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HomeMy WebLinkAboutMiscellaneous - Exception (193)p, All State Abatement Professionals, inc. 4 Wilder Drive, Suite 12 866 -565 -ASAP Plaistow, NH 03865 Fax: 603-378-0610 p RECEIVED June 14, 2013 Town of North Andover Health Department 1600 Osgood Street, Ste 2-36 North Andover, MA 01845 Phone #: (978) 688-9540 Fax #: (978) 688-8476 Re: Asbestos Abatement @ Brooks School, To whom it may concern: JUN �0 �,Q,13 -'OWN OF NOK i ji ANDOVER HEALTH DEPARTMEN-T House, 1160 Great Pond Road All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the above referenced project on the following dates: Start Date: 7/8/13 End Date: 7/8/13 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information, please do not hesitate to contact me. Sincerely, JScott Curley President JSC Jab Enclosures Asbestos - Masonry Cleaning - Selective Demolition - Shot/Sand Blasting - Mold Remediation Commonwealth of Massachusetts 7,71 Asbestos Notification Form ANF -001 ,F *ioii3 INSTRUCTIONS 3 1. All sections of this form must be completed in order to comply with 4. DEP notification requirements of 310 CMR 7.15 5. and the Division of Occupational Safety (DOS) notification requirements of 453 CMR 6.12 �o C r._N �o 0 a �o LL mmmmmmmmmZ Worksite Location: RUSSELL HOUSE a. Building Name/Building Location ��1 CENTER FIRST FOYER b. Building # c. Wing d. Floor e. Room Is the facility occupied? ❑✓ Yes ❑ No Asbestos Contractor: TALL STATE ABATEMENT PROFESSIONALS 1PLAISTOW I t. DOS License Number - J. SCOTT CURLEY JOSEPH R CURLEY 6' a. Name of On -Site Supervisor/Forem Al SPECTRUM SERVICES 7' a. Name of Project Monitor Al SPECTRUM SERVICES $' a. Name of Asbestos Analytical Lab 07/08/2013 9' a. Project Start Date mmlddl ) 7-3:30 c. Work hours Mon -Fri. 10. a. What type of project is this? 103865 1 ❑ Demolition 2] Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: El Glove bag ❑ Enclosure ❑ Cleanup ❑✓ Full containment F� Encapsulation ❑ Disposal only ❑ Other, specify: 4 WILDER DRIVE SUITE 12 b. Address 6033780600 e. Telephone Number g. Contract Type: 21 Written ❑ Verbal PRESIDENT i. Contact Person's Title AA000152 52 107/08/2013 b. End Date mm/ddl d. Work hours Sat -Sun. b. Describe b. Describe 12. Is the job being conducted: ❑✓ Indoors? ❑ Outdoors? anf001 ap.doc • 10/02 Asbestos Notification Form • Page 1 of 3 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: A. Asbestos Abatement Description When filling out forms on the computer, use 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied only the tab key residence of four units or less? ❑ Yes ❑✓ No to move your cursor - do not b. Provide blanket decal number if applicable: Blanket Decal Number use the return key. 2. Facility Location: BROOKS SCHOOL 1160 GREAT POND ROAD a. Name of Facility North Andover MA b. Street Address 01845 (978) 725-6284 c. City/Town d. State e. Zip Code f. Telephone Number INSTRUCTIONS 3 1. All sections of this form must be completed in order to comply with 4. DEP notification requirements of 310 CMR 7.15 5. and the Division of Occupational Safety (DOS) notification requirements of 453 CMR 6.12 �o C r._N �o 0 a �o LL mmmmmmmmmZ Worksite Location: RUSSELL HOUSE a. Building Name/Building Location ��1 CENTER FIRST FOYER b. Building # c. Wing d. Floor e. Room Is the facility occupied? ❑✓ Yes ❑ No Asbestos Contractor: TALL STATE ABATEMENT PROFESSIONALS 1PLAISTOW I t. DOS License Number - J. SCOTT CURLEY JOSEPH R CURLEY 6' a. Name of On -Site Supervisor/Forem Al SPECTRUM SERVICES 7' a. Name of Project Monitor Al SPECTRUM SERVICES $' a. Name of Asbestos Analytical Lab 07/08/2013 9' a. Project Start Date mmlddl ) 7-3:30 c. Work hours Mon -Fri. 10. a. What type of project is this? 103865 1 ❑ Demolition 2] Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: El Glove bag ❑ Enclosure ❑ Cleanup ❑✓ Full containment F� Encapsulation ❑ Disposal only ❑ Other, specify: 4 WILDER DRIVE SUITE 12 b. Address 6033780600 e. Telephone Number g. Contract Type: 21 Written ❑ Verbal PRESIDENT