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Building Permit #245-11 - 19 WAVERLY ROAD 9/22/2010
BUILDING-PERMIT oF�"°oT"qti TOWN OF NORTH ANDOVER ° ; APPLICATION FOR PLAN EXAMINATION * ' Permit NO: Date Received �SSgcHus���y . Date Issued: IMPORTANT:Applicant must complete all items on this page y9r'.yY:.�1Sg:r�y,,;Fc,tS:� - �Ytis:I--�.0 = ::J•"..3'9?':h� - - '"^,` - _ ��•'". 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Gi'L:f tt'- _>.�w=''rf-'+".===,.;y ,�,���- i.,t; _ u' ,1;R �' „��<s L,� �'�, ��v�/�`_ ��p (fir-/�y {e� p �+ - '�„++• a?.r..f.P'pM'H���,:3v��� .rj.:1t..:"uIIu't?Y`rS;.:af,••f =:Pf;�'r:�`f :,:5�;:nNrt:�,�r`fg;�.. •f¢ w;l"�{tw^���`rarF-l��.r;C!i.^�/N7Lli�l r7Ji�li,r aJl1Y� �N�Li-g.l,���r.�,�yaea7�°��0"✓a`y'^i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: �2- Commercial Repair, replacement Assessory Bldg Others: Demolition_ Other r>u-�� �...:��,,.���� - '`�rt� �, 4���.,���11�,�r�• '' ��'��1�7�C� ��°�•���w. �.3���5���; �1S�i��l�j?�,'t����a•�� ~�: - - s^� �' ��ti".�.'9+ �,'.'`�:,��� en''ri�'r4+•s:_+e�x= ^�.0<�1��- '>`�,Ik`,r'r.?��D� .'.j,4'.-. .}-rb`in+�,tk::� ����^�.+„ti;Y�'��Fl�^��•(��-�?5!JF��,,�?I�'i's`�:'_'Sry,��. .� ��� ��:'N�:Ej `� ,�?,,,�"*s� -�...�� ,?�,Pf= � "�.Yc�Gi �3'�u+�Y8:::^�.�,•,art�'?s�» -v[�}c• m=i-g,�_v/r. .�'S[�.a„3.5-.`t -•�'-`C-' ` T r;�'.i� � ,h-1 ._...-_�.... __..�_ r. _ �f,�'iiR_.,!4 =:Tar.:. ".:,-t- -4'::-Tx..,-n'y'�?:w-!f.*•,:;�,: -�..,r'7_z�s x.. ,..,.iy' _ _°i�C� rv;P,� -'dl DESCRIPTION OF WORK OBE PREFORMED: Identification PIeaseT e or Print CIearly) OWNER: Name: �1 Y �-� /'s Phone: 9 71- 1?k7T Address: rye- .v -_ '. - .:<,•s- _ 'ru i+e".rte`-�.r�'."_+:.��,sh:t•'«t�;"f".,;i';�1S:us.=ua:5M'/1c",T •=k Wl^:..,;-.:i••�::< -_t. .,� _ __ WERE! = "^""T�� �Fr3-7 �•r.J�,�,r-•.,zc c'�r tf-'.,�FnPJ,� ^" "3 y"-r'Jz;i� ��y - -'o .s- •,t^y'k�'-ex �S"' - S :y . E 'c ra �."` `'Ts- E r$' K•c•�'ay,. ' "• --lr- „5n� .,�Y'k�'1���:'s�,"•-i',is r- ?e'er'Sc`�'v"zj�..,. �vr.,3,,,�•:..1 ter. 4:�"'`� x ,fit , ,^1 F �c .e' -7 '-x' o •.":' cF ,t-rte.,+ r � ai 00-11. - �I r ir- `4^1t�L '�15W "'-,.-v"'^fnr ¢.r- 4 +{�^��y,"^��"� $�*-4x'. 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'=�' �-�z.;-at��@,{,-. � �.., y-'.':.' � .e� - .t,�:"�tY�:..;��;y�S;r - ,�_ y �a�i•���a�-'s.-`u,,, .l:;�gh:, 7e;>`.vr.'-cif�:`=�.� y`I1'Fj��e..n�'r3T',�'-r ^y'eSi:=•:�54''2::3�r.�''5:-�=�-`� 3 r��,4'G�'�t,,'� c� ���:� �, i�v�- uj, � .r.tb'"� ,�"' �-.- :s_:Jrr-- �•�ri.'_-...:_'.;'4a=. z`._,y,. U- � _ M rcya:••�'-� ,V .s "''��'.<�?.G,rk'^,hiE.na'a�r s�r;;�• .^,.^z"..� �..F;a�,:gv-�-:X>'s.S'rlti.. 'aiw" -,:."t._ � tz� � r=�'� ; -,'d_ ri,_.,,,..�: ._:.�.. ='f*^���s•,:.i•.r --_�',i"1.::���.�`"�,�eh.. ti=tu,_ '`' t?� �ka..�'r.:��+=7ts,. -:s. >,.,e�j'�Ri�� .i'T�_ �• .�',����1�'Ti�+�_='E� :a_ r_� �1��r��' ar��i�� s�r�j�jp�--��y�..�c. ''!'{"�'�� 'c'ff.�:.="L "rR'•�.�.,.4, - :�" .. a'xn"i' 15�;�;-��,'�• ,.,aaV� ru5�rry1�^.-�ar��' 6�' - - -���,.n. �i- flip -.t w� _.._,ef -. _'.�. ...=.'-ro "�`.Z.r�,,i•j�> �'a ..,-- �.�,: _ r?9r-,..t�N � r,xlM ARCHITECT/ENGINEER Phone: a Address: Reg. No. *� FEE SCHEDULE:BULD/NG P fi$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No. /1,3�_,..` 7 �, 'I": Receipt No. 34 NOTE: Persons contracting wick uni eb-stel ed conts•cior s do not have access - he g-uaran fund arryo► n nano r T -- _ `S:igraa u�eYo �con�;ra 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�a e J Private(septic tank, e•tc. Permanent D umpster 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 11f1\1\/��.(T %C30 INJIMEN IS HEALTH Reviewed on Signature COMMENTS n" 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: �r:..�...._.. ..::_;. ti:.. _ _ Located 384 Osgood Street :mel'- s ;_T,...-.. ' ' - >sE: — - cat - - _ y - - r � cte< r1 7 J - - __,........� v....: ''S. : L - .0 _ . 1 Dimension K Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following is'a fist of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, l.nterior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of N.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 n 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 .