HomeMy WebLinkAboutMiscellaneous - 209 CHICKERING ROAD 4/30/2018 (2)MetLife Auto & Home®
Homeowner Operations Field Claim Office
Attention: Claims
P.O. Box 6040
Scranton, PA 18505
(800)854-6011
March 3, 2015
North Andover Building Inspection
1600 Osgood St, Suite 2035
North Andover, MA 01845
Our Customer:
David T. and Maryellen C. Johns
Claim Number:
JDE93878 OG
Date of Loss:
February 15, 2015
Dear North Andover Building Inspection:
Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has
been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars.
Please let us know within ten (10) days if there is a pending or existing lien against the property as
provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien.
Loss Location: 209 Chickering Rd, North Andover, MA
Sincerely,
Home Ops CAT Team Sarah Lackey
Metropolitan Property and Casualty Insurance Company
Claim Adjuster
(800) 854-6011 Ext. 7440
Fax: (855) 411-6689
Email: MetLifeCatTeam@metlife.com
MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI. —_
MPL MA-REGDEPT
Printed in U.S.A 0698
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Date ........ - . Z.3:. 05 ...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that.............................................................................................
has permission to perform.....C
.......... .. O SLE ............................
wiring in the building of..........!.s.................................................
at ........ North Andover, Mass.
Fee ... ?`............ Lic. No..3.8..... ....., �+ f .........
ELECTRICAL INSPECTOR
Check # ? ?7 2-
7972
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Date./
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TOWN OF NORTH ANDOVER,
PERMIT FOR GAS INSTALLATION
This certifies that ... //5-/2 1./'? 9. �.........................
has permission for gas installation . .-r ..................
in the buildings//of ......................................
at ...Q .. C i :: �. F. * �� 11.-... , North Andover, Mass.
Fee. Lic. No..
GAS INSPECTOR
Check #
6302
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
1 V rm Anczo 6 !- , Mass. Date Permit #
Building Location Owners Name
79 — Oof 7,D4 (o Type of Occupancy Residential
New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No O
FIXTURES
Installing Company Name Heritage Htg . &Plg _ Co. Inc. Check one: Certificate
Address 35 Tleasant Street EX Corporation 7.14
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 781=A38-7776 7, Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes E No ❑
If you have checked .yes, please indicate the type coverage by checking the appropriate box_
A liability insurance policy 13 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ . Agent ❑
I hereby certify that all of the details and information i have submitted (or entered) in above application are true and accurate to the best of n
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 42 of the General Laws.
By
Title 5i ature of licensed Plumber
Type of License: Master ($ Journeyman C]City/Town
APPROVED (OrFICE USE dNLY) License Number 8322
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Installing Company Name Heritage Htg . &Plg _ Co. Inc. Check one: Certificate
Address 35 Tleasant Street EX Corporation 7.14
Stoneham, Ma 02180 ❑ Partnership
Business Telephone 781=A38-7776 7, Firm/Co.
Name of Licensed Plumber Gordon Switzer
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes E No ❑
If you have checked .yes, please indicate the type coverage by checking the appropriate box_
A liability insurance policy 13 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ . Agent ❑
I hereby certify that all of the details and information i have submitted (or entered) in above application are true and accurate to the best of n
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 42 of the General Laws.
By
Title 5i ature of licensed Plumber
Type of License: Master ($ Journeyman C]City/Town
APPROVED (OrFICE USE dNLY) License Number 8322
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No 2760 Date z ....... ................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
7
This certifies that ..................41'
......... ......... 41........
....................................
has permission to perform... ......
wiring in the building of ..: ....................... ............................................
at ............ ....................................................... . North Andover, Mass.
Fee..................... Lic. No.. . ... ..............i� .................. 11� ......................
ELECTRICALINSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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BOARD OF FIRE PREVENTION REGULATIONS
Vltieial Use O':iy
Permit No.
Occupancy and Fee Checked
treVI I199J
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL
All work to be perlbrmcd in accordanec wit,, t,;c Massac:l•usct:s Clcctrical Code M NCAL Y 1%ORK
IR 12.00
(PL LASE PRINT IN INK OR TYPE ALL INN' M,-17'ION) Date: 1 t
City or Town of: �� �- 00
By this application the undersigned _Loves mice of hiss or her _ e�tion to perform!To ! the ��7eCf °1 of jy ;!'es:
Location (Street & Number y� ,-!deal work described Lelow.
a� �` i J��� 1 1 I
OwnerorTe'ltarlt
Owner's Address Tetepllone No.
