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Miscellaneous - 547 OSGOOD STREET 4/30/2018 (2)
547 Osgood Street ` t i _t Date... ...2Z-� f HORTil 1 .';� °1'; TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHUs� / This certifies that .......................... C T��� ` has permission to perform .......... .:.. . wiring in the building of V�. �,2.�----�.. ... ...... ....... ............... ............................... . at.. � ".... oaf. . .... ... .....:.......... . orth Andover; s. Fee...... .......... ELECTRICALINSPECTOR ,a Check # ©Q � �O Commonwealth of Massachusettsy / Official Use Only r " Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION Date: U -ate-C� City or Town of. NORTH ANDOVERTo the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) y O o0 Owner or Tenant . oo �,�"` (4✓`�s�.� Telephone No. '�'6�5'l017-30a to Owner's Address Is this permit in conjunction with a building permit? Yes E3"--No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /(90 Amps A �olts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the ollowin table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Z Swimming Pool Above ❑ In- ❑ o.o mergency ig g rnd, rnd. Battery Units No.of Receptacle Outlets ) No. of Oil Burners FIRE ALARMS I4to. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices 1 No.of RangesNo.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No,of Self-Contained Totals: __......._......_......_._._._. .._. _._.... LDetection/AletinDevices No.of Dishwashers Space/Area Heating KW l❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of .Data Wiring: Si s Ballasts , No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications wiringt "l No.of Devices or Equivalent OTHER: �� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: / .(When required by municipal policy.) Work to Start: L{ )�-06' Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.. CHECK ONE: INSURANCE ❑ BOND ❑. OTHER ❑ (Specify:) I certify,under the pains and enaltzes o p ) P ofperjury,that the information on this application is true and complete. FIRM NAME• 4. - rz 4 LIC.NO.: 1A I !q 3 Licensee: rG t.N,.-` Signature (If applicable, enter"exempt"in the license number R line.) — LIC.NO.:. Address: 1+S_ C�.,., � � 2Bus.Tel.No.: -3&Y 69D J' *Per M.G.L c. 147,s.57-61,security work requir s Department of Public Safety S"License: �t L cl.No. -�( - a OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ -s'f Date. l . . . � f . TOWN OF NORTH ANDOVER s PERMIT FOR PLUMBING . SSACMUS� i This certifies that . . .�. .r".C. r9�. IIS . . . . . . . . . . IV has permission to perform . . . .`. . .. . . . . . . . . . . . . . . . . �w. plumbing in the buildings of . . . . . . . . . . . . . . . . . . . at. ^S. `/? . .� S'y.o . . . . . . . . . . . orth 'Andover, Mass. Fee.S��. . . .Lic. No. �?G -� . . . . . . . . PLUMBING INSPECTOR i Check .N lC i~ ?. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location, 0,SQQQP1 Owners Name CU Permit#��p y II� A Amount /�bf5 avAqyj D S -- ��. e� Type of Occupancy New ri Renovation Replacement Plans Submitted Yes No ❑ FIXTURES Z x o w o Lof x orA o o w x A a F w U SL$HSI�� BAWd T 1ST R-OCIZ ! ZD FUM 3MRCM M FLOM 5M KaR 6IH FI�I(%t _ 7MFM)M gm FLaR (Print or type) �b Check one: Certificate Installing Company Name_ h 1 ar vitt t/ f' �yl ❑ Corp. 1(6.1Q Address Aj V ❑ Partner. Business elephone _ - FimVCo. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EP Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and 'nstallation erfo ed under Permit Issued for this application will be in compliance with all pertinent provisions of the MassYW Plu h Code and Chapter 142 of the General Laws. By: ignacense um er Title y of Plumbing License � lCity/To PRwn Ai1✓cense Num er Master Journeyman PPROVED(OFFICE USE ONLY Y ❑ t Location 7 No. Date J MORTh TOWN OF NORTH ANDOVER 3? � X00` h0. y + ; : Certificate of Occupancy $ E Building/Frame Permit Fee $ -7 CMUS Foundation Permit Fee $ Other Permit Fee $ ar/ TOTAL $ Check # 184114 Building Infector t TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING I ",..a.�c±..r,;k A,Ar ,vx.xr' ur.,,' ,,x ,..._.,_, c—..... 4ys xy✓ x,r.....�;� 'iF`�n�-yya BUILDING PERMIT NUMBER: DATE ISSUED:`' M �� b2-9,SIGNATURE: Building Commissioner/I for of Buildings Date z SECTION 1-SITE INFORMATION , ti O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: . D�S600/V i 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 1.7 Water Spply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public R Private ❑ Zone Outside Flood Zone ❑ Municipal A— On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No , 111 2.1 Owner of Record WSJ' ✓ / C / / S J' l!Jj 5 /.J �out S 4/4 4 1�z41Ae2 e�fi Dame(Print) / Address for Service: �S �� Signa re Telephone 2.2 Owner of Record: Na$ie Print Address for Service: Si r%ture Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ OAA ,V'13 �vtic l-yam! " ✓!/� viG,� Licensed Construction Supervisor: �'�� 9 y License Number Addre Expiration Date g re Telephone �e 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name R Registration Number M j Address Expiration Date �z Signature Telephone 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.......❑ SECTION 5 Descri tion of Proposed Work check —applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: A A'r"Al. GtU�YCJ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost Dollar to bec yam{ OFFICIAL USE ONLY ( ) a•8 Ix k x l d ,ku ._K Completed b ermit a licant 7, §� r } ..r, x. 1. Building �dG (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 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 Here _ b authorize Y to act on My eh f,in a er rrive to razed by this building Permit application. - Si afar of O ierDate 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 Print Name Si ature of Owner/Agent Date L,_EZ112 Ml * NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN D11vIENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS OF GIRDERS '�- HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X F.. MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE F NORTH ONM Of gAndover No. , 41 - A E dover, Mass., 7 o �. COCMIC NE W ICK V sRATED P'P� �C5 - BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System Lo`O 0 �e t r ��� BUILDING INSPECTOR THIS CERTIFIES THAT...��X.. ..................................................................................................................................... Foundation has permission to erect.... ... h s. buildings on ...��� & s 05 4bo,b " Rough ........... ................................................. .................�' to be occupied as... .°I..'.. a. �►a..... .RMI� �r� .... Nrr.��...J6 �I../ � Chimney Ch' 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. 3(b PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS " g-I ��. ough OAF'd" 1 ..... ..... ........ 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. ACORD CERTIFICATE OF LIABILITY INSURANCE CSR SW DATE(MMIDDIYYYYI A KNOLL-1 04/28/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MF&T Ins. Construction Div. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Construction Division HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR. Accord Park Drive Unit B-1 ALTER THE'COVERAGE AFFORDED BY THE POLICIES BELOW.. =well MA 02061 Lihone: 781-261-2000 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance Companies Knollmeyer Building Corp. INSURERS: American International Co. Greylock Roofing, Inc. wsuRERc: At t: Michelle Granato 12 Linscott Road INSURER D: Woburn MA 01801 INSURER 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 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMIDD/YY DATE Mh9/ODIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,00d,000 A X COMMERCIAL GENERAL LIABILITY CPA-0133606 I 10/01/04 10/01/05 PREMISES(Eaoccurence) $ 100,000 CLAIMS MADE FX]OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X JECT F71LOC Emp Ben. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO MAA-0133607 10/01/04 10/Ql/05. $ 1 000 000 (Ea accident) r r ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED.AUTOS.........>,_ -.. ..- (Per person) '. .. X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 A X I OCCUR � CLAIMSMADE CUA-0133608 10/01/04 10/01/05 AGGREGATE $ 10,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER B EMPLOYERS'LIABILITY W775-82-31 10/01/04 10/01/05 E.L.EACH ACCIDENT $500 000 ANY PROPRIETOR/PARTNERIEXECUTIVE r OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDFn o.. NS 05-02-05P] 1 :32 FILE CERTIFICATE HOLDER CANCELLATION LONGVIE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE T DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ..b REPRESENTATIVES. AUT ED REP S TA71V ACORD 25(2001/08) ©ACORD CORPORATION 1988 / w Y STANDARD FORM OF AGREEMENT BETWEEN OWNER AND CONTRACTOR where the basis of payment is a STIPULATED SUM AGREEMENT Made July 15,2005 BETWEEN THE OWNER: Edgewood Retirement 575 Osgood Street North Andover, MA 01845 AND THE CONTRACTOR: Knolimeyer Building Corp 12 Linscott Rd Woburn,MA 01801 Mr. Christopher J. Knollmeyer,President THE PROJECT: Single Family Salt Box Renovations THE SUBCONTRACTOR AND THE CONTRACTOR AGREE TO SET FORTH THE FOLLOWING We,the undersigned,agree to furnish materials to perform the below-specified work. It is mutually agreed and understood that the work listed below constitutes this entire agreement. Any other work,done at the owner's request,or to correct concealed conditions,will be paid for as extras.The method for determining the value of any extra work will be either lump sum pricing or time and material invoicing in accordance with our standard rates SCOPE OF WORK • Roof back porch...........................................