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Building Permit #212-13 - 150 JOHNNY CAKE STREET 9/18/2012
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 3 Date Received Date Issued: 1/ IMPORTANT:Applicant must complete all items on this page i - — - - - R' t ', PRORERTV 01NNER �"L^� �✓'� ' - es o: Print_ � 10Q�YeariOldlStructure y - - a ;� nt est n �� . _ Mistonck�ast _. MAPt'NO /PARC,EL. ZONING►DISATRICT: •nog _„ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 17 ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionElOther _ p Watersh 1Netls®istrct ❑Septic, ❑Welly pFloo_dplaint ❑ etlands; . ❑{Water/Sewer: - - - R DESCRIPTION OF WORK TO BE PERFORMED: Q-OCit� �� j Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: _ C iA)__�Phon CT CONTRAOR�.''Name _ _ _ r I Address _ . z Su ervls .or�s�Co_nstrucfion} HomelmprovementLicens`e�; � � => Ex94 p• Date ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2 FEE: $ i Check No.: 93 V Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t uarll and �....�.� a-�S r�",'±�i'° �^.-��`.'.a: :•�.— ¢r -_ I Sl,gnaturebof contractoU-' SI natureof A"ent/Owner _z, a9: 9 � _ , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ . TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ I Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ .j Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE I E USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS m Zo-ning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submittedY es r Planning Board Decision: Comments Conservation Decision: Comments 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 Maln Street Fire partment signature/date " t a .t COMMENTS ; } ; Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: nt of Meter location mast or service drro ELECTRICAL: Movement p 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 I ® Notified for pickup - Date F[4 S Doc.Building Permit Revised 2010 I i i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit I ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ 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 i 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/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 Li Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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 I Doc: Doc.Building Permit Revised 2012 r 1 NORTH 1. c . . ve" '*. . No. 0)Q& Y Z — - h • • - o «I h ver, Mass, coc"Ic KIWK V �7,9 °RArED ►Pa,��(5 S U BOARD OF HEALTH Food/Kitchen Septic System LD THIS CERTIFIES THAT .....PERqL ........ ..... ! .................................................................... BUILDING INSPECTOR Foundation has permission to erect ........ ................ buildin on . . ....... .. .�....!!. ..... ........... OOL 4 z 'MRough to be occupied as .......... ..... ........ . ....�.............. . .�. .. ... .......... .... ..... .... ....... 01thimney 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 PERMIT EXPIRES 6 MONTHS _ ELECTRICAL INSPECTOR UNLESS CONST ION RTSRough 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 Det. SEE REVERSE SIDE 1 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supenisor 1 &2 Family License: CSFA-063168 ARTHUR F WANSON 3 EDGE MOlYx STSG DERRY NHP3038 Expiration , Commissioner= 02/12/2014 ?'°' r r}�yR'. 'fir R"a1CkA+� „4 L-J ••. T 'Office oon' mer airsi�inegu a xTi ' - HOME,�IMPROVENIENT COI°iTRACTOR Registra666:' 118848 °Type: �. i Expiration.