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Miscellaneous - 127 HICKORY HILL ROAD 4/30/2018 (2)
/ 127 HICKORY HILL ROAD 210/062.0-0117-0000.0 I I i I I i Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Department Building 20, Suite 2035 1600 Osgood Street North Andover, MA 01845 RE: Insured: Mark & Kalipso Girardi Property Address: 127 Hickory Hill Road Company: Ba y State Insurance Company p Y Policy/Claim Number: HP2521190, HP2521190 Date/Cause of Loss: 10/30/2017, Windstorm/Tree on Fence Our File Number: 35012-S Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 313 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured location otic n p , policy number,ber, date of loss and claim or file number. Dustin Sciacca, Ext. 119 On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. h6�.h'rz�-" // IZC)/7 Signature and Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Cc: North Andover Health Department North Andover Fire Department Building 20, Suite 2035 795 Chickering Road 1600 Osgood Street North Andover, MA 01845 North Andover, MA 01845 112 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that....... ........................ has permission to perform......�......... ..................... ................. plumbing in the buildings of.... .................................................... at..... d4 (/ ................ North Andover, Mass. .. ................................................................................. Fee Lic. No. PLUMBING INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY/t�L7� ��a�/� MA DATE S PERMIT# 1169V�) _ JOBSITE ADDRESS /2,2 /1" C XEnY`., OWNER'S NAME P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:$ PLANS SUBMITTED: YES❑ NO❑ FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 � BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY cQ ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ` WATER PIPING i OTHER INSURANCE COVERAGE: I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. . CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEhb 8,06L� T/0/'0 LICENSE# 8C>1 C SIGNATURE MP�'cj JP❑ CORPORATIONn# 33Y9 PARTNERSHIP❑# LLC❑# COMPANY NAME R ADDRESS )36 k `�(7 y CITY G►- VdL-- 4ockl/-P" STATES ZIP TEL P7 R FAX CELL 17—,e ` ��� `�3�G EMAIL POO 7 /y �5 Date..... ..................................... OF NORTN,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING s,CHUs� This certifies that ......... ......(...I - .................................................................... has permission to perform ........� ha �'z + S ................................................................................................ wiring in the building off.........G.'*.;?..191R..J.1� : /.. ................................................................ at ................! A.t !{ ''` `/ /� ` ''r} .......... Nord Andover,Mass. ............:7!........................... Fee....-' �'.............Lic.Noc�:?/76r........ h..!!i........�A! ....... ELECTRICAL INSPECTOR Check# �� 1 �- 4 / "'� t t q��� C'onunoniveaith.o f Vamaclwetb Official Use Only 2 cc77 epart.d of}ire Seruicw Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev- 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL RW TION) Date: jhWI S City or Town of: � kA'1'r 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) w7-e, Owner or Tenant Telephone No. Owner's Address ' Is this permit in conjunction with a building permit? Yes IN No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / / S90 Volts Overhead❑ Undgrdt No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 51 /tom /'Z,,ry Completion o the fiollowin table m be lvaived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total to No.of Alerting Devices No.of Waste Disposers eat mum er ons o.of el- ontaine Total? Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Key ecurity ystems:*' No.of Devices or Equivalent No.of Water KW o.a o.of Data Wiring: t Heaters Signs Ballasts No.of Devices or Equivalent 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 N"irer. Estimated Valueof Pec 'cal 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certifp,under the pains and penalties of perjury,that t�}e inf rtr{at on on this application is tare and contptete FIRM NAME: �G��. �ec . G i �I),,s tk % LL,C LIC.NO.: 91 20,< Licensee: Al2�e-P,l Signatures LIC.NO.: `'J2,01-;q- (If D(If applicable,enter"exempt"i the icen enttmberlin ) Bus.Tel.No.• Address: vy- Y17 4I� Alt.Tel.No.: *Per M.G.L.c. 147,s.57-6V,security work requires Depar6ment of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's tent Owner/Agent Signature Telephone No. PERMIT FEE.$ !�S � I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARylicant Information Please Print Leeibly Name(Business/Organization/Individual): Q�.0 �}a'��j�/ Z- WV-,e/- Address: City/State/Zip: r Phone #: �� -(�� •- re you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 0- 4. � I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. JZ Remodeling ship and have no employees These sub-contractors have g, E] Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. E]Building addition [No workers' comp.insurance comp.insurance.1 required.] 5. We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 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. xContractors 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 employee& Below is thepolicy and job site information. Insurance Company Name: �1—r49M✓&•` CiY�✓Yi Policy#or Self-ins.Lic. Expiration Date: Job Site Address: �l�Ji L/ -ems city/state/zip: /✓ 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 ai sand- enaltie of perjury that the information providedaj ve is true and correct Si ature: Date: Phone#: � 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 Mas usetts Division of Registratid Board of Electri MICHA I 9 WAVE NORTH A- Master Elec ' 'a 21705-A 07131/ 16 SVQ 008772 License No. Expiration Date. Serial No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name(Business/Organization/individual): Address: City/State/Zic�'r` O�'���°'c C ®\�` Phone#: C. ►7�� Ne you an employer?Check the appropriate box: Type of project(required): I am a employer with: 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. workers' comp.insurance. . insurance 5. 