$2,000.00 • Screens &deck repairs at back porch..................$1,000.00 New kitchen countertop ....$1,000.00 • Replace bulkhead..........................................$2,500.00 Total..................................................................$6,500.00 CLEANING Site shall be left broom swept and free of debris. SCHEDULE Job should be done approximately by November 1, 2005. PAYMENT i Invoice due 15 days from invoice date. I WARRANTY One Year. PERMITS All necessary permits are included in this contract. INSURANCE Certificates of insurance shall be provided upon request. � w ,w WARRANTY One Year. PERIVHTS All necessary permits are included in this contract. INSURANCE Certificates of insurance shall be provided upon request. CONTRACT SUM The owner shall pay the contractor for performance of the work, subject to additions and deductions by Change Order, as requested by Owner,provided in the Conditions of this Contract, in Current funds,the Contract Sum of Ninety Seven Thousand Six hundred Twenty Dollars. $97,620.00 Price to be honored for thirty days 4Owner's Signatur /Property Manag Date i Contractor's S gnature Y Dat g I W ✓1zeB�A'�B'��lu�',ul��li�lG`JR���nA1`t s I, . '.L°iceris`e:�-CONSTROCTION SUPERVISOR }3 G S 075942 Birthdate 11/24{1"46 ' i = Expir005 Tr.no: 7422.0 es:J 4/2 to R"trrcted r DANA E SMILEDGE 86 CENTRAL STREETS "h BYFI:ELD, MA 01922 Administrator' J o C) 12 6 hyk//v 5 J 6j-/ �7 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with therovision of MGL c 40 p S 54, a condition of Building Permit at: S ? ose-oa& is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: 2-- (Location of Facility) ignature of Permit Applicant Fire Department Sign off Dumpster Permit Date 04e C';ammanwealth of _4Ra!55arhU5Etts Office Use Only �j Department of Public Safety Permit No. ,o2 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 I Occupancy & Fee Checked 3/90 (leave blank) 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 11.3 City or Town of t)a A O V L"'n-+ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Cj Q Location (Street & Number) Owner or Tenant S ujo 0 S Owner's Address Is this permit in conjunction with a building permit: Yes VM No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. -601,561 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service VyAFb r%A-LJ �d Amps 2 k—) Voits Overhead Undgrd ❑ No. of Meters Number of Feeders'and Ampacity Location and Nature of Proposed Electrical Work TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In- No. of Lighting Fixtures Swimming Pool rnd. [:] rnd. ❑ Generators KVA No. of Emergency Lighting j No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones -Total No. of Detection and No. of Ranges No. of Air Conditioners Tons Initiating Devices Heat Total Total No..of,_Sounding Devices No. of Disposals No. of Pumps Tons KW No. of Self Contained Deteaion,'Sounding Devices No. of Dishwashers Space./Area Heating KW Municipal No. of Dryers HeatingDevices KW Local❑ Connection ❑Other No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: NOV 15 1:(,C1� INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws r i substantial equivalent.YES N ! have submitted valid roof I have a current Liability Insurance Policy including Completed Operations Coverage o is s bs eq a � O p of same to this office. YES LX NO Q If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER❑ (Please Specify) (See Attached) (Expiration Date) Estimated Value of Electrical Work S Work to Start I Inspection Date Requested: Rough Will Call Final Signed under the penalties of perjury: FIRM NAME Interstate Electrical Services; LIC. NO. A-5237 Licensee Pasquale A. Alibrandi — Signature-/ LIC. NO. Address 70 Treble Cove Road N. Bilwrioia _M�1'11_11_11ylwlBus. Tel. No. t1;09 667-�,�f10 Alt. Tel. No.ext• 257 OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) r Telephone No. PERMIT FEE S (Signature of Owner or Apeno p' y Date:../../... .��..CI�S 2667 N°RT1, " TOWN OF NORTH ANDOVER - PERMIT FOR WIRING 1 ,SSACMUS� :f This certifies that ...... I �.. has peimission:to perform ..rte .... .. ........ ........... wiringIn the uilding of .�G.. ...: . at......:. .. ,North Andover,Mass. Fee. .. Lic. .... .... .. ....... ............. 7�L] ELECTRICAL INSPECTOR O 1 75.00 P�I�D WHITE: Applicant CANARY: Building Dept. I K:Treasurer GOLD: File c L4£ (fQtTITItUnWEatt4 of 4Rca55arfi I5Ptt5 Office.use only 7Department of Public Safety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00e Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 Q Q (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) i Date—),Q) City or Town of fUO z JI AAhAdEp, 1� est To the Inspector of Wires: The undersigned applies for a permit /to perform the electrical work described below. Location (Street & Number) - f/ 7Z,r, Owner or Tenant G b ��f L Owner's Address Is this permit in conjunction with a building permit: Yes LNNo ❑ (Check Appropriate Box) Purpose of Building 1�LT112�!�Y/1?✓1) /`� 14nt �I A Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service �2-00OG6+r 300DAt ). LMA Amps / Volts Overhead ❑ Undgrd ® No. of Meters 'Dumber of Feeders'and Ampacity 1 Location and Nature of Proposed Electrical Work L-cJ� l l� �L � J G:)m P/-,!Pk 8'lz LfWs /�EG� TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA AboveIn- No. of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and _. No. of Ranges No. of Air Conditioners Tons Initiating Devices r Heat Tota Tota No. of Sounding Devices No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection'Sounding Devices No. of Dishwashers Space.!Area Heating KW Municipal Local❑ Connection F---1 Other No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No: Hydro Massage Tubs No. of Motors Total HP OTHER: 612 APO)iJ 6S - 1 :aLRI)I rJ l/ n4-P_pJ6-R Ee AAl b FM ° 1 -T#P" 1i<-w Ufa- ' AAJD � C?CJAn-a?. �p ec S� INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES FX NO L ! have submitted valid proof of same to this office. YES LX NO C If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER❑ (Please Specify) (See Attached) (Expiration Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough ` ill Call Final Signed under the penalties of perjury: FIRM NAME Interstate Electrical Services;,' -w.-MLIC. NO. A-521 7 Licensee Pasquale A. Alibrandi Signature LIC. NO. Address 70 Treble Cove Road N. B i Bus. Tel. No. Alt. Tel. No.ext. 257 O"'NER'S INSURANCE"'AIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Sod (Signature of Owner or Agent) GA �- 0 �q67 f5 Date...,< /A 17 1- 276 TOWN OF NORTH ANDOVER O P PERMIT FOR WIRING SSACMUSEt 1 �itQ� This certifies that ..... : 2 f. e......a.kf c........ . .. ................ r has permission to perform .. Pd,;J.�.c...+.... --x.y& .;... wiring in the building of......r l�s. o.j.....L ...C c Q......... ...... at.....1...q.7........d.. . ? .i') ......5 ....................... ;North Andover,Mass. Fee::-.' ... Lic.No. �7.: ... (�...... }9q ELECTRICAL INSPECTOR C '�( 1 ( d 3"500°Od PAID WHITE:ARplicant CANARY: Building Dept. PINK:Treasurer GOLD: File Cu -dn t 181..,Bow Bog Road Bow, NH 03304 (603) 224-7453 bcummings('a)grolen.com fax(603) 224-7467 June 18, 2001 Office of the Building Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Dear Sirs: Re: Edgeuvood Life Carne 1111—Building 7000 575 Osgood Street— North Andover, NIA This letter provides documentation for the June 18"' site inspection. The inspection was limited to the installation of the sprinkler system to provide protection in Building 7000. The contractor, Hampshire Fire Protection, has started to install piping on the third floor of the new building. The system is partially complete on this floor. The other areas are not started at this time. The work that has been completed to date appears to be in accordance with the design drawings submitted to the Town in late September 2000 (stamped September 22, 2000). Should you have any questions, please contact me at(603) 224-7453. Since OF M4, o ROBERT B CUMMINGS -4 C, FIRE PROTECTION `J' Robert B. Cummings, E. No.39299 0 �Q inn � h„ Cc Don McAllister- HFP °9o��Fc�s7�P��.