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Miscellaneous - 1423 SALEM STREET 4/30/2018 (90)
1423 SALEM STREET f 210/106.A-0026-0000.0 Date. . .5 . . .. TOWN OF NORTH ANDOVER ..` oWwo s PERMIT FO6.GAS�INSTALLATION CHUS This certifies that . . . . . . . . . . . . ) /. . . . . . has permission forgas installation t in the buildings of .C_'-.�i. f� . f 14 ! . . . . . . . . . .. . . at .(... . . . . . . . . . North Andover, Mass. Fee. 30rLic. No..,��. >. . .�. -�. . GASINSPECTOR Check it - 1 C C 6813 Date NoRTM . °..•'"c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CHUS of .This certifies that . has permission to perform . , (.� .S . .. �►s/. plumbing in the buildings of . . . . . . . . . . . . . . . . . ... . . . ... . . at . �/. ?.3: S��('` . . .., North-Andover, Mass. �U , Fee. ?. . . . .Lic. No../.t . . . . . . . . . . 1 PLUMBING I SPECTOR Check 8100 Date.......................Z—v i .5 f NORTH 3a°ce -°-:° o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 lo7 • i " Ss�CHUS 3 G This certifies that Gl has permission to perform .......k.nItl v } ....................................... wiring in the building of............ ! Jg �4. ................................ a at . a-{2 3 S. C , ,North Andover,Mass. w' Fee..i.................. Lic.No..../..9?71V...... .. .... 1 ...... 3� ELECTRICAL INSPECY�R ..Check li .4 8821 Commonwealth of Massachusetts official Use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked f" ,\ [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance.with the Massachusetts Electrical Code(ME , WORK (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER V By this application the undersigned gives notice of his or her intention to perform the electrical w ) ies nbed below. Location(Street&Number) L 3 �- Owner or Tenantr —�—`� �� ���v y C h� '� y a- Telephone No. Owner's Address ,e Is this permit in conjunction with a building permit? Yes Purpose of Building Sit n . No E] (Check Appropriate Box) � � f A—0 f� Utility Authorization No. ' Existing Service C� Amps i- /2 ki&Volts Overhead ❑ Und rd 1 g No.of Meters New Service Amps / Volts Overhead ❑ Undgrd No.of Meters Number of Feeders and.Ampacity ` Location and Nature of Proposed Electrical Work: S e Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)FansNo. of Total Transformers ISA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No:of Luminaires Swimming Pool Aboveo.o mergency ig g In d• rnd. � Batte Units -- No.of Receptacle Outlets No,Of Oil Burners r- FIRE ALARMS No.of Zones ' No.of Switches No.of asBuieis .-'ti N0..ofDetection and Ranges wtiatin Devices No.of Ran N g o.of Air Cond. otal Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number !!!MoKW _ o.of Self-Contained Totals: _ _. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipal Connection ❑ Other No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of No.of Devices or E uivalent 1 Heaters KW No. Si s Ballasas ts Data Wiring: . No.of Devices or Equivalent 1 No.Hydromassage Bathtubs No.of Motors Total HP No. Wiring: A OTHER: No.of Devices or E uivalent 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 Stark a / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE 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 cove ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER I certify,under the ains and enalties o ❑ (Specify:) P ofperjury,that the information on this application is true and complete. FIRM NAME: L Licensee: i G'a 1 C4 L � LIC.NO.: 1 ��' �., vV a :Siature (If applicable,' r"exemp " 'n the license number line.) IC.NO.: Address: '�1 G dj`�- K, �, � Bus.Tel.No.: 7 —36-0-17 S/t)7 *Per M.G.L, 147,s.57-61,sec rity work requires Dep artznent of Public Safety"S"License: Alt Licl.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. PERMIT FEE: $ The Commonwealth of Massachusetts 4 k� ! Department of Industrial Accidents Office of Investigations .. a600 Washington Street ,aq % Boston, MA 02111 www.mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers Applicant Information Please Print Legibly Name(Business/Organizafion/lndividual); Address: °� ly V. City/State/Zip:_ .1 `�7Le�1 c•e ` 01 Lf"Phone3 64 7 Are you an employer?Check-the appropriate box: LEI I am a employer with 4, Type of project(required): ❑ I am a general contractor and I � ❑ 21kemployees(full and/or part-time).* have hired the sub-contractors 6 New construction I am a.sole proprietor or partner_ listed on the attached sheet 1 7. ❑Remodeling ship and have no employees These sub-contractors have S. [J Demolition working for me.in any capacity, workers' comp.insurance. 9. []Building addition [No workers'comp, insurance S. ❑ We are a corporation and its required.] 10. Electrical red-) officers have exercised their ❑ repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.[] Plumbing repairs or additions myself. [No-workers'comp, C. 1.52, §1(4),and we have no l2,❑Roof repairs insurar►ce required.]t employees. [No workers' comp. insurance required_] 13,0,Other 'Any applicant that checks boat#1 must also fill out the section below showing their workers''compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and their wortrors•comp polity information. - t am an employer that is providing:workers'compensation insurance for m1'employees. Below is the policy and job site information. Insurance Company Name: V1 I C f �J/h{ r 14 Policy#or Self-ins.Lic. ?Z��iraati�Date: d l Job Site Address: s9 1.1 3 �j/�I��>7 S% City/State/Zip: G ue Attach a copy of the workers' compensation policy declaration page(showing the olio number f�4(S policy and expiration date). Failure to secure coverage as required under Section 25A o � f MGL c. 152 can lead to the imposition of criminal penalties of a• fine up.to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Si titre: Date: / U Phone# , Qf trial 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 6.Other Inspector 5.Plumbing Inspector .11 Contact Person: Phone#: a .. Information and Instructions r Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a,joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the owner.of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling ho*lof.another who employs persons to do mainteiia ce,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be,deemed to be an employer." MGL chapter 152,§25�C(6)also states-that"every state or local licensing agenecy�sh_all w*hhold'the issuance or renewal of ieen or permirto'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its politica]subdivisions shall enter into any contract for the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." 1( Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es),aind phone number(s)along with their certificate(s)of ' insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required-to carry workers'compensation insurance. If an LLC or LLP does have ' employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,notthe Department of industrial Accidents. Should you have any.questions regarding the law or if you are required to obtain a.workers' compensation policy,please call the Department at the nurnber.listed below. Self-insured companies should enter their ( 1, self insurance license number on the appropriate tine. City or Town Officials Please be sure that the affidavit is.complete acid printed legibly. The Department has provided a space at the bottom r .� �. � . o theiaffidavit for you to fill out i the event the Office'of`,Irivesh do ahhaas t,contact you f _ y , .ga ns o y regarding the applicant Plea a be sure to fill in the permit/license number which'will be used as a reference number., In addition,an applicant must,subinit multiple permit(license applications in any given year`,need only submit one affidavit indicating-current policy information(.if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for firtum-permits or licenses. A new affidavitmust be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of lnvestiWions would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. ` The Departinent's�address;telephone and fax number:" "�'����' �. ^������� LL The Commonwealth of M ssacliusesetts Department of Industrial Accidents Office of Investigations b 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE Fax#61 7-727-7749 Revised 5-26-QS i www.mass.gov/dia MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING f e (TYP or print) NORTH ANDOVER,MASSACHUSETTS _ Date Building Location / ff � � �� 7 Owners Name z�A2 G� /�f�� S Permit#?jo Amount -77 ,Z!t Type of Occupancy i New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES x o z w con z a 00 9z 94 O w w x zCC w aw o `� w x w W � 1:60gn z a z a a o HU z H w x W d � z a `" a s O d x 3 a W. A A a x H L7 A d a ca SLRBRa Rwnvr 6 BE HO MMOM 3M11" 41H RfM t. MHOM F s 6M H" 7M H OCR gm Imm (Print or type) / �L['Check one: Certificate Installing Company Name r / , ❑ Corp. Address _ CCS 11/4 uf-/ f �` Partner. Business Telephone EJ Firm/Co. Name of Licensed Plumber: i�t i ✓r�tact� d�b!�C Insurance Coverage: Indicate the type iff 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 I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and mstallat' pe lumrmed under Pe t for thi lication will be in compliance with all pertinent provisions of the Massachus bing Code d Gene aws. By: igna u is s um er Title Type of P,mbing License �,/ APPROVED icense u er Master I � Journeyman ❑ r, -_.... LTJ APPROVED(OFFICE USE ONLY -- The Commonwealth of Massachusetts k� jl Department of Industrial Accidents 1k. Office o f Invesk ations g i U9 600 If ashin-an Street Boston, MA 02111 Www massgov/dia . Workers' Compensation 1witrance Affidavit: Builders/Contractors/Electricians/Plumbers APPlicant Information Please Print Le-vibl Nallie (Business/OTpnizahon/individual): Address: City/State/Zip: Phone#: . Are you an employer?Check the appropriate box: 1•❑ I am a employer with 4• Type of proles(required): [] 1 am a general cont+s7heeFtt: employees(full and/or part-time).* have Hired the sub- 6 11 New construction 2.Q I am.a:sole proprietor.or partner. listed on the attacheZ• ❑ Remodeling ship and have no employees These suis-contractors have working for me.in g• D Demolition . arry capacity. workers' comp,insurance. [No workers. comp.insurance 5. 9- [] Building addition ' P ❑ We are a corporation and its required j officers have exercised their 10•11 Electrical repairs oradditions 3.;D i am a homeowner doing all wont right of exemption per MGL I I.0 Plumbing repairs or additions m self, }.� Y [No•workers comp. c, 152, §1(4),and we have no insurance required]t .employees. o workers' 12.[] Roof repairs 13. ca .Other mop. insurance ❑ 'Any applicant that checks ba#I must also alt out the section below showing their workers'compensation policy information• t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must �C .ftators that check this box musta_na submit a new affidavit indicating erred an additional sheet show tt ition. itfg tie name of the sols-contractors and their wottcers'roan^• r:—• • lam an employer that is ro , r p�••�:irftiroiatien. p vi&ng,:workers compensation insurancefor my ert3Ployem Below is the o ' information, p hcy and job site . Insurance Company Name: Policy 4 or Self-ins.Lic.#: Expiration Date: Job Site Address: . Ctty/State/Zip: Attach a copy of the workers' compensation policy declar atioo ae sho ' page( wing the policy number and expiration date). . Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above hue and cornet Si tore � Date: Phone#: Fog only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Heatth 2. Sulidiog Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son• Phone#: }t Information a itd Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and includirag the legal representatives of a deceased employer,or the receiver or tnrstm-of an individual,partnership,associatioin or other legal entity,employing employees. However the ownerof a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local Eiednsing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of'compliance with the insurance coverage required" Additionally, MOL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es),aired phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requiredito cavy workers'cflznpensation insurance. If-an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and-date the affidavit. The affidavit should be returned to the city or town that the.application for.the permit or license is being requested,northe Department of Industrial Accidents. Should you have any.Questions regarding the law or if you are required to obtain a workers' compensation policy,please-call the Department at the number.listed below. Self-ins:*ed rornpanies slro�ld Pre+�+h� ; self insurancelicense number on the'appropriate tine. ' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department ham provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which v-ill be used as a reference number. In addition,an applicant that must submit multiple pennit/Jicense applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been.officiaily stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for f th= permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit'to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone ana fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-977-MASSAFE Fax#617-727-7744 Revised 5-26-05 www_tnass.gov/dia mr M� .: MASSACHUSETTS LM ORM APPLICATON FOR PERMIT (Type or print) ��GA$�'IN�i NORTH ANDOVER, MASSACHUSETTS Date Building Logations3 .