Loading...
HomeMy WebLinkAboutMiscellaneous - 7 INGALLS STREET 4/30/2018 r { i Cunningham Lindsey U.S. Inc. g Y P.O.Box 703689 unnin lam Dallas,TX 75370-3689 Lindsey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM ***********************AUTO**3-DIGIT 018 771 T3 P1 95000058961 Building Commissioner or Inspector of Buildings 120 MAIN STREET N ANDOVER,MA 01845 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 121556 Policy Number: 121556 34 M Company Name: MERRIMACK MUTUAL FIRE INS co 0) Cause of Loss: ICE DAM Date of Loss: 3/9/2015 o Insured: RAYMOND A& ROSE MARY T SARACUSA Property Location: 7 INGALLS ST Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3B,,No insurer shall pay any claims (1) covering the loss, damage, or destructions to.a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the.city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the!said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to 'section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 N The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations UV 600 Washington Street Boston,MA 02111 www.mass.gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ��e Movi 1,Z Address: 3 3 F m :5A- City/State/Zip:S Meru 1, Phone#:-617 r �a �" �� 3 C2 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with-3i:vc M4^i L 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors , ,,� 2.El am a sole proprietor or partner- listed on the attached sheet. 7. !�nemodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. F1 Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E]Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 13.[_1Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.9:: Expiration Date: Job Site Address: °City/State/Zip: Vorh 4tjAou r Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido Izereby c try unde the pains and penalties ofperjury that the information provided above is true and correct. - Si ature: 4%u' �' Date: / Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants r Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials I Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submitI one,affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: `Zhe Gaonwealth oassarhusets Department of Jndustdal Accidents Office of Investigations 600 Washington Street Boston,NIA,02111 Tei,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 wwmwass, ovaa 'i M� t i a MM(TNw'EALTN, f?F°MSS A Ht SETT . : (N'p BOARD:dF n ELECTRICIANS � 'I SSUES, THE F.0L0WI NG ''L1 CENSE _ AS A REG JOURNEYMAN ELECTRi7 AN ;CC" PAttL G` PERE IRA 10 BERKSH I RE ST `� "tti ' W LItMBR I D G E MA" 02141 1902 3: 12871 B o7I31/16€. 81038 ;.. M Date� 3� �. ........ 1 066 "opT" TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING 88�cwus� .... .................... .. ' This certifies that..:.......p '..�? ..�. has permission to perform ��-'� �� � Q i_ .................................................................................................. plumbing in the buildings of.... ............................. at..... ........... J✓?........ ............:........................... North Andover, Mass. 00 Fee t� .. ....Lic. No.�a (? '... ..... '`................................................... Ei. PLUMBING INSPECTOR Check# 31n I 4 v ti- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYQAC^ MA DATE ( PERMIT# JOBSITE ADDRESS1_7 (�� l,�.S — �- OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:� REPLACEMENT:Rr PLANS SUBMITTED: YES 0 NOQ FIXTURES Z FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ___! __ DEDICATED GREASE SYSTEM ._..____i ( _[ DEDICATED GRAY WATER SYSTEM f _ ( ( _ ! __._..