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North AndoverBoard of Assessors Public Access
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Summary
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-A Page I of 1
-101 C-
mvs�
�4dProperty Record Card
Location: 275 ABBOTT STREET
Owner Name: NIEMI, WAYNE J
SANDRA C NIEMI
Owner Address: 275 ABBOTT STREET
City: NORTH ANDOVER State: MA Zip: 01845
Neigbborhood: 6 - 6 Land Area: 1.01 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 2100 sqft
ASSESSMENTS
.al Value:
Ming Value:
id. Value:
.rket Land Value:
apter Land Value:
CURRENTYEAR
492,500
283,800
208,700
208,700
PREVIOUS YEAR
447,800
240,800
http://csc-ma.us/PROPAPP/display.do?linkld=2252157&town=NandoverPubAce 3/18/2013
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PermitNO: I
Date Issued: I
N
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
LNIPORTANT: Applicant mus
t complete all items on this pag
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fdUYYar1&rd18truc
UFF
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
)�J-One family
El Addition
El Two or more family
D Industrial
D Alteration
No. of units:
0 Commercial
o!444epair, replacement
0 Assessory Bldg
0 Others:
El Demolition
0 Other
UL
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W6�tEL�rj: iwic
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ON OF WORK TO BE PERFORMED:
%\r, — AO S-1- A-1.1 -t, fl- k
Identification Please Type or Print Clearly)
OWNER: Name:-S>C(,%C�re^ Phone:
Address: .6 r- A
"oh6-5-b,
60001. ITU
Q.—
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S-- "0 P LP
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ARCH ITECT/ENGI NEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT'. $12,00 PER $1000.00 oF THE TOTAL EsTtMArED cosrBAsED ON $125.00 PER S.F.
'Total Project Cost: $ 5�(v 6\ tob FEE: $ &Z (J
Check No.: q 162 Z2 Receipt No.: 2M )Q
NOTE: PersoWs contracting with rinregistered contractors do not have access to marantyfumd
"ss to
�!y�h e r
na ure of A'" t1.0" - ff� " ` ".,
nafdre.bf con dor.
Plans Submitted U Plans Waived 11 Certified Plot Plan [I S Impned Plans
Location2q�� A64 5�-
No. -3-7s-�4 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL $
Check# Za kolr-5
Y
2 6 j— G /� Building Inspector
Plans Submitted El Plans Waived -n Certified Plot Plan [I Stamped Plans
TYPE:OYSEWERACTEDISPOSAL
Public Se,wer El
Tanning(MassageffiodyArt El
-Swimming Pools 0
well E]
Tobacco Sales El
Food Packaging/Sales 0
Private (septic tank, etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT El n
COMMENTS '
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH I Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfrecelpt submitted yes
Planning Board Decision: Comments
Conservation Decislion: Comments
Water & Sewer Connection it
DPW Town Engineer: Signature:
-7 Located 384 Osgood Street
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ene Wa I
Andersen.
so. . ...... k-C-4 y
ir(s) Name
MA Home Improvement Contractc
License #170810 (Expires 12123/2013
Renewal by Andersen Corporation Federal Tax ID #41-191841:
104 Ofis St. Northborough, MA 01532
(508) 351-22co Fax (508)-986-7072
CUSTOMER WINDOW AND DOOR REMODEI.ING AGREEMENT
SANDRA NIEMI I AUGUST 19, 2013
275 ABBOTT STREET I NORTH ANDOVER - I MA 1 01845
sandra niemi(aWahoo.com 1 6176809005
Buyer(s) hereby joirtly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance
Nith the terms and conditions described on the front and the reverse of this agreement and on the affached specification sheet(s) (collectively, this
'Agreement"). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Total Job Amount $ 5,601-00 Amount Financed $ 0.00 Est, Start Date Method of Payment
Deposit Received t33%)$ 1,867.00 7- 10 weeks Check /Cash
BaJance Start of Job (33%)$ 1,867-00 Front Deposit (50%) $ 0.00
Est. Install Time LV, Credit Card
Balance on Substantial Substantial
Completion of Job (33%) $ 1,867.00 Completion (50%) $ 0.00 1-2 days If credit is selected, please
yerlsl agrees ano unizersirancis met inis Agreement constriturres ime entire uncierstanoing Derwoon tne parties, ano triat tnere are no verinal
Jerstandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the
nod, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the
ms of this Agreement and has received a completed, signed and dated copy of this Agreement, including the two attached Notices of Cancellation,
the date first written above and 2) was orally Informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE
Y BLANK SPACES.
