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HomeMy WebLinkAboutMiscellaneous - 55 DEER MEADOW ROAD 4/30/2018 (2) 55 DEER MEADOW ROAD ad 210/104.s-0069-0000.0 &\ Commonwealth of Massachusetts - ---._ City/Town of RECEIVED System Pumping Record HAY 15 2012 Form 4 TOWN OF NORTH ANDOVER HEALTH D P R NT DEP has provided this form'for use by local Boards of Health. Other forms , information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving A. Facility Information - 1. System Location: Left/Right front of house, Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Cp Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Ems- If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of Sy��:�`� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loca' ere contents were disposed: 7G.L S. Lowell Waste Water �- r�- Sig t Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF M. kd�,e(- SYSTEM PUMPING RECORD T(- .,of FORTH AIVDUt" BOARD OF HEALTH DATE: U) (-0a- nr,T 1 rK92 I SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) Nv l� DATE OF PUMPING: A ) `V D o2- QUANTITY PUMPED : 6iOC) GALLONS CESSPOOL: NO YES EPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: TOWN OF NORTH -ANDOVER SYSTEM PUMPING RECORD - 3 STEM OWNER & ADDRESS w SYSTEM LOCATION ( zam�le: I f1 fr n� of house) �1 (�S ��-s ram 50 mer m�Paw l�- U:\•I•C OF PUMPING: 55-63 QUANTITY .PUmPCD ,,� LL��� > �. 1'00L: NO YES SEPTIC TANK: NO YES L/ MATURE OFSERVICE; ROUTINE EMERGENCY 1111.>rRV•�TloNs. GOOD CONDITION. NULL TO COVEIZ HEAYY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK... CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOYER O�H-F.fZ (EXPLA-IN) C u PNTS: 0 TJ ANSFC, IZIED TO: A( dress))6:5 '"'CA-pbw n Title of File Page of Date File Open: Date ale closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission — Building- -- Departrne�t G Commonwealth of Massachusetts nI tgndouer , Massachusetts System Pumping Record System Owner System Location nobs fc�l� SS .e� w Date of Pumping: gc)O OC) Quantity Pumped: )SOO gallons Cesspool: No �` Yes LI Vl SepticTank:ank: No Yes System Pumped by: Fareddet 50&0taej License# Contents transferrred to : Greater Lawrence Sanitary District Date: __ Inspector: , V ' ISO t; k � LcTr-2- ' 60)416Z �5 F� 1 I 1 \w` E LEy p►T i O I-4�5. _ 11.1V DtDF OUT OEHSE. Nllp-1 A u i L-r I Al V PIPE INTO TANtL I C} jjjy PtPFnt ITo TAt4y t -8 .49 ! V D1 DF 1 t�tTO D BOX 5 W • G 1 G T w�l INV Pi PE-421 JT 0 yXinx �Iy GwI0 of PI PE I (• S S'Z I N .,�•� :.arm"5,,,,,��t. ��U . � � �ti...� F o t2 x. I wo I 4P FG2A►�11C_ GC7Et_1NAS � AS5vC.14TE5 • k •"y�`4'�''r"`'r". 'a �N�1 NEE QS�. �.�Ll--1 ITEGT S 5 t A.N DG a►�/.Zw t2 `�� (�a. A N G�v�l�x2 . J 1 ` - __-_ _- __1 _f►_ Board of Health,, SEPTIC SISTEK North An ver Haas. INSTALLATION CmK LISP LOT � AVA Og FAIL CM DATE ISI PRM EMI easonst FAn 0K 1. Distance Tot a. Wetlands b. Drains c. Well 2. Water Line Location 3. No PPC Pipe $. septic Tank _ / a. . _Tess -_Length k To Clean 'Out Cowers. . - b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal AIDvvnts c. Ho Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth _ c. Capped Inds i d. Clem Double Washed Stone 7. Leach Pits r a. Dimensions b. Stone D th c. Spla Pads d. T s e. went Pipe to Pit - Both Sides. _ f. Clean Double Washed Stone Be No Garbage Disposal 9. -Final Grading Inspection lA. Barricading Covered System 1.1. As Built Submitted.. ..: ... - a. Lot Location'. : - b. Dimensions of System c. Location with Aegard_to Perc Test d. Elevations e: Water Table II Br'` X Health f N ►ndover,Mas s L r ice, saMyACE DISPOSAL DESIGN CHECK LIST - — - LOT APPROVED DATE DISAPPROVED DAIS Provided: Reasonis Title V FAIL Reg 2.5 4�1 he submitted plan must show as a minimums ) the lot to be served-area dimensions lot # abutters location and log deep observation holes-distance to ties ocation and results percolation tests-distance to ties design calculations & calculations showing required leaching area llocation and dimensions of system-including reserve area existing and proposed contours ) location any wet areas within 100' of sewage disposal system or ' / . disclaimer-check wetlands mapping v (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer U-) location any drainage easements within 100' of.sewage disposal system or disclaimer-Planning Hoard files t3) known. sources of water supply within 2001 of sewage disposal JOsystem or disclaimer location of arm proposed well to serve lot-1001 from leaching facility M) location of water lines on property-10' from leaching facility location of benchmark n driveways �Q) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations {r) maximum ground water elevation in area sewage disposal system s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks /(a) capacities-150% of flow, water table, tees, depth of tees, / access, pumping v (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 25+ from subsurface drains Reg 10.2 Distribution Boxes a) slope greater than 0.08 Reg 10.E b) sung 5 Shbsuriface De,911a Check List Pae 2' FAIL CK Leaching Pits Leaching pits are ferrel where the installation is possible i Reg 11.2 a) calculati of leaching area-minimum 500 eq ft { 11.4 b) spacing 11.10 c surfac irainage 2$ j 11.11 n cover material e),,gii' �A" splash pad f 'tee at elbow g) nobends in pipe from d-box to pipe Leaching Fields Reg 15.1 a) no greater than20 minutes/inch v area-minimum 900 eq ft 15.4 'onstraction of field 15.8 l/ surface drainage 2 $ 3,7 from cellar tall or inground swindng pool Leaching ftenchhs - Reg 14.1 s) cal a ns'o eaching area-min 500 eq ft 14.3Pb) spacing- ft min 6 ft with reserve between 1.4.4 c) diment ns 14.6 d) action 14.7 e) 14.10 lf)fface drainage 2$ Downh /1 e a slope :'x = be shown b y/x X 50 (to be shown Reg 9.1 a) app .vel 9.6 b) s d-by power 4 { i SOIL PROFTIj#0&-4PERCOLATION TEST DATA. North Andover,lSass. No.&Street Lot No. �,9 Loc./Subdiv. Plan Owner ` Investigator - Observer SOIL PROFILES-DATE 1. Elev. — 2. Elev. 3. Elev. 4—"Eley. 0 0 - 0 0 Ties to Test Fits 2 2 2 2 3 3 3 3 - — 4 4 4 4 S 5 S S 6 6 6 6 7 7 7 7 8 8' 8 8 9 9 9 9 10 10 10 10 Benchmark Location Elevation Datum VhPercolation Tests-Date 4 } Date-- - Pit Number 1 2 3 4 S f I Start Saturation o'' ' ' Soak-Mins. Start Test-Time -- - -_-_: s•- - - Drop of 3"-Time - Y� Drop of 6"-Time i! Bins_ 1st. 3"Dro Mins - 2nd 3"Dro - Percolation Rate Notes be Sketcbe s on Back --- Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health.. The System Pumping Record must be submitted to the local Board of Health or other approving authority. . A. Facility Information .Important: When filling out 1. System LQcation7 �nforms on the - ��.