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HomeMy WebLinkAboutMiscellaneous - 1420 GREAT POND ROAD 4/30/2018 / 1420 GREAT POND ROAD 2101062_0-002000.0 i i Date . .I D73/ l t • X,IKLRAldre,..:..• TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . k/ . . . . . . . .pal/:7 . . has permission to perform . . . . .�. r. wiring in the building off'. .5 .R,N. o n k.1. . . . . . . . . . . . . . . . . at . 40. R.P.P"I. .2-b . . . . . . . . . .N rth Andover, Mass. 0 Fee . . . Lic. No.. . 7741 R . . . . . . . . 01. ELECTRICAL INSPECTOR U Check 11183 "v Commonwealth of Massachusetts Official Use Only NEW Wffim Department of Fire Services Permit No. I ( F3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICIATION work to beperformed PErRMIT dance TOwith theaSsachPERFusettsEOReM ELECTRICALo WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:r I -'a City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives no 'ce of his or Kr intention to erform the electrical work described below. Location(Street& umber) Owner or Tenant Telephone No _ Owner's Address CH 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❑ Und rd g' ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Como--no the ollowin table ma be waived b the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- EJo.o mergency �g mg rnd. rnd. Batter 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. TotaTons l No.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal ❑ ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Syystems: No.of Devices or E uivalent No.of WHeaaterters KW No.of No.aof s Data Wiring: iSigns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent t OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. EstimatedVal*oEIctrical Work: y� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE GE: 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under t pains t7ndpe altiesXperjury,that the information on this application is true and complete. FIRM NAE: �LIC.NO.: /U Licensee: Signatu � �� h NO.: (Ifapplicab e, e "e npt"in the li n e number li Bus.Tel.No. I Address: S Alt.Tel.No.: *Per M.G.L c. 147,s. S7-61,14curity work requires Department of Public Safety "S"License, Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. , Owner/Agent tic Signature Telephone No. PERMIT FEE: $ (,� i I T D re 9323 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SSACHUS This certifies that .l C1l O,C'5 1 ��"`� �- has permission to perform .0 SS—)�.3 PI,.e J plumbing in the buildings of . . . G . . . . . . . . . . . . . . . . . . . at . . �Po - i!pc—c!l. . . . . �. . ., A o et, Mass. PLUMBI INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: Noll 4(1Ao'PCS' , MA. Date: d laa- �'� Permit# l� O ( b r 35(�r1)oprt' Building Location. a' ��� On Owners Na e: q c Type of Occupancy: Commercial ❑ Educational❑ lndustri ❑ institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No (:1 FIXTURES z z U) Ln CO Lu z O Y U N Cn U) co 1Q- X } Q V W O Q (0 Wz9toz Q O m N �, A Q k-- >- 2 9 W z to to U' OU a U. o s a �, Q ,U o Y y S a O F— V Q h H y d a to v_, ° a o N >aa > o = o Q g Q In m o o Ii (7 r 5G J Ly. (0cn 5 O SUB BSMT. BASEMENT i —i'7—FLOOR 2 NI FLOOR S 3 FLOOR 4 FLOOR. 5 FLOOR WH FLOOR 7 FLOOR 8 FLOOR /-/� Che k One Only Certificate# Installing Company Name: H��ntr`, 1 Corporation Address: Cityrrown: Lau ,,Vte--t- Stater Zip Code: ❑ Partnership Business Te1:97� l.$� 37'1 Cell: Fax: ❑ Firm/Company Name of Licensed Plumber: dol /V,C-60(g1 D0'?(,t INSURANCE COVERAGE: 1 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 of coverage by checking the appropriate box below. A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of I Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of owner or Owner's Agent I hereby certify that all of the details and Information I have submitted for entered!regarding this application are true and accurate to the best of 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 Chapteri o the General Laws. 414 By Type of License: Title. ❑Pt ber Axr- 'SIlg6ature of Licensed Plumber Cityrrown aster License.Number: 3042 APPROVED OFFICE USE ONLY) Journeyman the Coli ynompeelth ofI► assccillLvetts Department of IndustrialAccidents - Of zce ofInvestiga orlr 1 Cong-ress Street;Srtite 100 Bostopz,HA 02114d017 IPiinv.pptass.gouldhi Workers' Coln e"o-n Insurance A-Mdavi>t: Bull hers/Contractors/Pta+lectric>ians/Pgt��'e s AlgplUcaant Informatiola Please Pri>a>t Ie�bfl� Name(Business/Organization/lndMdual): 1S Address: �c�n�� City/StatefZip: l L-�w(tnfG Phone 0177 Are you ala employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ 1 am a general contractor and I . employees (full t:tnd/or part-time).