HomeMy WebLinkAboutBuilding Permit #671-13 - 67 SANDRA LANE 4/12/2013Permit NO: 01 —1
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print,
PROPERTY OWNE/�'�
F<J Kelc,4.r,-
���7 Pring
MAP NO: ��PARCEL: OW5Z-ONING DISTRICT: Historic District yes
;Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
e
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
Repair, replacement
Assessory Bldg
Demolition
Other
Septic, Well
Floodplain . Wetlands
Watershed Disffict
Water/Sewer
t5(;KIP UION OF WORK TO BE PREFORMED:
Type or Print Clearly)
OWNER: Name:
Address:
CONTRACTOR Name:?hone:7
.Address -
SU pervi§&s, Construction
ddress;SUpervisor's,Construction License-. 7$_4 a Exp. Date:
Home Improvement. License::.: _ ___
7 Exp: Date'-,9/7Z//V
6t/
ARCHITECT/ENGINEER � 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: $ 6 • FEE: $ 4
Check No.: Receipt No.: 2ee�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Slgnature�of Agent/Owner - 'Signature of contract r -
T
e
t
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 DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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
NOTES and DATA — (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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
❑ 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
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
❑ Copy of Contract
L3 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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HIC # 136779
-�— T' OMEY & LEGARE
CONTRACTING INC.
"Couldn't your your home use a little TLC?"���/.
Specializing in Residential Additions v
87 Belmont Street • North Andover, MA 01845
P: 978-685-7447 • F: 978-685-7446
NAME OF OWNER J� / r
ADRESS OF JOB �cx „C.
DATE:We hereby submit estimates for:�VC/.�ii $,ZS
-� L!
t���/ ,.
A
We Propose herby to furnish material and labor - complete in accordance with above specifications for the sum of:
dollars ($ CJS
Payment to be made as follows -�A of i
Authorized
(r✓ Signature
NOTE: This proposal may be withdrawn by us if not accepted with ir;?� days
Acceptance of Proposal - The above prices,
specifications and conditions are satisfactory and are herby
accepted. You are authorized to do the work as specified. Payment
will be made as outlined above.
..��40' __ ! Signature
Date ofAcceptance:Z% J� Signature'`
HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS (M.G.L.142A)
1. WORK: Provided the Homeowner performs under this agreement, the Contractor shall perform the work on the Property as specified Proposal, attached
incorporated herein. The work does not include extraordinary conditions of which the Contractor could not reasonably be aware. If such conditions are
encountered, this shall be an additional cost to the Homeowner. Materials selected by Homeowner may have to be ordered or custom made, which items are
specified in the Proposal. The Contractor is not obligated to agree to any modifications, extras or change orders unless such items are agreed to in writing by
the Contractor. All extras and changes shall be at an additional cost to the Homeowner. Contractor shall perform the work in a good and workmanlike manner
using materials consistent with this contract. Lawn or Driveway may be damaged by dumpster or equipment. Due to material shortages Contractor may
substitute materials of equivalent grade.
2. PERMITS: If a building permit is required for the work, the Contractor shall obtain same as Homeowner's agent. Contractor is not responsible for any
other permits that may be required for the Work, and Homeowner is responsible to determine whether any zoning, planning or wetland related permits or
approvals are necessary. Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund.
3. COMMENCEMENT AND COMPLETION: Homeowner acknowledges the commencement date of the work is fluid, and is subject to numerous factors
such as scheduling other contractors, delivery of materials and weather. Contractor and Homeowner shall determine the commencement date of the Work
when a more definite determination can be made and shall execute a written acknowledgment of same. The Work shall be substantially completed within 7
days of commencement, except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal, and subject to
delays for circumstances beyond Contractor's control. Notwithstanding, the commencement date and substantial completion date may be extended, and the
Contractor will not be liable for delays caused by, labor or material shortages, delays in delivery of items selected by the Homeowner, governmental action,
and unforeseen events beyond the Contractors control, including but not limited to weather, strikes, war, the acts of third persons or the acts of the
Homeowner. The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractors other jobs.