-• computer,use only the tab key Address to move your cursor-do not _ use the:retum Cityrrown ate " 60� Zi Code key. 2. System Owner: , �- pR�\AF�M�N( Name '(Q N� 1C 1 Address(if different from location) Cityrrown State Zip Cbde Telephone Number ..B. Pumping Record I. Date.ofPumping Date 2. Quantity Pumped: Gallons I Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes � If yes, was it cleaned? ❑ Yes`❑ No 5. Condition of System: 6. Systerp Pumped By- Name YName Vehicle License Number Company -- .7. Locatio here contents were i posed: oe— s , Sig ure er Date http://www.mass.g6v/dept to approvals/t5forms.htrn inspect t5fonn4.doc•06103 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD OCT 2 5 2001 1 � DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION �-A (example: left front of house) Ss DATE OF PUMPING: QUANTITY PUMPEDl 56C� GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSIERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: TOWN OF SYSTEM PUMPING RECORD DATE:_ �� SYSTEM OWNER& ADDRESS SYSTEM LOCATION0- II (example:left front of house) "Tr� Qlt 55 fi-CCIUJ DATE OF PUMPING: O v2�- O QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTBER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: I coNTENTs TRANSFERRED To: G.L.S.D Lowell Waste f f Commonwealth of Massachusetts Massachusett RECEIVED NOV - 2 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Syste� Pumping Record V System Owner System Location 01 Date of Pumping: Z' I- 04 Quantity Pumped: Sao gallons Cesspool: No [ Yes [] Septic Tank: No [] Yes [ System Pumped by: 64464" 45License# Contents transferred to: Greater Lawrence Sanitary District Date: I cr— a-� 0 Inspector: U Commonwealth of Massachusetts TOWN OF NORTH � F�,� BOARD FAL Massachusetts [OCT Z 5 1996 System PUM Inp Record System Owner System Location Date of Pumping: . b-9 — � Quabtity Pumped: G�'-2:0 gallons Cesspool: No Yes ❑ Septic Tank: No d Yes System Pumped by: Bladed rim#tet� License# P Contents transferrred to : Greaten Lawrence sanitary bistrlct Date: inspector: NORTH Town of . Andover 73 9 _ - 9►� o - LA E o dover, Mass., ei d • COCMICKEWICK yt 7d ADRATED S ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ft M BUILDING INSPECTOR THISCERTIFIES THAT..... .!............ .. ........r ........................................................................... Foundation has permission to erect... ..�.. .1i ............ buildings on..�i.�C?.....•7c ../!A!1•. lode�........ Rough to be occupied as [. �.�pj fr �� 0 i N �K I Chimney ... ........................... . ................................................ ........ ......... .............................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. mp i r 00 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. logelo'g Rough PERMIT EXPIRES IN 6 MONTHS Fina' UNLESS CONSTRUCTION ARTS ELECTRICAL INSPECTOR ... ................... ..r�. Service ... . . . .............................. . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDEJ1 Smoke Det. ►� 6 U 'l 2 Q Date... !.". s .... NORTH °f'"`° '•�"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING VSs^cwusEt This certifies that .........................a. ....'. �� has permission to perform wiring in the building of t�^? ..+a A.f?c......... ........................................... at.k.....,,..........�'....... . . �,� °s+ r te!,North Andover,Mass. 5........... Lic.Noa�i- . ..