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HomeMy WebLinkAboutMiscellaneous - 72 PATTON LANE 4/30/2018This certifies that ...... R... has permission to perform. , , �tiDL, , , , , ... . wiring in the building of .......(J`7"T.....�e ,,,, , , , , , , , , , , at .. % 2- .�,cs ,� 4,9 ..... , , , , , .. , North Andovea; Mass. Fee. A.�,." -Lic. No...1. t 9.-.? ...... ELEC RICAL INSPECTOR Check # 10969 l4muuad mau zoj Xidduag :a;oM *** ZIOZ `SI Isn9nV tpnoiq;.$utpua;xo puv 800Z `SI Isngny uo �utuut�aq pouad gutSjt;Znb au; quunp ,,aoua;stxa io;oaga u!,, sen' lugl Imiddu zo;tuuad Sue `alep uotluzzdxo alquogddu ostmiaglo slt puo faq szeoA mod iod `spualxo SIluotlutuolne loy aq; `suocldaaxa pa;rural RIIM 14iodoid luai jo luauzdolomp zo osn oq; 2utuzaouoo sosuaotl puu s;tuuad utu}zaa o; uotsualxa zua i -mod at;ouzo;nz we gutgstlqu;sa Xq asodznd still staging Ioy uotsua;xg;tuuad oql pue,4an000i ottuou000 uua;-guol pue TUmof goCa;omoid o; st In stgl jo osodmd atli -ZIOZ3o s;oy oill .Io 8 £Z jaldugD JO SL PUB K suotlooS Sq popualxa Pue O I OZ3o slog oq; jo ObZ !al ugz)3o £L I uotloog Xq pa;eazo soon Ia-r uolsua;xa Ilm zad oq j, El uotleotlddu ltuuad aql uo pa;u;s'Llguo $uglulsut oig zo zaumo aq;.tagptado lsonbat uallum oig uodn pa;uutuual oq hugs;tuuod y •osneo olquuosuoi zo•I palltuuad aq llugs Ntom3o uotlaldtuoa zoo autg�o uotsualxa uu `uot;uotlddu ualit.tm uod] l •pouad gluom-ZI 3utpaaaid aq; Outznp passoi2ozd jou suq zo paouaunuoo Iou seq }from pazTjoqln73 oqI Ietl; poumuolop suq oqs zo —ag3rptlenurpue pauopuuqu saztM;o-zo;oodsuragjATpauzaap-aq fuuz pub, SLltntlau not;angsuoa•guto2uo-3o aural aql of se pa;tuTtl oq—lugs sltuuad "I£ § `£t�I 'o "I'�J'I�I ut pannbaY su alzom agl3o notlalduzoodo not;uoggou aqI so; algtsuodsaz ag hugs alt;ua gons uopeotldde Ituuad aql uo paluls uotluzodzoo zo uug `uoszad otp of ponsst oq Ilugs Ituuod luotrlaalo ue `Z£ § `99I 'o TJ 'W o;;uunsind pa;tnoddn sanM;o ioloadp,*l uv Xq poldoom uaaq seq not;uogddu ;tuuad u cagy •uuo3 pogttosazd aql uo polrg oq Ilugs suotluotlddu puu `q;leannuotuuzoa a g Inoq$noigl uuo;tun ag hugs t urm jo uotlullu;su13o ootlou optnoid of uuoj uotluotldde Imaod sill `Z£ § `£�i'o 'TMJ w3o suotstnozd aqI q;tm-aauupi000u tzl :g aIn2I § 00'ZI MD US s;uaucpuawy apoD Ml4331g sl;asngoussHN ZIOZ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank 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 IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned ives notic of hi or her intention to perform the electrical work described below. Location (Street & Number) /2 %�Q Owner or TenantKra /f' l Telephone No. Owner's Address Is this permit in conjunction with as building permit? Yes No F1(Check Appropriate Box) Purpose of Building e efl.Q,eg! G e Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: l!/!af /4,9'~,V OdL Completion of the 07owing table may be waived by the Inspector 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 Above In- Swimming Pool rnd. ❑ rd. . o Emergency Lighting B6 Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number ................................... Tons ........... KW ........... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Dr y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring.. 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: 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 cover is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under theains and penal 'es o perjury, that the information on this application is true and complete. FIRM NAIV /�� G 0 Of a 1i �G r�G�dh LIC. NO.: Licensee: /G 1G �. a A!Q G Signature LIC. NO.� (If applicable, ent�z "exempt" i the I'cense n ber lin .) Bus. Tel. N0 -211 --A/W& Address: /. S ©Q Zw-' 40,f X 0M 4lp P Alt. Tel. No. � *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 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 PERMIT FEE: $ Signature Telephone No. r •.1�1.A.J1�'�u.r.l.J.i.I.�y�'{.;(CJ��-���-'{I,(,.(�C.f•�ii�j��■{{{''j�j.''[L���ij�))J'.e{Y'.(�L�j',.R 1�1�®j��f�'�($jPQ�j}�.Q/.(� �Q'y)� •�l'J�.L1�.IL.R�.I'Q JLe�J.G ®�•!.i I �'assec�•-• j) • �+'aisec��I � � �e,�us,�ectioxtxea�nixe� (��0.00)w [ � . �n5�ec�ox's' comtneJxts: ,. •(.�ns�iectoz's',�igxtature.