HomeMy WebLinkAboutBuilding Permit #558-15 - 118 SUTTON HILL ROAD 12/16/2014 BUILDING PERMIT No RT bgti
TOWN OF NORTH ANDOVER r02zh�
APPLICATION FOR PLAN EXAMINATION
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PermitNo#:22�& Date Received /4AORATED rPP`y(y
SS US
Date Issued:
P RTANT: Applicant must complete all items on this page
LOCATION -
PROPERTY OWNER
Print 100 Year Structure yes no
MAP t PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Co mercial
❑ Repair, replacement ❑Assessory Bldg Others:
❑ Demolition ❑ Other
q Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
�
DESCRIPTION�FV RK TO BE PERFORMED:
Identificati n-,Please a or Pr' t Clearly �G�
OWNER: Name: Phone: C� r����
Address: •
Contractor Name W4P h o n e:
Address.
C7.
Supervisor's Construction License: t J Exp. Date:
Home Improvement.License: _ 1 Exp. Date: .
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. l
Total Project Cost: $ (0 C")40, FEE: $ O
Check No.: Receipt No.: %
NOTE: Persons contracting with unregistered contractors do not have access to uaranty fun
Signature of Agent/Owner Signature of contractor
J
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE'dF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
4
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
6
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
C-onservation Decision: Comments
Water & Sewer Connection/Signature& Date
i Driveway Permit
DPW Town Engineer: Signature:
Located 3.84 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no _5
Located,at 124 Main Street - - -
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
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 Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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
Li Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a 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)
o Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o 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
o Engineering Affidavits for Engineered products
j NOTE: 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:Building Permit Revised 2014
Location 8 `V`�� \QJ .
No. 6 "'.l
Date
e - TOWN OF NORTH ANDOVER
•
Certificate of Occupancy $
P 41
Building/Frame Permit Fee $
s_
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#1 O
Building Inspector
�
Town of 2 e�ORT1y Andover
0%
No. 66B.0
h ver, Mass,
ACOC HIC Hl W1[�t �7'
�•9 �R�reo �Pa��S
S tl
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT .................. � ..... ,�i�,,, ,,, ,,,,,,,,,,,, BUILDING INSPECTOR
has permission to erect .......... buildings on` Foundation
................ ....... ... ... . ............... .1ap
Rough
to be occupied as ........ ... .. ... .... ... ................. .. .... :. .. ..-t................................. Chimney
provided that the person accepting t s permit shall in every respect nform 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
ottr
. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIS Rough
Service
................ ..... ... .... .......................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
�,S:I{ FOWLER LEP I IdSURANCE : . _ _
Y CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
TNtSGERTIFICATE IS ISSUED ASA 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
IMPORTANT:It the certificate holder Is an ADDITIONAL INSURED,the poliwies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
A&h MWLE;R M LL(.' PHONE FAX
`_Oil PARK STRF.FT (A1C.No,Ext): (AIC,NO):
E-MAIL
NOR'I'll R :ADI\U.1I. 018(,1 ADDRESS:
�vJhk
INSURERIS)AFFORDING COVERAGE NAIC 9
INSURED INSURER A: ,\(1 :�t73:Ki!_'.iti L�51 tL�:CE CtJ>9P,LV1'
BAY S` A 11 ROOFERS 1\(: INSURER 8:
INSURER C:
P0 HON (SV INSURER D:
INSURER E:
NORTH RF-ADING.NIA 01861
INSURER F: i
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED LOW HAVE BEGNISSUEDTO 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 TMS 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 LIMTS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDYYYV) (MMIDDIYYYY) LIMITS
GENERALLIABIUTY CH OCCURRENCE $
COMMERC AL GENERAL LABILITY _.
