Loading...
HomeMy WebLinkAboutMiscellaneous - 37 OLD VILLAGE LANE 4/30/2018November 15, 2012 Jonathan & Amy Moeller 37 Old Village Lane North Andover, MA 01845 pORTF► OfSt�le �6'9.1•� . 0 A r BUILDING �9SSHCHUSEt CONSERVATION DEPARTMENT Community Development Division 37 Old Village Lane, North Andover Removal of Concrete Patio & New Deck Construction Conservation Conditions of Approval, NACC #103 Pursuant to sections 4.4.2 Q) of the North Andover Wetlands Protection Regulations, Jonathan & Amy Moeller, applicants / homeowners, filed a small project application for work proposed at 37 Old Village Lane, North Andover. The work consists of removing an existing concrete patio and installing a deck in the same location with the addition of a set of stairs. All work will be conducted more than 50' from the Bordering Vegetated Wetland (BVW) and shall not exceed the limits of the existing concrete patio (with the exception of stairs). Crushed stone will be placed under the new deck. During the November 14, 2012 public meeting, the North Andover Conservation Commission (NACC) voted unanimously to approve this project. The following conditions are hereby mandated: RECORD DOCUMENTS: Application Checklist, Aerial photo of property (11x17") received November 2, 2012 (hand edited to show deck location and 50' distance from the patio). Sketch of Deck & Stairs (to be submitted prior to construction) Prepared by: Jonathan & Amy Moeller CONDITIONS: 1. Prior to the start of construction the owner shall ensure that the site contractor has reviewed the small project permit and is aware of the wetland resource areas and the limits of the proposed work. 2. Erosion controls should be installed between the work area and the wetland (more than 25' from the BVW). Trenched siltation fence or silt sock are approved options. No work shall occur beyond the erosion controls. 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://xv«nv.to-%vnofnorthandover.com/conservel.htm 3. Once the erosion controls have been installed the Conservation Department shall be notified to conduct a preconstruction inspection. 4. Excess material shall be properly disposed of offsite. No material shall be stockpiled on site. 5. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 6. Upon completion of the approved project and site stabilization, please contact the Conservation Department for a final inspection. 7. This permit shall expire 6 months from the date of issuance. Should you have any question or comments regarding the contents of this letter, please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Jennifer Hughes Conservation Administrator 1600 Osgood Street, Building 20, Suite 2-36, North Andover, 'Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web ww-w. http://www.townofnorthandover.com/conservel.htm vloo� Date.2. NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .... ')3 r, (2 ... 1. .................... has permission for gas installation PA". S 7'� ...... in the buildings of ..MZf•. . . . . . . . . . . . . . . . . . . . . . . . . . . at ...3.4.. . 0. (t�- . /Py M .......... North Andover, Mass. Fee. 60 Lic. ... ... GASINSPECT6R Check# 10 1- 5191 MASSACHUSI+JETS UNIFORM APPUCATON FOR PERMIT TO DO GAS nTnNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building / Building Locations �� 7 lJ ID Vll�jA 9 Permit # -a S-1 C•7 _ Amount � T /�f m 6- oC� lce- 6-wner's Name New Renovation Replacement Plans Submitted 6TH. FLOO-i- FLOOR 8TH. FL06R (Print or type) /� 'n C ec one: Certificate Installing Company Name_. ©� �r7 /� �rp. Address �C ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter IJd IT 1 l"5 1 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [3No ❑ d' t Covera e b checking the appropriate box. If you have checked yes, please m icate a ypeis g y ❑ Liability insurance 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 Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the detaus ana tnrormaaon i navc wullut-u k.,. rr =- •___ ____ ________ __ best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) S' ure of Licensed Plu r Or Gas Fi er tuber G Fitter fce se Number r Journeyman Location --3o Q�'�` U����� 64z"t-- No. Q Date is &ORTPI TOWN OF NORTH ANDOVER f �M i • OL .. i Certificate of Occupancy $ '�s''••B'' E<�' Building/Frame Permit Fee $ S s�cwus 1 Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # / .6 —S 15193 / Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION ,T...Q CQNSTRUC'r.REPAIR, RENOVATE, OR DEMOLISH A ONE,OR TWO FAMILY. DWELLING 3UILDING PERMIT NUMBER: S. DATE ISSUED: ` 3IGNATURE: Building Cominissioner/I ctor of Buildings Date SECTION. 1- SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /. j 3.1 Licensed Construction Supervisor: Not Applicable 0 r Map Nu . ber Parcel Number ! W c2. o9A- 7oc),< eq License Number jAddress 1.3 Zoning Information: 1.4 Property Dimms ohs: : tonin District ... Use '. // %� C� Q �'�il Lot Asea; s ront3ge oo 1.6 BUILDING SETBACKS ft r Front Yard Side Yard Rear Yard RegwiredPrryvide red Provided R red Provided - � o Company Name Registration Number 1.7 Water S M,GLC.40. 3q) 13. Flood Zone Information: Supply Zone outside Flood Zoo.., 0 1.8 Municipal Sewerage'D46sA System: 0 on Site Disposal System i1 - ?ublic ❑ Private 0 r a� Address Expiration Date SECTION 2 - PROPERTY OW'NER:SIIIPIAUTHORI' D AGENT signature _ Telephone 2.1 Owner of Record ;QP, Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: i Signature Telephone . { SECTION 3 - CONSTRUCTION SERVICES j 3.1 Licensed Construction Supervisor: Not Applicable 0 r Licensed Construd:ion Supervisor License Number jAddress i // %� C� Q �'�il Expiration DateISM Signature Telephone r / 3.2 Registered Home Improvement Contractor Not Applicable 0 - � o Company Name Registration Number r — r a� Address Expiration Date signature _ Telephone SECTION 4 - WORKERS COMPENSATION (AG.E C -IT § 25e(t ) Workers Compensation Insurance affidavit must be completed and submitted with this -app in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ❑ SECTION 5 'Deka ..tioli of. W06i&d Work"checkani hcable New Construction 0 , Existing Building 0 Repair(s) 0 Alfera Accessory Bldg. 0 Demolition ❑ Other ON ,Specify . Bri/ef D�esc 'gtio/n/of Proposed Work: A,) s l 11 / heitiop Failure to provide this affidavit will result4 tons(s) ❑ Addition 0 .r� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be - Conipleted.bypermita licant 1. Building ,. (a) ` Building Permit Foe Mult: lien 2 Electrical (b) Esrima%d TotalCost:of Gonslruction 3 Plumber Building Permit fee.t�l .x (b> 4 . Mechanical . HVAC. . { .. 5 Fire Protection..: f 6 Total 1+2+3+4+5 O, 14, Check: NitrFiber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN .� OWNERS AGENT OR CONTRAC`r0Jt APPLIES FOR BUII,DL-,G PER-NaT c I' as Owner/Authorized Agent of subject property "`� Herebyauthorize to act on My behalf, in all matters relatrve to work authorized by this building permit application. B Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,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 Of 0 BASEMENT OR SLAB SIZE OF FLOOR TRvIBERS 1 sr SPAN DIMENSIONS .OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Date SIZE THICKNESS X The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: bV r / � r 19 /1-) z,-- 9, V iv A -J fl Location: City Phone am a homeowner performing all work myself. 