i. Contact Person's Title AA000152 52 107/08/2013 b. End Date mm/ddl d. Work hours Sat -Sun. b. Describe b. Describe 12. Is the job being conducted: ❑✓ Indoors? ❑ Outdoors? anf001 ap.doc • 10/02 Asbestos Notification Form • Page 1 of 3 LlCommonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) 100179566 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: 10 _1 250 n TntA nines nr dii�r ftl b. I otal of er surfaces square c. Boiler, breaching, duct, tank 1� surface coatings Lin. ft. Sq. d. Insulating cement e. Corrugated or layered paper Sq'— ft pipe insulation Lin. g. Spray -on fireproofing Lin. ft. Lin. ft. Sq. ft. i. Cloths, woven fabrics Lin k. Thermal, solid core pipe insulation Lin. ft. Sq. ft. I. Specify 14. Describe the decontamination system(s) to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM. 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (d): DOUBLE 6 MIL POLY. 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a. Name of DEP Official b. Title c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver # e. Name of DOS Official f. DOS Official Title g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes.2 No B. Facility Description 1. Current or prior use of facility: 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes M✓ No 1BROOKS SCHOOL j 3' a. Facility Owner Name _ NO. ANDOVER, MA c. Ci /Town d. Zip Code NORMAND GRENIER 4' a. Name of Facility Owner's On -Site Manager ( - Ili c. City/Town d. Zip Code anf001 ap.doc • 10/02 1160 GREAT POND ROAD b. Address e. Telephone Number area code and extension b. On -Site Manager Address 978-725-6284 e. Telephone Number (area code and extension) Asbestos Notification Form • Pa e 2 of 3 Sq. d. Insulating cement Lin. Sq'— ft Sq ft. f. TroweVSprayer coatings Lin. ft. Sq. ft. ft h. Transite board, wall board SqL Lin Sq. ft. � 250 S . ft. j. Other, please specify: Lin. ft. S . ft. TILE & MASTIC Sq. ft. I. Specify 14. Describe the decontamination system(s) to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM. 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (d): DOUBLE 6 MIL POLY. 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a. Name of DEP Official b. Title c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver # e. Name of DOS Official f. DOS Official Title g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes.2 No B. Facility Description 1. Current or prior use of facility: 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes M✓ No 1BROOKS SCHOOL j 3' a. Facility Owner Name _ NO. ANDOVER, MA c. Ci /Town d. Zip Code NORMAND GRENIER 4' a. Name of Facility Owner's On -Site Manager ( - Ili c. City/Town d. Zip Code anf001 ap.doc • 10/02 1160 GREAT POND ROAD b. Address e. Telephone Number area code and extension b. On -Site Manager Address 978-725-6284 e. Telephone Number (area code and extension) Asbestos Notification Form • Pa e 2 of 3 Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 �o a -N �o �o �o _- o u- MMMMMM!=MZ a -Q Commonwealth of Massachusetts Asbestos Notification Form ANF -001 100179566 Decal Number B. Facility Description (cont.) 5' a. Name of General Contractor c. City/Town d. Zip Code f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? b. Address e. Telephone Number area code and extension) g. Policy Number _ h. Exp. Date mm/dd/ 10900 12 a. Square Feet b. Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): ALL STATE ABATEMENT PROFESSIONALS) 4 WILDER DRIVE, STE 12 a. Name of Transporter b. Address PLAISTOW, NH �� 03865 (603) 378-0600 c. City/Town d. Zip Code e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: J.O.B./ROLLOFF, INC. PO BOX 6037 a. Name of Transporter b. Address CHELSEA, MA 02150 (617) 387-1495 c. City/Town d. Zip Code e. Telephone Number 3. INIA a. Refuse Transfer Station and Owne`r� b. Address c. Ci /Town d. Zip Code e. Telephone Number 4. IWASTE MANAGEMENT OF MAINE a. Final Disposal Site Location Name b. Final Disposal Site Location Owner's Name AIRPORT ROAD INORRIDGEWOCK c. Final Dis osal Site Address� d. City/Town ME e. State