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HomeMy WebLinkAboutBuilding Permit #6-785 - 704 FOREST STREET 6/1/2007BUILDING PERMIT TOWN OF NORTH ANDOVER ( APPLICATION FOR PLAN EXAMINATION Permit NO:� ` 0 J Date Received w r" �... "6• rte\ 9fY p DESCRIPTION OF WORK TO BE PREFORMED: eh/ ARCHITECT/ENGINEER, . , Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $1200 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ < 77), — FEE: $ J-36, Check No.:Receipt No.:o;2CV S2 NOTE: Persons contracting with unregistered contractors do not have access to tpAguarantyfimq 15 Location No. �7 S� Date�-- MOR,M TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ 'Ss+cMU Building/Frame Permit Fee $, Foundation Permit Fee $ Other Permit Fee $ i, TOTAL $ Check # 'r 20255 Building Inspector 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑11 DATE APPROVED COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street 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 2007 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 o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 �� O, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: /&,) s City/State/Zip: AV )%ildD4/ei2 e,9/g�_Phone #: Are you an employer? Check the appropriate box: I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* h h ed the sub -contractors 2. [1I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. El am a homeowner doing all work myself. [No workers' comp. insurance required.] t ave r listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. E] Plumbing repairs or additions 12.0 Roof repairs 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 are doing all work and then hire outside contractors must submit a new 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 is providing workers' compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: 12n% 12/G'H1g/ Policy # or Self -ins. Lic. #: 1/y 6 �9��33 ' Expiration Date. Job Site Address: ;7e9 City/State/Zip-.A/# 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. I do hereby ce�fy under the painsand penalties ofpetjuiy th t the information provided above is true and correct Signature: Date: (/ Phone GP t5 Official use only. Do not write in this area, to be completed by city. or town official. City or Town: PermitJLicense # 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 #: 11 i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' .compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), 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 he the 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 pernuts 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office. of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia ACORD, CERTIFICATE OF LIABILITY INSURANCE oPID °"'0412E I p" 7 RATTE-1� 04/25/47 THIS CERTIFICATE IS ISSUED A! A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Michaud, Rove And Rusoak ins. HOLDER. THIS CERTIFICATE DOP3 NOT AMEND, EXTEND OR 198 Massachusetts Ave ALTER THE COVERAGE AFFORC.iD BY THE POLICIES BELOW. North Andover NA 01845 Phone -978. 688 8829 Fox:978 557 2130 INSURERS AFFORDING COVERAGI_ NAIL0 INSURED INSURER A: Azballa Protoatica ine. CO. 41360 INSURER B: safe lnsuraX 08 Company 33618 goer street. Ratte, Inc. MURER0: American In'toxnational COS 1 009V street >�1 01845 INSURER D: MURER E:-- ulwv SV W THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. Nr -MflTHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY OF ISSUED OR MAY PERTAIN. THE INSURANCE AfFORDED UY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERNS, EXCWSIONS AND GOND 'IONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REOUCEO BY PAID CLAIMS. LTT'R TYPE OF mum= POLICY NUMBER 02M DATE NT uMrrs GEIiBtALL"LITYEAC IOCCURRENCE $ 1000000'M'0 RENTED n.415ME 1ESRD ) _ 550000 COMMERCIAL GENERALLIABII.ITY 8500033367 CLAIMS MADE ® OCCUR MEC EXP {Any one person! S _ A X BUGi,n"z Owners 03/28/07 03/28/08 PEF:,ONAL&ADV INJURY 21000000 GEN IMALACONOATE s2000000 _ t GEML AGMGATE I.Ig6f APPLIES PER QRC �7UCTS • COMPlOP Am $2000000 POLICY SPT LOC AUTOMOBILE UAINLITY CDR ISINED SINGLE LMT S B ANY AUTO 1500030 01/16/07 01/16/08 (Ea " ) ALL OWNED