�` v JUN 2n 1G;i [—BUILDING DEPT. CAMy Documentfform Lefter.doc CLIFFORD E. ELIAS COUNSELLOR AT LAW 70 EAST STREET O METHUEN,MASSACHUSETTS 01844 Telephone(978)687-0151 Telecopier(978)685-9132 December 20, 1999 Mr. Robert Nicetta Building Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Re: Edgewood Retirement Community, Inc. Dear Mr. Nicetta: One of the law firms involved in the refinancing of the bonds for Edgewood has discovered that it will be necessary for Edgewood to apply.to the Licensing Commission of the Town (Board of Selectmen) for a license for the storage of inflammable materials. This applies to the garage where.resident parking takes place. Chief William Dolan of the Fire Department had already passed on the garage because it is fully sprinkled, but it will, still be necessary to obtain this license. The process is mandated by MGL c. 148 §§ 13 and 14. Sometime this week I will be submitting an application to the Licensing Board for such a license. It may well be that in the ordinary course of the processing of applications, your office may be notified. I have already spoken with Chief Dolan and he told me that insofar as the Fire Department is concerned, there will be no problem. While this is a fairly routine, straightforward matter, I thought I would extend the courtesy to you of notifying you in advance. Thank you for all your courtesies. and I hope your holidays are happy and healthy. S incerel.y yours,. ^7 .t L ', att - r 1. i � `� ,-4i Y,♦ . a2 \....: f: Clifford .E. Elias- C E E vm k ip l DEG 2 3 °� x NG DE1 EDGEWOOD FARM E (47.OSGOOD--STREET,-NORTH ANDOVER, MA-01845 Telephone (508) 686-0551 - Woodrow R Follett, Manager Linda M. Cunningham, Assistant Manager -0 November 20 , 1991 Town Manager Town Offices Main Street, North Andover, MA 01845 Dear Sir: In accordance with the regulations of the Mass . Department of Environmental Protection, I herewith attach a copy of the Approval dated November 8 , 1991 of the Waiver Application No. 91- 3-3403-1 for my property on Edgewood Farm, 547 Osgood Street. Yours truly, Samuel S . Rogers encl . cc : North Andover Board of Health Department of Environmental Protection i Owned and Operated by Samuel S. Rogers, P.O. Box '111, No. Andover, MA 01845 SECTION VIII WAIVER APPLICATION DISPOSITION (For DEP Use Only) 1. Application Number: 91-3-3403-1 Date Application Received: 06/06/91 2. Applicant Name: Mr. Samuel S. Rogers Applicant Address: 547 Osgood Street North Andover MA 01845 (City/Town) (State) (zip) 3. Site Name: Edgewood Farm 4. Site Address: 547 Osgood Street North Andover (City/Town) S. Site ID Number: 3-3403 6. Disposition Waiver Application Determination. (Check One) Fx1 Approved. Conditions of approval: 1. See Addendum Conditions on Reverse Side. Denied. Basis for denial: Application reviewed by: John J. Fitzgerald, Section Chief.._ Site Management Branch Signature: Date: NOV 0 8 1991 I. a tante of Waiver A lication Disposition I understand and agree to any and all additional conditions specified above for an approved application. (Signature of Ap)1licant) (Date) Applicant: For approved waiver applications, sign and date both disposition forms. Return ,one .com leted copy to the Department within 60 days of the - p P Y approval date, retain the second copy for your records. NOTE: The approval will become invalid if the disposition form, signed and dated by the applicant, is not received by the Department within 60 days of the approval date. Send completed form to: Department of Environmental Protection Northeast Regional Office 10 Commerce Way Woburn, MA 01801 Attn: Site Assessment Section/waiver Unit I 17 I MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION ADDENDUM TO WAIVER APPLICATION DISPOSITION FORM NORTHEAST REGIONAL OFFICE August, 1991 Please note the following instructions and conditions: (1) Sign and return one copy o)f the WAIVER APPLICATION DISPOSITION Form (Section VIII) to: Massachusetts AEP, Northeast Regional Office, 5A Commonwealth Ave. , Woburn, MA 01801, Attn: site Assmt Sect/ Waiver Unit. Retain one copy of the form for your records.. (2) ' It is the responsibility of the Waiver Recipient to promptly notify the Local Board of Health and chief Municipal official (i.e. Mayor, Manager, Selectmen) in the affected community(ies) of Waiver approval. Notice shall be provided in writing and be copied to this office. Notification to local officials shall include a copy of the Waiver Application Disposition Form. (3) Required reports and other document submittals to this office must clearly indicate the DEP Case Number and contain the designation "Waiver submittal" . (4) Contaminated soils from this site may not be transported to any other location within Massachusetts without specific approval from this office. unapproved, off-site disposition, including treatment, reuse, or disposal, may constitute a "release" of oil or hazardous materials and create a new "site" . soils contaminated only with virgin petroleum fuels should be handled in accordance with DEP's "Management Procedures for Excavated Soils Contaminated with virgin Petroleum oils" (Policy #WSC-400-89) . Treatment or reuse options are preferred. In-state landfill disposal will only be considered if documentation is provided that all available and applicable treatment options are not feasible. Soils contaminated with other oils or hazardous materials require site-specific approval, unless transported by a licensed hazardous waste transporter, under manifest, to a licensed facility, per 310 CMR 30.00, the "Massachusetts Hazardous Waste Regulations" . Proposals to treat, dispose, or reuse contaminated soils outside of Massachusetts must conform to all applicable in-state and out-of-state regulatory requirements, but do not otherwise require approval from the Regional office. The review and approval of soil disposition proposals by the Department is solely from the context of preventing releases of oil and hazardous materials in new locations, and is not to be construed as a review or approval of the Final Remedial Response Plan for the Waiver site under consideration. (5) If a public involvement petition has been or is hereafter submitted for the site under M.G.L. c. 21E, section 14(b) and 310 CMR 40.203, 'the waiver grantee must develop and implement a Public Involvement Plan in accordance with 310 CMR 40.203(4) and DEP's "Public Involvement Plan Interim Guidance for waiver Sites" . (6) Applicants are reminded of the necessity to comply with the risk characterization and permanency requirements specified in 310 CMR 40.545. (7) Dissolved volatile Organic Compounds (VOCs) at the water table interface can partition into the soil gas, and migrate into subsurface structures, including basements. such a migration pathway should be considered at sites where water-table plumes of dissolved VOCs are identified proximate to or under inhabited structures. (8) This office will conduct detailed audits on selected Waiver sites, on both a random basis and as a result of our initial review of waiver applications and report documents submitted (or not submitted) pursuant to the conditions specified in Section IV. Any questions regarding this matter should be directed to the above-specified address. I i i ow"nonwea" of JLM""aa,gloaltl� of 00&OfW - .it 6Y �5 6on Daniel S. Greenbaum ' 01d'0> Commissioner August 14 , 1991 Mr. Brian R. Hardy RE: NORTH ANDOVER-Edgewood Farm Environmental Systems05,:47-Osgo_od�street-;Lot #7 Engineering Company, Inc. -- - Waiver Application Number P.O. Box 652 #91-3-3403-1 Amesbury, MA 01913 Dear Mr. Hardy: , Y This letter is in regard to Waiver Application number 01-3-3403-1 submitted to the Department for the above referenced property hereafter referred to as the site. This waiver is being sought under the provisions of 310 CMR 40. 537. of the Massachusetts Contingency Plan in order to allow the applicant and his environmental consultant to assess and remediate oil and hazardous, material contamination without direct Departmental oversight. The Department has completed an initial review of the above referenced waiver application submittal concerning the site. Based upon this review, the Department has determined that the P p information provided in whole does not constitute a Phase I -Limited Site Investigation Report as defined by 310 CMR 40. 543 . Additionally, sections of the Interim Site Classification Form were determined to be inadequate and will have to be resubmitted. The Department hereby requests the following information - regarding -the site as discussed during our July 09, 1991 telephone communication: (2). (b) 5: the placement of utility lines at and nearby the location including; municipal water supply lines, private water supply lines, and other subsurface utilities including legible graphic representation; I g 9 P p §,'..(2.).(b) 6a: the identification of Zone IIs, public water supply wells, or private water supply wells nearby the location including legible graphic representation; the Department requires a minimum 2 , 640 foot radius survey of the site whenever a zone II has not been delineated. Original Printed on Recycled Paper i i i § (2) (b) 6d: the identification of nearby surface waters that are public recreation areas, are upstream of potable water supply intake, or are upstream of the recharge area for public or private water supply wells; § (2) (b) 6e: the identification of any food chain exposure pathway; v depth to groundwater data; _ well construction details for all groundwater monitoring wells used to establish groundwater contour maps; a complete list of all site- abutters- including use of each property; a discussion of the observations and finding associated 'with .the excavation and subsequent removal of all +' underground storage tanks formerly on site; interim Site Classification Form revisions are necessary for Criterion numbers three (3) , four (4) , five (5) , and eight (8) . The "supporting information and source" responses do not adequately answer the questions asked of the consultant. The purpose of this form is to draw from and augment a Phase I -Limited Site Investigation report. ' The above requested information should be submitted to the 'Department within thirty (30) days of the receipt of this letter. If you have any questions regarding this matter, please contact Steven S. Ross in writing at the letterhead address or' (617);"935-2160, extension 149. Sincerely, _ Steven S. Ross Environmental Geologist J. Fitzgerald Section Chief Site Assessment ,SSR/7 J f' cc: DEP, BWSC, 1 Winter St. , Boston, 02148 ; Attn: Elaine Jonnet Mr. Samuel S. Rogers, Edgewood Farm, 547 Osgood St. , North Andover, 01845 Town of North Andover Board of Health c���/GC/ � ✓���e%G7 02n - 4�� Of ✓fe, O�� Oo&vl?r - ✓YD&kC1f ✓L��1.0q 7 Daniel S. Greenbaum dW oao/ Commissioner AUG 1411991 (617) 935-2160 James P. McIver, Plant Manager RE: NORTH ANDOVER-Metropolitan Wheelabrator Environmental Boston/Northeast Region Systems, Inc. (WESI) 310 CMR 7 . 