Loading...
HomeMy WebLinkAboutBuilding Permit #641-15 - 104 MILK STREET 2/6/2015 N - BUILDING PERMIT of NORTH q- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION S Permit No#: Date Received �9SSgr¢o 5���9 C HU Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION - -Print PROPERTY OWNER _ Print 100 Year Structure yesno MAP _ a PARCEL: �_ ZONING DISTRICT: _ ___Historic District yes no Machine`Shop Village- yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: -_ -'Phone:. Address:- Supervisor's Construction License:. Exp. Date: _ -- r i Home'Improvement License _ _ -"Exp, pate"- ARCH ITECT/ENGI NEER ateARCHITECT/ENGINEER Phone:: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: I' OTE: Persons contracting with unregistered contractors do not have,access to the guaranty fund Signature of Agent/Owner Signature of contractor:.: _ i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � g Y) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Co of Contract t ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 N1 v' Plans Submitted El Plans Waived 0 Certified Plot Plan El Stamped Plans ❑ TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ,FIRE DEPARTMENT -Temp:Dumpster on site yes __ no ka Located z 124 Main Street Fire Department signature/date COMMENT ___ Dimension Number of Stories: Total square feet of floor area, based on'Exterior dimensions. Total land area, sq. ft.: l;< ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) i I A ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 49,780.00 m $ - $ 597.36 Plumbing Fee $ 74.67 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 74.67 Total fees collected $ 846.70 104 Milk Street Garage Reconstruction due to Fire BP#641-15 on 2/6/2015 Location ./ 1c/ No. Date f s - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �'-? Foundation Permit Fee $ rr, Other Permit Fee $ TOTAL $ ' Check#1J 2847 � Buildindinspector © 0 ' BUILDING&REMODELING CONTRACTOR MASSACHUSETTS HOME IMPROVEMENTS CONTRACT This form satisfies all basic requirements of the state's Home Improvement Contractor law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice q necessary.Any person planning home improvements should first obtain a copy of"A Massac husells Consumer Guide to Home Improvemenf before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 611-913.8787 or 14188.283.3751 or on our website. Homeowner Information Contractor Information Name Company Name Mr.&Mrs.McCleary Joscon Management,Inc Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 104 Milk Street Jonathan O'Sullivan Cityffown State Zip Code Business Address(must include a street address) North Andover,MA 01845 185 Atlantic Avenue Daytime Phone Evening Phone 978-688.2223 CitylTown State Zip Code Email:dennis.mccleary@gg.com Salisbury,MA 01952 Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number 603489.1568 61-1403121 Home Improvement Contractor Reg.Number 159444 Expiration date 4-30-2016 The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to complete;specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) The following scope of work and specifications have been based on my site visit and the original garage plans dated 7-4-97 by G.J Bruno Associates. Work to include the reconstruction of a 2 bay detached garage 28'x 24'. The new garage will be similar to the existing garage and the existing concrete foundation to remain along with the garage slab. General Conditions: • Town of North Andover building permit. • Project management and supervision. • Job site dumpster and debris removal. • Temporary protection throughout the construction project. Demolition&Site Work: • Demolition and removal of the existing garage structure. The concrete foundation to remain along with the slab. Further exploratory work needed to see if the existing concrete slab was damaged once all debris has been removed. • Remove the existing driveway asphalt approx.28'x 16'. Grade the area as needed and repave with a 2" binder and a 1"wearing course. Total asphalt thickness will be 3". Concrete Work: • Further exploratory work needed to determine if the existing slab was compromised. If so, repair cost to be proposed. Slab painting/coating TBD. Framing: • Per plans dated 7-4-97(code upgrades) • 2 x 4 exterior walls. • Lumber to be#2&better kiln dried spruce. • '/"OSB Tongue&Groove sub flooring throughout the loft area. • Y2" CDX fir wall sheathing • Y2'CDX fir plywood roof sheathing. • Install a steel beam per plans Roof: • Install 30lbs felt paper and white drip edge to the roof. • Ridge vent. • Install flashing as needed. • Shingle roof with Architectural 30YR shingles. Color TBD Exterior Trim: • PVC(AZEK or equal)exterior trim at the garage. PVC trim to be screwed and plugged. No painting of the exterior trim needed. Soffit to be AC plywood solid and painted the same as the trim color. • Furnish and install aluminum seamless gutters