HomeMy WebLinkAboutBuilding Permit #940-14 - 325 SUMMER STREET 6/25/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: q;qo - Date Received
Date Issued:
IMPORTANT: Applicant must
LOCATION
r-rint V
PROPERTY OWNER - VOU/ 1 f1l'O,
Print 1 00 Year Old Structure
M NO: /42 PARCEV
AP ZONING DISTRICT Historic District
Machine Shop Villa
all items on- this
e
yes,
yes
yes
TYPE OF IMPROVEMENT.
PROPOSED USE
Reqidential
Non- Residential
0 New Building
90ne family
0 Addition
0 Two or more family
El Industrial
El Alteration
No. of units:
0 Commercial
0 Repair, replacement
0 Assessory Bldg
El Others:
11 Demolition
0 Other
XSeptic 0 Well
0 Floodplain 0 Wetlands
0 Watershed District
0 Water/Sewer
Rem
OWNER: Name:
F.115156RM
CONTRACTOR Name:
I Address
DESCRIPTI?N OF WORK T9 BE PER ORMED:
1(t ono tiecb C40 J AVIT
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f t 10
lurt
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V9, M6 -I 1q,
Supervisor's Construction License: Exp. Date:
Home Improvement License:
Date:
AR�H ITECT/ENGI NEER Phone:
1-117�
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
0
Total Project Cost: FEE: $
Check No.: Receipt No.:
NOTE: Persons contractinAgt i unregistered contractors do not have access to the guarantyfund
re of Agpnt/Owne Siqinature of contractor
r
Plans Submitted Fj Wan�sived Certified Plot Plan Stamped Plans
Plans -Subm itted� Plans Waived ..7 -Certified Plot Plan El Stamped Plans-
�-TyPeE��OY.8EW-ERAGE-DISPOSA�L-
Public Sewer
Tanning/Massage/13ody Art El
Swimming Pools
Well El
-Tobacco.Sales
Food Packqging/Sales El
.-Private�(-septic tank,'etc-
ermailent Mmpster o I n.Site
-THE- FOLLOWING SECTIONS- FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
REJECTED DATEAPPROVED
PLANNING & DEVELOPMEN-r* F1
COMMENTS
CONSERVATION Reviewed on �— )I ko I � 1-( , � Signature � �,- J3 \�O/,
COMMENTS C)i t-\
"A
U
HEALTH Reviewed on Oirinnfiin=
COMMENTS
Zoning Board of Appeals: Variance, Petition No: 7oning Decisionlreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Con nection/Signature & Qate Driveway Permit
DPW Tovvx-: Engineer: Signature:
Located 384 Osgood Street
-FIRE D�PAIRTMENT-. -.7ehip Durniatter on site yes no
.-Lbcated-bt-124,MeiiriStrdet�-�-,-
"Fi. re Depa'ai-he It"silqhAtu'ed/dAte'tt
COMM
ENTS
Dimension -
Number of.Stories, Total square feet of floor area, based on Exterior dimensions.—
Total- land area- -sq. ft.:
ELECTRICAL: Movement of. Meter. locatdbn-,�mast-or service drop requires approval of
':Electrical Inspector Yes No
DANGER ZONEUTERATURE: Yes No
MGL-Chapter166. Section 21A—F and G min.$100-$1000,fine
NOTES and DATA — (For department use)
A(Z
El Notified for pickup - Date
Doc.Building Pennit Revised 2010
Building Department
---.:The foKSwmg-is�a- list of.the required.forms to be -filled out'fortheappropriate. permit ta be obtained.
Roofit�g, Siding, Interior Rehabilitation Permits
u Building Permit Application
Workers Comp Affidavit
_,.a --Photo Copy Of H*.I.C,. And[Or�G.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
o Building Permit Application
u Certified Surveyed Plot Plan -
u Workers Comp Affidavit
u Photo Copy of H. 1. C. And C. S. L. Licenses
ci Copy Of Contract
u 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)
u Building Permit Application
u Certified Proposed Plot Plan
u Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
u Copy of Contract
u Mass check Energy Compliance Report
u 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 apt),?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doe: Doc.Building Permit Revised 2012
Location ��v YK VA--#%-
WIWI--
Date Iq
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $—W—
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check #
2771.3 Building Inspector
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RENEY, MORAN & TIVNAN
REGISTERED LAND SURVEYORS
75 HAMMOND STREET — FLOOR 2
WORCESTER, MA 01610-1723
PHONE 508-752-8885
FAX: 508-752-8895
RMTGHSTGROUP.NET
A Division of H. S. & T. Group, Inc.