� _.cat: r n 'I ❑ �. i«-111 U rrroposed r�Oi'Io- 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 i NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Location No. Aw — Date "GRT" TOWN OF NORTH ANDOVER a G� • r Certificate of Occupancy k Building/Frame/Frame Permit Fee $ s4cnusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #� 234 `5 - Building Inspector Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh A Sons or 55 Pleasant Street 1-866-AJWALSH .North Andover, MA 01845 Proposal Submitted Ta � Job Name fJob# f �r Address Job Location Date Date of Plans Phone# Fax# t C Architect rWehereby sub it specifications and estimates for:__.--_...................._._._......_....___.._.._<_....................._.___.._......._...---._._......._......___----..__...___.......-.----.-._.---.----........_....-.----....._.._._.__—.__..-.-----__.._._. _ ---......... - _ ------- _:T -=-- �__= A....... .............-...................,_._.....------...------ ...----- ..... ---..... __..._............... We propose hereby to furnish material and labor---complete in accordance with the above specifications for the sum of: f `? 0 / / $ ©QV - / ./c�; CGrLJDollars i with payments to be made as follows: Any alteration or deviation from above-specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and submitted above the estimate.All agreements contingent upon strikes,accidents,or delays C beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. acceptance of propogai The above prices,specifications and conditions are satisfactory and are �ignature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above./ Date of Acceptance q /// /� Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies sl1 basic requaementa of the state's Home Improvement Contractor Law(MGL chapter 142A) but does not include standard language to protect homeowners. Seek,legal advice if necessary,"Any peisonplanning home"provements should first obtain a copy of"a Massachusetts.consumer guide to home,improvement"before agreeing.to any work on yourresidence,You may obtain=a free copy by'calling the Office of ConsmmerAffans:and Business-Regulation's Consumer Information Hotline at-617-973,8787-or 1::888:2834757. Homeowner Information 'Contractor Information Name PaDy Name- Sued ame Street Address(do not use a Post off�fice Boz address) jS tractor/fsal�espe son/Owner Name . ri(/i�v�i'Q,� � .�,✓ �rl ! if/`. . '�! �I�L�f� Citylrown 'tt'/state �Ziipp ,/dle `� C usinessss/Address(must include a streeett/addreia) /Q!., lz . Daytime none Evening PhomaZip / Code ry? �4�/Ddv�;e, 1/1or�/�'' Mailing Address(h different from above)' 3usiness Phone Veduld Employer ID or S.S.Number 1awregWmrWtmmthomeforl Acme C=MWRea:M®ha tww'MMmaoetmf Esse■ HapistiondtC' I .. asgimniaommhe 1�3 .s" r l The Contractor agreesto do the following work for the Homeo mer: 1 Z1. ...:..: CaG9�= /� Q�:�P �j( ,�� Required-Permits-The:following building permits are requited Proposed Start and Completion Schedule-The following schedule will and will besecured.by the contractor as the homeowner's agent; be adhered to unless circumstances beyond:the contractor's control arise (Owners who',secum&eir own permits will be exeluded1rom-the-Guaranty Fund-provisions of Date when eobtractorwill begin contracted work. MGL chapter 142A:) Date when contmctbd work will:be-listantially-completed Total Contract Price and Payment Schedule , The Contractoragrees to perform the work,furnish the material and labor specified above for the total sura of (s) i P eats will bemade according to the following schedule: 1 —upon-signing contract(not to exceed 1/3 of the wtaLcontract price.gr the cost.of nal order items w ' _ sPeCi hicheverisgreater) $ by or upon completion of $ Py�upon completion of fi'},� s' 7 jly upon completion of the contract (Law forbids dem mnding full payment until.contract is completed to both party's.satisfaction) i/ The following ma criaYaptipment must be special be paid for ordered before the contracted wmk begins in order S_ to be paid for to meet the completion schedule.