towel by Anderson Corporation Buyer(s) Buyer(s)
Signature of Project Manager Signature Signature
DAVID BARRY
Printed Name of Project Manager
SANDRA NIEMI
Printed Name
Printed Name
YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE
DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTCIE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NOTICE OF CANCELLATION NOTICE OF CANCELIATION
ate of Transaction 8/19/13 . You may cancel this
ansaction, without any penalty or obligation, within three,
usiness days from the show date. If you cancel, any property
adled in, any payments made by you under the Contract of Sale,
ad my negotiable instrument executed by you will be returned
ithin 10 days foUowing receipt by the Contractor ("Sell"") of
�ur cancellation notice, and any security interest arising out of
ketransactionwillbecanceled. Ifyoucancel,youranstmAke
vailable to the Seller at yew residence, in substantially as good
mclition as when received, any goods delivered to you under
kis Contract or Sale; or you may, if you wish, comply with the
Istructions of the Seller regarding the return shipment of the
oods at the Seller's expense and risk. If you do make the goods
vailable to the Seller and the Seller does not pick them up within
D days of the date of yaw Notice of Cancellation, you may
ttainor dispose of the goods without any further obligz6on. If
Do fail to make the goods available to the Seller, or if you agree
� return the goods to the Seller and fallto do so, then you remain
able for performance of all obligations under the Contract. To
ancel this transaction, mail or deliver a signed and dated copy
f this cancellation notice or any other written notice, or send a
Aegram to Contractor: Renewal by And—in, 104 Otis -St.
orthborough, MA 01532, BY NOT LATER TILAN AIMNIGHT
OF 8/22/13 .(Date) I HEREBY CANCEL THIS TRANSACTION.
Buyeft Signatum Pdw N— Dt.
Date of Transaction 8/19113 . You may cancel this
trousextion, without my penalty or obligation, within three
business days from the above date. If you cancel, any property
traded in, any payments made by you under the Contract of Sale,
and any negotiable instrument executed by you will be returned
within 10 days following receipt by the Contractor ("Seller") of
yew cancelliation notice, and any secoAty interest arising out of the
trausa�cdonwilllbecsnceled. Ifyouconmiyouraustruake
available to the Seller at yew residence, in substantial][y as good
condition "when received, any goods delivered to you under this
Contract or Sale; or you may, if you wish, comply with the
instructions of the Seller regarding the return shipment of the
goods at the Seller's expense and risk. Ifyoudoma thegoods
available to the Seller and the Seller does not pick them up within
20 days of the date of yew Notice of Cancellation, you may retain
or dispose of the goods without any further obligation. If you fail
to ma the goods available to the Seller, or if you agree to return
the goods to the Seller and faM to do so, then you remain liable for
performance of all obligations under the Contract. To cancel this
transaction, ---*I or delilver a signed and do" copy of this
cancellation notice or any other written notice, or send a telegram
to Contractor. Renewal by Andersen, 104 Otis St. Northborough,
MA 01532, BY NOT LATER THAN M[DNIG]HT
OF 8/22/13 . (Date) I HEREBY CANCEL THIS TRANSACTION.
Buyeft Signatum Pdm N— Date
R eneWa Renewal by Andersen Corporation MA Home Improvement Contractor
I
byAndersen. 104 Otis St. Northborough, MA 01532 License #1 7OB1 0 (Expires 12/2312013)
—Dow REP—cg.— —An&—Q�—y (508) 351-2200 Fax: (508)-986-7072 Federal ID #41-1918413
Window Specification Sheet
�Buyer(s) Nalme Date of AVepment
SANDRA NIEMI T JAugust 19, 2013
The buyer(s) listed above herebyjointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described
on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of
which the Specification Sheet is part.
WINDOW DETAHS
Style Pug / United Exterior Inmrior Hardware Hardware 1.wB4 Grille Grille -1ep,,r/
Roorn # S'yl� D—il insert l.chn Casings S& Color Color Color Style s—e. S—un Gilles' Sh 1/3 Sh 2 1,11. U.i..t!d
Living Fwg c RS Full 6068 Int -Ext Flat WH WH Brt-BrasXovingto FFG SmartSun No No Tent cr
Total I BAY&BOWD *See Bav/Bo- Measure Sheet
Roof Hard—
Room Count 3Vi. Flankers inch Casings Angle Liles Color Color Grill. S soffit Color
Slyk Det.11 Uil�d Approx. Nurnbc, Exterior I Interior End sashes I C-tc,r
sathes s—.
SPECIALTY BLM'AnS
Full/ Uilcd lowE/ ADDITIONAL WORK DETAEL NOTES E
Rourn Count Style Insm inches Stuarts- GrWa Grill, Style Warm system to coordinate
Possibly getting phantom retractable screen. TBD
Grey threshold
Primed interior casings
ADDITIONAL WORK DETAILS
i I No o�y of 0 sins 0 Sill noses to be replaced by Contractor.
i — .
2 No Contractor will remove metal firstiones of windows.
z 3 No Contractor win install new 0 paint-madyor 0 Stain-mady 0 Interim 0 Exterior casings in 0 Pine 0 Mintenance-firee material
4 No Contractor win instal] new 0 paint-madyor 0 Stain-mady 0 Interior 0 Exterior stops in 0 Pine 0 Maintenance�fme material
3 No Contractor will wrap exterior casings with oDil stock of color.
O-ae�ris aware that contractor does not do say painting/staining on, removallinstallation of alhur— system/hard—ure. It is the
ia
6
i jZ sponsibility of the homeowner to haw the alhurm system/hardwaze rem�d prior to installation. Customer is aware in some cases there
be glass loss. If there is, the amoumt will be dependent on the type of existing windows, type of installation, insert or full frame and
dc— style. We make no guarantee as to the anao,ant of glass loss. Custoover is a—e and undertstands any and all — rot is not
hnelodd th's rnarract. Should any "t be found there win be an Additional charare for time and M1&lCEjaJLM2JCss so stated in this contract,
7 Yes Contractor will insulate, caulk and sea] windows with 3 -point system to prevent water and air infiltration. Removal and disposal of all job related debris, windows,
storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued.