` 4!28/2013 -DBA A ATSON GENIi;ONT�RAGTING: ARTHUR WATSON ONT ' ! i . ST. v ;DERRY,NH 03058NIG, r °' Undersecretary J 7-CONTRACTOR TO BUILD OUT BACK OF CABINETS ON ISLAND WITH 2 X 4'S SO DEPTH WILL BE APPROX.28 1/2" BEADBOARD PANELING ON SIDES AND BACK OF ISLAND CONTRACTOR TO BUILD WALL 1391" 8"WIDE X 48"IN LENGTH TO SUPPORT GRANITE COUNTERS 30" 15" 471' 15" 30" COVER WITH BEADBOARD PANELING USE BBM8 FOR BASEBOARD ALL �' 47a" AROUND IS INCLUDING SUPPORT 47� 43,-" 119$" STRUCTURE 27 _33.. -24"- 2 2 1 4"22$" 727' �--25" F333 F333 8-FRIDGE END PANELS 1533 W3033 ro ORDERED 30"DEEP �� nt W3033 W1533 ro - TO BE CUT TO APPROX. � a � 28 1/2"DEEP/BLOCK +r APPLIANCE CHOICES: o B27 3DB24 SB33 24if iW; B27SS F3 O '" CABINET ABOVE g - CENTER DECORATIVE SAMSUNG FRIDGE ���m ----- DOOR PANELS ON - ----------------- 1 'MODEL#RFG237AARS p0 F330 �2 O PANEL ON LEFT SIDE GE CAFE_DUAL_FUEL RANGE___________________________O N ;o----------------- MODIrL#C2S985SETSS cn ------------------------- (ii BRoAN PRO-STYLE RANGE HOOD M - 8-DOUBLE WASTE BASKET UNIT MODEL#AP13OSS WITH 80 8 � v RECIFCULATING KIT A C W ; - 7 ao BOSCH DISHWASHER m m BE BE V --n I MODEL#SHE55M B12R BWI318 O1 BE Vb` m m w 3s1, rn ii < BE mBE V rn rn v G7 SCHROCK TRADEMARK 24" 22'- m ^, UPGRADED TO ALL PLYWOOD CONSTRUCTION fTWO R,1co O � - PARKER/SQUARE T T !' m : FLAMED DRAWERS 2-HALF DEPTH SHELF °_ 40 COCONUT ON MAPLE 3-FULL HEIGHT DOOR __-___--__--__- SSS S g O Nri CEILING HEIGHT 90 1/2" TRAY DIVIDER �S ca ' w F(ANGING HEIGHT 87" 1 w e ----- --------4-WALL-COR14ER-CABINET----- ------- ---------- n tfSE CAPMfOR WITH LAZY SUSAN x 0 'UNDERCABINET LIGHT w VALANCE 624SS 0 C'AS RANGE 3DB15 USE$FM8 FOR.SOFFIT 5-BASE CORNER-CABINET USE SWLCRMB FOR CROWN WITH 45 DEGREE ANGLE ® a - WITH SUPER LAZY SUSAN W2433 W3018 W2733 N PLAN#4 NO CF HOOD.1 1 ,. 24" 30 -15" ---38" 111 a' 39,4" 108" 154" L 24" 30"— -27"— -24" 259" w size deli ations =- - >: JANETMAGMA This is.an.original_,desigr� and must Designed: 8/26/2012 All dimensions _ gn given are subject to verification on JACKSON not be released or copied unless job Printed: 8/29/201 job site and adjustment to fit job KITCHEN applicable fee has been paid or conditions. DESIGNS order placed. HUNT KITCHEN 4 All Drawing #: 1 Scale : 0 5/16" = V ( The Commonwealth of Massachusetts FOR Board of Building Regulations and Standards � l -I'• MITI3ICIPALITY Massachusetts State Building Code, 780 CMR, 7d`edition USE r' r 'Revised Building Permit Application �nJannrrny 1,2008 This Section For Official Use Only Building Permit Number.- Date Applied: 'i Signature: Building Inspector Date t, SECTION 1:SITE INFORMATION Residential IT ` 'Col mtnercial 0 Other Description: I.1 Property Address:, ` _ `.".', 1.2Assessors Map&Parcel Numbers I.Ia Is this an accepted street?yes no ` Map Number 5 ' L Parcel Number' 1.3 ZoningInformntion: 1.4 PropertyDimenAGns:`, ' 'J-'' Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1,7 Flood Zone Information: 1.8 Sewage Disposal System: Public D Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Commercial- Service Size Check ifyes0 SECTION 2: PROPERTY OWNERSE[[p1 2.1 r'of R cord: nh�+� 16© Jdk a�� ca�e, 5T,Name nt} Address fo^r�Service- _ s, Ignat4k Telephone - - SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) . #-A New Constriction D Existing Building❑ Owner-Occupied Repairs(s) D Alterations) ID/ Addition D Demolition --' O eci Accessory Bldg. 13 Number of Units' Other D Specify:' Brief pescription of Pro osed Work'': e 0 VC C �tw Gi^eN Cel e, r e I' ow e b SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) y 1.Building $ 1. Building Permit Fee:$ 2.Electrical $ 2. Indicate how fee is determined: 13 Standard City/Town Application Fee 3.Plumbing $ E3 Total Project Costa(Item 6)x multiplier x 4.Mechanical (HVAC) $ 3. Other Fees: $ 5.Mechanical ^ (Fire Suppression) i pl Total All Fees:$ 6.Total Project Cost: $ �0 /I 221• ( Check No. Check J /l Amount: Cash Amount: i SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Su ervisor(C )� / S r , � f L�censeNumber Expiration Z D nteL�' Nama of CSL-Holder List CSL Type(see below) Addre '�A Type Description ult�-- (,1u) U Unrestricted(up to 35,000 Cu.Ft.) Restricted 1&2 FamilyDwelling Signature r M�� MasonryOnl. 