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HomeMy WebLinkAboutMiscellaneous - 159 SOUTH BRADFORD STREET 4/30/2018 / 210/104-C-0010-0000-0 � --_-_--_- ` � \. � � ` Location No. Date - � - dY ,I NORT" TOWN OF NORTH ANDOVER 0 M A Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s,�cHuso 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ b Check # f I 7 3 3 'i ��-�- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. _ f _ X C � SIGNATURE: Building ssioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I c)c4 CL- " Map Number Parcel Number Q , 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft (/1► 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided —+ v 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 Historic District: Yes No rn 2.1 Owner of Record Name(Print) d,�, dress for Service: I 3� Sign re Telephone 2.2 Owner of Record: O Name Print Address for Service: y rn Agnature Tele hone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 61 /f U J 2 ac, J,TuA.� P-�) �� a µ A.) i� License Number Wn Xddress / d L b 3o( 7) Expiration Date ic Sign re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v lJ- A-1 Dir Ej C, f Company / /Name ( 2 9�f fi rn Registration Number r ddress t1A Z Expiration Date Ys Sin re —Telephone •, 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.......❑ No.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 2' 0 -4 2Qnoo 1� 1 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) / 4 Mechanical HVAC /D D 5 Fire Protection l 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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 1, 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 Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS 1 SIZE OF FOOTING X MATERIAL OF CHEMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r The Commonwealth of Massachusetts - Department of Industrial Accidents A d Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affl davit Name Please Print c� Name: r o 3/ti A�t b,N st'-n4? Location: G gn.gs)ru ti i) 2 City A,,J 1� -k 1 f�,�-g S Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company name: inti... Address , --D U,-, City_ac to Phone#: 0 3 C In -56 ! � Insurance.Co. C r Q.-2tS:J i T'�/.a..--1 Policy# Company name: Address City: Phone#: Insurance Co. Policy# 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'imprisonmentas.well_as_civilpenaltiesinthefnrmof-a_ST_OP WORK_ORDER..and..a.fine_of.(.$100..D1D.)_a�day.against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cert nder the sins and penalties of perjury that the information provided above is true and correct. Signature Date 66 Print name ,„ `�-�'E-7JScG Phone# X3 50/ Z Official use only do not write in this area to be completed by city or town official' City or Town PermiULicensing Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other 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: u ve,—� (Location of Facility) r Signature of Permit Applicant A, c Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTIy Town of And O ..mt+M-. 'fir •;fir Ott 0 �• No.7Q' a dover, Mass., O CAK COCMICMEWICK x.95 RATED p` ,�5 7 V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System t4b4BUILDING INSPECTOR THIS CERTIFIES THAT... C V...... .....b.....`�46* i ... 0 ~ � .................... ......................... Foundation has permission to erect.... ........ buildings on ...............15....t....Sv.....&0 WZ1. ... ..... Rough "'t �'� r0 d � �1ne� C� Chimney to be occupied as......................................................................... ........ .................................................................................. 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 rel ting to the Inspection Alteration and Construction of d) 1 Buildings in the Town of North Andover. V G /0 /6)C ' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAR7ES Rough CC Service . 0m ................................................................................ BUILDING;INSPECTOR Final i 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 Be Done FIRE DEPARTMENT Until Inspected and..Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Page No. of Pages L Tom DeFusco 23 Dutton Road Home Improvement Reg. # 117756 Pelham, NH 03076 Tel 603-635-3017 Constr. Lic. #071037 Fax 603-635-3751 PR POSAL UBMljrj$tyftl>T�A PHONE DATE ��� I� d W G�Z TREE p JOB NAME Q ITY, TA E AND ZIP CO E JOB LOCATION ©o c 11 RCHITECT DATE 9t PLAN JOB PHONE We hereby submit specifications and estimates for: :....................................._............................................................................................................_.................................................................................................................................................................._................................._..._.............................................................................................................. I t 2 oG v �/ 1 ....... ...... .