�2 Permit Owner's Name ,/ Amount$ 3 y Newr Renovation ' J� Replacement y u Plans Submitted ❑ � w W Zw. a O .a m W p U ao c e a rn Z o o Z d w U O z SUB -BASW O EM ENT O c W F _ ASEM ENT. + U C > BF. p 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FL00'R v 5TH . FL0WR 6TH . FLOOR 7TH . .FL00^R. 8TH . FL0.0'R (Pint or type) Nan-,e [�. Checkone: Certificate Installing Company Address � � C-, 6 ElCorp, Partner. usmess a ep one 51 �Go -S- Name of Licensed Plumber or Gas Fitter 15m C-O. INSURANCE COVERAGE I have a current liability Insurance,policy or it's substantial equivalent. Check one: If you have checked"es please i cc a the type coverage by checkin Yes Liability insurance policy ® g thea appropriate box. No Other type of indemnity jp P u--� Bond Owner's Insurance Waiver f am 13 aware that the licensee does n—.haeme the Insurance coverage Mass. General Laws,and that my signature on this permit application wares this requirement. required by Chapter 142 of the Signature of Owner or Ovmer's Agent Check one: I hereby certify that all of the details and information 1 have submitted(or entered)Owner in above Agent best of my knowledge and that all plumbing work and installations compliance with all pertinent provisions of the Massachusetts rmed under P are true and accurate to the e Permit Issued for this application will be in Code and 42 eneral Laws. EAPPRO Ign ure of Licensed Plu er ,r Gas Fitter � Plumber DFitter erase umber _ merICE USE ONLY) Journeyman I � I � LAC e.ommorzwealth Of Massachrcret c Departrneni o.f Industrial Accidents Era! Off�eo ,,, ! i . Jf1rzvestigatiol?s "u ; 600 W ashtK&I Street Bastoet c - , 1VL4 02111 wx�x�-rriass.gov/din Wort�ers' Compensation Insurance.A-f iciavit, gwilders/Contractor Ap ;licant Information s/Electridians/Piltmbers Name (Business/or Please Print Legibiv ganiza#ion/Individual}: Address: City/State/Zip: ,a, �' CJ Phone#: Are yo an employer?Check the appropriate boz: l� . 1• I 8rn a employer with 4. ❑ I am a nen Type of pro'ect em 10 � eral contractor and I (required?: P Y -s(fill and/or part-time).* ?.❑ I am a sole r have hired the sub-contractors . ❑ New construction proprietor or partner- listed on the attached sheet, z 7. ❑ ship and have no employees These s�thea Remodeling. working for me in any capacity. workers' actors have ❑ co 8 Demolition m . [No workers comp. insurance 5..❑ We are.a co P insurance. 9. ❑ Building required] P corporation and its g addifion ' officers have'ex 10: 3.❑ I am��a homeowner doing all work richt of a ercised.theii• ❑ fiie�b-rca,l repairs or additions a myself. [No.workers' comp. c. 152 exemption per MGL I I.0 repairs or additions insurance required.] t ' � 1(4),and we.have no MP10yees, [No workers' 12�❑Roof repairs "Anv applicant.fhat checks box#I.must atso fill out the section bcw comp. in'Sttranct required.] 13 ❑ Other t iiornwwuefa whu submil:kbis rsiidevii indicetin�&,E-, are Join"L;V kfj, their work Icannactan Ehal''chcoh this hox.must O1d`comp:nsation policy infa mation. � z au Eben bite outside wntrxc;Eurs rnusi su'omii a new amdavii indi:aiin .-�� attached an additional sheet showiteg the � I am at1 entpL�J'e'��is providing �c natne.of ti:e sub-c�„uaetors and their woric:rs'comp.pot i , o workers orsper�,:atiorz i � tnionnation. information. assurance for�'employees. Below . ✓' tr the policy and job site Insurance Company Name: �' t/G f � Policy#or Self.ins. Lir,.#: Expiration Date: Job Site Address: Attach i copy of the workerg' compensation policy declaration Q City/State/Zip: .Failure to secure coverage as required under Section 25A of pabe(showing the policy number and expiration date) fine up to 51,500.00 and/or one-year imprisonment MGL c. 152 can le r y� P nt,as well as civil penalties in the Orme of a STOP WO Imposition Of minal penalties of a Of up to.5250.00 a day against the violator. Be advised that a copy of this stat Investigations of:the DIA for insurance RR ORDER and a fine coverage verification. ement mai be forwaroed to the'Office of I do hereby certify er eainc P es of er' that the or above in f mafion provided Signature: rs true and correct c`— Phone#: .-- Date: Ofj"al use orrl p. Do nor write in this area, to be.cnmplelred h ci J tj or town off City or Town: Issuing Authority(circle one?: Perm�tlLicense# L Board of Health 2. Building Department 3. City/Town fi: Other .Gerk 4. Electric � l Inspector S. Plumbing e Inspector Contact Person: Phone 4- i iniorma.non and lnsh•uctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensatiorfor their employees. Pursuant to this statute,an employee is defined.as"...every person in the service of another under any contract of h ire, express or implied;oral or written." An employer is defined as"an individual,partnership;association, corporation or other legal entity,or any two or more of the foregoing engaged in a'oint ente rise,and incluciiriQ h g g � J Tp .�the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, associate an or other legal entity,employing employees. However the owner of a dwelling house having not more than three ap artinents and who resides therein, or the occ ant of the uP dwelling house of another.whb employs persons to do mai-int--fiance.,construction or repair w ' -, _ . � ^' c rip, �work on such dwelling house or on o the grounds or buildin a rlrt"rtant thereto shall not because " a Pp of such „ °employment be,d.-grad to be an employer. MGL chapter 152, §25C(6)also states that"every state o r focal licensing agency shall withhold the issuance or renewal of a iieense or permit..tio operate iL.bttsiness or tto construct buildings in the commonwealth for.any applicant who has not produced acceptable evidence cwf compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states"Neither -the commonwealth nor any of its political sul�dMsionsshall enter into any contract for the performance of public wor;le =n lacceptable evidence of compliance with the insurance requirements of-this chapter have been presented to the oontra.cting authority.". Applicants Please fill ouf the workers'conilrensafion affidavit com' p,Vetely,by checking the boxes that apply to your situation and,if r necessary,supply sub-contractor(s)name(•s),.addresses) zind phone nuiber(s)along with their certificate(s).of insurance. Limited Liability Companies(LLC)or Limit✓ci Liability Partnerships(LLP)with no employees other than the members or.partners,are not required to carryv✓orkers'eompensabon insure ce. If an LLC or LLP does have.. employees, a policy is required. Be advised that this affici;a.vit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the.affidavit Theaffidavitshould be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you.have any questions re«a rding the or if you are inquired to obtain a vvorkeis' compensation policy,please call the Department at the nuanber.Iisted below. Self =--insured companies should enter their self-insurance license number on the appropriate Line. City or Town Officials Please be sure that the affidavit.is complete and printed egibly. The Department has provided a space at the bottom of the affidavit foryou to fill out in the_event the Office of Investigations has to contact you regarding the applicant. Please be sore to fill in the permitl)icerrse number which will be used as a ref rence.number. In addition, an applicant that must Submit multiple pzrmittlicense applications in arty given year,need only submit one affidavit indicatin;current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has beer, officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Mrh--m a home owner or citizdn is obtaining a licenses or permit not related to any business or commercial venture (i.e. a.dog license or permit to burnleaves etc.)said person is NOT required to complete this affidavit. �... T'he Office of investigations would like to thank you in advance for your cooperation and should.you have any questions, please do not hesitate to give us a call. The Department's address,telephone and far, number. The Commonweslfb of Massaachusetts' Department of lidustrial Accid nts Qfflee of Littvesfigations 600 Wasb_ngton Street Boston; MA 02111 TeL # 617-727-4900=I 406 or 1-8:7/7-MASSAFE Revised 5-26=05 Ear;TM'61 7-72.7-774'9 urww.m.ass.gov/dia i ` Date. . . ./.?,�F�l TOWN OF NORTH ANDOVER 40° PERMIT FOR PLUMBING ? 'SACMUS� i . . . . . . . . . . . . . . . This certifies that . . /.�. :". . . . .� !�•��� has permission to perform . . . . . . . . �. . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . A h.'.777r=. . . . . . . . . . . at . . . . . . . 5.1.91--. . . . . . . . . . . , North Andover, Mass. Fee. 3 Z.'�.Lic. No. . . . . . . . . PLUMBING INSPECTOR t_ t Check # 7 2Z 6781. TO : Jim Diozzi North Andover Plumbing Inspector FROM: Kimberly Chakravarti 1425:Salaw-Street Mr. Diozzi, j This letter is to inform you that Atlantic Restoration&]Development is no longer working on our home improvement project. William Barrett Homes was contracted to finish the project and is using Galinski Plumbing for any plumbing needs. The contact at Galinski Plumbing is Steve and the number is 978-374-1743. Please feel free to call me if you have any questions at 978-688-6029. Thank you, r Td Wd0S:0t 9002 01 *Uer 0Z0998%L6 'ON XHJ QW I121ti(1d2AUHa HdNd'J ''W08J ' b MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ("type or print) a ([p 6y� MASSACHUSE s , Date 1 l�0 Building Location Z 3 c ";"'N Permit # I# Amount ALL Owger'sM) ame -- New❑ Renovation Replacement rl Plans Submitted FIXTURES w w a w �o� 3M EWM 4M FILM s>�t 1D 6M Il; fm 7RI lE'IAQt M Hot (Print or type) Check one: Certificate Installing Company Name G a l i n s k v PluMbing & H e a t i n or 0 Corp. 1 Q(1 h Address P.O.Box 17 O 1 ❑ Partner. T-Tannrhi 1 1 MA (11 R11 _ Business Telephone 978-374-1743 ❑ Firm/Co. Name of Licensed Plumber: Stephen C. G a l i n s k y i Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond Insurance 3yaiyer: 1,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 I have submitted(or tered)in above application are true and accurate to the best of my knowledge and that all plumbing workand stall ti ns pe ed under Permit Issued fur this application will be in compliance with all pertinent provisions of the Massachusetts u i Code and Chapter 142 of the General Laws. By: Signature Biweensea Type of Plumbing License City/Town LielqmberMaster O lourneyman III APPROVED(OFFICE USE ONLY } Location I � r. No. a Date �+ " 6 y� v. NORTH TOWN OF NORTH ANDOVER 3 � t 9 Certificate of Occupancy $ M;r cwustt Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �'60 ;i Check # /3�! Budding Inspector � � x. 401. J TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: / DATE ISSUED: M d � a3 -o W cL _ SIGNATURE: � � Buildid Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: l 7_ Map Number arcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT ,ZA Owner of Record p N CGS 'lzf�VE' 16MlesrLy /qz '.me(Print) Address for Service W' Signature Telephone o 2.2 Owner of Record: Name Print Address for Service: M .Si'mature Telephone SCTION 3-CONSTRUCTION SERVICES 31 Licensed Construction Supervisor: Not Applicable ❑ X7113 �y Licensed Construction Supervisor: J �A . (�&971 License Number Address Expiration Date Signa re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 5-7 Registration Number 1„ Address 0, / / 7 ��5- 7 'Yy 7,11I< `�5~ � Expiration Date Signature Tele hone 4W - SECTION 4-WORKERS COMPENSATION(NLG.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.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of.Proposed Work: ' 1�1 I ), 3 4/ PAA b4r\K p Aga b tom SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ' OFFICIAL USE ONLY Completed b rmit a licant ` � r 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of �� Construction 3 Plumbing (, Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 p Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN 4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Herebyauthorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject Property +: Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name - Si ature of Owner/ Agent ent Date , NO.OF STORIES SIZE t BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 RD 3 SPAN DM ENSIONS OF SILLS DIN ENSIONS OF POSTS D]MENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH TO'" O Andover0 . . 0 No = A K E over, Mass., COCHICHEWICK'V�' ORATED P' �� lJ BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System Q BUILDINGINSPECTOR . . . ..THIS CERTIFIES � � ..................... Foundation has permission to erect.i?1.'X.3A."'