* have hired the sub-gontractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet: 7. ❑ Remodeling ship and bave no employees These sub-contractors have g_ ❑Demolition working for mein any capacity. employees and have workers, 9 Bwldin addition [No workers'comp.insurance comp.insur nce# ❑ !y recptired-] - 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑�I am a homeowner doing all work officers have exercised their 11.❑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.❑ Other Camp.insurance required..] 'Any applicant that checks box Rl must also fill out the section below showing theirworkers'compensation policy information. t.Homeowners who,submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractms that cbeck Us box most attached as additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-cootractors have employees,they must provide their workers'comp,policy number. -F M71 all elllpLoyar Mat is providing iporlws'con1pernation insuranceforllry elltployees. Below is illepolicy wad job site illfonnatioll- Insurance CompanyName: L WC��th °'� ^Svr t VNC Policy#or Self-ius.Lic.#: cpp 1 S $�� ' 6 Expiration Date: Job Site Address: �a0 rLC, .a� City/State/Zip: No(-#, 4-A8y c,- 171q Attach•a copy of the workers' compensation policy declaration page(showing the policy nnmber and expiration date). Failure to secure coverage as required tinder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1'500.04 and/or one-year imprisonment,as well as civil penalties in the folm 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 Of of Investigations of the DIA.for.insurance coverage verifieation- F do 1lereby cern uer th 1 e ants altd eualties of 'rtty that the i1:}onl:aiiott provided above it bite and correct Si ature: ----- -- -- Phone 9-- Offteial use only. Do not iprite in this area to be completed by city or to pit officiaL Citi-or'Towan: PermittLicense# Issuing Authority(circle one): 1.Board of Realth 2.Building Departibent 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othet Contact Person: Phone#: Date... -..Z........................ NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMU`�� This certifies that ......... V..�....................'........................ ... has permission to perform C �� L ................................................ )...... wiring in the building of.......... ! p?.4�AV© . ........................................... Y.?-.0.... ....... ,North Andover,Mass. d Fee.,5.26).:� ..... Lic.No.3.)..�'Cl.......... ...... ....... . Y ELECTRICA NSP iC Check # /U L111`2901Ds: �► 0674 0 -1 C,otnm-0nweahA o f YYjadackudeit9 Official Uyse�Only t cc�� cc77 Pernut No. n5parl�nenl orDJ!"e service9 ,•f _: Occupancy and. ee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev, 1107] ---- (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. All work to be performed in accordant.-with the Massachusetts Electrical Code(MEC),527 CMR 12.00' (PLE,4,S'EPRINT IIV,IIXORTYPEALLINFORAMTION) Date: ' Fe-B: 22 -2012. City or Town of, NORTH ANWVk_0 R_ To the Inspector of Wires: By this application the itn7dersigned gives notice of his or her intention to perform the electrical work described below, Location(Street&Number) 1 L{2,Q C�kV-A'T 16 1�e D Owner or Tenant SAnIRNCioRZ Telephone No, $ Oti19U Owner's Address S 1A rlr1 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Bos) Purpose of Building Utility Authorization No, Existing Service Amps / Volts Overhead❑ Undgrd❑ No,of Meters New Service Amps ! Volts Overlie i❑ Undgrd❑ No,,of lYleters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tJ R VN Tn o v N l_ ' Completion o the following table may be waived by the!ns eclor of Py-Ir", No,of Recessed Luminaires No.of Ceil,-Susp.(Paddle)Fans No,of Total Transformers•. KVA No,of Luminaire Outlets No,of Hot Tubs ' Generators KVA No.of Luminaires Swimming Pool Q bove ❑ In- EliNo,of mergency ig hng rnd. ¢rnd.a Battery Units No.of Receptacle Outlets No.of Oil Burnars N �a R ' FIRE ALARMS No.of Zones ' No',of No,of Switches No.of Gas Burners ' Detection and Initiatin Devices No,of No.of Air Cond. Total No,of Alerting Devices Tons g No,of Waste Dfs posers HeatPump Number Tons I�yY No,of Self-con tained Waste P " . Tatals:. "' ""' "' """ Detection/Alertin Devices No.of Dishwashers ` Space/Area Heating KW Local❑ CoMunicipalcoETOther • Connection No.of Dryers Heating Appliances ,'- XW Security Systems:-. No.of Devices or Equivalent No.of Water KW No.of No;of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No.Hydromassage Bathtubs No,of Motors Total HP. Telecommunications Wiring: No,of Deuces or Equivalent OTHER: Attach additional detail if desired,or as required by the inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:2-22^I 