,7 Room Master Closet 15'5 7'7 Cbeo ---ILL: < � 16' •. kitchen bath Master 46 15'1 Bedroom imud room a eta/tub Susan & Phil Parker garage 464 FosterStreet No Andover, MA. 62' 22' NORTH o o E over 0 .�,..�. � No. -2 o�A�oC,;,�� over, Mass., r DRA7ED p?�y�5 '9S H �'( BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT...�. c.b� .... .. ` , ............A R ���....................................................... Foundation �wr oa4t � %%4 • has permission to erect...�.�............................. buildings on .....44.4.4......... .............................................................. Rough ' l DASA `g V 14 v D• ����� 0 r................................................................... IYd �fiyWe Chimney to be occupied as.......................................�v'r.............. ....................... 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 Inspection, Alteration and Construction of Buildings in the Town of North Andover. &113 � 3 gY 10 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTSELECTRICAL INSPECTOR C Rough Service ......................................................................... 4100000 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 LathingD Wall To Be Done or � FIRE DEPARTMENT -� Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Town of North Andover ¢ �yORTH 1�� yt' i 4�yp O O Building Department o 27 Charles Street North Andover, Massachusetts 01845 i 4 978 688-9545 Fax 978 688-9542 �9SsgcHu5���� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 56a. The debris will be disposed of in/at: Facility location 4h Signature f Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. .. �� Town of North Andover -.'+ Building Department 27 Charles Street . North Andover, MA. 01845 D. Robert Nicetta ssAC►wse Building Commissioner (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print / DATE JOB LOCATION Numbertreet Address Map/ t "HOMEOWNER 1 �*Pho ' 1�, Name Home Phone / PRESENT MAILING ADDRESS Solm Y City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1)• DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE **F r 0E"Z_VV49!f—7�" APPROVAL OF BUILDING OFFICIAL PEfIkurr NO. ' APPLICATION FOR PERMIT TO BUILD 'NISI h /ANuUV ER, Or-^il. " t MAP 440. LOT NO. 12 L"AECORD OF OWNERSHIP JDATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. �� 1 OCATiON ST ►uRPOi[ or BUILDING is" m` OWNER'' NAME NO. OF STORIES .' BIZ[ OWNER'S ADDRESS 5/'N •ASEMENT OR SLAB ./ ARCHITECT'' NAM[ tfJJl��1! 612E OF FLOOR TIMBERS 19 amp 2ND 2RD�� �.�• BUILDER'' NAME Q"y �/h'j AAL J DISTANCE TO NEAREST,BUILDING DIMENSIONS Or SILLS DISTANCE FROM STREET POST' DISTANCE FROM LOT LINES - SIDES REAR GIRDER' AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW (�{� ��,p 1 A n,��_ � � - SIZE OF FOOTING �� x 10 BUILDING ADDITION LJ�I�V V MAT[RtAL OF CHIMNEY •� If BUILDING ALTERATION If BUILDING O SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED 70 TOWN WATER a BOARD OF APPEALS ACTION. IF ANY If BUILDING CONNECTED TO TOWN SEWER ? 