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HomeMy WebLinkAboutBuilding Permit #396 - 108 BRENTWOOD CIRCLE 12/15/2008 BUILDING PERMIT Of NORTH q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Jy yy /rw T s b T Permit NO: V► Date Received p ��SSACHU`-+���� Date Issued: ' �'�6 IMPORTANT:Applicant must complete all items on this page :x xu s r.+ t +(� 7 y LOCATION .x xPROP�EItTY OWNER MAP NO PARCEL <�ZONING DISTRICTHistofic Distract ; s no y .xn..W ; .s ar:f .tea t c s ....*� •«-t, .. ..,-' { c v. ' Machine{Sh`op aVilla a es no s TYPE OF IMPROVEMENT PROPOSED USE Re_side Non- Residential New Building < One family Addition '---Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other 'Sepfic �1Nell= Flgodplam� , Wetlands T Watershed;Distnctr~ 1'tl' 4n da x", Water/Sewer 4 :� 4 +. ,cz.� ��rka *xJ n fi#f _. _ - DESCRIPTIqN, OF WORK TO BE PREFORMED: Iden 'fication Pleas ype or Print Clearly) OWNER: Name: N �- pvwt��-v` Phone-q 2_^ n Address: �.��w�•S�'+ �?.{,�, ",� �,a �s- '�^+ ,�., ��' ,z� .K t s�: a�,� ..�€ �. "��°y'R� Y �<_� � L•-�.�""�s sw^ «;�.''r7-��+. "�i-t�+:c 1"'`� C^�g��a � �, ? s x.��'w..r�. �k:Y zsar'fii' °"t�..x*'� �'" w� aw_ � $r 4 '�s ,y= ty:t. 'gas k..�y a* fl, � �tyx"�•� CONTRACTORName �4�, Address- ? 5ss"' y..iay.'a: '� ar k � . v3 ? *. r L�+�. x yz S pervisoTsxGaristruction�'L�cense .���:� � t���.�-��`�� � 'Exp 'pate� a R -"'-u �p � ARCHITECT/ENGINEER Phone: I 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.:—,) r � NOTE: Pel"so s contracting with unregistered contractors do not have access o t guaranty fu d Signature ofYA ent/ S ,r k. k� �, Location Date No. MpRTM TOWN OF NORTH ANDOVER¢ F 9 Certificate of Occupancy 'ss�cHusttt'� Building/Frame Permit Fee $ Foundation Permit Fee $ I I Other Permit Fee $ 4 TOTAL $ r I Check # I 757 I i Building Inspector Plans Submitted Plans Waived Certified Plot Plan 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 NLY .INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS 4HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street FIREaf'. '$fie, . �DEPARTMENTem?IDunapstecoonslte yesTx, k ° � � w ": c.+-,` Locatedfats1�4a1n Street � F ,, y � i r`-- 5 � .rt .�r� 's`+z� t-w� a-,s +, S;.r`'' F� ,� .q A #'�.Y'�t as'�..,.a � � x�A'.r✓�`�„ '��=�,�. `�'"Ka ;+ � �..,ry' u � a �° -: ne +rx ,a Y:.�` -�.w+ -✓'� ruk:,.,.t'�'�'ts Z.�-;� g•r ted'.. , w� ,� ., � +r+ � 3• .�r`�"��� d"v` ��`¥' � �.,� ''„��'` � i.'�s�.sr�� � .�> �.�'�w.�*""'�:i r» ��.. 3,��'�+��„-`.w �".�, `'�°Y„ '�'��r"�.,+F.�M^' °4 saF. 's:,-„t� _�,+:.. ';p ��� �.• i���.,� rrs v�:.. .�..� x���' � ���b,,�. >`'' -� �7, �€-w_��{�.� r�� - F ..,�"-�y��:r . Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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.s100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 o 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 o Copy Of Contract . ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application L3 Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ 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 Application Revised 2.2008 ^Baystate Roofers, Inc. P.O. Box 189 proposal., North Reading,MA 01864 Tel. 978-664-0668 Date!' Estimate# Fax 978-664-4333 10/24/2008 444 . Name/.Address - Barbara Sonnier 108 Brentwood Circle North Andover,MA 01845, Bay State Roofers Inc proposes: Remove approximately 2800 square feet of the existing asphalt shingle roof down to the wood decking. Install new ice and water shield along the 6'roof edge, valleys and around all the roof penetrations. Install new 301b felt paper throughout roof area. Install new white aluminum drip edge along the roof perimeter. A new 25 Year GAF 3 - TAB asphalt shingle will be installed over the prepared substrate. A new ridge vent will be installed to ensure the proper roof ventilation. All roof penetrations and flashing will be installed according to manufacturers recommendation, specification and details. Cut and install new lead flashing on the roof chimney. Install new pipe flanges. Bay-State Roofers will properly dispose of all roof debris in our own waste containers. Any wood decking that needs replacement will be an additional $2.50 per square foot. Add additional $490.00 to remove old lead flashing from chimney and install new lead flashing and re - seal. New Shingle Roof i Authorized Signature: _ Total $8,840.00 Deposit Required $2,946.00 WlWcontainers supplied by Bay State Roofers, Inc. are for sole purpose of roof debris. Under no circumstance is the homeowner to use these containers for personal refurse. 