CLAIMSMADE [DOCCUR DAMAGE TO RENTED 5
REMISES(Ea occurrence)
ED EXP(Anyone person) $
GEN'L AGGREGATE LIMIT APPLIES PER ERSONAL&ADV INJURY $
ENERALAGGREGATE $
PCLICY 1:1 PROJECT LOC RODUCTS-COMP/OPAGG $
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE $
LIMIT(Ea acc,dent)
ALL OWNED AUTOS BODILY INJURY S
SCHEDULE AUTOS (Per person)
HIREDAUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE 5
(Per accldenti
UMBRELLA LIABOCCUR EACH OCCURRENCE 5
EXCESS LAB CLAIMS-MADE AGGREGATE Is
DEDUCTIBLE $
RETENTION : 5
A WORKER'SCONPENSATION AND `
EIVPLOYER'SLIABILITY YIN UB-a609P(Xi2-1a 0411 2J2014 04/1 212015
NIA E.L.EACH ACCIDENT 5 1,000,000
IMantlatorytnNFe E.L DISEASE-EA EMPLOYEE 5 1.000.000
E.L.DISEASE-POLICY LIMIT 5 1,000.000
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONWSPECIAL ITEMS
"IHISREPLA(?.5AN% PRIOR(3K?IF1Cn')YISM kI)'1O'MIw FR'n}li'A'ibHU117I:k,l:F},<'I'1\OWORt:FKS )11}'C"0\'FI'Aui
CERTIFICATE HOLDER _ ;CANCELLATION
( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL V DELIVEM
IN ACCORDANCE WITH THE POLICY PROM
:AUTHORIZED REPRESENTATIVE ``r
ACORO 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988.2010 ACORO CORP RA 10 . r"Ights riseived.
The Commonwealth of Massachresetis ,_ -
-• D al-tlnel2t ofIndusfr!g1 Accid&fs
office refInvesfigaflons
6001 Washington.Sheet
.Boston,lV1A 02111
ky www massgovldia
' orkexs9 Compensation hisurance Affidavit:Builders/Contxaetoxsl.Ei ctxiclkleaslxinl Lber
A Xl[cant Info xlHat ion
Name(Business/Organization/individad):
Address': Z46
-7i- (oC q 0 6(o8
City/State/Zip: ` Phone#:
Are you an employer?check the appropriate box: Type of project(required):
1.�am a employer with 4. ❑ I am a general contractor and I 6. Q New construction
_____ have hired the sub-contractors
employees(fall.and/or part-tame).• listed on the attached sheet." 7. ❑Remodeling
2,[( I am a sole proprietor orparfn0r
These sub-contractors have 8. [(Demolition
ship an&have no employees
working forma in any capacity. woxkers'comp.insurance. 9, Q Building addition
[No workers' comp.insurance 5. E]We are a corporation and its 10 p Electrical repairs or additions
required.] officers have exercised their
right of exemption Per MGL 11.❑plumbing.repairs or additions
3.❑ x an a homeowner doing all work c.152,§1(4),and we have no 12.p Roof repairs
myself.LNo workers comp. employees. o workers'
insuxancerequired.]ik13.[]Other
comp.insurance required.]
!Any applicant that checks box#1 mustato,fal outthe section below showingiheir workers'compensationpolicy information.
'Homeowners who suhmitthis affidavit indicatingthey 2•re doing allwork and then hire outside contractors must submit anew aff[devit indicating such.
xClomeofors that chec bmis box must attached an additional sheet showing the name of the sub-contracfors and their workers'comp.policy information.
X am an employer that isproviding workers,compensation insurance for my employees'. Below is the policy and job,site
information.
l,Ce
Insurance Company Name: A &�e
p � 2.c C�
Policy##or S elf ins.Lic.#1:
-�0 Z' Expiration Date:
t C' JStatep/Zi :
Sob S '
ite.A,ddress' 4 5J� r
o the olio number and expiration date).
'com ensatioz� olicy declaration page(Showing policy o the workers p �
�.CO �
Attach copy
Failure to secure coverage as xequixedunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a
firoe up to$1,5Q0.00 and/or one�year imprison ent,as wellas civilpenalties inthe form.of a STOP WORK ORDER and a fine
ofup to$250.00 a day against the violator: Be advised that a copy ofthis statement may be forwardedto the Office of
investigations of the DfA for insurance coverage vexirication.
