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Miscellaneous - 169 ANDOVER STREET 4/30/2018 (2)
169 ANDOVER S7 210/059.0-0018-0000.0 `. 1 i ' II � I r I I 4 i I I 1 i North Andover Board of Assessors Public Access Page 1 of 1 pORTH North Andover Board of Assessors � p t f '�i•�O•.no�4� 'sSwcHuSEs 7ziroperty Record Card Click Seal To Retum Parcel ID:210/059.0-0018-0000.0 FY:2013 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Elarc Search for Parcels ` Search for Sales Summary Residence " Detached Structure Condo t 1 Commercial Location: 169 ANDOVER STREET Owner Name: BOND,D STEPHENSON C/O KELLEY M.REED Owner Address: 169 ANDOVER STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 0.63 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 4941 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 659,700 791,200 Building Value: 462,500 589,500 Land Value: 197,200 . 201,700 Market Land Value: 197,200 Chapter Land Value: i LATESTSALE Sale Price: 660,000 Sale Date: 11/16/1999 Arms Length Sale Code: Y-YES-VALID Grantor: DOROTHY HAMMOND/HILL Cert Doc: Book: 05608 Page: 0344 http://csc-ma.us/PROPAPP/display.do?linkld=2253834&town=NandoverPubAcc 3/26/2013 1 Residential Property Record Card PARCEL_ID:210/059.0-0018-0000.0 MAP:059.0 BLOCK:0018 LOT:0000.0 PARCEL ADDRESS:169 ANDOVER STREET FY:2013 PARCEL INFORMATION Use-Code: 101 Sale Price: 660,000 Book: 05608 Road Type: T Inspect Date: 05/05/2011 Tax Class: T Sale Date: 11/16/99 Page: 0344 Rd Condition:_ P Meas Date: 05/05/2011 Owner: __ _ ,.,. BOND,D STEPHENSON Tot Fin Area: 4941 Sale Type: P CerUDoc: Traffic: IVI Entrance: C C/0 KELLEY M.REED Tot Land Area: 0.63 Sale Valid: Y Water: Collect Id: RRC: IO K - Grantor: DOROTHY HAMMOND/HILL Sewer: Inspect Reas: C 169 ANDOVER STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% I NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION i Style: CL Tot Rooms: 10 Main Fn Area: 3221 Attic: N NBHD CODE: 6 9N13HD CLASS: 6 ZONE: R3 _ Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1720 Bsmt Area. 1720 Seg Type Code Methodw Sq-Ff Acres Influ Y/NT Value Class _..__...___.._ Roof: _G Full Baths:•' '` 3- Add Fn Area:�-_• • Fn Bsmt Area: 1 P 101 S 27626 0.630 197,230 Ext Wall WS Half Baths: 2 Unfin Area: Bsmt Grade: FA DETACHED STRUCTURE INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 4941 _ o - Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond Good P/F/E/R Cost Class /o Foundation: ST Bath Qual: T RCNLD: 451776 -~ Kitch Qual: S Eff Yr Built: 1980 LL Mkt Adj: G1 S 440 0.00 1988 A A 50W50 7,700 SE C 512 0.00 1988 A A !//85 1,900 Heat Type: ST Ext Kitch: Year Built: 1836 Sound Value`. S1 S 160 0.00 1988 A A ///85 1,100 Fuel Type: G Grade: G Cost Bldg: 451,800 ' Fireplace: 6Bsmt Gar Cap:_ Condition: G Att Str Val 1: VALUATION INFORMATION Central AC: Y. Bsmt Gar SF: Pct Complete: __ Atf St Va12: Current Total: 659,700 Bldg: 462,500 Land: 197,200 MktLnd: 197,200 Att Gar SF: %Good P/F/E/R: /100//83 Prior Total: 791,200 Bldg: 589,500 Land: 201,700 MktLnd: 201,700 Porch Tyne Porch Area Porch Grade Factor W 216 SKETCH PHOTO 36 FM 501 Sq.R ' 33 3 44 J I va 2" e33 FU/FM693S33 s 1SSf 1027 Sq.R 24 18 RR Parcel ID:2101059.0-0018-0000.0 as of 3/26113 Page 1 of 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: -1 Date Received Date Issued: I� �I,- / IMPORTANT:Applicant must complete all items on this page LOCATION. t b`1 (fi4. &O ._ &Pa� _ -eN-c_ Print PROPERTY OWNER Print 100 Year Old Structure Ge no MAP NO: PARCEL: U"� ZONING DISTRICT: Historic District no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Crane family ❑Addition ❑Two or more family ❑ Industrial ❑ Iteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: c A Li aca( rz- 4,4,1 rel„ c--1 nju. (4.4 sAn,, eg Q.-L*a sc��r irM. C!t i\vrSw Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 1(.g Arrr6�,w 5��, rlo. A4vv- + v^r\a, CONTRACTOR Name: Phone: R-14 - 490 - 9q wo Address: 03 j Supervisor's Construction License: CS -0514 kcq Exp. Date:9---Z- ao 14 Home Improvement License:_ ( Co4t 1 ag Exp. Date: I'a - as au to 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: $ t Lk ,s-=, .00 FEE: $ c i Check No.: (U.� Receipt No.: S i NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of Agent/Owne ' r Signafure of contr . . _ - actor 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan F] Stamned Plans I-1 Location i m Ai�-11-- Date No.—q) TOWN OF NORTH ANDOVER ' 0ertificate of Occupancy $ Building/Frame Permit Fee $ — Foundation Permit Fee $ Y Other Permit Fee TOTAL $ Check# 25984 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ C TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature S ' COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature&Date Driveway Permit DPW Tow, Engineer: Signature: Located 384 Os ood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Departinentsignature/date COMMENTS II � 2 III X4'+5 "'xy Y � i w\ s a a5 t r I i The Commonwealth of Massachusetts j Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 U1. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ?_SV�A�tJc Address: 6t23 nr.p,mftS 1kmn, NOA City/State/Zip: Pki ,,,,, tqto p 3o-7b Phone#: 97k- q9t) (o(o Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. K I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.4 Roof repairs insurance required.]i employees. [No workers' 13.❑Other comp.insurance required.] Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' under the pains and penalties of perjury that the information provided above is true and correct. Sb4nattne: Date: b— Z Phone#: 9�?�'^ i0 -9Q(O& Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmefits and whoxesides=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 bicause-of-such employment be dee`mMtirbe'affeinployer` ` MGL chapter 152, §25C(6)also states that".every state or locai.licensing agency shall withhold-the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)bP'Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia i #"*'�HA9Jff Loff/we MAT# ER,5 inc_ November 11,2012 Sean Cormier ATTENTION: Sean 169 Andover Street PROJECT: 169 Andover Street No.Andover,Ma LOCATION: No.Andover,Ma 617-293-5294 Propos SCOPE OF WORK Furnish the labor and materials as follows: - Strip existing roof shingles off side of roof where extensive damage to roof rafters. I - Remove damaged pine boards and damaged roof rafters. - Install new roof rafters at damaged area. - Install new Y."plywood where pine boards were removed. - Remove exterior trim at bottom of same side of roof and install proper vents. - Reinstall trim with vents and new trim damaged from tree. - Install ice&water shield 3'up from bottom and install new 30 year roof shingles. - Install new cedar siding that was damaged or removed due to repair and stain to match existing. - Install new operating window at left side of fireplace&one in garage. - Install insulation in area that it was removed. - install new drywall where it was removed and install tape and joint compound. - Rebuild&install new sloped ceiling and interior window valence,pine,and crown molding at damaged area to match existing. - Pick up all debris from roofing and load into owners dumpster. - Install ridge vent along peak of roof. Total Price:$14,800.00 This proposal may be rescinded if not accepted within thirty days and is subject to approval of the construction work and payment schedule. Please give me a call if you have any questions. Thank you. David Maille &6m—Cormier Building Matters Inc. 563 Mammoth Rd. Pelham,NH 03076 978-490-9966 603-508-6792 (fax) AC40RVCERTIFICATE OF LIABILITY INSURANCE 11/14/2012°'Y ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pol)cy(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 endomement(s). PRODUCER CONTACT NAME: Jesse Foskett Anastasi Insurance Agency, Inc. aONE c, Ext: (508)248-1440 ac No:(508)248-1447 4 Brookfield Rd ADDREEMAILSS•a foskett@anastasiinsurance.com P.O. BOX 1261 CPRODUCER 00074874 U TOME Charlton MA 01508 —INSURENS)AFFORDING COVERAGE NAIC# INSURED INSURER A:Penn-America INSURER a:Commerce Insurance Company 279 Rodrigo Peroba, DBA: RGP Home Improvement INSURFRC:Liberty Mutual Insurance Cc 15 Lawrence St INSURER D: Apt. 2 INSURER E: Milford MA 01757 INSURERF: COVERAGES CERTIFICATE NUMBER:11-12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDDD EFF MM/DDY om EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 A CLAIMS-MADE OCCUR AC6972383 /12/2012 /12/2013 PREMISES Ea occurrence � 5,000 MED EXP(Arty one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE UMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY JECTPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT —$ ail ANY AUTO (Ea acddent) ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA UAB OCCUR . EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ SII DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION C VVC SLIMIT OTH- ANDEMPLOYERS'LIABILITY YIN TORY LIMIT ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE❑ EL EACH ACCIDENT $ 100 000 OFRCER/MEMBER EXCLUDED? N/A (Mandatory in NH) C131S375124010 0/28/2012 0/28/2013 E.LDISEASE-EAEMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Matters, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 563 Mammonth Rd Pelham, MA 03076 AUTHORIZED REPRESENTATIVE Paul Anastasi/ANAJFl ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. MF'df69fbd with pi fFactory trial The ACORD wwww pCl dC ory m d marks of ACORD NORTH own of t RAndover No. ver, Mass, • coc"ICNIIM ICK �,9 AORg7E 0 PQ s �U BOARD OF HEALTH PER Food/Kitchen Septic System THIS CERTIFIES THAT . ........ .Ire� �� !!��..... BUILDING INSPECTOR ............... IT... ....... .......... ..... ................... .. *a 211112 Foundation has permission to erect ...... .................. buildings on ....` ....... .. . ...... ....w............ Rough to be occupied as ............ ........... ...�!. .............. ... ...............................:.................. chimney provided that the person accepting,t is.permit shall in every resp 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 CONSTRUC N RTS Rough Service .............. .... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Massachusetts Home Improvement VENSe Contract This form satisfies all basic requirements ofthe s'tate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. }3omeowner�nforngaoll Contractor Information Name Company Name (1 aw J1 CU(Lr&-.ie r v c� Street Address(do not use aPost Office Boz address) Contractor/Salesperson/OwnegName I 3R A rv6 ve, g}. t Ate CA Q\Ai CityPTownState Zip Code Business Address(must include a street address) t�102kh ia+�Uw2✓^ VY�'ti. O $ ^ca '�-2. �d1� D'aytimePhone BveningPhone City/Town state Zip Code c�t r7- a - -a - Ma l ngAddress(It d ffere rt from above) Business Phone Federal employer ID or S.S.Number HameLnpmvement c-tmcterReg.Number Expiration date Law regnires thntmasHmmc hnprnyMhtnitian n avNid registration numGcr OCO The Contractor agrees to do the following work for the Homeowner: (Describe in detail the worlcto completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessa X .) 1'�`� se, KCTP.�`, Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as-the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits'witll be excluded from the Guaranty Fund provisions of t 20 t Date when contractor will begin contractedworlc. MGL chapter 142A.) LZ-L2-PLQ,—Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,ftnnish the material and labor specif ed above for the total sum of: S!44,$Uo y Payments will be made according to the following schedule: upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ Uvv by f 11112 or upon completion of $ by or/ or upon completion of $ Z_upon cempletion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)• The following material/equipmentmust bespecial $ to be paid for ordered before the contractedworlc begins in order to meet the completion•schedule.(**) $ to be paid for NOTE S,(1)Licluding all finance charges(*r°)Law requires that any deposit or down-payment required by the contractor before workbegins may not exceed the greater of(a)one-third ofthe total contract price or(b)the actual cost of any special equipment or custom made material which must be spacial ordered in advance to meet the completion schedule. LSmress warrtnty is nn exliress warranty bein provided by the contrgctar? ®Na❑''Ycs(SII terms of the warrinty mast be attached to the contract) party/subcontractor utilized by the contractor. The contractor further agrees to be solelySubcontractors The contractor agrees to be solely responsible for completion of the work described regardless ofthe actions of any third responsible for all payments to all subcontractors for materials and labor underthisa eement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not implythat any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract, e Don't be pressured into signing the contract.Take time to read and fully understand it.Ask questions if something is unclear, G Malce sure the contractor bas a valid Home Improvement Contractor Registration The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor registration by writing to theDirector at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. o Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or aslc to see a copy of a"proof of insurance"document. e 1R11owyour rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notifythc contractor in writing at his/her main office or branch office by ordinary mail,posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing oftbis agreement See the attached notice of cancellation form for an explanation of this right. DON®T"SIGN T19D[S CONTRACT II THERE ARE ANY ELAN]M<SPACES!I f o bat ics the contractmust be completed and sigeed.One copy should go to the lmmeoviner.The otter copy shotddbe kept by the contractor. Homeow Contractors Srgnatur �q t 1 Date Date �I Contractor Arbitration The Home Impiovemeut Contractor Law provides homeowners with the right to initiate an arbitration action(as an 'alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner'in court unless both parries agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home,Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this co -act,-the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary the rti e Office of Consumer Affairs and Business Regula' an e consumer shall be required to sub ' to ar ati as provided In Massachusetts General Laws,c HOme0wn s gn alt Con4x islgnature M E. e signatures of the patties above apply only-to ure agreement of the panics to alternative dispute on initiated by the contractor: The homeowner may initiate alternative dispute resolution even where this