Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 179 HAY MEADOW ROAD 4/30/2018
N � i D b � i o n Q v b o o � o� 0 0 0 9439 Date ....... .. Z" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform ... l"i�Ac. h../`.'n0. .... ....... plumbing—inn the buildings of ...,�.�l... at ...... /.!rell ................ . Nort_ Andover.'" Mass. Fee. �' . Lic. No..%S.3.�G PLUMBING INSPECTOR Check # p _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Y P TYPE OR PRINT CLEARLY CITY MA DATE ,j PERMIT # 7i C JOBSITE ADDRESS % %10 OWNER'S NAME fF OWNER ADDRESS moi__ t-� _�I TEL j1S FAX OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL 0 RESIDENTIAL NEW: © RENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES NOD FIXTURES Z 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 1mffil' ....._.._IDEDICATED WATER RECYCLE SYSTEM -_—fDISHWASHER i{ _-_._J ! 9 DRINKING FOUNTAIN -----.-_-_{__� _.__-_.P ......_.I ...-._._-` FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTEF KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _ OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES R NO M]I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Ej BOND F1 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 01 AGENT �01 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are and that all plumbing work and installations performed under the permit issued for this application will be in co Massachusetts State Plumbing Code and Chapter 142 of the General Laws. pbte to the best of my know] all Pertinent provision of the PLUMBER'S NAME % vt��J _ LICENSE # / G� SIGNATURE MPX JP R_! CORPORATION ni tPARTNERSHIPO# LLC i E COMPANY NAME ADDRESS �oN B vK CITY/ _._..STATE �� ZIP //d j' _ j TEL _.._ FAX _� ? _�E CELL EMAIL 01 W a w W LL 14 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of, l-nvestigations _ 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual):-3w yet y� C�fil Address: - - - - ,— City/State/Zip: W ve 6,• /7,4 v/ipyOPhone #: %%�'' /S�- ? 5 _ (o Are you an employer? Check the appropriate box: 1 • ❑ I am a employer with 4. ❑ I am a general contractor and I •-- employees (full and/or part-time).*' have hired the sub -contractors 2. am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub=contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3-0. 1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp, C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] *Any Ep phcent that checks box M rs,,st also fill opt the sPcction bei, -1-: _6_ -.. Type of project (required):' 6. ❑ New construction 7. Remodeling 8. EJDemolition 9. ElBuilding addition 10-ElElectrical repairs or additions 11.❑ Plumbing repairs or additions 12-ElRoof repairs 13.❑ Other 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 insurance for my employees Below, is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #. 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 a st the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the Di733r insurance coverage verification. I do hereby the pains andpenalties of perjure that the information provided above is true and correct 7y -'PIT s Official use only. Do not write in this area, to be completed by city or town official City or Town: PermilMeense Issuing Authority (circle one): - 1. Board of health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 6. Other 5. Plumbing Inspector e- 7 - /. Z Contact Berson: 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 6r implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling -house -of another who -employs _persons to -do -maintenance, -construction or -repair -work -on -such dwelling -house or on the grounds 6r 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 uncal 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 LL•C or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted.to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date -the affidavit. avit. The affidavit should be retar ed to the city or torm. that'&U0 Zy'tb0al-1 11 forie pe—tet: orli,--e se i being regaes�u, 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 per iittlicense number wbich 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would'like to thank you in advance f6r 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 ofhavestibations 600 Washington Street Boston, MA. 02111 Tel. # 617-727-4900 ext 406 or 1-8.77 MhSSA1iE Revised 5-26-05 Fax:Y 6.17-727-7749 A .11 II.P M TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................................................... ........... has permission to perform ... W I;;f ........................ wiring in the building of ....... ........................... ................ at.: ... 1.7,7 ......... .../& /f.. North Andover Mass ......... CAL........... NS' P**E* ** OR Fee ........... .... Lic. NAA2al�0' Check #2--,T Zy�� 715T 0880 Commonwealth of Massachusettts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. d a Occupancy and Fee Checked [Rev. 1/071 (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 (PLEASEPRINTIN) NKORTYPEALLINFORMATION) Date: 6 - 3 - Z7, 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)_ % 7 9 /Y4 y.Cl P o I ^,. 