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HomeMy WebLinkAboutMiscellaneous - Exception (517)TOWN OF NORTH ANDOVER Office of the Building Department NORTF� °`tt,,�o , 1tiv Community Development and Services 4.. • ...n6 6 3 - °� 1600 Osgood Street, Bldg. 20, Suite 2035 ° North Andover, MA 01845 978-688-9545 �9SSACHUS���� Donald Belanger, Inspector of Buildings August 25, 2016 To: James and Linda D'Angelo 172 Summer Street North Andover, MA 01845 From: Donald Belanger Re: 172 Summer Street, Map 38, Lot 334, Zone R2 Dear Mr. and Mrs. D'Angelo, A permit application was received on August 8, 2016 for a proposed new building described as an accessory building located on 172 Summer Street. This proposed building is not accessible from within/on the property at 172 Summer Street due to wetlands. The proposed building access is on Molly Town Road. Being an independent structure/ dwelling in its self creates a second structure/dwelling on a single lot in Residential Zone R2. The North Andover Zoning Bylaw 1972: Last amended May 10, 2016; Permitted Uses, Section 4.121.1: One family dwelling, but not to exceed one dwelling on any one lot. Permitted Uses, Section 4.121.4 b. Home Occupation, The use is carried on strictly within the principal building; (Principle Building is located at 272 Summer Street). Frontage Exception, Section 7.2.2 , does not apply to multiple structures/dwellings on the same lot. The permit application with documents and plans is being returned to the homeowner for the aforementioned reasons. Sincerely, Donald Belanj Inspector of E TOWN OF NORTH ANDOVER Office of the Building Department Community Development and Services 1600 Osgood Street, Bldg. 20, Suite 2035 North Andover, MA 01845 978-688-9545 Donald Belanger, Inspector of Buildings August 25, 2016 To: James and Linda D'Angelo 172 Summer Street North Andover, MA 01845 From: Donald Belanger Re: 172 Summer Street, Map 38, Lot 334, Zone R2 Dear Mr. and Mrs. D'Angelo, A permit,application was received on August 8, 2016 for a proposed new building described as an accessory building located on 172 Summer Street. This proposed building is not accessible from within/on the property at 172 Summer Street due to wetlands. The proposed building access is on Molly Town Road. Being an independent structure/ dwelling in its self creates a second structure/dwelling on a single lot in Residential Zone R2. The North Andover Zoning Bylaw 1972: Last amended May 10, 2016; Permitted Uses, Section 4.121.1: One family dwelling, but not to exceed one dwelling on any one lot. Permitted Uses, Section 4.121.4 b. Home Occupation, The use is carried on strictly within the principal building; (Principle Building is located at 272 Summer Street). Frontage Exception, Section 7.2.2 , does not apply to multiple structures/dwellings on the same lot. The permit application with documents and plans is being returned to the homeowner for the aforementioned reasons. Sincerely, r Donald Belanger Inspector of Buildings TOWN OF NORTH ANDOVER Office of the Building Department cf N° pTH qti Community Development and Services 1600 Osgood Street, Bldg. 20, Suite 2035 r ° North Andover, MA 01845 \o e.»* 978-688-9545 cec.wcwewww Donald Belanger, Inspector of Buildings August 25, 2016 To: James and Linda D'Angelo 172 Summer Street North Andover, MA 01845 From: Donald Belanger Re: 172 Summer Street, Map 38, Lot 334, Zone R2 Dear Mr. and Mrs. D'Angelo, A permit application was received on August 8, 2016 for a proposed new building described as an accessory building located on 172 Summer Street. This proposed building is not accessible from within/on the property at 172 Summer Street due to wetlands. The proposed building access is on Molly Town Road. Being an independent structure/ dwelling in its self creates a second structure/dwelling on a single lot in Residential Zone R2. The North Andover Zoning Bylaw 1972: Last amended May 10, 2016; Permitted Uses, Section 4.121.1: One family dwelling, but not to exceed one dwelling on any one lot. Permitted Uses, Section 4.121.4 b. Home Occupation, The use is carried on strictly within the principal building; (Principle Building is located at 272 Summer Street). Frontage Exception, Section 7.2.2 , does not apply to multiple structures/dwellings on the same lot. The permit application with documents and plans is being returned to the homeowner for the aforementioned reasons. Sincerely, Donald Belanger Inspector of Buildings } 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 §Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. Atter a permit application has beemaccepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation st6ted on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall_be limited as to the time of ongoing construction activity, and may be.deemed.by the.Inspector_of _Wires abandoned -and .iavalid_if_he— or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entitystated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. 