4. PAYMENTS: Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the
Proposal. Thirty percent (30%) of the total is to be paid as a deposit with the signing of this contract. Upon cancellation prior to commencement of the
Work, any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel. Final payment shall be due
upon completion of the Work and Homeowner agrees it may not hold any retainage. Late fees may be applied for late payments. Homeowner shall pay
Contractor's reasonable costs of collection, including attorney's fees and costs. Time is of the essence hereof.
5. WARRANTY: For a period of lyear after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship,
but not those caused by ice backing -up or extraordinary weather events, including blizzards, tornadoes, hurricanes or storms of greater than a twenty-five
year duration or intensity. Contractor gives no warranties with reference to any materials or equipment installed in the Premises, passes any such warranties
directly to Homeowner, and Homeowner agrees to look only to the manufacturer with reference thereto. This limited warranty extends to the Homeowner
only and is not transferable to succeeding Homeowners. This Limited Warranty specifically excludes (i) all consequential and incidental damages; (ii)
damage due to ordinary wear and tear, abusive use, misuse, or lack of proper maintenance; (iii) defects which are the result of characteristics common to
materials used; (iv) defects in items installed or supplied by anyone other than Contractor; (v) work done by anyone other than by Contractor; and (vi) loss
or injury due to the elements. There are no other expressed or implied warranties or representations made or given.
6. ENTIRE AGREEMENT: This contract and all documents referenced herein constitute the complete and final agreement between the parties. In the event
that any of the provisions of this contract shall be held to be invalid, the remainder of the provisions of this contract shall remain in full force and effect. Two
identical copies of this contract have been completed and signed. Homeowner acknowledges receipt of a completed contract signed by the Contractor.
7. HOME IMPROVEMENT REMAU In accordance with M.G.L.c. 142 A, § 9, Contractor is registered with the Bureau of Building Regulations
and Standards Registration NoHomeowner may verify by contacting the Director at (617) 727-3200, ext. 25205. A Homeowner's rights under
the Home Improvement Law (M.G.L.c. 142A) and other consumer protection laws may not be waived in any way. Homeowner acknowledges receipt of a
copy of 780 CMR R6 and Massachusetts General Laws chapter 142A, and which are available online at www.mass.gov. Questions may be directed to the
Consumer Information Hotline, (617)727-7780.
8. ARBITRATION: 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 such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs
and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A. No lien or security interest is
imposed on the Property as a consequence of this contract, but Contractor has the right to record this contract or a notice of this contract, or seek a lien if the
Homeowner breaches this Contract.
9. HOMEOWNER COVENANTS: The Homeowner agrees, represents and warrants that (a) the Homeowner grants permission to the Contractor to enter the
Property to perform the work as covered by this contract; (b) the Homeowner has funds available to make full payment under this contract to the Contractor
upon completion; (c) the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition, and agrees not to enter
portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed; (d) Contractor may need use
landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and (e) that code requirements may result in
roofing nails penetrating through roof decking and will be visible on the underside of some surfaces. The Homeowner indemnifies, exonerates and holds
harmless the Contractor from any loss, damage, claim, liability or expense (including reasonable attorney's fees, deposition costs and court costs) resulting
from a breach of this provision. Contractor is not responsible for damage to landscaping that will grow back during the next growing season.
10. CANCELLATION: Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not
later than midnight of the third business day following the signing of this agreement. f�
HOMEOWNER: �Jrnl)ATE:
Shingle:
A�V DEPOSIT:
The -commonwealth of Massachusetts
Department. of £industrial Accidents
officeof £rcvest%adons. .
. 60a R'asizina on Street
Boston, ALL 02111
- wrvw masgov/din .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electncians/Pumbers .
Aoolicant Tnfurmafion.
Please .PrintLe6i�iiv
Are yo employer? Check the appropriate bow `
Type of project (required):
1. am a emplyith'
d.❑Iam feral contactor and I
6.. ❑ New construction
employees (fiill and/or part-time).*
have hired the suircontraetors
2. D . I am a sole proprietor br partner-
listed on the attached sheet t
7•. ❑ Remodeling .
ship and have no employees` :
These sab-conaactors have
8. ❑ Demolition
working for mem any capacity.:
[No workers' comp. insurance
workers' comp. insurance. .
