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Building Permit #900-16 - 30 BEECH STREET 2/18/2016
Permit No#: Date Issued: LOCATION BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received RTANT: Applicant must complete all items on this 3® 8e'erd k h?Ve, /No e 0 O��tv6 � HQ 2 •'•r Y6 0 Print PROPERTY OWNER Z7 -A y � -T-u ' l Print 100 Year Structure yes QD MAP _ PARCEL:ZONING DISTRICT: Historic District yes �O Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑ Addition ❑ Two or more family ❑ Industrial X Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑� Septic ❑ \Nell EJ Floodplain 0 Wetlands ❑ Watershed District: o Mer/% r _ DESCRIPTION OF WORK TO BE PERFORMED: rComoeleI, 11�22-c-W el S,9,wa i l�,Q v �r ,� , �c�f�,� �•�do�v lS�y6b$L� Identification - Please Type or Print Clearly OWNER: Name: �"A V A4,62.0 ry Phone: iP� 6 -Gz3'9 Arlrlracc• _.RC1 G'lif# 4 k -e. Contractor Name: Address: Supervisor's Construction License: Home Improvement License: Phone: 9;d' 345- ,PYr Exp. Date: Exo. Date: ARCH ITEC ENGINEE � ��-�-� Phone: '?;2 Address: M FEE SCHEDULE. BOLDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �!'.S FEE: $ Check No.: Receipt Np.% ©o NOTE: Persons contracting with unregistered contractors do not have access to the_guaraafund Locatioa No. Date j Check,'# � �2z- TOWN OF NORTH ANDOVf-R Certificate of Occupancy $ Building/Frame Permit Fee ;1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming 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 e U FORM (PLANNING & DEVELOPMENT Reviewed On _ Signature. COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS ` E `HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 3 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Loc a ;jt54 usgooa Street F�IREDEPAR�TMEIVT Teri �pum stet on�sitelz . j r p Dnp: y s �r Sti't trti ,. �. � - �r .. d .. t : + \ i ., .. r t it •' i4 COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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 Li Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Enter construction cost for fee cal - North Andover Fee Caku/at%On Construction Cost $ 59,565.00 m $ - $ 714.78 Plumbing Fee $ 89.35 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 89.35 Total fees collected $ 993.48 30 Beech Street 900-16 on 2/18/2016 Remodel kitchen v U) n a O n Z y CD 0-0 CL F)- o �- N -a O vCD m o CL C CDD OCD � —•0 U) CL O y � v 0 U) n CD O o m 0 0 J m TX V m Z M ic Z cn OO0 cr U) Mo ca i < CDD fn c , CD CD n _0 �. C) m O N O O rt Q 0 m CD cma 0 2 O C CD � Q. O N � O O n rF I=Dr (Op t• (D o <(2 z CD 00 � a- rt D <D N Q" � 0 O 0_ to CL N N C O < O CD CL DO • N jo r� co � o 0 CO 0 c C$ C CD CD N CD NCD N vCD CD "0 r 7 rt O O O O Q O 4 J N 3 0' fD N (D `" � OZ W C j T 3 N :;a O C- 3 T O' D� Vf O w O C = T O' d wT O C =r O D) (") 7 (D aj O C 3' T O C O_ _w O V1 rD 'O 0 N T O O rr rt ++ 70 m 'm0 D m G1 > N n O Pm- m A A H m m 0 � C W H 0 � W C G Z H m O z 3 S A O x 2 Page No. �ro�ostt� 9 9th Street West Salisbury, MASSACHUSETTS 01952 +.J, L!:% 0274= *-'X.�:i Ir,-,T)v. 10'10r,5 Plicno (p713) MI -20M r.-3 (Z�G) Sin. -00,57 of Pages PROPOSAL SUBMITTED TO PHONE DATE jo-a, -t- Jam, 6, -Mw 14V /a za/� STREET / —JOB NAME 3o Z� �- 4441 �( CITY, STATE and ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS IJOBPHONE We hereby submit specifications and estimates for: y+� /% 0 o? 700 / 9' f� 3 Ivo rJ -e.�/a/ 4-4-t; ,new � u�-� w� a✓ Lc�-�. /.5; Jay _eY -2 roam-u�rd✓ f C We proPLISP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: f'�' tlollars ($ ). Payment to be made as follows: s Gt'YS( al All material is guaranteed to be as specified. All work to be completed in a workmanlikeA manner according to standard practices. Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature J/ v charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptaurr of Proposal— The above prices, specifications ` and conditions are satisfactory and are hereby accepted. You are authorized Signaturi to do the work as specified. Payment will be made as outlined above. Date of Acceptance: �/1 7/1(o Signature C 1haposal Page No. OK -7. 31:,le%nn 9 Sth Street Y!est Salisbu , ,*AASSACHUSETTS 010-52 ! Ft; --,Salisbury, " . 0 7r�rT ,,� :.cmc LaF,,. ? W:iC`s6 P€mno (M) 502-2072 Cc:9 (M) 314-0457 of Pages PROPOSAL SUBMITTL�D TOf ' v ( , / PHONE DATE --/ A-04, % le�a /o STRI rE r ' C JOB NAME 6 CITY, STATE and ZIP CODE JOB LOCATION )% a,,� -�14 d__ ARCHITECT ,r7 ! DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: r�i►�.L water-�� �a..� �-er..�cv��.� ���� Z-'._ � c�� � �ii,.c,.•.� �rta /S 925. oa Me prop SP-{hherreb�y to furnish material Qand dl labor — complete in accordance with above specifications, for the sum of: ✓!�' /Y -C /t.w��% �O�y — r-+�stf �ya dollars ($ Payment tdbe made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. Arreptaurr of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. a�-y7me will be made as outlined above. Date of Acceptance: , / , /6 Authorized Signature Note: This proposal mfay,be withdrawn by us if not acceptedrw thin days. c 3ignatur - `a Massachusetts Home Improvement Sample 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 Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name .Y A vd V FA _97ne 9;5 Street Add s (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Name SO $eAe,)- 4,1e q City/Town State Zip Code Business Address (must include a street address) Na . R�o✓P2 � � olcp S is Qv,E' /,rr A alp -j 2 Daytime Phone Evening Phone City/Town State Zip Code �17�6do�s $ 92,f -A3-1657 J� 3iY-�Ys 7 Mailing Address (Il different from above) Business Phone Federal Employer ID or S.S. Number Notre lnrprovemnrt Con -tor Reg. NntMer Expirntion date [A req, that most name pray a vaad reglstra[bo aom4r 4th Z-29-26 The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed, specifyin the �e, brand, an de of materials to be used, use additional sheets if necessary.) -P�h6Le Lrait,G- Avcm waLLQ s-n/Si�ae,4m. Ammer , c_ IAvZ. Oovtl/e fh%,Pd warid �,,,a bAyi ,*11— �OL43TA2 , C--' t-,7-W,,t/dCt4 ` -0- 44r.k�ft