HomeMy WebLinkAboutMiscellaneous - 267 Brentwood Circle (2)w
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4SACHUS
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Date. . 7�� .. ....
TOWN OF NORTH ANDOVER
PERMIT FOR � INSTALLATION
This certifies that ............. . ..
has permission for go nstalellati n .........
f
-s?or .. . .... . ... ......................
in the building
at North Andover, Mast
F e*
e ... ..... Lic. NAds-4
GAS INSPECTOR
WHITE: Applicant ----IMARY: Building Dept. PINK: Treasurer GOLD: File
office Use Only
01 4t UMMVnWt3# Of .4flaggar4UBtfto Permit No.
13evartment of Public —Aafetia Occupancy A Fee Checked A��
3/90 (leave blank)
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 X ta 93
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -5— � (� — 9C
(MYi or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Num
Owner or Tenant
Owner's Address SCA -11A
Is this r)ermit in coniunction with a building permit: Yes 2�1 N o (Check Appropriate Box)
Purpose of Building — S%11 Utility Authorization No
Existing Service .0 _"_::7Amps �-__-2__�Volts Overhead 0 Undgrnd
New Service — Amps —Volts Overhead El Undgmd
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ALZ—
No. of Meters
No. of Meters
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES --- NO
have submitted valid proof of same to the Office. YES —_ NO If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE !--BOND :: OTHER —� (Please Specify) en� &I —ce :Z�l (Expiration Date)
Estimated Value of Electrical Work S
Work to Start Inspection Date Requested
Signed under the Penalties of perjury:
FIRM NAME— A 44L.
Signature
Rough
Final
LIC. NO. _9_L1_'t0_-�
LIC. NO. J��
censee Bus. Tel. No.
Alt. Tel. No.
Address
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent
(Please check one)
Telephone No. _ PERMIT FEE S
(Signature of Owner or Agent) X-6565
Total
No. of Lighting Outlets
No. of Hot Tubs
o. of Transfor
N mers KVA
No. of Lighting Fixtures
Above In'
Swimming Pool grnd. E grind.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond. tons
initiating Devices
Heat Total. Total
No. of Disposals
No.of
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local Municipal El Other
C] Connection
I
No. of Dryers
Heating Devices KW
No. of N o. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES --- NO
have submitted valid proof of same to the Office. YES —_ NO If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE !--BOND :: OTHER —� (Please Specify) en� &I —ce :Z�l (Expiration Date)
Estimated Value of Electrical Work S
Work to Start Inspection Date Requested
Signed under the Penalties of perjury:
FIRM NAME— A 44L.
Signature
Rough
Final
LIC. NO. _9_L1_'t0_-�
LIC. NO. J��
censee Bus. Tel. No.
Alt. Tel. No.
Address
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent
(Please check one)
Telephone No. _ PERMIT FEE S
(Signature of Owner or Agent) X-6565
MAPFRE The Commerce Insurance Companyw
Citation Insurance Companyw
11 Gore Road, Webster, Massachusetts 01570
Commerce 508.949.15001 www.commerceinsurance.com
iNSURANCE'
April 09, 2015
BUILDING COMMISSIONER or Board of Health or
INSPECTOR OF BUILDINGS Board of Selectmen
TOWN/CITY HALL Town/City Hall
NORTH ANDOVER MA 0 1845
RE: Our Insured: BRENDAN NORTON / EMILY NORTON
Property Address: 269 BRENTWOOD CIR
Policy#: BDZZBZ
Date of Loss: 02/15/2015
Filek JXAT70-HNVTX5
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
ELIZABETH B07TIERI Telephone: (508)949-1500 Ext: 15284
Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15284
On this date, I cause copies of this notice to be sent to the persons indicated above, at the
address above, by first class mail.
April 09, 2015
ICE DAM, INTERIOR DAMAGE TO HOME.
CIC 254 (Rev. 4/95) MAIL M39
C) Cd
Location ,sJc-
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL ILI
Check # )Ia�DL
14 '/' 5 6
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT,
APPLICATION TO CONSTRUCT MPAIR, RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING
R -T= --- - -', .
BUELDING PERMH NUMBER: DATE ISSUED:
Z� M
SIGNATURE:
Building Commissioner/InSpector dBuildings Date
SECTION I- SITE INFORMATION I
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (sf) Frontage (1)
1.6 BUELDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1 42-'
zoo r
1.7 Water Sujply AG.L.C.40. 54) 1.5. Flood Zone Information:
public Ir Private 0 Zone outside Flood Z...
