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Miscellaneous - 126 PHEASANT BROOK ROAD 4/30/2018
126 PHEASANT BROOK ROAD 210/106.6-0224-0000.0 Insurance Adjustment Service, Inc. 435 King St. Littleton, MA 01460 (978) 952-6966 Fax (978) 952-2459 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B Date: July 15, 2004 TO: Board of Health/Building Inspector Town of N Andover N Andover,MA 01845 RE: Insured: Brett&Deborah Lazar Property Address: 126 Pheasant Brook Rd. N. Andover,MA 01845 Date of Loss: 7/1/2004 Policy Number: HMA0074142 Type of Loss: Water-Rot File or Claim Number: 16488 Claim has been made involving loss, damage or destruction of the above captioned property,which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6,to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, locations,policy number, date of loss and claim or file number. Thank you fo our cooperation. ve Mie atrisso Adjust r Ext. 11 I tr Location No Date r ° 'E. °R'" TOWN OF NORTH ANDOVER Ilkp Certificate of Occupancy $ ` + ; Building/Frame Permit Fee °$ CHuse Foundation Permit Fee $ Other Permit Fee $ _ " Sewer Connection Fee. $ Water Connection Fee ck - . TOTAL 'i $ :a Efuilding Inspector ,�18073 Div. Public Works 3 Location � �( 4 d✓�©©� No Date 07 vkoRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ ' *��o # Building/Frame Permit Fee=$ F � i ►+ustt Foundation Permit Fee $ Other Permit Fee t Sewer Connection Fee .- $ � )/v_. Water Connection Fee ` '� $ TOTAL $ I ect r 1 `...;. :2�. .. Di P lic Wor s PERMIT NO; ` APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4d0. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. LOCATION //�� —��� PURPOSE OF BUILDING WT ��Gi�cin'4 LSCu41� Q.4rY� �:.�+e..l�1n� OWNER'S NAME NO. OF STORIES SIZE X �� OWNER'S ADDRESS BASEMENT OR SLAB "A-0 �,r1�.cN�S�� t�b�,.+r+►- ARCHITECT'S NAME �`✓�'rU S'C'�. /%NvOuy�& 1A. M:L-5 SIZE OF FLOOR TIMBERS IST 2ND ZX(O 3RD L>lb BUILDER'S NAME '"('", SPAN IL(' DISTANCE TO NEAREST BUILDING l50, DIMENSIONS OF SILLS i1 ) a y 6 tq r �l DISTANCE FROM STREET 3% POSTS K DISTANCE FROM LOT LINES–SIDES 4 REAR cr GIRDERS AREA OF LOT \.0(.CI FRONTAGE HEIGHT OF FOUNDATION 6 1 THICKNESS tp t'1 IS BUILDING NEW Y45 SIZE OF FOOTING O ,V11 X IS BUILDING ADDITION No MATERIAL OF CHIMNEY N IS BUILDING ALTERATION oa10 IS BUILDING ON SOLID OR LLED LAND ULa,D WILL BUILDING CONFORM-TO REQUIREMENTS OF CODE ye IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY �b t IS BUILDING CONNECTED TO TOWN SY�WER l�0 IS BUILDING CONNECTED TO NATURAL GAS LINE .e– PROPERTY INFORMATION INSTRUCTIONS LAND COST CPO SEE BOTH SIDES EST. BLDG. COSTR l g E . COST PER SQ. FT. a PAGE 1 FILL OUT SECTIONS 1 - 3 I' PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM I �PERMIT NO. 4 AFS ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SEPTICPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS L PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR , A-4 DATE IL J 12P�� BUILDING INSPECTOR 1516NATURE OF VNER OR AUTHORIZED AGENT FEE xx OWNER TEL.# ' -717 -kI 1S PERMIT GRANTED U G i CONTR.TEL.# �7'g 19 CONTR.LIC.# \. 0 Y 9 O� / RIE PERMS$ 1r H.I.C.# H � BUILDING RECORD i OCCUPANCY 12 ARANCE SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND FROM MULTI. FAMILY OFFICES LOT'LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ \ UNFIN. \\1 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 1/2 '/, FIN. ATTIC AREA _ N_O 8 M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON JRAME Nl* BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME R.�trti+a CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR �y�ypOOR _ , ADEOUATEVr � NONE 5 OOF 10 PLUMBING GABLE HIP BATH 3 FIX. GAMBREL MANSARD TOIL R . 12 FIX. FLAT SHED ER ET _ ASPHALT SHINGLES WOOD SHINGES 'r H ,SNK I SLATE N O PLUMBING _ TAR 8 GRAVEL I STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR 4 ILE DADO �j 6 FRAMING '711 HEATING T W�p�g�TQ��Ia PIPELESS FURNACE -• ' � � FORCED HOT AIR FURN. TIMBER BMS. 8 COlS. STEAM \ � STEED �L� HOT W'T'R OR VAPOR s- ..J WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st } 13rd I NO HEATING FORM U - VERIFICATIOil FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 69-Vti L-A 2-_f!C--- Phone LOCATION: Assessor' s Map Number Parcel Subdivision 61J-&C 6Ae-eN STA-Fe s ' Lot (s) b /O�casa,.�G�oc� 1 19,9 Street Lw-t AM St. Number j 2 e4AO I �Use Only************************ RECO NDATIONS OF � WN AGENTS: l , ' �✓ ��� I l/�� 0_1Date Approved Aservation Administrator IpDate Rejl ed Comments ������1 UQ.✓8 Date Approved v Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected (� - j /D_ Date Approved / !� Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections � 2 - driveway permit _3 2 17 Fire. Department Received by Building Inspector Date NORTjy Town of _ Andover / � m * i dover, Mass., 199 _- LAKE COCHICHEM'ICK LY 1• '9s '#A'r D E BOARD OF HEALTH Food/Kitchen -PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................................... . ... j. ....... ..Z.. .��.....................................�e�Of' G Foundation I. has permission to erect........................................ buildings on........../...Z...G.........pif� Si. dg...P-cz. Rough to be occupied as........................................................—S'1, ..G.� ........... f!"'../...1�of ........................................ chimney . . . . . . provided that the person accepting this permit shall in every respect conform to the term 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 _ ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough 6. ......................................... Service ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. ��6I9 y �tb' bid ��vJ 6T �y •sa r��t,,ae ' �y,J1?�O j�� I9�pd�Jt �,_�/� ?6jlo, ,�`��%�� °dB •'tis,, dp 6 dUr •:T S' d � �! i I jil I iiiiiij _ - f , Rd Location 1 D Y No. Date aoRTh TOWN OF NORTH ANDOVER F Certificate of.Occupancy $ Mus9 Buildin /Frame Permit Fee $ akE Foundation Permit Fee $ Other Permit Fee $ r` TOTAL $ 3�d Check # A L 17423 Building Inspector i TOWN OF NORTH ANDO • ER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT RE&M RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: /Q D �Jic SIGNATURE: l Building Commission for of Buildings Date SECTION 1-SITE INFORMATION, , 1.1 Propert Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUR DING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided R 'red Provided 1.7 Water Supply M.G.L.C.40.t 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 0 2.1 Owner of Record e Name(Print) Address for Service N. P Signature Telephone 2.1 Owner of Record: i flame Print Address for Service: M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 7 msLicense Number , C ' Addres G z ZcOV -Z 66 (4'90 Expira'on D to Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1 Co any Name �/� 7 4�-e5:e4f(ville— A � � �,(� Registration Number ddress NOEM 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 buildi2l permit. Signed affidavit Attached Yes....... K No.......0 SECTION 5 Description of Proposed Work checkall applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other C9" Specify Q Brief Description of Proposed Work: L�Cf.A,�_Q �('°Rn C.�. c�(�tJr' �Q�C E'���� f k��i - /� .��-S Lam.• � ,• i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar) to be �+ Completed b permit applicant ` 1. Building (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 BUILDING PERMIT \ I, as Owner/Authorized Agent of subject property Hereby authorize to act on s My behalf,in all matters relative to work authorized by this building permit application. c Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATIONi 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 ' Si ature of Owner/Agent Date Mom NO. OF STORIES SIZE-\' .. N BASEMENT OR SLAB y SIZE OF FLOOR TINMERS iST 2 ND 3KD SPAN DIlvIENSIONS OF SILLS DWENSIONS OF POSTS DRVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE - r jZ�aIL ®F �cv�llc�� ` FORM U - LOT RELEASE FORM '(.I t tel 01 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*******"************** APPLICANT Debbie S Brett Lazar_ +PHONE_978-682-9092 LOCATION: Assessor's'Map Number 42986 I �� PARCEL ®- 0 SUBDIVISION LOT(S) 6A i STREET—Pheasant Brook Road ST.NUMBER-126 ********************* *************OFFICIAL USE ONLY******************* ************** RECO NDATIONS OUOVVI AGENTS: r CONSERVATION ADMINISTRA R DATE APPROVED O DATE REJECTED r COMMENTS c¢, e� I 790 Z4h2- TOWN PLANNER DATE APPROVED ,DATE'REJECTED COMMENTS FOOD INSP CTOR-HEALTH DATE APPROVED DATE REJECTED SEfT)6 1 CTOR- ALT DATE APPROVED Z DATE REJECTED COMMENTS 4/ PUBLIC WORKS-SEWERNVATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9`97 jm The Commonwealth of Massachusetts � t d Department of Industrial Accidents Office of Investigations m� Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am ahomeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �I I am an employer providing workers' compensation for my employees working on this job. Company name: Address Phone#: Insurance.Co. /Rci ko O.'a 02 SO'\ Policy# Company name: Address City: Phone#: Insurance Co. Policv# 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 vefl-as-civil.penatties inlhe.ftmcf-a-STOPWORK.ORD.ER..and.a.fine.of_(.$1.DO.DA)..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. l do hereby certify and r the nqNs and penalties of perjury that the information provided above is true and correct. Signature ' Date b Print name UC LlP_ Vr'O',/ Phone# (W60 Official use only do not write in this area to be completed by city or town official' City or Town PermitiLicensing i Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other 5/20/04 10:57AM; ->MORSE CONSTRUCTIONS •. MAY-20 ' 04 (THU) 09:52 MASON & MASON INS 781 447 2832 PAGE. 1 CERTIFICATE OF LIABILITY INSURANCE MIDDfVYYYI PnooucER (781)447-SS31 FAX (781)447-7230 0/2004 Mason & Mason Insurance Agency, Ync. THIS CERTIFICATE IS ISSUED AS ATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4S8 South Ave. HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Whitman, MA 02382 ALTER THE COV RA E AFFORDED 13Y TUg PO (CIES BELOW. INSURED Morse ons"'A""ons, Inc. INSURERS AFFORDING COVERAGE NAIC�/ 87 Central Street