HomeMy WebLinkAboutBuilding Permit #754-13 - 224 HILLSIDE ROAD 5/13/2013BUILDING - PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
✓ One family
Addition
Two or more•family
Industrial
Alteration
No. of units:
Commercial
Aepair, replacement
Assessory Bldg
Others:
Demolition
Other
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OF WORK TO BE PREFORMFr),
DESCRIPTION
Identification Please Type or Print CIearly)
OWNER: Name: Llorr& Ae- B=UdDIM _ Phone:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $1Z00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $123.00 PER S.F.
Project Cost: $ div d (� . 00 FEE: $_
Check No.: �j�'�i Receipt No.:�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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
o 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
-1 New Construction (Single and Two Family)
❑ Building Permit Application
❑ Ce iH 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 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
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
Doc.Building Permit Revised 2010
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT
COMMENTS
DATE APPROVED -
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS '
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
-Conservation Decision: Comments
Water & Sewer Conn ection/Sicinature & Date Driveway Permit
DPW Town Engineer: Signatiire:
Location v fi �' �d4e—
No.
Date
Check #7
26383
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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DAVID CASTRICONE
CASTRICONE ROOFING & SIDING INC.
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845
In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314
Uwe the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on premises below described:
l n
Owner's Name.......cGl -.....
.. , l 1 .r.:................r
..
......... Tel..ho.ne.#....�r... .....
.......
Job Address... NZ, All] .......lLL?`c........ ... ....................City.... ............ State.....
Specifications:
✓Strip existing shingles. i[s -,')---'X'
+,Apply new drip edge to all edges.
..............................................................i.....................................................................................................................................................
q.Apply, _feet ice and water shield membrane to bottom edges of house. 3 feet ice and wa rl shield membrane
in valleys and bottom edges of any -!nheated areas of house.
.............................................................................................: ................t..................................?..............................;1.............
Apply felt paper underlayment. .f:istall ridge vent to ) ,
.............................
Reroof using 1_1- ,A!-eee —4A4 LAX! shingles with a _
3n year warranty.
t o.................................................................................................. �....................................................................................................
unterflash chimney. -New vent pipe flashing. JLegal dis sal of all debris.
�.. �................................. ...........................
Area(s) to be worked on:.. ../� y
............`..:. ...............t. .....�...O..iS.l.......C;{1.:i......�'i...........b'.1.�?..1.?v:J.�'.P.!.e....�.li..C....� r
�' r `.:Fw...:it,.-•........................
:.. ....f..� c .....i...4.....t��r.r..::....................................................................
.................................................
........... ....5R.Id .....fit ?....... LT11_......(` t..1:k1.� C •�.............................. I........
..................................................................... /
t x,
...............
C f .................... �„_ ..:Zt �.`............ l.....T..�.y�.............................
Roof board replacement if necessary @�li(� /sheet or � -� /foot.
.................................................................................................................................................. -
S.... � ...............
Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as spe tied by maniiIket `
The actor agrees to erfoml the work and fu ' h the materials specified above for the SU of $... !- `
t/�% "Payable ....�< 4 .t1!...... on ... G Tda ............. —
Payable.........:.. ............ on.........:— ...............Balance a able on completion of job
Owner or Owners are not responsible for Property Damage or Liability white joE s m operation. _ - -- -
Contractor is not responsible for any damage to the interior of property, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or
conditions resulting from application of materials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in attic or other living
spaces). Items in attic may need to be covered by homeowner. All materials are property of contractor. Any dumpster placed by contractor is for his use only. Upon
Completion of above work, all undersigned agree to execute and deliver to contractor, theirjoint note in accordance with his (their) above obligation as requested by
contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It is
agreed that, if permitted by law, contractor shall be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that
shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith, It is further agreed that this contract may be assigned by
contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are)
the owners(s) of the above mentioned premises and that legal title thereto stands of record in his (their) namcs(s). There are no representations, guaranties or
warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is the contract dependent upon or subject to arty conditions not
herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties.
All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration
should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108
Tel: 617-727-8598
Any and all necessary construction -related permits shall be obtained by the Contractor. Any Owner who secures his own construction -
related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c. 142A.