� ii / S �d �p J f �� �/ ......A............... M _............... ../................ ......,.......o ...............................�......................... (w.... 0.._._............................._�..._..........<. GI<-* J.._l ........................_............................_......_..............................._............................. .....__ I -................. _v_... . /. ... .. ........_....._. ..................... . ........................................ J UC2�. _.........................................._..............................................................................._.............................................................................................................................................................................................. ........... . ' . ._u 1 ...... . .. ... . _ ................................................__ _. . ... ..._..........._..._............................................................................_......................................_.......................... ..........................................................................................................................................._.....................................................................................................................................:._... .......................... ................_ ......... ..............._.. .............................................................. .......................................................................................................................................... .......... .................._................................................_...................................................................................... i DYIISE hereby to furnish material and labor com a in ac ance with the above specifications, for the sum of: dollars ($—fig ). ay ent to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above Signature specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by us if not accepted within days. insurance. Our workers are fully covered by Workmen's Compensation Insurance. (4myfattrle of Proposal—The above prices,specifications Signature and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature I.. Bay State Gas Company GAS INSTALLATION AUTFtORIZATION y Date Issued to Address For Installation of: BTU Input Restrictions n, BSG Representativ A_ Z� PERMIT ISSUED BY INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment.- 0 quipment:❑ Heating System (BTU Input ) t ❑ Range ❑ Water Heater ❑ Clothes Dryer ❑ Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO.721 LAWRENCE,MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 IIIIIIloll III 111111111111111111111111111111111111111 31,. v 4- Date.. �...`. .. ... . ........ NORTH TOWN OF NORTH ANDOVER ° . pp PERMIT FOR GAS INSTALLATION n i X • 4 p � • ,SSACHUSEt This certifies that . . .�.::y. . ). .: l./. . . . . .�. ./.�. 2. . . . . . . . . . . . . i has permission for gas installation . . . . .. : . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . .k.,. . . . . . . . . . . . . . . . . . . . . . . . . . at .,�.� .`.�. . .�. . t.,/.*.f<. :l. . . . . . . . . . ., North Andover, Mass. Fee. . �. :�'. . Lic. No.. .� . . . . ..). I. 1'. . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer E MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print orr�/Type) NO ��tF1Z , Mass. Date ^a�O- 0.000 Permit # L Building Location_ q fS. 9- 7nt er's Name WEST GH 7E pe of Occupancy New ❑ Renovation ❑ plaPlans Submitted: Yes❑ No ❑ N N cc X WN N y U Z Q N O ? N X Xm w a a s m s � Z o u ~ Q Z Z O t w 4 ¢ O N W Q = z Mfr - t!7 d C � Q W Z N W Q CC O. p W Y 4 W j a Z F. H �W- N O > It }- V J N W a W > a W O Z. < CC a m Z O Z a O 0: '.x O M s U. n 3 a 0 -j c0� � > Q a0. F- O SUB-8SMT. BASEMENT 1ST FLOOR 2ND FLOOR 31113 FLOOR 4TH FLOOR ° STH FLOOR 6TH FLOOR " 7TH FLOOR STH FLOOR t9-1H±- LHH Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET �C] Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance y / ttY policy �( 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: Signature of Owner or Owners Agent owner[] Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accuWe to the best of my knowledge and that all plumbing work and installations performed under the permit Iss t r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ i Type of License: Plumber Signature of licensed Plumber or Gas Title Gasfitter Master License Number 8697 City/Town 9Journeyman APPFidVE O FIC SE ONLY _ i• BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO+D0 GASFITTING c NAME i!i TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE X19 GAS INSPECTOR Date..P&,rz TOWN OF NORTH ANDOVER PERMIT FOR WIRING war ,SSACHUSE� This certifies that IrOlpld....!