HomeMy WebLinkAboutMiscellaneous - 184 CARLTON LANE 4/30/2018Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 C R 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Jt
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her i e tion to perform the electrical work described below.
Location (Street & Number) V �j (-/Z—Ph e7
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes ❑ No [fl"— (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
No. of Meters
No. of Meters
W/
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑In- ❑
rnd. grud.
No. of Emergency Lighting
Batte Units
No. of Receptacle Outlets l
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat PumpNumber
Tons
...........
KW
................
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑Municipal 1:1 Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs J
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER: n i CQS
el Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of f lecIrical Work: Q (When required by municipal policy.)
Work to Start: ai ( Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVE E: 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:)
I certify, under the pains a d pe aloe of rjury, jl:at the information on this application is true and complete
FIRM NAME: C /L� C LIC. NO.: 70 14
Licensee: (Eµ LNSignature C. NO.: qiy
(If applicable, enter "exempt" in th license pumber line.) Bus. Tel No..
Address: 3 o U) Cc s dl Alt. Tel. No.
*Per M.G.L c. 147, s. 57-61, security work require Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE: $ �"
Signature Telephone No.
I
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
...... /w�.. Ice eb:eZr '7
...... ............
has permission to perform ........... ....... .... .. ...................... t4p
wiring in the buildin
g of
at
......... .... ... . North Andover, Mass.
Fee-5�-,-, Lic. No.
. ........
I'Ll"C" T** R** 'A' L** * I -N'
Check #
-1
01879-143--2-1
2QLLL9
-q
Official Use Only
Commonwealth of Massachusetts
Department of Fire Services Permit No. % 6 c
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 tMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: Aidp 4j - To the Inspec r o Wires:
By this application the undersigne(f g`iv'esnotice of his or her int ntion to perform the electrical work described below.
Location (Street & Number)
,Qq' Nn imlior► tan -c
Owner or TenantKra f 50.11 1(f- j -O n _ Telephone No. ���h -04d y
Owner's Address
Is this permit in conjunction with a building ermit? Yes No ❑ (Check Appropriate Box)
Purpose of Building ► a Utility Authorization No.
Existing Service ZCYC Amps I i d / ZZ,@ Its Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
I Number of Feeders and Ampacity
9 Location and Nature of Proposed Electrical Work:
Completion of the followinv tahle may he waived by the Incnerinr nfWirec
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires �,
Swimming Pool A ove ❑In- ❑
rnd. grnd.
o. O mergency Lighting
BatteryUnits
No. of Receptacle Outlets I
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches q
7
No. of Gas Burners
o. oDetection an
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
eat Pu
Totals:
um._....
'.....' ' """
ons
"' *.........."""
""'"""""
o. oSelf-Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
SecuritySystems:*
No. of Devices or Equivalent
No. o Water KWo.
Heaters
o o. o
Si ns Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Te ecommunicationsirmg:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Valueof le ical Work: l S°00 ,00 (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CO RAGE: 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:)
I certify, under the pains and penalties of perjury, that the information on this application i true and complete
FIRM NAME: LIC. NO.: 17238A
Licensee: Richard J. Arel Signature LIC. NO.: 27514E
(Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-372-1601
Address: 773 Wachi AnZtQn-_¢trggt Hayerhi 117 MA 01832 Alt. Tel. NO.: Q7R-'if17-71 R7
*Security System Contractor License required for this work; if applicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hm,e 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 went.
Owner/Agent
Signature Telephone No. PERMIT FEE. $_�
9468
Date ....6...... .
.. ... . .. ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............ ..........................
has permission to perform ........ ....................................................
wiring in the building of f /004)
9 —""v ...................................................
at ... ..... Z ........................... North Andover, Mass.
Fee..................... Lic. No . .. ... ... ... 7 ..........
E, R
Check # PE L)
14-\ Commonwealth of Massachusetts
Department of Fire Services
lug BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. IF (.-5- 2
Occupancy and Fee Checked
ev. 9/05] 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
(PLFSASE PRINT IN INK OR TYPE ALL INFORW TIOA9
City or Town of: /,)OM Ut)ddU
By this application the undersigned gives notice of his or
Location (Street & Number) /8y • 0,a, -u? YL
owner or Tenant
owner's Address
Is this permit in conjunction with a building permit?
Date: 5-15 D 9
_ To the Inspector of Wires:
to perform the electrical work described below.
Telephone No. 978. bffi .117-90Y
C
Yes ❑ No D--" (Check Appropriate Box)
Purpose of Building Utility Authorization No.
E*.is*ing Service
Amps
/
Volts
Overhead
❑
Undgrd ❑
New Service
Amps
/
Volts
Overhead
❑
Undgrd ❑
No. of Meters _
No. of Meters
Nualber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: /i ), „ , e® 5 7 px-e ,b0 Q� zt ,)�1z—iY C%'l74
Com letion ,f the ollowin table maybe waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Su sP• (Paddle) Fans
° LOW
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above'N—o.—oTEmergency
Swimming Pool Crud. Elrud. ❑
Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS INo.
of Zones
No. of Switches
No. of Gas Burners
No. of Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Toner
No. of Alerting Devices
No. of Waste Disposers
�To P
um er
ons
O. o e on taliked
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Munica
Local ❑ Connec on El Other
Heating Appliances KW
ec�h' ystems:
Equivalent
No. of Dryers
Na of Devices or
No. of Water KW
Heaters
NO. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Eydromanmean Bathtubs
NO. of Moton. Total I
a eCOmmIIIIICB OASing Wir 1:
No. of devices or Equivalent
OTHER:
,4naCn aaatnonat dela(t iJ aewrea, ur uo rcyuucu ✓y .nc ,..,,. .... •- -• ---
Estimated Value of Electrical Work(When required by municipal policy.)
Work to Start: �y(Sj0✓� 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 :)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME:�LLllln t Eck r-/ L LIC. NO.: 61111MLicensee: Signature `= ^Y� (r LIC. NO.:1476,3'1
" _4 79-�'
(fapplicable, ter'exe Ptin,the cense nmber line) Bus. Address: () / n Ji &2 lffloX Z7 g d4-
66ff,// Alt. Tel. No.:
*Security System Contractor License required for this work-, if applicable, enter the license number here:
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 0 owner's agent.
Owner/AgentPERMIT FEE. $ ab tO
Signature Telephone No.
f
Date ......
........ ..Z /......
�
of No oT ,'�tio
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
��
This certifies that ....rotllLC14
�� �� G- c.........................
has permission to perform`5-2o�� ,Boy LES
...............................................................................
wiring in the building of.E.�'�°�
.............................................................................
�92r�o�
at ............................................................. North Andover Mass.
/ Fee.." .�... Lic..................✓G��.1`��`"�...
EL�cr-
RICAL INVSP!MR /
Check # 1 Z /S 3
8,153
Alarms:
Fire
Burglar
Wiring for:
Heating
Air Conditioning
Controls
Computer
Installation
Residential
Commercial
Industrial
Renovations
Additions
Maintenance
Tenant Fit Up
Design Built
High Voltage
Work
Bucket Truck
March 15, 1999
James Decola
Town of North Andover
Electrical Inspector
120 Main Street
N. Andover, MA 01845
Dear Mr. Decola:
After unsuccessful attempts (via telephone and mail) to schedule an electrical
inspection for the following customer, I have requested (via mail) they contact
you directly:
Mr. & Mrs. Ken Heffron 184 Carlton Lane.688-2904 Permit #2195
Electrical in 1st floor bedroo� m
If you have any questions, please do not hesitate to call.