is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition.to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the.original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of finds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Impiovement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the 0CABRwebsite athtt7D://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit theBlCwebsiteatti=://www.tnass.g-ov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: h=://db.state.ma.us/li.oi-.neiLnpmv-eiment/licellseelist.au For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/2212010 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No M DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA—(For department use Notified for pickup - Date E - f Doc.Building Permit Revised 2010 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan u Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.,ted with the building application Doc: Doc.Building Permit Revised 2012 Date .l.� • .riL"Rlij ' TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . has permission to perform . . ��. � �.4 Ate,f. . .�jp,�, e,•,� wiring in the building of . .Cr��yy�. .61 . . . . . . . . . . . . . . . . . . • . • . • . at . .`. . . !�ji . .f ,. /.�'/) - -�e A . . . . .No h Andover, Mass. Fee . . . Lic. No. .i041 . . N�. . . . . . . . .�. t ELECTRICAL INSPECTOR Check# -7 91 1 1 189 i ! - L Official Use Only i Commonwealth of Massachusetts FP,-nTiit 4 Department of Fire Servicesnd Fee Checked BOARD OF FIRE PREVENTION REGULATIONS . (leave blank) I PERFORM ELECTRICAL WORK C 127 CMR 12.00. APPLICATION FOR PERMIT TOP ✓�j All work to be performed in accordance with the Massachusetts EDatC Code(MB ), IN OR TYPE ALL INFORMATION) Inspector o Wires: (PLEASE PRINT To the f City or Town of: NORTH ANDOVER r the undersigned gives notice of his or her intention to perform the electrical work described below By this application A �� Location(Street&Number) ��� Telephone No. owner or Tenant Jr' No (Check Appropriate Box) Owner's Address permit? Yes ❑ G� T O� Is this permit in conjunction with a buillding; Utility Authorization No.� Purpose of Building 6kl Volts Overhead Undgrd❑ No.of Meters p Amps 12012` 3 No.of Meters - Existing Service ?=0 _ volts Overhead® Undgrd❑ New e 2110-0 Amps 1 ZEA/ Number of Feeders and Ampacity 7,0Q Location and Nature of Proposed Electrical Work: y />� 56�� Com letion of the fo11owin table may be waived by the Ins ector of Wires. 4 Total � No.of IVA No.of Ceil:Susp.(Paddle)Fans Transformers KVA f No.of Recessed Luminaires Generators No.of Hot Tubs o.o mergency �g Ong i No.of Luminaire Outlets Above rnd. In Batter Units No.of Luminaires Swimming Pool rnd. FIRE ALARMS No.of Zones No.ofReceptacle tacle Outlets No.of oil Burners No.of Detection and tinitiaevi No.of Gas Burners InDces � No.of Switches Total No.of Alerting Devices No.of Air Cond. Tons Heat Pump Number Tons• K�?�!........... No.of Self-Contained No.of Ranges Detect►on/AlertiDevices n Totals: Local❑Municipal Other No.of Waste Disposers Connection ❑ Space/Area Heating KW Security Systems'. Heating t No.of Dishwashers Appliances KW No.of Devices or E uivalent i No.of Dryers No.of No.of Data Wiring: No.of Water KW Si ns Ballasts No.of Devices or E uivalent Heaters Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent ` OTHER' Attach additional detail if desired,or as required by the Inspector of Wires. A (When required by municipal policy.) Estimated Value of Electrical Work: ' issue unless Inspections to be requested h acorfor the performance of electrical work may ion. Work to Start: f RAGE Unless waived by the owner,n0 permit e or its substantial equivalent. The INSURANCE O com leted operation!' coverag P office. the licensee provides proof of liability insurance including" P 1 ersi ed certifies that such coverage is in force,and has exhi(Spe P jf of same to the ermit ie and complete. undersigned BOND ❑ OTHER ❑ ton is true n CHECK ONE: INSURANCE ❑ er u that the information on tis app C.NO.* f'rl�� I certify,ander the pains and pe al�f�c LIC.NO.: l FSM N�'� Signatur Bus.Tel.No.: Licensee r/t� �- > > f �p Alt.Tel.No.: a hcabl, enter exempt in the license number c. (If pp Lic.No.Address'. f S� e normally *Per ess'. c.147,s.57-61,security ork requires Department of Public Safety havepy not the License: ❑owner's agent. the Licensee do owner l R'S INSURANCE WAVER: I I h reby to V this requirement I am he(check one 10 ranee Covera OWNS required by law. By my signature below,I hereby pEj{MXT FEE: $ cl Telephone No Owner/Agent Signature —`- 3S: �seo BPI erg--j adoxis Town-of North Andover Page 1 of 1 S �I f i tD � oNDOVER ❑ Base Map Zoning 2008 Aerials Watershed Zone Utilities 0 Size 130E] Selection Legend Location M "Scale cale 1 =67 ih ' ....., ;Select (show all) 1 ' IOwner Pr p_ID 7 4 - ,BOND,D STEPHENSON 0 .0-0018-000C � I I I I I 1 1 se le d To Mailing Labels V Q Prop. Building Permits Pla I, owned ND,D STEPHENSON i Owner2 H THER ADAMS BOND Address 16 DOVER STREET s yr PropertyM 059.0 18-0000.0 Lot Size 27442. rw„ t , Fismt Year 2013 Land Use SC1 Code Last Sale 11/16/1999 Date �. Book/Page 5608 Total$791200 Valuation '.. Building CL Type Year Built 1836 e� $Y4'1} `fr 1PT1dt! ..'Y 4 1fY '13+'l.?