HomeMy WebLinkAboutBuilding Permit #002-12 - 374 SHARPNERS POND ROAD 7/1/2011 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ( � Date Received f
Date Issued: 7
IMPORTANT:Applicant must complete all items on this page
LOCATION -3r74 S o zs Po PcL
PROPERTY OWNER J rn f-' OL
Print
MAP NO: r{ .�PARCEL: 00A ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
KAddition 11 Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
t®Sephcy D Well �. D.Flood"Iairi- ❑'Wetlands ' 'Wafershed;�D str ct m
❑Wa_t_er/Sewer _
DESCRIPTION OF WORK TO BE PERFORMED.
ki�c1�Q^n�d�hi nG r®erm ao1r�►�-���m /re M c�e1 , remau&--I e M4 -
�,�h
Identification Please Type or Print Clearly)
OWNER: Name: ack m e C, tea.9-c) Phone:q 1 ��-
\_
Address: �� � �-YIC�'�-T��=�� ' \d YW
CONTRACTOR Name: �1 G1 (' _�� ►�'1 ll C)Y15� Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: 0 �-Q Exp. Date: �O
ARCHITECT/ENGINEER-al vzry&i- � Arclit -G�,s -_ Phone: (�(�`� SJ9 LHS
Address: aaL� Nc,,A-54 0n,Y Sig 1,14-0 DO N l 030;eg. No. K:21
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9 .00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $
O flOqEE: $ 6 O
Check No.: Receipt No.: 3 3
NOTE: Persons contra c ' with u registered contractors do not have access to the guaranty fund
Signature of Agent/Ovvne = Signature:
-- - - - ------ "-- - --
i
Plans Submitted 5( Plans Waived ❑ Certified Plot Plan R- Stamped Plans
FPublic
WERAGE DISPOSAL
❑ Tanning/MassageBody Art ❑ Swimming Pools ❑
❑ Tobacco Sales ❑ Food Packaging/Sales ❑c tank,etc. Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on d Signature A64,
f'
COMMENTS ji / S
HEALTH Reviewed on 3 Si nature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp p on
Dum ster site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA-- For department use
® Notified for pickup - Date
Doc:.Building Permit Revised 2009
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
�2�euilding Permit Application
orkers 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: II dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
�/BL ' ding Permit Application
ed Surveyed Plot Plan
kers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
❑ C y Of Contract
Floor/Crosse
ction/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
:�4ngisneering
check Energy Compliance Report (If Applicable)
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
Location 2 7 '�
No. 0�2 /2- Date
NORT1y TOWN OF NORTH ANDOVER
� A
+ ; ; Certificate of Occupancy $
CNUSE<�' Building/Frame Permit Fee $ ,•
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #1 '
24. J ;jJ
Building Inspector
NORTH
Tovm Of
0x1n
No. .�,_.
-7 zzzt
dover, Mass.,
0 LAKE
Ai I� COCHICHEWICK y�.
%ps RAT E D P �
7 BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
L" ". � BUILDING INSPECTOR
THISCERTIFIES THAT............................................................................................................................................................... Foundation
has permission to erect........................................ buildings on .3.74/......�/. .o..�' .moi ��"... ........ Rough
to be occupied as.... .............................................................. Chimney
provided that the person accepting this permit shall in every respe conform to the terms of the application 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 STARTS Rough
......... ...... . .. ... .....�...,.�.�................. .... ................
Service
UILDING 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 FIR_ E-DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
Office of Consumer Affairs&Business Regulation
— s HOME IMPROVEMENT CONTRACTOR
Registration:;- 156364 Type:
.'
Expiration:--.-'-6/25/20-1-3 DBA 1
K&R CONSTRUGTIQN'
SHAWN FALES
34 EVERGREEN ROAD-
STONEHAM, MA 02180- Undersecretary
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HOME 1:9PROVENNENT CONTPACTO. 1 ” �^ tl L.41p1 ti6;� ; ! 1 e n to
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ReGistration: '156364 (}I,e`.�alt'�ui tpn,f'licc ,.1:, 131,1
Expiration: 6/25/2011 Tr# 28!15Q B tau,. 1a.02108
F- ; Type: DBA
K&R CONSTRUOTION
SF:,'WV'q FALES'�,- --
34 EVE;-G,.EE N ROAD _ Gam--�,��, _ - ---• . � ,
I STONEHA!JI,,-MA 02100'
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In ormation and Instrnetions
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
ofthe 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,
-flPloYeas. Ho
owner of a dwelling house having not more than three apartinents and who resides therein,or�the occupant ofther 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.;deeined to bean employer."