Sincerel
Patricia Mc onagh
Crowe & Sons Electrical Corp.
Secretary
..---;- e
t
Licensed in Massachusetts • Maine • Vermont 6 New Hampshire
577 Middlesex St., Lowell, MA 01851 86 Swain Rd., No. Chelmsford, MA 01863
TEL. (978) 251-8573 - 453-6696 • FAX: (978) 459-1333
Location /f �`r"�' •=�
No. / Date
.a
TOWN OF NORTH ANDOVER
• � s
Certificate of Occupancy $
� O� <wlirw. w 4
�i7s'••°' Eta' Building/Frame Permit Fee $
Z
MUS
ti
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ C-2--a-
Check #1733)
Building Inspe r
Date....... �/...:...
° -lf '• TOWN OF NORTH ANDOVER
o�
p PERMIT FOR WIRING
This certifies that......
has permission to perform C� '�� / / '✓ °r
............................................................................
wiring,in the building of ......../..`�.. ��.s?. �.K...........................................
11
at ....... f .(�:r...`.'�! Y...�!....� .'.:........... . NqAh Andovqx, Mass.
Fee..... ......... Lic. N4r.. s ..................
/ECTRICAL INSPECTOR
Check #
5313)
THECOA MONWEALTHOFIVIASSACHUSEITS Office Use only
�T
DEPAOFPU&1CSAFE7Y Permit No. _ (6
BOARDOFFIREPREVE MONREGULAHONS527CMRI2.-00
Occupancy & Fees Checked
APPLICATIONFOR PERMIT TO PERFORMELEOWCAL 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 % - % -,:;4
Town of North Andover i To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) �,5�.Cc.To
Owner or Tenant ��t�FP/Laiy
Owner's Address S�
Is this permit in conjunction with a building permit: Yes E�3 No r7 (Check Appropriate Box)
Purpose of Building 1-1-1% .&,f i L -
'r Utility Authorization No. _
Existing Service AmpsVolts Overhead Underground 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 SC -00~Q 41— o x— 12.}ry X4 m c pEe-
No. of Lighting Outlets
Total
No. of Lighting Fixtures
FIRE ALARMS
No. of Receptac } Outlets
Tons
No. of Switch Outlets
4
No. of Ranges
Total
No. of Disposals
No. of Detection and
No. of Dishwashers
Tons
No. of Dryers
Initiating Devices
No. of Water Heate{s
KW
No. Hydro Massage Tubs
NQ..of Sounding Devices
OTHER-
No. of Hot Tubs
Swimming Pool Above
No. of Oil Burners
No. of Gas Burners
No. of T ranstormers
Below Generators
,,round
No. of Emergency Lighting Battery Units
No. of Air Cond.
Total
FIRE ALARMS
Tons
No. of Heat
Total
Total
No. of Detection and
Pumps
Tons
KW
Initiating Devices
Space Area Heating
KW
NQ..of Sounding Devices
No` of Self Contained
Detection/Sounding Devices
Heating Devices
KW
Local Municipal
Connections
No. of
No. of
Signs
Bailasis
No. of Motors
Total HP
Total
KVA
KVA
No. of Zones
F1Other
hwanceCovaage Putsttanttoftm metrtentsofNb%w&isemGemdLaws
lbawawnentLUALyIN==PbhqinckxkgGc)nipIMOLmhmCoverageoritsabstaraoWwaktt YES NO
Ihavesub rumdvalidproofofsametothe Offim YES rip Ifyouhawchedl YES, pleaseitdcalothetypeofcovaageby
cheddngthe box ��,,//
INSURANCE BOND r7 OTHER r7 (Please Specify) /%LrieGl�i}/V
F_xpirationDate
EsknatedValue ofE)evtacalWo& $
WotktoSlait 7- 7 ^ 0 4 hTecdionD&Requested Rao Final
Signed urxlaTe ares of papy.�
FIRMNAME Li No. L-'30 2s'S .
lica>�e 10�CT �,��.ri rw� Lr0 Sig��attue t/ ��/ Licmsc�Nots�
'/ BusirmTel.No. Goa 8§S ,;opG
ArkfiFcc / Nif>3ay ��Lc �•f Nyi+�eD N� X3077 Alt Tei No. G�3 �6sgr43
OWNER'S INSURANCEWAIVER;Iamawacethat the Licerg--does nothavetheinstuanceoovetageoritsstibs=alequivalent astegtmedbyMassachusetlsGeneralLaws ��
and that my sig ikiteonthispermitapplicaationwaivesthismgtmernertt
(Please check one) Owner Agent (
Telephone No. PERMIT FEE
tgna ure
of Owner or Agent
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation insurance Affidavit
Name Please Print
Name: JJ;P.--ew-Zit�Trt _fit
Location: /4 I,r.rs -AJ /Au.
❑•
t rN a /�V oral 77
a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
# aos
0 I am an employer providing workers' compensation for my employees working on this job.
Comoanv name:
Address
City: Phone #: `
Insurance Co. _ Policv #
Company name:
Address
City: Phone #:
Insurance Co. Policy # I
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500:00
and/or one years' imprisonment -as _well_as_civil.penattiesin the form of-a..SIOP WORK_ORDER..and_a fine. of.(.$100.00)..a-dayagainst.me. ti
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby 72�tA����
ns and penalties of perjury that the information provided above is true and correct.
Siqnature Date
Print name /Z a /,
AL
Official use only do not write in this area to be completed by city or town official'
# 6,13 Wr soP<
City or Town Permit/Licensing
Building Dept
❑Check if immediate response is required Licensing Board
❑ Selectman's Office
Contact persona Phone #a Health Department
Other
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
f6i U AI<
BUILDING PERMIT NUMBER: n DATE ISSUED: a _0
SIGNATURE:
Building missioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
/gni
1.2 Assessors Map and
le7 A
Map Number
Parcel Number:
0103
Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (so Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
ReqWred Provided
1.7 Water Supply M.GL.C.40. 54) 1-5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) — / Address for Service:
_4�g_ o
Signature Telephone
k
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
P,/,- iL zz le sr
Licensed Construction Supervisor:
Addre
M�— ��1j'_ " v�G
Signature Telephone
Not Applicable ❑
License Number
G
Expiration Date��
3.2 Registered Home Improvement Contractor
,Q?111Z�A4 t`iy: de, -S *ye
Not Applicable ❑
Company Name
Addre
vfo — d �1�
�ignature Telephone
Registration Number
Expiration Date
60
rn
X
ic
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 buildin permit.
Signed affidavit Attached Yes ....... No.... ... 0
SECTION 5 Description of Proposed Work check au
a Ucable
New Construction ❑
Existing Building ❑
Repair(s)
❑
Alterations(s)
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Propoosseed Work:
r / ,,/
`
4 ie
/7e to .%-4
c)A- 5wrnt u.n /I To
C'Lv:?7 ft ,ti 4r4 i, o4 e 5 .
