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HomeMy WebLinkAboutBuilding Permit #1114-15 - 118 BROOKVIEW DRIVE 6/29/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ( � `2� (z civ V tr2tc-> 1121v, _ Print PROPERTY OWNER t ,h_erc._Y L 1&Aa—C.ZAPrint 100�L MAP NO: �PARCEL:�ZONING DISTIRICT: Historic Old Structure yes, no 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 zAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District D Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: D,4 .4-- CA_r r 0, 1 Identification Please Type or Print Clearly) OWNER: Name: CP) ,.-n_V L- 3.A 2 c_z A I<_ Phone: 9 19 6 $ R Address: . v CONTRACTOR Name: Ci b.L Ly Co-Lrr- _ .Phone: g _S_3_k 3,1-t Address: 7;), 7) _LAj , ✓o,c� �>9 b0Z Y I�1 O l Cr' 6 Supervisor's Construction License: C S 4 4 -7 4, 3 Exp. Date:—cam-l (4 -I . Home.Improvement.License: / g ( l Exp. Date: -23--11 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. p � c Total Project Cost: $ ©, l S FEE: $ 0 Check No.: Receipt No.: Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owrie_r - _Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ r Location ' ` " ��'V U� tC' .—) �VA-1 No. Date . - TOWN OF NORTH ANDOVER • S��'rD 76q� . ` Certificate of Occupancy $ v Building/Frame Permit Fee $ ° Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t i i 1 Check# 2b 4 Building fnspector t 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 SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ { COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at'124 MainStreet Fire Departinent,signatureldate ` COMMENTS 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.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Dgoc.BuildinPermit Revised 2010 - b - r 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 pp Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ 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/Crossection/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: .AII dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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: Doc.Building Permit Revised 2012 NORTH Town ot _E , ndover 0 . : . �. to As- I No. r 15ver, Mass, U COCHIC RWICK 1' X11,9 AORATEo S U BOARD OF HEALTH Food/Kitchen PER T T D Septic System C � A BUILDING INSPECTOR THIS CERTIFIES THAT .. 1 Z....... ................. ......................... ...... .......e.R. ............... ....................... Foundation has permission to erect 6w� buildings .. ..... •• • !�'�•• • ••••�•••. •••••••p .................. Rough ....... ....:...............................................to be occupied as .....��....... Chimney ronform to the terms of the application Final provided that the person accepting this permit shall In every e p on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO A Rough Service .................... .... .. ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Page No,_�ot _Pages LEN GIBELY CONTRACTING CO., INC. r 23RWinterStreet 26479` PRQ,PQS� �.' L PEABODY, MASSACHUSETTS 01960 ' , All home Improvement contractors and subcontractors (978)531-8234 Fax(978)531-9304 engaged In home Improvement contracting, unless www.len ibel dontractin specifically exempt from registration by Provisions of 9 Y 9•com Chapter 142A of the generalllaws,must be registered Submitted l,, r $e;;a with,the Commonwealth of_Massachusetts anqulries To: -rt��!�- about•registration and stature should be made to the 1 I' Director;Home Improvement Contract Registration, U)PG�)J r One Ashburton Place,Room 1301;.Bostoii,ldA 02108 +' (617)727=8598 vOwners wtio°secure"their own ,ri< 'in It construction,related permits or deal,withwnregistered Ol �y � 19 yS . : contractors will be excluded from the Guaranty Fund Provision of MGL c.142A. .,. GATE I+ w.. :...w HEdISTRAf10N N0 HONE... --79 /���(�s.,�/»gip r,...._.� t, „MA REG �00811.:,i e qtr, Oe NAMERJO. 1^,-:illi :Y'. '.•J. .�, 't JOB LOCATION w.l{t -,t ti-tyre it +,':} Wehe re submit'pe mcagons and estimates for work to be performed and materials to be used: .. ,.1:: + �•t es � It;. .'i.r" ' y ,i.. - n1Yv(.i: ,: .d'r 'i..+ r. *)f �+ ��'l.. l,yi rk' f •.r� .. ;»'• :;'ri•R r-1 /fit iel-Ar a -71 In r fY7 �. • ,r<,. '•w.�u,y... +,�.r,_:4._.'y,.-,•.J.iF•,. ;S~+r.J._ ?R,� - 'u'« r` .e:ek...... �.W'x..r .«...+F•—i..,a6*Via. ,-t. {a�. 2ili4�fl�t t ll fY i �'JF r n ^P$• .t r �° t ril Ml -for Mo ° WORK HED n ".O�t)Rr• .f ti.,..a,- ii.: 1 . i-. rr ,�. Contr - %II be a work or order ft materials before the third day following the signing of this Agreement,unless specified hereinbwritl t'o I b in the work on or about t (dale).Barring delay caused by circumstances beyond Contractor's control the work Will be completed 41vly§ he Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shaJ►.