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Building Permit #114-15 - 164 MASSACHUSETTS AVENUE 7/30/2014
FI BUILDING PERMIT p` �oT TOWN OF NORTH ANDOVER �s `;t- _ •,` APPLICATION FOR PLAN EXAMINATION Permit Noll. Date Received Date Issued: D O t'AN't':AppUcwt must com fete all items on this page AD OPE .... ••.'•^r •+• � �r..:, .:.pny :1 Year b hruqtp.re---,,,va,,Z $ •; ., MAP BARGEE: =FONIN�'D1SiCT: Mistinc R,. Yss n - Machine Shop Village . yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building OrOne family 0 Addition ❑Two or more family ❑Industrial srAtteration No. of units: ❑Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑Demolition ❑ Other D Sepfic D Well 0 Floodplain 0 Wetlands 0 Watershed District DESCRIPTION OF WORK TO BE PERFORMED: Iden 'ficionT ►e or Print G7eariy �� OWNER: Na Phone Address: r� �. ..1 Contractor Name:. Wc) V7 ..oSupervisfs:Construcbon.Upprise: ir. �• 'r.r� � '�, •t.l! M\ :c :• ti`s' .. �, jai i y` :ate Home improvementEicerise: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERM?.•$1200 PER$100000 OF THE TOTAL ESTIMATED COSTBASED ON$12100 PER S.F. Total Project Cost: $ FEE: $ •� Check No.: Ak� Receipt No., 2— NOTE: Persons conwamns run r�nregistered contractors do not have access to tho�r—T..,,fv fund ignatU of AgentlOwne Signature of contractor NORTH BUILDING PERMIT °F10.Eo ,6q�o TOWN OF NORTH ANDOVER c� y� '- ` ... *° APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �reo �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Prin PROPERTY OWNERD�L''/tel Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE 1--101 Residential Non- Residential ❑ New Building . ❑ One family ❑Addition ,l )� [I Two or more family El Industrial El Alteration (/j 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: 14entification lease Type or Print Clearly OWNER: Name: � za�� r�,/,D� Phone: Address: Contractor Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered ntractors do not have access to the guaranty fund Signature of Agent/Owner l ignature of contractor "_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw"mning Pools ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on �;Lq I Ll Si nature CgMMENTS • HEALTH Reviewed on Signature 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 ✓ 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) i ❑ 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ 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 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) ❑ 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:Building Permit Revised 2014 NORTH own of s E : ndover 10 No. h ver, Mass, COC.41 Hl WIC« y1. �•9 q°R�reo �P�,��(5 S U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT ,,,.,,,,,,�,,,,,,, BUILDING INSPECTOR ........... ........ ................ ............................................ has.permission to erectg C �i�......MAA-K44om.emFoundation ................... buildin son .. .......... ............... Rough tobe occupied as ........... ... .. .. .............Llo..X14............................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6kNANTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIRough Service ................ ..... ... ................. Final f BUILDING INSPECTOR IGAS INSPECTOR I Occupancy Permit Required to Occupy Buildin, Rough Display in a Conspicuous Place on the Premises — Do Not Remove . Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. I AORT#i Town of s E : �� ndover O :. - 0 h ver, Mass, 'P CO[N1C Hl WICK[ �'�' i �.9 A°R^reo )kip �(5 S V BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT .....,....�............ BUILDING INSPECTOR ........... ........ ........... ............................................ .."........." Foundation ....... has-permission to erect ................... buildings on .. .......�......4�!ss f Rough tobe occupied as ........... ... .. .. ..............�.c�.. .c. ............................................................ chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 NTHS ELECTRICAL INSPECTOR • UNLESS CONSTRUCTIO TA Rough 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. i NORTH Town of sAndover No soh ver, Mass, oc"Ic to ADRATED '-V' �S S U BOARD OF HEALTH Food/Kitchen PER T LD Septic System �s THIS CERTIFIES THAT ,,,,,,,,,,�,,,,.,, BUILDING INSPECTOR ........... ........ ............... ............................................ has-permission to erect g ,,,,,. Foundation ................... buildin son J-4q ....... .. ... ............ Rough tobe occupied as ........... ... .. .. .............Lo..x1.. ............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 LATHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough ................. Service ILII ................ ... ..... ..... ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in Conspicuous Place on the Premises — Do Not Remove Final p Y a p No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Professional Building Services by PMC, LLC %r.£1 Professional Building Services by PMC,LLC � 9 Olde Woode Road Estimate Salem,NH 03079-1863 Date Estimate No. (603)898-2977 07/03/2014 2135 pete@professionalbuiIdingsery ices.corn wExp. Date vw.professionalbuildingservices.coin OU14 SERVICES 07/17/2014 Address Robert Cipro 42 Wildrose Drive North Andover,MA 01845 Sales Rep MB Activity Quantity Rate Amount •1'0R ADDRESS 164MASS AVE,NORTH ANDOVER,MAOI5 • Building Permit-Administration Fee 0 375.00 0.00 Home owner can pull building permit themselves. If customer wishes Professional Building Services to pull permit,please add $375. ** Profession Customer to reimburse � ial Building Services cost of permit fee paid to Town/City. ** • Building Permit Fee paid to Town/City-TBD 0 0.00 0.00 i Phis fee to br reimbursed to Professional Building Services or customer can pay directly to municipality I I i I Continue to the next page i i I ; Activity Page 2 of 3 Quantity Rate Amount •Trex Select decking and railing, 140 I 49.00 6,860.00 f f=ascia and stair risers to be wrapped with PVC. jWill use hidden.fastener system and color matching screws where necessary I Construct new Pressure treated frame with galvanized nails I Install ice and water shield behind ledger I Flash ledger with copper flashing i I i Lag ledger to foundation sill in"zig-zag"pattern. Picture frame deck Size- 14'x10' Deck color-standard colors Rail-White I •Trex Rain Escapes for Pressure treated frame 140 16.00 2,240.00 •Foundation: 3 250.00 750.00 Dig&pour 12"sonotube to 48"min depth If ledge hit and must drill&pin,add S100 per hole • Stairs and landng: 2 240.00 480.00 Stair tread stringers to be installed 12"o.c.with Trex matching decking and PVC on risers.