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Building Permit #300-2012 - 344 APPLETON STREET 10/6/2012
i NORTH BUILDING-PERMIT 0Fs�LEo TOWN OF NORTH ANDOVER _ o� sit'. ."✓'=_`'; APPLICATION �- FOR PLAN EXAMINATION 2P© `Q 2- / b Permit NO: ✓ Date ReceivedA •� ° RTE°'rM1 Date Issued: 0Z6pj �sSACHlISE�• 1 IMPORTANT:Applicant must complete all items on this page ' �_7_`<F::,4y_,4"_'- ��sd:-'st.:�.' _a•:rrs- _•-c?.. ?.I.: _ _ _ '.•,r: _ __ ..T3.1 .�:L•"�zi_,...._c:4,..nr-L=F._-,-.:-:,:=G v .:.�_.r'Y. ,�.,rz-,..,:I,f:•._ _ _ L,a -�!t�•=Y�,�'ti.• - - :-:`�7 •tea �:F_'._ - - - - __ •ri n - -•n - - - -_ .'kr•--i•-.-•.- i�v;3- •'./ =�.�ter.'._^"''.;`%:.: Lr�r - t. •_fin,, r.- �,'.'- ..,tE. 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'�':..;e� -cu��r.-�-_ 'Y�.,..,;.{'� 7�'- -T:J�.r'�`',,'H=.. �..�'.?'.__%*�^F• �,�.,,. ::r'Ff•'_F'=cz__ - -t ...�,:c_.-r� � �•°�-. .._._...r,._ r.. �=,:r..:.,::v.::r:�_...�3,-..-._..,..r+e; .e_e_.-.c.=.7�,._.a=n!f= __ _ _ - -_- - �„s�.- _err�a,��_ __•i:x,f-'� __ -••r�:__:-Tl..w:iY.rr.+rti�`:srr....s,v':,�n w�i:_4 •,v.:`•Fi �' �N.'__��•r.P - 'F'%__,��i<s - DESCRIPTION OF WORK TO BE PREFQRMED: •- p rV 2 ee , AZevs e Identification PIease Type or Print CLearly) OWNER: Name: �".s2sre S Phone: Address: , �_,.•a, «•��,cn.��•:t^4.'�_,1.1-.�.1r2'•r.�4•l-.-..n�7.�=3...>�.s...=iV���?�n„R_'-,--_-��'s•n`.,'^'��•+I,�--'.'``"�_'�-..:,�:.•F_,'J'7:x'a:n2>;:�f`-:s..:...�-.r•Xri;s.-. s,:.�✓_.-F ��.:..r� r.s�N'•'_.7'- --- - --- :�`.ti:.yi��c;,:_..^".;;:+*,'"•'-'�:;:.-i3;-.`:a-Lcm;�r;,_.Ir__ _' s�-�-.�.G1e�'•�.T���_�' ,o�.,��w�T'-��,:_�_->_,:r_..�:-��l'•.,��_-.v._:��:i'^:•.J4-_'�Kii_r�,_9�R•5:�%�h:i.�..S..:y•+r..5-:,:z=.••rL��-�_..,��`.t.�-��:�.-_�.�_:.-_1:a.-„•'rte�`.: �'�S_x��l.._.r`N"=_'„•a_tr.!:J::�S.:,.: m`•ga- n.x•' -Fsf42 �n �i..�^`-�__�K�..:.:f{,T:�,�.;;:s_r.r--.„_�e3:;31"�_�-w-�_r%;,�c`��.•_l;;��:c.�..u-.l�,am�„��Yl:�i..-<ren-.�...4:.x-i?,.`v.r-'s-_-:.y......y_-,rr-i-✓,r:�,.�rt.�.h�l.Y,•x-y�','���fr�:�.�v�,asc:'cli.�r�..,=.:-.;_..>._<-,cF'8 "1•.,arT�alm:.::-Lr_lJ- .. ,.[i _;.u,..,:,. �,, .i i. _ r" "k'L.-=•! - `a c^ �-di~�a...,. c-F" *��''�4r-�'-^�,�:••-',�_,,�2,W�->_=i'.'�`.`i'7��:r'=4�:"� '?7n-L_ ._ r2ur.:;� -�'s-.;,:a,\,: _ - '�..n�_,�.:_ -ref.• _ 'l+/ti'.-�- r • •'�"^.�:!".-- ..,r�•..:a^_.�x.S'•sc.Y. r,'!�-.:. wsw. _ ,. .,:,.r .�._- �t N&, 5.-s-�-_'---`°:�- t.�,.:. 'iF�. �'_ , •,: <� K eL" �srr ~t 14 { P aka - y 1 `� � 4 1� M `Y• L4 C, �F� "si J`� t },� Y � •s� �. 4� � J _1e 9' r- i - - .RNk1 Vt•'.[.:• .� ':2,.. h, -.Ina - _ �. al --•��i:�- ;e8+�1� � x_,. w';,?y�,�'l�A_'!.'=+, '.�Y-�_47l�•A.::YL,�:u,r!•?1.,�,Y.-.r_,,-,;`�;h�r<.�..y.`-'•I s.,�••�-.J:^""''�'."r&9.�?;.'�L(�'A•��-'•..7.?���2:._�Y.�'�,}Lfi1�.��s-°,i�t,�.aryr•.h�:Y}.1 '�t z;y..7.��.'T_a.:�. .:,��.`",1.Sa.o-2IF1:��Ca'y,fS�r=,,1in_Sfar .��L;�:h:n�'s-`_ -r..aa1l.�,.,��'.;�:y�fbrr_r` t�'?�"rL,�.-:r_" :.;'.�;:i:`-, F.r----_ ...S.r-_,Fr_�'s"YJ'�5L.n''Iks•a:';F.a.'_J,_f.:.v.R_.FH.S1N".r•�3 4.rJ fl-gn _INE ; ;�N•1=!. e � 'Svc•,: _ -.':(5>~:,:%'". - .a,�r�� -� Dc,T.. "- :3,R. F:�::G3A\: C._,L ,Jn-44- _ _ �'•:e: - �,�[�_._,,_k'.:=, _•:. 3!G'J i-,._.'=(. _ 1,.,•,ki,•`--:r,.-,y�".�a, ..j�,:f - .i':t.�ri..•ac�i�C-``� .r:r�.,.:_.5!.*',.!i.._���_ i•-1-,l,i^- i•�.�S'"-e ^+t':e.`er•: h. y='1.•_^i'.� •i-'„+ _=}:1.�� 2 .,".�)' --�u3�:;;<';,..' �:.,:.�_F.Y;`;_`'.:.�`•;•a_z�_✓-rr=r,r_•-_,-I _:.•a^,••u.at:•-nr,c..^^i»".-_�i.•`x-„t.,--r_ti._-�G-,�r�__ •Fi,�,-w n `�4y.._'p.fa-�{-�.-:?-�.,-.Y4.,.a.e3_'.xa:_;.r.J,�.i..K,�'c*4L_a�-�r1r.r'1•':':�,fi',�w1r�3E•i•:;'"'r�=-•,-•_s„ r •__'_"S_,_�:.. :. •.'�-d-�� �.�:,.. -�L-r�-n-•�:k:�:•:T�ter.--.�.t'.C.l..-.x.