Is this pertltit in conjutictioti with a building peril -114
1'ul•llose of 13uildilla
Existing Service Amps / _Volts
Nett' Scrvicc
-- Amps , / Volts
Number of Feeders and Anlpacity
Locatioll and Nature of Proposed Electrical Work:
No, of Recessed Fixtures
No. of Lighting Outlets
No of Lighting Fixtures
No. of Receptacle Outlets
' No. of Switches
No. of Ranges
No. of NVaste Disposers
No. of Dislovaslfers
No. of Dryers
No. of � ater
Heaters
Yes No ❑ (Ghee!: Appropriate 130.1)
Utility Authorization No.
Overllcad ❑ Undgrd ❑
No. or Meters
Overl,cud ❑ Ultdgrd ❑ No. of:WIeters
\
Cvnr fella" o%lire (otivrtiin(�uble uravbe crairccl be rl'c
No. or Ceii: Susp. (Paddle) Fans No. of
l'r•ansformers
No. of Ilot 'I'u1;s Generators
S�vinlnling Pool Above ❑ !ft- o. o ntergencg::
_ti LT
27n grrid. Batte Units
No. of Oil Burners
No. of Gas Burners
No. of Air Cond. Total
Tons
Hent ruulp Number 'ons 1
Totals:
Space/Area Heating KW
Heating Appliances I{,y
K_NV No. of No. of
Sins Ballasts
No. Hydromassage Bathtubs No. of itilotors Total IIP
OTHER. -
Irsvcctor• of 1 t'i'•es
'lbtal
KVA
K V,�
Ila
ALARAIS No. of Zof:es
71 Detection and
Ittitiativa. Devices
INo. of Alerting Devices
No. of c 1- ontailled
Detectioll/Alertina Devices
Local ❑ <tilullicipal
Collnecttoll ❑ Othe"
Security Svstems:
No. of Devices or Equivalent
Data lviriug.
No. of devices or Eguiv•llent
t eiecomnluntcations �l it ing:
No. of Detiices or E un'aterlt
Attack additional de'aif rf desired, or as required by rlre L•rsPeaor of FVir es. t
INSURANCE COVE 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 equiva!eat. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing of ice.
CHECK ONE: INSURANCE 4 BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work: �c) ,__ (When required by niuthicipal policy) t``P'ratien Datc)
Work to Start: "OU __ t a �0 lnspections to be requested in accordance with MEC Rule 10, and upon cor:,pletioa.
I calif}', utrrler the /,air's null Jter'ahies of perjury, that file itrfur»ratinn
IIILIINAIIli:of this applicatio►r t} true andco»tplett
_ r.r�C \ qr& ��
LIC. NO.:
a94E
Liccnscc: M �� �� ke0A.signature �.'
0 aPPfrcable, eracr "c_�cnrpt' it' dre !!cone rrmxberline.) LIC. NO.:
Address:y 2 �a VJa:u t c �` �SZ13us. Tet. No.:.1LUa- SZ,G• 62;0
OtiVNER'S 1NSUR.�NCk �VAIVI;IZ; hiii Ill he Licensee does not /rave the liabilityInsurance CO%-e,'a!,Je normally
required by law. $�• tlhy signature belo%v, I hereby waive this requirement. I am the (cliec:k one
Olvner/Aenl ) ❑ oh�ncr ❑ ohc�ner's a�,ent.
Signature* Telephuue Nu.111T �^ i
1 r.R;T. S I j
M.H. Falardeau Electric
17 Blue Jay Way
Litchfield, NH 03052
Phone(603)595-6680
Fax(603)882-4115
November 29, 2000
City Of North Andover
Electrical Inspectors Office
27 Charles Street
No. Andover, MA 01845
Dear Sir:
An electrical permit is needed for the following address (Johns, David Residence, 209 Chickering
Road, No. Andover, MA). A copy of my insurance binder and license is on file with your office
• therefore I am enclosing a check for $15.00 made payable to the City of North Andover. My
Electrical License Number for the Commonwealth of Massachusetts is #37294E. Kindly mail the
permit to Mark H. Falardeau, 17 Blue Jay Way, Litchfield, NH 03052.
Thanking you in advance for your timely handling of this matter.
