HomeMy WebLinkAboutBuilding Permit #132 - 171 KARA DRIVE 8/18/2006 I
1
TOWN OF NORTH ANDOVER NORTH
APPLICATION FOR PLAN EXAMINATION 6�'�'p
Permit NO: // Date ReceivedArED
*?o e
SSA
Date Issued: I -6 CHus���y
IMPORTANT: Applicant must complete all items on this page
LOCATION V k f
Knot
PROPERTY OWNER C\-\f-0, gn& V�e c'(, SL f I 1 uc t-,
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ❑ One family
❑ Addition ❑Two or more family ❑ Industrial
Alteration No. of units:
❑ Repair, replacement ❑Assessory Bldg ❑ Commercial
❑ Demolition
❑ Moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: C V, Phone:
Address:
CONTRACTOR Name: Q{c� '—PQ)-P, pe hoQ A�io VIS Phone: 4 0,-7&', 4C,,W S3
a
Address: �� �01 S� �. r �+ -hC�UL� r
Supervisor's Construction License: CS 0�-3 S o Exp. Date: �U '
Home Improvement License: l i3� Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: �---�� Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ /GI sl-o 1 EE:$ Qg2==
Check No.: �L Y Receipt No.:��-
Page 1 of 4
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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:BPFORM05
Pave 4 of 4
TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑
F] Tobacco
Art ❑ g
Public Sewer
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
Permanent Dumpster on Site ❑
Private(septic tank,etc. ❑ Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
V, Signature of A ent/Owner
g g Signature of contractor
U4e---�
Plans Submitted ElPlans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
j ❑ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑
s 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 Drivewav Permit
Temp Dum ster on site yes�no_ Fire Department signature/date
��
Building Setback (
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area,sq.ft.:
NOTES and DATA—(For department use)
i
I
Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan.2006
C
Location
No. Z— Date
v -
MaRT� TOWN OF NORTH ANDOVER
N 9
+
Certificate of Occupancy $
'Ss,cMusE Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # ��
c
937 3 _ Building Inspector
I
5�
. o
S
\SV
RED APPLE
RENOVATIONS
home 37'fliodeClll.1tr ptufo"sw'ott(it's
Construction Contract
This construction contract (the "Contract"), dated June 21, 2006 is by and between the
following homeowner(s) and contractor:
Homeowner(s): Chris and Becky Sullivan
Property address 171 Kara Drive
City, State, Zip North Andover, MA 01845
Contractor: Red Apple Renovations, Inc.
Representative: Chris Matey, President
Street 9 Bartlet Street, #332
Andover, MA 01810
Telephone 978.409.1293
Federal Identification Number: 56-2309042
Massachusetts License Numbers:
Construction Supervisor CS 083511
Home Improvement 138132
1. GENERAL
In consideration of the mutual promises contained herein, Contractor agrees to perform the
following work: furnish all labor, materials, tools, equipment, and supervision to construct
or renovate the Homeowner's residence according to this Contract and the following
documents (collectively with this Contract, the "Contract Documents"). The project is
generally described as remodeling the master bathroom (the "Project").
The Contract consists of this document, Exhibit I - General Conditions, Exhibit II - the
Project, and Exhibit III - Shower Sketch.
Change orders and modifications shall be in writing and shall become part of this Contract.
2. PRICE
The total projected price for the work agreed upon is $19,350. Payment terms are set out
below in Paragraph 6.
3. STARTING AND SUBSTANTIAL COMPLETION PROVISIONS
The work will begin on or about August 7, 2006 through August 18, 2006. The work will be
substantially completed on or about September 18, 2006 through September 30, 2006.
co PY
P
4. SPECIFIC REQUIREMENTS FOR
MATERIALS SrA`ND WORtor in a gKMdANSH IP
a. This Contract willcompleted
manner, using good quality materials.
es the allowances listed in the Contract Details
b. If applicable, the Contract price includ
Section.
