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Miscellaneous - 134 BEACON HILL BOULEVARD 4/30/2018
134 BEACON HILL BLVD 210/045.B-0052-0000.0 i/ BUILDINGFILE Date 11241 W 0- RT#t TOWN OF NORTH ANDOVER PERMIT FOR.PLUMBING CHU v��� �� Thiscertifies that.............................. ................................... .................................... 'r '00�';,/ has permission to perform.4........... .................. .................../j/ .......................... plumbing in the buildings of. ...................................................... at..../..��../........ North Andover, Mass. ............................................. Fee-55 .....Lic. No. . ................................................................................. PLUMBING INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I NORTH ANDOVER MA DATE 711412015 PERMIT# JOBSITE ADDRESS 134 BEACQrA-IILL BLVD OWNER'S NAMEJ AARONS OWNER ADDRESS TEL FAX P � 0 � TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ N00 FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 _nt BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OlUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN t[} SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION +! WATER HEATER ALL TYPES 22a 1 WATER PIPINGi R OTHER BACKFLOW FOR BOILER 1 INSURANCE COVERAGE: I have a current liabili 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 POLICYE] 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 nc v/ilq&LEaftinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I JEFF HUTNICK LICENSE# 15212 SIGNATURE MPQ JP 1:1 CORPORATIONQ# 3532 PARTNERSHIP❑#O LLC❑#� COMPANY NAME I CALLAHAN AC AND HTG ADDRESS 191 BELMONT ST CITY I NORTH ANDOVER STATE MA ZIP 01845 TEL '978-689-9233 FAX CELL 978 423 6305 EMAIL I PLUMBING@CALLAHANAC.COM Date.... ................ 01. NORTH 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHU This certifies that ........ .................................................................................................. has permission for gas installation ........ . ...... ............................................ in the buildings of.. .^�S .............................................................................. ....... ....0 61v'd .......... ............... North Andover,Mass. Fee3):!!........ Lic. No/� a.... . ..................................................................... GASINSPECTOR Check#_ l � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER MA DATE 7-14-2015 PERMIT# 16b JOBSITE ADDRESSI 134 BEACON HILL BLVD OWNER'S NAME I AARONS v OWNER ADDRESS TE IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT:E1 PLANS SUBMITTED: YESE] No F1 APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 0 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT [� OVEN POOL HEATER Q ROOM/SPACE HEATER [� ROOF TOP UNIT TEST - UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER y HH INSURANCE COVERAGE I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES F1 NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F1 OTHER TYPE INDEMNITY F 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 d rate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comps 'th al Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAME I JEFF HUTNICK LICENSE# 15212SI URE MP 0 MGF 0 JP❑ JGF Q LPGI Q CORPORATION Q# 3532 PARTNERSHIP Q# LLC❑#0 COMPANY NAME: CALLAHANA AC ANF HTG ADDRESS 191 BELMONT ST CITY I NORTH ANDOVER STATE MA ZIP 101845 TEL 978-689-9233 FAX CELL 978-423-6305 EMAIL PLUMBING@CALLAHANAC.COM ��� t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _) 1 Congress Street, Suite 100 F , Boston,MA 02114-2017 www niass.gov/dia `Yorkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Callahan A/C and Heating Services Inc Nagle (Business/OrgartizationJIndi�,idual): ' address:91 Belmont Street City/State/Zip: North Andover MA 01845 Phone#:978-689-9233 Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 1.nM 25 4.I am a employer with ❑ employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. listed on the attached sheet. 7. E]Remodeling El I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑Demolition working for me ni any capacity. employees and have workers' 9 ❑Building addition [No NNorkers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions q ] 3.❑ I am a homeowner doing ail work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 132, 51(4);and we have no employees. [No workers- 13-❑ Other comp. insurance required.] *Any applicant that checks box 1 must also till out the section below showing their workers'compensation policy information_ t Homeo-hers wiio submit this affidavit indicating they are doins all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet shovouro 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 joh site information. Insurance Company Name: Guard Insurance Policy#or Self-ins. Lic. #:CAWC586931 Expiration Date:09/25/2015 Job Site Address: 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. 