9. ❑Building addition [No workers' comp. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.[1.1 am a homeowner doing all work right of exemption per MG P P L 11.❑Plumbingrepairs p or additions Myself [No workers'comp. c. 152,§1(4),and we have no Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13. Other end,applicant that check box#i must also fill oui the section below shoe We'h L-wo l e s'camp=-; Policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside c ntractors 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 workers'comp.policy informisatin such. I am an employer that is providing workers' mpensation insurance for my employees. Below is the andjob site information. J Insurance Company Name: Policy#or Self-ins.Lic.#: ` ( �C� Q Expiration Date: Job Site Address: \k7\ U—\(4"z'S \N\ City/State/Zip'. Attach a copy of the workers'compensation policy declaration page(showing the Policy number and expiration date). e). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition im imprisonment, of criminal penalties of a fine up to$1,500.00 and/or one-yearp onment,as well as civil penalties in the form of a STOP WORK ORD ER an 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 d a fine Investigations of the DIA for insurance coverage verification. I do hereby certify under the ins a l penalties of perjury that the information provided above is true and correct Simattire: Date.: '1 Phone#: (�1Z�- '1�� -- j'?J� EEAuthority only. Do not write in this area, to be completed by city or town officiaL n: Permit/License# hority(circle one):Health 2.Building Department3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coinpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitilicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass-gov/dia N2 2792 Date...../ NORT/� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACMUSE� r This certifies that 1.......................— (� J e `.!.. . .°l ........... ........ has permission to perform ......... .4?. `' . ....................................... . ....-Q. wiring in the building of..... ?-I.. �+�{u ...................nn............................................... �/ �. .�. �r� .......!'t.! K .... North Andove , ass. at........ ..... ...... ........ / Y �1 �,t1° Fee... :�...:�tl... Lic.No!Y1/... //. ............... .....�!,l�... ................ ........ ELECTRICALI SPECfOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer \ ThECUM V0AWE4LTHOFMAMC USE77S Office Use only ra ' ' DEPARTMEIVTOFPUBLICSAFETY Permit No. ✓� BOARD OF ME PRE[BM70NREGULAT10AS 527 CMR 12:00 ' Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /.-I Zvd V0 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) (.Z Owner or Tenant V Owner's Address .k-AC Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building /L&-=, $-til �'L +� Utility Authorization No. Existing Service Amps / _Volts Overhead 1:3 Underground M No.of Meters New Service Amps Volts Overhead M Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting FixturesSwimming Pool Above Below Generators KVA ( and El ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets � No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other I r7 Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER InShca[=Co RestJ3ntiDthetaquitM12I,dM"dlBdISCOUalLaws IhawaamotLmbiltyh,&==PcLyrdudmgCmVWCLwaberfsCovwdWartsakgmtmdegzvalat YES NO IhawsthnftdvandptoofofsarnetotheOffnaYES [�JNO IfymhawdUAWYES,plemwdicaetherAxcf maWbydiada<gthe INSURANIM BOND 0 OTHR ft= ) Expizfm Dale � Fstar�6adVaiuecf�Ctriral Wak$ Wak>nSha<t ,I'--��,\�_ Ir>speCta►I7WeReq�ed Rout �-?-0 Ion ,� Fatal Signed unda�ie ofpsjtay FIRM NAME ^'t' L L LQ-L�� C� ,wtl� 5 Lioer�eNa �I/Lo (-o Licatsae �C�l�&-t, AA A�t ✓.�* t> Spoure v I�oa�eNo LL Z 7 $Q� BtdmTel.Na Irk t iU�t>r rU-�,4r AI<TeLNa OWNER'SWANFR;Iamaw=dXtlhel.ifsedoes�theitn�ra�oeoo�aaget s�sta�iale�mala>tastequut�dby�Gat�aliam and du(my signAmcri this permit ap pfica fim wain this teWiMnO . (Please check one) Owner a Agent o Telephone No. PERMIT FEE$ �� �� Location No. � V Date 4; NORTN TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ + i , 44' cMus s'•CHUS ' Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ r' TOTAL $ �' Check # 14 3 0 Building Insp4Ctor V TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: /^ DATE ISSUED: SIGNATURE: C BuildingCommissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: N 1 JOL)er O ,�K� Map Number Parcel Number G^�1.3 Zoning Information: 1.4 Property Dimensions: RI (PRD SFR 2N,611 (0z) Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 20' 2(.` zo ' Z0' 2U' F-00'� 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public X Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record M"rel a,4 �Q�� 6,�t�i i27 9 N m (Print) !E ! Address for Service: I ..;rK-t Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O a Z Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Ito Cy\a,%n. 7—(xhc) rqi K0 _ Licensed Construction Supervisor: OS SW;z I License Number 1 8 S �/i c�fo N// � A �e r ,�v9 Address Expirari°IJ oz ic n Date Sign Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑� 1 �� 4,S C) . 'RA 11�0 Company Name /07672 rn S ,CL `' �' /1 O , SJ Registration Number '••. Address Expiration Date ^z Si re Tele hone V 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 building permit. Signed affidavit Attached Yes......X, No.......❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: _godM ftpp 10.1J 1 y'x I I SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee 6 . S O 2 Multiplier 2 Electrical (b) Estimated Total Cost of i Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 2dOd a 0 O i 5 Fire Protection 6 Total 1+2+3+4+5 ) Sj} , Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Mac ( '('a C&k as Owner/Authorized Agent of subject property Hereby authorize h , 7� i tib to act on elia ,in a tt elat ve tq work autho b tis building permit application. L 11�Z1 i nature of Owner Date SECTION 7b OWNER/AUTHORIZ1E'D AGENT DECLARATION I, 1L1 X s .2Q,�',ulln r UI U 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-Deme 1 rZ�-x ,8�0ature of Owner/Agent Date NO. OF STORIES / SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 IT 3 SPAN DfMENSIONS OF SILLS 2 x (o DINIENSIONS OF POSTS x DIlvIENSIONS OF GIRDERS 3 2 k (D HEIGHT OF FOUNDATION g'S + ' THICKNESS SIZE OF FOOTING co QC C-&7K SO�JC) X M i U, "' LDg MATERIAL OF CHAINEY N IS BUILDING ON SOLID OR FILLED LAND '&04. 1J:) IS BUILDING CONNECTED TO NATURAL GAS LINE $ • FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT Z&n�,Os D. t, PHONJ,��Z6? M ASSESSORS MAP NUMBER LOTNtJMBER L SUBDIVISIONLOTNUMBER STREET 4-10Wl Rcaa STREET NUMBER f 2 ................. .................r.......■...........No's.................. OFFICIAL USE ONLY ............................................................................ RECOMNENDATIONS OF TOWN AGENTS ... - ...................................................... ...... ....... DATE APPROVED . � 4CCONK11ATIONADNMUS TOR r DATE REJECTED COMMENI'S ✓V 6 �4= TOWN P/ DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HFAL.TH DATE REJECTED DATE APPROVED D SEPTIC IhOnCTO ---HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-56W E R,/WATER CONNECTIONS f DRIVEWAY PERMTI: �1 (� E'it " l 2 0 f-4bE.PARTN1tN1 DATE APPROVED - DATE REJECTED COMivIENTS RECEIVED BY BUILDING INSPECTOR DATE Job No.. D.2/ico 7 _. 2 PRoposEb Roots AL1D N. 1y NOTES: PROPOSE tti1�D�T SUN �,,. �.ec .. . RT s���E �cx A,T IoN �S j" E- e �-� No K00SE'D G� W6eS C)< S7)NJG DdC /z� :.z'sriNG ZO wR06RISfiWtR Tobe RMovGQ p -%7�! 1 or eR ADI IJ G, �. Su BJtcT 5 tTF-- . ! - •�,_ DoT 9 ,�-►Z7 H�Gv�o� <c4�•, PAUL T� Dos y l) This plan was not prepared from an instrument MORTGAGE LOAN INSPECTION survey. Offsets and distances shown should not LOCA-11-10N: be used to establish property lines. o ,• .�-�. This plan is intended for mortgage.purposes SCALE: ��' r DATE:�r 2�- Rz only. I certify that the structure 2 shown on this REGISTRY: Plan in conformance with the zoning TITLE REFERENCE. setbacks in effect at the time of construction. PLAN REFERENCE: I certify that the parcel shown is -� located within a flood hazard area as depicted COREY & DONAHUE. INC. On FEMA Flood ?r-vnance Rake Maps fOr' >rnrsnacrz bSurvegors Community No: )1)8 Gambridgc Rnxd,wnhnrn,MA O�:g01 J G IRARDI ADD i tONJ r 12-7 HiCYORY KILL ROA NO RTH A NDOVE R , MA r E ' � twt>M�SID11J6 i ( EX11��N6 S SI NPS� Po 6bTul �... D6PT1-� � W E S�' E L�.Y•4`t�OtJ i • I I r 1 I � !� f 1 ISLAMb �XlS�1�1C� I f 1 �Am\LY Room �pERGo FLMR AS LOST, A+L+10°ja� �>t , o tA81NfTS ��ND`p Q ! oouw-c c,N&swxtOT ! TNNlmQrw p fths Hlti� \N t NDOZ \-&-,A�TIDJ1 V PERVOFIooRIN(� i TgD 3 ? I ((,LASS SifE lo � '2�i__ � MhTcN Ex� DEC.K < ��clE+JD NE�l(/K, SIMAU-1) C ?J p r l -4 CL (4--RvLoaTE szA\k5) s �1 TR1PLECA5SEpAxwT ANb"S'C'W PeRMRSNI ELb :t% 4 Ft,00R Pt_ArJ / J C.ONsTRuvtIoQ DsrAo-/NCTE5 - l �X. DWELLING 3 BLD PicoM \moi II ' t 2- Z Z k8 X16"aG R 30 FG (2)2 t to+kDR Cy12x6 a GI i WlN 0Ct. j d LOC ikTlON i FAMILY to a jr ti! l Q 9I to (��L� v,,,Tl 9�Y 2xk09tVOC R30VT 3/e P0,soVViT — — — — .— L 14 a� REG Roots n, - `y fk. FDT►� x PII�� .: � G �tZ�RDI ��� �i ►oil 2� H ICVORY N ILL ROAD NORTH ANDOVF R , MA i r, i - 1'RIM�SlD11.Xe Lu I S SIr+Ps�pU �y Po W. - —� --- \ 1M1, 811 I I1 D6PT1-� \.N ---T k i =s�r,u� ExIS I)JG _ T i F AANLY RooA (PcQGo FtmR AT tosr, A+L 10°l0� K�t c�4Eti1 I -- '-I c)ouau cAseMtuT PggRt�RS HIli� s ^ Ni I WINDOW r � � `oc atT►o� t9 PERceoFLooRIWCC I TaD 3 ? j GLASS sIf-E Zo JE C K Li � -2 __ I i m RTcH ex) U (Fx-%txz NeAlIN, Scavurs) W CTA�M TU N RTC >Jc\STIN(s� O t I d dry s J I � TR I PIECASCn�C�+T ANDBYCS ttl P�RMRSNI ELD f ±lye IQII _ � 1 FLooR PLAN / CONsTRUCZIOQ DeThIL/NOTES �x. DwE�LiNG 3 86�aaar,n J VEwRi1JCi � . lZ c '� � n0.CN 5�1�� • ox '— — 2 Y8 esl(o"ac. R so FG C2)2 t 10++DR I C4)2x$ WINOOLO I. JIC LOC RT ION J ` �I v T 3a" , _ Q < 4 j 3 FAJTA 1 LY RO OY-, k U rl >; 4 _ LV4TG 2xtoe16''ocR3oT-C, Sg�aR,a� RFc Roots h a � Ek. F1�T►� 13 P[i6� TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Constr. Spvsr. # 055417 HIC # 107679 Fed. ID#04-3516982 Agreement for Construction Services November 22, 2000 Parties, Contact Addresses, Telephone Numbers: Client: Mark and Kali Girardi Contractor: Tara.Leigh Development, LLC 127 Hickory Hill Rd. 185 Hickory Hill Road North Andover, MA 01845 North Andover, MA 01845 978-689-9164 978-687-2635 Location of Work: 127 Hickory Hill Rd.,N. Andover, MA Description of Work to be Completed: 11' x 14' Room addition/expansion; see attached Scope of Work/Plans Attachments: Scope of Work Plans Limited Warranty Proposed Work Schedule: Proposed Start Date Decmber 4, 2000 Proposed Completion Date January 5, 2000 Payment Schedule: At Time of Agreement 20% $6,370.00 Completed Frame 20% $6,370.00 Roof, Windows Complete 20% $6,370.00 Siding, Rough Mechanicals, Insulation, Drywall 20% $6,370.00 Completed 20% $6,370.00 Total as Proposed 100% $31,850.00 1 i ' I TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Permits: By this Agreement, Client acknowledges its authority and authorizes the Contractor to apply for and acquire all necessary construction-related permits (From time to time there are additional permits and approvals required prior to building permits, which have not been provided for in this Agreement. These may include Special Permits, Conservation Commission Conditions, Planning Board Approval, or Zoning Variances, among others, and these are not included, if necessary). Unless specified in attached Scope of Work, costs of permits, as well as any costs for application or documentation required to apply will be passed through to Client, over and above the terms of this Agreement, for reimbursement. Client acknowledges that no work can begin until all necessary permits are in hand, and that Contractor will use good and reasonable efforts to acquire the necessary permits, but Contractor does not control the timely issuance of said permits. Client agrees to endorse all applications as required to facilitate permitting. All work and schedules, as well as that of any subcontractors, will be subject to all applicable permits being available on a timely basis, and will be performed by licensed and insured professionals whenever required. General Conditions &Definitions: 1. This Agreement constitutes the entire agreement. 