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Building Permit #438-15 - 53 COCHICHEWICK DRIVE 11/5/2014
1 13UILUINU I'MMI f .� . TOWN OF NORTH ANDOVER , APPLICATION FOR PLAN EXAMINATION « ' Permit NO• �) Date Received '"o Date Issued: �cN CH us�� IMPORTANT:-—Applicant must complete all items on this paire :'r:�t:: _ ,.rte '.?. ::Ys, 1'r. iii' 'rrrr'. :r•_'•• ,u: 1. t�.. .til::' I'JJ• F'. .\+Y�l• ,I LOCATION•. �:•�,. �,. �.-.:: - �=1! ,fir �`y�` .; ,' �:;' .,, •,:• ;: -'�: ,:;:�. to!`` t r } ;tr"r.: ;. -r 1. ._• ,r• y ���`..,"r't ;}. ...v;.,.t nl il •:N �?A,i�C.�L:' r..ZOf�IIV�<�3- �RICT; '` , ��� ' ' �] � l-r•��-��� •Madhih�'.5��'��Il�•e.' es�':••.: ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building 0 One family -0 Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑I Demolition 0 Other _tah:3'e� �l•`• - .elle 1•i.'�•l;• ��.�" s,`.,. :.r. {::�..i1J'' .•`.: P#i�. F) o ,1 'in , . 41Nelands\ . : � IV'ate . ., ,. wil 'ewer' .,, €f=', :, ,, s��f , r D� frlct ,7 I .. -.,I r 1, ,l...:f.-�'+• � r ..it•;.;h , j aba- w z ..... ,5.... - i i - i Identification Please Type or Print Clearly) ' OWNER: Name: C,or►�j�i�r rJ x rrtr�S _ �o,� �,�.w u. Phone: 97� Address: 0 fox J r OJ R' 2 4 f1 { ! . S `•:. te„•�i..Y ,In. t 4 ` v ..`. •:�i Pe,� til 1 �+ 1 � {,j dt,f . MN � I�al�'��'J* c�,,+ }j�.s'rY 9�,= � r ; } L `•''• _ 'l tr t�� t� d.�.frl fix'\^,. 1�w rrr i,.ti•$t /�ddreSS•Y a Y t+, x 4` 1 r3, �` t .{'..•,i1 •, r art•}e { •Yt � t ,oYr' t ; w '; vK n. c ♦ ,S(,�Y i i t:i t•1 { .."� a ��.' _ tir \ i f l i t t `r r YI d ? , .r `. y't 1 t Y ;Im , ;���!Isd~�s�ogso'IRti% �•nse.. : �, f' C'�i �: l• A i y'••y.`� •t76 ` �:fir. � f ,� �+. F r<�' ! •;!.” '. `•y'••,+ry ri , � S I. _ �.�I. `•ii�;` •� � ^�J:✓.:; a.h6 '! :r �r ;.s� t 14. .�•.1 .,.1:,�.. ,ni:..\ ~' t��.'• :'.'r' -iiX� ,_T-n';:•rG :fit!;t::...ri:; �j�r�y yR }ti.:,•.',1`:tc;.".: >�t rY.I� ro e r r� :t. ARCHITECT/ENGINEER Phone: Address: Reg, No. — FEE SCHEDULE:SULD/NO PERMIT:$1200 PFR$1000.00 OF THE TOTAL ESnMA?W COSTBASED ON$J2&00 PER S.F, +, Total Project Cost: $ l;4&a. �a FEE: $.., Check No.:.. �(.t Receipt No.: q _ P NOTE: Persons contracting with unregistered contractors do not have access to '_z?2 gua?771ty nd me Sign tyre of Agent/Owrier .' : gnature'of contrlactor . Location No. t Date �, y . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ _ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# i Building Inspector Location C $�`�'' CL I)aLt r e, No. ' Date • - TOWN OF NORTH ANDOVER • gvs . Certificate of Occupancy $� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ` ' oI! (2 ^ `" `' Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑`�,St roped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on /�� - / Si nature i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments P Water & Sewer Connection/Signature& Date Driveway Permit DPW own Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on 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.$100-$1000 fine NOTES and DATA— For department use i I E I� I l I i ❑ Notified for pickup Call Email Date Time Contact Name I� Doc.Building Pennit Revised 2014 r i 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 ❑ Buildin Tna-it-App-l.ication f °, #mss Comp Affidavit ❑Photo Copy-Gf-}SI C. And/ r C.S.L. icenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of � , Bldg Permit Addition Or DeO �!"a�'1 0 �� ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ° Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan Hydraulic Calculations (If Applicable) p And I ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 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 y ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Pla Hydraulic Calculations (If Applicable) p n And ❑ 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 I" 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 Deed m ust be submitted with the building application s. One copy and proof of recording Doc:Building Permit Revised 2014 --TCOMMENTS - � � NORTfy Town of �. : _ ndover 0%O •�~' •Na.i..... ..I 405?4* I h ver, Mass, I S' CONIC Nl WICN y1• U BOARD OF;HEALTH Food/Kitchen PERMIT D oo�� /�� _ r/- V Septic System THIS CERTIFIES THAT ,�►,..).. C:(.l.Je\ Ce..k. � C�..� BUILDING INSPECTOR ....... ........ ....... ............................................ has permission to erect .......................... buildings on ..ckylllfLD.Yni�.. .................. Foundation ,� t Rough to be occupied as .AAA, 4Y� ��?�....� .e � � y provided that the person accepting this permit sha in every respect form to the terms of the application Final on file in 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 CONSTRUCTIO S Rough Service ................. .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. _Smoke Det:-- - -. Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration { Registration 123615 Type: Private Corporation Expiration: 3/14/2015 Tr# 236701 Schernecker Property Services, Inc. Fred Schernecker 283 Second Avenue __....._ _............... Waltham, MA 02451 __._...—__---.........-- � --------------- Update Address and return card.Mark reason for change. SCA 1 C,r 20M-05/1 t F-1 (j Address � Renewal Employment Lost Card QF11e Wim 116IM10711 c�C?'Laddnc r<Je/ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 3_,F�aME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: `eegistration: 123615 Type: Office of Consumer Affairs and Business Regulation xpiration: 3/1412015 Private Corporation 10 Park Plaza-Suite 5170 6� Boston,MA 02116 Schernecker Property Services.;Inc. Fred Schernecker 283 Second Avenue Waltham,MA 02451 Undersecretary Not valid without signature I I IIS Client#:1025557 SCHERPRO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIMY) 12/0612013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSUREb,the policy(les}must be endorsed.If SUBROGATION IS WAIVED,subject to !! the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER E;IT Kelly Grahn USI Insurance Solutions,LLCAHI Kr o Et):978-983-8827 Ne;978-688.5340 PO Box 3600 EMAILEKeiEIJ��,,Grahn I RSS: ' • @uSI.b1Z West Springfield,MA 01090-3600 ADDINSURERS AFFORDINO COVERAGE NAICIII INSURER A:ABC Mass Workers Comp Self-Insu 99999 INSURED ENSURER B: i Schernecker Property Services, 283 Second Avenue INSURER C: Waltham,MA 02451 INSURERD: INSURER E: INSURER P; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPE OF INSURANCE INSR U D PDUCY NUMBER M7DD EFF PMj ICY EXP LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY pAMAGE 7 R�ENTED PREMISES Ed occur race $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ PERSONAL R ADV INJURY $ GENERAL AGGREGATE $ GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOPAOG $ POLICY PEC LOC $ AUTOMOBILE LIABILITY (JEO 86 tlED ar'llSINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDAMAOE AUTOS Peraodden $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ I EXCESS LIAR CLAIMS-MADE AGGREGATE $ RETENTION$ $ A WORKERS COMPENSATIONABCMA12000114 0110112014 011011201 X WC STATU- OTH AND EMPLOYERS'LIABILITYS'1 ER l ANy PROPRI TOR(PARTMTMER/EXECUTIVE YEN E.L.EACH ACCIDENT $1,000,000 I OFFlCERiME SER EXCLUDED? a NIA (Mandatory In If under EL DISEASE-EA EMPLOYEE $1,000,000 OES deacdbNOFO E.LDISEASE-POLICY LIMIT $1000000 I DESCRIPTION OF OPERATIONS below I I 4 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more spade Is required) Proof of Massachusetts Workers Compensation Coverage. Proof of Massachusetts Workers Compensation Coverage I { I i CERTIFICATE HOLDER CANCELLATION For Insurance Purposes only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN QQ ACCORDANCE WITH THE POLICY PROVISIONS. I i AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD + #S113903211M11376382 CBPZP I S T ML2�11 s project: Campion Estates 53 Cochichewick Drive North Andover, MA 01845 'or: Cathy Deloge Royal Management Company PO Box 850 Methuen, MA 01844-0850 ;'r,,pared By: Blaine Abaray Schernecker Property Services, Inc. 283 Second Ave,Waltham, MA 02451 blaine.abaray@spsinconline.com www.spsinconline.com SPS HIC #: 123615 Expiration Date: October 19, 2014 I Date Submitted: July 21, 2014 Proposal #: 5440557 ' I tt Exterior Exit Roof Overhaang Campion Estates I Proposal#:5440557 i I General Description: SPS,Inc.till provide the necessary supervision,labor,and materials to perform the work specified in this PFS in a good and workmanlike manner and in compliance with applicable laws and codes.The pricing provided in this PFS encompasses,in general,the following: Building of an"A-frame"roof overhang at side exterior door, Included Areas; 1. Installation of(2)new footings dug to a depth of 4'.If foundation or other footing structure is encountered during excavation,footing(s)may need to be pinned to structure. 2. Framing of"A-Frame"roof and installation of asphalt roof shingles and lead flashing to tie into existing masonry wail.Full ice and water shield undedayment to be installed.Footprint of over hang to be approximately 5'0,5'. 3, PVC trim to be installed to fascia.Painting of trim to match existing trim in other areas. l 4. Vinyl soffit to be installed, Excluded Areas: 1. Architecture and/or engineering.If architecture or engineering is required from the town,additional fees will apply. 