02-Plan Approval Holt Road CONCEPTUAL APPROVAL North Andover, MA 01845 AONON File No. 3091024 Dear Mr. McIver: The Metropolitan Boston/Northeast Region of the Department of Environmental Protection, Division of Air Quality Control ("the Department") in response to your submittal entitled "Procedure for assuring the continuous compliance of the NESWC MSW/RRF with the S02 emission rate limit of the NESWC MSW/RRF PSD permit" dated May 3 , 1991, has reviewed the conceptual sulfur dioxide (S02) reduction program relative to the WESI-MRI , NESWC MSW-RRF, Holt Road, North Andover, Massachusetts . This preliminary proposal/application was submitted to the Department in accordance with Paragraph III , 16 of the Department ' s Administrative Order and Notice of Noncompliance (AONON) dated April 18 , 1991, File No. 3091024. This review of the submittal by Department engineers indicates that the proposed sulfur dioxide reduction program consists of: dry sorbent furnace injection, and a supplemental selective waste management program to identify, target and eliminate portions of the waste stream which may contain above average sulfur levels. i The Department is of the opinion that the submittal represents current air pollution control engineering practice and hereby grants CONCEPTUAL APPROVAL for the project subject to the following provisos: 1. That within 30 days of receipt of this CONCEPTUAL APPROVAL WESI/MRI shall submit to the Department plans, drawings and specifications for the installation of the dry sorbent injection system and appurtenances, and a waste management program at the subject facility. 2 . That within 30 days of receipt of this CONCEPTUAL APPROVAL, WESI/MRI shall submit to the Department a timetable which shall include a schedule for purchases .of equipment necessary for implementation, a schedule for submittal of complete applications for any required permits, approvals or licenses, and a schedule for i Original Printed on Recycled Paper Page 2 construction. Such timetables shall provide for full implementation of the procedures described in Proviso No. 1 above, in the shortest reasonable time possible provided that full implementation shall be achieved no later than 120 days after the Department ' s written Final Approval of this project. For your information, the proposed sulfur dioxide reduction program is subject to the Department ' s Permit Fee Program. This project has been categorized as a major comprehensive plan application (CPA) , a modification to a major source, specifically a Prevention of Significant Deterioration (PSD) permit source. The permit fee for major CPAs is $11, 250 . Enclosed please find a complete air quality permit application package and transmittal form for your proposed project. Please be advised that this CONCEPTUAL APPROVAL does not negate the responsibility of the WESI-MRI to comply with this or any other applicable federal, state, or local regulations now or in the future. Nor does this CONCEPTUAL APPROVAL imply compliance with any other applicable federal, state, or local regulations now or in the future. Should you have any questions concerning this matter, please do not hesitate to contact Mr. James Belsky, Air Quality Section Chief, Metropolitan Boston/Northeast Region, 5 Commonwealth Avenue, Woburn, Massachusetts 01801. Very truly yours, Edward H. MacDonald Regional Engineer for Waste Prevention EHM/EB/jb Board of Health, Town Building, N. Andover, MA 01845 Fire Department, 124 Main Street, N. Andover, MA 01845 DEP, One Winter Street, Boston, MA 01280 ATTN: Edward Kunce Diane Schachter, Esquire Robert Donaldson William Gaughn, DEP, NERO USEPA Air Management Division, (APC-2311) , JFK Building, Boston, MA 02203 - ATTN: Fred Weeks Factory Mutual Engineering Boston District Office 1151 Boston-Providence Turnpike P.O. Box 9102 August 9, 1991 Norwood, Massachusetts 02062 Telephone (617) 762-4300 Telex 92-4415 'Mr. Robert Nicetta, Building Inspector Town Hall 120 Main Street North Andover, MA 01845 Subject: Brooks School (Boathouse) North Andover, MA Loss No. 2776-91-01-01, June 8, 1991 Index No. 9174.25 Account No. 1-65795 Dear Mr. Nicetta: As adjusters for Allendale Mutual Insurance Company, we inform you that claim is being made for damages to buildings or structures located at Great Pond Road North Andover, MA owned by Brooks School. This notice is given as required by Massachusetts General Laws, Chapter 139, Section 3B and Chapter 175, Sections 97A and 99, as amended. Very truly yours, 4 _ Tyler E. Long, !taff Adjuster Boston District Office lcc: Mr. William Dolan, Fire Chief lcc: Ms. Allison Convoy, Health Insp. Town Hall Town Hall 124 Main Street 120 Main Street North Andover, MA 01845 North Andover, MA 01845 William F.Weld Governor ��,4zolQeOf�Yi✓IZ6G'CCI�Pi • Bureau of David P.Forsberg �+ ��,�/ �+ Communicable Secretary 305 cJof�ltr cftreet,, 0'0&,9,•1,,✓f 02130-3597 Disease Contra David H.Mulligan 617-522-3700, Fax 617-522-8735 Commissioner Alfred DeMaria, Jr. , M.D. Assistant Commissioner August 1991 CLINICAL ACTIVITIES RELATED TO COMMUNICABLE DISEASE CONTROL BY LOCAL BOARDS OF HEALTH Local boards of health play a critical role in the protection of public health and the control of communicable diseases remains a crucial element of public health programs . The continued control of communicable diseases depends on the maintaintence of basic activities of surveillance , clinical follow-up of reports , outbreak control , enforcement of isolation and quarantine requirements , ensuring hospitalization and treatment, implementation of tests , provision and administration of immunizations, assurance of safe and sanitary conditions and maintenance of communications with physicians and other health care providers. These activities , upon which the safety of the public depend and which are required by statute and regulation, require clinical experience, assessment and judgment. Infection control in the community is a clinical activity. Nurses are critical to infection control at the community level . The broad and comprehensive training of the nurse includes clinical evaluation and intervention, community health and health education. . These skills are essential for diagnosis; administration of medications and vaccines; disease investigation; interpretation of signs , symptoms and laboratory results; provision of health care advice and information; and formulation of disease control guidelines and strategies . While we try to cope with the erosion of the public health infrastructure, we must keep in focus certain critical and essential activit-ies-. Failure to do this will result in increased morbidity and mortality, a multiplication of harm due to the spread of communicable disease, and a compounding of cost that occurs when basic disease prevention is no longer effectively implemented. Following is a list of responsibilities of local boards of health, established by law, regulation and good practice , which require the clinical skills best represented in nurses . o Receive reports of diseases dangerous to public health (MGL, c . 111 , s . 111; 105 CMR 300 . 100) . This requires interpretation and evaluation of clinical data. Reports must be sent to other jurisdictions where an infected individual may reside, or where an individual may have had contact with the disease. This activity requires a detailed knowledge of disease epidemiology of a number of contagious diseases . Case investigation forms for certain diseases require completion of numerous medical questions . o Report cases of dangerous diseases to the Department of Public Health within twenty-four hours (MGL, c.111, s . 112; 105 CMR 300 .100) . This requires judgment as to whether the clinical information provided constitutes an adequate diagnosis of a designated disease. © Provision of treatment, transportation and protection of the sick person and the community at large in the case of a disease dangerous to the public health (MGL, c. 111, s . 6 ,7 , 94A; 95, 96 , 96A, 97) . Persons trained in the care and treatment of persons with diseases dangerous to the . public health are needed to implement this legal responsibility. e Consultation with the Department of Public Health regarding prevention of dangerous diseases (MGL, c . 111, s .7) . This requires a clinical background to adequately investigate and discuss outbreak and disease control and implement interventions . o Enforce isolation and quarantine regulations (MGL, c. 111 , s . 6; 105 CMR 300 .200) . Clinical situations must be interpreted and correct information about control methods be transmitted to a variety of institutions and public facilities, including health care facilities. ® Receive reports of eye abnormalities in newborns and take immediate action to prevent blindness (MGL, c.111 , s . 