1 do hereby certify under the pains and penalties of perjury that the information provided ahove is true and correct Simature: Date: i Phone rt: Official use only. Do not write in this area,to he 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 COMMONWEA.TH.OF MASSACHUSETTS State Of New HatTlpShIC@ • • • • + • MECHANICAL IDENTIFICATION BOAp OF PL:IIMBES.: lNI3 G{1SF ITTERS ISSUES THE- FOLLOWit& ktCENSE I NAME: JEFFREY HUTNICK I tE1�ISI13 AS A MASTER PLUMBER _ z LICENSElREGISTRATION 4: � W.J.EFF-REY P HUTN l CI( ` 41283 SERVICE GFE08 r 60 PLYtUT{>ST �b �[ETrfU�fi! t4A 0 r$44 4256_ i52 ...,-... 05/01/16:... :.; 199305 >.. g-:COMMONWEALTH OF MASSACHUSETTS. STATE OF NEW HAMPSHIRE o • • • e o • BUREAU OF BUILDING SAFETY&CONSTRUCTION ;,BOARDtOf PLUMBERS; aNV G A S F J.rTERS PLUMBING SAFETY SECTION ' ISSUES THE FOLLOWIK 'L "EN SE REcts-rEt�l~o as a PLUMBING CORP. NAME:JEFFREY P HUTNICK _ = JEFFREY HUTN I CK '° LIC#:4519 M IrALLAHAN A1`C ANS .HEATING SERVICE 60 FLYMOUTF# ST I� EXPIRES: 12/31/2015 fv -ETRUEN MA 01844-42FZ .. 352 _oSld 11 t<6 >:204054 COMMONWEALTH pF MASSACHUSETTS >r s + ;`. BOARD OF PLUMBER� ANIS GAsFITTERS, I ISSUES THE FOLLOW I NG L.F CENSE L I CENSEt) AS A JOURNEYMAN -PLUMSERs } JE FRf-Y P HUTN I CK .a° x� 6o' PLYMO:.UTH 5T �J METHUEiV MA 01$44 4256 2188. r fl3/o1;116 204053. e OP ID:PS ACORuCI` CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 10131!2014 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(ies)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). PRODUCER NAME:" Pete Sullivan Foster Sullivan Insurance 163 Main St. PHONE 978-686.2266 North Andover,MA 01845 AIC I E t: aC.No:978-686-6410 E-MAIL Stephen Sullivan ADDRESS,psullivan@fostersullivangroup.Com PRODUCER CALLA-1 CUSTOMER ID#: INSURED Callahan A C and Heating INSURER(S)AFFORDING COVERAGE NAIC R Services,Inc. INSURER A:LIBERTY MUTUAL INS CO 23043 Kate Callahan INSURER 8:GUARD INSURANCE COMPANY 91 Belmont Street INSURER C: North Andover,MA 01845 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 LTR TYPE OF INSURANCE 1 L POLICY NUMBER —fFO—LICYEFF MMIDDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CBP4016154 09/2512014 09125/2015 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 CONTRACTUAL LIAB PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMIT APPLIES PEFt PRODUCTS-COMP/OPAGG $ 2,000,00 POUCY X 'ROT LDC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO BA4544035 (Ea accident) $ 1,000,00 09725/2014 09!25/2015 LNON-OWNEDAUTOS UTOS BODILY INJURY(Per person) s AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ (PER ACCIDENT) $ X UMBRELLA X OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS LIARO CLAIMS-MADE A CU8809334 09/25/2014 09/25/2015 AGGREGATE $ 5,000,00 DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY TORY TIMI X DEH- B ANY PROPRIETORIPARTNER/EXECUTIVE YIN CAWC586931 09/25/2014 0912512015 E.L EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? ❑N N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 500,00 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMfi $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) fax # 978 688-9542 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BLDG.DEPT. 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE BLDG,201 SUITE 2035 NORTH ANDOVER,MA 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Location No. Date 2 L5115— i s' • - TOWN OF NORTH ANDOVER e ,. Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ 4 Other Permit Fee $ TOTAL $ Check# 20469 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,io?fI Permit NO. Date Received Date Issued: 2 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Lf �YUh�S � .- Prinf 100 Year Old Structure yesrnaMAP NO: r/ PARCEL: �`�'�ZON11 ING DISTRICT: Historic District yeMachine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building 0'15ne family ❑Addition ❑Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: cc, r-f— d- o{�� Identificqation Please ype or Print Clearly) OWNER: Name: /4mlri tiArCWS Phone: �D�7'Sl9 �57U Address: 13 ''l Bead 141 8l✓d, CONTRACTOR Name: Frie W Palm Phone: 1?J1-?Iq'F/q 3 3 Hihon Street Address: _ e..�em�rr`-nimn _ - Supervisor's Construction License: g 7 917 Exp. Date: q/9-3//(p Home Improvement License: 1 I'(a U _ Exp. Date.- ARCH ITECT/ENGINEER ate:ARCHITECT/ENGINEER Phone: Address: Reg. No. A FEE SCHEDULE:BULDING PERMIT.