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Miscellaneous - 127 BEVERLY STREET 4/30/2018 (2)
/ 127 BEVERLY STREET ` J1 210/005.0-0036-0000.0 '3 Date............................................ ................ OF &OR TOWN OF NORTH ANDOVER 1 0 PERMIT FOR WIRING mu 1q,4 CAII This certifies that ....................... 0 �n\t Py .3 -1411 l.,4,1 p� has permission to per- 0' wiring in the building of........ ...........................I............................... ... ..... ........... ............... at ................. ...... ............................ ............. h Andover,Mass. Fee.............. ...........Lic.No. ....... �T ..........a.. .. ...... . . ELE�FkCAL INSPECTOR 3 qS�Z, Check 11017 Commonwealth of Massachusetts Official Usgnly Permit No.NEW Qo�`" Department of Fire Services r 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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8/28/13 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) 127 BEVERLY STREET Owner or Tenant MOLLY TANNATT Telephone No. 978-247-2435 Owner's Address SAME Is this permit in conjunction with a building permit? Yes ox No 0 BLDG PERMIT# \\ Purpose of Building SINGLE FAMILY Utility Authorization No. N/A 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: FLOAT METER FOR NEW SIDING,RE-INSTALL EXTERIOR FIXTURES&OUTLETS Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 1 L 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 J.NumbeTon r s _ KW No.of Self-Contained Totals: _ - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Munic holn El other ConneNo.of Dryers Heating Appliances Key Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent 4i 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. Estimated Value of Electrical Work: $400.00 (When required by municipal policy.) Work to Start: 8/28/13 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C n ess 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 V) exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑X BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MIKE'S ELECTRICAL SERVICE OF SOUTH HAMPTON,INC LIC.NO.: A10421 m Licensee: MICHAEL KELLER Signature LIC.NO.: E25006 �4 (Ifapplicable,enter"exempt"in the license number line) Bus.Tel.No.: 603-394 0117 Address: 27 WOODMAN ROAD,SOUTH HAMPTON,NH 0382 Alt.Tel.No.: 603-231-6068 Per M.G.L.c.147 s.57-61 security work requires De artment of Public Safety"S"Licen LIC.NO.: k OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signa- ture below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:S / � . y /f /� �/r + G / �:. �'! � � //G �-�y.- .3 1 j ;- ., . . i The Commonwealth of Massachusetts Print Form viDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): MIKE'S ELECTRICAL SERVICE OF SOUTH HAMPTON, INC. Address: 27 WOODMAN ROAD City/State/Zip: SOUTH HAMPTON, NH 03827 phone#: 603-231-6068 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 2 4. [] I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. []Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp. insurance comp.insurance.: required.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LQ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. TRAVELERS Insurance Company Name: Policy#or Self-ins.Lie.#:INUB0008592913 Expiration Date: JULY 16, 2014 Job Site Address:127 Beverly Street City/State/Zip:N.Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ',fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct August 28, 2013 Si afore: Date: Phone#: 6d3-231-6068 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: COMMONWEALTH OF MASSACHUSETTS,_, p- o o - o 0 BQARD'OF ELECTRICIANS ISSUE.:S. THE FOLLOWING LICENSE AS 'A REG JOURNEYMAN ELE.CTRIGIl�N MGCHA.EL D KELLER �7 WOODMAN RD r S'0 HAMPTON NN 03827 3606 2500g I6.:..E 07%3.1./:a'{z...... 83675 IN IQ� I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 0 / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -1' < Print. PROPERTY OWNER. lVillo �_ /v Print 1o0 Year Old-structure yes. no.- MAP NO: PARCEL- ZONING DISTRICT: Historic District ye no. Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain D Wetlands ❑ Watershed District, . El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 0 q f enY�"ication Please Type or Print Clearly) OWNER: Name: Meh N Phone: � Address: 44 7-- oW7—y CONTRACTOR Name: C1.4"tl) Phone: 7 Address: 1JL,0L1 (.P/fl(J/7C- VL Supervisor's Construction Licenser Exp. Date: `;7A /A� Home Improvement License: 17LIYW Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 39 )-d o - On FEE: $ ]- a Check No.: Receipt No.: D NOTE: Persons contrac ing with unregistered contractors do not have access to uaranty fund ;Signatureof Agent/Owner" Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Locate No. i Date • - TOWN OF NORTH ANDOVER • S D', • • �. Certificate of Occupancy $ Buildin 9/Frame Permit Fee $ : m Foundation Permit Fee $ Other Permit Fee $ � " TOTAL $ Check# i rt V , Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ I Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS y HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/SDriveway Permit DPW Toibaa Engineer: Signature: Located 384 Osgood Street FIRE DEPARTML-NT`- Temp Dumpster on site yes no Located at'124 Mair Street Fire Departinerit signature/date { COMMENTS_ ` 4 �i I r• s � — c ✓>!ze �ooavriso•,uoeccl,C,/ o�../�aaaac�ucaelCa.� Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration:-,1170870 Tyke; Expiration: 1%10%2014 DBP, PROFESS IONAL".BUILDINGSERVICES INC. PETER CIARALDf{_` 9 OLDE WOODE RD g � � `. SALEM,NH 03079 :1•, Un&rsecrettaaryI Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction super',icor License: CS-097650 PETER M CIARA01 a r 9 OLDE W O O 0'� ' SALEM T t! Expiration 0710312015 } Commissioner 11 NORTH own of o . - �.: � 1 No. 4 C% I h , ver, Mass, COCMICHEWICK A°RATED jl*I? '(y s U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ,.a I T h r. BUILDING INSPECTOR I�4� 8.4.V404% Foundation has permission to erect ..................,....... buildings on ... �. ......... ......t. .............//�� cc � � .., Rough to be occupied as ............. .. .... ......... ......... ..... ........�.tlr�l.f......fK.�. .... ........... � Chimney provided that the person acce tin tis permit shall in every respect conform to the terms ol�the application Final p p p 9 on file in this office, and to the provisions of the Codes and By-Laws relating to the I spection,Alteration and Construction of Buildings in the Town of North Andover. 15NG t*'�4 O PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Iff UNLESS CONSTRUCTIOT S Rough Service .................It. ......................................... Final BUILDING INSP......... ....ECTOR- GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"a Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757. Homeowner Information Contractor Information Name Molly Tannatt Company Name PROFESSIONAL BUILDING SERVICES/PETER CIARALDI Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 127 Beverly St MA 9 01-DE WOODE RD City/Town State Zip Code Business Address(must include a street address) (978)886-0488 SAL[vl NH 03079 Daytime Phone Evening PhoneCity/Town State Zip Code Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number 603-898-2977 20-5303576 Law requires that most home Home Improvement Contractor Expiration Date Improvement contractors have a valid reg.number Registration number CS97650 7,14 The Contractor agrees to do the followi g work for the Homeown r: (Describe in detail the work to completed,spe Tying the type,brand,and gra of materials to be used,us( additional sheets if necess ) Reference Professional Building Services 1499,1500,1502 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following and will be secured by the contractor as the homeowner's agent, schedule will be adhered to unless circumstances beyond Owners who secure their own permits will be the contractors control arise excluded from the Guaranty Fund provisions of Week of 7/8/13_Date when contractor will begin contracted work. MGL chapter 142A.) 7/22/13 Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: 539,226 (* Payments will be made according to the following schedule: $_upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever' greater) $_13000.00 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,w rc ever is greater) $_13,000 by or upon completion of_Nouse Stripped and wrapped $ rem a I n d e r upon completion of the contract.(Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special$_N/A to be paid for N/A ordered before the contracted work begins in order$ N/A to be paid for N/A to meet the completion schedule.(**) NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractor? No Yes (all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it.Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance?Check to see that your contractor is properly insured. • Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. di Hom owner Signature Contractor's Signature 13 6/17/2013 Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. Home ner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation CX The Commonwealth of Massachusetts - Department of Industrial Accidents Office ofinvestigations 600 Washington Street kvi Boston,MA 02111 www mass.gov/dia 'Workers' Compensation insurance Affidavit: Builders/Contractors/El lease Print Le ibl Applicant Information Name(Business/Organization/Individual): E�p,�� Address: City/State/Zip: ✓1 � � Phone#: 0'j Are you an employer?Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 6• El New construction l 1•M I am a employer with have liired the sub-contractors employees(full and/or part-time).* 7. ❑Remodeling listed on the attached sheet. 8 ❑Demolition 2.El T am a sole proprietor or partner- These sub-contractors have ship nd'have no employees workers' comp.insurance. 9• E]Building addition working forme in any capacity. [No workers' comp.insurance 5. ❑ We are a corporation and its 10•0 Electrical repairs or additions required.] officers have exercised their 11. Plumbing repairs or additions 3.ElI am a homeowner doing all work right of exemption per MGL c.152,§1(4),and we have no 12.❑Roofrepairs myself. workers. comp. employees.[No workers' 13.0 Other insurancee required.] comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ed an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. $Contractors that check this box mast attach I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. l Insurance Company Name'. � - - Expiration Policy#or Self-ins.Lic.#: fiU �� h� r[ City/StatelZip: W d � -- Job Site Address: l�� -—T ` Attach a co of the workers'co, on declaration page(showing the policy number and expiration teof a A copy c.152 can lead to the imposition of criminal penalties ecti on 2 5A of MGL der S e ' edun d a fin uii an Failure to secure coverage as xeq s civil penalties m the form of a STOP WORK ORDER r imprisonment,as well a fine up to$1,500.00 and/or one=yea p of this statement may be forwarded to the Office of of up to$250.00 a day against the violator. Be advised that acopy Investigations of the DIA for insurance coverage verification. do hereb cerci er pains and penalties of perjury that the information provided above is true and correct. I Y f' l D ate. Si ature: Phone 4: �"2C Official use only. Do not write in this area,to be completed by city or town offrcial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: ContactPerson: 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 ort-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 0 p0 Professional Building Services by PMC, LLC Professional Building Services by PMC,LLC Estimate 9 Olde Woode Road ® Salem,NH 03079-1863 Date Estimate# � (603)898-2977 05/29/2013 1499_ pete@professionalbuildingservices.comxp._•Date www.professionalbuildingservices.com V► If 06/08/2013 _ (VEJCE Address' Molly Tannant 127 Beverly St North Andover,MA 01845 Sales Rep PMC Activity ,. Quantity -Rate.. Amount ,,.., .._ •Building Permit-Administration Fee 0 300.00 0.00 Home owner can pull building permit themselves. If customer wishes Professional Building Services to pull permit,please add $300. ** Customer to reimburse Professional Building Services cost of permit fee paid to Town/City.** •Building Permit Fee paid to Town/City-TBD 0 0.00 0.00 This fee to be reimbursed to Professional Building Services or customer can pay directly to municipality •30 yard dumpster with 4 tons.If additional dumpster needed,customer agrees to 1 675.00 675.00 pay for additional dumpster or dumping fee. Continue to the next page Q f",f)- Page{0}of{1} Activity,* Quantity Rate Amount •Total Coverage: 35 950.00 33,250.00 Strip all siding down to exterior sheathing and dispose Strip all window and door trim and dispose Strip all fascia and soffit and dispose Install Vycor(or equiv)wrap around all wndows and doors. Install Hardie wrap or equiv around entire dwelling and tape all seams Install Hardieplank Cedarmill painted fibercement siding to manufacturers specifications. Standard paint color-James Hardie COUNTRYLANE RED Trim color-Arctic white Reveal=5" Corner boards-4"fibercement boards Hardie fascia&soffit replacement included Window trim-4"fibercement boards on top and sides. CROWN MOLDING AND FREEZE BOARD ON RAKES INCLUDED to replicate horizontal Detail at gables-not included in this estimate Window sill to be standard PVC sill •Electrician to remove and reconenct electrical panel to code.Siding will be 1 300.00 300.00 installed behind panel. utters&downspouts Price per L.F. - - - - - - " 0 11.00 0.00 •R&R Vinyl Shutters per pair 0 75.00 0.00 •CONCEALED CONDITIONS:This Agreement is based solely on the observations 1 0.00 0.00 Contractor was able to