8 — PermitAl ate Closed: 0 Permit Extension Act — Permit/Date Closed: *** Note: Reapply for new permi*11 a Date A lo..i.... . • .�SL�ib7 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ .. ................. has permission to perform .. ey.k"... 1{ Ylr✓•. 5�JA...... wiring in the building of .. ... .ej.� ...................... at ... ` ... 31A.M.Vv M.M. . ......... North Andover, Mass. Fee ... Lic. No.161 �.a.. A....... ELECTRICAL INSPECTOR Check # .11351. CmmmnweeaLth W Vale" Official Use Only cepaPrnon�` tm Se1tNo. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev.11M eve blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the MassacbusoM Electrical Code (MEG'), 527 CMR I2.00 (PLEASE PRBVTW AW OR . City or Town of 1 V Ur� f�T 1I0f- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention: to, perform thee%eftical woA deserY)ed belavK. Location (Street & Number)) 7o SUm nl&r J"f'ry—+ Owner orTenant J n mL� T-) `A -n a rJ D Telephone Ownees Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Bog) Purpose of Building D 1 Q�� i !'1 A Utility Antborimflon No. Existing Service Amps I Volts Overhead El Undgrd-E- Nm of Meters New Service Amps I Volts Overhead CQ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: rwrnwi"v fnhlo min; he, waived by the Inspector of Ww' es. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans z, o Totat nsformers KVA No. of Luminaire-Outlets No. of Hot Tabs Generators KVA ir No. of Luminaes Swimming Pool .d- a ar d. Q No. o Emergency lAighting Sane units y No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. of tection an No. of Switches No. of Gas Burners initiatingDevices No. of Ranges Total No. of Air Cond. Tons 1No: of Aker�g DoOm No. of Waste Disposers Heat Pump .. umber ons Totals• ' o. o Self -Contained Detection/Alertin Devices o. of Dishwashe -s ( Space/Area Heating I{W Municipals Local Q Connection Q Security Systems:* No. of Dryers HeatingI . Appliances No. of Devices or Equivalent o. of WaterNo. of o. of Data Wiring: KW Ballad No. of Devices or E uivalent Heaters S' s ommunications No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent ATlTiRi. - 5/ Attach additional detail if'desired, or as required by dw Inspector of Wwes. Estimated Value of Electrical Work: (When reqrfired by municipal poYicp ) Whitt to Start:Inspections to be requested in accordance with MEC Rule 10, and upon completion. Yit for the performance of electrical work may issue unless NSURANCE COVERAGE: Unless waived by the owner, no perm the licensee provid4mproof of liability insurance including "completed operationcoverage or its substantial. equivalent The " undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CBEECK ONE: INSURANCE BOND T1 OTHER .0 (Specify-) I certify, ander thepains and penalties ofperjury, that the information on this application is tree and complete- FIRNAR'iEE: M&• E ftsi E IFC-• r A C rt i -SP LIC. NO.. FIRM ]Licensee: �r1t� � t'[��----- Suture LIC. NO.: (i, f'applicable enter "exempt„ in the license n ber lane) Bus. Tel. No. Address• .f Alt. Tel. No.�5-0 i&d- .• iia I *Per M.G.L. c. 147, s. 57-61, security works requires of Public Safety "S" Li.ense< Lie. 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 0 owner owner's a eat Owner/Agent Telephone No. �'EIBMIT' FEE.-``�`�, a� Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavits Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual).:-Mg f h 4tAS r ,` �Z rc7g t c& . F41/l e, . I N C Address: 1/0 ip: KtLGI, Are you an employer? Check the appr 1. I am a employer with _ employees (full and/or.part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. I am a homeowner doing all work myself. [No workers' comp. insurance required.] t S 7/i Phone #: late box: 4. (] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 5. [] We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' insurance 0 Y -x16'- 7y67 Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.tffElectrical repairs or additions 11. [] 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site in 6nnadon. Insurance Company Name: 6GIA/Z42 11y5 t4iQA V C 6' 000i� Policy #nor Self -ins. Lic. #: Expiration Date: Job Site Address: JT �l' ii s City/State/Zipffir h QyGI" IVA 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. I do hereby certify undeWepains an tatWofperjury that the information provided above is true and correct MSA Official use only. Do not write in this area, to be completed by city or town offtiarl 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 #: lyhis certifies thatt!