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HomeMy WebLinkAboutBuilding Permit #47-12 - 162 HAY MEADOW ROAD 7/20/2011 J TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / f Date Received Date Issued: -;-,o -�/ 17- IMPORTANT: Applicant must complete all items on this page LOCATION ✓Vt C 1?0CU-,) ?,OINO Print PROPERTY OWNER P0wktJ C . Unit# Print MAP NO: JC!! . PARCEL: bp73ZONING DISTRICT: Historic District yes 6 Machine Shop Village yes8 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ElNew Building ne family ❑Addition 0 Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I Ftex r1 K i tc L hL-- n t nc7,V- tr L- - i-ti L�ct k_-2 i _ (Identification Please Type or Print Clearly) -,f,�53 OWNER: Name: Phone Address: I�, 1��. •�1/��+ot tam c.. CONTRACTOR Name:l�rlt'IXAS I 7D22 Of Phone: S (2>5'Og Address: _� Q+`uu �ctxnn A e S�t Ram CInPs-If re ` )}� Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER N fir Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost. $ FEE: $_ --- '7-Lo Check No.: 3y �Z Receipt No.: OP NOTE: Persons contracting unregistered contractors do not have access t h"uaran fund ignature of Agent/Owne Signature-of contractor `_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools d Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS t HEALTH Reviewed on Signature L s COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 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 Main Street Fire Department signature/date COMMENTS s9 s Dimension Number of Stories: o� Total square feet of floor area, based on Exterior dimensions. 76 Total land area, sq. ft.: ��- PC ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi r k n. 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 4e Building Permit Application ❑ Workers Comp Affidavit S jKd ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract wa 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 Additjon,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 ❑ 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 Doc: Doc.Building Permit Revised 2008mi Location ��� /`�"�'ti 4'*wwo No. Date MORTM TOWN OF NORTH ANDOVER , • p y Certificate of Occupancy $ -.�. : C t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ' - 246 ('14 Building Inspector r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 uvwww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMC(Business/Organization/Individual): — Address: f�- City/State/Zip: N DU1 �l/�'Phone#: q l X Are you an employer?Check the appropriate box: Type of.project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its re uired.) officers have exercised their 10.❑Electrical repairs or additions 3.E jZ a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' q �- 1311 other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Polidy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby c of under the pains andpe Ities ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: Official use only. o rite in this area to be completed b city or town official ff y Don t w , p y ty .ff City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person Phone#: V4ORTH TO" Of No. o , dover, Mass., l 'a a•� Q -- LAKE COC MICF/E.I:K ORATED v U ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR 111014.9& THIS CERTIFIES THAT.....:. Foundation has permission to erect...:..... .... . .... buildings on.ifa.Z........ . ... 0 ....... Rough K Chimney to be occupied as ... ...... ... ...... ...........:....................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final- this inalthis 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 3Za PERMIT EXPIRES IN 6 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC. .. STARTS Rough . .......... ....... ...... ............ Service BUILDING INSPECTOR Final 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 FIR_ E_DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. ti a MW3036-18 CO F Fi4+'+13615 a) -79 cli 'Pik- Go ! y- _._.... ......... .... ' l z Csbinet=:Shlloh rsher illadoor=_tyle f __.--t.fZpls-Medlum-M".hs•Glaze 1318-3 Csranita:Boldooset �, B 44 ts'' r: LLJ R rr BPOS-11 a1-14412 BLE3,6-36SSR 0 DWP 112L' `~L L a ,� 3 36L wil 5Sr NASHUA WALLPAPER 603-882-2996 p.8 WOOD CHARACTERISTICS & FINISH AWARENESS Please check and read sections that apply to your order and sign. WOOD SPECIES © BIRCH Natural Birch is a medium density hardwood with a fine moderate grain pattern. The predominant sapwood*color is white to creamy yellow,while the heartwood**varies in color from medium or dark brown to reddish brown. This range in color makes a distinctive statement in you Birch cabinetry selection. O CHERRY Cherry is an elegant,multi-colored hardwood,which may contain small knots and pin holes. Natural or light stains accent these color variations making a distinctive stabemerrt in a full kitchen. Cherry wooil will darken or"mellow" with age. This mellowing is a natural occurrence and the benefit of owning a solid Cherry kitchen. 0 HICKORY Hickory is a strong,open grained wood that is known for its wide variation in color. It is not uncommcin to see doors or parts of doors that range in color from tight to a deep brown when finished in a light-or natural stain. Darker stains will mildly tone these color variations. These characteristics are what make each Hickory kitchen unique and the preference of those that love wood. Q( MAPLE Hard Maple is a strong, dosed grain wood that is predominantly off-white in color, although it also contains light hues of yellow-brown and pink. Hard Maple occasionally contains light tan or dark mineral streaks. ❑ 2AK Red Oak is a strong,open grained wood than has a range in color of white,yellow and pink. Red Oakls sometimes streaked with green,yellow and black mineral deposits and may contain some wide grain. ❑ g_UAR7ERSAWN OAK Red Oak is a strong open grained wood that has a range in color of white,yellow and pink Red Oak is sometimes streaked with green,yellow and black mineral deposits and may contain some wide grain. Quartersawn refers to the method of cutting the Red Oak. Boards are cut through the radius of the rings allowing wavy grain and flaked patterns to show on the face. ❑ LAMINATE During operation,ovens and ranges will emit heat and steam. To protect the finish of adjacent cabinets, we recommend the installation of Heat Shields. These heat resistant acrylic strips attach to the side Pf adjacent cabinets to shield the doors and drawer fronts from excessive heat. Required for warranty on laminate door styles. *Sapwood: The outer zone of wood in a tree,neztto the baric Sapwood is gerw2*tigtrterthan Heartwood. *'heartwood: The inner layers of wood in Swwaxtrees that have ceased to contour ruing ceits. Hearavood isgeneralily rfarkerthan Sapwood,but thetwo are not ahmp differentiated. Custarner Name 4�.T{i Lt Date 1 Customer Signature S f Zk 71-1 gear Name t; I ,ct,'C3�'O'C/L Date 1 i peeler Signaturee) fij- NASHUA WALLPAPER 603-882-2996 p.9 Final Cabinet list Quote PROJECT DETAILS ID: Rool-20110324_1 Creation da 3/24/2011 Dealer Nashua wallpaper Customer Kathleen & Ed Pease DESIGN DETAILS File name: C:\Users\Jerry\Documents\2020 Files\Jennifer Lemoine\Pea Reference: sold date: Designer ID 820100721 1 Delivery date- Designer na _ Installation d sort