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Building Permit #860-14 - 27 BELMONT STREET 5/29/2014
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION I Permit NO: (� .Date Received Date Issued:l' PO TANT: Applicant must complete all items on this page IS LOCATIa.IVI _ _�� -- --- - - -- -- 5 inti_ PROPERTY_- -. 00 Year OIFd Pnnt 1'. structure EMAP NO zPAR;CEL"�: ZONING"D4STRICT H stone District nM _hop age -, achin_e S Vill TYPE OF IMPROVEMENT. PROPOSED USE Wil! Certified Plot Plan Reside Non- Residential ❑ New Building ne family .%t�Q ❑ Addition ❑ Two or more family 0 Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 0 Demolition Other IflSeptie: OWell Via° _❑ ; pFloodplaii �:Wetlards ❑ 1Natersledi®istnct4 } _ ❑Water/Sewer_ I t DESCRIPTION OF WORK TO BE PERFORMED: OWNER: Name: Ar1drecc- Name_ C®NTRAC�OR Wil! Certified Plot Plan { Stamped Plans ❑ ;Address "GLA .%t�Q Supervisor's Construction `Lir Please TvApe or Print Clearly) bon f <xp D:ate " -- 4_ Phone: Address: Reg. No. FEE SCHEDULE: BOLDING Apgor. $12.00 PER $10©.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ (1 FEE: Check No.:�2 '1 (,p ZZ �1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to/t�he guaranty fund to, A . It R 2.0I>_w!CI.tGI Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I <21 Location No. Date TOWN OF NORTH ANDOVER'., Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL i Plans Submitted❑ 'Plans Waived ❑ _ . Certified Plot Plan 0 Stamped Plans ❑ ;TI'P OF SEWERAGED1&POSA1 Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc.- ❑ --- _ _permanent Dinpster 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 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 ConnectiotllSignature Date Driveway Permit DPW Tow;z Engineer: Signature: Located 3 s ood Street FIRE DEPAPTMr NT Ternp Dumpsier on site yes no Located at 124'Mair Street { 4' F°•ok..r. k r 0 1., toys 3 tie ! t:+ "�:.= Fire"Departme�it 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,locatton-, 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=$1000fine NOTES and DATA — (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fvl �w ng is a list of the required=forms to be filled outfor:the appropriate. permit to`.be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ ` 13,uilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/O'r'C.S.L Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products JOTE: All dumpster..permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ci Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o 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 !COTE: 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 apn•?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.+ted with the building application Doc: Doc.Bui?ding permit Revised 2012 in e A E9 * J W 2 U. 0 a m L = \ '6 LL E sU TO Ln U C Ln o d V1 z z O J m C m 'O C LL L 2' C E U LL d LA ? Zv mm G J a L � d' LL o 0. H Z W J W L 1' V Ln LL O U a Ln H Q L O' LL z W a W O W 6L Q/ CD z ++ �% Ln 4-; N o YQj O Ln n o O CU o 2 o s S E Q lid D O r N d <� W y0 -r O d�o_ C Q Q- o Q E ro L m > ® o 0 > N E Zo c R tm CL c m M O a 2 O Qd•� N Nw N O V m O LU I-- cn CLL6 N D R y C O t O u W E V o U g d N r-- a 0 0 I- m 4- CLO0 > i Z L CO Z W w X LUW a. ry V v O Z e s W Z 0 v+ a� V !13 CL U) V .Q N r_ v _co CL U) rte, mo O CL CL 0) o::( S J � OCL Z � N ®-face of Investigations (� 600 Washington Stt•eet Boston, JVA 02111 www. Mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/14 lectricians/Plulnbers Micant Information Please Print Legibly rte (Business/Organization/Individual): QAl-c_ cress: r/S Phone #: 9 you n employer? Check the appropriate box: am a employer with ,1 4. [] I am a general contractor and I employees (Rill and/or part-time).* have hired the sub -contractors I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.! required.] 5. ❑ We are a corporation and its 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1 l.❑ Plum ' g repairs or additions 12. oof repairs 1.3.0 Other )licatit that checks box ##1 must also fill out the section below showing their workers' compensation policy information. wners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tors that check this box must attached an additional sheet showing the name of the sub-contractors'and state whether or not those entities have :s. If the sub -contractors have employees, they must provide their workers' comp. policy number. i employer that is providing workers' compensation insurance for my employees. Below is the policy and job site .'