0l am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #. Insurance Co. Policy # Company name: G+Ji //� �� ��•� o CON 57` 0cTiow CD Address ,r C7_�J �9 w� D c -e o iP City: wizi ✓�Ui� _ /i-9 g> Phone #: 0/'7 16/ Insurance. Co. -.ZVsul?, 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' 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 of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the Signature and penalties of perjury that the information provided above is true and correct. Print name /,L)-/ J 1,1 ,9 M T a® iu 9,V/L) a Phone # 9 7 R- 4 8 G - o �Z XI8 Official use only do not write in this area to be completed by city or town official' []Check if immediate response is required Building Dept Contact person: FORM WORKMAN'S COMPENSATION R Building Dept E] Licensing Board p Selectman's Office F-1 Health Department 11 Other u-' 130ARD OF BUWNG REGULATIONS License; CONSTRUCTION SUPERVISOR Number.. CS 061248 . Birthdate: 11/2711941 i Expires 11/2712002 Tr. no 3557 ,s tea6lted To: 00 WILLIAM E BONANNO 68 BONANNO CTS j METHUEN, MA 01844 Administrator O oz P., ¢� A m c ° w° Q C/) o A Or - w° °co �° w°' U w a o H w a°' w a 0 w Wto C2 v) 78co w w°' u. W P4 cn Q cn C=, I H O CL • p� C m �• t c t N J ECF 0 CL a /� m n : N 1 e o® (%% Ci ` cm O •mm a p �• m 3 c N zoo .� N O O et : N +=+ m R 2mo `�. CLU I.:m V h O ac o CM Lc S c o a �_ (7i m p m 2S.ho caCZ caocm S � m•L.+ p N ~ 0h CD m CD s W 0 ; rs =o :1 LL ;;MD Cc O C O H N gas - Z cc=� m•N O H a D m � CQ _ A A ` N �� O H s O.�m C/) O U z O U Cn r-� O E � L v Z Z CL CD O y o Cm o•- y 2 m m •� O O 3.0 coLft O � i Cc 0 CDQ ca .�. 0 C O C.3 —J 'C O C CD C.3 y C C: C. CO2 } 0 U) U) IrW w w vJ f Date ...7..`r 85 ...... ti , � NOR71{ 4, '•, O� TOWN OF NORTH ANDOVER 0 p PERMIT FOR WIRING This certifies that ...........4�? 'rf.................................................. has permission to perform ............. e wiring in the building of M at ................... ......................... , North Andover, Mass. $ 23 �-� -r Fee.... Lic. No. °?..... 3 ................................. ELECTRICALINS PECrOR Check # 56S,` I r: 1d 40 The Commonwealth of Massachu, etts Office Use Only E = I PT -0/ x v� Department of Public Safety Permit No6�2 BOARD OF FIRE PREVENTION REGULATION/52CMR 1 2 00 Occupancy &Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TORFORM ELECTRICAL WORK All work to be performed in accord ce with tusetts Elec,ncal Code, 527 CMR 12 Ou (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date__ a� City or Town of /L.lLl4­1 Xh ,�n��%O _ _To the Inspector of Wires: The undersigned applies for a permit to perform,t/he electrical wor d scribed below. Location (Street & Numbed �OlC= Owner or Tenant -J-0 sJ_4l,__ (`owner's Address__ Isc-� - _ Is this permit in conjun-,tion with E, building permit yes no ❑ (Check Appropriate Box) Purpose of Building _ Ut Existing Service /00 Amps 120 New Service Amps / Volts Number of Feeders and Amoacity lily Authorization No._ Overhead ❑ Undgrd .R Overhead ❑ Undgrd ❑ No. of Meters / No. of Meters Location and Nature of Proposed Electrical Work X,'fC441S,1 Liy1t1j"%n Gms c Y e4� No. of lighting Outlets / No. of Hot Tubs TOTAL No. of Transformers KVA No. of Lighting Fixtures Above Swimming Pool grnd. In ❑ rnd ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 0 No. of Oil Burners Battery Units No. of Switch Outlets lZ No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and TOTAL No. of Ranges No. of Air Conditioners TONS Initiating Devices No. of Sounding Devices HEAT TOTAL TOTAL No. of Disposals No. of Pumps TONS KW No. of Self Contained Devices No. of Dishwashers Space/Area HeatingDetection/Sounding KW _ Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts lWiring No. of Hydro Massae