Loading...
HomeMy WebLinkAboutBuilding Permit #770 - 126 MOODY STREET 6/24/2008 BUILDING PERMITo` "o DTH qti TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit NO: 0 Date Received (� A�gA7ED N SS'iCHU`��� Date Issued: �0 2 p IMPORTANT:Applicant must complete all items o`nefflis'page LOCATION-_Q , Print PROPERTY OWNER Print MAP NO. 910 PARCEL: ZONING DISTRICT`: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential New Building ne famil' Additio Two or more family Industrial Alteratio No. of units: Commercial replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: - C Identification Please Type or Print Clearly) OWNER: Name: ^*"-- Phone:07-1 —0770 Address: CONTRACTOR Name: rs 6�,,:scl.,Ac, Phone 77Wk -A`,kC'l S'0a Address: . Supervisor's Construction License: Exp. Date; / 5~ [10 _ Home Improvement License: C t Exp. Date: Ila G 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. Total Project Cost: $ ! /0 Ci FEE: $— Check No.: ZJ-2 72 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 8lgnature of Agent/Owner Signature of contractor Plans Submitted Plans WaivedC=PlotStamped Plans TYPE OF SEWERAGE DISPOSAL ublic 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 CONSERVATION Reviewed on a�2 Si nature COMMENTS f()A4 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 Main Street Fire Department signature/date 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.$100-$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 ❑ 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: All 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 o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location /Z00 No. -7 7y Date ay 4 Ma�TM TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check # X3772 �- r + L � Bjddinginspector PROPOSED PLOT PLAN REV I Br 126 .MOODY STREET REV.2 BY- NORTH ANDOVER, HA PROSPECT STREET 50.01 LOT J12 AREA=-5,855 S.F. BUILDING SETBACK 9 9 lz 1 •7 LOT X10 LOT 1 # 4 I , PROP. 3 DECK N 12 6' t< EX/ST. DECK TO BE REPLACED I 9.9' 4' o IEXIST. ti DWELLING lz I 12.5 14.0' I.P.(FND. (HELD) _ 50.00' gooDY STREET �50,_puwc R a w) * BUILDING CONFORMS TO LOC& APPLIC48LE ZONING BY LAWS /N EFFECT WHEN CONSTRUCTED, WITH RESPECT 70 HORIZONTAL DIMENSIONAL REQUIREMENTS, OR /S EXEMPT FROM KOLAT/ON ENFORCEMENT ACTION UNDER M.G.L. T17ZE V/I, CHAP. 40 A, SECT. 7, UNLESS OTHERWISE SHOWN HERE/N. MIN/MUM BUIL DIA SETBACKS PLAN /S INVALID WITHOUT / CER77FY TO THE NORTH ANDOVER BLDG DEPT. RED,SURVEYORS SEAL FRONT YARD = 30' THAT THE PROPOSED DECK AS SHOWN DOES NOT CONFORM WITH THE TOWN OF N. ANDOVER ZONING SIDE YARD = 15' REAR YARD = 30' REGULA77ONS REGARD/NG SETBACKS FROM A S. 19 / ). DEED REF BK. 8438 PG. 262 S7REET LINES AND LOT LINE PLAN NO. 34, YEAR 1909 126 MOODY S71?EET ..:t-1 MEISNER BREM CORPORATION FERNANDEs SCALE- 11=20' 151 MM SnUT, SAM Nl 03M (on e93-mm113 142 UnLM M%UK 16,KSlFtxlq,W 01886 918 892-1313 DATE JUNE 17. 2008 JOB NO. Z:\Land Projects\MOODYST—PPP.dwg, 6/17/2008 3:09:56 PM, Auto HP Deskjet 5700 Series on KURT1 From: FAXmaker To: 19786889542 Page:3/3 Date:6/24/200811:39:17 AM I A_C4RD,M CERTIFICATE OF LIABILITY INSURANCE 6/242"'008 PRODUCER (781)393-4321 FAX: (781)393-4959 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LoPriore Insurance enc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 394 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford MA 02155 INSURERS AFFORDING COVERAGE NAIL# INSUREDINSURERA:Preferred Mutual 15024 Giordano Contracting Inc, DSA: Eric Giordano NsuRER&Acadia Insurance Company 27 St. Anns Avenue INSURER Q INSURER D: Peabody MA 01960 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AN 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. VTE LIMITS SHOWN MAY HAVE BEE q REDUCED BY PAID QLAIMS- NSR RL POLITYPE OF INSURANCE POLICY NUMBER DATE I�TIVE DATE(AMNDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY PREM 13ES0 eFo T Inc $ 100,000 A CLAIMS MADE —low t1R CPP0110589827 1/22/2008 1/22/2009 MEDE(P none arson 5,000 PERSONAt&ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 GEN1 AGGREGATE LRIIMpIT.APPLES PER: PRODUCTS-COMPIOP AGG 2,000,000 X POLICY PELT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: AGG EXCESSIUMBRELLA LU181UTY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE $ RETENTION B WORKERS COMPENSATION AND STAB OR - EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERAD ECUTNE E.L.EACH ACCIDENT $ OFFx:EWMEMBEREXCLUDED? WC-20-20-000002-00 2/6/2008 2/6/2009 E.L.DISEASE-EAEMPLOv 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHK:LESIEXCLUSKNJS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL Brian 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAME)TO THE LEFT,BUT 126 Moody Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE N Andover, MA INSURE ITS AGENTS OR REPRESENTATIVES. AUTHORMEDREPRESENTATNE -. Teresa Higgins/TH - -�-{'UG7�-- - '1 •ems.