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless-waived by the owner,no pennit for theperfonnance 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 ❑ (Sgeciry:) I cert,under the pains andpenalties ofperlury,that the information on this application is trite and complete • FMI NAtti1E: LIC.NO.: Licensee: --(!r_y%A Uj y N N F Signature �-� gl) . LIC,NO.: 1(,09-5 1E / (Ifapplicable,enter"exempt"in the license number line.) i0 Bus.Tel.No,: 9 178 YY Address: l In(c BPOADWAY HA✓e R11/ll 111A 0/982 Alt.Tel.No,: *Per M.G.L,c. 147,s.57-61,security workrequires Department of Public Safety"S"License: Lic,No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law/.'By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PETwIT nu. s r The Commonwealth of Massachusetts n 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 Applicant Information Please Print Legibly Name (BLIS iness/Organization/Indivi dual): TXA4 LOYNWF_ Address: ► 1 O G BROAbWAY HAV'CR6111 City/State/Zip: MA O 1$32. Phone#: Q78 99ti 6M Are you an employer? Check the appropriate box: general contractor and I Type of project(required): 1.[:J4.I am a employer with ❑ I am a g 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y P y• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. ` 5. We are a corporation and its 10.❑ Electrical repairs of additions required.] ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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' 131-1 Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: _ y 2n Cn RPaT ?©NO R 1>, City/State/Zip: tyop L[r`n kipoveR Mp Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). j 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 certifytiunder the p�a1 ins and penalties of perjury that the information provided above is true and correct. Si f nature: �.1�►nnn t��al/V1,N1 Date: Te.Y3, . 2 2 00 1 Phone#: 978 99 CaZZI 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#: Location No. �W v Date NORT" TOWN OF NORTH ANDOVER 3? � •• OL F 9 ` Certificate of Occupancy $ ��J' •t��' Building/Frame Permit Fee $ AC Nus Foundation Permit Fee $ Other Permit Fee $ � TOTAL $ Check # 17886 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLINGso i' � ' BUILDING PERMIT NUMBER: DATE ISSUED: Z C C ic SIGNATURE: Building Commissioner/In for of Buildings Date z SECTION I-SITE INFORMATION I 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSI3IP/AUTHORIZED AGENT "' %l 1i% nStniCt: )!S3 �,►� M 2.1 O;j er of Record Name(Print) Address for Service b Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 zp�s� lei Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ t C Licensed Construction Supervisor: �V 0 /Oa— ( /2r�1 Z 71 -d/t (✓�` License Number "n sad '`t > �U/U Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name a �- . a M Registration Number r Addr t (/ r �o5 2 JL" �? �� G �S -7j � Expiration Date Si nature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check ad applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 11 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 3�_L r SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMICIAL USE ONLY ,Cpmpleted by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection `7 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r I, C /i`rU �i✓� as Owner/Authorized Agent of subject property Hereby authorize �2(1 C EL-JEZ C-0-2—2 to act on r My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 1 C 1/ "� , I-7) �'C–uL� 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 Pr"it Name 6 f o SigiiaMrebt Owner/A ent Date NO. OF STORIES SIZE i BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2' 3 SPAN DIMENSIONS OF SILLS _ DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ,per ✓fie �amrmzomu�ealda o�'✓GLaaacicluiaeQ2 �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 106620 - Expiration: 7/24/2006 Type: Private Corporabon RICHARD FLUET CONTRACTING INC. Richard Fluet 102 Bridle Path Lane' s Methuen,MA 01844 Administrator /✓�.o, 4X, a ;.•..�[,rrkNxcl�tr,Kde r , BOARD OF BUILDING REGULATIONS' License: CONSTRUCTION SUPERVISOR Number: CS 050710 Birthdate: 04/22/1956 Expires: 04/22/2005 Tr.no: 9641 Restricted: 00 RICHARD A FLUET 102 BRIDLE PATH LNC-� 1 METHUEN, MA 01844 Administrator ,t,%0RTjj Town 0 4Andover : �0 No. dlO a 0 over, Mass., 0 LA Ij, COCHICHEWICK O"?ATED BOARD OF HEALTH Food/Kitchen Septic System MIT PER T D BUILDING INSPECTOR THIS CERTIFIES THAT............ . .. ...... (? Foundation has permission to erect........................................ buildings on-Alto..... 1. ................. ............................ ...L Rough tobe occupied ...................................................