/ buildings on ......,I,.yJ.3......S.AA.M.........96116ft......... � Rough to be occupied as... ������ i� �, �� �MMI1 t ���r Chimney .............. ................................ ...... �V 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-Law relating to the Inspe ion, Alteration and Construction of Buildings in the Town of North Andover. 1D` A4;i ` � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START$, Rough ..... ... ........................ .e Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove RoughFina, 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. v * f BOARD pp a BUILDING REGULATIONS ? t !License CONSTRUCTION SUPER SOB `s INumber55 r 053181 f "„ Bhxhdate 11/14/1949, Expires; 11%14/2005 '� t Tr.no: 11206 I Restric'te� 00 I CHARLES J PISCATELLI'k P 1 FLASH NO READING, MA 01864 Administrator Board of Building Regulations and Standards t HOME IMPROVEMENT CONTRACTOR Registration 134690 Expiration 114/2006 Type Private Corporation COLONIAL VILLAGE DEVELOPMENT CORP. CHARLES_PISCATELLI,,1 pA`'/ 1049 TURNPIKE ST CG--e ` v^ N.ANDOVER,MA 01845 Administrator NAt INSTRUCTIONS: This form is used to verify that all necessarya�� Boards and Departments having jurisdiction have been obtai a ap his 11d is/Perm not s from the applicant and/or.landowner from compliance with an a ied. This!does not relieve Y pp cable or!req.uirements. _ PPLICANT FILLS OUT THIS SECTION APPLICANT44 PHONE �9 LOCATION: Assessor's Map Number - 106 (9 PARCEL SUBDIVISION ; , ' IgZ3 LOT(S)---- STREET j S. T. NUMBER ***�********�****�**''`��►�"`�**i'"`*'wOFFlCtAL USE ONLY � RECOMMENDATIONS OF TOWN AGENTS: + , CONSERVATION ADMINISTRATOR DATE APPROVED I ; DATE REJECTED :.. COMMENTS ` TOWN PLANNER DATE.APPROVED DATE REJECTED COMMENTS I FOO INSPECTOR-HEALTH DATE.APPROVED DATE REJECTED S TIC INSPECTOR-HEALTH j DATE APPROVED DATE-REJECTED. COMMENTS N Q�c� •� f r7 J r, 1 or G•t PUBLIC WORDS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm I i i I I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: �zct2-y° �r�905 ��� (Location of Fa gnature of P rmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector f' ;BOARD OF BUILDING'�REGUU ATIO ` J �^ License CONSTRUCTION SUPERVISORf '', .; , Number ,,:..; S, X071934 y '' fl t�irttidate 08/26/1966: '` 7p x lExpires 08/26/2003 Trzno 1;2120 & Restricted"00 �i ENNEY,> 57HIGH PLAIN RDS�, y RAW AN DOVER; MA<Q1815''✓ ' A . tAdmrnstrator� jil Rp s # *� ar�uml1o��yu�Pay(L/G K dYy S *ya�� Board of Building Regulations nd Sdards ' .tjgHOME IMPROVEMENT CONTRACTOR f� „aExplratrorigyp ' I K{ 7'2/1j1/2rg 005 } Type DBA ¢ ATLANTIC RESTRORATION+DEVELOPMENT ALAN JENNEY. t t x S a �7 HIGH IN RD f`�ANDQVER MA�O'181`0`: ���� ✓ _ Admfnis't`rritor % 1 II 'ACr(JxM 4G R I I V Z%A'r1111— w 1120 aa-aa a PRODUCER THIS CERTIFICATE IS ISSUED A.;A MATTER OF INFORMATION y I C J McCarthy ins Agency, Inc- ONLY AND CONFERS NO RIGH-.'S UPON THE CEIIFICATE A Rub International Limited Co HOLDER.THIS CERTIFICATE DIES NOT AMEND,EXTEND OR .22 9 Andover Street ALTER THE COVERAGE AFFOSDED BY THE POLICIES BELOW. WiJAington MA 01887 Phone=978-657-5100 paxa978-658-9185 INSURERS AFFORDINGCOYERA13E NAIC# INSURED. MSURERA_ National Granite Mutual Ins. CO INSURER B: Company to Be As_ s�ned Atlantic Restoration & Develop wsunERC By Mass Worke:.s Comp P.O. Box 3266 INsuRERD: Assigned Risk Pool Andover MA 01810-0804 ER INSURE COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TNM POLICY PERIOD INDICATED.R ommiSTANDINLL ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUmENT WPAi REePECT TO WHICH THIS CERTIFICATE MAY 11 z_ISSUED OR MAY PERTAIN,THE INSLIRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSU81ECT TO ALL THE TL-RMS,EXCLUSIONS AND CONI)IT10NS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL R TYPE OF INSURANCE POLICY HUMBER DATE MID DATE(MMOD CfAllTS GENERAL LI,=Lrn En::H OCCURRENCE $1,000,000 A X COMMERCIALGENERALLIABIIiTY MRS70837 02/26/03 02/26/04 �S9MISE$ Eaoa„ -) s500000 CLANS MADE a]OCCUR MED EXP(Arty ww porgo+V S10000 PE7SONALAADV IMURY S1,000,000 GENERALAGGREGATE 52,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRDOUCTS-CONP/OPAGO �S 1 000,000 jPOLICY JECY F71LOC AUTOMOBILE LLiBIL ITY CC MBINED Sdo=LIMIT S (Ev aocFOent) ANYAUTO ALL OWNED AUTOS I BCDILYIwURY S SCHEDULED AUTOS ? �) HIRED AUTOS Bt OILY IN IUR1 S NDN.OWNEDAUYOS (F,7 a mann PI'OPURIY DAMAGE I (Puaaident) i 4(301:A69 LIABILITY A(TO ONLY-EA ACCIDENT S AUlt7O RERTEA ACC S A0'A%`NLY: AGG S gXCESAIMBR6LLALIASILITY E+CHOOCLIRREMCE 5 CUR J CLAIMSMA06 AIIGREGATS S s I DEDUM13LE S S RETQ�'TION S WORKERS COMPENSATION AND S B EMPLOYERS`UABILTTY TBD 05/17/03 05/17/04 E L EACH ACCIDENT 5100000 OFFICERIMEMBER LtlD � fLDISEASE-EAEPdPLO 6100000 H po gMa EL DISEASE-POLICY LIMIT 15 500000 g�Ec1d�At RO�nS10Ns tlelaw OTHER DESCRIPTION OF OPERATI NS i LOCATIONS I VEH6)LES 1 EXCLUSIONS ADDED BY 0IDO0EMENT!SPFGAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESGRIBE D POLICICS B6 CANCELLED BEFORE THE EXPIRATICP DATE THEREOF.THEISSMmaINSURED WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERnnCASE MOLDER IAMEDTO THE LEFT.BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR UABU W-)F ANY IOND UPON THF INGURER ITS AGENTS OR REPRESENTATIVES_ _ _ - - AUiTlOR6PA Tf1fE CORA CORPORATION 198; ACORN 25(2001(08) Liberty 1Mu1-utR Liberty Mutual Group P.O.Box 7077 Portsmouth,NH 03802-7077 Telephone:(800)653-7893 FAX:(603)431-5693 June 23,2003 E-Mail:IMS@LibertyMutual.com ALAN JENNEY DBA ATLANTIC RESTORATION&DEVELOPMENT PO BOX 3266 ANDOVER,MA 01810-0000 RE: Your Workers Compensation policy Policy number: WC5-31S-344316-013 --_Effective.date;-�.--May 1712003-- Dear 7,2003Dear Policyholder: Liberty Mutual is pleased to have been selected to service your Workers Compensation policy. We are completing our review of your application and expect to send your policy,along with an explanatory service package,within the next 30 days. However,to assist you in the interim,we are providing you i with your newly assigned policy number,(referenced above). i If you need to report a claim,please fax to(781)642-7499. For all other claims related issues,please call(800)762-5026. Prompt reporting of accidents is critical. It enables us to get involved in treatment early,to manage medical costs and set the stage for a successful return to work. For certificates of insurance,underwriting,billing or loss prevention questions,please call(800)-653-7893. For any other questions you may have,please contact your producer. Producer of Record: CJ MCCARTY CO Producer Phone No. (978)661-6715 If you open operations in additional states,please contact your producer. Depending on the state,we may - _ ---- --- or-may-not-be-able-to-provide coverage for-you.--.------- We look forward to servicing your business. Sincerely, 54 Robert Peters Involuntary Market Operations cc: CJ MCCARTY CO IM00260995 WC5-31S-344316-013 Page-1 Pat . STORY E 4 GARmel T. ® .•. EA0 D P `his table considers the combined loads from a call,second story floor(1/4 of total floor joist span) nd various roof truss spans with a 2'soffit. ntermediate floor beam assumed if the soffit a' xceeds 2',additional engineering will be necessary. VA ®®�® �B A SP Trib Area Rough � exceed Span Bt -STORY-1.8E RIGIDLAM— LVL (see page 46) Opening p snow(IM) Non-Snow(125%) Roof Loading 25 psf LL+20 psf DL 30 psf LL+20 psf DL 40 psf LL+20 psf DL 20 psf LL+15 psf DL 20 psi'11+20 psf DL 20 psf U+25 psf DL g tough Opening 93" 16'3" 18'3" 913" 16'r 18'3' 9.3" 1613" 18'r 9'3" 16'3" 18'3" 9r 16.3" 18'r 93" 16,r 18'r 2a 1--W'�2-16' 2-18•+ 2-9'k" 2`-16'+LL2=18'+ 2-9W 2-18'+ - 2-9'h' 2-16' 2-18" 2-9'h' 2-16' 2-18'+ 2-9'h' 2-16' 2-18'+ 3=99x" 3-14' 3-16" 3-9k' 3-14' 3-16' 3-9'h' 3-16' 3-16' 3-9'h" 3-14' 3-16' 3-9'h" 3-14' 3-16' 3-99x' 3-14' 3-16' 24' 2-9W 2-16'+ 2-18'+ 2-9'h' 2-18'+ - 2-11Th" 2-18'+ - 2-934' 2-16' 2-18'+ 2-914" 2-16'+ 2-18'+ 2-954• 2-16'+ 2-18'+ bofrnus 3-99x' 3-14' 3-16" 3-99x' 3-16' 3-16' 3-934" 3-16" 3-18'+ 3-9W 3-14" 3-16' 3-9'h' 3-14' 3-16' 3-9W 3-14" 3-16' " Span 2-11'h" 2-18"+ - 2-11Th' 2-18"+ - 2-11Th" - - 2-99x' 2-16"+ 2-18'+ 2-9'h" 2-18'+ - 2-11Th' 2-18'+ - whh 2' 28' e'. Soffit 3-934'. 3-16' 3-18' 3-9'h' 3-16' 3-Ur+ 3-99x' 3-16'+ 3-18'+ 3-934' 3-14' 3-16' 3-934' 3-16' 3-16' 3-934' 3-16' 3-18' �\ Issumed 2-I1W 2-18'+ - 2-11Th' - - 2-11Th+ - 2-9'h' 2-18"+ - 2-11Th' 2-18'+ - 2-11W 2-18'+ - 32' u 3-9'h" 3-16' 3-18'+ 3-9W 3-16'+ 3-18'+ 3-9'h' 3-16'+ - 3-91h' 3-16' 3-16' 3-99x' 3-16' 3-18'+ 3-99x' 3-16' 3-18'+ 2-11Th' - - 2-113r+ - - 2-11'.fi'+ - - 2-11Th' 2-18'+ - 2-11W 2-11W+ - 2-11W - - 36' 3-99x' 3-16"+ 3-181+ 3-9'h" 3-16'+ 3-18'+ 3-9'h" 3-18'+ - 3-9'h' 3-16' 3-18'+ 3-954' 3-16'+ 3-18'+ 3-991 3-16'+ 3-18"+ -STORY-2.0E RIGIDLAM'"' LVL Roof loading Snow(115%) Non-Snow(125%) 25 psf LL+20 psf DL 30 psf U+20 psf DL 40 psf LL+20 pd DL 20 psf LL+15 psi DL 20 psi LL+20 psf DL 20 psf LL+25 psi DL ough Opening 9,r 1613" 18'3" 9'3" 16'3' 18'3' 9'3" 16.3" 18'3" 9r 16'3' 18'3" 9r 16'3" itt,r 9'3" 16'3" 18.3" 20' 2-99x" 2-16' 2-18'+ 2-9'h" 2-16' 2-18'+ 2-99x" 2-16'+ 2-18"+ 2-9'h' 2-14' 2-16' 2-9'h" 2-16' 2-16" 2-9W 2-16' 2-18"+ 3-9'h" 3-14" 3-16' 3-9k' 3-14' 3-16' 3-9'h' 3-14' 3-16" 3-9'fh' 3-14' 3-14' 3-9'h" 3-14" 3-14' 3-9'h' 3-14' 3-16" 24' 2-9'h" 2-16'+ 2-181+ 2-99x' 2-16'+ 2-18'+ 2-934' 2-18'+ - 2-9W 2-16' 2-181+ 2-9W 2-16"+ 2-18"+ 2-9'h' 2-16'+ 2-18'+ oofTruss 3-9'h" 3-14' 3-16' 3-99x' 3-14' 3-16' 3-934" 3-16" 3-16" 3-9%' 3-14' 3-16' 3-9'h' 3-14' 3-16' 3-99x" 3-14' 3-16' Spm 2-99x' 2-16'+ - 2-99x" 2-18'+ - 2-11Th' 2-18'+ - 2-9'h' 2-16'+ 2-18'+ 2-99x• 2-16"+ 2-18'+ 2-9'h' 2-16'+ 2-18'+ with 2' 28' son 3-99x 3-14 3-16 3-9'h' 3-16' 3-16' 3-9W 3-16' 3-18"+ 3-99x' 3-14' 3-16' 3-914'. 3-14' 3-16' 3-9'h' 3-14' 3-16' isswed 32' 2-11Th" 2-18'+ - 2-11'h' 2-18'+ - 2-ll2-1179 - - 2-99x• 2-16'+ 2-18"+ 2-99x" 2-181+ - 2-11Th' 2-18'+ - 3-9'h" 3-16' 3-18'+ 3-9'h' 3-16' 3-18'+ 3-9'h" 3-16'+ 3-18"+ 3-9'h" 3-14' 3-16' 3-934' 3-16' 3-16' 3-9'h' 3-16' 3-18'+ 2-11Th' 2-18"++ - 2-11Th' - - 2-11W+ - - 2-9W 2-18'+ - 2_ T _ r• 36' llh" 2-18'+ 2-lth 2-18'++ - 3-.99x' 3-16'+ 3-18"+ 3-9h' 3-16"+ 3-18'+ 3-9h' 3-16"+ 3-18'+ 3-914' 3-16` 3-16 3-934" 3-16" 3-Ifr+ 3-9W 3-16'+ 3-18'+ see note 3 otes: Header sizes are listed as the number of ls/4'thick pieces by the header 4.All headers require support across their full width.Use 2x4 cripples for two depth.e.g.2-9'h"indicates two 1 sl'4"pieces by 9L'e"deep. piece headers and 2x6 cripples for three piece headers. Header sizes are based on the assumption that the floor joists are 5.Header sizes are based on residential floor loading of 40 psf live load supported in the middle of the building by a beam or wall. and 10 psf dead load.The roof framing must be trusses supported by the The minimum required bearing length(based on 700 psi)is 3"unless the exterior walls only. +symbol is shown.In that case,41h"is required. 6. Deflection is limited to L1360 at live load and L/240 at total load. WIVINIM low 1 10 ow Ir I-STORY WINt)OW & PATIO DOUK EAD. `'V".rk, ,t �t��4��c � his table considers the combined loads from a wall, xond story floor('/4 of total floor joist span)and arious roof truss spans with a 2'soffit.Intermediate oor beam assumed.If the soffit exceeds 2,additional ngineering will be necessary. B • ��A' Span A may v Trib Area Rough not exceed (see page 46) Opening .. -STORY-1.8E RIGIDLAM71° LVL Non-Snow(125%) Snow(115%) e Roof Loading zs psf u+20 psf of 40 psf:LL+20 psi of 20 psi u+15 psf of ZO psf u+is psf of tough Opening 6' 8' 9' 10' 12' 6' B` 9' 10 12' 6' 8' 9' 10' 12' 6' 8' 9' 10 12' 2-91h° 2-9Th° 2-111,"2-1N,"2-16". 2-9Th" 2-9Th" 2-117)"2-11Th"2-16' 2-9W 2-9Th" 2-9Th" 2-11,92-14' 2-9%' 2-9h" 2-1Y,'2-11Th"2-16' 20' 3-9Th" 3-9Th" 3-9yz" 3-7165°3-14" 3-9Th" 3-91h" 3-9Th" 3-117;5°3-14° 3-9'fi° 3-9Yz" 3-9Th" 3-9Th' 3-117h 3-9Th' 3-9W 3-9'fi° 3-117,5"3-14" 2-9W 2-9Th' 2-II'h"2-IITh'2-16" 2-914 2-9Th" 2-111)"2-14', 2-16' 2-9Th" 2-9'X 2-117,'2-117,'2-16" 2-9Th' 2-9Th" 2-I I W 2-I I TV 2-16' 24' 3-9 3-9 3-9W 3-11?h3-9U loaf Truss 3-9h' 3-9h' 3-9h° 3-117,°3-14"°3-9Th" 3-9Th" '3-14' Th" Th" Th' 3-11193-14' 3-934 3-914' 3-9Th" 3-11Th'3-14' Span 2-9Th" 2-9Th" 2-IIIb°2-14' 2-16" 2-9Th" 2-117A'2-11Th"2-14° 2-18"+2-9Th" 2-91h° 2-117)"2-I17W2-16' 2-9Th' 2-9Th" 2-I17h'2-14" 2-16" with 2' 28' Soffit 3-9W3-9Th' 3-9W3-117,'3-14" 3-9W3-9Th' 3-117)'3-117,"3-16' 3-9h' 3-9W 3-9Th' 3-117,'3-14' 3-9Th" 3-9h' 3-9Y! 3-117A3-14' Auumed 2-9Th' 2-9W 2-I17h"2-14" 2-16'+2-9Th" 2-117,'2-117,"2-14'+2-18"+2-9yf 2-9Th" 2-117)"2-141 2-16" 2-9Th' 2-9Th" 2-1115'2-14' 2-16'+ O o 32' 3-9Th' 3-9Th' 3-11Th"3-1Ph°3-14' 3-9'fe" 3-9'fe' 3-11T/e"3-1P/n"3-16" 3-9Th' 3-9Th' 3-9Yt" 3-11h'3-14' 3-9Th" 3-9Th' 3-1P/a'3-1P/a'3- 2-9h° 2-117)'2-11Th"2-14°+2-18'+2-9'fe" 2-117,'2-14"+2-14'+2-18' 2-9Th' 2-9Th' 2-117,'2-14' 2-16' 2-9h° 2-117,'2-11Th"2-14'+2-18'+ 36' 3-914" 3-9Y2" 3-lY,'3-117)'3-16" 3-934'.3-9h" 3-111,'3-14' 3-16' 3-9h" 3-9Th' 3-9Th' 3-111,'3-14' 3-934" 3-9h" 3-11T/a"3-117,'3-16" 2-STORY-2.0E RIGIDLAM- LVL Snow(115%) Non-Snow(I 2S%) Roof Loading 25 psf LL+20 psf DL 40 psf u+20 psi DL 20 psf ll+15 psi 0l 20 psf LL+25 psf DL Rough Opening 6' 8' 9' 10' 12' 6' 8' 9' 10' 12' 6' 8' 9' 10' 12' 6' & 9' 70' 12' 2-9Th' 2-9Th" 2-91h" 2-117)"2-14' 2-9Th' 2-9Th" 2-11Th"2-11Th"2-16' 2-9W-2-9W 2-9Th" 2-11?h"2-14" 2-9W 2-9Th' 2-9W 2-117;5'2-14' 20' 3-9Th' 3-9Th' 3-9Th' 3-9Th° 3-11Th 3-91h" 3-9Th" 3-9Th' 3-117)".3-14' 3-9Th" 3-9Th' 3-91Y 3-9Th' 3-117 3-9Th' 3-9Th' 3-99e' 3-9Th" 3-11,' O• 2-914 2-9Th" 2-117,'2-I17h"2-16' 2-9Th" 2-9Th" 2-11')'2-14' 2-16' 2-9W 2-934. 