8 Yes Building Permit—Contractor will secure any and all necessary permits. The fee for the parnit(s) is not included in the Contract Price and a separate check is
required at the time of sale [Drthis fee. Check# 5314 3 72
9 Yes All discounts have been applied to this agimement.
It
0 Z Yes U No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment I finance form(s).
It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM YONDOW AND DOOR REMODELING AGREEMENT, constitutes the entire
lunderstanding between the parties, and them are no verbal understandings changing or modif�ing my of the terms. This Specification Sheet may not be changed or its terma mottled or varied in
:1—y way unless such changes are in writing and signed by both the Buytqs) and Contractor. Buycr(s) hereby acluowledge that Buyerts) has mad this Sprcification Sheet.
�,Renewal by Andersen Corporation Buyer(s) Buyer(s)
Signature of Project Manager Signature Signature
DAVID BARRY SANDRA NiEmi
Print Name of Project Manager Print Name Print Name
The Commonwealth ofMassachuseUs
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.mass.gov1dia
Workers'- Compensation Insurance Affidavit: Buffders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lecibly
Nam�(�usiness/organization/Individual): &,newc,� VA
Address:
City/State/Zip: I A 0 \0c,.rV , Mp� 0 0,)?hone W:
Are you an employer? Check the appropriate box:
1.,2"1 am a employer with 3 J 4. E] I am a general contractor and I
Y -
. Type of project (required):
employees (full and/or part-time).*
have hired the sub -contractors
6. [] New con'stniction
2.0 1 am a sole proprietor or partner-
listed on the attached sh cet.
7. L2-1(emodeling
ship and have no employees
'
These sub -contractors have
8. E] Demolition
working for me in any capacity.
employees and have workers'
9. Building addition
[No workers' comp. insurance
comp. insurance.t
required.]
5. We are a corporation and its
10. D Electrical repairs or additions
3. El I am a homeowner d ' all work
omg
officers have exercised their
I I.[-] Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
12.[] Roof repairs'
insurance requiredJ t
c. 152, § 1(4), and we have no
13.F] Other
employees, [No workers'
comp. insurance reatiked.1
*Any applidant that checks box #1 must also fill out the section below showing their workers' compensation policy infbrinatio�.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such.
lContractors 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.
lam an enrloyer that isproviding workers'conrensallon Insurancefor my eiwlayees. BelOWIsthep - alky andjob site
Information.
insurance Company Name:__D_� �Cl `�:n cle)
Policy # or Self -ins. Lic. M MW C, lo i�� 3 5-q 0 6 Expiration Date:
City/State/Zip
JobSiteAddress: 0
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year unprisonment, 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 0
pains andpenalfies ofperjuiy that the information provided ibove is true and correct.
Phone #: sy� — 3!�� —
Official use only. Do not write in this area, to be completed by city'or town official
City or Town:
Permit/License #.
D - ( — I
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector . 5. Plumbing Inspector
6. Other
Contact
Phone#:
A R DATE MMMD
CERTIFICATE OF LIABILITY INSURANCE I 10 / C01,12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endarsement(s).
PRODUCER 1-612-333-3323
Hays Companies
8 0 South 8th Street
suite 700
CONTACT
NAME:
PHONE Edj� 612-333-3323 373-7270
me,
ADDRESS:
INSURERIS) AFFORDING COVERAGE NAAC #
Minneapolis, M I IN 55402
INSURER A: OLD REPUBLIC INS co 24147
-
INSURED I
Renewal By Andersen Corporation
INSURER : NATIONAL UNION FIRE INS CO OF PITTS 19445
INSURER C:
GENERAL LIABIL . ITY
104 Otis Street
INSURER D:
INSURER E:
Northborough, MA 02532
INSURER F -