Sincerely,
Mark H. Falardeau
cc: Bil-Ray Meter
Location .r �� �1r* el
No. h Z<� f Date
Check # ,-G Z
f;Z)'.J
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Ictor
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: /
DATE ISSUED: A
SIGNATURE:
Biii1ding Commissioner nfor of Buildings Date /bP
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map NumberaP rcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record -
DA -(/td 1T9415 ono � 0h(ICk1t1"1A& �h
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record: I
�. (flWI doy,/
Nam ri t 4V Address for Service:
ajV kl�G`
Si na re Tele hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
19? /pey/ 1141a, ) # * D 11S�l,
Registration Number
1-1—dl
Address
Expiration Date
Signatu elephone
n
k",,
4L
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result`
in the denial of the issuance of the buildi rrm ,
Si ned affidavit Attached Yes ...... No ....... 0
SECTION 5 Descri tion of Proposed Work check au applicable)
New Construction ❑ r,
+ },* s
�Existin&Bui�dling ❑
4S ft , - ..t.
Repair(s) ❑
Alteratiorls(s)�t, [3:
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify ( 076
Brief Description of Proosed Work; t
W5 rA a V(IUV 4 SI&X4 dve eV1;;7111 L
/K W VA � F-A11W
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed bypermit applicantEli
€' i?FF'ICLALUSE ONLY;.,.
r
1. Building n r r 1a
(a) Building Permit Fee
Multi lier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Pe rn it fee (e) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
_7
1, as Owner/Authorized Agent of subject property
Hereby at e to act on
My b h 1 in I matte re t o relative k authorized by this building pennit application.
IHS -
Sian e of (3,"Mil Date
SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION
I, J l t " ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
J;VR�JV
Print
SinaLxre of Owne A ent Date
Elm= I
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I ST 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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SALESMAN HAS NO AUTHORITY TO CIiANnE Ally TF.nm$ Ort tAAKt
ANY REPRESEN1AT10NS OTHER 1,AN COIIMAiTJED III TI(15 Mint l
"OWNER"
F. 2
t F.I.O. No, 11-2320449 Job/.
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ME lie. No. nb/P93 ti/�.i�
MA tic. o. 120A59
SALES: FOR ALL
New York: SERVICE(REPAIRS
A
HomeCentrai
New York Vopl• or Consumer
Aflolre Lk. Na. 07306aa Ep'a to
800.942-6111 PIEAS� CAtI
Boston: KEAS5 7294
The Service Side of Sears"
Nassau Lic, No. H2704150000
Suffolk Lk. No, 211a4Hr
800 -SEARS -3t
Hartford Area:
SIDING
volhkars 1397
Westchester weo6113 N87
000-SEARs•ogCONTRACT
Providence Area:
by law as lollows.
1. Owners who sedura Ilial► own Permits will be excluded from the
New Jetaey, Lia. No, lot 1604
Connecticut Dopc. of Consumer,
888 -SEARS -51
IN AN ESCROW ACCOUNT AT CHASE MANNAT1_FN SNR N109 1•
Ariel" Lia No. 00632774
SOLD TOS` `�(� y Rhode Island lie• No. X3707
_�4L r'i "�klN� 1 ya(111 F�IirJS DAYS I
ADDRESS RoJv�k�
Dale
PHONE (Home) 7�,)
Dan sign this agreement before you read t(or 11 It contains any blank
apace or if N does not contain everylhinp agreed upon.
CITY _."Ur,ay
STATE Mg ZIP
PHONE (Work) (07)
JOB SITE ADDRESS (if different)
APPLIED VINYL & ALUMINUM SIDING
Sold, FuMiehsd A lmtalled by 6r.Ray Aluminum Siding Corp or QVOSMe. Ina
48 Lyman SL, Suite Mt A aedH Aolhorked Contractor
Westborough, MA 01561 40 Elmonl Ad Etrnoni, NY 1.009
Gonoral Description of Work at Above Address: t
Approx. Start Data: r 15 2,oil
Type of House; NrFralme 0 Masonry Approx, Completion Dale:i L
SPECIFICATIONS
Soara ApprOvod rnDi4tials will bo lurrhlshed and Installed to these ismilileations;
YES NO i`I r,•Asr' nt AD CAnFFULLY• ONLY THE ITEM$ 014ECkED "YES" Ans nJC,I.UbFq
IN Y0I1R pflnrft
1. P4 I t 50LICYINYLSIDING •coveam Ha atlareasdeslgnaitdtorsiding,ext D1lA0saarasdes�pnale44dlow.Slze
Color JNI�I �— PallaM .� (� Package �l ( tt _,,,,` Custom cornet posts color
IA iA I I SIDING will be applied to tie following areas only:
Front Elevation i Might Elevation AEntirg
Details:
Rear Elevation
� len Elevallon p Parcel Iset otuILSJ
CI Other 0 (sie0ernne) ���� -
2 A l I INSULATION • cover 0111Y liathvall areas designated lot siding with —'1 Ll inch iniulallon.-
3 kX 11 Use Sears approved GALVANIZED STEEL STAMR STRIP where contractor d0ems necessary. (Not available with Nal itt.)