-�o$nzixais) �1ate 3. UNDAR GROW _WSRACTIOn. �'asseci-• j 1 �+'azIec�--j) �.te�fnspectzonxeguire�(��OAO) � j) �ns�ectazs' co�n.ents; , (lnsp8ctoxs:, sign*re-ao H ?als) ]ate asseei--[) �`aile�--j � �e-xnspectiox.xequize� (�50AD) � j) ' ts•�ectbxs' eo�nm.e�tfs: . (Iris ectoz s' ,�ignaiuxe o initials} Date L�,�'�+ C2'�TOS�T• � Off+ �se - £ ailer -- j )• Re Insp eciion xegwred ($50.00) - [ - tiectoYs' coutx�e7�fs: _ • ' .: �.[i�spectox�' �zgx�atcu'e •-xto �nitiaTs) date D5OP. TAG,g AM TO 33E +'MED QVT A. NOT . �psset�--• �+'a31eQ-�j ] �e-xuspeetzou xequzred'(��O.UO) � j j ' �nspectoxs' capamejats: -- Z�,.-- I Z;: . (JCnspectore S ignatuxe -•).o .bsllals) date �'assec�•-• j) • �+'aisec��I � � �e,�us,�ectioxtxea�nixe� (��0.00)w [ � . �n5�ec�ox's' comtneJxts: ,. •(.�ns�iectoz's',�igxtature.-�o$nzixais) �1ate 3. UNDAR GROW _WSRACTIOn. �'asseci-• j 1 �+'azIec�--j) �.te�fnspectzonxeguire�(��OAO) � j) �ns�ectazs' co�n.ents; , (lnsp8ctoxs:, sign*re-ao H ?als) ]ate asseei--[) �`aile�--j � �e-xnspectiox.xequize� (�50AD) � j) ' ts•�ectbxs' eo�nm.e�tfs: . (Iris ectoz s' ,�ignaiuxe o initials} Date L�,�'�+ C2'�TOS�T• � Off+ �se - £ ailer -- j )• Re Insp eciion xegwred ($50.00) - [ - tiectoYs' coutx�e7�fs: _ • ' .: �.[i�spectox�' �zgx�atcu'e •-xto �nitiaTs) date D5OP. TAG,g AM TO 33E +'MED QVT A. NOT J 1 A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi. 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): Address F Ar City/State/Zip: 1 %41L05 /'/r-/J�%y9 A'16 Phone #: f :,__,!rM_ 3373 Are you an employer? Check th appropriate box: 1'"; I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 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. $Contractors 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: Y Policy # or Self -ins. Lic. #: Q Expiration Date: Job Site Address: ?IC7/ 6zd�l 2 iZ L� City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under 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 DIA for insurance coverage verification. 1 do hereby certify under thains>dpenaltiesgfperjury tit the information provided above is true and correct. Phone #: ��" 3 � J-� 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, Q 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 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 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 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 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 `l 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. 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass,gov/dia Date "oRToo� TOWN OF NORTH ANDOVER ° i? .� '• PERMIT FOR PLU_MBIN ,SSACH This certifies that ... ems...•..•••••••••• has permission to perform ..... w ......................... plumbing in the buildings of . h. �� -.(./y ................. . at ... �... /.... ....t....... .`.... • • • • • • , North Andover, Mass. Fee. Lic. No.. . .7 ........ // ��"�•� PLUMBING INSPECTOR Check 4 0 C{ v city/Town,� Building Location: ��"-; Type of Occupancy: Commer. New: (l Alteration: 0 R �Jt�� FLOOR. i 2 FLOOR 3" FLOOR OOLF--FLOOR- OR 5 OF OOL R 6 FLOOR OOR FLOOR 8 FLo installing Company Name:f W Z ca < _ ur G Q LU ; f . In D a e LL i- Q u z co z Q to ups 0< 0 FL y Address' 4�,�.rr . r �-� Business Tel: Name of Licensed Plumber: EOR PERMIT TO MA. Dat ' I-errntUF_ Owners Name: Educational [] Industrial institutional Residential Fation: 0 Replacement: Plans Submitted: Yes ❑ No ❑ FIXTURES FLOOR. i 2 FLOOR 3" FLOOR OOLF--FLOOR- OR 5 OF OOL R 6 FLOOR OOR FLOOR 8 FLo installing Company Name:f Address' 4�,�.rr . r �-� Business Tel: Name of Licensed Plumber: EOR PERMIT TO MA. Dat ' I-errntUF_ Owners Name: Educational [] Industrial institutional Residential Fation: 0 Replacement: Plans Submitted: Yes ❑ No ❑ FIXTURES Check One Only Q Corporation Q Partnership af(;;;�Cornpany INSURANCE COVERAGE: I have a current iiabili insurance policy or its st stantiat equivalent which meets the requirements of MGL. Ch. 142 Yes NO If you have checked Yes, Please indicate the type 3f coverage by checidng #fie appropriate box below- If Ot5-er type of indemnity Q Bond El A liability insurance policy. Id . P'othave the � coverage required by Chapter 142 of the OwRERS INSURANCE WAIVER: I anaware that -Oie Issd Massachusetts General Laws, and that my signs#ireon#hipeinit ap on wacves fs requirement. Check One Only owner fl Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and