Tubs No. of Motors Total HP OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES IKNO ❑ I haave submit!.ed valid proof of same to this office. YES K --NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE = BOND ❑ OTHER ❑ (Please Specify)__ (Expiration Date) Estimated Value of Electrical Work $ Work to Start —CJ� Inspection Date Requested: Rough GUM "a Final 1<i(Cu_A�K Signed under the penalties of perjury: , FIRM- ..L^.r'{Q� tyQrQf'+ ClIU ��(/„fL _ LIC. NO. �3`�V Licensee Signature LIC. NO. 63�Y _ Address klr/w", Rd bIt"e-V vLlc, o2fv Bus. tel. No. f?Jf6of-1U'jF Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one) Telephone No. P- {MIT FEE $ O� �HORTM 1ti O 9 o •�'`t5 SACMUS� Date?�:.��:.�.'`�. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. R. n S.... P?9.4�. ! 5. ! ...................... has permission to perform .................. plumbing in the buildings of .. ? G c.C. C.1-YA% .................. at ............. . North Andover, Mass. Fee. 79-i.... Lu. No..//. ?-!� . ........ PLUMBING INSPECTOR Check # 1 G 0 6450 Building Location New El MASSACHUSETTS UNIFORM 0 14D U i'l l AC -E Renovation 0/ Of FOR PERMIT TO DO PLUMBING Acle*A rh �c mt-rttD," Date Permit # O Amount Plans Submitted Yes E] No (Print or type) nn __ p - Check one: Certificate Installing Company Name eCJIO PAR l s ! _ orp. Address c F1 ,Partner. Fq m S EH D # Business Telephone 663 303 08X? ❑ Finn/Co. Name of Licensed Plumber: ROE Ph ro'l Insurance Coverage: Indicate the type of - surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1-1Bond❑ Insurance Waiver: I, the under—signed, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Mass =hstate P b' Code and Chapter 142 of the General Laws. t^--� �✓l� Y: Signa uk r o icense lu er Type of Plumbing License Title !!S! 1 City/Town License um r Master Journeyman ❑ PPROROVED (OFFICE USE ONLY – -!Ell – – .i it -------------------------■ -------------------------, (Print or type) nn __ p - Check one: Certificate Installing Company Name eCJIO PAR l s ! _ orp. Address c F1 ,Partner. Fq m S EH D # Business Telephone 663 303 08X? ❑ Finn/Co. Name of Licensed Plumber: ROE Ph ro'l Insurance Coverage: Indicate the type of - surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1-1Bond❑ Insurance Waiver: I, the under—signed, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Mass =hstate P b' Code and Chapter 142 of the General Laws. t^--� �✓l� Y: Signa uk r o icense lu er Type of Plumbing License Title !!S! 1 City/Town License um r Master Journeyman ❑ PPROROVED (OFFICE USE ONLY Location 3 f r f No. S4 f Date a l40RTM TOWN OF NORTH ANDOVER . s Certificate of Occupancy $ Building/Frame Permit Fee $ 17(r6 — s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /76 Check # C>? 685 a Building Inspector /I/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE.OR DEMOLISH A ONE OR TWO FAMILY DWELLING per BUILDING PERMIT NUMBER: . a-- j DATE ISSUED: (Co-- (Co- SIGNATURE: A1W Building Commission&fnspector of Buildings Date -Building SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3 % ,01 Ui l4y tone 0a�02. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ Public ❑ Private 0 — SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT No 2.1 Owner of Record 7 Il �g," %aeK 0#144 Moe Ilei' o101I/j 9e e Name (Print) Address for Service Am5 Signature Telephone 2.2 Owner of Record: Name Frint Address for Service: Signature' Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ M ie,h7 1891 rel✓ 0✓j/� i� Licensed Construction Supervisor: License Number n 1 Address- ry f r 9 `p 7 ` 90 9/7917105-,_ `��Jr✓�J Expiration Date Signature TelephoneC �Sd�-17 5' 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address 90� 9/ /r f 