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09993 Date.�.'���I...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
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This certifies that .... ........ .
has permission to perform. l/�C�.:� c • • V Je4p..C. • .. • • ... .
plumbing in the buildings of. P. . 0 C.- ...............
^at • •1�P..4 •�,?� c!�c1� I• North Andover, Mass.
Fee3 l� ... Lic. No.�`T .. .
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PLUMBING INSPECTOR
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY NORTH A DMA DATE PERMIT#
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JOBSITE 1,EE S OWNER'S NAMESi/,;,e Ire Af evo&Xj
OWNER ADDRESS,SSP L TEL 7 FAX
TYPE OR
OCCUPANCY TYPE COMMERCIAL':-.'.." EDUCATIONAL RESIDENTIAL X
PRINT
CLEARLY
NEW: RENOVATION: , REPLACEMENT. PLANS SUBMITTED:
FIXTURES I FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
GROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOILISAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR / AREA DRAIN -J
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
§ERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
IE
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY'. OTHER TYPE OF INDEMNITY BOND
OWNER'S INSURANCE WAIVER- I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application Aging this requirement.
CHECK ONE ONLY: OWNER AGENT I.
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in
compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME THOMAS HALLORAN LICENSE # 24833 SIGNATURE
NIP; JP CORPORATION. PARTNERSHIP'. # LLC' . #
COMPANY NAME HALLORAN PLUMBING ADDRESS 826 DALE ST
CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-685-9504
FAX CELL EMAIL
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The Commonwealth of Massachusetts
Department of Industrial Accidents
v Office of Investigations
WA
600 Washington Street
Boston, MA 02111 t'
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric" s/Plumbers
Applicant Information Please Print Legibly
Name .(Business/Organization/Individual): 060'e A.i i.�m 43; Yla 6 -
Address: ?_-2_ 61 L14 L & _S' i
City/State/Zip:/Neel; ;�/ Phone.#: 9.75 —61 -5r 5- 75-0
Areyou an employer? Check the appropriate box:
1. ❑ I am a employer with ;
4. ❑ I am a general contractor and I
employees (full and/or part time)""
have hired the sub -contractors
2. �4 I am a 'sole proprietor or partner-
listed on the -attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.1
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right 6f exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no -
employees. [No workers'
coma. insurance reauired.l
Type of project (required);,
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ BuiIding addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13.❑ Other
*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, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company
Policy # or Self -ins. Lic. #:'
Expiration Date:
Job Site Address: City/State/Zip:.
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failuie 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 under thheee pains -and penalties of perjury that the information provided above is true and correct.
Signature: .7A— l� Date a %
Phone
not tvrite in this area, to
City or Town:
or town official
Perinit/License #
Issuing Authority (circle one):
'1 . Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector
6.. Other
Contact. Person:
Phone #:
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies that. l� � ..P�Ko,�
has permission for gas installation . vc"A ee— ...........
in the buildings of..
.......................
at
f..at .....Ub� .. Lk AU.��-(�'. .,. , North Andover, Mass.
Fee...P'' 1`
GASINSPECTOR
Check #
8735
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11A5r5A1;MU5E 1 15 UNIFUKIVI APPLIUA 1 IUN I UK A rLKMI I I U rtKrUKm l3A, rt I I INIJ VVK
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CIN NORTH ANDOVER MA DATE 41--2-Y 113 PERMIT # '6225
JOBSITE ADDRESS OWNER'S NAME s Esq t-e:'�D�G
y
ADDRESS TEL FAX
OWNER
TYPE OR
OCCUPANCY TYPE COMMERCIAL! ` EDUCATIONAL µ RESIDENTIAL ".i
PRINT
_ _
CLEARLY
NEW:,.-,. RENOVATION REPLACEMENT C PLANS SUBMITTED: YES. NO'1C
APPLIANCES Z 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
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM I SPACE HEATER
ROOF TOP UNIT
TEST
UNIT.HEATER
UNVENTED ROOM HEATER
WATER HEATER 1
ju ER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES G NO .