5.: ❑ We are a corporation and its
.9• Building addition
required.]
officers have exercised their
1010 .Electrical repairs or, additions
3. ❑ I am a homeowner doing all work
riaht.of exemption_ per. MGL
11:0 Plumbing repairs or additions
myself: [No workers' comp
c- 252, §1(4); and we -have no
12oof repairs
insurance required.] .t
employees; {No cvoriters'
.
I3.❑ Other �r
POMP. insurance requir. d ]
-, �.. �. ..-.-... ... .��v ---' vL L:::. JY' .::SVl•• ��'.�'aJCr::e>CQ'!'r��+ ..1:,,:: � Wa�C.�.'#IG1
" Fomegwu= who submit this affidavit indicating they a ed-cing aL:✓ort; anti thea hire outride r�^uactms mast submiC a nein affidavit indicating such.
+Cont mctxs that check- this box must attached an additional sheet showing the name of the snb-contactorsand their wark. comppolicy information;
I am an employer that is providing workers' compensation insurance for my employees. Beloio is the policy and job site
information._. —�,�-
Insurance Company I\Tatne:
Policy, t? or Self ins: Lit: t Expiration Date: q /,V-
Job Site Address: �92�-� �✓ City/State/Z'
Attach a copy of the workers' comgensation policy declaration paDe ;showing the policy number and expiration bate).
Failure to secure coverage as required under Section 25A ofMGL`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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Ofji of
Investigations of the DIA for insurance coverage verification
I do hereby certify under the pains and penalties of perjury that the information provided above is true and corregt.
Official use only. -Do not write in this area, to be completed hj: citjy or town ofcciaL
City or Town:
Permit/Lice tse 0
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk
6. Other
Contact Person:
4. Electrical inspector 3. PIumbing Inspector
Phone -#-
Rig.tfax C2-2 1/16/2013 5:01:57 AM PAGE 2/002 Fax Server
�' CERTIFICATE OF LIABILITY INSURANCE
DATE(MMlDDIYYYYI
T TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER.TIS
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 and endorsement. A statement on this certificate does not confer rights to
the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
PHONE
FAX
DOHERTY INS AGENCY INC
PO BOX 1985
(AIC, No, EXt):
(AIC, No):
E-MAIL
ANDOVER, MA 01810
ADDRESS:
ZZYMX
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
INSURER A: TRAVELERS INDEMNITY CO-
TWOMEY & LEGARE CONTRACTING INC
INSURER B:
INSURER C:
INSURER D:
PO BOX 366
INSURER E:
NORTH ANDOVER, MA 01845
INSURER F:
COVERAGES CERTIFICATE NUMBER. REVISION NUMBER:
THIS ISTOCERTIFY THAT THEPOLICIESOF INSURANCE LISTED BELOW HAVESEEN ISSUED TOTHEINSUREDNAMEDABOVEFOR THE POLICYPERIODINDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 POLICES. LIMITS SHOWN MAY
HAVE BEEN REDUCED BY PAID CLAMS.
NSR
ADD
SUB
POLICY EFF DATE
POLICY EXP DATE
LTR
TYPE OF INSURANCE
L
R
POLICY NUMBER
(WADDIYYYY)
(MMWI)%YYYY)
UMTS
GENERAL LIABILITY
Z-ACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE M OCCUR.
DAMAGE TO RENTED $
DREMISES (Ea occurrence)
ED EXP (Arty one person) $
ERSONAL & ADV INJURY $
GENL AGGREGATE LIMIT APPLIES PER:
ENERAL AGGREGATE $
POLICY 0 PROJECT[:] LOC
ODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILITY
COMBINED SINGLE $
ANY AUTO
LIMIT (Ea accident)
BODILY INJURY $
ALL OWNED AUTOS
SCHEDULE AUTOS
(Per person)
BODILY INJURY $
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
$
$
RETENTION $
A
WORKER'S COMPENSATION AND
EMPLOYER'S LIABILITY YM
UB-029OM994-12
09/18/2012
09/182013
XWC
STATUTORY
LIMITs
OTHER
E. L. EACH ACCIDENT $ 500,000
ANY PROPER ITOWPARTNERIEXECUTIVE F-1
OFFICERMEMBER EXCLUDED?