pLvrn 6 AINO ,�eTc%Piu Required Permits - The following building permits are required I Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeowner's agent: he adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) Total Contract Price and Payment Schedule Y- /6 Date when contractor will begin contracted work. when contracted work will be substantially completed. aY9 e-.., P the Uontractor agrees to perform the work, furnish the material and labor specified above for the total sum of: — f, — -- Payments will be made according to the following schedule: $ upon signing contract (not to exceed 1/3 of the totalcontractprice or the cost of special order items, whichever is greater) 00 0 by 3 / /6 / 16 or upon completion of �^' • +ry j,0 /� / Ux) k', p o & 7— - e! �j W g'Lti $ 4S 000 by / 6 �G or upon completion of �A�/ %% aZN e ",A-1 trS $%D ' upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special S to be paid for ordered before the contracted work begins in order to meet the completion schedule.(--) S to be paid for NOTES: (') Including all finance charges (°6) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty - Is an express warranty being provided by the contractor? 16 No ❑ Yes fall terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight ofthe third business day following the signing of this agreement. See the attached notice of cancellation forth for an explanation of this right. DO NOT SIG THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical fes of the co et must 6e complet and signed. One copy should go to the homeowner. The other copy shout be kept by the contractor. Gif/3 s Sig re / Contract 's Signature `—_ - /7 —2_0 /1 Date /6 ` # 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 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 retary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to s mit to suchitratio provided In Massachusetts General Laws, chapter 142A. Ho eowners gnature Contra or's Signature TICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute r olution 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 taw (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 property 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 tights. 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 Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.inass.Qov/ocabr! 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 Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at http://www.niass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: !=:Iidb.state.ma.us/lioiiieimprovement/licenseelist.Asp 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 or 413-734-3114 Version 2.1 - 112212010 `v NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller], AT [Address of Seller's Place of Business] NOT LATER THAN MIDNIGHT OF.;)—/ % ^ 20 /G (date). I HEREBY CANCEL THI RAN S TIO L" Date: OZ Buyer's Signa abs � CD � � O a (D y (D (D a (D O p, n A. cD a a�� O c 0 (D O O N �. fD C CD OCL z n UQ O _N N to C �•p'O. n � � � N O O� O abs � CD � � O a (D y (D (D a (D O p, n A. cD a a�� O c Na z oo O _N N to n � N � O� O Project: 0_9 Ninth St West Salisbury, MA_16026 Location: B21 W8 Uniformly Loaded Floor Beam [2009 International Building Code(AISC 13th Ed ASD)] A992-50 W8x13 x 16.67 FT Section Adequate By: 6.6% Controlling Factor: Deflection DEFLECTIONS Center Live Load 0.54 IN U367 Dead Load 0.24 in Total Load 0.78 IN U256 Live Load Deflection Criteria: L/240 Total Load Deflection Criteria: L/240 REACTIONS A B Live Load 3001 Ib 3001 Ib Dead Load 1309 Ib 1309 Ib Total Load 4309 Ib 4309 Ib Bearing Length 0.56 in 0.56 in BEAM DATA Section Modulus About X -X Axis: Center Span Length Plastic Section Modulus About X -X Axis: 16.67 ft Unbraced Length -Top 0 ft STEEL PROPERTIES W8x13 - A992-50 Properties: Read Provided Yield Stress: Fy = 50 ksi Modulus of Elasticity: E = 29000 ksi Depth:_ d = 7.99 in Web Thickness: tw = 0.23 in Flange Width: bf = 4 in Flange Thickness: tf = 0.26 in Distance to Web Toe of Fillet: k = 0.56 in Moment of Inertia About X -X Axis: Ix = 39.6 in4 Section Modulus About X -X Axis: Sx = 9.91 in3 Plastic Section Modulus About X -X Axis: ZX = 11.4 in3 Design Properties per AISC 13th Edition Steel Manual: 0 plf Flange Buckling Ratio: FBR = 7.84 Allowable Flange Buckling Ratio: AFBR = 9.15 Web Buckling Ratio: WBR = 29.91 Allowable Web Buckling Ratio: AWBR = 90.55 Controlling Unbraced Length: Lb = 0 ft Limiting Unbraced Length - Beam Self Weight: for lateral -torsional buckling: Lp = 2.98 ft Nominal Flexural Strength w/ safety factor: Mn = 28443 ft -Ib Controlling Equation: F2-1 Web height to thickness ratio: h/tw = 29.91 Limiting height to thickness ratio for eqn. G2-2: h/tw-limit = 53.95 Cv Factor: Cv = 1 Controlling Equation: G2-2 Nominal Shear Strength w/ safety factor: Vn = 36754 Ib Controlling Moment: 17959 ft -Ib 8.335 ft from left support Created by combining all dead and live loads. Controlling Shear: 4309 Ib At support. Created by combining all dead and live loads. Comparisons with required sections: Read Provided Moment of Inertia (deflection): 37.16 in4 39.6 in4 Moment: 17959 ft -Ib 28443 ft -Ib Shear: 4309 lb 36754 lb Member OK page Dan L Gelinas P.E. Gelinas Structural Engineering LLC 579A North End Blvd or Salisbury MA 01952-1738 ;Ph 978.465.6436 StruCalc Version 8.0.113.0 2/2/2016 1:48:46 PM LOADING DIAGRAM 16.67 ft FLOOR LOADING Side 1 Side 2 Floor Live Load FLL = 30 psf 0 psf Floor Dead Load FDL = 12 psf 0 psf Floor Tributary Width FTW = 12 ft 0 ft Wall Load WALL = 0 plf BEAM LOADING Beam Total Live Load: wL = 360 plf Beam Total Dead Load: wD = 144 pif Beam Self Weight: BSW = 13 plf Total Maximum Load: wT = 517 plf Width = 4 Weight 13#/ft is J yv 3 6T-, ob 153 Workers, Comupensationinsurance Affii..davit: )Builders/Contractors/EXectr�icians/Plumbexs. TO BE MED'PVl!TH THE PFIP-A [TT'NG AUTHORITY. A licant Information )?lease Print Ile 'bl Name (Bias#nessforganizadonllndividiZal): S/ © `'� 'S V Address: L7 g � X City/State/Zip: Are you an employer? Check the appropriate phone#: 9�� / (/-dJY -7 1.