HomeMy WebLinkAboutMiscellaneous - 66 VEST WAY 4/30/2018,6 4 S) r, Date. Z//". ......
�3
' Cf NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ... /.,14 -
has
n4 -
has permission for gas installation I./..............
in the buildings of ... 4 A.... 111ORY ...................
at 4t2..5.�"....1 t ......... ,North Andover, Mass.
Ae. ,PIQ ... Lic. No. JC)
GAS INSPECTOR
Check #
.A
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER ,Mass. Date MAY 16, 2011 Permit #
Building Location 66 VEST WAY
Owner Tel# 513-910-3275
Owner's Name ANN MOSBY
Type of Occupancy RESIDENTIAL
New a Renovation Replacement Plan Submitted: Yet No[:]
FIXTURES
Installing Company Name Eastern Propane & Oil, Inc
Address 131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628
Name of Licensed Plumber or Gas Fitter ROBERT WHITE
Check one: Certificate
Corporation
Partnership
❑Firm/Co.
INSURANCE COVERAGE:
I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No El
If you have c ecked rimes, 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's 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 wgbe,'compliance with all
ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene
By Type of License:
•member Signature o Licensed Plumber or Gas Fitter
Title -G fitter
aster License Number�7
City/Town • -Journeyman
APPROVED (OFFICE USE ONLY)
1
`
r
Installing Company Name Eastern Propane & Oil, Inc
Address 131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628
Name of Licensed Plumber or Gas Fitter ROBERT WHITE
Check one: Certificate
Corporation
Partnership
❑Firm/Co.
INSURANCE COVERAGE:
I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No El
If you have c ecked rimes, 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:
Owner ❑ Agent ❑
Signature of Owner or Owner's 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 wgbe,'compliance with all
ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene
By Type of License:
•member Signature o Licensed Plumber or Gas Fitter
Title -G fitter
aster License Number�7
City/Town • -Journeyman
APPROVED (OFFICE USE ONLY)
Date./ S ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS! INSTALLATION
This certifies that
has permission for gas installation ......
in the buildings of ...el-) �........................
at ...4- b P. le'4z ............ North Andover, Mass.
Fee. Lic. Nol....... ... !,G -A-.- : IN . ........
Check #,,/ ?3
7049
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
N ANDOVER
Building Location 66 VEST WAY
,Mass. Date 11/30 2009 Permit # 72 0 `f 1
Owner Tel# 978-691-5354 OR 617-884-1802
Owner's Name TOM GAROFANO
Type of Occupancy RESIDENTIAL
New F] RenovationF] Replacement
FIXTURES
Plan Submitted: Ye[] No❑
Installing Company Name Eastern Propane & Oil, Inc
Address
131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628
Name of Licensed Plumber or Gas Fitter ROBERT GRENHAM
Check one:
Corporation
Partnership
Firm/Co.
INSURANCE COVERAGE:
I have acures liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes
l ✓ I No ❑
If you have c ecked iy s, please indicate the type coverage by checking the appropriate box.
A liability insurance policy �✓ Other type of indemnity ❑ Bond ❑
Certificate
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:
Owner ❑ Agent ❑
Signature of Owner or Owner's 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
iowledge and that all plumbing work and installations performed under the permit issued for this applicaf will be in co liance with all
srtinent provisions of the Massachusetts State Gas Code and Chapter 142 o en al Laws.
By Type of License: MmC 44A
umber igna ure of L' a ed ber or Gas i
Title •Gas fitter
• -Master License Numb
City/Town • -Journeyman
APPROVED (OFFICE USE ONLY)
r,a Office Use Only (/
r u4E Cf ammunweafth of 5sar4l1�E� Permit No. -�.�_ r .
Egar=zrrt of jTublic gafitq Occupancy A Fee Checked
.1190 (leave blank)
80AA0 OF FIRE PREVENTION REGULATIONS 527 CAR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORKq(3�
All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR1 :00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
=Q or Town of NORTH NDOVER To the In pector of Wires:
The udersigned applies for a permit
/tJo perform the electrical work described below.
