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Home My WebLink AboutBuilding Permit #1123-2016 - 233 MAIN STREET 4/26/2016 AAW -6V NORTy BUILDING PERMIT o`<��E° �bgtio l ( TOWN OF NORTH ANDOVER 3� h ''` �6 APPLICATION FOR PLAN EXAMINATION T T± 14- Permit OPermit No#: J (�p Date Received 7RA°Awre° ""4`� �SSACHus�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 233 Kotta. 5� Print PROPERTY OWNER__o1'\LtA 6 h&.6,&4 P nt 100 Year Structure yes no MAP ()3 ` PARCEL-b-b-J� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Knne family 0 Addition ❑Two or more family ❑ Industrial >�Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑_Septic Well ❑ Flo:odlan ❑Wetlands ❑ UVatershed,Distract r q DESCRIPTION OF ORK TO BE PERFORMED: Identification- Please Type or Print Clearly �� l • Z� OWNER: Name: b( �-1 a h a�� Phone: Address: Z 3 3 tl (A-%r- S�- Contractor Name: kLu✓ c,qJ\( Phone: `q 35—U ' 3 `O 3 Email: Ykh l t r;n SO vN Address: ?oGzx 144 1g2i\ iCQKt1 A blg38 Supervisor's Construction License: 0-L��- Exp. Date: J I Z I I Home Improvement License: �7 L7 y t o Exp. Date:- ARCH ITECT/ENG I NEER ate:ARCHITECT/ENGINEER Phone: k 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: $ 33kt � 'C)�8 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM i PLANNING & DEVELOPMENT Reviewed On Signature— COMMENTS ignatureCOMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes -' Planning Board Decision: Comments " Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street F,IRMQERAR�TMENT �;T�emp Dumpster on=sitdA�� yes,,:.,A� ` �. ►�.tf, r ,,+r;-.-kr�x-�Yrt r e �. 1 Located of 124 (VlainStreet r _ „ :; ," �"`, t : —X 144 {; "rZV� ��,�� t}r��''!_. £r ��1 , .."�,5`�� r°r� 4 1;'_ -'4' .1 S;.a�; }Ft «s• •a¢ �x-*s•Tt�AY�r;ts'n•'^"h �- `; r �.......� «"'s.-�,s, COMMENTS,{ , ' �• i .,, ,-. ., ', ' , _ . �� t �:.#.,�;'.'�-.� - t , �.t 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.$10041000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name 5 Doc.Building Permit Revised 2014 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 4. 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 OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 Location C � 1' U -' No. O' ' D.A-2(I 1.�Y • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ 4-6 Foundation Permit Fee $ �, 4 Other Permit Fee $ �- TOTAL $ _. Check 011 1, — 7 H Building Inspector / Fad1d of C �w�+ RISE EnglnaarlTlS to w RISE,- A di.tmw of Three►Raalaeedaa CT GeaYsfer Win Me ENGINEERING' 601(farwmi V.11 b7-Cu104.ALL CONTRACT (401)714.)700 FAX(401171"10 ►aa + PR(xiRA.l1 COLA-IRS pwla�aa rr aonasor w an®mm anrira er wrwairaioroawawr em�waaolr �.��.� Nil. OaR air• wal�tatifll Donald Marked• (978)682-2408 02/192016 429732 00004 wawa min aur aranr . 