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HomeMy WebLinkAboutMiscellaneous - 190 APPLETON STREET 4/30/2018 / 190 APPLETON STREET / 210/064.0-0129-0000.0 1� I J ILL l J e BUILDING FILE 2012 Massachusetts Electrical Code.Amendments 527 CMR 12.00§Rule 8: In accordance-with theprovisions of M.G.L.c.143,§.3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed• IJd on the prescribed form.Atter a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c, 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion ofthe work as required in M.G.L.c.143,§3L. Permits shallbe limited as to the time of ongoing construction.activity,and may be.deemed_by-thelnspector_of_Wires abandoned_and_invalidifhe—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on thq permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 ofthe Acts of2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job,growth and long-term economic recovery and the Permit Extension Act faith ers this purpose by establishing an automatic four-year extension to certaispermits-and licenses concerning the use or development ofreal property.With limited exceptions,the Act automatically dxtends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence'during the qualifying period beginning/on August 15,2008.and extending through August 15,2012. Aule S—Permit/Date Closed: Note:Reapply for new permkQ 0 Permit Extension Act—Permit/Date Closed: 1 ,0318 Date.........2........ TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU This certifies that ................... has permission to perform ........ ................................................ wiring in the building of... /....... Asi:f. ................................ at... ...... ................ . orth Ayndov ,Mass Z� Fee.A,�........... Lac.Ndl'i��V...... ....... ............... ..............L....... . ................. LEcrRICAL INSPE R Check # Official Use Only Y ' / _ CDtlrntot>tt►acsltlt a�/J'fa3iacictt3a�3 �— Permit No. / °Uaparinwnf a Sarmcai -��' cy and BOARD OF FIRE PREVENTION REGULATIONS [Re.iw] Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),S37 CMR 12.00 (PLEASE PRW BVBVK OR 77'PEAL,LPORAL TI Date: 9, 07(„ ' j City or Town of: _ � a r��' To the Inspector of Tit fires: By this application the undersigned gives notice of hisor h r' tendon to perform the electrical work described below. Location(Street&Number) U Owner or Tenant Telephone No. Owner's Address y� Is this permit is conjunctionwitli building permit? Wes No ❑ (Check Appropriate Box) Purpose ofBuiWing 0S Utility Authorization No. Existing Service� 7 1,9(4()Volts Overhead L7 Undgrd❑ No.of Meters L Amps 7 New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of seeders and Ampacity Location and Nature of Proposed Electrical Work: Com letian oftlre fol/o1vin table may be vrafnd bit the jus error aNO.of TOM Fl?res_ No.of Recessed Luminaires No.of Cdl. Susp.(Paddle)Tans Transformers ICYA No.ofLuminaire Outlets No.of Hot Tubs Generators ICVA No.of Luminaires Swimming Pool Above [I In- ❑ o.of mergency lAghting grad. d. Batter y Units No.of Receptacle Outlets CIO No.of Oil Burners SIRE ALARMS No.of Zones o.of Detection Sri No.of Switches No.of Gns Burners Initiating Devices No.of Ranges No_of Air Cond. Taal No.of Alerting Devices Na.of Waste Disposers 13entPuin Number Tans IC o.of elf^ bntaiued Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Beating KW Local❑ Munic pat ❑ Other Connection Hentin A linnees Security Systems: No.of Dryers g pP I 4V No.of Devices or Equivalent No.of Water ICV No.of No.of Data Wiring: Henters Signs Ballasts No.of Devices or E uivnlent No.Hydromassage Bathtubs No.of Motors Total HP "E elecommunientions Wiring: Na of Devices or E niva-lent OTHER ANach additional detait if desired,or Its required by ilia Inspector of 11 fres: Estimated Value of Electrical ork: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion_ ======INStlRANC6=COYEItAGE:=Unless-tvnived by the-otivner;no permit=for die=perfoc►anderofeleeWeeal:wofk(slay issue uriiess the licensee provides proofof liability insurnnce including"completed operation"coverage or its substantial equivalent_ Th undersigned certifies that such covers is in force,and has exhibited proof ofsnme to a paroEttie!!androntplete- FERM `Tg� C1iECICONE: INSURANCE [BOND ❑ OTPER ❑ (Specify:) / I certify,under the pafits qnd penalties o perjury,that the b formation ou this application is'NAME: `I C L �°l 4 e l 1 �c 1C.No.: l Licensee: 4'li k e C(� c�g ignature LIC.NO.: �0.�6� Address ,b! ter" pt"in di licen girl r fine.), C Bus.Tel.No.: `2]ff S , Alt.Tel.No.: }Per M.O.L»c.147,s.57-61,security work requires Department ofPublic Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normnlly required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent Owner/Agent e- Signature 'Telephone No_ PERWT FWE. S Z10 �� COAIIMONWEALTH OF MASSACHUSETTS`... AS A-REG JOURNEYMAN,ELECTRI ISSUES THE ABOVE LICENSE TO MICHAEL J MCDONOUGH . I 17 :Si ROD RD WYN_DHAM NH 03087 1401 30369 E 07/31/13 851829..` x: Fold,Then Detach Along All Perforations i{ i y �.r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r� Please`Print Legibly Name (Business/Organization/Individual): V 1 G. "\��-�y� (-��K l:c yrc� Address: City/State/Zip: k �1 C A KV%r 6-)Whone#: yy 7 Armee you an employer?Check ttie appropriate box: Type of project(required): 1.[IjI am a employer with t 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑ 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 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ e 1C✓�,(� Policy#or Self-ins.Lic.#: Expiration Date: / Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: �2 Date: I ° -G 6 , Phone#: 17 5V f S yy7 3 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Location. v No. 13 Date fin " • - TOWN OF NORTH ANDOVER ` s LW • �. Certificate of Occupancy $ Building/Frame Permit Fee $ v Foundation Permit Fee $ '10 Other Permit Fee $ TOTAL $ I Check#�;7 Vv J Building Inspector L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ` _'17 Date Received Date Issued: < IMPORTANT:Applicant must complete all items on this page 1 Print ;PF2®PERTtY�OWNER� J� ��--- �' ��t--� " I �� Pea j+I u �_ YC) MAP NO' _ PARCEL �Z ZONING 0I$jT. T; 2 � :HistoridQst i6-Q yes f <__. � - - .�-_ � ��'- - ="Machne�Sh`,op�Village) yes =-,6oz TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building kOne family f'Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ! DlSeptl� OslNell ❑}Floodplain) Wetlands, OrlNatershed District _V,Water/,S,ewer . c _ DESCRIPTION OF WORK TO BE PERFORMED: ?.t��.-ia XlJ>7f11B 2L� l,,o.���Jln1C, �' ca����i v ti�w FG)?.'EQTU0z- tsc.YZ� F-bR-C44 ©f-3 6J9rZLLK--G-&J43 oi- l4b^�, QC-' t10CL- �7cl�T�n/G 74 W/�Wrics F,x7vrc_q r- 4-0WT7 W,N. 0uG7 FG 9J vA FrL I<rI TJ4 Gl � iIV,V;P .L Identification Please'Type or Print Clearly) OWNER: Name: VyxAL.r G77Z_ Phone: 4/3-6-6 7 351st Address:7.5- ?P-YMW00t7 R�= 1-,�� Gr� �Jo �a C31106 ~— Phone:T7 y74 CONTRACTOR Name= N -L.;• .Wc�, _%Z _ - _ - Supervisor(s)Consfructlon License-_ o l x p Home, m rovement�License: f✓ 9 Exp, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$$12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. 'Total Project Cost: $ FEE: $ Check No.: Receipt No.: 3 -- NOTE: Persons contracting with ccnregistered contractors do not have cess to the guaranty funs/ 'Signature of Agent/Ovvne /< Slg�ature of contractor G: _ Plans Submitted P' Plans Waived ❑ Certified Plot Plan Stamped Plans 0 Building Department The fohowing is a-list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L.- Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products 10TE: All dumpster-permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products !OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the aprn al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:-tted with the building application Doc: Doc.Bui!;iing permit Revised 2012 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use I El Notified for pickup - Date Doc.Building Permit Revised 2010 i, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE.DISPOSAL Public Sewer IVI Tanning(Massage/Body Art ❑. . Swinlln'ng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on G�/1.3 Si nature COMMENTS_ HEALTH Reviewed on Signature COMMENTS a Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes -- Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW Town, )Engineer: Signature: i Located 384 Osgood Street ` FOE DEPARTI4LNT` -Tem_p Dumpster on site yes no Located at'124 Maid:Strdet Fire Deparitmer t sigiiaturelaate - COMMENTS Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 45,00,0.00 m $ - $ 540.00 Plumbing Fee $ 67.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 67.50 Total fees collected $ 775.00 190 Appleton Street 885-13 on 6/18/2013 Remodel Exisitng Bath, Remove former kitchen and install bar sink I Ir , NORT1i : :. .c ver O - No. �` t - �A- h , ver, Mass, (� • 1 103 COCNICnl W1[x _1. A0R�TEO INPP�.(5 S U BOARD OF HEALTH Food/KitchenPER IT T LD . Septic System THIS CERTIFIES THAT .Q>t/L &j. -A .......... BUILDING INSPECTOR Fwt oundation has has permission to erect.......................... buildings on ......1.Iqa......AW .................; .#... ...... Rough 1 / to be occupied as ............fep�i �. .... .... ..er..................ia.. .1.x. Y'X.103- Chimney provided that the person ang this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 5f6 • UNLESS CONSTRUCTIO AR Rough OltService .................... . .................. ............... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE r c. Massachusetts Home Improvement Contract Contractor Information I Brian A. Lawler Brian Lawler General Contractor F.I.D.04-2960346 66 Wildwood Road Construction Supervisor's License 261 Andover, Massachusetts 01810 Home Improvement I (978) 470-1983 Contractor License 156915 1 Homeowner Information Name: Paul and Cecelia Walker Address: 190 Appleton Street North Andover, Massachusetts 01845 Telephone: (413) 567-3454 The Contractor agrees to do the following work for the Homeowner: Job will consist of removal of rear landing. Set 6 concrete footings to support structure. Build 12x12 deck and connect to new rear landing. Deck is to be built for future screen porch with roof. In addition, the existing original bath will be gutted to studs, with new insulation, plaster, tile and fixtures installed. Original kitchen will be removed and replaced with bark sink and built-ins. Total Estimated Cost $30,000.00 Required Permits: All necessary permits will be secured by the contractor as the homeowner's agent. Proposed Start and Completion Schedule: The work under this contract is scheduled to begin on or about June 1, 2013, and to be completed on or about July 15, 2013. This time period, may, however, be reasonably extended by the Contractor in the event of inclement weather which precludes the installation or other circumstances beyond the Contractor's control. The Homeowner acknowledges that he/she has been informed of, and consents to this time for completion. Total Contract Price and Payment Schedule: The Contractor agrees to perform the work, furnish the materials and labor specified above for an approximate cost of: $30,000.00(*). Payments will be made according to the following schedule: by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be completed and signed. One copy should go to the homeowner.The other copy should be kept by the contractor. The Homeowner„hereby acknowledges that he/she has fully read and fully understands the terms of this contract. Signed under seal this 1st day of May, 2013. Paul Wa Rer Brian A.Lawler Cecief fa Walker CKDAMUEDGE6 ENT avail RECERPT OF COPY The Hmneowner hereby acknowledges that he/she has recelved a copy of this contract signed by oth the meowner and the contractor. Paul walker Cn06a walker Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement.However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a co of all exhibits and referenced p lm PY documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three-day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However, in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law," contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170, Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston, MA 02108 (617)727-3200 ort-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General (617) 727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 $10,000.00 as an initial deposit upon signing contract. Progress payments will be requested by the Contractor as work proceeds. Contractor will provide the Owner with periodic updates that will include labor, stock and subcontractor costs to date. Final payment will be due upon completion of the contract. Work is to be performed on a cost plus basis. (Law forbids demanding full payment until contract is completed to both party's satisfaction). Notes: (*) Including all finance charges. Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a) one-third of the total contract price or (b)the actual cost of any special equipment or custom made material,which must be special ordered in advance to meet the completion schedule. Warranty: The Contractor hereby warrants that its installation shall be performed in a good and workmanlike manner in accordance with accepted industry standards and further warrants the installation against defects in workmanship for a period of one year from the date of installation. Subcontractors: The Contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The Contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Arbitration: The Contractor and the Homeowner hereby mutually agree in advance that in the event that the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved b the Secreta of the Executive Office of p pp Y Secretary Consumer Affairs and Business Regulations, and the Homeowner shall be required to submit to such arbitration as provided in M.G.L. c.142A. Contract Acceptance: Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or 1-800-223-0933. Does the contractor have insurance?Check to see that your contractor is properly insured. Licensee Detafls . - __.. Demi Information -- - - ull Name: BRIAN A LAWLER Gender Owner Name: License Address Information - ddress: 66 WILDWOOD RD Address 2: City: ANDOVER State: MA ipcode: ... ,01810 oun United States License Information License No: CS-=261 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 4110/2012 Issue Date: 3/23/2010. Expiration Date: 3/23/2014 License Status: Active Today's Date: 5/10/2012 Secondary License: oing Business As: tatus Change: 18 Prerequisite information No Preiiquisite Information Disc' line No Discipline Information Documenteun Massachusetts- Department of Public Safety Board of Buildin-Regulations and Standards Construction Supervisor License License: CS 261 Restricted to:-00 BRIAN A LAWLER c 66 WILDWOOD RD ' ANDOVER, MA 01810 ;" �--�--�! Expiration: 3/23/2012 Commissioner Tr#: 22966 Ottice0t(0urne� t ai�ifsiness eg ame. HOME IMPROVEMENT CONTRACTOR Registration: -.;,156915 Type: . Expiration: $!1572013 DBA B LAWLER GENEI,_ 00NTRACTOR BRIAN LAWLER = =_ _ .66 WILDWOOD RD AN MA 0181i]> - ;<`' Underseereta - -y - rX http:/%license chs.state.ma..usNerification/Details.asax?a--encv id=l&license id=700741A,. 5/1(1/LD1 The Commonweizith of JV assachusetts { Department o f Industrial Accidents Office ofrnvestibations 600 Tf7ashintrton Street Boston, ALq p?III 47KW.MaSS.OV�dia Workers' Compensation Insurance Affidavit: A g Applicant Information uilders/Contractors/E'Ieetricians/I'Iumbers . - PIease Print Legibly - Name(Business/Organization/Individue):_ ?—AO,-4 Address: City/State/Zip:/�-,ov i:7j,4 v'is K-mW Phone#: ?76- q7b-M-7, E an employer?Check the appropriate box: a employer with ' ?t_ 4. ❑ I am a general contractor and I Type of project(required): loyees(full and/or part-time).* have hired the sub-contractors 6 ❑New Construction a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling and have no employees These sub-contractors have ing for me in any capacity, workers' com .insurance. 8 ❑Demolition workers'comp: insurance 5, P 9 ❑Building addition ❑ We are a corporation and its ired] officers hake exercised their 10•❑Electrical repairs or additions a homeowner doing all work right of lf. exemption Per MGL I l.❑Plumbing repairs or additions [No workers'comp. c. 152,§I(4),and we have no aumrequired.] t ' employees. (No workers 12.0 Roof repairs - . comp.insurance required.] 13•❑ Other "=may armlirsnr Lhst checks box-:Hl mass sso rul out the section bellow shoY:r.. homeowners who submit this af5davit indica b their workers'co mp�_..,c�,;vs r cc:��on. ling they a.�dcmg all work and men hire outsldE YV. +Contractors that check this box must at(achA -as: contmeto;m s .b d as au—tional sheet show' the �-"t s��•�ri a new g davit indi sting such. same of the sub-e=--ctm,and their workers'comp,policy information, an employer that isproviding information_ workers'compensa><ion insurance for my employee& Below is thepolicy and job site Insurance Company Name: oc- policy#or Self-ins.Lic. Expiration Date: ? 11. Z 013 Sob Site Address- -A Attach a copy of the workers'compensCity/State/Zip /1W1:f yot,�p V tTLC.ation policy de'claratiionase showing the Failure to secure coverage as required under Section 25A ofN1GL c 152 can lead to the tiny ona"er and siexpiration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER penalties of a Of up to$250.00 a day against the violator. Be advised that a co RDER and a fine Investigations of the DIA for insurance coverage verification. of statement may be forwarded to the Office of I do hereby ccT fy under the pains and penalties of perjury thQt aor f malign.provided above is true and correct. Signature: Phone Official use only. Do not write in this area, to be com leted , P bJ ecty or town.offciaL City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2.Building Department.3. Ci /Town p 6. Other Clerk 4.EIectrical Inspector- 5.PIumbing Inspector Contact Person: Phone#: Informa.tion an— d Instructions Massachusetts General Laws chapter 152 requires all.employ<-_rs to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every PC---.rson in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,-associ.-=aLtion,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including tlhe Iegal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association sag-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 maint--mance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be:cause of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or Ia o&al licensing'agency shall withhold the issuance or renewal of a licenseor permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co:axp)iance 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 inZ-til 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 compleiAy,by checking,the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their cerdficate(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'comp ensation incmra„ce. If an LLC or LLP does have employees,apolicy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insuranot coverage. .Also be satire to sign and date the affidavit. The affidavit should be ictamned to the city or town that the ap.-uca on iir the pert-Or license is bring requested,not the Department of Industrial Accidents. Should you have any questions regardin-,,-the law or if you are required to obtain a workers' compensationpo4cy,please call the Department at the number listed below. Self-insured companies.should enter their self-instance license number on the appropriate line. City or Town Officials : Please be swt-that the affidavit is complete and printed leglbly. 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 pmmit/license number which will be used as a-reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary) and under`.`Job Site Address"-the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stampe=d 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 pernut not related to any business.or commercial venture (i-e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office oflnvestigations 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 Depart=ment's address,telephone.and.1ax-numbezv__. - . The Commonwealth GfMassachusetis. Department of FndustHal Accidents Office.of Inwesfi;afous 600 Wasliiag1tan Street Boston,MA 02111 Tal. ##617-727-4900 m t 406 or 1-877-MAS.SAFE Fax #6.17-72.7-7749 Revised 5-26-05 vmrvil.mass-_mov/dia. Oft.<<9 °qb0 a° 0 do"0 4 SSACtiUSE'( CONSERVATION DEPARTMENT Community Development Division June 14,2013 Brian Lawler 66 Wildwood Road Andover,MA 01810 Cecilia&Paul Walker 190 Appleton Street North Andover,MA 01845 190 Appleton Street, North Andover Construction of a 12'x 12' Deck on Sono-tube Footings Conservation Conditions of Approval,NACC#109 Pursuant to section 4.4.2 (A) of the North Andover Wetlands Protection Regulations,Brian Lawler (contractor for the owner),filed for a small project for work proposed at 190 Appleton Street, North Andover.The proposed work includes of a new 12'x 12'deck on six hand-dug sono-tube supports.The deck is approximately 71 feet from the edge of Bordering Vegetated Wetland (BVW) as shown on the herein referenced plan.The BVW area also serves as a stormwater detention basin. The detention basin was built in the late 1970's within a resource area and has been determined to be jurisdictional by the North Andover Conservation Commission (NACC). During the June 12,2013 public meeting,the NACC voted unanimously to approve this project.All work shall conform to the following- RECORD ollowingRECORD DOCUMENTS: Small Project Filing Including: Application Checklist and narrative; Certified Plot Plan prepared by John Abagis &Associates (with hand edits); Filing dated: 6/10/13 The following conditions are hereby mandated: CONDITIONS: 1. Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the small project permit and is aware of the wetland resource area and the limits of the proposed work. 1600 Osgood Street,Budding 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.httD://www.townofaordmdover.com/conservel.htm 2. Erosion controls are not required as the wetland resource area is up-gradient of the proposed work. 3. Excess construction material shall be properly disposed of offsite and accepted engineering and construction standards and procedures shall be followed in the completion of the project. 4. Upon completion of the approved project and site stabilization,please contact the Conservation Department for a final inspection. 5. This permit shall expire six months from the date of issuance. Should you have any question or comments regarding the contents of this letter,please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience.Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER ONSERVATION DEPARTMENT J nnifeJALghes onservation Administrator 1600 Osgood Street,Buil 20 Suite 2-36 North Andover Massachusetts 01845 , Phone 978.688.9530 Fax 978.688.9542 Web www.http://www.townofnordundover.com/conservel.htm I i ,I ©J- E C)IL 71 i i 1 r �or N N, — - - A v 1\ 0\ 1 1 , r\ , o r /Y hp�1 r� IV I i i W i Nnff! l 1 f r 110 119( I�St4(` IYD „Zz� Qxi 4( CERTIFIED PLOT PLAN tH OF'�WSS9c PREPARED FOR.- PAUL OR:PAUL & CECEUA WALKER As AT NO. 35M -v2 0 190 APPLETON STREET L LPW NORTH ANDOVER, MA. _ NORTH ESSEX REGISTRY OF DEEDS: BK. 7574 PG. 74 ASSESSOR'S MAP: 64, LOT 129 ZONING. R-1 SCALE.-1"=50' DA TE.• MA Y 29, 2013 NOTE:• EXIS71NG DIMENSIONS TAKEN TO CORNERBOARD. NOTE.• v =WEMAND FLAG AS PER NORSE ENVIRONMENTAL ON 07-12-10. S40'55'49"E 222.99' . 30' \ r- --- -- SETBACK ---LINE I \ I I I I \• I I \ I I � I I \ I I � I I \ I I � I DRAINAGE to!o o I EASEMENTrn Lo 0co I ' r- 10 z I 1 �2a I EpGE _ _of ---t GGE - w �N 1A 64 5A 4A l0A }-- 7A 24 8A 11A --�---I-9A 1 6� — 48.1' 62: 67.7' PROPOSE 67.1 6 I 166_37'._ 13.0' I �y6 71.8 147.7' 4.3' //��� ci NG 19 148.7' 12.0• 42.3' I ,° OOSD 00. P ry I cD i � A � 00 y L_--- --- — m 44.3' .�..—..—..-165.40' g71� EM I � 49t6' E\� � S :ROAD X7.7=.�— ---- /M ROV�MEN PavEmEq —�4 W Lz3� 0 EDGE 1 15.63 of �-- -N56 37 8 ------------- N43'00 53 W N42-331081.w ET APPLETON SIRE j PREPARED BY JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS 9 BARTLETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 5742 Date��.(�.'`D".......... NORTh a p TOWN OF NORTH ANDOVER * - PERMIT FOR GAS INSTALLATION . y SSA NUSESS j' This certifies that T�.V.m q,,e7. . . . . .;0/ .' . . . . . has permission for gas installation . . . �441d'. . . . . . . . . . . . . . . . . . y in the buildings of . . . .� . . . . . . . . . . . . at . .47777. . . .,eIN h over, amass. Fee./40 . . Lic. No.A. �' ,.:�. GPECTOR Check 83'l 6 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r« , CITY MA DATE PERMIT# JOBSITE ADDRESSN SY►— OWNER'S NAME V_ GOWNER ADDRESS _ a IAPP , Oti1 _ TE Yea FAX OR OCCUPAN Y TYPE COMMERCIAL Q EDUCATIONAL RESIDENTIAL __ PRINT CLEARLY NEW: . RENOVATION:01 REPLACEMENT:© PLANS SUBMITTED: YESE!�NO APPLIANCES'l FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER ( CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE _1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _... _I . .. _ T —L1 ROOM/SPACE HEATER ROOF TOP UNIT TEST ! __-1 L— - II _ I_— l! f _._J J UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER ( I -- _ - _ 1 � ► _I I J _I —(— J R� _ INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1[!_1 NO E] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COV GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ._J OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER E-] AGENT Q SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and aqpurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compI' ice w h all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM R-GASFITTER NAME Ay I N'Mq�f M1_ LICENSE#[j:0 I SIGNATURE MP�_I] MGF EJ JP _J JGF LPGI ( CORPORATION '# PARTNERSHIP # LL COMPANY NAME: a��_ ADDRESSJ, CITY --]TEL STATE ZIP FAXa� 0 CELL � I EMAIL - .. .NcMN. _._ _ COMC- ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes NO THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ x ' FEE: $ PERMIT# PLAN REVIEW NOTES a,f =>7 rx __ � µ .3. �l .T t . tz Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information q. r Please Print Legibly Name(Business/Organization/Individual): ��I 1"v� Zr-Aj,_K� Address: r �� �{ �D• City/State/Zip:_ Ql h Phone#: Are you an employer?Check the appropriate box: Type project(required): 1.❑ am a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. [J Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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. Ido hereby cert uncle e p ins andpenalties ofperjury that the information provided above is true and correct. Signature: _r Date: Phone#: L 7��0 7 V Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal ontity,employing employees. However the owner of a dwelling house having not more than'flireekapartmentAnd who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on.such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be dant8d to be'an employer." MGL chapter 152,,§25C(6)also skates tifaat�`every state or local liceinsigg agency shall Withiiold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city o pP r ( tY 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 Commonwoalth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M.A.02111 TeX.#617-727-4900 ext 406 or 1-877,7MASS.AFE Revised 5-26-05 Fax#617-727-7749 www.mass,8oV1dia 9 i Date. ,//. . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .. �I 'Oo•rw•��� ''SSACHUSE� This certifies that f??4/?'. ?1 . . .fi.. ... . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . 4'r! - ?. . . . . . . . . . . . . at. . ./. �. . .��p�?l �?. . . .. . . . .. North Andover,- ass. FeeAA r.+`�.Lic. No,///,,3 7,".e1. . . . PLUMBING INSPE6G Check # 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:_p� Da►�M MA. G �I Date- { a (� Permit# Building Location: 1 0 P�`E• O f-4 s1 Owners Name: A L!i; / Type of Occupancy: Com/�mercial❑ Educational❑ Industrial❑ Institutional❑ R New:[� Alteration:[/] Renovation:❑ Replacement: Pla ❑ ns Submitted: Yes FIXTURES DEDICATED LU a z SYSTEMS Z > Y O w Z h a.. z FQ Y 'Q U LU d IM w LY Z C to Z Q Q w C7 cr Z a O m vi = a FW- in } w Q h Y O a = N < w w 4 z Ln z w p 0 O W z w z - a L z _j Q Q v }" Ln n O r" U j d OLL - a z EE w w w 06 O w 5 a 11 m m o o LL z g S 0 y 3 3 Q ~ u a a .SUB BSMT. Q c� c� 0 � BASEMENT 1ST FLOOR 2ND FLOOR t 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR ►ns�-llir19C,;„f a.; lame:_11JIMAINI Pl�r��l�_ 1•»:, ,,�L,, ,ti �i� Address: El�R El Corporation — �� City/Town: 1 � State:,�. ” Business TeL•'�' asg �sp?Fax: _ _Y7 aCP7 0700 Partnership Firm/Company Name of Licensed Plumber: �N !'�'Y`� INSURANCE COVERAGE: I have a current Iia_ bility Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes N If you have the o❑ cke d Yes lease _,p � nate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ - OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that mysignature on this permit application waives this requirement. Check One Only 1i nature of Owner or Owner's A ent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate Knowledge and that all plumbing work and installations performed under the permit!ssued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the enerai Laws. to the best of my T e of License: Ile Signature j Plumber g ature of Licensed Plumber `Y/Town Master 1076 ` I 'PROVED(OFFICE USE ONLY) ❑Journeyman License Number: !T/V �� ! �. � +` ,.. r c .r. .. } 1 b + h�� k . � �. . �, '� N' ..� V .. .. io's.<, i R a c ��, .. � , .. �� C t'.. n � � i' L V \ � L� v The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): „( Address:_Q gRa4,��f R.A• !� City/State/Zip: N 0 l h� Phone#: V a D7 �'Z►�Q Forneowner n employer?Check the appropriate box: _ a employer with 4. ❑ I am a general contractor and I Type of project(required):oyees(full and/or part-time).* have hired the sub-contractors 6• ❑ ew construction sole proprietor or partner- listed on the attached sh%et. t 7• LJd Remodeling d have no employees These sub-contractors have 8. ❑Demolition ng for mein any capacity. workers'comp,insuranceorkers' comp.insurance 5. ❑ We aie a corporation and its9 ❑Building addition ed.] .officers have exercised their 10.❑Electrical repairs or additions homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,0 Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 Name: 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er epains andpenalfies ofperjury that the information provided above is true and correct. Signature- " } [ Date: Phone Official use only. Do not write in this area,to be completed by city or town official. I 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 apartiiienis'and wl'o resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair woxk,on such'dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be djeemed 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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax`numlier: The Corm-nonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111. Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia OP ID: MH DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 09/19111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERACT 978-975-1300 NAME, Se reve S Hall Insur.Assoc_lnc978-975-7596 AO"N, Ext): Aro No 305 North Maln 3L Andover,MA 01810 ADDRESS: Patrick D.Hall PRODUCER INMAN-1 CU$,TOM.ERJ INSURER(G)AFFORDING COVERAGE NAIC A INSURED Inman Plumbing&Heating INSURER A:Travelers Ins.Co. 2 Bradley Road INSURERB:Arbella Protection Ins.Co. 41360 North Reading,MA 0.1864 INSURER C INsuaeRD: INSURER E: INSURER F! COVERAGES I:ERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLI'IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER AL)IJL WD MM/DD ,.-,. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. B X COMMF-RCIAl,GENERAL LIABILITY 8500032303 10/24110 10!24111 pREMISEs Eo oteurrence &; 100,00 14 CLAIMS-MADE FRIOCCUR MED EXP(Any one arson) $ 6,00 PERSONAL&ADV INJURY 5 1,000,00 GENERAL AGGREOATE Is 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: .. PRODUCTS-COMP/OP AGG I $ 2,000,00 POLICYRO LOC P $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (ER aaaldord) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Foraccidant) 3 NON.OWNFD AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAM CLAIMS41ADE AGGREGATE DEDUCTIBLE 3 NTI N S WORKERS COMPENSATION X WC STATU- OTRH- AND EMPLOYERS'LIABILITY y r N A ANY PROPRIETORMARTNERGXECUTIVE r N!A 0522N707 05/20/11 05/20/12 E.L.EACH ACCIDENT S 100,00 OFPCERIMEMBER EXCLUOED? t E.L.DISEASE-EA EMPLOYEE $ 100,00 (Mandatory in NH) 0yyeE that 0 Undor 500t 00 E3GtRPTION OF OPFRATI NS holow E.L.DISEASE•POLICY LIMIT $ oESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (Attach ACORD 101,Additional Romarks Schedule,If more apace is rnqulmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Gas Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street Bldg 20,Suite 2-36 AUTHORIZED REPRESENTATIVE North Andover,MA 01845 /&� (� ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 1 V + COMMONWEALTH OF MASSAGNUSETYS LICENSED AS A JOURNEYMAN PLUMBER ISSUES THE ABOVE LICENSE TO: SHAWN INMAN m , 2 BRADLEY RD co NORTH READING MA 01864-1218. 20213 05/01/12 784379 9267 Date. //fig//Z-. . HORTM •��a TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s � a -TS US This certifies thatJam..Rw. .� G` . / .4 has permission to perform Aon A, plumbing in the buildings of . ���L .G!' '4��F.1'. . . . . . . . . . . . . . . at . . ./% . ./. .o qq orth Andover, Mass. Fee./. 'P .Lic. No.10.7.f'6. . // . . . . . . . . . PLUMBING TOR Check # ��.5� . i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location U ON, o Date Permit# Owner. V W a Amount New Renovation ❑ Replacement Plans Submitted Yes No FIXTURES S[BEME 1�141VII�TI' M FIDM 3oH2IIElQt , M FUM 4M ER e 1✓Owl 6M ELOM 7IH ELOM SIH1NIDM (Print or Installing Company Name 1NfAAO PLVm(�Im& Check one:0 Corp. Certificate 1 Address CJ QR/k�l.F_y Rd• NAk hot," MA• M-W ALI er. Business Telephone Co. Firm/ Name of Licensed Plumber: WN Insurance Coverage: Indicate the of insurance b coverage g y checking the appropriate box: Liability insrurance policy Other type of indemnity BondEl ❑ Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance rgmt= Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa c tts S to Pl bing Code and Chapter 142 of the General Laws. lity/Town1076!j y. rgnarure o rcense um er itle Type of Plumbing License APPROVED icense um er Master Journeyman tOFMCE USE Or LY I i j !' f �-� ��� �.� . , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Lnvesfigations ..600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A ficant Information Please Print Legib Name (Business/Orrga�nization/Individual): ft w6v Address._a City/State/Zip: N. PfAh;A �q. �i�by Phone#: g7Yd6ZO700 Are you an employer?Check the appropriate boa: Type o oject(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I j'employees(full and/or part-time).*' have hired the sub-contractors 6. New construction [2.[�I am a sole proprietor or partner- listed on the attached sheet# ❑Remodeling ship and have no employees These sub=contractors have 8. ❑Demolition working for me in any capacity. workers' comp,insurance. [No workers'comp.insurance 5. 9• Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingi all work right of exemption per MGL 11.❑Plumbing repairs or additionsmyself. [No workers'comp. C. 152,§1(4),and we have no 12.[:]Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 131-1 Other Any applicant that the lts box#1 roust also A . fill cut Elie section b..lo v t Homeownerswork WS-eu•workcrss-co pa•sation policy info.--�tion. who submit this affidavit indicating F � dreatin they are doing all c g eY g 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 isproviding workers'com enaton insu rance or m employees. Belo ff is the policy andjob siteinformation Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofM.GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un are p ins and penalties of perjury that the information provided above is true and correct Signature: G Date.: Phone#: 7 D a 0 7 0700 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.PIumbing 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 or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,'§25C('6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or erit 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 in 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 certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the Omty or town that the app 1mCfie erJii for the Le-alt p_r ls^znse mS bung requested,EE4Et thY Department f Yr artmen..o_ Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-72.7-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#6.17-727-7749 wwu,.mass.gov/dia 78 ; 0 Date. . .91.1.S�l.... .... r• NORTH of �` TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION O• SSAC HUSEtSy A This certifies that 9., . . . .r'. . . . . . . . . . . . . has permission for gas installation . .Xi70-4V./,4. . . . . . . . . . . . in the buildings of . . .�,4/� . . .4,41A.,. . . . . . . . . . . . . . . . . . . at . . . .1.7 6). . , North Andover, Mass. Fee.,Y0,.�ULic. No.1Yff,, ..�.�.,4 .4 . . GAS INSPECTOR Check# i I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: Q 10AyEX MA. Date: "L" Permit# Building Location: �(� 4-�'{Q� nj� , Owners Name: Type of O cupancy: Commercial El Educational❑ Industrial Institutional❑ Residential New: Alteration:[ Renovation: Re ❑ Replacement:ement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES co Lu W vi W W rn z Q rn N L) = wof W O cn = rn CO m x 0 W J U to H O of W Z z Z 0 W p FW- > (Wj Z CO W 0 O W � Q W � = X W I— Q u I W w Z x CO F- W I— o Z W �- !A _J H I— O Z J (� LL N x Z W W LY O Q W W m > O Z O 0 F- > z �' x OwO Q z z w V o o u_ C7 O x x � O a SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR ' 6 FLOOR 7 FLOOR 8 FLOOR p y xN(AAM Plum& (-, Check One Only Certificate# Installing Company Name: Q�� Rp. ` !! ❑Corporation Address City/Town: Qi N State:�� Business Tel: (i 7 �f r 5 ���FS Fax:A2U07 0`1'0(7 El Partnership Firm/Company Name of Licensed Plumber/Gas Fitter: 66W �q INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.,142 Yes No❑ If you have checked Yes,please in " ate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's A ent Owner ❑ Agent E] By checking this box❑;1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Cod e an Chapter apter 142 of the General Laws. 7Y, [01 e of License: By PlumberTitle r-UGas FitterSignature of Licensed Plumber/Gas Fitter Mastercity/TownJourneymanLicense Number:APPROVED O FICE LLP Installer ` i s F4 ` s M, e.. ��+d. a ' • i J 1 i • i � 1 � '�• R � ' k. 5 7 Date. ..C.�". . . ,.ORTH TOWN OF NORTH ANDOVER OF �h : O y`f�,,io 3 PERMIT FOR MECHANICAL INSTALLATION �� p 0. s io • Ss' CMUSESS This certifies that . .fGl!�.tjv-� . . . . /. . . . . . . . . . . . . . . . . . has permission for mechanical installation . .I!.l! . . . . . . . . . . . in the buildings of ..77. !?�!?. ./. g4".1 . . . . . . . . . . . . . . . . at . . ��4 . /.:,��hn.: . . . . . . ., North Andover,^Mass. Fee. . 4 . . . . Lic. No.. .,r 4,3. . . . . . . . . . . . . . . . . . GASINSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date: $ l b- Permit# Estimated Job Cost: $ j O �Cf s 5 Permit Fee: $ 11,'u Plans Submitted: YES �NO Plans Reviewed: YES NO Business License# �� Applicant License# Business Information: Property Owner/Job Location Information: Name: Li 0 f s,KKS Name: LkwV Street: SSS W v\ sq Street: QooL City/Town: I y City/Town: Telephone: S y Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO yStaff Initial /1Q-unrestricted license J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family ►/'— Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. Ll� over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC ►/ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: I -1-u�.,5�.�.-l l o�.� �,.�a f�^^ ��Y �.Y u�t�te wj�-�,/��G tlti �j�-5,�.►+,,�^'�' w�'��^ F RANCE COVERAGE: a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes�o❑ have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy [� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑Master s Title ❑Master-Restricted City/Town Permit# Journeyperson v Signature of Licensee Fee$ ❑Journeyperson-Restricted License Number: --�—? -31 El Check at www.mass.gov/dpl Inspector Signature of Permit Approval r' k Load Short Form Job: U-Ao� Date: Entire House BY: HEATING SERVICE Franks Heating Service 555 Woburn St,Tewksbury,MA 01876 Phone:978-851-4403 Fax:978-851-0398 For: 190 APPLETON STREET NO.ANDOVER, MA 01845 Htg Clg Infiltration Outside db(°F) 1 88 Method Simplified Inside db (°F) 70 75 Construction quality Tight Design TD (°F) 69 13 Fireplaces 1 (Tight) Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/Ib) 28 28 HEATING EQUIPMENT COOLING EQUIPMENT Make AMERICAN STANDARD Make American Standard Trade FREEDOM 95 Trade ALLEGIANCE 13 Model AUH2B060A9V3VA Cond 4A7A3024E1 AHRI ref Coil 4TXCB031 BC3+*UH2B060A9V3 AHRI ref 4935798 Efficiency 96 AFUE Efficiency 12.0 EER, 14 SEER Heating input 60000 Btuh Sensible cooling 16380 Btuh Heating output 57600 Btuh Latent cooling 7020 Btuh Temperature rise 67 OF Total cooling 23400 Btuh Actual air flow 780 cfm Actual air flow 780 cfm Air flow factor 0.029 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 0.50 in H2O Static pressure 0.50 in H2O Space thermostat Load sensible heat ratio 0.93 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) MASTER BED 252 3783 2723 110 129 MASTER BATH 112 1452 1176 42 56 SITTING 216 4239 3187 123 151 WIC 91 879 139 25 7 LAUND 48 101 18 3 1 MUD 76 1632 1043 47 49 OFFICE 414 6024 3633 174 172 WORKOUT 598 6617 3805 192 180 BATH 72 1231 558 36 26 CLOS 70 976 181 28 9 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2012-Aug-15 12:16:28 vvrightsoft Right-Suite®Universal 2012 12.0.09 RSU10062 �, Page 1 ACCP. F:\Wrightsoft HVAC2\Project\190 APPLETON ST N.ANDOVER,MA.rup Calc=MJ8 Front Door faces: N Entire House d 1949 26932 16464 780 780 Other equip loads 0 0 Equip. @ 0.93 RSM 15311 Latent cooling 1292 TOTALS 1949 26932 16604 780 780 Calculations approved b ACCA to meet all requirements of Manual J 8th Ed. pP Y q wri htsoft� 2012-Aug-1512:16:28 �~ 9 Right-Suitee Universal 2012 12.0.09 RSU10062 Page e 2 / .� F:\Wrightsoft HVAC2\Project\190 APPLETON ST KAN DOVER,MA.rup Calc=MJB Front Door faces: N Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license s� All sheet metal work being performed with proper joumeyperson-to- apprentice ratios �- Equipment sized per heating/cooling load calculations Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors t/ Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean -properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-off) i +COMMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS i -AS A JOURNEYPERSON-UNRESTRICTE "ISSUES THE ABOVE LICENSE TO' TIMOTHY R PALMER ' 11'2 LOWELL AVE ? HAVERHILL MA 01832-3710 3731 09/28/12 929164 iI ' I i i 111 1 i 1 J R� L cSX� s I i f { r \ ex r r' cr -44 4 4w dyS t` jv -21 ti C i I i Y f L f — --- ne I 4 ? i a • • r� r. �bS 4 a , tt 40 , �. a.L � <"X•'P:.1M1..p�- .. .�'.M'I('Ulli�i.4 -�3'1):.y4':x.. � �, :- -lit ` . } 1 T Date....... � ......z...a.. NORTIy °`t"`°;•�"� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING 41 �,SSACH This certifies that ......Am �,'',!.