AUTOS BO[ LY INJURY $100000 {Per WWI X SCHEDULED AUTOS R HIREDAUTOS BOE LY INJURY $300000 (Per acdt�rll) X NON -OWNED AUYOS M PR( *E TY DAMAGE $ 100000 (Per addont) i GARAGE LIABILITY AU1 17 ONLY : EA ACCIDENT $ ANYAUTO0•:RT EAACC OR S NLY: AGG L S EXCESSNMISFIL A LIABILITY EAC i OCCURRENCE S .... S OCCUR CLAIMS MADE AGGREGATE S _ $ DEDUCTIBLE - $ RETENTION S WORKERS COMPENSATION AND ro LIMtr8 ER_ EMPL,OYEFWUABILITY NC8944334 04/23/07 04/23/08 E.L.:AZMACCIDENT $100000 C ANY PROPRI11YORIPARTNERIEXECUTWE OFFICERIMEMSEREXCLUDED? $ 100000 E.L. )ISEASE-EA_EMPLOYEE dexnbe UnClOr WEAL PROVISIONS beta+' E,L. xSEASE . POLICY uMrr $ 500000 OTHER DESCRIPTION OP OPEM7MS I LOCA MSS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPWAL PROV SSiONS GCK71f IGA1C 17W1.WGfC—""-'--- - - r�. C2 SHOULD ANY OF THE ABOVE DESCRIBED :OLKAES 136 CANFA:ILFD BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOL OGR NA 1411D TO THE LEFT, BUT FAILURE TO OO SO SHALL IMPOSE NO OBLIGATION OR LIAHRITY OF ,LNY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. 26 (2001/06) — 0 ACORD CORPORATION 1985 i ubulW Home Improvement Contractor Look Up r cLgc t vl l Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number Select5earch type: re AND r OR T§earch . Search Results Reg. No. Ap lieant Street City I State lExpirationj ROGER J. 340 Mt. Ratte, 6/15/2008 100294 RATTE, INC. Vernon St Lawrence MA 01843 Jose h esident 0 Total of 1 Records matched. ;BOARD OF BUILDING REGULATIONS r.• { i License C,ONSTRUCTION'SUPERVIION ktirnw` 64" iOl5004 Birthte 08/27%195$ t iExp res 08/27/2007 Tr. no 15942 Restricted Mr 00� Y, , JOSEPHR RATTE r <<' t 340. MT VERNON ST � 1 ` f LAWRENCE, MA 0.1843 Commissioner fie e.mo..zaa o�✓%iaaoaceu�oe Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 100294 E piration: 6/15/2006 Type: - Private Corporation ROGER J. RATTE, !NC . Joseph Ratte 340 Mt. Vernon Sty Lawrence, MA 01843 Administrator J CONTRACTORS COPY O RESIDENTIAL CONTRACTING AGREEMENT O Read this agreement and make sure you understand it before signing it. This Agreement has legal force and effect binds those who sign it. Notice: All home improvement / general contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home improvement Contract Registration, One Ashburton, Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Roger J. Ratte', Inc. Salesperson's Name: Joseph R. Ratte' Registration Number: 100294 License Number: 015004 This agreement is made on May 21, 2007 between Roger. J. Ratte', Inc. DBA R. Joseph Ratte', Inc. of 10 Main Street North Andover, MA 01845 Ph. (978)-688-8839 hereinafter called "Contractor" and Joseph Lehmann and Jeanne Velde of 704 Forest St. North Andover, MA 01845 Ph. (978)-685.6362, hereinafter called."Owner". I. DETAILED DESCRIPI30N OF WORK TO BE PERFORMEb Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: Renovation of kitchen as per attached specifications and allowances. DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above descn1W work consist of the following: As per attached specifications and allowances. II. PRICE Contractor agrees to do all work described in Section I for the total price of $27,250.00 Twenty seven thousand two hundred fifty dollars. HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK: Hidden conditions or additional work may require adjustment in the overall price for the necessary work related to this contract. In such case the Contractor shall inform the Homeowner of such conditions forthwith and where necessary a written amendment of this Contract will be negotiated and executed by the Parties. Additional work beyond the scope of this contract will be billed at an hourly rate of $65.00 per man hour for carpentry and $85.00 per man hour for plumbing. Additional material and subcontract work will be billed at direct cost plus a 25% General Contracting fee. (978) 688-8839 • 340 Mt.Vernon Street • Lawrence, MA 01843 • Fax (978) 688-7476 M. PAYMENT Payment will be made as follows: 1r-'5; Offl?eposit with signed contract $ 5,000.00 At start of job. $10,000.00 Completion of window & door installation. $ 5,000.00 Completion of interior trim $ 2,250.00 Completion of job as per specifications. Payments as provided above shall be made when due. Any payments that are delayed shall be subject to a finance charge of 1.5% per month. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. TV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on or about June 18, 2007. Barring delay caused by circumstances beyond Contractor's control, the work will be completed on or about July 23, 2007. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made m advance of the time specified in Section III (Payment) above for the reason that he deems himself or the payments to be insecure. If, however, he deems himself to be insecure, he may require, as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself; his employees or his subcontractors in the performance 4 or as a result of, the work under this Agreement Contractor agrees to carry insurance to cover such damage or injury. (978) 688-8839 - 340 Mt.Vernon Street - Lawrence, MA 01843 - Fax (978) 688-7476 VII SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. VIII CONSTRUCTION -RELATED PERMITS The following construction related permits will be necessary in order to complete the scope of work included in this contract and are the responsibility of the Contractor: (mark X where applicable) Building X Demolition Plumbing X Electrical X The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction related permits. Home improvement work (i.e.. additions, garages, porches, etc.) may require other permits including but not limited to Variances and Special Permits under Zoning by-laws through the Board of Appeals, Board of Health Permits for expansion of sewage disposal systems, Conservation Commission for an Order of Conditions, etc. Such permits which may require non -construction related, engineering, technical or legal representation of the Homeowner, shall be the responsibility of the Homeowner. Notice: V the homeowner obtains his own construction -related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment and nonpayment of the Contractor, the homeowner will not be entitled to make a claim to or, collect from the guarantee fund established by Chapter 142A, M.G.L. DC. MODIFICATION This Agreement, including the provisions relating to price and payment schedule cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed). X WARRANTIES The Contractor warrants that the work fiumshed hereunder shall be free from defects in materials and workmanship for a period of one year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work (978) 688-8839 - 340 Mt.Vernon Street - Lawrence, MA 01843 - Fax (978) 688-7476 All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner maybe required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. XI. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the owner of a copy thereof. RIGHTS TO CANCEL The owner may cancel this agreement if it has been signed by the owner at a place other than an address of the contractor which may be his main office or branch thereof, provided that the owner notifies the contractor in writing at his main office or branch by ordinary mail posted by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation. HOMEOWNER DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. S�3D OWL�r Owner's Signature Date Signed Contractor's Signature Date Signed (978) 688-8839 • 340 Mt. Vernon Street • Lawrence, MA 01843 • Fax (978) 688-7476 Joseph Lehmann & Jeanne Velde 704 Forrest Street North Andover, MA 01845 May 21, 2007 SPECIFICATIONS AND ALLOWANCES FOR RENOVATION OF EXISTING KITCHEN PRELIMINARY Submit plans and specifications and obtain all required permits. INTERIOR DEMOLITION Remove all cabinets, countertops, appliances, floor covering, and underlayment in kitchen. Properly dispose of all debris. FRAMING /WINDOWS /DOOR Install new kitchen window over sink, in existing rough opening. Remove existing sliding door unit and frame in opening to accommodate new 36" Anderson Frenchwood door unit Install new door unit and repair exterior siding and trim as required. Allowance for window & door units: $1,350.00 ELECTRICAL Install new lights, receptacles, all associated switches / dimmers, and wire for new appliances as per code and as directed by owner. Allowance for electrical and fixtures: $2,500.00. PLUMBING Upon completion of cabinets and countertops, properly connect new appliances and new sink, faucet, and °� step r' All appliances shall be provided by owner. vJ z Allowance for sink, faucet, and hot water dispenser: $750.00 a i yf1Yt>e� HEATING I Relocate heat as required and install new fan forced "Kick-" heater in kitchen. 