HomeMy WebLinkAboutBuilding Permit #104 - 71 MARBLERIDGE ROAD 8/6/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Lo Date Received
Date Issued: `Z;
IMPORTANT:Applicant must complete all items on this page
ALOCATION '
' t
PROPERTY OWNER M tX V —Jo YVN
Print
MAP NO: = LPARCEL: _ZONING DISTRICT: Historic District yes t
Machine Shop Village yes (no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Iteration No. of units: Commercial
epair, rep acement Assessory Bldg Others:
Demolition Other
Septic I Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
RVN IS Qa r c�� '{" 4;y— YQ
Identification Please Type or Print Clearly)
OWNER: Name: Mo,r k e-zAeui Phone:
Address: iY
CONTRACTOR Name: Phone. {+
Address:
Supervisor's Construction License Exp. Date:
Home Improvement License: Exp, Date-
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: $ $ I , 00 FEE: $
Check No.: 1� t No.:
Receipt C�
� %kS
NOTE: Pers ns contractin
g with unregistered contractors do not have access to the guaranty fund
6
I
Signature of Agent/Owner - F ' m. i, , Signature of contractor
Plans Submitted Pla s Waive Certified Plot Plan Stamped Plans
i
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
o 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)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
mlt
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o 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 Ener Compliance Energy p e 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: Doc.Building Permit Revised 2008
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/MassageBody 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 Reviewed on Signature
COMMENTS
A
a
i
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
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureidate
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
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 Pernut Revised 2008
s
Location -71
No. Date V 1
HORTN TOWN OF NORTH ANDOVER
F fw
A
Certificate of Occupancy $
CXUs<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ti
Check # ! /
r
222 ) 3
Building Inspector
Date...... .....................
f NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
CHU
This certifies that ......
.................................... ..............................................
has permission to perform ....j...............................I... .....................................
wiring in the building of..:
w
............................
at�/.....
.............................. .................I.......n North AAndover,,,,MMas
F&-Z....-......... Lic.N .............. .......
-iNs� 0
..........S RICALINSPECT v—,
Check #
Commonwealth of Massachusetts Official Use Onk
Department of Fire Services Permit No.—BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/07
(leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
WORK
All work to be performed in accordance with the Massachusetts Electrical C4d ( C), 7 R 12.00
(PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: / ( 1,�
City or Town of: NORTH ANDOVER
To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)_rl Llf h Lerie' .
Owner or Tenant �Gi
n (E&I kl
Telephone No.
Owner's Address ( tea/ Lt e"t P led
Is this permit in conjunction with a building permit? Yes
NO ❑ (Check Appropriate Bog)
Purpose of Building &19PJ .eK-r r" Utility Authorization No.
Existing Service Amps r 20 l Z-'ta Volts Overhead ❑ Undgrd
No.of Meters
New Service Amps / Volts Overhead
❑ Undgrd ❑ No,of Meters
Number of Feeders and.Ampacity
Location and Nature of Proposed Electrical Work:
L
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.°f Total .
Transformers
No.of Luminaire Outlets {j No.of Hot Tubs I�p�
Generators KVA
j No.of Luminaires swimmingPool Above in o,o mergency Ig
d. ❑�rnd. ❑ Batte Units
— No.of Receptacle Outlets
b No.of oil Burners FIRE ALARIVIS No.of Ines
No.of Switches 7 No.of Gas Burners No.-of Detection and
No.of Ran Total
Initiating Devices
Ranges g No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers eat Pump Number Tons KW No.of Self-Contained
Totals: ___......_._.
Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection [] Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.ofo. No.of Devices or Equivalent
Heaters KW Si s Ballasts. Data Wiring:
No.of Devices or &I,uivalent
No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications Wiring:
OTHER:
No.of Devices or Eg.itivalent
N
Estimated Value of Elec 'cal Work: Attach additional detail if desired, or as required by the Inspector of Wires.
Lb (When required by municipal policy.)
Work to Stark 1 Q Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cove a ism force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ff BOND ❑ OTHER ❑ (Specify:)
P �':)
I certify,under the pains and penalties operjury, that the information on this application is true and complete.
FIRM NAME: t r h
LIC.NO.: Z-05 `'_7- �!
Licensee: ��o`���c� � Signature
(If applicable, enter exempt"in the license number line.) LIC.NO.:
Address: `34 Ntg®k� U(g�� ®� Bus.TeL No.: 7 /? /e
*Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt.TelLic.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT�FEE: '`�
r,
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The Commonwealth of Massachusetts
Department of Industrial Accidents
tri' Office of Investigations
600 Washington Street
Boston, MA 02111
{'S
1NWW.1f2Q:4sgOv1dla
Workers' Compensation 1witra.nce Affidavit: Buiilders/Contractors/Electricians/Plumbers
Applicant Information Please Print
Lenblr
Name (Business/orw.ization/Individual): �` A a r�1_/ S v
Address: /11 g4 h � SSR
City/State/Zip: or$j'-- Phone#: .