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PEWIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S ELECTRICAL INSPECTOR D"Y 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. Page No. ] of 1 Pages. RICHARD FLUET CONTRACTING INC. 498 X102 Bridle Path Ln. METHUEN, MASSACHUSETTS 01844 A (978) 685-7010 .,PHONE DATE TO Barbara Sadrnoori 978 689-04901110/5/2004 1420 Great Pond Rd. JOB NAME/LOCATION . N. Andover, Ma. 01845 WINDOWS, DOOR,AND BATH FLOOR. JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: INSTALL ONE 8 ' ANDERSON FRENCHWOOD GLIDING PATIO DOOR WIRH PIN SNAP IN GRIDS, BRASS HARDWARE,AND SCREEN. $2675 . 00 INSTALL 4 HARVEY WHITE CLASSIC MECHANICAL VINYL DOUBLE HUNG REPLACEMENT WINDOW WITH LOW "E" GLASS AND 1/2 SCREENS. $325 . 00 EACH TOTAL $1300 . 00 BATHROOM;REMOVE AND REINSTALL TOILET AND BASEBOARD,REMOVE TILE ON FLOOR,CUT =1 AND REPAIR ROTTED SECTION OF FLOOR, INSTALL NEW SUBFLOOR. $800 . 00 TILE LABOR WILL NEED TO BE ESTIMATED AFTER TILE IS CHOOSEN. WORK TO INCLUDE; INSTALLING, INSULATING,AND TRASH REMOVAL. WE LOOK FORWARD TO DOING THESE PROJECTS FOR YOU ! ! ! Extras or changes to be completed at a rate 0 L,0_0 per hour, per man. Unpaid balances subject to 11/2% finance charge per month. WE PROPOSE hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Zero . dollars($ ). Payment to be made as follows: 1/2 WITH ACCEPTANCE, BALANCE UPON COMPLETION. All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifica- Authorized f tions involving extra costs will be executed only upon written orders,and will become an Signature -- extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance. Note:This proposal may be Our workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: SAV (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts > Department of Industrial Accidents Office of/nvesdgedons Boston, Mass. 02111 - Wo►trers'Compensation Insurance Affidavit Name Please Print Name: � � q- S.n Location: L t,-y CSS 6yot-,) S7 City N �f Pnone ;At 0,4-( C i I am a homeowner performing all worts 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. Comtranv name: e ° C- H4/ ) 1 C �Vu-;7 C0Yv,-(I- Address City: -✓! ° � Phone it U(a Insurance.Co. �'C?V� C�4—e PolicvS W L Q �G / Comparw name: Address Phone# Insurance Co. Policv S FaiAue to secure coverage n required under Section 25A or MOL 152 can lead to the imposition of akninel Penalties d.a fine up to s1,500.00 andloroneyears'lmprisorrrrentswa0.as.cbdl.penakiesln]hei=AFA.STOP.WDRKORDERaW.a.fkwd.(.:940.W)AAgrapairW.ma I understand that a copy of this statement may be forwarded to the orrice of Investigadorn of the DIA for coverage verification. /ob hereby csrtNji un a Inaand na .orPariury that the Intbrmadw provlided above is true and carrsd. Si nature -�/7 Date G Print name Phone YS -' Official use only do not write In this area to be completed by city or town dffcief City or Town P ai []Check y immediate response Is requbd ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other 4180 Date A?J/ 0?� ........................ 'e TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 41 SACHUS Thiscertifies that ........................ ..................................................................... has permission to perform ... ...............It. ...... ............. wiringin the building of.......l'..-l_.2-�---_ -7- .r___'�T_ ................................ at.......................17....................... ...... North Andover,Mass. Fee/................ Lic.No'� :a!: ............................................... -ELECTRICAL INSPECTOR Check # THEC0AM0NWEALTH0F,tVIAMS4CHUSETTS Office Use only DE 4J?721IENNTOFP[W1C,W,6 Y �/ �1 BOARDOFFMPREVjyvWON)?EGULAHONS527C M,2..00 Permit No. _ O" Occupancy&Fees Checked O APPLICATIONFOR PERMIT TO PERFORMELECTRICAL 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 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) Owner or Tenant s �C Owner's Address Is this permit in conjunction with a building permit: Yes No F-1 (Check Appropriate Box) 1 �19/_, "L pUltIr / Utility Authorization No. Existing Service Amps Amps /c Z olts Overhead Under Underground f gr' No. of Meters l New Service Under 'ound Amps��Volts Overhead � gr [:3 No. of Meters Number of Feeders and Ampacity �— Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs S No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above BelowKVA Generators round round No.of Receptacle Outlets No.of Oil BurnersNo.of EmergenKVAcy Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS Tons No.of Zones _ No.of Disposals No.of Heat Total Total No.of Detection and Pum s TonsKW Initiatin Devices No.of Dishwashers Space Area Heating KW g No.of Sounding Devices No.of self Contained No.of Dryers Detection/Sounding Devices Heating Devices KW Local No.of