4 I i A Siding to be applied over exiMing losndallon.
9 tA. I I Use Sears approvod P(nMA TABS AND FINISH STRIP where contractor dcems neteSsary In same Color as siding. (Not available unlh Npullc )
6 D4 11 WINDOW OPENINGS
*11stgm wrap with Sears approved vinyl clad aluminumS f ol0r !.J a C ^}� i� bc(54-r.,;
( I Jump over castings with siding and 'J' channel Ah Color
i Ji
1 Channel existing wlil only leg. Anderson type or previously wrapped) s ^Cofer
Dclails -- --w
7 �( I 1CAUL7• ah sins with rubberized color co•ordlnaled caulking
6 I(1 I I DOORS • VIVOM wisp with SEAMS approved VINYL CLAD ALUMINUM N of oo0rs
Color -
9 I I GARAGE DOOR FRAMES - oustom wygp* wiih SEARS approvO WNYL CLAD ALUMINUM. Coiof L-Wili—,^- - _
( ) Single K Doubte Wlih Mug Q Double No Mug
10 t I FASCIA • custom wrap with SEARS approved VINYL CLAD ALUMINUM. Cotor—fib j1
11 I 1 I SOfr11•(taveSrOvedlanpe►coverwithSEARSapprovadSOLID VINYL SOTFITSYSTEM. ENCe0I4n0nnledbcfow,r/;Venlcd.Color-a'K4 _,•- _
17 1 I I ROTTEN WOOD - Willonity be ropahad or line Demlir Z7 listed below Anyaddilionatareas noodingarenalrwill betsnmakdupo1.
their discovery and priced accordingly. (Does not include wood studs, Or e),lsrior sheathing).
13. i I nemcve existing material on exterior or house.
1 I Vinyl XNrnninum t_T Wood Shingle p Wood Siding 171 Other
Docs 1101 include any asbestos famgvai.
141k PORCH CEILINGS- cover with SEARS 9DPf0vCdSOLID VINYL CEILING MATERIAL Inthe loxowingareas
�ll t�� •�.,_,___, •••
15 1 I yf-8EAMK0tUMN3-wtapwithSEARSapprovedVINYLCLADALUMINUM(Nocircularorroundcolumns) Color
16 f I P', GUT TEASILEADERS -remove existing and tgplace with new custom Sesmilets; 9010h; and le3dats, While Brown`
11 11 �C SHUT TEAS• orovldeand Install Dolt SEARS approved oolystooneshutivs.Color
19 )( f i MASTER MOUNTS- provide and install for 77 exleriatight fixtures only. Cobr_jJ_1)j _ _-
19 r I lilt OAOIE VENTS • provide and Install vents. color _ No circular or triangle vents
ZD W. f 1 CLEAN UP property at completion of work.-- i P % —0,1f7- •. _ _ - ___..._ .. .
21 f I INSURANCE - eft rtilVirtd WOnKMANS COMP. end LIABILITY 10 b0 11111111811101I All Df-rrn�nlc H7vn pnnn 41.1wd
22 i`4• r 1 WARRANTY •trial] to customer $Act completion and lull payment IS teceived.
29 41`4, 1 1 PAYMENTS • on NON -FINANCED orders installer is aulhorited to collect p1091`e51iya payments .• OelenM nnvm^,d. Mr •,^tt W,n r, r
24 %{t Ll ALL DISCOUNTS APPLIED.
25 �1 11 ADDITIONAL WORK - not soeellied above,
Cash Sale Total S,._—_ Less deposit 33% E Cash Balance S _ Other Payment (it any) S.-_...