233 Main Saw 233 Main Sheet uavic am Sunda acsiw an.eranis - North Andover.MA 0184S North Andover,MA 01845 JOB DESCRIPTION MR SEU W,:P—ide Isbor and ows na6bedb dor)—bamsplw wwut"past air ksaW 716 writ w11 be Pfffamed In cabal wish Oe meofspc6id rows d dtsp ra is ane b wan 0r1 Jow Game Will be kR wilh a ba difid 10M or u cmhmlpC d bc' air*oft.btalalah In be mcd Co mW rot lb n c liitade CUUM Rams and mho pond-cm Pvbn.y orcin fmsedin0 inch.&dr te3a0e w mt m bmweann,=&,A Q mad m other uahcamd aim(wkld—we s 0ambily addm.c L)This aro 19"k.l7)worthy tams A mdcidoa In albk Ra pa mknre(cna)of&Mlihmlkn r1n oK .but ai Mail m bo aefm is amp m="ced, M are conNkria of aw waehmj a—Work-d mw soMmed cost b Me farlmwner.a Ilmi bl—a dooraWar aanhwtion safeq•ano0s6 w91 be uadoctcd by the ssdreontmaor bamre tht sardy Draw indar dr gw6ry. 5393.00 ATnc n,%T:Aaride LMor d amends b kratl a Icr lava of R.33 Chas 1 Cdkdlwc added b(6301 spme Ad of opm wk $926.10 RKMWAIA S►sori6 td- W aaae m ksW12-FSK Ifcad s.WSW rbc O s b—d i—b ma to(363)erg km of kaeeaall brcA 51377.30 ATTIC ACCTS,lveride Ibbcr d nwAdo&to k—Iso aw bxk order mule dace rids 2-ripd Thrmaa band d std di dooh a10c with rwammyp*to radia W IcA pa. 5221.73 VENTILATION:Pmidc I*w=4 mmaiab b WmM vmtilmi m china in(42)mRa fags to mdmdn ak ftm. 504.00 nASEMEN T CFMM:Pmkk tabs d meatus to bota0 t149)Haar foci of R-19 mfbmd fib,%Ia bsolmiw b tke portend ofthebmaomto ibVeithetime sil 5260.95 I C FG F= V = D FRISE EnginecrisK.gRISZdlvWmar71ktr6E ENGINERgtlReeAeR 60 Sh.weul Vdt OLCOSM16 n1A CONTRACT (401)7844 M P+Oe = PROGRAM *rr,.�b rrernwwrr CMA-HFS OrfOWA Mrw _ww _ CJaaT� rewt AlRo1_. DonaldMn*cy (978)682-2408 02/19/2016 429732 00004_ rmvq siWt - wlt nrsr 233 Main Street 233 Main Street _ rrvw C"ATAT&W "L"n .Mme North Andover.MA 01845 North Andover.MA 01845 _ JOB DESCRIPTION Total: 53.366.08 Program incentive: $2,695.01 Customer Total: $770.08 N AGM RWer TO AM W ot",O"•C011PLM MACCopo"p VOM""*MCRCAMOM MR T"We Of •••Seven Hundred Seventy 8 08/100 Dollars X0'08 1MOA AY q'[C1rnw AHA0/AIn ARirlw[Or4 gRTp�rA AaAP m oruw�rr rrrt�froiM iR� AM u.AAe ArAAUAna�reaaAAtAnrm.auwa.rY*.�arnsa r �owu e. DO Nor 81aN TIeB CMlrRAC7IF {t/r0tBP d.�.Qlf� ewrvoArA.eni You""`'' �C•�r,.6 KGCJ�� a.r,r..R.a.y..... / e�nor�acvlYa� �/ l�j l� Rom+w ooRlrctr�vawngrwv Arwrwnavallw wm� LLL ACVr11CANOYI1AACt-MAAOAI�wco. pil �nrroarlPtrin AAA AtR M VAOIrb MMifYfwlLLM�Y�AAA�A111110uWOlOOA RRlNrUI t �V s FEB 2 201 RISE80 Shawmut Road,Unit 2 1 Canton,MA 020211339-502-6335 ENGINEERING www.RISE&ngln"ring.com OWNER AUTHORIZATION FORM (Ownner'd Name) owner of the property located at: (Property Addre Dom} ss) !Yf *iLr`fr 2 1 ) -_ �'(Propeirrttly.Address) N