�97R? 7./..! ©. ....................... has permission to perform .... J/ wiring in the building of...... j!►�/.�S f�r�'T ............................................................................. j : p0q� 51 ......... ,North Andover,Mass. Fee.... U4 Lic.No.jf7Ve5f 9..........t:`f.'-c-+!-r-c +.c;cl..G.;. ELECTR[cALINSPECTOR L Check # 5 i,. ; :� THE COMMONWEALTHOFIVIASSACHUSETTS Office Use only DEPAUMEATOFPUBIlC ETY Permit No. BOARDOFFIREPIiEVE1VT70N UTATIONS527CNIIZI2 010 ` Occupancy&Fees Checked APPLICATIONFOR PERMIT TO ESACHUSSTSERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WIT THE ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date y Town of North Andover To the spe or of Wires: The undersigned applies for a permit to perform the electrical work desc 'bed below. Location(Street&Number) E Owner or Tenant Owner's Address Is this permit in conjunction with a building pe t: Yes© No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps/ volts Overhead M Underground No.of Meters New Service Amps / Volts Overhead 1= Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 1- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures KVA Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.J(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.of Dryers Heating Devices KW Local Municipal Other No.of Water Heaters KW No.of No.of Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• kisuanoeCowrage.FtnsttanttothelegttiteileMofMmwhlsMGenetallaws IhaveaammtLiax11ybsur&=FbhcyinchdTComplete OLerahous CovwageorilssubUntlalegtriv�tleil YES ®. NO IhavEsubmittedvalidproofofsametoiheOffice YES If)vuhavedled0dYES,p themmof d=1d tgthe atebox ky INSURANCE BOND MER a ?"seSpe*) Q WodctoStart �. �- EstimaedValw0fE hicalWotk$ klspeaionDateR c1 Rough Final -)- Signedunderlie FIRMNAME N LiomseNo. liomsee s / G/VU Signahlte LicXIseNo �� BusmessTel.No. //G'� jt Tel No. J Cd 3 7 OWNER'S INSURANCEWANER;lam awatethattheIimm notbavedr nst wmcovaageoritssubstantialeguivalcntaslaqutedbyMassachusetisGenadLam and that my siguahne on this permit application waives this tegttitement (Please check one) Owner M Agent M Telephone No. PERMIT FEE$ Signature o caner or gen + Location No. 7.3 Date �°? aZo� NOD TOWN OF NORTH ANDOVER 10. s A + + + , + Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ p � 01618 � p Check # i 61 Q Building Inspector f � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVfA�T,�,, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / j (j DATE ISSUED: / `7 7 /-D. -�,/0 SIGNATURE: aaaal "L� ic Building Comn-dssioner/InWtor of Buildings Date SECTION 1-SITE INFORMATION I O 1.1 Property Address: sf 1.2 Assessors Map and Parcel Number: ID � � - I Map Number Parcel 14umber VV 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred —+ Provided Re(pired Provided v 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 ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1c: "1strict: 1(0�3 r�0 rn1 2.1 Owner of ecord te N es �0--et Name(Print)(Print) Address for Service Signature Telephone 2.2 k0ner of Record: Nade Print Address for Service: Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ -�(2 f 2 V L � �- Licensed Constructj&Supervisor: 0 PQ 1) 2 !/ y/� &A AD 117ALicenseNumber Im Address Expiration Date a. Signe^,;re Telephone r F� 3.2 Re 'stered Home Improvement Contractor Not Applicable ❑ LT N f 2 �Al A o /,-) /0 3� Company Name / {� / �� Registration Number Addres ^�•• Signature Telephone Expiration Date Y/ r � 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.......IT No.......❑ SECTION 5 Description of Proposed Work check as a Ucable New Construction 0 Existing Building 0 Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Wor SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL.USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection V 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIWfON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 as Owner/ uthorized A of subject c property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �s Print Name �a- Si attic Owner/ t Dat NO. 6F STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS 1' 2ND3 FLD SPAN DM ENSIONS OF SILLS DIMENSIONS OF POSTS " DINIENSIONS OF GMDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUELDING CONNECTED TO NATURAL GAS LINE Propozal Siding 1'0 Windows Jerry Lavallee Remodeling ii Roofing P.O. Box 374, Bradford, MA 01835cif ill A Carpentry Coll, 508-633-9141 air PROPOSAL SUBMITTED TO mom DHTj 9T"1117job HIM CITY, STATE AND UP COOS Jos LOCATION NIP ARCHITECT DATA OF PLANS JOB PHONE. We hereby submit specifications and estimates for: ... ......... -X. 0.......... ......... ...�N..'...,........ C14 ..............V...... .................. ............ ........ ........ 27- ....... e-r.................. -.k '!/ria...................... ........... -7 ....... ..........,L. . ............ . ....... ".,Z.......................... ................. ........... .... ... ............. ............. ............... ........... ....................................................................