Are you an employer?Cheek.the appropriate box:
Type of project(required):
1.❑ I am a employer with 4, ❑ i am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction
2.'—am a:sole proprietor or partner. listed on the attached sheet t t ❑Remodeling
ship and have no employees These std-contractors have 8. Q.Demoliti.on
working for me.in any capacity• workers' comp.insurance.
[No workers'comp. insurance 5. 9 ❑Building addition
p ❑ We are a corporation and its
required,] officers have exercised their 10 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work Tight of exemption per MOL I
1. Ptumbin
❑ airs or additions
myself � P §1(4),
repairs rtrons
y [No•workers'com , C. 152, 14 ,and we have no 12.❑Roof repairs
insurance required-It .employees. [No workers'
comp. insurance required.] I3.❑Other
`Any epplicartt that checks bort#I must also fill out the section below showing their workers'oompensatiori policy information
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afiidevit indica
�—_M Tactors that check this box mustatrached a ting such.
a additional sheet showing the risme df the subcontractors and their workers'comp•policy information.
I am an employer that is providing:workers'compensation inssumwe for nr employees; Below
information. is the policy and job site
Insurance Company Name:
Policy#or Self-ins.Lic.4: Expiration Date;
Job Site Address: City/State/Zip:
Attach a copy of the workers'.compensation policy declaration page(sh1.owing 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 forth 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 da hereby cerl4fy under the pal and enalties of perjury that the information provided above is true and correct
i Sierrature: L 0
Date:
Phone 7� �`7/e
F7Health
only. Do not write in this area,to he completed by city or town official
n: Permit/License#
hority(circle one):
Health 2. Building Department 3.City/Town Cleric 4.Electrical Inspector 5, Plumbing Inspectorson: Phone#•
Information a nd 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 legal entity,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 sucb 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 it business or to construct buildings in the commonwealth for any
applicant who has aot produced acceptable evidence.of compliance with the insurance coverage required"
Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the coritracting authority."
Applicants
Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to>your situation and,if
necessary, supply sub-contractors)name(s),address(es).and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not requimdl to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to 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,notthe Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the numberlisted below. Self-insured companies should enter their
self insurance license number on the appropriate line.
City or Town Officiais
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 permittlicense 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 1-8.77-"SAFE
Revised 5-26-05 Fax 4 617-727-7749
www.Mass-gov/dia
,ApRTH TOWN OF NORTH ANDOVER
0 OFFICE OF
0"" BUILDING DEPARTMENT
+ r a 1600 Osgood Street Building 20, Suite 2-36
A�rev °"tty* North Andover,Massachusetts 01845
SACHUSE
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
BUIDING PERMIT APPLICATION
Please print
DATE: GG_(
JOB LOCATION: Kk,
Number Street Address Map/Lot
HOMEOWNER 9qVVS_?Jj
Name Q Home Phone Work Phone
803 Cs�QSL
PRESENT MAILING ADDRESS_) car��
t h r✓� o10 -
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and
to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner
acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be
considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other
Applicable codes,by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNAT
APPROVAL OF BUILDING OFFICIAL
Revised 7.2009
Form Homeowners Exemption
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
'Me Com► ft eatfli of Massachusetts
' Department of.1Rdustrial Accidents
Qf ce of Invesfigations..
` 600 Ncavkington Street
Boston, MA 02111
c� �'�'-nzQssgov/die
Workers' Compensafion Insurance AffidavitA licsnt Inf.T.Mfton Buders/CoatacforsEectricians/Pi
amber
n n Please Print Le qbF
NBIIle (&usincss/brgenization/individual): 1 v\O�r �'
`� a' C F� �' Com,
Aa ss: ay'W_r l
Phone
A
res employer4 Cbeek.the appropriate box:
a employer with 4. �] I am a general contractor and I Type of project(req°ir,0:.
oyees(fail and/or part time).* have Bred the suh-corrtsactors 6• [].New const action .
aeok.proprietor orpartner- listed cm the attached sheet 3 7• ❑:Remodeling
nd leve no ernployees Theses su}i-contractota haveing for meat any capec4. workers' comp.insolence. 8' (]L?rmolition
orkers'comp,insru`ance 5. [] Weare a corpora#ion and its 9. []Building addition
ed.] ofFia= have exercised their homeowner do' I O'Q.Electrics]repairs or additions
mg all work right of exemption par MCL l lZ Plumbing repairs or additions
mysef [NO-workers'comp, c 152, §1(4),'and-we have no
insurance required.]t ..employers.[No worm' 12.[]Roof repairs
'may appiicarrttirer �P• insurance required.] I3.M'Ofir�
cheeks boil l must also flit outthe section below showing theirworkots'cotnpensetion policy ininmsetion
t fiomeowneta who sebmit this a'r davit indicetin they
h ars d ' all
;Caatracmts that check this box roust B °y ° M'ork and Ihen has outside con SWIM
must Submit a new afridnvit rrtd.
an ald.-fiow,sheat showing•the trema Irthe su B such.
b-cottnactors and tim' worio•ts`cc.
I an ewio er&Z is or» work. `' alive rr '"r•Folic; tnnaedan.
urfoTmution_ ; g eor: laza �risrcrance for rnp.enrp[�,pa. �'�.�1tl9 LS axe
PaLY andjob site .
