Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 1 GREENE STREET 4/30/2018
r 7397 Date�.- C�. � :. f. P ...... TOWN OF NORTH ANDOVER INSTALLATION This certifies that C . (' 0 ...................... has pe mission for gas installation �eAYI�. SyiS4.70-6 in the buildings of ��<,JA ... ��. �� � q�� . :. . at 40 Y� '�. .-�. . .4 (24Y 1P. North Andover, Mass. Fee. . Lic. No. ( .. .................... Check # GASINSPECTOR TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 40 SA "US This certifies that C.r.,inti.,r C' ........ ........... has permission to perform jcl' �7 plumbing in the buildings of at P. t7�iiq.. . /W.. .... North Andover, Mass. Fee.3.�.—. Lic. ... ....................... &S .... Check # Is�� 3e PLUMBING INSPECTOR 8 7 0 5- iVlAA CFFU TTS �UNJYORM AJPPLZCATXON POP. P£RNAIT TO JQ 0 PLUMBING (Type or print) NORM ANDOVER, MASSA.CHUSEM ,i BuildingLo r�UIL•a/�X•S New I MW Renovation Replacement 1009.o J1= 1q, 4Newz9e- Date �10?c� 511'1G- -� / Amount Plans Submitted Yes El No 1-1 ' -- Checkene: (prini•ortype) ez ib� { Corp. Oe �ti Installing Company Name t-. �,-12� ,�� El Partner. Address � � �� i�IJ V E►2S D �)iimnlCo. Business Telephone _ Name oELicensed Plumber: _ ro mate box: insurance Coverage: Indicate the type of insurance coverage by checking th aPP P Bond Liability insurance policy Other type of indemnity. Insurance waiver: I, the undersigned, have been inade aware that the licensee of this applic.ti.,, does not have any one o£the above three insurance y owner E] Agent to te I herebycertify that all of the details and information I have submitted (or entere aeinBabboov pp - { s application will be ince best ofmylrnowledge and that all plumbing work and installations performedun e and apter 142 o£the General Laws. compliance with all peitinent provisions of the as husetts 1 By. a o ei�de r Typeof lumbingLi e Title Master Journeyman City/Town kens nm er .APPROVED (OFFICE UsE ONLY The Cotnnaonvea&h of 1V.�dassachusetts ' �3epr�i�'ment�f.�",radt�s�iaz�ecider�ts - • flfjzce o. f t��estigatio�zs Washington Street Bostan, JW 021.21 WW-MasagoY lAz Workers' Compensation Insurance Affadavdt: B.xUder's/Contractors/Electridans/Plumbers .kra licaut Information ' t Please Print Le-cgblg Nam1e (Business/Oro nizatio&lndividual): 60AAM.S ------------ Address: Phone #_ " •Are you an employer? Checks, the appropriate box4 Type of project (required): 1: �� a employer with O�[ 4. ❑ I am a general contractor and I employees (RM and/orpazt-tim.e).* have hired the sub -contractors 6 Nein construction ?. ❑ I am a sole proprietor ozpartner- dialed on t=he attached sheet, # 7. Rremodeling ship and have no employees These sub -contractors have 8. (l Demolition working for mein any capacity. workers' comp. insurance. [No workers' comp. insurance �. 9. [] Building addition p [� We are a cozporaiion and its • required.] ofEicrrs have exercised their IO•[( Blectrical'repairs or additions 3.0 _I am ahomeowner doing all work night of exe,mp{ionper MGL 11.(] Plumbing repairs or additions myself. [No workers' comp. C. 152, §-1 (4), and We have no 17 Roofrepairs i'nmiance required.] t employee2. [No workers' 0 9.omp. msrzt anc� required ] I3.0 Other i`-x�.`+'•'-'r`n_..F3C=^_::5°-C.�•.:'.l�n Tjov 47_• ^-^•5 T=�^a^ Vr'CI: "..i.S' COL^""^ �rn.�8 i..... �u_.�,_ EIQMa,0Wn=WIIO submit ihas affidavit indicatingt_h t dT Y""c Y"•' � i..::.�:.;:s. q an �euz_ r11 wu ii and Shen hire -outside contmcto s iS&t �a wrt a new affidavit incicafing such. }Contreetnrsicheq'� the Loz �• o°t arc ed cu aaditionai Sheet showing the aame'of the sub -cont =tcn and theirworkers' comp. policy informatio, rzm an employer that is providing workers' corrzpensaiian in-swrance for rrzy ettzplbyees IfeX©its is the paiicp and job site. iPl. f07Tltd2ri'021. . Insurance Company Name:%��L- �j2j �► ,$C,E.f� /Y' Policy # or Self --ins. lain. ID S / EXpiration Date: Job Site Address -,Q-49 8L?&eC,rj,IU d6T,bP City/State/Zip:Al, J4,VbwElel Attach a coppof the workers' compensation policy declaratimn page (shoy;ng the policy number.and expiration f + Failure to secure coverage as required undar Section 25A of MGL c. 152 can lead to the imposition of c imfi al ,penalties of a Fine up to $1,500.00and/or one-year imprisonment, as Well as civil penalties in the form ofa. STOP WORK ORDER and a Fine of up to S250:00 a day against the violator Be 'advised that a copy of this statement may be, forwarded to the Office of Investigations of the DTA for insurance coverage verification. _ I do here/77s ceritfjr under the pains and peizal es afperjury thrxt the hLformaizon provided above -is true and correct: Sieuaiure: Date• • . 