HomeMy WebLinkAboutBuilding Permit #488 - 95 CAMPION ROAD 12/19/2011TOWN OF NORTH ANDOVER.
APPLICATION FOR PLAN EXAMINATION
Pemat ND. , �- Date Received
Date Issued
YMP®RTAI�T: Applicant must complete all hems on flus page
LOCATION 91 S"
� Print
PROPERTi' OWNER i!J
Print
MAP N0: �t= p R.CEL:� ZONING DISTRICT: Historic District yes i . o
Machine Shop Village yes no,
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
8-Bife family
❑ Addition
❑ Two or more family
❑ Industrial
No. of units:
❑ Commercial
❑ Alteration
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition _ - _ - -
•
5e tics ;OV1Te11
❑Other _ _
M#Wetlands \ `�` � ,;i
-
'�0 �Watershed�District `.
011,1 OJOE PE O ED:
(Identification Please Type or Print CIearly)
OWNER: Name: Phone: ? k _
Address: �� �" °�� k►� - -
CONTRACTOR Name: PedA � � d�t, ,^ �tJi � Phone: Z j ,-u
Address: �� �' -`°`"' acid f,� ot?22--
Supervisor's Construction License: _ 49 get Exp. Date: !d - 7- f- r
Home Improvement License: lv1il 7.7 `/ Exp. Date: /I —6.> - /3
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING MIT'. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST B' SED ON $125.00 PER S.F.
Teta} Project Cosi: $i �c�u FEE: $ l
Check No.: —7-75-7 Receipt No.:
XTngTv- Pnrcnnc contracting with unregistered contractors do nothave access to the guaranty fund
Location d
No. Date `
NpRTh TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
P Y \r
'aYs�c«�s `� Building/Frame Permit Fee $
Foundation Permit Fee $�
Other Permit Fee $
TOTAL $
Check # ;"T—
2`895
Building Inspector
— ---- -- _j
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer [] '
Tng/Massage/BodyArt T ngPooIs ❑
Well ❑
Tobacco Sales Private (septic tank, etc. ❑ ckaging/Sales ❑
Permanent Dumpster on site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN ®Ft - U FORIVI
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVA T ION Reviewed on
nature
COMMENTS
HEALTH Reviewed on
- Si nature
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
I'Pianning Board -Decision:
Comments
Conservation Decision:
Comments
Water & Sewer Connection/Signature & Date
Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTAENT .- Temp Dempster on siteyeS Located 384 Osgood Street
Located at 124 Main Street ' no
Fire Department signature/date
COABMNTS
O
7.
dim
a
P
F�
U
U
O
W
Q
�
W
A
O
10
O
u.
a0i
cn
a
p
w
O
cG
-[
U
G
w"
P-4
O
G
F
W
G
w
G
C/)
O
C/)
ui
am
0
�a
c v
o =
. C h
O O
C.,3 C.3
•Q,'fl
C C
Cc
m C
r.+
�p oCc
m
• 4Ea
o
�C
is r
0 4D
CD c E
: y to Lw
mm a
C m 3 s
'_m O
44. _ 'O y
H O O
E m
av o
e h m ' Z
Zi _w � C
o Q 'o
1 m
C3 H Z O
O
V a O CO C
` m C SCO
= m 0.e c2 N
H
CO3 Z:5
•N ACL C
W •E C=i .0 Cmc •V) O_
V m O 109 C_
y C m- OA
Z ev)p .,�LyC
I.- r .S C� m a
z
0
w
w
a
z
0
u
O
O
E
O
c L
_ O
O v
Z a
O y
D O
CD cm
i o
CD —
y O O
�E m m
0 o a�
CL
CD
O �CD
CD
0 Q
L
M O Q
CL Cm<
c
o -10" c
tc O
d O.00..
C Z �
C.3 Na
c C
C_
•s
cc
ca
cm
WIW
The Commonwealth of MassOONS
Departmefot oflEs�usiFlaleic�►def��s
G Office affi:vesilgatiotls
600 Washigton Street
Btistota� MA 02111
• wwwmassgovIdin
Workers' Compensation Insurance Affidavit, -
Q
Are yam in employer? Cheakgts appraptiete 6asa •
L alga employer with,,
4. ® I em a geaerld contractor WE
emptayees (fuli snrUarpazt��e�,
have IM t86 suk�aoattaa ag
.2.[� Iarnasoleprapdetarespe�rmez�
iigtedomtRa°stilka8adsbsek
ship pd hate no ecgplayees
These Sul-oumtma$ars have
warts -Arora !any cspacYiy.
a yses cad nava wosks�t
jNe wrabit camp. imunce
isquirsdj •
aemp.iRvedhe.t
3, 9 `a� .aha aic amdi
3.[3 19116 l neawaerdo4di wafif
c ee s veer roles d s .
ml self RIs auarkere caw.
d of a mptien par Mab
ia9mraaaeaaquiredjo.
®ndrre lasaveoa
emptoyeas, [ta vorbrs' .
$� mpalimantPhetahaci�bap.01am,,, 61%
osneoxnserawi',edodiOie:in3vi uiaavasfitev
affifloyeas,
!®a a an empioyerthat kjorovisiigworkers'
infuetjeotralt� _,,,®,
Lb:aii SUm./
-Type of pi'ojeat (required):
d. [j Newcoasisuai oa
7, Q Remada4g
I. Namolttiaa - .
4: 13 Building ®fid+tioa
Eo,[]aleafdcalrep h'seradidam
l l.d P%iiiap seQ�es cr addliiaa.�
12.0 Roofrepairs
Is.[] Dior
bit
offs®saia-aaa n as;dsaawireFhe�araetlhasaeaNdashave
myeftees, WON ft thepoliayaadjahAd.
Policy 0 or SOW. Lit.. tt.&a Date:
Iain Site Add;asa: thii+atelia
A-#€a-uh a copy of thewnr6grs' compemaden paiicy dadaraiteu area and egAtatlase datej.