REGISTRY ESSEX NORTH
OMM PAUL OHNO
ZT:
MORTGAGE INSPECTION PLAN
NAME
LOCATION 325 SUMMER STREET
NORTH ANDOVER, MA
SCALE 1 =60 DATE 06-24-14
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5
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 9 Date Received- t10 146C>16
Date Issued:
RTANT: A
L
P1
0R0,0'ERTY0WN,._*f31'.-
P1
00-`�-i 0� PARC�L: ZON. IN
.t must complete all items on this page
e
--Histbrib:Di§fndt- yes.:.: h(
DI.TRICT,�.
Machine Sh6p Village.
TYPE OF IMPROVEM�-N-T
PROPOSED USE
Residential
Non- Residential
0 qew Building
�One family
11 Addition
0 wo or more family
11 Industrial
"--U Alteration
No. of units:
0 Commercial
0 Repair, replacement
11 Assessory Bldg
11 Others:
El Demolition
El Other
0 well.,
o rlobdp'18in'� n 8
af�r8 ed District.
S6 wer
D
e� dorM ar.
Ul- VVUKK I U bt FtKt-UK1V1t:L):
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OWNER: Name: lvc?L�J i A U'I Q
Address: �4, A4 kA4k- A4k
M Ph 00
CON�McTbR am one:
d LW
A � a�oss, GCA �C/
dn/z
Exp."' a e..
se: 5307
-uper,visors onstructionLi6en' -
EXp . bat6:�4; � 1XI. . L�
H6jjj�. ih!&Venient License' -
A CHITECTIENGINE
Address:19 n4ih A , "nd i Alk 0 1967 -Reg. No.
FEE SCHEDULE. BULDING PERMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON
$125.00 PER S.F.
Total Project Cost: FEE: $_ OD
Check No.: Receipt No.: .293 C 6 ;7
is ere contractors do not have access to the uarantyfiund
NOTE: Persons contracting with unTek' t d
, �ySignature of Agent/Owner Signature of contractor
Plans Submitted [I Plans Waived F1 Certified Plot Plan El Stamped Plans
ETYPE OF SEWERAGE DI§P--OSAL
Public Sewer Tanning/Massage/13ody Art El Sw"'uning Pools
well El Tobacco Sales El Food Packaging/Sales El
Priv (s
Private (septic tank, etc. E] Pennanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT El
COMMENTS
DATEAPPROVED
El
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
Reviewed
COMMENTS____La� �cL
1
c,
411 P)c" k -n -z-, ,,I -�— / —
- r'-1 1--) r- � 0 a-c� (/
Zoning Board of Appeals: Variance, Petition No: ----__,Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments I
Com
Water & Sewer Con nection/sIgnature & Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Du
mpster on site yes no
Located at 124 Maihi.strdet
Fire Department'
sig'nature/date
COMMENTS
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
DAN( --=D 70NE LITERATURE: Yes No
MGL Chapter 166 Section 21A—t- and G min.$100-$1000 fine
Doc.Building permit Revised 20 1 O/Oct0ber
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
9�corkers Comp Affidavit
Photo Copy Of H. I. C. And/Or C. S. L. Licenses
CO
PY'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
c, Building Permit Application
• Certified Surveyed Plot Plan
• WorkersComp Affidavit
• , Photo Copy of H. I. C. And C. S. L. Licenses
• COPY Of Contract
• Floor/Crossection/EleVation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Mass check Energy Compliance Report (If Applicable)
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
• Building Permit Application
• Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
E3 Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
0 COPY of Contract
u Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
0TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Yn 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
Knust be submitted with the building application
Doe: Building Permit Revised 2008
Location.-3�?,�— J &109 S;/—
No. -3 '5'/ - -?0// Date
Check # Iff �/
23667
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
6
building Inspector
�J
Hudson D
Lc
Design GroupL t*5
February 4, 2011
Brian Leathe
Building Inspector
Town Hall
120 Main St.
North Andover, MA 0 1845
Re: Renovations/Additions
Diorio Residence
325 Summer Street
North Andover, MA
Dear Sir:
Representatives of Hudson Design Group LLC performed inspections during the construction of
.-.the Diorio Residence at the above -referenced address. The Final Inspection had been.
conducted on January 3, 2011.
Based on my knowledge, information and belief the completed construction substantially
conforms to the approved plans, Massachusetts State Building Code (latest edition):
1. Final Plan "S-1" dated 10-15-2010, prepared by Hudson Design Group LLC, entitled "325
Summer Street".