X do hereby certi ur2 the pa' e ltie ofperjury Mat Erie inprmadon provided above is/tate a t correct, -
Date:
Si atare•
phone
Offteial use only. Do not write in this area,to he completed by city or town official.
City or Town:
#
issuing Authority(circle one):
].Board of Health .2.BuildingDepartment 3.City/Town Clerk 4.mectrical Inspector 5.Plumbingxnspectox°
6.Other -
phone#:
Information and Instructions '
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 of hire,•
express orimplied,oral or written?,
An employe. is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormoxa
of the foregoing engaged in a joint enterprise,and including the legal representatives of wdeceased employer,or the
receiver or tt ustee`of an.Indiv dual,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 on the grounds or building appurtenant thereto shall not b ecause of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or lobal 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,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions spall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of 61s 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-contractor(s)name(s),address(es)and phonenumber(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members orpartuers,arenotrequiredto cartyworkers'compensationiasurauce. If anLLCorLLPdoes have
employees,apolicyismquired. De advised that this of idavitmay be submitted.to the Department of Industrial
Accidents for confnnation 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 the permit 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 tho appropriate line. `
City or Town Officials
Please be sure that the affidavit is complete andprinted legibly. The Departmenthas provided aspace at the bottom
ofthe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fIl in the permit/license number whichwill be used as a reference number. Th addition,an applicant
that must submitmultiple permit/license applications in any given year,need only submit ante af 11davit indioating curxent
policy information(ifnecessaty)and under"fob Site Address"the applicant shouldwrite"all locations fit-(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 affidavit is on flo for future permits or licenses.Anew affidavit must be filled out each,
year.Where ahome 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 NOTrequircd to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and shouldyou have any questions,
please do not hesitate to give us a call. '
The Department's address,telephone and fax number:
Tho CQ oxIWvoaltbL ofy-assaohmutts
DePattmmto. kdustdaxAM&ata
Boston, 02111
TO,4 617-727,4900 lmt 406 ox x-8,77,MMSA.'M
Revised 5-26-05 Fal,0 617-M-7749
Baystate Roofers, Inc. Proposal
P.O. Box 189
North Reading, MA 01864
Date Estimate#
Tel. 978-664-0668
Fax 978-664-4333 10/28/2014 15714
Name/Address HIC # 137193
Marilin Segal CSSL# 99895
118 Sutton Hill Rd.
N.Andover,Ma.01845
Bay State Roofers Inc proposes:
Remove approximately 2100 square feet of the existing asphalt shingle roof down to the wood decking.
Install new ice and water shield along the 6'roof edge, valleys and around all the roof penetrations.
Install new 151b felt paper throughout roof area.
Install new white aluminum drip edge along the roof perimeter.
A new Lifetime GAF Architectural asphalt shingle will be installed over the prepared substrate.
A new ridge vent will be installed to ensure the proper roof ventilation.
All roof penetrations and flashing will be installed according to manufacturers recommendation, specification
and details.
Install new pipe flanges.
Bay State Roofers will properly dispose of all roof debris in our own waste containers.
Any wood decking that needs replacement will be an additional $2.50 per lineal foot.
Install zinc strips on both front and back roofs. This is included in this proposal.
New Shingle Roof
Authorized Signatur .
nA
Tota $6,840.00
Waste containers supplied by Bay State Roofers, Inc. are for sole purpose of roof debris.
Under no circumstance is the homeowner to use these containers for personal use.
10 Year Workmanship Warranty on all roofs. (Except Repair Jobs)
CONTRACT ACCEPTANCE
The specifications,prices,payment schedule are satisfactory and hereby accepted. Date: j C( 4
BAY STATE ROOFERS,INC.is authorized to perform work as specified.
