HomeMy WebLinkAboutBuilding Permit #507 - 347 HILLSIDE ROAD 1/11/2007Permit NO Date Issued: /--//- 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ToOJSVReceived IMPORTANT: Applicant ' LOCATION nn ) Print A PROPERTY OWNER l) � U11J U Print MAP NO.: PARCEL: 'rX71OU AXTn YTQU nV DITTY "TN!_ must complete all items on this ZONING DISTRICT: ATCTnRIf DICTRirT VFN fl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 'Addition 0 Alteration ❑ One family 0 Two or more family No. of units: ❑ Industrial 0 Repair, replacement ❑ Demolition 0 Assessory Bldg 0 Commercial ❑ Moving (relocation) Other Su >>,, t ❑ Others: 0 Foundation only DESCRIPTION OF WORK TO BE PKh ORMhV Please Type or Print Clearly) OWNER: Name: A /\A �No&) , Arc nt kA Phone: Cl `7 Cr- It 1S` -10_R: Address: 2 �:1 1 A4 i \\ 51 r1 c- Qc.3A d CONTRACTOR Name:1J,4�2tt_1CS-}ct� SlfSH4it,ll�,l�u, �t� r»h S Phone: ,c-, Or- 1�--1 o Address: �A#- Uu�j k1- L R a^A LO I S.-1-b� c>LG V1 MA-- O 1 S y-1% Supervisor's Construction License: CD 4t l S 5r -L-> Exp. Date: e i �� 0 Fr Home Improvement License: 1 `y. 8' (� Exp. Date: 1 V / 6 / 6-7 ARCHITECT/ENGINEER Name: Phone: Address: S Sot ut-h» I��.c��� 1 �;1C �4 Reg. No. t03 � y FEE SCHEDULE: BULDINC PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ 5;- ""L r (Do C7 FEES Check No.: / �5�l :2 AOL Receipt No.: t a c� Page Iof4 M r TYPE OF SEWERAGE Dtc"" 3� - Department pudding riate perm►t to be o be filled out for the approp V of the required forms t The folloWin9 is a permits obtained • gehabilitati°n Siding interior goofing permit Application ° Building davit C.S Co Li mp Affi.L censes ° Worker CO f pI.I.C. kjjdjOT ° photo o f Contract Sed InteTioT W ork ° Copy plan OT propo ° Floor - Addition Or Decks- n Permit Application roposed Work With Sprinkler Plan And ,a -B IA e ed plot plan .able) ° S Affid�} ce Report (If Applicable) N a . W OTkers Come T� photo C°.Rngle and Two Family) co ting Permit Application Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENTMFORM05 Page 4 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA — (For department use) Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPEORM05 Created JMC. Jan.2006 TYPE OF SEWERAGE DISPO AL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer El F1- Tobacco Sales Food Packaging/Sales ❑ Well Permanent Dumpster on Site ❑ , Private (septic tank, etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of ge caner ��a6sature of contractor 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 DATE REJECTED DATE APPROVED VCONSERVATION T COMMEN DATE REJECTED DATF, APPROVED HEALTH 1 l,z� �r f 1taL COMMENTS z, l�c, _' 4. /� 1 res �l av�,.Grr�a�.�..s mc� FIRE DEPARTMENT - Temp Dumpster on site yes Fire Department signature/date COMMENTS 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 Location _2 V :� /liff . No. 504- Date TOWN OF NORTH ANDOVER .