6z:MkM-W,,rIffrIM= Official use only..Do not write in this area, to be completed by eitp -or tonin official City or Town. 1'erznitucense ,—u -g Authority (circle one;. 1. Board of Health 2. Buiidiab Department 3. Cify/Town Clerk 6. Other Contact Per -suit: 4. Electrical Inspector S. PlumbingrInspector Phone NHASSAaTSETTSI1NMRXIAPPUCATONFDR PERIMTO DO GAS FMING (Type or print) Date NORTH ANDD ER, MASSACHUSETTS Building Locations 1Qdc 1 f 0)eg- e5,4 Led J)DL 27 Permit# c&/46/ , j Dt� D� Amount $ ,Ej �/ �' 02 Owner's Name N 4f 0 gp NDLES/N& &2jPe=) New ® Renovation ® Replacement IT Plans Submitted (Print or `C- S Check one: Certificate Ins alling Company �2orp. ci�fv l� �-El--� Partner.. ® Firm/Co: Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®-- No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policyElCther type of indemnity E3Bond Owner's Insurance Waiver: I cum 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: Signature of Owner or Owner's Agent Owner ® 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 - [Jest of my knowledge and that all phmnbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach4&ts State ,,; C4 pter ? of ,�e General Laws. By: Title CityiTown APPROVED (oFFICE USE ONLY) Signature c Plumber Gas Fitter Journeyman Or Sias -fitter U �. H F z z a6 O F w A w w °° a G � o Z z z Q � � c�a +O Ah Ux OO Z �7 Q y a. F SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR . 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. I?LOOR R STH. FLOOR (Print or `C- S Check one: Certificate Ins alling Company �2orp. ci�fv l� �-El--� Partner.. ® Firm/Co: Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®-- No If you have checked yes, please indicate the type coverage by checking the appropriate box. Liability insurance policyElCther type of indemnity E3Bond Owner's Insurance Waiver: I cum 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: Signature of Owner or Owner's Agent Owner ® 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 - [Jest of my knowledge and that all phmnbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach4&ts State ,,; C4 pter ? of ,�e General Laws. By: Title CityiTown APPROVED (oFFICE USE ONLY) Signature c Plumber Gas Fitter Journeyman Or Sias -fitter ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID RP DATE(MM/DD/YYYY) CRANNCO 03/29/10 PRODUCER Thomas Gregory Associates Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Wakefield MA 01880 POLICY EXPIRATION DATE (MMIDDfyyj Phone: 781-914-1000 Fax: 781-246-2601 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Netherlands Insurance Co INSURER B: North River Insurance Company INSURER C: Cranney Companies, Inc. 10 Rainbow Terrace Danvers MA 01923 INSURER D: INSURER E: X .COMMERCIAL GENERAL LIABILITY VVY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE (MMIDDfyyj LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X .COMMERCIAL GENERAL LIABILITY CBP 840 43 40 03/25/10 03/25/11 PREMISES (Ea occurence) $ 300,000 MED EXP (Any one person) $15,000 CLAIMS MADE [j] OCCUR X Per Project AGGREGATE PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE 1$2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $2,000,000 PRO- LOC POLICY X I JE AUTOMOBILE LIABILITY A ANY AUTO BA 8400753 NA AUTOMOBILE 03/25/10 03/25/11 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS BA 8753297 03/25/10 03/25/11 (Per person) X HIRED AUTOS OUT OF STATE AUTCMDBILE BODILY INJURY X NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLAUABIUTY EACH OCCURRENCE $10,000,000 B X I OCCUR D CLAIMS MADE 553-093231-5 03/25/10 03/25/11 AGGREGATE $20,000,000 $ RDEDUCTIBLE Prod/CO $ X RETENTION $ 0 Ops Aggr i$10,000,000 WORKERS COMPENSATION AND X TORY LIMITS I I ER A EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC 840 47 40 03/25/10 03/25/11 E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1f0001000 OTHER 10 Days Notice of CANCELLATION applies for NON-PAYNENT OF PREMIUM DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS I.r-K 11rIl.A l r- 11ULUr-K GANGELLATION EVIDENC I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC Evidence of Insurance DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL XXX DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. From: 09/28/2010 13:29 #663 P.001/008 One Team 6 Total Solutions C ._ CRANNE111COMPANIES Electric fabrication o HVAC a Plumbing a Communications 10 RainbowTerrace * Danvers, MA 01923 a 800-559-7000 • FAX 978-750-0535 To: Brian Leathe From: Kim Fax: 978-688-9542 Pages: Phone: Date: 9/29/10 Re: i comments: CC: www.cranneycompanies.com Excellence Since 1982 From: 09/29/2010 13:29 #663 P.002/008 