110) . The vision of the involved infant may depend on clinical evaluation skills and prompt treatment. i 0 Provide antirabic vaccine and treatment (MGL, c. 140, s.145A) . Requires someone capable and licensed to administer a potentially life-saving treatment by injection. © Maintenance of close contact with area physicians and ,nurse practitioners is essential for successful disease intervention, adequate surveillance and prevention of outbreaks . a Receive reports of food poisonings and send these reports to the Department of Public Health (105 CMR 300.120) . Evaluation of signs and symptoms of foodborne disease and epidemiologic parameters is necessary to interp9;_gA,,tTports and implement control interventions and provide for enfbXcem6nt of Chapter X of the State Sanitary Code (MGL c . 111, s . 127A) m Require and enforce the immunization or revaccination of all town residents and occupants as necessary for public health and safety (MGL, c.111 , s .181 , 182) . Immunization records must be interpreted. . Up-to-date immunization guidelines and procedures must be interpreted and implemented. a Provide means for vaccinations, without charge, if such vaccinations are required by the board (MGL c. 111 , s .181) . Personnel to administer such vaccinations in an appropriate and safe manner is necessary. Immunization clinics are a routine and highly cost-effective public health activity. ® Maintenance of an established biologic (vaccine) distribution stationMGL c.111 s . 5 . 105 CMR 730 .000) ( . Operation requires considerable knowledge of appropriate handling of biologics and dispensing of vaccine with adequate and accurate information. e Receive and record reports of pulmonary and extrapulmonary tuberculosis (MGL, c .111, s . 111) . Requires interpretation of j medical reports and laboratory studies outlined in 105 CMR 350: Determining Active Tuberculosis . ® Investigate each reported case of tuberculosis determining the source and possible spread of infection to other persons . Identify and report appropriate contacts of infected persons and report these to the Department of Public Health. Screen groups within the general population using the Mantoux tuberculin skin test procedure. These activities require a knowledge of the medical and epidemiologic aspects of tuberculosis and the administration and interpretation of the Mantoux skin test. G Assist in the identification, transportation and hospitalization of patients eligible for admission to a hospital under contract with the Department of Public Health for tuberculosis treatment (MGL, c.111, s . 80; 105 CMR 360) . This .requires medical case management. o Ensure prompt diagnostic and follow-up examinations of patients and suspect tuberculosis cases and the uninterrupted treatment of patients with diagnosed tuberculosis (105 CMR 365) . This requires knowledge of the epidemiology of tuberculosis and control methods . o Provide appropriate nursing services, under medical orders, for administration of injectable tuberculosis drugs or -supervised chemotherapy apart from a tuberculosis clinic. o Proceed with compulsory hospitalization of uncooperative tuberculosis patients after exhausting all reasonable attempts to influence the patient to accept treatment or isolation (MGL, c.111, s. 94A or 95) . This is fundamentally a clinical activity of treatment and case management. i o Designate a staff person or a person or agency under contract to enforce the laws , rules and regulations pertaining to tuberculosis and carrying out public health duties and responsibilities . The public health nurse has traditionally and effectively performed this function and is uniquely suited to these activities . o Resident aliens in the U. S. with diagnosed or suspected tuberculosis or incomplete immunizations must be identified and all appropriate forms must be completed (Federal P.L. 87-301) . This requires the evalution of medical records , an understanding of tuberculosis and vaccine preventable disease clinical guidelines, and procedures and proper implementation of disease control protocols . 97e Owwzonwea" kLtm� 0 V V ✓ W'N WW Daniel S. Greenbaum `vGk , 0>&07 Commissioner (617) 935-2160 July 31, 1991 Mr. Brian R. Hardy 'RE: NORTH ANDOVER-Edgewood Farm Environmental Systems ,c57t_7=0-sgood-Street;Lot-#7----% Engineering Company Waiver Application Number Edgewood Farm #91-3-3403-1 Amesbury, MA 01913 Dear Mr. Hardy: This letter is in regard to Waiver Application number 91-3-3403-1 submitted -to the Department for the above referenced property hereafter referred to as the site. This waiver is being sought under the provisions of 310 CMR 40. 537 of the Massachusetts Contingency Plan in order. to allow the applicant and his environmental consultant to assess and remediate oil and hazardous material contamination without direct Departmental oversight. The Department has completed an initial review of the above referenced waiver application submittal concerning the site. Based upon this review, the Department has determined that the information provided in whole does not constitute a Phase I - Limited Site Investigation Report as defined by 310 CMR 40.543 . Additionally, sections of the -Interim Site Classification Form were determined to be inadequate and will have to be resubmitted. The Department hereby requests the following information regarding the site as discussed during our July 09 , 1991 telephone communication: § (2) (b) 5: the placement of utility lines at and .nearby the location including; municipal water supply p pp y lines, private water supply lines, and other subsurface utilities including legible graphic representation; § (2) (b) 6a: the identification of Zone IIs, public water supply wells, or private water supply wells nearby the location including legible graphic representation; the Department requires a minimum 2, 640 foot radius survey of the site whenever a zone II has not been delineated. i Original Printed on Recycled Paper § (2) (b) 6d: the identification of nearby surface waters that are public recreation areas, are upstream of potable water supply intake, or are upstream of the recharge area for public or private water supply wells; § (2) (b) 6e: the identification of any food chain exposure pathway; - depth to groundwater data; _ - well construction details for all groundwater monitoring wells used to establish groundwater contour maps;s; - a complete list of all site abutters including use' of . each property; a discussion of the observations and finding associated with the excavation and subsequent removal of all underground storage tanks formerly on site; Interim Site Classification Form revisions are necessary for Criterion numbers three (3) , four (4) , five (5) , and eight (8) . The "supporting information and source" responses do not adequately answer the questions asked of the consultant. The purpose of this form is to draw from and augment a Phase I -Limited Site Investigation report. The above requested information should be submitted to the Department within thirty (30) days of the receipt of this letter. If you have any questions regarding this matter, please contact Steven S. Ross in writing at the letterhead address or (617) ,-935-2160, extension 149. Sincerely Steven S. Ross Environmental Geologist J. Fitzgerald Section Chief Site Assessment SSR /JJf cc: DEP, BWSC, 1 Winter St. , Boston, 02148 ; Attn: Elaine Jonnet Mr. Samuel S. Rogers, Edgewood Farm, 547 Osgood St. , North — Andover, 01845 Town of North Andover Board of Health I M) GR&UfL �t7&Xeadf > C 6 ommonweam Daniel S. GreenbaNCrANDOVER BOARD OF HEALTK" aka'' Jf' 0>&01 Commissioner 120 MAIN STREET N.ANDOVER,MA.01845 O ctober 30, 1990 Mr . Samuel Rogers RE: NO. ANDOVER-ERB-N90-0746 P .O.. Box 111 -<54-7 Osgood Street No. Andover, MA 01845 Edgewoo(I-F F REFERRAL TO SITE MANAGEMENT BRANCH Dear Mr . Rogers : The Emergency Response Branch of this Office has collected and reviewed information relative to contaminant conditions at the above referenced location. Such information was collected subsequent to a determination that a release o_ gasoline h . , g had occurred at this site . This incident was investigated by personnel from the Emergency Response Branch of this Office on May 11 , 1990 . On May 30', 1990 , you were issued a Notice of Responsibility pursuant to M.G.L. c21E and 310 CMR 40 . 160 . This letter is intended to notify you in writing that : (1) Contaminant conditions at this location render the site an "LTBI" (Location . To Be Investigated) pursuant to the Massachusetts Contingency Plan (MCP) , 310 CMR 40 . 520 (1) . (2) This office is in receipt of the submitted site report prepared by Environmental Systems Engineering Company. (3) A decision on the final disposition of the site will be made by the Site management ement Bra of this Office after all the g pertinent data and response actions have been evaluated. Pending final determination of the site disposition: (1 ) Contaminated soil presently stockpiled on site, has not been removed for disposal in compliance with the existing "DEP Soil Policy You are therefore in violation of the Department ' s soil Policy and 310 CMR 30 . 000& 40. 