(**) NOTES:(*)including au f man.charges(•,)Law requires that any deposit or down-payment required by thecontractor before work begins may not exceed the greater of(a)one-third ofthe total contract price or(b)the actual cost of any specisl.equipm®t or custom made material which must be special ordered in advance to meet the completion schedule Express Warranty-Is an c wrm warranty bean¢movided by the contractor' No Yes (an tmm,v„tr io Subcontractors The contractor agrees to be solely responsible for completion of the work described repardlen of the actions ofany third Party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontraatorafor materials and labor under this agreement Contract Acceptance-Upon signing this document becomes a binding contract under:law. Unless otherwise no within this document,the contract shall not imply that any lien or other security intetrat Iters been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract Take time to read and ?• . fully understand it. Ask'questioris if somethcith ing is unclear. Make sure the contractor ha a valid Home IMRMement purrs' r Re¢isna" The hiw requires most home improvement contractors and. subcontractors to be registered with.the Director of Home Improvement Cont mctd Registration. You may inquire about.contractor registration by writing to the Director at.One Ashburton Place,Room 1301,Boston,MA 02108 or.by.,calling 617-727-3200.or . 1-800-223-0933. • Does the contractor have insurance? Check to we that your contractor is properly insured • Know your rights and responsibilities. Reed the Important Information on the reverse side of this form and get a copy of Ore consumer to the Home impiwement Contractor Law: You may cancel this agreement if it has been signed at a place other than the cootactties'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 later 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 BLANK SPACESM Two'dentia!pep'rsofarcmatraamustbeeomPleoedsad>*md,Ooeeopyahoulagotothehem wnc.Theodwee ythoatdbekeptbytMoonnagor. .. Homeowner's Srgrmture Contractor's Signature Date AMC Contractor Arbitration..'... The Home Improvement-Contractor Law provides;homeowners with the nghtu-initiate an arbitration action(as an alternative to court action)if they,have a dispute with.&contractor. The same right is not automatically afforded to'a. contractor,however: . a contractor;would have.tp resolve any.dispute he/she.has with a homeowner in court unless both parties agree to the optional:clause provided below..This clause would.give the contractor the same.right to arbitration as is afforded to the hom.eowner,by the Home Improvement Contractor Law. . The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a.private arbitration firm which has been.approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation andthe consumer shall be required tto,sub it to such arbitration as provided In Massachusetts General Laws,cha 142/4. AHomeowner's Sign.Ature Contractor's Signa, NOTICE:'The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The<homeownermay initiate alternative:dispute resolution even where this section is not separately signed�by:the parties;. Homeowner's Rights A homeowner's rights under thnHome'Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement: However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as descrri in a timely and workmanlike:manner. Homeowners may be entitled to.other specific legal:rights if the contractor guarantees, or provides an.express warranty for:workmanship or materials. In addition to guarantees or warianties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability:and:fitnesi,.fbr a particular purpose. An enumeration of other matters on which•the homeowner and contractor lawfully agree;maybe added:to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in du Lica a and should not be signed until a copy of all'exhibits and referenced documents have been attached Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by.the contractor. Any modification to the q�riginal'coniract must be in writing and agreed to by both parties.Contracted work may not begin until both parties havereceiveda fully executed copy of