$12A0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ (1V • ' FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/OwnT '' S�gature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The foEowing 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 o 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 o 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 cast2s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buiiding Permit Revised 2012 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments - onservation Decision: Comments 'Water& Sewer ConnectioniSignature&Date Driveway Permit DPW Tow;: Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT = Temp Dumpster on site yes_. no Located at 124 Mair,Street Fire Departmer f signature/date COMMENTS x 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-$1000 fine NOTES and DATA—(For department use D Notified for pickup - Date i = Doc.Building Permit Revised 2010 NOR T#1 own o , .Andover No. (�31 h ver, Mass6&u" Sj2 CNlwIC,t V 7�A°R.,TEo s � BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT .......... .. . . . „ ,... BUILDING INSPECTOR ••• ••••AA.rof**.� " . �* ��A1 •• Foundation has permission to erect .......................... buildings on ... • selt` Rough to be occupied as ........! n' A ... 1�... _....��.....1.� 6 ......................... Chimney provided that the person accepting this permit shall very respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T RTS Rough Service .................... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �W'ass2chmsetts f®ffie I Ed sam le Contract Tlds faint rdisbes�basic languagetoprotectbom� Iremeat loFl mst, 1 Nomelmp[oretq� �tassadtttscttsCotunmer wt's Seeklrealadt+loeifn � (hlCtl.cbamtertd2pj,bdoe, r' OfficeofCo "10mome '-�nyRMSM lemmghome' no mdtrdestand nsumerR rsagdBuSinesS��Ot� P ""inn""'atssbould mobio HomeotiSnerftlfo atioKsC ro 'n0 OnYaurreddenee.Youmey,ob�a �PYofA �$tion °r�tranHaHiaaotblR973$�g�ort-88$ -PYbycgbglhe Ormetion Granournvel Contractor Information Camma`� . StMtdddras(do not GezPcsrilso:ad ) CihYl'ottn ,[� e . 52tc ZiPCML- m*mzA to nyeme N .-J_ �A fr B rtaastiaal Daltime Phase - l a.. )01970 Phone GniTotm �Iailin . 70 S'am zip C.dc S Addres ilt ditFell from°botT) aas6ce$p herd)mF►aperID Or Member ° r °°aDera The ContrrctorSmtroadaaomtphteafeiAo»mgrgo(Descd6eindetz7rkforthenomeosne. I�U 3�/` the- � ardgrade of marsielttobettse��rreaddaimials -r- 1 6/xt- . cel%lose �tt�C 'g, Required Permitls-17te -s O�Ubv and ntllbesemmedbytl+CwAAap�t�hehom�m�m4�md ProposedStartandC (Q'ruetswhosecuretheirown a eatvaersageat be ttrunless a#0°Srb` tile-7hefolloninescheditill escluded from the Guaranty Fund its ssili be "'c1°"sta°ros beyond the contraeto fs ooAatd arise SGL Chapter)�,) Prnvisioas ofp °2 /. Date viten coAtratxorttU begin Total Contract Pticeand Pa --Dale nhm c0mcied xmrk-tt.�be TheCanaaaor YmmtSchedule ttteallycompieted toperfomrrhenm>s famishthe mmtaiaiaid laborSPWficdabaeforthe totalstmtof pZ pa!'ments M11 bemgdeatxording to the follawingsc6edule (`) upon timing CAAtrgCt(not to Mull ompl io ofthetotalcontt'netpriggthecastofspeaatulderitertts,weh"'risgreater) —`��rQ � /or upon completion of �;l �nPoa cam pletion of upon completion oFthe roaoeaQ �dean t r e calfmviacmateriaUerTu"oemm�bespeeial Ste!! � ��Misoompi to both o:dtred�orerbecmuauednmkbxiasinorder S tob�paidf �'•s�n�ction) ro mea completion sdhedat,f•ry 5 NOTES:t•1lnd 6etai o note a�h=nanecehat3es(°f)latrreeoiresOwam-if £ teraF(a)ten OpOsit ordavW uftieh must 6espedal ordered in a�dvetal� r or(b)theme rr4a rm In rhe taumm�a�nUr b�mar lnia� sWa i0m°tro0nalule �rPmentorcustomau�Crrptetial nh_Tsnn SubcontraMors_ reu�gr►nn fro Zhe°°n°8 fees to be solei n ❑�O Yes t er hr Pa+n/subcanIlluunindbvgK V2 YmVoastble,hrcmnPiefronofthen 'A11ft tnma,Is dj r der is Th °ra desaTb:dreg Qe$oftheactioAsofanythird n Contracr3cce dace- en agraesrobamle[yr�Ptrosi6l' WI corl shall not-mply dtat��•! Fill do p eat Payments to al!sobcoati actom for btxoms a binding entraet underlatti: carefully before si_ening this mntraa ry mtetesE bgs been UNess trtbenvise noted ai phtDed m the residence.Review dte fo3lrrvle thio this deemem,the ° Don't be seautiomand nodces Pressuted into si conb8tz Tatra time to ° Ivlasc ret,eeontrm Pdingthe fledand Full• subcontractors to be r a valid AomehaAro ce C nmuorBy d it Ask tecis►ered with the Di 9utstioasifsanetbitr2 is endear. regisAauonbivvtitmgtothe cectaroffiomelmprov'emeatCoatracrot8 retl*smostharne' i7te late ° Does thecoatractorhave' Directorat11P&kpla2V.RaomSlt ewnm lon "n�Ov�®tc0nit�torsaad smacopyofg �0e. Ask the Cectactorforhisrnstnaea4' 02116 or nttitt�abtrottnAttactor 'proofofirl'Itil re'dommeat bYcal6ng617-9T�7S7orSS8-�83-375;. ° in"3aurtightsmd CO 04t1 oasothatymtaaemfirmeovr.rage;ora;kto Guide to the Home lmp�me1ir Con Read drelmpouapl ttactorl.mvv: �ationontbeM,=e§deoftbisim,and getaco You rnav cancel this Py oFthe Coammer contractorinuTitingatat6- terormFirhasbtxnsimedatapiarxotherdtaathecon third businerda5fotloninedtesigtdAgofor d'ofocebyordinaryntat7Past smalllII laceafbusine ,Ptrnidedyrouao D©NOT SIGN T13I3 811t S" Pagel s Or �L,!l not later the anon Ftnm farad�P►anelioil Ofthisnmehdrriebc of the �twaac� ortLe aeolr NTRACT IF TgERE An ANY ° a�a a>~ 90,961 SPA r;r t>s�na:7f�uT.cea�9,rrs�5ua5elaeptb.