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ?.. ~ BOND 11_V,
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 ry AGENT ..p_�
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASATTER NAME LICENSE # 24833 SIGNATURE
MP , �T MGF JP j( JGF , LPGI 2 _. CORPORATION ,# PARTNERSHIP ,_ # LLC ._ #
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COMPANY NAME:THALLORAN PLUMBING ADDRESS 826 DALE ST.
CITY STATE ZIP TEL978-685-9504\L�1
NORTH ANDOVER MA 01843 �
FAX CELLei7Sf d�- ` EMAIL
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The Commonwealth of Massachusetts
Department of Industrial Accidents
+� v Office of Investigations
d 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name.(Business/Organization/Individual):�f�}✓. rf,NJ l�-
Address: 9,2(11 L)/14 i
City/State/Zip: //e- >--/ RC1 ' Phone.#: d7
Are ,you an employer? Check the appropriate box:
1. ❑ I am a employer with '
4. ❑ I am a general contractor and I
employees (full and/or part-time):'`
have hired the sub -contractors
2. D? I am a -sole proprietor or partner-
listed on the -attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.t
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.j
Type of project (requir
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
`Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors ?rust subrrit 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, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
itaformation.
Insurance Company N
Policy # or Self -ins. Lie. #:'
Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failuie 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 may be forwarded to the Office of
Investigations of the DIA for insuranc_e_coverage verification.
I do hereby certify under the pains -mad penattles ofperjury that the information provided above is true and correct.
Sign ature:��r Date: f
Phone #:
not write in this area, to be completed by city or town offaciaL
City or Town:'
Issuing Authority (circle one):
I. Board of Health 2. Building Department
6. Other
Perinitll�icense #
3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector
Contact. Person: Phone
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Post-it'"routing (,Quest pad 7664
Fto TING - REou ""T
Please
❑ READ
❑ HANDLE
❑ APPROVE
and
FORWARD
RETURN
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KEEP OR DISCARD G� t t e
REVIEW W 'T" WIE C�
From
Date -
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/I for of Buildings Date
SECTION i- SITE INFORMATION
1.1% Property Address:
1.2 Assessors Map and Parcel Number:
l0
X
Map 46nber Par umber
1.3 Zoning hiformation:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area s Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. ood Zone Information:
—],g— Sewerage Disposal System:
Public ❑ private ❑ 1 Zone Outside Flood Zone ❑
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record j
'uo 6�1," ZZ
"
Name rint) ' Address for Service
—gignaT&e Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Tel hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 LicensedConstructionSupervi r:
Not Applicable ❑
V
Licensed Construc n Supervisor:
License Number
Address
Exptrahon Date
elephone
=Improvement
C3.2Registered
Hom C
NApplicable ❑
Wor
Company Name
ration Number
Expirdtion Dates
Address
�^"-- _ '/
SiE r Tele hone
M
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 all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑Fe—rations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:,, r
�S
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
lompleted by permit applicant
OFFICIAL USE ONLY
, _. . .... ..... .
I . Building
1w,a
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (e) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AG RT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
e authorize to act on
behalf, in all matters r five to work authorized by this building permit application.
L
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
,. ... .�-E'er--.
NO. OF STORIES SIZE
BASEMENT OR SLAB
RD
SIZE. OF FLOOR T VIBERS 1 2 3
SPAN
DMIENSIONS OF SILLS
DIN ENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT jy "1 P
LOCATION: Assessor's Map Number PARCEL
d, SUBDIVISION LOT (S)
STREET l [1� 1 ST. NUMBER, -
************************************OFFICIAL USE
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR
COMME
TOWN PLANNER
COMM
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMME
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 jm
TE
The Commonwealth of Massachusetts =
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
perluirnmy an wain
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers'
for my employees working on this job.
Insurance Co. Policy # OL" � /O
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00
and/or one years' imprisonment_as_weU_as_civii.penaltiesinsheiorm..cfa STOP WORK ORDFR..and..afine cf..($IDOM)-a�day.againstme: I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
y
/do hereby certify undrwins and penal j jp dury that the information provided above is true and correct.