� w� !? �' { has permission to perform .. t .....t� u. :!................ i t plumbing in the buildings of. .. fie# Q ........ • • . • .. .. . at ..' .I:. 5�A VY1�V�r , • 5't : ,North Andover, Mass. Feer�''-� .. ..................... . .�-:. .. Lic. No.j.�?).� PLUMBING INSPECTOR Check FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) .ROOF DRAIN ,, HOWER STALL SERVICE./ MOP SINK TOILET C" URINAL WATER HEATER ALL TYPES WATER PIPING OTHER I have a. current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES El NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UA61UTY INSURANCE POLICY El OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application wales this requirement. CHECK ONE ONLY: 0 ER AGENT SIGNATURE OF OWNER OR AGENT 1. hereby certify that all of the details and information I have submitted or entered regarding this application are a to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pli all ertin ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEhillip J Durfee LICENSE# 13774 SIGNATURE MPO JP El CORPORATION # PARTNERSHIP# LLC f 152 COMPANY NAME ►fee Plumbing & Heating LLC ADDRESS A Huntington AVE CITY o*.Yarmouth STATE MA. ZIP 02664 TEL 08-619-3078 FAX 8w258-0592 CELL Q8-801-8004 EMAIL hil@durfeeplumbing.com iW'WNN6iVNNW11md 14W'i1m8N'AW6WYffi zz 1 X39- 5D R 14 10/11/2013 11' IM0001 111 1.wr:..s- / {. Beat/A6 02121 Wf :ia 1. ( l 1 ft R I I - 1+ -ya + IMMM ai3.- ,,,:a.t,�._.r�;,1_�. �,_.,,.,,/...:, <►���►��/�R�T�L;,�,�3/'/�i]�it►fi��I`► %.uyfutai 46e ';4V rf r t v1 l "4 rJ1x+x�.m • lv:y. AreeJ4 a ployer9 C1��� Rj? kiln &t= am a o�l,a t ,"./,_,_. 4• Z �m gener I can►tra or and I 2: ❑ z � a aoie pa boor arpntm listed ran e'a##arbcd shret sbx p-wdhzwwzu3p1oyM . 'worlang �'oz� m amy c�z�►. ��3'� and.havc warkers' (Na �vcrka' razap. ias+aance' camp. hr==t We ate k =p=hm and its • 3. 1 am s h==V=jd g au work offic= bave exm iwd tbcir . myself [NO wtMbM' COE?• 0£excmptiattperMCTL -3 t r. 152 §I(4}, and wa�mv*no �P�3-!tea a+aa�s' coup. I buA ==tabu M ovt the Beat= bulow Ambg a* Ii PoEwhaupEdOL t who a>bmit No zMdwkfi cxrmR t w =doing all workapdtbm hots oum. s xwh.. arms ffiats�edc�isbs as tioosi shrrxsbow�a Suf�ame cffiesnb-cam�ac�as >md state srxosAotffioee mfrs hays mopdayw - rtoO&C shsve=fil YM, *q zzd WVA &Cir wotloMV CoR . paq=Mbw ' • I � an �tplByar thatis�gworkers'rompetusatian insurancefar my asp, pJ� is the�laficg jab �6' • Policy # ar sdf im Ur.. ip, Date: �' � ' ��-• Job Sft :lo2�S�S�i'f- cst:lar t�Y'ilA AWS A#xch a eopp of t1e worms' =@ea fiou polfry dedaradon pW(dowt tg the policy nmmber and m#rsf m date). Failuretn sewn cnvexap a$ = mrd.,mdw Seed= 25A ofMGL o. 152 cam lead to tbz imps of c "anal p aatim a& fine tip to S1,*500.00 madfor ane -Year mqpiso as wrJi es civil paaaitiss is tiro foam of a SM? WORK ORDER and a fmc of up tD.$250.00 a day agar vicaa . Be advised tlis'c $ o�of this �tmaybe fav mirdsd tlZ 01"6e of I i v hereby c Axe''p trod powi is o f'padwy A& the LVimadan provided &6,6 h a4z& and corrrea paw I I uff—k Y an on y, Ao not wrft In thio arc% fb be a4bp- rW. r town orww - City or. Te1Wnm: Pernll,ieeuse # IssaingA�wriiY.(cirele oae): - ' :1. Board of Heaifh 2. BWi&g Departmen=t 3. My/Town awk 4. MacfticA fmpectar 5. PImaabing Lupedw 6. €)iher �onff�ct 1?'et�o�t: - • Y'hcon: #': - �BI��EP�1- ; • S S ANA GAS - ;:, ;��t�M'SER • .A �pB;ER � UES 14A 42-8.3.8.2��7• ,.- u= 1/14 oom pef(pr :GommoNWEAL7'y - _ OF � SAGHUSErit _ PLUMBERS AND GRSFITTERS 13OENSFD AS A JOURNEYMAN pLUly�BL ISSUES THE ABOVE U.CENSE T(3. pLiR J DURFEE ST MA 02638-2411' f:..: �' •Tw 6M - 85!01114 FW Thm Wuh ping ARPe - -�- OOMMONWEALTH OF MASSAlaWSMS• -i •PERS AND GASFI'i�RS. REGI ED AS A PLUMB � CORR ' 'IS§SUES THE ABOVE LICENSE TO: PHILLIP. J DURFEE V 'PLUMBING I}EATIt4G,- LLG =5 F1:A!- ST VENN•IS MA G263'8=- I'' 3152 05/01/14 _:180.98.3,-. LICENSENO. EXPIRATION DATE SERIAL No. Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 0184Y , (978) 688-9545 Fax (978) 688-9542 �` •"" m �cewc .1iYKlt APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS i I a 50MmeL Sr LOT NUMBER S UB D I VI S 10 N_,5',jU� DATE REQUEST FILED I O DATE READY FOR INSPECTION I FIVE [5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITIUN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY RO 'TIN CONSERVATION DATE PLANNING DATE —WATRETER`�D.P.W. ��L D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIGNATURE / DPW AUTHORIZATION rA°,, Date..