HomeMy WebLinkAboutMiscellaneous - 283 CAMPBELL ROAD 4/30/2018 (2)CD
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FORM U - LOT RELEASE FORM kA Vq 19 1- 1-
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INSTRUCTIONS: This form is used to verify that all necessary approvalt/pe(mits'from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
I ****** *** *'"APPLICANT FILLS OUT THIS SECTION 0
APPLICANT 1k0t, r6et "I'SIX W "STftcT'LkA PHONE q_ft S14 --1-24S
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT (S)
STREET 2—f3& (A(W4106ftL ST. NUMBER
CO
)q
*****OFFICIAL USE ONL
AGENTS:
DATE APPROVED %
DATE REJECTED_a.. f-5 2=6n!��
TOWN PLANNER DATE APPROVE
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
/1/, ce, /' . �( A /?__ .'J DATE REJECTED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT,
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR ---DATE
Revised 9197 Jm
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUELDING PERMIT NUMBER: ISSUED:
SIGNATURE:
Building Commissioner/Inspector of Buildings Date
SECTION I- SITE MORMATION
1. 1 Property Address:
2&S CtW6t--z(-
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (ft)
1.6 BUHDING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide ReTfired Provided
Required Provided
% 1 68 oi3
�/ -
1.7 Water SupplyM.G.L.C.40 54) 1.5. Flood Zone Inform2tion.
Public 0 Private ti� Zone - Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT
r1i6LOric, D—IsFct: Yes.—Njo
2.1 Ownerof Record
-n" I � *1Jr T-SrW tleT Cbapstu 4,�w
Name (Print) I NJ Address for Service
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
\/j , 71)� Hzw
Licensed Construction Supervisor:
Address
ALt,f 14
Signature As)�e� Telephone
Not Applicable 0
O -S 435!47�
License Number
2-&-46'
Expiration Dafe
3.2 Registered Home Improvergent Contractor
W h
Not Applicable D
Company Name
Registration Number
—6 f 9-01
Expiration bate
Address
Sionature
R
I SECTION 4 - WORXERS COMPENSATION (MLG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
–in the denial of the issuance of the buildinE permit.
–Signed affidavit Attached Yes ....... 0 No ....... 0
SECTION 5 Desciriipoon o Proposed Work (cheftvck appKcable)
New Construction h/
Existing Building 0
Repair(s) 0
Alterations(s) 0 —71—tion
0
Accessory Bldg. 0
Demolition V
Other 0 Specify
Brief Description of Proposed Work:
CCU S-4 )�K I e, -n Al Z I'
>tmc Lou-mcw I X
14,_) 16al) JiTnN rLM,?Z 1AA
LAI QbA-2,
0-NP-kWA,
SECTION 6 - ESTEVIATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed bV permit applicant
OFFICIALUSEIONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
CZ
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIILDING PERMIT
I , as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, m all matters relative to work authorized by this building pennit application.
Signature ofOwner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, W as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
VJ I LL, I a -t -A 'hw U_m V7'Y i,
Print Name
Si tL f n Date
NO. OF STORIES SIZE
BASENENT OR SLAB
SIZE OF FLOOR MIBERS sr 2x"5 3PD
SPAN
DINENSIONS OF SILLS
DIN4ENSIONS OF POSTS
DlIvIENSIONS OF GMDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHININEY
IS BUILDING ON SOLID OR FII�LED LAND
IS BUffD19G CONNECTED TO N.4TURAT GAS T LNE
ONTRACTORS INVOICE
C' t t b t) P- - -
WORK PERFORMED AT:
CitmPeLaL
JOURBIDNO.
All material is guaranteed to be as specified, and the above work was performed in accordance with the drawings and specifications
provided for the above work and was completed in a substantial workmanlike manner for the agreed sum of
--Dollars ($22, 2 6S - co
This is a El Partial VFull invoice due and payable by: %
Month Day Year
1 0
in accordance with our Q /Agreement El Proposal No. Dated S &P '
NC3822 Month Day Yearl
CONTRACTORS INVOICE
This form satisfies all basic requireincritsof the Home Imprxivernent ContractorLaw(MG1, chapter 142AI but does not indude standard
12nguage to protect homeowners. Seek legal advice If necessary. Any pes Planning ham improvements should lirst obtain a py of 'A
co
Consumer Guide to the Home Improvement Connector LW beft agreeing to sr�y work on your residence. You way obtain a free copy by
calling the Off'- of Consumer Aflans imd Business Regalimm's COM= Informatiort Hatime at 617-727-7790
Homeowner Information Contractor Information
Name
Name
-q?�q I /�W g, -Tse- tftea-
Ed
4 OC 4
Zoo
Strect Addiess' (do not use a Post 011ice Box address)
CoutractudSWeVersonl0wocrName
2�� (,0zXPV.,, ac e CQ
,�---Avx-
Cityrrown suft zip Code
Addrcic;
�, hwauyw- �em, c� 4fU "
0. 0
Daytime Phow Evening now
,17* - q -Ts --
Cityfr—
hsa-)Ave
state Zip Code
0-1210
Mmiling Address Ot difiercut figm above)
Bmin=FOM
1—K&W Em� ID or ba
INA) A
L"
The Contractor affm jZwork rtheHomeo=:*-M,---1-
t cz e -
Required Permits - The following building permits am required Proposed Start and Completion Schedule - The following schedule will
and will be secured by the cotitractor as the homeowncr�j ggett, be adliened to unless circtimstanocs beyond the contnicnies Control arise
(Owners who secure their own pennits will be
excluded from the Guaranty Fund Orovisions of Skt2i* 2:�(&+When contractor*will been contracted worL
MGL chapter 142A.) 2jciC-�
f'I � A IF1% 228" Dift: contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work furnish the material and labor specified above for the toWs-3f3S,6-4S--Cn
Payments will be made according to the following schedule: Rio e��:*
X M upon signing contract (not to excee� l/3 of the total contract pric� or the cost of special order items, %yWchever' greater)
2-64 2ZC4 2-T
S byW /_�o jcpt upon completion of 9*,,o Ca 4: sis
s -12- So b#&/ S -14-p-T
LOS _15 L2�4 upon ca-picuo Of
S -D I S06, upon completion of the contracL (Law forbids demanding full payment until contract is cmnplexd to both party's satisfaction)
The following matetial/equipment must be special S tA 14 to be paid for Lk i
ordered before die contracted work begins in order to be paid for
to meet the completion s6edWc.(**)
NOTES: (0) Including all finance chsrgesj�04) Law requires that any deposit or down-payment'required by the contractor bafm work begins may
not exceed the greater of (a) onethird of the total contract price or (b) the actual cost of any special equipment or custom made material
which pust be special ordered in advance to mcat the completion schedule.
Express Warranty -Is an express warranty being, provided by the contractor? No Yes (in terms of the vmrmnty most be attached to the contr2ctl
Subcontractors.- The contractor agrees to be solely responsible.ft completion ofthe work described regardless of the actions ofany third
p-ty/itti-ritractur utirilmd6y t6e contractor. 1%e contractor fartfier agroes-ti) 6e sol�i� responsiBib tar airpsyments; to airsudconiracrors rar
materials and labor under this a cut
Contract Accept�nce - Upon signing, this document becomes &binding contract under law. Unless otherwise noted within this document, the
contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract. Take time to read and fully understanid rL Ask questions if something is unclear.
• Make sum the contractor W a valid Ham Improvement Contractor Registration. The law requires most home impirovement contractors and
subcontractors to be regLitcred with the Mector of Home Improvement Contractor Registration. You n ay inquire about contractor
registrafio�i by writing to the Directoi at One Ashburton PIMP, Room 1301, Boston, MA 02108 or by calling 617-727-3200, cxL 25205.
• Does the contractor have insurance? Check to.sce, did your contractor is property insured.
• Know your rights and responsibilities. Read ft Important Information on *c rtvc= 3W of fids form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other dian the contractoes — place of business. provided you no* the
contractor in writing at his/her main office or lit office by ordinary mail postrA by telcgrain seat or by delivery, not Law than midnight of the
third business day following The signing of this.agricamicrit. See the attached notice of conceMon form for an explanation of this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SpAqM!!!
till
264 2—c0;&
6
CERTIFIED PLOT,
PLAN
PREPA RED FOR.
