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HomeMy WebLinkAboutBuilding Permit #654-2011 - 139 QUAIL RUN LANE 3/30/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: '1 -0,2011 Date Received Date issued: 4O-RTANNT. : A licant must complete all items on this page LOCATION ' riot PROPERTY OWNER Print MAP NO: O pARCEL:[A&ONING 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 ❑ Iteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg 11 Others: ❑ Demolition ❑ Other ` DSeptie ®►Well` Q+Floodplain ©Wetlands! ', '®=-,W b t]Water/Sewer I t -,_,- u�..ar. DFFSCRIPTON OF WORK TO BE PERFORMED: Identification Please Type or Print CIearly) OWNER: Name: �/117rr�ic/l ��n•�� -- Phone: �;�, /� Address: / /5 � t �,�/ CONTRACTOR Name: ��//�/,IJS�'Ci//yS' 1�i iUcJ Phone: Address: I Supervisor's Construction License: ��`iExp. Date: Home Improvement License: /,,�� r;G� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. N°. i FEE SCHEDULE:BULDING PE :$92.00��PERR OOO-0i0 F THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. v . D� Tota[ Project Cost: FEE: $ S/ ✓� t No.:Receipt 2 yo U Check No.: � G p NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 001 • ` Si nature of contrdcfor' Signature:of�Agent/Owner.. -��< - - - .-9__.____._ i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 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 Main Street Fire Department signature/date F CONIlVMNTS 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.$100-$1000 fine NOTES and DATA— For department use U 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) ❑ Muss 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 ❑ 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doe: Doc.Building Permit Revised 2008mi Locationy A C No. U// Dater NaR,h TOWN OF NORTH ANDOVER 3 � Tow F w i # �a Certificate of Occupancy $ MUS Building/Frame Permit Fee $ 3� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 24 � C. Building Inspector ORTij T0VM of ikndover LAKE _0 dover, Mass., COCHICMEWICK ADRATED SS BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ......... ........�....:r..der.�..:�........................................................................ ................ ....... Foundation has permission toerect buildings on ....� �............... .... 3 . . ...._ � XV Rough to be occu pied as p .................sv,1< ................yGl //Zz.. .�.�.�G..�...................................................................................... Chimney provided that the person accepting this rmit shall in every respect 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S ARTS ELECTRICAL INSPECTOR Rough ................ ........ / "�'�----,................................. 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner. Street No. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: �� is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: (Location of Facility) Signature of Pet Applicant �J Date 1 �eI,iS lv iss � 74 a,Pp 5- - , e rn%7 � � 4 �ee The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ozK/�JIy, Address: Sl�� City/State/Zip: , ���, -r17 G' / - Phone Are yqu an employer?Check t ppropriate box: Type of project(required): 1.VI am a empl ith 4. ❑ I am a general contractor and I employee(Kful d/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached shget. # 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers' comp.insurance 5. 9• E]Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F] mbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12• Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other Any applicant that checks box#1 must also fill 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. tContractors 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:1 ,1�1 1� / (B/ ��/ 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 certi&under the pains and enalties of perjury that the information provided above is true and correct. Si nature Date: U Phone#: Official7useD,,, not write in this area,to be completed by city or town offrcial. City or Permit/License# Issuing ircle one): 1.Boar .Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.OtheContact 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. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass,govldia RightFax N1-2 3/4/2011 9 : 02 : 27 AM PAGE 2/003 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDYYYY) 03:04/2011 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX FRA .NCIS E.PROVEN CHER (A%C,No,Ext): FAX (A'C,No): 530 ROGERS STREET E-MAIL ADDRESS: PRODUCER LOWELL,MA 01852 CUSTOMER ID#: 26F9G INSURER(S)AFFORDING COVERAGE _ NAIC# INSURED INSURER A: HARTFORD GROLP INSURER B: QUINN THOMAS DBA QUINNS CONSTRUC'TION INSURER C: INSURER D: 868 IMANB40TH RD INSURER E: DRACUT,MA 01826 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 ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF DATE POLICY EXP DATE TYPE OF INSURANCE POLICY NUMBER (MM•,DD\YYYY) (MM;DDWYYY) LIMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG S AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY S SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY S (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DEDUCTIBLE S RETENTIONS S WORKER'S COMPENSATION AND WC STATUTORY LIMITS OTHER EMPOLYER'S LIABILITY YiN UB-4116P704-11 01/1512011 01,15/2012 YIN E.L.EACH ACCIDENT $ 100,000 ANY PROPERITOWPARTNER/EXECUTIVE N OFFICER/{EM.BER EXCLUDED? N E.L.DISEASE-EA EMPLOYEE S 100,000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ 500,000 ii yes,cescrbe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF 0PERATIONSILOCATIONS;VEHICLES!RESTRICTIONSJSPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTL\G WORKERS COMP COVERAGE. THE WORKERS'CO'\1PEN SATIO\POLICY DOES NOT PROVIDE COVERAGE FOR QMNNT THO.LIAS. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Raman'Ayer From:Bonnie Welch Fax!D:9784549343 Page 1 of 1 Date:3i3/2011 11:54.AM Page:1 of 1 OP ID: BW DATE(tvttN v1/DD,YYY) CERTIFICATE OF LIABILITY INSURANCE 03/03111 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). ACT PRODUCER 978-459-8681 NAME' Francis Provencher InsurancePHONE FAX 978-454-9343 "C.No Ext): (ATC,No): Agency, Inc. E-MAIL 530 Rogers Street PRODUCER Lowell, MA 01852 I CUSTOMERIox:QUINN-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Quinn's Construction INSURER A:Endurance American Specialty 868 Mammoth Rd. INSURERB:Commerce Insurance Company 34754 Dracut, MA 01826 INSURER C INSURER D: INSURER E: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR I IADDL SUBR POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE •.INSR I WVD I POLICY NUMBER IMP 21 MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCt;RRE`:CE !$ 1,000,000 VAG= O RENTD A X CO!M_RC!AL GEl,zRAL LIABiuTY ! �CBC10000052400 01/13/11 1 01/13/12 PR=NIs s a occu;e- e S 50,000 C'_AIMS-V.ADE X OCCUR MED EXP(Any one?erso,) ;$ 5,000 i I PERSONAL&ADV N..kJRY $ 1,000,000 ! GENERAL AGGREGATE I$ 2,000,000 �_`i'L AGGREGATE LIMIT A?PLiS?ER: PRODUCTS-CGM?!OP AG G $ 2,000,000 I i POLICY F v=CT is AUTOMOBILE LIABILITY ! I COMB!P:.D SNGLE LIMIT I$ (Ea accident) B I ANY.AUTO ! BBGS68 05107!10 1 05/07/11 I BODILY INJURY(Pa.oe.son) !$ 250,000 j �ALL OWN EDAUTOS I ! 1 ; i s0D!LY INJURY(Per accident)j$ 500,000 X 1 SCHED'ULED AUT,OS PROPERTY! , I DAMAGE $ 250,000 X I HIREDA TOS I 1(Per accident) I I ; X NON-OWNED AUTOS j I i $ !UMBRELLA LIAB OCCUR I I EACH OCCURRENCE :$ I 'EXCESS LIAB ! CLA!MS MADE! I I AGGREGATE $ 1 DEDUC IBLc RETENT ON $ 1 ! 1$ .WORKERS COMPENSATION ! WC STAT U- ! CTH-i AND EMPLOYERS'LIABILITY ! I I ! TORY LiM!TS I ER i Y!N ANY PROPRiETORPART\Ri_XEC!JTVc ! 1 F L EACH ACCIDEt2T I S Oi:PiCERNEY.B=R EXCLUD=D'! I 11 N!A 1 (Mandatory in NH) E1 DiSEASE-EA EMPLOYEE-1$ i'yes,des be under D=SCR T!CN OF OPERATIONS below ! I I E`.DISEASE-PO'_iCY LIMIT I S I i j I I i DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) **CERTIFICATE FOR WORKERS'COMP COVERAGE WILL BE ISSUED DIRECTLY FROM THE COMPANY WITHIN 2 BUSINESS DAYS** 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Nlassachusetts - Department of Public afet� o- ✓fze �oorur�zaizc�ea�/�i o�'✓llaa sac>/ivaelZa Board of Builtlim', Re-ulatiuns anti Standur•ds Construction Supervisor License — Office of Consumer Affairs&Business Regulation License: CS 39732 HOME IMPROVEMENT CONTRACTOR Restricted to: 00 Regfl:x. .121604 Expiratian 512412012 Tr# 293905 THOMAS J QUINN Type: rndividual 868 MAMMOTH RD QUINN'S CONSTRUCTION DRACUT, MA 01826 _ THOMAS QUINN. 868 MAMMOTH RD. DRACUT,MA 01826 Undersecretary Expiration: 3/25/2012 Tr#: 18330 Restricted to: 00 00- Unrestricted License or registration valid for individul use only 1G-1 2 Family Homes before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of& Massachusetts State Building Code is causer revocation of this license. r Refer to: WWW.Mass.Gov/DPS Not valid without signature