No.of Municipal Other No.of Water Heaters KW1:3 Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP / OTHER• �f a imaanoeCor�age RualanttotheiagtlrtartmtsofM�adx>�tls haveaomatLmbl7ityhlsuratwpoky>t ixkgcmlp Co�erageoritSAtSMWegivajelt YES havesabrmtbdvandproofof Ogg,YES NO helg� lfyouhavec ted�dY1 ,P1 eirld thetypeofco ageby 14SURANCELZ BOND El (p y) w�/ C� F�ratiorrDa� �orktoSlart �/ - FstuD&dValleofEbcfiicalWo&$ ig>edunder'ie pgjtuyYA Rough Final RMNAME G Lia3tseNo. I=wNo 63 50? BusitmTeiNo. _Cl V 7S 9-%�7 JVNIIZ'S INSURANCE W ! P Alt Tel No. ANER;IamawarethattheLio�edoesnothavedrilullancecovuageoritsstlbsarttialequival�asIagttiledbyMassaclnt�ttsG Laws IdiatmysigrahneondrisPmTitapp)>�drisrequk rlfft lease check one) Owner Agent , o� Telephone No. PERMIT FEE ---Signature of Uwner or Agent 4�.N° Date....... . /� .. /.... . �10RTF� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING VSs^cmusE� This certifies that ... ............................................. has permission to perform ....... �.0 `� p. .P ...................... ................. wiring in the building of.....S..0 l e-1 a..!o()R. Office Use Only Permit Na I Dye�orr.+�ut P• Shay Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 11 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK •` All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1128:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to performtheelectrical work described below. Location(Street&Number ��2y �f�` ///�Yd 'e�D Owner or Tenant t) 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 ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work / T %�7 �E/�!/"/"r�a✓C1 Total No.of Ljght8ng Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA /J No.of Emergency Ughting No.of Receptacles Outlets �"/ No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices No.l of Self Contained No.of Dishwashers / Space/Area Heating KW DetectiorvSounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Baiiases I Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER /y/ G INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Lability Insurance Policy including-Completed ompleted Operations Coverage or its substantial equivalentt� NO = have submitted valid proof of same to the Offic�NO = if you have checked please indicate coverage by checking the appropriate box SURAN - BOND = OTHER = (Please Specify) ��/"!/�L=.�- RNs 41.1, (Expiration Date) Estimated Value of Electrical World Work to Start Inspection Date Reaquested Rough Final Signed under the Penalties of perjury: /I � C ��5 FIRM NAME U / 2-e-.e01-7 �t LIC.NO. �— 3 Licensee r% �` 1t'_Signature c� 9 / LIC.NO.2 U --Z 4 us.Tel No. e^ l 3 r! r 3 a 6. Address Alt Tel No. OWNER'S INSURANCE WAIVER: I am aware that the Lice es does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ � (Signature of Owner or Agent) Location No. Date NORTh TOWN OF NORTH ANDOVER Ot � o y,'y0 O? •' • OR F p Certificate of Occupancy $ Building/Frame Permit Fee $ — �'�b'••�'' c�' CH Foundation Permit Fee $ SswusE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ t �! P%LQ,]yq3 09:49 91.C9 ppILBuilding Inspector Div. Public Works Cocation No. �� Date ,40RTq TOWN OF NORTH ANDOVER O�• � o ,�1ti f? • •• 0 ksiwabL PA Certificate of Occupancy $ * ; , Building/Frame Permit Fee $ f "us Foundation Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ r Water Connection Fee $ TOTAL $ g4 lding Inspector Div. Public Works PCRM4T NO. P G 1 APPLICATION FOR PERMIT TO BUILD******/* N THANDOVER, MA hi%P NO. 06,2 LOT.NO. (�Q S� 2. RECORD OF OWNERSIIIP DATE BOOK PAGE ZONE SUB 1)IV. LOT NO. LOCATION 1 () C�i3'� �/AGI� PURPOSE OF BUILDING // � e� (blo S 'G ,;. ` T77 OWNER'S NAME /� � ` � � NO.OF STORIES nr SIZE b ! r OGS OWNER'S ADDRESS A ? BASEMENT OR SLAB ND ARC'I IITECI'S NAME SIZE OF FLOOR TIMBERS 1 2 3 RD BIIILDER'S NAME ! ti/ B! SPAN DISTANCE TO NEAREST BUII. DIMENSIONS OF SILLS DIS FANCE FROM STREET DIMENSI(NJS OF POS'i S DISFANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE FIEIGI IT OI-FOUNDAI"ION THICKNESS IS BUILDING NEW SIZE OF F("ING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECFED'FO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CCNJNECI'ED TO TOWN SEWER a IS BUILDING CONNECI ED TO NATURAL(TAS LI NE INSIAK'TIONS 3. PROPERTY INFORMATION LAND COST EST. BLDG.COST s PAGE I FILL OUT SECTIONS 1-3 FSI'.BLDG.COST PER SQ. 1: EST. BLIXi.COS F PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEI'FIC PERMIT NO. ATI ACHED GARAGES MUST CONFORM TOSTATE FIRE REGULATIONS 4. APPROVED BY: PIANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR RUI1DIN(: NSPECTOR DA IE FILED '�• f �'��� OWNERS'I'FLa� �y `) CONTR.LICN c `J QQ 1 Z� • SIGNATURE OF OWNER OR AU TI IORIZED AGENT { �a An z) ILLC.a FTI: $ O� PERMIT GRANTED Q l 1977-Ul / . The Commonwealth of Massachusetts _- Department of Industrial Accidents • Otflcsv/loyestlgatloas • 600 Washington Street Boston,Mass 02111 .Workers' Compensation Insurance Affidavit Iocntinn- r] // city e 0307 ❑ I am a homeowner performing aH work myself. ❑ I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compo ation for my employees working on this job. 6 :.... ... ::....:':::>:. x . .. : . h an insurance co, 'Tee nolicv# _ �±�:�vr' � �7:'•ti .