$260 per tread. •Trex lighting pricing: 0 0.00 0.00 Post cap$70/light Riser light S24/light i Recessed deck lights$24/light f Side post light-S50/light Labor to install-S30/light Transformer with timer switch-$259 �•Lattice: 0 250.00 0.00 Will install privacy lattice around bottom of deck as an upcharge if requested. Will frame with pressure treated wood Will use PVC;o trim out Price per section •Trex Transcend decking and porch planks installed by TrexPro Platinum's in 2012 (and beyond)will receive a free 2 year labor warranty from Trex upon project registration. When installed over Trex Elevations Steel Deck Framing,this coverage will be extended to 5 years. I 'Continue to the next page I i commenced which were not visible at the time the proposal was bid.Contractor will stop work and point out these unforeseen concealed conditions to Owner so that Owner and Contractor can execute a Change Order for any Additional Work. ROT REPAIR-remove,dispose,purchase and install 4x8 plywood-5100/sheet 1 0.00 0.00 , Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(\9GL 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. Ru neowner Information Contractor Information Name Robert 0pro Company 14ame PkttPl Stitt iNAl 131'11 01\r,Sl ltt tCI.S ll't l l•R(,I\1t vl.nl Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 42 Wildrose Drive 9rlt,Dl.V,()01* 10) City/Town State Zip Code Business Address(must include a street address) North Andover, MA 01845 '.At Lit Nil n:u-, Daytime Phone Evening Phone ity/Town State Zip Code 978-9715-05 74 Mailing Address(it different from above) Business Phone Federal Employer ID or S.S.Number bll i SVS 'H',7 45-3129l,17 Low mquircs that moat home Home Improvemcm Comnoor Lxpimian Datc Improstment contnemn hat c s valid reg.number Rcgistmlion number CSQ)650 '; 15 The Contractor agrees to do the follou•i tg work for the Homeown r: (Describe in detail the work to completed,specifying the type,brand,and gra of materials w be used,us additional sheets if necessary.) lLcference P"Ift's510n1t1 huilding Services F Oinrate it2135 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following and will be secured by the contractor as the ho neowner's agent, schedule will be adhered to unless circumstances beyond Owners who secure their own permits will be the contractors control arise excluded from the Cuaranty Fund provisions of 11 eek or S 11'14 Date when contractor will begin contracted work. ICL chapter 142A.) S 25114 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perforin the work,furnish the material and labor specified above for the total sum of: C 10.3:0.00_(•) Payments will be made according to the following schedule: S_3 44 3.00 upon signing contract(not to exceed 1/3 of the total contract price or the cost orspecial order items,whichever is greater) s_3,443.00 upon deck framed s_rerrainder upon completion of the contract.(Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must he special S_N/A to be paid for N/A ordered before the contracted work begins in order S— N/A to be paid for N/A to meet the completion schedule,(") NOTES:(`)Including all finance charges(")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 Warrant-Is an express vrarranty being provided by the contractor? No Yes (all 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. Contractor Arbitration The home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause Nvould give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. Homcowne� Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute re�,t!ution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty fund provisions of the Home hnprovement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer information Hotline Office of Consumer Affairs and Business Regulation • 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]ionic 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 One Ashburton Place,Room 1301,Boston,MA 02105 or by calling 617-727-3200 or 1-500.223-0933. • Does the contractor have insurance?Check to sec that your contractor is properly insured. 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. F may cancel this agreement if it has been signed at a place other than the contractor's normal place ofbusiness,provided you notify the tractor 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 third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. Homeowner's Sign,lure Contractor's Signature 7/10/2014 Date Date 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 ort-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (.508)755-2548 (413)734-3114 �o �yG�a9e�fo��a�i4 dse�i � � e dl.�toCoh��'d�,h�b'A�d 70/p�P °h % i���Pf �f 0°h, poi 0. ch�f�AG ��ch °hIA ie a� f JJ I , Sono Tubes 12 inch diameter. Re-use exisitng 4x6 anchor bases/4x6 PT posts Stairs 3ft min width. 7 1/2 inch riser- 12 tinch tread Trex standerred 36 inch rail height Balluster 3 1/2 inch OC Ledger attachment 3/8" x 4 5/8" 12 inch on center-zig zag : double ends Hurricane Clips Joists: 2x10 16" o.c. PT Beam 2- 2x10 PT 11 11 El le�11 11 I I i ACCORaCERTIFICATE OF LIABILITY INSURANCE 7/22/2014YY) 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(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Patricia Blais NAME: FA Financial Insurance Services Inc PHONE , (603)432-6414 1(A/C No):(603)432-3852 PO Box 950 E-MAIL ADDRESS:P blais@fisins.com INSURERS AFFORDING COVERAGE NAIC# Derry NH 03038 INSURER A.