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HomeMy WebLinkAboutMiscellaneous - 115 HILLSIDE ROAD 4/30/2018 (2) 115 HILLSIDE ROAD 210/098.C-0046-0000.0 `` Date....... ........................... Y _ t &ORTot 'yt ?;•'�". •°�"°O TOWN OF NORTH ANDOVER 3 t PERMIT FOR WIRING r ,SSACHUSE� This certifies that ............... mac CrE... ........ l S � .......................... Y f- has permission to perform ...... � �E � .................. ........... xs s; wiring in the building of...........��..............�....�................................... s1 L /(� - . at...... ........ ,North Andover,Mass. Fee.2'©."'.rLic.No..-�7 40.......... ELECrxICALINSP.z Check # 6834 'NCommonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. w3V BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 19 [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7/21./2006 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) 1.15 Hillside Road Owner or Tenant Ken Osborne Telephone No.691-5201 -- - Owner's Address__same Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters I New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity u� Location and Nature of Proposed Electrical Work: replace 2"d floor bath devices to white. Completion o the following table maybe waived by the Inspector of Wires; No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. E] of Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump J.Ny!qj?!er Tons J.K.W No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection - No.of.Dr ers .- __ _ Heating Appliances. KW Security Systems: y — - No.of-Devices or-E uiva!ent- _- No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Feb/2007 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 7/21/2006 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Kelly M.Casey Signature LIC.NO.: 37200 (If applicable, enter "exempt"in the license number line.) s.Tel.No. : 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut Mass 01826 Al .Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does thavethe liabili ' urance 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 PERMIT FEE: $20.00 Signature Telephone No. Date.. . J.e.... .. .. ,:ORTN pF TOWN OF NORTH ANDVER ' - PERMIT FOR GAS INSTAL} TION _ . � 1'xt ,SSAc HUSEt This certifies that . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . x `" . . . . . . . . . . . . . . . . . . . . . . . . . . at 4/! tIAc .� . . . . . . . . . . . . . North Andover, Mass. Fee./t, C- Lic. No..l ���.�. . . . . �.�.!) . . . . . GAS INSPECTOR Check# 5-588 8 NIASSACHUSIifiIS UNIFORM APPUCATON FOR PERNUr TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS r BuildingLocationsPermit# S .� ` j U Amount$ n Owner's Name New❑ Renovation ❑ Replacement Or Plans Submitted ❑ a w o U P; H z o ff wWx O z ow wa U E-4 >Uw z z M z O w 7 a U 4 OH W x A a F O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7 T H . FL O O R 8TH . FLOOR (Print or type) •J /� Gu C - Check one: Certificate Installing Company i J Name 3 � -P � `1 Corp. Address t`� x L U�`� Partner. Business Te ep one 7 X 6 X7- e) r 2--/ / l'Firm/Co. Name of Licensed Plumber or Gas Fitter I i GSC INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ta� No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy 13""' Other type of indemnity 13 Bond 1 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installat' ns perfo ed under Permit Iss d for this a lication will be in compliance with all pertinent provisions of the Massachuse State Ga ode an apter 1 of the Ge al Laws. By: S•gnature of Licensed Plumber Or Gas Fitter Title Plumber G� City/Town Gas Fitter Tense um er 13--Master APPROVED(OFFICE USE ONLY) [3 Journeyman 'Date. ..�.� off: y OR':�tio TOWN OF NORTH ANDOV p PERMIT FOR PLUMB G k : This certifies that . . . . . . . .... :. . . . . . . has permission to perform - - ^' - . ;i plumbing in the buildings of r*-- . . . . . . . . . . . . . . . . . . at • • • . .s, North Andover, Mass. I j Fee" . . . . . . .Lic. No.4f'' . . . . . . . . . . . . . . . . . . . . I•; P SING INSPECTOR Check ,7 p4ppF C 7 0 1 9 S.p t: MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location /l /7 ` l ( / DateA Q 6 Se d -POwners Name t /Fj� /Z�-� Permit# d/ Type of Occupancy Amount et— New ❑ Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES > z w U M' 4 z z3 Q a o° F SLRI VE RASEVM ISI:IH IM M Fam d C 3M HDM 41H FLOCK S1Q3IHIOG42 � 6[H ROM 7IH]HIDOR SIH FI" (Print or type) �--- any Name /l / �i� L � Check one: Certificate Installing Com � Corp. 11 C Address -� U (JCS l d S Partner. usiness Telephone 0-'Firm/Co. Name ofILicensed Plumber: Insurance Coverage: Indicate theme , e of insurance coverage by checking the appropriate box: Liability insurance policy UOther type of indemnity Bond Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and informatio ave su itted(or entered)in above plication are true and accurate to the best of my knowledge and that all plumbing work nd i tall s p'-formed nder Permit sued for thi ica[ion will be in compliance with all pertinent provisions of the ass use tat° tubigr ode and C ,pter 142 e oral Laws. By. ignaure o icense un Title Tye f Plumbing License City/Town tcen um r Master Journeyman APPROVED(OFFICE USE ONLY �sw.,;$""' +=fir a✓'��.'u"•�: :az-.;__ _ "a.r`-v,fi--^" �i+�:.