the contract,and the three day recission period has expired. Accelerated Payments A contractor mgy not demand payments inadvance.of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the.balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or.need additional information about the Home ImprovementContractorLaw or other consumer rights,.or if you wish to;obtain a free copy of"A Consumer Guide to the Home.Improvement Contractor Law, contact Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 " (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need•additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 or l-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against&,busm,essillcall: Constiri eecoinplaintSection Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of investigations . a 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): u eculs Address: 2- e-'e le Z- S� City/State/Zip: Ai/0 4n/IJ00 M /,%hone #: 9 qV 77 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with l 4. F1 am a general contractor and 1 6. ❑ New construction employees (full andlor part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions required.] officers have exercised thea 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ P] Ing repairs or additions inyself. [No workers' comp: c. 152, §1(4),.and we have no 12. Roof repairs - insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such 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. #: 7,,,' Expiration Date: // f Job Site Address: GtW/�Gl-e/eG City/State/Zip: Ale) 46/ 1_)a llelC 14'Wl- 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 coveragq-verification: I do hereby cep t' under the pains and penalties of per'ury that the information provided above is true and correct . Si afore: Date: lop, Phone# ;'/ 0 �� ��'�✓�,� Oficial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Towu Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: r I Information 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 legalentity,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 cornmonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compl1.iance 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 certificates) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees,,other than the Pce. If an LLC or LLP does have members carrycompensation. ... , , employees ra policy is required. Be required sea that this affidavit maybe submitted-W-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 toobtain 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us.a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900.ext 406 or 1-877-Iv1ASSAFE Fax # 617-727-7749 -evised 5-26-05 A ww.mass.gov/dia ., ✓!ze 6ar�z�norz�ue� a f Zt'a�uu t uae� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR :;; Registration: 103358 Type: Expiration: 7/7/2012 Private Corporatior A J.-WALSH&SONS,INC Arthur Walsh,Jr. 55 Pleasant St N Andover,MA 01845 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valiithout sig ture _ Ma"�achusctts- Dclutrtntent of Public Safco Board of Buildin-� Rc--ulations and Stand.u'ds Construction supervisor License License: CS 22680 ARTHUR J WALSH JR p 159A WAVERLY RD N ANDOVER, MA 01845 Expiration: 6/9/2012 ( nuni �i nuy Tot: 29327 NORTdy omm o _ 6 over yy �, over, Mass., O L LAK I� COCHICHEWICK 7� 0RATED OC U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THISCERTIFIES THAT S�-A�................... .......................................................................................... Foundation has permission to erect........................................ buildings on ...... . .-�..z.(.........Lc.� �l.....! .. Rough to be occupied as............... ....... . ........�.. .......I. .. Chimney . . .. . . . ................................ . . . ................ provided that the person acceptMg this permit shall in every respe nform 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 CONSTRU TARTS ELECTRICAL INSPECTOR Rough ....... ........................................................ Service .. . . ....... ....... ...... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.