2. Any changes are to be documented in writing and signed by all parties. Any changes will be paid for at the time of the change request, prior to the changed work being undertaken. TLD, LLC reserves the right to not accept specific requests for changes if and when acceptance of those change requests adversely affects integrity of work product or schedule. 3. Additional work will be billed at the rate of$42.00 per hour for licensed labor, $28.00 per hour for common labor unless otherwise agreed. 4. Work sites will be left in equivalent condition to those existing prior to contracted work; unless specifically agreed, no existing site conditions will be improved. 5. Any specific work hours which are restricted by local statute, agreement or association, and which adversely affect contractors' normal work schedule will cause completion time to be extended accordingly. 6. Completion time will be extended due to any delayed inspection services, beyond those specified by the current Massachusetts State Building Code. 7. Contract will be considered Substantially Complete when all work has been initially completed; repairs and warranty are beyond the scope of Substantial Completion and final payment will not be withheld due to repairs and warranty items. 8. Non-payment or delayed payment according to the Payment Schedule will result in work stoppage for the duration of any payment delays, and completion time extended accordingly. 9. Late payment will result in a finance charge applied to the entire balance due at an annual rate of 18%. 10. Only those work items specified in the "Scope of Work" and "Plans"are included in this contract, and this specifically excludes any items not specified, such as upgrades to electric service, water service, furnace/boiler, or other unspecified systems. 2 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Scope of Work Construct a+-14' x 11' room addition/extension per attached plans and specifications, including all demolition, cleanup, disposal, site stabilization and redressing. All materials and specifications to match as closely as possible/available with the existing structure. An allowance for permits of$208.00 has been included in the contract price. Electrical to include wiring for CATV, telephone, bulk workstation outlet if desired, (2) recessed can lights, wiring for ceiling fan. Heat/AC to be extended from existing circuits. Wall paint color choice, (2) coats, standard finishes. Pergo flooring to match as closely as possible from currently available finishes; option to upgrade/replace existing installation at cost of materials and labor plus 10%to provide continuity of flooring. Replacement deck stairs to be installed at north end of deck, specific location to be mutually agreed upon. 3 TARA LEIGH DEVELOPMENT, LLC 185 Hickory Hill Road,North Andover, MA 01845 978-687-2635 fax 978-689-2310 Additional Conditions for Residential/Home Improvement Contracts ONLY: 1. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 2. All home improvement contractors and subcontractors shall be registered, and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617) 727-8598. 3. Client is entitled to a three-day right of cancellation under MGL c.93, ss48;MGL c. 140D, ss 10 or MGL c. 255D ssl4, as may be applicable. 4. Client is entitled to owner's rights and warranties under the provisions of 780 CMR R6 and MGL c. 142A. 5. Unless otherwise specified or notified, there is no lien or security interest given on the residence as a consequence of this contract. 6. Any and all necessary construction-related permits are necessary for work to commence. 7. It is the obligation of the contractor to obtain such permits as the owner's agent. 8. Any owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guaranty Fund. 9.The contractor and homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in MGL. c. 142A. Owner Contractor This Agreement is available to contract only at the time of presentation. Agreed this day of , 2000, by: Client Contractor 4 Jab No. .2iio CiTrG i rim i Gc-r X IL 0 / PRoPosE� Roots _tel+ �f.0PoS6� P:�)U\710� �— u� 53 r / �� `S'SE/�v i �"`--`� No P�oPoSE� G�{AN6,S / -- - _ rX .S� ir')G06C; / Ex�SrIrJ(� _ . 70 wR1gR1s6Wv� 52Ct, / Lzi✓•� Y'1 ( DR I F'LUAY) o q CP CSR ADI G, SURjECT 5 tTE- - ' DoT q 1 2-7 c..ko C� OF �c^ PAULJ. y \�^y Des ' NSL LAAO MORTGAGE LOAN INSPECTfON This plan was not prepared from an instrument survey. Offsets and distances shown should not LOCATION: 'F'- be used to establish property fines. ��- This plan is intended for mortgage.purposes SCALE: '=--570 DA`fE: r"`2�-�� - only. I certify that the structure 'a'' shown on this REGISTRY: �'"• `"`�`sE''` Plan in conformance with the zoning TITLE REFERENCE- --f'z setbacks in effect at the time of construction. PLAN REFERENCE. .'