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Home My WebLink AboutBuilding Permit # 2/18/2016 ------------- ---------------..................--------------------------------------------------------------- BUILDING PERMIT ,AORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION % Permit No#: Date Received— SSACHUS Date Issued: ------------------------ — ----------------——------------------------—-------------- _ ----............................................... 01 1z, I 0RTANT.AppEcant must completeallitems on this page ,gve- LOCATION Print PROPERTY OWNER_ I-AV /-a 4 Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT:......--___Historic..........__Historic District yes 4.5 /- Machine Shop Village yes Qn:a) -—----------. -------------------------..... ........................... TYPE OF IMPROVEMENT PROPOSEDUSE -ReSiclen ti a1 --- Non-Residential ........ ------—----------------- E-i New Building A One family [J Addition Ll Two or more family 0 Industrial Z Alteration No.of units: 11 Commercial 0 Repair,replacement D Assessory Bldg D Others: D Demolition D Other Floodplain Welland- [1:Selp DESCRIPTION OF WORK TO BE PERFORMED: -I A; rC Ava P&�elz Anoo�,, ,1,+41 4 —------------- Identification- Please Type or Print Clearly OWNER: Name: ::I;9 V Phone: Address: Contractor Name. Phone: 31-,51-�'Y-1-7 Email: Address:— 97,� S7— g -�19J-a Supervisor's Construction License: —Exp. Date: Home Improvement License:__ ---Exp. Date: ARCH ITECTtENGINEERS 67 4-' Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BAS-0 ON$125.00 PER S.F. Total Project Cost:$ 15 FEE:$ Check No.: Receipt N&00--1;—LS- NOTE: Persons contracting with unregistered contractors do not have access to the zuarantvfiund ------------ ........... -----------J Town of } F NORYy / Andover 4 O to No. �DO— 2—o it 1 : h ver, Mass, .«' �.95 pA71E Oe U BOARD OF HEALTH Food/Kitchen 11 /y..,,�'_l♦ ILD Septic System THIS CERTIFIES THAT PERMIT ....... .`...r.T .... BUILDING INSPECTOR v has permission to erect..........................buildings on ..Q.... .. ..L..... ... .. ............... Foundation Rough to be occupied as........ w ^....... ..a............................................................... 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 Rough ............................ Service ....................... ....................... Service............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. Town of A nuover No. _1W4W%_W* h ver, Mass, U BOARD OF HEALTH Food/Kitchen PERMIT TO ILD Septic System THIS CERTIFIES THAT"�* * !.......:1* ..... ................................ BUILDING INSPECTOR has permission to erect..........................buildings ..... Foundation Rough to be occupied as.......'K1..4%-—---------A ............................................................... 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 CONSTRUCTIOWART4. Rough 1 14, Service ............. ..................................................... 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 Der. Page No. of Pages ST-E-E-P, 'EN I'VIL K-EIR-511ft",", 'w\ it -682 2W`245- i PROPOSAL SUEe—ED TC, I PHONE 1 DATE STREET I JOBNAME CITY,STATE-6 AIR CODE JOB LOO-We ARCHITECT 1 DATE OF PLANS i JOB PHONE we h—by submit peati-ficirr.and estimate.I- --Zit 7 7 t. it 7 Uir jhapoSP hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars($ Payment to be made aA Webb A. Afi=�gria—Wed I,tee -,p—tied,All Ao,k t,be—pltd,d n,eo,knoinlika 'd'g I.standard puirti..