Payment will be made as previously outlined. Signature L,((
All bills over 30 days are subject to 1 1/2%finance charge per month(18%
annual). Color VU " 00
PROVISIONS OF THE AGREEMENT
I.PROJECT PROVISIONS e. Damage to Project: Contractor will not be responsible for any
a.Guideline:The Project will be constructed in strict conformance damage caused by the Owner. or other causes beyond the control of
to the plans and specifications which have been examined and the Contractor.Owner will pay for any restoration work.
approved by the Owner. IV.CONTRACTOR'S RIGHTS AND RESPONSIBILITIES
b.Compliance:The Project will be completed in strict compliance
with all laws, ordinances, rules and regulations of the applicable a. Delay: Contractor will be excused for any delay beyond his
government authorities. reasonable control. These delays may include, but are not limited to
c. Control:The Agreement plans and specifications are intended Acts of God, labor disputes,inclement weather,acts of public authority,
to supplement each other. In case of conflict, the plans will control the acts of the Owner.or other unforeseen contingencies.
specifications and the Agreement provisions will control both. b. Right to Stop Work: If any payment under this Agreement is
d.Charge Orders:As directed by the Owner,construction lender, not made when due, the Contractor may suspend work on the job until
public body or inspector,any alteration or deviation from the specifications such time as all payments due have been made. Any failure to make
that involves extra cost(subcontract, labor, materials)will be executed payment is subject to a claim enforced against the property in
only upon the parties entering into a written change order. Expense accordance with the applicable lien laws.
incurred because of unusual or unanticipated conditions will be paid for c.Substitution of Materials:Contractor may substitute materials
by the Owner. without notice to the Owner in order to allow work to proceed, provided
e. Allowances: If the Agreement price includes allowances, and that the substituted materials are of no lesser quality than those listed
the cost of performing the work is greater or less than this allowance, in the specifications.
then the Agreement price will be adjusted accordingly. d.Salvage:All salvage resulting from work under this Agreement
II.FINANCIAL RIGHTS AND RESPONSIBILITIES is to be retained by the Contractor unless other agreements are
contained in the written specifications.
a. Labor and Material: Contractor will provide and pay for all e. Insurance: -Contractor will maintain workers' disability
labor and materials necessary to complete the Project. Contractor is compensation insurance for his employees and comprehensive public
released from this obligation for expenses incurred when the Owner is liability insurance policies.
in arrears in making progress payments.
b.Permits:Contractor will obtain and pay for all required building V.COMPLETION OF PROJECT
permits and licenses. a. Notice: Owner agrees to sign a Notice of Completion within 5
c.Taxes,Assessments and Charges:Taxes.special assessments days after completion of the project. If project passes final inspection
of all descriptions, and charges required by public bodies and utilities and the Owner does not sign the Notice,the Contractor may act as the
will be paid for by the Owner. Owner's agent and sign the Notice.
d. Deposit of Payments: Contractor is required to deposit all b. Clean-up: Contractor is responsible for removing debris and
payments received prior to completion in an escrow account. In lieu of surplus material from the property, and leaving the property in a neat
such a deposit,the Contractor may post a bond or contract of indemnity and orderly condition.
with the Owner guaranteeing the return or proper application of such VI.CONFLICT PROVISIONS
payments to the purposes of the contract. All advanced funds will be a. Arbitration: Any controversy or claim arising out of this
deposited as indicated under Special Provisions. Monies used in Agreement that cannot be resolved, is subject to arbitration, with
escrow become the property of the Contractor when they are applied an arbitrator of mutual agreement, and all parties (including
according to the Agreement payment schedule, when a breach of Owner, Contractor, Architect and Sub-Contractors) are bound to
contract by the Owner occurs, or when the Agreement has been this arbitration, If any party does not appear at arbitration
substantially performed. proceedings, the arbitrator is empowered to decide the controversy
e. Bankruptcy: It either party becomes bankrupt. the other party in accordance with whatever evidence is presented by the
has the right to cancel this Agreement. party(ies)that do participate.