5 Year Workmanship Warranty on all roofs. (Except Repair Jobs) CONTRACT ACCEPTANCE The specifications,prices,payment schedule are satisfactory and hereby accepted. Date: Attv� GLS BAY STATE ROOFERS,INC.is authorized to perform work as specified. Payment will be made as previously outlined. �G Signature All bills over 30 days are subject to 1 1/2%finance charge per month(1.8% annual). Color PROVISIONS OF THE AGREEMENT 1.PROJECT PROVISIONS e. Damage to Project•.Contractor will not be responsible for any a. Guideline:The Project will be constructed in strict conformance damage caused by the.Owner,or other causes beyond the control of to the plans and specifications which have been examined and the Contractor.Owner will pay for any restoration work. approved by the Owner. W.CONTRACTOR'S RIGHTS AND RESPONSIBILITIES b. CotttpGance:The Project will be completed in strict compliance a.Delay Contractor x417 be excused for any delay beyond his with all laws, ordinances, rules and regulations of the applicable reasonable control.These delays may include, but are.not limited to government authorities. Acts of God,labor disputes,inclement weather,ads of public authority, c. Controt:The Agreement plans and specifications ate intended acts of the Owner,or other unforeseen contingencies. to supplement.each other.In case of conflict,the plans will control the b.Right to Stop Work:If.any payment under this Agreement is_ specifications and the Agreement provisions willcontrol both not made when due,the Contractor may suspend work on the job until d. Charge Orders:As directed by the Owner construction lender. such time as all:payments due have been made.Any faGtxe m make Public body orinspedor any alteration or deviation from the specifications Payment is subject to a claim enforced against the Property in that involves extra.cost(subcontract,labor materials)wig be executed accordance with the applicable Gen laws. anly upon the parties entering 'alto a written change order.Expense- c.Substitution of Materials:Contractor may substiWte materials incurred because of unusual or unanticipated conditions will be paid for 'without notice to the Owner in order to allow work to proceed,provided by the Owner that the subsftod materials are of no lesser qualitythan those listed e. Allowances.If Vie Agreement pr[c-e kKA,des allowances,and in ft specifications. the cost of performing the work is greater or less than this allowance, d Salvage:All salvage resulting from work under this Agreement then the Agreement price will be adjusted accordingly. is to be retained by the Contractor unless other agreements are It.FINANCIAL RIGHTS AND RESPONSIBILITIES contained in the written speaficatioris. e. Insurance: Contractor will maintain workers' disability a. Labor and Material Contractor.will provide and pay for all labor and materials necessary to complete the Project_ Contractor is compensation assurance for-his employees and comprehensive public liability insurance polices. released from this obligation for expenses incurred when the Owner is in arrears in making:progress payments. V.COMPLETION OF PROJECT b. Permits:Contractor will obtain and pay for all required.building a. Notice:Owner agrees to sign a Notice of Completion within 5 permits and licenses. days after completion of the project. If project passes final inspection c. Taxes,Assessments and Charges Taxes,special assessments and the Owner does not sign the Notice,the Contractor:may act as the of Ali descriptions, and charges required by public bodies and utilities Owner's agent and sign the Notice. will be paid for by the Owner... b.Clean-up: Contractor is responsible for removing debris and d.Deposit of Payments: Contractor is required to deposit all surplus material.from the property, and leaving the property"in a neat payments received prior to completion in an escrow account In lieu of and orderly condition. such a deposit,the Contractor may post a bond or contract of indemnity VL CONFLICT PROVISIONS with the Owner guaranteeing the return or proper application of such a. Arbitration: Any controversy.or claim arising out of.this payments to the purposes of the contract All advanced funds will be Agreement that cannot be resolved,is subject to arbitration,with deposited as indicated under Special Provisions. Monies used in an arbitrator of mutual agreement, and all parties (including escrow become the.property of the Contractor when they are applied Owner,Contractor, Architect and Sub-Contractors)are bound to according to the Agreement payment schedule, when a breach of this arbitration: If any party does.not appear at arbitration contract by the Owner occurs. or when the Agreement has been proceedings,the arbitrator is empowered to decide the controversy substantially performed. in accordance with whatever evidence is presented by the e. Bankruptcy:1f either party becomes bankrupt,the other party party(ies)that do participate. has the right to cancel this Agreement. b. Attorney Fees:If either party becomes involved in.litigation iff.OWNER'S RiGHTS AND