f. Zip Code g. Telephone Number D. Certification The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or -Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. JUDITH BEREZANSKY a. Name b. Authorized Signature OFFICE MANAGER 6114/2013 7 c. Position/Title d. Date mm/dd/ (603) 378-0600 1 JASAP, INC. e. Telephone Number f. Representing 4 WILDER DRIVE, STE 12 Q. Address 103865 PLAK h. City/Town i. Zip Code anf001 ap.doc • 10/02 Asbestos Notification Form • Page 3 of 3 All State Abatement Professionals, inc. 4 Wilder Drive, Suite 12 Plaistow, NH 03865 4o// y%i May 91, 2004 - Town of North Andover Board of Health 120 Main Street North Andover, NIA. 01845 Phone k (978) 688=95401 Fax #: (978) 688-9542 Re: Asbestos Abatement @ To whom it may concern: Brooms School, Russell flouse 1160 Great Pond Road 866 -565 -ASAP Fax: 603-376-0610 VECEIVED JUN 15 2007 TOWN OF NO THP,NDOVER HEALTH DEFtRTI`ALNT All St -ate Abi�te;r�etse Professi3lrals, Inc. (ASAP- is scheduled to perform work for the above referenced project on the following dates.- Start azes: Start Date: End Date: 064W 6/l4/07 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information, please do not hesitate to contact me_ Sincerely, J. Scott Curley President JSC:jab Enclosures Asbestos . Masonry Cleaning • Selective Demolition a Shot/Sand Blasting • Mold Remediation -;� '-, Ic LI All State Abatement Professionals, inc. 4 Wilder Drive, Suite 12 Plaistow, NH 03865 To: '-Y Ile"I'm Phone: Fax. phone: $- 16 �S` Y CC: 866 -565 -ASAP Fax: 603-378-0610 Date: 6 //'//0 7 Number of pages including coves sheet: From: All State Abatement Professionals, Inc. Scott curl!x Phone: (603) 318-0600 Fax phone: (603)37M610 REMARKS; ❑ Urgent ® For your review ❑ Reply ASAP A-fose.d des ❑ Please comment Asbestos • Masonry Cleaning • Selective Demolition • Shoi/Sand Blasting % Mold Remediation Massachusetts Department of Environmental Protection 700056173 Bureau of Waste Prevention — Air Quality Oat Number Project Revision Notification For Asbestos Notification ANF -001 and AQ 06 G. Certification 1h-- "nftrr red hsfey sift?, under the POMIties of pa.%Iry, ftt 1e!stv has reed ftCom o' Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestaa, 453 CMR 6.00 and 316 CMR 7.15, and that the Information oontakwd in this rwtiification is true and consct Iso the beat of hiafier knowledge and belief. JUDITH SErtEZANSKY t. Name OFFICE MANAGER 2. FositioNTlde ASAP, INC. WILDER DR, STE 12 s. Address PI-AISTOW, NH -r. CWT&AM erMOePdm.doc • rev. 215/04 onaed Simmra 0611412007 3.fe mmfd rut 603) 378-0600 31365 S. Zip Code tmhprm'-n:_' vi"n tiihhg out tones on the computer. use only the tab key to move your cursor - do not use, the return lay, w INSTRUCTIONS 1. This form is aft. aeaftvis for mine Ming of project data revisions. 2. Frntar prajedt demi number - 3. Valdete that the project location is cohort for the entered decal. 4. Enteryournerw protea dates. & Codify your wwwation. SubwA date changes. Massachusetts Department of Environmental Protection I»+" M193 Bureau of Waste Prevention — Air Quality imi Number Project Revision Notification For Asbestos Notification ANF -001 and AQ 06 A. Facile Location BROOKS SCHOOL 1. Name of Foal* 116D GREAT POND ROAD ANDOVER 6. Telephone Number B. Project Cancelled Check Fere it thia prajeet o i*s cancelled. INA r- 4. Surto 5.2yp Code C. Project Dates OBi14/2�i 77 1. ort kh� start aata,(rrYwadJyy 2.2dgkW grid a ftMtddNwd 3. Latest Revised Sun biiio (nrwddryyyy) 4. Latest Revised End Date (n Wdd/yyyy) D. Revised Project Dates 08h8/2007 08119/Z007 1. Revised $tart We (nwWdd/tyyy) z. Revised Fed Date Oats (ffwWd&yyyy ) E. F. Revision e006pdrn.doc . rev. ZINN Revisions All State Abatement professionals, inc. 4 Wilder Drive, Suite 12 Plaistow, NH 03865 May 31, 2007 Town of North Andover Board of Health 120 Main Street North Andover, MA 01845 Phone #: (978) 688-9540 Fax #: (978) 688-9542 Re: Asbestos Abatement @ To whom it may concern: 866 -565 -ASAP Fax: 603-378-0610 RECE ` : JUN - 4 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Brooks School, Russell House 1160 Great Pond Road All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the above referenced project on the following dates: Start Date: 06/14/07 End Date: 06/15/07 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information, please do not hesitate to contact me. Sincerely, J. Scott Curley President JSC:jab Enclosures Asbestos 9 Masonry Cleaning 9 Selective Demolition • Shot/Sand Blasting 9 Mold Remediation Date.. ?....