-National Grange Insurance Co INSURED INSURER B:HartfOrd Insurance Company Professional Building Services, LLC INSURER C: 9 Olde Woode Road INSURER D: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDNYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500,000 A CLAIMS-MADE F_x1 OCCUR RPT1630H /5/2014 /5/2015 MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea aBINEDtSINGLE LIMIT 1 000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED B1T1630H /5/2014 /5/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per acc dent Medical pavrnents $ 5,000 UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NI ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) 4NECLB1809 8/5/2013 8/5/2014 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Job location: 164 Mass Ave, North Andover, Ma 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Robert Cipro ACCORDANCE WITH THE POLICY PROVISIONS. 42 Wildrose Drive North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Sam Fragala/PAT ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INRn25 mmnn5i n1 Tha Ar`mmn name onri Innn ara ranicforari mark&of af%non 07 66 j.,v�i a , N Page 1 of 1 .!D c s w r, https:Hemail.newenglandmoves.com/service/home/—/?auth=co&loc=en US&id=60044&p... 7/25/2014 dx/ . Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 170870 Type: DBA Expiration: 1/10/2016 Tr# 247737 PROFESSIONAL BUILDING SERVICES INC PETER CIARALDI 9 OLDE WOODE RD SALEM, NH 03079 Update Address and return card. Mark reason for cha 20M-05/11 Address M Renewal M Employment E] Lost s Office of Consumer Affairs & Business Regulation License or registration valid for individul use only �----40ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: " Registration: 170870 Type: office of Consumer Affairs and Business Regulation Expiration: 1/10/2016 DBA 10 Park Plaza - Suite 5170 Boston, MA 02116 SSIONAL BUILDING SERVICES INC. CIARALDI WOODS RD 1, NH 03079 Undersecretary Not valid without signature Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's 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 f Information Hotline at 617-973-8787 or 1-888-383-3757. Homeowner Information Contractor Information ~J Name lit;+c r t_:int't: Company 'ame I'li(.)!.:I:SSH?',%I I'll 1'R.WNG SPE ':fi'!.S.p11!.'r:CI::!t iISS Street Address(do not use a Post Office Box address) untractor,'Salespersoni Owner Name 42Drive 1.17i:,11'titli)' Rli _ .............—_ ...... ;ity Town State Zip Code Business Address(must include a street address) North Andover, MA 018.45 Daytime Phone Evening Phone City/Town State Zip Code 978-975-0574 ..tailing Address(It different from above) Business Phone federal Employer 1D or S.S.Number o03_`Yr_3,1'77 45-31":9"'! W La.retioms that mast hnme �H(mr Improvement ColniraclOr Expiration bate •--•� �w Imptacemem eonvmtors have a valid reg.rmmber Reaistratimt number C S 1)7 6 0 7.1;, The Contractor agrees to do the followi g work for the llomeown r: (Describe in detail die work to completed,specifying the type,brand,and gra of materials to be used,ust additional sheets if nmessar v.) l4fc•rence Professional BWilding Services Estimate q21.1; Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following and will be secured by the contractor as the homeowner's agent, schedule will be adhered to unless circumstances beyond Owners who secure their own permits will be the contractors control arise excluded from the Guaranty Fund provisions of WC ck of �*:l l%1.1 Date when contractor will begin contracted work. MGL chapter 142A.) i<;25.14 Date when contracted work will be substantially completed, Total Contract Price and Payment Sehedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: 10."130,f i —t*) Payments will be rnatle according to the following schedule: s-3 44 3.n0 upon signing contract(not to exceed 113 of the total contract price or the cost of special order items,whichever is greater) s_3.<}4 3.00 upon deck framed $ re't71111'de 11 upon completion of ale contract.(Law forbids demanding full payment until contract is coinplmd io boon Party-s satisfaction) The following materiab'equipmem must be special$_ NiA to be paid forN;A ordered before the contracted work begins in orders NIA to paid for'*******'*"' NtA to meet the completion schedule.(**) _. ' _.._. .......__ __..................... ..... ........... _.......-..._.. NOTES:(*)Including all finance charges(**)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-Es nn express warrur beinf provided by the contractor? \0 1'es ant terms of the»:Lrranty 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 partyisubcontractor utilized by the contractor,The contractor further agrees to be solely responsible for all payments to atl subcontractors_for material s_alxd._Iabor 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. Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate all arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. 1 WSin Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of alae parties to alternative dispute re_-t?ution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in du�e_and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been billed in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.however,in instances where a contractor deems him.?herself to be financially insecure,tite contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work,Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (017)973-8787 or 1-(888)2633757 If you want to verify the registration ofa contractor or if you have questions or need additional information specifically about the contractor registration component of the liome Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,.Boston,MA 02103 (617)727-3200 ort-800-223-0933 For assistance with informal mediation of'disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2543 (413)734-3114 ' 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 Res istration.