� ...........................e't:�....... .... p pct ELECTRICAL INSPECTOR r Check # z"19 III . DEPAWHATOFPUBiJCS MY LPerrmWtNo.BOWRDOFFIREPREVFNYMRBGUG4?W527aofit, im pigq d<Fees Checked — APPUCATiONFOR PERMIT TO PERFORMELE CAL WORK All.WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL COD 7 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) �j O12e P� t?c�4 ee W 4 Owner or Tenant S(>l'V/ '% 1?�r�f�f1 e •� Owner's Address is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpVolts Overhead Underground No.of Meters New Service Amps olts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 4�r 77– 7//y7 777 Ta2� No.of Lighting Outlets No.of Hot Tubs NO.of Transformers Total KVA No.of Lighting Fixtures Swimming Pooh Above Below Generators KVA (/ andground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners + No.of Ranges / No.of Air Cond. Total FIRE ALARMS No.of Zones No.of Disposals No.of Heat Total TOW No.of Detection and Pumps Tom KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/3ounding Devices �s No.of Dryers Heating Devices KW LOcd Municipal Other Connection No.of Water Heaters KW No.of No.of Sign Bailesia No.Hydro Message Tuba No.of Motors Total HP OTHER' `s jta,�toeCona�Plr�ettbQetOc}aarla�Ct'Ma�adl>etshGaleeILSVVB Iha�eaan�tlietatlityhgi®rtaeFbicl'irldrB(brnpl� ar�subAa>bdegtivalot YES NO Ihttresu nhidvddpwafafs=1od eOJlioe YFrS lrymavect�od®dYMpieaaertdicaleQteq'peafao�by RZ RANM >K oIIIkRlZeg– �— E?rpimtioniaale r E*n*dValreefEbc>dcal Wak$ Wo kbSwt �l �a 1 ,; "orlDwRac}and Pao Fmd Stgrra azar cfpt;jtxy. FMMNAME lioaneNa 1 i 1�d�'PI 117�� *on , IioaeeNo y.�"/l� &mi=TdNa / �. Al<TdNa 183:5r6 d 9 OWNER'SDMRAN EWAIVFR;IamawaledndzLic mdpmmta�ednits>mmaAaWorlssubs"dgivWnastegtae fM=d=MGalaWLam anddarrW igndmrndispa<ritappicftirowaivesaitstegi>iar�c (Please check one) OwnerInAgent a Telephone No. PERMIT FEE S - 'S� ya iSgnature of Owner or Agent Date.... ...... t NORTH 1 oroff TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� certifies that � �S Zeoiv,41z................ ..................... ............. . ...This certi ......................... has permission to perform ..( .......).....6A ....�- R............................ wiring in the building of YkC N at..........`..�..©.. 12AIC..A.dw. ....... North Andover,Mass. ....... . ........ e� — < Feer. ........... Lic.No. �'�1�. ........... :.., !/ - j .. ELECTRICAL INSPEM0' Check # 3 sd I 7720 �amtno►rtwraa:ri�b o�I'�laaase��ra�tdda � Uea ply � PQrttU1 Nta. ! 7 ,� rtnd►w�nfaf o �r:nn�nnuir.,na f�crupancy and.par C.1baked BOARD OF FIRE PREVENTION REGULATiONS jilt4,`01/07l Ky$ Innk)- s APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wank 1191191110016141 in u90011tnnua Willi IQs tdassac{luKatls Niaatrimil Coda(MRC),S27 CMR 12.011 (MASE PAW IN INK OR TYPA'ALS.fl+l✓"01t Mita 101V) Dow B City or Town�: �4�,� �"+� Elsa 11artac�dar�►f l�ir�.s, kly jibs uppliaulion tlttr uttQA> ig11O R ves ni-, ak vR or her tntanlion to por- mi the aiaatri4 walk dtlscrillml below. Loaatlon(Ehret dEt Number) 0 per h�ea� Awnor Tale hone No. , Ownet''s Addrtlss r^•� ��� / Ia thio permit In conjune loll with A bultdinA pe rnnit? Yon I._t No �, (Cheap Appropriate Us) p{ Purpose of buildin ��M, .�. ..__ ... U011ty Autlit►rixet long No, xlRtlrt�.�:prvdsa Amps VottR Ovarhend lJoditrd No. of Maters Amps / Volta overhand untlgrol NU,ofM,allors Number to(Fenders sad Amlpoclty ,_.. 