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
OFFICIAL USE ONLY
Completed by permit applicant
1. Building
d k 6—
342
(a) Building Permit Fee
Multiplier
(b) Estimated Total Cost of
a 6
2 Electrical
0 9
Construction
3 Plumbing
' 4o
Building Permit fee (a) X (b)
gD
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
7
Check Number
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
to act on
My behalf, in all matters relative to work authorized by this building
permit application.
Signature of Owner
Date
SECTIN 7b OWNER/AUTHORIZED AGENT DECLARATION
I, &"'e Ze �Jt9/'� S�
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
R/ r l r" T
Print Name
Signaturrof Owner/Agent
Date {
NO. OF STORIES
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1
ND RD
2 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHRANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL, GAS LINE
t
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL e 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in properly
licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A.
The debris will be disposed= of in:
J-114 Ir -
(Location of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
N2
0
Date.....1....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... e 1 -f c f � , (-
.................. ........... I ....................
has permission to perform ..............................
,'..k.ts .. L�.n ..........
wiring in the building of ........ t:�.n ........ v ...........................
at ......... /kl ...6 ,. 17 /Zn.......1 ......... . North Andover, Mass.
Fee. 0 ......... Lic. No. A-26..'17 ... ............
ELEcrRickL1NsFrEc-r0R
7 (rJ,
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
AGUKU CERTIFICATE OF
LIABILITY INSURANCE DATE (MM/DD/YY)
07/07/2003
PRODUCER. (603)669-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Infantine Insurance, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box S12S
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
POLICY EFFECTIVE
DATE (MWDDNYI
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Manchester, NH 03108
For Informational Purposes
Joyce McMann
INSURERS AFFORDING COVERAGE
INSURED Blackdog Builders, Inc.
07/01/2004
INSURER A: Acadia Insurance Co.
7 Red Roof Lane Unit 1
X COMMERCIAL GENERAL LIABILITY
INSURER B:
Salem, NH 03079
INSURER C:
MADE FX OCCUR
INSURER 0:
INSURER E:
rrNV=DAr_CQ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES: AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
/NSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MWDDNYI
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
For Informational Purposes
GENERAL LIABILITY
CPA006920012
07/01/2003
07/01/2004
EACH OCCURRENCE $ 1,000,00
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire) SCLAIMS
MADE FX OCCUR
MED EXP (Any one person) SAPERSONAL
& ADV INJURY S
GENERAL AGGREGATE S 2,000,000
L AGGREGATE LIMIT APPLIES PER:
�7POI-icy
PRODUCTS - COMP/OP AGG S 2 , 000 , 00
X PRO-
JECT LOC
AUTOMOBILE
LIABILITY
006920312
07/01/2003
07/01/2004
X
ANY AUTOS
COMBINED SINGLE LIMIT
(Ea accident) 1,000,000
ALL OWNED AUTOS
ASCHEDULED
AUTOS
BODILY INJURY S
(Per person)
X
HIRED AUTOS
X
i
NON -OWNED AUTOS
BODILY INJURY
(Per accident) S
PROPERTY DAMAGE S
(Per accident)
GARAGE LIABILITY
AUTO ONLY • EA ACCIDENT S
ANY AUTO
OTHER THAN EA ACC S
AUTO ONLY: AGG S
EXCESS LIABILITYUA006920512
07/01/2003
07/01/2004
EACH OCCURRENCE S 1,000,000
X OCCUR CLAIMS MADE
AGGREGATE S 1,000,000
A
S
DEDUCTIBLE
S
RETENTION S
S
WORKERS COMPENSATION AND
CA008018411 (MA)
07/01/2003
07/01/2004
X
EMPLOYERS' LIABILITY
TORY LIMITS ER
E.L. EACH ACCIDENT S 100,000
A
E.L. DISEASE • EA EMPLOYE9 $ 100,000
E.L. DISEASE - POLICY LIMIT I S 500,000
OTHR
or ers Compensation
WCA006920412 (NH)
07/01/2003
07/01/2004
EL Each Accident $100,000
A
Ind Employers Liab.
EL Disease -Ea Emp $100,000
EL Disease-Pol Limit 5500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
nvcucrc I ADDITIONAL INSURED- INSURFR I.FTTFR- CANCELLATION
t„a, i UAGORD CUKNUKATIUN 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
YKIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
For Informational Purposes
ED REPRESENTATIVE
rH'
i i.L,2.L
t„a, i UAGORD CUKNUKATIUN 1988
llo-38.000 d wzfted $10ow
(MGL C.112 S.60y
I & 21"Homes
Failure to Possess a current edition of the
Nassadtuaetts State Building Code
fis cause for revocation of this license.
t.
DIG SAFE CALL CENTER: (888) 344.7M3
trt•,._ ..-� -- "� '✓�e L�amma-re«ea�� `�sc%rwella
BOARO-OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 071569
Birtltdab: 06/15/1968
Expires: 06115/2004 Tr. no: 77569
Restricted To: 00
PETER K COOK SIR `
GARDEN ST
HAVERHILL, MA 01830 -Adintiftb or
�\ ✓ire >rommanuea�e u`,,. "ak;aciau�el�
Board of Building Regulations and Standards License or registration valid for individul use only
yHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
917
Registration: 106877 Board of Building Regulations and Standards
Expiration: 7/28/2004 = One Ashburton Place Rm 1301
Type: Private Corporation Boston, ala. 02108
BLACKDOG BUILDERS, INC
DAVID BRYAN
7 RED ROOF LN. X1
Salem, NH 03079
.administrator Not valid wi out nature
' BUSINESS CONDITIONS TO THIS
CONSTRUCTION CONTRACT
This Contract, dated is by and between:
Sally and Kenneth Heffron
184 Carlton Ln.
No. Andover, MA 01845-
Blackdog project code HEFFR-002
(Hereafter referred to as OWNER), and
Blackdog Builders, Inc.
7 Redroof Lane, Unit #1
Salem, NH 03079
(603) 898-0868
(Hereafter referred to as CONTRACTOR). Work will be performed at:
184 Carlton Ln., No. Andover, MA 01845 -
(Hereafter referred to as PROPERTY)
1. GENERAL
This CONTRACT is for the following work and materials to be performed by the CONTRACTOR on the
PROPERTY address shown above. The project is generally described as follows:
Bathroom Remodel
(Hereafter referred to as WORK)
The CONTRACT consists of this document, any plans, the itemized estimate, the specifications, the Blackdog
client package and the Construction Contract. (Hereafter collectively referred to as the "CONTRACT")
2. PRICE
The total price for the WORK agreed upon is $28,268.65. Payment terms are set out below in Paragraph 6. This
proposal may be withdrawn by us if not accepted within thirty (30) days.
3. STARTING AND COMPLETION PROVISIONS
The WORK will begin on approximately the week of June 7th 2004 and will be completed, absent unusual or
unforeseen circumstances, on the week of August 16th 2004 providing this CONTRACT and any related
CONTRACT documents are accepted when presented. Projects requiring two contracts (one for construction
work and one for bath or kitchen product) will not be slotted into the schedule until both agreements have been
executed. The aforementioned dates reflect our present workload. Projects are assigned a slot in our work
schedule as they are accepted, on a first come first served basis. These dates may move based on the
completion time of the project that immediately preceded yours.
