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Miscellaneous - 44 MILLPOND 4/30/2018
44 MILLPOND 2101095 000.0 J , 6 Date.... ."".f. ."..E..' GI M.. , , : °oma TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACMUS This certifies that ............ .. 31 has permission to perform ................�.j1...(.....G !-f.��............................. wiring in the building of....... '?Jt '.................................... L) Mi.L-1, ..!d7 ,North Andover,Mass. Fee..... ....... ' ..'Lic.No.. ........... .. ............... ............... .. ........... ELECTRICAL INSPECTOR Check # �-7_/._��_ • 10464 - - Commonwealth of Massachusetts official Use Only Department ®f Fore Services PermitNo. 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(MEC),5 7 CMR 12.00 (PLEASE PRINTW INK OR TYPE ALL INFORMATION Date: f/ & City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersign d 'ves notice of his or her intention to perfotm the electrical work described below. Location(Street&Number) /Z'l u i96,uD u W il Owner or Tenant �FUG-/0 4- Fi-,e4,4Af—tf— Telephone No. Owner's Address 5 141AA.—I. Is this permit in conjunction with a building permit? Yes No F] (Check Appropriate Box) Purpose of Building ��� Utility Authorization No. Existing Service ';W Amps `Volts Overhead ❑ Undgrd F�eP No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: �J e4j Completion of the following table may be waived by the Inspector of Wires. Recessed Luminaires No.of Total No,of__�_�sse__,_.�-_res Nc.of Ceil:Sr:sy.(Paddle)Fans Transformers KVA No.of Luminaire Outlets -1 No.of Hot Tubs Generators ICDA ; No.of Luminaires Swimming Pool Above El ❑ o.o Emergency Lighung nd. rad. Batter Units --_ No.of Receptacle Outlets } No.of Oil Baavners FIDE ALARMS No.of Zones No.of Switches No.of Gas Bummers No..of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pum .Number Tons KW No.of Self-Contained p Totals:P `.. . .... ........ . ........... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ M is tion El Other i Heating A fiances Security Systems:* { No.of Dryers g pp �' No.of Devices or Equivalent III No.of Water No.of No.of Heaters KW Ballasts. Data Wiring: Signs 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 Electrical Work (When required by municipal policy.) Work to Start: 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 proof of same to the permit issuing office. CHECK ONE: INSURANCE Ff BOND ❑ OTHER ❑ (Specify:) I certify, under the ains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: 9f2 AAf ��� � �C G7 L LIC.NO.:,q 0 6G br Licensee: 33ey f�,2�i� Signature LIC.NO.: (If applicable, ter"exempt"in the license numkr line.) Bus.Tel.No.:617—Ml63Y2— Address: n C£ l74 tAO&71a MJT 6)- 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 WT. I PERMIT FEE:S 0' The Communweralth ofMassachns=_ 1 Department of Industrial Accidents Office of Investigations. t list; j 600 Washington Street i'4,' Boston, MA 02111 {�t wwlw.)iaass.gov/dia . Workers' Compensation Insilira.nce Affidavit: Builders/Contractors/Electricians/Plumbers App.Iicant Information Pease Print Legibly Name (Business/organization/lndividual): y��d Fce wtw4q— Address: q7 C City/State/Zip: LJA�TOLAt- 6>4 F)Phon e Are you an employer?Check.the appropriate box: 1.❑ I'dm'a employer with 4, ❑ 1 am a general contractor and TF7Re Type project(required): employees(full and/or part time) have hired the sub-contractorsew construction 2. I am.a.sole proprietor.or partner- listed on the attached sheet,temodeling ship and.have no employees These sub-contractors have emolition working for mein any capacity, workers' comp.insurance. r [No workers'comp. 5. uilding additian p ❑ We are a corporation and its required.] officers have exercised#heir ectrical repairs or additions3.❑ I din a homeowner doingall work right of exemption per MGL mbing repairs or additionsmyself.[No-worke'rs'comp. c. 1.52, §I(4),'and we have no of repairsinsurance required.]# .employees.[No workers'comp. insurance required] her °Any applicant that checks boz#1 must also fill out the section below showing their workers'bompensation policy in t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit anew affidavit indicating such. - ;Contractors that check this box mustrtteched an edditior_al shyetshoaling Lke name ofthe sub contractor and th€ir worka corrp.policy info,;,ation. I carrc aria employer that es;sY®videi-jg:wo;,+aaPs'c®zaapensradofa arasura.,zrei`oP Oxy.erlaploy-es: Below is thepolicy andjob site information. Insurance Company Name: ' Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: ; Attach a copy of the workers' compensation policy declaration page(showing Po Y n the o p g ( g policy number and expiration dale). 