1.8 Sewerage Disliesal System:
M.,ip.1 OnSiteDisposal System 0
SECTION 2 - PROPEIM OWNERSIUVAUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service
4;F7-0*99VO
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephon
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction S sor:
Not Applicable 0
N!'yk--KA 'D, iwdl
Licensed Construction Supervisor:
061�13;L-
(16-, tot . Ve.,-oo vt 900�rd MIA ofc/Q-1
License Number
Address S
A�L-D. &5�e 9 � 3 - � S'L —704-0
,o,f b-0 /7*�L
Expiration Date
§.Tnaturc I Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
ljvvew
Company Name
5- nqt. Vtr000 Rd. &Aha, Mi'�- 01?2.1
Registration Number
// iojo
Expiratfon Date
Address
177 -35 -Z -3-04Y
Signature Telephone
T
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0
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90
0
ic
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0=15
z
0
I SECTION 4 - WOREIRS COMPENSATION (MG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the donial of the issuance of the 61�n P�mrit.
Signed affidavit Attached Yes ....... Ir No ....... 0
SECTION 5 Description o Proposed Work (chee applicable
New Construction 0
Existing Building Mf
Repair(s) 0
Alterations(s) Ef
Addition 0
Accessory Bldg. [I
Demolition
Other 11 Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to
Completed by pennit applicant
WONLY
Z�'
1. Building
*100
(a) Building Permit Fee
Multiplier
2 Electrical ft 306
(b) Estimated Total Cost of
Construction
3 Plumbing 4"700
Building Permit fee (a) x (b)
4 Mechanical (ITVAC)
5 Fire Protection
6 Total (1+2+3+4+5) 91
Check Number
SECTION 7a OWNER AUTHORIZATION TO Bt COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIELDING PERMIT
I, &I il- -
A w1n e, & UT A)A as Owner/Authorized Agent of subject property
I Herehy authorize ��J-elvhe,, to act on
TM c It', in. all in s ed by this building pennit applicati
c I A 1A � r� aw= I / ? q
Q,4,aturc of Owner U Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, D. 6WC�11 as Owner/Authorized Agent of subject
property I
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
nt Ik Af /.�-Oco
Si ature of O�vrier/A I ent Date
NO. OF STORIES SIZE
BASENENT OR SLAB
SIZE OF FLOOR ITIVIBERS isl 2 ND 3 RD
SPAN
DRAENSIONS OF SILLS
DEvfENSIONS OF POSTS
DINIENSIONS OF GIRDERS
HEIGHT OF FOUNDAEON TIUCKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
I IS BUTLDING CONNECTED TO NATURAL GAS LINE
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
RTH
0
Oq r
r
-
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit 9 the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL c 11, sl 50a.
The debris will be disposed of in /at:
e, Wad — �4e-rv%, by Peavroro &*inefl�uinf
Facility locatio6 V t6 L/ 14 e Ig
/A&. 4waj
�igiiaiure ofk�plicant
IC4, / L4 top
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
HOME IMPROVEMENT CONTRACTOR'
Registration 123237
Type - DBA
Expiration 01/10/01
HOWELL DESIGN & BUILD
T HEN 0. HOWELL
��EITIMT . VERNON RD
ADMiNISTRATOR
BOXFORD MA 01921
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 068232
Birthdate: 02/14/1962
Expires: 02114/2002 Tr. no: 17701 j
Restricted To: 00
STEPHEN D HOWELL
15 MT VERNON RD
BOXFORD, MA 01921 Administrator
I icclisc or registration valid for individual
Ilse �:Ally 6efore expiration date, If foUnd
1'(1 to n to: One Ashburton Place Rm 1301
ho�lon Ma. 02108
00 - 35,000 d enclosed space
(MGL CA 12 S.601.)
1 A - Masonry only
1 G - 1 & 2 Family Homes
Failure to possess a current edition of the
Massachusetts $late Building Code
is cause for revocation Of this license.
DIG SAFE CALL CENTER: (888) 344-7233
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
Pe -5 f 66t4l�tet � /(AC- -
We
�rpe �crming all woik �myse
F7I am a sole proprietor and have no one working in any capacity
-27 -3 52--Y49
I am an employer providing workers' compensation for my employees working on this job.
�54
Companvname: 11-�Iwcd 1pt��116k-41 Guild I^ C
Address
City: Phone
'17 Insurance Co. Policy;* Ogwf-cc-b,02 —
Company name._
Address
City: Phone #,
Insurance Co. Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties at a fine up to $1,500.00
andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORCER and a fine of ($100. 00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of lnvesfigaticns of the DtA for coverage verification.
I do herby certify under the pains and penalties of petiury that the information provided above �s true -and correct.