make with the structure in its current condition at the time this Agreement was bid.If additional concealed conditions are discovered once work has commenced which were not visible at the time the proposal was bid,Contractor will stop work and point out these unforeseen concealed conditions to Owner so that Owner and Contractor can execute a Change Order for any Additional Work. •ALL LEAD PAINT SAFE PRACTICES WILL BE IN PLACE AND COMPLIANT THANK YOU! We appreciate the opportunity and look forward to working Total $34,225.00 with you on your upcoming project. Accepted By ` J� Accepted Date �V 3 Professional Building Services by PMC, LLC Professional Building Services by PMC,LLC Estimate 9 Olde Woode Road Salem,NH 03079-1863 Date -Estimate# (603)898-2977 05/30/2013 1502 ta pete@professionalbuildingservices.com Exp. Date www.professionalbuildingservices.com�u - rs- 06/08/2013 Address Molly Molly Tannant 127 Beverly St North Andover,MA 01845 Sales Rep PMC Activity,., Quantity Rate Amount.e •Close off front bump out door: 1 375.00 375.00 Plywood over Insulate with R-13 faced Drywall and mud to sanded finish Paint-not included •Rear bump out: 1 626.00 626.00 remove shingles and rotted plywood Install 5/8 plywood supply&install Certainteed architectural shingles Trim out-included.in Hardie pricing ALL STEP FLASHING,DRIP EDGE AND SEALANTS INCLUDED •ALL LEAD PAINT SAFE PRACTICES WILL BE IN PLACE AND COMPLIANT THANK YOU! We appreciate the opportunity and look forward to working Total $1,001.00 i with you on your upcoming project. Accepted B. — (1A /I — aq it'"i �—Accepted Date Professional Building Services by PMC, LLC Professional Building Services by PMC,LLC Estimate Salem,NH 03079-1863 Date Estima.. to (603)898-2977 05/29/2013 1500 pete@professionalbuildingservices.com Exp. Date �r � ' www.professionalbuildingservices.com ��'��� �"�.�� 06/08/2013 �! B _ CSS; Address .. " Molly Tannant 127 Beverly St North Andover,MA 01845 Sales Rep PMC A Activity, Quantity_. Rate yAm ount •Building Permit-Administration Fee 0 300.00 0.00 Home owner can pull building permit themselves. If customer wishes Professional Building Services to pull permit,please add $300. ** Customer to reimburse Professional Building Services cost of permit fee paid to Town/City. ** •Building Permit Fee paid to Town/City-TBD 0 0.00 0.00 This fee to be reimbursed to Professional Building Services or customer can pay directly to municipality •Remove existing Porch posts,decking and-railing and dispose 98 - 35.00 -3,430.00 Replace with Trex Transcend flat post caps,skirts and 4x4 posts and railings. Trex Transcend decking-grooved.Not picture framed. No fascia and stair risers to be wrapped with PVC. Will use hidden fastener system and color matching screws where necessary. Replace existing foot print with decking and railing only.Frame to remain in place. Deck color-TBD.Non-Tropical Colors Rail color-white Continue to the next page Page{0)of(1) Activity Quantity. Rate PP P P 2 285.00 Amount •SUpply and install colonial structural support porch osts 570.00 •TRASH-if done at same time as siding.No cost. 1 0.00 0.00 If done at different time than siding-add$325 •Trex lighting pricing: 0 0.00 0.00 Post cap$65/light Riser light$23/light Recessed deck lights$23/light Side post light-$50/light Labor to install-$30/light Transformer with timer switch-$259 •Transcend decking and porch planks installed by TrexPro Platinum's in 2012(and beyond)will receive a free 2 year labor warranty from Trex upon project registration.When installed over Trex Elevations Steel Deck Framing,this coverage will be extended to 5 years. •CONCEALED CONDITIONS:This Agreement is based solely on the observations 1 0.00 0.00 Contractor was able to make with the structure in its current condition at the time this Agreement was bid.If additional concealed conditions are discovered once work has commenced which were not visible at the time the proposal was bid,Contractor will stop work and point out these unforeseen concealed conditions to Owner so that Owner and Contractor can execute a Change Order for any Additional Work. •ALL LEAD PAINT SAFE PRACTICES WILL BE IN PLACE AND COMPLIANT THANK YOU! We appreciate the opportunity pportunity and look forward to working Tot21 $4,000.00, with you on your upcoming project. Accepted By Accepted Date I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions__ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min. 100- 1000 fine e p $ NOTES and DATA— (For department use ® Notified for pickup - Date I Doc.Building Permit Revised 2010 Building Department The fol;ovving is a dist of the required forms to be filled out for the appropriate permit to be obtained. R.00fivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app)•-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subtriAted with the building application Doc: Doc.Buiiding permit Revised 2012 Date...... y... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �1SSACHUSE� This certifies that ....'..'..... has permission to perform .......,..........�'- .�......'............................................. wiring in the building of................... at.. �'�. ... � .. .......... ..... ,North Andover,Mass. Fee 00 Lic.No.`s....`..... ... .��.. . ... ELECTRICAL INSrE Check # r 7599 Commonwealth of Massachusetts Official Use Only �I Permit No. Department of Fire Services Q� BOARD OF FIRE PREVENTION kvi REGULATIONS Occupancy and Fee Checked �^ [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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: � — City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his her intention to perform the electrical work described below. Location(Street&Number) Z y L Owner or Tenant --_ �L P OK'2�—'070- /' �C�1�.fr�` Telephone N Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service f3 c5 Amps lx6 / c/i Volts Overhead Q` 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: Completion of the following table maybe waivIedby the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o,o mergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 1 No.of Switches No.of Gas Burners No.of Detection and- Initiatine Devices No.of Ranges No.of Air Cond. ons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained j Totals: - Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Municipal P g Local❑ Connection ❑ Other No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of Devices or E uival i � Heaters KW No Signs Ballasts . Data Wiring: -nt No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Te ecommunications Wiring: OTHER: No.of Devices or Equivalent ' Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: /lam- (When required by municipal policy.) Work to Start: — -7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. 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:) [ I certify, nder the pains andpenalties of perju that the information on this application is true and complete. FIRM NAME: � � '' LIC.NO.:!,ef,:� �6 Licensee: Signature LIC.NO.-, — Iapplicable,rncc.L e, enter"exempt"in the license number line.) Bus.Tel.No.•9' � Address: _�/ES �9 �� Ta-, 'G� �'r/ �/ s •, 'Z����=3 7y l � 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 b ow,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agegt� _ Signature! J Telephone No. PERMIT FEE: $ _ The Commonwealth of Massachusetts ki ' f Department of Industrial Accidents •.. ODIC--of Investigations 600 Washington Street i Boston, MA 02111 j www.mass.gov/dia . 1 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lmgibly Nanie(Business/Organization/individual);_ � r City/State/Zip: �1' // Phone #:_. %`�� ��— t2� Jn Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4, ❑ i am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E� i am a sole proprietor or partner- listed on the attached sheet.3 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working far mein any capacity. workers' comp. insurance. g, ❑Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its 10.❑-dectrical at required.] officers have exercised their repairs or additions 3.❑ I tim a homeowner doing all work right of exemption per MGL 1 L❑ Plumbing repairs or additions myself.[No-workers'comp. c. 1.52, §1(4),'and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 1311 Other 'Any applicant that checks bomC#l must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their worker;'comp.policy information. 1 am an employer that is providing workers'contpensa&n insurance for ray employees. Below is the policy and job site 1 information. ' Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration late: X Job Site Address:_���` City/State/Zip: Attach a copy of the workers'compensation policy tion page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine + of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. j I de hereby cerci under the pains and allies of perjury that the information provided above is true and correct. � � � Si afore. � - - �� Date: i -- Phone#: ------------------- Official use only. Do not write in this area,to be completed by city or town official j C' or Town: City Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/3 own Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: b Date.. .