61 "hone TeleP RC Residential Roofing Covering WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 ]Registered home Improvement Contractor(HIC) A F wa�lO G cam, J l lH zt8 HTC Company N=e or IRC Registrant Name /4t? JK1. . p Registraattion Number Address �to eN�OiU� O �� �� nn `22JlJ g l9T-4 Expiration Date Signatu Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes.......... 1, No...........❑ SECTION7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L as Owner of the subject property hereby authorize to act on my behalf; in all matters relative to work authorized by this building permit application. Signature of Owner - Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARA'.I'ION as Owner or Authorized A Brit hereb' declare that g Y at the tements and info ation on the foregoing application are true and accurate,to the best of m kuowled a and behalf. (' u ( 0 Y g Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) . NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program,and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basementlattics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR.,7'h Edition Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Twa-Family Dwelling SECTION 8:ADDITIONAL APPROVALS j 1. Ballardvale Historic District Commission: t Date: 2. Board of Health: Date: 3.• Conservation Commission: Date: 4. Design Review Board: Date: j 5. Electrical Permit Number: Date: 6. Fire Prevention: Date: i 7. Planning Board Lot Release: Date: 8. Preservation Commission: Date: 9. Zoning Board of Appeals: Date: The Conznz onwealtlt oflVlassacl:ccsetts Department ofbiduso al Accidents tr, - - Offcce Oflnvestigations 600 Wizslzington Street V Boston,M,4 0211.7 www.rnass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individu�al))-. (" WAt,,,,,, - �QwirC%G,i Address: 9—MOW 1 City/State/Zip: 1•JCf 0303,9 Phone#: ; Are you an employer? Cheek the appropriate box: 1.031am a employer with 4- ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor orpartner- listed on the attached sheet 7. [remodeling jship and have no employees These sub-contractors have g. E]Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp,insurance-t g- ❑Budding addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself 1 I•❑Plumbing repairs or additions i y [No workers comp, right of exemption per MGL insurance required-] t c. 152, §I(4).and we have no 12.Q Roof repairs employees. [No workers' 13.❑ Other comp.insurance required.] ;Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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. irthe sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that it providing workers'compensation insurance for information. 111Y employees. Below is the policy and job site / Insurance Company Name: L.1 edi utuca leg Policy#or Self-ins.Lie.#: (\,cs 3 S— 3`�64•0gS— e�1z Expiration Date: / �3 Job Site Address:- City/State/Zip ddress: City/State/Zi Mq 61 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 WORD 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 for insurance coverage verification. I do.hereby c rtr r roe"pen ofperjury that thein ormationp lded above is true and correct. Sip-nature: L � 1 --7 Phone#: 3 / G (3i- Oficial use only. Do not)trite in this area,to be completed by city or toren offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector 5.PIumbing Inspector It 6.Other ('nntnrt PPr¢nn` A. F. Watson General Contracting Estimate 3 Edgemont Street Derry,NH 03038 DATE ESTIMATE# Tel. 603-437-6134 7/25/2012 1500 Cell#603-661-5360 NAME/ADDRESS Steve Hunt 150 Johneycake Street North Andover,MA 01845 TERMS PROJECT Due on receipt Kitchen/Family Rn. ITEM DESCRIPTION QTY COST TOTAL Permit Town of N.Andover building permit fee allowance 450.00 450.00 labor Carpenter's labor 48 42.00 2,016.00 1.Demo existing sheetrock in family room Install new blue board ready for plaster skim coat. 2.Insulation adjust/replace to be determined? Disposal Dumpster for construction debree 580.00 580.00 Screws Screws 40.00 40.00 Blbd4x12 TX 12'X 1/2"Blue Board 24 14.25 342.00 Plastering Apply a base coat of plaster to all seams and plaster 2,200.00 2,200.00 veneer coat to entire area. labor Carpenter's labor 137 42.00 5,754.00 1.Demo existing kitchen cabinets strip flooring to plywood sub floor. 