��. I certify that the parcel shown is � - located within a flood hazard area as depicted COREY & pONAHUE. INC. ` on FEMA Flccd tns;::a^cz Rate N1aps for' ^ccr2 &SuY"`�°�' Community No: zroo 108 Cambridge Rnnti,Wohiun,MA 0;1901 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 055417 Birthdate: 04/05/1960 " Expires: 04/05/2002 Tr.no: 21877 Restricted To: 00 THOMAS D ZAHORUIKO 185 HICKORY HILL RD '"�`'. ! N ANDOVER, MA 01845 Administrator fie U/ominza�uuea�i a�✓�aeaac/u�aP,(,�a r y DEPARTMENT OF PUBLIC SAFETY License: HOISTING ENGINEER LICENSE r Number: HE 065667 Birthdate: 04105/1960 J ' Expires: 04105/2002 Tr.no: 19273 Restricted To: 2B THOMAS D ZAHORUIKO h b• _p�� 185 HICKORY HILL RD °dtP ✓� N ANDOVER, MA 01845 Acting Commissioner ra .J�C 1n07//d//Ol//IrP2���. O/J. /(/YJd(LC�[IbP.C�Q Board of Building Regulations and Standards License or registration valid for individul use only : .. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 107679 One Ashburton Place Rm 1301 Expiration: 8/5/02 Boston,Ma.02108 Type: INDIVIDUAL THOMAS DAVID ZAHORUIKO Thomas Zahoruiko 185 Hickory Hill Road !G_� .i North Andover,MA 01845 Administrator Not valid without signature MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 Checked by/Date CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 11-28-2000 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 70 Your Home = 62 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 168 30 .0 3 .0 5 WALLS: Wood Frame, 16" O.C. 288 19 . 0 3 .0 16 GLAZING: Windows or Doors 102 0 .350 36 FLOORS: Over Unconditioned Space 154 30 . 0 5 HVAC EFFICIENCY: Furnace, 90 .0 AFUE -- - - COMP IANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected o heat or cool the building shall be no greater than 125% of the des ' load as specified in sections 780CMR 1310 and J4 Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 .0 DATE: 11-28-2000 Bldg. Dept . Use CEILINGS: [ ] 1. R-30 + R-3 Comments/Location WALLS : [ ] 1. Wood Frame, 16" O.C. , R-19 + R-3 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1. U-value: 0 .35 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ J Yes [ ] No Comments/Location FLOORS : [ ) 1 . Over Unconditioned Space, R-30 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Furnace, 90 .0 AFUE or higher Make and Model Number THERMOSTATS: [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 .0 . DUCT CONSTRUCTION: i i i ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- i Department of Industrial Accidents v Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Aff1davit Please Print Name: --F-k0 Md S 7-6,L�Q 2A l�C� Location: 2 7. �. City I\) 2 M )) �'i Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job_ Company name: Address City Phone#: Insurance Co. Policy.# Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. 1 understand that a copy of this statement may b7foded to the Office of Investigations of the DIA for coverage ver cation. I do herby certify under the 'nsp andpenaNiesry that the information provided above is true and co.rrecG Signature Date Print name �v10'���d S //- ���� � d Phone# �� S�5,�79 Official use only do not write in this area to be completed by city or town official' 0 Building Dept ❑Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person- Phone#: i] Health Department Other ^ORM WORKMAN'S COMPENSATION Town of North Andovero� TAa DTH 6.6 0 Building Department 0 27 Charles Street 4( North Andover Massachusetts 01845 Z .^ (978) 688-9545 Fax (978) 688-9542 04 `°""��• �9SS�GHus���h DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the 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/at: Facility location ature of Applicant ! l Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. � NORTiy 0 0 _ 4Andover 1. �O J � "L ro O O C'o z- o dover, Mass., A; •swap COCMIc ME WICK V AORATED PS S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....AA 74 * �� I.;......�..I.r,......,...I................... .. ..... .. .................. ' Foundation has permission to erect..I...y.�.I.I.............. buildings on ./O?�I... �..e../ � y.....Iy�//..... ........ Rough to be occupied as.........FIS A#�y[.....11.1h N a �• Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. en 4& Q PO//,7 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR C 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. Location,/ No. �'f��/ / Date „OR*h TOWN OF NORTH ANDOVER p Certificate of Occupancy $ + i + Building/Frame Permit Fee $ C Eta' Foundation Permit J� s Other Permit Fee $ Sewer Connection FeeECSIVED $ ��► �� �� "priection Fee TOTAL $ =-1- NOV 251991 N® MdOver j'C; Building Inspector Div. Public Works Location �( �� �"" /r'`�-�-� i•�%% No. V4 2 / Date 1e 15�! NORTH TOWN OF NORTH ANDOVER C? •• ` OA Certificate of Occupancy $ Building/Frame Permit Fee $ j ,S`TACN415 -� ur #°`n. Pit Fee $ Z&L Other Permit Fee $ G 26evonnection Fee $ ) Water Connection Fee . $ � TOTA 0-0 - Building,lnspea6rf7� Div. Public Works PERlffT NO..VO APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. 1 PAGE 1 MAP +40. LOT NO. 2 RECORD OF OWNERSHIP (DATEBOOK PAGE ZONE l�K�- i SUB DIV. LOT NO. � j � -71I I Pu)j &�7 LOCATION 1c�Y IT�I L L `\d '^ PURPOSE OF BUILDING ( . OWNER'S NAME' t�j ,_.'� o NO. OF STORIES SIZE38 k'3!_ OWNER'S ADDRESS, Z�L v C 0\J. N`-j f)' p `+ - BASEMENT OR SLAB 'a pis f, �.y.,` �J ARCHITEC-v NAME v •W y ' / �" G\ ` O SIZE OF FLOOR TIMBERS `1ST ��j(`6��Td 2ND ;J y 10/1 3RD BUILDE NAME ^y^ka m /� SPAN `u �AA _ v� _ 'v' 1 1 �_Y-X _ DISTA E TO NEAREST BUILDING }_ DIMENSIONS OF SILLS DIST NCE FROM STREET ';' I /�\/ 1 ( l - '" POST�I�� �S �l V4ev1 DISTANCE FROM LOT LINES-SIDES•,tZ G7 1 , REAR 'T' 1 /1,�1 "" "' GIRDERS AREA OF LOT S ' FRONTAGE Il(Olt! HEIGHT OF FOUNDATION �.I`+C/1 THICKNESS IS BUILDING NEW YES, OF FOOTING 77 0 1/ X r© IS BUILDING ADDITION �b MATERIAL OF CHIMNEY �C✓� fcl IS BUILDING ALTERATION W6 IS BUILDING ON SOLID OR FILLED LAND C�.�y�l D WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y a IS BUILDING CONNECTED TO TOWN WATER y6lfl5 BOARD OF APPEALS ACTION, IF ANY (' -+' IS BUILDING CONNECTED TO TOWN SEWER dP5 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS3 PROPERTY INFORMATION PERMIT FOR FOUNDATION Olvt ". LAND COST J 000 SEE BOTH SIDES REGULATED BY PARA: 112.7 S.B.C'. ,^fir EST. BLDG. COST DATE: FEE PAID: .U/• EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 J ), EST. BLDG. COST PER ROOM 13j G 1 PAGE 2 FILL OUT SECTIONS 1 - 12 1 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED • a BOARD OF HEALTH SIGNATURE OF OW OR AUTHORTZED AGENT OWNER TEL# 373'176 F E E J� 3 D • D O CONTR.TEL.