HomeMy WebLinkAboutBuilding Permit #443-14 - 84 MOODY STREET 11/18/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received
f
Date Issued: �� I
-,IMPORTANT:Applicant must complete all items on this page
LOCATION
PROPERTY OWNER / int
s ohrae�_— Unit#
Print
MAP NO: PARCEL:ZONING DISTRICT:
Historic District yes no
nit Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
ResicKhtial Non- Residential
❑ New Building ITOne family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration
No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg
❑ Demolition ❑ Others:
❑ Other
D
DESCRIPTION OF WORK TO BE PERFORMED:
r L�G( v e /�
(Identification Please Type or Print Clearly) v'wl
OWNER: Name: Phone: 79•
Address:_ Mc r_ ,: Sf
CONTRACTOR Name: �i''r C P 41�
Phone: 978•- - 7W4-'1&,13
Address: !� .✓ S�- 5c,/cam M9 01270
Supervisor's Construction License: 209 77 Exp. Date: b3 f/q
Home Improvement License: 3//Z-//Z,/
Exp. Date:
ARCHITECT/ENGINEER Phone:
Address:
Reg. No.
FEE SCHEDULE.BULDING PERMIT.,$92.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $_ 3000 �' FEE: $ :3>(to
Check No.: e-3 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to&e guar
Signature of Agent/Owner / .w�� /a,u�a na
---
�c�_ 9_ ..fure of contractor i
1
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ T anning/MassageBody Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pemanerit Durapster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
i 4 .;moi+.d♦'i i id f'Izo Yl;l:l,f Uif Vll.l 11Gill..411:.
COMMENTS
HEALTH Reviewed on Signature
rz
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
FIRE DEPARTMENT -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
1
L
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 2011 June/mi
J
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
o 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 Per
Addition or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
1-1 COPY Of contrac`k
Cs ��fUUli�i El t:i✓ liil l/a.ieVcillul l i-Iian 01- i--'iropusea VV01-K VVI-cfI OPI-ilIKIC—W I-1611`1 Ana
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 Permi
New Construction (Single and Two Family)
o 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)
o Copy of Contract
❑ Mass check Energy Compliance Report
o 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 2008mi
Location
No.
F i ] �—� Date (l 1
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ >
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
I Building Inspector
ti
Massaeb}asetts gore J m rovement Sam Ie Contract
-Lis form satisfies all basic regairCmMtS ofthe state's Hpate
langaagetoprotect homeawhI lt Secici imProvemeatc ailh t°rLaw(lyfGLchapter142A),batJoesnotin.ludesta�nJ3rs
XMItchusI Consumer ( m advice if necessary.Any person planning home improvements should firstobtain a -r
Office o f GStide tC mess Improvement"before agreeing to any work on your residence:You may obtain a free copy by calling the
Consumer ASahs and Bt4sliness Regulation's Consumer Information Hodine at 617.973-8787 or 1-888-283-3757 or on otr w sit
HameoWner Irif�rmation __
Contractor Information
Jra/Yl C0°tPanyName __--
.Jcv:rdics(t'oa uscaPon &Boxaddress M
T ContmctodSa!l1espers tt�pr `,a I� :au r,•
st 1 6I P.T� � !�p
City/To V .nue
`�t -
.n
Business Address(mus[include tract-1
Daytime Phoner � O��y� i=iC3 l 01970
G / Evening Ph one City/fown
Q 7�7 -,j 2 State Zip Code
irleilingAddtrss(h diffeteat from abW
Business on* FQderdEmpIoycrIDorS.S.Nwnber
Lanrttgntre,tsar—nh=a _n "[e00�'�'0t ary;,rivaLc
re;bdam!I I,m,et6:r q 1 try nren dna
a ratid 1• ��v 3 J
TheControctoragrees todothe f,ot�r`owing rvorkfor the Homeotyner:
(Describe in detail the wotkto completed specifying the type,brand,and
grade of materia];to be used )97
-------------------
rise ndd tionel eh xis ifrt a )
Ragpircd Permits-The fallowin�brrtldingpermim arc red proposed Start and Completion Schedule-71te foAowing sc;s dune conA
to d will be secured by the ME
as the htuneowaets be adhered to trate;;circumstances beyond the contractor s cosy al arise
(0*nerS who Secure their o'?yn permits will be �����
tst Luded from the Guaranty I�1nd provisions of ��_
?YIGL chapter 142A.) Date when contractor will begin contracted wont
� d Date when contracted work to be substantially completed.