2-93'2' 2-1165"2-14' 2-9Th' 2-9Th' 2-117.4 2-117,"2-16" Roof Truss 24'uas 3-91h° 3-9Th" 3-914" 3-I17h"3-14" 3-9Th" 3-9YC 3-9Th" 3-117,'3-14' 3-9Th° 3-9Th' 3-9Yz' 3-9Th' 3-117V3-9yz' 3-9ye' 3-9Th' 3-111)"3-14" Span 2-9W 2-9Th' 2-117)°2-111,"2-16" 2-9W 2-9Th" 2-1164 2-14" 2-16'+2-9W 2-9W 2-111)'2-117/"2-16' 2-9Th' 2-91h" 2-111)"2-117,°2-16" with 2' 28' ' Soffit 3-9Th' 3-9Th" 3-9W3-111)'3-14' 3-9Th" 3-992" 3-9W3-117)"3-14" 3-9W 3-9Th" 3-9Th" 3-117,"3-14' 3-9W 3-9W 3-9W 3-117)"3-14' Assumed 2-9W 2-9Th' 2-117,'2-14" 2-16'+2-9Th' 2-117)"2-117)'2-14'+2-18'+2-9Th" 2-9Th" 2-117,°2-117,°2-16' 2-9Th' 2-9W 2-111)'2-14" 2-16'+ 7 32' 3-9Th" 3-9Th' 3-914' 3-117)'3-14' 3-9Th' 3-9'!f 3-117%3-111,'3-16' 3-9'fi' 3-934' 3-9Th" 3-111)'3-14' 3-9'fi" 3-9Th' 3-9Th' 3-17Th"3-14" v 2-91h" 2-91h" 2-117,'2-14° 2-16"+2-9Th" 2-117)"2-111)"+2-14°+2-IS°+2-9W 2-992' 2-1.17YV2-14' 2-16' 2-9Th" 2-934" 2-1114 2-14' 2-16"+ 36' 3-9Th" 3-9Th° 3-117,"3-117,"3-14" 3-9')" 3-91,' 3-111,'3-ITT,°3-16' 3-9Y2' 3-914' 3-9W 3-111W3-14' 3-9Th" 3-9T)' 3-111)°3-117,"3-14' + see note 3 Notes: 1.Header sizes are listed as the number of 1V&"thick pieces by the header 4.All headers require support across their full width:Use 2x4 cripples for two depth.e.g.2-9Th"indicates two 13/a"pieces by 91h"deep. piece headers and 2x6 cripples for three piece headers. 2.Header sizes are based on the assumption that the floor joists are 5. Header sizes ore based on residential floor loading of 40 psf live load supported in the middle of the building by a beam or wall. and-10 psf dead load.The roof framing must be trusses supported by the 3.The minimum required bearing length(based on 700 psi)is 3 unless the exterior walls only. +symbol is shown.In that case,4Th"is required. 6. Deflection is limited to L1360 at live load and the lesser of U240 or%6"at total load. tN 0 A WABLE LLO d ffi FLO ALLOWABLE CLEAR SPANS FOR RFPI"-JOISTS—40 PSF LIVE LOAD AND 10 PSF DEAD LOAD / 40/10 SIMPLE Span 10 MULTIPLE Span Roseburg APA PRI D , Designation 12"o.c. 16"o.c. 19.2"o.c. 24"o.c. ' 12"o.0 16"O.C. 19.2"o.c. 24"o.c. 18'-1" 16._3" 14'_10' IT-3" 9'h"RFPI"20 9'h"PRI"20 161-7' 15'-2" 14'-4" 13'-4' 15'-0" 1 T-1' 16'-1" 9+h"RFPI"'30 9'h"PRI'"30 17'-1" 15'-8" 14'-10" 13'_11' 18'-8' 14'-0" 16'-6" I5,-7" 14'_1• 19'-7" 17'-2" 15'-8" :. 9+h"RFPI'"40 9+h"PRI"40 18'-0"" _ 14'-5" 19'-5' 17'-9' 16'-9" 15'_8" 15' 5" _ 16'-4° " 10 _ 9'h"RFPI"50 9'h PRI 50 17 15'-7" 21'-0" 19'_2" 181-11 16' 11" 91h"RFPI"70 - 15'- 16'- 5'_5• 21'-8" 1S'-1 161-9" 13'- 5" 7 11 Th"PRI'"20 19'-11" 18'-2' 1 T-2" 11 A"RFPI" 20 16,-7, 22'-4" 20,_5" 181_10" 15'-0" 11 Tb"RFPI" 30 117A,PRI 30 20'-6" 181-9" 17'-9" r 21'-6" 19'-7" 18'-2' 16'-3" 23'_0" 191-11" 18'-2" 16'- I 1W b,_11W RFPI"40 11 A'PRI'"40 21'-3' 20-p"' q 19'-6 _18'-5' 1T-3" 43•_3.. 11?ATRFPI 50"_ .11T/a-PRI 50- --21 - " 25'-_1'" 22._11.. 21_.7' 113'=6•" • 191_'_10" 18._.7" �I'I"RFP[ 70 1 T?".PRI a70 "" 23-0•' 21'-0' 28'-8" 26'-1" 24_6" 21-10" I l TA'RFPI"'90 — 26•-4` 23'=11 22'-T 24,-4" 22'_1" 20'-2" 18'-0" 25'-6" 2Y-1" 2p_1" 18-0" 14"RFPI"'40 14'PRI-40 16'-1' P 21'-0" 19'=8" 26'-6° 24'-2" 20•_2• 14"RFPI'"50 14"PRI'"50 24'-4' 22-3'26'_1" 22 b" 21•_0" 28,_6" 25-11" 23'-2' 18'-6' 14"RFPI'"70 14'PRI'"70 23•_1 p" '- 14"RHI-90 - 29'-10' 27'-2" 25'-7' 23'-10" 32'-6' 29'-7" 2T-10' 23'-11' O 16"PRI'"40 27'-0" 24'-0" 21'-11" 19'-7" 27'-8" 23'_11' 21'-10" 19'-6" 16"RFPI"'40 29'_6• 24'-3' 20'-2' 16'-1" 16'PRI"50 27'-0" 24'-8^, 23'-4" 20'-2" 16'RFPI"50 rp 16'RFPI 70 16"PRI"70 29'-0" �26'-S_. 24'-11" 23'-1" 31'-7" 27'-10' 23'-2" 181-6" 33,_0" 30•_0" 28'-3" 25'-5" 36'-0' 32'-9' 3U' 0' 23'_11' 16"RFPI'"90 - v � ALLOWABLE CLEAR SPANS FOR RFPI'tJOISTS—40 PSF LIVE.LOAD AND 20 PSF DEAD LOAD 40/20 MULTIPLE Span 40/20 SIMPLE Span DO Roseburg Designation 12"o.c. 16"o.c. 19.2"o.c. 24"o.c. 12"o.c. 16"O.C. 19.2"o.c. 24"o.c. APA PRI 9'h"RFPI"20 9+h'PRI'".20 16'-7- 14'_11" 13'-7' 12'-2" IT-2" 14'-10' 13'-6" 11,-1" 9'h"RFPI'"30 9'h"PRI'"30 1 T-1" 15'-8" 14'_10" IT-9' 16'-8" 1 5, 81, 15'-4" 12'-b' 9'h"RFPI-40 9'h"PRI" 40 18'-0" 15'-9" 14'-4" 12'-10" 18'-1" 15 8" 14'-3" 12'-9" 9'h"RFPI-50 9'h"PRI"50 1T-10" 16'-4" 15'-5" 14'-5" 19'-5' 1 T-9" 16'-g" 13'-5" 19'-4" 17'-7" 16'-g" 15'-7" 21'-0" 19'-2' 18'-1" 14,_9" . " " _ 11' 0 " _ 13 11" 9h RFPI-7 lq•_lp• 16' 9 r 19'-11" 1 T-3" 15'-9" 131-8 117A,RfPI"'20 11 A"PRI'"20 19•_g^ 12'-6' 117A"RFPI"'30 l LTA"PRI"'30 20'-6" 18'-9' 17'-9- 15'-7" 22'-4" 18'-10" 16'-7' 14'-10" 21'-0" 18'-2' 16'-6" 11 TA"RFPI"40 11 TA"PRI"'40 21'-0" 1 B'-2" 13'-5" 11 TA"RFPI^50 11 TA"PRI'"50 21'-4" 19'-6" 18'-5' 16'_9" 23'-3" 20'-2" 16'-9' 18' T 25'-1" 22'-11" 19'-3" 15'-4" 11 TA"RFPI'"70 117W PRI'"70 23'-0" 21'-0" 19'-10" - 11 TA"RFPI-"90 - 26'-4' 23'-11' 22'-7' 21'-0° 28'-8" 26'-1" 22_q^ 18-2' 1 14"RFPI'"40 14"PRI'"40 23'-4' 20'-2" 18'-5" 16'-5" 23•-3" 20'-1" l 8'-4" 16'-4' 14'RFPI'50 14"PRI'"50 24'-4" 22'-3' 21'-0" 16'-9" 26'-6' 20'-2' 16'-9" 13'-5' 14"RFPI 70 14"PRI 70 26'-1" 23'-10' 22'-6' 19'-2' 28'-6" 23'-2" 19'-3" 15 4" 14'RFPI'"90 - 29-10" 2T-2" 25'-7" 21'-2" 32'-6' 29'-7" 24'-11° 19-11' 16"RFPI'"40 16"PRI_40 25'-3" 21'-11" 20'-0" 1 T-10" 25'-3" 21'-10" 19'-11' 13'-5" 16"RFPI-50 16"PRI"'50 27'-0" 24'-8' 21'-0" 16'-9' 27'-0' 20'-2" 16'-q" 16"RFPI-70 16"PRI"70 29'-0" 26'-5" 24'-0" 19'-2" 30'-11" 23'-2" 19'-3" 1 Y-4' e 16"RFPI"90 - 33'-0' 30'-0" 26'-6' 21'-2" 36'-0' 30'-0' 24-11" 19'-11" Notes: S ns are based on composite action with glued-nailed sheathing meeting •Spans are based on uniform loads as shown above.Use RfP-KeyBeam" 'the pfollowing APA requirements: sizing software for other loading. Joist Spacing •Web stiffeners are not required to develop spans but may be required Min.Thickness Span Rating for hangers. Rated 1W (40/20) 19.2'or less •Maximum deflection is limited to U480 for live load and L/240 for Sheathing -• (48/24) 24"or less total load. Rated 'I" 20'o.c- 19.2"or Iess •A minimum of 13/4"is required for end bearing,31h"for Sturd-i Hoon 2" 24'o.c 24"or less intermediate bearing. RtGtoFtoott� T% 32'o.c 24"or less •Spans include allowable increases for repetitive member use. Adhesives shall meet APA Specification AfG-01.Spans shall be reduced k nnilwd only. Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoftware Version 3.5 Release I Data filename: C:\Program Files\Check\REScheck\Chakravarti.rck PROJECT TITLE: Chakravarti Residence CITY:North Andover STATE:Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE: Other(Non-Electric Resistance) DATE: 02/09/04 DATE OF PLANS:2/6/04 PROJECT DESCRIPTION: 1423 Salem Street North Andover,MA 01845 DESIGNER/CONTRACTOR: Atlantic Restoration&Development 57 High Plain Road Andover,MA 01810 PROJECT NOTES: One Story Addition Over Garage. I COMPLIANCE: Passes Maximum UA= 144 Your Home UA= 118 18.1%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 756 30.0 0.0 26 Wall 1: Wood Frame, 16"o.c. 713 19.0 0.0 38 Window:DBLH: Wood Frame,Double Pane with Low-E 82 0.350 29 Floor 1: All-Wood Joist/Truss,Over Unconditioned Space 756 30.0 0.0 25 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheckVersion 3.5 Release I (formerly MECchec4 and to comply with the mandatory requirements listed in the REScheckInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1.25%of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer- Date Z 1l a i i kEScheck Inspection Checklist Massachusetts Energy Code 'REScheckSoftware Veision 3.5 Release Id DATE: 02/09/04 PROJECT TITLE: Chakravarti Residence Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: I Above-Grade Walls: [ ] I 1. Wall 1: Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: I Windows: [ ] I 1. Window:DBLH:Wood Frame,Double Pane with Low-E,U-factor:0.350 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes [ ]No Comments: I Floors: [ ] I 1. Floor 1:All-Wood Joist/Truss,Over Unconditioned Space,R-30.0 cavity insulation Comments: I Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. ] I When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfin(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/112 pressure difference and shall be labeled. I Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. I Materials Identification: Materials and equipment must be identified so that compliance can be determined. { ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. Duct Insulation: [ ] I Ducts shall be insulated per Table J4.4.7.1. � I Duct Construction: [ ] I All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed i using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. i I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and MA I I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. i Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) i own of Andover No. Al 7 S -5x5- -,.x.�, t -T� T0 : dover, Mass., - k", �® " Arxo s `Z l g BOARD OF HEALTH PER Food/Kitchen MI Septic System _ • BUILDING INSPECTOR THIS CERTIFIES THAT.. ... .. '.. � .. ........�......... 0.�'►�'.®...,,........ Foundation has permission to erect. 1... a dins on o , p .....:...... buildings ......�.. ... .013...... .�....... .......... Rough - to be occupied as...M. 441 a /" �9�� a ..... �.... M ...... ? oma 0 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-Law relating to the Inspe tion, Alteration and Construction of Buildings in the Town of North Andover. i®401 6a emp PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final day ] 771 g��� g ELECTRICAL INSPECTOR 1,J �7�TI—E,w.3S CONS]. ��4..,.+�ery l...;��.�"`I S 9 .R� Rough i .. ...... '... ........ ....:.:. ... .......,.. Service BUILDING INSPECTOR Final , Occvoancy Pem.a Required! to roc upr J GAS INSPECTOR Rough Display in a Conspicuous Place on the, Premises - Do Not Remove Final No Lathing or Dry Mall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE R E tl E RS E. S I D E Smoke Det. Date "oRTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . plumbing in the b ildings of . . . . . . .. . . . . . . . . . . . . North Andover, Mass. Fee. �(SLic. a (.02Z.�.� rr.Cf ~- PLUMBING INSPECTOR Check # "Z 6031 ' MASSACHUSETTS UNIFOR PPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER,MASSACHUSETTS �1�, Date /Z Building Location 14 23 7+'�l �"I O ane s Namef`i1 ` Cq0C4A1/^27? Permit# -01 WWI Amount 11'�Q Type of Lu anc 9t l(e— N—tnmuy New Renovation r Replacement ❑ Plans Submitted Yes No FIXTURES i H V. W IIS A surra llr BAmfNr lS>C 1I00It ma HDM Hf= 4M BLOM 5MH-0M 6M HDM 7M FLOM SIf�)HIDOI2 :. (Print or type) (( ` Check one: Certificate Installing Company Name N 1.MLL Ve-\IOyA-AoJ S M. Corp. Address S i k 1 A lwnl N \1 r2(L M 'N al Partner. Business Telep one q3-Z 00 ® Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity D 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 I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuseumng Cod ab d8apter 142 of the General Laws. By: Signanlre Of is nse umber Type of Plumbing License Title U City/Town License INUITIM Master Journeyman H APPROVED(OFFICE USE ONLY Y, N. `.fz"79 S3 ; W vk a'SS�:: i'� F l��ry�]� h "°Ff �` �c. y'. t� 3 .y E/{/.a I/N !".. _ .r^ '`O l,(: 4 s t `* fis S, .a•'s" 261 TI�"TAN/C �`•,}. s; � , APPROX/MATE rt Y•� � � a' n 5 ",. `' : � � � ?O /�A/N (;�° .' ,,, PROPERTY,L/NE(TYP.� D1/S7R/EtUAONr' � i 1 t :.✓x; a ix; '� r tT'-:..' , #t1. , saE s f :Q - BV/1- aim r ;.,' as ,-0 f *�� 3S.ssJ.��,��~+ .¢ i � '`d' � .� .d �� i t," ����, �.,,_ ..�_i<.....___�- - �•i t z :,, •', �`r =r# ; r";. A .... tt4}a,.:� ¢[d� -n ° e! a _ ;J ."td f -�2 r _ 51 x- _as'� ''V D r -°A` i•3 -. 'dr=.4i� �. _ y �.>1 r.• "!�i _ r i f 'i• 1 s _ - .s fi .^s 6 ,.J7 ns.. } �.' � •.$^;_ < DOSh r ! : y _. r <. F, #^" ." c i. 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R- .., �.: ,. fi. .!,:. ,s .ti. ,. .... < .,.. <> r) -, .r , ': .. # ,. . ,-}t✓ ,. ,- ,- .. t*?. f ..J ..A .,. ,�».`4• �n..•x_ `>�'S,�> :.:r�.t"�`,- .� e:.'s. ni.t. rif- - `:.� � - 4. : y� !yh, - It; . \r•. .:r-. .f •. t u'*- 4♦, „: i , 3 - ....,t.. .ti' ..v ♦ «,.7. _ F ,1 Z.-::S.t �z.�..s �`:..'r :� t's.: '•,a.�'�< t r �r 7 .,, ✓ .::. ;-�` F -.- , .,.a .] "-.: - ,:. :. ._. �. • �'.. � s,e;.: y:. .h`r-- a=`^ ,.syr-' r 3'.x:, :R`�'"S :A T r , { s:„,.:'. .�'".. l_•' .� .. :....e. -.: ' .. a i. , T _ �.¢�- 6*::, � -„}yy w Y�F, v�v. kr i� -.. • w.. ,,, ,.... m.-. .{,,. ,:.... �}K,.. .<: d� .. � ”, .- ,�1 � �.• -� s.�r" .tet,.• _ _ ¢ 'S.: ! .�,. � '>h: _'.,,, "µ,ms, a.{�•.} -i,e ..�,.. ... _:' --. -- � ., pp e7% � P L; •'i I j j..��, '1 O BUFFER fey k>O 5. Q ■ 4. +, 'T �' Y.k �' r r` ;'9' * • f ?l d 2 ; { ?x },.�-_:v�+w.#,� ,f' "� : r ���- ,{,�, fir. `•:,� ;� e; � � ����F�`^ $ •v. r !