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HomeMy WebLinkAboutMiscellaneous - 56 CASTLEMERE PLACE 4/30/2018/ 56 CASTLEMERE PLACE 210/037.A-0039-0000.0 Date.......... .... 0 TOWN OF NORTH ANDOVER . 0 PERMIT FOR WIRING vivss� . CHU Thiscertifies that ............................. .................k..........................10................... has permission to perform ............. ..... ................. ...........p....: ........... .. wiring in the building of.......P-415-�e- el ...................................................................................................... ...................................j.0.' OOJVI�- �..... ......................................,North Andover,Mass. ale Fee'00..................Lic.No�-?...../....y......... ............................................................................ ELECTRICAL INSPECTOR Checko 1 2901 1 r� Commonwealth of Massachusetts Official Use Only yrR Permit No. N O I Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL.INFORMATION) Date: // - a 'z( /, City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intentio/n�to erform the electrical work described below. Location(Street&Numbpr)_,56 CG,S �kmP" fl1C Owner or Tenant AlICK ,i C-t.. ; Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Y No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity e Location and Nature of Proposed Electrical Work: W1 re pie y let`f Ae4 106041,44 I!&AP��/t 4� Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires drNo.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets a2_ No.of Oil Burners FIRE ALARMS No. of Zones No.of SwitchesNo.of Gas Burners / No.of Detection and Sr / Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers / ....................... Totals: Detection/AlertingDevices No.of Dishwashers Z Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent Z. 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 w ived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability' surance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov gc is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the gins and enalties o perjury,that the information o�e this application is true and complete. FIRM NAME: . �� �1°tr �' LIC.NO.: 2 /L/ Licensee: kclert CV%" p> Signature 2, LIC.NO.: 2,1S /7 tE (If applicable,enter "exempt"in the license nzzmb r line.) j Bus.Tel.No.• Y)�•ry 7g 7110 Address: �6 22. E'/v T a Ye 2 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed d on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, § 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the i notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: . L Inspectors Signature: Date: PARTIAL RY6GH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: 444 Inspectors Signature: Date: ROUGH PECTION: Pass 1fl Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: K 4. Date: / W' /;S-- FINAL INSPE ON: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: t r Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massa.chusetts , F Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 .,�;�`t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl / e Name(Businesss/Organization/Individual): �° _ / ' ru J �'('t/ Address: I��, C� ` to 7 2. City/State/Zip: 5d,11f eA jV 11 C>3 Q 71_ Phone#: � ) ``7 '�7 � - Q C 6 Are you employer?Check the appropriate box: Type of project(required): 1. I am a employer with ?, . employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. F-1 Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs • These sub-contractors have employees and have workers'comp.insurance.