INSURER AI/Nationa Grange Mutual 14788 Somerville, MA 02143 INSURER e: Savers Property & Casualty Ins 000203 INSURER C: INSURER 0; INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDIN ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED TA MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS D SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OR ILT R D' TYPE OF INSURANCE POLICY NUMBER F C FE Y ATI N GENERAL LIABILITY EACH OCCURRENCE LIMIT@ MPK61289 01/01/2004 OZ/O1/2005 X COMMERCIAL GENERAL LIABILITY S 1 000 OO CLAIMS MADE a OCCUR D G RE D S SOO 00 A MED EXP(Any ono p(son) 8 10 00 PERSONAL 8 AOV INJURY ' 8 1 000 00 GEN%AGOREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S""14 2 000 00 POLICY JP COT LOC PRODUCTS-COMP/OP AGO S 2 000 000 AUTOMOBILE LIABILITYM9K61289 01/01/2004 01 ANYAUTO 012005/ / COMBINEDEI�waLe uMlr ALL OWNED ALTOS A X SCHEDULED AUTOS BODILY INJURY X HIREDAUTOS (Per person) ® 100000 X NON-OWNED AVT08 BODILY INJURY (Per eooldenq $ PROPERTY DAMAGE I GARAGE LIABIUTY (Per.00ldenl) E ANY AUTO AUTO ONLY-EA ACCIDENT S OTHER THAN EAACC S EXCEBBNMORELLALIABILITY AUTO ONLY: AGO S OCCUR 0 CLAIMS MADE EACH OCCURRENCE $ AGGREGATE S DEOUCTIBLE S 1. RETENTION S 8 GMPLO RB COMPENSATION AND WC0002132 01/01/2004 01 WC A - $ GMPLOYHR$'LIABIUTy O1 TU / /2005 O ANY PROPRIETORrPARTN M ERlEXECUTIVE OFFICERIME BER EXCLUDED 7 E.L.EACH ACCIDENT T m 100000 11yee,deeorlhe under E.L.DISEASE-Eq BPECIgL PROVISIONS below EMPLOYEE s 100000 OTHER E.L.DISEASE. POLICY LIMIT 500000 DESCRIPTION OF OpERAriONe/LOCAri0N8 f VBNICLfiB/EXCLUSIONS AODED BY ENDORSEMENT 1 SPECIAL PROV181oN6 I SHOULD ANY OF THE ABOVE pIBCWBBD POLICIES Be CANCELLED 118FORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL --19.DAYS WRITTEN NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover 400 Osgood Street BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABIUTY OFANYVJND PONTHEINSURER ITS AGENTS OR REPRESENTATIVES, North Andover, MA 0184S AUTHORI EO RlSfiNTgTrY ACORD 28(2001!08) FAX; (617)623-2999 ®ACORD CORPORATION 1988 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) i ature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector -;�`. ✓fT.6 f�IJ JJL7l24?i{llEfLGitb ��c/4�tX41dLLCfLGC.hr-�d _ BOARD OF BUILDING REGULATIONS I _ License: CONSTRUCTION SUPERVISOR €� Number: CS 069554 I Birthdate: 10/24!1963 Expires: 10/24/2004 Tr.no: 12782 j2 Restricted: 00- ROBERT W GRAY i 42 PROSPECT STS GEORGETOWN, MA 01833 Administrator :%fze Z�ammza�zcuea� a�✓��aaaacfic��ld Board of BuildingRegnlatinw and Standards HOME IMPROVEMENT CONTRACTOR - Registration: 116779 Expiration; 7/20/2006 Type: Supplement Card i MORSE CONSTRUCTIONS INC ROBERT GRAY 57 CENTRAL ST SOMERVILLE,MA 02143 :administrator 'a MORSE CONSTRUCTIONS, INC. 57 Central Street,Somerville,MA 02143(617)666-4460 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by provisions of Chapter 142A of the general laws, must be of Massachusetts. Inquiries about registration and status should be made registered with the Commonwealth Registration, One Ashburton Place,Room 1301, Boston,MA to the Director, Home Improvement Contractor 02108 (617) 727-8598. Designated Registrant's Name: Paul E. Morse,CR, and President of Morse Constructions,Inc. Registration Number: 116779(Card available on request) Salesperson's Name:Paul E. Morse,CR, and President of Morse Constructions,Inc. Fed. Identification Number: 04-2932940 This agreement is made on May 28, 2004 between Morse Constructions,Inc-, a Massachusetts Corporation located at 57 Central Street, Somerville,MA 02143,Telephone(617)666-4460 hereinafter called "Contractor"and Brett and Debbie Lazar, 126 Pheasant Brook Rd,North Andover MA 01845, telephone (978)682-9092 hereinafter called"Owner." PROJECT: Deck Construction PROJECT DESCRIPTION: Remove the existing rear steps and build a larger deck including adding a pair French doors with sidelights and replacing an existing door. PROJECT SPECIFICATIONS: O1GENERAL CONDITIONS Provide a building permit and necessary inspections. Note: this does not include surveys, variances or special permits 02 PROTECTION/DEMOLITION Provide site mobilization and protection Remove existing rear steps, door and siding as necessary Remove bay window, SAVE FOR OWNER 04 FOUNDATIONS Dig, set and pour up to(12)piers and(2)pads. Note: this does not include drilling or pinning to ledge ' 06 FLOOR FRAMING AND SHEATHING Provide and install PT framing for the deck and two sets of stairs as sketched by Morse Constructions, Inc. _ . -1 - 07 WALL FRAMING AND SHEATHING Adjust framing at the bay window for the new door 09 ROOFING/GUTTERS/FLASHING Supply and install aluminum gutters along the rear main roof with two downspouts 10 EXTERIOR TRIM Supply and install 5/4X6 PT decking Supply and install a 2x4 PT railing with 2x3 square PT balusters Trim new doors to match existing I I SIDING Patch the siding at the new double door 12 DOORS S&I a new Masonite steel 3068 door with interior blinds to the living room with a white full view storm/screen door S&I a new Masonite steel 5068 door w/sidelights with a pair of white full view