77M & JANE 7SCHIRHART
A T
28J CAMPBELL ROAD
NORTH ANDOVER,
MA.
NOR TH ESSEX � REGIS TR Y OF DEEDS. 8K. 5184
PG. 21
ASSESSOR'S MAP. 106D, PARCEL 60
ZONING. R-2
SCALE- 1 "80' DA 7E7'
DECEMBER
19, 2002
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STK.
SET
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83
.01
LOT 3
ROD
SET
2. 70 A C.
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NOTE: ABUTTER'S
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CD
STK.
DRIVEWAY ENCROACHES
ON LOT 3.
SET
%A OF
4N
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NO. 3577
Lmv
PREPARED B Y -
JOHN ABAGIS & ASSOCIA7ES, PROFESSIONAL LAND SURVEYORS
lJl PARK SMEET, NORM READING, MA.
(978)-688-4899
JOB NO. 5040
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CER TIRED PL 0 T - PL A N
PREPARED FOR.
77M & JANE 7SCHIRHART
AT
283 CAMPBELL ROAD
NORTH ANDOVER, tvfA.
NOR TH ESSEX � REGIS TR Y OF DEEDS.- BK. 5184 PG. 21
ASSESSOR'S MAP. 106D, PARCEL 60 ZONING: R-2
SCALE- l--80' DA 7E. DECEMBER 19, 2002
DH..
FND
STK.
SET
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NO.'
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.0 NOTE: ABUTTER'S
0 DRIVEWAY ENCROACHES
CD
STK. ON LOT 3.
SET
0
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Gi
,
NO. 3577
LAO
PREPARED B Y -
JOHN ABAGIS & ASSOCIA7ES, PROFESSIONAL LAND SURVEYORS
131 PARK SMEET, NOR7H READING, MA. (978)-688-4899
JOB NO. 5040
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OR
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Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registrafion: 101730
Expiration: 6/29/2006
Type: Individual
WILLIAM DAVY HOPE
William Hope
80 Campbell Rd
N. Andover, MA 01845 Administrator
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number CS 057754
Birthdate: 03104/1965
vow
Expires: 03104/2006 Tr. no: 17474
Restricted: 00
WILLIAM D
HOPE
PO BOX 5164
ANDOVER, MA 01810 —Ac—td1nj:!CLAM�1901er
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registrafion: 101730
Expiration: 6/29/2006
Type: Individual
WILLIAM DAVY HOPE
William Hope
80 Campbell Rd
N. Andover, MA 01845 Administrator
The Commonwealth of Massachusetts
Department of Industdal Accidents
Office of Investigadons
Boston, Mass, 02111 ,
WOrkers'COMPensetbn Insumnce Affldavit
Pleas Print
CHY �i - ku 0, ovx< Phone # '1113 -2,14 -724,3
I am a homeowner perloffning all work myself.
I am a sole proprietor and have no one working in any capacity
F__J I am an employer providing workers! compensation for nTy employees working on this job.
Company name:
Address
Ck. -Phone
InsurMce. Co. Pallcv
Compagy name:
Address
Ck. Phone
Insurance Co. P0UcV 0
Failure to samn covenige a requilred under section 25A or MGL 152 can lead to the Imposition of ciirrdnal penalties of,a fine up to 31,500.W
arKvor one yem'lmprisorrnent-n.we�.n.cbA4maRiaslnMmh=dASTOP.V.YDW.ORMRmW..a fina ct�($l 00_aA*aqaLndm1L I
ice of Invesfigatione of the DIA for coverage ver1fication.
understand that a copy of this statement may be forwarded to the Off Do. )
I do hereby cw* unj* fi�e p",Vd penaffles of pequiy that the information provided above is trim and "
print
Officlal use only do not write in this area to be completed by city or town AdW*
City or Town ensing
.4-
# 918 z 14- --7Z6 3
E]Check Y immediate response Is requked 0 Building Dept
0 Lkensing Board
Contact perso -Phone 0 Selectman's Office
0 Health Department
C] Other
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
in accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
dispose f in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in:
(Location of Fficility)
/A )#LW-
Sig6at-ure of Permit Applicant
Date I
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
— -A
Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. J�W� ..... ..................
has permission to perform ..... ................................................
r2
wiring in the buildingrf .... Ts --6 ..................................
at ..... cW .. 3 .... e-. AA&Ye ...... �(6 ............ . NorthAmdover, Mass.
Fee..,1,25-�rn .... Lic. No.3.?./�'74�� ........
ECTRICAL INSPECTOR
Check #
9 0 1� "5
4\1- Official Use Only
Comenwa& ol Ma-m"4waffi
Permit No.
MW 909-1
20rartment 01 3we se'viced
WM7 Occupancy and Fee Checked
T BOARD OF FIRE PREVENTION REGULATIONS I [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfortned in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PR[NT flV INK OR TYPE ALL INF04M Date: 19� _JZ5 —10 9
CityorTownofi . 1-1-16ry-� wMdA To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform t e electripi work described below.
Location (Street & Number) 8-3 Camy-,be)q �Eccw
Owner or Tenant
Owner's Address
W
No.
-7/.-),-
Is this permit in conjuncti ith a building permit? Yes El No FJ (Check Appropriate Box)
Purpose of Building_ Lew'Idehee Utility Authorization No.
Existing Service Amps volts Overhead [:] Undgrd [] No. of Meters
New Service Amps volts OverheadE] Undgrd F1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electricql Work: Oire ^il 4;�, re d Pzdae
Completion ofthefollowing ble maybe waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above r -j In-
:.�rnd. L -J grnd.
f Emergency Lighting
BatteEy, Units
No. of Receptacle Outlets
'.
No. of Oil Burne
FIRE ALARMS
—
rNo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
J.N!� ��!]Ton�
............
KW
.......................
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local R Municipal
Connection n Other
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
IOTHER:
00— Attach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Cbr-,J21 e,�C Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. 'ne
undersigned certifies that such co
�vqrage is in force, and has exhibited proof of same to the permit issuing office.
CBECK ONE: INS q BOND [] OTBER E] (Specify:) Zgn(
CE;�l I k C e
I ceyWfy, under the =Wns and ena—lides ofperjury, that the information o d is application Is true and complete
FHtM NAME: LIC. NO.: L�Ev � 2,
r
Licensee: Signature LIC. NO.:
(Ifapplicable, enter "exempt" - the license number line) /J� Bus. Tel. No.: tf5 7
Address: L '54 ) Z�pq A46 Alt Tel. No.:
M6 Z5 -71/ -
*Per M.G.L. c. 147, s. 57-61, security work requifes Depa ientofPublicS "S" Li�ense- Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (ch one) El owner F1 owner's t
Owner/Agent
Signature Telephone No. PE"IT FEE. $
Date. . - e'-' - e 9 -
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform ...................
plumbing in the buildings of ...... .....
7.
at. . . . .,,P 3 North Andover, Mass.
........... ....
3, .................
TOR
Fee'...:.... . Lic. No..i .... ��/x
Check # // Z14 LUMBI Gi SPCC
821�7
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
IVAL'-- it # 0--� -11,7
t:h Ain& JRfr,- Mass. Date Perm 00
Building Location
Q 17ajQ& JI 16 Owner's Name -Z i�q
7 25: - -2.7 Type of occupancy__j�esidential
New D Renovation El Replacement N Plans Submitted.- Yes 0 No CD
FIXTURES
Installing Company Name Heritage Htg. &P1g. Co. Inc. Check one.* Certificate
Addres IX Corporation 714
Stoneham, Ma 02180 0 Partnership
Business Telephone 781 —43 8 —7 7 76 1-1 Firm/Co.
Name of Licensed Plumber Gordon SwitzeLr
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch, 142,
Yes El No 11
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy CS, Other type of indemnity El Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement,
Check one'.
Owner El Agent n
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of theGeneral Laws.
By jq 2
Title naturebt UCLT'nsea Flumber
City/Town Type of License� Master Journeyman
APPROVED (OFFICE USE ONLY) License Number 8 3 2 2
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BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLO 0 R
8TH FLOOR
14+
Installing Company Name Heritage Htg. &P1g. Co. Inc. Check one.* Certificate
Addres IX Corporation 714
Stoneham, Ma 02180 0 Partnership
Business Telephone 781 —43 8 —7 7 76 1-1 Firm/Co.