# 6.E]we are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,ley must provide their workers'comp.policy number. I am an employer ifiat is pi oviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: �� ` � e- City/State/Zip: pfd-ZA Qf (.'ii"�/ 1'lfI er Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perju that the information provided above is true and correct. Signature: Date: Phone#: o f Ll 7 9 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure 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 fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia fT. OMMON E�- '00 t 'T • • • ,; gc1A-,D LEGT �G1p. AS WANG THE FULU� LEGT'R'�G � 4 ISSUES 9 MASTER Gr 1 Z AM REfa1 SERE ; K N . 4 fl[ F to ULHW 5. p pv 9 254 0307 � ,53 7° ��U�M 468 � 01�3 • _ _. �� Date.................................. f p0R7h�, 'y 3?,•_?�``o'""-fs�Opt TOWN OF NORTH ANDOVER sigma PERMIT FOR WIRING �SSCHUS This certifies that ........................... 7 ... !� �..... has permission to per ...:. 1� ��.�`l.1......C' `. wiring in the building of ..............- �A.... . !,, � �?(� .. at... ....... :.... ,..: ! 7�_�f:......!...... t.,/,;, ,North Andover,Mass. Lic. o ELECTRICAL INSPECTOR' Check �x 575 ,) O:iicc l�5 0�}l� J It The Comoro wealth of Massachusetts Permit No. D rtment of Public Sofety `ta Occupancy 6 Fee Checked ? / BOARD OF F1 E PREVENTION REGULATIONS S27 CMR 1200 3/90 heave blank) APPLICATION OR PERMIT TO PERFORM ELECTRICAL WORK All work to perigrmed 1n ccordance with the Massachusetts Electrical Code, 527 CMR 12:00 fI , (PLEASE RINT IN INFORMATION) Date Ci o r To 0f To the Inspec or of Wires: The undersi ed app es for a permit to perfop the electrica ork described below. Location (Stye Number) Owner or Tenant Q Q (✓ Owner's Address /{ Is this permit in con 7ction wi/th a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building (,t)e�( Utility Authorization N0. , I _ Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Above ❑ In- ❑ 8 8 Swi®ing Pool grnd. grnd. Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total tons No. of Detection and Initiating Devices No. of Disposals No. of Heat s Total Total No. of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 11 ❑Other Connection No, of o. o Low Voltage No. of Water Heaters Signs Ballasts Wiring No. Hydro Massage Tubs / No. of Motors Total HP OTHER: G�ldec�I�Du� 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❑ NO 0 I have submitted valid proof of same to this office. YES❑ NO If you have checked YE$, please indicate the type of coverage by checking the appropriate box. INSURANCE OND 0 OTHER ❑ (Please Specify) Expiration Date Estimated Value of Electrical Work S Work to Start —L/),I— Inspection Date Requested: Rough in Final Signed under the penalties of perjur / r FIRM NAME eor�� ✓Van d� G 2 LIC. N0. Licensee Siignatur IC. NO. Address 48' 3W 6-L `l �m��,/19f$ `� Bus. el. No.Cr 17 —(GO' Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) 'tel Telephone No. PERMIT FEE S 1.6�f dy � Signature of Rorer or Agent Qd The Commo wealth of Massachusetts n:ticc Use.. Permit `o. 2 �ly D rtment of Public Safety Occupancy a Fee Checked BOARD OF R E PREVENTION REGULATIONS S27 CMR 1200 3/90 - heave blank) APPLICATION OR PERMIT TO PERFORM ELECTRICAL WORK All Work to med In Accordance with the Macsachuserts Electrical Code. 527 CMR 12:00 (FLEASE RIM IN INFORMATION) Date Ci or To of To the Inspec or of Wires: The undersi ed app es for a permit to perform the electric, oorrk described below. Location (Stre Number) Owner or Tenant Alle Q Q (✓ t� Owner's Address 411 e Is this permit in con, with a building permit: Yes ❑ NoEll' (Check Appropriate Box) Purpose of BuildingL1e.