2. Gutters and downspouts. Total Price for work as specified in the Scope of Work: $71986.80 Additional Items,Alternate items and Unit Prices Pricing provided on Page 3 is for specific items not included in the contracted Scope of Work,Please note that these items are additional to the"Total Price". Schedule of Work (determined at proposal signing)The work heretofore described is scheduled to commence on with an expected duration of approximately days.Substantial completion is expected by V Acceptance of Proposal The undersigned,as authorized representative(s)of the property listed,have read the terms stated herein and accept the terms as written. o- X�-- 1 07/21/14 DATE s ATE Blaine Abaray Business Manager Cathy Deloge RME NAME TmE 1 I J Schemecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconline.com Page 2 of 5 I I I S Exterior Exit Roof Overhang Campion Estates I Proposal#:5440557 I%tal lit le_-e for v,irk as srx-,Cified in the Scone of V./erk , i Item Description Price 1. Provide labor and material to install wood framed roof overhang as described above. $7,986,80 Total: $71986.80 i �thrid" ,)DI itU�rr7 �l er!IL-A-e Item,; i ! f �, :� rail;.� +�I11. PiKt:S Item Description 'l,operbl Noes & Pre: nt lob Conc itior� . The following conditions were identified during the visual analysis of the property.These notes are not meant to be,nor to replace,an engine ring report.Additional historical information and/or an invasive analysis would be likely to provide further information. 1. Roof to serve as covering to protect residents from falling ice and snow.Snow will likely buildup between left side of building and new roof structure.Snow may need to be periodically removed from this area. EPA RRP/ Lead paint The pricing provided assumes that the property was built after 1978 or that the work being performed wiil not require SPS,Inc.to follow the EPA guidelines for renovation,repair and painting(EPA RRP rule).If the work is subject to the guidelines of the EPA RRP rule or any DEP or local rule regarding lead paint,then the pricing will be re-evaluated and will likely increase. Permit SPS,Inc.acting as the Owner's agent,will apply for and obtain any necessary construction-related permits.The cost of any such permits will be paid by SPS,Inc.and shall be included in the pricing provided,unless specifically excluded.The Owner or its agent shall assist SPS, Inc.,with any required signatures,documents,or other cooperation necessary to obtain such permits.Construction control by a licensed engineer or architect,if required by the permitting authority or if elected by Owner,is not included in the pricing provided and is to be contracted directly by the Owner. Unforeseen Conditions/Change Orders i Renovation work involves removal of existing materials to expose hidden surfaces.By its nature,renovation work is like to result in uncovering conditions that were not foreseen.It is likely that unforeseen conditions will be uncovered when existing materials are removed. Unforeseen conditions usually necessitate changes in the scope of work and an increase in the total price of services.Changes to the scope of work as a result of unforeseen conditions will be presented to the Owner or managing agent in the form of a written Change Order.All Change Orders,regardless of the reason for the Change Order,must be documented and approved in writing by SPS,Inc.and � Owner or Owner's agent.Change Orders may be approved by email. I Schemedrer Property Services 1 283 Second Avenue,Waftham MA 02451 1800.424.2468 1 spsinconline.corn Page 3 of 5 I i I I . i T , Exterior Exh Roof Overhang Camplon Estates Proposal#;5440557 , AdkIltic`"`iai Pricing Note 1 i I , I I , i I I M ,I Schemecker Propel;Services 283 Second Avenue,Waftham MA 02451 j 800.424.2468 I spsinconline.com Page 4 of 5 I I The Commonwealth of Massachusetts - Department of IndustriglAccidents i Office of Investigations 600 Washington Street Boston,MA.02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ' pplicant Information Please Print Legibly Name(Business/Organi-zation/lndividual): Scat-49cPe p p Kicl See-V ICi,S Address: 2a.3 sgwwo City/State/Zip: Wft-rymn , /ndo2H5l Phone W14 — :2V69 Are)you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with SO-- /A0 4. ❑ I am a general contractor and I ` _ . 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors FR<e 2.El am a sole proprietor or partner- listed on the attached sheet.� �• l�f remodeling � ship and'have no employees ' These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions, myself. [No workers' comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t-Homeowners who submit this affidavit indicating they a're doing all work and then hue outside contractors must submit anew affidavit indicating such. tCoutractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. AW. N5S woe-wS - flus of Policy#or Self-ins.Lic.