1 I CASH pQfINANCED S _23}�tk-j—_ I'doEs not include interest Balance on Substantial Completion S.._._.._ .. .
It financed. balance payable in 1(Q(
V Qr,�,�N �„URrl6Ath(y"installments of approximately a_ � �per month, payola by 'Owner' t0 ronupctor
cul it financed by Owner then Owner will 95Y said amount to the lending institution plus such intsmsl and credit service charge of said lending Inmtaution payable directly
In tilt finding instilution loaning such monies to 'Owner' and will execute a Retail Instailmom obligation and any documents required by much lording instiluUon in
connection wish such loan. D
26 11 WORK NOT lobe done._pc)rd1_ceA1_
rr..RirGn rti hr ti,
21 11 11RapOunrrOplacet�a{o v�zn�wooe �9p� aNO. � a�(<z4z!",1
111000; It Bnanil any holder of this Consumer Credit Contract Is soh•
Tt01 to all claims and defenses which the debtor could assert against
he sailer of goods or services obtained hereto of the
SALESMAN HAS NO AUTHORITY TO CIiANnE Ally TF.nm$ Ort tAAKt
ANY REPRESEN1AT10NS OTHER 1,AN COIIMAiTJED III TI(15 Mint l
"OWNER"
pursuant wish
proceeds boreal. Recovery by the debtor shall nal exceed amounts paid
MkNIT AND REI'RFSENiS INAT 1101IF. NAME Ft,,TN MAgr 111
00 RELIEU UPON BY °OWNER". YOU -An): tilt III 14 it) A Cnhtrl r t
by debtor hereunder.
LY FiLLED IN OUPLICAIF ORIGINAL OF 111113 AnnF514E11T
"OWNER REPRESENTS TO HAVE: REAb AND RECEIVED A OUPLI•
CATE ORIGINAL OF THIS AGREEMENT AND TO BE THE AUTHO-
"YOU, THE BUYER MAY CANCEL THIS TRAN5AC11ON AT ANY
TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
RIZED AGENT OF ALL "OWNERS" OF THIS PROPERTY UPON
NOTICE TO THE HOME THE MATERIALS
GUARANTOR($), BE SUPPLIED.
AFTER THE DATE OF THIS TRANSACTION. SEE AiIACHEO
NOTICECANCELLATION
THIS RIGHT. ON L 0 DERS CANCE LEDAFTERPTHERECISION
CO-SIGNE1%
PERIOD CUSTOMERS WILL 8E RESPONSIBLE FOR A 20myo
ADMIN)§TRATiVE AND RESTOCKING FEE.
Contractor, at the expense of owner, shall procure all permits required
by law as lollows.
1. Owners who sedura Ilial► own Permits will be excluded from the
THE COMPANY WILL DEPOSIT ALL MONIES RECEIVED FROM
guaranty fund provisions of MSL Chapter 142A.
IN AN ESCROW ACCOUNT AT CHASE MANNAT1_FN SNR N109 1•
2. Any person who shall have co-signed, guaranleed or signed any
062069 WITHIN FIVE BUSINESS DAYS OF ITS RECEIPT.
credit application or Role Tetating Io this agreement heratfy accepts
Dale
to be hbUnd by Ibis agreement,
7. Own ti(s) represents Thal the contents on the back of this agreement
Dan sign this agreement before you read t(or 11 It contains any blank
apace or if N does not contain everylhinp agreed upon.
Is I true part hereat and hall been Toad and accepted by Owner.
4. ALL INSTALLATION LABOR GUARANTEED 11 (ONE) YEAR,
PON
Silos n`* Nnmo ��jJ�—LVVI $ig^alUr9�
r\ ��� Cosi Sign Here)
Snl[sman�s /��� � /Ivl
Llconse No -al aStenalure
� � `
FvW�...
SEE REVERSE SIDE FOR ADDITIONAL
TERMS A n CONDITIONS Rev. 3100
HOME _�`PROVEMENT CONTRACTORS R.EGISTRAT CM
- Eoard a.= Euilding Regulations and StandardE
`-� One A=nburton Place - Room 1301
Foston, Massachusetts 02102
HOME IMPROVEMENT CONTRACTOR
Registration 120456 Expiration 01/01/01
Type - PRIVATE CORPOR=,TION
ETL-R.A'( ALUM_ SEDING CORP
.70HN O'NE L
40 ELMONT RD
ELMONT NY 11003
11!{l lV VV IVL, 11'LI
�l1 PHUDUCER
'vans rnt'ernaticr)al
10 Peninsula Blvd.
Lynhrook, NY 11563-2464
1.,Iwu t111L11111111VIInL 111V
FAX (516)596-2001
Attn: Rct7ert Scide Ext:
I...................................................................................................................