!tion. ce Company Name: / J CJ � y P--J4—,T0 / S or Self -ins. Lic. Expiration Date: l// / . Address: � � � City/State/Zip:1�0 _/��G>l� 4e 1V1_514'_ a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 $250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of rations of the DIA for insurance coverage verification. ,eby certify under lire pains and penalties of perjury that the information provided above is true andcorrect. Date: re: Z7/ pial use only. Do not write in this area, to be completed by city or town official or Town: Permit/License # ng Authority (circle one): sard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector :her art PPrcnn ^ Phone. #- OV CS # 022680 HIC# 103358 J A. J. Walsh & Sons 55 Pleasant Street .North Andover, MA 01845 # of 978-688-6737 or . 1-866-AJWALS H Proposal Submi_ o Job Name Job # Address Job Location (24 Date � e Date of Plans Phone # V ; (` 4- 7 _ 9k— O rO # Architect We hereby submit, specifications and estimates for. rr: - CIA, ,dlz-� We propose hereby to furnish material and labor — complete in acco ante with tieabove specifications for the sum of: o� $ �,,..�� G%v OD Dollars r with payments to be made as follows: �R 66h A-V..'- If'11 k__., � Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our cchtroi. Note — this proposal may be withdrawn by us R not accepted within days. SCCP,.ptancC of propot The above prices, specifications and conditions are satisfactory and are� Signature hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance"`-' Signature MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form, satisfierali basic requirements of the state's Home Improvement Contractor Law (MG): chapter 142A), but docs not include standard language to protect homeowners. Seek legal advice if necessary.- Any peisonplsnning home irinprovements shouldfusf obtaina copy of "a Massachusem,consumer.guide to hon improvement" before agteeing.to any work on yourresidenee. You may obtain -ii frac copy by'calling'the ' Office of ConsumerAffairs:and.Business tZgulation's Consuuler Information Hotline at617-9738787 or 1.8884283-3757. Homeowner Information Contractor Inforlmation �wnc pyny Name E&-ue_ T` o r'ItJ1l�.s C d S G S Street Address do not use.a Post Boit address ( )Contractor/ S esperson/OwnerName Cityyy State pZip Code �y usinm Address (must include a street address) . p NO 4j 0 Daytime Phone Evening Phone. 3ty/Town State Zip Code Mailing Address (It different from above) 3usiness Phone ederal Employee M or ..Number • tar l•gmRa lWl IDON homeim Aama tC®arCoraea rl®Iv ,;8apIr. matraetm�Wver //� ' The Contractor agrees to do the following work for the Homeo per. Required Termits - The -following building permits are required Proposed Start and Completion Schedule - The following schedule will and will besceured:by deo contractor as the'homeowner's agent; be adhered tovtiless circumstances beyond:the contractor's'control arise (Owners who,secure their own permits will be excluded from. the Guaranty Fund .provisions ofDate when contractor will begin contracted work. MGL chapter 142A.) Date when contracted .work willbe substantially. completed. Total Contract Price and Payment Schedule , The Contractor. agrees to perform the wO& furnish ffie material and lnhnr s ;A..t •h .,. F . a Payments will be cone according m the following schedule: i $ !7�upon,signing contract (not,tb exceed 1/3 of the total.eonttact pricc qt the cost:of special order items, whichever is.greater) $ by / / or upon completion of $ by _/_/ or upon completion of O P/S contract (Law forbids demanding full payment until .contract is completed to both party's saritfaction) The following material/equipment must be special $ �� � �be paid for ordered before the contracted work begins in order $_ to be paid for to meet the completion schedule*.(**) NOTES: (•) Including all finance charges (••) Law requires that any deposit or down -payment required by the contractor before wodc not,exceed the begins may greater of (a) one-third of the total coatraU prig or (b) the actual inn of any speciel.equipmmt or custom made material which must be special ordered in advance to meet the completion schedule. ;. Express Warrents - Is an expresswarrsaty being provided by th .....+..»...