# ,t1/l (a Q00J1 q Expiration Date: 111901T Job Site Address: .53 o'©e k)C_U V w I C k D&a- City/State/Zips/,Ad-QQV& • /M f} Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine = of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cerci der the pa' s an enaldes of perjury that the information provided abov is tr and correct. Si afore: Date: TSS .ffg� L Phone#• Official use only. Do not write in this area,to be completed by city or town official r 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#: I a a..: Ts - Ail- MAO! r- _F t d{4 / s J �, r A bUILVINU Pt:KMI.l TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received tau Date Issued: CHU TM.P.ORTANT:A licantmust complete all items on this page A ' T JON Inc % W-NER: 77 -J Ic TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential 0 New Building 0 One family -0 Addition D Two or more family 0 Industrial %AIteration No, of units: 11 Commercial 0 Repair,replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other —q -Y. 166do 6 i ktdt.5 4 -7 (0617W'r -SMAX 1-1 5 SLE,. Roofve- DkL ti TWD POSE 5, Identification Please Type or Print Clearly) OWNER: Name: Phone: ' { 97 Address: .4- ---r 7-1 u u Aiv olXW .4, 'rri v " J brneh L!M ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE,BULD"PERMIT-V12-00 PER$1000.00 OF THE TOM ESnUA7W COST BASED ON$125.00 PER IF. Total Project Cost: $ -4i q&a. F30 FEE: $.- '910-CID Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access toguar ty nd uar n1 Sign ul'e of Acient/Owher.& natUte'of contractor The f°l%win9 is Roo f h a list of the require 13W l a'hg D g� Si lih9�, lh d f°rmS to fi spa/ meht oBUilgrin ter;or Reha Ilea OUt for the b�litat;oappr°pri oPhoto C orhp A pplic tion h Perm;ts ate permit to ae ° COPY of op y©f l / raa art Obtained NST ° �/oor p/an Contra ct C' Anar r F All aum grneerin Cr pr°pose C's ice ns A Aster pern�i sMcle arts tod l ntenor es aaitioh requir, r En °rk �,3� e si 9'inee Or De� gn ° fro red Pro o ' m Fir duct ° Builai� L,,I © e Depart s Certifi g Pern7it �c.v Ment Prior o p°rke sa StIrv, plication r to rssuanoe Q Co Oto Cop omp Affix lot Plan of Bl a9 Perm. ° F/oOf Cor�tr of��C• A rt rt ° �yc/-`uraCrOss Sect t na C'Stic lic ro e es Typ NOT o �ass checCa/cu/atio/�/evation ns E All aum grneerin k Energy C ns (l f gppli Plan Of P - 0/Q, Aster gq ld °mpli cable ropose 0gaa, New C permits reaVrts for Fry nCe Rep d Work W �A/terat� ohstr4ct'o quire sign o9/neer ea (l f gpplic rth Sprink/e o Repair,l ° Build h (Sing/e a fro Fire Deproducts able) r Plan,Ana o o !�ioi�t�o1 ° h etre P ertified�rop ert77it q art meat prior wateris�� ° p T�O Famil to . .wo ho plc rsso Rorke o fy used p/off n uanoe Of 8l ° Two Se rs Com And C S l an ag Permit ts p qui �• Li ° C YdraUlic C f Bui/din as Vit ceases r Q Mas Y of cont lculatiog P/ans (O NOT ° F s chef ract (If (on To g 0WN�F E All aum gineerin k Energy C pplicable) e Returned qdare R• Name. r , Aster g q ffi om ) toss: that all Cases the ifa permits re`'1V/tS for p//anCe Re lnC/Ude S 'n Ost be appeal pe o nee or s e quire sign ngineer port prink/er p Contractor tn. d�s p clay off ed /an Name Do ted with tGe over. app�c�'an as re u from Fir prOdUCt$ And 'gaares D s c•8uddr°g Permit ding apply t-71ati n U then the r,Own epartment s'U Revised2 pl4 get this re Mrd d°f#'ce mus Ibrr°r t�iSSUa pe/y�SOr S CD at the glst,, decisi° ce of Bldg• P Home lmpro C0/7S C'Cen RestaA the D Pe t ve a se: R Beds OneCOPYnd gOard°f mi q CN/p m nt ticense: pr°O fO fre peals CT/�NG/ °rding Address. NEER F FFS Tptat CHEaU�F• f UCD/ C Project C Check �elt �G/'FRM/T.•�1?ooa ER,kk No .r 1'eysoyts e of ohf�aefi�g wl Agen 414th ung t/pwner eglsfe�'ec •� /�� to 00 et t��e r � lk OeV a� `� � NORTF� Town ) E �of �. : _ Andover No. * `-� IL h ver, Mass, I S' cochicMew�cK 1• R.,.rat) BOARD OF,HEALTH I' Food/Kitchen P r- it Septic System s BUILDING INSPECTOR o ............ ? N'���� .. 6. - - Foundation �� Rough '��*+' - �, Chimney Y, respect form to the terms of the application ,a I By-Laws relating to the Inspection, Alteration and Final PLUMBING INSPECTOR p o W CCD) n s Permit. Rough _ C .3CL Final r CD IN 6 MONTHS ELECTRICAL INSPECTOR I C: -� Z �- CTIO S RTS CD O O r Y Rough m 0 p Service Z ° liin O m .................................... CD .�CD _ BUILDING INSPECTOR. Final GAS INSPECTOR n �� ed to Occupy Buildinz Z Rough g the Premises - Do Not Remove Final all To Be Done FIRE DEPARTMENT by the Building Inspector. e � Burner Street No. Smoke Det. i (;971 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 123615 Type; Private Corporation Expiration: 3/14/2015 Tr# 236791 Schernecker Property Services, Inc. ,'. Fred Schernecker F 283 Second Avenue . _............. Waltham, MA 02451 C ----.._........ ...._ Update Address and return card.Mark reason for change. j Address Renewal L] Employment n Lost Card I SCA 1 Ci 20M�05111 � _ C-_'/1ty r!'nr1r,9NnJe[ilnezl/11 C�^-7'Gadlryc!