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Miscellaneous - 24 COBBLESTONE CIRCLE 4/30/2018
$9`/0 Date. f�.�.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... C C. P .P .... f.. l b"5 14,J ........ .... has permission to perform ....................... plumbing in the buildings of ... r. -a ! &I ...................... at. 02�... (,r � L/'0 .46Y.IQ .............. . North Andover, Mass. Fh.y7!!' ..Lic. No. .13P3.9�. .....,%14t;� .tom "WA .... PLUMBING INSPECTOR Check #_ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: No( D41 I MA. Date:, Perm' It# BuildingLocation:��j (�pj�-a Cj('Z�P OwnersName:- r&Zl4e � Type of Occupancy: Commercial ❑ Educational ❑ Industrial • Institutiona ❑ I ❑ Residential [� New: ❑ Alteration: ❑ Renovation: (� Replacement: ❑ Plans Submitted: Yes ❑ No FIXTURES, DEDICATED L Z SYSTEMS z z LU <Ln z ° V W W D: O' z Vl Q a' _z {n z Q Q y z w aC o m 'n w D ~ H a W Y tn 0 a X Q L. ~ LL Q h Q w ° O w Z w z U w .lid H 2 a ° U Z Q LL. a Q x w w w ° N 3 W Q Q rn O ° >> O° ° O z z Q Q ~ x O I a �- N a m m o o LL x ne 3 g y H 3 3 3 o u a a TUBBSMT. a 0 3 BASEMENT 1sT FLOOR 2ND FLOOR 3" FLOOR 4T" FLOOR ST" FLOOR 6T" FLOOR 7' FLOOR 8T" FLOOR Installing Company Name: {� 0,f -7-H L� Check One Only Certificate # r" Corporation 3313 Address. X Sac( C)i! City/Town: C-f�Yl(Jl State: Business Tel:,_ 603^ 00 Fax: (o d3El Partnership — j�-j - �(�� ❑ Firm/Company Name of Licensed Plumber: ��� M 1pervL, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No E]If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. i A liability insurance policy. [ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE; WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title 9P1umber Cityrrown master APPROVED (OFFICE USE ONLY► OJourneyman of License Number: Celli 0 12 .Y )100 —�- — Date .S .......A.......f ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .......................................... ..................,,- ............................. has permission to perform 17.-.,-7F 4 7- -�' .. ....................................................... ................................... r .................. wiring in the building of ...�.// ... .. ................................. at X (Pvd....rFTk4ve ......... ....... . North A.Adover, Fee./Z.� .. . ...... Lic. NoM7W .... ........ 1 -1ELECTRICAL T OR CAhec k # id COfYMOn wealth ®f Massachusetts Official Use Only _ Department of Fire Services Permit No, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank ---- APPLICATION FOR PERMIT TO PERF ®RM ELECTRICAL All work to be pedormed in accordance with the Massachusetts Electrical Code WO RK (PLE4SE PRINTININK OR TYPEALL .INFO (MEC), s27 CMR 12.00 City or Town of - TT011� Date: By this application thew" ed gives no ' e of his or her intention o To the electrical of Wires: Location (Street �& Numberwork described below. CO A?4F_ S-ayV6 C22LC.� Owner or Tenant j -r Owner's Address c -I rl� Is this permit in co t' Telephone No. nlunc on with a buildvng permit? Yes Purpose of Building �^ �. e --No PERMIT # M.o �°.� � —Utility Authorization No. Existing Service -6I-a Amps jkd / Volts Overhead ❑ Undgrda, No. of Meters NewServiceer— Amps -- ._,Volts Overhead Number of Feeders and Ampacity Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work.• Sr No. of Recessed Luminaires e—tur; of me Jouowing table may be waived by the Inspector of Wires. No. of Ceil.-Sus . No. of p (Paddle) Fans No. of Luminaire OutletsTransformers No. of Hot Tubs Total. rA No.' of Luminaires Above Swimming Pool nd. ❑ In- Generators KVA ❑ o. o mergeney ig ing No. sof Receptacle Outlets rnd• No. Oil Batte Units _ No. of Switches / �,! of Burners No. of Gas FIRE ALARMS No. of Zones ` Burners No. ofDetection and No. of Ranges ` No. of Air Cond. Total h.tiatin Devices No. of Waste Disposers / Tons Heat Pump Number Tons K�?V....,.. No. of Alerting Devices . ............................................ No. ofSelf-Contained No. of Dishwashers Space/Area Heating KW Detection/AIertin Devices Local ❑ Municipal No. of D ers / ry l Heating Appliances KW Connection ❑Other Security Systems: No. of Water ' Heaters No. of of Ns No. of Devices or E uivalent No. Hydromassage ]Bathtubs Si Ballo. asts Data Wiring: No. of Devices or E uivalent OTI3ER. No. of Motors Total HP � Telecommunications Wirm : g No. of Devices - J Q or E uivalent Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. Work to Start: / (When required by municipal policy.) S^ /� % Inspections to be requested in accordance with AMC 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 e uivalent. The undersigned certifies that such cover e is in force, and has exhibited proof of same to the permit issuing offi e. CHECK ONE: INSURANCE 19/ BOND El OTHER E] (Specify:) d cert, under the pains and penalties ofperjury, that the information on this application is free and cosreplet� FIRM NAM: � Z Z EC, 6r 7X ZC �N �. Licensee: 04 ,Q4s , Signature LIC. NO.. NA (Ifapplicable enter ` �t z t e li en er li e.) LIC. NO.: Address: . 41 MQ"�/ Bus. Tel. No.::e17 - SIl 6- Odv *Per M.G.L. c,147, s. 57-61, security work requires partment of Public Safe "S" Licen fit' Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insuran a c d.—. ge normally required by law. $y my signature below, I hereby waive this requirement. I am the (check one) El ❑ owner's agent Owner/Agent g Signature Telephone No. p PERMIT/'/S'� r/ ti ELECTRICAL PERMIT ISO.' INSPECTION REPORT: ELECTRICAL INSPECTOR -DOUG SMALL 1. ROUGH INS ECTION: Passed — [ Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature-:- no initials) ;� t, Date tNAECTION: Failed — [ ] Re-inspectionrequired ($50.00) - [ ] ments: (Inspectors' Signature - o initi Ys) / Date ?l. INSPECTION — SERVICE: DATE CALLED NATIONAL GRID: Passed — [ ] Failed — [ Inspectors' comments: (Inspectors' Signature - no NAME: ` :-inspection required ($50.00) - Date DOOR TAGS ARE TO BE FILLED OUT ArTD LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT I . ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. y I The Commonwealth of Massachusetts Department of Industrial.Accidents Ofjlce of Investigations 600 Washington Street Boston, MA 0211.1 Uvww.mass.gov1dia Workers' Comp ensation.Insuranee Affidavit: Builders/Contracto>rs) Electricians/Plumbers Applicant Information Please Print Leg li Nalzl:e(B.usiness/Organization/Individual): .EZ Z Fccc_ rxz Address:__q5 r7.S 7zCi S� City/State/Zip:_t /KJ r7 oleo A • Xd l'Y I Phony #: 17 Are you an employer? Check the appropriate box: L I am. a employer with 4• ❑ I am a general contractor and T Type of project (required): _? _ employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner have hired the sub -contractors listed on the attached sheet. i 6 ❑New construction 7. emodeling . ship and have no employees These sub -contractors have 8. [] Demolition working for me is any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. 0 Building addition required] officers have exercised their ME] Electrical repairs or additions ?. ❑. I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c.152, § 1(4), and we have no 12.F1 Roof repairs insurance required.] t employees. [No workers' 13. ❑ Other comp. insurance required.] *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 anew affidavit indicating such. tContractors 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. qq Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Data: i lob Site Address: .9 Y 6g if iESMf CzI City/State/zip.—W-- A,L✓pyp/— /W. 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 flue 06P to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance covex'werification. I do hereby certify,�cies• the pains that the information provided above is true and cor ect. MNMI M� 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): X. Board ofHealth 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone 3R4 .E 07/31/1380�� GAI4111VI if�WEALTH OF, MAS SA�t�USE'fT.S ' t..- 'DIVISION OF PROFESSIONAL LiCENSURE - BOARD ------ T ELECTRICIANS REGISTERED MASTEft ELfCTR]CAf� t ISSUE'S AWE A80V1_ LICENSE RAZZLTf2IC -SNC 0 Location No. Date NORTq TOWN OF NORTH ANDOVER O��•.ee ,e 1yo O? ee •• OL 41 9 41 • ^e, Certificate of Occupancy $ . b',he 'JaKM„SE��' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # L a 24U62 Building Inspector Permit NO: Date I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received -ANT: Av-plicant must complete all items on this Print PROPERTY OWNER 1 �- C CJS ( # F + flA i Print MAP NO:PARCEL: ZONING DISTRICT: Historic District yesn Machine Shop Village yes n MPROVEME!!�fROPOSED USE esi tial Non- Residential ilding EA One family ❑ Two or more family ❑ Industrial n No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �� S e tick ®kViTell� { p $,n l �-®aFlood l� � - i ` , - -� ain i�Wetlands#E # ' ❑ UVatershed Districts t t � 4CNC� OWNER: Name -Z- tL Address: Zy CONTRACTOR Name: Address: C� Type or Print Clearly) nature:ofaA en caner:;=:<;::.: 1 z - 16 S - 561 Supervisor's Construction License: Exp. Date: Home Improvement License: (o i T C- Exp. Date: Q ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.