• , 0 Certificate of Occupancy $ CMUs t� Building/Frame Permit Fee $ v Foundation Permit Fee $ — Other Permit Fee $ LL— TOTAL / _ j $ Check #"- 9933 V Building Inspector O ICEIS \ c� Pd 0 w A 90 o w o a: 4 q -[ U is q w C .a a oG u q w" a a W W °D o w G w U no o ci' G w" w w w �+ cn ° z cn Q ae o cn �. ' W a: d C X10 eC . � O O iiJ CD L CD CF CDce Q o a z N Dm Q Z u CD a E O m y CD C/) cm, z C/1 m� y C C � •O m o C/) az == C y Q A= W I` U LCJ c CJS cm J coa O. C m 1•x••1 N Z G a ' C � C2 Of C C 2 m/ F— o y o y0. ~ O COO OC C •+ LL •y C = O C Z C: G yuj C3 p o_ g COD a oo0o. Z tyv ��yO C F— t S c= 0 �i CD cm O C_ CO) p 'L7 C M O O FE m m L- � _ CL ♦-. 3� O O � O env o` �- a y C O +_-+ C O V J.O �C. O D y C CD CL �..± ca c C c CO2 W 0 C4 U) 19W W 19 W 0) U 3 W 0 O cn W Q � r� w �— Q OL < Z SZ} O w - 47 ULli0 O - zLij X z -� W N c,Q / O L..I w O U }- p :D LU w Q S Q U_ Y4 � FL S5" , DN fl. � Z . 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O Q <>-oo oonc� W pzQo- U d U m _ Z U LL O N >L U Q N J Q N Q C6O nj Ki d' LS7 N S W N OLLJ - wp N< p m N to N W U) N U Q Z� O Q.HO ns) U - (S) pL iL Ow¢ N�QSWi II hwjd �OpZ Z O � � WN p N W O� U N W U O Q� N W1 NZ nUJ Ld :D Z Q NQ :O <n} 3 C, g- O}L p-, Cl 0 W Z n n N w O> z Q~� Q= O W V� KJ Z LU :i°C .ID OQw}-ZW Om p QZQU?�N?w wJw Q}o�Nuw z N2N��}WZ�m ZJZ�Q Qt-N���O dflC � o Q �J Z O� o� p O Q� Q� U��OW Z w Q�OwZN Ow2m1u^Q0CE, 5, 00 w0QW = �PLU(3 z[flzQN� p EL,Q-U zo°�?2z=oLLJ 3���" OJW� WZ ZOW zxwp��O Z oz� =mU Q OZOL- Z- QZO }} Q 1 -OS � S QQZWOO- 01-<U F-- nj [n 'i N N t` J Betterliving SUNROOMS 78 Turnpike Road, Westborough, MA 01581 Phone( 08) 870-1900 Fax (508) 870-5756 EXISTING DECK 12'X16' (APPROX) I, 2X8 FRAME @ 16" O.C. 2. 5/ 9" DECKING 3,J015f HANGFP5 9.4X9 P055 5.(3) 10"O UNDFIERMINED FOOM65 6. D(3L 2X10 PPM UNDER @ 10'-1011 FROM HOUR 7, 5%V5 (f0 rt W MOVED) PROPOSED TrAPAM5 TO FX1511%4 DECK I, fO AIV 5/9" AWANTEC 5L13' -BOOR 2. TO APP M 51DE JOISTS PROPOSED NM DECK MN51ON I6'zlb' (A'PROX) I, 2X8 Pf FP.AME @ 16" O.C. 2,07) 12"0 X98" DEEP FT65 W/ ANCHOR5 OR fECHNO-P05f5 3, J015f M%ZV5 @ Al EVDS 9, (2) f?IU 2X8 Pf 6EAM5 UNDER @ 19' R 21' 5, (1) TIPLF 2X8 Pf END BEAM HIDDEN 6. M 51DE J0155 7.6X6 P055 W/ KNEE PWF5 8, 5TAIR5 W/ 9X9 LMPIN65 NOTE:O IN12ICM5 A NEW FOOING 6' NOTE: (1) ROOM TO BE INSTALLED ON EXIST. DECK (2) ROOM FLOOR FLUSH W/ EXIST. HOUSE FLOOR Project: ACCOLLA V? 51P NCS 397 HILL5IDE ROAD NO. ANDOVEM, MA 01895 Scale; I/8"41'-0" Dra.vuq: m E9 Befterliving SUNROOMS 78 Tumplke Road, Westborou h, M1101581 Phone (508) 870-1900 Fax (508) 870-5756 Project; ACCOM VNPFNC� 347 NItt5117E P0A17 NO. AN OM, MA 01895 PPOP05E17 5 51�A50N 5MOOM 19' X 16' ( APROX) 5UPIO 51YtE MLO91T, 9-I/ 2" EI'5 + N POOr 5Y5tM (19' 5°AN) NEW 6' DOOP FPOM 9MOOM ( NON-OPEPATIN(A) 5cale, 1/ 8" - '-011 Pate: 12/ 05/ 06 5TAIP & PAL 56" NIGH PAIL II" TPEA17 7-3/ 9" PIS 9" f9ALt6ft SPACE Praw Irq; A-2 Sheet 2 of 2 :, 4?n. i�'r !n v i0ii /'>> yin /� O ii /� 7?' e' v' Prop "e ty Own-ei IN 1St tifl?riplete and Si^Il Th s Sectio If UlSI: ? A .8u31d£: // 2S O'vb'?cT G t2 SLj-�frv'uc_t' .-i�? �' f� ? �.^^. i!., 31v J11hJ 1\'v. J,��'.'.. - i ali l� l�OG.C_J G :C':iCGI L'� :'C� on r:Is __J,( IJ•v' .�r.�i> __ ,..?: T ai...,_S .. ��G....�'!G �G i'.�,_>: ._�G ' i'. v`�i � ^d.J b. 211 d, -•T_wi'__. aDn,-ica, v >C1 a l.._�..J_n.... � `J 01.jGGi r ,l� .:pY' �..C' OlOJv u.ec_ai., L11U- c'1d _ :Q'.:Mct:GIl 6h, the iOT.,_Oi:l., cnL;, 1Cc"O' ZOT 0aL-T-05S O 1 '1CD� 71(' ROA Tu' a-nd aCCu'at 'G ,nF G St GI m- k_r_0� l :Gc` 2 _ CO `� ?