�ti,ry; q-7-mm.- ARCHITECT/ENGINEER ..., _- .a :..`,Y.q' .,�•?-.t .;_:.> -:,•_���.. -=... `�` i.�.37_-- =....y,:.�.:1.� « �f=-ii'. 4�.....,.-au/'�E!t - ..Yi-�T2'-ri`r:�sr•.--:._.��;r1Gg: l'=`?x„'i�:�-�'_--_� ra.Y rf3' 'ns�._!-,"-�,�.rY<�••'_;�.�:r F�+'�'.�_,y i7:7AWAfC-,r "'JT���C'ii11.7-T-r.1�J��.,L11I6V- -�w�, •'_�.�I'f�'I1Ni"�i Y'-" > �` _ -:1rn q���-•;•)_ky::r.c_ _ regi':�,,, !. ...i•�:• u-4'n• :J-. ".T!!e,. �51.k"L .'�:,c-,>- ��. - ____--:'xv=w_... _ �_. ..-r.!'caa4'9, _.rfr•-.4'��>xs'a�:�a^.,,,-;':: �-_d Y: I+�, ,r{ ::, _ _� ' -�,•--,.-.orf :x.:.w.r. •a,r•\.,.. ... ;. _ ARCHITECT/ENGINEER Phone: Address: - Reg. No. FEE SCHEDULE.'BULDiNG PERMIT,$12,00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F, Total Project Cosi: $ FEE: 0-0 Check No.: Receipt No.: �� 7� NOTE: Persons contracting with unI egisteyed contf actors do not have access to the aun ty fu d - r.t; y, _T _ 92 : irea?f�A''RN-TWOer - - _r�_ :..� -rina �are ofcon:ray; -r'..-`' -�-� _ ;-� - 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 a 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or..Decks o Building Permit Application. ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevati.on Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Nlass 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 .^ _V-0 -0❑ -e.L!. ed rR'. l.,.� rviiiis-' l ar, - ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products - NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the-building application Doc:Building Permit Revised 2008 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date I Doc.Building Permit Revised 2010 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL - Public Sewer Tanning/MassageBodyArt swimming Pools. Well Tobacco Sales - FoodPackaging/Sales Private(septic tank,etc. Permanent Dumpster on Site ' THE FOLLOWING SECTIONS FOR OFFICE FFICE•USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED. PLANNING &:DEVELOPMENT - - COMMENTS - - - - CONSERVATION Reviewed on Signature iD0MIIIMEN TIS HEALTH Reviewed on Signature COMMENTS A Zoning Board of Appeals,,.'Variance, Petition No: Zoning Decision/receipt submitted yes Planning aoard Decision: Comments t Conservation Decision: Comments Water& Sewer Connection/Signature&[late Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street d .$LV''^) i i.-J.`-:'•-F r rb..1:...._..,:r= .•l"_Y'r' _ ,44.r`i.'..:-.a":i:_-. 0 _ ,EA"i1�,1'i1"�31Yi :f•-v--- _t�c - - i -- - - - - -.„ .��'• P fid:._ e�� : .-.:�._V..z__�no:������_ �.._. _ _r.,��f.:, . .._G d t=1�° - riff L- �,E�i'afE�r, - - _ •:rz - .= - - — -`�' :Ccs;.,.�.. 4--=- :j:lln;•yt- . 4N; The Commonwealth of Massachusetts ! ` _ Department oflndustrialAccidents ? Office of Investigations 600 Washington Street Boston MA 02111 I s, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elect ricians/plumbers Applicant Information Please Prinf'Leaib1y Name (Business/Organization/Individual): s�2 ►� 7`C�a) /� L'�� Z-/�`—'— Address: 9 9 7� S City/State/Zip: .S~i� S 41x j IwA Phone#: 7,' 3 ;V— P`/5 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ElI am a general contractor and I 6. ❑New construction employees full and/or part-time).* have hired the sub-contractors 7. 1A Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet.# ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9_ ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 11. Plumbing airs or additions 3.El am a homeowner doing all work right of exemption per MGL ❑ g re p myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#I 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 aid their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 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). required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Failure to secure coverage as Q 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 may of up to$250.00 a day against the violator. Be advised that a copy of this statement y be forwarded to the Office of Investigations of the DIA for insurance*coverage verification. 1 do hereby certifyunderthe pains and /pen alties of perjury that the information provided above is true and co erect Sivature (/ / Date: z®// Phone#: 9V? 31Y- PV S 7 Official use only. Do not write in this area,to be completed by city or town of feiaL City or Town: 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#• 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 in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or 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. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who 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 fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than 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 Industrial Accidents for confrnnation of insurance coverage. Also be sure to sign and date the affidavit. 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 you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sur6,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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pennit/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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 eget 4.06 or 1-a77-MASSAFE Fax#617-727-774.9 Revised 5-26-05 wvvw.mass.govldia N2216 -Tli Streat,Addma(do not an a Post Offica Boz addnm) Sdegtesttm!OamaarNmoro - 3 y� fipple%N S/�,c�T ST ve ,E'eisG�.� � • CiWIr_ State Tip Code lombess Address(mad mdade a ShImt sddr s) Daytime Pbme 9vveniog Phone own Stale Zip Code - Tr drug Addie t diffamt Stam above) Pudo=Phoneme 3/ Veider.!FmployarID�SSNanaber • �tea+asemu®atmmeao- ib� t�etmrEa ttoebs IbrPindmdm • - - o•e�ommm..e.w. - . TM Contractor n A0 /Q .11 agrees to do the ranowl work for the Hamm exn ,. '.�-"Z 9"2-01 Z /22r►tDv2 Fj[ss j �ecx Ba g ort vd�PP.c�- L016"44 0c Az o J '%,Act a'rP /dy�se NQw PI< At StA-Z o,vfiis1-iRk •/. i,rf.ft�A/C 4u i✓A[,t,,r.TG-:cvje ke.a•y L 1Qc.C.�.t� /,vS ACIP d ae!( T/, (�Pd', view /i,v yC L�i�ee t i 2/At r✓.vd p RWtilred.Y'ermlls-The followini-baildiiq penults are ttxiuhed actor as the Proposed Stan t scud Complyflan Schedule-Thu following schedule will contrhomeownces aged be adh ned to unless ei unm beYo�ft eonmKm'a emaol arise andGbe s by site eis who secure their own pernft will be ezciWW from,the Guaranty Fund provisions-of a. 9 2o// Date whenturnaacdorw�lbei walk. MGL chapter 142A.) Data when ...treated work will be aubsumfid p complatad Total Contract Puce and Paymomot Schedule The Com agnmtr to perform tho wotk,fiienish the medal and labor gmcfW abwo for the total sum ut: Payr oo wig be toad.atemdmg to the following wbedat-- to Gn. upon dF&g contact(not to exceed 1J3 of tbo rata!ooatract pdee gE the cost of - r1 l order i(anoet,whichever is gteatm) - by/_1 or upon exompletiannf sO /O e,TPc-T' S `Jai QO_F by -or upon completion of > Tt0.9 t S upon completion of the conrtad. (Late&Mds dmatdmg tfrll psyrneutunh'1 contact is completed to both patty's mon) The follovAng iastaisUegaipsemt mnst be special t to be paid for atdcmd b0fmv the amIed wmYbegins In aider S to be paid fur ` to meet on compiation suede.