790 u! G ' Expiration Date Signature Telephone T M X z O v n M I 0 z M 90 0 M G) 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 ....... ❑ SECTION 5 Description of Proposed Work checkad a Reable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) 9- 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: Aen0rry)')MA &—e .1ih A'PAVI/e wg,ffs �tc/Ii4n liliradA RA A ; rtj g I SECTION 6 - ESTIMATF.n C0NCTR1irT1rnN rncTc I Item Estimated Cost (Dollar) to be Completed b emlit applicant OFFICIAL USE ONLY < 1. Building /� (a) Building Permit Fee Multiplier 2 Electrical / �0 ( �% (b) Estimated Total Cost of Construction 0o0 — 3 Plumbin Od(% Building Permit fee (a) x (b) / 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 6, Q Check Number Ia Vl"X11111V1\ 1V 11LLVIYIYLLlEL Wt].L;1V OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, � � 4 y /�Pr as Owner/Authorized Agent of subject property r v Hereby authorize_�1'�. !// O �4y �/ /� to act on My beh' in all matt relati to work authorized by this building permit application. ure of wirer y0ad S— Si r Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property f 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 of Owner/. Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' • 2 NU 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION _ _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHDvINEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgaftns Boston, Mass. 02111 Workers' Compensation Insurance Atfi int NwM 1Please Print Name• 'o, `e Lo Ion: rjty l t0,hjA 1/1 ,,1 fed M a55- Phone �v�- �iy'� �/ 2 0 lama all worts; myself. a n a sole proprietor and have no one worldng in any capacity 0 I am an employer providng workers' compensation for rry employees worldng on this job. /I 1 rivnnam names 4�;fW e,1 S %I- %y ek/ ^-/ i�5'S CRZ Phone t PoWv rmsancs Co. Polk v a FWWO to secure coverape as rWAred under Section 25A or MGL 152 can lead to d a kMaom of aknlnd pwwMUs d,a flne up to =1,5w.w mWoroneyen'ImprYorenent_aa.wed.aa_abd.paost3les.lofbSft=dABTDPVIIDMORDERmd.a.8eod.(SlW.CMAAwaprreti.ma I wxWn"W that a copy of this statement maybe forwarded to the Office d Inwsageft N of ft DIA for coverepe verirlco&m. I do hereby curdy unobr dre that the krtbrmetbn provided above Is hue and coned Nis Print nam -----g ` e �9 �� �v/�a� Phone Omgr use only do nd write In this arae to be completed by city or town oQk�ar City or Town PernitlLkeruino ❑ j;Ug ng D ❑Check I lmmedlete response Ia mquked ❑ Ucerwkg B09/d ❑ Se/edman's Ofts Contact person: Ph" A ❑ Health Depertnwnt 0 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 disp os qd of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Al BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR j Number. CS. 071725 ' Elirtll dAie:: 08/07/1957 Expire*. 00107/2005 Tr. no: 2728 �c:'�,. Restrict�ti 00. i �ICHAEL S BARLOW _ I RAILROAD ST{ NEWBURYPORT, MA01950 Administrator ��eo�nmtonufea o�./�aaoaciu�aella Board of Building Regulations and Standards HOME IMIAROVEMENT CONTRACTOR Registry ions ~128031 ,pli 8tota. 2/�4r5/2007 MICHAEL S. BAR. _A -I m MICHAEL BARLGQ _.= ,a 3 RAILROAD ST n°% ^y,_,✓, u NEWBURYPORT, MA 01950 Administrator O b f'� II Z ERL* 3 7 W A -e 3 i W Q � �I <u w ' �= QV v O Q ANG "VA. O.L 0 m c : O ` C N _Op C Ci C� 0.a m C O o 0 Ea 0 c a.- ��U r ti E� o ML 8 E occ ` r _= E o T T � lima ac ,C fCO ev c qCO' m '� 5 Z a C U O d z P CL t° 5 Z Lu C40 f- a CLE m T o a a � a v p w VO. w U w" p°G aG w —ca u. w cn cn cn -e 3 i W Q � �I <u w ' �= QV v O Q ANG "VA. O.L 0 m c : O ` C N _Op C Ci C� 0.a m C O o 0 Ea 0 c a.- ��U r ti E� o ML 8 E occ ` r _= E o T T � lima ac ,C fCO ev c qCO' m '� 5 Z a C U O d z P CL t° 5 Z Lu C40 f- a CLE m T