1 k?,,( Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a build ng permit? Yes VNo El (Check Appropriate Box) Purpose of Buildin p Pur '- II Building �"� 10Dt-f Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 2� Amps !2-l" / -7-2c-Volts Overhead ❑ Undgrd ❑ No. of Meters Avc- Number of Feeders and Ampacity Z Nature olProposed Electrical Work: No. of Recessed Luminaires ges / No. of CeH Susp. (Paddle) Fans No. of Luminaire Outlets No. of Hot Tubs No. of LuminairesS Tons Swimming Pool Above ❑ In- ❑ rnd. rnd. No. of Receptacle Outlets Heat Pump Number "" No. of Oil Burners No. of Switches lNo. of Gas Burners v ges / No. of Air Cond. Total Tons ste Disposers ! Heat Pump Number "" Tons 1 Totals: 2v hwashers Space/Area Heating KW ers kHydromassage Heating Appliances KW �i ter KR, eaters No. of No. of Si s Ballasts massage Bathtubs No. of Motors Total HP table may be waived by the Inspector No. of Total Transformers KVA Generators KVA No. o mergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Alerting Devices No. of Self -Contained Detection/Alerting Devices Local ❑ Municipal 11 Other Connection 5e1!u11 13, Syste 1.110 - No. No. of Devices orEauivalent "r• i Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ,P -T— .? (When required by municipal policy.) Work to Start: — 7 — (2 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Icertify, udder the ains andpenalties ofpedury, that the information on this application is true and corpieie.,� FIRM NAME: :t- `'re.- 6 ,-- LIC. NO.: pVO- Licensee: �' s tom. e 1,00-0 Signatur . NO.: 3O� Wapplicable, enter "exem t" to the license number line f1 S-o�►�-- Bus. Tel. No.• LEE- 'ZS—O Address: �® LT® d� 0 � 7 r y n/ Alt. Tel. No.: 'Per M.G.L c. I47, s. 57-61, security work requires Department ofPublic Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ �l/_ G - _ �i'iJ_►1L+�T��Y.�%L C �jl�i��R�1Ply®�7.�1py r� • •�� v.4I-�-�.L'+J.0. �.1�0111`IJ-►l1�L%C �CJIJl�J.7: _ 'assed-- j)' I)Ze-znspecizoo xet�uixeti ($50.00) Inspectoxs' coxnznenis: (Inspectors'ignaiuxe�r�oiniiiais) Pate Passed — [ x �spectoxs' eonameA�s: YAM — (hasp ectors' Signature •- dao f 'assea--[ 1 aspectoxs' colameats: NAME: . te-inspectzonx ate-insp ecti Date G!,Isp ectors, Minawe -• x.o miff als) Pate 1) G OR TAG19 APX TO BE M LED IT A" IEFT ON RITE N TM APXA TO 3E INSPE CTUDISNOT A AND b 4mri nn T.q rrn'n . VffARr'PD t cd The Commonwealth ofMassachusetts Departmint of IndustriqlAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual):. 4 z Address: City/State/Zip;Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/orpart-time).* 2. ❑ I am a sole proprietor or partner- ship and'have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have Hired the sub -contractors listed on the attached sheet. These sub -contractors have w rs' comp. insurance. 5. gme are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roofrepairs 13.0 Other 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew 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. lam an employer that is providing workers' compensation insurance for my employees Below is thepolicy and joh site information. Insurance Company Name: Policy # or Self -ins. L//ic. #: Expiration Date: Job Site Address:__ I -la 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. 1 do hereby cert under the pains andpenaldes ofperjury that the information provided above is true and correct. Signature: Date: Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - 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 apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction br 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 -contractors) 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 maybe 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 returnedto 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.`applicaut that must submit multiple permittlicense 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 bum leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance. for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of massacliuso-tts Department of Industrial Accidents Mice ofwestigations 600 Washington Street Boston, MA, 42111 Tel. # 61.7-727-4900 ext 406 or 1-877-MA.SS.A.F� Revised 5-26-05 Fax # 617;,727-7749 wWW mass,goV1dia Date: R' :�ti TOWN OF NORTH ANDOVE ° PERMIT FOR PLUM I G SlCNuSE� This certifies that . it..P� ,% ............ has permission to perform ... R .... ` ................ plumbing in the buildings of .'.f.`?'° ` . p at 1 � .......... , North Andover, Mass. Fee. l ..... Lie. No. e �.` ... :�, c:.t.� ��_.......... . PLUMBING INSPECTOR Check # ` , MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER MASSACHUSETTS Building Location I 79 #90'/&to� /�d ol of New 1:3 Renovation 1:1 Replacement FIXTURES Date 17,171f GT/ %ic�c��e �r9f�y Permit # d 71 O Amount l F Plans Submitted YesNo (Print or type) Check on Certificate Installing Company Name %`[ 2r lt!/ '/Jw.« �I //� -Eri CCorp. Addressg_i2/I s4 s m C Partner. 544 e sw hit- usmess a ep one a Firm/Co. Name of Licensed Plumber. /vd R •n ,# rr /2,- 4/ - Insurance Coverase: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner. 11 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts tate Pllumbi Code and Chapter 142 of the General Laws. BY i na o u nesngecr riumDer Type of Plumbing License Title City/Town i Master D Journeyman ❑ APPROVED (OFFICE USE ONLY - G S-71 i� ( - r" 4 �-" � x "�' Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. ............... . ............................. has permission to perform ...... ...................... ................................................... Il wiring in the building of 4 ...... ,at . /....... .......... I..:: ................... ..... ).... North Amdover, Mass. ( 1, r /- -." p 'V Fee ...... ................. Lic. No:............ 11.14 ........ Check # DEPARMO POFPOBUC.'SOM Petndt No. ' l BQ4RDOFFREPREMVnUIVRFxiiZ.417gi 527aM ao � Occupancy & Fees Checked •••• APPLICATION FOR PERMU TO PERFORM ELECTRICAL WORK Aly WORK TO BE PERFORMED BV ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMA 12:00 (PLEASE PRIIdT IN IMC OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: "Me undersigned applies for a permit to perform the electrical work described below. Location (Street d Owner or Tenant Owner's Address -3a hu is this permit in conjunction with a building PwWt: Yes® No a (Check Approprime Bos) d Purpose of Building Utility Authorization No. Existing Service Amps i&Volts Overhead Underground No. of Metas New Serve Ampsolts Overhead ® Underground No. of Meter Number of Feeder and Ampecity Location and Nature of Proposed Electrical Work A+ Wtp No. of Ligbft Outlets No. of Hot Tubs No. of Tranatbnosts Total KVA No. of Ughting R cmc / Swing Pad Above 11 Below rl Oematas KVA C OU0011111 nound No. of Receptacle Outlets I No. of 00 Bunwe No. of Emergency Ughdng Battery Units No. of Switch Outlets / J �1 No. of Oo Burners FERE ALARMS No. of Zones No. of Range No. of Air Cord. Tout Toon No. of Detection and No. of Disposals Na of Hat Total Taal PoTons KW Initiating Devices No. of Sormdhq Device ,ANo. of Dishwashee Space Mea Heating l KW -t(>e kick No. off gaff Coutebw ow1ounding Devices Laval Municipal Connections Other a No. of Dryer Heating Device KW No. of Water Heater KW Na of Na of Sims atless No. Hydro Massage Tuba No. of Moms Total HP Ihmaam=tLid*iaaraeibftFkj*ftplde cdbsfthrjWc intent Im NO13 IlareakM1bdvddpafof iOdreG�m Y$9 M i<yotrhtnededOdYBSP� ® � the bat. WSt1RANt:B BOM O MM BtQisilonDale EstmeddVakled&ctiarl Wa k S 1 6CO r. WodcbStaiti>spact�RDweRec}.,i�_ d PZ* Arlt Silted urrds Asretleacfpajigy , \ [ E e�r i c FBtMNAMB UcalsNa o%Q a 5 y A Ll;o�e f� nG e it f'C .Car E. f Lina m 511 q% C �C'nti3rsir»TdNa _41 S 3gi 9 (313 a,+t�aa I©�1 Lowell (Z& We�'l�r� , wt, ALTUNio, =_9-2'46& ZGQ OWT�WSMJRANMWA1VIIt;IamawaedatdzLizm hggQreiaaaroeaote;gaaata riiiegiivaiUN egmdbl+Mae® tUMCUUWLaria ardthetrny9g�aemdispeQrit�plcadmwaeadruegiil®t (Please chxk one) Owns � a Agan Telephone No. PERMIT FSE i 00 i✓ 01 70-,'J:v ;!f Permit No. �`' Occu Pay ar Fees Checked 6 APPUCAHONFOR PERMUTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WTnt THE MAWACHUSSTS ELECTRICAL CODE, 527 CMA 12:00 (PLEASE PRINT IN INK OR TYPE ALL 94MRMATION) D Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 3 Owner or Tenant Owner's Address -13Ct,n e - Is this permit in conjunction with a building permit: Yea® No a (Check Approprim Bo)L) Purpose of Building d o.t.l e vx Existing Service Q nN Amps f l Volts New Service Amps Volts Number of Feeders and Ampacity Utility Authorization No. OverheadUnderground Overhead Underground l..ocation and Nature of Proposed Electrical Work nc- 7777ri ►tics Me I— No. of Meters No. of Meters of ughthtg Oudw Na d Hat Tubs No. of Told of Lghting FixturesSwhmnft Pod" Abovevosw Below comm Oerbrator KVA KVA iof Receptacle Outlet No. of OU Burners No. of Emergeaay Lighting Battery Units 0 of switch Outlets Ll No. of Oas Bum= FBtE ALARM No, Of Zones k. of Ranges No. of Air Cond. Total 1 Tars No. of Debcdon wW No of Dispos is Nm of Hat Total Totd Po Ton KW Initiating Dem No. of Sounding Devices No. of Dishwashers Space Ara Hatlag 1 KW -toe- k i C k No. of SONCbntahred DeleCtionMoundinj Devices Local Mmdcipal Other I No. of Dryer Heating Devices Kw Connections � i No. of Wats Resters KW Na Of Na d shm Ballast No. Hydro Maasge Tabs No. of Motors Total HP ka maeCovama Plaaeatbberex�imdbafMe�ctiteettf3amlL j; Ihatesutrnilkdvalidp Wcf=nelDthOmae YM j Il� SLiA- lVC� � BCM OMM 1 WC&IDSM ir�per7irnDelegaqu�d Symdunder P =113cfpesji* , ' t fMMNACSC I� r l ►r +� rU=1MR11)a1zr 41 YB$ NO )<Jouhnetfesd�iY63,PiaindetaeIretypeciwo mpby Dab dVatreetT:iddcalWerkS 16w Rough find tec�ri•L uz=Na 26D.5Lol Liml em ButiesTaLNa 511g'(� t:--- 9- 9- 3elq ()i 3 -? , aWI�R's IIVS[JRAI�EWANIILIanawaedstdrelimsed�gIheirsaxo7m>�orik9.As, I11N4 �le4ivakntas��db1'l1�da�Ge»eraMA hi 9 lLawa a rddetnrysgawondis-' i' i®I--- --' sli lawbMM (Please check one) Owner [n Apo Telephone No. 'moi pBRMIT FEE t_• . S Location ,�-, No. l Date NORTh TOWN OF NORTH ANDOVER t s + ; , Certificate of Occupancy $ �'�'''••°''<�' 9 cNuBuilding/Frame /Frame Permit Fee $ ss�sa Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t�0 *118 7 6 8 Building Insp for '-%A " TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT4 OR DEMOLISH A ONE OR TWO FAMILY DWELLING 172TIF77-77 77M,77,77-77 WR BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Bui ' CommissionedI r of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 17� 1.2 Assessors Map and Parcel Number: er Parcel Number 1.3 Zoning Information: Zoning Distrid Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water S ly M.G l -C.40. 34) 1.5. Flood Zone Information: - Public Prhve ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System` SECT ON 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No,,K 2.1 OAvner of Record ` 1-79 I-<�y Nam ri t) Address for Service: Signature Telephone 3:2 Owner of Record: j Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address I' 1Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone Z O r v rn r r G) SECTION 4 - WORKERS COMPENSATION Workers Compensation Insurance affidavit must be cc in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work cl New Construction ❑ 1 Existing Building Accessory Bldg. ❑ L� G.L C 152 § 25c(6) ;ted and submitted with this application. Failure to provide this affidavit will result Repair(s) X I Alterations(s) ❑ 1 Addition ❑ Demolition ❑ 1 Other ❑ . Specify Brief Description of Proposed Work: ,,ee I SECTION 6 - F.STIMATED CONSTRITCTION COCTC I Item Estimated Cost (Dollar) to be Completed b rmit a licant s��OFFgICIALYJSIE -I "I _ r 1 . „ QN:Y 3 I „ 1. Building (a) Building Permit Fee Multiplier 2 Electrical OZi OD O (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) /Zy � 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, s Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all ma ers-r8lative to work authorized by this building permit application. Sigiraiure of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 9< as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief G e7—V Gc Q. -efts Print N e Sign;t7 re of er/AQent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a*�-:. s? x O " o o w N v cn U O a p o u2 o w -C U a X W C7 o a; a w a W C W o o2 �a c w 0 U o a: a x W a dw w W x o cry o cn o V) ui am H C#* W LL W L� y s H t� c o m c ;� O o O N c VO C) •CL C O. e0 Co :t O O � m Ea c o n N EE :gym o� CL C O O Elk ca m� C m W = c N 60 L"' N 0 CL CDV y 0 ; CM �Q N 60.1 y O cc 'E Z c 0 o. CDID o N m r0+ ~ c CO3m •N w �p CM0 '. c O 0� 'fl m co o m E N N c ch 0 CM c m 0 co c �C N 0 Z r.