Name of Licensed Plumber Gordon SwitzeLr
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch, 142,
Yes El No 11
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy CS, Other type of indemnity El Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement,
Check one'.
Owner El Agent n
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of theGeneral Laws.
By jq 2
Title naturebt UCLT'nsea Flumber
City/Town Type of License� Master Journeyman
APPROVED (OFFICE USE ONLY) License Number 8 3 2 2
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Date .............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... fl— . �. .. . . 3x . /.". . / !,.� ..................
has permission to perform ... .........................
plumbing in the buildings of ......................
at J.
/ ............ North Andover, Mass.
Fee ( ..... Lic. No.. J.( . . ; .. .........
'PLUMBING INSPECTOR
Check #
5 5 6 IS
4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DOYLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
0
New 0 Renovation 0
R
�/Ad.ers Name -T'S C � 'Ie
ate
Permit #
Amount
R4piamffient E3""" Plans Submitted Yes E] No
ie.el*vue
FIXT41RES
4a
NOMMOMMMMMMMM
MMM
allint'or type)
Installing Company Name P f'o tu 44 -e t4
Address 'S 0 13 0)4 r -j /I
- p-1 6 4,1'1 ':� 6 L/ '4
Ili-)
Check one: Certificate
Corp.
Partner.
9—pirm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity El Bond F1
insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 0 Agent n
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and inst;
�lationyperfbrmed und Permit I Zed b th' lication witt be in
compliance with all pertinent provisions of the Massachu'sdits Swe PI ing e
By: =ignature ol Licensed rlumb�y,
kype of Plumbing License
Title Y–D -3 (",
lCity/Town =icens-e Number Master Journeyman 0 -
APPROVED (OFFICE USE ONLY
4
4
Location
No. Date
TOWN OF NORTH ANDOVER
Check #
63 1 73
Building Insp6ctzr
Certificate of Occupancy $
i S
3
s Mu
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
63 1 73
Building Insp6ctzr
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
or
100A f
BUR,DING PERNUT NUMBER:
DATE ISSUED: o-7 0
SIGNATURE:
Building Commissioner/Inspedor of Buildings Date
SECTION I- SITE INFORMATION
1. 1 Property Address:
28-; CAMP6M iQ
1.2 Assessors Map and Parcel Number:
6 0 10066
Map Number Parcel Number
1.3 Zoning hiformation:
Zoning DA—rk—t Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (11)
1.6 BURDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
Required Provi&d
Required Provided
1.7 War. rly M.G.L ' C.40. 54)
lic Private 0 zone
1.5. Flood Zone Information:
Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT
2.1 Owner of Record
�4 cmt4 -rSC-H11ettX--g--T
Name (Print)
28.�, CoAlosftc
Address for Service
Siglature
Telephone
2.2 Owner of Record:
Name Print
Address for Service:
Signature
Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
\JILLIkm _0 �&Lz
Licensed Construction Supervisor:
n. -am 4
.A,ddress
glgna'ru�'
Mk
Telephone
Not Applicable 0
S --T-7 S!q
License Number
0 3 1 C)!q 200 4
Expiration Ilate
3.2 Registered Home Improvement Contractor
ljiU-i4m 1- I*e6- -.19A
Not Applicable 0
Comp�ny Name
?-C).
Registration Number
6 12 -el /2-06t
Expirafion Dad
Address
�V"
Signature —, , V
Telephone
Mo
M
z
0
0
z
M
90
0
ic
faaaa
M
faaaa
G)
SECTION 4 - WORKERS COMPENSATION (NiG.L. C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes ....... 0 No ....... 0
.SECTION 5 Description of Proposed Work (checb4 applicable)
New Construction 0 1 Existing Building V I Repair(s) 0 Alterations(s) if Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work:
6SUVe-&T 9-%1J1nkJ(x —2S?M6M&"T S#9AJ�& 'Tb CHIOZiR-C-Ml
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by pennit applicant
OFFICIAL USE ONLY
I . Building
9 22-
(a) Building Permit Fee
Multiplier
2 Electrical
'Z Soo
(b) Estimated Total Cost of
Construction
C�(
3 Plumbing
2 t5oo -
Building Perniit fee (a) x (b)
.4 Mechanical (HVAQ
t!5
5 Fire Protection
19
.6 Total (1+2+3+4+5)
21 q 2z- OCI
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERAUT
as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
as Owner/Authorized Agent of subject
I U- i k1A
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
WiLLik-Y4
Print Name
2609
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TDvMERS i ST 2 ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
fiE- IGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM U - LOT RELEASE FORM
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 or requirements.
I*****************************APPLICANT FILLS OUT THIS SECTION"""""
A PPL ICA NT-� PHONE 5
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT (S)
STREET- CAMP bel -L "FST. NUMBER28
USE
I RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATEAPPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
-/SEPTIC INSPECTOR -HEALTH DATEAPPROVED -3 A;2
DATE REJECTED
COMMENTS IPA eOL'te'
I
PUBLIC WORKS - SEWERAIVATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE_
Revised 9\97 im
Massachusetts Rome ImDrovement. Sample Contrac
Tbis forni satisfies al; bisic requirements of a3c state's Home Improvement Contractor T-a%v (MG1. chapter 142A), but does not include standard
language to protect bomeowners, Seek legal advice ifnecessiry. Any person planning home improveracrits; should rim, t Obtain a W -y of"A
Consannar Guido to tile Honle Improvement Contractor Izw" before ngw* triany work on your riesiderice. You rilay obtain a ftee copy by
callutp
, the Ofifte ofConsturcr Affairs and. Business Regulatiolis Conarntar InforrunL-or Hotline a 617-727-77K
Hoin cownerIn fo rxnt tion
Contractor luformation
Name
Company Name
(m
c7,k
Street Address (dFnol use a Nst OMjcc Box �ddrcw)
Contractor,' Sale mfsoa� Owner Name
__.31)
(AiWiUIL
AV tz- Ht -W
cityri,own State Zip Code
t�, - 16� Yk 01_9�
Business Addrou
S164 -
Daytime Phoint E vening Phone
stwe Zip Code
�T T4 8 S
&--,A 0 1 -3 1 q
Mefing Adrkrq� (71 diffi-mitt frum above)
Bus iness 111mac2,14 -42t-�g I Fc&ral Employer Mvr&S, Numbc,
2Q
16/
in 6-1 oil the I'V-ZA, to CLniplctcd, spocl"g thc qqit, bmn?, and grade of mated als to be ii�ad. use -additional Aeats if x-cass
i ;; 2 or )J6<I,<_
14- f,,ts
I Req it irod Parm its -The fol [owing build ing periniul are req uired Propoied Start and Completion Schedule -11hefollowing 9chedulevviiI
Iand will besecureA by the coritractor as file homeowlices apant, beadhercilto, unless circurristarlovs bayond the contractoes conLrol aiise
,Owneri who secure their oWn perullIts will be
&A2��Datc wincri contractor wi-Ill begin c��nitacted wodk-1
excluded ft-orn the Guarantv Fund pTovisions of
MGL cliapter 142A %
;W Date wfica coultratkud work -will Ill. sub'MaiatiaE C,0lIrpl:ACJ,,
Total Contract Price and Payment Schedule
The Clinurnetor agrm to perform ft work. furilish the triniatial and laborspecified zhovt forthe totalsum of:
Pay L� will be made liccordi g tuft following schedule:
upon sipting cont -act (not tocxcoetl 16 of tfiz: total contractPrice ILT the cost ofspccial order itain. whichevcris greater)
z;
uoll colrzietio,
_bW.,4,_M L k(
bo 11000 Cml_,plctimi of laic zortuac'. tl.aw rk-'hiIR demanding (till payin-mtunfil contract is compiz:Ied In both part*.
7
IJK must bit -pecial S J 1A , te,s�e for At
ordtle.el 1n,fory um mritrilctc-4 vmik bvgIns in oreezr lobzp'a:dN�
t, Irwe r ri I a I ell VI 0 sch C d irl
NOTP-q; (*) Incloding oil finance charges (**) Law requires that any dcposit at dmvn�payrncnt required by the contarforbefure vi-ork begins may
not cxzeecd die greater of (a) one-third of the total contrazt, pri ct or (b) the aLlual cn�q of any special equipaicir. or uKtom made niaturial
which must tic spc6a! ordered, in advance to rneet Itic caulpletion schcrIule.