09/30/2010 HDA 1032.3 P11 DHCD POU ...OWNER -CONTRACTOR AGREEMENT C0M MG16EALTH 0 F lNAssnt:rmsmn DEPARTMENr OP HOUS11m AND COmmuNm D9V6r.OPmENr 0002/007 This agreement made the 30th day of JUNE, 2010 by and between NORTH ANDOVER HOUSING AUTHORITY hereinafter called the "Owner", and CRANNEY COMPANIES, INC., bereinafter called the "Contractor, Vdnetsdk, that the Owner and the Contractor, for the consideration hereinunder named, agree as follows: Article 1. Scone of Work: The Contractor shall perform all Work required by the Contract Documents for furnance replacement at the 200-1 family housing development prepared by GRI MTH & VARY, INC., acting as and refeaed to in the Contract Documents as the "Architect". ARTICLEZ.TIME OF COMPLETION: The Contraetor;ball commence work under this Contract on the date bpeeifled in the written "Notice to proceed" and shell bring the Work to Substardial Completion within► 70 calendar days of said date. Damages for delays in the performance of the Work shall be in accordance with Article 9 ofthe Geaend Conditions of the Contract. ARTICLE 3. CONTRACT SUM: The Owner sball pay the Contractor, in current funds, for the performance of the Work, subject to additions and deductions by Change Order, of the Contract Sum of: ONE-HUNDRLD SEK -THOUSAND SIX -HUNDRED dollars $106 QQ,Qg, ARTICLE 4. TIIE CONTRACr DOCOMENTs: The following, together with this Agreement, form the Contract and all arc as fully a pari of the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents, Contract Forma, Conditions of the Coatrac4 and Specifications as enumerated in the Table of Contents, the drawings as enumerated in the List of Contract Drawings, DHCD publication known as the ConstructionHtmdbook, and all Modifications issued after execution of the Contract. Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions. ARTICLE 5. REAP CERT NCAn0N: Pursmat to M.G.I„ c.62(c) ¢49(a), the individual signing We Contract on behalf of the Contractor, hereby certifies, under the penalties of perjury, that to the best of their knowledge and belief the Contractor has compiled with all laws of the Conunonweddi relating to taxes, reporting of employees and contractom, and withholding and remitting child support ARTICLE 6. WQll;MI)ocumeWAMON CGrrrIFiCATION: In aocordaaca withExccutive Order4$1 the undersigned tamlter ccrtifinos under the penalties of perjury that the Contractor sholl not knowingly use ondoeatnented worirers in carmection with the performance of this contract; thatpursuent to federal requirements, the Contractor shall verify the immigration states of all workers assigned to such contractor without engaging in unlawful discrimination; end that it shall not knowingly or recklessly atter, falsify, or accept altered or falsified documents fram any such worker(s). The Contractor understand; and agrees that breach of any of these teams during the contraotperiod may be regarded as a material breach, subjecting the Contractorto sanctions, includingbut limited to monctarypeoal6es, withholding ofpoymenls, contract suspension or termination. ARTICLE 7. VALMAtION: This Contract will not be valid until signed by the Department of Housing and Community Development. In IP brawJFhereof,dwParWdNffreroTTaPsCWad A&Ta&umeWto6eF.zecat d UnderSoL r CONTRACTOR 2 AWARDINGAUTHORITY CR_ ANNEY COMPANIES, INC. N®aofCantmotsQ 10 RAINBOW TERRACE Stmt By: VARM riga contract. DHCD2009 a149 S10k 25k NORTHANDOVER ]HOUSING AUTHORITY Naim ofHouftAuftft • ONE MORKFSIQMEADOW$ N0.'ANDOVIK MA 01845 • deeir start d Seal S tA, Mae Attettr Ifdpedby 6omeonoothtrdmoa HoudagAuthority8amdmw#=, amcha copy afcwmt d Bused Vag theaipntoty to sign conbut Owner Contmclor Agremeal 1 Oft. UNM DEVELOPMENT and Rcvl6w thado. From: 09/29/2010 13:29 #663 P.003/008 0e/30/2010 HON 10%25 VAX DHCD PDO �j003/007 CERTIFICATE OF VOTE OF AUTHORIZATION ` June 30 2010 1 f hereby certify that a meeting of the Board of Directors of the: c Cranney Companies, Inc N" or CORPO MN duly called and held at 10 Rainbow Terrace on the 30 day of June 2010 At which a quorum was present and acting, it was voted that Brian Cranny i Name or Corporate Officer of the Cranney Companies, Inc , be and hereby is authorized to execute and deliver for and on behalf of the Corporation a Contract with. North Andover Housing Authority, for work to be done at State Aided Housing Project No. 196028 In the Cityfrown of No Andover And to act as principal to execute bonds in connection therewith, which Contract and Bonds were presented to and made part of the records of said meeting. I further certify that Brian Cranny Is duly qualified and acting Name or Corporate Officer President of the Corporation and that said vote has not been Title Repealed, rescinded or amended A true copy of the record, ATTEST: !