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Miscellaneous - 1476 SALEM STREET 4/30/2018
14M SALEM STREET , 210/106.A-0018-0000.0 Date.... ... .tf'.................. NORTH �r TOWN OF NORTH ANDOVER n PERMIT FOR WIRING This certifies that .... V1—t ��-- � t has permission to perform .......'/ wiring in the building of......... ...........:.IISo ...... ................................................. at .............. ........................,North Andover,Mass. 1'-�.. .... .... Fee.. ...—.........Lic.No5l?..T7`� ELECTRICAL INSPECTOR Check# 13-000 -/ , I�I� ���. � � � �� i Use Only � Commonwealth of Massachusetts Offic i Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(IvIEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigneV76 ives notice of his or her intention to perform the electrical work described below. Location(Street&Number) tSte/Em f Owner or Tenant ,StCAVr— -1- 41 SA SUA/A /�c3AJ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Re sl heArr/A4, Utility Authorization No. - Existing Service Amps / 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: ,�� ,,�� 1 Completion of the following table may be waived by the Inspector of Wires. � f No.of Recessed Luminaires Id No.of Ceil:Susp.(Paddle)Fans No.oTotal Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above [iIn- ❑ o.o mergency ig tmg rnd. grnd. Batter 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 Number Tons J.KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Dr Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: � Atfach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: �. 0"' f(When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O RAGE: 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 cpverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 06 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . LIC.NO.: '2 ZVS J K Licensee: Jr,- Signature ,IC.NO.: 0 7yS,j�'. (If applicable,enter "exempt"in the license number line) Bus.Tel.No.:<24-e" -mss yb%l Address: Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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 PERMIT FEE. $ � r Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, § 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: p g PARTIAL ROUGH INSPECTION: Pass R Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ]SINAI.,INSP CTION: Pass EN Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com yr The Commonwealth of Massachusetts F Department of IndustrialAccidefits I Congress Street,Suite 100 Boston,MA 02114-2017 ~: r www.mass.gov/dia Worker_s,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plu?nbers. TO BE FILED WITH THE PEPAUTT NG AUTHORITY* please Print Leejj& A, ''licant Information Name(Business/6rganization/Individual): r Address: �` 3 ti "te PhoneCity/State/Zip:Areyouanempoyer?Check the appropri Type of project(required): art time. 7. ❑New'construot[on 1. I am a employer with _.employees(frill and/or p ) employees Working forme in 8. Remodeling have no hi and h 2.❑I am a sole proprietor or partnership any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.0 lam a homeowner doing all work myself[No workers'comp.insurance required.]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 'Will Il.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole bin repairs or additions proprietors with ino employees. �•�v Pr g p and I have hired the sub-contractors listed on the attached sheet. 13•.[]Rb6f repairs 5,❑1 am a general contractor These sub-contractors have employees and have workers'comp.insurance 14 0 Other 6.❑We are a corporafiori and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have ri,employees:[No workers'comp.insurance required.] *Arty applicant that checks b'o s affidavit indi10 cating they are doing out the section all work and then hire outside w showing their workers7 compensation contractors must submit new affidavit indicating such Homeowners who submit t1u tContractors that check this box must attache"-n additional sheet showing the name of flip sub-contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing -workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date Policy#or Self-ins.Lie.#: City/State/Zip: - Job Site Address: 7l0 ' tholicy declaration page(showing the policy number and expiration date). Attach a copy of e yvoxkers'compensation p 25A is a nal olation Failure to secure coverage as required and M enalties?in the form of aaSSTOP rWORK ORDER Iand fine of up to $250.00 a and/or one-year'imprisonment,as well ascivil p day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do under the pains and penal' s of perjury that the information provided above is true and correct I hereby cerci . Si ature: Phone#: 66-75' yy Official use only. Do not write in this area,to be completed by city or town official Permit/License City or Town: # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: r , Information and 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." 