+ No yes r n e of the warranty mnat M h a o the soatracrt Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions'of any $aid party/subcontractor utilized by the contractor, The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and labor under ibis aereemcot 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'hes been placed on the residence. Review the following cautious and notices carefully before signing this contract • Don't be pressured into signing the contract Take time to read and fullyunderstand it Ask'questioris ifson3t thing is Unclear. • hake sure the conrrao rr has a valid Horne Imnroverne-t retractor R ¢icm�— The Wiv requires most home improvement eoutmetors and. subcontractors to be registered with .the Director ofHonte Improvement Contractdr Regiittration. You may inquire about contractor registration by writing to the Director at One Ashburton Place, Room 1301y Boston,'MA 02108 or by. calling 617-727-3200.or 1-800.223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured • Know your rights and responsibilities. Read the Important Information on thereverseside of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law: You tray cancel this agreement if it has been signed at a place other. than the contrecttir's'normel place of business, provided you notify the contracmr in writing at his/her main office or branch office by ordinary mail posted, by telegram sett or third business day following the sign' f this a by delivery, not later than midnight of the. agreement . See the notice o£ cancellation form for an explanation of.this right O OT I S CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two tial ioo the etmrstbetoMleWandsiaoed, on copy should go to" h0 other COPY abwht be v kept by the COatrsetm. Hom wner s gnaturc Contractor's Signature Dau ;Date Contractor Arbitration The Home lmprovementContractorLaw:provides;homeowners with:thesightu-initiatean arbitration action (as an alternative to court action) if they. ve a -dispute with.a contractor. The same Aghtis rioi automatically afforded to'a. contractor, .how.ever.-:.-'he:contractor.would have.tQ resolve any, dispute helsbe.itas.with ahomeowner in court unless both parties agree to, the optional clause provided below:. This clause would,give the. contractorthe.same.right to arbitration as is afforded to the homeowner.by the Home Improvement Contractor Law. The contractor and the bomeowndr hereby mutually agree in advance that in the event the contractor has a dispute concemin this con t�aslprovided ntractor may submit the dispute to a.private arbitration firm which has been. approved by, the Sec of a effice of Consumet Affairs and Business Regulation and the consumer shall be required to subm uch tra In.Massachusetts General Laws, cha 142A.� /,)/ A Homeowner's r re — Contractor's Signature - NOTICE:'The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner,may initiate alternative:dispute resolution even where this section. is not ao.,a"fPly rroned:}rvtha twii'es:' Homeowner's Rights A homeowner's rights undtf'thip. Home'Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (ie. 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.;w.orkmanlike-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 ffitness.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 lielow). 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 origin] 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 recission period has expired Accelerated Payments A contractor orgy not demand payments inadvance.of the dates specified on the payment schedule in cases where the homeowner deems himtherself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require thatthe. 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.freecopy of "A Consumer. Guide to.the Home Improvement Contractor - Law,'• contact Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1-(888) 283.3757 - If you want to verify the registration of a contractor or if you have questions or, need additional information speci 16ally 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 or 1-800-223-0933 For assistance with informal Mediation of dispittes or to register formal complaints against a biisittess, call: Constrii eecuftiplaint:Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 . ,. �viJ ic. t�,m 11.-1,I I L u.UV,NnHvl. IIV. LU7U f. 1] z1® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD- 9710412013 THIS CERTIFICATE 18 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 CONSTITJTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. MPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the Poilcy(les) must be endorsed. If SUBROGATION) IS WAIVED, subject to :he terms and conditions of the policy, certain policies may require an endorsement. A Statement on this Certificate does not confer rights to the ;ertlflcate holder in /leu of such ondorsement(s). )DUCER 00775 - 001 SRIeCT ttso S Jankowski Insurance Agency Inc FsUB.We, Exti. (97!)