inform Knowledge and that all plumbing work and Inst pertinent provision of the Massachusetts state By Type of Title Cityrrown [ jaurr subniltted (or erieredl regarding this appllca#on are true,and accurate to the best of mY e ersubm d udder the permit issued for this application will be in compliance with all Code and "Cl , er 442 of the General Laws. of Licensed 1 License Number. tri O ur . tri � a Q u z co z Z 0 FL y U3c u U. . D j 0 p i Z�< <i 4 4 W � .G � � ' 3: 3 �� l� . Check One Only Q Corporation Q Partnership af(;;;�Cornpany INSURANCE COVERAGE: I have a current iiabili insurance policy or its st stantiat equivalent which meets the requirements of MGL. Ch. 142 Yes NO If you have checked Yes, Please indicate the type 3f coverage by checidng #fie appropriate box below- If Ot5-er type of indemnity Q Bond El A liability insurance policy. Id . P'othave the � coverage required by Chapter 142 of the OwRERS INSURANCE WAIVER: I anaware that -Oie Issd Massachusetts General Laws, and that my signs#ireon#hipeinit ap on wacves fs requirement. Check One Only owner fl Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and inform Knowledge and that all plumbing work and Inst pertinent provision of the Massachusetts state By Type of Title Cityrrown [ jaurr subniltted (or erieredl regarding this appllca#on are true,and accurate to the best of mY e ersubm d udder the permit issued for this application will be in compliance with all Code and "Cl , er 442 of the General Laws. of Licensed 1 License Number. tri Date.... TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION 'ts,9SS^G NUSEt -' I Jl �llL.1.... This certifies that ... (` .... . .... . <.. ................ . had permission for gas installation .............. in the uildin-s of y .. '.. ..... . .............. at ./..�^,:C�?/� North Andover, Mass. Fee.c-;.,9.�', u"-VLic. No......... �.. ........................... kir GASINSPECTOR Clieck # .1 . LIN 4868 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Pint or Type) %A Building W EASM New ❑ Renovation ❑ _Z t)errnit # �v Owner's Nam c / , Type of Occupancy_ 1R E5l int:• N T i r4 Plans Submitted: Yes❑ No ❑ Installing Company Name :2 e ire a T A . `AM MA T A 40 Check one: Certificate Address 30 06 A C H m ,4 ,y 4 -KI, ❑ Corporation 111E 7 N U E tJ 01 A 0! k ❑ Partnership Business Telephone 1,o - 9 9 -7 f Corm/Co. Name of Licensed Plumber or Gas Fitter "f t�lBEPT A 5Ammi47APC-) IN- SURANCE COVERAGE: I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes No ❑ If i+u 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 WAVER: 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 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 the pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. Title City/iown 0 IC T of License: G� Plumber n ure of Licensedu or Gas Fitter asttter er License Number '� Journeyman III Y I� M ■��l�����������tvl�NOME NOMENESESSENNISIS MEN INE EMMONS IRS 0 Installing Company Name :2 e ire a T A . `AM MA T A 40 Check one: Certificate Address 30 06 A C H m ,4 ,y 4 -KI, ❑ Corporation 111E 7 N U E tJ 01 A 0! k ❑ Partnership Business Telephone 1,o - 9 9 -7 f Corm/Co. Name of Licensed Plumber or Gas Fitter "f t�lBEPT A 5Ammi47APC-) IN- SURANCE COVERAGE: I have a current I' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes No ❑ If i+u 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 WAVER: 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 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 the pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner Laws. Title City/iown 0 IC T of License: G� Plumber n ure of Licensedu or Gas Fitter asttter er License Number '� Journeyman 10 4. d . ~ J v z o o - 0 W O r H W, 66 • Q O Z O Z d J O O � W � 3 z 0 W w m V } d d0 C6 Q W W Q Z W 10 4. M CO) d C � CO) CO) 10 0 co n Z co) S O C. _• y nto -0 7� � 0 c CD CD O CL Q� s d CD CCD O CD C13 UP C CD y CD C. CO) CO CD I 00 E 0 I p cn V J O3 1 d 2 `Q y ...`—.� { = =% m m m 0 1 C) CA m d C W c.ry .