/ ,<tr ' pp s g� z ;: "ib,: ^t '+�� ;:T _._. •� .id t. ,.5<.M4 to M1�^t`.. r� a.... -... ,. a.•.�r.r-,t r .v. r - - - ., t •( 4,J'j r� ,Fr '117A VV' t1tt- - � -.a: ,��• '��.'�, aa' A. I ^-'� .a{' rt -' t' +::F r .F a3;t,."+ - ._.....,...� ,__.__. .,. "'-... _ '� ''r t -` s -) v,_ b/j�� Date TOWN OF NORTH ANDOVER 3? °� •° °L O PERMIT FOR WIRING ,SSCMUSE� .., This certifies that ....... ..... ..... ... ........ J ........ ............ ..................... ` � �has permission to perfo . ......... ,-... ... ......... .......... ............. wiring in the building of,..� rj ......!.. ....... ... :.. ........................... atbV'l'?J..,d.1... . 1............... .... ........................... .North Andover,Mass. J H 'h FeA�� Lic.No�� :- ELECTRICAL INSPECTOR Check # 5288 r vi Commonwealth of Massachusetts Official Use Onl , Department of Fire Services Permit No. ' BOARD OF FIRE PREVENTION REGULATIONS [Rev-11/99]and Fee Checked / leave blank I APPLICATION FOR PERMIT TO P RFORM ELECTRICAL WORK All work to be performed in accordance with the Mas achusetts Electrical Code(MEC),527 C R 12.00 (PLEASE PRINT IN INK O AL FO ATIO ) Date: City or Town of: 110A To the Inspector f fres: By this application the undersigne ives notice is r hery'inten ' n to perform the electrical work described below. Location(Street&Nu er) s Owner or Tenant Telephone No. l Owner's Address - � 1 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: p Installation of Security r' system — Completion system � ae _ Com letion o the follo,4in 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 o. Mg mg No.of Lighting Fixtures Swimming Pool Above In- of rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o Detection and No.of Switches No.of Gas Burners o. Initiating Devices i No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Wasie Disposers .. Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers . Space/Area Heating KW Local ❑ Municipal E:1 Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.o Water KW No.of No.o 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 Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I.certify,under thdpah4s an penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: li 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 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. f PERMIT FEE: $$ ti I, Date. .�'l D. D� <"_0 RT:1�o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING t SA US This certifies that . .`. . '!. . . . . . . . . . . . . . . . . . . . . . has permission to perform -t -f c —7-60J" (,CIA t`etl" plumbing in the buildings of . . !:`. . . . . .M0 jLb at . .1Y .. .S . ` e . .�'... .. . . . . . . . . . . . . . North Andover, Mass. Fee. .30. . . . .Lic. No..�°?a.© . .i~�.7,nZ1tAC(.��-+---: . . . . PLUMB NG INSPECTOR Check # c2z 5376 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date �p Building Location � Q Owners Name O� /� Permit# Amount . Type of Occupancy . New Renovation Replacement Plans Submitted Yes a No ❑ FIXTURES w w a � w Col. E a w o d � as A A a x BSrr - —EE>ffm M HJ" 3mHj" 4M Hi" 5M I i sM HIM L 7M1WR gm FIDCR (Print or type) / Check one: Certificate Installing Company Name ��J1tr/ 7j' �£ fj� r ❑ Corp. Address . �C �T Partner. 40 ? �7 usmess Te ep one V&P G �imi/Co. i Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance talicy 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 I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac s State Plu d er 142 of the General Laws. Signature of Elcensed r lumDe Title Ty e of Plumbing License City/Town i ense um er Master Journeyman APPROVED(OFFICE USE ONLY 4086` v Date The Commoni, eadth of Massachusetts �.V"ONr r� . IJemirr,,,f,nt o/ Public Suety 't. Ocwoancy•ra BOARD OF FIRE PREVV NTION REGULATIONS 927 CMR 12:00 3194 iksw tEerrtl AP'PLICAT'ION FOR F"JERMIT TO PERFORM ELECTRICAL WORK All worts to be perrarmr�!In acco►da"Ce with the Measschumme Electrical Code.527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL 4NIFORMATION) Date Ac Zen 0P, City. or Town,of llleev 11LTo the Inspector of Wires: The undersigned applies for a permit to o, rforrn the electric work described below. Location(Streoat 6 Number) Owner or Tenant... o"V OwwrWa Addraise is this pormit In coniums Ilh a builain, permit Yes No (Check Appropriate Boxy Purpm of Sukdinq - TSG�G . �rr�1 ✓�`" Utility Authorization No. EXlsting 9arviCe Amps,_,? _.L..IGQ Volts Overftesd Er'Undgrd 0 No,of MetersNU WWI � "_..,,_;_Amp§ LVolts Overhead ® Undgrd ® No.of Meters- hhle�rtbriar o! 'esders L rt and NatureofProposed Elecirical W'�,L^%� . 1G �'c„r �1.r�!.��' i r✓�a,P,��Z IF No.of UgMWQ Ouaots a.or Hot Tubs No,of Transformers Totd ,. KVA No.of Ug"199ture0 ::�+imrninq Apo! Above In- No. KVA t#. t_ No,of Effwgoncy Lighting Na of Outlets a.of QII s9urrtere Unite Na of IgvrMch Uudsla i of Gas ournere - ' - - - __ . FIRE ALARMS No.of Zo No.of!a /On ai No.of tion and angel of Air Gond, o Initiating Devices . _..... . Total Total No.of Dlopoaols i, of p mr a Tona KEN No.of Sowndhtq D No,of OlsitweMers `i)"/Area Hoeting KW Del c Self lion/ Devices No." Or"m :;sating Devices KW loco! Other __ U Mu rection ).of No.of Low e No Of t tars KW W NO.Mydrp Tuba i +>.of Motors Total HP OTHER: iNGURANCE COVERAGE:,. Pufwant to the r<>>Jrernents of MassaieWsotto Genal Laws I naves curront Liability Insurance Policy Inducing Compietad ahone Coverage or its substantial equlvaierd. YES O--�w t have aUb'ni ted valid proVl*swrie to this OIfPcl?. YES 1.d Noll It you hem chook �,pisses indicate the ty t ie of covers"by checking the'tllporoortste box, INSURANCECY SONO OTHER[.I (Phr.B,is Specify) W;� Estimated Vdus of Electrical Wofk$ ( 'Date) Work to SW Signed udder the se of Perjury. FIRM NAME '1 .._ LIC.No, J_. LOC. NO ra� � � - //5 sus Bei.No Aae . C ��_ fl ,r:. Aft Tel.No. 6wNEm* IN=ftANCE wAmu: t am awofe chat the Iloartves go"nqX he the Insurance oowrage or its substandal-equivalent as required by Massachusetts Gerund taws,ar-d Ihirt my signature on this permit aoplicstlon waives this requirsment. Owner C3'- Af,7 M (Pisaee shoot,'(rr*) (Slenskire of Owner or Atom)._ _... reloohone No. PERMIT FEE 4_2 I `:e Date. :..v�.................. HORTPf o °°� TOWN OF NORTH ANDOVER P. '° PERMIT FOR WIRING ��ss�twusE� This certifies that .....&D.11....................................................................... has permission to perform ...... . ..................................... wirzng in the building of... . r �!................................... at.....1`.� _ ^- . .}No, Andover Mass. Fee`S... ('-. ...... Lic.No./.Q,—kw............. � !y:,.,�. ... ��..�.....'.......... t LECfRICAL IwECTOR f Check #—'7119 f 4770 - V ` Commonwealth of Massachusetts Official Use only Permit No. N 7 Department of Fire Services oy Occupancy and Fee Checked 44� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TITEE ALINF RMATION) Date: City or Town of: To the Inspectol ofWires: By this application the undersigned gives notice his er intention erform the electrical work described below. Location(Street& tuber) , Owner.or Tenant4 Telephone No. ' Owner's Address Is this permit in conjunction with a building rerm`io. Yes.❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. rd Existing Service Amps / Volts Overhead❑ Und g ❑ 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: Installation of Security system Completion qf 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 AboveIn- .o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Bat-tor Units i. No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.o Detection and t Initiating Devices No.of Ranges No..of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers . Heat Pump I.Number Tons KW No.of Self-Contained Totals: I Detection/Alertin2 Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: F No.of Devices or Equi alent No.of Water No.o No.of KW No. Wiring: Heaters Signs Ballasts No.of Devices or Equivalent 1 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:) Estimated Value of Electric l Work: /, 9�' (Expiration Date) (When required by municipal policy.) Work to Start: (J,*5 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under tkk pain andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: Sa-Gur-ity Services LIC.NO.: 15 Jr Licensee: John S. Bassett Signature LIC.NO.: -1533C (If applicable,enter"exempt"in the license number line) Bus.Tel.No.: 603 594 S928 Address: Alt.Tel.No.: OWNER'S I -- -INSURANCE WAIVER: I am aware that the Lic, 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...! �.�7......... NORT„ i °ft °:•�"° TOWN OF NORTH ANDOVER p PERMIT'FOR WIRING �,SSACNUs� This certifies that .. ............ ... . .. "has permission to perform �C.,.,,....... wiring in the building of Y�. fi .. . .. .. ............ at,.... s... ..� �,�4 .. ,North Andover,Mass. �. Fee..�.: l..... ... Lic.No ,l ....... ...... ./Gt ! .r. 11 }� ELECTRICAL INSPECTOR Check # 5459 -t Official Use = Commonwealth of Massachusetts Only Depart, nt`of Fie Services Permit no. „ Occupancy and Fee Checked is BOARD OF FIRE PREY TION REGULATION [Rev.11/991 (leave blank) APPLICATION FOR PERMI TO PERFORM ELECTRICAL WORK All work to be performed in accordancewithth Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE'PRINT IN INK OR TYPE ALL INFORMATIOl� Date: 12.2.2004 Ci Or Town of: North Andover �{{ ' To thenecTre rib below. By this application the undersigned gives notice of his or h tention to perform electric r esc Location(Street&Number) 1423 Salem St , Owner or Tenant Kimberly Chakracarti Telephone No. 91- Owner's Address 1423 Salem St North Andover MA 01845 Is this permit in conjunction with a building permit? Yes [:]No N(Check Appropriate Box) Purpose of Building residential Utility Authorization No. Existing Service Amps / Overhead Undgrd No of Meters New Service Amps / Overhead Undgrd No of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: SEE ATTACHED SCOPE OF WORK No.of Recessed Fixtures 3 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures7 Swimming Pool Above In- No.of Emergency Lighting grad• F1rnd ❑ Batte Unifs No.of Receptacle Outlets1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches5 No.of Gas Burners No.of Detection and Initiating Devices i No.of Ranges No of Air Cond. No of Alerting Devices No.of Waste Disposers HeatPump Number Tons No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW LocalMunicipal Other E] Connection ❑ No.of Dryers Heating Applicances KW Security Systems: No.o1[Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices of Equivalent No.of Hydromassage Bathtubs No of Motors Telecommunications Wiring: Total HP No.of Devices of Equivalent OTHER ROUGH INSPECTION FINISH INSPECTION 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 suc verage is in forced has e proof of same to the permit issuing office. CHECK ONE: �INSURANCE " BOND " (Specify:) (Expiration Date) Estimated Value of Electrical Work: When required by municipal policy.) Work to Start: Tnspections to be requested in accordance with MEC Rule 10,and upon completion 'I certify,under the pains and penahies of per/'ury,that the information on this application is true and complete- FIRM NAME Power Wiring&Emergency Response,Inc. LIC.NO.: A17354 Licensee: Stephen Decker Signature LIC.NO.: (If applicable.enter"exempt"in the license number line) Bus. Tel.No.: 1-800-418-3221 . Address: 44 Stedman St,Unit 2, Lowell,MA 01851 Alt. Tel.No: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabic insurance cov a normally required by law. By,my signature below,I hereby waive this requirement. I am the(check one) o owner's a *ner/Agent PERMIT FEE 65.00 SCOPE OF WORK 1423 SALEM ST . N . ANDOVER 1 . INST. BATTERY OPERATED DOORBELL 2 . REPL . 2 0 / S LIGHTS BY GARAGE 3 . INST. CABLE JACK & OUTLET FOR TV IN DEN 4 . INST. LIGHT OVER DINING ROOM TABLE . S. MOVE GARAGE DOOR OPENER BUTTONS AND LIGHTS 6. INST. 2 DIMMERS FOR DINING ROOM LIGHTS 7. INST. 2 0 / S FLOODS 8 . INST. CEIL . LT. IN LIVING ROOM 9 . CLEAN UP WIRING IN ATTIC 10 . INST. 100A SUB PANEL IN BSMT. 11 . CHANGE SWITCH TO DIMMER IN BEDROOM 12 . INST. 3 REC. LTS . IN WEIGHT ROOM 13 . RE - POWER JACUZZI INSTALL GFI BREAKER 14 . ADD LIGHT IN ATTIC 15 . MOVE 3 LTS . IN STORAGE AREA 16 . ADD OUTLET IN WALK - IN CLOSET a F w Date. .... G^ ,s f+NORTH - A 3?°•`;�``°{°�"�o� TOWN OF NORTH .ANDOVER PERMIT FOR WIRING �sS^CHUS This certifies that .. ? s�-' ............. �t�l. ..... has j*rmission to perform ..... � �� ........... C/I Ll 1r4t/� 7t wiri6iin the building of................................................/................................. a3 4SQ�.* North�7pd at....... ...._.j..... .. .......... (! Fee., ....... Lic.Npll C! ).............. .. ............... . .....................y.. ELECTRICAL INSPECTOR Check # 5201 TBE COM[VIOn'WE4LTHOF[1A,S,SACMSE-TTS Office UsZgnly DEPARTAflATOFPUBLICSAFETY Permit No. BOARDOFFIREPREVE MONPBGULAHONS527CMRI2.