(") NOTES:(•)Iadadk ff a0 fume.cbmges(")Ezw rcqob03 tbet my dapmsit or down-psyvAut mMkW by the waharloc before wmk begins may a nm etcaed the Vcci r of(a)oneabisd of the total dn'rt edea or(b)dw 30x031 c0W ofmspecial al or metotu made toataiai wbtdt must be otderedla�vmtb to mem moompldian wbednle, �'-"'-"'1=�Ware�nlr Te as eZ�ea w�r�n:a i.e: tided by�a eadtrfe�'I Ne �. . Yes !aII Eeese� sohc¢ntraetors T�>Q'�tragot agnea to be an)ly responsible for moths mubtatememmusto Oo of We work dmagrod peity1subomhador ut'li=d by the contractor: The contaexoe insTlu r to be solely taspbnsr'b1e for al as.of Eta mtioua ofaup mud mactials and labor•ander is meerr�e,p[ PRY to all anbaotttraCtms for Contract all not ncehupl Upon•atg an o 1621 doeueoeat ri4r came s a btadmg contract under law. Unless otherwise noted within this doexrma>u,the contact sim11 not imply that any Beat en.Hien aexaority irrtateistbas beoa placed on the residcom Review the following mations and mtioe:a axttelitlly before signing this contract . • Don't be pressured into signing am contact Talcee time to nad and fully Tmdemtoa4 JL Auk questions if mncd ng is un.lem>~ • ' MWM mm the RmMetor han a.slid subeontractom to be Trig UmW with thea Dk=Xor of inne - - T�law*��mom botua htprov="mt couUmotma and ragiattatian 63' m the Dimetar at Om Aahbtaton GG��ebor moa. YOU�►1111111h about Motor 1-900;223-0933. . 02108 or by catling 617 727-3200 or • Dow the I U—tm•havo insurance? Check to sae Batt your twntaexnr is pmpedy hwmsd. Rnmv YOUT rights and responatbilities, Read t!m hfiWTtMW0MItion on the rte mm side of this form and Guide to Ste Home lmptovamcut Cour mw Law. r gad a copy tsf the Consamex You may came!this sgreement if it has beam signed at a pfmisotlior thea the conntracfat+a trtnntel ince of cmftctor in writing at hiAWmain offee.rbranch office by ardt�ey umif p You notify tha third business fioUowiu the si p° 'b' seat orbY dell�ety.not later than midnight of the �!' & tag of this agrtxmeat Sex the atmclmd notice of Matic fwm form an explanation of dds right DO NOT SIGN TRIS CONTRACT IF''THERE ARE TANY BLANK SPACES!!1 woidmtialco0121ofdmm magtbacmaplgedmdaWW&�o"P9>beddaeeot666oboeos.6Q Tbeatlaxm6Am0ldbe • >aptbrmaesmtauwr. maowaer's Signature CorAracfi-e Sigmlare ' Date: !1 c , -4- �Ol� Imre: 6 NORTH T® O An wn ®ve r 0 No. _ � 36o do% =- �]]`{{ 0 , over, Mass., /0' 6X� T Q LAKE /(• COCMICMEWICK yt 7�ADRATED 'P � S V BOARD OF HEALTH Food/Kitchen PE �RMIT T D Septic System �,c- BUILDING INSPECTOR CT �Qi�V Fi^ THIS CERTIFIES THAT............................................ ................................................................... Foundation has permission to e-rect f............................. buildings on .,,. !� !y ....l..:l/2.P.A.... ............................................. Rough to be occupied a ....................rp1 ,fir...... ems.. .�/...:......2(.( �' /1/ �!!O�✓V. ........ Chimney p' . . ....... S �' ..�` © .. .. .. .. .. 4................... provided that the person accepting this permit shall in every r sped conform to the terms of the ap�ation on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough �Q Service LDING INSPECTOR Final Occupancy Permit Required to OccuPy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIREDEPARTMENT Until Inspected and Approved by the Building Inspector. IBurner Street No. SEE REVERSE SIDE�Jj Smoke Det. i Page No. of Pages i STEPHEN M. KEISLING "Idilg & Re cling 9 9+.h Strom%Xfti Salislywry, fAASSACHUSETTS 01952 MA Lie, 07489 Hor ae @cr�pv. 101846 Phone (978) 582-2072 ® 978 465-4712 � I PROPOSAWUBMITTED TO s PHONE DATE STREETS ` JOB NAME 11 P CITY,STATE and ZIP CODE ` JOB LOCATION I ARCHITECT DATE OF PLANS JOB PHONE �~ We hereby submit specifications and estimates-for: y L.