Construction has been satisfactorily completed.
If you have any questions, comments or need further information, please do not hesitate to
contact our office.
Since ly;
Daniel Hal PE
P I
resid nt
Hudson Design Group, LLC -
1600 Osgood Street
Building 20 North Suite 2-101
p: 978.557.5553 f: 978.336.5586 a: 1600 Osgood Street, Building 20 North, Suite 2-101, N. Andover, MA 01845
p:413.588.8139 f:413.517.0590 a: 116 Pleasant Street, Ste 302, Easthampton, MA 01027
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Building Contractor
Proposal
Tw. Paul Diorio
325 Summer Street
North Andover, Ma 01845
Frorm Kevin Murphy
CQ
Daten 11/4/2010
Job: Office Addition
Date of planw. 8/10
ArchitO r ?
Location: same
Section I - Work SchWule
0 169 Boxford Street
0 North Andover, MA 01846
0 PH: 978-688-5335
0 FAX: 978-688-7207
All Horne improvernent Contractors and Subcontractors
engaged in horne Impravernent contracting, unless
specil'icafly exernpt from registration by provisions of Chapter
142A of the general lam, rnust be registered with the
Commonweafth of Massachusetts. Inquiries about
registration and Status should be made to the Director, Horne
Improvement Contract Registration, One Ashburton Plaoe,
Room 1301, Boston, MA 02108.(617�727 8598
Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in
writing contractorwill begin work on or about 10/15/10.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 12/30/10. The owner hereby acknowledges
and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as
violations of this agreement
Section 11 -Warranty
The Contractor warrants that the work fumished hereunder shall be free from defects in materials and workmanship for a period of 1 year
following completion and shall comply with the requirements of this Agreement In the event any defect in workmanship or materials, or
damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job,
including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair correct, replace, or cause to be remedied, repaired, or
replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in
connection with the agreed-upon work.
Section III - Scope of Work
ReVEM Umn-RDRY
BufldingContractow
169 Bo)ftd Street
North Mdow, MA01845
PH: 978ZBB-5335
FAX 978-6W)000(
Page 2 of I
General
Proposal is to build office addition above existing garage as shown on plans. Building permit will be provided by
Owner. Plans to be provided by owner. No allowance has been made for anything except labor.
Demolition
Existing sections of garage roof / ceiling will be removed as required.
Building
Labor will be provided to remove existing roof on rear of garage, construct new floor, install support beams,
build new wall and roof structures. Windows will be supplied by owner, installed by contractor. No allowance has
been made to supply or install any roofing. Siding will be installed to match existing. Ceilings will be strapped
and interior petitions will be built as shown on plans.
Items Not Included
There is nothing included. Labor only. Any materials or disposal fees provided will be an added extra.
Kevin Munplay
BuUding Contractor
169 Bo)dbrd Steel
North Andover, MA 01845
PH: 97&�
FAX 97&-6W)00(X
Section IV - Price Schedule
I Total
Page 5 of 3
We hereby propose to furnish material and labor — complete
in Accordance with above specifications -for the sum of ...................................... $9,000
Payment to be made as follows:
Percentage/item
Description
Amount
1
Roof removed
$2000
2
Job completta
$7000
2
$9,000.00
*14otice: No agrearnent for Horne opmernent contracting work shall reWire a down payment (advarice deposit) of more that one-third of the total contract Price of the total wwt of all deposits or
Mrwft which the contractor ffnist inake, in advanw, to order andlor othewise obtan delwy of special cater matenals and eclLr� 4vchever is Weater
Contractor: Kevin Murphy
169 Boxford Street
No. Andover, MA 01845
Registration No: 101874
Section V — Acceptance
Acceptance of Proposal — I have read this document and accept the prices, specifications, and conditions stated. I
understand that upon signing, this proposal becomes a binding contract You are authorized to do the work as specified.
Payment will be made as outlined above.
You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this
transaction cancellation must be done in writing
Signature.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Date
Signature Date
Mi�7� CERTIFICATE OF LIABILITY INSURANCE I I DATE ONYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS RIG U N E R A H ER. 17/1/2010
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL NO HTS PO TH CE TIFIC TE OLD THIS
TER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 19
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, SUNG INSURERS). AUTHORIZED
IMPORTANT: If the cOr"11001110 holder Is an ADDITIONAL INSURED, Me polky(les) must be endorsed. If . SUOR M IS WAIVED, subject to
the terms and conditions of the Policy, certain Policies may require an endomemeft A statement on this cordftab do" not confer rights to the
corlifieft holder In lieu of such endorsement(sl.