�.DA V U( has permission to perform .. DQ iT `E./ �s-f�. ............................... .............. wiring in the building of....../" L /��...................................... .............. d �i i0p� TD.0 ST North Andover,Mass. Fee. 5............. LIc.No .��( 3�.. .............. ! Ard-9R-ICAL INSPECTOR f Ch+e�ck/# 71 Z-�—� u Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 7 -17740 BOARD OF FIRE PREVENTION REGULATIONS [ Occ 1/071 y and Fee Checked eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: //. a� •0-7 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenantt Rr.C.) I Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 — No ❑ (Check Appropriate Box) Purpose of Building 1 s.tp— Utility Authorization No. Existing Service r2a� Amps /-2aoVolts Overhead ❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: DOL Completion the ollowin table ma be waived b the Inspector of Wires. No,of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesU Swimming Pool Above [IIn- ❑ o.o Emergency Lighting nd. rud. BatteryUnits No.of Receptacle Outlets NCZ 6, o.of Oil Burners FIRE ALARMS No.of Zones No.of Switches >-- No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump umber Tons o.of elf-Contained Totals: _.._.......--........._........._._._.._.._._...._. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local F-1❑ Connection EJ Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of Nf No.of Devices or Equivalent o.o Heaters KW Sips Ballasts DatN of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ���� (When required by municipal policy.) Work to Start: - 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 cern , under the pains and f3' p penalties of perjury,that the information on this application is true and complete. FIRM NAME: c LIC.NO.:--a303691 Licensee:'t=`/t e h n 1 Signature LIC.NO.: 43(2969 (If applicable, enter"tempt"in the license nu r line.) Address: _PD 5�->C tJF 1 t'i�p ,.; g Bus.Tel.No.:97.E 115-54273 ' n7� A Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires 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) El owner ❑owner's agent Owner/Agent Signature Telephone No. PERMIT FEE:$ �>'�. �ti. .. The Commonwealth of Massachusetts ,;� ' ! Department of Industria!Accidents _,4lid Office of Investigations 600 Washington Street i Boston, MA 02111 { www ntass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbers Aliplicant Information Please Print LeQibl Name (Business/Organization/Individual): i Address: fi C-) City/State/Zip: i!"�4 Phone#: . q 7 IF / t�.��7't Are you an employer?Check the appropriate box: Type of project(requireft I.MIT am a employer with�_ 4. ❑ 1 am a general contractor and I 6. ❑Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am.asole proprietorr or partner- listed on the attached sheet.I 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demoliti.on working for me.in any capacity. workers' comp. insurance. 9, ❑ Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F7 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions Myself.[No-workers'comp. c, 1.52, §I(4),'and we have no 12.[3 Roof repairs insurance required.]t .employees. [No workers' comp. insurance required..] 1.3:0 Other *Any applicant that checks boa'#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hie outside contractors must submit a new affidavit indicating such. 4contractors that check this box mustattaehed an additional sheaf showing the name of the sub-contractors and their worken,comp.policy information. I am an employer that is providing:workerscompensatwn insurance for my eneployeeL Below is the policy and,job site information. Insurance Company Name: ' .e Policy#or Self-ins. Lie.#: Expiration Date:_ Job Site Address: '( _ ) ��tiv► j�-- City/State/Zip: Attach a copy of the workers'.compensation policy declaration page(showing the policy number and expiration date) Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pat' and penalties of perju at the information provided above is true and eorrecL Signafore: Date: , Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions N.' 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 or repair work on such dwelling house or on'the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of license or permit too erste a business or to construct buildings in the commonwealth for an P P >'� Y applicant who has not produced acceptable evidence.of compliance with the insurance covers a required." PP . P P P g R Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or,Limited Liability Partnerships(LLP)with.no employees other than the r members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit.may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Aiso'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not`the Department of Industrial Accidents. Should you have any questions regarding the lawor 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 dine. 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating,current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)..". A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a flog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, ' please do not,hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industdal.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-7274900 Ext 406 or 1-877-MA.SSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia - - - -- .. LAWRENCE H.OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 lax 978—352-2858 pager 978-302-5921 December 8,2007 Mr.Brian Lawler 66 Wildwood Roar! Andover,Ma. 01810 R:E:,W&-H=Residence-190 Appleton_Su North Andover,Ma. Dear Mr. Lawler As you requested I visited the above project to review the installation of the LVLs engineered lumber utilized in the framing. These members were designed by me and specified on a drawing certified by me August 18,2007 I reviewed the installation of these beams used in the structure and can certify that to the best of my knowledge the beams are acceptable and meet the loading conditions required by the a Edition ofthe Massachusetts State Building Code. Should you have any questions please do not hesitate to call. Yo s truly, ��N orGo M� �77d wrence H. Ogden,P.E. Structural 27765Fc, �4 sTE. `'�dNAL f.N�✓ Date. �., . .. `dK 3�0*�4HO oT e,�OL fY p TOWN OF NORTH!ANDOVER PERMIT FOR GAS INSTALLATION `tet. '!s �°,,�o•'•��t9 9SSACHUSEt This certifies that . . ,/ � �a . .,�� . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . l C t"c. . . �. . A.`2'—: . . in the buildings of . . .t:,-. tX/.. h.t/.�. . . . . . . . . . . . . . . . . . . . . . . . . d at . . .19A. .1011elA n. . . . . . . . . . . North Andover, Mass. Fee. 7. . . . Lic. No../fa.?.t.!,! .--�. . . . . . GAS INSPECTOR Check# 3 >� 6249 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GASFlTTIN 7 (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations ��� Af h��0f� 5t Permit Amount$ y Owner's Name FAVL ��j�Q New Renovation n Replacement Plans Submitted ,W�`` � w a w ca y z U w x rn Z dFd `c O a > w C7 F Z F Q x W w C w F W F x x z w C7 O > rs, U v z w > x z a e o o w9 vF, x o x 3 o v a u m > o SU B -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) Check one: Certificate Installing Company Name ��WN -VwPm j 9Ly ❑ Corp. Address -,3 EVALa no f4�Q11 4 FV A (��(�� � � Partner. Business a ep one (y FyFirm/Co. Name of Licensed Plumber'or Gas Fitterh� NMAn.� INSURANCE COVERAGE Check I have a current liability Insurance,policy or it's substantial equivalent. Yes No If you have checked rtes,please' icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ED Bond 0 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: Signature of Owner or Owner's Agent Owner 13 Agent 13 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 State Gas Code and Tter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber 1 n?64 City/Town. Gas Fitter License um er ® Master APPROVED(OFFICE USE ONLY) 1:3Journeyman ....��.� it �r .� _ F .s Location ig() Or,, Ret TvY,% No. Date NORTH TOWN OF NORTH ANDOVER > Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �- 241,66 �- Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:ISS' Z Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 19d e!!S.RPLG i GQ Print _PROPERTY OWNER 'PAv L C.1C WAa. VVA L.► :t—P— Unit# Print MAP NO: (64 PARCEL: J 7- ZONING DISTRICT:12-I Historic District yes Qo i Machine Shop Village yeso 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ►a One family ❑Addition ❑Two or more family ❑ Industrial VAlteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Floodplaint �lWetlands ' ; � Watershed'Disfrict, '''Septic '�;Well � t b rr r DESCRIPTION OF WORK TO BE PERFORMED: G r)- 4AMPS) —i—� o s-y—rr�G cAA496 W-- I i I (Identification Please Type or Print Clearly) OWNER: Name: Peiz�,u�- d- C.G-ci--L-41q Phone: Address:-'7.5' EyNA�Wo ofl RP- �mow._=—�.mow Ot/a CONTRACTOR Name:")IL!ISN I,AvU4_m5-e- Phone: q 7 Address: 66_ye z woW o as 20, 01810 ��n- �✓i� 0l8/ D Supervisor's Construction License: 19t�, I Exp. Date: SA7 3/Lo/Z Home Improvement License: Exp. Date: �/�o ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $;=' ,O0Q) . FEE: $ tp • Check No.. ReceipfNOL NOTE_: Persons contracting with unregisfdo not�av-e ac" s=to the guaranty fund -' �'_.:'.:... .-_.;_._ .? ,[__..;_._...-. __..;__..._._... i;-----fP .Sianature.o aen caner:_ .:_ Signature of:contractor `"'1 - _ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ,addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) '�l ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require.sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe: Doe.BuiIding Permit Revised 2008mi Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, mast or service drop requires approval of Electrical Inspector Yes No a DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA— For department use t - I i ® Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Pr Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ - Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Sicinature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments J Conservation Decision: Comments I Water & Seaver Connection/Signature&Date- Driveway Permit i i DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Te#p Du nps e 4' In site yes no Located at 124 Main Street '�� Fire Department signature/date // COMMENTS tIORTH Town of _ ndover0 . . No _ LAKE o . dover, Mass., COCMICHEWICK �ADRAED PPS` �� Y '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... ...a.#L....... ....................................................................................... Foundation has permission to erect....... ....................... buildings on ...1q0......".jQ401AA+0.f%.... ........................ Rough .......... to be occupied as.............F�i4piing 4 ......... ............................. ................V..................................................................... Chimney provided that the person this permit shall in every,respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 3tp Final E-W E S 6n)._N[ ST ELECTRICAL INSPECTOR 12 LESS CO STRUCTI �S Rough ..................................................................... Service BUILDING INSPECTOR Final Occupancy F'er mit Required t® Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIR_ E"DEPARTMENT Until inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)::2)QlAl-,l WL QCT Address: 66 W Jt,_0W000 City/State/Zip: / ®a vC31L,M of 1 U Phone #: q 7 9 q7© —/9 Z Are ou an employer?Check the appropriate box: VI Type of project(required): 1. am a employer with�— 4. El am a general contractor and I 6 employees(full and/or part-time).* have hired the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sh%et. 1 ?• 52'Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatingsuch. #Contractors that check this box must attached an additional sheet showingthe 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 Name: ^t 1_A -JT C. Policy#or Self-ins.Lic.#: WCy,p Q p956 1 n i Expiration Date: `7h /76JA _ Job Site Address: —./!20 T j City/State/Zip:/1I,o 1Q,.1Dv v'czk_ S!o•;l OIE39, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienature: Date Phone `►—to [[Official useonly. Do not write in this area,to be completed by city or town official.ity or Town: Permit/License# suingAuthority(circle one): 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 or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance.. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. ## 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax##617-727-7749 www.mass.gov/dia vtassacnuscits- Department or runic Jarl'i� Board of Building Regulations and Standards Construction Supervisor License License: CS 261 Restricted to: 00 BRIAN A LAWLER 66 WILDWOOD RD ac+� ANDOVER, MA 01810 : Expiration 3/23/2012 ('ommi..ioncr Tr#: 22966 Office of'�o>�u er'�t aif-rs&�a ine`"�h'�on�b HOME IMPROVEMENT CONTRACTOR _ Registration: .:.156915 Type: Expiration: 0.1572013 DBA B LAWLER GENERAL CONTRACTOR BRIAN LAWLER ',' 66 WILDWOOD ANDOVER,MA 01810 Undersecretary Fing: EPA RRP Certified Renovator 3/25/2010 Test: 3/25!2010 RRP Initial Course(English) Brian Lawler 66 Wildwood Rd Andover,MA 01810 Expires:3/25/2015 R-1-18692-10-03188 °Lead-Edu 23 Nute Rd Madbury,NH 03823 0(603)749-5775 WO-R"RS'_COMPENSATION AND-EMPLOYERS LIABILITY INSURANCE POLICY- Information Page WC 00 00 01 Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00898101 1. INSURED. Y Prior Policy Number: WCV00898100 Brian A. Lawler Producer: 66 Wildwood Road Phil Richard &Associates Federal ID Number.-042960346 Insurance, Inc. Andover, MA 01810 27 Garden Street Unit 1-B Risk ID Number: Danvers, MA 01923 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: 2. POLICY PERIOD: The Policy Period Is From: 7/1/2011 To 7/1/2012 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates& Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $4,250 Interim Adjustment: Annually Servicing Office: Total Estimated Premium $4,002 25 New Chardon Street Surcharge(s) 248 Boston, MA 02114-4721 Total Premium an urcharge(s) $4,250 JUL 0 5 MI Issue Date 07/05/2011 Countersigned By: 0^9ate 75 Prynnwood Road Longmeadow, MA 01106 To Whom It May Concern: Brian Lawler is our agent for pulling the required permits and to perform work at our property located at 190 Appleton Street, North Andover, MA 01845. Respectfully yours, Paul and Cecilia Walker S Home Im rove meet Contract ett • MassaS tractor Information con F1.D.04-2 860346 ;sor's License 261 . e I Construcf Supry Improvement Lawler Contractor Nome Imp 156915 Brian A ler General Contractor License Brian La`N01810 66 W ildwpOd goad dusetts Andover,Massachusetts (97 S)470-1983 tier Information Homeown d Cecilia W alker Paul an Street 45 Name:ss. 190 Appleton er,Massachusetts 018 Addre North An 4 567-345 ner. (413) eoW � Telephone' ork for the Hom „ to allow for W to be raised 13 he following Floor Is r; ;d insulation W1l dot ,rage with g door s to existing gIt e filledand French kitchen Contractor aga e g eX;st;ng um�log- Floor area 4p0 Series wind closed cell foam insulation The of reloc us PI with R-21 New Anders lob Will du�Work and miscellan the area. w-11 be filled Crete will then cap vities the owner• heating of con erior wall Cavities by stone• 4 exterior wall. Ext will be counter toP $33,000•p0 be installed in Cabinet and before plaster. tal Estimated Cost the homeowner's agent- 'TO � Permits' secured by the contractor as Its: leted Required permits will be sec to be comp Schedule. 2011,and ended by the All necessary P out P'ugust 8, ably ext letion or ab reason they stances d Start and 'Completion to begin °n however, be circum lodes the she has been informed ose period, may• installation oro o , prop er this contract This time p at he/she The work and October 8, 2011• crit weather wh%ch precludes th on or about t of incle I The Nomeov,iner in the event control.completion- an beyond the Contracto me for comp above for to this tim ule: labor specified and consents shed rid payment S rnish the materials and �,price a e work, fu Total Contra to perform th To tractor agrees p0(*) The Con °f:$33,000. approximate cost I Payments will be made according to the following schedule: $10,000.00 as an initial deposit upon signing contract. Progress payments will be requested by the Contractor as work proceeds. Contractor will provide the Owner with periodic updates that will include labor, stock and subcontractor costs to date. Final payment will be due upon completion of the contract. Work is to be performed on a cost plus basis. (Law forbids demanding full payment until contract is completed to both party's satisfaction). Notes: (*) Including all finance charges. Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a) one-third of the total contract price or(b)the actual cost of any special equipment or custom made material,which must be special ordered in advance to meet the completion schedule. Warranty: The Contractor hereby warrants that its installation shall be performed in a good and workmanlike manner in accordance with accepted industry standards and further warrants the installation against defects in workmanship for a period of one year from the date of installation. Subcontractors: The Contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The Contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Arbitration: The Contractor and the Homeowner hereby mutually agree in advance that in the event that the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations, and the Homeowner shall be required to submit to such arbitration as provided in M.G.L. c.142A. Contract Acceptance: Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or 1-800-223-0933. Does the contractor have insurance? Check to see that your contractor is properly insured. i not restrict a homeowner's basic consumer rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three-day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 14888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 p8/11/2011 09:59 1-413-781-2319 UX WALKLK Laurie LaWler 978-470-1983 p.2 You may cancel this agreement if it has been signed at•a place other than the contracmes normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day foNowimg the signing of this agreement. Int NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed. One copy should go to the homeowner.The other copy should be kept by the contractor. The Homeowner hereby acknowledges that he/she has fully read and fully understands the terms of this contract. Signed under seal this 1st day of August,2011. H S): Contractor: Paul Wa er Wan A.Lawler MOM Walker ACKNOWLEDGEMENT and RECEIPT OF COPY The eowner hereby acknowledges that he/she has received a copy of this contract signed by oth the meowner and the Contractor. Paul Walker Gmciclia Walker Homeowoe�s RigNs A homeowner's rights under tiro Home improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement However, if the they choose is not as homevwriens may be excluded from certain rights contractor ey properly registered prescribed by law.Homeowners who seem their own building permits we automatically excluded from all Guaranty Fund provision of tiro Home imprvvemeat Contractor Law.The contractor is responsible fbr completing the work as described,in a timely and workmanlike manner.Homeowners may be ensiled to other specific lcgd rights if the coneractor guarantees or provides an cries warranty for workmanship or moseriais. in addition m guwntees or warranties provided by the contractor,all goods sold is Massac mtts carry an implied wanwity of mobility and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms ofthe contract as long as they do it I I I I Nt r- CO 7— Zx.L- -�O Twu-al o AND- FW454611 o 3 rrz�-C— �.a e e5G- r , n�M noz w73'638-t3 i-�S wires I . H /S IMG m�tnea I � Pi9nrlQ.S O -�/ d•ln�_i�n✓.li' SNeI —i�I Fe a'ST.Oi4 � �_ — i Na A y NRIL GLOSPT "� /t`D ,! -I / \MaY T Qty F�ZeC>' " WJid r�I �lY [�6Yd7 �, I. ts6S ItA a N .1 p.• St.a iY Q,1010.6000 ��7b•90 �9a � I 6 r syyi�t" zewmm IF to 3'l'd � _-�'ea� b/gyp• ✓ Sorrzsm,,S" A LEt � a A i TAe�E � Iib Smr/ub • RafA .✓�L�L 2T` W Ut i G Go 66 Fl .U/ h tE l� zxIo y�z - 2x IO ,� ,`�_ ,3•.� ' ' SUR t�ce x 16RC t �?C1JO. 40 LS L 14 eAOC P, ljo t�ti6 :—�— i 1 � I � JATMAT TO SA�ENL} ROM RAFTER P PA TE ��p�tN OF J� M'=S' LAWRENCEP UUMAX" # A"ONS,m STAII4ISS STEEL. H OLD IMUMONSBUTOORTAIN AND FOLLOW THE � T�T �t�I��TIONS AND pF p 1 I� [ �l-LVL DTAMS TS.�M WAY4 TO HAVE SI,TMCIEN'I•UNU TFRUPTE D SUPPORT FSS�oN E�G�� Mkt#' f dVi I+ T-()TfM FOU ATM OR NM LVL BEAM. ANCIES.PROPS DEM TIOM ANL)ACTUAL FIELD AT AOtnpT4gMM THAN DEMI TO THE ATTENTION OF THE TO�C� �GQ�' UCTION. + ,,WORK WITH TIM DRAWING AND ALL OTHER PROJECT r. SIS DAAWMS. UEAM AND Pl:ATES TO BE A-36 STEEL. INSTALLED PER OWAUJO PER BIGFOOT '!f$TEM TO$E s II AMAL- } p.Lt.4 P'SF,SECOND FLOOR 30 PSF,DL 15 PSF,ROOF SNOW s* LL 60 PSF • ? $ IM DOWN TO(JN+ppMTIt M SOIL HAVING A NUNDIUM G F R 7'f i c o F o l OF 2 TONS PER SQUARE FOOT. Q B 4 G N D a LV(- ENGINEER: I AVVRENCE H. OGDEN P.E. 1"EAST mAiN STREET GE ttiGE OWNt MA.01933 978-35 431891-cc+en 478.502-5421 _-- - L � r, 'mac 1� '•I 't I 77 � .t S If f '3Jq T i 't j1 t Tti./• -77 x16 vC_ - '�1X3 PIN }? �7Sa J0• N� = I .S� 2- -1-751c-9 ,2-5 '2 a - z 4 L UL- !-! AE�� f - Date. . . . a ?. . P TOWN OF NORTH ANDOVER ° : PERMIT FOR PLUJWBING -o•,r,..."�ti SS US 7 This certifies that . !. . . . . . . . . . . . . . . . . . . . . � has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .W'Ov. L.r?'5�/1. . . . . . . . . . . . . . . at . . . .( / . . . . . . . . . . . North 'Andover, Mass. Fee. . . . ..Lic. No.I©!�. . .