hereby authorizo C, �' ,\t r-r `� ,"`LJ-1-6 �— (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Owner's Signature "AAA — Date C CLLaMC D FEF, f 016 The Commonwealth ref.Wassacltusetts Department of Industrial Accidents Office of Investigations 4 �,t i Congress Street,Suite 100 Boston,M.4 02114-2017 www,ntass.gov1diu Workers*Compensation Insurance Affidavit:Buiider%,�Contractors.,Electricians%Plumbers Applicant information Please Print Legibly NaineiDiasi .:`slit}itntr.ssia,;timlittiiu:tW Gts,I�y f r tft+tt(, t 1 ,_..� 5.' _._. ... _ A,ldress: &G t3 o x 3'14 City state,Zip: W► t 3S Phone 3 S_to• 311 S 3 Are%.ou an emplocer:!Check the appropriate box: T%pe ol•project Irequired t 1. 1 ain s emphiyer t,,itli ® 1 am a�,cncral ccirura:tor:nd l cntplmctit#utl and urpar-tone)' ha%c hired the sub-cuntra�tvr, t' ® �i:+ rcln�tr,cttc+n . 1 ,m a tali p-xipn,tvr ur pit-trier- IISI d cm IIIc.,ra.1 ,!. heet. RcTrnrdeling ship and ha%c no cmplot cc, ! ;ha is x ®Demolition working, tor rite,n;Inc capa ik enipl cc,and hate�%orkcrs'M- } Rudding addition [NO UkCrl'Lonip.ursurancc ct,tnp. in�arjnco p� kg,�:t � ri d t:o otaiw:t anti as !i}„U ilectrical repairs or addiij}ns fs:a;nirCel J � �.! I am a hetiT,•LMAT.:r dmru,all 1Soil,: tilt:t::',l:at::\atx'lSetil their !1.®�1t)t:t�°l'sij'_rt:1”itr>Ot,i,t ttititT> ri_hi of cSClrt tion:�Ci'��G1_ nt5',clf. less at.trtcr> cunt: - C t_.®Roof repairs ,n+uranc.:re:-luircd.j :u,d tt c lute no cnspltncr, (tia ttc-ritels" ,:txnp in.:,raitre required] '.4rix r 1taCN)x=1 T Jrr tiout rtx{xRw a,,a., 1!i..a„r::t•'...t p:`t.tt .t t-;'.ta n: ,t tu,�n Norrie::beer,u :r tub rs,ttr,ai-idax t.r . C.,'t ^ true rz-&4- i E xi: 1 ,:r t .,.,x:t•t.l r rr.'r.,t:.n rr,t,uhrtr n:h 5'r1t:r! a tt:sg�xi taxi.tubo S 5 n'ra:*a ,. ata a.t t..:+ of s! c:,f:,a: L t`e rat,rc t:1:r.aFa ,,:,_;;, [s'.>e,.a:a'J?c a h:.tisr to no 't t'«cttrit i c::plo:.:.� t7 tk`i:ur•it''+rird:';�t,k ger:-r;,a:a+..; •.rt�,:prr�i�,!her ue:i,.-t. ,x:r_t• r�"•il'cum?><, i am an eniplot'er that is providinq tsorkers'conrpen%ation insurance lite m,)•emphiyers. Beloit•is the indict•and}ob dile' information. ir:.urretict`on)t>an Nan);,:J m& (k j41Se3fpin+,fj 1'.he t,r Slf 1siS.1 ic. Job site:lddress t,tt State ZlF•Y"' ftLuvc e, (1 01 __�_ .Attach a copy of the ssorkers'compensation polio declaration pare•Osho%ing the potic% number and etpiration date). Failure o sec:trc co%'erice as regwYed,:aider'SLction_5A 4„'NICT .c_ 15'c,n 1,td t.r ilii Hopi+,it,on tet crirnu..It pcttalties o:a tine up to S3.5tK1.0h and or ene car itnpriutnm.:nt.as tscll as cnit pcneltics,tr the.`tutsj is i`i€OP WORK ORDER and n fiiw of up to`+1150.(10 a day against the t uTlatw.