-............... .......- ................I........... .......... ......... ............................................. ..........- I I.................I........... ................ ......................I.................... .............11........ ....................- I ---........" .- -.1.......... .............. .......... ................... ............ ............................. ........................I - 1- 1.1--.1............. .. ...........-.1................. ..........I............ .......... ..........I....................... ............. ..............I I...................-1-1 1......................... . .. .........- .. ...........11............ .......... ........... ......................................................... .......-.1......I..........I........... ........... .......... ..................... .......... ..........I'll"........"..,......................... ....................I............... . .......... ..... ............. ............ .......... ................ . ....................... .................-..............-1-.1".-.................. . i�............... ....... .... .......-................I.......................................... .............................I.......................................... ...................... ... . .............................. ................ ................ ............. ........................-.................. ..................... ........... I ............. ...................... .................. ....................... ..................... ...............................-....................... ..... . ................. Vropoze hereby to furnish material and labor—complete In accordance with above speciftalons,for the sum f* f..— -/ --k. ..— -jr-1, '/ /— — doilains Payment to be made as follows: X AD material is guaranteed to be as specified.All work to be own~in a workmares manner AuMatUtZed according tO standard Practical.Any alteration or deviation from above specillmlions Involving xtra costs*111 he executed onty upon wMen orders,and will become art extra charge over and SIgnature above the estimate.All agreements contingent Upon*k".4001denIS or delays beyond our control.Owner to wry fire,tmnado,and cArm necessary insurarm.Our workers are fully cov- Note: ered by Workman's Compensation Insurance. This pfppo6aI be wtthdrawn by us If not azted within Z; days. ur Ziteeptante of Vropoisal--The above prkma,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the S; work as"clifiso.Payment will be made as outlined ab". Signature Date 01 Acceptance:-- Signature Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101031 f Expiration: 6/24/2006: f Type: Individual t JOHN COSTANTINO . John Costantino 226 Lincoln Avenue � � � Haverhill, MA 01830 Administrator C NORTH '9 Tomm Of _ Andover No. 3 y =_ TT .. % o dover, Mass., /22 —A A �.1 Civ got=, 0 COCMICME WICK ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ��� �S Irea BUILDING INSPECTOR THISCERTIFIES THAT.......0..............................................................A.Gtf............................................................ ...... /�� �. �^A � Foundation has permission to erect... �,.l .�.......... buildings on ...... ... ...... Rough to be occupied as � � �.11. ��il.'�.. �e.. ..�.... ...... Chimney C e provided that the person accepting this permit shall in every respect conform to the!nk the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 11pV C h O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR TRUCTI N TAR S UNLESS CONS Rough ......................... 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. n SEE REVERSE SIDE Smoke Det. x The Commonwealth of Massachusetts Department of Industrial Accidents Of ice of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affldavit Name Please Print Na t.cly Phone � I am a homeowner perforrning all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an employer providing workers'copensation for my employees working on this job. company e: LaL:�z L AAdress 0 &0 '� 4,/' CRY, Insurance Phone G 3 3 P e y a/ Comtrarnr name: , Address Ck' Phone; Insurance Co. PoICV S Faikve to secure coverep as required under Section 26A or MGL 152 can lead to the imposition d criminM andlor one years'Impriaminent.a@.WIU-as_chd 4=aRIWJn t e h=dA STOP WOW��a.fkw d��d.a tine up to 11,500.00 understand that a copy d this may be forwarded to the Office d Investigations d the DIA for coverap ve mon. �-me, I I db hereby cw*under the and n8ft", e that the 1 don provIded above Is tore and corned. Signature Date �� Z Print name Phone it 9 Official use only do not write In this area to be completed by city or town dioiar City or Town P ensi ❑Check X immediate response Is required ❑ Building Dept ❑ Licensing Board Contact person: ❑ Selectman's Office Phone s: ❑ Health Department ❑ Other