:"ailuro, to seouo covetMe as roqulrad under SeoaoasA of MOL. c• 1S2 of ocimlaet pajoes Of a
FMB up to $1,500,00 aadlor one year imptisommi% m weii as'OM panait3ss M farm of a STOP WOPM 08, 1t oral a be
of up to WIN a day agaimt ths VIolator. Da advised iht a co15Y of ft atacsl;et-my be fbmuded to the Mae of
ldo hereby Card& under1hapaans andpe►soddfes OfF4,117that tike, itafarlraftPrvideda6ave i's Irmo aeaaorreot
V-
NO
or (Own+,!+lead
City or `fovea' . _.� .. _,.. _ y's•t�ffLacease i
Iasctarsg Aatf�ori+y �eiz'ale saaepo
I, Board afi aaith 2. Building Departam:It I taibr!�'o�va Clark �, �1ac�cai ?��Nacsoc � °i�ambEa� iospeceor
�. ether
Contact Parma:
ACORD CERTIFICATE OF LIABILITY INSURANCE
071061120E1MMIDDfYYYY)
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 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
certificate holder in lieu of such endorsement(s),
PRODUCERNTA
T Dorothy A. Carielt, CIC, RPLU
NAR
Fred C. Church, Inc.
41 Wellman Street
HONE 978 322T23i FAX (978) 454.1865
o AIC No
Lowell, MA 01851
(800) 225.1865
E-MAIL dcodaNQfredcehurch.com
ADDRESS:
INSugli S AFFORDING COVERAGE NAIC ff
INSURERA: Citizens insurance Company ofAmerica 31534
INSURED
Hansurance Company 22292
INSURER B nover i
New England Window & Door LLC
Massachusetts Bay Insurance 22306
i
INSURER C:
45 Fondi Road
Haverhill, MA 01832.1302
Employers Insurance Company of Wausau 21458
INSURER D :
INSURER E:
MED EXP (Any aria person) S 10,000
INSURER P:
A
r:r1VFRARFC r.F:RTIFICflTF NI1MRFR- I—. Rixvi%inm N111MRFR!
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 CONTRACT OR 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.
LTR
TYPE OF INSURANCE
AODL
SUBR
POLICY NUMBER.
POLfCY EFF
MIDD
POLICY EXP
IIMIDp
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAWS•MAOE Ir7x OCCUR
i
DAMAGE TO RENTED 140 090
PREMISES Ea occurrence' S
MED EXP (Any aria person) S 10,000
PERSONAL & ADV INJURY 5 1,000,000
A
ZBN8161407
71112011
711;2012
GENERAL AGGREGATE S 2'000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG S 2'000,000
POLICY X PRO- 7_1 LOC
AUTOMOBILE
LIABILITY
COM@lN'e0 SINGLE LIMIT 1,00.000
�, Ea accida t S _ _
X
ANY AUTO !
i I
B—OD-ILY INJURY (Per person) S
gaplLy INJURY' (Per accident) S
C
ALL DINNED SCHEOULEO
AUTOS AUTOS
I
I ADN8162169 i
7111201 I
71112012
PRO5ERTYIDAMAGE 6
X
SWNED
HIR -ED AUTOS X NON-O
'
i
I
`
a
X
UMBRELLA LIAB
X
OCCUR
9,000,000
EACH OCCURRENCE 5
AGGREGATE S 9000,000
B
EXCESS LIAB
CLAIMS -MADE
I
UHN8167305
71120'.1
71112012
DED X RETENTIONS
S
j
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y I N
ANY PROPRIETORIPARTNERIEXECUTPJEE.L.
OFPICERIMEMBER EXCLUDED? !
(Mandatory in NN)
fIf N 1 A
WCCZ11259957011
7111201/
I
71112012
X Vv'C STATT• DTH•!
500,000
EACH ACCIDENT $
500,000
E.L. DISEASE - EA EMPLOYEE S
Iryes describe under
ONS"dRIPTION OF OPERATIONS belovr
I
'<
E.L. DISEASE • POLICY LIMITS 500;000
I
l
i
+
I
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES, (Aitach ACOR0101, Additional Remarks Schedule, If more sparse lsmquired)
ProcfofInsurance
CERTIFICATE HOLDER
ew Eng ant ,n ow ooh
45'rondl Road
Haverhill, MA 01830
l
(
1
GOsnt 3� e86u A4st H_
ACORD 26 (201 0105)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL PIE DELIVEP•ED IN
ACCORISANCE AIiTN?Fitt -OL l.Y FR041S10:48,
AUTHORIZE -0 RSPReSV!TkrWE I
Rte-
ter. !nlrl�r $ �f a oc 1988-2nja Acre. COR" RATION. All riehts reserved.
The ACORD name and logo are registered marks of ACORD
J
�
M c
O
c
0)
f N
U
O
..:
to
Vi
v
U
4)
g
z
o
'
CL
x
W
v
� NSI r2°'i�U
o
d
�+�a+t!��.v fir•
OD
to
LU
2
m W o V
Z
a
.O
Z
w
f �O Nt
w J
i-
CI V ._
iCC s:J�
Q
= .