EACH OCCURRENCE $ 1,000,000
_0AMAGl1T6W9RtE_ff__
m-alwil Plumor-Irt;
THIS IS TO CERTF THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT
TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADD
1. IL
SUBR
WVn
POLICY NUMBER
POLICY EFF
(MWDDNYYY)
POLICTE—XP
(MMIDONYYYI
LIMITS
GENERAL LIABIL . ITY
MWZY 300361
10/02/1--
10/01/14
EACH OCCURRENCE $ 1,000,000
_0AMAGl1T6W9RtE_ff__
X COMMERCIAL GENERAL LIABILITY
PREMISES (Ea ocourrence�) $500.000
CLAIMS -MADE ri-I OCCUR
MED EXP (Any me Person) $ 10,000
PERSCNAL & ADV INJURY S 1.000,000
GENERAL AGGREGATE S 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
-il
RODUCTS - COMPIOP AGG 6 4,000,000
POLICY 7 JERCOT F� LOC
I
�P 3
A
AUTOMOBILE
LIABILITY
MWTB 300026
10/01/1�
10/01/14
COMBINED SINGLE LIMIT
(E. accid nt) § 5,000,000
BODILY INJURY (Per person) s
ANY AUTO
ALL OWNED SCHEDULED
BODILY INJURY (Per accident) $
To
AU )S AUTOS
NON -OWNED
I
H RED AUTO� AUTOS
P DAMAGE $
_,PROP01TY
or acdd..t)
IS
UMBRELLA LIAB
OCCUR
20562235
10/01/ii
10/01/14
EACH OCCURRENCE $ 25, 000, 000
EXCESS 1148
CLAIMS -MADE
$25,000,000
IDED
IX I RETENTION$ 25, 000
$
A
WORKERS COMPENSATION
AND EMPLOYERS'LLABILITY
MWC 300359 00
10/01/ii
10/02/14
WC STATU- OTH_
ANY PROPRIETORIPARTNER/EXECUTIVE YIN
OFFICEPIMEMEER EXCLUDED? IN I
NIA
E.L. EACH ACCIDENT $ 2,000,000
(Mandatory In NH)
Was. describe under
E.L. DISEASE - EA EMPLOYEE $ 1,000,OOD
E.L. DISEASE - POLICY LIMIT $ 1,000,000
D SCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom apace Is required)
whom it may Concern
insurance Purposes Only
SHOULD ANY OF THE ABOVE DESCR93ED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
?Q_4�
-I _zulu AL;VKL) GORPORATION. All rlght5 reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
jhargrove
36122490
4�1_.ffice of Consumer Affairs & Business Regulation I
I
ME IMPROVEMENT CONTRACTOR
egistration., jb8�10 Type -
Expiration: " " 3 Supplement
12/231201
RENEWAL BY ANDERS6N CORPORATION
k
JOSEPH REZZA
104 OTIS STREET
NORTHBOROUGH, MA 01532 Undersecretary
Massachusefts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS -065272
\\ " %.. k .
JOSEPH P REZZe
168 KELLEY BLVD
N ATrLEBORO MA
Expiration
Commissioner 04125/2014
WIN Dews -DOORS
Andersen.
Andersen" NFRC Certified Total Unit Performance (carion4
Hic LIAN-E4
fill? tow -454
0.30
027
'M�77`
Andeften'TMDA
Glasslype
14-racbm"
SHW
VP
023
400 Sibrieli 'I
Fricuillarotair HP LaN-E4 Soft
0.32
Ran dwroor:
HP Low -fill Son
0-31
OAS
0.25
1 -154
or,
027
035
0.60
032
CIA4.
022.
HP Lmq4wlb) GiMes
Ole
031
054
030
0-18
chicie iiii-
HP Low -14 Sun
027
Oil
033
-
0.31
016
caseconiat Window
HP low -E4 Sun with Griffes
0.29
0-19
0-30
7
0.41
031
BF Lo*E4 SmartSurn
0.26
0-23
0.54
F-
T�n
0-17
7HP to --E4 Smanson wir-Mes,
0.28
0.21
0.49
0.15
0.23
0.29
M law -154
0.27
0.35
0.60
0.13
0.19
0.14
HP low-EAl with Galles
Dig
0-31
054
f�
0-37
.
HP 1mr-164 Sun
0.27
021
0,33
0-14
031
Circle & oni M*mlow
H? Low, -K Sun with Gilles
0.29
019
030
1,
F
0111
HP Low Smainsurn
-E4
026
0.23
0.54
%,
719
F'j
MP LOW+4 Smad5un w/Gilles
0.28
021
0.49
015
013
jlV.
wi"
028
D33
0 M
F1
0.19
HP tow -M vkh Grilles
0.29
030
0.62
91
0.37
HP Low -0 Sun
0.28
020
031
0-15
031
Amb Wilidari
HP Low -M Sun vM GdOes
029
D-18
028
H
'i HP lea -E4
0.31
r
In, Inw-154 SmarGun
027
OM
0.52
H _154 an
P LUK lhG11ReS
Z
029
HP Luw-154 SmartSurn w/Glifles;
028
021
0,46
031
F
031
HP Low -E4
0.27
0.33
058
0-18
H?tuw-E4vthGfflles
0.28
030
0.52
j7j�
Y"
'fl? Low -E4 Sun
0.27
Q20
031
r!
Hl` LenF-E4
HPlem-MonvillbGiffles
029
0.18
028
f
HP Law -154 wiM Grilles
0.30
lip tvw.E4 Smm%S%m
026
023
0.52
HP Low -M Stan
0.31
0.22
MP Low -154 SnmartSim wrGAIles
028
Oil
OA6
Vi
020
0.32
UP taw,4A
031
033
0.58
024
02511
H? lenrfil With Gilles
032
0.30
0.52
0M
F51'' FTE
H?Low-Murt
-031
020
031
rY 1711
HP lst*" an
'M ONES
HP Uw-E4 Sim will Grilles
0M
US
028
fivago favoring.