( (CORPORATE SEAL) On this4)4 day of I)rLL 2010 before me, the undersigned Notary Public, personally appeared fidim c. . duly designated by the board of directors and proved to me, through satisfactory eviden of Identification, which was If cent -e , that s/Fle is the person whose name is signed on the foregoing documents, and acknowledged to me that s/he signed it voluntarily for Its stated purpose and that it was her/his free act and deed. Notary Public'' My Commission Expfres,, ALANA JEANE BROWN NOTARY PUBLIC C0liWDtIWFJIITtI OF iNl4SACH1t6ETr6 + MY Carnet. Erb W 0Ct 91, 2014 MM DECD 912009 049 $169WI, Corporate Yale I or 1 From: D8/30/2010 KDN M25 PAX DECD PDU 09/29/2010 13:29 4663 P.004/006 FORM OF GENERAL CONTRACTOR'S EQUAL EMPLOYMENT CERTIFICATION Commonwealth of Massachusetts Department of Housing and Community Development This form must he completed and submitted by the Contractor prior to the signing of the Owner-ConlractorAgreement. This certifies that: Cranney Companies 4 Contractor 10 Rainbow Terrace Street Address Danvers, MA 01923 City/S141e0p Code i i 1. Intends to use the failowing listed construction trades In the work under this contract:- Plumbing ontractPlumbing i Electrical t 2. Will comply with the minority manpower ratio and specific affirmative action steps contained in Article 14 of the Conditions of this Contract; and 2004/007 l 3. Will obtain similar certifications from each of Its subcontractors and submit to the Owner prior to the award of iany subcontract under this contract the subcontraclor's certification. SIGNATu E OF AUTNDF'MD IREPRESENTATNE OF CONTRACTOR Ihl nil X11► Jan �1 r gl (Yin g i NANlE ATID Trr co holly DATE 1 DHCD GC EEO FORM 912009 Page 9 of 1 From: 08/30/2010 MON 10.26 FAX DHCD POU 09/29/2010 13:29 #663 P.0wuw @005/007 mna zl PERFORMANCE BOND COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT KNOW ALL MEN BY THESE PRESENTS: Thalwe , CRANNEY COMPANIES, INC., as Princlpal, and NORTH AMERICAN SPECIALTY INSURANCE COMPANY as Surely, am held and flrtnty bound unto the NORTH ANDOVER HOUSING AUTHORITY, as Obliges, In the am of N& HUNDRED 61I. OU t1ND dollars ti ftello.00 to be pall to the ObIbee, far which payments, well and truly to be made, we bind ourselves, our respective heirs, executors, adminlslrawre, successom and assigns, Jointly and severally, firmly by those presents. WHEREAS, the said Pdaclpal hda made e-cbnbaotwiththe'Ohllgae, beating Itodate of JunaL 2010, for furrmce replacamentatthe 200.1 family housing development In Horth Andover, Massachusetts, NOW, the condilion of tlrle cbllgallon to such that If the Principal and all Subcontractors undersold cantrW shell well and truly kelp and perform all the underWkinge, eovenento, agreement, tames and conditions of sold eordant on Its part to be kept and perlotmed during IN odelnal term of said canbact and arty G)bmlona thereof that may be granted by the Obilgae, wilt or without notice b ew'Surety, and dudq the life and any guarantee requited undhtr the contract, and shall also well and truly keep and pwbnn all the undettaktnge, covenants, agreementa, terms and condlltons of any and ail duly aulhodzed modiltcallons, ahltarcilons changes or additions to said contract that may hereafter be made, nottas to the Surety of such modt6ca0ons6 aftamllons, changes or addt(gnb being hereby waived, then this obllgetion shall become nhtil and void: • otherwise, ll shat rameM In fug farce end Nrtus. • j IN THE EVENT, Ihat ft contractlo abandoned by the Pdnclpd, or In the avant that the Obligee, underthe provisions of i Article 10 or thsi General CondlIlms of laid contract bmiInalaS the amPtoyrnant of the Principal or the authority of the h Principal to continue lihe work, said Surety hereby further agrees that sed Surety shall, If requested in wrung by the Obligee, lob suds ac0on as Is necessary to caarpiele void oontrahsl. IN WRNESS WHEREOF, the PrinrJiW and Swetyhave hereunto Gal iheirh m* and mole Oft; flay of 2010 NORTH AMERICAN SPECIALLY `'' PRINCIPAL co>uPaNl ,iNc SURETY INsuRnici CoMPANY seal At¢omey{n F{hct, sEter J Attest The rate trlhlsbond is 25 %foribalrst; 100,000 grid 15 % for the mod i 6.000 The told premium fortltis bond Is .