storm/screen doors 15 HVAC We are carrying an allowance of$800 to move or replace heating from under the bay window 16 ELECTRICAL We are carrying an allowance of$800 for rough and finish electrical work 20 INTERIOR TRIM S&I 2-1/2 Colonial casing in the living room and dining room 24 PAINTING Final prep including sanding and caulking as well as painting and staining by owner 25 SITE MAINTENANCE Provide daily and final clean up Maintain a 15 yd dumpster on site during construction 30 PICK UP &DELIVERY Provide for pick up, delivery and handling of materials PRICE Contractor agrees to do all work described in the Project Specifications for the total price of$35,000.00 ALLOWANCES: The following allowances are included in the above price: Doors $ 2,980.00 Heating $ 800.00 Electrical work $ 800.00 -2- f Note: These allowances represent the Contractor's actual cost for the items. All reconciliations will include the Contractor's standard overhead and profit margin of 35%, calculated as a percent of the total billed to the client for these costs. PAYMENT Payment will be made as follows: $10,500.00 Due upon execution of this contract(,Less$2,500.00 received) $10,500.00 Due upon commencement of the framing $10,500.00 Due upon commencement of the door installation $ 2,000.00 Due upon pre-completion walkthrough (The allowances will be reconciled in this invoice and a list written of the final items that need to be completed before substantial completion and commencement of the warranty perio(L) $ 1,500.00 Due upon substantial completion Alternate#1.Substitute Weather Best decking for PT decking Add$1,900.00 Alternate#2.Substitute Weather Best Crystal White Railing for PT railing Add $4,600.00 Above alternates,if chosen to be paid at second contract payment Terms: Service charge of 1.5% per month on past due accounts. Returned checks: A replacement check must be delivered to the office with an additional$25.00 returned check fee included in the remittance. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make,in advance, to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater. Any progress payment(s) made by Owner shall automatically constitute a representation, agreement, and acknowledgment by Owner, that all work and material represented by that progress payment has been completed, performed or supplied by Contractor in compliance with the contract terms and to Owner's satisfaction. The foregoing agreement shall be conclusively binding upon Owner, unless Owner provides Contractor, at the time said progress payment is tendered, with a written list of those items or matters which Owner deems incomplete or unfinished pursuant to the contract terms. If Contractor is required to bring suit for purposes of collecting sums owed under this contract, Contractor will have the right to be paid for and Owner shall pay Contractor for all of Contractor's costs and expenses in enforcing this agreement,to the extent not prohibited by applicable law. Those expenses include, for example, court costs and reasonable attorneys' fees. COMMENCEMENT AND COMPLETION OF WORK: Contractor will not begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing. Contractor will begin the work on or about June 14`s, 2004. Barring delay caused by circumstances beyond Contractor's control including but not limited to delays caused by strike, weather conditions, supply shortages, or work force shortages, the work will be substantially completed on or about July 3&,.2004. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. The project completion date shall automatically be extended by the same ` %. -3- number of working days lost due to delays arising from circumstances beyond Contractor's control, including but not limited to inclement weather, labor strikes, supply shortages, etc. Any extras or additional work orders . may also extend the completion date and Contractor shall notify Owner of same. VARIATIONS IN SCHEDULED START AND COMPLETION OF WORK The actual dates that construction will commence and be completed may vary due to; the time required to apply for and obtain necessary permits; delays caused due to necessary inspections; delays in the scheduling of work crew(s);the presence of hidden conditions or necessary additional work discovered during construction;. or delays in the receipt of equipment and/or materials which must be ordered and/or delivered to the site. NOTICE OF SCHEDULE CHANGES The Contractor agrees that when any such delays become known to the Contractor,the Contractor will advise the Owner as soon as possible. DELAYS IN COMPLETION DUE TO HIDDEN CONDITIONS The Owner hereby acknowledges that in certain remodeling work,the demolition of portions of the preexisting structure may reveal additional defects, conditions or the need for additional work, which must be repaired, altered or carried out in order to commence or to complete the work described under this contract. In such cases(s)the Homeowner agrees that the duration of the work and the scheduled date of completion may differ from the date contained above, and that such variation which is