•• +m'�triC1'�o�..s�% S7M•�^-�-rr+rr_.r-. ❑ I am a sale proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: Cmm�anV name• ..:..i.;r;•..n;�w•::moi':':r.:...::i.i;r::v:::�-;i'•;........illi?i':'i•::?is .:... .....:.. ::.. .... ♦ :.: ..:...."... �..:?.::?:••;:"�:i.ii:i?V!iiii!<ii.:v?•:i^'?tt i:':;ti:t:�:�: ��.• lIhone 2, ance co., :,i�.,i.,.; ...v..t4:•i:i:•:!::.,:•:}.,f ....S.W„?4 .::nY:lK::...:..Jv t•M/• ; ..:...is ...: :4,:;:. .. .... ...... .:,:..,:::.;,,..::... 'n011ttV . _.... .. ...:.,• ' ,cmm�anY nam!' .: •... ... . . '.`.<`•::;;:::'c•::a.t:::•:`;t i•<:;:iiiii::;•`::'•:•`::'::;iii:i:•:t•::::•:;>:;:';:::2:::>:ii i:<:`ii::ist•:::9;:::;:::i:;>is•:::;•::;i::a:a:::::<:a::::>::+ address: _. situ: •. .. _ ;•.: .... . Rhone#•. :.. :.. . i _Rance ro. •” '• '•• . Failure to secure coverage as required under Section 25A of MGL 152 caa lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one rears'imprisonment as well as civil penaidd la the form of a STOP WORK ORDER and a line of 5100.00 a day against me. I understand that a Copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerri(y under the paha an`d`persalt+es of pedury that the information provided above is true and correct Signature_, Print name1 '< est. phone# official use only "do not write in this area to be completed by city or town official ._ _ �.••_ ._ ,_ •• . _ .. city or town: permitAlcense p nl3uilding Department C3LlcensingBoard _ "' Q check if Immediate response is required OSeleetmea's Oftiee �Ilealth Department contact person: phone K; pother Oft 3M PIA) HOME IMPROVEMENT CONTRACTOR Registration .106877 Type - PRIVATE CORPORATION Expiration. 07/28/98 BLACKDOG BUILDERS, INC SCOTT GIBSON t011y Rd, No. 2 ADMINISTRATOR Salem NH 03079 � ---_---Otero tlN `83AOOHN.V_,_�.r O8 Ntl;.d-H�JN 6E ; 00 `ol,�pala�l}se8 , , 196T/10/SO 0001/LO/SO .6EZl'9.p $ alePVljT9 :saaTdx3 :�agapN 3SN33I1 80SIA83dOS 9,011161SN03 d133VS 3I180d 30 1NiAVd30 � apaan�nvav��� �n°nn�ou�u�o�i a�� NoRr Town of over " � L No. / * : _ * Z dover, Mass., S COC. IE ICNEWtCK L�'�• .� OqA E Pk' S BOARD OF HEALTH Food/Kitchen PERMIT D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............................... .. ............S.f ..!DP..j .4 ..1........................................................ Foundation has permission to.ecect.....141, r1 -....... buildings on ......I.Y.Z. ......... i ......... N. tom.... Rough. to be occupied as...................................................�,�, /k�d..o. ............... .......... 7T ............................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application an file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STTARTS Rough .... . . . .. ... ..... . ....... Service B LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. /9 Y Date. ' 9714 �<<'O R':�tio TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SSACMus� / This certifies that .13/9r .�G.y. . . �!� ""�' ! !: j5 . . . . . . . . . has permission to perform . . .R C' . . . . . . . . . . . . . . . . plumbing in the buildings of .5.7.".VCMwU PP.! . . . . . . . . . . . . . . . at. . / %?q . . vim/?P / o . . .,.nth Andover, Mass. a �'' 2��5 `� ` Fee Lic. No. . . . . . . . . .�'�1-- - - - - - - PLUMBING . . . . . .PLUMBING INSPECTOR 45/27/98 08:53 27.50 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer : z I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING +� (Type or print) I NORTH ANDOVER,MASSACHUSETTS Date S o7 ;S( Building Locations Permit Amount 7 .r�► c Owner's Name New M Renovation Replacement Plans Submitted FIXTURES Z z „aa Q U x CA Q w a w z Q a N z x a C F- Q Q W cz x w w G. E~ Q Q .. Q Q Q a Q z a Q o Q I�- x SLRB c FT s��vr LST F aR I 1 20 xlxR M IzaR 4nx FUM six Firm 6ix RIM 7M Flom 9M Rja R (Print or type) / Check one: Certificate Installing Company Name Address GK� 2 U�✓i' � Partner. w A� �3a75 Business Telephone 7 Q3 - �� �_ _p R Firm/Co. Name of Licensed Plumber: �i4>�i'�C- /W rC� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information ave submi d(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work d installations pe ed�undPe�rmitued for this application will be in compliance with all pertinent provisions of the sachusetts ng er 142 