`bb Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERF ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WIT THE MASSACHUS S ELECTRICAL CODE,527 CMR 12:00 ?LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: u The undersigned applies for a permit to perform the electrical wrk desc ' d below. Location (Street&Number) z7d5 Owner or Tenant Owner's Address V Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) i Purpose of Building Utility Authorization No. Existing Service 1 Amps/;fJ / '� Volts Overhead Underground No. of Meters New Service Amps �Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work + .-4-1 t44 — No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of ReceptalOutlets No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets O O No.of Gas Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Ng_,of Sounding Devices Na otSelf Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other Connections No.of Water Hears KW No.of No.of Signs Bailasis No.Hydro Massa^Tubs No.of Motors Total HP )THER- suianceCoveiage.Ptust>antbothetagitir�r�ntsofMassacln.LSetlsCet�allaws iaveaa erALiab>7ityltmr&=Pbhgiwhl&gCompfflells Covetagecritsstil�m>ialequivalent YES NO iawsubmth2dva}idpmfcfsanrtodrOffm YES lfyouhavEcheclp-dYES,pleaseir tbetypeofcovemgeby ����,7d^n�.,g CIdU(lb� ! j iSURANCEBOND OIT IER (Plea9eSpecify) / Q Estal7ated VahaeofEJecfticalWb1k$ oiktoStait onDateRegtiesled Rough Final 7.elunder�ie of -j � p. WNAME C `7aT lio=No. 0 I C Signahue LioffiseNo 411/#9 P , _ caets �-i Not Art Tel No. 7 ��^ ®t1 S dI\ER'S INSURANCE WAMT,I am aware the License does not have the insurance cow age orits subshan6al equivalent as mquaed by Massachusetts General Laws thatmy sigaalutc on this pennit appicat on waives this iequnement ease check one) Owner ED Agent v Telephone No. PERMIT FEE 7-nature oT Owner or gen Z w The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affl Name Please Print Name: Location: City Phone # F_� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for-My emp oyees working on this job. Company name: { Address `1 City Phone#: Insurance.Co. Polic ry# Company name: Address City Phone#: j, Insurance Co. __Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 .i and/or one years'imp risonment_as_well as_civil..penaitiesinthelorm ofa..S.T.OP WORK.ORDER.,and..a.fine.of_($1,00.00).adayagainst_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name P:h.on.e.# Official use only do not write in this area to be completed by city or town official' City or Town PermMicensing El Building Dept ❑Check ifimmediate response is required ' p licensing Board p Selectman's Office Contact person: Phone#: Health Department Other t THE COILMONWE4L7YIOFiVL4SS4CHUSETTSLOccupancy Office Usesnly f DEPA�RTA&ATOFPUBLICS4FElY BOARD OFFIREPRBVENTIONREGaWONS 527 CM 12:Gb 5 Checked O APPLICATIONFOR PERMIT TO PERF ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WIT THE MASSACHUS S ELECTRICAL CODE,527 CMR 12:00 ?LEASE PRINT IN INK OR TYPE ALL INFORMATION) � Date i Town of North Andover ; To the Inspector of Wires: The undersigned applies for a permit to perform the electrical wrk desc ' d below. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) �tirpose of Building Utility Authorization No. Existing Service Amps C / � •Volts OverheadUnderground No. of Meters Jew Service Amps / Volts Overhead Underground No. of Meters dumber of Feeders and Ampacity -- lature of Proposed Electrical Work i t�1 )utlets No.of Hot Tubs No.of Transformers Tota] 1 - xtures KVA Swimming Pool Above Below Generators KVA round round Outlets :� No.of Oil Burners y� No.of Emergency Lighting Battery Units 'lets No.of Gas Burners No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Heat Total Total No.of Detection and i Pumps Tons KW Initiating Devices Space Area.Heating KW Np..,of Sounding Devices No-a-Self Contained Dei'ection/Sounding Devices Heating Devices KW Local Municipal a Other rs KW No.of No.of Connections Signs Bailasis Tubs No.of Motors Total HP Musttanttotheraclttit�r�tsofMa��cln>Setts Cet>ecalLaws pDW Ir�titutcePblicyinch gComp'lete✓ 1 Covaageoritssubstantialec�u jCnt YES No D proofofsalwlotheoffK)ft YES I r�I IfyouhavecheckDd YES,phmirxbcajcdrgWofcovetagebyy �rcruv�n BOND � an-ERF7 (Please Specify) ExmahonD& Estitrtated Vahle of Elechical Wodc$ to Start Inspection DaleRetltested Rough Final d ruxlerTie of uy. 4 'INANI�E^ licertseNo. Sigr>ahne lict�>seNovto ✓'�-��1 t Bt TeL No. r Alt Tel No. [EP'�y}iRA1�10E WANF�2;I am aware the license does nothave the ittstuanc�cove oritS apt srmbal rtIlvllent as retlttired by Maaachlr�Us Ctl laws it my si�ahue�r this�nrnt app}iratiorl waives this mc�men�nt ,., se check- one) Owner -- Telephone No. F ER J�,/fIT FEE" :__>lSnature 01 UWner or gen 0 �� � � � �- ��n� C �o � � ���,� a ��-� � �. � ���� f O Commonwealth of Massachusetts o7Z�'�, Permit no.Department of Fi ServicesBOARD OF FIRE PREV TION REGULATIONS occupancy and Fee Checked p., [Rev.11/99] (leave blank) 4_ : APPLICATION FOR PERMI TO PERFORM ELECTRICAL WORK All work to be performed in 7hisorh w� MamachuseUs Electrical Code(MEC),527 CMR 12.00 (PLEAbI:'PRINT'IN INK OR TYPE INF0 Date: 12.2.2004 City or Town of: North AndovTo the Ins ct re o W' es By this application the undersigned gives notice tention to perform electncal NrPlc Te 40 Uefow. Location(Street&Number) 1423 Salem St Owner or Tenant Kimberly Chakracarti Telephone No. 91- Owner's Address 1423 Salem St North Andover MA 01845 Is this,permit in conjunction with a building permit? Yes []N0 ®(Check Appropriate Bog) Purpose of Building residentialIL 0%,Ip Utility �'� Authorization No. Existing Service Amps / Overhead Undgrd No of Meters New Service Amps / Overhead Undgrd No of Meters Number of Feeders and Amp acity Location and Nature of Proposed Electrical Work: SEE.ATI'ACHED SCOPE OF WORK No.of Recessed FixturesEi7 o.of CeiL-Snap.(Paddle)Fana No.of Transformers KVA No.of Lighting Outlets o.of Hot Tubs Generators KVA No.of Lighting Fixtures wimming pool Above �_ grnd. No.of Emerrggency Lighting No.of Receptacle Outlets rnd Batte Units P 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 5 No.of Detection and Ranges AiInitiatingDevices No.of Ran g No of r Cond. No of Alerting Devices No.of Waste.Disposers Heat Pum Number Tona p No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal Municipp�al Other No.of Dryers ❑ ConnecTion t7 Heating Applicances KW Secur�•ty Systema: of P.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Si s Ballasts No.of Devices of Equivalent of Hydromassage Bathtubs No of Motors Telecommunications Wiring: Total HP g No.of Devices of Ery ualent R: ROUGH INSPECTION -FINISH INSPECTION Attach additional detail if desired,or as required by the Inspector of Wires. UIZANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned res that suc verage is in force has a proof of same to the permit issuing office. CK ONE: �INSURANCE LJ BOND OTHER (Specify:) ' ated V (Expiration Date) Value of Electrical Work: When required by municipal policy.) to Start: Tncpections to be requested in accordance with MEC Rule 10,and upon completion under the pains and penalties of peJr'ury,Heat the infornwtion on this applicatuin is true and P co ower Wiring&Emer en Re mP NAME g S cy sponse,Inc. r LIC.NO.: A17354 see: Stephen Decker Signature '' 1` ' _�u ` r LIC.NO.: licable enter"exempt"in the license number line) 1-800-418-3221 ss: '44 Stedman St,Unit 2, Lowell,MA 01851 Bus.Tel.No.: L All. Tel.No: R'S INSURANCE WAIVER: I am aware that the Licensee does not have the habi ' insurance cov a normally required �I ` By my signature below,I hereby waive this requirement. I am the(check one ow owner's a I r/Agent ti PERMIT FEE 1 65.00 I� i _ to — oc P i I f i Staple oldelS BUILDING PERMIT o�"�°T bgtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 F 1. Permit No#: Date Received '1s 4gDAA7ED / gSSACHUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Y PROPERTY OWNER ` z�.. _n l -`. Pnnt z 100 Year Structure yes no MAP D to PARCEL ��`� ZONING DISTRICT Historic District yes no { � �'�' - _ " - Machine Shop Village :yes no TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non- Residential El New Building —2=family ❑Addition ❑ Two or more family ❑ Industrial ❑Alt tion No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ pSeptic ❑1Nell - � Floodplan 'Wetlands ❑' Watersheds"Clstnct; - "WateI�Sewer _ _ DESCRIPTION OF WORK TO BE PERFORMED:y� �GPo -7 Gc)//JOVA/S A,1D S/ ui -A'9-Ga/ — 4 A-r g f Identification- PIP Type or Print Clearly OWNER: Name: �-� I' S Phone: Address: Co-ntractor Name ,��!� /Z,�� Phone 7 Supervisor's Construction License _d9 / r' Exp Dated Ldp l�° T Home ImprovementfLicense x l 7 �» Exp TDa - t. 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: $ ld 78a,oy FEE: $ 1 !$ 1-1 FEE: Check No.: ,�[ Receipt No.: �E 1 NOTE: Persons contracting with unregistered contractors do not have access tot uaranty fund J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑' TYPE OF SEWERAGE DISPOSAL Public Sewer i ❑ Tanning/Massage/Body Art ❑ Swinuning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ElPrivate(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signafiure_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS ' HEALTH -_ ti; Reviewed on Signature _ i COMMENTS . +r e. Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes R � Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: 84 Osgood Street Located FIRE DEPARITiM T y..Temp Durnpster on site c � s 3no'�� _ Sj { i Fire l]epartment si � ° -' ;�..�t-��°#i, �*• . ,'�r,�`,��f ��,�.r ,.�, �� R .�a � � <�.��,_.� -� gnyature/date s 4y' "� ,� ,� '�,� � ��a t �•..,,(t r�{�fe .t*�t.„ t ";s F v "l�Sys Sti r tiy� �4rt i COMMENTS : � fis ! +':,. sS ,y M :°- -n a. 7i,,•, ,• ►., ''F� " >, Alf' � .. �t�.r"�xr_, te•x-t mai ;^� �I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of deter locations, 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.$1oo-$1000 fine NOTES and DATA-- (For department ease) i ® Notified for pickup Call Email Date Time Contact Name s Doc.Building Permit Revised 2014 _ r 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 OTE: 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/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products ' OTE: All dumpster,permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording with the building must be submitted g application Doc:Building Permit Revised 2014 Location �"r"" �-'�_ • No: It!`� Date �c o - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ Building/Frame Permit Fee $1M- y C �. . 0 Foundation Permit Fee , $ M-" Other Permit Fee $ TOTAL Check#1 LRO 28847 Bd ing Inspector NORT� AnnoveT ow-- n of t _E q_ No. _ C, h ver, Mass, COCKICK!WICK.y'►. A0, �1TE0 S K U '' BOARD OF HEALTH s � Food/Kitchen Septic System THIS CERTIFIES THAT .................. 1.. .. . �.e�-9 BUILDING INSPECTOR .... �. ................. ........................... AA Foundation has permission to erect .......................... buildings on ...V 35. . W. I. ........... n Rough to be occupied as ..... ... ... ... .. P .... ,. 1 ........................................ Chimney provided that the person acceptin' this per 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR . UNLESS CONSTRUCT10 STARTS 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. ZTG4"A Renewal , _1" MA Home Improvement Contractor, nderseYn. Renewal b Andersen Corporation.. License f Federal (Expires 12f23184 tea) ' � Federal Tax.lU#41-1918413; 'W#Kaatr 9FHRt0.eEla tide 3.h:'4S I,i.i L.a`ii':Mt: - 30 Forbes Rd. Northborough,SIA 01532 (508)351-2200 Fax(508)-986-7072 CUSTOMER WIl' DOW AND DOOR REMODELING AGREEMENT f Buyer(s)Name Date. CCIURTN Y"SCRUGGS MAY Bu er(s)Street AddressCity State Zip Code 1423 SXLE' rt'Sr. NORTFt:ANDOVER MA: 01845 Ernail Address, Horne Telephone,Number Work/Cell Telephone Nu tuber CORTNREYWELLS i 90YAHOO.COM 978-688-4177 978-684-2+43.4 Buyers)hereby Jointly and severally:agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor`),in accordance with the tercets and coriddions descri'loed on the front and the reverse of this agreement and on tete attached specification sheet(s)(collectively,this"Agreement"). Buyer(s)hereby agrees to sigma o6mpletion certificate after Contractor has completed all-work under this Agreement. Est.Start[?ate Method of Payment Total.icsbXinount $ 23,16 rExtumwinat $ 23i163 Deposit R ived(331%)" 0.00 oe"Sit at sig-mq CherktCash. 8-10 weeks Balance Start of Jett(33'�)$ 0.00 Check� Be)aricre tin Substantialat SatuiirrW Est.Install Time Credit Card � �,>~ Comptetiosi of Job(33%) 0.00 camptet;wn S 11,581.50 1.2 days it credit card.isseleetrxl,please -rtG#thm pynyxg 'a;'us d marded.umM pttes ate nfti od '.. See Qedit Card payffmnt:form--` Buyers)agrees and understands that this Agreement constitutes the entire understanding between the pa ides,and that there ars no verbal understandings :Changing or mbdifying:any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without thio signed,written consent of troth Buyer(s)grid Contractor"er(s)hereby acknowledges that Buy0s)1)has read this Agreement;understands the terms of this Agreement,and has received a compl�ted,signed and dated copy of this Agreement,including the two attached Notices of Cancellation;ori the date firstwrltten above and 2)was orally informed of:Buyer's right to cancel this Agreement. 