�-► � .d-► m y T is t Q a CD m y a CA o ..'d CD CD CD CD a �i op V ""• o tom• n :� C: �CD y'a as =7 CD m yCD zi! a p m N N ® d Q CD CA1 m m N 1� �W CD % �o 00'� O H 4CD. ,.1�'T•I••li�. O : H Z Y 0 o OM 0 9 ti 9��o�o n by r `�• rA j•y �� r" � M�M:jo ro o � cn \0 � o � �/-`yi O F+� jV t. 1* *T a -a W R v a 0 c Location r7.?, PA4L N C" .e. No. 0$ Date C/- /0 -0 a NORTH TOWN OF NORTH ANDOVER A i s Certificate Occupancy + ; . of $ s�CHus Building/Frame Permit Fee $ 020 O r Foundation Permit Fee $ Other Permit Fee $ C 2b 23 TOTAL $ 3&1-3 Check # 15847 c� Building Inspector 4: The Commonwealth of Massachusetts State Board of Building Regulations and TOWN OF NORTH ANDOVER Standar& BUILDING DEPARTMENT Massachusetts State Building code ep)IT14 780 CMR t..:�F�rtio¢ 1>aicnnationi. ARPLICATiON TO CONSTRUCT REP,#M REYOVATE, CHANCE THE U5)E OF OCCUPANCY OF, OR DAMOLISH ANY BLULDING OTIIER THAN A ONE OR TWqFAMILY DWELLIYG Building Permit Nimxben ' A If I Date Issued: dy tt. C? a. O A4G "00m;fto SECnON i- slT.E InRMQ9111 Nw Applicable 13 1.1 Propem Address: ' 11 Assessors Mop and Patccf number: License Number ep)IT14 P'metl�tcmber IO e t� M t..:�F�rtio¢ 1>aicnnationi. 1.4 Property Dimen0o= h St. To+.tin • A;e:rict J s tJee La a>ra (� Prontage(ft) � � � 1.6 Building Set ock 00 Not Applicable 13 xnwpan carne f ,fie Jfrl ^ ( _ Prax Yard Side Yard RM Yatd Requited Provided Required Provides R.egwmd Provid¢d / 7 •��• t � 3• � � r BLD. t 107 Waver St+pply>hS.O.L.C.40A 54 IJ. flood Zeno Idfomta40m . 1.8 Sememot Nspoanl Syetem: Public ?nv= Zone Ouoidc Flood Zone Mueietpal ® On Shc Dltponj Sy;.m I 2.1 Owner of Record � b Name, i t? Address: 5i 'iurr ky lam 2.2 AuthoxizedAgent: {Print y dress�Ie a r A/li Slgnflhlfe • .r�, 7 e1 SOna - — ' SECTION 3 CONSTRUC?ION SER%7C€S FOR PRO EGTS LrsSS TxAN 3s.Ooo CUBIC 6EET OF XNCLO5E0 SPCC 3.1. Licm-ad Conmcdon Shpervisor. Nw Applicable 13 Licensed Consttuofion Supervisor. License Number •� .. rario�t Date .. ;�R%. } . �F �,-.;,._..:..::.... ......._.... __- E1,.-J 3.2 Registered Home Improvement Contractor. + Not Applicable 13 xnwpan carne f ,fie Jfrl ^ ( Registration Nunber j ddres t 1 n My) s rj y, Lxpiration Date to ! %L Telephones '64'O SECTION a WORKERS' CONIPENSATION INSURAINCY AFFIDAVIT (NI.CJ.. c 152 § 25C(6)J denial o Compensation Insurance affidavit txitst be eompletai and submihed with this application, Failure to provide thL. a�davic will result in the denial of the ��uanee ofthe building pemit. SECTION 7 - USE GROUP, AND CONSTRUCTION TYPE USE GROUP Check as applicable) A Assembly A -i A-2 A-3 A-4 A-5 B Business ❑ lr Educational 13 F Factory ❑ F,I F-2 H M9h Hazard 13 IB 1 Ins4tutional ❑ II 1-2 1-3 M Mercantile 28 R Residential R-1 R-2 R-3 S Storage . S,1 S-2 U Utilii' ® Specify: M �dixcd Lis&, ® Specify: S Special ❑ Specify: CON LETL THIS SECTION IF EY.ISMIG BUILDING UNDERGOING RENOVATIONS. ADDITIONS AND/OR CHANGE IN USE Existi— Use G roup. Proposed. Use Group; CONSTRUCTION TYPE IA. ❑ IB Q 2A 13 28 0 2C ❑ 3A ❑ 3B ❑ 4 5A 13 Existing Hazard Index (780 CMR 34) Proposed Hazard Index (780 CMR 34) SECTION 8 - Buildix g Height and Area I BUMDING AREA Existing (if applicable) Pr. oposcd Nuu�ber of Floors or stories include basement levels CC �.�,` Floor .Area per Floor (s� s6j, LEU Dzr jF c 1 to e� Total Area (sf) Total Height (ft) SECTION 9 - STRUCTURAL YEER REV121N (780 CMR 110.11) I Independent Structural Engineering SITOCtural Peer Review Required yes ® 1'ro SECTION 1 Oa - OWNER AUTHORIZATION - TO BE COWLETHD WHEN DWNERS AGENT OR CONTRACTOR APPLIES -FOR BTJMDINCr P,ERW7.' ny 6ealf in all matters relative toto of subjecl property. . this building act on autborized by g perrtiit application. -.• .,..,�.,,� revised bldg foan/sTate JMC Data 0 -"A" avv - V 21"LIVALL HURIZ,ED ,AGENT DECLARATION ' as Owner,'. utho�zed A hereby declare that the Statements and information on. the foregoing application are true and accurate, to the best of my knowledge and belief Signed under the pains and penalties of perjury. «J ,Print Name Sigf a.true of Ow rlAgenr Date. SECTION 11 , ESTIMATED CONSTRUCTION COSTS ! item Estimated Cost (Dollars) to be completed b permit applicant I. Building 2. Blectncal 3. Plumbing 4. Mechanical (HV,AC) S. Fire Protection 6. Total Official Use Only (a) Building Permit Fee Multiplier (b) Estimated Total Cost of Construction from (6) Building Permit Fee (a)x(b)�— Check Number 17, F ti �,a GH�r jib . J arm A•'N, rc•�, a i 1 s 1 I 2 0 Al >L C a - p�0 12 _ y U LLI< :r^ o4') tv { 1 1 t 17, F ti �,a GH�r jib . J arm A•'N, rc•�, a i 1 s 1 I 2 0 Al >L C a I 15 F o° L �rrZ5 ��s a p ij C hpa o�OgZ<5 o>v PQQ4y 6 FX 4S � (� r r- 4 c in k.ri �cyj�i��0 YCy .