# CONTR.LIC.# S►:S PLANNING BOARD PERMIT GRANTED ©GT Z i9 BOARD OF SELECTMEN BUILDIN 1 SPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE 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 3 1 2 13 CONCRETE BL'K. ---III PINE BRICK OR STONE HARDw D PIERS PLASTER r DRY WALL t _ UNFIN. ./ 3 BASEMENT AREA FULL FIN. B M AREA _ V, 1/1 FIN. ATTIC AREA _ N_O 8 M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR BRICK ON FRAME QUU. -> lG I_ t CONC. OR CINDER BLK. S"('It% STONE ON MASONRY WIRING L STONE ON FRAME _ SUPERIOR 1. POOR ADEQUATE NONE rj ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) '1 GAMBRELMANSARD TOILET RM. 12 FIX.) FA—Tj I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER.CMI& S. STEAM STEEL BMS. & OL HOT W'T'R OR VAPOR WOOD RAFTER AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st 4 13rd NO HEATING I , FUM-1 U TOWN OF NORTH ANDOVER ' LOT RELEASE FORki �.. . �s SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMA 'NT ADDRESS SI EU 13Y U.Y.W. Z STREET APPLICANT6 ,Mai'' PHONE DATE OF APPLICATION 0 I b�� TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOj PLANNER DATE REJECTED CONSERVATION COMMISSION I DAT • APPROVED /f3 /6 A( ` CONSERVATION ADMIN. 0 U S REJECTED BOARD OF HEALTH DATE. APPROVED 10 /7 HEAT S IT DATE REJECTED 7Z) f0 Sow er4- ';; DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMITLLI� SEWER/WATER CONNECTIONS ' FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards , ` the Conservation Commission prior to the issuance of any building perml.ts for the subject lot. This form shall not releive the applicant from the ENVIRONEERS Lc-T r24i, ALFRED A. SHABOO, P.E. HIC.1G01';kY P.O. Box 516,lb-0-Pleasant Street, North Andover, MA 01845 • (508)683-3893 I Rorposmo siTV.6 QE:V aL-<XP Pvne►�� "- H ,cKoRy HILL Ro D AUGUST 199 3c/'",L E' =yo 0 'I f oyT W o 62— o• :fie:.:' ,A To P r,, A N f — w /5 y 3 co N �a 00 N in tp N � ISO Access/EGA flSeMENT- �/� LtrtE ,ye CCE / fiJ �i SS/E6T�ESS �R s,`M N r U. ( f � ' LoT <zy, 11 t s.F• ) . ENVIRONEERS •r'1ICKo1�y R►��Ra►n.hl..AN�v>�, M• ALFRED A. SHABOO,..P.E. • P.O.Box 516,16b'We2sant Street. North Andover, MA 01845 • 15081683-3893 CE'RTIF tEb �C]yt�t�pATtON, LAN -� H 1 c o RLL Ro f`vc7VEMa.�.f� 5ii..lgg1 g7 . I"•HOS `' r Yl . a� ? � N v o o.• a ter; hti r r � i W N J W Q r •u � Nto � oN p ' 0 � N (V N Vt�CGE3S .GGR1:.55 f ILTIE5 Ell SGMENr N CE4�T.cF�C 14 . Q.FF 5 EC'S J I'�c W N• C aN P�oRn�t to 4( e ZaN►NtG ABY- L-Nws OF . Q� Na'RT1-i tom• T' .. >' �:• Show N ��cZ� 1^ocz 1 �-1e, usE �� 42 of Tt1�. �UIL011JG �.Nst��cTVR OwLy ..1•.N 'V �ET�RM1NlNG �NING CONFd'(21�1tTY. E�/ Ess f` • •. . R s,�.M,e N r 44, Isl BUILDING DEPATMEN e � ��..:at.�• WY.r NORTIy 9 own ® ; i.6. ndover to No. 4 6C). ID - PIVEWAY ENTRY PERMIT er•• Mass. 19 C MEWICK I -lei �V . oR Pa `sS PERMI BOARD OF HEALTH WQ THIS CERTIFIES THAT.. ...54...... 4 V5............... ........,...... BUILDING INSPECTOR has permission toA�0.� ildings on x.2.02.,&rW... (.A?,P. Rough to be occupied as� ... �. ....�.�. ....... .... ChimneyFinal y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. -PERMIT-FOR FOUNDATION ONLY Final VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA: 112.7 S.B.C, PERMIT EXPIRES MONTIWE' /OZ,- FEE PAID:1.�vi ELECTRICAL INSPECTOR Rough UNLESS CONS RUC ST Service PERMIT FOR FRAME/BUILDING Final � � !� • •• BUILDINGINSPOR DATE: / 'z " FEE PAID. GAS INSPECTOR Occupancy Permit Required to Occupy Builds Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by STREET NCI, Smoke Det. Building Inspector `s CERTIFICATE OF USE OCCUPANCY °down of Mogih Andev g, Building Permit Number 4 6 9 ( 19 9 1 ) Date MAV 27 , 1 9 9 2 THIS CERTIFIES THAT e THE BUILDING LOCATED ON LOT #9 HICKORY HILL ( 12 7 ) MAY BE OCCUPIED AS SINGLE F A M I L Y DWELLING IN ACCORDANCE E WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. OF NORTH 9ti o� y, D 0 CERTIFICATE ISSUED TO T h o m a z D . Z a h o h u i k o l ADDRESS 2 d.2and Pante. Dec . � k� 9SSACHUSES ..,F ui n p ctor E fi 5 V� t F � �W �l� f�� � IN C:UNSENVA11UN 3/�FINAL PLANN1N _ FINAL, NORM., 2514 lye To W� n of Andover No. 469 DRIVEWAY ENTRY PERMIT .Y , -�K er, Mass. 199 [( C HEWICK j- _@ oR P� S$A � BOARD OF HEALT PERMI La THIS CERTIFIES THAT.:�� �SP .... I .....,. .... ...• . .••.. k B I P has permission tow��.� ildings on f.a..7.�""' .�A tCi n to be occupied as �� ... �, .. .....�.�.��� ............ y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in MBING SP TOR ._.this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of ough , /�G � Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY n Z REGULATED BYPARA: ` VIOLATION of the Zoning or Building Regulations Voids this Permit. 112.7 S.B.C. TE � LJ' FEE PAID: y ELECT ICA ECTOR PERMIT EXPIRES MONTIS ' -�=- UNLESS CONS RUC ST Se vi�7; PERMIT FOR FRAME/BUILDING Final a. *—r— BUILDING INSPORRpm; -Z ^ FEE PAID•- GAS INVECTOR tk Occupancy Permit Required to OccupyBuildi Rough � �' �, , Fin 4 Display in a Conspicuous Place on the Premises FIRE DE 3 �� Do Not Remove Burner 4 STREET No Lathing to Be Done Until Inspected and Approved by Smoke o NO.t.jM�f F •• ,. Building Inspector Date.. . . . . ./. . . . .�n HORTM o� TOWN OF NORTH A DOVER • - PERMIT FOR GAS INSTALLATION SgACHUgE This certifies that . . . . . . .`. .. . .`77:1 .. . . . . . has permission for gas installation `' . . . . . . . . . . . . . . . . . . in the buildings of .. . . . . . . . . . . . . . . . . . . . . � at . /. .� . _ . . . !