complete. Color TBD. Carpentry: • Install a Bessler attic stair unit. Model#70 Windows and Exterior Doors: • Entrance door to be a 6 panel door similar to the existing. • Windows to be Anderson 200 series double hung. Window grills TBD. • Garage doors with motors. Figured on a raised panel door without windows. Siding: • Install pre primed finger jointed cedar clapboards on all sides of the garage. • Siding to be over Tyvek house wrap or equal. Tape all Tyvek seams. Electrical • The electrical installation to include the material and labor for the following: • Further exploratory work needed to determine if the main feed from the house to the garage was compromised during the fire. If so,pricing TBD for a new feed. r , o (1)exterior light o (1)spot light o (1)exterior outlet o (2)garage door opener outlet/control o (7)interior single light fixtures o (5)interior GFCI outlets o (2)heat detector fire x o (2)smoke detector fire x. CO2 detector Exterior Painting: • Paint all siding areas of the garage. Trim will be screwed and plugged. No painting • Main house painting at the bay window area listed below. Bay Window(Main House): • Removal of the main house bay window. • Install a new Anderson TW double hung bay window including interior and exterior trim. Window grills TBD. • Siding repairs adjacent to the bay window. • Paint the exterior siding body on the first floor at the left side of the bay window to the corner board, right side of the bay window to the door trim and under the bay window. • Interior painting of the Anderson Bay window unit and trim work/casing. No walls. Sub total for the bay window project(pricing included in the total below: $4,347.00 Allowances:(Included in the total below) • Landscaping(disturbed areas) $1,500.00 • Steel Beam $750.00 • Garage doors incl motors $2,000.00 Total for the above project scope of work and specifications: $49,780.00 Required Permits— Building permit Proposed Start and Completion Schedule-The following schedule will be adhered to unless circumstances beyond the contractor's control arise. (Owners who secure their own permits will be excluded from the Guarantee Fund provisions of 2-16-15 Date when contractor will begin contracted wok. MGL chapter 142A,) 5.1-15 Date when contracted work will be substantially completed. Final completion depends on weather for painting and paving, Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of.$49,780.00 (*) Payments will be made according to the following schedule: $4,978.00 10%Deposit Upon signing contract. (not to exceed 113 of the total contract price or the cost of special order items,whichever is greater) $9,956.00 20%Upon the start of the project $14,934.00 30%Upon the of the completion of demolition and the start of the frame. $14,934.00 30%Frame and roofing completed. Siding 1 trim started. $ 4,978.00 10%upon substantial completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special$0 to be paid for NIA ordered before the contracted work begins in order to meet the completion schedule,(")$0 to be paid for NIA NOTES:(')Including all finance charges(")Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty•Is an express warranty being provided by the contractor? Mo o Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payment to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. MDon't be pressured into signing the contract.Take time to read and fully understand it.Ask questions if something is unclear. MMake sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. Moes the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a'proof of insurance"document. Wow your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESII Two' tica pi of the cg�tra mu be completed and signed.One copy aCQAA s ould go to the homeowner.The other copy should be kept by the co tract r �` �Homeow9er's S' n re. Contra cto ignature Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, c r 2A. Horn wner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials,In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumerihomeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems himtherself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http:/Iwww.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration corn t component of the Home Improvement Contractor Law,contact. Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http:/Am.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractors Registration:http://db.state.ma.us/homeimprovemenMicenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Jan.29.2015 02:17 PM Advantage Insurance Agenc 978 794 4933 PAGE. 1/ 1 CERTIFICATE OF LIABILITY INSURANCE 01/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NE(IATINEi_Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRE86NTAI IVE OR PRODUCER,AND THE CERTIFICATE HOLDER. e ce eta fielder IB sn ABDITI NAL IRIURED, the POW108) must 110 endorsod. If BR ATI , subject to the twine and conditions of the policy, certain policies may require an endorsement. A alltement on this cartl8alte doss not confer rights to the cectlflcate holder in lieu of such endomemor t s). PRt�UClR NpNTC PAUL DEVIN ADVANTAGE INSURANCE AGIICY INC. PHONE FAR Na.E 979-681-1055 (A�c,Ko)978-794-4833 184 PLEASANT VAL7AY STRRRT E401L .