•� 1 G L r L =1 7q ,a,��t7v. �u - p�0 12 _ y U Udo: G: I 15 F o° L �rrZ5 ��s a p ij C hpa o�OgZ<5 o>v PQQ4y 6 FX 4S � (� r r- 4 c in k.ri �cyj�i��0 YCy .•� 1 G L r L =1 7q ,a,��t7v. �u SJ LJv+ t The Massachusetts State Building Code (180 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to.be filed as part of the building permit application when a builder/contractor or homeowner, ' constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a 4 special energy conservation exemption option for "sunroom" additions to an existing house {780 CMR, to 0 Appendix -J, Section 31.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a c "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only d ^ intended to assist homeowners in becoming aware of some of the important energy conservation and year- ��° c round comfort considerations involved in selecting and utilizing a "sunroom" addition. W v"4 The connection of "sunroom" structures to residential buildings ray create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. in u d the selection and construction/installation of "sunroorns", included below is a non -required, open-ended list •� of product and design considerations that a homeowner may wish to consider before actually 9 o w constructinghnstalling a "sunroom". It is recommended that consumers carefully review these options with " w w 0 their designer, builder, or contractor, in order to minimize potential energy consumption and/or house c b 0) discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired � are important considerations. e . c a PRODUCT AND DESIGN CONSItDE TIONS RELATED TO'�SUNROOIVI5" 0 • Solar Orientation and Natural Shading • Type of Glazing G 4'A . Insulating value V � U . Solar heat gain 1 d 4 P-4• Frame materials "a, ; • Glazing to frame sealing and gasketing materials/ seal*durability and/or weather tightness of the sunroom • Adequate ventilation - Operable windows and fans • Applied Shading Systems • Insulation level in floors, walls,, and ceilings* Possible Sunroom isolation from the main house ria a wall and/or door ar slider • Heating and Cooling Methods: EMciency, Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section 71.1.2.3.1, requires that the actual prooertv owner (not the owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning sunroom comfort and energy conservation. Signa re of Actual Building Owner Print Name 7a p J Owner Address (if different than project location) •7-r-3 �a Date 7?- L«�, AJ - Address of Permitted Project Owner's telephone number FROM :.APS FAX NO. : 781 322 8655 Jul. 30 2002 11:00AM P2 --------------- - ---•----•----•---- •---- --- - - C E R T I F I C A T B 4 F I N S U R A N C E •----------•---------•----••-------- -•----•--------------•----- •----••----•-----•------------- •- DATE 01.30-02 (MMjDD(YY) PRODUCER - •• - - - •• _--- - --- •- - ---------------- ----- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER SALMERI INSURANCE AGENCY THE COVERAGE AFFORDED BY TH$ POLICIES BELOW. -----•----••---•----..----•----- _ ------176 416 MAIN STREET -------•----------••---•-------•- .- _ COMPANIES AFFORDING COVERAGE MALDEN NA 02148- COMPANY •-----------------•--------------- - A Scottsdale Insurance Company INSURBD----•-----------------•----•--- -• - - ........------------------••---------------- •--------------- -- COMNY -OMPA-------------------- MattOII Monitor SefniG2S ------••------------------------------------------------- JOB eph Shcemme CO)RPANYGG ddd Z 1 ar inal Court -----------------------••-_ -- Wilmington MA 01887--•- - -- -• - - •- --- -- COMPANY --- .................. D COVERAGE g - -•- ----• - --------------------•------------•--- -•-----•------•------------•----------------••----•--- TR�T�gg IS TO CERTIFY TEAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS BD TO THB INSURED NAMED ABOFB FOR THE POLICY PERIOD TERMINliICATED NOTWITHSTANDING ANY RE UIREMEgT TERM OR Cf�ITION OF ANY C�BNTRACT OR OTHER DOCUMENT WITH RE PBCT TO WBICB THIS S, EXCLUSIONS, ANBE IDSCOADITIOKS OF SUCH�POLICIAS$U LIN@IiTSFSHOWNBDMAYYHATV6 POLICIES DESCRIBED SDBJ$CT TO ALL THE --•------• - --•• - --- --- - -- ------SHOWN MA AMMO ----•--DUCE -- --------------------- - ---------------- TYPE • - POLICY EFFECTIVE POLICY E$RIR�TIIN jI 1 LTR TYPE OF INSURANCE ---------- ---POLICY NUMBER-- DATE -{MM DD YY) DATE -{MM -DD YY - -------------------------- ----------_ -LIMITS -•------------ Ta --- --- -- g Y ERZBR'S AL BRI�ALIGENERA IABILITY + CLAIMS MADE L OCCUR A CONT PR T ---••--------------------•---------.. A TOMOBILE LIABILITY ANY AUTO ppSS RCHEDULBD AUTOS HIREDAUTO g NON -OWNED AUTOS .