19 BUILDING CONNECTED TO NATURAL GAA LINE N a PROPERTY INFORMATION INSTRUCTIONS LAND COST SEE BOTH SIDES EAT. BLDG. COST . s� EST. BLDG. COST PER SQ. FT. - PAGE i FILL OUT BECTIONS 1 - S EST. BLDG. COST PER ROOM PAGE i FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC MET[PS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STAT[ FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR OATL FiL[D ZL SIGNATURE OF OWNER OR ANTHORIZZO AGENT Owners Tel # 97F—&o(4- eok + F E E Contrac� Tell 9-is �TJ� Sa"iT GRAPITKD \ tij Contra. Lic # ©�7 V 2- Z RIC # i2popp. $� HOME IMPROVE=MF'NT CONTRA(-TOR`-, REO:ISTRATION E3oar d of Building Ro-at.,1.at.i o ns and Standards iOne Ar:l1f';iir i;.nn p l RoSt.nrl M HOME IMPROVEMENT CONTF. Registration 124884 ` Type -- PRIVATE CORPORA HOME IMPROVEMENT CONTRACTOR Registration 124884 i • Apuat.i.me F�, ,-,l - ,y Type - PRIVATE CORPORATION Pater F . I,,Jh i .I ���� Expiration 09/08/99 28 Westford Rd Tyngs�ara N1A �?1 �t7 Aquatime Pools 1 �4Pger F. White � ADMINISTRATOR a Westford Rd Tyngsboro MA 01879 u 0 1 e3111 0u S :.1i j;:'? To afiU12q pug adta.2a 1C) cloI daa6L2T0 Alla ' 080999NAI p1Sa asoaatT al�tatm� T -P 1117 :{a}�ris�T# QH XNS3'IQQIN Ott ❑o ubTS pjo3 'moiioq gonia0 3ZIHM d E919d ---------___ _ _ 9661 -- ,- --- - 00 :off, pajatsjSad 69hi19Z:'i, B66T/9Z/LO ZBS6S0 SJ i; :.; saztdYN lxagmnN �Sti3�II aOSIAdBdnS NoIZJn8JSN00 s ii'H ' �J2ld d ii,9ii3HS' 4NO i- LS8Z9 Q SEI = -- 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 /APPLICANT Y��L�� 11 PARk�i� PHONE I LOCATION: Assessors Map Number PARCEL '��' r JSUBDIVISION LOT (S) STREET ST. NUMBER" **********OFFICIAL USE ONLY RECO)MM2ATIONS OF TOWN AGENTS: 7 CONS kVA ION ADMINISTRATOR DATE APPROVED I , DATE REJECTED COMMENTS .JI'1J) i1�J-��`-I'I oil �' �l> �//L ' r i TOWN PLANNER DATE APPROVED i DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED _Jii TIC*SPECTOR-HEALTH DATE APPROVED .� DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE �='o'tZ, Nt©RTC/s.Cz� PURhoSCs �--�C3 N�`r'NB�.tS�i►tJQ� (5i_ .SP.D UPnt,l PuBu G RE=PM5 AND EVf DF-uEb ADDRESS : , 4G4 Fo-sTE2 C✓T2�E'f ��2T�-1 QNDoV�.Q- - M0P.TGAG01Z = -SA SO U R,G E �, , S t3, i k. • ' �5-• �-. . 115,2' � a . . i PAI��EI. SAOWt�l ct4 ��` 6�(03 AO.. I SY 'SCALE:T' (got . ; . :. -PATEZ : ( f tp.�4 OWNERS) : PZE—F10 CERTIFICATE REGISTRY: SF E-)c MbP2MA I CERTIFY that the- Lot shown hereon DEED: BK. { (o Poo P. IE— � AOD that the1)w SL I _ ( K)C,• :shown PLAN : tr �' 3`� �a F-ML CERT. OF TITLE: IcTt-r T(-+ present Zoriingt N OTE: of the > of KIO2.T l-4 A N Do V Er P_,� The, premises do not lie within p a designated , Flood Hazard -" (J° iOS RT ' Zone. �� ��:' I :� ctLLE1 ROBERT G. GOODWIN , R.L.S.- �i..� GOGG�tt� 'e GooJ,vm 62 -CENTRAL STREET ! G► clt t�•l �"r\l 47syf."E`��} ANDOVER31, It I •'i°i:��Y��,�„�� J N OTLS WHITE GENERAL SPECIFICATIONS '� 3/� 1-800-301-SWIM I� /�PPt^IG t3tt c.o��S A . . ` (7946) SIZE 20-,%1- 40 AVC----,- 14 V�m cm 3 e-a9 G Tto MADEPTH 21'-�" To � 0"7 +6+1 SS R�Cr 31a LMS S� N POOLS AND SPAS \ R t_ OGi�L �V\tO� N C� GO�t.S z) CONCR6T-S. sVL.\_ Z,;= PLM QQ ) oUnca► S 0r2�3E 3Z� VOLUME S o \L. o � G O MP► c,T�1 C�ZF�v�L ;' � S `o N NwSTIC S£6L4NT BY Dom. SQ. FT PERIMETER 1 �;.O�+T�c TO R 3) uJRLL IkS_N6TWT to r- a,.= T M�rk NOTES M Itil '-! COO, I�S'r M1ry t/2'O MATE -RAM QCpANSI�N ATERIAL 5Y DKK IN G CONTRALTO R �GNGRE•� DISK OR dpp4N 6" WATER LJNE T[L.E � DECK -JUNCT{ON 2 8Ox(KR CODE) WATER IREVEL_ � I � DECK ITE BOND SEA —► Z "OR I' CONDUIT CON_'jjksUccJS 6" FROST PROOF TILE WITH DEPTH MARKERS 1 NICHE 6Rw::t'�D3 BAR= • P COPPER AN S' CL&VW(OR A5 PER CODE) TIED A2'O.C. BR LIGHT ►R ICH STA;NLESS y"I'EEt_ �'3Ri✓BAR, WlttTc h1t1R6iEi.(-ED-3s• , THRUUGt-WT Fro L1 W ITH NI' PL4STEE_I� 6"A�TERt�tL1`CE $ARS ' _ UNDER LIGHT FtORIZCNT;�LLy IN BOLD b DE4Om, 71F-p G"O.C. g'' vERT'iCA LL_Y 1HROU6 H- _ NAME: OUT DEEP END ANDBR�aK AR ADDRESS: , Tb Er1 �t �•'� —°it�ll _t (i!