KPILmir-Mon
0.33
HIP lo*E4 SmBTtSun
03D
0221
0.52
Ftl
M
0.23
HP Low -E4 SmarMin W/6111105
032
0.21
0.46
032
0.15
Hic LIAN-E4
fill? tow -454
0.30
027
0.45
HP UWU with b lles
'a
032
HP (jow-154 wM Gales,
-0.32
023
029
Fricuillarotair HP LaN-E4 Soft
0.32
Ran dwroor:
HP Low -fill Son
0-31
OAS
0.25
Pj
li�
GlIds"g?i4c) 0
119 PW
HPLaia-MuniviftGrMes
032
CIA4.
022.
0-15
jj
rl
RP Low -15A 5matiliSuft
030
0-18
0,111
019
0.32
017
HP Low -154 S=FtSuR W/691les
0.31
016
035
032
0.16
UP leo-154
031
024
0.41
031
0.16
HP Low -E4 Sun
HP Loar-M with QW15
032
am
035
0-17
Patio boor Trah'soin HP Lua�E4 Sun with Gilles
Fre"dwrow Hinged.
HP Wirr-M Sun
0.31
0.15
0.23
0.29
0.16
mraft.08tho boarr.
HP lew-E4 Sun Ab Grilles
032
0.13
0.19
0.14
032
HP Lo* -E4 Sun
HPLuctiMmantSun
030
0.16
0-37
window
HP uw-E4 Sort with Gilles
0.32
i HP lowE4 SmarriStin W/Qmes
0.31
0-14
031
P1
1:� F;
0.16
III, LOW -64
0-31
025
0-41
0111
0.17
038
HP low -154 adth Grilles
032
021
0-35
F'j
0.47
Farina . Traini . 211'Uhniled
HP Lori -E4 Son
0131
015
013
jlV.
RM
V Pa.,
HPism,1543imialifiGrilles
0.32
0.13
0.19
�fli
HP Low -154 Sun vilith Gilles
HP Lowt4 SmanSun
0_a0
MIT
0.37
NP Licav-164 SmairtSian
0.32
HP Im-Fil SmartSun w/GiMes
0.31
0-15
031
P'!
Fr. M
Hic LIAN-E4
031
022
0-37
HP UWU with b lles
'a
032
020
033
SHGC-
Fricuillarotair HP LaN-E4 Soft
0.32
0.14
0.21
1
ratio Dow sidengkii, HP LuVE4 Sun vft Goes
0.32
DA3
0-18
il
Q28
lip Loar-M SmadSun
031
0-15
033
rl
025
17 -
MP to.,E4 SmartSun WIGAIles
0.32
0-14
019
0.32
017
HP Lim -154
030
024
0.40
032
0.16
HP Uan-M with Grilles
030
021
0.35
031
0.16
HP Low -E4 Sun
030
0.15
0-22
rO
0-17
Patio boor Trah'soin HP Lua�E4 Sun with Gilles
031
0.13
0-20
jr�
HP Loyi,154 SmartSun
0.29
0.16
036
r�j'
fro
HP Low -154 SmortSun w/GrUles
DAD,
0.14
032
HP Lo* -E4 Sun
0.32
corallainal an nem PRO!
For NFRC certlfied total unit performance oil units with capillary breather tubes for high altitudes, please vislit andanuenwinclows-teran.
'Ifigh-Performance"Low-154"(HP Low-F4),'High-Perforinance'Low-E4'SmartSuir'IHP Low -154 SmartSun) and'ifigii-Perfunri Low -W Surr (HP Licia-174 Sun) am Andersen trademarks for'Low-V glass.
11-Factot defian the amount of best loss through the total unit in BTUfhr sQ- fL*F The lower thevirbal, the less heart is lost through Me entire producL worcow values represent non-tempeled glass- Use oftempered glass can
increase 11 -Factor ratings. See andersenwindows.com for specific performance valims- Door wives represeffittempered glass -
2 Solar HeatGain Coefficient (SHGC) defines Vie tracbmi ofsolar radiation admitted through the glass both offirectly transmitted and absorbed and subsequently released Immard.7he lowerthe value,the less ficall is Vansmfted
through the pmducL
3 VisibleTraftsmilitance (VT) measures how much tight comes through a product (glass and frome)- The higherlbe voice, from D to 1, the Mom dayrightitbe product lets in am the prodimrs total unit wrea.Visible Transmftance
ISMEMSuredave,the38OtoT6DnanameterportiDnofthesolofspectruM.
- NrRC ratings are based on modeling by a third Party agency as varidarted by air independent test lab in compfience with NFRC program and Procedural requirements.
nis data Is accurate as of December 2010. Due to ongoing product changes, updated le,stresults or new industry standards or requirements. this date may change ever time- Ratings ore for smes specified by HMC for
testingand cerrafication. Ratings may vary dependling on use oflempered glass, ififtereffligrille option, glass for righ anitudes, etc�
PossiveSun' glass values am available online at andersenwhidirrismorn.
0.7"IF
10.
a =0
rD all
E
al
Andersen- Pro�uct
Glass7ype
U-Factica"
SHGC-
HP LOW -Ell
032
Q28
OAT
HP LmwE4 wilb-Mles
032
025
0.42
HP Low. -E4 Sun
0.32
017
0.26
essamandviiindow..