*-- �' ACORD 25(2001/08) O ACORD CORPORATION 1988 This fax was sent with GFI FAXmaker fax server.For more information,visit: http://www.gfi.com GIORDANO CONTRACTING, INC. CONTRACT FOR HOME IMPROVEMENT/REPAIR Page 1 of 6 A. PARTIES TO THE CONTRACT 1. This Agreement made this 11thday of June by and between Giordano Contracting, Inc. hereinafter referred to as"Contractor", and Tong Fernandes hereinafter referred to as"Owner' is made in regard to the contracting services as set forth in Attachment"A", hereinafter referred to as the"Project". The Owner and Builder agree as set forte: below. 2. The address of the property where the Project is to be performed is: 14 oo (a v5v o ' � r l N- Owner hereby declares that he/she is the owner of record of the property, has the right and authority to have the Project performed on this property and maintains homeowner's insurance on the property. B. SCOPE OF WORK 1. Giordano Contracting, Inc. will provide only licensed and insured contractors to perform on the Project. Giordano Contracting, Inc. will perform only services for which it is licensed. 2. Giordano Contracting, Inc.will secure permits as necessary for the Project, but costs associated with the same shall be the sole responsibility of Owner. In the event that Owner elects to secure permitting directly, Owner will not be eligible to make a claim under the Contractor Guaranty Fund. In addition, if Owner elects to secure permitting directly, Owner shall be solely responsible for identifying and securing all applicable permits, as well as for assuring that the Project, as set forth in Attachment"An, sets forth proper materials and work process to comply with the requirements of said permits. Giordano Contracting, Inc. to obtain permits: X Owner to obtain permits: GIORDANO CONTRACTING,INC. CONTRACT FOR HOME IMPROVEMENTIREPAIR Page 2 of 6 3. The detail of the work process to be performed and the materials used appears at Attachment"A"to this Agreement. Any plans, blueprints, drawings, additional writings, etc., that are meant to constitute the Scope of Work for the Project shall be identified in Attachment"A"and shall appear as Exhibits attached thereto. Attachment W and any Exhibits thereto shall be signed by the parties to this Agreement in order to be valid. Attachment"A"and any Exhibits thereto, once signed by the parties, are hereby incorporated by reference and shall become part of this contract. In the event of conflict between the provisions of Attachment"A"or Exhibits thereto and this Agreement, the terms of this Agreement shall control. 4. The parties understand that Attachment"A"and Exhibits thereto, if any, provide for a plan of construction/repair. The parties further understand and acknowledge that Contractor will use best efforts to strictly follow the same as provided, however, circumstances may arise wherein deviations may be necessary, desirable or appropriate. Deviations, if any, shall be set forth in writing and, in advance of performance of such work, shall be consented to by Owner via execution of the written deviation description. C. TIME OF PERFORMANCE 1. Assuming all conditions are satisfied (e.g. securing of permits, remittance of initial payment)and weather, if applicable, permits, then the parties contemplate work under this Agreement to begin on 2008 . Contractor shall use best efforts to substantially complete the work by 2008 , although there shall be no definitive timeframes for the completion of work and time is not of the essence of this Agreement. Any time lost by reason of changes to this Agreement or changes in the anticipated work as set forth in Attachment"A"and/or any Exhibits thereto, other acts of Owner, strikes,weather conditions not reasonably anticipated, or any other condition not within Contractor's control shall be added to the specified time for completion. D. CONTRACT PRICE AND PAYMENT SCHEDULE 1. Price Owner agrees to pay a total price of $5,000 dollars to Contractor for the project, and Contractor agrees to provide all the labor, materials, equipment, tools, and