000 , and the Agency is looking into its enforcement options . (2) Groundwater and subsurface soils cannot be considered "clean" . Therefore, no excavation and removal of soils or pumping of groundwater from the site should occur without prior. DEP notification and approval . Original Printed on Recycled Paper Page 2 Site Disposition The Emergency Response Branch of the Department has concluded . that at this time there is no need for any further emergency Y response actions at the site. However, there are still concerns that further remedial measures could be required at the site after a detailed evaluation of the long term environmental/public health impact of the contaminant conditions at the site . The case is therefore being referred to the Site Management Branch of this Office for further investigation. However, due to the existence of a large number of more pressing priorities , the DEP cannot at this time devote further staff resources to the remediation of this site . No further investigative and/or remedial response actions may be initiated at this site without specific approval from the Site Management Branch unless a "Waiver" application is filed and , approved by the Department pursuant to the provisions of 310 CMR 40 . 537 . Finally, be advised that 310 CMR 40 . 520 and recent statutory amendments to M.G. L. Chapter 21E compel the Department to publish the addresses of all -sites and locations of confirmed or suspected releases of oil/hazardous materials to the environment . Contingent upon an additional review of available incident/site information, this location may be included in a future list publication . If you have. any further questions , please contact the Administrative Assistant for the Site Management/Technical Support Branch at the letterhead address or 935-2160 . All future communications regarding this matter - must reference the DEP case number 3-3403 . Very trujyours , Joanne Michaud EnvironmentalEngineer Ri rd J . Cha]. n Regional Engine. r for Waste Site Cleanup RJC/JM/ram cc : DEP/BWSC, Div. of Response & Remediation, Boston N. Andover Board of Health i e , 971& 6o) fnm���� Of JLM""&ZP 0_Jfe&vj6oZXwv _qoewn, - Aotb� 06z;q� C 935-2160 f't'0"CN!/57r, Aa OAVO/ Daniel S. Greenbaum Commissioner May 30, 1990 Mr. Samuel Rogers RE:iN.O_.:ANDOVER - ERB-N90-0746 P.O. Box 111 547-0sgood_Street! No. Andover, MA 01845 Edgewood Farm NOTICE OF RESPONSIBILITY/REQUEST FOR TECHNICAL INFORMATION PURSUANT TO M.G.L. CHAPTER 21E and 310 CMR 40.000 Dear Mr. Rogers: On May 11, 1990, Department personnel investigated reports concerning the release of an undetermined quantity of gasoline discovered during the removal of one 250 gallon, one 750 gallon, and one 1,000 gallon underground storage tanks at the above referenced location. Approximately eight cubic yards of contaminated soil was excavated and stockpiled pending disposal. The excavation was immediately backfilled with remaining excavated soil and graded with clean fill before remediation was complete and without authorization from this Department. Such incident is governed by the Massachusetts Contingency Plan (MCP) , 310 CMR 40.000 and Chapter 21E of the General Laws of Massachusetts (hereinafter "M.G.L. Chapter 21E") , the Massachusetts Oil and Hazardous Material Release Prevention and Response Act, which was enacted on March 24, 1983. Chapter 21E and the MCP identify as responsible parties the current owner or operator of a site at which there has been a release or threat of release of. oil or a hazardous material; the past owner or operator of a site where a release of hazardous material has occurred; any person who directly or indirectly arranged for the transport, disposal, storage or treatment or hazardous materials to or at such a site; and any person who caused or is legally responsible for a release or a threat of release of oil- or a hazardous material at such a site. Such parties are liable without regard to fault; the nature of this liability is joint and several. (M.G.L. Chapter• 21E, Section 5a) . This letter is to inform you in writing that: (1) The Department has determined that a release of gasoline has occurred at the subject site. (2) Information available to the Department indicates that you as owner of the subject site, are a liable and "responsible" party pursuant to Sectign 5(a) of Chapter 21E. Printerl nn Rervrled Paper a Page 2 (3) Contaminant conditions at this location render the site an "LTBI" (Location To Be Investigated) pursuant to the Massachusetts Contingency Plan (MCP) , 310 CMR 40.520(1) . , (4) 310 CMR 40.542 and M.G.L. Chapter 21E compel the Department to publish a list of all locations, confirmed or suspected disposal sites, where oil/hazardous materials have been released to the environment. This site may be listed in our next quarterly publication. (5) All further investigative and/or remedial response measures at this site must conform with the provisions of 310 CMR 40.000, the Massachusetts Contingency Plan (MCP) . As a first step .in this process, you are advised to contract with a professional environmental consultant firm to conduct a Preliminary Assessment (40.541) and a Limited Site Investigation (40.543) as defined in the MCP, and submit the results of your findings to the Department. Further investigative._ and/or remedial response actions may be initiated at this site without specific approval from the Department only if this is a "Non-Priority Site" and a "Waiver"-application is filed by you and approved by the Department pursuant tot he provisions of 310 CMR 40.537. (6) Should you fail to implement those actions deemed necessary by this Office, the Department may, pursuant to M.G.L. Chapter 21, take or arrange for any and all necessary actions at the site. If the public funds are expended under such conditions, Chapter 21E, Section 11 stipulates that the Attorney General of the Commonwealth of Massachusetts may initiate legal action against the responsible party(s) to recover all costs incurred by the Department in the assessment, containment, and removal of any release or threat of release of oil or hazardous material. (7) The liability of responsible parties in (6) above includes: a. Administrative costs incurred by the Department in handling this matter. b. Interest charges on the total liability at the statutory rate of 12% compounded annually; and C. Treble costing (i.e. , three (3) times the total amount of response costs the Department incurs) ; and i d. All damages for the injury, destruction or loss of natural resources due to the release. Page 3 This liability constitutes a debt to the Commonwealth. The debt, together with interest, creates a lien on all your property in the Commonwealth. Lien placement will increase your administrative cost liability. This liability will further increase if the Department is required to go to court to recover its costs. Administrative and legal costs for simple spill cases which reach this stage total at least $3,300.00. In addition to the foreclosure remedy provided by the lien, the Attorney General of the Commonwealth may recover that debt or any part of it in an action against you. You may also be liable for each violation of C.21E as well as for additional penalties or damages pursuant to other statutes or common law. Your acceptance of responsibility for such release means that (1) You will immediately initiate response actions at this "LTBI" in conformance with 310 CMR 40.535; 40.536, 40.541, 40.542 and 40.543 of the Massachusetts Contingency Plan (MCP) ; and (2) you will pay for all response costs incurred by the Department due to such release. Any further questions regarding this matter should be directed to .Joanne Michaud at the letterhead address or 935-2160 and refer to case number ERB-N90-0746. Very truly yours, oanne Michaud Environmental Engineer RichJ. Chalpin Regional Engineer RJC/JM/ram cc: DEP/BWSC, Div. of Response & Remediation, 1 Winter St. , Boston, MA 02108 DEP/BWSC, Div. of Fiscal Mgmt/Cost Recovery, 1 Winter St. , Boston, MA 02108 No. Andover BOH No.. Andover Fire Department �r s 9Z& 6ommonweaM ofJfau"awe" Aww� P� 0 935-21600/&0/ y �O-lJl!/YL, Daniel S. Greenbaum Commissioner May 30,,,1990 RE:NO. ANDOVER - ERB-N90-0746 Mr. Samuel Rogers P.O. Box 111 547 Osgood Street No. Andover, MA 01845 Edgewood Farms NOTICE OF RESPONSIBILITY/REQUEST FOR TECHNICAL INFORMATION PURSUANT TOM.G.L. CHAPTER 21E and 310 CMR 40.000 Dear Mr. Rogers: On May 11, 1990, Department personnel investigated reports concerning the release of an undetermined quantity of gasoline discovered during the removal of one 250 gallon, one 750 gallon, and one 1,000 gallon underground storage tanks at the above referenced location. Approximately eight cubic yards of contaminated soil was excavated and stockpiled pending disposal. The excavation was immediately backfilled with remaining excavated soil and graded with clean fill before remediation was complete and without authorization from this Department. Such incident is governed by the Massachusetts Contingency Plan (MCP) , 310 CMR 40.000 and Chapter 21E of the General Laws of Massachusetts (hereinafter "M.G.L. Chapter 21E") , the Massachusetts Oil and Hazardous Material Release Prevention and Response Act, which was enacted on March 24, 1983. Chapter 21E and the MCP identify as responsible parties the current owner or operator of a site at which there has been a release or threat of release of oil or a hazardous material; the past owner or operator of a site where a release of hazardous material has occurred; any person who directly or indirectly arranged for the transport, disposal, storage or treatment or hazardous materials to or at such a site; and any person who caused or is legally responsible for a release or a threat of release of oil