HIP LuwE4 Stan with Giffiles,
032
0.16
0.23
HP Luffw!54 SmarlSum
031
0.16
OA2
HP Luff -154 SmonSum w/Grifles;
031
0-17
038
MP lew-164
032
0_2B____
0.47
HP Low -164 eft GRes
0.32
025
0.42
Finmeh caimmeit
HP Lo* -E4 Sun
0.32
017
026
window
HP uw-E4 Sort with Gilles
0.32
016
023
HP Loer-E4 SMVISSM
031
0.16
0,112
HP UAY -E4 SmartSun w/GM[es
0111
0.17
038
HP tma-164
032
028
0.47
HP Low -M with Gilles
032
0.25
0.42
RM
HP Low -154 Sun
032
017
026
AunifingWilukaw
HP Low -154 Sun vilith Gilles
032
0.16
0.23
T-4 M
NP Licav-164 SmairtSian
0.32
0.18
0A2
FIN
_Wlew-M SmmISun W/Goes
0.31
017
o3 8
'i HP lea -E4
0.31
0,32
055
H _154 an
P LUK lhG11ReS
0.31
029
OA9
W Low -1554 Sun
031
020
-028
031
Pleb . mwbvi6w,
HP Low -154 Sun with Giffles
0.31
0-18
UP Ir*E4 SmartSim
031
021
&50
:3
HP LOW -M Smarsurn wrates;
031
0-19
0.44
r!
Hl` LenF-E4
Qzo
031
0.64
HP Law -154 wiM Grilles
0.30
033
0.W
HP Low -M Stan
0.31
0.22
036
Specially Window
HP Law -154 Son with Grilles
0.31
020
0.32
JoilK
MP Loar-154 SmarSurn
0.30
024
02511
HP Law -154 SmarnSun w/Giffes
0.30
0.22
0M
F51'' FTE
Up LOW -154
932
0.22 _1037
rY 1711
HP lst*" an
'M ONES
0M
020
033
-
fivago favoring.
KPILmir-Mon
0.33
014
Oil
-
french Doot
HP LOW -64 Sun Via Sides
0-34
0.23
0.18
-
HP Lovia SmailSun
032
0.15
0.33
1 VP lewV SmwSvn WMIles
0.33
014
030
P Low,
H -E4
0.33
025
0.41
HP Ini*E4 with Wes
0.34
022
036
Hinged flattering
HP Low-Mun
0,33
0.16
023
Rar" Docif
H? limr-154 Son vft Gilles
035
0.14
020
HIP Lw& SinclarlStin
0-92
0.17
037
HP Lowu Smartsun W/Ginks.
0.34
015
032
HP Low -154
0.33
023
038
HP Low -154 With GMWS
033
021
034
Flued-Firench Deal -
HP to# -E4 Son
0.33
014
0.21
1 HP loert4 Sun vifth Giffles;
034
OAS
0.19
-,ASun
I UP Ism,154 Sm.
0.32
0.15
0.34
HP LV*M Smvmn w[Gon
033
0.14
030
W Low -154
0.32
0.25
0.41
-E
HP Low A vft Gilles
0-33
022
037
I . libuid T!"M
�__MP Loa Sun
0.32
015
0-23
Fftch Door
HP LwA4 Sim uft Mes
633
U4
0.20
HIP Low -164 SMORSun
032
0.16
037
HPiew-154 SmaniSull w/Gffiles
OM
cis
033
HP LOWEY!
0.95
026
0.44
HP Imu,154 adth Met
0-36
am
038
HP Low -Ell Sun
0,95
0.26
0.24
Folding Door
HP Luff -154 Sim "M GiMes
0.36
0.14
0M
HP LOW -154 smamm
OA4
0 -IT
0-39
RP low -CA Smintsun WIGMIes
036
0-15
0,34
corallainal an nem PRO!
For NFRC certlfied total unit performance oil units with capillary breather tubes for high altitudes, please vislit andanuenwinclows-teran.
'Ifigh-Performance"Low-154"(HP Low-F4),'High-Perforinance'Low-E4'SmartSuir'IHP Low -154 SmartSun) and'ifigii-Perfunri Low -W Surr (HP Licia-174 Sun) am Andersen trademarks for'Low-V glass.
11-Factot defian the amount of best loss through the total unit in BTUfhr sQ- fL*F The lower thevirbal, the less heart is lost through Me entire producL worcow values represent non-tempeled glass- Use oftempered glass can
increase 11 -Factor ratings. See andersenwindows.com for specific performance valims- Door wives represeffittempered glass -
2 Solar HeatGain Coefficient (SHGC) defines Vie tracbmi ofsolar radiation admitted through the glass both offirectly transmitted and absorbed and subsequently released Immard.7he lowerthe value,the less ficall is Vansmfted
through the pmducL
3 VisibleTraftsmilitance (VT) measures how much tight comes through a product (glass and frome)- The higherlbe voice, from D to 1, the Mom dayrightitbe product lets in am the prodimrs total unit wrea.Visible Transmftance
ISMEMSuredave,the38OtoT6DnanameterportiDnofthesolofspectruM.