Qi,n�+v orn Ae�V—LD- nnttz �OJ410,*
Print name 'S P -p he -u, Y), )Vy W
Official use only do not write in this area to be completed by city or town afficial'
Elcheck t immediate response is required Building Dept
Contact person- Phone
FORM WORKMAN'S COMPENSAT70N
Phone#
E] Building Dept
E] Licensing Board
Selectman's Office
Health Department
Other
Aj!ZORD CERTIFICATE OF
DATE (MMIPDIYY)
LIABILITY INSURANCBHP01,DmL�
PROD CER
u
Brenton Tyler Insurance
The McCarthy Companies
P.O.Box 540169
Waltham MA 02454-0169
1 09/27/00
THIS CERTIFICATE IS ISSUED AS A MATTER OF WORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE -
Edward J. MacDonald
COMPANY
PhoneNo. 781-893-4808 FaxNo. 781-893-6679
A Hartford Insurance Group
INSURED
COMPANY
B Safety Insurance Company
Stephen Howell dba
COMPANY
Howell Design & Build, Inc.
C
15 Mt. Vernon Road
COMPANY
D
Boxford MA 01921
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTICO
RANCE
POLICY NUMBER
POLICYEFFECTIVE
DATE (MM/DDfYY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIA131LITY
MADE [X] OCCUR
OBSBAGH1835
06/01/00
06/01/01
GENERAL AGGREGATE s2,000,000
PRODUCTS - COMP/OP AGG $1,000,000
--::]CLAIMS
PERSONAL & ADV INJURY $1,000,000
OWNER'S & CONTRACTOR'S PROT
EACH OCCURRENCE $1,000,000
FIRE DAMAGE (Any one fire) $50,000
MED EXP (Any one person) $5,000
AUTOMOBILE
LIABILITY
B
ANY AUTO
COMBINED SINGLE LIMIT $
X
X
ALL OWNED AUTOS
SCHEDULED AUTOS
1500162
04/17/00
04/17/01
BOIDILY INJURY
(Per person) s250000
X
HIREDAUTOS
X
NON -OWNED AUTOS
BODILY INJURY
(Per accident) s500000
PROPERTY DAMAGE s250000
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE $
AGGREGATE $
OR
W KERS� COMPENSATION AND
EMPLOYERS' LIABILITY
I WC STATU-__F_ JOTH-
R
EL EACH ACCIDENT $100,000
A
THE PROPRIETOR/
PARTNERSIEXECUTIVE INCL
08WECCD0247
06/01/00
06/01/01
EL DISEASE -POLICY LIMIT s500,OOO
OFFICERS ARE: EXCL
OTHER
EL DISEASE - EA EMPLOYEE $100,000
E_
DESCRIPTION OF OP RATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
Carpentry Dwelling.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Michael & Kathrine Shumway
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
269 Brentwood Cir
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
No. Andover MA 01845
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-S (1/95)
-
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N2 2737
Date
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
+4—
. ..................................
This certifies that ......
.......
has permission to perform
..........
r
wiring in the building of ...... / ......... ..........................................
....... ...... ....... &orth Andover, ass
Fee ... 40.4 ....... Lic. NoA7 ........
Check # LlicMCAL 1NSPECTdR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
(,UAIYIMWJ��2� UP lis — Office Use only
DEPARTMUff OFPUBLICS4FM Pernut No.
BOAWOFFDZEPPff EVYONMGUATJONS527CW12�00 .273--.7
Occupancy & Fees Checked
U
APPUCATION FOR PERW TO PEUORM ELECF&CAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 cm 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datj
Town of North Andover
The undersigned applies for a permit to perform the electrical wo describedbelow. To the Inspector of Wires:
Location (Street & Number) In #
Owner or Tenant 01j)(e erro I - --, —
Owner's Address– >(
U rc;q
Is this permit in conjunction with a building permit: Yes I No (Check Appropriate Box)
Purpose of Building _ -- Utility Authorization No.
ExistingService Amps Volts Overhead Underground M No. of Meters
New Servi Amps Z:� �IXUJ Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity L�,4-
r .2e__
Location and Nature of Proposed Electrical Work A 10, -2 )x -7--t
No OfLighting Outlets
No. ofHot Tubs
No. of Lighting Fixtures
_,Xt_es
Smmming Pool
I No. ofReceptacle Outlets
No. ofOil Burners
No. OfSwitch Outlets
No. of SelfContained
No. of Gas B urners
No. ofRanges
No. ofAir Cond.