LIdsuacD '
QRG: The Gil -Ray Group, etal.
40 Elmant Roar!
Elmont, NY 11003
f na nu, U l uuour-uv 1
DATE (Td 1I1/0w% j
)5/15/2000
LNLYAND CONFERS NO RIGKTS UPONTHE CERTIFICATE
4. DER, TRIS CERTIFICATE DOES NOT AMEND, EXTEND AOR
LTER THE COVERAGE AFFORDED BY THE MUCIES BELOW.
COMPANIES AFFORDING COVERAGE
5 ................................ i.y.,,,,. .......... .......................�.....................................
COMPANY Aai l rai''ins Co
104 A
......................................
COMPANY.E'1'7 C311 H01118
B
i...:............................. .
COMPANY
C
............... . .................................................................
i COMPANY
D
11 iiS IS TO CERTI'F'Y 71iAT TI'i6 POLICIES OF INSURANCE LISTED BEL6W HAl i BEEN ISSUED TO THE INSURED NAMED Am01/E FOR THE POLICY PERIOD
RVOICAI-40, NOTWITHSTANDING M4Y WWREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CI PR IFICATC MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERRA,',,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.............................................•.............. ...
1,10 TYPE" Or IN9U'RAN0E PO(JCY NUMBER i POLICY EFFECTIVE j POLICY EXPIRATION LIb111'8
i DATE(MWDO/YT) DATE(MNIDDFYY)
O"NLILALLUIUIUTY
; GF,NERALAOCHlGATE : S 2,000,000
X COMMERCIAL ODIDIAL LIADILf1V
..
. ......
PRODUCTs.COMP/0PAC4 S 1, 000,OQ0
2�' ' CLAIMS MADE' i X OCCUR
A '`"' ' AOOAC08651
....., ..
PERSONAL6AOV.... : S 1,,000,000
05/14/2000 105/14/200;]
OWNER 5 6 CONTJJACTOKS P4tOT ;
: ............
; EACH OCCURRENCE; S 1, DOG, 000
..................................
.. ............ .
FIRG DAMAGE (Any one nre) -S 50 F 0Q(}
.........
_..._._—.__.....__ ..:
i MW EXP (Anyone person) S Q
AUTOMOBILE LUADILRY
ANY AUTO
c COMBINED SINGLE LIMIT S
AL L OWNCO ALTTIkS
:...................•....................:...................... -
901EDULEDAUTOS
BODLYRkUURY
(Pet vd=n)
IURCD AUTOS �
................................
� �
NON -OWNED AUTU8
IN
BODILY INJURY
: (Per ILY U I
PROPERTY DAMAGE I
GARAGu LL:m'TY
AUTO ONLY -EA ACCIDENT �S _•—• -- - _
ANY AUTO
,�,�% R"`:;`•;4> ::� ,w.:;..
. OTWM TNAr1AU,0 ONLY-
. ... .... ...... ........
EACH ACmnw: S
AGGREGATE. S
a``$ UAd3HJTY
EACH OCCURRENCE I 5,000_,000
w UMQRr-LLA FORM RXL 0252717
105/14/2000 05/14/2001 AGGREGATE S 5,000,000
i
UAY3111;1LA FORM;
„
—-ii3OTl`ICR'RLAN
W1RKER3 WAF'L"NSIA'rIONAND
11IMPLOVEIAS LIABILITY.
TORY. LIMITS..
B TIE"KOPRIVrAq/ WC6520150
,
05/14/2000 05/14/2001 : ��C"AccIoENT s 500,000
PARI NUFt'.'1W-.CUT1VE MCL
. EL DISEASE - POLICY LIMB ; I50(), Coo
–OFRCikSAR6' r"uy D(CL;---
OTHER
....................... ..., .,
ELOISEASE- EACMPLOYEE'i 500 000
_
F.fi1.l [t(r/ d OF Df k}UIIIUNWLLI A 'IQHB!'VpF(ICLPEVtAL ITEMS
@iiera. con -tractors or Home mproveRler►1;5
)rkers Compensation: in NY,GA,CT,MA,NC,NH,PA,
& RI
3RG: The Bil-Ray Group
40 Elmont Road
E7nwnt, NY 11003
SHOULD ANY OF THE ABOYE DESCRIDED POLICIES GE CANCEI t ED BEFOF(E i. C
PXPIRA71ON DATE THEREOF. THE I NO COMPANY WILL ENDEWOR To MAIL
10 WRITTEN HgTICE T E CERTIFICATE HOLDER NAUED TO THC I Ft T,
BUiEAILURE OMM SUC"NoT SHAD.LNPO$FN0001AGAMNoRur,IIILTTY
OF l KUD�E QOMP ITS AD04TS OR REPRG^ENTATIVES.