`� `�. , w . . . . . s-� . . . . . . . . / PLUMBING INSPECTOR Check # 3)—,� 3 7588 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO MBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ff Date �t ��7 Building Location �Q A�fpp ',S+ Owners NamePermit#_� -�j. Amount Type of Occupancy New Renovation © Replacement Plans Submitted Yes No ❑ . Er FIXTURES a a w x x H w 3 a a < cc SUB-FSNE BASEV>a�r 1ST l-OCIR arn>JOCIR 3MFLOOR aMRloM 51HR 61H HAOM - > s1x Hjocp (Print or type) ./ Ch one: Certificate Installing Company Name ��IIKAN LUn�lgtnJ6► Corp. Address ;� MoULv ft, r r iR6(, GGG���❑JJJ Partner. Business Telephone �Firm/Co. Name of Licensed Plumber: :%%W0 a JM NJ Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy T Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts to Plumling Co d Chapter 142 of the General Laws. By: igna ure 77 Mcenseci riumoer Title Type of Plumbing License '07�� City/Town icense um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY I "pRT1y TOWN OF NORTH ANDOVER 10 0 PERMIT FOR PLUMBING + � a s ,• •'a SA US t This certifies that �. has permission to perform ...--S`-. 6141 - . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . r':j'r! . . . . . . . . . . . . . . . . . . . at ., . . . .. . .' North Andover, Mass. Fee%�� . . .Lic. No./,,. 2:. . . . . . . . . . . PLUMBING-INSPECTOR Check # V 7558 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS n Date rb[� p Building Location C10 fl�l L14� f>f OwnersName buL w{F N-X Permit# c5�5Z3 �E Amount Type of Occupancy K New Renovation 0/ Replacement Plans Submitted Yes No ❑ FIXTURES 111 ••• zCn O W W F x ~d OT z 0-4 z a U U z w o a w w z a w x a x �" z w w H o d z o w o U SUE&B%K BASEMENr 1ST 11(m Za MOM I 1 M MOOR .. 41H FLOOR 5M FIfm 6M MOOR 71MH FIDOR r SIH H-O(R (Print or type) Check one: Certificate Installing Company Name —rN M AQ W VAS' Corp. Address ) 2P `I RA "a r)l6`I ❑ P ner. usmess Telephone o'7 7 D Firm/C0. ,Name of Licensed Plumber: awti J-7M�R�1 Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus State lumbii ode and Chapter 142 of the Genera]Laws. BY SignaLure or Llcenseca rium er Type of Plumbing License Title 10-76 City/Town icense um er Master Journeyman APPROVED(OFFICE USE ONLY ❑ pORTFI BUILDING PERMIT 41 o`.1-(L*0 6;�tio af.gP. n 6 O TOWN OF NORTH ANDOVER � i - p APPLICATION FOR PLAN EXAMINATION Z b � 3 S . ,. Date Received Permit NO: �9SSACHU`��� � _ I Date Issued: IMPORTANT Applicant must complete all items on this page ` 1W11 ffi { k,e �. x ,� j I O 'i IoN S PRQfEMMW .d ,. P INAPe RM' .. �F'ARCII. � ZONNG CJtS�R1CT r HistorcD�Strtct � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building se0ne family M'Addition ❑ Two or more family ❑ Industrial C' 41teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Flcibd, L letla d t r F d t tr x � _siil .. r+ DESCRIPTION OF WORK TO BE PREFORMED: iZn�r,x,41._�>^ ��w r 7nsC, C ' � -T�' Epk— JI ems, — fir C3s'X!��Ti/yG LIVfN,(� i�/LCt'/� LAJJfJ©bc�.9.� Identification Please Type or Print Clearly) OWNER: Name: �,o.�st_ -I& Ln.�/y j/Li�L_ Phone' �llr��T-3 Address a7 ! WGO oJ'i d } 77 77 O „r N�(T����� ����.fc X '� N 2/ �'���'y ��. F� l����e k 4 :.'�6• 'fin �' '`� Si"� se � ag < $t1 } rU�SOt'S ?C�tlG�lt LIL15e � ` EX-04,art A I-�ere Irnprdenerft Tense` . K . . x ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ //b 00 01 "� FEE: $ Q � Check No.: 1 Receipt No.: 2Z— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature #' genwner � S►gnatare of cttractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application ❑ Workers Comp Affidavit + (g1 Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) (l Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.s100-s1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date ......................... ....................................................................................................... .. ......................................._..................__........_......... ...... .................... Doc.Building Permit Revised 2007 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Nil' Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Drivewav Permit Located at 384 Osgood Street FIRE.©IEPARTMI=N7` r Teen DCarrrpste�r dri stte t bcate at 1'2` M' Street ' ! Nre #P arErnent srgna�ture/date , a Location No. �� Date M�RTN TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ Building/Frame Permit Fee $ s�cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 205'1 2 .a Building Inspector IAORTH Town of Andover ............... A.. I No. LAKE 0 over, Mass., COC MIC HEWICK 7dS RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ) BUILDING INSPECTOR THIS CERTIFIES THAT.. .......................................................................................... Foundation has permission to erect............... ........................ buildings on —Ift......A.P*+47A.....'". ft...................... Rough to be occupied as. - 4 Ic Chimney *41... --6W .........plew UdArwalffi. provided that the persoh accept this permit resp%cl conform to the terms of the application on file in i Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Nrmft. Rough Final 13 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU 4: STARTSTS INRSIPEN!UJUR Rough .. ....... Service BUILDING Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. SONSE'M Double 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP Roof Beam\RB01 BC CALCO 9.3 Design Report- US 1 span I No cantilevers 0/12 slope Tuesday,August 14, 2007 09:13 Build 057 File Name: BC CALC Project Job Name: WALKER RESIDENCE Description: RIDGE BEAM LOFT) Address: 190 APPLETON STREET Specifier: City, State, Zip: N. ANDOVER, MA Designer: Customer: BRIAN LAWLER GENERAL CONTRACTING Company: Code reports: ESR-1040 Misc: J 12 1 18-00-00 BO 131 DL 1879 lbs DL 1879 lbs SL 4095 lbs SL 4095 lbs Total of Horizontal Design Spans=18-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf. Area (psf) Left 00-00-00 18-00-00 15 35 13-00-00 Controls Summary Value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 26883 ft-lbs 80.5% 115% 3 1 - Internal Completeness and accuracy of input must End Shear 5151 lbs 48.1% 115% 3 1 - Left be verified by anyone who would rely on Total Load Defl. U221 (0.979") 81.6% 3 1 output as evidence of suitability for Live Load Defl. U322 (0.671") 74.6% 3 1 particular application.Output here based Max Defl. 0.979" 97.9% 3 1 on building code-accepted design properties and analysis methods. Span/Depth 15.4 n/a 1 Installation of BOISE engineered wood products must be in accordance with Notes current Installation Guide and applicable building codes.To obtain Installation Guide Design meets Code minimum (U180)Total load deflection criteria. or ask questions,please call Design meets Code minimum (U240) Live load deflection criteria. (800)232-0788 before installation. Design meets arbitrary(1") Maximum load deflection criteria. Minimum bearing length for BO is 2-1/4". BC CALCO,BC FRAMERO,AJST"" Minimum bearing length for B1 is 2-1/4". ALLJOISTO,BC RIM BOARD T- BCIO , Entered/Displayed Horizontal Span Length(s) = Clear Span + 1/2 min. end bearing + BOISE ,VERS E SIMPLE FRAMING SYSTEM@ 1/2 intermediate bearingRSA-LAM&,VERSA-RIM PLUS&,VERSA-RIM&, Member Slope=0, consider drainage. VERSA-STRAND&,VERSA-STUD@ are trademarks of Boise Wood Products, Connection Diagram L.L.C. b d—� a c j a minimum =2" c= 10" b minimum = 3" d = 12" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 BOISE- Triple 1-3/4" x 18" VERSA-LAM® 2.0 3100 SP Floor Beam\F1301 BC CALCO 9.3 Design Report- US 1 span I No cantilevers 10/12 slope Tuesday,August 14, 2007 09:11 Build 057 File Name: BC CALC Project Job Name: WALKER RESIDENCE Description:_GARAGE BEAM Address: 190 APPLETON STREET Specifier: City, State, Zip: N. ANDOVER, MA Designer: Customer: BRIAN LAWLER GENERAL CONTRACTING Company: Code reports: ESR-1040 Misc: i 22-03-08 BO B1 LL 4013 lbs LL 4013 lbs DL 1901 lbs DL 1901 lbs Total of Horizontal Design Spans=22-03-08 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf. Area (psf) Left 00-00-00 22-03-08 30 12 12-00-00 Controls Summary value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 32957 ft-lbs 47.1% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 5079 lbs 28.3% 100% 1 1 - Left be verified by anyone who would rely on Total Load Defl. U463 (0.578") 51.8% 1 1 output as evidence of suitability for Live Load Defl. U682(0.392") 52.7% 1 1 particular application.Output here based Max Defl. 0.578" 57.8% 1 1 on building code-accepted design Span/Depth 14.9 Na 1 properties and analysis methods. P P Installation of BOISE engineered wood products must be in accordance with Notes current Installation Guide and applicable building codes.To obtain Installation Guide Design meets Code minimum (U240)Total load deflection criteria. or ask questions,please call Design meets Code minimum (U360) Live load deflection criteria. (800)232-0788 before installation. Design meets arbitrary(1") Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". BC CALCO,BC FRAMER®,AJST"" Minimum bearing length for B1 is 1-1/2". ALLJOISTO,BC RIM BOARDT^^ BCI® , Entered/Displayed Horizontal Span Length(s) = Clear Span + 1/2 min. end bearing + SYSTEM®BOISE SYSTEMS, VERS E S SIMPLE FRAMING RSA-LAM®,VERSA-RIM 1/2 intermediate bearing PLUS®,VERSA-RIM@, VERSA-STRAND®,VERSA-STUD®are Connection Diagram trademarks of Boise Wood Products, L�b —d L.L.C. a o � o C e o 0 0 a minimum =2" c= 14" b minimum = 3" d= 12" e minimum = 3" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 ' a �1ze 1°omv.�arneurea� a�'✓�aaaa�%.,coel�a BOARD OF BUILDING REGULATIONS .t License: CONSTRUCTION SUPERVISOR Number: CS 000261 Birthdate: 03/23/1962 Expires:03/23/2008 Tr.no: 20506 Restricted: 00 BRIAN A LAWLER 66 WILDWOOD RD q7 ANDOVER, MA 01810 Commissioner ,per �/ee 1°o��vrxom,�ueall�i �/�aaaaclJiueel�s -\ Board of Building Regulations and Standards tr ; HOME IMPROVEMENT CONTRACTOR Registration: 156915 Expiration: 8/15/2009 Tr# 257965 Type: DBA BRAIN LAWLER GENERAL CONTRACTOR BRIAN LAWLER 66 WILDWOOD RD ,� ANDOVER, MA 01810 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents y Office of Investigations 600 Washington Street n Boston, MA 02111 -� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): ERJIPNFJ L/_\yyLGL Address:_j5;6_f/Y/CAVY00Q RJQ City/State/Zip:.,e�h"io o V tEaz-/'W 0/vt/C) Phone #: 776' 4 70-/W3 Are you an employer?Check the appropriate box: Type of project(required): 1. l am a with employer 4. F1 am a general contractor and I ---�- 6. ❑New construction empl6yees(full and/or part-time).* have hired the sub-contractors 2.❑ I am;a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. [Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions II� myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks boz#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-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 Name: 1 C/ ?