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Miscellaneous - 195 BARKER STREET 4/30/2018
195 BARKER STREET 210/061.0-0071-0000.0 ' J 1 i I i I i I i I 1/1212017IVIG 2987,JPG , t A" i� t a a a, ss b,�:.�.a�r�'�'`1`�4ty e„`vv�,,.z-..cv..�z.���m t i b 5�: 4 r ','z1s � § � �+.� sst r 1 "•;t, is Nx{{s �'t �; I I i hUps://mail.google.com/mail/ca/u/O/Mnbox/159947cc24c2a984?projector=1 1/1 7696 Date.. . NpRTM 0 TOWN OF NORTH ANDOVER - X PERMIT FOR GAS INSTALLATION u.•'�4h �,SSACHUSEt S This certifies that e . . . . . . . . . has permission for gas installation . . . . . .S. . . . . P in the buildings of ��.�??.! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c " - , North ov r, Mass. at . .w.�.S .`3.� Feg., . . . . . . . Lic. No.. .A�. . . . GAS SPECTOR Check# l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: �1 �� , �'/ire a 4-OL, , MA. Date: l/ Permit# Building Location: / R A-It '<.IL f-14 Owners Name: S Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [�}— New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ©— Plans Submitted: Yes❑ No❑ FIXTURES WUJ Z w Q = I.- co W m m 2 O� Lu 0 W v~ co 0 N O W Lu z I— Z 0 W w R 0 F- W u) W g m 0I— � uw Z I- a f' W w W x W I- R Q W w W z 0) X w � w 1- o u. Z W W Z � J H H O Z J (7 �- � = W FW- W W �- N a a m W 0 a z O �, > z _ 0 0 a LL UQ' 0 _ = g O a 2 H > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 TH FLOOR 5 FLOOR 6 FLOOR �- 7 FLOOR 8 FLOOR Installing Company Name: rEl eck One Only Certificate# hh Corporation Address:/)0 /J b X ` Ci /Town: jd / 44 ilt, . ❑Partnership Business Tel: S 7 fF- Z-d Fax: .SO�—t44 '� [}Firm/Company Name of Licensed Plumber/Gas Fitter: . . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes Q- No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy [g/ 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 El Agent El By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By ❑Plumber Title ❑Gas Fitter tignature of UcenWed Plumber/Gas Fitter ❑Master City/Town [-]journeyman 2 License Number: APPROVED OFFICE USE ONLY ElLP Installer J MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) -- ,qq� NORTH ANDOVER ,Mass. Date JUNE 22, 2011 permit# Building Location 190 BERRY ST. Owner's Name DOUG RODERICK Owner Tel# 978-973-0796 Type of Occupancy RESIDENTIAL New❑ Renovation❑ Replacement Plan Submitted: Ye[]No[] FIXTURES W a CIO S U W U) a PSG O rn x c� a >U `° H o�G U) Of LU w (7 H 7 / U 5 Date. ..67.t .-.1 l... .... SUB-BSMT BASEMENT f �aORTN , 1ST FLOOR o�.�`° '^.�o • o 2ND FLOOR 0j '._. p TOWN OF NORTH ANDOVER 3RD FLOOR ; ' ; PERMIT FOR GAS INSTALLATION 4T"FLOOR °,e.•_� _...,. 5T"FLOOR �9SSAC HU 6T"FLOOR 1` 7T"FLOOR This certifies that . -�.-�T4!:� . . ��,P. -�. .C.4�. . . • . • • • • • • • • • 8TR FLOOR has permission for gas installation .0 • C-s-& Installing Company Name Easterr in the buildings of . .D..F )c: . . 5�� 1' gt �.� . . . . . . • . . . . . . Address 131 We at K�� • • • • • • •f North Andover, Mass. e- ..�QCQ . Lic. No..l:A .7).5. . ./.� Danvers Fe GAS INSPECTOR Business Telephone# 800-322-6 Check# 7� _ Name of Licensed Plumber or Gas I INSURANCE COVERAGE: I have a cures liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes ✓ I No ❑ If you have c ecked y�s,please indicate the type coverage by checking the appropriate box. A liability insurance policy O Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above plication ar a an ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issu for is appli a in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen al La By Type of License: • umber Signat a of Li se I erer�Gas Fr Title Gas fitter (/Z •-Master Licen mb City/Town •-Journeyman APPROVED(OFFICE USE ONLY) E 9301 Date. . . . .�I. . . . . NORTH ? <;,�• "O°� TOWN OF NORTH ANDOVER o s PERMIT FOR PLUMBING SSACNUS� ,� -�. . This certifies that . ///rI4C e has permission to perform . . �Q 1�� .f .� !, / plumbing int buildings ofj . S ! . . . . . . . . . . . . . . . . . . . . !Y-5- r/�Qr ... . . , N rth Andover, Mass. at. . . . . . . . . . . . . . . � Fee. D� .Lic. No.. .�/7�. />�cl !