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un e.r thepains and penalties ofpedury that the information provided bov is true and correct: Signature: Date J 1 `L l Phone#: )4 G 7 LOf,ficia only. Do not w.rite;�tuts car ea,to be c.�,:.pl �d by city o,r tvrvps of ciaL wn: Permit/Licensethority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical lnspeetor 5.Plumbing Inspector son: Phone#: TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING p-�'e_„' _;is..` b BUILDING PERMIT NUMBER: DATE ISSUED:, . rn 3III. is •o X SIGNATURE: Building Commissioner/Inspector of Buildings Date JI — J.S.-SEJ Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: kit n / L nam Map Number Parcel Number 1.3 Zoning Information:f/ 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronto ft 1.6 BUILDING SETBACKS(ft) r Front Yard Side Yard Rear Yard Regifired ProvideRegured Provided Regured Provided 1.7 Water Supply M.Cd-C.40. 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: pubes ❑ pate ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No m 2.1 Owner of Record �nt) /Address for Service: . Signature Telephone O 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed struction Su sor:7 G� - License Number d.0 fav NMn Address `I �77� f_ Expiration Date Signature Telephone rM 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name RRg,'stration Number rM Address _r V4/ z Expiration Date /) [-Signature Telephone Y� SECTION 4-WORKERS COMPENSATION(NLG.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 rmit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construc n� Q �, � fisting Building ❑ Repair(s) Alterftiens(s) Addition ❑ 37 ti Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Propq Woork s: SECTION 6-ESTIMATED CONSTRUCTION COSTS llar)to be f / { FFICIA Item Estimated Cost(DoL>(JSl<r 4,1 O(, y , Afi ; C' Y N g V Completed by permit a licant 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 1 �y 5 Fire Protection 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 as Owner/Authorized Agent of subject property Hereby authorize "` �' f C to act on " Mylf,in all matters elative to work authorized by this building permit application. Si aturef Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 7M2 1\.A !:1_0 C u as Owner/Authorized Agent of subject property y Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 5 Print e Je Si a of Owner/Agent Date 110 1 IN MOMINS011 NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS iST2ND 3RD SPAN MIENSIONS OF SILLS DIMENSIONS OF POSTS DR ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE x w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4 02111 www.mass.g ov/dia 1 t ,� Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplicant Information Please Print Legibly Name (13usiness/organirution/Individual): J 1(� o r(7 14^ U Address: City/State/Zip: )?,It Lt .► 1-1 14-- Phone #: cv'�4c3,(, r) Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors ❑ artner- listed on the attached sheet. * E] Remodeling 2.❑ I ata a sole proprietor or p shipand have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL. I I.❑�oofrepairs epairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12, insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers compensation policy inlirrnuuion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors nmsksubmit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers comp.policy information. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy 4 or Self-ins. Lic.#: tU C- Expiration Date: Job Site Address: t t: ( 10611 City/State/Zip: A/ 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 tine 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 tine 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. /do her cert/fy under the pains and penalties of perjury them the information provided above is true and correct. Si nature: C— Date: Phone 4: Z,16 _3) Q11ic•ial use only. Do not write in this area,!o 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: Phone#: w- 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 the 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 perfonmance 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-contractor(s)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 confinnation 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 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 enter 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 till 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 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. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, 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 Revised 5-26-OS www.mass.gov/dia J I ✓die�om�eoozu�e� o�✓l/�aa:�cu.�ivae%la BOARD OF BUILDING REGULATIONS .�-s. License: CONSTRUCTION SUPERVISOR s is ri { Number: CS 071037 r.y Birthdate: 06/18/1950 Expires: 06/18/2007 Tr.no: 11773 Restricted:'00 THOMAS A DEFUSCO 23 DUTTON ROAD G' PELHAM, NH 03076 Commissioner _. ,. ,—°---""'`✓rie TDanYrrram�u�-a.Lcsz o��/l��ivae�a Board of Building Regulations and Standards _ ='6 HOME IMPROVEMENT CONTRACTOR Registration: 117756 Expiration: 11/15/2006 Type: DBA TOM DEFUSCO GENERAL CONT TaSMXC- DEFUSCO --� 23 DUTTON RD -- PELHAM,NH 03076 Adi�r J hoe QVT�c�� P. No, gf : of Pa Tom DeFusco 3 23 Dutton Road Home Improvement Reg.# 117756 Pelham, NH 03076 i constr. Lic.#071037 ;'aoPosAAi.SUBMITTED ro Tel 603-635-3017Fax 603-635-3751 i PHONE STREET DATE !?,U =� JOB AtWE G C STATE AND PC - �L/I UrJ r-- .D JOB LOCATION AT tf �►,J d a t_ DATE Z / OF We hereb submit s j+ 3 1 VVV JTTT08 PHONE Y pecifications and estimates for: O c C &ir ___-- o I p FrLT95V hereby to famish material and labor — complete in accordance with the abov e specifications, for the sum of: Pyrleto')a made made as follows: dol lars($ f fOQ e;) O' A�j �^ Oc All material is guaranteed to be as Veciged. Ag work to be c:omple manner according to standard practiceworkmanlikes. Any alteration or deviation from ab", Authorized - specifications involving extra costs will be axe ted-only upon written orders,and will become Suture an entre charge over and above the estimate. Ali agreements contingent upon strikes, accidents or delays beyond our contras. Owner to carry fire,tornado and other necessary Note:This proposal may be Insurance. Our workers are fully covered by woikmer's Compensation Insurance. withdrawn by tis if not kept p� days. -Tfz1ttrV of rlapnsal—The abm-prices,specifications and conditions are satisfactory and hereby acoepted.-You are authorized to do the Sign work as spedfied. Paymerrt wilt tie marte as oug'med above.r�� "" /� Signature 8 � J � . tT e � f I -� �, � t T - � ' � ' ' I .' _ 1 ._. .. _ _ - — ' � .... f S i r - � f - f - 1 Lv% It TOTAL $# , 0Z) Check # 18778 Building Inspector Wit' (�.. ... __....�-...�_.,».._..,......._.._�..._..�...�..�...� ,,,s-�...>,.»..�.........�:�r--:�:r.._-----_.oma;<, ..�,.,.._._. .�._..._..._..�—•,....._......,. \1� EXPLANATION AMOUNT ilk TOM DE FUSCO 16 GENERAL CONTRACTING 23 DUTTON RD. PELHAM,NH 03076 5-7515-11, PAY `� AMOUNT c DOLLARS OF CHECI DATE TO THE ORDER OFDESCRIPTION CHECK AMOUR NUMBER e, '2 X/ Av a a v ,,, ,; 3vkw` t] V �" = ': Sovereign Bank sovereign kank com f II'00 L 68 LII' i:0 L L0 ? 5 L 50i: 8 ? L000 3 ?4 380 F NORTH Town of over No. 3 ?3 - � o == LA dover, Mass., I� COCKICKEWICK 7�S RATED �i BOARD OF HEALTH Food/Kitchen PERMIT T Septic System y� Aoisoc BUILDING INSPECTOR ..THIS CERTIFIES THAT....MX.11... . ..... . .mo-aw-we b........ ..1............................ Foundation 1 has permission to ere ..................... ................. buildings on .... '......... a..��... ............................... Rough 1 to be occupied as1.. .... Chimney ...... .. .......... ... 1Mo f..................................................................................... provided that the person accep�ng 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 t the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6119 . AAt PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service BUI D G INSP CTOR 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. SEE REVERSE SIDE- Smoke Det. 1 TON" OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING - -'"`- _;..'""xis i''�k _ .- s<' .t« .. W . M BUILDING PERMIT NUMBER: DATE ISSUED. - -W X tqTL SIGNATURE: Buildi2&Commissioner/I r of Buildings Date 1160 IS • O Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: A q5 Map Number Parcel umber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Reqtlired Provided 1.7 Water Supply UG.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: .Pub ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record are( rin Address for Service: - ROOM q7j'-&1�6 Signature Telephone t 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O 2 � � �JIj ^ /� n�` / License Number 11 Address /�L, f (,f Expiration Date' � Signa re Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name / ' `� M 7 m Registration Number r Address _r f/ �f z Expiration Date ^ Signature Telephone YI .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.......❑ No.