/rcJe/i'i License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g Y kOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: o egistration: 123615 Type: Office of Consumer Affairs and Business Regulation xpiration: 3/1412015 Private Corporation 19 Park Plaza-Suite 5170 Boston,MA 02116 Schernecker Property. rvices;_Inc. t}�' Fred Schernecker 20 Second Avenue �•�--3a Waltham,MA 02451 Undersecretary Not valid without signature � I I 1 Client#:1025557 SCHERPRO ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 12/06/2013 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE$NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY 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 certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the I certificate holder In lieu of such endoreement(s). PRODUCER CONT Kelly Grahn USI Insurance Solutions,LLC ?"�"a Ext):978-983-6827 No,978-688.5340 PO Box 3600 "^mAILss: Keily.Grahn@usi.biz West Springfield,MA 01090-3600 INSURER($)AFFORDINO COVERAGE NAIC# INSURER A:ABC Mass Workers Comp Self-Insu 99999 INSURED Schernecker Property Services, INSURER B: 283 Second Avenue INSURER C: Waltham,MA 02451 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPE OF INSURANCE ADD UB POLTCY EFF POLICY EXP INSR WV POLICYNUMBER M1DD RAD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGET D�ENTED PREMISES eENT rrence $ CLAIMS-MADE FIOCCUR MED EXP none person $ d r PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPPUESPER: PRODUCTS-COMPIOPAGG $ POLICY PRC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EMS nl i ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTYDAMAGE AUTOS ercool nt $ UMBRELLALIABHC OCCUR EACH OCCURRENCE $ EXCESS LTAB LAIMS MADE AGGREGATE $ _ DEO RETENTION$ $ — A WORKERS COMPENSATION ABCMA12000114 1101!2014 01101/201 X WC STATU- O7H- AND EMPLOYERS'LIABILITYTORY UMITS ANY PROPRRI 70RlPARTMERIEXECUTIVE YIN E.L.EACH ACCIDENT $1,000,000 OFFlCER/MFBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 desa IfESCRIPTIs RIPT1 beON under OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 D 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Proof of Massachusetts Workers Compensation Coverage. Proof of Massachusetts Workers Compensation Coverage I I CERTIFICATE HOLDER CANCELLATION For Insurance Purposes only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN QQ ACCORDANCE WITH THE POLICY PROVISIONS. it AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S11390321IM11376382 CBPZP f i I i l I Lr. .•�.t Campion Estates 53 Cochichewick Drive North Andover, MA 01845 Prf.Lpafr.ed 'or: Cathy Deloge Royal Management Company PO Box 850 Methuen, MA 01844-0850 Prepared by: Blaine Abaray Schernecker Property Services, Inc. 283 Second Ave,Waltham, MA 02451 blaine.abaray@spsinconline.com www.spsinconline.com SPS HIC #: 123615 Expiration Date: October 19, 2014 Date Submitted: July 21, 2014 Proposal #: 5440557 i Exterior Exit Roof overhang Campion Estates I Proposal#;5440557 General Description: SPS,Inc.will provide the necessary supervision,labor,and materials to perform the work specified in this PFS in a good and workmanlike manner and in compliance with applicable laws and codes.The pricing provided in this PFS encompasses,in general,the following: Building of an"A-frame"roof overhang at side exterior door. Included Areas: 1. Installation of(2) new footings dug to a depth of 4'.If foundation or other footing structure is encountered during excavation,footing(s)may need to be pinned to structure. 2. Framing of"A-Frame"roof and installation of asphalt roof shingles and lead flashing to tie into existing masonry wail.Full ice and water shield underlayment to be installed.Footprint of over hang to be approximately 5'x4.5'. 3. PVC trim to be installed to fascia.Painting of trim to match existing trim in other areas. 4. Vinyl soffit to be installed. Excluded Areas: 1. Architecture and/or engineering.If architecture or engineering is required from the town,additional fees will apply. 2. Gutters and downspouts. Total Price for work as specified in the Scope of Work: $71986.80 Additional Items,Alternate Items and Unit Prices Pricing provided on Page 3 is for specific items not included in the contracted Scope of Work.Please note that these items are additional to the"Total Price". Schedule of Work (determined at proposal signing)The work heretofore described is scheduled to commence on with an expected duration of approximately days.Substantial completion is expected by Acceptance of Proposal The undersigned,as authorized representative(s)of the property listed,have read the terms stated herein and accept the terms as written. 07r'21/14 � IVYDATE S. ,E Blaine Abarzy Business Manager Cathy Deloge RAME THU NAME THE Schemecker Property Services 1 283 Second Avenue,Waltham MA 02451 1 800.424.2468 1 spsinconline.com Page 2 of 5 l I ExtericE Ext Roof Overhang Campion Estates I Proposalk 5440557 I 0!-d i it: ; for�,-big is as SDi.