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HomeMy WebLinkAboutMiscellaneous - 63 ELMCREST ROAD 4/30/2018 63 ELMCREST ROAD 210/055.0-0027-0000.0 l i f Date.... « / .... NORT/�, TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING 8s�c►�us� This certifies that..!... 4..... .1.� 1.. !..:................................................................ has permission to perform........ ,f�+,l. .r.... .................................. plumbingin the buildin s of............................................................................................. at h�. .../� ................................................, N&h Andover, Mass. Fee,54 ?...Lic. No. .�'1 p�''�r ....... .. ............ . ..... ..................... PLUMBING INPPECTOR Check# 2 Date..q l..�'o114................ OF�►ORT#4 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 88�cHU � I This certifies that . faV t .......................................................................................... ...................... has permission forgas installation .... ...... -er,,, ,,.,,D.................... inthe buildings of. .........................................................................I.......................... at... ? .., lfl�� .,No h Andover,Mass. ................ ......................................... .. ,,��--�� Fee,,. §��... Lic. No. �Ff.41 ASINSPECTORI Check# 9534 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 11 CITY E Q5 MA DATE ig ( PERMIT# -- _ ,,t5v; I JOBSITE ADDRESS OWNER'S NAME n POWNER ADDRESS TEL — FAX� J TYPE OR OCCUPANCY TYPE COMMERCIAL E3 EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: M RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES® NO© FIXTURES-1 FLOOR- BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BATHTUB -( { ( _ _ fL=J { CROSS CONNECTION DEVICE I ____{ DEDICATED SPECIAL WASTE SYSTEM _ ( 1 { _ J 1. { ___( ! DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM __.._-_.1 ___{ _._.j _._� �_J ( _) f 1 DEDICATED GRAY WATER SYSTEM ( _ E _( _ DEDICATED WATER RECYCLE SYSTEM =1 DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK -- __I_____J LAVATORY ROOF DRAIN { SHOWER STALL SERVICE I MOP SINK TOILET URINAL r � WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I _ i i _ 1 —€ I _ j { { WATER PIPING OTHER _ INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES _..TNNO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY� OTHER TYPE OF INDEMNITY 0I BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. t CHECK ONE ONLY: OWNER Q AGENT IEI SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicat are true and accurate the best of mx kn ledge and that all plumbing work and installations performed under the permit issued for this application will a in comp an with al .eminent pr vision the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME i IILICENSE# I IGNATURE IMP 3J JP o{ CORPORATION _J# PAR ERSHIPQ#®LLC COMPANY NAME - ; ADDRESS I y pr CITY - !�S -e 4 ___.._.. _.._.__I STATE .aJ �� ZIP TEL d ✓�6 qy FAX _ ]CELL — _...,..__..___._._I EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTWN NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I s The CommonwealthCommonwealthof Ma sach usetts Department of Industrial Accidents Office of fnvestigations 600 Washington Street Boston,MA 02111 www.massgov/dia ' W,orkexs'Compensation Insurance Affidavit:Builders/Conti°actorsXlectr icians/PZumbexrs Applicant Information Please,Prim Legibly Name(Business/Organization&d-vidual)' Address: City/State/Zip: Phone#• Are youan employer?Check the appropriate box: Type of project(required): 1.❑ I 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 2.E1 I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and'have no.employees These sub-contractors have 8. ❑Demolition working for me in.any capacity. workers'comp.insurance. 9. El Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised.theix 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself[Ebworkers'comp. c.152,§1(4),andwehaveno 12.QRoofrepairs insurancere ed. employees.[No workers' ] 1311 Other comp.insurance required.] Mny applicant that checks box#1 must also fill out the section below showingtheir Workers'compensation policy information. i Homeowners who subnutihis affidavit indicatingthey kedging allwork and then hire outside contractors must submit a new affidavit indicating such. TContractors that cheekthis 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•formy employees Bellow is the policy and job site information. Insurance Company Name% Policy#or Self ins.Lic.#: Expiration Date: rob Site Address: City/State/Zip: Attach a copy of the workers'compensation-poliey declaration page(showing the policy number and expiration date). failure to secure coverage.as required.under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fins up to$1,500.00 and/or one-year imprisonment,as well.a s 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. X do hereby certJy under the pains and penalties of perjury that the information provided above is true and correct. - Siunature• Date: Phone#• Oficial use only. Vo,not write in Mis area,to be completed by city or town official. City or Town: PerxnitlLicense# 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#: Information and. . d I nstrnctions . 