+ O z O 8 0 F. O cm i O O y O O •E m m co CD O � � L O d a opa co C cc v CD ca C � � C..i ca O C C c CIO .-° TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT }a 4= 400 Osgood Street North Andover, Massachusetts 01845 Gerald A. Brown Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Please print DATE: 11/ro/as Telephone (978) 688-9545 Fax (978)688-9542 JOB LOCATION: //_�, 1A,I-%nI40w h'ol-py Number Street Address Map/Lot HOMEOWNER , D�,c` % 714 el --k I =� Name Home Phone Work Phone PRESENT MAILING ADDRESS 179 h'e'y mom'%tv ✓�L? City Town State Zip Code 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 Andover Building Department minimum inspection procedures and requiree s an that he/she will comply with said procedures and requirements. i HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL . Revised 10.2005 Form Homeowners Exemption Date. C ...... "0 �T :�4, TOWN OF NORTH ANDOVER X? IE PERMIT FOR PLUMBING v This certifies that .... .. .. - ........ , ........... ,sohas permission to perform .: - ............. plumbing in the buildings of .<�- ?� ,--f�•.>a............... at �.........-A. ✓..... ..., North Andover, Mass, Fee... Lie. No�'�6... �?.f ............. PLU44G INSPECTOR Check # 5773 A 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS , Building Location 1-71 4,i y r%s `` 4— RkOwners Date 6 Co C ti �'e l JS Permit # Amount. `/% Type of Occupancy New Renovation El/ Replacement 1:1 Plans Submitted Yes 1:1 No ET FIXTURES (Print or type)y� Check one: Installing Company Name &9e^r �" y ❑ Co q i Address 13 v-e� 'Sf Partner v �S C9 (9-1 3 Certificate Business Telephone n / n Li Firm/Co. Name of Licensed Plumber: P&I.1 Insurance Coverage: Indicate the t)pc of insurance coverage by checking the appropriate box: Liability insurance policyOr Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pe �P'su or application will be in compliance with all pertinent provisions of the Massachusetts Stat lu mg ter of the General Laws. By:igna ure o ice se um er Type of Plumbing License Title t53 (--1 City/Town icense um er MasterJourneyman ❑ APPROVED (OFFICE USE ONLY ;11't 1111111111 -fill • �1, 1.1 :,qui (Print or type)y� Check one: Installing Company Name &9e^r �" y ❑ Co q i Address 13 v-e� 'Sf Partner v �S C9 (9-1 3 Certificate Business Telephone n / n Li Firm/Co. Name of Licensed Plumber: P&I.1 Insurance Coverage: Indicate the t)pc of insurance coverage by checking the appropriate box: Liability insurance policyOr Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations pe �P'su or application will be in compliance with all pertinent provisions of the Massachusetts Stat lu mg ter of the General Laws. By:igna ure o ice se um er Type of Plumbing License Title t53 (--1 City/Town icense um er MasterJourneyman ❑ APPROVED (OFFICE USE ONLY Date ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................ ....................... a ........ .............................. has permission to perform /Y ......................................................... wiring in the building of .............................................. at ....... North Andover, Mass. Fee..c . No . ............. .o..... .. ........................... ,ELECTRICAL INSPECTOR Check# � ", i' - 48L21' a f< THE COA MONWEALTHOFMASSACHUSEITS Office Use of DEPARTMENIOFPUXJCSAFE7Y Permit No. eg ZZs BOARD OFFIREPREVEMONREGUL47YONS527CttIR I2.�I,� �,// Occupancy & Fees Checked APPUCATIONFOR PERMFFTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1,013411-173 Town of North Andover To the Inspector c The undersigned applies for a permit to perform the electrical work described below. Location (Street Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Purpose of Building 2A /it r-404.411-11 914�i, Yes E5+NO [::] (Check Appropriate Box) Utility Authorization No Existing Service Amps / Volts Overhead n Underground �✓ No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 'Z yJ 1(v& `iOU/L No. of Lighting Outlets No. of Hot Tubs No. of Transformers To K` No. of Lighting FixturesSwimming Pool Above Below Generators KN ground 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 No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal Other Connections O. No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs ` No. of Motors Total HP /7 OTHER- 12#1L 4 SLLQ h>sutmx:eCowrage Ptltstmt�thelegtmerrla�sofMassadytl fetlel-alLaws Ihaw aamotLmb&ykELrmmFb]LynrixbngConT4eL-OpwWmCoveraWoritsstxtRtdeWakyt Y;;EcRale NO IbavesubmiMdvandploofofsametotheOffice. YES [� Ifycuha%et1mkedYES,e typeofwve-ageby ]NSURANCE box BOND OTHER �jLL.