• $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ Fr . q%. — FEE: $ ( 95, .Z 5 Check No.: ;�s— `1 ,>' 8000- Receipt No.: 0 q 0 �,e.�- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Mature l_ ------- -----g------ - - - Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENT CONSERVATION COMMENTS HEALTH ,C6MMENTS ' DATE APPROVED El Reviewed on Signature Reviewed on Signature N 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 COMNMNTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL:' Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use No VV r�✓td � L � � NJ LVL- n Doc:.Building Permit Revised 2008 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 Sdrveyedfi'lofi Plan t , ❑ Workers Comp Aff�Idavit ❑ Photo i C. ♦• � a +••:,s.`� I'.� � i �ense) w .,j ' t tit + %.I•i + Copy o H. (. AndA C. S. L. Lics 11 ❑ Copy Of Contract ❑ vatio Floor/Crossection/Elen plal Of Proposed Work With Sprnkler 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 Construction (Single and Two Family) Q Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building permit Revised 2008mi s•: i O �� v ° w° u a co U a 5 IS b, :j w2 x C U G:3 G w O H W a .� :3c A CZ W a W I CD cm,Q C C o � O CD CO) co w v z co v o co 01 O O W O ;a o v Z Q, CZ H I CD cm,Q C C o � O■� Q 'C CD CO) V � L N 0 m m CD CL 0 co C cc O C co c o •a , O �' cc C3 CL. � CMQ CLC cc C c 4*0� ecco CJ J 'a 41 cc O Z s C O C■ V c � L O C m N 0 Ea L 0 a E .E ' ow E 0 0 z cm :mc ��•• 4U : CLI= E ®m a C2 L Z' N cm O 3 m N C c � N-" m �: !0 "0 c c N c E m CRD p ci y m m o 1'z:5 •o a cm" c ._ _ N a c m p m N o V �Z O _ a o r� ): O a c m y m c IS* C = m o= 03 N ai W Occ Mw•GZ t r •N A �..� CL=c Z COO _ a m� o3 a ` y•� O F- cc r '.S aim 01 O O W O O v Z Q, O H I CD cm,Q C C CO3 O■� Q 'C CD CO) O O -FE m m CD CL 0 co CD cc O C co , O �' cc C3 CL. CL CMQ O c 4*0� ecco CJ J 'a O Z s C O C■ V c �i■ ■ C a h 0 ui U) U) 19 W 19 W cn r 4 i gr4cee6?ffl#?1VeAZJ%". 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 NOV ? Home Improvement C�.actor Registration 9 200 c,� ti Registration: 101542 Twka- PrivatP Corporation 7r� Expiration: 10/27/2012 Tr# 20W2 DATA INDUSTRIES, INC.' LU EDWARD.STEWART 24 ORCHARD.VIEW DR.; LONDERRY, NH 03053 w r a pdate Address and return card. Mark reason for change. �nfG�t v� v`0 Address Renewal Fmployment E] Lost Card M s DPS-CA1 0 5OM-04/04-01101218 -Liceiyse:;r-regsst;raEio;a3va0d.:fnr:iudividul..use.on ..._ offleak,o air a u before the expiration date. i If found return to: HOME IMP%tOVEIVIENT CON RACTOR;Type, Office of Consumer Affairs and Business Regulal. , ion Registration: 161542 :.10' Park Plaza - Suite 5.170; IFINDUST Expiration: AbQ7/2012 Private Corporation - !,Boston, MA 02116 EDWARD STE 24 ORCHARD Vlr ERRY NH Not v i with igna ND � Undersecretary v ' 4 1 4 ACORN, CERTIFICATE OF LIABILITY INSURANCE - DATEIMMlDDIYYm OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWrrHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PRooucER 603.431. 07/07/2010 3666 FAX 603.432.6076 THIS CERTIFICATE IS ISSUED AS A MA7'rER OFINFORMATION Lakeside Insurance Agency, Inc. ONLY 1,*indham, INSRI AND CONFERS NO RIGHTS UPON THE CERTIFICATE AMEND, EXTEND Three Wall Street ALTER CO RAGE POLICY NUMBER NH 03087 THE AFFORDED BY THE DATE MMID INSURERS AFFORDING A COVERAGE ' IN BURIED Data n ustr es, Inc. NAIC # DBA: dba Boardwalk North INsuRERa Maine Mutual Insurance Group SC10970519 24 Orchard view Drive INSURERS: Atlantic Charter Ins. Co. 06/01/2011 Londonderry, NH 03053 INSURER c: PREMISES Esacairrranca B ZSO Q0 INSURER D: PERSONAL A ADV INJURY 1 1 000 QO �INSURER E COVERAGES THE POLICIES ANY RE4UIREMENT, MAY PERTAIN, POLICIES. fan OwIrl OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWrrHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRI TYPE OR MSURANCE POLICY NUMBER M DATE MMID LIMITS A DENERALLWBILI7Y X COMMERCIAL GENERAL UABILITYIETZfR CWMSMADE aOCCUR SC10970519 06/01/2010 06/01/2011 EACH OCCURRENCE s 21000,00 PREMISES Esacairrranca B ZSO Q0 MED EXP ornpamn) t 5100 PERSONAL A ADV INJURY 1 1 000 QO GENERAL AGGREGATE ! Z 00.00 GENL AGGREGATE LIMIT APPLIES PER: POLMY MPRO' M LOC PRODUCTS-COMPIOP AGG f 2 000 00 AUMMODU X LMiUTY ANYAUTO ALL OWNED AUT08 KA10970519 06/01/2010 06/01/2011 coManvEO SINGLE LMITT (E"�din1) f 1 000 OO A SCHEDULED AUTOS BODILY MNRY 8 (Pap-" HIRED AUTOS NON-ovmED AUTOS BODILY INJURY S (PN acddald) PROPERTY DAMAGE(Per 80*10MI S eARAOELIABILrTY AUTO ONLY-EAACCIDENr S ANYAUrO OTHERTHAN EAACC S AUTO ONLr.. A130:8 A EKCESSILVAB■ELLAUABIUTY X 1 OCCUR Fj CLAIMS MADE KU10970519 06/01/2010 06/01/2021 EACH OCCURRENCE s 2 000 00 AGGREGATE S Z a 000 OO : DEDUCTIBLE X RETENTION IS 10,00 t i B ANDEM�PLOYEWu Briny ANYPROPRIET RA+AaTNERrEXE YIN OFFICERIMEMB�R EXCLUDED? CUTNE� IMandalery16 NH) 1 N yyrsaa daaaiba under EPE�UY. PROVISIONS bebw WCA00534100 - NH WM00419600 MA 06/01/2010 06/01/2010 06/01/2011 06/01/2011 X E E.LEACHACCIDENT S 500 0 E.L. DISEASE- EA EMPLOYE S 500 ,0 EL DISEASE -POLICY LIMB li SOO 0 I OTHER I DBiC111PT10NOFOPR CovMNI; AMUSILDGTWMDIVEMCLR IWMLUMON8ADD fD 1E11DORSEMENT/BPECW.PR carpentry and related operations orthe Named Insured during IONS the oolicv period. docker's Compensation statuto coverage is provided for New Hampshire and Massachusetts. No Executive Officers have elected coverage under Worker's Compensation. SHOULD ANY OF THE ABOVE DE8CRIZED POLOU LE CANCELLED LEFORE THE WMM101 DAT[ THEREOF. THE MBUMG INSURER MALL ENDEAVOR TO MAL DAYS wRnTEN NOTICE TO TNe CMFICAT! HOLDER NAMED To THE LEFT. BUT PALM TO DG SO eww. PWM? NO COUGA710M OR LIAOa.RY DF ANY MND UPON THt MUR/R, TTs A9NNTf OR AUTNORI ED REPRB88dTATNB Information Only for PresentationEdwin DuvaTT/LYNN AX ACORD 25 (9006/01) ®1888 2006 ACORD CORPORA The ACORD name and logo are m9latered mn*s of ACORD I .� w TO .}..lilt. cy 1 t U � c m i c U d tp y N J Q, ra CL y�M/IRO� O o 0 LO Z i U .►� i (for office use only) A Division of Data Industries, Inc. Office ................... BOARDWALK 24 Orchard View Drive Order NO ................. N=HLondonderry, NH 03053 TEL (603) 437-2500 Checked by .............. boardwalknorthxom Purchase Agreement Name of Purchasers) Email Address ER MA 01845 l 10 Ili DO (No.)SAMftee1l (city) cs'a'e) 978-682.4535 cz�P> Mailing Address if different Phone No. WORK SPECIFICATIONS KIT, MASTER BATH & M1SC. REMODELING PAGE 1 OF 1 We will furnish and install the as specified below: THIS PURCHASE AGREEMENT IS PART AND PARCEL TO THE FRAZIER PROPOSAL FEATURES CONSISTING OF SPECIFICALLY ITEMS # 1-30, CONSISTING OF (7) SEVEN PAGES IN TOTAL, ENDORSED AND DATED BETWEEN THE PARTIES AND AS SUCH REPRESENT THE TOTAL SCOPE OF WORK TO BE COMPLETED UNDER THIS AGREEMENT. THE UNDERSIGNED PARTIES ARE IN SAID AGREEMENT AND AS SUCH AGREE TO ALL THE TERMS AND CONDITIONS SET FORTH WITHIN THIS PURCHASE AGREEMENT. ANY FURTHER AGREEMENTS BETWEEN THE PARTIES SHALL BE FURTHER SPECIFIED AND ENDORSED UNDER SEPARATE COVER. II. I Remarks ,�lff"i7�ir.�' !4 Pd Tf.��" i7� „� �7 i��il i72wR M92 -- Ase-- .Vy�Aa%� ie ieseir This contract supersedes all conversations, statements and Price and Payment- 82 936.00 t d ' 1' d b t th Y th ' t Cash price .................................... $------- ----- ----- agreemen s express. or imp a ween a par , age. s and representatives. Purchaser(s) authorize Boardwalk North to investigate credit worthiness. All work started above, to be completed in a workmanlike manner according to the floor plan, job specifications and terms and con- ditions as stated on the back of this form. Payments to be made as the work progresses as per the Payment Schedule whichis�at ched�and made this Contract: --l--C%�`�--t-- --------------------- Date Owner ----- Datex !J'j�0„•I� Ok__ ner Boardwalk North 3/4/2011 By: ----------_TV - -------------- Date--------------- FRAZIER PROPOSAL FEATURES MARCH 4t", 2011 REMODEL THE EXISTING KITCHEN AND MASTER BATH TO INCLUDE MISC. REMODELING: OVERVIEW 1. REMODELING THE KITCHEN AND MASTER BATH, LOCATED AND SIZED PER THE CONCEPTUAL / CONSTRUCTION DRAWINGS DATED MARCH, 2011, TO INCLUDE ROUGH AND FINISH CARPENTRY, ROUGH AND FINISH PLUMBING, ROUGH AND FINISH ELECTRICAL, INSULATION, DRYWALL (MUD, TAPED, & SANDED AND PRIMED), NEW KITCHEN CABINETS, RANDOM SWIRL, SOFT TEXTURED, SAND FINISHED CEILINGS (OR SIMILAR TO EXISTING AS DETERMINED BY THE COMPANY). ALSO INCLUDES PATCHING OF THE INTERIOR DRYWALL WHERE NECESSARY AS A RESULT OF THE REMODELING EFFORT. ALSO INCLUDES: REMOVAL AND RELOCATION OF ANY EXISTING 1 IOV OUTLETS AS DEEMED NECESSARY BY THE COMPANY AND/OR ASSOCIATED PLUMBING, AS DETERMINED BY THE COMPANY. ALSO INCLUDES PROVIDING AND INSTALLING NEW RED OAK HARDWOOD FLOORING IN THE REAR HALLWAY AND REFINISHING EXISTING FLOORING. KITCHEN REMODELING: DEMOLITION 2. REMOVE AND *SALVAGE THE EXISTING KITCHEN CABINETS,. DISHWASHER, REFRIGERATOR AND FAUCET. THE DISHWASHER AND FAUCET ARE TO BE REINSTALLED WITHIN THE PROJECT, THE CABINETS AND REFRIGERATOR ARE TO BE REPURPOSED BY THE CUSTOMER. (*AS MATTER OF POLICY, THE COMPANY CANNOT INSURE THE SERVICEABILITY OF ANY SALVAGED PRODUCTS) ALSO INCLUDES REMOVAL OF THE EXISTING COUNTERTOPS AND SINK. REMOD 3. THE EXISTING KITCHEN WINDOW AND TRIM OVER THE EXISTING SINK TO REMAIN IN PLACE. KITCHEN REMODELING: ELECTRICAL 4. PROVIDE AND INSTALL A NEW SUB PANEL SIZED AND SELECTED AND LOCATED BY THE COMPANY. 