(11112-5175 , we . (978)794.0313 rth Andover, MA 01845 01E8e: A.I.M. Mutual Insurance )RED thur Walsh J Walsh 8. Sons Pleasant Street uth Andover, MA 01845 )VERAGES CERTIFICATE NUMBER: REVISION NUMBER: 33758 HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IDICATED, NOTWITHSTANDINQ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN Rana ICFn ctv Deln n: auAe TYPE OP INSURANCE GENERAL UAGILITY COMMERCIAL GENERAL LIABILITY Df CLAIMS MADE � OCCUR AIRS POLICY NUMBER LIMITS EACH OCCURRENCE b DAMAGE _KM EOEa ISES MED G XP (Arty one person) i PERSONAL& ADV INJURY S GENERALAGGREGATE i EML AGGREGATE LIMIT APPLIES PER: OUCYRO• OC PRODUCTS • COMP/OR AGG S AUTOMOBILELtAeILITY ANY AUTO ALL OWNED ULED SCHED AUTOS AUTOS HIRED AUTOS INON-OWNED AUTOS OM LE LIMIT S BODILY INJURY (Per peraen) $ BODILY INJURY (Per accident) i R PERTY DAMAGE a b UMBRELLA LIAOOCCUR EXCESS LIAR CLAIMS MADE EACH OCCURRENCE S AGGREGATE g OED RETENTION S S �1DRNEyg p EN�pT1pN ANyyD EMGLOCY NS' LIABILITY w10P1&T111%wPwnS ECUTNEr4 (Mandatory in NH) U dy �d@� ���R OF UP RATIONS below N ►A AWC-4Oo-7014648-2013AE.L. /1/1412013 11/14/2014 yyC gTp� TH X TORY LIMI 8 OER EACH ACCIDENT s 100,000.00 E.L. DISEASE • EA EMPLOYEE S 100,000.00 E.L. DISEASE. POLICY LIMIT b 500,000.00 2RIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Anted ACORD 101, AddlUoeal Remarks Schedule, If more apaee w requited) m Of North Andover ) Osgood Street A Andover. MA 01845 ORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 88-2010 ACORD CORPORATION. All rights rest The ACORD name and logo are registered marks of ACORD Office of Consumer o Affairs &-Busi cssR,gUa'1-ti n IMPROVEMENT CONTRACTOR .Iff-Registration: 103358 Type: --txPiratiow.-7/7 12014 Private Corporati( A. J. WALSH & SONS,INC. Arthur Walsh,Jr 55 Pleasant St N Andover, MA 01845 Undersecretary Massachusetts - 11—Palpartment of Public Safety Board of Building Regulations and Standards Construction Salm-Nism. License: CS -022680 ARTHUR J WALSH JR 159A WAVERLY-RD N ANDOVER MA 01845. ;.-o i ser 06/0912014 Location No. Date A- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ v TOTAL $ �-Check # bl 15180 i iBUJLDU�iG DEPARTMENT I PPLICATIQN TO CQNSI RUCT.REP1jl;, OR DEMOLISH ..-AONE.:OR TWO FAMILY DWELLING ..�. ffiVATE, 3UILDING PERMIT NUMBER: DATE ISSUED: 0 'I NATURE: � G U' Buildin Commissioner/I ctor of Buildin ECTION. 1- SITE INFORMATION �Msfessors 1.1 Property Address: -)Z 1.2 d Parcel Number: �eLVhvtiT %�` �r g OD i Map Number Parcel Num i �,3 Zoning Information: 1.4 Property Dimensions: tonin District .. U Lot.Arear s Fronta "::ff . L6 BUMDING SETBACKSM) fr Front Yard Side Yard Rear Yard Required Provide . .red Provided R red Provided 15Zone Infomatoa '1.7 Water SuPP S4 , .Flood yM.CLC.40 Zone Outside Flood Zone ❑ k8 Sawerago Disposal System Municipal ❑ On'Site 'EhSpoW System .Cl ` ?ublic ❑ Private ❑ SECTION 2 - FRQPERTY OVIFNERSI/AUTHORIZED AGENT F s 2.1 Owner of Record AV n� CL [lame (Print) Address for Service V 7f q1 Signature Telephone 2.2 Owner ofRecord: l 1- fi P Na e P n Address for Service: Sin re Tele hone . SECTION.3 - C NSTRUCTI N SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ v Licensed Construction Supervisor: C License Number Address Expiration Date Siggature Telephone sag 3.2 )Zegistered Home Improvement Contractor Not Applicable 0 Company Name n r Registration Number Addres vow919 T Expiration Date f SECTI'Uli' 4 - WORMRS COMPENSATION (I1LG.L. C 152 § 2'5e(6) Workers Compensation Insurance affidavit m be'completed and submitted with this-apphcatioh. Failuie to provide this affidavit will result in' the denial' of the issuance of the buildi rmit. Si ned affidavit Attached Yes ........ No ........ ❑ . SECTION 5 'Owen fidli df_Pf6VY.0kd Wotk;' check a l,a usable New Construction ❑ Existing Building ❑ Repar(s) Alierations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description. of Proposed Work: 3 SECTION 6 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com leted:b . permit a licant a 1. Building zLa!� (a) Buildutg Permit Fee Ntuln Tier I 2 Electrical (b) Estimated Total'Cost bf C construction.. 3 Plumb m Building Pernut fee!.).x (b) �►Q 4- MechanicaiN, I3VAC. 5 Fire Pi6tection M 6 Total,, 1+2+3+4+5 Check'Nuthber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WIZEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I L as Owner/Authorized Agent of subject property Hereby -authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION property as Owner/Authorized Agent of subject Hereby declare that the statements and information on the foregoing, application are true and: accurate, to the `best of my knowledge and belief e�- Print Nam Si ature f Owner/A nt Date SIZE OF FLOOR TIMBERS 1 ST ? z J IONS OF SILLS IONS OF POSTS IONS OF GIRDERS OF FOUNDATION OOTING L OF CHI1VFNEY ING ON SOLID OR FILLED LAND ING CONNECTED TO NATURAL GAS LINE THICKNESS X w A m 'Cy T cn cx OU w G co z z G w4 C2 U is w O W a ,� a�' ro w a O w u nwi W C u ci is ri O u a z -b m m w w A w a c' o Z �' C/) o cn I U c c am C o c � O c ` O N r C O V C.4) Ci C c m C: L O O • N � L E a L � o c. L C y... . O o C E!"mc CL= N R �mm 1? N CS 3 . 