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Miscellaneous - 120 COURT STREET 4/30/2018
120 COURT STREET 210/058.0-0025-0000.0 I Location r 2�z No. Date N°oT��h TOWN OF NORTH ANDOVER a Certificate of Occupancy $ ;,s"•••°•'<� Building/Frame/Frame Permit Fee $ s�CHust 9 Foundation Permit Fee $ S h5 Other Permit Fee _ $ Ke 40 TOTAL $ Check # 18899 �1,� �► Building Inspector Date...... .�� . HORT1� °`< °:•1"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �.�SS^cMusf� Thiscertifies that ............ ,......................................................... ..... ........ . has permission to perform .......... !Ue !� ?................................. r wiring in the building of......10! 1......5"r--./V'C .................................... 2 .........S el......................... .North Andover,Mass. v Fee..57.5........... Lic.No. .J.aw?w................... ..:. .. .?�....r�` ELECTRICAL INSPECTOR Check # �� ' 7117 Commonwealth of Massachusetts Official Use Only Permit No. l 17 wm Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: December 19, 2006 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) 120 Court Street Owner or Tenant Michael Senecal Telephone No.(978)688-4157 Owner's Address Same as above Is this permit in conjunction with a building permit? Yes ❑ No X❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: wire generator Completion of the ollowin table may be waived by the Inspector of Wires. t No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- o. omergencyiging rnd. rnd. ❑ Battery Units No.-of Receptacle Outlets - -- No. of.Oil.Burners FIRE ALARMS No. of Zones No. of Switches ' -" -_ No. of,Gas-Burners-- _ No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No. of Self-Contained Totals: I I etection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kit Security Systems: No.of Devices or Equivalent a No. of Water KW o. of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify,under the pains andpena/ties ofperjury, that the information on this application is true and complete. FIRM NAME:, 'Crowe & Sons Electrical Corp. LIC. NO.: 17168A Licensee: e James B. Crowe - Signature — LIC. NO.: 17168A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: (978)453-6696 Address: 576 Middlesex Street, Lowell, MA V1851 Alt.Tel.No.: (918)4b3-6696 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityinsurance 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 Signature Telephone No. PERMIT FEE. $ 55.00 fv C9 y TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT!VA. RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER 7Y, DATE ISS UED: ' / 0 X a� SIGNATURE: Building Commissioner/1 or of Buildings Date SECTION 1-SITE INFORMATION 1 0 1.1 property Address: 1.2 Assessors Map and Parcel Number. 4 6"Oe 4, 1. -s� 4 Map Number Parcel Number 1.3 Zoning Infomnation: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Fronto ft 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided Required Provided 1.7 Wata Supply AG.L.C.100.t 34) 1.3. Flood Zone Inf mnstioa: 1.: sewendo Disposal system: Public ❑ Private ❑ zow Outside Flood Zeas ❑ Municipal ❑ On site Disposal system ❑ a: SECTION 2-PROPERTY OWNERS1UP/AUTHORMD AGENT "�':��i�t: U ii 3tffCt: `,�� 2.10 2.1 Owner of Record 6L J�S,46&,qL �,o CoorT sfi 1lo, 4ludove-c A . Name(Print) i\ k Address for Service 06 Signatureelephone 2.2 Owner of Record: Name Print Address for Service: f f Signature Tele one SECTION 3-CONSTRUCTION SERVICES 3.1 L'censed Construction Supervisor: Not Applicable ❑ "tea J?h d L v9 0 6-oq --- Licensed Construction Supervisor: U rAla f l� �l('rfi,AvdoueYy— License Number Add j� 3 - 16 - 06 9, 6 (1 { D 07 Expiration Date VSignature Telephone r w ""tla 3.2 Registered Home Improvement Contractor Not Applicable ❑ or / 0-3-5 77 Company Nam M p a v rN P & e ms o. &J6 v a r Registration Number r dress r — D r Oo -7 -9 z o 'ration Date Si nature Telephone G) P SECTION 4-WORKERS COMPENSATION(NtG.L C 152 g 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 it. Signed affidavit Attached Yes.......0 No.......0 SECTION S Descri tion Proposed Work(check fd• ble New Constriction ❑ Existing Building . Repair(s) 0 Alterations(s) ❑ Addition 0 4 M4 04 ._ z"• Acces ok. t`*pi6lition ❑ Other ❑ Spec "_'� Brief Description of Proposed Work: V,'N VL 9;J,e -xj�s� b o i'Jd, A-),g t Co 0fJr /9 LL-fir1 *M Pdu) e A Ge A Lvm do uirishas Q- Ge- Al Yb A d,)6 SECTION 6-ESTIM[AIED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Mu1ti lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection /O 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT ORCCONTRACTOR APPLIES FOR BUILDING PERMIT I, �!