00 NOT SIGN.THIS CONTRACT IF THERE ARE ANY BLANK SPACES.. Reriewal by Andersen Corporatlah E3uye Buyer(s) Signature of Consultant nature Signature X BRUCE:'PECK- COURTNEY SCR:UGGS Printed Nam of Constittant Painted Name Prkited Nam I YOU,THE 60YER(S),MAY CANCEL THJS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AF MA THE DATE OF THIS TRANSACI'1OM. SEE THE ATTACHED NOTICE OF CANCELLA'nON FORMS FOR AN EXPUWATION OF THIS RIGHT. - ---"-'------=---------------------------------- ----- - N(YI"ICE OF CANcEt:G1€'i s .. NOTICE TIF CMCELL ATION Date of 1cansacrum 'VjVi'> .Youmay cancel this Date of Transaction VQII: You maycacw.'rlthis. tradsaction;.without any penalty or abligatiou;within three busiutrss data from the � traosacdon;witbout any penalty or obligation w4ehin 5;rwe business days from the abave� data If you,r nee7„any property traded in,..any payments made by*lou ander ahme date.if you cancel,ant property traded itt,any payments made by you under the Contract of'Sate�and wary negotiable Instrument executed by you twill be the Contract of Sale,and any negotiable Iorstrumeoi earcntad by you wwil i±e 'returned within 10 days iWowing receipt by the Contractor i'°Seiler"J of your � returned within 10 days following bytheCuniracasf(�Srfficr") of your cancellation not",sad any securityinteresf arising out of the transaction will be eaa llation:nodeea and mytaecuritt inlereal.arising not of the transaction win he canceled. If you c*mvet you uutst makeavaltable,to.the Serer at your ressdcnce,.in I- cunc+rles4 Ifyou cancel,you matt maim available to the serer a#y ourtv"dent"e in .suhstantially as gooey condition as when received,any:gocdx delivered m yea under I substantially as good eaatdition aswhen received,any goods delivered to you under' i this Contractor Sale;or you m' a v ifyou wish,comply with the instructions of the I. this Coatract or Sale;or"array,if you yrish,cotirply with.the.instrutd mx,of the Seller regarding the'return shipment of the goods at the Seller's expense and Irish. I Seiler regarding the return shipmentof the goods at the Seller's eapeast:and.risk. If you do make the goads avallabte to.the Seller and the Seller does not pick them up if you do make the goods available to the Seller and the Setter does not pick them up "w4#hixt 20 days of the date of yore tiTn#.$cr of Cancellation,you may retain or dispose.I- within 20 days of the date of your Notice of Cancellatihn�}'au may retain or dispose. of goods xithout am:fnether obtiodoo..:lf yoo fart to tttake the goads awaaaable�� of the goods without any further obai ation..lt yon fait en uiaixe#the puaaEs available.,: to the Seller,or if you agree to return.the.goads to the Seller and fa?i.ta do so,then I to the Sell",or if You,agree to return the gootis in the Seller andfail to do co,then yvrtt r,tmain 1iaWr for per fnranant a of all nbligaetonsc under the Contract.To cancel -�- you rental&liable for performance of alt obligations under it.Cassel.To cancel this transaction,mail or deliver a signed and dated espy of this cancellation notice. t this tramaction,mail or deliver a siga ed•and dated copy of this cancellation aesHce or any other wri#ern testi or send a telegram to Contrartar:R~. .wal by Andersen,i nr stay arker written notlre,ar pend s tell rant to ConiraMur. Renewal by Andersen, 30 Tarbes Rd. Norah horvugh KA 01332, r 30 Tarbes Rd.Northb ruttgh,NSA 41532. t IPF3iF,81'f:AivCEI.'I}if5'T1iANSAC'."i9t}Ifi:: I I HElimy cANcELTms T'RAxsAcrxo.N. 4�rycH's Sara..ra r ra Nar*ae.. JaDa Fiyrt'sroten Y,ieH Ne-,n. .._,_ . ......., eC1E'wI Renewal by Andersen Corporation AAA Horne Imp tavemeni Contractor. }yAridtse 30 Forbes rd Northborough,ASA 01532 I:tcense#170810 (Expires 12123/2015) ,w,»aow nrrtasenaen q r—C,E a- (508)351-2200 Fax.(508)-986.7072 Federal ID#41.1$18413 Window Specification Sheet 13tie i s Name Date tit'/sgrecrnrfit COUR-iNF-'Y 3CRUGGS TuE, MAY 12, 2015 1"tit IRilt ii i listed:tiXA !ht rrhy ifnlltl}`and'ievvralll.tgrvcto purcha"c dw goods and/ors n iccs lifted bt`low,in alronrlat1ce wit i the pt c(,.1 and terms descd7t;wd ori.tits.`o ifiratioll Sheet and the firtdl anti the tc k,vise of flit-acc.owntl ming" cl..S 1�t;Al 111�t`9OV AND I"OOR I21u't1t)i EUANf i-1C3RET.iLii?�"1;of uati(It fire 4lirritivation Sheet iq past..;. WINDOW&DOOR DETAILS ra=w Dnp npax E)(tanorflntertor Calor Hafthirare Harlome: LOWEst 4ar4na Cyrill" Glass Room: a &idlh nelpat UJ' WindOWII)Dor Slide DetatI Cast- z Eztdrlt Color stjlo sones snwuun Grike Sash ire'. sash 2: Uffs options Porch E ill trtttl" p PS raft int/Ext MF Flat VVH/WH Sat.Nickl Newbu FF.G Smartsu,, done Porch 102 ('1` 80" 0, PS.rafa Int/Ext MF Flat WHMH Sai.Nic'ki fiteww u FFG arisu. Porch' Io:'l tao sift lac; GTfultframe 1:2,1 Int/Ext MF Flat tilWH White Standard FFG:-smansir :tdra;m Bed 1 201 31 fit 76 DB rail-.ual insert sloped sill None MiAYH White Standard FFG 5rnartsur ttafvl 3/2 N2. Bad 1. `r(12 31 4:i 76 D6 sq call _oaf insert sipped silt None VH/WH White Standard FFG martsu: iiarw S/2,. 312 .. .. ..... Bed 1 203 20 6 84 UB- uare Cott full frame int/Ext MF Flat VVHIWH White Standard FFG mansor tmw 212 214 "tem r: Bed 1 M 20 (A- 84 DIS square colt full frame inVExt MF Fiat rH1WH White Standard FFG rnartS lialw 2/2 2I4 Temper jBed 2 2ti:r ;3176 DB sq rail equal insert sloped si11 None K101H White. Standard FFG arts iww 312 2,t2 d 2 206 :3) ,45 7& DB so rail equal insert sloped sill Norte HtWH Waite. Standard FFG ansu, Vow 312 3/2 d 3 207 31 15 76 DS sq rail equal insert sloped sill None WHIWH White.. Standard .FFG ismartsu-.1 Itaw I w2 312 i i Toni .10. BAY BOW&BUILD OVT DETAILS We Detail l .AP pmx Sryi width; Appraz, Ntunbaa Fratno Windos�r Eno! Center Low£t Roofs Mwelware3 Roo Couett a. Ftanteo i ha'in Cara Mgk Litee i fetter Exti7ntCasor Grifts sashes 3testtss Serecrts Snrrtaun Soffit Gator SPECIIA Y WINDOW DETAII Full r Approx. t.a,vE 1 Specialty RAY/HOW ADDITIONAL WORK NOTES --Room - Count Style Insert U.I. Grilles- Gr1lfp$-k£ ExVint Color t tt u"nrr i,"'Vi"IGV'l a,tett NIV in),xm,ntra.,unrks:.s ia+rdttr- tatriiib;ncaa!a*tletx. ADDITIONAL WORK DETAILS: ....... . I No Contractor will w!M exterior casings With coil stock color of Owner is aware that Contractor does not do env painting/staining or removelliristaltation of alarm system or window treatmentslhardwa ei It is the iesponsi6oity of the homeowner to have the alarmsystem and window treatmentslhardwaare removed prior to installation, We make no guarantee as to whetherale nns ar window y treatments/haiafware will fit after replacement. Customer is also aware in same cases there will be glass loss. If:ttiere is,tha amount wiR.tus.d rident on the type A of existing windows,ti ype of installation and window styte.Me make no guarantee as to the amount of glass loss.Customer is aware and.undeistands any and atl unseen rot is not included in this contract.Should any rot be found there wifibe an additional charge for time and mate4sa unless so.stated in this cantract. 3 yes Contractor will insulate,caulk and seat windows with 3-point system to prevent water and air infiltration.Removal and d€sposat of ail job.telated debris, windows,doors,storm Windows and vacuuMnightly included. Upon completion of the job and payment In full,a limited warranty shall be issued. i Yet,; Building Permit--Contractor Ninal secure any and all necessary permits. The fee for the Permit($)Is Included In the total contract price- 5 rig5 Yes All ciiswuhts have been applied to this agreement. s' v: Y"s N,, ::;Owner agrees to be present on the final day of installation for final inspection and to deliver final payment t finance formis). i FI[isagro'r'diirldkill,li'lNi(uA€wMid lie:tnaerntheRatifiersthatflu.lttiafii:aliml"+liveltalunlrtri€h Ois(1.DIY'ANSI\I)IAV:flit)DO(RIllxlt)l)f.l.L\r(.NtbI2I,I:MEV"I,restiesi,ttitisdie entin ;ttirtt.ibtaiitliti lx-tt"rvtt alit 1 site«„cct€i ilerer erre tirr rmrla"f etre la rJ.uict,tiq a lasust#nit tit iur)dalki:il am,tyf the trnis."hhi lin,itit::it ahs slw l earn'ai"d firs c;liatt),it ar qs lerlm noilified t,t caaricdiin arty n;it stuli"'e"treat("ltra,g t air ij,ointnx and sigtiM it la)tiI tc Buq`r't'.v'� sitt6 C lilracier. ' + Y:t Br1-ail n:a,led c di a 3""1 Tfr;lair wad du,ltxtisu uea.i S3ur,i; Renewal by Andersen Corporation Signature of Consultant: Signature Signature BRUCE.PECK COURTNEY SCRUGGS Print Name'of Consultant Print Name Print flame Ren' ' Renewal by Andersen Corporation,,. jGrtr� lc �' iigttra► ar, r « R t. srgs t € srre rtt YAn&m' n. Ing Mow(508)35 1-2201) Fax r ��rz�t,.,�s �� 10(T WINDOW RFPLAtj:M T- &4 1 a3xs fYi $rCR�9.. Com Uzi bt3t rt l t $. �° t t #s� t ktttk"i IN to the 0JN*T "A wjxtx.:l'w mv�t:y booMacl,,'FAR IN hGAUNUNT Beres# lvtwk,no it 1w Am&,r r coel-ki6lim aim L001 is.y r i o 4.x1 e'"") Umil for 140 BUY0,11. 1 wr dw agj.,:i tv iffilor€c Ald"niAty,' . tta'li,;a# wtoa st,it � `.#fte- rvemoIl wtil t imialsi.Ir it t. �t z arc foo,L #`irArrrCIIdmomi i 44 1#o#fir 1o'n;gi0 Ass r41rIf'io lxvimwni II 1� falkl wItiv,iiddii.lxmm,attorato oi= t #ion arse`vi mg ai:l , . DrOop4d 1 GT and ZPS gliders ,ort lnal'twtr,&ct $12,381.00subtracted f rant tot&l crest. As"A reugh of ffi�k er ralok Hive folk irrg tertxts& lbe Agivot'len r%,� mlsoAmv, bag fl loh blank or I+ ,,WMolafjL +x1rr "tr tt #I KL vi QV.1al d q,. (irMll Ski F`IMM ` " d ho rwciwd A c le d, sd,smd cf Ws t k on ft doc wAft Wow, E-Slq 1 ; QV`2412,01511641ZMCST Si ialu.retsC +� �y�t sr«`�`�•1l� � y���r�.gym r -#spa � fav PRODUCT PERFORMANCE Andersen'NRC Certified Total Ursa Pesforaaoee (continued) Andersen.Produci: Glass Type Mactor' SHGCI VP 'zoo Series. ;. . Clear Dual Pane 0.45 0.60 0.63 a - : . "Gear Dual Pane vrith Grilles 0.45 054 0.56 - -Tin-Wash Low-E 030 032 0.55 Double-Hung-Window Low-E with Grilles 0.30 029 0.49 n HP Lnw-E4 SmartSun 0.30 021 0.49 HP tow{&SmartSun w/Gales 0.31 0-19 0.43 - • Clear Dual Pane 0.45 0.61 0.64 - Narre6ne' Clear Dual Pane with Galles 0.45 0.54 0.57 - Double-Hung Window; Lmv-E 030 0.32 0.56 " low-E-th Galles 0.31 029 050 • .. Clear Dual Pane 0.44 0.63 0.66 1. NarroBne` - Clear Dual Pane with Galles 0.44 0.57 0.59 Transom Window Low-E 0.27 034 0.58 Low-E with Galles 027 C 30 0.52 Gear Dual Pane 0.45 0.60 0.63 - . Clear Dual Pane,.ft Galles 0.45 054 . 0.56 Gliding Window - I Law-E 0.30 0.32 0.55 . Low :with Grilles 0.30 029 0.49 - Lmw-E Sorenson 0.30 021 0.49 . P• - Low{SmartSun with Grilles 0.31 019 0.43 Clear Dual Pane 0.43 0.61 0.65 - Clear Dual Pane with Grilles 0.43 0-55 = 058 �6 Fured;Transom;,, Low-E 028 033 0.56 :,� Cirele Top'Window Lmv-E with Galles 028 030 050 '•J 'tow-E Sman_Sun 027 022 0.51 Loo E SmartSun with Galles 027 020 0.45 y{ - Clear Dow Noe 0.44 " 0.61 0.64 - �) Clear Dual Pane with Galles 0.45 053 0.56 - i 1nw{ 029 032 0.56 - NarmBne' - Low-E with Galles 0.30 029 0.49 Griding Patio Doors Law-E Son 029 020 0.31 Lnw-E Sun with Galles 0.31 0.18 027T y Lmv-ESmartSun 0.28 021 0.50 +p. w-E SmartSun vft Galles 0.30 0-19 0.44 Clear Dual Pane 0.43 0.61 0.64. - p r Dual Pane with Galles 0.43 054 0.56 - d Low-E 028 032 0.56 - f rma-Shield Low-E with Gn-Oa 0.30 019 0.49 Il tiding Patio Doers lovtE Sun 029 019 0.30 P - - Liz Sun wb Grilles 030 017 027 I _. Low-E SmartSun 027 022 050 low{SmartSun with Galles 0.29 019 0.44 ' Clear 0021 Pane 0.43 0.45 0.47 - Clear Dud Pane with Galles 0.43 039 DAD - •''4 Lox E 032' 024 0.41 ll HingedJnswing Low-E wMGnlles 0.33 021 0.35 Patio Doors ': Low{Sun 032 0.15 am Low-E Sun with Galla 034 0.13 0.19 - I4 LmwE SmartSun 032 016 037 Low{SmartSun with Galla 033 0.14 0.31 - �i i we' NDO WS•DOOIRS no Andersen NFRC Certified Tata! Unit Performance (continued) i " Glassl e I U Factor' SHGC2 VF' e ni 'Andersen'Product )rP Andersen'Product ' Glass Type U-Factor' I SHGC2 ! Vit' l ; 400 Series Arc0.47 F-7hitectural_. ; ' - � � HP law-E4 032 028 � i HP Lour-E4. 