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction 'song BB Iding ❑ Repair(s) Alterations 5, eg - Addition ❑ Accessory Bldg. (jam Demolition 4 ❑ Other ❑ Specify Brief Description of Pi d,4Worft . a XQ 7f40 9V t a000, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item c Estimated Cost(Dollar)to be Completed by permit plicant y k � . . 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee(e)X (b) 4 Mechanical HVAC Q, 5 Fire Protection 6 Total 1+2+3+4+5 Check Number r` • SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT.OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property i °r Hereby authorize to act on Y` My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 0-S C G 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 12 4!el FU C G Si ature o 'Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS iST2ND 3 SPAN DI1\4ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE � t IN, The Commonweahh of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 14 u Boston, MA 02111 www.mass.gov/dia ii Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (13 LIS incsS/Organiration/Individual):�('i /lit nh 4l C� Address: City/State/Zip: 2 .(A A ,.� �, 14- Phone #: 6?0; 6,'�r S 4 �7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- Iisted on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 �Gofrepairs epairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12. insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box u 1 must also till Out the section below showing their workers'compensation policy inlbrmation. y 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 their workers comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I Policy #or Self-ins. Lic. #: ttJ G Expiration Date: _ Job Site Address: 3"5-- !74( 1, ( ,PC,,— D City/State/Zip: 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 tine 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 tine 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 her certify under the pains and penalties of perjury that the information provided above is trite and correct. Si nature: --�_ �--- Date: Ic Phone 4: Z,3C 2 C) 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: r' a Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an emplo3,ee 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 the 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 perfonnance 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 bones that apply to your situation and, if necessary,supply sub-contractor(s)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 cavy 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 confinnation 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 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 enter 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 till 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 peri-nit/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 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. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, 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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia BOARD OF BUILDING REGULATIONS , w License: CONSTRUCTION SUPERVISOR M' Number: CS 071037 Birthdate_0.5/1.8/1950 Expires.:06/18/2007 Tr.no: 11773 Restricted: 00 THOMAS A DEFUSCO 23 DUTTON ROAD C PELHAM, NH 03076 Commissioner taanvnwnUl _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 117756 Expiration: 11/15/2006 Type: DBA TOM DEFUSCO GENERAL CONT QA6MX9 DEFUSCO ^� 23 DUTTON RD - PELHAM,NH 03076 Administrator y�rt f1t � PageFVa, of Pages l Tom DeFusco 23 Dutton Road j Home Improvement Reg.# 117756 Pelham, NH 03076 Constr. Vc.#071037 Tel 603-635-3017 �ROPosALsuaktlrrEoro Fax 603-635-3751 PtiOP1E - DATE ,/ STREET - /LI JOB NAME G CRY,STATE AND P CODE JOB LOCATION r: 1 ARctt CT A DATE OF PLANS A Nr 3 f JOB PHONE hereby submit specifications and estimates for: --34 tt Z 6 it �G� L,-47-4-) GCe�-�9 7 d 1 �. ✓--�.—ry"'----- •DIY'/ `/n w n� / ��� - - L ,r Xf i 4- civ u�tn•w Lt G C. S � ^j to P rOYOU hereby to furnish material and labor — complete in accordance with the above specification s, for The sum of. Payment to be made as follows: dollars($1�O O o v 64 Aje g- OC All material is guaranteed to be as specified. All work to be tom le manner accord) to standard p workmanlike Authorized n9 practices. Any aitera9on or deviation from above speciflaagons involving extra costs will be exeeuted-only upon written orders,and will become Signature an extra charge over and above the estimate. All agreements contingent upon strikes, - accidents or delays beyond our control. Owner to carry fire,tomada aid other netessary Note:This proposal may he Insurance. Our workers are fully covered by workmen's Compensation insurance. withdrawn by us if not accept r days. &AXaffiturr of topDISHX—The above prices,specifications and conditions are satisfactory and hereby acoepted. You are authorized to do the Sign j work as spedfietl. Payment wr1P the made as of p above. Signahrre •- - .. n w h _._ � � '� - .. r .. - - - - — -- - - .