No. of Disposals
No. of Heat
Pumps
No. of Dishwashers
Space Area Heatinj
No. �f Dryers Heating Devic
No. ot Water Heaters KW 70 of—
Signs
No. Ifydro Massage Tubs No. ofMotors
OTHER
No. ofTransfortt
Generators
No. ofErnergency Lighting Battety
FIRE ALARMS
Tons
if i otai
No, ofDetection and
is KW
Initiating Devices
KW
No. ofSounding Devices
No. of SelfContained
DetectionlSounding Devices
KW
Local 0-1 Municipal
No, of —
Connections
Total HP
Total
KVA
No. of Zones
M Othir
haNcaamtttLikkkwmxPobLymdxtMCcnpkieOPwdb=Co��crtsakshnideqrm6I YES ED No
IhmesubmftdV41dPU0f0f§F"lDdCOfflM YES El
qpoprialebcK F1 No F-1 If�whmdWedYESp6mmdcpktheWcfw,,,Wbydj.,gd,,,
UqSURANCE BOND MIER E:]
E#ation D*
Work iD Sian Eskrmd Vahjeaffimbical Work
Final
FIRM NAME
Lkensee
Rlsiress TeL Nk)L 17
2 Z13
AlL TeL NoL
OW,NFR'StWRANUWARU�lama,AmdUdrLjcaw&mrdt"is=ve -----------
Wy=g'-Q-Z&*SMrgdapYdbtasmqln�ibyMmxhumGarr;� Lam
(Please check one) Owner Agent 1:1 Telephone No. ERMIT FEE ?��, da_
N
N
/!�- /) - C ('
Date .. .........
N2 4632
TOWN OF NORTH ANDOVER
+ 0AL
PERMIT FOR PLUMBING
4SACHUS
/-'�7-X'
This certifies that F ..................
has permission to perform . . ............
plumbing in the buildings of ... T11. e'-� ...............
at ... 31? .............. North Andover, Mass.
Fee. .... Lic. No.. /157 . ....... ........
/ PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY� Building Dept PINK: Treasurer
.i
!!�63 J.,
N
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Town of %1dkef*fd-,Wassachusetts
A/ 14�1610vel-
Building Location )— 6 9 &
(Print or Type)
Date // 113 20 00 Permit#
Owner's Name 5�jy�\ Lyczy Type
New F Renovation r7
Permit Fee
Plans Submitted Yes E] No E]
Installing Company Name 'i Check One Certificate
Address �,c E] Corporation
( I ) a k L , /J 91 Partnership
Business Telephone - J 7 2 0 Firm/Co
Name of Licensed Plumber or Gas Fitter e,6,1 1�12 y. It
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142
Yes [I No F]
If you have checked yes, please indicate the type of covering by checking the appropriate box
A liability insurance policy E] Other type of indemnity 11 Bond El
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 lic ti n are tr e . accurate to the bestAf
my knowledge and that all plumbing work and installations performed under the permit is d for ' a - 6n in complianc it
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge I La s.
By �ppe of License t
lumber Signatui
Title Gasfitter
M -Master License Number 7-
City[Town H Journeyman
APPROVED (OFFICE USE ONLY) Inspection Date Requested
CE M
Installing Company Name 'i Check One Certificate
Address �,c E] Corporation
( I ) a k L , /J 91 Partnership
Business Telephone - J 7 2 0 Firm/Co
Name of Licensed Plumber or Gas Fitter e,6,1 1�12 y. It
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142
Yes [I No F]
If you have checked yes, please indicate the type of covering by checking the appropriate box
A liability insurance policy E] Other type of indemnity 11 Bond El
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 lic ti n are tr e . accurate to the bestAf
my knowledge and that all plumbing work and installations performed under the permit is d for ' a - 6n in complianc it
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge I La s.
By �ppe of License t
lumber Signatui
Title Gasfitter
M -Master License Number 7-
City[Town H Journeyman
APPROVED (OFFICE USE ONLY) Inspection Date Requested
//-. . /"'� , C'.
338 Date . . ...............
0RT#j TOWN OF NORTH ANDOVER
0
PERMIT FOR GAS INSTALLATION
This certifies that.. //�M .. /11� <.' .........................
has permission for gas installation . . 1�7 1 .' ) 1, �' - �'
...... ...........
in the buildings of ... ...........................
at ... .. .......................... North Andover, Mass.
Fee. J k . Lic. No..
GASINSPECTOR
.1
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Lu0s;
4"16 11 ce5v
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Town of wft� Massachusetts Date 19 Permit -L-
Permit Fee
Building Location i9re-jtA.,00d Owner's Name
, �� i P, Lee,/ —Type of Occupanc
New Renovation 5-
d Repla� ement [_j Plan bmitted: Yeso No E]
Installing Company Name _D� Check one� Certificate
Address -14 �7 11 Corporation
N, Partnership
Business Telephone_ Y_J_=_j U.0 [ I Flirm/Co.