-t�pet�ac Homern= aes Si 'm Contraaar's' rt,. Z Z Contractor Arbitration pro rides homeowners��iththe sameto initiate an arbitration action tad an The Home improvement ContractorLaw alternative to court action)ifthey have a dispute with a contractor.The same right is=atrtomaticelir afforded to a Contractor,bovrever.The connector would have to resolve any dispute helshe has with ahotneowner in court unless bath parties agree d w the homes vnerb the Hoptional clan pmiddad lomt:ltnprovem�ent Cant<acteruld giYft�a�.ntracbar the same ri�it to arbitration is The contractor and the homeo%vaerhereby mutually agree in advance that m the event the contractor has a dispute concerning this coutrat:4 the contractgr play submitthe dispute to aprivate arbitration firm Nxhich has been approved by on and the consumer shall be required the Secretary of the Five offici of Consum Affairs and Business Regulsu to submit to such arbitration as piotndid7a IVfassactiuseus GeneralLana'ch 1 o-A : r �'q 6`,i Homeowne ignatute . �— Contractor's Sisnatnre NOTICE:The signatures of the parties above apply only to the agreement:of the patties to alternative dispute resolution initiated by the contractor.The homeot;Fner may initiate altematrve dispute resolution even where this section is not sap uaWy signed by the parties. Homeowner's Rights A homeowne es rights underthe Home lmprovement-Co>nractor Law(MGI.chapter 142A)and other consumer protection taws re MGL chapter 43A)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 lav:. Homeowners who secure their own building permits are automaticallyle for completing fvtm.all the Guaranty Fund d,SiOnS a of the Home Improvement Contractor Law: The contractor U;resp ay be entitled to outer specific legal thghts if the contractor timely and Amnk nanTlm manner Homeo'n'ners m guarantees or provides an express xvertanty for Arrorltndaosbip or materials. In addition to gitarantees or N%arraotiees provided by the Contractor;all goods sold in massaclmsetis carry an impliedwatrara of merchantability and fitness for a particular purpose. An enomemdon of other matters on whirls the homeowner and contractor tawfiilly agree maybe added to the terms ofthe contract as long as they do not restrict a homeoj%mees basic consumer rights. If you bave questions about your consumerlhomeowner rights:contact the Consumer Information Hotline(listed below). Execution of Contract The contractmust be executed in g and should notbe simed.until a copy of all exhibits and tefhrenczd have been documents have been attached.Parties are also advised not to sign the documentoattactuaerrts to filled in ormari;ed as void,deleted:or not applicable. One oria_inal sigr►ed copy ofthe contract tntlr be given to the oumer and the other Crept by the contractor Any modification to the original eoutractmnst be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fiddly executed copy of the contract,and the three day mscisshon period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment sche e dule in cases where the homeonner deems bimtherself to be financially insec m the balance of fimds notyet due be placed iremint escra elf to be financially insecure,the contractor may require r account as a prerequisite to continuing the contracted worm.VAthdrirwai of fiords ficin sold account would require the siananrres of bothparties. Additional Information if you have general questions or need additional information about the Home Improvement ConnacmrLaw or odder Consumer rights=or ifyou wish to obtain a free copy of"A Massachusetts Consumer Guide to Rome Improvement° contact: Consumer Information Hotline OMM of.Consumer AffdM and Business Regulation 10 Park plVA,Room 5170=Boston.MA 02116 617-973-8787,888-283 3737 or visit the OCABR website at z=-�'�'•m'� If you%%-ant to verifythe registration of a contractor or if you have questions ntor ne dalor tadditi ntal information specifically about the contractorregistrationcomponemofthaHomeltnprove ent Director of Homelmpro-mment ContuactorRegistration office of Consumer Affairs and Business Re_ulation 10 park plaMRoom'517%Boston MA 02116 617-9-134787,888-283-3757 or visit the BIC website Go online to view the status of a Home Improvement Contractors Re_isnation: JL1•�.d^S13S.s Rtr".tL4Ztf}ml`=Sttr}n]YVSmwnL lrC�rlaLrlAl.