- NrRC ratings are based on modeling by a third Party agency as varidarted by air independent test lab in compfience with NFRC program and Procedural requirements.
nis data Is accurate as of December 2010. Due to ongoing product changes, updated le,stresults or new industry standards or requirements. this date may change ever time- Ratings ore for smes specified by HMC for
testingand cerrafication. Ratings may vary dependling on use oflempered glass, ififtereffligrille option, glass for righ anitudes, etc�
PossiveSun' glass values am available online at andersenwhidirrismorn.
0.7"IF
10.
a =0
rD all
E
al
PRODUCT PERFORMANCE
Andersen' NRC Certified Total Unit Performance (=ft -4
Aw��W,:Pfs
Ghmlype
UTedoil
SHW
a vrj
am Dual Parle
0.45
Mm
0.63
am Owl Pam vo Wes
0-45
a.5-4
0-56
10"
030
032
155
LOW -C wm Goes
0.30
0-29
0-49
IfP Uff-M SmitStm
0-30
UI
0-49
HP LvwLE4 SmvtSun wr.Mes
0.31
0119
ILG
Mar Da pme
145
(LfA
U4
.ivan,fi�
Mar Dual Pam wfth Goes
145
OZ4
0.57
Dwbrm4Wn9Wmdm,--
LmE
0.30
0-12
0.56
UYrA vft GMm
031
0-29
0-50
ctmDuwpwm
&44
0.63
(LS6
Claw DoW Pmevftb Gn
L44
0.57
om
'Tran4m.1findow
tmv6E
U7
034
0.58
lowl %a Goes
0.27
0.30
0-52
Ckmr Duid Pan
0-45
am
0.63
Clew Duw pmw vft Goes
0.45
0.54
0.56
LME
0-sc
0-32
om
lump -E wm 6ollas
uu
0.29
0.49
Lo*Esnmdsw
0.30
4.=
0.49
L& -E SMEFISIM VM SOM
0.aj
0.19
OAS
z
CImr DiEd Pan a
0.43
OM
0.65
Ckmr Dual Pwi vM GQm
0.43
om
om
LowE
0.28
Q.33
056
ETo
Ivw-E vM GnIm
0.28
0.30
1mE SmaikSun
0.27
-am
OL51
Lm4 SzotSun vM Gffim
0.27
Q.70
0-45
bewmidpine
0.44
0JSI
0.64
a. Dud Pam wM "m
0.45
0-53
cm
am
Lff" w1h GRIN
uo
Ui
0A
r 5,,-
Iffa-E Sm
us
020
031
IZAIESwIft"Im
031
DAB
U7�
LD*Esmaltsm
029
am
050
j-,:-
Imv-E &qmdSo vb Gn
On
Ma
0-19
OA
CimDuafFm
0.43
&SI
0.64
Chm MW ft= m% Cnks
0.43
0-54
&66
WAF-E
US
am
&M
UmE ift Gffles
030
0-1&
DA
--
ImUm
US
GAS
00
a
M m
Lco-E Sm vM fidUm
0.30
0.17
Q.27
Low -E Smadsm
017
0.22
am
La.E Sma4m um Gnum
us
0.19
0.44
,:.7
cim Dial pme
0.43
(L45
QA7
CIwDuaIFamvftf&m
0-43
am
CA
Loot
DM'
0.24
OL41
Law -E um Ga
om
Q21
035
N -
LUAIE SBA
0-32
0.15
cm
low6E Sim Ift SON
034
OM
US
L -E Smm%Sim
aw
Qm
0-16
037
Low -E SmuSun vft Onlim
033
0-14
0.31
A
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
WELDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE
Building Commissionerffq!RLctor of Buildings Date
SECTION 1- SITE INFORMATION
LI Property Address:
1.2 Assessors Map and Parcel Number:
22�- 51-
C
'?
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
LA Area (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Reqtired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 11 Private 0- Zone - Outside Flood Zone 0
Municipal 0 On Site Dis"I System n
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record
tx-) A --�Af PPW-A A) q ge C) 5r-,
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
jj!�-7 kT �T P
Li�ensed Construction Supervisor:
06,
License Number
Q3 L-� 0 o -b 0 6? 1 L/ or
Address
/1/-Z//06
9 2p- --S? �-- �,-IA D yExpirtition
Ddte
Telephone
3.2 Registered Home Improvement Contractor
Not Applicable n
R -4N( T- cou>-r.