not avoidable by the Contractor shall not be considered as a violation of this Contract. HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK Hidden conditions may require adjustment in the overall price of the necessary work related to this Agreement. In such case the Contractor shall inform the Owner of such conditions forthwith and where necessary a written amendment of this Agreement will be negotiated and executed by the Contractor and Owner. COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy thereof. The Contractor and Owner agree that the following additional documents, plans, specifications and change orders are attached hereto and incorporated by reference into this Agreement: 0 Sketches by Morse Constructions,Inc. 1 I l d C4- INSURANCE -INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by result of the work under this ce of or as a es , performance in the , Contractor, its employees or its subcontractorsp Agreement. Contractor agrees to carry insurance to cover such damage or injury. Insurance certificates are available on request. SUBCONTRACTING notwithstanding an agreement for materials and/or labor between Contractor and a Contractor agrees that, no g Y Owner for completion third party, Contractor is responsible to Own of all work described in a timely and workmanlike manner. -4- -�. CONSTRUCTION-RELATED PERMITS The following construction-related permits will be necessary in order to complete the scope of work included in this Agreement: Building permit issued by the Town of North Andover The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory permit granting or inspectional agencies,authorities or individuals, WARRANTIES limited warranty to Owner. This limited warranty is extended only to the Owner Contractor gives the following and is not transferable or assignable by Owner. This limited warranty is the only expressed warranty Contractor is giving to the Owner. This limited warranty specifically excludes consequential and incidental damages and there are limitations in the duration of this expressed warranty and the implied warranties, if any. This warranty is limited to the construction work that has not been modified, altered, defaced or had repairs made or attempted by others. Contractor agrees and represents that all work in connection with the construction of the project, undertaken and performed by Contractor or its subcontractors, shall be performed in a good and workmanlike manner. Provided written notice is received by Contractor on or prior to one year from the date of the project's completion, specifying exactly the defect complained of Contractor warrants for that one-year period that Contractor shall correct any defect in materials or workmanship of which Contractor received written notice from Owner within the said period of one year from the date of completion of the project;provided,however, that this limited warranty shall not apply to "defects" which are the result of contraction or expansion or the result of other normal or ordinary characteristics of building or construction materials. This limited warranty shall not apply in the case of"defects" resulting from or aggravated by any neglect or failure on the part of the Owner to properly maintain the premises in a manner as would a reasonably prudent person and shall not apply to fixtures, appliances, equipment or installations covered by manufacturers' warranties, to which Owner agrees to look solely to the manufacturer for replacement and/or correction of defects or malfunctions, all of which manufacturers' warranties, to the extent assignable, shall be assigned by Contractor to Owner upon completion of the project. Contractor agrees to assign to the Owner any and all manufacturers' warranties on all appliances or equipment that Contractor installs on the project. The Owner acknowledges that such warranties may include specific procedures, which must be followed by the Owner to have the warranty take effect (e.g., notification to manufacturer, registration or mailing warranty card). The Owner agrees that Contractor shall have no liability whatsoever for expressed or implied manufacturers' warranties. The Owner acknowledges that the following items are specifically excluded from this limited warranty: (a) Defects in appliances or pieces of equipment, which are covered by manufacturers' warranties. As these have been assigned directly to Owner, each manufacturer's warranty claim procedure must be followed when a defect appears in any of those items; (b)Damages due to ordinary wear and tear, misuse or lack of proper maintenance; (c) Defects which are the result of characteristics common to materials used, such as, but not limited to, warping or deflection of wood; fading, chalking or checking of paint due to sunlight; cracks due to drying and curing of concrete,plaster, drywall,tile,brick or masonry. (d)Defects in items installed or supplied by the Owner or anyone other than Contractor, or its subcontractors at Contractor's order; -5- (e) Work performed by the Owner or anyone other than Contractor, or its Subcontractors at Contractor's order; (f)Loss or injury due to the elements; and (g)Consequential or incidental,damages. If the Owner gives Contractor proper notification of a claimed defect, and if the defect is covered by this limited warranty, Contractor or subcontractors chosen by Contractor will replace or repair the defect (such a decision being Contractor's sole and exclusive choice) at no charge or cost to the Owner within a reasonable time,unless weather conditions,labor problems,material shortages or similar events cause delays. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturers' warranty, shall not create any responsibility for the Contractor to warranty such equipment. During the stated warranty period the Contractor shall be responsible for service for repair or adjustment BUT the Contractor shall NOT be responsible for normal maintenance, repair due to abuse or misuse, and normal wear and tear,which shall be the responsibility of the Owner. In the case of service by the Contractor under the warranty provision,the choice of repair or replacement shall be at the discretion of the Contractor. All claims for adjustments, repair or replacement shall be made by the Owner, in writing, and mailed by postage prepaid first class mail to the Contractor at the Contractor's address as given at the beginning of this Agreement. In the event that any provision of this limited warranty shall be invalid, the remainder of this limited warranty shall remain in full force and effect. -6- FORM INTENDED TO COMPLY WITH LAW The Contractor and Owner acknowledge that the form, substance, content and notices contained in this := Agreement are intended to comply with the applicable portions of Massachusetts General Laws Chapter 142A, and regulations promulgated thereunder. In the event of any instance of non-compliance, only such portion shall be invalid and the remainder of this Agreement shall be in full force and effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and applicable regulations. RIGHTS TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than an address of the Contractor which may be his main office or branch thereof provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation. A CANCELLATION NOTICE IS ENCLOSED WITH THIS CONTRACT. OWNER'S SI DATES NED OWNER'S SIGNATURE DATE SIGNED MORS ONS(1TRUCTIO,NSA,nINC BY- Q..� SIDENT DATE SIGNED <,::. -7- i NOTICE OF RIGHT TO RESCISSION Your Right to Cancel This Contract: You are entering into a contract that may result in a lien on, or a security interest in,your home. Federal law gives you the legal right to rescind or cancel this contract withoucost to you,but you must give t the following events occurs lit:notice of your decision to cancel within three(3)business days 1. The date you signed the contract,which is 2. The date you received this notice of your right to cancel. Payments made by you under the contract and any negotiable instrument executed by you will be returned within 10 business days following receipt of the seller of your cancellation notice. If you choose to cancel the contract,the lien or security interest is also canceled.Within 20 calendar days after we receive your notice to cancel,we must take the necessary steps to cancel any lien or security interest we have created in your home in conjunction with the contract. Although you may keep any money or property which we have given you until we have done the things described in the h you must then offer to return the money or property. If returning the property is impractical or unfair, previous paragraph, you must compensate us for its fair market vat home or at the location ofalue.You may offer to return the property y the address below. If we do not take possession of the money or property within 20 calendar days of your offer,you may keep it without further obligation. How to cancel If you decide to cancel this transaction,you may do so by notifying us in writing at: Remodeler's name: Morse Constructions,Inc. Street or Post Office Box: 57 Central Street City, State,Zip Somerville,MA 02143 i ed and dated you that states your intention to cancel,or you may use this notice ent s by You may use any written statement signed by dating and signing it below. If you cancel by mail or telegram,you must send the notice no later than midnight of (or midnight of the third business day of the events listed above).If you send or deliver your notice in some other way,it must be delivered to the above address not later than that time. I Wish to Cancel Client's Name: Date: 0 0 10 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ► tm—t —t— 11- - 2 x 10 PT joists 16"O.C.with bridging tyP.) 11 (2)2 x 10 PT Girder (tYP) Lazar Deck - Framing plan Date: 5/22/04 Scale: 1/4" = 1' 0" Morse Constructions, Inc. 57 Central St. Somerville Ma 02143 (617) 666-4460 Ph. (617) 623-2999 Fax o 0 o 50'-2 3/4" JG KITCHEN q ft 77/161. 