-- -----------------•----•---------- GARAGE LIABILITY IANY AUTO --------------------------------- TLIABILITY CESS LIABILITY 4THERLTHAN UMBRELLA FORM -- WoRIER'S COMPENSATION AND- EMPLOYBR'S LIRAR ILITY [ ...... BXHCUTIVBIdFFI EAR bRB: ( � BxCL --------------•------ OTHBR CLS0620616 10-21.02 1 10.21-03 -----------------------•---------4--------- ------ -------•---------------- • ---•• ---AMMO -••----.------- CRIPTION OF OPERATIONS/LOCATIONS/VBBICLES/SPECIAL- FIRE DAM GB (An one fife) MBD RIP Any one person -------------------------- COMBINED SINGLE LIMIT ODILpY INJngU)RY ODI Per Y Per accident) PROPERTY DAMAGE -• ABO ONLY - 1A ACCIDENT 0 OR THAN AUTOU EA A41DENT AGGREGATE --------- -•-- ---- EACH 8CCURRENCE -- AGGREGATE - 11_i -STATUTORY -LIMITS 500, H0 500, 0 1,000 00 100, 00 DISEASE -P LICY LIMIT • DISEASE-BRCR EMPLOYEB --------------•-------------------------- --------------------- -------------------------------- - CANCELLATION CERTIPICATB HOLDER ..---- -- ----------------- ----'-'----' - SBOULD ANY OF THE AB YE DESCRIBED POLICIES BE CANCELLED BEFORE Torn of N r $ And TEE EXPIRRATION DATE THEREOppF TBE ISSUINGggCOMpPANY WILL ENDEAVOR 27 C r es Stq Dept. TO THELLSFT, DABUT_ fAILURRENTOIKAILOSUCH CROTICR SHALLOiLiMPOSBAM10 o Charles Street OBLIGATION OR LIABILITY OF ANY BIND UPON THE COMpANy, ITS North Andover, MA 01845 AGENTS OR REPRESENTATIVES. --------------------------------------------------- AUT11ORI RBPRESBATATIY - - ---•- ------ -- -------------------------------- --------------------------- ----• - --it-�!- - -• ----- r FROM :_APS FAX NO. : 781 322 8655 Jul. 30 2002 10:59AM P1 7te / ��(ILDM/ PH C. � YZ -I, T- - S Ivr, SNI >✓ R x SALMERI INSURANCE AGENCY P.O. BOX 65 476 MAIN STREET MALDEN, MA 02148 TEL: (781) 322-4654 FAX: (781-312-8655 N S M = T •� �. T F A X # Nu m b e r o p a g e s (including this sheet) JCf any of these the eame fax copies are illegible, or you d of pages as s Y 4 not number rec,eve feted apovP, Please contact us at: (781) 322-0654 Jul Ze Ue U2: Abp tietteri wing ?Utf;J51Ebz�4 P.1 tlgW 6' FpOM R (wOr% M5 vleI EXtr" f012�MA SHOWN I FM CL.A FXI5" 6' DUOR FROM WOU%' 1 oe �u�:r �r caisioMe>�. (I3� NOf WU FOR WON PROMO NEW Ma 12116' ",PPM t, zee yr Ib° 04. 2.lkDl RDMIED I/ ?'X9" LA0552" O.C. 5. ,mr m aRS a LPAa 4, 2X8 Pf IM XAm 5. V& 5m JO19f5 6. (0 >z"O x a8" peep FIGS w/ PNoa �. 5/ 4" U6 FLY OVEN -AY p. 6x6 POO STORM( (AFPP.OX) me ENUAm r M ROOF 5Y%m AN) NEW 6' 000(`5 Flom POPCH (NOf 50W IN "Vm NEW6' DUO15 NEW b, POR—) FQOM FTCCH FRoM PORLH (NOr 511UN'N IN teras rt vm �oRc� 'XI�jf1NG I.ANI�JG '0 �MAQJ, NUf � �1UYuT1 CUMpl.E1E :oR aARIfY a;%IStiNGLANdNG-- t�WUPENtRCKfO TO It". NOf vc OuLf W a4roNVI SNCANN POk Gt tY NOr 90M COMPLK PORQ.AM Prolact� etfierliving NTL r 511 N(,� BPATIO ppROOMS Z N20RM WAR. MA 016" Wfo�tepA 399 o Pepe �j 393 0340 ( -I Date: 7/ 22/ 02 5b=t I del Property Owner Must Complete and Sign This Section If Using a Builder 0 I, Z N>," 13t" l\ , as Owner of the subject property hereby authorize Betterliving Patio Rooms (d.b.a. — Patio Rooms of America) to act on my behalf , in all matters relative to work authorized by this building permit application for: .Address of job: Sig ure of Owner ^� Date Owner or Builder (as agent of owner) Must Complete and Sign This Section Z 0— as Owner/ ze ge ereby declare that the statements and information on the foregoing appkeation . or {address of job} True and accurate, to the best of my ltnbwledge and belief Signed under the pains and penalties of perjury. Print Name -7 i 3 � o 2 - of Owner/Agent Date As+'MAVIT i ;CCa;danCe withL A.XL.'_cis I Section 114. 1.3 of the m ssactusetts State a-ailding Code, I certify Chat all debris res'alt Z.g from work associated with Pe,.m t 1416 will be properly disposed of at lics=sed Soak: aaaC GzsaOS21 f=t?liter as defined, by MCM czl, sisa;-f� sicmattars or 7arm.1t App?icanc E.t.HARVEY&SONS im 68 HOPK ! NTON RD WESTBORO, MA �= A 135) t5Ba �� 11X/"j GL` �rC a//J r" ),4Z LOA IJP _Ll�2f ?,-i t Name or m- Plicant. � �44irIiU6 i` n Nz_me if azzy) £xecti�o SeptembF,12. 