of the General Laws. By: l ,gnatUreyr Licenseaum of Plumbing License Title & City/Town =icense Mumcer MasterJoumeyman APPROVED(OFFICE USE ONLY NORTF BUILDING PERMIT 3�0�SttEo g1rO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ Permit No#: Date Received .7Eo SPP`c5 �SSACHU`��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ly oZo G-M `amu PontPROPERTY OWNER ) r�QXa. 5CLOC11000 Print 100 Year Structure yes o MAP bO�-'©PARCEL: a 5 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re 'dential Non- Residential ❑ New Building ne family ❑Addition Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �mvu� ryplacQ Cdr -es�4-War door - Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Leal(&(4 -�a3 1 Contractor Name: _ Phone. q•7 - I _°7 Rd n �.I Address: rj (�c11c�c -- Rd [1�K10A,-ryrt()-p I��O Supervisor's Constructiop, Licens A,3 550 Exp. Date a/f?//s- -&Me5 Bel 6 Ko&xvtel tcv- In r of �sb / Home Improvement License: ��r'.315 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. , FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO T BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ . � Check No. ° � a����6 Va6-7 iq Receipt No.: : NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature of Agent/Owner Signature of contractor 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 t"at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording m ust be submitted with the building application Doc:Building Permit Revised 2014 I ' IAORTH Town ofE : ndover O _ 0 ver, Mass, COC NICNf WICK ��� _ A�RATE0 IPP�,�S S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT4 BUILDING INSPECTOR Foundation has permission to erect .......................... buildings 61......... ....... ... . ....... ........... Rough tobe occupied as ...... ..... ................... ...... .. ................................... 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 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. The Commonwealth of Massachusetts Department of Industrial Accidents Ogice of Investigations 1 Congress Street, Suite 100 � Boston, MA 02114-2017 fj www.ma.vs.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leuibly t Name (Business/Organization/Individual): Address: Y�'�� &c e Cit /State/Zi fPhone 7 3 Are you an employer? Check th propriate box: Type of project(required): 1.11 am it 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ElRemodelin- ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers" 9 ❑ Building addition [No workers' comp. insurance comp.insurance.+ required.] 5. ❑ We are a corporation and its t0.❑Electrical repairs or additions 3.0 officers have exercised their l L Plumbing repairs or additions 1 att�a homeowner doing all work ❑ 1 myself. 1No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t C. 152.1 §§1(4),and we have no employees. [No workers` 13.[]Other comp.insurance required.] *Any applicant that checks box f 1 must also till out the section below showing their%Nwk-ers'compo nsatiotm polio information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have enmployees. If the sub-contractors have employees,they must provide their %vorkers'comp,policy number. I am an emplover that is providing workers'compensation insurance for m�v empk tees. Beloit,is the police,and job site information. Insurance Company Name: inn Oo t&y — Policy#or Self-ins. Lic.#: �I r 51 5q-3 //� Expiration Date: 11 b Job Site Address: l '1020 City/State/Zip: Al. 7At��M 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. t52 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 cert&under the pains rtd enalties of perjury that the information provided above is true and correct. i_ynaturc: Date: Phone#: 7Z 1-7Fa V 5` D7 3b Oficial 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#: c '4/fir rrttrutrr/rtirrr��/�t lr7J.utrftjr./J Office of Consumer Affairs&Business Regulation License or registration valid for individul use only i' rME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 175315 Type: Office of Consumer Affairs and Business Regulation x iration: 5/3/2015 Individual 10 Park Plaza-Suite 5170 p Boston,MA 02116 JAMES BELL JAMES BELL 5 ROOSEVELT RD NEWBURYPORT,MA 01950 Undersecretary Not valid without signature �` � "=. s a� ri 1;±t►v d��eesle rAwSIM140M v Ad lof Rndividuf cyst 00 Oar rApil-Afion 441f- If fYturll miaro tcr: •' "� ay e * , Typtf; Onkr of,Consumer At trr*ad,hwim s Repinden Il}PAO'k PlAtb-S4j,0r 117th Rol too,MA R!t04 {: 4 .. Leonrl SWUM= Astft ve t,PAA 0-16tk NP tAliwlticr��Cie'ne CS4 '� P: DATE '4 CERTIFICATE OF LIABILITY INSURANCE 11/06/2014YYY) 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 CONTACT NAME: EASTERN INSURANCEPHONE FAX 233 West Central Street E-MAIL A/c Ext: A/C