��e-L v' Sew ezo ,as Owner/Authorized Agent of subject property Hereby authorize �� l I• �� to act on ,. My behalf, ' all m rel five to wo authorized by this building permit application. Signature of Owner Date ' + SECTION 7b OWNPRIAUTHORIZED AGENT DECLARATION I, aoLA / 9 ,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 (A UL j l�d Print Name Si lure of Owner/A ent Date NO. OF STORES SIS BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2"U3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS 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 NORTH Town of t 4Andover No. 7 1 $ ,C% = dover, Mass., COCHICHEWICK 7�A�RATEO 0' �5 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 1 I BUILDING INSPECTOR THIS CERTIFIES THAT .�. ;:....���.... SSC JAI'C..C.�1.. ...................... ............... ........... ....... ""' Foundation 1 has permission to erect'. �...$�. ....�.... buildings on ....,. .... .a.....C:��lr. .........�.. .��.�' •..... Rough 1 to be occupied as..5.1.. . . /4 . .I.. .... o.441.l...rl Chimney l provided that the person cepting this permit all in every respect nform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatin to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough ..... ... Service B D T'O CR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous -Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SID!�_] Smoke Det. HIC # 126-356 ®rb C�CO�Orip �uIYbE>r$, �TCt. 0 4 13 SEWALL STREET C = PEABODY, MA 01960 `h'EGq�iv•GPPry� OFFICE: 978-922-6120 SPECIFICATION SHEET y 6 �� /U- Home Plrotre:J./.'. . . . . . . . . . . . . . . . . . Owners Name/ 2'f'1! _ Work Phone:�k. 7 k(• Home Address. . .�._ '. . . . . . - Cit / ! ��'�.t:� ?�'-. . . State. 7r:'. . Zip. . . . . . . . . Job Address. . . . . . . . • . ?s . . . . . . . . . . . . . . . . . . . . . City. . . . . . . . . . . . . . . . . . . . State. . . . . . . . . Zip. . . . . . . . . SIDING P r/ — 1. Siding Type L' � : . t?r-: r J._:1 !77? .. . . . . . . . . . . . . . . Width 7. . . . ... . . . Color ll . . . . . . . . . . 2.Area to be done. Main House-7 . .. . . . Breezeway` Garage . . . . . . . Additions, -:. . . . . . . 7 Dormers. . . . . . . . . . . . .: . . . . . . . . Otherll ' . . . . . . . . . . . . . I' �-- 3. lnsalatio .��-r-: cc-71. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Trim cover 0H'es, D No Color . . . . . . . . . ltir t be done: Soffit. . . . Fascia. . . . . . . . Rakes. . � . . . . . . . . . . . . . Ceilings. _ �L�L !, . . . . . . . . . . . . . . . . . . . . . . - - - . . . . . . . . . . . . . . . . . . . . 5. Casi)7 6. Gutters and spouts ❑Yes . .,3-�` L�.. � 'T '.–'..!,z7? .% .G.IIcz'-r 7. Shutters I.pYes ❑No LS8. Windows and Doors.!�" �G'y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ROOFING MaterialType. . . . . . . . . . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Color. . . . . . . . . . . . . . . . . . . . Areasto be dome. . . . . . . . .f. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . . . . . . . . . . Remove existing shingles Yes ❑No IS lb.fell. . . . . . .. . . . Metal Bdgin r° . . :. :::. . ::: . . . Chimney d ver , etc. . . . . .11 . . . . . . . . . . . . . . . . . . . . . . . . then . .r�. . . . l"' . . NOT .. %iZ. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .`�'.i. .._ � j.�.. .��/. �..0 1.4C! �f1!..fii�.!j.-.�� ^"•/^"'/•�''f,�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Deposit Material and labor to cost$. J - .,. • • • • . : • . • • • . • • • • • • • • •pc(vable as foliows: $. . . . . . . . . . . . .1st Installment � � a Installment $.1! j6ce.-. . . .Balance on completion Contractor gill do all said work in a good workmanship manner. You may cancel this agreement if it has been consummated b'v a party thereto at a place other than an address of the seller, which niav be his main office or branch thereof,provided roll nolib-the seller in writing at his main office or branch by ordinary snail posted,b.-telegram sent or by delivent not later than midnight of the third business den•following the sighing of this agreement. IN WITH SS THEREOF, the 'arties have hereunto signed their names this. . . . . . . . . . . . . . . .1 AccePtea ? 