-------- --
I nat mg o-,idrd bN, the. von I raftor? Nu Ves
Suben ittractors - The al�rees to biz soleky responsibic for car"Pletion or 9m Wor, It dvqnlihed regardless of die actions of any iltin�
utjiiv�el by the contracticir. The contnectorr further agrees, to be solely fespollsIblelfor all payrucills tu ali fivr
materials and lahar undler thIS
Contract Aceeptanee - Uipon signitv -ul-rient,
this documetit be -comes a binduig contract under law. Unless othcrxisc noted mithi this dac
contractsliall not.,niply drat any jic4- orothersocurity iraerts"Itas
. Don.'t be pressured into signing the contrazt. Take ti-ne tn -cad arid fully bndc-irstmd it. Ask questions if sor-latiling is unclear
40 Mal -L sat c the contractor has a valid Home Irn-,)rovericnL(2_o_nIm:_L
QL-jRcqj.jtm-j'on. The law requires most home improvement convacuin; and
subcontractors to bc rcgistered with the Dimclor aflio-mr Improvement Contractor Registration. You may inquire abouz contractor
registration by writing to the Director at Ono Ashburwri Plac�c, Room 1301, Boston. MA 02108 or by calling 6 17-727-3200, ext, 25205,
Drics the r.Pntr;u;fn.- have insurnricc? Chczk- to see that y(ra. is propcirly insured.
Read 1:14o Limp ant Infosmation. on the jtverso side of Ws form and ga a copy of thr Coonvsutrlvi
Gu�& to tbe Iforne kaptovenion, coritractior Law,
You may called this agreement if it has been stgned at a place o1ber than the contractori s tionral place of provided vott notify 03C
cantrac,ior ill Writing at hisl'he7r aviin office or branch offi(x by or4dftV;,-V r1lafl M
led, by telegratIl Sal' , -or by fjajjVerV, oi)j later dvain mWri;g�zi 7,11'Ific
lifilt! husinot's rav folk)W-ing tile siqong ofthis agre=unca .5ce the -jactied notice afcancclletion f'o-Irl for an C)�Planwioa ofthis riglit,
CT-IFTIMME, ARE ANY)MANKSPACEPS!1!
T,vqjdenfiWI.cWA- -jtlie mulract must he CM, J�ewd and siprL Ohle t'-py stinule, go 0 Ilm hm. 00%%mer. The elflier zipy s"4 be kept hy the ooattaztot.
T4—c-mcow.lizes 'are Si!uInwre
Contractor ArbitrallOn
111C I 101ne [Inprovellielit Coutractor Law pmvidos homeo-wilnis With the right to ifliLiate an al NU -:16011 action (as ul
allmr-native to Court nctioil) if th.v have a dispilic "'vith a, contractur. The saille riVlit is pot autollialicall1v afforded it) a
roulTactril., however, The Colitractor would have to resolve atly dispute halshe llas will] a lion] cowner in C-ourt ullIcss
11fAil 1,11bCs agree te, tile. option-il clause provided �iejoxv, 'T'his clau,—qe Nvould give die c"Wrictor tile. sariie right to
allaits-alitin as is 1501-ded to (lie barlwowner ky tile flouie Improveinent Contmetor Uw.
The contrami and tile holaeowner hereby mutually agree in
that in tile event the contnctor li;.js .1 t1ispute
ConGerilillf, this contrazt� the contractor mav submit the dispute to a private arbitration firin which has been approved
by ill,- Seerelail� of'�fie Executive Office of ConstinierAlTairs and Business Regulation atid the consumer shall be
required to submit to such arbilrition is provided Ill N11assach I i sells Cren
I lonicow, '%grilture.
NOTICT, Ole Signatorp"s of the nArties above apply only to tfie agreernent of the pariies to alternative dispute
Irc-nolution )niffintr-d 1)), the contrartor. TI)c 12onicolv`
ner mav Wtiattealwaiative dispute resolution everl wile.tr ti'lis
'4vetioll is lot.": parntclysigned I)y 010 Parties.
Jlumeovvmer's Rights
A homeown&s rights under tile 1-Ionle Improvement Contrnefor Law (NICTI, Ghapter 142A) and other consumer
protection laws (i.e. MOLPhapter 93A) may not b.- waived in anv wav, even by agreerrient, I lowever, boineowners
may be exci tided froin oei4il in rights if tile contraotor they choose. is not properly registered as prescribed by Jaw.
Homeowner's wbo secure tjw�r own building permits are autowaticaliv excluded ftvin all Guaranty Fund provisiow� of
The contractor is responsible fbrcom pleting i lie work as descri bed, in a
tiriely and Nvorkmajilike manner. flotneov.,ne:-s may be eticitled to otlier spcxific legal rights if tbe corlt;mctor
g1larantues or provides nn express warranty for workinaiiship or trinicrials. In addition to gm-trante" or warrrities
provided by the. coilt mtor, all goods sold in Massachusetts carry mi implied %varranty of TnerchantAbililyand fitness
fora pm-ficultir pm -pose. An eninneration of other niaaemon wbich the har"cowiler
and conuractor lawhilly agree imm,
be added to the *,E-niiis oftbe contma as long as they do- not rosiTitu a homeowner's basic CODSHIDN'tighlS. IfYOU haVe'
11wostions ab"'111 your rightq, contact thl� Cons'timer Information Hudine (listed bciow.).
Execution of Contract
The conlract niust be executed in �o
and s�otjld not he signed until a copy ofall exhibits mtd ref�rencM
docimiulltsbavo 'ozcn Pzt!�;-Q �r- -kn rldvirrtf,
11114: 10 siim Ili-, dor-ument tinfil all blank seciionsbmvt be,,ni
filed in or mirked as void
delelf-ed, or not ai plic-bi.t. One origiiial SiE )V of the OL,11,1111CI with amavllinellts is. 141
gneA Co.]
ac giver, in the owner and the odiler kept by the cortractor. Any alodific-ation to tile original cotitcact must i�e I(I %vi-lillig
andn peed to 1)), both pw-ties. ("ontracted Nvork Fna�! not begin until both patties have received a fully executed copy of
the contract, ajid Oic I hree-, da� recission period has expired.
Accf,.Jernletl PavineniLs
A C4)jjtrac4Lor inaynot denintid payinents ill advanGe of tile. dates specified oti the payment schedule in c-,ises where the
to be financiall - N, insecilm, the cx)lltractor Ilvny reqtlire ilint (lie baiauce offunds not yet due h3 plai:edl in ajoint escrow
;iew.unt as P. prerequislit: 10 C-olitillijing tile Coll1meled N."crk. Wifil"ITawli elf ffinds from said account would requiie dhe
siglialilres Orbodi pallies.
Additional Information
U You have i
A. genetal questions or need ald-ditional in-forlilatinn about tile Home I niprovement Contraettli UiNv or f)tlj<,r
consuiner rights, or if yOu ivish 1k) obtain a fice cotiv of- "A Consuilici Ouidtt w file Holue huprovenient Contractor
Law," contact:
Constimer Infornm6on HoNiT�le
Executive ON'tZe of Consumer A I.Tairs in(] Business Reaulation
One Ashbijilon Placc., Room 141 .1. Bostim. NIA OZT08
fb]7) 727-7780
Ifyou wint to vcri�y the, rcgi�;tration ofa coni=ctar or iryou have questions orneed additional infon-nation SpocificalIN
aboui. the contractor registration componorit ofthe Home improve-mcni ContmxtorLaw, contact:
Direcforc)f'Hortie Iniprovemen', Contraclor Rqgistralivri
Burean offluildint,
, Regulafionsand Scanda:rds
Onu Ashbution Place, Room i3016 . Boston, MA 02108
(611-1) 727-3200, ext. 25205
With info -mal nin-diation of dispuitg r.ir to mg a
gi�:ter fornial oompia-ints ap iast a bvi'siness, call:
Consumer Complaint Sce'dor
Office of the Altforllev Genova)
H-RH Construction
Scope of work
283 Campbell Road. N, Andover.
Overview:
To convert existing basement space to finished living space per the attached plans creating a mechanical room for
file clectrical sen -ice. thmace, and oil tank. Leaving one section of existing basement as unfinisbed T, c arca
0 sto ig
Reinovv small closel under existing stairs and re-fraine per the attached Man&
All new walls will be 2-" X 4" fbined with a Pressure treated sill attached to dic existing slab.