Approximate starting date of work ................................................ Completion date .........................................................
Receipt of a copy of this contact is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing
provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be
binding upon the parties and that all of the agreements and understandings of said parties are contained herein.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Owner has three business days to cancel this contract and incur no penalty (see noti of cancellation).
IN WITNESS WHEREOF, the parties have hereunto signed eir names this ."/bt
//
t,... day of ...
Accepted:
Signe....�......7....,......
-� Signed 4! Owner
David Castricone, President
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
''•"- ivww.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information �j Please Print Legibly
Name (Bus iness/Organization/Ind ividual):C1=i5'fR1LOt1 1�out l NCr 1 1pI N V" \ N _
Address: A3 I R SyAko a SA(te,\ 3 A%
City/State/Zip: No. MA o IgyS Phone #:
Are you an employer? Check the appropriate box:
1. ® I am a employer with 8
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12 C]Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
r 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.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: •.S
Policy # or Self -ins. Lic. #: w /0= 39 99 7k.3 Expiration Date:
rl q • o� 3 • a� ( 3
Job Site Address:_ /L� J 1 1� City/State/Zip:__ 3 �Q< /` �ja dAr
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requited 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 staternent may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under thhepa(i�ns andpena/ties ofpeijury that the informationprovided above is true and correct.
Signature: J / �M�' � _ Date: e_6/_0 It 3
Phone #: On D G 1 3 3�
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
EASTERN INSURANCE
AC RV CERTIFICATE OF LIABILITY INSURANCEg�ii 2D012
PRODUCER 978 273 6368 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Willows Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
51 Cochichowick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Andover MA 01845 INSURERS AFFORDING COVERAGE NAIC #
INSURED NBURER A,E STERN WORLD INSURANCE_ CO
DAVID CASTRICONE ROOFING 6 SIDING INC &
INSURER B:
CASTRICONE ROOFING 6 SIDING INC
I INsuaER c,
231 Sutton St #3A
INSURER D'.
NORTH ANDOVER MA 01845 INSURER E.
r_nvcazer_Fc
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 OFSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Castricone Roofing & Siding
INN HADD Ll TYEE OF INSURANCE POLICY NUMBER POT CY EFFECTIYE POLIIMM/Dofryyy) DATECY [XPDryYION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE S 1000000
jUARCIME
• COMMERCIAL GENERAL LIABILITY
_
TO RENTED
PREMISES (Es mcurrerpoj_..�.� 50000
A - CLAIMS MADE X j OCCURpP13 2898 9/6/2412 9/6/2013
ME_DEXP(Anvone porson) $___ 1000
PERSONAL d ADV INJURY $ 1000000
...._......
GENERAL AGGREGATE I $ _ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: I
PRODUCTS - COMP/OP AGG $ 2000000
PR
POLICY J5 - I ' LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMB
$
_ ANY AUTO
(EB eccidono
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per pemon)
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS i
(Par accldonl)
$
I
PROPERTY DAMAGE
$
(Per acOdenll
GARAGE UADIUTY I
I AUTO ONLY . EA ACCIDENT
$
ANY AUTO I
OTHER THAN EA ACC
$
AUTO ONLY' AGG
$
EXCESS I UMBRELLA LIABILITY
EACH OCCURRENCE $
' OCCUR i_ CLAIMS MADE
AGGREGATE
DEDUCTIBLE I
_—S_
RETENTION $
S
WORKERS COMPENSATION
WC STATU- OTH-
AND EMPLOYERS' LIABILITY
YIN
I TORY ,LIMLT. S.
ANY PROPILETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EYCLUDED7 F
E_L EACH ACCIDENT $
..-....
I (Mbrods Ory In NH)
n yee, deeerIN ander
_
E.L. DISEASE - EA EMPLOYE $
---- A ... ..._ ...-_---
SPECIAL PROVISIONS 06IQw
E.L DISEASE - POLICY LIMIT S
OTHER
I ,
DESCRIPTION OF OPERATIONS I LOCATION$ I VEHICLES I EXCLUSIONS AODED BY ENDORSEMENT/ SPECIAL PROYISIONS
0o cvva n�.vrv.r %,Vr%VUrcAI IJN. All rgnrs reserVOd.