MGL chapter 152,§25C(6)also states that"every state or local Iicensing 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 ofpublic 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)naine(s),address(es)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 confinnation 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 Oficials
Please be sure that the affidavit is complete and printed legibly. The Deparhnent 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 perinit/lieensenumber which will be used as a reference number. In addition,an applicant
that must submit inultiple permit/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 proofthat 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 cornmercial 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 Commonwealt Of Massachusetts
DTartment of Industrial.Accidents
Office of Investigations
600 Washington Street
Boston,ISA 02111
Tel.#617-727-4900 ext 406 or 1-877 MASSAFE
Revised 5-26-05 Fax#617-727 7749-
www mass.gov#dia
• The Commonwealth of Massachusetts
Department oflndustrialAccidents
'� "` , It Office of Investigations
'� :1 •�u 600 Washington Street
r t3uBOSton,MA 02111
www.mass gov/dra
Workers' Compensation Insurance Affidavit:Builders/Contractor•s/FIectricians/Piumbers
A.ppEcant Information . Please Print Legibly
Name(Business/organization/fndividual): k "r I 1 r an S�^UC--01
Address: 3 q •�JP� t-��°h AACity/State/Zip: Sfcm e I c_y n (,11-� 0 kI Whone#: 7D -9 S5`39 16
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. 0 New construction
employees(full and/or part-time).* have hired the sub-contractors
2.9 Iain a sole proprietor or partner- listed on the attached sheet.t 7. F1Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance, g. JABuilding addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ 1 ain a homeowner doing all work right of exemption per MGL - 11.0 Plumbing repairs or additions
myself.[No workers'comp. c. 1,52,§1(4),and we have no 12.[]Roofrepairs "
insurance required.]T employees.[No workers'
comp.insurance required.] 13.❑Other
*Any applicant that checks box#1 must also,fill out the section below showingtheir workers'compensation policy information.
t Homeowners who submit this affidavit indicating they ate doing all work and thep hire outside contractors must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information.
f am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name: I i° .sq-ri
Policy#or Self-ins.Lic.#: C '¢•fit;H ] 55 Expiration Date:
Job Site Address: 13 211 L5 ha r r)�,oy16'S Pd nA B�A City/State/Zip:1V, An km Gr- Q/RL-S
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 Geri fy under the pains and penalties ofperjury that the information provided above is true and correct.'
Signature: 41M, O ( Date: (L>17111
Phone#: 4 3 f� —34 F
FFPerson:
only. Do not write in.this area,to be completed by city or town official.
n: Permit/License#
hority(circle one):
Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
son: Phone#:
t=ax:17814385028 Oct 18 2010 10:12
ACORQ. CERTIFICATE OF LIABILITY INSURANCE 10/18/2010
ig/istzo><a �
T1418 CER7IFICATS IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEFL,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BV THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the GeRifoat0 holder is on ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the temts and conditions of the policy,Certain policies may require an endorsement. A statement on this cer(tfirate does not confer rights t0 the
certlficste holder In lieu of such 4ndorvement s.
rrOD000R CONTACT
NAM-
New England Heritage Insurance Agency Group, Inc. M r.*781.438.5000 Arc No.781.438.5028
335 Main Street
ADDRESS;
Stoneham, NIA 02180 MIMID*k
INSU B A"ORDING COVERAGENALCO
IN3UM ;NBURERA: TRAVELERS INSURANCE 10038
K & R Construction INSURERS: Granite State 1000111
DBA: Richard & Shawn Fales INSURER C:
34 Evergreen Road INSURER D:
Stoneham, MA 02180 Iia,
i� un;F
COVERAGES CERTIPICATE NUMBER:Master 10 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T4E INSURED NAMED ABOVE FOk 7r.E POLICY PERIOD
INDICATED. NOY'NITHSTANDING ANY PEQUIREMENT,TERM OR CONDITION-OF ANY CONTRACT OR OTHER DOCUMENT WITH P.ESPECT TO WHICH THIS
CERTIFICATE MAY LE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT 0 AU_THE TERLS$,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAI BEEN REDUCED BY PAID CLAIMS.