// Utility Authorization N0. 161 _ Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Above❑ In- No. Swimming Pool grnd. grnd. Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heat s Total Total No. of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection No. of Water Heaters KW SignsBalNo. of Low lastsBallasts Wirinoltage No. Hydro Massage 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 CJ NO [] I have submitted valid proof of same to this office. YES❑ 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 S Work to Start �j —d Inspection Date Requested: Rough Final Signed under the penalties of perj FIRM NAME (3eor�'e (V4 ur �C2S G le(141;61L, LIC. NO. Licensee Signatur 1C. NO. Address c., 8s �t ' AN Bus. el. No. 17 &o ` 's:'Y!?' Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that mysignature on this permit application waives this requirement. Owner Agent (Please check one) �11 Telephone No. PERMIT FEE S Signature of Owner or Agent i§OhLI),ING PERMIT TOWN OF NORTH ANDOVER I� I N -0t? APPLICATION FOR PLAN EXAMINAT PermftNO: Received Date Date Issued: C IMPORTANT:,..�Rhcant must complete all items on this va -,,e LOCATION r PROPERTY O'Mtt -4.5' no TYPE OF IMPROVEMENT— PROPOSED USE -1 Residential Non-Residential New Building ><One family o Addition Z*;,-J4rrc,,, D Two or more family 11 Industrial 0 Alteration No.of units: 0 Commercial 1-1 Repair, replacement D Assessory Bldg T--1Others: f-1 Demolition 11 Other Fi Se,pli r p LI FJ.bbdplafir77777� Wetlands Please Type or Print Clearly OWNER: Name: Al Zr He 4-4S 19e rte cc Phone:( tc— .10 Address: toN RAC- OR T, M 0 u pew!so tv, WOO Home'Improvern,ent-L-liberisw." v �7. ARCHITECT/ENGINEER Phone: Address: Rea. No. &UWWG PERNT."Zoo PER$1000-00 OF THE TOTAL ES77MATED COSTRAS ON$ 2 p S.F FEE SCHMULE ED St2s ER Total Project Cost: $ _ 3/ (0 0 0 FEE: Check No.: Receipt No.. NOTE: Persons contracting with anregistered contractors do not have access to theguarantyfand Signature of Agent/Owner 5iqf!qtuf1p,ofcontractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received pate Issued: LWORTANT:Applicant must complete all items on this page r4 � 10, _ � Print PROP RTtY OV1lNER. Y.ea�pfd Structure yes h Print MAP NO CE-1Q - ZONING®: TRI;CT ti�_ -_ istorir t"rict Y � { Shop INlachinet ViIN—g-a yes} prio ,J .w++wr,'✓{�.. y - � .. tir�A.r.+v2�a-r::='s:. 1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential j ❑ New Building ❑ One family El Addition ❑Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other , }� t� ? x,: �` =" ��� p��Vllat m-—— D stnct�. ., r�r> �� r _ D�Wetlands " Se tie Vllell ®Floodplain ^ — >. 'YZ..yt} "`....,#^ .e. -J�=v ,:. , , ,t ,Water/S.ewe—r DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address f ,�., j`{,.r •3i �" ,^.a»a ;� r�pµ'�`�L-� aG�-y� �r.z:.�,tr t t..? -•kt x t�- 9�k r + f '+� c8 •r�S Le '� ` h-- 1 ;'C" ':'1�'' f 'Jt , S"` 4 ..a bw;w4,� --} S,'u. t. - +. L ` CONTR'~ ACT "�OR`Name" ,' f'��'i Addresses—_ Exp Supeisor=s,.Construction` L�censeY _ �..8.� � -- • ; 'fir e a. ^ t Y1 1� i Wei t,..W..+� L• Horne Improvement License��:�:. T3 ."=S ., .s _ ate• . Exp ��,���. - - ARCHITECT/ENGINEER Phone: Reg. No. Address: FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ f Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �atu:re::gf:.confiractor._ F...�� .._'y.