4a. PROVIDE AND INSTALL NEW I IOV AND GFCI PROTECTED OUTLETS LOCATED TO ACCOMMODATE THE REMODELED KITCHEN AND AS DETERMINED BY THE COMPANY. ALSO PROVIDE AND INSTALL (10) RECESSED LIGHT FIXTURES ON TWO CIRCUITS, EACH TIED INTO A THREE- WAY SWITCH, WITH ONE OF THE SWITCHES BEING A DIMMER CONTROL UNIT. ALSO INCLUDES REMOVING AND/OR RELOCATING OR RECONFIGURE (IF NECESSARY) THE REAR HALLWAY LIGHTING SWITCHES TO ACCOMMODATE THE REMODELING EFFORT (SEE ALLOWANCE SCHEDULE). FRAZIER PROPOSALYEATURES MARCH 4th, 2011 KITCHEN REMODELING: ELECTRICAL (CONTINUED) 4b PROVIDE AND INSTALL NEW XENON UNDER CABINET LIGHTING (SEE ALLOWANCE SCHEDULE). 4c PROVIDE AND INSTALL (AND OR RELOCATE IF APPLICABLE) (1) DEDICATED 110V OUTLET FOR THE DISHWASHER, REFRIGERATOR, COOKTOP, AND MICROWAVE OVEN AND 220V LINE FOR THE OVEN AS DETERMINED BY THE COMPANY. 4d NOTE: ALL NEW WIRING TO BE TIED INTO A NEW AND PROPOSED SUB PANEL OR THE EXISTING PANEL AS DETERMINED BY THE COMPANY (SEE ALLOWANCE SCHEDULE). 4e REMOVE AND/OR REPLACEMENT OF THE EXISTING SMOKE DETECTORS TO BE QUOTED SEPARATELY UPON REQUEST. KITCHEN REMODELING: HEATING 5. THE EXISTING FHA TOEKICK REGISTER CURRENTLY LOCATED UNDER THE KITCHEN SINK TO BE RELOCATED TO ACCOMMODATE THE NEW DESIGN AND REMODELING EFFORT. NOTE: REPLACEMENT OF THE EXISTING HEATING UNIT AND/OR PROVIDING ADDITIONAL HEATING TO BE QUOTED SEPARATELY BY THE COMPANY. KITCHEN REMODELING: FLOORING 6. PARTIALLY REMOVE THE EXISTING REAR ENTRY TILE TO ACCOMMODATE THE NEW HALLWAY PARTITIONING AND THEN PROVIDE FOR PATCHING IN AND INSTALLING NEW 3/4" X 2-1/4" X RANDOM LENGTH RED OAK HARDWOOD FLOORING TO INCLUDE: THE APPLICATION OF THREE (3) COATS OF WATER BASED URETHANE WITH SANDING BETWEEN COATS. 6a ALSO INCLUDES RESANDING AND SEALING OF THE EXISTING KITCHEN AND DINING AND REAR HALLWAY AREAS TO INCLUDE: THE APPLICATION OF THREE (3) COATS OF WATER BASED URETHANE WITH SANDING BETWEEN COATS (SEE THE ALLOWANCE SCHEDULE). FRAZIER PROPOSAL FEATURES MARCH 4t", 2011 KITCHEN: CABINETS 7. PROVIDE AND INSTALL "DURA SUPREME" BRAND IN DESIGNER LEVEL (OR SIMILAR IN PRICE AS DETERMINED BY THE COMPANY.) CABINETS TO INCLUDE ALL PLYWOOD CONSTRUCTION, FULL EXTENSION DRAWERS, SOFT CLOSE DOORS AND ADJUSTABLE SHELVES. INCLUDED DOOR STYLE PER CURRENT CUSTOMER SELECTION IS ARCADIA CLASSIC, A SOLID RAISED PANEL STYLE IN MAPLE WOOD IN VANILLA PAINTED FINISH. BASED ON THE CONCEPTUAL DRAWINGS, THE KITCHEN DESIGN INCLUDES LARGE POTS AND PANS DRAWER, ONE CUTLERY DIVIDER, ONE SUPER SUSAN. NOTE: ANY MODIFICATIONS FROM THE 20/20 KITCHEN LAYOUT TO BE QUOTED SEPARATELY UPON REQUEST. KITCHEN: CABINET HARDWARE 8. PROVIDE AND INSTALL NEW KITCHEN CABINET HARDWARE (SEE ALLOWANCE SCHEDULE). NOTE: INCLUDED CABINET HARDWARE IS FROM THE AMEROCK ALLISON COLLECTION (OR SIMILAR IN PRICE AS DETERMINED BY THE COMPANY). KITCHEN: COUNTERTOPS 9. PROVIDE AND INSTALL GRANITE COUNTERTOPS (OR SIMILAR IN PRICE AS DETERMINED BY THE COMPANY), LOCATED AND SIZED PER THE CONCEPTUAL / CONSTRUCTION DRAWINGS MARCH 2011, (SEE THE ALLOWANCE SCHEDULE). KITCHEN: BACKSPLASH 10. PROVIDE AND INSTALL A NEW GRANITE BACKSPLASH, PER THE CONCEPTUAL / CONSTRUCTION DRAWINGS MARCH 2011, (SEE THE ALLOWANCE SCHEDULE). KITCHEN: PLUMBING 11. REMOVE AND RE -INSTALL THE EXISTING KITCHEN SINK AND FAUCET, LOCATED AND SIZED PER THE CONCEPTUAL / CONSTRUCTION DRAWINGS DATED MARCH 2011, (SEE ALLOWANCE SCHEDULE) KITCHEN: APPLIANCES 12. APPLIANCES TO BE SUPPLIED BY THE CUSTOMER, AND/OR QUOTED SEPARATELY UPON REQUEST. IF THE REQUIRED NEW APPLIANCES ARE PURCHASED THROUGH THE COMPANY -RECOMMENDED VENDOR THE CUSTOMER WILL BE PROVIDED WITH THE OPPORTUNITY TO PURCHASE SAID APPLIANCES AT THE COMPANY'S COST. THE COMPANY WILL ALSO AGREE TO COORDINATE THE DELIVERY AND INSTALLATION THEREOF. FRAZIER PROPOSAL FEATURES M RCH 4th, 2011 MASTER BATH REMODELING: OVERVIEW 13. REMODELING THE EXISTING MASTER BATH TO INCLUDE: DEMOLITION OF THE EXISTING TILE FLOOR, SINKS AND COUNTERS, VANITY MIRRORS AND LIGHT BARS, SHOWER STALL AND DOOR AND PARTIONING MADE NECESSARY AS A RESULT OF THE REMODELING EFFORT, AND TOILET., ALSO INCLUDES: NEW TILE FLOOR, NEW VANITY BASE CABINETS, NEW GRANITE COUNTERTOP, NEW SHOWER STALL, NEW PARTIONING TO ACCOMMODATE THE NEW WASHER AND DRYER LOCATION, NEW LINEN CLOSET, NEW MEDICINE CABINETS, NEW VANITY LIGHTING, NEW SHOWER AND LAUNDRY ROOM LIGHTING, REINSTALLED BIFOLD DOORS, NEW DOOR FOR LINEN CLOSET, AND ALL THE NECESSARY FINISH CARPENTRY. DEMOLITION 14. TO INCLUDE: DEMOLITION OF THE EXISTING TILE FLOORING, SINKS AND COUNTERS, VANITY MIRRORS AND LIGHT BARS, SHOWER STALL, DOOR AND PARTION, AND INTERIOR TRIM MADE NECESSARY AS A RESULT OFi THE REMODELING EFFORT AS DETERMINED BY THE COMPANY. NOTE: EXISTING TOILET TO BE SALVAGED AND REINSTALLED IN THE REMODELED MASTER BATH. MASTER BATH: VANITY CABINETS 15. PROVIDE AND INSTALL NEW VANITY BASE CABINETS LOCATED AND SIZED PER THE CONCEPTUAL DRAWINGS DATED MARCH 2011 (SEE THE ALLOWANCE SCHEDULE). MASTER BATH: BATH FIXTURES 16. PROVIDE AND INSTALL (2) NEW VANITY SINKS AND FAUCETS, (2) NEW VANITY MEDICINE CABINETS, (1) NEW SHOWERHEAD, AND (1) NEW SHOWER DOOR ASSEMBLY. REINSTALL EXISTING TOILET AND SEAT (SEE THE ALLOWANCE SCHEDULE). MASTER BATH: SHOWER UNIT 17. PROVIDE AND INSTALL (1) NEW ACRYLIC TWO OR THREE PIECE SHOWER UNIT TO WITH BASE TO INCLUDE SOLID SUPPORT UNDERLAYMENT FILLING (SEE THE ALLOWANCE SCHEDULE) . MASTER BATH: VANITY COUNTERTOP 18.' PROVIDE AND INSTALL NEW GRANITE VANITY COUNTERTOP LOCATED AND SIZED PER THE CONCEPTUAL DRAWINGS DATED MARCH 2011 (SEE T4 ALLOWANCE SCHEDULE) i MASTER BATH: ACCESSORIES 19. PROVIDE AND INSTALL BATHROOM ACCESSORIES I.E. TOWEL BAR, TOILET PAPER DISPENSER ETC. (SEE THE ALLOWANCE SCHEDULE). 4 FRAZIER PROPOSAL FEATURES MARCH 4th, 2011 MASTER BATH REMODELING: CONTINUED MASTER BATH: TILE FLOOR 20. REMOVE THE EXISTING TILE FLOOR DOWN TO THE EXISTING UNDERLAYMENT AND THEN PROVIDE AND INSTALL NEW TILE FLOORING USING A PERPENDICULAR FLOOR PATTERN (SEE THE ALLOWANCE SCHEDULE). INSTALLATION NOTE: DIAGONAL OR SPECIALTY INSTALLATION TILE OR CONFIGURATIONS TO BE QUOTED SEPARATELY UPON REQUEST MASTER BATH: LAUNDRY AND LINEN CLOSETS 21. PROVIDE AND INSTALL NEW PARTIONING FOR A PROPOSED LAUNDRY AND LINEN CLOSETS TO INCLUDE ROUGH AND FINISHED PLUMBING ROUGH AND FINISHED CARPENTRY, DRYWALL (MUD TAPED, SANDED AND PRIMED, AND REINSTALLED EXISTING BIFOLD DOORS WITH HARDWARE. ALSO INCLUDES. REPURPOSING THE WIRE SHELVING TO BE SET ABOVE THE WASHER AND DRYER. MASTER BATH: LAUNDRY AREA: ELECTRICAL 2 1 a PROVIDE AND INSTALL (1) NEW 110V OUTLET FOR THE WASHER AND (1):NEW 220 V OUTLET FOR THE DRYER, (1) NEW FLORESCENT CEILING MOUNTED LIGHT FIXTURE OPERATED ON A SINGLE POLE SWITCH. MASTER BATH: ELECTRICAL 21b PROVIDE AND INSTALL NEW 110V OUTLETS LOCATED TO ACCOMMODATE RECONFIGURED MASTER BATH LAYOUT. ALSO INCLUDES (1) NEW WET RECESSED LIGHT FIXTURE FOR PROPOSED SHOWER STALL, (1) NEW VENT/LIGHT UNIT, (1) NEW VANITY LIGHT FIXTURE. ALL TO BE OPERATED ON A SINGLE POLE SWITCH (SEE THE ALLOWANCE SCHEDULE). MASTER BATH: LINEN CLOSETS 22. PROVIDE AND INSTALL (4) MELAMINE SHELVES. ALSO INCLUDES: PROVIDING AND A NEW INTERIOR PREPRIMED, RAISED PANEL, PRESSURE MOLDED, HOLLOW CORE CLOSET DOOR WITH PASSAGE SET SIZED. GARAGE ENTRANCE CLOSET AREA MISCELLANEOUS REMODELING: OVERVIEW 21 RECONFIGURE THE EXISTING COAT CLOSET, WASHER & DRYER AREA TO INCLUDE: DEMOLITION AND CAPPING OFF THE EXISTING PLUMBING AND ELECTRICAL OUTLETS AND/OR FIXTURES, CUTTING BACK AND PATCHING IN THE EXISTING TILE AREA (USING THE CUSTOMER'S TILE REMNANTS) TO ACCOMMODATE THE PROPOSED HALLWAY DOOR AND REMODELING EFFORT. ALSO INCLUDES REPARTIONING THE AREA PER THE CONCEPTUAL DRAWINGS DATED MARCH 2011. FRAZIER PROPOSAL FEATURES MARCH 4th, 2011 GARAGE ENTRANCE CLOSET AREA MISCELLANEOUS REMODELING: CONTINUED 24.' CONSTRUCT A NEW WALL WITH DOOR FOR THE SAKE OF CREATING A MUDROOM TYPE ENTRY WAY TO INCLUDE PROVIDING AND INSTALLING A NEW 15 LITE PREPRIMED INTERIOR DOOR WITH FROSTED GLASS WITH HARDWARE SIMILAR TO EXISTING. RECONFIGURED GARAGE ENTRY CLOSET: (ELECTRICAL) 24a PROVIDE AND INSTALL (1) FLORESCENT CEILING MOUNTED LIGHT FIXTURE OPERATED ON A SINGLE POLE SWITCH. ALSO INCLUDES REMOVING AND TERMINATING THE EXISTING ELECTRICAL 110V, AND 220V OUTLETS (SEE THE ALLOWANCE SCHEDULE) RECONFIGURED GARAGE ENTRY CLOSET: (SHELVING) 24b PROVIDE AND INSTALL A SINGLE MELAMINE SHELF AND CLOSET POLE. RECONFIGURED GARAGE ENTRY CLOSET: (MILLWORK) 24c PROVIDE AND INSTALL (1) NEW CLOSET BIFOLD, PREPRIMED, PRESSURE MOLDED, RAISED PANEL, INTERIOR DOOR LOCATED AND SIZED PER THE CONCEPTUAL AND OR CONSTRUCTION DOORS. GENERAL AND MISCELLANEOUS REMODELING NOTES: 25. THE SCOPE OF WORK ALSO INCLUDES RELOCATING THE KITCHEN