Name of Licensed Plumber or Gas Fitter &92,g, Ar f, ; Y
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes W__ No 11
If you have checked yes. please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy LA Other type of Indemnity I I Bond D
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 p-e--rmit application waives this requirement,
Check one
n___5 �,es Agiant�____-- OwnW Agent D
Signature of OW er or
I hereby rertify that all of the details and information I have submitted (or enter d)i b ica ion are true a accurate to the bestAy
0 , ) I' his ppli i I complia 0 wi 11
knowledge and that all plumbing work and installations performed und r thEl prmillr`l,� -, ,
pertinent provisions of the Massachusetts State Gas Code And Chapter 142 of the G al Laws
BY---- I L' ein,ei - -
Title 'Fo`0Wmbre , i hatut o icerise turn e of -a-s-T-150,
aster License Number Xq
City/Town r"
Journeyman Inspection Date Requested
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SUB—OSMT.
BASEMENT
ISTFLOon
2ND FLOOR
3AD FLOOR
4TH FLOOR
STH FLOOR
STH F LO 0 R
fill
7TH FLOOR
8TH FLOOR
t.]
I I
Installing Company Name _D� Check one� Certificate
Address -14 �7 11 Corporation
N, Partnership
Business Telephone_ Y_J_=_j U.0 [ I Flirm/Co.
Name of Licensed Plumber or Gas Fitter &92,g, Ar f, ; Y
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes W__ No 11
If you have checked yes. please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy LA Other type of Indemnity I I Bond D
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 p-e--rmit application waives this requirement,
Check one
n___5 �,es Agiant�____-- OwnW Agent D
Signature of OW er or
I hereby rertify that all of the details and information I have submitted (or enter d)i b ica ion are true a accurate to the bestAy
0 , ) I' his ppli i I complia 0 wi 11
knowledge and that all plumbing work and installations performed und r thEl prmillr`l,� -, ,
pertinent provisions of the Massachusetts State Gas Code And Chapter 142 of the G al Laws
BY---- I L' ein,ei - -
Title 'Fo`0Wmbre , i hatut o icerise turn e of -a-s-T-150,
aster License Number Xq
City/Town r"
Journeyman Inspection Date Requested
a
Po
z
Date .........
N2 2561
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SS.4 us
This certifies that ....... C
has permission to perform ......... ...... . ................
wiring in the building of ...... 5 ... . ................................................
at .......... North Andover ass.
Fee.J.D.:.&. Lic. No—I�*4.,.,.,.,.-�,�, .......... - .. ....... I ......
Check # �, 1,-,tq - / ELEMICAL INSPECrOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Permit No --
occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMIR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date 1.0w
To the lnsp4ctorlof Wires:
Town of North Andnvpr
The undersigned applies for a permit to perform the electrical work d ibed below.
Location (Street & Number 126e, =1�
Owner or Tenant (i A
Owner's Address -4rt w
Is this permit in conjunction with a building permit Yes 0 No El (Check Appropriate Box)
Purpose of Building_ Ate�2e __Utility AuthortEation No./
06, Existinq Service 11W -Amps —Voits Overhead 0 Undgmd R- No. of Meters
New Service Amps Qd i
�Vo ts Overhead 0 Undgmcl R— No. of Meters
Number of Feeders and
Location and Nature of F
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalenQDNO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
Est' ated Value f Electrical Work$
Inspection Date Resquested Rough Final
Wo,k toStat —
Signed under th4eenfilties of perjury; LIC. NO.
FIRM NAME 127
Litenseea,2L�� Signaturc LIC.NO. 31-21�
e/ )
Bus. Tel NO. 9-7�(- %:�- X13
Address Z7 — '77V �3),Y 7C- 33
Q2 ��Alt Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the License does not' have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit applicati n waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITfEE $
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No.ofHotfuse
No. of Transformers KVA
Above 0
In 0
No. of Lighting Fixtures
Swimming Pool gmd gmd 0
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Tons
KVV
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space(Area Heating
KVV
Detection/Sounding Devices
0 Municipal 0 Other
No. of Dryers
Heatina Devices
KW
Local Connection
No. of
No. of
Low Voltage
No, of Water Heaters KW
Signs
Bailases
Wiring
No. Hvdro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalenQDNO
have submitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE = BOND = OTHER = (Please Specify)
Est' ated Value f Electrical Work$
Inspection Date Resquested Rough Final
Wo,k toStat —
Signed under th4eenfilties of perjury; LIC. NO.
FIRM NAME 127
Litenseea,2L�� Signaturc LIC.NO. 31-21�
e/ )
Bus. Tel NO. 9-7�(- %:�- X13
Address Z7 — '77V �3),Y 7C- 33
Q2 ��Alt Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the License does not' have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit applicati n waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMITfEE $
(Signature of Owner or Agent)
Date.