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 ofhire,• 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 foregoiizg engaged in a joint enterprise,and including the legal representatives of a•deceased employer,.or the receiver or trustee cf 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 ou the grounds or building appurtenant thereto shall not because of such employment be deemedto be,an employes." 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,MOL 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 chapterhave beenpresented to the contracting authority.." Applicants Please fill out the workers'compensailon affidavit completely,by checking the boxes that apply to your situation and,if nccessary,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 oilier than the _ members or partners,are notrequixed to carry workers'compensation insurance. If an LL C or LLP does have employees,a policy is required. Be advised thatthis affidavit maybe 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 xetumed to the city or town that the application for the pewit 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 thatthe 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 thatmust submitmultiple permit/license applications is any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Sob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamp ed or marked by the city or town may b e provided to the applicant as proof that a valid affidavitis on file for fature Hermits or licenses. A new affidavit must be filled out each year.More a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit 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: Tho Cmmouw.ealthofM-assachvsL3 - Dopaxi eznt ofl dustdal,Accidents Oft-e ofImstiga-0ous 60 Was gtoa St eeGt Boston,MA 02111 Tod,#617-7.27,4900 8A 406 or-1-877,MASSAM _ Revised 5-26-05 WWW-MamaQvIdia _Q\_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` CITY MA DATE PERMIT# JOBSITEADDRESSI� �'I�,e�PS'� �1OWNER'SNAME GOWNER ADDRESS I TEL IFAX[ TYPE OR OCCUPANCY TYPE COMMERCIAL 13 EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:D RENOVATION:D REPLACEMENT:® PLANS SUBMITTED: YES D NOD APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER 1; FIREPLACE FRYOLATOR - FURNACE GENERATOR , f . TI _ I .— �L_—___ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT . ... _ _. .. �— —. �_ _ I- OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER_�� _ .--- -- _---- � -- INSURANCE COVERAGE have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L`'7 OTHER TYPE INDEMNITY ® BOND E OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this applicatio are true`,and accura to the best of my kn ledge and that all plumbing work and installations performed under the permit issued for this application will b in compli��ce with ent pro ' 'on o the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME 4 _ �( LICENSE AIGNATUIRE MP GF El JP® JGF RLPGI© CCyO�RPORATION©# PARTNERSHIP® —=I# LLC COMPANYNAME:11ad,_."_ ���,4 ADDRESS CITY _ , !� D _ _ � STATE - ZIP 2 6 TEL FAX CELL EMAIL _ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FIN INSPEC I I NOTES Yes No !/ THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts - Department of Ind ifstriglAccMiks Office oflnvestigations 600 Washington Street .Boston,.ltlA 02111 vww.mass govktia Workers'Compensation]insurance Affidavit:Builders/Cont.actorsfFIectr iclans/Pli mbers ^App.jeant Information Please Print Le�ibiy Name(Business/Orgauization/.Gi(Rvidual): Address: - City/State/Zip: Phone#• Are you an employer?Check the appropriate box: Type of project(required): 1.[( I am.a employer with 4. El am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2.[] I am a sole proprietor or partner- listed on the attached sheet.x 7. ❑Remodeling ship and`have no employees These sub-contractors have ❑8. Demolition working for me in any capacity. workers'comp.insurance. y, E]Building addition [No workers'comp.insurance 5. ❑ We are a corporafon and its required.] officers have exercised.their 10.[1 Electrical repairs or additions 3111 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself EEO workers' comp. c.152,§1(4),and we have no p 12. Roofxe airs insurancere edemployees.[No workers' �' .a� 13.❑Other comp,insurance required.] xAny applicant that checks box#I must alsofill out the secfion below showingtheir workers'compensationpolicy information. ?'Homeowners who submit this affidavit indicatmgthey Die doing allwork and then hire outside contractors must submit anew affidavit indicating such, tContractors that checkthis box must affached m 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 infomadon. Insurance Company Name:. Policy##or Self ins.Lic.#: Expiration Date: Job Site Address: City%State/Zip: Attach a copy of the workers'compensationpolley declaration page(showing the policy number and expiration date). Failure to secure coverage as requkedunder Section 25A ofMGL o.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 may be forwarded to the Office of Investigations of the DIA.for insurance coverage-verification. Mo Hereby cert�V undar the pains and penalties ofpcelury that the information provided above is true and correct, - Signature: Date: Phone#: Official use&xly. -Vo not write in this area,to be completed by city or town official. City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuarit to this statute,an employee is defined as"...every person M the service of another under any contract ofhi m,• express orimplied,oral or written:' An employe is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oh t 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. Tfowever 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 ba deemed to be an employes." 