> ' - J' TLA Na" , Jima._. Dai., - The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER iNFORMA170N FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption Option for ,sunraom" additionsto an existitsg house (7$0 Glvm, Appendix J, Sr ---tion JI.I:2.3.1), This FORI4i Is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, farm of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a "sunroom" addition, The connection of "sunroam" structures to residential buildings rn&y create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. in the selecilon and constructionfinstallation of "sunrooms", included below is anon -required, opcn-ended list Of product and design Cnnsid"crrtion- tl�at a hoillevRiler mnay wish to Consider bt ore actually cons`uucting/in=- Hing a "sunrootn''. It is recommended that consumers carefully roview these options with ,,ftt5 eir dGSi err bUtiderf or (%"t lC r, to Order to minlrnise Potential er;t�r- c nstiz;;ptsCrs_ �t'l d/6r house d Iorlj lal i :vGu?.�i. ill _adO-for iv - 5�1�. J j , tae c)uaj,fj titins yRr .ap; alio s of is company Or hldividual. ,o E v hired u` , r?SltcJ,ns.d4jatlons. T.rn. -UT �. t`;is l r..v``c[rl..;ti`F.. ,?: Ls r ➢ f':?:+ �r `I'^.: n mlr^, u.np�r. ;F S^ o_r_ �' 4t'�rina tV Lr'S3�` S.lca:.%a1 e9 a 9srCE l 1 ie [ul5i SeFI f� ?3 _S tr;+(:6usmess of the Sunroon3 � V Ez6 ati0 U - 0 p> b1e Wi.dows ane fans Tnsulation level In 4ioors, Walls, and ceilings Possible SunreoWolatioa froth the main douse via a wail andJor door or slider Heating and Cooling Methods: Efi?ciency, Zoning and Controls Uomeow"Per Acknowledgment. The Massachusetts State Building, Code, Section J1.1.2,3,1; reouires that the actual, prone R owe,- (;,ot the owner's agent or representative) acknowledge receipt of this CONSUMER iNrORNgATTON Fp12M prior to issua�,ee of a F�j,idm9 Permit f r a project that includes "sunroom" additions to an existing residential building. accord nc.erequiremeht, the undersigned hereby acknowIedgcs that she/he has read the info atlo*%in this,< 1erit concerning sunroom comfort and energy conservation. gz�a� e of Actual Bui�ingpeer Date lo I1 �n� over iA� Print ame Address of Permitted Project towner Addrtss (if different than project location) Cwaer's telephone number 011 LiE OE't�•o �•�1,�0 � � j�����'IIVJJ o CONSERVATION DEPARTMENT Community Development Division December 8, 2006 Mr. Anthony Accolla 347 Hillside Road North Andover, MA RE: BUILDING PERMIT APPLICATION- 347 Hillside Road, North Andover, MA Dear Mr. Accolla, This letter has been prepared as a follow up to my inspection that took place on Thursday, December 7, 2006 relative to your building permit for the above -referenced property. The North Andover Conservation Department REJECTED your building permit application for the conversion of deck to a sunroom and the construction of a 16'x16' deck to an existing single-family house. During my inspection, I observed a large jurisdictional Bordering Vegetated Wetlands (BVW) along the north and western portions of the property. Please be aware any work proposed within 100 - feet of jurisdictional wetland resource