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Home My WebLink AboutBuilding Permit #441-14 - 148 MAIN STREET 11/18/2013 �l BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: t Date Received 3'SSAc Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIO'lV ��Print _ �iEFYIEf� l?ROPERTY 01JUNER �- —' �► M,4P NQ: ' : Ply RC ZE3 11l+IG ISTRiCT isti i'fc Drstiict Vires. i :( white Spivfrige TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential � New Building ❑ One family C Addition D Two or more family ❑ Industrial ❑Alteration No. of units: D Commercial X Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition Other �c 'K C Septic,, ' 1:U1(�Il' =., C Flotlplarn :Vttands C1 tilaErsl�sd 13rr#ct `:VllaterSeinler. - >n )40_4i*k `.�Di ,D�SS�tR.t'LIQ ort 51/ .L►r1'� AC 00*R Arlon YKJWg141-aJ �4AA 6&n4A0 5 >4rU WA41SA �d ort Identification Please Type or Print Clearly) 1 I OWNER: Name: � A yi i S �ll A Phone:/94 Address: OLIVA A � D . . ......... CON�"RACTQI�.. .Name.. : t., . ..,. . :. 5�.peritist�r's Cor�stru�t<.on:L�cextse. . :Exp �i�.afe• t Home lmpadve nen :Liven a Exp :Date; ARCH ITECTIENGINEER Phone: Address: Reg. No. c FEE SCHEDULE:BULDING PERMIT.$110o PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. LL Total Project Cost: $ 7'� ar� FEE: Check No.: loris Receipt No.: NOTE: Persons contracting with unregistered contractors do not have a est i guaranty fund Sgnaure.af AgeritlOwner: gnattsre of conraetor. £'d £059 L9Z8L6 Jetueuau0a1nu8 iVMS A098 d90:E0£6 20^oN s TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION -- _ Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: - _ 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 ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: _ _ Phone:. _ o I Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: i I i ARCHITECT/ENGINEER Phone: t 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: $ FEE: $ k Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature,of�Agent/Owner Signature of contractor Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The foh�owing is`a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, 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 ❑ 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo=,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui!ding Permit Revised 2012 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TI'PE_OF`SEWERAGE DISPDSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swimming Pools ❑ 0 Well ❑ l S Tobacco. aes r ❑ 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 t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments r � Water& Sewer Connection/Sitgnature& Date Driveway Permit I)PW Tow;! Engineer: Signature: � .r � Located 384 Osgood Street FIRE DEPARTEiVT = Temp Dumpster on site yes no Located at-124 Mair, Street.-.:.I Fire"D "Me; if signs /dat a" epartm r tune a ' - . . .,- �-, , _+�,, •, .,., COMMENTS ' Dimer-sion 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 DANCER ZONE LITERATURE: Yes No MGL-Chapter 166.Section 21A-F and G min.$100-$1000fine NOTES and DATA— (For department use ® Notified for pickup - Date S I Doc.Building Permit Revised 2010 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 i NOTES and DATA— For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 I Plans Submitted-[] -.Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE=OF--SEWER AGE DIS3?_OSAL Public Sewer ❑ 'Tanning/MassageBodyArt ❑. . Swimming Pools 0 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.APPR.OVED 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 i Conservation Decision: Comments 1 Plater & Sewer Connection/Signature& Date Driveway Permit I)PW ToNvo Engineer: Signature: Located 384 Osgood Street FIRE D-EPARTMLNT - Temp Dumpster on site yes no Located7at•124,Mair Street - Fire Departmeiifisignatbre/date-" COMMENTS Building Department The fol;swing'it--a-li'st of the required.forms to be filled out for-the appropriate:permit to be obtained. Roofivg, 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 ❑ 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apn:,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building permit Revised 2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page _ s LOCATION . Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: _ 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 ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature hof Agent/Owner Signature of contractor Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location ' T V No. Date t "`. i • - TOWN OF NORTH ANDOVER . ED z< • Certificate of Occupancy $ � r Building/Frame Permit Fee Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check# r � �' t1 L 7 ; ;e Building Inspector NORTF{ F Town of 2 _ Andover O No. o h ver, Mass, 3 CHIC to 1' S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT 9011,1 S / , ` . .......�� .1> Ad....cado BUILDING INSPECTOR p1 1 O Foundation . .. ... has permission to erect .. .......... ..... buildings on ....1 11 v�....i��! ot...�....Vl.�!............••••• .. ...................................................................... Rough to be occupied as ................�.�.Q�............... chimney provided that the person accepting this permit shall in Ivery respect conform to the terms 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final 3a ' PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ST 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. SEE REVERSE SIDE g North Andover &Servin SWAT Environmental Surrounding Areas 1k RADON GAS REMEDIATION DIVISION Phone: (978)261-5401 www.RadonLawrence.com Fax: (800)207-5685 1-800-NO-RADON RADON REDUCTION SERVICES FOR: Dennis Molla DATE: October 07, 2013 SERVICE ADDRESS: 148 Main St, North Andover QUALIFICATIONS: National Environmental Health Association Radon Mitigator NEHA#107023RMT E-P.A. Radon Proficiency Program Graduate(University of Minnesota) Federal ID#35-2466999 LIABILITY: Insurance:We carry full liability(general&umbrella),automobile,and workers compensation insurance. Certificate of Liability Insurance available upon request. METHOD: Active Soil Depressurization HOW IT WORKS: Radon typically enters a home or commercial building through the lowest level of the structure.ASD systems create a negative pressure field(is.depressurization)under the poured concrete slab in order to remove radon gas before it can enter the home or building.A radon collection chamber is created under the slab after a 5" hole is cored,then the gas is removed with an inline centrifugal fan and safely vented (2)feel above the save with either an internally or extem2lly fouled PVC pipe. PROPOSAL: i. Create a radon collection chamber beneath the concrete slab in an appropriate location based upon on-site diagnostic tests and building structural characteristics, most frequently in an unfinished utility room 2. Install and completely seal vent pipe in radon Collection chamber. 3. Run primary suction pipe in collection chamber from basement, through outside wall (external system) or into attic (internal system) . 4. install centrifugal inline fan to riser Pipe where it exits the outside wall (external system) or in attic (internal system) . Complete electrical work to supply power to fan. In situations where -power is not available or a dedicated circuit is required, it will be the customer's responsibility to have a certified electrician complete electrical work, or we will subcontract an electrician upon request_ 5. Continue vent riser pipe from the inline fan vertically until a height of two (2) feet above the eave is achieved (external system) , or, through the attic roof using an internal or external roof boot depending on pitch of roof (internal system) . 6. Supply and install a differential pressure gauge (Dynavac Manometer) on riser pipe to allow CantjnUgUp Mgnitoring of the fan vacuum pressure. This "U-tube" will be clearly Visible and marked by the technician. walls that could impede the 7. Technician will identify and seal any cracks in the basement floor or integrity of the ASD system. it is the responsibility of the customer to remove any stored items that prevent clear identification of cracks in the floor or walls. 