` �i _._._.._ ! i 1 L i DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _ I � _ I ( _ _! ! _{ � .---___J ..-_.... .__._..t i FOOD DISPOSERJ FLOORfAREADRAIN INTERCEPTOR(INTERIOR) _..._( ______! KITCHEN SINK LAVATORY III--] ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL __ WASHING MACHINE CONNECTION _! ._. ... .__._._._.4 I ! ! .__._._. 1 .._-.__j --j ___77 WATER HEATER ALL TYPES WATER PIPING ( _ _► i __ .f ! _ i ---.- ------- -_.--_._E I __._. _! �! _. __- INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES O'NO _1 `^ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Di BOND M OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ,i AGENT JEII SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this 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 provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �LICENSE# SIGNATURE MP El JP CORPORATION M#=PARTNERSHIP®# LLC COMPANY NAME I ADDRESS . Q F _ CITY STATE ZIP TEL FAX CELL��EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINALINSPECTION NOT Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: PERMIT# PLAN REVIEW NOTES i The Commonwealth ofMassachusetts - Department oflndustrialAccidents Office of Investigations 600 Washington.Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 2(-NLS(-r\ C\ Address:_6 City/State/Zip:Q uGUS m� �i�10� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. [J No. construction ployces(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.I 7• emodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner,doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. c'P erC to Policy#or Self-ins.Lic.#: \�1 W ��� \ Expiration Date: l� Job Site Address: �A)GA L a. S7 City/State/Zip:tya �� e' 1S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of 'Investigations of the DTA for insurance coverage verification. Ido hereby cern rider Chep ' andpenalties ofperjury that the information pro videdabove is true/and correct. - Si ature: Date: ,� -3t Phone#: F55%( o?©3 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: .. t Information and Instructiolm's Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having notmore than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date'the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only.submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. k The Department's address,telephone and fax number: Tho Cowm..onwealt�ofMassarlaysetts I Depaz`txzi.e.ut ofladustx.al.Accidents i OfAce ofInvestigations. I 600 Wasbingtoa Street Boston}MA 02111 TO,#61.7-727-4900 at 406 or 1.-877:MASSAFE Revised 5-26-05 Fax 617-727-7749 COMMONWEALTH OFM1iSACHUSETTS ® o ® o 0 PLUMBERS AND GASFITTE.'RS x' ISSUEST,.HE FOLLOWINGLICENSE: LICENSED AS A JDURNEYMANLUM R, GEa'R4*E SALSMAN JR r• i ° b ST JAMES RD �kUGUS MA 01906-4068 '' i I g 19 r,i r, IJ rtq S 4 p y.{1 3V , • a i., M yyyyy'� Ju S'in j/�s�a rl ,]�S F•i++�} �' ',+( iF�'i, `1 h r4Y` r 137 { ,i '` { t ? .{�'o i+ 4 r)'^kF r�{++} yjFa4A �I.�YF {•r. , /i'a' t{ h Fr k; •4 k r S,{, ^7} ,1 t'I's" jy !' }� TOWN OFNORTH ANDOVER 7 f H ' . SYSTEM PUMPING RECORD { 4 z., r r { irx. yya,� ra�. r�f'a i'j,'a'A)'{t��' y, •°- 4 VK­ 'SY&TEM'OWNER&ADDRESS SYSTEM LOCATION 3N} r �t 7+' _ . ( !r9dr, `" xa`j rV t (example: left fronto ouse 'Y;K� ►�l ~ L C.U� r���,. i� a '' ab�a� i�J! tv�I' �I{k n d•� 41+�T �r I of.,; { ,,ra� �.. _� a + f 6 eaAll. RP,�ti4��4' j ctit , FNpr�f+�f,S. ShY ���r•aS aaa/ 1ttn °9 T�}IyrF,R'p.� '� N� DATE OFF LIMPING: -b ` QUANTITY PUMPED 1 � 5+ A r Y GALLONS Nil t"CESSPOOL; ` b �•. . .. ` �NO YES ' SEPTIC TANK: NO t if §' ----- _ YES_ M NATURE OF SERVICE:, ROUTINE x , EMERGENCY u ,d t 'J c+ tTTYq Yn i .kms h e}•>" �n, t of'. ,b.t��+1r C•r�i �s`s�tt f*y ( y �, l ?