�Any Wtonrl—.,d-re...Peru Abu-�p—kihr— Authorized —Wing extra CON,.111 be execpted only riten A,Ptm.,dIPA and MU b-.Pw an extra Sigoalure, charge—and abye the IuAimat,,All ags onfing-I prin-k- ardent or delays beyond our oucoL 0,ric I, acy We t ,Audi the,ne—eay sr—D,. Note:This proposal may be n Our A,do,are fidly—wed by Gpe...Wn lb—a— withdrawn by us it not accepted within days. Arreptaure of proposal--The above prices,specificatioul and so dtfi-s Bre atisfactery and are hereby accepted,You are authorized Signatum— LZ to do the wok as specified Payment cill be made as outlined apotte. u Date of it Rseptarno signature Proposal Page No. of Pages st"i"�5 il"'CNIIG A-10 1%61 J- 'M 1.0BE I DATE is STREET JOB NAME 1 CITY.STATE-d ZIP CODE I JOB LOCATION I Z-o I ARCHITECT —FDATEOFPLAt>tS ITOPPRONE if We hereby submit specifications and estimates for c cc- Y We 131711PUSP hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: Payment to be—made as tallows dollars Allis ga—yd I.Ge as p-ifiial All—k I.be—prurd I, Authorized ma —.,a t,,,u,',,,,dam1 ty—lic—Any alteration or dessuir-frem b -e- a Signature sm be executed ,Iy rp— mer,and sill b—s xr. charge ovs,acd bri"the_rrm— All mseemerts r-fingsin p-Odk- der—n..,enMmI m car,tire Amud_and othe.,T.Ozi--nwacrs Note:This proposal-may be On, orkers are Wily cosered by prodaran c Compensation Insurance. yoffidown by us if net accepted Rhin days. it r Acceptance of jhoposal—The above prices.specifications Land condtons are satisfactory and are hereby accepted.You re autho-ed Sigr and ""nor t", to do the vack as specified.Payment Oill be made a,outlined abuse. jP If Acceribm Date ce Signaturs' Massachusetts Home Improvement Sample Contract This form satisfies alI basic requirements of the state's H.-hepme-pt Contactor Law(MGL chapter 142A),but does.nt include standard language to protect homeowners.Seek legal advice if necessary.Avy perwn planning borne improvements should first obtain a copy f".A Massachusetts Consumer Guide to Home Improvement"t•.efom agreeing to any work on your residence.Yea may obtain a Ree copy by calling the O(6cc ofConsumer Affaires and Business Re,l.we',Consumer lef eliee Huth-at 617-973-518]or 1-888-283-375]or on our melrsile. Homeowner Information Contractor Information ;lame Company Name J'fry-��-vdy Tea Ff2 o cel SJe,2 ,�P-�SC�.0 Sneer Add�ss( Bos addre=s) Cout creel Sale<persoN Ocarcr Neme 30 CiryTesv. State Lip Code Business Address hu-t ioclade ashewx address) 1Jo. fru m2 -nom o✓fi' s is l5' t I�b14 v/p-j 2 Dxyu Phone F.mg Ph- ceya"" tat Se Zip Cede �1)�6 P3 n25 y G2,f- -11 7 J`` S 7 %Whug Add-(11 diff mfie.above) Business Phone Federal�Ejmployes/ID or S.S Number / >aa�n,m•"maN ��f1��Y �Ca a� �'r�2 tl}�ZO f(o The Contractor agrees to do the followying work for the Homemvner. tDesentre in detail th A pl ted pec[p hclyg b d dyad f rials to be d ddtiwl h -fes.) ;Lla rhe d✓u�2! rLa�<x D,eyc,411-Oeli,i711, ��Fr v'Nd�u t ErkX m j,lie, Al, r-, ,V-.FeXe'ti Required Permits-The fot(owing building pxrmits a2 rcx7uimd Prop... Start and('ompietion Schedule-The follmving schedule will and will be secured by theeontmctor as the horrmon`ners agent: be adhered to unless cimuinstanees bayond the,enactors control arise (Owners who secure their own permits hill be - excluded from the Guaranty Fund provisions of )4Y-1(0 Date when repo-mor win begin mmmeted work. NM GL chapter 142A.) '20'��'Date rehev rnnhacted work will be subeavtially completed_ Total Contract Ptiee and Payment SchedWe The Contractor sgreze to perfrm the unA,furnish iha material and labor specified above fr the total sum oE_ -�t (') Pa} lin.,mill be made according to the folluwiag schedule: S/�,Ci7O upoa sig.mg wntmet(nut to exceed 1t3 ehill tot.)eo.taet priee or the coat of,p....I order items,Muhe-is greats 1 $.S�oa be 3x16;16 nruponeempleaaaof RV --7— d!)P�11'41[ s/5000 _by E1=G ✓b e-poneompleie—f Zzls+a Aw G- 4,46";ors S/G'SSG'6 upon e-pletian fthe wnhaet.