order: Tall/wall/Base CATALOG SHIL011B supplier W W WOOD PRODUCTS, INC. wall doorsAsherville RP wall Dr fGDrawer fronAsherville Drwr Frnt fu Tall doorsGroup B FOVL Dr on Tall Drawer pullsolid 3/4" Hardwd Dovet Base doorsASherville RP Base Dr fGDoor pulls: Item Qtyuser Code Manuf. Code Description BASIC PRICE Cabinets 1 1 REP3/4 90L-NREP3/4 90L-NRefrigerator End Panel 24D 2 1 SGD3018 SGD3018 straight Appl Garage w/ Doors 2.1 1 MODIFY/SQUARMODIFY/SQUARModify Square Cabinet HT-W-D % 3 1 MW3036-18 MW3036-18 Microwave Cabinet 3.1 1 F INT NO ROOF INT NO DOOFinished Interior without Doors 4 1 RW3615 Rw3615 Refrigerator wall Cabinet 5 1 w3636 W3633-BT wall Cabinet 5.1 1 WDEP36L WDEP36L wall Door Left End 12D 6 1 W1836L w1833L wall Cabinet 6.1 1 FIN END R&L FIN END R&L Finished Both Ends 7 1 w3636 W3633-BT wall Cabinet 7.1 1 FIN END R&L FIN END R&L Finished Both Ends 8 1 BPOS-12 EPOS-12 Base w/4 Tier Pull Out shelf 9 1 FD1824-2 FD1824-2 24"2-File Drawer Cabinet 9.1 1 MODIFY/SQUARMODIFY/squARModify square Cabinet HT-W-D 10 1 BLE36-36SSR BLE36-36SSR Base Rt Angle Expand Leg w/ susa 11 1 B18-3 B18-3 3 Drawer ease 11.1 1 BDEP RT BDEP RT Base Door on Rt End fAng. Corner 12 1 B12L-FHD B12L-FHD Base Full Height Door Page. 1 NASHUA WALLPAPER 603-882-2996 p.10 Final Cabinet list 12.1 1 MODIFY/SQUARMODIFY/SQUARModify Square Cabinet HT-W-D % 13 1 BBOXRP BBOXRP Oxford Raised Panel Bar Back 14 1 836-3 636-3 3 Drawer Base 14.1 1 BDEP LT BDEP LT Base Door on Left End 24D 15 1 BWDM18 9WDM18 Door Mounted waste Base 15.1 1 BDEP RT BDEP RT Base Door on Rt End {Ang. Corner 16 1 ABL12 ABL12 Angle Base Left 16.1 1 MODIFY/SQUARMODIFY/SQUARModify Square Cabinet HT-W-D % 16.2 1 BDEP LT BDEP LT Base Door on Left End 24D 17 1 CMF CMF Compactor Panel 15W 18 1 BEP1 1/2L BEP1 1/2L Base End Panel 19 1 DWP DWP Dishwasher Panel 20 1 SBA36 SBA36 sink Base Apron Cabinet 20.1 1 WSR WSR wide Stile R % 20.2 1 WSL WSL wide stile L % 20.3 1 FIM END R&L FIN END R&L Finished Both Ends 20.4 1 CTVAL-CUSTOMCTVAL-CUSTOMValance as FTK Base 20.4 1 MODIFY/SQUARMODIFY/SQUARModify Square Cabinet HT-W-D % 20.5 1 MODIFY/SQUARMODIFY/SQUARModify Square Cabinet HT-W-D % 21 1 TLI-3-341/2 TL1-3-341/2 Turned Leg 1 21.1 1 SPLIT SPLIT Split Turned Leg Charge 22 1 TLI-3-341/2 TL1-3-341/2 Turned Leg 1 22.1 1 SPLIT SPLIT Split Turned Leg Charge 23 1 3/4UC 3/4uC under Cabinet Trim Mould @96 24 3 3 1/2CRN 3 1/2CRN Crown Mould @120 25 2 4 1/4FBP 4 1/4FBP Furn Base Mould @96 26 1 F334 1/2 F334 1/2 Base Filler 27 1 F380 F380 Tall Filler Charges *28 1 MAPLE MAPLE Maple Premium total : x`29 9 OF-ASVL FOVLDF-ASVL FOVLAsherville Drwr Frnt {upchg, FOV *30 14 ASVL FOVL ASVL FOVL Asherville RP Base Dr {GR B-FOUL *31 12 ASVL FOVL ASVL FOVL Asherville RP Wall Dr {GR B-FOVL *32 9 DOVETAILBLU DOVETAILBLU Solid 3/4" Hardwd Dovetail Drw B *33 1 TUK TUK Fill Stick & Marker SHILOIIB net total : $11,614.06 i I Page 2 NASHUA WALLPAPER 603-882-2996 P.6 H 10 34 lotf nA 1 � 2 Q7ou - 0 X II NASHUA WALLPAPER 603-882-2996 P.5 342 it 'i. ou f - V co 1 7 a if 7.(rn 30vp ` 0 N RW3615 N T T co O "' M W3036-18 w w w N N F3 C� 80 SGD3018 r 36REF-3D T r r a r334FD1824BIA-FH a � J J 1 Q 2 Z „ 8" 3C, " 4 i ? I i N -58-8- -43 T 3 7-z a 0) W3636 W1836L W3636 N N co M O O ABL !2 CBEP1 DWP SBA3ETL1 -3- BLE36-36BBR a J J Q Q z 18"415"-/"' , 4;f r 31 rr 41 " 101 all M O 2"X, 131 a Q ! 