__.._.�..._.__..... ............_. ... ADORE69; NETRUEN M 01844 JNSURERIS)AFFORDING COVERAGE RAW MUA9hA:ARBELLA BROTECTION INSURRNCE OWANY IKsuReD INS!MRS ARBELIA MOUCTION INSURANCE COMPANY JOSCON bAM0MNT INC. 'W v^^- INBUR€R c 72 PROVIDFNCE HIM ROAD RavRERv: ATKINSON, NO 03011 INaURER E. INSURER P; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L18TED 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 WTH 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 OY PAID CLAIMS. 111311t — RUM BUS14 LTR TYPO OF INSURANCE INOR WW POUCY NUMBER (MµrpO/yYYY) (per _ LIMIT" X GENERALUaUfY 9500055690 05/30/201 05/30/2015 EAcrrOCCURRENCE a 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES $ 100,000 CLAIM&IAMB Fx IOCCUR MEREXP(Anyomp—r,) $ 10,000 PERBONALBAOVMURY $ 1,000,000 GENERAL AGGREGATE 9 2,000,000 GBNT.AGOREGATELIWTAPPIJF;'PER: PRoOuc7S-COMPIOPAGG s 2,000,000 - POLICY J"T LOC $ aarvn(aeKJ3 LIABILITY (Ee epcidwo _ s ANY AUTO BODILY INJURY(FW ponan) i ALLOWNED SCHEDULED SODaYINJURY(Parseeden0 t --- AUTOS AUTOS NOR OWNED HIRED AUTOS AUTOS (Pereccldano - .... ..-- UMBRELLA UAB pct uR EACH OCCURRENCE 9 8%tom LNUd CLAIMS-MADE ,uHGR EGATB. S _ PED RsTENTION .5 . . . .... s x YWORKERBCOaPENBATION 9121461012 10/05/2W.410/05/2015 TORYSTAI..'. Ep AND EMLOYERS'LIABIUTY ANY PROMIETORIPARTNER/EXECUTIVE YIN OFFICER7MEMBER EXCLUDED? ❑ MIA E.L.EAGH ACOIDEHT 9 1,000,000 IMendew.r NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 U SCRIPTION OT OPERATIONS b#WN EL.DISEASE-POLICY LIMIT 8 i',000,000 DESCRIPTION OF OPBRAM"I LOCAIMNB!VEHICLES YW=ACORO tot,Addlt*W RM WO BeMdutr,It n,om NMe It mqul m) GENEFULL QH977ZNTRT CERTIFICATE HOLDER CANCELLATION TOOM OF NORTH ANDOVER SVI7r02tQG DEPT. SHOULD ANY OF THE ANOVE DESCRIBED POLICIES BE CANCBLLEO BEFORE THE EXPIRATION DATE THVAEOF, NOTICE NRLL BE DEtdVFRM HN 1600 OSGOM STREET ACCARDANCE WPM THE POLICY PROVISIONS. BUILDING 20 SONE 2035 AUTHORMED NORTH ANDOVER MA, 01945 19611-2010 ACORD CORPORATION. AI dghtareserved, ACORD 25(2010/00) The ACORD name and logo are registerad marks of ACORD it The Commonwealth of Massachusetts Print Form Department of Industrial Accidents FOffice of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Jc ScciN rlctlCLgfneT t Address: 7�. (�rcv,�}2h re �-I��( rL J- City/State/Zip: K;t-sc►,• hJ ar{ ' >�Il Phone#: (,O3- Y �)9- ISO Are you an employer?Check the appropriate box: Type of project(required): 1.VI am a employer with__� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. []Demolition working for me in any capacity. employees and have workers' insurance.# 9. F]Building addition comP• [No workers'comp,insurance required.] 5. We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11. Plumbing re ❑ g pairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *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 thepolicy and job site information. Insurance Company Name: r�>e l)c pre tc�,c K •=n St r ch c c, Policy#or Self-ins.Lic.#:_9 1 O 61 o I a, Expiration Date: G �! o I S Job Site Address:_1 04 P-\ S41 qA City/State/Zip: M IJO V e, MA G y S` 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 hereb cerfi&under the pains and penalties o e 'u that thein ormadon provided above is true and correct. i Signature — Phone#: S Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• I � ��e���vrna�uueal'l�a�C��rxs:racfa�se/li� ` — Mee of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR gistration: 159444 Type: xpiration: 413012016_ Private Corporatio. JOSCON MANAGEMENTINC:r JONATHAN O'SULLIVAN f 72 PROVIDENCE 11ILL RD. ATKINSON,NH 03811 Undersecretary f1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards 1�I Construction Supervisor - I License: CS-070043 JONATHAN OSIJ�,�.IV 185 Atlantic Ave A �M s Salisbury MA 01952 i Expiration Commissioner ` 08/26/2016 1 t r 1 NORT#j . ve' 'o No. _ r * C, h ver, Mass, 1p A3, COCNICHlWIC.t 'ls.9s RATE[! U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... �I/ �'. „Ir-a.". BUILDING INSPECTOR .. .............. ....... .................................................................... .. has permission to erect ........................... buildings on .�.r�?�7.'.... .................................. Foundationi.:. ./.�..V.f / to be occupied as .... �1G�. ,1. � Rough ..1....:.. � .... G.h... Chimney provided that the person accepting this permit shall in everespect conf6rm to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR . UNLESS CONSTRUCTION STARTS Rough Service .................... ...... .................................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det.