Allflew Walls'will be, insulated with R-13 insulation cAv vapor barrier,
Existing ftoor joists in new living area ivillbestripped in preparation for slwainuck.
Existing conmte.floor in new living area will be covc.rcd %ith a new sub -floor system complete �vith vapor bamer
No finish flooring is included in this contract or scope of work. No sub -floor system will be installed in the
mechanical roont or under existing basement stairs.
All iimv walts and existing ceiling in nmv living area will be blueboard shectiock and veneer plastered ready for
paint, but no painting is included. fntcrior of new mechanical room will be 5/8" fire rated sheelrock. with irud and
tape joints.
Install new oak hand rail system on one side of the bottom section of the existing basoment stairs.
Fabricate and install a small access door Linder existing basemomt stairs -
Case existing center beamand exposed lally columns with pine to match doors and trim as closely as possible.
MI new interior doors will be slain grade, six panel, pine. with standard 2 1/2" stain grade colonial casing,
Nem extexior dow- to existing bulldicad -will be paint grade fiberglass; with si.%, lites.
New baseboard moldings will be -standard stain grade -3 3 !A-" colonial.
PlumbjpL.
Install one zone of standard baseboard heat in new basement living area.
Install make up air to existing furnace,
� I . 01
Elearical:
fnstall outlets to cWe in new living area.
histall-mwTV. cable outlet andvm telephone outlet.
IIIStall hVCIVC recessed lights, cliv bulbs and standard trims in ne.,vv living area split into two sets of six, both sets, oil
three way switches -
Install one florescent light fixture in new closet on single pole switch.
tnstall one florescent light fixture in new inechapical room on three, way switches.
Allowances
The total contract price of $21,922.00 includes the. folloviiig ailowances:
Plumbing-, $25000)
Electrical: $25500.00
2 six panal pre -hung pine door% c!Nv hardware: S 400.00
2 six panel pine door slabs cAv hard%= $ 250M
1 exterior fiberglass doorvifth sLix lites c./w hardware: $ 450.00
Baseboard molding- S 105.00
Total $6205.00
Allowances may be combined, added, or subtra, cted per homeowners wishes.
No painfing, staining, or varnishing of any kind.. either interior Or CXICTiOT. 011ICr thlan 111.11 SPOCifil-211y Stated-, is
included in this scope of work or con -tract.
All vkr,%qc material will be placed in heavy duty garbage bags and left ctirbside.
'I'lie site will be kept clean and orderly and swept daily, however. the homeowner understands that due to the
naujiv of (lie work some niess and some dust contamination of liNing areas is inevitable.
No changes to this scope of vvork or contract will be made without a sWjwd change order.
he total contract price includes regular permit 'Ibes. howvver, there is no allowance in this scope of ivork or
contract for an); engineering, architectural. or similar services that may be mquired by the building department, nor
does it include meetings with ain� board such as the historic conimission.
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Date.
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... /E/Z�r ......... .....................
' hA permission to perform ......... i, X-1 alel .....
Airing in the building of ....... //.. .........................................
.............. eorth Andover. M
at ............. I . . ......
Fee.RS7d.o.. Lic. No
41ARA ........
crRic sp
Check #
4 tit 9 4
TBE COAMONWEUTH OF AWSWBUSEHS Office Use o ly
DEPARTAIEWOFPUBLIC Permit No.
BOARD OFFMPREVEMONREGULAHONS 527 GW? 12 M
Occupancy & Fees Checked
APPLICA77ONFORPEIZWTO PERFORM ELECMCAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) i�!A2 Rr-�,
Owner or Tenant 44R t�
Owner's Address 6401MIF
Is this permit in conjunction with a building permit: Yes [El No
Purpose of Building t5l ,,<) E
To the Inspector of Wires:
(Check Appropriate Box)
Utility Authorization No.
11
Existing Service Amps Volts Overhead Underground No. of Meters
New Service Amps Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Locatiol'i and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No- of Transformers
Total
V
KVA
No. of Lighting Fixtures
Swimming Pool Above
Ei
Below
F1
Generators
KVA
Z0
— ground
ground
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
0-0
No. of Switch Outlets
I
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No- of Sounding Devices
No. of Dishwashers
Space Area Heating KW
.4
No. of Self Contained
Detection/Sounding Devices
Local Municipal
F—lConnections
F-1
Other
No. , of Dryers
Heating Devices KW
I
No. of Water Heaters KW
No. of No. of
I
Signs
Bailasis
No. Hydro Massage Tubs
I
No. of Motors
Total HP
F434-11-4-1*1
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OWiN�SINSURANCEWAIVER,Iamawmda&Lmmdbesnotbaw&msLwxmcowWoritsatzT)WecjwvalfftasmWiedbyNla%admscMGmYALaws
and that my sigphm on dm petmit apphcafion WEives this requitertf rt
(Please check one) Owner r-1 Agent F Telephone No. PERMIT FEE
Signature Of Uwner or Agent
Name
The Commonwealth of Massachusetts
Department of Industfial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance A ffldavit
Please Pdnt
Name:
Location:
cily Phone #
F1I am a homeowner performing all work myself
F-1 I am a sole proprietor and have no one working in any capacity
I am an employer providing workere compensation for my employees working on this job.
Compapy name:
Address
cibc Phone# -
Insurance. Go. Policv #
Company name:
Address
city: Phone * wk
Insurance Go. Policv #
Failure to seamecoveraW as required underSection2M or MGL 152 can lead to the impositiondcriminalpenalties of.afine UP to $1,5W.00
an&oromymm'xrpmonment-as-wdLascadimakws-m-lbelmn-dA-STQPV*VW-ORDfRmdafw*W-($IjOOM)-ajdayAgatrwjm_ I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
/ do hereby cerW undbo- the pains and penaffies otpefiLoy 1hat the ffdbrmabon provded above is bm and coned
Signature Date.
Print name Ph".#
Official use only do not write in this area to be completed by city or town officiar
City or Town Permitilicensing
Building Dept
E]Check if immediate response is requked Licensing Board
E] Selectman's Office
Contact person: -Phone k El Health Department
F, Other
Location 4; � A— /2-0,
No. 171' Date
TOWN OF NORTH ANDOVER
. jAiffiliW&
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
17626
Puilding Inspe �t
SECTION 1- SITE INFORMATION
1. 1 Property Address: 1.2 Assessors Map and Parcel Num1Z
//06 D 00 60
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required Provide Required Provided Reqt1ired Provided
1.7 Water Supply MG.LC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private 0 Zone Outside Rood Zone 0 Munic�! _0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT P40
2.1 Owner of Record
T Ts&lnha)2�-
Name (Print) Address for Service:
I- q1q-Nq--7-z03
tgnature Telephone
2�jl 0 Record:
L wner of
�Iaa, -T-S ah h(JQl-
Name Print Address for Service:
nn
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable P
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor, Not Applicable 0
Company Name
Registration Numt;�-r
04bq
Address 0
Expiratilon Date
k�, �natrkll/
T
M
X
z
0
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT A,
RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
5 INNER!
MR -1.1"M ... lllil� itki- W-""-
L" W-0 A
BUILDING PERMIT NUMBER:
DATE ISSUED:
SIGNATURE:
Building ---Yispector of Buildings Date
SECTION 1- SITE INFORMATION
1. 1 Property Address: 1.2 Assessors Map and Parcel Num1Z
//06 D 00 60
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area (sf) Frontage (ft)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Required Provide Required Provided Reqt1ired Provided
1.7 Water Supply MG.LC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public 0 Private 0 Zone Outside Rood Zone 0 Munic�! _0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT P40
2.1 Owner of Record
T Ts&lnha)2�-
Name (Print) Address for Service:
I- q1q-Nq--7-z03
tgnature Telephone
2�jl 0 Record:
L wner of
�Iaa, -T-S ah h(JQl-
Name Print Address for Service:
nn
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable P
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor, Not Applicable 0
Company Name
Registration Numt;�-r
04bq
Address 0
Expiratilon Date
k�, �natrkll/
T
M
X
z
0
I
V
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building-oermit.