�1I �J E*afim rt �© Q d • Eftlated Val &of l hMjcal Wolk $ Wolk toSta Irlsl�e onD�ReWesled R�/T /�3 Filial Signedundy'& esof FU?A4 NAME LimmNo. VS 14 Iia. Si, Lic�eNo 3 �S-6�i� ackhr cl G Gs7%Q''< S� /iw�1f�C/ yf 47ffi2 Bush sTel.No 97.0, S2f� -- -- AIL Tel. No. OWNER'S WSURANCE WAVER; I am aware that ft Lieerse does nothave the instuarlce coinage orits atsu)tial etlttivalerA as recgmed byMassachisE to General Laws nd that my s 9=i e on this peffnt application waives this recpurrement Please check one) Owner ® Agent ® Telephone No. PERMIT FEE Signature ot Uwner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print 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 # Insurance. Co. Policy # Company name: Address ^ City: Phone #. Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $I, _10 and/or one years' imprisonment_as_wtell_as_civil.penaltiesinsheliorm4-a-STOP WORK_ORDERind.a.fine_of.($InOM)-atlay-against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date >t Print name Pbone.# Official use only do not write in this area to be completed by city or town official City or Town Permit/Licensing I] Building Dept F-lCheck if immediate response is required E1 Licensing Boa, E] Selectman's C Contact person: Phone #: F-1 Health Depart n Other f l Location /9 l ISI `rr �a cry 1,c1, No. 4;2 5— Date >,G%-� MORTIy TOWN OF NORTH ANDOVER 3:0'x«•• :�,ti0 � w 9 } �• Certificate of Occupancy $ ;� s''�•�' E<� Building/Frame Permit Fee $ +cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `�6'7 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING w d BUII,DING PERMIT NUMBER: 3 �__ DATE ISSUED: SIGNATURE: (- Cq--� Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: ^ 1.2 Assessors Map and Parcel Number: c Map Number Parcel Number 1.3 Zoningg Information: 1.4 Property Dimensions: Zoning Dis rid Proposed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Recgired Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record c e,t, 1-19 Pay M eADoLs t�oN o Name for Service r p Q �-Address �Lk �A —1 L— ignature Telephone 2.2 Owner of Record: dame Print Address for Service: SY gnature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ STCOCAY 'F,. g Licensed Construction Supervisor: License Number 454 4,bC0S i �! _ 1X�/ . WV� Q �Z Address q Q ZC�C E xpira ' n Dall Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ _ z CA Sf RftVOW w►A7N SMU1 CE s 13 3 3 Company Name Registration Number - AIA) 5, /oPs�,q. V4 411e.? Ad ress ��g-213 •SSZ9On 206 xr Epiation ate Signature Telephone z O W �7 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ... .... ❑ No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: "4 I SECTION 6 - RST"AATRD CONSTRITCTION CncTc I Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) [ 4 Mechanical HVAC 5 Fire Protection 92 6 Total 1+2+3+4+5 Check Number to CY SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner/Authorized Agent of subject property Hereby authorize lJ %�i��GKIS�/ �%C Lt�CL� to act on V ehalf, in all matters r lative to work autho ' d by this building permit appl' ion. a^ Si ature of Owner Date V� SECTION 7b OWNER/AUTHORIZE04GFNT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRI 413ERS 1sr2 ND 3 RD SPAN DIMENSIONS OF SILLS DINvIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOJING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permitro 1 Number is that the debris resulting from this work shall be disposed f m P pe y licensed solid waste disposal facility as defined by MGL Chapter 111., S 150 A. The debris will be disposed of in: (Location of Facility) Applicant t� t�3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FROM KITTREDGE INSURANCE (MON)SEP 29 2003 9:54/ST. 9:53/NO.6310050056 P 2 ACORD CERTIFICATE OF LIABILITY INSURANCE CASE, ' 09..2910 ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ittredge Insurance Agency Inc HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 76 W.Main St., P.O. Box 1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES13CLOW Drthboro MA 01532 hone : 508-393-7744 INSURERS AFFORDING COVERAGE NAS REp INSURER A: Acadia Insurance Conpany_ INSURERS: Com erce Insurance C 347E C 8Q Handymen ServiCQ6 INSUR[RC: 5 Main street Corporation dba 5 Main Street . wsuRl R D. Topofield tea► 01983 INSURER E OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE N MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN 13 SUBJECY TO ALL THE TERMS, EXCLUSIONS AND 1 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUUMS. .WPPex .R NS TYPE OF INSURANCE PpUCY NUMBER DA DATE M GENERAL LIABILITY 1 X COMMERCIALOENERALLIABILI7Y BOA0076916-11 04/01/03 04/01/04 CLAIMS MADEOCCUR X Per Project -829 to L AGGREGATE LIMIT APPLIES PER: POLICY P LOC AUTOLlIOBRP UABILITY 9 ANYAUTO WX1133 03/28/03 03/28/04 ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NO"WNED AUTO$ GARAGE LIABLITY 7 ANY AUTO EXCEWNM9PmLA LtA'UTY 7 OCCUR [—I CLAIMS MADE DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND C EMPLOVERV LIABILITY 863X1418 04/04/03 04/04/04 ANY PROPRIETORIPARTNERIEXECUTN[ OFFICERIMEMBER EXCLUDED? OTHER OF [D.ON TWII'HSTANDING AY BE ISSUED OR IONDITIONS OF SUCH UNIITS EACH OCCURRENCE $1,000,000 PREIMSEs e• eocurarce 6 50 000 MED EXP (Arty Me Person) $ 5 , OOO PERSONALS ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS -COMProPAM $2,000,000 COMBINED SINGLE LIMIT S 1 r 000 , 000 (Ea acddeM BOOILY INJURY ; (Per person) BODILY INJURY 6 (Per soeiderd) PROPERTY DAMAGE $ (Per oodderd) AUTO ONLY • EN'S ACCIDENT $ OTHER THAN EAACC 6 AUTO ONLY- AW $ EACH OCCURRENCE S AGGREGATE 6 s s s WC BTAI U. Von TORY LIMITS ER E.LEACH ACCIDENT $100000 E.L.DISEASE- EAEMPLO 6 100000 E.L. DISEASE. POLICY LIMIT 3500000 CERTIFICATE HOLDER CANCELLATION TAGMML SHOULD ANY OF THE ABOVE DESCWBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL pNPM NO OUSATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR George Tagarelis 179 Halymeadow Rd N. Andover MA 01845 25 91te 76mmanalea" Board of Building Regulations and Standards One Ashburton