[] I am a employer with . _ employees (full andlor pari tune).' ,W I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] IF] I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole propille ors vrithno employee 5.FJ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors hale employees and have workers' comp. insurance.* 6.[] We are a corporation and ifs of gers have exercised their right of 'exemption per MGL c. 15% § 1(4), and we have no. e * oyees. [No workers' comp. insurance required.] Type of project (required): 7. [( New construction, 8. [] Remodelhig 9. ❑ Demolition 10 ❑ Building addition 11.F( Electrical repairs or additions 13. [j Roofrepairs 14.E] Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who sulifiiii this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must -attached an additional sheet showing the name of the, sub -contractors and state whether or not those entities have . employees. If the sub-con$racfors have employees,'tliey must provide their workers' comp. policy number. I am an employer that is p/'dvidiizg workers' compensation insurance for my employees ' .Below is the policy and job site information. Insurance Company Name; Policy # or S elf -ins, Lic. #: Expiration Date: fob Site Address: City/State/Zip: Attach a copy of the workers' compepsation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. do hereby certify under thepains andpp naldes ofperyur1that the informationprovided above is true and correct. /. � _,nO safe' Or—/2-2�014 7.' 3 /Y- eys�• Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): i 1. Board of Ifealth 2.130dingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumabinglnspector 6, Other Contact Person: Phone The Commonwealth ofMassachasetis Department oflndustrialAccidents u v 1 Congress Street, Suite 100 _Boston, MA 02114-2017 q4 avrvmmass gov/dia Workers, Comupensationinsurance Affii..davit: )Builders/Contractors/EXectr�icians/Plumbexs. TO BE MED'PVl!TH THE PFIP-A [TT'NG AUTHORITY. A licant Information )?lease Print Ile 'bl Name (Bias#nessforganizadonllndividiZal): S/ © `'� 'S V Address: L7 g � X City/State/Zip: Are you an employer? Check the appropriate phone#: 9�� / (/-dJY -7 1.[] I am a employer with . _ employees (full andlor pari tune).' ,W I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] IF] I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole propille ors vrithno employee 5.FJ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors hale employees and have workers' comp. insurance.* 6.[] We are a corporation and ifs of gers have exercised their right of 'exemption per MGL c. 15% § 1(4), and we have no. e * oyees. [No workers' comp. insurance required.] Type of project (required): 7. [( New construction, 8. [] Remodelhig 9. ❑ Demolition 10 ❑ Building addition 11.F( Electrical repairs or additions 13. [j Roofrepairs 14.E] Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who sulifiiii this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must -attached an additional sheet showing the name of the, sub -contractors and state whether or not those entities have . employees. If the sub-con$racfors have employees,'tliey must provide their workers' comp. policy number. I am an employer that is p/'dvidiizg workers' compensation insurance for my employees ' .Below is the policy and job site information. Insurance Company Name; Policy # or S elf -ins, Lic. #: Expiration Date: fob Site Address: City/State/Zip: Attach a copy of the workers' compepsation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. do hereby certify under thepains andpp naldes ofperyur1that the informationprovided above is true and correct. /. � _,nO safe' Or—/2-2�014 7.' 3 /Y- eys�• Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): i 1. Board of Ifealth 2.130dingDepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumabinglnspector 6, Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person is the service of another under any contract bf 11ke, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or othex legal entity, ox any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. HWever the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of anotherwho employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth" for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please flout the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-'cortractox(s) name(s), address(es) aad•phone number(s) along with their certificates) of iRs eo.---Limited-Liability-Eompanies-(L-L-C)-or-L-itaited-L— ability-Putn�rshr�(LDl') —with no emp ogees o er Man the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Ihdustrial Accidents for confamation ofinsurance coverage. Also be sure to sign and date the a-Mdavit. The'affidavit•should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if yo'u'are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self insured companies should'enter-iheix ' self-insurance license number on the appropriate line. - City or Town: Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license numb or which will be used as areference number. In addition, an applicant that must submit multiple peimit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.a. a dog license or permit to burn leaves etc.) said person, is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of ZndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. ## 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 devised 02-23-15 www.mass.gov/dia Farm Family Casualty Insurance Company Gkmraot, New York Farm Family Casualty Insurance Company P.O. Box 656 Albany, New York 12201 -0656 SELECT BUSINESS PACKAGE DECLARATION PAGE Policy Number: 2005X0431 Portfolio Number: Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY, MA, 01952-1702 Agent: 3485 D -JOHNSON INSURANCE AGENCY, INC. 7 GROVE ST STE 201 TOPSFIELD MA, 01983-1862 Agent Phone: 978-887-8304 Business Description: CARPENTRY Form of Business: Individual/Sole Proprietor Transaction Type: Renew Policy Period: From 03-21-2015 To 03-21-2016 Account Number: 12:01 A.M. Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THE POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE Buildings Business Personal Property Business Income & Extra Expense Other Endorsements LIABILITY COVERAGE General Aggregate Limit (Other than Products -Completed Ops.) Products -Completed Operations Aggregate Limit Personal & Advertising Injury Each Occurrence Limit Medical Expenses Other Endorsements PREMIUM Premium shown is payable at inception POLICY SUBJECT TO ANNUAL AUDIT: Yes TOTAL LIMITS OF INSURANCE $0 $5,000 Actual Loss Sustained Not Exceeding 12 Months See Schedules $1,000,000 $1,000,000 $500,000 EACH PERSON/ORGANIZATION $500,000 $5,000 EACH PERSON See Schedules The Declarations, Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date: 01-28-2015 X-3842 0214 Total Premium Page 1 of 4 2005X0931 01-28-2015 2028:09.00, Farm Family Casualty Insurance Company Farm P.O. Box 656 Albany, New York 12201 -0656 Family SELECT BUSINESS PACKAGE DECLARATION PAGE Casualty Insurance Company ® Glenmont, New York Policy Number: 2005X0431 Portfolio Number: Account Number: Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY, MA, 01952-1702 Agent: 3485 D -JOHNSON INSURANCE AGENCY, INC. 7 GROVE ST STE 201 TOPSFIELD MA, 01983-1862 Agent Phone: 978-887-8304' Business Description: CARPENTRY Form of Business: Individual/Sole Proprietor Transaction Type: Renew Policy Period: From 03-21-2016 To 03-21-2017 12:01 A.M. Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THE POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE Buildings $0 Business Personal Property $5,000 Business Income & Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements See Schedules LIABILITY COVERAGE General Aggregate Limit (Other than Products -Completed Ops.) Products -Completed Operations Aggregate Limit Personal & Advertising Injury Each Occurrence Limit Medical Expenses Other Endorsements PREMIUM Premium shown is payable at inception POLICY SUBJECT TO ANNUAL AUDIT: Yes $1,000,000 $1,000,000 $500,000 EACH PERSON/ORGANIZATION $500,000 $ 5,000 EACH PERSON See Schedules The Declarations, Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date: 01-29-2016 Total Premium , X-3842 0214 Page 1 of 5 2005x0431 01-29-2016 1926:38.00 Massachusetts - Department of Public Safety Board of Building Regulations and Standards mons' raction Supervisor License: CS -027489 STEPHEN M 9 9TH STREETS SALISBURY MA�OL'� T r r, Expiration Commissioner 07/16/2017 _ Office of consumer Affairs & Business Regulation PME IMPROVEMENT CONTRACTOR Type. egistration: 101846 KExpiration: 6129/2016 Individual STEP M. KEISLING Stephen Keisling 9 NINTH STREET ��L - SALISBURY, MA 01952 Undersecretary Lr) " 0M OO �z v rn bd �-' 0 nzi fU D Ln L' Ln Z 11-4 tj 3 m r =n r a> z F- � � C) 0 O T T -n W O m I I �, z O 0Cmz i depth= 9-1/2" QO I -� rn C { w o r' - o I w n < Ln CDP = (n 3 N ' z 1D. W N M (n X D :a. 2E< 3EK rn r vm�Orv�Z cnm OnC, mmrn rv0�v-n �� rn W �� OD =z��00 z ,�, m In z II >n�n 7oX z -z X' vow �N m C) � rnX D � 3 II xFt ¢ Ct w FOUNDATION WALL 00 N II N QO J N 6l � HT1 NU U W mG1 depth = d O t -h �3' X rn rt � D X rn r r z 0 r = H- I I 00 ~ H- I I m 0 0 0 r) X it �fi II N �t rn0'� c -r w ct 0) o oX X'(nU� F-' IJ- lQ II N O O II N W O N X W O N N ►-h depth = d depth = d Ifi I -n �3' C ;o Ft crt cn rn r O n �s Z REV DATE DESCRI ON PROJECT NAME PREPARED FOR: M �' O 2-2-10 ISSJED=OR CO 4STPUC TION z 30 BEECH AVE STEVE KEISLING Gelinas Structural ° NORTH ANDOVER, MA 9 NINTH St ENGINEERING c F--+ WEST SALISBURY, MA 579ANasth End Blvd. I Salisbuig MA01957-1738 1 978-465-6436 vnvwTlinass0uctuial.com I danig49gelinas9ruttum1— Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) LI 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. 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 TE: 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) .4. Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 Permit NO: 014 Date Issued:9—,,� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received /' 7�0 8 IMPORTANT: Applicant must complete all items on this page LOCATION ej-\y�- Print PROPERTY OWNER au P,-�,-rrbL-L) I Print MAP NO.:`�3 a PARCEL`'D �p TYPE AND USE OF BUILDING ZONING DISTRICT: HISTORIC DISTRICT YES ❑ ► o- ..^. 4 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ Addition ❑ Alteration 4-6ne family ❑ Two or more family No. of units: ❑ Industrial o�Aepair, replacement Demolition ❑ Assessory Bldg ❑ Commercial Moving (relocation) ❑ Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED p aAd rezhi1151e a<l Bhf,j,yk Identification Please Type or Print Clearly) OWNER: Name: Phone: �,, ij UJaj,1 Address: 0 Ge C14 / cX 11 ue_ -14 r CONTRACTOR Name 4-/Pp/ie— X(Johl7ll (Ji®/.t5 Phone: Address: �ad 0 &4,,? C�� �lJl �o ZZ� /ys� �l�''�'� IA Supervisor's Construction License: 9 /qJ -� /T Exp. Date: /0:Z —16 Home Improvement License: / d VS -6 % Exp. Date: ARCHITECT/ENGINEER Name: Phone: .Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. S12 PER 11000.00 OF THE TOT•4L ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost S FEE:$ 574, AA Check No.: Receipt No.: 1/3 v (� Wage lof4 Location No. A� Date �, (7 .0 01 40RTil -1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ C IM Building/Frame Permit Fee $ Foundation Permit Fee $ $ Other Permit Fee TOTAL $ -7 Check # 2 0 5 Building Inspoor J TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art E, Swimming Pools C Public Sewer r� � Well J ' ` R Tobacco Sales Food Packaging/Sales LE ti.i ❑ Permanent Dumpster on Site Private (septic tank, etc. Electriceterlocation to project NOTE: Persons contracting with unregistered contractors do not have access to ti:e guarantyend _J Signature of Agent/Owner Signature of contractor jtl;- -7—� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED El FIRE DEPARTMENT - Temp Dumpster on site yes. Fire Department signature/date COMMENTS DATE APPROVED no Zoning Board of Appeals: Variance, Petition No: "Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Desi iomr�., Comments Water & Sewer connection/Signature & Date Driveway Permit CO) m m 'M CO) m mm H .O C � CA Cl) 10 CD n Z y CD O -0 CL C) r o CL = y aUM -0 �C r CD v CD C7 CD CDC) CD C CD CO) �. CD CLO CO) C� CD I CO) O 1 Z CD O -r O CCD O CCD �n Vl 2 o� 0 c J t 0 0 CD O O _ _ m O c COD a so m m C O 0 CL CA h m m S C�0COD IC O y �m n m n Hma� 3, P-0 =r CL a c �� �:T _9 = m as O m H O y 1 = rF CD O ' mICWJ om: � H 'to CL �• •• O m O N CL m d CA N : GIM O' W- a �3 �C.CD CD: : H IE :C�3 O � N : :o mC, �O: CD o CA 'o O CD ,►: ..r O � m y CD SCD. z O to H 0 g . G! D ;� A m F;>' ti t` � ?l C/) R n b n \ / PO - "ti r z W O �. 