# 2,599- D}iCD5100K4111H • • I • PatormatuEtlad C14911010 1 ori i 3 From: 08/30/2010 MON 10:27 FAX DHCD PDU PAYMENT BOND 09/29/2010 13:30 #663 P.006/008 COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT - t •ICNOWALL MEN BYTHESEPRESENTS: That we, CRANNEY COMPAN.IES,1NCy as PdWpal, and NORTH MERICAN SPECIALTY INSURANCE COMPANY as Surety, aro held and tlnnly bound unto the NORTH AN130VB HOMING AUTHORITY, es Ch"a e, in the sum OfOL lNDREn 1U)I.TFIfluBpNO SIX44UNCRED do1lar8 5108.80OAo to be paid to the abligee, fur Which psymerds well end Indy to" be made, ws:bind bili tvas; our:rdapao0ve helm, etecutorc. admin ir6'sr$;;sumo'Mrs;cnd.*1g-ne' lainity and severally; tirtNybythsea`preaenfe. .'� . ..- • .. ,:.• �� - jWHEREAS, the said Pdndpal has made a contram wllh On ObltgAa, bemdrig the dam of Junee.2010, for furnance replacement e, the 2001 family housing development in North Andover, Maswchusaft. - i NOW the cond0lom orOds oblgallon See such that Rote Prtnelpal and et subcontractors under sold contract Shell pay for a0 labor perfancsd or %mlehed and for all malariels used or employed In said contract and In any and all duly auftkad nmdillcations, egsrelions, extensions of firma, ranges or add4lone to said contract that may hereatier he meds, notice to the i Surely of such modlfloadona, alterallorm, extenelo o of Ilme, changes or additions bebrg hereby valved, the foragoing to include any other purpose or items at ad In, and to be subject to. proAsImc; of M,G.L. 00 PRA, and M.QL 048 §28, as amended, then ihlo ob4gation Shell became nun and veld; otherwise it shall remain In full force andyirtua IN WITNESS WHEREOF, the Prinolpsl and Surely haws hereunto settheir harule andreale thIm Day of 2010 PRINCIPAL CPJMEYCMPAIMIE%INC seal NORT}I ANI�RICAN SPECIALTY SURETY IN8UIUINCE COMPANY Attom*fn Feol, Attest Thereteforilbbondle 25 %forthefa@t a 100P000 and 15 % for the next R 6,600 The total premium for this bond Is $ 215_ I p DECD $1009410H ftwat Bend 44412010 1 of 3 0006/007 From: 09/29/2010 13:30 9663 P.007/008 08/30/2010 MON 10128 FAX DHCD PDU 0007/007 NAS SURETY GROUP .� 'NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASMGTON WERNATIONAL MURANCE COMPANY GENERAL POWER OF ATI'ORNTY KNOW ALL M SY TImsE PRFSIiN'fS. THAT Nostb Amedcen Specialtylnsuranea Company, a cotPamttoa duly arganized and existing m&r laws of the Stole of New Iiampsbir% and baving lw principal office in the City ot'Manohester, Now Uampshhe, and Washhlgtoa Iotemntloael ! Insurance Compaq, n corporation organized and existing under the laws of the State of NOW Hampshire and having its principal office la the City of f Schnumbucg, Illinals, each does hereby make, constitute and appoint: JAMS J. AXON, GREGORY D. JUWA, MICHAEL. P. CARNEY. WILDER PARKS JR, PAUL A. PATALANO, ADAM W. DEBANCTIS, LECHAEL T. GILBERT, CFMIsTINE B. GALLAGHER, BRYAN F. JUWA, DAVID A. BOtJTt M, and BERYL A. FINN JOINTLY OR SEVERALLY Its true and lawful Attamey(*in-Fant, to make, rxcmtk Qee1 Bud deliver, Por and on its behalf mid as lts act and deed, bonds or other writings obligatmy in the Saline of a bond an behalf of each of sald Companies, as surety, an contracts of suretysbip as on or may be required or permltmd by law, reguinNm4 contract or otherwise, provided that no bond or oaderisking or contract or suretyship executed under this authority sha11 exceed the mount op. TWE:NrY-FM MIId.ION (325,000,00000) DOLLARS I i This Power of Attorney Is granted and is signed by iitesimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both Nortb American Specialty Imumace Company and Washington International h;sunu= Company of meetings duly called mdheld on the 24h ofMerch, 2000: °RESOLVED, that any two ofthe Preaideats, any Maaeging Director, any Soma' Vice President. any Vice Ptaddeaf any Assistant Vico: Pre9tdeta, the Searemry or any Assistant Secretary be, and emh or any of than hereby u authorized to executB a Power of Attorney qunllfyiog the awnegy, named is the given Power of Attorney is axeouta an behalf of the Company bond-, undartaldngs and all cantmetq Df surety. ad that each or any of thou hereby is authorized to arrest to the execution of mry noh power of Altomry and to attach therein rho seal of the Compner. and it is FURTHER RESOLVED, that the stgnatlam of such officers and the seal of the Company maybe stinted to ony such Power ofAttarney or to any eerti&ate relating thereto by fzdmile, and arty such power arAtlomey or certificate bearing such Arsimiie signabrres of &admila aeai shell be binding upon the Company when to affixed and to the future with tegmd to any bond, mrderloWng or contract ofsurety to which it Is attached," ei Uy�sumP."dmo�,rrUWW1&CfflW nd[ro0larrrafWWdeyoelolvoaaaerrtammnaCa ��%�S' °� 8 aaduvto! hatlmt rrxw9� AmclaaHyedaW fer.eon (ympmr �"� f SEAL 1 j DMd6I.Lym�a,BmlrrYGeP,mldm dWuldrrrmb,t.