1,4900n and Nature of Pralmookmi Iaatriml World, re- 61 `" Gu 1 lura o plloty n 1016,n ratvafllra'flop In tmwo ofWN' Nu.nt�ItrtlesRad 11�nittlnAlraw Nt1,est twall, ttsp,(Pgddlp)Pang No.of L1s1n1na11•a 0911416 No.of Alai'Dubs Generators KVA S1Wft>arrtltt Pool �" QVQ Fj a'" .A r mmon"Ay L111111111 Na.of�.uminslras g d, No.of Reaaptacle 00614N .0 01111ttrnora / Flu A,>GA,111;N1s Mo,of Zan o No,of switoltw No,of GAP k omere NO. MUM alt No.of Rangat{ 'No.of A1r Lend. tt No.of A1411ing 04vlaas Tom— No.taf Waste'Disposers ea hl ,„�!� , > �,,.. .......... ia,4 e A tl a ilia Ntt of 1�1Rltwaeltsre Spnrtr/Arom Hsating XW J-coal( HAAR ps altar No.of Dryers Hast>~tng Appllant as K'w,�.. ., pall o� e v m„ lI.g1',bN111.1.141 e,c r , o,AlllsllomatR Do%W1r1ag, gtltarR ... 1t� _ ss or Ragivr4lool, Na.k1 Arontnssa a 1lnthtulae No,of Motorm Total TIP a slits arta n Y g ass orR uive OTHER: Anr�nh nddirfn»�!alarroll(tV89 f'adl tar th9 1 Tilt Yiwx. astimatod Value of aieotricai Work: (Whan roquirod by nattnloipai policy,) Work to start d Cc--� rN� Imspoatlone to bo rngnastod in oacordmoc wit11 MEC Rt114 10,and upon ccnmlelicn, 1NS11R,ANC OV 1#i ; Vniess waived by the ownw,uo ptmtlit fol'The parfonjtanaQ of clactricRl work may ionic unless too liceapam provides proof of liability inouranem inalmiling"aompiated operation"tlovorttgr or its Rubstantiol squivolent. The onootolpltcd caniams that Ruch taovomse is to tares,told boo exhibitod proof of stoop to din permit issmins:offlaa. Mi~K ONE: INSURANCE XBOND U OTi°SR 0 csltaa;ly:) Z.unCh 1 rtrrti�.0.tflfdor tltrl,Paine olid ponrtdtles far a►yet►p.Mar flea hr r►►ttrrldetr oil rills nPP/1V011011 Is trap lino tr implem g'1liIV1 NAME `� e Li+t:;,NO.: 7. Licensee- UC.NO.. 01'appl:r:able,p+ita:n "manw?"do Ai lfcunyv ats1a164n 111016,; l#tts.Tal.No.i Uk- &a " Adttrcps► _. ,1 f� A -.-. A,lt.TcL No.. vPar M.O.L.c. 149,R,51.61,apprity wtark reritdras Dopa:'tontm of Public;Safety"9"Liam: Lir..No, OWNER'S INSLIRANCE W A,IVE,Rs I am nwarr,011 01 1„:cu:nauaa lives fra►belle alga Iiailiilily 1uanca uovarmse"mminlly teq►drad by law. 91,my 9191Ratum bolOw.I IM-017Y wtuve 1110 1`4401*1110nt. 14111 t11a ichec owner om c , ant. IawnarlA ditgn:erttr�r,pinnt 7'atepitans No. PEANIT PER. S DFFAA711 W0FPENXSAF'ETY d c z- Pertnit No. BUARDOFFLREPREVBVIIr0NR GULA11�Ol1 527(MIZiM 0 pamy Ak Fees Checked APPUCATTON FOR PERMIT TO PERFORM ELEcnuCAL 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) Dat 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) t, pe PjQ Owner or Tenant O `S'l A& 7— met'- Owner's Address c� &2 is this permit in conjunction with a building permit: Yes[a No [3 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps.olts Overhead Underground M No.of Meters New Service Ampa..L.Volts Overhead Underground C3 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical work 4) '?� Dlir�i'Iy •2� No.of Uglid"Outlet No.of Hot Tube No.of Trandustne a TOW KVA No.of Lighting Fuuom Swirmnins Foot Above Below Oen0 M KVA C/Noand Vound yo .of Receptacle Outlet rn No.of Oil Bues No.of Emarncy Ughting Buttery Units No.of Switch Outlet No.of an Bomers No.of Ranges / No.of Air Cond. TOWf FIRE ALARMS No,of Zones TOM / No.of Disposals Na of Hest TOW Total No.of Detection and pumps Tom KW Initiating Device. No.of Dishwashers Space Area Heating KW Na of Sounding Devices Na of Self Confined ��• DetectionlSounding Devices No.of Dryer Heating Devices KW Lord Mudcipd Office connections a No.of Water Heater KW No.of No.of sixthe Bailads No.Hydro Massage Tube No.of Motors Total HP ME1t ]rental QWWP A>tauentblkragtiesrrs�afMe�d>veettCim®1Lttws a Ihaieaa=9Lie6r leu= bicj hJudtgUornpltt cdhxbftMa}iajw YES NO Itansittdl edvAd afsauebdle0®ae Y$4 1f hatedtad�d Pouf }ou YBS, irdcaletbe of p� tYpe aoreqVbY BM t7II�R E' C �— P.