11 2 Signed . . . . . . . . . . . , ®Ib ` 01011P Arm Int. ��j,� o�ttie � Signed. ` ; . . ��. I Own . . . . . . . . . . . . . . . . . . . Re - e rive ent Authorized Rep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Strikes• labor disputes, inclement weather.or material supplier delaps resulting in work stoppage are beyond the control of the company. The company guarantees all workmanship for a period of I Year front the date of installation. Guarantee of workmanship assumes performance of product installation under normal gear and tear conditions and does not guarantee against storm dainage, ruts of God or nature, neglect of proper maintenance or malicious dainage•or vandalism. Material guarantees are the sole responsibility of the nunnifactarer. {.'i �. BOARD NS BUILDING RUCTION SUPERVISOR '.8 License: CON 039928 Number: CS Birthdate'. 0311611944 18357 J-a • `ri Expires: 0311612006 Tr.no: Restricted: 00 PAULA PIEROG 1000 TURNPIKE STC �-s 'n" N ANDOVER, MA 01845 Acting 00-35,000 cf enclosed space (MGL C.112 S.60L) 1A-Masonry only 1G-1&2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIG SAFE CALL CENTER: (888)344-7233 w The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations ,. Boston, Mass. 02111 ' Workers'Compensation Insurance Affidavit NameL Please Print Name: v 0 Ozw/ e.rc e ZIS• Y .5_, 5_1 Location: a D City I7Ao' ler Phone # 17 9,5`100 7 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers'compensation for my employees working on this job. Comoany name: Address City Phone# Insurance Co. Policy# Comoagy name: Address City: Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment-as_well_as_civil.penaltiesio.thelam d a.STOP.W.ORK_ORDERand..a fine of.(.$l00.00)-aAN against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains anpenalties of perjury that the information provided above is true and correct. 9 / Signature Date / P Print name Pl9 U L RY—y'-0 -i Phone# P 6 P� 0 7 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensin ❑ Building Dept []Check if immediate response is required 0 Licensing Board ❑ Selectman's Office Contact person: Phone#.• ❑ Health Department ❑ Other NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: r .Sf► /jfd�jpdiyWis that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws:Chapter 148 Section I 0A. The debris will be disposed of in: (Location of Facility) of Signatur f Permit Applicant Fire Department Sign off: Dumpster Permit Date G � � Date./ E TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 0-` p' A D' �,Sg�CNUs .. / This certifies that . . �. . � L�. . . . . ."` • • • • :• . • • • • • • • • �. i has permission to perform . . . . . . . . . . . . . . . . G plumbing in the buildings of . . . .0 . .,. . . . . . . . . . . . . . . i at . . . . .. . .. .�. . . . . . . . . . . . .. North Andover, Mass. .- 1 �u Fee. . .Lie. No.. . . . . . . . . PLUMBING INSPECTOR Check # 671 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS r Date % Z/ 7 U -, Building Location 12-0 ( d Lf YL-+— S-'T Owners Name e �� S �/ Permit# Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES F w Cn U � w w x o z Cn o 4 04 z A z Z dC6a Q x 3 3 Q > H Cn z z z Q a SLRBM RA WVENr iISr RDM { i ZO KOOR 3MHDM aM>H DM M FLOCIR 6M H DM 7M)FLOOR 9M HfM Print or type) J ��� Check one: Certificate Installing Company Name .G%iuu--e f�d%�- Corp. Address .S� 130 V rL,Ari( Partner. Business Te ep one G, G I-vim 13-Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity ❑ 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 ignature 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 best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and apte 142 of the Gen er Laws. By: Signature 01 Licenseaum er Ty e of Plumbing License 7777 Lk�'N Title City/Town icense Numoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Location /--2r—f-- w' No. Date 40OT" TOWN OF NORTH ANDOVER • ; : Certificate of Occupancy $ E�� cMBuilding/Frame Permit Fee $ s� us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3C.) Check # i 17865 `'Building Inspector 4 � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING M BUILDING PERMIT NUMBER. DATE ISSUED: Lo r X ic SIGNATURE: —A� Building CommissionerArtsRector of Buildings Date z SECTION t-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Zc7 Cy.l r-r— �• �� �S Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard . Rear Yard Required Provide Regaired —+ Pravided Re red Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT " ' D,,,!