-cifieci in the Scone of V'kilk . r Item Description Price 1. Provide labor and material to install wood framed roof overhang as described above. $7,986.80 Total: $71986.80 ��:r�,J�ir,i,._.I t��r��4 �t?s;�r:���tti �c�r� s a��t Jlii£ Prices lir . I s, Item Description i »� rf,y Notes & Nr;;Iscilt lob Conditions ions The following conditions were identified during the visual analysis of the property.These notes are not meant to be,nor to replace,an engineering report,Additional historical information and/or an invasive analysis would be likely to provide further information. 1. Roof to serve as covering to protect residents from falling ice and snow.Snow will likely buildup between left side of building and new roof structure.Snow may need to be periodically removed from this area. EPA RRP /Lead paint The pricing provided assumes that the property was built after 1978 or that the work being performed wiil not require SPS,Inc.to follow the EPA guidelines for renovation,repair and painting(EPA RRP rule).If the work is subject to the guidelines of the EPA RRP rule or any DEP or local rule regarding lead paint,then the pricing will be re-evaluated and will likely increase. Permit i SPS,Inc.acting as the Owner's agent,will apply for and obtain any necessary construction-related permits,The cost of any such permits will be paid by SPS,Inc.and shall be included in the pricing provided,unless specifically excluded.The Owner or its agent shall assist SPS, Inc.,wih any required signatures,documents,or other cooperation necessary to obtain such permits.Construction control by a licensed engineer or architect,if required by the permitting authority or if elected by Owner,is not included in the pricing provided and is to be contracted directly by the Owner. Unforeseen Conditions/Change Orders Renovation work involves removal of existing materials to expose hidden surfaces.By its nature,renovation work is llikeA to result in uncovering conditions that were not foreseen.It is likely that unforeseen conditions will be uncovered when existing materials are removed. Unforeseen conditions usually necessitate changes in the scope of work and an increase in the total price of services.Changes to the scope of work as a result of unforeseen conditions will be presented to the Owner or managing agent in the form of a written Change Order.All Change Orders,regardless of the reason for the Change Order,must be documented and approved in writing by SPS,Inc.and Owner or owner's agent.Change Orders may be approved by email. Schemecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spslnconMe.com Page 3 of 5 i Exterior Exlt Roof Overhang Camplon Estates Proposal#:5440557 Ad itlonall Pricing N10tes Schemecker Preoertp Services 1283 Second Avenue,Waftham MA 02451 j 800.424.2468 spsinconline.com Page 4 of 5 I i Exterior Exit Roof Overhang Campion Estates.)Proposal#:5440557 irnit-Jas ad "i C111��J Proposal: This proposal is valid until October 19, 2014. If this proposal has not been Indemnity:To the fullest extent permitted by law,the Owner shall indemnify,defend,and hold accepted by said date,then this proposal Is deemed withdrawn by SPS. harmless SPS,Inc.and its agents and employees of and from any claims by third parties or unit Acceptance of Proposal:The signature of the Owner or Owner's authorized agent shall owners arising out of SPS,Inc.'s performance hereunder unless it is finally,adjudicated that constitute Owner's agreement to the terms and conditions contain herein. such damages,loss or expense was due to gross negligence,willful misconduct or material Owner's Managing Agent:If Owner has engaged the services of a property management breach by SPS,Inc.Owner shall indemnify SPS,Inc.,for any and all damages,losses,and company("managing agent")to act an its behalf with regard to the subject matter of this expenses arising therefrom Including but not limited to attorney's fees and expenses. agreement,the managing agent and its representatives shall be considered authorized agents Termination:SPS,Inc.'s termination for cause.Should(1)the work be stopped by any public of the Owner.With regard to the subject matter of this agreement,Owner shall be bound by authority for a period of thirty(30)days or more,through no fault of SPS,Inc.;(2)the Owner and SPS,Inc.shall be entitled to rely upon statements and actions of the managing agent. fall to make any payment properly due hereunder in a timely manner;(3)the Owner cause or Entire Agreement: This proposal and any documents specifically listed under Contract fail to prevent a condition that results in an unreasonable delay in SPS,Inc.'s ability to perform Documentsror incorporated by reference constitute the entire agreement between SPS, hereunder;or(4)the Owner fail to comply with other material terms of this agreement,then