(Law forbids demanding bull payment auil wnbaet ie completed to bob pattyys satisfaction) Thef.11ptsang materiaLGlaipment,upst hespccial S to be paid for _ ordered beforethe-.-W begins..-de, to-the complome s,bW.1, S to be paid for NOTES:(-)including allfivcnr.;charges(")taw quires drat say deposit udmvn-payment e,,—by rho...uacmr before csark begius may cot cawed the grater of(a)one-third of the total comm.)price ar(b)the acral cost etanysperial equipment or custmp made material which must be pedal ude-i i,edwarn--e(Na see pku..schedules Ex s ss{4'arraph-Is an express trerranry heron nroyidea by the coptracfor? Na❑yes(all ter.0 of the warra.M1 must be ached ro nu, act) Snbeanfractors-The wn-L,agmen to be solely responsible fr complefion of the work described regudless of the aefom of am third on party(subcontractor utilized by the coneacmr.The-,p finther agrees to be solely responsible fez all payments to all nab-pt-lu e for materials and laborunder ihisa 'e pent Contract Acceptance-Upon signing,this document becomes a binding wntmet sutler low.Uplcss uh-ii,-noted within this docuuwnt,the wntmet shall not imply that any lieu ora her security intuest has been placed on the r.ideae,Revieav the following cautions and uotiees carefully bet re sig.ing this contact • Don't be presaured into signing hecomract.Take time to read and fill -ed it.Ask q...liens ifsometbiag is unclear. • M.ke sure the xontaetor has a valid Home Im ro rant C ulnae,Re isrcntion.The(aw zequires most home improvenn-nt e-uactore aad subcpnrradors to be zegisteted wish the Director ofHome lmprovement�praetor Rogistmfioo.Y,—yiuquimabvu e..tamor registatiou by syri6ng to the Director at t0 Park Plaza,R,,m 5170,Boston,MA 02116 oz bpealling 617-973-8787 or 888-283-3"757. • Dees the contmeror hake i...m...?Ask the C,pue, rfor hies inauaae mmpa.y infonrcatiav so that yon wn wafi n coyeage,or ask to copy of.pmofofivsmpnce"document. • Kay-rights and responsibilities.Read the Important lnfomvatien on the rerrrso side-of skis farntand gets copy of the Consumer Guide 1,the He.m Impmveme.1 Contractor Law. You may auwl this agmemxaz Wit has been eigned et a place ober than the wntmctots normal place ofb,,i.ess,provided you notify he wntractor in milting ae bisfier main otHce or bmneh of ice by 4rdi-,,mail pastel by telegmm ecru or by delivery,not later than midnight oMe third business day following the signing of this agreement Sex the attached notice ofc.ncellation f mt fr an explanaeov of this rieM. DO NOT SIG'THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Tu-o idn ca utltn zo nn�lM -1l—f Y -0 Fy'shealdgatoarctavrcauncr.The�tMr�oPy.=h tb tM conrca.rw. our iS Sig ContaY 's Sim gnaNre da Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)iftbey have a dispute with a contractor.The same right is not automatically afforded to a contractor,however_The contractor would have to resolve any dispute helshe has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the retary of[he Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to s mit to suchbittatio s provided In Massachusetts General Laws,chapter 142A. J� He e—ex tgnamre Conga or's sig ur- TICE:The signatures of the parties above apply only to the agreement of the parties to altemadve dispute Ell initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homemvner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.to addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homcowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in plicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/hemelf to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in ajoint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at Ii>tt .'anviv.mass,��ocbcabr;' If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of Elie Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website atrtiivtr v.mass.eeviocabr! Go online to view the status of a Home Improvement Contractor's Registration: hutR!