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HomeMy WebLinkAboutBuilding Permit #574-2017 - 136 COVENTRY LANE 11/29/2016� r i �uf"O RT 6 BUILDING PERMIT o ;�tio 32 a�rpt '+h 6 TOWN OF NORTH ANDOVER » - APPLICATION FOR PLAN EXAMINATION T � ey � Op <ocrcu.ewrcw 1' Permit No#: S7 V -9-617 Date Received 0R�rEo gSSACHUS�� 1+ Date Issued: — /4 IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER \ OC€ ✓ � P�r'1 ��'�'� iPrint 100 Year Structure yes no { MAP 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 gyration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other s8a e ❑ Fletlan � trit er/:Sewer . +a'.. f i. } DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: l�f,-AA3 IQ�k FO M r-R E-'T" Phone: T Address 3 6 CAVi�Tl�_`{ -,F►-N 6V c� �4 N©� �`� Contractor Name: BOE C'E V') BJ Phone: 7 9- 4� f�360 Em'I[ a° orl— t_/•IP AL)M-01i-�6- (01D /VI*4 - �a� cam/ S0 Supervisor's:Construction License: - �� Exp: Date: aZ o2 �� ovement License: ---Exp. � Home lmpr f Date: ARCHITECT/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: $ � '�. �f � U FEE: $ 191 . 12 Check No.: a�J Receipt No.: 3/ NOTE: Persons contractingw' unregistere=contract do not have access to the guaranty fund /E�nafijrg- pf-rontrantav&c�-1 ,. . Location No. S � << ' . d/ � �, Datetl� � � - OTO/ • - TOWN OF NORTH ANDOVER " Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � ' .mac .�.,---- » - Building Inspector J 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HE,�I,TH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Condervation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ oca • . e 384 Osgood Street FIRE DEPA„RT��MEN rnp Dum,�p``s e onsiye,�s "' �no� Located at,1►24 Main Streets CONIME Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Rllovement.of Rueter 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 I I NOTES and DATA--(For department use) ® Notified for pickup Call Email Date Time Contact Name =_ Doc.Building Permit Revised 2014 I r-- 1 _ 1 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 I Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses j Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products j OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application 4, Certified Surveyed Plot Plan 4. 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 i Hydraulic Calculations (if Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 i 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 2012 I ECC Energy code Engineering Affidavits for Engineered products Fire Department prior to issuance of Bldg. Permit from Fir off f OTE: All dumpster permits require sign p p 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 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 15,950.00 m $ - $ 191.40 Plumbing Fee $ 23.93 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 23.93 Total fees collected $ 339.25 136 Coventry Lane 574-2017 on 11/29/2016 bathroom remodel NORTH own of _ Andover No. 4- h ver, Mass, I 1 ' ,� A. • / 6 coc.uc«ew.cu �.es RA'rE D Jkr U BOARD OF HEALTH Food/Kitchen PERMIT T 6 LD Septic System �•THIS CERTIFIES THAT .�.. L.A.W.&AV# rV. .........W„ rr... BUILDING INSPECTOR has permission to erect .......................... buildings on ...1.3 40.....C 0.V..%qA 1 ..r... ......�... Foundatione Rough twif to be occupied as ..... .�. � .... Arto.0% ..... ... Chimney provided that the person accepting this permit shall in every respect conform to the Yerms 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 CONSTRUCT TART Rough Service .... r ......L. . ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. ?)RQ c?- X DANA {gym f*, -- 795 Dale Street North Andover, MA 01845 r IN _l Ks. VUJIA I � 1 I Powered by Blogger. r hftp://www.hanielas.com/2014/12/fresh-cranberry-white-chocolate-oatmeal.html?m=1 11/22/16,10:57 AM Page 6 of 6 ROBERT LANGEVIN Building& Remodeling ' Homeowner Information Contractor Information Name Company Name Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name City/Town State Zip Code Business Address(must include a street address) Daytime Phone Evening Phone City/Town State Zip Code Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home Improvement Contractor Reg.Number Expiration date Law requires that most home �— improvement contractors have ► / a valid registration number J I I // '7 The Contractor agrees to do the following work for the homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) S ccoyyl-PA-NY i W c Do N Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of / 4�//Z.Date when contractor will begin contracted work. MGL chapter I42A<) -2 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule specified �.. �' 9 �Q (#) The Contractor agrees to perform the work,furnish the material and labor above for the total sum o j J ' Payments will be made according to the following schedule: $ S C)C) 47. �3-ef the total contract price or the cost of special order items,whichever is greater) by / ! or upon completion of P t- $ y / upon completion of $ _! �© upon 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 $ �"—""10 be paid for ordered before the contracted work begins in order ---^— to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(*r)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. I Express warranty--Is an express warranty being provided by the contractor? Djo❑Yes fall 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 payments 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. a Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. a Make 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. O Does 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. ® Know 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 I ater 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'BLANI£SPACESBYI Two identical copies of the contract must be completed and signed. One copy should go to the h er. The other copy should kept by the contractor. Homeowner's Signatu Contractor's Signature t' 3� zOIL Date Date ROBERT LANG EVIN Building& Remodeling, LLC 795 Dale Street North Andover,MA 01845 (978)686-3607 HIC#111990 FID#26-0816298 www.LangevinBuilding.com Job Description Deanna and Bruce Pomfret 136 Coventry North Andover, Ma, 01845 Total bathroom remodel: 1. All necessary permits 2. Floor protection for the duration of the job 3. Complete demo down to framing and subfloor 4. Electrical: new ceiling lite/fan combo vented to outside, outlet and switching to remain in place, installation only of new light fixtures 5. Plumbing: installation only of 5' fiberglas tub, shower valve,toilet, sink and faucet. All remaining in the same location 6. Upgrade insulation: ceiling to R30 and exterior wall to R15 7. %2"durock tile backer on tub walls to 6' high and blueboard with skimcoat plaster on ceiling and all other wall surfaces 8. Shop built vanity the same size as the existing one in walnut with a granite top to be selected from remnants at Napolitano Marble and Granite of Lawrence 9. Durock floor prep and installation only of floor tile 10. Installation only of wall tile in tub area(one recessed alcove included) 11.New baseboard, window, and doorway molding 12.New closet shelving to your specs 13. All cleanup and trash removal Owner signature Date W7, 7holt Contractor signature Date ) 2 7 A R D CERTIFICATE OF LIABILITY INSURANCE °A THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDS ,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 doee not confer rights to the certificate holder in IIGU of such endorsement(s). PRODUCER N Edward W Hays Hays Insurance Agency Inc. PHONE (979)686.3162F NM: (978)689-4425 36 Hawthorne Ave. ADp haysinsurancegIcomCast.net NM MOURERS AFFORDING COVERAGE NAICS Methuen Ma 01644 INBURERA; Norfolk&Dedham Mutual Fire Insurance Company INSURED INSURER G: Roberto Langevin INSURHERC: 795 Dale St INSURER D: INSURER E. North Andover Ma 01545 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 DESCRRIED HEREIN IS$V8JEC7r TO ALL THE TERMS. EXCLUSIONS AND CON0171ONS OF SUCH POLICIES,WMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRH POLI F POLICY EXP L TYPE OR INSURANCE POLICY NUMBER (WIDOM 2LM1MLff—T—"1 LIMITS X Co MERCIALGENERALWBIUTY FACHOCCURRENCE S 1.000.000• CLAIMS-MADE D OCCUR MEMISES,Ea CN6tX n S 100,000. MED EMP An a"perwn S 5.000. A R0514357A 10/25/2015 10/2512016 PERSONAL 6ADV INJURY S 2.000.000• GEN'L AGGREGATE LIMIT APPLIES PEP. GENERALAOOREGATE S 2,000,000. PRO- POLICY j� 0 LOC PRODUCTS-COMPIOPAGG S 2.000.000. OTHER: S AUTOMOBILE LIABILITY COMBINE081N R S Ea acdde t ANYAUTO BODILY INJURY(Per pawn) S ALL OWNED SCHEDULED BODILY INJURY(Parnowenq S AUTOS AUTOS NON-OWNEO Pa�aeC1A D $ HIRED AUT08AUTOS S UMBRELLA LIABOCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DEC I I RETENTIONS S WORKERe COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE RH ANYPROPRIE'TORIPARTNER/EXECUTIVE NIA 1.PACM ACCIDEM S Mamwory to NH;t�cCLUDED9 EL.DISEASE•EA EMPLOYEE S N yn,deeeribe undar