HomeMy WebLinkAboutBuilding Permit #238 - 61 LANCASTER ROAD 9/25/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: S "D
IMPORTANT: Applicant must complete all items on this page
LOCATION c' Zc7 c
Print
PROPERTY OWNER CJ U r s -r- Q C.v r-Q r C rcVW 16
r
Print
MAP NO: 1044PARCELxn ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteratio No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please T pe or Print Clearly)
OWNER: Name:_/.o U f.s *f �l c�,4.•�k-r u c uc ^j r Phone:
Address:
CONTRACTOR Name. We,) 1dY4,rXPhone: 7247 Q
Address: l fz <a'lJ
�r
Supervisor's Construction Licenser42 Exp. Date:2-I! --,�2 6 (/
Home Improvement License: FaExp. Date: /(-,2 6'/(D
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $A 7� Q FEE: $ ( O �;,—
Check No.: b 59 Receipt No.: 91-
NOTE:
NOTE: Persons co tracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contract r
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
fFtE HOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
r
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:cSignaXure:
Located 384 Osgood Street
FIRE DEPARTMENT Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008
Locationf
No. 23e Date
MORTN TOWN OF NORTH ANDOVER
• s
• ; , Certificate of Occupancy $
;,ssACHUS t� Building/Frame Permit Fee $ '
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
UT 600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A plicant Information Please Print Legibly
—/LName(Business/Organization/Individual)' (f `-IJel /^
Address: Q cvJ
City/State/Zip: Phone#: /a g
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 I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2. am a sole proprietor or partner- listed on the attached sheet. 1 7. �J�et�odeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their
10.❑Electrical repairs or additions
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' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify r the. ains�np Z the information provided above is true and correct
Si ature: Date:
Phone#: 7 Q
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter hgve been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple 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 proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum 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,teleplione and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 5-26-05
www.mass.gov/dia
9/25/2009 9:24 AM FROM: Samel Insurance TO: 1-978-688-9542 PAGE: 003 OF 004
ACORD DAA(MAkDDVYYYY)
---�M. CERTIFICATE OF LIABILITY INSURANCE Ll 0E(MM)009
JONAPTMTHAN
Pho$ (9EL CIC LI Fdz:(9 8)470 0880 TF9S CERTIFICATE 16SUED AS R MATTER OF WORMATION
JONATHAN M SAMEL GC LU1 ONLY AND CONFER$No MHTS UPON THE CERTIFICATE
SAMEL INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
15 CENTRAL STREET COMRADE AFFORDED BY TNFI!QLKM BELOW,
ANDOVER MA 01810
INSURERS AFFORDING COVERAGE NAIL 0
PHONE: 978474.0810 FAX: 978.474.090
INSURED INSURER A: Max SpecaRy Insurance Company
THE COUNTRY CARPENTER TOPSFIELD,LLC INSURER e:
109 MAIN STREET INSURER C:
TOPSFIELD MA 01989
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERK I'
ANY REQUREMEhT, 7F3Nd OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT YOTTH RESPECT TO WHICH THIS CERTIF CAMAYY BE ISSUED NO
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
PCLIOES.AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RR AMITYPE OF LNSURANCE
LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPE4TION ��
GENERAL uAsx m TBA 09!19109 09119H0 EACH occuRRET4cE 11
X COMMERCIAL GENE-RAL LIABILITY DAMAGE TO RENTED
oREMSES(Eaacurmce) $ 50,000
CIJUMS MADE Q OCCUR MED.EXP(Any one person, $ 5,000
A
PERSONAL 8:ADV INJURY 1,000,000
GENERAL AGGREGATE 2,000,000
GENT AGGREGATE L'MIT APPLIES PER:
POLICYPRO- Loc PRODUCTS-COMPR)PAGG. $ 2,000,000
s
AUTOMOBILE LIABILm
ANY AUTO COMI NED SINGLE:]MIT
(Ea weldent) $
ALL OWNED AUTOS BODILY IrQUP.Y
perso
SCHEDULED ALITOS (PKn) $
HIRED AUTOS
BODILY INJURY
i NON•OY�D AUTOS (Per ecdtlerd)
PROPERTY DAM44E
(Par wOderd) $
GMAGE LNBtITY
ANY AUTO AUTO ONLY-EA ACCIDENT $
OTHER THAN —FAACC
AUTO ONLY: AGO
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR p CLAIMS MADE AGG%GATE $
$
DEDUCTIBLE
RETENTION $
s
RISERS COMPENSATION AND
EMPLOYERVLIABILITY TpRYupig OTHER
ANY PROPRIFNORMARTNERIEXECUTM E.L.EACH ACCIDENT
OFFICENMEWE N EXCLUOEOT
xy".4ueMMundn E.L.DISEASE-EA EMPLOYEE $
EPECIALPROVIsoNEwlw E.L.DISEASE-POLICYLMIT $
OTHER:
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS
OP Ions Usual to the Insured
CERTIFICATE HOLDER CANCELLATION
Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
1800 Osgood meet F-PIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITTEN TO THE CERTIFICATE HOLFAILURE
North Andover,MA 01845 DO SO SWILL IMNOTICPOSE NO OBLIGATION OR LLABIL�RY OF ANY KIND UPON THE INAMED TO THE LEFT. NSURER,RSO
AGENTS OR REPRESENTATIVES.