�gi�rnDo EMm*dVa►zd&cw alwok$ WotkbSM ltiipe�iDaRmeead Ra* 19riel 5redurid1r ft*1Mtfpajity. MMNAME Li==Na van44;ez� Zl/'L LioenteNo 2 MmstTMNa 91-3 ,6%i3 AtTe1Na C1VVI�ItsA1StJRA1�wAiVEtt;lamawrieQlatthelx>raed�rr tttltrgQleira>taneeoieagear�alb�>otltx�ivalaitar�c}iladbjrMesaad>t>se�GaieritlLawa a rdthatrnysignoliseoi°itpvwv= te ' gtier of (Please check one) Owner Agent D �v Telephone No. PERMIT FEE S alignature oi Owner or Agent Date. "7 NO0 TOWN OF NORTH ANDOVER �? �, ..+..• 0L PERMIT FOR/PLUMBING �► +OLr�o"A�[� ,SSACMUSE� This certifies that . . . f .�. R '�. . . ) . . . . . . . . . . . . . . 1' has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . Im.Q. . . . . . . . . . . . . . . . at . . .Q. . . e rrP Lf:r<J-1. .. . . . . . . . . . . .. North Andover, Mass. Fee.3.1.. . .. . .Lic. No.._ .s.! . . . . . . . . . . ' . . . . . PLUMBING INSPECTOR Check # 7 5`t 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) n`� � r ,� J-�n�_�.,_rn Ad'11in� maSS. DdtePermit # 7 � Building Location � °E'r!rttiQO(o[ 'I�UQwner's NamenuAhef'/ec S —2 76 D, /� / Type of Occupancy Residential New ❑ Renovation ❑ Replacement 09 Plans Submitted: Yes ❑ No ❑ FIXTURES { Y a r4 'P I , �� � I f J , � � o Z r o w v U1 ~ z o _ z ' a ?4 x _ x _ n = c; x w c X d a' u — a 3 R1 tiS r0 49 1 0 LO CC i r v Q x 3 = o0 z cn r Y a o a Y a z 34 34 34 G I a r � O N O ( O W O U a < 2 .._. _ Q a 0 1 Q -� J a C 5 X a C d i-� -� 49i-)a CU = s 3 3 3 SUB-13SMT_ ? i BASEMENT 1ST FLOOR R L 0. 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR i 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg_ &Plg. Co. Inc. Check one: Certificate Address 35 Pl a ant Street CX Corporation 714 Stoneham, Ma 02180 [] Partnership Business Telephone 781 —4 3 8 7 7 7 6 17 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch_ 142. Yes 9 No ❑ If you have checked yes. 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. Check one: Signature of Owner or Owners 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 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 Title Sigrratwe of Licensed Plumber Type of License. Master LT Journeyman E]City/Town APPROVED(OFFICE USE ONLY), License Number 8 3 2 2 1/2" Watts 9B bfp on v��ater line to water boiler y JDC��r oo Y.4 d'o go /,:�x a Locationl�/'� No. —1 _ Date 6-1-10 MORTFTOWN OF NORTH ANDOVER 3j � • OL • ; ; Certificate of Occupancy $ �' b',••°''<� cHuBuilding/Frame Permit Fee $ a�Q 'Ss^ sE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #-x2?"0 t 8291 `� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVA OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED / ic SIGNATURE: Building Commissioner or of Buildings Date z SECTION i-SITE INFORMATION O 1.1 Propaty Ate: 1.2 Assessors Map and Parcel Number: A? Map Numbed Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zarin District Proposed Use Lat Area Fronto it 1.6 BUILDING SETBACKS R Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Wata Supply MGI-C.40. 