„u11mu11nw�nwC�m� t VlsPaddeal dHaN, Amefea Lwneq t IN WMMS 9VHWOF, North American Specialty Insurance Company and Waddngtou International Insurance Campany have caused their official seals to be hereunto affixed, and these pmaeot- to be signed by their authorized officers thls nth day of May - , 20 l0. North American Speelalty Iosaranee Company Washington International Insurance Company State of IDincts County of Cook BE On this 9- day of May . 2010 • bofom me, allotary Public personally appeared Steven P_ Andemn . President and CEO of Washington latemational Insurance Camparry and Senior Vie Aosident ofNarth Amert= Specialty Imnuance company and David M.Layrnan , Senior Vice Prealdert of Washington International Insurance Company and Mae Preaident ofNorth American Specialty Insurance Company, perManaliy umowa to me, who botng by me duly sworn, acknowledged that they signed the above Power of Attoney as officers of end nolmowledged said instrument to be the valuntary got and deed ofehair mmective camoa Iles. D,l1'ffiBIrS r"�Q!'w'K" ��G ,�lrlA ttlu>J Donan D. Sldans, Notary Public From: 09/29/2010 13:30 4663 P.008/008 Commonwealth of Massachusetts DEPARTMENT or - HOUSING & COMMUNITY DEVELOPMENT Deva/ L. Patric/;, Govemor • O 'timothy P. Murray, Lt. Governor O Tina &W)d, iJnder =WtM j June 15, 2010 Cranny Companies, Inc. !. Brian Cranney, President 10 Rainbow Terrace ; Danvers, MA 01923 RE: :. Low-Bid Approval - North'Andover Housing Anthority Work Plan 19602.1013; DHCD FISH 196028; Designer: Griffith & Vary, Inc. Scope of Work: ARRA WAP HARD COS,TS, 200-1 . Dear W Crane i � This is to advise you that pending-receipt of-the'North Andover Housing Authority's, board vote, your company • : will ate awarded the ibove-re€erenoed contract in the amount of $106.600.00.. The Departinent ofHousing & Community-Development (DHCD) is the funding and approving agency for this 3 project and in this capacity,,we require specialized forms and documentation which are attached to the email i :,conveying this letter. f :,C4ioeryou,have executed-the contracts & have-assembled the. other required documents please forward the package ' •to the-housitlg authority ..within 10 days of receipt .At -that time., the housing authority will execute the contracts and submit them to DHCD for final review and approval. ' . If you have any'questions regarding these -requirements; .please contact Candace Tempests; Contracts Specialist at, 617-573-1507. Sinoe y Ray en, Director Bureau Housing Development and Construction 100 Cambridge Sheat, Suite 300 www.massSov/dhcd. Boston, Massachusetts 02114 .617.573,1100 ' "19463 Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... C; -v ........ A&0,6-) .......................................... has permission to perform ...... CF ..................................... wiring in the building of ...... y .......................................................... / /.� ......... . North Andovei, 'Mass. at ............................... .......... .............. Fee..7:P�::� .. . .... Lic. No. ...... ........... ............... Check, t 7--,2 6 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07.] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLE4SE PRINT IN INK OR TYPE ALL INFORMATION) Date: G f I(, ( do) D City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) / (y YA9--r--% S Owner or Tenant 5Ro� o,,- Telephone No. Owner's Address / &O-Z Is this permit in conjunction with a building permit? Yes ❑ No [0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Q (p e0 o Existing Service %UO Amps JaC) Volts Overhead G2"' Undgrd ❑ No. of Meters New Service ;v+' Amps *(� / Volts Overhead 1"' Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work. i1 x v t t Q A�eoi an A-2 /Oc>+ No. of Luminaire Outlets ut7 Cmmnlofinn nftho fnllnwi— tnhly — A. —A-4 A„ tho b--t.,...f W;. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In.. ❑o. rnd. arnd. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. oDetection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eat Pump Totals: , um er ,ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ municipal❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters o. of o. o Si s Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommunicationsirmg• No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: G p Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such c*vgne is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penahYes of perjury, that the information on this application is true and complete: FIRM NAME: f(o ) LIC. NO.:/�- Licensee: r) UV A✓1 J0 Signature LIC. NO.: (If applicable, enter "ex mpt" in the license number line.) Bus. Tel. No. - Address: Alt. Tel. No.