�`h' ast�3t}C' J W::'�aer V�9 Can to aur�+M�vty,aacanec«r.�rtee,ror�meair�a+�r«ea}nrsney�«aa arne+q.[d1plewmp � avalr�saa�enp+pnc e+mas«�Srsre pt9}ooa«ryoeeraaa a«+a"��mi.msayam�n«t+eu,ev�aat�eavr yn=fanwm � –^ k}YrV d MEntaane.9'Y.IOt p.—yatsC!dapmQxlrcaw,�papet *moP ft*qC ta9rna�+n`erackMl!r� +9 CommtmngGu`sta na ny�nedmsN«msu+teambanea Mabaerraame..ceameiew��eaacavaeygo«._tnbce.easweamsesmvsrsrn« R«esewnre as n crc a¢vs y«sya ewnaim xq u¢d vc romeort n a tK retlfaveaan�Lst I i I 1 i II I I http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 10/31/2012 Tom of North Andover Page 1 of 1 _ � f arinin'L Co, t ❑ Base Map Zoning 2006 Aerials Watersfied Zone Utilities ❑ Size OLIE] Selection Legend Location M Help Scale 1"=':67 '.ft ... .... . . 11.'y.. ( .....7 „,.„.„_. 7— .. -. ...-w-,,,_ .. ... ,(show alp- --- --- Nk Owner_ ProP_ID BOND D.STEPHENSON 059.0-0018.000[ y v S yi7 k �xR` N^. 1 selected To Mailing Labels To 5 re, 9 Spre. FP-p--y 8-,Idng Permits Pla Ownerl BOND,D STEPHENSON O vner2 HEATHER ADAMS BOND Address 169 ANDOVER STREET PropertylD 059.0-001B-0000.0 Lot Size 27442.8 S Fiscal Year 2013 lard Use 101 Code Last Sale 11/16/1999 T Date Book/Page 5608 z Total$791200 s a .� .� L ,k x� S r:• ar ' ,�l'� la( +^�� ''� Valuation � tt'" y t`'1 u ay 2 ~U x Ei2sx?x t Ix'S ax s 'is Building CL Type Year Suitt 1836 Gai c�ai:come€rq Imag ,;co �,sc ;5:.aar lartr a.�Tmage' 1 1 � r4 tnort.m[es rtaMtigtxxm�o,aoara mpsm.mvmr•em4�aecar�ad.nora.Knr�u�haxe�ore'artrtues acnaY.�anax�ere� � d�OL'YffidaC GmgediC t[.hr.�appy/i�en�l9 maaarydrermu nwLZl reuln.7ne Ea[amesmrxv.9 cxaaxdeade�[am ar�eyannnro l9amsbOm Te Pied t06.li�,hratltiva dayeog W=1ea6+e piope4ShA nP�rr���M1 aNa.Msraac*YnH'PamnOCmrNam e9�+'-�za LV i aM uY d e�C MavlmOn 0`rzvgr eo Or a rl331t._b Ra auce YM ll!kertmck Yary Plme�p CAln[S9Yx5^s fEYIJt[18t[mans ro�ee+aaes d apBarslb6Ebme anaydsatlr[o-nAYort Fny+�atl�tbnulbnbafrnemptli'laonN V- - I http://mimap.mvpc.org/NorthAndovermimap/Viewer.aspx 10/31/2012 i i GENERATOR APPLICATION DATE: �� I(2 LOCATION: lo. Z41A, / '" xj OWNERS NAME: M" � GENERATOR kw i NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* � CONTRACTOR: PHONE NUMBER: 77Rl Z"I S 1� ) ELECTRICAL GAS RESIDENTIA COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVAL��� 2 f l� m " �� ,S � 2 ONS Date //2/ —. . • yw Uhl ya • a '. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . .C. . . .�. . . . . . has permission to perform .4'' . 69-. T 1e k 7. . . U�. wiring in the building of . 4 . .0 .IM .� �. . . . . . . . . . . . . . . . . . . . . . . at . . . . . /6 g . Clev0. . . . >. : . . . . ,North Andover, Mass. Fee Lic. No)�� . /yQ . 9 ELECTRICAL INSPECXOR Check# 11289 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. i 12 �9-11, Occupancy and Fee Checked 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 TYPE ALL INFORMATION) Date: 12/7/12 City or Town of. North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 169 Andover Street Owner or Tenant Shawn Cormier Telephone No. Owner's Address Same Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box) Purpose of Building Single Family Residence 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: Replace 11 recessed lights with IC rated lights,wire split system Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures 11 No.of Ceil:Sus Paddle Fans LBattery Total p (Paddle) ormers KVA No.of Lighting Outlets No.of Hot Tubs ators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ Emergency Lighting rnd. rnd. Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Detection and Initiating Devices • No.of Ranges No.of Air Cond. 1 TotalTons2 No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices ' No.of Dishwashers Space/Area Heating KW Local [IMunicipalConnection ❑ Other No.of Dryers Heating Appliances KW Sec No of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiringl No.Hydromassage No.of Devices or Equivalent 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 El BOND ❑ OTHER ❑ (Specify:) Federated Insurance 2/8/13 (Expiration Date) Estimated Value of Electrical Work: $1,750.00 (When required by municipal policy.) Work to Start: 12/7/12 Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify,under the pains and penalties of perjury,that the information on this applica ' is true and complete FIRM NAME: C&W Electrical Contractors, Inc LIC.NO.: A16941 Licensee: Andrew E Cabral Signature LIC.NO.: A16941 (Ifapplicable,enter "exempt"in the license number line.) Bus.Tel.No.. 781-245-1711 Address: 151 North Ave Wakefield MA Alt.Tel.No.: 781-844-9797 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. $ II � m� I2- 11 -- �2 �, � � 3m_ �,� The Commonwealth of Massachusetts Print Form vi Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C&W Electrical Contractors,Inc Address:151 North Ave City/State/Zip:Wakefield, MA 01880Phone#:781-245-1711 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition I working for me in any capacity. employees and have workers' insurance. 