�:'�i Location Nos. L"a Dater A ;.oRTP TOWN OF NORTH ANDOVEFF A Certificate of occupancy $ 41 Irk # Building/Frame Permit Fee $ Foundation Permit Fee $ sACMUSE ,� L a %, �w�R rmit Fee $ Sewer Connection Fee $ 1 Water Connection Fee $ TOTAL r - �+ Bui ding Inspector 80 Div. Public Works PERJttT NO- APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 EMAP +40.' . LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ONE I SUB DIV. LOT NO. Z/ LOCATION goe- /1�! /PURPOSE O q OWNER'S ,i NAME (� / NO. OF STORIES IZE V OWNER'S ADDRESS �f BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN VVV � � I DISTANCE TO NEAREST BUILDING 000r DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS - AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY 't lS BUILDING ALTERATION - IS BUILDING ON SOLID OR FILLED LAND �NILL.-BUILDING CONFORM TO RE IREMENTS OF CODE e, IS BUILDING CONNECTED TO TOWN WATER OARD OF APPEALS ACTION. IFANY " IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LA ID COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PA��FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. LECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING - .. 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS /LANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATEL'X,'E ED BUILDING INSPECTOR SIGNATURE �OWNE2RAU�40 ZED AGENT F E E OWNER TEL.J/ PERMIT GRANTED CONTR.TEL# 0� L. 19 ® DT � CONTR.LIC.# f H.I.C.JJ 0016, n. BUILDING RECORD ' 1 OCCUPANCY_ 12 SINGLE FAMILY _ STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI.` FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT.PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 1 2 I3 CONCRETE BL K. PINE BRICK OR STONE HARDW D _ PIERS PLASTER _ DRY WALL _ _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ Y, '/i �/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ s• 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 1 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMMCN VERT. SIDING A$PH. TILE STUCCO ON MASONRY �— STUCCO ON FRAME BRICK ON MASONRY '� ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING _ STONE ON FRAME _ t SUPERIOR 1-1 POOR _ r ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD $HINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR i TILE DADO 6 FRAMING I 11 HEATING } WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR . WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T2nd T— ELECTRK •� "4� I 1st 13rd NO HEATING Castricone :Roofing .& Siding • P ti 4F6?4 t=> i ^;rn'•^A,!4 6D +.. REPAIRS FREE ESTIMATES ; P. '� Telephone:(508)'6824266 t " . MARIO•CASTRICONE 61 Water Street,No. Andover,Massachusetts 01845 - 4 Y I/we, the owner(s) of the premises mentioned below,hereby=•contract with and aIuthotize you as contractor, to.furnis'h all necessary materials,labor and workmanship,to install,construct and place the-impiovements according'to the following specifications, terms and conditions, on pr es below described: 4 Owner's Name ........ ;? Job Address ......... . �� " .... ...� _City .. .. . .. .. . . State ._ ..... .�....... SPECIFICATIONS r , 4 .. ... .` .:::: . ��..... .. .�M££-G�-t�.0 `'�I /� ....`% - I t/.I.:�....�C'Y` ^.:�...... ............ .. .............. .............................................................. ... ................................................................................................ ................................................... .... ::..::..::........::...... ......................................:::.......::.... :::::::::.::::::..::::.::::::::::::.............................. ...... G .. - ...................................... Materials and labor to cost $.�.�� .�................ Payable ...._..........:........ on .. .................... and balance in .:.............. n_enthly installments of'$ .................... each, payable on ........................ day of each and every month thereafter until paid in full (...:........% charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accord- ance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs,attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. I - It is further agreed.that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any sub- sequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not here. in contained shall be binding upon the parties and that all of the agreements and understandings of said parties are con- tained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in o i r. IN WITNESS WHEREOF, the parties have hereunto signed their names this W-7 day of Akc(..' 194 V Accepted: (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed Owner...... ., . _ Signed ......................................................._ ........................... ... .. _ Own ::i� PerALX-................. Signed ......... . .. ........ . . . .................................... Ae resents lve IIi - NORT ova Of � 4dover No. o - -i,;:, .. 159 0 . r -ort, cover, Mass,, 4RI& �. 19 0 y I T ° '- L A ICK COCHICHE W A°RA7ED E E BOARD OF HEALTH Food/Kitchen P Septic System ERMIT T BUILDING INSPECTOR THIS CERTIFIES THAT...... . .....< ✓�6/.�"�" (.. ........ 1 C..... ... . Foundation f:R 1 has � .......... .. • Rough...... buildings on ..