- tic adx i,e,i Ihat a crypt of ibis,satcinnit Istat b: fonarded*o the f_.),t`tcc o Imestipt,ons ofthe Dr,\fior inscranc co%eragc ttin icatiti:i. I du hereby c^erttifyy underthe pain-and penallics of perjury that the itifitrmativn pre)tridtd ahos'e h;true and correct. Dat t.'. Official use only. Do nut nlritc in this arca,to be completed by city or town n#Jciai. City or Town: Perntitft.icense;t Ksuine.Authority tcircle one,: 1.Board of health 2.Building*Department ?.CitFl I'tion(Teri. J.Electrical Imspector .Plumbing;lm, a-tar 6.Other C ontaet person: _ ___.____ Mine : CERTIFICATE OF LIABILITY INSURANCE TH15 C€RTIF:CATE IS iSSUEn AS A BATTER.OF I%Ft?R.MATION ONLY t'D C3N9F-RS*#C RIG-!i5-e CH"-!E CERIIF1 A E HO�j£R.THIS ! CcRTIFiCATE TOES NOT AF.=IR VAT€;HELY OR tiEGATIVELt ALM ZN:) =SeTEN0 OR ALTER THE COVE R.1,GE AFtCFPED 5Y T,-i€POLIMS fi BELOW THIS CERTIFICATE Of 274SUkkNCE DOGS NOT CU S iTUT:A CONTRACT BETWEEN -c ISSVING t^+St'R£RgSj.AUT-4L)RIZEO PEPRESEW,ATTVE OR DPOIDUCEA,A,YO THE CERTI=7CA'+_tiOLi_ER TI•TPCrRTANT:T..he cea4�F,L-zre her+s an AO+Dr 1�NA'a ISSt:.€G,CJrr_f�k"Y:�si rTsust tae ecid�rseti `cifBF.OGATIOrr'IS WAPd=D,sibs'-cT*o:tre 1 ,,sand cczvdoans of the pou„ cerin r.pclk;os may-rgare fi v--nl-serr..ert-A stStem-n-t cn vi 5 ceri.fk!t'e rv,aristo:� t tw eer+.dlcaae hc�cer m Iie",t of e'r�ose^neTMtts,, ,.�;,�'•. BerkTsa Assigned Risk ser"Ces�Giaytori 1iItaREn J IRs Agency Inc 1809IJorth$rnptan St PC}Box 989 800)634-459S «�. {Tito 2.T5 @IIS Holyoke MA 01041 c&eY TsrF:R+YrSk.cas I Me:K>iR A. ham '} Gauthier Insu4tion Inc *`-.Osa T. PO B9X 344 rvSL '.'R L. Ipswich,NIA 01938 a �=} Lsu= nrL�un= COVERAGES CERTIFICATE NUMBER-, REVISION NUMBER: THIS IS TO G€RT'ttY TI-AT:t€POUCIES OF NSuR,ANCZ L S T EO BEI;Av-+AVE BEEN aSS Fn j T-E NIc PED NAMW ABOVE FOP.TN_POLICY F_titccc N'—'X-ATF; NO,`.1THSTA,%DltG ANY P€QUV EM:.'mi TE.F2MOP^.(}NOETtG'r£�ArlY i'Oh7RAC.T OR Oi-Eft Or3CJ' cfvT tiRTn nESPt� 3 ii:stt'.•'Tr+ia C€RTIPICATEM✓.AY BE ISSUED GiR MAY P°ERiAN-T1 [Ni -gANCE--1-F DEts BY 7tiE KXICf_5 UESCR45EO+`rtERE+NIS SUBJ€C-I TO AU`ti=c TERt{SS EXG�_iRSSO+Fts artK)GCIr�a;X?t.5 L�StiCit r��"E5.LE:<.it1`S SH3csr?:�.Ar?�,s�vE F=,"`td HEi`•isCs'�3Y r�?70 c:..sauS. T—EG�s.'.:_g:sr. I CRCs-t .r::P'- R_n.y. i c�.u'vss Ess r! t 'ERSf`tfV.ds:d t.iY iahJs't 7 E>r3W A..4'.RsW'F S i a s 4iiiONbReCe ittDtlty r i �.. - -•. .+ = 5 - ;Mt ALa� D SC-E7'ie s..` 3 T D�dIY P.5P+" "GIs Q,+pt�'c 1 S y t i4°'=.EKLLA L" OC'A*t I AM eMiLCYRi i.Y1A..r`.' t:x. P eC..4f3r'S 77:77 HMAtWs9sry!)1 Mir +'vatic f ]c§4'�sR'R 4'L1P'6t TKY Ea4F ci_; -3•S€ »'+.^Y CMt' S 5wi COD f4acs:,r,:slaor�e £sws.r Srp:> 4rx aT�r. �,t-a--ecx. CERTIFICATE HOLDER CAN EELA ION or 7�c A q1_C:SMZEu PtY_r::tE tis O.KNO :.a=0 scfaORE Ctearesult TrfE EX RATKW.