8. Conduct diagnostic tests to verify adequate pressure differential between the indoor air and the soil/aggregate beneath the slab. 9. A.post-mitigation radon test (carbon) will be left by the technician in order to confirm proper radon removal. it is the responsibility of the customer to administer the test (full manufacturer directions included) or contact a third party to do so. Please note we recommend waiting a minimum of seven (7) to fourteen (14) days after installation before testing. 10. Lifetime warranty on our workmanship, fan is covered by a five (5) year manufacturer's warranty. 11. All warranties automatically transfer with the title to the property. TOTAL PRICE FOR ABOVE: $1647.00 SPECIAL DISCOUNT: -$100.00 ADJUSTED TOTAL(guaranteed price): $1547.00 ANM OPTIONAL ITEM(S): 1. COLOR MATCHED DOWNSPOUT OPTION - FOR COA APPROVAL., +$179.00 2. Color-match system to exterior of home! +$129.00 3. FanMax Upgrade- Typically achieves lowest radon level possible: +$219.00 PRICE IS GUARANTEED FOR FULLY-INSTALLED SYSTEM AS DESCRIBE[)IN THIS PROPOSAL AND INCLUDES ALL APPLICABLE PERMITS AND OTHER FEES.WE ACCEPT CHECK,CASH,VISA,MASTERCARD,AMERICAN EXPRESS,&DISCOVER.DISCOUNT APPLIES ONLY IF PAID DAY OF INSTALLATION.CANCELLATION FEE APPLIES WITHOUT 2a-HOUR NOTICE.HOMEOWNER IS RESPONSIBLE FOR MATERIAL&LABOR COSTS FOR FUTURE MODIFICATIONS TO SYSTEM. ./-d C09969Z9L6 18jUeUJIUOJIAU3J_VAAS A�098 \deZ:00 CI. 80 AONJ S��VAT Ernvironmental Serving North Andover & Surrounding areas RADON GAS REMEDIATION DIVISIONPhone: (978) 261-5401 ' www.RadonLawrence.com ~` Fax: (8001207-5685 1-800-NO-RADON RADON REDUCTION SERVICES FOR: Dennis Molla DATE: October 07, 2013 SERVICE ADDRESS: 148 Main St, North Andover Thank you for considering S.W.A.T_ Environmental to be your radon mitigation contractor. We take pride in designing highly effective as well as aesthetically pleasing radon removal systems. We use high quality materials in order to bring radon levels as low as mechanically possible, and back our systems with a warranty that is fully transferrable with the property title. Please feel free to contact us at (978) 261-5401 with any questions or concerns you may have about the system described in this proposal. We are proud of our work and look forward to providing you a high quality and competitively priced radon mitigation solution. Sincerely, Adam Neale Certified Radon Specialist IMPORTANT NOTES TO COMPARE (1.) We are one of the nation's largest and most referred radon companies. We've corrected radon problems for over 50,000 customers. (2.) Our radon mitigation systems include a lifetime warranty. (3.) Our systems conform to DEP, EPA, and ASTM Radon Mitigation Standards and meet all plumbing, electrical, and building code requirements. (4.) We offer high efficiency systems that typically reduce radon levels well below EPA recommendations. This system can also improve overall air quality by reducing molsture and removing various allergens. -:r- 9'd £09969ZU6 JejueWU0J1nu3 ivms 4 08E] d8�:£0£L 20^cN a C�r.-Pcjl Am sir 041!1. PF 3 b. f,*z"t t X0 C—JO OXi.I i, oft- c7f"1 51 a., AW AOL va ip t YW.4, 7r. ...... ....... by ?f-N—i A Mule 4S !7 OF—d L—J.- r#i4 "-7 Lb MaWrxpn 42-d C099L9NL6 lelUeWUOJIAU3 iVMS AP99 dqZ:Co£L 80 AON NORTENV-05 LCARUso DATE CMMIDWYYYY) Amo CERTIFICATE OF LIABILITY INSURANCE 10!81`2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY HANE D OA�� RIGHTS COVERAGE AFFORDED BY THE POLIC ES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEG=ATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS},AIITHORIZEQ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: it the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. 11 SUBROGATION IS WAVED,sub}ect 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(Q. CONTACT PRODUCER PHONE FAIL 81 933-9018 SalOM Five Insurance Services,LLC we N, �(781)933-3100 5126 INC,Not: ) 445 Main StreetA L Woburn,MA 01801 MAIC r INSURF3i(S)AFFORDING COVERAGE INSURERA:EVANSTON INS.CO. INSURED INSURER B:Commerce Insurance 34754 Northeast Environmental Services,Ine IIsuFtm c:Liberty Mutual Fire Insurance Com any 121 Boston Post Read INSURER D c Sulte#3 INSURER E Sudbury,MA D1TT6 tNSUAER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT L WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND GONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED lBY PAID CL ExpS_ LIU" ILTR I A POLICY NUMBER I Mwo MrWO TYPEOF INSURANCE 000000 EACH OCCURRENCE 5 1 i , GENERALIJABI1JrY 50 000 A X ;COMMERCIAL GENERAL L1ABILII'r 13P1CG02813 3/612(119 I 3!612014 PREMISES Ea oQucreace 5 MED EXP(Any one person) $ 55,000 CLAIMS-MADE C OCCUR 1 D00,00D PERSONALBADV INJURY is � GENERAL AGGREGATE S 2,000,060 PRODUCTS-COMP/OPAGG S 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER $ POLICY X PEa 1612 COMBINED SINGLE LIMIT 1,000.