9. E]Building addition comp.[No workers' comp. insurance P. required.] 5. ❑ We are a corporation and its 10.R1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Federated Insurance Policy#or Self-ins.Lic. #:9062587 Expiration Date:2/8/13 Job Site Address: 169 Andover Street City/State/Zip: N.Andover MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb certi under th ' and penalties o !!1u that the in ormation provided above is true and correct. Si nature: — Date: 12/7/12 Phone#:781-245-1711 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I ,professional Licensure: License Search Page 1 of 1 M ' ficial Website of the Office of Consumer Affairs and Business Regulation(OCABR) ision of Professional Licensure Mass.Gov Mass Home State Agencies A-Z Topics Home>Division of Professional Licensure ONLINE SERVICES ........... . ..., ................. ................... ........... ....... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change ----------------�—.—__------ �__--�_—_—.� Contact the Agency More... LICENSEE Name:ANDREW E. CABRAL REFERENCES& Business:C AND W ELECTRICAL CONTRACTORS INC RELATED INFO N READING,MA Disclaimer Regarding NEW SEARCH Website License Searches it **This Licensee has additional Licenses,click here to view them.** Enforcement Process Glossary Licensing Board: ELECTRICIANS Glossary of License Status Codes License Type: MASTER ELECTRICIAN TYPE CLASS:A More... License Number: 16941 Status: CURRENT Expiration Date: 7/31/2013 Issue Date: 4/24/2000 Exam Date: 6/6/1998 School: 1 i This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Wednesday,October 31,2012 at 12:17:16 PM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us htt ://license.re .state.ma.us/ ublic/ ubLicense .a ? — _ i p g p p Q sp board code—EL&type class A&1... 10/31/2012 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION O 9 Permit NO: 171 Date Received Argo Date Issued: SACHUSE�(� IMPORTANT:Applicant must complete all items on this page LOCATION C(D Pri nt PROPERTY OWNER_ Z61,,�— d �L Print MAP NO.: �r`j PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building V6ne family ❑Addition ❑Two or more family ❑Industrial I]Alteration No. of units: D Repair, replacement ❑Assessory Bldg. ❑Commercial —Demolition Moving(relocation) ❑Other ❑ Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED I Identification Please Type or Print Clearly) OWNER: Name: d� K!ad Vim. `i�c3y — Phone:Ct 1 P 6Ro —?6 6` Address:_1 �,q CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost 1 i 17t (VQ . O—D __ x12.00=FEE:$ _ Check No.: 0 Receipt No.: Page l of 4 Location F No. Date / NORTIy TOWN OF NORTH ANDOVER O F ' Certificate of Occupancy $ �,s'•^"'c�' Building/Frame Permit Fee $ sncMust Foundation Permit Fee $ a Other Permit Fee $ TOTAL $ Check # 19560 4§uilding Inspector TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistere contractors do not have access to lite guarantyfund '�ZSignature of Agent/Owner `S� gnature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS ` DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation.Decision: Continents Water&Sewer connection/Sii!nature&Date Driveway Permit Temp Dumpster on site yes_no_ Fire Department signature/date i I %,oRrh TOWN OF NORTH ANDOVER ?oy"e� a°MSL OFFICE OF BUILDING DEPARTMENT �o 1600 Osgood Street Building 20, Suite 2-64 p�MTtO�gh`y,5 North Andover Massachusetts 01845 AC US Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION I Please print DATE: - JOB LOCATION: I (Oct t,-J-6C- � Number Street Address MO/Lbt HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS_j Ct, I NDV4 _ c..daUeV UI^ - t S�-FS City Town State Zip Code j The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andovcr Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE `I l APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Fonn Honwowncrs Exemption BOARD OF APPEALS 688-9541 CONSERVA ZION 6830530 HEALTH 6880540 PLANNING 688- 0535 I VOO.D STOVE INSTALLAHON CHECKLIST FI_'.11iT [IU: Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stave installation and not to the stove construction. 't Stove A. New Used B. Type/radiant I Circulating C. Manufacturer t-ab.No. Name/Model No. Collar size (� Dimensions/Height Length Z-21= Width Chimney A. New Existing S. Size(flue area) C. Other appliances attached to flue(Number and flue size) D. Prefab(Manufacturer—name and type) E. Mascnry/tined Flue liner Unlined pro•4 manwacurar� F. Height(refer to diagrams) cap I OVER.ICr �.`� I IZ2t hlltl, I � 17 K I 3 N11 .0 � I��' � i•�Iti. .� 1 Z i • � it n HEARTH Mumma CHIMNEY HEIGHT Hearth(non-combustible) A. Materials 8. Sub-floor construction 6 tN14 tNP+1-_ k-1 I A30 _ C. Minimum dimensions(refer to diagram) Clearances and Wall Protection(see s,cve in_,allat:cn c'e=rances chart) A. Type of wall protection provided 4VZQti e-A,ej 0Z ja_I%1t k bilsInegg, ► l[� S. Clearances(refer to diagrams) 1® t t'1 -3 _ 10 Ire FIREPLACE ""' ~° ORrIE;� WALLCENTER. HearffiStone } i * We recommend that our f Quality'Home HeatingProducts �a� 'ye products be installed and serviced by professionals who _ are certified in the U.S.by NFI �H$TIT (National Fireplace Institute). www.nficertified.org F� C w ,,US ao..K. Craftsbury Wood Stffe (Model 8390) CONTACT LOCAL AUTHORITIES HAVING JURISDICTION(BUILDING DEPARTMENT or FIRE OFFICIALS)ABOUT PERMITS REQUIRED, RESTRICTIONS AND INSTALLATION INSPECTION IN YOUR AREA. x . OWNER'S MANUAL I INSTALLATION AND OPERATING INSTRUCTIONS E I I PLEASE READ THIS ENTIRE OW'NER'S MANUAL BEFORE YOU INSTALL AND USE !' YOUR NEW CRAFTSBURY WOOD STOVE. To reduce the risk of fire,follow the installation 1 instructions. Failure to follow these instructions may result in property damage,bodily injury,or x even death. SAVE THESE INSTRUCTIONS FOR FUTURE REFERENCE! C.fthb ry Model 3390 i N6 00-40454 Revised 3/22/06 I ` NORTH '9 Town of 2 Andover O LA O` dover, Mass., COCHICHEWICK �d ADRATED 7 S E BOARD OF HEALTH Food/Kitchen Septic System PERMI .T T D BUILDING INSPECTOR THIS CERTIFIES THAT................ . ................................. .............. ..............,............. Foundation has permission to erect........................................ buil 'ngs on ........4.. ......... ........��� Rough to be occupied as.............................. Chimney provided that the person accepting t is perm shall every pec co o the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 150owo Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST S Rough ---- "T .... ....... ........................... SR vice G INSPECTOR a Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Re uiredProvides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) i Page 3 oF4 i Uo,;:INSPEC"IIONAL Sh:RVICES DEPARTMEN"r:I3PFORM05 Creased 1110 Ian 1006 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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 must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTNIENTMFORN105 Pau>4(if 4 Locationr'V No. a Date TOWN OF NORTH ANDOVER A Certificate of Occupancy $ CHUS � Building/Frame Permit Fee $ Foundation Permit ee $ petre t - Other Permit Fee -stout $ I TOTAL $ a Check # 020 iy `15 14 6 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING I1 ,' BUILDING PERMIT NUMBER: DATE ISSUED- �l' C) rdvC' ` SIGNATURE: Building Commissioner/ImeEtor of Buildings Date SECTION 1-SITE INFORMATION z rV 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 1�t/ Map Number Parcel 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 Rfguired Provided 1.7 Water Supply M.G.LC.4o,1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record A Name(Print) Address for Service Signature Telephone Q 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Cionstruction Supervisor: Not Applicable ❑ Licensed Corttruction Supervisor: License Number on Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number M Address r zMaSS Expiration Date signature Telephone WOOD STOVE INSTALLA ON CHECKLIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. ( ' Stove .c A. New Used. B. Type/radiantL'.., P4- Circulating C. Manufacturere-1 --I 3b.No. Name/Model No. 2)c') r� Collar size Dimensions/Height ����� ��� Q� -fn __I_�ngth Width ChimneyL A. New __Existing B. Size(flue area) C. Other appliances attached to flue(Number and flue size) D. Prefab(Manufacturer—name and type) E. Masonry/Lined _ _.Flue liner._ Unlined — t'oe a m,"°r`„"°`t F Height(refer to diagrams) cap OVER IC' I I c.,T:P Ir I I2 kilt{ {2 MIN. \ 3'MIK io' ` I'�' 3';,tl tL 12 :��/C77•jIC� n, HEARTH CHIMNEY HEIGHT Hearth(non-combustible) A. Materials B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wall Protection(see stove installation clearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) 71 r FIREPLACE CORNIER WALL/CENTER ir NORTH TE 0 oAndover 0 ,.. No. 2o�ACOCHI� dover, Mass., 'gyp �RATE0 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 'c BUILDING INSPECTOR THIS CERTIFIES THAT............. ,? .v. ............ ................................................................................... Foundation has permission tobreebuildings on ...../ -.bb..... ...... _/.... .......,........, Rough ..............I.......... to be occupied as........ .....s�D -�......... N........12V,S t C/,e,4j c-�............... ..................... Chimney provided that the person accepting this permit shall in every respect.conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatin to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. Jr-c�► 7cp S- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU ON T TS ELECTRICAL INSPECTOR Rough ...... ...........&. .......... .......................... ................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT s Until Inspected and Approved by the Building Inspector. Burner Street No. r SEE REVERSE SIDE Smoke Det. I N° 2 { i Date , ..—h:.�'......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACMUSE� I i This certifies that has permission to perform .. wiring in the building of ..... ..................................'_/........ .......................... /l .. �' ....................NorthAndover,Mass. Fees.........-.... Lic.No ..- ` ... , a, :........... ELECTRICAL INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer C_ommortwaa[°�Of /aAjac/tcc�al�t a� 0(firal Usc Only Permit No. •_ � r �c�arfntart�o�,}ira �arvicsj BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ,?c'4�, Rev, 1,1199] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the 1la=chusctts El-cirical Code( ,IEC) 527 CNIR 12.00 (PLEASE PRINT LV INK OR TYPE:1 LL I'Y(•OIL�L I770tti) Date: ����� City-or Town of: k)Or---l4 AtJ�OUe2 Toll'eLrsPectorojFYtres: By this application the undersi;ned gives notice of his or her intention to perform the electrical work described below, Location(Street R Number) 4 (o 1�0Verz.IN Sj Owner or Tenant Owner's Address Telephone No• q 1���a_• 9aGS i Is this permit in conjunction*with a building permit? Yes ❑ No J (Check Appropriate Box) 1,u pose of Building Utility Authorization No. Existing Service r\tops / Volts Overhead . ❑ Undgrd ❑ No.of itileters•. New Service Amps ! Volts Ovcritc:td❑ Ilndord ❑ No.ofilleters: Number of Feeders and Antpacity Location and Nature of Proposed Electrical Work: comr letion olthe(ollonin¢'able"ray be Eciti•cd bv' he lniDcctor o(Wires. No.of Recessed Fixtures No.of Cel:Susp.(Paddle)Fans IND.of lbtal transformers KAVA +`lo- of Lighting Outlets No.of Ilot Tubs Generators KVA No.of Lighting Fixtures Above !n- t og Pool :o mergeitcv tg mingannd. rnd. Batte Units No.of.Receptacle Outlets. No.of Oil Burner FIRE ALAILMS No.of Zones` .:., No.of Switches No.of Gas Burners t o.o eteclion and InitlaUng,Devices No.of Ranges No.of Air Cond. TOW Tons IND.of Alerting Devices No. orwaste Disposers Heat Pump tVumberI Tons K1Y too.of elf- ontained Totals: DeteetionWertine Devices No.of Disltiraslters Spnce/Area Heating IM Local ❑ hlunicipal Other ton No. ofDrycrs Heating AppliancesKNj: cu ' , L14 o.of 1 ate' o.of Devices or Equivalent Heaters K1V t`to.o IND.o Data,Wiriug: Signs Ballasts No.or Devices or Equivalent No.Hydronnassage Bathtubs No.of Alotors Total HP 1'cleconimunications firing: , No.of Devices or E uivalent' OTHER: +roach additional detail if desired,oras required by the Inspector of!Vires. INSURANCE COVERAGE: Unless Nvaivcd by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability uuurmice 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 Datc) Estimated Value of El ctrii al�Vork:' 9q. (When required by municipal policy.) Work to Start: /� /" Inspections to be requested in accordance with MI EC Rule 10,and upon completion. I certify, under the pains aml penalties of perjury,that the it joruration oil Acis application is trite and comple•te•. I7I1L�i l`AIME: ADT SECURITY SERVICES INC. A LIC.N0.: C1533 LLicensee- JACR BASSETT Signature L1C.NO.:_C1533 (!f applicoLle,c"'er"tc:"rp'"in the lice+lse nu"tber li+reJ Bus.Tel.No.. (781) 278-1169 Address: 111 HORSE STREET, NORWOOD, 02062 Alt.Tcl.No.: f 78 )_2Z8=�131 OWNER'S INSURA`ICE WAIVER: I am a��are that the Licensee does not have the Inability insurance coverage normally required by law. By my signature below,t hereby waive this requirement. I am the(check onc)❑ owner ❑ owner's scent. OwncrlAocnt Sionatut-e Telcphonct\u. Pi:RaIIT FLL•: S . , I i AOT Security Services, Inc. 111 Morse Street Norwood MA 02062 Telephone 781 278 1000 Fax 781-278-1090 January 28, 2000 I TO WHOM IT MAY CONCERN: RE: JACK BASSETT'S ELECTRICAL LICENSE I i Jack Bassett is our NEW Electrical Licensed Person designated to sign the applications for electrical work (both burglar and fire alarms). Enclosed you will find a copy of his Safety License his Electrical. License from the State. I I Thank you for your cooperation! i JAIi-kASSETT Enc. A tgCO!NTERNATIONaL LTD. COMPANY i i u I ,,�,\ J�ie �nar�z�nayuuecz�t�i. c���ll�ac�c�:sel�s DEPARTMENT OF PUBLIC SAFETY License: SEC SYS CERT. CLEARANCE -1 Number: SS CC 000270 ��- Birthdate: 12/31/1947 Expires: 12/31/2001 Tr. no: 190 Restricted To: 00 JOHNS BASSETT 173 GREEN ST BROCKTON, MA 02401 Acting Commissioner COMMONWEALTH OF MASSACHUSETT OF ELECTRICIANS REGISTERED SYSTEM CONTRACTOR ISSUES THIS LICENSE TO ! ADT SECURITY SERVICES INC L JOHN S BASSETT cucu 111 MORSE ST c04 i NORWOOD MA . 02062 - 4.60 1533 C 07/31/ 01 018610