2.Strip sheetrock ceiling complete and Walls as needed. 3.Install Blue board ready for plastering. 4.Install new Glass door to deck. 5.Install new cabinets. 6.Install New flooring 0.00 0.00 Blbd4x12 4'X 12'X 1/2"Blue Board 11 14.25 156.75 Flooring Flooring Kitchen 260 sq.Ft. 260 5.75 1,495.00 Plastering Apply a base coat of plaster to all seams and plaster 1,000.00 1,000.00 veneer coat to entire area. Patio Door Perma-Shield Frenchwood Patio Door allowance 1,500.00 1,500.00 Subtotal labor&Materials 15,533.75 Cont.fee Contractors 10%Fee profit+overhead 10.00% 1,553.38 THANK-YOU A.F.WATSON TO�Aq , $17,087.13 SIGNATURELM 6 OWNERS SIGNATURE I Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the states Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name;,. Company ante Xtlf V,4&,eu &w t (fO{tf Street Address(do not use a Post Office Box address Contra c r/Sa erson/Owner Name /b0 o e c�Fe 7 l;ity/To S e Zip Code Busmess Add (must include a street address) ��IfV/q ot/e �emo�`v-r ST Daytime Phone Evening Phone city own nS�,to/ Zip Code c(t 03 d3a Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number name Impmvemem Contractor Reg.Numbs l:apiation date I..rermtq.itomdo..,thomel 3 . P t mntred..have ad rtgutntion number The Contractor agrees to do the following work for the Homeowner. (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets ifnecessarv.) R�lrv�ove-{- ��n�rq( e f31ue bob, P1astet- 1 N FQr�t y r>n + K l�ehely Gel i rine _'fj 0wr%e.fs �'rtCVieoj G,:t�iNct5- Tru. 01)t wmo\ C-6,6.w9 jou Re p1ae'e, 2xi5f t't.y3 st lAt'v olcrs f_ rtb &'k Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: beaked1ZI s circumstances beyond the conttactois control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of o when contractor will begin contracted work. MGL chapter 142A.) /7 ZDate when contracted work will be substantially completed. Total Contract Price and Payment Schedule / / �I 3 _ The Contractor agrees to perform the work,furnish the material and labor specified above for the total stun of. r, 413 / () Payments will fbe made according to the following schedule: $_4 /Jupon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $-L 49W 4by /_/ or upon completion of L $ by / /_or upon completion of /��Q jfief f !��� GCl& t 16�on completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for eo NOTES:(*)Including all finance charges('k)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-is an express warranty being provided by the contractor? ❑No❑Yes fall terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third businespfay following the signing of this agreement. Seethe attached notice of cancellatijun form for an explanation of this right. DO NOT GN THIS CONTRACT IF THERE BLANK SP SM coo identical c s o contract [be completed and signed.(hie copy should go to th o e other pt the cont omeowne s Si a mfrs s Sign re Date Date /12/2012 7:42:11 AM PST (GMT-8) FROM: 100005-TO: 17813244253 Page: 2 of 2 ® DATE(MMIDOWNY) A�v CERTIFICATE OF LIABILITY INSURANCE F 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 1S WANED,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). PRooucER PAUL T MURPHY INSURANCE AGENCY INC CONTACT N t=: 628 BROADWAY Pl{pryENo. - C Not (781 4-4253 MALDEN,MA 02148 E•Ma1L RES INSURERS AFFORDING COVERAGE NAIC# INSURER A rNAARRTNsuRERB ARTHUR WATSON : DBA AF WATSON GENERAL CONTRACTING NSUilERC: 3 EDGEMONT STREET NSURERD: DERRY NH 03038 NSURE.RE: NSURERF: COVERAGES CERTIFICATE NUMBER: 140 1768 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 NSURANCE AWL 51}eR POLICY NUMBER POLICY EFF POLICY MMONYXP LIMITS TR GENERALLIABILITY EACH OCCURRENCE $ DA GE TO RENTED COMMERCIAL GENERAL LIABILITY PRBAISES a occurrence $ CLAIMS-MADE El OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY D PRO• LOC $ AUTOMOBILE LIABILITY a aIXI Idet) $ BODILY INJURY(Pet person) $ ANY AUTO ABUT OWNED 8 SCHEDULED BODILY INJURY(Per accident) $ NON-OWNEDadAUTOSR�eMDANIPGE $ HIRED AUTOS AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAWS-MADE AGGREGATE $ DED RETENTION$ $ $ $ A WORKERS COMPENNDSATION WC5-31S-384095-012 1/5/2012 1/5/2013 TWO WOOF ITS AM YIN ./ LIMTS ANY PROPRIETORIPARTNERIEMCUTIVEE.L.EACH ACCIDENT Is 10000 OFFICERWEMSER EXCLUDED? a NIA (Mandatory 6n NH) E.L.DISEASE-EA EMPLOYEE 1$ 10000 Ryas,describeundar E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,IT more space Is required) THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR ARTHUR WATSON . Workers eornpensation insurance coverage applies only to the workers compensation laws of the state MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE STEPHEN HUNT THE DPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 150 JOHNNY CAKE STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE �1 Jeff Eldrid e ©1588-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CERT NO.: 14071768 CLIENT CODE: 1570924 Anne Chandler 9!1212012 7:39:01 A14 Page L of 1 This certificate cancels and supersedes ALL previously issued certificates. F AC40RV' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/09/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Obrey Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1E Commons Drive Unit 27 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Londonderry NH 03053 INSURERS AFFORDING COVERAGE NAIC# INSURED Af Watson General Contracting INSURER A: MAIN STREET AME RICA 3 Edgemont St INSURER B: INSURER C: Derry NH 03038 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FORTHE 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRDD'L POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR TYPE OF INqURANrr POLICY NUMBER TE IMMIDQD= GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY MPT4750C 10121!2011 1012112012 PREM ES a o r nc $100,00 CLAIMS MADE ®OCCUR MED EXP(Any one erson 5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 f GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 2,000,000 E POLICY PRO.JFCT LOC AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT $1,000,000 ANY AUTO B1T5304C 1012112011 10/2112012 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X7 HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- 01T- ANYEMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER(EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMEER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 150 JOHNNYCAKE STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR N.ANDOVER,MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �ry <KG> ACORD 25(2009101) ©1988-2009 ACORD CORPO ION. All rights reserved. The ACORD name and logo are registered marks of ACORD DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, May 17, 2007 2:29 PM To: Marianne Peters (E-mail) Cc: Daniel Ottenheimer(E-mail) Subject: 150 JohnnyCake- Final Construction Request Importance: High Hi, Please schedule a FC inspection with Todd Bateson for 150 Johnnycake Street. His number is: 978.815.2703. Thank you. 8¢g!R¢gu�ds, Pairy¢l�A D¢t�e¢G�l�iui¢ Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover,MA 01845 2978.688.9540-Phone A 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com I I 1 Date....... Of NORTp, " TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ......................... ,%-v ..................... ezl has permission to perform1. i , wiring in the building of >. at... �.