� w w
uiW
J CL
i
a
M c
70
U
O
to
Vi
v
U
'fl
g
z
o
'
w
v
� NSI r2°'i�U
o
d
�+�a+t!��.v fir•
to
LU
2
m W o V
Z
a
.O
Z
q Z of
CI
CI V ._
a
_IX
*OCWXXQ poG n7�
y 7.i 17 7 111p 717 N
0 0 09 Dm nm y' m 311
..O, !jm p
3 IN ISn �mEll m N�
M tQ m N O O m C O
D p
CL m o mina-w
A m a ZM —,g—z3
1 13»1 0 N N 0 nTIT� '_'IxD
3 0 w �N0) as
D y O A n N 7
V 07 O7 (.*n-3=---•XN
W N Fr
m -n Oy �m 3 m Ci tOC
U1. = m (D (n
C) °7om vmamma,'m
1 0Mn m@r>> N.n
O Q m m o 0
m — m a E d a m o
C3 �do3 ad;�� m
m 10 51_C NO. [_[gy�m y R0 m 0 .m j 'O m C1
C MDr2� CQDma
a Aac� 2=G m
M m A j W W
n3�
C) 0 m m m 3
�v
so O =
m - m n
^_
—oma a
A v W
a v n
m FL x
H
m », m
C
CL
CD m
r
3
u
N
N
C
m
II
0
G> T -7+ 30 z
m Z T A
L1 CD _
d a S 7
N j N Z
O
aD 0
a
A
cn
N
o
=
T
n Z r
_G,
-
o CD
W T
cCn
W
c
n O
C
x
Co
U3
O� -
O-
x
f°
m A
x
*OCWXXQ poG n7�
y 7.i 17 7 111p 717 N
0 0 09 Dm nm y' m 311
..O, !jm p
3 IN ISn �mEll m N�
M tQ m N O O m C O
D p
CL m o mina-w
A m a ZM —,g—z3
1 13»1 0 N N 0 nTIT� '_'IxD
3 0 w �N0) as
D y O A n N 7
V 07 O7 (.*n-3=---•XN
W N Fr
m -n Oy �m 3 m Ci tOC
U1. = m (D (n
C) °7om vmamma,'m
1 0Mn m@r>> N.n
O Q m m o 0
m — m a E d a m o
C3 �do3 ad;�� m
m 10 51_C NO. [_[gy�m y R0 m 0 .m j 'O m C1
C MDr2� CQDma
a Aac� 2=G m
M m A j W W
n3�
C) 0 m m m 3
�v
so O =
m - m n
^_
—oma a
A v W
a v n
m FL x
H
m », m
C
CL
CD m
r
3
u
N
N
C
m
II
0
G> T -7+ 30 z
m Z T A
L1 CD _
d a S 7
N j N Z
O
aD 0
a
A
cn
N
m y
CL
m m
11
O- d 1
aD1
n R
w
0
M
O
3
N
9
C
m
o
�
n Z r
c
cCn
c
n O
C
3
a
N 2
-U
(D
v
o v
n
'moIDo
�0
R
X �
n
N
a
W
'"
1
d
a
0
0.
O.
M
Day
r
a
m
y
D
A d O D O
D
O
0 3
=
0 CD M
z
zCD
CD
z
oCL
C
a 3
3
7
c tr
O
N
�
o
O
1 O �
a n N Z
NO
X C n v A
N Q N M
O m
3 N < fT
v > A
W O N 1j�
N N QDCO 1
N N X O
O Ul
N N
� rt
-n A 0
d
CL
00
CO W
co N
w O
v �
4
A O
v
CL
(n y N co
N w N 0
N N N N
W A ® M
m T -0 z
m K 0 3
W �p
z Z
V
LT T Q
W A (D
L (fl
^^G) O c-
@ @
m rn
N
W
O
a
O
7
O
3
w
N
.p
T
(D (D y � m NO r
C n y N d r I m 1= m G
N `I
y fD
VonC =a
N n
cCD0
�
rr. I m
y i n
m m K O ? z m m
o3'a°z o_ �Xa a
F• �' -- z ' cti w
a � v �• o � 02 m �
y
O m o O y
y^_
O
FA N
n o p
m— o �G'�coxC)5mC) 8
oa ° d a Q x m d Z
-n -n
i T •LDgg 03omao. rn n v S
N T w G' w N O °° O O
5:4 C O c° 0 0 7 n
io ro ".oxti . a m N m 0om'=.g`o3w� p
w Q . m
`o O O ry 3 r3ii 3^ 7 ,.� � (n f 1, -1
7'
Oe Oeo'aDn Na -�C C
yo p c .n n aCFm<�maNC 7
ro =
c c° c m O.� O nm m !Q
n m o �d m
os a -n 0 ; TA Ofnm°a
s N C°7� O L m oa t�C >>T z �smQ
dm0 mc
°�a m3p
oo. - 5d�om
o ° a roQc cwXhn
° n m v Oz ?a s
° =crow () _ m n m w
0
N n
o r (12 0
7 O O' N d N C T m Q)
�� O
o' 0 m 3 `� CL D
o � D S a v
0 'S ^y fI0 y m QCD
m
N ' y rt
O CD m
C C W Q
O EL
w » N
O y N n C
ID
N N n fA A A O 0
N -,, . @ `� Q HD N
O N N
G
(D
y
rD O N
O y Or C O Ct
'm
w cr N EA m
0.N
o w 0 3 u
CD
C d
V tD n d
°e c SIA SIA
O O _
� � 7
O
C p m m
° o Q w Q
7
O c
o m r°oco m
CL
rn
N
W,
v
w
co
m
A
XM>XxM> 5 =;; =;; x 5 x T 0 0 D7'�T.0 -00m vDD-iKxaa00m "Q m
m T m 0 m 2 N -V 'B 0 N m �j m y o m 0 C {D U m (D o m (D m 6 U m
3�g .9'mm p�cC'R 30� �v mo <>jo<33399 ® i'
p 0 3 7 N< — W— O (D m 7 7 7 Od _ O O O
< t0 N W r+ .0 < m ro W 0 W 3 m (O (0 O < < < O O m ��• O.
C< m m= N m O p) m m m 3 W m? (D .. 3 W .o CD m� c m N m= (� D
•W-,, m o m (D 0' O (n 7 Z X a Q m O- N m C' m O. O° Q �+' X �• X N O m
n x x.m v a a m 3 m m N o a S. p =r =r m c
T. O m q W m- _ a T O> > o_ = S.
O m m 0 - O N. p 3 Ph
m 7 (<D j• 7 m O O (Ci, cn O .N. v •.O[ rN+ n R S N N- m m 5-0 (c O D R a
(!1 a m i LO p O N N m n (D m m - Sd N-0 01 m m m fD N a W 'O W N ,
N W O r► 3 pl fl1 7 "a a m CD t<U CD y m S S O W .�+
O �+' m? 3 3 O -- a c p 2.6 „„ '< c .> :E a K (mn N 07 j ) O r w
3 m W �v 3 5x o a o p o m� o 1 CD -o3 Qum o W o (D
° Nflm� a@ Nana og' � 3 W CNC WU,W@
ONNN Nom oo'CD - .x3 o0' 3 <0 '02( n3NsIn m N S c
CL m c v a ° m S W eD g 3 m c= A o m m 0 D m
a 3 m a� ° n ��_ 0'S� �v �' F o a 1-7 °' c0c'o 3 v ID -a 0 v 0 m
m wa a3 03 - 0 r- c m o 3° o m@ Im � m m � m °1 y
3 0 (Dg N m m 3 5 n ick ic3 N� m>> o. W 3 r'f
CL
Q f -0- m a3 LO CL o m m w° °' o ° �'� 0 m a�� �• �' v o
W p 3. O 7 -O O O 'n x N y 5 (D N N O O o D?