Location (Street & ,Number)
Owner or Tenant
Owner's Address �
Is this permit in ccnjunction with a building permit:
Purccse of Suildina
Existing Service Amos Vcits
Yes No r (Check Appropriate Box)
Utility Autnarization No.
Overhead Unagrnd f No. of Meters
f
New Service Amps _!
1/sits Overr,eac _
Uncgrno _ No. of Meters
Numoer of Feeders and Amcacity
Lccattcn arta Nature of Pirccosec Elec:;:cat ."lcrx
No. or L:gn;ing Outletsi
No. c.:�ct -as
i
No. of transformers Toter
KVA
No. of Llgntfng Fixtures
Swimming ?col above.—
;n-
grna. _
Srnc.
Generators KVA
No. of Emergency Lighting
No. w Recectac:e Outlets
No. cf Cil Eumers
j
3arery Units i
No. of Switc:i Outlets
No. cr Gas Eurners
I FIRE ALARMS No. of Zones
No. at Cecection aha
Initiating s
Vo. ct Sounaing Devices
Na. of Sart Cantainea
No. W Ranges I No. at ,air ;:eo
nc. tons
tn
No. of Ciscosafs No.cr Heat Total --alai
?umcs Tons KW
� No. of Gisnwasners - �
ScacerArea Healing
fie
Ce:Dec;:onrSouncfng Cawcea
Lccai - Municioat ^ Other
_ Cannec::o
No. at Cryers Hea;;ng Cev:ces KW
No. cr No. at
Low voltage
Na. at •.eater Heaters KVI i
Signs 9a:lasts
wir:ng :.
No. Hycro Massage Tubs I
No. at Matcrs -alai HP
OTHER.
INSURANCE CCVERAGE: ?ursuant ;o the recufrements w %IassaCn.; sers ;enerai Laws —/N
I have a current Liamity Insurance Paucy inducing C:.m_:ec Oceraucns C.;verage or :is suastantfal ecuivaient. YES = O = I
nave suamittea valiC ;root of same to the Office. YES NO = It ycu nave crtecxea YES. Grease :nofcate ;no type of cov rage cy
cnecxing .no aapr nate oox. U
INSURANCE 3CNC = OTHER = tP!ease Scec:!,/j
Esumateo value at E!erncar 'Nowt S
io o D (Ex6raudn Dalai
Worx :o Start tnscec:ton Owe Aacues:ac: Rougn Final
S;gneo unser no Penalties of perjury:
FIRM NAME UC. NO.
Licensee 4.4j,4l' -4Gcie A S'g^at r o LIC.
0 d a j� ,t�p�rt Y A//44- a3 0 3 4 Sus. No. �a� y y� --
Acaress
r ,alt. Tet. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee aces not nave the insurance coverage or its suostannal eautvalom as re-
auirea oy Massacnusetm General Laws, ano that my signature on :n:s cermit aepticauon waives this reaufrement. Owner AZ
(Pease cnecx ones
7eiecnone No. PEAMIT FEE S
iSignaiure of Owner or ,tgenn
*-io-
n5
.
Date .......
1108
3?°e, °16 TOWN OF NORTH ANDOVER
• p PERMIT FOR WIRING ,
,SSACMUSf
.This certifies that ...................-�..^...
has permission to perform .... ......L". r ....... .......
. ��'4 i�
wiring in the building of ........ /.1..................�... s
at .:... ��... .P.K .. !.C.t..�/..... ......... ............ , North Andover; Mass. ;
Fee Pj;� '.4�..... Lic. No. v...
ELECTRICAL INSPECTOR
4 U
v (5f 08/14/97 12:15 35.00 PA
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer-
MASSACHUSETTS UNIFORM APPLICATION FOR, PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date % 19 Permit #
Building Location -66 tX 17- JAV Owner's.Name�ZRAf— --A A)(5
E
Type of Occupancy_
New p Renovation-1Replacement p Plans Submitted: Yesp Nom
Installing Company NameYA A) Check one: Certificate
Address_ _ _ f �CJ SQ /�1✓�•� S� Corporation 0.
p Partnership
Business .Telephone C3 -- %% ~ -.� 7(!!�O p- . Firm/Co.
Name of Licensed Plumber or -Gas Fitter �'u //"�;.J--S
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets: the requirements of MGL Ch. 142.
