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North Andover Board of,Assessors Public Access r C Page 1 of 1
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"ZiProperty Record Card
Parcel ID :210/047.0-0125-0000.0 FY:2013 Community: North Andover
SKETCH
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PHOTO
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Location: 24 ANDREW CIRCLE
Owner Name: MIN, JOO HUN
Owner Address: 43611 SOLHEIM CUP TER
City: ASHBURN State: VA Zip: 20147
Neighborhood: 5 - 5 Land Area: 0.44 acres
Use Code: 1.01-SNGL-FAM-RES Total Finished Area: 1152 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 213,600 216,600
Building Value: 77,400 76,800
Land Value: 136,200 139,800
Market Land Value: 136,200
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=2253452&town=NandoverPubAcc 3/26/2013
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Date ..r!: .......
3�Oi .ao ,s a O`
TOWN OF NORTH ANDOVER
^off j PERMIT FOR GAS INSTALLATION
This certifies that �:-:. ..`�.�-► , �..'. .
has permission for gas installation .. - !?-! ...............
in the buildin�gs /of '.. - y! ..........................
at ?� ... = �-- *'6���'-�-r ........ North Andover, Mass.
Fee.i7P. . Lic. No. /-; , ........ .
_
.� GAS INFECTOR
Check # (U.7
6086
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINGJD, �,V'
(Print or Type)
1
, , " 9j'.
Mass. Date $ 200 Permit # O �10
Building Location yAjyr,�
11t1 , Owner's Name
Type of Occupancy_
0
New C] Renovation ❑ Replacements
Plans Submitted: Yes ❑ No ❑
Installing Company Name
Address [d 11920.4
/ y�O.4
Bus4ness Telephone
P+ 4 Check one: Certificate
❑ Corporation
Name of Licensed Plumber or Cas Fitter
INSURANCE COVER
I have a curren blilty Insurance policy or its substantial equivalent, which meets the requirements of MCL Ch. 142.
Yes No ❑
If you have checked yes, please i ate the type of 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 s perm application waives this requirement
Signature of Owner or Owners Agent
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and Information I have submitted for entered) In above Icati n are true and accurate to the best of
my knowledge and that all plumbing work and installations performed under the permit Is ed for application will be in corn H
all pertinent provislons of the Massachusetts State Gas Code and Chapter 142 of the Cen I Laws
Type of License:
9y ❑ Plumber S gna re of L cen ed P umber or Gas Fitter
Tide ❑ G as fi tte r / �3
City/Town ❑Master license Number
APPROVED (OFFICE USE ONLY) ❑ Journeyman
i
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•
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•
•
MM
N®���nv�
MW
.. -
N
Nmmm
�s�������
Installing Company Name
Address [d 11920.4
/ y�O.4
Bus4ness Telephone
P+ 4 Check one: Certificate
❑ Corporation
Name of Licensed Plumber or Cas Fitter
INSURANCE COVER
I have a curren blilty Insurance policy or its substantial equivalent, which meets the requirements of MCL Ch. 142.
Yes No ❑
If you have checked yes, please i ate the type of 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 s perm application waives this requirement
Signature of Owner or Owners Agent
Check one:
Owner ❑ Agent ❑
I hereby certify that all of the details and Information I have submitted for entered) In above Icati n are true and accurate to the best of
my knowledge and that all plumbing work and installations performed under the permit Is ed for application will be in corn H
all pertinent provislons of the Massachusetts State Gas Code and Chapter 142 of the Cen I Laws
Type of License:
9y ❑ Plumber S gna re of L cen ed P umber or Gas Fitter
Tide ❑ G as fi tte r / �3
City/Town ❑Master license Number
APPROVED (OFFICE USE ONLY) ❑ Journeyman
oft
Location`?-`�'"'�
No. A/G/
Check # t�o / Z2
17025
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
/
—Building Inspector
TONI' OF NORl
\77fW 7Yf'f\flllf!lltOP'r'i��"�'YoitV�iR.-•fr':11llr�rl� ���r�ti�rr��.am_cc..roiwr csr. _.
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..��.-wAe -- -tea-. �.' . �... +.m,.'�_ _ .yl�.�.�...,�'� a ..a _ m- .�.c F +�� --v,�1�.�+"'�+—:--+w�!r �~ _ , __, <....s- ..
..� `�
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popwty
I wft dwlmm tbat the sWamma and Wkmmbon cgi me fargp S sobcnbm
aad b&W
Pr mt Name
Sjoatum of Ow=dA&d nate
is O madAu*m and A W of mbied
are bw wd awsate, to the best army kwwledge
Iz x•03
NO. OF STOMSIZE
BASEN TP OR SLAB
SIZE OF FLAodt raABERS I 2
SPAN
DDdENSMM OF SIU3
DIA ENSIONS OF POETS
DDAE43MM OF OfWERos .