N2 4S701
of 5. - + TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
US
This certifies that
has permission to perform ..........
plumbing in the buildings ..........
'7
-.z_, -7, A-�.A,
at ........................ North/Andover, Mass.
- ) - kj -
Fee.h'�� . . Lic. No?0'3C. . .........
PLUM13IN6'INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK. Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETrS
Building Location 0 (P'T 13 /Z z4-�' u -
3
New M Renovation 1:1
"'/4.. Name 13� 1/ 41 6
Type of Occupancy PLVe�
Replacement Plans S
Date
Permit C"'-'
ount
ibmi"�� 1:1 No F1
(Print or type) Check one: Certificate
Installing Company Name 4L ��z f- El Corp.
Address Partner.
Business Telephone 0- Firm/Co.
Name ofLicensed Plumber:
Insurance Coverage: Indicateth typ fm'surance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity F1 Bond
1 Y 11
Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature 1. Owner r Agent F-1 -
I hereby certify that all of the details and information I have s itted (or ered) in above application true and I accurate to the
- - M
r pplica WHI be in
I L
'n t f�,c S.
best of my knowledge and that all plumbing work and llation p e der Pernffl Issued for appli * wflI be in
t de �42 the
compliance with all pertinent provisions of the Mass us e mb' ode an/thapter 142 the I Luaws.
0 'cens urn er
By: or Licens
917e of Plumbing License
Title ---"'Journeyman
City/Town Licew-numoer Master El El
APPROVED (OFFICE USE ONLY I
WIMMINOW
OMMOMMMM
MM
mmmmmmmmm
=-.ivaiiaeimmmmmmmmmmmmmmmmmmmmmmmmmm
=Z14 MMMM1MM0MMMMMMMMMMMMWMMMMM
(Print or type) Check one: Certificate
Installing Company Name 4L ��z f- El Corp.
Address Partner.
Business Telephone 0- Firm/Co.
Name ofLicensed Plumber:
Insurance Coverage: Indicateth typ fm'surance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity F1 Bond
1 Y 11
Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature 1. Owner r Agent F-1 -
I hereby certify that all of the details and information I have s itted (or ered) in above application true and I accurate to the
- - M
r pplica WHI be in
I L
'n t f�,c S.
best of my knowledge and that all plumbing work and llation p e der Pernffl Issued for appli * wflI be in
t de �42 the
compliance with all pertinent provisions of the Mass us e mb' ode an/thapter 142 the I Luaws.
0 'cens urn er
By: or Licens
917e of Plumbing License
Title ---"'Journeyman
City/Town Licew-numoer Master El El
APPROVED (OFFICE USE ONLY I
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
PPLICATION TO CONSTRUCT REPAM RENQVATI� OR DEMOLISH A ONE OR TWO FAMILY DWELLING V
peg �Pa-w
WELDING PERMIT NUNBER: DATE ISSUED:
SIGNATURE., r6ec
Building Commissioner/Ip&xctor of BuildiAgs Date
I SECTION I- SITE INFORMATION I
1.1 Property Address:
7.,IA are4-t+VV00e�
1.2 Assessors Map and Parcel
64
Map Number
Number:
liq
Parcel Number
t4i&v ew- ? MR 0 V3 42�-
1.3 Zoning Information:
KPJ I f, Fk441 1'� d&v
Zoning District Proposed Use
1.4 Property Dimensions:
0 0
Lot A. (A)
15-'o
Frontage (ft)
1.6 BURDING SETBACKS (11)
Front Yard Side Yard
Rear Yard
ReqWred Provide Required
Provided
Required
T— Provided
-7
11WI. PWly CA0. 54) 1.5. Flood Zone luformstion:
Public Zone 0.ftide Flood Zn.
I
M.�ipl
S Dspml Srtenr
7W On Site Disposal System 0
I SECTION 2 - PROPERTY OWNERSHIP/AUTHORUMI) AGENT I
2.1 Owner of Record
.4ame (Print) Address for Service:
Signature
2.2 Owner of Record:
Name Print
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor.
N�y i"' ID, �.'z W , it
Licensed Construction Supervisor:
evit ve-00 MA 010i�l
Address
Av—;011.
Q�-turc I Telephone
3.2 Registered Home Improvement Contractor
4vve4l Pe-gfq�,A P, &L -M, lmc-
Company Name 1
15- 15aAhew I , ym
Address
1 -2 7 —3 5z — 3 e4?
Not Avrlicable, 0
196 1 )13 ;L -
License Number
�Xpiraeion ]Yale
Not Applicable 0
/,')-3 �-37)
Registration Number
- /z/o/e/
Expiration Dale:
T
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0
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1-4
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0
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0
ic
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0
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 2
Workers Compensation Insurance Affidavit must be completed and submitted
in the denial of the issuance of the bu4a permit.