-, ?, *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. i F 1 r .. � , , 4 � t ' � , .. � .. � , , t ' j.` -- . Location No. 66 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Sewer Connection Fee $ Water Connection Fee $ TOTAL $ --Eruilding Ins Uetor 12 9 4 91/21/99 14:38 65.00 11) Div. Public Works IF Z z m v vi Z y )' m z m0, y m (� . Z Z Z= Z a n 1� i > Y tt Y m 7 y m x rr. O v` A Z - y m y ti - ye. _ m _ y y Z z m z ;c = r, m X z m ? Z f G Y y Q x m m n O N y V.y y R m m d m rn> m Z - z C_ C_ C_ R =� m z m Z 7 �Z jSn NIZP.Lm m m y T ^ m r -n n n .� " z i n n L Z Z Z Q z > z = s nr,d m m n m m m Z O H m C Z z n O m m vi N X. �S � rt { xL C _ Z 'S F YX- z y m f Z_ x -"i a A v i y m 7F Ln Z - o y O N O � z w y is i� ? z a z A• mm r J IF Z z m v vi Z y )' m z m0, y m (� . Z Z Z= Z a n 1� i > Y tt Y m 7 y m x rr. O v` A Z - y m y ti - ye. _ m _ y y Z z m z ;c = r, m X z m ? Z f G Y y Q x m m n O N y V.y y R m m d m rn> m Z - z C_ C_ C_ R =� m z m Z 7 �Z jSn NIZP.Lm m m y T ^ m r -n n n .� " z i n n L Z Z Z Q z > z = s nr,d m m n m m m Z O H m C Z z n O m m vi N X. �S � rt { xL C _ Z 'S F YX- z y m f Z_ x -"i a A v i y m 7F Ln Z - o y O N O � z w y is i� r 10 03 C VC CA CD 0 Z CO) CD ® �. CL c � � c CA 7 C-) v CD CDCL O cr s �t d Co CD o CD W C O H CD CL O CO) 0� CD I CO3 O 1 z CD O � • CD O CD C O O Z O_ CD N O O to O CCPC CD C 01 O O G N N CD C ?� O O N �. N Q MCCDy -m n m C1 N m d C'3 �, W ?"o m N N .r .0-► ® a?w m O N CA O O i ? m O -% m 1 D CD O G cn O O LA. O =r N" . p o CL ,.� . ► m N : CD 1 CL NO o W N O � CL d W � d �mo tO c O N N m m 03 W �m O ° CD F 3 N ' : -0 O . cc CD D , OQ Vim: ='- cm N : CD O o m ro o, m CLom_ 7 C -) C-3 w . = ? t.. ci o=' 0 -s D- cn Iz m o Q ^' 1*7 T cW) � � cn cn W m o m cW) � � " n -n cn In p o o � a o o 017, w w 7 ° n cc 5. OQ tri ='- cm �� GO ro 7 ? t.. z ►� r� r O cn x y O � � F J� N�ll i y C � coo Cl) 10 0 CD z v, `D O �r d = y > to O CD 0 v CDCL O Q C CCD O CD C O N3 CD d ® `03 F 1p coi 0 CDCD z C7 �F O W CD O CD 0 I V J n G z n 0 z W �Ct C 0 O Z O s CD O to O C CD m O H C 0 G N N CD 3 0 m =_ o � m ,� :n y a y m C') N m a C �. m N m "► CL. =r a -+ 11 O m CD C CD ..� y .-1 �•2 0 O m m O CD O O. � O • C9 O CO Z�.n O N A O m N CL O CD N 1 CL CD d N CL d W d 0. 0 c N O N ,� O CD m O N -r CD ^' Cl) . o• 0 N .rt � O CD O CD CD 1 O 90 '� O C d O CL � n O N � O C O O�► O O CD s O fDz C7 rD ,� :n y 7C w L rnCIO � y rD G � y w G r Z `.n y n p ro 7y GGO x 'T7 G a w C7 C roOV Cn II n 'i7 p x C7 O x O v )Mq 0 9 0 c Location No. Date I YN OF NORTH ANDOVER ,ate of Occupancy $ ig/Frame Permit Fee $ ation Permit Fee Mrmit Fee Connection Fee ISWhter Connection Fee 9P 6�1 - A-"� - - jt,'�4-6uildln- ln�pector 9 TOTAL I/edol Div. Public Works PER31I'1 NO. I APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. IPAGE 1 MAP h40. , LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZONE i{ SUB DIV. LOT NO.—I LOCATION +. E.he % I N PURPOSE OF BUILDING �� c OWNER'S NAME ' �.'r' NO. OF STORIES SIZE Jd( �! i� Ccff OWNER'S ADDRESS /J r�if�l CC..77 li i�6 (i BASEMENT OR SLAB u/ �"•`J ARCHITECT'S NAME 00 SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME 13 elan, te Bp, y1 P (✓ A' ,Aq �sj 1�7`I l SPAN -- DISTANCE TO NEAREST E3U4XfDING / 1 J� o[ DIMENSIONS OF SILLS DISTANCE FROM STREET �^�( POSTS DISTANCE FROM LOT LINES — SIDES REAR GIRDERS i. AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW .h \ U SIZE OF FOOTING X IS BUILDING ADDITION h D MATERIAL OF CHIMNEY IS BUILDING ALTERATION h IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ygj IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS t - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR F E E-0- PERMIT GRANTED19 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST Iz 643b EST. BLDG. COST PERSQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN r BUILDI INSPECTOR 'NV1d 101d S30V1d3M SIHl 'C3SOdW1213dnS '013 'S30VEI 'V9 'S3H0HOd HIM 'S9NIC11n9 d0 SNOISN3WIC 10VX3 CNV S3N11 101 WONA 3ONV1SIC CNV 101dOSNOISN3wia 10VX3 MOHS18nW N01103S SIHl Zl aVOD38 JN1aiins 0NIIV3H ON —I PEI • 49L JIb1J313 P -Z I.W.9 110 SWOON dO 'ON L svo ""– S38n1X13 Nb340W b3MOH3 11VIS ON19Wnld ON NNIS N3HJ11)1 A801VAV1 13SO1J b31VM I'XI3 Z) Wb 131101 X13 0-H1V9 ON19Wnld OL ONISIM 80013 8 'sols JI11V dl 11VHdSV 1V13 389wVJ 319 V O 5 3WVb3 NO OJJn1S _�I 3111'HdSV _ v ONIQIS 'MA NOYIWOJ ONMIS SOIS39SV O,n\GdVH ONIOIS 11VHdSV H18113 S310NIHS 400M E �—z 1 9 3138JNOJ Sd8V109dONMS b4 Sb001d 6 S11VM b N3HJ11N N8340W W008 GV3H S3JVld 3813 1.W.9 ON V38V JIl1V 'NH %r °/L %i V38V .1.W.9 N13 lln3 V36V . I IN3W3SV9 £ _ _N13Nn nvtn oin I I __ 3NId f— N.19 313bJNOJ £ I Z I 9 