=1i"=1 iafrtmdaonof fiForassistancewith puws or to regdster formal complaints against a business:call Codsumer Complaint Section dffil:epfthe Attorney General 617-T_7-8400 NDlOR Better Business Bureau 5o8-652480o,508 7554549 or413-734311 c= 2t-tr. oro EZ-5-EE-3 OlMe � 021 b,04217 M n DO Musirless/O Latianr�t u7al -D antic Weatheh atiI LLQ ` `mss: 65iArm venue rete sal8 �: 8t y3 ' OmpIoyer �loyees(fell and/or —� a� a a general rs �3r aae i � - �Ei A. I am a sole•r° Part time.� have the s�:b-con c y� j: proprietor or P L er listed �e attached sheer. 5. 0 New construction ship a-nd hof e ao eMPI°yees ?• 0 Remodeling workrOr. M�y Ckimcitp. "!�l€se sub-coatmt jo��have T'ta ro - ,'c.0Q.instar, !°Yews and have,-r isers' 0 Demolitio;� ragt�ed.7 -Ce cornp-insw-ace. 9- Building additio;t3. a"-S-a fi ." neoVrer doing tilrok a Corporation and its mysel:. �T sqUf ers'ca cer tnve e� ised tbn I0-0 aebct o r addi iio7js Imt Z - ofe:emation per G; Plumbingrepairs araddiISsi(a) 2 .2 and we have no i Roofa pairs employees.OVO wofkers° i3.�.--,�- "'��Y Wf icant th cow• rice. __ rNS�tu cf0Mal mer,who chemo bo'a mast also i't12 out the sere L] submit this ars`tdavit section below shhon'ing thdrr�t�e ca `��actoks that shah tins bo;,must dtcaling they are doing mPCMdon policy inibrnmtion. employees. Irdle sub W an addiho� all tpatic and�(�onside contra -sontraetoctm must sub s h2�a employees. shocrtng the name of a suo-eontrct6 d srtate w;reiherorn davit iadigEing saeh fir:?:2F?e,.�,�E.;����.�: 's; F'aviae their.voticets'coma.policy number. �e�tities Have in5utailCe^ �.or�pany irTar�e: � / :r'aa���catbc���sib Po f cy#or SeLi-tins.i is r J � a70 rab Site afass: Bmiration D&-,p H�T.1LC$to SBCtir?Cc3J 5-�pg,Ca $.Ce mffOh Q y 'r.3y, i3f�StEt �7.iD- A/ o� Flo tCs�T �' metier se--ti"i c Fl`&`t�rJtz 94.0 gFi©s c, ' =,�QQ.QO ardor ons- r 25A of MOL g t to pact'1 ambey °C LP to�25Q-QQ a da a Yea. p►rIS°aeltt, wei L a I52 ctta lead to the im37p57{to�7 of�� $ o_ s� y gaiag the as civil? hies in the. mai. Z . ,�r dyadons Of the DL4 for violator.- advised that a t:o ..r arm E?i a 3 E3? QRtC�t� Ines of a .� i-.silraace coverage veF caiiau. pt' ,a dlis stateme my'e f ceded is the n and a,7ne o„_oma . = reg P� _ ice°f �" }1.7-a�Lrt'B: o Fy:'� r -.._•�,�' ?u• •ns�, a P-. VIM- DLJ ..E '8r!'��: '4:E`'r'✓ Els�SG%d$f�i t'Er?2 GG}s�����#jl C�:,j7�' '.f'f'Jr'2 FJ3� �' J LL^L_e ene;o o-$M LV � fk"'7 #S�: �► C-ams ''�ec$s3 zwp,-C, s. . n ; 5'' one ° t ° Rightfax N3-2 4/18/2014 7:54 :21 AM PAGE 2/002 Fax Server DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/1 PJ2014 T . IFICATE 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. IC HOLDER, IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the pol(cy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the arms and oondRions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 WEST CENTRAL STREET (A1C,No,Ext): (A/C,No): E-MAIL NATICK,MA 01760 ADDRESS: 22MLW INSURERS)AFFORDING COVERAGE NAIC It INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: INSURER D: 61 REAR JEFFERSON AVE INSURER.E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED:NOTWITHSTANDING ANY REQUIREMENT,TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THEINSURANCE AFFORDED BY THE POLICIES DESCRIBED HERONS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LBrITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (111IDD w") (MIADDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGETORENTED $ CLAIMS MADE M OCCUR. DREMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY [::]PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE "` AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-58270121-14 03/202014 03/20/2015 ! LIMITS ANY PROPERITORIPARTNERIEXECUTIVE Q NIA E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE-THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPR N ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 19W-*2010 ACORD CORPORATION. All rights reserved. A�RD CERTIFICATE OF LIABILITY INSURANCE DATE 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(les)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 endorsements). PRODUCER CONTACT COAstruCtion NA E' Eastern Insurance Group LLC PHONE (508)651-7700 FAX 1AIC No AIC o 233 West Central Street E-MAIL - INSURERS AFFORDING COVERAGE NAIC>t Natick NA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED INSURER 8-Arbella Indemnity Ins Co. 10017 Atlantic Weatherization INSURERCNautiluS Insurance CO 61 Rear Jefferson Avenue INSURERD: INSURER E: Salem MA 01970 INSURERF: COVERAGES CERTIFICATE NUMBER3laster 2014 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 ADDLSUBR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 }( COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE ❑X OCCUR 8500042816 /20/2014 /20/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY FRI PRO LOC $ AUTOMOBILE LIABILITY COMBINED LIMIT 1,000,000 ANY AUTO BODILY INJURY(Perperson) $ B ALL OWNED XSCHEDULED 1020015871 /20/2014 /20/2015 BODILY INJURY(Per accident). S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Paracadent PIP-Basic $ 8,000 X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE S 1,000,000 DED I I RETENTION$ 600058654 /20/2014 /20/2015 $ WORKERS COMPENSATION WC STATU- 1TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE — NIA E.L EACH ACCIDENT $ OFFICERIMEMSER EXCLUDED? (Mandatory in NH) . E.L.DISEASE-EA EMPLOYE $ I yes,describe under DESCRIPTION OF OPERATIONS below I E.L DISEASE-POLICY LIMIT $ C POLLUTION LIABILITY CPL200378602— 0/1/2013 0/1/2014 GENERAL AGGREGATE $1,000,000 < EAPOLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Addirtonal Remarim Schedule,If more space IS required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '!'OWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 160.0 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Ronald Cleaves/SNE ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025ontnnm of Thr ArnRn nama unrr Innn 2m raniatannrl awarde of a(Y1Rn UMassachusetts-Deparrrnemxsof Pudic Sa;ety Board of Building Regulations and Standards Canctrtia:tion Su ercilior License: CS-W7977 i ERIC W PALM 3 HILTON ST Salem MA 01970= Co a�n issiensr 04/2312016 ��e �!a»r»ra�rrriealff r./C-'ldtr.;JrrcfrrJeffJ Office of Consumer Affairs&Business Regulation — ME IMPROVEMENT CONTRACTOR ETypeIstration: 142089 iration: 3112/2016 LM Liability Cotpo�. ATLANTIC WEATHERIZATION L.L.C. ERIC PALM 61 R JEFFERSON AVE SALEM.MA 01970_ Undersecretary Location No. � Date �1 . - TOWN OF NORTH ANDOVER • BD,h 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# i 27 658 Building Inspector TOWN OF NORTH ANDOVER j� APPLICATION FOR PLAN EXAMINATION Permit NO: IJV � Date Received 1 I Date Issued: IMPORTANT:Applicant must complete all items on this page [ t_ r a 4 LOCATION-. -Print PROPERTY OWNER _ 1T> .►�1 Print 100 Year Old Structure yes n- TYPE MAP NO: ARCEL: . ZONING DISTRICT: ,Historic District yes - - Machine Shop Village yes-OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ther ❑ Septic ❑Well 11 Floodplain. ❑Wetlands0 Watershed District ❑Water/Sewer ' DESCRIPTION OF WORK TO BE PERFORMED: X ID Identificati n Please Type or Print C early) OWNER: Name: Phone: Address: 3 ®fir /A/I �- b l CONTRACTOR Name: Phone: Address: Supervisor's Construction License: - p. Date: Home Improvement License: 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: $ d FEE: $ Check No.: /9-27 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of�AgentlOvvner'" Sig��eture of contractor . - _',,�' '�"� �i Plans Submitted i_J Plans Waked ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department :The following is'a list of the required.forms to be filled ouf#of the.appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits u , 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 FireDepartment prior to issuance of Bldg Permit Addition Or Decks a Building Permit Application ❑ Certified Surveyed Plot Plan a 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) o 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 o 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 cnst�s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subWted with the building application Doc: Doc.Building permit Revised 2012 i -.-Plans-Submitted ❑ Plans=Waived-0 ..Certified Plot Plan Stamped Plans El TYPE-OF SEW-ERAGEDISPOSAL-- Public YPEOF:SEWERACEDISPOSAL- Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning Pools ❑ Well ❑ Tobacco.Sales Food Packaging/Sales ❑ Private:(septic tank,etc- ❑ permanent Dempster on Site ❑ THE FOLLOWING SECTIONS-FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM _: DATE REJECTED DATE-APPROVED PLANNING &DEVELOPMENT - ❑ ❑ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Nater& Sewer Connection/Signature&Date Driveway Permit I)PW Town! Fngineer: Signature: Located 384 Osgood Street F',RE-DEPARTMr NT -Tehip Dumpster on site yes no Located at 124.Mair Street: Fire ®epartme%it sigriture/date Y = ' COMMENTS 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 DANCER.Z®NE LITERA`fURE: -Yes No MGL.ChapterlW.Section 21A.=F and G min.$100-$1000 fine NOTES and DATA—(For department use 4 Ir i EI Notified for pickup - Date Doe.Building Permit Revised 2010 NORTF/ Town of ¢ Andover 0 ver, Mass �Dlq O COCNICHEW, N 1' A- 7�S U BOARD OF HEALTH Food/Kitchen PERk ! LD Septic System THIS CERTIFIES THAT ............ �......A 1a1 .................................. .. ...... .. ........... BUILDING INSPECTOR has permission to erect ...... buildings on 4 ...2ft.. . Ca. . I Foundation .................... loll .. .loom.. .................