��.�� ➢� NORTH U//TOWN OF NORTH ANDOVER Oc �,ti0 PERMIT FOR PLUMBING This certifies that .. �W.i. 4s.1..i.... .... .C. `............. has permission to perform...1wf" ... `.... . plumbing- rin the buildings of -carrot . U.t+s' `t MvCr (d/► at .... .......... , N h And/o�ver, Mass. Fee .91Q.. Lic. No. t Is1(a�l PLUMBI G INSPECTOR Check ,N 9 7 84 6530 1'� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS _ Date `1 Z 7—obs Building Location �1a. �t�;v�av�z✓ `�� Owners Name ONa&c CjDt-6 , Permit# Amount Type of Occupancy t�� New 121 Renovation Replacement Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Installing Company Name C-0 r./\ Poi 'i c: GIS Z 1. E Corp. 0<0 —>_0 Partner. Firm/Co. Name of Licensed Plumber. AAAt [ lA - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity El Bond 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 igna ure Owner El Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License tcen a um r Master 3 Journeyman ❑ j 5910 Date.................................. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ......... ...... .7 ......................... has permission to perform ....... ............................ ...................... wiring in the building of ....... C" 'rz— .... ;r tZ-,. Sel 4 at .............. 7........ ........................ North Andover, Mass. Feel7, - ...,"�......... Lic. No�.M..? . ........... ELECTRICAL INSPECTOR/ Check # A --- + r DEPARTMWOFPUBLICS MY Permit No. /® BOARD OF F7REPREVEM70NRWU ATIOAS527 R 12.00 Occupancy & Fees Checked VjAPPI.�ICATIONFOR PERMITTO PERF ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC[ R15STS ELECTRICAL CODE, 527 CMR 12:00 �_ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) /��} �(,1lnlnex- �/ - Owner or Tenant 4a4'7a.Q-01-{-' CO L/ 'T' -- - Owner's Addresses Is this permit in conjunction with a building ermit: Yes [3 -."No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead a Underground No. of Meters New Service Amps Volts Overhead Underground En No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above ground B Generators KVA No. of Receptacle Outlets ,?av No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets e� No. of Gas Burners FIRE ALARMS No, of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local a Municipal Connections No. of Zones a Other No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Heat Total Total Pumps Tons KW No. of Dishwashers / Space Area Heating KW No. of Dryers / Heating Devices KW No. of Water Heaters KW No. of No. of Signs_Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHE ' 111s aroeCo►aage, PtaWatmtheragtmartais XXftGffxdLaws Iha%eaamattLiabidyhtst==PdLYidu*gComplde . Ca►e�or�s�b antidafivalet YES a NO Ihme%hnfedVddptod0fsarebthe0foeYES n IfjcuhmdvdWYFSpimeQfimmteWofwm'Wb'dakigthe C 0 IC�SOTU 0 � tJRANCE 1iDN° - EViW,Dale Fsfim*dVahiedE�Wc& $ WolktoShat _ D*Ra* Ftp Sgted`axla�iePlS`fpajlay`/�oe-1.��?-��j u=No. e23 F9 2- FIRMNAME Lioatsee�J ,` t�l , � L,, � Sae . I�oa>seNo V B4=TdNa Add= AiTd.Na OWNER'SP4SURANCEWANER;IanawaethattheI�oa>sedmnot theitstratoeeo►aageerAssi�ta>bale�la�alaltasttx�c¢edtryM adxseisC�e{tr7alIaws andthatmysg�ltaeonth'sparrrtapp&atiatwars�tegtmarlai (Please check one) Ownera Agent a Telephone No. PERMIT FEE Sr__�'.:�-.�� It i Date... 1.?.`.n .�.. . V/ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. &K' ...!??? ............ has permission for gas installation ..1. v :'e'. c•!.. `�-... . in the buildings of .. �'�'�.�� ... 4�!`.....'............... . at .11 61_. ........... ,North Andover, Mass. Fee. .!% .. Lic. No..7;T7..w-1.n-111. Vv GAS INSPECTOR heck # C�2' / i9 & 5'76 MASSACHUSETTS UNIFORM APPUCATON FOR PERNU TO DO GAS FPrnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date ') _ 1-7 • Zv1:�� Building Locations \'-1 a ISy rv^ VX--LL-1 Permit # Amount $ Owner's Name l I Co �,3 s �- New ® Renovation ❑ Replacement ® Plans Submitted ❑ Wo U U `„ z p W F O a p p z W� a ° H w U a H H a�1 0 O SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 1 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FL0O,.R STH. FLOOR (Print or type) Chec one: Certificate Installing Company Name �M%l��T I Corp. -c7 ❑ Partner. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �� a I (A,�/j ,g, Ll•� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy [Z]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 ❑ Agent ❑ ♦r.,n n„� n rofn fn ti.o I hereby certify that all of the aetans ana InrorMaL1Ul1 t llavc auu1111LM wa �1R. Y� ..........l Y.