areas must be preceded by a Request for Determination of Applicability (RDA) or Notice of Intent (NOI) application (whichever is appropriate) before the North Andover Conservation Commission (NACC), per MA Wetlands Protection Act-M.G.L. c.131, §40 and the North Andover Wetlands Bylaw (C.178 of the Code of North Andover). Additionally, under the provisions in the North Andover Wetlands Protection Regulations, the NACC enforces a 25 -foot No Disturbance Zone and a 50 -foot No Build Zone from the edge of a wetland resource. This will require you to hire a Professional Wetland Scientist to delineate all jurisdictional wetland resources within 100 -feet of the proposed project In addition, a Professional Civil Engineer or Registered Professional Land Surveyor would need to prepared a plan showing all proposed activities; the wetland boundary and its associated Buffer Zone (25' No Disturbance Zone, 50' No Build Zone, and 100' Buffer Zone. Additionally, I have enclosed a list of wetland consultants, engineers and surveyors for your use, along with the 2007 meeting schedule and abutter notification. Please also be aware that the building permit application must be reviewed by the North Andover Health Department since your house has a septic system and a well 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://www.townofnorthandover.com/conservel.htm Should you have any questions regarding the filing process, please do not hesitate to contact the undersigned at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Pamela A. M Conservation Associate Cc: North Andover Building Department Patrick Stevens, Better Living Sunrooms 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://www.townofnordiandover.com/conservel.htin 401 SOILTTBRI { r C 1 � 106.SER Jti iav�Y CO�NiGP�A U ( PROP5ED ENCL05ED DECK *-,OPEN DECK) NORTHERN ASSOCIATES �I�TC. WAY,LAWRENCE MA.0184-3-3522 TEL:(978) 837-3335 FAX:(978) 837-3336 N/F TROMBLY 2 \00, LCAT >1-402_ T C2- 1 57,05�-, sf _ O 0 0 O ��g Q- 0� �_ 1 (0 l— LOT C2 m/ 3900, ryp//� — SCENIC EASEMENT -�- 23. o // LO LOT D2-1 4205f± �\ §I /� proposed __o4open deck ` �proposed 16,_0. O° o encl.deck �j °_ i -o^ / (0 2 I .5 story 1.5 sty. 0 00 --- wood% l 1 wood 20 , #347 I _ 00 %7 SCENIC EA5EMENT LOT C2-2 I `\O O '� 4205f± ' --- — ----- O '---' DETAIL : SCALE: 1 "=30' 1� (D ��------�/ 1 20.92' o AD "V C:!Aot PREPARED FOR:ANT110NY � SANDRA TRANFAGLIA-ACCOLA LOCATION:347 HILLSIDE ROAD CITY,STATE:NORTH ANDOVER MA DATE:MARCH 3 1 ,2002 SCALE: I "=GO' REVISED: DEC. 1 ,2006 M 1. Property/House is not in Flood Hazard. O 2. Property/!louse is in a Flood Hazard Area. M S. Infirmation is insufficent to determine Flood Hazard. Flood Hazard delernined from latest Federal Flood Insurunce Rate Map Pani 250098-000GC Data G-2-93 zOt1e X -UNSHADED � �;r.r✓�zaa�,ryzar✓✓z ni�✓r��,�ac�.%z-.c<:.v� . BOARD OF BUILDING REGULATION$ License`. CONSTRUCTION SUPERVISOR ' Number.: CS 081580 6irthdat�s 02/1,9/1950 Expires: 02/19/2008 Tr. no: 16699 Restricfed: 00 PATRICK A .STEVENS 24 FORD RD STERLING, MA 01564 !/J�i Com:missi66ei _.._--_.--� -.___.� .�17� VO%'f�.//%2O%ZU�,.C7L(n%/ Cn�✓I�.�iO.�!