-... ... nafure of•Agent/.Owner;_:; ..::. .:: g t Plan El Stamped Plans El Plans Submitted F1 Plans Waived !i' ` Certified Plo Building Department Tine following is a list of the required forms to be filled out for the appropriate permit to be obtained. I� FZoofil1g, 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Fioor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 40TE: 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) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the; appal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must b�- subm:tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Piot Plan ❑ Stamped Plans ❑ 1 TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑... Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS � Zoning Board of Appeals: Variance, petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Seger Connection/signature Date Driveway Permit DPW Town Engineer: Signature: � �� F(RE;®EPA�T�ir� lT _ Located 384 Osgood Street Temp Dumpster on site yes no Located at'124 Mair.,'Street Fire Deparfrney"if signatureldate COMMENTS — d T - _ _ L 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 re uires Electrical Inspector Yes g approval of No DANGER 7t)m;z LITERATURE: Yes MGL Chapter 166 section 21A-F and G min.$100-$1000 fine �® I NOTES and DATA— (For department use I B Notified for pickup - Date Doc-Building Permit Revised 2010 r Location *A No. ! /� got? Date /40- o,o) • • TOWN OF NORTH ANDOVER • xy Certificate of Occupancy $ Building/Frame Permit Fee $ fir Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check# '? G' r� ,� It/L/ 3147 S' % /Building Inspector � NORT►� Town of 3LAndover O MAW- No. * -� qo61z oh ver, Mass, / ;;LQ' 7 COC141CHIW CK a• x,95 RATEo U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..... V ......L 6 b V L r BUILDING INSPECTOR ........................... .........................V......�...1.............. has permission to erect ........... buildings on ....5.10 Foundation A ... . Rough to be occupied as ......... C.........Cl " .!.!'�.C:.....,, A.$v�ii�e/ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO A TS Rough Service ............. .... .. . ...0.. ................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. Pr-T i Federal It)#05-0405679 RISE Enn"Incering R1 Comm.ctor Registmii(pst No 6186 MA contractor Registmlion ft IM-19 RISE 60'Shaumut Road.(,uptam.AIA CrC10n11=tVr1?e9ISt7`j6Cw NO ENCANEERIMG� (.t(f 1)784-3700 FA2X 140117,14-3710 CONTRACT Page PROGRAM `iii`CX810RAG#6FJirF.Rritr VaOGETWEViRm CAIA-ftp es airmarattaEcusraxteRrrntaropitas DESCRIBED MAM DAM CMUTs Vialu ORDER Nicholas Petrucci (978)696-5290 1210742016 427911 35004 56 Cwstlemere Place 56 Castlemere Place North Andover.,MA 01845 North Andover,MA 01845 JOB DESCRJPTION AIR Sr-AI-M, G.Pwxidc laNr uatd ittaterials jose2l=a,,of Nvw home almimst mugerul.exi:055 air kakaac. 11tis Avod'will Iss:peffarmUM 51,020-00 in comenwc ith the w ofsjvrias kt+e';:rid dingmistic(1:gs to wsw.c that I YME iwnW vwill be left with a hsatthful kvd orair cNchanpc and isidwr air qtmfh .Material.5 it,I%-iyw, 4 to se-al yvur lHitne can incl"&-t2tdlLi-limit's 4"d 0111cf PupdUCK Prifrlar.V arm(w Scaliny- incluilcair lealzag -e jijactwd W.kersand other milicated arts(win&M-"are still "is will uquirc q 121 worrLin.