HomeMy WebLinkAboutMiscellaneous - 95 APPLETON STREET 4/30/2018Location
No. Date
�aRTM TOWN OF NORTH ANDOVER
OL
9
Certificate of Occupancy $
ACHUS BuildinglFrame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #LLQ
24864 Building Inspector
I \
............
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: q,,33' Date Received
Date Issued: //-2'1
IMPORTANT: Applicant must complete all items on this page
A p��e-ka r
r' Print
MAP NO: 210 PARCEL: .
Print
ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Resioential
Non- Residential
❑ New Building
eOne family
❑ Addition
[I Two or more family
11 Industrial
IK ration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
Os' Well1_
fFlood lam ® Wetland
a P
r 11®aSeptrc
®'WatershedtD stnct;�
p�Water'/Sewere
_
- -
OWNER: Name
Address- OA �
DE5SUMF 11UN Ur W UK1L 1 U Or, rr,tcr U1N-'vmJJ-
0� oq?&J 0�
tification Please Type or Print Clearly)
�wnor
oyrf fy� 0
�uje
Phone: 9) 8 A e b
olE Yf
ame: CoAc— Q04NO!2) Phone: �� %t
CONTRACTOR N l r
Address: kn S -i S U f e— ZZ(o PAC
`A C
Supervisor's Construction License: q 013.8 )Bxp. Date:
Home Improvement License: I 0 4 �-6� Exp. Date:
ARCHITECT/ENGINEE
Phone:
Address: Reg. No
�-i to—(3
FEE SCHEDULE. BULDING PERMIT.' $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
aJ
Total Project Cost: $ 0 00 - FEE: $ i 20
Check No.: Receipt No.: 0
NOTE: Persons contracting with unregistered contractors do not have access to thheegguarantyfund
S�gnatu_re of Agent/Qwner :. w �Signatu[6:b , o.ntractor. ;�:
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, 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
o Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
(VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition or Decks
Li Building Permit Application
❑ Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/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
NOTE: 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)
o Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
(VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
In
i
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE APPROVED
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comm
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS ' -
Dimension
Number of Stories:_
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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Uwe the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
tqoWtionsj-on premises below described: A.
OwnerA
Is Name...... ...... ........... I ylefhone
Job Address .......
. ..... ................ Sul, ...... ... h
Specifications:
........................................................... I ..........................................................................................................................................................
,,Strip existing shingles(1) Apply new drip edge to all edges.4,1,i, 9 rr
............... I .............................................. 4 ............................................................................................... ............................................
-Apply —L—feet ice and water shield membrane to bottom edges of house. 3 feet ice and.water shield membrane
4
in valleys and bottom edges ofany unheated .areas ,of,house
.-',
............... .......
................. .........
................. .................................................. .......... ........
-/Apply felt Pa d,er,]
aymentInstall ridge vent to A .7 'r &.;37f
.......... .... M :.....""j ............ ...........................................
-illifigies - year warranty.,
�Reroof uhn. 0-L with a, 1171,
................................................ . ................. I ................................................................. I ....................... I .........
-Cifiunterflash chimney. New vc-it pipe flashing. —Legal disposal of all debris.
............................................................................... . ...........
. A:'� ; ........... ......c
Arca(s) to be worked on:
........ I ....... ..................... ... ... . .
...................................7 ..I
V", '�.�
"a A
. . .......................................................
................................ I .................................... r .................... ...... 6 ................................................................................................... ..........
Roof board replacement if occcss°.ry @ �p' /sheet
............... ............................................................................. . ..............................................................
Two Year Workmanship Warranty (Not Transferable) Wanufacturer's Warranty as specificilly manufacturer
The eonQactor agps to Perform the work a
.ad ftaishthe materials specified above for the S Sc
I ayab 1120 0
Payable ............... on ........... payable on completion of job
Owner or Owners arc not responsible for Pr�perty Damage or Liability while jog --isin operation. 000
Contractor is not responsible for any damago to the interior oirproperty, including pre-existing conditions (i.e. water stains, crumbling p Is
conditions resulting from application ofmxiuials specified above (i.e. objects coming loose from walls, crumbling plaster, exposed nails, dust in an.ic or other living
spaces). Items in aui: may need to be cover.! by homeowner. All materials are property of contractor. Any dumpster placed by contractor is for his use only. Upon
completion of above work, all undersigned s,ree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation as requested by
contractor. Upon refusal to do so, contracte may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It is
agreed that, ifpermitted bylaw, contractor , 0 be paid by the owners) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that
shall be incurred in tnforcing the terms and xiditions of the contract and/or any lien in connection herewith. it is further agreed that this contract maybe assigned by
contractor, and also that the obligaticashm fshall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they am)
the owners(s) of the above mentioned premnu s and that legal title thereto stands of record in his (their) names(s). There are no representations, guaranties or I .
warranties, except such as may be herein in! rporated, if any, nor any agreements collateral h6rilo, nor is the contract dependent upon of subject to any conditions not
herein stated. Any subsequent agreement in - ^fcrcncc hereto shall be binding only if in writing and signed by all parties.
