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Foundation has permission to erect.. ....................... buildings on .... ... .... .....al-w.5i........... Rough tobe occupied as ........... ................................. ......... .......................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final I ELECTRICAL INSPECTOR PERMIT EXPIRESRough Service ..UNLESS .. ..,,,ON .. .. .. ... .. . . ..... Final BUIL IN ECTOR GAS INSPECTOR Occupancy Permit Required to Occupy By Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final ® Lathing r all ® Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. A WOODWORKS Estimate 90 Boston St North Andover, Ma 01E MA 01845 (978)305-2547 Date: 04/12/16 cbawoodworksCu)email.com Estimate# 0726 Salesperson Job Payment Terms 1/3 deposit 2/3 completion Brian Kathy Belton Bath Item Description Line Total $0.00 1-Bath Demo bath down to studs and concrete floor. 14,400.00 Frame&prep for widened walk in shower. Install tile floor&walk in shower floor&walls with curb. Electric-Replace vanity light, exhaust fan.Add new shower recessed light. Plumbing-Modify plumbing for widened shower, new vanity&toilet(same location ). Install all fixtures. Plaster walls&ceiling smooth finish. Install wood base molding&door trim,vanity,misc. wall fixtures,mirror etc. Paint walls,ceiling,trim. Contract installed glass shower doors.-Allowance$1300.00 (included ) 2-Bar Sink Remove, modify&reinstall existing base cabinet for 1,200.00 bar sink. Run water lines,drain,vent for sink. Install fixtures. Patch wall as needed. 3-Upstairs Toilet Patch subfloor, replace tiles, resecure toilet as needed 775.00 if determined there is damage. Includes contract/coordinate all trades, disposal, permits. Excludes purchase plumbing fixtures,tile,vanity etc. Total $16,375.00 Quote prepared by: Brian Beasley '4'\At This is a qoutation on the goods named,subject toco itW s nd b ow: tot To accept this quotation, sign here and return: Thank you for your Buisness! UbA vv-o-ocjworK 90 Boston St.No.Andover, MA 01845 Tel : 978-305-2547 Fax: 978-208-8331 Email: cbawoodworks@gmail.com www.cbawoodworks.com it X �r -- ( -!.tea- ! I I � � ` ��-}jet)a� rte. Ty Ve'- ,I - . , 6q"P�j 1-4 c3-M T- 90 Boston St. North Andover,MA 01845 Tel: 978-305-2547 Fax: 978-208-8333 Email: cbawoodworks@cbawoodworks.com 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 at: i C� ��,1�(� (�G-t-h 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 11, S 150 A. der Fire Prevention laws Chapter 148 Section Also, note Permits are required un 10A. The debris will be disposed of in: (Location of Facility) SignaturMf ermit Applicant Date hqs 1 �2© 4 ree- :t ne c.ommonweatrn of massacnstserts Department of Industrial Accidents Office oflnvestigadons IF 600 Washington Street Boston,MA 02111 wwsu massgov/dlia Workers'Compensation Insurance Affidavit"Builders/Contractors/Electricians/Plumbers Ailnlicant Information ( Plea Print Legibly Name(BusinesslOrgaaizationfladividual): Gr lawN (3 i:`-E;t 1�j3 u ��t.yycJn(v Address: 40 6©5 Tdn P City/State/Zi : rt/U t^�1 A�,b hone#: 6n 0— © a 6-142 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. Q I am a general contractor and I 6. ❑New construction mployees(full and/or part time}, have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition wotking for me in any capacity. employees and have workers' 9. [�Building addition [No workers' comp.insurance doe'insurance t 10. Electrical repairs or additions ��1 5. We are a corporation and its ❑ p 3.❑ I am a homeowner doing all woad officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp. right of ex mption per MOL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.0 Other employees.[Ido workers' comp.insurance required.] J. *Any applicant that checks box#1 must also Pili 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 mast submit a new ai5davit iadicaft sorb. #Cantractors that check this boxmmt attached an additiand sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-ooatmetota 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 thepolley and job site information. Insurance Company blame: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Q VD 5' McVn Nrlr`t n�n�s'(9i,�rA CitylState/Zip: �v'J,3" 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenehies of perjury that the information provided above is true and correct. Sitntature Date• c�5'131�1 to Phone# OfJ9eial use on1A Do not write in this area,to be completed by city or tofu official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other ConbetPerson• Phone#: TE D1YYY CERTIFICATE OF LIABILITY INSURANCE DA6/1/2016 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Paul J. MacDonald CPCU CIC NAME: MTM Insurance Associates PHONE (97$)681-5700 F No:(978)681-5777 1320 Osgood Street E-MAIL ADDRESS:certificates@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:Preferred Mutual Ins Cc 15024 INSURED INSURER B. Brian Beasley dba CBA Woodworks INSURER C: 90 BOSTON ST INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR S POLICY NUMBER MMIDD/YYYY MM/DD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED A CLAIMS MADE $❑OCCUR PREMISES a occurrence $ 50,000 BOP0100715042 11/1/2015 11/1/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 B POLICY❑PECOT- F-1LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIErOR/PARTNER/EXECUTIVE ❑ EL.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlonai Remarks Schedule,may be attached If more space Is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 P MacDonald CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r9memi +--f Board of Building Requiations a ud 4 �t�st�ucEicm Sccprn�s{�r -r t _icanse:CS 107038 t BRIAN BEASLEY;-- 68 RUSSELL STREET North Andover NSA 01845 r J.+�� cxpiration Commissioner 03/29/2017 - �. `�>;��e3irirrc�srrrrc�rlf���'�=��r�.:.�iclrr•�/1 Office ofCamumw•AfFain&Business Re it6 r CME IMPROVEMENT CONTRACTOR Ze9isiratian_ -181826 Type; a Expiration: 5r5f2Ek37 DBA CBA WOODS BRWN BEASLEY 90 BOSTON ST NORTH ANDOVER,MA 01845 T3ndcrsen scary