"LTR EFF
TYPE OF INSURANCE INSR WVD I POLICY NUMBER NAVPOLA MD Y ! umft
XGENERAL LIABILITY 680-3979M40 0711812010107118/2011 I EACHOCCURRENOE .s 1,000.0
I C0L4AASRCIAl GENERAL LIASILnY i I nomj B 3110,0
cuvn a Ex-J occuRI MoD D(P t"ane tenon! s ?0.0
A ` I I PERSONAL&AD'V INJURY $ 1 000 ID0
GENeRAL AGGREGATE ;S 2,000,00(
3EteL A()GKE3Ar1E LIMIY.APPLIEB FFft; I FRODUCTE•COMF;OrAGG 8 2.000100
POLICY� 11
SGT I LOC E
AUTOMOBILE LIABILITY COMSINEDSINGLE LIMIT
(Es Seeder $ 1
ANY AUTO i BODILY INJURY(Perpefson) t.
ALL O1WNr.D AUTOS BODILYINJURY(Perscoded) S
SGNEDULED AUTOS PROPERTY DAMAGE
(f�11 HIRED AUT09 (Pet 9cd0ent) s
{NO"WHEDAUTOS I I 6
r
UIUBRELLAUAB OCCUR I EACHOOCURRENGE 13
EXCESS LIAR GLAIM"AOE
AGGREGATE Sr
DEDUCTIBLE ! ! S -
RMNTION € I 1 I s
oRRrrt caMPeNsa WC 743541 08!27/2090 08!27/2091SAT - H
AND EMPLOYERS'LIABILITY YIN I D1ER
�ANYPROPRICrOPPARTNEWEXECUTIVEIN/AI I E.L.SACHAG:IDENT 3 100100
g OFFWeA%T.ISfiREJ(CLUDED? �J
(I161ndalarY in NHI I ! 1;-L.09EASE-EA EMPLO '$ 3.00,00
I ITYeE.desolbe'O TI W. E.L.DISEASE,POLICY I ImT S 5()0,00(
I
EICRIPTiON OF OPWT10NS I LOCATIONS I Ylt11CLE3(AMM ACORD 101,Addkicnai Rz-.w a SehMub,iTmom space Ii,reVAred)
rpentry contractor
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF YHE ABOVE DESCRIBED POLICIES as CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE%ITN THE POLICY PROVISIONS.
AUTHORIZED RErRESE ffAnVC
- Wi11iam Kell VIM /
01988.2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009108) The ACORD name and logo are registered marks*f ACORD
,, �Py
K& R COnstl"uction w
34 Evergreen Rd,Stoneham MA,02180 Office 781-438-3418
Diglt@comcast.net HIC#156364 CS#96874
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 Co ractor Information
Name Com any N me
�t Caris�ry
Street Address(do not use a Post Office Box a ress) Contractor/Salesperson/Owner Name
3��( �har neer-5 rang RA Jhaw rtle5 Aic6scl Fude5
City/Town State Zip Code Business Address(must include a street addresAs
� Ar,Aauelr- MA 01`sLi S 3H Fver- -,
Daytime Phone Evening Phone City/Town State Zip Code
►�1-7331 (040-5 S4vnc�Narj V)I� x.( 60
Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number
Law Home Improvement Contractor Reg.Number Expiration date
tha
improvement cot mostcontractors
have (S�3 �q
improvement contractors have
a valid registrntion number
The Contractor agrees to do the following work for the Homeowner:
(Des ribe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessaU.)
(Des
quc
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and will be secured by the contractor as the homeowner's agent: be 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 */// Date when contractor will begin contracted work.
MGL chapter 142A.)