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 One Ashburton Place,Room 1301,Boston,IMA 02105 or by calling 61-7-727-3200 or 1.800-223-0933. Does the contractor have insurance?Check to see that your contractor is properly insured, Know your sighs and resporsibiiities.Read the Important),)formation on the reverse side of this fort 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 ol'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 rridnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!If identical copies of the contract must be completed and signed.One copy should go to the homeowner,The other copy should be kept by the contractor. HoMeowner's Sign lure Contractor's Signature J � . ___ _�7/10/2014 azc - Date _.....___� Professional Building Services by PMC, LLC Professional Building;Services by PMC,LLC 9 Olde Woode Road Estimate Salem,NH 03079-1863Date ESUMate No. (603)898-2977 07;03,12014 2135 wttprofesssionatbuilding ervices.com �— .—P t � Ex Dated L� 07/17/2014 i _.. ..__ VIC Address Robert Cipro 42 1Vildrose Drive North Andover,MA 01.845 Sales Rep MB Activity. _ 1777 — _ •I OR ADDRESS 164 MASS AVE,NORTH ANDOVER,MA 01845 Quantity Rate Atnoun# -� Building Permit-Administration Fee 0 375A0 0.00 Home owner can pull building permit themselves. j 3 If customer wishes Professional Building Services to pull permit,please add $375. k ** Customer to reimburse Professional Building Services cost og'perntit fee paid to Town/City.** •Building Permit Fee paid to Town/City-TBD 0 } 0 00' 1 1 0.00 This fee to b^reimbursed to Professional Building Services or customer can pay directly to municipality f j i Continue to to the next page f , ........... _ ..............._..... ' � I ......1 Page 2 of"s Activity ,'`. -•---1 I .'>.:. Quantify Rate Amotan#;: Trex Select decking and railing. 140 _... 'i 49.00 6,3G0.00 Fascia and stair risers to be wrapped with PVC. j I 1 � I 1 Will use hidden fastener system and color matching screws where necessary E Construct new Pressure treated frame with galvanized nails i � Install ice and water shield behind ledger ! j # I Flash ledger with copper flashing E Lag ledger to foundation sill in"Zig-zag"pattern. Picture frame deck I ! 1 j Size- 14'x10' Deck color-standard colors Rail-White 1 •Trex Rain Escapes for Pressure treated frame ( 140 16.00; j •Foundation: j _40.00 3750.00 750.00 Dig&pour 12'sonotube to 43"min depth I i If ledge hit and must drill&pin.add$100 per hole •Stairs and landng: 2 240.00� 480.00 ! Stair tread stringers to be installed 12"o.c.with Trex matching decking and PVC on risers.$260 per tread. •Trcx fighting pricing: Post cap$70llight 0 0.00; 0.00 Riser light$24/light ]] 1 Recessed deck lights$24/light Side post light-$501'light Labor to install-$30flight E ! Transformer with timer switch-$259 I •Lattice: 0 250A0, , Will install privacy lattice around bottom of deck as an upcharge if requested. 0.00 Will frame with pressure treated wood Will use PVC io trim out i Price per section •Trex Transcend decking and porch planks installed by TrexPro Platinum's in 2012 {and beyond}will receive a free 2 year labor warranty from Trex upon project registration.When installed over Trex Elevations Steel Deck Framing,this coverage will be extended to 3 vears. i l i I lContinue to the next page ' l } v.�-...�...._ commenced tivhich were not visible at the tihie the prop�isal ua bid.Contractor-w-iTlj - I , stop work and point out these unforeseen concealed conditions to owner so that Owner and Contractor can execute a Change Order for any Additional Work. •ROT REPAIR-remove,dispose,purchase and install 4x3 plywood-$1001sheet1 f 0.00: 0,00 MORTGAGE INSPECTION PLAN 401 SOUTH BROADWAY, NORTHERN,BASSOCIATES,3-3522 INC. MORTGAGOR:.CLA551C RI=ALTY TRU5T 335 FAX:(978). ) 28/58 36 LOCATION: I G4 MA55ACHU5ETT5 AVEN E DEED REF: .2405 8 PLAN REF: 2409 CITY.5TATE: NORTH ANDOVER. MA� 5CALE; 1"=30 DATE: 8/1 11201 I 0 JOB #: 21 1 ,02071 `\ 100.00' GARAGE �, V V� 8 g � 1 1/2 STORY WOO��D #164 100.00' MA55ACHU5ET75 AVENUE CERTIFIED TO: NORTHMARK BANK, FPS 5UCCE550R5 AND A551GN5 ATIMA 11oad hasard sans has been dete mined by seals and is not necessarily acowntaUntit definitive pians are issued by MID and/or a wrtieal control surwov is I—Prmed,preoiee elevations cannot be determined burr M& wort~ !vn: tion wee }n and � rr n+e.tS..ee perp.+. owty awd w.�`'' .i� Cif�:1 weA, ►.�~ ash J..d� a .ws.a.we. is not to a rdted `= ee a Iswi o► peopray .yy sae• Law line ewwv. used pr reoerdiwe. pre;,, deed �," ; C\ S`Ii lwepead"m nr odspted ay*As teeeeo&tmLQtb aoard of dneript{one, or oenttrudim No eernere were ,"r' '�. Arvistrw" of l mesio ml suo w r and ton/ eel BeYd loeat4t►anrd e ♦ S 250 CYtt 006. a7+A v lomw on ground and `;+=�' ! Rr\IG r ! atase tot in P+n�nteae opinion so �Aet C. he structures abnen eultA !Jr bsoal sa►iy Aarlsontat en eAowR sPeNlloatl .Ow senint deannim"m �rl,NCLIi2F. A cn vdimensiond edbwt irswouls dd she tiev of aondrortun or only awd air wet to 6e Used to oetaSl{eA pro 'T r�qu ilnet tis wmam Shawn(ween cue117 t! 096mPt under previeiowe e�ACRL L7L 40–I see. V. ddwd—j1rwtaAod taAwn..tfen and "say be sue}or a 0 , " 1 l t�,r:�.. . l Pro /;wrse N wet a flood Idaesei to rrtAer cul–esia% tsAtr�Ot esrwrr+d+ and r'4%e ��4-UfF.' s. Rv /JYf.U.. (. aw. n«s lfe.s.a Arms. of tislr. and o0wr wmtani of.event and pnaerpltw s r r , O a t.w a iney�iosrlt a dsterwtiwe /iced tAvani or otAer rtsMa AurfAerw lweoiob+. MAL ar+Uwne no neponedno y Ae eu s dsrd enmrr or ewUppOont. / Real Afeeans deterwadeod plena latest /ednai flood aoeepte ro »sporudOtitty fpr denisyoa na�dtiwe JMa eodd f�"��./ ti..G�.•r i region by sr.V~ at/or than tAe said enerler4/ro and ite �at� r iw oewnratiow wW w pnpoesd w�atpaee ftwanetiy to eadd nwreeoee. l ( hvrwerw !tate Ysp fRwN .tote 1-'•?- �y•% Zorn )(._.