54) 1.5. Flood Zone Infonnotion: 1.8 SewaW Disposal system: Public 0 lrivue 0 Zone Outride Flood Zane ❑ Municipal 0 On Site Disposal System 0 J SECTION 2-PROPERTYOWNERS111P/AUTHORIZEDAGENT 1-111-7711 le •'ictr!Ct: Yes No M 2.1 Owner of Record nwR M/?3 dnyxERJ"�t Name(Print) Address for Service: 0 Signature Telephone 2.3 Owner of Record: liame Print Address for Service: C M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ p,qv/- 'Vllo l d� 9pGf Licensed Construction Supervisor: 0 License Number y ? ryt�Rr�r sr ��3wR�Nair i1 Address _ > ' ! J' 4-1V Expiratijn Date dA j snort; Signature Telephone1. 1 2 Registered Home Improvement Contractor Not Applicable ❑ ti Company Name t M Registration Number rano y g Address 3 a 7 „_ o7 R "y✓�i�(/C .Z �� 91,71t to X,j- o e✓l Lz Expiration Date G) Signature Telephone pCC64.0tc0 lbq of 3 �•e.2.4Ur� �P a� uti. � e N CAO S"C p-o J� tZSdr� 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 SECTIO APPLICANT /� /jS �I?Un R,7'�ic PHONE f7lr- '176--U 93 9 LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT(S) STREET G,o GGR Aeg Po w /:fJ ST. NUMBER �4 OFFICIAL USE ONL A NS TOWN A ; CONSERVATION ADMINIS RATOR DATE APPROVED • DATE REJECTED COMMENTS441AI , 6 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS �00D INSPE4"r0 ATE APPROVED 'IRATE REJECTED P IC INSPECT - TH DATE APPROVED LID DATE REJECTED COMMENTS 610 r-/', PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RevhW 07 jm r:+.i:5z W.P1 G K. tiU10VF_Y r t r MORTGAGE EK SURVEY INC, AOORESS OF FRINOPLE aulLOING PLAN � REF.DAIor 07 `, ,64 old 601 ter 1704 • r. iE MOA04W TO& 'Thle fn6.-f-*0* 0 C? O'0 f�rR ✓ I�Wolv w Yv 0 D t O � yl 00 �t ,+541 9 �---- 9 I1 •—� J4 .�a�2t� 5 Mz �To70 lsC� �,neN GO D,GER��ja Pvw R A tl - - T - - - - - - - �� TOP - - - - - - - - - E-- I N' yip Pavxt Ii G if �Joy► �,' rAr6 f -DION'S HOME REPAIR SERVICE 49 Market St. Lawrence, MA 01843 Office # 1-978-685-0514 NAME/ADDRESS MA Lic. 069061 & Reg.123689 Dr. Mukherjee Fully Insured 60 Deermeadow Rd. DATE North Andover, MA PROPOSAL 51311'05 DESCRIPTION 13. Install propoane fire place on driveway side of addition. 14. insulate with R13 in walls, R30 in ceilings and floor. 15. Sheetrock, tape and paint. 16. Install hard wood floor on new addition, approximately 26 X 11' 6" Remove all debris and clean up. Estimated cost with appliances: 0000.00 Thank you for your business. Q TOTAL $90,000.00 SIGNATUI�ke 2 DION'S HOME REPAIR SERVICE 49 Market St, Lawrence, MA 01843 Office # 1-978-685-0514 NAME!ADDRESS MA Lic. 069061 & Reg.123689 Dr. Mukherjee Fully insured 60 Deermeadow Rd. North Andover, MA PROPOSAL DATE 5/31/'05 DESCRIPTION Kitchen Remodeling and Addition 1. Remove all old cabinets and counter tops. 2. Install new ceramic floor in kitchen area. 3. Add additional lighting in kitchen. 4. install new cherry cabinets with granite counter tops. 5. Install propane cook top and conversion oven. 6. Extend back porch 24 feet in length. (1lfeet 6 inches out). This will be adding approximately 12 feet in length to the existing porch. 7. Match siding with existing siding of the house. 8. Prime and stain new addition to match existing house. 9. Take existing set of stairs and move over to new open 10' X 14' deck. 10. install five foot slider onto 10' X 14' open deck. (Trex decking) 11. Install 36" bannister around new 10' X 14' deck. 12. Install 2 sky lights in vaulted ceiling. Thank you for your business. TOTAL � SIGNATUTAge 1 = M The Commonwealth of Massachusetts d Department of Industrial Accidents F Office of Investigations ,.r Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: /yiR. MRS /wPK11i'1?TEE Location: /C) I? R 11,914 Po u/ A City MORT# �N�Oyf.2 Phone # 9`!