/db state nig uaho nore,emenl,1u cnseehst.up For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 ve.i-z1-un:nmo NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE;OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT, TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF TIES CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO[Name of Seller],AT[Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OFA—/V—20 16 (date). I HEREBY CANCEL THI RANS TIO Date: < Buyer's Signatu .!I'— 83;x.......------X 'I 41$'— 41 D = A 201»"___._ 120" --------- 79 ...... ....... t 20'------ .. .... 79ia—-------------------- 1 -----1 15 31 N 5 m 13;' 30" 36' 22„' 7 38 2 f,73 n” 781C30 MESE 21 to U30842455F3� I N � 3 � P 618W82 ,�yQ�i{ I � � E'RC2430R 1 3 � I W?330WCM �� •�- - � '4, _ „l 111 � _ 38-711".--------- '0, _.—. _. ........ - _33 _________ u•_.____ 5�._._________90�+d.� 231V.....................................___ _........________________....__..__ _._..... _.._._ __...._ ....._ .— ...... __........................._.____________.— _ .._ 11 dimensions_size designations Copyright 2015 This is an original design and must Designed:2/15/2016 ven are subject to verification on Pridecraft,Inc not be released or copied unless Printed: 2/18/2016 site and adjustment to fit job All Rights Reserved applicable fee has been paid or job ----------- )nditions. order placed. - --- - ...._... g._— . arrow Kitchen Option 2 Rev 1 ____. _..-_..-_ P All Drawm #: 1 No Scale.'; Project:O 9 Ninth St West Salisbury,MA 16026 Lf Dan L Gar...P.E. Location621 W8 Gelinas Structural Engineering LLC Uniformly Loaded Floor Beam 579A North End Blvd [2009 International Building Code(AISC 13th Ed ASD)] Salisbu hAA 01952-1738:Ph 978.465.6436 A992-50 W8x13 x 16.67 FT StruCalc Version 8.0.113.0 2/2/2016 1:48:46 PM Section Adequate By:6.61 LOADING DIAGRAM Controlling Factor:Deflection DEFLECTIONS Center Live Load 0.54 IN U367 Dead Load 0.24 in Total Load 0.78 IN 11256 Live Load Deflection Criteria:L/240 Total Load Deflection Criteria:11240 REACTIONS A B Live Load 3001 Ib 3001 to Dead Load 1309 Ib 1309 Ib Total Load 4309 Ib 4309 Ib Bearing Length 0.56 in 0.56 in BEAM DATA Center A Span Length 16.67 It Unbraced Length-Top 0 It STEEL PROPERTIES FLOOR LOADING W8x1 3-A992-50 Side Side Floor Live Load FILL= 30 psf 0 psf Properties: Floor Dead Load FDL= 12 psf 0 psf Yield Stress: Fy= 50 ksi Floor Tributary Width FTW= 12 It 0 ft Modulus of Elasticity: E= 29000 ksi Wall Load WALL= 0 pit Depth: d= 7.99in BEAM LOADING Web Thickness: tw,= 0.23 in Beam Total Live Load: wL= 360 plf Flange Width: of= 4 in Beam Total Dead Load: wD= 144 plf Flange Thickness tf= 0.26 in Beam Self Weight: BSW= 13 plf Distance to Web Toe of Fillet: k= 0.56 in Total Maximum Load: wT= 517 plf Moment of Inertia About X-X Axis: lx= 39.6 in4 Section Modulus About X-X Axis: Sx= 9.91 m3Plastic Section Modulus About X-X Axis: Zx= 11.4 m3A_u v: Design Properties per AISC 13th Edition Steel Manual: Flange Buckling Ratio: FBR= 7.84 Allowable Flange Buckling Ratio: AFBR= 9.15 ` f Web Buckling Ratio: WEIR= 29.91 Allowable Web Buckling Ratio: AW BR= 90.55 Controlling Unbraced Length: Lb= 0 it [} Limiting Unbraced Length- for lateral-torsional buckling: Lp= 2.98 it Nominal Flexural Strength avl safety factor Mn= 28443 ft-Ib Controlling Equation: F2-1 Web height tothickness ratio: h/tw= 29.91 _ Limiting height to thickness ratio for eqn.G2-2:hRw-limit= 53.95j Cv Factor: Cv= 1 - v