All Home improvement Contractor shall be registered and any inquiries about a contractor or subcontractor relating to a registration
should be directed to: Director, Hoi..c improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108
Tel: 617-727-8598
Any and all necessary construction-. elated permits shall be obtained by the Contractor. Any Owner who secures his own construction -
related permit or deals with unregist-red contractors ' . s ex . r-uI d d from the Guaranty Fund provisions of MGL c. 142A.
. E� ......
Approximate starting date of work.. Completion date .....
Rccci t ofa coof this contact is kere acpwt it.is,-fiother acknowledged bythepndorsiped that the loi�ezqing_
py y kp
provisionshavc been read and the r thereof. Idersio"o'd and that no representation or1greement not herein contained shall. be
binding upon the parties and that al, of the agreements and understandings of said parties are contained herein.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Owner has three business days to cancel this contract and incur no, penalty (see noire of cancellation).
IN WITNESS WHEREOF, the parties have hereunto signed their names this ............r:.... day of ........... 20...........
Accepted:
Signed ............. .......... . ............
Owner
Signed ....... ............................................................
Owner
.. ....... . ............................
David Castricone, President
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
u,p www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): l HSTae/ C n /ye - Rbo F iNG � Z/b /lI-its /AJ1 1.
Address: :,2G[? -�o7nM-Sir SUI71-ZLk
City/State/Zip: No. AiyboVex,' _
HA 01 Nf Phone#: 971 6 M 2V3 D
Are you an employer? Check the appropriate bog:
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). *
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
7. ❑ Remodeling
ship and have no employees
These sub -contractors have
g. ❑ Demolition
workingfor me in an capacity.
y p ty•
employees and have workers'
comp. insurance.1
9. ❑Building addition
[No workers' comp. insurance
5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
11. E] Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
12.;gRoof repairs
insurance required.] t
c. 152, § 1(4), and we have no
13.❑ Other
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.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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 Name:__ 4 tc T7 S
Policy # or Self -ins. Lie. #: WC0 QJ 2 Lb 2 2 J Expiration Date: 9 - a 3-1 -�
Job Site Address: "lS City/State/Zip: fV() �Ir 10t1 I rl it O�� r
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
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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: .`J../ C Date:
phnne. #• (?7k 4 U
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 #:
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
DEBRIS DISPOSAL FORM
pORTH
0*
a _ r
V
LA 'pq t0t 11tI 1.
°RAreo 1.r
�SSHCIIList
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit # the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MG.L c11, s150a.
The debris will be disposed of in /at:
kZ,-- E INC -
Facility location
Signature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
Project th[Ough the Office of the Building Inspector.
Massachusetts - Dep.artmcnt of Puhlic Safert
Board of Builtlin1,
Re,1•�ulations and Standard
Construction Supervisor Specialty License
License: CS SL 99358
Restricted to: RF,WS
DAVID CASTRICONE
31 COURT STREET
NORTH ANDOVER, MA 01845
e
Expiration: 12/16/2013
('unuuixiuucr Tr#: 7924
1
;:+. .176 "�n0/I"L/l24724,!!(LGL/[ /,�/,...'000lddurr✓un1P�d
O"icc of Consumer Affairs & 1311siness Rcgutation
�k�11 ,HOME IMPROVEMENT CONTRACTOR
�- �,
Expiration:
104569 Type:
r i
ration: 7/14/2012 Private Corporatio
DAID CASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 226
NORTH ANDOVER, MA D1845
Undersecretary
CERTIFICATE OF LIABILITY INSURANCE I oDAT�E)MMIDD/YYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sy, AUTHORIZED
••In TI� +�nT11'4+UTr1 nrn
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
'astern Insurance Group LLC - Main PHONE _ - 7 (FAX
'astern
233 West Central StreetEMAIL
aatick MA 01760 ADDRESS
INSURED 31969 INSURER B:
David Castricone Roofing & Siding Inc INSURER C:
200 Sutton Street #226 INsuRERD:
North Andover MA 01845
COVERAGES CERTIFICATE NUMBER: 71 ai F-;-Aan7 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
,ii28SXrFlii
iPIWU AXP
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1-1 OCCUR
EACH OCCURRENCE Is
PREMISES Ea n.I $
MED EXP (Any oreperson) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN1 AGGREGATE LIMIT APPLIES PER:
POLICY 7 SEPT, LOC
PRODUCTS - COMP/OP AGG $
$
AUTOMOBILE
X
LIABILITY
ANY AUTO
AULOWtJED SCHEDULED
AUTOS X AUTOS
HIRED AU TOS X NON -OWNED
AUTOS
BCNGCV
/1/2011
/1/2012IMIT
Ea accblarM 1000000
BODILY INJURY (Per person) $20000
BODILY INJURY (Per $40000
( )
PROPERTYDAMAGE
Peraccbent$
UMBRELLA U46
EXCESS UAB
OCCUR
CLAMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION$
$
g
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YfN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMSER EXCLUDED?