Signed affidavit Attached Yes ....... I?' No ....... 0
SECTION5 Descriptiono ProposedWork(ch 2pplicable)
New Construction 0 Existing Buil ding 2" Repair(s) 0
Z
with this application. Failure to
Alterations(s)
Accessory Bldg. El Demolition M' Other 0 Specify
K
/yr
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Addition 0
will resullp
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
ME
IN
1. Building
-
(a) Building Pennit Fee
�&
Multiplier
2 Electrical
0 0
(b) Estimated Total Cost of
Construction
3 Phimbing
0, a
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
0
5 Fire Protection
19
6 Total (1+2+3+4+5)
000
Check Number
btt;'IlUf47aUWf4EMAUI'LIUKILNI'IUIN IUMUUMPLEUD WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERM[IT
1,
, A ey/r�l as Owner/Authorized Agent of subject property
I Herelly authorize to act on
M If, in all ve to work authorized by this building permit applicati
1, / IJ4 1�,VA 4jM. /
of Owner U Date
SECTION 7b OWNERJAUTHORIZED AGENT DECLARATION
1, 'Oac'he� a 16'qwc-4 as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate; to the best of my knowledge
and belief
tA�
Print N 4��'
nkE�n .
Signa(ur� of CIGner/Agent Date I
NO. OF STORIES SIZE
BASENIENT OR SLAB
SIZE OF FLOOR TINIBERS I ST 2 No 3 P'D
SPAN
DEvENSIONS OF SILLS
DINENSIONS OF POSTS
DRyIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
November 20, 2000
Ms. Heidi Griffin, Planner
North Andover Planning Department
27 Charles Street
North Andover, MA 0 184 5
Re: 267 Brentwood Circle
Dear Ms. Griffin:
RECEIVED
NOV 2 1 2000
NORTH ANDOV5R
PLANNING DEPARTMENT
This letter is sent relative to the alterations to the dwelling at 267 Brentwood
Circle. The homeowners, Michael and Katherine Shumway, would like to add a 6' by 8'
deck with roof to the left front comer of the dwelling. This deck will require the
installation of a 10" diameter concrete pier at the outside comer, which will be dug by
hand. A new gutter will be installed along the roof and connect to the existing house
gutter system. (see attached plan).
The Shumways would also Eke to add a new stairway at the rear of the dwelling to
replace a stairway removed from the area behind the garage. The new stairway will require
the installation of a 10" diameter concrete pier and a 12" wide by 12" deep by 48" long
concrete step at the bottom of the stairs. (see attached plan).
The Shurnways property lies within the watershed protection district around Lake
Cochichewick. It is my professional opinion that the proposed work described above will
not have an effect on the quality or quantity of runoff entering the watershed.
Should you have any questions concerning this letter, please contact me.
JOSEph
Sincerely,
J.
SERWATKA
CIVIL CA
No. 36981
tat ckk
eph J. Serwatka Z�
F
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SX..�f-�
Z�o el
-37 S -OS 7�
41
NOW
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F'rw+ �10rA 4- SA-emv- 9-ItLociA I(,,.> -0-z�,
FORM - U - LOT RELEASE FORM
C
INSTRUCTIONg: This form is used to verify that all -necessary approval / permits from
BQards aild Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
Am Emmons man on a liesqRsamom men Ross am summom Sao Won names mom man son man WON son somm"No
I e— S�Umv)
APPLI(,'ANT PHONE
ASSESSORS MAP NUMBER 'LOT NUMBER
SUBDIVISION LOT NUMBER
-4 STREET C\%k'k/ -AbV 0 d C' VC��_STREET NUMBER
I a a a a a . . . . . . . . on OEM mango Monson.. was on,onax mom . . .. I a
OFFICIAL USE ONLY
9 a a a a a a 0 a a a a a a a 0 a a a 0 a 0 a a a a a a 0 2 0 0 0 a a a a 0 a 0 a a 0 a a a a a 0 a a a a a 0 a a a a a a x ............