(MarMatoryin NH)
NIA
E.L. DISEASE - EA EMPLOYEE $ 500,000
9 yes, describe under
DESCRIPTION OF OPERATIONS below
E.L- DISEASE -POLICY LIMIT S 500,000
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPEC(AL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER
CANCELLATION
- _
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 REPRESENT - lZ .`-
- 3.Z:��I.e•.:. "fit_
AGVKU ZD (ZUTUIUD) Ine At.UKU name ano logo are reglsterea mares or AwICU 1Joo,-LV IV ml -v RU %,vmrurm 1IVPI. Ati tigrnl5 te5er VEA.
4'1ien4!!• 41?02
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ACORD,. CERTIFICATE OF LIABILITY INSURANCE1;$
MIDOM ")
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
D 12
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Doherty Insurance Agency, Inc.
P.O. Box 1985
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW -
21 Elm Street
PDE
MMUDIM
Andover, MA 01810
INSURERS AFFORDING COVERAGE MAIC #
INSURED
Twomey 81 Legare Contracting, Inc.
PO Box 366
North Andover, MA 01845
INSURER A: Arbella Protection Ins Company
INSURER B.
INSURER C.
INSURER D:
INSURER E:
COVE!"GES
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 RESPECTTO 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
94SR
LTR
plug
NSR
TYPE OF INSURANCE
POLICY NUBBER
Y ECTNE
O
PDE
MMUDIM
SDS
A
GENERAL LIABILITY
8500043255
06122112
06122113
EACH OCCURRENCE S1 000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $100,000
CLAIMS MADE 5-1 OCCUR
MEO EXP (Anyom person) $5,000
PERSONAL 8 ADV INJURY $1 000 Q00
GENERAL AGGREGATE $7-000.000
GENL AGGREGATE LIMIT APPLIES PER
PRODUCTS- COMPIOP AGG s2,000,Q00
X POLICY JECT LOC
AUTOMOBILE LIABR.ftY
COMBINED SINGLE LIMIT
ANYAUTO
(Eaawdeno S
BODILY INJURY
ALL OWNED AUTOS
SCHEDULEDAUTOS
(Po p�Oa) S
8001LY INJURY
HIRED AUTOS
NCN•OWKED AUTOS
(Per accden) S
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT S
OTHER THAN EA ACC S
ANY AUTO
AUTOONLY: AGG S
EXCESSIUMBRELLAUABUTY
EACHOCCURRENCE S
AGGREGATE $
OCCUR D CLAIMS MADE
S
S
DEDUCTIBLE
$
RETENTION S
WORKERS COMPENSATION AND
TQRY NC IIMIT OTH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
ANY PROPRIETORiPARTNERfEXELUTNE
E.L. DISEASE - EA EMPLOYEE S
OFFICEFUMEMBER EXCLUDE07
er1SfPCLLOON
Rej S below
i
E.L. DISEASE -POLICY LIMIT S
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Covering operations usual to Twomey & Legare Contracting, Inc...
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING RIMER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TODD SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE DISURER.ITS AGENTS OR
AUTHORIZED
ACORD 25 (2001108)1 of 2 #S28467IM28466 ` DML G)KCORO CORPORATION 1988
.Massachusetts - Department of Public Safet-,
9 Board of Building Regulations and Standards
Construction $upervisor License
License: CS 67560
SHAUN M TWOMEY
61 PATROIT ST
N ANDOVER, MA 01845; !
�--�- -�� Expiration: 10/25/2013
('ununissiuncr Tr#: 4913
a
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards.
Construction Supervisor
License: CS -055108
DOUGLAS J LEGAVE;
79 GARY AVE - s
AAVERBILL MA 01830
Expiration
Commissioner 09/02/2014
Ulln CYloo77mzoAu[teclt�lL a�(%//Ln'1Jrlc�flJel�J ,
Office of Consumer Affairs & Business Regulation
_ME IMPROVEMENT CONTRACTOR
egistration: 136779 Type:
xpiration 8126/2014-__ Partnership
TWOMEY + LEGARE CONTRACTING INC.
SHAWN TWOMEY _ -
87 BELMONT ST. _ g
N. ANDOVER, MA 01845 Undersecretary
Location o LN -
No.- (01� —\-5 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee M -.42P
Foundation Permit Fee
Other Permit Fee
TOTAL
Check 1'7641 /1
4' T
26286 Bu ilding Inspector