Yes No O
If you have checked res, 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:
Owners Agent. p
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true ands ac5i � o(><he t of rKy W
knowledge and that all plumbing work and installations performed under the permit issued for.this:app on II iri- tVr I arce�rnnthIl _� ° f
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G�r Laws: , _ i
i
.'. :
BY T of license: a '
Plumber Ngnafure ofUcensed. Plumber or Gas' itteY r
Title_asfitter �y
ster License Number
City/Town Journeyman
APPROVED(OFFICE S ON
it
11
Y
W11111=-
MOMENNIONEENIMME
MEMO
oil
0---
0
• •
■®A.■■E■.■■E®®ME®ME®■..■..1
Sol
r . ..
■o.���e��.e■®�®®�®®��■
son
Installing Company NameYA A) Check one: Certificate
Address_ _ _ f �CJ SQ /�1✓�•� S� Corporation 0.
p Partnership
Business .Telephone C3 -- %% ~ -.� 7(!!�O p- . Firm/Co.
Name of Licensed Plumber or -Gas Fitter �'u //"�;.J--S
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets: the requirements of MGL Ch. 142.
Yes No O
If you have checked res, 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:
Owners Agent. p
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true ands ac5i � o(><he t of rKy W
knowledge and that all plumbing work and installations performed under the permit issued for.this:app on II iri- tVr I arce�rnnthIl _� ° f
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G�r Laws: , _ i
i
.'. :
BY T of license: a '
Plumber Ngnafure ofUcensed. Plumber or Gas' itteY r
Title_asfitter �y
ster License Number
City/Town Journeyman
APPROVED(OFFICE S ON
4
Ira
June 12, 1996
Russo Products, Inc.
Richard Russo, President
G1 pleasant Street
Randolph, MA :02368
You are hereby advised th-d on June 5, 1990 the Girard took action pursuant to your =
application(s) for extcnslons of product appruvals as indicated on the attached list.
Approvals
The approvals shown have been granted subject to installation in compliance wlth CMR 218,
Massachusetts State (dumbing Code and/or the Mass;Ichuselts Fuel Gas Cade; said
approvals are in effect for three years beginning June 5, 1996• At the expiration of the three
year extension approvals it will be necessary for the manufacturer to petition this Board for
another extension of said approvals. You are furtljer acivised that the preceding approvals
are not to lie construed as an endorsement Of these products nor is this letter to be used or
reproduced as advertisement of the products,
If you have any questions about the action taken by tho Board on your aplAcation, please call
the Board Office at (617) 727.9952.
Very truly yours,
For the Board / r
Louis J. Viseo, Executive Secretary
Board of State Examiners of Plumbers and Gas ritturs
Application forCxlenslon
ryp Gas
Manufacturer.-
Wolf Sten l Lid
Product Noma
Model
Acfio}r
Napoleon
GD22N
3 Yi Apprvl
Napoleon
0022P
3 Yi Apprvl
Napoleon
GD32.00.6N
3 Yr. Apprvl
Napoleon
OD3200-UP
3 Yr Apprvl
Napoleon
G13014B-N
3 Yr Apprvl
Napoleon
G1301Q-P
3 Yr Apprvl
't
Board Meeting pate: 05 -Jun -96
Approval coda ; l:xpiratlon DefelTabling Reason
G3-0696.55: 05 -Jun -99
G3-0696.55: 05 -Jun -99
f33-0696.55: 05 -Jun -99
63-0690-55: 05 -Jun -99
G3-0606-65: Ub-jun•99
G3-0690-55: 05-Jun-99-
x'645
Date. -k.
c
H
HORTM
TOWN OF NORTH ANDOVER
0y`t,.ao ,e 1tipL
p PERMIT FOR GAS INSTALLATION
M
N
This certifies that : .`.:...- 1........" ............. r-
•p,
has permission for. gas installation . ...................
in the buildings of, N&Al ..... . ........................... .
at rth Andover, Mass.
heed.. u Lic. No. ..�?.. .......