(.GICHf✓GO' IR�. Board of Building Regulations and Standards _�I� C _- _ ` HOME 1MP;ROVEMENT CONTRACTOR E RVegisfraton�14.8576 " ' _,Ez"irafion=::i'0/6/2007 _ = J -'Type:= -Supplement Card NH Patio Rm(dba)Bet#ee:l�iV_in0-7,.-S u"i Painck Stevens 1 Action Blvd. Z�7 LondonDerry, NH 030.53 Administrator 10/18/2006 16:34 6035460814 RJ PRATT ENTERPRISES PAGE 01/01 Betterilving® CONTRACT CHANGE ORDER Phone ---508.870.1900 Customer: A nA A es -o t Ua Fax ---508.870.5757 Address: 3` -1 41 �i-��, �� Date: � 0�) £ � `��,�t d � $ Lt J At the request of the above referenced customer, the following changes to the original cotztraet and/or previously executed change order between the undersigned and BLSNE, Inc, are hereby agreed to: 0\sae. Due 4wfwd l,i -su 5 + vl 1Au j nul n rron W I SG{'PPfl Contract Amount Prior to this Chamge Order: Change Order Additional Charges / (Deductions) New Contract Amount after this Change Order Amount Previously Paid by Customer Amount Paid with this Change Order Remaining Balance (Payable as Follows) Due Prior to Ordering of Materials: Due on Initial Delivery of Materials Due on Commencement of Framing Due on Completion �:1 1 00'Z APMQY-A S: The undersigned agrees to the changes noted above and the revisions to the contract amount and payment schedule shown. This change order is subject to all terms copdi ns cr the original contr�een Owner: Owner: Product Saftice Use Only_ Initialed by President: Filed by: Sales file Install file Betterliving Betterfivin�' gmi..� Contractor I? e istration s MA.148574 78 Turnpike Road, Westborough, MA 01581 (508) 870 -1900 -voice (508) 870-5757 fax Installation I n sta I ! ati o ('•7a A re eFment MA 1.48576 MA 148575 www.patios.com RI 26615 This order is for work to be. performed by BLSNE Inc. and/or its subsidiaries, Patio Rooms �ofAmerica Inc., Patio Rooms of Springfield Inc., Patio Rooms of Worcester Inc., New Hampshire Patio Roonns Inc., (d.b.a. Betterlivitng of New England) (the "Company") as specified below Customer Name QA 1' fly �9 C C Cx_ _ Home Phoue TJ 9 %S ' /CT7 Daytime Phone Entail.: .���t NQL qlq Yeeic, (20 C.t m� C")r /- IV e-1- 1 - Address of Work ( �S ` dL=� g1J*'ye-a` f� t� ()1 'r" Lt S t# ( & Street Cit ) (City) (State) (Gip) (Municipality) Work Specifications Agreed to: Furnish and Install one Betterliving three season patio enclosure (the "Sunroorn") with the following specifications: (Fill in or check where appropriate) 1. Enclosure Size (apBrox). 4x x �e - 1 2. RootStleHoneycomb Panel - 3/�/z Color n 1 Inside Outside 3. Walls: Glass Type: �lnb�s I'a�'` tr�1(�cr`f,c (n1 S��e 1 i,11t'i} Kneewall Style -Color Gable or rng Style IEC:,�:e' l Wall Il:eight , �� Transom: ©'Glass ❑Panel Color lywood 4. Decks: Build New under Enclosure s Ft Build New Open S� Ft Existing 1 cl � S .Ft. Reinforce �& Vapor Barrier Steps: # Z� Width Handrails � ^ ,,.Ft] Deck Skirting: ❑Yes ❑ No Type: S. Concrete: Install New PadS .Ft. Foot Existing Pad _ Lin.Ft. 6. ❑ Standard Electrical Package 7. Accessories: 8. Removal of Existing: 9. Capping: Items _ ��❑ Color 10. Vlisc: House Wall Door (See Attached Spec Sheet) ❑ Yes ETNo ❑ cutout ❑ Dormer ❑ Overhang Cutback I.I. Other: 12. Customer