Oa W �, - O- (D `G CML
p o m a O N m p 5 0 j ° Q 3 O Ntr C K
N _
7 (D ,6 O a 0 n m O S A S 0 m O: m W m m n
m W 0 O O O m G Im cD O0 -O N m
N 3 �_ O ]• 3 (Wii N d pSi
!y p �; N? p v �W.. i� w
11 7 O t�
m �m �o �oa0a�mcp'o = a o (D0 m a c
a n i C7 o- 3 3 0 f o" 0
m c m w o a 0 m 3 m v a m °� S
n m m
7 S (n 0 W !!1 CD -0 O M fl, t0 N n
°- � c0 oo°m_ m(n CDN ( y
- CD- !D (D 0. p CL o
x (° �3 m v' ° 3 °g m 3 f
-0 c0 m N 2p C) ¢� a fl y = O o
C N m O O W C C O m m m
m a 3m3 r.c W �° 00' 7
0 ] N --a � — 7�,C a � R
N a (D m3m 3 W m ^'v m
m 7 O Q (D WO
N C
o -5 0 CA �0 0
p +3 0� oa N Q T
vi a �°
> j m m � an' : (D E'
(0 cZc N(D0.�-
O �. m �, W p S n' 3 0.
M m R
m 5 o N O
C m O fl N n 0) Q N 7 ro
==h,< m (0 y
m m 7 a O CL N O
=O O
010
7
33 w
m m 0
n N O
(D
0
3
IDD
RL
m
"O
W
v
m
y
7w
R
m
Z
c
3
o -
m
V
z
O
Q
V
m
C
O
co
Z
c
3
o -
m
W
W
v
a
v
-
41
^ n M
0 n /
® � qg It
3 \ G 2 0
CD
t
yr\ \ \
£ �k
ƒ
E EG
; 0
{ )
£ �
2�
ƒ�
(
§
(
R
0
�
'
o
'
{ //
0
6
—FD
;
E
g
x
ƒ
&$U
R
\,D
[
ƒ
/
\
[
a7m
lw
9
���
�/$
<
&Q
/
E
D
CL
0
E°
In
/
$
//In
U
ƒ
0 W,
P.
N
;
0
/
/
)cr &
0°C°-�
E
G
&
& k
i
/K2)N
,
=
22
.
0/
CD
<(n
&
a
�
{ //
OF
ƒ
R
\,D
{k/
/
\
[
a7m
9
���
/
/
\
D
/
In
/
$
//In
U
ƒ
0 W,
\
;
0
/
/
)cr &
E
G
&
& k
i
,
=
22
0/
CD
<(n
&
�
�/
k/
ea
�
§\
x
}
\
En
a
NOTICE OF CANCELLATION
Customer Name: rJp P4 Dr'Ci—Z-07<
(Please print)
Date of transaction: t,61 • ?Xt ! ')-VIA
You may cancel this transaction, without any penalty or obligation, within three business
days from the above date.
If you cancel, any property traded in, any payments made by you under the agreement,
and any negotiable instrument executed by you will be returned within ten business days
following receipt by the seller of your cancellation notice, and any security interest
arising out of the transaction will be cancelled.
If you cancel, you must make available to the seller at your residence, in substantially as
good condition as when received, any goods delivered to you under this agreement; or
you may if you wish, comply with the instructions of the seller regarding the return
shipment of the goods at the seller's expense and risk.
If you do make the goods available to the seller and the seller does riot pick them up
within twenty days of the date of your notice of cancellation, you may retain or dispose
of the goods without any further obligation. If you fail to make the goods available to the
seller, or if you agree to return the goods to the seller and fail to do so, then you remain
liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation
notice or any other written notice, or send a telegram to
Pella Windows and Doors, at 45 Fondi Rd., Haverhill. MA 01832
not later than midnight of t,6� ;-,�l 70 (three business days from the date of
transaction above).
I hereby cancel this transaction.
(Date) (Buyer's signature)
k
DISPUTES
Job Name �APA3yr"S
Date 110y. o`y, ? o ! E
THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN
ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS
CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE
ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY
OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS
REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO
SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A
?E'L A
Contractor
� 6��, s
omeowner
NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE
AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT
INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE
ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT
SEPARATELY SIGNED BY THE PARTIES.
PELLA WINDOWS AND DOORS CONTRACT
1. TERMS AND CONDITIONS
These Terms and Conditions are. an integral part of the contract set forth on the
Product Order (the "Contract") betv.cen New England Window and Door LLC
dba Pella Windows S Door, Inc. ("Pella") and the person(s) identified on the
Product Order ("Owner") to supply the products (the "Products"), and perform
the work (the "Work") described or referred to in such Contract. For Product
Only purchases, a signed "Product Only Addendum" is a required part of the
contract.
2, OWNER
Pella is not responsible for any existing security systems. Owner shall remove
all shades; verticals, blinds, curtains, drapes or window mounted air
conditioners. prior to the installation of the Products. Pella's installers arc not
responsible for the removal or installation of these types of items. Pella is not
responsible for pre-existing window coverings fitting on newly installed Pella
windows.
The Owner shall provide complete access to the work site between the hour.
of 7:00 a.m. and 6:00 p.m. (Monday through Friday) for Pella's installers to
deliver the Products and perform the Work.
3. PELLA
Pella will be responsible for and have control over construction means.
methods, techniques, sequences and procedures and for coordinating all
portions of the Work. Pella will be responsible for the Work of its Pella
Contractors who will install the Products.
Unless provided otherwise in the Work description, Pella will provide and pay
for all labor, materials, equipment, tools and machinery, transportation. and
other facilities and services necessary for the proper execution and completion
of the Work.
The materials and equipment furnished under the Contact will be good quality
and new unless otherwise required or permitted, rte Work will be free from
defects not inherent in the quality required or permitted, and the Work
conform with the requirements of this Contract. Pella shall not be responsible
for damages or defects caused by abuse, modifications not executed by Pella,
improper or insufficient maintenance, improper operation or normal wear and
tear. Pella will keep the premises and surrounding area free from
accumulation of waste materials or rubbish caused by performance of the
Work.