Controlling Equation: G2-2 r; Nominal Shear Strength wt safety factor: Va= 36754 to --- -- '--- ---- Controlling Moment: 17959 ft-Ib : 3- - 8.335ftfrom left support Created by combining all dead and live loads. Controlling Shear: 4309 Ib At support. Created by combining all dead and live loads. Comparisons with required sections: Read Provide Moment of Inertia(deflection): 37.16 m4 39.6 in4 Moment: 17959 ft-Ib 28443 ft-Ib Shear: 43091b 36754 Ib NOTES Member OK Vob 153 7 The Commonwealth of Massachusetts Departinent oflndustriatAccidents X Congress Street,Suite 100 V- -° Foston,MA 02114-2017 wwturnassgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/EZectricians/Plumbexs. TO BEMET)WZTHTHEPEIttYR-MiGAUT110RITY. Please Print Legibly Applicant Information Name(Bus nesstOrgan zaf onttndiv dnal): �/ ✓� e �cx/(l �r s^ Address: �i T�u� /¢ Phone# 5'�� ry%y SYS City/StatelZip: — Are Yen an employer?Checkflie appropriate ax: Type of project(Tviquived): IQ I am aemployerwith empleyees(fir11.and/orpart-time).+' '/. E]Near construction 2- Iamasoleproprictororpartocohipand have nosmgloyeesworsingformein 8. C(Remodeling any capacity.(Nowell exe,comp.insurance required.] 9• El Demolition 3.C]Icon ahorncevmerdoing allworkmysclENoworkers'comp.bzsnrancerequired"t 10d$nildiagaddition 4.[]I am ahomeowner andvRl be biring contractors to coaduot allworkmmy Property.Iwill IQ]Electrical xepairs or additions ensmethat all conhecons either have workers'compensation insurance or ars sole S.Q I am a general contractorandShayel?iradfhs sub-contractors 7isfed oaths attached sheet. 13•�RoOfxepaixS These sub-contractors hada employees andfiavaworkers'comp.insurancet 14❑Other 6,E]Weare a corporation and ifs gifto have exerclsedtheir Tight of'exempfion per MGL c. 152,§S(4),andwehava no.cmglgyees.�N'o workers'comp.insumnca required.] "Anyapplicantthatcheckslox#tmustalso filloutthosectionbdowshowingths'workers'ecmpeasationpolicy information t Homeowners who sutimifffii,ah8davitindiectingthey are doing all workandtheahire outside contractors must submit anewaffidevit indicating such. =Confraatars that cheskthls boxmustattached an additional sheet sfiowingthe name oFthe suh-contcactom and sfatawhether ar notthose entities haus employees.IFthe subconlraaiorshaYe empioyees,theymust prnvidethsir workeis'comp.pelicynumber. - Ionian eniployer iflat ivproviditag workers'compensation insuranceforr my employees.'Below is thepolicy andjob site information. 7usaranco Company Name; policy#or Self-ins,Lic.#: Expiration Dato: - Sob Site Address: City/State/Zip: Attach a copy of tho workers'campensation policy declaration page(showing the polleynumber and expiration date). failure to secure coverage as required under MGL e.152,§25A is a criminal violation punishable by a lima up to$1,500.00 and/or one-year imprisonment,as well as civil penalties bathe form ofo.STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement:may be fortivarded to the Office of Investigations ofthe DIA.for insurance coverage verification. fdohe ebycert iaiderthe all's andprouritlos ofpeijupy that the informationprovided above is irtre and correct Date: Signafire• Phone# P2 f Official use only.Do notivrite in this area,to be completed by city or lawn official. City or Town: Permit/License# Issuing Authority{circle one): i 1.Board of Health 2.Building Department 3.City/Torun Clerk 4.Electrical Inspector 5.PIumbingluspeetor 6.Other Contact Person: phone 0: Farm Family Casualty Insurance Company Farm P.O.Box 656 Albany,New York 12201-0656 Family SELECT BUSINESS PACKAGE DECLARATION PAGE Casualty Insurance Company a --t- Policy Policy Number: 2005X0431 Portfolio Number: Account Number: Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY,MA,01952-1702 Agent: 3485 D-JOHNSON INSURANCE AGENCY,INC. 7 GROVE ST STE 201 TOPSFIELD MA,01983-1862 Agent Phone: 978-887-8304 Business Description: CARPENTRY Form of Business:IndividuaUSole Proprietor Transaction Type:Renew Policy Period:From 03-21-2015 To 03-21-2016 12:01 A.M.Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THE POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE Buildings $0 Business Personal Property $5,000 Business Income&Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements See Schedules LIABILITY COVERAGE General Aggregate Limit(Other than Products-Completed Ops.) $1,000,000 Products-Completed Operations Aggregate Limit $1,000,000 Personal&Advertising Injury $500,000 EACH PERSON/ORGANIZATION Each Occurrence Limit $500,000 Medical Expenses $5,000 EACH PERSON Other Endorsements See Schedules PREMIUM Premium shown is payable at inception Total Premium . POLICY SUBJECT TO ANNUAL AUDIT:Yes The Declarations,Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date:01-28-2015 X-3842 0214 Page 1 of 4 2005—.1-2&2015-2— Farm Family Casualty Insurance Company Farm P.Q.Box 656 Albany,New York 12201-0656 Family SELECT BUSINESS PACKAGE DECLARATION PAGE Casualty Insurance Company Policy Number: 2005X0431 Portfolio Number: Account Number: Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY,MA,01952-1702 Agent: 3485 D-JOHNSON INSURANCE AGENCY,INC. 7 GROVE ST STE 201 TOPSFIELD MA,01983-1862 Agent Phone: 978-887-8304 Business Description: CARPENTRY Form of Business:Individual/Sole Proprietor Transaction Type:Renew Policy Period:From 03-21-2016 To 03-21-2017 12:01 A.M.Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THE POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE Buildings $0 Business Personal Property $5,000 Business Income&Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements See Schedules LIABILITY COVERAGE General Aggregate Limit(Other than Products-Completed Ops.) $1,000,000 Products-Completed Operations Aggregate Limit $1,000,000 Personal&Advertising Injury $500,000 EACH PERSON/ORGANIZATION Each Occurrence Limit $500,000 Medical Expenses $5,000 EACH PERSON Other Endorsements See Schedules PREMIUM Premium shown is payable at inception Total Premium POLICY SUBJECT TO ANNUAL AUDIT:Yes The Declarations,Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date:01-29-2016 X-3842 0214 Page 1 of 5 --1 011-M 1.2-. t Massachusetts e Department OF Public Safety Board of Building Regulations arid Sant=lord: License:CS-027$89 N STEPHEN M RE -- 9 9TH SIREET V&ES` , SALISBURY MN-01 —- `fit+s w-; ;ssiflne; 0711612017 s Otfce Cion me Affairs&business Reg 1 t n NOME IMPROVEMENT CONTRACTOR Type: T3egistration: 101676 xpf,,tion: 6!2912016 Individual STEPHEN M.KEISLING Stephen Keisling 9 NINTH STREET - SALISBURY,MA 01952 Undersecretary �U �J \ C. Ca - GABLE END G„ 2ND FLOOR (5) 1-3/4"X9-1/2"SCREW 2 ROWS 12"O.C.TRUS LOC SCREWS BEAM-HEADER OR W6x20 OR W8xl3 Z SIMPSON H2.5A EACH JOIST IF BEAM 16'-6" cL BEARING (4)2"x4., OR W10x12 N co m IS DROPPED JOIST HANGERS IF FLUSH Y z (4)2"X4" z w EXTERIOR WALL Width = bf U) 3: z 1st FLOOR BLOCK SOLID - II STAIR BLOCK SOLID ¢ 41 20W EXISTING > W = NEW 3-1/24 I Ir� LALLY I p W 6x20Y m00 Wz ¢ LALLY COLUMN I ( _ p d = 6.20 inch oa o bf = 6 . 02 inch o z BASEMENT SLAB u weight 20 # /ft Width Five 1-3/4" ;.: . 8-3/4" NEW FOOTING 2'x2'xl' 4000 PSI CONCRETE Width = bf j' Width = bf 28 DAYS OPTION 14"THICK 18"02"WITH#4 BOTTOM / t `r EACH WAY 6"O.C. u ='r" PROVIDE 3"CLEAR 1 QQ(D j 1 1itCL -0 W 10x12 ( W 8x13 T d = 9 . 87 ,nch d = 7 . 99 inch HEET NO Scr Lac ELEVATION bf = 3 . 96 inch bf 4 inch SGI Screws two Rows SCALE. 1/4"=l'-O" weight 12 # /ft weight 13 # /ft 12" c. c .