+'Y 1� Ft7 Y ' •- .. t I.IS ^� 54f ra rSJ( �r Itr AOOD CONDITION ; FULL TO COVER ; HEAVY GREASE BAFFLES . IN P _ .�., LASE RQOTS, LEACHFIELD RUNBACK EXCESS �... �� r- S IVE SOLIDS.:` ;FLOODED CARRYOVER r`� OTHER(EXPLAIN) �5+u ii�,s N rF r pfvk{4, bJ. 111 R"s'�H it �,�E�i ¢ +tti �L�rr�Fr S�l�7t;�h ,i.,4f�1 r ti' t � s �ri•� k + -,+1 f t � .. S 'EM pUMpEA $Y' v r- (` I • v V ` `•—�j� I 'M ' pelf b i�� r `frr hYvl+ ^1 ""ni (ti t�t{� k,r3 � it l'' Ssr} I(( r a n0 E I 1Y S t f r(t1 C a ` Jm'� Q F {1 ,d,I tF w ,� , � F _�..-n•- +� '+... ,. , ry�ENTS: (. •Ih ti"fl.�tt7l'1+kt"Tgtul �'+, 7ojy r•*ST1`4+'}•r� �- i f F-10 �' ��° I tx. 54, ct a'+2oa� `vr{ �!!"__ri1 :+y7r yj Vie sW. "��^a'ra• r 's i�`'", l i 'I9 MI<Tgf,Z3 ^1� k{ l( }�, ,.j d _. t? , 13 °yett1 � RI H+�r b" Pd ' ' +F r f •� 4 ''•. - 4; Bn , tryAPA eq`1F:b ` rrrH�tir Y_ � �AyY•p ikll�, r Fd' ` � h i Off! �YTS,TRANSFE Tp �a1,+{k t�rM1 tiS I,Y 'till c(� m a r� 'c '�+at '.,j �r • S " �1""' ° "d �` +� PIP '� a (�xya�iafvxt�� r rt4+ n-= +`+ 'r {1 � ._ 4 •I,M fl �t,�A,• ZfFY� rt.�y'"{ 'V�,,i{{���r'i s]„7yrrrf.Yf s C( +. r�' {I at a... t S __IS�,r : .ill p 04 f J � f 1431 d ^,,r,*� i t tit -, +�✓, •.._b+ �,.?, I `z �i{ 3 r. ? . APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application fo a permit for a sewage disposal installation at .z�'7 , , ,--,���� I will install this system in ac- cordance with all th/( laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of .North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 29o`. I will install a con- crete septic tank of - 10-7---v --in size. A manhole (s) permitting easy cleaning, will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of /F'd lineal (square) feet of effective absorption area. Thepipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single the line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation.will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE /V/ 7-Y Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Inspecting Officer Percolation Test J✓tlx�c�� � � : , - Garbage Grinder R A � AM Q I�0 1526Town - of Andover w � North Andover Mass. 19 - SA ITARY eENGJNEER1 V , FERMI 1 11 � 2 LD G` . THIS CERTIFIES THAT . . . . . � . � --���.�. . . . . . 6 ILDINd IN PECTOR � has permission to erect—altep ..... . . . . . . . . . . . . . . .b i . . . . . �- . . . . . . . . . to be occupied as . . . . . . . . j ' . . . . . . :, - ` -PFJ PLUMBING INSPECTOR provided that the person acceptins;1i permit shall in:eve y es ect q reform b e f+e of the application on file in this office, and to the provisions of the Statutes and.By- .' s r g to he ec ion, Alteration and Con- struction of Buildings in the Town of North Andover. L JS ELECTRICAL INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR . . . . . . . . . . . . . . . . . . r'. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �.- BUILDING,INSPECTOR n0ccupy:Building,Apply at`Building Inspector's Office, Town Hall. This Card Must be Displayed ina Conspicuous Place on the Premises and Not Torn Down or Removed No Lathing to Be Done Until Permission is Issued by Buildng_ hspetor: nrw i % o T•/ Aro.-- -- Fee 1. 6 V THE COMMONWEALTH OF MAS iACH.USETTS i BOAR® OF HEALTH is hereby granted permission to install- CESSPOOL—SEPTIC nstall- CESSP®®L—SEPTIC TANK on the premises at in accordance with an application on le at this office. Said work must be done in strict conformity with the requirements of the regulations of 13oatdj6f Health relating thereto. CHAIRMAN OF THE BOARD OF HEALTH Violation of any of the requirements or conditions will cause Immediate revocation of this permit. j