SINK PLUMBING TO ACCOMMODATE THE PROPOSED RELOCATION OF THE SINK AND FAUCET. ALSO INCLUDES CAPPING THE GAS LINES BELOW THE FLOOR. PAINTING 26. ;INCLUDES ALL PRIMING OF NEWLY INSTALLED DRYWALL. ALL OTHER PAINTING, STAINING AND/OR PREPARATION THEREOF TO BE COMPLETED BY THE CUSTOMER OR WILL BE QUOTED SEPARATELY UPON REQUEST. LEAD TESTING: 27.. BASED ON THE AGE OF THE HOUSE, LEAD TESTING IS NOT REQUIRED. PLANS 28. FINAL CONSTRUCTION DRAWINGS, ENDORSED THEREIN, SUPERSEDE ALL CONCEPTUAL DRAWINGS GENERATED DURING THE DESIGN PROCESS. NOTE: THE NEED FOR ANY ENGINEERING REPORTS SUCH AS PLOT PLANS, OR VARIANCE -REQUIRED PLANS AND/OR STUDIES DUE TO EXISTING CONDITIONS, WILL BE QUOTED SEPARATELY UPON REQUEST. FRAZIER PROPOSAL FEATURES MARCH 4th, 2011 DEBRIS REMOVAL 29.'INCLUDES REMOVAL OF ALL DEBRIS GENERATED AS A RESULT OF THE RENOVATIONS DESCRIBED ABOVE. I BUILDING PERMITS 30. INCLUDES THE BUILDING, ELECTRICAL AND PLUMBING PERMITS FEE AND APPLICATION THEREOF EXCEPT AS NOTED. NOTE: SURVEY AND/OR CERTIFIED PLOT PLANS, ZONING BOARD, AND/OR CONSERVATION COMMISSION APPLICATION(S) EFFORT TO BE QUOTED SEPARATELY UPON REQUEST. THE AFOREMENTIONED PROPOSAL FEATURES ARE HEREBY AGREED TO BETWEEN THE PARTIES AND AS SUCH ARE CONSIDERED TO REPRESENT THE ENTIRE SCOPE OF WORK TO BE PERFORMED. FURTHERMORE THE PARTIES AGREE THAT SAID SCOPE OF WORK IS COVETED AND SUBJECT TO ALL THE TERMS AND CONDITIONS AND PROVISIONS SET FORTH WITHIN THE PURCHASE AGREEMENT DATED MARCH 4T", 2011. NOTE: THE PARTIES FURTHER AGREE THAT THERE ARE SIX (7) PAGES OF PROPOSAL FEATURES REPRESENTED WITHIN THIS AGREEMENT AS DATED BELOW. SIGNED: DATE PRINTED NAME SIGNED: DATE PRINTED NAME COMPANY REPRESENTATIVE: SIGNED: DATE PRINTED NAME TOTAL PURCHASE AGREEMENT PRICE: $82,936.00 Location 2� `�-� la6a—; S OoE 5 -pi �S /0(s No. COCA Date o1a_ TOWN OF NORTH ANDOVER yCertificate of Occupancy $ i� > ; • Building/Frame Permit Fee $ 0. ,SSA�MU`+Et Foundation Permi Fee $ T2" d Other Permit Fee r&o $ Sewer Connection Fee $ i. Water Connection Fee $ Z TOTAL $ 3�OC3 kl Building h Inspector lt�,9,R�II} * S f `� t Div. Public Works PERMIT NO. 00 6 I 9 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. to PAGE 1 MAP K -4O. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. LOCATION lo �� �rg L) L. PURPOSE OF BUILDING OWNER'S NAME J•\ „!/` l C I� �-tJ NO. OF STORIES SIZE OWNER'S ADDRESS V -t j` I_j� / BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST ���✓ 2ND 3RD BUILDER'S NAME 1 /_ v� SIL„ �� `ZLv SPAN DISTANCE TO NEAREST BUILDING n7� V DIMENSIONS OF SILLS --- DISTANCE FROM STREET Com/ v POSTS DISTANCE FROM LOT LINES - SIDES T REAR 50 GIRDERS AREA OF LOT L / G FRONTAGE HEIGHT OF FOUNDATION THICKNESS CD IS BUILDING NEW SIZE OF FOOTING 'x1 IS BUILDING ADDITION i )'� MATER:AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE `/�� L IS BUILDING CONNECTED TO TOWN WATER i Q `(i BOARD OF APPEALS ACTION. IF ANY �O N c 4• IS BUILDING CONNECTED TO TOWN SEWER i eS �(„ IS BUILDING CONNECTED TO NATURAL GAS LINE �j 6 INSTRUCTIONS SEE BOTH SIDES PAGE i FILL OUT SECTIONS 1 j- 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 LE DATE F D et I ,C L SIGNATURE OF OWNER OR AUTHORIZED AGENT L _ pFEE 1 JL .PERMIT GRANTED i 3 PROPERTY INFORMATION LAND COST BLDG. COST PER SQ. FT. QST. BLDG. COST PER ROOM SEPTIC PERMIT NO. .w.r- 4 APPROVED BY OWNERTEL.# (ZI - Ll 0 7- 6 CONTR.TEL. # (Uy' 15 53s CONTR.LIC.#. o573b `� H.I.C. # 1 D 971 L4 BUILDING RECORD 1 OCCUPANCY 12 It SINGLE FAMILY sroRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.1 A4 w M CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE PINE 3 _ ! 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PLASTER DRY WALL UNFIN. PIERS 3 BASEMENT AREA FULL FIN. B'M'T AREA '/. 1/2 1/ FIN. ATTIC AREA N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS II 9 FLOORS CLAPBOARDS B 1 2 3 _ _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW0 COMMCN ASPH. TILE 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 SUPERIORPOOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLEHIP BATH Q FIX., _ GAMBREL MANSARD TOILET RM. 12 FIX.1 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 PIPE LESS 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 I 12nd I to L/ 3rd I NO HEATING A4 w M fi PER THISCERTIFIES THAT .JAQ ....(;...................................................................................................................... has permission to owct..A4(9.*A.. ................. buildings on ....Qww.s.-t��.... !!...4>.................. to be occupied as ....(L... uwt�..-....... provided that the person accepting this permit shall in every respect conform to the terms of the application 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. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRE 6 MONTHS UNLESS CONS AP T ........ .. . ... ..................... .. ........ ..... ..... BUILDING NSP OR Occupancy .Permit Required to Occupy Building - Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. PLANNING FINAL SEWER / WATER FINAL CONSERVATION FINAL DRIVEWAY ENTRY PERMIT i over SS., Z Ahj uAe.&j c 19 qS BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR Foundation Rough Chimney Final PLUMBING INSPECTOR Rough i Final ELECTRICAL INSPECTOR Rough Service Final GAS INSPECTOR Rough Final FIRE DEPARTMENT Burner Street No. Smoke Det. , .01 _fF 7P4s— Location No. w Date TOWN OF NORTH ANDOVER . ; Certificate of Occupancy $ * # Building/Frame Permit Fee $ - -� Foundation Permit Fee $ s�CHU Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TZZ/7 �33 Building Inspector _— 67 l Div. Public Works Sewer Connection Fee $ Water Connect�n $ TOTAL NO, 2 ,b-$189&0 - 0 U Building Inspector .' —� 6653 41 Div. Public Works V %l6cation kt r i b. 'Z 7 Date .4 -a f NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ # Building/Frame Pgrmit Fee $ ,SSACNUS Foundation Permit .Fqe. $ 'ice U f Other Permit Fee r - -- Sewer Connection Fee $ Water Connect�n $ TOTAL NO, 2 ,b-$189&0 - 0 U Building Inspector .' —� 6653 41 Div. Public Works Laeation �O 1 No. d"" � Date 663 �3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ T Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $2 Sewer Connection FeEMOV $ /,,ZXFN^I Water Connection Fee $ cZy TOTAL $ _ wilding Inspector Div. Public Works u . . z N 1 c n 0 z 1n 0 m Z 0 3 ->i 0 z m f r. m m> U ° v A m Z > m 0 -1 m ->I A ° r m C F m C> F O z i > Z i D Z v n -i Z m z x� n z m \ ° 0 " > 0 z 0 Z G1 0 Z cl 0 Z 0 m r m m m m a n n y o 0 Z 0 0 m > Z O s r -1 s O z m A O ;; m 0 p m Z D 3� a O O; m \� c I y n z 0 O -� r m � O N m m 130 N 141, 0 m 0 ; a Z z z -1 r m m i c u . . z N 1 c n 0 z 1n 0 m Z 0 3 ->i 0 z m f r. m m> v v 0 � AA � —1 rti 0 0 r- N ol u . . z N 1 c n 0 z 1n 0 m Z 0 3 ->i 0 z m f a m m> v v 0 m> 0 0 r- N ol A ° r m C F C ,_ C> F O it > Z i > Z i D Z r m n -i Z m z x� n z m 0 " > s r 0 Z G1 0 Z cl 0 Z 0 m r m m m m a n n y y 0 Z 0 m > Z O s r -1 s O z m A O ;; m 0 p m Z D 3� a O O; m > m y n z > O -� F \ O x m m 130 N 141, n 0 0 ; a Z z tv r m m i c ? 0 0 y � c 0 *I z m o O ��yy `1 y m Z ° 0 m Q 0 N \ fZ1 r n 0 m 0 Z m A C t, c1 ' + y O W W W m c 3 > m I m O y 9 > z a m a m z 7 m p c c 0 r c v v m i 'p' = i Z y r m p r v N M m m m m 0 '� 0 r 0 z a r O O -1 -� 0 p w C) 0 0 0 z z 0 z p a= � zi v c z 0 �I y A -4> m m C_ r O 0 m m m m m m°< _r m >i 0 0 p m a r a m A m z m m O O O A z y a z 0 0 '1 � 0 � p � }C I I ` � I � m _ x z z r �• � > w r m 0 i i > -1 > Z:, O Q a >y z r a z m - > z M'. x -4 ° m R1 z m I �. � o O ° �`• w o •r, to I> m BUILDING RECORD 1I OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION LA I 8 INTERIOR FINISH CONCRETE PINE 3 t 2 13 CONCRETE BL'K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN. _ 3 BASEMENT 1. AREA FULL FIN. B'M'T' AREA Y. 1/2 % FIN. ATTIC AREA _ NO B M -T FIRE PLACES _ L HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES CONCRETE EARTH B 12 �_ 3 _ _ ASPHALT SIDING ASBESTOS SIDING HARDIV D COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY, BRICK ON FRAME ATTIC STRS. 3 FLOOR (_ CONC. OR CINDER,BLK. WIRING STONE ON MASONRY STONE ON FRAME . SUPERIORPOOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE HIP. BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES >e LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GAS 7 NO. OF ROOMS OIL B'M'T 2nd to C 13rd i I ELECTRIC NO HEATING . 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. " t 1 I t` l .. 1. r t FORM U - IAT RELEASE FORM 1 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. *****************�A�p�plicant fills out this section***************** APPLICANT: (.z 14I -e- , 1t0t& 'S&1 fit•. us JPhone 6R 9- /tZ9ff, LOCATION: Assessor's Map Number r Parcel Subdivision (�&Wt3&.•s [tfllsp a Lot (s) Street m ,_r, )tC f .L- St. Number Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: —TE� Date Approved Conservation Administrator Date Rejected Comments Date A roved - /- 4w—!An Planner P Date Rejected Comments �N Date Approved -9/Z Z. pp owed Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector OCT 2 0 �5 Date M lel 111.1 )IN(; C:()N I :I (VA'1'1()N I ll:AI:1'I I 1'I.ANNIN(; I Yown of NORTH ANDOVER 1 II\'INII IN 1 II- 1'Lili,NNING. & ('00AIMUNITY DEVl;1,01'AU N'1' ATE c )CATION �fl I:AHWN'I 11.1'. NI:I.tiI )N. I,Iltt:(: I ()It CHIMNEY APPLICAI-IOU ANO I'EI3III* d, ? *-5,30 I :!f I rd. 011 ! ,III -i • I r,l fill 1 :%-I If I hl:Ititi;li IIIrx•fl';1IIt'.