4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW
a. All work to be done under this CONTRACT will be in accordance with local, state and county building code.
The CONTRACTOR shall obtain all necessary permits and pay all required permit and plan fees from the
CONTRACT sum, unless otherwise agreed. The CONTRACT price does not include any fees, which may be
incurred to obtain a variance, if required. The CONTRACT price does not include any unbid items required by any
local building official to bring the project into compliance with any relevant local, state and county building code.
b. All home improvement contractors/subcontractors working in the state of Massachusetts must be licensed and
03/17/2004 Contract Proposal — Page 4 of 22
tAn1 t r-�,11
registered by the Bureau of Building Regulations and Standards. All inquiries concerning the CONTRACTOR
should be transmitted to that office. In Massachusetts Blackdog Builders, Inc. operates under License number
CSO48847 and Registration number 106877.
5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP
a. This CONTRACT will be completed by the CONTRACTOR in a good and workmanlike manner, using quality
materials.
b. If applicable, the CONTRACT price includes the following allowances: See allowances under specifications.
6. PAYMENT
a. Timely payment by the OWNER of all sums due under this CONTRACT is of the essence to this
CONTRACT. The parties agree to the following schedule of payments:
Deposit with this contract: $1,413.43
Payment Schedule amounts reflect a Partner Plan credit of $2,000.00
b. Payment Schedule
Start of demolition
$7,622.27
Start of electrical rough -in
$7,622.27
Start of Tile work
$7,622.27
Substantial Completion
$1,242.76
Completion of Punch List
$745.65
c. Allowances for Owner Selected Components
d. The CONTRACTOR may cease operations if any payment is not made by the OWNER as required herein,
and proceed to collect any balance due through any remedy provided by law. Payments are due when the
aforementioned progress milestones have been reached. It is understood that minor adjustments to the
payments schedule may be necessary due to the flow of work or delays beyond the control of the
CONTRACTOR.
e. DEFINITIONS
Substantially complete - The space or project is substantially complete when the space or project can be used
for its intended purpose and only punch list items remain.
Punch list - Work or product that has not been performed or provided.
Warranty item - A product or service that has been provided or performed that does not meet or exceed industry
standards.
THESE CONDITIONS MUST BE ACCOMPANIED BY THE CONSTRUCTION CONTRACT
03/17/2004 Contract Proposal — Page 5 of 22
e,
Section I I
Construction Contract
of the
Contract/Proposal
for
Sally and Kenneth Heffron
03/17/2004 Contract Proposal — Page 6 of 22
6
CONSTRUCTION CONTRACT
This Contract is by and between:
Sally and Kenneth Heffron hereafter referred to as "OWNER", and Blackdog Builders, Inc hereafter referred to as
"CONTRACTOR" for work at184 Carlton Ln., No. Andover, MA 01845- dated . This CONTRACT consists of this
document, any plans, the Specifications and Business Terms that are enclosed and the Blackdog Builders Client
Package. (Hereafter collectively referred to as the "CONTRACT")
1. CONTRACTOR'S DUTIES -- GENERAL
a. To direct and control the work contracted for in accordance with the terms of this CONTRACT and all
applicable codes, laws, and regulations, and as the building permits issued for this project, if any, require.
b. To inspect the site, examine the plans and specifications, if any, and supervise all of CONTRACTOR's
employees, and to direct the work of all subcontractors selected by CONTRACTOR.
c. To maintain the work site in a safe and clean condition, to the extent consistent with the CONTRACT.
d. To advise the OWNER promptly if concealed conditions are ascertained which require additional or different
work, and to proceed in such event in accordance with this CONTRACT.
e. To provide locked storage for any equipment, tools, or other PROPERTY used in the performance of this
CONTRACT, unless otherwise agreed in writing.
2. OWNER'S DUTIES -- GENERAL
a. To provide adequate utilities for the work agreed upon.
b. To advise the CONTRACTOR of any condition of the PROPERTY which affects CONTRACTOR's ability to
perform.
c. To provide secure storage areas for materials delivered to the work site.
d. OWNER shall be entitled to make periodic inspections of the work site, provided such inspections do not
interfere with the work and can, in the judgment of the CONTRACTOR, be made safely. Any other entry onto the
construction site shall be at OWNER's risk.
e. OWNER shall notify his insurance agent of the execution of this agreement and obtain any necessary riders to
his current coverage or any locally customary forms of coverage, such as builders risk, to cover OWNER's
interests and liabilities during the construction process.
f. To perform no work on the project without a written agreement with the CONTRACTOR.
g. To make no agreements with any trades person, subcontractor, or CONTRACTOR'S employees outside the
scope of this CONTRACT without the written consent of the CONTRACTOR.
03/17/2004 Contract Proposal — Page 7 of 22
3. MATERIAL SUBSTITUTION
CONTRACTOR reserves the right to substitute other materials, products and/or labor of equal or superior quality,
utility, or similar color.
4. DELAY
CONTRACTOR shall not be responsible for delays caused by events beyond the control of the CONTRACTOR,
including but not limited to: strikes, war, acts of God, riots, governmental regulations and restrictions. Delays
caused by OWNER's failure to make allowance materials selections or caused by the performance by
CONTRACTOR of extras or necessary work (as described in Paragraph 6) shall likewise be excusable delays.
& INSURANCE
CONTRACTOR agrees to maintain all necessary forms of insurance to protect the OWNER from liability for any
occurrence arising from the performance of this Contract. CONTRACTOR agrees that he shall cover his own
employees for worker's compensation and carry general liability insurance, and that all forms of insurance
referenced herein shall be with reputable companies licensed to do business in the state where the project is
located.
6. HIDDEN, CONCEALED and UNFORESEEN CONDITIONS
a. The parties agree that in the event CONTRACTOR discovers a hidden, concealed or unforeseen condition
requiring an extra cost that they shall proceed as follows: The CONTRACTOR shall notify the OWNER verbally
to expedite agreement as to any charge necessary to correct or cure such condition, and provide a written Work
Order (as described in paragraph 7a) as soon as practicable. The parties must agree to such extra charges, or
agree to a resolution method, or this CONTRACT may be cancelled by either of them.
b. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean a condition not
readily observable to a prudent CONTRACTOR inspecting the subject PROPERTY for the purpose of performing
this Contract. Examples of such conditions can include, but are not limited to; rot under siding; ledge below grade;
pre-existing plumbing or electrical work not performed to code and pre-existing mold.
c. Any change in the WORK required by building officials assigned to this project, including structural and/or any
environmental hazards will be billed as an EXTRA charge to this CONTRACT and paid for by the OWNER as a
Work Order. CONTRACTOR may cease operations if OWNER refuses to pay
7. EXTRAS
a. Any extra work or materials desired by the OWNER shall be agreed upon in writing and such extras shall
become a part of this CONTRACT as if fully set forth herein. Unless otherwise agreed, extra work shall be paid
for as performed. Failure of the OWNER to sign a change order shall not preclude recovery for any work
performed by CONTRACTOR, and acceptance of said extra work or materials shall be presumed, unless there is
written notice to the contrary.
b. CONTRACTOR shall advise OWNER, at the time of agreement on an extra, as to any additional time required
to perform this CONTRACT.