Signed affidavit Attached Yes ....... Cl' No ....... 0
SECTION 5 Description o Proposed Work (check applicable)
New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) I,'-] Addition 0
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Bi�ef Description of Proposed Work:
1/11/) 11-4 ) e-4�L
,,rli-r
mural ourli
1-7 �Ya �? 09n -�'
I SRCTTON 6 - RSTIMATRD CONSTRUCTTON COSTS I
/ e e- C 0J �el--
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
Of
'RC USE ONLY"
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERAUT A,
I as Owner/u
_�orized DAgent o subject property
Hereby authorize
My behalf, in all matters relative to work authorized by this building pennit application.
q -'/0- 0
Signature of Owner Date
SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION
1. as Owner/Authorized Agent of subject
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Iq AJ
q>Kint Name
- zn
,5rgnature o)TOwner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 2 ND 3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GUZDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
I—IS BUILDING CONNECTED TO NATURAL GAS LINE
address:
city state: zip: phone #
work site location (full address):
I am a homeowner performing all work myself. Project Type: New Construction F�Remodel
I am a sole proprietor and have no one working in any capacity. Buil . ding Addition
I am an employer providing workers' compensation for my employees working on this job.
company name: 30 PER -1 OE. —LrJi---.)L)5T12AF-S , INO- -
address: 33 6rze�pi— P—(3,,4-jD
citv: SHi(F—LE1f phone#:
insurance co. poliv # A VV C --10 11 S to 2- CJ i 2 C)C
am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
citv: phone #:
insuranc noliev #
company name:
address:
citv: phone #:
insurance co. policy #
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500-00 and/or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 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.
I do hereby certij� Einder thepains andpe���r ury that the information provided above is true and correct.
Print name
# V6 -'12 T —66,rO
official use only do not write in this area to be completed by city or town official
city or town: permit/license # []Building Department
MLicensing Board
F� check if immediate response is required OSelectmen's Office
[]Health Department
contact person: phone #; ElOther
(revised SCpL 2003)
)OUCER
B 0 r- e, &G,0 -
Inc.
3,41
SUPe,r'l Inc.
6:4 8,pio c,.,',t,, ��Cl' 0
�d.
L i't t-,-je 'b
"MA, 460
Rig 1. 31.10 W.' O/Y
DATE (MM/O y
... ........
THI CERTIFICATE ISIOS�'SUED
A MAMA OF INFORMATIO—N----
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
—COMPANIE
L —SAFFORDING
A A"Nautilus Ins. Co.
COMPMY
a Safety ins. co.
%-UMIaANY
c AIM
I D
19QVCY I U I HE INSUR50 NAME
-ERTIF ICATE:MkY BEASSUED jjO
TERM OR CONDITION OF ANY CONTRACT OR OT D A OVE FOR THE POLIC
y Y PERIOD
,At h- I HER DOCUMENT
'-TAIN THE NSURANCEAPFO
DI WITH RESPECT TO WHICH THIS
-XCLUS TIONS"OF 9.'6"bf ��PWCIES LIMITS SH
FIDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
OWN MAY HAVE BEEN
REDUCED By PAID CLAIMS. TERMS,
TYPE OF INS. 4NCE
POLICY NUMBER
PO ---------
PIRATION
GENERAL LIAZICI . yy
ATE (MWDofyy) DATE (MWDD/yy) LIMITS
COMt-4EAPiAL'OE-N�.RA�.:LIA'giLl,t.Y'
r
GENERAL AGGREGATE ; s
C
2 000
AD TS COmplOP AGG $
12/17/03 12/17/0 P
PERSONAL
AOV 1 .0-0
6 Y S
�—]� �' -0-cw
EACH OCCURRE CE
IRE DAMAbE (Any one 1,10) S
5 0 0
-0 -
MED EXP (Any one personj' s
ANY AVtO
ALL OWNED AUTO
QS
COMBINED SINGL E"LIMIT S
I *- -.11000,00
SCHEDULEb ' I
HIAED Auto 6 0 9
..S
BO ILY INJURY
1/8/04 (Peolperson) $
1/8/05
NON-OWI,,-E.D�UtOS,
BODILY INJURY
(Pef aCcident)
PROPERTY DAMAGE S
ANY.�UTO
AUTO ONLY - EA ACCIDENT S
OTHER THAN AUTO ON
q
EACH ACCIDENT
CESS,LIABILITY
. . . . ............
AGGREGATE S
UfAaAELLA-FIJAM.
. I 1 :1 .. . . I
. EACH OC CURRIENCE S
OrHeA THAN 40A4
AGGREGATE S
�A�fl S:C,Omp �T.
D
'E
L IIA� A
kS: TY�..: .
. . ... .......
,IETOR� 13 6 2 0 12 0 3
UNERSi E�XECIJTIVE �. INCL
TORY LIMITS E A 7.7. 777 777�777
2/17/04 EL EACH ACCIDENT I
. .1
:ICEAS . . .
ARE: E -x:
: $1 000
EL DISEASE I
POLICY LIMIT
1 000, 000
p
EL DISEASE - EA EMPLOYEE 0 0 ---
0 1 000
I I: L
SHOULD ANY OF THE ABOVE DESCRISFC') PO'L"�*IES BE CANC : E . LL _ E . 0 BEF . OR . E , TH I.. E
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
1�� DAYS WRTTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY
OF AWY-A61ND UPON Twi: Y. ITS AGENTS OR REPRESENTATIVES.
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901,41,
up,,ellf or
INDUSTRIES INC.
ROOFING GUTTERS RUBBER ROOFS
August 16, 2004
HRH/ Dave Hope
283 Campbell Road
No.Andover, Ma.
1-978-314-7263 V
Roof Will Be Hand Nailed Only
1. Details of area to be completed: Install a Complete Roofing System Entire House.
2. First step consists of installing a tarp or tarps from the roof to the ground to prevent damage to the
house or to plantings or lawn area.
3. Next, remove existing layers of asphalt shingles and dispose of properly.
4. Completely de -nail roof and re -nail roofing boards as needed.
Replace any rotted or broken wood (roofing boards) at no cost up to 100 linear feet.
(Additional board feet available at $3.50 per ft. and $1.85 per sq. ft. for V2" plywood.)
6. Apply six feet of Certain Teed Winterguard or GAF Stormguard along the eaves of the roof, three
feet along the sidewalls, three feet around chimneys and pipes, three feet in all valleys and three feet
along the rakes.( 9 feet on North side)
7. Next, apply a Certainteed Roofers Select or GAF Shinglernate felt paper to the remainder of
exposed roofing area.
8. All wall flashing will be inspected and replaced as needed. Any and all rotted or damaged trim or
siding that needs to be replaced to ensure proper flashing will require a Master Carpenter and will
be billed out at an Hourly Rate plus material cost if completed by Superior Industries, Inc. (Any and
all lead or copper wall flashing which needs to be replaced or installed will be done so at an
additional charge).
9. All skylights will have ice & water shield around them. Older skylights may require new flashing
kits, which will be purchased and installed by Superior Industries Inc, at an additional cost.
1 -888 -618 -ROOF - Fax: 978-486-0906
64 Spectacle Pond Road - Littleton, MA 01460
781-643-2999 Arlington - 978-369-0950 Concord
978-486-0900 Littleton - 617-969-8900 Newton - 781-274-6600 Lexington
�/ , A
10. Chalk lines every five inches.
11. Install eight -inch aluminum drip edge to all rakes and eaves ( MILL).
12. Install pipe flanges as needed.
13. Apply a 30 year Certain Teed or GAF Architechual AR Shingle
Color:
14. Re -step flash chimney? YES Re -lead chimney? NO
15. Install a Certainteed Air Vent or GAF Cobra Ridge Vent on the House to allow for proper
Ventilation.
16. Install 4" x 16" Rectangular Eave Vents: N/A.
17 . Work site shall be cleaned on a daily basis and all areas will be gone over with a magnet to pick up
the nails.
18. Superior Industries will supply the customer with any and all permits pertaining to the job.
19. Superior Industries will furnish a Certainteed SureStart warranty that entitles homeowner to Fifteen
full years or GAF Golden Pledge 12 years of non -prorated coverage including labor, materials,
workmanship errors and disposal costs.