1 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'a trustee 6fan 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 such employment b6 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 a business or to construct buildings in the commonwealth for any applicant-who has not produced-acceptable evidence of compliance with the insurance coverage r'equi'red." Additionally,MGL chapter 152,§25C('1)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 thi's chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required 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,not the Department of Industrial-Accidenis. 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 number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials i 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 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 write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-A4ASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia COMMONWEALTHOF MASAC� l1SETTS P p p p p ELECTF�ICIANSNG'- ` ISSUES THE FUi_LOWIL1C.ENSE AS J ?URNEYMAN::.ALECTJf,, qH ¢' OSNU{ J LAR I VI ERE �� 18 ALEXANDER RD4.li LONDONDERRY; N}1 03053 2627 2 4 .1R0 8 1 1r i 6 N° ?J 7 4 Date...- .y..d .. f NORTH 1 "oo TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SS�cMusE� This certifies that ..........`.C:....C<.f!.C-.............C!. ..!.....J\. .................................. has permission to perform ..... /..�!. r C....-i ca,., / ...................... ..... .......... ging in the building of........ti.�� .. �..:. ....................................................... atr.....�.T4 Z j�.....;��%1.�`' !...Cr�......... ................. orth Andover,Mass Femme J ..(�:. .... Lic.No.�!n './`.: ......... �a.^f -ti:..... ELECTRICAL INSPECTOR Check # 7 �C1 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer nW00MV0NWE4LTH0FM1MCHUSE77S Office Use only DEPARTAIVTOFPUBLICSFIFL+TY Permit No. _ BOARD OFFBZEPREYE MONRF,GM4770AN 527CYIR 12:W /72 Occupancy&Fees Checked XPPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date_ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. - Location(Street&Number) I�} �s—ti „Q t.`�,• � ' Owner or Tenant C Qftll 4-Lul rl Owner's Address l tk t,c►+ t a VIC M It Is this permit in conjunction with a building permit: Yes M No © (Check Appropriate Box) Purpose of Building .¢ (:.a Utility Authorization No. Existing Service ...LS .� Amps0 Volts Overhead Underground M No.of Meters OA_) . New Service d__ Amps - 9 3d Volts Overheard [:D'Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical—WorkI Y 5,9 c fM S'T. S' y/C 1 N G rq 5Z.' No.of Lighting Outlets No.of Hot Tubs No.ofTransformets Total KVA No.,pf Lighting Fixtures Swimming Pool Above Below Generators KVA ground El ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.'Of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No_jif Dryers Heating Devices KW Local Municipal Other Connections. No.of Water Heaters KW No.of No.of Si Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER E Itstaartoe Ptltscallt�the �Cx�alLaws I ha%eamuct �>re or YES NO Liabtb'ty Pb}icyittclttciing . IhmeshniftadvaWptafbfsarnetothe011ioeYES NO T��d�YESp��IhetMmcfmc'aWbYdmkwgf INSURANCE BOND OTHER (PlMeSpa*) E*atim D& Estim*dValuedIv]acttid Wc&$ WO&toSW InspecknD*Re*jmted Ratgh Final Sigttedutlda`tTie}�talfiesaFpajta�: �1 FIRMNAME r5 �c 1 It IG Ae� 1C l� / 0 L+oenseNa 096 rl' Limme l C ,, L Q U eS Sigr m. Li�nseNo G' Btlsir=Td.Na IVX 0, OWNI:R'SWSURATK�WAIVER;IamawmethattheLi�sedoesnot theinstsaroeoo�ecrasstf��iale �te�tmadbyMa�adx>�GateralIaws aod�atnTys+g�aernfl»p�eppfi�ionvmivQsd>isn �. g f P h on Ow er/ Agent , .,. J Telephone No.� p-.��2� '� 4Y PERMIT FEE • _ . I .-u... ....ti.._..•-- - - ! s J t.�)rl l- yah. 'z t x� h � �JI J, •/. - J �? 11 1 r4 i � !y a r y1,3 j/ 4 rs ' i� I F i ,t a A,y 11.1" }1 5• r a .,{,'. r a O 0) r 37 Oma'. .lr r t n ..{ v, I., J, t s., }. 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NORTH TOWN OF NORTH ANDOVER _ p PERMIT FOR PLUMBING }}} �►,^�^^r,o^ASS }- SA US _ This certifies that . . .� <. !A !. .,� . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . h plumbing in the buildings of . . .1-k , .�.fit r.t�. . . . . . . . . . . . . . . . . . . at . . �. !?. . . . . 4.! . . . . . . . . . . . . , North Andover, Mass. (}Fee. . }. . .Lic. No.. . . . PoLUMBING INSPECTOR Check # 7 7397 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) r 44 i? , Mass. Date—,, �Z Permit# 77 3 Building Location / 7� L�� �� � . Owner's Name/9l�ei" — � 8— 6,23 — 6,. 56 T Type of Occupancy Residentia ij New ❑ Renovation ❑ Replacement 99 Plans Submitted: Yes ❑ No O FIXTURES P Z �< 2 N Q w 0 s S4 S4 S4 N U. aU) w ti (n x ¢ c w cn z a V ¢ a c 3 (13rtS rd B 14 I V z o � n w i a w _ o ¢ _j Z cc a 11) 'J�' x r�I LL, r W ¢ N c J ¢ J — o o LU :Z F. U > F- O a' N f' z O O N w �.` O V N yy3c..-lll�� Q 0 ¢ J J ¢ rc a a C ¢ +� S 1 3 Y m o o J 3• S r N u 3«f gig b rtf 3 SUB—BSMT. BASEMENT . 