• -• •• - ---- ------------- -- --- best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. APPROVED (ONCE USE ONLY) Signature of Licensed Plumber Or Gas Fitter L/3 Plumber 1 13 j j� ❑ Gas Fitter r-lcense Number ®® Master �j Journeyman c DFPARTMF vT OFPUBLICSAFETY BOARD OFFIREPREV rFMNREGVL 770M527CNR12.00 Permit No. Occupancy & Fees Checked APPUCATTONFOR PERMITTO PERFORM aE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHI.ISSTS ELECTRICAL CODE, 527 CMR 12:00 pp (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) /'a. ,s7amM Owner or Tenant Owner's Address Is this permit in conjunction with a building it: Yes [a -No (Check Appropriate Box)37 l 301011oft L -C— T• C Purpose of Building 4e�w � me Utility Authorization No. Existing Service Amps Volts Overhead Underground [:] No. of Meters New Service .�— Amps / Volts Overhead Underground En No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above uound M Below around Generators ` KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets e�a No. of Gas Burners FAZE ALARMS No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local Municipal El Connections No. of Zones a Other No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Heat Total Total Pumps Tons KW No. of Dishwashers / Space Area Heating KW No. of Dryers / Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER � Ii6U'dtOeC.o�e'� H15u3tbd1el�9i��119�SC810dII1lWS wratliai*h m=PbrEYirdud *CaMk* #u�ttialac(tmakit YES M NO Iha♦esubmiladvaGdpoofofsatrebde0� YES COMWcrtsstrJ (fjcuha�ed�ad®dYES,pk=ht�>hetypeafaovaa®ebYcfiodalgtfe bcK 1N5URANCE BOND OTHER � (P=aseSpeafy) �. F�iadmDiale Etm*dVA2dPie 1EdWak S WakiDSwD*Regllelled Ro* Fkl S�redundWS�eRwJ1Je;efpew �/r-✓b LiarlseNa Z NAME -- �3 FJr'Z_ Sir. -` Bix*=Td.Na 9 7� a�/S-10109 {- WNFR'SINSURAN MWANER;Iamaw=hatlheiio®edwnot theirnvarnea�ua ark ntalec�irelatasrac}aedbyly aeusCsrnalIar�s -�' �ratmysg�l<eoa wit lease lease check one) Owner Agent Telephone No. PERMIT EEE $ 9�• %54wo Coe ,may � aQ )97,-�07 C- n Location P Sy vNA w v t S,•f' 44 AI No. 7 Date L OfNORTH TOWN OF NORTH ANDOVER 3?� SOL � 9 Certificate of Occupancy $ cNuse Building/Frame Permit Fee $ 7(9 30 s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t.� 1 7 ✓ `Building Inspector 93/39/2096 14:37 9793723960 CHRISTIANSEN 8: SERGI PAGc 01/01 FOUNDA TION LOCA TION PLAN f,r m s REOMMEMM Or � � m APftX4Kf ZONM NY -LAWS IN MR COAWRLMM HON OM NOr C ANY 0"00 cimm NO. ANDOVER R. T. onvm or �° use or THE CLIENT FpR ANY POSE 01M TMN nur CfJ"In A90b�[XCE" Wlfsr "K Ilw"EN P£Rmis3 ON orCNAUMNSEN a SEAMr AV_ .ftN1 MUNOW M ARAWAMo IS "K 61'k7 MM M M/S CMROA /S MADE AND LIMITED Pf?OPE1RiY w CM MUMM * SM W- AND ANP M THE ABOVE CLIENT. "UnADrQ m usr s MGMMR1bD.CN9PL5mmm & Sow Tmn w Rmpamsoffiff fm ?w LAA { ust mor fik4 MMM op ANY R�fofi- ApT�%LMS ON. OCA770N., NO.ANDOVERgUA. O DAM 3/30105 Sma i "x'80NO. 3,1 CHRISTIANSEN &SE'RGI � -St�� P 180.SUMMER S% HAVOML469 ofoJO ML om4n-osfo Ono or cmwrA4A N k 31" im OWG�.N0.:A706dOf0 Location )olc:,2 Y-) /W �AlveC' No. / Date a �� ~ORTN TOWN OF NORTH ANDOVER S Certificate of Occupancy $ '�S • Eta' Building/Frame Permit Fee $ JQCMUS Foundation Permit Fee $ t? Other Permit Fee $ TOTAL $ gip` �a Check # A391 18017 / Building Inspector TOWN OF NORTH ANDOVER B UELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING :r a re •'TIf9S Section for official Use OPA BUILDING PERMIT NUMBER: 1 / 9S- DATE ISSUED: SIGNATURE: Building onamissioneor of Buildin Date 1 -a 1.1 Property Address:. 1.2 Assessors Map and Parcel Number: IVLO I Ot Map Num Parcel Number 1.3 Zoning Information: � � ��� i 11'tl (,y / 1.4 Property Dimensions: � l—NdN4as� 1�. �� � 3 (� (`1 ,e`er ( e w.� iu p `J Zoning District Pr osed Use( ` Frontage\JftV C -3 �Z 'e -Lot Area s� 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R uired Provided Re red Provided O 1.7 Water S ly M GL C 40 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone � Municipal On Site Disposal System f 2.1 Owner of Record wA2� weQt3sa rl, l�mw . of Name (Print) Address for Service J Vow me s � C�,�a V7 - a77 � Signa e � p c n . Telephone ��J�l 2.2 Authorized Agent Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor q 'l Not Applicable ❑ - &)ftOle s (fArro 1 S p 3 S"® 3 Address 1,q �lPeg (6� w � �� Q 6i 0 License Number Licensed Construction Supervisor: V 978 'yj s - j .l �`[ Expiration Date lure Telephone Q3..cgistered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address -- -- E t Expiration Date Signature Telephone M "q M O 1 M X Z M 90 M Z G) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. Sinned affidavit Attached Yea ....... V No ....... ❑ 5.1 Registered Architect: Av d Name: Address Signature A _,:�50 C . Irl_ L... CAAtlr. 