�tj��,.✓r-'r. (..`.-�-.�1t.a-� G`j'�,�,r"is-r-�yzF �.-Q�'�,-.°-'fit �G-�-r;a�..� G.'Y`.. -�v/f1'=.f-.�J f�-rrL-"7`'/�;�}�:''.,f /X�` L�.1[, `� -'t•-� �c„� r ..J�f', 1..�•' -O( ., . ,-{� �fcz ' �vs ��r- -Y,..�,�,.€ .-3-T.1. 1 .`..:cc�i-,-�.�� Gs-,�Z rte t:.=--' 't:Lr- r•Fa e�1�v^ f v!'� C`[y t�Q.e d r� t� f Y zi, "e"-'e, �C - ' U f f (T f I, tiLY-Z4<•� er x�"fr",93 G' e� y 9 0 r J We pTO�IOSP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ ). 'I Payment to be made as follows: i 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 Authorized ,yam, ✓ � ; involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents J or delays beyond our control.Owner to carryfire,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. I Acceptance of Prup6sttl The above prices,specifications � � and conditions are satisfactory and.arei:hereby accepted. You are authorized Signature to do the work as specified. Payrpent will_:be made as outlined above. Date of Acceptance: f a 'j �,1 Signature Contractor Arbitration ' The Home Improvement Contractor Law provides homeowners with dre 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 at�rde�to s 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 aMrded to the homeowpe_r by the Home Improvement Contractor Law mu agree in advance that in event the contractor has a dispute er h re.-tolntracand the homeown hereby ttrally n this contract,the contracformay submit the dispute to a privatearbitration firm which fres been apprpvedby getary of onus ecntive Officeof Consumer Affairs and$nsiness Regulation and the consumer shall be t to such a_rbitration-as provided In Massachusetts QORersl Laws,chapter M A. meownees Signature Contrac s Signa NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the cmnhwtor. The homeowner may initiate alternative dispute resolution even where this sption 14 not s si by the parties, Homeowner's Rights; A homeowner's rights tinder the Home Improvement Contractor Law(MOL chapter 142A)and other consumer protection laws(i.e-m(3L chaptw 93A)may not be waived in any way,.eves►by agreemenf. 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-Pund provisions of the Home Improvement Contractor Law. The Contractor is responsible for completing the work as scribed,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal tights if the contractor guarantees or provides an express wauaniy for workmanship or materials. In addition to guara�s or warranties provided,by the contractor,all goods sold in Masssehnsetts carry an implied warranty of merchantability and fitness for a particcilar purpose: An enumeration of othermatters I011which the homeowner and contractor lawfully agree may be addea to the tetras of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have gnestioffil abort your conso medhemeowner rights,contact the Consumer Infammuon Hotline(listed below). Execution of Contract - TEre contract must be executed in duplicsite and should not be signed until-a copy of all exhibits and re�ced 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 adacbmenti is for . be given to the ownefand the other kept by the contractor. Any modification to the original contract must be in i?vritin9 and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,-and tho three day recission 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/hetself to be financially insecure. However;in instances where a contractor deems himl4erself -to be financially insecure,the