�r�.r'rI-j�•Yi�,r Location It, 4—� No. + — Date 7a, 4,� }� 1 • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ `� Building/Frame Permit Fee $�S` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check r Building Inspector NORTl1 BUILDING PERMIT o "t, -o b,�tio TOWN OF NORTH ANDOVER o i APPLICATION FOR PLAN EXAMINATION Permit No#: Date ReceivedQ,<�.,-.wK.", q9 gSSACHUs�� Date Issued: IMP RTANT: Applicant must complete all items on this page LOCATION t Pf Gk JJ V5J�f � �, ffdl ®✓ Pnnt PROPERTY OWNER q ��cl e Print 100 Year Structure yes no MAP �I PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building m'One family ❑Addition ❑Two or more family ❑ Industrial P,Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District DESCRIPTION OF WORK TO BE PERFORMED: 1l1 Aft 51 'D 146a a- I entific-"on- Pe ase Type or Print Clearly �n� 1���� OWNER: Nam&- �J�� (�� Phone % ����i Address: Lq Contractor Name: , d � / / Address:q 0,1LI& /�.1� C� �11���'i Pik IX4- �/ Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ TOy FEE: $ W / � �Check No.: ��! Receipt No.: ZS NOTE: Persons'contracting with unregistered contractors do not have access t the guaranty fund Signature of Agent/Owne 1 Signature of contractor Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 Pennit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ 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 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) ❑ 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:Building Permit Revised 2014 Location Y —c— No. �• Date l7 • - TOWN OF NORTH ANDOVER • IMFD l6� • • Certificate of Occupancy $ . .,,. Building/Frame Permit Fee q�/ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#_ ✓ Building Inspector ' 1 ® DATE(MMIDD/YYYY) A�V CERTIFICATE OF LIABILITY INSURANCE 7/24/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Eric Hasbany & Regan Insurance Agen PHONE Eidi. 978) 685-3188 AC No: (978) 685-9460 IAIC.254 Pleasant Street ENTAIL ADDRESS: eric@hasbany.com Methuen, MA 01844 INSURERS)AFFORDING COVERAGE MAIC# INSURER A:Western World INSURED INSURERS:Liberty Mutual Joshua Dupont INSURER C: DBA Joshua Dupont Construction INSURER D: PO Box 684 INSURER E: Hampstead, NH 03841 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INR WVD POLICY NUMBER M/DDIY MM/DD/YYYY LIMITS A GEN ERAL LIABILITY NPP8103930 5/29/14 5/29/15 EACH OCCURRENCE $ 1,000,000 COMMERCIALGENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrencg) $ 50QQQ CLAIMS-MADE F_I OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT CEO,accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC5-31S-377807-022 9/9/13 9/9/14 WCSTATU- I OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACG DENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is reclul red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover ACCORDANCE WITH THE POLICY PROVISIONS. barbara.grasso@nemoves.com AUTHORIZED REPRESENTATIVE Emily Crossman ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: A�® CERTIFICATE OF LIABILITY INSURANCE 7�llit2o14YY) 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(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Patricia B1aiS NAME: Financial Insurance Services Inc PHONE . (603)432-6414 FAX, X No):(603)432-3852 PO Box 950 E-MAIL ADDRESS:Pblais@fisins.com INSURERS AFFORDING COVERAGE NAIC# Derry NH 03038 INSURERA:National Grange Insurance Co INSURED INSURER B:Hartford Insurance Company Professional Building Services, LLC INSURER C: 9 Olde Woode Road INSURER D: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 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. ILTR TYPE OF INSURANCE AA211_vm D L SUB POLICY NUMBER POLICY EFF MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500,000 A I CLAIMS-MADE Fx-]OCCUR KPT1630H /5/2014 /5/2015 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY 7 PRO LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED B1T1630H /5/2014 2/5/2015 BODILY INJURY Per accident $ AUTOS AUTOS X HIRED AUTOS �{ NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- 70TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I I FIR ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory In NH) 4WECLB1809 8/5/2013 8/5/2014 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Job location: 164 Mass Ave, North Andover, Ma 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Robert Cipro ACCORDANCE WITH THE POLICY PROVISIONS. 42 Wildrose Drive North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Sam Fragala/PAT ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INR1712.9;rgninnsi nt Th=A!`non nam=and Innn aro ranicfnrcfl marlea of Annizi 1 i hi, Li i EN' L L -H W, FA L C 'M-+LA' E Uff I W , lb 4-- -' -- -- 5 (.:-�-..'. . '�' •_. :[ g i - ���^.f 'r -1. r rte` ��`� �=- MR- .'i,.1 ri Two �. � Page 1 of 1 n S yS a .? Gam :. https:Hemail.newenglandmoves.com/service/home%/?auth=co&loc=en US&id=60044&p... 7/25/2014 aiJac XIMIJeaj =` Office of Consumer Affairs and Business Regulation ' 10 Park Plaza - Suite 5 .170 .Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 170870 Type: DBA Expiration: 1/10/2016 Tr# 247737 PROFESSIONAL BUILDING SERVICES INC PETER CIARALDI 9 OLDS WOODS RD SALEM, NH 03079 Update Address and return card. Mark reason for cha J 20M-05/11 Address F] Renewal [] Employment E] Lost 1 Office of Consumer Affairs & Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 170870 Type: Office of Consumer Affairs and Business Regulation ;expiration: 1/10/2016 DBA 10 Park Plaza - Suite 5170 Boston, MA 0211.6 _SSIONAL BUILDING SERVICES INC. Z CIARALDI WOODE RD 1, NH 03079 Undersecretary Not valid without signature i NORTH own of 2 : ndover :� . 4 5 a �o I h ver, Mass, C OCHICH[WIC" 1 1. RATED /.P�`�,�5 U BOARD OF HEALTH Food/Kitchen T. Septic System THIS CERTIFIES THAT .......... A.......PERM [T LD ............. � vory BUILDING INSPECTOR f, Foundation , has permission to erect .......................... buildings on .....i.Y........... . . � ♦ . Rough c � to be occupied as ............UIAA.�L........ �1 .4... ......... ...................................... Chimney provided that the person acceptinhis permit shall in eve espect 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 IN 6 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI S TS Rough 7" 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. f ' �d�i'�.d.�x:C�u���:1t _ �>•,1.art xrc~�; �� rya. .•:. S�P��� 'A z� PETER NI CIARA - 4 s VN ml op"ho iL/'/.`Ti 4+ Dupont Construction Vinyl Siding,Roofing&Replacement Windows P.O Box 684 Hampstead NH 03841 C: 603-300-7865 H. 603-382-0470 6-MOU Proposal Submitted to: Work to be Performed at: Robert Cipro 164 Mass Ave. N. Andover MA We hereby purpose to furnish the materials and perform the labor necessary for completion of: • Install moisture barrier over existing siding • Install standard white vinyl corner posts • Install vinyl blocks behind all lights, vents and sill caulks • Install vinyl soffit beneath all overhangs • Install aluminum trim over all rakes and fascia boards • Install Mastic Carvedwood D4 vinyl siding (Color: Pebble stone clay ) • Clean and dispose of all debris All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and sp-eecificationnss submitted for above work and completed in a substantial workmanlike manner for the sum of: $/,�.00 With Payments to be made as follows: Half when Material is delivered Half when complete *Any alternation or deviation from above specifications involving extra cost will be executed only upon written order,and will become an extra charge over and above the estimate:All agreements contingent upon strikes, accidents,or delays beyond our control.* Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to d e work specified. Payments will be made as outlined above. Signature: Datefile Signature Date '' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: � ' 14, IMPORTANT: Applicant must complete all items on this page LOCATION z6y �J� . r L-1 HP-1 PROPERTY OWNER �'� N L �- Print 100 Year Old Structure yes no MAP NO: PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -ErOne family ❑Addition ❑Two or more family ❑ Industrial 4�1AAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: v a All — I 2c I�— Id tification lease Type or Print Clearly) OWNER: Name: c�'t iw ��2' Phonec/ Address: CONTRACTOR NarheV.Z ,/_Q Phone: Address: C/1 h k4-r-_ 'V 41 Supervisor's Construction License: Exp. Date: / ` �d Home Improvement License: Exp. Date: ��':Z21 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$T2.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S -3• aFEE: $ Check No.: � �p Receipt No.: C .� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of tnr oAgen /Ow +eigpatueof Plans Submitted �.j Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ ..Certified Plot Plan ❑ Stamped Plans ❑ - TYPE OF::SEWER-AGE-DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swimming Pools _ D a, Well ❑ Tobacco.Sales 0 Food Packaging/Sales ❑ Private(septic tank,etc._ Ell permanent Duinpster on-Site ❑ THE-FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE.APPR.OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Sic' nafure COMMENTS HEALTH Reviewed on Signature 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 Os ood,Street FIRE DEPARTiWL--NT'.-:Temp Dumpster on site yes no ♦. Located'at•124,Main Street-- -'Fire-Deparme►ifsignatu're/date- COMMENTS 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--.Chapter166.Section 21A-F and G min.$10041000 fine NOTand DATA— (For department use Ll Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department _:The fol owing is:'a=list ofthe required-forms to befilled outfor:the appropriate.permit to.be obtained. Roofirg, Siding, Interior Rehabilitation Permits u' Building Permit Application ❑ Workers Comp Affidavit ❑ 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 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 ❑ 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 apw-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding permit Revised 2012 Location No. Date • -MV TOWN OF NORTH ANDOVER n • s�;f'� r64a � • • Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# J Building Inspector NORTI•f Town ofndover . : . to ver, Mass, 1�r LAN! �,— COC NIG N!WKK S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT �D\f\-n.........� ........................................................ BUILDING INSPECTOR •�, Foundation has permission to erect .......................... buildings on ..... .�1. ....... . . . 5....... !r+G-�••t•••••••••••• Rough ,. � �. ��..... Chimney to be occupied as ........... y �' d...... �!1�. • • ... 7........ . 1•••••• provided that the person accepting this permit shall in every respect conform to the s 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST RTS Rough 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. CONTRACTOR WORK ORDER Conser ation Services Group " 50 Washington St.Suite 3000 Printed: 3/5/2014 Westborough,MA 01581 Work Order Id: S90159P95058C238 Contractor Information Customer/Site Details Polar Bear Insulation John Cote Email: barbara.grasso@nemoves.com PO Box 958 164 Massachusetts Ave Phone(Eve): 978-502-6242 Phone(Day): 978-602-6242 Andover,MA 01810 North Andover,MA 018454152 Site ID: S00002190159 Total Installed Measures Location Description Quantity Unit$ Total$ Door Sweep 4 $21.17 $84.68 Living Space Perform Air Sealing at Estimated 62.5 CFM50 1 $77.00 $77.00 I Exterior Door Weather Stripping 4 $25.20 $100.80 Living Space Insulate Rim Joist with 6.25"Fiberglass Batting 68 $2.09 $142.12 Sheathing Access 2 $33.00 $66.00 Living Space Door:Thermal Barrier Polyiso 2"(Attic) 1 $74.31 $74.31 Living Space Door:Thermal Barrier Polyiso 2"(Attic) 1 $74.31 $74.31 I Damming 14 $1.85 $25.90 Living Space Insulate Buffer Wall From Interior With 4"Dens 66 $2.11 $139.26 Living Space Attic Floor Enclosed Cellulose Dense Pack 8" 1,133 $2.37 $2,685.21 Living Space Insulate Wood Shingle Sided Wall With 3"Den 1,035 $1.82 $1,883.70 Installed Measures Total $5,353.29 WorkOrder Notes ` < Payments Incentive Payments Air Sealing