03/17/2004 Contract Proposal — Page 8 of 22
r^
`y
8. ESCALATION
CONTRACTOR reserves the right to pass on additional costs to OWNER resulting from the escalation of the cost
of lumber or lumber byproducts. This cost may be passed on only, if after the CONTRACT is signed but before
the construction commences, an increase in lumber costs is experienced. The CONTRACTOR must substantiate
the change with evidence of the difference between lumber costs at the time of the CONTRACT and lumber costs
at the time of construction. Only direct cost differences may be passed on, no allowances for overhead and profit
shall be included. Any additional costs will be collected per Work Order (as described in paragraph 7a.).
9. EXCESS MATERIALS ON SITE
CONTRACTOR routinely stores extra materials on site to improve efficiency and reduce the likelihood of running
out of stock in the middle of a task. Unless otherwise specified in writing all excess materials on site at the end of
the project are the PROPERTY of CONTRACTOR.
10. SUBCONTRACTORS
a. CONTRACTOR shall select subcontractors as required to complete this CONTRACT. OWNER acknowledges
that subcontractors will do various portions of the work. Any subcontractor selected by the CONTRACTOR shall
have all requisite licenses for the work to be done by such subcontractor.
b. It shall be the duty of the CONTRACTOR to use reasonable care in the selection of subcontractors. Absent
objectionable performance by any subcontractor, the selection of subcontractors shall be an exclusive right of the
CONTRACTOR. The CONTRACTOR shall require all subcontractors to have workmans compensation and
liability insurance in force.
c. CONTRACTOR shall pay subcontractors in a timely manner and obtain from subcontractors any necessary
documentation required to release their liens, if any, as the work proceeds..
11. TERMINATION AND CANCELLATION
The CONTRACTOR may terminate and cancel this CONTRACT if any payment called for hereunder is not
received as scheduled, provided that notice is given to the OWNER as provided below. Upon such termination,
the CONTRACTOR shall have all remedies provided by law, including such lien rights as then apply.
The OWNER may terminate this CONTRACT upon the following conditions:
a. Failure of the CONTRACTOR, or his subcontractors, to pursue the work contracted for, absent excusable
delay, as provided in Paragraph 4 above, for a continuous period of fourteen (14) days, without a written
agreement permitting same, such agreement may be satisfied by a single notation to this CONTRACT.
b. Failure of the CONTRACTOR to rectify any condition for which building code enforcement authority has issued
a citation of violation notice, within fourteen (14) days notice of such violation, unless OWNER and
CONTRACTOR otherwise agree.
c. Any other failure to perform this CONTRACT required by the terms of this CONTRACT.
03/17/2004 Contract Proposal — Page 9 of 22
i�
d. No termination shall be effective unless 10 days notice of OWNER's intent is given as required below, during
which time the default may be cured by the CONTRACTOR.
e. Deposit monies - Cancellation of this CONTRACT prior to the commencement of work shall result in the
forfeiture of any and all deposit monies collected. All deposits are non-refundable. The parties hereby agree that
upon such cancellation, the CONTRACTOR shall suffer damages including but not limited to the cost associated
with designing and preparing the project for commencement.
f. You may cancel this agreement by observing the requirements of The Notice of cancellation you have
received.
g. If a dispute arises out of or is related to this Contract, or the breach thereof, the parties shall endeavor to
settle the dispute first through direct discussions. If the dispute cannot be settled though direct discussions, the
parties agree the dispute shall be settled by arbitration administered by the American Arbitration Association
under its Construction Industry Arbitration Rules. In the event that arbitration is necessary, the parties agree that
arbitration proceedings shall be conducted by a mutually agreed on arbitrator in Rockingham County, New
Hampshire. If the parties cannot agree on an arbitrator, either party may file a written demand for arbitration in
accordance with the rules of the American Arbitration Association. The arbitration award shall be final and
judgment on the award may be entered in any court having jurisdiction thereof. This CONTRACT shall be
governed and interpreted in accordance with the laws of the State of New Hampshire. The parties acknowledge
that this agreement to arbitrate shall be governed by Chapter 542 of the New Hampshire Revised Statutes
Annotated. Either party may, without waiving any remedy under this CONTRACT, seek from any court having
jurisdiction any interim or provisional relief that is necessary to protect the rights or PROPERTY of that party,
including but not limited to the right to seek liens or attachment. The prevailing party in any dispute arising out of
or relating to this CONTRACT or its breach that is resolved by a binding dispute resolution process shall be
entitled to recover from other party reasonable attorneys' fees, costs and expenses incurred by the prevailing
party in connection with such dispute resolution process. Consumers in Massachusetts shall be required to
submit to such arbitration as provided in MGL c. 142A.
Sally and Janneth Puron
Blackdog Builders, Inc.
Notice: The signature of the parties above constitutes an acknowledgement of the agreement between the parties
to alternative dispute resolution. Massachusetts consumers may have the right to initiate alternative dispute
resolution even where this section is not signed by the parties.
h. Unless otherwise agreed in writing, CONTRACTOR shall continue the WORK and maintain the agreed work
schedule during any dispute resolution proceedings. If CONTRACTOR continues to perform, Owner shall
continue to make payments in accordance with this Contract.
12. ENVIRONMENTAL HAZARDS
03/17/2004 Contract Proposal — Page 10 of 22
a. The CONTRACTOR is NOT responsible for the inspection, discovery, abatement or removal of any
environmental hazard including, but not limited to: asbestos; mold; lead; radon; ground water or environmental
pollution at the work site, unless specifically covered in the specifications.
b. In the event that any hazardous material is discovered during the course of construction, the testing,
abatement and/or removal shall be shall be the sole responsibility of the OWNER.
c. Any additional costs incurred on account of suspension of the construction or changes to the specifications
due to a hazard or its removal are the responsibility of the OWNER and will be handled by a Work Order.
d. In the event that work does not resume within 30 days of the stoppage, OWNER agrees to immediately pay
the CONTRACTOR the pro rated amount of the CONTRACT price applicable to work done up to that point
pursuant to the Contract.
WARRANTY
OWNER warrants that as of the date of this CONTRACT: (1) the PROPERTY (including the land, surface
water, ground water, and improvements to the land) is, and will continue to be, free of all contamination,
including (a) "oil, petroleum products, and their by-products" (b) any "hazardous waste" as defined by
the Resource Conservation and Recovery Act of 1976, as amended from time to time, and regulations
promulgated thereunder; (c) any "hazardous substance" as defined by the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980, as amended from time to time, and regulations
promulgated thereunder, specifically including asbestos and mold; and (d) any other "hazardous
substance" (2) the PROPERTY is in compliance with all environmental laws and regulations; and (3) there
are no underground tanks on the PROPERTY
INDEMNITY
OWNER expressly acknowledges and agrees that it will reimburse, defend, indemnify and hold harmless
CONTRACTOR, all Sub -contractors, their successors, assigns and employees from and against any and all
liabilities, claims, damages, penalties, expenditures, losses or charges (including, but not limited to, all costs of
investigation, monitoring, legal fees, remedial response, removal, restoration or permit acquisition) which may,
now or in the future, be undertaken, suffered, paid, awarded, assessed, or otherwise incurred as the result of:
(a) any contamination, existing in, on, above or under the PROPERTY (including, but not limited to, contaminated
soil, mold, buildings, facilities and/or ground water);
(b) any investigation, monitoring, clean up, removal, restoration, remedial response or remedial work undertaken
on the PROPERTY; and
(c) OWNER'S breach of any warranty given herein.