�. .; ' -� . �� ....... ,North Andover,Mass. Fee...:.......... Lic.Nos... ......... �.,............................. r.......... . I ' ELECTRICAL INSPECTOR Check # /�l h'a S �v 7307 Official Use Only eyJL Permit No. �y&yrtrraut o6�at(Iie Sa6dq .-� BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 Occupancy&Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be perfbimed in accordance with the Massachusetts Electrical Code 527 CMR 1200 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a rpermit to perform the electrical'work described below. Location(Street&Number Owner or Tenant $s Owner's Address Is this permit in c orijunction with a building permit Yes ❑ No�(Check Appropriate Boot) Purpose of Building Utility Authorization No. Existing Service Amps Vols Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Wits Overhead ❑ Undgmd ❑ No.of Meters 'r Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work / t' 4,p_ ,Q v� �� C-n F�"lv io lS o....-g- CIA o,l¢-vt- Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and .Ao.of Ranges No of Air bond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers S ce/Area Heating KW Detec ionlSounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW I Signs Bailases I Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requi men6ts of Massachusetts General Laws 1 ha Liability Insurance Policy incl pleted Operations Coverage or its substantial equiva ES NO = ve submi fid proof of same to the Ofti NO = If you have checked YES please indicate the a by checking the appropriate box INSURANC = BOND = OTHER = ( pecify) {Expiration Date) Estimated Value of Electrical Works t S O d Work to Start !C(-O 7 Inspection Date Resquested Rough Final Signed underPeq es of perjury: FIRM NAMErr l w. 11 LIC.NO. Liensee Jh V\ Signature LIC.NO Z 7 3 r Bus.Tel No. 7 S[ t(3 1`OSS Address `� c— AltTel.No. 4;A-_6 7 /s� OWNER'S INSURANCE WAIVER: t am aware that the Ucen does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMITTEE s "� (Signature of Owner or Agent) e ' 7 i Y(�i }Y.. F: Location_ 5 No. Date 111 (kis 'AO TOWN OF NORTH ANDOVER Certificate of Occupancy $ * �� ; Building/Frame Permit Fee $ cwuBEt� Foundation Permit Fee $ Other Permit Fee $ r Sewer Connection Fee $ Water Connection Fee $ t TOTAL $ ' Building Inspector 11/Ol/ b0 78.00 PAID M'' Div. Public Works r i PEI Afrr NO. �^ ` PAGE 1 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. MAP K-4O. 'rj7A LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. !+3g Q LOCATION (gt) SpE,N Ny(A_ NK C ST. — POSE OF BUILDING FINIS N BO-NM G ti OWNER'S NAME p �Mu.T. 1 .-66� NO. OF STORIES SIZE OWNER'S ADDRESS 17V �uSRfpjtjL F-�AV 1 BASEMENT OR SLAB ARCHITECT'S NAME CjC SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY &-M BUILDING ALTERATION • IS BUILDING ON SOLID OR FILLED LAND --4.VILL BUILDING CONFORM TO REQUIREMENTS OF CODE ycS IS BUILDING CONNECTED TO TOWN WATER ,_pOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ST. BLDG. COST /,;?, oOl�V PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED- A A J ✓ BUILDING INSPUCTOR SIGNATURE OF OWNER OR AUTHORIZE AGENT FEE OWNERTEL.# PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.A T-r H.I.C.# A j BUILDING RECORD I -- 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- _ APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ 1/4 1/1 1/. FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B l 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD%fJ'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I-I POOR ADEQUATE ONE 5 ROOF 11 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO I6 FRAMING 11 HEATING li WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM . STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING , RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS, GAS IL O B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING NORTly 0 0 over No. o brt dover, Mass., o� t 194,x' cocH,CHEWIc ADRATED P1? A\ `-' BOARD OF HEALTH Food/Kitchen Septic System PERMIT T Di BUILDING INSPECTOR �................................................................................................. THIS CERTIFIES THAT '�QrmVT..... ......... Foundation ,... "....................... has permission to eirteet`....