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. ... �.. t ............ �................. . has permission for gas installation ..... ". in the buildings of .. . n.`..` ..... (.. f .... ` .. `... `........ . at ...%� �. �....�� !� ' `... ............ North. Andover, Mass. Fee. Lic. NO.G l:... .... ...... OAS INSPECTOR 1 Check # { 3�'54 rf�uSC MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations o,6 l Owner's Name New Renovation ❑ Replacement ❑ Date A 3 p Z Permit # 39 Y ount $ Plans Submitted ❑ Wrint or type) '7� VaMA A Vt. 4— # - , Address I II r�—! V' ©) / / Business Telephone Name of Licensed Plumber or Gas Fitter (I A v e: Corp. Certificate Installing Company ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checkedyes , please indicate the type coverage by checking the appropriate box. Liability insurance policy EL , �. Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [IAgent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above a 1* ti are true and accurate to the best of my knowledge and that all plumbing work and installa�i�xs-per� under � P s eds application will be in compliance with all pertinent provisions of the Massachus State C e Cha er 1 o General Laws. (OFFICE USE ONLY) mature ofLiceMed Plumber Or Gas Fitter ❑ Plumber Gas Fitter Ice a Numbler m 0 Journeyman • FLOOR �--_--_�---_------_-® / 1 -------------�--___-- / 1 --m------------------ Wrint or type) '7� VaMA A Vt. 4— # - , Address I II r�—! V' ©) / / Business Telephone Name of Licensed Plumber or Gas Fitter (I A v e: Corp. Certificate Installing Company ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checkedyes , please indicate the type coverage by checking the appropriate box. Liability insurance policy EL , �. Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [IAgent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above a 1* ti are true and accurate to the best of my knowledge and that all plumbing work and installa�i�xs-per� under � P s eds application will be in compliance with all pertinent provisions of the Massachus State C e Cha er 1 o General Laws. (OFFICE USE ONLY) mature ofLiceMed Plumber Or Gas Fitter ❑ Plumber Gas Fitter Ice a Numbler m 0 Journeyman Location No. —214r -Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ >: Building/Frame Permit Fee $ yes ACH Eth Foundation Permit Fee $ s�cHus —Esq Other Permit Fed�$ Sewer Connection Fee $ Water Connection Fee $ cstr TOTAL $ _ L Building Inspector t 06/06/95 14:22 98.00 PAID TA 8331 Div. Public Works PERJIIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. F- J LOCATION �R - PURPOSE OF BUILDING / WNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRES V ASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME S SPAN DISTANCE TO NEAREST BU LDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO TOWN WATT" IS BUILDING CONNECTED TO TO" ^ IS BUILDING CONNECT-" o JI'/ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE BOARD OF APPEALS ACTION. IF ANY INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATJL F LFn 0/- /L / ]� Ll— A SIGNATURE OF'OWNXR OR AUTHORIZED AGENT F E E PERMIT GRANTED (c 19 0 °ORMATION pec ROOM f.a11T NO. APPROVED BY NUILDINO INtPtCT01! OWNERTEL. CONTR. TEL. a -7 CONTR. LIC. # CS 10'V61077 H.I.C.# / 1 dgg 1.3 �3 I � k(jo BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 I3 PINE CONCRETE CONCRETE BL K. BRICK OR STONE HARDW D— PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/7 % FIN. ATTIC AREA N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 �_ 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING HARD!