GAS INSPECTOR
/F WHITE: Applicant CANARY: Building D t. PINK: Treasurer
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Town. of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
'Lease print)
DATE%
JOB LOCATION
number
:�)MEOWNER" c A
-'RESENT MAILING ADDRESS
Street( Address
ection of town
one
City own State Zip code
The current exemption for "homeowners" was extended to include owner
-occupied dwellings of six units or less and to allow such homeowners to
engage an:individual for hire who does not :possess a license, provided
that the owner acts as'supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
reside, on which there is, or is intended tq. be-, a one to six family dwell-
ing, attached or detached structures accessory t.o such use and/or farm
structures. A person who constructs more than one home in a two-year
period shall not be considered a homeowner. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding Official,
that he/'she shall be responsible for all such work performed under the
building permit. (Section 109.1.1)
the undersigned "homeowner" assumes responsibility for compliance with the
State Building Code and other applicable codes, by-laws, rules and_
regulations.
i'he undersigned "homeowner" certifies that he/she understands the Town of
Orth Andover Building Department:mi_nimum inspection procedures and
�quirements and that he/she will comply with said procedures and
equirements.
IOMEOWNER'S SIGNATURE, �G
,PPROVAL OF BUILDING OFFICIAL
dote: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
,:untrol.
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FORM U - IAT 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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: �� E �a Phone 61kl- 5-1> Sy
LOCATION: Assessor's Map Number Parcel
Subdivision Lots) 5
Street 2s� L�� �, , , St. Number
************************Official Use Only************************
RE TIONS OF TOWN AGENTS:
Date Approved
Cons rvation Administrator `jam DateReejected
Comments _ __ �� �7 ( � � wl 4 -Au � / % A t
., Town Planner
Comments
Food Inspecto -Health
r
-S`e is nspector-Health
Comments
i
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
601
60
00
-ell
cv
CP
4WAi
00 j
EE
Location
No. Date Fq
i
HORT�y TOWN OF NORTH ANDOVER
�a,0•i"•' •,h0
• cA Certificate of Occupancy $
Building/Frame Permit Fee $ c.5
sqCHUs t� Foundation Permit Fee $
i
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $_
TOTAL $ S'
Building Inspector
f f 3 1101/99 14:18 ID
'� Div. Public Works
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67 (Policy Provisions: WC 00 00 00 (NM ONLY) , WC 00 00 00 A)
29
vM INFORMATION PAGE - WCIP
WZ WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
NCCI Company Number: y�THE
Company Code: 6 MRTFORD
Suffix
_ LARS RENEWAL
POLICY NUMBER:
Previous Policy Number: 77 W7 =2962
1. Named Insured and Mailing /Address: NORMAN GAY DHA ALL UNDER ONE
(No., Street, Town, State, Zip Code) ROOF/PEST IN PEACE
70 JEFFERSON STREET
FEIN Number: 028349269 NORTH ANDOVER, MA 01845
Stats Identification Number(s):
The Named Insured is: INDIVIDUAL
Business of Named Insured: ROOFING
Other workplaces not shown above: 70 JEFFERSON ST. , NORTH ANDOVER, MA 01845
2. Policy Period: From 11 / 0 9 / 9 8 To 11/09/99
12:01 a.m., Standard time at the insured's mailing address.
Producer's Name: MASS WORK COMP A R DIRECT
LENNOX INSURANCE AGENCY
PO BOX 462
LYNNFIELD, MA 01940
Producer's Code: 083477
Issuing Office: THE HARTFORD
4801 NORTH WEST LOOP 410, SUITE 200
SAN ANTONIO TX 78229
(800) 852-7221
I ne poncy is not otnaing u..tsss counters,,jns oy "r authorized representative.
a
?417,Authotized Representative
Obm WC 00 00 01 A Printed in U.S.A. Page 1 (Continued on next page)
Process Date: 10/ 09/98 Policy Expiration Date: 11 / 0 9 / 9 9
ORIGINAL
2r 984
Date
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIOII�,
ui
This certifies that_,.
hat,...... • • • . � .......
has permission- for gas installation • .. • ..
in the buildings of ............. .......................... .
at'�. 1/1 .. ,
Fee... North Andover, Mass.
�1' /� �
%..... Lic. No........... ..........................