1A c a _ m o � � N L N C c O O `E y m ii lco, cm CD r! y o L N Cc* QI c„=c o N CD p m ci Z o .2`�0•� rn 4 0 a C C ;ago N y o L 4;:E fl L r+ dt O C O vy V N O oCD c g m•� G boy•— O Q ♦ O.. C1 w m z O U �91 O I O co �i. C O v Z CD I O CO) C IO Om C CO) G3 co) • M —M�y� ffW W CL .0 O.0 Cl) O � i COD C Q O O w J g -0 C Z CD CD CL V CO) O C CL # j Q <� 1 Q J w Lij Ir w IrW NOV-14-2001 02:15P FROM: 70:15084855121 P:2/2 o-/.. ' . F.I.O. Nri 11-7.720449 SKITTFRF pnlvkhl find ihclhre pair SEARS approved 001YO Me shutters. Cobr MASIER MOUNTS • provide and Install lot exterior light rultureu ordy Orke MEUs. No. DO IM Sr�o'fua ee Job a .'+�te-1 ('S NN 410. No. MA Lie. No.12WA r,LtAN Ur prnplvey m onitti ykrn M wink iN ;1IRANCE - all squired WOTWMANS COMP. AND LIABILITY to be nutinl2thod. (,-ryArernr n� min•. u„m ala, Nxnrrr 22. rT New YOrh .Nr. of Sanatrrrlar SALES: FOR All MomeCentral' Affairs UC. No. 073OGoO New York: SERVICEMEPAIRS The Service Side of Sear9 New ou Lie. No. 1,12M4150000 000.942-8111 PLEASE CALL Suffolk Lie. No. 211940 Boston: OBS -245-7294 190 Cedar Hill Road Ynnkcnx 1397 500 -SEARS -31 Marlboro, MA 01752 Westchoeter wC0613*87 Hartford Area: New JereNy I,ir Ne.L011aa4 800 -SEARS -99 SIDING CONTRACT oe00337"neulner CmmoAffeln Provideno Area: Sag, Frnat" a lada0ad W Oln•aW AlumlaYnr mon CM. d ouernr. %c Us. 774 Us. No 0053 VT LIG- iso. OBB-732.7751 Asian Antlstlmd CofnnetP nbcode laland Lk. No. 17707 868-4ftEAR$ 51 to rhadld flood. ansa, 9Y Frons TOLD AUUFIESS CITY $TATE JOB SITE ADURCU5 (11 dillerenl) DATE PHONE (Nonv) (f! / 1 .... ZIP ✓�f %y PHONE (Wolk) ( ) APPLIED VINYL & ALUMINUM SIDING General Dparriplinn of Work at Above Addro s. Approx. Start Dale Type of I -louse rrarrhP; ❑ Mennnry Approx. Completion nate.. j. .. SPECtROATICINS Ellam approved malerlolo will bo kanislred ;ani krolenud to moo 4rAMirAtinns• YEj NO 1+1 I -A!4- ►n -AI f CAArrui LY: ONLY TI IE ITCMS CNECKE0 IVEW ARF WI I IDFU IN YOUN UHUEK. 1. ( n SOLID VINYL 3I NO ;e r Only honvoll ar do,9lgnnINd for^,kanry 1 nil nr9ae area$ designated below • SIXII 7 Ctdpr/,A vatlem� PackApe 1� CUStomeom%er/�prrisft .431 r, -��• "• 1A U CInI o will va 1dO wing ou o Iy: iL �--+ 1 .417 F! FroAI Glevaaen !+' nl0rt! Erevetrtn O Fnikr. Detaos' ' .�. 'Al lion I`rovrak Al X Lett Elevation � Partial INC 901Ar.:A n Other U (x-CYLIA-LC)L ✓� a �t U INSULATION *o,— only IlAtwpll Areas el"innAlAd for Sit olio_7 ' inch ht;edalimi _ S fit ❑ Jr.*i.:aarA afhprdvod GALVANIZED STEEL STRIP where r nnImr.Inr rhaso:: un"aary.1NW available with Nailite 1 4 D we 'N Siding to be appood rf nsiJker irnnrddntrl 5 zij U ll:ar Signa p'grwed PFmA TAMS AND nNrA I STAipwhore conbedor neosskw i, -moors, rxAr. fir: milillJf (hkd syarlFel9 wEm Natae,) ti P rl WINDOW OPENINGS � .1. ' U Cullom wrap with Sears approvcd vkryl d;Pj; knnimcn p Color D Jump ovnr crvahxr rrimh r�lkul mkt "J' chonnM p Color—..._ 0 rhnnnrl exleting window only (eg. Andersen type or provtiwly wruppvd) Details—_-- /. f rT AULK - all sills Wlih tuotlorhed Cola Co-ordlnaled coulking GTlu -Custom wrap with SEARS nplsrrvnl VINYI CI An At 11MINi1M. h of Doors COta 0 U r 4 GARAGIF nnCIR PRAMPS - afatam wrap with SEARS approved VINYL CLAD ALUMINUM. Cobh P Smgle U Double Wim Mull ❑ Voubla No Mull , 10 )u U rA*CIA - Custom wrap Wnn SLAWS op01MVOd VINYI 0 AD At UMINUM. COror 11 D I;01Fpl I' InnvrrJMMrrNnge) toyer with SCAnL approved SOLID VINYL SOFFIT SYSTEM. ExCW ales noted tvllnrr 1/:1 VARMA Color 12. U ! ROTTEN WOOD • will *-,Ay be rApAnArl or raptarod wham erweillon on line hem #27 Ilsted below Any adralklrrnl urn in, m:rnarkj a lepalr Wie be "Throttled Won Their discovery and priced acaPdlr4y (nine; rnrl hwjude wood stud$, or exterior 911631 rig.) 10 ❑ nemove axis" material on eAcrinr of I■rrr. U Virry! L) Ahnrdmknn rl wood Shingle G Wood Siding ❑ Other Does not trictute any asbe9te9 removal 14 U r oncm GEILINt95 - W— wdh $PARA rhplumixi SOLID VINYL CEILING MATERIAL In the following areas 15. U BEAMMOLUMN$ - wrap W ilk SFARS arirnt ood VINYL CLAD ALUMINUM (No circular or rvNgrikl hmkhmre:) nrkn I G. ❑ GUTTERS/LrAD05 - remove exis ling and reDlla'o with now a Wnnt t;mimkme gutters and leaders. White Drown 17 ❑ W IA� rl SKITTFRF pnlvkhl find ihclhre pair SEARS approved 001YO Me shutters. Cobr MASIER MOUNTS • provide and Install lot exterior light rultureu ordy Orke 19. Ll }d GAOLC vCNT 5 - provide ata Install vr..nks (1.1410 No drwlar or biangfq ec;IU. 20. �r� Dt (0 r,LtAN Ur prnplvey m onitti ykrn M wink iN ;1IRANCE - all squired WOTWMANS COMP. AND LIABILITY to be nutinl2thod. (,-ryArernr n� min•. u„m ala, Nxnrrr 22. rT WARRANTY - mail to ClPlornpt alter LtimplL:lwn and lull paymord is reoAivad !Li/ 23 U PAYMENTS ulr NUN+INANt EU ordain inslenAr G ahahnd7M M rnAArt Ptogreaslva Mirrrra rnrmcrtl