Tota!Contra acl xnca and Payme tiSehcrlulc
The Contractor agrees to perform itie vrorlr,ftnnish the material and labor
specified above for the total sum of
Payments will be made according to Aha following schedule: (°)
upon stgmng con3aetZnoi to`exce Z,3'of the tofai'wn-hnec ace
P+--2 Taa ao`si bispedlai orderiieras`wnicnev'er is gra en j-
S by / cr upon completion of
S ' by.L/ 0/—[g or upon completion of
S Upon Completion 6ithe contract
l (Law forbids demanding fo Payment trill contract is plc to both
The following material Party's satin action)
ordered before the cortksored nbt�}bust be special S to be paid for
m meet the completion sehedulel?•)3tr>s in orad;
S tobepaid
f
NOTES:(<)Including all fmanco caeiges Law requires that airy deposit or do
not exceed the 9---r of!(a)one-third of the total contract price
or(b)Hthe aactuel wrt of anY, e wnhactor before work b gins may
which must be special or in advance to meet the completion scbedule spzial cquipmcnt orcmtstom made meterisl
E res; n ntv.Ts n con'�,ntv b ino vided b thecontrmctor7 ❑ o
Snbconh actors-The cotrtracior agrees to be solely responsible for completion of the work tdesmbe i re e 5r 'n tta had to m con ct
pzrty/subcontractor utilized by the cdnfractor.The conGzetor£nether P�ardtess of the actions of zn
d a o agrees to be solelyresponsible for all n t Y third
s e t aymems to al subcontractors for
cO ntra shall npmnce that
sigmt erg ibis docnmentbecomes ebiadmg contractupdetlaw.Unless otherwise noted within this document,the
contract shall not imply this any lieh or other security interesthas been placed on the residence.Review the folio
carefully before signing this Contract! wing cautioav and notices
•: Don't be pressured into signing tLe contract Take time to read and full and
e Mair_.sure the contractor hoe a'vatid Hmm r Y understand it.Ask questions ifsomething is unclear.
subcontractors to be ovement Contractor ram• a n, The lawrequires most
home improvement connectors and
gisteted4nth the Director ofHome Imptpvement ContractorRegistration. You may inquire about contactor
registration by writing to the Dt.rior at 10 P2&?Iaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
Does he contractor Neve inset ritdce7 Ask Bre Contractor fpr his iasmauce company tnfotmation so that you can confirm coversge or ask to
see a copy of a"profofinsartace"document
ights
Guide your -;Iom and prnpe responsibilities Read the Important lnfozmation on the reverse side of this form and get a copy of Bre Consumer
Guide to the Home improvement CoatractorLaw.
You:blusiees,
ay cancel this agreement if it eras been signed at a place other than the contractors normal place of busincsg Prvided you notify rite
contrin writing ethic/her mainldEice or branch office by ordinary mail postcon by teleg am sent or by delivery,not later than otify the of the
third day following the sign g of this agreement See the attacbed notice of cancellation form for an explanation of Brig right
DO NOT SIGN THIS CONTRACT It+THERE ARSB,g
t\w td :at eapin of tEe eo:..ti^:t hsst b:ws;ptaL-d d ztgaed.Oa:copy sCeatd ro to rah:LoKE A L��SPACM H
_ 'n -otter copy should tr_kaptbytlr cs:.
/' 2� COntractDeS.Signature
Date !