+AIF—HER=GE-.10 Z ;b't=BE.ELI�,ErM- tS ACCC'R::X14:E WT}'THE�Lz'LCl x c,;�td5 Contractor Sven k* �2 E ♦.fi= 50 Washington Street Westborough,MA 01581 Signature: ACORD 25(2010;x05; BRAC 3139 A��® DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 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 CONTACT Nancy Usher Martin J Clayton Insurance Agency, Inc. aCONN Ext: (413)536-0804 AX Nod:(413)534-7874 1649 Northampton Street E-MAIL ADDRESS: P. 0. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURER C: 44 ESSEX ROAD INSURERD: INSURER E: IPSWICH MA 01938 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER D LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE YOCCUR DAMAGEPREMISESS(RENTED 50,000 Ea occurrence $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I RETENTION BE020792125-194985 10/18/2014.10/18/2015 $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 7 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD P0Pb?b9tbd with pdfFactory trial version www.pdffactory.com M0 Massachusetts.Department of Public Safety fiord of Building Regulations and Standards f.Ytwtt ck�i�arr S1�irrrr�N=,h site, License:CSSL.102382 ,. P.A.Box 344 Ipswich MA 019�t carvtr,,;s Expiration ssioner 0512312017 M /1l f' (In111111t?11t(lf'(tl1Jl 014?) MajClfllCG�f' � #' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 j Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10/1/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 IPSWICH, MA 01938 Update Address and return card.Mark reason for change. Address i Renewal Employment Lost Card SCA 1 is 20W05h 1 %/rr Y r,xn,i n,.,nA/r.� '&.....rl,...,// ,\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: }fit f a-1 HOME IMPROVEMENT CONTRACTOR Registration: 173410 Type: Office of Consumer Affairs and Business Regulation Ft - z ;,.'Expiration: 10/1/2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER f J 44 ESSEX RD —r41 IPSWICH,MA 01938 Undersccretary of valid wi out signature I t%O R TFi Town of ndover No. I XIL h ver, Mass, 7LAam coc"IcMew,c.c y1• �.9s RATED Jkf U BOARD OF HEALTH PER MT D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ................. . .s1,1 . . ....... :fir..'... ............. Foundation has permission to erect .......................... buildingson ... ... ........ ... . lw..... .. ............ .......�:. % ,` � . 0 � Rough to be occupied as .. .. . ....�.. .MSI �"� Chimney provided that the person accepting this p` it shall in every respect conform to the terms o the applicationV� Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Ins ecti n 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .....,y ...... ........................ ��'Lll�y` �""".'............. 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.