+P'; .Ilii illill!i•li i!�� • I'LIZrII•I'. � � LINER'S NAME:. ,D C4"vu Ink b ) _ IILDER'S NAME: ' ' ISDNS NAME: 113 u - At/ / w LJi ,v' I SON'S ADDRESS: V) ISON' S TELEPHONE:!! ;TERIAL OF CHIMNEY: ITERIOR CHIMNEY: EXIERIOR CUBINEY: flit BER AND SIZE OF! FLUES: II CK14ESS OF HEARTH: i - :U Chbiney Oh• O(Aepeacc don(jaAm to Mlle UJiMi)(01101 "S u() •ULC Code and have "mcc.3 cull( :gu,ea .cons bee11 %eceZved: -- -- TE:Ar C .GNATURE OF MASON': -RMIT GRANTED: //7 WBERT NICETTAj ILDING INSPECTOR J F L L' „?,�-- -o 0 SPECTEO: -- :MARKS: i SOLID BLOCK REQUIRE D THIS PERMIT f,l[IS i GC U I SPLAYL O OIJ 111E I'KCM SE S /V QTE'".. /�O(ie/DAT/O.a/ LdGgT/O•V F,@drYJ , M 1 2 1993 i2 f1E.�EBY IE.eT/FY TO >�YE T/TLE /.(/SU•PO,PANO �G. O T TD THE' B4 N.Y T.S/g7' T.s/E Oti'EGL/.u6 /S GOC.4TE'O O.V Tf/E Gar.9S S.ff�/I'N ANO T//gT/TOc�S CD,1/FOPA! //�/ %Y/Ti'/ Tf/E TawN' OF !vb• ANDo✓C,C ZON/NG .PE6!/LATi49.(/S REGA.PD/.1/G SETBAC.t'S F�Oif! ST.PEET,S E LOT G/t/ES. "' ��'=T"/+/ /9,vp0 vire/ /%7A,5'S, S FU.�rHE.P CE.PT/FY TN.OT Tii�/,S O.Y'EGL/.Y6 /S �vOT GnLgTEO I -Ile FEOE.PAG 1,0000 h'92AP0 APER, O,iV FO.P SHawN O/S/ i'EM�t' C�ti/MUN Ty /a,4NG.`L '� CdB,QGE•STOc/� ��eass/.vG I>E✓L"Gol��rlE.VT ?-MO 96 0003 c iVOT FD.P Bovv"y Bovvo.4.eYiti.�o.P•rs- /ifE.P�P/rff•9G� E'.vGic/EE.P�.tiG SE.PI�/�'Es ,47-10,V TAKE.(/F X/ST/.(/C .eECO,POS. �G f'-?�P� .ST.PEET ..t:....e u.. u.�. . �sl.... v.:� �..wuw^�'=a:8�'7r7e-�+•F.7i7.• <a��:.c�.�.:�r.r=� _—'� t'._ _ - .:�.c�.....c�.ww,.�,...u......, _ �..r...-. z z z z C') 0 z m D C) z T z CO) .0 a Z Cl) O ar O. _. O v CD%cc CL Qr CD o F—Wam .. CO) -v CD 0 M CO) d O 'v C7� O H C) CD O rl• CD CD y. CD CO) 1- 0 co 0 CD G O �. y O Cr y cCD .a y Wm C7 HpaC) CA .+ � "O'� C y TI C a=C o m CD CA O —1 o m ) CD ,o c ` � --1 0 O y CD ay�w�� O CD y O CD . d � W GO) .:.' I y ?� O. D, O W CZ CDo CA <CC7 y CA < O CD go fAUK =Cot ;t! `ate. 00 E CDo A SIS4641 1* CA 4 .�CD411 -��-Sfit CD co CD A cn cn W 7o cn i = ro m n•n C/)rti In G O m OIt O O O O x n m oda w n. pip Cil pCq w aqq O.. (D r" CL o:71 PTI D w 7C O t� 9 M M �O v 0 c CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 487 Date DECEMBER 2-1, 199-1 THIS CERTIFIES THAT THE BUILDING LOCATED ON LOT 2 - COBBLESTONE CIRCLE #2 MAY BE OCCUPIED AS _SINGLE FAMILY DWELLING W/2 CAR IN ACCORDANCE GARAGE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Cn hh l es tone C r n c c i ng R P,31 t y Trust 0�l o. 733 Turnpike St. ADDRESS Nn _ AnrinvAr MP ~7J.��I1au tier Building nspector 0 m I u -0 m A D z z z v y CACD C7 Cl) Z H Q p n� r ,W � o CL = y aCO -0 � o n CD v CDCL O cr CD CD0CD C CD y� y . p �C C=D 0 C 0 0 z 0 CD 0 O c Co CD c O O CO) G 0 CL CO) c��o m =_ �. CO) O CS CO) �. CD ti aCD o CD C7 0 y C0D . a, = �,O CA CD aim m o Cn O CIA) D _ CD -1% � a 0, c` � �� o Zy. CO2 O CD �y� w W 7 O o CL CDcD C* CD N d y CL a O o cD � Cfl CD CDH y Co tco" oft CD o :A =�w tea•ft CD c.250 4 11 -� ad boA ill 0 z F G m G aq o_ 0 0�1� x w O NIPID wp v w mi 0=3 0 9 O C CD aoloadsul 6uiplm8 i $ Idlol $ aad Iivaaad aayj0 $," 99=1 }ivaaad uoijepunod aad Iivaaad owead/buippq $ ` Aouedn000 jo aleoip}aao a3AOaNd HIHON =10 NMOI abed Pd 14/ 16 PA 'ON uoileool L, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received vale i55ueu. r IMPORTANT: Applicant must complete all items on this page .,�, �^•"-*•,�r.t"•'�-�r..�--xxr,�-�r, y'�r�^ "frt �*"""..�"' F '""' *' � ` q„"".�"�'" r'"r .�....�-...�_� , � . ..,.-r-- T-x+-�r'""-, ,,...� � C f.� ;PR®PERTtYJQWNER / 1 v z Pnnt 100 Y,,e�ar Oltl Structure} wyes o o� D + =HistoncD's£ricty a a1111AP�N0 _/ PARCEL: -5 1, asJ �. _�... - _ Slop�Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family 11 Addition El Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other h.r {� y, 0 Septic ©iV11eIlI tsr `< '47F. 7 W^•tT 'i' u.� • •'.. Citi �1Flood lain7"�O� 'r '' y ? �- '14 lis StK1'V'7 ti fL�i �.+• 1 0� Vllatershed;DYisct A ,•"- , ... �1Wetlantls L =Ji. OWNER: N DESCRIPTION OF WUKK 1 U tat rtKrUKivicu: Type or Print Clearly) z ie,c ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 'Total Project Cost: $ FEE: $ CAJ, u� Check No.: c �9 Receipt No.: 9_� NOTE: Persons contracting with unregistered contractors do not have access to ie gu rano;fund ! ignatuce of Ag "iWOWner ...: Stg:%atu:re of contra:cto�.:.. . Inr.:....a I-1 n...s:r...a 01-4. Of �I nrr�rtnri Dl�nn F] Plans Submitted ❑ Plans Waived -0 Certified Piot Plan ❑ Stamped Plans ❑ . TYPE OYSEWERAGEDiSPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Mas s age/B o dy Art Tobacco Sales Permanent Dumpster on Site ❑ Swimming Pools ❑ ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED - DATE APPROVED PLANNING & DEVELOPMENT ❑ n COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMtNTS Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submifted yes _ Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConnecitionlSignature & Date Driveway Permit DPW Tow ]En�inieer: Signature: nnnhzri 3Rd ncnnnrl Cmnof FIRE 'DEPAI 'Located at •124 Fire Depart COMMENTS 'N - I emp Dumpster on site yes no Street t•�igriatiire/elate • - • • Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: (Movement of Motor location, mast or service drop requires approval of Electrical Inspector Yes No )ANGER ZONE LITERATURE: Yes No AGL Chapter 966 Sec#ion 21A—.F and G min.$10041000 fine 'oc.Building Permit Revised 2010 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 10TE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition OrlDecks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and TWo Family) ❑ Building Permit Application Q Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers, Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products -TE: 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 roust be submitted with the building application Doc: Doc.Bui1ding permit Revised 2012 CA m m m CA m m m X 'o 55 cn Z O O o. CD N O O O CQ O CLW to X CD co 0 N O Q: N S cn CD OO rt !y 2 O O = < N �.CD o Ci 0 � Q O rn o .5 o � °r rD-Ln � sz 0� M ir Cn W D. 'a N p cD 2 7 O O n to CLO N' O gnu 5 rt C (D S �D CD O < to N o 0 0 y 0 c CD U 2 v : n CLQ. co _ N N O CD CD sv W FL �N :E � CIO m C.) 0 =r CD '•' N � c cD N O 0+ CD sv � ci 0 sv O CL L O fD V1 M z W O 3 �+ mq mZ y 70 Z -1C I T 5. N = O 04 S H v, A 700 T j' D/ N O C (DS � O m m m D r N A 0 T :3O Cl � m S 'O C 9 W Z H A 0 T j N (7 _S N x O S m O :3 0 0 3m C ,_ g �? Z N !Q O N m ct N a 3 N W O D O 2 -r-I 2 • � O n CD C) Z N A C D O Z CL .r 0— m n) = It N Q.�= (% cn n to N n O O -s Z v CD Cn C CD O CL cr CD VINZ mocD O W n =bco lz CL N b � cQ cp ;, Cl) I v Z CD 0, r v O GZi c CD z N : O m. O m X 'o 55 cn Z O O o. CD N O O O CQ O CLW to X CD co 0 N O Q: N S cn CD OO rt !y 2 O O = < N �.CD o Ci 0 � Q O rn o .5 o � °r rD-Ln � sz 0� M ir Cn W D. 'a N p cD 2 7 O O n to CLO N' O gnu 5 rt C (D S �D CD O < to N o 0 0 y 0 c CD U 2 v : n CLQ. co _ N N O CD CD sv W FL �N :E � CIO m C.) 0 =r CD '•' N � c cD N O 0+ CD sv � ci 0 sv O CL L O fD V1 M z W O 3 �+ mq mZ y 70 Z -1C I T 5. N = O 04 S H v, A 700 T j' D/ N O C (DS � O m m m D r N A 0 T :3O Cl � m S 'O C 9 W Z H A 0 T j N (7 _S N x O S m O :3 0 0 3m C ,_ g �? Z N !Q O N m ct N a 3 T O Q n : W O D O 2 -r-I 2 MA Home Improvement Contracto n I I1 L!, I�W�I ,�� — License #170810 (Expires 12/23/2013), �YAndersen. i Renewal by Andersen Corporation Federal Tax ID #41-191841 :WINDOW REPLACEMENT an.4,nlrnrnCwm�ryn.' 104 Otis St. Northborough, MA 01532 (508) 351-2200 Fax(651)351-4810 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT i Buyer(s) Name Date: LESLIE FRAZIER - BILL FRAZIER_ SEPTEMBER 5, 2013 I Buyer(s) Street Address, City, State and Zip Code 24 COBBLESTONE CIRCLE NORTH ANDOVER MA 01845 j Email Address Home Telephone Number Work/Cell Telephone Number Bill@protronicscor .Com 978-682-4555 978-902-2590 Buyer(s) hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this i "Agreement"). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 19,452.00 Amount Fl$ 0.00 Est. Start Date . of Yment Method Paounced Deposit Received (33%)$ 6,484.00 Q. Check/ Cash 1 10 weeks Balance Start of Job (33%)$ 6,484.00 Front Deposit (50%) $ 0.00 j Credit Card Est. Install Time Balance on Substantial Substantial Completion of Job (33%) $ 6,484.00 Completion (50%) $ 0.00 2-3 daysIf credit is selected, please see Credit Card Payment Form. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Buyer(s) Buyer(s) By: �itir✓, WcC60 �` u '17 F Signature of Project Manager "Signature -' Signat re TOM WILSON LESLIE FRAZIER BILL FRAZIER 1 Printed Name of Project Manager Printed Name Printed Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTCIE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. ------------------------------I---- ---------------------- - - - - -- i NOTICE OF CANCELLATION NOTICE OF CANCELLATION I Date of Transaction 9/5/13 . You may cancel this Date of Transaction 9/5/13 . You may cancel this trawaLctioo, without any penalty or obligation, within three I transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property I business days from the above date. If you cancel, any property traded in, any payments made by you under the Contract of Sale, I traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed by you will be returned I and any negotiable instrument executed by you will be returned within 10 days following receipt by the Contractor ("Seller") of I within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of - I your cancellation notice, and any security interest arising out of the l the transaction will be canceled. If you cancel, you most make I transaction will be canceled. If you cancel, you must make 3 available to the Seller at your residence, in substantially as good 1 available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you order condition as when received, any goods delivered to you under this this Contract or. Sale; or you may, if you wish, comply with the I Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the I instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods I 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 I available to the Seller and the Seller does not pick them up within . 20 days of the date of your Notice of Cancellation, you may 1 20 days of the date of your Notice of Cancellation, you may retain retain or dispose of the goods without any further obligation. If I or dispose of the goods without any further obligation. If you fail you fail to make the goods available to the Seller, or if you agree I to make the goods available to the Seller, or if you agree to return I to return the goods to the Seller and fail to do so, then you remain I the goods to the Seller and fail to do so, then you remain liable for . liable for performance of all obligations under the Contract. To I performance of all obligations under the Contract. To cancel this cancel this transaction, mail or deliver a signed and. dated copy _ transaction, mail or deliver a signed and dated copy of this of this cancellation notice or any other written notice, or send a I cancellation notice or any other written notice, or send a telegram telegram to Contractor: Renewal by Andersen, 104 Otis St. I to Contractor. Renewal by Andersen, 104.0tis St. Northborough, Northboroueh. MA 01532, BY NOT LATER THAN AIIDNIGHT I MA 01532, BY NOT LATER THAN MIDNIGUr OF 9/8/13 .(Date) I HEREBY CANCEL THIS TRANSACTION. I OF 9/8/13 .(Date) I HEREBY CANCEL THIS TRANSACTION. I II I BUyer's Signature Print Name Date I Buyer's Signature Print Name Date I 1 Renev�ral Renewal by Andersen Corporation MA Home Improvement Contrato bvAndersen: 104 Otis St. Northborough, MA 01532 License #170810 (Expires 12/23/2013) 'winnow REPLACEMENT (508)351-2200 Fax:(651)351-4810 Federal ID #41-1918413 Window Specification Sheet Buyer(s) Name Date of Agreement LESLIE FRAZIER - BILL FRAZIER Se tember 5, 2013 The buyers) listed above herebyjointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which the Specification Sheet is part. WINDOW DETAIIS Style Pull / United Exterior Interior Hardware Hardware L FA / Grille Grille Temper/ Room # Style Detail Inert Inches Casings SiRs Color Color Color Style Screem Smartsun Grilles Sash 1/3 Sash 2 Lifts Laminated Front 14 DB:S uare Equal Insert 90 No Slo ed CV CV Canvas Regular FFG Low -E4 GBG 3/2 No No Bath 1 2 DB:S uare Equal Insert 90 No Slo ed CV CV Canvas Regular FFG Low -E4 GBG 3/2 No No I I I Total 16 BAY & BOW DETAIIS *See Ba /Bow Measure Sheet. Style Detail / United Approx. Nsmhbcr Exterior Interior Center LowE / Roof / Hardware Room Count Style Flanker, inch Casino Angle Lits Color Color Grilles End sashes sashes Screens Smarmin Soffit Color Pull / United LowE / . ADDITIONAL WORK DETAEL NOTES Room Count Style Insert Inches SmartSun Grilles Grille Style Replacing some rotted casing boards on the front and back. No Tax I ADDr1'IONAL WORK DETAIES 1 No Qty of 0 Sills 0 Sill noses to be replaced by Contractor. 2 No Contractor wil remove metal frames of windows. 3 No Contractor will install new 0 paint -ready or 0 Stain -ready 0 Interior 0 Exterior casings in 0 Pine 0 Maintenance -free material 4 No Contractor will install new 0 paint -ready or 0 Stain -ready 0 Interior 0 Exterior stops in 0 Pine 0 Maintenance -free material 5 No Contractor will wrap exterior casings with coil stock of color. 6 Owner is aware that Contractor does not do any painting/staining or removaldinstallation of alarm system/hardware. It is the responsibility of the homeowner to have the alarm system/,hardware removed prior to installation. Customer is aware in some cases there will be glass loss. If there is, the amount will be dependent on the type of eadsting windows, type of installations insert or full frame and window style, We make no guarantee as to the amount of glass loss. Customer is aware and understands any and all unseen rot is not ct. Should. Itnoy rot he found them will be an additional charze for time ainif materials unless so stated in this contract. 7 Yes Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. Removal and disposal of all job related debris, windows, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued. B Yes Building Permit --Contractor will secure any and all necessary permits. The fee for the permit(s) is not included in the Contract Price and a separate check is required at the time of sale for this fee. Check # 663 S 195 9 Yes' All discounts have been applied to this agreement. 10 Yes Q No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment / finance form(s). €€It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Andersen Corporation Buyc{s) Buyer(s) By Signature. ` TOM WILSON LESLIE FRAZIER BILL FRAZIER - Print Name of Project Manager Print Name Print Name Renewal by Andersen Corporation Renewal; • Massachusetts 01532 MA Home Improvement Contractor 104 Otis Street Northborough, MA License # 170810 (expires byAndersen. Phone ( 508 ) 351-2200 • Fax (508 ) 986-7072 12/23/2013) � Federal Tax ID# 41-1918413 ���i �� ���� WINDOW REPLACEMENTanAndesenCompany Credit Card CONTRACT AMENDMENT This Amendment ("Amendment") is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ("Agreement") by and between Renewal by Andersen Corporation and William Frazier ("buyers"). Contractor and Buyer(s) hereby agree to amend and modify the Agreement as indicated below. Other than as specifically indicated below, all the terms and conditions of the Agreement will remain in full force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following additions, alterations, or deletions to the products and services Buyer(s) ordered are being made: Adding 4 Double Hung windows to the order. As a result of these changes, the following terms of the Agreement are also changing (if there is no change, an item will be left blank or marked as "N/A", indicating that no change applies: NEW Total Job Amount: $24,312.00 i Payment Method: New Deposit Received (33%): $6484.00 Received Credit Card New Balance at Start of job (33%): $8914.00 Check/Credit Card New Balance on Substantial Completion of Job (33%): $8914.00 Check/Credit Card *Please Note- Your job will be delayed until amendment is signed and received. It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding be- tween the parties, and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby acknowl- edges that Buyer(s) has read this Amendment and has received a completed, signed, and dated copy of this Amendment on the date written below. Renewal by Andersen Corporation By: Signature of Product Manager Tom Wilson Print Name of Product Manager Doc ID: 20130920113405485 Sertifi Electronic Signature Buyer(s) Signature Date 9/20/2013 E -Signed : 17`3/23/2013 08:32 AM CST William Frazier Date bill@pratronicscorp.com tR: 108.49.255,62 The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street -Boston,,AM 02111 www. mass gov/dia Worker's'. Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aanlicant Information Please Print LeAW Name (Business/Orga!&ation/Individual): �6, o eco C. \p Address: V6 y S� City/State/Zip: ! y o (`kVN \OoN , N%A ® M.Aone #:-5-0 9 - 35 ( - fir} 06 Are you an e,`mployer? Check the appropriate box. 112r,11, am a employer with 7 4• ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6 ❑New construction ' 2. F1 am a sole proprietor or partner- listed on the attached sheet. 7. Q-I(emodeling ship and have no employees These sub -contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance required.] comp. insurance.: P• 5. ❑ We are a corporation and its � 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumliitig repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required;] ? ' c. 152, §1(4), and we have no 131–Other employees, [No workers' comp. insurance reauired.