RESPONSIBILITIES arising out of Agreement,the Court shall award costs/expenses a. Cancellation: Owner has an.unconditional right to cancel the including attorney fees to the party justly entitled to them. Agreement, without penalty or obligation, until midnight of the .third c. Limitations:No action related to this Project may be made business'day after the Agreement was signed. Cancellation must be by either party against the other more than 2 years after the done in writing. Upon cancellation, any property traded in, any completion of work. payments made under this Agreementand any negotiated instrument Vil.GENERAL PROVISIONS executed will be returned within 10 business days following receipt by the Contractor of cancellation notice. a. Notice:Any notice required or permitted under this Agreement b. Property Lines: Owner shall locate and point out property may be given by certified or registered mail at the addresses contained j in the Agreement. fines to the Contractor.Contractor may,at his option,require the Owner to provide a licensed land surveyor's map of the property b. Prohibition of Assignment: Neither party may assign this Agreement or payment due under this Agreement without the written c. Liens:Failure to pay persons supplying materials or services consent of the other party. according to the terms of this Agreement may result in the filing of mechanic's liens on the affected property. Owner has the right to ask c. Oualification:.This document constitutes the entire agreement the Contractor for lien waivers from all persons supplying these of the parties. No other agreements exist. This Agreement can be materials or services.fn:the event any mechanic's lien is filed through modified only by written agreement signed by both parties. no fault of the Owner, then the Contractor agrees to take all steps d.Governance:This Agreement shall be construed in accordance necessary for the release and discharge of such.fien. with and governed by, Me laws of the.state in which the Project is d. Insurance:Owner will maintain:property damage insurance at located. least equal to the Agreement price. The Commonwealth of Massachusetts Department of Industrial Accidents Dffece of Investigations l% 600 Washington Street Boston MA 02111 W wK'-"nZSS.gov1dda Workers' Compensation Insurance.Affidavit: guilders/Coni tractors/Eler-tricia.nS/PlumberS Applicant Information Please Print LeQibiv Namt (Business/Organization/Individual): Address: a 4 6 � .k City/State/Zip: /U 16P wA—c� Phone#: y - ��f{ AZzan n employer?Check the appropriate box: 1. a employer with 4. ❑ I am a general contractor and 1 . Type of project(required): employees(frill 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 I �• ❑ Remodeling ship and have no employees The sub-contractors have working for me in an capacity. workers 8. E] Demolition Y P �'• ' comp. insurance. [No workers' comp. insurance 5..❑ We are a corporation and its 9' ❑ Building addition 3.❑ required.] ofiicem have exercised.their 10:❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1..(4). and we have no insurance required.] t employees. [No workers' 12•❑ Roof repairs comp, insurance required.] 13•❑ Other 'Any appiic ant.that checks box#1.must also fill out the section below showing their workers'compensation poiic},information. t Hurneowners who subnlii•(liiS ai%ldevit indicatil'12 thev alt coin&El,kvo k anri fficri hire ottiSfdB COniY11CWr6 t[tilSl aubmli a xConnactors that check this box must attached an additional sheet showing the n�+ f new atndavit indicating me o..the s S sorb, 5-conand their workers'comp,pot i�—information. I am ann employer that is providing workers'compensation insurance for nye a to ees. Below is the policy information. ° y p cy and job site Insurance Company Name: JM)Ae �y Policy#or Self-.ins. Lic. Expiration Date: Job Site Address _I �u-�sa� p ,�(� City/State/Zip: M k A'vdolev, Attach a copy of the workers' compensation -policy declaration page(showing the Policy P b p y number an .Failure t d expiration o secure coverage as re uire A p ration date). d under Sectio ) q n 25A of • MGL c. 152 can iP imposition of criminal fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDERIand of a of up to.S250.00 a day against the violator. Be advised that a a rine investigations of the o COPY of this statement may be forty b DIA insurance cove,age verification. � forwarded to the Office of Ido hereby cns e �p . 7 that the information provided above is true a Signature: CV�y and correct Dates: Phone 6� OffcciaL 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. Buiidine Department 3. City/Town Clerk 4. Electrical Inspector �. PiumbiuQ Inspector 6.Other p b Contact Person Phone 3L-'- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined.as"..