Date when.contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of: 4 6, 3 0
Payments will be made according to the following schedule:
Q�'-upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater)
s35 by /_/_ or upon completion of -t-r�UV�ae�T( -N191
�-
$ by / /_ or upon completion of
$ 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 $ to be paid for
ordered before the contracted work begins in order
to meet the completion schedule.(**) $ to be paid for
NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may
not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express Warranty-Is an express warranty being Provided by the contractor? ®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 1 ater than midnight of the
third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical copies the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor.
H
om wner's Si ature Contractor's Signature
Date Date
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 Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
to sub ' to such rbitration as provided In Massachusetts General Laws, ch a ter 1442
Ho eowner's ignature Contractor's Signature
NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute
resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this
section is not separately signed by the parties.
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer
protection laws(i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights, contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract must be executed in 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.mass. ov/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 hM2://www.inass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
!=:Hdb.state.ma.us/homeimprovement/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 2.1-11/22/20 10
Permit Number
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la Checked By/Date
TITLE:FARO RESIDENCE ADDITION
CITY:North Andover
STATE:Massachusetts
HDD:6322
CONSTRUCTION TYPE: I or 2 Family,Detached
HEATING SYSTEM TYPE:Other(Non-Electric Resistance)
DATE:06/24/11
'✓
DATE OF PLANS:5/16/11
PROJECT INFORMATION:
KITCHEN ADDITION
COMPANY INFORMATION:
K&R CONSTRUCTION
COMPLIANCE:Passes
Maximum UA=99
Your Home=97
2.0%Better Than Code
Gross Glazing ,
Area or Cavity Cont. or Door
Perimeter R-Value R-Value ll Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 212 38.0 0.0 6 t
Wall 1:Wood Frame, 16"o.c. 470 21.0 0.0 20
Door 1:Glass 21 0.330 7
Window 1: Wood Frame,Double Pane with Low-E 106 0-330 35
Basement Wall 2:
Solid Concrete or Masonry,8.0'ht/3.0'bg/8.0'insul 288 0.0 10.0 23
Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 212 38.0 0.0 6
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications,and other calculations submitted with the permit application. The proposed building has been
designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release Ia.
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable
Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be
no greater than 125%9fthe design load as specified in Sections 7WCMR 1310 and J4.4.
Builder/Designer Date p�V /
r
Permit Number
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.2 Release I Checked By/Date
TITLE:FARO RESIDENCE ADDITION
CITY:North Andover
STATE:Massachusetts
HDD:6322
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE:Other(Non-Electric Resistance)
DATE:06/24/11
DATE OF PLANS:5/16/11
PROJECT INFORMATION:
KITCHEN ADDITION
COMPANY INFORMATION:
K&R CONSTRUCTION
COMPLIANCE:Passes
Maximum UA=99
Your Home=97
2.0%Better Than Code
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 212 38.0 0.0 6
Wall 1:Wood Frame, 16"o.c. 470 21.0 0.0 20
Door 1: Glass 21 0.330 7
Window 1:Wood Frame,Double Pane with Low-E 106 0.330 35
Basement Wall 2:
Solid Concrete or Masonry,8.0'ht/3.0'bg/8.0'insul 288 0.0 10.0 23
Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 212 38.0 0.0 6
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications,and other calculations submitted with the permit application. The proposed building has been
designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release la.
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable
Standard Design Conditions found in the Code. The HVAC equipment selected to heat or coot the building shall be
no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4.
Builder/Designer Date
I
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.2 Release I
DATE:06/24/11
TITLE:FARO RESIDENCE ADDITION
Bldg.
Dept.
Use
I
Ceilings:
[ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation
I Comments:
I
Above-Grade Walls:
[ ] I 1. Wall 1:Wood Frame, 16"o.c.,R-21.0 cavity insulation
Comments,
I
Basement Walls:
[ ] I 1. Basement Wall 2: Solid Concrete or Masonry,8.0'ht/3.0'bg/8.0'insul,
R-10.0 continuous insulation
Comments:
I
Windows:
[ ] I 1. Window 1:Wood Frame,Double Pane with Low-E,U-factor:0.330
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes[ ]No
Comments:
I
Doors:
[ ] I 1. Door 1:Glass,U-factor:0.330
#Panes Frame Type Thermal Break?[ ]Yes[ ]No
Comments:
I
Floors:
[ ] I 1. Floor 1:All-Wood Joist/Truss,Over Unconditioned Space,R-38.0 cavity insulation
Comments:
Air Leakage:
[ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air
leakage must be sealed.