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
• (Print or Type)
N A4Q _�d M Is, S. to
City, Town
Permit
Building Owner's
AT: Location -6-6-.. LA§_145=__ _(,j t-1 V Name'
Type of Occupancy: -
Renovation ❑ Replacement F]
Yes El No W
rin
Check One:
or Type) Certificate
Installing Company Name.
Corp.
Address zpi;o El Par't"nership
9 2
Firm/Company
Business Telephone—!? -2,?'— -7zl .4V1 V Name of Licensed Plumber or Gasfitter
0, 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
yyr I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
��� Signature of Owner/Agcm
wrent liability insurance policy to include completed operations covet -age.
,By
,Title
'APPROVED (OFFICE USE ONLY)
FORM 1243 HOBBS &WARREN. INC, 1989
TYPE LICENSE:
❑
Plumber
Signa ure of License J
fGa
r
rluml� sf
`Plumber or'Gasfitte
I
❑
Gasfitter
❑
Master
❑
Journeyman
License Number
1111111111
1111
No
NINNEENNININ
01
INNININ
MEN
NMI
EM
'•�SC'
BERM
EMENNEENEEMEN
EM =
rin
Check One:
or Type) Certificate
Installing Company Name.
Corp.
Address zpi;o El Par't"nership
9 2
Firm/Company
Business Telephone—!? -2,?'— -7zl .4V1 V Name of Licensed Plumber or Gasfitter
0, 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
yyr I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
��� Signature of Owner/Agcm
wrent liability insurance policy to include completed operations covet -age.
,By
,Title
'APPROVED (OFFICE USE ONLY)
FORM 1243 HOBBS &WARREN. INC, 1989
TYPE LICENSE:
❑
Plumber
Signa ure of License J
fGa
r
rluml� sf
`Plumber or'Gasfitte
I
❑
Gasfitter
❑
Master
❑
Journeyman
License Number
DEPARTMENT OF PUBLIC SAFETY
SPRINKLER CONTRACTOR LICENSE
Numb er° Expires:
M
SC :ERI02265 OB`/31 /1999
SALEM, MA 01970
Birthdate:
08/31/1957
Restricted To: 00
m
I.
Fold, Then Detach Along All Perforations
t COMMONWEALTH OF MASSACHUSETTS J
BOARD_
IN PLUMBERS AND GASF ITTERS
IMPORTANT NOTICE
;y...
PL
LICENSED AS A JOURNEYMAN PLUMBER
ISSUES THIS LICENSE TO
PERMITS FOR PLUMBING AND GAS FITTING
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE
.. I.
TYPE
THOMAS R GAGNON
OFFICE OF THE STATE BOARD.
PO BOX 8860
�1
SALEM-8860MA 01971
572487
18597 05/01/00 572487
f
c7
j
Fold, Then Detach Along All Perforations
I
I COMMONWEALTH OF MASSACHUSETTS
BOARD '
IN PLUMBERS AND GASFITTERS
IMFOi?TANTNOTICE
<m.
PL
LICENSED AS A MASTER PLUMBER
PERMITS FOR PLUMBING AivDGAS FITTING
ISSUES THIS LICENSE TO
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
TYPE
THOMAS R GAGNON
_M,
! m
'N
PO BOX 8860 N
SALEM MA 01971-8860
a
572485
10136 05/01/00 572485
Fold, Then Detach Along All Perforations
~'z
Fold, Then Detach Along All Perioratirns
COMMONWEALTH OF MASSACHUSETTS
BOARD
IN PLUMBERS AND GASF InTTERS
IMPORTANT NOTICE
10
PL
REGISTERED AS A PLUMBING CORP.
c
ISSUES THIS LICENSE TO
PERMITS FOR PLUMBING AND GAS FITTING
INSTALLATIONS ON STATE OWNED OR USED
FACILITIES MUST BE FILED AT THE
' TYPE
THOMAS R GAGNON
OFFICE OF THE STATE BOARD.
—C
m
eq
PO BOX 8860
{
SALEM MA 01971-8860
572486
1524 05/01/00 572486
a
Fold, Then Detach Along All Perforations
JdCG!' 2l.�JQCId
".