�t.r t: e3 2.1 Owner of/Record ~ Name(Print) Address for Service: V Signature Telephone 2.2 Owwr of Record: Name'Print Address for Service: �y r i Signature Telephone 90 SECTION 3 CONSTRUCTION SERVICES 3.1 Licensed Construction7,& rvisor: Not Applicable ❑ S1.4+ (�o�rc Licensed Construction Su rvisor: License Number -r1 Address 6— y r a Expiration Date ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ & Company Name l Z fJ 77 `I M (/ ^ t` D Registration Number Address _ 1j_ z - 05 G5 7,z 5 S Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.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 buijOing permit. Signed affidavit Attached Yes. -...❑ No.......❑ SECTION 5 Description of Proposed Work check au a cable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ^❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / yl o F�_W e41,, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building �� f e► (a) Building Permit Fee ` Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUrLDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize 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 D/EC'LARATION ,as Owner/Authorized Agent of subject r property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and Qbelief f4 Print Name / /�- 7-ay Si tire of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I s 2' 3RD SPAN DIMENSIONS OF STILLS DIMENSIONS OF POSTS DMENSIONS OF GIRDERS } HEIGHT OF FOUNDATION _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t %!ie fanmo�uleal�/ a�,<l.zcluaelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 089839 Birthdate: 06/19/1972 Expires: 06/19/2008 Tr.no: 89839 Restricted: 00 SCOTT P HOUSE 854 ROADWAY HAVERHILL, 0RHILL, MA 01832 Commissioner ;,_. v%tze �aorinza�acuP.alll cf"�-��cz.�:actruaetf Board of Building Regula:'rrns and Standards HOME IMPROVEMENT CONTRACTOR Registration: 129774 Expiration: 11/2/2005 Type: Supplement Card PELLA WINDOWS AND DOORS SCOTT HOUSE 45 FONDI RD. HAVERHILL, MA 01832 Administrator NUMBER 966 DRIVER'S LICENSE .� DATE OF BIRTH CLASS REST HEIGHT SEX _ ,16_t 9--;'97 2 D 6.00 M EXPIRES r . 0USc SCOTT P 854 BROADWAY APT#1 06-19.1972 HAVERHILL,MA 01832 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 Workers' Compensation Insurance Affidavit Applicant Information:,: .:......... : .........;:.:;:;>:; Property Owner Name: A Job Location: City: /1/ Phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity. i:v:Aii:i>i:'iiiii>iii:vviiii: ii:vi:v:{vii::::;i:;ii:;i:;}i}iiiiv:tit+Ji:•i:?!•ii:•:?•::•iii:^:•i:•:•i:•i::P:^?i:!.i::.i':XXX, I employer er rov .. s e sa on for. P Y providing workers'or c p or my employees working on this job. Company Name: jaw Address: c J . � City: Haver ,tt J Phone# �717- 2 se�'_ 7*2SS Insurance Co. � � I yl S, �t'D U� Policy# 0?_W S KL 1/2(11 c/ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: Company Name: Address: City: Phone# Insurance Co. Policy# _ .;;: ;; :.;:.;;............................................................ . :::::::::: ::::::::::;;:.;:.;;::•;:.iii:;•i;:.:; :>:>:r >: ...::: s : » >...:....... ............... : : : :: > : . .... .................>.:.................. r: >. »CompanyName : . ...................... ........... Address: City: Phone# Insurance Co. Policy# siY: '2 .:<.::<r:.-::;:::r;:•;':i:•:::::::.:;•:;:: ::::.:_.:::::::::............. ....... ..E.:. ::::. ..::.. ii::;% iS? s:::._:::. .. . .: ::::: : :::::::::. ::: ::::: : :? ? : Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature /�` Date q Print Name SU.*+4 V.35. '� �'� �� �. ✓l W l Phone# Official use only. Do not write in this area,to be completed by city or town official ❑Building Department City or Town: Permit/license# ❑Licensing Board ❑Selectmen's Office ❑ Check if immediate resnonse is reouired ❑Health Department Contact person: _ Phone#: 11 Other 1 1►-��-' l a'� 1- HIC Registration#129774 Federal ID#04-3277886 Pella Windows & Doors of Boston 451la Fo dli1Ro do d &Doc Viewed to be the Best" Haverhill, MA 01832 PH: (800) 866-9886 Service: Ext. 124 WINDOW CONTRACT Fax: (978) 373-7274 l Sales: (866) Pella06 Sold To: C"• G Date: %Z3 -�yo _ Address:_ /-)-o CaV 2.z S— PS�`7�l 1-- yl�� City: �o23u1 ��-- State: A Zip: hone (Home) 66 Job site Address (If different): Phone (Work) =,t.M),-6 A Phone (Cell) I/ ( ) pprox. Start Date: _ _ Approx. Completion Date: 23. �� ❑ Remove and Dispose of existing Windows and/or Storm Doors 24. ,� ❑ All workman's compensation and liability insurance maintained 25. lid / ❑ Warranty mailed to customerupon completion when full payment is received 26. IfY —❑ / Total Project Amount$�0. 