[ ] I When installed in the building envelope,recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfin(0.944
Us)air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled.
i
Vapor Retarder:
[ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
I
Materials Identification:
[ ] I Materials and equipment must be identified so that compliance can be determined.
[ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
[ ] I Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications.
Duct Insulation:
[ ] I Ducts shall be insulated per Table J4.4.7.1.
Duct Construction:
[ ] I All accessible joints,seams,and connections of supply and return ductwork located outside
conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed
using mastic and fibrous backing tape installed according to the manufacturer's installation
instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
[ ] I The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
[ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
I
Heating and Cooling Equipment Sizing:
[ ] I Rated output capacity of the heating/cooling system is not greater than 125%of the design load as
specified in Sections 780CMR 1310 and J4.4.
Circulating Hot Water Systems:
[ ] ( Insulate circulating hot water pipes to the levels in Table 1.
I
Swimming Pools:
[ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
I
Heating and Cooling Piping Insulation:
[ ] I HVAC piping conveying fluids above 120°F or chilled fluids below 55 OF must be insulated to the
levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes.
Insulation Thickness in Inches by Pipe,Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature(F) Up to 1„ Unto 1.25" 1.5"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pie Sizes
Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD(Building Department Use Only)
K & R Construction '_ _ Estimate
34 Evergreen Rd
Stoneham MA, 02180
Date Estimate#
Name/Address 12/30/2010 265
Jim and Marie Faro
374 Sharpeners Pond Road
North Andover,MA 01845
Project
Description Total
Foundation- 13,800.00
Excavate full basement and install continuous concrete footings
Install poured concrete foundation walls as per plan
Install compacted gravel and 4"concrete floor
Install damproofing on foundation as necessary
There is no allowance made for ledge removal if it is encountered during excavation.Soil will be stock
piled until backfilling is complete.Excess will be removed.
Floor framing-1st Floor 2,020.00
Supply all materials and frame floor as per plan 16"O.C.
3/4"T&G Advantech glued and screwed
Beam installation- 6,800.00
Construct temporary walls to support second floor of house
Frame in pocket for steel beam W 12x58-weighs approximately 1972lbs(assuming engineering has been
done for sizing)
Build supporting structure to rest beam on and maneuver into desired location
3 posts will be needed to support the beam-steel columns will have to rest on top of foundation wall and
new footing
Wall Framing-1st Floor 1,625.00
Supply all materials and frame first floor walls as per plan
2 X 6 Exterior with appropriate headers and blocking
1/2"advantech sheathing
Floor framing-2nd Floor 1,980.00
Supply all materials and frame floor as per plan 16"O.C.
3/4"T&G Advantech glued and screwed
Wall framing-2nd Floor 2,520.00
Supply all materials and frame Second floor walls as per plan.
2 x 6 Exterior walls with appropriate headers and blocking
1/2"zip Syst sheathing and taped seams
2 x 4 interior ails
Signature LA� Total
Page 1
K & R Construction Estimate
34 Evergreen Rd
Stoneham MA, 02180
Date Estimate#
Name/Address 12/30/2010 265
Jim and Marie Faro
374 Sharpeners Pond Road
North Andover,MA 01845
Project
Description Total
Strap ceilings-first and second floor addition and existing living area 880.00
Roof framing- 3,600.00
Supply materials and labor to frame roof structure as shown in plan
16"O.C.rafter spacing
5/8"Zip system sheathing and taped joints
Roofing Allowance-approx 650 sf 4,060.00
Ice and water shield-valleys and perimeter
Iko architectural shingles to match existing,dripedge flashing ect.