INS025 (200901).01 The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCPLLED BEFORE THE EXPIRATION
'
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Castricone Roofing & Siding
NOTICE TO THE CERTIFICATE MOLDER NAMED TO T14E LEFT, BUT FAILURE TO DO 90 SHALL
Unit 3A
IMPOSE NO 06LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
231 R Sutton Street
REPRESENTATIVES. l
North Andover, MA 01845
AUTHORIZED REPRE A
eI^nan �a r�nnorn�i
0o cvva n�.vrv.r %,Vr%VUrcAI IJN. All rgnrs reserVOd.
INS025 (200901).01 The ACORD name and logo are registered marks of ACORD
Aco OR � CERTIFICATE OF LIABILITY INSURANCE
DATE M/DDIYYYY)
9/ 24/20 4/2012
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).
PRODUCER
Eastern Insurance Group LLC Main
233 West Central Street
Natick MA 01760
NAME: Select Dept P)d 66807
a°No E :508.651-7700 ac No : 03-653-8089
E-MAIL
ADDRE ss:seiQctworkaeasterninsurance.com
INSURER S) AFFORDING COVERAGE NAIC 8
INSURER A Industry
INSURED 31969
David Castricone Roofing & Siding Inc
231 Rear Sutton Street, Unit 3A
North Andover MA 01845
INSURER B
INSURER C:
INSURER D:
INSURER E
INSURER F:
cnvGaenFc CFRTIFICIITF NUMRER, 1czAcni.)a7 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IPJSR
LTR
TYPE OF INSURANCE
A
INSR
R
WVD
POLICY NUMBER I
POUCY EFF
MM/DO..eYYYY
POLICY EXP
MMIDD/YYYY
LIMITS
AUTHORIZED REPRESENTATIVE
GENERAL LIABILITY
COIAMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
j
EACH OCCURRENCE $
PREMISES Ea occunenoe $
MED EXP (Any one person) $
PERSONAL R ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE UP:IIT APPLIES PER:
POLICY PRC- 7, LOC
PRODUCTS COMPiOP AGG $
$
1 AUTOMOBILE LIABILITY
ANY AUTO
ALLOVJNED SCHEDULED
AUTOS I_ -II AUTOS
NOIJ-OWNED
HIRED AUTOS AUTOS
Ea accidern
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Pei acx J."'
UMBRELLA LIAR I OCCUR
F—
EXCESS LIAR CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTIONS
_
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROP RI ETORIPARTPIGRIEXECUTIVE
OFFICERNEMBER EXCLUDED?
(Mandatory in NH)
II pes, describe under
DI=SCRIPTION OF OPERATK )NS below
N; A
WC003969723
/23/2012
/23/20Q
X WCSTATU- OTH-
t RY LIMITS 1 1 FR
E.L. EACH ACCIDENT $100,000
E.L. DISEASE - EA EMPLOYEE $100,000
E.L. DISEASE - POLICY LRdR I $500,000
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
CERTIFICATE HOLDER CANCELLATION
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
David Castricone Roofing & Siding Inc
ACCORDANCE WITH THE POLICY PROVISIONS.
231 Rear Sutton Street, Unit 3A
North Andover MA 01845
AUTHORIZED REPRESENTATIVE
I
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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License: CS SL 99358
Restricted to: RJi
DAVID CASTRICONE
31 COURT STREET
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NORTH ANDOVER, MA 01845
Expiration 12/16/2013
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Office of Consumer Affairs & Business Regular o'n
900 }'OME IMPROVEMENT CONTRACTOR
j;i =°Registration: 104569
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1x E_._ ;;Expiration: 7/14/2014 Private Cor oration
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DAVID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 226
NORTH ANDOVER, MA 01845 --
Undersecretary
Town of North Andover
Building Department
27 Charles Street
Nort11 Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
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In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a..
The debris will be disposed of in /at. -
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Facility location
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Signature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project tluough the Office of the Building Inspector,