S. EXPIRATION OF THIS CONTRACT
This Contract will expire thirty (30) days after the da afirs at titten above if not accepted in
writing by Homeowner returned to
Contractor within
6. PAYMENT r of
a. Timely payment by the B
sums due under this Contract is of
owne
The
essence to this Contract. parties agree to the
to the following schedule of payments;
1. Initial payment: $4,500 (due at time of Contract signing).
2. Progress payments: leted
The Homeowner will sit ill
ly for Homeowonerthe rk cw Ilpbe applied d to the final
h the end
of that week. The depo paid by the
invoice. 3,000
Demolition Complete 1,500
Shower Framing Complete 1,200
Shower Pan Installed 2,350
Rough Plumbing Completed 1,300
Finish Plumbing completed 2,000
Floor Tile Completed 2,000
Shower the Completed
3. Final payment: $1,500 Due at the completion of the project.
The Contractor shall provide the Homeowner with hisown
s paymenaiver
tr cumulative
subcontractors' waivers equal to the amount paid for any progressdoes not
eowner as required herein
b. The Contractor may cease operation cath to collif the Hom ect any balance due with any legal
make any progress payment, and p
remedy. Alternatively, the Contractor may continue operations, as set forth in the
attached.
7. SIGNATURE the
Attached hereto as EXHIBIT I are General Conditionsffurther
subject o the' dobligations
laws of Massachusetts
the parties to this Contract. The parties a
governing contracts and mechanics'ale s,arty of the acknowledge
o dge the
herright of the Contractor to
place a lien or security interest on t property
IN WITNESS WHEREOF, we have hereunto set our hands and seats this
3 day of �J r , 20 r__(____--
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Homeowner(s) Contractor
Homeowner(s) -=
EXHIBIT I
GENERAL CONDITIONS
These General Conditions are part of the Contract between Chris and Becky Sullivan
("Homeowner") and Red Apple Renovations, Inc. ("Contractor") for work at 171 Kara Drive,
North Andover, MA 01845, dated June 21, 2006.
1. CONTRACTOR'S DUTIES — GENERAL
a. To direct and control the work contracted for in accordance with the terms of this
Contract and all applicable codes, laws, and regulations, and as the building permits,
if any, issued for this project require.
b. To inspect the site, examine the plans and specifications, if any, and supervise all of
Contractor's employees, and to direct the work of all subcontractors selected by
Contractor.
c. To maintain the work site in a safe and clean condition, to the extent consistent with
the Contract. The worksite will be left in a"broom clean" condition at the end of each
day.
d. To advise the Homeowner promptly if concealed conditions are ascertained which
require additional or different work, and to proceed in such event in accordance with
this agreement.
2. HOMEOWNER'S DUTIES — GENERAL
a. To provide adequate utilities for the work agreed upon.
b. To advise the Contractor of any condition of the property which affects Contractor's
ability to perform.
c. To provide secure storage areas for materials delivered to the work site.
d. To execute in a timely manner all permit applications and other documents
necessary for the work to proceed as identified by the contractor.
e. To perform no work on the project without a written agreement with the Contractor.
f. To avoid interfering with workers.
g. To make no agreements with any tradesperson, subcontractor, or Contractor's
employee outside the scope of this Contract without the written consent of the
Contractor.
h. Homeowner shall notify his insurance agent of the execution of this Contract and
obtain any necessary Riders to his current coverage or any locally customary forms
of coverage, such as Builder's Risk, to cover Homeowner's interests and liabilities
during the construction process.
3. DELAY
Contractor shall not be responsible for delays caused by events beyond the control of
the Contractor, including but not limited to: strikes, war, acts of God, riots,
governmental regulations and restrictions. Delays caused by Homeowner's failure to
make allowance materials' selections or caused by the performance by Contractor of
additional or necessary work shall likewise be excusable delays.
CC
to Homeowner and demand payment for all completed work and materials ordered
through the date of work stoppage, and any other loss sustained by Contractor,
including the balance of the Contract. Thereafter, Contractor is relieved from all other
contractual duties. Upon such termination, the Contractor shall have all remedies
provided by law, including such lien rights as then apply.
The Homeowner may terminate this Contract upon the following conditions:
a. Any other failure on the part of the contractor to perform this Contract required by
the terms of this Contract.
b. No termination shall be effective unless 10 days notice of Homeowner's intent are
given as provided below, during which time the default may be cured by the
Contractor.
9. DISPUTE RESOLUTION AND ATTORNEYS' FEES
a. Dispute Resolution. The Contractor and the Homeowner hereby mutually agree in
advance that in the event that either party has a dispute concerning this contract,
either party may submit such dispute to a private arbitration service which has been
approved by the Office of Consumer Affairs and Business Regulation and the
consumer shall be required to submit to such arbitration as provided in M.G.L. c.
142A.