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR r 'r 8TH FLOOR Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate Address 35 Pleasant Street CX Corporation 714 Stoneham, Ma 02180 ❑ Partnership Business Telephone 781 -4 3 8-7 7 7 6 R Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142_ Yes ® No ❑ It you have checked_yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy L Other type of indemnity ❑ Bond ❑ 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: Owner ❑ Agent❑ Signature of Owner or Owner's 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 o he Qeneral laws. By Title Sigfature of Licensed Plumber- City/Town *Type of License: Master lX Journeyman❑ APPROVED(OFFICE USE ONLY) License Number 8 3 2 2 I/2" Watts 9D bfp on water line to water boiler / North Andover Board of Assessors Public Access Page 1 of 1 p0nd:over Beard of Assessors Ss�cNuse roperty Record Card Parcel ID :210/106.A-0018-0000.0 FY:2012 Community:North Andover IV T- Mwl- Click on Sketch to Enlarge Click on Photo to Enlarge r • — a !! 4 1476 SALEM STREET ' L.= J Location: 1476 SALEM STREET Owner Name: KOENIG,ALBERT F GENEVIEVE M KOENIG Owner Address: 1476 SALEM STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6-6 Land Area: 1.02 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2462 sqft Total Value: 442,100 442,100 Building Value: 235,000 235,000 Land Value: 207,100 207,100 Market Land Value: 207,100 I Chapter Land Value: Sale Price: 0 Sale Date: 01/01/1969 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book: 01133 Page: 0456 I http://csc-ma.us/PROPAPP/display.do?linkld=l 895332&town=NandoverPubAcc 4/12/2012 Date . . .7— TOWN :TOWN OF NORTH ANDOVER PERMIT FOR WIRING. i This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . �. .` � . SIYS. .t�. . ... . . . . wiring in the building of . . . . . . �.0.. . . . . . . . . . . . . . . . at . . .I. { �? . S4 -r�-t.oS-7. . . . . . . .No Andover, Mass. a67o� Fee . . . . . ©. . Lic. No. . T/6, . J�� . . . . . . . . . . V ELECTRICAL INSPECTOR Check# 6 S 10980 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. 1 � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(�4E ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2l/ 2- 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) N76 5K-OA S--1-9.En Owner or Tenant �,G JEK-T K-oEo]G Telephone No.q 7L&$3'6�Zl Owner's Address .5A lA e Is this permit in conju tion with a building permit? Yes ❑ No E] (Check Appropriate Box) Purpose of Building I;Sr^�11� Utility Authorization No. Existing Service Amps / 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: r Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E] o.o Emergency ig ng rnd. rnd. Batte 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 Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent 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. Estimated Value of Elect 'cal.Work: �,�d (When required by municipal policy.) Work to Start: z r 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 coverage is in force,and has exhibited roof of same to the permit issuing office. p p g CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 1 certify,under the ains a d enalties ofperjury,that the information on this application is true and complete. FIRM NAME: iiia c L t✓ LIC.NO.: Zc(,`�O /4 Licensee: t�?rS� Gr�rl Signatur 4) LIC.NO.: /j(p /T (Ifapplicable,enter "exempt,,in the kc n mberli e.) Bus.Tel.No. 6- yZ`7'CFa Address: �y � k tor, Z&/ s L, /VJ4 e t?yt Alt.Tel.No.:'OV-92-L-1 S3 *Per M.G.L c. .147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.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: $ " �/ v L / trect Address(do not use a Post Office Box address) Contractor/Salesperson/Owner ame 1 L( 1 C Sal �� ,Sr yp� City/To*n State Zip Code Business Address(must include a street address) Daytime Phon �-B Q ing Phone j City/Town State Zip Code Ab �,b G W Y Mailing Address(It different from above) Business Aone Federal Employer ID or S.S.Number Home Improvement Contractor Reg.Number Expiration date Law requires that most home improvement contractors have 1673,3S �r 73,3 S J 0 I G a valid r istratnumber / a// The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) i Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be 3u rce ' excluded from the Guaranty Fund provisions of _6T#fq Date when contractor will begin contracted work. MGL chapter 142A.) V 3 1 Date when contra ted work will be substantially completed. qj Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: M Payments will be made according to the following schedule: $_ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by / / or upon completion of $ by _/ /_ or upon completion of $ U010i upon completion of the contract. (Law forbids demanding full payment until contract is completed to both part satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order I VA to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of (a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractor? ❑No Eryes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, ch ter 142A. Asv, LAI C Homeowners i tur ontractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e. MGL chapter 93A)may not be waived in any way, even by agreement. 