4 " 'J 6 92 $ 11 37-L" 4 2 311 16 2 ' N N 00 M co (Y) w fv1W343 -1 C'7 (YO) t acv SGD3018 r Lu � rl�+ BLE36-368SR DS- 30-RANGE3 B"-3 g1 L-FHD a � r J J Q ~ Z 3811 211 30" 18 , 41111 11 f 1811 Q 2 NASHUA WALLPAPER 603-882-2996 P.1 NASHUA WALLPAPER CO., INC. 129 VILEST PEARL STREET, NASHUA, NH 03060-3391 PHONE: (603) 882-9491 FAX: (603) 880-0367) KITCHEN FAX: (603-882-2996) P R 0 P 0 S A L PROPOSAL . . . . t DESCRIPTION i . . . JOB CUSTOMER: Kathleen & Ed Pease — -- JOB: Kitchen Remodel ADDRESS: 162 Haymeadow Rd ADDRESS Same CITY:North Andover STATE:NH CITY STATE DATE 5127111 PAGE 9 WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: Shill Cabinetry for Kitchen $11,614 Asherville Door in Maple Medium with Mocha Glaze All wood construction with dovetail drawers with full extension &soft close Gold Coast Granite $ 3038 'Hardware QTY 14 -1307-ART knobs QTY 12 -1300-ART pulls $ 38 Total $14,773.38 � 2-ti 165 .00 WE HEREBY PROPOSE TO COMPLETE IN ALL MATERIAL IS GURANTEED TO BE AS SPE ED. ALL ACCORDANCE WITH THE ABOVE SPECIFIGATIONS, WORK IS TO BE COMPLETED IN A WORKMANLIKE MANNER FOR THE SUM ACCORDINGTO STANDARD PRACTICES. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS $ 13 INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS AND WILL BECOME AN EXTRA CHARGE OVER WITH PAYMENT TO BE MADE AS FOLLOWS. AND ABOVE THE ESTIMATE. ALL AGREEMENTS CONTINGENT 5(1%down_50%at granite install UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL. OWNER TO CARRY FIRE, TORNADO AND OTHER NECESSARY INSURANCE. OUR WORKERS ARE FULLY COVERED BY WORKMEN'S COMPENSATION INSURANCE. AUTHORIZED SIGNATURE NOTE: THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN 34 DAYS. ACCEPTANCE PROPOSAL THE ABOVE PROCESS,SPEClFlCATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WIBE MADE AS OUTLINEDABOVEADD _ SIGNATURE DATE ACCEPTED SIGNATURE r Universal Decor & Installations Proposal # 521 B Name Ed Pease Date 4/5/11 Street 162 Hay Meadow Rd Job Name Pease Kitchen City North Andover Ma Location Home in North Andover Phone (617)856-8453 Contact Ed Pease E-mail epease@brownrudnick.com Description: Kitchen remodel to include: Remove and dispose all kitchen counters. Remove and dispose tile and subfloor in sunroom. Remove and dispose baseboard and undercut affected doors. Remove and relocate appliances affected by the remodel. Assist w/ templating of new counters. Install new cabinets in kitchen Install new counters in kitchen Install new faucet and kitchen sink Install new subfloor material recommended by manufacturer. Install new hardwood flooring in sunroom and kitchen. Install new base board in sunroom. Proposal includes complete cleanup of affected areas. Proposal includes all scheduling. Proposal inclueds hard wood flooring We hereby propose to furnish labor and materials and complete in accordance with the above specifications for the sum of: $12,000.00 All material is guaranteed to be as specked. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviation from above specifications involving extra costs will be executed upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accident or delays beyond our control. This proposal subject to acceptance within 10 days and it is void thereafter at the option of the undersigned. Thank You i Richard Galipult (603) 845-8508 NOTICE _ NOTICE TO a TO EMPLOYEES 4 EMPLOYEES O,aM S�gv The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street,Boston,Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22&30,this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: HARTFORD UNDERWRITERS INSURANCE COMPANY NAME OF INSURANCE COMPANY P.D. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (6856008-4267P99-7-11) 06-13-11 TO 06-13-12 POLICY NUMBER EFFECTIVE DATES HAYS COMPANIES 133 FEDERAL ST i = BOSTON MA 021101703 NAME OF INSURANCE AGENT ADDRESS PHONE# SURGE RESOURCES INC VARIOUS CLIENT CO: UNIVERSAL DECOR & VARIOUS MA 02110 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(1F ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers'Compensation Act.A copy of the First Report of Injury must be given to the injured employee.The employee may select his or her own physician.The reasonable cost of the services — provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury.In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS coma W20PIG02 TO BE POSTED BY EMPLOYER i Apr OG 11 10:05a P•2 ACORD CERTIFICATE OF LIABILITY INSURANCE ""34O0HY"' 04Jo612011 PROOIILER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION La vis insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 22 Concord Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Nashua NH 03064 !INSURERS AFFORDING COVERAGE 1 NAIC A Universal Decor&Installations,Inc. INSUftc k Merchants Mutual Insurance Co 186 GRANITE STREET INSURERS'. MANCHESTER,NH 03101 :NSUPERC INSURER O'. INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INT..CATED.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 SNO"MAY HAVE BEEN REDUCED BY PAID CLAVAS. _ MSR OD POLICT HUNKER ROLICY EFFECTIVE POLICY IXPAPM1I GENERAL LIABILITY 1 EACH OCCURRENCE 31000,000 A ! �( •TMWGE t0RE 0 COM3V:RGAL cn�au uAealrY BOP 9097606 09161/2110 09/01/2091 REMIA,.ES ,100,000 cLnnns MArre UOcam M=DEXP —PFJ 1$5,000 _ PERSOf—ADV RiJU _1 3 1,000,000 _ GEH'=PAL AGGREGATE 3 2,000 ODO 'L AGGREGATE IDNT AP1-1. PLIES PER:' i PRODUCTS-CdKAAW AEG 32,000,000 POLICY PRP �I.00 AUTOMOBILE LMBILITY CCMam.V 9NGLE UMT S aNY AUTO � T2ASCP3mB ALL Ot,WEO AU'OS BODILY M) 3 i SCH'cOULEO AVTCS iPerfn3M'•1 . P.MEDAUTO$ BOOBY QLURY 3 NOx-0Y.xEO ALTO$ (Pa a4tivMj PROs' IOAt.WGE _ GARAGE LMBR.ITY I�Av-GTAY-EA ACOIO=NT IS RA--0 EA AG: S OTFIEATHAN AUTO CTRY: PGG S I FXCESSNM-ELLA LULBIUTY ( EALtI O URREN,= 3 1 .CUR El CLAIMS MAGE ALiCaREGA?E I S _ If `DEDLIC'R$E I 3 ftETEM10N ( I �f 3VORNER3 CONPENSATOt14N0 I 1YCSTA79 0-1 EMPLOYERS'LIABILITY '— ANYPROPRIETORIPARTHERA:XECIff E EL.EACR ACCICEN, OFFICER W—BSP EXCLUDEDT E.L DISEASE-EA EMPLOYE 3 u XPs,W IIn unix - CMLP0.CV 1.'SLB. E.L DsEASE-POLICY LIMIT 3 OTHER f i OESCgIPROx OF OPERpTMN61 LOCpTORS3VETRCLE6I EXCW6pN54°DED BY tNpORBEMENTt SPECWL MR IWO" Carpentry. CERTIFICATE HOLDER CANCELLATION SNOULD A-OF THE ABO VE DE6CRIBFD PgIC1E5 BE CANCELLED BEFORE TIE E%PIRI TAN F DATE iNE0.ET)F.THE IS6UINO INSURER WILL Q.^JEAVdt TO DA0. 10 DAYS WRITTEN NOTICE TO THE CEITPRCATE—ER TUWED TD THE LTTT,BOT FAILBRE TO 00 SO SHALL IMPOSE NO MUGATION OR LJABRrtY OF ANY RING UPON THE INSURER ITS AGENTS OR TD:PRERENTATIVES AUTNORQID REPRESEMATVE ACORD 25(2001/08) ®ACORD CORPORATION 1988 oq µb TH�4" TOWN OF NORTH ANDOVER °0 OFFICE OF BUILDING DEPARTMENT * 1600 Osgood Street Building 20, Suite 2-36 ��o North Andover Massachusetts 01845 SacHUS Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please-print DATE: 7 1 JOB LOCATION:_ Number Street Add . ress Map/Lot � HOMEOWNER %DG .5C a(T 7-t-(,L 5 t _6 3 Name Home Phone Work Phone PRESENT MAILING ADDRESS' 16� ow A'ezA(%C ) CAD City Town SL-te. Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. i HOMEOWNERS SIGNATURE --------------------- APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Repla-ce Ccs OS e .s l c©u r,�cS CL F lW3036-18 ( 1 31 RW3615 � t i9s Z ...._......._......_.. ........ f --___..,..._._ �� aQ IPA 0 � .,............... ...... Cslrinets:Shlloh I , Ashen•IIIa door style 1J r- (,lspls4dedlum-Macba-dlaze 818-3', ; � E•• 1 �.. t.'..�. ... ,r, Granite:Bold ooest 44""_...� ......, _._... lg � .C' , Q ; w BPOS- a '...-.. _,...._...........; 41L2 - ......... . .. ....... ...................... ......... ..... 6BLES5R Q DWP 1 j2L' D 36 3BZ.b Z 13$" .---•-� 238.x' 1 '