�_ ._ � .. 1 r � � i . __' i _ _ - _ - _ 1 =371— ..40 37Z - 3 73 aLyy.... ' �� �� d ic`ation No. ��i? 3*7 Date .1 HQRT1y TOWN OF NORTH ANDOVER 0 h 9 ♦ i Certificate of Occupancy $ Building/Frame Permit Fee $ ++ Foundation Permit Fee $ go Other Permit Fee Ybo` $ . Lih TOTAL 0 Check # 18778 &,erci ld 6ywrt -M, Building Inspector numeimprovementKeg.# ii7756 Constr. Lic #071037 .t 23 Dutton Road Tel 603-635-3017 Pelham,NH 03076 Fax 603-635-3751 BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP ar _2VAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER 3 71 DATE ISSUED: O M M SIGNATURE: I VOWED Building COME[lirisiOner/InSpector of Buildings Date — _ — SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: cfIV IA 'AA ) - L Y q 00 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Pr Use Lot Area Frorrta ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide red Provided R red Provided 1.7 Water Supply M C.L.C.40. 54) 1.5. Floud Zone lidoimation: 1.8 Sewerage Disposal System; Public ❑ pie ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ > SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENTq Historic District: Yes No m X'me of Record /r "rin4 Go1✓�1t-irS Afe�j, + / J -'-J / oyj�� Address for service: IF1 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Si ature Tel hone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ go Licensed Construction Supervisor. �.Z License//Number dress L3 —,//,/0 (- Signa re Expiration Date Telephone 3.2 Registered Home ImprovementContractor Not Applicable ❑ f- Company Name f Registration Number M Address r 1�j1 �C.o Si at ire Telephone Expiration Date z f • 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 it. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Desci i tion of Proposed Work check au applicable) New Construction ❑-. �Exi4ing wilding ❑ Repair(s) �J/ Alterations(s)j 1 Addition ❑ 1 .� Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 37—/J - is L Rraor) 4y �,. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item v Estimated Cost(Dollar)to be OFFTG '' USE ONLY �r Completed by permit a licant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (n) 4 Mechanical HVAC ��// � 5 Fire Protection 1r e Ge 1 Pt 1 4 Q 7`(� 6 Total 1+2+3+4+5 Check Number ,. SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN c OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT w� as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent o 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 D ',�c � Pant Name Si ature of Owner/Agent Dab NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T MBERS 1 2ND 3RD SPAN DIN ENSIONS OF SILLS DDvfENSIONS OF POSTS �, s DIlVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name (l3LIS incss/(hganiration/Individual): i 6 (�_n`y-(' C CD Address: `?� o-u.,-) �-2 i City/State/Zip: ,i,t a 1-1 4 Phone #: Q 3 (,'_?.4C34 � 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ l am a sole proprietor or partner- listed on the attached sheet. * 7. 0Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all ark right of exemption per MGL, I I.❑ Plumbi epairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12. oof repairs insurance required.]t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box 81 must also till out the section below showing their workers'compensation policy inibrmation. +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 their workers'comp.policy information. I um an employer that is providing workers'compensation insurance fir my employees. Below is the policy and job site information. Insurance Company Name: Z-( '9 Policy #or Self-ins. Lic. #: UJ C_ Expiration Date: _ Job Site Address: 3 5'-' 44 t L( P&, p City/State/Zip: J(/ 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 tine 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 tine 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 h certify under the pains and penalties of perjury that the information provided above is trite and correct. Si nature: Date: Phone 1": — OJ#ic•ial use only. Do not write in this area,to be completed by city or town o#Jicial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk a. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: f S 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 the 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 perfonnance 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-contractor(s)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 to sign and date the affidavit. The affidavit should he 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 enter 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 till 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 peri-nit/license applications in any given year, need only submit one affidavit indicating current policy infonnation(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. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, 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, NIA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 617-1xea��v»zaru�ie o�%��raaaclu�ve%la BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 071037 Birthdate: 06/18/1950 Expires: 06/78/2007 Tr.no: 11773 Restricted:.00-' THOMAS A DEFUSCR, 23 DUTTON ROAD PELHAM, NH 03076 Commissioner —- '----'~"'✓tie toanzinaa�uue� °� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration' 117756 Expiration: 11/1512006 Type: DBA TOM DEFUSCO GENERAL CONT Ta61MY9 DEFUSCO pA 23 DUTTON RD G'G-- PELHAM,NH 03076 Adm �. y� ����n•��� Page No. of Pages Tom DeFusco 23 Dutton Road Pelham, NH 03076 Home Improvement Reg. # 117756 Tel 603-635-3017 f Constr. Lic. #071037 Fax 603-635-3751 1R0P0SAL SUBMITTED TO ++ PHONE DATE 7 T L 1J 1 G STREET JOB NAME /q/ /1./f r`f l of L!''z✓ V C3 CJ Te (J CL/.I felt• CITY,STATE AND ZIP CODE JOB LOCATION 60 CUAS 4X=-) T o 1/LJ 1 0 z 9 3 ARCHIT CT DATE OF PLANS JOB PHONE XV/ n1tG( 4V�>— S ©i 3 / We hereby submit specifications and estimates for: t' Z US t .. I......... ................. ................._��......._......... - ...............__..........S_T _ Vin..._..._ '.��.� .../r..._�_...._..._. - ..... .........._._ r. f_s -: ..........._......................._..._....._.._...............__... - - - .._.......a..._..........._._.......................-------- , '-` .._____a_ _.._ : -y ..T ...._ T:Ta. , ._ �'- _�v : _....__.._.-_... ..' ... ....................... -.......... -..._....._ L..................�e.....::1 5...--...._..-.........-...................._.._.............. _.__....- ..._.........__..........._._._....... - ---- .v � ._ ..._-.........c .._._'............/1=. L _r: ...L -r__........... .............` .'.._ :.._._ .._ .._ _. __.._. ...... - -- ..__.. :.6/..._...._..._ 1...n...z,:c% __r�...- ._..._.._. ._............_ ---- . :._ ._ �.C...-C -L-. _...1 �..r : c...1...---..................—.__._...-- ....__.._.._-.--_..._.._...._._...------ -... Cd ' t✓ a - ; r 2 — i C i d .� �S 2 L i U z,1V�V t1 :..... .............11. ..........-......fi-.........._. ._.._. 1...._....................................... ....1 J......_a_.........._C._.._........ ...........-.._..t .. . 7......G�.. ....� '.�......._...... S ,j Ft..:.:2........._.................._ ...._._._._.:. P � K) . 5 C v / f> _.._........ 1:.._._.we ._ __.......... ............................._.......: _.. ........... L: _....._` .:/.__...__..._..._.._.. __... ._1....,. ....._.__...._ .......................... -- .._..._._._..._..__......_....._.........._._...__. ayd`/ 017/ XS �-/0, , AXE propUSE hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: !'t-' rU�' �ypc1 S�;c) j �1� Y i✓ �.:'IJCJ dollars($ 2T GGA Payment to be made as follows: All material is guaranteed to be as specified. All work to be complete 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 �j ! accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by us if not accept days. insurance. Our workers are fully covered by Workmen's Compensation Insurance. , xrrpyf nnrr of 'proposal—The above prices, specifications Sign and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment wiill be made as outlined above. Date of Acceptance: ! ti �� ! Signature . y .�, z � �. i i { ,..: - - i �+ 1 i l� I 1 F V40RTH own of 4Andover No. 3 WIN - - 50 ,o dover, Mass.,LA 1 1 • O.S COCHICHEWICK ^ 7 ORATED PY �SBOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .... .. ... ..............�bMtIOW. ....��... .5. co.......................................... Foundation has permission to erect........................................ buildings on .....tO...... ....................................... Rough to be occupied as .:; *.....1 'e .r{ .Q�•............................................................................................... Chimney provided that the person acce ing 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 o the Inspection, Alteration and Construction of Buildings in the Town of North Andover. elf, �q 0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST T Rough Service L ING 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. SEE REVERSE SIDE Smoke Det.