4. CHANGES
The Owner may order in writing changes in the Work consisting of additions,
deletions. or modifications ("Change Order'). Any Change Order shall
include an adjustment to the Price and the Substantial Completion Date, as
determined by Pella. Pella reserves the right to approve or disapprove any
Change Order and any such Change Order must be signed by both Owner and
Pella to be effective.
SUBSTANTIAL COMPLETION
Owner understands and agrees that the Substantial Completion Date is an
estimate only and that the actual date on which the Work is completed may be
extended to allow for Change Orders requested by Owner or if the time to
complete the Work is affected by conduct of the Owner, weather, labor
disputes, availability of subcontmetor, acts of God, fire or other causes
reasonably beyond Pella's control. if for any reason the Work is not fully
completed by the Substantial Completion Date (including any extensions
contemplated above), but is substantially completed by such date, i.c., the
Product has been installed, but minor parts or components are missing or need
to be replaced or repaired, a hold back proportionate to the cost of remaining
parts or work to be completed is acceptable. However, the holdback will not
exceed the amount of the completion costs or 10 % of the remaining unpaid
balance of the Price, whichever is less.
6. FINANCING
If payment of the Price is financed with a financial institution through Pella, all
financing paperwork must be completed upon signing of this Contract and the
requisite approvals and authorisations for the full amount of the requested
financing shall have been received from the financial institution.
7. PAYMENTS
Pella shall be entitled to stop the Work upon written notice to Owner for any
material default or failure by Owner, including but not limited to, the Owner's
failure to pay Pella the amount due within seven days after the date payment is
due.
CORRECTION OF WORK
Pella shall correct installation. Work not in conformance with therequiremrnts
of the Contract- if notified in writing by the Owner within two years after the
Completion Date or, if earlier, the date on which the Work is substantially
completed and payment of the Purchase Price made subject to a holdback as
provided above. Correction of Work as herein provided shall be Owner's sole
remedy for defective workmanship, and is provided in lieu of any and all other
remedies. Pella's obligation to correct Work is conditioned on Pella's prior
receipt of all payments then due.
LIMITED PRODUCT WARRANTY
Pella shall warrant all Pella products, but only in accordance with the Pella
Windows & Doors Limited Warranty. THIS LIMITED WARRANTY SHALL
BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND
PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES,
EXPRESS OR IMPLIED, WRITTEN OR ORAL (INCLUDING WTI HOUT
LIMITATION ANY WARRANTY OF MERCHP.NTABILrrY OR FITNESS
FOR A PARTICULAR PURPOSE).
10. NO CONSEQUENTIAL DAMAGES
UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR
CONSEQUENTIAL, INCIDENTAL, INDIRECT, OR SPECIAL DAMAGES,
WHETHER FORESEEN OR UNFORESEEN.
HOME IMPROVEMENT CONTRACTORS
All home improvement contractors and subcontractors shall be registered with
the director of the Home Improvement Contractor Registration Program
administered by the Board of Building Regulations and Standards. PeLa and
any of its subcontractors identified in this agreement have been registered.
Any inquires about Pella or any of its subcontractors relating to registration
should be directed to: Director, Home Improvement Contractor Registration,
One Ashburton Place, Boston, MA 02108, 617-727-8598
12. PERMITS (MA customers only)
Pella o i led to and will obtain the following permits for this project:
Homeowners who secure their own permits will be
excluded from the guaranty fund provisions of Massachusetts General Laws,
chapter 142A.
In addition to the rights and warranties enumerated in this agreement, you may
have additional rights under Massachusetts General Laws, chapter 142A and
780 Code of Massachusetts Regulations R6.
13. NOTICE OF CANCELLATION
You may cancel this agreement if it has been signed by a party
thereto at a place other than an address of the seller, which
may be his main office or branch thereof, provided you notify
the seller in writing at his train 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 the attached Notice of Cancellation for an explanation of
this right.
Do not sign this contract if there are any blank spaces.
x
C omer sign mT
Date 1
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. i.:,
ELECTRICAL: Movement of M6fer 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.s100-$9000 fine
DomBuilding Permit Revised 2008mi
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained,
Roofing, Siding, Inferior Rehabilitation Permits
❑ Building Permit Application
❑ !"porkers Comb 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 Con-tl-act
❑ Ploor/Crossectiion/Elevation Plan Of Proposed Work with Sprink{er 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
a Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
"OTE: 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.BuildingPermit Revised 2008mi
a�
3867
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ........ ..... �
has permission to perform Q ............ ............... .
plumbing in the buildings o .. .WNT
�.
at. .... . ........ ........... North Andover, Mass.
Fee g5. �!. Lic. No. ............NO.V ..1.0.1998.... .
� PLU�►�I�A��UVER
TREASURER—COLLECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
I
....`Type or Print) ... __._.. ,... . . .......,,;• ,iivv�t'I.u111�D1(�y c .
NORTH ANDOVER ,Mass. Dam;'
Building Location �3 C� iQ/O cTi Permit a
NO�-
Owners Named � -eTl , Coa
New Renovation Replacement [] Plans Sybmitted . X,
r -1 %/-T-1 lnr[' '
(Print or Type) r Check one: Certificate
Installing Company Name G 14=e )r4Z Corp.
Address aol�f�Y' �✓�26�1 u✓�1 �. d/S~�-� Partner._
Firm/Co.
Business Telephone����
Name of Licensed Plumber: « /c?/G,/b rfCz _
Insurance Coverage:. Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy , Other type of indemnity E] Bond ❑
Insurance Waiver: I, the undersigned, have been made aware- that the licensee of
this application does not have any one of the above three insurance coverages.
Signature of owneriagent of property Owner D Agent% ❑
I bcrcby cutifr Wal all of UIc dclails wad in(osasalion I lu.c submit lcd (at cntucd) in alkavc AM'Iicaliae sic este a T�PU&44 to Un beat r W1
kssowkdgt wad ltsal all pluatbing walk and insullalinns loa(ntnocd undo reswi( i1sucd (or this applkatilw wilt be in oeMpuep �jlM ey ►gt�KM �
IWO" of tbt bUS"msetls Slate f Iumbiag Colic and Cluptcr 112 of Clic GCACA l La«L
i t
By
Title
City/Town:
A DDQr)VFn 70FFICF USE ONLY1
Sig
LicerWEd Plumber
Ty a of Plumbing License
License Number Master ❑ Journeymen
Date .. �ZIglw .......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that . .......... ..... .
has permission for as installation
P g � f
in the Qbuildinn sof . (.�!C!� .�!""R,PRae!. P -v .................
at ... 7,1 .,e�io✓� /°cam ...... . , North A oar r, ass.