Incentive $262.48 Weatherization Incentive $2,000.00 Total Incentive Payments $2,262.48 { Customer Share Total Customer Share $3,090.81 Less Deposit Of $1,030.27 Customer Share Balance(Due Contractor) $2,060.54 Conservation Services Group-50 Washington Street Suite 3000-Westborough,MA 01581 -(508)836-9500 k mass sage PERMIT AUTHORIZATION FORM I, John Cote ,owner of the property located at: IOwner's Name,printed) 164 Massachusetts Ave N.Andover i+ } (Property Street Address) (city) I hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. l: Xi Robert P,(�is)Feb 5.2 alnico t owner's signature i r Feb 5,2014 Date is FOR CSG OFFICE USE ONLY i Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: i i }' Participating Contractor Date 4 I t I i P � I r i - Off Di f ordff c*UssOrtly Rev.12132011 a OP ID:SS CERTIFICATE OF LIABILITY INSURANCE °"'212312013 12123/2013 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: N the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed 9 SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement s PRODUCER CONTACT NAME: Durso&Jankowski Ins Agcy LLC PHONE FAX 198 Massachusetts Avenue Arc N E AIC No North Andover,MA 01845 ADDRESS: Durso 8:Jankowski Ins.Agcy. oMER w:POLAR4 INSURER(S)AFFORDING COVERAGE MAIC 0 INSURED Polar Bear Insulation Co.Inc. INSURER A:Penn America 32859 P 0 Box 958 Andover,MA 01810 INSURER B:Safety Insurance Co. 33618 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. MIR AML SUOR POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER D MIMONYM O LIMns GENERAL LIABLRY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PAC7022861 03/24/2013 0312412014 pREMISEt Ee.ffen. $ 50,00 CLAIMS-MADE i OCCUR MED EXP(Any ane person) E 5,00 PERSONAL 6 ADV INJURY S 11000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 B ANY AUTO 2100826 01/04/2014 01104/2015 (Ea occident) ALL OWNED AUTOS BODILY INJURY(Perperson) S X BODILY INJURY(Peracdderd) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) S X NON-OWNED AUTOS S s UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIM CLAIMS-MADE A PAC6906385 03/24/2013 03/2412014 AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONS TH- AND ENPLOYER5 LIABILITY YIN TRY U IT PER ANY PROPRIETOR/PARTNEREXECUTIVE OFFICERIMEMBEREXCLUDED? El MIA E.L.EACH ACCIDENT $ (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE S B describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 II�O�CATKINS I VEHICLES(Attach ACORD 101,AddNlonal Rte•SeMdul%N more spw to requlnd) Insulation Work;Additional insured for general liability aith xespec to work performed on their behalf by the above insured is: "National Grid Corporate Services LLC DBA National Grid, DBA Boston Gas Co DHA Essex Gas Company, 6 Action Inc" CERTIFICATE HOLDER CANCELLATION ACTIONi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Action Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 47 Washington St ACCORDANCE WITH THE POLICY PROVISIONS. Gloucester,MA 01930 AUTHORIZED REPRESENTATIVE ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD POLABEA-04 KSKA A4�'�� CERTIFICATE OF LIABILITY INSURANCE DA121302013 12/30/2013 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorsements PRODUCER NAME: Automatic Data Processing Insurance Agency,Inc PHONE Ax 1 ADP Boulevard Ne: Roseland,NJ 07068 Mr. INSURER(S)AFFORDING COVERAGE NAIL f INSURER A:NorGuard Insurance Company 11111 INSURED Polar Bear Insulation CO Inc INSURER B: 51 South Canal St INSURER C: PO BOX 958 INSURER 0: Lawrence,MA 01843- INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE POLICY NUMBER /D EFF P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ COMMERCU�L GENERAL LIABILITY ren PREMISES Ea accurca S CLAIMS•MADE E1OCCUR MED EXP(Airy one Person) $ PERSONAL d ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POUCV PRO- LOC S AUTOMOBILE LIABILITY C8tEO denISINGL LIMITS ANY AUTO BODILY INJURY(Per person) S � AUTO OWNED SCHEDULED AUTOSBODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accidentS S UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I I RETENTION S $ WORKERS COMPENSATION X OC V AMUS O R AND EMPLOYERS'LIABILITY A ANY PROPRIETOMPARTNERIEXECUTNE Y— POWCS"065 1/1/2014 11112015 E.L.EACH ACCIDENT $ 1,000,00( OFFICEMMEMBER EXCLUDED? N N I A IMar"Imory in I" E.L.DISEASE-EA EMPLOYEE $ 1,000,00 r desciunder DESCRIPTIONbe OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Albeh ACORD 701,AddMonal Rernerq Schedule,if awes spam k requlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Action Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 47 Washington Street Gloucester,MA 01890 AUTHORIZED REPRESENTATIVE L� ®1988-2010 ACORD CORPORATION. A0 rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Uttice otConsumer Affairs&Business Regulation-Mass.Gov Page 1 of 1 The Oficial Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affa r; and OuSiness Regugcatiion -- Home Consumer Home improvement Contractinc HOme limPrOvemenQ. t C GntractGr Regan"ptration Lookup You can search/ifter the registration list by any of the criteria below. Search by Registration Number Search! Search by Regisarant Name V0EAR SEAR IIdSULATi Search-by CKhj =ANDOVER ! Zip Code Search Registrants: Click on the registration number to view Complaint history.You can also N+iek,:,arbiirarion and historv. The list is current as of, Sunday, May 12, 2013, Search Resu is REGISTRANT RESPONSIBLE REGISTRATION E}'PIRATION NAME INDIVIDUAL NUMBER ADDRESS STATUS DATE POLAR BEAR LeBlanc, Vincent 1102726 P.O. BOX 958 07102/2014 Current rNsul.aTlanl CO. ANDOVER, MA 01810 ©2012 Commonwealth of Massachusetts. Mass:Gov®is a registered service mark of the Commonwealth of Massachusetts. ` r V1assachuses - eP nmc_ Jc� 3o�,rd as Buiid;na ?aC Ula ions and - t�jn,tructiur Sut�cn i;,r Siacriait� -:cense: CssL-10592$ VINCENT E LEBLz4NC 24 LANDING DR METH"N MA 61844 �omrnisstoner 01!3012016 fµORTM 1 o , I % . TOWN OF NORTH ANDOVER o'_�. __. ,>�".