RECONPOENDATIONS OF TOWN AGENTS
$no NOME ME a an a am mom non= so am an MUNN 0 a am ass A a am on NON a x 8 a a am Una us's A. n a: am a
CONgERVAnONADMNISTRATO'R
DATE APPROVED
DATE REJECTED
L
CONMIENTS
7-
f
DATE APPROVED
TOWN Pl��
6e(oj
DATE REJECTED
CONDAENTS
0
DATE APPROVED
FOOD INSPECTOR - HEALTH
DATE REJECTED
DATE APPROVED
SEPrC INSPECTOR - HEALTH
DATE REJECTED
CONQ&-NTS
PUBLIC WORKS - SEWER I WATER CONNECUONS
DRIVEWAY PERMIT'
DATE APPROVED
FIRE DEPARTNIENT
DATE REJECTED
CONDAENTS
RECEIVED BY BUILDING INSPECTOR
--DATE
08/14/98 15:13 FAX 978 474 6067 NORTHRN ASSOC U001/001
MORTGAGE INSPECTION PLAN
. NORTHERN ASSOCIATES, INC. -
34,;' /V. NA41V STREET AML70VER MA 01810 rEL; (976) 474-4410 FAX: (978) 474-5067
Q, MICHAEL E. & K=Kk C. SRUWAY
MOP 1'GA G0j .. -
L 0GA TIGN.' 26 9 BREMVQQD CIRCa
CITY S TA TE: NQRTH AMOVER MA
oFEjo REF- 1322 / 634
PLAN REF." # 4869
SCALE- = 60'
dos #11 98/10572
C,5jq 7"IFIED TO.'
L 0 T 25
68,800 Sf.+/-
Am 2,x I P,
X,
141't
T-
(5f7CAfrL0Q00
r- I P. C, L IE
NORWEST MORTCAG.8 0? YIA INC.
I
rn
U11'r 2-(0
! s�
V6'iE:' 'ThIS'nortgage in5PtOtIOh WNEI PrOP11170d
Tilir mol'I:qlkqL l"ri-lectJoll Was prepnirna Ilk occorditthee
pprciricAi3y for mortgage pur"OAR 0111y and
witli the rcchnical qtandnrdr. for flartcjtk�ja I.nnn
is not to be relivo upon as a land or prtpartv
11A OF
Inrpaction-a as adopted by tlia Pitt q�klchuxe 1: ta A�,hrtj of
1 e b,t rvkly, uslad ror recording, Preparino dA*,d
1 n
dc� cr iptions, or contitruchion- Ito corners were
Ilegiutration oi nrolasrdonoi Enghtears and Land
SUrvoyory Z:)O Urn 603.
T furthor Umt In that
�et�oU,jJ2(ll,,q J(,jprjan and offsets are
n
App .1m:iLely located an Like gtOt"Id 09-d
CAR EN
A
e -tet, my professional allinlan
the rtruv.l;u%'kks qjii)wn wltil kilo tuning horltan.
a a shown �pevifjcajjy rqr marking determination
t44TES
dimitlinion-11 xethank 4%t Llie tIlPq Of GVhGtVU9tlL
Dnly and are hot to no uned to establish
r ore"."y
are exempt undar provialOnr or H.C-;-- Cit. 40-A Sec. 7.
lines; Tle j",,l;Lers kthot;n h area. are bomed 0J.-
":et
NC,
ul'aJi.h.el infarllktatiork and maj, bt S -I. 'J":
en _f j pt
,
X.I.Property/lIouse ia not in a Flood Hazard.
to forthar out-�-Ia5, thk1holl, e&6GIh9ntF or., ,,.ht--
02.Praptrty/1lou!F;e J -,k in Es FlOod 11a2ard Area.
of way, and other matLers of ir�kcqrd pnd prescripti-a
AsoocinT.-c. Inc. "nnumet: n
03.1information is insufficient to determine
or oth cr rivhtv. it oirthern
t LAV"
Flt)nd lia7ard-
respon�lbillcy h6veln to the land owner at Occupant,
neeftpr.r. no raspon:;iblilty far davjvqc5 resulting fk:c�
F'lqod Hnzard determined from lzItR t Fedrrill Flood
reliance by anyone a1zher than the e;ALd nortgugoa and
v --signs
a
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
TEL. 682-6483
Ext23
This form must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a coloV of the sewer connection permit.
Name bicx Kprrt!> Phone
Address <469
Contractor hired for work:
Name �aLbep' ootoz�—%'.' Phone 7M-P-(Z5�
Address 40o W()Rupv�
,Date for scheduled abandonment—
Method of septic tank abandonment (check one).
removal sandf ill crush other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspecting Agent Date
Comments
0
Y
N2 1022
E
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.--/:g�—L :5- 19
Application by the undersigned is hereby made to connect with the town sewer main in. Street,
subject to the rules and regulations of the Division of Public Works. 'A
The premises are known as No. 26
or subdivision lot no.
Owner
Contractor
0
t" r
Address
ApplicanVa,!Si8onlatu,,�
C-6 q -�e'ry 4 � I el
PERMIT TO CONNECT WITH SEWER MAIN
Street
The Division of Public Works hereby grants permission to
- a6q Ll Street
to make a connection with the sewer main at -Z� cob clig.
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
0
By
See back for rules and regulations
Division of Public Works