Contractor:
Homeowner:
Homeowner:
NOTICE: The signatures of the parties above apply only to the agreement of the parties
to alternate dispute resolution initiated by the Contractor. The Homeowner may initiate
alternative dispute resolution even where this section is not signed separately by the
parties.
b. Small Claims Court. Any controversy or claim arising out of or related to this
Contract involving an amount of less than $2,500.00 (or the maximum limit of the
court) must be heard in the Small Claims Division of the District Court in Essex
County.
c. Attorneys' Fees. In the event of any litigation between the parties relating to this
Contract, the party against whom any adverse final judgment is entered (as
specifically determined by the Court), following the expiration or exhaustion of all
appeals, shall reimburse the other party for such party's costs and expenses
(including, without limitation, all reasonable attorneys' fees, expenses and
disbursements) of such litigation.
d. Inquiries Regarding Contractor. All home improvement contractors and
subcontractors shall be registered and that any inquiries regarding a contractor or
subcontractor relating to a registration should be directed to:
NOTICE OF CANCELLATION
You may cancel this Contract, without penalty or obligation, within three (3) business
days from the date this Contract is fully executed. If you cancel, any property traded in,
any payments made by you under the Contract, and any negotiable instruments
executed by you will be returned within ten (10) business days following receipt by the
Contractor of your Cancellation Notice, and any security interest arising out of the
Contract will be cancelled. If you cancel, you must make available to the Contractor at
your residence, in substantially as good condition as when received, any goods delivered
to you under this Contract; or you may, if you wish, comply with the instructions of the
Contractor regarding the return shipment of the goods at the Contractor's expense and
risk. If you do make the goods available to the Contractor and the Contractor does not
pick them up within twenty (20) days of the date of Cancellation, you may retain or
dispose of the goods without any further obligation. If you fail to make the goods
available to the Contractor, or if you agree to return the goods to the Contractor and fail
to do so, then you remain liable for performance of all obligations of the Contract. To
cancel the Contract, mail or deliver a signed or dated copy of this Cancellation Notice or
any other written notice, or send a telegram to RED APPLE RENOVATIONS at 9 BARTLET
STREET, #332, ANDOVER, MASSACHUSETTS 01810 not later than midnight of the third
(3rd) business day after the execution of the Contract.
I HEREBY CANCEL THIS CONTRACT.
Date: Homeowner:
i
RED APPLE
RENOVATIONS
honi!'
Exhibit II
The Project
Remodel Master Bathroom
This project involves remodeling the existing master bathroom within the existing
footprint. The renovation of the master bathroom would include the following:
n.: The existing shower will be removed and replaced. The the walls, floor and
ceiling of the existing shower will be removed. A new custom shower pan will
be installed. A vapor barrier will be installed over the framing and then 1/2
inch cement board will be installed to provide a solid base for the tile. The
following tile will be installed in the new shower:
Type Manufacturer Model Number Description
Shower wall tile BT:Austin 20131141 OA3900002 Bronce 10x16 (15 pc
AZUAUBRIO16 per package)
Shower border tile BT: Kenitra 20331550OK0501002 Bronce 2.6 x 10 Listel
AZUKEBR310
Shower bullnose tile BT:Austin 20331269OA3910003 Bronce pressed
AZUAUBRBN bullnose 3 x 10
Shower floor tile BT: Satin to AOTD1222 Almond 2x2 GRPI
The design of the shower will be based on the sketch attached as Exhibit III.
n' A single corner bench will be installed. The ceiling of the shower will also be
tiled.
This proposal includes an allowance of $250 for a new shower door.
`' A new recessed light fixture will be installed in the shower ceiling.
Based on the water damage around the shower, there may be some damage
to wall or floor framing underneath the shower tile. Once the tile is removed,
the framing will be examined to determine if any repair is required. If repair
is needed, the homeowner will approve any repairs before they are done.