FWe� '?? . Lic. No.......�j� �G= .....
GASINSPECTOR
Check # 20 0/3
7951
ft
110
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER ,Mass. Date DEC. 13, 2011 permit #
Building Location 95 CAMPION RD.
Owner Tel# 978-268-8624
Owner's Name NICK PAPAPETROS
Type of Occupancy RESIDENTIAL
New W1 Renovation❑ Replacement ❑ Plan Submitted: Ye[] No❑
FIXTURES
Installing Company Name Eastern Propane & Oil, Inc
Address
131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628
Name of Licensed Plumber or Gas Fitter ROBERT GRENHAM
Check one: Certificate
ZCorporation
Partnership
Firm/Co.
INSURANCE COVERAGE:
I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No ❑
If you have c ecked iy s, please indicate the type coverage by checking the appropriate box.
A liability insurance policy F✓ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all p bi work and installations performed under the pe ' sue r this applicatio will be i co liance with all
ertinent visi s of sac usetts State Gas Code and Chapter 142 f the ene Laws.
By Type f License:
lumber Sign ture of License Plumbe Gas itter
Title -Gas fitter /a/ �r7S, l D
•
-Master License Number l
City/Town • -Journeyman
APPROVED (OFFICE USE ONLY)
1
=
u
MEMO
■■■■■■■■■■■■■■■■■■■■■■
..-■■■■■■■■■■■M■■MM■■MMM■■■■■
Installing Company Name Eastern Propane & Oil, Inc
Address
131 Water Street
Danvers, MA 01923
Business Telephone # 800-322-6628
Name of Licensed Plumber or Gas Fitter ROBERT GRENHAM
Check one: Certificate
ZCorporation
Partnership
Firm/Co.
INSURANCE COVERAGE:
I have a cur liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No ❑
If you have c ecked iy s, please indicate the type coverage by checking the appropriate box.
A liability insurance policy F✓ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all p bi work and installations performed under the pe ' sue r this applicatio will be i co liance with all
ertinent visi s of sac usetts State Gas Code and Chapter 142 f the ene Laws.
By Type f License:
lumber Sign ture of License Plumbe Gas itter
Title -Gas fitter /a/ �r7S, l D
•
-Master License Number l
City/Town • -Journeyman
APPROVED (OFFICE USE ONLY)
Aug 12 2010 9:360
NG. 3096 F- /
'
The Commonwealth of lllassachsrsetzs
Department of Indusvial Accident
Office of Investigations
600 Washington Street
Boston, M4 62111
Workers' CompensatiolQ3nsurance Affd2vjt: Bulid--:s/ContractorsMe--tsicians(Piumbers
.Applicant Information Please Print Lecabl�'
Name Businessornnintionllndividuan:
Address:
City/State/Zip; ��i i �/'�� S % of y' phone .#: % %J -�So
Are you an employer' Check the appropriate box:
Type of project .(required) -
I _ I am. a employer with
4.7 1 am a general contractor and
6. [D New contra^tion
employe --s (ful] and/orpart-time)."
have hired the sub -contractors
7. 17ketnndehng
2. 1 am a sokP ro Pnefor or partner-
listed on the attached sheek $
ship and have no employees
These sub -contractors have
8. [] Demolition
working for me in any capacity.
workers' comp. insurance.
g. Building addition
[No workers' eomp. insurance
5- We are a corpotatim and its
n
10.7 T.lect6cal repairs or additions
required.]
3..(Q I atn a homeowne doing all work
ofncers have ex,rcised their
right.of exemption per MOIL
11.[ Plumbing -repairs or additions .
myself. [No workers' comp:
t
c. _152, § 1(4), -and we have no
employees. [No workers'
12.0 Roof repa=.
instnnnee required.]
:
13. Other G�S.l'�°�i"�,r'-
comp. b surance required_]
;Any amplicaml at ebecks bat #1,mast also Il oat the secdoc below sbowing thdsavu=' mon poky tnftomatioa
t Homeowneto wbo submit this afftdpvt•, mdiesarg-they tae donor alt Work and taco has n m caatsact= mun Utz x omw afdaN t indi=tM'r sxs
cau=== tiros boxmi Moir w itess' cmc
I aw an employer shat k providtr4 workers' compensudvn irrsrsrat:se for -m3' :employees. Below is the.p0hey and job site .
iJ7fOrQi027ti2/ —
Insumuc . Company Name: e, f ti
Policy kor Self -ins, .Lic. 0; % t�//—
r
„ Job Site Address: Q S CQ tin %. tn,.
e: trutitaste=
Attseh.s copy.of the workers' :eompeasa�on policy deelaza;jnn:p��lshowlag.tne:polt'g number $md �.. on
Fail= to secure cowmge as required ander Section 25A of MGL .c.:IS2 .= lead to the bopositiim, of Crimi . penalties .of a '
fine up to. $1,500.00 and/or one-year imprisonment, as well as eivE pmaltics'in' tke form of a STOP WORK ORDr-R and E. fine .
of up to $250.00 a day against. the.violaim. Be advised that a cagy of this statement may be forwarded to the Of-ricc of
Investigations of the DIA for inst>ianee coverage verificabon �
I do hereby.cerfift under_the pains and p peuhrq e -information prov td a6,av .rmc imd correct
Date: �.