or a hazardous material at such a site. Such parties are liable without regard to fault; the nature of this liability is joint and several. (M.G.L. Chapter 21E, Section 5a) . This letter is to inform you in writing that: (1) The Department has determined that a release of gasoline has occurred at the subject site. (2) Information available to the Department indicates that you as owner of the subject site, are a liable and "responsible" party pursuant to Section 5(a) of Chapter 21E. r` J P6,o—1 nn PrrNwlrd Pnrrr Page 2 (3) Contaminant conditions at this location render the site an "LTBI" (Location To Be Investigated) pursuant to the Massachusetts Contingency Plan (MCP) , 310 CMR 40.520(1) . i (4) 310 CMR 40.542 and M.G.L. Chapter 21E compel the Department to publish a list of all locations, confirmed or suspected disposal sites, where oil/hazardous materials have been released to the environment. This site may be listed in our next quarterly publication. (5) All further investigative and/or remedial response measures at this site must conform with the provisions of 310 CMR 40.000, the Massachusetts Contingency Plan (MCP) . As a first step in this e advised to contract with a professional environmental process, you are Assessment 40.541 and a consultant firm to conduct a Preliminary A ( ) Limited Site Investigation as defined in the MCP, and submit ( ) g 40.543 the results of your findings to the Department. Further investigative and/or remedial response actions may be initiated at this site without specific approval from the Department only if this is a "Non-Priority Site" and a "Waiver"_application is filed by you and approved by the Department pursuant tot he provisions of 310 CMR 40.537. (6) Should you fail to implement those actions deemed necessary by this Office the Department pursuant to M.G.L. Chapter 21, take or i P maY u lic 'ons at the site. If the b n and all necessary acts P arrange for a Y g Y funds are expended under such conditions, Chapter 21E, Section 11 stipulates that the Attorney General of the Commonwealth of Massachusetts may initiate legal action against the responsible b party(s) to recover all costs incurred y the Department in the assessment, containment, and removal of any release or threat of release of oil or hazardous material. (7) The liability of responsible parties in (6) above includes: a. Administrative costs incurred by the Department in handling this matter. b. Interest charges on the total liability at the statutory rate of 12% compounded annually; and C. Treble costing (i.e. , three (3) times the total amount of response costs the Department incurs) ; and d. All damages for the injury, destruction or loss of natural resources due to the release. i Page 3 This liability constitutes a debt to the Commonwealth. The debt, together with interest, creates a lien on all your property in the Commonwealth. 'Lien placement will increase your administrative cost liability. This liability will further increase if. the Department is required to go to court to recover its costs. Administrative and legal costs for simple spill cases which reach this stage total at least $3,300.00. In addition to the foreclosure remedy provided by the lien, the Attorney General of the Commonwealth may recover that debt or any part of it in an action against you. You may also be liable for each violation of C.21E as well as for additional penalties or damages pursuant to other statutes or common law. Your acceptance of responsibility for such release means that : (1) You will immediately initiate response actions at this "LTBI" in conformance with 310 CMR 40.535, 40.536, 40.541, 40.542 and 40.543 of the Massachusetts Contingency Plan (MCP) ; and (2) you will pay for all response costs incurred by the Department due to such release. Any further questions regarding this matter should be directed to Joanne Michaud at the letterhead address or 935-2160 and refer to case number ERB-N90-0746. Very truly yours, Joanne Michaud Environmental Engineer Rich J. Chalpin Regional Engineer RJC/JM/ram cc: DEP/BWSC, Div. of Response & Remediation, 1 Winter St. , Boston, MA 02108 DEP/BWSC, Div. of Fiscal Mgmt/Cost Recovery, 1 Winter St. , Boston, MA 02108 No. Andover BOH No. Andover Fire Department vl/E4f7Zf'i?�i Q�ii (9�tPPI� DANIEL S.CREENBAUM Commissioner June 26, 1991 aCM Board of Health RE: NORTH ANDOVER - Edgewood Farm Town Building 54-7 Osgood Street North Andover, MA 01845 DEP Case No.3-3403` WAIVER APPLICATION NOTIFICATION Dear Local Official: This letter is to notify you that the Department of Environmental Protection (DEP) received a "Waiver of Approvals" application for the above referenced disposal site. The application was submitted by Samuel S. Rogers, Edgewood Farm. The Massachusetts Contingency Plan (310 CMR 40.00, the "MCP") establishes procedures for assessing and cleaning up sites where there has been a release of oil or hazardous materials. The MCP requires that six specific reports be submitted to the Department during the response action process. The Department must approve each of the reports before the next phase of work can be conducted (310 CMR 40.536) . The MCP also allows those conducting response actions at NON-PRIORITY DISPOSAL SITES to apply to the Department for a waiver of required approvals (310 CMR 4.0.537) . When a waiver is granted, remedial response actions must still meet all the requirements of M.G.L. c. 21E and the MCP, including submittal of documents to the Department. However, no Department approvals of reports, plans, or other documents will be required as long as the waiver remains in effect. A waiver of approvals will expedite the performance of a remedial response action. At this time, the Department is focussing its limited resources on the disposal sites which present the greatest and most immediate threats to public health and the environment. These are generally sites classified as PRIORITY, based on specific criteria in the MCP (310 CMR 40.544) . At non-priority sites, contamination does not currently threaten public health or the environment, but may at some time in the future if no action is taken. A waiver of approvals allows assessment and cleanup of non-priority sites which otherwise would have to wait until the Department has staff available to oversee response actions. North Andover Page 2 DEP expects to complete its review of this waiver application and all other relevant information within 60 days of the receipt of the application. An estimated date of the commencement of review is July 5, 1991. The waiver application and any other information submitted to the Department can be reviewed by appointment at this DEP Regional Office. Please call Adeline DelBene at (617) 935-2160 to make an appointment to review the file. If you would like to provide the Department with additional information to be considered in the decision to grant or deny this waiver application, please submit to: Waiver Unit, DEP Northeast Regional Office at the letterhead address. Information should be submitted as soon as possible within two weeks from the date of this letter so that we may include it in our review of this application. We will notify you of our decision on this application at a later date. The Department appreciates any assistance that you may offer in this matter. If you have any further questions regarding g this letter, please contact Ida Babroudi at (617) 935-2160. Sincerely, Ida Babroudi Environmental Engineer �d{ M. Johnson Acting Chief, Site Assessment SMJ/IB/ae cc: DEP,BWSC, 1 Winter Street, Boston, MA 02108 5th Floor Samuel S. Rogers, Edgewood Farm, 547 Osgood St. , No. Andover, MA 01845 WAIVER APPLICANT ENCLOSURE ?ob"�.o b'6ti BOARD OF HEALTH 120 MAIN STREET c►+usst�h NORTH ANDOVER, MASS. 01845 TEL. 682-6400 May 12 1986 TO: Keith Bergman, Executive Secretary FROM: Board of Health Date : May . 12 1986 Re: F.dgewood Life Care Center Inc. The Board of Health can not comment on the need for such a facility in , the community. We do however have the following concerns regarding the actual construction of the buildings . 1 . The public sewer system must be extended to. the site. 2 . Construction must take place in such a way that no silt enters Lake Cochechewick or any tributary to the lake. 3 . No lawns or gardens that require the use of fertilizers for their existence should' be constructed on the portion of the sitethat is within the watershed of ,Lake Cochichewick. Very truly yours C iron Board go/gc I L r jY TO: Keith Bergman, Executive Secretary FROM: Hoard of Health l Date: May 12, 1986 Re: Edgewood Life Care Inc. The Hoard of Health can not comment on the need for such a facility in the community. We do however have the following concerns regarding the actual construction of the buildings. 