'r7 C Pj cn I TI p CL 7C yo 94 H 'ti �n Vl 2 o� 0 c J t 0 0 CD O O _ _ m O c COD a so m m C O 0 CL CA h m m S C�0COD IC O y �m n m n Hma� 3, P-0 =r CL a c �� �:T _9 = m as O m H O y 1 = rF CD O ' mICWJ om: � H 'to CL �• •• O m O N CL m d CA N : GIM O' W- a �3 �C.CD CD: : H IE :C�3 O � N : :o mC, �O: CD o CA 'o O CD ,►: ..r O � m y CD SCD. z O to H 0 g . Cn El 77C CD G! D ;� b7 =° m F;>' ti t` �.A Cn El 77C CD CC ° b7 =° n7 w PO 00w ?l C/) R 9j OGO- Crl Ix w PO - "ti r z W n ` 7d G 'r7 C r" Cn D'+ C/) Ctz I TI p CL 7C yo H 'ti tz I DAVID CASTRICONE I!,!_ 0 '' 2flfl8 D CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOV* Y' -- HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 6'Ilgverhx 978-374-7314 I/we.the owner(s) of tate premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below described: / . T phone #....ta..�.�..."-:...... .................................................. Owner's Name.... sa (`.�EP..I.te�..... s p j .. State..... .1P> city r....n . u.t�t ate.-................... Job Address....'................2...�.�................... Ci Specifications: .//....................................... ................. VStrip existing shingles.�'A) vA►pply new drip edge to all edges. IV, � g..........................................................I.............................. yjApply feet ice and water shield membrane to bottom edges of house. 3 tee 'ce and water shield membrane in valleys and bottom edges of any unheated areas of house. f 4 �� / L,: , J .". t>1� f' �� >` r .................�(�. j....................!............... � i ., s �vrr ry t 6Apply telt pager andante ent. nstall rid event to (`................ ........ .................................... ...... .........:............................... ..................fL-.. .A.,,.:.. shingles with a �� year warrao t,R'eroot using.................................... ..................................................................... ....................................................... iCounterflash chimney. $- New vent pipe flashing. r 42gal disposal of all debris. .............................................. i.i......L................... ....... ......................................................................... Area(s) to be worked oo:...1:(. f......c...�5.�i-.1.i............................................... .................... �. .�f..i............................................................................. 1..1�f�. lh......+k.......Q............c.rv+�......... ................................•............................................................. ................................................ ..... .................... � Roof board replacement if necessary @ Cb q/foot. /sheet or ••.••„••.,,,• ................................................................................................................................................................. Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as sped by �1, utacturer The c ctor a es to perform the work an sh the materials specified above for the S of $....... ....� ..... . &ayabl 'T 0.D.......... on ....5 --......... Payable .......-••••••• on ................................ Balance payable on completion o Jo Owner or Owners are not responsible for Property Damage or Liability wh�b is in operation.or of ater stains, crumbling piaster, exposed nails) or Contractor is not responsible for any of mage to t e intedecif, d above a property, objects coming louding ose from wsting ralls,scrumbling plaster, exposed nails, dust in or other living conditions resulting from appby spaces). Items in attic may need to be covered by homeowner. execute aria l materials to contractor, their rty joint n ter. Anin accordance with placed s (thci� above obligation fgat on requested by completion of above work all undersigned agree to contractor. Upon refusal to do so, contractor may at its option declare the entire contract price to so much as then remains unpaid immediately duo and payable. , is agreed that, if permitted by law, contractor shall be paid by the owner(s) all reasonable costs, attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of the contract andfor any lien in connection herewith. It is further aged that this cotttrffixthat Y isassigned contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates n the parties. Theames(s). There; e [to representations, guaranties ICY ) the owners(s) of the above mentioned premises and that legal title thereto stands record in hieral � nor s the contract dependent upon or subject to any conditions not warranties, except such as may be herein incorporated, if any, Y Acorn herein stated. My subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home improvement Contractor Registration,8On8e Ashburton Place, Room 1301, Boston, MA 02108 Tel: Any and all necessary construction -related permits shall be obtained by the Contractor. y OOs ons of MGL Ce his own Construction - related permit or deals with unregistered contractors is excluded from the Guaranty p Completiondate ......................................................... Approximate starting date of work ............................................... Com P Receipt of a copy of this contact is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 4� Lria,.,- /15 /(i.,,17 Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). a ,' J M41-7-)., Avg- IN vg_IN WITNESS WHEREOF, the parties have hereunto signed the names this .................. day of ............................ 