Phone 41-
- — — --- ----
Ofj'l-aw use only. Do .Rat write in this area; to be completed by city Or town nfficlal
City or T.o,wn:
Perrulsll.feense_
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. Ctry/I'owr Cierk Q. Electrical Inspector 5, Plumbing.Inspe.etor
6. Other
Contact Person: phone #t:
U
x
C4
cz
.1,
c
fly
w
t
ZZ
Z
�
U
v
C
G
_
li
N
C
z
—
C
7G
^ —
1
Q
e—
N
z
�
�
Z
k
J
_
Z
Z
j
_
G
e
C
y
W
_
v
Cr
O
V
Cz7..w
U
�
Z
o
f
C
CL
V
�
r�
z
n
—
-
U
x
s
w
t
ZZ
t
�
U
C
_
C
C
z
—
C
1
U
�
Z
Z
e
C
s
w
t
ZZ
t
�
U
C
_
C
C
—
C
1
W
W)
cz
.�
w
w
u
o
w°
v
T
A
0O
w
z
z
A
°
ro
Cm
w°
04
U
w
w
c�°
i
w
W
U
U
W
P4
cn
w
�"
O
w
-•
O
Con
�ro
w
E�
W
w
A
w
w'
cn
v
Q
cn
H �
a Lij
z
O
O
E
O
o v
Z co
CL
O y
D �
I cm
ca ''ww O -
W Q
� Hs
CL ♦..�
�3
O >
CD
Q
L
cc O d
M: Q1 Q
C
o s C cc
c
CJ J .O
C Z O
V t/2
O C
_c
0.
_0
C/)
U)
W
w
W
LLJ
U)
o
CD c
c �
o c
L
CH
O
. C
O
v U
•d'c
;ac
ea �
CD c
:z o
:.� cc
O
N
Ea
m c
m
: = V
c
VJ
O m
c�
O O
C..
'CD
E
y R
CD m
m
d.
O
L
H
v,
CD
M
••
C_(
C
H
' C',
!^�Em
C
O
v / m o
C
' CLC.) 1-:m
N m
c
N
CD p
m
cc � Z
o
:coa
c'
c
Q
V
CL
H m C
Q
x
m
cc
N
f-
o
40
COD
F-
of
C ca .cLU
Z
�
O o y
O
U
Lm
d
O O C
C#*
CL
m � O '�
`
a�m�
O
O
E
O
o v
Z co
CL
O y
D �
I cm
ca ''ww O -
W Q
� Hs
CL ♦..�
�3
O >
CD
Q
L
cc O d
M: Q1 Q
C
o s C cc
c
CJ J .O
C Z O
V t/2
O C
_c
0.
_0
C/)
U)
W
w
W
LLJ
U)
3 0
Date .. . ...... .
A
TOWN OF NORTH ANDOVER a
PERMIT FOR GAS INSTALLATIONo
N
M
d
This certifies that ................ ....... ......................
has permission for gas installation .............. ° ...........t
in the buildings of... `.:.:...:........ t.................... .
at ......I...........,' .: - ..:r'..!.... , North Andover, Mass.
Fee.'. . ... Lic. No.:.::.?.... .........................
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
0
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
L-C� l Rnrkn, h cC Mass. Date 11 19 gff Permit # 2- CJ
Building Location 95 00 vvt �j �rJ �� Owner's Name UG N Cef S ca ! P
Type of Occupancy Residential
New ❑ Renovation ❑ Replacement IN Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Heritage Htg. &P.lg. CO. Inc. Check one: Certificate
Address 3Pleasant Street LX Corporation 714.
Stoneham, Ma 02180 C1 Partnership
Business Telephone 781 -437 L1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 9 No ❑
If you have checked Les, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy 0 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
_ Owner ❑ Agent ❑
I hereby certify that all of the details and information I havo submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbin Code and Chi a 142 of the General Laws.
By —
Signature of Licensed Plumbe17
Title _
City/Town Type of Liconse: Master [:X Journeyman ❑
8 3 2 2
APPROVED ZO€FICEUSE ONLY) License Number
W�'
F
N
N
Z
0
U
X 'Q
Z
••
N
-ri
O
H
W
'a
'
Q
~
O
Z
N
of
Q
2
O
F
U
Q
vl
Z
Q
`n
O
4
J
—
to
m_
N
x
Q
a
w
N
Z¢
a
c�
Z
C
x
rd
M
w
t-
w
Q
o
Q
m
e
m
J
_
p
¢❑
LL
$
x
x
x
w
F
z
U
Q
y
X
F-
3
O
3
=
O
a'
7
=
vt
r..
Y
Z
a
O
O
F'
to
¢
z
Y
x
W
O
O
T.
Q)
n�(1
Q
F
Q
Q
S
N
N
Q
Q
O
Q
J
J
"�
2
rt
rtr,
-t-�
3
Y
J
ti
O
C9
i
I
N
O
J
y
r-
(!i
LL
7
0
Q
LS
m
O
SUB—BSMT.
BASEMENT
I
1ST FLOOR
W
2ND FLOOR
N
A
3RD FLOOR
D
IT
4TH FLOOR
j
IT
STH FLOOR
R
S
6T11 FLOOR
E
7TH FLOOR
C
9
8TH FLOOR
`1.'
D
Installing Company Name Heritage Htg. &P.lg. CO. Inc. Check one: Certificate
Address 3Pleasant Street LX Corporation 714.
Stoneham, Ma 02180 C1 Partnership
Business Telephone 781 -437 L1 Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes 9 No ❑
If you have checked Les, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy 0 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
_ Owner ❑ Agent ❑
I hereby certify that all of the details and information I havo submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbin Code and Chi a 142 of the General Laws.
By —
Signature of Licensed Plumbe17
Title _
City/Town Type of Liconse: Master [:X Journeyman ❑
8 3 2 2
APPROVED ZO€FICEUSE ONLY) License Number
N
z
0
U
W
N
z
N
N
W
cc
t�
O
m
CL
W
W
U.
N
z
O
h
U
W
M
N
z
J
a
Z
LL
0
z
0
z
cl
JI.
a'.
m'
LL
O
W
a
N
r
w
a
z
a
w
m
0
O
R
co
1
—� cn o m m 0
p
Dm
o
>
m
o
>
?
m
m=
o
CL
o
c
a
j
T
m
0
0
co
.�
c�
c
Z
4
lo*
C
CD
o»
C
C
CD
m
3
=rt
�
m
CDO
CDC
CD
CZ
j
�
11
Z
-i
6969(06969�696n
CD
= o 0 °g
n z z z
I z m
m m
_^ f7 r r
1�
j
0
z
i
C
A
m
0
O
f
z
m
A
0
A
>
C
i
>
m
z
i
O
i
m
r
m
O
A
D
T
0
L
m
v
10 > D m
O 0 m
m m m
N - 0
r r N
0
C c mN
N N
-4 1
z z
N N
w
N
Z
c
0
4
0
z
N
w
.D
0
v
m
Z
0
A
3
0
z
M
m
f�
y
o>
o
v
o
m>
O
O
r
N
3
>
r
c
c
_
c>
_
Ni (
>
Ni
>
N+
>
r=
m
z
m
z
m
0
Z>
m
v
0
m
S
r
0
r
0
r
0
O
m
z
00
z
z
0
A
1
m
A
N
A
N
>'n
r
Z
Z
Z
rIn
O
m
m
m
-4
N
11
-�
>
z
Z
o
A
3
A
3
0
z
N
O
>
0
n
r
m
m
_o
f
m
x>
m
m
m
N
O
z
A
>
0
i
A
A
m
m
N
0
0
0
Z
m
1
0
3
z
z
N
a
w
r
zO
0�
o
W
o
0
Z
,
C
s
m
N
RR
0
[
/
`
0
0�
x
�/
I
N
ZI
0.