III.OWNER'S RIGHTS AND RESPONSIBILITIES b. Attorney Fees: If either party becomes involved in litigation
a. Cancellation: Owner has an unconditional right to cancel the arising out of Agreement, the Court shall award costs/expenses
Agreement, without penalty or obligation, until midnight of the third including attorney fees to the party justly entitled to them.
business day after the Agreement was signed. Cancellation must be c. Limitations: No action related to this Project may be made
done in writing. Upon cancellation, any property traded in, any by either party against the other more than 2 years after the
payments made under this Agreement, and any negotiated instrument completion of work.
executed will be returned within 10 business days following receipt by VII.GENERAL PROVISIONS
the Contractor of cancellation notice.
b. Property Lines: Owner shall locate and point out property a. Notice:Any notice required or permitted under this Agreement
lines to the Contractor.Contractor may, at his option,require the Owner may be given by certified or registered mail at the addresses contained
to provide a licensed land surveyor's map of the property. in the Agreement.
c. Liens: Failure to pay persons supplying materials or services b. Prohibition of Assignment: Neither party may assign this
according to the terms of this Agreement may result in the filing of Agreement or payment due under this Agreement without the written
mechanic's liens on the affected property. Owner has the right to ask consent of the other party.
the Contractor for lien waivers from all persons supplying these c. Qualification:This document constitutes the entire agreement
materials or services. In the event any mechanic's lien is filed through of the parties. No other agreements exist. This Agreement can be
no fault of the Owner, then the Contractor agrees to take all steps modified only by written agreement signed by both parties.
necessary for the release and discharge of such lien.
d.Insurance:Owner will maintain property damage insurance at d.Governance:This Agreement shall be construed in accordance
least equal to the Agreement price. with and governed by, the laws of the state in which the Project is
located.
3
1
./1ze 1o�rrunwouuec>�� a�,.�aaaac�u�ael�`6 '
Office of Consumer Affairs&Business Regulation
_ HOME IMPROVEMENT CONTRACTOR
Registration X137193 Type,,
Expiration:=10115/20x,6 Supplement l;
it li — k
PI
BAY STATE ROOFERiINC. x
ROBERT O'KEEFE `
PO BOX 189
N.READING MA 0186d'
Undersecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards'
Construction Supervisor Specialth
License: CSSL-099895
+ ROBERT E OKEEFE
21 FRANCIS STR:EETII"
NORTH READING 1VIA 08
;, ++A'` Expiration
09/29/2015
� Commissioner •
Date.��' � . . �-' . . .. . .
i
HORTp
41
L
to
TOWN OF NORTH ANDOV R
• PERMIT FOR GAS INSTAL/LLATION
• o i
t ,S SAC HUSE�Sy .,
This certifies that . .�,. . .. . .�/�!�! . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . .
in the buildings of . . . C,r ,� .( . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at ��. r17: . . . . . . , North Andover, Mass.
Fee. . .:?r' . . Lic. No.. . . . . . . . .../INSPECTG v. . .. .. . . . . . . .
GAS
vv
Check#�! ? 7 ? , ,
r
NIASSACHUSEM UNIFORM APPUCATON FOR PERNIlT TO DO GAS MM
(Type or print) Date i/�j�Q
NORTH ANDOVER,MASSACHUSETTS
Building Locations Sv MVS ! .t�1"^ �� s 6P-
Permit#
Amount$
Owner's Name Sem j
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Q 1ST. FLOOR t
2ND . FLOOR
3RD . FLOOR
i! 4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR —ELM
(.Print or type) ` �j Che one: Certificate Installing Company
Name `-.. ) ,5 /L!2t e`72 p d'"t/-- 471
Corp.
Address l � To c2 1 _ `
U 13Partner.
oL. U✓--� ve �t y¢
Business a ep one s p 64
n - Firm/Co.
Name of Licensed Plumber or Gas Fitter L Ole 4-2�1 44,lt -e
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes 0--- . No 13
If you have checked Les,please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond
�Ow•ner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.General Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 1:3 Agent
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
hest of my knowledge and that all plumbing work and installatio s performed under Permit Issue for this application will he in
compliance with all pertinent provisions of the blassachusettiSte Gas de and C ter 142the Gen Laws.