20........... Acca Sign......................... �3�0� Owner 7 �i................................ Owner Sign- David ign David Castricone, President �� AAs k [/d j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): � �J (��� ^�tQ 1 p(� Qpp r i (��. S 1 D til (, Tjj(, Address: G1 -r4 ,,L_1' So k-'z—Z.•2..10 City/State/Zip: R. AN b o & x �Ya Q i Et{ s Phone #: IV 6 U,3 `f J -y Are you an employer? Check the appropriate box: 1. RC I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 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 3. ❑ I atm a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t 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 11.❑ Plumbuig repairs or additions 12. 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �F[ NSU ICAi.}CL CO Q S� -?A Policy # or Self -ins. Lie. #: w C. 1 )Lal a0 $ Expiration Date: gla3 ! Q Job Site Address: .. J-4 &ftx-.k N Lnue- City/State/Zip: qo I r n All( uyy - )1A 0/Y 41 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby e(r under Mpg •ns andpenalties ofperjury that the information provided above is true and correct Phone#: use only. Do not write in this area, to City or Town: oi•.town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Massachusetts - Department ol, Public SafetN Board of Buildinl- Rel-ulations and Standards Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 C'uuuniaiuncr Expiration: 12/16/2011 Tr,': 99358 ,./ft¢ toant�nzorttuea`lia a�✓��,!�4d2c1G[�defr�6 Board of Building Regulations and ,Standards. HOME IMPROVEMENT CONTRACTOR Registration: 104569 Expiration: 7/14/2008 Type: Private Corporation DAVID CASTRICONE ROOFING, SIDING & ,)avid Castricone zoo SUTTON ST SUITE 226. &•�°" —� NORTH ANDOVER, MA 01845 Deputy Admir:istratar Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM 011 46 L `. �u T Q ryAM/ ie 1{ . 7 DRwrao QFµ` ,(y �ss.�cNus�� In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, 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.: N U"1 LN and UA 1'A — (Nor department use Page 3 o CreatedlAIC Jan '006 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 - o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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: INSPE('TIONAL SERV l(:ES DEP,%R'I'NIENT:UPFORh105 Paige 4 of 4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:IU" I ' , Date Received Date Issued: — Z� IMPORTANT: Applicant must complete all items on this page LOCATION 3a �eec? /9ye _ rint PROPERTY OWNER J t7Z9,eeQA-2 Print MAP NO: 33 PARCEL: ZONING DISTRICT: Historic District yeso Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 0 Well ❑ Floodplain ❑ Wetlands 0 Watershed District . ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: aW 44-c & I Od /Z f Pn, aye �-'P D �stce ,ea,y?f 6�4c,� LJ odR /�� uS �' G � d � 2 OA) 0 f �Pn1ayQ f f P ls>z a i% c /i�P� W/ A/d o w Identification Please Type or Print Clearly) OWNER: Name: T/q'Y F,9,ee040 Phone: Address: '30 4 x Ue CONTRACTOR Name: S'Y% ve 1//w C— Phone: 92(p 3/�/- d' Address: ' Q% xe,, / Supervisor's Construction License: of % y e 9 Exp. Date: Home Improvement License: /d/ouV46 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. 7—/w/- 2 o / 1 ,(— 2 j-, 20 /Z FEE SCHEDULE. BULDING PERIyIjT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ IP FEE: Check No.:�3 & Receipt No.: v� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location-3�0 e -a !� r- - No. —6'1- 5 Date TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ CLC�! Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 4 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENT CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments 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 / / / $ \ / j C: 7 \ mx -M . o: > m . f...m 'gS. y� k k C, m f 2 \g 0 i ' t:\�// m A] y . \ �( k -mom G/z7 - __ o / 7 ( \ \ ) \ (IQ . .9 ; 0 Onto cn cn n O cn cn 2 O7� O cn C C rrN Q H lo $ L _ • O d O m .o y ®� m C7 C Hc�a2 P m Z N �. .+ = '••� m L.O. �1 m yam o CDy CD -40 m y O > > m m m CD 0 C, CC; 00 o m : C may- : CL a o �o CD CA co c�� o m m 3 O y d N Hcr a d C t o aH � mC to O CA -54�. O H O m � ca j O O CD 0 1 CD CD o C° ' CA CD oCD o dm: o a -o• Cl) �•! o ^; C. 0 0 oI: O = • � CD • A w w v :v w y 'O C � � t ..i O 7d hO pi 'z � y d C7 CD n Z cz y 'v a rr C 0 ,hOd CD O CL r C'2 m MM c.� C CD m CO) > CO O I „ O v n `° CD O Y/„�w Q m "C CO CD y O CCD CCD yCD. CCD CL. CO) O 5.0 � CO2 v O 10 O Z O • CD O CCD 0 Onto cn cn n O cn cn 2 O7� O cn C C rrN Q H lo $ L _ • O d O m .o y ®� m C7 C Hc�a2 P m Z N �. .+ = '••� m L.O. �1 m yam o CDy CD -40 m y O > > m m m CD 0 C, CC; 00 o m : C may- : CL a o �o CD CA co c�� o m m 3 O y d N Hcr a d C t o aH � mC to O CA -54�. O H O m � ca j O O CD 0 1 CD CD o C° ' CA CD oCD o dm: o a -o• Cl) �•! o ^; C. 0 0 oI: O = • � CD • A w w m It q - :v w z � w � t ..i O 7d hO pi 'z ”"ar t Z GO M � a rr C 0 ,hOd b O p x ;J 0 v 0 c Page No. of Pages �; c�J•.. �L' moi.\: .vv■ a '��s1_y�:��� 9 SM Strezt krfast SEBSbu-Y, f;fASSACXUSE17S 01952 PROPOSAL SUBMITTED TO PHONE DATE STRE JOB NAME / 3 o 94.,t a,.-- CITY, STATE and ZIP CODE JOB LOCATION ),;,1a ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: uo.l � f:.�c..� ytio-�q ,��- �-e.� c.cy� 7'�r-�.-•-•%.t'� .�-S a � a °" -e- cam■ . - p1 92 3 7 3'o JC G r��� �% � s�� �� �. xcar. ,�.r tic ,�..-7�0� f �-1-�-�•. �,�.,.� �u��. �/-n-�-D 7 . 3 oe(l (00 �,�.�Q �.a �� Y/�+ �c f-�a�or' /a- J a ° MiYrGtre. l� i G tG 1 �i,a.� /� G /7'1 q� /Jei�t'_ Q"7 Zv -e /X16) � oz.. ,�.;, �.tr�-�d ,,C� �r,+.a.�`�..��t�; �'-•: � a.,.� u�.�- ,,�� �.c.�?`D Z Jia t�-�t..C,-�a...� p vxvP ,,- t coil-e.r a_ io�rz� it s d Or PropuSP hereby to furnish material and labor — complete in accordance with above specifications for the sum of: Payment to be made as follows: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. Arreptaure of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payr t will be made as outlined above. Date of Acceptance: I// dollars ($ Authorized / Signature Note: This proposal may be withdrawn by us if not accepted within Signature Signature days. SUBMITTED TO 1 Page No. Stre t VIcsi SakbL.11, 14 S'5ACHUSETTS 01952 (e.n a-32.