9-70 (( S Telephone Not Applicable ❑ CompanyName: I Responsible in Charge of Construction Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name • r Address ° Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Not Applicable ❑ CompanyName: I Responsible in Charge of Construction 700.�.zrde`rs;".` ��3&YB:F Lkh#k'all asrslxcablei' New Construction Existing Building ❑ Repair(s) ! 0 Alterations( ;J 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: CbkS ru 5�� t{ �t� :16n� V V0,9-1, f H High Hazard 0 USE GROUP Check as applicable) A Assembly 0 A-1 ❑ A-2 0 A`3 �0 A-4 ❑ A-5 B Business 0 C Educational ❑ F Factory 0 F-1 0 F-2 H High Hazard 0 IInstitutional ❑ 1-1 ❑ 1-2 M Mercantile 0 R residential ❑ R-1 0 R-2 S Storage ❑ S-1 ❑ S-2 U Utility M Mixed Use S Special Use 0 ❑ 0 Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILT Existing Use Group: Existing Hazard Index 780 CMR 34: BUILDING AREA Number of Floors or Stories Include Basement levels Floor Area per Floor (so Total Area (sf) Total Height (ft) CONSTRUCTION TYPE IA ❑ 113 0 ;A❑ fA B 0 3 �, , 14 3 ❑ 0- ���3q 715. ❑ ❑ m5 a3 1 -3 3 g.— A7- h S /* 5 _ F3 +0A _ � I / ', J © op /� I Independent Structural Engineering Structural Peer Rei SECTION 10a Owner Authorization - TO BE COM OWNERS AGENT OR CONTRACTOR APPLIES I AND OR CHANGE IN USE IR 34: 1, ,as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date W_3. C4(r L 0 > as Owner/Authorized Agent 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 JV Prin arne, Si a of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed b permit applicant P by PP::., 1. Building l 1 S-�O '1 (a) Building Permit Fee Multiplier SSS, OA 2 Electrical l ®O� (b) Estimated Total Cost of /J Construction from (6) / f3/ D v 3 Plumbing (C f 000 Building Permit fee 1a1 x tbl /� O 4 Mechanical (HVAC) (a t 000 5 Fire Protection o d O 6 Total ()1+2+3+4+5) Check Number s } ��� .tri: {.Y `1J �.� t. d �,E�1 � ��f.. i.,Ay. Y1•A11 �'1 4 ��1�'NA 5{'�� t¢f y�/ t i �i s;.; at�1' :d trail �. �' ���,rfr'k�p1 � F iii \ji' if .� Y..t1l SAN. ;Y.Y�.'��� vA .'1^' f ' i 3. 4n r.... �v' •?�.?.`',ab.7 ri �;: .; ,3. '�..: {. ,. y,t:.t-Ar �;'+�i,�'d;;u .,. ,+.4 ,�:•�:tiH .'r�.,'�rK .,�-r it ylixy4ty, �w`i' S'��i C,c :-iJ 3. 4�r Yi4r t::.�F�:x;:..yyA'�i. .�^' lS�F,'). '� A'int K::fi:�`tr: 4 ••:�' '3 �t;: tf ?�.k.'•5�•y,..� aP.. nr�. xy Y'�JiPi.((L76.>,.,""fi�`-5�,.1: ,� %;'r�Y.,. �;�f�': � J1'r 1;Y �-fry;Y. Y}¢ K 7 �'?rk G}Yl Y' `� fi� 3 S Y F �f St'i'�, u`? 2l ♦F : � Vii. ��� f t� R''Fiz St ,x D, y.,: i �f l.� t �. 1 a� 'f r7��Nr k-.vJ�tF �'tn n'L.4� �ht �' ro✓ '�' �i '2'i� �' .'}f� l�1 i xh..��. ' �.'TS � 'T�t.t ,�.�;3'{ e� , _: .r i. i �F., mak, �. � i � �i�'.±I' ;! \rh» U'�� �+. ..���N'� • T.i .%}'. �IJ,7'�._tt��_ ,•i 1 L'E<.r� tiri �� NO. OF STORIES SIZE BASEMENT OR SLAB � �SQ�vv�' SIZE OF FLOOR TIMBERS iST 1 2ND �✓1� PD SPAN j �o DEMENSIONS OF SILLS DEMENSIONS OF POSTS U D13,4ENSIONS OF GIRDERS to HEIGHT OF FOUNDATION 6 THICKNESS SIZE OF FOOTING Q4 L' X (� MATERIAL OF CHIMNEY -6 Ft C K IS BUILDING ON SOLID OR FILLED LAND j 4 a V ti 4 a V V o� W D w' U, o WO a LL z W aan It h'4ot x�• 4 P 0 in I o CL O � M z 4 471 ccoo cm N t , t �a� .'O O CA C m O � N EC iv a� �E IL Co):m� N c cc O O Em � mo ILS CD ac • o cm o .cca m o oCD _ Eft: o= c s �cso S 0 map - Lu p- m Lu C O = m � C .Orr C� ... p •N dt O G O O Lu W� CC COD O. ID O 'fl tR = W�`.�� O ♦- t � a i mF. AG a �z +* � O o �z W0 c W 0 cm C 'E m ow ®� CD O . ®a c cc 0 CD C CD CL .v CL 0) W 0 W U) LLI 0 uj N �P, 0 vIJ A �- 4 471 ccoo cm N t , t �a� .'O O CA C m O � N EC iv a� �E IL Co):m� N c cc O O Em � mo ILS CD ac • o cm o .cca m o oCD _ Eft: o= c s �cso S 0 map - Lu p- m Lu C O = m � C .Orr C� ... p •N dt O G O O Lu W� CC COD O. ID O 'fl tR = W�`.�� O ♦- t � a i mF. AG a �z +* � O o �z W0 c W 0 cm C 'E m ow ®� CD O . ®a c cc 0 CD C CD CL .v CL 0) W 0 W U) LLI 0 uj N FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE Z8 03 _ -�36 LOCATION: Assessor's Map Number PARCEL �(1 �Z c �© SUBDIVISION Jy I -,A S -T LOT (S) VV STREET Sf ST. NUMBER USE ONLY***************************** R M D S or ib GENTS: CONSLWATION ADMINISTRATOR DATE APPROVED L " nATF RFJFCTFn COMMENTS . FOOD INP TOR -HEAT DATE APPROVED �/ DATE REJECTED TH , DATE APPROVED tiftp DATE REJECTED COMMENTS Q4 C1 PUBLIC WORKS - SEWERMATER DRIVEWAY PERMIT FIRE DEPARTMENT .1rej f1an tnIIrr tf&- RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 4 + REScheck Compliance Certificate 2000 IECC RES checkSoftware Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\PL2713.rck PROJECT TITLE: PLAN NO.29421 CITY: Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: Single Family WINDOW / WALL RATIO: 0.16 DATE: 02/06/05 DATE OF PLANS:' 5-30-00 PROJECT DESCRIPTION: COLONIAL HOUSE DESIGNER/CONTRACTOR: BRUNO ASSOC. 