Exterior trim-Frame in soffit overhangs and finish with white vented vinyl 1,334.00
Pine fascia and rakes-wrapped with Alcoa-White Aluminum trim stock
Siding-Vinyl Siding to match existing 4,760.00
Demo and disposal costs-Allowance 3,500.00
Windows-Allowance 8,500.00
Supply and install Andersen windows
specs to be determined before ordering(13 total)
Doors-Allowance- 2,500.00
Supply and install Andersen Exterior door onto patio,6ft sliding
Install 10'6"LVL Headers over new opening to dining area 1,650.00
Finish new opening with arched trimwork,remove foyer closet and dining room wall,repair ceilings 1,250.00
(flooring unknown)
Insulation Allowance-Fiberglass batts,proper vent in roof,seal around windows and doors,vapor barrier 3,480.00
Fireproofing n f 300.00, - I
Signature Total
Page 2
K & R Construction Estimate
34 Evergreen Rd
Stoneham MA, 02180
Date Estimate#
Name/Address 12/30/2010 265
Jim and Marie Faro
374 Sharpeners Pond Road
North Andover,MA 01845
Project
Description Total
Electrical Allowance-basic layout and devices,no fixtures(wall or hanging) 10,000.00
Plumbing/Heating Allowance-Layout as shown in plans 17,000.00
Blueboard and plaster(Allowance) 5,000.00
Interior Trim-Allowance 2,200.00
Install 7 1/4"MDF primed Baseboards throughout new areas
Interior doors-Allowance 3,100.00
Supply and install prehung interior 6 panel doors(qty 6)
Supply and install pocket door into master bath
Install kitchen-Allowance 4,500.00
cabinets,appliances and trim
Heated floors-warn tiles-electric cables under tile 3,500.00
Flooring allowance-Supply and Install 5 1/4"Walnut flooring-foyer,dining room,family room,kitchen 15,550.00
Radiant heat allowance-downstairs area-kitchen/living room 10,000.00
(Allowance)Remove Existing front doorway and install new Therma Tru fiberglass entry door with azek 2,000.00
casing and kickplate(many styles available-broad range of pricing
Install railings on front entry-Azek composite rail system 2,150.00
Install perimeter drain around new foundation and along existing east side foundation wall.Install filter 2,000.00
fabric and 4"corrugated pipe surrounded by crushed stone.Drain pipe may run to sump pump catch basin
in new basement floor or to daylight depending on depth and available locations to do so.(allowance)
Cut doorway through existing foundation wall to new addition. 950.00
Install siltation fence and hay baI s to meet state requirements 1,600.00
Signature Total
Page 3
K & R Construction Estimate
34 Evergreen Rd
Stoneham MA, 02180
Date Estimate#
Name/Address 12/30/2010 265
Jim and Marie Faro
374 Sharpeners Pond Road
North Andover,MA 01845
Project
Description Total
Remove asphalt driveway section as shown in plan and install loam then plant wild seed mix.Install 2,200.00
shrubs as shown in plan.
This estimate is based on the plans provided by Silverwatch Architects LLC for 374 Sharpners Pond Rd. 0.00
Realistic allowances have been made to provide an appropriate estimate for the project as a whole.Not all
aspects of the project have been included in the estimate as they have not yet been determined.(For
example-Tile,skylights,trim style,landscaping ect..)Any work that is not quoted in this estimate will be
discussed before it is performed,and all applicable charges will be in addition to this estimate.As work
progresses,an invoice will be sent for work completed to date.
Signature Total $146,309.00
Page 4
y _
•'' TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received f �1
Date Issued:
IMPORTANT:Applicant must complete all items on this page
II ''
LOCATION 3 74 Saf-, o 'u
-.- (Jod .P,�, .-ont
PROPERTY OWNER M CC 12
Print
MAP NO: PARCEL: 00A ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
SAddition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition El Other
p£S.eptc 0 Well �Flood Flaur. '0 Wetlands WatershedDistnct . _I
on,
JL
�(t�.
s.. t_ R_ _.._.
DESCRIPTION OF WORK TO BE PERFORMED:
reprm aAd\Alcn remockg-- 1 Irem\aua-i-e m454-� >
.b C,Y a h Ck )IA VV\ rs�- t
Identification Please Type or Print Clearly) j
/"
OWNER: Name: C mES Q� b� Phone• 7E- -;5)-
�J
Address: 2) �� YIC CZ-��1��� �O CNC , yw f
CONTRACTOR Name: a c- Co n5+, Phone: 7& -13 ;3 e
Address: 3 �A itcl ,
Supervisor's Construction License: �l-+ CJ �p Exp. Date: j
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:_(,()� �q q
Address: Da`� Mci,\AS ✓ n) SIS 1,�-n2N�J 030 eg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ 1 6A , vil FEE: $
Check No.: Receipt No.:
NOTE: Persons contrac ' with ut,registered contractors do not have access to the guaranty fund
Sig69uw of Ment/OMe_ : Signafiure;of contractor :;:..