Any additional repairs required are not included in this contract.
n The existing tile floor and baseboard molding in the bathroom and toilet
closet will be removed. The floor will be covered with ceramic tile installed
over 1/4 inch cement board. All of the installed the will be grouted and the
grout will be sealed. The following the will be installed on the floor of the
bathroom in a grid pattern:
T e Manufacturer Model Number Descri tion
Floor the BT: Austin 202511720A3900003 Bronce 12.6 x 12.6
AZUAUBR13P Porcelain
The existing tub will remain in place. The area above the tub deck
approximately 18 inches up the wall will be tiled. The wallboard in this area
will be removed and replaced with 1/2 inch cement board to provide a stable
surface for the the installation. The following tile will be installed on the wall
around the tub approximately 18 inches high:
T e Manufacturer Model Number Description
Whirlpool BT: Austin 203511720A3935006 Br 6 x 12 6 Mosance 4x4 ic
backsplash tile AZUAUBR44
mounted
The following new fixtures will be installed:
T e Model Number Descri tion
Shower Fixture 28.179.000 To 4 Hand shower
Shower Fixture 28.417.000 59 inch shower hose
Shower Fixture 28.401.000 Ad ust handle:shower
Mower Fixture
26.409-000
00
0 Walt Union:shower
S
' Shower Fixture 28.275.000 Showerhead
shower arm
Shower Fixture 27.412.000 Volume control:
Shower Fixture 29.358.000 shower 1A inch t 2
Shower Fixture 19.614.000 Trim: shower
Shower Fixture 34.122.000 Valve: shower
RED APPLE
RENOVATIONS
l�nrtrr rru,url�lli�l;; j�rr.,�i•.�.�irriri.l.�
Exhibit III
Master Bathroom Renovation
•1. } Z [
f
IaA
r�
1x
H;
9 Bartlet Street#332,Andover,MA 01810 tel: 978.409.1293 fax: 978.945.2446
BOg6tp p!cE1IAS
C(3lVST£313GT1f ,:SCIF'viftS.OR
��date T(3/2`$fT,g�
Tx.DO: 83511
CHfiiSTOPk#Efi.J,.MATEY .
32 k AS} NGTF AVE r-
A�VaOYEFi A311 0181 ;`i
Adnin�stratcr
HOWE INSURANCE Fax:9784752171 Jun 2 2406 9:13 P.02
i
CORD m CERTIFICATE of LIABILITY INSURANCEmmm
06(0212006THE HOWE iNSURANG
(979)4TE G Fax:(87B)e18 2171 ! THIS CERTIFICATE Is ISSUED A9 A MATTER OF INFORMATION
AGENCY ONLY AND CONFERS Nb RIOWS UPON THE CERTIFICATE
4 ANDOVER MA
HOLOGR. THIS CERTMATE DAM NUT AMEND, BXTESID OR
ANDOVER MA 01810 L ALTER 1"I 9933ME AFFOROW BY THE M.
0 NUM
om By
INSIUMM AI°FOMINev COVERAGE MAIC#
INSURED INSURER A: Nodonal Granov Mutual
RED APPLE RENOYATIONB INC INSURER S: Commerce Insurance Co
32 WASHINGTON AVENUE
ANDOVER MA 01810 INSURER Q granite 5tete Nlsuranu;a Compa
INSURER M
•-
THE
i
POLIOUS OF INBIIRA ME USTEO BELOW HAVE tS TO THE MUM ksAft ABOVEFOR
ANY REQUIREMENT,TERM OR CONDITION OF ANY WffPW 9R gnio OOWmmr WRIT I b N TMSTANOING
MAY PERTAIty TNfi INSURANCfi AFIiaRpBp By THE pOL D Ii H IN IS SUBJECT TO ALIT ICATE" DE 138UEp OR
PDUClE3.AGGREGATE LIMITS SIIt141h1 MAY NAVI; AE4UCEo 6Y PAID CLAIMS TFJTAAS EC4LU610N9 AND OONOITION3 OF SUCH
NSR
IT*I TYPE OF INSURANCE PONCYNVIlIM �flmllfpwm
b�leutAl.GIA8IUTY LIMITS
' i26�e 08t25m7 H S 1 000
X COMMERCIAL GENERAL LIABILITY INCE
G(AIMS WDEFX WGUR PReMSBS °°01a'� s x,000
A MSO E7�(AIT Dna aelsvlli i 101000
PEr�94NAl3AtnYINauRY 9 1,000,000
'TE
LMITavr PS $GENLAGGREGATE 2,000 000
POLLCIf LOC PRooum94OMPPDPAQ% i 2,000,000
AUTOMOSU UANUTY 08MMNHNT24 10/13/OS 10/18106
ANY AVM j (OOMaINED'INME UMIT i
ALL OWNED AUTOS i
X 80ON.Y INJURY
B s eow.co alrros (Pwr ) S 250,000
X HIREDAUTOS ,
X NON-OWNED AUM
fNJURY
i
DOOILY(Far Aam
i
PROPERry W
NA4150000,,00000GARAGE UABUTY A ONLY-EAACCDENTANpip 0
i
OT►IERTtiAN EI,Ax s
AUTO ONLY: A� S -- •.