other services necessary to complete the project as set forth in Attachment W and the Exhibits thereto. GIORDANO CONTRACTING, INC, CONTRACT FOR HOME IMPROVEMENT/REPAIR Page 3 of 6 2. Terms After the three-day rescission period that starts with the signing of this Contract, if Owner elects to proceed with this Contract, Owner shall provide 1/3 of the total price to Contractor as a deposit. For the project at issue, said deposit is $1700.001100 Dollars.00). If said deposit is paid by check, Contractor shall not be obligated to purchase materials for the project until the check has cleared processing with the bank. Owner agrees to make the final payment of the remaining 2/3 of the total price in simultaneously with Owner's final inspection and acceptance of the project. For the project at issue, said payment is $3700.00 and 00/100 Dollars.00). If necessary, at the final inspection, Owner will give Contractor a signed and dated list that identifies any alleged deficiencies in the quality of the work or materials. In this event, Contractor shall receive the final payment at the second final inspection described below_ Contractor shall correct any items that are, in the good faith judgment of Contractor, deficient in the quality of the work and/or materials according to the standards of construction in this geographic area. Contractor shall complete an effort to correct those defects within a reasonable period of time and a second final inspection shall take place. Owner shall then sign a certificate of acceptance acknowledging that any alleged defects have been corrected according to the standards of this contract. 3. Additional Costs In addition to the contract price, Owner shall be responsible for costs in addition to labor and materials necessary for the completion of the project. Said costs shall include; but not necessarily limited to the following: a. Disbursements made and obligations incurred for or in connection with the furnishing, delivery and installation of machinery, equipment and other items that may be required to complete the project. In the event that additional machine, equipment or other items beyond those contemplated in Attachment"A"and the Exhibits thereto are required, Owner will contacted for consent by Contractor as per the change order process of this Contract. b. Necessary approvals, permits, easements, assessments and charges(of those other than Contractor)as may be required for completion of the project. c.Water, heat, electricity and utilities as may be required for completion of the project. GIORDANO CONTRACTING, INC. CONTRACT FOR HOME IMPROVEMENTIREPAIR Page 4 of 6 d. Costs associated with providing a suitable work environment for Contractor relative to climate control, cleanliness and access where applicable. E. INSURANCE Contractor shall obtain all worker's compensation, commercial general liability insurance and comprehensive liability insurance necessary to protect Contractor from claims for damages due to bodily injury, including death, and for damages to property that may arise out of and during operations under this Contract. Owner shall purchase his own liability insurance including fire and casualty insurance to the full insurable value of the house. Owner's insurance shall include"all risk" insurance for physical loss or damage including, without duplication of coverage, theft, vandalism. and malicious mischief. Each party shall issue a certificate of insurance to the other prior to the commencement of the project. F.ACCESS Owner shall have access to the property and the right to inspect the work in the presence of Contractor at any time. If Owner enters the immediate work area during the course of the project without the permission of Contractor, he does so at his own risk, and Owner hereby releases Contractor and does hereby hold Contractor harmless from any all claims for injury or damage to his person or property, and to the person or property of any person accompanying the buyer, as well as to damage to the project work itself. G. ENFORCEMENT In construing and enforcing this Agreement, the laws of the Commonwealth of Massachusetts shall apply. In the event that legal counsel is utilized to enforce the terms of the Agreement, the successful party may collect all expenses associated with the same for enforcement or defense, including litigation costs and reasonable attorney's fees. GIORDANO CONTRACTING, INC. CONTRACT FOR HOME IMPROVEMENTIREPAIR Page 5 of 6 H. MISCELLANEOUS 1. Governing Law This contract will be construed, interpreted, and applied according to the law of the Commonwealth of Massachusetts. This Contract shall not be assigned without the written consent of all parties. 