$r 9z5--o 9 ? 9 I am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address y9 ldze,v RK4E.,T 5 f City 1,Vh'Fav 1'!yi J! Phone* 97 2rr,3- Insurance Co. Poli # z6Lr& /5-5- Company name: Address City: Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisamnent.as_molt.as_civil.penaltiesinThefmn dA.STOP.W..ORK.ORDER..and..afine of_(..$1DO.OD)Aday against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date_ &-I& Print name -)V0 N Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/1-icensing Cl Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A- ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: 4 do-S 498 R7" 3 7 S4A4 A" (Location of Facility) Signature of Permit Applicant M4 31 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BROOKHAVEN 1 WINFIELD CATHEDRAL TOPS A38 BRASS FLORAL KNOBS FOR DOORS CHERRY,BURGUNDY STAIN C24 BRASS PULLS FOR DRAWERS , ' 1794.' i CEILING HEIGHT APPRX.89 3/4: HANG AT 84"ABOVE FINISHED FLOORS ODI PULL OUTS IN ALL BSD CABINETS MTTE804 MOULDING ON TOP OF CABINETS r f EXCEPT WHERE NOTED SHALLOW DEPTH 5"X 96"PANEL FOR SOFFIT MATERIAL MCR82S8 CROWN MOULDING AT CEILING VSE UNDER CABINET LIGHT MOULDING ISLAND 1-REFIRGERATOR OPENING:36"X 72" RECOMMEND APPRX.8-9" CUST.REF.36W x 69 S/2H x31"D MAXIMUM OVERHANG USE UNDER CAB. MOULDING ON COUNTERTOP FOR ISLAND \ ______________________________________________________ 2-TILT DOWN SINK TRAY FOUR TFCA FEET FOR EACH CORNER OF ISLAND v 3-SINGLE TRASH PULL OUT AND CUTLERY DIVIDER WAINSCOTTING PANEL FOR BACK AND DECORATIVE SIDE PANELS = 4-LAZY SUSAN BASE CORNER CAB. EACH END OF ISLAND (SHELVES ONLY IN WALL CORNER CAB.) 5-WOLF 48"COOKTOP SPECIAL BASE 16 PULL OUT CUTTING BOARD O O WITH WOLF 48"HOOD ABOVE (HANG HOOD AT 84"A.F.F. 17-BREAD BOX BOTTOM DRAWER 6-DOUBLE OVEN CUTOUT WOLF DO30 28 1/2"W x 49 5/8"H 18-WOOD CUTLERY DIVIDER GJ FOUR WOOD TRAY PARTITIONS IN TOP SECTION, LEFT SIDE ILL - cL 0) 7-MICROWAVE OVEN CUTOUT IN WALL CAB. 19-SOLID STOCK SUPPLIED o® FOR GE MONOGRAM ZEM200SF 24 7/8"W X 15" TO USE AS PLATFORM ON WITH TRIM KIT JX827BN RANGE8-OVEN CUTOUT FOR WOLF WARMING DRAWER CHECK OP CABINET ��gg nn ����xx gg��� 44 N�I CHECK RANGETOP TO ALLOW NECESSARY 9-MOLL&MPKA W�LLF8�6S.(3 DOORS) CLEARANCE WITH ADJOINING CABINETS 10-MULLION GLASS WALL CABS.W3030(2 DOORS IN CENTER ONLY) 'n co 11-BASE FILE DRAWER WITH PULL OUT TRAY 12-BASE DOUBLE FILE DRAWER 13-APRON DRAWER BETWEEN FILE CABINETS ----------------- PANEL FOR WALL BETWEEN FILE CABINETS 14-DANBY SILHOUETTE 24"WIDE UNDER COUNTER WINE CAB OWC512BL J 15-36"X 15"WINE RACK UNDER 3615 o OD N 95-1" K. 36" 1,1 '„ 64 " 13"--f-24" 89 4„— --36" ,f-15" 36" -------------------------------- F29----------------------------- ALAN E WITH PLANCH D ,. r r 1 i"J .;Ao 1230 �13301JLWAC24301_ c co °D N W36122 A 13" 52 " C M39' BF ISH-IQ BSC3634 B1OS53 6 0Wj 1S S G m `------------------------------- --------- -------- -3-----4 N b � � O OI 2 O w N m cf) C:! _ N O J a0 M = N pp 80q N a) O A A b m J „ im i 51 D3034 B1D3034 83024341 1834 45nN CL � O O I' Lo-" --------PWs1023401L--------- w N 30" 30" 24" 18" - - u') 102,. 0) ua m SHALLOW DEPTHS B3D3334 IN BASE CABS HEREr_- 1184 F TIC308421 IDIS L TIC308421 - --------------------------- ----- - TOA338424 N M:330 O9 W18301. 7ww�o 8 --------------- -------------- 30" 33" 18" 30"— — 893'— 33" 33'• 38" 3141, 33" 18" 119. 33 71 3-05-1"- -