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. $Contractors 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 am an employer that isproviding workers' compensation insurance for my employees Below is the policy find job site information.' 4 Insurance Company Name-_D1 Policy # or Self -ins. Lie. #:_ �w c, (_)6 ,3S -q .06- Expiration Date: Job Site Address a jL City/State/Zip: 8� ✓'' 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. Ido hereby certl/y under thepains andpenalties ofperjury that the information provided above is true and correct V F Phone #: 'V Se, 3cS/ — d- a'-0 e Official use only. Do not write in this area, to be completed by cityor 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 #: A� D CERTIFICATE OF LIABILITY INSURANCE DAT 0"/20"3"' POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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: H the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 1-612-333-3323 Hays Covaniee 80 South 8th Street Suite 700 ' CONTACT NAME: PHONEIM.No,612-333-3323 FAX No: 612-373-7270 E,�LL ADDRESS: INSURERS AFFORDING COVERAGE NAIC0 Minneapolis, MN 55402 INSURER A: OLD REPUBLIC INS CO 24147 OMITS INSURED Reneval By Andersen Corporation INSURE Re: NATIONAL UNION FIRB INS CO OF PITTS 19445 INSURER C : 104 Otis Street INSURER O: INSURERE: Northborough, MA 01532 INSURER F: R COMMERCIAL GENERAL LIABILITY THIS IS TO CERTIFYTHAT 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 TYPE OF INSURANCE SBR POLICY NUMBER POLICY EFF POLICY EXPmaunotnnm MM OMITS A GENERAL LIABILITY, MNZY 300361 10/01/1 10/01/14 EACH OCCURRENCE $ 1,000,000 R COMMERCIAL GENERAL LIABILITY 7ADDL DAMAGE TO RENTED 500, 000 REMISS ocanenoe $ MED EXP (Any one erson) $ 10, 000 CLAIMS -MADE a OCCUR PERSONAL AADV INJURY S 1-000,000 GENERAL AGGREGATE $4.000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOPAGG $4,000,000 R POLICY 'PRO• LOC 5 �► AUTOMOBILE LIABILITY PINTS 30002610/01/ii 10/01 1 COMBINED SINGLE LIMB R 5,000,000 BODILY INJURY (Per person) $ ANY AUTO -ALL OWNED SCHEDULED BODILY INJURY (Per Kddent) S AUTOS AUTOS WON -OX HIREDAUTOS X AUTOS ED AUTOS PROPERTY DAMAGE $ JEM aoddent s B X UMBRELJJILULB X OCCUR 20562235 10/01/1 10/01/14 EACH OCCURRENCE $ 25, 000,000 EXCESSLUI9 CLAIMS -MADE AGGREGATE $ 25,000,000 DED I R I RETENTION$ 25,000 S A WORKERS COUPE NSATION EMPLOYERS!=ILLTY MNC 300359 00 10/01/1 10/01/14 RWCSTATU- 0AND TH- ITORYLIMITS FR YIN ANY PROPRIETOR/PARTNER/EXECUTNEE.L. OFFICERMLEMBEREXCLUDED? Q NIA EACH ACCIDENT $ 11000,000 (Mandatory in NN) K s, desvite udder E.L. DISEASE - EA EMPLOYE S 1, 000, 000 E.L. DISEASE • POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allooh ACORD 101, Additional Ren uks Schedule, N mom specs Is mqulmd) To TrhOxa It May Concern For Insurance Purposes Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 AGURU 25 (2010105) The ACORD name and logo are registered marks of ACORD Jhargrove 36122490 All rinMn r a.—A c l%n- Tpoaninwau�eal�i o�C��aac'�iu�b � —9�1MCC of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR I egistration: 1`7.p8'10 ., Type. Expiration: -1212312013 Supplement RENEWAL BY ANDERSON CORPORATION t t JOSEPH REZZA j 104 OTIS STREET NORTHBOROUGH, MA 01532 Undersecretary i I Massachusetts - Department of Public Safety Board of Building Regulations and Standards . Construction Supen-isor , License: CS -065272 z JOSEPH P REZW --- '•�. 168 KELLEY BLVD s N ATTLEBORO KA s 9546 - Expiration Commissioner 04/25/2014 I ' N Staple oideis. Permit NO: / 09— 1 5 0 j l Date Issued: /01 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received PORTANT: Applicant must lete all items on this LOCATION te--� `•-i (-O-V1O�S(iC Print PROPERTY OWNER L ifs I i (? t'7 Print MAP NO: PARCEL ZONI=NG DISTRICT: Historic District yeno Machine Shop Village ve no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ILae family Addition ! i Two or more family Industrial oo�Afteration_ No. of units: Commercial Others: Repair, replacement 7 Assessory Bldg Demolition I' Other 0 Septic 0 Well 0 Floodplain D Wetlands 0 Watershed District 0 Water/Sewer I Identification Please Type or Print Clearly) OWNER: Name: Address R Name: <4-Uv5A Address: Supervisor's Construction License: Home Improvement License: Phone: Phone: =__ 4 -M Exp. Date: Exp. Date: ARCHITECT/ENGINEER Phone: Address: I Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost:l $ _��-{ �� FEE: $ 4 Check No.: 1(/. -4 -t Receipt No.: NOTE: Persons contracting with unregistered contractors do not'have access to th ghtaranty fund { .. Signature of Agent/Owner Signature of contractor e - �--- z4e�I s, Location &q ccl Q. -TDVK (/L Date��� No. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $— Foundation Permit Fee $ t Other Permit Fee $ TOTAL '3 ' Check. # Building Inspector Permit No#: Date Issued: LOCATION `f BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑ Addition El Two or more family ❑Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg_ ❑ Others: ❑ Demolition ❑ Other ' -`Q Septic D>Well } ❑Floodplain ❑ Wetlands ❑ . Watershed District p'Water /S'ewer DESGFZIF I IUN Ur vvUKn 1 v ac rr-mrvnmw. Identification - Please Type or Print Clearly OWNER: Name: Phone: I-%UUI GOJ. Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp Home Improvement License: Exp Date: Date: ARCHITECT/ENGINEER Phone: Address: I Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting hzth t4;registered contractors do not have access to the guaranty fund Plans Submitted ❑tet Plans Waived ❑ Certified Plot Plan ❑r 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 ❑ v THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &gate Driveway Permit DPW Town Engineer: Signature: <� Located 384 Os( AFIRE DEP#�+ NT ,T m pg, �, RTMET t� pt ► umpstera�onisite 'esu >. �a.� Lo ated at124Mamtr ei Fire De mentsign v tura`%dates -- ,fP,Part^f - , 1J 7i ,.1, 4p C0MMENTS� Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector yes . No DANGER ZONE LITERATURE: yes MGL Chapter 166 Section 21A—F and G min.$1o0-$1000 fine M Doc.Bnilding Pennit Revised 2014 J 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) � Building Permit Application 4 Certified Proposed Plot Plan 6 Photo of H.I.C. And C.S.L. Licenses * Workers Comp Affidavit * Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 I ECC Energy code Engineering Affidavits for Engineered products TOTE: 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 U 0 Z O Cr 2 C ,a> to O O v CL Cr (D O' W 03 a v o (DI n O C cn o �% v a)__ cCD n � C1 0 0 0- 0 3 m o �-0 y o OQ• h —w�m W D• CD H cn p •.� CD 2 Q• 2) •O' CD O O Cl) to N O fl1 O h n 3 n CD O o O < (Q y, rt O S O 3 U) — COW, .A O n03 CLO —lun) O < N O �, �CD CCD D U) rC U) 0 m n o ' O CD CD O O tR � I O N f7 OO4L i, DCD (D o o as o C 0 � z 0 e V1 N WT x T N Pp T PO T (") ;;a T VI T 3 O (D fD (D 1 (D m' c m MI D m Z 5' IIl O C S yF H z cn O j, N O O C S m r- y r- m o ry O N O C Q S M rl(D W m -I � �' S 7 O C S O C r? O W M n O ry (D "6 n O 3 O O \ n S . O > v O m = Federal l0 # 05-0405829 RISE Engineering RI Contractor Registration No 8166 MA Contractor Registration No 120979 A.division of Thieisch Engineering //r %i %j/ % //0 60 Shawmut Unit #2, Canton, MA 02021 339-50,2-6335 CONT RACT 'm?'%�%''! FAX 339-502-6345 R I 7Page 1 PIt4GRAM THIS CONTRACT IS ENTERED INTO BE'T'WEEN RISE CUSTOMER FOR WORK AS Il~NG1hi)gER,1K CMA-HES NEERINODESCRIBED �� 'CUSTOMER PHONE DATE CUENT0 WORK ORDER Leslie Frazier (978)6824555 05/28/2015 415118 00002 SERVICE STREET BILLING STREET 24 Cobblestone Circle 24 Cobblestone Circle SERYlCE CITY., sTATE. ZIP BILLING Cm, STATE, ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for scaling include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) (8) working hours. At the completion of the weatherization--work, and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER: (4) working hours. $340.00 ATTIC FIAT: Provide labor and materials to install a 14" layer of R49 Class l Cellulose added to (20) square feet of floored attic space. $42.00 DAMMING: Providejlabor and materials to install a 12" layer of R-38 unfaced fiberglass baits to (58) square feet for damming purposes. $1'18.90 ATTIC.I:LAT. Provide labor and materials to install a 6" layer of R-21 Class 1 Cellulose added to (935) square feet of open attic space.SEE DIAGRAM!!! THIS INCLUDES OVER MAIN ROUSE AS WELL AS MASTER BED+BATH EXPOSED SLOPE AND VAULT! 51,178.10 KNEEWALLS. Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to (248) square feet of kneewall area. $868.00 KNEEWALL FLOOR: Provide labor and materials to install a 6" layer of R-21 Class 1 Cellulose added to (136) square feet of open kneewall.floor,.SEE DIAGRAMM THIS INCLUDES OVER MAIN HOUSE AS WELL AS MASTER BED+BATH EXPOSED SLOPE AND VAULT! $163.20 ATTIC ACCESS: ProWide labor and materials to insulate the back of (1) attic hatch with 2" rigid Thermax board. Weatherstrip the perimeter. $60.00 ATTIC ACCESS: Provide labor and materials to make (1) temporary access to an attic area. The opening will be closed with materials similar to those existing. finish sanding and painting is not included. $85.00 VEN 11 ATION: Provide labor and materials to install (I )insulated exhaust hose with gable wail mounted flapper vent to exhaust existing bathroom fan(s). $118.75 RISE Engineering will apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measure, Columbia Gas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 1000% for the Air Sealing measures up to the first $680 and an additional $340 if savings are justified by the auditor. Federal ID # RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielseh .Engineering CT Contractor Regisbatton No 60 Shawmut nit 02, Canton IMA 02021 CONTRACT" %i0111;, 339-50U335 FAX 339-502.5313 Page 2 R I S E PROGRAM THIS CONTRACTtG ENTERED MO BEVNEEN RISE ENGINEERING CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCFUM BELOW __,......._,,._............ .........�._...�,_..v.._„W..__,_,....._........._......._._...,_....,...._,_.,,......_.....__......__...,...,......_.................._.,...___._... _............. ... PHONE ,__...._..._._..._..._._...,.._,..........__,_.._,..._.,.._.m.,_.�........_...._.__w.�.._._.._..,,,.....,..._ CUSTOMER OATH CUENTS WOAKOROER Leslie Frazier (978)6824555 0512112015 415118 00002 SERVICE STRW INUUNG STREET 24 Cobblestone~ Circle 24 Cobblestone Circle ................ ..__._.. _.__..,.__. _ —_, _.,..._.__.... _.._......__._._ _._.._ W.__ _..,__ _..,,.___._.._.._........._..._ 8ERVK0: CfTY,8TATE.TIP WWNG CITY, STATE, ZIP North Andover; MA 01845 North Andover, MA 01845 _..__...._................ _...__ ...__....__ .........._.._ _..___..,....._,,..._......_ ...__. _._......... _ .. i JOB DESCRIPTION For the safety and health of your home's indoor air quality, we will be conducting a blower door diagnostic of the available air fhnv in your home both before the work is begun, and after the weatherization wort is complete, We will also conduct a full assessment of the combustion safety ofyour heating system and water heater. This has a value of $90 and is at no cost to you. Total allowable weatherization incentive is $3,1 10. $90.00 I EERV MAY 2 2 2015 Total: $3,743.95 Program Incentive: $2,990.00 Customer Total: $753.95 WE AGREE HERESY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. r-OR TME SURF OF """Seven Hundred, Fifty Three & 95/100 Dollars $753.95 UPON'FINAL PECTION AND APPROVAL BY RISE ENOWEERING. CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1% WILL BE CHARGED MONTHLY ON ANY UNPAID 30 DAYS. SE!REVVpE FOR IMPORTANT INPORMATKNI ON GUARANTEES. RIGHTS OF RECISION. SCNHODUNG. AND CONTRACTOR REGISTRATION. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 8IGNA AYp CUSTOMER ACCEPTANCE . _. NOTE: THIS CONTRACT#W BE LNTHDRAWN BY US W NOT VMCUTEO WITHIN DATE OF ACCEPTANCE... ...........--_ ._ .t._/._._..........___,...,,._...—.._.....,,,_.......,,.,,,,,.... ACCEPTANCE or CONTRACT. THE ABOVE PRICES. SPECIFlCATIONB AND CONDmONS ARE 90 DAYS. SATMFACTORY TO US AIS ARE HEREBY ACCEPTED. YOU ARE AUTHORM TO OOTNEWORK AS SPECITIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE i sr n��� .»>k.»ritrs;rne�r���.i�n�ra :e.avescx�►y t - c - r r L S r a_Lr c'._ _ _ c c p;A,f;§cD cG'✓E rr"G Tr-, PO 1CY PERIOD T HIS IS TO CECTiF'Y T t,=.T "HE POLICIE- OFF III URA.N E I ; E� �_ JJd H;�'JE 2EEf: IS Ut TC , ric INSU. _G Jt':iJJ{v<. J'r"�`-r"•: ,r•� ��rryy '['y ty (fi- #{ jt��'�� a j{_ � j( (�1�( CERTIFICATEY IN 'ISI" THIS CERTIFICATE IS ISSUED AS, A iJATiER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE A FORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSUPANCE DOES NOT CONSTITUTE A CONTRACT BETy'JEEN THE ISSUING INSUR.ER(S), AUTHORIZED REPRESENTATIViE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(Jes) mus, be enddKed. It SUEr'GGr".TIGl1 IS VvAIVEv, subject to the terms and conditions of the policy, certain policies may require an endorsernent- A statement or, this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COtJ i;.CT PH6 t8et; 761' ?'-' I F^)' cClu-;63-CI Aon i:iSl: services, Central, inC.. SOUthifi e l d M7 office IAJC. No. Ertl E -MAIC '000 Tows. Cen C r; r Suite 31000 ! :DDREs'S INSURMS) AFFORDING COVEPAGE NAicI SGUtf.rJeid M:I 48()✓ UtiA I{JS:h2ED INSURER;. Did kepubllC n;.ur;,�nCc Compur:y 11414' NSURERE .ndemnil tj' inSUratiCE- CG ul I.Cr L;: Artier"ICc :.%J r Builder Services Group. ]rlc. d/b/a QualiTy Insolation - IfJSURErC - A^': 'iCi1IJ:r �) 1661 A M. -SCO Corporation Company INSURER Act i?r-( U'1Gc7"r.'ritir; n5urarle CG. AIG P'?r-!{ileie! Prjad kasha Nr' 0:()63-ii01 US HSURER E 11J5URER E: I I _EtJE= . AGGFcv.T.=~' sr n��� .»>k.»ritrs;rne�r���.i�n�ra :e.avescx�►y t - c - r r L S r a_Lr c'._ _ _ c c p;A,f;§cD cG'✓E rr"G Tr-, PO 1CY PERIOD T HIS IS TO CECTiF'Y T t,=.T "HE POLICIE- OFF III URA.N E I ; E� �_ JJd H;�'JE 2EEf: IS Ut TC , ric INSU. _G I{` DC 0I ,TED. PNOTV'JITtiST,'.NDITJG AN''Y REQuIR..ENcNT, TEP!?•/1 J}�'�. CC)t1--r;j7jjW Or kln' CJti'in:�.C7 OR, rT .Er v0':UMEi�7 .,+r ?cEPcCT'��'✓v;:. 'ISI" CERTIF ICATE tJ:r,Y BE ISSUED OR hr::•.Y PERT L.11.1 THE INSURANCE- F.FF0RDE B'! THE �'J_ICIEc LESCrI°ED HEREV, ISrSuE:JECT TG r._- T"r.E TERNS F, CLUS10pC kNrv O,^uJJITI%Fc OF SUCH PGLCIcZEC. SHOWN td A.`:ur JE �__._ 1 . FErCEM 6Y PAID CLAIMS Lnft: sho:: arc Ps requested, ( T:: TYPE 0= INSURA+ICE I :riJ.', JIJSD: i PGJCY neUk. PY POLICY -:-: IFtfaD'ff/1': I rPni6;Dprfr:^•'a A i }; COU,MIERCIAL GENERAL L,JA2iiiTY,EitC;E:,DGG,GI.+J� ^ 'i.l!•tSkhF: :.E vG._J'r � I i, I _,e 110srE iE.—tren:cr.i `-%,000,0001 �' it. i i ftED .. y �. �,,. paraoc; I c , c 00'0' I _EtJE= . AGGFcv.T.=~' SS.GGJ.{IJU I GEw nGGc'� -�: iIAF.:" APP: FEr r. 7: Y'r LGG S 1C, GGG. GUU II ?" I A:1T0{F,OB4LE LLQh-{TY kt.vF1L 'J� -.':ti jCj'-'.�'.�,-j_4 J. I 'I {':Y A„T;, I BOL! 1 'Up P-perbGA; r J_J A-, - n,r __C SCH_ I i i -ODIL" IIiJU'?' :Pe' i-,LI;OS 1 A.IIT G_ X HfrtED t.UTCS i F :,J7C.5 � j UMBRELLA LJAB I i O•C JR I i EACH CAC'-! OC : EXCESS LIA-, !I C:AIiJS-'✓:.A;/c tii S Ni:1R3CERS CGiFPEi�SAT'Oru AAtC �--rS•:L ' RCS f,Eb•1 .•, CEr,,:.•�_..Ii: i,: �,, •!<.._ >. _�_ -_ � O I IS; I-- Y EM-LOYERS' L!ABILM Iy. _ II Y i i OP{ri(iN -EY-��'.l'..L I!T.I'' e_LC'_;10F,.. 4 02 :L•,/7,.lp�,' .. _l. c - H, f I.00b, 000 C -J=: ='C1�+.i,:aE�+.n£i•E>;:.u;;! =., r:._ RC%$88 .. - - torys NH1;! D=d - CA., t!•. ' 11 yts :^SG^bC i1nC I C c : C; -. _ . _ ... Aa .P .o-.:; •: ih?i" �: S ..00C., DGG - OF, SCRIP' ERFI _ uic C EY.CeSs rW.. I IY10jC'i88843C', iGn;'Ili;<V1-'OS,-.G; .._ De 4jctile S2,000.000 I Selr-?nSurfC ::eiCS _?r -r included i STR applie.S per pol^C',• 1Prn15 & CC•nd'(i0':5 I' DE 5CRJR TON OF OPE RAT TONS i LOCATIONS i VEHICLES IAC ORD 1C;, Add,aonal Re,-.. kL 5. hec.11, may ix zr;aches it mom apace a r; puredl E•d'idenCi. G? ;nSUranCE- ---------------- CERTIFICATE HOLDER till- trjer Ser-vite5 Group. incl. dir. ouiri-iy insulation .r, ue5tn Corpora; on Company, 113i, Perm'ieTe- Road INa[hu2 ,'•t{i 0306-3, USA `l5 t....a CANCELLATION SHOJ!-D .Cr,^' OF THE ABOVE OESCRi2ED POLI�iE_; Elf CANcELLED BEFORE; THE: 'cnP{R?.TIOrJ DATE TIi`REO= fJ0?ICF: VALL BE MILWEPED L' ACCORDANCE Vd;T F. iii£ �. FGL1dY PF.O`>I530N5. aCIT HORL%EG F,EPRF.SENTLAVF. r Oc I988-2014 ACORD CORPORATION. All rights reserved. ACOFZZD 25 (2014/01) The ACORD name and Toga are registered marks of ACORD � AGE: tCv: CLI STOW tt1: 570000027887 �----ADDITIONAL RBOIARKS SCHEDULE ttrt Rini SerVICeS CenTral, Inc. POLICY NUMETP See Certificat:!e rturriber: 57GJ54GCI 2>? CAR:i1E R See CertifiCate Number: 570�40)261 ADDI t d0trA!- REIVARKS THIS ADDITIONAL REMARKS FORK; IS A SCHEDULE TO ACORD FORM, I FORrO NUMBER: ",COPD 25 FORM TITI E' Cendicale Of L lab!li':y insurance. INSURER(S) AFFORDING COVERAGE 1 r dr_ Du±� — r _ 2 po11 L: I)Clif+': dOCS 11i,i ,r: Cllii;!- li;7a! i'i1!-Irilt iii h;i?. l'4 (_i il. i1 :.�.._1.il,i:iu!^. �� ��,.i l:. ., t;lt Ihc: ^•,( tlr: ii � ccriitir:ztc Iz,rnSt�lr •rv!Ic�: lin-,;,_, - 3:tiSi2' TP l.Tfi 1'_. f)r I\'Sl:iiatit: E'. ACii1i.�5t!Li ll 1 DATI 1.IN17 v'GRt,£A5 COwa=ra�;,TrU^: 11; !+1 •T>Li^.'S'Y\ I �h1'N'(tii'S"5 S 1 v,? On ; y' B ',;(.Rz-.4�Er842, + Or, J li 3j3 i 3 i � 9 1 l )7 I i ACOPO 90; }29riml) Z, 200E ACORD CORPOP,4710!v. AV rigiEs rexerved, ihP ACORD name and logo are ragis:eretl marks of ACORD V lhe , teguationll ice of ConsumeiAlH aks Al �nd Business R' 1-0 Park "laza - Suite 5170 Boston, Massachusetts 02116 1 Home Improvement ContraCtor Registration Registration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC. Expiration 6/2512016 RICHARD SCHWARTZ 110 PERIMETER RD NASHUA,'NH 03063 1 1!'pd2t-- Address and return card. Mark reason for change. Addres� keneF%;fl Employment Lost Card vilice 4A Consumer A & Busintss Regulalion License or registration valid for individul use onk ki-OME IMPROVEMENT CONTRACTOR before the expiration dale. If found return to: 0 fifi c e of Co n s urner Affairs and Business ReTwlaiiori Registration: 179141, Type 0 Kar"- Maza - Su to 5 � 70 Expiration: 6J25/2016 Supplement --a.,d Boston. MA 021 R) JILDER SERVICES GROUP, INC. CHARD SCHV�JARTZ 0 JIMMY ANIN DRIVE �.YTONA BEACH, FL 3211 < Not valid without sigw!iure \ ƒ b Code End