(�oybe considered as Vic so.lfa of this Agreement. Hidden rot or candiUona nal seen at tined esWnate that are required to be repaired in order to complete this contract will be completed at$�—per man hour(MAN HOUR).... WARRANTY �V�✓� The Contractor warrants that the work furnished hereunder shall be free from defects In material and workmanship for a period of following completion and shalt comply with the requirements of this Agreement.In tins event anydated In workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after Completion of wry job,Including dean up,the Contractor shag,al his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired,or replaced, such damage crouch defect in materials or,"rkmenehip.The foregoing warranties shall survive any Inspection performed in connection with the,agreed-upon work.- We Propose�her- eby to furnish material and labor,-complete In accordance with above specifications for t sum of: •--.1- Y.•,.�-*.P--^...".`" � Payment to be made as follows: Remove all job trash. r ' ', All guarantees on all products from manufacturer. I Cs �yJ; ,li }I°:'• _% ..dsd,L—)upon signing_Contract Add permit cost if needed-we pull permit ( f upon completion of - Notice: No agreement for home Improvement contracting work shall require a. _���$ down payment(advance deposit)of more than one-third of the total contract k($ )upon completion of price or the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise obuit delivery of special order _ shall be made forewifh upon materials and a ent ,"•3 i.($ )completion of work under this contract - .:., tit C .F "4 t.S ( i-'ueiU .may{ +:r f •. 3 1 ;J r. ,1. .. • `1.t 1• -e «,, ,rt,nva ,t .. Note.This proposal may be wnhdrewn by uIllI notexcepted within days• pnaturezs,l fit.•- i ko ...r ..x .b4A-47 r +."if•, r--t r,.,y aJ •"�fi:,kh ,:y.,;i:•S,,$Ao , ,.1„ s1 a Acceptance Of PrOp05al.I have read both sides of this document and accept the prices,"specificatiofis end conditions stated,`I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified:Payment will be made as outlined above. You-the Buyer,may-cancelrthis transaction at any time prior to midnight of the third business day after,the date of this transaction,Cancellation must be done in writing ;, t n DO NOT SIGN THIS CONTRACT,IF THERE ARE ANY BLANK SPACES ( "Date '-,� Signature Date ` Signature .. , IMPORTANT INFORMATION ON BACK 1 t ', � � -The'Comino altJt.o - Department oflndustr alAccass�-husettsidehis' rwe oflnpodgations, 1 Congress S'tre`et Suite 100 Boston,MA 02114-2017 WW-W s goy/iia. Workers'Compensation InsuranceAf�davit:Builders/contractorsAnectrie><ans/i'lumbers . Aualicant Information %ase 'nt Lembly Nalrie(BusinesslOmwizahon/individual):_- -e..w • b L1( �` Addrew . Ci /State✓Zi ..= . ' Aiyou an employer?!•Check the%appropriate box. r J. I am a employer with o�l-': 4: I am a general contractor and I ?'Ype ofR_. ogFct::P,, iced) employees Cfull and/orpart-time).* haveh t+ed-the subcontractors �. :�]New construction . 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. a Itemodehtg ship'gnd`have`no employees These-sub-contractorshave.,.. forme in an 8•'[]'Demolition war y capacity. employees and have workers' IN o workers' comp.insurance comp-insurance.: 9. []Building addition re4uiied•l 5• We are a corporation and;its 10[J Electrical repairs or additions 3.❑ I axn a homeowner doing all work office have exercised tfieir 11, ply, m self o ... rep Y [N wQ ars' comp. i�ght of'eicemptidh pet MGL Pairs or additions insurance required.)t c. 15d"'41"(4)'' and a"'hav, n- 1 z.,.�Roof repairs employees [No workers' 13.0 Other comp �ti urance regwred AnY applicant flint checks box#1 mutt also fill out the section below shgwrn�thga workers'oompensapon h utfomuuion. t Homeownvn who submit this affidavit indica' po cy y „ ip bias they.ar a doing all work Arid then hire outside conftactois must subnut a new affidavit indicating such. tContraetors that check this box wrist attached'an additional shda showl6g the name'of _sub�on6actots'and state whether or not those eatides have .. employees. If the sub-oontractors have crployees,they must provide their workers'comp policyntdttber: I am an employer that is providing workerscompensation bisurance for my employees Below Is the o and ob sfle� information. P J InsuranceCompan Name: . Y '� M� P a� Policy#.6t Self-ins-I;ic.*Lk—WC10 O- bpi n 147 — yt^iExptfatton Date Job Site Address: tZ o ^ } �k, `.�n—.. • City/Sttt�Zip�n,��v,�a,ti_ Attach a copy of the workers'compensation policy declaraon a e show.in the lit , umber and explratr date Failure to secure cov a as. p g ( g po y n t upder S.ec_'on 25A of MGI,'c. 152 can 1,to.the imposition o> criminal pent}ltiea ofn fine up to$1,500.00 and/or one-year rnppusonnient,as well 4s:civil pepalti,"the forme of a STOP WORK .4-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;DlA,for insurance., x erifiCafOlL erage: Ido hereby y cfy under,thep .andpenldes,ofPerJu ry,dW he infgmtalion prpW*d abov.0.ls.