27. Financed If Yes:Amount Financed$ (Reference# ) 28. Deposit Received$ l`�l � dG 29. ❑ ❑ Balance on Substantial Com letion$ %�5 • Z1 p (Payment is payable to installer at completion of job) 30. ❑ ❑ Additional Comments: _O_jird R9AL-f+."SS CrJvL-vt w!7y a-zN&©tL- -grva "4u,w- lb� 44�-u, Dnti � PELLA IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE PLEASE REMOVE ALL SHADES,VERTICALS,BLINDS,CURTAINS,DRAPES ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT OR WINDOW MOUNTED AIR CONDITIONERS,PRIOR TO THE INSTALLATION AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OR OF YOUR NEW WINDOWS.INSTALLERS ARE NOT RESPONSIBLE FOR THE RELIED UPON BY "OWNER". YOU ARE ENTITLED TO A COMPLETELY REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. FILLED IN DUPLICATE OF THIS AGREEMENT. CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A CONTRACT SUBJECT TO FINAL INSPECTION BY PELLA CONSTRUCTION WARRANTY PROBLEM. DEPARTMENT. TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract is a legal document. Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OR CANCELLATION BE POSSIBLE BEYOND THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED AND DEPOSIT PAID. BY SIGNING BELOW YOU ARE ACKNOWLEDGING THAT THE ABOVE SPECIFICATIONS FOR THE PELLA PRODUCTS YOU ARE ORDERING ARE CORRECT Pella Rep.Signature: G �v 1 —'� ' Date: y� '�� Customer Signature: Date: J White al Yellow-Customer Pink-Store A��R®r•., 'r —_ DATE MM/DD mYYI _ 'IFI ( Clc� CAFE (�F LIABILITY INSURANCE 07/07/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Starkweather&Shepley ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 549 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Providence, RI 02901-0549 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' 401 435-3600 INSURERS AFFORDING COVERAGE NAIC# INSURED New England Window And Door Inc. INSURERA: Hartford Ins Group dba Pella Windows and Doors INSURER B: 45 Fondi Road INSURER C: Haverhill, MA 01832 INSURER D: COVERAGES INSURER E: 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. INSR LADD11 POLICY EFFECTIVE POLICY EXPIRATION LTR )NSRO TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY 02UUNUE3852 07/01/04 07/01/05 EACH OCCURRENCE S1.000000 X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100.000 CLAIMS MADE OCCUR MED EXP(Any one person) $5,000 ' I PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000.000 IMIT POLICY I PO- GEN'L AGGREGATE PRO- APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 JECT I LOC A I j AUTOMOBILE LIABILITY 02MCPUE4706 07/01!04 07/01/05 X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S1,000,000 1,000,000 ALL OWNED AUTOS I BODILY INJURY SCHEDULED AUTOS (Per person) S X HIRED AUTOS "I BODILY INJURY X NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE $ I (Per accident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S I ❑ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: qGG $ � A EXCESSIUMBRELLALIABILITY 02RHUUE3782 07/01/04 07/01/05 EACH OCCURRENCE 59000,000 OCCUR u CLAIMS b1ADE AGGREGATE S9,000,000 5 HI DEDUCTIBLES RETENTION S10000 S A WORKERS COMPENSATION AND 02WBKL4264 07/01/04 07/01/05 X WC SjTjU oTH- EMPLOYERS'LIABILITYCRYTjj ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? If yes.Cescnbe under E.L.DISEASE-EA EMPLOYEE 5500,000 SPEC!AL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EVIDENCE OF INSURANCE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _-1n DAYS WRITTEN FOR PELLA WINDOWS - HAVERHILL 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. AUTHORIZED REPRESENTATIVE a j ,=;CORD 25 12001/081 1 of 2 #M103205 MBB © ACORD CORPORATION 198E NORTH Town of `.. t 4Andover 0 No. dover, Mass., AlAq vp or COCHICMEWICK A. 7�ADRATED `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... ................ ��C4-46..� �........ .... .................................� ................. ......�.............................................. Foundation has permission to erect............./....................... buildings on .....I........................ .................................. ................. Rough to be occupied as W �iy� ...................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS RTS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STA C Rough ... .. ... Service ... .. . ... . ........... ...... ........ ........ BUILDING INSPECTOR Final Occupancy Permit Required to Ocayy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.