� .XNorth Andover, Mass. Fee- . . . . . . Lic. No: .. . . . . -. . . . . . . . . . . . �,.. . GAS INSPEOR Check# 7079 MASSACHUSETTS UNIFORM APPLICATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date n NORTH ANDOVER,MASSACHUSETTS BuildingLocations �� � - Permit# Amount$ Iz, Owner's Name Ne Renovation E Replacement ❑ Plans Submitted ❑ 7 ate' �W � w � Hon G x H o o o � o w C7 F Z F d F W C7 O > t: Fw V a F W z d w a z o z o x �a x o x w 3 c U a° > a ° H o SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 15TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print o�type) \ �T, eck one: Certifi�at�stalling Company Name- C�`�'�� l� �►��VIL,'� (A Corp. Address ❑ Partner. ��c,.+Vy aC 13'\C>A1C).3 use ine s'e ep one ck14�)) Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Chec ne: I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked yes,ple a indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 0 Bond 1 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 0 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit ksued for this application will be in compliance with all pertinent provisions of the MassachusettsS to Gas Co d Ch ter 1 of the General Laws. By: Signature of Licensed PI mb r Or'4 Fitter Title Plumber Cl1-)2 City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r j t Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION` Qay Print PROPERTY PROPERTY OWNER ,�1�. .e, ' ;��/U40 1 Print MAP NO: PARCEL:Q 1'7 ZONING DISTRICT: Historic District yes o Machine Shop Village yes 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 Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 0600 Identification Please Type or Print Clearly) OWNER: Name: 'A'x"e K'iQ gel Phone: Address: CONTRACTOR Name: '" h� Phone: �0 '- -- /f Address: Supervisor's Construction License: 0 7,�Z1 Exp. Date: //-6/ Home Improvement License: ` vZ 'Exp. Date: Lf' 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: $_ . 3, %o FEE: $ &O Check No.: t9( '�— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t gua nd ,�ignature of Agent/Owner Signature of contra r i 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 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 j 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/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood,Street FIRE DEPARTMENT - Temp Dumpster on site yes no . �. Located at 124 Main Street Fire Department signatureldate COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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 NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, 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 ❑ 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 appeal period is over. Thea applicant must st thenet this recorded a S t the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 T— - Location No. — Date r • - TOWN OF NORTH ADOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $� TOTAL $ � Cheek#�6q� i r Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 23,400.00 m $ - $ 280.80 Plumbing Fee $ 35.10 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 35.10 Total fees collected $ 451.00 127 Hickory Hill Road 018-2016 on 7/2/2015 Reno 2 Baths NORTH own of s E ,, Andover No. 01 E - 020► * _ - h ver, Mass, COCNICKt WICK y1' ADRATED S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT .......... �r .............. � �'r BUILDING INSPECTOR ................ `: ............ .......................... ......................... 17� .... �.�,.. Foundation has permission to erect buildings on . ......! Rough tobe occupied as .a............� . .. ... ... ................ .-.................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 p� ( UNLESS CONSTRUCTION FARTS Rough Service ..................... ..... .... .............................................. BUILDING INSPECTOR Final 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. 4 d d a ` PROPOSAL REVISED Mark& Kali Girardi 127 Hickory Hill Road North Andover, MA 01845 kn ir�gcomcast.net (H) 978-689-9164 (C) 978-204-9651 April 15, 2015 Master Bath Remodel Work to be included includes: • Acquire Building Permit • Removal of existing tub, toilet,tile floor. • Complete all required plumbing. • Complete all electrical. • Install Custom 36 x 60 inch shower. • Install new Custom Shower Enclosure. • Plaster patch where needed. • Install DenseShield tile board on floor. • Install new tile floor. • Install new baseboard heat cover and baseboard. • Install new toilet paper holder,towel bars. • Removal of all debris. TOTAL LABOR AND MATERIAL $ 10,300.00 Install pocket door. $ 1,500.00 Additional tile labor charge. $ 650.00 Install electric heat in floor. $ 1,200.00 Install new Panisonic Vent Unit. 250.00 TOTAL $ 13,900.00 Note: This quote does not include any plumbing fixtures,vanity,tiles,grout,granite, n Tor paint. A 1(J Terms: 4 $$'9,300.00 4,600.00 upon signing of contract(not to exceed 1/3 of contract price) when job complete Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (H)978-794-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel: 617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisf n are hereby accepted. You are a thor' ed to do the work as specified.Paym e d as o dined above. Date Homeowner Signature Date /a iV Contractor Signature r 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 onsumer Affairs and Business Regulation and the consume shall be requir to submit to such arbitration as=��seral Laws,Chapter 142A. Homeowner's S ature �ontra 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 be 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 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or(888)283-3757 f" PROPOSAL REVISED i Mark&Kali Girardi 127 Hickory Hill Road North Andover, MA 01845 kn irardikcomcast.net (H) 978-689-9164 (C) 978-204-9651 April 27,2015 Kids Bathroom Remodel Work to be included includes: • Acquire Building Permit • Removal of existing tub,toilet, vanity,tile floor. • Complete all required plumbing. • Complete all electrical. • Install vanity. • Install new tub. • Install DenseShield Tile board on tub walls. • Install tile on tub walls. • Remove existing beadboard. • Plaster patch where