—�1 PAULA. UP , IN SHALLow END —:�, ; Z PHc^JW AC+ 111 13" ANTI. VORTJC MAIN DRA014 dullNo.34751 W=. 14,HYDI PO TUBE 'S VALVE �.�'�fc,rrft►Eo i� f'a'roKAtILIA 'I_►I=:, _ 3/4' WASHED RXK SUMP .�t , � .� � RES: SEC � SON OF POOL WALL, ���� �� � � � LIGHT PHONE OFC: .700-( •- � � MAP BOOK PG: SEC: DATE DRAWN: i.d�(� DESIGNER: ' OWNER: SCALE 1/8" = 1 ' " GENERAL SPECIFICATIONS WHITE �/fi�tt�/fj//��j��PP `` - 1-800-301-SWIM fel �'�'I�irf�L"/i�V� (7946) SIZE 20 X 4 POOLS AND SPAS DEPTH ,.� VOLUME 24,CCo GiSIS o K17D1� 1�I,ODINC� ��� SQ. FT. 535 PERIMETER (1�}- 2'(j'� iNtS NOTES o pool. F71rsN 30 7�6" 6 7�T SPl (=iQEDMO.' • st)P75P\j15e:v LYC4vAI t� .1, ` � „�E,S�, , \\, • 4 PAF s o sw�Nt��T �ToN 9R FtJ�L-! � � . io'R ^ w � • KiGDtt WR.^..� ��1VCt—� TIME C LUC}� • �� r1 C Gf-l�M•�'DK NAME: RjILIAP�5QU N BRiG SiDNE ADDRESS: L6• RZ515Q : Kfc.AN L>ov Er MA �, ✓ Gt,�i� RES: PHONE 1 P� _-Gulp OFC:(970) r6}-- 1617 MAP BOOK PG: SEC: DATE DRAWN: 9 �o I9-7 DESIGNER: p vA JH I T-e OWNER: PAtG �r Town of _ - Andover °o i LAKE i dover, Mass., /b 2 19 , 9 COCHICMEWICK '�• 4O v BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System f� THIS CERTIFIES THAT...................................................�.�.�. .�.`��:............................................................................... BUILDING INSPECTOR Foundation has permission to erect........... ..�?.. ............. truildifIgs-on .....` G ...... =C "7` 2................. t Rough tobe occupied as................................................: .x.. .......... .bd/...................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST FELECTRIICAL INSPECTOR ..................................................... I.. ............................................... B WING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS'INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. I CERTIFICAT-a OF UABILITY INSURANCE: tS iSSUFO A3 A MATTER OF NFORMATION ATIFICA.7i OW-7 AND �lorjr!PS 140 q1011tS UPON THE CE WICATE 111^1.'-lFFl. Tlm:S ^7fA'IRCATF tiOFS NOT AMEND, MNO OP a F Pq _nL-_ L IE P, 0 goit 14V? l -,P *.117;1 lhi-;; .. Lr c r &APANIES AFFORDIN(A COVERAGE poppereft A(A 41�,eJ144! A COMOSOVAL UNION TpfA 'tic, -AomtttlAcg IW$, CO, Ad. XA-JSA%; WSURAACE CO. f -rp $ 2-00, 'o'co, 000 it I 3 NC-,l JAY lo FMIll -V 4 ok-fl,cSeger• 5"1 000 li ' ;. ._,.._ ., . ...---._.-..._� _... . _________.__ %!P4LZl--ATVj.N David K, HeWfoo RAIQ i IPA Q �/ �� The Commonwealth of Massachusetts Permit UK only „+� N�. l } ?;l Department of Public Safety 3Occupancy 0 w & (k.��k) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /d— 2_4- 7 7 City or Town of TLj �j�l/���lt��'' To the Inspector of Wires: The undersigned applies for a�permit to perform the electrical work described below. Location (Street & Number)// -/ )=0 6 7– � Owner or Tenant Ph I i/”n/Z eb r I-c e�' ' Owner's Address Jr (a,/n e Is this permit in conjunction with a building permit: Yes 9 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization N0. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity, Location and Nature of Proposed Electrical Work Ul l'� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA ovIn- Z No. of Lighting Fixtures Swimming Pool Ab ❑ grnd. ❑ Generators KVA d No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units 3 No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones e " Total No. of Detection and oNo. of Ranges No. of Air Cond. tons Initiating Devices = Heat Total Total W No. of Disposals No. of Pumps Tons KW No. of Sounding