�t . . . . . . . PLUMBING INSPECTOR Check # SL Z �I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK C CITY a _ .cl06ell MA. DATE (O /o`I PERMIT# JOBSITE ADDRESS S� e&,' 71 OWNER'S NAME . o P _ OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALO PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:9 PLANS SUBMITTED: YES❑ NOV FIXUTRES 7 FLOORS Bsmt 1 2 3 4 5 6 7 8 9 1 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL / J RVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING 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 indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ 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 [I AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicatil will be in compliance 'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUMBER NAME:I MICHAEL HOUSE LICENSE# 7173 SIGN TURE �MPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS: 15 AEGEAN DRIVE,UNIT 3 CITY: METHUEN STATE: MA ZIP: 01844_ FAX: 97&689-2206 EL: 978-689-0224 CELL: 978-884-3427 EMAIL: LLITTLE@MVALLEYCORP.COM MASTER JOURNEYMAN CORP RATION ■❑# 337 7 PARTNERSHIP❑#[=LLC❑# 7 //Z Date.. .�/. .. .. . . ... .. .. NORTp pf 't'O o� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION 9 y,SS�CMUSEtS This certifies that . . `. /K . . !" has permission for gas installation P.k. ? ? . . . . Q . in the buildings of Ste!17. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . l 9S . . . . . . . . . N�°rth ndover., Mass. Fee.,,R f Lic. No.. 2 . . . . . . . . �!�d.. . !.?. GASINSPECTOR Check# 8044 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE r /x PERMIT# JOBSITE ADDRESS a /KI—I ce,& OWNER'S NAME OWNER ADDRESS TEL,I FAX I TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL I RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES[ 0)( APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER E CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE I - i GENERATOR GRILLE INFRARED HEATER ; LABORATORY COCKS _ MAKEUP AIR UNIT :. ' r OVEN _ M POOL HEATER ROOM I SPACE HEATER _.._ l. . . . ROOF TOP UNIT TEST UNIT HEATER '. UNVENTED ROOM HEATER WATER HEATER_ OTHER I INSURANCE COVERAGE j I have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY i— BOND I OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER -. AGENT ! SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c mp tAnU1ce y✓ith all�i e t r(vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /J PLUMBER-GASATTER NAME=MICHAEL H HOUSE LICENSE# 7173 SI NAT R MP v MGF JP i JGF LPGI CORPORATION Iv # 3377 C PARTNERSHIP # LLC COMPANY NAME,MERRIMACK VALLEY CORPORATION ADDRESS. 15 AEGEAN DRIVE,UNIT#3 CITY :METHUEN STATE MA ZIP;01844 TEL 978-689-0224 ICYFAX;978-689-2206 CELLI 978-884-3427 EMAIL]Ilittle@mvalleycorp.com or srutter@mvalleycorp.com 1 �- i ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /� FEE: $ PERMIT# PLAN REVIEW NOTES I r C / r IF I I'he Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations. 1 CongressStreet, ,Suite 100 Boston, ALA 02114-2017 } www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legible' Name (Business/Organizationffndividual): l141le'll Address: ( - City/State/Zip: �� 1 /�/r9 /8f Phone Are ou an employer?Check the appropriate box: Type of project(required): 1.9 F11 am a employer with �, � 4. I am a general contractor and I ❑ -'�'L--* have hired the sub-contractors �6. New construction employees (full and/or part-time).* 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers9 Building addition o workers' com insurance comp.insurance.l re p 5We are a corporation and its 10.❑Electrical repairs or additions quired] . ❑ 3.F1 officers I am a homeowner doing all work have exercised their 11.El Plumbing repairs or additions myself. [No workers comp. right of exemption per MGL 12.❑Roof repairs c. 152, §1(4),and.we have no , insurance required.] t employees. [No workers' 13. Other -� comp.insurance required_] L *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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I arra 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.