4 PLASTERING (� Repair kitchen walls and ceiling as required. CABINETS/COUNTERTOPS/APPLIANCES Upon completion of cabinet installation, supply and install new Granite countertops as per plan Allowance for countertops: $4,000.00 Install and connect all new appliances supplied by owner. Install and vent new exhaust hood. All cabinets, hardware, and installation by others. INTERIOR TRIM Trim out new window and door with trim to match existing, and repair baseboard as needed. PAINTING Prime and paint walls, and stain and urethane new woodwork as needed. Allowance for painting & staining: $1,500.00 FLOOR COVERING Install new 2'/a" oak flooring in kitchen area Sand floor and apply three coats of high quality urethane. Complete clean up and removal of all debris. Estimated additional cost for hardwood flooring in living room: $3,500.00 We are licensed, registered, and fully insured. License #015004 Registration #100294 Complete cost as described above: $27,250.00 Final cost reflects elimination of cabinet installation Owner Qa Contractor (978) 688-8839 • 340 Mt. Vernon Street • Lawrence, MA 01843 • Fax (978) 688-7476 The Commonwealth ®f Massachusetts Department of Fire Services Office of the State Fire Marshal P. 0. Box 1025 state Road, Stow, NIA 01775 PERMIT � � North Andover perni tNo Date: z ( City of Town) ( If Applicable) Dig Safe Nvm r In accordance with the provisions of M G.L.14 $ Chapter1Q_ as provided in section S 7.] f M R 34 Start Date This Permit is granted to:s��� Full name of person, Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25' from structure if unable to place with r'eouired Restrictions: clearance dumpster must be covered with plywood or tarp endof work -day ( Give location by street and no., or describe in such manner as to provied adequate identification of oration ) Fee Paid$ 50.00 Fire Chief This Permit will expire. Signature of offical granting permit Offical grantingpermit (Title ) uj zCL a w w v U w a w c� a w w O ` w a ZO A cn uj zCL M, fil rz O .P" c c CD p� .� y O O 'g m m CD Hr O O p LM ci CL O C Q COD c ev co C ZCL m V y c C C cc C40) p W U) W W 19 W N 'ID o c� O ` C H O C C3 CS •C. ' `�t C CL O W m c ;Z O o m CDa :.. c N is m O I 0 d E� m c rti v O cm mi (�. m c E 1 y r o LA cmce *' MO Goc o Amo I v:�CDID t= O cm c �Q pct o .Go 'OD m c �S w Z 0 co d c, C m :m3 = 0 m$� m MM z C 1° F.. cc Vi C ct ic h Z O Lu COD a :3 'o 5 = w jo m= o H t O dim M, fil rz O .P" c c CD p� .� y O O 'g m m CD Hr O O p LM ci CL O C Q COD c ev co C ZCL m V y c C C cc C40) p W U) W W 19 W N _ Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boarer -Heafth—. The,System Pumping Record must be submitted to the local Board of Health or othppr incauthoiralty,: A. Facility Information DEC 3 0 2008 Important: LHEAL WN OF NORTH ANDOVER When filling out 1. System Location: THDEPAp7iUSNT forms on the ^-� ' t y— computer, use T © `� t" o <C S i S+ re CN only the tab key Address to move your N a`N� cursor - do not 1 use the return City/Town State Zip Code key. 2. System Owner: �� Name Address (if different from location) City/Town State Zip Code q3(oa. Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): koh 2. Quantity Pumped Date Cesspool(s) JM Septic Tank 4. Effluent Tee Filter present? ® Yes ❑ No 5. Condition of System: 6. System Pumped By: Name _ /R -U ' �ee +r V i c,2 1 CZC Comps Gallons ❑ Tight Tank If yes, was it cleaned? ® Yes ❑ No Vehicle License Number 7. Location where contents were disposed: �o/ice I0� Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 WELL & PUMP CO. ' B&R CONST 477 ANDOVER ST NO ANDOVER MA 01845 RT. 28 WINDHAM,N'H'03087 [603]898-4232*[61718875808 TEL. NO. 686-3635 LOT NUMBER OR SAMPLE LOCATION.