1'91 the Department, vL �.ealth/Code Rnforce-ment actina under Chap -e= 1 Article 13 of the 1586 YYQZC�SL'�� tCESF'�S Vxi ��sauaCcS 8: "zrea k,,:�oof ^ F d3 cr+�Q? 1 pr debris gener'o Wed as a result of ^this permit _ 'The proof shall be, a dat--c a --:a siggned receipt. from the licensed disposal facility containing ;:be folloiying information. A descriptionof the debris, the weight and vcl=e of the. debris anch te io,cat�.oa of the disposal �acility. The reoeipt must also ;recce P, signahture of te owne=/operator of tbet disposals facility_ razlt{_a to comply with the se o- Cb_i.s Ozzdzna:=e '.:'Z1j x-emi11t iz;. oioxcem..—t- act20D. by tba City. 'nDTAL P. e2 05/1.5/02 7uli 12:1.7 .r`:� ;34 467 3A-% ACORD CERTIFICATE OF LIABILITY INSURANCEOA;EiMINDD,YY, ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ^ 03/1142002 1 PRODUCER Joseph McKeane THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE= DOES NOT AMEND, EXTEND OR JP McKeone insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES E3ELOW INSURERS AFFORDING COVERAGE P.O. Box 333 Ann Arbor MI 48106-0333 _ INSURED QaVo Rooms of New Hempahire INSURSRA; Hitrfford INSURER B: BetteNiving Sun Roams o` New Hampshire INSURER G: 1 Action Blvd # 5 8 8 INSURER D: Londonberry, NH 03053 INSURE.? E: rnVFREPGS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY- PERIOD INDICATED. NgTwITH$TANomG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AQGREOATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N TYPXOFINSUFANC$ POLICY NUMBER DATE 1a100h 0 A ON 02/01/2003 UMIT$ A ERALL'ABILITY MERGAL GEN$4AL LlagrLlTv 35 SSVV KZ7087 02/01/2002 EACHOCCURRE.MCS I a 5.000 _ FIRE DA6AOE (Any ono Are) 8 300 000 CLAIMS MADE 0 OCCUR mei, EXP (Airy one Person) g 10,000 ERSONALB?•OVINJURY S DGE:`JBFIALAGG.TEGATe ZG1;vL S 2 0tX) OGO GREGATE UMR APPLIES F .; PROOUCTB - COMPIOP Ara S 2.000:000IO' PROT n LOC I A AUTOMOBILE UABIUTY ANY AUTO 35 UEG UH3916 02/01/2002 02/01/2003 COMBINEDStNGLEUMIT a i,D00,000; IES'AW60 ) BOQILY INJURY $ (PRIpa'On), X ALL OWNED AUTCS—r ISCHEDULE0AUTOS 9OD0.Y INJURY $ (PRr acdoEnp NIRSO AUTOS NON-OWNL-0 AUTG3 1 i PROP dent) MAGE S (Par acdclCanl) ' GARAGE UAMLMY I I AUTO ONLY-E.A AccioeTT S 0-11En THAN EAAC6 0 AUTO ONLY: AGe FS ANYAUTO I RiI ' I CESS LIAMLITY OCCUR CLAIMS MADE i J EACH OCCURRENCE S AGGREGATE S �_ ~ S _ _ DEDUCTIBLE RMNT70N SWORK $ d EMPLOY�esw UAe STY Gu AND 35 WEG 02/7597 02/01/2002 02/01/2003 i ro' �Nlns 1 A I_ D.LEA01ACCIDENT it E.L.;OISEASE . EA EMFLOYE+ : 100,000 E.LDISEABE-POMYLIMIT I S 600,000 OTH(m DESCRIPTON OF OPERATIONSILOCATIO.VSJVEHICLEBItXCLUEfONS ADDED BY ENOOR&EMENT/SPECIAL PROVISIONS f INVYI{KJNML1ry ifYKCY; Irv�YNti I.F.TrFH: 1rHr\yGL1.MIlV{\ SHOULD ANY OF TMX ABOVE "SCRIBED POUCIBS BE CANCELLm XSFORE THE FWMRATION DATE -, tItAPCP. THE ISSUING INSURER ULL 7.41DEAVOR TO MAIL 30 DAYS WRITTEN INSURED COPY ,NOTICE TO THE CERTIFICATE HOLDER NAMED YO TME LEFT, BUT FAILURE TO DO $O SHALL ItAPOSF NO OBUGATIOH OR UAJLDy OF ANY IKINO 10ON TME )NBURE9. ITS AGENTS OR RE9+^.g9CNTATIVEg, ALTTH�ORiz,m QEPRLS A -n ,%�To - Zmage Ava-; Iable & ACORD CORPORA Apr 05 02 10:24a BetterLiving 5083512934 P.1 Board of.Building. Rcgu4tONF Licuse. (z r. egistrY.aaa �,Od for 'rijividul use on)v HOME I M �kO V E M E NT C 0 N T F -Ar, 0 Rl bufort the s,:Piraii011 43:zl- if iowid mum to. d of Bu, es1stix.tE and Surdvd 3(,jrdirig P DR) gra 0 Ome.�hbiz;-,01, place ).Zm 13011 PAT) 0 m 8 Or 8 as AND Ews m 100 OTIS $T NO' TH30POUGIri, MA 01522 Admini;i-atur N.ror, valid N%,jjhoxj". Sjgjlmre --IQARD OF 3Ui—,DWG REGULATNONS cense" C W. Numbot- C5- 01 NO 7 n.g-. 