13. WARRANTIES
a. The work of the CONTRACTOR, including materials and labor, shall be warranteed for a period of three (3)
years, during which period CONTRACTOR shall at its own expense correct any defect arising from its work
unless it is a non -warrantable condition as set out in the Blackdog Builders Client Package. That package shall
become a part of this CONTRACT as if fully set forth herein.
b. Any and all warranties for appliances or mechanical systems shall be delivered to OWNER as the
CONTRACTOR receives them.
03/17/2004 Contract Proposal — Page 11 of 22
c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be
brought against the CONTRACTOR on this CONTRACT for the performance of this work, except as provided
above.
14. SEVERABILITY
If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall
remain in force between the parties.
15. ENTIRE AGREEMENT
This CONTRACT consists of the documents defined herein, and constitutes the entire agreement of the parties.
It can be modified only by a written document. OWNER acknowledges that he has read and received a legible
copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received
a legible copy of every other document that OWNER has signed during the negotiation of this Contract..
SUBMLZTED:
Am* 11(IcNarria � J
Kitc en Bath Departm nt Manager
Bla kdog Builders, Inc.
ACCEPTED:
G, DATE: /
S Aly He on
DATE:
Kenneth Heffron
03/17/2004 Contract Proposal — Page 12 of 22
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ADMINISTRAMR `� 3
C$ 04x530 O1iO3%1447 07/03/1951
Restricted lo: 10
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No. Date
NORTH
TOWN OF NORTH ANDOVER
F p
Certificate of Occupancy
Building/Frame Permit Fee
$
$ 2 i (u
�' b"'••°' Eta
cNus
Foundation Permit Fee
$
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$
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$
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$
TOTAL
$
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sp ce tce for
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSAcmUS�
This certifies that/LL c�51 j !
has permission to perform
plumbin the bui di gs of . Ir!%Z% • 1 �•,d < 1'%�
at
5 • • • ......... .: , North Andover, Mass.
Feel ... � Mass.
No �„" /'
i i PLUMBING INSPECTOR
Check # �J
6�_6i
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Location lqq
New Renovation
�/ Date
)wn Irs Name ����� t� It LC" Permit #
Amount ,
of Occu anc e�
Replacement ri
FIXTI IRF.0
Plans Submitted Yes No ❑
(Print or type)Check Certificate
Installing Company Name U) Corp.
Add ess b
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Business Te epho e
Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate th a of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity rl Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑ Agent n
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 perforined-20tr Permit Issued for this application will be in
compliance with all pertinent provisions of the ;Massachusate Plu Code Chapter 142 of the General Laws.
By: e 57T Licensearju—m-rer—
Type of Plumbing License
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- FORM U - LOT RELEASE FORM
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 OUTTHISSECTION
APPLICANT 1).4xlk�1911/' �Vi/�Y PHONE
LOCATION: Assessor's Map Number__ PARCEL f f�
SUBDIVISION)) LOT (S)
STREET CJ4Y'-26 �/9f1�`e ST. NUMBER ! P i
***********OFFICIAL USE
RECOMMENDATIONS OF TOWN AGENTS:
S, t'k- I t-,,) L- ��>
CONSERVATION ADMINISTRATOR DATE APPROVED IA ZlG�
`' DATE REJECTED
COMMENTS
�,o �, a�) Uv
TOWN PLANNER
COMMENTS
FOOD INSPKTOR-HEALTH
EALTH
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED /a,
DATE REJECTED
COMMENTS
r a r<
Grp fe,V--.�
PUBLIC WORKS - SEWER/WATER:_CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9197 jm
z1v k 0 j /Vf)-
I cotol
I
tea.
I
10/25/1999 10:30 5034607009
d) 1 1 4 S
0
LIRA ARCHITECTS PAGE 02
l�
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North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number" is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
hA al') l 40
(Location of Facility)
tignatuk of Permit Applicant
ate
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
R
ALAN SMALLMAN
Building & Renovating
190 Middleton Rd.
Boxford, MA 01921
r �' �`' r�� �nmemca�uuea� �<fi , aac/uaetGr
. DEPARTHENT OF PUBLIC SAFETY
0
AMMON SUPERVISOR LICENSE
Expires: Birthdate: i
01/12/2000 01/12/1955
'�: i
`�i _�-��►�AtInAH ,
� 2 �r�Anow i
BOXFORO, HA 01921 '
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name S jy _AvddrY Please Print
Nam
Location:
Y l ,
City Phone # _
F71 am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
I am an employerVU1 enovat�±n�ensation for my employees working on this job.
Comoanv name: 190 Middleton Rd.
Asmos '21
Address
City: Phone#
Ins
0
Companv name:
ii
Address
Citv: Phone #:
L 5z I/
Insurance Co. Policv #
Failure to secure coverage as required under Section 25A or MGi_ 152 can lead to the impcsition of criminal penalties of a fine up to $1,500.00
and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of (5100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the paint' and penaXes oKlerjury that the information provided above is true and correct.
Signature Date
Print name f 11/ �yyJ�j J&14 11/ Phone #
Official use only do not write in this area to be completed by city cr town cfficiaf
City or Town \ Permit/Licensina
Building Dept
❑Check d immediate response is required ❑ Licensing Ecard
❑ Selectman's Office
Contact person. Phone ❑ Health Department
7 Other
DESCRIPTION.W
OPERATIONS/LOCATI CLES/SPECIAL ITEMS
1 ti..
SHOULD ANY OF THE ABOVE DESCRD)ED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTE TO THE CERYWIC479 HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCij,NOT= SHALL NIP08.9 NO OBLIGATION OR U"UTY
OF ANY KIND UPON THE COMPANY, RS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIIVR,,
Philip G. Cheslev, JD PH A
.::::. /:�::.::.:::.
:. ..
:.. ....- .: p:. <
:: <::: ::. <:<:: •:::::•:.:::::•i:
>:::::Sf:• ...... ' •: i<....,. ..,:5.•'' i:::...'iP+::lS:>S: ?':,^. ;.:;>' DATE (MM/DD/YY) :.i
09/24/99
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
THE MEDALLIQN INS AGENCIES INC
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
180 EXCHANgg STREET
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P 0 BOX 367#
COMPANIES AFFORDING COVERAGE_
COMPANY
MALDEN MA
02148
A NATIONAL GRANGE MUTUAL INS CO.
INSURED
COMPANY
ALAN SMALLMAN
B GRANITE STATE INS CO
_ _
COMPANY
BUILDING & RENOVATING
190 M I DDLETON RD
C
BOXFORD MA
01921
COMPANY
D
CO......RAG......................................:
::.:::::.;>:;::;.:::<.>::;::.::.:::::::..