Devices � No. of Self Contained D No. of Dishwashers Space/Area Heating KW m Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal Connection❑Other No of No. o g U. No. of Water Heaters KW Signs Ballasts Wirinolta e f 0 No. Hydro Massage Tubs No. of Motors Total HP U. OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or,its substantial equivalent. YES K NOD I have submitted valid proof of same to this office. YEStA NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE h'-/ BOND ❑ OTHER ❑ (Please Specify) Expiration Date Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final 0, f' Signed under the penalties of perjury: FIRM NAME^PP i " Der) 6'a cLxeLIC. N'". 6 0 Licensee /) _�/.�1 -0/�') Signature LIC. N0. Address ]ZSCi./Jr�If��P/�^S 51– 41 ��t�e_12 Bus. el. No, -7 /l �- —Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this pe it application waives this requirement. Owner Agent (Please check one) e� Telephone No. PERMIT FEE Signature of Owner or Agent Date... . oh. 9.235 TOWN OF NORTH ANDOVER PERMIT FOR WIRING &S, USES This certifies that ... (14 ........... ... ........................ has permission to perform .....ke-.J.. ......... ................ wiring in the building of ................................... °" at... .................................. .North Andover,Mass. Fee.?5 Lic.No. .0.......................................................... ELECTRICAL INSPECTOR 31.3 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 1 J I Date... . . ... ... . . ...... .. ra F NpRTH TOWN OF NORTH ANDOVER ,e1tipL p � PERMIT FOR GAS INSTALLATIONS 9 • oma,- .,.. ,. � 7 •.ao err`,�h �ASSACMUSES .a e. This certifies that . :. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .S_ has permission for gas installation . . . . . . . . . . . . `. . . . . . . � in the buildings of . . . . . .!:. :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . .-'. . . .`.. ...` . . . . . . . . . . . . . . .. North Andover, Mass. Fee. :. . . . . . Lic. No.:: J.. . . . . . .. . . . . . . . . . . . . . . . . ::. . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer /Ij v fi1fl�"�. � C'JS;��xcr2_ ��� �zCL'«3c� <�w�L�o C.p�,►¢j.�-�'' �� l r Jype MASSACHUSETTS UNIFORM APPLICATON FOR PERMITTO DO GAS FITTING or print) Date �• �/ 19 NORTH ANDOVER, MASSACHUSETTS Building Locations / `o rs7E�- Is r ' Permit 9 24 Amount S �— Owner's Name � � S us)4j 1O;✓L,k��, Newo Renovation ❑ Replacement ❑ Plans Submitted ❑ m n C Z r C L N y y z Z y A z C m n _ Q C..)75 z-l ` tl03 ENT B A S E M E NT IST. FLOOR 2N D. FLOG R 3RD. FLOOR 4T H . F L O O R 5'r 11 . FLOG R 6'r It FLO O R 7T 11 . FLOOR 8T 11 . FLOOR (Print or type) � P�P� �w - 33� one: o: Certificate Installing Company Name .�y^_y/ �( � - -- rp- Address 4��� SOS/ CYv -s T- �( Partner. �3 - Z?k- ?P17 Business Telephone Kp , 2 39- 2-311 ❑ Firm/Co. G Name of Licensed Plumber or Gas Fitter �ffvr` C,;te� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked ves;please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all ofthe details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts St ,a Code a Chapter 142 ofthe General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber tj F7S— City/Town 117-7 Gas Fitter License ( umber ❑ Master APPROVED(OFFic� USE ONLY) r7 Journeyman C4 1 1 ` 1 i Nod _ g'j O v�'c��� G�i�►�+�� -z �!5��� , ��aM w a ` Date.`-:. . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s � a ,SSACMUS� This certifies that . . :. .'. . ''`'�. . . . . . .N . . i' has permission to perform_.