�1G CA4: .GLT�- 4 c� Policy#or Self-ins. Lic.#: WC_VO n IA AOS Expiration Date,:�yt' 6 2�-d 6 Job Site Address:) ?0 199A_C-lb+--� Sj, N, lqOV V,�V 06— City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienatu :--� Date: A//.5--/07 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License it 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#: WORKERS' COMPENSATION AND EMPLOYERS LIABILI'T'Y INSURANCE POLICY i' Information Page _., WC 00 0001 I Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00478203 1. INSURED: Prior Policy Number: WCV00478202 Brian A. Lawler Producer: 66 Wildwood Road Doherty Insurance Agency, Andover, MA 01810 Federal ID Number:042960346 Inc. Risk ID Number: PO Box 1985 Andover, MA 01810 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured:See WCE106 Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 11/6/2006 To 11/6/2007 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers-Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states liste here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A.The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates& Rating Plans.All information required below is subject to verification and change by audit. Code Premium,Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $3,204 Interim Adjustment: Annually Servicing Office: Total Estimated Premium $3,087 s e 25 New Chardon Street Surchaeg ( ) 117 Boston, MA 02114-4721 Total Pr ium and Surcharge(s) $3,204 Date NOY 0 2 200 Issue Date 11/02/2006 Countersigryed.By: ; ,., CONTRACTOR'S AGREEMENT BRIAN LAWLER F.I.D. #04-2960346 GENERAL CONTRACTOR Registration #156915" . ,66'Wildwood Road Mass Builder's License #000261 Andover,MA 01810 f ("8)470-1983 Date: CUSTOMER INFORMATION Name and Address: Home Telephone: p/-N4j C- 4 iL 190 Sze 'Cr. lV�/bs",(M V0'4- Work Telephone: CONTRACT TERMS IN CONSIDERATION OF THE PROMISES AND AGREEMENTS SET FORTH IN THIS CONTRACT LAWLER AND THE CUSTOMER AGREES AS FOLLOWS: 1) Services: The Customer hereby requests,contracts with and authorized Lawler to provide the work and the materials described below: Z 'i?J 7i i 00M AZOvi; 64W66 Onll mzAL 2) Date of Installation: The work under this contract is scheduled to begin on and to be completed-onAPr'fLy)4 "4&7 This time period may,however,be reasonably extended by Lawler in the event of inclement weather which precludes the installation or other circumstances beyond Lawler's control. The Customer acknowledges that he/she has been informed of, and consents to,this time for completion. 3) Cost to Customer and Payment Terms: The total cost of the services and materials to be provided by Lawler is$ //0, 0 0 0 . This customer cost shall be paid as follows: a) $ (331/39'0)shall be paid upon execution of this Agreement. b) $ (66 2/39:o)shall be paid upon completion of the work. 4) Customer Cooperation: On the date for installation set forth in paragraph(2)above,as such may be extended the Customer shall allow Lawler and his agents reasonable access to the premises at reasonable times. 5) Warranty Lawler hereby warrants that its installation shall be performed in a good and workmanlike manner in accordance with accepted industry standards and further warrants the installation against defects in workmanship for a period of one year from the date of installation. Lawler,however,is not the manufacturer of the materials used in the installation and has not made and does not make any representation,warranty or covenant with respect to the condition,quality, suitability or merchantability of the materials in any respect or any other representation,warranty or covenant,express or implied. Lawler will,however,take any steps reasonably within its power to make available to the Customer any manufacturer's or similar warranty applicable to the materials. Lawler shall not be liable to the Customer for any liability,loss or damage caused or alleged to be caused, directly or indirectly,by the materials,by any inadequacy thereof or deficiency or deficit therein. 4 i� 6) Arbitration THE CONTRACTOR(Lawler)AND THE HOMEOWNER(Customer)HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THAT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER(Customer)SHALL BE REQUIRE7Cmer IT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A. 9rian Lawler NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY THE CONTRACTOR. THE OWNER MAYINITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. 7) RIGHT OF RESCISSION YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER(Lawler),WHICH MAY BE ITS MAIN OFFICE OR BRANCH THEREOF PROVIDED YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED,BY TELEGRAM SENT OR BY DELIVERY,NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. 8) Acknowledgment of Rights The Customer hereby acknowledges that he/she has been informed that he/she has legal rights related hereto under the provisions of M.G.L.c. 142 A.and 780 CMR-6. Pursuant to M.G.L.c. 142A and 780 CMR all home improvement contractors and subcontractors shall be registered by the director. Any inquiries about a contractor or subcontractor relating to registration should be directed to:Director, Home Improvement Contractor Registration, One Ashburton Place,Room 1301,Boston,MA 02108, (617)727-8598. 9) Necessary Permits The construction-related permits which are required for installation are as follows: 4 It shall be the obligation of Lawler to obtain such permits,if any,as the Customer's agent. Customers who secure their own construction-related permits or deal with unregistered contractors will be excluded from the guaranty fund provisions of M.G.L.c. 142A. 10) Miscellaneous This Agreement is made and executed in the Commonwealth of Massachusetts and shall be construed in accordance with the laws of that state. In the event that for any reason any provisions of this Agreement shall be declared invalid or unenforceable,it shall not affect the validity or enforceability of the remaining provisions. This Agreement sets forth the entire contract between the parties and it may be modified or amended only by a written instrument executed both by Lawler and the Customer. THE CUSTOMER HEREBYACKNOWLEDGES THAT HE/SHE HAS FULLY READ AND FULLY UNDERSTANDS THE TERMS OF THIS CONTRACT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SIGNED UNDER SEAL THIS DAY OF AV60 S7— r: Brian Lawler it Prin ACKNOWLEDGMENT AND RECEIPT OF COPY I'I The Customer hereby acknowledges that he/she has received a copy of this contract signed by both the Customer and Brian Lawler. I Customer REScheck Software Version 4.1.0 Compliance Certificate Project Title: Walker Report Date:08/13/07 Data filename:Untitled.rck Energy Code: Massachusetts Energy Code Location: North Andover,Massachusetts Construction Type: 1 or 2 Family,Detached Heating Type: Other(Non-Electric Resistance) Glazing Area Percentage: 12% Heating Degree Days: 6322 Construction Site: Owner/Agent: Designer/Contractor: 190 Appleton Street Brian Lawler Brian Lawler North Andover,MA 01845 66 Wildwood Road Brian A Lawler General Contractor Andover,MA 01810 66 Wildwood Road 978.470-1983 Andover,MA 01810 balawler@conicast.net 9781170-1983 balawler@comcast.net Ma)dmum UA:123 Your Home UA:116=5.7%Better Than Code Gelling 1:Flat Ceiling or Scissor Truss 754 30.0 0.0 26 Wall 1:Wood Frame,16"o.c. 634 13.0 0.0 46 Window 1:Wood Frame:Double Pane with Low-E 79 0.340 27 Floor 1:All-Wood JoistlTruss:Over Unconditioned Space 528 30.0 0.0 17 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 4.1.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code.The HVAC equipment selected to heat or cool the buikling shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. " LAN LtV2 Cid-V'�L Cel tg,�- 4�1. O Name-Title ffigifature Date Walker Page 1 of 4 REScheck Software Version 4.1.0 Inspection Checklist Date:08/13/07 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-13.0 cavity insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,Udador.0.340 For windows without labeled 1.1-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Floors: ❑ Floor 1:NI-Wood Jast/Truss:Over Unconditioned Space,R-30.0 cavity insulation Comments: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ When installed in the building envelope,recessed lighting fixtures#meet one of the following requirements: 1• Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2• Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 Us)air movement from the the conditioned space to the ceiling cavity_The lighting fixture has been tested at 75 PA or 1.57 Ibs/ft2 pressure difference and shall be labeled. Vapor Retarder: ❑ Installed on the warm-inwinter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R-values and glazing 1.1-factors are clearly marked on the building plans or specifications. ❑ Insulation is installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without compressing the insulation. Duct Insulation: ❑ Duds are insulated per Table 34.4.7.1. Duct Construction: ❑ All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,are sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions.Mesh tape may be omitted where gaps are less than 1/8 inch.Dud tape is not permitted. ❑ The HVAC system provides a means for balancing air and water systems. temperature Controls: ❑ Thermostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating andlor cooling input to each zone or floor is provided. Walker Page 2 of 4 Heating and Cooling Equipment Sizing: ❑ Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and AA. Circulating Hot Water Systems: 0 Circulating hot water pipes are insulated to the levels in Table 1. Swimming Pools: Cj All heated swimming pools have an on/off heater switch and a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps have a time dock. Heating and Cooling Piping Insulation: 0 HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F are insulated to the levels in Table 2. Walker Page 3 of 4 Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in inches by Pipe Sizes Non-Circulating Runouts Circulating Mains and Runouts Heated Water Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" Temperature("F) 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2:Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness in inches by Pipe Sizes Piping System Types Range("F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for teed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 405 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD:(Building Department Use Only) Walker Page 4 of 4 I 08/13/2027 03:31 4137812319 PAULWALKER MD PAGE 02/03 75 Prynnwood Road Longmeadow, MA 01106 To Whom It May Concern: Brian Lawler is our agent for pulling the required permits and to perform work at our property located at 190 Appleton Street, North Andover, MA 01845. Respectfully yours, Paul and Cecilia Walker I