By. Signature of Licensed Plumber Or Gas Fitter
'Title 0-1p`iumher 3
City/Town 1:1 Gas Fitter ter nseiNLIrnber
I-4- _-Master
kPPROV ED(OFFICE USE ONLY) rl Journeyman
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINC
1 (Print or Type)
NORTH ANDOVER Mass. 'D Date
tuilding Location �/ }� Su r f(J� /� ��I Permit # 2
sem. r
.� Owners Name';� ,�, rC� .�
• New '-1 Renovation D Replacement J�K Plans Submitted
FIXTUR=(z
W
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N t» U Z Q to
0
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a to H N W a o ° ° Z
Q w Q W m t, rn a cc y 4
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0 F- Z •�j F' z H W W O O > tL lcc It W. —1 C7 Q
X .d W G cc
, ' Z O O N Z
tr > 2O O W !—
Qa
Q x o o z u. x a o ..t c > ca n. t— O
BASEMENT
1ST FLOOR
2ND FLOOR
3110 FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR
(Print or Type) /�/ Check one: Certificate
Installing Company 'Ncame f' /�vyJ�/ l q Q Corp.
Address Sb T?0 X Partner.
/l �✓cl, lJ ✓ er/Z. "Zit d �� rm/Co.
Business Telephone:1R�C�}
Name of Licensed Plumber or Gas Fitter
Insurance Coverage_. Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policyOther type of indemnity 0 Bond
Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owner/agent of property Owner 1 1 Agent
1 hereby certify that all of the dctails and information I have submitted (or entered)in above application are true and accurate to the bcst of mY
knowledge and that all plumbing work and Instillations performed under Permit issued fo: this application will fie in compliance with all pertinent
provisions of the Massachusetts State Gas Grade and Chapter 142 of the General Laws.
B TYPE LICENSE:
By Plumber
Title Gasfitter Sig Lure of Licensed
City/Town: :aster Plumber r ,Gasfitter
Journeyman
APPROVED (OFFICE USE ONLY) License Number
Date. . r ./..
,,pRTI, T5" OF NORTH ANDOVER
6
pf 4+�ao ,e'
3? �+ •+ r"
o p ERMIT FOR GAS INSTALLATION
°+,no✓� t5
SACHUSEt
'
This certifies that . . . . . . . . ..i� . . . . . . . . . . . . . . . . . . . . . . .. . . . . .
has permission for gas installation .! . . . . . . . ... . . . . . . . . . . . . . .
in the buildings of . . . . .,- . . r�. ,
rl
.r. . ., North Andover, Mass.
Fee.`. . f. Lic. No.. . . . . . . . . . ...t . . . . . . . . . . . . ... . . . .
GASINSPECTOR
WHITE:Applicant --CANARY:Building Dept. PINK:Treasurer GOLD: File
Bay State Gas Company
C�J GAS INSTALLATION AUTHORIZATION
Date 0-
Issued to
Address H9 1,4+1ah 4;t/ d., ti Ada, /
For Installation of: Furnaro, OWee—HPAO/
BTU Input 2561ald
Restrictions
BSG Representative
PERMIT ISSUED _ BY
INSPECTOR
This Portion of Authorization To Be Returned to BSG.
Inspection Has Been Made of the Following Gas Equipment:
❑ Heating System (BTU Input ) ❑ e Ran
i 9
❑ Water Heater ❑ Clothes Dryer
❑ Room Heater
Location
All Work Has Been Done In Accordance With The Massachusetts
State Gas Code And Is Ready For Use.
INSPECTOR
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
BUSINESS REPLY CARD
FIRST CLASS PERMIT NO.721 LAWRENCE,MA
POSTAGE WILL BE PAID BY ADDRESSEE
BAY STATE GAS COMPANY
ATTN: SALES DEPT.
55 Marston Street
Lawrence, MA 01840