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 work 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 and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor 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). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits 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 contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received 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 deems him/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 due be 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 Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website a h //www.inass. ov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website adhttv://www.mass.p-ov/ocabr/ Go online to view the status of a Home Irn rovement Contractor's Registration: ht ://db.state.ma.usihomeim rovement/licenseelist.as For assistance with informal mediation of disputes or to register formal complaints against a business, call: NOTICE z NOTICE TO a TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22& 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-023ON91 -9-11 ) o3-ii -ii TO 03-11 -12 POLICY NUMBER EFFECTIVE DATES m- GILBERT INS AGCY 137 MAIN ST READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE # DUVAL ROOFING LLC 184 PARK STREET NORTH READING MA 01864 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE ^ MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services a provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 001638 W20PIG02 TO BE POSTED BY EMPLOYER I The Coin nronwealth ofilYlassachusetts -- Department of Industrial Accidents Office of Investigations �U 0 600 .:� =;�� Washington Street ' -. . Boston, NIA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractol•-s/Electl-icians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): P® BOX 6-37 Read�rly, A Address: 01864 City/State/Zip: Phone #: ' �i(Oct '(255 FAre an employer? Check the appropriate box: Type of project(required): P? a Pmnlmtar ixtith 4. ❑ I am a general cnntractor. aned 1 nln -_ have hired the suL--rnn�'CtC.rS I ! 6. ❑New construction �.ittYtvy�,�.S�t uac aitw�t }tett-tit Tlc�. � 2.El listed on the attached sheet. 7.I am a sole proprietor or partner- E] Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.t 9. ❑ Building addition required.] S. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑P] bing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[?Roof repairs insurance required_] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box ill must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information_ Insurance Company Name: l Policy #.or Self ins. Lic. fi:' ` j' �a3�.��� Gf l --v�--- _ ` Expiration Date: _ �A 1ob.Site Adch:eas. I '71f�� C� City/5(aie/Zt P:- Attach a copy of the workers' compensation policy declaration page(showing the policy nuniber'and expiration date): Failure to secure coverage as required under Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify-wonder the pains andpenalties ofperjury that the information provided above is true and correct. Si natu Date: c-F-4�? Phone #: 6 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Information and 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 die 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 such 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 a business or to construct buildings 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)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 contracting 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 required 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 io 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,not the 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 number listed below, Self-insured companies should.entei their self-insurance license number on the appropriate line. City or Town Officials 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 0,11 in the event the Of ice of I.nvestigati.ons has to contact you regarding the applicant. . Please be sirre.to fill in.the pe.rmiUlicense number which will be used as a reference number.. 1n addition an applicant that must submit multiple,pennit/lrcense applicatrons,in arty:given.year,need.only submit:one affidavit indicahna curren(. 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 burn leaves etc.) said person is NOT required to complete this affidavit_ vesti ations would like to thank you in advance for our cooperation and should you have any questions, The Office of In Y Y P Investigations 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 1-877-MASSAFE Fax # 617-727-7749 �• Nlassachusetts- Department of Public SafetN Board of Buildin!ty Regulations and Standards Construction Supervisor License License: CS 58443 Restricted to: 00 KENNETH P DUVAL PO BOX 190/72 NORTH ST f N READING, MA 01864 PIP i Expiration: 12/10/2011 1 ('unm�isiuner Tr#: 10475 Office of Consumer Affairs&B sines Regulation HOME IMPROVEMENT CONTRACTOR Registration:. 