rnklhrl M� nv h� paymenl9. I ?4 rl ALL IJACOUNTS APPLIED. -- — 2b. X ADDITIONAL WOnK - not specified above. Cash Sale Total 44=U Lcss deposit 33% S Cash Balartun $ _ Other Payment (if any) $ 0 CM;n p FINANCED S A 1 i does not Include Interest Balance an Substanlilll Cumplalinn If ttnenr,.cA. Ilaaur n p rykdlk7 hr .. monllvy mast mmu of approximately Simper month, payable by "Owner' to ill, inn, IF it Irnanced by Owner then Owner Wtll pay said amount to the lending Institution plus such Intenxa nnrl rnrnfil rAvvk;n tbaftio of Ram lending institution payable dhectly to the lending Instautron leaningy �such mrxrire In "0wrrer" mol writ nAnrdilo a Relall Instalment Obligation and any d9umenl9 reWrtlrf by 91A,91 ImNtIn11 Oe:IilndlAl in ta"Ith,01011 with Saw 20. fl F; WGIK NOT to be done a7 13 171 Ulltral U non-structural carpentry includdd, Noting: 11 financed, any holder of this C411100rier cradle Contract it silt• SALESMAN HAS NO AIITIIORITY TO CHANAr ANY TEAMS OR MAKE IPKI se all elnlmx and defensex which the dithlor could wool opincl ANY REP08FN1ATIONS DTHFR THAN CONTAINED IN THIS AGREE. The teller of goods of Services obtained filliscooll berele or WRIT the MENT AND -OWNER' REPN£SENIS [HAI NUNS HAVE NEFN MADF TO proceeds Ilereol. Recovery bytbe debtor ahAll net ercend amounts paid OR RELIED UrON DY "oWNw. YOU Milk LN I IttEll TO A COMPLETE by aeolor hereunder LY F111#0 IN 1111P1 ICATF OAMINAI, Of Tills ARREEMENT. CATE OnIG1NAL OF THIS ACREEMENI AND RECEIVED 0BE HE AUTHO- TIME PRIORI BUYER RAIDNIGHT OF THISTHE THIRD 6 SINESS DAY RIZEO AGENT OF ALL -OWNERS" OF THIS PROPERTY UPON AFTER THE DATE OF THIS TRANSACTION. SEE ATTACHED WHICH THE WORK OR T HE MATERIALS ARE TO BE SUPPLIED. NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF NOTICE TO THE HOME OWNER(S), GUARANTOR($), LESSEE($), THIS RIGHT. ON ALL ORDERS CANCELLED AFTER THE RECISION CO-SIGNER(S). PERIOD, CUSTOMERS WILL BE RESPONSIBLE FOR A 20% Contractor, at the salience at owner, shall procure all permits required ADMINISTRATIVE AND RESTOCKING FFE. by law ai follows. 1. Owners who secure their awn permits Will be excluded Iron the guaranty fund provisions al MSL Chapter 142A. 2. Any person who shell have cp•yignad, gaurpntehd vt signed any credit epplleotten or nott refatleg to this agreement heresy accepts Is be bound try Ihls ayroomenl 9 Owners) repreaants that file contents an the back at this agreement Is a Ince pail hereof and has eon read and acdepled by OMnet, 4. ALL INSTALLATION LABURVE10AYiEED 1 IONEI YEAR. Prim 80kni vrn'A Salmalsnl'c License No Signature THE COMPANY WILL DEPOSIT AIL MONIES RECEIVFn FROM IN AN ESCROW ACCOUNT AT CHASE MANHATTAN BANK #105.1- 08209 WITHIN FIVE BUSINESS DAYS Of ITS RECEIPT Date Do not Slgrl this anreemem before You read If or if if contains any blank Space or if It don not contain everylnjAll agreed open, SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS Rev Volt YVi— 0f�6 ��„ . � u.^ ^' _fir �r� Gs.�✓%',_.,_:^_ �, L -.t T CCNi rc=.0 i 0!:�= F�E=-= c_- --cr =!=-- — =cam 1�G= 01/01/02) ,Ci -;N C NE=L =0 EL ~IGNT �C, 0INT NY 2. _00= RD F.G.SCS 7�q�ncY� BOX 300 lI c3r;.c- G -,,--at Nlk NY x951 =PWK-710 Bil-Ray D/B/;L 3ca=3 HcMQ qvnt!731 Ao v-1 nt Road _01=nt V 11003 7-c,akr5 Tr c oq/2/ol ......... ..................... IS IFIC -1 1 S I a 5 U E 10 V9 ;�TTii Rs No RlcH-rs U�ON THE 0E:RTlFjCAT5 L Ly, E�crr.No OR CERTIFICATE DOES M�TAMEN . HOLDER• THIS ,HE poLICIES ALTF 5- a AFFORDED 6y 'E 5E:ow- A C MMPAMY 0 1. ...... .. ...... - vs L -W HAVE Ilt!!H M3UFQ To Doctims INaLfLmcz I.�M mL 7KS is TO CERTIFY THAT THE PCLICIE 6 1 oP CONVTION V- INDICATED, NOTWITKETANDING ANY RE`-UPLf-vCr'rT- TERPY BY THE PCUOZ-S OVC't= HIFWN 16 KrTMATE MAY BE ISSL� OR MAY FE-KrAIN. THE Ids ArI'C4t0 ED wq Duc=o BY F= CLxAu- 1-0 6H,4a�,vN MAY HMi — xt, A LW5 r MF .............. F4 r. I :) . R THS POLICY AP -Rico FtjSp2EcT TO WHOH T1115 T TO RLLTHe TV:Ug- ?-Xc-'UsIcNs AND CONDMCK5 CIF MVL--% 1O PC L)cy pWCY r.40RAMN uws co rin OF 14. q POLY:-( N Lw fl Eq aAl-ZCAM=fr() aATg C49,OC(M ------- 0 coo 000 cog;L f " �c=Wpj:C:F �01 ft LTR ��lll 00/25/02 1. 000,000 p, p 0 0 U CM�:- A 9 _ QENERAL uAaLrry 08/25/0-1 PWMOMA�J, ACV NJURY A 3, 000 coo A X oaWA84C;,kL (3C-I*RAL LlAMLrrY e.ArH C=LMTP'M= I 00 0, 000 C=Lln 0MA06 100,000 CCKMACrOWS PRAT 19RE 5 Goo AUTLQL-JEUjJA0lLfTy Arly AU7'0 ALL avY tt= AUTOS tc-7c0uL-ALT-25 hip= WTC2 NCN,,w c; -.LrTrS rArMACZ LIABILITY I ANY AUTO i.LAz4JT'y L"4&pZ.LL ;:eRDA ,,,R)C5U COAAfttA4AT)Ct4 ArC E.ApLcyszg LiAamJTY -, rz p AoPRrEMRf F11INCL PART Oj=RC2M ARF- occ. WED ESP r/�AY Oms ogckcn BcoLyv4jvxy (pw u -W--0 pROF- ;Zr '00 AMAGE AUTO Ot4L GA AC=EPqT ,egnjkA AUTO —y: ACOM&GA-M ZACH (=URP'64C'- c X I WR 4 05/14/ 02 a om-' GL LAC way s soo coo A -K - 05/14/01 :tL M=XISO - "" 'Ly�- F goo '000 Cf TW- ASQ SAVOR To 6kA,L 0 =ZAP -I1,04 CAM TM 30 rJYyv+src'n+rrxsr�mec.