` APPLICATION FOR PLAN EXAMINATION ,SSACHU`�F� Permit NO: Date Received: Date Issued: " JLC` 40 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print / MAP NO.:--ZO PARCEL: 3 ZONING DISTRICT: "7' TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) 1 ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: l °o Phone: 7 Address: 1 CONTRACTOR Name: ,24! at�ezzze4 Phone: 6(::U 970' Address: 1:! `0 5 16 S Supervisor's Construction License: i�2�/�9 Exp. Date: Home Improvement License: O 2-`) Exp. Date: 6 p ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ j' S f�D, ° x10.00=FEE:$ ' Check No.: 4� - ICJ 4,1 ^r_. _ Receipt No.: /'?0 U Page I of 4 TYPE OF SEWARGE DISPOSAL i wmmn SiPools El Art ❑ g Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales 11❑ ❑ Permanent Dumpster on Site Private(septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St ped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS i DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS u Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes—no— Fire Department signature/date Building Permit Approved and Issued :bY Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 Location No. d Date,-3-2e) e)l �aRTM TOWN OF NORTH ANDOVER F A f1 :io Certificate of Occupancy $ 444 y�s'••°'''<�' Building/Frame Permit Fee $ s4c Nust Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # l,, 9, s � J r /J 19( - 72 ,' Building Inspector' MAR-30-2006 THU 01 :57 PM WYZE BUS CTRS INC FAX N0, 16038931050 P. 02 n i f J � r arm.rreiruaet?) p0.3S.000<t J:nrloaa Tar[: f'.gARM OF 13U11,01XG REGULATIONS (MOL CA125 COO Licr_n>�: C0N4TRU(:T•Ir2P1SUPERVISOR tA-Mu,miyonly - I G• 16 2 Fa n:ly Hames ,k �« Nunlh ur• CS 071: 9 Failuu;I,)pn„e;,r.1 r.Iirmnt P0,tirr,a'nn M.tssachlJst:¢'s 514k Suildiml CoCS -.•' -, t]hLhU.atO: Od11I/1072 is c•u,r,c for revocation or this lirrrcx. Fzl)ira:: 04/11/2UC4 Tr.nn; 9759.0 Ra,.uJcw'd: 00 14"X"ADOW LANC 6A1, 'ut Nt•I t1.)OJS! �•••"�artu,)�.uator DIG SAFE CALL CENTER: (0118}344-72,13 i t .';/fie vo•�.tJ.J.wJJr.••,�ntbr ./. ��r.hct.'%tl...i(:r%1 • ITaan1 of Itniltlillf,Ile;ui:Jria�s autl StnnJards License or regisironon valid for imlividul uAc 0111v �• '.;" ilUf�E IMr RL)VFYIF:VT 'ONTRACTOR Uilorc the tslsirition dale, if fonmt rctJArJt tn: } y (Hoon!of Building ide;ul;llions and Slandartls a ,, - I>,;cJi;;trOtinrt: 11h0�9 One Axhburvsn Plan Rig) 1301 �tpu~tion: fi1,1Y20C Bo,.tn,r,%la.02108 fypc: indivim!LI C,1.;iL.C'rt L•tilt lJ ' GIC-NIEU �J 1.s NAKA00W I.ANL- ,l.__ -^ "•r c� ��,�:,'•.�r�..,�`�� . ._.�� SAtiiF vl.N11 02028 aQluuusuawr Not valid"villtnul kilialurt ' i MAR-30-2006 THU 01:57 PM WYZE BUS CTRS INC FAX N0, 16038931050 P, 03 Licensed Contractor o o .r_Jp ticlr;ct Iltc.Search liicllrnrl: N1mo ,l\tar ikntknk �yry,uf,cr of�u:�tchcs: r25''":� I;,►Icr Seal cir lernm separated by spaces. . —__� "�-_—• M r�rl�reni�r Select Scarab AND r Cllt `scarai_ _.—/il-12-_c_s�t-r�ir.t_iu::--r'tJLl�,;.-a--..�»r..._a_l_i:_a.;r:,J--- ,S,:...t:�_._-- .__-••.:_-te--IfI :-%-- - _ ,11ty/CctirName �7ADO.SAI.IM � IfW r . 2/2 N11 030 I l IkL{Ir'fkell. 11WIS Y'rivoU Statcment r�lt�://rit�.,wt�ttu.ku,►.usJiyl�t:5/c:c���tr:r�;t.� ! 2/2.32005 MAR-30-2006 THU 01 :57 PM WYZE BUS CTRS INC FAX NO, 16038931050 P. 04 Rus I of I Ill',I.Wovement Coontractor Look Up ["III"I'SCII IT-11 t c"I ns va I cd by spurn. Searcjl AND OR .......... Z 'eel, )-,I cg. N o. A 'lilt (.r.c.c Name pp lie 13(029 RD stil,11c Sn1 1'.." Nf 1 03079 (11ll 0 W N El 11 00� ' 01UNIF R CA R 1, 5' ._ ._...._`__. ,.,_ I ofial of I Rccords 111.1tchvd. Back it) I loine. ji.i p,/1 Date. 1614*.............. ! NOR71, °:`1"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ► r ,SSACHUSf This certifies that .... .!!!t!.... � .t.` `' ...... ........................................... has permission to performer w 1 t't' ............. ........................ ........................................ wiring in the building of ...:14,?.G' ....................................... at....................................... / .,.. .. ........................ ,North Andover,Mass. .� .. .. ............................... .. !.. .. .... � Fee .... Lic.No. ' �� � � ELECTRICAL INSPECTOR Check # 6Fi5 TBE COAMONWEALTHoF'mAs AClIIIS'ms Office Use only DEPARTA1ENT0FPUBIICWVY Permit No. X BOARD 0FFIREPREVEIW0NR C-UTAT70NS527OM12:OIO Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date `7 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform ferform the electrical work described below. Location(Street&Number) ` 7 /)s' 'fir Owner or TenantQi/'-},�; Owner's Address Is this permit in conjunction with a building permit: Yes[EErNo r7 (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps �Volts Overhead Underground M No.of Meters New Service Amps / Volts Overhead Underground 1:3 No. of Meters Number of Feeders and Ampacity QST Location and Nature of Proposed Electrical Work lilir2N ,e 40147- 64816E — /eIIA 1 A162✓ Fj�-yJ No.of Lighting Outlets 3 No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above Below Generators KVA KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of DryersHeating Devices KW Local � Connections Municipal Other �p No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER 1/.L/ ��CJa� 220d�-- (/,c..p�2G�✓a�/J p c � C hmuanoeCoverage.RusstantrotheracltrrtanaysofMa�ac11<rseftsGa�ralLaws IhaveatzinattLiatxlrtyh»relicyinchrdngCorripWComrageoritssubb�tialegtuvalai YES NO IhaNe&hTMdvandgoofof=wbotheOffim YES � ryp IfycuhawchedodYES,plemindic&theeofooNa�by INSURAN F- BOND r7 OTHER (Plem*ci'y) F�uation Dafe p Estinl*d Value OfDearical Wotk$ WodctoStart Irq)earonl a1eRff ested . Rcth Final &gred underTe anakies of pOW.. FIRM NAME Lime � 44--" Sigrmn �^ LicffWNo - `, Bustn�TeL No. 179 37 S S`7 3 J , ddiecc t� S'% wig'--c .�� f�1� 1��� d Alt.Tel No. —f73 L=6 2 6 i`-2— OWIgR'SINSURANCEWANER,Iam awarethattheLioerwdoes nothavvetheirmnanceoo orAssubAarrial and that my sig>ahrre on this pemnit application waives this req me�-at �� ��as�����G=al Laws (Please check one) Owner M Agent a Telephone No. PERMIT FEE$ 5ignature Or wner or Agent