#:� /�/�C,�/.9f� �j�13`i 1,114 Expiration Date: /.3 City/State/Zip: Job Site Address: /__ /�1� ✓ '> N i"",f t%y� �®R�.c� 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 ce fy n r the nainspenalties of erjaary that the in ormation provided above is true and correct. Si afore: 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): 4.Electrical Inspector 5.Plumbing Inspector 1.Board of Health Z.Building Iepartnent 3.City/Town Clark 6. Other Contact Person: Phone#• Date. ?. G NOR71y �'..�•° .otic TOWN OF NORTH ANDOVER 3? .�.r -�•-'.• of s PERMIT FOR PLUMBING • 4 � • o • i SSACHUS� This certifies that C E has permission to perform . . . �` .�/. ./4. X.'l . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . at . .tel . : . . . . ., North Andover, Mass Fee. Lic. No.C3re1. '?!C . . . . . . . . . . PLUMBING INSPECTOR Check # f `� 5244 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING f)?rfnt or Type) A Ml Mass. Date J �� Permit Building Location Owner's Name Type of Occupancy Q, New ❑ Renovation 0— Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES ` B .P .# SEWER# SEPTIC# z 'n h- Vf J y O z }' W W Y J to V FQ- y O C7 y ¢ y U) Z y Q ¢ Q = y a ?C .0.1 y W y N W y H U W y Y Q W W ¢ m ¢ < z c a O Q Q O z 0 0 m d W Q y yyj - o z ¢ a ¢ y C ¢ W W to y ¢ J — O ¢ a A J C W SL Y < H y F- O U. N y :3 y F- Z O O y = z W F- O Q 'b X ? <' < _ < Q O Q J J < ¢ ¢ nr Q 0 Cr �t J c J 3 z F y W D a s d 3 C m p O SUB-BSMT. y BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing.Company Name rV Check one: Certificate # Address / ❑ Corporation 2M 90 Partnership Busine s Telephone ❑ Firmxo. Name of License.Plumber " I INSURANCE COVERAGE: I have a current liability insurance policy;or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes X., No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner El Agent O Signature of Owner or Owner's 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 rfo a permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum 'n and Cha er i of the General laws. BY SFgWVf Li5ensed"Plumber Title Type of License: Maste//rte,// Journeyman❑ APPf�ONED O:FI US ONLY) Ucense Number Location No.' Date f NORTh TOWN OF NORTH ANDOVER-=> `p Certificate of Occupancy $ Building/Frame Permit Fee $ cMu <�' undation Permit Fee $ s� sE � m { ,Other Permit Fee $ ' Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works Location_ No. Date MaRTM TOWN OF NORTH ANDOVER C O • • OR p Certificate of Occupancy $ " 40 Y Building/Frame Permit Fee $ J ua sic us`�• undation Permit Fee $ l • ,O#beec Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ o� TOTAL $ 0 Building Inspector 12621 Div. Public Works PERMIT NO. �� APPLICA'T'ION FOR PERMIT TO BUILD********NORTII ANDOVER, MA MAP NO. - LOT.NO. 2. RECORDOFOWNERSIIIP DATE BOOK PAGE "LONE SUB DIV. LOT NO. S� PIKPEOFB11LDIN(LOCATION Y VL �y( 7� OWNER'S NAME NO.OF STORIES 4-1 SIZEy - K 6 OWNER'S ADDRESS ,(ot Q t/ �� St BASEMENT OR SLAB L J� ARCHITECT'S NAME SIZE OF FLOOR TIMBERS ST 2 3 RD BI IILDER'S NAME lk SPAN DISTANCE TO NEAREST I .DING DIMENSIONS OF SILLS DIS 1'ANCE FROM STREET DIMENSIONS OF"'I'S DISTANCE FROM LOT LINES-SIDS REAR DIMENSIONS OF GIRDERS AREA Of LOT FRONTAGE HEIGIFF OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOO"TINCT X IS BUILDING ADDITION MATERIAI.OF CIBMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Will BUILDING CONFORM TO REQUIREMENTS CODE IS BUILDING CONNECT"ED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY ISBUILDINGCCNNNECIEDTOTO"SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INS-1-II(Ale)NS 3. PROPERTY INFORMATION LAND COST EST. BIT)G.COST AGE I FILI.OIIT SECTIONS 1-3 EST. BLDG COST PER SQ. FT. EST. BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORNITO STATE FIRE REGULATIONS a. APPROVED BV: i PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR l MNG INSPECTOR DATE FILED OWNERS IE1.4 7 �j Q G7 CONTRA-EIA I CONTR.LICIT SIG URE OF OWNER OR AUTI IORIZED AGENT FET_ $ PERMIT GRANTED 19 NORT�y i Town of over o m No. Z L-4 _ Ju * � s . dover, Mass., 19 0 LAKE d� v w 9 "cocNicHEWICK '�1 '9 A�4A T E D S E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT.................................................................................................:.......... .... .. ......................................... Foundation has permission to erect....... .N.....