(Manda)ory in NH)
If )res, describe urder
D SCRIPTIONOFOPERATIONSbebw
NIA
COD3989723
9/23/2011
9/23/2012
X I WC STATU• OlN-
OR
E.L. EACH ACCIDENT $100000
E.L. DISEASE - EA EMPLOYE $100000
—
E.L. DISEASE - POLICYLIMIr I $500000
,n,,,,,,,vnuwr,—anionarnemarKascneoure,nmore spaoeisregmred)
Castricone Roofing & Siding
Suite 226
200 Sutton Street
North Andover, MA 01845
CANC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
® 1988-2010 AC(
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
All rights reserved.
A� CERTIFICATE OF LIABILITY INSURANCE
DATE
PRODUCTS :CDMPIOP APG
9/9/t 011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holier Is an ADDPTIONAL INSURED, the poltoy(Iss) must be endersed. If SUBROGATION IS WAIVED, subject to
the terms and condMons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such andorseman a .
PRODUCER
CONTACT
Willows Insurance Agcy
PHONE c U 976 475 3414 j
51 Coehichewik Dr
NoJ;
B
_
s
PR UCER
North Andover Mp► 01 945
INSURER(S) AFFORDING COVERAGE MAIC Y
INSURED
INBURERAMaiden Special Ins Co
DAVID CASTRICONE ROOFING & SIDING INC
—
INeURERG:
. - ..._.-.—.-
200 Sutton St Suite 226
1NaIJRlR p :
—-••-
NORTH ANDOVER MA 01045
INSURER E I
!`AVCDAr_ee
INBURER F:
-- — - --- •�.vna nvwcrc.+�++aavvca� REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS_ SHOW_ N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSA ct SUBR
LTR ' TYPE OF INSURANCE V ...__ POLICY NUMBER MEfF MOLN:Y EJW ---- •LNNRe
0ENERALLU1BiLRY EACH OCCURRENCE S 1000000
X COMMERCIAL GENERAL LIABILITY DAMAGE TU RIENTED•.__..._....._..__ ..
� PR M0.E§i6eSramen� 1 S 5000C
A = CLASaS•MADE I x l OCCUR 00031600 9/06/2011 /6/2012 MED EXP An ens on S _ _ 1000
"' "' ""— - • PER30MAL b ADV INJURY S 100000C
GEN'L AGGREGATE LIMIT APPLIES PER:
7 POLICY 7 Pia n LOC
AUTOMOBILE LIABILm
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRRD AUTOS
NON -OWNED AUTOS
UMBRELLA LII$ __JOCCUR
EXOBas LLAe CLAIMS.MADE
DEDUCTIBLE
AND EMPLOYERS' UASMITY T f N
ANY PROPRIETOR/PARTNERIEXEOUTNE
OFFICE 11BER EXCLUDED7 D I N1 A
(Mond. IA NMI
t)asc mw OF OPEur4w i LOCA"m, VEHieLES (A"W ACORD tot, Addllanu ReNerko Schedule, ff MM epaee h Nqu)red)
GENERALAGGREGATE
S 2000000
PRODUCTS :CDMPIOP APG
j 100000011
s
COMBINED SINGLE LIMIT
(Fa n0 enl)
S
...-
BODILY INJURY (rw Penon)
S
BODILY INJURY (Per 906dwq
S
PROPERTY DAMAGE
(Per ecdoenp
B
B
_
s
EA.CI1000URRENCE
AGGREGATE
S
E.L. EACH ACCIDENT j
E.L. DISEASE . EA EMPLOYE j
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
David Castricane Roofing S Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS.
Castricone Roofing
200 Sutton Street Suite 226 AUTHORIIIEWUPRESEVTATM
N Andover, MA 01845 n
ACORD 25 (2008109)---6101988
` SI 1988 CORD CORPORATION. All rights reserved,
INS023 (zooeve) The ACORD name and logo are registered marks of ORD
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WILLIAM 1. SCOTT
Director
Town of North Andover t p°RTp,
OFFICE OF
i
COMMUNITY DEVELOPMENT AND SERVICES °
146 Main Street
North Andover, Massachusetts 01845
In accordance w'th the provisions 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 c l 11, S 150A.
The debris will be disposed of in:
pe
(Location of Facility)
Signature of ermit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this
project through the Once of the Building Inspector.
BOARD OF APPEALS 688-9541 BUII.DING 688-9545 CONSERVATION 688.9530 HEALTH 688-9540 PLANNING 688-9535