-2,7
Company Name
Registmfion Number
CIP -lop 4�1 �rC 1.11.4
Address
6,2
Expiration Date
Sign;t—ure Telephone
T
M
z
0
0
z
M
90
0
M
rM
G)
SECTION 4 - WORICERS COMPENSATION (M.G.L C 152 4 2506)
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 '6 &-, I's 6
Signed affidavit Attached Yes ....... 0 No ....... 11
SECTION5 Descriptiono Proposed Work (check applicable)
New Construction 0
Existing Building 0
RepaiT(s) 11 -111"terations(s)
0
Addition 0
Accessory Bldg. 0
Demolition 0
Other Id' Specify rC- A�
Brief Description of Proposed Work:
4 0 D M <T 7( 1 C' 7' 1 A) G c d -tW2"�c T-
7-0 C>-t-tf-0L
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
ltem Estimated Cost (Dollar) to be
Completed by permit applicant
O,MCIAL USE ONLY,
Building
F2
(a) Building Permit Fee
Multiplier
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) S- 0
Check Number
SECTION 7a OWNER AUTHORILK11ON TO BE COMPLETED WREN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-I, LJ A 1 /0 &- Ive /.,-,n i — as Owner/Authorized Agent of subject property
Hereby authorize )(10'9 6-4 r T. /Z- ep(j C C r- to act on
My behalf, in all matters relative to work authorized by this building permit application.
- C-� A Z -/g:v (3 C�
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
ep 0 C- c r- 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
F- 0 9 C2- J C C -
Print Name
(? 1161 Oc)
Signature of 0-%Nme ent Date
IN 11 ---
112,0022 . . . . . . . . . . . . . . . . . . . . . . . . ................. ............... . . . . . . . . . . . . . .
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T11VIBERS Ir 2ND 3PZ
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIWNSJONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHFvINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
15.
BUILDING DEPARTI'vM-NT
DEBRIS DISPOSAL FORM
In accordance with the provm—ons of MGL c 40 S 54, a condition of Budding Permit Number
Is that the debris resulting form dus work sha.11 be disposed of in a properly licensed solid waste disposal facility as
deflned by MGL c 11, S 150A '
nc debris will be disposed of in:
C-- LA/ C)
Location of Facility
Signature of Permit Applicant
41 1 1
DEPARTMENT Of PUBLIC SAFETY,
"F
CH"TRUCTION s Ili P t . Y' I S 0 R
-Rug0er Expires - -irthdate:
41121/2000 11 /21/1965
To: "N
4i
ROBOT "[WvCi
30 C.W0qf[TIfi R�l
MA 01983
iOPSFIELO,, j J
HOME IMPROVEMENT CONTRACTOR
Registratiop 127156
Type - INDIVIDIUAL k'
-Expiration- 4014/00
ROBERT J. REPUCCI
30 C.AMPMEETING.RD
g,'�gSFIELD MA !01983
LWMINISTRATQP
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations 01
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
Name: i2oogd-A--t- a - F=-Spoc_�2
Location: Q '? S_ A 19 090 7' ?:"— . "7 1— ,
city 9) - lbvwi IKA - Phone !2/1V — 6,
71 am a homeowner performing all work myself.
I am a sole proprietcr and have no one working in any capacity
F -)T I am an employer providing workers' compensation for my employees working on this job.
Company name: rzx..J C_ C_ T7
Address -De> 12—().
City: tS2 0 S, -9 t e --r C-0 Phone 612 cP — '3 2S-- "/ 6 2'y
Insurance Co. P OliCV
Company name:
Address
Ci!Y: Phone *
Insurance Co. Policy
1116111111111111
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of aiminal penalties of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy cf this statement may be forwarded to the Office of I nvestgations of the DLA for coverage verfficafion.
I do herby cer* under the pains and penalties of peijury that the intbrmation provided above is true and correct
Signature C;_z_1 Date 14§Lo-b
Print name L OV2 6-,(— T- C_ —Phone#
Official use only do nct write in this area to be completed by city or town official' Building Dept
r7Check f immediate response is requffvd Building Dept Licensing Board
Selectman's Office
Contact persom Phone 4. Health Department
Other
FORM WORKMAN'S COMPENSATION
DECKED OUT INSTALLATIONS
TO
ADDRESS ? --I Y3 P(� Tr S
p'), o . u /V\ r-�.
TEL(H) ?
?
(W)
DIMENSIONS iO`N�' '20
MATERIAL
RAIL
JOIST
DECKING
POST
FOOTING
ii
A
, r
FLOOR HEIGHT
STEPS
LATT I C E
SEPTIC
SET BACKS
SIDING
PERMIT C7, -1-
"K3,"
f I
Dimension
Number of Stories:— Total square feet of floor area, based on Exterior dimensions. --
'Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location mast or service drop requires approval of
Electrical Inspector Yes —No
DANGER ZONE LITERATURE: Yes No
IOGL Chapter 166 section 21 A �F and G min.$100-$1000 fine
NOTES mentuse
I i
D Notified for pickup - Date
Doo.Building Permit Revised 2010
%JLCAI I 1WK-,U I- IC11 JZj "
n
Building Department
The foR'-oWinb is a -list of the required forms to be filled out for the appropriatepermit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L.- Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
10TE: All du:mpster.permits require sign off from Fire Department prior to issuance of Bld.9 Permit
Addition Or Decks
• Building Permit Application
• Certified Surveyed Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S1. Licenses
• Copy Of Contract
Ei Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
D Engineering ki'Yidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
• Building Permit Application
• Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
• Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
• Mass check Energy Compliance Report
• Engineering Affidavits for Engineered products
ME: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Kin all cascls if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the RPYJ�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm'Ated with the building application
Doc: Doc -Building Permit Revised 2012