7427 Resiricisd To"' 13. ANC)PEWT MAL64E, I WAS+iINGTON ST 9-2 mATICK. MA, 01760 in;grator I Action Blvd., Suite I Londonderry, NU 03053 phone' (603) 537-9256 fax: (603) 537-9258 08/28/02 Mr. Brian I LaGrasse, On 07/31/021 submitted an application for a permit for a 3 -season sunroom. It was denied because you needed a Certified Plot Plan showing the septic system. I had spoke to you after receiving the letter, and we had agreed that 1 would be able to fax you the P/P showing the septic to avoid a variance. Enclosed, is the Certified Plot Plan from our Surveyor to show the septic. - Please review and forward to the Building Department for their review. If there should be any questions, please feel free to contact me at the number above. Thank You, Virginia McDonald Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles street North Andover, Massachusetts 01845 Sartd.ra Starr Health Ditrcior August 8, 2002 Bryan and Jennifer Neill 72 Patton Lane North Andover, MA 01895 Re: Application for a sumoom addition to an existing home Dear Mr. and Mrs. Neill: Telephone (978) 68&9540 Fax (978) 68895512 Your application for a swroom, addition at 72 Patton. Lane has been reviewed by lite Health Department. The application was denied. on August 8, 2002 for the following reasons: L X Missing information To address the problem(s). If #1 is checked,please supply: b. Cealfied plot plan showing the house, location of the septic system and the location . of the proposed suaroom addition. If #2 is checked: a. Have the septic system inspected by a ceralbied Title 5 inspector to determine the size of tate system and whether it is operating properly: OR b. Tie-in to municipal sewer. If #3 is checked: a. Relocate the project The deck appears to traverse the septic line between the existing dwelling and septic tank. Covering an existing septic line with any type of structure is not acceptable. . Please feel free to call the Health Office at 97UN-9590 with any questions you may have. S� ly, B ' i LaGrasse, Health Inspector Cc: Betterliving Patio Rooms, Attn: Andrew Malone 100 Otis Street, Norihboro, MA 01532, Building Department Fide BOARD OF APPEALS 688.9581 BUIIAII3'L3 6U-gUi C0NSMvA-17ON &889530 NURSB 688-4543 PLA 688.9535 W 11 -7R.-if ' ,fly �'Y� �✓ 0 Lot sC 3.10 Acres �0 e/ PLOT PLAN OF BLAND 72 PAT'T ON LANE NORTH ANDOVER MASS Scale 1 inch '= 40 I'e®t July 27, 2002 Robert P. Morris P.L& 21 Carter Street Tewksbury, Man. I certify that the Dwelling is located as shown And that it conformed to the Zoldng bylaws Of North Andover when Construe �1 Robert P. Morris P.L„( tr4 WkIt 4:)R ;IPPP. R;I. '6n14 vvcm zqq A) r, : 'nN :CHS S S NNnw—A— s Mt 1 n 1 : taw 4 • t O� t G 69- �� Lot 5C o� 3.10 Acres I b' PLOT PLAN OF LAND 72 PATTON LANE NORTH ANDOVER MASS Scale I inch = 40 feet July 27, 2002 N Robert P. Morris P.L.S. 21 Cartear Street Tewksbury, Mass. I certify that the Dwelling is located as shown t{� And that it conformed to the zoning bylaws Of North Andover when Constructed Robert P. Morris P.L. v�^ � ROBERT 1 P. e=. CJ No 22159 �•' I& X 1 G �U%, k\ oc) ox FORM U - LOT RELEASE FORM 8 _ 03, INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANTIr,(�roQ *aeNrJt(��o Jv C( I PHONE LOCATION: Assessor's Map Number I NO PARCEL 0 SUBDIVISION LOT (S) STREET_ ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** �476UUIVIIVIENDATIONS OF CONSERVAT1614ApDMINISTF ,r COMMENTS / TOWN PLANNER COMMENTS F401) INSPECTOR -HEALTH 1 SEPTIC INSPECTOR-HEALTI ENTS: DATE APPROVED 7/ �DATE� REJECTED � DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm TE Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles street North Andover, Massachusetts 01845 Sandra Starr Health Director August 8, 2002 Bryan and Jennifer Neill 72 Patton Lane North Andover, MA 01845 Re: Application for a sunroom addition to an existing home Dear Mr. and Mrs. Neill: �Z Telephone (978) 688-9540 Fax (978) 688-9542 Your application for a sunroom addition at 72 Patton Lane has been reviewed by the Health Department. The application was denied on August 8, 2002 for the following reasons: 1. X Missing information; 26 9 "j-jTitle 5 inspeeWft of u%Yua, s" , To address the problem(s): If #1 is checked, please supply: a. Noer- plan of the e�dsfing diveNing and the pfopesed addition-, b. Certified plot plan showing the house, location of the septic system and the location of the proposed sunroom addition. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If #3 is checked: a. Relocate the project The deck appears to traverse the septic line between the existing dwelling and septic tank. Covering an existing septic line with any type of structure is not acceptable. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. SiVJT.LaGrasse, BHealth Inspector Cc: Betterliving Patio Rooms, Attn: Andrew Malone 100 Otis Street, Northboro, MA 01532 uilcling -1�ep_artme�it File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535