//.S. . �. ..... � 441 i '. ...d to be occupied as.... .................... .. Chimney provided that the perso accepting this permit shall In every respect conform to the terms of t e applic ion 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 r VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough t Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. r UNLESS CONSTRU TIO STARTS • Rough Service BUILDING INSPECTOR Final s Occupancy Permit Required to Occupy Building GAS INSPECTOR la in a- Conspicuous Place on the Premises — Do Not Remove Rough Display Y P Final t No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner s PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. '"' SEWER WATER FINAL DRIVEWAY ENTRY PERMIT a•- { Location No. f Date 3 42 , d 3 p0RTly TOWN OF NORTH ANDOVER 0 9 ' Certificate of Occupancy $ gib'•^ E<� Building/Frame Permit Fee $ JJgCHUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �D Check # t ! 6225 'A / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLII�S]H�••A ONE OR TWO FAMILY DWELLINGMU i�. T Vaall�,V'3G BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1 f S7 LLS IPE__ I J Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ - Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record (. . Name(Print) Address for Service: W c7 77 6 ?;2,, Signature Telephone ' •' 2.2 Owner of Record: UV Name Print Address for Service: O z M Signature Telephone 00 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ I. I Licensed CdAistruction Supervisor: License Number } mn Address Expiration Date Signature Telephone I 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name s q b o S tj-T7-, _ ST - ` 1 6 , � y� _ V� MA Regis rat tion Number �• dre � ' t b '— // 93'-',3 Z b Expirationate St nature Telephone V 4 SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......C1 No.......❑ SECTION 5 Description of Proposed Work check applicable) New Construction 11 Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Pro sed Work: tt,•S—�I SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QF UAL USE QNLY '`wh4F CoAipleted by permit a ' licant _ k 1. Building (a) Building Permit Fee G � Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -F I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 7DA V 1 D CA STA Ie- Alk— ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 1114 V D C=,4 MJ, N Pri Na i ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building;Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A.. The debris will be disposed of in: (Location of Facilit ) Signature of Permit Applicant 3/l�� Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector I i ✓fie (�a�'�mzoruue? before the expiration date. If found return to: Board of BuildingRegulations and Standards License or registration valid for indiretul use: y HOME IMPROVEMENT CONTRACTOR 9' Board of Building Regulations and Standards 10456 ' One Ashburton Place RM 1301 Reg'istratiori 9 Ix Boston,Ma.02108 Exp�rati�on 7y1412004 Pnyate Corporation DAVID CASTRICON�RO©F►NG ,S a inir - -astncone +� ___ T Hillside Road "r ,. Not valid without signature Administrator Boxford,MA U1921 F. . Town of E A. ndover No1 _ _- o�A LOCH ..op dower, Mass., 3 ORATED p`?� 5 S H k w% E BOARD OF HEALTH Food/Kitchen Septic System r RMIT T D 0 ms.Odr *jBUILDING INSPECTOR / 0. THISCERTIFIES THAT... ... .............s ��............................................................................................. ...................... ................ Foundation has permission to erect.....1, ....... buildings on �, 1 �1 g ... .................................. . .......... Rough .......................................... �Ar- FNAr * * r144L OD fir! f 1 'V Chimney to be occupied as............ y . . .. . . ... . . . . . . . . . . . .. ........................................................................ provided that the person accepting this rmit shall in every respect conform to the terms of the application on fi in Final this office, and to the provisions of the Codes and B -La s relating tot � Inspection, Alteration and Construction of Buildings in the Town of North Andover. �� PLUMBING INSPECTOR y VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHSMONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS RTh Rough .... .. ..��.....CL ................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 See" Workers'Compensation Insurance Affidavit Name Please Print Name: 6 i ,n _ c (I a �. Location: Y 1 Y s r^ CitV NO Phone # — — . I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer provi ing workers' compensation for my employees working n this job. Y Company name: S Address o?-6,6 -� Ci -&I.'A/ Phone#: 9 Insurance.-Co. r POlICV# Company name: , Address City: Phone# Insurance Co. Poiicv# Failure to secure coverage as required.under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as_vrelLas_c Mi.penaltiesinlhelarm-fa-STOP WC)RK ORDERAid_afire_d_($1D.O.DD)-aiiw agwnstmle- 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby cert' the pat s and penalt' of perjury that the information provided above is true and correct. v � Signature Date 3 63 r Print name Phone Official use only do not write in this area to be completed by city or town official' City or Town Perrtit/Licensi D Building Dept []Check if immediate response is regui�ecl 0 Licensing Board Contact person: Phone#. p Selectman's Office E] Health Department Other