THIS IS TO CERTIFY THAT THE P. IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDIN REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED' Y PERTAIN, THE
INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS`., SUCH POLICIES. LIMITS
SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTA TYp�,'
OF INSURANCEz f' , POLNtV NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MMMWff)
LIMITS
GENERAL UABILITY ;"" .V P P 2 9 9 2 6
10 / 0 1 / 9 9 1 0/ 0 1 0.0
GENERAL AGGREGATE s2 000, 000
X COMMERCIAL GENERAL LIABILITY" �F
PRODUCTS • COMP/OP AGGI 52 , 000, 000
PERSONAL 6 ADV INJURY S 1 000 000
CLAIMS MADE OCCUR.
~
EACH OCCURRENCE S 1, 000, 000
OWNER'S 6 CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire) ! S_ 500 , 000
MED EXP (Any one person) S 10 000
AUTOMOBILE
LIABILITY
ANY AUTO
C,
COMBINED SINGLE LIMIT $
—
il
elDI �J
-
ALL OWNED AUTOS
C'U�`
v
BODILY INJURY
S
SCHEDULED AUTOS
(Per person)
BODILY INJURY S
HIRED AUTOS
NON -OWNED AUTOS
(Per accideni)
.,4
PROPERTY DAMAGE S
GARAGE LIABILITY '.,$
AUTO ONLY • EA ACCIDENT
$
OTHER THAN AUTO ONLY:
u F' ti
ANY AUTO
EACH ACCIDENT
S
AGGREGATE
I $
EXCESS UABILITY ;5
EACH OCCURRENCE
Is
AGGREGATE
is
UMBRELLA FORM
S
OTHER THAN UMBRELLA FORM,'
3
WORKM' COMPENSATION AND : C 8111014
9/01/99
9 / 01 0 0
X R ER
EL EACH ACCIDENT
g 100,000
,
EMPLOYEiiE' LUU3IUTY .y
1.
EL DISEASE -POLICY LIMIT
Is 500,000
THE PROPRIETOR/
PARTNEASIEXECUTIVE
OFFICERS ARE: F�x EXCL
EL DISEASE -EA EMPLOYEE
S 100,000
OTHER. "�
-i:
I q ']
'''1
i
DESCRIPTION.W
OPERATIONS/LOCATI CLES/SPECIAL ITEMS
1 ti..
SHOULD ANY OF THE ABOVE DESCRD)ED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTE TO THE CERYWIC479 HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCij,NOT= SHALL NIP08.9 NO OBLIGATION OR U"UTY
OF ANY KIND UPON THE COMPANY, RS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIIVR,,
Philip G. Cheslev, JD PH A
........... ...................
........... .......... . -...".`.".,."..X ....... :'
.............
DATE (MM/DDN
X .......... 0 8/ 3 1 9 9
x ................ ....... ............
...... imEm .... ..........
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
PRODUCER I NM zt)7 81- 3 2 4 - 4 118
THE MEDALLION INS AGENCIES INC
180 EXCHANGE STREET
P 0 BOX 367
MALDEN MA 02148
COMPANYl
NATIONAL GRANGE MUTUAL I
BINDER #
SMAA50-
EF7
DATE
CnV9 TIME
EXPIRATION
I DA
10/01/99
12:01
N
AM 1
PM
11/01/99
NOON
X
I
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY
� PER EXPIRING POLICY#: MPP29926
CODE: 20-215 SUB -CODE:
CUSTOMER 0: ASMAA50-2
DESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY (Including Location)
PACKAGE POLICY
INSURED
ALAN SMALLMAN
BUILDING & RENOVATING
190 MIDDLETON RD
PDXFORD MA 01921
... . .... ...... .......... ..
.......... . .................
;:xxxxxxxxxx:x, .........................
... ............. ..
. ...... . ... ::x . ................
. . .... .............. ..............
. . . . . . . ..... ......... .
xxx: . ................ X.
..... xa Ex x, . ............ .. ......
TYPE OF INSURANCE COVERAGEIFORMS AMOUNT
.........
............
DEDUCTIBLE COINS %
PROPERTY CAUSES OF LOSS
F
BASIC r_� BROAD rX SPEC
Contents -ACV
'IS & Equipment Floater
MiSC Too
5,000.00
2,500.00
$250
$250
80
80
GENERAL
LIABOM
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE rXOCCUR
7
OWNER'S & CONTRACTOR'S PROT
Mechanical, Electrical & Pressure
System Breakdown included in General
Liability Aggregate limits on a
per job basis
RETRO DATE FOR CLAIMS MADE:
GENERAL AGGREGATE s2,000,000
X
PRODUCTS - COMP/OP AGG s2,000,000
PERSONAL & ADV INJURY $1,000,000
EACH OCCURRENCE $1,000,000
FIRE DAMAGE (Any one fire) 6 500,000
MED EXP (Any one person) $ 10,000
AUTOMOBILE
IIJABILIITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT $
BODILY INJURY (Per person) 6
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
MEDICAL PAYMENTS $
PERSONAL INJURY PROT $
I.
UNINSURED MOTORIST $
$
AUTO PHYSICA4 DAMAGE DEDUCTIBLE
COLLISION:
07HER THAN COL-
ALL VEHICLES SCHEDULED VEHICLES
ACTUAL CASH VALUE
OTHER STATED AMOUNT $
OTHER
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GARAGE LUUMLITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY: x .. .....................
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
RETRO DATE FOR CLAIMS MADE:
EACH OCCURRENCE $
AGGREGATE $
SELF-INSURED RETENTION $
WORKER'S COMPENSATION
AND
EMPLOYER'S LIABILITY
STATUTORY LIMITS .............
. . .. .. .. . .......
EACH ACCIDENT $
DISEASE - POLICY LIMIT $
DISEASE - EACH EMPLOYEE $
SPECIAL BINDER ISSUED PENDING RECEIPT OF POLICY FROM NATION GRANGE MUTUAL INS CO
OTHER ONDITIONS/
COVERAGE$
................... ..
...............................
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MORTGAGEE ADDITIONAL INSURED
LOSS PAYEE
LOAN •
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Date. ��? ,/ �!�..`......... .
,HORT„ TOWN OF NORTH ANDOVER
pb`t,.ao ,s ,tiOpL
p PERMIT FOR GAS INSTALLATION
This certifies that .: '.'17.111 r� ell.... ..� .............. .
has permission for gas installation .... :S: .............
in the buildings of ..�7'/ . t ....................... .
at ./ Y .S .. C`'«i? Z. Zq t-.e� :! ... North Andover, Mass.
Fee. Lic. No.. l,. . ... �\.. .......
IGAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
9
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
,s (Print or Type)
Cog
Mass. Date /1' G 19 J Permit # Z J
���.Building Location � Owner's Name
G
Type of Occupancy.
New ❑ Renovation Replacement ❑
FIXTURES
Plans Submitted: Yes ❑ No Chi
irl;lalling Company Name Uptack Plumbing & Heating, Inc.
Addres,. 32 Rochambault Street
Haverhill, MA 01832
IiLISMess Telephone 508 372-8503
,vamv of Licensed Plumber or Gas Fitter Leonard A. Hall
Check one:
(J Corporation
t-1 Partnership
Ll Firm/C.O.
INSURANCE COVERAGE:
I nave a current liability insurance policy or it% substantial equivalent which meets the requirement, of MGI. Ch. 142.