DESCRIPTION OFOPERATIONS bolow E.L.DISEASE:POLICY LIMIT S DESCRIPTION OP OPERATIONS I LOCAnONS I VEHICLEN(ACORD 101,AEaluonal It marke Schadule may be eRethod ttmom opaw le repuiroa) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES 98.2014 ACORD CORPOOMON. All rights reserved. ACORD 25(2014/01) ;f `The ACORD name and logo are registered marks of ACORD A RU® CERTIFICATE OF LIABILITY INSURANCE FDAT1 9/2DIYYYn 11/2912016 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 cortlficate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED Provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certainlicies an en Po may require uire q dorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen S). PRoouc N A Edward W Hays Hays Insurance Agency Inc, PHONE (878)686-3162 FAX (g78)688�425 AIC No): 36 Hawthorne Ave, ADDRESS, haysinsurance®comcast,net INSURER S AFFORDING COVEM09 NAIL 9 Methuen Ma 01844 tNaumRA: Norfolk&Dedham Mutual Fre Insurance Company INSURED INSURER B: Robert D Langevin INSURERc: 795 Dale St INSURER D: INSURER E North Andover Ma 01845 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 DESCRIAED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rnV OF INSURANCE POLICYNUMBER MMIDDIYYYY UCYEXP LIMITS X COMMERCIALOENERALLIAeIUTY EACH OCCURRENCE $ 1,000,000, CLAIMS-MADE FOCCUR PREMISES Eso $ 100.000• MED EXP(Any one person) 5 5,000. A R0514357A 10/25/2016 10/25/2017 PERSONAL&ADV INJURY S 2,000,000- 'L AGGREGATE LIMIT APPLIES PER: ,000,000,'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE S 2,000,000. POLICY a 52m8T 0 LOC PRODUCTS-COMPlOPAGG S OTHER: b AUTOMOBILELIABILITYM I I MIT S Ea acrJdenl ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY IAUTOS BODILY INJURY(Per axldenq S HIRED NON OWNED OPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per see Zt S $ UMBREU.A UAB OCCUR , EACH OCCURRENCE 8 EXCESS UAB HCLAIM&MAOE AGGREGATE 5 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYCRS'LIABILITY YIN STATURE ER ANYPROPRIETOR/PARTN6RIEXECUTIVE OFFICEPMEMBHREXCLUDED7 NIA E,L,EACH ACCIDENT $ In If Ga.dtory be un E,L 013EASE-EA EMPLOYEE $ If yea,Cesafbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPT10N OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 7011,Additional Remarks St) ZIS,may DG attechee If more space 15 reguked) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ISE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N0710E WILL BE DEUVERED IN Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Building Inspector Aun+ol:I71988-201�SACORD 120 Main St. North Andover Me 01845 CORPORATION_ All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investigations 600 Washington Street ` �i �y Boston,MA 02111 r i- www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):'RO BI'�T I-.t-t v,�C­E V I >rJ Ij�4)6: d' R E-MO T Ly Address: _7 9"�_ D Aj-1-f 5- r--City/State/Zip: 00\2_r4 Phone#: r'J 7 G F6' 3 6'©7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.Jam a sole proprietor or partner- listed on the attached sheet. t 7 Remodeling ' ship and have no employees These sub-contractors have 8. emolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its re 10. lectrical repairs or additions required.] officers have exercised their p q ] of right of exemption per MGL 11. umbin repairs or additions 3.❑ I am a homeowner doing all work g p p �� g P myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. 13.[:]Other insurance required.]q *Any Applicant that checks box#1 must also 511 out the section below showing their workers'compensation policy information. I 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.pol icy information. I am an employer that is providing workers'compensation n insurancefor myamlayees. Below is thepolicy y andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 cert' under he pains and penalties of pefjury that the information provided ab ve is true ndd correck Signature: Date: 3 �G Phone#: �7 ? o K 3 6 ©-7 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 i I I _ Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-002685 Construction Supervisor ROBERT M LANGEVIN f 795 DALE STREET- NORTH ANDOVER MA 01845 { expiration: Commissioner 02/24/2018 �e et.'ama�zo�zruca��o���r5ear.�«:te/f' Office of Consumer Affairs&Business Regulation — OME - � IMPROVEMENT CONTRACTOR egistration 111990 ,r Expiration 2/x_1/2017__- Type: LLC ROBERT LANGEVIN BLDG&REMOLDING LLC. k ROBERT LANGEVIN � _ e 795 DALE ST N ANDOVER,MA 01845 Undersecretary