�............ on ....:.�9..,�.......... Rough to be occupied as......................... .... ,,. 6. ..44k.4.. .. ... ............... . ...... ................................................................ Chimney provided that the person accepting this p rmit shall in beery 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 Constru ion f Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Permit. �� Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARS Rough Service B ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. t Smoke Det. 05/27/1999 16:55 7512249491 BLANCHARD AWNING PAGE 02 P, 1 i} `a � • •;r # � �aa, ,kr, �#�"., � "r� ���w��"�$ d �,�§ � � n��� �� X �, '��,�t� wr e, #� f� F 4"'�' � � '±, •it,'• Al a VVi' t txi4 arwvzt� 3�x' ° r ' •i ^ "yn5 4'R" t;;: '�s^� ti',,t � #�s" �x� w a "#�' �'°,� ^` r i, r•n �" 1� �: wa, ;v�''�°�'Y?;+♦ �w ��'`� � q•'" s r }•�i,r k , y .<, � �y Yu, Y° �8 (�a•, .as '`"' " a'i, ,°+,. *✓ _ w 'ri" h ? 3 ^w ,, a p s e , ,� w i �>r�1+Y� ,��� ,��• r ,p �a �' �a���*m;: 'w^'d "5� �, �' � ? 4 � �` i 's i�� `�i �� w�r#V�Zt,: ��,�' '��'w4.rr,:; ,� •;'}`�i�f i._ ^ ^ w a%3° w '" '� ,wya', ( ,},. r p w:.. w�• a "`sp,.t * >!.' Mr;; w a wY MICA t fi,, ,k^riy e,a, IN s i y a AM s�tt4^, �*� � r �Y''�a�"`�,"� ,�, tlt�as'n:` 1:0,r 4a i YK, >.•wr�au� �" � ^"� e � >�"�x c"tn., � �.r � � a`�"*.� �t3.��� w' b' 1 � Ys,�ti `' 4�." �;��`f i •Q�; C:. 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This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION************************ APPLICANT Sg _SY1n 4� PHONE q)G" LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET ST. 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',Y"�.+: r. ,, � ' M1'`'.i < •✓• k+ '•,'�,pgsrtrr4•. F r ''•<I. 'e;�.,t�`JL..,+.. ,,.rifq",�, +,�n'"'�;•• ''X,i.; .`•R�J�!:'r:.rf,.. rr,-v'` . .,{;,r.':i• ••I::SS�� t:�rfaP.4^'�'7i7T>:elK•1i,^.fr:`;,.. ,..,S.45i'ti+;•i•, 1 6 / Of NORTH °`t TOWN OF NORTH ANDOVER . FO •. � p PERMIT FOR WIRING 0, CHUS E i This certifies that .......... has permission to perform ........................................ wiring in the building of. .......................... ' . ......... G North at 1 � Andover, /.r../....... Mass. Fee..r .. ...... Lic. `` . ................ .......ECALINSPECTO R Check # I f 4 7 Commonwealth of Massachusetts Official Use Only r Department of Fire Services Permit No. ��� 77 t - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: C R o 07 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned ive tice of his or her intention to perform the electrical work described below. Location(Street& Number) ; 1.7 e pe )e(2/ . Owner or Tenant �/ 7 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 4t?L C.—,V, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: qlzPr / /C Ct-A4-•--P er- L"f- -0#1-f- Com letion of the followin table ma be waived by the Inspector of lVires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above El In- 1:1o.o Emergency Lighting rnd. gr 1:1 Batter Units No.of Receptacle Outlets No.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. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number I Tons I KW No.o ,..e _ ont ine Totals: D rection/Alertia r Devices No.of Dishwashers Space/Area Heating KW L al[3unicll a Other Connection No.of Dryers ]Heating Appliances Key eeurtty Systems: No.of Devices or Equivalent No.of Water KW No.of No.o Data Wiring: Heaters I Signs Ballasts No.of Devices or E 'uiv<alent T-eTNo. Hydromassage Bathtubs No. of Motors Total HP eeornrtuntcatons trstlg: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of I4Vires. Estimated Value of Electrical Work: U (When required by municipal policy.) Work to Start: 6-o�Q °-07 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 E] (Specify:) I certify,under the pains and enalties o perjury,that the information on this application is true