Print naPhone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
Building Dept
❑Check if immediate response is required Q Licensing Board
p Selectman's Office
Contact person: Phone #: ❑ Health Department
Ei Other
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in: W111�� �ca lgev��/l
(Ldcation oTFacility)
Signatu
10
rmit Applicant
�i6 z
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
P, ,
Proposal Submitted To:
t'����
Address
Phone #
We hereb sl' it s
Page # of pa
Cr
Job Name Job #
Job Location
-f Date Date of Plans
Fax # Architect
ons and estimates for:
We propose hereby to furnish material and labor — complete in accor ance with the above specifications for the sum of:
$ Dollars
< C
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs will be Respectfully
executed only upon written order, and will become an extra charge over and submitted
above the estimate. All agreements contingent upon strikes, accidents, or delays
beyond our control. Note — this proposal may be withdrawn by us if not accepted within days.
acceptance of Vropogai = .
The above prices, specifications and conditions are satisfactory and are Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Signature
sem: NC3819 MADE IN USA
Location / � %' i
No. —42 1— Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # y aJ
1 5t,%3 'Building Inspector
TO" OF NOT ANDOVER.
BUILDING DEPARTMENT
LPPLICATION-.TQ,CONSTRUCT REPAIR, RENOVATE,,.,OR ;DEMOLISH: _,ONE OR,T,WO.FAMILY..DWELLING
M, .,
WMDING PERMIT NUMBER ' y DATE ISSUED:
-IGNATURE:
Date
6: BUILDING SETBACKS ft
Front. Yard .—Side Yard Rear Yard
R ''reel Provide R ` red` Provided red Provided
Water Supply M G.LC.4tl. 34) 1.5. Flood Zone Information.LV. Sew eiag6 Dnposa)rSyst�m
flit . ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal'. Sys em; .15
CTION 2 - PROPERTY OWNERSIDP/ALTM- ORIZED AGENT ,
Owner of Record
A4
me (Print) Address for Service:
;nature Telephone
Owner of Record:
lame Print
Address for Service:
nature --
.�-., .. ..� :Tele :hone ,
MON 3 - CONSTRUCTION SERVICES
tegistered I
me IImprovement Contractor
pany Name el
Expiration Date
Not Applicable ❑
// �?,1
Registration Number
ofi-
Expiration Da e
SECTION 4 - WORKERS COMPENSATION (NLG.i; C 1'52 `§ 25c(6)
Workers Compensation insurance affidavit must be completed and submitted with thisapplication. Failure to provide this affidavit will result
in the denial of -the issuance of the building rmit.
Signed affidavit Attached Yes ....:,0
SECTION 5 DeSCn"titin of PmO&WWOrk-&6eckail8 "livable , .
New Construction 0
Existing Building 0'
Repairs) ❑
Alterations(s)
Addition D
Accessory Bldg., 0
Demolition_ ❑
Other 0 Specify
j
Brief Description of Proposed Work:
O'P%,iivl. V- r 0JLJ1v1JLxr Jl.v1VD Anut-1xvlv`l l`la Ata
ItemEstimated Cost (Dollar) to be
Completed by permit applicant
1. Building (a) Building Permit Fee
IVlulti tier' .
2 Electrical - ,
(b) .Estimated Total Cost of
.,Consouction
3: ,Plumb n ...: B.uilding..Permit fee (a) x (b)
41
Mechanical.: HVAC
5 ..Fie Protection. � a
6 Total _ 1+2+3+4+5 Check'Iuiiber
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , 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 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
t
Print Name
Si ature of Own er/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SITE OF FLOOR TLIVIBERS 1 2 3 RD
SPAN
DII, ENSIGNS OF SILLS
DIMENSIONS OF POSTS
DINMNSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
VIATERLAL OF CH1tVD;EY
S BUILDING ON SOLID OR FILLED LAND
S BUILDING CONNECTED TO NATURAL, GAS LINE
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
.,Z z -/-. -S7
C)OifV a T� f
(Locato of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
e
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 035152
B i it hd ate: -08131/1,948
Exkpires:'*8 1/2003 Tr. no: 2254
Restricfda. 00' .
GLENN C COTE
11 KOPER LN (_«0�
PEL'HAM, NH 03076 Administrator
71.
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration:: 1.14134
lug kx`piration: `08/06/2003
Type:. DR'A
Salem Vinyl, Siding & Windows
I GLENN COTE p'
11 KOPER LN
PELHAM, NH 03076 Administrator
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