Yes Iii No F]
It sou have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy I X Other type of indvimmy I , Bondi .
Certificate
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
(wnetal Laws, and that my signature on this permit application waives this requirement.
gnature of Owner or Owner's Agent
Check une:
Owner I - i Agent
i I„ •Irby i,•,Iiiy that all of the detail, and imurmattun I Ila— .ubnumtl lot emer tli m the A -W, apph, aUmt an• True and a, curate to the Ix•a o1 my 1,11—I' dge aloof Ihat all plumbing w,,,k
.end m.tatl�nnnt+ lo•tlortnd W>der the Ixnmu i»uitt art thu appl,ratuul Mill he to compliance with all lo•tluleul imm-,n. of Ifo• Ma—i,hu tall-( a ,.N` AM Chapt1•r 142 on Ihl• rd'n1't,ll Laws.
F
I% Joe of 1 n emr.
i ,�� ----- � _.__. ✓Floud°•t
"'�' Kt• w r on Ltiea—t Mont •r I, Ca. hale,
I.,unn•ym.ut p
Iitm1wNundwa ..$67.8._.
41'PRO)VLD 10MCE USE ONLY)_-- --- __
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irl;lalling Company Name Uptack Plumbing & Heating, Inc.
Addres,. 32 Rochambault Street
Haverhill, MA 01832
IiLISMess Telephone 508 372-8503
,vamv of Licensed Plumber or Gas Fitter Leonard A. Hall
Check one:
(J Corporation
t-1 Partnership
Ll Firm/C.O.
INSURANCE COVERAGE:
I nave a current liability insurance policy or it% substantial equivalent which meets the requirement, of MGI. Ch. 142.
Yes Iii No F]
It sou have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy I X Other type of indvimmy I , Bondi .
Certificate
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
(wnetal Laws, and that my signature on this permit application waives this requirement.
gnature of Owner or Owner's Agent
Check une:
Owner I - i Agent
i I„ •Irby i,•,Iiiy that all of the detail, and imurmattun I Ila— .ubnumtl lot emer tli m the A -W, apph, aUmt an• True and a, curate to the Ix•a o1 my 1,11—I' dge aloof Ihat all plumbing w,,,k
.end m.tatl�nnnt+ lo•tlortnd W>der the Ixnmu i»uitt art thu appl,ratuul Mill he to compliance with all lo•tluleul imm-,n. of Ifo• Ma—i,hu tall-( a ,.N` AM Chapt1•r 142 on Ihl• rd'n1't,ll Laws.
F
I% Joe of 1 n emr.
i ,�� ----- � _.__. ✓Floud°•t
"'�' Kt• w r on Ltiea—t Mont •r I, Ca. hale,
I.,unn•ym.ut p
Iitm1wNundwa ..$67.8._.
41'PRO)VLD 10MCE USE ONLY)_-- --- __
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N° 4.2-
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ../...% l%(. ..... . %. '. ..........
has permission to perform .... ................
plumbing in the buildings of .... !.t .............
at ... /j. A ............ , North Andover, Mass.
Fee. . ? ... Lic. No..s. (4.7S .. ....... .. ? : -�� �........ .
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
L
MASSACHUSETTS UNIFORM APPLICATION FOR PER TO DO
(Print or Type) PLUMBING
�- Mass. Date 7119a- Permit _ �p
Building Location i f � E _Owner's Name
Type of Occupancy
New ❑ Renovation 2' Replacement ❑ Plans Submitted: Yes ❑ No S'-�
FIXTURES
Installing Company Name U p t a c k Plumbing & Heating, Inc Check one: Certificate
Address 32 R o c h a m b a u l t Street ecorporation f/
Haverhill, MA 01832 ❑ Partnership
Business Telephone 508 372-8503 ❑ Firm/Co.
Name of Licensed Plumber Leonard A. Hall
INSURANCE COVERAGE:
I have a curren liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy (S( 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 Mass. General Laws. and that my signature on this permit application waives this requirement
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed up ermit issued for this application will b in compliance with all
pertinent provisions of the Masmchusetfs State Plumbing Code and' ter 2 of th eral Laws.
BY
pnature wulcensedeWber
Title Type of License: Master (" Journeyman ❑
City/Town 8678
License Number
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BASEMENT
15T FLOOR
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2ND FLOOR
IRO FLOOR
4TH FLOOR
STH FLOOR
eTH FLOOR
7TH FLOOR
STH FLOOR
Installing Company Name U p t a c k Plumbing & Heating, Inc Check one: Certificate
Address 32 R o c h a m b a u l t Street ecorporation f/
Haverhill, MA 01832 ❑ Partnership
Business Telephone 508 372-8503 ❑ Firm/Co.
Name of Licensed Plumber Leonard A. Hall
INSURANCE COVERAGE:
I have a curren liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy (S( 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 Mass. General Laws. and that my signature on this permit application waives this requirement
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed up ermit issued for this application will b in compliance with all
pertinent provisions of the Masmchusetfs State Plumbing Code and' ter 2 of th eral Laws.
BY
pnature wulcensedeWber
Title Type of License: Master (" Journeyman ❑
City/Town 8678
License Number
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N2 1 . ,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that "^-� °�� a...................................................................
has permission to perform ........... %r ..................
wiring in the building of ... .................................
at Z el......... ^::.... ::......-?"- ................... . North Andover, Mass.
Fee.. 3s. ..... Lic. No?1..:5.....':..`.. `.....y � ... '.:' '
f7
ELECTRICAL INSPECTOR
ti
12/28/98 14:29 35.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
I
A
The Commonwealth o Massachusetts o Use only
Permit No. rne No. �'
Department of Public Safety-✓�'
Occupancy & Fee Checked
k BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave bunk)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
N Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 184 Carlton Lane
Owner or Tenant Ken Hef f ron
Owner's Address Same
Is this permit in conjunction with a building permit: Yes ❑
Purpose of Building Residential
Existing Service Amps / Volts
New Service Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Electrical in lst floor bedroom
Date December 21, 1998
To the Inspector of Wires:
No ❑ (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Ab nd Eland ❑
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
Battery Units
No. of Switch Outlets
No. of Gas burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond. tons
Initiating Devices
Heat Total Total
No. of Disposals
No. of Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Municipal
Local ❑ Connection ❑ Other
No. of Dryers
Heating Devices KW
of No. of
Low Voltage
KWNo.
No. of Water Heaters K
Signs Ballasts
Wirin
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.
I have submitted valid proof of same to this office. YES ® NO ❑.
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ® BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $
Work to Start Inspection Date Required: Rough
Signed under the penalties of perjury:
FIRM NAME CROWE & SONS ELECTRICAL CORP .
YES ® NO ❑
(Expiration Date)
Final
-AUC. No. A6 0 5 8
Licensee JOHN A. CROWE Signn iur��/ I M ( LI NO. A6058
577 MIDDLESEX STREET LOWELL MA 01851 Bus.Tel.No* (978)453-
6696
Address � r Alt. Tel. No. 9 8)251—
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage or its substantial equivalent as
required by Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Owner ❑ Agent ❑ (Please check one)
Telephone No.
(Signature of Owner or Agent)
PERMIT FEE $ 35 .00