Inc. and Owner. Both parties warrant that there have been no promises,obligations or SPS,Inc.,shall give written notice by certified mail or by hand to Owner or Owner's authorized undertakings,oral or written,other than those herein set forth.No material modification of agent specifying the grounds for termination.Owner shall have seven(7)days to correct the terms of this Agreement shall be effective unless approved in writing by SPS,Inc,and the condition giving rise to the notice.If the Owner fails to cure within seven(7)days after Owner or Owner's agent,Modifications may be approved by email, receipt of the notice,then SPS,Inc.may stop work or terminate the Contract.SPS Inc.shall Work Progression:Start dates,amount of time needed to complete the work,and completion be entitled to recover from Owner payment for all work executed plus twenty percent(20%) dates will be estimated at the time of signing of the PFS,prior to the commencement of the of the value of the work remaining to be performed under the agreement work.The schedule may be modified by mutual agreement for any reason.Changes in the Owner's termination for cause.Should SPS,Inc.(1)abandon the work;(2)fail to diligently Scope of Work are likely to impact the schedule,Inclement weather and other circumstances prosecute its obligations under this agreement; (3)or blatantly disregard applicable laws beyond SPS,Inc.'s control are also likely to cause changes in the work progression.Delays and codes;then the Owner shall give written notice by certified mail or by hand to SPS,Inc., caused by Owner, is managing agent or their representatives, may result In additional specifying the grounds for termination.SPS,Inc.,shall have seven(7)days to correct the charges. condition giving rise to the notice.If SPS,Inc.,fails to are within seven(7)days after receipt Representations: SPS, Inc. is in the business of providing maintenance and capital of the notice,then the Owner may terminate the Contract.SPS,Inc.shall be entitled to recover improvement services to real property.The PFS contained herein has been prepared on the from Owner payment for all work performed to the date of termination. basis of a visual inspection of the property.SPS makes no warranties or representations about Ownershall also have the right to terminate the agreement for convenience,Owner shall give the physical condition of the property at the time of ih!s proposal. SPS,Inc.ten(10)days advance written notice.Owner shall be respons!ble for paying SPS Materials Storage and Inspection: SPS, Inc. requires that it be allowed to store the for all work performed to the date of termination pius SPS reasonable costs of demobilizing materials andmen ui eq p . t necessary for the performance of the specified wok on the property plus twenty percent(209'x)of the value of the work remaining to be performed under the in a mutually agreeable location.Such materials and equipment shall be subject to inspection agreement. and approval by the property agent. Governing Law/Venue/Dispute Resolution:This agreement Is governed by and subject to Protection of Work Areas:The work areas are to be secured and protected during the the law of the Commonwealth of Massachusetts.In the event of a breach of this agreement,the performance of the work.Unless otherwise noted,SPS Inc.will be responsible for damages non-breaching party shall be entitled to recover its reasonable attorney's fees and expenses. to the Owner's property caused SPS Inc.during the performance of the work Any issue,claim,or dispute related to this agreement,its performance or a breach thereof Rubbish Clean Up and Removal:SPS,Inc.will dispose of'Ftrbbish,trash and debris resulting shall be shali be decided by an Independent single arbitrator in or within 25 miles of the city of i from the performance of the work in a manner approved by the Owner or authorized agent. Boston using American Arbitration Association,JAMS,or another similar mutually acceptable Such disposal will be in compliance with applicable laws and regulations. SPS,Inc, shall arbitration service.The arbitration shall be conducted in accordance with the Construction maintain the job site in reasonably neat and dean condition during the performance of the Industry Arbitration Rules of the American Arbitration Association currently in effect.The award work• rendered by the arbitrator or arbitrators shall be final,and judgment may be entered upon Completion and Acceptance:The work will be deemed to be complete when the conditions it in accordance with applicable law in any court having jurisdiction thereof.The finding shall as described in the PFS have been performed by SPS,Inc.Upon completion,SPS,Inc.will be binding with no other recourse.The parties shall share equally the cost of arbitration I provide