Place,- Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 136331 Type: DBA Expiration: 7/16/2004 CASE HANDYMAN SER. STEVEN BLOOM 58 MAIN ST. TOPSFIELD, MA 01983 Update Address and return card. Mark reason for change. Board of Buildina= • • One Ashburton Q� Boston, r ! ' ! ! • cense: i Birthdate: 04/20/1948 Number: CB 074109 Expires: 04/20/2004 - Restricted To: 00 STEVEN E BLOOM 494 LOCUST STREET DANVERS, MA 01923 Tr, no: 21229 Keep top for receipt and change of address notification. -- ----- ------ F/7 L J Case Handyman® Services CONTRACT CASE HANDYMAN SERVICES PROJECT NAME: Mr. George Tagarelis 179 Haymeadow Road N. Andover, MA 01845 978-685-9155(H) Date: 9-4-03 Consultant: Steven Bloom We hereby propose to perform remodeling and/or repair work upon the above mentioned premises per the following description, scope, allowances, exclusions and general conditions. GENERAL NOTES: The homeowner is responsible for moving all valuables and breakables from the project area prior to the start of work. We assume all pre-existing conditions to be sound, any additional damage that is found will be addressed on a time and material basis Homeowner to make plans for house pets that may be affected by the project. Building permit is included per allowance. Provide zip wall door at Bathroom entry. Provide runners at stairs and hallways. Provide tack mats at demolition entry and exit points. Area of construction to be broom cleaned at the end of each days work. All job site debris to be hauled away at the completion of work, and the construction area to be left in a Broom -cleaned condition 1.) BATHROOM REMODEL: Remodel existing Master bath per plans. Permits are included per allowance. DEMOLITION AND ROUGH CARPENTRY - Provide site and dust protection as practical. - Remove existing sheetrock walls and ceiling, owner to remove all fixtures and ceramic. ** We assume existing walls contain no pipes or ducts. - Layout new interior walls per plans. New interior walls to be constructed with 2x4s. - Furnish & install Velux VS -75 vented skylight (21.5" x 47") with shaft. MECHANICAL - Re -rough -in plumbing, to code, per plans. - Install electric, to code, per plans. - Furnish & install 2 recessed can lights. - Furnish and install vanity fixtures per allowance. Furnish and install Panasonic low sone exhaust fan, exhausted to exterior. ** No work has been included to upgrade existing plumbing service, electric service or H.V.A.C. systems. INSTALLATION AND FINISH WORK - Layout new bathroom design. - Finish walls with 1/2"blueboard, slick finished. - All ceramic surfaces to have Durorock as a substrate. - Furnish & install 3 5/8" crown molding. - Install new ceramic shower surround and faucet. - Bathroom floor to be ceramic, picked by owner per allowance. - Install pedestal sink furnished by owner. - Install new toilet furnished by owner. - Install new sink faucet. - Install new glass shower door enclosure, per allowance. - Painting / Wallpapering has not been included. (978) 213.9929 Tele Case Handyman Services (978) 887.3308 Fax CO 1 0.......1 /*;;\7 CONTRACT CASE HANDYMAN SERVICES • L J PROJECT NAME: Case Mr. George Tagarelis Date: 9-4-03 Handyman® 179 Haymeadow Road N. Andover, MA 01845 Services Consultant: Steven Bloom 978-685-9155(H) The following allowances are included: Area 1: PERMIT SERVICE, BATH REMODEL, ALLOWANCE. $375.00 Area 1: PLUMBING FIXTURES: ALLOWANCE, By Case. $800.00 Area 1: ELECTRIC FIXTURES: ALLOWANCE, By Case. $200.00 Area 1: SHOWER ENCLOSURE $1156.00 Area 1: BATH ACCESSORIES, MATERIAL ALLOWANCE. $100.00 Area 1: CERAMIC FLOOR TILE: Thin Set, Material Allowance, By Case. $792.50 The following items are not included: Area 1: New Electric Circuits w/ associated patch & paint, if required by authorities, are not included. Area 1: New Smoke Detectors w/ associated patch & paint, if required by authorities, are not included. The lump sum bid price of this project as described above is Twenty Seven Thousand Dollars. PAYMENT will be made as follows: 1. $9,000.00 upon signing 2. $9,000.00 upon start 3. $3,000.00 at start of plaster work 4. $3,000.00 at start of ceramic work 5. $3,000.00 net upon completion License Number: CS -074109 Expiration Date: 4/20/2004 Reg. Number: 136331 Expiration Date 7/16/2004 Fed. ID Number: 01-0624772 START DATE: CASE will contact the owner within three to five business days upon receipt of signed Decision/Selection sheet to schedule work. ACCEPTANCE: The above prices, specifications, conditions, and `Terms and Conditions' on the attached sheets are hereby accepted. are authorized to perform the work specified. Please refer to General Conditions on back of contract. You have the right to rescind this Contract within three days of signing. Do not sign this contract if there are any blank spaces. /? Steven E. Bloom, President f Datif Case Handyman Services (978) 213.9929 Tete Case Handyman Services (978) 887.3308 Fax coR..._ c•—,.... You iayi neadowRd 79 N M -Sink co - " e es a 4, _ x cv 00 -= Closet , - ' 11" 5CA&e /�--/ i Ok ri UD C w m u U v' O F-4 P-4 Z A o c b wO 'nOCp P4 v U U � P' a Cop "O � O w � U w O ` p v a w�C w a4 d w G z �b cn o o cn a ;!1 2 CO) y O CL co C O CD Q _m CL CO2 0 O V CA e O .0 0. CO2 r�� CDV co C. y C C CM Qco C o� C93 m CD co CD Q CD C. cnQ C 0-0 C !D CD O O Z CD C. C4 C 0 _ ,Fn C i Ir w crW c o m c c s O ` O y c vO V •nom' • p, c m c = O EQ L m � m sa y • c dw: m O s Li 0 y R.t;CD L CA m c=:, L �_ y m Z +• cm � O J c � "� ea y ` =0 �= E y ' a Amo m nt3 Of .o m 0 V H Z O .: c 2 o y c .O Q � t O C m= o = m ~ S h O N VJ ev t m 1JJO � yam„ C � O •�- I.