No: L Natick, MA 01760 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: INSURED INSURERS: AmGUARD Insurance Company 42390 Brendan Bell B&B Contracting INSURERC: 5 Roosevelt Place INSURER D Newburyport, MA 01950 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 0 CLAIMS-MADE 1-1OCCURMED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 0 GENERAL AGGREGATE $ 0 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 0 17 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB 4CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATIONWC STATLI OTH- AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER ANY B OFFICER/MEMBER EXCLUDED Y]] N/A R2WC515931 11/03/2014 11/03/2015 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Exclusions: Brendan Bell; CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowes Companies Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: IS Insurace Co. PO Box 1111 AUTHORIZED REPRESENTATIVE / North Wilkesboro, NC 28656 ,+ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR MLPRM LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE:(603)681-4218 541 SOUTH BROADWAY SALESPERSON:JOSEPH CAVALLARO SALEM, NH 03079-4499 SALESPERSON ID:897831 Document Print Date: 01/22/2015 This is only a Quote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto,shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE"TERMS AND CONDITIONS." BEFORE SIGNING Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S BARBARA SADRNOORI 978-689-0490 O Customer Address Other Phone 1420 GREAT POND RD 508-397-7766 L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 1420 GREAT POND RD O Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY { 19238 : 444 8PINE : STK : PNE CASE 444 5/8"X3-7/16"X8' : PNE CASE 444 5/8"X3-7/16"X8' : EMPIRE COMPANY, INC. (THE) - QTY 3 J59.31 Materials Price $ INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Exterior Select Location : Front Door Select New Door : Single Pre-hung "'' Project No. 431045159 for BARBARA SADRNOORI Page 1 of 8 STORE,L Number of Doors to Install : 1 Side Lights or Transoms : No O� Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None / Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Install Storm Door: No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door: Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit: Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : Modify opening to accept larger door size Other Work Charge : Yes Comments : * meassure for new entry door....sos door previously ordered cus- tomer had contractor but cancelled. Labor Charges $454.7 5 Detail Deduction -$ 35.00 Additional Specifications: F Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In- stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in. and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful pur e, including, but not limited to, marketing, advertising, publi- f c:py, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this { Contract is calculated upon both the value of the estimated Goods required to fulfill the Contract (including waste), which may exceed the actual square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Con- tract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. `2.382 Project No. 431045159 for BARBARA SADRNOORI Page 2 of 8 1 STORE COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES 'where applicable SUB-TOTAL $479.0 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $479 BALANCE DUE , i Work is to commence upon reasonable availablity of Contractor which is anticipated to be1/122//1em [fill in date]. Estimated completion date is 7. [fill in date]. I NOTICE TO CUSTOMER I All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: J,Customer to Pay in Full; OR [_]Customer to use the following payment schedule: (1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ to be collected upon or after the commencement of work. Me authorize Lowe's to do one of the following (check ap- propriate box below): Ll Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or L] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. r Store 2382 Project No. 431045159 for BARBARA SADRNOORI Page 3 of 8 STORE COPY DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. 042A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. // By: Date: IAZ1s— Lowe's H e Center LLC By' Date: Owner By: Date: Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES WITNESS OUR HAND '-S)AND SEAL(S) BELOW THIS 72 41-% DAY OF. ��1�'/ Lowe's Home Centers, LLC By: (Seal) Print Name: G✓_ �f1f�l�fll L� -SL�•� _J'W S- n-'amb L-?4:� % (Seal) Address er j City State/Province Zip/Postal Code Print Name (Seal) r Store 2382 Project No. 431045159 for BARBARA SADRNOORI Page 4 of 8