28 BERKELEY ROAD N. ANDOVER, MA 01845 Permit Number Checked By/Date COMPLIANCE: Passes Maximum UA = 455 Your Home UA = 361 20.7% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R --Value R --Value IJ -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 1680 30.0 30.0 -29 Wall l: Wood Frame, 16" o.c. 2512 13.0 13.0 101 Window 1: Vinyl Frame:Triple Pane with Low -E 36.0 0.330 119 Door 1: Glass 39 0.330 13 Basement Wall 1: Solid Concrete, or Masonry` 1680 19.0 19.0 99 Wall height: 8.0' Depth below grade: 7.0' Insulation depth:,4.0' COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 IECC requirements in RES checkVersion 3.6 Release 1 (formerly MECchec4 and to comply with the mandatory requirements listed in the RES checkInspection Checklist. Builder/Designer i Date I • L— 0 J REScheck Inspection Checklist 2000 IECC RES checkSoftware Version 3.6 Release 1 DATE: 02/06/05 PROJECT TITLE: PLAN NO.29421 Bldg. Dept. Use I Ceilings: ( ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity + R-30.0 continuous insulation I Comments: Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity + R-13.0 continuous insulation Comments: Basement Walls: 1. Basement Wall 1: Solid Concrete or Masonry, 8.0' ht/7.0' bg/4.0' insul, R-19.0 cavity + R-19.0 continuous insulation Comments: Exterior insulation must have a rigid, opaque, weather -resistant protective covering that covers the exposed (above -grade) insulation and extends at least 6 in. below grade. Windows: [ ] 1. Window 1: Vinyl Frame:Triple Pane with Low -E, U -factor: 0.330 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments: Doors: 1. Door 1: Glass, U -factor: 0.330 I Comments: Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be 1) Type IC rated, or 2) installed inside an appropriate air -tight assembly with a 0.5" clearance from combustible materials. If non -IC rated, the fixture must be installed with a 3" clearance from insulation. Vapor Retarder: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: [ ] Materials and equipment must be installed in accordance with the manufacturer's installation instructions. [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R -values and glazing U -factors must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-6.5. I Duct Construction: [ ] I All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic -plus -embedded -fabric, or tapes. Tapes and mastics must be rated UL 181A or UL 181B. Exception: Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Service Water Heating: [ ] Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. [ ] I Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 105 OF or chilled fluids below 55 OF must be insulated to the I levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulgling Runouts Circulatin2Mains and Runouts Temperature (Fl Un to 1" to 1.2.5„ 1.5" to 2.0" Over 2„ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pining System Types Range ( F) 2 RunoutsVandLess 21. 5 , to 2" 2.5 , to 4" Heating Systems Low Pressure/Temperature Low Temperature Steam Condensate (for feed water) Cooling Systems Chilled Water, Refrigerant, and Brine 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 Any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) TOWN OF NORTH ANDOVER °t 10R7M Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ACHust Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX February 10, 2005 North Andover Realty Corp. 459 East Broadway Haverhill, MA 01830 RE: Subsurface Sewage Disposal System Plan for Lot 2 Summer Street, Map 65 lot 91, Map 38 Lot 42 North Andover, MA 01845 Dear Landowner, The North Andover Board of Health has completed the review of the septic system design plans for the above referenced property submitted on your behalf by Christianson and Sergi dated October 4, 2004, last revised on February 8, 2005. The design has been approved for use in the construction of an onsite septic system for a residential home of 5 - bedrooms (total of 11 rooms maximum). This approval is valid for two years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be re'ached at 978-688-9540 with any questions you might have. Sincerely, Y. Sawyer, REHS/RS Public Health Director encl: List of licensed septic system installers cc: Christiansen & Sergi file The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigation Boston, Mass. 02111 - Workers' Co Vw=tbn Insurance Af davit Nine Please Print Name: � Location: []Check X immediate response is requi L ken&V Board ❑ City Phone a 0 I an a homeowner perfurrning all work myself. 