HEIGHT CF•FOUNAATM TIOCKNM
WE OF F001M
x
MATERIAL OF CIOWY
BUJIMM ON SOLm OR FILIM LAND.
18 BUILDM CCNWEC'I-ED TO NATI-T-4L 03118 IDW
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesd9adons
Boston, Mass. 02111
Workers' Compensation insurance Affidavit
Please Print
Name —300 i't'j V-' t-\ • r
LQC" tion d.A A r
_._ t"X n \ ..'. "� M. f C-r<�1 a�5 -obi s
EJam a homeowner performing all work myself.
�l am a sole proprietor and have no one working in any capacity
r
�am an employer providing workers' compensation for my employees working on this job.
mDarjy l3ame.• 9, M/4 })w" `L S i tv_%. T"(-
0
Insurance Co. Policv k -
Failure to secure ooverape as required under Section 26A or MGL 152 can bad to the imposition of crMninal penalties of a fine up to $1,W0.00
andfor one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fire of (b100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do herby cerbYy under the pak%A(d penaifiea of pe+y that the information provided above is true and correct.
1011W E
Print name D,1 V "`^"' �""L-- Phona # 0 7S b -b 6 bb
Official use only do not write In this area to be oompleted by city or town official' D 80ding Dept
[]Check it immediate response is nxfuired Building Dept p Licensing Board
0 Selectman's Office
Contact person: phone #: 0 Health Department
0 !dor
FORM WOi "AN'8 COBAENSATOM
ra ' 4
Branch Name: c' C� btc_ Date:
Sold, Furnished & Installed by
i The Home Depot Installed Sales
Worceser, MA
Branch Number: — Job #: �� Z Toll Free (800) 657-5182;e(508)756-6686; Fax: t 508-756-280160759
Federal ID# 75.2698460 MEY.ic # C 02439 RI Cont. Lic# 16427 CT Lic# 565522
MA Home Improvetpent Contractor Reg. # 126893
1-1
Installation Address: _
City — - State , Zip
Home Address:
(if different from Installation Address) City State Zip
Project Information I/We ("Purchaser"), the owners of the property located at the above installation address, offer to
contract with The Home Depot ("Home Depot") to furnish, deliver and arrange for the installation of all materials as described
on the attached Spec Sheet incorporated herein by reference and made a part hereof.
. , � S Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it
11' `�11 cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.ENT OPTIONS
�I (.)00CONTRACT
AMOUNT
$
*LESS DEPOSIT
$�
BALANCE DUE
ON COMPLETION
S
*25% of Contract Amount due upon execution of this
contract. One-third (1/3rd) of Contract Amount is required
for MASSACHUSETTS RESIDENTS ONLY.
Indicate Payment Method For
BALANCE DUE ON COMPLETION
DEPOSIT PAYM /
(Subject to fund verification and/or credit approval.)
1. Check, Cashiers Check or US Postal Service Money Order / Z, NNNN
(made payable to The Home Depot).
2. Credit Card* and/or other payment options -Circle One Below t 0 le
Visa Mastercard Discover American Express
Home Improvement LoamHome Depot Credit Card
Available Credit: $( IL ADCC ONLY)
Cvp s 3"Wil Lf q� 2 7 J >4a
Acct /p
Name as it appears on card:
*By my/our signature below. I/We agree to allow The Home Depot to charge the
above refaKnced chit card for the deposit indicated.
Signature
Date
If this is a finance transaction, the agreement for financing is contained in a separate document, which is incorporated herein by
Reference, and made a part hereof. At -Home Services Credit/Loan Application Ref. #
Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay any
balance due (unless the job is financed, in which case, upon submission of the executed Completion Certificate, Home Depot will be paid in
full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder.
For Mass. Residents Only: Contractor, at owners expense, shall procure all permits required by law as follows: Owners who
secure their own permits will be excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted
within this document, this contract shall not imply that any lien or other security interest has been placed on the residence.
Entire Agreement : This agreement and its attachments, including any financing agreement, contain the complete agreement
between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep
it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed
by the owner prior to the actual completion of the work to be performed under the contract.
You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this right. There will be a service charge equal to 25% of the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE BELOW, VWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. UWE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, VWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MYIOUR
CREDIT HISTORY AND VWE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES, INC., A HOME DEPOT AUTHORIZED
CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING
AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS.
17
—�
SUBMITTED BY: !- `� Date:
T'Sal onsultant
1
ACCEPTED BY: Date: //-/3 ��
Homeowner 11-14-03P01:52 RCVD
Date:
Homeowner
NOTICE: ADDITIONAL TERMS, CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT
White -Branch File Yellow -CustomerPink- Sales Consultant
9-18-02 C -SC
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