3138JNOJ HSINId VC 183INI j NOUVONnOd Z N0110na1SN00 S1N3W1bVdV S3JI3jo AlIWV3 I11nW S31E0!S x I AIIWV3 31`JNIS AONVdn000 t ONINOI11aNOJ bIV S8313Vb DOOM bOdVA bO 8.1.M IOH S10J B 'SW9 1331s WV31S _ 'S10J'8'SW8b3SW11 Nbn3 bIV IOH 03J803 3JVNbn3 SS313dld 1SIOf 400M ONIIV3H ll I 'JNIWVIId 9 ""– S38n1X13 Nb340W b3MOH3 11VIS ON19Wnld ON NNIS N3HJ11)1 A801VAV1 13SO1J b31VM I'XI3 Z) Wb 131101 X13 0-H1V9 ON19Wnld OL ONISIM 80013 8 'sols JI11V dl 11VHdSV 1V13 389wVJ 319 V O 5 3WVb3 NO OJJn1S _�I 3111'HdSV _ v ONIQIS 'MA NOYIWOJ ONMIS SOIS39SV O,n\GdVH ONIOIS 11VHdSV H18113 S310NIHS 400M E �—z 1 9 3138JNOJ Sd8V109dONMS b4 Sb001d 6 S11VM b N3HJ11N N8340W W008 GV3H S3JVld 3813 1.W.9 ON V38V JIl1V 'NH %r °/L %i V38V .1.W.9 N13 lln3 V36V . I IN3W3SV9 £ _ _N13Nn nvtn oin I I __ 3NId f— N.19 313bJNOJ £ I Z I 9 3138JNOJ HSINId VC 183INI j NOUVONnOd Z N0110na1SN00 S1N3W1bVdV S3JI3jo AlIWV3 I11nW S31E0!S x I AIIWV3 31`JNIS AONVdn000 t NOH1H F • � O 1 OFFICES OF:. Town of APPEALS NORTH ANDOVER BUILDING; CONSHIWATION ss " ° DIVISION (W HEALTH PLANNING PLANNING & COMMUNI.TY DEVELOPMENT KAREN H.P. NELSON, 0111EC-1.011 120 Main Street North Andover, M<lsSM71111SCIIs O 1845 (61 7) G85-4775 In accordance 1/ provisions of MGL c 4 Number 0, S 54, a condition of Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL e 111, S 150A. The debris will be disposed of in: r tion of Facility) nature of crrttit Ap ' nt ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building'Inspector. i F Z O 0 cr A 0 A A C fD' C26 to W !A 0 v �^ . ' T v rn T_T °' C m C) a MUn rn O °' (p W " :5 m O �+ n 70 M P^ T °' m O co 'o C n "' T °' o _� 3 m O c r ° _ M m CO p a o 2 m `-1 i E 0 fiz C0 m I� I I t� I ceacv 1� � ;4 Location No. Date 4- d; -,) v TOWN OF NORTH. ANDOVER 0 Certificate of Occupancy $ CHU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # '70e) 17210 B1111ding Inspecv1p TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING e BUILDING PERMIT NUMBER: DATE ISSUED: L� / /� SIGNATURE: '� Building Commissioner/1of Buildin Date SECTION 1- SITE INFORMATION 1.1 roperty Address: 1.2 Assessors Map and Parcel Number: a / Mp—NA16 Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage R) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Leq±ed Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 Public ❑ Private 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT y 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Alddress for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Supervisor: License Construction License Number / Address J7� / / !fill ll` rJ / JG �i '_ Expiration Date Signature �— Telephone 3.2 Registe ed Home lmproifenient c9ritractor licable ❑ . Not Apptic � � P Company Name Registration Number �% �,/� Lel"` 7L Address /`�'t!/Gi �4 ✓',7(/a Sig _ Telephone Expiration Date 4!v SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant O +CTAT. x` �.IF.. USE ONLY x: 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee Tal X (b) _ 4 Mechanical HVAC 5 Fire Protection 6 Total .(1+2+3+4+5) U Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS Af.,ENT OR CON CTOR APPLIES FOR BUILDING PERMIT as Owne Authorized Agent o subject property Hereby uthorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TRABERS 1 ST 2` ° 3 RD SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DRvvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL, GAS LINE O W R; •. m c o CIS o ` C CO) O C rO. V Gi p, C t0 W m C 0 Cc N o� 3 w V 0O. N CIO LU m ui u co O O Qca o z W a O co b x v a U w ® a a�' w a o w w w°' cn —co w p H a w�' —cd u, H w W c � w z ., cn Q cn m c o CIS o ` C CO) O C rO. V Gi p, C t0 W m C 0 Cc N o� 3 w V 0O. N CIO LU m ui u co O �3ID N Of ID C C � m N A N Ec, ' N m CO Q N p,Ct ® o m Z O. ® iOA ® C O m ®, 4- N r0• C a .04- .y O C 'C .E r cs o U .ca ®. vm ®SEE N ® N t O. m E Maa N N C O cm cc O! C CA 0 ca c_ �C AI O A Z 0 N � E � L CD O Z d O y � G 0 pm ca I 0 y O O 'E CO co 0 CD CL CD �3 O O ® O L O CL CLca G V �O 'a G ai CD CL G) y O G G •® G CO2 S, Iq Ll a Ll S ✓ire V� omv�na�u��eaulr. a��/��rr4e.�a� BOARD OF BUILDING REGULATIONS `-° License: CONSTRUCTION SUPERVISOR / Number: CS 034049 Birthdate: 12/08/1923 --� _ Expires: 12/08/2005 Tr. no: 12443 Restricted: 00 MARIO T CASTRICONE 31 COURT ST N ANDOVER, MA 01845 Administrator � ' �� ✓�e L� r»irorta�uriea�it• a���/p(.�lda���,def�6 Board of Building Regulations and Standards HOME IMPROVEMENT ' CONTRACTOR Registration: 103317 Expiration: 7/7/2004 Type: DBA CASTRICONE ROOFING & SIDIN Plano Castricone 31 Court St. 31 Court St. z:;--�� N. Andover. MA 01845 t - — (ATTACH TEMPLATE #2 HERE) TEMPLATE #3 (FIRST FLOOR) - PAGE 1 OF 2 TEMPLATE #3