-lk-,sm A rzibAL6441 in C"bic k-ez p'l saintae(Crilt)ofair infilli-Aim will mcur.but slat:a.ttt9i imatbet 01'erm iy M-4 guarantecd. At the cs)niplajisp1 tof jjw-m,211jerizagion uolk..;Sad at Ito additiom)cess"tip the lumtxamm a fina)b1mL7 sarety anaiys;is will bc,:vmdwcd by she iub-contmatpr To Lowe the safety of tlw-indow aft qualik%, I'M M MING:11"i&I abir.and materials 10 istZiN a 12'facer of It-3 mufaccil I ikxgkass bates to t�55 6)soleus:rw Ins,dan Insi Rg, SI fniquyses. APAQ FIX EXISTING INSULATION:Slash ft vaptV Ismier,Ilip,or rc-position(400)squaw fect 9(insialalioss in jhcauic a= S100.00 AITIC ACCESS:Provide hdw rt d mate6als W hiss ale the back of(I)attic botch with rigid b(=d at R-14)m prwer%ith the required W.09 tire sting,Wcallicssirip the Isminmer. V M- TI LA110K.Ikovide fatim and snatcrial,to install 01 imalm,d vxhmvit lmsc v4th rmfopotmied*-jqvf vent to C.4taug L.N-i.sjjftg S593.75 bathrotmn fan0r).Broan model 0036 m cquiralmd. VENTILATION:f1mitle labor and mawrHs,tip install vm(Axion chuze-,in(236)rafter bay.N to Inaimiln at;now. VA Fed"al ID V 0540 SS29 RISE Euggincering MContractor Registration noa-18a MA CDntra#Or Pegtsi 7Wm NO 128979 PUSEcr CO:rttastOi sdeglsraatlora No kA ENGINEERING' FAX Sh#riDsut Road.C-intun,MA t3iil. 7R€-�itll# 7CON T 4 TRAC Page 2 1r12 i1a'!',M J RISE CMA-IIES X�eurc CUSTOVER OR DRXAS PBErts�tr CUSTORtEYr WOVE _ .. 04TE CLK&1ra Yom OVLD?:f! Nicltol.'sPetrtacci (97S)686-52911 1210712016 427911 35004 SERWCE.STR.EET Ea.;"M ZrREET . 56 Castlemem Place 56 Castlernere Place 5ET3Ya5F Cl—If S:67Ei,.ZrF �4iL4S'C CEIY,✓.AiE:Lii� .. ... North Andover.X11 OM5 Norilt Andover.MA 01545 JOB DESCRIPTION RISE l ragineeriDg xaitl Wtr all applicable,eligible incentivcs tO this amram ou%'Mi Billy be billed th--Na a r€c;c€crs. C wCally.fnr S19tLCHa eligible amwurcs,Columbia Cray officTs 75,Q rout-Raiac.am to cA ceJ S2,0W pia calc adar yciv ww an irat r :iW,of IW,'u for the Air `acalin;mmmr vt w.it)tlte.tarsi St'xW,anal an Witional 5340 if-.niu,.tsarc ji0ifood to tin-auditor. 1-or dw s:aietc and lWaltlt ei mmy dnf€a w's instate air t" 'aliay.€€c+rill ttr tvwJudiFag;at lsltnwrdwr dT rttstis amf t4Tw a€asitablc air l9cax€iaa ynUr N)SUC NO tVfsa C the VMA is KTUn,.and att'.r daa €xcr dreiization A is Ctagtpkte..We mill also L unduet a full ordw ca"mtuntituT safrt4e Lof eattrr It a aria 4i c;rt aia€S€rr €heat .1 his has t rwtaac cel"�! tri a}zt rr€y cant tai guac. Tiqalalhmablc weadwriratio"incentive is 53.1104. 1'hc Prmait will 1?s. cc€arcd by the insulxim wralractkir.::t Ma additi€ar d Cost,It is ax thmi na-mel"'s respwx**WT-.tsa zls?sr aim t$tr5 pirrrtit by.amtacaita�thairrastzi icitliar u fit.caxtatala aiarft3tix€xa rl, iV 3�l :tf..--X! I Total: $3,533.55 Program Incentive: S2,929AO Customer Total: $664.15 WE FAMEE HEMBY TO FURtnSH SERMES•COr,9PLETE H4 ACCOROVXe€`RMm ABOVE SPMFICATUM.FOR TWE SUSS OF '**Six Hundred Sixty-Four&161100 Dollars $664.15 UiPWIWCAL MSPEC4IOU l:t.D F.RPrOVAL err a ME E:4 3A!;U Mt...CtM TOWER AGREES.O FE+.tr AFtSFFVa3Xi DUE M FUU-MEREST QG 7Y.r ILL BE C"ARaEDT 4iF RM' WY AIM raFd=,AMR XT 1MY3.bLE REVERS"L FCR 04POR MUT V.TWttAi+7Wj WNCUgRAN EE31 ArOrM Or alEC7af!{RJ,SCHECUt;Caq Fia:D ClOKM*CT"RrcGY9T84a X. A.MUCO YED SIGNATURE• ME.Enginennvq cdd(�iSf ..ttS.Pi�taC£ d) - / 2 NOTE:i7a1S COaFiRACr aRD.Y Be xYaT11DRAR'i4 aaYUS+lF 1=7 EXECUTED€YTlPtt OArE Or'e'iCCE�AE:CE .. '2...� ACCiEFTAtME CW CA!fr ACI. I r.A80,tZ P9ZE.S.5PCaRCArr^,-X A.'O CO?y7r3M7Y..'