-n "V-0. IIJT A Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .,.,AcmU This certifies that ....................................... has permission to perform .... ........................... plumbing in the buildings of ... ........................ 7 at. . J. ................. , North Andover, Mass. ...... Lic. No.. ......... Fee. ............. ...... PLUMBING INSPECTOR 01/04/94 (j9*.57 30. 00, PAID WHITE: Applicant CANARY: Bbilding Dept. PINK: Treasurer GOLD: File 30 a "MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) AyJ02kf— , Mass. Date �� 19 73 Permit # _ Building Location 0`��ML911� Owner's Name �'i ►1aJf J'C.cn Ty e of Occupancy New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name jh X!Pf `-1 eck one: Certificate Address—W91 Corporation ❑ Partnership Business Telephone�'$�`- oZ ❑ Firm/Co. Name of Licensed Plumber INSURANCECO RAGE: I have a curre lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Ckvnar nr ralnor� n„e..a Owner ❑ Agent ❑ nereoy cermy tnat all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed u er the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code a apter 142 of Gen ral ws. [Title Signature of censed PlumberTownType of License: Master ( Journeyman OVED (OFFICE USE ONLY) I License Number \ i_ ...f ONES MEN NEI BASEMENT MEMIE ME —MENOMINEE MEN OMEN SEEMS so E14a IMENIMMEMMENISMIS MEN no MEMEMMOSSIM IN INEEMEMEMINE SEEN OMEN NEESE No MINSIMENNIMEN Installing Company Name jh X!Pf `-1 eck one: Certificate Address—W91 Corporation ❑ Partnership Business Telephone�'$�`- oZ ❑ Firm/Co. Name of Licensed Plumber INSURANCECO RAGE: I have a curre lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Ckvnar nr ralnor� n„e..a Owner ❑ Agent ❑ nereoy cermy tnat all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed u er the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code a apter 142 of Gen ral ws. [Title Signature of censed PlumberTownType of License: Master ( Journeyman OVED (OFFICE USE ONLY) I License Number \ i_ ...f D v V C: 0 A 0 z In 0 z M Z m 0 3 -a 0 O 0 V r c c z 0 z N V m 0 -1 m m m w O m m N � Z A m 0 m � � O z r c 0 n z o O z N � m n Iz D v V C: 0 A 0 z In 0 z M Z m 0 3 -a 0 O 0 V r c c z 0 z N V m 0 -1 m m m m m r O m 0 O m m 0 M c N m O z r w O 0 m N N Z N m 0 -4 O Z 0 m m r O m 0 O m m 0 M c N m O z r 4 15 Date.;o .................. 40RTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION '") J This certifies that ........................... has permission for gas installation ..................... in the buildings of .... � .............................. at ... 2. t .............. I North Andover, Mass. Fee. ..... Lic. No.. J ........ .......................... 01/04/94 09:57 jGA%&40VEcT4SD WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MAFFEI PLUMBING, INC. DATE 12/30/93 Pay to: TOWN OF NORTH ANDOVER 2 PERMITS CHECK A 4047 $45.00 CHECK DATE CONTROL NUMBER 12/30/93� 4047 TOTALS $45.00 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) f\_0, \0n�(1c�. Y"tMUpr� ,Mass. Date 30 19 � Permit # Building Location 0 t— l + Owner's Name___ STE ` f f e 9__ Type of Occupancy N� New ❑ Renovation ❑ Replacement LB' Plans Submitted: Yes[] No Installing Company Name�- Check one: Certificate Address � % �� Corporation ❑ Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter CTre a, (%tC e INSURANCE COV AGE: I have a current ' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please 'ndicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Y ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General s. BY TI/Gasf* of License: Title Signature of Licensed Plumber or G ter City/Town License NumberAPPROVED (OFFICE USE ONLY) man N � w �n N N Z a:CC N W W OC O V m F x F- x sn Z O U, P Q Z Z O } w Q: m N W H Q a tJ ¢ W O �- O n a O C ^' ` �> F" a W W N N J C7 = = _ W � W I. W �. W Q W Q C Za U, U. - i- LU JaW O t/ ccL > WM 3 O O W O c cti JOpp v> > c Oo SUB—BSMT. BASEMENT 1 1STFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name�- Check one: Certificate Address � % �� Corporation ❑ Partnership Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter CTre a, (%tC e INSURANCE COV AGE: I have a current ' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked res, please 'ndicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Y ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General s. BY TI/Gasf* of License: Title Signature of Licensed Plumber or G ter City/Town License NumberAPPROVED (OFFICE USE ONLY) man J Z O W N D W U. LL LL O tl O LL. 3 c J w m z 0 I -- L) w a- 40 _z N w w tr O O m CL N w U F - w Y N 0 z F- I- LL N a C� O O O I- t _t c a o W Z 4. Z tl 0 U. O D F tl J LL Z o tL a ow m 0 LL a O O c3 0 IL f. m O a L a z. la 2 z U. a ,� N2 3544 Date .... 