&ue.and correct , n Poh 'Dade IS e#: Cif l FFOther only. Do not wrke in this area,to be conrpleredby city or town official n: Permit(U ansa ority(circle one): ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son• Phone#• CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYW) �..� 08101/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.,-THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01634-001 VAJACT Edward F Sennott Insurance DPW E.0:16 South Main Topsfield MA 19831 ��Rss: INSURER(S)AFFORDING COVERAGE NAIC N INSURED JR-SUBER A: A.I.M.Mutual Insurance Company 26158 Len Gibely Contracting Company Inc INSURER 0, 23 Winter Street Rear INSURER C' Peabody,MA 01960.6941 INSU ER D: INSURER I INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ ITR TYPE OF INSURANCE I yP' � POLICY NUMBER Mh1M1iUlYYY � �Py LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL COMMERCIAL GENERAL LIABILITY DAMAGETO $ CLAIMS-MADE OCCUR ncel MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ _--.-_ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY —r R O" OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident)ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON.OVMED PROPERTY AUTOS DAMAGE(Pot accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ yypRDEEpDg ERETTpETNTIONN$ y�;STq U 7F $ ANNNyDy PPEgqMppRpOR���77��PS��'CIgqARR8TT1�NN4EE4R/ Y N X TORY LIMITS _ GERI A OFFICER/MEMBER�EJCCLUDERECUTIVE� NIA VWC-100-6010979-2014A s/3/214 8/3/2015 E.L.EACH ACCIDENT $ 600,000.00 (Mandatory in NH) FN I E.L.DISEASE-EA EMPLOYEE $ 500,000.00 D�SCRIWO O��PERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) TM 01/30/2015 PRODUCER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 4S7 Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Len GT e y Contracting Co., Inc. INsuRERA: First Mercury Insurance Co 23R Winter Street INSURER B: Safety Indemnity 33618 Peabody, MA 01960 INSURER C: INSURER D: j INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR F4DD*L POLICY EFFECTIVE POLICY EXPIRATION -LTRjNSRC TYPE OF INSURANCE POLICY NUMBER DATE MMIDO DATE MM/D LIMrrS GENERAL LIABILITY _ _ MA-CGL-0000051263-01 01/29/201S 01/29/2016 EACH OCCURRENCE $ -1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,00 CLAIMS MADE I OCCUR MED EXP(Any one person) $ S,00 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYF—j JEECTT RO- LOC AUTOMOBILE UABIUTY 6221693 COM 02 01/29/2015 01/29/2016 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ B .) X SCHEDULED AUTOS (Per X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F]CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER - ANY PROPRIETOR/PARTNERIEXECUTIVEa E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) - E.L.DISEASE-EA EMPLOYE $ S yes,describe under IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ SPEC OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS roof of insurances. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robert Sennott RP ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .......................w.« Massachusetts .'Department of Public Safety Board of Building Regulations and Standards Cun�tructiun Supervl�ur License: CS44783, i THOMAS R DOB#IN 010 Expiration Commissioner 05/1412010 (921 wwwnOMveal 0110A aacsliu 60 ifice of Consumer Affairs&Business Regulation License or registration valid for individul_.use only OME IMPROVEMENT CONTRACTOR before the expiration date. if found'return to: Office of Consumer Affairs and Business Regulation TRegistra ion;; q Type: 10 Park Plaza-Suite 5170 Expire `_ r Supplement Card Boston,MA 02116 LEN GIBELY CON Y INC. { THOMAS DOBBIN .' RR 23 R WINTER ST G. -�: PEABODY,MA 01860 �• '^~"—��-"��- Vadersecretary Not valid without signature , f • r f C10RTIy Town of dover No. y �' 1 dower, Mass., 9"0/07,-o?d0 QCOCMIC W � "ted ADRATE D P?�,`�5 H E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT..... BUILDING INSPECTOR s . ........t .......6.............. 3 ati d ' oun on has permission to erect.s7.93..x...�.Q1..- ..... buildings o ,. .....�..,B���v/r w....a���� Rough to be occupied as..A' r0V N� Chimney ............................................................ provided that the person accepting this permit shall in every respect conform to the terms of the appli ation on file in Final I this office, and to the provisions of the Codes and By- ws relating to he Inspection, Alteration and Construction of Buildings in the Town of North Andover. �D ` '7' a �D PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough O 0 PERMIT EXPIRES IN 6 MONTHS Final �'• �)�t LESS CONSTRUCTION ELECTRICAL INSPECTOR POP�{ ON STAR Rough L�N .......... .... ..... ... .. ....... .......................................................... Service ' BUILDING INSPECTOR 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.