-W /4. DAYS. SATi<ACTORYTO US AIM ARE HEREBY ACCEPTED.YOU ARE AUTHDRUM TO DD T"r rxm AS SP9CerKB.P An!M,€'Alii BE NADE AL OUTLINED ABOVE MSE60 Shawmut Road.Unit 2 1 Canton,MA 02021 339-502-6335 ENGINEERING WWW.PJSEengineeiing.com OWNER AUTHORIZATION FORM (Ownees Name) ownerof the property located at: ro D P.ly Ad d r e s (Property AddreSS) vc he-ebyauthoti,ze_ ;-in authorized subnontraclor for RISE Epainaering,to If,'* 'Al spy t,.tzatt to of*An a building t pernift anti tic)perfoar.work ora my property.T.Isis ferret;is OWY V�alfd�"J!th siysezt coirtmrf. - responsibility to closL,out this Permit by contarnng their rumucipalay at Jit,cc:nl;Aetion 0,ftss work. a—t v The Coma mwafth ofMasmAtmeos DV4rhna??it of IndastrkI AcddenIs office of 1nl gi oris ky "0 Washwgion Sftet 1loston,]JL4 021.11 a.mas&g0VMa Workers'Compemation h urance Af tlawt-Budders/Contmeton&hwtneo sfflk nbers Ane>limnt Information _®Please Print Legibly • Name tBosinessI(rrganizatioai/bWividwI).AAfwrAftbj ► Address-e V'%�'�� r{ Gty/St3k/zig: A k.+v to VI Phone#: 401.Cless Are you an employer?Check the appraprbte box: 'type efp (required): 1.W am a employer wig�_ 4- I am a goat contractor and la G. []New Gurtstructim employees(W a ndlor part time).' have hired the yrs 2.®I am a sola proprietor or partner. listed on the attached sheet t 7. []Remodeling ship and have no employees 'These sub-conn actors have 8. Q Demolition workitg for the in any ca<pacitp. workers'comp.insurance. 9. Burkhog addition [� [No wor$eas'� ru mP.a�santc. 5. El Viae are a corporation and its I0.[]Electrical repairs or additions required.] officers have exercised their 3.'[D I am a homeowner doingall work light of exemption IVIG l I_ Ptutnb' L or $h emp .per [� rng r>rgalts additions myself[No workers'comp. c.152,§1(4),and we have no 12.0 hoof repairs insurance requinAl f employees-[No workers' Inr comp.instarance required.] 13.®{)tit� �� pn 'Arty ap UcxM tFlat accirs ban 4l neat else fall om dre sdion bdmv Aowneg ail*wwkcw�,t7D Y�• t Iiomemvaas who submit dais af6dwa ismea wg ilmy ora doing all www and nkat lim gide contractors m ,suj"it a new afrA vit nWicat®g 511911.�Ualtaetcsrs tIM check this boas r anaahed an ad&harW short dowing ft came of tht sub col tats and jhW V WI 'oMP.Policy"i librmatian lana an errwtaryer that isprorWnig worlrers'coaateaasetivn imswancefor my erntaloyem Bdow is fire policy and job ske infbrarratiom Insurance CompanyName: M Ik11101•� Policy A or Self ills.Lic.#l:__ ' t xpindon bate: Job Site Address: GityfState p: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date}. Failure to secure coverage as required Mier Section 7.5A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 artdlor one-year:imprisonment,as well as civil penalties in the form of a STUPWORK ORDER and a fine of up to WO.041 a day against the violator" Be advised that a copy of this statement may he forwarded to the Office of Investigations ofthe DIA for insurance coverage ve rifrraatiolL Ido akff*centrf der jh perbs ataapwfit d of jtredkry that the iaaloraaaation pard arbow is Nave aid eorrea S' attire: per: 44 Phope#: 1401 • Q fe s • B S12- OA S1$Ojj dd aseOR64 Tho fi&write in dds Nzai to he canwietad by city or toren ofci l City or Town: _ permidLicellse# Issuing Authority(circle one): I.Board o€Neaith I Buililing Deparhueut 3.City/Town Clerk 4.Electrical ULniectDir 5.Plumbing Inspector 6 weer Contact Person: Phone#; The Commallwealth of Maswr��� u _ DePaf*nefft Oflndusftial A mdents Office of Int-est'iga'ierns 600 Ifla ringlon Street' -= Boston MA 02111 ���s:r�rasx got�Ix�au WorkersCoope lsatiOn lnsurance.Affidavit4uilde `C'on actors/El'ectcie Plumbe Applicant-Info mt ti. Ply print s9x2gE? (I3ar5iru."�iCh-g Ajnriosn: ividerll 13 Are you an etnpfoyer-'�Check the appropriate box: µ.__ . am a� ion ea� : �.