1. The public sewer system must be extended to the site. 2. Construction must tape place in such a way that no silt enters Lake Cochichewick or any tributary to the lake. i. No lawns or gardens that require the use of fertilizers for their existence should be constructed on the portion of the site that is within the watershed of Lake Cochichewick. I I I I I rr^ TOWN OF NORTH ANDOVER, MiASSACHUSETTS OFFICE OF BOARD OF SELECTMEN NORTH TELEPHONE 682-6483 SSACHUS� TO: Development Committee FROM: Keith A. Bergman, Executive Secretary DATE: May 8, 1986 SUBJ: Proposal for Health Care Facility Attached is a copy of a Citizen article concerning a proposal by Edgewood Life Care, Inc. for a long-term health care facility at 547 Osgood Streeti(Edgewood Farm) . May we have your written comments as soon as possible on this proposal to facilitate the Board of Selectmen's position thereon. Thank you. /ch Attachment cc: Town Planner, Karen Nelson Bldg. Inspector, Charles Foster Cons. Commission Asst. , Tracy Peter Fire Chief, William Dolan Supt. of Public Works, Joseph Borgesi (Chm.' Bd. ~of Health, Gayton Osgood' Highway Surveyor, Bud Cyr 1 ' 38/Thursday, April 24, 1'986, North Andover Citizen f _ Legal (Notice Legal Noth r PUBLIC ANNOUNCEMENT CONCERNING $2,489.4 38 Gaily known as :dgewoocf arra, a a maximum cap. a expenc i ure A public hearing shall be ordered on the application at the request of any tax talpapi NEW HEALTH CARE FACILITY I of the Commonwealth made in writing, not later than May 22, 1986 to the Massachtr'a,11 Edgewood Life Care, Inc., 800 Second Avenue, Des Moines, Iowa 50309, intends to file Department of Public., Health, Attention; Determination of Need Program, 81h Floor. ' Tremont Street, Boston, Massachusetts 02111. The application may be inspected at „I j an application with the Massachusetts Department of Public Health for a Determination of address and also at the Merrimack Valley Health Planning Council, 191 Parker �;trrl j Need to construct a new long-term care facility with 45 level 1/11 beds, in a continum add uof renr.,e, MA 01843. care with a 250 independent living unit lite care community at 547 Osgood Strr:et, NorthLaw ( on the application may be made to the above addresses. 1 p I I ROBERTS INSURANCE AGEN TEL :508-683314' Nov 15 '99 8 :43 No .001 P .01 niooiioen TNIS CERTIRCATH M ISSUED AS A MATTER OF INFORMATION ONLY AND CONMM NO ANWT B UPON THE CERTIFICATE HOLDER. THIS comF1CATtE DDE$NOT ANOW,EXTEND OR ALTER THE COVERAQZ AFFOPJ=BY THE BELOW. M.P. ROBERTS INS AGCY INC COMPANIES AFFORDING COVERAGE 1060 OSGOOD ST NOANDOVER MA 01845 ................................ .................................................................................................................................... A ::..................... .....:.MERCHANTS INSURANCE CO ............................................. .. ....................................................... .........................................................................:....................... Douce Lurnm 8 HANOVER INS CO ......................I.......................... .. ..................................................................................... OOwAw CREATIVE BUILDERS INC C ... 58 WATER ST ............................................................................................. ........................................................... cartPANY NO ANDOVER MA 01845 � D EASTERN CASUALTY LCOMPANY E THIS IS TO CEATWY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POUCH PERIOD WDICATED,NOTWITHSTANDING ANY REDUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH Two CERTUTATE MAY BE ISSUED OR MAY PERTAIN,THE WSURANCE AFFORDED BY THE POLICIES DESCMaEo HEREIN IB SUBJECT TO ALL THE TERMS, EXCLUSIONS AND OONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ................ ooL1a1 NLIM/EA.................. co: , ": TrvLt a aaILI1tAMCe Y"W W'�Y T"a Lamne CMP-6147175 9/05/99 05/00 'GENOWAGGREBATE ;$1,000 X OOLMWAWL BL�IERAL L,AsnnY :............................. ..........................'......................... ,...,:..;.......... ......... PRODUCTAGO. 0 00 : CLAIM LAADi:x Comm' �.�...0[.�......._.. B�MP�oP :s ....... ...... % .........: PEReoNAL a ADV.ewwRr.... ...... l Q00 000 a s OONTW:=" A B PADT. EAc++OCCURRIME rt ........ ..................................................... ;...................................., r.. ..........................00 RM DAMAGE IAn�oro a.. +140 0 ..... ..... +wnoeaooaK LW6atT �Mw�Elovlea(Aro aro s v�V; 5 000 AFN 4343861 5/08/99 5/08/00 COMBINED IIIIN H ANY AUTO LOW • ALL&IIPM AUT" .................................................................................... ,: X as ALRCO 8004-y uQuay >,. :IpwvM+ay a1 0 .......X::lGI=IAwa ... `NON,Ow m AVHOB soolL IIYt a00idM4 Y X GARAGELIASRftY ....................................... 300!000........... PROPERTY DAMACA ' 100 000 �0 Li�BEUTY `L4ACH OOCURRBiCE :i IA®RB.IA!TORN .........................................:.......................... . AGGREGATE ......... OTHM THAN UMBRULA FOfIM Y:.<.,..,.,.,v....,:...... WC9 6 oOLxNrMAnOeL 0202 Q 3/29/99 3 ,STA TUTORY L.I... . AND EACH ACCIDENTir::r'srt .................................................:!100,000.... ...... OILFL vgw UASILRv IISEASIB-POLICY LIMIT :45001 COO. ...........r............... DIG AW-•IlAOI EMPLAY>9 :8100,000 anaft""or oPEa►nowertioaA agar,nEue FAX NO. 688-9542 sib_ TfiDI't SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC use BEFORE THE EXPIRATION DATE THEREOF. THE ISSUMIO COMPANY WILL ENDEAVOR To TOWN OF NORTH ANDOVER " MAIL 10 DAYS WRITTEN NOTICE TO THE CEMMCATE HOLDER NAMED TO THE BUILDING DEPARTMENT " SFT s RA RET OBLIGATION OR UABP 27 CHARLES STREET Aad EBENTATNE6. NORTH ANDOVER MA 01845 Mi be ....:..::::..:.. ' 3921 HORo TN o TOWN OF NORTH ANDOVER �a O ,� ti OL PERMIT FOR PLUMBING i. ,SSACHUSE� This certifies that � '��.ip� ��!. . . . ....�--�_ . .- . . . . . . . . Chas per to perform f �. . . . . . plumbing in the buildings of . . . . at. , North lover, Mass. R F og Lic. o.� l. . . . . . '4� .. . . . . t PLUMBING INSPECTOR as_Da PAID WHITE:.Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPUCATION FOR ERMIT TO DOnp PLUMBING (Print or Type)---* Mass. Date.'l .3 w 19 Permit:# N _ E� 0 017 .`J Owner's Namea• �'cv - K hL/01 �2�"� `v T Building on Locati - -'Tyle of Occupancy ~y New ❑ Renovation 0 Replacement ` Plans Submitted Yes❑ No ❑ , FIXTURES z - 2 y y 4' > y y O .ZW f y J > V < y p p Q ¢. U) Z y < ¢ Q: _ ¢ y Z y0, O — W. t- W y �, Vus. V. J& d 3 = V y ¢ m 0 H W > '< F- f0A Z O < p a 0 W ¢ W O 7 cc < y ¢. < W 3r —1N ¢ J Z 0 C G. LL Q F- 0 > f O = C y F' T O O y .W O t1 Z < f < < x .y y < < O < .J J < ¢ ¢ ¢ Sun—BSMT, { BASEMENT T I ;a IST FLOOR 2ND.FLOOR 3RV,FLOOR .,.4TH FLOOR STH- FLOOR - 6TH FLOOR 7TH FL60R" 8TH FLOOR �1©� �/ Installing Company Name 1'T Check one:. Certificate Address - � #9 R �^ /� ❑ Corporation V r R )11/9 S S OG�I " ( Partnership s /P Business Telephone 2 `r 3 Je x ❑ Frrn/Co. Name of Licensed Plumber �'`�s �/ r'�` �apoet 0,4' INSURANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142: Yes No ❑ If you have Aecked YL, please indicate the type coverage by checking the appropriate box. A 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. Owner EO F 5 Agent❑ Signature of Owner-or Owne'r's Agents I hereby certifyahafall of the d"etails and information I have'submitted(or entered)in above application are triie`and"acci��ate'to tfie best of my " knowledge and that all plumbing work and installations performed under the permit issued for this application-will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. BY Signature of Ybensed Plumber Title - Type of License: Master . . Journeyman Gty/Town APPfiOVEp(OFFICE USE ONLY) License Number Date. NORTk o� TOWN OF NORTH ANDOVER 40 PERMIT FOR CAS INSTALLATION h SACMUSESS This certifies that . . . . ,. J , . . .Th`! . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . o.,. . . . . . . . . . . . . . . . . . . . in the buildings of . . . . f . . . . . . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee. 2! .- . . Lic. No.. ....3 C . . . . . G/S INSPECTOR Check# Q Z 4318 E MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING r (Type or print) Date �/3/� 3 NORTH ANDOVER,MASSACHUSETTS S- / .. Building Locations L� S v �-�� Permit# '31 Amount$ Owner's Name New❑ Renovation ❑ Replacement Plans Submitted 0 w � z o ' a H z ° W x H c a w w a w H z F ° o c x O A C�7 U it A a H O SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR r 7TH. FLOOR 8TH . FLOOR (Print or type) one: Certificate Installing Comp any hec Name � � � P /�t.�� -f- l� Corp. Address 5 J�)Sc Fv d� �- ❑ Partner. Business Telephone U, F G- U rL//��J, Firm/Co. Name of Licensed Plumber or Gas Fitter f 3 J UJJ� �� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked M,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 ofthe 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 accurateto the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts/'State C9de and7apter 142 fthe C�5e-ral Laws. r/ By: Signature of Licensed Plumber Or Gas Fitter Title [3--plumber City/Town ❑ Gas Fitter License Number ❑,Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Ba s 1� y tateGas A NiSource Company March 4,2003 Samuel Rogers Account Number: 1974530059 547 Osgood St North Andover MA 01845-1935 Dear Mr.Rogers: This follow-up letter is to inform you that your.gas water heater located at 547 Osgood St., North Andover, MA has been tagged due to a violation of state safety regulations. It is unsafe to use until the following condition has been corrected. Gas leak on Burner tube at valve on water heater. The Masachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737 Acts of 1960,requires that the condition be remedied. If you have questions or would like to discuss this issue, please call 978-687-1105 and ask for the Service supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Service or Meter Department Bay State Gas Company CRR: CRR# CAcisupdatedletters\236 03/04/03 55 Marston Street PO. Box 869 Lawrence, Mn 01841-2312 978-687-1105 Fax 978-688-1875