- co)dZ 'E C 40.y Z o v m om�c A ti "= O i ` :a . =. a ;!1 2 CO) y O CL co C O CD Q _m CL CO2 0 O V CA e O .0 0. CO2 r�� CDV co C. y C C CM Qco C o� C93 m CD co CD Q CD C. cnQ C 0-0 C !D CD O O Z CD C. C4 C 0 _ ,Fn C i Ir w crW Location /7/1 - -/:�� vo.y� 6 Date Check #14129 / ✓� Building Inspe to TOWN OF NORTH ANDOVER fNpRTH o ,,,.° :, 3? ' 0 AL a • Certificate Occupancy $ Ip of SACMUS Eck' Building/Frame Permit Fee $ �G Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #14129 / ✓� Building Inspe to TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERNUT NUMBER: ; DATE ISSUED: 009, SIGNATURE: Building Co missioner/lArwor of Buildings Date - SECTION 1 -SITE INFORMATION 1/..1 Pr000p+erty Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RegWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) / C / Address for Service Ts� Signature Telephone 2.2 Owner of Record: I Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 060 Q Licensed Construction Supervisor: Zo_g Address iC.1s jo Signature Telephone 2C-6 t 2- Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor �%t�/1 Not Applicable ❑ Company Name Registration Number Address (� G Expiration Date Signature' Telephone M M X z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Pa il foe SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OF)F�ICIAI UEFpNLY ` t ff 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction + a (1 3 PlumbinE Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlABERS 1 ST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE k CERT I F I CATE OF L IAB I L I TY I N S U R A N C E I DATE 05 -OB -00 (MM/DO/YY) PELHAM INSURANCE SVCS INC 122 BRIDGE STREET PELHAM NH 03076 - INSURED Tl,omas Doyle DBA Thompsons Construction & Roofing 8 West St. Salem NH 03079 Li VG _ "GES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: The Maryland INSURER B: Liberty Mutual INSURER C: INSURER D: INSURER E: 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 T"E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE ' $1,000,000 A [X] COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300.000 ( ] CLAIMS MF,DE [X] OCCUR SCP 34865353 04.15-00 04-15.01 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1.000,000 GENERAL AGGREGATE $2,00".2^0 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2.000.000 [ ]POLICY [ ]PROJECT [ ]LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ] ANY AUTO (Each accident) $ [ ] ALL OWNED AUTOS BODILY INJURY [ ] SCHEDULED AUTOS (Per person) $ [ ] HIRED AUTOS BODILY INJURY [ NON -OWNED AUTOS (Per accident) $ [ J PROPERTY DAMAGE [ ] (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ j AUTO ONLY; AGG 8 1 EXCESS LIABILITY EACH OCCURRENCE $ [ ] OCCUR [ ] CLAIMS MADE AGGREGATE $ 8 [ ] DEDUCTIBLE $ [ ] RETENTION $ $ WORKER'S COMPENSATION AND [ ] WC STATUTORY [ ] OTHER B EMPLOYER'S LIABILITY WC2.31S-314995.019 04.21.00 04.21.01 E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500.900 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Roofing I CERTIFICATE HOLDER ( ]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPJRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR Don Foss TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 9 Gumpus Pond Rd. TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR Pelham NH 03076 REPRESENTATIVES. AUTHORI REPRESENTATIVE (7/97) Page 1 ^f 2 Page of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 ,n- n% �n-# .4occ 11 THOMPSON'S ROOFING Shingles — Slate — Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO PHONE DATE NearTaciarelis 5-11-00 STREET JOB NAME 179 Hay,�neadow Road CITY, STATE AND ZIP CODE JOB LOCATION / o h Andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Strip do6f all roof shingles on house and garage Rena l- al -1 loose plywood ;:stall aluminum drip edge around roof lLne Apply ice and water shield 3 ft. up all along edges Apply 15 lb. felt paper on rest of roof area Reshingle with a 25 year Architect, your choice of color Install new flanges around soil pipe Install ridgg vent Remove all work related debris 25 year warranty on material 10 ,Year guarantee on labor Construction lic. #060112 ,= .-nprovement #128612 We propint hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: mix thousand four hundred -- ------' dollars ($.6,4 00.00 �. Payment to be made as follows: -' All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving Authorized be Signal �= extra costs will executed only upon written orders, and will become an extra charge over and aoove the estimate. All agreements contingent upon strikes, accidents or delays beyond our J control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully Note: This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if not ar-r-antwd within A.— ZICCEPUTICE Of PrOP00111— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature, V \ ; '���- — — Signature Town of North AndoverNORTH Of�tLSo o Building Department 0 27 Charles Street North Andover Massachusetts 01845 z .^ (978) 688-9545 Fax (978) 688-9542�,'QoR�Ttp rPw"�5 ACHU DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: /--()ur-e �/ k C L L 5 (,Piers'' -,f ��� Y �� G� '� S� Facility location Signature of Applicant ? a �� Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. . C/) m .1! Cf) 0 m v H 'v C � CA Cl) CD CS! Z CA CL o CL CO) 0 CD o p CD O CLQ �C m CD CD o CD ww C CD y� �. CD CK O co) a= CD F v CO) O 'oZ CD CD CD O CCD V J 2 o� 0 cn C 0 cz Z 0 CD O m 0 C n m m C o: 0 N C O CL N S y m C ?� O -• 0 0) =_ N N a d O oc Co 07 m n N m ..f C �. 'Jq O ] .+ CLd CL C T m =r m y N � O �co N m = n O Cn (D 10 ncpti Z C. CO's O N !7 : O D ; S y 1 n � gm � CL r.,.. C2 m H CD 1 C-)= m CL N d N C S O. d � d CD m O 3EC N Co.) CS m wH gym: 19 oc: O CD N "F � O . S: eo CD C N CD C3 d CD W d o, a'S. Cl) C., c o !