0 I an a sole proprietor and have no one worldng in any capacity I am an employer providing workers' compensation for my employees working on this job. r; Y79 -a17( w C5 1?0q Polkv ! FdMue to secnee coverage as requUsd under Section 25A or MGL 152 can lead to the hgmklon of ah" peneNee d•a Ana up to $1.5w.00 andlorone years, imprison.rent.M.wd.M.CbdlPKWPJesJnlbsf=dASTOPYlfDM.oFD A2Cia.fkWd.($100.QM-aANagaind.me.1 understand that a copy of this statement may be forwarded to tM Office of Investigations of the DIA for coverage vertilcdlon. I db hereby candy under the pales and penalties QFPw qY that the InftMOSM provided above la bus and carred 6S II r Print namey,)rime V Carat V, P -Phor> #U g1g-i 7X Official use only do not write In this area to be completed by dty or town dW*r City or Town P � • Building Dept []Check X immediate response is requi L ken&V Board ❑ Selectman's Oflice Contact person: Phone !� 0 Health Department 0 Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL 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 licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: 30���� �c�w,r?s i �Q ter- lia 5��./ (Location of Facility) V� Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r I FROM :ROBERTS INSURANCE FAX NO. :9706033147 Mar. 11 2004 05:0711 F2 ACORQ,, CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMrDONY; 03/11/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M, P. Roberts 1'nnv,ratic:e Agonay Tnc; ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1060 OPquod Street ALTER THE COVERAGE AFFORDED BY, THE POLICIES BELOW. Nor"1:h Andover MA 0.1.845 978 683-8071 INSURED T'd1FV!T 1MOWTZ 1(:E.Ai'PY COIt>✓. 100 JO11N'NYC:.A.KE ROAD no. .ANT)OVFR, MA 0184') ,978-686 '1'14 OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A0CVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRCMI°IJT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE' MAY BE ISSUED OR NAY PERTAIN, THE INSURANCE AFFORDED BY THF POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH M^1 10,cc AnncFnA'l R 1 IhAITS SI•IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, �rSR I INSURERS AFFORDING COVERAGE INGURCil & WESTERN 111TORT 0 INSHK P Ch CC ;N3URERR HANO'VER INSURANCES INCURER C: GEN ERALUABILITY X mommLRCIAL GINEltA! I IAhil.f I Y ;;LAIMGMADE UCC:UR N9JRERD: UNTTF.D 3TATVS L1AD1LITY :I:N"1)RAN> F INSURER GUARD INSURANCE GROUP OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A0CVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRCMI°IJT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE' MAY BE ISSUED OR NAY PERTAIN, THE INSURANCE AFFORDED BY THF POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH M^1 10,cc AnncFnA'l R 1 IhAITS SI•IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, �rSR I TYPE Of INCUR ANCC ••• j �• POLICY NUMBER POLICYEFFECTNH DATE —...... Ppp ICYEKPIRATION ' D�T6 MMIDDWI I _.---... --- LMdITB A GEN ERALUABILITY X mommLRCIAL GINEltA! I IAhil.f I Y ;;LAIMGMADE UCC:UR N1111 70`T•14 0:1/13/04 U:?/7.3/(: i ai:H:�'=CURRGNCC — I FIRE DAMA,'IF (Any Mt. I'm) L 1,000,000 5 5u, 00 5,000 s 111 ORO, 000 MCUCXI'.Anyonohrmon; I11 PCsoNAt&ADV INJURY r?E.NERAI. AC,AR9AA76 L 2, 00D, 000 ' CiEN'L AOGREC+ATE LIMIT PLP. I $ 1/ 000, 000 ?RODJCT?-COMPKiPA,GO r _ I'rJLICY ,IDCR•; r-- PG 1 LCC I AUTOMOBILE n LIABILITY ANYAt10 c (Fnnc.^.Iean'j 1, 000, 000 GODILY IN:UPY (PeI pvrpOn) X ALL OYVINFr) AurOU gr,HEDUi.ED Alms:; I ; —......_..... 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I () DAV) WRITTEN 36 R.AR7I,E,TT STRLST 40TICE TO THE CERTICfCATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SMALL ANDOVER., MA O.1.A 10 IMP08E NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, 179 AGENTS OR UTREPRFRENTATN@S ANOM' . .EFREDINTATIVE IA ACORD 28-S'(7197) v ., rz' ACORD CORPORATION 1988 Z N D 0mK 0:�m < m cn M ;Q < 0 n D oZ0 w o m n M. m x -o m 0 N O O N W r z C �I n 3 N co d Q m O D : n X o n 0 Z V) � � O � W C C 1 n r' "' o -1 O oZ CD ZG w C/) M m� < D Xz Name L� Location 17,21- Check 7zCheck # _- l0 Date Note: RECEIPT NO( 1325 WHITE: Applicant TOWN OF NORTH ANDOVER Sewer Mitigation Fee $ --� Sewer Connection Fee $ -� Water Connection Fee $ Meter Fee $ Other $ TOTAL $ , Div. Pubic Works CANARY: Department PINK: Treasurer GOLD: File N m X m m m y m F, m wm o m so p ai ? 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