M P ROBERTS INS AGCY INC --U—*
1060 Osgood Street ._pfialp
,M,(978)683-8073 AJC
jmss:s!'!�@ robertainsurance. com
North Andover, MA 01845 0.1—M.
INSURED Irm"MM), AFFordMe CoVeV=
PMV N MU"Hy BUILDING & PM40DELING INSURER A: PROVID MUTUAL
, 11 E
169 BOXFORD STREET INSURER B:MERCHANTS 114Mwamr-w
169 BOXFORD STREET TINSURER C: 6tw LL40UFANCE
'NSU
NORTH ANDOVER, MA 01845 INSURER D:
THIS IS TO CER Mt:VIb1QN NUMBER:
INDICCAATED. N ISSUED TO T ED NAMED ABOVE FOR THE POLICY PERIO5
CERTIFICATE ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EXCLUSIONSAN E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERms,
w, UCED BY PAID CLAIMS.
it I POLICV-EFF- -- '"-
GENERAL L MWD W"90'Ar
LIMITS
!EACH OCCURRENCE $ 1,000,C
COMMERCM GENERAL LIABILrrY — -----------------
Milrl S. 100
CLANSMADE I - I OCCUR I
A CPPOO60868 11/22/09 11/22/10 MED EV (Any one person) $
L �80NA=,�;INJUIRY
L AGGREGATE LIMIT IES PE
J7POLI Y JACOT LOC
APPL R
AUTOMOBILE LIABILITY
ANYAUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS WA7013608
HIRED AUTOS
NON -OWNED AUTOS
UMBRELLA LAB OCCUR
EXCESS LIM CLAIMS -MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENsATiow
AND EMPLOYERV LIABILITY YIN
NIA
gftdm y in NM KENC109881
COMPIOP AGG
1000,
;UO -01
S
/01/10 07/01/11 L. EACH ACCIDENT — $ 500,
El DISEASE - r -A FmpLOyEE �-50 0 1
— -�--L--OISEASE - POLICY LIMIT � 500,
OF OPERATIONS I LOCATIONS I VEHICLES ~ ACORD 101, Addfticnm Ronaft sehoWle. if mom $p9w is' WMred)
TCUR OF NORTH AmDOVER
NORTH ANDOVER, NA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED
01988-2009
ORD25(2009M) The ACORD name and logo are registered marks of ACORD
All rights reserved.
COMBINED SIN GIE LIMIT
(Ea Goddent) 11000,000
BODILY INJURY (Per person)
/23/10
01/23/11
BODILY INJURY (per eCddeN) $
PROPERTY DAMAGE
(Per accdenI) $
�HOCCUR!RENCE
S
/01/10 07/01/11 L. EACH ACCIDENT — $ 500,
El DISEASE - r -A FmpLOyEE �-50 0 1
— -�--L--OISEASE - POLICY LIMIT � 500,
OF OPERATIONS I LOCATIONS I VEHICLES ~ ACORD 101, Addfticnm Ronaft sehoWle. if mom $p9w is' WMred)
TCUR OF NORTH AmDOVER
NORTH ANDOVER, NA 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED
01988-2009
ORD25(2009M) The ACORD name and logo are registered marks of ACORD
All rights reserved.
The Commonwealth ofHassachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street,
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers
Applicant Information 'Please Print Legib
NaMe (B:usiness/Organizatioii/Individual):
Address: Oo,
City/State/Zip: K/0 -
Are you an employer? Check the appropriate box:
'l.g I am a employer with
4. El I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2-E-1 1 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. El We are a corporation and its
required.]
officers have exercised their
3 -El 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. F1 Now construction
7.4,:�? Remodeling
8. E] Demolition
9--�413uilding addition
10. F1 Electrical repairs or additions
11. E] Plumbing repairs or additions -
12.E] Roof repairs
13.0 Other
!Any applicant that checks box #1 must also fil 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.
lContractors 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 isproviding workers'coin
pensation insurancefor my enployee�. Below is thepollcy andjob site
information.
Insurance Company �CR
Policy # or Self -ins, Lie. L,-, C_ � V'S Expiration Date: 0 J
JobSiteAddress: 3ZIC Citv/Stato/Zip: NA. o Is Ll
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 coverage verification.
I do hereb eel U4dejahe19ah<andpena1fies o that the informationprovidedabove is true andcorreel
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
ContactFerson: Phone
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