- LOI ff6 LTMM7731 WATER TEST RESULTS 15 MAY 84 *************************************************** HARDNESS 51.3 (0-50 REC STANDARD) IRON 1.5 (0—.3 REC STANDARD) MANGANESE 0 (0—.05 REC STANDARD) HYDROGEN SULFIDE 0 (0—.01 REC STANDARD) Ph(ACIDITY) 8 (6.5-7.5 REC STANDARD) TURBIDITY 1 (0-20 REC STANDARD) CHLORIDES 30 (0-150 REC STANDARD) COLIFORM BACTERIA 0 (O REQUIRED STANDARD) **************************************************** CHARGE FOR CHEMICAL & BACTERIA TEST ** $25.00 **************************************************** ABOVE TESTS MEET REQUIRED STANDARDS AND BASED ON THESE, WATER IS SAFE FOR HOUSEHOLD USE AND HUMAN CONSUMPTION. THERE ARE OTHER LESS COMMON MINERALS WHICH CAN AFFECT QUALITY OF WATER. Pumps *Submemib|e * /et *Centrifugu| *CeUar *5evvage Tanks � Filters *Gwftener * |nnn ' *Charcoa| * Neutralizer � *Cartridge � Water Testing Pump Parts � Motor Controls Water Softener Salt Resin Cleaner Rust & Stain Remover Potassium Permanganate Plastic Pipe & Fittings Lawn Watering ' Systems . Water Heaters * Solar * Heat Pump • Electric * Energy Saving VVeUu *DriUed *Oriven *Dug *Grav| Chemical Feeders Tank Alarms & Controls Hoist Service Portable Pump Puller Emergency Service Goulds Aermotor jacuzzi Red Jacket Fairbanks Morse Wayne /\quatron Well-X-Tro| Town of Forth Andover,Mass. Permit # Date 19 APPLICATION FOR WELL & PUMP PERMIT Application is beteby made for permit to drill a well ( ). Application is made to install (_) a pump system. Location: Address Owner Address A,(1 -0M' -7X -7X T7` Tel. Well Contractor �% ,� _Address _ _ 'T6e1. - - - - - - -�' Pump Contractor _��` —_ —Address for WELL CONTRACTOR (To be completed at time of pump test) Type of Well_— — Well used for Diameter of Well Size of Casing 40 Depth o -f Bed Rock s Depth casing into Bed Rock Was Seal Tested? Yes No (_) Date of Testing___% �fG ----- Depth of [arell dQ l'Jell Ended in [•khat Material Depth to [~rater Delivers- Gals.Per Min. for 4 hours Drawdown_ IV feet after pumping`—hours at _5 --GPM Date of Completion ��%�i�' � - ------..---~ - '� -----�a,�n.- Si&nature [�? 11 Cotracto .1, J.._J-.L� i; i`.L..�J_J-J�.l.J_J..1..1�.L.L.l..1..1�_�.1_.L .L1J-J_J..L _L J..L J--n-•n � � -n i� _ iL •n � - iL -!__ _n�i-i� _-_�- n •ri --n n i n i� �n �� � n _ -`n n .. n n n n n n n n n n n n n n n n n n n n n n n n n n n n.n n n n n n n n n ., i. n n • i. n n n i. i. n n n PUMP INSTALLER- (To be filled -- in before i.nstaIIation) Size .& Name -Pump ------P,i;np Type Used [Fater Pump Delivers-- GPM Size of Tank Pipe Material Used -in Well: -Cast Iron ( ) Galvanized ( ) Plastic ( ) Well Pit (_) or Pitless- Adapter ( ) Was sleeve used to protect pipe? .Yes (_) NO( _) Type or N;Lme ['Jell Seal Date 7 — .r....,.,.any:n5t'+t+.:Yr.nr�..ur2,�.c;�rrNr�i'�541i9r5ti53.'ii'i;;.i,.rtt�ii��.r':1'...;5°ii:.,,,;.:n,...,,.....,.,.,.:z;i.i.i.i.,,�i.ri[iiriii Date Water analysis report submitted to Board of Iiealth Date release.given to owner of record & Bldg. Insp --------- 1 i c, a J_ t. h 7 n s p e c t o r -- ----- -- - - - WELL DATABASE ADDRESS: L-7(- /-��.. �/' �4- Co AGE OF WELL: / 3 WELL DRILLER: WELL PERMIT C' y ` WELL LOCATION: / C0) �- �, w/ �J.•�-��� WT.r. PERNIIT DATE: 4 -)?- DEPTH OF WELL: TYPE OF WELL: a.. DRILLED b. DUG c. UNK�ii 0 TYPE OF WATER BEARING ROCK. WATER ANALYSIS DATE. HIGH MANSE: Y HIGH IRON: Y �> OTHER CONT Y CIw WELL DATABASE ADDRESS: AGE OF WELL: -Y v.) WELL DRILLER: C" WELL PERMIT,-,: 7 y WELL LOCATION: WELL PERMIT DATE:- — DE OF WELL: — TYPE OF WELL:(::al a.. G b. DUc. ti Ni _---� TYPE OF WATER BEARING ROCK: w 00 OWN WATER ANALYSIS DATE: HIGH MANGANESE: Y HIGH IRON: Y N OTHER CONTAMINANTS: Y N N SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No C -o¢- i7 -6e -EST r Lot No Loc/Subdiv. Pland Owner Investigatory (aEo. CANssj LT. Observer SOIL PROFILE DATES l.�Elev 2.Elev 3.Elev 4.Elev (p1i��3 n 0 $ 0 L n ti 4 5 6 7 B 7E Benchmark Elevation 2 3. 4 Tl�l 5 6 '�Gc,�sdL 7. 9 10 DATES E 5 6 _7 � �ws�t✓ TiestsTest 0 8 - 8 � r � 9 9 10 10� Location Datum PERCO" T,,A ION TESTS ►1 7.'5 23 i1\,x101,1, Pit Number ✓1 i 2 3+ 4 Start Saturation Soak -Minutes Start e �. p ICA Drop of 3" -Time Dropof 6" -Time �N m6ms.lst 3" drop Mins.2nd " Drop Percolation 4-71141 J_ p O f- 0 .