and complete. FIRM NAME: r' 1-eC x-x * C LIC. NO.:Z Licensee: I�IY bkVKl f/ Signatur LIC. NO.: el?ro J"OZ, (If applicable, enter -exe,t t"in the license number line.) Bus.Tel. No.: 92r,-6-r Address: ��/ /-� GG <Hf �orvo/ �d 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, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 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): r!ler Q e,(Se, E2,eC TV tC Address: qAC,_6C f/-57 1pD/✓d X d City/State/Zip: 9&0/d1J_t- M Q Phone #: �79 — .2 Are you an employer? Check the appropriate box: Type of project(required): C I am a C employer with 4. El am a general contractor and I" * have hired the sub-contractors 6. F1 New construction employees(full and/or part-time). 2.❑ 1 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.E] 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. 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: ,y�/. Ilre/'e A?�` City/State/Zip: AV /7y�1yQJOUerlwK, 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: 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Staple oldejS IOIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII A ��'Q tiyORTy . , �- lir BUILDING PERMIT Z qq6 4 TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXAMINATION ~ Permit No#: Date Received �,�° °Rwre° 9�SAC HUS�� Date Issued: (71 -o hv ORTANT:Applicant must complete all items on this page �.j �.�..rr.,Y�r�c.r - _ y!- '.T.'I Y .tom`� _'' • -, ll��.! kqint Pn t r —71 oOiYtruc G a ty s" •rte x MAP` - PARCEL: _ _ :ZONINGfDISTRICTti ' _. HsfgrtclDistncfFyest . n L -Ze � � ,._ .' M66Yiine'Shop�Village`` yes;` . , r �. -u..,,. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial AAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other El Septic' -0 V1/ell ❑ Floodplain 0 Wetlands-' h ❑ Watershed iNsffi6,A o,.Water/Sewer—,. e� DESCRIPTION OF WORK TO BE PERFORMED: 'QJ Q"a A \x NCwJ cq(s Ge..,—,�-trS rrloa rte ' - Identification- Please Type or Print.Clearly OWNER: Name: Ne- x -+- lCr� S�� mQ0 Cy Phone: 6S6 Address: I R S lZox Ike= vg� -Contractor Name:S%r--, T>°S�� Phorie: . n t Address: .` SupervisorssConstr`uctionL'icenseDate { g I .L Home;ImproVemenlrubd se 'Exp; Date- � � �1 l y' �.� w w; _r. _. .._ . __ �. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT;$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. '- rotal Project Cost: $ –79/ 000 FEE: $ ��y Check No.: C�Z3 Receipt No,, '�k�>i NOTE: Persons contracting with unregistered contract do not have:access to the guaranty fund Si "natu�e_of_Agent/O her Sign ture of contractor'' 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) { g y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan And ( ) p Hydraulic Calculations (If Applicable) I'I ❑ Copy of Contract act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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:Building Permit Revised 2014 F Location 1�7 `/y I ' VL f No. G* - .21 Date lZ IZ r' ` • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check# 6 1 6 i 9 L,,/ Building Inspector i. Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 78,000.00 m $ - $ 936.00 Plumbing Fee $ 117.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 117.00 Total fees collected $ 1,270.00 195 Barker Road Kitchen Remodel 670-2017 on 12/27/16 i NORTIy Town Of : _E : �' . ndover . No. � C h ver, Mass, ,�• o� > COCMICNIWICK RATED /•PP�,�� U BOARD OF HEALTH Food/Kitchen PE T D Septic System THIS CERTIFIES THATMIT - BUILDING INSPECTOR ... . ... ...... .,�. ...� ..... t............ ................ has permission to erect .............. buildings on Foundation . .... ....19.2... ....... ... ................ r •� Rough to be occupied as �. .........� .. :. +"..! .. .•6��••. �................. ....... ... . Chimney provided that the person accepting 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 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUaTION S T Rough Service i . ..... .. :/..... ............................... 