20. Superior Industries will supply the customer with a liability ($2,000,000.00) and workers'
compensation ($1,000,000-00) insurance certificate. (All workers are employees, not
Subcontractors.) Massachusetts License #133639. Better Business Bureau #83356.
21. Any alteration or deviation from the above specifications involving extra costs will be executed
only upon written orders and will become an extra charge over and above the estimate.
22. Payment to be made as follows: 1/3 deposit due upon signing, 1/3 due halfway through the job and
the balance due upon completion of the job.
23. Attention Home Owners: please cover all personal belongings in the attic or storage area due
to the possibility of roofing debris or dust coming in through the cracks of the wood. Superior
Industries will not be responsible for debris or dust in the attic or storage spaces.
24. Superior Roofing is not responsible for the recalibration of any satellite dishes or antennas.
We recommend you call your satellite company to make aware of any recalibrations that may
be needed after removal and replacement of such device
& 1. '1
COST: $8,875.00 COMPLETE ROOFING SYSTEM
TOTAL: $8,875.00
0
ACCEPTANCE OF CONTRACT
The above prices, specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do the work as specified. Payment will be made as outlined above.
Superior Industries, Inc.
B. Talbot
Authorized Agent
Date
Homeowner or Autho ized Signature
-7�` AJ
Name:
-Z za- E0-Z;!:KK
Date
ATTENTION: All buildings, homes and structures that have accessible attic' space must have such
attics checked by client for the existence of mold or any other type of mildew. By signing this
contract the client is stating that their attic has been checked for mold/mildew and that there is no
mold/mildew present. Customer Signature:
(Must be signed in order for contact to be processed)
We now accept Visa — Mastercard —Discover — American Express!
Credit Card #
COMMENTS: CHIMNEY LEAD LOOKS GOOD.
Exp. Date Vin#
* Any questions please call me at 978-580-0058. Thank You, Bob Talbot.
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Location D( 0
No. 1/40 Date
I&ORTN TOWN OF NORTH ANDOVER
Certificate of occupancy $
Building/Frame Permit Fee $
C"^
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 6�q
181/1-01.9
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT RENOVATFft OR DEMOLISH A ONE OR TWO FAMILY DWELLING
saw" #a
BUILDING PERM[rr NUMBER: —716 DATE ISSUED:
SIGNATURE:
Building Commissioner/122�Llor of Buildings Date
sIcTioN I- SITE INFORMATION
1.1 Propesty Address:
1.2 Assessm Map and
1 061)
Map Number
Parcel Numbw.
4b
Parcel Number
1.3 Zoning Information:
Zoning District Propow use
1.4 Property Dimensions:
Lot Area (d) Frontage (111)
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yad
Rear Yard
ReqWred Palvide Regifired. Provided
Regifired Provided
1.7 Wear Supply NLGJLC.40. 34) 1.5. Flood Zone Infouniaius:
Public 0 PrMft 0 zM OuW& Flood Zow 0 manicipia
1.8 SewcnW Dbpoul Systaur
0 On She Disposal System 0
SEMON 2 - pRoPERTY OWNERSHM/AUTHORIZED AGENT
1,7; Uist(ict: ",/,?3 —P.10
2.1 Owner of Record
,-j-1 M I A*-" 0- :T- SCA tic ft-e-�
Name (PriAt)j Address for Service
am P 6 otc X
Signature Telephone
2.2 Owner of Record:
k Name Print Address for Service:
Signature Telephone
SEC77ON 3 - CONSTRUC77ON SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor
0
Addre
9 -tmc) 9 14 72- 3
- W-&
Signature Tclephone
Not Applicable 0
(n<s7aS4
License Number
Expiration Date
3.2 Registered Home Improvement Contractor
/ - �), &�i -a U (4
Not Applicable 0
I o)
Company Name.
16 zr-
—
Registration Number
I
12-9 )2-W4
i;��tion Date'
Address
1A <1VA 1,122
SignaftVe —' � - -
r Telephoni
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152
Workers Compensation Insurance affidavit must be completed and subm
in the denial of the issuance of the buildiplf permit.
Signed affidavit Attached Yes...... -Q/ No ....... C1
SECTION 5 Descrietion o Proposed Work (check spokabh
New Construction 0 Existing Building 0 1 Repair(s)
Accessory Bldg. 0 Demolition 0 Other
Brief Description of Proposed Work:
with this application. Failure to provide this affidavit will
Alterations(s) 0 1 Addition 0
0 Specify ' '
I wrnm 6 - RSTfMATyn r0N%TR1TrT1nN rOQT.4Q I
item Estimated Cost (Dollar) to be
ComPI by permit aWlicant
oyncla usz ONLY
1, Building
SS S6 (50
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5) CFO
Check Number
aJL%1JLJLV111 In V'"I'Mm Inv Ir"JIUZAILIUS JLqUnJLq�V1WrLY11E1JWHZfq
OWNERS AGENT OR CONTRACTOR APPLIES FOR BU11DING PERAHT
1, AZfZ=t�J24- - --1 as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Si2Eture ot'Owner
SECTION 7b 0%
Date
1, (IAA IL-) As Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
vy
Print Name
Signature of C
W0,9101
NO. OF STORIES SIZE
BASEUENT OR SLAB
SIZE OF FLOOR TUvIBFRS IS7 2'*4u 3 RD
SPAN
DUvENSIONS OF SILLS
DINIENSIONS OF POSTS
DRAENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHRdNEY
IS BUILDING ON SOLID OR FILLED LAND
is BUILDING CONNECTED TO NATURAL GAS LINE
his form satisfies all basic requirements of the states Rome ImPrOvemem %_O11UdL6LV1
. Any person planning home
V11 12 , rtguage to protea homeownem Seek legal advice ifneceftry , improvement should first obtain a copy of"A
Consumer Guido to the Homo Improvement ContractOr-lAw" before agreeing to atijr.work an your residence. YOU may obtain a free copy by
—it;.. th. riffine of Consumer Affairs and Bmin= RegWB6(m's COUSUD'or Information Hotline at 617-727-7780'
Homeowner Information Contractor Information
Name 5c H 1)z H A jt7—
a� 1A.f
Street AddO-*do not we 2 Post um- 13ox—addrew) C�ntrzcnrd &
state Zip Code
Business Address
Qn C-14-1 /ki
Daythne Phone evening Phone
LAY/Town Zip Code
fwAL M6,
Mailing Lddrm (it different ftm ab"e)
kj MI iD or SS. Nurnber 17b - 244:2 le.+
111111111:1 lesil: Fbi 1:11c; I mi i 26.3 Fad&
11
1 Evv�_ dM
MIA
hcmx�
a 2mC
a 160-3
The Co spoottying type, brand, mud grade of materials to be we addftioWAR9&MM_)
(Describe in ddail the wait to completed, SP=nywg
li�A*
hTrArtffo Scc-A&
Required Pemits - 'Me following building permits are required
Proposed Start and Contpkwflon S edule - The following schedule will
be to unless circumstances beyond the contracines control arise
and will be secured by the onituactor as the borneown&j agent
adlicred
(OVvners Who secure their own permits will be
z*.PeN5S
Ng -when tritetor will begin contracted work -
con
from the Guaranty Fund provisions of
excluded
MGL chapter 142A.)