� � � €ata ecne�co�ctor and d �� of lera�ect;se+�ts ���. CrOployee")(full a "Cri,' €t-tiros,. have hared.the sub-cootraLtors 6- F1 New construction . l am a sole proprietor at pang Wed on d1w attached.shect. s. 1 ship and have no eMjoyecs Thew. sol:-contract have "c'or'n;.in'9 for"M w any capacity, CTUT40�%Ws and have woa-ers" �De Iitistrn No wwkers'.con"i.insurance comp.insurance. 9- Buifdkat addition required.) 5. El 'We are a corporation and.its I'D-D Ekmicai repairs or additions 3.El I ariv a hcnweowner doing al!'c'ork OfiCas have exercisM dreir "wself-['4'o workers'ccxup. a i;�nt of exemption peg hfCL. l l-C1 Plumbing re ins or additions irmwance required:.] c. 152,§l(4),and we have no 12.[]Rooftpirs rntVI"Ces.t o v%m,,k xs' li t Othe8� fz A F fro�o conv.insznta r-eqtr red.j 'Ari appLc sa cwt s jL-,bas#I st ja- dw section bdow vmfias�Yh�s 4�rs' ers�es �cc�a yas?crga�ziiQ�z. t ttrari Ya�x 5 w9nca ask sir.IMS ftVil iN&�anS tt •arc a i a sand a ,Csi:r r s s ie.r cztzaa z� s�x s�sb r y a toss a au 6a etieav;za sv tau +:`r trr •n s rkxet check this tsna rr rko-est a i¢6oui dea s"-c fear.c of c �aE car not those meati€ice t�atkc)y titFre sutarsrs > akz�yrs+rs. rs ,srtret r �rxzs'erassaks..k �rets. Ivor an rmplow that ispnt► °,ung were'eawpettsatiarrt inxura nc;p for�r empinpees, l3etaw is tiepoficy�arard jaab site itrf vrtrtaatiatar Insurance CoxvpanyNanw-,---A��w I'01;C°#ear Self-ins, Lic. 39 Job Site —PQ .Citwsutt'6-€p _ Attach a cook u t#tt�casr ens"cr►rnape ttioan poi+ciy daclaratiora page(SbOMU-9 the POLICY number and iexoratian date). Failure to secure coverage as required under Section 25Aof MGL c. 1'52 can kad to the iniposition of-criminal pena,ICies of iron up W S I;500-00 axn&or -year imprison"neat,as nv eli as civ-i1 Penalties in the form of a STOP IVC)1tK ORr)ER.arnd a tis , of up to 52500 a day against dw.violator. Be advisW dOt a Copy'Of this staterwent nub,be forwarded to die Office of $RvestiCations of'the DU for insuratnCe cerifnsatilons. 1 dei herre ky eer ,ander tine pains and penalties of perjurer that the ittformaation provided ubor'e is true and,eorroc'r: Date: l+l fesrn irae', a1n': D(n trot ^r%ke asxs rsrea.aat is cotaieted b�tr art}.or Iowa ffeaaA Gtv or Town- _ _---Pernnit/11cernse Issuing Authority(circle owe): 1. Board of Health 1 Building @epartrnerrt 3.Citkr°'l'arwn Clerk, 4.Electrical Inspector S.Plumbing Irnspecto G.€!then Contact PrXsannt:� Phone#• J6-� CERTIFICATE OF LIABILITY INSURANCE 4f8/2016 'MIS S►'MIISSUED ASAMATTER OFDW4)RMATM ONLyAD CONFERS No RIGHTS CERTI ►-FE CE!mFtCATE DOES NOT LY 71VEL�OR NEGATIVEA3 OR ALTER THE SER "DTHE IETHIS CERTIFICATE OF DISURAWCE DOES I=C093STITUTE A CONTRACT S REMSMTATIVE OR�AAW THE GER'TWIGATE AUTHORIZED �T s sm � is an ADDITIONAL.MURED,the Z to� IS WANED.sUbjw to Me temm and condWans Offt pervy.ceetm Ioftks my requ&e an mrIffica*haIdw in Um of such omWrsemml(s). Loiselle InsuranceAgency ('1013723-8510 Falx t�4��72s ��zo 279 Dexter Street P. O. Box 11448 PaTxblacket RI 02862-1.148 AWCFJ=COVERASEVISURED aA/c a rFRAOC InSUraDee Company ameaco l .mutual Insurance Co 035 Affordable Buildingg �t�=i�tiosa, Inc_ ZMAMERC � 41312 77 100 a Street a ut Ins- CO.. unit 1(308 + jProvidence BI 02906 F: COVERAGEAfS CERTIRCATEnMERiIa.a* 2016 I� L- E HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LOTED�Ow HAW BEEN ISSUED TO THE R pg 0 ABOVE FOR THE POLICY PEF400 I3ICATED i OTWITHSTANOW ANY REOUTZ ,TERM OR CONDITION OF ANY c;om v4cT OR OTHER DOCUMENT WITH RESPECT To Vi"CH TEAS ERTIFICATE MAY BE ISSUED OR MAY PERTAJK THE INSURANCE AFFORDED BY THE.POUC�S HEREIN 