-. .` . �aORT►, °ft"'°:•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUS This certifies that ...................................................................�-� L G f� ........... . ... .... has permission to perform .......... .f�oa�........� ....! ~ ` wiring in the building of M. .................................... r �'7 4 V. : T North Andover,Mass.. at............................ ......................... ,l Fee..q-," ......... Lic.No..4 I;�3eO............ .....eIC ............t. ....... ... LEALINSPECTOR Check # -LI �1yg 8105 { 'L 1b� Commonwealth of/fia-mackwettd Official Use Only 2.partment ol3ire Services Permit No. Occupancy and Fee Checked -, ,B&RD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (MEC), 27 CMR 12.00 i (PLEASE PRINT 1NIIVK OR TYPE 4LIN O TI011� Date: City or Town of: e) To the Ins ector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,efz, Owner or Tenant11l L Telephone No. i jl Owner's Address Is this permit in conjunction with a buildipermit? Yes No ❑ (Check Appropriate Box) Purpose of Building1 le �►, Utility Authorization No. 5 � sti 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: � �� PFJ Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA P No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above d. - o.omergencyigg un d. ❑ Batte Units 3 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection an No.of Switches No.of Gas Burners No.Initiating Devices No.of Ranges No.of Air Cond. 'TI'ons No.of Alerting Devices No.of Waste Disposers IleatPump um er ons— o.of Self-Contained Totals: 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.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirmg No.of Devices or Equivalent OTHER. Attach additional detail if desireit or as required by the Inspector of Wires. Estimated Value ofectrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. A INSURANCE RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability' rance including"completed operation"coverage or its substantial equivalent. The -1 undersigned certifies that such cover a is m force,and has exhibited proof of same to the pe .t issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (J (/E�i �� I certify,under thepains andpenalties of ary,that the infor on this application is true and comp ete,� f FIRM NAME: � t( �' LIC.NO.:; Licensee: ^ ei, Signature LIC.NO.: (If applicable,enter ' t"ire icense umber line.) Bus.Tel No.- Address: m l/ Alt.Tel.No.• *Per M.G.L.c.147,s.57-61,security work requir6s Department of Pub is 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:S ' Signature Telephone No. I {I Date1. ................... I NORTH TOWN OF NORTH ANDOVER I . L PERMIT FOR WIRING SACHUS This certifies that ... .. ................ ................................ has permission to perform .............................. .............................................. wiring in the building of.... .fir................... ........................................... at.,!.'...........: ...z;......... ............... .North Andover,,,Mass. .. -J .. ..... Fee..................... Lic. ............. ELECTRICAL IINISP�90*R? Check # 7119 Commonwealth of Massachusetts Official Use Only Permit� No. 11 Department of Fire Services �- r Occupancy and Fee Checked ed BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code X EC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: A Obi Ci or Town of: PDv ty /�,�, V tit To the f o Inspector Wires: r By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /9S— 13FV ERL y S j Owner or Tenant )q CSL- 'Ll:O Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building /-JU USir Utility Authorization No. Existing Service al00 Amps /--)0 /aYa Volts Overhead Undgrd ❑ No.of Meters t New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 4 Location and Nature of Proposed Electrical Work: W9; i Leva 4 J"D IRE),-VD81 FCool? Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires /0 No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets /r No. of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o.o Emergency Lighting rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets S-0 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 g No.of Waste Disposers j Heat Pump Number I Tons KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers I Space/Area Heating KW Local❑ Municippi ❑ Other Connection No.of Dryers / Heating Appliances Kms, Security Systems: No.of Water No.o No.o No.of Devices or E 4 uivalent Heaters KW Data Wiring: Si ns Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 000 04.1- 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: Inspections to be requested in accordance with MEC Rule 10,and upon completion. 