432 /16" 432 sq ft T-4 9/16" 3'-0" 8'-7 1/2" 6'-6" 17'-6 1/4" 3'-1 1J4" 3068 6640 7468 M DN ZO O Align stair with window trim DN r` rn � 9'-0' iba CO DECKT- r (3)2x12 PT stringers 319 sq ft 4 x 4 PT posts on 10"concrete piers 48"below grade or pinned to ledge 36"high railing(typ) 12'-0" — 22'-0 Lazar Deck - Plan View Date: 5/22/04 Scale: 1/4" = 1' 0" Morse Constructions, Inc. 57 Central St. Somerville Ma 02143 (617) 666-4460 Ph. (617) 623-2999 Fax RTH Town of Andover No. P ............16 7 C' LAK over, Mass., //B/y y COCHICHE RA TE D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.......3P 07*........d d) 2A J* BUILDING INSPECTOR ................................................................................................................. Foundation has permission to erect... I...... buildings on ...1.011P......P.h*.j.&AVt.....BIPOOILM Rough L to be occupied as....... ........ K......V.N.....t.. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file Final this office, and to the provisions of the Codes and By-Laws relating to the Insp n, Alteration and Construction of Buildings in the Town of North Andover. IV& is / ca al PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT' EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIOTT �TAP S ELECTRICAL INSPECTOR bT, Rough .......... ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. N" 122 122 •� 1,.w to 'ht .�fg ' , 3 . W 1 . , ? _ 1 A - 122 +':;, _ / — .,a 1 : _ 1 _ , C3 j. :I 2 .. r 8 Cl \ioopf aoo , / l , , ... _ ,:,. ,,.., — ,....• �_„' _, _fir, ..._., •. .. 25 IDE IVEWAY & A :M E" SE ENT' 70 {• ,. ,_: .. a. ,; r _ , .. .. ...70:.:.. : ._:. RC1 /' C�y N, a ,e.:., k:' ,,. -.. : ,.,. .-'.. ...+f• //_ 4 �. .:,. T , , (. ACRESv 4z F , \ p 1096 � D- BOX SEP K h \ . \ 3 1 4 \ NO—DISTURBANCE ZONE . \ mo=w, / �. j lT OF �TOPSO/L, `�\ 1 WATER SERVICE ?SOIL; SAND' UNSU/TABLES ►ER/AL :EEXCAVATION 1 •! ! \ - fig, 49! / yC EDGE OF WETLANDS I FND.' fDRA/N / // / \ / . �� W`12 W-11 X32 � lNV .:I 122.0 I 1 � ; /. / i ',+ - ;, � \ ,� ,� // 136 / �� � � •. _, _, 77 r--- : ELEVA TIONS DESIGN AS—BUILT . INV. OF PIPE OUT OF HOUSE 125.00 XXX INV OF PIPE AT SEPTIC TANK INLET 123.25 123.42 INV. OF PIPE AT SEPTIC TANK OUTLET 123.00 123.24 INV. OF PIPE AT D—BOX INLET 120.61 120.68 094INV.. OF PIPE AT D—BOX OUTLET 120.44 120.51 ' INV. AT END OF DISTRIBUTION PIPE 1 120.00 120.01 1 ec - VENT INV. AT END OF DISTRIBUTION PIPE 2 120.00 120.01 ' INV. A T END OF DISTRIBUTION PIPE 3 120.00 120.01 f n _ TP TP-6-1 A x� LOT 6A 1 �� D 74gq0' AREA = 1.05 ACRES roN�t tM° NOTE: THIS PLAN /S NOT A WARRANTY OF THE SYSTEM. IT IS A RECORD OF THE LOCATIONS OF THE EXISTING STRUCTURES. INTERIM AS-BUILT PLAN \ D—BOX ��s OF SUBSURFACE DISPOSAL SYSTEM 47' 1500 G LLON ` C A T 51 SEPTIC TAN 66.79' r, LOT 6A, EVERGREEN ES TA TBS _xis riNc IN FND. NORTH A NDO VER, MASS T.O.F.=133.7' PREPARED FOR: BRETT LAZAR LOT �) SCALE: 1" = 20' DATE: 7/28/97 `o I �+,'� `-� � �X �`~ PROFESSIONAL ENGINEERS PLANCHRISTl�4 NSEN SERGI LAND SURVEYORS 160 SUMMER ST. HAVERHILL, MA 01830 TEL. 508-373-0310 SCALE: 1" = 20' Q 1997 BY CHRISTIANSEN & SERGI INC. _ DRAWING NO. 94036042 CERTIFICATE OF USE & OCCUPANCY Torn of North Andover ,p G� Building Permit Number / Date i i THIS CE ES THAT THE BUILDING LOCATED ON �d) s MAY BE OCCUPIED AS—�� IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSE S STATE BUILDING CODE AND I SUCH OTHER REGULATIONS AS MAY APPLY. I Cq CERTIFICATE ISSUED TO O � , ADDRESS C �� P ' 4sACNI1S�� Build' g nspector i The Commonwealth of Massachusetts FOR OFFICE USE ONLY Department of Public Safety Permit No. _ BOARD OF FIRS PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee Checked(leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date May 8, 1997 City or Town of North Andover To the Inspector of Wires: The undersigned'applies for a permit to perform the electrical work described below: Location(Street and Number) 126 Pheasant Brook Rd. Map: Lot: Owner or Tenant Mr.Bret Lazar Zone: Owner's Address same Is this permit in conjunction with a building permit? Yes® No❑ (Check Appropriate Box) Purpose of Building Residential Utility Authorization No., 703631 _*Existing Service Amps Volts Overhead❑ Underground❑ No.of Meters New Service " 200 Amps 120/240 --- Volts Overhead❑ Underground X No. of Meters I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Connections for new modular home,service and wiring in basement. No.of Lighting Outlets 10 No.of Hot Tubs No. of Transformers Total KVA No.of Lighting Fixtures 20 Swimming Pool Above grnd. ❑In-grnd. ❑ Generators KVA No. of Receptacle Outlets No. of P 60 Oil Burners No. of Emerg. Lighting Battery Units No.of Switch Outlets 20 No.of Gas Burners 1 FIRE ALARMS No. of Zones No. of Ranges 1 No. of Air Cond. Total Tons No. of Detection and No.of Total Total Initiating Devices No. of Disposals 1 Heat Pumps Tons KW No. of Dishwashers 1 Space/Area Heating KW No. of Sounding Devices No. of Self-Contained No. of Dryers 1 Heating Devices KW Detection/Sounding Devices 3 No. of Water Heaters KW No. of Signs No. of Ballasts Local® Muncipal Connection❑ Other No. of Hydro Massage Tubs No.of Motors Total HP Low Voltage Wiring thermostat/tel/door bell OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES®NO❑ I have submitted valid proof of same to this office.YES ®NO❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE®BOND❑ OTHER❑(Please Specify) 10/07/97 (Expiration Date) Estimated Value of Electrical Work$ Work to Start May 8, 1997 Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME Simoes Corporation LIC.NO. A10333 � Licensee Gaspar Simoes Signature LIC NO. Address P O Box 286 Peabody,MA 01960 Bus. Tel.No. 508-532-1242 Alt.Tel.No. 508-977-0241 FAX OWNER'S INSURANCE WAIVER: I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner❑ Agent❑ (Please check one) (Signature of Owner or Agent) Telephone No. PERMIT FEE$ 270 c �� :�,,,yu"�..