Responsibilities: Electrical Work & Permit ❑ Relocation of. Exhaust Vents 0 Water Spigots dElectrical Meter 19/ Other: Q C �nl� ` �- `� t'� If` L�1 I I r G i (21 tl k 1210 (1 nticipated Installation Schedule: Planned Start Date:� � U � Planned Completion Date: I LG Company agrees to furnish labor and materials to complete the wort: specified above for the amount shown below in accordance with and subject to the terms and conditions on the reverse side, which are part of this Agreement. Company carries Workers Compensation and Liability insurance. Work will be performed in accordance with Company specifications. Trash removal is included in this contract. Unless specified above Customer is responsible for re -finishing of house wall enclosed. Building permit service included. (in Massachusetts, contractors and subcontractors must be registered by the Chief Administrator of the Massachusetts Board of Building Regulations and Standards. Customers securing their own construction --related permits or dealing with unregistered contractors will not be eligible for Guaranty Fund Protection(s) under the Home Improvement Contractor Law.) NOTICE TO CUSTOMER:: Do not sign this Agreement before you read it. You are entitled to a completely filled-in copy of this Agreement at the time you sign it. If it involves an installment: sale, understate law you have the right to pay off the full amount due in advance and under certain conditions to obtain partial rebate of the finance charge. Any holder of this consumer credit contract is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed amounts paid by the debt hereunder. You, the buver, may cancel this transaction at Cash Price � � o S s Paid With Order `G' w 1. o U (D Due Prior to Ordering Q of Materials s- tl�(<2 Due on Initial Delivery � o of Mrtterials . _ KIq 2 3 Due on Commencement � _ 7 Dec 28 2C05 10:21 JF`4NcK'ecnemins . 13"c 672 J1Q1 A C OR D- cam_ >^ e1 Ept !p tq 6 �¢ ( 1 ��—,N V E R i i i F 1 C." � 0 /� �c � P A �7 I [ a�� fe K ra � .' * r•{�I t I �I' i L.. LIA B k L I 1 I', i' k� S U. .mow N ti.!';� � I Its WDDM Ptt Duc R 12/28/2005 THIS GIRT {; tC NF is ISSUED A3 A fiIATR OF INFORMATION JOScDi1 MCKeOn9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RTlRD OR JP McKeon'✓ Irsu:Gnce Aaency, I(}C. HOLDER. THIS CERTIFICATE DOES NOT "END, =XTEND OR P.C. Box 333 � � ALTER IiE COVERAGE AFFORDED BY THE POLICIES BELOW. / f1(1 PJ70C, PVI 8 (0p_0�33 IWSURERS AFFORDING COVERAGE INSUFL�O- - Patio Rooms of America I IN -SU R_RA: Harford dba BeterLiving Patio Rooms j ItasuaEa _>: q, mall= ?8 i umpike Rd i INSURER C: Westborough, MA 01581-1730 COVERAGES I INSURER =_ THE PQLICIES OF INSURANCE LIST D BELOW HAVE BEEN ISSUED TO THE INS, -;RED N NED SGVE 0?-. _ v ANY PERTAIN, '_NT, TERM C AFFORDED I ED OF YE CONI PACT OF,, G T HCR DOCUI TENT WiTH RESP=CT TO W; -;ICH T: SIS CERTIFICATE MhY BE ISSUED HE.OLIC. F-Fi1ODINDICfiT�D.NG JVr STANDING MhY PERTAIN, 7HE INSURANCE AFFORDEG BY 7HE POLICIES DcSCRiBEG HEREIN !S SUB)=CT T O r",LLTr,- q. r',IS ^` POLICIES. AGGr.EGA T E,LlAAf I S SHOVJN MAY HA '- - - OR `E SEEN REDUCE TERMS, XCLUSi0N5 f,RD CONDITIONS OF SUCH INS BY PAID CLAIMS. LTR1 _ TYPE OFII'll SORANCE P.