2. Entire Agreement This Contract and Attachment"A"and any Exhibits thereto states the entire Agreement between the parties and neither party shall be bound by any stipulation, representation, Agreement, promise or otherwise not printed or inserted in this document or as an Exhibit. 3. Effective Date Upon the signing of this Contract, a three-day period of rescission at Owner's option shall begin. Said period shall terminate 72 hours thereafter and, at that time, this Contract shall become effective and binding upon the parties. In the event that Owner elects to rescind this Contract, said rescission must be communicated to Contractor prior to the commencement of work. Rescission may be communicated by_ We, the undersigned, have read, understood, and agree to each of the provisions of this contract and hereby acknowledge receipt of a copy of this Contract. V� 'L�t, Date: Contra Dat Owner Date: Owner The Commonwealth of Massachusetts I Department of Industrial Accidents Office of Investigations a.... y 600 Washington Street Boston, MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r Please Print Legibly Name(Business/Organization/Individual): r� � �i� ciC ►�.ca �-ZC Address:(, 9 , Aj e— City/State/Zip: �eS6Ay . ,AAA Phone Are you an employer?Checktheappropriate box: Type of project(required): L E lam a employer with C 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.[] Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ac.,xcs-'_ -1^ r"C-c 1 6 Policy#or Self-ins. Lic.#:VJ(_-dj.2,U'Q(7000Ja-O Expiration Date: 01 tp Job Site Address: \�ro �CC[ �_ N l 'Lls-&C /" \/ City/State/Zip:,Jl}, 'k-Aatr 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 under pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: Oficial 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#: 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 hire, express or implied,oral or written." An employer is defined as"an 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 be an employer." MGL chapter 152, §25C(6)also states that"every state or 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 for any applicant who has not produced acceptable evidence of 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 completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)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 be 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 regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job 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 license 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 of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia { ✓le �om,norzcu _ - � BOARD OF BUILDING REGULATIONS �s ¢License: CONSTRUCTION SUPERVISOR , k Number:-CS 093839 i - Birthdate;02/25/1980 I r Expires 02/25/2010 Tr. no: 93839 Res'tricted_00z. ERIC F GIORDANO'`- 27 IORDANO`27 ST ANUS AVE PEABODY, MA 01960 ' Commissioner ^Y ante �aiYvrripnurea�C/i a ��N+� ivaeCle Board of Building Regulations and Standards lug HOME IMPROVEMENT CONTRACTOR Regist[aHOW 158611 xpiratr-n 2/12/2010 Tr# 264227 'rYp�e Prt�rate Corporation GIORDANO CON�TICTI►�G,HVC' GIORDANO 27 ST./ PEABODY,MA 01960 Administrator �ORTIy Town of sAndover 0 No. 770 o o dover, Massa LA COCHICHEWICK �A0RA7'ED P,?a` �y BOARD OF HEALTH E Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �'��✓�,���� �:c' ................ ................ .............. ............................................................................... Foundation has permission to erect........................................ buildings on ..✓' ... ��-a ....... ,� .............................. Rough to be occupied as............... ... ...�`".4'.�.-. ....�..... ..a'.".�'....� �..',�'-�:.............................................. Chimney provided that the person accepting this permit shall in every res ect conform to the terms 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 PERMIT EXPIRES IN 6 MONTHS S Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough ............ ......... �.,,,+,. ...M............................. Service BUILDING INSPECTOR Final Occupancy .Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and.Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det.