Insurance Company Name:
Policy#or Sell-ins. Lic.#:
Ekpiration Date:
Job Site Address. .
Attach a copy of the workers' cora � � Ip
pensation policy declaratiou page(showing the peficy number and expiration date
Failure to secure oavert3ge as required under Section 25A of .
fine up to 51,500,00 and/or one-year imprisonm MCL c. 152 can lead to the imposition of crurtinal patties of a
Of up to$250.00 a ;as well ags civil penalties in the form of a STOP WORK ORD"cR anti a fine
3 against tfre Viol Of Be advised that a copy of this statement may be forwarded to the Cq-nm of
Investigations of the DIA-for insurance coverage verification.
I do hereiry certify under the pains and
Pees fpe'7�'tsfiat the informafon pravuded above true and aorrfd
Si
—
Phone#:
off'ir.ial use only. Do not write in this a�Pq,ip be c»mple�ea!by or town OfftxaC
City or Towne:
Permit/License#
Issuing Authority(circle one):
1. Board of Health.2. Rulidi%0 Department 3.City/Tewn Clerk 4. Electrical Inspector 5.Plumhiag Inspector
6.Other p�
Contact Person:
Phone#:
'i
Information a- iid IA'S' tructions-
Massachusetts
Gencral Laws chapter 152 requires all emp 3 overs to provide workers' compensation far their employees.
Pursuant to this stature,an employee is defined as"..:every person in the service of another under any contract A*
express or implied,oral or wrhtm" ! I`
An a ngnloyer is defined as"an individual,partnership,assc:gdiafion, corpomfian or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and includia-ig the legal representatives of a di x:easmd employer,or the
receiver orbmtee•of an individual,partnership,associatiain or other legal entity,employing mnployees.'14oweverthe
owner'of a dwelling house having not more than three spa-rtments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maimtermce,construction orrepair wcirk on such dwel fthouse
or on the grounds or building appurtsnaitt thereto shall not bc;rause of such employment be'deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state oar-local licensing agency shall withhold the ismance.or
renewal of a license or permit to operate a business or too construct bulwings 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)stains`Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the perfonnence of public wort-_ rustlwaccaptable evidence of compliance,with the insurance
Tcqun=nents.of this chapter have been pre=tted to the caritractiing aruhority."
' APPficacEs .. •
Please,fill oirt the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, augply sub-contractors)name(s),address(es):az rd phono numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no-employers otherthan the
members or partners,arc not rquired,to carry workers'ct,Typarisidion insurance. )fan LLC or LLP does have
empioyees,a policy is required. Be advised that this affdavit may be submitted to the Depmtraemf of Industrie)
Accidents for oon,5,ma6cm of insurer=coverage, Also.fine sure to sign and-date the affidavit The affidavit should
be retuned to the city or town that the application for the Pz;mit or license is being requested,oetlht Department of
Industrial Accidents Should you have any questionsregas-ciing the law or if you are required to obtain it workers'
oaenpensation policy,please-call the Department at the nurmber.listed below. Self-insured companies should enterthe;ir
self insurance,license number on lite appropriate arm.
City or Town Officimis
Please be sore 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 invesiigafions has.to contact you regarding the applicant
Please be sura to fill in the permit/license number which Will be used as a reference number. In addifion,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 writo"all locations in (city or
town),A oopy of-the affidavit that has been officially staimped or marked by the city or gown may be provided to the
applicant as proof that a valid affidavitis on file for titin permits or licenses. A new affidavh must be filled out tach
year.When a home owner or citizen is obtaining a license 'or permitnot related to any business or commercial venture
(Le. a dog license or permit to bum leaves etc.)said pmsor3 is NOT required to complete this affidaviL
The Office of Investigations would fila 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 member,
The Commonvmalfh of Mawachusetts
De partinsnt of LodustmW Accidumts
4fnce of EnVesthigRfiuns
600 Washington Ste=t
Bosfon, MA 0:2111
TeL 4 617-7274900 eat 406 or 1-877-MASSA:FE
Fax#617-727-774
Revised S-Zb-QS www.mass.gov/dia
NORTH '9
Town of ::� Andover .
No. /D '- kv•
T � T
- 4 o dover, Mass.,
COCHICHEWICK
ADRATE D PPS` 5
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
l ' BUILDING INSPECTOR
THIS CERTIFIES THAT...... ....�` ................ �.�w�t....S...l.r�!!!4 .5�. I.i....I......................... Foundation
has permission to erect .......... buildings on .1.(.......m.4r.��....I. .*t.00.40...... .R.. Z Rough
to be occupied as....... �1/. T.. �5�''��..,�! Chimney
.. . . . ......................................................................................
provided that the person accepting this permit shall in every respect conform 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 CONS TS ELECTRICAL INSPECTOR.
I Rough
............. ......................................................................
... Service
BUILDING INSPECT3
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina,
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT'
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE y Smoke Det.
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(�( �l� r o� - a r a.Q- 6 aS-e Mo rte{
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