0.27 035 0.60 NP Law-E4 withGrilles 028 031 0.54 HP law-E4 with Grilles 0.32 025 0.42 s HP Lmv-E4 Sun 0.32 0.17 0.26 Circle Top" HP Low-E4 Sun 0.27 021 0.33 N Casement Marlow Casement Window HP Low-E4 Sun with Grilles 0.29 0.19 030 i HP Low-E4 Sun wNr Gillies 0.32 0.16 0.23 _ HP Low-E4 SmartSun 0.31 Ell 0.18 0.42 "' I t' HP La'w-E4`SmartSun 0.26 023 0.54 (M .' Ffl HP lax E4 SmartSup w/Grilles 028 021 0.49 ^•�. � HP tan-E4 SmartSun w/GdBes 0.31 0.17 038 �2 HP Low-E4 0.32 028 0.47 HP Low-E4 021 035 0.60 HP Low-E4 with Gilles 0.32 025 0.42 :M , - HP Law-E4 wdh Grilles 0.28 031 0.54 HP Low-E4 Sun 0.32 0.17 HP lmr-E4 Sun 0.27 021 0.33 French CasementHP E4 Sun with Grilles 032 0.16 023 Circle&Oval Window HP Low-E4 Sun with Grilles - 029 019 0.30 Window _ HP Low-E4 SmanSun 031 0.18 HP Law-EQ'SmartSun 0.26 023 0.543 _ HP Law-E4 SmanSun w/Grilles (1.31 0.17 0.38 r ;. HP Low-E4 SmadSuh w/Gnlles 0.28 0.21 0.49 i fffl. f i,1 r. ,�'' HP Law-E4 032 02 0 8 .47 : HP low-E4 028 0.33 0.58 _ -}a HP low-E4 with Gilles 0.32 025 0.42 . HP lour-E4 with Grilles 0.29 0.30 0.52 028 HP Low-E4 Sun 020 0.31 th M IIP Low-E4 Sun 032 0.17 026 Awning Window Hp(Ayr-E4 Sun with Gilles 032 016 0.23 °rl Arch Windim HP Law-E4 Sun with Grilles 0.29 0.18 028 4 HP Low-E4 SmartSun 0.31 0.18 0.42 HP lmv-E4 SmanSun 027 023 052 . '*. F HP Low-E4 Low- n /Grilles 0.28 021 0.46 F�� -`..r HP Lmv-E4 SmartSun w/Grilles 031 0.17 0.38 r' HP Low-E4 031 0.32 0.55 ••f 'IHP Low-E4 0.27 033 0.58 s IIP low-E4 with Grilles 0.31 029 0.49 HP Law-E4 with Grilles 028 030 • 0.52 - HP Low Sun 031 020 0.31 HP Low-E4 Sun 027 020 0.31 I Casement/Awhing 0.18 0.28 ). Flexlframe`Window Picture Window HP Law-E4 Sun with Gilles 0.31 HP Low-E4 Sun„wfth Grilles 0.29 0.18 028 T '`i R HP Low-E4 SmanSun 0.31 021 0.50 ( j HP low-E4 Smar(Sun 0.26 023 0.52 0.19 0.44 SmartSun w Gr01es 0.31 UP Low-Ell / HP Luer-E4 SmoriSun w/Grilles 0.28 021 0.46 '4 HP Low-E4 030 0.37 0.64 ? ljHP Low-E4 031 033 0.58 HP twr-E4with Grilles 0.30 033 0.57 '�'�i' HP low-E4,wBh Grilles 0.32 030 0.52 Fr•� ,: � HP law-E4 Sun 0.31 022 036 -.. In- 0.31 020 0.31 ow 32 �N HP Low-E4 Su Specialty wmd 020 0 spdngline'window - Sp ty HP Low-E4 L Sun with Grilles 031 NP Law-E4 Sun,�,wRh Grilles 0.33 0.18 028 � �� ,^; "••=. HP Lmv-E4 SmartSun 0.30 (124 0.58 HP low-E4 SmartSun 030 023 0.52. ,lei F HP low-E4 SmartSun w/Grilles 0.30 022 0.52 l:k;, UP Low-E4 SmortSun w/Gdlles _0.32 021 0.46 E's • �"t� Hp kyr{q 0.32 022 037 �; HP Low-E4 0.30 027 0.45f fR, HP low-E4 with Grilles 033 020 033 HP low-E4 with Grilles 0.32 023 0.39 %iiti "�' HP Lmv-E4 Sun 0.31 0.16 025 f Hinged inswing HP Imv-E4 Sun 0.33 0.14 0.21 - Frenchlwood' - - - Finned Door HP Low-E4 Sun with Grilles 0.34 0.13 0.18 Gliding Patio Door tip low-E4 Sun with Gil '" Grilles 0.32 0.14 0.22 qi:. lip SmartSun SmartS032 IIP Low-E4 SmartSun 0.30 0.18 0.41 R? UP lots{4 Spin w/GdOes 0.33 0.14 0.30 - � HP Lmr-E4 SmartSun w/Gilles 0.31 016 0.35 >' s HP Law-E4 033 025 0.41 a HP lave{4 0.31 024 0.41. Tiq :`1 _ � ., 5; IIP low-E4 with Grilles 0.3M1 022 0.38 w j HP tmr{4 with Grilles 0.32 021 ." 035 HP law-E4 Sun 033 0.16 0.23 o HPLow-E4 Sun 031 0.15 0.23 !"x °` 'i Hinged Outswing _ Fnmchwood^Hinged- i French Door HP Low-E4 Sun with Gfi 035 0.14 0.20 Inswing Patio Door HP Low-E4 Sun with Gilles 0.32 0.13 0.19 - Ilp 1px{q SmartSun 0.32 0.17 037 F! HP low-E4 SmartSun 0.30 0.16 0.37 ?'s HP Law-E4 SmartSun w/Gilles 034 0.1 _ UP lour-E4 SmartSun w/Gilles 0.31 0.14 0.31 f�?. i:?r. 5 0.32 - E e 1-:;F: HP Law-E4 033 023 0.38 HP Low-E4 031 D25 0.41 rHp Law-E4 with Grilles 0.33 021 0.34 - NP Low-E4 with Gilles 0.32 02 1'4�f 1 0.35. ,rr,._i - Hp�y{q Sun 0.33 0.14 021 - HP:Lmr-E4 Sun 031 0.15 023 *'•i FI Feed French Door- - Frenehng.Pa Hinged'; ' Sidelight HP low-E4 Sun with Gilles D34 0.13 0.19 Outswing Patio Door l HP Low-E4 Sun with Grilles 032 0.13 0.19 .t1 - - LIP Low-E4 SmanSun 032 0.15 034 - HP Low-E4 SmartSun 0.30 0.17 037 b. '!• Hp Low-E4 SmanSun w/Grilles 0.33 014 0.30 - HP Lmr-E4 SmartSun w/Gdfles 0.31 0.15 0.31 � + HP Wv-E4 032 025 0.41 - j Q HP Low-E4 031 0.22 0.37 " - HP Low-E4 with Gilles 033 022 037 - HP Law-E4 with Gilles 0.32 020 0.33 i[•i 'j t{p Law{q Sun 032 0.15 0.23 - Frenchwood` HP Low-E4 Sun 0.32 0.14 0.21 h°i !•':�f Feed Transom - _ French Door HP Low-E4 Sun with Gilles 033 0.14 0.20 Patio Door Sidelight NP law-E4 Sun with Grilles 0.32 0.13 0.18 _'�`_. t Hp lnv{q SmartSun 0.32 0.16 037 - HP lax-E4 SmartSun 0.31 0.15 0.33 i f°" HP Low-Ell SmartSun w/Gilles 0.32 0.15 0.33 - HP low{4 SmanSun w/Gilles 0.32 0.14 0.29 "* ? Np�yr{q 035 026 0.44 - HP Low-E4 0.30 024 0.40 _ HP lmr{4 with Gillies 036 023 038 HP Low-E4 with Grilles 030 021 0.35 F '+ HP Law-E4 Sun 0.35 0.16 0.24 -_ NP Low-E4 Sun 0.30 015 0.22, irk ` '�! Faldmg Door Frenchwood' _ DHP LD-&-E4 Sun with Gilles 036 0.14 021 - Patio Door Transom HP Lmr-E4 Sun with Grilles 0.31 0.13 0.20 Vq Np Low-Ell SmartSun 034 0.17 039 - HP low-E4 SmartSun 0_29 0.16 0.36 Hp tow-E4 SmartSun w/Gilles 0.36 0.15 034 - fIP Lmi-E4 SmarlSun /Grilles 0.30 0.14 0.32 r'.FA continued on nert page •For NFRC certified total unit performance on units with capillary breather tubes for high altitudes,please visit andersenwindows.com, "High-Performance"Low-E4- Low-E4), -Performance"Low-E4'SmartSun-(HP(HP Law-E4 SmartSun)and"lligh-Performance Low-E4'Sun'(HP low-E4 Sun)are Andersen tredemarks tor'Low-E glass_ -" ' U-Factor defines the amount of heat lass through the total unit in BTU/hr sq-ME The lower the value,the less heat is lost through the enure product Window values represent non-tempered glass.Use of tempered glass can increase Il-Factor ratings.See andersenwfndows-com for specific performance values.Door values represent tempered glass. nd subsequently released inward_The lower the value,the less heat is 2 Solar Heat Gain Coefficient(SHGC)defines the traction of solar radiation admitted through the glass both directly transmitted and absorbed atransmitted through the product freme).The higher the value,from 0 to 1,the more daylight the product lets in over the product's total unit area.Visible Transmittance 2 Visible Transmittance(VF)measures how much light comes through a product(glass and is measured over the 380 to 760 nanometer porton of the sola(spectrum. •NFRC ratings are based an modeling by as third party agency as validated by an independent lest lab in compliance with NFRC program and procedural requirements. • duct changes,updated test results or new industry standards or requirements,this data may change over time-Ratings are for sizes specified by NFRC for This data is accurate as of December2010_Due to ongoing pro rille options,glass for high altitudes,etc. testing and certification.Ratings may vary,depending on use of tempered glass,different g •PassiveSun"glass values are avafabte online at andersenwindows.com. 277 I/ Renewal bYAndersena 71 WINDOW, REPLACEMENT anAndetsm(>;npaop r Wood/Vinyl Composite IF 'f ` ' Dual Argon Low E4 SmartSun Double Hung 100-00473518-010 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient ao2 9 0019 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance I ® o ��. Manufacturer stipulates that them ratings conform to app6:aala NFRC procedures la determiniig Whole product performance.NFRC rafts are determined for a Fored set of environmental conditions and a specific product site. NFRC does not recommend any product and does not warrant the sueandey of any product for any speeft use. Consuh manufacturer's literature for other product performance information. y www.nfrc.org " ✓� This product meets Green Sears envconmental standards governing energy '• �'r.�.. �x• elheianzy,heavy metals in ''the Irame and eash f';rx,^:•^;;y:o,-:`yi:r >.%;•. ftmateral,Paclmging,and ®• ::k: . .,c.;%S;s f•.{� { 7GM consumer educational [? `•{'`":"S%..�t �}C`� .:...:.;....::` i`. - c��r materials. ,w„w•rsr ..jr.'.- •.�:j•iY'� I DESIGN PRESSURE(PSF) ' 'a Manu afaeWrtrsmcatim LC25 RbA DB Sl pedacom Sill DH IN TestedtolUFS42araaMA4'AMIJCS 1 0404)& Manutac•Ner st tes conformance to Ltea ficamta startaarfle. ,deete or exceeds M.E.C.,C.E.C,81.E.C.C.Air InlNtration requirements WDMA Hallmark Cenifieation Program. { i I Do not remove until final code inspection. Save label for future reference. 13i :,,w� I 7 energystar nman- ;1 `•� t rnean.gccaca {E .,t7.Y ='• t 'k C14 0) zm v �• �� energystar.gov ®=Qualified/Admissible 1 I Rene al WINDOW REPLACEMENT anAn&rsenC:ompany AND-N-35 3`r.�:1.,.,a;r. Wood/Vinyl Composite FF Dual Argon Low-E4 SmartSun Product Type: Glider ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0.29 1.65 021 U.S./I-P Metric/SI • ADDITIONAL PERFORMANCE RATINGS Visible Transmittance o 0 o 4 Manufacturer supulstes inat these ratings conform to applicaole NERC procedures for determining wnote product performance.NFRC ratings are determined for a feces set of enironmentat contlitions and s specific product sae. NFRC does not recommend any product and does not warrant the suitatioity of any product for any specific use. Consul manufacturers literature for otner product performance information. www.nfrc.org a Window and Door D Mnsou twef. CCL Andersen Co oration:Rwo Win Glidin dow anutec ren pu a es contormanee o e ro ovnng standards Standard Rating OFS OgBr/Ms1s^JC4Rk Ed,•xtl?":S.^Jh9C0 0fs..... D'P pst--I.S-C35- Tnls product meets Green Sears 4 i environmental standards f:Dgoverning energy efficiency,navy metals in the frame and sssn materizi.pacnging,and Ilk-N consume r educational UA materials 100-00512036-015 Wats or e x els M.E.C.,C.E.C.&I.E.C.C.Air Innldration requirements WOMA Matlman(ceftlflcation Program. 4 The Commonwealth of Massachusetts Department of Industrial Accidents Offwe of Investigadons I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApIRlicant Information Please Print Le •bl Name (Business/Organiza6onllndividual): RENEWAL BY ANDERSEN Address:30 FORBES ROAD City/State/Zip-NORTHBORO, MA 01532 Phone#:508-351-2200 Are you an employer?Check the appropriate box: l. 1 am a employer with 30 4. ❑ I am a general contractor and 1 Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a soie proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working forme in any capacity, employees and have workers' Building[No workers' comp.insurance comp. insurance.: g. ❑ ng addition required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doingall work officers have exercised their 11.0 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 comp.insurance required.] t •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. s t Homeownerswho 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-conttactors and state whether or not those entities have employees. If the sub-contractors have employees,they mast provide thou workers' comp.policy number. I ani an employer that lsproviding workers'compensation Insurance for my employees'. Below is the polky and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy#or Self-ins.Lie. •#.MWC 30293800 Expiration Date: 10/01/15 Job Site Address: / `� 3�4� S� City/State/Zin• t O Aw0 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 s 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 A for insurance coverage verification. I i I do hereb R and penalties of perjury that the information provided above is true and correct Date: 05/19/15 Phone M 5 51-2200 Official use only. Do Trot write in this area,to be completed by city or town official. s i City or Town: PermWUcense# Inning Authority(circle one): 1.]Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phoned: 4 f ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCEDATE 1101120 14 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. ff ,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 endorsement(s). PRODUCER CONTACT NAME: CertlflCa Ilis.com Willis of Minnesota,Inc. PHONE c/o 26 Century Blvd No Ext:(877)845-7378 FAX No:(888)467-2378 P.O.Box 305191 E-MAIL Nashville,TN 37230.5191 -- ---- -- --- -- 1.NSU�S AFFORDING COVERAGE NAILS INSURER A:Old Republic Insurance Company 24147 INSURED INSURER 0: Renewal,by Andersen Corporation INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01632 o SURER 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 CONTRACTOR 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. INS1 TYPE OF INSURANCEEXP I POI.JCY NUMBER LI Lam A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. CLAIMS-MADE a OCCUR MWZY302940 1010112014 10/01/2015 PREMISES Ea arum S 500,004 MED EXP(Any ate person) $ 10,0 PERSONAL&ADVIWURY $ 1,000,00 GEMLAGGREGATE LIMIT AP(PUESPER: GENERAL AGGREGATE ; _4,000,00 X POLICY❑JECT U LOC PRODUCTS-COMPIOPAGG S -- 4,000,00 OTHER: ; AUTOMOBILE LIABILITY a O I $ 5,000,00 A X ANY AUTO MWTS302676 10101/2014 111110112015 BODILY INJURY(Per person) s ALL OWN ED AUTOS ED ABODILY INJURY(Per aoddenQ S HIREDAUTQS NONAUT-OWNED PE DA E S ; UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE ; OED RETENTION$ ; WORKERS COMPENSATION X AND EMPLOYERS LIABILITY YIN STATUTE ER A ANY PROM ETORIPARTNERIEXECUTNE M=30293800 10101/2014 10/0112016 E.L.EACH ACCIDENT $ 1,000, OFFICERIMBABEREXCLUDED? a NIA PkyeMs,ktMyleNMI E.L.DISEASE-EA EMPLOYEE S 1,000, DESCRI,,,00,0,OPERATIONSddow E.L.DISEASE-POLICY LIMIT S 1,000,0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMmW Remarks Sdwdde,may be d4c1ted B nae apace Is n dyed) .f s 6 s s E I F CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3 AUTHONZrD REPRESENTATIVE Evidence of in mance 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD tJ Massachusetts-Department of Public Safety Board of Building Regulations and Standards. Construction Supenisor ,z License:CS490125 r%, 1 ��/ JAIME L MORIN= ;r `" 2! ,,r r , 86 GARDINSR SSlF . •. :ff .• . LYNN MA 01998 .' z � �"tiwtw k• 4A Expiration Commissioner 10/08/2018 g G�i�s �ooaxmwneu.ea�o�Q!1!{aa� l � 4 9 s ifice of Coaaamer Affairs&tinalness Replatioo t E QYIPROVEIVIENT CONTRACTOR ttep'mtratlon:.,1701tE3. F.xptraaon. Type, Supplement I RENEWAL BY ANbER$ON CORPORATION ;4;• JAIME MORIN t 104 OTIS STREET NORTHBOROUGH,MA 01532 Underwereta i s r f 1