--'�...yea'-+•G::,.'10"".'..'`ti,'.., _ ' _ ...4-...- —. i- ... .w.- »ate+€.c�,..-�"". Date...........:........... ...... - ` 93 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ;,SSACMUSES This certifies that e S Cd R �? ' has permission to perform .........M�.W........'.{. wiring in the building of......�/: . �.....2A �P4s4 at.:... ,:...�...... ......... ..:/............... .............North Andover,Mass. Fee... 7 .:.U.. Lic.No,—A ELECTRICAL INSPECTOR _ 05/12/97;10.15 270.00 PAI WHITE:Applicant CANARY: Building Dept. PINK Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI"N-G (Print or Type) I NORTH ANDOVER ass. Date �uilding Location a 7z1e;4W0('-00e Permit - Owners Name k-,( • = New Renovation D Replacement Plans Submitted D F I X T U P rn , � w 14 N x Q � Lu 0 z a t- a z =- o t- W Z W H t' W W p 0 0 a W t- a 0 r3 w -cc x = F' to ap y W w rn z a x a a a w t- W ;t- x c0 t= O t. x ,� f- z y W w O > u. t- V .1 t- W z Q W < CC f' S- N Cd = O Z rzW O N = Q W > C W :3Z 4 G 4 s( O O W _ O W N cc x O V 5 hr_ A O ,.t U M > Q o. t- O SUR-BSTMT. t BASEMENT G1 IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR EST H FLOOR H FLOOR (Print or Type) .� Check one: Certificate Installing Company Name L Cor Q P- Address () A 4 '� .!/"� e - Partner. 6e# 5 W-V (5/X6 Firm/Co. Business Telephone: fbtp -S-3 2 -19 Z�Z J _ Name of Licensed Plumber or Gas Fitter lC *e f Z6 G.� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1�f Other type of indemnity Q 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 owner/agent of property Owner Q Agent M I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and tlhat ail plumbing work and installations performed under'Permit iueed for this application will-be In compliance with ad pertinent provisions of tho Massachusetts State Cas Code and Chapter 142 of Cho General Caws. By TYPE LICENSE i Title Plumber Gasfitter ignature Licensed City/Town: Master Plumber or G slitter Journeyman APPROVED (OFFICE USE ONLY) Licen a Nuthber ��,��`r":,��.�a'xc='�w ---• r :sir.:3='ems+„ - ''�r�+'n;r.'e9a�, e� 2557 Date. "Of? - TOWN OF ;NORTH.ANDOVER' + PERMIT FOR GAS INSTALLATION • A . .. �9SSACMU5Et This certifies that . .. has permission for gas installation . :..Ef`u :Y:. . . . . in the buildings of ? ; at .��? .,--:13 ?� UP/(. . No Andover, Masi Fee. ..?. Lic. AS INSPECTOR WHITE:Applicant CANARY:Building;Dept. PINK:Treasurer GOILD (Print a type)- nes• s v �� r-�.u�a�u��w NORTH ANDOVER, Mass. 09 , .Ifi 7 ?0' Bundtng F t l L, /¢.2- Permit Location a l P ,�Nr 81-00 k Owners �•e.� � , L`¢/e ` ' Name New Renovation O Replacement O: Pians Submitted: Yes Q No.p FIXTURES I va w o e s o s a s w w o = s 'o s " �log .4 w N = w 16 s i, err r H 2 r w = s 1 A s er I" 3P 1wX le Y = At 0 d • ` � " ` � nor r i. S It = w suer—assrT. • 'I aAeaMGMT taT FL00R !NO FLOOR t)RO FLOOR 4THFLOOR now j aTH FLOOR i aTH FLOOR. TTH FLOOR aTHFLOOR Check one: cadvicate Installing Company C Address ) r O O Partnership U S !�/3s.Tf KFIrm/Co. Business Telephone C9 – S L — 4 9ZZ Name d licensed Plumber [. S a l o 7f}--J a . INSURANCE COVERAGE: ecVne I; I have a current liability Insurance policy or Its substantW equNatent. Yes No ❑ I. It you have checked yam, please Indicate the type coverage by checking the appropriate box 4 A Ilabltly Insurance policy O Other type d Indemnity O Bond O, OWNER'S INSURANCE WAIVER: I am aware that the Ilcenies does not have the Insurance coverage required by Chapter tet of the Maas. General Laws. and that my signature on this permit application waives this requirement. Check one: a urs o err«ownN en Owner ,O Agent ❑ 1 herby cuft that al of the details and Infamatlon 1 have submitted for entered)h above appifcatlon are true and accurate to the pest of my Inowiedpa and that aspIumbinq work and Installations performed under the p nrA lasted a ap will 1: la with aA pertinent provislons of thi Massachusetts State Plumbing Code and Chaptar 142 al OY TRIO YM ere o an um er C8ylTown License Number APPfMD(OFIICE USE ONLY) Type of Plrrnrbkro Uwnsg: Master Journe n ❑ f � Date . . . ' 3 57 ? 0°Tao TOWN OF NORTH ANDOVER a m PERMIT FOR PLUMBING ,SSACMUS� • 4 This certifies.that fiq e�+ >�! . . . .r�a�. f7f. . . . . . . . . . . . . . . . N has permission to perform . ., .F. V, . . . . . . . . . . . . . . . . . . f lumbi in the buildin s of . p g g �. . . . L.. .�G�F at. .� . .�,: .�'�c�9.s�1 .{ . . o rf . . . . ., North Andover, Mass. :9 f � Fee. 49, :Lic. No.. . .(!W. 7 . . . . . . MBING INSPECTOR O `8 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer