Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 17 GRAY STREET 4/30/2018 (2)
17 GRAY STREET 2101107-B---0000.0-- , ,I r 1W Date �2....... ... .... NONTIy _ TOWN OF NORTH ANDOVER o s PERMIT FOR WIRING S`S�CHUS� This certifies that5 e— ...................................................................... has permission to perform ....... (�-P ureCL--Q .................................................. wiring in the building of............. P P.— at ... ....1 �.t.... ......, .... .................................. .I North Andover,Mass. 1 � � Fee.......�.'�.:n........Lic. No-ZZ 41� .................... ELECTRICAL INSPECTOR Check# 100 Commonwealth of Massachusetts Official Use Only De artment of Fire Services Permit No. Zw' i—I ` p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527�MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:/7 � 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) )-) S-�- Owner or Tenant l yk CC Telephone No. C44�-a-73 Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fi Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA 31 ' No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Batteryits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Dis posers Heat Pump Number.Tons KW No.of Self-Contained P Totals: ". Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal F] Other P g Connection No.of Dryers Heating Appliances KW SecN oto.o Systems:* or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Ea uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El ectri7/�- 1 Work: (When required by municipal policy.) Work to Start: /pk I ) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covera e is. force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Icertify,underthe ns andpenalties of er' ry,thatthe inforn2ati n this application is true and complete. FIRM NAME: " �C n LIC.NO.: Licensee: l L& � W�,* Signature LIC.NO.: ao Qom` (If applicable,enter"exempt"in the license number h e. Bus.Tel.No.: Address: Q (Z'-L car '� Alt.Tel.No.: — *Per M.G.L c. 147,s.57-61,se6rity work requires Department of Public Safety" icense: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the i notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending-through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ i Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass[M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS CTION: Pass 0 V Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: r Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts IndustrialAceidents - Department o.f M X Congress Street,Suite 100 _' - d 0211420X7 _ Boston,MA ,�� www.mass.gov/dia o�M sy�V �Varkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/�lumbers. TO BE FILED WIT TgE PERMITTING AUTHORi��'. _Please Print Le 'bl A '�Hiicant� InformationName(Busnexgauizationllndividual): `C Address: City/State/Zip: Phone ' Are you an employer?Checic the appropriate box: Type oftproject(required): 1.Q I am a e ployer with- employees(full and/or parttime). 7. []New'constraction 2. ' am a sole proprietor or partnership and have no employees Working for me in 8. emOdOlk any capacity.[Noworkers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.] 10[]Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will II.E]Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12 Q pj=a ing repairs or additions ,g,+r proprietors with no erriployees. 5-ElI am a general contractor and I have lured the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance# 14 tj Other 6.Qwe are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no empldydgs.[No workers'comp.insurance required.] *Auy w showing their applicant that checks box#i must�s out they aze domg section all work andthen hire outside contractors compensation omust submit a new affidavit indicating such. i Homeowners who submit•this affidavit g tcontmctors that cbeckthis box must attached'an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.eeS. Below is the policy and job site I am an employer that is pr�ovidingwor•ker's'compensation insurance for my employ information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: iration date). Attach a copy of the�evorkexs'compensation policy declaration page� violation punishable by and exp up t$1,500 00 Failure to secure coverage as required under MGL a. i the§25f is a criminal and/or one-year imprisomnunt,as well as civil penalties e in the to the fficof a STOP e O of Ian orations of the DIA.for insurance? a day against the viola d'r.A.copy of this statementmaybe coverage verificati / Ido Iter eby cert" un er pain enaltieS of per jury that the information provided abo712 is try and.correct. Date: ) tS� Si ature: �( Phone#:. Official use only. Do not write in this area,to be completed by city or town official Permit/License# City or TOwn' Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.other Phone#: Contact Person: i 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 titre, express or implied,oral or written." An employer is defnied 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 receivet'or trustee of an individual,partnership,association or other legal entity,employing employees.•However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of 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)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial•Accidenis. 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 proofthat 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-A4ASS.AFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia i a corhmonwealth of Mas usetts Division of Profession 'ce ure >� Board of State cians 9 CHRIST W 16 SOUT BRADFO r Master Elec ' 'a 22063-A 0713112016 nr SJ 0010203 License No. Expiration Date. Serial No.. Date...14;LI .........I.6..... OF NOR7/�,�0 TOWN OF NORTH ANDOVER 0 p PERMIT FOR PLUMBING t BsgCHU5E Cnc- �c.�V- h�. -. - Tiscertifies that....1..!. -............................................................... ............................... has permission to perform....... f�J oar cx� ;-Q.(................ plumbin int buildings of... . e cx „R....................................................... at..... G` , North Andover, Mass. ................................ .. ........ Fee�.�.............Lic. No. .... .�. ................................................................................. PLUMBING INSPECTOR Check# • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE Z 17 —li,�' PERMIT#J V3'�4 JOBSITE ADDRESS 6v, S•k OWNER'S NAME fZ-C-AA— POWNER ADDRESS a . TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL { SERVICE 1 MOP SINK TOILET { URINAL WASHING MACHINE CONNECTION ATER HEATER ALL TYPES WATER PIPING ('ETHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 12/ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE T TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with WI Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i PLUMBER'S NAME LICENSE# `�00 SIGNATURE MP[ JP❑ CORPORATION d# 3 b(- PARTNERSHIP❑# LLC❑# COMPANY NAME SL`s -���` G � c�� ADDRESS CITY ��v��^'��. STATE�A ZIP 6�1 3 Z TEL 4\ O FAX CELL EMAIL �l s E• SJV 4 The Commonwealth of A assoOusetts Vepartivnent oflndustir'ialAceldents M a X Congress Street,Suite 100 Boston,MA 02114-20X7 ' www.mass gov/dia .r� •.•••sVs„ • Workers:,Compensation insurance Affidavit: xctriciansllumbexs TO BE�ED �THTHEPERMITTINGAUTHORITY . Please Print Legibly Applicant information \ �>1�S• 1 v�G. ` Name(Business/Organization/Individual): Address* City/State/Zip: � Type of project(�egnired): Aseyou an employer?Check flee app?oprlate box: 7. Q New.construction employees(pull and/or part thne).�` 1,P4I am.a employerwith _ Remodeling 2.Q I am a sole proprietor or partnership and have eq no employees working for mein 8 any capacity.(No workers'comp.insurance required.] 9, ❑Demolition o workers'comp.insurance required•]' 10 ❑Building addition 3..❑I am.a homeowner doing all work myself[1Q 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11 ical repairs or additions ensure that all contractors either have workers'compensation insurance oz are sole 12. �Cbing repairs.or additions_._,. propzietois wif11 no employees. " ' '- 5.❑I he a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14•[J Other , -right of eMGT G. 6.Q Weare a corporation and it ra their insurance 152,§1(4),andwehavena.erP10YesNOworkers -' showing their worke tion below *Any applicant that checks box 4ll mdusl�insdi fill ng that'are doing all work and then hire outside ontractors musts bmit a new affidavit indicating such i Ilomeowners who submi t• the name o£the sub-contractors and state whether or not those entities have }Contractors that check tbis box must'attached an additional sheet showing employees. If the sub contractors have employees,they must provide their workeis'comp.policy number. an erre to er that is pt ovidirzg workers'compensation insurance for•my employees.' Below is the policy andjob site Pam P Y information. 0. Insurance Company Name: Pe e Ae x S C ( 1®., ExpirationDate: —t7 Policy#or Self-ins,Lic. - r /�u City/State/Zip: Job Site Address: 7 raY S t number and expiration date). Attach a copy of the workers'compensation policy me up to$1,500-00 declaration page(showing the y Failure to secure coverage as required under MGL e es inthe f irm of s a aSTOP inal violation WORK ORDER and a fine of up to$250.00 a and/or one-year imprisonment,as Well as civil penalti day against the violator.A•copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. ado Xzer eby certify under tlaepains andpenalties ofperjury treat the information provided above is true and correct n Date: Z 17—< 57 Signature. Phone#: 6 3 7 I I i•F SO In this area,to be completed by city or town official Official use only Do notwrite l. permit/License# City or Town: issuingAuthority(circle one): ' Clerk 4.Electrical inspector 5.pIumbinginspector ealth 7 Building]Department 3.City/Town CI 1.Board of P[ 6,Other phone#• Contact Person: s Information and Instructions Massachusetts General Laws chapter 152 requires ag 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 bf hire, express or implied,oral or written.,, An,emPlayer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enfexprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of 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-conlractoi(s)name(s),address(es)and-phone numbers)along with their certificates)of —insurance—L-imiteel-Liability-Companies-(L-L-C�x Limited-Liability Partuxrslups(T:,LP�th no e members or partners,are not required to m"Joy es o er an tie--"— --- carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may l be submitted to the Department of Industria Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. TIie'affustridaashould 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 yo'u'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self insured companies should'euter-their,' self insurance license number on the appropriate line. City or Towu 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"fob 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 maybe 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.'There 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 0211.4-2017 Tel.#617-727-4900 ext.7406 or 1-877-AIASSAFE Fax#617-727-7749 Revised 02-23-15 W.Ww.mass.gov/dia i (x::COMMONWEALTH OF MASSACHUSETTS gml • • • • • PLUMBERS i4ND GASFITTf ISSUES;; THE FOLLOWING LICENSE REG 1<ST>=RED AS A PLUMB I�G COftP.,l s � M;ICH:EL J KIMBALL t KIMBALLMECHANICAL SERV.ICEul �Sa,,I1�C Z i 3 FIELDSTONE WAY J � .HAVERHILL Mp 01832 Location / �/' �/' No. Date % 3 �oR,M TOWN OF NORTH ANDOVER 41 A Certificate of Occupancy $ CM bBuilding /Frame Buildin /Frame Permit Fee $ ss� USE i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 6 3 v Check # 'i 657 Building Inspector F TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING use Wftdofo 77 BUILDING PERMIT NUN IBER. DATE ISSUED. rn SIGNATURE: Building Commissioner/l-for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number U 7Q C/O J 1.3 Zoning Information: 1.4 Property Dimensions: 51 y60 ��a Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired I Provided Ij 6 6 I s& I v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 4fi Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: <y Signature Telephone 2.2 Owner of Record: V" Wame Print Address for Service: rn Si*nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor:6g5O // /� //� �f� G✓ License Number mn Address �s Eviration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name rn Registration Number rm Address ExpirationDate ^� Si nature Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......V No.......❑ SECTION 5 Description of Proposed Work check altapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 14/ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee /6 b Multiplier 2 Electrical 6 (b) Estimated Total Cost of Construction 3 Plumbingd Building Permit fee(a)X (b) 4 Mechanical HVAC /�,�� .�-- 5 Fire Protection 6 6 Total 1+2+3+4+5 QQ— Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,��e1Fd/J d✓6/�.�1� ,as Owner/Authorized Agent of subject property Hereby authorize 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 fi as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name/J 117 Si ature of Owner/Agent VDate NO. OF STORIES SIZE -`O d. -U BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS q� 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 r r� US 1 100 o(keA ___ 6,K 1.6 SoK3ro©w`- FORM U'- LOT RELEASE FORM �of- PrL� � INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does-not relieve the applicant and/or landowner from compliance with any applicable or requirements. *APPLICANT FILLS OUT THIS SECTION APPLICANT 71h/3 w Cv1 e kA PH � � L� 3 ON LOCATION: Assessor's Map Number I PARCEL c5 SUBDIVISION LOT(S) STREET ST.NUMBER *** *******************************.OFFICIAL USE RECO ENDATIONS 0 TOWN AGENTS: CONSERVATION ADMINIS ATOR DATE APPROVED DATE REJECTED COMMENTS +� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED �Q SEPTIC INSPECTOR-HEALTH DATE APPROVED-- Z6[&0,5_ — j / DATE REJECTED 4 a�) . PUBLIC WORKS-SEWER)WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9W jm TWOMEY & LEGARE CONTRACTING Professional Building / Remodeling P.O. Box 366 Shaun Twomey North Andover, MA 01845 Doug Legare 978-685-744 978-556-1547 CONTRACT 1. Date of Contract Signing: , 2. List of documents part of this agreement: A. Contract B. Specifications (see Exhibit B) C. Drawing (see Exhibit C) D. Payment Schedule (see Exhibit D) E. Limited Warranty(see Exhibit E) F. Notice of Cancellation 3. Parties to Contract: A. Contractor: Twomey&Legare Contracting Shaun Twomey/Doug Legare Federal Id#: 04-3610112 Address: P.O. Box 366 North Andover,MA 01845 Contractor Registration No.: 136779 B. Homeowner: John& Cheryl Reade 17 Grey Street North Andover, MA 01845 (978)688-3482 C. Late Payments / Defaults — should the homeowner fail to pay the contractor in the manner as agreed, the oontractor shall be entitled to stop work until paid in addition to taking all legal steps including the placing of a mechanic's lien on the property to obtain payment. Any late Payment shall accrue interest at the rate of 1.5% per month Homeowner agrees to pay*,ollection costs and attorney's fees for any payments due but not paid in a timely manner. D. Insurance—Contractor agrees to provide evidence of liability,worker's compensation, and other risk insurance. Owner agrees to provide copy of hazard insurance as is required by contractor to coordinate policies. Owner. Contractor. i�,e Notice: The signatures of the parties above apply only to the agreement of the parties to alternate a resolution initiated the contractor. The owner initiate alternative disput by may dispute resolution even where this section is not signed separately by parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. P., O er to D to � f ` Owner Date Contractor Date 4 i M 4 Payment Schedule- Exhibit D Job Total $62,950.00 Payment Balance 1st Deposit on signing $15,000.00 $47,950.00 2nd Completion of exterior demo $15,000.00 $32,950.00 & completion of foundation 3rd Completion of weather tight addition $15,000.00 $17,950.00 4th Completion of all plumbing &electrical $10,000.00 $ 7,950.00 Roughs 5th Insulation, drywall, &plaster $ 5,000.00 $ 2,950.00 Installation of hardwood, interior trim, & doors 6th Balance upon substantial completion $ 2,950.00 r Y Specifications- Exhibit B Addition 1. Provide addition to residence at 17 Grey Street, North Andover, MA in accordance to plan provided by contractor, these specifications shall prevail 2. Excavate as required for full foundation with cut through to main house 3. Foundation height to be same as existing to match floor height 4. Damp proof foundation with asphalt by contractor 5. If ledge is encountered, ledge removal cost is not included - &underground utilities(not included) 6. Basement will have 4" concrete finish floor with vapor barrier 7. Structures to be built per plan 8. Subfloor to be 3/4"Advantee plywood 9. Wall sheathing to be %2" OSB 10. Roof sheathing to be 5/8" CDX plywood 11. Install ice&water shield 3 feet up from eaves 12. Roof addition with 25 year shingle by builder 13. Color by owner i 14. Wrap exterior walls with tyvek house wrap 15. Install tilt wash Harvey windows to include: 2846-2 4 Units Double Hung 3646-2 3 Units Mulled Casement With grids, screens, &Low E 16. Doors: 15 Light French Doors 4 Light with full view storm door Door to addition- 6 panel steel insulated 17. Siding to be primed Cedar Shakes nailed with 5 D galvanized nails 18. Insulate addition to code -2- 19. Demo existing sun room 20. Windows: 4 Anderson Double Hung 1-10' Anderson 5-panel casement 21. Contractor is not responsible for landscaping. Contractor to provide & spread screened loam where necessary-homeowner to seed. 22. Contractor is responsible for all interior&exterior painting - Color by owner 23. Plumbing to be done per plan 24. Contractor to provide heating to addition off existing -baseboard heat in dining room 25. Owner to purchase light fixtures - list provided by contractor 26. Drywall in addition to be smooth walls, skip trowel ceilings 27. Hardwood oak in new addition area 28. Interior trim to match existing 29. Door knobs to be schlage brass 30. Electrical: Contractor to provide - 4 Recessed cans in addition 1 Ceiling fan(fan provided by owner) 1 Outside flood light (light provided by owner) 2 Porcelain Basement Lights 31. Provide side porch 3x3 P.T. Framing, decking, & stairs 32. Due to large trucks, dump trucks, concrete mixers - driveway may crack, create divots, etc. -Contractor is not responsible for 33. Permit &plans by contractor 34. 16' feet of gutter& down spouts 35. Plot plan 36. Title 5 Inspection General Notes Unforeseen changes& extras 1. Existing unforeseen structural code violations are not included in this contract &will be priced at time &material 2. Any unforeseen frame or sheathing wood rot is also not included in price 3. All subs are in contract with builder and not available for hire by homeowner for a time of six months after completion of job 4. Contractor will keephome & site as neat as possible -At end ofjob home owner is P J responsible for final cleaning &window washing 5. Any plumbing, electrical, or miscellaneous material purchased by home owner is owner's responsibility to get product to site in a reasonable time for installation(Contractor does not hold warranty on items) 6. If contractor is needed to pick up product - trip charge will be an extra$50.00 per hour 7. Any additional work beyond contract will only be done with signed&price agreed change order sheet -to be paid in full on next progress payment 8. If item is not in contract - consider it not included in the project 9. Please review all items r on ons specification pages - Due to verbal adds&wants if not in r writing could be missing in project 4. Description of work to be done and the materials to be used: See Specifications(see Exhibit B) 5. Total amount agreed to be paid for work to be performed under the contract: 6. Time Schedule ofa ents to be made under the contract, finance charges for late fees, if P Ym g any. * See Payment Schedule(see Exhibit D) *Any deposit required to be paid in advance of the start of the work shall not exceed one-third of the total contract price or actual cost of any material or equipment of a special or custom made nature, which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties 7. A. Date work is scheduled to begin: See No. 14 B. Date work is scheduled to be substantially completed: See No. 14 8. Notice . A. All home improvement contractors and subcontractors shall be registered and that nay inquiries about a contractor and subcontractors shall be registered and that any inquires about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,Massachuseft 02108 Telephone No. (61 7) 727—8598 B. For contractors' registration number,see top of first page. C. Homeowner's have three-day cancellation rights under MGL c 93 § 48; MGL c 140D § 10 or MGL c 255D § 14 as may be applicable(see attached Notice of Cancellation). D. For owner's warranty rights,see 780 CMR R6 and MGL c 142A- 9. There is no lien or security interest on the residence as a consequence of this contract. 10.Permit Notice: A. The following permits will be required in connection with the work to be performed on your property: B. It is the obligation of the contractor to obtain these permits as the owner's agent. 2 C. Any owner who secures their own construction—related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 11. Contractor reserves the right when he deems himself to be insecure to require as a prerequisite to continuing work that the balance of funds due under the contract,which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 12.The parties agree that no work shall begin prior to the signing of the contract, transmittal to the owner of a copy of the contract and the expiration of any applicable rescission period. 13.Arbitration Clause: The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. 14. Other Provisions: A_ Commencement of Work/Completion-Contractor agrees to proceed diligently with the agreed upon work, commencing promptly following: • The completion of the Title V installation and certification of compliance by the Town_ • Issuance of a building permit by the Town, • Estimated date of completion: Completion date shall be automatically extended by the number of days equal to those on which seller shall be prevented or hindered from completion due to weather conditions, other acts of God,inability to obtain materials or schedule work due to delays caused by homeowner's selection process or change of orders, and/or failure of homeowners to make timely payments as agreed. B. Final payment shall be upon the satisfaction of the homeowner. The parties agree that the issuance of a certificate of occupancy shall be the objective standard that the contract has been completed and the parties are satisfied. Any punch list items shall be reduced to writing, with a date for completion. The parties agree that no escrow will be held for punch list items. IAORTH Town of AAndover 0 ,: No. 4 � z � L A 0 It- dower, Mass., C� COCHIC WIC ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ch � BUILDING INSPECTOR ................................. THIS CERTIFIES THAT...... ..............�t;................ .... . ... Foundation erect.... / 07 & O%wc has permission to en .......................... buildings oil ....... . y .........S..4 ............................... . ....................................... ough 4 P%e PIAC f. /& I )e I & 'S 60*uroo W S-4 new MO^al Chimney tobe occupied as......................................I................................................................................................................................. 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 7rlating to the Inspection, Alteration and Construction of Buildings in the Town of North13 , Andover. %5 / J( 6 &3 40 M"'W PLUMBING INSPECTOR 'ftb VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final AD ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TAIN. S )I Rough 41..........................................�..O*............................................ Service . ..... .......... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street NO. SEE REVERSE SIDE Smoke Det. Date..©.9 .......... NORTH 3r0;��`".;°�"o°� TOWN OF NORTH ANDOVER PERMIT FOR WIRING V l This certifies that '/......AP........ ..�" .. ��.����... .... ....................... has permission to perform ..........G:..../P/l...€...j�....... ......c...l..:..................... wiring in the building of.... .. ....�.T?f `�....: ............. e-1.71JO.4 at......, :o..................................North Andover,Mass. Fee.&?.n 5::Q... Lic.No A4 ...... nr-- ' ELICALINSPECTOR J / ✓ JJ Check # d� 47 /- ) NORTH omm Of � 4Andover 0 No. * _ � O LC WI�J dower, Mass., COC HICK wIC � A�RATED S 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT...... .. . .... .... 00.0-Y...I.............�ti ! ................................. BUILDING INSPECTOR Foundation has permission to erect....R10000"i&. .... buildings on ....... .I:..a.0%1& y...;.. .....'................ "'O .......... ough to be occupied as.. ... � �� ' , / ~~� �,�� 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 FrIating to the Inspection, Alteration and Construction of j" Buildings in the Town of North Andover. •' 67 'JI( 43 40 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations.Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina UNLESS CONSTRUCTION TARS ELECTRICAL INSPECTOR , Rough 3/............ ........... ...................# ... Service , BUILDING INSPECTOR '/,�0 Fina ('1 „!!! Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT _ Street No. LSEE REVERSE SIDE ' Smoke Det. THE COMMONWEALTHOFMASSACHUSETTS Office Use only ` DEPARTAff 0FPUBIICSAFMY Permit No. BOARD OF FIRE PREVE MONREGUI ATIONS 527 CMR I2b Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORMS CTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRIC CODE,527 CMR 12:00 �_ // �� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /6 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below Location(Street&Number) Owner or Tenant .7-z> y-/ /eex/JE Owner's Address Is this permit in conjunction with a building permit: Yes[;: No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service ate_ Amps Zo/Zeovolts Overhead Underground m No. of Meters New Service Amps / Volts Overhead M Underground ® No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work w 1ker /9th/T/W No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures / Swimming Pool Above Below Generators KVA (� ground El ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices i No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• InstuanceCorrage.PtltstWtodrteWtemaltsofMmmdusertsG=allaws IbawaaraentLmbilityh►stnanoePbhcyinchr ingComplete Opetaftons CDmnWcritssttslarlbalequivalatt YES NO y Ibawaftntledvalidpwofofsametothe 0�YES � If}ouhawdrekedYES,pleveindi&thetypeofcovaageby INSURANCEd BOND r7 GITIER a ftmSpo*) EsWn&dValueofFlecWAW0&$ WodmStatt �'1'�6'a 3hpoctionDaIeRMiestedRough cJ'-��-0 3 Feral signe d u roffTr Ptw ies ofptew- !l FIRMNANIE v/ �'LFG7�/ G�•�-• c i: LioffseNo. Lioatsee Si, la� Lic W NO ,r/ Busin Tel.No. 171 4,r?-esu i Add J � ��D ST G4r.�.�¢ � 0$4 A>t TeL NO. 173- 3*7 T S"7 3 S4 OWNER'S JNSURANCE WAIVER;I am aware that the license does nothave the iruuance cove orits abort al etluivalent as reytmed by Massachusetts Genet-al Laws and that my signahue on this permit application waives this tegunement. (Please check one) Owner = Agent �rp Telephone No. PERMIT FEE$ V Signature ot Uwner or gent w The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # 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 employees working on this job. Company name: Address City: Phone#7 Insurance.Co. Policv# Company name: Address d City: Phone#7 Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the i ►ripositior►of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment_as_weLas_cMi,penattiesinshelorm-fa_STOP WDW..ORDFJtW_a.fine_of_($1DO-W)-aAay.againsY me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification. I do hereby certdy under the pains and penalties of perjury that the information provided above is true and correct. Signature pate Print name phone# y Official use only do not write in this area to be completed by city or town official' City or Town ensing D Building Dept ❑Check if immediate response is required [] Licensing Board Ei Selectman's Office Contact person: Phone#: o Health Department Ei Other