F SIUMBMLAUAINUTY
WH ORZCURRENCE
OCCUR D CWM8 MALIE i
AGGREGATE i
OEDUCTIBLE i
RETENTION j
WORKLMCOMPIINSATIONAND
EMPLOYERS!LIABILITY WC87461t18 06/08/08 08f08/OT ill 01MEn
ARYPPAFWM APAMWOMOMOVIAPE EJ-EACH ACCIDENT i 100,000
. 6 L OISEASEEwxor� $ 100,000
OTHM, -O�EAS�Pgd.1CYLiMTT $ 500,000
---
i
DESCRIPTION OF CIPERATKINSILOCATIONNMICL SS/EXCLUSIOK ADDED BY EN
DORS A$MT/SI CIAL PROVISIONS
CERTIfiTB HOLDER I CANCELtA7WN
ICED APPLE T RENOVATION ! SNOULO ANY Op TME ABOVE DESCRIBE)POLICIES BE
32 WASHINGTON�1VPJVUE 004RAYION DATE TFIF.RBW CET IED BEFORE TNR
AN THE 5UU1A INSURER WILLGNMVORTO MAIL70 0AY8
DCY6R,MA 0191b WRITTEN NOTICE TO TMfi CERTIPM�q 1 HOLDER NWEO BUT WR8
S#gw IMP086 NOOOLIdAT4pw Ma f MJMn OF ANY rpNp up�om-mm jm VRM1.
t S�AGENT90gk6arisgENrATNE$.
i
i AUTNORIZfD AVE
4
Atterrtion: 97580.2" f/
ACORD 26(2m/") I Ouis
Cerfificabe}# 1801 18 ACORD CORpgRAnON 1988
The Commonwealth of Massachusetts
Depaninent of Industriall Accidents
(^i Office of Investigations
d 600 Washington Street
Boston, MA 02.111
uwiv.nlass.govIdla
Workers' Compensation Insurance Affidavit: Build ers/Contractors/El ectricia us/Plumbers
_Applicant Information Please Print Le E:ibly
fi n r��oyatt�yr s ►`(
Name (Business/Organization/individual):
Address:
City/State/Zip: �—r�cn of Phone #:
- �
Are you an employer? Check the-appropriate box: Type of project(required)-.
1. I am a employer with 15- 4- F1 am a general contractor and I 6. El 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.
t 7. PVRemodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers'comp. insurance 5- ❑ We are a corporation and its • 10.❑ Electrical repairs or additions
required.] officers have.exercised their
Tight of exem tion' er MGL 11.0 Plumbing repairs or additions
3.El am a homeowner doing all workp 'p
myself. [No workers' comp. c. 152,§1(4), and we have no 12.0 Roof repairs
insurance required.) t employees. [No workers 13.El Other
camp.insurance required.]
;Any applicant that checks box It 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.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I an: an employer that is providing workers'compensation insurance-for my employees. Below is the.policy and job site
information_
Insurance Company Name: C S '` � G f
� � �
Policy#or Self-ins. Lic. #: C s14: CF t Expiration Date: (04-10-7
i
I `�
Sob Site Address: 1'-I \ X-arl, City/State/tip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failtue to secure coverage as required under Section 25A of MGL c. 1!52 can lead to the imposition of crirninal 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 insuxance coverage verification.
I do hereby cert' urt er the pains and penalties of perjury that the information provided above is true and correct
r « G
Signature: Date:
Phone#
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permi�Liceuse#
I
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: I Phone#-
I t �
F NORTH
omm Of 4Andover
No.
= dover, Mass.,,T�
COCHICHEWICK 11
ADRATED C5
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
* � BUILDING INSPECTOR
THISCERTIFIES THAT........ ....... R. .......4.11.5 .t. . .........................................................�............... Foundation
tA
has permission to erect........................................ buildi s on .....�.1...I..........�. ......... ............................ Rough
to be occupied as-MAN �. llow
*. ......................................... Chimney
.�� .... ......... ...
provided that the person accepting this permit 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 ELECTRICAL INSPECTOR
UNLESS CONSTRUC ST S Rough
.. . ................ ................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
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.