141L
1
Date
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate aniarbitration action(as an
alternative to court action)if they have a dispute with a contractor. The same right isnotatrtomatically afforded to a
contractor,however- The contractor would have to resolve any dispute he/she has with a ho��rteowner in court unless
both pa1'l1eS agree t0 the 0pti0ngi clause provided below. This clause would give the contra
pebtothe same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the edntractor has a dispute
concetg :°omtract,'the'eolpnctor may,Submit the dispute to a private arbitration firm H,hich hes been approved by
the Seciefarp of tlieBxeeutive Office 0f Consumer Af[airs and Business Re
to submit to sue'albittW6n as provided to Massachusetts General Laws,c gelation and fihe1consumer shad be required
Homeowners Srgnature
NOTICE:The signatures of the parties above apply onlyto the Contractor's Signature
resolution initiated by the contractor. The homeowner may initiate alternative dispute rsesR alternative dispute
section is not se arntely signed by the paries. y P gljztion even where this
Homeowner's,Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumerprotection laws(i.e,MGL chapter 93A)may not be waived in any way,even by agreement,i However,homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the,NYork as described;in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability andfitness for
a particular purpose. An enumeration of other matters on which the homeowner and contragtor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below).
Etecution of Contract
The contract must be executed in du lieate and should not be signed until a copy of all e*bits and referenced
documents have been attached Parties are also advised not to sign the document until all blank sections have been
filled in or marked as void,deleted,.or not applicable. One original signed copy of the contact with attachments is to
be given to the owner and tate other kept by the contractor. Any modification to the original contract.M_us�be.h wd�E
ar-d agreed-to�by both-pai tie,,^C0ntracted N-Vft-may no`tbegin until bot�i paiaes hate receivred a fully executed copy of
the contract and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the
homeowner deer4-Nni/herself to be financially insecure. However,in instances where a contractor deems him/herself
to be financially insecure,-the contractor may require that the balance of funds not yet duej>a placed in a joint escrow
account as a prerequisite to continuing the contracted work Withdrawal of funds from said account would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvemei Contractor Law or other
consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guid
contact: e to Home Improvement"
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park PIaza,Room 5170,Boston,MA 02116 j
617-973-8787,888-283-3757 or visit the OCABR website at htt0://www.tnass eov/ccabr/
If you want to verify the registration of a contractor or if you have questions or need additipnal information specifically
about the contractor registration component of the Home Imp
rovemetrt Contractor Law,contact;
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116 ^ i
617-973-8787,888-283-3757 or visit the MC website at htto:!/wivw.mass zov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
lrttn://db.state.meas/homeimnrovement/licenseelistasp
For assistance with informal mediation of disputes or to register formal complaints against)a business,call:
-Consumer Complaint Section I
"ice of the Attorney General
'; 617-727-8400
AND/OR
'i
Better Business Bureau
508-652-4800,508-755-2548 or-413-134-3114
Vmion 2.1-11nM010
3 , The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
-` = 600 Washington Street
t Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
dame (Business/Organization/[ndividual); f�tl..'�`�Weatll�r!zat10J1,LLL,
Amme
Address: Salem MA 01970
City/State/Zip: Phone#: 97,i�- 7tjq- 9'/y 3
Ar�yo n employer?Check the appropriatea employer with 12 4. F� I am a general contractor and I Type of project(required):
employees(full and/or part-time).* have hired the sub-contractors 6. ❑\ew construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g. El Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance= 9. Building addition
required.] 5. [] We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doingall work officers have exercised their
1 1- Plumbing repairs or additions
myself. [NNo workers' comp, right of exemption per MGL
insurance required.]' c. 152, §1(4),and we have no 12 of repairs ! /
employees. [\o workers' 13. Other_ Sk./
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ani an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company'.Name:. U r
Policy#or Self-ins. Licc..#: D 0 J I I Expiration Date: 31;0 /
Job Site Address: 6 y ff?GQGty/ J�• City/State/Zip:&_A.� pkzl,�--
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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the forin of a STOP WORK ORDER and a fine
of up to S250.00 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 Hereby certify under the pains aAlenalties of perjury that the information provided above is true and correct.