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. "J'"LE S TA Building and Remodeling Start date 5 APPLETON STREET Finish date NORTH ANDOVER, MA 01845 HIC Lic. 120296 Expires 11/19/17 (978) 682 2023 CSL Lic. CS 54718 Expires 6/8/18 Proposal Aug 18, 2016 Proposal Submitted To: Alex and Kristin Moody Cell Phone: Kristin-857 2721153 195 Barker Road Alex-978 807 6564 North Andover, MA 01845 Job. Remodel kitchen Obtain building permit Complete removal of all demolition and construction materials generated By Testa Building and Remodeling and its subcontractors. DEMOLITION: Remove all cabinets and counter tops and appliances. Remove the plaster on the wall and ceiling. Remove the flooring and underlayment and prep for oak flooring. CONSTRUCTION: Move the location of the window framing an opening for an Anderson triple casement 7' Wide, Add an Move the opening to the dining room. Remove the pantry closet and the short wall across the door opening. Remove bay window and frame wall. Patch siding as necessary. PLUMBING: Move the vent for the sink as it runs up the wall where the new window will be framed. Plumb new sink, two dishwashers and appliances. Re run gas from old location to new stove location. Remove baseboard heat and replace it with a kick space heater. Question about whether we could add plumbing for pot filler above stove? i Note: There is no allowances for plumbing fixtures for the kitchen. ELECTRICAL: Use the existing wiring in the kitchen area. Run new lines where necessary to bring the kitchen to code. Wire all new appliances.Wire for under cabinet lighting. Install 12 5" recessed lights with Install under cabinet lights. Install a new sub panel near the existing panel to provide room for new circuits. Note: There is no allowances for light fixture other than the recessed lights. INSULATION: !I i i Install R 15 insulation with a vapor barrier on the exterior walls. PLASTER: Hang 1/2" blue board on the ceilings and the walls. Skim coat plaster will be applied to all the walls and ceiling in the kitchen. Ceiling in the kitchen will be sand finish to match the rest of the house. CABINETS: Install all cabinets and moldings in the kitchen according to the plan. Install all appliances. FLOORING: Install new oak flooring in the kitchen and Foyer. Butt up to the flooring to the dining room, Sand and poly three coats in the kitchen and Foyer only. TILE: Install and grout tile for kitchen back splash. Note: No allowance for tile and grout. Labor and adhesive only. VENTING: Pipe the exhaust blower for the cook top.Will provide all duct work needed. PAINTING: Prime all walls and new trim. Paint two coats of finish on ceiling,walls and trim. NOTE: There is no allowances for Kitchen cabinets, granite, plumbing fixtures, appliances, the and light fixtures. A finance charge of V/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications,for the sum of: $ 38,791 Thirty Eight Thousand Seven Hundred Ninety One Dollars One-third to start,one-third after rough inspection,one-third upon completion. Authorized signature C I reserve the right to cancel this contract if not accepted in_30_days Signature Signature i DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) Express Warranty-Is an express warranty being provided by the contractor? No Yes(all terms of the warranty must be attached to the contract) 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. 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. ❑,r 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 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. (D Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you 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 following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO 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. Ho eowner's Signature Contractor's Signature i h Date Date —� Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an I arbitration action(as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Ma sachusetts General Laws,c r 142A. Homeowner's Si re Contractor's Signatu NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 9'N may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights.if you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline (listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of 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 Massachusetts Consumer Guide to Home Improvement" i contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/licenseelist.as For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1—11/22/201 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPISE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OF i I 0 (date). I HEREBY CANC L THIS TRANSACTION. Date: / h Buyer's Signature: 235.25" 83.00" 62.25" 84.00" 48"PRO HOOD W2853 D54 D/W SB36;FARM SINK D/W DS31 838/36 NBC3053 16"DP ESL 1" UR STILES DOWN SPICE LZ-SUSAN 4.25"DP ESR 3/4'. SL 1/2" 48"RANGE S L SINK BASE WILL COME 35-1/2"H-TRIM AS 67,50" B32 NEEDED TO SCRIBE ESR 1" TO FLOOR W2853 PULL BASE CABS 16"DP 1/4"FROM WALL B6;WINE 108.00" TEP 1.5 X 26 X 90 W3735 TRIM TO 88.75H CUTLERY FRG TRIM TO 25-1/2DP PLATE DRA 48.00" B27;DS3 B27;MICRO BEP 1-1/2-36.27 OLID WOOD R STILE DWN L STILE DWN TRIM HEIGHT AND ABOVE FRIDGE 62.00" WIDTH AS NEEDED /4 X 4.75 X 48 39.00" PLAIN PANEL 54 X 34-1/2 TEP 1.5 X 26 X 88.75 82.00" " TRIM TO 88.75H TRIM TO 25-1/2DP 40.72" "BUILD SOFFIT ABOVE TALL CABINETS'' PULL AS NEEDED TO ALIGN W/CORNER T3384-11"DP; T3384-11"DP; ESR 3/4" ESL 3/4" 67.50" IsmFINAL falk(pull •The Commonwealth of Massachr�setts Dep VtMent of indastrialAceldents M Y X Congress Street,Sufts 10 0 M d --20X7 Boston,MA 02114 www mass.gov/did a�M sus Wa kexs' Compensation Insurance A£ P ddb iIl�G AUI O s cians/PInm errs. TO BE FILED Elease Pxint� A j) -antlnfoxmation 1 C�c .meg Name(Business/OrgavizafiionAndividual): �v Address: �- 1v� ✓n>g °t$11 Phone#: -a��3 City/State/Zip: �� j :..�x�=. = • - Type of project()required) Axe yon an employer? .-ecktIie appropriatebox: F em to ees fuIte and/or part-time).* 7. ElN6V1 constr&ilon 1.❑I am a employer with P y 2.RjI am a sole proprietor or partnership and have no employees working forme in 8. Remo deliiig any capacity.[No workers'comp.insurance required-] 9. F]Demolition 3.Q I am ahomeovrmz doing all workmyself[No workers'comp.insurancerequired]' 10 Q Building addition ¢-❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 11.❑Electrical repairs or additions ensure that all,confractbfs eifh'rhave workers'compensation insurance or are sole plumbi:a re airs or additions praprietorswithnoemgloyees. �'L�!`• . g p 5.❑I am a generate couuactor and Ihave aedthe sub-contraetozs lisEed onthe attached sheet 13'.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance. It} Other 6.nWe are a corporatio1i and ifs,off[ces have exercised their right of•exemption per MGL c. 152,§1(4),and we have no empldyees.[No workers'comp.insurance required.] *Anyapplica thatchgcksbox#1 mustahsdfilloutthesection below showingthuirworkers'compensationpolicyinfora new mation Homeowners who submittbis affit hatua additionate thy are sheet showing the name of the sub c' -work andthanhire outside allconiractors and state ontractors must whether or nofihos indicating such Contractors that checkthis tioxmust co onumber. employees. If the sub-contractors have employees,they must provide their workers'Gump-plicY jam an employer that is providing�vorkeNs'compensation insurance for°my empZoyee� Below is the policy and jour site information. Insurance CompanyNarne: ExpirationDOo' Policy#or Self-ins.Lie.#:. City/State,/Zip- .. lob Site Address: Attach a copy of the woxl�exs' compensation policy declaration page(showiag the policy number and expiration dateHmi . e by a ffib to$1,500-00 Failure to secure coverage as required underMOL�c 152,§22in 5 f is of a TOP WORK ORDERUPa fine ofup to $250.00 a and/or one-year imprisonment,as well as civil pen day against the violator.A copy of this statement may be forwarded to the Of sce of Investigations of the DTA fox insurance coverage V,erification. X do hereby cern under the andpenaltie.s ofperjury drat the infor7azation provided wave s true and correct ✓L' Date: p'T a 0/ Si at-ure: Phone#: Official use only. Do not write in this area to be completed by city or town official. permit/License# City or Toyvn- Issuing Authoxity(circle 4 one): i ector 1.8oard ofealtb 2.Building Department 3.City/Town Clerk. .Electrical Inspector �.Plumbing Tnsp 6.Other Pho)ae#: Contact Person• 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'd'efizied as"an individual;partnership,asso ciaoon,corporation or other legal entity,or two or more any of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivefor trastde of an individual,partnership,association or other legal entity,employing employees.