�0.L;?��_.............. buildings on ..�.��....���!�... •• Rough Chimney to be occupied as...PAsef .....1� !�AC.?I)el............j 1.1.. . . . Z'�Lr..�app eY provided that the person accepting this permit shall in every respect con rm to he rms of tation on file in Final 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 �� • p — PERMIT EXPIRES IN 6 MONTHS Final UNLESS CO S S ELECTRICAL INSPECTOR Rough ................. Service B U I PECTOR Final y Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. f Q�C� TOWN of NORTH ANDOVER AFFIDAVIT Hue hUmvenant Gmbmtor law S RAM]ant to lit tffOCatirn M3 c. 142 A recd that the 'V=sULctim, altmatirn, muistim, repair, wjmd md,3n, oarmxs=, igxuA int, rauml, dmditian, or caisUw-tim of an adlitim to any pre- eadstiig aaim-a n#ed bAld- irg cmtaumg at least ane but mt Mxe than far del irg units...or to stmcbxes 4fich are adjam t to suds tesL�e or h.ni]&W'be dam by registered cmbnctom, nth own ezxptLcm, alag with othw --Type of Work: "I AJ N /'3'ASS /1 C—A) T Est. Cost T --Address of Work S0 O HDU/V K CA rr S'T- ,-Awner Name: _9 rmGl T IV- G�' 15it/�',�° _--pate of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Far office Use Only Work excluded by law dot ND. Job under $1,000 Date Building not owner-occupied -Owner pulling awn permit Other (specify) Notice is hereby given that: WERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Sign d Larder penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name it ih�b - b� 9 - �� s 8(o d Vv ` -<-�-3no (TNv f J:--doN _Ixvv 121v N IN v_�j I171�715 53111711Y) —— —— - -. _.. --- -- — - —� ----' - --— ----- �� — � � _- - - - 41 71-W Vj I ' I i I 4F- • - -------- -- -- - - - I - -- --I --! CLOSET —1 -- i -ct q 57, -eir►DER S i�A�R3- � I I jI i i j -71-D N3 I ti J Office Use Only 014t (ommonwtalt4 of filus#usets Perm No. 71g Pepattairnt of Ilublit i6afxtg Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) �oZ 33 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM12:00 p (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Data I 7 or Town of ' NORTH ANDOVER To the Ins ecto of Wires: . The udersigned applies for a permit to perform-t-hee electrical work described below. J Location (Street & Number) I )d e)�Vtw Owner or Tenant �� �u�n -- Owner's Address If � Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) 'r Purpose of Building Utility Authorization No. Existing Service ?,br, Amps 1ZGJJ__.L�Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd. ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work j.!-i Z_ �+gw�t��-, a� &Mn Ple r tsl��1 A, No. of Lighting Outlets u I No. of Hot Tubs No. of Transformers Total KVA / r- In- KVA No. of Lighting Fixtures Above / I Swimming Pool grnd. i I grnd. ❑ Generators y No. of Emergency Lighting No. of Receptacle Outlets L c I No. of Oil Burners I Battery Units No. of Switch Outlets 1 b I No. of Gas Burners FIRE ALARMS No. of Zones E No. of Ranges I No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals I No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers I Space/Area Heating, KW Detection/Sounding Devices No. of Dryers I Heating Devices KW Local I I Municipal r^Other L : Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massacnusetts general Laws I have a current Liability Insurance Policy including Ccmoieted Operations Coverage or its substantial equivalent. YES _ NO _ I - have submitted valid proof of same to the Office. YES = NO = If you have checked YES. please indicate the type of coverage by checking the appropriate box_ INSURANCE flc�,BOND -_ OTHER (Please Specify) Imo. 12 iq,.