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 Q] BOND ❑ OTHER ❑ (Specify:) I certify,under lite pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: r r%wNf( J)EP►Uv9 Signature LIC. NO.: E3 19 S's (Ifapplicable, nter "exempt"in the license number line.) Bus. Tel. No.:178-670-977 Address: ro. -po-x a0P t N1rNURS i, mA . Q1$6b Alt.Tel. No.:.fVF'JV9-a-7Gg *Security System Contractor License required for this work; if applicable,enter the license number here: 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent [PERMIT FEE: $ Signature Telephone No. Date. .1 . No 4. 65 4 TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING ' ^� a +, ,0•'+.`th ,SSACNUS� This certifies that . . . . has permission to perform . . . . . . . ..``. . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .1114 . . . . . . . . . . . . . . . . . . . . at . . l .7. . vz. ...... . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . .�. . . . .Lic. No.. �. �.3. ��. . .1. .-��... . . . ... . . . . . . . . PLUMBING INSPECTOR Check # cj� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) _ Mass. Date %l � Permit # S L Building Location /07-76 Owner's Name rJr�/ATT /l l� A fJ�JC�J tk A Type of Occupancy E IJ -h r-�L_ V New ❑ Renovation ❑ Replacent 93"' Plans Sub ed: Yes ID No ❑ FIXTU S Z CM _Z N Z x Q .. N O Z H W Y J (A } V < N ' W W N Z N < ¢ _ ~ Z O 2 N a x JN W y t� W ¢ Y <LU (A N W Z d ` F- G7 Z ¢ 02 Vf H W >. < F- Vl Z ¢ d t7 < < C K O M ¢ < ¢ r: < W C < H Z .¢ a ¢ � W ¢ W H F� W to D J N ¢ ¢ J C G C W S Cj < x � x a Z S Y d O ~ = Z d W W x W F O = of f' Z O N - W t' O < < < x H N < Q O < -j < ¢ ¢ a < O < H 3 Y -� m N D O J 3 Y F N li t7 p Q S E 61 O SUB—BSMT. BASEMENT IST FLOOR v 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name P1/� ot,�Ee"r Check one: Certificate Address ��f C'L AC H ma n) s.A , ❑ Corporation /r E TW i 'F_ A)-. AlA A . y t F(A/ C] Partnership Business Telephone �� Z-X97 1 2-Arm/Co. Y` Name of Licensed Plumber T fyf �!eMM14 reg INSURANCE COVERAGE: I have a current ffability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q' No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy (� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner El 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 installationsormed under the permit issu for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plum g Oode and Cbapter of the eral Laws. Title re of licensed Plum r City/Town Type of License: Master % Journeyman C] APPROVED OFFICE USE ONL License Number !j33 5 0 y 476 Date. .. ,40RTp TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ri r �,SSACMUSEt ,This certifies that . .. . . • !!• • • • • • • • • • • • • • • • has permission for gas installation . . . . . . . . . . . . . . . . . in the buildings of . . .•. f %. .. . . . . . . . . . . . . . . . . . . . . . . at . . . . • , Noah Andover, Mass. ` Fee.JD. . . . Lic. No. . . . . . `.Wit..%, . . . . ,� . . . . . . . GAS.INSPEC�TOR . WHITE:Applicant CANARY: Building Dept. PINK:Treasurer I MASSACHUSETTS LNTORM APPL.ICATON FOR PERMIT TO DO GAS FITTING �t ype or print) ate NORTH ANDOVER, MASSACHUSETTS Building Locations Permit# '&Z20- Amount &Z70Amount S Owner's Name M o flu IQnr� O.'�. New❑ Renovation ❑ Replacement d Plans Submitted ❑ vi y � C C z ^ m %t '� Z Z C Z F z Z '� :d �% i C cam.. st rn Z 't _ -t -t C it ,. C L L ^ SU B-B .1SENI ENT B A S E M ENT Is,r. F L 0 0 R 2N D . F L O U R 3RD . FLOUR -4T 11 F L O U R 57 11 FLoo R 6T If FLOU R 7 T If . F L U O R 8%41I . FI, O O R (Ont or type) Check one: Certificate Installing Company Name Andover Md. & Mg. Co.. Inc. 0 Corp. PI 29 Address 20 Agean Dr., Unit-10 ❑ Partner. Methuen, Ma. 01844 Business Telephone (978) 685-8383 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter George LaRosp INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes Q No❑ If you have checked Nes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: ❑ 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 - PP best of my knowledge and that all plumbing work and installations perto ed under Permit Issued for this application will be in compliance with all pertinent provisions of the h/lassachusetts State Ga ode and Ch pt ' he General Laws. Bv. ignature of �nsed Plumber Or Gas Fitter Title [Plumber . 9983 CityiTownn has Fitter License I umber u/(Vlasfer APPROVED IOFFICF.usE ONLY) ❑ Journeyman i I