0
m
0
O
d
A
A
m
Z
4
m
>
>
0
A
m
�+
N
m
Z
c
�►
c
m
c
C
m
0
m
0
=
z
i
m
0
m
x
T
0
r
r
r
O
A
D
m
'iUZI'
'n
m
,�
N
m
- m
z
z
z
z
r
o
�z+
0
p
,).0000OOim
�/
0
0
A
A
m
'
Z
Z
Z
z=
0
Z
0
O
z
A
N
t
N
C
O
Z
Z
Z
0;
O
D
o
A
vi
0
N
;
>
m
0
i
i
_r
0
z
<
i
0
o
-Ni
N
r
N
m
p
z
0<
o
m
O
m
O
m
O
0
A
Z
N
N
Z
0
0
0
T
0
m
A
>
i
*
i
*
r
r
I
N
_
i
A
z
z
O
v
T
r
a
o
0
F
-4
o
N
N
m
_
�
r
z
x
iTT
>
m
m
r
r-4
n
x
z
qi
N
0
0
m
M
A
0
o
a
m�
LL
WW
Z
Nin
0
c► o � .
Z�Z
a a
0
G, �u,-
Oo�
mJuai
Z
emu
o ZLL
4c w0a
gmw
UNI
QZxwF
w�W
Som
a.
u
mall
W
a.
Zam
OmFu-•
uww
W
mJW
m
N 10<
u
Z
Q
a
u
01
7FI ITITF
O
�, l!
O O
a Z
z
2
O
z
°c
LL
p
a
Z
-I I 1 T
ro� I I
m I
7.
w W
Z
O
O
OJ
LL
z
n
T
T
m
f
W
p
L °e
Q
>
Z
O
�
Q
�
as
;
I
�
w
Yp�>�
W
ZQ
oeO�w
Z
0
W
'
Q W
V V
Y
d
X
. i
N
Z z
m
3 X
p LL
K
p 0
i
1-
w 0
p
o x
Q
w w
Z
O w
Q
Z
�
m Q a
Z
w
U?
O
v r
N
O a
s d
n
V
Z
N z
O Q
LL D
W 0
~
ZO z
U Q
2
K W
S
0w
D
N>
zz1.
p
=
U
�
W
2 a
N O
!?aa�Z
�
OQaO�
V
w x
V a
�
Q
�0
N Q
a0
m ''
�0�p�_
Y Z
0�
r �-
�
1
=0:
to S
<u
Q o[
0
J
�%
zI�
o
a
�
N
i
z
O
�-
y
ce
y
Y
y
m w
a
w
Z
p
O
_z
J
O
O
r
F
W
a
W
p
Z
ZO �
Q<
Z
2
� Z
O
a 4=
x
N
f
p 11
O
w
O
o v
j
N
Z
Y
m0
Z
W
a
-
s
Npc�oop:E
Z
-
a<
Q
0
W
- 0
�Z
�L
u0
ad
K
W
=
C`1 t7
TF
Zp
Q QZ
O
W
N
0
J
�_ �
:
O
O
Z
a 9
Z -
v 1
N z
o
Z Z
0 0
z Z
U
ocZZ
0 0
0
2
"'x
Z
v
Q
<0
0 0
_N
O
N
�inQ
m f
LL
g
0t-o�
W
V VYN
O
O
w\m0
md0=�'�OOY
0
0
OtjZZ
w
�m�x0�-��
0
0
O
mwO
0
~
wI i¢
N
O O
a
N
Q ZI
S
a
�20-Q>
U O
3 Q
N N
m m
O
O
If1
c7 c7
LL Q
3 N
Sp
3
N
3
n
m
C7
0
z
U)
m
D
0
z
P�o
C
v
CA
d
C �
CO) CO)
10 0
CD
C0 Z CO)
CLO n�
r
c
C � C
C. �• y
O
O CD
CDO
C.
Q
CD
CD O CD
CD
v CD
O y
�CD
CO) O
'O Z
CD
O CD
O
CD
I c�
/�
cf 1
E~ 1
J
".
0
t.�
C
O
0
z
0
CD
N
O
_
_
co
0
CL
00
tL]
CD
co
c
co
O
_
y
O
CL
N
CO)
CD
MU
o
mca
v
H
0
Go
�
rD
ao�o cr
i`r
CA
»:m o
O
C7
co o a�
coD ...► C
3
m
=-o
W
N
y
=
T
CD n=M
o
en
m
O CD H
c
rD
�•
o
a'
:
oho:
O
= W H
O
O y O
moCID:
CO)
CL
O 3s:
Cl)
�
H :1
A�
C CD
CL-,
CD
CO)
1
N
LUcr
CL
•
c
W —
CL
d W
_
lE O
N
CDCD
.d•► CA
= CD
co ;
„n,►
.. C-) :
o
VI
�
O
n►
CD O
'O O
W �
�Nb
CD�
o:a
•
_
oCD:"1
d .
a �
anal i
C O
o
MU
o
mca
v
H
0
cn
77,
O
crn
CDD
o
�s
�
rD
i`r
D
a
m
�
o
n
OQ
y
??
w
o
OCG
r
m
W
o
en
o
�
�'
r
c
rD
�•
o
a'
:
cn
77,
O
crn
CDD
o
�s
�
rD
??
w
�
ao
a
??
w
c
o
n
OQ
y
??
w
o
OCG
r
m
W
o
en
o
�
�'
r
c
rD
�•
o
a'
:
o
x
a
0
c