6 S4,4ECT TO Ali.THE TES , =US AND CONDITIONS OF SUC14 POL=ES.E&66fS SHOWN MAY HAVE B BY PAID CLAW_ TYPEOFORSURANCIE POLICY Im9mmR POtlGIy EFF tlrtFS LL462HY FACHOCCURR89CE S 1,000,000 X COMWERCUL GEMMALLbtGUTY UAMRSETO S 50,00 A � La('�]OCCUR X 4957 /10/2026 "12ft7 �� � ) s 5,000 P Lg.A V*L%W S 1,000,000. e- AI_A 7E S 2,000,00c GEWLA ATEUWTAPPUESP$1: PRODUCTS-COMMOPAM S 2,000,000 lC POLICY it3G S AISt M t £ S 1,000,000 A aK]E�RYYCPer ) s ALLOWNEDSCHBXXM Alit X Mi X69957 /141/2916 11012Or 6 lX CaABiYIRsa mei S X HIREDAUTOS X AUTOS Va PE XM6lAG� $ -- ilied�6 S X I e A UAS X OCCUR EAL14 OCCURPEMCE _ S 2,000,000 HI owMUMSSMS � At GAYS S 2,000,06)0 I MMME 14, 64457 1141/24616 !10/24116 tlJ18 Jff X $ wssTATu otr� via a��REXCU93W? Mg) uto TL A s 504 000 t r�+ roe f2?f2O15 fs7facras -EAOF $ s00 000 OPERAIRMS bdaw F- 4 -vOucrt"T S -- 500 000 IDC Employee Dishonesty 358563 /x0/201la !10!2017Rials Uoxker'S 336'55 slT�l2OL:i 115f2Ca 6 ems► DESCIOPnONOFOPEMIT0MILOCA17Dl� I=M,ES IAmcbAe atea.AdA�sor�a9am,�sS nac�es�ar8;s 4ubmq National grad is d as atn aiBc3itional insured ou the ��� T and be+silmss auta policies as required by signed written contract- CERTIRCATE HOLDER CAINCES1AT" SHOULD ANY OF THE ABOVE DESCRIBED POLWAES BE CANCELLED BEFORE T14E ;EXPRA710H DATE 11HEREOP, NOTICE Y=-L BE DELWERW IN National Grid ACCCOMA14M VOTH 7W POuCypROVIS#ON& 40 'Washington Street Westborough, NA 01581 MMWWZEDeTATM ACORO 25(201011)5] 191US-2010 ACORD CORPORATIWL A8 rtg3<ts resmved. IlNS462517mm,m 7t,o Arrxan.,>...o�.,,�e..,...a.... .»n ...--"-T Arman Z2. ez^:a,.•,:F_ sn:i'ae��:rruss}p��'_��,�•FkUi �p ��sgy ��`pie3;a,, TODD LEWC ._ 95 QUEM M East t=om w gms 024SrM0 Restricted To:(SSWC-Insulatwn Contraa ar a ?aalesr a to passsess a airrent editim of the Mx6adnsem mate RuV.,Hrq Code is cause for revocation of Uhis:tieense- :Yx6>�Sti�tewsartgiri"inrrrs�oxsasrzir: nesv�as.419�s�CoYfuPS ��t' r grit.+tt.trf'z'%r(fC r fi#rxii ar rs<,>'r; License or registration V2tid for individual usi only w Office of Consumes-At'Eairs&Bananas Regalatio befarc the expiration date. if found returns to: HOME IMPROVEMENT CONHTRACTOR 5 ?'Registration: 17 12 Type: of Consumer Affairs and Business Regulation 5 10 Park Ply-Suite 51.70 x r Expiration: 811812018 Corporation Boston,lois!021 16 AFFORDABLE BUILDING&WEATHERIZATION INC TODD L€DUC / '.�'" 330 VICTOR RD.SUITE A .. ATTLEBORO,MSA 02703 undersecretsry hout signature ru"Ilmension Number of Stories:. �� Total square feet t of floor area, used on Exterior dimensions. ---4/4� Total land area, sq. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector lies No DANGER ZONE LITERATURE: Iles No MGL Chapter 166 Sem,21A—F and G min.$100-$1000 tine DOTES and DATA--(For department use) CI Notified for pickup- ©ate Doc.Buiiding Permit Revised 2012 Plans Submitted Puns Waived 0 Certified Piot Pian 0 Stamped Pians 0 TYPE OF SEWERAGE DTSP®SAL Public Sewer /� n Tanningfl+fassage/ ody Art El Swimming Pools Q WeII /t 0 Tobacco Sales Q Food Pac /� kag�ng/Sales �1�"`�i� Private(septic tank,etc. Q Permanent Dempster on Site TIME FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF -l- FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT COMENTS CONSERVATION n [� COMMENTS DATE REJECTED DATE APPROVED HEALTH El COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decisiontreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer ConnectioPermit Located at 384 Osgood Street FINEAFtT& El TOrnriper#nom Vires no t Located at 1,24 Main Street :a Fire Department Si r a€ f0 x :'bowl EW .. i d ,r