notice to the Owner that the entire work or an agreed portion thereof is complete. and arbitrator's fees.The prevailing party shall be entitled to recover its attom ey 's fees and Upon such notification the Owner or Owner's agent will promptly inspect the work and will expenses including its share of the cost of arbitration and arbitrator's fee, l notify SPS,Inc.of any incomplete or defective work SPS,Inc.shall take such measures as are No Consequential or Delay Damages:SPS,Inc.and Owner waive claims against each reasonably necessary to complete such work or remedy such deficiencies. other for consequential damages arising out of this agreement.This mutual waiver includes Insurance:SPS,Inc.maintains Worker's Compensation Insurance,General Liability Insurance damages incurred by Owner for delay,rental expenses,loss of use,income,profit,and the and Automobile Insurance.Upon request,SPS,Inc will facilitate the delivery of a Certificate of like.This mutual waiver includes damages incurred by SPS,Inc,for office expenses,office Insurance from its insurance agent naming the property Owner as an"Additional Insured." personnel,business and reputation,and for loss of profit except anticipated profit arising Warranty:Unless otherwise noted,SPS,Inc warrants the work performed under this PFS directly from the work,as specifically provided for herein, against defective wnrkmanship for a period of two(2)years from the date of completion and No Third Party Beneficiaries:This Agreement will not confer any rights or remedies upon acceptance.This warranty is expressly conditioned upon the Owner's full performance of its any person other than SPS, Inc. and Owner. Specifically,this is not an agreement with payment obligations hereunder.Any holdback or nonpayment by Owner will Invalidate this any individual unit owner of a condominium association when the Owner is a condominium warranty. association,No unit owner has the right to expect or demand any work or performance by Safety:SPS,Inc.will maintain a safe work zone.Anyone entering the work zone should wear SPS,Inc. appropriate Personal Protective Equipment(PPE).At a minimum this includes hard hat and safety glasses,Other PPE may be required depending on the work being performed.Once inside the work zone,any outside party including inspectors shall comply with SPS,Inc,and OSHA safety guidelines.Inspectors and/or outside parties should be escorted by an SPS,Inc. employee Inside the work zone. Schernecker Property Services 1 283 Second Avenue,Waltham MA 02451 1800.424.2468 1 spsinconrine.com Page 5 of 5 The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers i Applicant Information Please Print Legibly • I _ Name(Business/Organization/Individual): PQ_Q}p cy S V 165 S Address: 2o3 Sfwwo &f, City/State/Zip: (/d1fti- t/n�1' d eag5I Phone ' 00 Are on an employer?Check the appropriate box: Type of project(required): J.[�I am a employer with SO-- 100 4. ❑ I am a general contractor and I ` . 6. El construction employees(full and/or part-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.I 7• emodeling ship and'have no employees These sub-contractors have S. ❑Demolition working for mein any capacity. workers'comp.insurance. g• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E]Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information. -Homeowners who submit this affidavit indicating they are doing all work and then 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 and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolley and job site information. Insurance Company Name:. D Q, m o o f Policy#or Self-ins.Lic. ro n 1;Q©D i q Expiration Date: 1 IgOK, Job Site Address: 53 eO C L!t'N Vw 1C k D0J 16- City/State/Zips/,&0cVF_1.° - 1V)4 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 I fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby cerci der the pa' s an enalties of perjury that the information provided abov is tr and correct. Signature: Date: �� Phone#: 8 — z" Offccial use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: e w a� y I f � e IJ I x*e s� r i R Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen'isor '* License: CS-081439 BRIAN D BROWN 11 PEARL RD a Boxford MA 01911 Expiration Commissioner 06/01/2015 4 CLOSET BEDROOM "H F/C=7.4 FT. iD z= ( AREA COMMON AREA 00 — — FUTURE PATIO 00 I (NOT BUILT AS OF THIS DATE) KITCHEN F/C=9.7 FT. 0.9 I COMMON AREA RESERVED FOR UNIT 7 � II UNIT 7 DINING M C6 II � TOTAL FLOOR AREA AREA II =1 ,280 S.F. II I I - 3ET CLOSET 1.5 _ __ J 10.3' LIVING ROOM FF/C=8.3 FT. c� o li UP 13.4' I COMMON AREA 13.2' k o LAV. C) 0- 8.0 LIVING ROOM ori F/C=8.3 FT. CLOSET ,- 26.2' , UTILITY / ��ti /c,° DINING AREA )SET �� F/C=8L3 FT. UNIT 8 �Fy TOTAL FLOOR AREA KITC / =1 ,780 S.F. BEDROOM F/C=8.7 FT. CLOSET i > CLOSET CLOSET CLOSET tih