•However the owner of a dwelling house having not more than threeartments and who resides there' e aP m,o rth occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house eP g 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 opdrate a business or to construct buildings in the commonwealth for any appliematwh6 has not produced-acceptable evidence of compliance with the i asurance coverage regiziired." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 necessazy,supply sub=contractor ,address es and one numbero (s)name(s ) h ) ( p (s) along certif'(cate s of insurance. Limited LiabilityComPanies(LLC)or Limited Liability Partnership s(LLP)with no employees other than the members oxartners e not required c P �are q arty 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 IndustrialAccidents. Should you have any questions regarding the law or if you axe 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 ethPPlicant. a Please be sure to fill in the p ermit/liceme number which will be used as a reference number. lh 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 tower.maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit burn leaves etc. said person' P n zs NOT required to coin complete ' Ppl this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depai went of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617.727-4900 ext.7406 or 1-877-MASSAFE Fax# 617-727•-7749 Revised 02-23-15 wwwmass.gov/dia ACOPRa CERTIFICATE OF LIABILITY INSURANCEDATE(MM,/D�YYYY)16 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 policy(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). PRODUCER NAMEACT : Rich Testa R.W. Testa Insurance Agency, IPHONE FAx 978) 681-9002 (978) 685-1150 AI No: 855 Turnpike Street E-MAIL : rich@testainsurance.com North Andover, MA 01845 ADDREINSURERS AFFORDING COVERAGE NAIC# INSURER A:COMMERCE INS CO INSURED INSURER B Testa Building And Remodeling INSURER C: 5 Appleton Street INSURER D North Andover, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MIDDIY MMIDDIYYYY LIMITS A GENERAL LIABILITY S16388 6/1/16 6/1/17 EACH OCCURRENCE $ 1,000,000 }C COMMERCIAL GENERAL LIAB ILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE Fx]OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PROT 171 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I P e P .E Y DAMAGE $ HIRED AUTOS _ AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY I IM IT� ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) 195 BARKER ST, NORTH ANDOVER, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED RE PRESENTATNE RICHARD W TESTA JR ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: �/c�ra�rr»ro�rrrerr�/f n�CifrRJJrlC�rrJe%l. ! N Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 120296 Type:l ON Expiration: 11/19/2017 DBP, ,- TESTA BUILDING&REMODELING JAMES TESTA 5 APPLETON STREET N.ANDOVER,MA 01845 Undersecretary , i p{ Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-054718 Construction Supervisor JAMES M TESTA 5 APPLETON ST y '' N ANDOVER MA 01845 "� h i CA-- Expiration: Commissioner 06108/2018 I f t I Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ " COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS y Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT' - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS limension 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.Yrequires 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 V ❑ Notified for pickup Call Email ate Time Contact Name Doe.Building Pennit Revised 2014