-&-.172 ("st) 423-4,7?2 PHONE JOB NAME of Pages DATE h? u✓ / J, Zoi/ CITY, STATE and ZIP CODES JOB LOCATION O LLQ-�nJc l %'Y1 6� ARCHITECT % DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: CAA, C A..; r .3 CAae,�-- %yt as cap Aji-t Wr PropUSr hereby to furnish material and labor — complete:in accordance with above specifications, for the sum of: Payment to be made as follows: r All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. dollars ($ Authorized Signature ✓ /{ Note: This proposal may be withdrawn by us if not accepted Within Arreptattre . d toposal —The above prices, specifications � r and conditions are satisfactory and are hereby"accepted. You are authorized Signature/ -61 to do the work as specified. Payment will be made as outlined above. U , ,,- / Date of Acceptance: '? +� // Signature l-1, _ ,P days. 7/9- V . 19;4L_AAbw et Ad do not use a Post Office Box ad -30 ,6P/9'e X41/2 Daytime Phone to Zip Code ,07,+ O/V SSS from agrees to do the -following work for the ar/ Salesperson/ Owner/Name dress (must include a street address) � T'X State Zip Code 11014. O /9.x'2 me=t COna•nms have a ����m�� ��« y� 6=29- 20-11Zr: 'oPlore 6eee �Z�w�� ap/0r� f,tP t? �iio',fT •+-,vd bsc� �1oa2 Z .r:Pw s%aieti-► t��ri�C ni�ru Tic/ '" a ti. ^61-1-a lfj-e A0194f-c P /� o,c c Required.Permits - The following-buildiing permits ars required Proposed Start andCompletions Schedule - The following schedule will and hill be secured by the cofactor as the homeowner`s agent, be adhered to unless circumstances bayoild the contructues control arise (Ovdners who secure their own permits will be exclilded from the Guaranty Fnnd provisions of �P�iG_� Date when contractor will begin contracted work. MGL chapter 142A.) may/ Date when contracted work will be substantially completed. Total Contract Pi•ice and Payment Schedule . The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum oD (*) PaMebts will be made according to the following schedule: upon signing contract (not to exceed 1/3 of the'total/contract prix or the cost of spa ial ardor itpins, whichever is greater) S 5000 by �/ •%3 J 20// ar upon completionnf _ d l,%.e R aiif/ir S1000 by /ZO Ila// .or upon completion of _ _�P [-.4, upon completion of the coihttact (Uw forbids demanding full paymeatuntil contract is completed to both party's satisfaction) The following materiaVaquipmeat must be special S to be paid for ordered before the contracted wadf begins in order S 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 work begins may not exceed the greater a f (a) one-third of the total contract prica or (b) the actual cost affray special equipment or custom made material which must be special ofderedin advance to meet the completion schedule, Snbebntractors-T6etanhacmra -- -� •..u,,,• ■me S< e c the n Ct grecs to be solely responsible fur completion o the work described regardless of the actions of any third paity/subeont actor utilized by the contractor. The contractor further bgteep to be solely responsible for all payments to all subcontractors for materials and labor Illider this aererhnent Contract Acceptance -Upon, signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract. Take time to read and fully understand it Ask questions if something is unclear. • ' Dake sore the contractor has a valid Hoare lmgmv—errtent Centraeto a <«... -Me law regnbts most home improvement contractors and subcontractors to be registered with the Director ofHotue lmprovtmtent Contractor Registration, You may inquire about contractor registration by writing to the Director at One Ashburton Place, Raom 1301, 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. Bead the Important Inforination on the reverse side of this form and get a copy of the Consumer Guide to the Homolmpmvement Contractor Law. You may cancel this agreement if it has been signed ata place usher than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or deljv third business day following. the signingof this a �' cry, not later than midnight of the agreement. Sex the attached notice of cancellation form for an explanation of this right, DO NOT SIGN THIS CONTRACT IF THE ARE ANY BLANK SPACES!!! identical tsrpies of the-contmitt— be completed and signed. One COPY ahoidd go to the hoineownec •rhe naterpysh - enatld !><kept by the COatracmr. o t o/me/r's Signature ignaturc Date Date - ------ r• �14W ��•� �. Lllla clause wows 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 ar-bitiation film which has been a n the Secretary" of the Executive Office. of Consumer Affairs and Business Regulation and the consumer shall. bequired to ub such arbitration as provided In Massachusetts General haws, chapter 142A. wner's Signature ntra is Signature ICE: The signatures of the parties above apply only to the agreement of the parties.to alt initiated spute Mol by the contractor. The homeowner may initiate alternative dispute resolution even wherethisve spcti n iq not tion separately signed by the parties, -- " Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law WglC chapter 142A).and other consumer Protection laws' (Le. NMOL chapter 93A) may not be waived in any way, -even agreement may be excluded from certain rights if the contractor they choose is notproperlyb However, homeow�pers Homeowners who secure their own building _ g as prescribed by law, the Home Improvement Contractor Law, the e�oniracior is tip ns bl for complly excluded eting the work as ty Pu described, of timely and workmanlike manner. Homeowners may be entitled 'to otherspecific 1 al ri8itts if the contractor guarantees or provides an1rg pPess warranty for workmanship or materials_ In addition to guarantees or warranties proeided,by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular PurpO3e. An enumeration of other matters -on which the homeowner and contractor lawfuily 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 