� • s� � Rough tobe occupied as ..................................................f� ........................................................................ 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 UNLESS CONSTRUCTION STARTS Rough 0001 1111101111111111111....... ........ Service Final BUILDING INSPECTOR 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. North Andover MIMAP May 9,2014 av �' a rd 9 ° v a I L� e ro r , . � I r f Interstates —1 —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, --Roads Meters Data Sources:The data for this map was produced by Merrimack C rEasemenls Valley Planning Commission(MVPC)using data provided by the Tmn of OMVPC Boundary North Andover.Additional data provided by the Executive Office of Enviranmenlal Affairs/M—GIS.The information depicted on this map is CParcels �" _ _ L for planning purposes only.It may not be adequate for legal boundary OR definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY i a e# OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 4y e F ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION 1"=62ft u , C-) North Andover MIMAP May 9, 2014 5_G; . i I r 135'BEAGgN^HILL BLVD , F I 145$EAGflN HILL{=.BLS 51 lab ���� QSI.I22 "WRWT t Q�ksS41 ; i 1E44 B1q CON 4LLill BL1(-Q)� 1 445 57 1 �1rBEAC{3PF FIILI},Bl-VD 4 512MASSAC11i1SETfS'AVE_J 66 5-003T� I1T,@AY�STATE RD 131 BAY:STATE R #415 8036! 131i§A i:S!A`EIRQ; I 5t4,�t_ASS AC�tUSETTS>�'AVE �ti. 1p1 ~`K 6 id� L 4 ` Ii15,GQO1Qi � —Rail Line '=a Wetlands Zoning Interstates C Exempt Lands .Busine.1 District —1 GBusine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum i— SR aBus ine s 3 Dislnct Meters Data Sources:The data forthis map was produced by Merrimack 1mBusine s 4 District �¢g, Valley Planning Commission(MVPC)using data provided by the Town of . R-ds =Gerrem Business District `Q.a 4�, North Andover.Additional data provided by the Executive Office of ,7, Easements 3Planne Commercial Dev r �<��' •e Envirenmental Affairs/MassGIS.The information depicted on this map is C Corrido Development Dist 3 for planning purposes only.It may not be adequate for legal boundary ©MVPC Boundary Ill Corr Dist ¢'.� — definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER OMuniclpal Boundary OCorridc Development Dist �` 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING In=. 1 District Zoning Overlay THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY .`:Industn 12 District E3Ad It Entertainment s OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ODowntown Overlay District t13lnduslii 13 District * ''4 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE DR MISUSE OF QHistoric Distrix Glndustn S District THIS INFORMATION OWater Protection Reside cel DistriG :Reside ce 2 District ❑Parcels 11 P—idei cc 3 District ❑Hydrographic Features62 ft de ce 4 Distncl 1"= deLmi)� D�ri—StreamsdeeMial District 3990 �/ q Date ..d :.. NORTH 0. °`��``° '°�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING s i a ,SSACMUSE� This qertifiesthat ......... ...r s. ...:.... 4......... ................. has permission to perform .......... .P.t'............ .r�Sf.Pkr.a:.................. wiri `g in the building of..... . .g.l.!. : ....... t.r?!..I.................................. 7 at...... ....... ....(.le.. orth Andove ,M r� LECTfjR ..........Fee. j/.�/. ......... ..CTOR[CALINS�11 Check # 4" Commonwealth of Massachusetts official Use only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 7 CM 12.00 (PLEASE PRINT IN INK OR TYPE A L INFORMATION) Date: 01 City or Town of: To the Inspec or of fres: By this application the undersi a 'ves ii . e of his or her int e ion to perfo the el trical work described below. Location(Street&N Per) J, Owner or Tenant NIS Telephone No. — 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 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: Installation of Security system f Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o mergency jg ing rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 13 No.of Switches No.of Gas Burners N-o-.-57 Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:I I 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 E uivalent 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 Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) _ (Expiration Date) Estimated Value of E ec cal Work: , (When required by municipal policy.) Work to Start: 00�_ Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under th pains bndpenallies of perjury,that the information on this application is true and complete. FIRM NAME: Sacur-ity LIC.NO.: 1 S33C— Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line) Bus.Tel.No.: 603 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li*see see 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 Signature Telephone No. PERMIT FEE: $ Date. . HCItTM �?