Plans Submitted Ly Plans Waived ❑ Certified Plot Plan Stamped Plans Q'
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/MassageBody 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 ❑ ❑
COMMENTS
CONSERVATION Reviewed on -d c Signature
COMMENTS - c�j /� -21 - -. ,j
T
` HEALTH Reviewed on Signature
COMMENTSry `�
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer ConnectioY7/Signature Date Driveway Permit
I)-PW Town.Engineer: Signature:
FIRE DEP TMENLocated 384 Osgood Street
T -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Departnaent signature/date
COMMENTS
CUT OR TAX MAP 90B PARCEL 16
RICHARD GRAHAM
-�I A TED 2177 SALEM STREET
oz LOT AREA , a TAX MAP 908 PARCE
47,590 S.F.f �' EDWARD SKINNEF
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2189 SALEM STREI
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t` PROP. ADDITION ABOVEGROUND ?
X. 1,500 v POOL
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BIT. CONC.
`�-JK DRIVEWAY
.NO. S
1. THE
TOPOGRAPHY, SITE DETAIL & SUR FACE
IMPROVEMENTSILURVEY CONDUCTED ON
HEREON WERE OBTAINED FROM A PA
JUNE 5, 2010 BY SULLIVAN ENGINEERING GROUPLLC.
, DISTRICT R1.
2. THE LOCUS PROPERTY DEPICTED IS LOCATED IN ZONINGTHE
3. THE LOCUS PROPERTY IS DEPICTED I - M P AS PARCEL
ON
TOWN OF NORTH ANDOVER
ARE
MA
WN
4. THE LOCATION OF ALL UNDERGROUND UTILITIES SND COMP/LA�ION IOFTE
AND ARE BASED UPON A PARTIAL FIELDS EPI COT OR NOT DEPICTED.
PLANS
OF RECORD. THE DESIGN ENGINEER NOT WARRANTY NOR
GUARANTEE THE LOCATION OF ALL UTILITIES CONTACT DIG SAFE AT
THE CON PRIOR TO COMMENCEMENT OF CONSTRUCTION, SHALL
VERIFY THE LOCATION OF ALL UTILITIES
1-888-344-7233.
R UNWRITTEN
5. THIS PLAN DOES NOT SHOW ANY UNRECORDED ATTEMPT HAS EBEENEMADE
WHICH MAY EXIST. A REASONABLE AND D
AT NO SUCH EASEMENTS EXIST.
TO OBSERVE ANY APPARENT, VISIBLE USES OF THE LAND; HOWEVER, THIS
DOES NOT CONSTITUTE A GUARANTEE T N AN ASSUMED DATUM.
6. THE ELEVATIONS DEPICTED HEREON WERE BASED UPON
AS DEPICTED ON THE
7. THE LOCUS PROPERTY I CE RATE MAP.D WITHIN A FLOOD SPECIES
LATEST FLOOD INSURANCE
8. THE LOCUS PROPERTY IS LOCATED WITHIN PRI EQITIHABITAT
N1 DATED OCT 1 S 2006
PER THE MASSACHUSETTS HERITAGE ATLAS,
374 SHARPNER
S p oND ROAD
SITE PLAN OF LAND
A. LOCATED IN r1 s
MASSACHUSET
o. NOR TANDOVER, CO UNI')
c (ESSE
X
PREPARED FOR
JAMES & MARIE FARO
so 0, DAIS; FEBRUARY 21) 2011
SCALE. I 2 R
P.REPAED BY
"RING GROUP, LL
ENGINESULLIVAN
22 VOUNT VERNON ROAD
BOXFORD, MA 01921
f s3 (978) 352-7871
� AL SHEET No. 1 0F