needed. • Install DenseShield tile board on floor. • Install new tile floor.. • Install new baseboard heat cover and baseboard. • Install new toilet paper holder,towel bars. • Removal of all debris. LABOR AND MATERIAL $ 9,000.00 Install Panisonic vent unit in kids bath-and downstairs bath. $ ,•500.00 TOTAL LABOR AND MATERIALS $ 9,500.00 Note: This quote does not include any plumbiilg fixtures,vanity,tiles,grout,granite, or paint. Custom Enclosure would be an additional$ 1,700.00 Terms: ,150.00 upon signing of contract(not to exceed 1/3 of contract price) $6,350.00 when job complete Submitted By: Chris Rivet MA Lic#CS072173 HIC#139962 207 Winter Street (C)508-265-3115 (I)978-794-1165 North Andover,MA 01845 All Home Improvement Contractors shall be registered.Inquiries about a contractor relating to a registration should be directed to; Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston, MA 02108 Tel:617-727-3200 ext.25239 All building permits required will be the obtained by the contractor.Homeowners who obtain their own permits are excluded from access to the Guarantee Fund. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are sat' ory ar reby accepted. You are authorized to do the work as specified.Pay willb m ou ined above. Date 5 Homeowner Signature Date S /a? /S Contractor Signature A d � 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 o onsumer Affairs and Business Regulation and the con er sh1 be re red to submit to such arbitration as pr sa usetts General Laws,Chapter 142A. Homeowner's Si ture Vontractor'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 be 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 b the Y 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 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 888 283-3757 The Cosntnonwealth ofMassachusetts Departinent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ip wivfv.inassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aviglicant Information / please Print I,eoibly- NaMe (Business/Organization/Individual): Address: ot, 0 City/State/Zip: Phone : 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. El New construction I- (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• []Remodeling ship and have no employees. These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their . _ 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]1 employees.[No workers' nl-1 Other comp.insurance required.J Any applicant that checks box r1 must also fill out the section below showing their«rorker'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor must submit a neNv affidavit indicatins such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information 'am an employer that isproviding'workers'compensation insurance for n{y employees Below is thepolicy aizd job site nforrnation. nsurance Company Name: .jrr/i�� r,!� �fii"Ll� 'olicy iz or Self-ins.Lic.- r' �i%; Expiration Date: `, ob Site Address: �r� /Y/l'Xvf�,S/ ,l//L,/ City/State/Zip: /(/o 4C.,51Z ,ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 'allure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ine 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. cZo hereby cert fly rz zder lie pain:s mid p IIallies of perjrzzj,that the information provided above is trite and correct. ienature: Date: honey �; �'� �� l i Official zrse only. Do not write in this area,to be completed by city or town official City or Town:3 PermitlLicense a Issuing Authority(circle one): 1.Board of H.ealth 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone E: OP ID:SHHE CERTIFICATE OF LIABILITY INSURANCE F DAT 09130D/YYYY) 09/30/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(jes)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ONTACT PRODUCER Phone:978-688-6921 NAME: Macdonald&Pangione Insurance P.O.Box 428 Fax:978-688-5350 (AJC, o Ext: I A/c No: 104 Main Street E-MAIL North Andover,MA 01845 ADDRESS: Michael Pangione CUSTOMER ID#:CHRIS-5 INSURERS AFFORDING COVERAGE NAIC# INSURED 207ChristopherterSt.vet INSURER A:Preferred Mutual Ins Co 15024 207 Winter St. North Andover, MA 01845 -INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I INSR ADDL SUBR� POLICY NUMBER MM/DD/YYYY I MM/DD/YYYY I LIMITS LTR TYPE OF INSURANCE `i POLICY EFF POLICY EXP GENERAL LIABILITY + i EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY j CPP 0180 57 0105 I 09/26/13 09/26/i r DAMA E TO R NT D PREMISES(Ea occurrence) S 100,000 I CLAIMS-MADE X OCCUR I i MED EXP(Any one person) S 5,000 i I PERSONAL&ADV INJURY S 1,000,000 I-� I GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG 5 2,000,000 {1 POLICY r PRO- LOC S AUTOMOBILE LIABILITY S i_ I COMBINED SINGLE LIMIT 1 ANY AUTO I(Ea accident) I BODILY INJURY(Per person) I S —I ALL OWNED AUTOS I ! BODILY INJURY(Per accident)I$ _j SCHEDULED AUTOS j i f i PROPERTY DAMAGE I HIRED AUTOS f I ` I(Per accident) S NON-OWNEDAUTOS I t UMBRELLA LI AB I -1-1 OCCUREACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE I AGGREGATE S _ II DEDUCTIBLE y1 RETENTION S i Is WORKERS COMPENSATION Y/N I TNRY LATT I (OTH-1 AND EMPLOYERS'LIABILITY IM ANY PROPRIETOR/PARTNER/EXECUTIVE I i I S OFFICERIMEMBER EXCLUDED? N/A (E.L.EACH ACCIDENT (Mandatory in NH) i {E.L.DISEASE-EA EMPLOYEEI If yes,describe under S i DESCRIPTION OF OPERATIONS below E 1 I E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA 01845 AUTHORIZED REPRESENTA Michael Pan gio/r I ©1988-2009 ACORD CORPORATION. All rights reserved, ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD til Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-072173 ` CHRISTOPHER F3tIVET '- 207 WINTER ST; s N ANDOVER MA 01843 Expiration Commissioner 06/02/2016 - r/k, .lnutruirica//�"Ic/r'�launr./u.;r/G' -...Office of Consitsner 1ffa.rs&Business Itebul�ttinn Z�G' ;:_ • ME IMPROVEMENT CONTRACTOR y egistration: 139962 Tj?e= Expiration: 9/8/2415 Individual 6,.. CHRISTOPHER F.RIVET CHRISTOPHER RIVET 207 WINTER ST. N.ANDOVER,MA 01845 Undcrsccretar�-