� ' moo: O � .� z Cn Cn z W ,Gy m O "g1 O ? z O 'Jq O ] :v O PoIrl O S- O O 'rJ O m tv Cn (D 10 ncpti "17 O 0 y 0 9 0 c S Location 7 , No. / I �r Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foupdation Permit Fee $ Ot '4 Derr it -Fee T $ Sewer Connection Fee $ Water C nnection Fee $ [JUL, :I, �OA�$ A " A ^ ^ A /, Building Inspector Div. Public Works N N vi d VI X N It mi W W Z p 0 z Z W m l 0 J J O W m _ � m rc o~C 0 0 O Z W m 0 W K 0 N D N d Z M F LU W d m I S o 3 Q Z � ILV H i d �O 0� J N fn �M 0 7 r W QZ o f N 04 0 rc 0 z N F N N It W m i F O J LL LL 0 W N_ m 0 b Z O N a O d z O LL LL 0 F x x W a lz 0 U. 0 Z 0 0 LL LL 0 W N_ OW N N � w � m Z l7 W 4 O 1- I.- � f u W Z < m Z ut p 0 O 4 m m LL 0 o 4 0 M - W N W l W l7 o Z - d d 4 m W W V � H J f o Z W > W II 0 m F I N N vi d VI X N It mi W W Z p 0 z Z W m l 0 J J O W m _ � m rc o~C 0 0 O Z W m 0 W K 0 N D N d Z M F LU W d m I S o 3 Q Z � ILV H i d �O 0� J N fn �M 0 7 r W QZ o f N 04 0 rc 0 z N F N N It W m i F O J LL LL 0 W N_ m 0 b Z O N a O d z O LL LL 0 F x x W a lz 0 U. 0 Z 0 0 LL LL 0 W N_ OW N Z 0 U N Z N N � s m Z l7 W 4 O 1- I.- � f u W Z < m Z ut p 0 O 4 m m LL 0 o 4 0 M - W N W l W l7 o Z - d d 4 J W W V � H J f o Z W > W z 0 m F Z F } m O rc� W r- W < z F 0 a � 6 6 Z' OW .w C a0IL 0 0 F C 0 N W W N J Z <_ 3 W u < a Z 0 0 d z<< W a M W d a ' u m o m m u Z L Z O LL Ix LL 0 O O O p < N J Z_ z J LL C W u W U W U LL _Z O 0 O > 0 W Z Z Z 0 J J J m O O N N la N W m m m J < m N; m 0 0 < -0 N Z 0 U N Z N N � s m Z m 4 z a 0 O 1- I.- � f u m m H tl p 0 O 4 m J J 0 4 0 M - W N W l W l7 o Z N d d 4 J W W V � H J f W � � Cr1 427 C2 'G F } m W < O W N � 6 6 Z' OW K 0 0 0 .lY IL IL 0 0IZ uu u Z <_ L C t7 Q O �u L7 d z O W a M W d a ' u m o m m u 01 j W W W � m 'Q - N Z 0 U N Z 1. N N � c m Z m 4 z a 0 O 1- I.- � f u m m H tl p 0 O 4 m J J FLL 4 0 M - W N W l W l7 l7 4 N d d 4 J W W V � H J f 1. �. J W W V � H J DVF- W � � Cr1 427 C2 'G F Mz W < O W N � C 0 K 0 rc W z O 0 .lY IL NT\ 0 Z <_ C t7 W ~ z O W a M W d a ' IK I G D vC N yOD S O C A A 1 u >p D O W n3T o A m n n z N � O x m I 0 n ti~ mA I- n n c c A D p* m Vv O^ O p a A x rl0 Z _� D O W o A m n n z N D 3 y cIz N .. J( 7[ O ti~ D O N D N A r) A ti O Z Z O O O v 0 N N S_ o A A 0. c m A T T w z D T A i Z Z Z C.7O N O Z Z N0 G1 G1 3 N y C C N; 3 �0DN T z� N y T T zx o << Z; < T O ZN T ? •�� � Q Z n I11LJI D a n x n 3 T T T nH Sm 3.Z S f Z p >T TO D OZ N Z D rmm Z v ^NnDD {0 n�Zc >> ° z IIII ° II OO A � 1—Ii— II II II IyI -LLI� '�L. I1.1IIII- I I I I I V IIMI►" Iill II 0ON N m z �N1 DO NZZ °c �XN T0I 0 1 00 N ° G Pim ion 5noo �z- MWE TOM �mZ c MWo N_m v r rr-°O Z Ic)r -000 r- -1 D*D m 2�z A xo 0 �v 0� v :0a n in mm 00m 0 3 KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properiv licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: LTJ LtgL'r c"14U (Location of .Facflity) ..i Signature of Permit Applicant -- `% G -q? Date �— NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Tower "Qf 120 Main Street OFFICES OF:01, APPEALS „ r: NORTH ANDOVER _ North Andover. o 1845 BUILDING ._=:= t, DivIS10N OF' Massachusetts -. (6171685 4775CONSERVATION HEALTH _ ... .. PLANNING & COMMUNITY DEVELOPMENT PLANNING KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properiv licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: LTJ LtgL'r c"14U (Location of .Facflity) ..i Signature of Permit Applicant -- `% G -q? Date �— NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. AMERICA iwREMODELING ` Contract / Proposal NAffl;I1" KEEN CONSTRUCTION CO. NATIONAL ASSOCIATION OI the REMODELING INDUSTRY 21 HEWITT AVE. NORTH ANDOVER, MA 01845 Date - -` C "� TEL. (508) 691-5201 r, "1 1171 Submitted To Work To Be Performed At Name z +'l `1 Street ) -Oct Street 1 o'( o +i Lrj a City } Sate , City/ State J I U et Date for Work to Begin q) Tel. No. 1y�7 / • C/S=Customer Supplied • S&I=Supply & Install MATERIALS LABOR SUBTOTAL - L Ls Tp Cc I , t` f,4 C i I'Ji ren -Dc C �LS� P1 a pl� T �FF � � , c - C'c �� � � U n.t ` r L S PJ I Z. N �.I � C ` ✓LS . TOTAL Payment to be made as follows: 0 `" �GuJ r� � O E-) U C w r'2- ri al All material & labor is guaranteed to be the quality specified above. Removal of all debris generated from above work is the responsibility of the customer, unless specified in this contract. Any alteration from above specifications will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, weather conditions, material availablity, or d ys eyond our control. MA Reg. No. /n G Respectfully submitted r' / Note—This contract/proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF CONTRACT/ PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. A r Dole Signature § \e' . 4 � • � . ' # 0 / § m� w®$ / ® » ' ■ ,�k » ^ Bek }I ƒ - e&§| § M 6 0 m © p$ » m e ® -1 � �T. \ \ gT, � / - @ c §���� 5 2§ /f 7 § n $ m z e J t . 4 | � $ &� mm2 / 8421-0 co E _� f mm omoo o I� 99®/ z ` $ %/ 7mi p3 MKZ ED \� | z% ^ }I ƒ - e $Ic gT, � $ H = < @ c 5 2§ /f 7 § n $ m z e J t < (D � U a \ � | � $ &� mm2 / 8421-0 co E _� f mm omoo o I� 99®/ z ` $ %/ 7mi p3 MKZ ED \� r1l) 4 5 Al Z5 cp CO CO) 10 a Z CD O CL r O ,O♦. O � CL n� O v CL Q CD O ff .. CZ O CO CD H CD O 0) O CO) C7 C O c COD CD O rF CD CD3 y CD CO) O O CCD O C CD C c��o � S O —• N O C N CD C CO ffy dp m Cl) Co N CO . Oa W Z � c vi .-► m d d T p m N G y p .••� > > r So No --i co O+• G o o N• A W 4 o � C• coCL . VJ ` W W N Cn sa mom c a O�m N ,1 ._n. O d N �./ N CL �_ /^� c C/) EL gcD y C CO) N o : % N � 7 m a1 MCD =10 •�' � 'o'er O ...r � o .. AN CD CD AftN W .rt N CD o� G) C,) n : n n CS : SII ' CA COn C, cn 07 ^n ?? ^n ro x n ° o x o o 10 o O w C y < G m p) G O - a' x a C" � a QJ n rD 7 d z OZ O z � Z G411x HtTl 7d y 0 0 c