^,UCY;JUMSBSR I P ..Y ❑r?=C i'R+= ir' !-I ""•, ;J,:ID. ' .DATE !Mi LVED7""� i DATE ?.;ez.�nr+yt ; J n '-c —L LIA.3LITY BVV i'3v15352 UN7S 35 S 1 i;01f2005 + 11/G -il'20,05 I/\ ! GOtJ. Yic'r.CiA! GENERAL LIAS)L iY �J F1RE DAMAGE (Am-, e fuel 5 _CLARf,S WADE' Ell OCCUR I I 1l7(J,O� MED EXP i The Cornnionwealth of ,blassuchuserts Department of Industrial: lecitlents Office of Investigations l 1 " 600 Washington Street Boston, A14 02111 b www.inass.gov/din 1. Workers' Compensation Insurance Affidavit: Builders/Contractors/E:lectricians/Plumbers 1pplicant Information Please Print Legibly C. 'dame(13usi11essit)r"Mliialit,nil11(1ivirluttl): address: C ity State. Zip: W a e%tion ff\(�— Phone #: 5_0'a -x'10 t q c\3 Are you an employer? Check the appropriate box: ' 150 1 am a employer with 6 4. ❑ I am a general contractor and I _a ._ employees (full and'or part-time).* have hired the sub -contractors 2. ❑ 1 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. 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 NiGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 3. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13�Other S,,,,1por.� _ `Any applicant that checks box d I must also IitIo tit the section below showing their workers' compensation policy information. y Homeowners who submit Ihis affidavit indicating they are doing AI work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name oft lie sub -contractors and their workers' comp. policy information. I um rin employer that is providing workers' compensation insurtmc•e for my employees. Below is the policy and job site information. i_ Insurance Company Name:_- ��)RJ1 t3-- —__--_ —__--- --- __-- Policy it or Self -ins. Lic. 4: 35" \A i�6�S43S3 _ Expiration Date: I 1 -o Job Site Address:. -34-1 ��+�t 3tOlt �Z7 City; State'Zip�_�i�t�u�e� r1l A17— 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'IviGL c. 152 can lead to the imposition of criminal penalties of a Fine up to 51,500.00 and/or one -,year imprisonment, as well as civil penalties in the form of a STOP �k ORK ORDER and a tine Of up to $250.00 a clay 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 certi ' la-tder the pains a%ndpenahies of perjury that the information provided above is tare and correct. – tii .nature: \M �1 J[: t nate: ' 150s.70 -kms ___ Ijicial use only. Dir rut write in ibis arra, to be •nrrrpleted by c:l►. nr town Alicia/. City ar Town: ;',:emit/License 4 -- Issuing ,Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk d. Electrical inspector i. f lumbing Inspector 6. Other Contaet Pcr,zon: Phone #: TOWN OF NORTH ANDOVER y Building Department 400 Osgood Street h `°+ North Andover MA 01845 +° rap `y '�i �e►�` gssACHUgtt Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: kelp , '7 a QQ W0( L TEL #: cr 499 - X54 "Me, TEL* . 978- Coa\ 847( FROM: aco k Pori v \n ADDRESS: X 5102, Rd, COMPLAINT AGAINST: Electrical: Plumbing: Gas: Building Contractor: Property Owner A,)i-ki on Address Other: i`1i u� ,n e,� �1 �lJ� t� �y-2 �.�'2� a �s-�� ►� or k b fie. P. �j kooks -e� e. n-�� Signed: ( Revised 11.5.04 RECEIVED FEB 8 2006 WILDING DEPT,