AUTFMIZED
Q
Attention. fax 1-978-688-9545 Jonathan M.Same!
ACORD 25(2001!08) Certificate 9 28687 0 ACORD CORPORATION 1988
NORTH
Town of 4 over .
No.
z== LAKE dover, Mass.,Tr�J '
I� COCMICMEWICK y1.
ADRATED
`S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......L C- w O
..d V...J................U.................................................................................................................. Foundation
I
has permission to erect........................................ buildings on . ............ .............. .r.................. Rough
`-}I
tobe occupied as......Ai�.........o .."�......... ... ........o. �............................................................................. Chimney
provided that the person accepting this permit shall in every respect 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
s® PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU SARTS Rough
Service
BUIL M04NSPECT6R
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 FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
The Country Carpenter Topsfield, LLC Estimate
109 Main Street Date Estimate#
Topsfield,MA 01983
9/13/2009 9
C4U�iTUA CARP
Name/Address m
j" ,
Louis&Joanne Luciano I
61 Lancaster Road
North Andover,MA
Terms Project
Description Total
Remodel of Existing Master Bathroom per design plans from LI Designs,LLC of North Andover,MA. 8,740.00
Phase One:
Delivery of a 20 yard container to be located in a location on driveway as approved by customer.3/4 inch
plywood to laid on driveway below dumpsite.
Stairs and floors to be protected with drop cloth material.Door way to bathroom to be secured with
plastic material drape.
All tile on floor and wall to be removed.Tile on floor and underlayment to be removed down to the sub
floor and disposed of in container.
Jacuzzi tub to be removed and set aside pending directions from customer
Existing shower stall to be removed in pieces and disposed of in container.
Portions of existing wall between shower,water closet and main bath to be removed as needed.
Phase Two:
Walls to be built as per plan in coordination with plumber and electrician.New tub platform to be built
in place as coordinated with plumber,electrician and cabinet maker.
All framing material to be number one KD stock.Tub platform to be covered with AC exterior grade
plywood and template cut out for new tub.
Wall in shower are to include 2 niches and blocking for all plumbing and for future grab bars as well as
shower seat.All framing to be coordinated with tile installer.
Opening to shower to be framed in coordination with tile setter.
Opening to water closet to be coordinated with designer for determination of either a pocket door or
swinging door.
Exterior walls affected by remodel to examined for proper insulation and moisture barrier and any
deficiencies repaired
All new walls will be covered with sheetrock.New walls and existing walls affected by remodel will be
finished with joint compound and prepared for painting.
All trim work and door will match existing.
Total
Phone# E-mail Web Site
978-887-1090 chucksouthard@verizon.net TheCountryCarpenteTopsfield.com
The Country Carpenter Topsfield, LLC Estimate
109 Main Street Date Estimate#
Topsfield,MA 01983
9/13/2009 9
Name/Address
COUNTRY CAHpt�jt4
Louis&Joanne Luciano j
61 Lancaster Road
North Andover,MA
Terms Project
Description Total
Walls and woodwork will be primed and will be paint ready.
The Country Carpenter Topsfield,LLC agrees to coordinate the project along with LI Designs,LLC but
will not be the general contractor for the project
The Country Carpenter Topsfield,LLC will pull the permit for the project but each licensed contractor on
the job will pull their own permits and be responsible for the warranty of their work and materials
supplied,each will be responsible for all appropriate insurance coverage.The customer will pay each.
contractor directly for their work
TERMS:33%($2930.00)to start,33%($2,930.00)upon completion of framing,23%($2,063.10) upon
completion of work listed above,10%($870.90)upon completion of project as designed.
Total
Phone# E-mail Web Site
978-887-1090 chucksouthard@verizon.net TbeCountryCarpenteTopsfield.com
The Country Carpenter Topsfield, LLC Estimate
109 Main Street Date Estimate#
Topsfield,MA 01983
9/13/2009 9
Name/Address 0�
COUNTRY CA PEN
It
Louis&Joanne Luciano
61 Lancaster Road
North Andover,MA
Terms Project
Description Total
Building Permits 50.00
The Country Carpenter Topsfield,LLC will remove all work related debris and dispose of such in a 20 0.00
yard container on the property provided by G.Mello of Georgetown,MA
The container is for job related debris only.Any additional charges due to disposal of personal property
will be charged to the customer.
Total $8,790.00
Phone# E-mail Web Site
978-887-1090 chucksouthard@verizon.net TheCountryCarpenteTopsfield.com
CONSTRUCTION CONTRACT
[The Country Carpenter Topsfield,LLC shall provide all necessary labor and materials,and perform all work
of every nature on the proposed remodeling in accordance with this proposal,the specifications,and the
accompanying drawings. If applicable,The Country Carpenter Topsfield,LLC shall obtain the building
permit. All subcontractors will take out their own permits and pay for them. The owner,if necessary,will
have the lot surveyed and will apply for all zoning,historic preservation or other related permits as
necessary. Work for any of these are not included under this contract. All work is to be executed in a
workman like manner in accordance with the contract,plans,and specifications as presented in the attached
estimate and in this agreement.