� (Expiration Date) '- Estimated Value of Electrical Work S Work to Start Inspection Date Recuested: Rough Final Signed under the Penalties of perjury: I FIRM NAME I s \ LIC. NO. Licensee c Signature LIC. NO. Bus. Tel. No. 6h�C Address o Alt. Tel. No. �— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) , Telephone No. PERMIT FEE 5 (Signature of Owner or Agent) X-6565 d Date...... ...... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... F ((-Ct . ... ....................................... "I,*,"Tpermission to perform ...................... ............................ �A wiring in the building of........ .......................P.(A q.T A 9 .... at..... ...... ..C�?... .... ..... Nort-WAndover,Mas Fee. /).............. Lic.No. r.211c.......... ....... a ELECTR16AL INSPT R Check ,, stn Date............... ... .1 ! 2719 t NORTH, ° '"`°-• "°O TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SS/ICIIuS(c� This certifies that .... ....,... .. ^: has permission to perform :. ?.:. .`....,Of // . r wiring in the buildinof....:� .Y. ..!�� ................................................ at:.,!, .. . ...:.:... ,North Andover,Mass. Fee.7� . .... Lic.N.. .I��?&......... t; LELECTRICAL INSPECTOR 11/23/95 Ph" 75.00 PAID_ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Office Use Only 37dUIP Loom TIonwralt4 Uf �{a55atljll5£tt5 Permit No. q3cVar=cnt of Publit aafrtu Occupancy& Fee Checked (leave blank) 2 BOARD OF FIRE PREVENTION REGULATIONS '27 CIJIR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Jgssachusetts Electrical Code, 527 CMR � 0�00 (PLEASE PRINT IN INK OR TYPE ALL INFORM.ATION) Date 14` City or Town of N OQT6 AN nyem To the Inspector of Wires: The udersigned applies for a permit to perform ^.e electrical work described below. Location (Street & Number) Isp �yhK�r Owner or Tenant STQ+1e NT' .. ,,"Ara, Owner's Address V i I No heck Appropriate Bex 1s this permit in conjunction with a building per-it: .es � Purpose of Building Utility Authorization No. Existing Service Amps _� Volts Cverhead ❑ Undgrnd ❑ No. of hleier� kNew Service Amps _J Voits Overhead li Undgmd ❑ No. of Meters .Number of Feeders and Ampacity 11-ocation and Nature of Proposed Electrical Work No. of Transformers Total ' N0. of Lighting Outlets No. of Hoe Tubs KVA AboveIn- No. of Lighting Fixtures I Swimming Pool grnd ❑ grnd. ❑ Generators' KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets i No. of Gas Burners FIRE ALARMS No:-of Zones- - --- ^ TCaI No. of Detection and A, No. of Ranges No. of Air Gond. i� tons .,J Initiating Devices No.of Heat Total Total y No. of Disposals I Pumps Tons Kw No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Deteclion/Sounding Devices Municipal No. of Dryers I Heating Devices KIN Local ❑ Connection ❑Other No. of No. of Low Voltage No. of Water Heaters KW I Signs Balla= Wiring No. Hydro Massage Tubs , No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws / _ 1 have a current Liability Insurance Policy including Comptes Operations Coverage or its substantial equivalent. YES � NO I have submitted valid root of same to the Office. YES NO = if you have checked YES, please indicate the type of coverage by checking the appr nate box. INSURANCE: BOND = OTHER C (Please Specify) (Expiration Date) Estimated Value of El e trical Work S Work to Start "�'�oZ• Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME PIM Et E��+-`R��rAN LIC. NO. Licensee Signature Cor �! 2 Lac.'NO. t 36?l2 Address�tk IZ� • EC KL� • QI '-7N MA . Bus. Tel. No. • � Alt. Tel. No. � ?"&IZ OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this reeuirement. Owner Agent (Please check one) 30.Cts Telepnone No. PERMIT FEE $ (Signature of Owner or Agent) x-ESES