��,<A �',;•.;hooc TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING "'SA US / This certifies that has permission to perform /. . . �!- . . . . . . . . . . . . . . . . . plumbing 'n the buildings of,. . .� �` . . . . . . . . . . . . . . . . . . . at I . ..���. � ? �Y/�� c'th Andover, Mass. � ' 4 Fee. Lic. No..1���. . ��r-. . . . 7�al- 6441 PLUMBING INSPECT6oCheck !t VV l - MASSACHUSETTS UNIFORM APPLICATION OR PERMIT TO DO PLUMBING (PrintorType) _a- Mass. Date Permit # Building Locationreplacement Owner's Name ! /'r» I Type of Occupancy Residential New ❑ Renovation ❑ Plans Submitted: Yes❑ No ❑ UU zul - r-I N V) a N w o Z W Y J f!! )' U Q N = W W Z N Q a `r ~ _z O 2 _N a �I N u ¢ m ¢ > a r z ¢ a c7 QC 3 �7Ny' R1 �l^yi, a W Fes., W a N 0 J N rr J = T� r v a x 3 = ° z i ,c a o H a x .� W `L x > r- o. ►- z o 0 a Z z w ► 0 U a F 4 d x N Q d 0 a J J a a a a d Y J m N O Q J x F N w l7 0 d C 6l N rd rt 33 3 �n1 SUB—BS MT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg. &Plg. Co. Inc. Check one: Certificate Address_ 35 Rlpaaant Street IXCorporation 714 Stonehami Ma 02180 ❑ Partnership Business Telephone 781 -4.3 8—7 7 7 6 C] Firm/Co. c - Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142: Yes ® No ❑ If you have checked yes. please.indicate..the type coverage by.checking the appropriate box. A liability Insurance policy L$ 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 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 provisions of the Massachusetts Stale Plumbing Code and Chapter 2 of the General Laws. BY Tills Signa fe o icensedum er, Type of License:Master[X Journeyman E]City/Town . 8322 APPROVE0(OFFI USE ONLY`- License Number_ %"Watts 9D bfp on water line to water boiler BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE - NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED - DATE 19 PLUMBING INSPECTOR t t NORTH ° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �ITS�C U � . f � This certifies that .A ...�� //.// <. l has permission to perfo �!� : . �� +t..f�� ....... wiring in the building of... -� -............= . i at.B �_ -��MVZ) .s!, i, .:!�-�b � ;-North Andover,Mass. ELECTRICAL INSPECTORp j ✓✓✓ 'Check # 576 ' U11C Willy OmI Y�mJ Fec-Cbethed BDARn 0�-- FpE PREvF kvj N'rION RF )U)-A.T�OM blmsk) zt,:5%V.1 APPLICATIONFOR PERMIT 1-0 PEP�(ORM ELECTRICAU WORK III wmit 10 Ile Perio(mcd in acciI\-,O, ,1( Nlis,,�ldlw: Codc IMRI^),A)J L'NIR 12 00 0-51 IN INK OR F0)), -ell of: tL Jescri city OrToi Clull w1kyo beili below. qVitc-.11101) Olc u(ldc"VIC111 LlIVICS llol�cp 11!q 0 11IN11 �11 I C' 1.0iI (Strect 't Owner orTcli-alit Tlvlvp�lolle NO, 11I Cl—71p-, 0 ess is this permit it, (11111dill; put i�:�! Ajs�)roprivo Uo.-,) of W,it tj ill 4' LJ I ilit y Aut h)1'17.11 i u 11 N u. ild"r 0 No. of Alairs VAt 01 N 110.ILI U u kills O�C] 11�.ld No. 01-Alefels. A.ill NuilI of T�cederi nod ArII m% im4lNifurc of Propel 7T 111�1-fhlnvbc tit"/,,j '11h,vs, INO. of Rm'..5set) 0.0 rr-insformer s ,No. of Ugil!�nv,oillims of HvITUIls KVA !3 wgilicvT A ovit. -R.il", it iNo, of Lighfing FixtIlITS No.of ReajI Oullels FIME ALARN)i "f-1 Z 1,0 1-1.1 eg [No. of Sivildles INU, of Rall�C5 No,ol Air Cc,-ksJ. No,of Alerflog Devices Tolls No. of)lvlste Dispriscus T0111 No. of N51111.1shus Ilt-ming 10V L a c 31 01be Ncl, of DO-Yel-.5 )Jnling Appl,micir,li K'I No.of Devices or Equivilplit N 0, o I' D,1 f n NV:Ir Ill C: A en(P.I S S I i No.0(Devices 01.E , Welit gmfv, No� HI-droill-mvige B-1110(uhs No.ofMolons Tola� 11P Tcr"061111"111059%M111111191 'No of Ulm ices Or r OTHER. ,ifloc�1 )Miflaw)f drind ifdI w,as regoiroi 6.1 tj,e inspecior of Mircl; I-NSU)4-.kN('v. CovIR 1UNGE: UnIcss w.itvc6 by ibc o,%oci, no pri mit fw the perfurrmnce Of clecaical %vork way issuC 1,1111"S tilt licensinc piovitics proof a(liability iii5kiralicr.iochidliq,- con,p)�-IH i�pciratioti"congige 0i i's ub)wntill equil*clll. Thc unlI e ri roic C,lori III 1� C diih;v!d pf')OC(ir$a0lic 10 Itic peiniii 4smjiv,office, vrd(�(Trllirlcq that Sticli rcmru, is i Cf-Ir-QI( ONE IN RAINCE JL7rfD'0i\I() C1 0 111 F.R iSpcc i ry A- .._. J—\P I Ild 11)uc of E kc il ic 31 wol k�. —36. Mieri;c qolickl I)), niiiii;c,pi)poh,�) \Votk (o Sni 111SPM1011S tobc fq[,C�'Ctl Ill jJ111"C! "011NIFCAide 10, ind ujjt)fjl,,.)rip1eijon. (e, it I h e poill i 171td/w,!a"I 1'..j i.fil-il'i'll n1? r1j,5 1)� �N frih?omil romple"e, 1:1 RA I J\-It N I t� U C. NO, 1J(- Ar 11,1 r 31AS. T C.1.N o, I �Irnj�� rc d�:I( dic 1, ),(-%a lbe 1- il,l) A d d t cis: Az,� I�/L�–,0/1 'I Ta No.:---- -qI;.WS NSrn ci NvN 1;. C E N A tllswl�lmc,Cc,,er:lew norni-illy beluv, lic-it+) 7r �Ifr�iJ Ili 3 ill 0'e lieck. 0 110 1.)it Ile I 0\1,?tQ r 5 al"Cill. oil flerh\�C111 are P;:RJI1T1-T-r,- S