111A �142 A. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ......................... * ...................................................... . .... ..... ....... ...... b,as permission to perform ........... ................... wiring in the building of ....... ........... ........................... at ..... . L7 ... �of AV- ^orth Andqyer Mzs�.� A . ..... .... Fee .... Lic. No. ...... .............. I LECT .. I - AL -iri ............ Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer =6 omffrotttuoall�i o� ///a�eac�itcde!/.1 Official lis: Only i PermitNo, Occupancy and Fee Checked i BOARD OF FIRE PREVENTION REGULATIONS ttov, l 1/99] !!cave blsnk) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be peribrnicd in occordance with the Massachusetts Electrical C(ldc 0113C). 527 MR 12.00 (PLEASE PRLVTININK 011' TYPEALL 1NFORAL1770N) Date: \ °\��Z._ City or Towil of: �o r �,� To Ihe' Inspector ojbYires: By this application the undersigned gives nutice of his or her intention to perform the electrical work described below. Location (Street & Number) ,�� Owner or 1'enant � n Telephone No. Owner's Address _ CL n-, Is this permit In cortjultctiomit tt�ivitft a building per? Yes Na Purpose of Buildin; ❑ (Clieck Appropriate Box) Utility Authorization No, Existing Service Amps/ Volts Overhead ❑ Undgrd ❑ No. of illctcrs Nen Sen'ice Amps / Volts Ovcrltesd ❑ Undart! ❑ b No. ofhleters' Number of Feeders and Anipacity Location and Nature of Proposed Electrical Work: 1W a - No. of Recessed Fixtures - - - No. of Ceil. Susp. (Paddle) Faits +•�•+r ur rcan'C[t OC O:C /[tsOCCfOr 11, ir vs 1 0. of Total Trausfortaers KVA j No. of Lighting Outlets No. of Ilut Tubs Generators ii1'A j No. of Li;itting Fistures Sttiimming Poo! Above ❑ !it- ❑ o. o ntergencv caitrtttg— rnd. rrtd. Batte L'itits No. of Receptacle Outlets No. of Oil Burners FIRE ALAILMS ' No. of Zones Vo. of Switches No. of Gas Burners t o. of Detection and Initiatino Devices 10. of Ranges No. of Air Cond. total Tons No. of Alerting Devices No. of Waste llisposers !-feat Puuip Number _ o.ns _ h� No. oC Self-ontaincd __ Totals: Detection/Alerting Devices No. of Disler asiters SpacdArea Heating iiNV Local ❑ tllutticipaI t Connection ❑ Other No. of Dryers Heatlu.o Appliances Security vstems: No. of Water tVo. of LN, o. of No. of Devices or E uivalettt lIcatcl's H\�. Si�tts Ballasts Data IVirhig: 1 iNo. of Devices E No. Hydroritassage Bathtubs No. of i<lotors Total IIP or uivalent 1'elecomntunications lVirtna: n•r•u c• n . iVo. of llevices or E uivalerit Atfach addifiottal detail ,Jdesircd, or as required br the hispecior of Wires. INSURANCE COVF,RAGE: Unless waived by the owner, no permit for the performance of electrical work niay issue unless the licensee provides proof of liability insurance including "completed operation' covera�,,e or its substantial equivale:it. The undersigned certifies that such coverage is in force, and has exhibited proof of sonic to tite permit issuing office. CHECK ONE: INSURANCE 6� BOND ❑ OTHER ❑ (Si)ccify:) Estimated Value of Electrical Work: _t 60 �— (When required by ntuuicipnl policy.) t`'�P'ration Date) Work to Start: \1 ltzspcetions to be requested in accordance with iVIEC Rule 10, and upon, completion. certify•, render the pains amt pelfalties of ptlfjug•, thar the btformatiaJr oft 11$45 altplicatiaff Ls true aril complete. FI1L'11 NAME: C Ar c\LIC. NO.: Llcenscc: 1�„ A- C),A . ignature 1 n t ltc •O•� it: 11hc license uuntber titre.) Address: N� '�13us. Tcf. No.: !a tt�-Loln$O OWNER'S lNSU1::1NC1: 1VAlb'lslt. tt aware Ih he Licensee does not have the liability ins uranc coverage normally required by law. BY my signature below, l hereby waive this requirement• I ant tite (check onc) ❑ owner ❑ o-witer's agent. Owner/Agent Signature '1'elepilune Nu. P1sRH1T FE'h : S i �' _ M.N. Falardeau Electric 17 Blue Jay Way Litchfield, NH 03052 Phone (603) 595-6680 Ma Lic 37294E Fax(603)882-4115 January 9, 2002 City Of North Andover Electrical Inspectors Office 27 Charles Street No. Andover, MA 01845 Dear Sir: An electrical permit is needed for the following address (Nelson, Steven's Residence, 27 Belmont Street, No. Andover, MA). A copy of my insurance binder and license is on file with your office therefore I am enclosing a check for $15.00 made payable to the City of North Andover for this permit. My Electrical License Number for the Commonwealth of Massachusetts is #37294E. Kindly mail the permit to Mark H. Falardeau, 17 Blue Jay Way, Litchfield, NH 03052. Thanking you in advance for your timely handling of this matter. Sincerely, off %9N., I ff, ,._Vl. Mark H. Falardeau cc: Bil-Ray Meter