U 0 a_
DEPARTMENT OF PUBLIC SAFETY
SPRINKLER CONTRACTOR LICENSE
Numb er° Expires:
M
SC :ERI02265 OB`/31 /1999
SALEM, MA 01970
Birthdate:
08/31/1957
Restricted To: 00
m
North Andover Board of Assessors Public Access
t NoarN 1
p 4t��o e• �O
�,SSACHUg t�
Click Seal To Return
Search for Parcels
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Summary
Residence
Detached Structure
Condo
Commercial
North Andover Board of Asse
Page 1 of 1
k"lProperty Record Card
Location: 66 VEST WAY
GAROFANO, THOMAS J
Owner Name:
FAYE A GAROFANO
Owner Address: 66 VEST WAY
N City: NORTH ANDOVER State: MA
Zip: 01845
Neighborhood: 7 - 7 Land Area:
1.00 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area:
2696 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 552,600 582,900
Building Value: 327,000 358,100
Land Value: 225,600 224,800
Market and Value: 225,600
Chapter Land Value:
LATEST SALE
Sale Price: 1 Sale 04/16/1996
Date:
Arms Length Sale F-NO-CONVNIENT Grantor: FAYE REALTY
Code: TRUST
Cert Doc: Book: 04479 Pap -e: 0317
http://csc-ma.us/PROPAPP/display.do?linkld=1517949&town=NandoverPubAcc 8/16/2010
�t
y ECEIVED
SEP - 7 2010
T n byy
CX
0 R�rea �rB�g TOWN OF NORT" ANDOVER
PUBLIC HEALTH DEPARTMENT
fommunity Development Division
�El�'IFIC.A� OF CO�Vl�1'GIA�VC'�E
As of:
August 17, 2010
This is to certify that the individuaf subsurface disposal system received a
SA21'STACT0RT I5YSTEC 10X of the:
(placement of a Component:
Ustri6ution fox:
Tor an On -Site Sewage OisposafSYstem
'By:
John Soucy
t:
66 Vest Way
Map .104. B; (Parcef-- 0169
Xorth rtdover.9 Wei 01845
The Issuance of this certificate shaft not be construed as a guarantee that the system wid
function satisfactonTy.
r
9
heCe E. Grant
ft 6Cac Meafth Inspector
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 fax 918.688.8416 Web www.townofnerthandover.com
Commonwealth of Massachusetts
Ce p
Title 5 Official Inspection Form ���
Subsurface Sewage Disposal System Form - Not for Voluntary Assessme s SEP
le
> 'DOWN OR NORTH AN00vR
66 Vest Way
Property Address
Fay Garofano
Owner Owner's Name
information is N. Andover MA 01845 08/18/10
required for every REVISED
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: When
A. General Information
filling oUt forms
on the computer,
use only the tab
1. Inspector:
key to move your
cursor - do not
James Wright
use the return
key.
Name of Inspector
Aspen Environmental Services LLC
�y
Company Name
270 Lawrence St
Company Address
Methuen
MA 01844
City/Town
State Zip Code
978-681-5023
2035
Telephone Number
License Number
B: Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 C R 15.000). The system:
Passes ❑ Conditionally Passes ❑ Fails
Further Evaluation by the Local Approving Authority
J`1-1
Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""*.This report only describes conditions. at the time of Inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins • 09/08 Title 5 Official Inspection form: Subsurface Sewage Disposal System • Page 1 of 17
Commonwealth of Massachusetts
w City/Town of RECEIVED
X ° System Pumping Record
Form 4 Q E C 15 2009
M
DEP has provided this form for use by local Boards of Health. Ot wpm he
information must be substantially the same as that provided here. tri ck with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left side of house, Right side of house, Left front of horilng.
t front of house,
Left rear of house, Right rear of house. Left rear of building. Right rear of,
Address
City/Town
2. System Owner:
Name
Address (if different from location)
City/Town
State
Zip Code
Stat i Code
(-8X5 1
Telephone Number
B. Pumping Record
n-c�C
1. Date of Pumping Date 2. Quantity Pumped
3. Type of system: ❑ Cesspool(s) eptic Tank
Gallons
❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes �a No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
L,S.D - n „ Lowell Waste Water
of
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1