luf0mantion Hotline (listed below). Execution of Contract The contract must be executed in dot plicae and should not be signed u documents have been.attached. Parties are.also advised nntil.s copy of all exhibits and referenced filled.in or marked asot to sign the document until all- blank sections have been 'void, deleted, or not applicable. One original signed co .be given to the ownq and the other kept by the contractor. Any modification po the originay of the contract ccontract m cc be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of in the contract,. and the three day recission period has expired Accelerated Payments A contractor may not demand payments in advance of the dates specified on the s homeowner deems him/heEself to be financially insecure- P yment schedule in cases where the to be financiaU Y However in instances where a contractor deems y insecure, the contractor May hirNllerself account as a re Y require that the balance of funds not yet due be placed iri a joint escrow prerequisite 'par ie 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 Co consumer rights, or f you wish to obtain a flee co of A Consumer Guide•to the Home Improvement Contract ' e Law," collect: PY.. �� Contractor Law or other tp Consumer Information Hotline - Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (6I7) 973-8787'or 1-088) 2833757 Ifyou want to verify the registration bf a contractor or if you have Questions Or II about the contractor registration component of the Home" Improvement Contra eed addlennal �0rmatlon specibcajly - 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 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 FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE SOP000916906 ® DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE JOHNSON INSURANCE AGENCY, IN 7 GROVE ST STE 201 Name and Mailing Address of First Named Insured: TOPSFIElD MA 01983-1862 STEPHEN KEISLING 9 9TH ST W SALISBURY MA 01952-1702 The Insured is: INDIVIDUAL Transaction Type: RENEWAL Policy Period: From 03/21/2011 To 03/2112012 Business Description: CARPENTRY Business Property Coverages Buildings Business Personal Property Business Income and Extra Expense Other Endorsements Transaction Effective: 03121/2011 12:01 A.M. Standard Time Total Limit of Liability Term ADDURTN Premium Premium $5,000 $22.00 Actual Loss Sustained Not Exceeding 12 Months SEE SCHEDULE BUSINESSOWNERS LIABILITY Except for Fire Legal Liability, each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Business Liability Limits of Insurance Bodily Injury/Property Damage $500, 000 $1,000,000 EACH OCCURRENCE AGGREGATE $1,000,000 AGGREGATE FOR PRODUCTS/COMPLETED OPERATIONS HAZARD Medical Expenses $5,000 EACH PERSON Fire Legal Liability $50,000 Other Endorsements ANY ONE FIRE OR EXPLOSION SEE SCHEDULE POLICY SUBJECT TO ANNUAL AUDIT: YES TOTAL PREMIUM The Declarations, Schedules and These Forms and Endorsements Make Up Your Complete Policy: SP00021299 SP00060197 BP00090197 BP04170196 BPO4190689 BPO4961001 BPO5140103 BP07010197 BP10040498 BF30061103 BF40380902 BF40390303 BF40861010 BF40910708 OF40921010 BF41090204 BF41321008 F199020108 Page: 1 of 2 ANX-3190 INSURED COPY Countersigned By Authorized Representative Processed Date: 02/15/2011 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician,-/Plumbers Applicant Information ,,� / Please Print Legibly Name (Business/Organization/Individual): J / eVe- /Ot /f C I A,,76/ Address: ? Q7-) ae City/State/Zip: S,4 lis G'v ey ^4 Phone #: %JP .3/f- ?Ys % 10, Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4- ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors listed on the attached sheet. z 2.V I am a sole proprietor or partner- ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. 0 Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new'affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,. as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify t4n der tthe paaiin%sj and penalties ofperjury that the information providedaab-ovee is true and correct. Signature Date Cj'^`� l2 2y /J Phone #: 9 `7 rP 3,15/— P VS- Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone '�� -C;2,1- "'/ Date. . ............... TOWN OF NORTH ANDOVER 41 PERMIT FOR GAS INSTALLATION 7e 1-:�z This certifies that .... .............. .. ....... has permission for gas installation ........... in the buildings of .... .. ..... ��* ............ ....... ..... .......... at North Andover, Mass. A. Lic. Fee .... No Check # GAS IWrFtC&OR 55 7" 7 1 NLA SSACHUSEIIS UNIFORM APPLICATON FOR PERMIT TO DO GAS FI Y MG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations Permit # Amount $ � , Owner's Name Ty�l.�,ft� � New ❑ Renovation Replacement Plans Submitted ❑ (Print or type) Address -. ?9— Co 1,1�,V YJ Nqe) c ` f f �//, �/y3�3r i Name of Licensed Plumber or Gas Fitter C eek one: Certificate Installing Company Cff Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one. ,, -**- I have a current liability Insurance policy or it's substantial equivalent. Yes MI, I No O If you have checked yes, please indicate the type coverage by checking mthe appropriate box. 13Liability insurance policy M Other type of indenity 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 1 hereby certify that all of the details and information I have submitte or entered) in above application are true and accurate to the hest of my knowledge and that all plumbing work and instal ns p ormed under Permit ued for t i� pplication will be in compliance with al] pertinent provisions of the Massae etts S Gas Code and C trr <,F�2,O,ni r :i�. By: Title City/Town XPPROVED (OFFICE USE ONLY) bnarure at P umber fMas Fitter Master MJourneyman Licensed Plumber (Jr Gas Fitter tense NUFFFer 0 -ation —aj 4 )=gf No. Date ,&ORTN TOWN OF NORTH ANDOVER .0 WNW Certificate of Occupancy $ Building/Frame Permit Fee $ ACHUS zz Foundation Permit Fee $ 8 Other Permit Fee $ 14 Sewer Connection Fee $ Water Connection Fee $ CU TOTAL $ Building Inspector Div. 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