- .. ... . . . . . . . `. . . . . .. plumbing in the buildings of . . .: . . .` . . . . . . . . . . . . . . . . ' at . .`� `.!. . . �r . . .`'. . . .- -" . . . . . . North Andover, Mass. Fee Tom. . . Lic. N6?y4? . 3,-e .. . . . . . . . . . . . PLUMi181NG INSPECTOR Check # 5163 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) _ NORTH ANDOVER,MASSACHUSETTS Date _600�Building Location p fFp sAtee r Owners Name ��� /��g,�,�� Permit l Amount /2' Type of Occupancy New Renovation Replacement Plans Submitted Yes © No FIXTURES BASEVIIVr IST HDCit 3RD FLO[gt ' 4II3 FIp(I2 SIHFLOClt s>HF><,oalt 7IHHIM 8II-I FIID()it (Print or type) Installing Company Name <� .;4 Check one: Certificate ❑ Corp. Address �f ,•Ssi�l ff(�sr7 �,L �?i �i+r /�l� D/R6 S/ 0 Partner. Business Telephone f9�,P —,46Y—9776' Firm/Co. Name of Licensed Plumber. iff,��,y�/ �'�/F-�j '-7r— Insurance Coveraize: Indicate a type of insurance coverage by checkingtheappropriate Liabiliinsurance policy box: Liability P y .� Other type of indemnity D Bond Q Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does have any one of the above three insurance Si gnature ` Owner El Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta P mbing Code d C apter 142 of the Genera]Laws. By. igna ur icense um er Title Type of Plumbing License City/TownPPROVED io�rcE usB ONLY u�y� 9 Elicen a um er Master Journeyman (�� A 36 _ G Date..... .. ez NORTiy °`, :•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41 �,SSACMUSE� This certifies that . u v / Uv . ........ .....� .. .......... .......................... .. ..... .... .. . has permission to perform .........//r, . ��s 1.�, (. , ............. . .............. wiring in the building of... '� ..... .. ................................................................... at....... .... .... d..................j... .................. orth Andover,;m Fee..................... Lic.No.......�... ........... ..,��.f... .�.......... ELECTRICAL INSPECTOR Check # THE 09M110NWE4LTH0FMAS&4CHIIS'E77S Office Use o y DEPARTMENTOFPUBLICSAFM Permit No. BOARD 0FFIREPREYEW0NREG MT10AN5r0 R12'Q0 � Occupancy&Fees Checked A PPUCATTONFOR.FOR TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) / Owner or Tenant L l�ral/-r° Owner's Address -e— Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building l-C l T) 0 Utility Authorization No.0 Z-_ Existing Service Q Amps olts OverheadUnderground No.of Meters —ice New Service yo D Amps/20/ 2- Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1 L ) `i' f > `No.of Lighting Outlets No.of Hot Tubs No.ofTransforners Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Vohs KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other COMCCIIOr1S No.of Water Heaters KW No.of No.of P Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• lrwarceCovw- Puss>anctofhetec ana,��eer,aalIaws Iha%eawnatLiabiUyhmw=PbbcymdudmgCarVi* afiaat YES a NO I,ha emhnftdVWpmofofsamebtheO>llm YES M ffjcutnedle WYFS,PIeawir►k*ftWofwvwWbydmdzgttie box L.L� I - WSURANCEr7l BOND ouim E—] ft=Spacify) Faia6m D* -� EMrna ed VakrecfE6Mcal Wdk$ WotkiDrt�p.� ,/— Z hV cli.D kReg.W R,,* Final FIRM - � y OG� liar>seNa l p 5-F Li=mI I�-V i �, / J T1:� . . s'd�^""' M C ��f L W ;[prcP.NI) f96..6__,_,,, BminfmTd.Na Add, ?r� �:.—� 6i�1�(��l P AIL TeLNa '6 - 6 OWNER'Sll,�URA WANER;t.amawaretttatthet (,a mSLam and ttrat rrry signatueon this parrl<appliralial w�ttes ragt�srrat (Please check one) Owner F-1 Agent a Telephone No. PERMIT FEE V"�-✓