167338 Type: Expiration: Al-10/2012 LLC D AL ROOFING;LLC KENNETH DUVAli � t 72 NORTH ST NO.READING, MA 01$64-. Undersecretary � Page No. of Pages Builders License # 58443 ter,% ti Home Construction Reg. # 109288 � I Dada o I (781)944-1994 (978)664-2557 "The Areas Oldest and Most Reputable Roofing Company" P.O. Box 637, North Reading, MA 01864 PROP UB T ` DATE i t f STREET ")" OBNAME CITY,STATE N ZIP CODE ,jveJOB LOCATION r We hereby submit specifications and estimates for: I I f C RUC, Rip& Remove all shingle debris from roof&job site with our own disposal truck: ❑ 1 layer 2 layers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. (additional at$1.70 per ft.) Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown Install ICE&WATER underlayment along horizontal eaves,valleys, sidewalls, sky-lights and chimneys Install premium base sheet underlayment between rooeck and roofing shingles Ef Install your choice of Tamko/GAF or IKO Lifetime architectural roof shingles See manufacturer warranty policy for more details Install new aluminum vent-pipe flange (s) Chimney(s)-counter-flash and re-step existing flashing w ❑Cut& Install new lead flashing �+ 9 Continuous Ridge-'vent with low profile design, hidden by shingle caps ❑Soffit-ventilation ❑ Roof louver-vents ❑ Seamless aluminum gutters-custom fabricated at job site by our own gutter machine ❑Downspouts ❑Leaf gutter guards Other lea h �' • f civ 7 ?E% *Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: aooTotal price not including options. dollars Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized 1 completion. Signature -Accepting proposal means agreeing to the terms of the enclosed binder Note:This pr posal may be contract. withdrawn by us if not accepted within�,,,� days 1�� ^�y`;ti.:-J"a`""''+�.-."`py+.+//'��-°'";+wf+""w.=�'.�ti,e.""'_^""'+s'u"++"=:K.:-.-W:•r.y-�rs',.. ....GYirki-,,.r r'�T.., Location__�TSI BGG Yd No. 4-1 o Date W Zkok6- TOWN OF NORTH ANDOVER NORTq N-r. p�tt�ae •1,,,0 Certificate of Occupancy $ + + Building/Frame Permit Fee -T IcMus`� Foundation Permit Fee $ Other Permit Fee qA7'F- $ tr „ Sewer Connection Fee $ C Water Connection Fee $ TOTALS BMfimrng inspector 7611 Div: Public Works PERMIT NO. 4--7 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE i MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE I SUB DIV. LOT NO. yLOCATION QPURPOSE OF BUILDING �7� �O� ,OWNER'S NAME L./J/2eye'• NO. OF STORIES "SIZE "bWNER'S ADDRESS!///7,7 6 sale,., AC7les s,�— BASEMENT OR SLAB ARCHITECT'S NAME L SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �f�r n,(1% `' 1' • '�` SPAN _— DISTANCE TO NEAREST BUILDING wy V 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 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES w EST. BLDG. COST ® (�J PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER St). FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND /APPROVED /BY BUILDING INSPECTOR 21". x DATE FILED /®'�� O — / / BUILDING INSPECTOR SIGNATURE OFpV fiAER OR AU ORIZED AG T �• �7 //�_, F E"E Lin pt OWNER TEL. PERMIT GRANTED CONTR.TEL.# f� 19 _ CONTR.LIC. IT FOR FRAMUBUILDING H.I.C.k PERM DATE: Lo Z�e FEE PAID- ' BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES 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 P —_ —— PIERS PLASTER — DRY VJAII UNFIN. 3 BASEMENT AREA FULL FIN. B M T AREA _ '/ 1/2 1/. FIN. ATTIC AREA _ NO B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMtACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS • - r� 7 NO. OF ROOMS GAS f OIL B'M'T — 2nd _ ELECTRIC 1st 13rd NO HEATING p over 0o o � . } _ 2 N478 ort : dover, Mass., dc'� COUI1C MFi wIC 1t BOARD OF HEALTH Food/Kitchen Septic System PERMIT . T M1' BUILDING INSPECTOR THIS CERTIFIES THAT.. ...4 A..�J�,tA....�' klM ..................� 1.1Q.....SA�.........5.......................................... Foundation W d ' has permission.to erect.....FX .... ?X:E'ale....... buildings on ..`... .............................. ....5-T..................................... Rough to be occupied as..T;xX& .....�,'?ep.......��.... ....5�...... 4t�l.�i............................ 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 Insp MUMM"b"Pith 's Buildings in the Town of North Andover. PLUMBING INSPECTOR �A VIOLATION of the Zoning or Building Regulations Voids this Permit. DATE: FEE PAID:_.. Rough Final PERMIT EXPRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON '"It I( u rA�' Rough Service BUILD SPECTOR :- Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y Final No `Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT t Burner r� PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER WATER FINAL DRIVEWAY ENTRY PERMIT -7(o I(