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 insurancecoverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisionsshall enter into any contract for the performance ofpublic 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-coniractor(s)name(s),addresses)andphonenumber(s)along with their cer0cate(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. De advised that this affidavit maybe.submitted tothe Department of Industrial Accidents fox confi oration 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 theperra t 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 lino. City or Town Offfeials 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 whichwill be used as a reference number. In,addition,an applicant thatmust submitmultiple permit/license applications is any given year,need only submit one affidavit indicating current policy information(if necessary)and under""lob 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 afCdavitis on file for future permits or licenses. .A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpetmit 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: Tho Comm oassarhvsPtEs - DoPat ent of hdustdal Accidents Moe OU vestigaVom 600 Wasbb g-�on ixeel Boston,MA021Xt TQJ, 617-7.2'-4.900 e:.Kt 406 ox-1-87.7— SEAFT3 Revised 5-26-05 Fay,0 6 17-72 7-7 749 vawW-Mass,gov1dxa Location ,. No. Date r 4 °RTS TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ Building/Frame Permit Fee $ ,SSACHUSEt Foundation Permit Fee $ ' r� Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ - wilding Inspector �6 13:45 Div. Public Works PERMIT NO. 2-3 APPLICATION FOR PERMIT TO BUILD — NORTH ANDD ER, MASS. PAGE MAP 4-40. (f):s:J"1 LOT NO. �/'� 2 RECORD OF OWNERSHIP IDATE (BOOK ;PAGE ZONE SUB DIV. LOT NO.. �— LOCATION �'` PURPOSE OF BUILDING - - ' ' OWNER'S NAME P/1 / Q v )� s J� NO. OF STORIES SIZE --F ` - OWNER'S ADDRESSBASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME-`+ J t,� Q i�na� � SPAN DISTANCE TO NEAREST BUILDING ,\ DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES — SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION P✓�'� 8 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST . .. - ... -• - -. SEE BOTH SIDES EBT. BLDG. COST .. -....:. . ... .. .: ...:... EST. BLDG. COST PER SQ. FT. - PAGE i FILL OUT SECTIONS 1 - 3 EST. BLCr.. COOT PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED — l7 jigBUILDING INBPIECTO/ 11_ SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E �- OWNER TELL © d -3ZFZ PERMIT GRANTED CONTR.TEL# S 19 CONTR.LIC. :..;:.. w, . r ' t BUILDING RECORD 1 OCC�ANCY 12 SINGLE FAMILY S;oRIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM .. . .-. ...... MULTI. FAMILY OfFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d' I 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS I PLASTER _ -� DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M"T' AREA _ v, '/r r/ FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD"J"D - ASBESTOS SIDING COM/dCN j VERT, SIDING ASPH. TILE _ STUCCO ON MASONRY - STUCCO ON FRAME " BRICK MASONRY ATTIC STIRS. 3 FLOOR ... _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME - SUPERIOR POOR ADEQUATE - ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR-& GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES ,!` TILE FLOOR TILE DADO 6 FRAMING 11 HEATING _ } WOOD JOIST I PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. R COLS. STEAM j STEEL BMS. 6 COLS. HOT W"T'R OR VAPOR _ WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G - UNIT HEATERS ILII GAS 7 NO. OF ROOMS 011 - B M-T 12nd _ ELECTRIC - - Ist 3rd I NO HEATING OFFICES OF: �r 1 Qwn of ��- A 20 M3itt Sireef - `'PPE''.L-S .� -�►: = NORTH ANDOVER worth Andover. BUILDING t�-'ire - MassdchLkSens O 18-15 CONSERVATION 4""''' Dt%WON OF HE--kLTH < r11.1%,G PLANNING & COMMUNITY DEVELOPSIENT KAPLF— H.P_`ELSO`.DIRECTOR -- In zccrrdZnce with the �rcvsic S54. a condition of Building Pe:i^it Nurtbe: s^ thct :^e dcd;s resultinC :ret^ this work shell be disnas r' Cf in s e gene: by NIG LCII.. S i ne debris will be disposer' cf ic*_ Siem._,re Of PCMA Applicant Date NOTE: Demolition permit from the Tow-a of :forth Andover must be obtained for this project through the Office of the Building Inspector. Town of d o* ver No. Z 3 cl4� }. o dower, Mass. �' 7 19 Coc MichEWICK 4) 0RA7ED VC� 1 S BOARD OF HEALTH Food/Kitchen PERMIT T D * Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......................................... ... -�-t...�........NX)... ... .. ............................................... Foundation has permission to emet.....A4._7�,�..e-C ..... buildings on ...... .. ........ C.1-:F,..S...(.-77.-..0, Rough t0be OCCUpled as......................................................R'.r.�''-. ..-....................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ftST.. ELECTRICAL INSPECTOR Rough ........................................ Service DING INSPECTOR Final Occupancy Permit Required to Occupy BuildingGAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det.