(104 AUTOMOBILE LIABILITY I Ea a S B ANYBBWIX5B AUTO 31152013 3115'5/2014 BODILY INJURY(Per paSort) $ ALL AUTO X SCHEDULED BODILY INJURY(Per accident) S OWNEAUTOS AUTOS PROPERTY DAMAGE S NDN-OWNED Par geddent X HIREOAUTOS X AUTOS S I X UMBRELLA L1AD X OCCUR EACH OCCURRENCE S 1,000'40 A I EXCESS LIAR ,CLAIMS-MADE13EM00346 3/6/2013 316/2014 AGGREGATE $ 11000,000 I S DED I RETENTION WC STATU- OTH- ERS ERS COMPENSATION TO 41 ER AND EMPLOYERS LIABILITY 00,000 C ANY PROPRIEr0RIPARTNERIEXECUTIVE r C231S3B9621013 3R/2D13 3rT/20i4 EL EACHACCIOEPIr $ OFFICERIMEMBEREXCLUDED? RIA00000 (Mandatory in NH) E.L.EDISEASE-F�FJ,PLO S I yes,de TIO under E.L DISEASE-POLLCY IT S 500,000 DESCRIPTION OF OPERATLONS below DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES(AtaehACORD 101,AdditlanalRemerksSchedule,llmom space lsroqulred) Additional insured wlregards to General Liability:Dennis Molla,Unit#0102 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOMFED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 6'd C099 LK9L6 IelU9WUOJIAU3 lb'MS Aloe8 d L£ EO 0L 80 ASN NORTHEAS" ADAM NEAT 121 BOSTOI SUDBURY, I SCA 1 Co 2OM-06/11 .� Office of Consumer? ME IMPROVENII egistration: 174 t, xpiratton: 214121 NORTHEAST'ENVIRONMENT ADAM NEALE 121 BOSTON POST RD SUIT SUOWRY,VA 01776 N f z 0 C) OD OD W O W W 1 i I I SCn n�)' ?'�/�?Pik/!'Z��IC�CYi�ti� m Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 � Boston, Massachusetts 02116 Z3 Hoine Improvement Contractor Registration °' Registration: 174397 Type: Corporation Expiration: 2/412015 Tr# 235961 I EAST ENVIRONMENTAL SERVICE NEALE STON POST RD S UITE 3 IRY, MA 01776 � .: : � ------ Update Address and return card.Marit reason for change. [� Employment 1 ] Lostcard Acids-ess L] Renewal co License or registration valid for individul use only N sumer Affairs&llusiness Reg ulntion rn before t11c expiration ds�tc. If found return o' ;OVEMENT CONTRACTOR Type. Office of Consumer Affairs and Business Regulsltion cn Cn 1: 174397 10 Park Plaza-Suite 5170 O 2/4/2015 Corporation Boston,MA 01116 NMENYAL SERVICES, INC. Undersecretary VIVO .it+d ritltout signature O t of i �Ta:iooai Radon Ps©ticiency Probram i A AR ST gyp. r� PSG i �3l�aDn17 PilaF1C�'nt�V F Adam T.Neale Residential Mitigation Provides 10 Number. 107023 RNIT EYpiralion: 7J231201 aceto To confirm"idity Oftlis cenifimtioncall(d00)169.11�J-Verifraum oFadtKse s.%u and loci M-a;ions is ad.ised S....=for specific a ftificatian aenczrnotri ~ 107023 Rtt1T Adam T.Neale This individual has demons",led knoviedge in tite drsigo;fad installation of radon mitigation systems in residential structures. This person trn_s agreed to adhere to local building code regulations and state radon regulations(ifapplicable), and to install systems in accordance with the protocols recognized by NRPP- Tho radon office for the stale in-which this person resides ml'be contacted For information on radon and local requirements- l:oradditional information I0111aCt NRPP at Sool2G4-417;,or visit l6c NRPP v eb-site at nrpP.info I State Radon PCOLT.m Contact N.b,. goo-RA)JDN95 I L 6'd £099�9UL6 IeIuawuoJIAu3 JVMS AC)e8 d£b:£0 0 L 80 ADN 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 cv/Workers Comp Affidavit d`P hoto 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 )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract ❑ Floor/Cfossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit zi Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products DTE: 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:LNSPECI ZONAL SERVICES DEPARTMENT!BPFORM07 Revised 2.2007 Z-d £099 69Z8L6 Jelu8Wu0a1nu3 JVMS A10e8 d90 Co£L 20 AO