contractor may require that the balance of funds not yet due lie phuxd i.a joint esGt ow account as a pracquisite,to continuing the contracted work Withdrawal of fiords from said account would require the signatr>res ofbottiparties. Additional information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or'lf you wish to obtain a free copy of "A Consumer Owde to the$ome Improvement Contra*r Law,"contact: ' Cousumer Information Hotline_ Office of Consumer AM.and Business Regulation - .10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787`or 1-(8-88)2833757 �- If you want to va*the registration bf s contractor or if you have qutatiols or Reed aflditional inf[mnation s mWeally about the eolittaetor registration component of the Home Improvement Contractor Law,contact: Directof of Home Improvement Contractor Registration Bureau of Building Regulations and Standards OnerAshburton Place,Room.1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 - For assistance with hdorimal mediation of disputes or to register formai complaints against a business,call:' 0 :1.s. 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'I•t' - t Sl', 4 ai1 :* FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE. BOP000916906 ® DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE JOHNSON INSURANCE AGENCY , IN 7 GROVE ST STE 201 TOPSFIELD MA 01983-1862 Name and Mailing Address of First Named Insured: STEPHEN KEISLING 9 9TH ST W SALISBURY MA 01952-1702 The Insured is: INDIVIDUAL Transaction Type: RENEWAL Transaction Effective: 03121/2011 Policy Period: From 03/21/2011 To 03/21/2012 12:01 A.M. Standard Time Business Description: CARPENTRY Total Limit of Liability Term ADDL/RTN Premium Premium Business Property Coverages Buildings Business Personal Property5 $ ,000 $22.00 Business Income and Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements 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 Y Limits of Insurance Bodily Injury/Property Damage $500,000 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 AGGREGATE FOR PRODUCTS/COMPLETED OPERATIONS HAZARD Medical Expenses $5,000 EACH PERSON Fire Legal Liability $50,000 ANY ONE FIRE OR EXPLOSION Other Endorsements SEE SCHEDULE POLICY SUBJECT TO ANNUAL AUDIT: YES TOTAL PREMIUM The Declarations, Schedules and These Forms and Endorsements Make Up Your Complete Policy: BP00021299 8P00060197 BP00090197 SP04170196 8P04190689 BPO4961001 SP05140103 BP07010197 BP10040498 BF30061103 BF40380902 BF40390303 BF40861010 BF40910708 SF40921010 BF41090204 SF41321008 F199020108 Countersigned By Page: 1 of 2 Authorized Representative ANX-3190 INSURED COPY Processed Date: 02/15/2011 q'1' �5•.S� } r t .y A. ,u i ra t' i O t" ��,;� � Y^ic.' .r N� inti°.'..,�.-•� k ! t,, _ nn tA T Q ED VOk s;]6.-00, N 0 1 , .a1i- • 'i . ,f' ...J,' .. .,,.. � +. " .;kl •!rr:J{. • �ir!'sy.+ ,ea 4��-''.r�;.e.��P - s ,� -��lJ. .,S.:J';y�;..•.�. ...... . _.)• 'C" .. a —J f ._ _a.. C'. . P'.a�~• .. ..'-/ 6.'.."� S. ♦ti•fu: J fR 1��"F \I.�.PSYMpi�f� ...v � }'.°!b ✓*4 �u d•31�� �'$•�C$nsumer At�i'a rs&B V,iness Regulation HOME IMPROVEMENT CONTRACTOR VRegistration: _Y101846 Type: s Expiration: :t/29/2012 Individual M `HEN M.KEISLING Stephen,Keisling _. 9 NINTH STREET SALISBURY,MA 01952;1 Undersecretary r - Massachusetts- Department of Public Safety Bom-d of Building Regulations and Standards Construction Supervisor License License: CS 27489 _ STEPHEN M KEISLING 9 9TH STREET WEST SALISBURY, MA 01952 Expiration: 7/16/2013 ('onuuissio°cr Tr#: 19624 ,� a. 4 .F "F�:E F— �� i� s f r .L s � � .. J. • ' 1 1 T i .. v• ,:c�`_ i ,� ?- _ ._ .