-every person in the service of another under any contract of hit--, express or implied, oral or written." An employer is defined as`pan individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state o r local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings in the commonwealth forany applicant who has not produced acceptable evidence olf compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill out the workers' compensation affidavit compi-etely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es) and phone number(s)along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or.partners,are not required to carry workers'compensation insurance. If an_LLC or LLP does have _. employees, a policy is required_ Be advised that this affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The,affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regi ding the iaw or if you a*e required to obtain a workens' compensation policy,please call the Department at the nmazrber:Iisted beloi;,. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the`affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant: Please be sure to fill in the petmitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitAicense applications in arry given year,need only submit one affidavit indicating current policy information(if necessary)and under".lob Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a Iicense or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department ofLridustrial Accidents. Office of favesfibatioas 600 'Wadi ngton Street Boston, MA 02111 Te1. # 617-727-4900 vct 406 or 1-8.77-MASSAFE Revised 5-2645 Fax#617-727-7749 v^morass.c ov/dia I ACORD,. CERTIFICATE OF LIAB.ILITY INSURANCEOPID S3 DATE(MMIDDIYYYY) BAYSTI4 04/22/08 PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MacIntyre Fay & Thayer Ins Agy HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norwell MA 02061 i Phone: 781-261-2000 Fax:781-261-209 INSURERS AFFORDING COVERAGE MAIC#' INSURED _ - INSURER A:- National Union Fire Insurance ' INSURER B: —�--_- _ _`_•^� - Bay State Roofers Inc. tINSURER C: PO Box 189 r INSURER D: North Reading MA 01864 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T01 HE.INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT 0'R 0' ER00CUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCR� EC:HEREIN ISISUBJECT TO ALL THE PERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.'.: ADD' _ ___ _--..r PtjLIC NUMBER l--G'Y #FCTVI=;PILI -EXP7RATTON �---�_ LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DDIYY [ DATE MMIDD/YY GENERAL LIABILITY i EACH OCCURRENCE $ -DARWGETO-RENTE(S'—"-—...'.. COMMERCIAL GENERAL LIABILITY i PREMISES(Ea occurence) $ _- CLAIMS MADE OCCUR MED EXP(Any one person) $ - f --- $ i PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ I GEN'L AGGREGATE LIMIT APPLIES PER:j PRODUCTS-COMP/OP AGO I$ -- POLICY PRO- i JECT LOC AUTOMOBILE LIABILITY 'COMBINED SINGLE LIMIT _ ANY AUTO ! (Ea accident) $—Y� ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS i (Per person)- - - !! HIRED AUTOS BODILY INJURY M $ V , (Per accident) NON-OWNEDAUTOS -_- PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTOj EA ACC $` ^ 1 OTHER THAN f' AUTO ONLY: AGO $ EXCESSIUM13RELLA LIABILITY ! EACH OCCURRENCE $ I—�OCCUR CLAIMS MADE - AGGREGATE _- $ _ - i _ DEDUCTIBLE $ RETENTION $ I We STATU- H- WORKERS COMPENSATION ANDTORY LIMITS ER _ A EMPLOYERS' 531-5167 04/03/08 04/03/09 E.L.EACH ACCIDENT -�$500000 ANY PROP RIETORIPARTNERIEXECUTIVE -•-• i OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I$500040 OTHER i III ii ! i DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Evidence of WC insurance for Inslhrwhileiacting in the scope of their normal operations. i CERTIFICATE HOLDER CANCELLATION v 1 EVOFINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI01 i DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Evidence of Insurance IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR I i REPRESENTATIVES. j. AUT ED REP TAT1yF-y 8 ACORD 25(2001108) ! /_ ©ACORD CORPORATION 198 i I NORTH ovm 0 T f Andover No. 39to is .ir e ge o � dower, Mass. AIt > > �J GOCMICMEWICK . 7d ADRATED p' "�� `S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR. THIS CERTIFIES THAT.... .r..4. w............Sa.!! /1. .`• .......................................................I....... Foundation 11 f, ,R . .w.. .........� �, " Rough has permission to erect........................................ buildings on 1 ....:...�i . . to be occupied as.............. ...... ........... ...... I I �..... Chimney ' e provided that the person accept! this permit shall in every r pact conform to rms of the application on file in Final 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 CONSTRU T TS Rough Service BUILDING INSPEC Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.