(Owners who secure their own permits or deal with unregistered contractors will be excluded from
the Guaranty Fund provisions of MGL,chapter 142a)
CONTRACTOR
Charles H Southard III
109 Main Street
Topsfield,MA 01983
Federal Employer ID Number: 11-3820566
Home Improvement Registration Number:278042
Construction Supervisors License Number: 4723
WORK DESCRIPTION:
(See attached estimate)
PAYMENT SCHEDULE:
(see attached estimate)
ACCESS TO WORK AREA:
The Owner shall grant free access to work areas for workmen and vehicles,and shall allow areas for
storage of materials and rubbish. The Owner agrees to keep driveways clear and available for movements
and parking of trucks during normal work hours.
EXTRA WORK:
Extras or Credits: Any deviation from the above specifications involving extra costs and extra work will be
executed only upon written orders,and will become an extra charge over and above the estimate.This extra
work will be ordered through a change order signed by the Owner and the The Country Carpenter Topsfield,
LLC.
DAMAGE TO PROPERTY:
The Country Carpenter Topsfield, LLC shall not be held responsible for damage caused by Owner's
employees,acts of God,soil slippage,earthquake,fire,riot,civil commotion,or acts of public enemy.
WARRANTY:
All materials are warranted by manufacturer. All work is warranted for one year after date of completion.
Warranty does not cover damage caused by settlement of fill placed by others,by machinery or other heavy
vehicles,by other trades on site,by bad weather or natural disasters.All material is guaranteed to be as
specified.All worts to be completed in workman like manner according to standard practice.
SCHEDULE:
Proposed Start and Completion Schedule-the following schedule will be adhered to unless circumstances
beyond the contractor's control arise.
i
i
Contractor will begin contracted work on a mutually agreed upon date with the homeowner
Date when contracted work will be substantially completed e
PERMITS:
This estimate is subject to approval of job specifications by all local inspectors.Changes made to the plans
or job scope by the local inspectors may lead to additional charges and will fall under the heading of"Extra
Work"(see above).
DEBRIS:
The contractor will be responsible for the removal Of all debris as noted in the estimate.
RIGHT TO CANCEL:
You may cancel this Contract if it has been signed lat 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 and delivered, not later than midnight of the third day following the signing of this
agreement. Refers to MGL c93 s48;MGL c 140D s 10 or MGL c255D s 14 as may be applicable.
Note:This proposal may be withdrawn by us if not'accepted within 5 days.
i
i
DO NOT SIGN THIS CONTACT IF THERE ARE ANY BLANK SPACESM
AGREEMENT:
I/We Louis&JoanneLuciano agree to the above costs and specifications and authorize you to do the work
as specified. Payment will be made as outlined in the terms above.
Customer Signatu I Date:
Aj
Contractor Signatur .: I Date: q
Chuck outhard for They Country Carpenter TAsfiel 9LC/
CONTRACTOR ARBITRATION !
The contractor and 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 submit such arbitration as provided in Massachusetts General Laws,
chapter 142A.
Homeowner:
Contractor:
NOTICE:The signatures of the parties above apply only to this 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 parties.
All home improvement contractors and subcontractors shall be registered and that any inquiries about a
contractor or subcontractor relating to the registration should be directed to:
Registration Division,Program Coordinator
One Ashburton Place Room 1301
Boston,MA 02108
(617)727-3200 ext 2523
LI DESIGNS, LLC
Designer: Lisa Pearce 9'-41+
6Tolland Rd
North Andover, MA 01845
P- 978-314-9219- f- 978-687-2302
o TUB DECK
- - - - -
_ 3t_A+1 \ \
6608 oval
drop intub
J1
SEAT
, —Niche
r
N --
1�} MASTER BATH
00 N 9'-4" "
x 5'-9
W/C - - - - - - - - - - - - - - - - - - - - - - -
- -
- _
9'-4" x Y-6" - - - - - - - - Existing granite top -
AD
Lou &Joanne Luciano 7001
61 Lancaster Rd. --
North Andover, NIA
Plan 4A 3'-11" 9'-411
13'-7 1/2't
}� ��
- \ Board of Building Regulations and Standar
HOME IMPROVEMENT CONTRACTOR
Registrahtin 161804
hx /ratiQir 1'./24/2010 Tr# 278642 `
TYpe
i
BAYSTATE RESTURANT BROKERS LLC.
CHARLES SOUTHARp
109 MAIN STREET
TOPSFIELD, MA 01983, Administrator
�• Nlassachusetts- Department of Public Safety
Bourd of Building; Re�-ulations and Standards ,
Construction Supervisor License
License: CS 47023
Restricted to: 1G
CHARLES H SOUTHARD III
109 MAIN ST .
TOPSFIELD, MA 01983
Expiration: 3/6/2011
(unuu,isinu:r Tr#: 12675