/Si nature: L• Date:
Phone#: -11�7-7 tftl- 944 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. Cityrrown Clerk 4. Electrical Inspector 5, Plumbing Inspector
6.Other
Contact Person: Phone#:
Rightfax N2-1 3/11/2013 X55 : 57 AM PAGE 2/002 Fax Server
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER. 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
hetr %--sand 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:
EASTERN INS GROUP LLC PHONE FAX
233 WEST CENTRAL ST (A/C,No,Ext): (AIC,No):
E-MAIL
NAT'ICK.MA 01760 ADDRESS:
22MLW INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY
ATLANTIC WEATHERIZATION LLC INSURER B:
INSURER C:
INSURER D:
61 REAR JEFFERSON AVE INSURER E:
SALEM,MA 01970
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
T OERITY THAT THE POLICIES OF INSUSIN 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. THEiNSURANCE 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 ' ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIODIYYYY) (MMIDDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE 0 OCCUR. DREMISES(Ea occurrence)
ED EXP(Any one person) $
�IERSONAL&ADV INJURY $
GENL AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE
POLICY PROJECT Q LOC ODUCTS-COMPIOP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
{Per accident)
NON-OWNED AUTOS PROPERTY DAMAGE $
ti (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB rl CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION AND XWC STAMORY OTHER
EMPLOYER'S LIABILITY YM UB-58270121-13 0320/2013 0320/2014 LIMITS
ANY PROPER rrOR/PARTNER/EXECVTIVE a N/A E.L.EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under
E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED
1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THEVOLICY PROVISIONS.
NORTH ANDOVER,MA 01845 AUTHORIZED REPR=TA
y.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
Rd,
Unrestricted-Buildings of any use group-which
CS-487977 contain less ishan 35,000 cubic feet(991n?)of
z enclosed space.
ERVC W PALM'
3 HILTON ST
SALEM MA=01974
S
��+ - :♦'` Failure to possess a current edition ofthe Massachusetts
0412312014 State Building Code is cause for revocation of this license.
For DPS licensing information visit www.mass.6ov/DPS
,,,, ✓.r'va._:.�
Uffiee a!'Consomer�FS
�.moME imPRovr:mENT CONSFRACTOR
` Re istration 1c}2Dgg Type: License or reg-astration valid for individul use only-
5 1 fr 9 before the expiration date. if found return to:
Expiration: 3112!2014 Ltd 13abTity Corpor Office of Consumer Affairs and Business Regulation
10 Park Yla2a-Suite 5170
AT +}TIC WEATHERr7miQtflL..L.C.
_. Boston,h1e10Zi16
ERIC PALM
61RJEFFERSON AVE
SALEM MA 01970 Undersecretary
Not valid without signature
a
NORTFj
own of ) t ndover
o . - ..
10
No. 441 — iq
h , ver, Mass, �.IM h,
2613
'I,
cocNJC"1WIC1t *_
7.O A�RATeO /'PP,`'�5
S U
BOARD OF HEALTH
P. ERMIT T LD Food/Kitchen
Septic System
THIS CERTIFIES THAT O-A Y�Nfk%&......7� ........................................... BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on ...�.......... d ..................
Rough
to be occupied as .. Frr.A?.%%J�AQ;;�XI0 ........................................................................................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 6M HS ELECTRICAL INSPECTOR
UNLESS CONST5 RTS Rough
Service
..... ......................................................................... 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.
SEE REVERSE SIDE
NO
RTy
Town of 2 ? EAndover
No. 441 — iq
Z ' h ver, Mass _l
LAKI
O COCNIClw.CK 1
�d OR�TEO ►'PP��y
S U
BOARD OF HEALTH
P. ERMIT T.. LD Food/Kitchen
Septic System
i
THIS CERTIFIES THAT Qar.W.`. 1......� �. 1'a. .................................01, BUILDING INSPECTOR
.. ...... .......
has permission to erect ........... buildings on ... Foundation
1 �� Rough
tobe occupied as T ... .....\ ........................................................................................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 6 M HS ELECTRICAL INSPECTOR
UNLESS CONST RTS Rough
Service
..... ......................................................................... 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.
SEE REVERSE SIDE