✓'D COMMON ASPH. TILE VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I�POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP ATH (3 FIX.) GAMBRELMANSARD 11 TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES oAAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 10 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. PERMIT NO. f APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZONE SUB DIV. LOT NO. IF— LOCATION PURPOSE OF BUILDING �L� vK14 V ""�T^I----ywig► WNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRES �- ASEMENT OR SLAB J/ ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME S SPAN DISTANCE TO NEAREST BU LDING DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES - SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST `/ (� TV i' EBT. BLDG. COST PER 8Q. FT, J ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR F E.E no PERMIT GRANTED (o 19 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY �-Y BUILDING INSPECTOR OWNERTEL.# CONTR. TEL. #©.. .e�a 1-7 CONTR. LIC. N 05 0 Y cS 3 0? H.I.C. # . % A /-3 03�i � ttIZ 1 OCCUPANCY SINGLE FAMILY STORIES _ MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BUK. PINE BRICK OR STONE H RDW PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 1/1 'h % FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I g FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDIU'D ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAMF 1­11-7— BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. G DKIIN VIV MAJUNKT BRICK ON FRAME Allit-JIKJ. 6 f•IVVK _ •, - CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR AD _ EQUATE NONE 5 ROOF 10 PLUMBING GABLE I I HIP GAMBREL MANSARD FLAT SHED ATH 13 FIX.) TOILET RM. 12 FIX.) WATER CLOSET ASPHALT SHINGLES AVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL Bst^ T 13 d I ELE NOCTRIC HEATING Z z z C) z cn m D O z z rD- C 0 z O_ CD 0 _ 3 co 0 cis E 0-4m C d r! y o _ CL N C 0 N VJ m O z 1 V/ c��0 m 0co aodcm y = m 0CD Cl) Co m . N C 3 =0 to ?w co m o. ? m = m —40 m N o XmN a 1 � o e• ?�+ ? _ co, C rt CD m 4 O m O. m N D1 N CL cr CO T: Xm2H � N �; 0 m m y� 0 A CD S. m rt rt O oo. rt = CD C (� 'A VIA CD CD .T N0 ' d m ,� o.* b 0= r o � 0 O rt 5F. m O �r-Dy v, M z y C oa S C � C� n' ry G oa :r 'ter] w 'j7 G ov T d O CO) n 'r1 C O. Cl)CD Z y 'O � D O c� O. O CO) lz � c `o ,n CD cr 11C C=Dr CD CCM p CM O CD -� =0 CD CO) co CD O CO) .a c� Z oq� o � co 0 CD C 0 z O_ CD 0 _ 3 co 0 cis E 0-4m C d r! y o _ CL N C 0 N VJ m O z 1 V/ c��0 m 0co aodcm y = m 0CD Cl) Co m . N C 3 =0 to ?w co m o. ? m = m —40 m N o XmN a 1 � o e• ?�+ ? _ co, C rt CD m 4 O m O. m N D1 N CL cr CO T: Xm2H � N �; 0 m m y� 0 A CD S. m rt rt O oo. rt = CD C (� 'A VIA CD CD .T N0 ' d m ,� o.* b 0= r o � 0 O rt 5F. m O �r-Dy �t 0 M z w C oa S Z y C� n' ry G oa :r 'ter] w 'j7 G ov T ^J tv z z '�1 y 3CIO ,i1 C 'r1 C O. tz z Cn b n E3 •r1 O ►�w a ►�1 d o N Wv I•� 0=3 0 0 c OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING Town of NORTH ANDOVER °Q•��a•` DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street North Andover, Massachusetts 01845 In accordance with the provisions of LIGL c 40. S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly liczascd. solid waste disnosaI facility as defined by MGL c 111, S 150A. The debris will be disposed of in: 0 Sienat a of Permit Applicant A5 - Date NOTE: Demolition permit from the Tourn of :forth Andover must be obtained for this project through the Office of the Building Inspector. 7m — G. s ylG4 o�.i taaaaa�uaelta _HOME�IMPROVEMENT CONTRACTOR Regrstration..112613: tTypeyPRIVATE CORPORATION z: � ExPuation` X04/13/97 C 7 AIERS 8 50N'INC iiE C STfPIiEN MIERSTM{^� 1-W kRE AD1�""TOR WINDHAM NH 03087 _ - QfS;RICTIONS: , .40: 07. �a�nmzoouuealCi o�� �<r�;ariru:eCt DEPARTMENT OF PUBLIC SAFETY y 1A - Masonry only License: CONSTRUCTION SUPERVISOR 16 - 1 5 2 Faoily Hones Nutber, - Expires Birthdate CS 040329 12/03/1996 12/03/1911 CHARLES S NIERS Zl VEST SHORE RD YINOHAN, NN 03087 COMMMSiONER