PER11IT NO._',',4&8. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
JPAGE 1
MAP h40. //l0
LOT NO. O
I
2 RECORD OF OWNERSHIP iDATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO.
—
I
LOCATION Q
PURPOSE OF BUILDING
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS v
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME in.a
IfCJ/ �J
SPAN --
a
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED
/�AND APPROVED BY BUILDING INSPECTOR
/.YDATE FILED L p (` 9v
ig&#TURE OF
S OWNER RI� L/ 01' AGENT
E
FEE
PERMIT GRANTED
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
INSPECTOR
OWNER TEL. #
CONTR. TEL. #
CONTR. LIC. N Leo ` r
H.I.C. ✓fi A913 3 17
1 OCCUPANCY
SINGLE FAMILY S ORIES _
MULTI. FAMILY OFFICES _
APARTMENTS
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 3 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER _
_ DRY VJALL
UNFIN.
3 BASEMENT
AREA FULL IN. 8'M'T' AREA _
1/4 1/1 1/1 FIN. ATTIC AREA _
N_O B M'T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING �I CONCRETE
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASOP
STUCCO ON FRAME
EARTH
10 PLUMBING
GABLE
_
HARDW D
6 FRAMING
BATH (3 FIX.)
GAMBQEI
COMMON
MANSARD
_
ASPH.TILE
FORCED HOT AIR FURN.
SHED
TIMBER BMS. & COLS.
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
ATTIC STRS. 6 FLOOR
HOT W'T'R OR VAPOR
I
WIRING
5 ROOF
10 PLUMBING
GABLE
HIP
6 FRAMING
BATH (3 FIX.)
GAMBQEI
MANSARD
TOILET RM. 12 FIX.)
FLAT
FORCED HOT AIR FURN.
SHED
TIMBER BMS. & COLS.
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WC)ao SHINGFS
HOT W'T'R OR VAPOR
KITCHEN SINK
Jr- .\
BUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
TILE FLOOR
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
ELECTRIC
B'M'T 2nd _
1st 13rd
NO HEATING
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Location
No.
Date Xl�-
TOWN OF NORTH ANDOVER
p Certificate of Occupancy $
Building/Frame Permit Fee $
'Ss�cHUst` Foundation Permit Fee $
Other P it Fee $ke
�nection Fee $
uVater Con
it
Fee $
=fib T�,► $✓�
Building inspector
Div. Public Works '
PEW-sfTY N*.
.r
• I
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
(�AAP.hdO.
,ZONE
LOT NO.
2 RECORD OF OWNERSHIP jDATE
BOOK 'PAGE
SUB DIV. LOT NO.I
LOCATIO
PURPOSE OF BUILDING /
OWNER'S AME
( `) 0
NO. OF STORIES SIZE
OWNEV ADDRESS
BASEMENT OR SLAB
ARCH ECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME /v rC_ t
G!J ��
SPAN
DISTANCE TO NEAREST BUILDING
--
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES
REAR
GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION /-
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF
CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED / ', I D ` / /
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E f I"i
PERMIT (lRANT D
OWNER TEL. #
CONTR. TEL. #_.
CONTR. LIC. #
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST �hf�
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
/i � di
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
Si ORIES
MULTI. FAMILY
OFFICES
APARTMENTS
_
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
3
l
2 13
CONCRETE BL K.
PINE
BRICK OR STONE _
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M AREA
_
'/, 1/2 1/1
FIN. ATTIC AREA
NO BMT
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
_
_
4 WALLS I 9 FLOORS
CLAPBOARDS
B
_
1
2
�_
—{I_
3
_
f
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
HARDV✓'D
COMMON
ASPH. TILE
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
_
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. &FLOOR _
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
GAMBRELMANSARD
I
A
HIP
BATH 13 FIX.)
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
—
ASPHALT SHINGLES
LAVATORY
_
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
_
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd _
1st 13rd
ELECTRIC
NO HEATING
r1►
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
s.
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