do co=a=d work. will be substiaWally completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perfaim the work, furnish the material and labor specified above for the total am . Of;�
payments will be made according to the following schedule:
$45 . 07—M upon signing contract (not to e Xcecd 113 of the total contract price or the cost of special order itenis, whichever is greater)
S_12��Ob� by or upon completion Of
SjZr&� by -tion of
or upon complL
$12DO upon completion of the contracL (Law forbids demanding full payment until contract is completed to both party Is satisfaction)
The following material/equipment must be special S to be paid for
begins In order to be paid for
ordered before the contracted work
to meet the complation-schedu1c.(")
NOTES: Including all finance Charges �") Law requires that any dePOSK Or down-payinent . required by the contractor before work begins may
not exceed the greater of (a)'Ont-thlrd. oftbe total contract price or (b) the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule,
Warran -Is 8 arran bein rovide(I bV We ;Wloss Uf the actions of any third
Subcontractom - The contractor agrees to be solely responsiblelkir Completion Ofthc WOM nesenoco t tractors ror
fartfier agroos.tb 6e sol�ly responsibib ior all'paymentt to aIrsudcOn
party/jul;confiuctor ueflffzcd�y tfie contiract6r. Tfie contractor
materials an I d 11 )or under this a ent ''I b Unt other Vylise noted v�ithin this document, the
Contra I Accep . nce - Upon signing, this docurnen t b omes a binding contract under law . the following cautions and notices
contr*act shall not imply that any Hen or other security interest has been placed on the residence Review
carefully before signing this contract
e contract. Take time to read and fully understand it Ask questions if something is unclear. is and
• Don't b0pressurca into signing tb The law requires most home improvement contracto
• Make sure the contractor W a valid orne rovemen Dr Registration. YOU in" inquire about contractor
�t= e.Director OfRoInt Improvement ContraM.
subcontracwtors to be stere 08 or by calling 617-727-3200. exL 25205.
regh;tratio�l by writing to the Directoi; at One Ashburton Place, Room 1301, Boston, MA 021
• Does the contractor have itimmlam? . Cbeck to see that your contractor is property insured. this form and'gct a copy Ofthe Consumer
• Fnow your rights and responsibilities. Read me Imporiant Information on 4he mverse side of
Guide to the Home Improvement Contractor IAw
of business, provided you no* the
You may cancel t�his ag�l�efft �If it has �be== sign�nrdt , pI hTrj, not later than midnight of the
contractor in writing at his/her main office or branch office by Ordinary mail posuA. by triegism seat or by del
t See the attached notice of ceucdWon form for an explanation of this righL
third business day following the signing of this.agreciaen
z _! — : I — IF ERE REk ZYiiLANKSPACMT1l
01 1 [6T SIGN TM97 ffOlMILACT ......
C C4.orl Vimmlat.,6g,
on or's
/W1 (_
Contractor Arbitration the right to initiate an arbitration action (as an
The Home Improvement contractor IAW provides homeowners with
alternafive to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor, however. The contractor would have to resolve any dispute helshe has with a homeowner in court unless
both parties agree to the optional clause provided below. Ibis clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement -Contractor Law.
Ile contractor and the homeo hereby mutually agree in advance that in the event e contractor has a dispute
concerning this contrac� the contractor may submit the dispute to kL'private arbitration firm which has been approved
onsurner Affairs and Business Regulation and the consumer shall be
by the Secretary Of the Executive Office of C General
orb as.provided in Massachusetts
b
required to submit to such or n as- prov'o'
su
s Si
Home i ees atare
own ab ent of the parties to alternative dispute
:ms 'es ove
pmt
Of tdor. 0 om
NOTICE: e gnalures of the parties above apPlY 0111Y to the 8-9me
th )
resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this
parties.
7 _ __, ��j
_v, y theV
section is not separately signed by th
Hoineownet's Rights ad IAW (MGL chapter 142A) and other consumer
A bomeownerts. rights under the Home Improvement Contr , toT
be waived n any way, even by agreement However, homeowners
protection laws (i.e. MOL apter 93A) may not erlyregistered as prescribed by law.
may b�- excluded from ce4n rights if the contractor they choose is not prop
are automatically excluded from allQuaranty Fund provisions of
Homeowners who. secum their own building permits
the Home Improvement Contractor Law. The contractor is responsible for completing the -work as described, in a
. Homeowners may be entitled to other specific legal rights if the contractor
timely and workmanlike manner on to guarantees or warranties
guarantees or provides an express warranty for workmanship or materials. In addid
an implied wanwty of merchantability and fitness
provided by the contractor, all goods sold in Massachusetts carry
cration. of other matters on which the homeowner and contractor lawfully agree may
for a particular purpose, An eman ct a homeownees basic consumer rights. If You have
be added to the tdrms of thi contract as long as they do nor restri ted below).
questions about your consumerlhomeowner rights , contact the Consumer Information Hotline (lis
F,lecution of Contract in duplicate and should not be signed until a copy of all exhibits and refemenced
-ecut5d __ _
The contract in ' ust be ex so T SM n,t.to sign the document until all blank sections havc been
documents have becr, m1-ta6hzd. Parties Pre- P!- advi5 f the contract with au=hments is to
filled in or marked as void, deleted, or not applicable. One original signed copy 0
be given to the owner and the other kept by the contractor. Any modification to the original -contract must be in writing
and agreed to by both parties. Contracted work may no . t begin until both parties have received a fully executed copy of
the contract, and the three day recission period has expired.
Acmlemted Payments ce of the dates specified on the Payment schedule in cases where the
'A contractor may not demand payments in advan where a contractor deems himtherself
ever, in instances
ho . meowner deems him/herself to be financially insecure. How int escrow
to be financially insecum, the contractor may require that the balance of funds not yet due be placed in a joi
account as a prerequisite to continuing the contracted work. Withdrawal of fbnds from said account would require the
signatures of both parties.
Additional Information al information about the Home improvement Contractor Law or other
if you bave general questions or need addition tractor.
ish to obtain a free copy of. 'A Consumer Guide to the Home improvement Con
consumer rights, or if you w
Law," contact
consumer Information Hotline
Executive office of Consumer Affairs and But. siness; Regulation
One Ashburton Place, Room'141 1, Boston, MA 02108'
(617) 727-7780
ons or need additional information specifically
If you want to verify the registration of a contractor orif you haw questi
of the Home improvement Contractor Law, contact:
about the contractor registration component
Director of Home improvement Contractor Registration
Bureau of Building R6gulations and Standards
One Ashburton Place, Room 1301, Boston, MA 02108
(617) 727-3200, ext. 25205
For assistance with informal mediation of disputes or to regi. -ter formal complaints against 2L business, call'
Consumer Complaint Section
Offca of the AttorneY General
(617) 727-8400
HRH
CONSTRUCTION
Scope of Work
283 Campbell Road. N.Andover. Ma.
April 15'b, 2005.
Overview:
Remove the existing Front door and demolish the existing brick front steps to provide access to
the rotted sill below the front door and behind the front steps. Replace the rotted sill for up to six
feet on either side of the door measured from the center of the door. Install new 1/2" plywood
sheathing in the effected area and new clapboards. Install new front door and trim supplied by
homeowners.
NOTE: New front steps are to be fabricated and installed by others
All Labor and materials to be provided by HRH Construction. All Lumber will be grade 2 or
better. All waste, scraps, cut offs etc. will be placed in an onsite dumpster, space permitting, for
removal upon completion of the project or via pick up in the event that there is insufficient space
for an on site dumpster. An on site Porta Potti will be provided for the duration of the project. The
site will be kept clean and orderly and swept daily. All work will be performed in accordance
with the sixth addition of the Massachusetts state building code.
Miscellaneous: N�/
No electrical, plumbi ng, or heating work is included in the scope of work or contract. vl�
��YV`4
HRH Construction accepts no responsibility for the structural integrity, level, or plumb of any
existing structure, wall, floor or ceiling. Homeowner understands that while repairs to level or
support existing structures may be required, for example, to provide adequate support or a plumb
wall for kitchen cabinets, they are not included in the contract price.
No changes to the Contract, Scope of Work, or Drawings will be undertaken without a signed
change order.
No painting or staining of any kind, other than that specifically stated is included.
It is the homeowner's responsibility to remove all personal belongings from the work area prior
to work commencing.
While every effort will be made to minimize any dust or mess, homeowners understand that due
to the nature of the work some mess and certainly some dust contamination of non -work areas is
inevitable.
No finish flooring of any kind is included.
While standard permitting fees are included in the contract total there is no allowance for any
additional meetings that the building department may require, nor is there any allowance for any
engineering or meetings with other boards, such as Historic, Conservation, Planning, or Health.
Schedule dates are tentative and include no allowance for weather days. Changes to the contract
or Scope of Work will impact schedule dates.
1— /15; tt_
HRH CONSTRUCTION. P.O. BOX 5164. ANDOVER. MA 01845
978-314-7263. brhconstruction@comcastnet
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in:
(Location of Facility)
/A V-4 V
Signatur'le' 6f PArmit Applicant
&&&j 2-3± 2a,(L
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
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